A peptic ulcer is an open sore that forms on the lining of the stomach or the first part of the small intestine (the duodenum). This sore develops when the protective mucous layer of the digestive tract is eroded, allowing stomach acid to damage the underlying tissue. A bleeding ulcer is a serious complication where this sore has worn away the tissue deeply enough to reach and erode a blood vessel. This event causes internal bleeding into the gastrointestinal tract, immediately elevating the condition to a medical emergency.
The Mechanism of Fatal Risk
The danger posed by a bleeding ulcer stems from the potential for rapid, massive blood loss, a condition medically termed hemorrhage. If the ulcer erodes into a large artery, the blood can pour out quickly into the stomach or intestine, leading to a sudden, significant drop in the body’s total blood volume. This severe loss of circulating blood volume then triggers a life-threatening state called hypovolemic shock.
Hypovolemic shock occurs when the heart can no longer pump enough blood to supply oxygen to the body’s tissues and organs. The body attempts to compensate by increasing the heart rate and constricting peripheral blood vessels, diverting blood flow to preserve the brain and heart. However, if the bleeding is not stopped and the volume is not replaced, this compensatory mechanism fails.
When the organs are deprived of oxygen-rich blood, they begin to fail. The loss of a large volume of blood also disrupts the body’s ability to maintain a normal acid-base balance, leading to acidosis, which further impairs organ function. Death from a bleeding ulcer is possible if the hemorrhage is not controlled quickly.
Recognizing Severe Bleeding Symptoms
Identifying the signs of a severe bleeding ulcer is necessary because the rapid loss of blood requires immediate attention. One manifestation is hematemesis, which is the vomiting of blood.
This vomited material may appear bright red if the bleeding is brisk and fresh, or it may look dark and granular, resembling coffee grounds. The “coffee ground” appearance results when stomach acid partially digests the blood, oxidizing the iron in the hemoglobin.
Melena describes black, sticky, and tar-like stools, indicating that blood has traveled through the digestive tract. Enzymes and bacteria break down the blood, causing the dark appearance. Beyond the visible signs of bleeding, the body will also display systemic symptoms of early shock due to the volume loss, including dizziness, faintness, and sudden weakness, especially when moving from a sitting to a standing position.
Early stages of shock exhibit pallor, a rapid heart rate, and cool, clammy skin as the body attempts to shunt blood away from the extremities. The presence of any of these symptoms—vomiting blood or passing tarry stools combined with signs of systemic distress—signals a medical emergency.
Emergency Treatment and Immediate Recovery
The medical response to a severe bleeding ulcer begins with immediate stabilization of the patient. Healthcare providers first focus on resuscitation by establishing intravenous access to rapidly replace lost fluids and blood, often requiring blood transfusions if significant volume has been lost.
Once the patient is stabilized, the primary procedure is an upper endoscopy, ideally performed within 24 hours of presentation. This procedure involves inserting a flexible tube equipped with a camera down the throat to visualize the upper digestive tract and locate the site of the bleeding ulcer.
The endoscopy is not only diagnostic but also therapeutic, as doctors use specialized tools passed through the scope to stop the bleeding. These methods include injecting epinephrine into the tissue around the ulcer, using thermal probes to cauterize the vessel, or applying mechanical clips to close the bleeding source. Combining injection with another technique, such as cauterization, is often more effective at preventing re-bleeding than using a single method.
Following the successful control of the hemorrhage, a high-dose regimen of a proton pump inhibitor (PPI) medication is administered intravenously for up to 72 hours. PPIs work by drastically reducing stomach acid production, which helps stabilize the blood clot. This acid suppression promotes healing and significantly reduces the risk of the bleeding recurring during the immediate recovery phase.