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Ulcers (Peptic, Stomach & Duodenal)

A peptic ulcer is a sore in the lining of the stomach or the first part of the small intestine. Most are caused by an H. pylori infection or by NSAID pain medicines, and most heal with treatment. Vomiting blood, black or bloody stools, sudden severe belly pain or fainting are emergencies — call 911.

Call 911 or go to the nearest emergency room if you have any of these. They can be signs that an ulcer is bleeding or has torn through the stomach wall (NIDDK, ACG, NHS):

  • Vomiting blood (red blood in the vomit) or vomit that looks like coffee grounds.
  • Black, tarry or sticky stool, or red or maroon blood mixed with the stool.
  • Sudden, sharp or severe belly pain that doesn’t go away, or a belly that is painful to touch.
  • Feeling dizzy or fainting, a rapid pulse or other signs of shock.

Don’t drive yourself. Ask someone to drive you or call 911, and bring the medicines you take (NHS; the NHS page uses UK emergency numbers, so use 911 in the U.S.).

See a doctor soon if you have ulcer-type pain and it is getting worse or won’t go away, you have lost your appetite or feel full after a very small amount of food, you have lost weight without trying, swallowing is painful or difficult, you keep vomiting, or you feel tired all the time (NHS). Slow bleeding can also cause anemia, with tiredness, shortness of breath when you exert yourself and pale skin (ACG).

The word “ulcer” just means an open sore. This guide is mainly about peptic ulcers — sores in the stomach or the first part of the small intestine. Pressure sores and diabetic foot ulcers are different problems; they are covered briefly near the end of this page.

What is a peptic ulcer?

A peptic ulcer is a sore on the lining of your stomach or your duodenum, the first part of the small intestine (NIDDK). Doctors also call them stomach ulcers (gastric ulcers), duodenal ulcers or peptic ulcer disease. Researchers estimate that about 1% to 6% of people in the United States have one (NIDDK). The lining is damaged when the acids that help you digest food damage the walls of the stomach or duodenum (MedlinePlus).

Symptoms

Pain or discomfort in the upper belly, anywhere between the belly button and breastbone, is the most common symptom. It may be dull or burning and may come and go over time (NIDDK). Other symptoms can include feeling full too soon or uncomfortably full after a meal, nausea and vomiting, bloating and belching (NIDDK). Heartburn and indigestion are common too (NHS).

The pain pattern varies. For some people it comes when the stomach is empty or at night and eases for a short time after eating; for others, eating makes it worse (NIDDK). It is often worse at night (NHS). Many people with peptic ulcers have no symptoms at all and may not notice anything until a complication such as bleeding develops (NIDDK). This is why the emergency signs at the top of this page matter even if you have never had belly pain.

What causes ulcers?

The two most common causes are infection with Helicobacter pylori (H. pylori) bacteria and nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen and naproxen; other causes are uncommon or rare (NIDDK). People are also more likely to get ulcers if they are older, have had an ulcer before, or smoke (NIDDK).

  • H. pylori: About 30 to 40% of people in the United States get an H. pylori infection, most often as a child, and it usually causes no symptoms (MedlinePlus). In some people it breaks down the stomach’s protective coating, which can lead to gastritis or an ulcer (MedlinePlus). Researchers are still studying how it spreads; it may pass from person to person through contact with an infected person’s vomit, stool or saliva, or through contaminated food or water (NIDDK).
  • NSAIDs: These relieve pain but also make the stomach lining more prone to damage. Your chance of an NSAID ulcer is higher if you take them for a long time, take a high amount or more than one NSAID, take them with other medicines that raise ulcer risk, or are also infected with H. pylori (NIDDK). The ibuprofen drug label warns that NSAIDs may cause ulcers, bleeding or holes in the stomach or intestine, that this can happen without warning symptoms, and that the risk may be higher with long-term use, older age, poor health, smoking or drinking large amounts of alcohol (MedlinePlus drug information).
  • Less common causes: other infections; corticosteroids, medicines for low bone mass and some antidepressants (especially with NSAIDs); surgery or procedures that affect the stomach; cancer or Crohn’s disease; injury, blockage or poor blood flow; critical illness; severe long-term diseases such as cirrhosis or COPD; and Zollinger-Ellison syndrome, in which tumors make the stomach produce too much acid. Sometimes doctors cannot find a cause (NIDDK).

