Bleeding Ulcer Symptoms and Causes

It started with feeling a little run down after working extra hard, perhaps there was some lightheadedness when he stood too quickly, and then came the fatigue. The baseball world blamed Ichiro Suzuki's malaise on playing too much in the World Baseball Classic. During spring training, baseball players are supposed to lounge and gradually get themselves into shape, not play like it's the World Series in October. But the baseball world was wrong. It was discovered in April 2009 that Ichiro was tired because he was anemic and because he was bleeding from an ulcer.

The scenario plays out routinely off the playing field too often. A person feels run down and blames it on all sorts of circumstances, but finally goes to their doctor to get some help. The clues come from the history of heartburn and indigestion, or maybe it was the extra aspirin or ibuprofen to help with the stress headaches at work. There may be a little tenderness in the belly, and after some coercion on the part of the doctor, the patient agrees to a rectal exam. It shows that the stool has occult blood in it (rectal bleeding); that is blood that cannot be seen with the naked eye but shows up with a chemical test. A blood test (CBC) shows that the patient is anemic, meaning there is a low red blood cell count. Putting the clues together, the doctor tells the patient that the fatigue and tiredness is due to bleeding.

The stomach is a mixing bowl, allowing food and digestive juices to combine and allow digestion to begin. But the stomach has a protective lining that prevents digestive enzymes from eating away at it. If this lining is damaged, inflammation and pain may occur. If the inflammation becomes worse, it can cause the lining of the stomach or the duodenum (the first part of the small intestine) to bleed. The bleeding may not be noticeable, and the patient may not seek medical care.

Red blood cells carry oxygen to all the organs of the body. If there are too few red cells, symptoms may occur. Some of these symptoms are pretty non-specific, like

• fatigue,
• weakness, or
• lack of energy.

As the anemia becomes more severe, shortness of breath or chest discomfort during activity may occur. Lightheadedness may occur if a person stands up too quickly, since the body isn't able to pump oxygen-carrying red blood cells fast enough to the brain. It usually resolves in a few seconds as the body adapts or if the person sits down. Sometimes, though, the lightheadedness leads to fainting or "passing out."

Inflammation in the stomach also may cause a small crater, or ulcer, to form. If there happens to be a blood vessel under the ulcer, a lot of bleeding can develop and then the symptoms aren't so subtle. The patient may vomit blood, or the blood may pass into the intestine, get digested, and come out as black, tarry stools.

Bleeding ulcers are a big deal. Often, having endoscopy is both diagnostic and therapeutic. A gastroenterologist can use a fiberoptic camera to view the inside of the stomach and duodenum, searching for a source of bleeding. If a blood vessel is leaking, it's possible to cauterize or burn the blood vessel and take care of the problem right away.

QUESTION

Pancreatitis is inflammation of an organ in the abdomen called the pancreas. See Answer

However, there is still plenty of work for the patient to do. The treatment of ulcers is multi-pronged. Aspirin, ibuprofen, alcohol, and smoking are harmful to the lining of the stomach and need to be discontinued. Medications such as

• ranitidine (Zantac),
• omeprazole (Prilosec, Zegerid), and
• lansoprazole (Prevacid, Prevacid SoluTab)

can be used to decrease acid secretions in the stomach and allow it to heal. Routine use of antacids can help reduce whatever acid production is left.

Baseball players are superstars when they hit 300, meaning they succeed only 30 percent of the time. As an elite athlete, Ichiro knows his body well and also knows when something is wrong. It's a good thing that his doctors listened and batted a thousand when they got the diagnosis right.