How Serious Is a Bleeding Stomach Ulcer?

The inner lining of the stomach is made up of protective tissue called the mucosa, which protects the underlying tissues from acidic stomach contents. Any break or sore in this mucus membrane layer is called a stomach ulcer or peptic ulcer. 

• Duodenal ulcers: Ulcers in the first part of the small bowel (duodenum)
• Esophageal ulcers: Ulcers that develop in the esophagus (the tube that connects the mouth with the stomach)

Symptoms of a stomach ulcer vary from person to person and may range from mild to severe. However, some people may not have any symptoms, particularly in the initial stages of the disease. 

The most typical symptom of a stomach ulcer is a dull, burning pain in the upper part of the abdomen (epigastric pain). This pain particularly occurs after eating fatty or spicy foods or when the stomach is empty (between meals). It may even wake you up from sleep. The pain may last from a few minutes to a few hours and may be relieved by eating certain foods that buffer stomach acidity (such as milk or bananas) or taking antacids or acid-reducing medications.

Common symptoms of a stomach ulcer may include:

• Burning pain in the upper abdomen
• Bloating
• Nausea
• Heartburn
• Belching 
• Intolerance to spicy or fatty foods
• Reduced appetite

Serious symptoms of a stomach ulcer may include:

• Blood in vomit (or vomit that looks like coffee grounds)
• Black or tarry stools
• Severe abdominal pain
• Unexplained weight loss
• Shortness of breath
• Palpitations
• Dizziness or fainting

Stomach ulcers may result from any or a combination of the following factors:

• H. pylori infection: This bacterium causes inflammation in the stomach lining leading to ulcer formation. The risk is even higher when the infection is present in people who smoke.
• Prolonged use of nonsteroidal anti-inflammatory drugs: These include aspirin, ibuprofen, ketoprofen, and naproxen.
• Zollinger-Ellison syndrome: Zollinger-Ellison syndrome is a rare condition that causes the formation of one or more tumors (cancerous or noncancerous) in your pancreas or duodenum. Gastrin, a hormone secreted by these tumors, causes an increase in stomach acid production and the development of ulcers. 

Other factors that may increase the risk of stomach ulcers include:

• Smoking
• Alcohol consumption
• Diet high in spicy foods
• Prolonged stress
• Other medications such as steroids, alendronate, or selective serotonin reuptake inhibitors

Your doctor may diagnose bleeding stomach ulcers based on the following:

• Medical history includes asking you about your symptoms and current medications
• Physical examination includes the examination of the skin for pallor (pale appearance), tenderness or swelling in the abdomen, and bowel sounds.
• Tests may include:
  • Blood counts
  • Stool examination for blood cells and the presence of H. pylori
  • Urea breath test (to diagnose H. pylori infection)
  • Upper gastrointestinal (GI) endoscopy
  • CT scan
  • Upper GI series (to examine the shape of the upper GI tract)

Treatment for a bleeding stomach ulcer varies depending on the severity of the bleeding. You may require a blood transfusion to make up for the blood loss. The bleeding vessel may need to be repaired through endoscopic surgery. If there is a perforation or hole in the stomach lining, urgent surgery may be required.

Your doctor may also prescribe medications and suggest lifestyle modifications. Medications may include:

• Antibiotics to treat H. pylori infection
• Antacids or medications that neutralize stomach acids
• Proton pump inhibitors and H2 blockers (medications that reduce stomach acid secretion)
• Cytoprotective agents or medications that protect the stomach lining

Lifestyle modifications may include:

• Quitting smoking
• Avoiding alcohol 
• Avoiding spicy and fatty foods
• Eating a healthy diet rich in vegetables and fruits
• Maintaining a healthy weight