Symptoms of acute peptic ulcers are usually of short duration. Slight attack of dyspepsia may go unnoticed. These ulcers are more often unrecognized till they cause hematemesis (vomiting of blood).
Acute peptic ulcer may be the cause of hematemesis in both sexes in all ages. Occasionally an acute ulcer may perforate particularly when it occurs in the wall of the duodenum. Acute ulcers may progress to chronic ulceration.
Symptoms Of Chronic Gastric Ulcer
- Age: The patients are usually middle aged.
- Sex: More common in males than in females.
- Constitution: The patients are usually thin and anemic with J-shaped hypotonic stomach.
- Periodicity is less marked. The attacks last several weeks followed by intervals of freedom from symptoms for 2 to 6 months.
- Pain is strictly epigastric. Pain is boring or pricking in nature. When the ulcer penetrates, pain may radiate to the back.
- Site- in gastric ulcer pain is complained of in the mid-epigastrium or slightly to its left.
- Relation with food- pain occurs almost immediately or any time up to 1 and ½ hour after meal, as food irritates ulcer.
- Pain is not felt in empty stomach.
- Food does not relieve pain; on the contrary it aggravates pain
- Pain is not felt at night.
- Vomiting: In more than half the cases vomiting is a notable symptom. It often occurs after food. It relieves the pain and may be self-induced.
- Appetite is good. But the patient is afraid to eat as this initiates pain.
- Diet: These patients usually learn to avoid fried and spicy foods since this initiates pain immediately.
- Weight: Some loss of weight is usually present.
- Hemorrhage is less common than in duodenal ulcer. Hematemesis is more common than melaena (blood in stools).
- On examinationtenderness can be elicited in the mid-epigastric or slightly to the left of it.
Chronic Duodenal Ulcer Symptoms
- Age: The patients are usually young adults or mid-adults (25 to 40 years).
- Sex: Males dominate though not as much as gastric ulcer.
- Constitution: The patients are healthy males with steer-horn stomach which is high in position.
- Periodicity is well marked. The attacks also last for several weeks with intervals of freedom from 2 to 6 months. Attacks usually appear in the spring and autumn.
- Pain is more severe and spasmodic in character.
- In duodenal ulcer patient complains of pain on the trans-pyloric plane about 1 inch to the right of the midline.
- Relation with food: Pain usually starts 2 and ½ to 3 hours after food when the stomach gradually pushes the food into duodenum and irritates ulcer.
- Pain is very much felt in empty stomach which is called ‘hunger-pain’. Excess acid is not neutralized by food and irritates ulcer.
- Food relieves pain as this dilutes acid.
- Pain at dead of night is very characteristic. The patient gets up with pain, he takes biscuits and milk. He is relieved of pain and goes to sleep.
- Vomiting is rare, unless pyloric stenosis complicates the procedure. More common is regurgitation of the acidic fluid into the mouth or pain behind the sternum due reflux esophagitis.
- Appetite is good and he eats frequently to avoid pain.
- Diet: As particular food does not initiate pain immediately; he usually does not avoid anything.
- Weight: Some gain of weight is expected, as the patient learns to take food frequently.
- Hemorrhage is more common than in gastric ulcer. Melaena is more common than hematemesis.
- On examination tenderness can be elicited at the duodenal point which is situated on the trans-pyloric plane 1 inch right of the midline.