Stomach Ulcers: Symptoms, Causes, Treatments, and Natural Approaches

Stomach ulcers can cause a different kind of pain than a regular stomachache.

Stomach ulcers can cause burning pain and discomfort, often made worse by stress or certain foods. The Epoch Times/Shutterstock

Stomach ulcers can cause burning pain and discomfort, often made worse by stress or certain foods. The Epoch Times/Shutterstock

Stomach ulcers are open sores that form on the lining of the stomach when the protective mucus layer is weakened or damaged.

4 million Americans develop stomach ulcers each year. Normally, the stomach produces strong acids to aid digestion and kill harmful bacteria. However, when this mucus barrier breaks down, stomach acid can erode the lining and lead to ulcers.

Stomach ulcers can cause dull pain, which is different from an ordinary stomachache. However, some ulcers cause no symptoms—so it’s important to watch for other signs. Certain foods and diets can help ease the condition.

Stomach ulcers form when acid breaks through the protective lining, damaging the stomach wall. The Epoch Times/Shutterstock

What Are the Symptoms of Stomach Ulcers?

Stomach ulcers typically measure between one-quarter and one-half inch in diameter. The most distinctive—and often most uncomfortable—symptom is the pain: a persistent, gnawing discomfort that can feel like a slow burn in your upper abdomen, right below the breastbone. This pain isn’t your average stomachache. It can be surprisingly mobile, sometimes spreading to your neck, belly button, or back, and may leave you feeling truly miserable.

The pain might begin a few hours after eating, worsen before meals, or even intensify after you’ve eaten. For some people, the pain is so disruptive that it can actually wake them up at night.

Common symptoms include:

• Pain
• Indigestion
• Nausea
• Loss of appetite
• Heartburn
• Early satiety

Early satiety is a peculiar symptom—you might sit down to eat and feel uncomfortably full after just a few bites.

In about two-thirds of cases, stomach ulcers do not cause noticeable symptoms. In such instances, they are often detected only when a complication arises, such as bleeding from the ulcer, which can be life-threatening. Severe cases may involve:

• Anemia: Bleeding from an ulcer can range from slow and unnoticed to severe and dangerous. Slowly bleeding ulcers may not show symptoms until anemia develops. When the blood lacks sufficient oxygen-carrying capacity, anemia can cause light-headedness, fatigue, pale skin, and shortness of breath.
• Dark, sticky, or tarry stools: Stools that look dark, sticky, or tarry may signal the presence of old blood in the digestive tract.
• Bloody or coffee ground-like vomit: Vomit that appears bloody or resembles coffee grounds is a sign of internal bleeding in the stomach.
• Shock from blood loss: Severe blood loss can lead to shock, which may cause rapid heartbeat, low blood pressure, confusion, and fainting.

Anyone experiencing these symptoms should seek immediate medical attention.

What Causes Stomach Ulcers?

Your stomach is like a high-tech processing plant. It takes in food, breaks it down with powerful digestive juices, and protects itself with a special mucus lining. Sometimes, this delicate system can be disrupted when an imbalance between the stomach’s protective mechanisms and its digestive acids leads to painful ulcers.

There are two main causes of stomach ulcers:

1. Helicobacter pylori (H. pylori)

H. pylori is a type of bacteria that colonizes the stomach lining, often without causing symptoms. The bacteria causes irritation by penetrating surface cells and triggering them to release chemicals (cytokines) that promote inflammation and weaken the stomach’s protective mucus barrier. As a result, acid can damage the underlying tissue.

H. pylori is also a major factor in gastritis, dyspepsia, and stomach cancer. The bacteria spread primarily through contaminated food and water, as well as direct contact with infected saliva, stool, or vomit.

Despite the bacteria being widespread—infecting up to 40 percent of adults in the United States—only 10 percent to 20 percent of those infected develop ulcers.

2. Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)

NSAIDs are among the most common causes of gastric ulcers. These medications—such as ibuprofen, aspirin, naproxen, ketorolac, oxaprozin, and diclofenac—are available over the counter and widely used for pain, fever, and inflammation.

