What causes a bleeding ulcer, and is it serious?
Most commonly, when people refer to an ulcer, they are referring to peptic ulcers that develop in the digestive tract. The term peptic means it is related to acid.
Peptic ulcers may be in the stomach, the small intestine just below the stomach, or the food pipe above the stomach.
Sometimes, peptic ulcers can bleed (known as bleeding ulcers). More severe bleeding, known as hemorrhaging, can be life-threatening. Minor bleeding in an ulcer, however, is usually not as immediately serious and may go unnoticed, but it still requires treatment.
- Symptoms vary in severity, but notably, there is a pain in the upper abdomen.
- Infections and some medications can cause bleeding ulcers.
- With proper treatment, bleeding ulcers can be cured.
- Bleeding ulcers are usually diagnosed and often treated by an endoscopy.
A peptic ulcer that develops in the digestive tract may begin to bleed, which could lead to a rapid loss of blood.
Peptic ulcers can be difficult to diagnose because some people never display symptoms. Those who do experience symptoms often find them quite noticeable. Symptoms include:
- a pain in the upper abdomen, which may get worse after eating or when the stomach is empty
- nausea or vomiting
- feeling full or bloated
If a peptic ulcer begins bleeding, a person may notice:
- stools that are dark and sticky
- stools that are dark red in color
- vomit that looks like coffee grounds or has blood in it
- fainting or feeling lightheaded
A person with any of these symptoms should seek emergency medical care. A severely bleeding ulcer can cause rapid loss of blood and possibly death if left untreated.
A slow-bleeding ulcer may gradually cause anemia. Anemia means the body does not have enough red blood cells and hemoglobin, which means the body's organs cannot get enough oxygen. Anemia can make a person feel tired or short of breath. It can also cause paleness in skin color.
The stomach produces powerful acids that are necessary for digestion. These acids do not usually damage the digestive tract because of a protective mucous lining.
In some cases, however, the body is producing too much stomach acid, and the mucous lining becomes damaged or worn away. When this happens, the acid may damage the lining of the digestive tract and cause a sore (ulcer).
Most peptic ulcers develop for obvious reasons, and certain factors can cause them or increase the risk.
Use of NSAIDs
High doses of common NSAIDs such as ibuprofen and aspirin may cause peptic or bleeding ulcers.
Using certain pain relief medications known as NSAIDs (non-steroidal anti-inflammatory drugs) at high doses or for extended periods can cause peptic or bleeding ulcers. This is because NSAIDs block a particular chemical in the body that helps protect the stomach lining from acids.
The most common NSAIDs are:
NSAIDs can also decrease the blood's clotting ability, which can make ulcers more likely to bleed.
H. pylori infection
Helicobacter pylori, or H. pylori is a type of bacteria that can infect the stomach. It attacks the stomach's mucous lining, allowing acid to penetrate and damage the tissues.
Experts do not know for sure how people become infected with H. pylori. But some believe it is found in contaminated food and water.
H. pylori may also spread from person-to-person. Being diligent about hand washing and consuming only clean, safe food and beverages are the only known ways to avoid the infection.
Zollinger-Ellison syndrome (ZES)
Zollinger-Ellison syndrome (ZES) is an uncommon condition that causes tumors in the stomach, duodenum, or pancreas. These tumors cause the stomach to produce more acid than it needs, leading to peptic ulcers. The tumors caused by ZES may or may not be cancerous.
According to the National Institute of Diabetes and Digestive and Kidney Diseases, ZES is rare, occurring in only 1 in every 1 million people.
Symptoms of ZES may be similar to those of regular peptic ulcers, such as dull or burning pain in the belly, as well as digestive problems, such as diarrhea, nausea, decreased appetite, bloating, and burping. It is believed to cause less than 1 percent of all peptic ulcers.
Ulcers with other causes
Previous studies have stated that up to 90 percent of peptic ulcers are caused by H. pylori and NSAID use. But, a recent review in the Asian Pacific Journal of Cancer Prevention states that ulcers without H. pylori infection or NSAID use are increasing.
The study, which took place in Thailand, suggests that other factors, including alcohol, other infections, medications, or diseases, including stomach and intestinal cancer, may be to blame.
Diagnosis and treatment
An upper endoscopy may be used to diagnose and treat a peptic ulcer.
People with symptoms of a peptic ulcer may undergo a test known as an upper endoscopy. A doctor passes a lighted, flexible tube with a camera through the mouth and into the stomach. In some cases, it is possible to treat a bleeding ulcer during the endoscopy.
Doctors often treat ulcers with medications that block or reduce stomach acid. These medicines include:
- Proton pump inhibitors (PPIs) - dexlansoprazole (Dexilant®), esomeprazole (Nexium®), omeprazole (Prilosec®, Zegerid®), lansoprazole (Prevacid®), pantoprazole (Protonix®), and rabeprazole (Aciphex®).
- H2 blockers - cimetidine (Tagamet®), famotidine (Pepcid®), nizatidine (Axid®), and ranitidine (Zantac®).
People who take NSAIDs and who are diagnosed with a peptic ulcer may need to stop taking the NSAID.
When a doctor diagnoses a person with a H.pylori infection, they will prescribe antibiotics and other medicines to kill the bacteria. H. pylori is tricky to kill, so to ensure that the treatment is successful, a person must take all medicines as prescribed, even if they feel better.
For many years, people thought ulcers were caused by stress or emotional causes. But, the American College of Gastroenterology say that these factors do not cause ulcers, nor do certain foods or diets. A special diet is not recommended for people with ulcers, but taking their medications as prescribed is key.
With proper treatment, a peptic ulcer can be treated, and most people recover completely. They may need to avoid taking NSAIDs, and many people need a follow-up endoscopy to ensure the ulcer is gone. Any signs or symptoms of a bleeding ulcer require urgent medical attention.