A bleeding ulcer is a serious medical condition that can be fatal if not promptly treated. Understanding its nature, causes, and potential for life-threatening outcomes is important for recognizing symptoms and seeking help.
What a Bleeding Ulcer Is
A peptic ulcer is an open sore that forms on the inner lining of the stomach or the first part of the small intestine, known as the duodenum. Ulcers located in the stomach are called gastric ulcers, while those in the duodenum are duodenal ulcers. These sores develop when the protective mucous layer that lines the digestive tract is compromised, allowing stomach acids to erode the underlying tissue.
An ulcer becomes a “bleeding ulcer” when this erosion deepens into a blood vessel within the stomach or duodenal wall. The severity of bleeding can range from minor oozing to rapid, significant blood loss depending on the size and type of blood vessel affected. The two primary causes for peptic ulcers are infection with the bacterium Helicobacter pylori (H. pylori) and the long-term or high-dose use of nonsteroidal anti-inflammatory drugs (NSAIDs). H. pylori can weaken the protective mucous layer, while NSAIDs directly irritate the lining and can also interfere with the blood’s clotting ability.
Symptoms to Watch For
The signs of a bleeding ulcer vary with the rate and amount of blood loss. Slow, chronic bleeding may not be immediately obvious but can lead to anemia symptoms. These include pale skin, fatigue, and shortness of breath, particularly with physical activity. Lightheadedness can also occur.
In cases of rapid and severe bleeding, symptoms demand immediate medical intervention. A person might vomit blood, which can appear bright red or have a dark, granular texture resembling coffee grounds due to partial digestion. Passing black, tarry, sticky stools (melena) is another strong indicator of upper digestive tract bleeding. Severe abdominal pain, dizziness, and fainting can also occur from significant blood loss.
How a Bleeding Ulcer Can Be Fatal
A bleeding ulcer can become life-threatening through several mechanisms. Rapid and substantial blood loss (hemorrhage) can lead to hypovolemic shock. This occurs when insufficient blood volume circulates oxygen and nutrients to organs, leading to organ failure.
Beyond blood loss, an ulcer can erode completely through the stomach or intestine wall, causing a perforation. This opening allows digestive contents and bacteria to spill into the abdominal cavity, leading to peritonitis, a serious infection and inflammation of the abdominal lining. Peritonitis can spread infection throughout the body, potentially resulting in sepsis and multiple organ failure. If severe shock or widespread infection persists, multiple organ systems can shut down, which can be fatal.
Factors increasing the risk of death include advanced age, especially over 65 years. Pre-existing medical conditions (comorbidities) also elevate this risk. Delayed diagnosis and treatment further contribute to severe complications and mortality. While treatable, overall mortality rates for bleeding peptic ulcers range from 5% to 10%, increasing considerably in high-risk populations.
Diagnosis, Treatment, and Prevention
Diagnosing a bleeding ulcer involves several medical procedures. An endoscopy, using a flexible tube with a camera, visualizes the esophagus, stomach, and duodenum, allowing direct observation of the ulcer and bleeding assessment. Blood tests check for anemia from blood loss. Additionally, tests for H. pylori infection (breath, stool, or biopsy) identify the underlying cause.
Treatment for an acute bleeding ulcer focuses on stopping the hemorrhage and then healing the ulcer. During an endoscopy, procedures can be performed to stop the bleeding, such as injecting medication into the ulcer, applying clips, or using heat to cauterize the vessel. Blood transfusions may be necessary to replace lost blood.
Long-term management often involves medications like proton pump inhibitors (PPIs) to reduce stomach acid production, which helps the ulcer heal. If H. pylori is present, antibiotics are prescribed to eradicate the bacteria. Surgery is considered a last resort for severe cases where bleeding cannot be controlled by endoscopy, or if there is a perforation.
Preventing future ulcers or re-bleeding involves addressing the root causes and modifying certain behaviors. Avoiding the excessive or long-term use of NSAIDs is important, and alternative pain relievers like acetaminophen may be recommended. Managing H. pylori infections through prescribed antibiotic regimens helps prevent recurrence. Lifestyle adjustments, such as avoiding smoking and excessive alcohol consumption, also contribute to prevention.