For decades, we have been told that stomach ulcers are the price we pay for a high-pressure lifestyle. The common story is that rushing through meals, drinking too much black coffee, and carrying the weight of the world on our shoulders eventually "burns a hole" in the stomach. Whilst it is true that our stomachs often churn when we are anxious, the medical reality is quite different. Most ulcers are not actually caused by a bad day at the office or a love for spicy sambal. Instead, they are usually the result of a specific bacterial infection or the way we use common painkillers.
The Real Culprits: Bacteria and Medication
The primary culprit in the majority of cases is a hardy bacterium called Helicobacter pylori, or H. pylori. This organism is uniquely adapted to survive in the harsh, acidic environment of the human stomach. It produces an enzyme that creates a tiny alkaline "buffer zone" around itself, allowing it to burrow into the stomach's protective mucus layer. Over time, this persistent presence triggers chronic inflammation. This weakens the stomach's natural defences, eventually allowing stomach acid to erode the lining and form an open sore, which we know as an ulcer.
Because H. pylori is so well-adapted, it often spreads through routine household habits that we rarely think twice about. In many families, the bacteria moves from person to person through shared eating practices. This includes using the same spoons for shared dishes, sharing drinks or straws, and even the common habit of "double-dipping" a tasting spoon whilst cooking. Poor hand hygiene after using the toilet or before preparing food also plays a significant role in how the infection travels within a home.
Whilst the bacteria is the leading cause, the second most common trigger is the frequent use of non-steroidal anti-inflammatory drugs, or NSAIDs. These include everyday painkillers like ibuprofen and aspirin. These medications work by blocking certain chemicals in the body that signal pain, but those same chemicals are also responsible for maintaining the stomach's protective lining. When these defences are lowered, the stomach becomes much more vulnerable to acid damage. This risk is particularly high for those who take these painkillers for more than a week or two, or for older individuals who may already have a more sensitive digestive system.
Understanding the Role of Lifestyle
This brings us back to the role of stress, coffee, and spicy food. Whilst they are often blamed for causing ulcers, they are usually just "amplifiers" rather than the root cause. If your stomach lining is already inflamed by H. pylori or weakened by painkillers, a fiery meal or a stressful deadline can certainly make the symptoms feel much more intense. Stress can also slow down the body's ability to heal an existing ulcer and might push us toward habits that make things worse, such as smoking or drinking more alcohol.
It is also important to understand that many people carry H. pylori without ever feeling a single symptom. For those who do experience discomfort, it often feels like typical indigestion—bloating, frequent burping, or a dull, burning ache in the upper abdomen. However, there are "red flag" symptoms that should never be ignored. If you experience unexplained weight loss, persistent pain that wakes you up at night, or more serious signs like vomiting blood or passing black, tarry stools, you should seek medical attention immediately.
Navigating Testing and Treatment
The good news is that once the real cause is identified, ulcers are highly treatable. Diet alone is rarely enough to clear an H. pylori infection because the bacteria is so stubborn. Instead, doctors usually prescribe a combination of antibiotics and acid-reducing medication. Completing the full course of treatment is essential to ensure the bacteria is fully eradicated and does not become resistant to medicine.
Many people wonder if they should get tested even if they feel fine. Whilst routine screening for everyone isn't always necessary, it is often recommended if you have a family history of stomach cancer or recurring gastric issues. If you do test positive, it is worth considering testing your close family members as well, as the bacteria is easily passed through shared meals. Once treated, re-infection is uncommon in adults, but maintaining good hygiene remains the best way to ensure it does not return.
Managing Your Recovery
During the healing process, which usually takes a few weeks, many patients ask what they can safely eat. Whilst there is no "magic" food that kills the bacteria, sticking to a bland diet of porridge, steamed fish, and non-acidic vegetables can help soothe the stomach. It is best to avoid caffeine, alcohol, and very spicy foods until the lining has fully recovered. Some people look for natural alternatives like Manuka honey or probiotics; whilst these can support general gut health, they should be seen as helpful additions rather than a replacement for the antibiotics needed to kill the infection.
For those who take low-dose aspirin for heart health, the situation requires a careful balance. You should never stop heart medication without consulting your doctor, who may prescribe a stomach-protecting medicine to allow you to continue your treatment safely. Similarly, if you are unsure whether your pain is an ulcer or just acid reflux, a professional evaluation is key. Whilst both can cause burning and bloating, an ulcer requires a specific approach to prevent serious complications.
Ultimately, protecting your stomach is about moving past the old myths and focusing on practical habits. Using serving spoons for shared meals, practising consistent handwashing, and being mindful of how often you reach for certain painkillers can make a world of difference. By identifying the real triggers—rather than just blaming a busy life—you can stop managing the pain and actually start the healing process. Your stomach is remarkably resilient, but it performs best when we respect its natural defences and address the real culprits behind the discomfort.