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Ulcer nausea in morning: Bloating, Heartburn, Nausea, Pain, & More


Peptic Ulcer Disease: Symptoms and Complications

Peptic ulcers are open wounds found either in the stomach (gastric ulcers) or the upper part of the small intestine, otherwise known as the duodenum (duodenal ulcers). Peptic ulcers can cause a variety of symptoms, such as pain, discomfort, or gas, though many people do not experience any symptoms at all.

Peptic ulcers can get worse, may bleed, and can cause a perforation (hole) or obstruction (blockage) in the digestive system—all serious emergencies. This is why you should consult your doctor if you notice any related symptoms. 

Anna Bizon / Getty Images

Frequent Symptoms

Pain is the most common symptom of a peptic ulcer. It is typically located in the upper part of the abdomen, anywhere from your breastbone to your navel, but you may also feel it in your back. Your pain may be dull, burning, or gnawing; it is less commonly intense or stabbing. Often, the pain is worse at night or in the morning, but it can vary. The duration of pain can last from a few minutes to a few hours.

Many people with peptic ulcers particularly complain of pain on an empty stomach. You may experience relief immediately after eating only to have pain return or worsen within an hour. This brief reprieve does not cause people with ulcers to overeat, however, as frequent nausea and discomfort can squash appetite or the desire to eat. Some people feel that certain foods (like fatty choices) exacerbate the symptoms, while other foods either alleviate or do not affect them.

While pain is the most common symptom, be aware that more than half of the people with peptic ulcers have no symptoms at all.

Other common symptoms of peptic ulcers include:

  • Discomfort, bloating
  • Indigestion, heartburn
  • Chronic nausea or a sense of discomfort with eating
  • Frequent burping
  • Loss of appetite

Signs can include unexplained anemia or iron deficiency.

Rare Symptoms

These symptoms are rare, but are more severe and could point to a complication:

  • Vomiting (with or without blood)
  • Blood in the stool; black and tarry stool
  • Fatigue or weakness, which can result from malnutrition or anemia due to small amounts of bleeding from the ulcer
  • Unexplained weight loss

Symptoms of peptic ulcers can occur as a result of other conditions, including gastroesophageal reflux disease (GERD), chronic dyspepsia, gallbladder disease, liver disease, or a gastrointestinal infection. It’s important to see your doctor to determine what’s at the root of your pain.


There are a number of complications that can occur if you have a chronic or worsening peptic ulcer. These include:

  • Bleeding: Bleeding is the most common complication of peptic ulcer disease. Slow and subtle bleeding can often go unnoticed and may be detected only once you have developed anemia due to this constant small loss of blood. Black or tarry stools are a sign of this bleeding. But the ulcer can erode a blood vessel and cause a sudden and even massive loss of blood, becoming life-threatening.
  • Malnutrition: You can become deficient in vitamins and minerals due to low food intake. Immune deficiencies, bone weakness, and skin fragility can all result from malnutrition, but may not be noticeable at first. However, malnutrition is not common in today’s world as a complication of peptic ulcers.
  • Perforation: An ulcer can eventually wear away at the lining of the stomach or small intestine, causing a perforation (hole), which can leak gastrointestinal fluid into the body. This can cause severe abdominal pain and shock. This is an emergency that requires urgent medical treatment, which is often surgery.
  • Obstruction: An ulcer can become inflamed, blocking the passageway of digested food and causing severe dysfunction of the small intestine. Like perforation, this is a medical emergency.
  • Fistula: A perforated ulcer can establish a connection (fistula) with an adjacent abdominal organ or structure, including the colon, biliary tree, pancreas, or a major blood vessel. This results in exchanges of material and fluids, which can result in vomiting these materials or hemorrhages. This is a medical emergency that requires surgical correction.

People are prone to peptic ulcers due to infection by the Helicobacter pylori bacterium, but there are some habits that can contribute to their development, such as taking non-steroidal anti-inflammatory medications (NSAIDs) or smoking. These habits interfere with your natural production of the mucus that coats your digestive system to protect it from acidity, abrasion, and bleeding.

Despite common misconceptions, one lifestyle factor that does not cause ulcers is stress. Doctors used to attribute ulcers to stress until Helicobacter pylori was discovered.

When to See a Doctor/Go to the Hospital

You may feel relief with an antacid, but you should not ignore symptoms of a peptic ulcer. If you have persistent symptoms for longer than a week, it is best to see your doctor. He or she will determine whether you need prescription medications and whether you have complications, such as bleeding or anemia. 

Make an appointment with your doctor if you have:

  • Pain that radiates to the back
  • Pain that doesn’t go away when you take medication
  • Unintended weight loss
  • Weakness, fatigue
  • Vomiting
  • Difficulty swallowing

Call or see a doctor immediately if you have these serious symptoms:

  • Vomiting blood
  • Black or tar-like stool
  • Sudden, severe pain in the abdominal area
  • Fever
  • Chills, shaking
  • Dizziness
  • Loss of consciousness

Frequently Asked Questions

What are the symptoms of a bleeding ulcer?

Symptoms may include vomiting blood that looks like coffee grounds and bowel movements that look black and tarry. You may also have anemia from bleeding, which can cause you to feel weak or faint. Seek emergency care for symptoms of a bleeding ulcer.

How long do ulcer symptoms last?

Pain may last for minutes or hours at a time. Symptoms will keep coming back until you get treatment for the ulcer. With treatment, the ulcer may take about eight weeks to heal, but the pain usually goes away after several days.

A Word From Verywell

Peptic ulcers do not simply go away on their own. Be sure to see your doctor when you notice the symptoms. While such an ulcer can take time to heal, the discovery of H. pylori as a cause makes it curable rather than something you must simply learn to live with.

Peptic Ulcer Disease | Michigan Medicine

Topic Overview

What is a peptic ulcer?

A peptic ulcer is a sore in the inner lining of the stomach or upper small intestine.

Ulcers form when the intestine or stomach’s protective layer is broken down. When this happens, digestive juices—which contain hydrochloric acid and an enzyme called pepsin—can damage the intestine or stomach tissue.

Treatment cures most ulcers. And symptoms usually go away quickly.

Peptic ulcers that form in the stomach are called gastric ulcers. Those that form in the upper small intestine are called duodenal (say “doo-uh-DEE-nul” or “doo-AW-duh-nul”) ulcers.

What causes peptic ulcers?

The two most common causes of peptic ulcers are:

H. pylori and NSAIDs break down the stomach or intestine’s protective mucus layer.

What are the symptoms?

Symptoms include:

  • A burning, aching, or gnawing pain between the belly button (navel) and the breastbone. Some people also have back pain. The pain can last from a few minutes to a few hours and may come and go for weeks.
  • Pain that usually goes away for a while after you take an antacid or acid reducer.
  • Loss of appetite and weight loss.
  • Bloating or nausea after eating.
  • Vomiting.
  • Vomiting blood or material that looks like coffee grounds.
  • Passing black stools that look like tar, or stools that contain dark red blood.

Different people have different symptoms, and some people have no symptoms at all.

How are peptic ulcers diagnosed?

Your doctor will ask you questions about your symptoms and your general health, and he or she will do a physical exam.

If your symptoms aren’t severe and you are younger than 55, your doctor may do some simple tests (using your blood, breath, or stool) to look for signs of H. pylori infection.

The only way for you and your doctor to know for sure if you have an ulcer is to do a more complicated test, called an endoscopy, to look for an ulcer and to test for H. pylori infection. An endoscopy allows the doctor to look inside your esophagus, stomach, and small intestine. An endoscopy is usually done by a gastroenterologist, a doctor who specializes in digestive diseases.

How are they treated?

To treat peptic ulcers, most people need to take medicines that reduce the amount of acid in the stomach. If you have an H. pylori infection, you will also need to take antibiotics.

You can help speed the healing of your ulcer and prevent it from coming back if you quit smoking and limit alcohol. Continued use of medicines such as aspirin, ibuprofen, or naproxen may increase the chance of your ulcer coming back.

Ignoring symptoms of an ulcer is not a good idea. This condition needs to be treated. While symptoms can go away for a short time, you may still have an ulcer. Left untreated, an ulcer can cause life-threatening problems. Even with treatment, some ulcers may come back and may need more treatment.


The two most common causes of peptic ulcers are:

  • Infection with

    Helicobacter pylori


    H. pylori

    ) bacteria. Although many people are infected with H. pylori bacteria, only a few get ulcers.

  • Nonsteroidal anti-inflammatory drugs (NSAIDs)
    . When used for weeks or months, NSAIDs can damage the lining of the digestive tract, causing an ulcer or making an existing ulcer worse. NSAIDs include aspirin, ibuprofen, and naproxen.

A rare cause of peptic ulcers is Zollinger-Ellison syndrome. In this condition, the stomach makes too much acid, damaging the stomach lining.


Common symptoms

Common ulcer symptoms include:

  • A burning, aching pain—or a pain that feels like hunger—between the navel and the breastbone. The pain sometimes extends to the back.
  • Belly pain that can last from a few minutes to a few hours and that usually goes away for a while after you take an antacid or acid reducer.
  • Weeks of pain that comes and goes and may alternate with pain-free periods.
  • Loss of appetite and weight loss.
  • Bloating or nausea after eating.

Less common symptoms

Less common but more serious symptoms of ulcers include:

  • Vomiting after meals.
  • Vomiting blood and/or material that looks like coffee grounds.
  • Black stools that look like tar, or stools that contain dark red blood.

Ulcers and pains

Symptoms of ulcers in the upper small intestine (duodenal ulcers) and in the stomach (gastric ulcers) are similar, except for when pain occurs.

  • Pain from a duodenal ulcer may occur several hours after you eat (when the stomach is empty) and may improve after you eat. Pain also may wake you in the middle of the night.
  • Pain from a gastric ulcer may occur shortly after you eat (when food is still in your stomach).

Silent ulcers

Some ulcers don’t cause symptoms. These are known as silent ulcers. Silent ulcers are more common in:

Symptoms in children

In children, symptoms vary with age:

  • Toddlers and young children may complain of general stomach pain.
  • Teenagers may have symptoms more like those of adults.

The symptoms of an ulcer often can be confused with other abdominal conditions, such as dyspepsia or gastroesophageal reflux disease (GERD).

What Happens

Many people who have peptic ulcers may not see a doctor when their symptoms begin. Their symptoms, such as belly pain, may come and go. Even without treatment, some ulcers will heal by themselves.

And even with treatment, ulcers sometimes come back. Certain factors such as cigarette smoking and continued use of nonsteroidal anti-inflammatory drugs (NSAIDs) increase the risk of ulcers coming back.

Sometimes ulcers can cause complications, such as bleeding, perforation, penetration, or obstruction. That’s why it’s important to treat an ulcer, even if you have one that isn’t causing any symptoms.

