Symptoms

Dyspepsia. The most common symptoms of peptic ulcer are known collectively as dyspepsia. However, peptic
ulcers can occur without dyspepsia or any other gastrointestinal symptom, especially when they are caused by
NSAIDs. Dyspepsia may be persistent or recurrent and can lead to a variety of upper abdominal symptoms,
including:
 Pain or discomfort
 Bloating
 A feeling of fullness -- people with severe dyspepsia are unable to drink as much fluid as people with
mild or no dyspepsia
 Hunger and an empty feeling in the stomach, often 1 - 3 hours after a meal
 Mild nausea (vomiting may relieve symptoms)
 Regurgitation (sensation of acid backing up into the throat)
 Belching
 Occasionally, symptoms of GERD are present

Many patients with the above symptoms do not have peptic ulcer disease or any other diagnosed condition. In
that case, they have what is called functional dyspepsia.

Ulcer Pain. Some symptoms are similar to those of gastric ulcers, although not everyone with these symptoms
has an ulcer. The pain of ulcers can be in one place, or it can be diffuse (all over the abdomen). The pain is
described as a burning, gnawing, or aching in the upper abdomen, or as a stabbing pain penetrating through the
gut. The symptoms may vary depending on the location of the ulcer:
 Duodenal ulcers often cause a gnawing pain in the upper stomach area several hours after a meal, and
patients can often relieve the pain by eating a meal.
 Gastric ulcers may cause a dull, aching pain, often right after a meal; eating does not relieve the pain and
may even worsen it. Pain may also occur at night.

Ulcer pain may be particularly confusing or disconcerting when it radiates to the back or to the chest behind the
breast bone. In such cases it can be confused with other conditions, such as a heart attack.

Because ulcers can cause hidden bleeding, patients may experience symptoms of anemia, including fatigue and
shortness of breath.
EMERGENCY SYMPTOMS

Severe symptoms that begin suddenly may indicate a blockage in the intestine, perforation, or hemorrhage, all of
which are emergencies. Symptoms may include:
 Tarry, black, or bloody stools
 Severe vomiting, which may include blood or a substance with the appearance of coffee grounds (a sign
of a serious hemorrhage) or the entire stomach contents (a sign of intestinal obstruction)
 Severe abdominal pain, with or without vomiting or evidence of blood

Anyone who experiences any of these symptoms should go to the emergency room immediately.

What is a peptic ulcer?

A peptic ulcer is a hole in the gut lining of the stomach, duodenum, or esophagus. A peptic ulcer of the stomach
is called a gastric ulcer; of the duodenum, a duodenal ulcer; and of the esophagus, an esophageal ulcer. An ulcer
occurs when the lining of these organs is corroded by the acidic digestive juices which are secreted by the
stomach cells. Peptic ulcer disease is common, affecting millions of Americans yearly. The medical cost of
treating peptic ulcer and its complications runs in the billions of dollars annually. Recent medical advances have
increased our understanding of ulcer formation. Improved and expanded treatment options are now available.

What are the causes of peptic ulcers?

For many years, excess acid was believed to be the major cause of ulcer disease. Accordingly, treatment
emphasis was on neutralizing and inhibiting the secretion of stomach acid. While acid is still considered
significant in ulcer formation, the leading cause of ulcer disease is currently believed to be infection of the
stomach by a bacteria called "Helicobacter pyloricus" (H. pylori). Another major cause of ulcers is the chronic use
of anti-inflammatory medications, commonly referred to as NSAIDs (nonsteroidal anti-inflammatory drugs),
including aspirin. Cigarette smoking is also an important cause of ulcer formation and ulcer treatment failure.

H. pylori bacteria is very common, infecting more than a billion people worldwide. It is estimated that half of the
United States population older than age 60 has been infected with H. pylori. Infection usually persists for many
years, leading to ulcer disease in 10 % to 15% of those infected. H. pylori is found in more than 80% of patients
with gastric and duodenal ulcers. While the mechanism of how H. pylori causes ulcers is not well understood,
elimination of this bacteria by antibiotics has clearly been shown to heal ulcers and prevent ulcer recurrence.

