Most Common Complication of Gastric Ulcer
Upper gastrointestinal bleeding is the most common complication of gastric ulcer. 1
Epidemiology of Gastric Ulcer Complications
- Hemorrhage (upper GI bleeding) is the most common complication of peptic ulcer disease, with an annual incidence of 0.02% to 0.06% in the general population 1
- The ratio of perforation to bleeding in gastric ulcers is approximately 1:6, clearly indicating that bleeding occurs much more frequently than perforation 1
- Perforation has a lower annual incidence of 0.004% to 0.014%, though it carries a higher 30-day mortality rate (23.5%) compared to bleeding (8.6%) 1
- Gastric outlet obstruction has become a rare complication due to improvements in medical management of peptic ulcer disease 1
Risk Factors for Gastric Ulcer Bleeding
- NSAID use significantly increases the risk of gastric ulcer bleeding, with even low-dose aspirin (75 mg/day) doubling the risk compared to non-users 1, 2
- Patients with a history of previous ulcer complications have the highest risk of recurrent ulcer bleeding, especially when continuing NSAID use 1
- Other important risk factors include advanced age, concomitant use of anticoagulants, steroids, multiple NSAIDs, and high-dose NSAID therapy 1, 2
- Helicobacter pylori infection, along with NSAID use, is a major cause of gastric ulcers and their complications 3
Diagnosis and Management of Gastric Ulcer Bleeding
- Endoscopy is the primary diagnostic tool for patients presenting with suspected gastric ulcer bleeding, identifying the source of hemorrhage in 95% of cases 1, 4
- Upper endoscopy not only identifies the bleeding source but also facilitates intervention to achieve hemostasis, decreases rebleeding risk, and provides prognostic information 1, 5
- Excessive blood covering the examination field is the most common cause of missed diagnoses during initial emergency endoscopy for gastric bleeding 6
- All gastric ulcers require biopsy and histological examination to exclude malignancy, which is another potential complication 1, 3
Clinical Pearls and Pitfalls
- While perforation and malignant transformation are serious complications of gastric ulcers, they occur less frequently than bleeding 1
- Modern treatment approaches focusing on eradicating H. pylori and discontinuing NSAIDs can potentially cure benign gastric ulcers, reducing the risk of complications 3
- Prompt resuscitation with appropriate intravenous fluids and a restrictive transfusion threshold of 7-8 g/dL is vital in the initial management of upper GI bleeding 4
- Pre-endoscopic risk stratification tools can help identify high-risk patients who may benefit from more urgent intervention 4