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Published on: 2/24/2026
Persistent upper abdominal burning that worsens on an empty stomach often points to a stomach ulcer, most commonly from H. pylori infection or regular NSAID use, and it needs prompt evaluation and targeted treatment to prevent serious complications like bleeding or perforation.
There are several factors to consider; see below for key symptoms and red flags, the tests doctors use, which medications help and how long healing takes, and lifestyle changes that can guide your next steps.
A constant burning feeling in your upper abdomen is not something to ignore. If it feels like fire just below your breastbone—especially if it worsens when your stomach is empty—you could be dealing with a stomach ulcer.
A stomach ulcer is a sore that forms in the lining of the stomach. It's also called a gastric ulcer, and it's a type of peptic ulcer disease. While ulcers are common and treatable, they can become serious if left untreated.
Let's break down why ulcers happen, what symptoms to watch for, and what medical steps you should take next.
A stomach ulcer is an open sore that develops when the protective lining of the stomach is damaged. Normally, your stomach produces strong acid to digest food. A layer of mucus protects the stomach wall from that acid.
When that protective barrier weakens, acid can erode the tissue underneath. Over time, this creates a painful sore.
Think of it like a wound inside your stomach that is constantly exposed to acid.
There are two major causes of stomach ulcers:
This is a common bacterial infection. Many people carry H. pylori without knowing it, but in some cases, it damages the stomach lining and causes ulcers.
You can get H. pylori through:
Nonsteroidal anti-inflammatory drugs (NSAIDs) reduce pain and inflammation but also reduce the stomach's protective mucus.
Common examples include:
Taking these regularly—especially without food—raises your risk of a stomach ulcer.
While H. pylori and NSAIDs are the main causes, other factors can increase your risk:
Rarely, tumors that increase acid production (such as Zollinger-Ellison syndrome) can cause recurrent ulcers.
The most common symptom is burning stomach pain.
This pain:
Other symptoms can include:
A stomach ulcer can bleed or perforate (tear through the stomach wall). These are medical emergencies.
Call a doctor immediately or go to the ER if you experience:
These signs may indicate internal bleeding.
If your symptoms suggest a stomach ulcer, your doctor may recommend:
This can be done with:
A thin tube with a camera is inserted through the mouth to look at the stomach lining. This is the most accurate way to confirm a stomach ulcer.
Doctors may also take a biopsy to rule out stomach cancer, especially in patients over 60 or those with concerning symptoms.
In some cases, imaging tests may be used if complications are suspected.
If you're experiencing persistent upper abdominal burning and want to understand what might be causing it before your doctor's appointment, you can use a free AI-powered Gastroduodenal Ulcer symptom checker to help evaluate your symptoms and determine if they match this condition.
The good news: most stomach ulcers heal with proper treatment.
Treatment typically includes:
This combination is taken for 10–14 days. It's critical to complete the full course, even if symptoms improve.
Your doctor may:
Common acid-reducing medications include:
These allow the stomach lining to heal by reducing acid production.
Most stomach ulcers heal within:
Follow-up testing may be required to ensure healing, especially if the ulcer was large or bleeding.
Medical treatment is essential, but lifestyle changes can help prevent recurrence.
Contrary to popular belief, spicy food alone does not cause stomach ulcers—but it can irritate an existing one.
Ignoring symptoms can lead to:
These complications can be life-threatening.
This is why ongoing burning pain should never be dismissed as "just indigestion" without evaluation.
Other conditions can mimic ulcer symptoms, including:
In some cases, persistent ulcer-like symptoms could signal stomach cancer, particularly in older adults. This is uncommon but serious.
If your pain:
You should speak to a doctor.
You should schedule a medical appointment if you have:
Seek urgent medical care if you notice any signs of bleeding or severe pain.
A stomach ulcer is treatable—but only if properly diagnosed.
A constant burning sensation in your upper abdomen could be your body signaling a stomach ulcer. Most ulcers are caused by H. pylori infection or long-term NSAID use, and most heal with medication.
But ulcers can become dangerous if ignored.
Pay attention to persistent symptoms. Consider starting with a free online Gastroduodenal Ulcer symptom checker, and most importantly, speak to a doctor about any symptoms that concern you—especially if they could be serious or life-threatening.
Your stomach lining can heal. The key is timely care.
(References)
* Lanas A, Scheiman JM. Peptic Ulcer Disease. N Engl J Med. 2021 Jul 22;385(4):341-352. doi: 10.1056/NEJMcp2032243. PMID: 34289270.
* Malfertheiner P, Megraud F, Rokkas T, Gisbert JP, Liou JM, Schulz C, Arevalo J, Kim SG, Hunt RH, Sung JJY, El-Omar EM, O'Connor A, Fock K, Sugano K, Wang JD, Wu CY. Management of Helicobacter pylori infection: the Maastricht VI/Florence Consensus Report. Gut. 2022 Oct;71(10):1999-2022. doi: 10.1136/gutjnl-2022-327392. PMID: 35850912.
* Scarpignato C. NSAID-Induced Peptic Ulcer Disease. Curr Treat Options Gastroenterol. 2023 Sep;21(3):364-386. doi: 10.1007/s11938-023-00465-9. Epub 2023 Jul 21. PMID: 37478083.
* Chung CL, Chang CC, Su HC. Management of Peptic Ulcer Disease and Its Complications: A Clinical Practice Update. J Formos Med Assoc. 2023 Aug;122(8):666-675. doi: 10.1016/j.jfma.2023.04.017. Epub 2023 Apr 29. PMID: 37121971.
* Sung JJ, Chan FKL. Peptic Ulcer Disease. Lancet. 2017 Jul 8;390(10091):249-261. doi: 10.1016/S0140-6736(16)32030-0. Epub 2017 Jan 20. PMID: 28118900.
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