When dyspepsia is of long duration and severe in character, and is accompanied with persistent vomiting and acute pain after food, ulcer of the stomach may be suspected; if to these symptoms is added the vomiting of blood, then there is little room for doubt. Ulcer of the stomach is a most intractable disease, and its situation in a hollow organ which is subject to incessant movement during the process of gastric digestion, renders it very difficult to treat.

Ulcer of the stomach is of different kinds; it may be small, circular, or oval in shape, with sharp, perpendicular edges, and looking as if a portion of the mucous membrane of the stomach had been punched out; or it may be large and spreading, with thickened sloping edges. The floor of the ulcer may be formed of the outer coats of the stomach; or it may be constituted by one of the adjoining organs, the liver or pancreas, which has become adherent to the stomach by the process of inflammation and ulceration having extended to its surface. Sometimes gastric ulcers cicatrise and heal, sometimes they remain quiescent for a time, giving the false impression that cure has taken place; but the ulcerative process often begins again, and in many cases ends in perforation. Perforation may take place into the peritoneum, into the colon or intestine, or into an artery, in which case profuse haemorrhage occurs. Sometimes, however, ulceration and infiltration of the tissues may extend to the adjoining organs, and a communication may even thus be established between the stomach and the external air through the abdominal walls.

The symptoms of gastric ulcer are pain, vomiting, and haematemesis or bleeding from the stomach. The pain is characteristic. It occurs almost immediately after taking food, and it is either felt at the epigastrium, which becomes tender on pressure, or it is referred to the region of the spine corresponding to the last two or three dorsal or first two or three lumbar vertebrae, or to the region between the shoulders, the muscles on either side often being tender; or again it may occupy the umbilicus or some area or point near, and when severe it radiates from its chief point of intensity towards the oesophagus, backwards to the loins, or downwards and laterally over the whole of the abdomen. The pain, when severe, is of a burning, boring, and shooting character, attended with a sense of soreness. Vomiting is a later symptom, but it is generally very persistent. The pain and vomiting occur soon after the ingestion of food. Haemorrhage takes place from time to time, the bleeding being from the excoriated surface of the ulcer, or when very profuse from the erosion of an artery.

The tendency of gastric ulcer is towards recovery; and when death occurs it is from perforation of an artery causing profuse haemorrhage, or from perforation into the peritoneum, when collapse and death take place in a few hours, or from perforation into the viscera. Death may be caused by exhaustion in consequence of the patient sinking under the long-continued pain and vomiting, and becoming worn out by the want of food (Bristowe).