However, when taken frequently or at high doses, they can irritate the stomach lining by reducing blood flow, decreasing mucus production, and impairing cell repair—increasing the risk of ulcers and gastrointestinal bleeding.

The risk of developing a gastric ulcer from NSAIDs increases with:

• Long-term use
• High doses
• Use of certain high-risk NSAIDs
• A history of ulcers
• Combining NSAIDs with other ulcer-causing medications
• Having an H. pylori infection at the same time

In cases where ulcer risk is a concern, acetaminophen is considered a safer alternative for pain relief.

NSAIDs also increase the risk of gastrointestinal bleeding by interfering with blood clotting—an important issue given that gastric ulcers may bleed. This risk persists as long as the medication is taken and may continue for up to a year after stopping. However, short-term NSAID use for temporary pain relief is generally safe, as the stomach has time to heal.

To minimize risks, NSAIDs should be used at the lowest effective dose for the shortest duration possible.

Rare Causes

Less common causes include things surgeries or medical treatments that affect the stomach. Certain conditions—such as cancer or Crohn’s disease—can also lead to ulcer formation.

A rare condition called Zollinger-Ellison syndrome accounts for less than 1 percent of gastric ulcers. Zollinger-Ellison syndrome is characterized by gastrin-secreting tumors that cause excessive acid production and hard-to-treat ulcers.

Additionally, injuries, blockages, or reduced blood flow to the stomach can contribute to ulcer development.

Other risk factors:

• Smoking: Smoking increases the risk of developing stomach ulcers, especially in people with an H. pylori infection. It can also irritate the stomach lining and make treatment less effective.
• Alcohol: Drinking excessive alcohol irritates the stomach lining and stimulates increased acid production.
• Other medications: Using multiple ulcer-risk medications together increases the likelihood of ulcers and complications. Drugs that may aggravate ulcers include anticoagulants such as warfarin, selective serotonin reuptake inhibitors used for depression, oral corticosteroids, bisphosphonates used to treat osteoporosis, certain chemotherapy drugs, spironolactone used to treat high blood pressure, niacin used to lower cholesterol, and bevacizumab—a colorectal cancer treatment linked to gastrointestinal perforation.
• Age: Stomach ulcers become more common with age due to a decline in mucous-producing cells and reduced bicarbonate secretion, which helps neutralize stomach acid. The risk increases after age 60.
• Sex: Stomach ulcers are more common in women than in men.
• Blood type: People with blood type O are more likely to develop gastric ulcers—especially when infected with H. pylori—compared to those with other blood groups.

How Are Stomach Ulcers Diagnosed?

A doctor will review medical history, assess current medications, perform a physical examination, and request several tests, such as:

• Breath test: A breath test is a highly accurate method that involves swallowing a special urea solution. If H. pylori is present, it breaks down the urea, which is then detected in the breath. The test is about 99 percent accurate and is available in nonradioactive versions for children and pregnant women.
• Blood test: A blood test detects H. pylori antibodies with 80 percent to 90 percent accuracy. While quick, it cannot distinguish between past and current infections. It may also be used to check for signs of bleeding.
• Stool antigen test: A stool antigen test is another highly accurate method that identifies bacterial genetic traces in a stool sample. It typically provides results within two to three days.

The gold standard and most comprehensive diagnostic tool is an endoscopy, in which a thin, flexible camera is inserted through the mouth to directly examine the stomach lining. During this procedure, doctors can inspect the stomach, collect tissue samples, screen for potential cancer, and identify and potentially treat bleeding.

Additional imaging, such as X-rays or computed tomography scans, may be used to detect stomach perforations.

What Are the Treatments for Stomach Ulcers?

With proper treatment, ulcer symptoms often improve within days or weeks, but complete healing may take one to three months. The main treatment options include:

1. Antibiotics

If a stomach ulcer is caused by an H. pylori infection, treatment typically includes a combination of antibiotics and a proton pump inhibitor (PPI). This approach is also recommended when the ulcer results from both H. pylori infection and NSAID use. Most patients improve within a few months. However, if the infection persists, a different antibiotic regimen may be necessary.

