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When and why do ulcers bleed and what can be done about it?C P Swain. Aliment Pharmacol Ther. 1987. AbstractThis article reviews the pathophysiology and management of bleeding peptic ulcer. Ulcers bleed when and because they erode into a blood vessel, and bleed massively when they erode into a medium- or large-sized artery. Focal pathology at the bleeding point (such as arteritis, aneurysmal dilatation or recanalized thrombus) contributes to the timing and clinical pattern of ulcer bleeding. Big bleeds are probably associated with erosion into big arteries. The identification of a visible vessel in the floor of an ulcer that has recently bled is predictive of further bleeding, while the absence of a visible vessel or stigmata of recent haemorrhage is strongly predictive that further bleeding will not occur. Unfortunately, no conventional method of managing gastrointestinal bleeding from ulcers has been convincingly shown to be better than placebo in controlled clinical trials. The value of transfusion and surgery has never been tested in controlled trials, while many small studies of drug therapy, especially of H2-receptor blocking agents, and a few small studies of early surgery afford generally negative or equivocal results. There is some evidence that new physical methods such as lasers or bipolar probes applied at endoscopy are superior to placebo though negative trials have also been reported. Studies randomizing larger numbers of patients with bleeding ulcers are required if therapeutic benefit of any aspect of management is to be demonstrated or refuted. Similar articles
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It started with feeling a little run down after working extra hard, perhaps there was some lightheadedness when he stood too quickly, and then came the fatigue. The baseball world blamed Ichiro Suzuki's malaise on playing too much in the World Baseball Classic. During spring training, baseball players are supposed to lounge and gradually get themselves into shape, not play like it's the World Series in October. But the baseball world was wrong. It was discovered in April 2009 that Ichiro was tired because he was anemic and because he was bleeding from an ulcer. The scenario plays out routinely off the playing field too often. A person feels run down and blames it on all sorts of circumstances, but finally goes to their doctor to get some help. The clues come from the history of heartburn and indigestion, or maybe it was the extra aspirin or ibuprofen to help with the stress headaches at work. There may be a little tenderness in the belly, and after some coercion on the part of the doctor, the patient agrees to a rectal exam. It shows that the stool has occult blood in it (rectal bleeding); that is blood that cannot be seen with the naked eye but shows up with a chemical test. A blood test (CBC) shows that the patient is anemic, meaning there is a low red blood cell count. Putting the clues together, the doctor tells the patient that the fatigue and tiredness is due to bleeding. What Is a Bleeding Ulcer?The stomach is a mixing bowl, allowing food and digestive juices to combine and allow digestion to begin. But the stomach has a protective lining that prevents digestive enzymes from eating away at it. If this lining is damaged, inflammation and pain may occur. If the inflammation becomes worse, it can cause the lining of the stomach or the duodenum (the first part of the small intestine) to bleed. The bleeding may not be noticeable, and the patient may not seek medical care. Red blood cells carry oxygen to all the organs of the body. If there are too few red cells, symptoms may occur. Some of these symptoms are pretty non-specific, like
As the anemia becomes more severe, shortness of breath or chest discomfort during activity may occur. Lightheadedness may occur if a person stands up too quickly, since the body isn't able to pump oxygen-carrying red blood cells fast enough to the brain. It usually resolves in a few seconds as the body adapts or if the person sits down. Sometimes, though, the lightheadedness leads to fainting or "passing out." Inflammation in the stomach also may cause a small crater, or ulcer, to form. If there happens to be a blood vessel under the ulcer, a lot of bleeding can develop and then the symptoms aren't so subtle. The patient may vomit blood, or the blood may pass into the intestine, get digested, and come out as black, tarry stools. Bleeding ulcers are a big deal. Often, having endoscopy is both diagnostic and therapeutic. A gastroenterologist can use a fiberoptic camera to view the inside of the stomach and duodenum, searching for a source of bleeding. If a blood vessel is leaking, it's possible to cauterize or burn the blood vessel and take care of the problem right away.  SLIDESHOWSuper Tips to Boost Digestive Health: Bloating, Constipation, and More See SlideshowBleeding Ulcer MedicationsHowever, there is still plenty of work for the patient to do. The treatment of ulcers is multi-pronged. Aspirin, ibuprofen, alcohol, and smoking are harmful to the lining of the stomach and need to be discontinued. Medications such as
can be used to decrease acid secretions in the stomach and allow it to heal. Routine use of antacids can help reduce whatever acid production is left. Baseball players are superstars when they hit 300, meaning they succeed only 30 percent of the time. As an elite athlete, Ichiro knows his body well and also knows when something is wrong. It's a good thing that his doctors listened and batted a thousand when they got the diagnosis right. Health NewsHow serious is a bleeding ulcer?A bleeding ulcer can lead to anemia, bloody vomit, or bloody stools. A bleeding ulcer usually results in a hospital stay. Severe internal bleeding is life-threatening. Perforation or serious bleeding may require surgical intervention.
Can a bleeding ulcer heal on its own?Some peptic ulcers heal on their own. But if you don't treat them, the ulcers tend to come back. They can erode the blood vessel wall in your stomach or small intestine. The ulcers also can eat a hole through the lining and get infected.
Should I be worried about a bleeding ulcer?Left untreated, peptic ulcers can result in: Internal bleeding. Bleeding can occur as slow blood loss that leads to anemia or as severe blood loss that may require hospitalization or a blood transfusion.
How do they fix a bleeding ulcer?Air is used to expand the digestive tract. Once the ulcer is located, tools are passed through the scope to stop any bleeding. These may include clips or devices that use heat or electricity. In some cases, alcohol or adrenaline (epinephrine) is injected directly into the ulcer to help reduce bleeding.
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What happens when you have a bleeding ulcer
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