Overview

A bleeding ulcer refers to an open sore that develops in the lining of the stomach, upper small intestine (duodenum), or lower esophagus and begins to bleed. This condition is considered a medical emergency and can lead to serious complications if not treated promptly. Bleeding ulcers are a type of peptic ulcer disease (PUD) and occur when the protective lining of the gastrointestinal tract is damaged, exposing blood vessels. Common signs include abdominal pain, vomiting blood, and black, tarry stools. Early diagnosis and treatment are crucial to prevent life-threatening outcomes.

Causes

Several factors can lead to the development of bleeding ulcers, primarily related to the breakdown of the stomach’s protective barrier:

• Helicobacter pylori Infection: A common bacterial infection that weakens the stomach lining and increases ulcer risk.
• Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): Frequent use of pain relievers like ibuprofen, aspirin, or naproxen can irritate and damage the stomach lining.
• Excessive Alcohol Consumption: Alcohol can erode the stomach lining and increase acid production, contributing to ulcers.
• Smoking: Smoking impairs the healing process of ulcers and increases stomach acid production.
• Stress: Severe physical stress, such as major surgery, severe burns, or head injury, can cause stress ulcers.
• Other Medical Conditions: Rarely, conditions like Zollinger-Ellison syndrome cause excessive acid production leading to ulcers.

Symptoms

The hallmark symptom of a bleeding ulcer is gastrointestinal bleeding, but other associated signs include:

• Abdominal Pain: A burning or gnawing pain in the upper abdomen, often relieved or worsened by eating.
• Vomiting Blood: Vomit may appear bright red or resemble coffee grounds due to digested blood.
• Black, Tarry Stools (Melena): Dark, sticky stools caused by bleeding in the upper gastrointestinal tract.
• Fatigue and Weakness: Resulting from blood loss and anemia.
• Dizziness or Fainting: Especially after standing, due to significant blood loss.
• Shortness of Breath: Severe bleeding can reduce oxygen delivery to tissues, causing breathlessness.
• Loss of Appetite or Nausea: Discomfort after eating may reduce food intake.

Diagnosis

Diagnosing a bleeding ulcer involves identifying the ulcer and confirming the presence of bleeding through various tests:

• Medical History and Physical Exam: Assessment of symptoms, medication use, and medical history.
• Endoscopy: The primary diagnostic tool where a flexible tube with a camera is inserted into the stomach to visualize the ulcer and active bleeding.
• Biopsy: Tissue samples may be taken during endoscopy to test for H. pylori or rule out cancer.
• Stool Tests: Fecal occult blood test detects hidden blood in the stool.
• Blood Tests: To check for anemia, infection, and overall health status.
• Urea Breath Test or Stool Antigen Test: To diagnose H. pylori infection.

Treatment

Treatment for bleeding ulcers focuses on stopping the bleeding, healing the ulcer, and preventing recurrence:

• Hospitalization: Most patients with bleeding ulcers require admission for monitoring and treatment.
• Endoscopic Therapy: During endoscopy, techniques like cauterization, clipping, or injection of medications can stop the bleeding.
• Proton Pump Inhibitors (PPIs): High-dose PPIs reduce stomach acid, promoting healing and preventing re-bleeding.
• Antibiotics: Used to eradicate H. pylori infection if present.
• Blood Transfusions: Administered if there is significant blood loss leading to anemia.
• Discontinuing NSAIDs or Harmful Substances: Stopping the use of NSAIDs, alcohol, or smoking is crucial for recovery.
• Surgery: Reserved for severe cases where endoscopic treatment fails or if complications arise.

Prognosis

The prognosis for bleeding ulcers is generally good with prompt treatment, though outcomes depend on the severity and underlying health:

• Good Recovery Rate: Most patients recover fully with appropriate medical management.
• Risk of Recurrence: Rebleeding can occur if the underlying cause, like H. pylori or NSAID use, is not addressed.
• Serious Complications Possible: Delayed treatment may lead to severe blood loss, shock, perforation, or death in rare cases.
• Long-Term Management: Lifelong use of acid-reducing medications may be necessary in some individuals, especially if NSAID use must continue.
• Positive Outcome with Early Care: With early diagnosis and modern treatments, long-term complications are significantly reduced.

Early recognition and treatment of bleeding ulcers are critical to ensuring complete recovery and minimizing health risks.