Stomach ulcers are a common digestive problem and can cause significant discomfort. Sometimes these ulcers, which are open sores, may bleed. This can continue intermittently for weeks and even months. However, in some cases it can arise suddenly and be severe. As with any blood loss, this can be dangerous. For high risk patients like the elderly it can even lead to death if there is extensive blood loss without medical treatment.
How To Spot Bleeding Stomach Ulcers
It is important to understand a few facts about peptic ulcers and bleeding from the upper gut. Firstly peptic ulcers refers to stomach ulcers and duodenal ulcers (located in the small intestine). Between the two, duodenal ulcers are more common. Secondly there are many possible causes of bleeding from the upper gut (esophagus, stomach and first part of the small intestine). A bleeding peptic ulcer is only one possible cause of upper gastrointestinal bleeding, albeit the most common.
Sometimes the signs and symptoms of an upper gastrointestinal bleed, like a bleeding ulcer, is overt and therefore obvious. It may be seen as fresh red blood in the vomit or similar to dark coffee grounds in the vomit. At other times the bleed is less obvious. A person may not vomit, may not seen any overt signs of bleeding and the bleed is discovered routinely with diagnostic investigations or when complications like anemia arise. Therefore there is no definitive way to spot a bleeding stomach ulcer in these cases without a medical assessment.
Read more on stomach ulcers.
Why do stomach ulcers bleed?
Stomach ulcers are open sores in the wall of the stomach. It is more likely to occur when a person uses large amounts of pain relievers and other drugs for long periods of time, or when there is an infection with a certain type of bacteria known as H.pylori (Helicobacter pylori). People who consume alcohol and smoke tobacco are at a greater risk. However, these open sores do not always bleed. A person can live with ulcers for months and even years, despite the pain and other digestive symptoms.
Bleeding ulcers is often associated with H.pylori infection. The bacteria has the ability to withstand the strong stomach acid and digestive enzymes. It burrows into the stomach wall tissue and can penetrate deeper into it. In the process it weakens and even destroys the blood vessels in the stomach wall. This results in a bleeding ulcer. The severity of the bleed depends on the blood vessels that is affected and the severity of the damage.
Read more on causes of stomach bleeding.
Blood in the Vomit
Vomiting does not always occur but when it does, blood may be visible in the vomitus. This is more likely to occur with an acute bleed where there is extensive bleeding. Vomiting may be associated with the ulcer itself or occur due to other reasons where the blood is then noticed. The vomit may be stained with fresh blood or degraded blood may appear as black coffee grounds in the vomit.
Blood in the Stool
Blood in the stool is a more common symptom. However, most of the time the blood is degraded by the time it passes from the stomach down the intestines to the rectum. The stool may appear dark and tarry. This is known as melena. However, there are instances where fresh blood may be visible in the stool particularly when wiping after a bowel movement. This is more likely to occur when there is a severe bleed or diarrhea.
Dizziness or Fainting
Dizziness is another sign of a bleeding ulcer but is more likely to occur in severe bleeds and particularly in the elderly. The blood loss can lead to low blood pressure and anemia, both of which contribute to dizziness. Pain may further contribute to it. In severe cases, a person may even have fainting spells. Loss of consciousness is a serious sign, especially in the elderly.
Upper Abdominal Pain
Pain in the epigastric region (upper middle abdomen) is another common sign. It may even be present before the ulcer starts to bleed. With a bleeding ulcer the pain may be constant and sometimes it is not localized. Instead a person complains of diffuse abdominal pain. However, it is not uncommon for a person with a bleeding ulcer to experience no pain.
Indigestion includes symptoms like abdominal pain or discomfort, nausea and a feeling of fullness in the stomach region. Most people with gastritis and ulcers experience these symptoms. Usually there is a history of indigestion for weeks or even months prior to the bleeding ulcer. However, with a bleeding ulcer there may be no indigestion symptoms, just as there may be no pain.
Although not a common sign, a bleeding stomach ulcer may cause weight ulcer. This is more likely to occur with minor chronic bleeds. Due to the host of signs and symptoms associated with ulcers, a person may experience a change in eating habits and specifically a loss of appetite. This gradually leads to weight loss over weeks and months.
Tests for Bleeding Ulcers
The most definitive way to diagnose a bleeding ulcer is to visualize it with an upper gastrointestinal (GI) endoscopy. However, other tests may also help with the diagnosis in conjunction with a physical examination by a doctor and the signs and symptoms mentioned above.
- Low hemoglobin count indicates anemia. While there are several possible causes, it should be considered as an indicator of a bleeding ulcer when there are symptoms like bloody vomit and indigestion.
- Positive fecal occult blood test (FOBT) is another indicator of a bleeding ulcer when there are upper GI symptoms like indigestion.
However, both tests may be positive due to other causes. For example, a low hemoglobin count may also occur in women with heavy menstrual bleeding. A positive FOBT does not conclusively indicate that the bleed is from a stomach ulcer. Instead the bleeding could occur lower down in the bowels as may be the case with inflammatory bowel disease (IBD).
WARNING: Always consult with a medical professional. Some of these signs and symptoms may also occur with other conditions like stomach cancer.