Stomach Ulcer: 13 Critical Signs and Safe Treatment

A stomach ulcer is an open sore in the lining of the stomach. The two main causes are Helicobacter pylori, usually called H. pylori, and regular use of certain pain medicines called NSAIDs. Burning upper abdominal pain is common, but some ulcers cause few or no symptoms until bleeding develops.

The good news is that most ulcers can heal once the cause is found and treated.

One myth needs clearing up at the start: spicy food and everyday emotional stress do not normally cause peptic ulcers. They can make symptoms feel worse in some people, but they are not the two main causes.

This article is for general information and education. It does not replace medical advice, diagnosis, or treatment.

For more digestive guidance, visit the Digestive Health and Gut Hub, Stomach Pain After Eating, and Acid Reflux Guide.

What is a stomach ulcer?

A stomach ulcer, also called a gastric ulcer, is a sore in the lining of the stomach.

A similar sore in the first part of the small intestine is called a duodenal ulcer.

Together, gastric and duodenal ulcers are called peptic ulcer disease.

The stomach normally protects itself from acid with mucus, blood flow, and other defense systems. An ulcer forms when those defenses are damaged enough for a sore to develop.

The two causes that matter most are:

• H. pylori infection
• NSAID use, including medicines such as ibuprofen, naproxen, and aspirin

NIDDK identifies these as the two most common causes of peptic ulcers.

Know the emergency warning signs first

An uncomplicated ulcer can hurt.

A complicated ulcer can become an emergency.

These signs can mean gastrointestinal bleeding or ulcer perforation.

Do not try to manage these symptoms with antacids at home.

13 critical facts about stomach ulcers

1. H. pylori is one of the main causes

Helicobacter pylori is a bacterium that can live in the stomach lining.

Many infected people never develop symptoms. In some people, however, H. pylori causes inflammation and damages the protective lining enough to contribute to an ulcer.

It is also linked with a higher risk of certain stomach cancers, which is one reason current gastroenterology guidance takes diagnosis and eradication seriously.

If H. pylori is found, it should be treated rather than simply suppressing stomach acid and ignoring the infection.

2. NSAIDs are the other major cause

NSAIDs are common pain medicines.

Examples include:

• Ibuprofen
• Naproxen
• Aspirin

These medicines reduce chemicals that help protect the stomach lining.

Risk rises with factors such as higher doses, longer use, older age, previous ulcer history, and certain other medicines.

If you take prescribed aspirin for heart or stroke prevention, do not stop it on your own because of stomach symptoms. Talk with the clinician who prescribed it.

3. Stress does not usually cause ordinary peptic ulcers

The old idea that a busy job, worry, or emotional stress simply burns a hole in the stomach is not supported by modern ulcer research.

Everyday emotional stress can make stomach symptoms feel worse.

It is not the same as the main ulcer causes, H. pylori and NSAIDs.

Severe illness in critically ill hospital patients can cause a different problem called stress related mucosal injury, but that is not what most people mean when they talk about a stress ulcer.

4. Spicy food does not cause an ulcer

Spicy food can irritate symptoms in some people.

It does not create most stomach ulcers.

Mayo Clinic specifically notes that spicy foods and stress do not cause peptic ulcers, although they can worsen symptoms.

This means you do not need to blame yesterday's curry for an ulcer caused by H. pylori or years of NSAID use.

5. Some stomach ulcers cause no symptoms

This surprises many people.

NIDDK and Mayo Clinic both note that some people with peptic ulcers have no obvious symptoms.

An ulcer may only become apparent when it causes:

• Bleeding
• Anemia
• Sudden severe pain
• Persistent digestive symptoms

This is why the absence of strong burning pain does not completely rule out an ulcer.

6. Burning pain is common, but the pain pattern is not a diagnosis

A stomach ulcer can cause dull, aching, or burning discomfort in the upper abdomen.

The pain may occur when the stomach is empty, at night, or after food. The exact pattern varies.

Other conditions can feel almost the same.

Acid reflux, gastritis, gallbladder disease, functional dyspepsia, pancreatitis, and even some heart problems can produce upper abdominal or chest discomfort.

Do not diagnose an ulcer based only on the location or timing of pain.

See Stomach Pain After Eating if meals are a clear trigger.

7. Black stool can mean bleeding

Blood from the stomach or upper small intestine can be digested as it moves through the bowel.

The result can be black, sticky, tar like stool.

Slow ulcer bleeding may also cause iron deficiency anemia, tiredness, shortness of breath, weakness, or dizziness.

See Iron Deficiency Anemia for more information about anemia, but unexplained anemia still needs its cause identified.