NSAIDs are medications for arthritis and other painful inflammatory conditions in the

body. Aspirin, ibuprofen (Motrin), naproxen (Naprosyn), and etodolac (Lodine) are a few of the examples of this
class of medications. Prostaglandins are substances which are important in helping the gut linings resist
corrosive acid damage. NSAIDs cause ulcers by interfering with prostaglandins in the stomach.

Cigarette smoking not only causes ulcer formation, but also increases the risk of ulcer complications such as
ulcer bleeding, stomach obstruction and perforation. Cigarette smoking is also a leading cause of ulcer
medication treatment failure.

Contrary to popular belief, alcohol, coffee, colas, spicy foods, and caffeine have no proven role in ulcer formation.
Similarly, there is no conclusive evidence to suggest that life stresses or personality types contribute to ulcer
disease.

What are symptoms of an ulcer?

Symptoms of ulcer disease are variable. Many ulcer patients experience minimalindigestion or no discomfort at
all. Some report upper abdominal burning or hunger pain one to three hours after meals and in the middle of the
night. These pain symptoms are often promptly relieved by food or antacids. The pain of ulcer disease correlates
poorly with the presence or severity of active ulceration. Some patients have persistent pain even after an ulcer is
completely healed by medication. Others experience no pain at all, even though ulcers return. Ulcers often come
and go spontaneously without the individual ever knowing, unless a serious complication (like bleeding or
perforation) occurs.

How is an ulcer diagnosed?

The diagnosis of an ulcer is made by either a barium upper GI x-ray or an upper endoscopy (EGD-
esophagogastroduodenoscopy) The barium upper GI x-ray is easy to perform and involves no risk or discomfort.
Barium is a chalky substance administered orally. Barium is visible on x- ray, and outlines the stomach on x-ray
film. However, barium x-rays are less accurate and may not detect ulcers up to 20% of the time.

An upper endoscopy is more accurate, but involves sedation of the patient and the insertion of a flexible tube
through the mouth to inspect the stomach, esophagus, and duodenum. Upper endoscopy has the added
advantage of having the capability of removing small tissue samples (biopsies) to test for H. pylori infection.
Biopsies can also be examined under a microscope to exclude cancer. While virtually all duodenal ulcers are
benign, gastric ulcers can occasionally be cancerous. Therefore, biopsies are often performed on gastric ulcers
to exclude cancer.

Patients with ulcer bleeding may report black tarry stools (melena), weakness, a sense of passing out upon
standing (orthostatic syncope), and vomiting blood(hematemesis). Initial treatment involves rapid replacement of
lost body fluids intravenously. Patients with persistent or severe bleeding may require blood transfusions. An
upper endoscopy is performed to establish the site of bleeding and to stop active ulcer bleeding with the aid of
heated instruments.

Ulcer perforation leads to the leakage of gastric contents into the abdominal (peritoneal) cavity, resulting in acute
peritonitis (infection of the abdominal cavity). These patients report a sudden onset of extreme abdominal pain,
which is worsened by any type of motion. Abdominal muscles become rigid and board-like. Urgent surgery is
usually required.

Patients with gastric obstruction often report increasing abdominal pain, vomiting of undigested or partially
digested food, diminished appetite, and weight loss. The obstruction usually occurs at or near the pyloric canal.
The pyloric canal is a naturally narrow part of the stomach as it joins the upper part of the small intestine called
the duodenum. Upper endoscopy is useful in establishing the diagnosis and excluding gastric cancer as the
cause of the obstruction. In some patients, gastric obstruction can be relieved with tube suction of the stomach
contents for 72 hours, along with intravenous anti-ulcer medications, such as cimetidine (Tagamet)
and ranitidine(Zantac). Patients with persistent obstruction require surgery.

What treatments are available for peptic ulcers?

The goal of ulcer treatment is to relieve pain and to prevent ulcer complications, such as bleeding, obstruction,
and perforation. The first step in treatment involves the reduction of risk factors (NSAIDs and cigarettes). The
next step is medications.

Antacids neutralize existing acid in the stomach. Antacids such as Maalox, Mylanta, and Amphojel are safe and
effective treatments. However, the neutralizing action of these agents is short-lived, and frequent dosages are
required. Magnesium containing antacids, such as Maalox and Mylanta, can cause diarrhea, while aluminum
agents like Amphojel can causeconstipation. Ulcers frequently return when antacids are discontinued.

