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.