8. An ulcer can perforate

Perforation means the ulcer makes a hole through the wall of the stomach or duodenum.

This can spill stomach contents into the abdominal cavity and cause a serious infection.

The classic warning sign is sudden, severe abdominal pain.

This is an emergency.

9. H. pylori treatment has changed because antibiotic resistance has changed

This is one of the biggest updates since the old article.

Older advice often listed a proton pump inhibitor plus clarithromycin and amoxicillin as the default treatment.

That is no longer a good one size fits all recommendation.

The 2024 American College of Gastroenterology guideline warns that resistance to clarithromycin and levofloxacin has increased.

When antibiotic susceptibility is not known, the guideline recommends an optimized bismuth quadruple therapy regimen as a preferred treatment for many treatment naive adults.

Other regimens are available depending on allergies, prior antibiotic exposure, local resistance, and individual circumstances.

This is why H. pylori treatment should be prescribed rather than copied from an old online regimen.

10. H. pylori treatment is not finished until eradication is confirmed

Feeling better is not proof that H. pylori is gone.

The 2024 ACG guideline says every treated patient should have a test of cure.

Testing is normally done at least four weeks after the treatment course ends.

Accepted tests include:

• Urea breath test
• Stool antigen test
• A biopsy based test when endoscopy is being performed

To reduce false negative results, the ACG advises being off proton pump inhibitors or potassium competitive acid blockers for about two weeks before the test and off antibiotics and bismuth for at least four weeks.

Do not stop prescribed medicine without asking the clinician who is managing your ulcer. They can tell you how to prepare safely for the test.

11. Proton pump inhibitors help ulcers heal

Proton pump inhibitors, often called PPIs, reduce stomach acid.

They give the injured lining time to heal and are a main part of treatment for many peptic ulcers.

Examples include omeprazole, pantoprazole, esomeprazole, and lansoprazole.

The medicine does not fix every cause by itself.

If H. pylori is present, the infection still needs treatment.

If NSAIDs caused the ulcer, the medication plan still needs review.

12. There is no universal ulcer diet

The old article gave a large list of foods that everyone with an ulcer should avoid.

Current NIDDK guidance is much simpler.

Researchers have not found that a special diet plays a major role in causing, preventing, or treating peptic ulcers.

You do not have to automatically remove:

• Citrus fruit
• Tomatoes
• Coffee
• Chocolate
• Spices

unless they clearly make your symptoms worse or your healthcare professional gives you another reason.

Food can change comfort.

It does not eradicate H. pylori or reverse NSAID injury.

13. Treating the cause is what prevents recurrence

An acid medicine can help the sore close.

But if H. pylori remains, or the same ulcer causing NSAID exposure continues, the ulcer can return.

The strongest prevention plan is therefore cause based:

• Eradicate H. pylori when present
• Confirm eradication
• Review NSAID use
• Use acid protection when a clinician decides it is needed
• Stop smoking
• Follow up if symptoms return

What symptoms can a stomach ulcer cause?

Can a stomach ulcer feel like acid reflux?

Yes, symptoms can overlap.

Ulcer discomfort usually comes from the upper abdomen, while classic acid reflux often produces burning behind the breastbone or sour fluid moving into the throat.

But symptoms alone are not always clear enough to separate them.

If your main symptom is chest burning, read Acid Reflux.

If you mainly have upper abdominal burning or pain, especially with NSAID use or H. pylori risk, ask whether ulcer testing is appropriate.

Is stomach acidity the same as a stomach ulcer?

No.

Acid is normal and necessary for digestion.

An ulcer is a physical break or sore in the lining.

Reducing acid can help the sore heal, but simply having “too much acid” is not the usual reason an ulcer began.

See Stomach Acidity and High Stomach Acidity Treatment for the difference.

How does H. pylori cause an ulcer?

H. pylori can live within the protective mucus layer of the stomach.

The infection can cause ongoing inflammation and weaken the stomach or duodenal lining.

Once that protection is reduced, acid and digestive enzymes can contribute to tissue injury and ulcer formation.

Most people with H. pylori do not develop an ulcer.

That does not mean the infection should be ignored once it has been identified.

How does H. pylori spread?

Researchers are still studying the exact routes.

NIDDK says H. pylori may spread through contact with an infected person’s stool, vomit, or saliva.

Contaminated food or water may also play a role.

Basic hygiene matters, especially hand washing after using the bathroom and before preparing food.

How do doctors test for H. pylori?

Several tests are available.

Medicines can change test accuracy, so tell your clinician about PPIs, antibiotics, and bismuth before testing.

When is an upper endoscopy used?

