How Emergency Endoscopy Stopped a Bleeding Ulcer
Patient Profile
| Age | 48 years |
| Gender | Male |
| Occupation | Factory Floor Supervisor |
| City | Pune |
| Presenting Complaint | Vomiting of fresh and altered blood, black tarry stools, light-headedness, and a racing heartbeat over two days |
| Diagnosis | Acute upper GI bleeding from a bleeding duodenal (peptic) ulcer, linked to long-term painkiller use and H. pylori infection |
| Duration of Issue | Acute bleed over 2 days; recurrent burning upper-abdominal pain for roughly 10 months |
| Previous Treatments | Self-purchased painkillers for back pain and antacids for the burning, with no endoscopy and no diagnosis |
| Date of Procedure | January 2025 (emergency endoscopy); managed over a short admission |
| Outcome | Bleeding stopped endoscopically, ulcer treated, H. pylori eradicated, no surgery and no recurrence |
Patient identity withheld per confidentiality guidelines. Patient name is not included; all other fields are accurate.
The Problem
Condition
Upper gastrointestinal bleeding means blood loss from the food pipe, stomach, or the first part of the small intestine. In this patient the source was a peptic ulcer, a raw crater in the lining that had eroded into a small blood vessel. The tell-tale signs were vomiting blood and passing black tarry stools, the colour that blood turns once it has been through the gut. Rapid assessment through Endoscopic Services in Pune allowed the bleeding point to be found and treated in the same sitting. Untreated, this kind of bleed can drop the blood pressure dangerously and become life-threatening, which is why it is handled as an emergency rather than a routine complaint.
Emotional & Psychological Impact
For a 48-year-old supporting a family on a supervisor’s income, vomiting blood was terrifying and came without warning. He had quietly lived with burning stomach pain for months, treating it as ordinary acidity and reaching for over-the-counter painkillers that, unknown to him, were steadily damaging his stomach lining. When the bleeding started he feared the worst, that it was cancer, that he might not make it, and that a long hospital stay would cost him his job. By the time he reached emergency care he was frightened, weak, and exhausted, a state that calm explanation and rapid, decisive treatment would soon settle.
Consultation & Treatment Plan
What Was Assessed During the Consultation?
- Rapid history of the bleed, the black stools, the months of burning pain, and the regular use of over-the-counter painkillers for back ache
- Vital signs and resuscitation assessment, checking pulse, blood pressure, and signs of significant blood loss before anything else
- Blood tests including haemoglobin, clotting profile, and blood grouping to gauge the severity of the bleed and prepare for transfusion if needed
- Urgent upper GI endoscopy (EGD) to locate the exact bleeding point and treat it in the same procedure
- Patient goals, stop the bleeding safely, avoid open surgery, find the underlying cause, and prevent it from ever happening again
Why This Endoscopic Approach Was Chosen
Dr.Ksheetij Kothari chose urgent therapeutic endoscopy as both the diagnostic and treatment step, the standard of care for Upper GI Bleeding Treatment, rather than moving straight to surgery. The reasoning:
- Endoscopy over surgery: the bleeding vessel could be reached and sealed through a thin scope passed via the mouth, stopping the bleed without any incision.
- Diagnosis and treatment together: the same procedure that finds the ulcer also treats it, with clips, heat, or injection applied directly to the bleeding point.
- Treating the root cause: high-dose acid-suppressing medication plus testing and treatment for H. pylori tackles why the ulcer formed, not just the bleed itself.
- Removing the trigger: stopping the regular painkillers that had damaged the stomach lining was essential to prevent the ulcer from bleeding again.
Baseline Imaging & Documentation
Baseline assessment documents the starting clinical condition and anchors the endoscopic plan. Blood counts, clotting studies, and the endoscopic findings were recorded on arrival to confirm the source and severity of the bleed before treatment began.
Management Protocol:- Step by Step
- Immediate resuscitation with intravenous fluids and, where needed, blood transfusion to stabilise the patient before the procedure
- High-dose intravenous proton pump inhibitor started promptly to reduce stomach acid and support clotting at the ulcer base
- Urgent therapeutic endoscopy performed to locate the bleeding duodenal ulcer and confirm it as the single source
- Endoscopic haemostasis applied directly to the vessel using a combination of clips and injection to stop the active bleeding
- Testing for H. pylori, followed by a full eradication course of antibiotics with the acid-suppressing medication
- Short observation for rebleeding, with repeat haemoglobin checks to confirm the bleed had truly stopped
- Discharge with a clear plan to stop the offending painkillers and continue ulcer-healing medication
Management Facts
| Programme Duration | Short emergency admission with one therapeutic endoscopy session |
| Anaesthesia | Sedation only, no open surgery and no general anaesthetic incision |
| Key Therapeutic Tool | Upper GI endoscopy (EGD) with clip and injection haemostasis |
| Approach | Endoscopic bleeding control plus acid suppression and H. pylori eradication |
| Complications | None |
| Hospital Stay | Short, with discharge once the bleed was controlled and counts were stable |
Post-Management Results
The active bleeding was stopped during the endoscopy, and the patient’s vomiting of blood and black stools settled over the following days. Repeat blood counts stabilised, his light-headedness and racing heartbeat resolved, and his strength steadily returned. H. pylori was successfully eradicated and the ulcer was confirmed to be healing, with the offending painkillers stopped to prevent any recurrence. He was able to return home and back to work without ever needing open surgery.
Outcomes at a Glance
| Outcome Metric | Result |
| Active Bleeding | ✔ Stopped endoscopically during the same procedure |
| Haemoglobin / Blood Count | ✔ Stabilised, no further drop after treatment |
| Duodenal Ulcer | ✔ Treated and confirmed healing |
| H. pylori Infection | ✔ Successfully eradicated |
| Patient Satisfaction | ✔ Very high, rapid relief and no open surgery |
| Complications | ✔ None |
Patient Feedback
“Vomiting blood was the most frightening thing that has ever happened to me. I was sure I needed a major operation. Instead the bleeding was stopped through a scope, I was given the right medicines, and within days I felt like myself again. The team kept me calm and explained that my painkillers were the real problem.”
Profile: Male · 48 years · Factory Floor Supervisor · Pune
Procedure: Emergency endoscopy for bleeding ulcer · Pune · January 2025
Surgeon: Dr. Ksheetij Kothari · Consultant Gastroenterologist
Ongoing Care & Maintenance
Instructions Given to Patient
- Stop all over-the-counter painkillers of the type that damaged the stomach lining and use only doctor-approved alternatives for back pain
- Complete the full H. pylori eradication course and the prescribed ulcer-healing medication without skipping doses
- Watch for and report any return of black stools, vomiting of blood, dizziness, or weakness without delay
- Avoid alcohol and smoking, both of which slow ulcer healing and raise the risk of rebleeding
- Eat regular balanced meals and avoid long gaps on an empty stomach during the healing phase
- Attend follow-up, including a confirmation test that H. pylori has cleared and the ulcer has fully healed
Recovery & Reversal Timeline
| Timeframe | What the Patient Could Expect |
| First 24–48 hours | Bleeding controlled, fluids and medication stabilising blood pressure and counts |
| Days 3–5 | Vomiting and black stools settling; blood counts stable; discharge home |
| Weeks 1–2 | Return to normal activity and work; ulcer-healing medication continued |
| Weeks 4–6 | Eradication course completed; confirmation test for H. pylori clearance |
| Ongoing | Periodic review and avoidance of trigger painkillers to prevent recurrence |
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