Studies have shown that a protein in the stomach called histamine stimulates gastric acid secretion. Histamine
antagonists (H2 blockers) are drugs designed to block the action of histamine on gastric cells, hence reducing
acid output. Examples of H2 blockers are cimetidine (Tagamet), ranitidine (Zantac), nizatidine (Axid),
and famotidine(Pepcid). While H2 blockers are effective in ulcer healing, they have limited role in eradicating H.
pylori without antibiotics. Therefore, ulcers frequently return when H2 blockers are stopped. Generally, these
drugs are well tolerated and have few side effects even with long term use. In rare instances, patients
report headache, confusion, lethargy, or hallucinations. Chronic use of cimetidine may rarely cause impotence or
breast swelling. Both cimetidine and ranitidine can interfere with body's ability to handle alcohol. Patients on
these drugs who drink alcohol may have elevated blood alcohol levels. These drugs may also interfere with the
liver's handling of other medications like Dilantin, Coumadin, and theophylline. Frequent monitoring and
adjustments of the dosages of these medications may be needed.

Proton-pump inhibitors such
as omeprazole (Prilosec), lansoprazole (Prevacid),pantoprazole (Protonix), esomeprazole (Nexium),
and rabeprazole (Aciphex) are more potent than H2 blockers in suppressing acid secretion. Different proton-
pump inhibitors are very similar in action and there is no evidence that one is more effective than another in
healing ulcers. While proton-pump inhibitors are comparable to H2 blockers in effectiveness in treating gastric
and duodenal ulcers, it is superior to H2 blockers in treating esophageal ulcers. Esophageal ulcers are more
sensitive than gastric and duodenal ulcers to minute amounts of acid. Therefore, more complete acid
suppression accomplished by proton-pump inhibitors are important for esophageal ulcer healing. Proton-pump
inhibitors are well tolerated. Side effects are uncommon; they include headache, diarrhea,
constipation, nausea and rash. Interestingly, proton-pump inhibitors do not have any effect on a person's ability to
digest and absorb nutrients. Proton-pump inhibitors have also been found to be safe when used long term,
without serious adverse health effects reported.

Sucralfate (Carafate) and misoprostol (Cytotec) are agents that strengthen the gut lining against attacks by acid
digestive juices. Carafate coats the ulcer surface and promotes healing. The medication has very few side
effects. The most common side effect is constipation and the interference with the absorption of other
medications. Cytotec is a prostaglandin-like substance commonly used to counteract the ulcer effects of NSAIDs.
Studies suggest that Cytotec may protect the stomach from ulceration in those who take NSAIDs on a chronic
basis. Diarrhea is a common side effect. Cytotec can cause miscarriages when given to pregnant women, and
should be avoided by women of childbearing age.

Many people harbor H. pylori in their stomachs without ever having pain or ulcers. It is not completely clear
whether these patients should be treated with antibiotics. More studies are needed to answer this question.
Patients with documented ulcer disease and H. pylori infection should be treated with antibiotic combinations. H.
pylori can be very difficult to completely eradicate. Treatment requires a combination of several antibiotics,
sometimes in combination with a proton-pump inhibitor, H2 blockers or Pepto-Bismol. Commonly used antibiotics
are tetracycline, amoxicillin, metronidazole(Flagyl), clarithromycin (Biaxin), and levofloxacin (Levaquin).
Eradication of H. pylori prevents the return of ulcers (a major problem with all other ulcer treatment options).
Elimination of this bacteria may also decrease the risk of developing gastric cancer in the future. Treatment with
antibiotics carries the risk of allergic reactions, diarrhea, and sometimes severe antibiotic-induced
colitis (inflammation of the colon).

There is no conclusive evidence that dietary restrictions and bland diets play a role in ulcer healing. No proven
relationship exists between peptic ulcer disease and the intake of coffee and alcohol. However, since coffee
stimulates gastric acid secretion, and alcohol can cause gastritis, moderation in alcohol and coffee consumption
is often recommended.

