If a gastric ulcer or duodenal ulcer is left unattended, it can worsen and give rise to more serious peptic ulcer complications.

There are five major complications of peptic ulcer disease (PUD): bleeding, perforation, penetration, obstruction, and malignancy. These complications can occur in patients with peptic ulcers that develop due to any etiology or risk factors.

The effects of the complications can be dangerous, even life-threatening, and therefore on any ulcer symptoms presenting themselves, immediate medical help should be sought.

If any of these problems explained below present themselves, do see your doctor. Else, the results can be fatal.

Peptic ulcer complications

Complications arise because many people who have an ulcer do not experience any symptoms. Being unaware, they do not take treatment nor observe any dietary restrictions. This allows the ulcer to progress and give rise to its dangers.

According to American Family Physician, abdominal pain, which is the classic symptom of ulcers is absent in 30 percent of the older people

Penetrating ulcer

In a penetration ulcer, the ulcer, stomach or duodenal, extends deeper through the wall of the stomach. The ulcer may go on deepening and penetrate an adjacent organ, such as the liver or the pancreas.

Penetration is pathologically similar to perforation, except that the ulcer erodes into another organ such as the liver or the pancreas, and not into the peritoneal cavity.

The ulcer penetrates through the stomach or duodenal wall without free perforation. There is no leakage of stomach or duodenal contents into the peritoneal cavity.

In a penetrated ulcer, there is no association of the pain with meals and the patient gets no relief with food and medication. The commonest sites into which penetration by the ulcer occurs are the pancreas, gastrohepatic omentum, liver, and biliary tract.

Bleeding ulcer

Internal bleeding is the most common complication of peptic ulcers. An untreated ulcer while growing deep, may corrode into the adjacent small arteries resulting in internal bleeding into the stomach or the duodenum. Internal bleeding is the most common complication of stomach ulcers.

Bleeding from an ulcer can be gradual or severe. Ulcers that bleed slowly might not produce the symptoms until the person becomes anemic.

When the bleeding is severe, the patient may usually need hospitalization or a blood transfusion. Severe blood loss may cause black or bloody vomit with a coffee ground appearance or black tarry stools.

Perforating ulcer

A peptic ulcer may grow deep so as to perforate the wall of the stomach and cause a hole. This results in the contents of the stomach spilling into the abdominal cavity.

This causes the infection to spread into the peritoneum (sac covering the contents in the abdomen) causing peritonitis. There is a collection of fluid in the peritoneal cavity.

Perforation is a serious complication of PUD and patients with a perforated ulcer often present with acute abdomen. Acute abdomen is a condition that requires urgent attention and treatment. and is associated with a high risk for morbidity and mortality.

The lifetime prevalence of perforation in PUD patients is about 5%. It carries a mortality rate ranging from 1.3% to 20%.

Perforating ulcer signs: The patient experiences sharp shooting pain in the abdomen associated with nausea and vomiting. Abdominal dimension is also present.

Pyloric obstruction

Pyloric obstruction is a well-recognized but rare complication of PUD. An ulcer at the junction of the stomach and duodenum or in the pyloric canal may get scarred or there may be swelling as a result of which there is an obstruction at the pyloric junction. This is referred to as pyloric obstruction or gastric outlet obstruction.

The obstruction can be due to an acute occurrence due to acute inflammation and edema or, it could be chronic due to scarring and fibrosis.

Pyloric obstruction ulcer signs: As a result of this obstruction, the food is unable to pass from the stomach into the duodenum. This results in vomiting after food. The patient has a loss of appetite, which results in weight loss.


A small percentage of gastric ulcers may turn malignant. The ulcer located in the stomach has the potential to turn malignant. The gastric acidity is often normal or low.

As a gastric ulcer is an open sore, bacteria can easily infect it. This can cause mutations in the DNA and damage the cells of the stomach lining. This can lead to chronic inflammation of the stomach and even stomach cancer.

The lesser curvature of the body of the stomach is the most common site for malignancy to develop from a gastric ulcer, followed closely by the region of the pylorus.