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Health Protocols

Peptic Ulcers

Symptoms And Complications

Common Symptoms

Up to 40% of all patients with uncomplicated peptic ulcer disease do not have symptoms. Older people in particular are likely to be symptom free (DiMarino 2016a; Kuipers 2012).

Pain is the most common symptom of peptic ulcer disease, and is often felt in the upper abdomen. It is often described as gnawing, burning, or tenderness that may be relieved by food or antacids (Lee 2013; DiMarino 2016a). Because ulcer pain may radiate to the back, chest, and other parts of abdomen, it is sometimes mistaken for other problems, including a heart attack (Ferri 2016; UMMC 2012). Pain that disrupts nighttime sleep often indicates a duodenal ulcer (DiMarino 2016a).

Other possible symptoms include nausea, vomiting, and heartburn. Severe abdominal pain, loss of appetite, weight loss, black or bloody stools, and vomiting that may include blood could indicate an ulcer complicated by bleeding or perforation; anyone experiencing these symptoms should seek medical care immediately (Kuipers 2012).


Bleeding internally is the most common complication, occurring in up to 15% of patients with peptic ulcer disease. Ulcers caused by NSAIDs are more likely to bleed than those caused by H. pylori (UMMC 2012; Milosavljevic 2011).

Perforation, in which ulcers breach the wall of the duodenum or stomach, causing damage to nearby tissues and organs, occurs more commonly in older patients and is a medical emergency requiring surgical intervention. Perforation occurs in 2% to 10% of peptic ulcers. When perforation directly affects an organ it is called penetration (Ramakrishnan 2007; Meyer 2015).

Obstruction that blocks stomach emptying can result from inflammation, spasm, or scarring from recurrent ulcers. Symptoms of obstruction include repeated vomiting as well as sustained fullness and bloating after eating (Ramakrishnan 2007; Meyer 2015).

H. pylori-associated peptic ulcer disease increases by three- to six-fold the risk of developing stomach cancer later in life (DiMarino 2016a).