Hi, thanks for posting your concern in the HCM. In case of gastric ulcer disease, the precipitating cause should be identified. Gastric ulcer occurs due to numerous reasons. Drugs (e.g. NSAID with or without corticosteroids), H. pylori infection, lifestyle factors including smoking, hypersecretary states (e.g. antral G cell hyperplasia, mastocytosis, leukemia, cystic fibrosis, hyperparathyroidism etc.), stress, liver disease, autoimmune diseases, some infections are the important causes. In case of long-standing ulcer, refractory to treatment H. pylori infection should be ruled out first. If there is no evidence of offending medication use or any other precipitating factor or disease, treatment against H. pylori infection is started and patient is asked to avoid stress, smoking, alcohol and NSAID. The recommended primary therapy to fight against H pylori infection is proton pump inhibitor–based triple therapy. Only PPI (e.g. omeprazole) may not be able to heal the ulcer. Cytoprotective agents like misoprostol or sucralfate may be added in case of non-healing ulcer. A repeat endoscopic visualization is needed after 6-8 weeks to check the healing status. For any further query please write back to us. Regards. Dr. Kaushik