Peptic Ulcers (Stomach Ulcers)

An ulcer is an open sore that may be painful and slow to heal. They can occur on the inside or outside of the body, on areas including the skin, eyes, and internal organs. Peptic ulcers are the most common type of ulcer. Around 5 to 10 percent of people will develop peptic ulcers in their lifetimes. Peptic ulcers are sometimes referred to as peptic ulcer disease.

Peptic ulcers develop in certain parts of the gastrointestinal tract, also known as the GI or digestive tract. This is the group of hollow organs (including the stomach and small intestine) that run from the mouth to the anus. The word “peptic” refers to pepsin, which is a digestive enzyme produced by the stomach to help break down food.

Organs in the GI tract are coated with a mucous lining. This protects the GI tract from the materials that pass through it. A peptic ulcer develops when pepsin and stomach acid begin to burn through a part of the mucous lining, usually in the stomach or small intestine. The resulting ulcer may bleed and cause pain.

Most cases of peptic ulcers have two possible causes: infection with Helicobacter pylori (H. pylori) bacteria or frequent use of certain pain relief medications. Spicy foods and frequent stress do not cause stomach ulcers on their own, although they can worsen symptoms.

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There are two main types of peptic ulcers:

• Stomach ulcers: A stomach ulcer develops in the stomach. These are also called gastric ulcers. Close to 20 percent of peptic ulcers are stomach ulcers.  
• Duodenal ulcers: A duodenal ulcer develops in the duodenum, which is the upper part of the small intestine located immediately below the stomach. Nearly 80 percent of peptic ulcers are duodenal ulcers.

Less common types of peptic ulcers include:

• Esophageal ulcers: An esophageal ulcer develops in the esophagus, which is the muscular tube that carries food and liquids from the mouth to the stomach. This type of ulcer is usually linked to gastroesophageal reflux disease (GERD).
• Jejunal ulcers: A jejunal ulcer occurs in the middle part of the small intestine, called the jejunum. It’s typically a complication of gastrojejunostomy surgery, which may be performed to remove a blockage in the intestine or as part of weight-loss surgery.

Other types of ulcers

In addition to peptic ulcers, other types of ulcers include:

• Leg and foot ulcers: These sores develop on the skin of the legs, ankles, feet, or toes. Leg and foot ulcers are often related to conditions that can reduce circulation in the lower body, such as diabetes and heart disease.
• Pressure ulcers: These sores result from prolonged periods of bed rest. Also called bedsores, pressure ulcers tend to occur on skin over bony areas, such as the hips and tailbone. 
• Genital ulcers: These sores can develop on the vagina, penis, or anus. They typically result from bacterial or viral infections, including some types of sexually transmitted infections.
• Mouth ulcers: These sores can appear on the lips, gums, tongue, roof of the mouth, or inside of the cheeks. A canker sore is a common type of mouth ulcer.
• Corneal ulcers: These sores develop on the front of the eye. Corneal ulcers are usually caused by infections, although dry eye and eye scratches may also cause ulcers.

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Around 70 percent of people with peptic ulcers don’t have noticeable symptoms. Those who do may experience:

• Burning or gnawing stomach pain
• Upper abdominal pain
• Quickly feeling full when eating
• Loss of appetite
• Frequent burping
• Heartburn
• Bloating, which may worsen after eating fatty foods
• Nausea and vomiting, which may contain blood
• Difficult or painful swallowing
• Feeling as if food isn’t going down your throat correctly

The most common symptom of a peptic ulcer is burning or dull abdominal pain. Indigestion, which describes burning abdominal pain and a lingering feeling of fullness shortly after eating, is another notable symptom of peptic ulcers.

It’s not always possible to differentiate stomach ulcers from duodenal ulcers based on symptoms alone. But the timing of symptoms can provide some insight. A person with a stomach ulcer may experience worsening symptoms 15 to 30 minutes after eating. During this time, gastric (stomach) juices are breaking down food. Symptoms of duodenal ulcers tend to worsen two to three hours after eating, as food passes through the duodenum.

An esophageal ulcer can cause heartburn (a burning pain in your throat or behind your breastbone) that may worsen at night. Painful or difficult swallowing is also common with esophageal ulcers.

