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EspañolEsophageal ulcer symptoms: What are the early signs of an esophageal ulcer?
What does an esophageal ulcer feel like?
An esophageal ulcer is an open sore along the inner surface of the esophagus. Also called the “food pipe,” the esophagus is the tube that runs from the neck to the stomach and carries food down to the stomach. One or more esophageal ulcers can form anywhere along the lining of the esophagus, but usually, they form at the bottom near the stomach. That’s because the most common cause of esophageal ulcers is stomach acid reflux in people with gastroesophageal reflux disease (GERD). Another common cause is certain types of caustic pills, such as aspirin, antibiotics, or potassium supplements. The hallmark feature of an esophageal ulcer is pain, usually a burning pain right behind the breastbone. The chest pain can be so bad that the back hurts as well. People with an esophageal ulcer typically find swallowing fluids or food to be painful or hard to do. These symptoms are often experienced on top of other GERD symptoms, such as regurgitation, indigestion, nausea, vomiting, bad taste in the mouth, bloating, lack of appetite, dry cough, and a lump in the throat.
Key takeaways:
An esophageal ulcer is a common health condition that mostly affects people with GERD, but it can affect anyone regardless of age, sex, race, or ethnicity.
Early signs of an esophageal ulcer include burning pain, regurgitation, and pain when swallowing.
Serious symptoms of an esophageal ulcer, such as symptoms of blood loss (weakness, dizziness, lightheadedness, pale skin, blue skin, and fainting), may require immediate medical attention.
Esophageal ulcers are usually caused by GERD or certain types of caustic pills. Less common causes include induced vomiting (bulimia), infection, radiation therapy, medical procedures, Crohn’s disease, food stuck in the esophagus, pemphigus (an autoimmune disorder), and consuming caustic substances. Eating acidic foods or a Helicobacter pylori infection may worsen an existing esophageal ulcer.
Esophageal ulcers usually require a medical diagnosis.
Esophageal ulcers generally require treatment. Esophageal ulcer symptoms typically resolve within several weeks of treatment or longer.
Treatment of an esophageal ulcer may include stomach acid-reducing drugs, antimicrobial drugs, lifestyle changes, and, in the most severe cases, endoscopic or surgical procedures.
Untreated esophageal ulcers could result in complications, such as bleeding, narrowing or blockage of the esophagus, or perforation.
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What are the early signs of an esophageal ulcer?
The early signs of esophageal ulcer are usually due to inflammation of the esophagus (esophagitis), like heartburn, nausea, or vomiting. These may not be the symptoms of an esophageal ulcer, but if esophagitis lasts long enough, it could develop into an ulcer.
Once an esophageal ulcer develops, the earliest sign will be pain:
Heartburn
Chest pain
Other early signs of esophageal ulcer can include:
Nausea and vomiting
Vomiting blood or blood clots
Pain when swallowing
Difficulty swallowing
Loss of appetite
A feeling that something is stuck in the throat
RELATED: What causes acid reflux chest pain? Related conditions and treatments
Other esophageal ulcer symptoms
The symptoms of an esophageal ulcer associated with GERD include:
Heartburn
Chest pain (usually a burning sensation)
Back pain
Blood or blood clots in the vomit
Black and tarry stools (blood in the stools)
Nausea and vomiting
Sour taste in the mouth
A feeling something is stuck in the throat
The symptoms of esophageal ulcer associated with other causes may be different:
The most common symptoms of drug-induced esophageal ulcers are pain when swallowing, pain behind the breastbone, and trouble swallowing.
The most distinguishing symptom of an esophageal ulcer due to a fungal infection is pain when swallowing, usually right behind the breastbone.
Herpes simplex virus (HSV) infections of the esophagus are marked by painful swallowing, along with heartburn, chest pain, nausea, and mouth sores.
Esophageal ulcer vs. peptic ulcer symptoms
A peptic ulcer is an open sore on the inside lining of the stomach (stomach ulcer) or the inside lining of the duodenum (duodenal ulcer), the first part of the small intestine connected to the stomach. The signature sign of a peptic ulcer is a burning or sharp stomach pain that gets worse after eating. Additionally, the stomach area is tender to the touch when pressed. Unlike an esophageal ulcer, a stomach or duodenal sore is exposed to stomach acid. As a result, it takes a long time to heal. Peptic ulcers also differ from esophageal ulcers because they could keep occurring if there is an underlying H. pylori infection.
