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Stomach pain, difficulty swallowing, nausea, vomiting—is it heartburn or something else? You take an antacid or two, but the pain still persists. There are different types of ulcers, each with its own causes, symptoms, and set of treatments. Here’s what you should know about ulcers and how to treat them.
What is an ulcer?
Ulcers are open sores on the inner lining of the lower esophagus, stomach, or the upper portion of the small intestine. They are often painful, particularly after eating, and can bleed into the stomach or intestines.
Ulcers are identified by the location of the sore:
- Esophageal ulcers occur on the lower part of the esophagus, the muscular tube that connects the throat to the stomach.
- Gastric ulcers form in the stomach lining.
- Duodenal ulcers form in the lining of the small intestine near the stomach called the duodenum.
Esophageal, gastric, and duodenal ulcers are collectively called peptic ulcers or peptic ulcer disease (PUD). They are closely related both in causes and treatments. Compared to gastric and duodenal ulcers, esophageal ulcers may arise from different causes and require different treatments in some cases.
Peptic ulcers are due to an erosion of the defenses the stomach or intestinal tissues use to protect themselves against harmful stomach acid. When these defenses are compromised, the acid can eat away at the lining of the stomach or duodenum, causing sores.
The two most common causes of peptic ulcers are infection by the bacteria, Helicobacter pylori, or regular use of nonsteroidal anti-inflammatory drugs, such as aspirin or ibuprofen. Other factors can increase the risk of peptic ulcers, such as excessive alcohol consumption, smoking, tissue death, and severe injury or illness (can lead to what’s known as a stress ulcer). Conditions that stimulate the overproduction of stomach acid, such as Zollinger-Ellison syndrome, can also cause peptic ulcers.
The tissues lining the esophagus do not have the same defenses against acid as the stomach tissues. Instead, the esophagus is protected from stomach acid by a strong, tight muscle at the bottom of the esophagus that prevents backflow from the stomach. The most common cause of an esophageal ulcer, then, is gastroesophageal reflux disease (GERD), a condition in which stomach contents, including stomach acid, flow back up into the esophagus. Other causes of esophageal ulcers include infection or repeated vomiting.
Lifestyle factors, such as eating spicy foods or stress, are no longer considered risk factors for developing peptic or esophageal ulcers, but they may worsen ulcer symptoms.
Like most sores, ulcers usually go away with appropriate treatment, but the harsh acidic environment in the stomach means that the sores can take weeks to heal. Ulcers can develop into larger and deeper sores resulting in serious complications, such as heavy bleeding, obstruction of the path between the stomach and the small intestine, and, in the worst cases, a hole or tear in the stomach (perforation).
Peptic ulcer disease is very common. Anywhere from 5% to 10% of the population will develop a peptic ulcer at some time during their lives. About 2% to 7% will experience an esophageal ulcer in their lifetime, mostly due to GERD.
How are ulcers diagnosed?
Ulcers are diagnosed with a medical history, physical examination, and tests. Most ulcers will be diagnosed and treated by a general practitioner, but some cases may require a gastroenterologist, a doctor that specializes in the digestive system.
The medical history will help the doctor diagnose the condition and discover any complications or red flags. You should be ready to answer important questions, such as:
- Is your stool black or bloody?
- Are you throwing up?
- Have you lost weight?
- Is it difficult to swallow?
- Has any related family member had cancer in the digestive system?
- Do you use NSAIDs or anticoagulant medications?
The symptoms of peptic ulcers can include stomach pain, early feeling of fullness when eating, weight loss, and mild nausea. For a stomach ulcer, the pain increases two to three hours after a meal. The pain of a duodenal ulcer decreases after a meal, which can lead to weight gain in some people with duodenal ulcers.
Esophageal ulcer symptoms are different. They include pain when swallowing, heartburn, upset stomach, nausea, vomiting, vomiting blood, and a feeling that food is getting stuck after swallowing.
In a physical examination, the healthcare provider will be looking for signs of tenderness around the stomach. Because ulcers can cause significant bleeding, a blood test will be required to check for signs of anemia. To identify any complications from the ulcer, the healthcare provider may order a chest X-ray, which would include the use of barium to coat the digestive tract (called a barium swallow). An abdominal CT scan may be required to rule out other suspected conditions, such as a swollen pancreas.
All patients with stomach pain will be tested for H. pylori bacteria. A urea breath test is fast and accurate, but stool or urine tests may also be used.
The doctor may want to look at the stomach lining using an endoscope, a long flexible tube with a light and camera at the end, in a procedure called an esophagogastroduodenoscopy (EGD). If there is an H. pylori infection, the gastroenterologist may also remove a small tissue sample during the EGD to test the bacteria for drug resistance.
Ulcer treatment options
Both peptic and esophageal ulcers will involve treating the underlying cause and reducing stomach acid. Severe complications, such as perforation, will require surgery.