Peptic Ulcers
Article Page Navigation 

Introduction 
Causes
Symptoms 
Complications 
Risk Factors
Diagnosis 
Treatment 
Treatment for NSAID-Induced Ulcers 
Medications 
Treatment for Bleeding Ulcers 
Lifestyle Changes 
Resources

Description
 An in-depth report on the causes, diagnosis, treatment, and prevention of stomach and
GI ulcers.

Alternative Names

Duodenal Ulcers; Gastric Ulcers; H. Pylori; Nonsteroidal Anti-inflammatory Drugs, or

NSAIDs

Symptoms

Dyspepsia. The most common symptoms of peptic ulcers are known collectively

as dyspepsia. Peptic ulcers can occur without dyspepsia or any gastrointestinal
symptoms, especially when caused by NSAIDs. Dyspepsia may be persistent or
recurrent and can encompass a variety of problems in the upper abdomen, including the
following:

 Pain or discomfort.
 Bloating.
 A feeling of fullness. (People with severe dyspepsia are unable to drink as
much water or other beverages as people with mild or no dyspepsia.)
 Hunger and an empty feeling in the stomach, often one to three hours after a
meal.
 Mild nausea. (Vomiting, in fact, may relieve symptoms.)
 Regurgitation. (The sensation of acid backing up into the throat.)
 Belching.

Ulcer Pain. The pain of ulcers can be either localized in one place or diffuse. The pain
has been described as burning, gnawing, or aching in the upper abdomen, or as a
stabbing pain penetrating through the width of the gut. The symptoms may vary
depending on the location of the ulcer:

 Duodenal ulcers often cause a gnawing pain in the upper stomach area several
hours after a meal, and the pain is often relieved by eating a meal.
 Gastric ulcers may cause a dull, aching pain, often right after a meal; eating
does not relieve the pain and may even worsen it. Pain may also occur at night.

Ulcer pain may be particularly confusing or disconcerting, however, since it may radiate
to the back or to the chest behind the breastbone. In such cases it can be confused with
other conditions--even a heart attack.

Symptoms of Anemia

Because ulcers can cause long-term hidden bleeding, patients may experience the
symptoms of anemia, including fatigue and shortness of breath.

Emergency Symptoms

A sudden onset of severe symptoms may indicate intestinal obstruction, perforation, or

hemorrhage, which are all emergency conditions. They may include one or more of the
following:

 Tarry, black, or bloody stools.

 Severe vomiting, which may include one or more of the following: blood or a
substance with the appearance of coffee grounds (a sign of a serious hemorrhage) or
 entire stomach contents (sign of intestinal obstruction).
 Severe abdominal pain with or without vomiting or evidence of blood.
 Persons who experience any of these symptoms should go to the emergency
room immediately.

Peptic ulcers may lead to emergency situations. Severe abdominal pain with or
without evidence of bleeding may indicate a perforation of the ulcer through the
stomach or duodenum. Vomiting of a substance that resembles coffee grounds,
or the presence of black tarry stools, may indicate serious bleeding.

Peptic Ulcer: Diagnostic Tests

The list of diagnostic tests mentioned in various sources as used in the diagnosis of Peptic
Ulcerincludes:

 Gastroscopy
 Endoscopy
 Upper gastrointestinal (GI) series
 Barium meal x-ray
 Blood H pylori test
 Breath H pylori test
 Helicobacter pylori stool antigen (HpSA) test
 Stomach biopsy
 Tissue H pylori test
powered by RightHealth
Read More On:
 severe.

Related Peptic Ulcer Info

Videos about Peptic Ulcer

Grocery Shopping Tips Part 2Watch Video

Tip: Grazing, Smaller MealsWatch Video

Related Pages

1. Peptic Ulcer: Introduction

2. Symptoms Overview
3. List of Symptoms of Peptic Ulcer
4. Tests to Confirm Diagnosis
5. Home Diagnostic Testing
6. Failure to Diagnose
7. Alternative Diagnoses
8. Misdiagnosis information
9. Complications
10. More about Symptoms
11. Article Excerpts
12. Medical articles

Typical symptoms include epigastric pain, and burning in the upper abdomen. Other symptoms can
includenausea, vomiting, and pain between theshoulder blades in the back. The pain of
a pepticulcer often begins about two hours after eating and also occurs at night. Eating more food
or taking an antacid often decreases or relieves the pain.

