Table of Contents
Introduction
Semaglutide is a prescription medication used to help manage type 2 diabetes and obesity. It works by copying the action of a natural hormone in the body called glucagon-like peptide-1, or GLP-1. This hormone helps control blood sugar levels by making the body produce more insulin when needed, reducing the amount of sugar made by the liver, and slowing down how fast the stomach empties. Because of these effects, semaglutide not only lowers blood sugar but also helps with weight loss. It is available under brand names such as Ozempic, Wegovy, and Rybelsus, and is usually taken by injection or tablet once a week or daily, depending on the form.
Although semaglutide is widely used and has many benefits, it can cause side effects, especially in the digestive system. Common side effects include nausea, vomiting, diarrhea, and constipation. These effects usually happen when the treatment first begins and may become less severe over time. However, some patients may experience ongoing problems. As semaglutide becomes more popular, questions have come up about whether it might also cause ulcers in the stomach or small intestine.
An ulcer is a sore or break in the lining of the stomach or the upper part of the small intestine, called the duodenum. These sores can be painful and, if not treated, may lead to more serious problems. Ulcers are usually caused by an infection with a type of bacteria called Helicobacter pylori (H. pylori) or by long-term use of medications like aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs). But some new reports and questions from both patients and doctors suggest that semaglutide could also be linked to ulcer development in some cases.
The purpose of this article is to look closely at the possible connection between semaglutide and ulcers. It explains how the drug works, what symptoms to watch for, and what current research says about its risks. The article also discusses how common ulcers may be among people who take semaglutide, what factors might increase the chance of getting an ulcer, and how healthcare providers diagnose and prevent them. It provides clear and simple answers to the most common questions people search for online when they are worried about this issue.
Understanding the possible link between semaglutide and ulcers is important for anyone using the medication or considering starting it. While semaglutide has helped many people improve their blood sugar and lose weight, safety is always a priority. People need to know what to expect and when to talk to a doctor about symptoms. With better information, patients and healthcare providers can make more informed choices about treatment.
The article does not include personal stories or opinions, and it does not suggest other medications as replacements for semaglutide. Instead, the focus stays on facts, medical evidence, and clear explanations. The information comes from drug studies, medical reports, and trusted sources in healthcare. This helps to provide a full picture of what is currently known and what is still being studied.
By the end of the article, readers will have a stronger understanding of how semaglutide might affect the stomach and intestines, what warning signs to look out for, and what steps can be taken to reduce risk. The goal is to give helpful, easy-to-read medical information that supports safe use of semaglutide and encourages early action if problems arise.
What Is Semaglutide and How Does It Affect the Digestive System?
Semaglutide is a medication used to treat type 2 diabetes and obesity. It belongs to a group of drugs called GLP-1 receptor agonists. These drugs work by mimicking a natural hormone in the body called glucagon-like peptide-1 (GLP-1). This hormone plays a key role in controlling blood sugar levels and appetite. Understanding how semaglutide works helps explain why it can affect the digestive system and why some people may develop stomach problems.
How Semaglutide Works in the Body
GLP-1 is a hormone made in the gut after eating. It tells the body to release insulin, which helps lower blood sugar levels. It also slows down the movement of food from the stomach into the small intestine. This is called delayed gastric emptying. When food stays in the stomach longer, people feel full for a longer time. This is one reason why semaglutide helps people lose weight.
Semaglutide is a lab-made version of GLP-1. It lasts much longer in the body than the natural hormone. It is usually given as a once-weekly injection. There are also oral tablets available in some cases. The drug helps lower blood sugar and reduce appetite, which is why it is approved for people with type 2 diabetes and for those who are overweight or obese.
Effects on the Digestive System
Since semaglutide slows down how quickly the stomach empties food, it can lead to changes in the digestive process. This effect is helpful for controlling appetite and blood sugar, but it can also cause side effects in the stomach and intestines.
The most common digestive side effects of semaglutide include:
- Nausea
- Vomiting
- Bloating
- Diarrhea
- Constipation
- Stomach pain
These side effects are usually mild to moderate and often improve over time. However, for some people, the symptoms may continue or become more severe. Doctors usually start patients on a low dose and slowly increase it to help the body adjust.
Semaglutide and Stomach Irritation
While semaglutide is mostly well-tolerated, there have been reports of stomach irritation in some users. This includes symptoms like heartburn, acid reflux, and stomach discomfort. These problems may be due to food staying in the stomach too long, which increases acid exposure and pressure.
In rare cases, some people may develop more serious stomach issues, including gastritis (inflammation of the stomach lining) or even ulcers. An ulcer is a sore that forms in the lining of the stomach or the first part of the small intestine (called the duodenum). It can cause burning pain, especially when the stomach is empty. These complications are not common, but they can happen in certain people, especially those with other risk factors.
Connection to Ulcers
Researchers are still studying the link between semaglutide and ulcer formation. There is no strong evidence yet to show that semaglutide directly causes ulcers in most people. However, its effect on delaying stomach emptying, combined with increased stomach acid in some cases, could make the stomach lining more sensitive.
People with a history of stomach problems or those who take other medicines that irritate the stomach—such as nonsteroidal anti-inflammatory drugs (NSAIDs)—may be more at risk.
Role of the Gut-Brain Axis
Another important part of semaglutide’s effect is how it works with the gut-brain axis. This is the system where the stomach and brain communicate with each other. GLP-1 sends signals to the brain that help control hunger. At the same time, the brain can influence digestion. This communication system is one reason why semaglutide reduces appetite and helps with weight loss, but it also plays a role in the digestive symptoms that some people experience.
Semaglutide is a powerful medication that helps manage blood sugar and weight by working like a natural hormone in the body. It slows down digestion, reduces appetite, and helps control blood sugar. However, these same actions can lead to digestive side effects such as nausea, vomiting, and in some rare cases, stomach irritation or ulcers. Understanding how semaglutide works in the digestive system is an important step toward recognizing and managing these effects.
Can Semaglutide Cause Stomach or Peptic Ulcers?