Most peptic ulcers without complications heal, regardless of the cause. But an ulcer is likely to come back if you have an H. pylori infection that is not successfully treated. Recurring ulcers caused by reinfection with H. pylori are not common in the United States, except in areas that are overcrowded or have poor sanitation.

Ulcers in the stomach (gastric ulcers) often heal more slowly than ulcers in the upper small intestine (duodenal ulcers).

What Increases Your Risk

Risk factors you can control

The following things can increase your chance of getting a peptic ulcer and may slow the healing of an ulcer you already have:

  • Taking nonsteroidal anti-inflammatory drugs (NSAIDs). These include aspirin, ibuprofen (such as Advil), and naproxen (such as Aleve).
  • Smoking.
  • Drinking too much alcohol. This is more than 2 drinks a day for men and more than 1 drink a day for women.

In the past, spicy foods, caffeine, and moderate amounts of alcohol were thought to increase ulcer risk. This is no longer believed to be true.

Risk factors you cannot control

Some things that you cannot control may increase your risk of getting an ulcer. These include:

  • A Helicobacter pylori ( H. pylori) infection, the most common cause of ulcers.
  • Physical stress caused by a serious illness or injury (such as a major trauma, surgery, or the need to be on a ventilator to assist breathing).
  • Hypersecretory condition, in which your stomach produces too much acid.
  • A personal or family history of ulcers.

When should you call your doctor?

If you have been diagnosed with a peptic ulcer, call 911 or other emergency services immediately if you have:

  • Symptoms that could indicate a heart attack or shock.
  • Sudden severe, continuous belly pain or vomiting.

Call your doctor or seek medical attention right away if you have:

  • Frequent feelings of dizziness or lightheadedness, especially when moving from lying down to a seated or standing position.
  • Blood in your vomit or something that looks like coffee grounds (partially digested blood) in your vomit.
  • Stools that are black or that look like tar, or stools that contain dark red or maroon blood.

Call your doctor if you have been diagnosed with a peptic ulcer and:

  • Your symptoms continue or become worse after 10 to 14 days of treatment.
  • You begin to lose weight without trying.
  • You are vomiting.
  • You have new belly pain or belly pain that does not go away.

Watchful waiting

If you have been diagnosed with a peptic ulcer and medical treatment is not helping, call your doctor. Waiting until your symptoms get worse can be serious.

If you don’t know if you have a peptic ulcer and you don’t have any of the emergency symptoms listed above, you may try taking an antacid or nonprescription acid reducer and other home treatment, such as making changes to your diet.

  • If your symptoms don’t get better after 10 to 14 days, call your doctor.
  • If your symptoms go away after you take antacids or acid reducers and try home treatment, but then the symptoms come back, call your doctor.

Who to see

To evaluate your symptoms, see your:

If further testing or treatment is needed, you may need to see someone who specializes in the treatment of diseases of the digestive tract (gastroenterologist).

If surgery is needed, your doctor may refer you to a general surgeon. But surgery is rarely needed to treat ulcers.

Exams and Tests

Although not all peptic ulcers are caused by bacteria, it’s getting more common to do a test for Helicobacter pylori whenever someone has ulcer symptoms. This includes testing your blood, breath, stool, or a sample of tissue from your digestive tract (biopsy).

An endoscopy may be done so that a doctor can:

  • Look at the inside of your stomach and your upper small intestine to check for an ulcer.
  • Collect a tissue sample (biopsy) that can be tested for H. pylori or cancer.

If you are older than 55, you may need an endoscopy because of a higher risk for stomach cancer. This is especially true if you have:

  • Ulcer symptoms for the first time.
  • Ulcer symptoms that return before or after treatment is completed.
  • A family history of stomach cancer.
  • Other symptoms that may point to a more serious problem, such as stomach cancer. These include:
    • Blood in the stool.
    • Weight loss of more than 10% of body weight.
    • Difficulty swallowing (dysphagia).
    • Jaundice.
    • Abdominal mass.

Other tests that may be done include:

  • Fecal occult blood test (FOBT). This test may be done to detect blood in the stool, which may be caused by a peptic ulcer or another serious problem, such as colon cancer. By itself, an FOBT cannot diagnose peptic ulcer disease, but it may show if an ulcer is bleeding.
  • Complete blood count (CBC). This blood test may be done to look for anemia, which may be caused by a bleeding ulcer.
  • Upper GI series. This X-ray exam of the esophagus and stomach may be used to diagnose peptic ulcer disease, although this test is being used less frequently.

Treatment Overview

Left untreated, many ulcers eventually heal. But ulcers often recur if the cause of the ulcer is not eliminated or treated. If ulcers keep coming back, you have an increased risk of developing a serious complication, such as bleeding or a hole in the wall of your stomach or intestine.

Most of the time, treatment means taking medicines—such as h3 blockers and proton pump inhibitors (PPIs)—and making lifestyle changes, including:

  • Not taking nonsteroidal anti-inflammatory drugs (NSAIDs), if possible. These include aspirin, ibuprofen (such as Advil), and naproxen (such as Aleve).
  • Quitting smoking.
  • Not drinking too much alcohol (no more than 2 drinks a day for men and 1 drink a day for women).

H. pylori infection

If your ulcer is caused by Helicobacter pylori ( H. pylori) bacteria, treatment usually involves a combination of medicines, including antibiotics.

If treatment isn’t working, you may need more tests to look for bacteria. If you still have an H. pylori infection, your doctor will likely try a different combination of medicines. He or she may also suggest that you see a gastroenterologist. This specialist will do an endoscopy to look at your ulcer and to take a tissue sample (biopsy).

Treatment if ulcers get worse

If you have serious complications from a peptic ulcer, such as bleeding or obstruction, you may need an endoscopy, even if you have already had one.

If your stomach or intestine has a perforation or your ulcer continues to bleed despite treatment, you may need surgery. But surgery is rarely used to treat an ulcer.


You can greatly reduce the chance that you will get a peptic ulcer if you:

  • Don’t smoke. Smokers are much more likely than nonsmokers to get ulcers. For ways to quit smoking, see the topic Quitting Smoking.
  • Avoid NSAIDs. Avoid taking aspirin, ibuprofen, and other nonsteroidal anti-inflammatory drugs (NSAIDs) for longer than a few days at a time. If you are taking one of these medicines daily, for example taking aspirin for heart problems, ask your doctor about taking medicine to help protect your stomach and intestines from ulcers.
  • Drink alcohol only in moderation. Limit alcohol to 2 drinks a day for men and 1 drink a day for women.

Home Treatment

Many people who have mild ulcer symptoms first try home treatment for a short time without seeing a doctor.

But see your doctor if your symptoms don’t get better after 10 to 14 days of home treatment, or if you have other symptoms such as weight loss, nausea after eating, or consistent pain. This is even more important if you are middle-aged or older, because the risk for cancer or other illnesses that cause symptoms similar to peptic ulcer disease increases with age.

Try these home treatment steps to stop symptoms and help an ulcer heal:

  • Stop smoking.
  • Try nonprescription medicines that reduce stomach acid. Make sure you tell your doctor about any medicines you are taking.
  • Make changes to your diet, such as eating smaller, more frequent meals. (These changes may improve your symptoms, but they won’t help your ulcer heal.)
  • Drink alcohol only in moderation, or not at all. Limit alcohol to 2 drinks a day for men and 1 drink a day for women. Drinking too much alcohol may make an ulcer heal more slowly and may make your symptoms worse.


Medicines are used to:

  • Treat peptic ulcers by reducing the amount of acid produced by the stomach.
  • Kill Helicobacter pylori ( H. pylori) bacteria if they are infecting the stomach lining.
  • Protect the lining of the stomach and upper small intestine from injury caused by nonsteroidal anti-inflammatory drugs (NSAIDs). These include aspirin, ibuprofen (such as Advil), and naproxen (such as Aleve).

Medicine choices

Medicines to reduce stomach acid

Medicines that reduce the amount of acid produced by the stomach are used to treat all forms of peptic ulcer disease.

  • Antacids (such as Tums)
  • Acid reducers

    • h3 blockers (such as Pepcid). Some h3 blockers are available without a prescription.
    • Proton pump inhibitors (PPIs) (such as Prilosec). Some PPIs are available without a prescription.

Be careful when you take over-the-counter antacid medicines. Many of these medicines have aspirin in them. Read the label to make sure that you are not taking more than the recommended dose. Too much aspirin can be harmful.

Medicines to kill H. pylori bacteria

Doctors prescribe combination drug therapy to cure infection with H. pylori bacteria. This usually includes at least two antibiotics, a proton pump inhibitor, and sometimes a bismuth compound.

Medicines to protect the stomach

Medicines used to protect the stomach from damage caused by frequent use of aspirin or other NSAIDs include:

  • Acid reducers. These include:

    • h3 blockers (such as Tagamet).
    • Proton pump inhibitors (PPIs) (such as Prilosec).
  • Prostaglandin analogs (such as Cytotec).

You can get some h3 blockers and PPIs without a prescription (over the counter or OTC). If you are using OTC acid reducers (such as Prilosec or Pepcid) to help with your symptoms for more than 10 to 14 days at a time, or if your symptoms are very bad, be sure to see your doctor.


Surgery is rare, but it is needed sometimes to treat:

  • Ulcers that don’t heal (intractable peptic ulcers).
  • Life-threatening complications of an ulcer, such as severe bleeding, perforation, or obstruction.

If surgery is suggested, you may want to:

  • Seek a second opinion and ask whether all medicine treatment options have been tried.
  • Compare the cost of long-term medicine treatment to the one-time cost of surgery.
  • Remember that no surgery can completely prevent ulcers from returning.
  • Find a surgeon who has a lot of experience with surgery for ulcers.

Surgery choices

When surgery is done, it usually involves one or more of the following:

  • Cutting one or more of the nerves to the stomach (vagotomy).
  • Widening the opening of the bottom of the stomach (pyloroplasty).
  • Removing part of the stomach (partial gastrectomy).


Other Works Consulted

  • Yang YX, et al. (2006). Long-term proton pump inhibitor therapy and risk of hip fracture. JAMA, 296(24): 2947–2953.


Current as of:
April 15, 2020

Author: Healthwise Staff
Medical Review:
E. Gregory Thompson MD – Internal Medicine
Adam Husney MD – Family Medicine

Peptic Ulcer Disease – Causes, Symptoms, Treatment, Diagnosis

A peptic ulcer is an erosion or sore in the lining of the stomach or intestine that occurs when the protective mucus layer wears away in certain areas, allowing damage to occur from the natural acids of the stomach.

Around 10% of people will have peptic ulcer disease (PUD) at some point in their life. The majority of peptic ulcers are caused by bacteria called Helicobacter pylori (H. pylori) or by taking ASA (acetylsalicylic acid) or nonsteroidal anti-inflammatory drugs (NSAIDs; e.g., ibuprofen*, ketoprofen, naproxen).