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It’s a good idea to visit a healthcare provider (HCP) if you’re experiencing symptoms like abdominal pain and indigestion. This is especially true if over-the-counter medications like acid blockers and antacids provide only temporary relief from your symptoms.

Although uncommon, some peptic ulcers can cause health complications that require immediate medical care. Promptly visit an HCP if you experience any of the following:

• Vomit that contains blood or resembles coffee grounds
• Fainting or dizziness
• Difficulty breathing
• Stool (poop) that’s bloody, black, or tarry
• Abdominal pain that’s sudden, severe, sharp, or unrelenting
• A rapid pulse
• Unexplained weight loss
• Worsening peptic ulcer symptoms

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H. pylori infection and regular use of certain pain relief medications are the main causes of peptic ulcers. 

H. pylori bacteria

H. pylori is a type of bacteria that’s commonly seen on the lining of the stomach and small intestine. As many as 75 percent of people around the world have H. pylori bacteria in their GI tracts. For reasons that are unclear, these bacteria sometimes cause inflammation that can lead to a peptic ulcer. H. pylori bacteria are linked to 70 to 90 percent of stomach ulcers and 90 percent of duodenal ulcers.

Research suggests that H. pylori may spread from person to person through contact with an infected person’s saliva, vomit, or poop. Many researchers also believe the bacteria can be transmitted through food and water that’s contaminated with an infected person’s saliva.

NSAID overuse

Using a type of oral pain medication called a nonsteroidal anti-inflammatory drug (NSAID) can result in a peptic ulcer. NSAIDs include ibuprofen, aspirin, ketoprofen, and naproxen.

Acetaminophen—another common pain reliever—is not an NSAID.  

NSAIDs decrease the production of prostaglandin hormones. These hormones help make substances that protect the stomach lining from the harsh effects of stomach acid. In this way, taking high doses of NSAIDs, taking multiple types of NSAIDs, or taking NSAIDs for several weeks or months at a time can damage the lining of the stomach and small intestine and make it more vulnerable to ulcers. Using an NSAID while having an H. pylori infection can also result in a peptic ulcer.

Additionally, pairing an NSAID with certain other medications raises your risk of a peptic ulcer. These medications include:

• Selective serotonin reuptake inhibitors (SSRIs), which are used to treat anxiety and depression
• Corticosteroids, which are used to lower inflammation levels in the body and help manage conditions like asthma and arthritis
• Anticoagulants, which are used to prevent blood clots and issues involving blood clots like stroke
• Alendronate and risedronate, which are used to prevent and treat osteoporosis

Other causes of peptic ulcers

Less commonly, peptic ulcers are caused by:

• Certain medical treatments: Some medical procedures and treatments (such as radiation therapy and chemotherapy) that involve the esophagus, stomach, duodenum, or jejunum can cause peptic ulcers as a side effect.
• Infections: Infections caused by certain fungi, viruses, or bacteria (besides H. pylori) can result in peptic ulcers.
• Conditions that affect the stomach: These include issues like cancer and Crohn’s disease. GERD, which occurs when stomach bile or acid moves up the esophagus, is the most common cause of esophageal ulcers.   
• Zollinger-Ellison syndrome: This rare disease occurs when tumors in the GI tract cause an overproduction of stomach acid.
• Other chronic (long-term) conditions: Chronic obstructive pulmonary disease (COPD) and cirrhosis (a chronic liver disease) are also associated with peptic ulcers.  

Sometimes, the cause of a peptic ulcer is unknown. HCPs call this an idiopathic peptic ulcer.

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A risk factor is something that can increase your chances of developing a certain condition. Risk factors for peptic ulcers include:

• Sex assigned at birth: Duodenal ulcers—the most common type of peptic ulcer—occur more frequently in men and people assigned male at birth than women and people assigned female at birth.  
• Age: Peptic ulcers are most common in middle-aged adults, although they can occur at any age. 
• Smoking: Smoking makes people with H. pylori infection more vulnerable to peptic ulcers. 
• Chronic stress: Experiencing frequent stress increases stomach acid production, which can contribute to peptic ulcers and worsen symptoms. (Stress alone does not cause a stomach ulcer, however.)
• Alcohol: Drinking alcohol raises the risk of peptic ulcers by increasing stomach acid production and weakening the lining of the stomach.  
• Weight: Having obesity is associated with a higher risk of peptic ulcers.