Common side effects of antibiotics include nausea, diarrhea, and a metallic taste.

2. Proton Pump Inhibitors (PPIs)

PPIs are the primary treatment for stomach ulcers. They block acid production, allowing ulcers to heal and preventing further damage.

3. Other Medications

In addition to antibiotics and PPIs, several other medications can support healing, reduce acid, or protect the stomach lining.

H2 receptor blockers: Also called H2-receptor antagonists, H2 receptor blockers reduce stomach acid by blocking histamine, a natural trigger for acid secretion.

Protectants: Medications such as sucralfate and misoprostol protect ulcers by forming a barrier against stomach acids and enzymes.

Antacids: Antacids provide quick symptom relief from ulcers by neutralizing stomach acid and are often used alongside other treatments. However, they may take hours to become effective.

4. Surgery

Stomach ulcer surgery is a last-resort treatment for severe cases where other treatments have failed, including persistent ulcers, frequent recurrences, or complications such as bleeding or stomach perforation.

Surgical approaches include vagotomy, which involves cutting nerve signals to reduce acid, various stomach reconstruction techniques like Billroth I and II, which remove part of the stomach and reconnect the remaining tissue to the intestines, and procedures to remove ulcerated sections or enlarge intestinal openings.

For bleeding ulcers, emergency interventions may include surgical repair or minimally invasive endoscopic techniques. These can stop bleeding through medication injection, cauterization, or the placement of clips on damaged blood vessels.

What Are Natural and Lifestyle Approaches for Stomach Ulcers?

In addition to conventional medicine, some people explore natural and lifestyle-based treatments to help manage stomach ulcer symptoms and promote healing.

1. Food and Diet

While acidic or spicy foods and stress do not cause ulcers, they can worsen symptoms. Eating smaller meals can reduce stomach strain. Avoid eating three to four hours before bedtime to limit acid buildup overnight.

The following foods may support ulcer healing:

• Fruits and vegetables: High-fiber diets, particularly those rich in fruits and vegetables, may cut gastric ulcer risk in half and speed up recovery.
• Garlic: Garlic may have protective properties against stomach cancer, though large amounts can cause digestive discomfort.
• Olive oil: Olive oil contains phenolic compounds that may help fight antibiotic-resistant H. pylori strains.
• Propolis: Propolis is a resin-like material collected by bees. A 2021 systematic review found that propolis shows strong potential as a protective treatment for gastric ulcers caused by NSAIDs. Propolis appears to help protect the stomach lining by reducing harmful factors, such as excess stomach acid and pro-inflammatory cytokines, while also offering antioxidant, anti-inflammatory, and cell-protective benefits.

Trigger foods—including fatty foods, tomatoes, spicy foods, and caffeine—may worsen symptoms. Coffee and carbonated drinks increase stomach acid production, and drinking more than three cups of coffee daily may raise H. pylori infection risk, although no direct link to ulcers has been confirmed.

2. Lifestyle Modifications

Lifestyle changes can enhance treatment outcomes and reduce the likelihood of ulcer recurrence.

• Quit or avoid smoking: Smoking weakens the stomach’s defenses, slows healing, and increases the risk of ulcers and complications.
• Limit alcohol: Alcohol raises stomach acid levels and hinders healing.
• Engage in regular exercise: Regular physical activity may reduce ulcer risk in some people, and maintaining a healthy weight can further support digestive health.

3. Acupuncture and Moxibustion

A 2023 modified Delphi consensus study conducted three rounds of expert consultation on acupuncture treatment for gastric ulcers. The experts agreed that acupuncture may help treat gastric ulcers and reduce adverse drug reactions. A semi-standardized treatment approach was developed based on these findings.

Additionally, a 2022 meta-analysis of 25 Chinese studies found that acupuncture—combined with traditional Chinese medicine and Western medicine—was more effective than Western medicine alone. The treatment combination resulted in higher H. pylori clearance rates, fewer side effects, and a lower recurrence rate, all with statistically significant improvements.

