This article discusses the complications of peptic ulcers, warning signs, and when to get medical help.
Who It Affects
A peptic ulcer is a sore in the lining of either the stomach or the duodenum, the first part of the small intestine. About 10% of Americans develop at least one peptic ulcer during their lifetime. Approximately 4.6 million people are diagnosed with a peptic ulcer every year in the United States.
Ulcers can develop at any age but are rare in teenagers and even rarer in children. Duodenal ulcers (in the small intestine) usually occur between the ages of 30 and 50.
Stomach ulcers are more likely to develop in people older than 60. Duodenal ulcers occur more frequently in men than women. Stomach ulcers develop more frequently in women than men.
Symptoms and Complications
The symptoms of a peptic ulcer can often be vague, manifesting with pain or discomfort in the upper left abdomen as well as heartburn, indigestion, nausea, and gas.
In some cases, complications can occur, leading to more severe symptoms. For example, overusing nonsteroidal anti-inflammatory drugs (NSAIDs) like Advil (ibuprofen) can cause peptic ulcer bleeding to turn from mild to severe.
There are three serious complications of a peptic ulcer that may require emergency intervention:
Perforation is a hole in the wall of your stomach or small intestine. It’s a serious condition in which an untreated ulcer can burn through the wall of the stomach. Digestive juices and food can seep through the hole into the abdominal cavity. It can lead to peritonitis (inflammation of the abdominal lining) and sepsis. Internal bleeding occurs if there is a broken blood vessel in the stomach or small intestine. This can lead to a drop in blood pressure and symptoms like dizziness, weakness, pale skin, rapid heartbeat, and fainting. Some people experience bloody vomit, while others will develop melena (dark, tarry stools). Intestinal blockage occurs when food can’t move from your stomach into your small intestine. This happens when ulcers cause strictures (narrowing of the intestinal passage). Symptoms include severe stomach pain, nausea, vomiting, constipation, and inability to pass gas.
Perforation affects around five of every 100,000 people with peptic ulcers in the United States. Internal bleeding affects up to 57 of 100,000 people with peptic ulcers. Both account for the majority of peptic ulcer-related deaths.
Causes
Ulcers form when the lining of the stomach or duodenum becomes eroded. Small ulcers may not cause any symptoms, but large ulcers can cause serious bleeding.
Most ulcers occur in the first layer of the inner lining. If the ulcer erodes beyond that, a hole can open that goes all the way through the intestine, causing perforation. A perforation is always considered a medical emergency.
Most ulcers can be treated with medications, including antibiotics. But surgery may be needed in some cases, including cauterization, in which tissue is burnt to close off a bleeding blood vessel.
When to Seek Medical Attention
Most peptic ulcers are not a medical emergency and can be treated on an outpatient basis. But if there has been a perforation, severe internal bleeding, or obstruction, you’ll need to seek immediate medical care.
Call 911 for any of these warning signs:
Vomiting blood Vomiting substances that look like coffee grounds Severe rectal bleeding and/or bloody stools Sudden, severe pain in the upper abdominal area with or without evidence of bleeding Cold, clammy skin Rapid heartbeat Fainting
Summary
Peptic ulcers usually cause only discomfort, but sometimes, they can worsen and lead to life-threatening complications. Call 911 for any warning signs of perforation, internal bleeding, or intestinal obstruction. These include vomiting blood, bloody stools, severe pain in the upper abdomen, clammy skin, fast heartbeat, and fainting.
Over-the-counter NSAIDs include Advil and Motrin—both ibuprofen—and Aleve (naproxen sodium). Prescription NSAIDs include Celebrex (celecoxib), Mobic (meloxicam), Toradol (ketorolac), and others.
Contrary to popular belief, stress and spicy foods do not cause ulcers, however, they can contribute to symptoms.
An ulcer caused by H. pylori will need antibiotics to clear it up. There are other medications that can help ease symptoms, including proton pump inhibitors (PPI), Histamine receptor blockers, antacids, and Pepto-Bismol.
