Peptic Ulcers (Stomach and Duodenal)

Peptic Ulcers (Stomach and Duodenal)

What is a peptic ulcer?

A peptic ulcer is an open sore developing in one’s digestive tract where the tissue lining is damaged from stomach acid and gastric juices. The term ‘peptic’ pertains to or is associated with the digestive system. Whereas ‘ulcer’ refers to a sore on the skin or mucous membrane that is accompanied by damage to the tissue.

Peptic ulcer disease (PUD) is a general phrase for the occurrence of ulcers in the digestive tract lining in either the stomach lining or the upper portion of the small intestine known as the duodenum.

The following are a few key points regarding peptic ulcers:

  • Peptic ulcers are sores or erosions found in the gastrointestinal tract lining.
  • The lining made of mucous membranes begins to erode and breakdown causing tissue damage.
  • This damage will result in a burning pain that is felt in the middle upper area of the abdomen, this is typically the first symptom of peptic ulcers.
  • The majority of peptics ulcers are very small, however, some of them can result in a considerable amount of abdominal pain.

The types of peptic ulcers include:

  • Gastric ulcers – These types of peptic ulcers occur on the stomach lining.
  • Duodenal ulcers – These types of peptic ulcers occur in the lining of the of the upper part of the small intestine (duodenum).

Peptic ulcers can affect anyone at any age, they are, however, more commonly seen in adults and less so in teenagers and children.

Fortunately, over the past 20 years there has been a great deal of research conducted on peptic ulcers and as a result, there are a number of effective therapies and treatments available for patients.

What are the symptoms of a peptic ulcer?

Most people do not know that they have a peptic ulcer as ulcers often do not result in any symptoms. In some cases, a number of severe complications can arise, with bleeding being one of the most severe complications and this is then identified as the first evident sign of the ulcer’s presence.

The most prominent symptom, as stated, is a burning sensation in the stomach accompanied by abdominal pain.

This sensation is described further below:

  • Abdominal pain is typically felt in the middle upper area of the belly (abdomen), being just below the chest and above the navel (belly button).
  • The pain from a peptic ulcer is a gnawing or burning sensation that can even be felt through to one’s back at times.
  • Peptic ulcer pain is normally worse during the early morning and at night.
  • The pain can last between a couple of minutes up to a number of hours.
  • Peptic ulcer pain is often temporarily relieved through vomiting, eating something or taking antacids, these are medications that aid in relieving the symptoms of indigestion.
  • Abdominal pain is often accompanied by bloating, heartburn (also known as acid reflux) and indigestion.

Additional peptic ulcer symptoms may include the below:

  • Vomiting
  • Nausea
  • Loss of weight
  • Loss of appetite

More severe ulcers can result in bleeding from the duodenum or stomach lining. This bleeding can sometimes be the only visible symptom of the peptic ulcer. The bleeding can occur slowly or rapidly. Rapid, or fast bleeding, may reveal itself through one of the following:

  • Vomiting up dark material that resembles ground coffee or vomiting up blood. Should this occur, it is a health emergency and will require immediate medical attention.
  • Finding blood in the stool or having tarry, black and sticky stools.

Bleeding that occurs slowly is harder to detect due to the symptoms being less prominent and dramatic. These ‘slow-bleed’ symptoms are as follows:

  • Having a low blood cell count, this is known as anaemia (a reduced number of red blood cells).

    The symptoms of anaemia are:
    • Fatigue (tiredness)
    • Lethargy (lack of energy)
    • Pallor (pale skin)
    • Tachycardia (rapid heartbeat)
    • Weakness
    • Light-headedness

When to see a doctor regarding a peptic ulcer

  • If there is a burning pain present in the upper stomach region and this is temporarily relieved through taking antacids or eating, then it is best to see your doctor. Remember, never assume that you have an ulcer as there are a number of other conditions, such as gastritis, that can result in the same symptoms.
  • If you show any signs of internal (gastrointestinal) bleeding, such as vomiting blood, then you should see a doctor immediately. If peptic ulcers result in a large amount of bleeding, then you may need to have surgery or a blood transfusion. We will discuss the surgery options later in the treatment section.
  • If there is any severe pain in your abdomen, so much so that it hurts to walk or move, then this may suggest that there is a tearing or perforation of the ulcer, which is a medical emergency and surgery will be required to repair the hole in the digestive lining.
  • Abdominal pain or vomiting can also be an indication of a complication such as an obstruction. This may also require surgery.

