A stomach ulcer is an open sore in the lining of the stomach. Doctors may also use the broader term peptic ulcer, which includes ulcers in the stomach and the first part of the small intestine. Stomach ulcers are common, treatable, and very often caused by either Helicobacter pylori (H. pylori) infection or regular use of non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, naproxen or aspirin.
Many people assume an ulcer is just “too much acid” or stress, but that is usually too simplistic. Stress can make upper-digestive symptoms feel worse, and smoking or alcohol may make healing harder, but the two main causes clinicians look for are H. pylori and NSAID use.
This guide explains what stomach ulcers are, what symptoms they cause, how H. pylori fits in, how diagnosis usually works in the UK, what treatment involves, and when symptoms should never be ignored.
If your symptoms are more general or overlap with other digestive problems, you may also find these helpful: Digestive Health: Symptoms, Common Conditions and Treatments, Heartburn, Acid Reflux and GORD, and Bloating: Common Causes, Relief and When to Worry.
What is a stomach ulcer?
A stomach ulcer happens when the stomach lining is damaged enough for a sore to form. Normally, the stomach protects itself against acid. But if those defences are weakened, acid can irritate and damage the lining instead. That is one reason H. pylori infection and NSAIDs matter so much: both can reduce the stomach’s natural protection.
Some ulcers are mild and heal quickly once the cause is treated. Others are more persistent. A small number can lead to bleeding, perforation or blockage, which is why persistent symptoms or warning signs should not be shrugged off. NHS guidance advises urgent assessment for warning symptoms such as vomiting blood, black stools, sudden severe pain, or signs of bleeding.
Common causes of stomach ulcers
1. H. pylori infection
H. pylori is a type of bacteria that can live in the stomach. Many people with H. pylori do not know they have it, but in some people it causes inflammation and contributes to ulcer formation. Treating the infection is a key part of treatment because the ulcer is much more likely to come back if the infection is left in place.
Real-life example: someone has months of gnawing upper-abdominal pain, keeps buying antacids, gets temporary relief, then the symptoms return. Testing later shows H. pylori infection. In that kind of case, acid-lowering treatment alone may not be enough unless the bacteria are also eradicated. This follows the treatment approach described by NHS and NICE guidance.
2. NSAID painkillers
NSAIDs include medicines such as ibuprofen, naproxen, diclofenac and aspirin. These drugs can interfere with the stomach’s protective lining and increase the risk of ulcers, especially with regular use, higher doses, older age, or previous ulcer history. Even “ordinary” over-the-counter pain relief can matter here.
Real-life example: someone with back pain takes ibuprofen most days for weeks, then develops burning or gnawing pain in the upper abdomen, nausea and indigestion. That is a classic situation where an ulcer has to be considered.
3. Less common factors
Smoking and heavy alcohol use are not usually the main root cause in the way H. pylori and NSAIDs are, but they may worsen upper-digestive symptoms and can make ulcer healing harder. Rarely, ulcers may be linked to other medical problems.
Symptoms of a stomach ulcer
The most typical symptom is a burning, gnawing or aching pain in the upper abdomen, usually somewhere between the breastbone and the tummy button. NHS guidance also lists symptoms such as indigestion, heartburn, loss of appetite, nausea, vomiting and weight loss.
Common symptoms may include:
- burning or gnawing pain in the upper tummy
- indigestion
- heartburn
- feeling full quickly
- bloating or burping after eating
- feeling sick
- loss of appetite
- weight loss in some cases
Symptoms are not always dramatic. Some people have a fairly vague pattern: discomfort after meals, repeated indigestion, and a sense that something in the upper stomach “isn’t right”. Others get more obvious pain that comes and goes for weeks.
What ulcer pain can feel like
Ulcer pain is often described as a dull, burning, gnawing or hunger-like discomfort in the upper abdomen. It may come and go, and it may briefly improve with antacids or acid-lowering treatment, only to return later if the underlying cause has not been dealt with. That pattern can fool people into thinking the problem is minor when it is actually persisting.
Not every case of indigestion is an ulcer, of course. Reflux, gastritis and other causes of dyspepsia can feel similar. That is why recurring upper-abdominal symptoms need a proper look at the pattern, risk factors and warning signs. NICE guidance treats dyspepsia and peptic ulcer disease as structured clinical problems rather than something patients should self-diagnose indefinitely.
H. pylori: why it matters so much
H. pylori matters because it is both common and treatable. If it is present and linked to an ulcer, the usual aim is not just to suppress acid for a while, but to eradicate the infection. NICE and NHS guidance both describe treatment with antibiotics plus an acid-lowering medicine.
A practical point that often gets missed is that acid-lowering medicines can affect H. pylori testing. NICE quality standards say adults receiving proton pump inhibitors should usually have a 2-week washout before H. pylori testing. That is one reason self-treating for weeks and then requesting a test later can complicate things.
How stomach ulcers are diagnosed in the UK
Diagnosis often starts with a GP or specialist asking about the pain, indigestion, NSAID use, previous ulcer history, bleeding symptoms and weight loss. Depending on the situation, you may be offered:
- H. pylori testing
- blood tests, especially if bleeding or anaemia is a concern
- an endoscopy or gastroscopy
NICE guidance on dyspepsia and GORD includes recommendations on H. pylori testing and management, while NHS stomach ulcer guidance explains that some people will also need tests to confirm the ulcer and check it has healed.
