Complications of Ulcers: Understanding Risks and Management Strategies

An ulcer refers to an ulcer. Ulcer diseases include both gastric ulcers and duodenal ulcers. Treatment can usually take place on an outpatient basis. In addition, no bed rest is necessary. Nevertheless, serious complications can occur during the treatment of an ulcer disease.

Complications of ulcer disease

Potential complications of treating ulcers include:

• Bleeding with Shock (Bleeding Ulcer)
• Perforation (breakthrough of the ulcer)
• Penetration (breaking of the ulcer into neighbouring organs)
• Pyloric stenosis (scarring narrowing of the stomach outlet)
• Malignant degeneration

 

bleeding ulcer

Stomach and duodenal ulcers can bleed when they first appear, but they can also be recurrent in chronic ulcer disease. Therapy with particular pain medication alone or in combination with cortisone is the most critical risk factor. Male gender, older age (older than 60 years), previous ulcer complications and ulcer diameter of more than two centimetres also increase the risk of ulcer bleeding. About 10 per cent of all ulcers bleed, and 10 per cent of bleeding ends fatally.

Large blood vessels run behind the stomach outlet, which are attacked by a bleeding ulcer and can bleed themselves. There is a risk of death because it is tough to get to this part of the body during an emergency operation, and there is a risk that the hefty bleeding cannot be stopped in time. Chronic ulcer bleeding often goes unnoticed for a long time and is often only noticed during a routine examination due to anaemia. Acute ulcer bleeding, on the other hand, can be highly dramatic.

Symptoms include massive loss of blood (bright red blood is excreted with the stool, vomiting of blood and shock). If bleeding from an ulcer is suspected, the patient must be admitted to the nearest hospital as soon as possible and examined there! If heavy bleeding has already occurred, the first step is stabilizing the circulatory system with blood reserves and sugar solutions.

After or parallel to the stabilization of the circulatory system, the source of the bleeding is located endoscopically and stopped by injecting suprarenal and fibrin glue. If the endoscopic techniques fail, emergency surgical hemostasis is indicated. To do this, the abdomen must be opened, the source of the bleeding localized and the ulcer removed. In addition, the bleeding vessel is tied off with a thread. A (partial) stomach removal is now only necessary in rare cases.

Erupting (perforating) ulcer

Perforations are more often from duodenal than gastric ulcers. They connect the duodenum, stomach, neighbouring organs ( pancreas, transverse large intestine), or the free abdominal cavity. The most significant risk factor is the use of certain pain medications. Typical symptoms are sudden onset of severe upper abdominal pain radiating to the back.

Chest x-ray shows air under the diaphragmatic domes when perforated, which is not usually found there. If the surgeon sees this X-ray, he immediately initiates the emergency operation. In addition, highly effective antibiotics are given because, even today, severe peritonitis is life-threatening. As a rule, the ulcer is sutured or excised. Partial removals of the stomach have become rare.

 

Gastric outlet stenosis (narrowing of the stomach outlet)

Gastric outlet obstruction is caused by ulcers in some regions of the stomach. They can result from inflammation of the gastric mucosa around acute ulcers or have arisen from scarring after the ulcer has healed. The patients only eat small portions of food. Because of this and frequent vomiting, they lose weight.

The diagnosis is made by examining the gastrointestinal area. If the gastric outlet stenosis was caused by gastritis surrounding an acute ulcer, the probability that the narrowing will recede after treatment is very high. The situation is different with chronic gastric outlet stenosis. This results from a shrinking of the scars that every ulcer leaves behind. These do not heal spontaneously but must be reopened by what is known as endoscopic balloon dilatation.

The danger that the narrowing will come back is very high, even with medication. In this case, an operation is necessary. The passage is restored by what is called a pyloroplasty.

Reconsider taking pain medication.

Smoking, alcohol, and caffeine consumption irritate the stomach lining and contribute to damage to the stomach lining. If you have pain in the pit of your stomach, you should not immediately resort to painkillers. Although these can lead to short-term pain relief, they also attack the mucous membrane in the small intestine. Pain medication should only be taken after consulting a doctor.

In the case of chronic diseases that require constant pain therapy (e.g. chronic articular rheumatism), it is usually only possible to a limited extent or not at all to do without these pain-relieving and anti-inflammatory drugs . Here, it should be checked whether newer substances that are more compatible with the stomach can be used.