Most peptic ulcers are curable with a combination of acid-suppressing medication and, when a bacterial infection is involved, a course of antibiotics. The two main causes of ulcers are infection with a bacterium called H. pylori and long-term use of pain relievers like ibuprofen or aspirin. Identifying which cause is behind your ulcer determines exactly how it’s treated.
Finding the Cause Comes First
Before treatment starts, you’ll typically be tested for H. pylori infection. The most common methods are a breath test, where you drink a solution and breathe into a collection bag, and a stool antigen test. Both are noninvasive. Stool antigen testing has near-perfect specificity (essentially 100%), meaning a positive result almost certainly confirms active infection, though its sensitivity for catching every case runs around 61%. A blood antibody test is more sensitive (about 94%) but can’t distinguish between a current infection and one you had years ago, so it’s less useful for guiding treatment decisions.
If H. pylori isn’t found and you haven’t been taking NSAIDs, your doctor may investigate less common causes. Ulcers that keep coming back, resist treatment, or appear alongside chronic diarrhea can signal a condition called Zollinger-Ellison syndrome, where small tumors cause your stomach to overproduce acid. This is rare but important to rule out.
Treating H. pylori Infection
If H. pylori is the culprit, the goal is to completely wipe out the bacteria. The current recommended first-line treatment is a 14-day regimen known as bismuth quadruple therapy. You take four medications simultaneously: an acid-suppressing drug twice daily, plus tetracycline four times daily, metronidazole three or four times daily, and bismuth (the active ingredient in Pepto-Bismol) four times daily. It’s a lot of pills, and the schedule is demanding, but this regimen has an eradication success rate of about 90%.
Older regimens based on clarithromycin, which used to be the go-to approach, are no longer recommended as a default. Resistance to clarithromycin in the U.S. now runs around 31%, and resistance to metronidazole and levofloxacin is even higher (42% and 38%, respectively). The American College of Gastroenterology specifically recommends against clarithromycin-based therapy unless lab testing has confirmed the bacteria are sensitive to it.
Finishing the full 14 days matters enormously. Treatment failure is often traced back to missed doses, and partially treated infections can develop further antibiotic resistance. Smoking, age, and interactions between medications and food also affect how well the regimen works. If the first round fails, your doctor will choose a different antibiotic combination for the second attempt, sometimes guided by susceptibility testing to see which drugs will actually work against your particular strain.
Acid Suppression: The Core of Healing
Whether your ulcer is caused by H. pylori, NSAIDs, or something else, reducing stomach acid is central to letting the ulcer heal. Proton pump inhibitors (PPIs) are the standard tool. Common options include omeprazole (20 mg once daily at standard dose), lansoprazole (30 mg once daily), and pantoprazole (40 mg once daily). These drugs block the mechanism that pumps acid into your stomach, giving the damaged tissue a chance to repair itself.
Ulcers heal faster than most people expect. Even without active treatment, ulcer size shrinks by roughly 70% to 80% within three weeks, following an exponential curve with a healing half-life of less than two weeks. With proper acid suppression, the timeline is faster and more reliable. Duodenal ulcers (in the upper small intestine) tend to close slightly quicker than gastric ulcers (in the stomach lining). Most treatment courses run four to eight weeks depending on ulcer location and size.
When NSAIDs Are the Problem
If your ulcer was caused by regular use of ibuprofen, naproxen, aspirin, or another NSAID, the most straightforward step is stopping the drug. Combined with a PPI to suppress acid, this is often enough for the ulcer to heal completely.
The picture gets more complicated when you can’t stop taking NSAIDs. People on long-term aspirin for heart protection, for example, may need to restart it as soon as bleeding is controlled because the cardiovascular risk of stopping outweighs the ulcer risk. In these cases, treatment focuses on managing both risks at once. If you have a high risk of developing another ulcer but low cardiovascular risk, switching to a COX-2 selective anti-inflammatory (a type of NSAID that’s gentler on the stomach lining) is one option. If cardiovascular risk is also high, the standard approach is to add a daily PPI alongside your regular NSAID.
Risk factors for NSAID-related ulcers include older age, a history of previous ulcers, taking high doses, and combining NSAIDs with blood thinners or steroids. If you fall into a high-risk category and need long-term NSAID therapy, you should also be tested for H. pylori, since treating an underlying infection on top of NSAID use significantly reduces the chance of ulcer complications.
Protective Agents That Shield the Stomach Lining
A different class of medication works not by reducing acid but by physically protecting the damaged tissue. Sucralfate, the most well-known example, forms a thick, paste-like barrier over the ulcer crater. This coating shields the raw tissue from stomach acid, digestive enzymes, and bile. Beyond acting as a physical barrier, sucralfate stimulates mucus production, boosts the stomach’s own bicarbonate (a natural acid neutralizer), and binds growth factors to the tissue to speed repair.
Sucralfate isn’t used as often as PPIs for routine ulcer healing, but it fills specific niches. In critically ill patients on ventilators, for instance, it’s sometimes preferred for preventing stress ulcers because, unlike acid-suppressing drugs, it doesn’t raise stomach pH in a way that allows harmful bacteria to multiply.
What Helps and Hurts During Recovery
Spicy foods and stress do not cause ulcers, but both can intensify symptoms while you’re healing. Alcohol irritates the stomach lining directly and increases acid production, so cutting back or eliminating it during treatment gives the ulcer a better environment to heal. Smoking is particularly harmful: it raises ulcer risk in people with H. pylori and can slow healing.
There’s no specific “ulcer diet” backed by strong evidence, but practical strategies help. Eating smaller, more frequent meals can reduce the volume of acid your stomach produces at any one time. Avoiding alcohol and not eating close to bedtime are simple changes that minimize acid exposure to healing tissue.
Warning Signs of Serious Complications
Most ulcers heal without incident, but complications can be dangerous. An ulcer can erode into a blood vessel, causing internal bleeding, or burn through the full thickness of the stomach or intestinal wall (perforation). These are medical emergencies.
Get to an emergency room if you experience sudden, sharp abdominal pain, especially if your abdomen becomes rigid and extremely tender to touch. Vomiting blood (which may look like coffee grounds) or passing dark, tarry, or maroon-colored stools are signs of significant bleeding. Symptoms of shock, including fainting, heavy sweating, or confusion, signal that blood loss may already be substantial.