Even though more than 25 million Americans will suffer from a stomach ulcer at some point during their lifetime, according to the Centers for Disease Control and Prevention, you don’t need to put down the jalapeño poppers just yet. Contrary to popular belief, spicy foods don’t cause stomach ulcers. Neither does stress. (If you already have an ulcer, however, both can make your symptoms worse.)
“The two main causes of ulcers in the U.S. are a bacterial infection called H. pylori, and long-term use of aspirin and NSAID painkillers (ibuprofen and naproxen),” says Shipla Ravella, M.D., gastroenterologist at NewYork-Presbyterian and Columbia University Medical Center.
Basically, there’s a thick layer of mucus that protects your stomach from digestive juices, which are hella acidic. And anytime there’s a mucosal drought, the juices eat away at the tissues that line the stomach, causing an ulcer. Gah.
Think you might have one? The primary symptoms to look out for are pretty non-specific (translation: they can be caused by a variety of conditions besides ulcers), says Ravella, so it’s important to check in with your doc if you ever experience any of the following five issues:
The most common stomach ulcer symptom is, not surprisingly, stomach pain—typically, a dull, burning sensation in the mid-abdominal area. “Because ulcers are literally sores in the lining of the stomach or small bowel, pain classically presents in relation to acid secretion in the intestines,” says Rusha Modi, M.D., gastroenterologist and assistant professor of clinical medicine at Keck Medical Center in California. The pain usually peaks between meals and at night, when acid has been secreted into the stomach but there’s no food to act as a buffer. Taking antacids can temporarily relieve the pain, but odds are it will keep coming back until the ulcer is treated by a professional.
Because the ulcer is being perpetually doused in acid, stomach pain can often be paired with chronic heartburn and regurgitation (that icky feeling of acid backing up into your throat). Other symptoms, such as bloating, burping, or feeling perma-full, may not be far behind, says Ravella. If taking an OTC antacid only relieves symptoms temporarily, or they seem to strike no matter what you eat, you may want to discuss this with your physician.
“Nausea and vomiting are also due to the inflammatory cascade that occurs as a result of the ulcer’s development,” says Modi. The inflammation of the stomach lining itself causes intermittent contractions (cue nausea)—and if the muscles of the abdominal wall contract with enough force, it can cause full-on vomiting, says Rudolph Bedford, M.D., gastroenterologist at Providence Saint John’s Health Center in Santa Monica, California.
In some cases, these symptoms strike because the ulcer is causing a blockage in the stomach and food isn’t able to pass easily into the small intestine. Your doctor can determine the exact cause of the ulcer and, most likely, treat it with antacid medications—but, if there’s evidence of a blockage, you’ll be admitted to the hospital for further treatment, says Modi.
Ulcers can bleed and cause vomiting—particularly, vomiting of blood or material that looks like coffee grounds (which is digested blood that’s been sitting in the stomach), says Sophie Balzora, M.D., gastroenterologist and assistant professor of medicine at NYU Langone Medical Center. Your poop may also become black in color, which, again, can be indicative of digested blood. “Both are signs that require urgent and emergent medical attention,” she says.
Pain from a stomach ulcer can travel, radiating to the back or chest. “If the ulcer has penetrated through the bowel wall, the pain can become more intense, longer in duration, and harder to alleviate,” says Ravella. Ulcers can also cause perforation (where the lining of the stomach splits open), in which case you may experience sudden and severe stomach pain that continually gets worse—and should head to the ER, stat.
If you’re not experiencing symptoms that require urgent medical attention, set up a time to chat with your doctor about the best course of action is. “If there’s a high suspicion for an ulcer, you may be advised to undergo an upper endoscopy to formally diagnose and treat it accordingly,” says Balzora. Ulcers are primarily treated with acid-lowering medications—and, if H. pylori is detected, a round of antibiotics.