What Are Stomach Ulcers? Peering Into Peptic Pain

Medically reviewed by Aaron L Weigmann MD., MS Plastic Surgeon May 09, 2024| Written by Shahid Bashir

What Are Stomach Ulcers? Peering Into Peptic Pain

A stomach ulcer, also called a gastric ulcer, is a condition of developing sores in the inner lining of the stomach. Sores develop, in part, when gastric acid and enzymes come in direct contact with stomach walls. 

Gastric acid can also attack the first section of the small intestine, which is called a duodenal ulcer. Peptic ulcer is a combined term for both gastric and duodenal ulcers.

Normally, a mucous lining covers the inner wall of the stomach and prevents the direct contact of gastric acid with the stomach walls. Certain conditions like bacterial infections or drug overuse can damage the mucous lining - facilitating the development of sores.

Stomach ulcers cause a burning sensation and pain in your upper abdomen, especially when your stomach is empty between meals. Some people also complain of burning sensations soon after they eat a meal. Water intake and taking drugs to reduce gastric acid can relieve the symptoms temporarily.

If left untreated, sores continue to erode and cause bleeding in the stomach, characterized by blood in the vomit and stool. At this stage, the patient must get immediate medical assistance.

Statistics show that peptic ulcer is a common condition, affecting around10% of the population worldwide. In the USA, peptic ulcers affect about4 million people each year.


Stomach ulcers can cause several characteristic symptoms but can also be asymptomatic in many cases. The most common and initial symptoms of stomach ulcers are pain and burning sensations in the stomach, which you can feel in the upper abdomen. 

The severity of pain increases in between meals or late at night. It is due to increased gastric acid buildup in the absence of food. However, pain can also increase after meals if there are duodenal ulcers as food and gastric acid enter the duodenum after a meal.

Some other common symptoms that indicate the presence of stomach ulcers are:

  • Bloating
  • Indigestion
  • Heartburn
  • Nausea
  • Vomiting — bloody vomiting in severe ulcer
  • Dark stools (like coffee grounds) — the presence of blood in the stool
  • Loss of appetite


Stomach ulcers develop when there is some imbalance in the stomach acid levels or a compromise in the protective mucous lining of the stomach. 

Two major causes of stomach ulcers are:

1. H. Pylori Bacteria

Helicobacter pylori, or H. pylori, is a bacteria that grows and lives inside the stomach. It is harmless until the overgrowth of this bacteria happens. When there is an overgrowth of H pylori in the stomach, it can cause infection and damage the protective lining of the stomach. 

Small infections of H. pylori are common and heal themselves without causing symptoms or serious complications. According to aCenters for Disease Control and Prevention report, two-thirds of the world’s population have H. pylori.

When the infection continues, and bacteria get a suitable environment for overgrowth, small infections may evolve into severe stomach ulcers. Some people are more likely to develop H. pylori ulcers than others for unknown reasons. If your doctor diagnoses you with this infection, it is likely they will recommend prompt treatment.


Nonsteroidal Anti-inflammatory Drugs, or NSAIDs, include over-the-counter painkillers like ibuprofen, aspirin, and naproxen. The chemical nature and reaction of these drugs in the stomach can reduce the protective mucous lining by severalmechanisms.

Research shows that long-term use of NSAIDs accounts for 90% of all ulcers in the body. Approximately 25% of NSAID users develop stomach and duodenal ulcers.

How Do I Know If I Have an Ulcer In My Stomach?

If you are feeling burning sensations or pain in your stomach, it may or may not be due to an ulcer. You need to analyze other symptoms in your body and see if they match the symptoms of an ulcer, like loss of appetite, vomiting, and blood in stool. 

Medical history is important in diagnosing stomach ulcers. History of H. pylori infection and usage of NSAIDs supports the diagnosis of an ulcer in the case of abdominal burning and pain.

Here are certain tests and procedures that can confirm that you have an ulcer in your stomach:

a) Breath Test

In the breath test, the carbon dioxide levels in your breath tell the presence of H. pylori. The principle of this test is that H. pylori breaks down urea and releases carbon dioxide.

To start this test, the examiner will ask you to exhale into a bag. The air in the bag measures the carbon dioxide levels in your breath. After that, the examiner will ask you to consume a solution containing urea and breathe again into a bag. The examiner then measures the carbon dioxide in the air you exhale after consuming the solution.

If carbon dioxide levels are higher in the air after consuming the solution, it shows that H. pylori is present, which breaks down the urea and releases carbon dioxide.