An upper endoscopy lets a doctor look directly at the esophagus, stomach, and duodenum with a thin flexible camera.

During the test, biopsies can be taken.

Endoscopy can:

• Confirm an ulcer
• Look for bleeding
• Test tissue for H. pylori
• Evaluate suspicious tissue
• Sometimes treat bleeding during the same procedure

Not every person with burning stomach pain needs immediate endoscopy.

The decision depends on age, symptoms, bleeding, anemia, weight loss, vomiting, medication use, cancer risk, and other clinical factors.

Why might a gastric ulcer need a biopsy?

Most stomach ulcers are benign.

However, some cancers can look like ulcers.

For that reason, a clinician may take biopsies during endoscopy and may recommend follow up endoscopy in selected patients to confirm healing.

This is one reason a diagnosed gastric ulcer deserves proper follow up even when symptoms disappear.

How is H. pylori treated now?

Treatment uses several medicines together.

The exact combination should come from a healthcare professional because antibiotic resistance, allergies, previous antibiotic use, and local patterns matter.

The 2024 American College of Gastroenterology guideline recommends optimized bismuth quadruple therapy for 14 days as a preferred empiric option for many patients when antibiotic susceptibility is not known.

Other evidence based regimens are available.

The guideline specifically warns against routine clarithromycin or levofloxacin containing therapy unless susceptibility is known.

This is a major change from older internet articles that recommend the same three antibiotics to everybody.

Why is the H. pylori test of cure so important?

Because symptoms are unreliable.

You can feel much better while bacteria remain.

Persistent infection can allow ulcers to return and keeps the long term risks of H. pylori in place.

ACG recommends confirming eradication in every treated patient.

The usual plan is:

1. Finish the complete treatment course.
2. Wait at least four weeks after antibiotics are completed.
3. Prepare for testing according to your clinician’s instructions.
4. Use a urea breath test, stool antigen test, or biopsy based test.

ACG notes that PPIs or potassium competitive acid blockers should generally be stopped for about two weeks before the test, while antibiotics and bismuth should be avoided for at least four weeks.

Your clinician can tell you what is safe to hold and what can be used temporarily for symptoms.

How are NSAID ulcers treated?

The first question is whether the NSAID is still needed.

A healthcare professional may recommend:

• Stopping the NSAID when safe
• Lowering the dose
• Using it for a shorter time
• Changing pain treatment
• Adding a PPI when NSAID treatment must continue

Do not stop prescribed aspirin or other important medicine without medical advice.

The risk of stopping a heart medicine suddenly can be greater than the ulcer risk in some people.

Can acetaminophen replace ibuprofen?

Acetaminophen is not an NSAID and does not damage the stomach lining in the same way.

That does not make it safe for everybody.

People with liver disease, heavy alcohol use, or other health conditions need individual advice about dosing.

Ask what pain medicine fits your medical history instead of simply switching products yourself.

What foods should you eat with a stomach ulcer?

There is no proven ulcer healing menu.

NIDDK says doctors do not recommend one special diet for treating or preventing peptic ulcers.

The practical approach is to eat foods you tolerate well while the medical cause is being treated.

Simple choices may include:

• Vegetables
• Fruit
• Whole grains
• Lean proteins
• Beans and lentils if tolerated
• Yogurt or other dairy if tolerated
• Enough fluids

These foods support general nutrition.

They do not replace H. pylori eradication or acid suppression when those treatments are needed.

For broader nutrition guidance, visit the Gut Health Foods Hub.

What foods should you avoid?

Avoid foods that clearly make your own symptoms worse.

There is no evidence based rule that every ulcer patient must remove all:

• Spicy food
• Citrus
• Tomatoes
• Coffee
• Chocolate
• Fatty food

If coffee worsens burning, reduce it.

If spicy food causes no symptoms, having an ulcer does not automatically make chili the cause of the disease.

Does milk heal a stomach ulcer?

No.

Milk can briefly soothe burning for some people, but it does not eliminate H. pylori or repair the underlying cause.

Do not use milk as ulcer treatment in place of prescribed therapy.

Do probiotics cure H. pylori?

No probiotic should be used as a substitute for an H. pylori eradication regimen.

Some research has looked at probiotics as an addition to standard treatment, mainly for side effects or eradication rates.

The evidence does not justify replacing prescribed antibiotics and acid suppression with yogurt, kefir, or a supplement.

Can alcohol make an ulcer worse?

Alcohol can irritate the stomach lining and may worsen symptoms.

If you have an active ulcer, especially one that has bled, ask your healthcare professional whether alcohol should be avoided completely while you heal.

Does smoking slow ulcer healing?

