Peptic Ulcer Disease Signs & Symptoms | Gastric vs. Duodenal Ulcers

 hey everyone this lesson is on the signs and symptoms of peptic ulcer disease so we're going to talk about the common less common and more rare signs and symptoms that occur in peptic ulcer disease and we're going to talk about why they occur. if you want more information on peptic ulcer disease in general please check my lesson on that topic but before we get into the signs and symptoms of peptic ulcer disease what is peptic ulcer disease it is a disease of focal defects or discontinuation which really means an ulceration of the gastrointestinal mucosa so the lining of the stomach in the lining of the duodenum which is the first part of the small intestine so here's your stomach and here is the duodenum and you can have ulcerations occurring in the stomach and the duodenum the first part of the small intestine and you can also have them in the esophagus as well but we're not going to talk about those as much here so again the stomach and or duodenum may be affected if the stomach is affected that is a gastric ulcer if it's the duodenum that's affected it is a duodenal ulcer.

i'm going to briefly talk about some of the causes here if you want more information please check out my overview lesson on peptic ulcer disease for way more causes of this disease but some of the main causes of peptic ulcer disease include infection with helicobacter pluri which is a bacteria this is by far the most common cause of peptic ulcer disease we can also see that chronic use of non-steroidal anti-inflammatory drugs can lead to peptic ulcer disease so drugs like ibuprofen or advil use of other certain medications including some chemotherapies can lead to peptic ulcer disease and some other medical conditions as well like crohn's disease before we get into these signs and symptoms it's important to note that approximately 20 of patients with peptic ulcer disease are asymptomatic so there's 20 of patients that do have ulcers that actually don't experience any symptoms at all so that's very important to note but if patients do have signs and symptoms of peptic ulcer disease what are some of those signs and symptoms well the most important one to note is dyspepsia so this pepsi is you can think of it as indigestion it's more of a pain or discomfort in the epigastric area an epigastric area is the area in the central upper area of your abdomen above your belly button it can be described as a gnawing and burning sensation and the onset of the discomfort or pain differs depending on the type of ulcer we're going to talk about this in more detail here so here is an image of gastric ulcers and duodenal ulcers so the gastric ulcer again is in the stomach and the duodenal ulcer is in the first part of the small intestine the duodenum so with regards to gastric ulcers the epigastric pain or discomfort occurs within 15 to 30 minutes of eating this makes sense if you have eaten.

you have food and gastric acids within the stomach and this can lead to irritation of the gastric ulcer and it usually occurs within 15 to 30 minutes of eating and it is worsened or exacerbated by eating so when you eat and your stomach becomes full your pyloric sphincter this area here closes to hold the stomach contents within the stomach to allow digestion of those gastric contents and there's release of stomach acids and all of these things can irritate those gastric ulcers so eating can worsen gastric ulcers now let's talk about duodenal ulcers now that we know what can happen when we do eat it makes sense that the epigastric pain or discomfort that occurs with duodenal ulcers occurs later it often occurs within one to three hours of eating so for a time that pyloric sphincter closes keeping that gastric contents within the stomach but the pyloric expenditure will slowly open and release some gastric contents from the stomach after a certain time and you can imagine that if you're releasing some gastric contents and some of that acidity comes out it can irritate those duodenal ulcers and this is why we see duodenal ulcers having epigastric pain or discomfort approximately one to three hours after eating so it occurs later than gastric ulcers and it also makes sense that this is improved with eating in antacids so when you eat the pile or expansion closes preventing gastric contents from emptying into the duodenum at least for a time so this is why we see improvement with eating we can also note some different characteristics with regards to duodenal ulcers are more likely to be described as a burning sensation and patients with duodenal ulcers often times have a relapsing remitting course so that means that they have symptoms for a period of time and then

