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Overview

What Is an Ulcer?

An ulcer is an open sore in the lining of the stomach or the upper part of the small intestine. A gastric ulcer develops in the stomach, while a duodenal ulcer develops in the first part of the small intestine. Adults are commonly affected, but peptic ulcers can occur at different ages. The term ulcer usually refers to a break in the lining that has not healed normally.

Symptoms

Ulcer Symptoms

  • Upper abdominal burning or aching pain
  • Indigestion (dyspepsia)
  • Bloating
  • Nausea
  • Vomiting
  • Feeling full soon after starting a meal (early satiety)
  • Unintentional weight loss

Warning signs

Get urgent help for bleeding

Black or tarry stools, vomiting blood or material that looks like coffee grounds, fainting, or sudden severe abdominal pain may indicate bleeding or a perforation. Seek urgent medical attention rather than waiting for these ulcer symptoms to improve.

Causes

What Causes Stomach Ulcers?

H. pylori infection

Helicobacter pylori, often called H. pylori, is a bacterium that can weaken the protective mucus lining of the stomach and duodenum. This allows stomach acid to irritate the tissue and promotes inflammation, which can contribute to peptic ulcer disease.

Regular or high-dose use of nonsteroidal anti-inflammatory drugs (NSAIDs), including ibuprofen, naproxen, and aspirin, can reduce substances that protect the stomach lining and may directly injure it. Less common contributors include excess acid production, severe physical stress, smoking, and rare conditions that cause unusually high stomach acid. Spicy foods and ordinary daily stress do not usually cause an ulcer by themselves, although they may worsen symptoms for some people.

Risk Factors

Risk Factors for Ulcers

Risk-factor typeExamples
ModifiableH. pylori exposure or infection; regular NSAID or aspirin use; smoking; heavy alcohol use
Non-modifiable or difficult to changeOlder age; a previous ulcer; a family or personal history of ulcer complications

Using more than one ulcer-promoting medicine or having several risk factors can increase the chance of developing ulcers. If you take NSAIDs long term, review their need and possible alternatives with a clinician rather than stopping a prescribed medicine on your own.

Complications

Ulcer Complications

  • Gastrointestinal bleeding
  • Perforation, or a hole through the stomach or intestinal wall
  • Penetration into a nearby organ
  • Gastric outlet obstruction that interferes with food leaving the stomach
  • Anemia caused by ongoing or hidden blood loss
  • Recurrence of the ulcer

Medical emergency

Serious complications

Vomiting blood, black stools, severe sudden abdominal pain, persistent vomiting, marked weakness, or fainting can signal bleeding, perforation, or obstruction. These symptoms require immediate medical assessment.

Diagnosis

How Ulcers Are Diagnosed

Diagnosis begins with a review of symptoms, a physical examination, and questions about NSAID or aspirin use. A clinician may also assess for signs of bleeding or anemia and decide whether testing for H. pylori or a direct examination of the stomach and duodenum is needed.

  • A breath test or stool test can look for H. pylori infection.
  • Blood or stool tests can help identify anemia or hidden bleeding.
  • Upper endoscopy uses a flexible camera to examine the esophagus, stomach, and duodenum.
  • Imaging or a biopsy may be recommended when clinically indicated.

Treatment & Management

Ulcer Treatment and Management

TREAT THE CAUSE

H. pylori ulcers are treated with a combination of antibiotics and acid suppression. For NSAID-related ulcers, a clinician may review or change the medicine and prescribe treatment to reduce acid and support healing.

PROTECT THE LINING

Proton pump inhibitors, H2 blockers, and other protective medicines may reduce acid and help the ulcer heal. Symptom relief should be guided by a clinician, along with avoiding medicines or triggers that worsen irritation.

Treatment may include a proton pump inhibitor, an H2 blocker, a protective medicine, or antibiotics for H. pylori. Follow-up testing may be needed to confirm that the infection has cleared. Do not rely on over-the-counter products such as Pepcid for persistent ulcer symptoms without an evaluation, because ongoing pain or bleeding needs medical assessment.

Prevention

Can Ulcers Be Prevented?

  • Use NSAIDs only as directed.
  • Ask about stomach protection if long-term NSAID treatment is necessary.
  • Do not smoke.
  • Limit alcohol.
  • Take H. pylori treatment exactly as prescribed.
  • Do not share or reuse antibiotics.

There is no routine screening test for ulcers in people who have no symptoms. However, people with recurring symptoms or high-risk medicine use should discuss prevention and safer treatment options with a clinician.

Outlook and Prognosis

Ulcer Outlook and Prognosis

Most uncomplicated ulcers heal with appropriate treatment, but healing time varies. The cause and size of the ulcer, ongoing NSAID use, H. pylori status, smoking, and any complications can all affect recovery and the risk of recurrence.

When Should You See a Doctor

When Should You See a Doctor for an Ulcer?

  • Recurring upper abdominal pain
  • Persistent indigestion
  • Unexplained nausea or vomiting
  • Unintentional weight loss
  • Symptoms that begin after starting NSAIDs
  • A personal history of ulcers

Seek emergency care

Emergency warning signs

Call emergency services for vomiting blood, black or bloody stools, sudden severe abdominal pain, fainting, confusion, or signs of shock. These symptoms may indicate serious bleeding or a perforated ulcer and should not wait for a routine appointment.

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