What should you do for stomach bleeding? 5 effective treatments and first aid methods

Gastric bleeding can start from a seemingly small ulcer but becomes dangerous when stomach acid continues to damage blood vessel walls. Upper gastrointestinal bleeding is a common emergency, with an incidence rate of approximately 50–100 cases per 100,000 people per year.

Alarmingly, not everyone with gastric bleeding recognizes it immediately. Some cases only experience pain or burning in the epigastric region, while bleeding may continue silently. When symptoms such as vomiting blood, black stools, dizziness, severe fatigue, or shock appear, the patient needs timely emergency medical attention and assessment.

So, how is gastric bleeding treated, can gastric bleeding be cured with medication, or is other intervention needed? This article, Tiptory helps readers understand the causes, dangers, and common methods of gastric bleeding treatment used by doctors, from medication to endoscopic hemostasis when necessary. According to professional guidelines, patients with upper gastrointestinal bleeding are usually endoscoped within 24 hours of hospital admission, after appropriate resuscitation.

Gastric bleeding needs early treatment

Recognize symptoms and seek medical attention immediately

• If epigastric pain, nausea, vomiting blood, or black stools appear, the patient needs to see a doctor early. These can be signs of gastric bleeding due to an ulcer damaging blood vessels.

• Do not self-monitor at home if there are signs of gastrointestinal bleeding, especially when accompanied by dizziness, weakness, pale skin, rapid heartbeat, or shock. These symptoms may indicate significant blood loss and require urgent treatment.

Use medication to reduce acid and help ulcers heal

• After identifying the cause, the doctor may prescribe medication to reduce or inhibit stomach acid secretion, often proton pump inhibitors (PPIs), to create conditions for ulcer recovery and reduce the risk of continued bleeding.

• Patients need to take medication at the correct dose, for the correct duration, and according to the doctor's instructions. Do not stop medication on your own when symptoms improve, as the ulcer may not be completely healed.

• Depending on the cause, the doctor may also treat underlying factors that contribute to ulcers, such as Helicobacter pylori (H. pylori) infection or the use of nonsteroidal anti-inflammatory drugs (NSAIDs).

Severe cases require intervention for hemostasis

• If the ulcer is actively bleeding or has a high risk of re-bleeding, gastrointestinal endoscopy can be used to identify the location and perform hemostasis procedures.

• For severe gastric bleeding that cannot be controlled by endoscopy, the patient may require vascular intervention or surgery to control the bleeding source.

• Therefore, the question of how gastric bleeding is treated does not have a single answer. The method for curing gastric bleeding depends on the extent of blood loss, the cause of the ulcer, the location of the ulcer, and the response to treatment.

Prioritize treating the cause to limit recurrence

• After controlling the bleeding, the patient needs to continue ulcer treatment as prescribed and eliminate factors that increase the risk of recurrence.

• Do not self-medicate with pain relievers or anti-inflammatory drugs without consulting a doctor, especially if you have a history of ulcers or gastric bleeding.

• If you have had bleeding due to an ulcer, regular follow-up appointments help assess ulcer healing and reduce the risk of re-bleeding.

Part 1: Gastric bleeding symptoms requiring urgent medical attention

Note 1: Epigastric pain may be due to stomach ulcers

Pay attention to epigastric pain

• Pain in the upper abdomen, just below the breastbone and above the navel, is a common symptom in people with gastric and duodenal ulcers. The pain can feel like a burning sensation, dull ache, or discomfort and may come and go.

• Epigastric pain due to stomach ulcers can vary with eating times. Some people feel more pain after eating, while others experience pain when hungry or after several hours without food.

• Do not rely solely on the timing of pain to self-diagnose an ulcer or gastric bleeding, as this symptom can occur in many other gastrointestinal diseases.

Monitor for warning signs of bleeding

• If epigastric pain is accompanied by vomiting blood, black, tarry stools, dizziness, severe fatigue, or shock, seek immediate medical attention or emergency care. These can be signs of gastric bleeding and should not be self-treated at home.

• For people already diagnosed with stomach ulcers, the appearance of bleeding signs needs early assessment to determine the extent of blood loss and the cause.

Don't just relieve pain and ignore the cause

• Pain relievers can make symptoms feel better but do not mean the ulcer has healed. When epigastric pain is prolonged or recurs, the patient should have the cause assessed by a doctor.

• If an ulcer at risk of bleeding is found, the doctor will choose an appropriate method of ulcer treatment, which may include acid-reducing medication and treatment of underlying causes such as H. pylori infection or the use of nonsteroidal anti-inflammatory drugs.