Gastroscopy or endoscopy
A gastroscopy is a test in which a thin flexible camera is passed through the mouth to look at the oesophagus, stomach and duodenum. If an ulcer is seen, biopsies may be taken. This can help confirm the diagnosis, test for H. pylori in some cases, and rule out other causes. Some NHS hospital guidance notes that gastric ulcers are often biopsied because, rarely, an ulcer can be linked to cancer rather than a straightforward benign ulcer.
Many people worry about gastroscopy, but it is a routine test. The most important thing is not to delay assessment if symptoms or warning signs suggest you need it.
Treatment for a stomach ulcer
Treatment depends on the cause. NHS guidance says treatment may include antibiotics for H. pylori and medicines to reduce stomach acid, usually proton pump inhibitors. Treatment duration varies depending on the cause, but NHS notes it can range from about 1 week to 2 months.
If H. pylori is the cause
The usual treatment is a combination of two antibiotics plus an acid-lowering medicine. Some NHS patient leaflets describe this as triple therapy, commonly taken for around a week. It is important to complete the course properly.
Common side effects can include nausea, indigestion, diarrhoea or a strange taste in the mouth. These are unpleasant but usually temporary.
If NSAIDs are the cause
If an NSAID has caused or contributed to the ulcer, the medicine may need to be stopped, changed or reviewed, and acid-lowering treatment is usually given. Do not stop prescribed medicines without medical advice, especially if you take aspirin or anti-inflammatory medicine for another important reason.
Acid-lowering medicines
Proton pump inhibitors are commonly used because they reduce acid and give the stomach lining a chance to heal. In some cases, further testing is needed after treatment to make sure the ulcer or infection has resolved. NHS stomach ulcer guidance notes that follow-up testing may be needed.
What you can do while recovering
While medical treatment is central, a few practical steps may help recovery and reduce irritation:
- avoid NSAID painkillers unless a clinician says they are safe for you
- take treatment exactly as prescribed
- avoid smoking if possible
- go easier on heavy alcohol use
- avoid repeatedly relying on over-the-counter indigestion remedies without follow-up if symptoms persist
These steps support healing, but they do not replace proper treatment of H. pylori or review of NSAID use.
What to avoid
- assuming repeated indigestion is always “just reflux”
- taking ibuprofen or naproxen day after day without considering the stomach effects
- starting and stopping acid tablets randomly without investigating the cause
- ignoring black stools, vomiting blood or unexplained weight loss
- stopping prescribed aspirin or other medicines without medical advice
One common mistake is getting short-lived relief from antacids and assuming the problem has gone away. Ulcer symptoms often improve temporarily but return if the cause is still there.
Red-flag symptoms: when to seek urgent help
Seek urgent medical help if you have:
- vomited blood
- black, tarry stools
- sudden severe abdominal pain
- difficulty breathing, dizziness or collapse with suspected bleeding
- symptoms suggesting a stomach bleed or perforation
NHS guidance is clear that these symptoms need urgent assessment. Bleeding ulcers can be serious.
When to see a GP
Book a GP appointment if you have recurring upper-abdominal pain, repeated indigestion, symptoms that keep coming back after antacids, or a history that suggests H. pylori or NSAID-related ulcer disease. See a GP sooner if symptoms are worsening, you are losing weight, or you are not sure whether you should still be taking an anti-inflammatory medicine. NICE guidance supports structured assessment of dyspepsia and ulcer-related symptoms rather than indefinite self-management.
If getting assessed is difficult, you may also find this useful: How to Get a GP Appointment Quickly in the UK.
Frequently asked questions
Are stomach ulcers caused by stress?
Usually no. The main causes are H. pylori infection and NSAID medicines. Stress may worsen how symptoms feel, but it is not usually the main cause.
Can ibuprofen cause a stomach ulcer?
Yes. Ibuprofen is an NSAID, and regular NSAID use is a well-recognised cause of stomach ulcers.
How is H. pylori treated?
Usually with two antibiotics plus an acid-lowering medicine.
Will antacids cure a stomach ulcer?
Not usually. They may reduce symptoms temporarily, but if the ulcer is caused by H. pylori or NSAIDs, the underlying problem still needs proper treatment.
Do stomach ulcers always cause obvious symptoms?
No. Some people have relatively vague upper-abdominal pain, indigestion or nausea rather than dramatic symptoms. Others first present with complications such as bleeding.
Final thoughts
Stomach ulcers are common and often very treatable, but they are not something to keep self-managing indefinitely with antacids and guesswork. The two big causes to think about are H. pylori and NSAID use. Once the cause is identified, treatment is usually straightforward, but warning signs such as bleeding, black stools or sudden severe pain need urgent attention.
If you have recurring upper-abdominal pain, indigestion that keeps coming back, or symptoms linked to NSAID use, it is worth getting checked properly rather than treating the symptoms on repeat. For official patient information, see the NHS stomach ulcer page and NICE guidance on dyspepsia and GORD in adults.
