Doctors classify an ulcer, the formation of a round or oval open sore that occurs anywhere in the lining of the digestive tract, as a peptic ulcer. Recent advancements in medications increase the rate of successful treatment and decrease the need for endoscopic treatments. However, because bleeding ulcers carry a 3 to 10 percent mortality rate, people who fail to respond to medications may require endoscopic treatment, according research published by Wang et. al in "The Canadian Journal of Gastroenterology."
Endoscopic Diagnosis
Doctors classify ulcers that occur in the lining of the stomach as gastric ulcers and those that occur in the lining of the first portion of the small intestine as duodenal ulcers. Duodenal ulcers occur more often than gastric ulcers, according to the Merck Manual. Although the study published in the "Canadian Journal of Gastroenterology" reports that up to 80 percent of bleeding ulcers resolve on their own, continuing symptoms lead patients to seek a diagnosis.
Symptoms such as vomiting bright red blood, vomiting reddish-brown clumps that appear similar to coffee grounds, or passing black or bloody stools, lead doctors to suspect bleeding in the digestive tract. One of the most common causes of bleeding is the formation of an ulcer. To determine the presence and location of an ulcer, doctors utilize an endoscope --- a long flexible viewing tube --- to visualize the lining of the digestive tract.
Endoscopic Hemostasis
To perform hemostasis means to cause the bleeding process to stop. Once doctors confirm a bleeding ulcer, they can use the endoscope to administer endoscopic hemostasis. The Merck Manual describes two different procedures; one involves cauterizing the ulcer, which means using heat to destroy it; the other injects a substance into the ulcer to promote blood clotting.
Surgical Procedures
On the rare occasion that medications and endoscopic treatments fail to stop the bleeding and heal a peptic ulcer, other surgical procedures may become necessary. Because vagus nerve stimulation triggers the production of stomach acid, doctors can cut the vagus nerve in a procedure known as a vagotomy. This procedure may be performed either through open surgery or as a laparoscopic procedure utilizing several small incisions.
A pyloroplasty describes a procedure that cuts the pylorus, the opening between the stomach and the small intestine. This helps relax the muscle so stomach contents empty more quickly to decrease stomach acid irritation and relieve the bleeding ulcer, as described by the University of Maryland Medical Center.
