Peptic ulcer history and symptoms

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:  :Manpreet Kaur, MD [2]

Overview

The hallmark of peptic ulcer disease is an episodic epigastric pain which cause awakening at night.A positive history of epigastric pain, use of drugs like NSAIDs including aspirin which inhibit cyclooxygenase,use of antiplatelets ,steroids and family history of peptic ulcer disease is suggestive of peptic ulcer disease. The most common symptoms of peptic ulcer disease include episodic epigastric pain, heartburn, loss of appettite, gastroesophageal reflux, waterbrash,hematemesis and melena. Less common symptoms of peptic ulcer disease include bloating,intolerance to fatty food

History

Obtaining the history is the most important aspect of making a diagnosis of peptic ulcer disease. It provides insight into the cause, precipitating factors and associated comorbid conditions.

Past Medical History

• A history of epigastric pain, dyspepsia, or prior peptic ulcer may suggest the diagnosis of peptic ulcer disease.

Medication History

• Prior use of aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) is important because these patients have an increased risk of gastric ulcer and a fourfold risk of significant GI bleeding compared with other patients

Social History

• Helicobacter pylori infection is more common in low socioeconomic status and increased number of siblings
• Alcoholics also frequently have peptic ulcers or gastritis
• Cigarette smokers have a significantly higher rate of the recurrent duodenal ulcer as compared with nonsmokers

Family History

• Family history of peptic ulcer disease increases the risk of peptic ulcer
• History of peptic ulcer disease in mother increases the risk of peptic ulcer disease in children

Symptoms

• The majority of patients with the peptic ulcer disease are symptomatic but some people donot show any symptoms,called as a silent ulcer.
• The hallmark of peptic ulcer disease:
  • Episodic gnawing or burning epigastric pain which occurs one to five hours after meals or on an empty stomach
  • Nocturnal pain relieved by food intake, antacids, or antisecretory agents
  • Chronic use of NSAIDs

Difference in symptoms of gastric and duodenal ulcer
	Gastric ulcer	Duodenal ulcer
Epigastric pain	Occurs 1-2 hours after eating	Occurs 2-5 hours after eating
	Increases with eating	Decreases with eating
	Pain at night is less common	Pain at night is more common
Heartburn, chest discomfort and early satiety	Occurs commonly	Less commonly occurs
Bleeding presentation	Melena Hematemesis	Melena Hematochezia

Common Symptoms

Common symptoms of peptic ulcer disease include:

• Episodic epigastric pain
• Heartburn
• Waterbrash
• Indigestion
• Hematemesis
• Melena
• Loss of appetite

Less Common Symptoms

Less common symptoms of peptic ulcer disease include:

• Intolerance to fatty food
• Bloating

References

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