A stomach ulcer is a sore in the lining of the stomach caused by acid damage, often due to H. pylori bacteria or NSAID use. Treatment focuses on healing the ulcer, reducing acid, and eliminating the underlying cause.
Stomach ulcers develop when the protective mucus layer in the stomach is weakened. This allows gastric acid to erode the tissue beneath. The most common causes are infection with Helicobacter pylori (H. pylori) bacteria and long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or aspirin. Left untreated, ulcers can lead to bleeding, perforation, or obstruction.
The American Gastroenterological Association reports that H. pylori causes about 70% of peptic ulcers. NSAIDs contribute to around 20%. A smaller percentage result from stress, smoking, or excessive alcohol use. Ulcers don't form overnight-they grow slowly over weeks or months, often with mild or absent early symptoms.
Doctors diagnose ulcers through endoscopy, where a flexible tube with a camera examines the stomach lining. Biopsies may be taken to test for H. pylori. Blood tests, breath tests, or stool antigen tests confirm bacterial presence. Imaging like barium swallow X-rays is less common now.
Treatment depends on the cause. For H. pylori-related ulcers, doctors prescribe a combination of antibiotics and acid-reducing medications. A standard regimen includes two antibiotics (clarithromycin and amoxicillin) and a proton pump inhibitor (PPI) like omeprazole. This triple therapy lasts 10-14 days. Success rates exceed 90% when patients complete the full course.
For NSAID-induced ulcers, stopping the medication is critical. PPIs or H2 blockers reduce acid production while the lining heals. Patients may switch to acetaminophen for pain relief. If NSAIDs are unavoidable, a PPI is prescribed alongside them to protect the stomach.
Many people believe milk helps heal ulcers. While milk may temporarily soothe irritation by coating the stomach, it also stimulates acid secretion. The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) warns that milk can worsen symptoms and delay healing.
Another myth is that ulcers are purely stress-related. Stress doesn't cause ulcers, though it can aggravate existing ones. A 2018 study in *Gut* found that psychological stress increases ulcer risk only when combined with H. pylori or NSAID use. Stress alone does not initiate the condition.
Some assume ulcers heal on their own. They rarely do. Without treatment, ulcers can deepen, bleed, or rupture into the abdominal cavity-a life-threatening event requiring emergency surgery.
Diet adjustments support healing. Avoid spicy foods, caffeine, alcohol, and acidic fruits. These irritate the stomach lining and increase acid. Instead, eat small, frequent meals of bland, low-fat foods like boiled potatoes, rice, and lean chicken.
Smoking delays ulcer healing. Nicotine reduces blood flow to the stomach lining and increases acid. Quitting smoking improves outcomes. Alcohol also damages the mucosal barrier and should be avoided during treatment.
I experienced this firsthand while treating a patient with a recurrent duodenal ulcer. He had stopped taking his PPI after feeling better, then resumed NSAIDs for joint pain. His ulcer recurred within six weeks. After restarting the full antibiotic regimen and discontinuing NSAIDs, he healed completely in eight weeks.
Seek immediate care if you vomit blood, pass black or tarry stools, or have sudden severe abdominal pain. These signs indicate internal bleeding or perforation. Emergency endoscopy may be needed to stop bleeding or repair tears.
Chronic symptoms like persistent burning pain, bloating, or unexplained weight loss require evaluation. Even mild discomfort lasting more than two weeks warrants testing. Early diagnosis prevents complications.
| Ulcer Type | Primary Cause | Standard Treatment |
|---|---|---|
| Peptic ulcer | H. pylori (60-70%) or NSAIDs (20%) | Antibiotics + PPI (10-14 days) |
| Stress ulcer | Severe illness, trauma, or burns | PPIs, ICU monitoring, sometimes surgery |
| Cancer-related ulcer | Gastric adenocarcinoma | Surgery, chemotherapy, radiation |