That burn in your belly

Stress, increase in travel times, work-life imbalance, shift work... the downside of modern day lifestyles has meant more people are having poor meal habits, which in turn has attributed to many suffering from gastritis, an inflammation of the lining of the stomach. Here Professor Kemal Deen MD, Consultant Surgeon and Former Senior Professor of Surgery at the University of Kelaniya Medical School, explains what causes gastritis, how it may sometimes co-exist with gastro-oesophageal reflux disease, who is most at risk and why it needs to be properly diagnosed.

Excerpts:

Q: Gastritis is now on the increase among the Sri Lankans, both young and old. What is gastritis? How do you describe it in medical terms? Is it a disease or a condition?

A: Gastritis is referred to by medical practitioners as an inflammation of the lining of the stomach.

It is often associated with a bacterium called helicobacter pylori. Gastritis may co-exist with reflux of either hydrochloric acid, which is naturally secreted by the stomach lining, or food retained in the stomach, or both. The latter is called gastro-oesophageal reflux disease, in short GORD or GERD. In this context gastritis is a disease condition. Often, laypersons use the word 'gastritis' to refer to any form of abdominal pain. This is not a specific disease but is a symptom that would require careful evaluation by a medical practitioner because there may be any number of abdominal conditions that may cause abdominal pain.

Q: Compared to a decade ago, do you see an increase in gastritis patients? What is the estimated increase?

A: There has been at least a 5-fold increase in such patients.

Q: What is the cause or causes?

A: There are multiple causes for the increase in the number of patients seeking treatment. Firstly, people are aware, more than previously, of this condition called gastritis and there has been an increase in the number of trained specialists in diseases of the intestinal tract who now serve the population of Sri Lanka, both in the centres and in the provinces.

There are a number of health education programs that have increased common knowledge of this condition.

And, of course, modern-day lifestyles have contributed significantly to the true increase in the number of people seeking treatment; stress, an increase in travel times, work-life imbalance, shift work, seamless target and goal setting, all of which eventually result in more people consuming instant foods and having poor meal habits.

Aspirin and a category of medication known as non-steroidal anti-inflammatory drugs (NSAIDS) are a common cause of gastritis, or even ulcers in the stomach, mostly in the middle aged and elderly, who may be on medication for heart disease and such conditions as arthritis.

Q: Who are most at risk?

A: School children, adolescents and the middle aged are most affected.

Q: What is the best way to treat gastritis?

A: First, it would be imperative for the medical practitioner to ascertain if the symptoms a patient complains of are consistent with gastro-oesophageal reflux disease. This is followed by a thorough physical examination to exclude conditions other than reflux disease, or disease conditions that may co-exist with reflux disease, such as stones in the gall bladder, a tumour in the abdomen or even pregnancy in a woman of childbearing age. Standard investigation may be first line blood tests, an ultrasound scan of the abdomen and endoscopy of the upper (gastroscopy) or the lower intestinal tract (colonoscopy) or both.

The need for some or all of these investigations would be based on the interview with one's doctor. However, it would not be common practice for a patient to be given medication alone if such symptoms have gone unabated for a period of three months or more.

Q: Can early treatment prevent re-currence? Or is it a life time disorder?

A: Recurrence of reflux disease, once treated successfully, is mainly prevented by the patient fully understanding the nature of the disease, being made aware of all of the trigger factors for symptoms, and understanding the importance of lifestyle correction.

Symptom based medication as and when required is not the preferred option and may have serious consequences in later years, even the emergence of cancer of the lower gullet.

Q: As a Western medical practitioner what is your opinion of alternative treatment like Ayurveda, Homoeopathy, touch therapy, yoga....?

A: I believe alternative treatments are useful and complementary to Western medicine.

It is essential, however, that a diagnosis of reflux disease is made before alternative treatment is sought, because, at the present time, Western medicine provides a comprehensive array of diagnostic investigation that allows for an accurate diagnosis to be made.

For example, it would be futile if a patient with a bowel tumour, who presents with symptoms of 'gastritis', to be treated for reflux disease!

Q: Is gastritis preventable?

A: It is totally preventable if people understand the causes, triggers and strive to adhere to a lifestyle suited to gastro-intestinal health.

Q: Can it be inherited?

A: We have no proof of this.

Q: Can allergy to certain foods also lead to gastritis?

A: The specific allergy we are referring to here is gluten allergy- a condition known as coeliac disease that is becoming increasingly recognised in our society. This may produce excessive gas and bloating that may be misinterpreted as reflux disease. The diagnosis is clinched by a combination of antibodies in the serum (blood tests) and a biopsy of the lining of the duodenum, which can be achieved with upper endoscopy examination.

Q: Many school children and adolescents are now getting gastritis. What is the reason?

A: It is to do with lifestyle, not spending enough time at a meal, skipping meals, stress and instant foods, which contains a high fat content. Spices and chilli containing foods, contrary to popular belief, are not the primary causes of reflux disease.

Q: Can a patient treat himself at home? Or does he have to be hospitalised?

A: It is unsafe for patients to treat themselves, other than taking an antacid for occasional gaseous symptoms. It would be best to seek the advice of a family practitioner (general medical practitioner) early. Once diagnosed, reflux disease (GORD) is usually treated on an outpatient basis and, in general, will not require treatment in hospital.

Q: What happens if a patient with gastritis does not get treatment in time? What are the health complications?

A: Delay in seeking medical help may result in symptoms that are severe enough to interrupt one's daily lifestyle and disrupt family life and efficiency at work. Late stage diagnosis may also warrant surgical correction of the disrupted sphincter mechanism between stomach and oesophagus, a procedure called fundoplication.

Q: Can gastritis lead to other health complications in the long term?

A: No, but a heart attack or angina and bowel cancer may present with symptoms that are similar to 'gastritis'. This is why a person suffering from such symptoms will require careful assessment by a medical practitioner.

Q: What are the new advances in detection and treatment of gastritis?

A: There are no revolutionary new advances in detection or treatment of reflux disease.

The reason why patients continue to suffer is purely because of a lack of personal adherence to advice. Rarely, a diagnosis may have to be reviewed if symptoms persist. Recent available methods to evaluate this condition further are physiology laboratory based assessment of oesophageal pressure, motility and pH studies, to assess excess acid reflux over a 24 hour period.

In cases of "gastritis", where there may be a subtle difficulty in swallowing, especially in young persons, a Barium swallow study may be undertaken to exclude a not so common condition called achalasia of the cardia, where treatment will differ from conventional treatment for reflux disease.

Q: What is the diet you recommend for a gastritis patient?

A: In short, a diet low in fat content, and of equal importance, adherence to regular healthy diet times.

Q: Many parents are worried when their children get gastritis. Can worry increase stress on the part of the children and further enhance complications?

A: Stress and worry often worsens any disease condition. Consultation with a family medical practitioner will help allay anxiety and reduce worry.

Q. Your message to parents and patients

Parents - Undertake good healthy eating practices at home and encourage such practice among immediate and extended family. In short, parents must be good role models.

Patients - Refer to any one of a number of health guides available on the worldwide web regarding good dietary practice.

It is essential to remember that management of reflux disease requires a 2-handed approach; the doctor and, more important, the patient. Successful treatment of GORD, or reflux disease, should not be singularly doctor based!