Peptic Ulcer Disease: Causes, Symptoms, Treatment and Warning Signs

A peptic ulcer is an open sore that develops in the lining of the stomach or the first part of the small intestine, called the duodenum.

When an ulcer develops in the stomach, it is called a gastric ulcer or stomach ulcer.

When it develops in the duodenum, it is called a duodenal ulcer.

Together, these conditions are known as peptic ulcer disease.

Peptic ulcers can usually be treated successfully, particularly when the underlying cause is identified and treated.

However, an untreated ulcer can sometimes lead to serious complications such as internal bleeding or perforation.

Is a Stomach Ulcer an Infection?

Not exactly.

The old version of this article described a stomach ulcer as an infection caused by Helicobacter pylori.

That is inaccurate.

A peptic ulcer is a sore in the lining of the stomach or duodenum.

However, infection with the bacterium Helicobacter pylori (H. pylori) is one of the two major causes of peptic ulcers.

The other major cause is the use of nonsteroidal anti-inflammatory drugs (NSAIDs).

What Is H. pylori?

Helicobacter pylori is a bacterium that can infect the stomach.

Many people infected with H. pylori never develop symptoms or ulcers.

However, in some people the infection causes chronic inflammation of the stomach lining and contributes to the development of peptic ulcers.

Long-term H. pylori infection is also associated with an increased risk of certain types of stomach cancer.

For this reason, identifying and appropriately treating H. pylori infection is important.

What Causes Peptic Ulcers?

The two most common causes are:

1. H. pylori Infection

H. pylori can damage the protective environment of the stomach and duodenum and contribute to ulcer formation.

If an H. pylori infection is responsible for an ulcer, treating the infection helps the ulcer heal and reduces the likelihood that it will return.

2. NSAID Medicines

NSAIDs are widely used pain-relieving and anti-inflammatory medicines.

Examples include:

• aspirin,
• ibuprofen,
• and naproxen.

These medicines can interfere with protective mechanisms in the stomach and duodenum, increasing the risk of ulcer formation and gastrointestinal bleeding.

The risk can be greater with:

• prolonged NSAID use,
• higher doses,
• using more than one NSAID,
• older age,
• a previous ulcer,
• H. pylori infection,
• and certain other medicines.

Should You Stop Taking NSAIDs?

Do not automatically stop a prescribed medicine because you have read that NSAIDs can cause ulcers.

If you regularly take aspirin or another NSAID and have been diagnosed with an ulcer—or believe you may have one—discuss the medication with your healthcare professional.

Depending on your circumstances, they may recommend:

• stopping the NSAID,
• reducing the dose,
• changing medication,
• shortening treatment,
• or adding a medicine that protects the stomach.

People taking aspirin for cardiovascular protection should be particularly careful about stopping it without medical advice.

Do Spicy Foods Cause Stomach Ulcers?

No good evidence shows that spicy food is a major cause of peptic ulcers.

This corrects an important misconception in the old article.

Likewise, acidic foods are not considered one of the main causes of peptic ulcer disease.

However, certain foods or drinks may worsen pain, indigestion or other symptoms in individual people.

If a particular food consistently makes you uncomfortable, you can reduce or avoid it for symptom control.

But eliminating spicy food will not eradicate H. pylori or heal an NSAID-induced ulcer.

Does Stress Cause Peptic Ulcers?

Ordinary day-to-day psychological stress is not considered one of the two main causes of peptic ulcers.

The major causes remain:

• H. pylori infection,
• and NSAID use.

However, severe physical illness—such as critical illness, major burns, severe injury or sepsis—can cause stress-related damage to the stomach lining in hospitalized patients.

This is different from saying that everyday worries directly cause ordinary peptic ulcer disease.

Does Smoking Affect Peptic Ulcers?

Smoking can increase the risk of peptic ulcers and interfere with ulcer healing.

If you smoke, quitting is beneficial not only for digestive health but also for your:

• heart,
• lungs,
• blood vessels,
• and overall health.

Smoking cessation should therefore form part of an overall health plan.

What About Alcohol?

Heavy alcohol consumption can irritate and damage the stomach lining and contribute to gastritis or gastropathy.

Alcohol is not regarded as one of the two principal causes of ordinary peptic ulcers in the way H. pylori and NSAIDs are.

However, heavy drinking can aggravate gastrointestinal problems and may increase other health risks.

Rare Causes of Peptic Ulcers

H. pylori and NSAIDs account for most cases, but other causes exist.

One rare example is Zollinger-Ellison syndrome.

In this condition, one or more tumours called gastrinomas cause the stomach to produce excessive amounts of acid.

Other uncommon causes can include:

• certain infections,
• Crohn's disease affecting the upper digestive tract,
• some medications,
• severe illness,
• and other uncommon medical conditions.