Drug discontinuation
Ulcers caused by drugs such as NSAIDs, anticoagulants, or corticosteroids will be treated by immediately discontinuing the drug along with medications to reduce stomach acid.
Antimicrobial agents
Ulcers caused by microbes will be treated by antimicrobial therapy along with medications to reduce stomach acid. Helicobacter pylori infections are treated with a double dose of antibiotics, typically clarithromycin and amoxicillin, along with proton-pump inhibitors to reduce stomach acid and, sometimes, bismuth subsalicylate to neutralize stomach acid. Esophageal ulcers can be caused by viral, bacterial, or fungal infections, so the appropriate antimicrobial agent will be used to clear the infection.
Medications
Medications are used to reduce stomach acid to give the ulcer time to heal. Proton pump inhibitors (PPIs) are the drug of choice for peptic or esophageal ulcers, but H2 receptor blockers are also commonly prescribed.
Surgery
Surgical treatment for ulcers is usually performed only for medical emergencies, but surgery may be offered to patients who are not improving with treatment or who have an obstruction. Severe bleeding or perforation will require emergency surgery to close the wound or remove part of the stomach. Partial or complete removal of the stomach (gastrectomy) is required if there’s massive bleeding.
Cutting the vagus nerve (vagotomy) to reduce stomach acid secretions is the most common elective surgery for patients who aren’t getting better. A vagotomy is also commonly performed with other surgeries, such as pyloroplasty, which increases the opening of the stomach to the intestines, or antrectomy, which involves removing the bottom third of the stomach.
Ulcer medications
Both peptic and esophageal ulcers are treated with antisecretory drugs that reduce the stomach’s production of acid, protecting the sore from further injury and giving it time to heal.
Proton pump inhibitors
The first-line medication for treating and preventing esophageal and peptic ulcers are proton pump inhibitors, such as pantoprazole, omeprazole, and esomeprazole. They are also the first-line treatment for GERD, the most common cause of esophageal ulcers. Proton-pump inhibitors block the ability of the stomach to produce acid, decreasing the acidity of the stomach. Proton pump inhibitors are taken once or twice daily and, in order to be effective, must be taken for several days or weeks depending on the type of ulcer being treated.
H2 blockers
Normally, when a person eats, histamine is released into the stomach and signals stomach cells to secrete acid. H2 blockers–their full name is histamine H2 receptor antagonists (H2RAs)–prevent histamine from attaching to the acid-stimulating H2 receptors. H2 blockers, such as famotidine, ranitidine, or nizatidine, are usually taken once per day. Compared to proton pump inhibitors, H2 blockers start working more quickly to suppress stomach acid production.
Other medications
In addition to drugs that reduce stomach acid, patients with esophageal or peptic ulcers will often take other medications to help relieve symptoms. Antacids, such as calcium carbonate, magnesium hydroxide, or bismuth subsalicylate, can be taken with meals to neutralize the acid in the stomach. Pain relievers, such as acetaminophen, can help reduce discomfort. After an ulcer has healed, the doctor may prescribe drugs, such as misoprostol, that prevent recurring ulcers by protecting the stomach lining from acid.
What is the best medication for an ulcer?
Ulcers are primarily treated with medications that reduce stomach acid, but other medications such as antacids or pain relievers might be used, as well. However, if there’s an underlying infection, that infection will need to be treated with antimicrobial medications as well. There is, then, no “best” medication for ulcers, only the best combination of medications for a particular situation.
| Best medications for ulcers | ||||
|---|---|---|---|---|
| Drug Name | Drug Class | Administration Route | Standard Dosage | Common Side Effects |
| Protonix (pantoprazole) | Proton pump inhibitor | Oral | 40 to 80 mg once daily for up to eight weeks | Headache, diarrhea, nausea |
| Prilosec (omeprazole) | Proton pump inhibitor | Oral | 20 to 40 mg once daily for up to eight weeks | Headache, abdominal pain, nausea |
| Nexium (esomeprazole) | Proton pump inhibitor | Oral | 20 to 40 mg once daily for up to eight weeks | Headache, diarrhea, nausea |
| Prevacid (lansoprazole) | Proton pump inhibitor | Oral | 15 to 30 mg once daily for up to eight weeks | Diarrhea, abdominal pain, nausea |
| Pepcid (famotidine) | H2 blocker | Oral | 40 mg once daily for up to eight weeks | Headache, dizziness, constipation |
| Zantac (ranitidine) | H2 blocker | Oral | 300 mg once daily or 150 mg twice daily for four to eight weeks | Constipation, diarrhea, stomach pain |
| Tagamet (cimetidine) | H2 blocker | Oral | 800 mg once daily at bedtime, 400 mg twice daily, or 300 mg four times dailys with meals and at bedtime for eight to 12 weeks | Headache, diarrhea, nausea |
| Axid (nizatidine) | H2 blocker | Oral | 300 mg once daily or 150 mg twice daily for eight weeks | Headache, dizziness, diarrhea |
| Pepto-Bismol (bismuth subsalicylate) | Antacid | Oral | For H. Pylori infection with combination therapy: 300 mg four times daily for 10 to 14 days | Constipation, abdominal pain, black tongue |
| Tylenol (acetaminophen) | Analgesic | Oral | 325 to 650 mg every four to six hours as needed. Maximum dose of 4,000 mg per day. | Nausea, stomach pain, headache |
The standard dosages above are from the U.S. Food and Drug Administration (FDA), the National Institute of Health (NIH), or off-label studies for the treatment of peptic ulcers. Dosage is determined by your doctor based on your medical condition, response to treatment, age, and weight. Other possible side effects exist. This is not a complete list.