Semaglutide is a medicine that helps manage blood sugar and body weight. It belongs to a group of drugs called GLP-1 receptor agonists. These drugs work by copying the action of a natural hormone called glucagon-like peptide-1. This hormone helps the body release insulin and lowers blood sugar levels. Semaglutide also slows down how fast food moves through the stomach. Because of these effects, some people may experience digestive side effects like nausea, vomiting, or stomach discomfort.
A question that is becoming more common is whether semaglutide can cause stomach or peptic ulcers. While ulcers are not listed as the most frequent side effect, some reports and medical concerns suggest that there may be a possible connection. It is important to look at what peptic ulcers are, how they form, and whether semaglutide plays a role.
What Are Peptic Ulcers?
Peptic ulcers are open sores that form on the lining of the stomach, the upper part of the small intestine (duodenum), or the lower esophagus. There are two main types of peptic ulcers:
- Gastric ulcers – found in the stomach lining.
- Duodenal ulcers – found in the first part of the small intestine.
These ulcers happen when the protective lining of the stomach or intestine breaks down. This lining is supposed to protect the tissue from stomach acid. When the balance between acid and protection is off, acid can damage the tissue and cause an ulcer.
What Causes Peptic Ulcers?
The most common causes of peptic ulcers include:
- Infection with Helicobacter pylori (H. pylori) bacteria.
- Long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or aspirin.
- Smoking and heavy alcohol use.
- Physical stress or certain illnesses.
- Rare conditions like Zollinger-Ellison syndrome, which causes high stomach acid.
Some medications, especially those that affect the stomach, may increase the risk of ulcers when combined with other risk factors. Researchers and doctors have started to explore whether semaglutide may contribute to this risk in certain cases.
How Could Semaglutide Be Linked to Ulcers?
Semaglutide slows down how fast the stomach empties. This action helps people feel full longer and can aid in weight loss. However, delayed stomach emptying may also increase pressure in the stomach and lead to discomfort. In theory, if the stomach holds food and acid for a longer time, the lining may be exposed to acid longer than usual. This could make it more likely for an ulcer to form, especially in people who already have a sensitive stomach or a history of ulcers.
Another possible way semaglutide could play a role is through nausea and vomiting. Repeated vomiting can irritate the stomach lining and cause damage over time. If the stomach lining becomes weak or inflamed, it may be more likely to develop ulcers.
Semaglutide may also reduce the secretion of acid-neutralizing substances in the stomach by slowing down the digestive process. This might lower the stomach’s ability to protect itself from acid damage, particularly when other risk factors are present.
What Do Drug Labels and Authorities Say?
The United States Food and Drug Administration (FDA) and the European Medicines Agency (EMA) list several gastrointestinal side effects of semaglutide. These include:
- Nausea
- Vomiting
- Diarrhea
- Abdominal pain
- Constipation
Stomach ulcers are not listed as a common side effect in the main clinical trials. However, the drug’s label does mention rare but serious problems, such as inflammation of the pancreas (pancreatitis) and possible stomach problems that may need medical attention. While ulcers are not highlighted in most official sources, some post-marketing reports and case studies have raised questions.
The makers of semaglutide recommend that doctors monitor patients for signs of serious digestive issues. If a person has a history of ulcers, stomach inflammation, or digestive bleeding, the healthcare provider should carefully consider the risks and benefits.
Is There a Definite Link?
Right now, there is no clear proof that semaglutide directly causes stomach or peptic ulcers in most people. The available evidence suggests that ulcers are rare in people using this medicine. But research is still ongoing. Some individuals may be more sensitive than others, especially if they already have digestive problems or are using other medicines that affect the stomach lining.
Doctors and researchers are continuing to study how semaglutide affects the digestive system over long periods of use. For now, it is important to watch for signs of ulcers, especially in patients who already have a higher risk.
While semaglutide may not directly cause ulcers in most cases, it can affect how the stomach works. These changes could lead to a higher chance of ulcers in certain people, especially if other risk factors are also present.
What Are the Symptoms of Ulcers Potentially Linked to Semaglutide Use?
Semaglutide is a medicine used to manage type 2 diabetes and help with weight loss. It works by copying a natural hormone called GLP-1 that affects how the body handles blood sugar and hunger. Like many medicines, semaglutide can cause side effects. Some of these side effects are related to the stomach and digestive system. A less common but serious concern is the development of stomach or peptic ulcers.
Ulcers are open sores that can form in the lining of the stomach, the upper part of the small intestine (duodenum), or the lower esophagus. When semaglutide slows down the emptying of the stomach, it can lead to changes in the stomach’s environment. These changes might raise the risk of ulcers in certain people. Recognizing the symptoms of ulcers early is important so that treatment can begin before the condition becomes worse.
Common Symptoms of Ulcers
Ulcers usually cause a group of symptoms related to pain and discomfort in the stomach area. The most common symptom is burning stomach pain. This pain often occurs between meals or at night when the stomach is empty. The pain may feel like a sharp, gnawing, or aching sensation and is usually located in the upper middle part of the abdomen. Eating food or taking antacids might reduce the pain for a short time, but the pain often comes back.
Another common symptom is bloating. This is when the stomach feels full or swollen, even if a person has not eaten much. Some people also experience belching or burping more than usual.
Nausea and vomiting can also be signs of an ulcer. These symptoms are also known side effects of semaglutide itself. This can make it hard to tell whether they are caused by the medicine alone or by an ulcer that is starting to form. Vomiting that contains blood or material that looks like coffee grounds is a warning sign of a more serious ulcer.
People with ulcers may notice a loss of appetite or feel full quickly after eating a small amount of food. As a result, some may unintentionally lose weight. This can be especially hard to notice in people taking semaglutide for weight loss, where appetite reduction is expected.
Heartburn or a burning feeling in the chest and throat can also happen, especially if the ulcer is near the esophagus or if stomach acid is backing up into the esophagus.
In more serious cases, ulcers can lead to bleeding. This may cause black, tarry stools or visible blood in the stool. These symptoms suggest that the ulcer is bleeding and needs urgent medical attention.
