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Understanding Stomach Ulcers: What Happens in Your Body

A stomach ulcer is an open sore that develops in the lining of your stomach or small intestine. Your stomach normally produces acid to break down food and kill bacteria. The stomach's inner lining has a protective layer of mucus that shields it from this acid. When that protective layer breaks down, the acid can create painful sores.

According to the National Institutes of Health, approximately 6 million Americans develop ulcers each year. The two most common causes are infection with a bacterium called Helicobacter pylori (H. pylori) and regular use of nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and naproxen. H. pylori causes about 90 percent of duodenal ulcers and 70 percent of gastric ulcers. NSAID use accounts for most of the remaining cases.

Your stomach is constantly working to protect itself. The mucosal lining of your stomach renews itself roughly every three to five days. When bacteria damage this lining or when NSAIDs reduce the body's ability to create protective mucus, ulcers form. The sore can range from small to quite large, and the pain typically stems from stomach acid touching the exposed tissue.

Common symptoms of stomach ulcers include burning stomach pain (especially between meals or at night), feeling full quickly when eating, loss of appetite, nausea, vomiting, and dark or bloody stools. Some people experience no symptoms until serious complications develop. This is why understanding what causes ulcers and how they develop matters for your health decisions.

Practical Takeaway: Recognizing that ulcers result from specific causes—mainly bacterial infection or medication side effects—helps you understand that they are treatable conditions. If you experience persistent stomach pain, keeping a record of when pain occurs and what you were doing when it started can provide useful information to share with a healthcare provider.

Common Causes and Risk Factors You Should Know About

The bacterium H. pylori spreads from person to person, typically through contaminated food or water, or through close contact like sharing utensils or toothbrushes. This bacteria infects the stomach lining and causes chronic inflammation, which eventually leads to ulcer formation. Research shows that H. pylori affects roughly 4.4 percent of the U.S. population, though rates are higher in other countries and in certain age groups.

NSAIDs are medications many people take without thinking about potential stomach effects. Common NSAIDs include aspirin, ibuprofen (Advil, Motrin), and naproxen (Aleve). People taking these medications daily—whether for arthritis, headaches, or other chronic pain—face increased ulcer risk. The risk grows higher when NSAIDs are combined with corticosteroids or taken in high doses. People over age 65 are particularly vulnerable to NSAID-related ulcers.

Several other factors can increase your chance of developing an ulcer. Smoking damages the protective stomach lining and increases acid production. Alcohol irritates the stomach and can contribute to ulcer formation. Severe physical stress—such as major surgery, severe burns, or critical illness—can trigger stress ulcers. Some people have a family history of ulcers, suggesting a genetic component to ulcer susceptibility.

Contrary to popular belief, spicy food and stress do not directly cause ulcers, though they may worsen symptoms in some people. However, a common misconception blamed ulcers on these factors for many decades before scientists identified H. pylori in 1982. Understanding the actual causes helps you avoid feeling guilty about lifestyle factors that may not be responsible for your condition.

Certain medical conditions also raise ulcer risk. People with advanced liver disease, kidney failure, or severe lung disease face higher rates. Those taking medications that suppress stomach acid production for other reasons, or those with Zollinger-Ellison syndrome (a rare condition causing excessive stomach acid), need special consideration.

Practical Takeaway: If you take NSAIDs regularly or suspect you may have H. pylori infection, documenting your medication use and symptoms gives you important information. Noting when symptoms started relative to medication changes or travel to areas with poor sanitation can help guide conversations with healthcare providers.

Recognizing Symptoms and When to Seek Care

Stomach ulcer symptoms vary widely. Some people with ulcers experience no symptoms at all until complications develop. When symptoms do occur, the most common is burning abdominal pain—typically located between the navel and breastbone. This pain often develops two to three hours after eating or may wake you during the night. The pain may temporarily improve after eating food or taking antacids, since these actions buffer stomach acid.

Additional symptoms may include bloating, heartburn, loss of appetite (sometimes leading to unintended weight loss), nausea, and feeling uncomfortably full after eating only small amounts. Some people report vomiting, and in severe cases, vomit may contain blood (appearing dark red or like coffee grounds). Stools may appear black or tarry from old blood, or bright red if bleeding is recent and active.

The severity of symptoms does not always reflect the severity of the ulcer. A large ulcer may cause few symptoms, while a small ulcer can cause intense pain. This unpredictability is one reason why unexplained stomach pain warrants medical evaluation. A healthcare provider can distinguish ulcer-related pain from other conditions like acid reflux, gastritis, or irritable bowel syndrome.

You should seek medical care if you experience severe abdominal pain, bloody or black stools, vomiting blood, feeling faint or dizzy, or unexplained weight loss. These could indicate complications like internal bleeding or perforation (a hole in the stomach wall). Even without these severe symptoms, persistent stomach pain lasting more than a few weeks deserves professional attention.

Keeping a symptom diary helps you and a healthcare provider identify patterns. Record when pain occurs, what you were eating or doing beforehand, which foods or activities seem to trigger or worsen symptoms, and how long the pain lasts. Note any accompanying symptoms like nausea or changes in bowel habits. This information makes medical conversations more productive.

Practical Takeaway: While many stomach discomforts resolve on their own, ulcer symptoms that persist warrant medical evaluation. Creating a simple symptom log before your appointment—noting the type of pain, timing, and associated symptoms—provides concrete information that helps distinguish between various digestive conditions and guides appropriate testing.

Diagnostic Testing and What to Expect

When you report stomach symptoms to a healthcare provider, they may recommend several types of tests to determine whether an ulcer is present and identify its cause. The most common initial approach involves testing for H. pylori, since treating this infection cures most H. pylori-related ulcers.

H. pylori testing can be done through several methods. A breath test requires you to drink a special liquid, then breathe into a collection device. The bacteria produce unique compounds in your breath if present. Blood tests detect antibodies your body has created in response to H. pylori infection. Stool tests can also identify H. pylori antigens. An endoscopy—a procedure where a thin camera on a flexible tube is passed down your throat to visualize your stomach—allows direct observation and permits tissue samples (biopsies) for testing.

Upper endoscopy is often performed when ulcer complications are suspected or when symptoms are severe. During this procedure, a gastroenterologist can see the exact location and size of the ulcer, determine if bleeding is present, and take samples to test for H. pylori or rule out stomach cancer. While the procedure sounds uncomfortable, most patients receive sedation and report only mild discomfort or no memory of it.

Additional imaging tests like CT scans or X-rays with barium may be recommended in certain situations. These tests create detailed pictures of your digestive tract and help identify complications. Blood tests may check your hemoglobin levels to determine if chronic bleeding has caused anemia.

If you take NSAIDs regularly, your provider may stop or reduce these medications as part of ulcer treatment. They will likely test for H. pylori simultaneously. Some providers recommend testing even before symptoms develop if you take NSAIDs long-term, particularly if you are over 65 or have other risk factors.

Practical Takeaway: