Peptic ulcers are open sores that form on the inner lining of the digestive tract, typically in the stomach (gastric ulcer) or the initial segment of the small intestine, the duodenum (duodenal ulcer). These ulcers arise when the protective mucous lining becomes compromised, allowing digestive acids to erode the tissue.
How Ulcers Cause Bleeding
Peptic ulcers can lead to bleeding when erosion extends beyond the superficial lining to a blood vessel. As the ulcer deepens, it can wear away the stomach or duodenal wall, damaging underlying blood vessels, causing internal bleeding. The most common causes of peptic ulcers include Helicobacter pylori (H. pylori) infection and regular use of nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen. These factors weaken the digestive tract’s protective mechanisms, making the lining vulnerable to acid damage.
Not all ulcers will bleed. However, when bleeding does occur, it can range from slow, subtle blood loss to significant hemorrhage. A severe bleed can happen if the ulcer erodes into a medium- or large-sized artery, which can be a serious complication.
Recognizing Blood in Stool
Blood from a bleeding ulcer, originating in the upper gastrointestinal (GI) tract, typically appears in stool as “melena.” Melena is characterized by black, tarry, and often foul-smelling stools. This distinct dark color and odor result from the blood being digested as it travels through the intestines, as hemoglobin interacts with digestive enzymes and intestinal bacteria.
For stool to become black and tarry, a certain amount of blood (usually 50 milliliters or more) needs to be present in the upper GI tract. While melena is the most common presentation for upper GI bleeding, a very rapid or severe bleed could potentially lead to bright red or maroon-colored blood in the stool, known as hematochezia. This occurs when blood moves through the digestive system too quickly to be fully digested.
When to Seek Urgent Medical Care
Any suspicion of blood in stool, especially if it is black and tarry, warrants prompt medical evaluation. A bleeding ulcer can lead to significant blood loss and serious complications. Critical accompanying symptoms include dizziness, lightheadedness, fainting, or severe abdominal pain.
Other signs requiring immediate medical attention include vomiting bright red blood or vomit resembling coffee grounds. These symptoms, along with pale skin, a rapid heartbeat, or other signs of shock (such as cool, clammy skin and confusion), signal a potentially life-threatening situation. Prompt emergency care is important to address the bleeding and prevent further complications.
Medical Evaluation and Treatment
Healthcare professionals diagnose a bleeding ulcer through symptom review and medical history. An upper gastrointestinal endoscopy (EGD) is a common procedure to visualize the lining of the esophagus, stomach, and duodenum, directly identifying the bleeding source. During an endoscopy, a biopsy may be taken to test for H. pylori infection or to rule out other conditions.
Treatment for a bleeding ulcer often involves endoscopic interventions to stop the bleeding, such as cauterizing the wound or injecting medication into the site. Medications to reduce stomach acid, like proton pump inhibitors (PPIs), are also prescribed to promote healing and reduce rebleeding risk. If H. pylori infection is identified, antibiotics are typically given to eradicate the bacteria, addressing a primary cause.