What is Peptic Ulcer?


Peptic ulcer, also known as stomach ulcer, is a break in the lining of the stomach, duodenum (upper part of small intestine) or occasionally the lower esophagus when gastric acid erodes the protective mucous lining. Peptic ulcer consists of:

  1. Gastric ulcer – symptoms include worsening pain during a meal*, belching, vomiting, weight loss and poor appetite.
  1. Duodenal ulcer – symptoms include being awoken from sleep in the night with a sharp upper abdominal pain (the pain would be initially relieved by a meal*).

*A gastric ulcer would cause a pain to worsen during the meal. This is because gastric acid production is increased when food enters the stomach. On the other hand, pain due to duodenal ulcer would be initially relieved by a meal, as the pyloric sphincter (smooth muscle at the junction between the stomach and duodenum) closes to contain stomach content, and no acid will reach the duodenum. 2 to 3 hours after the meal when the food is digested and the acid enters the duodenum, the pain would be felt most significantly.

  1. Esophageal ulcer – symptoms include heartburn, nausea, vomiting, indigestion, upper abdominal pain, back pain and loss of appetite which results in unintentional weight loss.

Of the three types of ulcers, duodenal ulcer is more common than gastric ulcer, while oesophageal ulcer is comparatively rare. 

Peptic ulcer

What Happens When Peptic Ulcer is Left Untreated?

Peptic ulcer that is not treated will worsen over time, this can lead to severe health complications such as bleeding, perforation, penetration or obstruction.

1. Bleeding:

Bleeding ulcers can result in slow but significant blood loss into digestive tract. Over time, anemia develops with symptoms such as lightheadedness and dizziness.

In severe cases where ulcers damage the large blood vessels, sudden and serious bleeding in the intestinal tract can lead to death if the bleeding is not stopped in time. Other signs of bleeding ulcers are vomiting blood, and black, bloody or maroon-coloured stools.

A bleeding ulcer

2. Perforation:

Perforation is a hole that develops when an ulcer breaks through the stomach or intestinal wall, into the abdominal cavity. This perforation causes bacteria, partially digested food and enzymes from the digestive tract to leak into abdominal cavity, provoking an inflammation and infection. Severe abdominal pain is the symptom and immediate medical attention and surgery are usually necessary.

peptic ulcer - perforation


3. Penetration:

Penetration is a form of perforation in which the perforating ulcers erode the whole thickness of the stomach or duodenal wall, into adjacent abdominal organs such as liver, pancreas, bile duct or intestines. Pancreas is the most typical site of penetration. A combination of serious ulcer symptoms including abnormal pain distribution and decreased response to conventional treatment are signs of ulcer penetration.

peptic ulcer - penetration


4. Obstruction:

Gastric outlet obstruction is an obstruction at the pylorus, (an opening from the stomach into the duodenum) due to swelling or scarring. This blocks the food passage from the stomach to the small intestine and causes sufferer to experience nausea, vomiting, fullness or epigastric pain (at the upper abdomen right below the ribs).

Gastric outlet obstruction