Stomach Ulcers and IBS: When to Seek Further Evaluation

Gastric ulcer issues?

Hello Doctor: In early January of this year, I experienced abdominal pain and bloating, so I underwent a gastroscopy, which revealed that I had a gastric ulcer and gastritis.
The colon only had benign polyps.
I was prescribed a proton pump inhibitor (PPI) for four months.
After completing the medication, I had another gastroscopy and an abdominal ultrasound, which showed that the wounds had completely healed, with only mild inflammation remaining.
However, I still experience daily abdominal pain and bloating, and occasionally have issues with constipation and flatulence.
I consulted a family medicine doctor who suspected I might have irritable bowel syndrome (IBS) and prescribed three medications: Splotin, ERA, and Trancolon, to be taken for three months.
Initially, I felt somewhat better, but soon the discomfort returned daily.
I am now even concerned that it might be cancer, as I think about this issue every day.
It has been almost a year, and I am very worried about my health.
I would like to ask the doctor if I should undergo further examinations or if this is simply a manifestation of IBS.
Thank you.

Jason, 20~29 year old female. Ask Date: 2021/12/27

Dr. Lin Minghui reply Gastroenterology and Hepatology

Hello, after improvement of the gastric ulcer, abdominal pain and bloating still occur daily, and there are occasional episodes of constipation and flatulence.
For gastric ulcers and gastritis, it is important to pay attention to diet: avoid eating too quickly and refrain from consuming irritating foods such as coffee, chocolate, and spicy foods.
During episodes of bloating, limit the intake of gas-producing foods; otherwise, symptoms may recur.
Additionally, it is crucial to check for Helicobacter pylori infection, as eradicating this bacteria is essential to prevent the recurrence of peptic ulcers and the risk of cancer.
To prevent gastric cancer, increase the intake of fresh foods and limit the consumption of processed and grilled foods.
If experiencing irritable bowel syndrome, in addition to dietary considerations, it is important to manage stress and engage in regular exercise.
If gastrointestinal symptoms do not improve and there is weight loss, it is recommended to follow up with outpatient treatment.
Wishing you peace and health.
Sincerely, Dr.
Ming-Hui Lin, Attending Physician, Department of Gastroenterology, Taoyuan Hospital, Ministry of Health and Welfare.

Reply Date: 2021/12/27

More Info

It sounds like you have been through a challenging journey with your gastrointestinal health, and it's understandable to feel concerned about your symptoms and the possibility of serious conditions like cancer. Let's break down your situation and discuss the implications of your symptoms, the diagnoses you've received, and when it might be appropriate to seek further evaluation.

From your description, you have been diagnosed with stomach ulcers and gastritis, which can certainly cause abdominal pain and discomfort. The fact that you underwent treatment with proton pump inhibitors (PPIs) and that follow-up endoscopy showed healing of the ulcers is a positive sign. However, persistent symptoms such as daily abdominal pain, bloating, constipation, and flatulence can be frustrating and distressing.

Your healthcare provider's suspicion of irritable bowel syndrome (IBS) is not uncommon in cases where patients experience a combination of gastrointestinal symptoms without clear evidence of structural abnormalities. IBS is a functional gastrointestinal disorder characterized by symptoms like abdominal pain, bloating, and changes in bowel habits, including constipation and diarrhea. The exact cause of IBS is not well understood, but it is thought to involve a combination of gut motility issues, sensitivity to gut stimuli, and possibly psychological factors.

The medications prescribed to you—Splotin, ERA, and Trancolon—are commonly used to manage IBS symptoms. Splotin (which may refer to a medication like hyoscine butylbromide) can help relieve cramping and spasms in the gut, while ERA (possibly referring to an antispasmodic or a medication that affects gut motility) and Trancolon (which may be a type of laxative or fiber supplement) aim to improve bowel function. It is not unusual for these medications to take some time to show their full effect, and sometimes adjustments in dosage or type of medication may be necessary.

Given that your symptoms persist despite treatment, it is reasonable to consider further evaluation. While IBS can certainly cause chronic symptoms, it is essential to rule out other potential causes, especially since you have a history of gastric ulcers. Here are some steps you might consider:
1. Follow-Up with Your Gastroenterologist: If you haven't already, schedule a follow-up appointment with your gastroenterologist. They can assess your ongoing symptoms in the context of your previous diagnoses and treatments.

2. Consider Additional Testing: Depending on your gastroenterologist's assessment, they may recommend additional tests. This could include imaging studies, such as an abdominal ultrasound or CT scan, or even repeat endoscopy if there is a concern about any new developments.

3. Monitor Your Symptoms: Keep a detailed diary of your symptoms, including when they occur, their severity, and any potential triggers (such as specific foods or stress). This information can be valuable for your healthcare provider in determining the best course of action.

4. Psychological Support: Since IBS can be influenced by stress and anxiety, consider discussing your mental health with a healthcare provider. Cognitive-behavioral therapy (CBT) and other forms of psychological support can be beneficial for managing IBS symptoms.

5. Dietary Modifications: Some patients find relief by making dietary changes, such as following a low-FODMAP diet, which can help identify food triggers that exacerbate symptoms. Consulting with a registered dietitian may be helpful.

6. Stay Informed but Avoid Excessive Worry: While it is natural to worry about serious conditions like cancer, try to focus on the information and guidance provided by your healthcare team. They are best equipped to evaluate your symptoms and determine the need for further investigation.

In summary, while your symptoms may align with IBS, it is crucial to maintain open communication with your healthcare providers and consider further evaluation if your symptoms do not improve. Your health and peace of mind are paramount, and taking proactive steps can help you manage your condition effectively.

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