Definition

What Is Peptic Ulcer Disease?

Peptic Ulcer Disease (PUD) is the formation of open sores (ulcers) in the lining of the stomach (gastric ulcer) or the first part of the small intestine (duodenal ulcer). Unlike gastritis (surface inflammation), ulcers penetrate through the mucosa into the muscle layer below, making them deeper, more painful and more dangerous.

Most peptic ulcers are caused by H. pylori infection or NSAIDs¹³. Less common causes: Zollinger-Ellison syndrome (gastrin-secreting tumor), severe physiological stress (ICU patients), Crohn's disease, certain cancers. Lifestyle factors (smoking, alcohol, chronic stress) impair healing but rarely cause ulcers alone.

Untreated ulcers can bleed (sometimes massively), perforate the stomach or duodenum (medical emergency) or obstruct the gastric outlet. Most ulcers can be treated successfully with prescribed medicine, yet H. pylori-positive ulcers recur in a large proportion of patients within a year if H. pylori isn't eradicated³.

⚠️ Sudden severe abdominal pain, vomiting blood, black tarry stools or fainting in someone with known or suspected ulcer disease is a MEDICAL EMERGENCY. Bleeding and perforation account for the major mortality of PUD.

Types of Peptic Ulcers

Duodenal Ulcer

Located in the first part of the small intestine. Classic pain: 2 to 3 hours after meals, often relieved by eating. About 95% are associated with H. pylori¹¹. Very rarely cancerous.

Gastric Ulcer

Located in the stomach. Classic pain: worsened by eating. About 70% are associated with H. pylori¹¹. Because stomach cancer can look like an ulcer, any gastric ulcer found on endoscopy is biopsied⁴.

Stress / Refractory Ulcers

Severe stress ulcers in ICU patients (mechanical ventilation, burns, head injury). This group also includes chronic refractory ulcers that don't heal: investigate for Zollinger-Ellison, malignancy, hidden NSAID use or H. pylori resistance.

Signs & Symptoms

Symptoms of Peptic Ulcer Disease

Classic textbook symptoms vary by ulcer location, but about two in three people found to have a peptic ulcer have no symptoms¹⁵, and some first learn of it from a complication such as bleeding¹³. Vague upper abdominal pain in NSAID users always warrants evaluation.

Symptom	What happens
Pain Patterns
Burning Epigastric Pain	Classic ulcer pain: gnawing, burning or aching in the upper central abdomen. Duodenal ulcer pain typically wakes patients at 1 to 3 AM (acid peak). Gastric ulcer pain often worsens with food.
Hunger Pains (Duodenal)	Duodenal ulcer pain occurs 2 to 3 hours after meals (when food has left the stomach) and is relieved by eating. Patients often wake at night with hunger-like pain. Antacids transiently help.
Food-Aggravated Pain (Gastric)	Gastric ulcer pain worsens shortly after eating. Leads to weight loss because patients avoid food. Distinguishes it from duodenal ulcers, which are relieved by food.
Nausea, Vomiting, Early Satiety	Particularly when ulcers are near the pyloric channel (causing functional obstruction). Vomiting that relieves pain is characteristic.
Red Flag & Complication Signs
Hematemesis (Vomiting Blood)	Bright red OR "coffee ground" emesis. Indicates active bleeding ulcer. MEDICAL EMERGENCY. Call 911 or go to the ER immediately.⁴
Melena (Black Tarry Stools)	Digested blood from upper GI source. Sticky, foul-smelling, jet-black. EMERGENCY. Distinguish from iron supplements (which darken stool but aren't tarry/foul-smelling).
Sudden Severe Abdominal Pain	Sudden, severe, "knife-like" pain with rigid abdomen = perforation. Surgical emergency. Mortality rises with delay. Call 911.
Unintentional Weight Loss	Especially with gastric ulcer pain. Patients avoid eating because of pain. Significant weight loss demands endoscopy to rule out malignancy.

Causes

Causes of Peptic Ulcer Disease

Two causes account for most peptic ulcers, H. pylori infection and NSAIDs, and a few others add to the risk or are rare¹³.

