Symptoms:

Dyspepsia. The most common symptoms of peptic ulcer are known collectively as dyspepsia. However, peptic ulcers can occur without dyspepsia or any other gastrointestinal symptom, especially when they are caused by NSAIDs. Dyspepsia may be persistent or recurrent and can lead to a variety of upper abdominal symptoms, including:

• Pain or discomfort
• Bloating
• A feeling of fullness -- people with severe dyspepsia are unable to drink as much fluid as people with mild or no dyspepsia
• Hunger and an empty feeling in the stomach, often 1 - 3 hours after a meal
• Mild nausea (vomiting may relieve symptoms)
• Regurgitation (sensation of acid backing up into the throat)
• Belching
• Occasionally, symptoms of GERD are present

Many patients with the above symptoms do not have peptic ulcer disease or any other diagnosed condition. In that case, they have what is called functional dyspepsia.

Ulcer Pain. Some symptoms are similar to those of gastric ulcers, although not everyone with these symptoms has an ulcer. The pain of ulcers can be in one place, or it can be diffuse (all over the abdomen). The pain is described as a burning, gnawing, or aching in the upper abdomen, or as a stabbing pain penetrating through the gut. The symptoms may vary depending on the location of the ulcer:

• Duodenal ulcers often cause a gnawing pain in the upper stomach area several hours after a meal, and patients can often relieve the pain by eating a meal.
• Gastric ulcers may cause a dull, aching pain, often right after a meal; eating does not relieve the pain and may even worsen it. Pain may also occur at night.

Ulcer pain may be particularly confusing or disconcerting when it radiates to the back or to the chest behind the breast bone. In such cases it can be confused with other conditions, such as a heart attack.

Because ulcers can cause hidden bleeding, patients may experience symptoms of anemia, including fatigue and shortness of breath.

Emergency Symptoms

Severe symptoms that begin suddenly may indicate a blockage in the intestine, perforation, or hemorrhage, all of which are emergencies. Symptoms may include:

• Tarry, black, or bloody stools
• Severe vomiting, which may include blood or a substance with the appearance of coffee grounds (a sign of a serious hemorrhage) or the entire stomach contents (a sign of intestinal obstruction)
• Severe abdominal pain, with or without vomiting or evidence of blood

Anyone who experiences any of these symptoms should go to the emergency room immediately.

Peptic ulcers may lead to emergency situations. Severe abdominal pain, with or without evidence of bleeding, may indicate that the ulcer has perforated the stomach or duodenum. Vomiting of a substance that resembles coffee grounds or the presence of black tarry stools may indicate serious bleeding.