How to tell if an ulcer is getting worse? Know the critical signs

September 27, 2025 •

4 min read

According to Yale Medicine, roughly 70% of people with peptic ulcers have no symptoms. However, for those who do, understanding how to tell if an ulcer is getting worse is critical to preventing serious, life-threatening complications like bleeding and perforation.

Quick Summary

Progressive pain, unexplained weight loss, and signs of internal bleeding like bloody or tarry stools are definitive red flags that a peptic ulcer may be worsening. Urgent medical attention is necessary if these critical symptoms appear.

Key Points

Red Flag Symptoms: Watch for severe, sudden pain, bloody vomit, and black, tarry stools, as these indicate a medical emergency.
Persistent Discomfort: Increased or persistent burning pain that isn't relieved by medication is a sign of a worsening ulcer.
Bleeding Indicators: Signs of internal bleeding include dizziness, weakness, and fatigue, in addition to changes in stool or vomit appearance.
Monitor Weight and Appetite: Unexplained weight loss or feeling full after eating very little can signal a severe ulcer complication, possibly an obstruction.
Seek Medical Attention: Any concerning change in symptoms warrants a consultation with a healthcare provider to prevent serious complications.
Lifestyle Management: Continuing to smoke, drink excessively, or use NSAIDs can make an ulcer worse and delay healing.

The Progression of an Ulcer

A peptic ulcer, an open sore on the lining of the stomach or duodenum, typically progresses through several stages if left untreated. In its early, acute stage, it might present as a mild erosion of the mucosal lining. If the cause is not addressed, it can evolve into a chronic, true ulcer, a deeper disruption of the tissue. The most severe and life-threatening stage occurs when the ulcer erodes into a blood vessel, causing bleeding, or eats a hole completely through the organ wall, a perforation. Recognizing the warning signs of this progression is crucial for timely and effective treatment.

The 5 Key Warning Signs Your Ulcer Is Worsening

Increased or Persistent Pain

Typical ulcer pain is often described as a dull, burning, or gnawing sensation in the upper abdomen, which may come and go. If your ulcer is getting worse, you might experience a significant change in this pain. Look for:

Pain that becomes more severe and constant, not just intermittent.
Discomfort that spreads to your back or chest.
Pain that is no longer relieved by antacids or the remedies that previously helped.
Intense pain that wakes you up at night, or occurs even when you have an empty stomach.

Signs of Gastrointestinal Bleeding

Internal bleeding is one of the most serious complications of a worsening ulcer and requires immediate medical attention. Be vigilant for these tell-tale signs:

Vomiting blood or a substance that looks like coffee grounds. This is a critical red flag indicating significant bleeding in the upper digestive tract.
Bloody or black, tarry stools. Dark, sticky, tar-like stools (melena) are the result of blood being digested in the stomach, while brighter blood in the stool indicates bleeding further down the GI tract.
Dizziness, weakness, and fainting. A rapid drop in red blood cell count (anemia) from blood loss can lead to light-headedness or fainting.

Unexplained Weight Loss and Changes in Appetite

As an ulcer worsens, it can interfere with your ability to eat and digest food normally. This can manifest as:

Feeling full quickly, even after eating very little food.
A significant loss of appetite.
Noticeable weight loss without any change to your diet or exercise routine.

Nausea, Vomiting, and Bloating

While mild nausea and bloating can be common with ulcers, they can become more severe as a condition progresses, especially if an obstruction is developing.

Increased nausea and persistent vomiting can indicate that food is not passing through the digestive tract properly.
Frequent burping or a feeling of abnormal fullness can also signal a potential blockage.

Sudden, Severe Abdominal Pain (Emergency Warning)

This is the most critical warning sign and may signal an ulcer perforation, where a hole has eroded through the stomach wall. This is a life-threatening medical emergency requiring immediate attention. Symptoms include:

The sudden onset of very severe, sharp, and intense abdominal pain.
A rigid, board-like abdomen that is tender to the touch.
Fever, chills, and signs of shock, such as a rapid heart rate.

Understanding Complications: Bleeding, Perforation, and Obstruction

For a comprehensive overview of peptic ulcer disease and its potential complications, consult the resources available from the National Institutes of Health. Source: National Institutes of Health

An ulcer that erodes a blood vessel can cause internal bleeding, which can range from slow, chronic blood loss leading to anemia to a severe, acute hemorrhage. This requires urgent treatment, often through an endoscopic procedure. A perforation is an extremely serious condition where the ulcer creates a hole, allowing stomach contents to leak into the abdominal cavity and cause a dangerous infection called peritonitis. Finally, repeated ulcer healing and scarring can lead to gastric outlet obstruction, which blocks the passage of food and causes severe vomiting and feeling of fullness.

Comparing Typical vs. Worsening Ulcer Symptoms

To help you better differentiate between standard ulcer discomfort and a worsening condition, here is a helpful comparison.


Symptom	Typical Ulcer	Worsening Ulcer
Pain	Dull, burning, or gnawing; intermittent pain relieved by food or antacids.	Severe, constant, or sharp pain that may radiate; not responsive to standard medications.
Nausea/Vomiting	Mild, occasional nausea.	Persistent nausea, frequent vomiting, vomiting of food or blood, or coffee-ground-like vomit.
Stool	Normal appearance, possibly constipation.	Black, sticky, or tarry appearance due to digested blood.
Weight	Stable or minor fluctuations.	Unintentional and progressive weight loss.
Digestion	Bloating, burping, or feeling full.	Feeling full very quickly, inability to finish meals, or severe bloating.
General Well-being	Can feel run-down, but generally stable.	Extreme weakness, dizziness, fainting, or pale skin due to anemia.

When to Seek Help

If you have an ulcer and notice any of the signs listed above, it is imperative to contact a healthcare provider for an evaluation. For symptoms indicating a serious complication—such as signs of bleeding, severe abdominal pain, or symptoms of shock—seek immediate emergency medical care. While many ulcers are curable, timely intervention can prevent a mild issue from becoming a life-threatening emergency.

Frequently Asked Questions

Yes, an ulcer can worsen even with medication if the underlying cause isn't fully treated. For instance, if an H. pylori infection is present, it must be eradicated with a specific course of antibiotics alongside acid-reducing drugs. Simply taking antacids won't heal the ulcer.

Worsening ulcer pain may become more intense, constant, or spread to other areas like the back. Unlike typical ulcer pain that comes and goes, this pain is more persistent and less responsive to standard remedies like antacids.

A perforated ulcer means a hole has formed in the stomach or intestine wall, allowing contents to leak into the abdominal cavity. This can cause a life-threatening infection called peritonitis and requires immediate surgery.

Emergency symptoms often involve sudden, sharp, severe pain that doesn't go away, along with signs of bleeding (bloody vomit, black stools) or shock (dizziness, fainting, rapid heartbeat). Typical symptoms are usually milder and more intermittent.

Unintentional weight loss is a significant warning sign that the ulcer is worsening. It can be caused by pain preventing eating, nausea, or a blockage forming in the digestive tract.

Vomit with a coffee-ground appearance is a serious sign of gastrointestinal bleeding. The dark, grainy texture is a result of stomach acid acting on the blood, and it warrants immediate medical attention.

Factors that can exacerbate an ulcer and hinder healing include smoking, excessive alcohol consumption, and continued use of NSAID pain relievers like ibuprofen. Managing stress can also be beneficial.