October 25, 2022 9 min read

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    Captain, the proton pump inhibitors have failed! One more photon torpedo from the Helicobacter Pylori and we'll be destroyed!

    As if you needed one more thing to worry about, now you know there's such a thing as proton pump inhibitors (PPIs). But fret not, PPIs are your friend if you have a peptic ulcer or ulcer symptoms. They are medicines that work to reduce the amount of stomach acid made by glands in the lining of the stomach. Many PPIs are available over-the-counter.

    Helicobacter pylori (H. pylori), on the other hand, is a type of bacteria. These spiral-shaped germs live in your digestive tract and really are "the bad guys". A helicobacter pylori infection can cause sores (peptic ulcers) in the lining of your stomach and the upper part of your small intestine. Although H. pylori is not the only cause of ulcers, it is the main one.

    Whatever the cause, some major ulcer symptoms include:

    • Abdominal pain
    • Bloating and/or belching
    • Heartburn
    • Intolerance to fatty foods
    • Nausea
    • Unexplained weight loss
    • Black/tar-like stools (in advanced cases)

    While no bacterial infections are good, an H. pylori infection is no laughing matter. When you're getting blasted by the Helicobacter Pylori, you definitely don't want the proton pump inhibitors to fail.

    H. Pylori Infection

    What are Peptic Ulcers?

    A peptic ulcer is a sore on the lining of your stomach, small intestine, or esophagus. A peptic ulcer in your stomach is called a gastric ulcer. A duodenal ulcer is a peptic ulcer that develops in the first part of the small intestine (duodenum). An esophageal ulcer occurs in the lower part of your esophagus.

    Besides an H. pylori infection, long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve) can be the cause of peptic ulcers. Stress and spicy foods do not cause peptic ulcers. However, they can make your symptoms worse.

    Stress and Spicy Food Worsen Ulcers

    Stress Ulcers

    Wait, hold the phone, Mr. Toad! Did you not just say that stress is NOT a cause of peptic ulcers? Indeed, because the vast majority of peptic ulcers are caused by H. pylori infection. However, as an article from Medical News Today, What to Know About Stress Ulcers, points out, " A stress ulcer is not the same as a peptic ulcer that is made worse by stress."

    Peptic ulcers are generally a long time in coming, while a stress ulcer is usually more sudden, frequently as a result of physiological stress. If the stressful situation is severe and causes a major increase in stomach acid, a stomach ulcer or esophagus ulcer may be the result. If long-term stress levels are high, the increase in acid secretion can eat away at the mucosal lining of the entire digestive system, but especially the esophagus. When the esophagus is attacked by excess stomach acid, we experience it as heartburn. Long term heartburn can lead to an esophageal ulcer.

    Confused? "Why yes I am," we can hear you saying. That's because, although stress ulcers are generally sudden or acute, they can also be a chronic or long-term issue. To muddy the water even further, the physiological stress that causes a stress ulcer can be caused by a bacterial infection. Ironically, this would include an H. pylori infection, the main cause of peptic ulcer disease.

    Who Cares?

    Well, your gastroenterologist for one! Even though they both cause similarly unpleasant ulcer symptoms, knowing the root cause of an ulcer is going to help your health-care provider design a treatment plan. He or she will help you identify what risk factors are present in your life, what lifestyle changes you can make, and what foods to avoid.

    Your doctor may also recommend that you speak to a mental-health care provider. In the last couple of decades, gastroenterology and psychiatry have become good friends! According to an article from Medical-News.net, "University of Queensland researchers have confirmed a link between depression and stomach ulcers, in the world's largest study of genetic factors in peptic ulcer disease." Also, high stress, anxiety disorders, PTSD, etc, are common causes for a compromised immune system and a prevalence of stomach acid. These two factors, taken together, make a person ripe for either a stress ulcer or for H. pylori to get a foothold, leading to a peptic ulcer.

    Are Stomach Ulcers Hereditary?

    According to an article called Peptic Ulcer on the Drugs.com website, families can have a history of peptic ulcers. It's not that ulcers are hereditary, per se, but one can be more predisposed to have the underlying risk factors. For instance, the News-Medical article mentioned above says that genetic factors can lead to a higher incidence of depression, which is linked to a higher prevalence of ulcers. The same researchers in this study of 456,327 people identified six genetic conditions that predispose people for H. pylori infection. So it's not like your family can literally give you an ulcer (although it may feel that way sometimes!), but ulcers do tend to run in the family. It's definitely something you should share with your health-care provider.

