The very mention of the word “ulcer” is likely to cause an internal, evidently physical discomfort. That’s exactly what peptic ulcers do. They cause a difficult-to-ignore burning pain in your stomach, sometimes in the dead of night, capable of stirring you awake. Misjudging this pain to be a simple case of indigestion may be your natural reaction. However, if this has been happening frequently, do not carelessly dismiss it because pain is your body’s way of signaling you to take care of yourself.
To make some sense and understand where the malfunction lies, we first need to understand what peptic ulcers are.
What Are Peptic Ulcers And How Are They Caused?
Duodenal ulcers are common in the middle-aged (between ages 30 and 50) and in men, whereas stomach ulcers are common in the elderly (older than 60) and in women.1
Peptic ulcers are open sores that develop in the lining of the esophagus, stomach, or duodenum (the beginning of your small intestines) when the protective mucus overlaying this lining is eroded.
The acid-resistant gut mucosa can be compromised because of:
- An H. Pylori bacterial infection2: This infection disrupts the integrity of the muscosal lining.
- Long-term use of NSAIDs (nonsteroidal anti-inflammatory drugs)3: NSAIDS include common OTC drugs like aspirin, ibuprofen, and naproxen.
- Zollinger-Ellison syndrome4: In this condition,abnormal gastrin secretion by tumors in the duodenum or pancreas cause stomach acids to be produced in excess of the normal. High concentrations of acid become too overbearing for the mucosal layer to counteract.
Whatever the reason for erosion of mucus, it leaves the stomach and duodenal lining exposed, vulnerable, and at the mercy of strong stomach acids.
Symptoms Of Peptic Ulcers
Proper medical identification of the root cause for peptic ulcer disease is obviously crucial for accurate diagnosis. However, with a little prelim self-diagnosis, you may be able to tack a stitch in time. Watch out for these symptoms.
1. A Dull, Burning, Or Hunger-like Abdominal Pain
Approximately 1 in 5 senior citizens suffering from abdominal pain are likely to have a peptic ulcer. Peptic ulcer disease accounts for 16 percent of older patients complaining of abdominal pain.5
The most predominant symptom of a peptic ulcer is abdominal discomfort – a gnawing or burning pain between the navel and the breast bone being most evident.6
- Duodenal ulcers generally cause a gnawing pain in the upper abdomen that encroaches on an empty stomach hours after eating.7 Eating some food may offer some relief.
- Stomach ulcers, on the other hand, cause a dull ache on a full stomach (just after a meal) or in the middle of the night.8 Consumption of food does not help and may only make matters worse.
Some individuals may experience an empty feeling in the stomach – a pain that feels like hunger – 1 to 3 hours after a meal.9
Peptic ulcer pain can last from a few minutes to hours and may intermittently keep troubling you over a span of days and even months.10
2. Bloating And Heartburn
To add to your visceral woes, bloat is another symptom of peptic ulcers.11 This stems from the general abdominal discomfort accompanying these ulcers.
Also, the burning sensation from the pit of your stomach may escalate toward your chest, imparting a heartburn-like sensation. 12
3. Poor Appetite And Inexplicable Weight Loss
Recurrent vomiting may further deteriorate your health by depriving your body of block-building nutrients.
4. Nausea And Vomiting
No surprises here! Problems with your body’s food processor is bound to manifest as nausea and vomiting.15 The stomach ache, bloating, and heartburn may collectively make you feel like your insides are churning and may tempt you to throw up.
5. Lower Back Pain
This seemingly unrelated warning sign may come as a surprise to most. However, it makes logical sense when you picture an ulcer in the back wall of your duodenum pressing against your vertebral column. This makes it necessary for health advisers to not entirely dismiss the possibility of peptic ulcers when diagnosing lower back pain.16
While there are no discrepancies in what the symptoms of peptic ulcers are across sexes and ages, the intensity of symptoms may vary according to your body’s constitution, the strength of your immune system, and certain habits.
Chronic smokers and alcoholics may experience more intense symptoms than others.
