Stomach Ulcer: Everything You Need to Know in 2026
Complete and updated guide about stomach ulcer: causes, symptoms, treatment and prevention based on the latest scientific evidence
Visual representation of a gastric ulcer in the stomach mucosa
Quick Summary - The Essentials
🎯 What is a Stomach Ulcer:
- • A deep "wound" in the stomach or duodenum wall
- • Mainly caused by H. pylori bacteria and anti-inflammatories
- • Heals completely with treatment in 4-8 weeks
- • Affects millions of people but has a solution
💊 Main Treatment:
- • Omeprazole or other acid inhibitors
- • Antibiotics if H. pylori bacteria present
- • Stop anti-inflammatories, tobacco and alcohol
- • Medical follow-up to confirm healing
What is a stomach ulcer really?
A stomach ulcer is a lesion or "wound" in the inner wall of the stomach (when located in the stomach it's called a gastric ulcer) or duodenum (the first part of the small intestine, then called a duodenal ulcer). Imagine that the protective layer lining your stomach from the inside gets damaged and forms a kind of crater or sore that penetrates beyond the surface.
The important thing is that, although it sounds alarming, stomach ulcer is a very common and perfectly treatable condition. With proper treatment, the vast majority of ulcers heal completely in 4 to 8 weeks. We're not talking about something irreversible or difficult to manage in most cases.
Important Fact
According to recent studies published in JAMA (2024), peptic ulcer disease remains an important cause of medical consultation, but rates of serious complications have decreased dramatically in recent decades thanks to advances in diagnosis and treatment.[1]
What causes stomach ulcer?
For a long time it was thought that stress and spicy food caused ulcers. Today we know this is not true. Ulcers have very specific and well-identified causes:
1. Helicobacter pylori (H. pylori) Infection
This spiral-shaped bacterium lives in the stomach of approximately half of the world's population. It's the main cause of ulcers: present in 70-90% of duodenal ulcers and 50-70% of gastric ulcers.[1][2]
How does it cause ulcers?
H. pylori weakens the stomach's protective layer and allows gastric acid to damage the inner wall, creating the ulcer. The good news: it can be completely eliminated with specific antibiotics.
2. Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)
Medications like ibuprofen, naproxen, diclofenac and aspirin are the second most common cause of ulcers. These drugs block substances called prostaglandins that protect the stomach mucosa.[1][3]
Examples of common NSAIDs:
- • Ibuprofen (Advil, Motrin)
- • Naproxen (Aleve)
- • Diclofenac (Voltaren)
- • Aspirin (various brands)
Important: Risk increases with high doses, prolonged use, advanced age, and especially if combined with corticosteroids. If you need to take NSAIDs regularly, consult your doctor about gastric protection with acid-inhibiting medications.
3. Other Risk Factors
Modifiable factors:
- • Tobacco: impairs healing and increases recurrence
- • Alcohol: irritates mucosa and increases complications
- • Corticosteroids: increase risk if used with NSAIDs
- • Severe stress: in critically ill hospitalized patients
Less frequent causes:
- • Zollinger-Ellison syndrome: tumor producing excess acid
- • Certain medications: specific chemotherapy
- • Advanced age: higher prevalence of idiopathic ulcers
What does NOT cause ulcers (common myths)
- • ❌ Spicy food: doesn't cause ulcers, though may bother if you already have them
- • ❌ Emotional stress: not a direct cause, but may worsen symptoms
- • ❌ Coffee or soft drinks: don't cause ulcers in healthy people
- • ❌ Irregular meal times: meal schedule doesn't cause ulcers
What are the symptoms of a stomach ulcer?
Symptoms can vary greatly from one person to another. Some people have very clear symptoms, while others have no symptoms until a complication appears (this is more common in elderly people and those taking NSAIDs).[1][4]
Most Common Symptoms
Pain or burning in the upper abdomen
The most characteristic symptom. Pain usually appears between meals or at night, when the stomach is empty. Many people describe it as "burning" or "painful hunger" in the pit of the stomach.
