Someone in your family probably told you at some point that peptic ulcers come from worrying too much. Or maybe you blamed that extra-spicy curry you had last Tuesday. We’ve all heard some version of this. And honestly, it’s hard to know what to believe when there’s so much noise out there about stomach problems.
Here’s the thing, though, most of what people “know” about peptic ulcers is flat-out incorrect. That matters because if you’re blaming the wrong thing, you’re never going to fix the actual problem. And for a lot of people reading this, that burning feeling in the gut isn’t going away on its own.
Let’s talk about what’s really going on.
First, What Exactly Is a Peptic Ulcer?
Think of the lining of your stomach and small intestine as having a protective coating, a thick layer of mucus that sits between your digestive acid and the tissue underneath. When that coating gets worn down or damaged, the acid starts eating into the lining itself. That’s a peptic ulcer: a raw, open sore on the inside of your digestive tract.
Depending on where the sore develops, it gets a different name:
- Gastric ulcers sit in the stomach lining itself
- Duodenal ulcers show up in the duodenum, which is the very first stretch of the small intestine right after the stomach. This is actually the most common location
- Esophageal ulcers form in the esophagus and are less common, often tied to acid reflux or certain medications
Peptic ulcer disease (PUD) isn’t some rare thing that only happens to other people. Around 1 in 10 Americans will deal with it at some point in their life, and about 500,000 new cases are diagnosed every year in the U.S. It’s common, and the good news is, it responds really well to the right treatment.
The Myths That Keep Getting Repeated
Before we get into what actually causes peptic ulcers, it’s worth clearing the air on a few things people have been getting wrong for decades.
“It’s from all the stress you’re under”
Stress gets blamed for ulcers all the time, but that’s not really how it works. It can make pain feel worse and slow healing down, but it doesn’t actually create the ulcer. The biology just doesn’t support it.
That said, extreme physical stress is a different story. Someone recovering from major surgery or a serious injury can develop what doctors call a stress ulcer. That’s a specific medical situation, not the kind of stress that comes from a rough week at work.
“You eat too much spicy food”
Spicy food gets a bad rap with this one. If you already have a peptic ulcer, certain foods and drinks can aggravate it and make the pain worse. But no amount of hot sauce is going to punch a hole in a healthy stomach lining. Spicy food is a trigger for discomfort, not a cause of the condition.
What Actually Causes Peptic Ulcers
A Bacterial Infection Most People Don’t Know They Have
Back in the early 1980s, two Australian doctors, Barry Marshall and Robin Warren, discovered that a bacterium was behind most peptic ulcers. Nobody believed them. Marshall literally drank a petri dish full of the bacteria to prove his point. They won the Nobel Prize for it in 2005.
That bacterium is H. pylori. It quietly burrows into your stomach lining, weakens its protective layer, and raises acid levels often for years before you notice anything wrong.
It causes around 60% of all peptic ulcers. But here’s the interesting part: most people who carry H. pylori never actually develop an ulcer. Smoking, heavy drinking, and regular NSAID use seem to be what push some people over the edge.
You can learn more about how we diagnose and treat H. pylori at GI Partners of Illinois.
Pain Relievers You Take Without Thinking Twice
The other big culprit is NSAIDs, ibuprofen, naproxen, and aspirin. The kind of stuff most of us grab without thinking twice.
These medications block enzymes that cause pain, but those same enzymes also protect your stomach lining. Use NSAIDs occasionally, and you’re probably fine. Take them regularly for months, and that lining starts to break down.
People managing chronic pain or taking daily low-dose aspirin for heart health need to be especially careful here. Worth knowing: Tylenol works differently and doesn’t carry the same stomach risk, which is why doctors often recommend it as the safer swap.
If NSAIDs are part of your daily routine, bring it up with your GI doctor. There are ways to protect your stomach while still managing your pain.
