Dyspepsia and Other Symptoms of Peptic Ulcers

The most common symptoms of peptic ulcers are known collectively as dyspepsia, and they encompass a variety of problems in the upper abdomen, including pain, discomfort, bloating, fullness, nausea, heartburn, regurgitation, and belching. Dyspepsia may be persistent or recurrent. Pain can be either localized in one place or diffuse. It may be described as burning, gnawing, or aching in the upper abdomen or, in some cases, as a stabbing pain penetrating through the width of the gut. Sometimes pain radiates to the back or to the chest behind the breastbone where it seems like heartburn. Symptoms usually occur one to three hours after a meal and can include dyspepsia or even hunger and a feeling of being empty. Eating a meal usually relieves the pain of a duodenal ulcer but does not relieve pain from gastric ulcers and may even worsen them. Vomiting may relieve symptoms. Peptic ulcer disease can also occur with only a feeling of indigestion or mild nausea or even without dyspepsia or other symptoms at all, especially when they are caused by NSAIDs. Because ulcers can cause chronic and hidden bleeding, patients may experience the symptoms of anemia, including fatigue and shortness of breath. 

Emergency Symptoms

A sudden onset of symptoms, such as severe abdominal pain even without vomiting or external bleeding, may indicate perforation and emergency conditions. Tarry, black or bloody stools, vomiting of blood, or vomiting of a substance with the appearance of coffee grounds could be the sign of a serious hemorrhage. Persons who experience any of these symptoms should go to the emergency room immediately.

Bleeding and Perforation

Although peptic ulcers are rarely lethal, the disease can be very serious if it progresses to the point of hemorrhage or perforation of the stomach or duodenum. Of the people who get ulcers, up to 15% will experience some degree of bleeding. Fortunately, the incidence is declining with the introduction of effective treatments, but it is still one of the most common medical emergencies. Bleeding is more apt to occur with ulcers caused by nonsteroidal anti-inflammatory drugs (NSAIDs) than those caused by the bacteria H. pylori. NSAIDs cause bleeding in 1% to 2% of people who are taking them. NSAID-related stomach problems may be responsible for 60,000 hospital admissions and over 3,000 deaths each year in American patients. Because there are usually no symptoms until bleeding begins, physicians cannot predict which patients taking these drugs will develop bleeding, although elderly patients and those with serious conditions, such as congestive heart failure, are at greatest risk. The mortality rate for bleeding peptic ulcers is about 10%. The risk for a poor outcome is increased by certain factors, including ongoing bleeding, abnormal blood-clotting tests, low systolic blood pressure, mental instability, and the presence of another serious, unstable medical condition. 

Obstruction

Ulcers that form where the small intestine joins the stomach can swell and scar, resulting in a narrowing or closing of the intestinal opening. In such cases, a patient will vomit the entire contents of the stomach and emergency procedures are necessary. 

Stomach Cancer

Between 30% and 90% of stomach, or gastric, cancers are linked to H. pylori, and people with stomach ulcers from the bacteria are at twice the risk for stomach cancer than those without such ulcers. Those with duodenal ulcers, however, appear to be at lower risk for stomach cancer. Some evidence exists that people who harbor the specific, virulent H. pylori genetic strain called cagA are at even higher risk for stomach cancer.

Heart Disease

Some research had reported a very high rate of H. pylori infection in men with coronary artery disease, but more recent work has found no relationship between the bacteria and a risk for heart disease. 

Migraine Headaches

One study found an association between H. pylori and migraine headaches in people who also have gastrointestinal problems. Eliminating the bacteria reduced the frequency and intensity of migraines in half of these patients.