The most effective treatment for a stomach ulcer depends on what caused it, but nearly every case involves an acid-suppressing medication called a proton pump inhibitor (PPI). If your ulcer is caused by a bacterial infection, you’ll also need antibiotics. Over-the-counter antacids can ease the burning in the short term, but they won’t heal the ulcer on their own.
Proton Pump Inhibitors: The Core Treatment
PPIs are the foundation of ulcer treatment. They work by shutting down the acid pumps in your stomach lining, dramatically reducing the amount of acid your stomach produces. This gives the damaged tissue time to heal. Omeprazole (sold as Prilosec) is the most commonly prescribed, though several others work similarly.
For a standard stomach (gastric) ulcer, the typical course is 40 mg once daily, taken before a meal. Duodenal ulcers, which form in the first part of the small intestine, generally need a lower dose of 20 mg daily. Treatment usually lasts 4 to 8 weeks. PPIs heal ulcers faster than older alternatives like H2 blockers (famotidine/Pepcid) or sucralfate, and randomized trials consistently confirm this advantage. You’ll typically start feeling better within a few days, but the ulcer itself needs the full course to close up completely.
Antibiotics for H. Pylori Infections
About half of all stomach ulcers are driven by a bacterium called H. pylori that burrows into the stomach lining. If testing confirms you have it, killing the infection is essential. Without eradication, the ulcer will likely come back.
The standard approach is a combination regimen taken for 14 days. The American College of Gastroenterology currently recommends a four-drug protocol: a PPI twice daily, tetracycline four times daily, metronidazole three or four times daily, and a bismuth compound (the active ingredient in Pepto-Bismol) four times daily. This is a lot of pills, and side effects like nausea and metallic taste are common, but the regimen has strong cure rates. Older three-drug regimens using clarithromycin are no longer recommended as a first choice because antibiotic resistance has made them less reliable.
Your doctor will typically retest you after treatment to confirm the bacteria are gone. If the first round doesn’t work, a different antibiotic combination is used for the second attempt.
What to Do If NSAIDs Caused Your Ulcer
The other major cause of stomach ulcers is regular use of nonsteroidal anti-inflammatory drugs like ibuprofen, naproxen, or aspirin. These medications suppress the protective mucus layer in your stomach, leaving it vulnerable to acid damage.
If you can stop taking the NSAID, the solution is straightforward: a PPI for several weeks while the ulcer heals. The trickier situation is when you need to keep taking the medication, particularly low-dose aspirin prescribed for heart protection. In that case, a PPI is taken alongside the aspirin long-term to protect the stomach lining. European guidelines recommend that if aspirin must be paused for an active bleeding ulcer, it should be restarted within three to five days because the cardiovascular risks of stopping outweigh the stomach risks.
Regardless of what caused the ulcer, your doctor should also check for H. pylori. Having the infection on top of NSAID use compounds the damage, and treating it improves healing rates.
Over-the-Counter Options for Quick Relief
Antacids like calcium carbonate (Tums) or magnesium hydroxide (Milk of Magnesia) neutralize stomach acid on contact. They can relieve burning pain within minutes, which makes them useful for managing flare-ups while you wait for a PPI to take full effect. But as the NHS notes, they treat symptoms for a few hours at best and do nothing to heal the underlying damage. Long-term reliance on antacids alone is not a substitute for proper treatment.
Some PPIs, including omeprazole, are available over the counter at lower doses (20 mg). If you suspect an ulcer but haven’t seen a doctor yet, an OTC PPI is a more effective stopgap than antacids. That said, ulcer symptoms overlap with other conditions, so getting a proper diagnosis matters.
Supplements That May Help Healing
Zinc L-carnosine is the most studied supplement for stomach ulcers. It’s not an antacid or acid blocker. Instead, it has a natural affinity for damaged stomach tissue, where it reduces inflammation, stabilizes cell membranes, and scavenges harmful free radicals. In a large double-blind trial of nearly 300 patients, 60% of those taking zinc L-carnosine twice daily for 8 weeks had fully healed ulcers on endoscopy, compared with 46% taking a standard mucosal protectant.
Perhaps more interesting is its potential as an add-on to antibiotic therapy for H. pylori. In one controlled trial, adding zinc L-carnosine to standard triple therapy boosted the bacterial eradication rate from 61% to over 80%. Another study combining it with bismuth and antibiotics achieved a 94% eradication rate compared to 70% with antibiotics alone. These results are promising, though zinc L-carnosine is best viewed as a complement to conventional treatment rather than a replacement.
Foods and Drinks That Slow Healing
No diet alone will cure a stomach ulcer, but certain foods and drinks can irritate the exposed tissue and make symptoms noticeably worse. The main categories to limit or avoid while you’re healing:
- Acidic beverages: coffee (regular and decaf), orange and grapefruit juice, cola, alcohol, and both green and black tea
- Spicy seasonings: chili powder, black and red pepper, curry powder, mustard seed, and hot peppers
- High-fat and processed foods: fried foods, fast food, sausage, bacon, salami, and full-fat dairy
- Other irritants: chocolate, tomato-based sauces, citrus fruits, and peppermint or spearmint tea
You don’t necessarily need to eliminate every item on this list permanently. Most people find that a few specific triggers bother them the most. Paying attention to what worsens your pain after meals helps you identify your personal problem foods. Once the ulcer has healed, many people can gradually reintroduce most of these without issues.
Warning Signs of a Serious Complication
Most ulcers heal without complications, but a small percentage bleed, perforate (break through the stomach wall), or cause a blockage. These situations require emergency care. Get immediate help if you experience black or tarry stools, vomit that contains blood or looks like coffee grounds, sudden severe abdominal pain that doesn’t let up, dizziness or fainting, or a rapid pulse. A change in your usual ulcer symptoms, especially if pain suddenly gets much worse or shifts location, also warrants urgent evaluation.