Bleeding Ulcer

Ulcers definition

bleeding ulcer
Image courtesy of: National Kidney & Urologic Diseases Information Clearinghouse (NKUDIC)

An ulcer is a break in the covering surface of skin or any internal organ. In this article, we will be talking specifically about the types of ulcers in digestive system that can cause internal bleeding. The two common types of ulcers in digestive system are stomach ulcers and duodenal ( the upper part of the intestine ) ulcers.

Can you die from a bleeding ulcer?

You can actually die from a bleeding ulcer if you don’t get proper treatment in a timely manner. Bleeding ulcer in the stomach or the duodenum can cause severe life threatening blood loss. Most patients with rapidly bleeding ulcer are very sick and unstable.

However, due to recent advances in bleeding ulcer treatment, bleeding ulcer death is very rare as long as you get proper medical care. If you don’t have any other complicating medical problems, the treatment for bleeding ulcer is relatively straightforward and you are expected to recover and go home.

Unfortunately, there is no recent study to quote the exact stomach ulcer death rate from bleeding ulcers. Most studies were done more than a decade ago. In those studies , case fatality rate on patients hospitalized for bleeding ulcers had ranged anywhere from 5% to 15%. Those numbers seem too high for today.

Bleeding ulcer symptoms

Bleeding ulcer symptoms depend on many things but the most important factor is the rate of bleeding. Depending on the rate of loss of blood, bleeding ulcer symptoms can be divided into rapidly bleeding ulcer symptoms and slow bleeding ulcer symptoms.

Rapid bleeding ulcer symptoms

Rapid bleeding ulcer symptoms are the result of rapid blood loss. Here are some of the worrisome signs and symptoms of an actively bleeding ulcer:

  1. Throwing up blood
  2. Feeling dizzy and lightheaded
  3. Palpitation
  4. Low blood pressure
  5. Black tarry stool
  6. Feeling very tired
  7. Running out of breath with activity
  8. Burning type pain in the upper abdomen
  9. Suddenly appear very pale and anemic
  10. Feel like fainting
  11. Actual fainting
  12. Bloody stool

Not all patients with rapid bleeding ulcers will have these symptoms. It is very rare to have both throwing up blood and bloody stool. But when those two symptoms occur at the same time, it is very serious. It means that the bleeding is so fast that it can cause death within a few hours without proper treatment.

The abdominal pain in rapid bleeding ulcer may or may not happen at the same time as the other symptoms. For example, you may have the pain at night before going to bed and have the other symptoms in the morning when you wake up.

Slow bleeding ulcer symptoms

Slow bleeding ulcer symptoms are different from rapidly bleeding ulcer symptoms. You do not have signs of rapid blood loss. You may have peptic ulcer symptoms from time to time. However, peptic ulcer symptoms are very non-specific and hard to differentiate from stress induced gastritis or general stress related stomach pain. Burning pain in the stomach, usually after meals, may be present in any of those conditions. Other symptoms of peptic ulcer such as belching, bloating, distention, and heartburn are also very non-specific.

Symptoms of blood loss from slow bleeding ulcers are follows

  1. Slowly progressing weakness over weeks or months
  2. Slowly worsening shortness of breath with activity
  3. Slight puffiness of face
  4. Pale face
  5. Decreased energy level
  6. Use of antacids for ulcer pain relief at night

It is difficult to know if you have bleeding ulcer when the bleeding is too slow. If you have any of the above listed symptoms of slow bleeding ulcers, you need to talk to your doctor. Many patients with slow bleeding ulcers are discovered after routine blood tests that show evidence of anemia.They may not remember any slow bleeding ulcer symptoms or may have some recollection of taking antacids for stomach ulcer pain relief.

Burst ulcer symptoms

Burst ulcer( also called perforated ulcer) symptoms are significantly different from bleeding ulcer symptoms. When your ulcer bursts, the contents of your stomach spills out into your abdominal cavity. It causes severe inflammation and sepsis. You may have sudden severe unrelenting abdominal pain. Your belly will be hard and very tender to touch. You may develop fevers, chills and even die from septic shock if left untreated. As opposed to bleeding ulcer surgery, burst ulcers surgery is required most of the times and is a life saving procedure. Perforated ulcer death is the most likely outcome if surgery is not done in timely manner.

Can stress cause ulcers?

Prior to 1980s, stress was thought to be a major cause of stomach and duodenal ulcers. After the discovery of bacteria in stomach ulcers, scientists believed that ulcers were actually caused by the bacteria Helicobacter Pylori or H. Pylori. However, recent research has shown that stress can still play a role in development of ulcers in the digestive tract.

The role of psychological stress in causation of ulcers is much smaller than previously thought. However, significant bodily stress can still cause ulcers in hospitalized patients. People who had significant bodily stress from major trauma, significant burn, prolonged surgery, major brain bleeding and similar medical events can have stomach ulcers or duodenal ulcers while being treated in the hospital. In those patients, preemptive administration of medication to avoid ulcers is the standard of care.

