Most people think stomach ulcers are caused by stress or spicy food. That’s not true. The real culprits are far more specific-and treatable. Peptic ulcer disease (PUD) is a break in the lining of the stomach or the first part of the small intestine, and it affects about 8 million people worldwide. The good news? If you’ve got one, it’s not a life sentence. With the right treatment, most ulcers heal completely and don’t come back.
What’s Actually Causing Your Ulcer?
There are two main causes of peptic ulcers today, and they’re not what you’d guess. The first is a bacteria called Helicobacter pylori (a spiral-shaped bacterium that lives in the stomach lining and triggers inflammation). Back in 1982, two Australian doctors, Barry Marshall and Robin Warren, proved this link-something no one believed at the time. They even drank a culture of the bacteria to prove it caused ulcers. They won the Nobel Prize for it in 2005. Today, H. pylori is found in over half of all duodenal ulcers and 30-50% of gastric ulcers.The second major cause? NSAIDs (nonsteroidal anti-inflammatory drugs like ibuprofen, naproxen, and aspirin). These are the painkillers people take for headaches, back pain, or arthritis. But they weaken the stomach’s natural defenses. In fact, NSAIDs now cause more than half of all peptic ulcers, especially in older adults who take them daily. Unlike H. pylori, NSAID damage doesn’t go away just because you stop the drug-you need help healing the lining.
Other things like smoking and heavy alcohol use make ulcers worse. Smoking doubles or triples your risk. Drinking more than three alcoholic drinks a day raises your risk by 300%. Stress doesn’t cause ulcers, but it can slow healing. And while coffee or spicy food might sting, they don’t create the ulcer itself.
How Do You Know You Have One?
Symptoms are often misleading. The classic sign is a burning or gnawing pain in the upper belly-right below the breastbone. For many, the pain gets better after eating or taking an antacid. That’s because food temporarily buffers the acid. But it comes back, often at night or between meals.Other signs include:
- Feeling full too fast
- Nausea or vomiting
- Loss of appetite
- Intolerance to fatty foods
- Unexplained weight loss
These aren’t emergencies-but if you see blood in your vomit or stool (it looks like coffee grounds or black tar), or feel dizzy and weak, get help right away. That means bleeding, and that’s serious.
Doctors don’t guess. They test. The gold standard is an endoscopy (a thin camera passed through the mouth to view the stomach and duodenum). They’ll look for the ulcer and take a small tissue sample. They’ll also test for H. pylori using a breath test, stool test, or blood test. If you’ve got an ulcer and no H. pylori, they’ll ask about your NSAID use.
Antibiotics: The Real Cure for H. pylori
If you have H. pylori, you don’t just need acid reducers-you need antibiotics. That’s the key. Treating the infection cuts your chance of the ulcer coming back from 70% down to just 10%.The standard treatment is called triple therapy (a 7- to 14-day course of two antibiotics plus a proton pump inhibitor). Common combinations include:
- Amoxicillin + clarithromycin + omeprazole
- Metronidazole + clarithromycin + pantoprazole
- Amoxicillin + metronidazole + esomeprazole
Some patients get quadruple therapy (adding bismuth to the mix), especially in places where clarithromycin resistance is high-like the U.S., where over a third of strains no longer respond to it.
Antibiotics are tough. People report bad side effects: metallic taste (especially with metronidazole), diarrhea, nausea, and bloating. But you can’t skip doses. If you don’t finish the full course, the bacteria survive-and come back stronger. That’s why treatment fails more often than not: people stop when they feel better.
Doctors now recommend testing for antibiotic resistance before treatment, especially if you’ve had prior antibiotic use. By 2025, 60% of H. pylori treatments in the U.S. will be guided by these tests-up from just 15% in 2022.
Acid-Reducing Medications: Letting the Ulcer Heal
While antibiotics kill the bacteria, you need acid blockers to give your stomach lining time to heal. There are two types:Proton Pump Inhibitors (PPIs)
These are the first-line choice. They shut down acid production for up to 72 hours per dose. Common ones include:- Omeprazole (Prilosec)
- Esomeprazole (Nexium)
- Lansoprazole (Prevacid)
- Pantoprazole (Protonix)
- Rabeprazole (AcipHex)
PPIs work best when taken 30-60 minutes before breakfast (and sometimes dinner). They’re not just for symptom relief-they actively help the ulcer close. Studies show they heal 90% of ulcers in 8 weeks.
But they’re not perfect. Long-term use (over a year) has been linked to lower vitamin B12 levels, higher risk of bone fractures, and a rare kidney condition called acute interstitial nephritis. The FDA added warnings for these in 2010-2011. Some people also get rebound acid reflux after stopping PPIs-so doctors often taper the dose instead of quitting cold turkey.
H2 Blockers
These are older drugs that reduce acid for 10-12 hours. They’re less powerful than PPIs. Examples:- Famotidine (Pepcid AC)
- Cimetidine (Tagamet)
- Nizatidine (Axid)
They’re still used sometimes-especially at night to control nighttime acid. But they’re no longer the go-to for healing ulcers. PPIs are simply more effective.
