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 tractThe 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.
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'
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).