• Understanding symptoms correctly from the outset helps patients not overlook dangerous signs and proactively seek ways to treat gastric bleeding or ulcer treatment when necessary.

Note 2: Persistent nausea requires attention

Monitor recurrent nausea

• Nausea due to stomach ulcers cannot be identified based on a single occurrence. However, if nausea recurs multiple times a week, especially accompanied by epigastric pain, bloating, or discomfort after eating, the patient should seek medical attention to find the cause.

• Nausea and bloating can occur together in people with stomach conditions. The level of discomfort does not necessarily accurately reflect the amount of blood being shed, as symptoms also depend on the location of the ulcer and the individual's condition.

Pay attention to changes in eating sensation

• When nausea persists, the patient may experience loss of appetite, eat less than usual, or feel full quickly. If this continues, unintended weight loss may occur.

• Unintended weight loss is not a specific sign of gastric bleeding, but if it appears along with epigastric pain, vomiting, or other abnormal digestive signs, this is a reason to be evaluated by a doctor.

Do not self-conclude based solely on nausea symptoms

• Nausea can stem from many causes such as gastric ulcers, reflux, gastrointestinal infections, medication side effects, or other conditions. Therefore, one should not rely on the frequency of nausea to self-diagnose gastric bleeding.

• If nausea is accompanied by vomiting blood, coffee-ground-like vomit, black stools, dizziness, severe fatigue, or shock, seek immediate emergency care. These can be signs of gastrointestinal bleeding requiring urgent treatment.

Seek medical attention to determine the cause and treatment plan

• When symptoms recur, the doctor may assess the patient's medical history, current medications, and order tests or endoscopy when necessary to find the cause.

• If a bleeding ulcer is identified, treating gastric bleeding must be done according to the cause and severity of the bleeding. Treatment may include acid-reducing medication, endoscopic hemostasis, and more intensive measures in severe cases.

• Therefore, if you are wondering how gastric bleeding is treated, the most important step is not self-medication but recognizing warning signs and having the cause correctly assessed by a doctor.

Note 3: Vomiting blood requires immediate emergency care

Check for signs of blood in vomit

• Vomiting blood is one of the important warning signs of gastric bleeding. Blood can appear bright red or have a dark brown, grainy appearance similar to coffee grounds due to contact with acid in the stomach.

• If there is an actively bleeding gastric ulcer, the patient may also feel nausea, epigastric pain, or abdominal discomfort. However, nausea or repeated vomiting alone is not enough to confirm bleeding.

Seek emergency care if gastrointestinal bleeding is suspected

• If blood or coffee-ground-like vomit is observed, do not wait for symptoms to resolve on their own or attempt to treat gastric bleeding at home. This could be acute gastrointestinal bleeding requiring medical intervention.

• It is especially important to seek emergency care immediately if vomiting blood is accompanied by dizziness, sweating, pale skin, rapid heartbeat, weakness, shortness of breath, or fainting. These can be signs that the body is losing a significant amount of blood.

Pay attention to accompanying digestive symptoms

• People with stomach ulcers may experience heartburn, bloating, nausea, or discomfort after eating. Some people find symptoms worse after fatty meals, but this symptom is not specific to ulcers or bleeding.

• Because the symptoms of digestive diseases can overlap, patients should not rely on "not seeing blood" to rule out gastric bleeding. Bleeding can manifest as black stools or other signs of blood loss.

Identify the cause for correct treatment

• When bleeding due to an ulcer is suspected, the doctor will assess the extent of blood loss and locate the bleeding site. In appropriate cases, gastrointestinal endoscopy can both help identify the cause and perform hemostasis.

• Depending on the cause and severity of bleeding, how gastric bleeding is treated will be decided based on the specific situation. Treatment may include acid-reducing medication, endoscopic hemostasis, and other interventions if bleeding is severe.

• The most important point is: vomiting blood or coffee-ground-like vomit are not symptoms to be self-monitored at home. Early intervention helps reduce the risk of complications from blood loss and provides conditions to control the cause of the ulcer.

Note 4: Anemia can be a sign of bleeding

Pay attention to subtle signs of anemia

• Gastric bleeding does not always cause vomiting blood or black stools immediately. If the ulcer bleeds only in small amounts but persists, the patient may gradually lose blood and develop symptoms of anemia due to blood loss.

• Easily recognizable signs include:

  • Dizziness, lightheadedness, especially when standing up or changing positions.

  • Persistent fatigue, lack of energy despite rest.

  • Pale skin or mucous membranes compared to normal.

  • Shortness of breath, especially during exertion or strenuous activity.

  • Some people may experience a rapid heartbeat or reduced concentration.

