That burning sensation
One of the most common complaints that drives people to consult an gastroenterologist is stomach pain that comes and goes but never seems to get any better.
Often the diagnosis is a peptic ulcer, a collective name that actually refers to peptic ulcer, gastric ulcer and duodenal ulcer. Intermittent stomach pain, occasionally with such complications as internal bleeding, is common to all three conditions and they also share similar causes.
While a peptic ulcer can be caused by a variety of factors, it is the end result of be an imbalance between stomach acid and protective mucosal coating. Increasing stomach acid production will almost certainly result in a peptic ulcer. Stress, anxiety, high caffeine consumption and poor eating habits are also among the culprits.
Another important and frequently seen cause is infection with a type of bacteria called Helicobacter Pylori. H Pylori is transmitted from person to person through saliva. The bacteria live in the mucous layer that covers and protects the tissues that line the stomach leading to inflammation, which develops into an ulcer.
Gastric mucosal damage can be caused by the consumption of aspirin, bone and joint pain relievers such as ibuprofen, alcohol and spicy food.
The most common symptom is a burning sensation that occurs below the xiphoid or upper abdomen. It usually comes on when the patient hungry or when the stomach is empty and is often experienced during the night. The pain is not constant but comes and goes.
Abdominal distension, bloating, rumbling sounds in the stomach, gas in stomach, nausea, and vomiting may also be present.
In more complicated cases, there may be vomiting of blood, black stool as a result of bleeding in the stomach, and severe abdominal pain due to the development of a perforated peptic ulcer.
Various techniques can be employed in the diagnosis of a peptic ulcer. The easiest and least expensive is the barium X-ray – a study of the upper GI tract. While efficient, it does not allow for tissue samples to be collected and sent to the lab for examination.
Oesophagogastroduodenoscopy or EGD is a diagnostic procedure used to examine the lining of the oesophagus, stomach, and first part of small intestine. It can examine the stomach thoroughly and remove tissue samples for examination in a lab. This procedure is widely and safely used.
Generally an injection is given to help the patient relax and a local anaesthetic is often sprayed into your mouth to prevent coughing or gagging when the endoscope is inserted. In some cases, patients may be given a general anaesthetic to make |them sleep during the procedure.
Diagnostic tests to determine Helicobacter Pylori infection include a blood test for immunity, a urea breath test and an |endoscopic biopsy that allows for a rapid urease test, microscopic examination and culture test.
Treatment mainly consists of medications that block acid |production and promote healing. They need to be taken for six to eight weeks.
Antibiotics will be added if the cause of the ulcer is H. Pylori.
Patients will also be advised to make a number of lifestyle changes to allow the ulcer to heal and prevent a recurrence.
These include:
- Developing good eating habits.
- Eating foods that are easily digested and bland.
- Avoiding spicy foods, preserved foods and soft drinks.
- Refraining from smoking and drinking.
- Stopping aspirin and NSAIDs for pain relief
- Avoiding stress and anxiety.
DR NATHAVUT SIRIMONTAPORN is a specialist in gastroenterology and hepatology at Samitivej Sukhumvit Hospital’s Liver and Digestive Institute. Call (02) 711 8822-4.