    Is There a Link Between Stomach Ulcers and COVID-19?

    The name of the following article might give away the answer to THAT question: Peptic Ulcer Disease as a Common Cause of Bleeding in Patients with Coronavirus Disease. According to the authors, there is an anecdotal link between COVID and peptic ulcers. Not enough data exists nor have any controlled studies been carried out to make a definitive link. However, they report seeing COVID patients in their clinic develop peptic ulcers despite having no family-history of ulcers or H. pylori infection at the time of admission.

    From their own observations and reports from other physicians, it appears that the physiological stress of the disease as well as the psychological stress of being a COVID patient can directly cause damage to the stomach lining and actively cause mucosal inflammation. Comorbidities such as advanced age or a compromised immune system appear to exacerbate the gastrointestinal bleeding.

    Got Milk?

    For many years, people with peptic ulcers were told to drink lots of milk, with the belief that it would soothe the stomach and help heal the ulcers. But that's not always true. It might help for a few minutes, but milk also stimulates your stomach to produce hydrochloric acid, which can make ulcers hurt more.

    And for folks who are lactose intolerant, milk might be more of a problem. In an article for the US National Institute of Health, researchers recommend lactose-free dairy products for those who are lactose-intolerant and have peptic ulcer disease. In fact, almost half of their study participants experienced severe ulcer symptoms after drinking whole milk.

    Milk Can Make Ulcers Hurt More

    What Causes or Increases My Risk for Ulcers?

    To recap, some things that are common causes of ulcers:

    • Helicobacter pylori infection
    • Certain medicines, such as NSAIDs or aspirin
    • Physical stress, such as an injury or severe illness
    • Psychological stress such as anxiety disorder
    • A family history of peptic ulcers

    Add to this list:

    • Cigarettes
    • Alcohol

    Yup, smoking and alcohol can be a problem, especially if your family has a history of ulcers. From the ominously named article, Alcohol Drinking and Cigarette Smoking: A "Partner" for Gastric Ulceration, researchers report evidence of a causal relationship between ulcers and drinking alcohol and/or smoking tobacco. Alcohol irritates the lining of the stomach and may make you more susceptible to H. pylori infection. Heavy, prolonged alcohol use can cause active gastritis, damaging the mucosal defenses against ulcers.

    From the same article, cigarette smoking is linked to the onset and continuation of gastric ulcers. Public-health studies show that cigarette smoking increases both the prevalence and relapse rate of peptic ulcer disease and can also delay ulcer healing times. Drinking and being a smoker, together, greatly increases the risk of gastric ulcers. In laboratory experiments, cigarette smoking amplified alcohol-induced gastric mucosal damage.

    Alcohol And Smoking Can Worsen Ulcers

    How is a Peptic Ulcer Diagnosed?

    • Blood tests may be done to test for H. pylori.
    • Stool sample. A sample of your bowel movement may be tested for H. pylori or blood.
    • Urea breath test to check for H. pylori.
    • Endoscopy. An endoscope is a flexible tube with a camera (and light!) that a physician uses to peek inside of your digestive system. Visible signs of ulcers may be detected and/or samples taken and sent to a lab for analysis.

    Will Ulcers Heal on Their Own?

    Though ulcers can sometimes heal on their own, you shouldn't ignore the warning signs. Without the right treatment, ulcers can lead to serious health problems, including:

    • Bleeding.
    • Perforation (a hole through the wall of the stomach).
    • Gastric outlet obstruction (from swelling or scarring) that blocks the passageway from the stomach to the small intestine.
    • Stomach Cancer.

