What Causes Stomach Ulcers (Women and Men)

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What causes stomach ulcers? That’s a familiar question when it comes to discussing about ‘peptic’ (a Latin and ancient Greek vocabulary) that refers to the ‘digestive system’. There are several answers since many times the problem is a consequence of more than one factor.

First off, what are actually ulcers in the stomach?

The anatomy of your healthy stomach is naturally coated in a tough layer of mucus. This sticky mucus layer plays a key role for lots of things, including for protection. It is responsible to protect the lining (soft tissue) of the stomach.

This mucus is crucial part of the balance system to keep the stomach lining healthy in long term. For example, it’s important to protect the soft lining during digestion, including from foreign pathogens and stomach acid that breaks down food.

And when something goes awry with the balance, — let’s say when the mucous layer loses its ability to protect the lining of stomach or when you end up with a lot of stomach acid (higher than normal) –, your stomach is likely to digest itself, resulting in an open sore called ulcer.

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Ulcer that forms in the stomach is called ‘gastric or stomach ulcer’. It also can affect soft-lining tissues in the upper portion of small intestine, in such case the condition is called ‘duodenal ulcer’. Both types belong to a group of open sores affecting digestive tract known as peptic ulcers [1].

The size of gastric ulcer can vary, depending on how severe it is. When it occurs for the first time, the size is usually very tiny. But over time it may get worse and become larger in size (could be over an inch long).


Early diagnosis is important to treat the disease more effectively so the patient can have a complete recovery with no lingering after effects.

Unfortunately, many people with the disease may not seek medical help until the symptoms become quite advanced. Even about three-quarters of all cases, there is no early warning sign of the disease.

When the open sore is small, there is usually no symptom. As the disease progresses, a number of discomforts and symptoms will occur. They may vary greatly from person to person. But the most common one is a burning pain in the upper abdomen.

The pain usually gets worse with empty stomach (when your stomach acid is high) and will relieve for a while when you take antacids. Other symptoms may include heartburn, bloating, feeling of fullness, belching, and indigestion

Image credit to scientificanimations.com

In less common cases, the disease may also cause severe symptoms such as changes in appetite (appetite loss), trouble breathing, weight loss with unknown reason, dark blood (tarry) in the stools, feeling faint, or even vomiting blood [2].

How serious is the problem?

Stomach ulcer complications are rare – but if they occur, they could be very dangerous. These include; internal bleeding, perforation (a dangerous condition in which the ulcer causes a hole through the stomach wall), and swelling that can be large enough to block the passage of food through the stomach.

A burst ulcer is more likely to occur if an ulcer develops at the site of a blood vessel. And when it carves into a blood vessel in the stomach, this triggers bleeding which may occur rapidly (acute) or slowly (long-term bleeding). This bleeding could be fatal (life-threatening) so it requires immediate treatment or (if necessary) surgical intervention. 

The bleeding may develop in the following ways:

  1. Slow, chronic long-term bleeding. It can cause anemia (a condition of when the body is at a low red blood cell count (lower than normal) due to inadequate iron). Sometimes patients may not notice this slowly bleeding until they become anemic.
  2. Severe bleeding that progresses rapidly. This kind of heavily bleeding is rare, but it is very dangerous if not immediately treated.

Internal bleeding that continues without medical intervention could be very dangerous. Losing about one-third of the total blood could be enough to cause serious consequences such as the failure of some organs – or even a death if you lose one-half of your total blood [3].

Ulcer complications are preventable. With prompt treatment, the disease can be cured – especially if it hasn’t become advanced.

So, what causes stomach ulcers?

For many years, it’s was thought that excessive acid is to blame for the cause of stomach ulcer. But today we know that most cases of peptic ulcer are not caused by acid damage, though excess acid can worsen the open sore.

In fact, the disease is often caused by the following two main factors [4]:

  1. Blame it on Helicobacter pylori, a kind of bacteria that commonly live in the stomach and small intestine. Though not all people with H-pylori infection develop ulcers, it’s common to find this bacterial infection in many patients with peptic ulcers.
  2. Regular use of pain relievers especially NSAIDs. Those medicines can hurt the lining of the stomach and small intestine, leading to an open sore in long term.

Helicobacter pylori

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It’s probably not fully understood yet why bacterial infection caused by Helicobacter pylori is the leading cause of peptic ulcers – about 60-70% in stomach ulcers and over 90% for duodenal ulcers.

About half of all people at the age of 60 have been infected. Interestingly, the vast majority of people with this bug remain healthy (they don’t have symptoms of peptic ulcer disease). Only a small percentage (for unknown reason) develops the disease [5].

But we know that the bacteria can inflame the stomach and small intestine’s walls. And this may make ulcers more likely!

Also, the bacteria that live close to the stomach’s surface lining may stimulate more acid secretion. As a result, excessive amount of stomach acid would provoke further damage.

