The most telling sign of a peptic ulcer is a dull or burning pain in your upper abdomen, somewhere between your belly button and breastbone. This pain often comes and goes over days or weeks rather than striking once and disappearing. About 10% of people will develop a peptic ulcer at some point in their lives, so it’s common, but the symptoms overlap with many other digestive issues. Here’s how to sort out what you’re feeling.
What Ulcer Pain Feels Like
Ulcer pain is distinct from a sharp, stabbing stomachache. Most people describe it as a gnawing or burning sensation that sits high in the abdomen, not down near the intestines. It can last minutes or hours, and it tends to cycle: you might have a bad stretch for a few days, feel fine for a week, then have it return.
The relationship between the pain and food is one of the most useful clues. For some people, eating temporarily relieves the pain because food buffers stomach acid. These people notice the burning most when their stomach is empty, especially in the middle of the night. For others, eating makes the pain worse. Neither pattern rules an ulcer in or out on its own, but if you notice a consistent link between meals and that upper-abdominal burn, it’s worth paying attention to.
Other Symptoms Beyond Pain
Pain gets the most attention, but ulcers cause a cluster of digestive symptoms that can be just as disruptive:
- Feeling full too quickly when eating, even with small meals
- Uncomfortable fullness that lingers well after a meal
- Bloating and frequent belching
- Nausea, sometimes with vomiting
- Heartburn that doesn’t fully respond to antacids
Some people with ulcers have no pain at all. These “silent” ulcers are more common in older adults and in people who take anti-inflammatory painkillers regularly. In those cases, the first sign of a problem can be a complication like bleeding rather than day-to-day discomfort.
Warning Signs That Need Immediate Attention
Most ulcers cause manageable discomfort, but they can erode into a blood vessel or eat through the wall of the stomach or intestine. These complications are emergencies. Get to an emergency room if you experience any of the following:
- Vomiting blood, which can look bright red or dark like coffee grounds
- Black, tarry stools or visible blood in your stool
- Sudden, severe stomach pain that doesn’t let up
- Feeling faint or dizzy, pale skin, or signs of significant blood loss
Black or tarry stools happen because blood from the ulcer is digested as it moves through your intestines. It’s easy to miss if you’re not looking for it, so keep it on your radar if you suspect you have an ulcer.
What Causes Ulcers in the First Place
Two things account for the vast majority of peptic ulcers: a bacterial infection and pain medication.
The bacterium H. pylori lives in the mucus lining of the stomach and weakens the protective barrier that keeps acid from damaging tissue. It’s extremely common. In studies of people with ulcers, roughly 70 to 75% tested positive for H. pylori. Many people carry the bacteria without ever developing an ulcer, but for those who do, treating the infection is the key to healing.
The other major driver is regular use of nonsteroidal anti-inflammatory drugs, the category that includes ibuprofen, aspirin, and naproxen. These medications reduce a chemical in your body that helps maintain the stomach’s protective lining. In research comparing ulcer patients to healthy controls, about 60% of people with ulcers were regular NSAID users, compared to about 27% of those without ulcers. The risk climbs with higher doses, longer use, and when NSAIDs are combined with an existing H. pylori infection.
Smoking and heavy alcohol use don’t cause ulcers on their own, but they slow healing and make the stomach lining more vulnerable if one of the primary triggers is already present.
How Ulcers Are Diagnosed
You can’t diagnose an ulcer based on symptoms alone because the same burning, bloating, and nausea show up in acid reflux, gastritis, and functional dyspepsia. A doctor will typically start with one or two straightforward tests.
Testing for H. Pylori
The simplest options are a breath test and a stool test. For the breath test, you swallow a small capsule or liquid containing a tagged form of urea. If H. pylori is present in your stomach, the bacteria break the urea down into carbon dioxide that carries a detectable marker. You breathe into a container a few minutes later, and the lab checks for it. A stool test works similarly by detecting proteins from the bacteria in a stool sample you collect at home. Both are noninvasive and highly accurate.
Upper Endoscopy
If your doctor needs to see the ulcer directly, or if your symptoms are severe, the standard tool is an upper endoscopy. A thin, flexible tube with a camera is guided down your throat into your stomach and the first part of your small intestine. The doctor can see the ulcer, assess its size, and take a small tissue sample to check for H. pylori or rule out other conditions. The procedure usually takes 15 to 30 minutes, and you’re sedated for it.
What Recovery Looks Like
Most peptic ulcers heal within a few weeks once the underlying cause is addressed. If H. pylori is found, you’ll take a short course of antibiotics alongside an acid-reducing medication. The acid reducer lowers the acidity in your stomach enough to let the damaged tissue repair itself. If NSAIDs caused the ulcer, stopping or switching the medication is usually the first step.
You’ll typically start feeling better within a few days of beginning treatment, though full healing of the crater in your stomach or intestinal lining takes longer. Your doctor may retest for H. pylori after treatment to confirm the infection is gone, since incomplete treatment can lead to recurrence. People who keep taking NSAIDs without protection, or who have an untreated H. pylori infection, tend to develop ulcers again.
How to Tell It Apart From Other Conditions
Acid reflux (GERD) causes burning higher up, usually behind the breastbone, and gets worse when you lie down. Gallbladder pain tends to hit the upper right side of the abdomen, often after fatty meals, and comes in intense waves. Gastritis, an inflammation of the stomach lining without an actual crater, can feel nearly identical to an ulcer and sometimes only gets distinguished through endoscopy.
If your upper abdominal pain is persistent, tied to meals or hunger, and lasting more than a week or two, an ulcer is high enough on the list of possibilities to warrant testing. The diagnostic process is quick, the tests are straightforward, and treatment is effective for the large majority of people.