A peptic ulcer, often called a stomach ulcer, is an open sore in the lining of the stomach or the upper part of the small intestine. It forms when stomach acid damages the protective lining, most often because of a bacterial infection or the long-term use of common pain relievers. Contrary to a widespread belief, stress and spicy food do not cause ulcers, though they can make symptoms worse. Peptic ulcers are very treatable once the cause is identified, and most heal within weeks. This guide explains what a peptic ulcer is, its symptoms and warning signs, what actually causes it, how it is diagnosed, the treatments that heal it, and the latest research on eradicating the bacteria behind many ulcers.
What is a peptic ulcer?
A peptic ulcer is a sore that develops where stomach acid and a digestive enzyme called pepsin erode the protective lining of the digestive tract. When the sore is in the stomach itself, it is called a gastric ulcer; when it is in the duodenum, the first part of the small intestine, it is called a duodenal ulcer. Both are grouped together as peptic ulcer disease.
Ulcers happen when the balance between stomach acid and the lining’s natural defenses breaks down, allowing acid to damage the tissue underneath. Interestingly, up to 70 percent of people with peptic ulcers have no symptoms at all, and ulcers are often discovered only when they cause pain or a complication. The great majority heal fully with appropriate treatment, usually within a few weeks to about two months.
| Type | Where it forms |
|---|---|
| Gastric ulcer | In the lining of the stomach |
| Duodenal ulcer | In the duodenum, the first part of the small intestine |
Symptoms of a peptic ulcer
The most common symptom is a burning or gnawing pain in the upper abdomen, somewhere between the breastbone and the navel. The pain often has a relationship to eating and may come and go over days or weeks, and many people notice it at night. Other symptoms include bloating, belching, heartburn, nausea, and feeling full quickly. Because many ulcers cause no symptoms, their first sign is sometimes a complication.
Certain symptoms are red flags for a bleeding or perforated ulcer and need urgent medical care. These include vomiting blood or material that looks like coffee grounds, black or tarry stools, sudden severe abdominal pain, and signs of significant blood loss such as lightheadedness or weakness. Slow, hidden bleeding from an ulcer can also lead to iron-deficiency anemia over time, causing fatigue and paleness.
What causes peptic ulcers?
Two causes account for the large majority of peptic ulcers. The first is infection with Helicobacter pylori, a bacterium that lives in the stomach lining and can spread between people through contact with saliva, vomit, or stool. The second is regular, long-term use of nonsteroidal anti-inflammatory drugs, or NSAIDs, such as aspirin, ibuprofen, and naproxen, which weaken the stomach’s protective mucous layer.
It is worth clearing up a common myth: stress and spicy food do not cause peptic ulcers, although they can aggravate the symptoms of an existing one. Other factors that raise risk include being over 60, having had a previous ulcer, taking high doses or combinations of NSAIDs, smoking, and drinking alcohol. Because the causes overlap with other digestive conditions, ulcers are sometimes considered alongside the stomach-lining inflammation of gastritis and the acid symptoms of acid reflux.
How a peptic ulcer is diagnosed
The most direct way to diagnose a peptic ulcer is upper endoscopy, in which a thin, flexible camera is passed into the stomach and duodenum to see the ulcer directly and take small tissue samples. Those samples can confirm the ulcer, test for H. pylori, and rule out other causes. Endoscopy is especially important for older adults or anyone with warning signs.
Testing for H. pylori is a central part of the workup and can be done without endoscopy in many cases. A urea breath test detects the bacteria from a breath sample, and a stool antigen test looks for signs of the bacteria in a stool sample; understanding the Helicobacter pylori antigen measured in stool shows how this noninvasive option works. Blood tests help detect complications, since a complete blood count can reveal anemia from a slowly bleeding ulcer, and a fecal occult blood test that checks for hidden blood in the stool can flag bleeding as well. Learning how to read the flags and reference ranges on a lab report can help you follow these results.
