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Friday, June 18, 2010

A Family Doctor's Tale - GASTRITIS


Irregular meals, incomplete time for eating, hunger, stress, tension, smoking, alcohol, black coffee and certain medications all will lead to gastritis. You will feel bloated, heartburn and stomach pain. That is what you will feel as a victim of this very common condition.

Gastritis(A Simple Guide to Gastritis) is a common medical condition in a lot of people including myself. 

I developed gastritis after working night shifts in the hospital as a result of incomplete meals from emergency resuscitation and stress. 

It usually manifests itself as bloating of the stomach , heartburn, indigestion and epigastric pain(below the ribs and between the ribs). 
There may be gastroesophageal reflux with acid coming upwards to the throat. 
The patient usually feel that the food is not well digested.

It is important to explain the causes of the gastric problem to the patient so that the patient will 
1.avoid irregular meals and take small but frequent regular meals
2.avoid stress and nervous tension and learn to relax
3.avoid smoking and alcohol
4.tested for helicobacter pylori and if confirmed treated for the bacteria for at least six weeks of antibiotics.

The patient should always be advised to have a gastroscopy to exclude other causes of gastric pain such as gastric polyps and cancer. 
One of my patient was very lucky to have a biopsy of his gastric ulcer during a gastroscopy and was found to have very early lymphoma. He was treated immediately with chemotherapy and has no more recurrence of his lymphoma. That was 20 years ago.

An ultrasound of the gallbladder and liver should also be done to exclude pain due to gallbladder trouble.

One of my patients was found to have gallstones and after the removal of her gallbladder did not have any more abdominal discomfort.

Patients with gastritis should always be advised not to rush through their meals and to take more diluted food or liquids to dilute the food. 
I would advise patients to walk for a short period after the meals to help the food to move through the intestines and stomach especially the night meals.
It is important for the patient to relax after a meal but not on the couch in front of the television.

In patients with gastroesophageal reflux not to sleep flat on his/her back but with the upper body slightly raised to prevent the acid from flowing upwards to the throat. 
This can done with a slightly raised pillow so that the acid cannot flow to the mouth so easily.

The other thing is to watch the diet taken. 
A bland diet with no rough food, spicy food, fried or oily food , sour or acidic fruits and food or even very cold food from the refrigerator is better in preventing an attack of gastritis. 
Any food that is noticed to cause more gastric discomfort should also be avoided.

Smoking and alcohol is definitely to be avoided as they stimulate the production of gastric acid. 

Black coffee(Caffiene), strong tea(Tannic acid), aspirin, pain killers and drugs which irritate the stomach lining should also be avoided.

My treatment inevitably contains 
1.a mild tranquillizer for the stomach combined with a anticholinergic to reduce the acid

2.a H2 antagonist(cimetidine,famotidine or ranitidine) or Proton pump antagonist (omeprazole or nexium) to 
prevent the production of the gastric acid

3.most importantly an antacid to counter the acid in the stomach. 
The best way to take the antacid is to take the antacid like a milk drip (chew a antacid or take a tablespoon of antacid suspension every half hourly until the stomach pain or discomfort disappears). 
This also works for most cases of hiccups. 

I had one patient who had tried everything (Drinking water, shock techniques, chinese medicines etc) without effect except by the taking the antacid continuously just like the milk drip.

4. If a bacteria is causing the gastritis, it is important to take a six week course of antibiotic to get rid of the helicobacter pylori.

In fact one of my patient who had chronic gastric problem was cured after the bacteria was found and removed. 

In fact this bacteria can also be a cause of gastric cancer. 

Gastritis is a common condition but can be cured with educated knowledge of your condition and taking prevention

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