What is the name of the specialist who treats peptic ulcers?

If you think you have an ulcer or are diagnosed with one, then this consultation will initially be conducted by your family doctor. If you need further treatment, then it is likely that you will be referred to and treated by a gastroenterologist, this is someone who specialises in the disorders of the gastrointestinal (digestive) tract.

If there is an emergency situation present, such as severe belly pain or vomiting blood, then you may be assessed by the specialist on duty in the emergency room. A general surgeon can sometimes perform an emergency surgery when one is needed, this is, however, not commonly seen.

What causes a peptic ulcer?

How does food get digested?

When we eat food, our stomach produces a chemical known as hydrochloric acid, as well as this, an enzyme termed pepsin is also secreted, this acid and enzyme combination aid in the digestion of food.

Food is then partially digested when it is in the stomach, and from here it moves to the upper part of the small intestine (duodenum) where the process of digestion continues.

A peptic ulcer may occur if the acid (hydrochloric acid) and enzyme (pepsin) create an imbalance in the lining of the digestive tract (either in the stomach or duodenum) and overcome the defence mechanisms in place in the digestive tract which usually aid in protecting the lining from these harsh substances. This may result in the mucous membrane (mucosal wall) eroding, and in doing so, an ulcer will form.

It was previously thought that the peptic ulcers were a result of specific eating habits that involved highly acidic foods and other lifestyle factors such as smoking cigarettes and stress. It is now evident that those who suffer from peptic ulcers may have an imbalance in the blend of pepsin and acid present in the digestive tract, combined with the failure of the digestive tract to protect its mucosal wall from these extremely harsh substances.

Peptic ulcer explained

Thus, ulcers are caused by:

  • An imbalance of the digestive substances pepsin and acid,
  • coupled with the digestive tract’s self-defence failure allowing for the mucosal wall to be penetrated by the harsh substances.

Research conducted during the 1980s contained evidence showing that ulcers are often a result of the bacterial infections of the bacterium H. pylori (Helicobacter pylori). However, not all cases of ulcers are caused by the bacterium and can also be from the prolonged use of certain pain medications such as aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs).

The three main causes of peptic ulcers that can damage the digestive system’s defensive ability or result in the accumulation of digestive substances are:

  • Helicobacter pylori bacteria
  • Prolonged and regular use of specific pain killers and anti-inflammatories
  • Other medications

These causes are further explained below:

There are also some kinds of medical treatments and therapies that contribute to the formation of ulcers. The following are factors that may result in the weakening of the mucosal barrier’s ability to protect the digestive lining. These factors increase one’s chances of developing an ulcer and can slow the process of healing of any existing ulcers:

  • Medications - Aspirin (pain killers), as well as nonsteroidal anti-inflammatory drugs (NSAIDs) which include - Naproxen and ibuprofen (Motrin IB and Advil), while newer forms of these drugs include celecoxib, also known as Celebrex. These drugs can inflame or irritate the stomach and intestinal lining.
  • Other medications – The combination of other medications with NSAIDs, which include steroids, selective serotonin reuptake inhibitors (SSRIs), risedronate (Actonel) and alendronate (Fosamax) can increase the risk of ulcers developing.
  • Radiation therapy – Such as radiation used for the treatment of cancer may lead to ulcers or prevent healing of existing ones.

Further risk factors regarding anti-inflammatory medications and the development of ulcers include:

  • Elderly people who have existing conditions such as arthritis and are taking anti-inflammatory drugs are particularly vulnerable.
  • Those who have had a peptic ulcer before or have suffered from intestinal bleeding.
  • Those who take anti-inflammatory drugs or aspirin have an increased risk of developing a peptic ulcer regardless of whether or not they have an H. pylori infection.

If you take these medications regularly then you should discuss what other options there are with your doctor. Particularly if you already suffer from heartburn or indigestion after taking them.

