Stomach

Reasons Your Stomach Hurts

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Tummy Trouble

Tummy Trouble

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Everyone’s stomach gets a bit out of sorts from time to time. But in some cases, depending on your symptoms, you may need to see your doctor.

Gastritis

Gastritis

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The liquid that helps you digest food has a lot of acid in it. Sometimes these digestive juices get through the protective barrier in your stomach and irritate its lining — that’s called gastritis. It can be brought on by bacteria, regular use of pain relievers like ibuprofen, too much alcohol, or stress. You can sometimes treat it with over-the-counter antacid or prescription medicines. But see your doctor because  it can lead to bleeding or stomach ulcers.

Peptic Ulcer

Peptic Ulcer

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These are open sores on the lining of your stomach or the upper part of your small intestine. The most common cause is bacteria, but again, long-term use of aspirin, ibuprofen, and other painkillers can play a role. And people who smoke or drink get these ulcers more often. They’re usually treated with prescription medicines that decrease stomach acid or antibiotics, depending on the cause.

Stomach Virus

Stomach Virus

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Also known as the stomach flu, this is a viral infection in your intestines. You may have watery diarrhea, cramps, or nausea, and you might throw up. You can get it from someone who has it or contaminated food. There’s no treatment, but it usually goes away on its own. See a doctor if you have a fever, you’re throwing up, dehydrated, or you see blood in your vomit or stool.

Food Poisoning

Food Poisoning

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Bacteria, viruses, and parasites in food cause this illness. You may have diarrhea, nausea, and vomiting. It happens when food isn’t handled properly. It usually gets better on its own, but see a doctor if you’re dehydrated, see blood in your vomit or stool, or you have diarrhea that is severe or lasts for more than 3 days. Also call your doctor if you have any symptoms of food poisoning and you have other health problems or have a weak immune system.

Irritable Bowel Syndrome

Irritable Bowel Syndrome

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This common illness affects your large intestine (also called the colon). It can cause cramping, bloating, and mucus in your stool. You may go back and forth between diarrhea and constipation. It’s not clear why it happens, but food, stress, hormones, and infection may all play a part. A doctor may be able to help you control symptoms through changes in your diet or lifestyle, or medication.

Lactose Intolerance

Lactose Intolerance

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Lactose is the sugar in milk and other dairy products. If you don’t have enough of an enzyme called lactase, your body can have trouble breaking it down. That can cause diarrhea, gas, bloating, and belly ache.  There’s no cure, but you can manage it if you have only a small amount of dairy in your daily diet, buy lactose-free dairy products, or take over-the-counter lactaid pills.

Pelvic Inflammatory Disease

Pelvic Inflammatory Disease

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This happens to women: It’s inflammation of the reproductive organs, often following a sexually transmitted disease like chlamydia or gonorrhea. Besides pain in your belly, you might also have a fever, unusual discharge, and pain or bleeding when you have sex. If you catch it early, it can be cured, usually with antibiotics. But if you wait too long, it can damage your reproductive system.

Food Allergy

Food Allergy

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This happens when your body mistakes a certain food for something harmful and tries to defend against it. In addition to a stomachache, symptoms also can include tingling and swelling in your mouth and throat. In severe cases, it can cause shock and even death if it’s not immediately treated with a drug called epinephrine. Shellfish, nuts, fish, eggs, peanuts, and milk are some of the more likely triggers.

Appendicitis

Appendicitis

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Your appendix is a finger-shaped organ that is found at the beginning of your colon in the lower right part of your belly. It’s not clear what the appendix does, but when it’s inflamed, it’s usually infected and should be taken out. If it bursts, it can spread bacteria. Pain often starts at your belly button and spreads down and to the right. See a doctor immediately if you think you might have appendicitis.

Gallbladder Attack

Gallbladder Attack

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This happens when gallstones — small rocks made from juices that help with digestion — block the tubes, or ducts, that run between your liver, pancreas, gallbladder, and small intestine. The most common symptom is abdominal pain — if it is severe or lasts more than several hours, call your doctor. You may also have nausea, vomiting, fever, tea-colored urine, and light-colored stools. The stones often move on their own, but you might need surgery if they don’t.

