Editing Peptic ulcer disease (section)

==Signs and symptoms==
[[File:Duodenal ulcer01.jpg|thumb|upright=1.2|Duodenal ulcer A2 stage, acute duodenal mucosal lesion (ADML)]]
Signs and symptoms of a peptic ulcer can include one or more of the following:<ref name=":0">{{Cite web |title=Symptoms & Causes of Peptic Ulcers (Stomach or Duodenal Ulcers) - NIDDK |url=https://www.niddk.nih.gov/health-information/digestive-diseases/peptic-ulcers-stomach-ulcers/symptoms-causes |access-date=2024-06-07 |website=National Institute of Diabetes and Digestive and Kidney Diseases |language=en-US}}</ref>
* [[abdominal pain]], classically [[epigastric]], strongly correlated with mealtimes. In case of duodenal ulcers, the pain appears about three hours after taking a meal and wakes the person from sleep;
* [[bloating]] and abdominal fullness;
* [[Hypersalivation|waterbrash]] (a rush of saliva after an episode of regurgitation to dilute the acid in esophagus, although this is more associated with [[gastroesophageal reflux disease]]);
* nausea and copious vomiting;
* [[Anorexia (symptom)|loss of appetite]] and weight loss, in gastric ulcer;
* weight gain, in duodenal ulcer, as the pain is relieved by eating;
* [[hematemesis]] (vomiting of blood); this can occur due to bleeding directly from a gastric ulcer or from damage to the esophagus from severe/continuing vomiting.
* [[melena]] (tarry, foul-smelling feces due to presence of [[oxidation|oxidized]] iron from [[hemoglobin]]);
* rarely, an ulcer can lead to a gastric or [[Gastrointestinal perforation|duodenal perforation]], which leads to [[acute peritonitis]] and extreme, stabbing pain,<ref>{{cite book | last = Bhat | first = Sriram | year = 2013 | title = SRB's Manual of Surgery | page = 364 | publisher = JP Medical | isbn = 9789350259443 }}</ref> and requires immediate surgery.

A history of [[heartburn]] or [[gastroesophageal reflux disease]] (GERD) and use of certain medications can raise the suspicion for peptic ulcer. Medicines associated with peptic ulcer include [[NSAID]]s (non-steroidal anti-inflammatory drugs) that inhibit [[cyclooxygenase]] and most [[glucocorticoid]]s (e.g., [[dexamethasone]] and [[prednisolone]]).<ref>{{Cite web |title=Treatment for Peptic Ulcers (Stomach or Duodenal Ulcers) - NIDDK |url=https://www.niddk.nih.gov/health-information/digestive-diseases/peptic-ulcers-stomach-ulcers/treatment |access-date=2024-06-07 |website=National Institute of Diabetes and Digestive and Kidney Diseases |language=en-US}}</ref>

In people over the age of 45 with more than two weeks of the above symptoms, the odds for peptic ulceration are high enough to warrant rapid investigation by [[esophagogastroduodenoscopy]].{{cn|date=July 2022}}

The timing of symptoms in relation to the meal may differentiate between gastric and duodenal ulcers. A gastric ulcer would give [[epigastrium|epigastric]] pain during the meal, associated with nausea and vomiting, as [[gastric acid]] production is increased as food enters the stomach. Pain in duodenal ulcers would be aggravated by hunger and relieved by a meal and is associated with night pain.<ref name="Angel 2017"/>

Also, the symptoms of peptic ulcers may vary with the location of the ulcer and the person's age. Furthermore, typical ulcers tend to heal and recur, and as a result the pain may occur for few days and weeks and then wane or disappear.<ref name="Peptic Ulcer">{{cite web |url=http://www.merckmanuals.com/home/digestive_disorders/peptic_disorders/peptic_ulcer.html |title=Peptic Ulcer |date=October 2006 |work=Home Health Handbook for Patients & Caregivers |publisher=Merck Manuals |url-status=live |archive-url=https://web.archive.org/web/20111228042709/http://www.merckmanuals.com/home/digestive_disorders/peptic_disorders/peptic_ulcer.html |archive-date=28 December 2011 |df=dmy-all }}</ref> Usually, children and the [[elderly]] do not develop any symptoms unless complications have arisen.

A burning or gnawing feeling in the stomach area lasting between 30&nbsp;minutes and 3&nbsp;hours commonly accompanies ulcers. This pain can be misinterpreted as [[hunger]], [[indigestion]], or [[heartburn]]. Pain is usually caused by the ulcer, but it may be aggravated by the [[stomach acid]] when it comes into contact with the ulcerated area. The pain caused by peptic ulcers can be felt anywhere from the navel up to the [[Human sternum|sternum]], it may last from few minutes to several hours, and it may be worse when the stomach is empty. Also, sometimes the pain may flare at night, and it can commonly be temporarily relieved by eating foods that buffer stomach acid or by taking anti-acid medication.<ref>{{cite web|url=http://www.mayoclinic.com/health/peptic-ulcer/ds00242/dsection=symptoms|title=Peptic ulcer|access-date=18 June 2010|url-status=live|archive-url=https://web.archive.org/web/20120214221325/http://www.mayoclinic.com/health/peptic-ulcer/DS00242/DSECTION%3Dsymptoms|archive-date=14 February 2012|df=dmy-all}}</ref> However, peptic ulcer disease symptoms may be different for everyone.<ref>{{cite web|url=http://www.ulcerdisease.net/|title=Ulcer Disease Facts and Myths|access-date=18 June 2010|url-status=dead|archive-url=https://web.archive.org/web/20100605040219/http://ulcerdisease.net/|archive-date=5 June 2010|df=dmy-all}}</ref>

