A stomach ulcer, or peptic ulcer disease as it is known medically, is a common problem of the digestive system, involving a sore that develops on the lining of the stomach or duodenum. Although in many cases a stomach ulcer heals well with appropriate treatment, it is important to be aware of the possible complications, which can lead to serious, and in some cases life-threatening, conditions. Early recognition of the symptoms and professional medical help are crucial.
This article provides a detailed overview of the most common complications of gastric ulcers, their symptoms, diagnostic methods and treatment options. We also look at lifestyle changes and practical advice that can help reduce the risk of complications. The aim is to provide reliable and clear information to help you understand the signs your body is giving you and seek medical advice in good time. The Endomedix Gastroenterology Centre Our specialists are committed to providing patients with thorough examinations and effective treatment.
What is a stomach ulcer and what causes it?
A stomach ulcer is a lesion of the mucous membrane of the stomach or duodenum, characterised by a deep defect in the tissue at least 3 millimetres in diameter. An imbalance between the factors that protect the mucous membrane and those that damage it plays a central role in its development.
The main causes and risk factors for stomach ulcers:
- _Helicobacter pylori_ infection: This bacterium is responsible for a significant proportion of stomach ulcers. _H. pylori_ colonises the stomach lining, causing inflammation which weakens the body’s defence mechanisms and promotes the development of ulcers. It can be detected in 70–90% of duodenal ulcer cases and in 30–60% of gastric ulcer cases.
- Non-steroidal anti-inflammatory drugs (NSAIDs): Commonly used painkillers and anti-inflammatories such as aspirin, ibuprofen or diclofenac can, when taken regularly, increase the risk of developing peptic ulcers by up to four times. These medicines inhibit the production of prostaglandins, which protect the stomach lining.
- Smoking and excessive alcohol consumption: Both factors impair the stomach’s defence mechanisms and slow down the healing of ulcers.
- Stress: Although it rarely causes ulcers on its own, prolonged physical or psychological stress can exacerbate existing symptoms and hinder the healing process.
- Less common causes: Certain conditions, such as Crohn’s disease, gastrinoma (Zollinger-Ellison syndrome) or cancer, can also lead to the development of ulcers.
The symptoms of a stomach ulcer can vary widely; around 70% of patients are even asymptomatic. Typical complaints include dull, cramping epigastric (upper abdominal) pain that worsens after eating, a feeling of fullness, bloating, nausea and loss of appetite. In contrast, duodenal ulcers are characterised by hunger pain, which is temporarily relieved by eating. Gastroscopy is essential for making an accurate diagnosis.
The most common complications of a stomach ulcer
If a stomach ulcer is not treated promptly and appropriately, serious complications may arise that require immediate medical attention.
1. Upper gastrointestinal haemorrhage
This is the most common and best-known complication of a stomach ulcer, occurring in approximately 15–20% of cases. It is caused by damage to the blood vessel at the base of the ulcer, which can range from mild, oozing bleeding to arterial, spurting bleeding.
Typical symptoms:
- Vomiting blood (haematemesis): Fresh, bright-red blood or coffee-ground-like, clotted blood is passed via the mouth.
- Tarry stools (melena): Black, tar-like, greasy, foul-smelling stools, which are black due to digested blood. Even a small amount of bleeding can cause this.
- Paleness, weakness, dizziness: Symptoms resulting from blood loss.
- Low blood pressure, rapid pulse: Signs of shock in the event of severe, massive blood loss.
To assess the severity of bleeding during an endoscopic examination, the so-called Forrest classification is used, on the basis of which a decision can be made as to whether therapeutic intervention is required.
2. Perforation of the stomach wall
Perforation is the second most common, but extremely serious, complication of a gastric ulcer, occurring in 2–10% of cases. In such cases, the ulcer penetrates the entire thickness of the wall of the stomach or duodenum, and stomach contents enter the free abdominal cavity, causing peritonitis. This is a life-threatening condition that requires immediate surgical intervention.
Typical symptoms:
- Sudden, extremely severe, stabbing abdominal pain.
- A stomach as hard as a plank: The muscles of the abdominal wall tense up as a defence mechanism.
- Fever, chills, rapid pulse.
- The patient is in a poor general condition and is unable to move due to the pain.
3. The ulcer extending into the surrounding organs (penetration)
This is a specific type of perforation in which the ulcer does not perforate into the free abdominal cavity but into an adjacent organ (most commonly the pancreas, less commonly the liver or the large intestine).
Typical symptoms:
- A change in the nature of the pain: The pain previously associated with the ulcer becomes persistent and more severe.
- Pain radiating down the back: This is particularly common when the ulcer penetrates the pancreas.
- Symptoms of inflammation of the affected organ (e.g. pancreatitis).
4. Narrowing (stenosis) of the pylorus
Scarring that develops as ulcers in the pylorus or duodenum heal can narrow the pyloric opening. This prevents food from passing into the small intestine. This complication occurs in 9–10% of cases.
