How to Treat Ulcers

Medically reviewed by Sarah Gehrke, RN, MS

Last Updated: March 18, 2023 Approved

Ulcers are sores or lesions in your stomach or the upper part of your small intestines. Ulcers develop when the acids that digest foods damage the stomach or intestinal walls. Connected to a variety of causes like stress, diet, and lifestyle, scientists now know that many ulcers are caused by a type of bacteria called Helicobacter pylori, or H. pylori. Left untreated, most ulcers will continue to get worse, so it's important to receive a proper diagnosis and make the dietary and lifestyle changes that will allow you to heal fully.

Part 1

Part 1 of 3:

Receiving Medical Treatment

1
Identify the symptoms of ulcers. Abdominal problems are often difficult to diagnose since the symptoms of any one problem are reminiscent of lots of different kinds of issues, including gastritis, pancreatitis, Crohn's disease, and a variety of other problems. It's important to see your doctor and arrive at a proper diagnosis if you think you may have an ulcer, so you can receive the proper care. Ulcer symptoms include:^{[1]
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- Persistent or recurring stomach or abdominal pain
- Discomfort or a bloating sensation in the abdomen
- Nausea and vomiting
- Loss of appetite
- Traces of blood in vomit
- Dark black or tarry-looking stool indicative of bleeding from the upper part of the small intestine
- Weight loss, pallor, lightheadedness, and weakness due to persistent blood loss
2
Consult your doctor to eliminate other possibilities. If you're having stomach problems, it's not necessarily an ulcer. Based on the history of your symptoms, your diet, and a physical exam, your doctor will be able to rule out the possibility or might advise further investigations to confirm it.
- The doctor may start you on medication to reduce the pain and acidity if the symptoms are mild.
- Inform the doctor if there is persistence of blood in your vomit, if the stools continue to appear black, or if your symptoms worsen. There may be an underlying serious condition that needs to be taken care of. In such a case you will be asked to undergo tests to determine the cause of the bleeding.
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3
Get a diagnosis. Your general practitioner may recommend that you visit a GI (gastrointestinal) specialist, during which time you may go through tests which can be used to properly diagnose any kind of digestive ulcer.
- Two non-invasive tests that can be used to rule out other causes include an ultrasound of your whole abdomen and an MRI. While these tests won't show an ulcer, they do help your doctor rule out other issues.^{[2]
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- Non-invasive upper gastrointestinal (GI) x-rays can help your doctor see an ulcer. After drinking a chalky substance called barium, you will have x-rays taken to look for signs of ulcers in your stomach.
- Once the ulcer is detected, the doctor may advise endoscopy to know the exact location and extent of the ulcer. While you are under mild sedation, the doctor will insert a thin tube with a small camera at the end down your throat and into your stomach. The camera allows the doctor to see inside of your digestive tract and take a tissue sample, known as a biopsy. This is a simple and almost painless procedure.^{[4]
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- A breath test will be conducted to see if your body currently has an active ulcer caused by H. pylori bacteria. If you do have an ulcer, it will convert urea used in the test to carbon dioxide, which you will exhale.
- A stool test with a culture is done to confirm bleeding and also the presence of H.pylori.
- Blood tests will be performed to check for growths or antibodies to H. pylori. Blood tests can only show exposure to H. pylori, so it won't confirm that you currently have an ulcer.^{[5]
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4
Tackle the root of the issue. Ulcers need to be healed by addressing the underlying condition of the ulcer specific to you. That's why it is important to get a proper diagnosis and follow through with your doctor's recommended treatment. Most treatments involve medication, eliminating the cause of the ulcer and dietary changes.
- Often, H. pylori infection is to blame, in which case the doctor will prescribe an antibiotic to help eradicate it. Since treating H. pylori requires a combination therapy, you will also be prescribed a proton-pump inhibitor like omeprazole (Prilosec) or an H2 agonist (Pepcid), which blocks the production of acid in your stomach and allows your stomach to heal.^{[6]
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- Sucralfate is also used often to treat ulcers.^{[7]
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- In extreme cases, surgery may be necessary, especially if complications develop as a result of ulcers that go too long without treatment.
5
Avoid taking NSAIDs and aspirin. Aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs) can cause ulcers and can exacerbate the symptoms. Avoid taking NSAIDS while you have an active ulcer and for extended periods of time thereafter.^{[8]
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- If you need to take medication to deal with pain symptoms, ask a doctor about your options. In some cases, you might be able to take NSAIDs along with an acid reducer, or you can pursue alternative pain treatments.
6
Try over-the-counter antacids to help reduce your symptoms. Often you will feel indigestion and heartburn, with burning and nausea in the upper abdomen under the ribs. Antacids can be used to provide temporary relief of symptoms, but will not ultimately cure ulcers. Be careful when using antacids as they can prevent your medications from working. Over the counter antacid choices include:
- Calcium carbonate, found it products like Tums and Rolaids, is probably the most common OTC antacid.
- Sodium bicarbonate products such as Alka-Seltzer and Pepto Bismol (Bismuth Subsalicylate) can also be used to soothe the lining of the stomach, and are widely available.
- Magnesium hydroxide is also commonly recommended, marketed as Phillips' Milk of Magnesia.
- A mix of aluminum hydroxide and magnesium hydroxide is sold as Maalox, Mylanta and other brands.
- Less common antacids include aluminum hydroxide, sold under the brand names AlternaGEL and Amphojel, among others.
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Part 2

