You and Your Stomach Problems

What are they?

'Oesophagitis' and 'gastritis' refer to inflammation of the oesophagus [gullet] and stomach respectively. They may be caused by irritating chemicals such as alcohol and aspirin, by infection by viruses and bacteria, and both stomach and oesophagus can be affected by both benign [non cancerous] ulcers and cancer.

What are the causes?

Most problems with the stomach and oesophagus are related to lifestyle and diet. The stomach normally produces  strong acid, which is essential for digestion and protects the stomach from invasion by organisms such as Helicobacter Pylori, a bacterium which is the cause of many cases of ulcers, both gastric [stomach] and duodenal. The stomach is usually well protected against the effects of its own acid, but may become irritated by strong chemicals, especially alcohol, leading to pain and nausea.

Normally a strong muscle at the bottom of the oesophagus called a sphincter, closes the opening into the stomach where it passes through the diaphragm. This prevents regurgitation of foods and is the reason why we can stand on our heads without the contents of our stomachs responding to gravity. Sometimes the sphincter muscle may be weakened, or there may be a hernia, with part of the stomach rising through the diaphragm, allowing acid to be regurgitated into the oesophagus causing heartburn, as it is not designed to handle the strong acid produced by the stomach. The stomach contents may also flow up the oesophagus at night and irritate the throat, causing cough and even hoarseness. This combination of problems is known as Gastro-oesophageal Reflux Disorder or GORD and may eventually lead to inflammation and precancerous changes, known as Barrett’s oesophagus.

What they are not

While certain foods make GORD worse, these problems are not due to excess acid in the rest of the body; neither are they caused by foods fermenting in the stomach.

Who gets them?

Problems are commonly seen in the obese, in smokers and drinkers, and in those who eat a westernized diet with little fibre and excess sugars. Fizzy [gas] cool rinks also contribute.

Tension and stress also cause excess acidity and there is a genetic tendency towards problems such as ulcers.

Heartburn is common in pregnancy due to pressure on the stomach from the growing womb.

Certain medicines are well known to cause stomach problems. These include aspirin and anti-inflammatory medicines, some antibiotics, cortisone for long periods, and medicines used in treatment of osteoporosis.

Cancer of the oesophagus is sometimes caused by eating smoked foods over a long period of time.

What is the usual treatment?

The aim of treatment is to keep the stomach lining intact in order to fulfill its normal digestive function in the presence of normal concentrations of acid. Initially heartburn and stomach problems are treated symptomatically with antacid medicines to neutralise the acid, medicines to coat the oesophagus, and others that reduce the production of acid by the stomach such as H2 antagonists and proton pump inhibitors [PPIs].

When the cause is infection, a 4 week course of antibiotics is given.

These treatments may effectively treat the symptoms in the short term, but have several long term results; H Pylori actually prefers an alkaline environment, so reducing the acid production by the stomach encourages its growth. Stomach acid is needed for the absorption of Vitamin B12, iron and folic acid, and prolonged reduction of acid can lead to a deficiency of these vitamins, eventually causing anemia.

Sucralfate is a protective agent that forms a paste which protects the ulcer and allows it to heal. It is very effective and does not affect acid production. The disadvantage is that it must be taken 4 times a day, 1 hour before meals and at bedtime, so compliance may be a problem.

Bismuth is another protective substance, also very effective but unpleasant to take. It is used 4 times a day ½ hour before meals.

What other treatments are available?

Some problems with indigestion are the result of too little stomach acid, not too much; an easy way of determining whether you have enough is to drink a teaspoon of sodium bicarbonate in water. The acid in the stomach will cause immediate bloating and belching. If this does not happen, be suspicious that you have insufficient acid. Hydrochloric acid capsules can be taken by those with low acid.

Chew your food well and eat slowly Chewing is the very important 1st stage of digestion.

Eat at least 3 regular, balanced meals daily, preferably 5 smaller meals; If you cannot arrange to eat 3 proper meals, then prepare your weeks meals in advance at weekends, and keep them in the freezer. At worst, keep a supply of Build Up or similar dietary supplement, and use that in emergency, rather than resorting to junk food.

Eat either live yogurt or a probiotic preparation, e.g. Reuteri, every day, to encourage the correct microbial environment in your bowel.

Increase your intake of omega 3 oil, e.g. by taking flax seed or salmon oil, or by eating a mixture of sunflower, pumpkin, flax and sesame seeds. These may be eaten as is, or ground in a coffee grinder or food processor. Alternatively, soak 1-2 tablespoons of linseeds in water overnight, and mix with your morning yogurt. These help the immune system protect against infection.

Liquorice, both Western and Chinese varieties has long been known to cure both gastric and duodenal ulcers. The main problems are the side effects of fluid retention with loss of potassium n from the body, and hypertension [high blood pressure]. To overcome this, deglycyrrhinised liquorice [DGL] has been developed, although it does still contain a certain amount of the original. The usual dose is 2-6 gm liquorice extract. It is not advised in pregnancy, and should only be taken under medical supervision by those with any kind of heart or blood pressure problems.

Cabbage, especially the centre core, eaten raw or preferably juiced, is known to heal the stomach.

Slippery elm is an herbal preparation that protects the stomach, and helps the bowel to heal itself.

L- Glutamine 1.5 gm daily, an amino acid, helps heal gut tissue, especially when taken with cysteine, both precursors of Glutathione, an important amino acid for the immune system and gut tissue.

Garlic is a natural antibiotic and 5gm or 1 clove can be eaten daily.

Gamma –orazynol, a rice bran extract, has anti inflammatory properties for the gut.

Digestive herbal aids e.g. Bioharmony’s Amara, digestive enzymes, or a mixture or pawpaw seeds and pineapple are often of help when indigestion occurs an hour or 2 after eating.

Comfrey and marshmallow root are soothing when taken as a tea, as well as yarrow and fennel.

Ginger is an excellent remedy for nausea. The root can be grated and made into a tea.

Aloe vera juice is a known remedy for GI upsets.

Lycopodium is a homeopathic remedy for bloating and flatulence.

Tissue salts Nat Phos ,or a Digestive Combin may help indigestion.

Avoid carbonated [gassy] soft drinks and anything containing caffeine.

Do not smoke! Tobacco is irritating to the stomach as well as the respiratory tract.

Alcohol will worsen symptoms, and should be used moderately, and only after food.

WHEN TO WORRY

Please see your Doctor if any of the following occur:

Pain that is not relieved by antacids, or if pain is worse after meals.

Vomiting after food.

Unintentional weight loss.

If the pain is associated with shortness of breath.

If you have difficulty in swallowing certain foods.

 
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