An acute gastric ulcer with hemorrhage is a critical gastrointestinal condition characterized by a sudden breach in the gastric mucosa accompanied by bleeding. It can lead to significant morbidity and mortality if not promptly diagnosed and managed. The primary causes include Helicobacter pylori (H. pylori) infection, nonsteroidal anti-inflammatory drug (NSAID) use, stress-related mucosal damage, and chronic conditions affecting gastric health.
Pathophysiology of Acute Gastric Ulcer with Hemorrhage
A gastric ulcer forms when the protective mucosal barrier is compromised, allowing gastric acid and digestive enzymes to erode the underlying tissues. Hemorrhage occurs when the ulcer penetrates a blood vessel, leading to gastrointestinal bleeding.
- Helicobacter pylori Infection: A primary contributor to ulcer development, causing inflammation and mucosal damage.
- NSAID Use: Chronic consumption weakens gastric defenses, increasing ulcer risk.
- Excessive Alcohol Intake: Irritates the gastric lining and impairs healing.
- Smoking: Reduces gastric blood flow, delaying ulcer healing.
- Severe Stress and Trauma: Common in critically ill patients, leading to stress ulcers.
- Chronic Conditions: Liver disease, Zollinger-Ellison syndrome, and autoimmune disorders contribute to ulcer development.
Clinical Symptoms
Patients with an acute gastric ulcer with hemorrhage may present with:
- Hematemesis: Vomiting of blood, indicating upper gastrointestinal bleeding.
- Melena: Black, tarry stools due to digested blood.
- Epigastric Pain: Burning sensation that worsens with fasting.
- Fatigue and Weakness: Resulting from blood loss and anemia.
- Hypotension and Tachycardia: Indicating significant blood loss and potential shock.
Diagnostic Approaches
1. Endoscopy
- Esophagogastroduodenoscopy (EGD): Direct visualization to confirm ulcer presence and assess bleeding severity.
- Biopsy: Rules out malignancy and detects H. pylori infection.
2. Laboratory Tests
- Complete Blood Count (CBC): Evaluates hemoglobin levels to assess anemia.
- H. pylori Testing: Urea breath test, stool antigen test, or biopsy.
- Coagulation Profile: Identifies clotting abnormalities.
3. Imaging Studies
- Abdominal CT Scan: Detects perforations and complications.
- Angiography: Identifies active bleeding sources when endoscopy is inconclusive.
Treatment Strategies
1. Medical Therapy
- Proton Pump Inhibitors (PPIs): Omeprazole, pantoprazole to suppress acid production and promote healing.
- H. pylori Eradication Therapy: Combination of PPIs, clarithromycin, and amoxicillin/metronidazole.
- Antacids and Cytoprotective Agents: Sucralfate and misoprostol enhance mucosal defense.
- Blood Transfusion: For severe hemorrhage and anemia.
2. Endoscopic Hemostasis
- Injection Therapy: Epinephrine injection to constrict blood vessels.
- Thermal Coagulation: Argon plasma coagulation or heater probe to stop bleeding.
- Hemoclips or Band Ligation: Mechanically sealing the bleeding vessel.
3. Surgical Intervention
- Partial Gastrectomy: Indicated for refractory ulcers.
- Vagotomy: Reduces acid secretion in recurrent cases.
- Angiographic Embolization: Non-surgical option for uncontrolled bleeding.
Prevention Strategies
- Avoid NSAIDs and Aspirin: Use with caution and under medical guidance.
- Healthy Diet and Lifestyle: Reducing alcohol, smoking cessation, and balanced nutrition.
- Regular Screening: For at-risk patients, especially those with a history of ulcers.
- Early H. pylori Treatment: Prevents recurrence and complications.
Prognosis and Complications
If left untreated, acute gastric ulcers with hemorrhage can lead to:
- Hypovolemic Shock: Life-threatening blood loss.
- Perforation: Ulcer deepens, leading to peritonitis.
- Gastric Outlet Obstruction: Due to scarring and inflammation.
Early diagnosis, prompt treatment, and preventive strategies significantly improve patient outcomes and reduce recurrence risks.
Conclusion
Acute gastric ulcer with hemorrhage is a severe medical condition requiring immediate attention. Comprehensive management through medical therapy, endoscopic interventions, and lifestyle modifications can prevent complications and improve survival rates. Raising awareness and ensuring timely treatment remain key to reducing morbidity and mortality associated with this condition.
