Clinical characteristics of peptic ulcer

Written by Jiang Guo Ming
Gastroenterology
Updated on September 01, 2024
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The main cause of peptic ulcers is believed to be infection by Helicobacter pylori. Other factors such as smoking, alcohol, poor diet, living habits, medication use, or emotional issues can also play a role. Clinically, these ulcers are often characterized by upper abdominal pain. In the case of gastric ulcers, the pain is primarily in the upper left abdomen or below the sternum, and can manifest as dull pain, blunt pain, or a feeling of distension. This pain is often more apparent after meals, commonly occurring half an hour to an hour after eating, and usually subsides two to three hours later. Duodenal bulb ulcers are characterized by upper abdominal muscular pain, occurring around two centimeters above and to the right of the navel, sometimes accompanied by nighttime pain. If the ulcer is located behind the bulb, back pain can also occur. Peptic ulcers can lead to other complications, such as perforation, bleeding, or even cancer.

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Written by Jiang Guo Ming
Gastroenterology
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The main symptoms of peptic ulcers

Common types of peptic ulcers, including gastric ulcers, duodenal bulb ulcers, complex ulcers, and anastomotic ulcers after gastric resection, share common characteristics and have their own distinct symptoms. Abdominal pain is a usual symptom. The pain from duodenal bulb ulcers tends to be dull, bloating, or blunt, and it is generally more noticeable when hungry. The pain often eases after eating as food neutralizes stomach acid. Sometimes, there is pain at night. If the ulcer is beyond the bulb or is a penetrating ulcer, it often comes with back pain; gastric ulcers primarily manifest as postprandial pain, meaning pain occurring half an hour to an hour after eating, which gradually alleviates; complex ulcers often present with both types of symptoms mentioned above. As peptic ulcers are often associated with excessive stomach acid, symptoms like acid reflux, heartburn, and nausea are common.

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Gastroenterology
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Causes of Peptic Ulcers

Peptic ulcers, which include gastric ulcers, duodenal bulb ulcers, complex ulcers, and anastomotic ulcers following gastric surgery, are among the common gastrointestinal diseases. It is currently believed that the infection of Helicobacter pylori is closely associated with gastritis, ulcer activity, gastric cancer, etc., thus, Helicobacter pylori infection is considered the main cause of gastric ulcers. Other factors, such as excessive smoking and alcohol consumption, can also lead to peptic ulcers. Poor dietary and living habits, such as binge eating, excessive consumption of cold, greasy, spicy, or alcoholic foods, can cause this condition as well; moreover, excessive emotional stress, such as long-term mental pressure, can also lead to the development of peptic ulcers.

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Peptic ulcer clinical symptoms

Helicobacter pylori infection is considered the primary cause of peptic ulcers, often leading to excess stomach acid, abnormal gastric motility, and other symptoms. Excess stomach acid can cause acid reflux, heartburn, and a burning sensation, while abnormal gastric motility may lead to nausea, belching, and even vomiting and bloating, with stomach acid irritation likely causing upper abdominal pain. Gastric ulcer pain is generally located in the upper left abdomen or below the sternum, typically presenting as postprandial pain. Duodenal bulb ulcers generally cause pain to the upper right of the navel, typically fasting pain that eases upon eating, sometimes accompanied by menstrual-like pain, with pain from ulcers behind the bulb potentially radiating to the back.

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Gastroenterology
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Can peptic ulcers be cured completely?

Peptic ulcers, including gastric ulcers and duodenal bulb ulcers, can generally be completely cured in most cases. Treatment plans are usually determined based on the presence of Helicobacter pylori infection. If there is an infection with Helicobacter pylori, quadruple therapy is typically used to eradicate the bacteria. If there is no Helicobacter pylori infection, symptomatic treatment is sufficient. Some patients may experience recurrent peptic ulcers, which are usually caused by several factors. Firstly, the failure to completely eradicate Helicobacter pylori can lead to recurrent ulcers. Additionally, the recurrence of ulcers might also be facilitated by poor dietary and lifestyle habits after the ulcers have healed, such as long-term alcohol abuse, smoking, or consumption of spicy and irritating foods.

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Written by Jiang Guo Ming
Gastroenterology
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How to treat peptic ulcers?

The treatment of peptic ulcers should be based on specific causes, as well as the patient's gender, age, medical history, and medication history, among other factors. Generally speaking, the primary cause of peptic ulcers is usually Helicobacter pylori infection. Therefore, the first step is to test for Helicobacter pylori. If Helicobacter pylori is present, antibacterial treatment is required, with the first choice being quadruple therapy, which includes a proton pump inhibitor, two types of antibiotics, and a bismuth agent, administered over a 10 to 14-day treatment course. If there is no Helicobacter pylori infection, the first choice would be proton pump inhibitors and gastric mucosal protective drugs, combined with symptomatic treatment. Meanwhile, it is crucial for patients with peptic ulcers to develop good eating and living habits, and relaxing their mindset can also be helpful.