Newer options are coming. In January 2023, the FDA approved vonoprazan (a potassium-competitive acid blocker that works faster and stronger than PPIs). In Japan, it’s already shown 90% success in killing H. pylori-better than traditional PPIs.
What If Your Ulcer Was Caused by NSAIDs?
If you’re on daily ibuprofen or naproxen for arthritis or back pain, stopping isn’t always possible. So doctors have two options:- Switch to a safer painkiller like acetaminophen (Tylenol)-it doesn’t hurt the stomach lining.
- Keep taking NSAIDs but add a PPI daily for protection.
Some patients get misoprostol (a synthetic prostaglandin that rebuilds the stomach’s protective mucus layer) as a preventive, especially if they’re high-risk. But it causes diarrhea and cramping, so it’s not first-choice for most.
COX-2 inhibitors like celecoxib (Celebrex) are gentler on the stomach than older NSAIDs-but they’re not risk-free and can raise heart risks. Always talk to your doctor before switching.
Lifestyle Changes That Actually Help
Medication works best when paired with smart habits:- Quit smoking. Smoking cuts blood flow to the stomach lining, slowing healing by up to 50%.
- Limit alcohol. More than 3 drinks a day triples your risk of ulcers.
- Avoid NSAIDs. Use acetaminophen instead for pain.
- Eat normally. There’s no “ulcer diet.” Skip the myths. Don’t starve yourself. Just avoid foods that make you feel worse.
- Take meds on time. PPIs before meals. Antibiotics exactly as prescribed.
Most people feel better within a week. But healing takes time. Don’t stop your meds just because the pain’s gone.
What If the Ulcer Doesn’t Heal?
If your ulcer hasn’t improved after 8-12 weeks of treatment, it’s called a “refractory ulcer.” That usually means one of three things:- You didn’t take your antibiotics correctly.
- Your H. pylori strain is resistant to the drugs used.
- You’re still taking NSAIDs or smoking.
Doctors will repeat the endoscopy, test for resistance, and check your medication adherence. Sometimes, they’ll switch to quadruple therapy or try vonoprazan. Rarely, surgery is needed-but that’s now very uncommon.
What’s Next for Peptic Ulcer Treatment?
The future is personalized. We’re moving away from one-size-fits-all treatment. By 2026, doctors will likely:- Test your H. pylori strain for antibiotic resistance before prescribing
- Use vonoprazan as first-line in high-resistance areas
- Offer long-term PPIs only to those who truly need them (like NSAID users)
- Reduce H. pylori screening in young, low-risk people as infection rates drop
While H. pylori ulcers are fading in places like Australia and the U.S., NSAID-induced ulcers are rising-especially in older adults. That means PUD isn’t going away. But it’s no longer a mystery. It’s a solvable problem.
Can stress cause a peptic ulcer?
No, stress doesn’t directly cause peptic ulcers. While it can make symptoms feel worse or slow healing, the two main causes are H. pylori infection and NSAID use. The myth that stress causes ulcers comes from older beliefs before H. pylori was discovered in 1982.
Can I take ibuprofen if I’ve had a peptic ulcer?
It’s risky. If you’ve had a peptic ulcer, taking ibuprofen or other NSAIDs again can trigger a new ulcer or cause bleeding. Talk to your doctor first. They may suggest switching to acetaminophen (Tylenol) or adding a daily PPI if you must keep using NSAIDs. Never take NSAIDs without medical advice after an ulcer.
How long do I need to take antibiotics for H. pylori?
Most people take antibiotics for 10 to 14 days, along with a proton pump inhibitor. It’s critical to finish the full course-even if you feel better after a few days. Stopping early increases the chance the bacteria survive and become resistant. After treatment, you’ll usually get a follow-up test (like a stool or breath test) to confirm the infection is gone.
Do PPIs cause long-term damage?
Long-term PPI use (over a year) has been linked to small risks: lower vitamin B12 levels, slightly higher fracture risk, and rare kidney issues. But for most people taking them for 4-8 weeks to heal an ulcer, the benefits far outweigh the risks. If you need long-term acid suppression, your doctor will monitor you and use the lowest effective dose.
Can I test for H. pylori at home?
Yes. Stool antigen tests and breath tests are reliable and can be done in a clinic or with a home kit approved by your doctor. Blood tests are less useful because they show past exposure, not current infection. The breath test is the most accurate for detecting active H. pylori and is often used after treatment to confirm it’s gone.
Is surgery still used for peptic ulcers?
Rarely. Surgery was common before antibiotics and PPIs. Today, it’s only needed in emergencies-like if the ulcer bleeds uncontrollably, perforates the stomach wall, or blocks the digestive tract. Over 95% of peptic ulcers are now cured with medication alone.
What Should You Do Now?
If you’ve been told you have a peptic ulcer, don’t panic. This isn’t a life sentence. It’s a diagnosis with a clear, effective path forward. Get tested for H. pylori. Stop NSAIDs if you can. Take your antibiotics exactly as prescribed. Don’t skip your PPI doses. Quit smoking. Cut back on alcohol. Follow up with your doctor.Most people heal completely. And once the infection is gone and the lining repairs itself, you can get back to living without the pain-or the fear it’ll come back.