More about H. pylori bacteria

  • The bacteria spread through the faeces of someone who is infected.
  • The infected faeces can contaminate water or food through poor hygiene practices (usually when people don’t wash their hands after using the toilet and then handle or prepare food).
  • After entering a person’s mouth, the infected faecal particles will move through the digestive tract with the contaminated water or food that was ingested.
  • This is what is known as faecal-oral transmission, which is the most common form of the infection spreading.
  • pylori bacteria are naturally found in the mucous layers protecting and covering the tissues of the stomach lining and the lining of the small intestine. In most cases, the bacteria do not cause any issues, unless they manage to penetrate the lining of the digestive tract and cause damage which manifests through open sores known as ulcers.
  • Those who have been recently infected tend to develop their symptoms in the first few weeks after the initial infection.
  • The bacterium can infect people of all ages, regardless of their socioeconomic class or race.
    • It commonly infects adults, but it may be due to people being infected during childhood and carrying the bacteria with them into adulthood.
    • Lower socioeconomic classes tend to have a higher infection due to their living conditions and poor practices of personal hygiene and sanitation.
  • It is vital to know the difference between ulcers that are caused by the bacterium H. pylori and ulcers that are caused by medications as the treatment will be vastly different.

Peptic ulcer and bacteria

Other medical conditions and ulcers

Ulcers can also be linked to other medical disorders which include:

  • Generalised anxiety disorder – Those who constantly worry in an excessive manner are thought to suffer from a condition known as generalised anxiety disorder, this has been linked to peptic ulcers. Prolonged anxiety and stress are known to have an effect on the production of stomach acid, resulting in an imbalance of the digestive components and penetration of the mucosal wall.

Risk factors

  • Lifestyle factors – It was previously thought that spicy foods and mental stress could directly cause ulcers, however, there is a lack of hard evidence to prove this. These lifestyle factors can aggravate the symptoms of the ulcer. Thus, stress, smoking cigarettes and spicy foods are seen as risk factors rather than direct causes.
  • Drinking alcohol – Anything that irritates the natural balance of digestive enzymes and stomach acid will increase one’s chances of developing a stomach ulcer. Alcohol, when consumed in excessive (sometimes even in moderate) amounts, can eventually erode and damage the mucosal wall of the stomach and increase stomach acid production. When alcohol is taken with pain killers (which is often the case as those with drinking problems may often take anti-inflammatories or aspirin to relieve their hangover symptoms), this can often result in a peptic ulcer.

Complications of a peptic ulcer

If peptic ulcers are left untreated, they may result in the below complications:

  • Internal bleeding – Peptic ulcers may result in bleeding and either slow or fast blood loss. As previously mentioned, a severe loss of blood will require a blood transfusion or surgery. A slow loss of blood is evident through the vomiting of blood or a bloody or black stool.
  • Obstruction – Inflammation, scarring and swelling can often be the outcome of an ulcer. These complications may block food from passing through the digestive tract leading to weight loss and vomiting.
  • Infection – When peptic ulcers perforate the lining of the small intestine or stomach, this increases the risk of a severe infection developing in the abdominal cavity, this is known as peritonitis.

Who is affected by peptic ulcers?

Peptic ulcers have been shown to be a common occurrence in the general population with roughly one in ten people having a peptic ulcer at least once in their life. Stomach ulcers can affect people of all ages but are commonly seen in those who are over the age of 60. Men are more commonly affected than their female counterparts.

What is the diagnosis procedure for a peptic ulcer?

In order for the diagnosis of a peptic ulcer to be confirmed, a diagnostic imaging test is typically performed. The most commonly used imaging tests are:

  • UGI (upper GI series) – GI, which stands for gastrointestinal, this is a test is a kind of X-ray where you will have to drink a chalk-like liquid that will increase the contrast shown on the X-ray. This allows for specific features to be seen easily by the doctor. Images of the oesophagus, stomach and small intestine will be created. The liquid, containing barium (this test is sometimes referred to as a barium swallow because of this), will coat the digestive tract in order for the ulcer to be made visible in the X-ray image.
  • EGD (endoscopy) – This test uses a scope known as an endoscope which is a flexible and thin tube, a camera is placed at the end of the tube to allow for the doctor to get an inside view of the digestive tract. You will be given a mild sedative or may be placed under local anaesthesia if you wish, whilst the doctor will pass the endoscope down the throat, into the oesophagus, stomach and finally, the small intestine. If an ulcer is detected, a biopsy may be conducted to remove a small tissue sample to be sent for examination in the lab. This will help to determine if there is an H. Pylori infection present in the digestive tract lining.

    An endoscopy is more likely to be performed on older patients, or if there are any symptoms of internal bleeding or significant recent weight loss due to a difficulty in swallowing (often from a blockage). If an ulcer is found, then the doctor may suggest a follow-up endoscopy to ensure that the ulcer has healed through treatment.

