Penetration and Perforation of Ulcers

What is penetration and perforation of ulcers?

Penetration and perforation are complications of an ulcer in the stomach or upper intestine. An ulcer is a sore on a tissue surface that causes the layers of tissue to break down. When an ulcer makes a hole through the tissue it is called perforation. When an ulcer spreads to other nearby organs or tissues it is called a penetrating ulcer. These two types of ulcer complications are severe and life threatening if they are not treated.

How does it occur?

Ulcers occur when an area of the lining of the stomach or intestine is eaten away by stomach acid and digestive juices. The linings of these organs are normally protected from stomach acids. However, under certain conditions the protection fails and ulcers can result.

Common causes of ulcers are:

• a type of bacteria called Helicobacter pylori, also called H. pylori
• long-term use of anti-inflammatory medicines, such as aspirin, ibuprofen, and naproxen.

Ulcers occur more often in people who drink a lot of alcohol and smoke cigarettes. Other things that increase the production of stomach acids, such as caffeine, worsen the pain of ulcers, but they probably do not cause them. Stress does not appear to cause ulcers, but it may make ulcers worse.

Ulcers can develop slowly for months or rapidly in a few days. When an ulcer worsens, it can penetrate through the stomach wall and into organs such as the pancreas and liver.

What are the symptoms?

The symptoms of perforating ulcer include:

• sudden severe upper abdominal pain
• extreme tenderness of the upper abdomen
• loss of color in the face
• weakness
• chills
• fast, shallow breathing
• fast heart rate
• dizziness
• bowel movements that are black and tarry bowel or bloody.

The symptoms of a penetrating ulcer include:

• pain that radiates into the back
• pain that gets worse at night
• little pain relief from food or antacids (for example, Maalox)
• fever.

How is it diagnosed?

Ulcer complications can be emergencies. Your healthcare provider will ask about your symptoms and do a physical exam, especially of your abdomen. You may have one or more of these tests:

• lab tests of blood and urine samples
• X-rays
• upper endoscopy, a procedure that allows your provider to see the ulcer with a thin flexible tube and tiny camera inserted through your mouth down into your upper digestive tract.

How is it treated?

If the ulcer has made a hole all the way through the tissue, it causes bleeding inside the abdomen. If you are bleeding inside, you will be hospitalized and given emergency treatment for blood loss. You will have surgery to close the hole.

You will be closely observed while you are in the hospital. You may have a tube from your nose to your stomach to suction and rest the stomach by keeping it empty. This also allows your healthcare provider to know if the bleeding has stopped.

Further treatment may include:

• medicines that reduce the amount of acid your stomach makes or that coat the area needing to heal
• when you are able to eat again, a liquid diet for 24 hours, followed by soft foods and then a regular diet, depending on how quickly your stomach heals
• antacids
• antibiotics to prevent or treat infection
• pain medicine.

How long will the effects last?

The length of your recovery will depend on your condition at the time of surgery, how difficult your surgery was, and whether you had any complications. In most cases you should feel a lot better by the end of 2 to 3 weeks. However, it is likely to take at least 6 weeks before you completely recover from the surgery and begin to have your normal level of strength and energy.

How can I take care of myself?

• Follow the full treatment prescribed by your healthcare provider. Keep your follow-up appointments.
• Avoid alcohol until your provider says it's OK to have an occasional drink.
• Do not smoke cigarettes.
• Avoid taking anti-inflammatory drugs such as aspirin, ibuprofen, and naproxen.
• You may want to make other lifestyle changes such as:
  • Eating healthy meals. Having small meals 4 to 5 times a day may be better than 2 or 3 large meals. Follow the diet prescribed by your healthcare provider.
  • Avoiding coffee, including caffeinated and decaf coffee, colas, and any other food or drink that may bother your stomach, such as acidic foods like oranges and other citrus fruits.
  • Getting plenty of rest and sleep.
  • Exercising as recommended by your provider.
• If you keep having symptoms or your symptoms get worse, tell your provider promptly.

How can I help prevent an ulcer from penetrating or perforating?

• Follow the treatment your healthcare provider prescribes, including taking all of your medicines.
• Ask your provider if you need to take medicine to prevent new ulcers.
• Avoid the things that are known to cause or worsen ulcers.