What about stress, spicy food and diet?

These are the most common myths. Stress and spicy foods do not cause ulcers, though they can make them worse (MedlinePlus). NIDDK says researchers have not found that diet plays an important role in causing, preventing or treating peptic ulcers, and doctors do not recommend a special diet or avoiding particular foods or drinks to prevent or treat them (NIDDK). The NHS suggests that once you have seen a doctor, you avoid any food or drink that triggers your own symptoms — fatty or spicy foods, coffee and chocolate are common examples — and take steps to manage stress, since stress, anxiety and depression can make symptoms worse (NHS). In other words: no “ulcer diet,” but it is reasonable to skip whatever bothers you.

Two more myths: antacids and milk can’t heal a peptic ulcer (MedlinePlus). Pain may stop briefly after you eat or take antacids (MedlinePlus), but an ulcer needs real treatment and a search for its cause.

Smoking and alcohol

Smoking raises the chance of getting an ulcer, can slow ulcer healing, and quitting lowers your risk and helps existing ulcers heal (NIDDK, NIDDK). MedlinePlus advises not smoking and avoiding alcohol (MedlinePlus), and the NHS says not to drink too much (NHS). The American College of Gastroenterology adds that alcohol and smoking can raise ulcer risk in people with untreated H. pylori (ACG).

Why finding the cause matters

Peptic ulcers get worse if they are not treated (MedlinePlus). Taking medicine and treating the underlying cause heals most ulcers (NIDDK). Doctors treat the underlying causes to help ulcers heal and to keep them from coming back, and finding and treating a cause such as H. pylori can lower the chance of future ulcers (NIDDK). For related topics, see our Heartburn, Acid Reflux & GERD, Hiatal Hernia and Digestion guides.

Side by side

Six approaches compared

For every condition we look at the same six approaches: what each involves, what it typically costs, and what a patient can realistically expect.

ApproachWhat it involves Estimated costWhat to expect
Conventional medicine (AMA) Testing for H. pylori (breath, stool or endoscopy), acid-reducing medicines, an antibiotic combination when H. pylori is found, and changing or stopping NSAIDs with your prescriber’s help. Complications such as bleeding are treated in the hospital. An upper endoscopy without insurance can run about $990–$4,483 through prepaid providers (one marketplace average is $2,660). Costs of visits, H. pylori tests and medicines: cost estimate being researched. Medicine and treating the cause heal most ulcers. H. pylori treatment lasts about two weeks and should be finished, with a re-test afterward.
Chiropractic No established role in treating ulcers. We found one small 1994 pilot study of spinal manipulation for duodenal ulcer; it cannot show that it works. Not a treatment for ulcers, so no cost is listed. Ulcer pain or any warning sign needs a medical evaluation, not a trial of spinal adjustments. Don’t delay testing for H. pylori.
Acupuncture Fine needles, sometimes combined with Chinese herbal medicine. We found little research on acupuncture alone for peptic ulcers. About $125–$230 for a first private visit and $90–$185 for follow-ups; community clinics about $50–$90. Medicare covers acupuncture only for chronic low back pain. A 2026 review of acupuncture plus Chinese herbs for gastric ulcer was encouraging but rated its evidence low certainty. It does not replace testing or H. pylori treatment.
Herbal medicine Probiotics added to H. pylori treatment, mastic gum, licorice and Chinese herbal formulas have been studied. The strongest evidence is for probiotics as an add-on, not a replacement. Cost estimate being researched. Tell your doctor about everything you take. Licorice that contains glycyrrhizin can cause serious heart effects; mastic gum on its own did not reliably clear H. pylori in small studies.
Massage therapy No role in treating ulcers. Some people use massage to relax; it does not treat an ulcer or its causes. Not a treatment for ulcers, so no cost is listed. Don’t use massage for new or severe belly pain. Black stools, vomiting blood or sudden severe pain are emergencies.
MBHA Wellness Coach Support for finishing the full H. pylori course, working with your prescriber on NSAIDs, quitting smoking, cutting back on alcohol, managing stress, and tracking symptoms and triggers. Cost estimate being researched. Coaching supports your medical care and never replaces testing, medicines or a doctor’s advice. It can help with habits and follow-through.

