5 Warning Signs of Ulcers

Symptoms to look for in this common ailment that can be dangerous if left untreated

illustration of a female doctor holding a clipboard and a male doctor holding a magnifying glass over a distressed stomach

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Michelle Crouch,

AARP

En español

Published March 15, 2023

Did you know that the acid and enzymes in your stomach are so powerful that studies show they can dissolve metal items such as coins and razor blades?

Imagine if those fluids started eating away at your organs.

That’s what happens when you have a peptic ulcer, a painful sore that develops in the lining of your stomach or small intestine.

As many as 1 in 10 people worldwide will have an ulcer, according to a 2022 study published in the journal PLoS One.

Normally, a special mucus membrane keeps digestive fluids away from the surface of your stomach and intestine. Ulcers form when that barrier is damaged or overwhelmed, allowing acid to leak through.

Doctors used to believe that emotional stress alone could cause ulcers, but they now know that’s not the case. Though stress is associated with an increased risk of ulcers, experts say most are caused by one of two triggers:

Helicobacter pylori (H. pylori) bacteria: Thirty to 40 percent of people in the United States have this bacterium living in their stomach, often without any obvious symptoms. H. pylori can break down the protective lining in the stomach. Scientists don’t know exactly what percentage of stomach ulcers are linked to H. pylori, but the Cleveland Clinic estimates 40 percent.

Overuse of certain pain medications: The use of nonsteroidal anti-inflammatory drugs (NSAIDs) at high doses or over a prolonged period increases your risk of ulcers. The medications can irritate and thin your stomach lining and interfere with your body’s ability to repair damage to the area. Researchers estimate half of stomach ulcers are caused by NSAID overuse, according to the Cleveland Clinic. Common NSAIDs include aspirin, ibuprofen (Motrin, Advil), naproxen (Aleve), ketorolac (Toradol) and oxaprozin (Daypro).

Ulcer causes often overlap, experts say. Being infected with the bacteria makes it much more likely that an NSAID will degrade your stomach lining.

Older adults at higher risk

Anyone can get an ulcer, but your risk increases with age, experts say.

That’s partly because H. pylori infections are more common in older adults, says gastroenterologist Nimish Vakil, a professor at the University of Wisconsin School of Medicine and Public Health.

Research shows that relative to other birth cohorts, people born in the 1940s and 1950s have a higher prevalence of H. pylori, according to a Japanese study. Older people are more likely to use NSAIDs, whether it’s daily low-dose aspirin for a heart condition or ibuprofen to relieve pain from arthritis, says Ekta Gupta, a gastroenterologist and assistant professor at Johns Hopkins Medicine.

Peptic ulcer symptoms

Gupta says early ulcer symptoms can be subtle, “so it’s important to be mindful and aware of the signs.”

If left untreated, ulcers can cause complications including a hole in the stomach lining, a blockage in your intestines, stomach cancer or life-threatening internal bleeding.

Worried you might have an ulcer? Here are the symptoms to look for:

1. Burning pain in the upper abdomen

The classic symptom of a peptic ulcer is gnawing or burning pain above the belly button. The pain is typically worse at night or on an empty stomach, but not always. “Often, patients report it gets better if they eat something,” Gupta says.

The pain usually comes and goes for several days or weeks. Taking antacids may help temporarily, but the pain will keep coming back.

2. Bloating, fullness or loss of appetite

When you have an ulcer, inflammation causes the lining of your stomach to thicken, leaving less room for food, says Tinka Barnes, a family medicine staff physician at Novant Health in Charlotte, North Carolina. As a result, some patients say they feel like their stomach is distended or that they fill up quickly when they eat.

“You’re not able to take in as much,” Barnes says.

3. Nausea and vomiting

Although less common, ulcers can make you feel sick to your stomach, especially if you haven’t eaten in a while.

4. Fatigue, shortness of breath, pale skin color

Left untreated, peptic ulcers can start to bleed. The slow loss of blood can cause anemia, or iron deficiency. In some cases, anemia symptoms such as fatigue, pale skin and shortness of breath with exercise can be the first signs of a bleeding ulcer.

5. Bloody or dark stool, bloody vomit

Sometimes, an ulcer causes severe bleeding, and that’s a medical emergency. Signs that an ulcer is bleeding heavily include: stool that looks jet black, that seems sticky or that has dark red blood mixed in; bloody vomit or vomit that looks like coffee grounds; and dizziness, fainting or light-headedness. If you experience any of those symptoms, you should call 911 or head for the nearest emergency room.

Diagnosis and treatment

If your medical provider suspects an ulcer, he or she may conduct tests to see if you are infected with H. pylori. In many cases, you may be referred to a gastroenterologist for an endoscopy.

Treatment typically includes medications to block acid production such as proton pump inhibitors or H2 blockers. If H. pylori is the culprit, you may also need to take a course of antibiotics. Most ulcers can be treated and will heal after several weeks.

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Michelle Crouch is a contributing writer who has covered health and personal finance for some of the nation’s top consumer publications. Her work has appeared in Reader’s Digest, Real Simple, Prevention, The Washington Post and The New York Times.