Acidity or Gastric trouble: A Medical Perspective (Part II)
In the first part, Acidity or Gastric trouble: A Medical Perspective (Part:I), we discussed about gastric trouble and how it can be more serious than just acidity and also how it mimics other important conditions. In this second part, the article highlights the way doctors try to differentiate the other conditions and in brief the treatment for the condition.
What other conditions mimic Gastric trouble
- Biliary Colic or Cholecystitis : Since, bile from the liver and gallbladder is important for digestion and given it's close proximity to the stomach, it is not surprising that gallbladder disease is often mistaken for acidity. The clues that one be aware are, pain related to gallstones often comes on after a fatty meal or food at a wedding or a party. This pain is much worse than the pain of acidity and is more likely to require a visit to the hospital for pain relief. Biliary pain can be like a band in the upper abdomen that can be intense and persistent for a few hours. Simple measures and home remedies often are not helpful. Further relevant details about gallstones and gallbladder disease can be found in Gallstone disease and its complications
- Pancreatitis : In simple terms, the pancreas lies between the lower stomach/duodenum and the spine (it is quite deep). Like the gallbladder, the pancreas is also intricately related to digestion by the secretion of pancreatic juice. Pain related to pancreatitis (acute or chronic) is often more intense with pain travelling from the front of the upper abdomen to the back. Pain of pancreatitis also may force one to visit the hospital for further treatment. Often alcohol, stones in the common channel of the bile and pancreatic duct are the triggering factors
- Cardiac disease : We all have read about heart attacks and the current trend about heart attacks occurring in young adults who sadly collapse in the office, at home, on the streets or while on a holiday. Acute myocardial infarction is the correct medical term for heart attack, this again is noted as an intense pain in the lower part of the chest, around the middle and left. It can be mistaken for gastric trouble and can lead to delays in seeking timely medical help. The clue here would be a pain with sweating, pain traveling along the left side of the chest to the left upper limb, pain at the left shoulder pain and unrelenting pain that can incapacitate the person
- Tumours of the stomach and lower food pipe (esophagus) : Like any other part of the body the stomach is also susceptible to develop a malignant change. This presents similar to gastric trouble and by the time a diagnosis is made on further investigations it can be too late in some cases. These conditions would often be associated with a weight loss, generalized tiredness, stomach pain boring into the back and does not get better with antacid medications or regular painkillers. Some of them may have passed black colored stools or had blood in the vomitus (this can happen in patients with just a stomach ulcer also)
- Tumours of the pancreas : Since the pancreas is snugly placed between the stomach and the duodenum, any condition affecting the pancreas can mimic gastric pain. At times tumors or collection of fluid around the pancreas would present with upper abdominal pain that does not resolve fully with stomach ulcer treatment. After a few months, patients can develop loss of weight, loss of appetite etc
What tests are carried out for gastric trouble?
- Upper Gastrointestinal endoscopy : Doctors often do not jump in for investigations at the first visit itself, unless there is a pattern of recurring symptoms, other findings that stand up as red flags (loss of appetite, weight etc). The most common test carried out is an endoscopy (insertion of a flexible tube via the mouth into the stomach and duodenum, where the doctors can see the inner lining of the food pipe, stomach, and the duodenum, to check for any abnormalities or ulcer etc. In some patients, this can show findings suggestive of a growth in the stomach or the duodenum wherein the doctors would take a biopsy to confirm their suspicion.
Many gastroenterologists do a biopsy or a test to look for indirect evidence of a bacterial infection seen in patients with acidity. If this test is positive, the patient would be prescribed antibiotics along with ulcer healing medicines.
In patients with gastro-oesophageal reflux disease, the endoscopist can also diagnose a hiatus hernia which is the upper part of the stomach slipping across the diaphragm into the chest. This condition can also lead to heartburn and upper abdominal discomfort
- Abdominal ultrasonogram : This test is done more to rule out diseases of the gallbladder or liver, pancreas rather than to check for an ulcer in the stomach
- CT scan : This scan is performed in patients who have findings that arise the suspicion that the patient has something more than just gastric trouble. The would help in assess more carefully the liver, pancreas, and tumors of the stomach
- Blood tests : Blood tests are rarely done to diagnose ulcer or inflammation of the stomach. Certain blood tests are carried out to assess the function of the liver, look for pancreatitis and importantly to rule out a heart attack (along with an ECG, Cardiac marker blood tests are done). If these are abnormal, they are dealt with appropriately and in cases of confirmed heart attack, an action is taken emergently.