Approach 1 of 6

Conventional medicine (AMA)

Care usually has three parts: healing the ulcer, treating its cause and watching for complications.

Healing medicines. Doctors typically recommend or prescribe proton pump inhibitors (PPIs), H2 blockers and sometimes other medicines to help an ulcer heal (NIDDK). Both kinds of medicine work by decreasing the amount of acid the stomach makes (MedlinePlus drug information, MedlinePlus drug information). Omeprazole, a PPI, is prescribed for ulcers and, together with other medicines, for H. pylori ulcers (MedlinePlus drug information); famotidine, an H2 blocker, is also prescribed to treat ulcers (MedlinePlus drug information). Prescription omeprazole should not be stopped without talking to your doctor (MedlinePlus drug information).

Treating the cause. If the ulcer is from H. pylori, doctors prescribe a combination of medicines; if it is from NSAIDs, they look at changing the pain medicine. Both are covered in the sections below: Treating H. pylori and Pain medicines and ulcers. Diagnosis is covered in How ulcers are diagnosed.

If an ulcer doesn’t heal or comes back. Your doctor may check again for things that could be causing it (such as H. pylori), recommend that you quit smoking, prescribe more medicine, or recommend an upper endoscopy with biopsies; in rare cases surgery is recommended for ulcers that don’t heal (NIDDK). The NHS says treatment usually lasts from 1 week to 2 months depending on the cause, and that you should go back to the doctor if symptoms return (NHS).

What it costs

We have a price figure for one test only. An upper endoscopy without insurance can cost about $990 to $4,483 through current prepaid U.S. providers, with one marketplace average of $2,660; other databases show lower figures because they measure narrower bills, and anesthesia and pathology may be billed separately (The Pricer, 2026). Our cost estimates for office visits, H. pylori breath and stool tests and ulcer medicines are still being researched. With insurance, what you pay depends on your plan.

Find a medical doctor in our directory

Approach 2 of 6

Chiropractic

Chiropractic care has no established role in treating peptic ulcers, and the research is very thin. The one study we found in PubMed is a 1994 pilot trial in which 11 adults with endoscopically confirmed ulcers received spinal manipulative therapy and were compared with 24 people given usual medical treatment. The authors reported pain relief and earlier clinical remission in the manipulation group, but also wrote that the physiological basis for such results has yet to be established (Pikalov et al., 1994). It was a very small study, and its abstract does not describe random assignment or any test for H. pylori, so it can’t tell you that spinal adjustments heal ulcers or clear the infection. We found little other research on chiropractic care for ulcers or H. pylori.

Safety: serious problems from spinal manipulation are very rare, but a type of neck manipulation has been linked to small tears in neck arteries that can lead to stroke (NCCIH). The bigger risk with ulcers is delay: upper-belly pain can come from an ulcer, and bleeding ulcers are emergencies. If a chiropractor is part of your care, keep your medical diagnosis and treatment on track and tell the chiropractor about any NSAIDs or blood thinners you take.

