Part I: Understanding Gastric

Gastric pain is a common problem in our community. Try to look around you, perhaps you can discover some of your family members or friends are having this irritable problem. But, what is gastric? Generally, GASTRIC, sometimes called as DYSPEPSIA (indigestion) is a type of stomach discomfort and pain (stomach fullness, bloating, and nausea). Gastric can be termed as gastrointestinal esophageal reflux disease (GERD) if it is related to acid reflux and heartburn. Gastric can be persistent or recurrent.

Note: The LOWER ESOPHAGEAL SPHINCTER muscles opens (relaxes) to allow food to pass through stomach and closes (contracts) to prevent food entry into stomach. Acid reflux occurs when the sphincter muscle does not contracts completely, allowing gastric acid and semi-digested food to push back into the oesophagus. Eventually, it causes heartburn, a feeling of discomfort and burning sensation in the chest and throat, sometimes accompanied with nausea.

What is the triggers of gastric/GERD? Who is at risk of gastric/GERD?

Diet with high content of fats, oils, coffee, alcohol, and citrus fruits can trigger gastric. Persistent and intense stressful lifestyle (anger and hostility) can increase the amount of acid in the stomach. With most of the people living their stressful and hectic working lives, people tends to have irregular meal that will make harm to the stomach. People with weakened immune system (kidney failure, viral infection) have higher risk to suffer from gastric. Long-term use of certain medication (particularly pain killers known as NSAIDs) can increase the risk of gastric incidence. Acid reflux (GERD) and asthma are sometimes interrelated, meaning they may trigger one another. Certain asthma medication (theophylline and bronchodilators e.g. salbutamol) can cause esophageal sphincter muscle to relax, allowing the stomach contents to flow back into the throat. The stomach contents may then enter the lungs (aspiration) and irritate the airways.

How to know which type of gastric you are having? If you have the symptoms of gastric pain, your pharmacist might dispense you some medication but you are advised to go for a checkup to find out the cause of gastric. The first approach of the checkup will be endoscopy so that the doctor can observe whether there is any presence of stomach ulcer and inflammation along the digestive tract. In this procedure, you will required to fast or have at least 8 hours without having any meals in order to clear your digestive tract for better visualisation. You might require to be hospitalised in order to perform the procedure whereby a thin, flexible telescope will put into your throat to your stomach.

 If the test result is normal with no ulcer shown, this type of gastric is termed as FUNCTIONAL DYSPEPSIA. There is no particular cause for this gastric and mainly due to weakened lower oesophageal sphincter, causing an acid reflux problem (can refer to the risk/triggers of gastric above). Majority of the people suffered from functional dyspepsia  but they usually do not benefit from gastric medication for examples H2 blockers or proton pump inhibitors (PPI). However, they  can consider antacid, which is available over-the-counter to relieve the pain rapidly if needed. If there is inflammation on the wall of gullet, this indicates that you are having acid reflux (GERD). On the other hand, NON-FUNCTIONAL DYSPEPSIA can be classified if the result shows the presence of peptic (stomach) ulcers. In this case, gastric medication will be beneficial and further test of Helicobacter pylori (H. pylori) will be carried out.

What is H. pylori?  H. pylori is a stubborn bacteria that have hairs to punch holes in our stomach, causing ulcers (as shown in the picture above). This bacteria can be detected through urea breath test, blood test or even stool sample or a biopsy sample taken during an endoscopy. In most of the case, if H. pylori is found, then it is likely to be the cause of the ulcer. H2 blockers or proton pump inhibitors (PPI) for acid suppression will be given along with the antibiotic as a whole course of H. pylori treatment (at least 1 week).

If H. pylori is absent, doctor will collect some information from you and identify the triggers of your gastric. For instance, if you are taking pain killers for long-term, you have higher risk in developing gastric problem and it may worsen your pre-existing gastric problem. Pain killers (non-steroidal anti-inflammatory drugs (NSAIDs)) for example aspirin, ibuprofen, diclofenac, mefenamic acid, and naproxen may be the cause of your gastric. To avoid gastric problem, you are advised to take pain killers only when necessary and not on regular basis.

If the cause is still unknown with persistent stomachache, accompanied with some alarming symptoms (difficulty swallowing, weight loss, black stools and persistent vomiting with blood), more investigation is needed. The condition can be presence of gallstone or even throat cancer (Barrett’s esophagus), stomach cancer and liver cancer. Infection with H. pylori seems to be a major cause of stomach cancer. Other risk factors could be: family history, tobacco use, and unhealthy diet.

Alright, that’s all for now. A full detailed of gastric medication (highlighted in light blue) will be further discussed in Part II. Stay tuned.

Author:

Lok Ker Yee

B Pharm (Hons) (IMU)

Editors:

Ong Jijien

B Pharm (Hons) (IMU)

Tan Sue Fern

B Pharm (Hons) (IMU)

Jordy Wong Der Yuan

B Pharm (Hons) (IMU)