Stomach Ulcer: Causes, Symptoms, Diagnosis & Treatment

Prevention

Stomach ulcers can often be prevented. The most effective steps are treating H. pylori infection early, using NSAIDs only when necessary, and avoiding habits — such as smoking and heavy alcohol use — that weaken the stomach's protective lining. A full prevention guide is included at the end of this article.

Overview

What Is a Stomach Ulcer?

A stomach ulcer — medically called a gastric ulcer — is an open sore that develops on the inner lining of the stomach. The stomach lining is normally protected by a thick layer of mucus that shields it from digestive acid. When that mucus layer is damaged or reduced, stomach acid erodes the tissue beneath, creating a painful wound.

Stomach ulcers belong to a broader category called peptic ulcers, which also includes duodenal ulcers (sores in the upper part of the small intestine). The key distinction is location: gastric ulcers form inside the stomach; duodenal ulcers form just beyond it.

According to Mool Health's gastroenterology team, stomach ulcers are one of the most frequently misdiagnosed digestive conditions because their symptoms closely resemble those of acid reflux and indigestion.

How stomach ulcers form — at a glance:

• The stomach produces hydrochloric acid to digest food
• A mucus lining normally prevents acid from contacting stomach tissue
• When the mucus barrier is compromised, acid reaches the stomach wall
• Repeated exposure causes tissue damage, forming an ulcer
• If untreated, the ulcer can deepen and cause serious complications

How common are stomach ulcers?

Stomach ulcers affect approximately 10% of people at some point in their lives [1]. Globally, peptic ulcer disease — which includes stomach and duodenal ulcers — affects an estimated 4 million people each year. In India, H. pylori infection rates, the leading cause of stomach ulcers, can be as high as 70–80% in some populations, making stomach ulcers a significant public health concern [2].

Symptoms and Causes

What Are the Symptoms of Stomach Ulcers?

The most common symptom of a stomach ulcer is a burning or gnawing pain in the upper-middle abdomen, often between the navel and the breastbone. This pain typically occurs when the stomach is empty — such as between meals or during the night — and may temporarily improve after eating or taking antacids.

Common symptoms of stomach ulcers include:

• Burning or dull aching pain in the upper abdomen
• Pain that worsens on an empty stomach and improves after eating
• Nausea or vomiting
• Feeling of fullness, bloating, or belching
• Indigestion (heartburn-like discomfort)
• Loss of appetite
• Unexplained weight loss
• Dark, tarry, or bloody stools (in more serious cases)
• Vomiting blood or material that looks like coffee grounds (requires immediate medical attention)

How Serious Are Stomach Ulcer Complications?

Stomach ulcer complications are uncommon but potentially life-threatening if left untreated. Mool Health's clinical team identifies four major complications associated with untreated or poorly managed stomach ulcers.

1. Bleeding (Haemorrhage)

The most common complication. The ulcer erodes a blood vessel in the stomach wall, causing internal bleeding. Symptoms include black or tarry stools and vomiting blood. Severe bleeding can require hospitalisation and blood transfusion. Bleeding occurs in approximately 15% of peptic ulcer cases [4].

2. Perforation

The ulcer creates a hole through the full thickness of the stomach wall. Stomach contents leak into the abdominal cavity, causing a severe infection called peritonitis. Perforation is a medical emergency requiring urgent surgery. Mortality risk increases significantly with delayed treatment.

3. Obstruction

Swelling or scarring around the ulcer can partially or fully block the passage of food from the stomach to the small intestine. Symptoms include persistent vomiting, inability to eat, and rapid weight loss.

4. Penetration

The ulcer extends through the stomach wall into an adjacent organ, such as the pancreas. This causes intense, persistent pain that may radiate to the back and does not respond to standard antacid treatment.

What Causes Stomach Ulcers?

Stomach ulcers develop when the balance between acid production and mucosal protection is disrupted. There are two primary causes and several contributing factors.

H. pylori Infection

Helicobacter pylori (H. pylori) is a bacterium that infects the stomach lining. It is the leading cause of stomach ulcers worldwide, responsible for approximately 60–70% of gastric ulcer cases [5]. H. pylori works by:

• Producing enzymes that neutralise stomach acid locally, allowing the bacteria to survive
• Releasing toxins that damage the stomach's mucus-producing cells
• Triggering inflammation (gastritis) that weakens the protective mucosal barrier
• Allowing stomach acid to reach and erode the exposed stomach lining

H. pylori infection spreads through contaminated food, water, and close contact with an infected person. It is especially prevalent in areas with poor sanitation. Infection can persist for years without causing symptoms, which is why ulcers may appear to develop "suddenly" in some individuals.

