That nasty burning sensation in your stomach could be many things, but 2 common causes are peptic ulcers and gastroesophageal reflux disease (GERD). Though the symptoms may be different, the conditions are often confused. “Sometimes it’s challenging to figure out what’s going on,” says Ruth Brocato, MD, a family medicine specialist at Mercy Medical Center in Baltimore. “There are so many conditions that can cause abdominal symptoms.”

As you wait to see your doctor about your bellyache, here’s what you should know about the 2 conditions. (The Optum Perks mobile app can save you money on prescription medication. Click here to learn more.)

How to recognize an ulcer

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 painful.

Ulcer symptoms

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 1 ulcer develops. And severe cases can be life threatening. Book an appointment with your doctor today if you’re experiencing pain or any of the following:

  • Vomiting blood or dark material that looks like coffee grounds
  • Extreme weakness or dizziness
  • Blood in your 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
  • Losing weight without trying

Different kinds of peptic ulcers

There are 2 main types of peptic ulcers:

  • Gastric ulcers: These happen in your stomach.
  • Duodenal ulcers: These occur in your duodenum, the top part of your small intestine.

Peptic ulcers are very common, and they become more common as you age.

Causes of ulcers

There are many causes, but 2 big ones are certain pain relievers and a kind of bacteria called H. pylori.

  • Pain relievers: Compounds that block your pain can also eat away at your stomach lining, says Kathryn Boling, MD, a family physician in Baltimore. “Watch out especially for NSAIDs (nonsteroidal anti-inflammatory drugs), such as aspirin and ibuprofen,” she says. Those pills may kill your headache, but they can replace it with a nasty bellyache. Naproxen is another common NSAID that can up your risk.
  • H. pylori: This little bug is common, and in most cases, it causes no noticeable harm. But in some people, it can damage the mucus lining that protects your stomach and duodenum. With that coating worn away, stomach acids that usually break down food begin working away at your stomach lining. That can hurt.

Diagnosing an ulcer

First, expect some questions. “I’ll ask the patient about the pain,” says Dr. Brocato. “What does it feel like? When is it happening? And, of course, I’ll want to know about the other medications they’re taking.”

Be ready to answer these questions from your doctor:

  • Where does it hurt? Pain in the middle of your belly, between your belly button and breastbone, is more likely to be an ulcer.
  • What is the pain like? “Sharp, gnawing pain often points to an ulcer,” says Dr. Brocato.
  • When does the pain happen? Pain from ulcers is generally worse when you’re hungry, Dr. Brocato explains. “People with ulcers can feel either better or worse after they’ve had something to eat.”
  • What medications are you taking? “If a patient has been taking a lot of NSAIDs, that’s a good clue that it’s an ulcer,” says Dr. Boling.

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 stool test to check for H. pylori.
  • Endoscopy. The doctor will give you a sedative to make you sleep, and then she or he will insert 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, along with a stool test checking for the presence of blood, can tell your doctor if you might have an ulcer that’s bleeding.

Treating an ulcer

Treatment depends on the cause. “If the ulcer is caused by H. pylori, we prescribe a course of 3 different antibiotics,” says Dr. Boling. “And if we think the cause is too many NSAIDs, just stopping those pain relievers often makes the problem go away.”

Your doctor may also prescribe medication to lower the amount of acid in your stomach while the ulcer heals. Some possibilities:

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How to recognize GERD

GERD is a plumbing problem. It 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. “When you’ve got GERD, acid is coming back up and bathing your esophagus, instead of staying in the stomach where it’s supposed to be,” says Dr. Brocato. “That gives you a sensation of food coming up and irritation in your throat.”

GERD is very common. According to the National Institutes of Health, it affects about 20% of Americans.

GERD symptoms

The most common symptoms of GERD are heartburn and the burning sensation of acid in your mouth. Other symptoms include:

  • Sense of food caught in your throat
  • Chest pain
  • Difficulty swallowing
  • Vomiting
  • Sore throat
  • Hoarseness

Did you know that heartburn could result in ear pain? Click here to learn more about the condition.

Causes of GERD

Milk, spices, fried foods or asthma medication can trigger GERD in some people. Other risk factors include obesity, smoking or pregnancy.

Diagnosing GERD

Just as with peptic ulcers, your doctor will ask you some questions.

  • How often do you experience symptoms?
  • Are there specific foods that set you off?
  • What time of day do you notice problems?
  • Are you having trouble swallowing?
  • Do you have a cough that wakes you up at night or annoys you during the day?
  • Are you eating close to bedtime, then experiencing problems when you lie down?’

Your doctors will likely also examine your throat to see if there’s any inflammation around the esophagus, says Dr. Boling. This is a critical clue that points toward GERD.

Treating GERD

There are several treatment options: over-the-counter (OTC) medications, prescription medications or surgery.

  • OTC: Antacids such as Mylanta® or Tums® can neutralize stomach acids. But watch out for nausea or other side effects. Other OTC options include H2 blockers (such Pepcid AC®), which can decrease acid production, and PPIs (such as Prilosec OTC®), which help your esophagus heal. (Prilosec is also available as a prescription.)
  • Prescription: Your doctor might also prescribe stronger versions of OTC medications. “These tend to be very successful,” says Dr. Boling. Common prescriptions include Prilosec (omeprazole) and Nexium (esomeprazole), both of which might also be used for ulcers. (If you need coupons for these medications, click the drug names.)
  • Surgery: If medications don’t do the job, your doctor may suggest a more serious measure. One common procedure is called fundoplication. It tightens the muscle between your esophagus and stomach and prevents acid from easily traveling back up toward your mouth.

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Additional sources
GERD overview: The Mayo Clinic
Ulcer overview: MedlinePlus