Smoking worsens symptoms of peptic ulcers triggered by an H. Pylori infection.17 It also increases risks of an H. pylori infection making you more susceptible to developing these ulcers or suffering the relapse of one.
Regrettably, alcohol too plays foe. Alcohol consumption further destroys your already-ulcer-destroyed stomach’s mucosal layer.18
Pregnant women may have less intense symptoms.
It was also previously believed that menstruation and menopause worsen peptic ulcer symptoms while pregnancy does the reverse.19 These hypotheses were linked to stress levels and hormonal imbalances. However, there is no concrete evidence yet to support these claims.
Indicators For Medical Emergencies
Often seemingly harmless peptic ulcers may worsen and cause more injurious, serious, and possibly fatal complications. Here are warning signs to watch out for.
- Bloody vomit (hematemesis): Strong stomach acids may sometimes abrase the stomach mucosa to the extent of exposing blood vessels and causing internal bleeding.20 Vomit resembling coffee grounds is a cause for concern.
- Abnormally dark stools (melena): Because of internal bleeding, stools may be tainted with blood because of which they appear dark in color. This again may signal a more serious complication.21
- A sudden sharp abdominal pain that worsens with time: An expanding peptic ulcer may penetrate the wall of the stomach or duodenum and is likely to cause unsuspecting severe abdominal pain.22
- Shock-like symptoms: Your body may cave under the immense pain and go into shock. So, pay heed to shock symptoms like excessive sweating, breathlessness, and lightheadedness.23
If one or more of these alarm bells ring, don’t hesitate to hasten to the nearest medical facility.
Peptic Ulcers Are Often Symptomless
About 30 percent of 60 year olds with confirmed peptic ulcer disease have no abdominal pain.24 This means 1 in 3 old people without the slightest hint of the major symptom of peptic ulcers actually have them.
As if it was not already challenging to diagnose what cannot be seen, sometimes individuals suffering from peptic ulcers do not experience any symptoms.
Older people and children are, unfortunately, at a higher risk of belonging to this no-symptoms niche. This increases the likelihood of a delayed diagnosis and grave complications like perforation and internal bleeding.
Another group of individuals who may struggle with identifying peptic ulcers are those who are heavily dependent on NSAIDs. Even though abdominal pain is the most prominent indicator of peptic ulcers, such is not always the case. To our dismay, 1 in 3 people with peptic ulcers don’t have any abdominal pain, particularly those popping NSAIDs.25 26 27 This resonates with research findings that NSAIDs mask the symptoms of peptic ulcers.28 It is, thus, advisable to exercise caution if you need to regularly take these painkillers to treat other conditions.
Having no symptoms or weak symptoms, hence, does not rule out the possibility of peptic ulcers.
Tips To Help Self-Diagnose Peptic Ulcers
The suspicion radar needs to be especially sensitive in the case of old people and children.
As is evident from the vague list of symptoms, it is outright difficult for one to self-diagnose peptic ulcers. Absence of symptoms, symptoms overlapping with other conditions (like gastroesophageal reflux disease, gastritis, and more serious stomach cancer), and poorly localized symptoms don’t help our cause. The first step in identifying peptic ulcers is a mere hunch. The following tips may help you become more aware.
- If you are in the habit of regularly popping antacids, we recommend you cut back on the frequency. Sit back and take note of the effects of one antacid. Predictably, it will give you relief. The real test is whether or not your symptoms resurface after the antacid wears out. If they do, peptic ulcers is a possibility. See a doctor.
- Observe patterns in the occurrence of your symptoms. Abdominal pain just after a meal, pain that feels like hunger, and pain that wakes you up at night should be looked upon with suspicion.
- When it comes to yourself, your old parents, or your children, bloody vomit, bloody stools, sudden sharp abdominal pain, and shock symptoms don’t need a second thought . Ditch the self-diagnosis and head to a medical facility.
- Regular checkups in the elderly may help in early and timely diagnosis of the disease before more fatal complications arise.
