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Can Peptic Ulcer Disease Cause Black Stools?
Question: Hi Doctor,
about 5 days ago at 7 pm I went to the bathroom I saw that I had a black stool, similar to tar, it's hard normal stool not loose.
I don't have diarrhea, vomiting or any other symptoms, other than upper abdominal pain especially when hungry.
I always had symptoms of peptic ulcer, such as pain in the upper abdominal area when hungry, sometimes heartburn.
4 days ago after seeing the black stool, I bought triple therapy medications from the pharmacy, omeprazole 20mg BID, Clarithromycin 500mg BID, and Amoxicillin 1000mg BID, just in case there is ulcer bleeding.
The black stool went away since the last 5 days but came back again today, my stool was half normal and the end half black stool.
I don't recall eating any of the food that might suggest is the cause, other than some green vegetables. I don't take iron supplements or bismuth.
However i recognized that everytime i smoke the pain becomes hard to bear, and also alot of pain when i first wake up in the morning. The pain is tough when i first eating the first couple of bites but after eating well i feel relieved. however about one hour after eating the pain comes back again.
I'm thinking to do upper endoscopy to see what's going on but i'm also hoping the tripple therapy might as well treat it without the need to go to gastroentrologist.
here are few questions I have.
1.could this be peptic ulcer bleeding, given that i still don't have any other symptos such as vomiting, diarrhea?
2. why don't i see improvement after 4 days of taking triple therapy, could that suggest that this is not peptic ulcer bleeding?
3.if it's not peptic ulcer bleeding then what could cause upper abdominal pain accompanied by black stool?
4. what do you suggest i should do?
5.shouldI be worried about Zollinger–Ellison syndrome? given my age is 28?
about me
1.weight 84kg
2.regular smoker about half a pack per day, usually the abdominal pain increase when i smoke, especially when I'm hungry. smoking for almost 10 years now.
3.Don't drink alcohol at all.
4.age 28
about 5 days ago at 7 pm I went to the bathroom I saw that I had a black stool, similar to tar, it's hard normal stool not loose.
I don't have diarrhea, vomiting or any other symptoms, other than upper abdominal pain especially when hungry.
I always had symptoms of peptic ulcer, such as pain in the upper abdominal area when hungry, sometimes heartburn.
4 days ago after seeing the black stool, I bought triple therapy medications from the pharmacy, omeprazole 20mg BID, Clarithromycin 500mg BID, and Amoxicillin 1000mg BID, just in case there is ulcer bleeding.
The black stool went away since the last 5 days but came back again today, my stool was half normal and the end half black stool.
I don't recall eating any of the food that might suggest is the cause, other than some green vegetables. I don't take iron supplements or bismuth.
However i recognized that everytime i smoke the pain becomes hard to bear, and also alot of pain when i first wake up in the morning. The pain is tough when i first eating the first couple of bites but after eating well i feel relieved. however about one hour after eating the pain comes back again.
I'm thinking to do upper endoscopy to see what's going on but i'm also hoping the tripple therapy might as well treat it without the need to go to gastroentrologist.
here are few questions I have.
1.could this be peptic ulcer bleeding, given that i still don't have any other symptos such as vomiting, diarrhea?
2. why don't i see improvement after 4 days of taking triple therapy, could that suggest that this is not peptic ulcer bleeding?
3.if it's not peptic ulcer bleeding then what could cause upper abdominal pain accompanied by black stool?
4. what do you suggest i should do?
5.shouldI be worried about Zollinger–Ellison syndrome? given my age is 28?
about me
1.weight 84kg
2.regular smoker about half a pack per day, usually the abdominal pain increase when i smoke, especially when I'm hungry. smoking for almost 10 years now.
3.Don't drink alcohol at all.
4.age 28
Brief Answer:
It's probably upper gastrointestinal bleeding.
Detailed Answer:
Hello,
It does sound like upper gastrointestinal hemorrhage (bleeding) but an upper endoscopy is required.
(1) yes, you can have gastrointestinal bleeding with minimal symptoms only.
(2) no... first of all, the drugs you're taking are supposed to treat Helicobacter pylori infection, not an actively bleeding peptic ulcer. A bleeding ulcer is treated with proton pump inhibitors, nil food intake and sometimes with endoscopic techniques but a diagnosis is needed first! Failure to respond to the treatment does not mean it's not an ulcer.
(3) a tumor... a tear on the mucosal surface... a bleeding tortuous vein in the esophagus... etc.
(4) you should do the upper endoscopy as soon as possible (immediately).
(5) Zollinger-Ellison is not a common diagnosis, so it's not very likely. Your doctor would suspect it in case the ulcers are atypical (more than one, on atypical locations, refractory to treatment) and will ask for gastrin measurement to confirm it. Your age is not suggestive of this syndrome either although it may occur to 28-year old individuals.