NSAIDs (Non-Steroidal Anti-Inflammatory Drugs)

Regular or long-term use of NSAIDs — including aspirin, ibuprofen, naproxen, and diclofenac — is the second leading cause of stomach ulcers. NSAIDs cause stomach ulcers because they block prostaglandins, chemical compounds the body uses to maintain the stomach's mucus lining. Without adequate prostaglandin activity:

• Mucus production in the stomach decreases
• The stomach lining becomes thinner and more vulnerable to acid
• Ulcers can form even in individuals with no H. pylori infection

Risk is higher with higher doses, longer duration of use, and in individuals over 60 years of age. Taking NSAIDs on an empty stomach further increases ulcer risk.

Other Causes

Less common causes of stomach ulcers include:

• Zollinger-Ellison syndrome: A rare condition where tumours in the pancreas or small intestine produce excessive gastrin, which triggers extremely high acid output in the stomach
• Stress ulcers: Acute ulcers that can develop in critically ill patients — for example, following major surgery, severe burns, or serious illness requiring intensive care
• Other medications: Corticosteroids, anticoagulants (blood thinners), and certain chemotherapy agents can increase ulcer risk, particularly when combined with NSAIDs
• Radiation therapy: Treatment targeting the abdominal region can damage the stomach lining

Does My Lifestyle Encourage Stomach Ulcers?

Lifestyle factors do not directly cause stomach ulcers but can worsen an existing ulcer or slow healing. According to Mool Health, the following lifestyle habits are known to aggravate stomach ulcers:

• Smoking: Reduces prostaglandin production and impairs ulcer healing; smokers have approximately twice the ulcer risk of non-smokers [6]
• Heavy alcohol consumption: Irritates and erodes the stomach lining and increases acid secretion
• High stress: Psychological stress does not directly cause ulcers but can increase acid production and reduce immune defence against H. pylori
• Spicy or acidic foods: Do not cause ulcers directly but can intensify pain and discomfort in individuals who already have an ulcer
• Skipping meals: Allows stomach acid to sit on an empty stomach, which worsens ulcer pain

The previously held belief that stress and diet alone cause stomach ulcers has been largely disproven. The primary drivers remain H. pylori infection and NSAID use.

Diagnosis and Tests

How Is a Stomach Ulcer Diagnosed?

A stomach ulcer is diagnosed based on symptoms, medical history, and confirmatory tests. A doctor will typically ask about the nature, location, and timing of pain; current medications (particularly NSAID use); and any family history of ulcers or stomach cancer.

Because stomach ulcer symptoms overlap with other digestive conditions — including acid reflux, gastritis, and gallstones — confirmatory testing is usually required before treatment begins.

What Tests Are Used to Diagnose Stomach Ulcers?

Endoscopy

Upper gastrointestinal endoscopy (also called gastroscopy or OGD — oesophago-gastro-duodenoscopy) is the gold-standard diagnostic test for stomach ulcers. During this procedure:

1. A thin, flexible tube with a camera (endoscope) is passed through the mouth and down into the stomach
2. The doctor directly visualises the stomach lining and identifies any ulcers, their size, and location
3. A small tissue sample (biopsy) may be taken from the ulcer site to test for H. pylori infection and to rule out stomach cancer
4. The procedure typically takes 15–30 minutes and is performed under mild sedation

Endoscopy is particularly important when symptoms are severe, when red-flag signs are present (such as bleeding, weight loss, or difficulty swallowing), or when the patient is over 55 years of age.

Other Tests

The urea breath test and stool antigen test are the most accurate non-invasive tests for H. pylori infection. Mool Health recommends confirming H. pylori eradication with a follow-up breath or stool test at least 4 weeks after completing antibiotic treatment.

What Other Conditions Could Be Mistaken for a Stomach Ulcer?

Several digestive conditions produce symptoms similar to those of a stomach ulcer. Accurate diagnosis requires testing, not symptom assessment alone.