Understand why bleeding can cause anemia

• When the body loses blood, the circulating red blood cell count decreases, which affects the ability to transport oxygen to tissues. If the bleeding is silent, symptoms can progress slowly and be easily mistaken for common fatigue.

• Therefore, anemia due to gastric bleeding can sometimes be the first sign that alerts a patient to a problem, even if no blood has been seen in vomit or stool.

Do not ignore prolonged fatigue

• If you frequently experience dizziness, fatigue, pale skin, or shortness of breath without a clear cause, especially when accompanied by epigastric pain, nausea, or dark stools, you should seek medical attention.

• The doctor may order a complete blood count to assess for anemia and perform additional necessary tests to find the source of bleeding in the gastrointestinal tract.

Treatment needs to focus on the source of bleeding

• If an ulcer is identified as the cause, treating gastric bleeding should not only aim to improve anemia but also control the ulcer and prevent further bleeding.

• Depending on the severity, how gastric bleeding is treated may include acid-reducing medication, endoscopic identification and hemostasis, or other interventional measures if the bleeding is severe.

• If there are signs of shock, fainting, severe shortness of breath, rapid heartbeat, or vomiting blood, seek emergency medical care immediately instead of waiting for anemia symptoms to improve on their own.

Note 5: Black, tarry stools can be bleeding

Pay attention to the color and consistency of stool

• Black stools are an important sign to note when suspecting gastric bleeding. When blood bleeds in the upper part of the gastrointestinal tract, it can be altered as it passes through the stomach and intestines, turning the stool black.

• Stools from gastrointestinal bleeding often have characteristics of being dark black, sticky, and resembling tar, often referred to as melena.

• Do not rely solely on stool color to self-diagnose. Some foods, medications, or iron supplements can also turn stools black without being due to bleeding.

Be especially cautious when black stools appear suddenly

• If black, sticky, unusual stools appear along with dizziness, severe fatigue, pale skin, rapid heartbeat, shortness of breath, or epigastric pain, the patient needs to be examined immediately to rule out blood loss.

• If there is also vomiting blood or coffee-ground-like vomit, seek emergency care immediately. These can be signs of acute gastric bleeding.

Do not self-treat when bleeding is suspected

• Black stools due to bleeding can be a sign of an actively bleeding gastric or duodenal ulcer. This condition needs to be evaluated by a doctor to determine the location and severity of the bleeding.

• Depending on the cause, how gastric bleeding is treated may include acid-reducing medication, endoscopy to identify and stop the bleeding, or other interventional methods in severe cases.

• Therefore, when you notice black, tarry stools, especially if the cause cannot be explained, do not delay seeking medical attention. Early detection and treatment are crucial to limit blood loss and severe complications.

Note 6: Gastric bleeding requires immediate emergency care

Seek emergency care when a bleeding ulcer is suspected

• Gastric bleeding due to an ulcer can cause gastrointestinal blood loss and become a life-threatening condition if the bleeding is severe. When bleeding is suspected, the patient needs to go to the emergency room or a medical facility capable of managing gastrointestinal bleeding immediately.

• Do not wait for symptoms to subside on their own or try to treat gastric bleeding at home. Severe blood loss can progress rapidly, especially when the patient already shows signs of shock or circulatory collapse.

Recognize signs of severe bleeding

• Signs that require particular caution include:

  • Severe epigastric pain or unusual upper abdominal pain.

  • Severe fatigue, weakness, dizziness, or lightheadedness.

  • Vomiting large amounts of blood or dark brown vomit resembling coffee grounds.

  • Black, sticky, and tar-like stools, which may indicate upper gastrointestinal bleeding.

  • Pale skin, rapid heartbeat, shortness of breath, sweating, or fainting can be signs of significant blood loss.

Don't wait for bright red blood in your stool

• In upper gastrointestinal bleeding, blood often does not remain bright red when passed through the digestive tract. The blood can be altered, turning the stool black and tar-like.

• Therefore, black stool due to stomach bleeding needs to be distinguished from dark stools caused by food, iron supplements, or other reasons. If black stools appear unusually and are accompanied by symptoms of blood loss, a doctor's evaluation is needed promptly.

Treatment must be carried out at a medical facility

• Upon arrival at the hospital, the doctor will assess the patient's circulatory status, the extent of blood loss, and identify the source of bleeding. Depending on the case, treatment may include resuscitation, acid-reducing medications, and endoscopy to identify and stop bleeding from the ulcer.

• If bleeding cannot be controlled with endoscopy, the doctor may consider other interventional methods. Therefore, how stomach bleeding is treated depends on the extent of bleeding, its cause, and the patient's response.

