It started in the month of the audit. A burning under your ribs, worse at night, easier for a while after you eat. Your colleague says it’s ulcer from skipping lunch. Your mother blames the pepper. The chemist sold you something that worked for a week. Now you’re wondering whether the real cause is the job.
Not on its own. Most stomach ulcers are caused by an infection with bacteria called H. pylori, or by regular use of anti-inflammatory painkillers such as ibuprofen and diclofenac. Stress can make ulcer symptoms worse, and it causes stomach pain and indigestion of its own, which is why the two get mixed up so often. The only way to know which one you have is a doctor and a test. Our guide to stress in Nigeria covers stress itself. This piece is about the ulcer question.
See a doctor first
Stomach pain has many causes, and nobody can tell an ulcer from indigestion, an anxious stomach or something more serious from a description. Don’t settle it at the chemist.
Call 112 now, or 767 in Lagos, or get to the nearest emergency unit if:
- you vomit blood, or your vomit looks like coffee grounds
- your stool is black, sticky and tarry, or has blood in it
- you have sudden, sharp or severe stomach pain that doesn’t go away, or your tummy hurts to touch
- you have chest pain that started suddenly
- you feel dizzy or faint, or your heart is racing, along with stomach pain
Don’t drive yourself. Ask someone to take you.
See a doctor soon if:
- your stomach pain keeps coming back or is getting worse
- indigestion doesn’t settle
- you’ve lost your appetite, feel full after very little food, or are losing weight without trying
- swallowing hurts or is difficult, or you keep vomiting
- you feel tired all the time
- it feels as if there’s a lump in your tummy
These lists come from the NHS and the US National Institutes of Health (NIH).
What actually causes stomach ulcers
A stomach ulcer is a sore in the lining of the stomach or of the first part of the small intestine, the duodenum. Doctors also call them peptic ulcers. The NHS and the NIH name the same two main causes.
H. pylori. This is a bacterial infection of the stomach lining. Researchers are still working out exactly how it spreads, but the NIH says it may pass between people through saliva, vomit or stool, or through food and water contaminated with them. It is very common in Nigeria. A 2017 review that pooled studies from 62 countries put Nigeria’s rate at about 88% of the people studied, the highest country figure in the analysis, though most of those studies are now old. Many people who carry H. pylori never get an ulcer, according to MedlinePlus, the NIH’s health information service.
Anti-inflammatory painkillers. These are the NSAIDs, a group that includes ibuprofen and diclofenac. They ease pain, but the NIH says they also make the stomach lining more prone to damage and ulcers. The risk is higher if you take them for a long time, take a lot, take more than one, or also have H. pylori. In Nigeria they’re easy to buy at the chemist for body pain, back pain, period pain and headaches, and easy to keep taking for weeks without a doctor knowing.
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Smoking, getting older and drinking too much alcohol also raise the risk. Less common causes include other infections and some other medicines, so tell a doctor about everything you take.
Where stress fits in
Neither the NHS nor the NIH lists stress among the causes of ulcers. MedlinePlus says stress and spicy foods do not cause ulcers but can make them worse. Its medical encyclopedia does put stress on a longer list of things that raise the risk, alongside alcohol and smoking. That’s why “not on its own” is the fairest answer.
Stress does make ulcer symptoms worse. The NHS says a doctor treating an ulcer may recommend help with stress, anxiety and depression for that reason, and it lists managing stress among the things that help.
Stress also causes stomach symptoms of its own. Indigestion, the burning, bloated, queasy feeling, can be caused or made worse by stress and anxiety, according to the NHS, with no ulcer anywhere. We cover that side in physical symptoms of anxiety.
And stress changes what people do. It brings tension headaches and a stiff neck, which are easy to answer with painkillers every day, and the NHS lists drinking and smoking more among its effects on behaviour. Painkillers, alcohol and cigarettes are all on the ulcer risk list.
Doctors use “stress ulcer” for something else: ulcers and bleeding in people who are critically ill, for example on a breathing machine in intensive care. That stress is severe physical strain on the body.
Why so much stomach pain in Nigeria gets called ulcer
“Ulcer” has become the everyday word for almost any pain or burning in the upper stomach. You skipped breakfast and lunch in traffic, had pepper soup at a party, or fasted all day, and when your stomach complains, the verdict is ulcer and the chemist has something for it.
