Peptic ulcer disease is one of the most common conditions affecting the gastrointestinal tract. Ulcers may develop several complications, with bleeding being one of them and perhaps the most frequent complication. According to Sabiston Textbook of Surgery, peptic ulcers account for approximately 50 percent of upper gastrointestinal bleeding.
Ulcer Growth
As an ulcer progresses, it erodes the lining of the stomach or the small intestines, depending on its location. The ulcer also erodes an underlying blood vessel, resulting in bleeding into the gastrointestinal tract. Occasionally, bleeding arises from an ulcer that is healing and has been irritated by the acidic contents of the stomach.
Symptoms
Vomiting blood is the chief sign that a peptic ulcer is bleeding. The blood may have one of two appearances. It may be bright red and easily recognizable or if slow bleeding has been taking place over a number of days, it may appear dark brown and look like coffee grounds. Bleeding from the rectum may be a symptom in massive, rapid bleeds. Such bleeds often cause significant falls in blood pressure, leading to fainting.
Tests
An Upper GI Endoscopy confirms that the cause of the gastrointestinal bleed is indeed an ulcer and also offers an option for treatment as the bleeding vessel can be stopped using several different techniques, all of which are done via the endoscope, a special camera which passes through the mouth and into the stomach and upper small intestines, allowing examination of the bleeding area.
Treatment
Even if the bleeding can be arrested endoscopically, further treatment is required to reduce the possibility of a re-bleed. This involves the use of medication to reduce the acid production of the stomach, such as omeprazole and lansoprazole. Because most peptic ulcers are caused by infection with the bacteria helicobacter pylori, antibiotics are added to the treatment regimen to eradicate it. Massive bleeds require transfusion of blood as well.
Failure of endoscopic control can occur, leaving surgical intervention as the only other option. Surgical therapy control of bleeding can involve removal of the bleeding portion of the stomach or simply suturing a knot around the bleeding vessel.
Prognosis
Bleeding is a serious complication of peptic ulcer disease and requires emergent care. According to the medical textbook "Surgery: Scientific Principles and Practice," the prognosis worsens for those older than 60, with the risk of death being 13.4 percent.
References
- "Surgery: Scientific Principles and Practice". Greenfied et al. 1990
- "Sabiston Textbok of Surgery". Townsend et al. 2008