  • Gastric ulcers are sores in the lining of the stomach.
  • Duodenal ulcers are those in the first part of the small intestine, called the duodenum. This is an area where food is digested after passing through the stomach.

  • Causes

    Although stress and spicy foods might make the symptoms of peptic ulcer worse, they aren’t the cause of the condition as was once thought.

    A bacterium called H. pylori causes the majority of ulcers. The bacteria can spread into the mucus lining that usually protects the stomach and small intestine from digestive acids, damaging it in the process. By 60 years of age, up to 50% of people are infected with this bacteria, but only 10% to 20% of these people will actually develop stomach problems.

    The other major cause of PUD is the use of ASA (acetylsalicylic acid) and other NSAIDs such as ibuprofen or naproxen. NSAIDs can penetrate the lining of the stomach and release substances that damage cells. NSAIDs also block natural chemicals called prostaglandins that can help to protect and repair those cells. People more at risk of ulcers caused by NSAIDs include those who:

    • are seniors
    • have a history of a peptic ulcer
    • have a family history of peptic ulcer disease
    • are also taking glucocorticoids (e.g., prednisone, dexamethasone)
    • are taking high doses of NSAIDs or ASA
    • have several medical conditions
    • are taking more than one NSAID or ASA

    Excessive alcohol use can put people at higher risk for PUD, but it isn’t a true cause.

    Symptoms and Complications

    The most common symptom of peptic ulcers (both duodenal and gastric) is a gnawing or burning pain in the abdomen between the breastbone and the navel, sometimes passed off as “heartburn. An ulcer can also feel like a dull ache or strong hunger pangs. Yet some people, especially the elderly, may not feel any pain at all from an ulcer. Ulcer pain can come or go and can be aggravated by eating or an empty stomach. Ulcers can also cause belching and bloating.

    The most common complication of stomach and duodenal ulcers is bleeding. Although the blood loss is usually too slow to be noticed, it might be enough to make you tired, pale, and weak.

    If bleeding from the peptic ulcer is heavier, blood may show up in the stool or vomit. Stools that have blood in them may look tarry, black, or red. If you notice any of these signs, see a doctor right away. If a bleeding ulcer is severe, it can be fatal if left untreated. Keep in mind also that, since NSAIDs are such strong painkillers, they can mask the pain of bleeding ulcers.

    Very rarely, ulcers can make a hole, called a perforation, in the stomach or intestine. This can cause sudden and severe pain. Sometimes an ulcer can create a blockage out of the stomach or in the duodenum. This may cause bloating, feeling full after eating, vomiting, and weight loss.

    If an ulcer causes scarring, spasm, or inflammation, it is considered a gastric outlet obstruction and may lead to weight loss and dehydration. It may cause loss of appetite with fullness after eating, or it may cause large-volume vomiting up to 6 hours after a meal.

    Making the Diagnosis

    If you have the typical symptoms of PUD, your doctor will perform a physical exam and may order one or more of the following tests:

    A breath test (drinking a fluid and exhaling into a tube), blood test, or stool test may be used to check for H. pylori infection. If you have H. pylori, treatment may be given to cure the infection without the need for more invasive tests.

    A series of GI (gastrointestinal) X-rays may be done. These are X-rays of your stomach, duodenum, and esophagus (the swallowing tube). To make the ulcer easier for the doctor to see, you’ll first need to swallow a chalky liquid called barium.

    Endoscopy is another test used to detect ulcers. After numbing the throat, the doctor carefully guides a thin tube with a tiny camera on its end into the mouth and down the throat to get close-up pictures of the esophagus, stomach, and duodenum.

    If ulcers are detected by these tests, then appropriate treatment will be prescribed.

    Finally, all people older than 50 years who, for the first time, show symptoms suggestive of a stomach acid-related disorder, and anyone of any age with “alarm” features such as vomiting, bleeding, anemia, an abdominal mass, unexplained weight loss, or trouble swallowing should have an endoscopy to identify the cause quickly and to rule out cancer.

    Treatment and Prevention

    Medical treatment focuses on eliminating the H. pylori bacteria in people where it has been detected. The majority of peptic ulcers caused by H. pylori can be cured with a combination of antibiotics and acid-reducing medications called proton pump inhibitors (PPIs; e.g., omeprazole, lansoprazole, esomeprazole, pantoprazole, rabeprazole) plus two antibiotics (clarithromycin plus amoxicillin or metronidazole), all taken twice a day for 2 weeks.

    Other combinations of acid-reducing medications and antibiotics may also be used, including ones that use a total of four medications. For some people, several courses of treatment may be needed to get rid of H. pylori. Once the treatment for H. pylori is complete, the acid-suppressing medication should be continued for a total of 4 to 6 weeks.

    When an ulcer is not associated with H. pylori or is caused by NSAIDs, treatment with a PPI is prescribed for 2 to 4 weeks. Some people may need to continue treatment for longer periods of time. Another type of acid reducer, h3-antagonists (e. g., ranitidine, nizatidine), may also be used.

    If the peptic ulcer was caused by NSAIDs, such as ASA, your doctor will most often recommend that you stop taking them if possible. Some people are more susceptible to peptic ulcers caused by NSAIDs, including those who:

    • are seniors
    • have a history of a peptic ulcer
    • are also taking glucocorticoids (e.g., prednisone, dexamethasone)
    • are taking high doses of NSAIDs or ASA
    • have several medical conditions
    • are taking more than one NSAID or ASA

    If you’re taking a NSAID and have one of these risk factors, your doctor may prescribe a protective medication to take along with it. Acid-suppressing medications (e.g., PPIs) or misoprostol may be used for this. Misoprostol encourages the stomach to produce its protective mucus coating and improves blood flow.

    It’s important for people with PUD to quit smoking. Smoking can delay healing and can cause ulcers to return.

    Very rarely, surgical treatment may be needed for PUD and its complications.

    All material copyright MediResource Inc. 1996 – 2021. Terms and conditions of use. The contents herein are for informational purposes only. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Source: www.medbroadcast.com/condition/getcondition/Peptic-Ulcer-Disease

    A Case Report and Literature Review

    Medical and surgical disorders in pregnancy can be can be quite challenging for the obstetrician gynaecologist even in resource rich countries. Reaching an accurate diagnosis and admininstering appropriate management can be difficult in the presence of an on-going pregnancy. The importance of involving specialist from other disciplines (multidisciplinary care) cannot be overemphasized. We present an interesting case of perforated duodenal ulcer in a pregnant patient, review the literature ,discuss the differential diagnosis and evaluate the management principles for this rare condition.

    1. Introduction

    Peptic ulcer disease (PUD) is uncommon in pregnancy and pureperium. Pregnancy creates several difficulties in the diagnosis and management of peptic ulcers. Firstly the symptoms of PUD (nausea, vomiting epigastric discomfort) are also quite common in pregnancy, secondly diagnostic tests for PUD in the general population (upper gastrointestinal series X-rays and esophagogastroduodenoscopy EGD) are only performed with great hesitancy in pregnancy, and thirdly some drugs used in the general population for PUD (e.g., misoprostol) are contraindicated in pregnancy. Nevertheless prompt diagnosis and timely management of PUD in pregnancy are essential as complications can result in quite significant morbidity or even mortality for the patient. We present an interesting case of perforated duodenal ulcer in the puerperium.

    2. Case

    A 27-year-old primiparous patient presented to our unit when she was 38-week pregnant with the complaint of recurrent episodes of vomiting, general malaise, back pain, and vague lower abdominal discomfort. Pregnancy had been uneventful until then. She had attended antenatal clinic when she was 10-week pregnant for a booking appointment. She had no significant medical history and was on no medication. Booking blood tests as well as ultrasound scans (both booking and at 20 weeks) were normal. This admission at 38 weeks was her first admission to hospital in the pregnancy. On physical examination at admission she looked rather unwell. Her temperature was 36°C. Blood pressure and pulse were normal. Her abdomen was soft and not tender. Uterine fundal height was consistent with gestational age. Cardiotocography (CTG) demonstrated a reassuring fetal heart pattern. A presumptive diagnosis of urinary tract infection was made. Blood sample was obtained for FBC (full blood count), serum urea and electrolytes (U&E), Liver function tests (LFT), and C-reactive protein (CRP). A mid-stream urine sample was sent for culture and sensitivity, and she was started on antiemetics and antibiotics. The blood tests showed a serum potassium of 3. 4 mmol/l (3.5–5.5 mmol/l) and a raised CRP of 25 mg/L (1–10 mg/L). In spite of regular antiemetics, the patient’s vomiting became worse, occurring more frequently and becoming increasingly bile stained. The abdominal pain also became more localized to the upper abdomen. Uterine contractions ensued the same day, and she had ventouse delivery early hours of next morning on account of persistent decelerations of fetal heart rate on the CTG (cardiotocography) at full cervical dilatation. after delivery, the patient’s upper abdominal pain and vomiting continued. She also developed quite significant tenderness in the epigastrium. General surgeons were asked to see the patient. Blood tests were repeated; an abdominopelvic ultrasound scan and a chest X-ray were requested. The ultrasound scan showed a collection of fluid in the right upper quadrant of the abdomen (measuring about 8.5 × 3 cm). The fluid appeared to surround the liver and gall bladder. Liver, gall bladder, and kidneys looked normal. Uterus and ovaries looked normal. Chest X-ray was normal. Other than an increase in CRP to 131 mg/L, all the blood tests (FBC, U&E, LFT) remained normal. Based on the worsening clinical condition and these investigations, a diagnostic laparoscopy was performed. Laparoscopy revealed copious amount of pus and extensive adhesions around the stomach. Laparotomy (with a midline incision) was performed. This revealed an anterior perforation of the 2nd part of the duodenum. The perforation was repaired. An omental patch (Graham’s patch) support was created. A Nasogastric tube was left in after the operation, and the patient was kept nil by mouth for 24 hours. The patient made an uneventful postoperative recovery and was discharged home on the 7th postoperative day. She was discharged on omeprazole for a month, and clarithromycin/metronidazole for a week.

    3. Discussion and Review

    Multiple epidemiologic studies support a decreased incidence of PUD (Peptic ulcer disease) in pregnancy and pueperium [1].

    Several theories explain the apparent decrease in incidence of PUD during pregnancy. In 1945, Horwich explained the rarity of peptic ulcer in pregnancy by correlating hypochlorhydria with increased secretion of anterior pituitary-like hormones in the urine [2]. It has also been suggested that female gestational hormones (particularly progesterone) decrease the rate of ulcer formation by increasing gastric mucus synthesis. An increase in plasma hitasmine in pregnancy (caused by placental histaminase synthesis) increases metabolism of maternal histamine, thereby reducing gastric acid secretion during pregnancy [3]. Avoidance of ulcerogenic factors such as cigarette smoking, alcohol, and NSAIDS (Nonsteroidal anti-inflammatory drugs) all probably contribute to the reduced incidence of PUD in pregnancy.

