Stomach Ulcer: Causes, Treatment, and Prevention

Stomach ulcers are painful sores that develop in the lining of your stomach or the first part of your small intestine. They’re also called peptic ulcers. These ulcers form when stomach acid damages the protective lining of your digestive system.

If you have a stomach ulcer, you’re not alone. About 10% of people will develop a peptic ulcer at some point in their lives. The good news is that most ulcers can be treated successfully with the right medications.

Types of Stomach Ulcers

There are two main types of peptic ulcers, depending on where they occur in your digestive system.

Gastric Ulcers

Gastric ulcers form in your stomach lining. They tend to heal more slowly than duodenal ulcers. Studies show that H. pylori eradication therapy has similar cure rates for both gastric and duodenal ulcers (1).

Duodenal Ulcers

Duodenal ulcers occur in the duodenum, which is the first part of your small intestine. These are more common than gastric ulcers. About 95% of duodenal ulcers are associated with H. pylori infection (2).

What Causes Stomach Ulcers?

Two main factors cause most stomach ulcers. Understanding these causes helps you and your doctor choose the best treatment.

Helicobacter pylori (H. pylori) Infection

H. pylori is a type of bacteria that lives in your stomach. It’s the most common cause of peptic ulcers. About 70% of gastric ulcers and 95% of duodenal ulcers are linked to this infection (2).

The bacteria damage the protective mucus layer in your stomach. This allows stomach acid to create ulcers in the lining. Getting rid of H. pylori can cure your ulcer and prevent it from coming back.

NSAIDs (Nonsteroidal Anti-inflammatory Drugs)

Regular use of NSAIDs like aspirin, ibuprofen, and naproxen is the second most common cause of ulcers. These medications can damage your stomach’s protective lining. The risk increases with:

• Higher doses
• Longer duration of use
• Older age
• Previous ulcer history

A major study found that NSAIDs increase the risk of upper GI bleeding by about 3.8 times (3).

Other Risk Factors

While less common, other factors can contribute to ulcer development:

• Smoking
• Excessive alcohol use
• Severe stress or illness
• Family history of ulcers
• Being over 60 years old

Symptoms of Stomach Ulcers

The most common symptom is a burning pain in your stomach. This pain often:

• Occurs between meals or at night
• Stops briefly when you eat or take antacids
• Lasts for minutes to hours
• Comes and goes for days or weeks

Other symptoms may include:

• Bloating
• Burping
• Nausea or vomiting
• Poor appetite
• Weight loss

How Are Stomach Ulcers Diagnosed?

Your doctor will ask about your symptoms and medical history. They may order tests to confirm the diagnosis.

Tests for H. pylori

Several tests can detect H. pylori infection:

• Breath test
• Stool test
• Blood test
• Biopsy during endoscopy

Endoscopy

This is the most accurate way to diagnose ulcers. A thin tube with a camera is passed down your throat to view your stomach and duodenum. Your doctor can see the ulcer directly and take tissue samples if needed.

Treatment Options for Stomach Ulcers

Treatment depends on what’s causing your ulcer. Most ulcers can be cured with the right medications.

For H. pylori-Related Ulcers

If you have H. pylori, you’ll need combination therapy to kill the bacteria. This usually includes:

• A proton pump inhibitor (PPI) to reduce stomach acid
• Two antibiotics (usually clarithromycin and amoxicillin or metronidazole)
• Sometimes bismuth subsalicylate

This treatment, called triple or quadruple therapy, can cure H. pylori infection in about 70-90% of cases. H. pylori eradication therapy is effective for healing ulcers when combined with ulcer healing drugs (2).

For NSAID-Related Ulcers

If NSAIDs caused your ulcer, treatment includes:

• Stopping or reducing NSAID use if possible
• Taking a PPI or H2 blocker to reduce acid
• Switching to a COX-2 inhibitor if you must continue NSAIDs

PPIs are more effective than H2 blockers for healing NSAID-related ulcers. Omeprazole has been shown to heal about 80% of ulcers in 8 weeks compared to 63% with ranitidine (4).

Acid-Reducing Medications

Several types of medications reduce stomach acid and help ulcers heal:

Proton Pump Inhibitors (PPIs)

PPIs are the most effective acid reducers. They include:

• Omeprazole (Prilosec)
• Lansoprazole (Prevacid)
• Esomeprazole (Nexium)
• Pantoprazole (Protonix)

Research shows PPIs heal ulcers faster than H2 blockers. Omeprazole provides significantly better healing rates for both gastric and duodenal ulcers (5).

H2 Receptor Blockers

These medications also reduce acid but are less potent than PPIs:

• Ranitidine (Zantac)
• Famotidine (Pepcid)
• Cimetidine (Tagamet)

Preventing Stomach Ulcers

You can reduce your risk of developing ulcers by taking these steps.