If an ulcer repeatedly returns despite appropriate treatment, further investigation may be necessary.

What Are the Symptoms of a Peptic Ulcer?

The most common symptom is pain or discomfort in the upper abdomen.

The pain may feel:

• burning,
• dull,
• aching,
• or gnawing.

It may come and go.

Other possible symptoms include:

• feeling full too quickly while eating,
• feeling uncomfortably full after a meal,
• bloating,
• belching,
• nausea,
• and vomiting.

Not everyone experiences the same symptoms.

Can Eating Make Ulcer Pain Better or Worse?

Yes.

The relationship between food and ulcer pain varies.

For some people, pain occurs when the stomach is empty or during the night and temporarily improves after eating.

For others, eating may make the discomfort worse.

This is one reason symptoms alone cannot reliably determine whether someone has an ulcer or where it is located.

Can You Have an Ulcer Without Symptoms?

Yes.

Some people with peptic ulcers experience few or no obvious symptoms.

Occasionally, the first noticeable problem occurs when the ulcer develops a complication such as bleeding.

This is particularly important in people at higher risk, including some older adults and people taking NSAIDs.

Is Heartburn a Symptom of an Ulcer?

Heartburn and peptic-ulcer pain can sometimes be confused, but they are not the same condition.

Heartburn is commonly associated with gastro-oesophageal reflux, where stomach contents move upward into the oesophagus.

Peptic ulcers develop in the stomach or duodenum.

Someone with persistent upper-abdominal or chest discomfort should not assume they have an ulcer based on symptoms alone.

How Is a Peptic Ulcer Diagnosed?

Diagnosis begins with your symptoms, medical history and medication history.

A healthcare professional may ask whether you use:

• aspirin,
• ibuprofen,
• naproxen,
• other NSAIDs,
• blood-thinning medicines,
• or other medications.

Tests may then be recommended.

Testing for H. pylori

Several tests can be used to detect H. pylori.

These include:

Urea Breath Test

You swallow a specially prepared substance containing urea.

If H. pylori is present, the bacteria break down the urea, producing substances that can be detected in your breath.

Stool Test

A stool sample can be tested for evidence of H. pylori infection.

Endoscopy and Biopsy

During an upper gastrointestinal endoscopy, a thin flexible tube containing a camera is passed through the mouth into the upper digestive tract.

This allows a healthcare professional to examine the:

• oesophagus,
• stomach,
• and duodenum.

Small tissue samples called biopsies can also be taken when appropriate.

When Might You Need an Endoscopy?

An endoscopy may be recommended depending on factors such as:

• age,
• symptoms,
• bleeding,
• anaemia,
• unexplained weight loss,
• persistent vomiting,
• difficulty swallowing,
• recurrent symptoms,
• medication use,
• or concern about another condition.

Recommendations differ between countries and depend on individual circumstances.

How Are Peptic Ulcers Treated?

Treatment has two main goals:

1. Heal the ulcer.

2. Treat or remove the underlying cause.

Simply reducing the pain without addressing the cause can allow the ulcer to return.

Proton Pump Inhibitors

Medicines called proton pump inhibitors (PPIs) reduce stomach-acid production.

Examples include medicines such as:

• omeprazole,
• lansoprazole,
• pantoprazole,
• esomeprazole,
• and others.

The exact medicine, dose and treatment duration depend on the patient's circumstances.

Reducing acid gives the damaged tissue an opportunity to heal.

H2-Receptor Blockers

Another group of acid-reducing medicines is known as H2-receptor blockers.

These may be used in certain circumstances.

Your healthcare professional will determine which treatment is appropriate.

How Is H. pylori Treated?

H. pylori infection generally requires a combination of medicines.

Treatment commonly includes:

• acid-suppressing medication,
• multiple antibiotics,
• and sometimes bismuth.

The exact combination depends on factors such as:

• local antibiotic resistance,
• previous antibiotic exposure,
• allergies,
• and national treatment guidelines.

Because antibiotic resistance has become an important global problem, the exact antibiotic regimen should not be selected casually.

Don't Treat H. pylori Yourself With Leftover Antibiotics

Do not attempt to treat suspected H. pylori using leftover antibiotics.

The wrong antibiotics or an incomplete course may:

• fail to eradicate the infection,
• contribute to antibiotic resistance,
• and make future treatment more difficult.

Take prescribed treatment exactly as instructed.

Finish Your H. pylori Treatment

Completing the entire prescribed course is important even if your symptoms improve before the medicines are finished.

Feeling better does not necessarily mean the bacteria have been eradicated.

Stopping treatment early may result in treatment failure.

Should You Be Tested Again After H. pylori Treatment?

