Could you have an ulcer and not know it?

Peptic ulcers are sores that develop in the lining of your stomach or small intestine. More than 3 million people in the United States—about 1 percent of the population—are affected, according to a 2024 review in JAMA. Despite their prevalence, the symptoms of these ulcers can frequently be mistaken for other conditions, such as heartburn. Some people may not show any signs at all.

If you’re concerned that your stomach pain could be something more serious, learn about the causes, treatment, and prevention methods for peptic ulcers.

Understanding ulcers

Peptic ulcers occur when acids that help digest food damage the lining of your organs. If this occurs in the stomach, it’s called a stomach ulcer or gastric ulcer. If it occurs in the small intestine, it’s called a duodenal ulcer. Normally a thick layer of mucus protects this lining from the effects of digestive juices, but many things can reduce this layer.

The most common cause of peptic ulcers is a bacterial infection with Helicobacter pylori (H. pylori). As much as half the world’s population is infected with H. pylori, but for most people, it causes no symptoms. In a small subset of people, however, it can result in inflammation in the stomach lining. Over time this can lead to complications like peptic ulcers.

A second cause is the overuse of nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen. Taking these pain relievers for the occasional headache or bout of arthritis won’t cause a peptic ulcer, but the risk increases for people who take them frequently.

“NSAIDs can cause ulcers by reducing the ability of your stomach lining to protect itself from gastric acids,” explains Akiva J. Marcus, MD, PhD, a gastroenterologist in West Palm Beach, Florida.

There is some evidence that stress, anxiety, or depression can contribute to the development of ulcers, worsen existing ulcers, or impair healing. The relationship between stress and ulcers isn’t completely clear, however, and more research is needed on the topic.

What about food? Despite what you might have heard, there are no convincing data that specific foods, beverages, or spices cause peptic ulcers. Smoking and drinking alcohol can increase your risk of developing peptic ulcers, especially among people who take NSAIDs or have H. pylori. These habits may also worsen existing ulcers or prevent healing.

Symptoms of peptic ulcers

Nearly three-quarters of people with peptic ulcers don't have symptoms. They only become aware of their condition when complications arise or when the ulcer worsens. Older adults and those who take NSAIDs are more likely to have no symptoms but may later develop ulcer complications.

For those who do experience symptoms, gastric ulcers can cause burning or dull pain in the stomach or upper abdomen. It can also present as a gnawing pain when your stomach is empty. Other symptoms include:

• Feeling full after eating
• Bloating
• Belching
• Nausea or vomiting
• Heartburn
• Having a poor appetite
• Unexplained weight loss

“Generally, stomach ulcers will get worse after eating when digestive acids are secreted,” explains Dr. Marcus.

Duodenal ulcers, on the other hand, often get better after eating. That’s because eating stimulates the release of bicarbonate in the small bowel, where duodenal ulcers are located. This neutralizes stomach acid. Pain may then occur two to five hours after eating, especially after dinner when there are hours before the next meal.

With either type of ulcer, symptoms can last for minutes to hours. They often come and go for several days or weeks.

In severe cases, ulcers may bleed or extend deep into the wall of the stomach or intestine. They can also cause a perforation, a hole or puncture in the stomach or duodenum, which may occur without bleeding. A perforation or bleeding ulcer can be a life-threatening emergency. If you experience any of the following symptoms, get medical help immediately:

• Blood in stool or vomit
• Black stools
• Sudden, sharp abdominal pain
• A hardened abdomen
• Rapid heartbeat
• Pain in one or both shoulders

Peptic ulcers will get worse if they’re not treated, so contact your healthcare provider (HCP) if you have any symptoms or worrisome signs. “Unfortunately, a lot of the time, the way people find out they have an ulcer is by developing bleeds,” says Marcus. “They’re taking a lot of aspirin or NSAIDs and they either start vomiting blood or have black, tarry stool.”

Your HCP may be able to diagnose a peptic ulcer by talking with you about your symptoms. Be sure to mention whether you take NSAIDs.

Some tests may be required to confirm a diagnosis. For example, to see if you have an H. pylori infection, your HCP will test your breath or stool. They may also look inside your stomach and duodenum with an endoscopy or X-ray. An endoscopy is a procedure during which a thin, lighted tube will be inserted through your throat and into the stomach to check for abnormalities.

Peptic ulcer treatment

If you test positive for H. pylori, treatment to clear the bacteria includes a minimum of two antibiotics and acid-suppression medication.

But once it’s found, H. pylori needs to be wiped out. Besides causing ulcers, the bacteria can lead to stomach cancer in some people. Your HCP may also recommend taking medications such as a protein pump inhibitor or a histamine receptor blocker to suppress the acid in your stomach.

“You’re attacking it from two different directions,” explains Marcus. “By stopping the irritant and reducing the acid, you give the ulcer the chance to heal.”

Ulcers caused by taking NSAIDs or other medication should begin healing almost immediately after you stop taking the drug.

Don’t be fooled if you start feeling better without treatment. An ulcer may temporarily heal without antibiotics, but if the bacteria aren’t killed, the condition may recur—or another ulcer may form nearby. Follow your provider’s recommendations for finding the treatment that would work best for you.

Preventing peptic ulcers

There are some steps you can take to help avoid getting an ulcer:

Avoid overusing NSAIDs

If you’re concerned about how the use of NSAIDs will affect your digestive system, speak to your HCP. To help reduce irritation, you may be advised to take these drugs at the end of a full meal or with an antacid. Another option is to switch to acetaminophen (Tylenol), which doesn’t increase the risk of ulcers and is often just as effective for pain relief. That said, do not begin taking acetaminophen unless given the okay by your HCP.

If you smoke, take steps to quit

Studies suggest that smoking increases the risk of H. pylori infection, slows the healing of peptic ulcers, and increases the chances that peptic ulcers will recur. So if you smoke, there’s no better time to break the habit.

Drink moderately or avoid alcohol entirely

“Alcohol is a direct irritant to the GI tract,” says Marcus. If you drink, limit your intake as much as possible. If you don’t drink, don’t start.

For additional preventive measures that work with your lifestyle and health status, speak with your HCP.