Acute Peptic Ulcer Complications

What are acute peptic ulcer complications?

Peptic ulcers are small wounds that form on the inner lining of the stomach and the upper section of the small intestine. Acute peptic ulcer complications are harmful developments of these wounds, such as internal bleeding, severe abdominal cavity infection, and systemic infections. Experiencing these complications is typically a serious medical emergency that requires prompt medical attention since, if left untreated, they can be life-threatening.

What causes acute peptic ulcer complications?  

Bacterial infections, such as helicobacter pylori infections, are a prevalent cause of peptic ulcers.

The formation of peptic ulcers is triggered by acid eating away at the inner layer of the digestive tract. If an ulcer becomes deep or severe, it can penetrate the stomach or duodenal wall, leading to bleeding or perforation, which are serious complications.

The most prevalent risk factors for peptic ulcers and their complications include the following:

  • Bacterial infections: For instance, Helicobacter pylori (H. pylori) infections damage the mucus on the inner layer of the stomach and small intestine, making it easy for acid to eat away at the organ tissue, resulting in peptic ulcers and paving the way for complications. 
  • Regular use of certain medications: The chronic consumption of ibuprofen, aspirin or Selective Serotonin Reuptake Inhibitor (SSRIs) can be a risk factor for peptic ulcers and their complications. They may irritate or inflame the lining of the digestive tract, which increases the chance of an ulcer forming. 
  • Smoking and alcohol consumption: These risk factors can exacerbate peptic ulcer conditions and contribute to complications.
  • Stress: While stress alone may not cause ulcers, it can worsen symptoms and delay healing, potentially leading to complications.
  • Genetic factors: Family history of peptic ulcers or related conditions can increase susceptibility to complications.

What are the symptoms of acute peptic ulcer complications? 

A burning sensation in the gut often accompanies peptic ulcers.

The most prevalent symptoms of peptic ulcer complications include:

  • Burning sensation in the gut
  • Sharp pain beneath the abdomen
  • Dull abdominal ache
  • Constant bloating or belching
  • Feeling of fullness
  • Heartburn
  • Ache or nausea after eating fatty food

Usually, these symptoms worsen after spending too long with an empty stomach during the day. Taking medication that neutralises stomach acid can usually relieve these symptoms temporarily.

In rare cases, more severe symptoms could appear:

  • Vomiting blood
  • Dark blood in stool
  • Chronic nausea
  • Appetite changes
  • Sudden loss of weight
  • Shortness of breath

Are acute peptic ulcer complications painful?

Sharp pain is a common sign of internal bleeding.

Peptic ulcer complications such as internal bleeding can be very painful. It is often described as sharp, stabbing pain beneath the tummy. Obstructions can start out as a mild discomfort as food can not pass through the digestive tract, but as it worsens, it can start manifesting as a severely dull ache around the abdomen.

Should I go to A&E with suspected peptic ulcer complications?

Should you suffer from multiple of the aforementioned symptoms, especially the severe ones like vomiting blood, having dark blood in stool, and chronic nausea, it is important to promptly seek assistance from a general surgery clinic or dial 995 to reach a nearby hospital's Accident & Emergency (A&E) Department. This urgency stems from the critical need for timely treatment to prevent further complications. 

ACE Specialist Surgery and Endoscopy Clinic provides emergency services around the clock for acute peptic ulcer complications cases. Individuals with symptoms of acute appendicitis can seek medical help at any hour for assessment and necessary treatment. Our specialist clinic can be contacted any time of the day. We strive to arrange appointments or urgent surgical procedures with our endocrine and general surgeon as swiftly as possible.

How are acute peptic ulcer complications diagnosed? 

Laboratory tests can detect peptic ulcer complications.

