Peptic Ulcer Disease as a Cause of Chest Pain

Peptic ulcer disease is a common medical condition that can sometimes produce symptoms similar to those of angina or a heart attack. In fact, it is not uncommon for someone with acute peptic ulcer symptoms to call 911 thinking that they're in the middle of a cardiac emergency.

The cause of this is not well-understood, but it is thought that multiple factors contribute to noncardiac chest pain (NCCP) in people with peptic ulcers. This includes altered nerve signals and violent contractions of the esophagus (feeding tube) due to the backflow of stomach acid.

This article explains what peptic ulcer disease is and how it can lead to symptoms of NCCP. It also helps you tell the difference between acute peptic ulcer symptoms and those of angina or a heart attack.

A man experiencing chest pain.
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What Is a Peptic Ulcer?

Peptic ulcer disease is characterized by the development of open sores (ulcers) in the lining of the stomach or the first part of the small intestine (called the duodenum). These ulcers are often quite painful and may be accompanied by additional symptoms like:

  • Bloating
  • Gas
  • Nausea
  • Vomiting
  • Heartburn
  • An acidic taste in the mouth

Peptic ulcers occur when the mucus that protects the lining of the stomach decreases or the production of stomach acid increases.

The primary cause of peptic ulcers is an infection with a bacteria known as Helicobacter pylori (H. pylori). The overuse of nonsteroidal anti-inflammatory drugs (NSAIDs) like Aleve (naproxen) can also lead to peptic ulcers.

Peptic ulcer pain is often relieved by eating a meal but is often made worse by lying down, smoking, or drinking alcohol or caffeine.

Symptoms of Chest Pain With Peptic Ulcers

Typically, the pain from peptic ulcer disease is perceived as a sharp or stinging pain in the pit of the stomach but can sometimes cause noncardiac chest pain.

NCCP is defined as recurring chest pain—typically behind your breast bone (sternum)—that is not related to your heart. It is not only associated with peptic ulcers but also with gastroesophageal reflux disease (GERD). Extreme stress and anxiety attacks can also bring on NCCP.

NCCP easily mimics the symptoms of angina, causing chest pain just behind the sternum or, in some cases, on the right or left side of the chest. The pain can also radiate to your neck, left arm, or back. There may also be rapid, pounding heartbeats as well as palpitations (skipped heartbeats).

In their totality, these symptoms can easily be mistaken for a heart attack.

Causes of Chest Pain With Peptic Ulcers

The cause of NCCP is not entirely clear, and it is likely a combination of physiological and psychological responses that contributes to the onset of angina-like chest pain.

What is known is that acid reflux (common with peptic ulcers and GERD) can cause the esophagus to spasm wildly. People with long-standing reflux appear to be at greater risk and often have a hypersensitive response to the backflow of stomach acid.

Studies suggest that persistent reflux alters nerve signals from the esophagus to the dorsal spinal root, one of the two main nerve roots of the spinal cord. The altered signals can amplify the sensation of pain in a way that is easily mistaken for angina.

It can cause referred pain in which pain radiates to other parts of the body, such as the neck, back, and left arm.

These sensations can be intensified if you think you're having a heart attack. During moments of extreme anxiety, the body will release a stress hormone known as cortisol that causes your heart rate to increase dramatically.

Peptic Ulcer vs. Angina

Usually, it's not difficult for a healthcare provider to distinguish chest pain caused by peptic ulcer disease from angina or a heart attack. The characteristics are usually quite different.

Peptic Ulcer
  • The check pain is usually sharp, burning, or stinging.

  • Pain starts after eating or drinking.

  • Pain worsens with lying down.

  • Pain is accompanied by bloating and altered taste.

  • Pain eases with antacids.

Angina
  • There is more chest pressure, heaviness, or tightness.

  • Pain happens suddenly or with exertion.

  • Pain worsens with exercise.

  • Pain is not accompanied by bloating and altered taste.

  • Pain does not ease with antacids.

Nevertheless, it may be important to do confirmatory tests to confirm the diagnosis.

Endoscopy (an examination of the upper digestive tract with a special flexible scope) is the favored method of diagnosis of peptic ulcer disease, especially in people who have evidence of bleeding or other severe symptoms.

Testing for the presence of Helicobacter pylori may also be helpful. X-rays of the upper digestive system may also be recommended.

If your healthcare provider is concerned about the possibility of angina, a stress test may be helpful in differentiating the conditions.

Treatment

If a peptic ulcer is the cause of NCCP, the appropriate treatment will almost invariably reduce the risk of future episodes.

Treatment options include:

In rare cases, surgery may be considered if an ulcer fails to heal.

3 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Durazzo M, Garguilo G, Pellicano R. Non-cardiac chest pain: a 2018 update. Minerva Cardioangiol. 2018 Dec;66(6):770-83. doi:10.23736/S0026-4725.18.04681-9

  2. American College of Gastroenterology. Peptic ulcer disease.

  3. Frieling T. Non-cardiac chest pain. Visc Med. 2018 Apr;34(2):92–6. doi:10.1159/000486440

By Richard N. Fogoros, MD
Richard N. Fogoros, MD, is a retired professor of medicine and board-certified in internal medicine, clinical cardiology, and clinical electrophysiology.