Why does a peptic ulcer bleed?

Written by Jiang Guo Ming
Gastroenterology
Updated on January 20, 2025
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Peptic ulcers include gastric ulcers, duodenal bulb ulcers, and so on. Gastrointestinal bleeding is one of the common complications of peptic ulcers, usually caused by the ulcer being relatively large or deep, invading the blood vessels, leading to vessel rupture and resulting in bleeding. For minor bleeding, the patient may not have any discomfort symptoms, primarily indicated by black stools or a positive fecal occult blood test. If there is substantial bleeding, it can lead to symptoms such as vomiting blood. Such cases need attention and usually require hospitalization for observation and treatment. Sometimes, recurrent gastrointestinal bleeding may require surgical treatment.

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Written by Jiang Guo Ming
Gastroenterology
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How is peptic ulcer treated?

The treatment of peptic ulcers mainly depends on their cause. It is generally believed that infection with Helicobacter pylori is most closely related to peptic ulcers. In such cases, the first step is to check for Helicobacter pylori infection. If there is an infection, antibacterial treatment is generally used, with the common regimen being quadruple therapy: a proton pump inhibitor plus two antibiotics and a bismuth agent. If there is no Helicobacter pylori infection, symptomatic treatment is generally sufficient. The preferred method is to use acid-suppressing and stomach-lining-protecting medications, combined with symptomatic treatment. At the same time, it is helpful to develop good dietary and living habits, opt for a light and easy-to-digest diet, and eat regularly in fixed amounts. Avoid overeating and excessive fatigue; abstain from smoking and alcohol, and maintaining a good mood all help. (Medication should be used under the guidance of a professional doctor.)

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Symptoms of peptic ulcer

Peptic ulcers typically include gastric ulcers, duodenal bulb ulcers, and complex ulcers, among others, all of which feature upper abdominal pain. For gastric ulcers, the pain is generally located below the xiphoid process or in the upper left abdomen, primarily occurring after meals and often accompanied by symptoms such as abdominal bloating and acid reflux. Duodenal bulb ulcers usually present as hunger-like pain in the upper abdomen, which can be alleviated by eating and may include nighttime pain, often with significant acid reflux and heartburn. These can be definitively diagnosed via gastroscopy. Additionally, many elderly individuals may develop gastric ulcers after taking nonsteroidal anti-inflammatory drugs, often without significant pain, typically requiring a gastroscopy for accurate diagnosis.

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Symptoms of peptic ulcers

Upper abdominal pain is a symptom common to peptic ulcers, including dull, mild, or bloating pain, which is generally tolerable and varies in characteristics. For instance, the pain from a gastric ulcer is usually located in the upper abdomen, predominantly on the upper left side, and sometimes extends to the lower abdomen. It typically occurs about half an hour to an hour after meals and gradually eases after two to three hours. For duodenal bulb ulcers, the pain is generally around two fingers to the right of the belly button. It often presents as hunger-like pain in the upper abdomen, accompanied by nighttime pain. If it is a post-bulbar ulcer, it often causes back pain. Complex ulcers may exhibit characteristics of both types. Additionally, ulcers are generally associated with excessive stomach acid, leading to symptoms like acid reflux, heartburn, and abdominal bloating. If there is bleeding, it is often accompanied by black stools or even vomiting blood.

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Is peptic ulcer serious?

Peptic ulcer is a common disease of the upper gastrointestinal tract, including gastric ulcer, duodenal bulb ulcer, and gastroduodenal complex ulcer, etc. The primary cause is often infection with Helicobacter pylori. Other factors, such as poor dietary habits, smoking and alcohol stimulants, drug irritants, or emotional factors, can also lead to peptic ulcers. As for the severity of peptic ulcers, it should be judged based on the patient's age, medical history, medication history, and the results of gastroscopy, among other factors. Generally, peptic ulcers are not serious and can be cured with medication. However, a minority of recurrent cases might have a tendency to become cancerous. These cases can be effectively treated with a combination of medical and surgical treatments, and are generally not severe.

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Can people with peptic ulcers eat meat?

Peptic ulcers generally require conventional medication treatment first. If accompanied by bleeding or severe symptoms, hospitalization may be necessary. It is important to pay attention to dietary and living habits in such cases. Initially, one should consume light and easily digestible foods, such as soft and mushy rice, porridge, and the like. Fresh vegetables and fruits are also suitable, but they should not be too cold or raw. At the same time, remember not to overeat or drink excessively; it is best to eat regular, measured meals or small frequent meals. As for meat, if it is during the acute phase of the ulcer or if there is bleeding, try to avoid meat consumption; if it is during the recovery phase of the ulcer, meat can be consumed in small amounts but should not be too spicy. (Specific medication should be administered under the guidance of a physician)