What Is a Peptic Ulcer and What Causes It to Bleed?
A peptic ulcer is an open sore in the lining of the stomach, small intestine and/or esophagus. Until fairly recently, peptic ulcers were believed to be caused by excessive stomach acid due to stress, personality type, or too much spicy food, caffeine, coffee, cola sodas and alcohol. Now, peptic ulcers are believed to be primarily caused by either an infection of the stomach by the bacteria Helicobacter pylori (H. pylori) or the use of nonsteroidal anti-inflammatory drugs or NSAIDs, such as aspirin, ibuprofen and naproxen.
The gastrointestinal tract is coated with mucus that protects tissue from damage from digestive juices. Both H. pylori and NSAIDs cause the mucus lining to break down, allowing the digestive juices to irritate the walls of these organs and cause peptic ulcers. Peptic ulcers are more commonly found in the duodenum — the first part of the small intestine — and less frequently in the stomach. Cigarette smoking is also a contributing cause to the development of peptic ulcers.
Peptic ulcer bleeding is the most common complication of peptic ulcers and can be potentially fatal if left untreated. According to the New England Journal of Medicine, approximately 400,000 hospital admissions are made per year for acute upper gastrointestinal bleeding due to peptic ulcers, many of which can be attributed to NSAID medication use. Over two-thirds of these admissions are for people over age 60 (and one quarter are over age 80) and the mortality rate is 5 to 10 percent.
Peptic ulcers bleed because the irritation becomes so severe that the blood vessels in the walls of the gastrointestinal tract actually rupture. The internal bleeding can occur slowly or hemorrhage quickly at a critical rate. The type of internal bleeding — whether it is a slow trickle or hemorrhaging excessively — also determines which signs and symptoms are present during a peptic ulcer bleed.