• When vomiting blood, black stools accompanied by dizziness, fainting, or weakness occur, the most important priority is to seek emergency care immediately. In this situation, time is not a minor detail but can be a decisive factor for the patient's safety.

Part 2: Standard Medical Procedure for Gastric Bleeding Examination

Step 1: Stool test helps detect bleeding

Collect stool samples when requested by your doctor

• If gastric bleeding or gastrointestinal bleeding is suspected, your doctor may request a stool test to check for blood. This test can help detect bleeding that the patient cannot see with the naked eye.

• If instructed to collect a sample at home, the patient should:

  1. Defecate into a clean container, avoiding direct contact of the stool sample with urine or water in the toilet bowl.

  2. Use a clean tool to collect a quantity of stool as instructed by the testing facility.

  3. Place the sample in a specialized container, seal it tightly, and label it as required.

  4. Deliver the sample to the medical facility within the instructed time. Do not store the sample in the refrigerator without instructions from medical staff, as storage methods may vary depending on the type of test.

Stool test can detect occult blood

• The fecal occult blood test helps detect very small amounts of blood that are not visible to the naked eye. A positive result indicates the presence of blood in the stool but does not identify the location or cause of the bleeding.

• If the patient already has black stools, vomiting blood, or signs of blood loss, the assessment should not rely solely on a stool test. The American College of Gastroenterology guidelines recommend risk assessment and early endoscopy for appropriate cases of upper gastrointestinal bleeding.

Do not use a stool test to rule out bleeding on your own

• A stool test result that does not detect blood does not definitively mean there is no gastric bleeding. The doctor needs to combine symptoms, clinical examination, blood tests, and other diagnostic methods when necessary.

• If you are experiencing vomiting blood, tar-like black stools, dizziness, shock, fatigue, or rapid heartbeat, you should go to an emergency medical facility immediately instead of waiting to collect a stool sample or waiting for test results.

Treatment depends on the cause of the bleeding

• If an ulcer is identified as the cause, the question of how gastric bleeding is treated will be decided by the doctor based on the severity of the bleeding and the patient's condition. Treatment may include acid-reducing medications and endoscopic hemostasis; if not controlled by endoscopy, arterial intervention may be necessary.

• Therefore, a stool test is only one part of the evaluation process. Effective treatment for gastric bleeding requires correctly identifying the source of bleeding and addressing the cause, rather than just focusing on symptom relief.

Step 2: Endoscopy helps identify the bleeding ulcer

Endoscopy is an important method for finding the source of bleeding

• When gastric bleeding due to ulcers is suspected, the doctor may recommend an upper gastrointestinal endoscopy. A small, flexible tube with a camera is inserted through the mouth, down the esophagus, and into the stomach to directly observe the mucous membrane, identify the ulcer, and locate the bleeding site.

• Endoscopy not only helps with diagnosis but can also stop the bleeding during the procedure. This is why endoscopy plays a central role in managing upper gastrointestinal bleeding due to ulcers.

Perform endoscopy as early as possible when bleeding occurs

• For patients with upper gastrointestinal bleeding, the timing of endoscopy depends on the severity and circulatory status:

  1. Patients with hemodynamic instability require resuscitation and urgent endoscopy after optimal stabilization.

  2. Stable patients are usually endoscoped within 24 hours of hospital admission.

• If endoscopy reveals an actively bleeding ulcer or signs of high rebleeding risk, the doctor may use techniques such as clipping, thermal coagulation, or a combination of hemostatic methods.

Discuss medications and sensations during endoscopy with your doctor beforehand

• Endoscopy can cause discomfort or nausea as the tube passes through the throat. Depending on the patient's health, the medical facility, and the procedure, the patient may receive appropriate sedation or local anesthesia.

• Before endoscopy, inform your doctor about medications you are taking, underlying medical conditions, allergies, and any issues related to anesthesia or sedation. This helps the team choose safer options.

Biopsy may be performed when necessary

• In some cases, the doctor may take a small tissue sample during endoscopy for a biopsy. Whether a biopsy is needed depends on the appearance of the lesion and the diagnostic purpose.

• Not all cases of gastric bleeding require a biopsy. The doctor will decide based on the characteristics of the ulcer and specific risk factors.

Do not substitute endoscopy with other tests yourself

• Some imaging diagnostic methods may be used in certain situations, but when a patient has upper gastrointestinal bleeding, endoscopy is preferred because it helps identify the source of bleeding and allows for hemostatic intervention.

• Therefore, if you are looking for information on how gastric bleeding is treated, it is important to understand that endoscopy is not merely a step to "look into the stomach." In many cases, this is the step that helps the doctor locate the correct ulcer, assess the risk, and manage the bleeding promptly.