- Even though peptic ulcers are relatively rare in children compared with adults, parents must not let their guard down. 29 Encourage your child to express how they feel and keenly observe their behavior and movement. Peptic ulcers may occur in infants as well who may not be able to communicate their pain or discomfort. This makes it all the more necessary for parents to be alert and closely monitor their child’s behavior.
|↑1, ↑18, ↑22||Peptic Ulcer. Harvard Health Publications.|
|↑2, ↑3||Voutilainen, M., T. Mäntynen, Martti Färkkilä, M. Juhola, and P. Sipponen. “Impact of non-steroidal anti-inflammatory drug and aspirin use on the prevalence of dyspepsia and uncomplicated peptic ulcer disease.” Scandinavian journal of gastroenterology 36, no. 8 (2001): 817-821.|
|↑4||Metz DC. Diagnosis of the Zollinger-Ellison syndrome. Clinical Gastroenterology and Hepatology. 2012;10(2):126–130.|
|↑5||McCarthy DM. Acid peptic disease in the elderly. Clin Geriatr Med. 1991;7:231–54.|
|↑6, ↑13||Malfertheiner, Peter, Francis KL Chan, and Kenneth EL McColl. “Peptic ulcer disease.” The Lancet 374, no. 9699 (2009): 1449-1461.|
|↑7, ↑8, ↑9||Peptic Ulcers. University of Maryland Medical Center.|
|↑10, ↑11, ↑15, ↑20, ↑21||Symptoms and Causes of Peptic Ulcers (Stomach Ulcers). National Institute of Diabetes and Digestive and Kidney Diseases. National Institutes of Health.|
|↑12||Malfertheiner, P., J. Dent, L. Zeijlon, P. Sipponen, S. J. O. Veldhuyzen Van Zanten, C‐F. Burman, T. Lind, M. Wrangstadh, E. BayerdÖrffer, and J. Lonovics. “Impact of Helicobacter pylori eradication on heartburn in patients with gastric or duodenal ulcer disease—results from a randomized trial programme.” Alimentary pharmacology & therapeutics 16, no. 8 (2002): 1431-1442.|
|↑14||Peptic Ulcer. U.S. National Library of Medicine.|
|↑16||Weiss, David J., Theodore Conliffe, and Narayan Tata. “Low back pain caused by a duodenal ulcer.” Archives of physical medicine and rehabilitation 79, no. 9 (1998): 1137-1139.|
|↑17||Parasher, Gulshan, and Gregory L. Eastwood. “Smoking and peptic ulcer in the Helicobacter pylori era.” European journal of gastroenterology & hepatology 12, no. 8 (2000): 843-853.|
|↑19||Clark, Douglas H. “Peptic ulcer in women.” British medical journal 1, no. 4822 (1953): 1254.|
|↑23||Peptic Ulcer. Harvard Health Publications. 2014.|
|↑24, ↑27||Hilton D, Iman N, Burke GJ, Moore A, O’Mara G, Signorini D, et al. Absence of abdominal pain in older persons with endoscopic ulcers: a prospective study. Am J Gastroenterol. 2001;96:380–4.|
|↑25||Kauvar DR. The geriatric acute abdomen. Clin Geriatr Med. 1993;9:547–58.|
|↑26||Rothrock SG, Greenfield R, Falk JL. Acute abdominal emergencies in the elderly: clinical evaluation and management. Part II – Diagnosis and management of common conditions. Emerg Med Reports. 1992;13:185–92.|
|↑28||Mellem, H., R. Stave, J. Myren, M. Osnes, L. E. Hanssen, J. Mosvold, and K. Hebnes. “Symptoms in patients with peptic ulcer and hematemesis and/or melena related to the use of non-steroid anti-inflammatory drugs.” Scandinavian journal of gastroenterology 20, no. 10 (1985): 1246-1248.|
|↑29||H. Shu-Ching, S. Bor-Shyang, L. Shui-Cheng, et al., “East etiology and treatment of childhood peptic ulcer disease in taiwan: a single center 9-year experience,” African Medical Journal, vol. 86, no. 3, pp. 100–109, 2009.|