Cause	How It Contributes to Peptic Ulcer Disease	What Helps
H. pylori infection	Associated with 95% of duodenal and 70% of gastric ulcers¹¹; it spreads through contact with an infected person's vomit, stool or saliva, or food and water contaminated by them¹³.	Prescribed eradication therapy and a test to confirm it has cleared, which sharply cuts the chance of the ulcer coming back (conventional care); no food or supplement on this page clears it
NSAIDs and aspirin	They act throughout the body to weaken the stomach lining's protection, so enteric coating does not remove the risk¹. The risk is higher with long-term or high-dose use, more than one NSAID or H. pylori infection at the same time¹³.	Stopping NSAIDs where possible; if one must continue, acid-reducing medicine alongside it, decided with your prescriber (conventional care)
Other medicines taken with NSAIDs	Corticosteroids, medicines for low bone mass and some antidepressants raise ulcer risk, especially when combined with NSAIDs¹³.	A medication review with your prescriber; do not stop a prescribed medicine on your own (conventional care)
Smoking and older age	Ulcers are more common in people who smoke, and the risk rises with age¹⁴.	Stopping smoking (Nutritional Strategy)
Serious illness	Life-threatening conditions that need critical care, and some severe long-term diseases, can cause ulcers¹³.	Treatment of the underlying illness by the hospital or specialist team (conventional care)
Rare causes	Zollinger-Ellison syndrome, in which gastrin-making tumors drive excess acid, and diseases such as cancer or Crohn's disease that affect the stomach¹³.	Testing when ulcers are multiple, recurrent or unusual, including a gastrin level, and biopsy of stomach ulcers (Diagnosis; conventional care)

Treatment Comparison

Conventional and Holistic Treatment for Peptic Ulcer Disease

🌿 HOLISTIC

💊 CONVENTIONAL

🌿

Holistic / Functional Approach

Mastic gum, zinc carnosine, DGL, glutamine and other supportive nutrients

Cabbage Juice, a Historical Note

A 1949 uncontrolled report described faster ulcer healing with fresh cabbage juice. It predates the discovery of H. pylori, now known to cause most ulcers. Interesting history, not a basis for treatment⁶.

Zinc Carnosine

Approved for ulcers in Japan; clinical trial evidence for mucosal healing, though comparative data against prescription therapy is limited

Timeline

With a PPI, most duodenal ulcers heal within 4 weeks and some need 4 more; benign gastric ulcers are treated for 4 to 8 weeks⁸

Advantage

Adjuncts that can sit alongside eradication therapy and a PPI healing course

Full Holistic Approach Includes

Mastic gum 500 to 1,000 mg 2x/day on empty stomach, laboratory activity against H. pylori; it does not clear the infection
Zinc carnosine (Polaprezinc) 75 mg 2x/day, small trials suggest a benefit to the stomach lining; it does not clear H. pylori
DGL Licorice 380 to 760 mg chewed 20 min before meals, stimulates mucus production and prostaglandin synthesis
L-Glutamine 5 g 2x/day, a fuel for gut lining cells; evidence in peptic ulcer is limited
Slippery elm + marshmallow root tea before meals, demulcent coating; take them at least 2 hours apart from your antibiotics and other medicines, as the coating can reduce how well tablets are absorbed
Manuka honey (high methylglyoxal grade), antimicrobial against H. pylori in lab studies, soothing
S. boulardii + L. reuteri probiotics, alongside prescribed antibiotics only; S. boulardii modestly raised eradication and reduced side effects in pooled trials¹⁹
Eliminate triggers: NSAIDs (ask your prescriber about acetaminophen if pain medication is needed, and keep taking a prescribed low-dose aspirin unless you are advised to stop¹⁸), alcohol, smoking
Stress management: chronic stress impairs mucosal blood flow and prostaglandin synthesis

⚠️ Important: For active bleeding ulcers, conventional acute care is essential. Holistic approaches work best after initial stabilization, alongside H. pylori eradication or for prevention of recurrence.

Nutritional Strategy

Diet for Peptic Ulcer Disease

No food treats an ulcer; prescribed medicine does that. The aim of diet is to avoid irritating the ulcer and to cut out what slows recovery, such as smoking, alcohol and NSAIDs.