Treatment options for peptic ulcers
Treatment targets both the sore and its cause. Reducing stomach acid lets the ulcer heal, and proton pump inhibitors are the mainstay for this. When H. pylori is present, eradicating it with a combination of antibiotics plus acid suppression is essential, both to heal the ulcer and to prevent it from coming back. For ulcers caused by NSAIDs, stopping or switching the medication, lowering the dose, or adding ongoing acid protection is key.
| Approach | Role |
|---|---|
| Acid-reducing medicine | Proton pump inhibitors lower stomach acid so the ulcer can heal |
| H. pylori eradication | A combination of antibiotics plus acid suppression to clear the infection |
| NSAID management | Stopping, switching, or lowering NSAIDs, or adding acid protection |
| Follow-up | Confirming H. pylori is gone and, for gastric ulcers, that healing is complete |
Most peptic ulcers heal within a few weeks to about two months once the cause is addressed. Confirming that H. pylori has been cleared after treatment is important, because rising antibiotic resistance can cause standard regimens to fail. A newer class of acid-blocking drug is also expanding the options for treating ulcers and eradicating the bacteria, which research suggests can improve cure rates.
Complications and when a peptic ulcer is serious
Although most ulcers heal well, untreated peptic ulcers can lead to serious complications. Bleeding is the most common and can be slow, causing anemia, or sudden and severe, which is an emergency. Understanding the low red blood cell counts of anemia helps explain the fatigue that a slowly bleeding ulcer can cause. Less commonly, an ulcer can create a hole through the wall of the stomach or intestine, called perforation, or cause swelling and scarring that blocks the passage of food, called obstruction; both require immediate care.
There is also an important long-term reason to take H. pylori seriously: the infection increases the risk of stomach cancer over time, so clearing it matters beyond healing a single ulcer. This connection is one reason doctors test for and treat the bacteria thoroughly, and it links peptic ulcer disease to the risk factors described in this guide to stomach cancer.
Latest scientific advances in peptic ulcer research
Recent research centers on the biggest challenge in curing ulcers caused by H. pylori: antibiotic resistance. According to PubMed-indexed research, a 2026 review in Gastroenterology described how rising resistance to the antibiotics traditionally used against H. pylori is undermining standard treatments and driving a shift toward newer regimens, along with early-stage approaches such as vaccines and other novel therapies (Rokkas et al., 2026). What this means for you: the medicines used to clear the ulcer-causing bacterium are changing, which is why your doctor may choose a different combination than in years past and may confirm the infection is gone after treatment.
A 2026 network meta-analysis in Frontiers in Physiology compared newer acid-blocking regimens and found that combinations built around the potassium-competitive acid blocker vonoprazan achieved the highest H. pylori cure rates, around 90 percent, though most evidence came from Asian populations (Mi et al., 2026). What this means for you: a newer class of acid suppressant is improving cure rates for the infection behind many ulcers. A separate 2026 analysis in the Journal of Gastroenterology and Hepatology found that a simpler two-drug vonoprazan regimen was as effective as a more complex four-drug therapy, with fewer side effects (Passos et al., 2026). What this means for you: treatment may become simpler and easier to tolerate, though these newer approaches still need more testing in United States populations.
Glossary of key peptic ulcer terms
| Term | Definition |
|---|---|
| Peptic ulcer | An open sore in the lining of the stomach or upper small intestine. |
| Gastric ulcer | A peptic ulcer located in the stomach. |
| Duodenal ulcer | A peptic ulcer located in the first part of the small intestine. |
| Helicobacter pylori | A bacterium that infects the stomach and causes many ulcers. |
| NSAIDs | Common pain relievers such as ibuprofen that can damage the stomach lining. |
| Proton pump inhibitor | A medicine that strongly reduces stomach acid to allow healing. |
| Perforation | A hole through the wall of the stomach or intestine, a medical emergency. |
Frequently asked questions about peptic ulcers
What is the difference between a peptic ulcer and a stomach ulcer?