Complications of peptic ulcer include the development of a perforated peptic ulcer, which can
bleed. Symptoms of a perforated peptic ulcer include blood in the vomit (hematemesis) and black
tarry stools(melana). A bleeding perforated peptic ulcer is a life-threatening condition and
a medical emergency.

Bleeding from a peptic ulcer can result in anemia. Symptoms of anemia include fatigue, weakness,

andlight-headedness. Severe bleeding (hemorrhage) can result in shock and death.

If a peptic ulcer gets deep enough to go through the stomach wall, stomach contents may spill into
theabdominal cavity, resulting in a serious complication called peritonitis.

Peptic ulcers that have left scars can result in the develoment of a complication called pyloric
stenosis. Symptoms of pyloric stenosis include projectile vomiting immediately after a meal.

Bloody stools, tarry black stools (melana), and vomiting blood can be symptoms of serious, even

life-threatening diseases and conditions. These symptoms are a medical emergency that should be
immediately evaluated in an emergency setting...

A peptic ulcer is a hole in the lining of the stomach or the duodenum of the small intestine. There

are two types of peptic ulcers. They include a gastric ulcer, which is a peptic ulcer in the stomach.
A duodenal ulcer is a peptic ulcer in the duodenum, the first section of the small intestine.

Peptic ulcer is a common condition. Peptic ulcers form when the lining of protective mucus and
other substances break down, which allows acidicdigestive juices to damage the stomach or
duodenal lining.

Peptic ulcer is frequently caused by an infection of a type of bacteria called Helicobacter pylori.
Other causes of peptic ulcer include long-term use ofnonsteroidal anti-inflammatory
drugs (NSAIDS), such as ibuprofen (Advil, Motrin) or naproxen(Aleve), which are irritating to the
stomach lining. Peptic ulcer can also occur after within a few days after a physically stressful event,
such as an illness, surgery or injury, and result in peptic ulcers that can bleed. Peptic ulcer can also
be caused by a stomach tumoror pancreas tumor. Smoking is a risk factor for developing a peptic
ulcer.

Typical symptoms of peptic ulcer include heartburn and pain in the upper abdominal area. If left
untreated peptic ulcer can lead to complications, including life-threatening complications. For more
details about symptoms and complications, see symptoms of peptic ulcer.

Diagnosing peptic ulcer and its root cause begins with taking a thorough personal and family
medical history, including symptoms, and completing a physical examination.

Diagnostic testing generally includes an endoscopy procedure. In this procedure, a special lighted
instrument is inserted through the mouth and throat into the stomach. This instrument, called an
endoscope, takes pictures of the stomach and/or sends images to a computer monitor.

A biopsy may also be taken during an endoscopy. A biopsy involves taking a small sample of
esophagus or stomach tissue to examine it under a microscope.

Blood tests may also be done to test for a Helicobacter pylori infection, the most common cause of
peptic ulcer. A stool sample may be tested to determine if there is blood in the stool, which could
indicate that there is a perforated peptic ulcer that is bleeding or a variety of other conditions.

Diagnosis may also include a complete blood count, which can determine if anemia is present and
may indicate that a peptic ulcer has become a perorated ulcer and is bleeding.

A diagnosis of peptic ulcer and its cause can be delayed or missed because symptoms of peptic
ulcer may be intermittent and for other reasons. For information on misdiagnosis, refer
tomisdiagnosis of peptic ulcer.

Treatment of peptic ulcer involves reducing the amount of stomach acid so that the stomach or
duodenum can heal. Surgery may be required in severe cases. For more information on treatment,
refer to treatment of peptic ulcer. ...more »

Peptic Ulcer: Peptic ulcers are an inflammation of the stomach or duodenal lining. Once believed to
be caused by spicy food and stress, these have been found merely to be aggravating factors, and
the real causes have been found by research to include bacterial infection (H pylori) or reaction to
various medications, particularly NSAIDs. The identification of H. pylori ulcers has led to a cure for
this subtype that was discovered as recently as 1982. Whereas treatment used to involve bedrest
and antacids, modern treatment involves killing the H. pylori bacteria or removing the underlying
NSAID medication. ...more »