There are three different kinds of tests that are able to detect the presence of H. pylori:

  • Blood tests – Blood tests are able to detect if there are any bacteria present through measuring the number of antibodies compared to the levels of bacteria present. Our immune system produces proteins known as antibodies in order to defend the body against foreign invaders, in this case the invader is H. pylori. A blood test is generally an inexpensive and routine procedure that is done at most medical offices. The down side of blood tests is that they may have a positive result in those who have already had an ulcer in the past and who have been treated accordingly. This impacts the accuracy of the results.
  • UBT (Urea breath test) - A breath test is able to detect the presence of bacteria through measuring the amount of carbon dioxide in your breath once you have ingested a specialised tablet or liquid that contains urea (made up of minimally radioactive carbon and nitrogen). After this, you will need to exhale into a bag which will then be sealed. If infected, the breath sample will contain the radioactive carbon that was swallowed, now in the form of carbon dioxide, as the body will rid itself of carbon through breathing the substance out as carbon dioxide. H. pylori will break down the carbon in the stomach and thus increase the amount of carbon present in your blood and breath. A breath test is often more accurate than a blood test, particularly if blood tests are not routinely performed. This test is also sometimes used after you have been treated to ensure that the bacteria is no longer present.
  • Tissue tests – Tissue tests are only used if the endoscopic biopsy was conducted and the sample tissue needed is available for analysis in order to detect H. pylori. These are done in a laboratory.

How are peptic ulcers treated?

The cause of the peptic ulcer will lead the treatment protocol. Typically, the treatment plan will involve eliminating the bacteria, if H. pylori are the cause, or reducing, if not entirely stopping the use of pain medications. This will all be coupled with aiding your ulcer to heal through the administration of medication and lifestyle changes.

The medications used to treat ulcers include:

  • Antibiotics – There are a number of antibiotic medications that will be needed to eliminate the bacteria. If H. pylori have been detected in the digestive tract, then it is likely that your doctor will suggest you take a combination of prescription antibiotics. Some options of these drugs may include:
    • Amoxicillin (Amoxil)
    • Metronidazole (Flagyl)
    • Clarithromycin (Biaxin)
    • Levofloxacin (Levaquin)
    • Tetracycline (Tetracycline HCL)

These antibiotics will be chosen according to your medical history and state of antibiotic resistance. You will typically take a course of the drugs for a period of two weeks with additional medications that will aid in reducing your stomach acid, this includes proton pump inhibitors (PPIs).

  • PPIs – These medications aid in blocking the production of stomach acid which will promote healing of the peptic ulcer.

PPIs include:

  • Esomeprazole (Nexium)
  • Pantoprazole (Protonix)
  • Lansoprazole (Prevacid)
  • Omeprazole (Prilosec)
  • Rabeprazole (Aciphex)

Your doctor may also couple a PPI with Pepto-Bismol (bismuth subsalicylate). If these drugs are used long-term in high doses, this may put you at risk of wrist, hip and spine fractures. It is best to speak to your doctor about calcium supplements you should be taking in order for this risk to be reduced.

  • Acid blockers – These drugs will also aid in the production of acid being reduced and are known as histamine (H-2) blockers. These are available over-the-counter and include:
    • Ranitidine (Zantac)
    • Cimetidine (Tagamet HB)
    • Famotidine (Pepcid)
  • Antacids – These drugs will aid in neutralising the stomach acid that already exists in the digestive tract which often provides relief from the pain experienced due to an ulcer. The side effects may include diarrhoea or constipation, but this will be dependent on the ingredients of the drugs. These medications generally provide pain relief but are not used in the treatment of the ulcer to promote healing.
  • Cytoprotective agents – These are medications that help in protecting the lining of the small intestine and stomach. Some of these may include:
    • Misoprostol (Cytotec)
    • Sucralfate (Carafate)

Follow-up care after the initial treatment and medications

Peptic ulcers will often heal after treatment is administered and guidelines are followed accordingly. However, in some cases, the symptoms can be very severe or continue regardless of the treatment, in this case, a doctor may suggest you undergo an endoscopy before and after treatment to ensure that the ulcer has healed. Speak to your doctor about your symptoms and if you have any concerns regarding the success of the treatment administered or medications that he or she has issued you with.

