Skip to main contentLast updated: 27-Oct-2026
Dr Harsh Shah
MS, MCh (Surgical Gastroenterology), DrNB (Surgical Gastroenterology)
Registered with Gujarat Medical Council, Reg. No. G-38738
Gastro & Cancer Surgeon
Apollo Hospital, Bhat, Gandhinagar · Gota OPD, Ahmedabad · 18 years of experience
★★★★★ Google: 4.89 from 216 reviews (Gota clinic) · 4.94 from 18 reviews (Apollo, Bhat)
In short
A stubborn ulcer is rarely a mystery. Most often the acid tablet is not working as planned. Or the germ is still there. Or a pain tablet is still being taken.
A stomach ulcer that will not close needs a fresh biopsy. This is how a growth hiding behind an ulcer is ruled out.
Too much acid from a rare gland tumour is checked last, with a blood test taken off the acid tablet. Surgery for a plain ulcer is now a last resort.
The full care plan for ulcers is on the peptic ulcer treatment in Ahmedabad page. This post is for the person whose ulcer did not follow the usual script. It lists what to check, in the order a surgeon checks it.
These are two different problems with different causes. Naming the right one saves months of guessing.
| Term | What it means | What it usually points to |
|---|---|---|
| Ulcer that will not heal | Still open on a repeat scope after about two months of proper treatment | Weak acid control, germ still present, hidden pain tablets, or a growth |
| Ulcer that comes back | It healed on a scope, then a new one formed | Reinfection with the germ, a returning pain tablet, or a rare acid disorder |
| Ulcer after an operation | Ulcer next to a join between stomach and bowel | Acid reaching bowel that is not built for it, smoking, or a missed acid disorder |
| Ulcer with no known cause | No germ, no pain tablet, nothing else found | A long-term condition that needs steady acid control |
Symptoms alone cannot tell you which one you have. Burning can continue after the ulcer has healed. A healed ulcer can also bleed without burning at all.
A repeat scope is the only way to know. Many people are labelled as having a stubborn ulcer by their symptoms, when the scope shows a healed lining.
How an ulcer is told apart from other causes of stomach pain is in stomach pain: is it an ulcer.
Four common and fixable causes explain most stubborn ulcers. They come before any rare disease, because common things are common.
Most “stubborn” ulcers close once one of these is fixed. The pain tablet trap is explained in painkillers and stomach ulcers.
An acid tablet makes the germ harder to find. A breath or stool test done while you are on it can say “negative” when the germ is still there.
The medicines, and how the germ is proved gone, are in found H. pylori: the 14-day medicines, step by step. Why the germ is so common here is in H. pylori is common in India.
Some ulcers are driven by a rare tumour of the gland cells that makes a hormone called gastrin. It floods the stomach with acid. It is uncommon, but it must not be missed.
| Clue | Why it matters |
|---|---|
| Several ulcers at once, or ulcers beyond the first part of the small bowel | Ordinary ulcers sit in one or two usual places |
| Watery diarrhoea that improves on the acid tablet | Excess acid damages the bowel |
| Ulcers that return even after the germ and pain tablets are dealt with | The usual causes have been removed |
| Thick folds in the stomach on the scope | Excess acid stimulates the lining |
| High calcium, kidney stones, or a family history of gland tumours | The tumour can be part of an inherited pattern |
The first test is a blood level of gastrin. It is only meaningful when taken after the acid tablet has been stopped under your doctor’s guidance. An acid tablet pushes gastrin up and gives a false alarm. Never stop it on your own.
A small group of people have no germ and take no pain tablet, yet they get ulcers. This is a real condition. It is treated as a long-term one.
Very large ulcers are a special case. A large stomach ulcer has a higher chance of hiding a growth. A large duodenal ulcer is more likely to bleed or burst. Both need close follow-up.
An ulcer next to the join between the stomach and the bowel is called a marginal ulcer. It needs a blood test for gastrin, not just a bigger acid tablet.
An ulcer scar can also narrow the stomach exit and cause repeated vomiting. That problem is covered in vomiting undigested food: when the stomach exit is blocked.
Surgery for an ulcer that does not heal is now rare. It is considered only after every cause above has been checked and fixed, and the ulcer is still there.
The choice balances the chance of relapse against the side effects of a bigger operation. An acid-making tumour is always ruled out first, because the operation for it is quite different. What happens after a bleed or a hole is in what happens after an ulcer bleed or hole.
Good records shorten the search. The next doctor should not have to start again from the beginning.
Yes. The germ can return, and a pain tablet can start the ulcer again. Staying off pain tablets and testing after treatment lowers that chance.
For a stomach ulcer, usually yes. Feeling better does not prove the ulcer has closed, and a repeat scope with biopsy rules out a growth.
Not always. Many people can stop. Some need to continue, such as those who need a pain tablet or aspirin, or who had a bleed. Your doctor decides.
An acid tablet gives a false result on the germ test and the gastrin test. Stop it only as your doctor directs, with cover for the gap.
Sometimes, which is why it is biopsied again and scoped until it heals. Most stubborn ulcers are benign, and the biopsy is how we know.
Seldom. Almost all heal once the cause is found and fixed. Surgery is a last step after every cause has been checked.
The full range of care is on the peptic ulcer treatment page. For questions before you travel, call +91-63555-64601.
Shah’s Gastro, Cancer & Robotic Surgery Centre, Gota, Ahmedabad
Consultation, review of endoscopy, biopsy and scan reports, second opinions and follow-up.
Apollo Hospital, Bhat, Gandhinagar
Apollo Hospital International Limited, GIDC Bhat Industrial Estate, Bhat, Gandhinagar. Endoscopy and biopsy, CT scans, surgery for stomach and duodenal disorders, and inpatient care.
An ulcer that does not heal, or returns after it healed, almost always has a reason that can be found. Have you taken acid tablets for months and still feel the burning? Send us your scope report and your tablet list. We look at both with you and plan the next step after examination. Call +91-63555-64601 Send your scope report before the visit
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