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A. The two most common and constant symptoms are abdominal pain and vomiting. Others may occur with varying degrees, such as nausea, heartburn, regurgitation of the acid contents of the stomach into the food pipe, weight loss (although some notice a weight gain because they take more food to ease the pain); constipation. Often there is tenderness of the abdomen just near the ulcer.

Q. Let’s look at these symptoms a bit more closely. Pain. What kind of pain, and is there any typical way in which it occurs?

A. The answer is that pain and tenderness are nearly always present. It is often very explicit, and frequently the patient can point to the exact spot with his finger. ‘It is right there,’ he will say dogmatically, pointing to a small circumscribed area. This is usually the midline, in a place doctors call the epigastrium. This is just below the lower end of the breast-bone, and between this and the navel. It is usually central, but may be a bit to the left or right. It is often extremely tender if pressed — the patient will give a yelp as the doctor’s examining hand presses deeply and firmly into the part.

However, there are wide variations, and some complain of a more general kind of pain which may be anywhere from the line of the nipples down to the groin.

Q. Is the pain present all the time?

A. Typically the pain sets in about 30 minutes to three hours after a meal. It is often relieved by taking antacids (mixtures, tablets or powders), milk or more food. Very commonly it comes on during the night, and will often wake the patient with gnawing discomfort. In times past, ulcer patients traditionally took a glass of milk and had this at the bedside in case they awoke with the ulcer pain.

What is more, the ulcer pain characteristically waxes and wanes. It may be present for some time, then wane for no obvious reason, only to recur again weeks or months later. Usually, the worse the pain, the deeper and more serious the ulcer. Sometimes it will completely penetrate the stomach or duodenal wall, and affect adjacent organs. It will then often produce pains produced by interference with the nerves supplying that organ also. Often the pain will radiate to the back between the shoulder blades. But if the pancreatic gland (located close by) is involved, the pain may develop in the lower part of the back.

Q. What causes the pain?

A. I suppose it is much like any pain occurring when the normal surface is broken. Mouth ulcers are painful; an ulcer on the skin is also sore. In the gut system, acids touching the delicate nerve endings will make the pain even more severe. In the main, ulcer pain is usually deep seated, related to food intake, occurs at night and waxes and wanes over a period of time. I might add that with successful treatment, pain is the first symptom to vanish. It is often magical. However, this does not mean the ulcer has suddenly healed for it usually takes up to six weeks for this to occur, even though pain may disappear within a few days.

Many patients under treatment are often lulled into a false sense of security believing that magic (and the pills) has suddenly cured them, when this is often just the beginning. Some foolishly stop medication, only to find the entire set of symptoms recur again fairly quickly. So, ulcer patients, do not be fooled.

Q. What about vomiting? You said this was also a fairly common symptom with ulcer patients.

A. Most ulcer patients suffer from vomiting, and this may occur from various causes and at various times. Often it will develop suddenly, probably when the abdominal pain is at its worst. Often it will produce some relief, and the patient frequently feels much better. The reason is not clear, but it may be due to a sudden cleaning out of the stomach, including removal of the large build up of irritating acid and pepsin.

Q. Do some people try and initiate vomiting because they realise this will bring some kind of relief?

A. Most certainly. Induced vomiting is well known. I hardly blame the person. If I had a horrid pain gnawing at my inside, and I knew it would vanish if I simply stuck my fingers down my throat and had a good vomit, I think I would be tempted to try it. Who wouldn’t. We are all human!

Q. Are there other causes for the vomiting?

A. Certainly. Sometimes the ulcer develops at the far end of the stomach, near the narrow canal called the pylorus where food travels to the duodenum. As this heals, fibrous tissue forms, and as this contracts, the canal may become much more narrow than normal. In fact, the canal may almost completely close over. In short, the patient develops an obstruction to the normal passage of food. It simply cannot pass normally, or at least at the normal rate. So, it simply flows back in a reverse direction, in the form of vomiting.

I well recall a patient, an older man who had been in the RAAF during the war and had suffered a great deal of stress. Unbeknown to anyone, he suddenly developed vomiting, sudden weight loss, and became very ill. By the time he came for treatment — like many ex-servicemen, he rarely sought treatment — he was drawn and thin, and looked nigh unto death. An x-ray examination showed that the pyloric canal was virtually non existent. He had endured a symptom free stomach ulcer near the canal. On healing, this had caused the canal to almost entirely close over. Hence the vomiting, and weight loss for he was not absorbing his food.

A surgical operation almost immediately cured the problem and within a few weeks he was back to normal. Weight gain and a happy disposition replaced the thin, wan appearance, and feeling of malnourished gloom and doom.

Q. Is it possible to differentiate between a G. U. and a D. U. on the symptoms?

A. Not really, and there is little point in trying to find out. Often the pain after food is longer in coming on with the D.U. patient, probably because the food, acid and pepsin have longer to travel. Generally, the D.U. patient tends to vomit less, and is more favourably affected by therapy. But, there is not a great deal between the two. Many ulcers do not cause any symptoms at all, whilst about one in four produces symptoms that are not typical. It is a strange disorder.

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