Peptic ulcer history and symptoms

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:  ;Manpreet Kaur, MD [2]

History and Symptoms

Symptoms of a peptic ulcer can be:

• Abdominal pain, classically epigastric with severity relating to mealtimes, after around 3 hours of taking a meal (duodenal ulcers are classically relieved by food, while gastric ulcers are exacerbated by it);
• Bloating and abdominal fullness
• Waterbrash (rush of saliva after an episode of regurgitation to dilute the acid in esophagus)
• Nausea, and lots of vomiting
• Loss of appetite and weight loss;
• Hematemesis (vomiting of blood); if the blood is just streaks, then the esophagus probably got hurt from all the vomitting.
• Melena (tarry, foul-smelling faeces due to oxidized iron from hemoglobin)
• Rarely, an ulcer can lead to a gastric or duodenal perforation. This is extremely painful and requires immediate surgery.

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 include NSAID (non-steroid anti-inflammatory drugs) that inhibit cyclooxygenase, and most glucocorticoids (e.g. dexamethasone and prednisolone).

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).

The timing of the symptoms in relation to the meal may differentiate between gastric and duodenal ulcers: A gastric ulcer would give epigastric pain during the meal, as gastric acid is secreted, or after the meal, as the alkaline duodenal contents reflux into the stomach. Symptoms of duodenal ulcers would manifest mostly before the meal — when acid (production stimulated by hunger) is passed into the duodenum. However, this is not a reliable sign in clinical practice.

Overview

The hallmark of peptic ulcer disease is an episodic epigastric pain (pain relieved with taking food, antacids, pain occurs in between the meals and cause awakening at nights).A positive history of epigastric pain and use of NSAIDs is suggestive of peptic ulcer disease. The most common symptoms of peptic ulcer disease include episodic epigastric pain, heartburn, and hematemesis. Less common symptoms of peptic ulcer disease include indigestion, intolerance to fatty foods, and loss of appetite.

History and Symptoms

• The majority of patients with the peptic ulcer disease are symptomatic but some people don't show any symptoms, present as a silent ulcer.
• The hallmark of peptic ulcer disease is an episodic gnawing or burning epigastric pain; occurs two to five hours after meals or on an empty stomach; and nocturnal pain relieved by food intake, antacids, or antisecretory agents. A positive history of episodic epigastric pain and use of NSAIDs is suggestive of peptic ulcer disease. The most common symptoms of peptic ulcer disease include episodic epigastric pain.
• Symptoms of peptic ulcer disease include episodic epigastric pain, bloating after eating food and heartburn. 

History

Patients with peptic ulcer disease may have a positive history of:

• Episodic epigastric pain
• Use of NSAIDs
• Heartburn

Common Symptoms

Common symptoms of [disease] include:

• Episodic epigastric pain
• Heartburn
• Hematemesis

Less Common Symptoms

Less common symptoms of peptic ulcer disease include

• Indigestion
• Intolerance to fatty food
• Loss of appetite
• Positive family history

References

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