Yes, confirming that H. pylori has been eradicated is important.

Current clinical guidance recommends a test of cure after treatment.

Testing is generally performed at least four weeks after antibiotic treatment has been completed.

Certain medicines, particularly proton pump inhibitors, can affect test accuracy, so your healthcare professional will tell you whether and when they need to be temporarily stopped before testing.

Do not stop prescribed medication without appropriate instructions.

Can an Ulcer Come Back?

Yes.

An ulcer can recur if its underlying cause remains.

Examples include:

• persistent H. pylori infection,
• continued high-risk NSAID use,
• smoking,
• or another untreated cause.

Treating the underlying problem reduces the chance of recurrence.

Is There a Special Ulcer Diet?

There is no universally recommended special diet that cures peptic ulcers.

Research has not established that a particular diet plays a major role in causing, preventing or treating ordinary peptic ulcer disease.

This means people with ulcers generally do not need to live on bland foods unless particular foods worsen their symptoms.

A varied, balanced diet is usually appropriate.

What Foods Should You Avoid?

There is no universal list.

Instead, pay attention to your individual symptoms.

If a food consistently causes pain or indigestion, reducing it may make you more comfortable while receiving appropriate medical treatment.

Common individual triggers can include:

• spicy foods,
• very fatty meals,
• alcohol,
• coffee or other caffeinated drinks,
• and acidic foods.

But these foods should not be blamed as the underlying cause of every ulcer.

Do You Need to Eat at Fixed Times to Heal an Ulcer?

There is no strong evidence that simply eating at fixed times or never skipping a meal will cure a peptic ulcer.

Regular nutritious meals may help some people manage symptoms and maintain good nutrition, but they do not replace appropriate treatment for H. pylori or NSAID-associated ulcers.

Can Milk Heal an Ulcer?

Milk is not a treatment for peptic ulcer disease.

It may temporarily soothe discomfort for some people, but it does not eradicate H. pylori or correct NSAID-related injury.

Do not rely on milk instead of appropriate medical treatment.

Can Herbal Remedies Cure an Ulcer?

Be cautious about products claiming to “cure ulcers naturally.”

Herbal preparations and supplements may:

• lack reliable evidence,
• interact with medicines,
• cause side effects,
• or delay effective treatment.

H. pylori requires appropriate medical treatment when eradication is indicated.

Discuss supplements and herbal products with a qualified healthcare professional.

Can Antacids Cure an Ulcer?

Antacids can temporarily neutralize stomach acid and may relieve some symptoms.

However, symptom relief is not the same as curing the underlying cause.

An antacid does not eradicate H. pylori.

Persistent symptoms therefore require proper assessment.

What Complications Can Peptic Ulcers Cause?

Although many ulcers heal successfully with treatment, complications can occur.

These include:

Gastrointestinal Bleeding

An ulcer can damage a blood vessel and cause bleeding.

Slow bleeding may contribute to iron-deficiency anaemia.

More severe bleeding can become life-threatening.

Perforation

An ulcer can create a hole through the wall of the stomach or duodenum.

This is called a perforation.

Stomach or intestinal contents can then leak into the abdominal cavity, causing serious inflammation and infection.

This is a medical emergency.

Penetration

An ulcer may extend through the stomach or duodenal wall and affect a nearby organ.

Gastric Outlet Obstruction

Inflammation or scarring can sometimes obstruct the passage of food from the stomach into the duodenum.

Symptoms may include:

• persistent vomiting,
• abdominal fullness,
• and difficulty eating.

What Does a Bleeding Ulcer Look Like?

Warning signs of gastrointestinal bleeding include:

• vomiting red blood,
• vomit resembling coffee grounds,
• black, sticky or tar-like stools,
• red or maroon blood in stool,
• dizziness,
• fainting,
• weakness,
• or a rapid pulse.

These symptoms require prompt medical attention.

When Is a Peptic Ulcer an Emergency?

Seek urgent medical care if you develop:

• vomiting blood,
• coffee-ground-like vomit,
• black or tarry stools,
• significant blood in the stool,
• sudden severe abdominal pain that does not go away,
• a rigid or extremely tender abdomen,
• fainting,
• severe dizziness,
• confusion,
• rapid heartbeat with weakness,
• or other signs of shock.

Contact your local emergency medical service if the situation appears life-threatening.

Do not attempt to treat suspected internal bleeding at home.

When Should You Arrange a Medical Appointment?

Seek medical assessment if you have persistent or recurrent:

• upper-abdominal pain,
• indigestion,
• nausea,
• vomiting,
• early fullness,
• unexplained loss of appetite,
• unexplained weight loss,
• or symptoms associated with NSAID use.

You should also seek medical advice if previously diagnosed ulcer symptoms return after treatment.