Find a chiropractor in our directory

Approach 3 of 6

Acupuncture

We found little research on acupuncture alone for ordinary peptic ulcers. The most recent review we found combined acupuncture with Chinese herbal medicine: a 2026 meta-analysis of 17 randomized trials with 1,632 people with gastric ulcer reported better clinical efficacy, H. pylori clearance and recurrence rates than herbal medicine without acupuncture, but it rated the certainty of the evidence as low because the trials were small and of low quality, and it called for larger, better studies (Liang et al., 2026). That design can’t show what acupuncture adds to standard treatment with acid-reducing medicine and antibiotics.

Safety and cost: relatively few complications have been reported, but nonsterile needles and improper treatment have caused infections, punctured organs and injury to the nervous system; most states license acupuncturists (NCCIH). A first private visit is about $125–$230, follow-ups about $90–$185, and community clinics about $50–$90 (The Pricer, 2026). Medicare covers acupuncture only for chronic low back pain (Medicare.gov).

Find an acupuncturist in our directory

Approach 4 of 6

Herbal medicine

Several herbs and supplements have been tried for ulcers and H. pylori. Most research is about helping standard treatment, not replacing it, and a natural product can’t heal an ulcer if the infection or NSAID cause is left untreated.

  • Probiotics (added to treatment): a 2025 meta-analysis of 12 trials with 2,144 people found that taking probiotics before H. pylori treatment was linked to a higher eradication rate (about 80% vs. 70%) and fewer side effects (Zhang et al., 2025). Another 2025 meta-analysis of 19 trials with bismuth-based treatment found that adding probiotics improved eradication and lowered side effects such as diarrhea and nausea (Liu et al., 2025). In one double-blind trial of 158 people with H. pylori-positive ulcers, those given probiotics along with standard treatment had higher ulcer-healing and eradication rates than those given a placebo, though the authors called for larger studies (Saha et al., 2024). Products and study designs differ, so no single probiotic can be recommended from this research.
  • Mastic gum: in a 52-person randomized pilot, 4 of 13 and 5 of 13 people on mastic gum alone tested negative for H. pylori afterward, compared with 10 of 13 on standard antibiotic treatment; the authors concluded mastic has some bactericidal activity (Dabos et al., 2010). A separate study of nine people found no effect on H. pylori (Bebb et al., 2003). A 2026 pilot of 64 people found a higher eradication rate when mastic gum was added to bismuth-based treatment, but the difference was not statistically significant (Tulsian et al., 2026).
  • Licorice: NCCIH says it is unclear whether licorice products on their own help digestive symptoms. Licorice contains glycyrrhizin, which can cause serious problems such as irregular heartbeat and cardiac arrest, especially in large amounts or long-term use, and even small amounts have been linked to severe effects in people with high blood pressure, heart or kidney conditions, or a high-salt diet. Products with the glycyrrhizin removed (“DGL”) might be safe for up to 4 months (NCCIH). In a 2016 trial of 120 people, adding licorice to standard H. pylori treatment was linked to a higher eradication rate (Hajiaghamohammadi et al., 2016). We found little other current research on DGL for ulcers.
  • Chinese herbal formulas: a 2019 meta-analysis of 8 trials (919 people) found that herbal medicines added to drug treatment cleared H. pylori more often and had fewer side effects, but rated the quality of evidence very low (Shi et al., 2019). A 2017 analysis of 58 trials of one formula, Jianzhong decoction, was also favorable (Sun et al., 2017). Both analyses pooled trials found in Chinese and English databases, and the 2019 authors called the studies low quality. Work with a licensed practitioner and tell your doctor.

Safety: supplements are not approved by the FDA before they are sold (NCCIH). Tell your doctor and pharmacist about everything you take so nothing interacts with your ulcer medicines. Cost estimate being researched.

Approach 5 of 6

Massage therapy

Massage has no role in treating a peptic ulcer or its causes, and we found little research on it for ulcers. Some people find it relaxing, and the NHS notes that stress can make ulcer symptoms worse (NHS), but relaxation is not a treatment for the ulcer itself.

Safety: the risk of harm from massage appears low, though rare serious problems such as a blood clot, nerve injury or fracture have been reported, and some involved vigorous styles such as deep tissue massage (NCCIH). If you have belly pain, get it evaluated first, and don’t use massage to put off seeing a doctor. Not a treatment for ulcers, so no cost is listed.