Incarcerated Hernia

Incarcerated Hernia

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A hernia happens when a part of your intestines slides through your abdominal wall. When it gets twisted or moved, and cut off from its blood supply, it can cause severe pain in your belly. Surgery is often needed quickly to correct the problem.

Constipation

Constipation

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Exercise, plenty of water, and foods that have a lot of fiber, like prunes and whole grains, can help. But if you regularly pass fewer than three stools a week, have to strain to go, and your stools are usually lumpy and hard, that can be a sign of a more serious condition. See your doctor if you have any of these.

Pancreatitis

Pancreatitis

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This happens when your pancreas, an organ that helps your body process sugar and digest food, gets inflamed. You may have pain in your upper belly that gets worse after you eat. You may also have nausea, and you might throw up. Mild cases may go away on their own, but severe cases can be dangerous. Your doctor may ask you to stop eating for a day or two and give you pain meds. If that doesn’t clear it up, you might need to be in the hospital to get nutrition and fluids.

Inflammatory Bowel Disease (IBD)

Inflammatory Bowel Disease (IBD)

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Inflammatory bowel disease, or IBD, has two main forms: ulcerative colitis (UC) and Crohn’s disease. In both conditions, your immune system seems to overreact and inflame your intestinal tract. Though IBD doesn’t affect your stomach directly, belly pain and nausea are common symptoms, along with diarrhea, joint pain, fever, skin rashes, and other symptoms. Your doctor can help you manage your IBD with special medications along with lifestyle changes. 

Diverticulitis

Diverticulitis

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Small bulging pouches can form in the lining of your digestive system, usually in the lower part of your large intestine. They’re pretty common and don’t typically cause problems. But if they get inflamed or infected they can cause severe abdominal pain, nausea, and changes in bowel movements. Rest and changes in your diet can help. Your doctor might prescribe antibiotics as well.

H. Pylori Eradication Might Reduce Recurrent Gastric Cancer After Surgery.

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Thirty-six months after subtotal gastrectomy for gastric cancer, patients who were H. pylori-free had less glandular atrophy and intestinal metaplasia than infected patients.
Intestinal metaplasia (IM) and glandular atrophy (GA) have been identified as preneoplastic conditions in patients infected with Helicobacter pylori. The role of H. pylori eradication in improving these conditions after subtotal gastrectomy for gastric cancer is unclear.

To investigate this issue, researchers in Korea randomized 190 patients with gastric cancer and H. pylori infection to receive 7 days of proton-pump inhibitor–based triple therapy or placebo prior to surgery. The greater and lesser gastric curvatures were biopsied prior to surgery and at 12 and 36 months after surgery and evaluated according to the updated Sydney criteria. H. pylori infection was determined by both a rapid urease test and histologic examination of endoscopic biopsies. Histological findings of GA and IM were scored to indicate presence and severity (absent, 0; mild, 1; moderate, 2; severe, 3).

At 36 months, 75% of patients in the treatment group were free of H. pylori compared with 41% of the placebo group. The mean GA and IM scores did not differ between the two groups. However, compared with H. pylori-infected patients, those without H. pylori had less atrophy (P=0.005) and IM (P=0.03).

COMMENT

The lack of difference in glandular atrophy or intestinal metaplasia between study groups at 36 months might be explained by a type II error. Histological scores for both were lower in the treatment group, but these differences did not reach statistical significance, possibly because of the low eradication rate in the treatment group, the high spontaneous remission rate in the placebo group, or the relatively large number of patients lost before the final analysis. As the authors concluded, the findings suggest that successful H. pylori eradication might reduce the preneoplastic changes in the gastric remnant after gastric surgery, but the clinical significance of the histologic changes remains to be determined.

Source: NEJM

Wireless Motility Capsule Versus Other Diagnostic Technologies for Evaluating Gastroparesis and Constipation: A Comparative Effectiveness Review..

