Peptic ulcer disease occurs when an open sore develops in the lining of the stomach or the first part of the small intestine.
An ulcer in the stomach is called a gastric ulcer, while one in the first part of the small intestine, known as the duodenum, is called a duodenal ulcer.
Peptic ulcers may cause burning upper-abdominal pain, nausea, bloating and early fullness. Some people have few or no obvious symptoms until complications such as internal bleeding develop.
The two most common causes are infection with Helicobacter pylori, usually shortened to H. pylori, and the use of nonsteroidal anti-inflammatory drugs such as aspirin, ibuprofen, diclofenac and naproxen.
Medical disclaimer: This article provides general health information and does not replace examination, diagnosis or treatment by a qualified healthcare professional. Vomiting blood, passing black stools, fainting or experiencing sudden severe abdominal pain requires urgent medical attention.
What Is Peptic Ulcer Disease?
A peptic ulcer is a sore in the protective lining of the stomach or duodenum.
The digestive system naturally produces acid and enzymes to help break down food. A layer of mucus protects the stomach and upper intestine from these digestive substances.
An ulcer can develop when this protective lining becomes weakened or damaged.
The two principal forms are:
Gastric ulcer
A gastric ulcer develops in the lining of the stomach.
Duodenal ulcer
A duodenal ulcer develops in the duodenum, the first section of the small intestine.
Although people commonly use the term “stomach ulcer” for both conditions, not every peptic ulcer is located in the stomach.
Most peptic ulcers can be treated successfully. However, untreated ulcers may sometimes lead to bleeding, perforation, or blockage within the digestive tract.
A Brief History of Peptic Ulcer Disease
For many years, peptic ulcers were widely blamed on psychological stress, spicy food, alcohol and personality type.
Doctors understood that stomach acid contributed to ulcer formation, but the main underlying cause of many ulcers was unclear.
That understanding changed during the 1980s through the research of Australian scientists Barry Marshall and Robin Warren. Their work showed that a bacterium later named Helicobacter pylori was responsible for many cases of chronic stomach inflammation and peptic ulcer disease.
The discovery transformed ulcer treatment.
Instead of relying only on long-term acid suppression or surgery, doctors could treat many ulcers by eliminating the bacterial infection. Marshall and Warren received the 2005 Nobel Prize in Physiology or Medicine for this discovery.
Today, H. pylori infection and NSAID use are recognised as the two leading causes of peptic ulcer disease.
What Causes Peptic Ulcers?
1. Helicobacter pylori infection
H. pylori is a bacterium that can live in the protective lining of the stomach.
The infection may cause long-term inflammation and weaken the stomach or duodenal lining. This makes the tissue more vulnerable to damage from digestive acid.
Many people with H. pylori do not develop ulcers. However, the infection remains one of the most important causes of peptic ulcer disease.
H. pylori may spread through contaminated food or water or through contact with saliva, vomit, or stool from an infected person.
2. Nonsteroidal anti-inflammatory drugs
Nonsteroidal anti-inflammatory drugs, also known as NSAIDs, include:
Aspirin
Ibuprofen
Diclofenac
Naproxen
These medicines reduce pain and inflammation, but they can also weaken the protective lining of the stomach.
The risk of an ulcer is higher when a person:
Uses NSAIDs frequently or for a long period
Takes a high dose
Uses more than one NSAID
Has previously had an ulcer
Is an older adult
Has H. pylori infection
Smokes
Takes certain other medicines
NSAIDs can affect more than the digestive system. Frequent or inappropriate use may also contribute to kidney problems in susceptible people. You can read more in our guide to protein in urine, its causes and its connection with kidney disease.
People who take aspirin to prevent a heart attack or stroke should not stop it without speaking with their healthcare provider.
3. Less common causes
Less common causes of peptic ulcers include:
Zollinger-Ellison syndrome, which causes excessive acid production
Severe illness requiring intensive care
Crohn’s disease
Reduced blood supply to the stomach or duodenum
Certain infections other than H. pylori
Some medicines, particularly when combined with NSAIDs
Stomach cancer
Previous surgery involving the stomach or duodenum
In some people, no clear cause is found. These may be described as idiopathic peptic ulcers.
Do Stress and Spicy Foods Cause Ulcers?
Ordinary psychological stress and spicy foods are not the main causes of most peptic ulcers.
The leading causes remain:
H. pylori infection
NSAID use
However, stress, alcohol, and certain foods may worsen pain or digestive discomfort in some people who already have an ulcer or another digestive condition.
There is no single “ulcer diet” that works for everyone.
A person may reduce or avoid a particular food if it repeatedly worsens symptoms, but dietary changes should not replace proper testing and treatment.
Symptoms of Peptic Ulcer Disease
Some people with peptic ulcers have no obvious symptoms.