Yes.

NIDDK notes that quitting smoking can lower ulcer risk and help existing ulcers heal.

Smoking can also make recurrence more likely.

Quitting is one of the few lifestyle steps with a clear role beyond symptom comfort.

Can a stomach ulcer cause anemia?

Yes.

An ulcer can lose small amounts of blood over time without obvious red blood appearing in the stool.

Slow blood loss can lead to iron deficiency anemia.

Symptoms can include:

• Fatigue
• Weakness
• Shortness of breath
• Pale skin
• Dizziness
• Fast heartbeat

If iron deficiency is found without an obvious reason, the source of blood loss may need investigation.

Can a stomach ulcer become cancer?

A typical benign ulcer does not simply transform into cancer in a predictable way.

However, gastric cancer can sometimes look like an ulcer during endoscopy.

H. pylori itself is also an important stomach cancer risk factor.

This is why gastric ulcers may be biopsied and why H. pylori infection should be treated and confirmed eradicated.

How long does a stomach ulcer take to heal?

There is no single healing time for everyone.

Healing depends on:

• Ulcer size and location
• Whether H. pylori is present
• Whether NSAIDs continue
• Smoking
• Treatment adherence
• Whether complications are present

Do not stop treatment simply because the pain disappeared after several days.

Follow the full treatment plan and complete any recommended follow up testing.

What happens if an ulcer does not heal?

An ulcer that remains despite appropriate treatment is sometimes called a refractory ulcer.

A clinician may look for:

• Persistent H. pylori
• Continued NSAID exposure
• Smoking
• Poor medication adherence
• Antibiotic resistance
• Rare acid producing conditions
• Crohn disease
• Cancer or another ulcer like condition

Repeat endoscopy and biopsy may be appropriate depending on the situation.

What complications can a stomach ulcer cause?

When should you arrange a medical appointment?

Make an appointment if you have:

• Persistent upper abdominal pain
• Repeated burning stomach pain
• Ongoing nausea or vomiting
• Unexplained weight loss
• Loss of appetite
• Feeling full after very small meals
• New anemia
• Regular NSAID use plus stomach symptoms
• Symptoms that keep returning after acid medicine

Do not keep masking persistent symptoms with antacids for months without finding the cause.

Seven practical steps if you think you have an ulcer

1. Check your medicines

Write down every aspirin, ibuprofen, naproxen, steroid, anticoagulant, and supplement you take.

2. Do not stop prescribed aspirin by yourself

Talk to the prescribing clinician first.

3. Ask whether H. pylori testing is appropriate

Breath and stool testing can identify active infection without endoscopy in many situations.

4. Take prescribed treatment exactly as directed

Incomplete antibiotic treatment can contribute to treatment failure and resistance.

5. Complete the test of cure

If H. pylori was treated, do not assume that symptom relief means eradication.

6. Avoid smoking

Smoking can slow healing.

7. Know the bleeding warning signs

Black tarry stool, blood in vomit, fainting, or sudden severe pain need urgent medical care.

Conclusion: treat the cause, not just the burning

A stomach ulcer is usually very treatable, but the treatment should match the cause.

If H. pylori is present, eradicate it and confirm that it is gone. If NSAIDs are causing the damage, review the medication plan. If bleeding or sudden severe pain appears, treat it as an emergency rather than another episode of indigestion.

Your next step: if upper abdominal pain keeps returning, make a list of your pain medicines and ask whether H. pylori testing or an ulcer evaluation is appropriate. Do not rely on a restricted diet alone.