    In spite of all these reasons PUD occurs in pregnancy and pueperium. The diagnosis is often made late in pregnancy with quite devastating consequences. In their literature review in 1962, Paul et al. describe 14 cases of perforated duodenal ulcer in pregnancy in which all 14 women lost their lives [4].

    The symptoms of PUD are mimicked by other common gastrointestinal problems in pregnancy (e.g., Gastroesophageal reflux disease, Nausea and vomiting of pregnancy, Hyperemesis gravidarum, and Cholecystitis). Cardinal symptoms of PUD are Pain, nausea, and vomiting. The pain is often epigastric and worse at night. In the presence of a gravid uterus (and especially when labour ensues) it can be quite difficult for patients to localize pain. In our patient, pain was initially localized to the lower abdomen! Unlike Reflux disease the pain is not exacerbated by recumbency or associated with regurgitation. Although nausea and vomiting occurs in 50%–80% of normal pregnancies, it is uncommon for these symptoms to persist beyond 20-week gestation. Nausea and vomiting of pregnancy is classically most intense in the morning whilst PUD symptoms are worse nocturnally and postprandially during the day. PUD symptoms also get worse with increasing gestation and are therefore usually most severe in the 3rd trimester. Occasionally PUD may present with hematemesis. Uncomplicated PUD produces minimal physical signs. When complicated physical signs are often present, abdominal tenderness (or even guarding), rebound tenderness, and fecal occult blood may be present.

    Management should always be multidisciplinary involving obstetricians, gastroenterologists, and surgeons.

    Baseline investigations should include Full blood count, serum urea and electrolytes, liver function tests, and serum amylase. Abdominal ultrasound evaluation is useful to exclude cholelithiases and gall stone pancreatitis. Although abdominal X-rays are generally contraindicated in pregnancy, they must be performed when there is suspicion of gastrointestinal perforation to assess the presence of pneumoperitoneum. The maternal and fetal benefits of prompt diagnosis and treatment far outweigh any fetal risks of teratogenicity or childhood cancer. Several studies suggest that when indicated (e.g., in patients with gastrointestinal haemorrhage or gastric outlet obstruction) esophagogastroduodenoscopy (EGD) is safe both for fetus and mother [5]. When gastrointestinal perforation is suspected, EGD is contraindicated. This is because endoscopic intubation can convert a contained perforation into a free intraperitoneal perforation thereby promoting intraperitoneal spillage of contaminated intestinal contents.

    For patients who have mild symptoms of PUD, lifestyle changes (avoidance of fatty foods, caffeine, cigarette smoking, alcohol, and NSAIDS) or medications such as antacids or Histamine receptor antagonists, for example, ranitidine can be used. Surgery becomes mandatory when perforation is suspected. Early surgery improves maternal and fetal prognosis. Fluid resuscitation and correction of electrolyte imbalance should be instituted before surgery. Surgery for duodenal perforation usually involves a Graham patch closure (primary closure with omental patch support). For patients who are preterm at the time of diagnosis, laparotomy may result in premature labour, and hence intramuscular steroid administration for fetal lung maturation must be considered.

    Postoperative antibiotics should be continued for at least a week. Medical treatment for PUD must be started and continued until patient is seen at the follow-up clinic. Our patient was started on omeprazole a PPI (Proton pump inhibitor). These agents are highly effective in treatment of duodenal ulcers and can be used once patient has delivered. Their safety in pregnancy is however currently unproven because of scant clinical data. Clear follow-up instructions must be given before discharge.

    4. Conclusion

    Complications of peptic ulcer disease do occur in pregnancy (albeit very rarely). Often times when they occur, diagnosis is made very late with resulting severe morbidity. In the case above, we have sought to highlight the main features to look for in diagnosing complicated PUD in pregnancy. We also outline the management of perforated duodenal ulcer in pregnancy. We hope that this increases the awareness of health practitioners of this rare complication of duodenal ulcer in pregnancy.


    Copyright © 2011 Papa Essilfie et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

    Why Does My Stomach Hurt When I Wake up? Behind Your Morning Discomfort

    Should you be concerned about stomach pain? Nearly everyone experiences a stomachache from time to time and the underlying cause could be just about anything. From indigestion and gas to constipation, many different health issues can afflict the stomach, causing you to feel some kind of pain or discomfort in the abdomen area. But if your stomach hurts almost every time you wake up, you deserve answers – not guesses.

    Why does your stomach hurt when you wake up in the morning? It could be related to a wide variety of things, whether it’s due to a serious health condition, if its mood related, or simply you’re simply passing gas. Keep reading to find out what could be causing your stomach pain in the morning and consider consulting a physician if the pain or discomfort persists.

    Sometimes stomach pain can be serious, while other times, it isn’t.

    Some conditions that cause stomach pain, upon diagnosis, require medical care. Per Oxford Academic, 1 in 10 patients suffering from abdominal pain are experiencing a symptom that stems from an acute disease, such as appendicitis (1.9 percent), diverticulitis (3.0 percent), biliary or pancreatic (4.0 percent), or neoplastic (1.0 percent) diseases. However, unless you’re experiencing other acute symptoms, your morning stomach pain is most likely harmless, due to gas, overeating, or constipation.

    Stomach pain can also be caused by stress, depression or anxiety. Per U Chicago Medicine, high levels of cortisol – the stress hormone – can cause gastrointestinal discomfort while dealing with stress.

    “When a person is stressed, the adrenal glands make and release the hormone cortisol into the bloodstream,” according to U Chicago Medicine. “This causes the fight-or-flight response and can also trigger abdominal discomfort, stomach cramps, constipation, diarrhea, nausea, and other symptoms.

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    You may have eaten something the night before or are preparing for a bowel movement

    Most likely, your stomach hurts when you wake up because of something that happened the night before. Perhaps you ate something that didn’t agree with you, ate late at night, or ate a too much. As a result, you might be experiencing constipation, diarrhea, or indigestion. Stomach pain in the morning could also indicate that you have to make a bowel movement — if your stomach pain feels like a cramping sensation, this might be your body preparing to relieve itself.

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    Stomach pain in the morning could also be due to an empty stomach. Simply put, you could be hungry, and your body could be telling you it needs food. However, it can be due to a more serious, longterm condition.

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    You may have a longer-term stomach issue, if the feeling persists.

    If you have a stomach ulcer, you may experience more pain when your stomach is empty as well. While antacids can help with this pain, you should consult a doctor if you think you may have a stomach ulcer. Irritable bowel syndrome (IBS), on the other hand, is characterized by lower stomach pain, bloating, diarrhea, constipation, excessive gas, or mucus in the stool. If your stomach pain is also accompanied by any of the aforementioned symptoms, ask your doctor about IBS.

    Stomach pain spans a wide umbrella and it could be a symptom of any number of issues. If your stomach pain or discomfort persists, consult your doctor, as it could be an indication that you are dealing with a serious issue such as a pancreatic disease like pancreatitis (which is a kind of inflammation), Crohn’s Disease, colitis, diverticulitis, gallstones, Celiac disease, or some other kind of food allergy.

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    There are many possible cures for stomach pain.

    Stomach pain can be extremely frustrating to deal with as well as debilitating. If you want to relieve your symptoms or discomfort, there are a few natural things you can do to make yourself feel a bit better. Ginger supplements, ginger drinks, and ginger chews, for example, are extremely effective at curbing stomach discomfort and aches, studies show. It has even been recommended for cancer patients dealing with nausea and vomiting as a result of chemotherapy treatments.

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    Drinking peppermint tea or munching on the peppermint leaves will also help, but if you rub a few drops of peppermint essential oil right onto your belly (along with a carrier oil), you should be relieved of your stomach pain. You can also smell the peppermint essential oil if you prefer that. (It’s good for curing headaches, too!) Peppermint is a natural analgesic, so it has the ability to reduce pain and curb feelings of nausea.

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    Chamomile is also an anti-inflammatory and in most cases of an upset stomach, some form of inflammation is to blame. Brew yourself a chamomile tea to help the muscles of your stomach relax — as the muscles calm down, you will likely experience less spasms or cramps, and ultimately, less pain.

    If you have a heating pad, crank it up and apply it to your afflicted area, or, if you don’t own a heating pad, you can simply heat up a water bottle and apply it to the area. Like chamomile, heat relaxes stomach muscles and can therefore keep the pain, discomfort, and cramps to a minimum.

    ACV also contains acids that can target starch digestion, which allows starch to move forward through the body, and keeps your intestines healthy. As a result, you may feel experience less discomfort. 

    If you experience stomach pain when you wake up rather frequently, you could try one or all of these natural cures — here’s to hoping it’s nothing serious.

    Morning Sickness Symptoms and Causes

    Morning sickness is probably the most infamous symptom of pregnancy. And even though morning sickness symptoms are pretty well known, they can also throw you for a loop. After all, how do you know whether it’s pregnancy making you feel sick or something else? And what sort of nausea and vomiting is considered normal when you are pregnant? Also, how exactly are you supposed to get through the day when you’re constantly getting sick anyway? We’re here to give you answers on all the morning sickness symptoms and how to deal with it.

    When Does Morning Sickness Start?

    It’s common for morning sickness sufferers to start to feel icky around 6 weeks pregnant. But for some, it takes a little longer before they begin a strict diet of saltines and ginger ale and storing barf bags in the glove compartment. Morning sickness tends to peak in the first trimester. “Morning sickness, fatigue and breast tenderness are the most common symptoms of early pregnancy,” notes Dr. Kim Langdon, MD, OBGYN.

    How Long Does Morning Sickness Last?

    Unfortunately, morning sickness symptoms can last for weeks or even months. “Symptoms usually start around 6 weeks and peak at 9 or 10 weeks and then get gradually better,” says Dr. Sarah Yamaguchi, MD, FACOG, OBGYN. Each pregnancy is different though and your sickness could last longer or shorter than others. According to the American College of Obstetricians, morning sickness typically goes away by the start of the second trimester (14 weeks pregnant) for most pregnant people. And, though the name suggests you might only feel awful in the morning, many people experience nausea and vomiting all day.

    If your morning sickness lingers after 14 weeks pregnant—or if you can’t keep any food or liquids down at all—tell your healthcare provider. These are signs of hyperemesis gravidarum, a more severe condition that is basically morning sickness symptoms on steroids. HG can cause dehydration, weight loss and electrolyte imbalance and can get pretty serious, so it should be treated by a healthcare provider.

    What Causes Morning Sickness?

    Morning sickness is typically blamed on the hormones that flood your system when you become pregnant. It has also been linked to proteins released by the placenta. But doctors don’t truly know the purpose of all that unpleasantness.

    One theory is that morning sickness symptoms are evolution’s way of preventing pregnant people from eating potentially harmful foods while the fetus is most vulnerable.

