Gastric ulcers, also known as stomach ulcers are one of two types of ulcers that affect the stomach and small intestine. An ulcer can be defined as a break in the continuity of the skin or mucous lining due to multiple reasons such as acid overload, drug abuse, stress, and infections. Similarly, stomach ulcers are a discontinuity in the stomach lining that leads to various troublesome signs and symptoms. They occur when the thick mucus layer that protects the stomach from harsh acid and digestive juices is reduced or broken down. It allows acid to digest the tissues and stomach lining, causing a stomach ulcer.
Peptic ulcers (stomach ulcers + duodenal ulcers) are common among men and elderly around the world. They may affect 10-15% of the population. The most common causes of stomach ulcers include long term use of aspirin or other nonsteroidal anti-inflammatory drugs such as Aleve, Advil, etc. and infection with the bacterium H. Pylori., Although spicy foods and stress don’t cause stomach ulcers, they can aggravate the underlying condition and make your symptoms worse.
The most common signs and symptoms of gastric ulcers include;
1) Upper Abdominal Pain
Although upper abdominal pain is the most common symptom, approximately 50% of people with stomach ulcers don’t experience this symptom at all. The affected person may experience an aching, burning or gnawing pain between the breast bone and the belly button (navel). Its aggravating factors include taking aspirin or NSAIDs, stress and spicy foods. It may also radiate towards the back. The pain can last for a few hours and may go and come back for weeks.
Interestingly, the pain of stomach ulcers aggravates when your stomach is empty while that of duodenal ulcers relieve in this condition. This is due to the fact that stomach acid and other digestive enzymes are diluted by the food you eat. Dilution of digestive secretions don’t cause irritation of the stomach lining and thus provide temporary relief. This association of pain aggravation or relief is also important to differentiate the origin of pain, i.e, stomach or duodenal ulcers.
The pain may become worse at night and 2-3 hours after a meal due to mucosal irritation by acid. It usually goes away for a while after you take an antacid or acid reducer. If your condition becomes chronic and you feel a sudden onset of severe upper abdominal pain, it can be due to perforation of the stomach ulcers that indicate a medical emergency and will be discussed later in this article.
2) Indigestion
The indigestion of food is a common symptom in people with stomach ulcers. It usually causes pain and discomfort in the stomach area. It can also lead to several conditions secondary to indigestion such as anemia and malabsorption. The most common complication of indigestion is fatty food intolerance that may cause gas, bloating and abdominal cramps.
3) Tender Abdomen
Feeling pain on touch is termed as tenderness. It is a non-specific symptom of stomach ulcers that causes a rigid, hard abdomen that is tender to touch. Applying pressure on the ulcerated area can irritate the stomach lining and causes pain. This method was used by doctors in the past to locate or give a rough idea about the location of ulcers in the stomach. It is now obsolete due to the emergence of modern imaging techniques like ultrasound and endoscopy.
4) Heartburn
Heartburn is characterized by pain in the lower part of the chest or throat. Stomach ulcers can cause heartburn due to acid reflux or gastroesophageal reflux disease (GERD) that can develop as a complication of ulcers. It feels slightly upper from the stomach and usually misunderstood by most patients as upper abdominal pain.
5) Vomiting
Vomiting is another common symptom of gastric ulcers. It may vary from person to person in both incidence and frequency. You may experience vomiting after every meal or 1-2 times a day. The vomitus is usually yellow and contains stomach material and freshly eaten food. It may also be followed by abdominal pain or cramps.
Bleeding occurs from an ulcer site if there is a broken blood vessel in the stomach or an ulcer has eaten its way into the blood vessel. It will appear as fresh or occult blood in the vomitus. If you experience fresh or coffee-colored blood in the vomitus, which only happens with severe ulcers and indicates the erosion of the stomach lining, call your health care provider right away.
6) Colored Stools
Although this symptom is not very common, if present, it may indicate that the disease has progressed. You may experience dark brown or black colored stools (looks like black tar) with normal frequency (no associated diarrhea or constipation). The black color is due to occult blood and shows that the bleeding point (stomach) is away from the anus (the exit point).
Of note, you will never experience fresh blood in the stools because that indicates that the bleeding point is near the anus. If you are experiencing this, it can’t be due to stomach ulcers and you may have some other gastrointestinal problems.
7) Loss of Appetite
Loss of appetite or anorexia is a common symptom of most gastrointestinal diseases. It usually occurs when the disease progresses and becomes chronic. The other associated factors like abdominal pain, cramping, vomiting, and stress play a major role in the loss of appetite. You may feel full after eating a small portion of food followed by bloating and belching. Catching the disease earlier and following proper treatment can reverse these symptoms.