References and Sources

1. National Institute of Diabetes and Digestive and Kidney Diseases. Peptic Ulcers: Definition and Facts.
   Used for ulcer definition, main causes, complications, and peptic ulcer terminology.
   https://www.niddk.nih.gov/health-information/digestive-diseases/peptic-ulcers-stomach-ulcers/definition-facts
2. National Institute of Diabetes and Digestive and Kidney Diseases. Symptoms and Causes of Peptic Ulcers.
   Used for H. pylori, NSAID causes, symptoms, bleeding signs, perforation warning signs, and emergency guidance.
   https://www.niddk.nih.gov/health-information/digestive-diseases/peptic-ulcers-stomach-ulcers/symptoms-causes
3. National Institute of Diabetes and Digestive and Kidney Diseases. Diagnosis of Peptic Ulcers.
   Used for H. pylori breath testing, stool testing, upper endoscopy, biopsy, and diagnostic evaluation.
   https://www.niddk.nih.gov/health-information/digestive-diseases/peptic-ulcers-stomach-ulcers/diagnosis
4. National Institute of Diabetes and Digestive and Kidney Diseases. Treatment for Peptic Ulcers.
   Used for PPIs, H. pylori treatment, NSAID management, smoking, test of cure, and management of persistent ulcers.
   https://www.niddk.nih.gov/health-information/digestive-diseases/peptic-ulcers-stomach-ulcers/treatment
5. National Institute of Diabetes and Digestive and Kidney Diseases. Eating, Diet, and Nutrition for Peptic Ulcers.
   Used for the correction that no special universal ulcer diet is recommended.
   https://www.niddk.nih.gov/health-information/digestive-diseases/peptic-ulcers-stomach-ulcers/eating-diet-nutrition
6. American College of Gastroenterology. ACG Guideline on Treatment of Helicobacter pylori: New Recommendations. 2024.
   Used for optimized bismuth quadruple therapy, antibiotic resistance, avoidance of empiric clarithromycin and levofloxacin treatment, and universal test of cure after H. pylori treatment.
   https://gi.org/journals-publications/ebgi/schoenfeld_sep2024/
7. Mayo Clinic. Peptic Ulcer: Symptoms and Causes.
   Used for symptoms, H. pylori and NSAID causes, risk factors, and the correction that stress and spicy food do not cause ordinary peptic ulcers.
   https://www.mayoclinic.org/diseases-conditions/peptic-ulcer/symptoms-causes/syc-20354223

Internal Links + Hub

Author Bio

Frequently Asked Questions

What is a stomach ulcer?

A stomach ulcer is an open sore in the lining of the stomach. It is one type of peptic ulcer. A peptic ulcer in the first part of the small intestine is called a duodenal ulcer.

What causes most stomach ulcers?

The two main causes are H. pylori infection and regular use of NSAID pain medicines such as ibuprofen, naproxen, and aspirin.

Does stress cause stomach ulcers?

Everyday emotional stress does not usually cause peptic ulcers. It can make digestive symptoms feel worse. H. pylori infection and NSAID use are the main causes.

Does spicy food cause stomach ulcers?

No. Spicy food does not usually cause an ulcer. It can worsen burning or discomfort in some people, so avoid it if it clearly triggers your symptoms.

What does stomach ulcer pain feel like?

Ulcer pain can feel dull, aching, or burning in the upper abdomen. It can occur between meals, at night, or after eating, but the timing alone cannot confirm an ulcer.

Can you have a stomach ulcer without pain?

Yes. Some peptic ulcers cause few or no symptoms. In some people, bleeding, anemia, or another complication is the first clue.

What are the warning signs of a bleeding ulcer?

Warning signs include black tarry stool, red or maroon blood in stool, vomiting blood, vomit that looks like coffee grounds, dizziness, fainting, weakness, or a rapid pulse. These need urgent medical care.

How is H. pylori diagnosed?

H. pylori can be diagnosed with a urea breath test, stool antigen testing, or tissue testing during upper endoscopy. The best test depends on your symptoms, medicines, and clinical situation.

How is H. pylori treated in 2026?

Treatment uses several medicines together. The 2024 American College of Gastroenterology guideline recommends optimized bismuth quadruple therapy as a preferred empiric regimen for many adults when antibiotic susceptibility is unknown. Treatment should be chosen by a healthcare professional because resistance, allergies, and previous antibiotic use matter.

Why is clarithromycin triple therapy no longer used for everyone?

Resistance to clarithromycin has increased, which can make the old triple regimen fail. Current ACG guidance advises avoiding clarithromycin-based treatment unless testing shows that the H. pylori strain is susceptible.

Do I need another H. pylori test after treatment?

Yes. Current ACG guidance recommends a test of cure for every patient treated for H. pylori. Testing is normally done at least four weeks after treatment using a breath test, stool antigen test, or biopsy-based test.

Does a stomach ulcer require an endoscopy?

Not every person with upper abdominal pain needs immediate endoscopy. Endoscopy may be used when symptoms, age, bleeding, anemia, weight loss, vomiting, cancer risk, or other findings make a direct look at the stomach necessary.

What foods heal stomach ulcers?

No food has been proven to heal a peptic ulcer by itself. NIDDK does not recommend a special ulcer diet. Eat a balanced diet and avoid foods only when they clearly worsen your symptoms.

Can a stomach ulcer cause iron deficiency anemia?

Yes. Slow bleeding from an ulcer can cause iron deficiency anemia even when you do not see obvious blood in the stool.

When is a stomach ulcer an emergency?

Seek emergency care for vomiting blood, black tarry stool, fainting, signs of shock, or sudden severe abdominal pain that does not improve. These symptoms can signal bleeding or perforation.