By Cristina Mutchler 

 Medically reviewed by Shadi Hamdeh, MD

A stomach ulcer is a sore or break in the lining of the digestive tract. It develops when stomach acid damages this lining. Stomach ulcers usually occur due to a bacterial infection or frequent use of certain over-the-counter (OTC) pain relievers.

Many people with stomach ulcers experience symptoms like abdominal pain or discomfort, bloating, heartburn, and nausea. Stomach ulcers are fairly common and can be easily treated with medications and lifestyle modifications in most cases. Severe stomach ulcers may require surgery.

This article provides an overview of stomach ulcers and what to expect when they develop.

Types

Although the term stomach ulcer is used broadly, they are actually a type of peptic ulcer. Peptic ulcers are differentiated by where they develop in the digestive tract:1

• A stomach/gastric ulcer is located in the stomach (the organ that sits between the esophagus and small intestine)

• A duodenal ulcer is located in the duodenum (the upper portion of the small intestine)

Both types of ulcers have similar causes and come with similar or nearly identical symptoms. A healthcare provider would need to perform an imaging test or procedure to find the exact location of the ulcer.

Causes

Stomach ulcers form when stomach acid eats away at the lining of the digestive tract. This is usually caused by:

• Helicobacter pylori (H. pylori): An infection with this bacteria can damage the mucus coating that protects the stomach lining. This allows stomach acid to contact the lining, causing inflammation and ulcers. It's estimated that an H. pylori infection causes about 75% of stomach ulcer cases in the United States.2

• Prolonged use of NSAIDs: Long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs) like aspirin, ibuprofen, or naproxen is linked to peptic ulcers.3 These medications are thought to interfere with the stomach's ability to protect itself from gastric acids.

Contrary to popular belief, stress and spicy foods do not cause stomach ulcers, but they can aggravate existing ones.

Other, but less common, causes of peptic ulcers include:

• Ischemia: Decreased blood flow to the stomach and/or duodenum

• Zollinger Ellison syndrome: A rare condition that results from tumors that have formed in the pancreas and/or the small intestine, secreting a hormone called gastrin, which stimulates stomach acid production resulting in ulcers

• Crohn's disease: A form of inflammatory bowel disease

• Stressful events: Like traumatic brain injury (Cushing ulcer), severe burns (Curling ulcer), or other trauma, injury, infection, or surgery4

• Other medications: Chemotherapy drugs or osteoporosis medication like Fosamax (alendronate)

In addition, the following factors may play a role in the development of peptic ulcers:

• Genetic susceptibility to developing an H. pylori infection5

• Cigarette smoking, particularly if you are infected with H. pylori6

• Heavy alcohol consumption, particularly if you've been diagnosed with cirrhosis of the liver7

Symptoms

There are several different symptoms linked to stomach ulcers. The severity of the symptom usually depends on the severity of the ulcer.  For example, smaller ulcers may not cause any symptoms, but larger ulcers can cause intense pain and potentially lead to serious bleeding, or cause narrowing of the lumen, resulting in bowel obstruction.

The most common symptom of a stomach ulcer is pain in the upper abdomen (between your chest and belly button). This pain can last for a few minutes or several hours.

The pain differs depending on the location of the ulcer. Stomach (gastric) ulcers may cause pain soon after eating, whereas duodenal ulcers are likely to present with abdominal pain a few hours after meals, when the stomach is empty (including nighttime abdominal pain). Stomach ulcer pain gets worse after eating, but improves after eating in duodenal ulcers.8

Other symptoms commonly seen with stomach ulcers include:9

• Heartburn

• Abdominal cramping

• Nausea

• Vomiting

• Indigestion

• Gas

• Bloating

• Fatigue

When To Call a Healthcare Provider

While stomach ulcers can be painful and uncomfortable, they're rarely life-threatening. But if you notice changes in appetite, unexplained weight loss, vomiting blood, dark black or bloody stools, or trouble breathing, call a healthcare provider or seek immediate medical attention. These serious symptoms could be signs of perforation (hole in the stomach lining), internal bleeding, or a blockage, which all require emergency care.

Diagnosis

If your symptoms point to a diagnosis of stomach ulcers, your healthcare provider will want to run several tests to confirm the potential diagnosis.

There are several ways to initially diagnose a peptic ulcer caused by H. pylori bacteria, including:10

• Blood antibody tests can detect whether specific defensive proteins, known as antibodies, have been produced by the immune system in response to H. pylori bacteria. However, this test is not specific for current or old infection and positive results do not necessarily indicate active infection.

