An ulcer that keeps growing usually means something is actively preventing it from healing. The most common culprits are an ongoing bacterial infection, continued use of pain relievers like ibuprofen or aspirin, or lifestyle factors like smoking. Less commonly, an enlarging ulcer can signal something more serious, including a rare hormone condition or even cancer. Understanding what’s driving the growth is the first step toward getting it under control.
How Ulcers Normally Heal
Duodenal ulcers (in the first part of the small intestine) typically heal within about six weeks on standard acid-reducing medication. Gastric ulcers (in the stomach) take longer, often two to three months. If your ulcer hasn’t improved after 8 to 12 weeks of treatment, or if it’s visibly larger, it’s classified as refractory. That label matters because it triggers a different diagnostic workup to figure out what’s going wrong.
The Two Most Common Reasons
Ongoing H. Pylori Infection
H. pylori is the bacterium responsible for most peptic ulcers, and if it isn’t fully eradicated, the ulcer won’t stay healed. The problem is that this bacterium has become increasingly resistant to common antibiotics. In many regions, resistance to clarithromycin (one of the standard treatments) exceeds 30%, and resistance to another commonly used antibiotic, levofloxacin, runs above 30% as well. That means a significant number of people complete a full course of antibiotics and still carry the infection. If your ulcer is growing despite treatment, confirming whether H. pylori was actually eliminated is one of the first things your doctor should check.
NSAID Use
Nonsteroidal anti-inflammatory drugs, including ibuprofen, naproxen, and aspirin, are the other leading cause of ulcers that won’t heal. These drugs work by blocking an enzyme involved in inflammation, but they also block the same enzyme in your stomach lining. That enzyme normally produces protective compounds that keep your stomach’s mucus barrier intact and maintain healthy blood flow to the tissue. Without it, the lining breaks down and can’t repair itself. Even occasional NSAID use can stall healing. If you’re taking these medications for pain or heart protection, your ulcer will likely keep growing until you stop or switch to an alternative.
Smoking and Alcohol Slow Repair
Cigarette smoking delays ulcer healing through several pathways at once. It reduces blood flow to the stomach lining, suppresses the growth of new cells needed for tissue repair, increases damaging free radicals in the tissue, and lowers levels of a key growth factor that normally speeds healing. Alcohol damages the stomach’s protective mucus barrier directly. Together, the two are particularly destructive: animal studies show that smoking amplifies the damage alcohol causes to the stomach lining, reducing mucus production even further while ramping up inflammation. If you smoke and drink while trying to heal an ulcer, you’re working against your treatment.
Your Medication May Not Be Working
Acid-suppressing drugs called proton pump inhibitors (PPIs) are the backbone of ulcer treatment, but they don’t always do the job at standard doses. If your ulcer isn’t responding, the typical next steps follow a specific checklist: confirm you’re actually taking the medication consistently and correctly (PPIs need to be taken before meals), verify H. pylori has been cleared, rule out hidden NSAID use (including over-the-counter products and low-dose aspirin), and confirm you’ve stopped smoking. If all of those check out and the ulcer still isn’t healing, your doctor may double the PPI dose or switch to a different PPI for another 6 to 8 weeks.
When a Growing Ulcer May Be Cancer
This is the concern most people searching this question are really worried about, and it deserves a straight answer. Most enlarging ulcers are not cancer, but the risk does go up with size. Research on gastric ulcers found that 86% of ulcers larger than 3 cm turned out to be malignant, compared to only 2% of ulcers smaller than 1 cm. Doctors look for specific visual features during endoscopy: irregular borders, raised edges compared to the ulcer base, and discoloration at the base. Each of these features individually has high sensitivity for detecting malignancy. A benign ulcer, by contrast, tends to have smooth, flat borders and a clean base.
This is why follow-up endoscopy with biopsies is standard for gastric ulcers that aren’t healing. If your doctor hasn’t already taken tissue samples, a growing ulcer is a strong reason to do so. Duodenal ulcers very rarely turn out to be cancerous, so this concern applies mainly to stomach ulcers.
Rare Conditions That Cause Persistent Ulcers
Zollinger-Ellison syndrome is an uncommon condition where tumors called gastrinomas form in the pancreas or small intestine and pump out massive amounts of a hormone that drives acid production. The result is severe, recurring ulcers that resist standard treatment. Doctors suspect this condition when ulcers keep coming back despite proper therapy, when there’s no H. pylori infection or NSAID use to explain them, or when chronic diarrhea accompanies the ulcer symptoms. A blood test measuring gastrin levels after fasting can help identify it.
Other rare causes of refractory ulcers include cytomegalovirus infection (particularly in people with weakened immune systems), Crohn’s disease affecting the stomach or duodenum, and crack cocaine use.
If Your Ulcer Is on Your Skin
If you searched this about a leg or foot ulcer rather than a stomach ulcer, the reasons for growth are different but equally important. Arterial ulcers grow when blood supply to the area is insufficient, starving the tissue of oxygen. The most common cause is atherosclerosis, often worsened by smoking, high blood pressure, diabetes, or high cholesterol. Venous ulcers on the lower legs grow when they become infected, with the most common culprits being staph bacteria, Pseudomonas, and streptococci. Infection can cause rapid deterioration in either type. Any skin ulcer that’s getting larger, developing new discoloration, producing more drainage, or becoming more painful needs prompt evaluation for infection and vascular assessment.
Signs of a Dangerous Complication
A growing ulcer raises the risk of serious complications. Seek immediate medical attention if you notice black or tarry stools, which indicate bleeding in the digestive tract. Vomit that looks like coffee grounds or contains red blood is another emergency sign. Sudden, severe abdominal pain that doesn’t let up could mean the ulcer has perforated (broken through the wall of the stomach or intestine). Feeling dizzy, faint, or having a rapid pulse alongside any of these symptoms suggests significant blood loss and requires urgent care.