Find a massage therapist in our directory

Approach 6 of 6

MBHA Wellness Coach

An MBHA Wellness Coach is not a medical provider and cannot diagnose an ulcer, test for H. pylori or change a medicine. What a coach can help with is the follow-through that medical treatment depends on:

Cost estimate being researched. Coaching supports medical care; it never replaces it.

Another approach

How ulcers and H. pylori are diagnosed

To diagnose an ulcer, find its cause and check for complications, your doctor will ask about your symptoms, past ulcers or H. pylori infections, the medicines you take (especially NSAIDs), and family history of ulcers, H. pylori or digestive-tract cancer, then do a physical exam and sometimes order tests (NIDDK).

  • Urea breath test: you swallow a capsule, liquid or pudding that contains urea with a special “labeled” carbon atom. If H. pylori is present, the bacteria turn it into carbon dioxide, and a breath sample a few minutes later shows the labeled carbon (NIDDK).
  • Stool test: you collect a stool sample at home to be checked for H. pylori. Antigen tests are the most common type (MedlinePlus).
  • Blood test: can check for signs of H. pylori or complications (NIDDK), but blood antibody tests aren’t commonly used to diagnose H. pylori because they can’t tell a current infection from a past one (MedlinePlus).
  • Upper GI endoscopy with biopsy: a doctor passes a flexible tube with a camera through the mouth to look at the esophagus, stomach and duodenum, and takes tiny tissue samples that a pathologist examines (NIDDK). It is done in a hospital or outpatient center, you will likely be given a sedative, it takes about 10 to 20 minutes, and you will need a ride home; you may be asked not to eat or drink for up to 8 hours beforehand (NIDDK). It can also treat bleeding from ulcers (NIDDK), and biopsies can be tested for H. pylori, abnormal cells and cancer (ACG). Serious complications are rare; there is a very small risk of a tear and a small risk of bleeding at a biopsy site (MedlinePlus).
  • Upper GI series: X-rays after you swallow a chalky barium liquid, used in some cases (NIDDK).

Prepare for the test. Before an H. pylori test you may need to stop some medicines for two weeks to a month, including many that people take for their symptoms, so ask your provider about everything you take before you stop or skip anything (MedlinePlus). The ACG notes that PPIs should be stopped for two weeks before a cure test because they can make results less reliable (ACG). Don’t stop a prescribed medicine on your own (MedlinePlus drug information).

Another approach

Treating H. pylori

If you have an ulcer and H. pylori, treating the infection helps the ulcer heal and helps keep it from coming back (NIDDK). Treatment is a combination of medicines, most often two or more antibiotics and a PPI, and in some cases bismuth subsalicylate (NIDDK). Your doctor may avoid antibiotics you have taken before, because the bacteria may have become resistant to them (NIDDK).

The 2024 American College of Gastroenterology guideline names bismuth quadruple therapy for 14 days as the preferred first treatment when antibiotic susceptibility isn’t known, with other regimens as alternatives for some people, and addresses who should be tested and the need to test afterward to confirm the infection is gone (Chey et al., 2024). Your regimen is your doctor’s decision; it depends on factors such as penicillin allergy, antibiotics you have taken before and whether the bacteria’s antibiotic susceptibility is known, and we do not give doses here.

Take every dose exactly as prescribed. If you stop early, some bacteria may survive and become antibiotic resistant (NIDDK). The ACG says to take all the medicines until they are gone and notes that side effects such as stomach upset, nausea or diarrhea typically go away when the medicine is finished; call your doctor or nurse about side effects (ACG).

Re-test. To find out whether treatment worked, your provider may recommend testing at least 4 weeks after you finish the antibiotics; if the infection is still there, you may be given a different combination (NIDDK). Making sure that all the H. pylori is gone is important (NIDDK). The infection can lead to gastritis and stomach cancer if it is left untreated (MedlinePlus, NHS).