Overlapping Symptoms with Semaglutide Side Effects
Semaglutide is known to cause nausea, vomiting, constipation, and stomach discomfort, especially when a person first starts the medicine or increases the dose. These side effects usually get better over time as the body adjusts. However, some of these symptoms are also signs of a possible ulcer.
This overlap can make it harder to figure out whether someone has an ulcer or is just experiencing common side effects of semaglutide. For example, stomach pain and nausea may be dismissed as expected reactions to the drug. But if these symptoms are severe, do not go away, or start after someone has already been using the medicine for a while, they may be signs of something more serious, such as an ulcer.
When to Seek Medical Attention
It is important to watch for warning signs that may suggest a more serious problem like an ulcer. These include:
- Ongoing or worsening stomach pain
- Vomiting with blood or material that looks like coffee grounds
- Black or tarry stools
- Sudden drop in blood pressure or feeling faint (may indicate internal bleeding)
- Unexplained weight loss
- A hard or tender stomach when touched
If any of these symptoms occur, medical care should be sought right away. A healthcare provider may run tests, such as an endoscopy, to check for ulcers or other stomach issues.
Early treatment can help prevent complications like bleeding, perforation (a hole in the stomach or intestine), or infections.
Ulcers related to semaglutide are rare, but recognizing their symptoms can help prevent serious health problems. Stomach pain, nausea, bloating, and changes in appetite can happen with both ulcers and semaglutide. Paying attention to symptoms that last too long or become severe is key. Getting checked by a doctor early can make a big difference in treatment and recovery.
What Does Current Research Say About Semaglutide and Ulcer Risk?
Semaglutide is a medication that helps people manage type 2 diabetes and obesity. It works by mimicking a natural hormone in the body called GLP-1 (glucagon-like peptide-1). This hormone helps control blood sugar and appetite. While semaglutide is effective for these health conditions, there have been questions about whether it might increase the risk of stomach or peptic ulcers.
Researchers have studied semaglutide in many large clinical trials. These trials help doctors and scientists understand how safe and effective a medicine is. So far, the data shows that semaglutide does not cause ulcers in most people. However, it can cause side effects in the stomach and intestines, and some of these symptoms are similar to ulcers. These include nausea, vomiting, stomach pain, bloating, and heartburn.
Evidence from Clinical Trials
Several large studies have tested semaglutide. These include the SUSTAIN, PIONEER, and STEP trials. These trials followed thousands of people for months or even years to check for side effects and benefits.
In these studies, the most common digestive side effects were mild to moderate. They included nausea, vomiting, diarrhea, constipation, and loss of appetite. These symptoms usually happened in the first few weeks of treatment and became less over time.
Stomach or duodenal ulcers were not reported as common side effects. In fact, ulcers were rarely mentioned in these large trials. For example:
- In the SUSTAIN trials, which studied semaglutide in people with type 2 diabetes, ulcer events were very rare.
- The STEP trials, which looked at semaglutide for weight loss in people with obesity, also did not show a high number of ulcers compared to people taking a placebo (a pill with no medicine).
Still, these trials may not catch every possible side effect. Rare problems, like ulcers, may not appear in a study with a limited number of participants. This is why post-marketing surveillance and real-world data are also important.
Case Reports and Post-Marketing Data
After a medicine is approved and used by many people, doctors and researchers continue to report any unusual side effects. These reports are collected by health agencies like the U.S. Food and Drug Administration (FDA) and the European Medicines Agency (EMA). This process is called post-marketing surveillance.
There have been some individual case reports where people developed ulcers while using semaglutide. These are not common, but they raise questions about whether semaglutide played a role. Some people had symptoms like stomach pain, bleeding, or acid reflux that were later found to be caused by ulcers. However, it is not always clear if semaglutide caused the ulcers directly, or if other factors were involved, such as the use of NSAIDs (like ibuprofen), smoking, alcohol, or a past history of ulcers.
These case reports are useful because they help doctors recognize rare side effects. But they do not prove that semaglutide causes ulcers in most people. More research is needed to understand if there is a direct link.
Possible Reasons for Concern
Even though ulcers are not listed as a common side effect, semaglutide slows down how quickly food moves through the stomach. This is called delayed gastric emptying. When the stomach holds food for longer, it can lead to more acid exposure in the stomach lining. In theory, this might increase the risk of irritation or even ulcers in some people. However, this is still being studied.
Another reason for concern is that nausea and stomach pain—known side effects of semaglutide—can look similar to symptoms of an ulcer. This can make it harder for doctors to tell the difference unless tests are done.
Current Research Gaps
So far, no large study has proven that semaglutide directly causes ulcers. But researchers agree that more detailed studies are needed. It would help to follow people with a history of ulcers or stomach problems to see how semaglutide affects them. It would also help to compare the rate of ulcers in people taking semaglutide to those taking other diabetes or weight loss medications.
Doctors and scientists are continuing to collect data to learn more. As new studies are published, health guidelines may be updated to better explain the risks.
Clinical trials do not show a high risk of ulcers with semaglutide. Most people experience mild digestive issues that improve over time. A few rare cases of ulcers have been reported, but more research is needed to know if semaglutide is the cause. Doctors should be aware of the symptoms and investigate them if they last or get worse.
How Common Are Ulcers in People Taking Semaglutide?
Semaglutide is a medication used to treat type 2 diabetes and to help with weight loss. It belongs to a group of medicines called GLP-1 receptor agonists. While this medicine is generally safe and helpful for many people, some have reported stomach problems, including ulcers. An ulcer is a sore that forms in the lining of the stomach, small intestine, or esophagus. These sores can be painful and may cause serious problems if not treated.
The most common side effects of semaglutide are nausea, vomiting, diarrhea, and constipation. These are known and listed in the drug’s safety information. However, ulcers are not among the most common side effects. Even so, some reports and studies have raised questions about whether semaglutide might increase the risk of ulcers in certain people.