What About Unexplained Weight Loss?

Unintentional weight loss should not simply be attributed to an ulcer without assessment.

Many different medical conditions can cause weight loss.

Persistent digestive symptoms combined with unexplained weight loss require proper investigation.

H. pylori and Stomach Cancer

Most people infected with H. pylori will not develop stomach cancer.

However, long-term H. pylori infection is an established risk factor for certain forms of gastric cancer.

H. pylori can cause chronic inflammation of the stomach lining, and over many years this may contribute to changes associated with cancer development in some individuals.

This is another reason appropriate diagnosis and treatment of H. pylori are important.

Peptic Ulcer vs Gastritis

These terms are sometimes confused.

Gastritis refers to inflammation of the stomach lining.

A peptic ulcer is a deeper open sore in the lining of the stomach or duodenum.

H. pylori and NSAIDs can contribute to both conditions, but gastritis and peptic ulcer disease are not identical.

Peptic Ulcer vs Mouth Ulcer

A mouth ulcer is also completely different from a peptic ulcer.

Mouth ulcers develop on tissues inside the mouth.

Peptic ulcers occur in the stomach or duodenum.

The fact that both conditions contain the word “ulcer” does not mean they have the same causes or treatment.

How Can You Reduce Your Risk?

Not every peptic ulcer can be prevented, but several steps may lower risk.

These include:

• avoiding unnecessary NSAID use,
• using NSAIDs at the lowest appropriate dose and duration when medically suitable,
• discussing stomach protection with a healthcare professional if you require long-term NSAIDs,
• getting appropriately tested and treated for H. pylori when indicated,
• completing prescribed H. pylori treatment,
• confirming eradication after treatment,
• and stopping smoking.

People with a history of ulcers should tell healthcare professionals before starting NSAIDs or medicines that increase bleeding risk.

Don't Ignore Recurrent Symptoms

A peptic ulcer that repeatedly returns despite treatment needs further investigation.

A healthcare professional may reconsider:

• whether H. pylori was successfully eradicated,
• whether NSAIDs are still being used,
• medication adherence,
• smoking,
• another underlying condition,
• or whether the diagnosis itself needs reassessment.

An endoscopy and biopsy may sometimes be appropriate.

The Bottom Line

A stomach or duodenal ulcer is not simply caused by eating spicy food, acidic food or missing meals.

The two major causes of peptic ulcer disease are:

H. pylori infection

and

NSAID medicines such as aspirin, ibuprofen and naproxen.

Modern treatment focuses on identifying the cause, reducing stomach acid so the ulcer can heal, eradicating H. pylori when present, and managing NSAID use appropriately.

There is no special food that reliably cures an ulcer.

Most ulcers can be successfully treated, but complications such as internal bleeding and perforation can be life-threatening.

Remember the major emergency warning signs:

Vomiting blood.

Black, tarry stools.

Sudden severe abdominal pain.

Fainting or signs of significant blood loss.

These symptoms require urgent medical attention.

Medical Disclaimer

This article provides general health information for an international audience and is not a substitute for diagnosis or treatment by a qualified healthcare professional. Peptic-ulcer testing and treatment—including H. pylori antibiotic regimens—can differ between countries and individuals because of factors such as antibiotic resistance, allergies, other medicines and medical history. Do not start or stop prescribed medicines based solely on this article. Seek urgent medical care for signs of gastrointestinal bleeding, severe abdominal pain, fainting or other potentially serious symptoms.

Sources and Further Reading

National Institute of Diabetes and Digestive and Kidney Diseases — Peptic Ulcers

https://www.niddk.nih.gov/health-information/digestive-diseases/peptic-ulcers-stomach-ulcers

NIDDK — Symptoms & Causes of Peptic Ulcers

https://www.niddk.nih.gov/health-information/digestive-diseases/peptic-ulcers-stomach-ulcers/symptoms-causes

NIDDK — Diagnosis of Peptic Ulcers

https://www.niddk.nih.gov/health-information/digestive-diseases/peptic-ulcers-stomach-ulcers/diagnosis

NIDDK — Treatment for Peptic Ulcers

https://www.niddk.nih.gov/health-information/digestive-diseases/peptic-ulcers-stomach-ulcers/treatment

NIDDK — Eating, Diet & Nutrition for Peptic Ulcers

https://www.niddk.nih.gov/health-information/digestive-diseases/peptic-ulcers-stomach-ulcers/eating-diet-nutrition

American College of Gastroenterology — H. pylori Treatment Guideline

https://gi.org/journals-publications/ebgi/schoenfeld_sep2024/

International Agency for Research on Cancer — Stomach Cancer

https://www.iarc.who.int/cancer-type/stomach-cancer/