How to Treat Gastric Ulcer

If you suffer from gastric ulcers (a type of peptic ulcer), your stomach lining has been damaged by acid erosion. Gastric ulcers aren't caused by anything you ate. Instead, they're usually caused by a bacterial infection or by frequent use of nonsteroidal anti-inflammatory drugs. Regardless of whether the pain is mild or severe, you should get medical attention to treat the cause of the gastric ulcer.

Part 1

Part 1 of 3:

Getting Medical Treatment

1
Take antibiotics. If your gastric ulcer was caused by an H. pylori infection, your doctor will prescribe antibiotics.^{[1]XExpert SourceRoy Nattiv, MD
Board Certified GastroenterologistExpert Interview. 18 December 2020.} These will kill the bacteria so the ulcer can heal. Fortunately, you won't need to take antibiotics for a prolonged period of time.
- You'll probably need to take antibiotics for two weeks.^{[2]XTrustworthy SourceNational Health Service (UK)Public healthcare system of the UKGo to source} Be sure to take the full course of treatment so the bacteria doesn't return. Even if your symptoms resolve, this doesn't mean you can stop the medication. Make sure you take every single dose of antibiotics as instructed by your doctor.
2
Use acid-blocking medications. You'll most likely need to take proton pump inhibitors which block stomach acid. Prescription or over-the-counter medications may include: omeprazole, lansoprazole, rabeprazole, esomeprazole, pantoprazole.^{[3]XTrustworthy SourceMayo ClinicEducational website from one of the world's leading hospitalsGo to source}
- Proton pump inhibitors do have some long-term side effects which include an increased risk of pneumonia, osteoporosis, and intestinal infections.
3
Take antacids. Your doctor may also prescribe antacids to decrease the production of stomach acid, protecting and healing your stomach lining.^{[4]XExpert SourceRoy Nattiv, MD
Board Certified GastroenterologistExpert Interview. 18 December 2020.} This can help relieve pain from gastric ulcers. You may experience constipation or diarrhea as side effect.^{[5]XTrustworthy SourceNational Institute of Diabetes and Digestive and Kidney DiseasesHealth information from the National Institute of Diabetes and Digestive and Kidney Diseases, a division of the U.S. National Institutes of HealthGo to source}
- Antacids treat the symptoms of gastric ulcer, but you'll need to take other medications to treat the cause of your gastric ulcer.
4
Switch the pain medications you take. Regularly taking NSAIDs (Non-Steroidal Anti-Inflammatory Drugs) is one of the main causes of gastric ulcers. If you often use aspirin, ibuprofen, naproxen, or ketoprofen, consider changing pain medications.^{[6]XTrustworthy SourceNational Institute of Diabetes and Digestive and Kidney DiseasesHealth information from the National Institute of Diabetes and Digestive and Kidney Diseases, a division of the U.S. National Institutes of HealthGo to source} Ask your doctor about using acetaminophen for pain relief since it's not associated with ulcers. Always follow the manufacturer's dosing instructions and don't take more than 3000 to 4000 mg a day.
- Try not to take pain medications on an empty stomach. This can be hard on your stomach. Instead, take pain medications with a meal or snack.
- Your doctor may also prescribe you carafate (sucralfate), which coats the ulcer from within your stomach, allowing your stomach to heal itself.^{[7]XExpert SourceRoy Nattiv, MD
  Board Certified GastroenterologistExpert Interview. 18 December 2020.}
5
Stop smoking. Smoking can contribute to ulcers by wearing down the protective lining of the stomach. It also increases stomach acid which can cause upset stomach (dyspepsia) and pain. The good news is that stopping smoking will have an immediate effect on these symptoms.^{[8]XTrustworthy SourceJohns Hopkins MedicineOfficial resource database of the world-leading Johns Hopkins HospitalGo to source}
- Ask your doctor to recommend smoking cessation programs. You might join a support group or take medication to help you cut back on smoking.^{[9]XTrustworthy SourceAmerican Lung AssociationNonprofit health organization dedicated to improving lung health through education, advocacy, and researchGo to source}
6
Have an endoscopic procedure if the ulcer is more severe. If medications don't help your ulcer pain, your doctor may run a small tube from your mouth down into your stomach. There's a small camera on the end of the scope, and the doctor can also use it to administer medications or to clip or cauterize the ulcer.^{[10]XExpert SourceRoy Nattiv, MD
Board Certified GastroenterologistExpert Interview. 18 December 2020.}
7
Monitor your recovery. You should feel relief within two to four weeks after starting treatment, although it may take longer if you smoke. If you're not feeling better after four weeks, talk with your doctor. You may have an underlying condition or a refractory ulcer.
- Be aware that many medications will need to be taken long-term. This is why it's important to watch for side effects and talk with your doctor if you have concerns.^{[11]XTrustworthy SourceNational Health Service (UK)Public healthcare system of the UKGo to source}
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Part 2

