Signs of an Ulcer (Stomach and Duodenal Ulcers)

Stomach and duodenals ulcers (jointly known as peptic ulcers) are a common problem that affects about 4.5 million people in the United States. At any one time about 10% of Americans have symptoms of peptic ulcers. The rest may never know that these open sores are present in the stomach or first part of the small intestine known as the duodenum. Although we often think that it is not a serious condition, peptc ulcers can affect a person’s life in various ways and in rare cases it may lead to serious complications.

How To Spot Peptic Ulcers

Ulcers refers to open sores which can develop anywhere on or in the body. Most of us think of stomach and duodenal ulcers but these open sores can also form in the mouth or on the skin which are completely separate conditions from peptic ulcer disease. Some of the more common causes of peptic ulcers are H.pylori infection and excessive use of certain drugs like NSAIDs. Spicy food, caffeine, alcohol and cigarette smoking may worsen symptoms.

The signs and symptoms of peptic ulcers can sometimes be misleading. It may be mistaken for a host of conditions, including indigestion (non-ulcer dyspepsia), acid reflux and even gallstones. Many of the signs and symptoms of peptic ulcers overlaps with these conditions. In rare cases, peptic ulcer pain may even be mistaken for cardiac (heart-related) diseases like angina or a heart attack, especially when it is accompanied by acid reflux.

Read more on what is a peptic ulcer.

How does it happen?

Normally the mucus barrier, produced by the stomach cells, prevents the gastric acid within the stomach from making contact with the inner lining. Once this acid passes into the first part of the small intestine known as the duodenum, it is neutralized and does not pose a problem to the intestinal wall. In this way the stomach and duodenum have their own mechanisms to avoid tissue damage by the gastric acid.

However, when this mucus barrier is impaired or the gastric acid secretion is increased then it can lead to open sores in the stomach and/or duodenum. This is known as peptic ulcers. As mentioned, H.pylori infection and excessive use of NSAIDs are the main causes. The H.pylori bacteria wears out an area of the mucus barrier thereby letting gastric acid make contact with the stomach wall. NSAIDs also neutralizes the mucus barrier.

Burning or Gnawing Pain

A burning pain is the most common symptom that a person experiences with peptic ulcers. Sometimes it may also feel like a gnawing ache in the stomach.It is typically felt in the middle portion of the upper abdomen (epigastric region) but some people may experience it lower. In stomach ulcers the pain occurs shortly after a meal whereas with duodenal ulcers it occurs 2 to 3 hours after eating. The pain comes and goes, sometimes easing for weeks before returning.

Read more on peptic ulcer pain.

Belching and Bloating

Belching is normal but with peptic ulcers it may be excessive. There may also be bloating, which refers to a sensation of fullness even after eating a few bites. There may also be abdominal distension to some degree. Collectively these symptoms are seen in indigestion even without peptic ulcers. Indigestion is common with overeating but in peptic ulcers the symptoms arise on its own.

Nausea and Vomiting

Nausea is another common symptom of peptic ulcers. It may worsen and ease with the same factors as the burning abdominal pain. Sometimes there may be vomiting and if the ulcer was bleeding then there may be signs of blood in the vomitus. It may not always appear as fresh red blood. Instead it may appear as coffee grounds in the vomit due to the degraded blood. The sign of blood in the vomit or recurrent vomiting requires immediate medical attention.

Alterations of Appetite

Many people experience a change in appetite. Certain foods can help ease the ulcer pain and there may be an associated increase in appetite. Often there is a tendency to want to eat when the pain occurs or if it worsens. The pain is sometimes mistaken for hunger pangs. However, since the pain tends to worsen after a meal there may also be a loss of appetite as a person unkowingly avoid food to prevent the exacerbation of pain.

Nighttime Exaceration of Symptoms

Another typical feature of gastric ulcers is the exacerbation of symptoms like abdominal pain at night. This is due to the circadian rhythm which causes an increase in stomach acid secretion at night. It usually occurs around 3am. The increased acid secretion coupled with the lack of food in the stomach further irritates the the exposed tissue in the ulcer. It may cause a disturbance in sleep.

Unexplained Weight Loss

Another possible complication of peptic ulcers is unexplained weight loss. It tends to occur with peptic ulcers that are not properly treated and managed in the long term. The weight loss is largely due to the changes in appetite. However, stomach ulcers increases the risk of stomach cancer. This only affects a small percentage of people with stomach ulcers. Therefore the unexplained weight loss could also be a result of cancer.

Anemia with Blood Loss

People with bleeding ulcers may not even be aware of the blood loss. Instead the bleeding is slow and occurs over a long period of time. Eventually this lead to anemia. Therefore the presence of anemia should be considered as a possible sign of peptic ulcers. The symptoms of anemia can vary from fatigue to paleness and even shortness of breath in severe cases.

Warning Signs

One of the acute medical emergencies that can arise with peptic ulcers is a perforation. This is where the erosion of the stomach or duodenal wall may penetrate through the entire thickness of the wall. There may be severe pain, bloody or recurrent vomiting, total loss of appetite and can lead to peritonitis if treatment is not commenced promptly. Sometimes there may be little to no symptoms of peptic ulcers and then a perforation occurs where the symptoms are sudden and intense.

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