Foods that are easier on an ulcer, and what to limit

What to eat or do	Details
✅ Prioritize These:
Broccoli Sprouts	In a small trial, sulforaphane-rich sprouts lowered markers of H. pylori and stomach inflammation while they were eaten, but the markers returned after stopping and the infection was not cleared¹⁶. The trial used 2.5 oz (70 g) of sprouts a day.
Manuka Honey (high grade)	It inhibits H. pylori in laboratory culture only¹⁷; eating it is not a treatment for the infection. 1 tsp 2 to 3x/day soothes. Standard honey doesn't have the same effect.
Bone Broth & Soothing Soups	Claims that they repair the stomach lining are unproven. Easy to digest during acute phase. Add ginger and turmeric for anti-inflammatory benefit.
❌ Limit or Eliminate:
NSAIDs (Avoid Where Possible)	NSAIDs such as ibuprofen, aspirin and naproxen are, with H. pylori, the most common causes of ulcers¹³. Ask your prescriber about alternatives such as acetaminophen, and if you take a prescribed low-dose aspirin, keep taking it unless you are advised to stop¹⁸.
Smoking	Raises ulcer risk and slows healing. Stopping is one of the most important changes once H. pylori and NSAIDs are dealt with.
Alcohol	Direct mucosal irritant. Impairs ulcer healing and increases bleeding risk. Complete avoidance during healing phase; minimal/none long-term.
Coffee & Acidic Drinks	Stimulate acid secretion and directly irritate. Avoid during acute phase; gradually reintroduce as ulcer heals. Decaf is still problematic; both forms stimulate acid.

Supplement Protocol

Evidence-Based Supplements for Peptic Ulcer Disease

These supplements are used alongside prescribed treatment, for symptom relief and for the nutrient shortfalls long-term PPI use can cause; none of them clears H. pylori.

Supplement	What it is for	Typical range	Timing	Notes & cautions
Mastic Gum	Inhibits H. pylori in the laboratory, but it has not been shown to clear the infection and is not a substitute for eradication therapy.	500 to 1,000 mg 2x/day	Empty stomach	4 to 8 week courses; can repeat.
Zinc Carnosine	Approved ulcer drug in Japan. Small trials suggest a benefit to the stomach lining; it does not clear H. pylori.	75 mg 2x/day, roughly 17 mg elemental zinc per 75 mg dose	Empty stomach	Take separately from antibiotics & iron.
DGL Licorice	Stimulates mucus secretion and prostaglandin synthesis. Soothes inflammation. No BP effect (vs regular licorice).	380 to 760 mg chewable, 2 to 3x/day	20 min before meals	Chewable form is used for action in the stomach.
L-Glutamine	A fuel for gut lining cells; evidence in peptic ulcer is limited.	5 g 2x/day	Between meals, in water	Tasteless. Ask your oncology team before taking it if you have cancer; avoid it with severe liver disease.
S. boulardii + L. reuteri	Added to prescribed antibiotics, S. boulardii modestly raised eradication and reduced side effects such as diarrhea in pooled trials¹⁹; it does not treat the infection on its own.	S. boulardii 250 mg (about 5 billion CFU) to 500 mg (about 10 billion CFU) + L. reuteri per label	Throughout the antibiotic course + 2 weeks after	S. boulardii is safe with antibiotics (yeast, not bacteria). Use caution with immunosuppression or a central line, as yeast bloodstream infections have been reported; discuss with your team.
Vitamin C	Concentrates in gastric mucosa; evidence that it helps ulcers is limited. Low gastric vitamin C is associated with H. pylori and gastric cancer.	500 to 1,000 mg/day	With meals (buffered forms if sensitive)	Don't take large doses on empty stomach during active ulcer.
Vitamin E + Selenium	Antioxidant duo concentrates in gastric tissue. Evidence that it helps ulcers is limited.	200 to 400 IU E + 100 to 200 mcg selenium daily	With fat meal	Selenium dose should not exceed 200 mcg/day chronically. Vitamin E can raise bleeding risk with blood thinners or aspirin; do not take it with an active or recent bleeding ulcer unless your clinician agrees.
Vitamin B12 (post-PPI/eradication)	PPIs & H. pylori both impair B12 absorption. Test serum B12, methylmalonic acid; supplement if deficient.	1,000 mcg/day sublingual	Any time	High-dose B12 by mouth or under the tongue works even when stomach acid is low, because a small share is absorbed passively.

What to Expect

What to Expect Over Time

Most ulcers are treated with prescribed medicine: H. pylori is an infection cleared with antibiotics, and diet supports recovery around that treatment.

Treatment and supportive care, together

First Weeks

Acid-reducing medicine is usually taken for 4 weeks for a duodenal ulcer (4 more for some) and for 4 to 8 weeks for a benign gastric ulcer⁸. If H. pylori is present, a prescribed 14-⁠day course of several medicines is the preferred first treatment⁹. Take every dose, even once the pain eases, because stopping early can let some bacteria survive and become resistant to antibiotics²⁰. NSAIDs are stopped where possible.

Months 1 to 3

A breath or stool test after treatment confirms that H. pylori has cleared². Gastric ulcers are usually checked again by endoscopy, because stomach cancer can look like an ulcer⁴.

Months 3 to 12

Once H. pylori is cleared, relapse is much less common: duodenal ulcers came back in 12.9% after eradication, against 64.4% with no treatment¹¹. Acid-reducing medicine is not continued past the planned course unless your clinician advises it.