4. Herbal Extracts

An earlier review examined the effects of certain herbal extracts, such as Piper betel, and found that herbal therapies may help treat gastric ulcers by enhancing protective mucus in the stomach, reducing oxidation, and lowering stomach acid production. Some herbs also exhibited antimicrobial activity. The researchers considered these herbs a promising treatment option for gastric ulcers, with minimal side effects.

5. Traditional Chinese Medicine (TCM)

A 2024 review found that they showed promising results for TCM in treating gastric ulcers. TCM, including herbal formulas, may help heal gastric ulcers by reducing inflammation, balancing oxidative stress, promoting blood vessel growth, protecting the stomach lining, regulating gut bacteria, and supporting cellular repair and survival.

How Does Mindset Affect Stomach Ulcers?

Mindset plays a significant role in the development and healing of stomach ulcers. While stress and anxiety do not directly cause ulcers, they can weaken the immune system, making it harder for the body to fight H. pylori infections—a major cause of ulcers. Chronic stress may also increase stomach acid production and inflammation, worsening symptoms and delaying healing.

A positive mindset and stress management techniques—such as getting adequate sleep, exercising regularly, practicing yoga, or even taking a daily walk—can help reduce stress, support healing, and prevent ulcer recurrence. Therefore, maintaining a balanced mental state promotes overall digestive health and may speed recovery.

How Can I Prevent Stomach Ulcers?

You cannot completely prevent stomach ulcers, but you can take measures to reduce your risk.

If you have an H. pylori infection, your doctor will likely prescribe antibiotics to eliminate the bacteria and help prevent ulcers. Additionally, drinking cranberry juice regularly may reduce H. pylori infection in populations where the bacteria are common.

To lower the risk of NSAID-related ulcers, take the lowest effective dose for the shortest time possible. Your doctor may also recommend an acid-lowering medication during NSAID use to help protect the stomach lining.

What Are the Possible Complications of Stomach Ulcers?

Untreated stomach ulcers are more likely to recur or worsen.

Possible complications include:

Hemorrhage (Bleeding)

Bleeding is the most common and serious complication of gastric ulcers, especially in older people and those taking antiplatelet agents or anticoagulants. A hemorrhage can occur when an ulcer erodes a nearby blood vessel. NSAID-induced ulcers are more likely to cause hemorrhaging.

Bleeding may be slow and chronic, leading to anemia and causing symptoms such as fatigue, pale skin, shortness of breath, and heart palpitations. In more severe cases, rapid bleeding can occur, presenting as coffee ground-like vomit, black, tarry stools (melena), vomiting blood (hematemesis), fresh rectal bleeding, and signs of hemodynamic instability such as low blood pressure or shock.

Hemorrhaging is particularly dangerous and can be fatal, particularly in older people or those with other health conditions. Stomach bleeding is a medical emergency and requires immediate attention. People taking antiplatelets such as aspirin and clopidogrel are at higher risk for bleeding ulcers and may benefit from taking preventive anti-ulcer medication.

Ulcer Perforation

Perforation occurs when an ulcer causes a hole in the stomach wall, leading to serious complications. A perforated ulcer is a medical emergency—digestive fluids and food can leak into the abdominal cavity, causing inflammation and infection.

The ulcer may also penetrate nearby organs such as the liver or pancreas, often requiring emergency surgery. If bacteria from the stomach escape into the peritoneum, they can cause peritonitis—a severe abdominal infection that may spread to the bloodstream and other organs. If left untreated, peritonitis can potentially cause multiple organ failure and death.

Gastric Outlet Obstruction

Gastric outlet obstruction occurs when an ulcer near the junction of the stomach and duodenum causes swelling, inflammation, or scarring that blocks the passage of food.

Symptoms include repeated vomiting—often with undigested food—persistent bloating, early satiety, and unintentional weight loss. Ongoing vomiting can also lead to dehydration and further weight loss.