Typical symptoms:
- Feeling full too soon, bloating after a meal.
- Regurgitation of large amounts of stagnant stomach contents, vomiting: Vomit may contain food that was eaten days earlier.
- Significant weight loss, loss of appetite.
- Epigastric pain.
Diagnosis and management of complications
If complications are suspected, an immediate medical examination is required. The Endomedix Gastroenterology Centre It offers patients access to modern diagnostic tools.
Diagnostic methods:
- Physical examination: Palpation of the abdomen, and checking blood pressure and pulse.
- Emergency upper gastrointestinal endoscopy (gastroscopy): This is the most important examination when bleeding is suspected. It enables the source of the bleeding to be identified and treated immediately via endoscopy (e.g. applying a clip, cauterisation, or injecting tissue adhesive).
- Imaging studies:
- Native abdominal X-ray: When performed with the patient standing, it can detect free air beneath the diaphragm, which may indicate a perforation.
- Abdominal CT scan: It provides a more accurate picture of the perforation, the penetration and the condition of the surrounding organs.
- Laboratory tests: A blood count indicates the extent of blood loss, whilst inflammatory markers indicate infection.
Treatment options:
- In the event of bleeding: In addition to endoscopic haemostasis, high-dose proton pump inhibitor (PPI) infusion therapy is required to reduce gastric acid production. If endoscopic intervention is unsuccessful, angiographic embolisation (injection of a substance to block the blood vessel) or surgical intervention may be necessary.
- In the event of perforation or penetration: These conditions almost always require urgent surgical intervention, during which the perforated ulcer is treated and the abdominal cavity is drained.
- In the event of a bottleneck: In milder cases, endoscopic dilation (balloon dilation) may be attempted. In cases of more severe, recurrent stricture, surgery is recommended to ensure patency of the pylorus.
Practical advice and prevention
Preventing complications of gastric ulcers depends on the timely diagnosis and appropriate treatment of the condition. The Endomedix Gastroenterology Centre Its specialist doctors draw up a personalised treatment plan for each patient.
What can you do to avoid complications?
- Please see a doctor in good time! If you have symptoms suggestive of a stomach ulcer, do not delay having a gastroenterological examination. Early diagnosis and treatment are the best form of prevention.
- Follow your doctor’s instructions! Take your prescribed medicines regularly, particularly acid-reducing medicines (PPIs) and antibiotics used to eradicate _H. pylori_. Following successful eradication of _H. pylori_, the risk of ulcer recurrence falls to less than 10%.
- Take care of your lifestyle!
- Stop smoking: Smoking has been shown to reduce the chances of an ulcer healing.
- Reduce your alcohol intake: Alcohol irritates the stomach lining.
- Be careful with painkillers: If you take NSAIDs regularly, consult your doctor about options for protecting your stomach (e.g. taking a PPI alongside them) or about alternative medicines.
- Follow a diet that is gentle on the stomach:
- Eat frequently, in smaller portions: This will help you avoid overeating.
- Avoid foods that irritate the stomach: These include overly spicy, fatty or smoked foods, strong coffee and fizzy drinks.
- Eat easily digestible foods: Steamed vegetables, lean meats, fish, potatoes, rice.
- Learn how to manage stress: Look for relaxation techniques such as yoga, meditation or regular exercise, which can help relieve tension.
- Do not stop taking your medication before the course is finished! It takes time for an ulcer to heal (up to 8–12 weeks in the case of a stomach ulcer). Even if your symptoms improve, you must continue with the prescribed treatment until you have fully recovered.
- Please go for your check-up! In the case of a stomach ulcer, a follow-up endoscopy is required 6–8 weeks after treatment, during which a tissue sample is taken to rule out a malignant tumour.
When immediate help is needed
Complications of a stomach ulcer can be serious and life-threatening. If you notice any of the following symptoms Call an ambulance immediately or go to the nearest A&E department:
- Sudden, unbearable, stabbing abdominal pain.
- A rock-hard, toned tummy.
- Vomiting a large amount of fresh, red blood.
- Jet-black, greasy stools, accompanied by weakness, dizziness and a feeling of faintness.
- High fever, chills, feeling generally unwell.
Summary
A stomach ulcer is a treatable condition, but neglecting it can have serious consequences. Bleeding, perforation and stricture are complications that pose a serious threat to health. The key to prevention is a responsible approach: taking symptoms seriously, seeking medical examination in good time and strictly following treatment instructions.
From Endomedix Gastroenterology Centre With experienced specialists and state-of-the-art diagnostic facilities, we are here to diagnose stomach ulcers and their potential complications in good time and treat them effectively. Don’t wait until your symptoms get worse! Book an appointment for a gastroenterology consultation and take a step towards a healthy, symptom-free life.