To identify an ulcer, your general surgeon will understand your medical history and conduct a physical examination. Subsequently, if you show signs of acute peptic ulcers and their complications, you may undergo diagnostic evaluations, including: 

  • Laboratory tests for Helicobacter pylori: Your general surgeon might suggest tests to detect the presence of H. pylori bacterium in your body. These tests could involve analysing blood, stool, or breath samples, with the breath test being the most accurate. During the breath test, you consume a substance containing radioactive carbon, which H. pylori breaks down in your stomach. If you are taking antacids prior to this test, inform your general surgeon or nurse, as stopping the medication may be necessary to avoid false-negative results.
  • Endoscopy: Your general surgeon may perform an endoscopy to examine your upper digestive system, checking for ulcers by inserting a hollow tube with a camera down your throat. If an ulcer is found, a biopsy may be taken to analyse tissue and detect H. pylori bacterium. Endoscopy is suggested for older individuals, those with signs of bleeding, recent weight loss, or difficulty eating. Even with symptom improvement, a follow-up endoscopy after treatment is advised to confirm ulcer healing.
  • Biopsy: During endoscopy, a biopsy may be taken to rule out gastric cancer or infection with Helicobacter pylori
  • Upper gastrointestinal series (UGI):  Also known as a barium swallow, this series of X-rays captures images of your oesophagus, stomach, and small intestine. During the X-ray procedure, you ingest a white liquid containing barium, which coats your digestive tract and enhances the visibility of ulcers.

How serious are acute peptic ulcer complications? 

If left untreated, peptic ulcers often lead to complications. Acute peptic ulcer complications can range from minor to potentially fatal conditions. 

  • Bleeding Ulcers: A peptic ulcer that bleeds can lead to significant blood loss, resulting in anaemia or even hemorrhagic shock if not promptly treated.
  • Perforation: When a peptic ulcer penetrates through the stomach or duodenal wall, the hole can cause peritonitis, a severe abdominal cavity infection, which is a medical emergency requiring immediate intervention.
  • Obstruction to the digestive tract: The blockage may cause swelling and inflammation but typically does not require hospitalisation. However, in some cases, ulcers can cause swelling and scarring that block the passage of food through the digestive tract, leading to vomiting, severe pain, and potential complications like aspiration pneumonia.
  • Gastric Outlet Obstruction (GOO): If left untreated, it can result in electrolyte imbalances and dehydration, which can be life-threatening.
  • Systemic Infections: Severe ulcers and their complications can lead to systemic infections, affecting other organs and potentially leading to sepsis, a deadly condition.

What are the treatment options for acute peptic ulcers? 

Oral medications such as antibiotics can treat peptic ulcers.

It is best to cure peptic ulcers before they develop into threatening complications. The treatment approach for peptic ulcers depends on the underlying cause. Treatment may encompass: Antibiotic Medications, Medications Blocking Acid Production, Medications Reducing Acid Production, Antacids, and Cytoprotective Agents.

Your medication regimen will be tailored based on your specific condition, taking into account factors such as the presence of H. pylori bacterium and individual health considerations.

However, if your peptic ulcers have resulted in various complications, further treatment is required.

What are the possible treatments to consider for acute peptic ulcer complications? 

If conservative treatments fail, surgery may be necessary to treat acute peptic ulcer complications like perforation, bleeding, or gastric outlet obstruction.

Internal bleeding: This complication has to be given immediate medical intervention, usually consisting of blood transfusions. In some cases, a medicine called epinephrine may be directly injected to the ulcer to stop the bleeding. It is not uncommon for patients to be hospitalised for internal bleeding to better monitor the ulcer site.

Perforation: Surgery is often required to repair the perforated area (area with a hole) and remove any damaged tissue.

Obstructions:  These are treated by the administration of medicine through an intravenous (IV) line. However, if it has become too severe, emergency surgery to remove the obstruction may be performed. 

Visit ACE Specialist Surgery & Endoscopy

Acute peptic ulcer complications can affect anyone and can be dangerous if ignored for too long. However, with immediate medical help, almost all cases can be resolved. 

If you are suffering from acute peptic ulcer complications or suspect that you may be suffering from one,  schedule an appointment with ACE Surgery and Endoscopy for a detailed examination and responsive treatment. 

References

  1. Peptic ulcer. Mayo Clinic
    https://www.mayoclinic.org/diseases-conditions/peptic-ulcer/diagnosis-treatment/drc-20354229
  2. Bleeding Peptic Ulcer: Treatment. Saint Luke’s
    https://www.saintlukeskc.org/health-library/bleeding-peptic-ulcer-treatment#:~:text=Air%20is%20used%20to%20expand,ulcer%20to%20help%20reduce%20bleeding.
  3. Stomach cancer. Mayo Clinic
    https://www.mayoclinic.org/diseases-conditions/stomach-cancer/symptoms-causes/syc-20352438