Relief with food
In duodenal ulcers, pain usually improves when eating or taking antacids, because food "buffers" the acid. In gastric ulcers, food can sometimes worsen the pain.
Nausea and feeling of fullness
Feeling full quickly when eating, nausea, frequent burping and, in some cases, vomiting. This is more common in gastric ulcers.
Loss of appetite and weight
Some people lose their appetite due to fear of the pain caused by eating, which can lead to unintentional weight loss.
Alarm Symptoms: When to Seek Urgent Care
If you have any of these symptoms, you should seek immediate medical attention, as they may indicate serious complications such as bleeding or perforation:[4][5]
🚨 Signs of bleeding:
- • Vomiting red blood or "coffee grounds"
- • Black, tarry or bloody stools
- • Dizziness, weakness or fainting
- • Severe paleness
🚨 Signs of perforation:
- • Sudden and intense abdominal pain
- • Rigid abdomen, painful to touch
- • Fever
- • Rapid general deterioration
How do I know if I have gastritis or an ulcer?
Gastritis and chronic abdominal pain can cause symptoms very similar to ulcer: pain, burning, nausea. The key difference is that:
- • Gastritis: superficial inflammation of the stomach mucosa
- • Ulcer: deep lesion that penetrates beyond the surface
The only way to differentiate them with certainty is through a gastroscopy, a procedure that allows direct visualization of the stomach interior and biopsies if necessary.
Do you have persistent digestive symptoms?
As a specialist in gastrointestinal disorders, I can help you correctly diagnose your problem and design the best personalized treatment.
Book an AppointmentHow is a stomach ulcer diagnosed?
Accurate diagnosis is essential to establish the correct treatment. The main methods are:
Gastroscopy (Upper Endoscopy)
It's the most accurate diagnostic method and the "gold standard". It allows direct visualization of the stomach and duodenum mucosa through a flexible camera inserted through the mouth.
Advantages:
- • Direct visualization of the ulcer
- • Allows biopsies for H. pylori
- • Rules out other pathologies (cancer, esophagitis)
- • Can treat bleeding if present
When is it recommended?
- • Alarm symptoms (bleeding, weight loss)
- • Over 55 years with new symptoms
- • Family history of gastric cancer
- • Persistent symptoms despite treatment
Tests to Detect H. pylori
Identifying whether there's an H. pylori infection is crucial, as it requires specific antibiotic treatment.[2][7]
Urea breath test
Non-invasive and very accurate test. You drink a liquid with labeled urea and breath is analyzed. Sensitivity >95%. Ideal for confirming post-treatment eradication.
Stool antigen
Detects bacterial proteins in a stool sample. Also very accurate and non-invasive. Useful for initial diagnosis and confirmation of cure.
Biopsy during gastroscopy
If endoscopy is performed, samples are taken for rapid urease test, culture and microscopic analysis. Also allows studying antibiotic resistance if necessary.
Important: You must stop acid inhibitors (omeprazole) at least 2 weeks before the test to avoid false negatives. Antibiotics should be stopped 4 weeks before.
How is a stomach ulcer cured?
The good news is that stomach ulcer heals completely with proper treatment. Management is based on three fundamental pillars: inhibiting acid production, eliminating H. pylori if present, and stopping risk factors.[1][3]
1. Proton Pump Inhibitors (PPIs)
They are the first line of treatment. These medications block acid production in the stomach, allowing the ulcer to heal.[1][3]
Common examples:
- • Omeprazole 20-40 mg/day
- • Lansoprazole 30 mg/day
- • Pantoprazole 40 mg/day
- • Esomeprazole 40 mg/day
Treatment duration:
- • Duodenal ulcer: 4 weeks
- • Gastric ulcer: 4-8 weeks
- • Large ulcers (>2 cm): up to 8 weeks
- • Healing rates: >90%
Side effects: PPIs are very safe. They may cause mild symptoms (headache, diarrhea) in some people. Long-term risks are controversial and not confirmed in clinical studies.[1][3]
2. H. pylori Eradication
Essential if the bacteria is present. Requires a combination of antibiotics for 14 days. The cure rate increases significantly (up to 50% fewer recurrences) after eliminating the bacteria.[1][2][6]
Triple therapy (most common):
- • PPI (omeprazole 40 mg) every 12 hours
- • Amoxicillin 1000 mg every 12 hours
- • Clarithromycin 500 mg every 12 hours
- • Duration: 14 days (more effective than 7 days)
Quadruple therapy with bismuth:
- • PPI + Bismuth + Tetracycline + Metronidazole
- • Indicated if clarithromycin resistance or penicillin allergy
- • Success rate >90% in Europe[2][6]
Very important: You must complete the entire antibiotic treatment, even if you feel better earlier. Premature discontinuation increases the risk of resistance and treatment failure.