To understand how often ulcers occur in people taking semaglutide, it helps to look at the data from large research studies. These studies include clinical trials, real-world observations, and reports from doctors and patients.
Data From Clinical Trials
Before any drug is approved for use, it goes through many phases of testing. These studies are called clinical trials. In the case of semaglutide, the trials are known as the SUSTAIN (for injection), PIONEER (for oral tablets), and STEP (for weight loss) programs. Thousands of people took semaglutide in these trials. The main goal was to test how well the drug worked and how safe it was.
In most of these trials, the number of people who developed ulcers was very low. Gastrointestinal side effects were common, but they were mostly mild and did not include ulcers in large numbers. When ulcers were mentioned, they were usually rare and occurred in people who may have already had other risk factors for stomach problems.
Post-Marketing Safety Reports
After a drug is approved and used by the general public, doctors and patients can report any side effects they notice. This process is called post-marketing surveillance. It helps catch rare problems that may not have shown up during clinical trials.
In these safety reports, some cases of stomach or peptic ulcers have been linked to semaglutide. However, it is important to understand that these reports do not prove that the drug caused the ulcer. Many of the people who reported ulcers were also taking other medicines that can harm the stomach, such as aspirin or NSAIDs. Others had a history of stomach problems.
Still, these reports show that ulcers might be a possible risk for a small number of people, especially if other risk factors are present. The actual number of ulcer cases is not high, and most patients taking semaglutide do not report serious stomach issues.
Comparing Ulcer Rates With the General Population
Ulcers are not rare in the general population. Millions of people develop peptic ulcers each year, even without taking semaglutide. Common causes include infection with Helicobacter pylori bacteria, regular use of painkillers like ibuprofen, smoking, alcohol, and stress.
So far, studies have not shown that people on semaglutide are more likely to get ulcers than people who are not using the drug. In fact, in large studies comparing semaglutide to other treatments, the overall rates of ulcers remained low.
Ulcer Risk With Other GLP-1 Medications
Semaglutide is one of several GLP-1 receptor agonists. Others include liraglutide, dulaglutide, and exenatide. These medicines have similar effects on the stomach and also list nausea and vomiting as common side effects. Some case reports have linked other GLP-1 drugs to ulcers, but the link remains unclear. Overall, the risk seems to be low across this group of medicines.
While ulcers have been reported in some people taking semaglutide, they are not common. The drug does not appear to cause ulcers in most patients. People who have other risk factors—like a history of ulcers or regular use of NSAIDs—may be more at risk. Monitoring for stomach symptoms and working closely with a doctor can help reduce the chance of serious problems. More research is needed to better understand the link, but for now, the number of ulcer cases remains small.
What Are the Risk Factors for Developing Ulcers While on Semaglutide?
Semaglutide is a medication used to manage blood sugar levels in people with type 2 diabetes and to help with weight loss. While it is generally well-tolerated, some people may develop stomach or intestinal ulcers while using semaglutide. An ulcer is a sore that forms in the lining of the stomach or upper part of the small intestine. Understanding what increases the risk of developing ulcers can help prevent them or reduce their severity.
History of Gastrointestinal Conditions
People who have had stomach or digestive problems in the past may have a higher risk of developing ulcers while taking semaglutide. This includes anyone with a history of:
- Peptic ulcers (sores in the stomach or upper intestine)
- Gastritis (inflammation of the stomach lining)
- GERD (gastroesophageal reflux disease)
These conditions weaken the lining of the stomach or intestines, making it easier for new sores to form. When semaglutide slows stomach emptying or causes nausea, it may increase acid buildup or irritation in people with pre-existing digestive issues.
Use of Certain Medications
Some medications are known to irritate the stomach lining. When taken along with semaglutide, these drugs can increase the chance of ulcers. These medications include:
- NSAIDs (non-steroidal anti-inflammatory drugs) such as ibuprofen, aspirin, or naproxen. These drugs are commonly used for pain or inflammation. They can damage the protective layer in the stomach, especially when taken regularly or in high doses.
- Corticosteroids like prednisone can also weaken the stomach lining over time, especially when taken for weeks or months.
- Blood thinners (anticoagulants) such as warfarin or direct oral anticoagulants. These do not directly cause ulcers but can increase bleeding from an existing sore or small injury in the stomach or intestines.
Combining semaglutide with any of these drugs without proper medical supervision may raise the risk of ulcers or make symptoms worse.
Helicobacter pylori (H. pylori) Infection
- pylori is a type of bacteria that lives in the stomach lining. Many people who have ulcers are infected with H. pylori. This infection weakens the protective mucus layer of the stomach and leads to inflammation. If someone has H. pylori and starts semaglutide, their stomach may already be sensitive or irritated. This combination may increase the chance of ulcers forming.
Doctors may test for H. pylori before starting certain medications, especially if a person has had ulcers in the past. Treating the infection with antibiotics can lower the risk.
Lifestyle Habits
Some daily habits can also increase the chances of getting ulcers. These include:
- Smoking cigarettes: Smoking reduces blood flow to the stomach lining and slows healing. It also increases stomach acid, which can damage the lining and delay ulcer recovery.
- Drinking alcohol: Alcohol irritates the stomach and can erode the lining, especially in large amounts or over long periods. Alcohol also increases acid production, making ulcers more likely.
People who use semaglutide and continue to smoke or drink heavily may have a higher risk of ulcers or digestive problems.
High Doses or Long-Term Use of Semaglutide
Semaglutide is often started at a low dose and slowly increased. This helps the body adjust and reduces side effects like nausea or vomiting. However, using higher doses or taking the medication for a long time may raise the risk of gastrointestinal issues, especially in people who are already sensitive.
The longer the digestive system is exposed to changes caused by semaglutide, such as slower stomach emptying or delayed bowel movements, the more likely discomfort or irritation may build up. This can make it easier for ulcers to form if other risk factors are present.
Older Age and Medical Conditions
Older adults may have a higher risk of ulcers for several reasons. As people age, the stomach lining becomes thinner and may not heal as quickly. Many older adults also take multiple medications, some of which may interact with semaglutide or increase irritation in the stomach.
