Myth 1: Ulcers are caused by stress and anxiety eating you up inside.

Myth 2: Spicy foods burn holes in your stomach.

Myth 3: To heal ulcers, eat only white foods (milk, potatoes, rice).

Myth 4: Ulcers happen only in your stomach.

Myth 5: There's no cure. You just have to live with ulcers.

All of those statements are false. The facts are that ulcers are caused by either:

  • A bacterial infection
  • Certain medications

While extra stomach acid and spicy foods can irritate a stomach ulcer you already have, they don't cause ulcers. Ulcers can happen anywhere along your digestive tract and are curable. Untreated, they can lead to serious, even life-threatening complications.

Now that we've set the record straight, let's take a look at the symptoms, diagnosis and treatment of this all too common pain in the gut.

What exactly are ulcers?

Peptic ulcers (peptic means related to the digestive system) are open sores on the lining of your stomach, upper small intestine (duodenum) or esophagus. You can have more than one ulcer. According to the National Digestive Diseases Information Clearinghouse (NDDIC): "If ulcers are found in the stomach, they're gastric ulcers. In the duodenum, they're duodenal ulcers." Stomach ulcers affect about 10 percent of the American population.

What causes ulcers?

Dr. Derek Taylor, gastroenterologist at Northwest Gastroenterology in Portland, Oregon, says, "Stress worsens symptoms but doesn't cause ulcers, except in extreme cases of malnutrition. Ninety percent are caused by either helicobacter pylori [H. pylori] infection or nonsteroidal anti-inflammatory [NSAID] use [Advil, ibuprofen, Motrin, naproxen and aspirin]. Some patients take NSAIDs for a week and develop an ulcer. Others take them all their lives, but then add another medication and that triggers an ulcer."

The NDDIC explains: "Strong acids digest food. A lining protects the inside of your stomach and duodenum from these acids. Both H. pylori and NSAIDs weaken the lining, so acids can damage the stomach or duodenal wall."

The H. pylori bacteria causes two-thirds of ulcers. Twenty percent of people younger than 30 and half of those over 60 carry the bacteria, but many don't get an ulcer. H. pylori lives and multiplies within the tissue that lines the stomach and small intestine and often causes no problems. Sometimes, however, it irritates the stomach lining and causes an ulcer.

H. pylori spreads by close contact and through food and water. Dr. Taylor says the most common source is fecal–oral. "It's a hygiene issue. Most people get it at home from friends and family who don't wash their hands well enough."

What are the complications with ulcers?

Other than ongoing pain, untreated ulcers can lead to a painful and life-threatening abdominal infection. Ulcers may also cause internal bleeding and cause scarring that keeps you from absorbing food or makes it hard for food to move through your gut.

How do you know if you have one?

They're painful. You feel a burning pain somewhere between your navel and breastbone that lasts several minutes to hours. It's generally worse when your stomach is empty or at night. The pain may get better if you eat acid-reducing foods or take drugs that reduce stomach acid. The pain may come and go, even for weeks at a time. If you have severe, life-threatening ulcers, you may vomit blood or have bloody or tarry stools, nausea, unexplained weight loss, lack of appetite or show signs of infection.

If you smoke, have a family history of ulcers or drink alcohol, you have a greater chance of getting an ulcer.

How are they diagnosed?

Ulcers are diagnosed through a blood, breath or stool test that detects H. pylori. Your doctor may also order an X-ray of your digestive system or an endoscopy (a long, narrow tube with an attached camera threaded down your throat into your stomach and gut). Your doctor may also do a biopsy to rule out cancer.

How are ulcers treated?

If your ulcer is caused by an H. pylori infection, it is treated with antibiotics and acid-reducing drugs. Dr. Taylor says, "It sometimes requires several medications to knock out H. pylori because it's becoming a 'smart bug.'"

If your ulcer is caused by NSAID use, you quit taking NSAIDs until the ulcer heals. Your doctor may prescribe other drugs, too. Dr. Taylor says: "Patients should take the lowest possible NSAID dose and only as needed. Tell your doctors if you're taking them so they don't prescribe other medications that conflict with NSAIDs and cause ulcers. Some patients can eventually return to NSAID use, but they'll also need to use medications like Prilosec to protect their stomach."

Most ulcers heal well with treatment. "If not," says Dr. Taylor, "there's something else going on." Like what? According to the Mayo Clinic: "Peptic ulcers that don't heal with treatment are refractory ulcers. They can result from not taking medications as directed, antibiotic resistance, tobacco, alcohol, and/or NSAID use, extreme overproduction of stomach acid, infection with bacteria other than H. pylori, stomach cancer and diseases like cirrhosis and chronic obstructive pulmonary disease."

We've come a long way since the time when the only treatment was mashed potatoes and milk.

Published on June 12, 2009; updated on May 29, 2014.