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To systematically review the evidence comparing wireless motility capsule (WMC) with other diagnostic tests used for the evaluation of gastroparesis and slow-transit constipation, in terms of diagnostic accuracy, accuracy of motility assessment, effect on treatment decisions, effect on patient-centered outcomes, harms, and effect on resource utilization. Data sources. We searched Medline ® and Embase ® from inception through July 2012. Additionally, we scanned reference lists of relevant articles and queried experts. Review methods. We included studies in any language that compared WMC with other diagnostic tests among patients with suspected gastroparesis or slow-transit constipation. Two reviewers independently assessed articles for eligibility, serially abstracted data from relevant articles, independently evaluated study quality, and graded the strength of the evidence (SOE). We summarized results qualitatively rather than quantitatively because of the heterogeneity of studies. Results. We included 12 studies (18 publications). Seven studies evaluated diagnosis of gastric emptying delay; we found low SOE that WMC alone was comparable to scintigraphy for diagnostic accuracy, accuracy of motility assessment, effect on treatment decisions, and effect on resource utilization. Sensitivity of WMC compared with gastric scintigraphy ranged from 59 to 86 percent and specificity ranged from 64 to 81 percent. We found two studies evaluating WMC as an add-on to other testing. The SOE was low for diagnostic accuracy and for the accuracy of motility assessment by WMC in combination with other modalities. The addition of WMC increased diagnostic yield. Nine studies analyzed colon transit disorders and provided moderate SOE for diagnostic accuracy, accuracy of motility assessment, and harms. WMC was comparable to radiopaque markers (ROM), with concordance ranging between 64 percent and 87 percent. Few harms were reported. The evidence was insufficient to justify conclusions about effects of WMC on treatment decisions and resource utilization. Conclusions. WMC is comparable in accuracy to current modalities in use for detection of slowtransit constipation and gastric emptying delay, and is therefore another viable diagnostic modality. Little data are available to determine the optimal timing of WMC for diagnostic algorithms.

Source: AHRQ Comparative Effectiveness Review.

Is Helicobacter pylori Eradication Sufficient for Bleeding Ulcers?

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A prospective study suggests that peptic ulcer rebleeding is very unusual after H. pylori eradication and that maintenance antiulcer therapy may not be needed.

Helicobacter pylori infection is associated with peptic ulcer disease, and eradication of the infection reduces ulcer recurrence. The need for maintenance acid-reduction therapy in this setting is controversial.

To explore this issue, investigators at 10 university hospitals in Spain prospectively studied 1000 patients with endoscopically documented bleeding peptic ulcers and H. pylori infection. Participants were treated until eradication of the infection was confirmed by breath test. Thereafter, they received no acid-reduction therapy and were told not to take aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs). They returned at 1-year intervals for a clinical examination and a breath test for H. pylori. If signs or symptoms of upper gastrointestinal bleeding occurred, urgent endoscopy was performed.

All participants were followed for at least 12 months (total, 3253 patient-years of follow-up). Recurrence of peptic ulcer bleeding was rare, occurring in three participants during year 1 and two during year 2. All five cases of rebleeding involved either H. pylori reinfection or NSAID use. The cumulative incidence of rebleeding was 0.5% (95% confidence interval, 0.16%–1.16%) overall and 0.15% (95% CI, 0.05%–0.36%) per patient-year of follow-up.

Comment: These findings provide excellent evidence that H. pylori eradication is sufficient therapy for peptic ulcer patients — even if they had bleeding — in the absence of other causes for ulcers. Forty-one percent of the patients in this study had previously used NSAIDs or aspirin. Without a control group in which NSAIDs are continued, we cannot assess the effect of H. pylori eradication alone, but if such agents are avoided, H. pylori eradication appears to be definitive ulcer therapy. The real clinical challenge is to keep these patients from taking NSAIDs and identify those at high risk for H. pylori reinfection to determine who should be considered for continued antiulcer therapy.

Source: Journal Watch Gastroenterology