Ulcer treatment

Treatment of bleeding ulcer is different from ulcer treatment without bleeding. Ulcer treatment without bleeding simply involves taking the combination of prescribed pills. Most ulcers are caused by H. Pylori bacteria. Medication prescribed for ulcer treatment consists of a combination of different antibiotics and acid reducing agents.

Bleeding ulcer treatment requires a visit to the emergency department and hospital admission. First step in bleeding ulcer treatment is establishment of venous access to start saline infusion. Saline infusion is really important for bleeding ulcer treatment because it helps stabilize the circulatory system and prevents shock. The next step is to check the hemoglobin level in the blood and start blood transfusion if it is too low. In the meantime, infusion of medications to rapidly reduce the amount of acid in the stomach is started.

Endoscopy is the procedure required for bleeding ulcer treatment once the patient is stabilized with saline infusion. An endoscope can directly visualize the bleeding ulcer inside the stomach and the operator can use the tip of the scope to stop the bleeding.

Most bleeding ulcer treatment is achieved by using IV medications, blood transfusion when necessary, and upper endoscopy. Bleeding ulcer surgery is rarely done these days as most people stop bleeding with the other treatments.

Bleeding ulcer diet

When you have a bleeding ulcer, you need to completely stop eating and drinking until the bleeding has stopped. NPO diet (nothing by mouth) is a part of the standard bleeding ulcer treatment protocol. Similarly NPO diet is the absolutely required ulcer diet when you have a burst ulcer.

The role of food for ulcer relief is less clear for people with stable ulcers. Before the discovery of H. Pylori and specific medical regimen for ulcer treatment, doctors recommended patients to eat ulcer friendly foods at dinnertime to help ulcer pain relief at night.

Today, the recommended ulcer diet in stable patients is less restrictive. An ulcer diet with enough proteins and vitamins to promote healing is recommended over a traditional stomach ulcer diet menu with ulcer friendly foods. Currently, there are no stomach ulcer diet restrictions other than a general recommendation to avoid alcohol and smoking.

You need to use your own personal experience and common sense to choose the right ulcer diet for yourself. If there are certain foods that always make your ulcer symptoms worse, it may be a good idea to avoid such food for ulcer relief. For example, some people have worse ulcer symptoms after eating spicy foods while others have no effect at all. If you love spicy foods and your ulcer symptoms are unaffected by them, you may continue to enjoy spicy foods. If spicy foods make your ulcer symptoms worse, you should avoid them.

Bleeding ulcer symptoms: An example of a patient I treated personally

Most bleeding ulcer patients are treated in ICU. I will describe one such patient with bleeding ulcer that I admitted to the hospital.

Mr. K is a 65 year old retired high school teacher who has bad arthritis in his knees and his hips. He used to be very active and athletic when he was young but had been severely limited by joint pain in the last three years. He had tried several different medications in the past with only minimal relief.

Recently, his doctor changed his medication. After he started taking these new pills, he felt somewhat weak. He occasionally had some burning sensation in his stomach after he took the pill. He also felt sick to his stomach after meals. Despite these side effects he felt like the new medication was helping his arthritis pain and he continued to take them. After 10 days, he had an episode of severe stomach discomfort one night after his dinner. He said it felt more like burning, fullness and discomfort rather than actual pain. As his symptoms worsened, he became more nauseated. He also felt very weak and dizzy. He was so weak that he felt like he was going to faint. He called his son and they called the ambulance and took him to the hospital right away.

When he arrived in the ER, he was in a bad shape. His blood pressure was low and his heart was racing fast. They put an IV line and started to infuse him with IV fluids. His blood pressure improved after the fluid but his heart was still racing. He was still having some discomfort in his stomach. As they were planning to do more tests, he told the doctors that he had noticed somewhat unusual bowel movement the night before. He told them he had a black tarry stool the other night. As soon as he mentioned that, the ER doctor was immediately worried about a bleeding ulcer. The ER doctor diagnosed him as possible bleeding ulcer and sent him to ICU.

In the ICU, I treated the patient after consulting with a specialist who specializes in conditions like bleeding ulcer in the gastrointestinal tract. We checked his blood count and he was severely anemic from the bleeding. We transfused a total of six units of blood. We started him on an IV medication to help prevent further bleeding. After his blood pressure stabilized, he had an upper endoscopy done. It was a thin long tube with camera. They passed it down his mouth into his stomach to see what exactly was going on inside the stomach. They found two separate patches of bleeding ulcer. They stopped the bleeding.

He felt better the next day and remained stable.

In this patient, the bleeding ulcer was caused by the arthritis medication. A class of medication very useful in treating arthritis and other painful conditions called NSAIDs(non-steroidal anti-inflammatory drugs) are known to cause bleeding ulcers in some patients. It is very hard to predict who might develop the bleeding ulcer. Once a patient has developed bleeding ulcer after taking this class of medicine, they should not take those medications again. Common examples of NSAIDs that can cause bleeding ulcers are ibuprofen, naproxen, indomethacin and several other medications in the same class.

I hope the story of Mr K helped you understand more about bleeding ulcer symptoms.