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Diagnosing a peptic ulcer typically begins with a physical exam, during which your HCP may gently press against your abdomen to check for areas of pain, tenderness, and swelling. You’ll also be asked a series of questions about your symptoms, medical history, and what medications or supplements you take.

Your HCP may then perform one or more tests to diagnose a peptic ulcer or rule out other conditions that can cause similar symptoms, such as pancreatitis (inflammation of the pancreas) and gastritis (inflammation of the stomach lining).

Common tests for peptic ulcers include:

Tests to screen for H. pylori infection

H. pylori testing might include a blood test, stool test, or urea breath test.  

A blood test involves collecting a small blood sample, which is evaluated in a lab for signs of H. pylori infection or indicators of peptic ulcer complications.

A stool test involves screening a stool sample for H. pylori bacteria. Your HCP will provide a container and instructions for delivering the sample.

A urea breath test involves swallowing a liquid or capsule that contains urea (a natural waste product found in blood) with radioactive carbon atoms. If present, H. pylori bacteria will break down the urea in your stomach and convert it into carbon dioxide. You’ll then breathe into a container. An H. pylori infection will be confirmed if your breath sample contains radioactive carbon.

X-ray imaging

A series of X-ray images called an upper GI series may be taken to view pictures of your esophagus, stomach, and small intestine. You’ll be asked to swallow a chalky liquid that contains barium before the test to help the digestive tract appear more clearly on X-rays. (Barium is a substance used to show contrast on images.)

Upper GI endoscopy

An upper GI endoscopy is used to confirm a peptic ulcer diagnosis. During an endoscopy, a thin, flexible tube with a small camera on the end (called an endoscope) is gently fed down your throat. The endoscope allows your HCP to view the lining of your esophagus, stomach, and duodenum and look for ulcers on a monitor in the operating room.

Your HCP may also use the endoscope to collect a small sample of tissue for H. pylori testing. This is called a biopsy. You’ll be given a sedative or anesthesia before the endoscopy to help you feel comfortable.  

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Being diagnosed with a peptic ulcer may leave you seeking information about your condition. If you have questions, don’t hesitate to bring them up to your HCP. Gaining a clearer understanding of your condition can help you make educated treatment decisions and feel better as quickly as possible.

Some common questions about peptic ulcers you may want to ask your HCP include:  

• What type of peptic ulcer do I have?
• What is the most probable cause of the ulcer?
• Are there foods or beverages I should avoid when I have an ulcer?
• Can the ulcer be cured? What is the likelihood that the ulcer will return?
• What type of peptic ulcer treatment do you recommend?
• How can I manage peptic ulcer disease with other conditions I have? 
• Am I at risk of peptic ulcer complications?
• When should I contact you? Is there a scenario in which I should seek emergency care?

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Peptic ulcers may be treated by your primary care provider or a gastroenterologist (a medical doctor who specializes in the digestive system). For many people, peptic ulcer treatment involves medication to clear an H. pylori infection or to reduce stomach acid levels. If the peptic ulcer is a result of an underlying medical condition, that condition will be treated or managed.

Medication for peptic ulcers

Medication is typically the first course of treatment for peptic ulcers. Depending on the cause and severity of your ulcer, your HCP may prescribe:

• Antibiotics to destroy H. pylori bacteria: Commonly used antibiotics include amoxicillin, doxycycline, clarithromycin, and metronidazole.
• Medications to block stomach acid production and encourage healing: Proton pump inhibitors (PPIs) like lansoprazole, pantoprazole, omeprazole, rabeprazole, and esomeprazole prevent cells from producing stomach acid and promote healing.
• Medications to protect the stomach and small intestine lining: Cytoprotective agents like misoprostol, sucralfate, and bismuth subsalicylate help coat and protect the lining of the stomach and small intestine. 
• Medications to decrease stomach acid production: Histamine receptor blockers (also called H2 blockers) like cimetidine, famotidine, and nizatidine stop the action of a chemical involved in stomach acid production.
• Antacids to neutralize stomach acid: Antacids like calcium carbonate and magnesium hydroxide can help counteract the effects of stomach acid and provide quick (though temporary) relief from stomach ulcer symptoms.