The terms overlap. “Peptic ulcer” covers sores in both the stomach and the upper small intestine, while “stomach ulcer,” or gastric ulcer, refers specifically to one in the stomach. A peptic ulcer in the small intestine is called a duodenal ulcer.
Can stress or spicy food actually cause a peptic ulcer?
No. The main causes are H. pylori infection and long-term NSAID use, not stress or spicy food. However, stress and certain foods can worsen the symptoms of an existing ulcer, so managing them may help you feel better while the ulcer heals.
What are the symptoms of a peptic ulcer?
The most common symptom is burning or gnawing upper abdominal pain, often related to meals and sometimes worse at night, along with bloating, belching, heartburn, and nausea. Many ulcers cause no symptoms, and warning signs like vomiting blood or black stools indicate a bleeding ulcer and need urgent care.
How is a peptic ulcer diagnosed?
Doctors often use upper endoscopy to see the ulcer directly and take biopsies, and they test for H. pylori with a urea breath test, a stool antigen test, or a biopsy. Blood tests can detect anemia from bleeding, and a fecal occult blood test can reveal hidden blood in the stool.
Can a peptic ulcer be cured, and how long does treatment take?
Yes. Most peptic ulcers heal within a few weeks to about two months once the cause is treated, whether that means eradicating H. pylori with antibiotics and acid suppression or stopping NSAIDs. Confirming that H. pylori is gone helps prevent the ulcer from returning.
How dangerous is an untreated peptic ulcer?
Untreated ulcers can cause serious complications, including bleeding, a hole through the stomach or intestine wall, and blockage of the digestive tract, all of which can be life-threatening. In addition, long-term H. pylori infection raises the risk of stomach cancer, so proper diagnosis and treatment matter.
Sources
- National Institute of Diabetes and Digestive and Kidney Diseases — Peptic Ulcers (Stomach Ulcers) — NIDDK, 2024 — niddk.nih.gov
- Mayo Clinic Staff — Peptic Ulcer: Symptoms and Causes — Mayo Clinic, 2024 — mayoclinic.org
- Cleveland Clinic — Peptic Ulcer Disease — Cleveland Clinic Health Library, 2023 — my.clevelandclinic.org
- Rokkas T, Graham DY, et al. — The Unfinished Agenda in Helicobacter pylori Treatment: Resistance, Microbiome Effects, and Future Directions — Gastroenterology, 2026 — doi.org/10.1053/j.gastro.2026.02.041
- Mi C, Zhou K, Shi Y, et al. — Comparing potassium-competitive acid blocker-based therapies for Helicobacter pylori infection: A Bayesian network meta-analysis — Frontiers in Physiology, 2026 — doi.org/10.3389/fphys.2026.1843686
- Passos PRC, Filho VOC, Noronha MM, et al. — Vonoprazan-Amoxicillin Dual Therapy as an Alternative for Bismuth-Based Quadruple Therapy: A Systematic Review and Noninferiority Meta-Analysis — Journal of Gastroenterology and Hepatology, 2026 — doi.org/10.1111/jgh.70565
Further reading
- Understand a related stomach condition in this guide to the stomach-lining inflammation of gastritis.
- Compare ulcer pain with a common acid problem in this guide to the symptoms and treatment of acid reflux.
- See how the bacterium behind many ulcers is detected in this guide to the Helicobacter pylori stool antigen test.
- Learn about a complication of a bleeding ulcer in this guide to the causes and symptoms of anemia.
- Build confidence reading test results with this guide to reference ranges, flags, and next steps on a lab report.
Understand your lab results with BloodSense
A peptic ulcer touches several parts of a lab workup, from the stool test that detects the H. pylori bacterium to the blood counts that reveal anemia from a slowly bleeding ulcer. Seeing how each value sits against its reference range makes it easier to understand what your tests are showing and what to do next. BloodSense translates a full lab report into plain language, showing what each marker means and helping you track changes over time instead of reading one line in isolation.
