Five-alarm blaze: when PUD is an emergency

There are 5 ulcer-related alarm features that signal an urgent need for medical evaluation. If you experience any of the following symptoms, visit your doctor immediately or go to the emergency department of a hospital:

  • persistent vomiting  
  • bloody vomit or black, tarry stools. Sometimes ulcers can bleed. Although the blood loss is usually too slow to be noticed, it might be enough to make you tired, pale, and weak from anemia. Your doctor will do a blood test to determine whether you are anemic.
  • weight loss with no apparent cause
  • a lump in the abdomen
  • difficulty swallowing

Your doctor has a variety of tests to diagnose peptic ulcer disease (PUD). Endoscopy involves inserting a thin tube with a tiny camera on its end into the mouth and down the throat to get close-up pictures of the esophagus, stomach, and duodenum. Endoscopy is not performed on all patients with PUD, and your doctor may decide to treat your ulcer without doing this test first. To detect Helicobacter pylori bacteria, a breath test (drinking a fluid and exhaling into a tube) or blood test can be used.

The most serious complications of PUD are bleeding, perforation (tearing of the stomach or intestine lining), and obstruction (where scarring or swelling related to the ulcer causes blockages in the stomach or intestines). These complications may be life threatening. The alarm symptoms listed above are warning signs that these complications may be occurring. Get medical attention immediately if you notice any of these symptoms.
Cancers of the esophagus and stomach become more of a concern when people reach the age of 50. If you are 50 or older and have PUD, consult a doctor or health care professional to ensure that cancer is not the cause of your symptoms. Your doctor may do a biopsy (take a small piece of tissue to examine under the microscope) for confirmation.

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