    Some doctors say morning sickness symptoms are a sign of healthy pregnancy, which is a teensy bit reassuring, although there are plenty of healthy babies whose parents didn’t get the queasies. Some people are just more vulnerable to getting nausea, so they’re more likely to have morning sickness symptoms.

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    Morning Sickness Symptoms and Signs

    Morning sickness is nausea, vomiting or a combination of the two, caused by pregnancy and can be a really challenging hurdle for pregnant people, says Ana Genao-Tanney, antenatal and postpartum doula. Morning sickness is also “a misnomer,” she explains, “[as it] strike at any hour of the day. “It can often be accompanied by food aversions where you can’t stand the smell or taste of a certain food,” she tells us.

    What is morning sickness like? Well, it can be different for different women. Some just have mild queasiness here and there for a couple weeks. Others have full-blown nausea and are throwing up, unable to keep any food down. There’s definitely a range in severity of morning symptoms, and it’s hard to predict what your unique experience will be like. Some people even have different morning sickness symptom experiences from one pregnancy to the other.

    If you’re not yet feeling sick, count your lucky stars—you could even be one of the lucky one-in-five pregnant people who doesn’t get morning sickness.

    Usually, you’ll know you’re experiencing morning sickness symptoms because you won’t have other signs of illness or disease.

    Signs it’s not morning sickness include:

    • Late start: If you have nausea or vomiting that starts after 9 weeks pregnant, it might not be morning sickness at all. Look into other potential causes.
    • Pain: If you also have stomach pain or abdominal pain or tenderness, you could have another problem, such as food poisoning, a stomach bug or an ulcer.
    • Fever: A fever is a sign of illness, not a morning sickness sign.
    • Headache: Same goes for headache. If you have one, there might be some other explanation for your nausea, though headaches can be a pregnancy symptom (confusing, we know!).
    • Swelling in the neck: Thyroid problems can sometimes cause nausea. Your thyroid gland is in the front of your neck, so take note if you’re swollen there.

    If you have any of the above symptoms, talk to your healthcare provider just to be sure.

    How to Treat Morning Sickness

    We’re not promising you’re going to feel like a million bucks, but typical morning sickness symptoms can be eased using a few smart strategies. You’ll have to troubleshoot a bit to see what survival plan works best for you, but we recommend trying any and all of these:

    • Keep food in your nightstand: Really! Eating a few crackers or a granols bar first thing in the morning can help settle your stomach before you even get out bed.
    • Eat often: And really, don’t let your belly get empty if at all possible, because that’s when morning sickness symptoms tend to strike.
    • Keep meals small: Don’t overwhelm that tummy with tons of food, even if you finally have your appetite back and want to take advantage. You may be less likely to aggravate your digestive system if you eat often but in small amounts. Also, sip drinks throughout the day; don’t guzzle them down. Some people find sparkling waters help ease the queasiness. “Eating small frequent meals, staying hydrated and avoiding foods that trigger an aversion are common best practices,” explains Genao-Taney.
    • Go with it: We get the guilt of not wanting healthy foods (like salad!) and just wanting to subsist on grilled cheese for now. But if all you can stomach is grilled cheese, then just eat the grilled cheese. “I tell my patients to try to be as healthy as they can as far as activity and diet,” says Dr. Yamaguchi, “but in the first trimester, some people have to eat junk food just to get by and that’s just how it is.” Focus on getting food into your body for now. When you feel better, you can concentrate more on balanced nutrition.
    • Experiment with carbs vs. proteins: Some pregnant people find that starchy foods like crackers and chips curb their morning sickness symptoms. Others get more relief from protein, like nuts and poultry.
    • Try different flavors: Ginger, lemon and watermelon are just a few flavors (and scents) that help some women soothe morning sickness symptoms. Try them fresh, or stock up drinks, candies or lollipops with the flavors that help you most.
    • Avoid offending smells and flavors: Can’t stand the sight or smell of certain foods? Stay far, far away.

    If your morning sickness symptoms are severe, your healthcare provider might prescribe:

    • Vitamin B6 supplements: “Taking vitamin B6 supplements could help,” says Dr. Yamaguchi. These are considered safe to take and have shown to ease morning sickness symptoms in medical studies.
    • Doxylamine: This antihistamine is typically used to treat allergies but may also help with morning sickness symptoms.
    • Anti-nausea medication: There are some anti-nausea drugs that are considered safe to take during pregnancy and may be worth taking if the morning sickness symptoms are interfering with your ability to get through the day. “Medicines like diclegis [could] help with morning sickness and [there are other] stronger medicines that [can] treat vomiting,” explains Dr. Yamaguchi. Talk over all the pros and cons with your healthcare provider.

    Remember: Don’t take anything—whether it’s a supplement or an OTC or prescription med—unless your healthcare provider gives the OK. And hang in there. You may feel terrible, but your baby’s doing just fine on the inside—and the morning sickness will end eventually.

    6 signs that you may be suffering from a stress-related ulcer

    What happens during exposure to stress?

    Your body activates the fight or flight response, more formally known as the sympathetic response. Following exposure to stress, this evolutionary mechanism interprets the stimulus as a threat, something that is putting you in danger. This was useful during times of a hunter-gatherer society when large predators hunted humans.

    Epinephrine (adrenaline) is released into the blood stream from the adrenal glands and causes an array of rapid changes.

    Heart rate increases to circulate blood through the body at a quicker pace, delivering oxygen to the many muscles working hard to fight off or flee the beast. The blood vessels constrict, causing the blood pressure to increase while the airways dilate to allow a greater amount of air to enter the lungs. The pupils become larger to allow more light in while the perception of pain is reduced.

    While all of these changes sound extreme, they help us in the moment and are balanced by the parasympathetic response that counteracts all of these processes. The real danger is when the stress becomes chronic and the body has difficulty ‘turning off’.

    What other changes can stress cause?

    In certain individuals, changes in the secretion of stomach acid and mucous protecting the stomach tissue from the acid may lead to erosions in the tissue over time, a condition known as a gastric ulcer. While some research shows stress to be a direct cause of ulcers, current research has also shown that the experience of psychological stress influences health risk behaviours. These behaviours in themselves place the individual at a higher risk of developing an ulcer and include smoking, lack of sleep, and use of nonsteroidal anti-inflammatory drugs such as aspirin or ibuprofen.

    What are the symptoms of stomach ulcer?

    • The most concerning sign is coughing or vomiting blood as it indicates that the erosion of the stomach wall is quite far along.
    • Another sign could include dark stools as a result of blood that has been processed through the digestive tract and is now being excreted in the stool, more formally known as melena.
    • Bloating,
    • Abdominal pain,
    • Heartburn, or even
    • Weight loss in extreme cases as the pain affects appetite.

    Do stress ulcers go away?

    The healing of a stomach ulcer is facilitated by the fact that the cells forming the stomach wall have a high turnover rate, one that is increased in those with ulcers. This makes sense because the cells in this environment are exposed to acids, large muscle movements as the food is churned, different spices, foods of various textures, etcetera. This means cells can ‘wear out’ quickly and need to be replaced. The larger danger occurs when the tissue is ulcerated for so long, that the cells begin to mutate, potentially placing you at a higher risk of developing stomach cancer.

    However, if the tissue hasn’t reached a state with mutations, then given enough time and with a reduction in stress, the tissue will eventually return to its pre-ulcerated state.

    How do you treat stress ulcers?

    Mindfulness could be part of a protocol to help heal the ulcerated tissue and improve symptoms such as bloating and abdominal pain. Women participating in an 8-week course where they practiced mindfulness-based stress reduction (MBSR) experienced a 26.4% reduction in their symptoms and when researchers followed-up after 3 months, these same women had now experienced a 38.2% reduction in symptoms. MBSR has also been shown to stabilize cortisol rhythms which fluctuate throughout a 24-hour period, otherwise known as the stress hormone.

    Diet can play a large role as well with certain foods demonstrating ulcer-fighting properties, mostly in animal studies. S-methylmethionine is a compound that can be found in abundance in cabbage and has been shown to have anti-ulcerogenic properties. Some research has demonstrated an ability to accelerate the healing of ulcers, and in another study where conventional treatment failed, -86% of recruited patients found relief from pain within two weeks of starting to take cabbage juice.

    While treating is important, prevention is key. What means of prevention are available to you?

    Stop stressing! Easy right? No. A herculean statement with so many factors to consider, but some gentle help from various herbs may help you cope with stressors a little easier. One such plant to consider is Passion Flower (Passiflora incarnata), a plant with anxiolytic, hypnotic, and anti-spasmodic effects. In patients experiencing anxiety prior to undergoing a dental extraction, Passion Flower was as effective as midazolam, a common anti-anxiety pharmaceutical. 20% of those in the study who took midazolam reported amnesia while those taking Passioflora incarnata demonstrated no significant memory issues. In another study, the effects of passion flower were comparable to oxazepam in the treatment of generalized anxiety disorder. So, reducing anxiety and the associated stress may help to reduce the formation of ulcers.




    90,000 Tortured by nausea in the morning? Constantly cloudy after eating? Dealing with the reasons!

    Published: Aug 1. 2020

    Nausea, a feeling of heaviness in the abdomen, heartburn are familiar to everyone. Overeat fatty delicacies at the festive table – unpleasant sensations will not keep you waiting long. I drank expired kefir or too much alcohol – nausea is right there. The reasons are simple and straightforward. In the first case, there were not enough enzymes to digest food, and the liver had to work to the limit.In the second, toxic substances entered the body, which caused poisoning. These symptoms are unpleasant, but they are temporary. And they usually pass in a few days or even hours. But what if you feel sick all the time? We need to figure out the reasons!

    Why do you feel sick in the morning?

    Daily morning awakening with a feeling of nausea, which makes you refuse breakfast and “come to your senses” for a long time, may be associated with nocturnal gastroesophageal reflux (reflux of bile into the esophagus).By itself, it is not a pathology, since it normally occurs mainly after eating and does not cause discomfort. To suppress it, the body includes compensatory antireflux mechanisms.

    But if an unpleasant symptom is observed often and lasts a long time, then we can talk about gastroesophageal reflux disease or about diseases of the gastrointestinal tract. An abdominal MRI will help to find out the exact cause and make a diagnosis.

    Causes of nausea after eating

    Nausea after breakfast or lunch can be caused by heavy food (mostly fatty), overeating, psychogenic eating disorders (anorexia, bulimia).

    But in most cases, the patient’s unpleasant condition is associated with pathologies of the gastrointestinal tract: gastritis, colitis, peptic ulcer, enteritis.

    How to determine the exact cause of nausea?

    The spectrum of possible violations, as we see, is quite “rich”. The liver, gallbladder, biliary tract, pancreas, stomach, small intestine, duodenum, lower esophageal sphincter, and gastroesophageal junction can cause nausea.

