- 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 copious vomiting;
- loss of appetite and weight loss;
- hematemesis (vomiting of blood); this can occur due to bleeding directly from a gastric ulcer, or from damage to the Oesophagus from severe/continuing vomiting.
- melena (tarry, foul-smelling feces 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 two 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.