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Understanding Stomach Ulcers: What Causes Them and How They Form

A stomach ulcer is a sore that develops in the lining of the stomach or the first part of the small intestine (called the duodenum). These sores can be painful and may bleed. To understand stomach ulcers, it helps to know how the stomach normally works. Your stomach produces strong acid to break down food during digestion. The stomach lining has a protective layer of mucus that shields it from this acid. When this protective layer breaks down or becomes weakened, the acid can damage the stomach tissue underneath, creating an ulcer.

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Research shows that two main causes account for most stomach ulcers. The first is infection with a bacterium called Helicobacter pylori, or H. pylori. According to the National Institute of Diabetes and Digestive and Kidney Diseases, about 30 to 40 percent of Americans carry this bacteria. The second major cause is long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or aspirin. These medications can wear away the stomach's protective mucus layer over time. Other less common causes include stress, smoking, and alcohol use, though these alone rarely cause ulcers.

The symptoms of stomach ulcers vary from person to person. Some people experience burning stomach pain, especially when the stomach is empty or at night. Others feel fullness, bloating, heartburn, or nausea. In some cases, people may vomit blood or have dark, tarry stools, which indicate bleeding from the ulcer. However, some people have no symptoms at all and only discover they have an ulcer when it causes a serious complication like a perforation or bleeding.

The good news is that stomach ulcers are treatable. Once you understand what caused your ulcer, you and your doctor can work together on a treatment plan. If the ulcer is caused by H. pylori, antibiotics can cure the infection. If NSAIDs caused it, stopping or switching medication often allows the ulcer to heal. Medications that reduce stomach acid, such as proton pump inhibitors, help ulcers heal faster by giving the lining time to repair itself.

Practical takeaway: Recognizing the symptoms of a stomach ulcer and understanding the common causes can help you seek medical care early. Keep track of your symptoms and share this information with your doctor to help them determine the best course of treatment.

Common Symptoms and When to Seek Medical Attention

Stomach ulcer symptoms can range from mild to severe, and some people may not notice any signs at all. The most common symptom is a burning sensation in the upper part of your stomach, usually between the breastbone and belly button. This pain often occurs when the stomach is empty, such as between meals or during the night. Some people find that eating food, drinking milk, or taking antacids temporarily relieves the pain, while others notice their symptoms get worse after eating.

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Beyond burning pain, stomach ulcers can cause several other uncomfortable symptoms. These include feeling full quickly while eating, bloating or swelling in the stomach, heartburn or acid reflux, nausea, and loss of appetite. Some people experience vomiting that may contain blood, which appears bright red or looks like coffee grounds. You might also notice stools that are dark, sticky, or tarry in appearance. These symptoms involving blood can indicate that the ulcer is bleeding and require medical attention.

Most people with stomach ulcers experience symptoms for a few weeks, then the symptoms may disappear on their own, even without treatment. This does not mean the ulcer has healed—it may simply mean the pain has temporarily stopped. The ulcer could still be present and may get worse over time. This is why it is important to seek medical care rather than waiting for symptoms to disappear.

You should contact a healthcare provider if you experience persistent stomach pain lasting more than a few weeks, if you vomit blood, or if you have dark or bloody stools. If you experience sudden, severe abdominal pain, it could indicate a complication such as a perforation (a hole in the stomach lining) and requires emergency care. Other warning signs include unexplained weight loss, persistent nausea or vomiting that prevents you from eating normally, or anemia symptoms such as fatigue and weakness.

Be especially cautious if you are taking NSAIDs regularly. Long-term use of these medications increases your risk of developing ulcers. If you take NSAIDs and develop stomach pain, inform your doctor about your medication use. Similarly, if you have been diagnosed with H. pylori infection or have a family history of ulcers, report these factors to your healthcare provider.

Practical takeaway: Do not ignore persistent stomach pain. Document when your symptoms occur, what makes them better or worse, and any other health changes you notice. Share this detailed information with your doctor to help guide their evaluation and diagnosis.

How Doctors Diagnose Stomach Ulcers

When you visit a healthcare provider with symptoms that might indicate a stomach ulcer, they will start by asking detailed questions about your medical history, current medications, and symptoms. They will want to know when your pain started, where exactly you feel it, what makes it better or worse, and whether you take NSAIDs or other medications regularly. This conversation helps your doctor narrow down the possible causes and determine what tests might be needed.

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One of the most common diagnostic tools is an upper endoscopy, also called an esophagogastroduodenoscopy or EGD. During this procedure, a thin, flexible tube with a small camera on the end is passed down your throat to examine the inside of your stomach and small intestine. This allows your doctor to see the ulcer directly and determine its size and location. If an ulcer is present, your doctor can also take small tissue samples for testing. The procedure typically takes 15 to 30 minutes and is performed with sedation to keep you comfortable.

Testing for H. pylori infection is a crucial part of ulcer diagnosis. Several types of tests can detect this bacterium. A breath test, called the urea breath test, involves swallowing a special liquid and then providing breath samples that are analyzed for the presence of H. pylori. A stool test examines your stool sample for signs of the bacteria. Blood tests can show antibodies to H. pylori, indicating past or present infection. A biopsy taken during endoscopy can also be tested for H. pylori. Your doctor will choose the test that works best for your situation.

In some cases, doctors may use other imaging techniques to evaluate stomach ulcers. X-rays with contrast material can show ulcers in some cases, though endoscopy is more accurate. If your doctor suspects complications such as perforation or bleeding, they may order a CT scan for more detailed imaging. Blood tests may also be performed to check for signs of bleeding, such as low red blood cell counts (anemia), or to check your kidney and liver function before starting certain medications.

The specific tests your doctor orders will depend on your symptoms, medical history, and any medications you are taking. If you have been taking NSAIDs, your doctor will likely focus on that as a possible cause. If you have risk factors for H. pylori, your doctor will prioritize testing for that infection. Understanding which tests you need and why helps you prepare and cooperate fully with the diagnostic process.

Practical takeaway: Before your doctor's visit, write down all symptoms you have experienced, all medications you take (including over-the-counter medications and supplements), and any family history of ulcers or stomach problems. This information helps your doctor select the most appropriate diagnostic tests.

Treatment Options and How They Work

Once your doctor confirms you have a stomach ulcer and determines the cause, treatment can begin. The primary goal of treatment is to reduce the amount of acid in your stomach so the ulcer can heal and pain can decrease. Medications that reduce stomach acid are the cornerstone of ulcer treatment. Proton pump inhibitors, or PPIs, are among the most effective. These medications work by blocking the cells that produce acid in the stomach. Common PPIs include omeprazole, lansoprazole, and pantoprazole. These medications typically need to be taken for four to eight weeks for an ulcer to heal completely, depending on the size and location of the ulcer.

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H2-receptor antagonists, or H2 blockers, are another class of acid-reducing medications. Examples include famotidine and ranitid