What are the common side effects of ulcer medication?
All medications may produce side effects, and side effects will vary depending on the type of medication. This is not a complete list of possible side effects, so consult with a healthcare professional about any concerns or questions you may have regarding your specific situation.
Proton pump inhibitors and H2 blockers are relatively safe medications available in prescription and over-the-counter formulations. The most commonly experienced side effects are digestive system problems such as abdominal pain, nausea, vomiting, diarrhea, and constipation. H2 blockers can also affect the central nervous system, so headaches, drowsiness, and dizziness are often experienced.
Proton pump inhibitors can reduce the absorption of calcium in the body, which can lead to an increased risk of osteoporosis and bone fractures. Patients will often be prescribed or recommended calcium supplements to take along with proton pump inhibitors. Other serious side effects of proton pump inhibitors may include kidney disease, vitamin B12 deficiency, and diarrhea caused by Clostridium difficile infection.
The most serious side effects of H2 blockers are related to their effects on the central nervous system. These side effects may include delirium, hallucinations, extreme drowsiness, and slurred speech.
What is the best home remedy for an ulcer?
An ulcer needs time to heal, so the best home remedies help guard the stomach against unnecessary irritation and work to lower stomach acid. Here are some examples:
- Avoid foods that increase stomach acid such as dairy, coffee, and soft drinks
- Avoid foods that irritate or damage the stomach such as alcohol, spicy foods, and fatty foods
- Eat small meals throughout the day
- Smoking also increases stomach acid, so stop smoking
- Avoid NSAIDs (nonsteroidal anti-inflammatory drugs) for pain if you’re at risk of getting an ulcer. They reduce prostaglandins that protect the stomach lining from stomach acids. Use acetaminophen instead
- Stress and nervousness may increase stomach acid, so manage stress with relaxation exercises, stretching, yoga, and other stress management techniques
Frequently asked questions about ulcers
Can ulcer heal on its own?
Ulcers can heal on their own. However, untreated ulcers may progress to a more severe injury.
What does stomach ulcer pain feel like?
Stomach ulcers aren’t always painful. Mild cases might feel like indigestion or stomach upset. Many people will feel a localized burning pain in the stomach, usually maxing out about two or three hours after eating.
What is the best medicine for an ulcer?
The most commonly used medications for ulcers are proton pump inhibitors to reduce stomach acid.
How can I permanently cure a stomach ulcer?
Like any other sore, a stomach ulcer can be permanently cured. However, this doesn’t mean that new ulcers won’t form later, especially if there is an underlying and untreated infection causing the ulcers.
How long does it take for a stomach ulcer to heal?
A simple stomach ulcer without complications can take about one to two months to heal with the right medications. Duodenal ulcers can heal more quickly, typically within four to six weeks. An esophageal ulcer typically heals in two weeks to two months.
What to avoid if you have an ulcer?
If you have an ulcer, avoid NSAIDs or smoking, which can reduce the ability of the stomach lining to protect itself against stomach acid. Foods that increase stomach acid, such as dairy, coffee, and soda should be taken out of the diet. Highly acidic foods, such as tomatoes and citrus, will only make things worse. Finally, substances that irritate the stomach, such as alcohol or spicy foods, are probably not a good idea.
What are the best foods to eat when you have an ulcer?
There are plenty of foods that are safe to eat with an ulcer. These include rice, grains, and vegetables. However, the best foods to eat are rich in water content because the extra water can help dilute the stomach acid.
What drinks help ulcers?
For most medical conditions, the best drink is water. For an ulcer, other types of drinks, such as dairy and juice, can increase acid production in the stomach. Some drinks, such as orange juice, are acidic, so you’re just pouring gas on the fire. Plain and simple, water not only doesn’t irritate the stomach or increase stomach acid, but it can also dilute and weaken the acid in the stomach.
What does ulcer pain feel like?
Ulcer pain can feel mild, like that experienced from heartburn. It may also feel like a localized burning or gnawing sensation just below the breast bone.
Is milk bad for ulcers?
Milk and other dairy products increase the amount of acid produced by the stomach, so they do not help ulcers.