A stomach ulcer is an open sore that forms in the lining of your stomach when the protective mucus layer breaks down and stomach acid eats into the tissue underneath. Around 6.5 million people worldwide are living with peptic ulcer disease at any given time, though rates have dropped significantly over the past three decades as doctors have gotten better at identifying and treating the root causes.
How a Stomach Ulcer Forms
Your stomach produces hydrochloric acid strong enough to dissolve food, but a thick layer of mucus normally shields the stomach wall from digesting itself. When something damages that protective barrier, acid reaches the exposed tissue and creates a raw, crater-like sore. This isn’t a one-time injury. The ulcer stays open because acid keeps irritating it, preventing healing the way a cut on your skin would heal if you kept pulling it apart.
The two most common things that break down this barrier are a specific type of bacteria and common pain relievers.
The Two Main Causes
H. pylori Infection
A corkscrew-shaped bacterium called Helicobacter pylori is the leading cause of stomach ulcers. It burrows into the mucus lining and triggers inflammation that weakens the stomach’s defenses. Most people who carry H. pylori never develop symptoms, but in some, the infection erodes the protective coating enough for acid to reach the stomach wall. The bacterium spreads through contaminated food, water, or close contact, and many people pick it up in childhood without knowing it.
Pain Relievers (NSAIDs)
Over-the-counter anti-inflammatory drugs like ibuprofen, naproxen, and aspirin are the other major culprit. These medications block the production of chemicals that help maintain the stomach’s mucus barrier. The damage can happen remarkably fast: a single dose of aspirin can cause visible injury to the stomach lining within 15 to 30 minutes, and virtually all people who take aspirin continuously develop surface erosions within the first few days of use. The risk climbs with higher doses, longer use, and older age. If you take these medications regularly for pain or heart health, this is worth knowing.
Other factors that increase your risk include smoking, heavy alcohol use, and high levels of stress on the body from severe illness or injury. Contrary to a persistent myth, spicy food does not cause ulcers, though it can make an existing one feel worse.
What a Stomach Ulcer Feels Like
The most common symptom is a burning or gnawing pain in the upper abdomen, roughly between your belly button and breastbone. The pain often shows up when your stomach is empty, particularly between meals or in the middle of the night, and may temporarily improve after eating or taking an antacid. Some people describe it as more of a dull ache than a burn.
Other symptoms include feeling full quickly when eating, bloating, nausea, and a loss of appetite. Some ulcers cause no noticeable symptoms at all, especially in older adults or people taking pain relievers that mask the discomfort. Smaller ulcers can go undetected for months.
Signs of a Serious Complication
Most stomach ulcers are manageable, but some develop complications that need immediate attention. The most dangerous is bleeding, which happens when the ulcer erodes into a blood vessel. Warning signs include:
- Vomit that contains blood or looks like dark coffee grounds
- Black, tarry stools (a sign of digested blood)
- Bright red blood in your stool
- Sudden sharp abdominal pain that doesn’t let up
- Feeling faint, dizzy, or unusually tired
Severe bleeding can lead to shock, which shows up as a rapid heart rate, pale or cold skin, confusion, and sweating. A perforated ulcer, where the sore eats entirely through the stomach wall, causes sudden, intense pain and is a surgical emergency. These complications are uncommon but serious enough that recognizing the symptoms matters.
How Stomach Ulcers Are Diagnosed
The standard diagnostic tool is an upper GI endoscopy. A doctor passes a thin, flexible tube with a tiny camera down your throat and into your stomach, allowing them to see the ulcer directly and assess its size and location. During the same procedure, they typically take small tissue samples (biopsies) from the stomach lining. These samples serve two purposes: testing for H. pylori and checking for any abnormal cell changes.
Doctors can also test for H. pylori through a breath test, stool test, or blood test, though endoscopy gives the most complete picture because it reveals both the infection and the physical damage.
Treatment and Healing Timeline
Treatment depends on what caused the ulcer. If H. pylori is present, the goal is to eliminate the infection completely. Current guidelines from the American College of Gastroenterology recommend a 14-day course of multiple medications taken together: an acid-reducing drug, two types of antibiotics, and a bismuth compound (the active ingredient in Pepto-Bismol). This combination approach is necessary because H. pylori has become resistant to some individual antibiotics over time.
Whether or not H. pylori is involved, the cornerstone of ulcer healing is reducing stomach acid with a class of drugs called proton pump inhibitors (PPIs). These medications dramatically lower acid production, giving the stomach lining time to repair itself. A typical course lasts 4 to 8 weeks, and most ulcers heal completely within that window. If NSAIDs caused the ulcer, stopping or switching the medication is essential, since the ulcer will keep reopening as long as the irritant is present.
For people who need to stay on anti-inflammatory drugs for conditions like arthritis or heart disease, a doctor may prescribe a long-term low-dose acid reducer to protect the stomach lining.
Diet and Lifestyle Changes
There’s a long-standing belief that ulcer patients need to follow a bland diet, but research doesn’t support this. The National Institute of Diabetes and Digestive and Kidney Diseases states directly that diet and nutrition do not play an important role in causing, preventing, or treating peptic ulcers, and doctors do not recommend avoiding specific foods or following a special diet.
That said, you’ll likely notice on your own that certain things irritate your stomach while it heals. Alcohol, coffee, and acidic foods are common triggers for discomfort, and avoiding them during treatment can make the healing period more tolerable even if they don’t affect the ulcer itself. The one lifestyle change with clear evidence behind it is quitting smoking. Smoking slows ulcer healing and increases the risk of recurrence.
Can Stomach Ulcers Come Back?
Recurrence depends on whether the underlying cause was fully addressed. If H. pylori was successfully eradicated, the chance of the ulcer returning drops substantially. If NSAID use was the trigger and you’ve stopped taking those medications, the ulcer is unlikely to recur. The highest recurrence rates happen when people continue the habits or medications that caused the problem in the first place, or when an H. pylori infection wasn’t completely cleared on the first round of treatment.
Global rates of peptic ulcer disease have fallen by roughly 40% since 1990, largely because of widespread H. pylori testing and more effective eradication treatments. What was once a chronic, recurring condition for many people is now, in most cases, fully curable.