When symptoms occur, the most common is discomfort or pain in the upper abdomen, between the lower chest and the belly button.
The pain may feel:
Burning
Gnawing
Dull
Aching
It may come and go.
For some people, the pain occurs when the stomach is empty or during the night and improves temporarily after eating. In others, eating may make the discomfort worse.
Other possible symptoms include:
Feeling full earlier than expected
Uncomfortable fullness after meals
Bloating
Belching
Nausea
Vomiting
Reduced appetite
Unexplained weight loss
These symptoms do not always mean a person has an ulcer. Gastritis, acid reflux, gallbladder disease, and other conditions can produce similar symptoms.
A healthcare professional should assess persistent or recurrent symptoms.
Warning Signs of a Complicated Ulcer
A bleeding or perforated ulcer can become a medical emergency.
Seek urgent medical attention for:
Black or tarry stools
Red or maroon blood in the stool
Vomiting blood
Vomit that resembles coffee grounds.
Sudden or severe abdominal pain
A rigid or very tender abdomen
Dizziness
Fainting
Rapid heartbeat
Severe weakness
Shortness of breath
Persistent vomiting
Signs of shock
Slow internal bleeding may lead to anaemia, tiredness, weakness or shortness of breath.
Do not try to manage these warning signs with antacids, herbal mixtures or home remedies.
How Is Peptic Ulcer Disease Diagnosed?
A healthcare professional will normally ask about:
The location and nature of the pain
Whether symptoms occur before or after meals
Previous ulcer disease
Previous H. pylori treatment
Use of aspirin, ibuprofen, diclofenac or other NSAIDs
Smoking and alcohol use
Other medicines
Existing medical conditions
Family history of digestive disease or cancer
The person may then need one or more tests.
Tests for H. pylori
Urea breath test
The patient swallows a substance containing specially labelled urea.
If H. pylori is present, the bacteria break down the substance and produce carbon dioxide that can be measured in the person’s breath.
Stool antigen test
A stool sample is examined for evidence of H. pylori infection.
This test may be used to diagnose an active infection and to confirm that treatment has eliminated the bacteria.
Blood antibody test
A blood test can detect antibodies produced in response to H. pylori.
However, these antibodies may remain after an old infection has been successfully treated. A positive blood result may therefore not confirm that the infection is still active.
Biopsy during endoscopy
During an endoscopy, small tissue samples may be taken from the stomach lining and tested for H. pylori or other abnormalities.
Some medicines can affect H. pylori test results. Patients should follow the preparation instructions given by their clinic rather than stopping prescribed medicines independently.
Upper Gastrointestinal Endoscopy
Upper gastrointestinal endoscopy allows a doctor to examine the upper digestive tract directly.
A thin, flexible tube containing a camera is passed through the mouth to inspect the:
Oesophagus
Stomach
Duodenum
The procedure can confirm the presence, location and appearance of an ulcer.
A biopsy may also be taken to:
Test for H. pylori
Examine abnormal tissue
Exclude stomach cancer
Investigate an ulcer that has not healed
Endoscopy may be particularly important when a patient has:
Digestive bleeding
Persistent vomiting
Unexplained weight loss
Anaemia
Difficulty swallowing
Recurrent symptoms
Other concerning clinical findings.
Other Tests
Additional investigations may include:
Complete blood count to check for anaemia.
Stool testing for hidden blood
Kidney and liver function tests
Upper gastrointestinal contrast imaging
Abdominal imaging when perforation or another complication is suspected
Kidney-function assessment may be especially important for people who use NSAIDs frequently or have conditions such as high blood pressure or diabetes. Our article on proteinuria and kidney disease explains why abnormal protein in urine may require further assessment.
Treatment of Peptic Ulcer Disease
Treatment has two main goals:
Heal the ulcer.
Identify and treat its underlying cause.
Taking an antacid may reduce symptoms temporarily, but it does not necessarily treat the cause of the ulcer.
Treating H. pylori Infection
When H. pylori is confirmed, treatment usually includes:
Two or more antibiotics
A proton pump inhibitor
Sometimes a bismuth-containing medicine
The exact combination depends on:
Local antibiotic-resistance patterns
Previous antibiotic exposure
Medicine allergies
Previous H. pylori treatment
Current clinical guidance
Patients should:
Take each medicine exactly as prescribed.
Complete the entire treatment course.
Report serious side effects.
Avoid sharing medicines
Avoid reusing an old antibiotic prescription.
Attend follow-up testing
Stopping antibiotics early may allow the infection to persist and contribute to antibiotic resistance.
A follow-up breath or stool test may be needed to confirm that H. pylori has been eliminated.
Feeling better does not necessarily mean that the infection is gone.
