Peptic Ulcers : Insights and Practical Tips for Patients & Caregivers
Written by: Wendy Haaf
Updated: September 24th, 2025
While today’s treatments can successfully heal most peptic ulcers (stomach ulcers) and lower the risk of recurrence (coming back), they aren’t effective for everyone. Some patients continue to struggle, and in some cases, ulcers appear without any clear underlying cause.
To close these gaps, researchers are pushing the science forward. Here are just a few of the areas they’re actively exploring in the area of peptic ulcers. And at the end of this article, we’ll also share practical tips for patients and caregivers to better manage life with peptic ulcers.
Identifying causes other than H pylori and NSAIDs
“We’re not sure why, but we see more ulcers than in the past that are not Helicobacter pylori related, and not NSAID or Aspirin related, and there is research looking into that,” says Dr. Veldhuyzen van Zanten, an Emeritus Professor of Medicine in the Division of Gastroenterology at the University of Alberta in Edmonton.
It’s likely that there’s more than a single culprit behind unexplained peptic ulcers. However, scientists have homed in on one of the potential suspects. Some research suggests that, “some of the antidepressants may increase the risk,” notes Dr. Veldhuyzen van Zanten. The medications in question are SSRIs, which include sertraline (Zoloft), fluoxetine (Prozac), and escitalopram (Lexapro).
Finding answers for antibiotic-resistant infections
Roughly 90% of H pylori infections can be cured with a course of a combination of two or three antibiotics given for two weeks. However, the remaining 10% don’t respond to treatment, “presumably due to antibiotic resistance,” says Dr. Keith McIntosh, an Associate Professor of Medicine at Western University and Gastroenterology Site Director at St. Joseph’s Health Care London (Ontario). “So then we have to look for an alternative antibiotic regimen. The question of what the best antibiotic regimen is in these cases is an ongoing knowledge gap.”
Why symptoms sometimes persist after successful treatment for H pylori infection
“Some people say, well, the Helicobacter is gone, all of my problems should be gone. We thought that might be the case, but unfortunately, it isn’t,” notes Dr. Veldhuyzen van Zanten. “Some people, even if we cure H pylori, may need lifelong proton-pump inhibitors (medications that block the production of acid in the stomach) to treat dyspepsia, he says. Dyspepsia is the medical term for symptoms that occur in the upper part of the stomach. These include pain or discomfort located just below the breastbone, sometimes associated with a burning feeling.
How best to manage patients on blood-thinning medications
“We now have a lot more patients on blood thinners than in the past, and there are a lot of new blood thinners,” explains Dr. McIntosh. Not only can these medications make it more challenging to stop bleeding from an ulcer, they increase the odds of serious bleeding and getting another bleeding ulcer in the future. And it isn’t yet entirely clear whether there are differences in bleeding risk among the different blood thinners for people with a history of peptic ulcers.
“That layer of complexity, and the fact that we have so many patients on blood thinners, is probably what’s keeping the rate of bleeding ulcers as high as it is,” Dr. McIntosh notes.
“How to treat patients who are on blood thinners and come in with bleeding, and which are the best blood thinners to be on,” for those with a history of bleeding ulcers, “is an evolving area of research,” Dr. McIntosh says.
Further refining endoscopic tools
During a gastroscopy (the test used to diagnose bleeding ulcers), a flexible tube with a tiny camera on the end is passed from the mouth down into the stomach. “Our cameras have gotten smaller, and resolutions (level of detail we can see) have gotten so much better that we’re doing pretty well diagnostically, but there may be room for improvement,” when it comes to treating bleeding ulcers endoscopically, says Dr. McIntosh. “Our endoscopic tools are good, but they’re not perfect. We’re operating in a small space with a small scope, and if the ulcer is in a very awkward location, it can sometimes be a challenge,” he adds. Researchers are investigating ways of further refining existing endoscopic tools and techniques.
Whether new-generation medications may be more effective than PPIs
“There are some exciting new medications that are coming out that may be more effective than some of the PPIs,” Dr. McIntosh explains. These drugs, called potassium-competitive acid blockers (P-CABs), “might have a role in future, both for the treatment of ulcers or the treatment of H pylori as well,” he says.
