Gastric Pain and Heartburn

Introduction

Gastritis refers to an inflammation of the stomach lining. This might occur suddenly or develop slowly over time. On the other hand, heartburn is a condition in which acidic contents of the stomach flow back into the food pipe. Normally, a barrier known as the lower esophageal sphincter (LES) prevents this from happening. For heartburn sufferers however, the tone of the LES is insufficient, causing reflux. Some patients experience gastritis or heartburn separately, while others might experience them together.

Signs & Symptoms

Gastritis:

  • Nausea and vomiting
  • Stomach bloating
  • Burning, sharp pain in stomach

Heartburn:

  • Discomfort in chest and stomach after eating
  • Burning sensation in the throat
  • Tasting something sour (acid) in your mouth
  • Coughing
  • Difficulty in swallowing

 When to Seek Medical Attention

  • If symptoms persist for more than two weeks
  • If the pain in your chest is accompanied by other symptoms such as difficulty breathing, squeezing sensation in the chest and pain radiating to other body parts
  • When the pain is severe
  • Presence of blood in vomit or stools, or if the latter is black and tarry
  • Paleness
  • Rapid heartbeat
  • Dizziness and weakness
  • Unexplained weight loss

Causes

  • H. Pylori, a bacterium implicated in stomach disorders
  • Stomach infections, such as viral gastroenteritis (stomach flu)
  • Certain foods such as citrus fruits, milk, tomato pastes, chocolate
  • Obesity
  • Smoking
  • Stress
  • Alcohol
  • Medicine use:
    • Nonsteroidal Anti-inflammatory Drugs
    • Oral steroids
    • Antibiotics
    • Sleeping pills
    • High blood pressure medicines

 Lifestyle Modifications

Eat smaller but more frequent meals to aid digestion.

Try not to lie down too soon after eating a meal. Raise the head of your pillow by about 30 degrees to prevent heartburn when lying down.

Wearing tight clothing such as corsets can worsen heartburn as they put extra pressure on your abdomen.

Keep a food diary to try and identify any foods that might be causing the symptoms, and do your best to avoid them. Look out for foods with a high fat content as they cause your LES to relax, and slow down your digestion.

Stop smoking and cut down alcohol and caffeine consumption.

If you suspect your medication is worsening your condition, speak to a doctor or pharmacist. Do not discontinue treatment on your own.

If you are overweight, the extra stomach fat can put pressure on your abdomen and worsen your heartburn symptoms.

Treatment Options

Antacids are useful for mild cases of gastric hyperacidity, and are used to neutralise gastric acids. Examples of antacids include sodium bicarbonate, calcium carbonate, magnesium carbonate and aluminium hydroxide. Do take note that patients on a sodium-restricted diet should avoid sodium-containing antacids. Calcium and magnesium-containing antacids might cause diarrhoea while aluminium-containing ones might cause constipation. Antacids are best taken about one hour after meals. They interfere with some medications, such as antibiotics, so check with your pharmacist or doctor before starting treatment.

Alginates work by reacting with your saliva and stomach content to form a physical barrier. This helps to prevent corrosive acid from coming in contact with the food pipe. It works best if you stay in an upright position after taking the alginates. Remember not to administer alginates and simethicone together, as the medicines will be less effective.

Simethicone is an anti-foaming agent, which joins up small bubbles of gas in your stomach, making it easier to pass out. This can help relieve bloatedness.

Histamine-2 Receptor Antagonists (H2RA) are medications that help to inhibit gastric acid secretion. Cimetidine, Ranitidine and Famotidine are medications in this class. You can find them in an oral tablet or syrup formulation. They are available from a pharmacist or a doctor.

Proton-pump inhibitors (PPI) are medications that suppress your acid production to a greater extent than H2RA. PPIs are under prescription, although omeprazole and pantoprazole 20mg are available in restricted quantities from your pharmacist. PPIs work better when taken about half an hour before meals.

If H. Pylori is implicated, your doctor will prescribe a triple therapy for you, consisting of antibiotics and a PPI.

 

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