Peptic ulcer

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Symptoms of a peptic ulcer vary in intensity and can be difficult to recognize. The symptoms will change during the course of the day, and from day to day. Abdominal pain (classically epigastric) that is eased by eating or antacids is the most common complaint. Almost half of the patients that have this condition deny any correlation between the pain and meals. Another fairly common complaint is to wake up in the middle of the night because of abdominal pain. A history of heartburn, gastroesophageal reflux disease (GERD) and use of certain forms of medication can raise the suspicion for peptic ulcer. Reduced appetite and weight loss, nausea and vomiting as well as bloating and abdominal fullness is more linked to stomach ulcers than to duodenal ulcers. A bleeding ulcer can cause symptoms of anemia (you become faint, pale and dizzy).

About one out of four will experience complications caused by peptic ulcers. Elderly and people that frequently use NSAIDs are at larger risk of this. Gastrointestinal bleeding is the most common complication, perforation (a hole in the wall) can lead to dire consequences. Scarring and swelling due to ulcers causes retention (narrowing in the duodenum and gastric outlet obstruction). These patient often presents with severe vomiting. When NSAIDs is the cause of the condition, about 60% will not display any symptoms until a complication occurs. The reason for this is that the analgetic effect of the NSAIDs hide the symptoms.

  • Gastrointestinal bleeding. This complication occuirs in 15-20% of those with a peptic ulcer (the most common complication). Sudden large bleeding can be life threatening and is the most common cause of death in peptic ulcers. It occurs when the ulcer erodes one of the blood vessels. Up to about 20% of those who develop a gastrointestinal bleeding has not experienced any symptoms until the bleeding starts. Hematemesis (vomiting of blood) can occur due to bleeding directly from a gastric ulcer, or from damage to the esophagus from severe/continuing vomiting, and melena (tarry, foul-smelling faeces due to oxidized iron from hemoglobin) can cause the development of anemia.
  • Perforation(a hole in the wall). This complication will strike about 1-2% of the people with peptic ulcers. Erosion of the gastro-intestinal wall by the ulcer leads to spillage of stomach or intestinal content into abdominal cavity. Often the first sign of the complication is sudden intense abdominal pain, some people will complain of pain radiating to the back due to this condition. Perforation leads to acute peritonitis, a lift-threatening condition.
  • Retention. This is a condition tha will occur in less than 5% of those with a peptic ulcer. Scarring and swelling due to ulcers causes narrowing in the duodenum and gastric outlet obstruction. This can cause severe vomiting as the stomach needs adittional time to empty itself. Bloating and abdominal fullness can also be a result of this.
  • Malignant tumors. About 5% of the ulcers in the stomach are cused by malignant tumors. Duodenal ulcers are generally benign. Biopsies are the most common way of determening if the ulcer is benign. The biopsy is controlled by a patologist, and in that way checked for cancer of the stomach. This is why an upper GI endoscopy (UGIE) is very important with this condition. As a rule, all patients above the age of 50-55 should recive an UGIE.
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