    Problems can cause inflammation, erosion, ulcers, cysts, tumors, gallstones.The cause may be stenosis (narrowing) of the outlet of the stomach, fibrosis, cirrhosis, and fatty degeneration of the liver (hepatosis). Often, patients are diagnosed with functional disorders.

    To establish the gastroenterological cause of nausea, to exclude the presence of a tumor causing dysphagia (impaired passage and stagnation of food), it is recommended to do an MRI of the abdominal cavity.

    Highly informative research allows the patient not to run around doctors’ offices, checking each organ separately.And immediately simulate a three-dimensional image of each organ, see its layer-by-layer sections. And to get an idea of ​​the general picture: the thickness and changes in the walls of the stomach, the state of the gallbladder, the size of the liver, pancreas, duodenum, esophagus, to track their functions in real time. MRI provides better visualization of the gastrointestinal tract than CT, so this method is preferable in most cases.

    Examination can be done without contrast and with contrast. In the second case, the price of an abdominal MRI will be higher, but the study will provide more accurate information on tumor neoplasms.

    What if the gastroenterologist found no abnormalities?

    It also happens that after the examination, the gastroenterologist tells the patient that no pathologies have been identified on his part. However, such good news does not yet mean that the person who came with complaints is healthy in a heroic way.

    The etiopathogenesis of nausea can be associated with:

    • vascular pathologies;
    • hypertension;
    • diseases of the inner ear;
    • endocrine disorders;
    • pathologies of the brain and central nervous system;
    • head injuries and post-traumatic syndromes;
    • viral, bacterial and parasitic infections (often not associated with the gastrointestinal tract, but affecting the lungs, ENT organs, central nervous system).


    Nausea is not a disease, but a symptom of some disorder or disease. Therefore, if it is not associated with toxic poisoning, then you need to look for and eliminate the cause, and not fight the consequence.

    Some drugs (eg metoclopramide) can help reduce nausea. But it is advisable to take any medication only as directed by a doctor, because self-medication can only aggravate the problem.

    Article reviewed by a specialist doctor:

    Basargin Alexander Ivanovich

    MRI diagnostician, CT diagnostician, Radiologist

    Computed tomography doctor, magnetic resonance imaging doctor, category I doctor

    Total work experience: 14 years.

    Since 2011, an active member of the ESR society.

    Specializes in:

    • neuroradiology;
    • angiography;
    • examination of a patient using computed tomography, magnetic resonance imaging of the head, thoracic region, spine, and limbs.

    Place of work: Regional hospital. Wagner E.A. Berezniki

    90,000 Why do you feel sick, what to do and when to see a doctor

    25 June 2019 10:30
    Alla Lysak

    Causes of nausea


    Nausea occurs after a decrease in stomach tone with simultaneous tension in the duodenal region.

    Doctors say that the cause of nausea can be defined as follows: the body’s desire to get rid of something that is aggressive for it.

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    The stomach tries to signal and we feel it in the form of nausea. In many diseases of the gastrointestinal tract, there is no direct effect of the factor on the gastric mucosa, such as in food poisoning, intestinal infections, when the pathogen circulates in the blood, however, nausea also occurs.

    What abnormalities are indicated by nausea?

    Nausea after eating most often indicates the pathology of the biliary tract, especially if it occurs after eating fatty foods. In addition, gastric ulcer or duodenal ulcer, pancreatitis are thus identified. Until the time of contacting a doctor, it is recommended that you refuse to eat food that makes you nauseous (fatty, salty, sweet).

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    Nausea with abdominal pain is characteristic of gastritis or gastroduodenitis (inflammation of the stomach).If the pain is localized in the navel, and nausea leads to vomiting, we can talk about food poisoning.

    Nausea after cigarettes associated with erosive gastritis, peptic ulcer disease.

    If you feel nausea in the morning , there may be a pathology of the biliary system. Due to stagnation of bile and its subsequent release into the stomach, irritation and nausea appear. This symptom is combined with bitterness in the mouth, a yellow coating appears on the tongue after sleep, and weakness occurs.

    Nausea as a symptom requires examination by a doctor. He will help you choose the right treatment so that discomfort is a thing of the past.


    City Clinical Hospital # 31 – IBD: Ulcerative colitis. What does the patient need to know? (page 4)

    Page 4 of 10

    Ulcerative colitis symptoms

    In the majority of patients (75%), the disease begins gradually. Sometimes patients for a long time do not seek qualified help from a specialist doctor, regarding the presence of blood in the stool as a manifestation of chronic hemorrhoids.It can take from 10 months to 5 years between the onset of the first symptoms of UC and the moment of diagnosis. Much less often, the YAK makes a sharp debut.

    The severity of the clinical manifestations of UC depends on the length of the inflammatory lesion and the severity of the disease. Symptoms characteristic of UC can be divided into three groups:

    • intestinal
    • general (system)
    • extraintestinal.

    The most frequent intestinal symptoms are stool disorders in the form of diarrhea ( in 60-65% of UC patients, stool frequency ranges from 3-5 to 10 or more times a day in small portions) or constipation (at 16-20 % of cases, mainly with lesions of the lower colon).In more than 90% of patients, an impurity of blood is found in the feces. Its amount is different (from veins to a glass and more). With inflammation of the lower colon, the blood is usually scarlet and sits on top of the stool. If the disease has affected most of the colon, then the blood appears in the form of dark cherry-colored clots mixed with feces. Often in the stool, patients also notice pathological impurities of pus and mucus. Typical clinical signs of UC are fecal incontinence, urgent urge to empty the bowel, false urge with the release of blood, mucus and pus from the anus, practically without fecal matter (“rectal spitting”).Unlike patients with functional intestinal disorders (irritable bowel syndrome), UC patients also have stool at night. In addition, about 50% of patients complain of abdominal pain, usually of moderate intensity. More often pains occur in the left half of the abdomen, after the passage of the stool, they weaken, less often intensify.

    General or systemic symptoms of UC reflect the effect of the disease not only on the large intestine, but also on the entire patient’s body as a whole.Their appearance indicates a severe and widespread inflammatory process in the intestine. Due to intoxication and loss of useful substances along with loose stools and blood, the patient develops an increase in body temperature, loss of appetite, nausea and vomiting, increased heart rate, weight loss, dehydration, anemia (anemia), hypovitaminosis, etc. Often, patients have various disorders from the psycho-emotional sphere.

    Extraintestinal manifestations of UC occurring in 30% of patients are the result of immune disorders.The severity of most of them is associated with UC activity. It should be noted that patients often do not associate these symptoms with intestinal pathology and seek help from various specialist doctors (rheumatologists, neuropathologists, ophthalmologists, dermatologists, hematologists, etc.). Sometimes their appearance precedes intestinal symptoms. A variety of organs can be involved in the disease process.

    In case of damage of the musculoskeletal system patients complain of pain, swelling, decreased mobility of various joints (knee, ankle, hip, elbow, wrist, interphalangeal, etc.). As a rule, pains migrate from one joint to another without leaving significant deformities. The defeat of large joints is usually associated with the severity of the inflammatory process in the intestine, and arthropathy of small joints occurs independently of the activity of the UC. The duration of the described articular syndrome sometimes reaches up to several years. Inflammatory changes in the spine with limited mobility (spondylitis) and sacroiliac joints (sacroiliitis) may also appear.

    Lesions of the skin and the mucous membrane of the oral cavity in patients with UC are manifested in the form of various rashes.Typical are painful red or purple subcutaneous nodules on the arms or legs (erythema nodosum), vesicles in areas with a small thickness of subcutaneous tissue – the legs, in the sternum region, self-opening with the formation of ulcers (pyoderma gangrenosum), ulcers on the mucous membrane of the cheeks, gums, soft and hard palate.

    With the involvement of eyes patients with UC develop pain, itching, burning in the eyes, redness of the eyes, photophobia, a feeling of “sand in the eyes”, blurred vision, headaches.Such complaints accompany the appearance of inflammation of the mucous membrane of the eye (conjunctivitis), the iris (iritis), the white membrane of the eye (episcleritis), the middle layer of the eye (uveitis), the cornea (keratitis) and the optic nerve. For a correct diagnosis, patients need an ophthalmologist’s consultation and a study using a slit lamp.

    Often, the extraintestinal symptoms of UC include signs of damage to other digestive organs (liver and biliary tract (incl.including poorly amenable to drug treatment primary sclerosing cholangitis), pancreas), disorders in the blood system (phlebitis, thrombosis, autoimmune hemolytic anemia).

    90,000 How do endocrine system disorders affect the digestive tract?

    We are used to associating such symptoms as nausea, vomiting, stool disorders (diarrhea or constipation) with diseases of the gastrointestinal tract, and when they appear, we turn to a gastroenterologist first.However, in some cases, in addition to the main indicators, the gastroenterologist recommends checking the work of the endocrine system or consulting an endocrinologist. Often this causes bewilderment, and sometimes even suspicion that the doctor is interested in prescribing more examinations.

    In fact, more than 80% of endocrine system diseases can be hidden behind gastroenterological symptoms, making it difficult to determine the true causes of poor health. To understand why this happens, knowledge about the structure and functions of the endocrine system will help us.

    How does the endocrine system work?

    The endocrine system consists of a network of glands, tissues and cells located throughout the body that secrete biologically active substances (hormones), and target cells that have receptors that capture these hormones. It provides regulation of such body functions as behavior, nutrition, metabolism, immunity, reproduction. That is, the endocrine system performs the coordinating function of most processes in the body.

    If the endocrine system is not healthy, a person may have developmental problems during pregnancy, growth and puberty.Endocrine disruptions can affect the functioning of various body systems, including the gastrointestinal (GI) tract.

    Hormones and their role in the body

    Hormones are chemicals that the endocrine system uses to transmit “messages” to organs and tissues throughout the body. Once in the bloodstream or in the intercellular space, they are directed to certain organs or tissues that have receptor cells that recognize the hormone and respond to it.

    Diseases of the thyroid gland and gastrointestinal tract

    Thyroid hormones, produced by the thyroid gland, help control most bodily functions, including metabolic rate and energy levels. They affect both increased appetite, the rate of secretion of digestive juices, and the motility of the gastrointestinal tract. Therefore, any deviation of the level of thyroid hormones from the norm can cause disruption of the digestive system.

    Lack of thyroid hormones (hypothyroidism) leads to a slowdown in gastric emptying and the passage of food through the intestines.The amplitude of the contractions of the large intestine also decreases. As a result, in some patients with hypothyroidism, stool frequency decreases less than once every 2 days, and in some patients there is constipation that cannot be treated with laxatives.

    Other symptoms of hypothyroidism include:

    • constant weakness, drowsiness;
    • weight gain, swelling;
    • Constant chilliness;
    • slowing heart rate.

    The most common cause of hypothyroidism is autoimmune thyroiditis, associated with the aggression of the immune system against its own thyroid cells.

