- Peptic ulcer disease (PUD) is characterized by a break in the inner lining of the stomach because of gastric acid secretion and pepsin. It can extend into the smooth muscle layer of the gastric epithelium. It may also involve the lower part of the esophagus, distal duodenum, or jejunum (the part between the duodenum and the ileum (the last part of the small intestine).
Peptic ulcer symptoms are seen in only some patients with peptic ulcer disease (PUD). Usually, a patient with a peptic ulcer may not present any symptoms in the initial stages or even in the later stages.
These silent ulcers are detected ultimately when some ulcer complication develops such as perforation or bleeding. The ulcer may come and go without you knowing that you were having an ulcer.
A study conducted in Taiwan revealed that 67% of PUD patients had no remarkable symptoms. Some of these patients with PUD are detected only when life-threatening complications such as bleeding or perforation develop.
A peptic ulcer is a sore that occurs in the lining of the stomach or duodenum (the initial part of the small intestine).
It is caused by a bacterium, called H. pylori, which has been identified as the main etiological factor of an ulcer. There are certain factors that increase your risk of getting an ulcer or aggravating an existing one.
Peptic ulcers can be effectively treated with medication. There are some natural remedies also that can be taken along with medication and which hasten the healing of the ulcer. Certain dietary restrictions also form an integral part of ulcer management.
Once the warning signs appear, your healthcare provider will conduct certain tests to confirm the diagnosis of the ulcer. Once diagnosed, you should start treatment because untreated ulcers can cause certain serious complications.
Symptoms of peptic ulcer in men and women
The symptoms and signs of an ulcer, when present are classic and invariable. Symptoms are more commonly seen in females and usually after the age of 40 years. They are explained below:
1. Burning abdominal pain (Dyspepsia)
This is one of the classic early warning symptoms of peptic ulcers. Ulcer patients feel pain in the abdominal area between the umbilicus and the breastbone. It is called epigastric pain.
It is a burning or gnawing type of pain and the timing of the pain varies in gastric and duodenal ulcers. This is the most common peptic ulcer symptom
In the case of a gastric (stomach) ulcer, the pain is felt within 15 to 30 minutes after meals because of the secretion of gastric acid to aid digestion. In the case of duodenal ulcer symptoms, the pain is felt 2 to 4 hours after the meals. Nocturnal pain is common with duodenal ulcers.
In a gastric ulcer, the pain is aggravated by food, while, in a duodenal ulcer, the pain is relieved by food. For this reason, despite a normal appetite, the patient with gastric ulcer does not eat for fear of developing abdominal pain.
In both cases, the pain may last for a few minutes to a few hours. It may disappear and reappear after a few days or weeks.
2. Regurgitation
In GERD (gastroesophageal reflux disease), there is the regurgitation of pungent-tasting gastric contents into the mouth. It occurs when stomach acid flows back into the esophagus. The body mechanism reacts by the secretion of saliva to dilute these regurgitated contents.
The main symptoms are persistent heartburn and regurgitation of acid regurgitation. Some people may not have heartburn. Instead, they may experience chest pain, hoarseness of voice, or trouble swallowing.
3. Loss of appetite resulting in weight loss.
Another sign of a stomach ulcer is a complete loss of appetite, which will cause you to lose weight. When your stomach or the duodenal inner lining is inflamed and damaged due to an ulcer, scar tissue begins to form.
This raised scar tissue can block the passage of food through your stomach and the duodenum.
This will make you feel as though your stomach is full, even though you haven’t eaten anything. This causes a loss of appetite and over time you start losing weight.
4. Nausea and vomiting
Stomach ulcers can make you feel sick early in the morning since you have gone for a long time without food. Stomach ulcers can cause inflammation in the stomach, which can cause stomach contractions and subsequently vomiting.
5. Abdominal fullness and distension
The outlet of the stomach may become blocked as a result of scarring or inflammation caused by a stomach ulcer. You may also feel bloating of the stomach after eating. Your stomach swells because it is full of gas or air and you may experience burping.
6. Haematemesis – a symptom of a bleeding ulcer
Haematemesis means blood in the vomitus. Blood vomits, which may look like coffee grounds occur due to a bleeding gastric ulcer, which is a complication of an untreated long-standing stomach ulcer.
7. Melena – another symptom of a bleeding ulcer
Melena is the presence of blood in the stools. Black tarry stools are due to a bleeding ulcer. The black color is due to the oxidation of the iron (hemoglobin) in the blood present in stools by digestive enzymes and intestinal bacteria. This again is a symptom of an untreated ulcer complication of bleeding.
8. Symptoms of perforated peptic ulcer
Patients with perforated peptic ulcer disease usually experience severe, sharp abdominal pain of sudden onset. Most patients have generalized abdominal pain, while some present with acute epigastric pain. Even slight body movement can aggravate the pain.
You may not experience all these peptic ulcer symptoms, but the presence of even one or two of these should be investigated and promptly treated.
Earliest symptoms
Of all the symptoms described above, the earliest symptoms of peptic ulcer to manifest include:
- Epigastric pain. A dull or burning pain in the epigaterium (part of the upper abdomen between the breastbone and umbilicus). The pain can occur between meals or at night and can last from a few minutes to a few hours.
- Nausea and vomiting. These may or may not be associated with meals
- Feeling full. Feeling full after eating a small amount of food.
- Bloating. Bloating fullness after eating food
Warning symptoms and signs of complications
Warning symptoms or alarm symptoms that require immediate medical evaluation include:
- Unintentional weight loss
- Progressive burning pain in chest and epigastrium
- Visual gastrointestinal bleeding
- Iron deficiency anemia
- Recurrent forceful vomiting
- Family history of malignancy of the upper gastrointestinal tract
Other conditions with similar symptoms – Differential diagnosis
Some conditions may cause symptoms similar to those of peptic ulcers. Therefore, your doctor may conduct certain tests to rule them out.
These conditions include:
- Gastritis: Gastritis is inflammation of the inner protective lining of the stomach. It causes abdominal pain, heartburn, bloating, and indigestion. It is usually caused by prolonged use of NSAIDs, alcohol abuse, and chronic stress
- Gastroesophageal reflux disease (GERD): GERD occurs when stomach acid or contents flow upward into your esophagus. Symptoms of GERD include heartburn, belching, and difficulty in swallowing.
- Pancreatitis: Pancreatitis is inflammation of the pancreas causing the pancreas to become red and swollen. It can last for a short period or can become chronic. Symptoms may include upper abdominal pain, a rapid pulse, and nausea.