Stomach Ulcer

What is a stomach ulcer?

A stomach ulcer (or gastric ulcer) is an open sore in your stomach lining. It’s a common cause of focal stomach pain — pain that you can feel coming from a particular spot — often with a burning or gnawing quality. But not all stomach ulcers cause noticeable symptoms.

Stomach ulcers are common and treatable, but they can become serious if they go too long without treatment. Some ulcers bleed continuously, which can lead to significant blood loss over time. Some can continue to erode through your stomach wall until there’s a hole.

Sometimes, a stomach ulcer is called a peptic ulcer. Stomach ulcers are one type of peptic ulcer disease.

How common are stomach ulcers?

In the U.S., healthcare providers treat about 4 million stomach ulcers every year. Ulcers are common in our society because their main causes are also common. These include use of over-the-counter (OTC) pain medications and a widespread bacterial infection called H. pylori.

What are the symptoms of stomach ulcers?

A stomach ulcer feels like a sore spot in your stomach, which is located in your upper abdomen, between your breastbone and your belly button, a little to the left.

Typical ulcer pain feels like an acid burn in your stomach, or like something is eating it. This feeling isn’t an illusion. Stomach acids, enzymes and other chemicals are eating away at the wound.

Many people experience indigestion with stomach ulcers, which means burning stomach pain together with a feeling of fullness. You might feel full shortly after you’ve started eating and/or long after you ate.

People also report:

• Acid reflux and heartburn.
• Nausea and vomiting.
• Bloating, belching and gas pain.

These symptoms are related to the conditions that caused your stomach ulcer.

Some people don’t feel their stomach ulcers at all. These are called silent ulcers. You might not experience any symptoms until you develop complications, like bleeding or a perforation (hole).

These symptoms might include:

• Pallor (paleness).
• Dizziness, weakness or faintness.
• Black blood in your poop.
• Vomit that looks like coffee grounds.
• Sudden, severe abdominal pain that doesn’t go away.

If you develop any of these symptoms, see a healthcare provider right away.

How serious are stomach ulcer complications?

Bleeding ulcers: Active bleeding from a stomach ulcer can be mild to severe and can affect you a little or a lot. Moderate blood loss can lead to anemia, while severe blood loss can lead to shock.

Perforated ulcers: An ulcer that erodes all the way through your stomach wall is rare, but it’s an emergency. Stomach acids and bacteria that leak from the hole into your abdominal cavity can cause an infection. Infection in your abdominal cavity can easily spread to your bloodstream and lead to sepsis.

What causes stomach ulcers?

The two most common causes of stomach ulcers are the H. pylori bacterial infection and overuse of nonsteroidal anti-inflammatory drugs (NSAIDs). These two causes together account for about 99% of the stomach ulcers U.S. healthcare providers treat.

H. pylori infection

H. pylori is a very common bacterial infection that affects up to half of people worldwide. It primarily lives in your stomach. In many people, it doesn’t seem to cause any problems. But sometimes, it overgrows and takes over. As the bacteria continue to multiply, they eat into your stomach lining, causing chronic inflammation that leads to gastric ulcers.

NSAIDs

NSAIDs (nonsteroidal anti-inflammatory drugs) are common over-the-counter pain relievers, like ibuprofen, naproxen and aspirin. These medications irritate your stomach lining on contact, and they also inhibit some of the chemicals that defend and repair it.

Your stomach lining is designed to recover from these minor insults. But if you take too many NSAIDs too often, eventually it won’t be able to keep up with repairs. The more the protective lining wears away, the fewer resources it has to recover.

Other causes

Less common causes of stomach ulcers include:

• Other infections. Rarely, other bacterial, viral or fungal infections can take over in your stomach and cause erosive gastritis.
• Zollinger-Ellison syndrome. This is a rare condition that causes your stomach to produce too much gastric acid, which erodes the lining.
• Severe physiological stress. You may develop a stress ulcer if your body is struggling to recover from a life-threatening illness or injury. Severe physiological stress changes your pH balance, making your stomach more acidic.

Does my lifestyle encourage stomach ulcers?

Normal lifestyle factors, like your day-to-day stress levels and what you eat and drink, don’t cause stomach ulcers. But they can make your symptoms worse if you have one. Anything that makes your stomach more acidic can irritate the wound, including:

• Smoking.
• Alcohol.
• Spicy and acidic foods.

How is a stomach ulcer diagnosed?

Your healthcare provider will begin by asking you about your symptoms and medical history. They’ll want to know if you frequently use NSAIDs or have a history of H. pylori infection. If signs point to an ulcer, they’ll take a look inside your stomach to find it.

What tests are used to diagnose stomach ulcers?

Your healthcare provider will want to check for H. pylori infection, then look for the ulcer itself inside your stomach. They can do these things in a few different ways. One common method is an upper endoscopy exam, which can accomplish both at once.

Endoscopy

An upper endoscopy (EGD test) goes inside your stomach with a tiny camera on a long, thin tube (endoscope). The tube goes down your throat while you’re under sedation. Through the tube, a healthcare provider can pass long, narrow tools.

Your provider can use these tools to take a tissue sample (biopsy) and test it for H. pylori. They can also use tools to treat a stomach ulcer on sight. This is especially helpful if your provider suspects complications like bleeding.

