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What Causes Stomach Ulcers?

Stomach ulcers are open sores that form on the inner lining of your stomach when that protective lining breaks down. The two leading causes are a bacterial infection called Helicobacter pylori (H. pylori) and the long-term use of certain common pain-relief medicines — and in Kenya, both of these triggers are widespread enough that understanding them could genuinely protect your health.

Understanding What a Stomach Ulcer Actually Is

Your stomach produces acid every day to help digest food — whether that is a plate of ugali and beef stew or a quick mandazi with chai in the morning. To protect itself from that acid, your stomach wall is coated with a thick layer of mucus. A stomach ulcer forms when something damages or thins that mucus layer, allowing acid to eat into the stomach wall itself, creating a painful sore.

According to the World Health Organization (WHO), H. pylori infection affects approximately 44% of the global population, with rates significantly higher in low- and middle-income countries — including Kenya, where poor sanitation and crowded living conditions in urban areas like Nairobi's Eastlands or Mombasa's Old Town make transmission easier.

It is important to know from the start: stress and spicy food alone do not cause ulcers. They can make symptoms feel worse, but they are not the root cause. The causes are more specific — and more treatable — than many people realise.

The Main Causes of Stomach Ulcers

1. H. pylori Bacterial Infection

This is the single biggest cause of stomach ulcers in Kenya and worldwide. H. pylori is a bacterium that burrows into the stomach lining, weakening the mucus layer and triggering inflammation that, over time, leads to ulcers. Most people pick it up in childhood and carry it for years without knowing.

The bacteria spreads through:

• Contaminated water — drinking untreated or poorly treated water, which remains a challenge in many Kenyan counties
• Unwashed hands — particularly important in settings where hand-washing facilities are limited
• Shared utensils or food — a common practice in communal eating settings
• Close contact with an infected person — living in a crowded household increases risk significantly

A KEMRI (Kenya Medical Research Institute) study found H. pylori prevalence rates above 60% in some Kenyan communities, making it one of the most common bacterial infections in the country. Many of those infected will never develop an ulcer, but a significant number will — especially if other risk factors are present.

2. Overuse of Pain-Relief Medicines

The second major cause is frequent use of a class of medicines called NSAIDs (Non-Steroidal Anti-Inflammatory Drugs). These are the everyday pain relievers many Kenyans pick up over the counter at the local duka la dawa for as little as KES 10–30 per tablet to manage headaches, back pain, joint pain, or period cramps.

NSAIDs work by blocking certain chemicals in the body that cause pain and inflammation — but those same chemicals also help protect the stomach lining. Use them occasionally and your stomach usually recovers. Use them regularly, especially on an empty stomach, and the lining begins to erode, sometimes leading to an ulcer.

Risk is higher if you:

• Take these medicines daily for weeks or months
• Swallow them without food or water
• Are over 60 years old
• Already have an H. pylori infection (the combination dramatically raises ulcer risk)
• Drink alcohol alongside them

3. Other Contributing Factors

While H. pylori and NSAIDs are responsible for the vast majority of ulcers, a few other factors can damage the stomach lining or set the stage for an ulcer:

• Alcohol — Heavy, regular drinking irritates and erodes the stomach lining directly
• Smoking — Tobacco use weakens the stomach's natural defences and slows healing of existing ulcers
• Rare acid-overproduction conditions — A rare medical condition called Zollinger-Ellison Syndrome causes the stomach to produce far too much acid, leading to severe ulcers
• Severe physical stress — Major surgery, serious burns, or critical illness can trigger what doctors call "stress ulcers," though these are different from the typical stomach ulcer most people experience

Why Kenyans Are Particularly at Risk

Several everyday realities in Kenya raise the risk of developing a stomach ulcer in ways that are worth naming plainly:

• Irregular eating schedules — Skipping meals because of long matatu commutes or demanding work shifts means more time with an empty, acid-filled stomach
• High reliance on cheap OTC painkillers — Because accessing a doctor is expensive, many Kenyans self-medicate pain with over-the-counter medicines for months at a time
• Water safety — Access to clean, safe water is still inconsistent in parts of Nairobi, the Coast, and rural counties, making H. pylori transmission more likely
• Delayed diagnosis — Ulcer symptoms are often dismissed as "just acidity" or managed with milk and soda, allowing damage to quietly worsen

Recognising That You Might Have an Ulcer

Knowing the causes is useful, but recognising the symptoms is what pushes someone to seek help. The most common signs of a stomach ulcer include:

• A burning or gnawing pain in the upper or middle part of your abdomen — often worse when your stomach is empty, like in the morning before breakfast or late at night
• Pain that temporarily improves after eating or drinking milk, then returns
• Bloating, burping, or feeling full quickly even after a small meal
• Nausea, sometimes with vomiting
• Dark or tar-like stools, or vomiting blood — these are serious warning signs that need emergency care immediately
• Unexplained weight loss or loss of appetite over several weeks

If you have been managing persistent stomach pain with milk, antacids, or soda for more than two weeks without lasting relief, your body may be telling you something more is going on.

What You Can Do Right Now

You cannot undo past exposure to H. pylori or the pain medicines you have already taken, but you can take steps today that protect your stomach going forward:

• Always drink water that has been boiled or properly treated
• Wash your hands with soap before eating and after using the toilet
• Never take pain-relief tablets on an empty stomach — even a small piece of bread first helps
• Avoid or limit alcohol, especially spirits taken on an empty stomach
• If you smoke, reducing or stopping will allow your stomach lining to heal more effectively
• Eat at consistent times — even if it is just a small snack — to avoid long stretches of an empty, acid-filled stomach

Most importantly: get tested. H. pylori is a bacterial infection, which means it can be