Destruction of the stomach's protective mucosal lining from stomach ulcers may cause mild to severe symptoms. This condition, called peptic ulcer disease, or PUD, is usually caused by the common bacteria Helicobacter pylori (H. pylori). Abdominal pain 1 to 2 hours after meals is a common presenting symptom. Progression of peptic ulcer disease causes the most serious symptoms, including perforation, penetration, infection and obstruction.
Perforation (Internal Bleeding)
Erosion of the gastric mucosal can progress beyond the mucosal barrier into the stomach lining. This occurs in approximately 10 to 15 percent of patients. Ulceration of the epithelial lining is similar to a break in the surface of external skin and is recognized as the most common complication of peptic ulcer disease. Under the surface of the stomach's lining is important connective tissue where blood vessels are located. Patients with peptic ulcer disease are at risk for ulcerating blood vessels of the stomach lining. Bleeding may be slow or worsen to represent severe blood loss causing symptomatic anemia. Hypotension is an indication of significant blood loss that must be managed in the hospital with a blood transfusion. Depending on the size of the ulcer, bleeding may stop on its own. In the event that bleeding continues, surgical intervention may be required. Mortality rate is 29 to 60 percent, according to the "Merck Manual of Geriatrics."
Penetration
Similar to perforation, and seen in 5 to 10 percent of PUD disease, penetration is a full thickness ulceration that may penetrate to adjacent visceral organs. At risk are those organs closest to the stomach: pancreas, intestines and the liver. This is not a common complication of the disease but it is significant. Resulting pancreatitis and fistulas (abnormal connections between organs) are severe complications that are difficult to treat and increase morbidity and mortality. Elderly patients are particularly at risk, with penetration often presenting with sepsis.
Infection
Penetration is a direct cause of infection. The body's inner cavity is typically impervious to external conditions and bacterial invasion. Unless there is a breach in the abdominal cavity, wall organs are protected from direct invasion. This is the scenario when the gastrointestinal system has a hole in its lining. This hole allows for the introduction of external content and acidic fluids into the peritoneal cavity, increasing the risk for serious infection. The combination of fluid and foreign organisms are a recipe for peritonitis, inflammation of the peritoneum. In addition to infection by organisms, direct irritation to the tissues of the peritoneal cavity lead to hyper-responsive tissues exacerbating the condition.
Obstruction (Scar Tissue and Swelling)
Repeated exposure of the epithelial surfaces cause an inflammatory reaction that will, over time, create scar tissue. Resultant swelling and abnormal tissue is the body's mechanism for protecting itself. Mechanical obstruction occurs due to inflammatory response material and strictures that narrow passageways. Gastroduodenal obstruction occurs when there is inflammation, swelling and scarring near the opening of the stomach that leads into the first section of the intestine. This is referred to as gastric outlet obstruction. Two to 5 percent of patients present with gastric outlet obstruction. Symptoms may include the sense of early satiety (fullness), nausea and vomiting. Additionally, there is a tendency for unintended weight loss due to a decrease in dietary intake. Medical treatment usually resolves this condition. Risk of complications increase as patients age.