Ulcers failing to heal

If your peptic ulcer does not heal, despite the treatment, this is known as a refractory ulcer. Refractory refers to the ulcer being resistant to the chosen methods of treatment. There are a number of reasons as to why your ulcer will not heal, these include:

  • Not following the specific treatment plan accordingly
  • There are some types of H. pylori bacteria that can be resistant to the antibiotics
  • Regularly smoking cigarettes
  • Regularly using pain killers such as aspirin and ibuprofen as these can increase your risk of developing an ulcer and aggravate any ulcer you currently have, preventing it from healing.

In fewer cases, your refractory ulcer may be from:

  • An extreme amount of stomach acid being produced due to a disorder called Zollinger-Ellison syndrome. This is a very rare condition wherein one or more tumours will form in the small intestine or pancreas and cause a large amount of a hormone known as gastrin to be secreted which will result in a large production of stomach acid.
  • Stomach cancer
  • A bacterial infection that is not H. pylori
  • A number of other conditions that may result in sores similar to ulcers in the small intestine and stomach, one of these conditions is Crohn’s disease.

The treatment for your refractory ulcer will typically involve the elimination of some factors that are likely to be interfering with the healing of your ulcer, combined with a different course of antibiotics. If a severe complication has developed from your ulcer such as perforation or acute bleeding, then you may require surgery. However, the cases of surgery are few are far between now with the advances in medicine.

What are the surgical options for a peptic ulcer?

When medical therapy is not effective in treating ulcers, then surgery may be required. Surgery is not commonly used as an alternative to medication.

Some of the surgical options that are used for peptic ulcers may include:

  • Vagotomy – This surgery involves removing part of a nerve known as the vagus nerve. This is responsible for the transmission of messages between the brain and the stomach and removal can reduce the amount of acid secreted. This nerve is spread across a number of different locations from the thorax to the abdomen. However, in cutting off some of this nerve, other stomach functions may be interfered with. There is a more advanced form operation that can cut the only part of the vagus nerve that directly affects the secretion of acid.
  • Antrectomy – This procedure is often conducted with a vagotomy. This surgery involves the antrum (lower portion of the stomach) being removed. The antrum is the part of the stomach that is responsible for producing a hormone that increases stomach acid production. Other adjacent sections of the stomach may also need to be removed.
  • Pyloroplasty – This is a procedure that is also conducted in a combination with a vagotomy. This surgery will enlarge the pylorus (this is the opening between the small intestine and stomach, which will encourage the passing of food that has been partially digested. When the food is able to pass, this will normally stop acid production.
  • Artery surgery – If there is a large amount of internal bleeding, then a surgery may be conducted to tie off one of the arteries to stop the flow of blood to the peptic ulcer and in turn, stop the bleeding.

Alternative medicine

There are a number of over-the-counter (OTC) medications available that contain a component called calcium carbonate, such as Rolaids or Tums, which may be able to aid in treating peptic ulcers, but these should not be the primary option of treatment. There has also been some evidence suggesting that zinc may help in the healing of ulcers.

Over-the-counter options are helpful and easily obtained, however, you should never use these as the primary means of treatment as there is no evidence that suggests that they are effective in the initial healing of peptic ulcers. Therefore, it is best to always speak to your doctor regarding diagnosis and appropriate treatment. 

What are some home remedies for a peptic ulcer?

There are several ways that your pain may be relieved from a peptic ulcer that can be followed at home. These remedy methods include the following:

  • Sticking to a healthy eating plan consisting of vegetables, fruits and whole grains. It is best to eat foods that are rich in vitamins to help your body heal the ulcer.
  • Eliminating most dairy products as milk and other dairy products may make your ulcer even worse. Most people may tell you to drink milk as this can help in relieving the pain short-term, but in reality, dairy will cause the stomach to produce more digestive juices and acid which can aggravate the ulcer.

Avoid dairy products

  • Switching your pain killers and eliminating the dangerous ones entirely will help in the healing of your ulcer. Your doctor may allow you to use Tylenol, but it best to speak to a medical professional first.
  • Controlling stress will also help as stress can aggravate the symptoms and signs of the peptic ulcer. It is understandable that some stress cannot be avoided, but there are a number of ways to deal with it through breathing techniques, meditation, psychological therapy and exercise.
  • Stop smoking cigarettes as the smoke affects the lining of the digestive tract, therefore making your stomach more vulnerable to an ulcer developing. Smoke will also increase the amount of stomach acid produced.
  • Avoiding alcohol particularly in excessive amounts as alcohol can erode the mucosal wall of the digestive tract and result in bleeding and inflammation.
  • Ensuring you are getting enough sleep and this aids in giving your immune system the strength it needs to heal the ulcer.

