Peptic ulcer natural history

Overview
Peptic ulcers tend to come back if untreated. Cure rates are high and recurrence is low, if patient is compliant to treatment.

Complications

 * Gastrointestinal bleeding is the commonest complication. Sudden large bleeding can be life threatening . It occurs when the ulcer erodes one of the blood vessels.
 * Perforation (a hole in the wall) often leads to catastrophic consequences. Erosion of the gastro-intestinal wall by the ulcer leads to spillage of stomach or intestinal content into abdominal cavity. Perforation  at the anterior surface of stomach  leads to acute peritonitis, initially chemical and later bacterial peritonitis. Often first sign is sudden intense abdominal pain. Posterior wall perforation leads to pancreatitis; pain in this situation often radiates to back.
 * Penetration is when the ulcer continues into adjacent organs such as liver and pancreas.
 * Scarring and swelling due to ulcers causes narrowing in the duodenum and gastric outlet obstruction. Patient often presents with severe vomiting.