A peptic ulcer is an open sore in the lining of the stomach (gastric ulcer) or the first part of the small intestine (duodenal ulcer). The two main causes are infection with the bacterium Helicobacter pylori and regular use of anti-inflammatory painkillers (NSAIDs) such as ibuprofen, diclofenac and aspirin. Stress and spicy food don’t cause ulcers, although they can make symptoms feel worse.
Symptoms
- Burning or gnawing pain in the upper tummy (epigastrium)
- Duodenal ulcer pain often eases with food and returns 2 to 3 hours later or at night
- Gastric ulcer pain may get worse with food
- Bloating, nausea, indigestion and loss of appetite
- Some ulcers cause no symptoms until a complication occurs
Red flags: seek urgent help
- Vomiting blood or “coffee grounds”
- Black, tarry stools (melaena)
- Sudden, severe abdominal pain with a rigid abdomen (possible perforation)
- Persistent vomiting (possible obstruction)
- Unintentional weight loss, difficulty swallowing, or new symptoms over age 55 (to exclude cancer)
- Dizziness, fainting or signs of anaemia
How it is diagnosed
- H. pylori tests: urea breath test, stool antigen test or biopsy during endoscopy. Proton pump inhibitors (PPIs) should usually be stopped 2 weeks before breath or stool testing, and antibiotics 4 weeks before, to avoid false negatives.
- Endoscopy: for people with red flags or who don’t respond to treatment.
Treatment
- H. pylori eradication: usually a PPI plus two antibiotics (e.g. amoxicillin with clarithromycin or metronidazole) for 7 to 14 days, as per local guidelines, which depend on antibiotic resistance patterns
- PPIs (omeprazole, esomeprazole, pantoprazole) to reduce acid and allow healing
- Stop or reduce NSAIDs where possible; if they must continue, a PPI is given for protection
- Re-test for H. pylori after treatment if advised
- Bleeding ulcers need emergency resuscitation and endoscopy
Nursing care
- Assess pain, its relation to meals, and stool colour
- Monitor vital signs and haemoglobin; watch for signs of bleeding (tachycardia, hypotension, pallor, melaena)
- For suspected upper GI bleeding: two large-bore cannulas, bloods including group and crossmatch, nil by mouth, and urgent escalation
- Give medicines on time and explain the importance of completing the full antibiotic course
- Review all medicines for NSAIDs, steroids and anticoagulants
Patient education
- Take the full course of eradication therapy even if you feel better
- Avoid over-the-counter NSAIDs unless a doctor says otherwise; paracetamol is usually safer for pain
- Stop smoking and limit alcohol to aid healing
- Eat regular meals; avoid foods that personally worsen symptoms
- Know the red flags and seek help immediately
Frequently asked questions
Can stress cause a stomach ulcer?
Everyday stress doesn’t cause peptic ulcers, but severe physical stress in critically ill patients can cause “stress ulcers”.
Does milk help ulcers?
Milk may soothe briefly but then stimulates acid. It is not a treatment.
How long does an ulcer take to heal?
With treatment, most heal within 4 to 8 weeks.
Related reading: Upper GI bleed nursing care · Acute abdomen nursing assessment · Antimicrobial stewardship
Checked against NHS guidance on stomach ulcers. Updated 5 November 2026.