Complications
Occurs when chronic ulcer penetrates the entire thickness of the stomach or duodenal wall, into an adjacent organ such as the pancreas, but without free perforation into the peritoneal cavity.
Management is the same as that for standard ulcer therapy; however, surgery is sometimes necessary.
Gastric outlet obstruction from chronic pyloric stenosis may occur as pyloric channel ulcers heal with scarring and oedema.
May present with nausea, vomiting, and weight loss. A succussion splash may be elicited on examination.
Management is aimed at treating the cause of the ulcer. High-dose proton-pump inhibitors are also used in the management of this condition. Endoscopic dilation is often helpful, with surgery reserved for refractory patients.
Peptic ulcer disease is the cause of around 35% of cases of life-threatening acute upper gastrointestinal bleeding.[56][127]
Bleeding is an infrequent complication of peptic ulcers but the most common cause of hospitalisation and mortality. It occurs when an ulcer erodes into the wall of a gastroduodenal blood vessel.
Despite the decrease in Helicobacter pylori incidence, peptic ulcer disease remains a major issue, largely due to the use of non-steroidal anti-inflammatory drugs (NSAIDs) in older patients. NSAIDs are the major risk factor for peptic ulcer bleeding and promote bleeding partly through their anti-platelet effects.[12]
Patients with overt bleeding (haematemesis and/or melaena and/or shock) should be evaluated in the emergency department and endoscopy should be performed promptly.
Caused by erosion of the ulcer through the wall of the stomach or duodenum into the peritoneal cavity.
Most perforations occur in older patients, in patients taking NSAIDs and in patients with ulcers in the duodenum or gastric antrum.
Usual presentation is with shock and peritonitis.
Patients should be referred to the emergency department for surgical evaluation.
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