UOMC Doctors Urge Against Ignoring Belly-Aches
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ATHENS, Ohio (January 12, 2001) -- A belly-ache is never pleasant, but most people have learned not to complain. Most Americans suffer from dyspepsia (literally "bad digestion") at one time or another. The term covers a variety of aches, discomfort, burning and bloating in the upper abdomen-usually associated with eating.
For unknown reasons, persons suffering abdominal pain have higher than average scores for depression, anxiety and other psychiatric disorders. But even if your belly-ache seems to get worse during times of stress, what you're feeling is certainly not in your head and may well signal a medical problem that requires early treatment.
According to Steven G. Carin, Jr., D.O., associate professor of internal medicine at the Ohio University College of Osteopathic Medicine (OU-COM) and chief of the department of gastroenterology at O'Bleness Memorial Hospital, "Ulcers have long been linked to acid, but it's now known that most cases involve a bacterial infection that can be treated with antibiotics."
"Heartburn is an even more common cause of dyspepsia, affecting about 40 percent of the population at least once a month. But even heartburn, if it's chronic, can lead to more severe medical problems and should not be taken lightly," cautioned Dr. Carin.
Whether you suffer from ulcers, heartburn or merely bloating and gas, numerous over-the-counter medications are available, but they seldom offer a long-term solution. For a belly-ache that persists, you're better off seeing your doctor.
New View on Ulcers
According to Dr. Carin, "If you suffer from a gnawing pain in the area between your navel and your breastbone that tends to be worse when your stomach is empty, you may have an ulcer. About one of every 10 Americans suffers from a peptic ulcer, defined as a sore on the lining of the stomach or small intestine."
The pain may last from a few minutes to many hours-often severe enough to awaken you in the middle of the night. The symptoms can usually be relieved by eating food or taking an antacid or acid blocker.
More severe symptoms include vomiting blood (which may be either red or black), dark blood in the stool, nausea, vomiting, unexplained weight loss and pain in the upper back.
For years, patients assumed that their ulcers were a chronic condition brought on by stress and spicy foods. At one time they were even advised to drink milk, which is now known to actually increase the production of acid in the stomach and make matters worse.
In 1982, Australian researchers Barry Marshall and Robin Warren challenged that traditional view with results showing that a bacterial infection-and neither stress nor diet-was the cause of most ulcers. To silence the many skeptics, follow-up studies consistently demonstrated that about 80 percent of stomach ulcers can be linked directly to a helicobacter pylori (H. pylori) infection which can be eradicated in a matter of weeks with a course of antibiotics.
H. pylori damages the lining of the stomach and also the cells that produce acid-thereby resulting in excess acid. H. pylori is common; about 80 percent of the population in third world countries and about 50 percent of older adults in the United States are infected, possibly because of consuming contaminated food or water at some time during their lives. For reasons unknown, however, only about one of six infected persons develops ulcers or other digestive problems.
Ulcers can also be caused by chronic use of aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, naproxen sodium and ketoprofen.
Rarely if ever does an ulcer require a bland diet or even antacids; it does help, however, to stop smoking. Treatment with antibiotics generally must be accompanied by medications that reduce the amount of digestive acids-usually H2 blockers (Tagamet, Pepcid, Axid, Zantac) and/or proton pump inhibitors (Prilosec, Prevacid, Protonix, Aciphex).
Healing the Burn
Even if you've never experienced heartburn yourself, you've undoubtedly seen the condition graphically portrayed in TV ads. More than 15 percent of Americans have symptoms of heartburn at least once a month and up to seven percent suffer on a daily basis.
James Bove, III, D.O., associate professor of surgery at OU-COM, states, "As opposed to the gnawing pain of an ulcer, heartburn involves the regurgitation of acids from the stomach into the esophagus, typically resulting in a burning pressure or pain from the breastbone up the throat."
The pain, sometimes lasting several hours at a time, may get even worse right after eating or when you're lying down or bending over. It's often severe enough to be mistaken for a heart attack.
According to Dr. Bove, "Causes of heartburn include overeating, obesity, tight clothing or a malfunction of the muscular valve that controls flow between the esophagus and the stomach. This malfunction in turn can be traced to foods such as coffee, tea, cola, chocolate, alcohol, garlic, onions and fatty foods or to nicotine or certain medications that tend to relax this valve. Positions such as bending over or lying down can also allow stomach acid to flow up the food tube."
When symptoms are severe or when they occur at least twice a week, they may represent gastroesophageal reflux disease (GERD), a serious disorder that can lead to even more severe problems.
Dr. Bove added, "Chronic inflammation caused by heartburn symptoms can eventually produce bleeding sores in the esophagus. When these sores heal, they often form scars that narrow the tube and make it difficult to swallow."
Most severe is a conditioned called Barrett's metaplasia which involves the growth of abnormal cells in the lower esophagus caused by heartburn irritation. These cells are less sensitive to acid-thereby reducing the pain-but they create an elevated risk of cancer of the esophagus, a disease that has been increasing at alarmingly high rates over the past three decades, particularly among white males.
Only two percent of persons with GERD develop sores and scarring. Only two to five percent of those with Barrett's metaplasia get esophageal cancer. Nevertheless, the risk is high enough that anyone with severe, recurring symptoms of heartburn should not hesitate to see a doctor.
Treatment usually involves lifestyle changes-smoking cessation, weight loss and avoidance of foods that cause the problem-plus antacids, H2 blockers, proton-pump inhibitors, coating agents such as sucralfate (Carafate) and prokinetic agents such as metoclopramide (Reglan). Another prescription prokinetic agent, cisapride [Propulsid], was taken off the market earlier this year because of reports of heart rhythm abnormalities and several deaths.
As an alternative to lifelong medical treatment, a surgical procedure to prevent acid reflux has been developed. In cases where ingesting medicine has been ineffective, or when younger patients decide that a definitive short-term solution is preferable, many have turned to this operative cure for acid reflux. Dr. Bove and colleague, J. Michael Sutherland, D.O., also an associate professor of surgery at OU-COM, perform a minimally-invasive surgical procedure for patients who suffer from GERD at O'Bleness Memorial Hospital and Doctors Hospital of Nelsonville. This videoscopic surgery for appropriate patients with GERD has a 90% success rate and involves minimal scarring, a short hospital stay and quick recovery.
Patricia Orth, 54 yrs., a McArthur resident, suffered with symptoms of GERD for several years until she learned about the new surgical treatment. "I would wake up 3 or 4 times each night with acid burning in my throat," said Orth, who is a leader in the Three Spirit Band of Free Cherokee. "I couldn't sleep. I would have to sit up."
Before surgery, tests revealed that Patricia's pyloric sphincter valve was eaten away and the lower part of her esophagus was ulcerated. Ms. Orth underwent the Laparoscopic Anti-Reflux procedure at O'Bleness Memorial Hospital last summer. In her case, the surgery took about sixty minutes. Now, after surgery, life is a lot different for Orth. "I feel much better," said Patricia. "I can eat what I want and I can go camping or participate in normal activities without fear. And, best of all, I can sleep all night through again!"
In addition to heartburn, GERD and ulcers, there are many reasons you may experience pain or discomfort in the upper abdomen. These include gall bladder disease, a viral infection, poor digestion of carbohydrates, stomach cancer or an H. pylori infection that has not yet become an ulcer.
Only 25 percent of Americans suffering from dyspepsia go to the doctor, but most of those who do have an identifiable medical disorder that requires treatment. Both Dr. Carin and Dr. Bove strongly recommend that if you have symptoms that are severe or recurrent you should consult your physician.