Part 2 of 3:

Changing Your Diet

1
Avoid any foods that aggravate your symptoms. Ulcers vary from person to person, so it's hard to say what foods are good for ulcers and what foods are bad.^{[9]
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Research source} For some people, spicy food may cause no problems, but olives or pastries may drive them crazy with pain. Try to eat a relatively bland diet while your ulcer heals, and identify the things that make it worse. Identifying the triggering factor helps prevent ulcers in the future, too.
- Often, high-sugar foods, processed foods, fried foods, salted meats, alcohol, and coffee make ulcers worse.
- Increase your fluid intake.
- Try keeping a food journal and write down everything that you eat in a day, so that you can have a record of which foods cause a flare up of pain.
- Be judicious about what you cut out in the short term to heal up in the long term. A little discipline now will help your stomach heal quickly and let you get back to a less restricted diet and lifestyle.
2
Eat more fiber. Some estimates show that the average person gets about 14 grams (0.5 oz) of fiber a day. Try to get upward of 28–35 grams (0.99–1.2 oz) of fiber a day to treat your digestive tract right.^{[10]
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Research source} A high-fiber diet that contains a lot of fresh fruits and vegetables helps to reduce your chances of getting an ulcer, and helps existing ulcers heal.^{[11]
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Research source} Try getting fiber from the following sources:
- Apples
- Lentils, peas, and beans
- Brussels sprouts, broccoli, and other brassica
- Berries
- Avocados
- Bran flakes
- Flaxseeds
- Whole wheat pasta
- Barley and other whole grains
- Oatmeal
3
Eat lots of foods that contain flavonoids. Some research suggests that foods containing naturally occurring flavonoids can help to heal ulcers more quickly.^{[12]
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Go to source} Flavonoids occur naturally in many fruits and vegetables, making them good for you to consume on two levels. Good sources include:
- Apples
- Celery
- Cranberries
- Blueberries
- Plums
- Spinach
Teas and supplements containing licorice root can help to heal ulcers and keep them from coming back. It's important to distinguish between sugary licorice candy, which can make stomach troubles worse, and natural licorice root, which is used in supplements and teas. Only use the latter as an additional treatment for ulcers.
5
Avoid spicy foods like hot peppers or spicy seasonings. Cut back or eliminate those foods from your diet.
- Although doctors now believe that spicy foods do not cause ulcers, some people with ulcers do report that their symptoms worsen after eating them.
Acidic fruit drinks, including orange juice, grapefruit, and other citrus juices can make the symptoms of ulcers much worse. For some people, it may not be a problem, but it can be extremely painful for others. Limit your citrus-intake, if it seems to bother your ulcer.
7
Cut back on coffee and carbonated drinks. Coffee is highly acidic, which can exacerbate the symptoms of ulcers. Carbonated soft drinks and colas likewise can irritate your stomach lining and make your symptoms worse. Try to cut out your morning cup of coffee in the short-term if you're suffering from an ulcer.
- Caffeine in and of itself doesn't make ulcers worse, but acidic soft drinks, some strong teas, and coffee do. Try switching to more gentle herbal teas if you have an ulcer. If you need a little caffeine kick, try adding some guarana to your tea.^{[13]
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Part 3

Part 3 of 3:

