From the Guidelines
The most common complication of gastric ulcer is upper gastrointestinal bleeding (option c). Gastric ulcers can erode through blood vessels in the stomach wall, leading to hemorrhage that manifests as hematemesis (vomiting blood) or melena (black, tarry stools) 1. This complication occurs in approximately 15-20% of untreated gastric ulcer cases. While perforation, malignant transformation, and gastric outlet obstruction are all potential complications of gastric ulcers, they occur less frequently than bleeding. Perforation happens when the ulcer erodes completely through the stomach wall, causing gastric contents to leak into the peritoneal cavity. Malignant transformation is a concern particularly with gastric ulcers (more so than duodenal ulcers), which is why endoscopic biopsies are often performed. Gastric outlet obstruction can develop due to inflammation, scarring, and edema near the pylorus, but is less common than bleeding complications. Some key points to consider in managing gastric ulcers and preventing complications include:
- The use of proton-pump inhibitors (PPIs) to reduce the risk of rebleeding and promote mucosal healing 1
- The importance of testing for H. pylori and eradicating the infection if present, as this can reduce the risk of recurrent bleeding and other complications 1
- The potential benefits of using COX-2 inhibitors or misoprostol in patients who require nonsteroidal anti-inflammatory drugs (NSAIDs) and are at high risk of ulcer complications 1
- The need for urgent endoscopy in patients with active bleeding, as this can help to identify the source of bleeding and guide treatment 1
From the Research
Complications of Gastric Ulcer
The most common complication of gastric ulcer can be identified by analyzing the provided studies.
- Upper gastrointestinal bleeding is a major complication, as evident from the studies 2, 3, 4, 5, 6.
- The studies suggest that upper gastrointestinal bleeding is the most common cause of gastrointestinal emergency, with peptic ulcer being the most common cause 5.
- Endoscopic therapy is recommended for patients with high-risk stigmata, such as active bleeding and visible vessels, to prevent rebleeding 2, 3, 4, 5, 6.
- The application of proton pump inhibitors and Helicobacter pylori treatment are important adjuncts to endoscopic therapy 2, 3, 4, 5, 6.
- Based on the evidence, the correct answer is (c) upper gastrointestinal bleeding.
Comparison of Options
- Malignant transformation (a) is not mentioned as a common complication in the provided studies.
- Perforation (b) is not discussed in the context of gastric ulcer complications in the studies.
- Gastric outlet obstruction (d) is not mentioned as a common complication in the provided studies.
- Upper gastrointestinal bleeding (c) is consistently mentioned as a major complication of gastric ulcer across the studies 2, 3, 4, 5, 6.