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ABDOMEN THE MAGIC BOX - III (February, 2004)
Abdomen, the Magic Box ! (partII)
When the house is on fire !!
One of the commonest stomach (abdominal) problems in our people are the result of excessive production of "Acid Gastric Juice" in the stomach. The causes for this excess are far too many - the type of food we take, the addictions to tobacco, alcohol etc and the type of individual you are - whether highly nervous and excitable or otherwise. The symptoms due to excessive acidity (hyperacidity) are also of various descriptions(as  described by a patient). Very often it is like burning fire ! There is "burning sensation ", sometimes severe and intolerable, almost like a "house on fire". This burning pain may be in upper stomach(epigastrium), just below the rib cage, in the middle of chest, in the region of breast bone (called as "heart burn", but nothing to do with heart) or even in the neck & throat, sometimes middle of the back or spine. In extreme cases, burning pain may even be felt later in the anal region while passing motion! This burning pain often has some relation to food. It tends to come on empty stomach and may be partially relieved on taking food. Or another variation is that it is induced by taking any food!
The excruciating pain in the chest is sometimes mistaken for a heart attack. And pain in a heart attack may resemble pain due to effects of acidity.
However, a doctor who takes the time to carefully elicit patient's history/ symptoms in detail and makes a thorough examination of the patient, is more likely to be able to come to a logical and more or less correct diagnosis. Of course the diagnosis, if in slightest doubt needs to be supported by some tests/investigations.
What produces acid in stomach?
Intake of any food induces production/secretion of digestive juice in the stomach. But mere thought of food or tasty food has the same effect. Tasty food, spicy food, coffee, tea, tobacco, alcohol and a large variety of drugs that we take for various diseases, particularly cortisone group and NSAID group of drugs are all stimulants of gastric acidity/juice. Rarely some internal tumors (gastrinomas) can induce such uncontrolled acidity that it leads to some of the severest varieties ulcers due to acidity. All these diseases are sometimes called as "Acid peptic disease".
One more important cause of acid peptic disease is infection by a bacteria called as "helicobacter pylori". This infection occurs due to consuming contaminated food and water.
Normal and abnormal effects of gastric acidity.
In the stomach, food is retained for a couple of hours, churned and mixed thoroughly partially digested and then only transmitted to the small intestines. Secretion of the stomach is highly acidic and if in contact with any living tissues, can erode and damage it. Only the stomach has a protective mechanism against damaging and digesting its own inner layer or mucosa. If this acid comes in contact with other parts of intestinal tract above (the oesophagus or food pipe) or below it (the small and large intestines), it causes severe \ damage or a sore/ulcer in that area. But normally this acid is neutralised by the alkaline secretions of bile from liver and pancreatic juices immediately beyond the stomach and the whole of the small intestines particularly initial part secretes alkaline juices. The most vulnerable parts for damage by acidity of stomach are either the last part of oesophagus (food pipe) just above stomach or the initial 2-3 cms of small intestines (I part of duodenum) before the entry of bile into intestines. It is in these parts that damage/sore or ulceration due to acid occurs, leading to oesophagitis or duodenal ulcer. Stomach is guarded by unidirectional valves preventing acid juice from going up in reverse direction into oesophagus and allowing orderly and staged outflow of diluted and digested stomach contents into intestines.
In a normal healthy individual, this intricate and delicate mechanisms of digestion works in an excellent synchronised way. But this delicate balance may be upset leading to excessive production of acidity in stomach or reverse flow of highly acid juice into eosophagus or highly acid contents going into and damaging the I part of duodenum or in some situations like following some surgical bypass operations from stomach directly into small intestinal loops. All these situations often lead to sores in these parts and patient experiences various types of pain in abdomen.
The severe burning pain in different parts in and around the abdomen is literally like a "house on fire " !
How does a doctor diagnose?
A detailed history and complete examination, as always leads to proper diagnosis. Few tests like Endoscopy, Barium contrast X-rays and sometimes acid secretion studies or endoscopic biopsy may be needed to confirm diagnosis. Rarely hormonal studies in blood (serum gastrin) may help.
Treatment & prevention :
# Mental equaminity should be practiced; for this inculcate and follow simple yogic way of life. ( See newsletters on Yoga for you ).
# Avoid strong stimulants of gastric acidity like tobacco, alcohol, "strong" coffee and tea, and highly spicy food.
# Take meals and snacks at more or less timely fashion, avoiding unduly long gaps between meals.
# Drink a glass of milk or similar beverage before going to bed at night.
# Drugs to reduce acid production and /or neutralise acid, as prescribed by your doctor.
# Specific treatment for H.pylori infection if suspected or confirmed by your physician.
# In very few instances, a surgical operation or some more radical measures may be suggested by your doctor.
# PREVENTION is by following the above mentioned first 4 measures, and one more below.
# Take precautions against infection spread by contaminated water & food. (See newsletter on this subject in our site).
Be well informed; follow preventive health measures; and learn what to do when the "house is on fire".
Dr. M.Mohan Rao, MBBS,MS,FICS,MCH,
M.D. & Chief Surgeon, Dr. U Mohan Rau Memorial Hospital.
E-mail: mmr@mohanraohospital.com
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