Complications of peptic ulcers

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People who have peptic ulcers generally continue to function normally, and some ulcers heal spontaneously without medication.

Many others, however, experience complications such as bleeding, obstruction of the gastric system and perforation (where a hole goes right through the stomach or duodenum).

Bleeding
If you have a bleeding ulcer, you’ll have black, tar-like stools (called melaena) and you’re most likely to feel weak – so much so that you may feel as if you’re going to faint when standing. You may also vomit blood. The blood in the stomach is usually changed by gastric acid, giving it a grainy, black appearance (like coffee grains).

The initial treatment consists of rapidly replacing lost body fluids. If bleeding is severe or persists, you may need a blood transfusion or even an operation.

Gastric-outlet obstruction
If you have a gastric-outlet (pyloric) obstruction caused by an ulcer, you’re most likely to experience increasing abdominal pain and you may vomit undigested or partially digested food because it can’t pass into the rest of the digestive tract.

The obstruction usually occurs at or near the pyloric canal – the naturally narrow part of the stomach that connects it to the upper part of the small intestine, the duodenum. You may also experience weight loss and a diminished appetite.

Your doctor will most likely perform an upper endoscopy to exclude the possibility of gastric cancer – a common cause of gastric-outlet obstruction.

Perforation
In the case of a perforated ulcer, gastric contents will leak into your abdominal cavity. This causes acute peritonitis (inflammation of the abdominal cavity). You will have sudden and severe abdominal pain, which worsens whenever you move. The abdominal muscles become rigid and board-like, and surgery is usually urgently required.

Penetration
Sometimes an ulcer at the back of the bowel might break through the wall. You might experience pain radiating to the back, especially when you lie down.

Because there’s no free perforation, you won’t be as sick as with a perforation, but a lot of fibrosis (thickening and scarring of the connective tissue) may occur in that region.

Read more:
Preventing peptic ulcers
The symptoms of peptic ulcers
Treating peptic ulcers

Reviewed by Dr Estelle Wilken, senior specialist in Internal Medicine and Gastroenterology at Tygerberg Hospital. December 2017.

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