People with other medical problems like liver disease, kidney disease, or heart disease may be more vulnerable to ulcers, especially if their overall health is already weakened.
Recognizing these risk factors is important when using semaglutide. People with a history of stomach problems, those who use certain medications, or individuals with specific lifestyle habits may need extra care. Identifying risks early and working with healthcare professionals to manage them can reduce the chance of developing ulcers while continuing to benefit from semaglutide therapy.
How Are Ulcers Diagnosed in Patients Using Semaglutide?
Ulcers in the stomach or the upper part of the small intestine (duodenum) can develop for different reasons. While semaglutide is mainly used to help manage blood sugar and weight, there have been concerns about its possible link to digestive side effects, including ulcers. When someone using semaglutide experiences symptoms that could suggest an ulcer, doctors follow specific steps to make a proper diagnosis.
Recognizing the Symptoms
Symptoms of an ulcer can be mild at first but often become more noticeable over time. The most common signs include:
- A burning or gnawing pain in the upper stomach area
- Pain that may improve after eating or worsen on an empty stomach
- Feeling full quickly or feeling bloated after eating
- Nausea or vomiting
- Unexplained weight loss
- Loss of appetite
- Dark or black stools, which may suggest bleeding in the digestive tract
Some of these symptoms, such as nausea or fullness, are also known side effects of semaglutide. This makes it important for doctors to look carefully at the full picture. For example, if a person has been using semaglutide for several weeks and begins to experience new or worsening stomach pain, further evaluation is often needed.
Medical History and Physical Exam
To begin the diagnosis process, a healthcare provider usually starts by asking about the person’s symptoms, how long they have lasted, and what makes them better or worse. The doctor may also ask if the person has had ulcers before or if they are taking other medicines that can irritate the stomach, such as non-steroidal anti-inflammatory drugs (NSAIDs) or aspirin.
Information about alcohol use, smoking, stress levels, and eating habits may also be important. These factors can increase the risk of ulcers or make symptoms worse.
During the physical exam, the doctor may press on different areas of the stomach to check for tenderness or pain. Sometimes, this can give clues about where the problem is.
Endoscopy: A Key Diagnostic Tool
If an ulcer is suspected, doctors often recommend a procedure called upper endoscopy (also known as esophagogastroduodenoscopy, or EGD). This test allows the doctor to look directly at the inside of the esophagus, stomach, and duodenum using a thin, flexible tube with a camera on the end.
The person is usually sedated during this test so they feel comfortable. The doctor gently guides the tube through the mouth and down into the stomach. If an ulcer is present, it can often be seen clearly during this procedure. In some cases, a small tissue sample (biopsy) is taken to check for infection or to rule out other conditions.
Endoscopy is the most accurate way to confirm whether an ulcer is present. It also helps doctors see how deep the ulcer is and whether there is any bleeding.
Testing for H. pylori Infection
One of the most common causes of stomach ulcers is infection with a type of bacteria called Helicobacter pylori (H. pylori). Even if someone is taking semaglutide, it is important to check for this infection because it may still be the main reason for the ulcer.
Several tests are available to detect H. pylori:
- Urea breath test: The person swallows a special substance, and then breath samples are taken to look for signs of the bacteria.
- Stool antigen test: This test looks for parts of the bacteria in a stool sample.
- Biopsy during endoscopy: A tissue sample from the stomach can be tested for H. pylori.
If H. pylori is found, treatment with antibiotics is usually recommended to get rid of the infection and help the ulcer heal.
Blood Tests and Other Labs
Blood tests may also be ordered to check for anemia (low red blood cell count), which can be a sign of bleeding from an ulcer. Low iron levels or other changes in blood counts may provide clues that support the diagnosis.
In some situations, imaging tests like an upper gastrointestinal (GI) series using X-rays may be used, especially if endoscopy is not available. However, endoscopy remains the preferred method because it provides a direct look and more accurate results.
Differentiating Semaglutide Side Effects from Ulcers
Because semaglutide can cause nausea, vomiting, and fullness as part of its known side effects, it can be hard to tell whether these symptoms are from the drug or from an ulcer. Key signs that may suggest an ulcer rather than just drug side effects include:
- A sharp or burning stomach pain that does not go away
- Pain that worsens at night or between meals
- Signs of bleeding, such as vomiting blood or black stools
If any of these symptoms appear, further testing should be done to rule out or confirm an ulcer.
Diagnosing ulcers in people who take semaglutide requires careful attention to symptoms, medical history, and possible risk factors. Endoscopy remains the most reliable test to confirm the presence of an ulcer, while checking for H. pylori and reviewing medication use are also essential parts of the process. By identifying ulcers early and accurately, doctors can provide the right treatment and help prevent more serious complications.
What Can Patients and Healthcare Providers Do to Prevent Ulcers During Semaglutide Treatment?
Preventing ulcers during semaglutide treatment is important, especially for people who may already have stomach issues or other risk factors. Semaglutide is a medicine used for treating type 2 diabetes and obesity, and while it works well for many, it can affect the stomach and digestive system. Taking steps to prevent ulcers can help people stay healthy while using this medicine.
Use of Protective Medications
One way to lower the chance of ulcers is to take medications that protect the stomach. These medicines are often called gastroprotective drugs. Two common types are:
- Proton Pump Inhibitors (PPIs): These reduce the amount of acid made by the stomach. Less acid means a lower risk of irritation and ulcer formation. Examples include omeprazole and pantoprazole.
- H2-Receptor Blockers: These also reduce stomach acid, though they work a little differently from PPIs. Ranitidine and famotidine are examples.
Doctors may give these medicines to people who are at higher risk of ulcers. For example, someone with a history of ulcers or someone taking other drugs that irritate the stomach might need this extra protection.
