Stomach Ulcers: Causes, Symptoms, and Treatment

A burning pain in your upper belly shows up between meals, eases when you eat, then returns an hour or two later. Antacids help for a while, then stop helping. You cut out coffee and spicy food, you start skipping dinner, and the pain keeps coming back anyway.

That pattern is classic for a peptic ulcer: a sore in the lining of your stomach or the first part of your small intestine. About 25 million Americans will develop one in their lifetimes, per the National Institutes of Health. Most heal completely with treatment, often within weeks, but they rarely heal on their own, and ignoring one can lead to bleeding or a serious emergency.

What a stomach ulcer actually is

Your stomach handles acid strong enough to dissolve metal, surviving only because a thick layer of mucus shields its lining. An ulcer forms when that shield breaks down and acid eats into the tissue underneath, creating an open sore.

Doctors call these peptic ulcers. A sore in the stomach itself is a gastric ulcer; one in the duodenum, the first stretch of small intestine past the stomach, is a duodenal ulcer. Duodenal ulcers are more common and often cause pain that wakes people at night or strikes a few hours after eating, when the stomach is empty again.

The two real causes

For decades, doctors blamed ulcers on stress and spicy food. That turned out to be wrong: stress and spicy food can worsen symptoms, but they do not cause ulcers. Two things cause the large majority of them.

1. H. pylori bacteria. Helicobacter pylori burrows into the stomach's mucus layer and weakens it. Roughly 30 to 40 percent of Americans carry it, per the Centers for Disease Control and Prevention, though most never develop an ulcer. It spreads mainly through close contact and contaminated food or water, often picked up in childhood. Long-term infection also raises stomach cancer risk, one more reason to treat it.

2. NSAID painkillers. Drugs such as ibuprofen (Advil, Motrin), naproxen (Aleve), and aspirin block the chemicals that protect the stomach lining. Taken occasionally, they are usually fine. Taken daily for months, especially at high doses or combined with steroids, blood thinners, or alcohol, they are a leading cause of ulcers and stomach bleeding.

Symptoms worth paying attention to

The most common symptom is a dull, burning, or gnawing pain in the upper abdomen, between your breastbone and belly button. It often:

• Feels worse when your stomach is empty, such as between meals or at night
• Eases briefly after eating or taking an antacid, then returns
• Comes and goes for days or weeks at a time

Other symptoms include bloating, nausea, and feeling full after eating very little. Some people have no pain at all, and their first sign of trouble is a complication.

Warning signs: get care fast

Most ulcers are uncomfortable, not dangerous. But these symptoms should never wait for a routine appointment:

• Vomiting blood, or vomit that looks like coffee grounds
• Black, tarry, or bloody stools
• Sudden, severe abdominal pain that feels like the worst pain you have ever had
• Fainting, dizziness, or a rapid heartbeat along with stomach pain
• Unexplained weight loss of 10 pounds or more

Vomiting blood or black stools means the ulcer is bleeding. Sudden severe pain can mean it has burned through the stomach wall, a perforation that needs emergency surgery. Call 911 or go to the emergency room for any of these.

How doctors diagnose an ulcer

If your symptoms fit, your doctor will usually start with a test for H. pylori: a breath test, in which you drink a special solution and breathe into a bag, or a stool test that detects the bacterium's proteins. Blood tests exist too, but they cannot tell an old infection from a current one, so they are less useful.

If symptoms are severe, persistent, or come with warning signs, the doctor will likely recommend an upper endoscopy: a thin camera passed down your throat while you are sedated, to look directly at the stomach and duodenum and take a biopsy for H. pylori testing. You may need to stop acid-blocking medicines for about two weeks before H. pylori testing, because they can cause false negatives, so ask your doctor first.

Treatment: most ulcers heal in weeks

If H. pylori is the culprit, you will take antibiotics plus an acid-blocking medicine, usually a proton pump inhibitor (PPI) such as omeprazole, for 10 to 14 days. Finish every dose, even if you feel better after a few days, because stopping early lets resistant bacteria survive. Your doctor should retest you afterward to confirm the infection is gone.

If NSAIDs are the culprit, the first step is stopping or reducing them, with your doctor's help. A PPI or an H2 blocker such as famotidine (Pepcid) then lets the lining heal, usually within four to eight weeks. If you must stay on one long term, your doctor may add a protective acid blocker or switch you to acetaminophen (Tylenol) or topical treatments.

Surgery is now rare. Before modern acid blockers and H. pylori treatment, ulcer surgery was common. Today it is mostly reserved for emergencies like perforation or bleeding that cannot be stopped during endoscopy.

What actually helps while you heal

• Eat regular, smaller meals rather than letting your stomach sit empty for hours.
• Cut back on alcohol and smoking. Both slow healing, and smoking makes ulcers more likely to return.
• Do not rely on milk. The old advice to drink milk for an ulcer is a myth: milk briefly soothes, then stimulates more acid.
• Be careful with over-the-counter painkillers. Ask your doctor or pharmacist whether acetaminophen is safer for you than ibuprofen or naproxen.
• Take your PPI as directed, usually 30 to 60 minutes before a meal. Stopping early can let the ulcer reopen.

Spicy food and coffee need not be banned for life; just avoid anything that reliably worsens your pain while you heal.

Can you prevent an ulcer?

You cannot always prevent one, but you can cut your risk. Use NSAIDs at the lowest effective dose for the shortest time you need them, taken with food and water. If you need one daily, ask your doctor about a stomach-protecting medicine. Get tested for H. pylori if ulcers or stomach cancer run in your family, or if you have had an ulcer before. And if you smoke, quitting helps more than almost anything else.

The bottom line

A stomach ulcer is not caused by stress or hot sauce, and it is not something to tough out with antacids for months. It is usually caused by a treatable infection or a common painkiller, and both have clear fixes. If burning upper belly pain keeps returning, see a doctor and ask about H. pylori testing. A few weeks of treatment now prevents a much bigger problem later.

This article is for general information only and is not a substitute for medical advice. If you have persistent stomach pain, vomiting, or bloody or black stools, seek medical care promptly.