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Esophageal Ulcers located in the lower esophagus, often from reflux Causes / Risk Factors Helicobacter pylori infection (most common) NSAIDs (ibuprofen, aspirin) Excess stomach acid / hypersecretory conditions Smoking and alcohol consumption Stress (minor role) Zollinger-Ellison syndrome (gastric acidproducing tumor) Symptoms Epigastric pain (burning, gnawing, or hunger-like) Pain may improve or worsen with food: Duodenal: pain often relieved by food Gastric: pain may worsen with food Nausea / vomiting Bloating, belching Loss of appetite / weight loss Heartburn or acid reflux Warning signs (complications) Vomiting blood (hematemesis) Black, tarry stools (melena) Severe, sudden abdominal pain (possible perforation) Diagnosis Endoscopy gold standard, allows visualization and biopsy H