Both beliefs start from something real. The NIH says ulcer pain may come when the stomach is empty or at night and ease for a while after eating, so people with ulcers notice that skipping meals hurts. The NHS lists spicy and fatty foods among things that can trigger symptoms in someone who already has an ulcer. So an empty stomach and hot pepper can make an ulcer hurt, but neither has been shown to cause one: the NIH says researchers have not found that diet plays an important role in causing ulcers.
Indigestion is very common and usually not serious, and the NHS lists many causes, including rich or spicy food, coffee, alcohol, smoking, some painkillers, and stress and anxiety. When all of it gets called ulcer and treated at the chemist for months, a real ulcer from H. pylori or painkillers may never get the treatment that clears it, and a stomach that’s reacting to stress keeps hurting because nobody asks about the stress. Warning signs get missed too. Left untreated, an ulcer can bleed, cause anaemia or make a hole in the stomach wall, and untreated H. pylori raises the risk of stomach cancer.
How ulcers and H. pylori are tested for
A doctor will usually ask about your symptoms, the medicines you take (especially painkillers) and your family history, and examine your tummy. Tests may include:
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- a breath test for H. pylori, where you swallow a drink or tablet and then breathe into a tube
- a stool test for H. pylori
- a blood test
- a gastroscopy, also called an endoscopy, where a thin, flexible tube with a camera is passed through your mouth into your stomach. This is the test that confirms an ulcer.
A positive H. pylori test tells you the bacteria are there. Since so many people carry them without an ulcer, it doesn’t prove they’re causing your pain, and only a camera test lets a doctor see an ulcer directly. Ask which test you’re having and what it can show.
Treatment depends on the cause, and a doctor decides it. The NHS says most people recover with treatment. Tell the doctor about every painkiller you’ve been taking, including ones bought without a prescription.
What to do about the stress part
Once a doctor has checked you, look at the stress.
- Look for the pattern. Does the pain follow deadlines, exams, money worries or family meetings? Two weeks of noting pain, food, sleep and what was happening usually shows it.
- Eat smaller meals, and finish your evening meal three to four hours before bed. That’s the NHS’s advice for ulcer symptoms.
- Count the painkillers. If stress headaches and body aches have you taking them most days, tell your doctor or pharmacist.
- Cut back on alcohol and smoking. Both are on the ulcer risk list.
- Deal with what’s causing the stress, in steps. Our guide to stress in Nigeria covers what helps and when to get support.
When a therapist helps
A doctor treats the ulcer. If stress keeps flaring your stomach, has you living on painkillers or drinking to unwind, or is costing you sleep, or if worry about your stomach has taken over your days, talking to a therapist helps. Therapists who work with sleep and physical symptoms are on Mytherapist.ng, by video, voice or chat, and they work alongside your doctor, never instead of one.
If stress has brought thoughts of harming yourself or ending your life, call 112 now, or 767 in Lagos, or Safe Place Nigeria on 0800 800 2000, free and answered 24 hours a day. The full list is on our helplines page.
Frequently asked questions
Can stress cause ulcer?
Not on its own. The main causes are H. pylori infection and regular use of anti-inflammatory painkillers such as ibuprofen and diclofenac. Stress can make ulcer symptoms worse, and it can cause indigestion and stomach pain that feel similar, so see a doctor to find out which you have.
Can skipping meals cause ulcer?
There’s no good evidence that it does. Ulcer pain can be worse on an empty stomach, which is why people connect the two, but the NIH says diet doesn’t play an important role in causing ulcers. Regular, smaller meals can still make an ulcer or an anxious stomach more comfortable.
Does pepper cause ulcer?
No. Spicy food can trigger symptoms in someone who already has an ulcer or indigestion, but it doesn’t cause ulcers.
Can anxiety cause ulcer symptoms?
Anxiety can cause burning, cramps, nausea and indigestion that feel like an ulcer, and it can make a real ulcer hurt more. It doesn’t create the ulcer. A doctor can tell the difference with tests.
How do I know if I have ulcer?
Only tests can tell. A doctor may check for H. pylori with a breath, stool or blood test, and a camera test (gastroscopy) can confirm an ulcer. Get emergency help for vomiting blood, black or bloody stool, or sudden severe stomach pain: call 112, or 767 in Lagos.
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This article is awaiting clinical review. It’s based on published research and health guidelines, and we’ll update it once a clinician has reviewed it.
