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Feb 21, 2008

Sad, benign guts

In the conclusion of this two-part series, we look at the benign diseases of the upper gastrointestinal tract.

ALTHOUGH stomach cancer can be a possible cause for stomach discomfort, there is no reason to panic when we experience pain in the stomach region.

...‘When people describe their abdominal pain as ‘gastric’, they are usually talking about a condition called dyspepsia.’...

There are also some diseases which are not cancerous that could affect the health of your stomach as well, said upper gastrointestinal surgeon Dr Ramesh Gurunathan.

For 26-year-old Mohd Sobree Johad, irregular eating habits and a penchant for hot and spicy food has taken a toll on his stomach.

As a silat teacher, he would teach all day without taking solid food, except for the occasional cup of Milo and teh tarik to keep him going during busy days. When he finally sits down to have a meal, he spices up his meal with sambal and cili api.

After three months preparing for a competition with those eating habits, he developed what he termed as “gastric”.

“At first it was just a dull stomach discomfort when I eat after a long day without solid food, then it progressed to an excruciating pain that hits me intermittently throughout the day,” Mohd Sobree said.

He then underwent an endoscopy and found out that there were infection and lesions in his stomach. Soon after, when the medications he took for about a year had ceased to assuage his pain, he was referred for an operation to remove part of his gastrointestinal tract.

“At first I was unsure about the operation and delayed it ... now I’m just relieved that it is all over,” he added.

Now, he is a changed man. Apart from eating more vegetables and staying away from spicy food, he is also determined to eat regularly and reduce his smoking.

While traditional medicine may offer relief to symptoms of some benign diseases, it is also important to get medical consultation to diagnose your condition before embarking on any form of treatment, Dr Ramesh added.

Many common diseases of the stomach such as the Helicobacter pylori (H. pylori) infection and gastroesophageal reflux may lead to more serious illnesses (such as stomach cancer and perforation of the gastrointestinal tract).

“Besides endoscopy (which is the gold standard for diagnosing diseases of the stomach), benign diseases such as peptic ulcer and gastroesophageal reflux can also be diagnosed with other tests such as blood tests,” said Dr Ramesh.

That is why your doctor may carry out other tests to rule out benign diseases before referring you for an “invasive” procedure such as an endoscopy.
What do you mean by ‘gastric’?

“When people describe their abdominal pain as ‘gastric’, they are usually talking about a condition called dyspepsia,” Dr Ramesh said.

Dyspepsia, sometimes also known as indigestion, can be described as a bloated feeling and a feeling of discomfort in the stomach region.

Other signs of dyspepsia may include a gnawing or burning stomach pain, nausea, vomiting or burping. However, signs and symptoms may differ between individuals2.

“The pain may be caused by many contributing factors, including causes other than gastric (stomach) ones,” surgeon Dr Ahmad Sudirman said.

“It may be due to diseases of the stomach such as stomach ulcers, gastritis, gastric reflux, cancer or other causes such as gall stones, inflammation to the pancreas, heart disease and lung infection.

“But the most common causes of upper abdominal pain are still peptic ulcer and gastritis,” he added.

If the symptoms of dyspepsia are persistent even with medication – and come with other symptoms such as sudden and unintentional loss of weight, having trouble swallowing solid food, persistent vomiting and passing black stools – you might need to seek medical assistance as soon as possible.
Usually, blood and stool tests can be done to identify the cause of gastritis so that you can be treated accordingly. If further investigation is needed, you may be referred for an upper gastrointestinal endoscopy to examine your stomach lining

Other than cancer, what could go wrong?


There are a number of factors that lead to gastritis (inflammation of the stomach).

It can be caused by drinking too much alcohol, prolonged use of drugs such as non-steroidal anti-inflammatory drugs (NSAIDs) like aspirin or ibuprofen, certain chronic diseases such as pernicious anaemia (autoimmune disease) and chronic bile reflux.

“Infection with H. pylori can also cause gastritis as well,” said Dr Sudirman, who emphasised that a proper diagnosis of stomach diseases should be done, as their symptoms are similar.

Common symptoms of gastritis are abdominal upset or pain, belching, a feeling of fullness or burning in the upper abdomen. Other symptoms such as blood in your vomit or black stools may be a sign of bleeding in your stomach, which requires immediate medical attention4.

Usually, blood tests and stool tests can be done to identify the cause of the gastritis so that you can be treated accordingly. If further investigation is needed, you may be referred for an upper gastrointestinal endoscopy to examine your stomach lining.

