Stomach ulcers are a common and treatable health condition, but they can become serious if not treated promptly. Before discussing the main symptoms, it’s important to understand some key facts about this condition: (1)

Definition

A stomach ulcer is an open sore that develops on the inner lining of the stomach or the intestines.

Types

The two most common types are:

  • Gastric ulcer (stomach ulcer): occurs in the wall of the stomach.
  • Duodenal ulcer: occurs at the beginning of the small intestine (duodenum) and is more common. It is possible for a person to have both types simultaneously.

Causes

The most common causes of stomach ulcers are:

  • Helicobacter pylori (H. pylori) bacteria
  • Long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen

Symptoms

  • Recurring burning stomach pain
  • Up to 70% of patients may have no clear symptoms

Complications

  • Bleeding: can be slow and unnoticed or severe and life-threatening
  • Perforation: a hole in the stomach wall
  • Obstruction: blockage in the stomach

Detailed Symptoms of Stomach Ulcers

The most common symptom is a burning pain in the upper abdomen, usually below the breastbone and above the navel. Pain may:

  • Worsen after eating (stomach ulcer) or when the stomach is empty (duodenal ulcer)
  • Last from a few minutes to several hours
  • Occasionally wake the patient at night due to discomfort
  • Be temporarily relieved by certain foods (like cucumber, banana, milk) or antacids
  • Be associated with bloating, nausea, vomiting, burping, changes in appetite or weight

Symptoms may disappear for days or weeks and then return, causing intermittent pain.

Symptoms of Ulcer Bleeding

Sometimes, an ulcer can cause bleeding, producing symptoms such as: (2)

  • Blood in vomit: may be red or black, sometimes resembling coffee grounds
  • Black or tarry stools
  • Persistent nausea or vomiting
  • Symptoms of anemia if bleeding continues, such as fatigue, shortness of breath, or pale skin

Seek emergency care immediately if you experience:

  • Vomiting blood
  • Sudden, severe abdominal pain that worsens over time

Difference Between Stomach and Duodenal Ulcer Symptoms

Symptoms are very similar and can only be definitively distinguished with endoscopy, but timing may differ slightly: (3)

  • Stomach ulcer: pain usually increases after eating, as food triggers more stomach acid.
  • Duodenal ulcer: pain usually improves after eating but returns a few hours later when the stomach empties; often recurs at night.

Treatment of Stomach Ulcers

With proper treatment:

  • Duodenal ulcers usually heal within 4 weeks
  • Stomach ulcers usually heal within 8 weeks (5)

1. Antacids and Acid-Reducing Medications

These are the mainstay treatment for ulcers: they reduce stomach acid, allowing the ulcer to heal gradually.

  • Proton Pump Inhibitors (PPIs) are commonly used, such as:
  • Esomeprazole (Nexium)
  • Lansoprazole (Lanzor)
  • Omeprazole (Gasex)

2. Treating H. pylori Infection

If the ulcer is caused by H. pylori, antibiotics are added to the treatment, usually as quadruple therapy, which is preferred in regions with high antibiotic resistance.

Quadruple therapy generally includes:

  • Two antibiotics
  • Bismuth subsalicylate (or a third antibiotic in some cases)
  • Acid-reducing medication (PPI)

Triple therapy (two antibiotics + PPI) is now less commonly used, only in areas with low resistance. (3)

  • Important: Complete the full course of treatment, even if symptoms disappear, to fully eradicate H. pylori.

Duration of Treatment

  • Antibiotics for H. pylori: usually 10–14 days
  • Acid-reducing medication: may continue for several weeks to ensure full healing (1)
  • After treatment, a confirmatory test (breath or stool test) is recommended to ensure H. pylori eradication.

Tips for Healing Stomach Ulcers

  • Avoid NSAIDs like ibuprofen or naproxen; consult your doctor for safer alternatives such as paracetamol (acetaminophen)
  • Quit smoking: it slows healing and increases complications
  • Avoid foods that irritate the stomach, such as fatty, fried, or spicy foods
  • Take medications exactly as prescribed and follow up with your doctor to ensure healing





References


  1. American College of Gastroenterology - Peptic Ulcer Disease Overview
  2. Gastrointestinal Society - Ulcer Disease
  3. Up To Date - Patient education: Peptic ulcer disease (Beyond the Basics) - UpToDate
  4. The American Journal of Gastroenterology - ACG Clinical Guideline: Treatment of Helicobacter pylori Infection