Step 3: H. pylori testing recommended for ulcers

Check for H. pylori to find the cause of ulcers

• Helicobacter pylori (H. pylori) is a bacterium that can cause inflammation of the stomach lining and increase the risk of gastric and duodenal ulcers. H. pylori infection is also associated with an increased risk of bleeding complications from ulcers.

• If you are being evaluated for gastric bleeding or stomach ulcers, you should discuss H. pylori testing with your doctor to determine if you are infected with this bacterium. The test results help the doctor choose the appropriate treatment course rather than just controlling symptoms.

There are several ways to test for H. pylori

• Depending on the situation, the doctor may choose one of the following methods:

  1. Stool test: detects H. pylori antigens in the stool sample.

  2. Urea breath test: the patient drinks a labeled urea substance, then exhales into a specialized bag. If H. pylori is present, the bacteria will break down the urea, producing a substance detected in the breath.

  3. Blood test: can detect antibodies related to H. pylori, but is not the best option for identifying active infection because results can be misleading.

• According to American College of Gastroenterology guidelines, urea breath tests and H. pylori stool antigen tests are non-invasive methods with good accuracy and are often preferred.

Inform your doctor about the medications you are taking

• Some medications can affect H. pylori test results. Therefore, patients need to fully disclose proton pump inhibitors (PPIs), antibiotics, bismuth-containing medications, and any current stomach medications they are using.

• Do not stop medication on your own for testing. The doctor will instruct you on when to stop or adjust medications if necessary to minimize the risk of false-negative results.

If positive, treatment and retesting are required

• When H. pylori infection is confirmed, the doctor usually prescribes a multi-drug regimen, including antibiotics and acid-reducing medications. Do not self-medicate with antibiotics, as drug selection needs to consider antibiotic resistance and the patient's treatment history.

• After treatment, it is necessary to retest to confirm H. pylori eradication. The ACG recommends performing a confirmation test using a urea breath test, stool antigen test, or biopsy-based test, typically at least 4 weeks after completing antibiotics and after discontinuing PPI/PCAB for a sufficient duration according to guidelines.

H. pylori treatment helps reduce the risk of ulcer recurrence

• If H. pylori is the cause, complete eradication of the bacteria is an important part of treating gastric bleeding due to ulcers and preventing ulcer recurrence. However, if the patient is bleeding, managing the bleeding is prioritized; do not wait for H. pylori test results to seek emergency care.

• When learning how gastric bleeding is treated, it is important to remember that treatment is not just about stopping the bleeding. The doctor also needs to find and treat underlying causes such as H. pylori or non-steroidal anti-inflammatory drugs to reduce the risk of recurrent bleeding.

Part 3: Effective Treatment for Gastric Bleeding

Method 1: Acid-reducing medication helps ulcers heal

Use medication strictly as prescribed by your doctor

• When bleeding gastric ulcers are confirmed, the doctor may prescribe acid-suppressing medications, especially proton pump inhibitors (PPIs). Reducing the amount of acid in the stomach helps create conditions for the ulcer to heal and supports control of recurrent bleeding risk.

• Some active ingredients in the PPI group commonly used include:

  • Omeprazole

  • Lansoprazole

  • Pantoprazole

  • Esomeprazole

• The choice of medication, dosage, and treatment duration must be based on the specific situation. Patients should not self-medicate or increase the dose of acid-reducing drugs just because they have stomach pain or suspect gastric bleeding.

PPIs are especially important after endoscopic hemostasis

• For ulcers with high-risk features that have undergone endoscopic hemostasis, the American College of Gastroenterology guidelines recommend high-dose PPIs for the first 3 days, followed by oral PPIs twice daily for the first 2 weeks in high-risk groups.

• This indicates that acid-reducing medications are not the sole measure for treating gastric bleeding. If bleeding is occurring, the patient may need resuscitation and endoscopic hemostasis first; PPIs are used as an important part of the treatment regimen.

Do not self-treat if you are showing signs of bleeding

• If you experience vomiting blood, coffee-ground vomit, black tar-like stools, dizziness, shock, or fatigue, you should go to a medical facility immediately instead of just taking acid-reducing medication at home.

• For patients with upper gastrointestinal bleeding, endoscopy is usually performed within 24 hours of hospital admission; if an actively bleeding ulcer or exposed vessel is found, the doctor may perform endoscopic hemostasis.

Treat the cause to limit recurrence

• PPIs help control acid but do not eliminate all causes of ulcers. If the ulcer is related to H. pylori, the patient needs to be treated for bacterial eradication. If related to non-steroidal anti-inflammatory drugs (NSAIDs), the doctor will evaluate discontinuing, changing, or adjusting the medication.

