What are complications of peptic ulcer disease?

Peptic ulcers can cause some discomfort but are rarely life-threatening. With that said, severe ulcers can sometimes lead to perforation and internal bleeding and require emergency surgery to prevent serious illness or death.

This article discusses the complications of peptic ulcers, warning signs, and when to get medical help.

A peptic ulcer is a sore in the lining of either the stomach or the duodenum, the first part of the small intestine. About 10% of Americans develop at least one peptic ulcer during their lifetime. Approximately 4.6 million people are diagnosed with a peptic ulcer every year in the United States.

Ulcers can develop at any age but are rare in teenagers and even rarer in children. Duodenal ulcers (in the small intestine) usually occur between the ages of 30 and 50.

Stomach ulcers are more likely to develop in people older than 60. Duodenal ulcers occur more frequently in men than women. Stomach ulcers develop more frequently in women than men.

The symptoms of a peptic ulcer can often be vague, manifesting with pain or discomfort in the upper left abdomen as well as heartburn, indigestion, nausea, and gas.

In some cases, complications can occur, leading to more severe symptoms. For example, overusing nonsteroidal anti-inflammatory drugs (NSAIDs) like Advil (ibuprofen) can cause peptic ulcer bleeding to turn from mild to severe.

There are three serious complications of a peptic ulcer that may require emergency intervention:

• Perforation is a hole in the wall of your stomach or small intestine. It's a serious condition in which an untreated ulcer can burn through the wall of the stomach. Digestive juices and food can seep through the hole into the abdominal cavity. It can lead to peritonitis (inflammation of the abdominal lining) and sepsis.
• Internal bleeding occurs if there is a broken blood vessel in the stomach or small intestine. This can lead to a drop in blood pressure and symptoms like dizziness, weakness, pale skin, rapid heartbeat, and fainting. Some people experience bloody vomit, while others will develop melena (dark, tarry stools).
• Intestinal blockage occurs when food can't move from your stomach into your small intestine. This happens when ulcers cause strictures (narrowing of the intestinal passage). Symptoms include severe stomach pain, nausea, vomiting, constipation, and inability to pass gas.

Perforation affects around five of every 100,000 people with peptic ulcers in the United States. Internal bleeding affects up to 57 of 100,000 people with peptic ulcers. Both account for the majority of peptic ulcer-related deaths.

Symptoms of a peptic ulcer include pain in the upper abdomen, heartburn, nausea, indigestion, and gas. It can sometimes cause serious complications, such as perforation, internal bleeding, or a blockage, requiring emergency care.

Ulcers form when the lining of the stomach or duodenum becomes eroded. Small ulcers may not cause any symptoms, but large ulcers can cause serious bleeding.

Most ulcers occur in the first layer of the inner lining. If the ulcer erodes beyond that, a hole can open that goes all the way through the intestine, causing perforation. A perforation is always considered a medical emergency.

Despite the popular belief that spicy foods and stress cause peptic ulcers, most are caused by bacteria called Helicobacter pylori (H. pylori). Peptic ulcers can also occur with the prolonged use or overuse of NSAIDs.

Most ulcers can be treated with medications, including antibiotics. But surgery may be needed in some cases, including cauterization, in which tissue is burnt to close off a bleeding blood vessel.

Most peptic ulcers are not a medical emergency and can be treated on an outpatient basis. But if there has been a perforation, severe internal bleeding, or obstruction, you'll need to seek immediate medical care.

Call 911 for any of these warning signs:

• Vomiting blood
• Vomiting substances that look like coffee grounds
• Severe rectal bleeding and/or bloody stools
• Sudden, severe pain in the upper abdominal area with or without evidence of bleeding
• Cold, clammy skin
• Rapid heartbeat
• Fainting

If left untreated, intestinal perforation and internal bleeding can lead to shock, coma, multiple organ failure, and death.

Peptic ulcers usually cause only discomfort, but sometimes, they can worsen and lead to life-threatening complications. Call 911 for any warning signs of perforation, internal bleeding, or intestinal obstruction. These include vomiting blood, bloody stools, severe pain in the upper abdomen, clammy skin, fast heartbeat, and fainting.

Frequently Asked Questions

• How do you know if you have a bleeding stomach ulcer?

  A bleeding stomach ulcer symptoms include vomiting blood or passing stools that look like black tar. A bleeding ulcer can cause a drop in blood pressure and symptoms like dizziness, weakness, pale skin, rapid heartbeat, and fainting.

• What causes stomach ulcers?

  Peptic ulcers are caused either by an infection with a bacteria known as Helicobacter pylori or long-term uses of nonsteroidal anti-inflammatory drugs (NSAIDs).

  Over-the-counter NSAIDs include Advil and Motrin—both ibuprofen—and Aleve (naproxen sodium). Prescription NSAIDs include Celebrex (celecoxib), Mobic (meloxicam), Toradol (ketorolac), and others. 

  Contrary to popular belief, stress and spicy foods do not cause ulcers, however, they can contribute to symptoms. 

• Will an stomach ulcer go away without medication?

  Possibly. An ulcer caused by overuse of NSAIDs may go away on its own with lifestyle changes, including diet, stress reduction, and eliminating caffeine, alcohol, and NSAIDs. 

  An ulcer caused by H. pylori will need antibiotics to clear it up. There are other medications that can help ease symptoms, including proton pump inhibitors (PPI), Histamine receptor blockers, antacids, and Pepto-Bismol. 

Thanks for your feedback!

What are your concerns?

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

1. Di Saverio S, Bassi M, Smerieri N, et al. Diagnosis and treatment of perforated or bleeding peptic ulcers: 2013 WSES position paper. World J Emerg Surg. 2014;9:45. doi:10.1186/1749-7922-9-45

2. National Institute of Diabetes and Digestive and Kidney Diseases. Peptic ulcers (stomach ulcers).

3. Ocasio Quinones GA, Woolf A. Duodenal ulcer. In: StatPearls [Internet].

4. Malik TF, Gnanapandithan K, Singh K. Peptic ulcer disease. In: StatPearls [Internet].

5. Drini M. Peptic ulcer disease and non-steroidal anti-inflammatory drugs. Aust Prescr. 2017 Jun;40(3):91–3. doi:10.18773/austprescr.2017.037

6. Søreide K, Thorsen K, Harrison EM, et al. Perforated peptic ulcer. Lancet. 2015;386(10000):1288-1298. doi:10.1016/S0140-6736(15)00276-7

7. Ya LJ, Sung J, Hill C, Henderson C, Howden CW, Metz DC. Systematic review of the epidemiology of complicated peptic ulcer disease: Incidence, recurrence, risk factors, and mortality. Digestion. 2011;84:102–13. doi:10.1159/000323958