Several common habits, medications, and conditions can make a peptic ulcer worse, slowing healing or pushing it toward dangerous complications like bleeding or perforation. The biggest culprits are ongoing use of anti-inflammatory painkillers, an untreated bacterial infection in the stomach, smoking, alcohol, and chronic stress. Some of these factors caused the ulcer in the first place, and continuing to expose your stomach lining to them keeps the wound open and deepening.
Pain Medications That Damage the Stomach Lining
Nonsteroidal anti-inflammatory drugs, commonly called NSAIDs, are one of the most significant things that make ulcers worse. This category includes ibuprofen, naproxen, and aspirin. These drugs work by blocking the production of compounds called prostaglandins, which normally protect the stomach lining by maintaining its mucus barrier, promoting blood flow, and regulating acid. When you suppress those protective compounds, the lining becomes vulnerable to the acid sitting in your stomach every day.
The numbers are striking. Studies of NSAID users show that 10% to 30% develop gastric ulcers, with higher rates in older adults and people with other health conditions. Among elderly NSAID users, the ulcer hospitalization rate is about four times higher than in non-users. Roughly a quarter of people who take NSAIDs long-term develop ulcer disease, and 2% to 4% of those will experience bleeding or perforation.
If you already have an ulcer and keep taking NSAIDs, you’re essentially reopening the wound each day. Even low-dose aspirin taken for heart protection can be enough to delay healing.
The Steroid Combination That Multiplies Risk
Corticosteroids (like prednisone) on their own carry roughly double the risk of peptic ulcer disease compared to not taking them. But the real danger appears when corticosteroids are combined with NSAIDs. People taking both drugs simultaneously face a risk 15 times greater than people taking neither. Corticosteroids alone, without NSAIDs, barely raise the risk at all. So the combination is what makes things significantly worse, not steroids by themselves.
An Untreated H. Pylori Infection
The bacterium H. pylori is the other leading cause of peptic ulcers, and leaving it untreated is one of the surest ways to make an existing ulcer worse. This organism has an arsenal of tools to survive in stomach acid and damage the tissue around it.
H. pylori produces an enzyme that breaks down urea into ammonia, which neutralizes acid in its immediate surroundings and lets the bacterium thrive. But it also carries genes that stimulate higher gastric acid production overall, meaning the rest of your stomach gets bathed in more acid than normal. At the same time, the bacterium releases substances that break down the fatty molecules in your stomach’s protective mucus layer. It also produces a protein that cuts apart the connections between cells lining the stomach, weakening the barrier that keeps acid away from deeper tissue. The result is a stomach lining that’s simultaneously more exposed to acid and less able to defend itself.
Treating this infection is essential for ulcer healing. Standard antibiotic regimens clear the bacteria in roughly 80% to 85% of first-time patients. But if you’ve had a failed treatment before, success rates drop, sometimes below 50% depending on the regimen. This is why confirming that the infection is actually gone matters for long-term healing.
Smoking and Alcohol
Smoking attacks ulcer healing from multiple directions at once. It reduces blood flow to the stomach lining, which starves the tissue of the oxygen and nutrients it needs to repair. It suppresses the production of prostaglandins, the same protective compounds that NSAIDs block. It slows the growth of new cells at the ulcer site and inhibits the formation of new blood vessels in healing tissue. On top of all that, tobacco suppresses bicarbonate secretion from the pancreas. Bicarbonate is your body’s natural acid neutralizer in the upper intestine, so less of it means the duodenum (the first section of the small intestine) sits in a more acidic environment. This is why smoking is a recognized risk factor for both ulcer formation and perforation.
Alcohol is a direct irritant to the stomach lining. Heavy consumption erodes the mucus barrier and can increase acid secretion. Occasional moderate drinking may not meaningfully affect an ulcer, but excessive intake is listed among the established risk factors for perforation, the most dangerous ulcer complication.
Chronic Stress
The relationship between stress and ulcers was once considered folklore, then dismissed, and has now come back into focus with better evidence. Chronic psychological stress activates your body’s hormonal stress response, raising cortisol levels. Elevated cortisol increases gastric acid secretion, creating a more corrosive environment for an already damaged stomach lining.
Population-based studies have found clear associations between mental health conditions like depression and anxiety and higher rates of peptic ulcer disease. This doesn’t mean worry alone creates an ulcer from scratch, but ongoing stress can meaningfully slow healing and worsen symptoms if an ulcer already exists. The mechanism is straightforward: more stress hormones lead to more acid, and more acid on an open wound means slower recovery.
Foods That Irritate but Don’t Cause Ulcers
Spicy food is widely blamed for ulcers, but the evidence doesn’t support the idea that it causes them. The real causes are H. pylori infection, NSAIDs, and other factors described above. That said, if you already have an ulcer, certain foods can make it feel worse by irritating exposed tissue. Acidic foods like citrus and tomatoes, very spicy dishes, coffee, and carbonated drinks can all trigger pain or burning in people with active ulcers.
The distinction matters because avoiding spicy food won’t heal your ulcer. It may reduce discomfort in the short term, which is worthwhile, but it’s not a substitute for addressing the underlying cause. If you notice specific foods consistently trigger pain, avoiding them while your ulcer heals makes practical sense.
What Happens When Ulcers Get Worse
An ulcer that keeps getting aggravated doesn’t just stay painful. It can progress to serious complications. The most common is bleeding, which can show up as dark, tarry stools or vomiting material that looks like coffee grounds. A deeper ulcer can erode entirely through the stomach or intestinal wall, creating a perforation. This is a medical emergency that causes sudden, severe abdominal pain and requires surgery.
The risk factors for perforation overlap heavily with the factors that make ulcers worse in general: NSAID use, H. pylori infection, smoking, corticosteroids, excessive alcohol, and conditions that cause extreme acid production. Having a previous history of ulcer disease also raises the risk, which means that if you’ve had an ulcer before, the habits and exposures described here matter even more for you than for the average person.
Ulcers that are actively being treated with acid-reducing medication heal within weeks for most people, as long as the factors aggravating them are removed. The ulcer itself is treatable. The challenge is identifying and stopping whatever keeps making it worse.