Eradication confirmation: It's recommended to repeat the test (breath or stool) at least 4 weeks after finishing antibiotics and 2 weeks after stopping PPIs.[2][7]
3. Risk Factor Modification
Essential for healing and preventing recurrences. Some changes are temporary, others should be permanent.[1][3][4]
Stop NSAIDs:
- • Ibuprofen, naproxen, diclofenac, aspirin
- • If essential, use with gastric protection
- • Consider alternatives (acetaminophen, selective COX-2)
Eliminate tobacco and alcohol:
- • Tobacco significantly delays healing
- • Alcohol irritates mucosa and increases complications
- • Additional benefit to your overall health
Review other medications:
- • Corticosteroids (prednisone, dexamethasone)
- • Anticoagulants (increase bleeding risk)
- • Consult your doctor before stopping
Balanced diet:
- • No strict "ulcer diet" required
- • Avoid foods that personally bother you
- • Regular meals, don't skip meal times
Realistic Treatment Expectations
- • ✅ Symptom improvement: in 2-3 days with PPIs
- • ✅ Complete healing: 4-8 weeks in >90% of cases
- • ✅ Recurrence rate: <5% if H. pylori eradicated and NSAIDs avoided
- • ✅ Return to normal life: immediate after finishing treatment
Follow-up and surveillance: Do you need another gastroscopy?
Follow-up depends on the type of ulcer and whether there are risk factors for gastric cancer.
When is it recommended to repeat gastroscopy?
Gastric ulcer (stomach)
YES, repeat endoscopy is recommended after 8-12 weeks of treatment to:
- • Confirm complete healing
- • Rule out malignancy (gastric cancer can mimic ulcer)
- • Especially in those over 55 years or with cancer risk factors
Duodenal ulcer (intestine)
NO routine control endoscopy recommended if:
- • Symptoms disappear with treatment
- • H. pylori was eradicated correctly
- • No alarm symptoms
- • Cancer risk in duodenum is virtually nil
Refractory ulcers (don't heal)
If after 8 weeks of treatment the ulcer doesn't heal, you should:
- • Double PPI dose (e.g. omeprazole 40 mg every 12h)
- • Confirm H. pylori was eradicated correctly
- • Rule out inadvertent use of NSAIDs or other drugs
- • Investigate rare causes (gastrinoma, cancer)
My approach as a specialist
In my practice, I use advanced endoscopy techniques with high-definition equipment that allows detection of minimal lesions and precise biopsies. This is especially important in following up gastric ulcers in patients with cancer risk factors, where early detection makes all the difference.
Who has the highest risk of complications?