===Complications===
[[File:Deep gastric ulcer.png|thumb|right|An [[Esophagogastroduodenoscopy|endoscopic image]] showing deep gastric ulcer.]]
[[Image:Gastric ulcer 2.jpg|right|thumb|[[Esophagogastroduodenoscopy|Endoscopic]] image of a small gastric ulcer with visible blood vessels, a potential warning sign for [[upper gastrointestinal bleeding]]]]
* [[Upper gastrointestinal bleeding|Gastrointestinal bleeding]] is the most common complication. Sudden large bleeding can be life-threatening.<ref name="pmid9391242">{{cite journal | vauthors = Cullen DJ, Hawkey GM, Greenwood DC, Humphreys H, Shepherd V, Logan RF, Hawkey CJ | title = Peptic ulcer bleeding in the elderly: relative roles of ''Helicobacter pylori'' and non-steroidal anti-inflammatory drugs | journal = Gut | volume = 41 | issue = 4 | pages = 459–62 | date = October 1997 | pmid = 9391242 | pmc = 1891536 | doi = 10.1136/gut.41.4.459 }}</ref><ref>{{cite journal|author=Blackford, John W.|author2=Williams, Robert H.|author-link2=Robert Hardin Williams|title=Fatal Hemorrhage from Peptic Ulcer: One Hundred and Sixteen Cases Collected from Vital Statistics of Seattle During the Years 1935-1939 Inclusive|journal=Journal of the American Medical Association|volume=115|issue=21|year=1940|pages=1774–1779|doi=10.1001/jama.1940.02810470018005}}</ref> It is associated with 5% to 10% death rate.<ref name="Angel 2017"/>
* [[Gastrointestinal perforation|Perforation]] (a hole in the [[gastrointestinal wall|wall of the gastrointestinal tract]]) following a gastric ulcer often leads to catastrophic consequences if left untreated. Erosion of the gastrointestinal wall by the ulcer leads to spillage of the stomach or intestinal contents into the abdominal cavity, leading to an acute chemical [[peritonitis]].<ref>{{cite book |last1=Gossman |first1=William |last2=Tuma |first2=Faiz |last3=Kamel |first3=Bishoy G. |last4=Cassaro |first4=Sebastiano |title=StatPearls |date=2019 |publisher=StatPearls Publishing |url=https://www.ncbi.nlm.nih.gov/books/NBK519554/ |chapter=Gastric Perforation|pmid=30137838 }}</ref> The first sign is often sudden intense abdominal pain,<ref name="Angel 2017"/> as seen in [[Valentino's syndrome]]. Posterior gastric wall perforation may lead to bleeding due to the involvement of gastroduodenal artery that lies posterior to the first part of the duodenum.<ref>{{Cite journal |last=Weledji |first=Elroy Patrick |date=2020-11-09 |title=An Overview of Gastroduodenal Perforation |journal=Frontiers in Surgery |volume=7 |pages=573901 |doi=10.3389/fsurg.2020.573901 |doi-access=free |issn=2296-875X |pmc=7680839 |pmid=33240923}}</ref> The death rate in this case is 20%.<ref name="Angel 2017"/>
* Penetration is a form of perforation in which the hole leads to and the ulcer continues into adjacent organs such as the [[liver]] and [[pancreas]].<ref name="Peptic Ulcer"/>
* [[Gastric outlet obstruction]] (stenosis) is a narrowing of the pyloric canal by scarring and swelling of the gastric antrum and duodenum due to peptic ulcers. The person often presents with severe vomiting.<ref name="Angel 2017"/>
* Cancer is included in the differential diagnosis (elucidated by [[biopsy]]), ''[[Helicobacter pylori]]'' as the etiological factor making it 3 to 6 times more likely to develop stomach cancer from the ulcer.<ref name="Peptic Ulcer"/> The risk for developing gastrointestinal cancer also appears to be slightly higher with gastric ulcers.<ref>{{cite journal|title=Long-term risk of gastrointestinal cancers in persons with gastric or duodenal ulcers|year=2016|pmc=4924392|last1=Søgaard|first1=K. K.|last2=Farkas|first2=D. K.|last3=Pedersen|first3=L.|last4=Lund|first4=J. L.|last5=Thomsen|first5=R. W.|last6=Sørensen|first6=H. T.|journal=Cancer Medicine|volume=5|issue=6|pages=1341–1351|doi=10.1002/cam4.680|pmid=26923747}}</ref>