Stomach Ulcer Symptoms: What That Gnawing Pain in Your Upper Belly Could Mean

What does stomach ulcer pain typically feel like?

Most people with peptic ulcers describe a burning, gnawing, or hollow ache — sometimes called a 'hungry' feeling — centered just below the breastbone or in the upper middle abdomen. The discomfort usually comes and goes over days or weeks rather than being constant.

Timing relative to meals offers a useful clue. Gastric (stomach) ulcers sometimes worsen right after eating, when acid is released. Duodenal ulcers — which form in the first part of the small intestine — more commonly hurt when the stomach is empty, particularly overnight or in the early morning, and may ease temporarily after eating or taking an antacid 1Ref 1Chey WD, Howden CW, Moss SF, Morgan DR, Greer KB, Grover S, Shah SC (2024).ACG Clinical Guideline: Treatment of Helicobacter pylori Infection.H. pylori as a primary cause of peptic ulcers, testing methods (breath test, stool antigen), and that eradicating H. pylori is often curative; also timing of pain relative to meals in duodenal vs gastric ulcers.

Not everyone fits these patterns. Some people have an ulcer with no noticeable pain at all — which is one reason that a clinician's evaluation matters.

What other symptoms can accompany an ulcer?

Beyond the central ache, a peptic ulcer can also cause nausea (sometimes with vomiting), a feeling of fullness or bloating after small amounts of food, decreased appetite, or mild heartburn. These symptoms overlap heavily with other digestive conditions — including functional dyspepsia, GERD, and gastritis — which is why testing and a clinical evaluation are important for a clear diagnosis 2Ref 2Moayyedi P, Lacy BE, Andrews CN, Enns RA, Howden CW, Vakil N (2017).ACG and CAG Clinical Guideline: Management of Dyspepsia.Differential diagnosis of upper abdominal pain including functional dyspepsia vs peptic ulcer, GERD overlap, and when endoscopy is indicated; stomach cancer as a differential in appropriate-risk patients.

What causes peptic ulcers?

The two most common causes account for the large majority of cases 1Ref 1Chey WD, Howden CW, Moss SF, Morgan DR, Greer KB, Grover S, Shah SC (2024).ACG Clinical Guideline: Treatment of Helicobacter pylori Infection.H. pylori as a primary cause of peptic ulcers, testing methods (breath test, stool antigen), and that eradicating H. pylori is often curative; also timing of pain relative to meals in duodenal vs gastric ulcers3Ref 3National Institute of Diabetes and Digestive and Kidney Diseases (2022).Peptic Ulcers (Stomach or Duodenal Ulcers).NSAID use as a leading cause of peptic ulcers alongside H. pylori; role of smoking and alcohol in impaired healing:

H. pylori infection. Helicobacter pylori is a bacterium that erodes the protective mucus lining of the stomach or duodenum, allowing stomach acid to damage the tissue underneath. H. pylori infection is very common worldwide, and treating it is often curative 1Ref 1Chey WD, Howden CW, Moss SF, Morgan DR, Greer KB, Grover S, Shah SC (2024).ACG Clinical Guideline: Treatment of Helicobacter pylori Infection.H. pylori as a primary cause of peptic ulcers, testing methods (breath test, stool antigen), and that eradicating H. pylori is often curative; also timing of pain relative to meals in duodenal vs gastric ulcers.

Regular NSAID use. Ibuprofen, naproxen, aspirin, and similar medications taken regularly suppress the prostaglandins that protect the stomach lining. Daily or near-daily NSAID use is a leading cause of peptic ulcers 3Ref 3National Institute of Diabetes and Digestive and Kidney Diseases (2022).Peptic Ulcers (Stomach or Duodenal Ulcers).NSAID use as a leading cause of peptic ulcers alongside H. pylori; role of smoking and alcohol in impaired healing.

Stress and spicy food do not cause ulcers on their own, though they may worsen discomfort once an ulcer is present. Smoking and heavy alcohol use slow healing and increase the risk of complications.

How are ulcers diagnosed?