Testing for H. pylori Infection
Helicobacter pylori (H. pylori) is a type of bacteria that can live in the stomach. Many ulcers are caused by this infection. If a person has H. pylori and starts taking semaglutide, the risk of ulcers may be higher. A simple test can find this infection. It might be:
- A breath test
- A stool antigen test
- A blood test
- An endoscopy with biopsy, in some cases
If the test shows H. pylori is present, doctors will usually treat it with antibiotics and acid-reducing medicine. Getting rid of the infection before or during semaglutide treatment can help prevent ulcers from forming.
Tracking and Reporting Symptoms Early
Semaglutide can slow down how fast food leaves the stomach. This might cause nausea, bloating, or stomach pain. These symptoms are common but should not be ignored, especially if they get worse. Some early signs of ulcers include:
- Burning stomach pain
- Feeling full quickly after eating
- Nausea that does not go away
- Vomiting with blood or material that looks like coffee grounds
- Black or tarry stools
Telling a doctor about these symptoms early can help catch problems before they turn serious. Healthcare providers may decide to adjust the dose or run tests to check for ulcers.
Using the Right Dose and Starting Slowly
The risk of stomach problems may be lower when semaglutide is started at a low dose and increased slowly. This is called dose titration. The goal is to let the body get used to the medicine. For example, semaglutide may begin at 0.25 mg per week and go up step by step over several weeks.
People who experience stomach side effects may stay at a lower dose for a longer time. This slower approach can reduce the chance of ulcers by lowering stress on the stomach lining.
Avoiding Other Medicines That Irritate the Stomach
Some other drugs can make the stomach more likely to develop ulcers. These include:
- Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or aspirin
- Steroids like prednisone
- Blood thinners, which may increase bleeding risk if an ulcer forms
If possible, these medications should be avoided or replaced with safer options. If they must be used, doctors may also give protective stomach medicine.
Following a Stomach-Friendly Diet
Certain foods and drinks may irritate the stomach and increase ulcer risk. People taking semaglutide can reduce irritation by avoiding:
- Spicy foods
- Acidic foods like citrus fruits and tomatoes
- Coffee and caffeinated drinks
- Alcohol
Eating small, frequent meals and chewing slowly can also reduce pressure on the stomach. Drinking plenty of water and avoiding lying down right after meals can help prevent stomach discomfort.
Healthy Habits for Prevention
Other lifestyle choices can make a difference. For example:
- Quitting smoking: Smoking weakens the stomach’s natural defenses and increases the risk of ulcers.
- Limiting alcohol: Alcohol can damage the stomach lining, especially in large amounts.
- Managing stress: High stress can affect digestion and increase stomach acid.
Practicing these healthy habits can improve overall stomach health and lower the chance of ulcer development during semaglutide use.
Preventing ulcers while taking semaglutide involves careful planning. Using protective medicine, treating infections, avoiding irritants, starting with a low dose, and following healthy habits can all help protect the stomach. Working closely with a healthcare provider to watch for warning signs and manage risk factors can keep treatment safe and effective.
What Should Be Done If an Ulcer Develops While on Semaglutide?
When an ulcer develops in someone taking semaglutide, quick and proper care is important. Ulcers are sores that can form in the lining of the stomach or small intestine. They may cause pain, bleeding, and other health problems if not treated early. Semaglutide, a medicine used to manage type 2 diabetes and help with weight loss, can affect the digestive system. Though ulcers are not common with semaglutide, they can happen in some people. Knowing what to do helps prevent the ulcer from getting worse and protects overall health.
Recognizing Ulcer Symptoms Early
Ulcers can start with mild symptoms that grow over time. Common signs include a burning feeling or pain in the stomach, especially when the stomach is empty. This pain might feel better after eating or taking antacids. Other signs can include nausea, bloating, burping, loss of appetite, or weight loss. In more serious cases, ulcers can cause dark or black stools, vomiting blood, or severe stomach pain.
If any of these symptoms appear in someone taking semaglutide, a healthcare provider should be contacted right away. These symptoms may also look like common side effects of semaglutide, such as nausea or stomach discomfort. This can make it hard to know if an ulcer is present. For this reason, it is important not to ignore ongoing or worsening symptoms.
Stopping or Adjusting Semaglutide
Once a healthcare provider suspects or confirms an ulcer, they may decide to stop semaglutide or adjust the dose. This decision depends on how serious the ulcer is and the person’s other health needs. If the ulcer is small and symptoms are mild, the provider may lower the dose or pause the medicine to see if symptoms improve. If the ulcer is more serious or if bleeding occurs, semaglutide is usually stopped.
Stopping semaglutide can help the stomach heal faster and reduce irritation in the digestive system. At the same time, other medicines or treatments may be started to treat the ulcer directly.
Medical Treatment for Ulcers
Ulcers are often treated with medicines that reduce stomach acid. These include proton pump inhibitors (PPIs), such as omeprazole or lansoprazole, and H2 blockers like ranitidine or famotidine. Lowering stomach acid helps the ulcer heal and prevents new sores from forming. If the ulcer is caused by Helicobacter pylori (H. pylori) bacteria, antibiotics are given to remove the infection.
During treatment, the provider may recommend stopping other medicines that irritate the stomach, such as NSAIDs (like ibuprofen or aspirin). If semaglutide is causing or making the ulcer worse, avoiding these other drugs can help reduce stress on the stomach lining.
Healing time for ulcers depends on the cause and treatment. Most ulcers begin to heal within a few weeks of proper treatment. Follow-up care may include testing to make sure the ulcer is gone and checking for signs of bleeding or other problems.
Referral to a Specialist
In some cases, a referral to a gastroenterologist is needed. A gastroenterologist is a doctor who specializes in the digestive system. This happens when the ulcer is deep, bleeding, not healing, or comes back after treatment. The specialist may perform an endoscopy to look inside the stomach and small intestine. This test helps find out how bad the ulcer is and whether other problems are present.
Endoscopy is a safe procedure done in a clinic or hospital. A thin, flexible tube with a camera is passed through the mouth into the stomach. It helps the doctor see the ulcer directly and sometimes take a small sample for testing.