    Foods to Avoid If You Have an Ulcer or Are at Risk

    An article titled Stomach Ulcer Diet: Foods to Eat and Avoid lists these foods to avoid if you have an ulcer or are at risk of one, because they may increase secretions of stomach acid:

    • Coffee (including decaf)
    • Tea, including black and green
    • Chocolate
    • Spicy food
    • Alcohol
    • Acidic foods, such as citrus and tomatoes
    • Caffeine, including caffeinated sodas
    • Pepper, including black pepper and other types of peppers
    • Peppermint
    • Spearmint
    • Carbonated beverages, because they can create carbonic acid
    • Raw vegetables and salads

    Foods That May Help

    A Healthline.com article entitled Stomach Ulcer Diet, lists these foods as potentially beneficial to ulcer sufferers:

    • Cauliflower
    • Cabbage
    • Radishes
    • Apples
    • Blueberries
    • Raspberries
    • Blackberries
    • Strawberries
    • Cherries
    • Bell peppers
    • Carrots
    • Broccoli
    • Leafy greens, such as kale and spinach (lightly steamed)
    • Probiotic-rich foods, such as yogurt, kefir, miso, sauerkraut, and kombucha
    • Olive oil and other plant-based oils
    • Honey
    • Garlic
    • Licorice
    • Turmeric

    Foods Potentially Beneficial to Ulcers

    See Your Doctor!

    If you suspect you may have an ulcer, consult your health-care provider immediately. Some things they may suggest, prescribe, or order:

    • Blood, breath, or stool testing.
    • An endoscopy.
    • Proton Pump Inhibitors: These medications can relieve symptoms of acid reflux, treat a duodenal or stomach ulcer, and/or treat an esophageal ulcer.
    • An antibiotic to fight an H. pylori infection.
    • Stopping the use of NSAIDS.
    • An antihistamine. Histamine in your system can increase stomach acid.
    • Protective medications: Doctors commonly recommend Carafate or Pepto-Bismol to prevent further damage from digestive acids and enzymes.
    • Taking an antidepressant.

    Other Things That Help

    Good hygiene: Since the exact mode of H. pylori bacteria transmission is unknown, it is recommended that all people thoroughly wash hands frequently, wash vegetables and other foods, and drink from clean water sources.

    Avoid sketchy restaurants: People who don't wash their hands well when preparing food can cause bacterial infections, including H. pylori.

    Small meals: Moving away from eating three large meals a day to eating smaller meals every three hours is a key component of managing stomach ulcer symptoms for many people. An empty or hungry stomach is an acidy stomach.

    Avoid late-night snacking: eating within two to three hours before bed may worsen acid reflux symptoms.

    Hydration: Staying well hydrated is on the list of every wellness article. However, it is actually recommended that you drink lots of water to help decrease inflammation in your mucosal stomach lining.

    Probiotic supplements: An over-the-counter probiotic supplement is almost never a bad idea. Talk to your health-care provider first, of course, but probiotics are effective in treating ulcer symptoms because they out-produce "bad" bacteria, such as H. pylori. They will help repopulate your digestive system with "good" bacteria if your doctor prescribes an antibiotic.

    Collagen peptides: Collagen contains large amounts of the amino acids glycine, glutamine, and proline which can be beneficial to the intestinal tract and stomach.

    • Collagen peptide supplements:Collagen peptides supplements are an easily digestible way to get these important amino acids.
    • Powdered gelatin: Gelatin is the cooked form of collagen. By adding powdered gelatin to your soups, stews, and broths, you can quickly bump up your collagen consumption.
    • Bone broth: Bone broth is made by simmering bones to extract the collagen from them. It tastes good and is easy to add to your diet through soups and stews.
    • See our recent blog IsCollagen Destroyed by Heat? for more information about collagen peptides and for a recipe for making your own bone broth at home!

    Reduce your stressors: Easier said than done, we know! This may be a reason to see a counselor or mental-health care provider. He or she can help you navigate the stressful situations/relationships in your life.

    Quit smoking: Always a good idea!

    Alcohol: Eliminate or greatly reduce your alcohol consumption.

    Summary Points:

    A peptic ulcer is a sore on the lining of your stomach, small intestine, or esophagus. A peptic ulcer in your stomach is called a gastric ulcer.

    Peptic ulcers are generally a long time in coming, while a stress ulcer is usually more sudden, frequently as a result of physiological stress.

    Though ulcers can sometimes heal on their own, you shouldn't ignore the warning signs. Without the right treatment, ulcers can lead to serious health problems.

    Collagen contains large amounts of the amino acids glycine, glutamine, and proline which can be beneficial to the intestinal tract and stomach.

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