How Are Stomach Ulcers Treated Today?

Modern ulcer care starts by identifying the cause: H. pylori infection or anti-inflammatory drugs.

Find the cause. Finish the treatment. Prevent the comeback.

The treatment of gastroduodenal ulcers has changed radically, moving from a simple reduction of stomach acidity to a targeted therapeutic strategy. The new Japanese guidelines of 2026 stress the importance of identifying the precise causes, notably Helicobacter pylori infection or the use of anti-inflammatory drugs, in order to prevent recurrences. This article explains these changes in simple terms.

1. What Is a Gastroduodenal Ulcer?

A gastroduodenal ulcer, also called a peptic ulcer, is an open sore in the lining of the stomach or of the first part of the small intestine (the duodenum). Typical signs include burning pain in the upper abdomen, bloating, or nausea. Some ulcers cause few symptoms until a complication, such as bleeding, appears.

2. From Acid Reduction to Targeted Treatment

For many years, treatment focused mainly on lowering stomach acid so that the sore could heal. This remains useful, but it is no longer enough on its own. If the underlying cause is left untreated, the ulcer is likely to come back.

Today, the strategy is to find out why the ulcer appeared and to treat that cause directly. This is the main shift described in the 2026 guidelines of the Japanese Society of Gastroenterology.

3. The Two Main Causes to Identify

Helicobacter pylori infection: a bacterium that lives in the stomach lining and is a major cause of ulcers.
Anti-inflammatory drugs: nonsteroidal anti-inflammatory drugs (NSAIDs) and low-dose aspirin can damage the stomach lining.

Some ulcers have neither cause. Finding the right one guides the treatment and helps prevent recurrences.

4. A Personalized Approach to H. pylori

The fight against H. pylori now requires a personalized approach in the face of growing antibiotic resistance. A treatment that worked well in the past may be less effective today, depending on local resistance and on a person's earlier antibiotic use. Your doctor chooses the regimen with these factors in mind.

5. Vonoprazan: A More Powerful Acid Blocker

The use of vonoprazan, a more powerful acid inhibitor, is becoming a leading option. Stronger acid suppression helps antibiotics work better against the bacterium. Vonoprazan is also suggested after endoscopic treatment of bleeding ulcers, according to the 2026 Japanese guidelines.

Availability and approved uses vary from country to country, so ask your doctor what is appropriate where you live.

6. Duration Matters More Than Higher Doses

Research confirms that strictly completing the full length of treatment matters more than increasing the doses. In practice:

Take every dose, at the times prescribed.
Do not stop early because you feel better.
Do not change doses on your own.
Tell your doctor about side effects rather than stopping the treatment.

7. Feeling Better Does Not Always Mean the Bacteria Are Gone

Symptom improvement does not always mean the bacterium has been definitively eliminated. Pain can fade while some bacteria remain. This is why doctors usually recommend a follow-up test after treatment, such as a breath test or a stool test, to confirm that the infection has cleared. Guidelines generally advise waiting at least four weeks after treatment before testing.

8. Preventing Recurrences

Treat H. pylori when it is found, and confirm that it is gone.
Review your use of anti-inflammatory drugs with your doctor, and never stop a prescribed aspirin without medical advice.
Avoid smoking, which can slow healing and raise the risk of recurrence.
Limit alcohol.
Keep your follow-up appointments.

9. When to See a Doctor Quickly

Seek urgent medical care for black or bloody stools, vomiting blood, sudden severe abdominal pain, dizziness or fainting. These can be signs of a bleeding or perforated ulcer.

Ulcer care has moved from simply reducing acidity to a targeted strategy: identify the cause, treat H. pylori with a personalized regimen, use powerful acid inhibitors such as vonoprazan where appropriate, complete the full treatment, and confirm that the bacterium is gone. Following this approach is the best way to heal an ulcer and keep it from coming back.

ZenHealth