Long Term

If an NSAID must continue, acid-reducing medicine is taken alongside it. Stopping smoking lowers the risk of another ulcer. If symptoms return, see your doctor¹⁴.

When to Seek Care

Call 911 or go to the emergency department now, without waiting or trying diet first, if you vomit blood or material like coffee grounds, pass black, sticky or bloody stools, have sudden severe abdominal pain or a belly that is painful to touch, or feel faint with a racing pulse¹⁴¹³. Bleeding and perforation can be fatal, and delay raises the risk¹².

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References & Evidence Notes

Each numbered entry below is either a source you can follow or a note setting out what the evidence does and does not support. Both are numbered together so the markers in the text line up.

Last reviewed October 20, 2026. Supplement entries are cross-checked against the NIH National Center for Complementary and Integrative Health and the Linus Pauling Institute Micronutrient Information Center.⁷ The single most useful thing here: most peptic ulcers are caused by Helicobacter pylori infection or by NSAIDs, and both causes are addressable. If you have an ulcer, get tested for H. pylori, and if it is present, take the eradication course and have the cure confirmed with a test afterward. Untreated infection is why ulcers come back. Nothing on this page eradicates H. pylori; the supplements here support mucosal healing alongside treatment. Some symptoms are emergencies rather than nutrition problems: vomiting blood or coffee-ground material, black tarry stools, sudden severe abdominal pain with a rigid abdomen, fainting or a rapid pulse with breathlessness. Those mean bleeding or perforation and need an emergency department immediately.

On causes: H. pylori infection and NSAID use together account for the large majority of peptic ulcers. Aspirin and other NSAIDs cause injury by inhibiting prostaglandin-mediated mucosal protection, an effect that is systemic rather than local, so enteric coating does not remove it. Less common causes include Zollinger-Ellison syndrome and severe physiological stress. ↩
On eradication: current guidance favors bismuth quadruple therapy or other regimens chosen with local resistance in mind, over the older clarithromycin triple therapy where resistance is high. Confirming eradication with a urea breath test or stool antigen test after treatment is standard and often skipped, which matters because a meaningful share of first-line courses fail. Both tests need proton pump inhibitors stopped for around two weeks beforehand. ↩
On why recurrence is so different with and without eradication: ulcers recur in a large proportion of patients within a year if H. pylori is not cleared, and in a small proportion if it is. This is the strongest single argument for testing and treating rather than managing symptoms. ↩
On endoscopy and alarm features: hematemesis, melena, dysphagia, unexplained weight loss, persistent vomiting, anemia or new dyspepsia in an older adult warrant endoscopy rather than empirical treatment. Gastric ulcers are generally re-scoped to confirm healing, because gastric cancer can present as an ulcer. ↩
On mucosal support: zinc carnosine has small randomized trials suggesting improved mucosal healing and reduced NSAID-induced injury. Deglycyrrhizinated licorice is used for symptom relief and lacks the mineralocorticoid effects of whole licorice, which raises blood pressure and lowers potassium, PubMed 42292819. These are adjuncts and none of them clears the infection. ↩
On cabbage juice, and on the age of evidence: a 1949 Stanford report of rapid ulcer healing with fresh cabbage juice was uncontrolled. It predates the discovery of H. pylori by more than three decades, so the ulcers being treated were understood in a completely different framework. It is a genuinely interesting piece of history and it is not a basis for treatment decisions today. The same caution applies to any supplement claim resting on a single mid-century uncontrolled series. ↩
National Center for Complementary and Integrative Health (NIH), nccih.nih.gov, and the Linus Pauling Institute Micronutrient Information Center, lpi.oregonstate.edu/mic. ↩
On ulcer healing with a proton pump inhibitor: the US prescribing information for omeprazole gives 20 mg once daily for active duodenal ulcer, noting that most patients heal within four weeks and some need an additional four, and 40 mg once daily for 4 to 8 weeks for benign gastric ulcer, FDA prescribing information, 2011. ↩
On first-line H. pylori treatment: the 2024 American College of Gastroenterology guideline recommends bismuth quadruple therapy for 14 days as the preferred regimen for people not previously treated, when antibiotic susceptibility is unknown, PubMed 39626064. ↩
On how common peptic ulcers are: a 2009 systematic review found yearly rates of 0.10 to 0.19% for physician-diagnosed peptic ulcer, with most studies reporting a fall over time, PubMed 19220208. ↩
On H. pylori eradication and relapse: a Cochrane review of 55 trials found that 95% of duodenal and 70% of gastric ulcers are associated with H. pylori, and that eradication therapy cut duodenal ulcer recurrence to 12.9% against 64.4% with no treatment, and gastric ulcer recurrence to 16.3% against 52.4%, though the evidence was rated very low quality, PubMed 27092708. ↩
On complications: a systematic review of 93 studies put yearly peptic ulcer bleeding at 19.4 to 57.0 and perforation at 3.8 to 14 per 100,000 people, a 7-⁠day rebleeding rate of 13.9% after an ulcer bleed, and average 30-⁠day mortality of 8.6% after bleeding and 23.5% after perforation, higher with older age, other illness, shock and delayed treatment, PubMed 21494041. ↩
On causes and warning signs: the National Institute of Diabetes and Digestive and Kidney Diseases names H. pylori and NSAIDs as the most common causes, lists medicines and illnesses that add to the risk, and advises seeing a doctor right away for black or bloody stools, blood or coffee-ground vomit, sudden severe abdominal pain, dizziness or fainting, NIDDK. ↩
On emergency signs and follow-up: the NHS advises calling emergency services or going to an emergency department for vomiting blood or coffee-ground vomit, black, sticky or bloody stools, or severe abdominal pain, notes that ulcers are more common in people who smoke and with age, and advises seeing a doctor if symptoms return after treatment, NHS. ↩
On ulcers without symptoms: a 2019 review reports that about two-thirds of people found to have peptic ulcer disease have no symptoms, and that most cases are associated with H. pylori infection, NSAID use or both, PubMed 30611829. ↩
On broccoli sprouts: in a trial of 48 adults with H. pylori, 70 g a day of broccoli sprouts for 8 weeks lowered breath and stool markers of H. pylori colonization and blood markers of stomach inflammation, against alfalfa sprouts; the values returned to baseline 2 months after stopping, so the sprouts did not clear the infection, PubMed 19349290. ↩
On manuka honey: in laboratory culture, manuka honey stopped the growth of H. pylori isolates taken from gastric ulcers; this is a test-tube finding, and it is not evidence that eating honey clears the infection, PubMed 8308841. ↩
On low-dose aspirin: the NHS advises people who regularly take low-dose aspirin to keep taking it unless they are advised to stop, and lists stomach ulcers and bleeding among its serious side effects, NHS. ↩
On S. boulardii: a meta-analysis of 11 randomized trials with 2,200 participants found that adding S. boulardii to a standard H. pylori regimen modestly raised the eradication rate, which still fell short of the desired level, and reduced treatment side effects, particularly diarrhea; it was studied only as an addition to antibiotics, PubMed 25898944. ↩
On finishing H. pylori treatment: the NIDDK advises taking every dose exactly as prescribed, because if the medicine is stopped early, some bacteria may survive and become resistant to antibiotics, NIDDK, treatment for peptic ulcers. ↩