Making Lifestyle Changes

1
Stop smoking. Smoking increases the chances of ulcers developing and makes it more difficult for existing ulcers to heal.^{[14]
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Go to source} Smokers are twice as likely to develop ulcers as non-smokers, making it critical that you quit smoking if you want to allow your ulcer to heal properly.
- Smokeless tobacco and other forms of tobacco come with the same, and even increased, risk of stomach problems. Try your best to quit tobacco altogether if you have an ulcer.
- Talk to your doctor about tapering methods, including using prescription medication to help you ease off of a nicotine dependence. Over the counter patches and nicotine supplements are also available, which can help.
2
Avoid all alcohol until your ulcer is completely healed. Alcohol irritates the stomach lining, and it takes a while for the stomach to heal completely. If you're recovering from an ulcer, or any kind of stomach trouble, it's important to avoid alcohol while you're recovering.^{[15]
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Go to source} Even a beer or two can aggravate your ulcer.
- Alcohol in moderation may be alright after all treatment has ended, but you should discuss it with your doctor before resuming drinking in any capacity.
For some people, ulcers can get a lot worse at night. Laying flat on your back can cause certain ulcers to become more painful, and nighttime is the worst time to be in pain. Try sitting with your head and shoulders elevated slightly off the mattress, to keep yourself at an inclined position. Some people have success sleeping more soundly like this when ulcers are bothering them.
4
Eat smaller meals at regular times. Eating a big meal in the middle of the day can make an ulcer worse. Instead, try to time your meals at regular times throughout the day, and have more small meals, as opposed to a few really big ones. This will help your stomach to process smaller amounts of food more easily.
- Avoid eating food too close to bedtime, which can cause nighttime pain that will keep you from sleeping more soundly.
- Some people find that the symptoms of ulcers are made worse after eating, while others find that eating can soothe the ulcer pain. Experiment some with your diet to see what works for you.
Any time you go to the doctor from here on out, you need to let them know that you've dealt with ulcers in the past, and you'd like them to consider your history of stomach troubles when prescribing medication. Even if you've been ulcer free for many years, certain medications can irritate your stomach and make it much worse. Always consult your doctor before switching medications or taking something new.
6
Give it time. The stomach can take quite a while to heal completely, and most doctors recommend that you take a fairly rigorous approach to your recovery, and allow a period of at least 2-3 months before you consider yourself "healed."^{[16]
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Research source} Even then, a return to a diet or lifestyle that resulted in your ulcers flaring up in the first place can cause your ulcers to come back, perhaps stronger this time. It's important to commit to your health and give your stomach the time it needs to heal.
- Some people may heal faster than others, but it's important to continue your dieting and lifestyle changes well beyond when your symptoms subside. Don't celebrate having no stomach pain with a couple drinks, or the pain could return.
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Question

What are the main symptoms of an ulcer?

Sarah Gehrke, RN, MS
Registered Nurse
Sarah Gehrke is a Registered Nurse and Licensed Massage Therapist in Texas. Sarah has over 10 years of experience teaching and practicing phlebotomy and intravenous (IV) therapy using physical, psychological, and emotional support. She received her Massage Therapist License from the Amarillo Massage Therapy Institute in 2008 and a M.S. in Nursing from the University of Phoenix in 2013.

Sarah Gehrke, RN, MS

Registered Nurse

Expert Answer

Main symptoms of an ulcer: If you feel better when you eat or drink and then worse 1 or 2 hours later it may be a duodenal ulcer. If you feel worse when you eat or drink it is possibly a gastric ulcer. Ulcers may cause stomach pain that wakes you up at night. You may feel full fast. A heavy feeling, bloating, burning or dull pain in your stomach is also common. Vomiting and unexpected weight loss may also occur. Please see your doctor if you are experiencing pain or unexplained symptoms.

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Can ulcers cause nausea?

Kirsten Kind, MD
Family Medicine Physician
Dr. Kind is a Family Medicine Physician specializing in pediatric radiology in Scotland. She received her MD from the University of Edinburgh Medical School in 2009. In 2017, she was elected as a Fellow of The Royal College of Radiologists.

Kirsten Kind, MD

Family Medicine Physician

Expert Answer

Yes. Pain of any kind can make you feel nauseous, and pain from ulcers is no different. It would be unusual for nausea to be the only symptom of an ulcer, but it is possible.

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Can ulcers cause halitosis?

Sarah Gehrke, RN, MS
Registered Nurse
Sarah Gehrke is a Registered Nurse and Licensed Massage Therapist in Texas. Sarah has over 10 years of experience teaching and practicing phlebotomy and intravenous (IV) therapy using physical, psychological, and emotional support. She received her Massage Therapist License from the Amarillo Massage Therapy Institute in 2008 and a M.S. in Nursing from the University of Phoenix in 2013.

Sarah Gehrke, RN, MS

Registered Nurse

Expert Answer

Halitosis, or bad breath, is a clinical sign that can point to several things. It's possible for the bacteria that causes ulcers, H. Pylori, to cause some people to have bad breath. Bad breath is caused by excessive bacterial activity on the tongue in most cases (85%-90%), and gum disease which produces high levels of foul odors. A small percent of bad breath is related to the stomach. If oral hygiene is not the case, speak to your doctor regarding possible other causes.

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