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Digestive Disorders > Upper Abdomen

Gastric ulcer symptoms

Dr. med. André Sommer

Dr. med. André Sommer

A gastric ulcer is ulcerative mucosal defect in the stomach wall. Another medical term for this is ventricular ulcer. Men and women are affected equally. A gasrtic ulcer develops in the context of gastroduodenal peptic disease.

Structure of the stomach wall

The stomach wall itself is made up of different layers. Roughly speaking, it consists of a mucosal layer and a muscle layer, each of which consists of different layers. The defect in the gastric mucosa with a ventricular ulcer extends to the smooth muscle cell layer (lamina muscularis mucosae).

Symptoms of a gastric ulcer

The symptoms gastric by a gastric ulcer can be divided into general and specific gastric ulcer symptoms. The general or non-specific symptoms of a gastric ulcer include:

  • Upper abdominal pain
  • Food intolerances
  • Vomiting, including vomiting of blood
  • Anemia
  • Very dark to black stool (so-called tar stools)

A gastric ulcer can also, in some cases be symptomless, which means that the affected person is free of symptoms and the ulcer is noticeable only through bleeding. Indications of gastric bleeding can, however, include anemia, vomiting blood and tarry stool.

Symptoms from internal bleeding

Anemia is caused by a decreased number of red blood cells (Erythrocytes), a lower proportion of the red blood pigment (hemoglobin) or a reduction in the cellular proportion of blood (hematocrit), the majority of which make up the red blood cells. Since the erythrocytes are responsible for the transport of vital oxygen in the blood, the symptoms caused by a reduced number of erythrocytes are:

  • Shortness of breath during exercise or in severe cases at rest
  • Fatigue and exhaustion
  • Pale skin

The blackening of so-called tarry stool (Melena) arises from the formation of hematin. It is a chemical reaction product, a complex compound that arises when blood comes into contact with stomach acid. The iron component of the red blood pigment is oxidized by the stomach acid and the tar-black hematin is then produced. Tarry stool is therefore a sign of bleeding in the upper digestive tract.

What are specific symptoms of a gastric ulcer?

In addition to general symptoms of gastric ulcer, which often also occur with other diseases, there are also more specific signs of the presence of a gastric ulcer. Typical signs of a gastric ulcer include:

  • Pain immediately after eating (postprandial pain)
  • Pain that occurs regardless of food intake
  • Pain relief with gastric acid-inhibiting medication

Nevertheless, the diagnosis of ulcer ventriculi alone cannot be made after recording the more specific symptoms. The strongest indication of the presence of a gastric ulcer is the combination of different symptoms.

Which symptom combinations are common in gastric ulcers?

The combination of upper abdominal pain after eating, feeling unwell, pain relief from vomiting and also from gastric protection tablets justifies the suspicion of a gastric ulcer. However, it is not enough for the doctor to make the final diagnosis of ulcer ventriculi.

What are the causes and risks for the development of a gastric ulcer?

There are many reasons for the development of a gastric ulcer. Basically, a distinction is made as to whether an ulcer disease is bacterial, namely due to infection with the bacterium Helicobacter pylori (HP), or not. If there is Helicobacter pylori colonization of the gastric mucosa and gastric mucosal inflammation has occurred more frequently in the patient's past, this is referred to as Helicobacter pylori positive ulcer disease.

In addition to HP infection, there are several other factors that pose an increased risk of developing an ulcer. In this case one speaks of aHelicobacter-negative peptic ulcer.

Risk factors for the emergence of a HP-negative gastric ulcer

  • Stress (and as a result of this increased cortisol levels)
  • Excessive use of painkillers such as ibuprofen, diclofenac, aspirin, etc.
  • Nicotine and alcohol consumption
  • Taking antidepressant drugs such as SSRIs (selective serotonine reuptake inhibitors)
  • Age over 65 years
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How is the diagnosis of a gastric ulcer made?

When upper abdominal pain occurs - especially when it is connected to food intake and a meal can no longer be eaten without symptoms - the alarm bells ring in many people. If the pain is also accompanied by symptoms of internal bleeding, such as pallor and tiredness, you should see a doctor.

Survey of medical history and physical examination if gastric ulcer is suspected

When making a diagnosis, the doctor first asks for indicative symptoms - such as upper abdominal pain that increases after eating - and does a physical examination.

Physical examination of the abdomen (abdomen) includes:

  • Abdominal wall inspection
  • Eavesdropping on the abdomen
  • Palpation of the abdomen

In particular, palpation of the abdomen can be very painful for those affected.

What is gastroscopy and what is it done for?

If there is any suspicion of a gastric ulcer, gastroscopy should also be performed.

A gastroscopy or an examination of the esophagus, stomach and duodenum (esophagogastroduodenoscopy, ÖGD) is performed to confirm the diagnosis of a gastric ulcer and to rule out malignant tumors as the cause of the symptoms. Tissue specimens can be taken during gastroscopy, which are then examined for colonization with Helicobacter pylori and malignancy.

Therapy: How is a gastric ulcer treated?

Depending on the cause, a gastric ulcer is treated either by combating the cause or purely symptomatically. This in turn means that in the case of Helicobacter pylori positive ulcer disease, the cause of the disease can be combated - and should also be combated- using antibiotics. A Helicobacter pylori negative ulcer disease, on the other hand, i.e. a gastric ulcer that did not result from bacterial colonization of the gastric mucosa with Helicobacter pylori, is usually treated symptomatically with stomach protection tablets (Proton pump inhibitors, PPIs - reduce gastric acid production).

Medical therapy of a gastric ulcer

HP-positive ulcer disease HP-negative ulcer disease
Combination of:
  • Gastric acid inhibitors in an increased dose
  • and two antibiotics for 7 days
  • Gastric acid inhibitors
  • Avoiding risk factors and harmful substances (smoking, alcohol and coffee, etc.)

In rare cases, complications such as unstoppable bleeding during gastroscopy can also occur. Then hemostasis may have to be done surgically.

Herold, G. (2019). Innere Medizin 2019. Walter de Gruyter GmbH & Co KG.

Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF). S2k-Leitlinie Helicobacter pylori und gastroduodenale Ulkuskrankheit. Downloaded on 1 June 2018:

Fischbach et al.: Deutsches Ärzteblatt International 2009: 106(49): 801-8; DOI: 10.3238/arztebl.2009.0801. Downloaded on 20 May 2018 from:

Hans C. Dollinger et al.: Peptische Magen-Darm-Erkrankungen: Organische und psychosomatische Aspekte. Springer Verlag Berlin-Heidelberg 1990. Accessed online on May 20, 2018 at (Google Books)

Dr. med. André Sommer

Dr. med. André Sommer

I’m André, a medical doctor from Berlin. Together with a team of medical doctors, nutritionists and data scientists we empower people to understand digestive issues with our app Cara Care.

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