• Therefore, when learning how gastric bleeding is treated, patients should understand it as: stopping bleeding when necessary, reducing acid to promote ulcer healing, and addressing the underlying cause of the ulcer. This is a more comprehensive approach than just focusing on pain relief or discomfort reduction.

Method 2: H. pylori treatment for ulcer healing

Use antibiotics when H. pylori test is positive

• If H. pylori is confirmed by testing, the doctor may prescribe an H. pylori eradication regimen. Eliminating the bacteria helps control the cause of inflammation and ulcers and reduces the risk of ulcer recurrence, thereby supporting the process of treating gastric bleeding due to ulcers.

• Patients should not self-medicate with a single antibiotic to treat H. pylori. Currently, regimens often require a combination of multiple drugs and are chosen based on the patient's history of antibiotic use, antibiotic resistance, and current treatment guidelines.

Medications that may appear in the regimen

• Some antibiotics that may be used by doctors include amoxicillin, metronidazole, or tinidazole. However, not all patients use these drugs, and self-combination of drugs should be avoided.

• Modern H. pylori treatment regimens often combine antibiotics with acid-reducing medications and/or bismuth, depending on the regimen chosen by the doctor. Following the correct regimen is more important than self-selecting a single antibiotic.

Ask your doctor about test results

• After testing, patients should clearly ask whether the H. pylori result is positive or negative and what to do next. The time to get results depends on the type of test and the facility performing it, so do not assume results will always be available within a few hours.

• If you are experiencing symptoms of gastric bleeding such as vomiting blood, coffee-ground vomit, black stools, dizziness, or shock, do not wait for H. pylori test results to seek medical attention. This is a situation that requires urgent assessment and management.

Recheck after completing treatment

• Completing treatment does not mean H. pylori has been completely eradicated. Patients should perform a confirmation test for H. pylori eradication as scheduled by the doctor, usually with a urea breath test or stool antigen test.

• According to the American College of Gastroenterology recommendations, confirmation testing should be done at least 4 weeks after completing antibiotics, and proton pump inhibitors (PPIs) should be discontinued for a sufficient duration according to guidelines to minimize the risk of false-negative results.

H. pylori treatment is part of the relapse prevention process

• When learning how gastric bleeding is treated, it is important to distinguish between two goals: controlling acute bleeding and addressing the cause of ulcer recurrence.

• If H. pylori is the cause, eradication therapy is an important step to reduce the risk of recurrent ulcers. However, patients who are actively bleeding still need to have the hemorrhage managed according to its severity; antibiotics cannot replace necessary hemostatic measures.

Method 3: Gastric mucosal protective drugs

Use medication as prescribed by a doctor

• In some cases of gastric and duodenal ulcers, doctors may prescribe medications that protect the mucosa, allowing the ulcer to heal and reducing the impact of acid on the injured area.

• Some medications that may be used include:

  • Sucralfate: creates a protective layer on the ulcer surface, limiting contact with acid and irritating factors.

  • Misoprostol: increases mucosal protective mechanisms and is often considered in some cases related to non-steroidal anti-inflammatory drugs (NSAIDs).

Do not self-medicate for gastric bleeding

• Mucosal protective drugs do not replace hemostatic measures when the patient is experiencing gastrointestinal bleeding. If there is vomiting blood, coffee-ground vomit, black stools, dizziness, or faintness, seek emergency medical attention.

• For gastric bleeding due to ulcers, doctors may need to combine several methods such as resuscitation, acid-reducing drugs, and endoscopic hemostasis, depending on the severity of the bleeding.

Drug selection depends on the location and cause of the ulcer

• Not all ulcers are treated with the same type of medication. The doctor will consider whether the ulcer is in the stomach or duodenum, its cause, the extent of the damage, and the medications the patient is currently taking.

• If the ulcer is related to H. pylori, eradication therapy is needed. If it's related to NSAIDs, the doctor may assess discontinuing or changing the medication causing mucosal damage.

Comprehensive treatment helps reduce the risk of recurrence

• When learning about how to treat gastric bleeding, patients need to understand that mucosal protective drugs are only one part of the treatment plan and not suitable for all cases.

• The goal of treating gastric bleeding due to ulcers is to control bleeding, help the ulcer heal, and address the underlying cause. Therefore, patients should take medication as prescribed, follow up on schedule, and not arbitrarily change the regimen.

Method 4: Surgery for severe bleeding ulcers

Surgery only when other measures fail to control bleeding

• Gastric bleeding due to ulcers is typically managed primarily with resuscitation, medication, and endoscopic hemostasis. Surgery is not the first choice but is usually considered when severe bleeding cannot be controlled endoscopically or when bleeding recurs despite appropriate treatment.

