Abdominal pain affects millions of people each year, yet experts say most causes are innocent and will either disappear without treatment or with over-the-counter medicines. For the patients who see their doctor, there’s usually a simple explanation for their cramps, niggles, bloating and nausea.
But occasionally a stomach issue can herald a more serious illness. It could be a sign that you’re suffering from a medical emergency such as an infection, or a serious disease like gastric or pancreatic cancer. In these cases, getting help sooner rather than later is imperative and could be the difference between life and death.
“The most important part in diagnosis is the patient’s history,” says Dr David Forecast, a gastroenterologist at the London Clinic in Harley Street. “Of every 100 patients I see with stomach pain, 95 of them don’t have a serious problem. Generally, pain isn’t usually a symptom of serious disease such as cancer. I am much more concerned when patients feel unwell, have lost weight without trying, are having problems swallowing food or are experiencing unusual bleeding.”
We identify what different types of stomach pain could mean.
What it probably is: Heartburn
“Most people get heartburn some of the time, especially if they have had a curry or a pizza the night before, and it is the commonest reason for any person to see a doctor,” says Dr Forecast. “The stomach is able to tolerate a very acidic environment, but in many people, if the acid gets squirted on to the lining of the oesophagus, it will cause them pain.”
Heartburn can be treated with over-the-counter antacids. If it persists, a doctor will probably prescribe PPI (a proton-pump inhibitor), which is a drug that reduces gastric acid secretion in the stomach.
BEWARE! Acid reflux could be a sign of stomach cancer or oesophageal cancer.
If you have prolonged bouts of acidity in the stomach and an unexplained stomach ache, or if you feel full after meals even when you’ve eaten less than normal, and you have lost weight without dieting, your doctor may suspect gastric cancer and refer you to a gastroenterologist. Other symptoms include passing blood in vomit and/or faeces. If you’ve lost weight, you feel unwell and you’re having problems swallowing food, cancer of the oesophagus is a possibility. Both oesophageal and gastric cancer can be treated with surgery, chemotherapy and radiotherapy, depending on the stage the cancer is at.
What it probably is: Irritable Bowel Syndrome
“This condition has four symptoms,” explains Dr Forecast. “They are abdominal pain, bloating, especially towards the end of the day, a change in bowel habit and a feeling of incomplete evacuation – after they have been to the toilet, the patients still feel as if they haven’t emptied themselves.
“IBS has a high association with stress and difficulties in life and fear and anxiety affect your gastrointestinal tract. If you’re alone at home and you hear an intruder, you may well feel afraid, get cramps and need to go to the bathroom. If you get a nasty letter, you’ll also get discomfort in the abdominal area.” A GP will carry out blood tests to rule out coeliac disease, a digestive condition caused by an adverse reaction to gluten, which mimics IBS symptoms. If IBS is suspected, a change of diet may also ease symptoms. Research has found a diet high in short-chain carbohydrates, such as apples, watermelon, asparagus, honey, pasta, soft cheeses, legumes, beans, onions, lentils and mushrooms, may aggravate IBS.
Peppermint oil is often the base of many medicines for IBS.
BEWARE! In women, persistent stomach and pelvic cramps could be caused by ovarian cancer. Other symptoms include persistent bloating, difficulty eating, feeling full very quickly, nausea and the need to urinate urgently on a regular basis.
Women with ovarian cancer often have high levels of the chemical CA125, which a doctor can check for with a blood test. An ultrasound of the pelvic area will also be carried out so the ovaries can be checked for tumours and cysts. Almost all women with ovarian cancer will undergo some form of surgery, and some will have surgery and chemotherapy.
What it probably is: Cystitis
“If you have this type of ache, you are urinating more often, there is blood in your urine and you get a burning sensation when you go to the toilet, then you probably have cystitis,” says Dr Forecast. “It is often associated with fever. Women are more susceptible to cystitis because their urethra is shorter than men’s.”
A urine test using a dipstick (a chemically treated strip of paper) can be used to diagnose cystitis. Once diagnosed, antibiotics can be taken. Cranberry juice is a favourite preventative measure for some.
BEWARE! “Don’t ignore cystitis,” advise Dr Forecast, “because the infection can track northwards into the kidneys and you’ll end up with a kidney infection. Any infection is associated with a decrease in function so every time you get a kidney infection, a piece of the kidney dies.”
What it probably is: Biliary colic
This occurs when a gall stone blocks one of the bile ducts, which are tubes that carry bile from the liver to the gall bladder, then into the digestive system.
Attacks can last from a few minutes up to five hours and also cause nausea and some bloating. The pain may spread to the shoulder.
Gall stones are more common in obese people with a high blood cholesterol. “A doctor will look at the patient’s history,” says Dr Forecast. “Women who are fat, 40 and fertile are most likely to get gall stones. In the first instance an upper abdominal ultrasound will enable a doctor to examine the gall bladder.” A decision will then be made about the next step. Some patients will be advised to wait and watch for any changes. Eating a healthy diet and avoiding foods such as chocolate, cheese and pastry may help. Painkillers are also given for a mild attack.
BEWARE! You may have gall bladder disease, and the only solution for this is surgery, often laparoscopic, to remove the whole organ.
What it probably is: Diverticulitis
Diverticular disease and diverticulitis are related digestive conditions that affect the large intestine (colon). Small bulges develop on the lining of the intestine and become inflamed or infected, causing pain and bloating.
“This pain gradually increases in severity, is tender to touch and is made worse by coughing, movement and going to the toilet,” says Dr Forecast.
The condition is usually diagnosed with a colonoscopy, where a camera is inserted into the rectum to inspect the large intestine. Mild cases can be treated with antibiotics and painkillers.
BEWARE! In rare cases, an infected diverticula can split, spreading infection to the lining of your abdomen. This infection, known as peritonitis, causes a high temperature and vomiting and can be life-threatening.
“We don’t like to do emergency operations on these patients,” explains Dr Forecast. “We treat them with intravenous antibiotics and bed rest, and then six weeks later, we operate to remove the affected gut.”
What it probably is: A stomach ulcer.
Also known as gastric ulcers, stomach ulcers are open sores that develop on the lining of the stomach. Along with pain, you may have bright-red or dark-brown blood in your vomit, and black tar-like stools.
“If the pain is on the soft part of the abdomen, at the bottom of the breast bone, it may be a stomach ulcer,” says Dr Forecast. “In some cases the pain can be made worse with food, and in others it’s better after you’ve eaten something. It’s usually central and it may radiate through to the back.
“It’s the kind of pain that wakes you at 2 or 3 in the morning and you feel nauseous with it, but after you’ve had a glass of milk you feel better.”
Many ulcers are caused by the germ Helicobacter Pylori (H Pylori), which can be treated with a fortnight’s course of antibiotics. Testing for H Pylori can be done with a breath, stool or blood test at the doctor’s surgery.
BEWARE! “Helicobacter Pylori is a class 1 cancer-producing organism, and the commonest cause of gastric cancer, so it needs treating fast,” warns Dr Forecast. “Gastric cancer is more common in people who have a high-fat diet, or are obese, but if it is caught early, it can be cured by surgery.”
For more information visit: www.thelondonclinic.co.uk.