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This article is educational and does not replace your doctor's advice. Seek urgent care for any red-flag symptoms.
What is it?
A peptic ulcer is an open sore in the lining of the stomach (gastric ulcer) or of the first part of the small intestine (duodenal ulcer). Helicobacter pylori (H. pylori) is a bacterium that lives in the stomach lining, causes long-term inflammation (gastritis) and is the main cause of ulcers; it also raises the long-term risk of stomach cancer, which is why it is treated. Old advice to drink milk, to eat a bland diet or to avoid all spicy food was based on the idea that acid and diet cause ulcers. We now know that this is not so. This article explains what food can and cannot do, how to eat during antibiotic treatment, and how to protect your nutrition. For the diseases themselves, please read our articles on peptic ulcer disease and H. pylori infection.
How common is it?
H. pylori infects roughly half of the world’s population, usually acquired in childhood, and several studies from Saudi Arabia have reported high rates among adults, with lower rates in younger people as hygiene improves. Most infected people never develop an ulcer; only a minority do. Ulcers linked to anti-inflammatory painkillers are also common because these medicines are widely used and often bought without a prescription.
Why does it happen?
The two main causes are H. pylori infection and regular use of non-steroidal anti-inflammatory drugs (NSAIDs, such as ibuprofen, diclofenac, naproxen and higher-dose aspirin). Both weaken the protective mucus layer so that stomach acid injures the lining. Smoking delays healing and makes ulcers return, and heavy alcohol use irritates the lining. Spicy food, coffee and stress do not by themselves cause ulcers, although they can make the discomfort worse in some people. Rarely, ulcers are caused by very high acid production or by other conditions.
Symptoms
- Gnawing or burning pain in the upper abdomen, sometimes at night or between meals
- Pain that eases or worsens with food, depending on where the ulcer is
- Bloating, belching, nausea and feeling full early
- Loss of appetite or weight loss in some people
- No symptoms at all until bleeding or anaemia appears
Red flags — seek urgent medical care
Vomiting blood, or vomit that looks like coffee grounds
Bleeding ulcer. Call emergency services or go to the emergency room immediately.
Black, tarry, sticky and foul-smelling stools
Blood from the upper digestive tract. Go to the emergency room. (Bismuth in some H. pylori medicines and iron tablets can also darken stools, but then the stool is dark-grey or black without being sticky and you feel well. If in doubt, ask.)
Sudden, severe, constant abdominal pain, a rigid belly, or fever with pain
Possible perforation (a hole) in the ulcer. This is a surgical emergency. Go to the emergency room immediately.
Repeated vomiting, inability to keep food down, or feeling full after only a few mouthfuls
The ulcer may be narrowing the stomach outlet. See a doctor urgently.
Unintended weight loss, difficulty swallowing, dizziness, pallor or ulcer symptoms returning after treatment
Needs prompt review; an ulcer that does not heal, or anaemia, requires further tests.
How is it diagnosed?
H. pylori is detected with a breath test, a stool antigen test or biopsies taken at endoscopy. Acid-reducing tablets (for about 2 weeks) and antibiotics (for about 4 weeks) can give false-negative results, so your doctor will tell you what to stop before testing. An endoscopy shows the ulcer, and gastric ulcers are often biopsied or re-checked to make sure they heal, since a few can be cancer. After treatment, a test of cure at least 4 weeks later confirms that the bacteria are gone. A dietitian is helpful if you are losing weight, anaemic or avoiding foods.
What the latest science says
Current guidance agrees that diet does not cause or heal ulcers. The ACG (2024) guideline on treatment of H. pylori and the Maastricht VI/Florence consensus (Gut, 2022) focus on testing, 14-day antibiotic combinations (often bismuth-based quadruple therapy because of antibiotic resistance) and confirming cure; they do not recommend ulcer diets. The NIDDK states that researchers have not found diet to play an important role in causing, preventing or treating ulcers. Historic bland and milk diets were abandoned: milk can briefly soothe symptoms but then stimulates acid. Observational studies link diets rich in fruit, vegetables and fibre with fewer ulcers, and high intakes of salt-preserved, pickled and smoked foods with more stomach cancer in people infected with H. pylori. Meta-analyses suggest that some probiotic strains given with eradication therapy may reduce side effects such as diarrhoea and slightly improve eradication, but the evidence is moderate to low and strain-specific. Foods and supplements such as broccoli sprouts, honey, black seed, garlic and green tea have been studied only in laboratories or small trials and cannot replace antibiotics.
Outlook — what to expect
With the right treatment, most ulcers heal within weeks and H. pylori can be cleared in the large majority of people, which greatly lowers the chance of the ulcer coming back. The main risks come from missed treatment, continued NSAID use, smoking, and complications such as bleeding. Diet will not heal the ulcer, but eating well supports recovery and comfort.
Treatment
Habits & Lifestyle
The habits that count most are about smoking, painkillers and finishing treatment.
- Stop smoking (including shisha): smoking slows ulcer healing and makes ulcers come back.
- Avoid ibuprofen, diclofenac, naproxen and other anti-inflammatory painkillers unless your doctor prescribes them. Ask about paracetamol for pain. Do not stop aspirin prescribed for your heart or brain without asking your doctor.
- Take the full course of antibiotics even if you feel better. Stopping early can leave resistant bacteria behind.