Other tests

Although endoscopy is the best method, sometimes an imaging test like an upper GI X-ray series can identify a stomach ulcer without going inside your stomach. Specific tests for H. pylori infection include a breath test, blood test or stool test.

What other conditions could be mistaken for a stomach ulcer?

If it turns out you don’t have a gastric ulcer, you might have:

• Gastroesophageal reflux disease (GERD). Chronic acid reflux can cause heartburn, burning stomach pain and nausea.
• Functional dyspepsia. This means you have chronic indigestion without any obvious physical reason for it. The symptoms are similar, but acid doesn’t cause them, and there’s no visible erosion of your stomach lining.
• Stomach cancer. Gastric cancer is rare, but it can cause similar symptoms to stomach ulcers.

What is the fastest way to cure a stomach ulcer?

Your stomach lining will begin to heal when the cause of the ulcer goes away. If you can make it go away without treatment — for example, if your ulcer is due to NSAID use and you stop taking NSAIDs — this might be enough for the ulcer to heal by itself.

On the other hand, if you have an H. pylori infection, you’ll probably need antibiotics to make it go away. Your provider can also prescribe other medications to help reduce the acid in your stomach and protect your stomach lining to promote faster healing.

What treatment is available for stomach ulcers?

Healthcare providers treat most ulcers with a combination of medications to reduce stomach acid, coat and protect the ulcer during healing, and kill any infection involved. Occasionally, you might need a procedure to stop bleeding or repair a hole.

Medications

Medications to treat stomach ulcers include:

Antibiotics. If you have an H. pylori or other bacterial infection, your healthcare provider will prescribe some combination of antibiotics to kill the bacteria.

Common antibiotics for H. pylori infection include:

• Tetracycline.
• Metronidazole.
• Clarithromycin.
• Amoxicillin.

Cytoprotective agents. These medicines help to coat and protect your stomach lining. Healthcare providers often prescribe them to treat and prevent stomach ulcers related to NSAID use. They include:

• Sucralfate.
• Misoprostol.
• Bismuth subsalicylate.

Histamine receptor blockers (H2 blockers). These drugs reduce stomach acid by blocking the chemical that tells your body to produce it. They include:

• Famotidine.
• Cimetidine.
• Nizatidine.

Proton pump inhibitors (PPIs). These drugs help reduce stomach acid and also coat and protect your stomach lining to promote healing. PPIs include:

• Esomeprazole.
• Dexlansoprazole.
• Lansoprazole.
• Omeprazole.
• Pantoprazole.
• Rabeprazole.

Medical procedures

If you have a complicated ulcer, your provider may need to treat it directly. They can usually do this during your endoscopy exam. Providers treat bleeding by cauterizing or injecting medication into the wound. If you have a hole, a colorectal surgeon may need to stitch it.

Rarely, some people have persistent stomach ulcers that don’t respond to treatment or that keep coming back. This can cause chronic pain and scarring in your stomach. Scar tissue may even obstruct the outlet at the bottom of your stomach. This might require surgery to:

• Remove scar tissue or open up the outlet (pyloroplasty).
• Sever the nerve that triggers stomach acid (vagotomy).

How can I prevent a stomach ulcer from occurring or returning?

To prevent a stomach ulcer, take steps to:

• Eliminate H. pylori. Most people who have H. pylori infection aren’t aware of it. You can find out if you have it by taking a simple breath test or stool test. If you do, you can treat it proactively (before it causes any problems).
• Use NSAIDs as directed. If you’re in the habit of managing daily aches and pains with NSAIDs, make sure you aren’t taking more than the recommended dose. If you take them for medical reasons, talk to your provider about reducing your dosage, switching your medication or taking other medications with them to protect your stomach lining.
• Reduce other irritants. Smoking, alcohol use and certain other medications can make ulcers more likely if you also have H. pylori or take NSAIDs.

How long does it take for a stomach ulcer to heal?

If you’re taking your medications as prescribed and avoiding things that might aggravate the ulcer, it should heal within a few weeks. Your healthcare provider may conduct follow-up tests to make sure the ulcer has healed, and any infection has cleared.

Most people will only need short-term treatment, but some people have chronic conditions that can cause chronic ulcers. For example, Zollinger-Ellison syndrome causes your stomach to produce too much acid. Chronic conditions might need long-term medication.

What should I do if I think I have a stomach ulcer?

Always seek medical care for a stomach ulcer. While you may be able to manage your symptoms temporarily with over-the-counter medications, like antacids and bismuth subsalicylate, these won’t heal the ulcer. You need to address the underlying cause.

An untreated ulcer can lead to serious complications, even if you don’t have severe symptoms. The major cause of stomach ulcers, H. pylori infection, can also lead to other complications. For example, it’s a risk factor for developing stomach cancer.

When should I go to the ER?

Seek emergency care if you have:

• Severe pain that doesn’t go away.
• Signs of blood in your poop or bloody vomit.
• Signs of severe blood loss, such as paleness and faintness.

A note from Cleveland Clinic

Stomach ulcers are common and treatable, but they can also be serious. Even when they don’t cause symptoms, they still need treatment. While lifestyle changes can help you feel better, it’s important to identify and treat the underlying cause.

A stomach ulcer means that your natural stomach acid is overwhelming your protective stomach lining. That’s a situation that can only get worse if it isn’t managed. Your healthcare provider can help prescribe the right treatment for your condition.