What causes H. pylori in your stomach? The exact answer is not known. But in general, the infection is likely to occur in areas of overcrowding and poor sanitation. It may also spread through close contacts (e.g. tainted foods or kissing).

Medicines that cause ulcers in the stomach

Credit to Photo Researchers / Science Source

After H. pylori infection, blame it on certain medicines that provoke inflammation in your stomach lining.

Let’s say pain killers – the most popular ones include ibuprofen, aspirin, naproxen sodium, or ketoprofen – these NSAIDs (non-steroidal anti-inflammatory drugs) could be tough on your digestive system. They can set the stage for a peptic ulcer either in the stomach or small intestines [6].

This risk is particularly true when you take the medicines for long-term use. The same goes for other medicines such as blood thinners, steroids, and some drugs for treating osteoporosis since they may also provoke inflammation in the stomach lining (especially when you take them along with NSAIDs).

But the effects of these medicines also vary from person to person. Some people could be more sensitive than others. Not everyone is at risk of developing side effects (including ulcers) of NSAIDs.

To keep safe, discuss with your doctor if you’re in doubt on any medicines you’re taking. If necessary, your doctor may prescribe extra therapy (proton pump inhibitor for example) to help control your stomach acid level or prescribe the medicines at lowest dose possible.

What else?

The risk of developing ulcer in the stomach may also increases with the following risk factors:

Age factor — as with most health conditions, the risk for stomach ulcer increases with age! In other words, it’s likely to form later in life (most commonly over age 60 or 70).

How about gender? Yap, it also have an effect but not significant. Women are likely to develop the disease than men. The story is different for duodenal ulcers, because it affects more men than women [7].

A personal history of stomach ulcer! If you have had the disease before, you’re likely to have it for the second time. So it’s important to follow treatment plan completely so the risk of recurrence can be minimized.

Lifestyle factors! These include cigarette smoking, stress, and poor diet.

Tobacco smoke is bad for lots things in your body, including the digestive system. It has toxins which some may hurt your stomach lining. It also puts you at high risk of getting H. pylori infection. In fact, active smokers are likely to get peptic ulcers if compared to non-smokers [8].

High perceived everyday life stress has an effect, too. Although now we know that stress is not the main underlying cause of stomach ulcer, it’s still to blame to increase the risk or make the disease get worse during treatment.

Unfortunately, having painful disease such as stomach ulcer would increase your stress tension or even make you depressed. But though stress is inevitable, it’s manageable!

How about your diet? Diet is probably not the main underlying cause, but it can increase the risk of the disease.

Your stomach is a crucial organ to digest foods. So it’s always worthwhile to pay attention on what you eat. If you think you’re at high risk of developing stomach ulcer, here are a few common culprits to restrict in your diet:

What Why
Milk, including dairy products Milk can drive more acid production in your stomach. Even if you’re not lactose intolerance, it’s much better to consume milk and dairy products in moderation. This idea is also good for your weight control!
Alcohol Like smoking, alcohol can also irritate your stomach lining, especially when you drink excessively. Even drinking a little may make your stomach secrete more acid than usual.
Overload dietary fiber While fiber is a good way to help keep your digestive system work in balance, overload fiber in the stomach could be counterproductive. Too many fibers may result in increased amount of stomach acid. Again, the key is a healthy balanced diet (eat them in moderation).
Also, avoid or restrict such things as:
Large meals (overeating).
Eating late at night, including late night snack. Finish eating at least 2-3 hours before bedtime.
A long gap between meals. Eat you meals regularly! Letting the stomach go empty without any foods for long periods of time can significantly raise your stomach acid.
Acidic foods, chocolate, fatty foods, fried foods, carbonated drinks, caffeinated drinks, tomatoes, spicy foods, and strong-flavored cheeses

How about prognosis and outlook of the disease? Ulcer in the stomach usually will go away without leaving serious problems – though in a few cases it may fail to heal.

With prompt treatment, stomach ulcer will heal within several weeks (for more information about how long it takes to heal completely, see more here).

But be careful, it may return months or years afterwards if you don’t reduce your risk of having the recurrence such as cigarette smoking and overuse of painkillers (especially NSAIDs). And if you drink, do it in moderation (limit it to 2 drinks a day, or no more than 1 drink a day for women)!

Also, protect yourself from H-pylori infection. Although the way of how H-pylori bacterium spreads is not fully understood, it’s always worth a try to maintain personal hygiene such as frequently washing your hands (especially after going to the toilet) and cook your foods properly! For examples – poultry, pork, burgers, kebabs, offal, and sausages must be cooked thoroughly.

Treatments for stomach ulcer are now much better than before. Surgery is rarely used, typically only suggested when serious complications of the disease (such as perforation) have occurred.

However, there is also a chance for the open sore fails to heal. Stomach ulcer that fails to heal after treatment is also called as refractory ulcer. This may occur due to the following reasons:


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