- Book the test of cure at least 4 weeks after you finish treatment.
- Wash your hands before eating and after using the toilet, and drink safe water; the infection spreads within families, so ask your doctor whether relatives with symptoms should be tested.
Diet
There is no special ulcer diet. Eat a normal, balanced diet and avoid only the foods that clearly make your own pain worse. The tips below also cover eating during antibiotic treatment.
- Eat regular meals. If large meals bring on pain, try smaller, more frequent ones. Do not go for long periods without eating if that makes your pain worse.
- You do not need to give up spicy food, coffee, tea or chocolate for the ulcer to heal; they do not cause ulcers. If one of them clearly increases your pain, leave it out until you feel better and try it again later.
- Do not rely on milk or “bland” diets. They do not heal ulcers and milk can stimulate more acid after a short soothing effect.
- Include fruit, vegetables, legumes and whole grains. Observational studies link higher-fibre diets with fewer ulcers.
- Avoid alcohol, which irritates the stomach lining, and limit heavily salted, pickled, smoked and charred foods, which are linked to stomach cancer in people infected with H. pylori.
- During antibiotic treatment: follow your pharmacist’s advice on taking each medicine with or without food. Some antibiotics are absorbed less well if taken together with milk, calcium, iron or antacids, so ask how far apart to take them. Avoid alcohol while taking metronidazole and for a day or two after (it can cause severe nausea and flushing; this includes alcohol in some mouthwashes, syrups and herbal tinctures).
- Side effects such as a metallic taste, nausea, loose stools or a dark tongue and stools (with bismuth) are common and usually pass. Eat small meals, sip fluids, and eat yoghurt or laban if you tolerate it. Tell your doctor if you cannot keep the medicines down, or if diarrhoea is severe or bloody.
- Probiotic yoghurt or laban is safe for most people. Probiotic capsules may reduce antibiotic side effects, but the evidence is moderate to low and depends on the strain; they are optional, and your doctor or pharmacist can suggest a product.
- Be careful with “natural cures” (honey, black seed, garlic, broccoli sprouts, green tea): they do not clear H. pylori reliably. Use them only in addition to, never instead of, prescribed treatment, and ask before combining with your medicines.
- If an ulcer has caused anaemia, eat iron-rich foods (red meat, liver, chicken, lentils, chickpeas, dates, leafy greens) with a source of vitamin C, and take iron tablets only as prescribed; iron also darkens stools.
Medications
The medicines that heal ulcers are described in our H. pylori and peptic ulcer articles. In brief:
- A combination of antibiotics plus acid-reducing medicine, usually for 14 days, to clear H. pylori. Follow the schedule exactly and do not use leftover antibiotics at other times.
- Acid-reducing medicine (a proton pump inhibitor) for several weeks to let the ulcer heal.
- Stopping or replacing anti-inflammatory painkillers, and sometimes protecting the stomach if you must continue them (for example for the heart).
- A test of cure afterwards; if the first treatment fails, your doctor will choose a different combination.
Procedures & Surgery
Most ulcers are treated with medicine alone. Procedures are used for diagnosis and complications:
- Upper endoscopy to see the ulcer, take biopsies and test for H. pylori.
- Endoscopic treatment (clips, injection or heat) to stop a bleeding ulcer.
- Repeat endoscopy for some gastric ulcers to confirm healing.
- Surgery is now rarely needed, mainly for a perforated ulcer or bleeding that cannot be controlled.
Living with the condition
- Keep a list of your medicines, including painkillers bought without a prescription, and show it to every doctor and pharmacist.
- Know the signs of bleeding and what to do.
- Return for the test of cure; do not assume you are clear just because the pain went away.
- If symptoms return after treatment, see your doctor rather than restricting your diet further.
In the Saudi context
Painkillers are easy to buy and often taken at suhoor or on an empty stomach for headache or joint pain; many contain ibuprofen or diclofenac, which can cause ulcers and bleeding. Use only what your doctor advises. Traditional remedies such as honey, black seed (habbat al-barakah) and herbal teas are popular; they may be taken as part of a balanced diet, but they do not replace antibiotic treatment of H. pylori. Spicy dishes are not a cause of ulcers, but choose lighter dishes while pain is active. Ramadan: studies on fasting and ulcer complications are mixed, so if you have an active or recently bleeding ulcer, or are in the middle of the 14-day antibiotic course, ask your doctor before fasting; the treatment schedule can sometimes be arranged around iftar, after Tarawih and suhoor, or started after Ramadan if the ulcer is not urgent. Break your fast gently with water and dates, avoid very hot, fried or spicy foods at iftar, and do not take anti-inflammatory painkillers on an empty stomach.
Questions to ask your doctor
Save this list or print it before your appointment — doctors appreciate prepared patients.
- Do I have H. pylori, and which treatment schedule fits my daily routine (and Ramadan)?
- Can I keep taking my painkillers or aspirin, or do I need an alternative?
- Are there foods I should avoid while on antibiotics?
- When will I be tested to confirm the bacteria are gone?
- Should my family members be tested?
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Status: Approved for publication by SGA; individual clinician review is ongoing · Published 24/04/2026
For general education only; it does not replace your doctor’s advice. Individual clinician review of this guide is ongoing. SGA clinician? Review this guide