Most ulcers are caused by a bacteria called Helicobacter pylori (H. pylori). A majority of ulcers heal when medically treated. However, some ulcers do not. Instead, they grow large enough to cause bleeding. Bleeding from peptic ulcers is the most common cause of emergency bleeding, according to Gut Journal. This bleeding is potentially life threatening and requires the immediate attention of a medical professional.
Fluid Resuscitation
Patients who present with signs of bleeding receive intravenous fluids. Symptoms indicating low volume status include fainting, lightheadedness, pale skin, sweating, low blood pressure and a fast heart rate. Intravenous fluids replace fluid lost as a result of bleeding.
Analgesia
Not all patients with bleeding ulcers present with pain. In fact, many do not. Symptoms associated with blood volume loss are the most common reason patients seek a physician. However, those complaining of pain seek relief from ulcers causing "burning" abdominal pain, which may range from mild to severe. In some cases, ulcers manage to break through the wall of the stomach. In these cases, patients experience severe diffuse pain as stomach contents irritate other sensitive parts of the abdominal cavity. This is a medical emergency. Doctors control pain using narcotics or anti-inflammatories administered through a vein for quick pain relief. Until further evaluation, this method also allows doctors to bypass the stomach as a route of treatment. After doctors locate the source of bleeding, patients resume normal medication regimen by mouth, usually within the first 24 to 72 hours.
Nothing By Mouth
Limiting a patient's access to food and water intake prevents further irritation to the stomach lining, allows the ulcer to stop bleeding and prevents food interference with upcoming endoscope exam. Bleeding usually resolves within the first day. Patients resume feeding after endoscopic exam, usually performed within 24 hours. If patients tolerate clear liquids, they progress to solids a few hours after the endoscopic exam.
Endoscopy
Multiple causes of bleeding exist. In order to diagnose and treat bleeding ulcers, doctors must look directly at the source of injury.
Small bleeds only require cautery of small to control the bleeding. Cautery is the destruction of small these vessels with the use of heat to prevent bleeding.
Another method for moderate to small bleeds is to inject chemicals at the site of bleeding cause vessel constriction. Vasopressin is a drug used in cases of mild to moderate ulcer bleeding.
Embolization is another method physicians use to control bleeding. Physicians inject a material directly into blood vessels, at the site of injury, causing them to clot.
Surgery
In some case, bleeding is profuse and medical management is not enough. In the event that medical management fails, patients need surgical intervention. The source of the bleeding determines the specific type of surgery necessary. However, surgery is not without its own complications and performed only when necessary. Surgery involves removal of the nerves or removal of a portion of the stomach. The Merck Manual reports 30 percent of patients who undergo removal of a portion of the stomach for peptic ulcer disease experience significant symptoms afterward.
Treat Conditions that cause bleeding
After controlling the emergent cause of bleeding, treating the underlying cause is the next step. Helicobacter pylori leads to ulcers by weakening the protective mucus of the stomach. Antibiotics eradicate the H. pylori infection and reduce risk of recurring and rebleeding ulcers.
Gastroesophageal reflux disease also harms the lining of the the stomach. Treatment with proton pump inhibitors (PPIs) significantly reduces rebleeding and histamine blockers (H2-blockers) control acid reflux. Reducing acid reduces risk of new ulcers.
Finally, other drugs like misopristol help heal the source of the bleeding--ulcers
