Ulcers are more than just a bad upset stomach. They’re more than just a sharp stomach pain, too. Ulcers are a breakdown in the protective layer of your digestion and can continue to get worse without care. Not all ulcers are in the stomach either. Gastric ulcers are in the stomach, and duodenal ulcers are in the intestine. Together, they are considered peptic ulcers. Understanding what causes ulcers and their symptoms can help you know what to look for, when to get help, and maybe even prevent them.

What Causes Peptic Ulcers?

The process that creates an ulcer is pretty straight forward. The digestive system is covered in a protective mucus layer that guards the stomach and intestinal lining from the acid that breaks down your food. An ulcer occurs when there is breakdown in this protective layer, allowing the acid to come in contact with the intestinal lining. This damages the lining, leaving behind open sores or ulcers. If left untreated, they could become a health emergency that requires immediate medical attention.

The most common causes of ulcers are nonsteroidal anti-inflammatory drugs (NSAIDs), which are pain medications that can also reduce inflammation, fevers, and your risk of blood clots. This includes common medicines like ibuprofen and aspirin. NSAIDs slowly wear away at the protective mucus layer, so generally you would need to take them at higher doses or over a long period of time to cause an ulcer. You may also be at a higher risk of developing ulcers from NSAID-use if you’re 70 or older, are female, use a corticosteroid at the same time, or have a history of ulcers.

NSAIDs slowly wear away at the protective mucus layer, so generally you would need to take them at higher doses or over a long period of time to cause an ulcer.

The other common cause of ulcers is an infection from the bacteria H. pylori. This bacterium is incredibly common, with an estimated 50 and 75 percent of the world population likely having an H. pylori infection. H. Pylori bacteria enters the mucus layer protecting your digestive system, causing inflammation that breaks it down. This allows stomach acid to come into contact with the tissue, causing ulcers. Even if you have an H. pylori infection, it doesn’t mean you’ll form an ulcer. Only between 10 to 15 percent of people with H. pylori develop them.

Your chances of getting an ulcer are increased if you have both an H. pylori infection and are taking NSAIDs, especially in larger quantities or over longer periods. Experiencing serious illnesses, having surgery, or having a rare condition called Zollinger-Ellison syndrome can all cause ulcers in rarer cases. Overindulging in alcohol or smoking cigarettes can increase your risk, too. That said, common myths about coffee or spicy foods do not cause ulcers.

What are the Symptoms of Ulcers?

Sometimes, you may have an ulcer and not even know. You won’t always experience pain or other symptoms. That said, if you are suffering from ulcers, you’ll likely have some pain in your stomach, especially after meals or at night as you digest food. This could feel like a burning pain in the center of your stomach. The pain may go away if you take something that helps control stomach acid, like an antacid. You may also experience bloating and indigestion. Heartburn or acid reflux are common, too. As an ulcer worsens, you may feel nausea or even vomit.

The most common test is with an endoscopy, which would allow them to locate and see the ulcer.

These all sound like common symptoms for a wide range of illnesses, which can make it more difficult to pin down the cause. If you’re having these symptoms, talk to your doctor. If they think it is an ulcer, they may try to diagnose you. The most common test is with an endoscopy, which would allow them to locate and see the ulcer. A doctor may also run an H. pylori test, or, less commonly, imaging tests like x-rays and CT scans. Once an ulcer has been diagnosed, treatment can begin.

Are There Treatment Options?

As mentioned earlier, without treatment, an ulcer can worsen as acid continues to damage the tissue. While some ulcers can heal on their own, the risk of a worsening ulcer can lead to a perforation, internal bleeding, scarring, or gastric obstruction from swelling or scarring. For this reason, if you’ve been diagnosed with an ulcer, you should begin seeking treatment.

Either way, there’s a good chance you’ll also be given a PPI or an H2 blocker, both of which reduce the acid in your stomach.

The first step to treatment is to figure out what caused the ulcer. If the ulcer has been caused by H. pylori, you’ll likely be prescribed an antibiotic. This treatment wouldn’t be effective if the ulcer is caused by NSAIDs, though. Either way, there’s a good chance you’ll also be given a proton pump inhibitor (PPIs) (like omeprazole, pantoprazole, and esomeprazole) or a histamine receptor blocker (H2 blockers) (like famotidine, cimetidine, or nizatidine), both of which reduce the acid in your stomach. By controlling the amount of acid in your stomach, you can allow the ulcer to heal. Finally, you may also be given a protective medication (like Pepto-Bismol and Carafate) that covers the inside of your stomach and digestive tract, almost like a band-aid. This allows the ulcer to heal underneath the protective layer the medicine creates. Most ulcers take a few months to heal after treatment begins.

When are Symptoms Serious?

We’ve already discussed some of the risks of leaving an ulcer untreated. When you start to notice those symptoms (nausea, vomiting, extreme pain, internal bleeding, swelling), it’s time to seek emergency aid. Signs of internal bleeding include vomiting blood or vomiting a substance that looks like coffee grounds. You may experience similar symptoms from the other end, with black, tarry stools and a similar coffee ground-like substance.

A perforated ulcer can be a severe medical emergency that needs immediate medical attention.

If you experience a sudden, sharp pain that spreads to the back or shoulders, nausea or vomiting, a lack of appetite, and a swollen or bloated stomach, head to the emergency room. These are signs of a perforated ulcer, or a hole allowing undigested food and digestive juices to leak out of the digestive tract. This can be a severe medical emergency that needs immediate medical attention.

Finally, if you’ve begun treatment for an ulcer but symptoms have continued for a little while, it may be worth talking to your doctor. Either the medications you’re trying aren’t working or there may be another cause that isn’t being treated.

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If you’ve ever had an ulcer or know someone who has, you’ll know just how painful and frustrating they can be. Hopefully, that’s all they become, as leaving an ulcer untreated can be deadly. While there’s not too much you can do about H. pylori infections, you can make sure you’re not taking too many NSAIDs. If you have concerns, talk to your doctor, especially during your annual wellness check. It’s a great time to discuss your lifestyle, diet, and health habits, and how you can prevent health concerns like ulcers.