Although most ulcers heal without problems, some groups of people have a higher risk of serious complications such as hemorrhage or perforation:[1][4][5]
Elderly people
- • Over 65 years, especially >75
- • Greater use of NSAIDs and anticoagulants
- • Less obvious symptoms (late diagnosis)
- • Higher mortality from complications
Multiple drug users
- • Combination NSAIDs + corticosteroids
- • Anticoagulants (warfarin, apixaban)
- • Antiplatelet agents (aspirin, clopidogrel)
- • Risk multiplies with combinations
Previous history
- • Previous ulcer or digestive bleeding
- • Family history of gastric cancer
- • Large ulcers (≥1 cm)
- • Significant recurrence risk
Severe comorbidities
- • Cardiovascular diseases
- • Renal or hepatic insufficiency
- • Cancer under treatment
- • Critically ill hospitalized patients
Gastroprotection in High-Risk Patients
If you belong to one of these groups and need to take NSAIDs or antiplatelet agents chronically, you should receive prophylactic gastroprotection with PPIs (omeprazole, lansoprazole).[1][3]
The American College of Gastroenterology recommends PPIs in: those over 65 years, users of NSAIDs + anticoagulants/antiplatelet agents, history of ulcer or hemorrhage, and concomitant use of corticosteroids.[1]
Committed to your digestive health
Final message: Stomach ulcer has a solution
Key Takeaways
Stomach ulcer is common, treatable and curable. With the correct diagnosis and appropriate treatment, you'll return to your normal life in a few weeks.
As a specialist in gastrointestinal disorders and advanced endoscopy, I have treated thousands of patients with peptic ulcer. The key is in accurate diagnosis, complete treatment and appropriate follow-up according to the individual case.
If you have persistent symptoms of abdominal pain, burning, nausea or any alarm signs, don't hesitate to consult. Early diagnosis and correct treatment make the difference between a quick recovery and avoidable complications.
Need a personalized evaluation?
I can help you correctly diagnose your digestive problem and design the best treatment for you.
Book an AppointmentRelated articles
Frequently Asked Questions (FAQ)
What are the symptoms of a stomach ulcer?
The most common symptoms include pain or burning in the upper abdomen (especially between meals or at night), feeling of fullness, nausea and, in severe cases, vomiting blood or dark stools. However, some people have no symptoms.
What happens when there is an ulcer in the stomach?
An ulcer is a wound in the inner wall of the stomach that penetrates beyond the superficial layer. This can cause pain, bleeding and, if untreated, complications like perforation. With proper treatment, most heal completely in 4-8 weeks.
How is a stomach ulcer cured?
The main treatment includes acid-inhibiting medications (omeprazole) for 4-8 weeks and, if H. pylori bacteria is present, specific antibiotics for 14 days. It's also essential to stop anti-inflammatories, tobacco and alcohol to allow healing.
How do I know if I have gastritis or an ulcer?
Although both cause similar symptoms, an ulcer usually produces more intense and specific pain that improves with food. The only way to differentiate them with certainty is through a gastroscopy, which allows direct visualization of the stomach mucosa and biopsies if necessary.
Scientific References
- 1. Vakil N. Peptic Ulcer Disease: A Review. JAMA. 2024;332(21):1815-1825. doi:10.1001/jama.2024.20115
- 2. Almadi MA, Lu Y, Alali AA, Barkun AN. Peptic Ulcer Disease. Lancet. 2024;404(10471):68-81. doi:10.1016/S0140-6736(24)00155-7
- 3. FDA Orange Book. Proton Pump Inhibitors and P-CABs. FDA Database. Accessed January 2026.
- 4. Hunt RH, Malfertheiner P, Yeomans ND, Hawkey CJ, Howden CW. Critical Issues in the Pathophysiology and Management of Peptic Ulcer Disease. Eur J Gastroenterol Hepatol. 1995;7(7):685-699.
- 5. Kavitt RT, Lipowska AM, Anyane-Yeboa A, Gralnek IM. Diagnosis and Treatment of Peptic Ulcer Disease. Am J Med. 2019;132(4):447-456. doi:10.1016/j.amjmed.2018.12.009
- 6. Arshad SA, Murphy P, Gould JC. Management of Perforated Peptic Ulcer: A Review. JAMA Surg. 2025;160(1):86-95. doi:10.1001/jamasurg.2024.4606
- 7. Lau JY, Barkun A, Fan DM, et al. Challenges in the Management of Acute Peptic Ulcer Bleeding. Lancet. 2013;381(9882):2033-2043. doi:10.1016/S0140-6736(13)60596-6
