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Understanding the Main Cause of Ulcer — and How to Prevent It

Joseph Abu
Joseph Abu
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Understanding the Main Cause of Ulcer — and How to Prevent It

(By Joseph Abu — SEO content writer & health-aware blogger with 5+ years’ experience)

I still remember the first time a close neighbor came over clutching her stomach after weeks of dull upper-abdominal pain. She’d tried antacids and “toughing it out,” but one night she vomited blood and we ended up in the ER. The diagnosis was a bleeding peptic ulcer linked to long-term use of ibuprofen. That moment stuck with me: ulcers can feel minor at first, yet become dangerous if ignored. I started reading clinical reviews and patient guides so I could explain the reality — not the myths — to friends. This article is the result: clear, evidence-based, and written as if I’m talking to a friend who wants to understand what really causes ulcers and practical, realistic ways to prevent them.

What is an ulcer — short plain answer

A peptic ulcer is a sore that forms in the lining of the stomach (gastric ulcer) or the first part of the small intestine (duodenal ulcer). The lining normally resists stomach acid, but when that protective barrier breaks down, acid can damage tissue and create an ulcer. The two main, well-established causes are infection with Helicobacter pylori (H. pylori) and regular use of nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or aspirin. (Mayo Clinic)

The real root causes — explained simply

1. Helicobacter pylori (H. pylori) — the bacterial cause

H. pylori is a common bacterium that can live in the stomach lining. For many people it causes no symptoms, but in some people it triggers chronic inflammation that weakens the protective mucous layer — allowing stomach acid to erode tissue and form ulcers. Because it’s an infection, antibiotic treatment can eradicate H. pylori and heal ulcers, which revolutionized ulcer care since the 1980s. Testing and treating H. pylori is central to preventing recurrence. (Mayo Clinic)

2. NSAIDs — the medication-related cause

NSAIDs (ibuprofen, naproxen, diclofenac, aspirin) interfere with protective prostaglandins in the stomach lining by inhibiting COX enzymes. This weakens mucosal defenses and increases acid-related damage. The risk grows with higher doses, longer use, older age, and when NSAIDs are combined with other risk factors (like H. pylori infection). For many patients, stopping or reducing NSAID use and using protective medicines reduces ulcer risk. (PMC)

3. Other contributors (less common or indirect)

  • Smoking increases ulcer risk and slows healing. Alcohol and heavy drinking can irritate the stomach lining. (PMC)

  • Serious illnesses, some medications (steroids, anticoagulants combined with NSAIDs), and very rarely, tumors (Zollinger–Ellison syndrome) can cause or worsen ulcers. (NCBI)

Important myth-buster: modern evidence shows stress and spicy food do not cause ulcers. They may make symptoms feel worse, but the primary causes are H. pylori and NSAIDs. (NHS inform)

How common are ulcers?

Estimates vary by region and method of measurement, but peptic ulcer disease has affected a significant portion of the population historically. Older studies suggested up to ~1 in 10 people may develop an ulcer at some point, while more recent global analyses show incidence and hospitalization rates have generally declined with improved H. pylori detection and changes in NSAID prescribing — though the disease still causes meaningful illness worldwide. (CDC)

Common symptoms and possible complications

Typical symptoms include:

  • Burning or gnawing pain in the upper abdomen (often related to meals).

  • Bloating, belching, nausea, poor appetite.
    Red flags that need urgent care: vomiting blood, black/tarry stools, fainting, severe sudden abdominal pain (possible bleeding or perforation). If you have these, seek emergency medical attention. (Mayo Clinic)

Three real-world case studies (anonymized)

Case 1 — H. pylori causing recurring pain (Tamara)

Tamara, 34, had months of intermittent epigastric pain and bloating. A breath test confirmed H. pylori. She completed a 14-day triple therapy (two antibiotics + acid suppression) and symptoms resolved. Follow-up testing showed eradication. Lesson: diagnosing and finishing the full course of antibiotics usually cures H. pylori–related ulcers. (Mayo Clinic)

Case 2 — NSAID-induced bleeding ulcer (Mr. Ahmed)

Mr. Ahmed, 68, used high-dose ibuprofen daily for chronic joint pain. He presented with black stools and low blood pressure. Endoscopy revealed a bleeding gastric ulcer. He stopped NSAIDs, received endoscopic treatment and a PPI, and his outcome improved. Lesson: long-term NSAID use without protective measures can cause serious, even life-threatening ulcers. (PMC)

