GERD vs. an ulcer: How to tell what you have
Many things can cause that painful burning sensation in your stomach after you’ve eaten, but two common causes are peptic ulcers and gastroesophageal reflux disease (GERD).
Though their symptoms may be different, the conditions are often confused. Many conditions can cause stomach symptoms, making it challenging to know exactly what’s happening.
Some key differences between these conditions can help you and a doctor determine what’s affecting you. This can help you seek the treatment that works best for you.
GERD vs. an ulcer
GERD and ulcers can cause a burning, painful sensation in your stomach. You might notice symptoms after you’ve eaten. But both are very different conditions, with different symptoms and treatments. Some key differences include:
- Symptoms: GERD can cause heartburn, regurgitation, and sometimes a sore throat or sour taste in your mouth. Ulcers do not cause these but can cause a feeling of fullness and nausea or vomiting.
- Type of pain: Both can cause stomach pain, but the pain with GERD is more of a burning pain in the upper stomach, while ulcers cause severe, sharp pain that can travel to your back.
- Severity: GERD is often treatable with over-the-counter remedies, while ulcers need medical intervention by a doctor.
- Causes: Certain foods can trigger GERD, while some bacteria or certain medications can cause ulcers.
If you’re experiencing concerning symptoms, you should consider speaking with a doctor. Only a healthcare professional can properly diagnose and treat your condition.
GERD, also known as acid reflux, starts at the bottom of the esophagus, the tube that carries food from your mouth to your stomach. When the valve at the bottom of your esophagus doesn’t close properly, acid backs up and causes a painful burning sensation in your chest and throat.
GERD is very common. According to the National Institutes of Health (NIH), it affects about 20% of adults in the United States.
Some 2018 research suggests that GERD and indigestion (which commonly causes stomach pain) had links in one-third of cases. GERD doesn’t technically cause this type of pain, which mostly occurs in the lower stomach area.
Causes of GERD
The exact cause of GERD is unknown to researchers. Its root cause may have a link with genetics, or a damaged esophagus can cause it. Different risk factors may be causing GERD. These include:
- overweight and obesity
Certain foods and drinks, including spicy or acidic foods and drinks containing alcohol, can trigger GERD.
So, to diagnose GERD, a doctor is likely to take into account your situation and ask you questions about your symptoms, including:
- How often do you experience symptoms?
- Are there specific foods that trigger your GERD?
- What time of day do you notice problems?
- Are you having difficulty swallowing?
- Do you have a cough that wakes you up at night or annoys you during the day?
- Are you eating close to bedtime and then experiencing problems when you lie down?
The doctor will likely also examine your throat to see if there’s any inflammation around the esophagus, which can signal acid reflux.
An ulcer is an open sore in the lining of your stomach or the upper part of your small intestine. It can break through the tissue’s protective layer, letting stomach acids in. That can be very painful.
They are medically known as peptic ulcers.
Peptic ulcers are less common than GERD, with only about 1–6% of people in the US experiencing them, but they become more common as you age.
Some people with peptic ulcers may not have any symptoms, or their symptoms may be very mild. Symptoms tend to worsen as an ulcer grows or if more than one ulcer develops. And severe cases can be life threatening.
Symptoms to look out for include:
- vomiting blood or dark material that looks like coffee grounds
- extreme weakness or dizziness
- blood in stools (your stools may look black or like tar)
- nausea or vomiting that doesn’t get better or gets worse
- a sudden, severe pain that may spread to your back
- feeling full quicker after eating
These symptoms may get better or worse after a meal.
Causes of ulcers
There are many causes, but two of the most common are certain pain relievers and a kind of bacteria called Helicobacter pylori (H. pylori).
- Pain relievers: Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Advil) and naproxen (Aleve) can harm your stomach lining and lead to peptic ulcers.
- H. pylori: This bacteria is common, and in most cases, it causes no noticeable harm. But, it can damage the mucus lining that protects your stomach. With that coating worn away, stomach acids that usually break down food begin affecting your stomach lining, causing ulcers.
Diagnosing an ulcer
Like with GERD, a doctor will ask questions about your symptoms and risk factors. Your answers to these questions may lead to a diagnosis. But often, your doctor will want to follow up with tests. Some of the most common ones include:
- A blood, breath, or rectal test to check for H. pylori.
- An endoscopy, where the doctor gives you a sedative to make you sleep and then inserts a thin tube with a tiny camera on it into your throat. It will enter your digestive tract and let the doctor see the location and size of any ulcers.
- A blood test for anemia and a stool test for checking the presence of blood can help your doctor determine if you have a bleeding ulcer.
Healthcare professionals may treat GERD and peptic ulcers in similar and different ways.
In both cases, certain lifestyle factors can help treat the condition. With GERD, you can consider avoiding foods that trigger GERD, maintaining moderate weight, and quitting smoking (if you smoke). For NSAID-induced ulcers, stopping taking NSAIDs can help treat ulcers.
But often, medications will be necessary. Sometimes, the same antacid medications can treat both GERD and ulcers. These include:
- Proton-pump inhibitors (PPIs): Examples include omeprazole (Prilosec), esomeprazole (Nexium), and pantoprazole (Protonix).
- H2 receptor agonists: Examples include cimetidine (Tagamet), famotidine (Pepcid), and nizatidine (Axid).
For severe cases of peptic ulcers, an endoscopy might be necessary to stop the bleeding. And if the ulcer causes a hole in your stomach or obstruction to your digestive system, you might need surgery.
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Both GERD and ulcers can cause intense stomach pain, which might flare up after a meal. But there are several key differences between the two. They have different causes and some differing symptoms.
The same medications can treat both conditions, but always consider speaking with a doctor before taking any medication. They can give a proper diagnosis and prescribe the treatment accordingly.
Download the free Optum Perks Discount Card to save up to 80% on some prescription medications.
- Antunes C, et al. (2023). Gastroesophageal reflux disease. https://www.ncbi.nlm.nih.gov/books/NBK441938/
- Argyrou A, et al. (2018). Risk factors for gastroesophageal reflux disease and analysis of genetic contributors. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6107529/
- Broderick R, et al. (2020). Clinical presentation of gastroesophageal reflux disease: A prospective study on symptom diversity and modification of questionnaire application. https://karger.com/ddi/article/38/3/188/95673/Clinical-Presentation-of-Gastroesophageal-Reflux
- Definition & facts for peptic ulcers (stomach or duodenal ulcers). (2020). https://www.niddk.nih.gov/health-information/digestive-diseases/peptic-ulcers-stomach-ulcers/definition-facts
- Malik TF, et al. (2023). Peptic ulcer disease. https://www.ncbi.nlm.nih.gov/books/NBK534792/
- Richter JE, et al. (2018). Presentation and epidemiology of gastroesophageal reflux disease. https://europepmc.org/backend/ptpmcrender.fcgi?accid=PMC5797499&blobtype=pdf