The breath test accurately diagnoses the active H. pylori infection and stomach ulcers.

b) Blood Test

A blood test is a convenient procedure to analyze the presence of H. pylori in your body. The immune system of the body makes antibodies against H. pylori antigens in the case of infection. Your blood sample undergoes examination for the presence of antibodies against H. pylori. 

However, a blood test is not accurate in diagnosing active infection. Antibodies can be present in the blood from past exposure to H. pylori.

c) Endoscopy

Endoscopy of the stomach and small intestine is helpful in the diagnosis of ulcers. In this method, the doctor inserts a tube with a camera and a light from your mouth to the stomach. The real-time camera view on the screen helps the doctor to analyze the presence of ulcers and bleeding.

Sometimes, a fragment of infected tissue from the stomach is taken out for biopsy. A biopsy of the sample tissue tells whether or not H. pylori is present at the site of infection.

Do Stomach Ulcers Go Away?

Stomach ulcers can sometimes go away if you eliminate the risk factors that cause them. Reducing the use of NSAIDs and otherirritants like smoking and alcohol use can help in the natural recovery of stomach ulcers.

But without any medical treatment, you may not be able to save yourself from the recurrence of stomach ulcers. Therate of recurrence of stomach ulcers from H. pylori infection is high. Pain and discomfort can also become unbearable if you wait for ulcers to go away. 

There is also a risk of severecomplications from stomach ulcers if left untreated, including gastrointestinal bleeding, perforation of the stomach wall, and intestinal obstruction from scarring.

The ideal management plan is to eliminate risk factors when you experience ulcer symptoms. If you feel relieved from the symptoms, you don’t have to rush for medical treatment options and let the body heal itself naturally. But if you experience symptoms like unbearable pain and blood in vomit and stools, you must immediately consult your doctor for treatment options.


Treatment plans for stomach ulcers depend on the underlying cause. The goal of treatment is to eliminate the cause, heal the ulcer, and recover the stomach's protective mucosal lining. Two treatment options are available for stomach ulcers, which are medications and surgery.

A. Medications

Medication is the most widely used and effective treatment option against stomach ulcers. Different medicines follow different mechanisms to achieve the treatment goals depending on the cause of ulcers.

Here are some effective medicines for stomach ulcers:

1. Antibiotics 

When H. pylori is the cause of developing stomach ulcers, your doctor will prescribe antibiotics to fight the bacterial infection. Certain factors, such as past medical history and bacterial resistance, contribute to determining the antibiotic type. 

After completing the antibiotic dosage, the doctor will ask you to test for H. pylori. If the bacteria shows in the test even after antibiotic therapy, it indicates that the bacteria has developed resistance against that antibiotic. In such cases, the doctors will prescribe a different combination of antibiotics to treat ulcers.

Some commonantibiotics for treating stomach ulcers include amoxicillin, levofloxacin, tetracycline, and metronidazole.

2. PPIs 

Proton Pump Inhibitors, or PPIs, work by blocking the production and release of acid in the stomach. PPIs protect the stomach lining from further damage by gastric acids and enable the naturalhealing of peptic ulcers.

Some effective proton pump inhibitors for stomach ulcers are omeprazole, pantoprazole, and lansoprazole.

3. Bismuth Subsalicylate

This class of drugs effectively prevents the growth and spread of H. pylori bacteria. This drugprevents the binding and growth of H. pylori on the protective mucosal lining of the stomach. It also has a soothing effect on the ulcer which may decrease symptom severity.

Some common drugs of the bismuth subsalicylate group that are effective against ulcers are kaopectate, peptobismol, and Maalox.

B. Surgery

Most stomach ulcers don’t require surgery and can heal through medication. However, if the infection is critically severe and causes uncontrolled bleeding, perforations in the lining of the stomach, or obstruction in the digestive tube. Then, surgery becomes necessary.

A few surgical procedures for stomach ulcers include:

  • Omental patch - repairing of perforations in the walls of the stomach:
  • Partial Gastrectomy - removal of a small area that is causing uncontrolled bleeding
  • Vagotomy - Cutting some branches of nerve supply to reduce gastric acid production 
  • Pyloroplasty - Opening the passage between the stomach and small intestine 

To perform the above surgical procedures, the surgeon can either go for open surgery, calledlaparoscopic surgery, or a minimally invasive method, calledendoscopic surgery.

Can Lifestyle And Diet Help With Ulcers?

Before the availability of scientific evidence about the causes of ulcers, it was common to link the incidence of ulcers with the diet. Thanks to scientific research, we know that dietary changes can not cause ulcers but can reduce the risk factors and help relieve the symptoms. Similarly, lifestyle changes can also help in the management of symptoms of ulcers and promote the healing process.

