Ever heard the phrase “all this stress is giving me an ulcer,” or “too much coffee will burn a hole in your belly?” There are a lot of preconceived notions and misconceptions about peptic ulcers.

It is true that these open sores, which develop on the lining of your stomach or small intestine, are common. In fact, about 1 in every 10 people will develop a peptic ulcer at some point in their life. But do not blame stress or those extra cups of Joe. Researchers have found that the overuse of certain medications and bacterial infections are in fact the most common culprits.

The digestive tract is usually protected by a thick layer of mucus or lining. When this lining becomes damaged, acidic digestive juices can cause a break at the surface of the stomach or intestine.

The telltale sign of a peptic ulcer is upper abdominal pain. They are often chronic, meaning that the discomfort felt may come and go over time.

“No one should suffer in silence. Ulcers are very treatable with a variety of acid-suppressing medications,” says Michael Fuhrman, MD, a gastroenterologist at Summit Health. “When left untreated, however, they can lead to severe complications that can become life-threatening. If you have any symptoms of an ulcer, speak with your primary care provider, or consult with a gastroenterologist.”

Dr. Fuhrman and his colleague, Jeffrey Okun, MD, help patients manage the painful symptoms of peptic ulcers. Together, they answer frequently asked questions about diagnosis, treatment, and prevention. They even help dispel some common myths about these pesky stomach sores.

Q. Why do peptic ulcers develop?

Dr. Fuhrman: There are many possible causes of peptic ulcers. One of the most common culprits is the overuse of a category of medications called non-steroidal anti-inflammatory drugs or NSAIDs. These include aspirin and ibuprofen. NSAIDs can lead to ulcers by impairing the stomach lining’s ability to protect itself from acid. Another frequent cause is a bacterial infection called Helicobacter Pylori (H. Pylori). This infection can lead to increased acid production and impair the body’s ability to protect against injury. Smoking and alcohol use also increase your risk for developing peptic ulcers.

Q. Is it a myth that stress can cause ulcers?

Dr. Okun: It is a misconception that stress can cause ulcers. The gastrointestinal tract has five times as many nerves as the spinal cord. So while stress and anxiety may cause an upset stomach, it is not going to harm the tissue itself to either cause an ulcer or worsen an existing one.

Q. But wait… I have heard of stress ulcers. What are those?

Dr. Okun: Stress ulcers are unrelated to peptic ulcers. They occur in very sick people that are under extreme physiological stress from being in an ICU or a burn unit, for example. Stress ulcers are unrelated to the psychological stress people experience.

Q. What about spicy food and coffee? Can they make things worse?

Dr. Okun: It is true these foods can give you an upset stomach, but like stress they do not cause an ulcer. When you eat very spicy foods, the body tries to counteract the acid by producing chemicals. This is what causes the discomfort.

Q. What are signs you may have a peptic ulcer? What does the pain feel like?

Dr. Fuhrman: The most common sign of a peptic ulcer is upper abdominal pain. This feeling is usually located just below the chest, in the middle of the abdomen. However, sometimes it is found more to the left or right. Patients often describe the feeling as a burning sensation or gnawing pain. Other symptoms include bloating, nausea, and heartburn. 

Q. Does anything make the pain either better or worse?

Dr. Fuhrman: Depending on the location of the ulcer, eating can sometimes help. However, some individuals find that food makes them feel worse. Using an antacid like Tums, which neutralizes the acidity, can help alleviate symptoms.

Q. Is it true you may not even know you have an ulcer?

Dr. Okun: The vast majority of people that have ulcers probably do not realize it. In fact, a large percentage of patients never actually experience any symptoms. Sometimes patients find out when they are having an endoscopy for another reason.

Q. How do you diagnose an ulcer?

Dr. Fuhrman: The best way to find an ulcer is with an upper endoscopy. It allows the doctor to visualize the stomach and small intestines. They can also biopsy the area to help diagnose H. Pylori and rule out other less common causes of ulcers.  If the ulcer is bleeding, it can be cauterized or clipped to stop the bleeding during the procedure.

Q. Will my ulcers go away on their own?

Dr. Fuhrman: Ulcers may resolve on their own, but most people need medication. Trying to address the underlying cause is important.  For example, if the patient is found to have an H. Pylori infection, antibiotics will be prescribed to help eradicate the infection. If the ulcer is caused by NSAIDs, stopping these medications should help.

Q. Are there medications that heal ulcers?

Dr. Okun: The stomach is a very acidic environment, so it makes a coating to protect itself. When an ulcer occurs, there has been some damage to that protective coating. There are various medicines that can inhibit the stomach’s production of acid and allow the stomach to heal. The most effective of these medicines are proton pump inhibitors, such as omeprazole and pantoprazole. By taking away the cause of the ulcer, it allows the stomach to repair itself a little faster. Topical medications like magnesium hydroxide (Maalox) or bismuth subsalicylate (Pepto Bismol) can also help coat the stomach and make someone with an active ulcer feel better.

Q. Can peptic ulcers lead to other complications?

Dr. Fuhrman: Ulcers can lead to gastrointestinal bleeding or perforation, which is a hole in the intestine. Symptoms of a complication from an ulcer could include persistent vomiting, severe abdominal pain, the presence of red blood in the stool, or a dark, tarry appearance to bowel movements. 

Q. Will I need surgery?

Dr. Fuhrman: Surgery has very rarely been needed to treat ulcers since the development of these proton pump inhibitors. It is primarily used for complications of severe ulcers such as perforation of the bowel or bleeding that cannot be controlled through other means. 

Q. Is anyone more likely to get a peptic ulcer?

Dr. Fuhrman: Ulcers are twice as common in smokers as they are in non-smokers.  Excessive alcohol consumption can also raise your risk. Growing up in a household with someone who had an ulcer caused by H. Pylori infection may also increase your chances.

Q. How can you prevent ulcers?

Dr. Okun: The best thing you can do is minimize the use of anti-inflammatories. If you have to take these medications, pair them with food and speak with your doctor about using a protein pump inhibitor. Eating a well-balanced diet is always important. If you are a smoker, quitting or even cutting down can also help the stomach heal more effectively. Alcohol may also exacerbate the symptoms people experience. 

Q. Can home remedies help?

Dr. Okun: Patients often ask me if drinking milk or taking apple cider vinegar can help. While none of these things have been proven to heal ulcers, I tell my patients they are fine to use as an adjunct, but they should not replace actual treatment.