    An excess of thyroid hormones (thyrotoxicosis), on the contrary, causes the activation of gastrointestinal motility, and as a result, patients are often disturbed by diarrhea.

    The most common symptoms of thyrotoxicosis are :

    • sudden weight loss;
    • increased heart rate, heart rhythm disturbance
    • increase in blood pressure
    • nervousness, irritability
    • increased sweating.

    The development of thyrotoxicosis is most often caused by an autoimmune disease of the thyroid gland – diffuse-toxic goiter (Graves’ disease). In this case, the immune cells overstimulate the production of thyroid hormones.

    Therefore, in the presence of gastrointestinal disorders (diarrhea or constipation) of unexplained origin, it is necessary to exclude disruption of the thyroid gland.

    How are autoimmune diseases of the thyroid gland and the gastrointestinal tract related?

    Autoimmune diseases of the thyroid gland, such as autoimmune thyroiditis and diffuse-toxic goiter (Graves’ disease), are often combined with other autoimmune diseases, including liver diseases (primary biliary cirrhosis and autoimmune gastric hepatitis), autoimmune diseases (ulcerative colitis, Crohn’s disease).

    Parathyroid glands, blood and gastrointestinal calcium levels

    If many people know about the thyroid gland and its functions, then we are much less aware of the parathyroid glands. Few people know that behind the thyroid gland, on both sides, there are small paired parathyroid glands that produce parathyroid hormone, which is involved in maintaining normal blood calcium levels. If the amount of parathyroid hormone produced by the parathyroid glands increases, for example, in benign tumors of these glands, then the level of calcium in the blood also increases, and in the bone tissue, on the contrary, decreases.This condition is called primary hyperparathyroidism. An increased level of calcium from the gastrointestinal tract is manifested by a decrease or complete lack of appetite, nausea, and vomiting. In addition, patients often have constipation, cholelithiasis, chronic pancreatitis, gastric ulcer and duodenal ulcer may develop.

    Other manifestations of hyperparathyroidism include increased blood pressure, fragility of bones (osteoporosis and fractures), and the formation of kidney stones (urolithiasis).

    Influence of diabetes mellitus on the digestive tract

    Diabetes mellitus is one of the most common endocrine-metabolic diseases. With a long course of diabetes, more than 75% of patients are concerned about various symptoms from the gastrointestinal tract:

    • constipation,
    • nausea and vomiting,
    • abdominal pain,
    • diarrhea,
    • fecal incontinence,
    • Swallowing disorder (dysphagia).

    The cause of complaints is an increased blood sugar level and, as a consequence, the development of autonomic neuropathy – a violation of the sensitivity of nerve fibers due to damage to small blood vessels. In addition, diabetes mellitus increases the susceptibility to infections that can cause the development of diseases of the gastrointestinal tract.

    Gastroenterological manifestations of tumors of the diffuse endocrine system (carcinoids)

    The diffuse endocrine system is the most mysterious and currently the most studied part of the endocrine system.It includes single, or grouped together, hormonally active cells located throughout the body in the endocrine and non-endocrine organs.

    Since the end of the 19th century, when the first cells of the diffuse endocrine system were described, more than 60 of their species have been studied. A significant number of these cells are found in the digestive tract, heart, thymus, mucous membranes of various organs and tissues. Cells produce hormones and biologically active substances that are involved in the regulation of vital processes in the body.

    Benign and malignant neoplasms from cells of the diffuse endocrine system are called neuroendocrine tumors (carcinoids), most often such tumors arise in the gastrointestinal tract, but can also affect other organs. A feature of these neoplasms is that, in an active state, they are capable of producing a large amount of hormones, causing syndromes associated with an excess of these hormones.

    The gastrointestinal tract is the largest producer of hormones, at the moment there are more than 10 different biologically active substances involved, primarily in the processes of digestion and metabolism.Tumors originating in the gastrointestinal tract can cause carcinoid syndrome, which is manifested by diarrhea, cramping abdominal pain, flushing of the face and trunk, increased heart rate, and shortness of breath.


    Most of the endocrine disorders described in this article were encountered in the clinical practice of gastroenterologists and endocrinologists of our center. Carcinoid syndrome, which occurs in neuroendocrine tumors of the gastrointestinal tract, is the rarest endocrine disorder.But endocrine disorders leading to gastroenterological manifestations caused by diseases of the thyroid and parathyroid glands, are widespread in the North-West region of .

    You can check the state of these glands using the “express diagnostics” programs:

    Programs were developed by our doctors based on their diagnostic and treatment experience, as well as in accordance with Russian and international clinical guidelines.You can sign up for a survey or clarify your questions by calling +7 (812) 426-33-88 or through the form on the website.

    toxicosis, bowel problems and heartburn

    Learn how pregnancy affects the digestive tract, which trimesters are more likely to experience bowel upset and nausea symptoms, and what to do to manage them.

    During pregnancy, the load on the mother’s body increases. The body needs more nutrients, the body produces additional hormones.And the growing fetus presses on neighboring organs, including the stomach and intestines. We will tell you what symptoms are observed in each trimester, how to cope with toxicosis and get rid of heartburn.


    Changes in the work of the gastrointestinal tract by trimester of pregnancy

    The average gestational age is 40 weeks, which are usually divided into trimesters in accordance with the stages of intrauterine development of the child.

    Each trimester is accompanied by a number of changes in the body, including in the gastrointestinal tract:

    First trimester of pregnancy

    1-13 weeks



    Week 26

    Third trimester of pregnancy

    Week 27-40

    Morning sickness

    Morning sickness


    Upset bowel

    3 Increased appetite


    Intestinal upset

    Acid reflux

    Pain in the upper gastrointestinal tract

    Disorder of bile outflow



    9016 Heartburn

    9016 Heartburn

    0 0377

    Genetic Test Atlas will help you find out how your genes affect the level of female sex hormones needed for fertility and pregnancy.

    Causes of gastrointestinal problems during pregnancy

    Every pregnancy is accompanied by inevitable changes in the functioning of the digestive system. More often they are caused by hormonal changes and increased load on organs, but they can also be associated with lifestyle and health conditions, for example:

    • Sedentary lifestyle and unbalanced diet;
    • Certain drugs, including antacids with calcium or aluminum;
    • Viral and bacterial infections;
    • Intolerance to certain nutrients and allergic reactions;
    • Stress;
    • Thyroid diseases.

    If you have a chronic gastrointestinal disease and are planning a pregnancy, try to consult with your doctor beforehand. Symptoms of conditions such as irritable bowel syndrome (IBS) or acid reflux are likely to worsen during gestation. The doctor will help prepare the body and make a prevention plan to relieve symptoms during this time.

    Irritable bowel syndrome or IBS is a functional bowel disease that is accompanied by frequent abdominal pain, impaired peristalsis, bloating, constipation or diarrhea.

    Morning sickness, vomiting and general malaise during pregnancy

    Doctors find it difficult to say with certainty why pregnant women feel sick in the morning. The main theory is hormonal changes. But there are also some patterns associated with an increased risk of morning sickness:

    • Multiple pregnancy;
    • Toxicosis during a previous pregnancy;
    • History of morning sickness during pregnancy in close relatives;
    • Tendency to motion sickness in transport;
    • Use of oral contraceptives containing estrogen prior to pregnancy;
    • Frequent migraines;
    • Body mass index 30 and above;
    • Elevated levels of stress hormones

    Risks of severe toxicosis and how to reduce nausea

    Usually, nausea and vomiting are not associated with a risk for mother and baby and go away by 16-20 weeks of pregnancy, but it is not necessary to wait that long – there are ways that can help reduce nausea and enjoy the process of waiting for a new person more:

    • Get plenty of rest – fatigue increases toxicosis;
    • Avoid odors and foods that cause nausea;
    • Eat something right after waking up.Toast or a slice of bread can help relieve nausea;
    • Avoid hunger – an empty stomach worsens nausea. Eat small meals often, preferring low-fat, high-carbohydrate foods;
    • Try ginger – studies show it can help fight nausea;
    • Drink in small sips as often as possible and prefer still water.

    In rare cases, pregnant women may develop hyperemesis of pregnancy or excessive vomiting.It is a serious condition that can lead to dehydration, impaired kidney function, seizures, irregular heartbeats, and even death.

    Signs of dehydration include dry mouth, dizziness, dark urine, occasional urination, and / or dizziness.

    Symptoms of excessive vomiting of pregnant women:

    • frequent nausea for a long time and regular vomiting after eating;
    • dry skin and lips;
    • sudden weight loss;
    • low blood pressure (below 90/60).

    Diarrhea during pregnancy

    The word “diarrhea” comes from the Greek language and literally means “to flow through.” This is a condition in which bowel movements or bowel movements occur three times a day or more often. This phenomenon is especially characteristic of the third trimester of pregnancy, but it can also occur earlier.

    Symptoms of diarrhea:

    • Three or more bowel movements per day
    • Urgent urge to empty the bowel
    • Pain and cramps in the abdomen
    • Bloating

    Causes of diarrhea during pregnancy

    In ordinary life and during pregnancy the causes of diarrhea are similar: it can be excessive consumption of certain foods, medications, food poisoning, dysbiosis, bacterial and viral infections:

    Gastroenteritis Consumption of lactose and gluten with intolerance to these nutrients
    Bacterial infections: listeriosis or salmonella Chronic gastrointestinal diseases: Crohn’s disease, IBS, ulcerative colitis
    Certain antibiotics and antacids to reduce acidity Laxatives
    Sugar substitutes, e.g. sorbitol Excessive consumption of certain foods

    Tip: If you recently returned from a vacation in an exotic country with nausea and diarrhea, and found out that you are pregnant, see your doctor as soon as possible.


    One of the most common causes of diarrhea during pregnancy is gastroenteritis or stomach flu. It is caused by bacterial or viral infections: norovirus, rotavirus, E. coli, salmonella, which enter the body through contact with contaminated surfaces, dishes, food and water.

    Gastroenteritis usually lasts about three days. However, a severe illness is dangerous to health, especially during pregnancy, as it can cause dehydration, electrolyte imbalance, and lead to premature birth.

    The main symptoms of gastroenteritis include diarrhea without blood, nausea and vomiting, stomach cramps and pain, mild fever, headache, and muscle pain.

    Increased precautions such as frequent hand washing and surface disinfection can help reduce the risk of illness. If the expectant mother has small children, it is not recommended for them to use the same cutlery.

    Risks of diarrhea during pregnancy

    Usually diarrhea during pregnancy is not a cause for concern.However, you should see your doctor if you experience any of the following symptoms during this period:

    • Diarrhea for more than two days;
    • Stool with blood or mucus;
    • Severe weight loss;
    • Abdominal pain;
    • Dehydration.

    How to treat diarrhea during pregnancy

    If you develop diarrhea during pregnancy, drink as much fluids as possible, avoid foods high in fat and sugar, and avoid dairy products or caffeinated beverages.