• When surgery is required, the main goal is to control the source of bleeding and treat the ulcer, while ensuring the patient does not continue to lose blood.

The doctor will choose the method based on the actual situation

• Surgical methods are not fixed for all cases. The doctor will consider the ulcer's location, the extent of bleeding, circulatory status, co-existing medical conditions, and the response to previous hemostatic methods.

• Some surgical techniques previously used in the treatment of severe ulcers include:

  1. Suturing or direct management of the bleeding site: helps control the source of hemorrhage at the ulcer.

  2. Partial gastrectomy: may be considered in some special cases where the ulcer cannot be controlled by less invasive methods.

  3. Techniques to reduce acid secretion or alter the food pathway previously played a role in ulcer treatment, but are currently not routine options solely for managing ulcer bleeding.

Interventional radiology may be an option before surgery

• If endoscopic hemostasis fails or bleeding recurs, the doctor may consider transcatheter arterial embolization before proceeding to surgery, depending on the medical facility's capabilities and the patient's condition.

• Therefore, the question how to treat gastric bleeding needs to be answered according to each level: stabilization and medical treatment, endoscopic hemostasis when needed, followed by consideration of interventional radiology or surgery if bleeding remains uncontrolled.

Recognize when emergency care is needed

• If there is vomiting blood, coffee-ground vomit, black stools, dizziness, faintness, rapid heart rate, pale skin, or extreme fatigue, the patient needs to go to the emergency room immediately.

• Do not wait until surgery is needed to seek medical help. For gastric bleeding, early detection and timely control of bleeding are crucial factors to limit blood loss and complications.

Surgery is not a common way to treat gastric bleeding

• After bleeding is controlled, the patient still needs to treat the underlying cause of the ulcer, such as H. pylori or non-steroidal anti-inflammatory drugs (NSAIDs), and use acid-reducing medications as prescribed.

• Therefore, treating gastric bleeding is not simply "closing the ulcer." The long-term goal is to stop the bleeding, heal the ulcer, and eliminate the ulcer-causing factors to reduce the risk of re-bleeding.

Method 5: Pain relief as the ulcer heals

Continue treatment as instructed by your doctor

• After starting treatment, pain from stomach ulcers may not disappear immediately. The mucosa needs time to recover, so patients should continue to take medication at the correct dose and for the full duration as prescribed, rather than stopping medication on their own when they feel better.

• If the pain persists or worsens, you should inform your doctor for a re-evaluation of the cause and treatment effectiveness. In particular, persistent pain should not be considered merely a symptom to "endure" during the healing process.

Avoid factors that irritate the ulcer

• Some people find that spicy foods, alcohol, coffee, or specific foods worsen their symptoms. If a certain food has been identified as increasing symptoms, it can be limited or avoided while the ulcer heals.

• Quitting smoking is also beneficial, as smoking can hinder ulcer healing and increase the risk of recurrence.

• Do not adopt an overly strict diet simply because of an ulcer. The realistic goal is to maintain a suitable, nutritious diet and avoid things that actually worsen your symptoms.

Be cautious with NSAID pain relievers

• Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, naproxen, or aspirin can damage the mucosa and increase the risk of ulcers and gastrointestinal bleeding in some people.

• If you are taking NSAIDs and experience stomach pain or have a history of gastric bleeding, discuss this with your doctor before continuing use. Do not stop aspirin prescribed for cardiovascular prevention without consulting your doctor, as abruptly stopping the medication can increase cardiovascular risk in some cases.

No need to force the stomach to be "full" or "empty"

• Eating 5–6 small meals a day is not a mandatory requirement for ulcer healing and there is no evidence that all stomach ulcer patients need to eat this way.

• If eating a lot at once makes you uncomfortable, you can try splitting meals into smaller portions and eating more frequently throughout the day. Conversely, if skipping meals worsens symptoms, you should avoid getting too hungry.

Revisit the doctor if pain does not improve

• If pain persists, recurs, or does not improve after a period of treatment, patients should seek re-examination instead of self-medicating or trying to treat gastric bleeding on their own.

• Specifically, vomiting blood, coffee-ground vomit, black stools, dizziness, faintness, or extreme fatigue are signs that require immediate emergency care.

• When learning how to treat gastric bleeding, it's important to remember that pain control is only one part. Proper treatment must simultaneously help the ulcer heal, control bleeding, and eliminate the cause of the ulcer to limit recurrence.

Ulcers need time to heal

Ulcers often take several weeks to heal

• The healing process for gastric and duodenal ulcers typically takes several weeks and depends on the cause, ulcer location, extent of damage, and response to treatment.

