Peptic Ulcer Disease III: Clinical Manifestations and Complications

Duodenal Ulcers

Duodenal ulcers are the most common form of peptic ulcer disease, presenting with chronic, intermittent epigastric pain. Pain typically appears 2–3 hours after meals, especially when the stomach is empty, often waking patients at night. It is characteristically relieved by food or antacids (“pain–food–relief”). Some patients remain asymptomatic until complications like bleeding or perforation emerge, particularly with NSAID or anticoagulant use.

Gastric Ulcers

Gastric ulcers share similar mechanisms but differ clinically. Pain usually begins shortly after eating and is not relieved by food, often worsening it. This leads to anorexia, early satiety, and weight loss. Nausea and vomiting are more common, and the disease often follows a chronic course without clear remission patterns.

Comparison of Clinical Features

Both cause epigastric discomfort, but timing differs. Duodenal ulcer pain is nocturnal and relieved by food, often leading to weight maintenance or weight gain. Gastric ulcer pain follows after meals, discouraging intake and leading to weight loss. Shared symptoms include heartburn, eructation, vomiting, and altered bowel habits.

Three major complications of peptic ulcer disease include gastrointestinal bleeding, which is most common, especially in duodenal ulcers, presenting as hematemesis or melena. Perforation is most life-threatening, causing sudden severe pain, a rigid abdomen, and shock due to peritonitis. Gastric outlet obstruction is caused by scarring or inflammation, leading to bloating, distention, and vomiting of undigested food. These are all medical emergencies that may require surgical intervention.

Long-Term Considerations

Both types of ulcers require monitoring, especially if large or complicated. Gastric ulcers carry a risk of malignancy. This risk may be elevated in patients who continue long-term proton pump inhibitor (PPI) therapy after Helicobacter pylori eradication.