those symptoms go away for a period of time so it's a waxing and waning type of pattern of symptoms and another important point to note with duodenal ulcers is that a lot of times patients with duodenal ulcers can have interrupted sleep so you can imagine that if you had eaten a few hours before and by the time that gastric content reaches that duodenal ulcer it may have taken a few hours and that patient may have gone to bed they may be sleeping and their sleep can become interrupted they can become awoken from symptoms due to duodenal ulcer so that's another important point to note another important sign or symptom that is associated with dyspepsia is heartburn so heartburn in peptic ulcer disease can occur because ulcers can cause issues with gastric emptying so gastric contents can sit in the stomach and reflex of those gastric contents and the gastric acid can reach the esophagus leading to heartburn another symptom of peptic ulcer disease is bloating so patients may have issues with burping and belching along with the bloating and this most often occurs postprandially so that means that it occurs after eating so after they've had something to eat they can have issues with bloating or burping or belching more than usual patients with peptic ulcer disease can also have issues with nausea and vomiting.

this is due to irritation of the ulcer but it may also be due or secondary to epigastric pain or discomfort but what i want you to take away is that oftentimes nausea and vomiting is uncommon in peptic ulcer disease individuals with peptic ulcer disease can also complain of sensation of abdominal fullness this may be due to the fact that irritation of the ulcer may cause a sensation of fullness and related to abdominal fullness is early satiety so patients with peptic ulcer disease can also have early satiety which means that they can become full very quickly and easily so they may feel very hungry they may start eating and they get full quicker than they would have anticipated and this can be a sign of peptic ulcer disease as well especially if you see a lot of the other signs and symptoms we've talked about before and when there is complications of peptic ulcer disease we'll see the following symptoms as well one of them is molina so molina is black tarry stool so the stool is very tarry and it often has a distinctive smell this molina stool is caused by a bleeding ulcer so you can imagine that if there's some ulcer in the stomach or the duodenum it can start to bleed and what happens is that the blood that is lost from those ulcers becomes digested and this leads to a black tarry stool so that's why we get black coloration because that is digested blood and we can also see hematokesia now hematochesia is red bloody stool and

it too is caused by a bleeding ulcer so you might be wondering what's the difference here if both of them are caused by bleeding ulcers why is one black and the other one red well we've alluded to this before molina stool is from digested blood so blood slowly goes through the gastrointestinal system and gets digested and becomes black in coloration but if there's hematokesia due to peptic ulcer disease it is because there is quick rapid bleeding from the ulcers so there's brisk bleeding so the blood briskly or rapidly flows through the gastrointestinal system preventing the gastrointestinal system from actually digesting it so it goes through the system very quickly so there's no digestion of blood that's why we see red coloration the distance between these ulcers is not that different and a lot of times again it's going to be how fast the bleed is or how slow the bleed is it's going to distinguish the coloration of the stool either molina or hematochesia and another thing to point out here is that if there is bleeding from an ulcer that causes molina or hermetice often times patients may have iron deficiency anemia so they lose so much blood that their blood count goes down the red blood cell count goes down and their iron stores go down as well so they get iron deficiency anemia and that often times is a warning symptom if patients are losing a lot of blood and some other signs and symptoms of peptic ulcer disease are weight loss and on the opposite end weight gain and you might be wondering.

why these two occur weight loss and weight gain occur depending on what type of ulcer a patient might have so if a patient has a gastric ulcer we talked about eating exacerbating symptoms of a gastric ulcer so oftentimes patients will try to avoid eating and this leads to weight loss on the other end if they have a duodenal ulcer we talked about the fact that duodenal ulcers are improved with eating so oftentimes patients might continue to try to eat to suppress or relieve their symptoms from the duodenal ulcer which leads to weight gain so the type of ulcer is one factor that may determine whether a patient has weight loss or weight gain and i also want to make note of the alarm symptoms or warning symptoms in peptic ulcer disease so some of them include overt gastrointestinal bleeding so molina or hematochesia iron deficiency anemia which indicates there's significant blood loss from bleeding ulcers weight loss is also another warning symptom and some other ones include recurrent vomiting that is also another warning symptom as well so if you want to learn more about peptic ulcer disease including more causes how it's diagnosed and how it's treated please check out my lesson on that topic. more