How to Tell the Difference Between Acid Reflux and Stomach Ulcers

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Gastroesophageal reflux disease (GERD) and peptic ulcers share similar symptoms, so it's easy to confuse them. But they're two different conditions with different causes. And GERD is much more common than peptic ulcers. So before you convince yourself that the feeling of acid in your chest or indigestion is an ulcer, let's take a closer look.

Here we'll explain the difference between these two conditions, how to tell them apart by their symptoms, and how they're sometimes connected.

What's the difference between GERD and ulcers?

When you have GERD, it means the acid from your stomach travels up into your esophagus - the tube that carries the food or liquid you swallow into your stomach. Normally, a rubber band-like muscle keeps the stomach contents from flowing backward. But if this muscular band loosens, or the pressure in the stomach is too high, stomach contents can enter the esophagus. This can damage the esophagus because it can't handle acid as well as the stomach. It can also cause uncomfortable symptoms like heartburn and cough.

Peptic ulcers are quite different. They are open sores that form in the lining of the stomach or the first part of the small intestine (called the duodenum). Like GERD, high amounts of stomach acid can cause peptic ulcers to form.

GERD and peptic ulcers can cause some similar symptoms. But there are also two important differences:

• GERD affects mainly the esophagus, while ulcers are usually an issue in the stomach or intestine.

• GERD irritates the tissue lining, while ulcers wear away the tissue lining. It may help to think about it like sand on the beach. GERD is like the ocean waves that turn dry sand into wet sand. Ulcers are like beach erosion that happens over time.

Below we outline the similarities and differences between GERD and peptic ulcers.

GERD vs. peptic ulcer

Why is the difference important?

In many cases, the treatment for both GERD and ulcers uses the same medication: a course of proton pump inhibitors (PPIs), an acid-blocking medication.

But sometimes an ulcer needs additional medications. This is because the cause of many ulcers is a bacterial infection from Helicobacter pylori (H. pylori). And this infection requires treatment with multiple medications, including antibiotics. So knowing the exact cause of your symptoms can change the treatment.

Another important reason to differentiate ulcers from GERD is that each condition can lead to different complications. For example, long-standing GERD can cause Barrett's esophagus, a condition where there's damage to the lining in the lower part of the esophagus. And it's a risk factor for esophageal cancer.

Ulcers don't increase your risk of esophageal cancer. But they do increase your risk of:

• Bleeding from the digestive tract

• Developing a hole in the stomach or intestine, which is a medical emergency

• Having certain types of stomach cancers

So it's helpful to know if the cause of your symptoms is an ulcer or GERD. That way you can also understand the potential complications.

GERD vs. ulcer symptoms

It's possible for you to have GERD or ulcers - or even both - without experiencing any symptoms. If you do have symptoms, GERD and ulcers can share some similar ones, including:

• Upper abdominal pain that people often describe as "burning"

• Nausea and/or vomiting

• Decreased appetite

• Symptoms that get worse with certain types of foods, such as spicy food, acidic food, chocolate, or peppermint

• Symptoms that get worse with certain medications, like aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs)

• Symptoms that get better with antacids or acid-blocking medications

Even though there's overlap between GERD and ulcer symptoms, there are some important differences. One common symptom of GERD is burning pain that rises up into the chest, which people often describe as "heartburn." It may get worse after a large meal or if you lie down right after eating. This doesn't happen with peptic ulcers alone. GERD can also cause trouble swallowing and a cough, which isn't typical of peptic ulcers.

What does ulcer pain feel like compared with GERD?

Ulcer pain is usually located in the upper abdomen, rather than in the chest. And you may notice it on an empty stomach or a few hours after a meal. This is less likely with GERD, which tends to happen quickly after eating. In fact, sometimes people notice that their pain from an ulcer gets better when they eat something.

Another important difference in symptoms is that peptic ulcers can bleed. This can cause many different symptoms:

• Bloody vomit, or vomit that appears to have coffee grounds in it

• Dark, tar-like stool

• Fatigue, shortness of breath, or weakness from anemia (low blood count)

Causes of stomach ulcers vs. GERD

GERD happens when stomach acid makes its way into the esophagus. There are barriers between the stomach and esophagus that normally block the backflow of acid. Some of these barriers include:

• A flap-like valve at the bottom of the esophagus (gastroesophageal flap valve)

• A band of muscle between the esophagus and stomach (gastroesophageal sphincter)

• A flat muscle that separates the chest and abdomen (diaphragm)

• Gravity

Any factor that disrupts these barriers can allow reflux to happen. These include:

• Lifestyle habits like lying down after large meals

• Having a heavier body weight

• Eating certain foods (chocolate, fatty foods, caffeine)

• Drinking alcohol

• Smoking

• Hiatal hernia

Stomach ulcers happen when the protective barrier of the stomach is damaged. This barrier lining is made of mucus and bicarbonate, which helps to protect it. If disrupted, stomach acid can then cause ulcers in the lining of the stomach.

The most common causes of stomach ulcers are:

• Taking NSAIDs like ibuprofen and naproxen

• H. pylori infection

There are many other causes of peptic ulcer disease, but they are uncommon. These include:

• Intensive care unit (ICU) hospital stay

• Corticosteroids like prednisone

• Zollinger-Ellison syndrome

• Cirrhosis

• Crohn's disease

Can GERD cause stomach ulcers?

GERD doesn't cause peptic ulcers, or vice versa. Ulcers develop when there's too much acid in the stomach. GERD develops when the acid is in the wrong place.

While these conditions can't directly lead to the other, it helps to remember that some of the causes and risk factors overlap. For example, long-term NSAID use can increase the risk of both conditions. And many people associate their symptoms with stress.

It's possible that some people may have ulcers and GERD at the same time. But GERD is much more common than ulcers, so most people with GERD will not have ulcers.

Frequently asked questions

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