Clinical features

The classical symptom of peptic ulcer is upper abdominal pain which is described as indigestion, heartburn, dyspepsia, hunger pain, soreness etc. It may vary in intensity from mild to severe and tends to occur after eating. The pain is relieved by eating food, drinking milk or taking simple antacids. However certain types of food e.g. spicy foods, citrus fruit, may exacerbate the pain. The pain may occur at night. Untreated the pain remits and relapses with flare-ups lasting several days or weeks. A minority of people with peptic ulcers, often the elderly, experience no pain at all.

It is worthy noting however that indigestion is a common symptom in the general population, and does not necessarily indicate the presence of an ulcer. Associated ulcer symptoms include nausea, feelings of fullness, vomiting, poor appetite and weight loss.

There are often few findings on clinical examination apart from some mild tenderness in the upper abdomen.

Complications

Complications are uncommon because treatment is usually successful. Elderly people are more likely to development complications than younger adults. The complications include-

• Minor recurrent bleeding causing anaemia.
• Difficulty in swallowing
• Unintended weight loss.
• Haematemesis (severe sudden copious bleeding from the ulcer leading to vomiting of blood) and melaena (internal bleeding into the intestine with passage of black tarry faeces). The haemorrhage may cause sudden collapse and is potentially life threatening.
• Perforation – the contents of the stomach or duodenum empty into the abdominal cavity, if the ulcer breaches the entire wall of the gut. This may cause a life threatening peritonitis if not treated by surgery.
• Recurrent symptoms despite initial successful treatment.

Amended April 2008