Amongst the gastric problems seen in adults, the most common ones are either lifestyle-related like gastroesophageal reflux disease [GERD] and acid peptic disease or infectious diseases like acute gastroenteritis and acute viral hepatitis.
Peptic ulcers occur when the production of gastric acid in the stomach increases. They also occur when the protection of stomach wall is compromised. Whenever the balance between the acid and the mucosal protection is lost, an ulcer is formed. Commonly-used painkillers weaken the defence of the stomach and are a common cause of ulcers.
Symptoms: Burning abdominal pain is the cardinal symptom of peptic ulcer—pain usually occurs a few hours after meals. In most cases, the pain awakens the affected person at night. Occasionally, those with peptic ulcer are devoid of symptoms and directly experience complications like bleeding. The bleeding can be severe and manifests as blood vomiting or passing of blood in the stools.
Diagnosis: This is done by flexible endoscopy. Endoscopy also helps to detect complications of peptic ulcers such as bleeding and obstruction.
Remedy: Pain is usually relieved by eating some food or taking an antacid. In severe cases, surgery is the only option.
Treatment: Once peptic ulcer has been diagnosed, using painkillers [especially Nonsteroidal Antiinflammatory Drugs or NSAIDS] is prohibited. Antacids like omeprazole or rabeprazole, which minimise the acid secretion, are administered in high doses. Tests are done to diagnose and cure all factors [stomach infections] that may be weakening the stomach wall. During the treatment, eat bland food and abstain from tobacco and alcohol.
Gastro oesophageal reflux disease [GERD]
GERD is caused by a reflux of stomach contents into the oesophagus. This is the commonest GI problem; almost 15 per cent of people have heart burn at least once a week.
Symptoms: A burning sensation is experienced in the chest or abdomen, which may move up and down the chest like a wave. When severe, it may radiate to the sides of the chest, the neck and the angles of the jaw. Occasionally, a patient may have difficulty in swallowing solid food [dysphagia] due to narrowing of the oesophagus. The reflux of stomach contents into the wind pipe and lungs may also cause chronic cough and throat hoarseness.
Diagnosis: In most patients, the diagnosis is made by history alone. Diagnostic tests are required in patients with persistent symptoms or those who have complications like bleeding or dysphagia. Diagnostic tests include an upper GI endoscopy to look for injury of the oesophagus wall or even a 24 hour pH metry [a test that monitors acid exposure . Those with severe GERD may develop complications such as Barrett's oesophagus, which is a premalignant condition. Such patients require undergoing routine surveillance endoscopy.
Remedy: Sitting in an upright position and drinking plenty of water helps. Taking antacids is a more reliable remedy. Drugs like omeprazole and rabeprazole help in reducing acid secretions. Occasionally, surgery may be required to strengthen the anti-reflux barrier.
Treatment: GERD can be managed by modifying certain lifestyle habits—taking small frequent meals, weight reduction [if obese], abstaining from tobacco, alcohol and fatty foods. Not consuming mint and orange juice also helps. You may also need to avoid some drugs like calcium channel blockers and beta blockers for hypertension.
Acute viral hepatitis
This disease is caused by hepatitis A, B, C and E viruses of which A and E are food or waterborne viruses. The hepatitis A virus is transmitted by contaminated food, water, milk or sometimes, even person-to-person. This virus commonly affects children. By adulthood almost everybody is exposed to hepatitis A virus.
Symptoms: Although symptoms of viral hepatitis are variable, they often include—anorexia, nausea vomiting and fever. Jaundice usually follows a few days later. Itching develops later and can be quite troublesome. It can also cause hepatic [liver] failure, but only in rare cases.
Diagnosis: Liver function tests [which are blood tests] and viral markers help diagnose viral hepatitis.
Remedy: There is no temporary relief available. As sanitation and hygiene improves in a community the incidence of hepatitis A infection reduces.
Treatment: This is a self-limiting disease and treatment is usually only to control the symptoms. Vaccines are available against A and B virus. The best precaution is to ensure the food and water we consume is not contaminated.
Gastroenteritis is caused due to a bacterial or viral infection. Bacterial infections which are seen in association with poor hygiene and sanitation are more common. Viral gastroenteritis lasts for one or two days, but the bacterial cases can last longer.
Symptoms: Fever, vomiting, diarrhoea and abdominal pain are common symptoms. More serious symptoms include blood vomiting, blood in the stool, very high fever and extreme dehydration.
Diagnosis: The doctor usually diagnoses acute gastroenteritis by physically examining the patient and enquiring about his/her medical history. If symptoms persist, blood and stool tests may be needed.
Remedy: Maintain strict personal hygiene and keep a watch on what you eat or drink. Avoid unhygienic places and eat hot home-cooked food.
Treatment: Antibiotics are given depending upon the cause of gastroenteritis. In case of severe dehydration, oral rehydration therapy [ORT] is prescribed and in extreme cases intravenous fluids are administered.
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