We call peptic ulcer lesions that appear on the most superficial layer of the mucous lining of the stomach or duodenum (first portion of the small intestine). When the ulcer appears in the stomach, it is called gastric ulcer; when it appears in the duodenum, it is called duodenal ulcer.
As is known, the stomach produces hydrochloric acid, a substance that helps in food digestion process. Usually, the interior of our stomach acid has a pH around 4 to 5. However, when we eat, the production of hydrochloric acid rises and the pH of the stomach can drop to 1 or 2, making it an extremely means acid and hostile to any organic element.
For all of that acid produced does not corrode the wall of the stomach itself, it is coated with a thick layer of mucus, which serves as protection for the mucosa (tissue that covers the inner wall).
The ulcers occur when there is a fault in this protection either because the amount of mucus was reduced or because the amount of acid became excessive. Regardless of the cause, peptic ulcers arise when the acid in the digestive tract corrodes the wall surface inside of the stomach or duodenum. The acid contact with the mucous can open a wound, whose most common symptoms are pain and bleeding (gastrointestinal bleeding).
In this article we make a review of the main symptoms of gastric ulcer and duodenal ulcer.
Differences between the symptoms of peptic ulcer and gastric ulcer
The two forms of peptic ulcer disease have very similar performances. In fact, in most cases, peptic ulcers often asymptomatic or have little relevant symptoms, whether they are in the duodenum or stomach. When really there are symptoms, both bleeding and abdominal pain are the most common forms of presentation.
Pain intensity has no direct relationship to the severity or the size of the ulcer. Indeed, as we will explain to the front, ulcers that cause gastrointestinal bleeding are usually those that have developed asymptomatically.
The pain of peptic ulcer is usually called dyspepsia, which is effectively the name used to describe a variety of symptoms originated in the stomach, which include burning in the stomach, stomach pain, indigestion, upset stomach, fullness, bloating, stomach distended, etc. Dyspepsia is both ulcers and in gastritis.
In accordance with the following we will explain, there are some details that differentiate the pain of duodenal gastric ulcer pain, for example, its relation with feeding and time of day that the pain is more intense. However, these differences are often subtle, which in most cases does not allow us to state with precision the location of the ulcer without the help of endoscopy. It is not uncommon for a patient with a more similar complaint with duodenal ulcer has actually a stomach ulcer or gastritis only.
Gastric ulcer is more common in patients over 50 years, while duodenal ulcer typically affects young adults, from 25 years. However, again, this is not a rule. Seniors can have duodenal ulcer and young people can have gastric ulcer.
The stomach ulcers often have abdominal pain as the main symptom. The pain of gastric ulcer is usually a pain or discomfort like a burning sensation or a feeling of something eating away at the stomach, which usually is located in the upper region of the abdomen, about 4 fingers above the navel, location that laymen call it pain in the stomach.
Occasionally, this discomfort of stomach ulcer is located just below the ribs on the right or left, in the region called hypochondria. In some patients, the pain may radiate to the back. However, pain in the back alone is usually not a typical presentation of stomach ulcers.
Contrary to what occurs in the duodenum ulcer, pain stomach ulcer usually deteriorate soon after meals, especially in cases in which gastric ulceration is the pylorus terminal region of the stomach connects with the duodenum. In some cases, the ulcer in the pyloric region may cause swelling of mucosa and obstructing the passage of food, causing epigastric sense of fullness (full stomach), early satiety (satisfied with a small amount of food) and food vomiting after meals.
Other possible symptoms of stomach ulcer are increased belching (burping), intolerance to fatty foods and nausea and occasional vomiting.
Gastric ulcers may not cause any symptoms and is only discovered when the patient presents a gastrointestinal hemorrhage. Patients who have asymptomatic ulcers are those that have increased risk of bleeding, since as such ulcers are not diagnosed, they can continue their gastric mucous erosion process to the point where they meet a blood vessel. When the vessel undergoes corrosion bleeding arises.
The patient with bleeding ulcer can have 4 types of clinical presentation:
If bleeding is small, but steady, the amount of blood will not be enough to change the characteristics of the stool or to cause bloody vomiting. However, the continued loss of small volumes of blood leads in the medium term, the emergence of anemia by iron deficiency. In such cases of anemia without apparent cause, upper gastrointestinal endoscopy is able to make the diagnosis.
If bleeding is moderate, the patient may have bloody vomiting (called hematemesis) or very dark stools, which are the result of digestion of blood as it passes through the intestines. This type of stools and dark digested blood is called melena, it has a very strong and unpleasant odor and usually has a well pasty consistency.
If bleeding ulcer is bulky, the patient usually has vomiting of living and abundant blood, and feces also with fresh blood, because the speed and volume of blood is so great that there's no time for it to be digested and transformed into melena.
In addition to the gastrointestinal bleeding, another serious complication of gastric ulcer is the perforation of the stomach. If the ulcer is asymptomatic and not find a large vase by the way, it continues its wall corrosion process the stomach to make a hole on the other side. Symptoms of perforation are a sudden abdominal pain associated with a belly rigidity.
As mentioned above, the symptoms of duodenal ulcer are very similar to those of gastric ulcer. Much of what has been described above apply to this topic.
However, it is worth drawing attention to possible differences. In general, duodenal ulcer hurt more usually in the periods between meals and during the night fasting. The "classic" pain of duodenal ulcers occurs two to five hours after a meal and between 23:00 and 02:00, time of day in which the pH of the duodenum is usually lower.
Dyspepsia of duodenal ulcers is usually relieved by food, while gastric ulcers can get worse. But this is not a rule.
Regarding complications, bleeding from duodenal ulcer usually causes melenas more often than bloody vomiting. Already the bleeding stomach ulcers often cause hematemesis.
Duodenal ulcers usually causes no obstruction to the passage of food.