A clinician will typically start by testing for H. pylori — this can be done with a breath test, stool antigen test, or blood antibody test 1Ref 1Chey WD, Howden CW, Moss SF, Morgan DR, Greer KB, Grover S, Shah SC (2024).ACG Clinical Guideline: Treatment of Helicobacter pylori Infection.H. pylori as a primary cause of peptic ulcers, testing methods (breath test, stool antigen), and that eradicating H. pylori is often curative; also timing of pain relative to meals in duodenal vs gastric ulcers. An upper endoscopy (EGD) can directly visualize the stomach and duodenum, confirm an ulcer, take biopsies to rule out cancer, and test for H. pylori at the same time 2Ref 2Moayyedi P, Lacy BE, Andrews CN, Enns RA, Howden CW, Vakil N (2017).ACG and CAG Clinical Guideline: Management of Dyspepsia.Differential diagnosis of upper abdominal pain including functional dyspepsia vs peptic ulcer, GERD overlap, and when endoscopy is indicated; stomach cancer as a differential in appropriate-risk patients. A complete blood count can detect anemia that might suggest slow bleeding from an ulcer 4Ref 4Laine L, Barkun AN, Saltzman JR, Martel M, Leontiadis GI (2021).ACG Clinical Guideline: Upper Gastrointestinal and Ulcer Bleeding.CBC as a test for anemia suggesting bleeding from a peptic ulcer; endoscopy in suspected upper GI bleeding.

What else could cause this kind of upper abdominal pain?

Upper abdominal pain has several common causes that can feel similar to an ulcer:

• Functional dyspepsia — very common; the stomach is structurally normal but symptoms of bloating, early fullness, and nausea persist, often worsened by stress 2Ref 2Moayyedi P, Lacy BE, Andrews CN, Enns RA, Howden CW, Vakil N (2017).ACG and CAG Clinical Guideline: Management of Dyspepsia.Differential diagnosis of upper abdominal pain including functional dyspepsia vs peptic ulcer, GERD overlap, and when endoscopy is indicated; stomach cancer as a differential in appropriate-risk patients
• GERD — burning that rises toward the chest or throat, worse lying down or after large meals 2Ref 2Moayyedi P, Lacy BE, Andrews CN, Enns RA, Howden CW, Vakil N (2017).ACG and CAG Clinical Guideline: Management of Dyspepsia.Differential diagnosis of upper abdominal pain including functional dyspepsia vs peptic ulcer, GERD overlap, and when endoscopy is indicated; stomach cancer as a differential in appropriate-risk patients
• Gastritis — inflammation of the stomach lining without a full ulcer; can feel nearly identical
• Gallbladder disease — upper-right or mid-upper abdominal pain, often after fatty meals, sometimes with radiation to the shoulder blade
• Stomach cancer — uncommon, but worth discussing with a clinician if there is unintentional weight loss, persistent vomiting, difficulty swallowing, or you are over 55 2Ref 2Moayyedi P, Lacy BE, Andrews CN, Enns RA, Howden CW, Vakil N (2017).ACG and CAG Clinical Guideline: Management of Dyspepsia.Differential diagnosis of upper abdominal pain including functional dyspepsia vs peptic ulcer, GERD overlap, and when endoscopy is indicated; stomach cancer as a differential in appropriate-risk patients

When should you see a clinician?

If you are having recurrent upper abdominal pain that suggests an ulcer, it is worth contacting your primary care clinician. A straightforward test for H. pylori can be done without an endoscopy in many cases 1Ref 1Chey WD, Howden CW, Moss SF, Morgan DR, Greer KB, Grover S, Shah SC (2024).ACG Clinical Guideline: Treatment of Helicobacter pylori Infection.H. pylori as a primary cause of peptic ulcers, testing methods (breath test, stool antigen), and that eradicating H. pylori is often curative; also timing of pain relative to meals in duodenal vs gastric ulcers. If you take NSAIDs regularly and have developed stomach symptoms, tell your clinician — switching medications or adding a stomach-protective drug may be appropriate. Do not simply increase antacid use without an evaluation.