If you take NSAIDs, your HCP may lower your dose or advise you to try a pain reliever that’s easier on the lining of your digestive tract, such as acetaminophen.

As is the case with any medication, drugs used to treat peptic ulcers come with a risk of side effects. These may include diarrhea, constipation, stomachaches, dizziness, and fatigue, among others. Contact your HCP right away if you experience unexpected or severe side effects after taking medication.

What is the fastest way to cure a stomach ulcer? 

There’s no speedy way to cure a stomach ulcer, unfortunately. The best way to find fast relief from your symptoms is to visit your HCP and start treatment as quickly as possible. The sooner you begin treatment, the sooner you can start to feel better.

Many people with stomach ulcers are prescribed a medication regimen of one PPI and two antibiotics. This regimen typically lasts one to two weeks. Your HCP may also recommend you take an antacid, which can provide fast relief from symptoms while the other medications work to heal your stomach. 

Taking your medication exactly as your HCP prescribes can help ensure successful and efficient treatment. This means completing your prescriptions, even if your symptoms improve after a few days. Avoiding things that can aggravate the lining of your stomach (such as alcohol) can also streamline your treatment and help you feel better faster.

Lifestyle changes for peptic ulcers

Combining your HCP’s treatment plan with GI-friendly habits can help ease peptic ulcer symptoms and promote healing. When receiving treatment for a peptic ulcer, try to:

• Skip the alcohol. Alcoholic beverages can inflame and irritate stomach lining.
• Avoid smoking. Smoking cigarettes increases stomach acid and can interfere with the ulcer healing process.
• Manage stress well. Chronic or poorly managed stress can exacerbate peptic ulcers and make treatment more difficult. To keep stress in check, try getting more sleep, saying “no” to unnecessary obligations, exercising regularly, and setting aside time for activities you enjoy.

Should you avoid certain foods if you have a stomach ulcer?

The old notion that spicy foods cause stomach ulcers has been proven false. But this doesn’t mean that spicy items are an ideal snack for people with peptic ulcers. Spicy foods like hot sauce and jalapeno peppers contain a chemical called capsaicin, which may irritate open sores like stomach ulcers and make symptoms worse.  

Overall, though, there’s no special diet that’s recommended for people with stomach ulcers. If you find that a specific food or beverage aggravates your symptoms, simply avoid it until your ulcer heals.

Additional treatments for peptic ulcers

Some peptic ulcers are slow to heal or have a tendency to return. Because of this, your HCP will likely retest you for H. pylori bacteria at least four weeks after you’ve finished taking antibiotics. If you still have an H. pylori infection after treatment, you may be prescribed a different combination of antibiotics or other medications.

A peptic ulcer that doesn’t heal despite treatment is called a refractory ulcer. Several factors are linked to refractory ulcers, including:

• Continued NSAID or tobacco use
• Antibiotic-resistant H. pylori bacteria (this means the bacteria do not respond to treatment with conventional forms of antibiotics)
• Underlying conditions, including Crohn’s disease, other infections, stomach cancer, or Zollinger-Ellison syndrome

Refractory ulcer treatment may include trying different medications, quitting tobacco or NSAID use, avoiding irritating foods and beverages, and reducing stress.

Although uncommon, medical procedures are sometimes necessary to treat a refractory ulcer. You may be advised to have surgery to remove the affected portion of the stomach (a procedure known as a partial gastrectomy) or to cut the nerve that prompts the stomach to produce acid (called a vagotomy).

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A peptic ulcer that’s left untreated can sometimes cause health complications. These may include:

Internal bleeding

A peptic ulcer can bleed into the esophagus, stomach, or duodenum. This slow blood loss can result in bloody or black stools, vomit that resembles coffee grounds, or anemia (a lack of healthy red blood cells). Signs of anemia include weakness, rapid heartbeat, dizziness, and unusually pale or yellow skin.

Treatment for a bleeding ulcer may involve using an endoscopy to inject medication into the ulcer or to cauterize it. (Cauterizing involves strategically burning an area of tissue to close a wound.) Severe blood loss may require a blood transfusion and hospitalization.

Gastrointestinal obstruction

Inflammation and scarring related to recurring peptic ulcers can block the passage of food from the stomach to the duodenum. Symptoms of a GI obstruction may include abdominal pain and swelling, constipation, nausea, and feeling full quickly after eating. Surgery may be necessary to remove the obstruction.

