In Sunday’s episode of “Downton Abbey,” dinner at the Abbey turned into a Quentin Tarantino scene when Robert Crawley, the Earl of Grantham (Hugh Bonneville), began vomiting blood all over the linens — and his shocked wife, Cora (Elizabeth McGovern), too.
The reason: He had a burst ulcer, which explains his stomach-clutching over the past few episodes.
But that was 1925 England — surely the same diagnosis today wouldn’t result in such a bloodbath, right?
Wrong. Dr. Paresh Shah, director of general surgery at NYU Langone and a “Downton” fan, says he’s seen the condition before. It happens when a patient’s ulcer carves into a blood vessel in their stomach, triggering bleeding and the vomiting of blood.
“I’ve certainly seen it more than a few times,” he says. “The presentation of this was actually done fairly well and fairly accurately.”“The presentation of this was actually done fairly well and fairly accurately,”
- NYU's Dr. Paresh Shah
Nowadays, burst ulcers are less common, thanks to the discovery in the 1980s that most ulcers are caused by a bacterial infection and the development of endoscopies and X-rays to catch it — medical advances the “Downton” crew wouldn’t have had.
Gastrectomies — like the one the Earl received to remove the burst ulcer and a section of his stomach — have dropped significantly.
“We’ve gotten much, much better at treating them,” Shah says. “We’ll see half a dozen [ruptured ulcers] a year nowadays, where you used to see half a dozen a week.”
Shah says if you notice persistent upper abdominal pain or blood in your stool, or you’re vomiting blood, you should see your physician immediately.
It’s advice the Earl could have used.
“He is a classic example of someone who’s got symptoms but doesn’t actually seek treatment until it’s too late.”