Your body makes strong acids that digest food. A lining protects the inside of your stomach and duodenum from these acids. If the lining breaks down, the acids can damage the walls and cause an ulcer. Both H. pylori and NSAIDs weaken the lining so acid can reach the stomach or duodenal wall.  The symptoms of NSAID-induced ulcers are typically less noticeable to patients and may appear suddenly. However, abdominal discomfort is the most common symptom of an ulcer. This discomfort usually

• comes and goes for several days or weeks
• is a dull, gnawing ache
• is relieved by antacid medications
• is relieved by eating
• occurs 2 to 3 hours after a meal
• occurs in the middle of the night-when the stomach is empty

Symptoms of a stomach ulcer
Some people experience only very mild symptoms of an ulcer, or none at all. The most common symptom of an ulcer is a burning pain in the stomach between breastbone and navel. Characteristics of this type of burning pain follow. Burning pain in the stomach related to an ulcer often:

• can be temporarily relieved by eating certain foods
• can be temporarily relieved by taking an acid-reducing medication
• disappears and then returns for a few days or weeks
• flares at night
• is worse on an empty stomach
• lasts from a few minutes to several hours

Other symptoms of an ulcer include:

• anemia
• bloating
• burping
• difficulty swallowing
• poor appetite
• weight loss

Less often, ulcers may cause severe signs or symptoms such as:

• dark blood in stools or stools that are black or tarry
• loss of appetite
• nausea                      
• unexplained weight loss
• vomiting
• vomiting red or black blood (like coffee grounds)        

Complications
If an ulcer begins to bleed and is left untreated, anemia (low blood count) and weakness can manifest. Left untreated, peptic ulcers can result in:

Internal bleeding - occurs when acid or the ulcer breaks a blood vessel and can occur as slow blood loss that leads to anemia or as severe blood loss that may require hospitalization or a blood transfusion.

Infection - peptic ulcers can eat a hole through the wall of your stomach or small intestine, creating serious risk of inflammation of the abdominal cavity (peritonitis) that can lead to infection from bacteria of the gastrointestinal tract.

Perforation - occurs when an ulcer burrows through the stomach or duodenal wall.

Scar tissue - ulcers can create scar build up that can obstruct passage of food through the digestive tract, causing you to become full easily, to vomit and to lose weight.

Tumors - the presence of an ulcer stimulates a continuous process of healing the lining of the GI tract. As cells multiply in order to close the sore, some may grow out of control and create a tumor.

When to seek help 
An ulcer isn't something that you should treat on your own without a doctor's help. Over-the-counter antacids and acid blockers may relieve abdominal pain temporarily, but relief is short-lived. If you have signs or symptoms of an ulcer, schedule a visit to your doctor for diagnosis and treatment.  Other symptoms can be signs of a serious problem such as perforation, internal bleeding, or obstruction. If you have exhibit any of the following symptoms, call your doctor right away:

• bloody or black stools
• bloody vomit or vomit that looks like coffee grounds
• sharp, sudden, persistent stomach pain

Doctor can help determine if ulcer(s) are a diagnostic possibility and work with you to help control symptoms. But what tests do doctors use to rule out more serious conditions? To learn more about how doctors diagnose peptic ulcer, read the Diagnosing an Ulcer section that follows.