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===Complications=== [[File:Deep gastric ulcer.png|thumb|right|An [[Esophagogastroduodenoscopy|endoscopic image]] showing deep gastric ulcer.]] [[Image:Gastric ulcer 2.jpg|right|thumb|[[Esophagogastroduodenoscopy|Endoscopic]] image of a small gastric ulcer with visible blood vessels, a potential warning sign for [[upper gastrointestinal bleeding]]]] * [[Upper gastrointestinal bleeding|Gastrointestinal bleeding]] is the most common complication. Sudden large bleeding can be life-threatening.<ref name="pmid9391242">{{cite journal | vauthors = Cullen DJ, Hawkey GM, Greenwood DC, Humphreys H, Shepherd V, Logan RF, Hawkey CJ | title = Peptic ulcer bleeding in the elderly: relative roles of ''Helicobacter pylori'' and non-steroidal anti-inflammatory drugs | journal = Gut | volume = 41 | issue = 4 | pages = 459–62 | date = October 1997 | pmid = 9391242 | pmc = 1891536 | doi = 10.1136/gut.41.4.459 }}</ref><ref>{{cite journal|author=Blackford, John W.|author2=Williams, Robert H.|author-link2=Robert Hardin Williams|title=Fatal Hemorrhage from Peptic Ulcer: One Hundred and Sixteen Cases Collected from Vital Statistics of Seattle During the Years 1935-1939 Inclusive|journal=Journal of the American Medical Association|volume=115|issue=21|year=1940|pages=1774–1779|doi=10.1001/jama.1940.02810470018005}}</ref> It is associated with 5% to 10% death rate.<ref name="Angel 2017"/> * [[Gastrointestinal perforation|Perforation]] (a hole in the [[gastrointestinal wall|wall of the gastrointestinal tract]]) following a gastric ulcer often leads to catastrophic consequences if left untreated. Erosion of the gastrointestinal wall by the ulcer leads to spillage of the stomach or intestinal contents into the abdominal cavity, leading to an acute chemical [[peritonitis]].<ref>{{cite book |last1=Gossman |first1=William |last2=Tuma |first2=Faiz |last3=Kamel |first3=Bishoy G. |last4=Cassaro |first4=Sebastiano |title=StatPearls |date=2019 |publisher=StatPearls Publishing |url=https://www.ncbi.nlm.nih.gov/books/NBK519554/ |chapter=Gastric Perforation|pmid=30137838 }}</ref> The first sign is often sudden intense abdominal pain,<ref name="Angel 2017"/> as seen in [[Valentino's syndrome]]. Posterior gastric wall perforation may lead to bleeding due to the involvement of gastroduodenal artery that lies posterior to the first part of the duodenum.<ref>{{Cite journal |last=Weledji |first=Elroy Patrick |date=2020-11-09 |title=An Overview of Gastroduodenal Perforation |journal=Frontiers in Surgery |volume=7 |pages=573901 |doi=10.3389/fsurg.2020.573901 |doi-access=free |issn=2296-875X |pmc=7680839 |pmid=33240923}}</ref> The death rate in this case is 20%.<ref name="Angel 2017"/> * Penetration is a form of perforation in which the hole leads to and the ulcer continues into adjacent organs such as the [[liver]] and [[pancreas]].<ref name="Peptic Ulcer"/> * [[Gastric outlet obstruction]] (stenosis) is a narrowing of the pyloric canal by scarring and swelling of the gastric antrum and duodenum due to peptic ulcers. The person often presents with severe vomiting.<ref name="Angel 2017"/> * Cancer is included in the differential diagnosis (elucidated by [[biopsy]]), ''[[Helicobacter pylori]]'' as the etiological factor making it 3 to 6 times more likely to develop stomach cancer from the ulcer.<ref name="Peptic Ulcer"/> The risk for developing gastrointestinal cancer also appears to be slightly higher with gastric ulcers.<ref>{{cite journal|title=Long-term risk of gastrointestinal cancers in persons with gastric or duodenal ulcers|year=2016|pmc=4924392|last1=Søgaard|first1=K. K.|last2=Farkas|first2=D. K.|last3=Pedersen|first3=L.|last4=Lund|first4=J. L.|last5=Thomsen|first5=R. W.|last6=Sørensen|first6=H. T.|journal=Cancer Medicine|volume=5|issue=6|pages=1341–1351|doi=10.1002/cam4.680|pmid=26923747}}</ref>
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