Case 3 — Incomplete treatment and recurrence (Lina)

Lina felt better after a few days of antibiotics for H. pylori and stopped treatment early. Her pain returned months later and testing showed persistent infection. After completing a full eradication course under follow-up, she remained symptom-free. Lesson: finishing therapy and confirming eradication matters to prevent recurrence. (Mayo Clinic)

How doctors diagnose and treat ulcers (practical overview)

  • Tests for H. pylori: urea breath test, stool antigen test, blood antibody tests (less preferred), or biopsy during endoscopy. (Mayo Clinic)

  • Endoscopy (gastroscopy) is used when there are alarm signs (bleeding, weight loss, anemia) or to directly visualize and sometimes treat ulcers. (Mayo Clinic)

  • Treatment: eradication therapy for H. pylori (antibiotics + acid suppression), proton pump inhibitors (PPIs) to reduce acid and allow healing, and stopping or substituting NSAIDs when possible. In bleeding or perforated ulcers, urgent endoscopic or surgical care may be necessary. (Mayo Clinic)

Practical prevention — what you can do today

  1. Know your NSAID risk. If you take NSAIDs regularly, talk with your clinician about alternatives (acetaminophen where appropriate), using the lowest effective dose, or protective therapy (PPI or misoprostol) if long-term NSAIDs are unavoidable. This is one of the most powerful prevention steps. (PMC)

  2. Test and treat H. pylori when indicated. If you’ve had an ulcer or symptoms consistent with peptic disease, ask about noninvasive H. pylori testing (breath or stool tests). Eradication prevents ulcer recurrence in many cases. (Mayo Clinic)

  3. Stop smoking and limit alcohol. Both increase risk and delay healing. (PMC)

  4. Take meds safely. Avoid mixing NSAIDs with anticoagulants or steroids without medical advice; review all medications with your clinician or pharmacist. (NCBI)

  5. Finish prescribed antibiotic courses for H. pylori and return for follow-up testing if recommended. Partial treatment raises recurrence risk. (Mayo Clinic)

Comparison table — quick at-a-glance

Cause How it causes ulcers Typical clues Prevention / Treatment
H. pylori infection Chronic inflammation weakens mucosa Gnawing epigastric pain, positive breath/stool test Test + complete eradication therapy; follow-up testing. (Mayo Clinic)
NSAIDs Reduce protective prostaglandins → mucosal damage History of long-term/high-dose NSAID use; may present with bleeding Use lowest dose, consider PPI prophylaxis, switch meds if possible. (PMC)
Smoking / Alcohol Irritation + impaired healing Worse symptoms, delayed recovery Smoking cessation; limit alcohol. (PMC)
Rare causes (Zollinger–Ellison, medications, stress ulcer in ICU) Excess acid production or severe illness Recurrent, multiple, or atypical ulcers Specialist referral, targeted therapy, treat underlying cause. (NCBI)

When to see a clinician — red flags

Seek urgent care if you experience:

  • Vomiting blood or material that looks like coffee grounds.

  • Black, tarry stools.

  • Dizziness, fainting, shortness of breath (signs of significant bleeding).

  • Sudden severe abdominal pain (possible perforation). (Mayo Clinic)

Final thoughts — empathy and practical encouragement

Ulcers once carried a terrifying reputation, but modern medicine has made them widely treatable and often preventable. The two big, actionable facts to remember are: H. pylori is a treatable infection, and long-term NSAID use is a modifiable risk. If you or someone you care for has persistent upper abdominal pain, a history of NSAID use, or alarm symptoms, don’t delay asking a clinician about testing and appropriate treatment — early steps make a big difference.

If you’d like, I can:

  • Draft a one-page symptom checklist you can bring to your doctor.

  • Produce a short script to help you ask about H. pylori testing and NSAID safety during an appointment.


Author bio & call to action

Joseph Abu — freelance SEO content writer and health-adjacent blogger with 5+ years translating medical topics into simple, practical guides. (This article is educational and not a substitute for professional medical advice. If you have concerning symptoms, contact a healthcare provider immediately.)

If this helped, comment with one sentence about your symptoms (how long, what makes it worse) and I’ll suggest the top 2 things to mention to your clinician or pharmacist.

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