Complications

The main complications of peptic ulceration are:

• gastrointestinal bleeding - occurs in 25% to 33% of cases and accounts for 25% of ulcer deaths. Haemorrhage arises from the small blood vessels at the base of the ulcer. Uncommonly, it may be the initial presentation of a peptic ulcer. (1) In patients whose ulcers have bled, eradication of H. pylori is more effective than long-term acid suppression without eradication. (2)
• perforation and penetration into adjacent structures - pancreas, liver and retroperitoneal space. (3)
• gastric outflow obstruction / pyloric stenosis:
  • reversible - from oedema and spasm
  • irreversible - from cicatricial stenosis

Malignant transformation has been reported in gastric ulcers but it is more likely that such "ulcers" were malignant in their inception.

Reference:

1. National Institute for Health and Care Excellence. Acute upper gastrointestinal bleeding in over 16s: management. August 2016 [internet publication].
2. Gisbert JP et al. H. pylori eradication therapy vs. anti-secretory non-eradication therapy (with or without long-term maintenance anti-secretory therapy) for the prevention of recurrent bleeding from peptic ulcer. Cochrane Database Syst Rev. 2004;(2):CD004062.
3. Narayanan M, Reddy KM, Marsicano E. Peptic Ulcer Disease and Helicobacter pylori infection. Mo Med. 2018 May-Jun;115(3):219-224.