What are the symptoms of peptic ulcer?
Symptoms of a peptic ulcer can be abdominal pain, hematemesis (vomiting blood), melena (tarry feces due to oxidised iron from hemoglobin), weight loss. Rarely, an ulcer can lead to a gastric or duodenal perforation. This is extremely painful and
requires immediate surgery.
Duodenal ulcers tend to produce pain in a small area between the breastbone and navel. The pain may vary from a hunger pain to a continuous gnawing or burning sensation. Sometimes, the pain is felt during sleep and may be strong enough to awaken the ulcer sufferer in the middle of the night. Usually, however, the pain of a duodenal ulcer occurs two or three hours after eating, when the stomach is empty. Other common symptoms include a bloated feeling immediately after eating and weight gain due to the tendency to relieve pain and discomfort by overeating.
Gastric ulcer pain may be felt in the same place as the pain of duodenal ulcer or slightly higher up. There may also be sensations of feeling full, indigestion, and heartburn. Sometimes, pain occurs when the stomach is full, causing a loss of appetite and weight. The pain of both types of ulcer tends to be relieved by medications that neutralize stomach acid or prevent its secretion. In the course of medical evaluation, the presence or absence of H Pylori should be checked for.
A history of heartburn, gastroesophageal reflux disease (GERD) and use of certain forms of medication can raise the suspicion for peptic ulcer. Medicines associated with peptic ulcer are NSAID (non-steroid anti-inflammatory drugs) that inhibit cyclooxygenase 1, and most glucocorticoids (e.g. dexamethasone).
In patients over 45 with more than 2 weeks of the above symptoms the odds for peptic ulceration are high enough to warrant rapid investigation by EGD (see below). In earlier times it was thought that the timing of the symptoms in relation to the meal could differentiate between gastric and duodenal ulcers: a gastric ulcer would give pain during the meal, as gastric acid was secreted, while duodenal ulcers would only hurt after the meal—when acidic chylus was passed down to the duodenum. This theory has not been proved in practice.