10 Symptoms of Peptic Ulcer Complications

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Peptic ulcers can cause some discomfort but are rarely life-threatening. With that said, severe ulcers can sometimes lead to perforation and internal bleeding and require emergency surgery to prevent serious illness or death.

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About 25 million Americans develop at least one peptic ulcer during their lifetime, with an annual incidence of around 4.6 million cases. Ulcers can develop at any age but are rare in teenagers and even rarer in children. Duodenal ulcers occurring in the junction between the stomach and small intestine usually occur for the first time between the ages of 30 and 50.

Stomach ulcers are more likely to develop in people older than 60. While duodenal occur more frequently in men than women, stomach ulcers develop more frequently in women than men.

Symptoms and Complications

The symptoms of a peptic ulcer can often be vague, manifesting with pain or discomfort in the upper left abdomen as well as heartburn, indigestion, nausea, and gas.

In some cases, complications can occur, leading to more severe symptoms. The overuse of nonsteroidal anti-inflammatory drugs (NSAIDs) like Advil (ibuprofen) is one such example where bleeding from a peptic ulcer can turn from mild to severe.

There are three serious complications of a peptic ulcer that may require emergency intervention:

  • Perforation is a hole in the wall of your stomach or small intestine. A perforated ulcer is a serious condition in which an untreated ulcer can burn through the wall of the stomach, allowing digestive juices and food to seep into the peritoneum (abdominal cavity). This can lead to peritonitis (inflammation of the intestinal wall) and sepsis (a severe reaction to infection).
  • Internal bleeding occurs if there is a broken blood vessel in the stomach or small intestine. This can lead to a drop in blood pressure and symptoms like dizziness, weakness, pale skin, rapid heartbeat, and fainting. Some people experience bloody vomit, while others will develop melena (dark, tarry stools).
  • Intestinal blockage occurs when food is prevented from moving from your stomach into your duodenum (the passage to the small intestine). Ulcers located at the end of the stomach can cause swelling and scarring, leading to intestinal strictures (narrowing or closing of the intestinal passage). Symptoms include severe stomach pain, cramps, nausea, vomiting, constipation, and the inability to pass gas.


Ulcers form when the lining of the stomach or duodenum (known as the mucosa and submucosa) becomes eroded. Small ulcers may not cause any symptoms, but large ulcers can cause serious bleeding.

Most ulcers occur in the first layer of the inner lining. If the ulcer erodes beyond that, a hole can open that goes all the way through the intestine, causing perforation. A perforation is always considered a medical emergency.

Despite the popular belief that peptic ulcers are caused by spicy foods or stress, most peptic ulcers are caused by infection by a bacterium called Helicobacter pylori (H. pylori) and can also occur with the prolonged use or overuse of NSAIDs.

Most ulcers can be treated with medications, including antibiotics. But surgery may be needed in some cases, including cauterization in which tissue is burnt to close off a bleeding blood vessel.

When to Seek Medical Attention

Most peptic ulcers are not a medical emergency and can be treated on an outpatient basis. If there has been a perforation, severe internal bleeding, or obstruction, you may need to seek immediate medical care.

Warning signs of a medical emergency include:

  • Vomiting blood
  • Vomiting substances that look like coffee grounds
  • Severe rectal bleeding and/or bloody stools
  • Sudden, severe pain in the upper abdominal area with or without evidence of bleeding
  • Cold, clammy skin
  • Rapid heartbeat
  • Fainting

If left untreated, intestinal perforation and internal bleeding can lead to shock, coma, multiple organ failure, and death;

A Word From Verywell

Perforation affects around five of every 100,000 people with peptic ulcer in the United States, while internal bleeding affects up to 57 of 100,000 people with peptic ulcers. Both account for the majority of peptic ulcer-related deaths.

If you develop any of the signs of these peptic ulcer-related complications, seek help without delay.

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