Other Things That Tip the Odds Against You
H. pylori and NSAIDs together account for the vast majority of peptic ulcer cases. But a handful of other factors can either contribute directly or make an existing ulcer harder to recover from:
- Smoking throws off the balance of acid and protective factors in the stomach, and it dramatically slows the healing process once an ulcer has formed
- Regular heavy drinking wears away at the stomach lining and amplifies the damage
- Certain medications like corticosteroids and blood thinners, especially when taken alongside NSAIDs, can increase risk
- Rare medical conditions like Zollinger-Ellison syndrome cause the stomach to overproduce acid in ways that can lead to ulcers even without H. pylori or NSAID use
How Do You Know If You Have Peptic Ulcers?
Some people have no idea they have a peptic ulcer until a routine scope catches it by accident. Others feel it is clearly a burning or gnawing pain in the upper abdomen, usually between meals or in the middle of the night when there’s nothing in the stomach to absorb the acid.
Other signs to watch for:
- Nausea or vomiting
- Bloating or persistent indigestion
- Loss of appetite
- Unexplained weight loss
Some symptoms can’t wait, though. Go get checked the same day if you notice:
- Black or tarry stools
- Vomiting blood or something that looks like coffee grounds
- Sudden, severe abdominal pain that won’t let up.
Getting a Diagnosis for Peptic Ulcers
Your doctor will start with your symptoms and a physical exam. If a peptic ulcer is suspected, an upper endoscopy is usually the next step. A thin, flexible scope goes through the mouth so the doctor can directly see what’s happening inside your stomach and small intestine.
H. pylori testing is standard in any ulcer workup. It can be done through a breath test, stool test, blood test, or a biopsy taken during the endoscopy.
Wondering what to expect? Check out the procedures we offer at GI Partners of Illinois.
What Treatment Looks Like for Peptic Ulcers
Peptic ulcers heal well, but the treatment has to match the cause.
H. pylori? A short course of antibiotics paired with an acid-suppressing medication, usually for 10 to 14 days. Finish the full course. Stopping early is exactly how ulcers come back and how antibiotic resistance develops.
NSAIDs? Stop or reduce the medication if possible. Acid reducers help the lining recover, sometimes alongside a stomach-protective medication.
On top of that, a few lifestyle shifts make a real difference:
- Quit smoking, it genuinely slows healing
- Cut back on alcohol while the ulcer is active
- Eat regular meals instead of going hours without food
- Avoid whatever foods you know set your symptoms off
Can Peptic Ulcers Be Prevented?
You can’t control everything; some risk factors are harder to avoid than others. But there’s quite a bit within your reach:
- Take NSAIDs only when you genuinely need them. If long-term use is unavoidable, ask your doctor about stomach-protecting strategies.
- If you have recurrent upper GI symptoms or a family history of ulcers, get tested for H. pylori. It’s a simple test, and treating the infection early prevents a lot of downstream trouble.
- Smoking and heavy drinking both work against you; quitting or cutting back improves your gut health in more ways than just ulcer risk.
- Pay attention to symptoms that linger. A week of stomach discomfort that doesn’t improve deserves a proper look, not another round of antacids.
That Burning Feeling Isn’t Normal. Let’s Figure It Out.
You don’t have to keep guessing or keep hurting.
At GI Partners of Illinois, we see patients across the Chicago area who’ve been dealing with stomach pain for months, sometimes years, before finally getting answers. One appointment can change that.
Book your visit at GI Partners of Illinois today and walk out with a real plan, not just another maybe.
Frequently Asked Questions
Is a peptic ulcer the same as GERD or acid reflux?
Not the same thing. GERD is acid backing up into the esophagus. A peptic ulcer is actual damage to the stomach or intestinal lining. They’re different conditions.
Can I take ibuprofen if I’ve had ulcers before?
Check with your GI doctor first. There are safer options worth knowing about. COX-2 inhibitors are gentler on the stomach, and pairing a PPI with NSAIDs can help if you can’t avoid them altogether.
What foods should you avoid with an ulcer?
There’s no single list that works for everyone, but coffee, alcohol, spicy foods, citrus, and carbonated drinks are common triggers of peptic ulcers. Pay attention to what consistently bothers you; that’s your personal list.
Which organ is most affected by peptic ulcers?
The stomach is most commonly affected, though peptic ulcers can also develop in the upper part of the small intestine, called the duodenum, which is actually where they show up most often.
