Vomiting blood, black tarry stools, or sudden severe abdominal pain needs emergency care immediately. Bleeding and perforation are the serious complications of ulcers and both are emergencies. Go to the nearest hospital.
An ulcer in the stomach or the first part of the small intestine. Most are caused by Helicobacter pylori infection or by anti-inflammatory painkillers, and both causes are treatable.
The important point is that this is usually a curable infection rather than a chronic condition. Treating the acid without eradicating the bacterium means the ulcer returns as soon as the tablets stop.
The stomach lining is protected from its own acid by a mucus barrier. When that barrier is breached, acid erodes into the wall and produces an ulcer — in the stomach itself or, more commonly, in the duodenum just beyond it.
Two causes account for the large majority. Helicobacter pylori is a bacterium that colonises the stomach lining, causes chronic inflammation, and is present in a large proportion of the population across South Asia, the Middle East and Africa. Non-steroidal anti-inflammatory drugs — including ordinary painkillers taken for joint pain — damage the protective barrier directly and are a very common cause in older patients.
The distinction matters because treatment differs entirely. An ulcer caused by H. pylori is cured by eradicating the bacterium. An ulcer caused by painkillers is treated by stopping them and protecting the stomach. Suppressing acid alone treats neither cause, and the ulcer returns when the tablets stop.
H. pylori also matters beyond ulcers: it is a recognised cause of stomach cancer, and eradicating it reduces that risk. In populations where stomach cancer is common, that is a substantial argument for testing and treating.
Two errors are common. The first is treating an ulcer with acid-suppressing tablets alone without ever testing for H. pylori, so the underlying cause remains and the ulcer returns. The second is treating the infection and never checking whether it cleared. Antibiotic resistance is now common across South Asia and the Middle East, and eradication fails in a meaningful proportion of patients — silently, because symptoms may improve anyway. A urea breath test or stool antigen test at least four weeks after finishing treatment, and off acid-suppressing tablets for two weeks beforehand, confirms whether it worked. Ask for that confirmation rather than assuming.
Testing for the cause matters as much as seeing the ulcer.
Anti-inflammatory painkillers are among the commonest causes of ulcers and patients rarely mention them, because they are bought over the counter for knee or back pain and not thought of as medication. Include everything — tablets, powders and injections, and any traditional preparation. Send that list alongside your endoscopy report, any H. pylori test result with its date, and a note of whether you were taking acid-suppressing tablets when the test was done.
Cure the cause rather than suppressing the symptom.
A combination of two or three antibiotics with an acid-suppressing drug, taken for ten to fourteen days. Regimens differ by region because resistance patterns differ, and local guidance matters. Completing the full course exactly as prescribed is what determines success — partial courses drive resistance.
A urea breath test or stool antigen test at least four weeks after finishing antibiotics, having stopped acid-suppressing tablets two weeks beforehand. Eradication fails in a meaningful proportion of patients and it fails silently. This step is frequently omitted and it should not be.
Stopping the anti-inflammatory painkiller where possible, and where it cannot be stopped, adding a proton pump inhibitor for protection. Alternative pain treatments should be explored, since ongoing use with an ulcer risks bleeding and perforation.
Endoscopic treatment of a bleeding ulcer — injection, clips or thermal therapy — is highly effective and is the standard first response. Surgery is now reserved for perforation, bleeding that endoscopy cannot control, or obstruction from scarring.
H. pylori, painkillers, or both. The treatment differs completely and suppressing acid alone treats neither.
Not assumed — tested, at least four weeks after treatment and off acid suppression.
Stomach ulcers need biopsy to exclude cancer and repeat endoscopy to confirm healing. Duodenal ulcers generally do not.
If you have been on acid-suppressing tablets for years without ever being tested for H. pylori, that test is the most useful thing you could arrange — and it can be done where you are.
A bleeding or perforated ulcer is a surgical emergency requiring endoscopy or an operation within hours. Both are treated where you are.
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A bacterium that colonises the stomach lining, causing chronic inflammation and most peptic ulcers. It is very common across South Asia, the Middle East and Africa. It also raises the risk of stomach cancer, so eradicating it has benefits beyond healing the ulcer. It is cured with a course of antibiotics.
Because eradication fails in a meaningful proportion of patients — antibiotic resistance is now common — and it fails silently, since symptoms may improve anyway. A breath or stool test at least four weeks afterwards, off acid-suppressing tablets for two weeks, confirms whether it worked. This step is often skipped and it should not be.
Very possibly. Anti-inflammatory painkillers taken for joint or back pain are among the commonest causes of ulcers, particularly in older patients, and they are frequently not mentioned because they are bought without prescription. Bring a complete list of everything you take, including powders and traditional preparations.
It depends on your age and symptoms. Younger patients without alarm features can reasonably be tested for H. pylori and treated without endoscopy. Endoscopy is needed where there is bleeding, weight loss, difficulty swallowing, persistent vomiting, anaemia, or in older patients, because these raise the possibility of cancer.
They differ in one important respect. Gastric ulcers require biopsy to exclude cancer, and repeat endoscopy afterwards to confirm they have healed. Duodenal ulcers are almost never malignant and do not need this. Both are usually caused by H. pylori or painkillers.
Not usually, if the cause is properly addressed. Successfully eradicating H. pylori cures most ulcers permanently, and stopping the responsible painkiller does the same. Recurrence after apparently successful treatment usually means the eradication failed, the painkillers resumed, or another cause exists.
Send your endoscopy report and any H. pylori result with its date, and list every painkiller you take — including ones you buy yourself.
Your reports go directly to our medical team. We do not share your records with hospitals until you tell us to.
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