If You Take NSAIDs

If you need to take NSAIDs regularly:

• Use the lowest effective dose
• Take them with food
• Ask your doctor about protective medications
• Consider alternatives like acetaminophen when possible

Misoprostol can significantly reduce the risk of NSAID-induced ulcers. All doses of misoprostol are effective, though higher doses work better (6). PPIs are also effective and better tolerated than misoprostol.

Lifestyle Changes

These healthy habits can help protect your stomach:

• Don’t smoke
• Limit alcohol
• Manage stress through relaxation techniques
• Eat a healthy diet with plenty of fruits and vegetables

Testing for H. pylori

If you have a family history of ulcers or stomach cancer, ask your doctor about H. pylori testing. Early detection and treatment can prevent ulcers from developing.

Complications of Untreated Ulcers

Without treatment, ulcers can lead to serious complications.

Bleeding

This is the most common complication. About 15-20% of people with ulcers experience bleeding. Signs include:

• Vomiting blood or coffee-ground material
• Black, tarry stools
• Feeling weak or dizzy

Perforation

An ulcer can create a hole in your stomach or intestinal wall. This is a medical emergency requiring immediate surgery. It affects about 2-3% of people with ulcers.

Obstruction

Swelling and scarring from ulcers can block food from passing through your digestive tract. Symptoms include:

• Repeated vomiting
• Feeling full quickly
• Weight loss

Living with Stomach Ulcers

Most people with ulcers recover completely with proper treatment. Here’s what you can expect.

During Treatment

You’ll likely feel better within a few days of starting medication. However, it’s important to:

• Take all prescribed medications, even if you feel better
• Avoid NSAIDs unless approved by your doctor
• Follow up with your doctor as recommended

After Treatment

Once your ulcer heals:

• You may need follow-up testing to confirm H. pylori is gone
• Continue avoiding NSAIDs or use them with protection
• Report any recurring symptoms to your doctor

Research shows that successful H. pylori eradication significantly reduces ulcer recurrence. Eradication therapy is much more effective than no treatment for preventing both duodenal and gastric ulcer recurrence (2).

Myths About Diet and Stomach Ulcers

Many people believe certain foods cause ulcers, but this isn’t true. Research shows there’s no link between specific foods and ulcer formation.

Foods Don’t Cause Ulcers

Coffee is often blamed for causing ulcers, but studies show no association between coffee consumption and either gastric or duodenal ulcers (7).

While spicy foods, citrus fruits, and tomatoes don’t cause ulcers, they may worsen your symptoms if you already have one. If certain foods bother you, avoid them during treatment.

Foods That May Help

While foods don’t cure ulcers, some may support healing:

• Fruit extracts high in flavonoids may have protective effects against NSAID-induced ulcers (8)
• High-fiber foods like fruits, vegetables, and whole grains
• Lean proteins
• Foods rich in vitamins A and C

Natural Remedies and Supplements

Some people try natural remedies alongside medical treatment. Here’s what the research shows.

Probiotics

Probiotics may help improve H. pylori treatment success. Studies show that adding probiotics to standard triple therapy can:

• Increase H. pylori eradication rates from about 86% to 94% when using specific probiotic formulations (9)
• Reduce side effects from antibiotics (10)

Aloe Vera

While aloe vera is sometimes promoted for ulcers, research doesn’t support its use. A study in horses comparing aloe vera to standard ulcer medications found it was much less effective than omeprazole (11).

Special Considerations for Low-Dose Aspirin Users

Many people take low-dose aspirin to prevent heart attacks and strokes. If you’re one of them, you should know about your ulcer risk.

Increased Risk with H. pylori

If you have H. pylori and take low-dose aspirin, your ulcer risk is significantly higher. H. pylori increases the risk of aspirin-related ulcers by almost 70% (12).

Should You Be Tested?

If you take low-dose aspirin regularly, consider asking your doctor about H. pylori testing. Getting rid of the bacteria before starting aspirin may help prevent ulcers.

Prevention Options

If you must continue aspirin, your doctor may recommend:

• Taking a PPI along with your aspirin
• Using the lowest effective dose of aspirin
• Testing and treating for H. pylori if present

When to See Your Doctor

Don’t ignore stomach pain. See your doctor if you have:

• Persistent stomach pain for more than a few days
• Pain that wakes you at night
• Unexplained weight loss
• Difficulty swallowing
• Persistent nausea or vomiting

Remember, stomach ulcers are common and treatable. With the right care, you can heal your ulcer and prevent it from coming back. Work with your healthcare provider to find the best treatment plan for your situation.