Dr Ganesh Ramalingam: How do I differentiate gastric pain from a stomach ulcer?

Many stomach conditions often share the same symptoms — a dull or gnawing, burning pain in the upper part of the belly, nausea, heartburn and so on. More often than not, we’re inclined to link our abdominal pain with stomach flu or gastric pain, partly because our population is used to having recurring gastric pain attacks. That and no one would actually suspect they have a stomach ulcer — at least for the majority of my patients when I give them a diagnosis. 

However, it’s crucial to monitor how often you get gastric pain or gastritis as persistent abdominal pain can be a sign of serious underlying issues like a stomach ulcer. What should you look out for, and how are stomach ulcers diagnosed? Let’s find out. 

Gastric pain and stomach ulcer: What’s the difference? 

Gastric pain is a term used to describe pain in the middle of the upper abdomen. Often, this pain arises from an irritation and inflammation of the stomach lining. Patients with severe gastritis can get shallow sores in their stomach lining known as erosions. A stomach ulcer is a deeper and open sore which occurs in the stomach lining and the first part of the small intestine. You can get a duodenal ulcer, gastric ulcer or peptic ulcer. 

Both carry similar symptoms, which include: 

  • Dull or burning stomach pain in the upper portion of the stomach 
  • Heartburn 
  • Loss of appetite 
  • Excessive gas and frequent burping 
  • A feeling of bloating  
  • Nausea that may come with or without vomiting 
  • Weight loss 
  • Changes in bowel movement 

The most common characteristic of a stomach ulcer however is a dull pain around your breastbone and belly which occurs around meal times and wakes you up at night. What you also want to especially look out for are bloody or tarry stools or blood in vomit. If you experience these, please see a doctor immediately as regular gastric pain should not come with those symptoms.

Gastric Pain or Stomach Ulcers?

Are the causes and risk factors for gastric pain and stomach ulcers the same? 

Pretty much, yes. Both conditions carry similar causes and risk factors which include:

Long term use of NSAIDSs (non-steroidal anti-inflammatory drugs) 

NSAIDS are over-the-counter pain and fever medications such as ibuprofen, aspirin and naproxen. While they are remarkably helpful in reducing pain and safe to take for a short period of time, they should not be taken for long as prolonged use can damage the mucus that protects your stomach lining, causing stomach ulcers and heartburn. In general, I’d advise not to use NSAIDs continuously for more than three days for fever and 10 days for pain — unless your doctor gives the go ahead. 

Helicobacter pylori infection 

Most stomach ulcers are caused by a bacteria called H. pylori. This bacteria corrodes the mucus that protects your stomach lining and the first part of your duodenum, eventually causing stomach acid to get through the lining. 

Tobacco and alcohol use 

As I’ve mentioned several times, smoking and alcohol cause your stomach to secrete more acid than usual and contribute to gastric pain and the formation of stomach ulcers.

How are stomach ulcers diagnosed? 

Diagnosing abdominal pain can be tricky, and we don’t want to assume that all cases of gastric pain are linked to stomach ulcers. 

Apart from conducting a basic physical examination to determine the region of the pain, I may first recommend imaging tests such as an ultrasound or CT scan to identify the presence of any tumours in the organs. I may also ask that you do a colonoscopy to check for abnormalities within the colon and large intestine or gastroscopy to detect inflammation and irregularities in the oesophagus and stomach. 

To check for the H. pylori infection, I may have to collect your blood and stool samples and have you do a urea breath test. 

How are stomach ulcers and gastric pain treated?

First, it is essential that you make basic lifestyle changes which include: 

  • Avoiding food makes your symptoms worse. For some, this could be spicy and/or sour food. I recommend keeping a food diary and tracking your triggers.
  • Quitting smoking. If you have a stomach ulcer, smoking can prevent the ulcer from healing.
  • Consuming alcohol and caffeine in moderation
  • Avoiding NSAIDs

Medications like proton pump inhibitors, antacids and H2 blockers are often used in the treatment of gastric pain and stomach ulcers. If your tests come back positive for the H. pylori bacteria, you’ll be put on a series of antibiotics to kill the infection. 

In severe cases, surgery may be required — but that usually only happens if the patient delays treatment. Remember: many conditions can be prevented as long as you adopt healthy living habits and go for regular testing. 


  1. Schmocker, R. K., & Lidor, A. O. (2017). Management of Non-neoplastic Gastric Lesions. The Surgical clinics of North America, 97(2), 387–403. https://doi.org/10.1016/j.suc.2016.11.011 
  2. Cole, E., Lynch, A., & Cugnoni, H. (2006). Assessment of the patient with acute abdominal pain. Nursing standard (Royal College of Nursing (Great Britain) : 1987), 20(39), 67–75.