    Dehydration is a serious risk, especially during pregnancy, so the first step is to restore the electrolyte balance with fluids and simple food:

    Fruit juices in moderation Drinks without alcohol and caffeine
    Bananas Potatoes
    Rice Toast
    Crackers Light soups and broths
    Pasta Applesauce

    Use the Atlas Microbiota Test to learn about your body’s ability to break down lactose and gluten.

    Stomach pain and heartburn during pregnancy

    During pregnancy, many women experience stomach pains, especially in the upper part, as well as heartburn – a burning sensation in the chest and esophagus.

    This is more common in the third trimester, after about 27 weeks. This is an unpleasant but natural phenomenon during pregnancy: the baby grows inside the uterus and presses on other organs, including the stomach. And hormones cause the muscles to relax, which causes acid from the stomach to enter the esophagus and irritate it.In addition, painful sensations can be caused by problems with some organs such as the gallbladder, or inflammation of the pancreas.

    Symptoms of heartburn during pregnancy:

    • Burning in the chest and esophagus;
    • Feelings of overeating, heaviness, or bloating;
    • Belching, including with acid and / or food particles;
    • Nausea.

    It is unlikely that cramps and heartburn can be avoided during pregnancy. However, some tips can help reduce their frequency:

    Smoking and alcohol: In addition to known harm to the mother and baby, tobacco smoke also relaxes the muscles in the lower esophagus, allowing acid to enter the esophagus.And alcohol provokes heartburn and acid reflux.

    Although stomach pain and heartburn often accompany pregnancy, abdominal pain, especially in the third trimester, should be taken seriously. This could be a sign of premature birth or placental abruption, and puts both mother and baby at risk.

    If during pregnancy you experience severe abdominal pain accompanied by the following symptoms, seek medical attention as soon as possible:

    Abdominal pain and fever Bleeding
    Regular cramps Unusual vaginal discharge / spotting
    Vomiting Low back pain
    Pain or burning sensation when urinating Severe pain that lasts 30-60 minutes

    Bloating, constipation and microbiota during pregnancy

    Flatulence – Abdominal distention due to flatulence.

    Here are some simple rules to help you improve your bowel movements and avoid constipation and bloating:

    • If you don’t usually eat a lot of fiber and hard-to-digest foods like legumes, try to gradually introduce them into your diet;
    • Do not abuse carbonated drinks and fatty foods;
    • Move more;
    • Drink plenty of fluids.

    If bloating and constipation are accompanied by severe pain that lasts more than 30 minutes, or if you have constipation for two or more weeks, see your doctor.

    Gut microbiota and bacteria during pregnancy

    During pregnancy, the female body undergoes many changes, and this can affect the microbiota – the ecosystem of bacteria living in the gut. Trillions of microorganisms do important work for the entire body: synthesizing vitamins and important acids, supporting your intestines and protecting them from disease and inflammation.

    The additional influx of female hormones that accompanies pregnancy, alters bowel function and affects the microbiota.This is good because the bacterial community constantly adjusts to the external and internal conditions in order to keep up with the needs of the body.

    Microbiota Test Atlas helps you understand how to prepare your gut for future pregnancy and reduce your risk of digestive problems.

    ☝️ Mark

    Now you have all the necessary knowledge and tools to help you cope with digestive problems during pregnancy. They are quite varied and quite natural, but in some cases it is necessary to immediately seek medical help:

    • Vomiting blood;
    • Blood in the stool;
    • Diarrhea for more than two days;
    • Constipation for more than two weeks;
    • Severe weight loss;
    • Severe pain that interferes with daily activities;
    • Shortness of breath;
    • Pain when swallowing or difficulty swallowing;
    • Excessive fatigue.


    • Mayo Clinic, Morning sickness, 2018
    • Lindsey J Wegrzyniak, Treatment of Hyperemesis Gravidarum, 2012
    • Edwards A. et al., The Maternal Gut Microbiome During Pregnancy, 2018
    • National Health and Safety (NHS), Vomiting and morning sickness in pregnancy
    • Kudzai Kanhutu, Travel and pregnancy: an infectious diseases perspective, 2011
    • CDC, Pregnant travelers
    • U.S. Department of Health and Human Services, Agency for healthcare research and quality, Abdominal Pain in Early Pregnancy
    • Robyn Horsager-Boehrer, M.D., UT Southwestern Medical Center, Should pregnant moms be concerned about gastroenteritis ?, 2018
    • International Foundation for Gastrointestinal Disorders, Pregnancy and Irritable Bowel Syndrome, 2016
    • NHS, Vomiting and morning sickness in pregnancy
    • NHS, Severe vomiting in pregnancy
    • Lindsey J Wegrzyniak et al., Treatment of Hyperemesis Gravidarum, 2012
    • Karen Miles, Diarrhea during pregnancy, 2020
    • Cleveland Clinic, Diarrhea
    • You and your hormones, Progesterone
    • Traci C.Johnson, MD, Pregnancy, Bloating, 2020

    90,000 treatment and diagnosis of symptoms, causes in Moscow

    Agarkova S.A.

    15 June 2021

    I express my heartfelt gratitude to Valeria Alexandrovna for her attentive, professional and patient attitude towards patients. Communication with you gives hope for recovery and the fact that in our medicine there are real specialists in their profession.Thanks to all the advisory …

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    Kurochkina Valentina Nikolaevna

    4 June 2021

    Inna Yurievna is a competent specialist. It is noticeable that he wants to cure the patient from the heart. Competent approach to work. I am grateful to her for making the correct diagnosis and choosing a treatment regimen.

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    Ptitsyna Natalia Nikolaevna

    5 March 2021

    I want to express my deep gratitude to the gastroenterologist Olga Chuikova, this is a high-level specialist, when assigning me to remove a tumor in the intestine, she checked all the information on my examinations in the clinic, even for 2020 and 2019, prescribed tests, not only with regards to this situation…

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    Antonovich Ivan

    17 March 2020

    I would like to express my gratitude to Elena Yurievna Lopatina for her professionalism.
    Very quickly cured me of biliary slange (previously suffered with it for 4 months)

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    Feyzrakhmanoa Ildar Fatehovich

    15 November 2019

    Many thanks to Lopatina E.Yu for my salvation and competent treatment of the gastrointestinal tract, was able to quickly cure and avoid gastric resection. No operation needed! Many thanks and health to all of us!
    Spouses Ildar Feyzrakhmanoa and Zuleikha Anderzhanova

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    Natalia Viktorovna

    22 May 2019

    Good afternoon! 21.05.2019 was consulted by a gastroenterologist, Ph.D. Lopatina Elena Yurievna. I would like to express my gratitude for such high professionalism. A very competent and talented doctor. She clearly described the treatment regimen, explained everything. All my questions were answered …

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    Vasilyeva E

    15 May 2019

    I would like to express my gratitude to the gastroenterologist T.V. for professional work and dedication to the profession. Very attentive doctor. Professional with vast experience !!

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    Functional gastric hypersecretion ›Diseases› DoctorPiter.ru

    Functional gastric hypersecretion (irritable stomach syndrome, hyperacid state) is a pathological condition, which is popularly called “increased gastric acidity”, and doctors characterize it as an increase in gastric secretion and acidity of gastric juice.


    Irritable stomach syndrome can often be asymptomatic at all. But it happens that it is manifested by ulcerative pain and burning in the epigastrium (upper abdomen), heartburn, sour belching (appears within an hour after eating), bursting and heaviness in the epigastric region. Attacks are more likely to occur on an empty stomach and at night. Also quite often there is nausea and vomiting on an empty stomach with a large amount of gastric juice. After vomiting, stomach pain subsides as excess acid is removed.


    Irritable stomach syndrome is a fairly common pathology, it occurs in about 80% of the population. For the first time, irritable stomach syndrome was described by the head of the department of stomach diseases of the clinic of the Research Institute of Nutrition of the Russian Academy of Medical Sciences, O.L. Gordon. Then he proposed to call this syndrome “functional diseases of the stomach.”

    Basically, gastric secretion increases due to improper nutrition. Blame for this:

    In addition, gastric functional hypersecretion can occur during mental agitation, stress, as well as at the initial stage of thyrotoxicosis.

    Pain syndrome in gastric functional hypersecretion is caused by spasm of the pylorus (a sphincter that regulates the flow of gastric contents into the duodenum) and increased peristalsis of the digestive tract. The pain usually worsens in the autumn-spring period.


    For the diagnosis of irritable stomach syndrome apply:

    • Radiography. The X-ray shows a large amount of gastric juice on an empty stomach.
    • Intragastric pH meter. In this study, a probe with electrodes is inserted through the mouth into the stomach, which measure the acidity at the point in the stomach where this electrode is located. This device can measure the basal (in different parts of it on an empty stomach) acidity of the stomach and the rate of acid production (for this, the patient is given an alkaline solution to drink). You can also assess the number of cells that produce acid and the quality of their work. To do this, the patient is given a test breakfast, and then the acidity is measured in different parts of the stomach.Normally, in the body of the stomach, where acid is produced, the acidity before stimulation should be from 1.6 to 2.0, and after – from 1.2 to 2.0. In the lower part of the stomach, the acidity should be at least 5.2, since an alkaline secret is produced there.
    • Fractional gastric intubation using gastric secretion stimulants. This method is used to establish basal (on an empty stomach) and stimulated (after eating) stomach acidity.

    When making a diagnosis, you need to make sure that it is not a gastric ulcer or duodenal ulcer or pancreatitis using fibrogastroscopy (FGDS) to make sure that there is no ulcer, and an ultrasound to make sure that there are no changes in the pancreas


    Treatment is aimed at normalizing the lifestyle, diet and activity of the nervous system.

    So, food should not irritate the stomach. That is, you can not eat fatty, fried, spicy, salty, solid foods and carbonated drinks. Food should slightly excite the stomach and leave it relatively quickly. All dishes should preferably be steamed or cooked, and then wiped or chopped in a blender.

    From medicines, drugs are usually prescribed that block the production of acid or antacids that neutralize it. In addition, sedatives are prescribed if the illness is caused by mental stress.


    If you have irritable stomach syndrome, follow these 12 rules:

    1. Eat slowly.
    2. Chew food thoroughly to make it easier for your stomach to digest. In addition, pieces of poorly chewed food can injure the esophagus and stomach.
    3. Give up fatty foods – it is hard and takes a long time to digest.
    4. Eat often but little by little. So the food is better absorbed and less stress on the stomach.
    5. Avoid spices – curry, paprika, pepper and some other spices, of course, give the dishes a special taste, but they also stimulate digestion. And you don’t need this, you already have an excess of gastric juice.
    6. Avoid foods that can cause bloating. Primarily from cabbage and legumes.
    7. Give up alcohol.
    8. And give up nicotine too.
    9. Some medicines damage the stomach lining.In this case, the acid will irritate your stomach even more.