In patients with recurrent ulcerations despite effective treatment, the doctors look for certain endocrine disease (checking for parathyroid adenoma or a gastrinoma) that makes the stomach produce higher quantities of acid
- Oesophageal Manometry In patients who have persistent symptoms or heartburn and the diagnosis is likely to be Gastro-oesophageal reflux disease (GERD), then the doctors perform this test to check how well the lower oesophageal sphincter is working ( to prevent reflux of acid from stomach into the lower part of the food pipe). It also checks how the food pipe muscles work in propelling the food from the mouth, along the food pipe into the stomach.
Treatment of Gastric acidity
- Medical Management : Acidity is a good example of the old adage prevention is better than cure. There are many home remedies, dietary suggestions to keep the stomach healthy and prevent symptoms of heartburn, stomach pain etc Top 12 foods to ease acidity and heartburn naturally.
Most doctors and gastroenterologists prescribe anti-ulcer medications like ranitidine, omperazole, pantoperazole etc for a period of 4 weeks with or without oral antacid syrups to quickly relieve the symptoms. The medications used to treat acidity or ulcer broadly include medications that reduce the acidic nature of the stomach content by inhibiting the acid production or medications that strengthen the lining of the stomach. They would also suggest dietary changes and food habits be followed. A word of caution, please do not self-medicate even though these medications are available at many chemists across the counter.
Simple tips to help in Gastric trouble
- Stop smoking and alcohol consumption
- Avoiding spicy food
- Maintain a regular diet pattern and timing when possible
- Take precautions while having medicines that irritate the stomach
- Reducing weight in overweight or obese individuals
- Avoiding junk food, fried or fatty food stuffs
- Having small frequent meals
- Allowing at least an hour to pass before lying down
- Elevating the head end of the bed by at least 4 inches, this reduces reflux of stomach contents into the food pipe.
Often patients feel better and don't feel the need for a follow-up visit. Some keep taking the same medicines again when they have similar symptoms, which is more like self-medications. Such practices are best avoided, based on the accessibility and availability, such patients should re-visit the doctor rather than continuing the same medications. In a small sub-set of patients, symptoms do not resolve as expected and they remain status quo, at such times, it would be worthwhile to have a second opinion or a consultation to re-assess the illness and the developments so far with a fresh pair of eyes
- Surgical Management : Before the advent of medicines like omeperazole and newer acid-reducing medications, surgery was more often performed for a gastric or duodenal ulcer. Now, most patients can be managed without surgery for acidity related issues
- Perforation of Ulcer : This is an emergency condition wherein a hole occurs in the duodenal ulcer or the gastric ulcer leading to intense pain and worsening of the general condition of the patient. Such patients often need an emergency operation to close to hole and wash out the contamination. This surgery is often performed as an open operation. In some cases at an early stage of perforation, this can be performed laparoscopically but not in all cases
- Obstruction of the stomach : Occasionally ulcers of the duodenum heal with bad scarring and narrow the outlet of the stomach ( at the pylorus) and hence can a delay or a blockage in the stomach emptying. In such instances, the narrowing is widened or the area bypassed by a surgical procedure
- Repair of Hiatus Hernia : In patients with reflux of acid into the food pipe due to a hernia at the level of the diaphragm a surgical option is offered when medical treatment fails. Hereby open or laparoscopic technique the hernia (defect) is narrowed and the upper stomach is wrapped around the junction of food pipe and stomach in a way that a hernia is corrected
Conclusion Acidity is a term we commonly use for symptoms related the adverse effects of acidic content in the food pipe or a weakened stomach. Often, it does not cause much trouble, if one follows the preventive measures. However, self-medication, ignoring persistent symptoms can mean something more serious or even sinister. A medical consultation (with our without an endoscopy) would guide the further management in a rational manner. Many tests and medications are available but the treatment varies depending on the condition causing the acidity.
For readers who wish to read the first part for better understanding, please refer Acidity or Gastric trouble: A Medical Perspective (Part:I).