Conditions commonly mistaken for stomach ulcers:

• Gastro-oesophageal reflux disease (GORD/GERD): Causes burning chest and upper abdominal pain, particularly after eating; often worse lying down
• Gastritis: Inflammation of the stomach lining without a full ulcer; produces similar burning pain and nausea
• Functional dyspepsia: Chronic indigestion without an identifiable structural cause; symptoms closely mirror ulcer pain
• Gallstones (cholelithiasis): Can cause upper right abdominal pain after fatty meals
• Irritable bowel syndrome (IBS): Causes cramping and bloating but is typically associated with bowel habit changes
• Stomach cancer (gastric carcinoma): Early-stage symptoms including pain, nausea, and weight loss can resemble ulcer symptoms; biopsy during endoscopy is essential to rule this out

Management and Treatment

What Is the Fastest Way to Cure a Stomach Ulcer?

The fastest way to heal a stomach ulcer is to address its root cause directly. For H. pylori-related ulcers, this means completing a full course of antibiotic-based eradication therapy (typically 10–14 days). For NSAID-related ulcers, this means stopping or reducing NSAID use and starting acid-suppressing medication. Most stomach ulcers heal within 4–8 weeks of appropriate treatment when the underlying cause is removed.

What Treatment Is Available for Stomach Ulcers?

Stomach ulcer treatment depends on the underlying cause. Mool Health outlines the primary treatment options below.

Medications

1. Proton Pump Inhibitors (PPIs)

PPIs are the cornerstone of stomach ulcer treatment. They work by blocking the enzyme system in stomach cells responsible for producing acid (the proton pump), reducing acid output by up to 90% [7]. Lower acid levels allow the stomach lining to repair itself.

Common PPIs include:

• Omeprazole
• Pantoprazole
• Esomeprazole
• Lansoprazole
• Rabeprazole

PPIs are typically taken once daily, before a meal, for 4–8 weeks. For H. pylori-related ulcers, PPIs are combined with antibiotics.

2. H. pylori Eradication Therapy (Triple or Quadruple Therapy)

For ulcers caused by H. pylori, antibiotic therapy is required to eliminate the bacteria and prevent recurrence. Standard regimens include:

• Triple therapy (7–14 days): A PPI + two antibiotics (typically clarithromycin and amoxicillin, or metronidazole)
• Quadruple therapy (10–14 days): A PPI + bismuth + two antibiotics (used when triple therapy resistance is suspected)

3. H2 Receptor Antagonists (H2 Blockers)

H2 blockers — such as famotidine and ranitidine — reduce acid production by blocking histamine receptors in the stomach. They are less potent than PPIs but may be used as an adjunct or alternative in some patients.

4. Antacids and Sucralfate

Antacids provide short-term symptomatic relief by neutralising stomach acid. Sucralfate forms a protective coating over the ulcer surface, providing a physical barrier against acid. Neither treats the underlying cause but both can reduce discomfort during recovery.

5. Stopping or Switching NSAIDs

For NSAID-related ulcers, the treating doctor will advise stopping the NSAID if clinically possible. If NSAID use must continue (for example, in patients with arthritis or cardiovascular disease), the lowest effective dose should be used alongside a PPI. COX-2 selective inhibitors (such as celecoxib) carry a lower ulcer risk than traditional NSAIDs.

Medical Procedures

Most stomach ulcers heal with medication alone. Medical or surgical intervention is reserved for complications.

Endoscopic Treatment

Bleeding ulcers can often be treated during endoscopy without surgery. Techniques include:

• Injection of adrenaline around the bleeding vessel to constrict it
• Thermal coagulation (heat application) to seal the vessel
• Mechanical clipping of the bleeding vessel

Surgery

Surgical intervention may be required for:

• Perforated ulcers (emergency surgery to close the perforation)
• Ulcers that do not respond to medical treatment (refractory ulcers)
• Gastric outlet obstruction not resolved with endoscopic balloon dilation

Surgical options have become significantly less common since the introduction of PPIs and H. pylori eradication therapy. According to published data, surgical rates for peptic ulcer disease have declined by more than 80% since the 1980s [8].

Outlook / Prognosis

How Long Does It Take for a Stomach Ulcer to Heal?

Healing time for a stomach ulcer depends on its size, cause, and whether treatment is started promptly.