What are the signs and symptoms of a peptic (peptic ulcer disease) ulcer?

From the Guidelines

Peptic ulcers typically present with burning or gnawing pain in the upper abdomen, often occurring between meals or at night when the stomach is empty, and may be accompanied by other symptoms such as bloating, belching, and weight loss, with severe signs including vomiting blood, dark or tarry stools, and severe abdominal pain, which require immediate medical attention 1. The symptoms of peptic ulcers can vary, but common signs and symptoms include:

• Burning or gnawing pain in the upper abdomen
• Pain that occurs between meals or at night
• Pain that improves with food or antacids
• Bloating and belching
• Feeling of fullness
• Nausea and vomiting
• Poor appetite and weight loss More severe signs that require immediate medical attention include:
• Vomiting blood or coffee ground-like material
• Dark or tarry stools
• Severe and persistent abdominal pain
• Unexplained weight loss It is essential to seek medical attention promptly if any of these warning signs occur, as they could indicate complications such as bleeding, perforation, or obstruction 2. In patients with suspected complicated peptic ulcer disease, prompt recognition, resuscitation, and appropriate antibiotic therapy are crucial, along with timely surgical or radiological treatment 1. The management of peptic ulcers involves various subspecialties, including surgeons, gastroenterologists, and radiologists, and requires a multidisciplinary approach to improve patient outcomes 1. Non-operative management may be considered in extremely selected cases of perforated peptic ulcer, where the perforation has sealed, and the patient is stable, but surgery is often necessary to prevent further complications 3.

From the Research

Peptic Ulcer Signs and Symptoms

• Peptic ulcer disease affects 1% of the population in the US, with approximately 54,000 patients admitted to the hospital annually for bleeding peptic ulcers 4
• The principal causes of peptic ulcer disease are Helicobacter pylori infection (affecting approximately 42% of patients) and aspirin or nonsteroidal anti-inflammatory drug (NSAID) use (affecting approximately 36% of patients) 4
• Complications of peptic ulcer include bleeding (73% of patients), perforation (9% of patients), and pyloric obstruction (3% of patients) 4
• Approximately 10% of patients presenting with upper abdominal pain in a primary care setting have a peptic ulcer as the cause of their symptoms 4

Diagnosis and Treatment

• Endoscopy definitively diagnoses peptic ulcer disease 4
• Acid blockers, such as omeprazole, can heal peptic ulcers in approximately 80% to 100% of patients within 4 weeks, but gastric ulcers larger than 2 cm may require 8 weeks of treatment 4
• Eradication of H. pylori decreases peptic ulcer recurrence rates from approximately 50% to 60% to 0% to 2% 4
• Discontinuing NSAIDs heals 95% of ulcers identified on endoscopy and reduces recurrence from 40% to 9% 4
• Proton pump inhibitors (PPIs) are effective in preventing gastrointestinal lesions induced by NSAIDs, with a significant reduction in ulcer complications and endoscopic peptic ulcers 5
• Omeprazole is a well-studied proton pump inhibitor that reduces gastric acid secretion and is effective in treating Helicobacter pylori infection, gastro-oesophageal reflux disease, and peptic ulcers induced by NSAIDs 6

Prevention of Recurrence

• Recurrence of ulcers can be prevented by eradicating H. pylori if present and discontinuing aspirin or NSAIDs if applicable 4
• Long-term therapy with a proton pump inhibitor may be useful in patients with H. pylori-negative ulcers, which are more aggressive and have higher recurrence rates 7
• PPIs, such as lansoprazole and omeprazole, can reduce ulcer recurrence rates in patients who require continuous NSAID therapy 7, 5