Hope I have answered your query. Let me know if I can assist you further.
Regards,
Dr. Panagiotis Zografakis, Internal Medicine Specialist
It's probably upper gastrointestinal bleeding.
Detailed Answer:
Hello,
It does sound like upper gastrointestinal hemorrhage (bleeding) but an upper endoscopy is required.
(1) yes, you can have gastrointestinal bleeding with minimal symptoms only.
(2) no... first of all, the drugs you're taking are supposed to treat Helicobacter pylori infection, not an actively bleeding peptic ulcer. A bleeding ulcer is treated with proton pump inhibitors, nil food intake and sometimes with endoscopic techniques but a diagnosis is needed first! Failure to respond to the treatment does not mean it's not an ulcer.
(3) a tumor... a tear on the mucosal surface... a bleeding tortuous vein in the esophagus... etc.
(4) you should do the upper endoscopy as soon as possible (immediately).
(5) Zollinger-Ellison is not a common diagnosis, so it's not very likely. Your doctor would suspect it in case the ulcers are atypical (more than one, on atypical locations, refractory to treatment) and will ask for gastrin measurement to confirm it. Your age is not suggestive of this syndrome either although it may occur to 28-year old individuals.
Hope I have answered your query. Let me know if I can assist you further.
Regards,
Dr. Panagiotis Zografakis, Internal Medicine Specialist
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
1.thanks, doctor I'm currently taking 20mg omeprazole BID. I'm thinking to switch to 40mg Omeprazole BID for a stronger effect?should I?
2.my main worry is tumor given that I was smoking for 10 years, so now I'm thinking since I didn't respond to PPI for 4 days then it's likely it's not a peptic ulcer.
2.my main worry is tumor given that I was smoking for 10 years, so now I'm thinking since I didn't respond to PPI for 4 days then it's likely it's not a peptic ulcer.
Brief Answer:
You can... but should you?
Detailed Answer:
Hi,
Regarding your first question: you can take a higher dosage, 40mg twice daily is acceptable although - normally - it's not necessary. What's more important is to do the endoscopy! Although the presence of solid stool almost excludes massive bleeding, nobody can really say whether bleeding may recur or not. The endoscopic appearance of the ulcer (or other bleeding structure) is important to determine the prognosis. Sometimes endoscopic treatment is necessary.
So although a higher dosage is acceptable, I insist on proceeding with the endoscopy as this is the most important next step right now.
Regarding your 2nd question: Smoking does increase the risk for malignancies (including those of the gastrointestinal tract) but this is not adequate evidence that you have a tumor. The endoscopy again holds the answer...
Hope I have answered your query. Let me know if I can assist you further.
Regards,
Dr. Panagiotis Zografakis, Internal Medicine Specialist
You can... but should you?
Detailed Answer:
Hi,
Regarding your first question: you can take a higher dosage, 40mg twice daily is acceptable although - normally - it's not necessary. What's more important is to do the endoscopy! Although the presence of solid stool almost excludes massive bleeding, nobody can really say whether bleeding may recur or not. The endoscopic appearance of the ulcer (or other bleeding structure) is important to determine the prognosis. Sometimes endoscopic treatment is necessary.
So although a higher dosage is acceptable, I insist on proceeding with the endoscopy as this is the most important next step right now.
Regarding your 2nd question: Smoking does increase the risk for malignancies (including those of the gastrointestinal tract) but this is not adequate evidence that you have a tumor. The endoscopy again holds the answer...
Hope I have answered your query. Let me know if I can assist you further.
Regards,
Dr. Panagiotis Zografakis, Internal Medicine Specialist
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
thanks doctor
final questio. what kind of endoscopic treatments are there for peptic ulcer? do you mean such as cauterization of the bleeding ulcer?
also can i go for video capsule instead of endoscopy?
final questio. what kind of endoscopic treatments are there for peptic ulcer? do you mean such as cauterization of the bleeding ulcer?
also can i go for video capsule instead of endoscopy?
Brief Answer:
No capsule...
Detailed Answer:
Hi,
There are treatments like placing metallic clips, infusing adrenaline and cauterization of the ulcer.
The video capsule is used for bleeding supposedly located in the small intestine. It's not a great method and it's not recommended for upper gastrointestinal bleeding. Endoscopy is the only valid method for your case.
Hope I have answered your query. Let me know if I can assist you further.
Regards,
Dr. Panagiotis Zografakis, Internal Medicine Specialist
No capsule...
Detailed Answer:
Hi,
There are treatments like placing metallic clips, infusing adrenaline and cauterization of the ulcer.
The video capsule is used for bleeding supposedly located in the small intestine. It's not a great method and it's not recommended for upper gastrointestinal bleeding. Endoscopy is the only valid method for your case.