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RELATED: Ulcer treatments and medications
When to see a doctor for esophageal ulcer symptoms
Any one of the most commonly experienced symptoms of an esophageal ulcer, including unspecified chest pain, difficulty swallowing, pain when swallowing, and vomiting blood, are signs that medical help is needed. Make an appointment with a doctor or other healthcare professional. Blood in the vomit or stools is a sign of internal bleeding, so seek medical help as soon as you can.
Healthcare providers diagnose esophageal ulcers based on a medical history, the symptoms, and a physical examination. People will likely be referred to a specialist in digestive system diseases, called a gastroenterologist. A barium contrast X-ray is the first test used to identify an esophageal ulcer. Confirmation and a more refined diagnosis may require an endoscopy. During this procedure, the clinician inserts a long tube with a camera down the throat to view the lining of the esophagus. This endoscopic exam allows the clinician to look at the lesion and possibly identify its cause. During this exam, the clinician may use the endoscope to take tissue samples of the ulcer for a biopsy.
Complications of an esophageal ulcer
An esophageal ulcer is a relatively serious problem that can result in complications such as:
Excessive bleeding
Anemia
Narrowing or blocking of the esophagus (stricture)
Hole in the esophagus (perforation), a severe complication with a high mortality rate
How to treat esophageal ulcer symptoms
To prevent complications, an esophageal ulcer requires treatment.
Most esophageal ulcers are caused by GERD and are located near the junction of the esophagus and the stomach. Esophageal ulcers associated with GERD are primarily treated with drugs that decrease the production of stomach acid, such as proton pump inhibitors (PPIs) or H2 blockers (a type of antihistamine). These drugs reduce acid reflux and give the esophagus lining time to heal. Side effects are relatively minimal, and many of these drugs are sold over the counter.
Esophageal ulcers caused by infections are treated with antimicrobial drugs:
The most common infection that causes esophageal ulcers is a yeast infection of the esophageal mucosa. Candidiasis is treated with antifungal medications.
A herpes or cytomegalovirus infection is treated with antiviral medications.
A bacterial infection is treated with antibiotics.
If an H. pylori infection is present along with the ulcer, people will be put on standard H. pylori antibiotic treatments.
Severe cases with complications like stricture or perforation will require surgical intervention.
Living with an esophageal ulcer
Esophageal ulcers are acute. That means that it starts and ends just like any other sore or infection, like the common cold. However, the most common cause of esophageal ulcers is GERD, which is a chronic condition. As a result, anyone with GERD is at risk of developing esophageal irritation, inflammation, and ulcers repeatedly. To avoid these problems, people can take measures to control acid reflux:
See a doctor about GERD symptoms and take medications as instructed.
Adopt a GERD-friendly diet that is high in fiber, water, and alkaline foods, such as bananas and cauliflower.
Avoid foods that promote stomach acid production, such as fatty foods, spicy foods, acidic foods, coffee, tea, and carbonated drinks.
Avoid eating in the hours before bedtime.
Cut back or eliminate alcohol.
Over-the-counter antacids taken before meals may help reduce stomach acid reflux.
Always swallow pills with plenty of water, particularly nonsteroidal anti-inflammatory drugs (NSAIDs), antibiotics, bisphosphonates (osteoporosis medications), and potassium supplements—one study showed that 85% of people with drug-induced esophageal ulcers were swallowing pills dry or not drinking enough water with the pill.
Don’t overuse NSAIDs like aspirin and ibuprofen—they are not only associated with esophageal ulcers, but peptic ulcers as well.
RELATED: The best diet for acid reflux: 3 foods to eat—and 8 to avoid
Most importantly, see a doctor
Cuts and sores on the skin are rarely something we pay attention to, let alone worry about. Tears or sores inside the body are a different matter. Besides being more painful, there’s a risk of serious problems if they’re not fixed. The symptoms of an esophageal ulcer should cause concern, especially any sign of internal bleeding, like bloody vomit or black and tarry stools. Unlike a cut or sore on the skin, you don’t know what’s causing the pain or bleeding because you can’t see it. You won’t know if it’s something minor or something worse. See a healthcare professional for an evaluation and proper diagnosis. Only they have the training and experience to know where to look and what to do.
Additional resources for people with esophageal ulcer symptoms
Test and diagnostics
Esophageal ulcer, UC San Diego Health (2021)
Esophageal ulcer, StatPearls (2023)
Treatments
Esophageal dilation, UC San Diego Health (2022)
Esophageal ulcer, StatPearls (2023)
Scientific studies and clinical trials
Etiology, treatment, and outcome of esophageal ulcers: A 10-year experience in an urban emergency hospital, Journal of Gastrointestinal Surgery (2003)