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Forum Name: Gastroenterology Topics

Question: stomach problems


 karladd - Wed Sep 29, 2004 10:43 am

FOr the past few days i have had pain in my abdomon above my navel and what i think is heart burn (it stings in my chest) and a bit of pain in my left abdomen when walking for a while. My stomach is constantly churning as thought it is hungry even after i eat and i cant stop burping. i can feel my intestines churning too but i do eat and its hard for me and emberassing because i am always burping. the last time i burped so much was when i had my tonsillectomy a year and a half ago... i got the pain in my stomach the day after i went running it hurt when i ate but now it just hurts food doesnt effect it anymore...
 Dr. Tamer Fouad - Sun Jul 02, 2006 3:03 pm

User avatar Hello,

Dyspepsia is upper abdominal pain or discomfort that is episodic or persistent and often associated with belching, bloating, heartburn, nausea or vomiting.

There are many causes for dyspepsia which include peptic ulcers and gastroesophageal reflux disease (GERD). Other causes include irritable bowel syndrome, biliary tract disease or medication induced.

Gastric or esophageal cancers are serious causes but account for fewer than 2 percent of cases.[1]

In about 50 to 60 percent of patients, a specific etiology is not identified (ie, "functional" or nonulcer dyspepsia) which is the most common cause of dyspepsia.[3]

After a thorough clinical evaluation and detailed history, conditions such as GERD, irritable bowel syndrome, biliary pain and medication-induced dyspepsia can most likely be confirmed or excluded.[2]

Those at high risk for serious disease (cancer) should be identified. Those include patients above the age of 50 years, those with dysphagia, anorexia with weight loss or persistent vomiting; in addition to those with a palpable mass or those with evidence of GIT hemorrhage (melena, anemia or hypotension) and those presenting with a board-like abdomen. All patients at high risk should undergo immediate endoscopy.

The remaining patients probably have ulcer-like, dysmotility-like or functional (nonulcer) dyspepsia.[3]

Once it is determined that the condition is safe the patient may be given a trial of empiric antisecretory drug therapy.

In all patients, management includes avoidance of ulcerogenic agents (including alcohol), patient reassurance, stress reduction and smoking cessation. All empiric drug trials should be stopped after 6 to 8 weeks, and endoscopy should be performed if symptoms return or continue.[1]

References:
==========
1. Talley NJ, Silverstein MD, Agreus L, Nyren O, Sonnenberg A, Holtmann G. AGA technical review: evaluation of dyspepsia. Gastroenterology 1998; 114:582-95.
2. American Gastroenterological Association medical position statement: evaluation of dyspepsia. Gastroenterology 1998;114:579-81.
3. Talley NJ. The role of Helicobacter pylori in nonulcer dyspepsia. A debate--against. Gastroenterol Clin North Am 1993;22:153-67.

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