Gastrointestinal perforation (hole)

It’s possible for a peptic ulcer to burn through the lining of the GI tract until a hole forms. This can lead to a serious infection in the abdomen called peritonitis. Signs of stomach or duodenal perforation include fever and sudden and intense abdominal pain. Emergency surgery is typically required to repair the hole. 

Stomach cancer

Chronic inflammation related to H. pylori infection is associated with an increased risk of certain stomach (gastric) cancers. The World Health Organization even recognizes H. pylori as a carcinogen (cancer-causing agent). Still, stomach cancer is uncommon. Some research even suggests that the presence of this bacteria may lower the risk of esophageal cancers. 

Possible symptoms of stomach cancer include abdominal fullness, fatigue, dark stools, bloody vomit, and unexplained weight loss. Treatment for stomach cancer usually involves a combination of surgery and chemotherapy.

Chronic fatigue syndrome

A 2021 study published in Scientific Reports found rates of chronic fatigue syndrome (a condition characterized by extreme fatigue) to be significantly higher in people with peptic ulcer disease than in people without it. More research is needed to confirm a connection between these conditions, however.

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Some peptic ulcers are preventable. To lower your risk of peptic ulcers, try to:

Avoid infections

Taking steps to protect yourself from infections may help you avoid H. pylori bacteria and other germs that can affect your health. For example:

• Wash your hands with soap and water regularly and thoroughly
• Avoid needlessly touching your face
• When eating, use clean hands and make sure your food is fully cooked   

You can also ask your HCP for a urea breath test, which can help detect an H. pylori infection before it causes an ulcer.

Use NSAIDs wisely

Using NSAIDs for several weeks or months at a time can damage the lining of the GI tract and increase the risk of peptic ulcers. If you are taking an NSAID, be sure to follow dosage directions listed on the package or your HCP’s guidance. Your HCP can work with you to find a lower dose that still offers pain relief, or they may advise you to try acetaminophen instead of an NSAID.

If you must use an NSAID, taking it with a meal can help minimize damage to your stomach lining and lower your risk of a stomach ulcer. Avoid taking NSAIDs with alcohol, as this combination can be hard on your stomach.

People who regularly use NSAIDs and have peptic ulcer risk factors may be advised to take a medication to help protect their stomach lining and lower the risk of ulcers. Your HCP may recommend this if you:

• Have a history of peptic ulcer disease
• Are older than 65 
• Take a high dose of an NSAID or multiple pain relievers at the same time
• Take an NSAID as well as a corticosteroid, anticoagulant, or aspirin (even in a low dose)

Medications that can help prevent peptic ulcers in people who take NSAIDs include proton pump inhibitors and H2 inhibitors. Ask your HCP if these preventive measures are right for you.

Make healthy choices

Many of the lifestyle choices that are recommended to help treat peptic ulcers may also help prevent them. For example:

• Don’t smoke
• Incorporate stress management techniques into your daily routine
• Avoid alcohol or drink it only in moderation

The Centers for Disease Control and Prevention (CDC) advises men and people assigned male at birth to consume no more than two alcoholic drinks per day. Women and people assigned female at birth should limit their consumption of alcohol to one drink per day. One “drink” is defined as:

• 12 ounces of beer
• 8 ounces of malt liquor beverages, including malt-based seltzers
• 5 ounces of wine
• 1.5 ounces of distilled spirits, such as rum, whiskey, vodka, and gin

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People who have peptic ulcers generally have a positive chance of recovery. Most peptic ulcers can be successfully treated in a few weeks or months with medication. A mild peptic ulcer that’s caused by NSAID use may resolve on its own if the NSAID is discontinued. 

Still, more than 60 percent of peptic ulcers return. Smoking, drinking alcohol, and using NSAIDs can increase the risk of recurrence. Receiving follow-up care and promptly reporting new or unusual symptoms to your HCP can help prevent serious complications like internal bleeding and perforations in the GI tract.

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To learn more about peptic ulcers, including your individual risk factors or symptoms to watch for, contact your HCP. They can help you identify ways to prevent peptic ulcers and improve your digestive health. You can also learn more about stomach ulcers, duodenal ulcers, and other types of ulcers from organizations such as the National Institutes of Health.

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