Differentiating Between Irritable Bowel Syndrome and Stomach Ulcers

The difference between irritable bowel syndrome (IBS) and peptic ulcer disease?

Yesterday, while preparing breakfast, I suddenly experienced severe stomach pain, making it difficult to stand upright.
The pain radiated to my chest and back.
I took one Omeprazole (OMEZOL), which alleviated the pain, and then I fell asleep.
When I woke up, I ate something, but I still felt bloated and uncomfortable.
Before bed, I took one Nexium (40 mg) but it didn’t help much.
An hour later, I took two EpiLons, which seemed to improve my condition a bit, allowing me to fall asleep.
(I am currently abroad, and the pain was so severe in the morning that I could barely walk, so I took my usual medications.)
The next day, I visited a doctor (a physician from a developing country), and I was a bit apprehensive.
Besides explaining what happened the previous day, I also mentioned that two weeks ago, I woke up in the middle of the night with stomach pain for two days, but I was able to fall back asleep, although I woke up several times.
After examining me, he suggested that I might have Irritable Bowel Syndrome (IBS) and prescribed Nexium, Sertal Compuesto, and Aero OM Forte (125 mg).
He also requested urine and stool tests, as well as an abdominal ultrasound.
The reports are not out yet.
That evening, I took Sertal Compuesto and Aero OM Forte (125 mg), but I felt no relief, as my stomach still felt uncomfortable and bloated (I have been burping and passing gas frequently).
I researched the symptoms of IBS at home and felt that I didn’t match the typical profile; my bowel movements are generally normal.
However, I do notice that sometimes after a bowel movement, my stomach feels fine.
I also looked into peptic ulcers and found that I don’t experience stomach pain after eating; rather, I feel pain when I haven’t eaten.
I am confused about why the severe pain occurred and why I currently feel bloated.
Does my situation resemble more of IBS or a peptic ulcer? (Having lived abroad for an extended period, I have some doubts about the local healthcare, so I appreciate your time in diagnosing and responding.)

XYZ, 30~39 year old female. Ask Date: 2017/03/07

Dr. Chen Shidian reply Gastroenterology and Hepatology

Hello, miss.
Please wait for the test results and take the medication for a while to observe the response.
If necessary, you may undergo an endoscopy to rule out other possible conditions.
Changhua Hospital cares about your health.
Chen Shidian.

Reply Date: 2017/03/07

More Info

Differentiating between Irritable Bowel Syndrome (IBS) and stomach ulcers can be quite challenging, as both conditions can present with overlapping symptoms, but they have distinct characteristics and underlying mechanisms.

Understanding the Symptoms:
1. Irritable Bowel Syndrome (IBS):
- IBS is a functional gastrointestinal disorder characterized by symptoms such as abdominal pain, bloating, gas, and altered bowel habits (diarrhea, constipation, or alternating between both).

- Symptoms often improve after a bowel movement and can be triggered by stress, certain foods, or hormonal changes.

- Patients may experience a sensation of incomplete evacuation after a bowel movement.

2. Stomach Ulcers (Peptic Ulcers):
- Stomach ulcers, or peptic ulcers, are sores that develop on the lining of the stomach or the first part of the small intestine (duodenum).

- Symptoms typically include a burning stomach pain that may improve or worsen with eating, nausea, and in some cases, vomiting or changes in appetite.

- Unlike IBS, the pain from ulcers is often more localized and can be severe, especially when the stomach is empty.

Your Symptoms:
From your description, you experienced sudden and severe stomach pain that radiated to your chest and back, which is concerning for a possible ulcer or other serious gastrointestinal issue. The fact that you found relief with medications like OMEZOL (a proton pump inhibitor) suggests that your symptoms may be related to excess stomach acid, which is common in ulcer cases.
The sensation of bloating and discomfort after eating, along with the relief you experienced after taking certain medications, further complicates the picture. While IBS can cause bloating, the acute nature of your pain and its association with meals leans more towards a gastric issue, such as an ulcer.

Diagnosis and Treatment:
- Diagnosis: To accurately differentiate between IBS and stomach ulcers, further diagnostic tests are essential. An upper endoscopy (EGD) can directly visualize the stomach lining and identify ulcers. Additionally, tests for H. pylori, a common cause of ulcers, may be warranted.

- Treatment: If ulcers are confirmed, treatment typically involves proton pump inhibitors (PPIs) like OMEZOL or NEXIUM to reduce stomach acid, along with antibiotics if H. pylori is present. For IBS, treatment may include dietary changes, stress management, and medications aimed at alleviating specific symptoms.

Follow-Up:
Given the severity of your symptoms, it is crucial to follow up with a healthcare provider who can perform the necessary tests. If you continue to experience significant discomfort or if your symptoms worsen, seeking immediate medical attention is advisable.

Conclusion:
In summary, while both IBS and stomach ulcers can cause abdominal discomfort, the nature of your symptoms, particularly the acute pain and its relationship to meals, suggests that further investigation for a possible ulcer is warranted. It's essential to work closely with a healthcare provider to obtain an accurate diagnosis and appropriate treatment.

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