• Carbon urea breath tests measure the amount of carbon dioxide in a person's exhaled air to determine if there's an active H. pylori bacterial infection.

• Fecal antigen stool tests look for foreign H. pylori proteins (antigens) in a stool sample.

For these tests, you may be asked to stop taking antacids, proton pump inhibitors, and Pepto-Bismol (bismuth subsalicylate) for at least two weeks before. It might be necessary to wait up to four weeks after stopping an antibiotic before taking an H. pylori test

If needed, additional diagnostic procedures may include:11

• Upper endoscopy, which involves the insertion of a flexible fiberoptic scope into the throat to view the lining of the stomach. It’s performed under mild sedation and allows small pieces of tissue (a biopsy) to be taken from the lining of the digestive tract for further testing.

• Upper GI series (also known as a barium X-ray), which involves swallowing a chalky liquid containing barium before a series of X-rays are taken. The barium helps the internal organs show up on imaging. It's much less invasive than an endoscopy, but it can sometimes be less accurate if the ulcer is small.

Treatment

Most stomach ulcers are fairly easily treatable if caught relatively early enough. Treatment options include:12

• Medication: Acid-reducing drugs known as proton pump inhibitors (PPIs), bismuth subsalicylate tablets (such as chewable Pepto-Bismol), and antibiotics to kill off H. pylori bacteria may be used. Because NSAID pain relievers need to be avoided, Tylenol (acetaminophen) can be used to treat any pain or fever.

• Dietary modifications: While foods and beverages don't cause stomach ulcers or cure them, some dietary tweaks can help repair damaged stomach tissue instead of irritating it. Your healthcare provider may recommend avoiding fried foods, spicy foods, acidic foods, caffeine, and carbonated drinks, or anything with caffeine to help keep symptoms under control and speed up healing.13

• Lifestyle changes: Reducing cigarette smoking, alcohol use, and stress can help manage uncomfortable stomach ulcer symptoms, allowing the ulcer to heal. Some mind-body treatment approaches, such as breathing exercises, meditation, yoga, or massage, may be suggested as a complement to medication and diet changes.

• Endoscopic intervention: Upper endoscopy may be required in ulcers with ongoing or recent bleeding. An ulcer that’s bleeding could be cauterized (sealed by heat) or clamped. Medication can also be injected during this procedure. 

• Surgical intervention: Surgery is usually only required in extreme cases, where there's a perforation, obstruction, or severe bleeding. Planned surgical procedures can be performed laparoscopically (with a small incision and tool), while emergency surgical procedures are typically performed as an open procedure (with a traditional incision).14

In many cases, ulcers that are treated with medications can heal in several weeks, though some gastric ulcers may take longer to heal than duodenal ulcers.15

Your healthcare provider will likely request a follow-up appointment after you complete the course of treatment to make sure that the bacterial infection and ulcer are gone.

Ulcers and Stomach Cancer

Some research shows a possible connection between H. pylori bacteria, ulcers, and stomach cancer.161718 Your healthcare provider will recommend a biopsy of the ulcer if this is suspected, but know that the overall risk is relatively slim and more research needs to be done on this topic.

Summary

A stomach ulcer is a sore that develops in the stomach lining, usually due to a bacterial infection or long-term use of certain OTC pain relievers. They are a type of peptic ulcer. Lifestyle factors such as smoking may also contribute.

The most noticeable stomach and peptic ulcers symptoms include pain in the upper abdomen, heartburn, nausea, indigestion, and gas. Treatment options include acid-reducing medications, antibiotics, dietary or lifestyle changes, and (more rarely) surgery.

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Deding U, Ejlskov L, Grabas MPK, Nielsen BJ, Torp-Pedersen C, Bøggild H. Perceived stress as a risk factor for peptic ulcers: a register-based cohort study. BMC Gastroenterology. 2016;16(1):140. doi:10.1186/s12876-016-0554-9

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Bang CS, Baik GH, Kim JH, et al. Peptic ulcer disease in liver cirrhosis and chronic hepatitis: impact of portal hypertension. Scand J Gastroenterol. 2014;49(9):1051-1057. doi:10.3109/00365521.2014.923501

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Vomero ND, Colpo E. Nutritional care in peptic ulcer. Arq Bras Cir Dig. 2014;27(4):298-302. doi:10.1590/S0102-67202014000400017

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By Cristina Mutchler
Cristina Mutchler is an award-winning journalist with more than a decade of experience in national media, specializing in health and wellness content.