Peptic ulcer prevention

It may be possible to prevent an ulcer from developing and reduce any risk factors you may have when following the above home remedies as well as some of the below:

  • Protecting yourself from any potential infections – There are a number of steps that you can take to afford you protection against the spread of H. pylori bacteria. It is not quite clear as to how the bacterium spreads, but evidence suggests that is may be transmitted through personal contact with an infected person or through contaminated water and food. Through good practices of personal hygiene and washing your hands with water and soap before eating and after going to the bathroom you may be able to reduce your risk.
  • Using caution when taking pain killers – The regular use of pain killers will increase your risk of developing a peptic ulcer. There are ways that pain killers can be taken. Taking your medication with meals and in smaller doses may also help. It is best to work with your doctor regarding the use of pain killers.

The peptic ulcer diet

There is a specialised diet, or rather, eating guidelines, that will significantly increase your ulcer’s rate of healing. When this diet is followed, it will limit the foods that will irritate the ulcer as certain foods can aggravate the symptoms and result in bloating, heartburn, stomach pain and indigestion.

It is vital that you stick to this eating plan as anything that aggravates your ulcer will only make your symptoms worse and your healing process longer. You may also be putting yourself at risk of other complications developing such as the peptic ulcer bleeding should you not adhere to these recommendations.

Please note that this eating plan is not a means of treatment, but rather a way to promote the healing of your ulcer. You will need to still have your ulcer diagnosed and treated by your doctor and stick to the treatment therapy accordingly in order to ensure that you undergo a full recovery. 

The following can also be used for those who suffer from gastritis.

What foods and beverages should be avoided or limited?

It is best to avoid any spicy, acidic or high-fat foods. It is suggested that you learn to identify what foods have the worst impact on your peptic ulcer symptoms, everyone is affected by food differently. The foods to avoid pertain to the ones that result in the over-production of stomach acid which can interfere with the healing of the ulcer and irritate the lining of the digestive tract.

The following foods may aggravate the symptoms of an ulcer:


  • Chocolate milk and full-fat milk
  • Hot chocolate
  • Carbonated beverages
  • Caffeinated beverages
  • Decaffeinated or regular coffee
  • Spearmint or peppermint tea
  • Black or green tea
  • Citrus fruit juices
  • Alcoholic beverages

Seasonings and spices

  • Red and black pepper
  • Chilli powder
  • Nutmeg
  • Mustard seed
  • Salt

Other foods

  • Chocolate
  • Dairy foods that have been made from cream or full-fat milk
  • Strongly flavoured or spicy cheeses that contain black pepper or jalapenos
  • High-fat meats that are highly seasoned such as ham, cold cuts, bacon and sausage
  • Peppers and chillies
  • Sugar – highly refined sugars found in foods create a harsh environment in the stomach as they are difficult to digest
  • Tomatoes - any tomato products such as tomato paste, tomato sauce or tomato juice
  • Highly processed carbs such as white bread, cakes, cookies and doughnuts.
  • Fried foods such as French fries, potato chips, onion rings.
  • Margarine – this is a highly processed spread that takes very long for the stomach to process.
  • Gravies
  • Red meat – This contains a high amount of protein and takes a longer time to digest, therefore resulting in more stomach acid. Red meat also contains more fat than white meat, this also requires more stomach acid for digestion.
  • Chewing gum – This causes a build-up of stomach acid as the body detects the saliva in the mouth and chewing as actual food and prepares itself to digest it.

What foods and beverages can I have?

There are a number of foods and beverages that you are still able to consume that will help promote the healing of your ulcer. Try to eat vegetables and fruits that are high in vitamin A and C as these are vital for your immune system function, giving it the strength it needs to help the body heal the peptic ulcer. Whole grains and fibre-rich foods are a great option, as well as healthy fats.

Those who follow these eating guidelines will note a significant improvement in their ulcer symptoms and their general well-being.