8) Bloating or Nausea After Eating
Bloating and feeling nauseated is a common sign of peptic ulcer disease (gastric + duodenal ulcers). It is characterized by a strong sensation of an urge to vomit. It is also one of the commonest reasons behind loss of appetite. Usually it is acute and short-lived, however, when prolonged, it can become debilitating.
9) Fatty Food Intolerance
Intolerance towards fatty food is a common symptom of gastric ulcers. A person with gastric ulcers is unable to digest fats, and this leads to oily or greasy stools, medically known as “steatorrhea”. Although fatty stools are more common in other gastrointestinal diseases like celiac disease and ulcerative colitis, they can also develop in patients with stomach or duodenal ulcers. These stools have a characteristic smell and they are difficult to flush. The reason behind fatty food intolerance is the absence of enzymes that digest fats.
Fatty stools rob the body of many important micronutrients such as fat-soluble vitamins (Vitamin A, D, K, and E). A deficiency of these important vitamins can lead to several conditions such as night blindness (due to vitamin A deficiency), malabsorption of calcium and phosphate (due to vitamin D deficiency), deranged functions of blood clotting factors (due to vitamin K deficiency), and disorientation and muscle weakness (due to the deficiency of vitamin E). Furthermore, with steatorrhea comes malabsorption due to diarrhea caused by the undigested fats. Chronic malabsorption along with the loss of appetite can lead to weight loss.
10) Weight Loss
Weight loss can occur in 40-50% of people suffering from stomach ulcers. It is not sudden and may progress gradually in several months. Weight loss is not directly linked to stomach ulcers, rather it occurs secondary to other symptoms and conditions such as loss of appetite, feeling full after eating a small portion of food, fatty food intolerance, and bloating. Subsiding of these signs and symptoms after proper treatment can reverse the weight loss in weeks to months.
11) Anemia
Anemia is a late symptom that can develop as a complication of chronic stomach ulcers. It can turn your skin and sclera pale and leads to shortness of breath, easy fatiguability and tiredness all the time. The type of anemia you can develop could be hemolytic anemia (due to loss of blood through vomiting or feces) or macrocytic anemia. The reason behind the latter includes deficiency of Vitamin B12 due to fat intolerance and malabsorption.
Anemia should be dealt with separately and you should take measures to uplift your declining hemoglobin levels. Depending on the cause, your doctor may prescribe blood transfusion or multivitamins to treat this condition.
12) Obstruction
A stomach ulcer located at the end of the stomach (antral area) can cause sphincter or intestinal obstruction. It is due to inflammation or scarring of the stomach ulcers in the antrum that can narrow or close the intestinal lumen. It prevents food to move from your stomach into the duodenum. This further leads to the accumulation of food in the stomach, resulting in vomiting the food contents and acid. The vomiting that results from stomach or intestinal obstruction is called “projectile vomiting” as it ejects the gastric contents with great force.
13) GERD
Gastroesophageal reflux disease or GERD is one of the most drastic complications of stomach ulcers. This condition is more common in people with stomach ulcers near the duodenum. When obstruction becomes chronic, it leads to the regurgitation of stomach contents (acid + other digestive juices) in the esophagus. Heartburn is the most common symptom of GERD that usually aggravates when you lay down or eat spicy foods.
14) Perforation
If you are suffering from stomach ulcers for months or years and suddenly feel intense pain in the upper abdomen, then it could be due to perforation of an ulcer. Perforation means the formation of a hole in the lining of the stomach or intestine. It is a very serious condition in which acid and other digestive juices can seep into the abdominal cavity and causes damage to the other organs. An perforated ulcer can lead to burning of the stomach or intestinal wall, inflammation or infection of the surrounding tissues. Its symptom includes severe pain and burning sensation in the abdomen.
People who are regularly taking NSAIDs or aspirin as a treatment of arthritis are more prone to develop this condition. If you are already a diagnosed patient of stomach ulcers and experience these symptoms, quickly rush to seek medical attention.
15) Hemorrhage and Shock
Perforation of an ulcer can result in bleeding from the surrounding blood vessels. If bleeding is severe and not treated promptly, it can lead to shock. Shock results from excessive loss of blood from the body. Its main symptoms include active bleeding (internal or external), lightheadedness, fainting, low blood pressure, rapid pulse and shortness of breath. It is a potentially life-threatening condition and should be treated quickly in the hospital.
If you are experiencing any of these symptoms, especially the dangerous ones, don’t waste your time and consult your healthcare provider. In the majority of the cases, the underlying cause is an infection by H. Pylori that can be treated by specific antibiotics. If the underlying cause is overuse of NSAIDs, your doctor will recommend you to immediately stop the medicine and replace them with other options.