From the Guidelines
The most common complication of gastric ulcer is upper gastrointestinal bleeding (option c). This complication occurs when the ulcer erodes into blood vessels in the stomach wall, leading to hematemesis (vomiting blood) or melena (black, tarry stools) 1. According to a recent study published in 2020, hemorrhage is by far the most common complication of peptic disease, with a reported annual incidence of hemorrhage in the general population ranging from 0.02 to 0.06% 1.
Key Points
- Upper GI bleeding is the most common complication of gastric ulcers, occurring in approximately 15-20% of untreated cases.
- The bleeding occurs due to the erosion of the protective mucosal lining of the stomach, exposing underlying blood vessels to acidic gastric contents.
- Management of a bleeding gastric ulcer typically involves immediate fluid resuscitation, proton pump inhibitors, and endoscopic intervention to achieve hemostasis, followed by treatment of the underlying cause, often H. pylori infection or NSAID use 1.
- A 2024 update on nonvariceal upper gastrointestinal bleeding highlights the importance of prompt recognition and management of this complication, with esophagogastroduodenoscopy being the usual first-line diagnostic and therapeutic investigation 1.
Complications of Gastric Ulcers
- Perforation (complete erosion through the stomach wall)
- Malignant transformation (development of gastric cancer)
- Gastric outlet obstruction (blockage preventing food from entering the small intestine)
- Upper gastrointestinal bleeding (the most common complication) While other complications such as perforation, malignant transformation, and gastric outlet obstruction can occur, they are less frequent than upper gastrointestinal bleeding 1.
From the Research
Common Complications of Gastric Ulcer
The most common complication of gastric ulcer can be identified by analyzing the provided evidence.
- Upper gastrointestinal bleeding is a major complication, as studies 2, 3, 4, 5, 6 consistently discuss its management and treatment.
- Malignant transformation, perforation, and gastric outlet obstruction are potential complications, but they are not as frequently discussed in the context of the most common complication.
- The provided studies primarily focus on upper gastrointestinal bleeding, suggesting that it is a significant and prevalent issue associated with gastric ulcers.
Comparison of Complications
Comparing the options:
- (a) Malignant transformation: not frequently discussed in the provided studies as the most common complication.
- (b) Perforation: mentioned as a potential complication, but not as the most common one.
- (c) Upper gastrointestinal bleeding: consistently discussed as a major complication in the provided studies 2, 3, 4, 5, 6.
- (d) Gastric outlet obstruction: not frequently discussed as the most common complication in the provided studies.
Evidence-Based Answer
Based on the provided evidence, the most common complication of gastric ulcer is upper gastrointestinal bleeding, as it is extensively discussed in the studies 2, 3, 4, 5, 6.