Proton Pump Inhibitors
Proton pump inhibitors, or PPIs, reduce stomach-acid production and allow the ulcerated tissue to heal.
Examples include:
Omeprazole
Esomeprazole
Lansoprazole
Pantoprazole
Rabeprazole
A healthcare professional should determine the appropriate medicine, dose and duration.
PPIs are also included in most H. pylori treatment combinations.
People should not remain on long-term acid-suppressing treatment without clinical review simply because these medicines may be available without a prescription.
H2-Receptor Blockers
H2-receptor blockers reduce stomach-acid production through a different mechanism.
They may be used in selected situations, although proton pump inhibitors usually provide stronger acid suppression.
Antacids
Antacids neutralise stomach acid and may provide short-term relief.
However, they do not:
Eliminate H. pylori
Reverse NSAID-related injury
Confirm that an ulcer is present.
Prevent every ulcer complication.
Frequent reliance on antacids may delay an accurate diagnosis.
Managing NSAID-Related Ulcers
When an ulcer is associated with an NSAID, a healthcare provider may recommend:
Stopping the NSAID where medically safe
Reducing the dose
Using the medicine for a shorter period
Switching to another pain-management option
Prescribing a proton pump inhibitor
Testing for H. pylori
People who need aspirin or another NSAID for an important medical condition should discuss stomach protection and possible alternatives with their healthcare provider.
They should not stop a prescribed medicine independently.
NSAIDs may also affect kidney function, particularly in people who already have kidney disease, diabetes, high blood pressure, or dehydration. Readers concerned about kidney warning signs can review our article on protein in urine and its possible causes.
Is Surgery Needed?
Most peptic ulcers heal with appropriate treatment.
Surgery is now uncommon but may be required when an ulcer causes:
Uncontrolled bleeding
Perforation
Obstruction
Penetration into a nearby organ
Persistent disease that does not respond to treatment
Some bleeding ulcers can be treated during endoscopy without open surgery.
Lifestyle Measures That May Support Healing
Lifestyle changes cannot eliminate H. pylori or replace prescribed treatment, but they may support recovery.
Stop smoking
Smoking may delay ulcer healing and increase the likelihood of recurrence.
Use pain medicines carefully.
Avoid frequently taking aspirin, ibuprofen, diclofenac, or naproxen without medical guidance.
Ask a healthcare professional which pain-relief option is safer for your health history.
Limit alcohol
Alcohol can irritate the stomach lining and worsen digestive symptoms.
Avoid personal trigger foods.
Spicy food does not cause most ulcers, but it may worsen discomfort in some people.
There is no need to remove every spicy, acidic, or fatty food unless it repeatedly triggers symptoms.
Take medicines correctly
Follow the instructions regarding:
Dose
Timing
Food
Treatment duration
Follow-up testing
Manage stress
Stress is not the main underlying cause of most ulcers, but managing it may reduce digestive discomfort and improve general wellbeing.
Helpful measures may include:
Adequate sleep
Regular physical activity
Relaxation exercises
Counselling when needed
Regular meal times
Foods to Eat or Avoid With an Ulcer
There is no universal diet that cures peptic ulcers.
A balanced diet may include:
Vegetables
Fruits
Whole grains
Beans
Fish
Eggs
Lean meat
Other suitable protein sources
Adequate fluids
Patients may reduce or avoid foods that consistently worsen their personal symptoms.
Possible triggers include:
Alcohol
Very spicy meals
Large fatty meals
Excessive caffeine
Meals eaten shortly before lying down.
Milk is not an ulcer cure. It may provide temporary relief, but it can also stimulate further acid production.
Dietary changes should never replace:
H. pylori testing
Prescribed antibiotics
Acid-suppressing treatment
Medical assessment for warning signs
Possible Complications
Gastrointestinal bleeding
An ulcer can damage a blood vessel and cause slow or severe bleeding.
Slow bleeding may lead to anaemia, while heavy bleeding can become life-threatening.
Perforation
An ulcer may create a hole through the wall of the stomach or duodenum.
Digestive contents may then leak into the abdomen and cause serious infection.
Penetration
An ulcer may extend into a nearby organ.
Gastric outlet obstruction
Inflammation or scarring may block the movement of food from the stomach into the small intestine.
Recurrence
An ulcer may return when:
H. pylori remains present
NSAID use continues
Treatment is incomplete
Another underlying cause has not been addressed
How Can Peptic Ulcers Be Prevented?
Not every peptic ulcer can be prevented, but risk may be reduced by:
Avoiding unnecessary NSAID use
Using the lowest effective NSAID dose when prescribed
Taking stomach-protective treatment when recommended
Testing for and treating H. pylori
Completing prescribed treatment
Confirming that H. pylori has been eradicated
Avoiding smoking
Limiting alcohol
Attending follow-up for persistent symptoms
Avoiding unregulated antibiotic use
Avoiding repeated self-medication
Good hygiene and access to safe food and water may also help reduce exposure to infections such as H. pylori.