The following are some fibre-rich foods that you will promote healing:


  • Celery
  • Bell peppers
  • Squash
  • Peas
  • Beans
  • Other legumes
  • Kale
  • Spinach
  • Carrots
  • Sweet potatoes
  • Cucumbers
  • Broccoli
  • Sprouts


  • Apples
  • Strawberries
  • Blueberries
  • Cherries
  • Bananas
  • Melons
  • Pears

Whole grains

  • Millet
  • Oatmeal
  • Quinoa
  • Barley
  • Whole grain cereals
  • Brown rice

Healthy foods for protein

There have been studies that suggest that eating protein is vital for ulcers to heal. Protein promotes the healing of all wounds. Some healthy proteins include:

  • Eggs (egg whites)
  • Lean meats
  • Fish
  • Turkey
  • Chicken
  • Pork
  • Seafood
  • Duck
  • Tofu
  • Legumes

Healthy fats

It is vital that you choose healthy fats over trans fats as these may help in alleviating the symptoms of an ulcer. These include:

  • Olives
  • Vegetable oils
  • Fish oils – these can also be taken in the form of supplements (Omega-3s)
  • Seeds
  • Nuts
  • Seed and nut butters
  • Avocados

Foods rich in probiotics

These may be able to help in the relief of ulcer-related pain and include:

  • Yoghurt – some research suggests that natural yoghurt contains active cultures which are good bacteria that may be able to promote the healing of the ulcer and inhibit the growth of H. pylori
  • Kefir
  • Sauerkraut
  • Aged cheese - this may contain the same cultures as yoghurt

Beverages and condiments

  • Filtered water
  • Herbal tea
  • Honey
  • Plant-based milks

Supplements, spices and herbs

  • Cranberry extract – This may stop the growth of the H. pylori in your stomach
  • Mastic extract – This may also inhibit bacterial growth in your stomach
  • Vitamin C – Promotes the healing of ulcers through boosting the immune system
  • DGL-liquorice extract – This may help to protect the digestive tract from anti-inflammatory drugs
  • Probiotics – These aid in the ulcer recovery and help in counteracting the side effects of other medications such as antibiotics which upset the natural intestinal flora balance of the stomach


Individual tolerances to spices may vary and it is best to know what aggravates your symptoms personally. Some ‘safe’ herbs include:

  • Sage
  • Cardamom
  • Thyme
  • Oregano
  • Cinnamon
  • Coriander
  • Turmeric
  • Basil
  • Cumin
  • Marjoram

Other helpful diet guidelines

It is best to stop eating for at least two hours before you go to bed as this will help prevent any heartburn and indigestion. It is also advised that you eat smaller meals more frequently as this will be easier on your stomach and digestion. 

The above list is more of a guideline and you may find that some foods that are allowed may aggravate some of your symptoms. Therefore, you should spend time in identifying your individual problem foods and avoid these until your ulcer has completely healed.

What is the outlook for a peptic ulcer?

Through following a proper treatment and eating plan, most ulcers will heal. Bear in mind, if you do not take your medication, discontinue it too early, continue smoking, drinking and eating problem products, then your ulcer will battle to heal and this can result in a number of complications. It is best to schedule an appointment to see your doctor for a follow-up to ensure that your ulcer has healed.

Roughly 8% to 11% of women and 11% to 14% of men will have a peptic ulcer at least once in their life.

The peptic ulcer mortality rate is low with only one in 10,000 patients dying from ulcer-related complications. The mortality rate as a result of haemorrhages (internal bleeding) is roughly 5%. However, the prognosis is often positive for most peptic ulcers if adequately treated.


How long does it take for peptic ulcers to heal?

Treatment to rid the digestive tract of H. pylori bacteria will take roughly two to three weeks where you will take a course of antibiotics for this period of time. Medication to lower the amount of stomach acid produced may also be prescribed for a period of eight weeks. Following from this, the complete healing process for uncomplicated ulcers may take between two and three months.

Do stress and spicy foods cause peptic ulcers?

Before the discovery of H. pylori infections, it was thought that one’s diet and stress levels were a direct cause of peptic ulcers. This has now been proved wrong as these factors will irritate the ulcer but not cause it. The main causes of stomach ulcers is an H. pylori bacterial infection and excessive use of medications such as painkillers and anti-inflammatories (NSAIDs).

How dangerous are peptic ulcers?

Most ulcers can be cured through detection and treatment. However, if left untreated they can be life-threatening as they pose risks of perforation, bleeding (haemorrhage), obstruction and cancer. 

Disclaimer - is for informational purposes only. It is not intended to diagnose or treat any condition or illness or act as a substitute for professional medical advice.