Hope I have answered your query. Let me know if I can assist you further.
Regards,
Dr. Panagiotis Zografakis, Internal Medicine Specialist
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thanks Doctor for your prompt responses, highly appreciate it.
I just came back from emergency to check hemoglobin level and occult blood in stool test.
I'm surprised it didn't show any blood in the stool and my hemoglobin level was 15.
i uploaded test results above.
When i went to the bathroom before I went to the hospital the stool was more like black but when i gave the sample in the hospital it was slightly black to somewhat dark brown.
1. could it be that i had dark stool sign of bleeding but when i went to hospital the bleeding was stopped?
2.if there was bleeding that would show in stool wouldn't hemoglobin level below?
3.does these test results show it's not GI bleeding? then what could this dark stool and painful epigastric area be?
I just came back from emergency to check hemoglobin level and occult blood in stool test.
I'm surprised it didn't show any blood in the stool and my hemoglobin level was 15.
i uploaded test results above.
When i went to the bathroom before I went to the hospital the stool was more like black but when i gave the sample in the hospital it was slightly black to somewhat dark brown.
1. could it be that i had dark stool sign of bleeding but when i went to hospital the bleeding was stopped?
2.if there was bleeding that would show in stool wouldn't hemoglobin level below?
3.does these test results show it's not GI bleeding? then what could this dark stool and painful epigastric area be?
Brief Answer:
Not really surprising.
Detailed Answer:
Hi,
Sometimes patients report 'black' stool but it's not always black. If may be a very dark greenish stool or other colors. Dark stool can be caused by either the presence of too much blood (eating food that contains blood or internal bleeding) or the presence of substances that stain the stool (like beetroots for example) or ingestion of iron supplements.
The color of the stool can be misleading in a picture or in the toilet. Comparing the color of the stool with the color of the stained paper may help more. For example, iron causes the production of dark green stool that may look like black at first but you can see the difference more clearly on the toilet paper.
So getting back to your case,
(1) it is possible if the stool you got for testing was normal
(2) not always, it depends on the amount of lost blood
(3) the results show that there is no active bleeding, they don't make sure that there was no blood unless you gave them a black stool and it was proved to be clear of blood.
My conclusion is this, if the stool you got for testing was black, then blood should have been present provided that blood was the cause of this discoloration. Otherwise, another etiology is more likely. I can't say what caused it but if it's not blood, you should check for supplements or remember what you ate 1-2 days before the stool. Then I'm sure you'll come up with a suspicious food or supplement.
Hemoglobin levels 5 days later should have been a little lower than usual but it depends on the amount of lost blood. Since the stool was solid, the presumably lost blood was not much (larger amounts of blood would have caused diarrhea), so we can't be sure about the expected decline in hematocrit.
Pain in this area may be caused by many disorders including some transient ones (like mild gastroenteritis), so you can't approach it this way. What's important is that no blood was found. If you'd like to be absolutely sure about it then you can still do the endoscopy.
Hope I have answered your query.
Regards,
Dr. Panagiotis Zografakis, Internal Medicine Specialist
Not really surprising.
Detailed Answer:
Hi,
Sometimes patients report 'black' stool but it's not always black. If may be a very dark greenish stool or other colors. Dark stool can be caused by either the presence of too much blood (eating food that contains blood or internal bleeding) or the presence of substances that stain the stool (like beetroots for example) or ingestion of iron supplements.
The color of the stool can be misleading in a picture or in the toilet. Comparing the color of the stool with the color of the stained paper may help more. For example, iron causes the production of dark green stool that may look like black at first but you can see the difference more clearly on the toilet paper.
So getting back to your case,
(1) it is possible if the stool you got for testing was normal
(2) not always, it depends on the amount of lost blood
(3) the results show that there is no active bleeding, they don't make sure that there was no blood unless you gave them a black stool and it was proved to be clear of blood.
My conclusion is this, if the stool you got for testing was black, then blood should have been present provided that blood was the cause of this discoloration. Otherwise, another etiology is more likely. I can't say what caused it but if it's not blood, you should check for supplements or remember what you ate 1-2 days before the stool. Then I'm sure you'll come up with a suspicious food or supplement.
Hemoglobin levels 5 days later should have been a little lower than usual but it depends on the amount of lost blood. Since the stool was solid, the presumably lost blood was not much (larger amounts of blood would have caused diarrhea), so we can't be sure about the expected decline in hematocrit.
Pain in this area may be caused by many disorders including some transient ones (like mild gastroenteritis), so you can't approach it this way. What's important is that no blood was found. If you'd like to be absolutely sure about it then you can still do the endoscopy.
Hope I have answered your query.
Regards,
Dr. Panagiotis Zografakis, Internal Medicine Specialist
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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