Acidity or Gastric trouble: A Medical Perspective (Part:I)


Acidity or Gastric trouble is a widely misused term by the general population. By and large, this term is used by people who have upper abdominal pain, bloating sensation after food, burning sensation in the upper abdomen just beneath the rib cage and in the middle of the chest. People have their own home remedies, treatment suggestions from friends or often self-medicate. This article gives an insight into the likely conditions related and disease that can mimic and mislead patients and doctors.

Introduction

We would have heard the term gastric trouble, acidity or stomach ulcer being used by people around us or some of us may have applied this to a set of symptoms and self-diagnosed ourselves. Although this is not a scientific or a medical terminology, it is accepted in spoken language. The issue here is that many people do not know what all conditions (some are simple, some have the potential to become a major illness) that can be included in this 'Gastric trouble'. The medical equivalent of gastric trouble is 'Acid peptic disease' and includes inflammation of the stomach, food pipe (oesophagus), ulcer of the stomach (gastric ulcer) or duodenum (duodenal ulcer) or reflux disease.

Dynamics of the upper digestive tract

The food pipe is a hollow strong muscular tube that has to accept the food swallowed and deliver it into the stomach. In the stomach, digestion begins and it delivers the food (mixed with gastric digestive juices) to the small intestine starting from duodenum to the ending at ileum. Along this route, from the mouth to the small intestine, the only part that can handle acidic content, is the stomach. The stomach has amazing properties that it secretes acid and yet can protect itself from self-harm. It is at times when this protective mechanism fails or is disturbed, that symptoms of acidity creep up. Similarly, when the gastric acid moves up into the food pipe or goes down into the duodenum, symptoms of acid-induced damage start.

Common Symptoms

  1. Heartburn : A burning sensation in the middle of the chest more in the front than the back. It is commonly seen after a meal, after coffee or spicy food and on stooping (bending down)


  2. Waterbrash : Excessive salivation/bringing up of acidic clear fluid up to the mouth during burping, during brushing or after a heavy meal


  3. Epigastric pain : Pain in the upper abdomen just below the ribcage in the middle after a meal. Often difficult to differentiate between this and hunger pains


  4. Sense of bloating : The unemptied stomach tries to either push to contents down or throw up, in this process, people feel heaviness or a bloating sensation that gets better after sometimes with home remedies or medications


  5. Nausea : A feeling or a sensation to vomit, that gets better after burping, actually vomiting or after taking an appropriate home remedy/medication.

  6. Vomiting
  7. Forceful expulsion of contents of the stomach, (can be food, partly digested food, undigested food or just gastric juice)

  8. Vomiting of blood : Bringing up blood either in streaks or large amounts


  9. Passing black sticky stools : Black smelly stools that do not flush away easily


  10. Severe abdominal pain : Upper abdominal pain in the middle that does not settle with medicines or home remedies, often needs admission or observation with anti-ulcer medicines given as injections


  11. Being sick or individual collapsing : In some conditions wherein an ulcer perforates (hole at the place where the gastric or duodenal ulcer is) or when individuals vomit blood or pass black sticky stools, they can be ill enough to be unable to get out of bed or even collapse because of intense pain or after vomiting or passing the stools


Is it important to know the underlying cause?

Yes, it is important to know what the cause of the symptoms is. Is it part of the acid peptic disease or it is something that is masquerading as Gastric trouble. The treatment, severity of the illness, lifestyle changes and the follow-up would be different depending on the underlying primary cause. For instance, in patients with 'Gastritis', doctors wouldn't be too concerned because this would settle with medicines and simple diet changes. In contrast, when there is an active duodenal ulcer or a gastric ulcer, then the doctors would be concerned about patient compliance with medications, regular follow-up and even a second endoscopy.

The correct diagnosis is even more important in patients who have major cardiac or pulmonary conditions that need regular blood thinning medications. In patient's who need to go on anti-coagulants or who are on anticoagulants, 'Gastric trouble' should be taken seriously and investigated promptly as they can have just gastritis ( inflammation of the stomach) that can settle with just medications or have a duodenal ulcer that would need aggressive medical therapy or even changing/stopping anti-coagulant medications.

In patients who have chronic liver disease related to alcohol, gastric trouble could also mean having dilated blood vessels in the food pipe (called as varices) that can lead to a life-threatening bleeding, vomiting of blood and or death. So, these patients would need regular long-term follow-up, medications and periodic endoscopies.

Elderly individuals, people who are overweight often have joint pains and would need to be on painkillers regularly. In such patients 'gastric trouble' could just be an unwanted effect of the medicine swallowed or worsening on an undiagnosed gastric or duodenal ulcer that needs to be addressed more proactively.
Some individuals or patients keep taking anti-acid medications or alternative forms of therapy and present late to the doctors when the disease is different, one that could have been managed better if diagnosed early.

It is often a cause for concern if symptoms are worsening in the elderly patients. When the symptoms are becoming regular, associated with loss or weight, weakness, lethargy or stomach pain going to the back it needs to be investigated adequately, for doctors find it is gastric trouble because of an underlying stomach cancer or a pancreatic problem.

Conditions masquerading as 'Gastric trouble'

  • Biliary colic or Cholecystitis:
  • Pancreatitis
  • Cardiac disease
  • Tumours of the Stomach and esophagus
  • Tumours of the pancreas


How can we differentiate among the conditions? what are the relevant tests? what would the treatment measures and preventive measures? would be discussed in the second article. Acidity or Gastric trouble: A Medical Perspective (Part:II).


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