• If the cause is H. pylori, the patient needs to complete the full bacterial eradication regimen. Afterward, the doctor may continue acid-reducing medication for an appropriate period to support ulcer healing.

• Do not stop medication on your own just because the pain has subsided. Disappearance of symptoms does not mean the ulcer has completely healed, especially in those who have experienced bleeding.

Distinguish between gastric ulcers and duodenal ulcers

• Gastric ulcers are located in the stomach lining, while duodenal ulcers are in the first part of the small intestine.

• Both can cause bleeding. Therefore, when a patient shows signs of gastric bleeding, the doctor needs to determine the location and cause to choose the appropriate treatment method.

Follow-up to prevent recurrent bleeding

• After the ulcer heals, patients still need to reduce factors that increase the risk of recurrence:

  • Thoroughly treat H. pylori if tested positive and recheck as instructed.

  • Limit or avoid NSAID use if not truly necessary and only use as prescribed.

  • Take acid-reducing medications at the correct dose and duration when prescribed.

  • Revisit the doctor if pain, nausea, or upper abdominal discomfort returns.

Severe cases may require blood transfusions or intervention

• If gastric bleeding causes significant blood loss, the patient may need a blood transfusion depending on the degree of anemia and clinical status. The decision to transfuse blood is made by the doctor based on the patient's overall condition, not just on a single laboratory value.

• If bleeding is not controlled endoscopically, the doctor may consider interventional radiology or surgery to control the source of the hemorrhage.

Know when to seek emergency care

• If there is vomiting blood, coffee-ground vomit, black, tarry stools, dizziness, faintness, syncope, or extreme fatigue, seek immediate medical attention.

• Regarding the question how to treat gastric bleeding, the important principle is not to simply wait for the ulcer to heal on its own. It is necessary to control bleeding, treat the cause, and support ulcer healing, while also having a plan to prevent recurrence.

References

1. Laine, L., Barkun, A. N., Saltzman, J. R., Martel, M., & Leontiadis, G. I. (2021). ACG Clinical Guideline: Upper Gastrointestinal and Ulcer Bleeding. The American Journal of Gastroenterology, 116(5), 899–917. doi:10.14309/ajg.0000000000001245.
2. National Institute for Health and Care Excellence. (2012). Acute upper gastrointestinal bleeding in over 16s: Management (NICE Guideline CG141). London: NICE.
3. National Institute for Health and Care Excellence. (2013). Acute upper gastrointestinal bleeding in adults: Quality standard QS38. London: NICE.
4. Chey, W. D., Mégraud, F., Laine, L., et al. (2024). ACG Clinical Guideline: Treatment of Helicobacter pylori Infection. The American Journal of Gastroenterology. American College of Gastroenterology.
5. Sung, J. J. Y., Kuipers, E. J., & El-Serag, H. B. (2009). Systematic review: The global incidence and prevalence of peptic ulcer disease. Alimentary Pharmacology & Therapeutics, 29(9), 938–946.
6. Malfertheiner, P., Chan, F. K. L., & McColl, K. E. L. (2009). Peptic ulcer disease. The Lancet, 374(9699), 1449–1461.
7. Sung, J. J. Y., Chiu, P. W. Y., Chan, F. K. L., Lau, J. Y. W., Goh, K. L., Ho, L. H., Hsu, P. I., Wu, K. C., Wu, D. C., Leung, W. K., & others. (2018). Asia-Pacific working group consensus on non-variceal upper gastrointestinal bleeding: An update 2018. Gut, 67(10), 1757–1768.
8. Barkun, A. N., Almadi, M., Kuipers, E. J., Laine, L., Sung, J., Tse, F., Leontiadis, G. I., Abraham, N. S., Calvet, X., Chan, F. K. L., Douketis, J., Enns, R., Gralnek, I. M., Jairath, V., Jensen, D. M., Lau, J. Y. W., Lip, G. Y. H., Loffroy, R., Maluf-Filho, F., Meltzer, A. C., Reddy, N., Saltzman, J. R., Schulman, S., & Bardou, M. (2019). Management of nonvariceal upper gastrointestinal bleeding: Guideline recommendations from the International Consensus Group. Annals of Internal Medicine, 171(11), 805–822.
9. Barkun, A. N., Bardou, M., Kuipers, E. J., Sung, J., Hunt, R. H., Martel, M., & Sinclair, P. (2010). International consensus recommendations on the management of patients with nonvariceal upper gastrointestinal bleeding. Annals of Internal Medicine, 152(2), 101–113.

Content edited by: Rowan Hudson Le.

Information consulted and verified by expert: Sophia Miller.