What Does a Peptic Ulcer Feel Like and Where
Peptic ulcer disease typically causes epigastric pain—a discomfort or burning sensation located in the upper central abdomen, between the breastbone and navel—that characteristically improves with food intake or antacids and often awakens patients at night or occurs between meals. 1, 2
Location of Pain
- The pain is centered in the epigastrium (upper central abdomen), which is the hallmark anatomical location for peptic ulcer disease 1, 2
- Pain may occasionally radiate to the chest (retrosternal pain), particularly when gastritis or esophagitis coexist with the ulcer 1
- Unlike irritable bowel syndrome, the abdominal pain in peptic ulcer disease is unrelated to the need to defecate 3
Quality and Characteristics of the Pain
- Epigastric discomfort or burning is the most common sensation, rather than sharp or stabbing pain 1, 2
- Pain that is relieved by food intake or antacids is highly characteristic of peptic ulcer disease 2
- Nocturnal pain that awakens the patient from sleep is a classic feature 2, 4
- Pain occurring between meals (when the stomach is empty) is typical 2
Associated Symptoms
- Loss of appetite and weight loss may accompany the pain 2
- Nausea and vomiting can occur, though persistent vomiting suggests complications or another diagnosis 1, 5
- Most patients with peptic ulcer disease remain asymptomatic, with only approximately 10% of patients presenting with upper abdominal pain in primary care having a peptic ulcer as the cause 6, 7
Critical Warning Signs Requiring Urgent Evaluation
- Sudden, severe epigastric pain with fever and abdominal rigidity suggests perforation, a life-threatening complication with mortality rates up to 30% if treatment is delayed 1, 8
- Hematemesis (vomiting blood) or melena (black, tarry stools) indicates bleeding, the most common complication occurring in 73% of complicated cases 1, 6
- Occult blood in stool indicates gastrointestinal bleeding even without visible blood 1
- Persistent vomiting, unexplained weight loss, or difficulty swallowing are alarm features mandating urgent endoscopy 5
Common Pitfalls to Avoid
- Do not dismiss epigastric pain as "just indigestion" without considering cardiac causes, especially in women, diabetics, and elderly patients, as myocardial infarction can present with epigastric pain and carries 10-20% mortality if missed 8
- The symptoms of peptic ulcer disease overlap extensively with gastroesophageal reflux disease, gastritis, and functional dyspepsia, requiring careful evaluation 1, 5
- Approximately 66% of patients with GERD and heartburn also experience epigastric pain, making differentiation challenging 8
- The combination of H. pylori infection and NSAID use synergistically increases bleeding ulcer risk more than sixfold 4