Test	What it shows
Direct Visualization
Upper Endoscopy (EGD)	Gold standard. Directly visualizes ulcer location, size, presence of bleeding. Biopsies confirm H. pylori, rule out cancer (especially gastric ulcers), check for premalignant changes. Allows therapeutic intervention if bleeding.
Upper GI Series (Barium Swallow)	X-ray after drinking barium contrast. Less accurate than endoscopy, so it can miss ulcers. Used when endoscopy unavailable or contraindicated. No biopsy capability; endoscopy is still required for confirmation.
H. pylori Testing & Workup
Urea Breath Test or Stool Antigen	Non-invasive H. pylori detection. Ask your prescriber about stopping your proton pump inhibitor (PPI) 2 weeks before the test, for accuracy. Used to confirm eradication 4+ weeks after treatment.²
Biopsy + Rapid Urease Test (CLO)	During endoscopy, gastric tissue biopsy is tested for urease activity. Highly specific for H. pylori. Histology also identifies inflammation severity, atrophy, intestinal metaplasia.
CBC, Iron Studies, Fecal Occult Blood	Check for iron-deficiency anemia from chronic blood loss. Positive fecal occult blood in someone with epigastric pain raises suspicion for bleeding ulcer.
Serum Gastrin (for Refractory Cases)	Elevated in Zollinger-Ellison syndrome (gastrinoma). Consider in multiple ulcers, refractory ulcers, ulcers in unusual locations or ulcers with severe symptoms.

Peptic Ulcer Disease

What Is Peptic Ulcer Disease?

Types of Peptic Ulcers

Duodenal Ulcer

Gastric Ulcer

Stress / Refractory Ulcers