Treatment and prevention of peptic ulcers and peptic ulcer bleeding is constantly evolving. If you have any questions about your personal risk factors, talk to your health care team.
Blood thinners
Many people are on long-term treatment with medications that interfere with blood clotting to reduce their risk of heart attack and stroke. These blood-thinning medications fall into two categories.
These include:
Antiplatelet medications make platelet cells that normally clump together to help form clots less ‘sticky’.
- Aspirin (acetylsalicylic acid or ASA)
- Clopidogrel (Plavix)
- prasugrel (Effient)
- ticagrelor (Brilinta)
Anticoagulants inhibit clotting in other ways. Examples include:
- Warfarin (Coumadin)
- Newer-generation direct oral anticoagulants (DOACs)
DOACs include:
- apixaban (Eliquis)
- dabigatran (Pradaxa)
- rivaroxaban (Xarelto)
- Edoxaban (Lixiana)
Patient and Caregiver Tips
Red- and Yellow-Flag Signs and Symptoms
If you or your family member has been treated for a bleeding ulcer, be on the lookout for these warning signs and symptoms in the person who is recovering.
Reasons to get medical help right away:
- Sudden, sharp pain in the abdomen
- Vomiting blood or material that looks like coffee grounds
- Passing bloody or black stool
- Fainting, seeming confused, or feeling sweaty or clammy
Reasons to contact your health care provider promptly:
- Light-headedness or dizziness
- Persistent pain or discomfort in the upper part of the stomach
- Loss of appetite
- Vomiting
- Unintentional weight loss
Someone who has had a bleeding ulcer in the past should not take any of the over-the-counter pain and fever medications listed below without consulting their doctor or pharmacist first.
(Similarly, if another care provider, like a doctor at a walk-in clinic, or a dentist, writes you a prescription for pain medication, make sure you tell them you’ve had a bleeding ulcer.)
- Aspirin (acetylsalicylic acid or ASA)
Non-steroidal anti-inflammatories (NSAIDs)
- Advil (ibuprofen)
- Aleve (naproxen)
- Ibuprofen
- Motrin (ibuprofen)
- Naproxen
Remember to check the ingredient labels of cold and flu products for any of the above, too.
Your doctor or pharmacist may suggest a different medication, or prescribe a stomach-protecting medication (proton pump inhibitor or PPI) to take along with the NSAID.
Tips for Patients and Caregivers
- Keep a medication list: Write down all prescriptions, over-the-counter drugs, and supplements. Share this list at every healthcare visit.
- Meal support: Encourage small, balanced meals and avoid foods or drinks that irritate the stomach (such as alcohol, caffeine, and very spicy foods).
- Hydration and rest: Make sure the recovering person drinks enough fluids and gets adequate rest, both of which support healing.
- Monitor closely: Caregivers should keep track of any changes in symptoms, energy levels, or appetite, and communicate these to healthcare providers.
- Emotional reassurance: Recovery from a bleeding ulcer can be stressful. Offering encouragement and helping with daily tasks can reduce anxiety and promote healing.
- Follow-up care: Remind and accompany the patient to follow-up appointments, since repeat scopes or bloodwork may be necessary to monitor healing.
Summary and Key Takeaways
- Researchers are trying to close gaps in the treatment and prevention of bleeding peptic ulcers. Questions as yet to be answered include:
- Why some people with no known risk factors develop peptic ulcers and bleeding ulcers.
- Why current treatment regimens for H pylori infection don’t always work, and which drug combinations to use when this happens.
- Why symptoms persist for some patients with H pylori-related ulcers after treatment successfully cures the infection.
- How best to manage patients who need to take blood thinners for other conditions.
- How current endoscopic tools and techniques can be further refined
- Whether a new class of medications might be more effective than PPIs for healing peptic ulcers and preventing them from recurring.
Tips for Patients and Caregivers
- Learning the potential warning signs of re-bleeding that need immediate attention can give patients and their families greater peace of mind after treatment for a bleeding peptic ulcer.
- If you’ve ever had a bleeding peptic ulcer, check with your doctor or pharmacist before taking an NSAID medication like ibuprofen.
- There are simple ways you can help support someone while they are recovering after treatment for a bleeding peptic ulcer.
