An ulcer refers to an ulcer. Ulcer diseases include both peptic ulcers and duodenal ulcers. Treatment can usually take place on an outpatient basis. In addition, bed rest is not necessary. Nevertheless, serious complications can occur during the treatment of ulcer disease.
Complications of ulcer disease
Possible complications of treating ulcers include:
- Bleeding with shock (bleeding ulcer).
- Perforation (breakthrough of the ulcer)
- Penetration (breaking of the ulcer into adjacent organs).
- Pyloric stenosis (scarring narrowing of the gastric outlet).
- Malignant degeneration
Bleeding ulcer
Gastric and duodenal ulcers can bleed when they first manifest, but they can also bleed as recurrent ulcers in the setting of chronic ulcer disease. Therapy with certain pain medications alone or in combination with cortisone is the most important risk factor. Male gender, older age (older than 60 years), previous ulcer complications, and ulcer diameters greater than two centimeters also increase the risk of ulcer bleeding. About 10 percent of all ulcers bleed, and 10 percent of bleeding is fatal. Large blood vessels run behind the stomach outlet, which can be attacked and bleed themselves if the ulcer bleeds. There is a danger to life because it is very difficult to get to this area of the body during emergency surgery, so there is a risk that the very heavy 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 the lack of blood. Acute ulcer bleeding, on the other hand, can be highly dramatic. Symptoms include sometimes massive blood loss (bright red blood is excreted with the stool, vomiting of blood and shock). If ulcer bleeding is suspected, the patient must be admitted to the nearest hospital as quickly as possible and examined there! If severe bleeding has already occurred, the first measure to be taken is to stabilize the circulation with blood units and sugar solutions. After or in parallel with the stabilization of the circulation, the source of bleeding is localized endoscopically and stopped by injection with suprarenin and/or fibrin glue. If endoscopic techniques fail, emergency surgical hemostasis is indicated. This requires opening the abdomen, locating the source of bleeding, and removing the ulcer. In addition, the bleeding vessel is stopped with a suture. Nowadays, gastric (partial) excision is necessary only in the very rarest cases.
Breakthrough (perforating) ulcer.
Perforations originate more frequently from duodenal ulcers than from gastric ulcers. They create a connection between the duodenum or stomach and neighboring organs (pancreas, transverse colon) or the free abdominal cavity. The most significant risk factor is the use of certain pain medications. Sudden onset of severe upper abdominal pain with radiation to the back is typical. The chest x-ray shows air under the diaphragmatic domes in the case of perforation, which is not normally found there. If the surgeon sees this x-ray, he or she will immediately initiate emergency surgery. In addition, highly effective antibiotics are given, because even in modern times, severe peritonitis is life-threatening. As a rule, the ulcer is sutured or excised. Partial stomach removals have become rare.
Gastric outlet stenosis (narrowing of the stomach outlet).
Gastric outlet stenoses are caused by ulcers in certain areas of the stomach. They may be the result of gastric mucosal inflammation around acute ulcers or are caused by scarring shrinkage after ulcer healing. Patients only eat small portions of food. As a result, and due to frequent vomiting, they lose weight. Diagnosis is made by endoscopy of the gastrointestinal tract. If the gastric outlet stenosis has developed due to gastritis around an acute ulcer, the probability of a decrease in the narrowing after treatment is very high. The situation is different in chronic gastric outlet stenosis. This has developed as a result of shrinkage of the scars left by each ulcer. These do not heal spontaneously, but must be reopened by a procedure called endoscopic balloon dilatation. The risk that the narrowing will reoccur is very high, even with medication.In this case, surgery is necessary. The passage is restored by a procedure called pyloroplasty.
Reconsider taking pain medication
Smoking, alcohol and caffeine consumption cause irritation of the gastric mucosa and contribute to damage of the gastric mucosa. Pain in the pit of the stomach should not be addressed immediately with pain medications. Although these can provide short-term pain relief, they can also attack the mucosa in the small intestine. Pain medication should only be taken in consultation with a physician. In the case of chronic diseases that require permanent pain therapy (for example, chronic rheumatoid arthritis), these pain-relieving and anti-inflammatory drugs can usually only be dispensed with to a limited extent or not at all. In this case, it should be investigated whether newer substances that are more tolerable to the stomach can be used.