Weighing the Risks and Benefits of Continuing Semaglutide
If someone has had an ulcer while using semaglutide, the healthcare team will consider whether it is safe to restart or continue the medicine. This depends on how serious the ulcer was and what other options are available. For some people, the benefits of using semaglutide may still be greater than the risks, especially if they have diabetes or obesity that is hard to manage.
In these cases, doctors may take extra steps to lower ulcer risk. This could include using a lower dose, taking a stomach-protecting medicine at the same time, or doing regular checkups to catch any symptoms early.
Healthy Habits That Support Healing
Good lifestyle choices can also help ulcers heal and reduce the chance of another one forming. These include:
- Avoiding smoking and alcohol
- Eating smaller, more frequent meals
- Staying away from spicy or acidic foods if they cause discomfort
- Managing stress
- Following all instructions for ulcer medicine
Healing from an ulcer while on semaglutide often takes teamwork between the patient and healthcare providers. Early action, correct treatment, and follow-up care are key to preventing serious problems. When managed properly, most ulcers heal well and do not return.
Are Certain Populations More Susceptible to Ulcers on Semaglutide?
Some people may have a higher risk of developing ulcers when taking semaglutide. This is not because semaglutide always causes ulcers, but because some conditions or traits make the body more sensitive to side effects. Understanding which groups may be more likely to develop ulcers can help doctors and patients take steps to reduce the risk.
Older Adults
People over the age of 65 are often more vulnerable to gastrointestinal problems. As the body ages, the stomach lining becomes thinner and less able to protect against stomach acid. Older adults may also have slower digestion and weaker muscles in the stomach and intestines, which increases the risk of irritation and damage.
Older adults are also more likely to be taking multiple medications. Some of these medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs), blood thinners, or corticosteroids, can increase the risk of ulcers. When semaglutide is added to these medications, the risk may go up further.
Because of these factors, older adults may need closer monitoring when they start semaglutide. Doctors may check for signs of ulcers more often and may recommend other medicines to protect the stomach lining.
People With a History of Ulcers or Stomach Problems
People who have had ulcers in the past may be more likely to develop them again while taking semaglutide. A history of peptic ulcers, gastritis (inflammation of the stomach lining), or gastroesophageal reflux disease (GERD) suggests that the stomach lining may already be sensitive or damaged.
Semaglutide slows down how quickly the stomach empties food into the small intestine. This delay can increase stomach acid exposure and cause symptoms like nausea, bloating, or discomfort. In people with previous stomach problems, this effect may be enough to trigger a new ulcer.
Doctors may advise these patients to take extra care and possibly start on a lower dose of semaglutide. In some cases, they may also prescribe acid-reducing medications, such as proton pump inhibitors (PPIs), to lower the chance of an ulcer coming back.
People Who Use NSAIDs or Other Risky Medications
NSAIDs such as ibuprofen, aspirin, and naproxen are known to damage the stomach lining if used often or in high doses. These medications can block the production of protective mucus in the stomach, making it easier for acid to cause harm. When used together with semaglutide, the combined effects might raise the chance of ulcers.
Other medications that increase ulcer risk include corticosteroids (like prednisone), blood thinners (such as warfarin or aspirin), and some antidepressants. People taking any of these should talk to their doctors before starting semaglutide. If semaglutide is needed, extra steps may be taken to lower the ulcer risk, such as adjusting doses or changing medications.
People Who Smoke or Drink Alcohol Regularly
Smoking is a known risk factor for ulcers. It reduces blood flow to the stomach lining and weakens the body’s natural defenses against acid. Smokers may take longer to heal from ulcers and are more likely to have ulcers come back.
Alcohol, especially when used often or in large amounts, can irritate and damage the stomach lining. It can also increase the amount of stomach acid, which raises the risk of ulcer development. Semaglutide might add to this effect by slowing digestion, which keeps acid in contact with the stomach lining for a longer time.
For people who smoke or drink regularly, the chance of having a stomach ulcer while on semaglutide could be higher. Quitting smoking and limiting alcohol can lower this risk.
People With H. pylori Infection
Helicobacter pylori (H. pylori) is a type of bacteria that lives in the stomach lining. Many people have it without knowing. In some cases, it can cause ulcers by damaging the protective layer of the stomach and increasing acid production. If someone already has an H. pylori infection, taking semaglutide may make the stomach more sensitive to acid and worsen the problem.
Doctors may test for H. pylori, especially if a patient has stomach symptoms or a history of ulcers. If the infection is found, treatment usually involves antibiotics and acid-lowering medications before or alongside semaglutide use.
Differences in Sex, Ethnicity, and Body Weight
Some research suggests that women may experience gastrointestinal side effects more often than men when taking GLP-1 receptor agonists like semaglutide. The reasons are not fully understood but may involve hormonal differences, body size, or differences in drug absorption.
Ethnic differences in drug metabolism or stomach sensitivity may also play a role, though current research is limited. In some studies, people of East Asian descent reported more stomach-related side effects from GLP-1 receptor agonists.
Body weight may also affect how the drug works. People with lower body weight may absorb semaglutide more quickly or at a higher concentration, which could lead to stronger effects on the stomach. This might increase the chance of nausea, vomiting, or ulcers in some cases.
Knowing which people may be more likely to develop ulcers while on semaglutide helps guide safe use of the medication. Risk factors such as age, medical history, medications, lifestyle habits, and infections should all be considered when starting or continuing treatment.
Conclusion
Semaglutide is a medicine that helps manage blood sugar levels and reduce weight. It works by copying a hormone in the body called GLP-1. This hormone helps with insulin release and slows down how fast food leaves the stomach. Semaglutide is often used to treat type 2 diabetes and obesity. While it has many benefits, some people have reported stomach problems. These include nausea, vomiting, and sometimes ulcers. Ulcers are sores that form inside the stomach or upper part of the small intestine. They can be painful and, in rare cases, serious.
