The most telling sign of a stomach ulcer is a dull or burning pain in your upper abdomen, roughly between your belly button and breastbone. This pain often follows a predictable pattern tied to meals, and it can come and go for days or weeks at a time. But ulcers don’t always announce themselves clearly. About 25% of people with peptic ulcer disease have no warning symptoms at all, with a serious complication like bleeding being the first indication something is wrong.
What Ulcer Pain Feels Like
The classic sensation is a gnawing or burning ache in the upper middle part of your stomach. Some people describe it as a hunger pang that won’t go away. It can last anywhere from a few minutes to several hours, and it tends to flare up and then fade in cycles over weeks.
The timing of the pain relative to eating is one of the most useful clues. If the pain kicks in within 15 to 30 minutes after a meal, the ulcer is more likely in the stomach itself. People with stomach ulcers often eat less because food triggers the pain, which can lead to weight loss. If the pain shows up two to three hours after eating, or wakes you up at night, the ulcer is more likely in the duodenum (the first section of your small intestine, just past the stomach). Duodenal ulcer pain actually improves with food, so people with this type sometimes gain weight because eating brings relief.
Beyond pain, common symptoms include feeling uncomfortably full after small meals, bloating, frequent belching, heartburn, and nausea. These overlap with many other digestive issues like acid reflux or indigestion, which is why ulcers are easy to dismiss or misidentify on your own.
Ulcers That Cause No Symptoms
Not everyone with an ulcer gets that telltale burning pain. Silent ulcers are particularly common in older adults and people who regularly take anti-inflammatory painkillers like ibuprofen or naproxen. One theory is that these medications may mask the visceral pain that would otherwise serve as a warning signal. Research has identified several independent risk factors for having an ulcer without knowing it: older age, male sex, current smoking, obesity, and H. pylori infection. If you fall into multiple categories and have even mild, vague digestive discomfort, it’s worth investigating further.
The Two Main Causes
Stomach ulcers aren’t caused by stress or spicy food, though both can aggravate symptoms. The two primary culprits are a bacterial infection and pain medications.
H. pylori Infection
A bacterium called Helicobacter pylori is responsible for the majority of peptic ulcers worldwide. It burrows into the protective mucus lining of the stomach and triggers chronic inflammation that eventually eats through the tissue. Roughly 44% of the global population carries H. pylori, though rates vary enormously by region: under 20% in parts of Western Europe and as high as 70 to 90% in parts of Africa and South Asia. Most people with the infection never develop an ulcer, but it dramatically raises the risk. The infection persists for life if untreated.
NSAIDs and Aspirin
Anti-inflammatory drugs like ibuprofen, naproxen, diclofenac, and even low-dose aspirin are the other major cause. These medications work by blocking an enzyme involved in inflammation, but that same enzyme also helps maintain the protective lining of the stomach. Without that protection, stomach acid can damage the tissue directly. All NSAIDs carry some risk, but the degree varies. Ibuprofen sits on the lower end, diclofenac in the middle, and naproxen and indomethacin at the higher end. The risk climbs with higher doses, longer use, and older age.
How Ulcers Are Diagnosed
You can’t confirm a stomach ulcer based on symptoms alone. A doctor will typically start by testing for H. pylori using one of several non-invasive methods: a breath test, a stool sample, or a blood test. Each has trade-offs. Blood antibody testing tends to be the most sensitive (picking up about 94% of infections), while breath and stool tests are slightly less sensitive but more specific, meaning fewer false positives.
If your symptoms are severe, you’re over 55, or there are red flags like unexplained weight loss, the standard diagnostic tool is an upper endoscopy. A thin, flexible camera is passed down your throat to visually inspect the stomach lining. This allows a doctor to see the ulcer directly, check its size and location, take tissue samples if needed, and rule out anything more serious. It’s usually done under sedation and takes about 15 to 20 minutes.
Warning Signs That Need Immediate Attention
Most ulcers are manageable, but complications can become life-threatening. A perforated ulcer, where the sore burns entirely through the stomach wall, carries a mortality rate that can reach 25% in the most severe cases. Overall 30-day mortality after perforation is around 3%, but it climbs steeply with age: roughly 1% for people under 60 and close to 19% for those over 80.
Get emergency care if you notice any of the following:
- Black, tarry stools or stools with visible red or maroon blood (a sign of internal bleeding)
- Vomit that contains blood or looks like dark coffee grounds
- Sudden, sharp abdominal pain that doesn’t let up
- Dizziness, fainting, or a rapid pulse (signs of significant blood loss or shock)
These symptoms indicate bleeding or perforation and require treatment quickly, not a wait-and-see approach.
What to Pay Attention To
If you’ve had recurring upper stomach pain that comes in waves, worsens or improves predictably around meals, and has lasted more than a week or two, those are the patterns most consistent with a peptic ulcer. The pain doesn’t have to be severe to matter. A mild but persistent gnawing ache that you’ve been writing off as indigestion, especially if you regularly take NSAIDs or have never been tested for H. pylori, is worth taking seriously. Ulcers are highly treatable once identified, but they rarely resolve on their own, and ignoring them gives complications more time to develop.