Peptic Ulcer Disease in Nigeria
In Nigeria, some people with recurring upper-abdominal pain repeatedly use antacids, acid-reducing medicines, painkillers, or herbal preparations without confirming the cause.
This may provide temporary relief while allowing:
H. pylori infection
NSAID-related injury
Internal bleeding
Another digestive condition
to remain undiagnosed.
Patients should seek professional assessment when symptoms:
Persist
Return frequently
Disturb sleep
Occur with unexplained weight loss.
Are accompanied by repeated vomiting
Occur with black stools.
Begin after frequent painkiller use.
Fail to improve after treatment.
Antibiotics should not be taken simply because a person believes they have an ulcer.
The correct treatment depends on:
Confirmation of the diagnosis
Previous antibiotic use
Medicine allergies
Local resistance patterns
Other health conditions
Frequently Asked Questions
What is the main cause of stomach ulcers?
The two most common causes are H. pylori infection and the use of NSAIDs such as aspirin, ibuprofen, diclofenac, and naproxen.
Can stress cause an ulcer?
Ordinary emotional stress is not the main cause of most peptic ulcers. However, stress may worsen symptoms, and severe physical illness can contribute to ulceration in critically ill patients.
Does spicy food cause ulcers?
Spicy food does not cause most ulcers. It may worsen discomfort in people who are already experiencing digestive symptoms.
Can peptic ulcers heal completely?
Most peptic ulcers can heal when the cause is correctly identified and treated.
Recurrence is more likely if H. pylori remains present, NSAID exposure continues, or treatment is not completed.
Can an ulcer become cancer?
A peptic ulcer does not automatically become cancer.
However, some stomach cancers can resemble ulcers. Doctors may therefore perform an endoscopy and biopsy, particularly when a gastric ulcer or concerning symptoms are present.
How do I know whether I have H. pylori?
H. pylori may be detected through:
Urea breath testing
Stool antigen testing
Biopsy during endoscopy
Can I treat an ulcer with only omeprazole?
Omeprazole may reduce acid and support ulcer healing.
However, if H. pylori is present, omeprazole alone will not eliminate the infection.
Is milk good for an ulcer?
Milk is not a treatment for peptic ulcer disease. Any relief is usually temporary.
How long does an ulcer take to heal?
Healing time depends on the cause, location, and severity of the ulcer and whether treatment is taken correctly.
Many ulcers heal after several weeks of appropriate treatment, although follow-up may be needed.
What are the signs of a bleeding ulcer?
Warning signs include:
Black or tarry stools
Blood in vomit
Vomit resembling coffee grounds.
Weakness
Dizziness
Fainting
Shortness of breath
Can painkillers cause ulcers?
Some pain medicines, particularly NSAIDs such as aspirin, ibuprofen, diclofenac and naproxen, can increase the risk of peptic ulcers.
They may also affect kidney function in susceptible people. Read more about protein in urine and possible kidney disease.
When to See a Healthcare Professional
Arrange a medical assessment for:
Recurrent upper-abdominal pain
Persistent nausea or vomiting
Early fullness
Unexplained weight loss
Symptoms after frequent NSAID use
Symptoms that return after treatment
Difficulty swallowing
Anaemia
Reduced appetite
Seek emergency medical care for:
Vomiting blood
Black or bloody stools
Sudden severe abdominal pain
Fainting
Rapid heartbeat
Severe weakness
Signs of shock
Related Health Guides
Continue reading:
More internal links should be added here as relevant AnjKreb guides on gastrointestinal bleeding, medication safety, diabetes and digestive health are published or updated.
Conclusion
Peptic ulcer disease is an open sore affecting the lining of the stomach or duodenum.
The two main causes are H. pylori infection and NSAID use, not ordinary emotional stress or spicy food.
Effective management requires more than temporary symptom relief with antacids. The underlying cause must be identified through appropriate examination and testing.
Treatment may involve:
Acid-suppressing medicine
H. pylori eradication therapy
Changes to NSAID use
Follow-up testing
Treatment of complications
Most peptic ulcers can heal successfully.
However, vomiting blood, passing black stools, fainting, or experiencing sudden severe abdominal pain requires urgent medical attention.
About the Author
Adeyinka Joseph Alonge is a public health professional, researcher and writer with interests spanning health, science, technology, personal development and practical knowledge for everyday life.
His health articles translate clinical and public-health evidence into clear, practical information for patients, families and the general public.
Last fact-checked and updated: July 2026
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