Prevention. There is no vaccine for H. pylori. Because it may spread through unclean food and water, MedlinePlus suggests washing your hands after using the bathroom and before eating, eating properly prepared food, and drinking water from a clean, safe source (MedlinePlus).

Another approach

Pain medicines and ulcers

If an ulcer was caused by NSAIDs, your doctor may recommend changing your medicines. Depending on why you were taking them, that could mean stopping NSAIDs, switching to a different NSAID or a lower-dose one, or using a different medicine for pain; if you need to keep taking NSAIDs, your doctor may also recommend a PPI (NIDDK). The ACG says that if NSAIDs caused your ulcer you should avoid them and discuss other pain medicines with your doctor, and that acetaminophen, which is not an NSAID, is the preferred non-prescription pain reliever for people at risk (ACG).

Don’t make these changes alone. Aspirin is sometimes taken to prevent heart attacks and strokes (MedlinePlus drug information), and NIDDK says the right change depends on the reason you take an NSAID (NIDDK). If you take daily aspirin, talk with your doctor before taking ibuprofen for pain (MedlinePlus drug information). Tell every doctor and your pharmacist which NSAIDs you use, including over-the-counter ones. For people at higher risk who must keep taking NSAIDs, NIDDK lists safer-use strategies a doctor may suggest: a different type or lower amount, a shorter course, a PPI alongside, or testing for and treating H. pylori before starting long-term NSAIDs (NIDDK).

The ibuprofen label says to stop taking it and call your doctor if you have stomach pain, heartburn, vomit that is bloody or looks like coffee grounds, blood in the stool, or black and tarry stools (MedlinePlus drug information). See also our Medication Safety guide.

Another approach

Complications, hospital care and surgery

If not treated, ulcers can cause bleeding in the stomach or duodenum; a perforation, or hole, through the wall that can lead to peritonitis (infection of the lining of the abdominal cavity); penetration of the ulcer into a nearby organ; or a blockage that stops food from leaving the stomach (NIDDK). The NHS adds that bleeding can cause iron-deficiency anemia and that an untreated H. pylori infection raises the risk of stomach cancer (NHS). Our Anemia and Cancer guides cover those topics.

Doctors typically treat complications in a hospital, using procedures such as upper endoscopy or surgery (NIDDK). The ACG’s guideline for upper GI and ulcer bleeding suggests that people hospitalized for bleeding have endoscopy within 24 hours, recommends endoscopic treatment for ulcers that are actively bleeding or have a visible vessel, and recommends strong acid-suppressing medicine afterward (Laine et al., 2021); if endoscopic treatment fails it suggests a procedure called transcatheter embolization (Laine et al., 2021).

Surgery is uncommon. MedlinePlus says you may need surgery if your ulcers don’t heal (MedlinePlus), and NIDDK says surgery is recommended in rare cases for ulcers that don’t heal (NIDDK).

Another approach

Other kinds of ulcers

Pressure ulcers (bed sores) are areas of damaged skin caused by staying in one position too long, commonly over bony areas such as the ankles, back, elbows, heels and hips; people who are bedridden, use a wheelchair or can’t change position are at risk (MedlinePlus). They are unrelated to stomach ulcers. See our Bed Sores guide.

Diabetic foot ulcers are foot sores that can develop when diabetes causes nerve damage and reduced blood flow; you may not feel a blister or pebble in your sock, and sores can become infected. Foot ulcers that do not get better with treatment can lead to amputation (NIDDK). See our Diabetes guide.

Mouth sores (Canker Sores) and inflammatory bowel disease (Colitis, Crohn’s Disease) are also separate conditions with their own guides.

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This page is for education only and is not medical advice. Costs are typical U.S. ranges and estimates; yours will depend on your provider, location and insurance. Talk with your doctor before starting, stopping or combining any treatment. In an emergency, call 911. See our disclaimer.

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