Complications

Hemorrhage is the most common complication of PUD and may occur when an ulcer erodes the wall of a gastric or duodenal artery. Bleeding may be occult (hidden) or may present as melena or hematemesis. Bleeding occurs in approximately 15% of PUD patients and is more common in patients more than 60 years of age, particularly those who ingest NSAIDs. Up to 20% of patients who develop a PUD-related hemorrhage do not have prior symptoms. Death occurs primarily in patients who continue to bleed, or in those who rebleed after the initial bleeding has stopped.

Gastric outlet obstruction occurs in approximately 2% of patients with PUD and is usually caused by ulcer-related inflammation or scar formation near the peripyloric region. Signs and symptoms of outlet obstruction include early satiety after meals, nausea, vomiting, abdominal pain, and weight loss. Ulcer healing with conventional acid-suppressive therapy is the primary treatment, but if this is unsuccessful then an endoscopic procedure (e.g., balloon dilation) is required.

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