Part 2 of 3:

Recognizing and Diagnosing Ulcers

1
Pay attention to pain. Although symptoms of stomach ulcers can vary from person to person, pain is a common symptom. You may have pain in the area just below your rib cage near the center of your chest. In fact, you might notice pain anywhere from your belly button up towards your breastbone.^{[12]XTrustworthy SourceFamilyDoctor.orgFamily-focused medical advice site run by the American Academy of Family DoctorsGo to source}
- Don't be surprised if the pain comes and goes. It might be worse at night, if you're hungry, or it may go away and return weeks later.
2
Look for ulcer damage. In addition to pain, you may experience nausea, vomiting, or bloating.^{[13]XTrustworthy SourceCleveland ClinicEducational website from one of the world's leading hospitalsGo to source} These can be caused by damaged stomach walls where the ulcer has formed. Then, when your stomach secretes acid it needs to digest food, the acid irritates and damages the ulcer even more.
- In severe cases, you may vomit blood or notice blood in your stools.^{[14]XResearch source}
3
Know when to see a doctor. You should be able to spot "red flags" or warning signs of an ulcer.^{[15]XTrustworthy SourceNational Health Service (UK)Public healthcare system of the UKGo to source} If you have any of these symptoms along with stomach pain, call your physician or 911 right away:
- Fever
- Severe pain
- Diarrhea that lasts longer than two to three days
- Persistent constipation (longer than two to three days)
- Blood in the stools (which can appear red, black, or tarry)
- Persistent nausea or vomiting
- Vomiting blood or material that looks like coffee grounds
- Severe tenderness of the belly
- Jaundice (yellowish discoloration of the skin and the whites of the eyes)
- Swelling or visible bloating of the abdomen
4
Get a diagnosis. Your doctor will probably want an EGD (EsophagoGastroDuodenoscopy). During this procedure, a small camera on a flexible tube is inserted into your stomach. This way, doctors can visualize the ulcers on your stomach and determine if any are bleeding.^{[16]XResearch source}
- X-rays of the upper gastrointestinal tract can also diagnose gastric ulcers, although these aren't as widely used since they can miss small ulcers.
- After your initial treatment, your doctor may wish to perform an endoscopy, a procedure during which your doctor will use a tube with a tiny camera and light to examine your digestive tract. This way your doctor can ensure that the ulcer responded to treatment and was not actually a symptom of stomach cancer.^{[17]XResearch source}
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Part 3

Part 3 of 3:

Managing Gastric Ulcer Pain

1
Reduce pressure on your stomach. Since your stomach is already under great stress, avoid putting extra physical pressure on your stomach. You can wear clothing that doesn't constrict your stomach or abdomen. And, you might get relief by eating smaller, more frequent meals instead of a few large meals.^{[18]XResearch source} This reduces the amount of acid in your stomach and keeps the pressure off your stomach.
- Try not to eat within two to three hours before going to bed. This will keep food from putting pressure on your stomach while you sleep.
2
Consult with your doctor. There a number of herbal approaches you can try to treat ulcer pain.^{[19]XResearch sourcePizzorno, JE., Murray, MT., Joiner-Bey, H. The Clinician’s Handbook of Natural Medicine, pg.392-397, 2002.} Talk to your physician before trying herbal or home remedies. In general, they're all very safe, but you should make sure that none of the herbs will interact with any medications you're taking.
- Since some remedies haven't been tested for use by pregnant people, it's important to talk with your doctor about using them if you're pregnant or nursing.
3
Eat a low-acid diet. Acidic foods can irritate your ulcer, making the pain worse. In addition, avoid greasy or fried foods, and don't drink alcohol.^{[20]XExpert SourceRoy Nattiv, MD
Board Certified GastroenterologistExpert Interview. 18 December 2020.}
4
Drink aloe vera juice. Research shows that aloe vera can help heal gastric ulcers.^{[21]XTrustworthy SourcePubMed CentralJournal archive from the U.S. National Institutes of HealthGo to source} Aloe juice decreases inflammation and acts to neutralize the stomach acid, reducing pain. To use it, drink 1/2 cup of organic aloe vera juice. You can sip this throughout the day. But, since aloe vera can act as a laxative, limit your drinking to a total of 1 to 2 cups a day.
- Make sure to buy aloe vera juice that contains a high level of aloe vera juice. Avoid juices that contain a lot of added sugars or fruit juices.
5
Drink an herbal tea. Ginger and chamomile make great anti-inflammatory teas which can soothe an irritated stomach and reduce nausea and vomiting.^{[22]XTrustworthy SourceCleveland ClinicEducational website from one of the world's leading hospitalsGo to source} Fennel helps settle the stomach and decreases the acid levels.^{[23]XResearch sourcePizzorno, JE., Murray, MT., Joiner-Bey, H. The Clinician’s Handbook of Natural Medicine, pg.392-397, 2002.} Mustard also acts as an anti-inflammatory and as an acid neutralizer. To prepare:
- Ginger tea: steep packaged tea bags. Or, cut up 1 teaspoon of fresh ginger and steep it in boiled water for 5 minutes. Drink ginger tea throughout the day, especially 20 to 30 minutes before meals.
- Fennel tea: crush about a teaspoon of fennel seeds and steep them in a cup of boiled water for five minutes. Add honey to taste and drink 2 to 3 cups a day about 20 minutes before meals.
- Mustard tea: dissolve powdered or good prepared mustard in hot water. Or, you can take 1 teaspoon of mustard by mouth.
- Chamomile tea: steep packaged tea bags. You can also steep 3 to 4 tablespoons (44.4 to 59.1 ml) of chamomile in 1 cup of boiled water for five minutes.^{[24]XTrustworthy SourcePubMed CentralJournal archive from the U.S. National Institutes of HealthGo to source}
6
Take licorice root. Licorice root (deglycyrrhizinated licorice root) is commonly used to treat peptic ulcers, canker sores, and reflux.^{[25]XResearch source} Take the licorice root (which comes in chewable tablets) according to the manufacturer's instructions. You'll probably need to take two to three tablets every four to six hours. The taste might take some time to get used to, but licorice root can heal your stomach, control hyperacidity and relieve pain.^{[26]XResearch source Glick, L., Deglycyrrhizinated liquorice for peptic ulcer. Lancet. 1982 Oct 9;2(8302):817}
- You can also take slippery elm as a chewable tablet or drink (3 to 4 ounces). Slippery elm coats and soothes irritated tissues. It's also safe to use during pregnancy.^{[27]XResearch sourcePizzorno, JE., Murray, MT., Joiner-Bey, H. The Clinician’s Handbook of Natural Medicine, pg.392-397, 2002.}
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Which medicine is best for gastric ulcer?
Roy Nattiv, MD
Board Certified Gastroenterologist
Dr. Roy Nattiv is a Board-Certified Pediatric Gastroenterologist in Los Angeles, California. With over 20 years of experience he specializes in a broad range of pediatric gastrointestinal and nutritional illnesses such as constipation, diarrhea, reflux, food allergies, poor weight gain, SIBO, IBD, and IBS. He completed his pediatric residency at the Children’s Hospital at Montefiore, Albert Einstein College of Medicine in New York, and his fellowship at the University of California, San Francisco (UCSF). While at UCSF, he was a California Institute of Regenerative Medicine (CIRM) fellowship trainee and was awarded the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) Fellow to Faculty Award in Pediatric IBD Research. Dr. Nattiv received his undergrad degree from the University of California, Berkeley, and his medical degree (MD) from the Sackler School of Medicine in Tel Aviv, Israel.
Roy Nattiv, MD
Board Certified Gastroenterologist
Expert Answer
Gastric ulcers are typically treated with strong antacids to decrease the production of acid in the stomach. They're also sometimes treated topically with something called carafate (sucralfate), which will act to coat the acid from within, allowing the stomach to regenerate and heal itself from the outside in. If the ulcer is caused by an H. pylori infection, that should also be treated with antibiotics.
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Tips

Take an antacid to deal with ulcer pain. You can also eat an apple day, since the pectin in the peel acts as a natural antacid.
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