Role of Diet in Ulcers

A balanced diet has plenty of benefits for many health conditions, and ulcers are no exception.Studies show that people who consume a low-fiber diet are at higher risk of developing ulcers. 

Fiberreduces the concentration of gastric acid, lowering the risk of damage to the gastric walls. Soluble fibers helpincrease the viscosity of the intestinal content, preventing direct acid contact with inner linings and improving the healing process. 

See Also:21 Easy Ways to Get More Fiber in Your Diet

Insoluble fibers such as those from nuts, beans, and wheat branincrease the stool bulk and reduce the intestinal transit time. Increased stool volume and reduced transit time help relieve the symptoms of ulcers, such as bloating. 

Consuming a diet high in probiotics and antioxidant properties also helps with ulcers. Probiotic foods increase good gut bacteria concentration andreduce the infection of H. pylori. Probiotics also help to counter the side effects of antibiotics against H. pylori. Diets rich in antioxidants helperadicate H. pylori

Role of Lifestyle In Ulcers

Lifestyle modifications can significantly relieve the discomfort and complications from ulcers. Some effective lifestyle modifications against stomach ulcers are quitting smoking, limiting alcohol intake, drinking plenty of water, avoiding coffee, and limiting the use of NSAIDs. 

If you are a regular tobacco smoker and have ulcers in your stomach, you are most likely to aggravate the condition. Tobacco smoke contains nicotine, which canincrease gastric acid production. 

Alcohol consumption, especially frequent consumption, can damage the stomach lining and increase the risk of ulcers. It can also increase the production of gastric acid, which is a risk factor in developing ulcers. 

Caffeine, an ingredient in coffee, can alsoincrease acid production and risk for ulcers.

Drinking plenty of water will dilute the acid in the stomach, relieving the pain and discomfort. You must also avoid the use ofNSAIDs where possible, as their side effects are among the primary causes of ulcers. 

What Foods to Eat for Stomach Ulcers?

While food is not directly associated with the incidence of stomach ulcers, certain foods can lower the risk factors. For example, foods high in probiotics and antioxidants help the body fight against H. pylori. Similarly, certain foods have healing properties and promote efficient recovery from ulcers. 

Here are some foods to eat for stomach ulcers:

1. Fruits & Vegetables

Fruits such as apples, pomegranates, grapes, and leafy green vegetables are high in fiber and antioxidant properties. Fiber lowers the concentration of gastric acid and protects the stomach lining byincreasing the viscosity of digestive content. Antioxidants are effective ineradicating H. pylori and reducing the severity of ulcers.

2. Fermented Foods

Fermented foods like kefir and yogurt have probiotics in them. Probiotics are good gut bacteria that compete against H pylori and reduce infection. Antibiotic treatment of ulcers can harm good gut bacteria, so probiotics help lower the side effects of antibiotic therapy.

3. Cranberries

Cranberries have antioxidant properties and are effective against stomach ulcers because of a compound called flavonoids.Studies show flavonoids can reverse gastric ulcers by neutralizing acid secretion and improving gastric mucosal lining. This compound also has anti-inflammatory and antibacterial defense mechanisms against gastric ulcers. 

4. Sweet Potato

Sweet potatoes have plenty of vitamin A — a single sweet potato can fulfill your daily vitamin A requirements. Vitamin A has wound-healing properties and canpromote the healing of ulcers. Vitamin A has a keyrole in normal mucus production, which increases the protection against gastric acid.

5. Bell Peppers

Bell peppers are a rich source of vitamin C — one average-sized red bell pepper gives you 169% of your daily vitamin C requirements.Studies show that vitamin C is critical for wound repair, and its deficiency increases the risk of developing ulcers.

6. Extra Virgin Olive Oil

Extra virgin olive oil haspolyphenols, which are an effective anti-bacterial compound.Studies show that extra virgin olive oil can eradicate H. pylori and heal the mucosal lining of the stomach.


  • What is the fastest way to cure stomach ulcers?
  • The fastest way to cure stomach ulcers is to diagnose the underlying cause and design a treatment plan instead of just managing the symptoms. For example, if H. pylori is the cause of an ulcer, you must initiate antibiotic therapy for a timely cure.

  • What drink is good for ulcers?
  • Cabbage juice, herbal teas, yogurt drinks, cranberry juice, honey water, and high-fiber drinks are good for ulcers. Other drinks with probiotic and antioxidant properties are also good for healing ulcers.

  • Is milk good for ulcers?
  • You can get temporary relief soon after milk intake as it initially coats the stomach lining against acid. However, after the initial healing effect, milk stimulates the acid production in the stomach and thus can aggravate the ulcers. 

    I hope this article helped you learn everything you needed to know about stomach ulcers.