Although ulcers are not among the most common side effects of semaglutide, there have been reports of them. Some research studies and case reports suggest that there might be a connection between semaglutide and ulcers. However, more research is needed to fully understand how often this happens and why it may occur in some people but not others. Clinical trials for semaglutide, such as SUSTAIN and STEP, have recorded gastrointestinal side effects. These side effects include nausea and delayed stomach emptying, which could make ulcer symptoms worse or harder to detect.
Ulcers can cause symptoms such as burning pain in the stomach, bloating, feeling full quickly, and loss of appetite. In some cases, a person might feel sick or vomit. Because semaglutide already slows down digestion and can cause nausea on its own, it can be difficult to know whether symptoms are caused by the medicine or by an ulcer. That is why it is important to monitor new or worsening symptoms closely.
Most people who use semaglutide will not get ulcers. Still, it is important to know what might raise the risk. People who already have stomach problems, such as a history of ulcers or acid reflux, may be more likely to have issues. Other risk factors include using certain medications like NSAIDs (for example, ibuprofen), smoking, drinking alcohol, and infection with a bacteria called Helicobacter pylori (H. pylori). Age, other illnesses, and taking multiple medications at once can also play a role. Healthcare providers may recommend checking for H. pylori before or during semaglutide treatment in some cases.
Diagnosing an ulcer usually starts with understanding the person’s medical history and symptoms. A doctor may order tests, such as an upper endoscopy, to look inside the stomach. Breath or stool tests can check for H. pylori infection. If an ulcer is found, treatment may include medicines to reduce stomach acid, treat infection, and protect the stomach lining. Sometimes, changes in diet and lifestyle can help healing. If semaglutide is thought to be making the ulcer worse, a doctor may reduce the dose or stop the medicine.
There are steps that may help prevent ulcers while using semaglutide. These include avoiding alcohol and tobacco, eating meals that are gentle on the stomach, and taking medicines with food when possible. Using stomach-protecting drugs, such as proton pump inhibitors (PPIs), might also help, especially for people at higher risk. Regular check-ups can help detect problems early. If someone starts to feel sharp stomach pain or has other new symptoms, telling a healthcare provider right away is important.
Some groups of people may be more likely to have side effects, including ulcers. Older adults, people with other health problems, or those who take many medications may need closer monitoring. Each person reacts differently to semaglutide, so care should be personalized.
Understanding the possible link between semaglutide and ulcers helps patients and doctors work together safely. While the risk is low, being aware of the symptoms and risk factors allows for early action and better health outcomes. More research will help provide clearer answers in the future, but for now, caution, regular check-ups, and good communication between patients and healthcare providers remain the best tools for managing this concern.
Research Citations
Huang, X., Wu, M., Lin, J., Mou, L., Zhang, Y., & Jiang, J. (2024). Gastrointestinal safety evaluation of semaglutide for the treatment of type 2 diabetes mellitus: A meta-analysis. Medicine, 103(21), e38236. doi:10.1097/MD.0000000000038236
Lewis, J. E., Omenge, D. K., Patterson, A. R., Anwaegbu, O., Tabukum, N. N., Lewis, J. E., & Lee, W.-C. (2025). The impact of semaglutide on wound healing in diabetes-related foot ulcer patients: A TriNetX database study. Diabetes and Vascular Disease Research, 22(2). doi:10.1177/14791641251322909
Werkman, N. C. C., Driessen, J. H. M., Klungel, O. H., Schaper, N. S., Souverein, P. C., Stehouwer, C. D. A., et al. (2024). Incretin‐based therapy and the risk of diabetic foot ulcers and related events. Diabetes, Obesity and Metabolism, 26, 3764–3780. doi:10.1111/dom.15721
Hsu, J.-H., Bai, H.-F., Chen, M.-T., & Tsai, M.-H. (2025). Glucagon-like peptide-1 receptor agonists lead to gastrointestinal benefits in patients with type 2 diabetes: A real-world study. Medical Science Monitor, 31, e946935. doi:10.12659/MSM.946935
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Questions and Answers: Semaglutide and Ulcers
Semaglutide is a glucagon-like peptide-1 (GLP-1) receptor agonist used to treat type 2 diabetes and for weight management in individuals with obesity or overweight with related conditions.
Semaglutide is not known to directly cause gastric or duodenal ulcers, but it can lead to gastrointestinal side effects such as nausea and vomiting, which may exacerbate existing ulcers or lead to mucosal irritation.
There is no strong evidence that semaglutide significantly increases the risk of bleeding ulcers, but in patients with pre-existing peptic ulcers, caution is advised due to potential for nausea, vomiting, and gastric irritation.
Semaglutide can be used cautiously in patients with a history of ulcers, but it is important to monitor for worsening gastrointestinal symptoms and consider gastroprotective strategies if needed.
Common side effects include nausea, vomiting, abdominal pain, and indigestion, which can mimic or worsen symptoms seen in patients with ulcers.
If a patient develops a confirmed ulcer, especially with bleeding or severe symptoms, discontinuing semaglutide temporarily and initiating ulcer treatment may be appropriate. A healthcare provider should make this decision based on individual risk-benefit assessment.
Semaglutide delays gastric emptying, which may contribute to fullness, bloating, or discomfort, and in some cases, might exacerbate symptoms in patients with active ulcers or gastroparesis.
Yes, consider starting at a lower dose, titrating slowly, monitoring symptoms closely, and using proton pump inhibitors (PPIs) or H2 blockers if indicated to reduce acid and protect the gastric lining.
Semaglutide does not have significant interactions with PPIs or antacids, but delayed gastric emptying could affect the absorption of oral medications; spacing administration times may help.
They should report symptoms such as persistent abdominal pain, dark stools, vomiting blood, or severe indigestion to their healthcare provider promptly for evaluation and management.
Dr. Melissa VanSickle
Dr. Melissa Vansickle, MD is a family medicine specialist in Onsted, MI and has over 24 years of experience in the medical field. She graduated from University of Michigan Medical School in 1998. She is affiliated with medical facilities Henry Ford Allegiance Health and Promedica Charles And Virginia Hickman Hospital. Her subspecialties include General Family Medicine, Urgent Care, Complementary and Integrative Medicine in Rural Health.