The treatment of gastritis depends on the cause of the condition. If your gastritis is caused by an infection such as H. pylori, your doctor may prescribe antibiotics to clear the infection.

As stomach acid irritates inflamed tissue in the stomach, treatment also usually involves taking drugs (antacids) to reduce stomach acids so that the healing process can be facilitated.

Peptic ulcer

A peptic ulcer is a sore in the lining of your stomach or duodenum (first part of your small intestines).

The most common symptom of this condition is a burning pain in the gut that feels like a dull ache. It comes and goes for a few days or weeks and starts two to three hours after a meal. Sometimes it comes in the middle of the night when your stomach is empty and usually goes away after you eat3.

Peptic ulcer is one of the most common causes of abdominal pain.

According to the US National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), H. pylori causes almost two-thirds of all ulcers. However, not everyone who has an infection will develop an ulcer.

Other causes include the chronic usage of NSAIDs like aspirin and ibuprofen and rare disorders such as the Zollinger-Ellison syndrome.

But isn’t peptic ulcer also about stress and spicy foods? Surprisingly, according to the NIDDK, neither of them causes ulcers. However, just like alcohol and smoking, they could make ulcers worse.

Tests that could be done to diagnose peptic ulcers are a barium x-ray (you drink liquid containing barium and do an x-ray) or an endoscopy.

Although it is benign in nature, peptic ulcers should not be taken lightly. As ulcers involve the erosion of the stomach lining, it may carry a risk of perforation (the ulcer has gone through the stomach or duodenal wall).

Certain symptoms to look out for are black or bloody stools and bloody vomit. These could be signs of the ulcer damaging a blood vessel, stopped food from moving from the stomach into the small intestines or gone through the stomach wall3. If you have these symptoms, medical treatment must be sought quickly.

Peptic ulcers can be treated by medication such as proton pump inhibitors, said upper gastrointestinal surgeon Dr Grace Lim. If there is a bacterial origin to the ulcer, antibiotics are given to kill the bacteria.

Gastroesophageal reflux disease (GERD)

Gastroesophageal reflux disease (GERD) is a more serious form of the common gastroesophageal reflux (GER)1. An endoscopy can show the examining doctor lesions in the gastrointestinal tract such as ulcers and growths.

“Most of the patients say that they have burning chest pains which goes up to the mouth, and sometimes they have a bitter taste in their mouths,” Dr Ramesh said.

“Some of them can’t sleep at night, because when they lie down after meals they feel a volume of acid going up (from their stomach). These are typical symptoms of reflux.”

GER with atypical symptoms such as chronic cough and sore throat may be difficult to diagnose, he added.

Food regurgitation and feeling bloated are also typical symptoms of GER, Dr Sudirman said.

The reason some people develop GERD is still unclear1. However, one of the reasons associated with the disease is loss of tone in the stomach muscle that prevents the acid from the stomach from going to the oesophagus, Dr Ramesh said.

The weakening of these muscles will allow the acid to go into the oesophagus, causing the burning sensation in the upper abdomen or chest, Dr Lim added.

Other factors that may contribute to GERD include obesity, pregnancy and smoking.

In a fact sheet on GERD by the NIDDK in May 2007,it is stated that there are a few common foods that can worsen reflux symptoms.

They are citrus fruits, chocolate, drinks with caffeine or alcohol, fatty and fried foods, garlic and onions, mint flavourings, spicy foods and tomato-based foods such as spaghetti, salsa, chilli and pizza.

“The way to assess a (gastroesophageal) reflux is to have an endoscopy done,” Dr Lim said.
Dr Ahmad Sudirman ... ‘The most common causes of upper abdominal pain are still peptic ulcer and gastritis.’

“Manometry studies to assess your muscle tone and pH studies to assess the pH levels in the stomach are also ways to confirm the diagnosis,” Dr Ramesh added.

Depending on the severity of your GERD, treatment may involve one or more of lifestyle changes, medications and surgery.

Examples of these lifestyle changes are smoking cessation, weight loss if needed, eating small but frequent meals, wearing loose-fitting clothes and avoiding lying down for three hours after a meal1.

For Mohd Sobree, whose GERD had become serious, surgery was the best option.

After his operation, Mohd Sobree reckoned that it was not as bad as he thought. Rather, he was relieved that he was finally feeling better.

“Do not be afraid of going to the hospital ... seek treatment before it is too late,” Mohd Sobree advised.

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