Symptoms & Diagnosis of Peptic Ulcer

Peptic ulcer is a chronic disease with spontaneous remission and relapses which can last for decades or in some cases may last life-long. There is a popular saying among medical fraternity (doctors) “once you are ulcer patient, you are life-long ulcer patient” (which means it is very difficult to cure ulcer permanently and relapses are common, so peptic ulcer should be suppressed adequately).The commonest symptom of peptic ulcer is recurrent pain in upper abdomen or epi-gastric part of abdomen. The pain is felt about 2 to 3 hours after food depending on the location of ulcer. Sometimes pain may be felt on empty stomach and patient may mistake it as “hunger pain” as the pain is relieved by eating. Patient of peptic ulcer may wake up in the middle of night from sleep due to pain and if this symptom is present it is diagnostic of peptic ulcer (no other disease has this type of long standing pain which wakes up the patient during sleep).

Another important symptom of peptic ulcer is the periodicity of symptoms, mainly abdominal pain. The abdominal pain lasts for about one to three weeks at a time, three to four times a year. Between the episodes of abdominal pain patient feels perfectly well. There may be other symptoms of peptic ulcer like heartburn, vomiting, loss of appetite etc. It is difficult to distinguish gastric ulcer and duodenal ulcers by symptoms only.

Diagnosis of peptic ulcer:

Peptic ulcer can be diagnosed with endoscopy (with endoscopy diagnosis can be almost 100% accurate) and double contrast barium meal examination. Endoscopy is preferred diagnostic procedure for peptic ulcer due to its certain advantages. Advantages of endoscopy are the direct visualization of the ulcer (accurate diagnosis due to direct visualization) and sample for biopsy can be collected (gastric ulcers may turn malignant though rarely and biopsy is must for gastric ulcers). In case of gastric ulcer endoscopy must be repeated after proper treatment to confirm that the ulcer has healed and to obtain further biopsies if it has not healed. For duodenal ulcers repeat endoscopy is not necessary. In case of duodenal ulcer during endoscopy biopsy is taken to do histological examination to confirm presence of H. pylori (90% of duodenal ulcers are due to H. pylori).

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