1. Endoscopy to Diagnose and Treat Bleeding Ulcers
Before any other treatments are tried, your doctor will probably want to do an endoscopy. An endoscope is a thin, plastic tube that gets placed into your mouth, down your esophagus and into your stomach. This allows your doctor to determine the severity of the bleeding and the condition of the ulcer. This can help reduce the risk of further problems and also help your doctor select the treatment most appropriate for your situation.
In addition to using endoscopy to diagnose your condition, the endoscope can be used as a form of treatment. A small probe is put down the tube and then electricity, heat or small clips are used to coagulate the blood and stop the bleeding. Endoscopy is most effective for areas of bleeding that are less than 2mm in diameter. It is also useful if you have ulcers that are not currently bleeding, but that have features that indicate a risk of bleeding.
2. Using Medication in Combination With Endoscopy
Your doctor may want to use certain drugs in combination with the endoscopy in order to improve the effectiveness of the treatment. Epinephrine can be injected into the ulcer to aid in the coagulation process and narrow the blood vessels. Proton pump inhibitors are sometimes used to reduce the likelihood of re-bleeding and to avoid the need for surgical intervention. Research has shown that the use of these medications in conjunction with endoscopy is more effective than endoscopy alone.
H2 blockers, an acid-blocking medication, can be given intravenously. These are most useful for gastric ulcers but seem to be of little benefit for bleeding duodenal ulcers.
3. Treat the Underlying Causes of Ulcers
Dealing with the bleeding is generally your first priority, but it is also important that you address the underlying cause of the ulcer. If your ulcer was a result of NSAID use, your doctor will want you to discontinue taking these medications right away. If the ulcer was caused by the H. pylori bacterium, you will be given antibiotics to clear it up. Antibiotic therapy is usually started immediately after endoscopy.
If you have a persistent peptic ulcer or if you are at risk for re-bleeding, you may be given a hormone called somatostatin. This hormone is used to prevent bleeding and though traditionally used for cirrhosis, can be beneficial for bleeding ulcers.
4. Surgery for Hard-to-Treat Bleeding Ulcers
Surgery is generally used only as a last resort. If you've had an endoscopy that has failed and medication has also proven to be ineffective, abdominal surgery may be recommended. Surgery is also indicated when the bleeding leads to a medical emergency. For example, an ulcer can perforate the walls of the stomach or intestine, leading to severe infection. In this case, surgery is required to repair the perforation.
Surgery is sometimes also used to offer long-term relief from ulcers. A vagotomy is a procedure in which the vagus nerve is cut, preventing the brain from sending messages to the acid-secreting cells in the stomach. In an antrectomy, the lower part of the stomach is removed, thereby eliminating the hormone that is responsible for releasing digestive juices. Your doctor may feel that these procedures are necessary if you are suffering from chronic ulcers and their complications.
