Generality
Stomach pain is a widespread symptom, presumably experienced by the vast majority of the population, on at least one occasion in life.
Precisely this second possibility explains why it is important to recognize the extent of a stomach ache, understanding its severity and when it requires a medical consultation.
The correct interpretation of stomachache, however, is not always simple, given the extreme variability of potentially responsible conditions. This is why in-depth investigations may be necessary, using blood tests, radiological examinations and gastroscopy.
As can be guessed, the therapy of stomach pain varies in relation to the triggering causes.
What is stomachache?
Stomach pain is a symptom that people complain of having when they suffer from pain in the upper and middle part of the abdomen. A feeling, this, quite common, proven at least once in life by most of the population.
Although the presence of the term "stomach" may mislead, stomach pain may be the clinical manifestation of not strictly gastric problems; as will be seen, in fact, it can be the consequence of problems in the duodenum, pancreas etc.
So, with "stomach ache" we want to indicate more a localized sensation in a specific area of the body, in which the stomach is also included, rather than a sensation that only affects this organ.
Medical definition of stomachache
Often, referring to stomachache, doctors prefer to talk about " epigastric pain ", that is, of that painful sensation that is located at the level of the epigastrium .
In anatomy, the epigastrium (or epigastric region ) is the highest and central area of the abdomen, bounded, above, by the costal cartilages, and, inferiorly, by the umbilical region.
Causes
In most cases, stomachache is a passing disorder, which does not require special treatment or is resolved with simple behavioral and / or pharmacological interventions; more rarely, it represents the manifestation of an important clinical condition, which it is good to be able to recognize in time and which requires appropriate, specific and sometimes timely medical treatment.
In this section of the article, the causes of the most common and least worrying stomach pains and the most unusual and clinically relevant causes of stomach pain will be discussed.
Uncommon causes of stomach pain
Causes of stomach pain relatively unimportant from a clinical point of view, but very common in the general population, are:
- Meteorism, also known as gas in the belly, air in the stomach or (improperly) flatulence ;
- Digestive problems ( indigestion ), resulting in meals that are too abundant or difficult to digest;
- Constipation, also known as constipation or constipation ;
- Cigarette smoke ;
- Anxiety ;
- Stress ;
- Taking certain medications, including anti-inflammatory NSAIDs such as aspirin or ibuprofen;
- Excessive alcohol consumption ;
- Sporadic episodes of gastroesophageal reflux, which is the abnormal rising phenomenon in the esophagus of the acid contents of the stomach.
To learn more, read: Heartburn; Gastroesophageal reflux
Important causes of stomach pain
The causes of less common stomach pain, but of substantial clinical relevance, include:
- Gastric ulcer : it is an erosion, more or less deep, of the mucous membrane of the stomach, which is very reminiscent of the lesions left by cigarette butts in contact with the skin.
- The duodenal ulcer : it is a lesion, more or less deep, of the mucous wall of the duodenum (which is the first part of the small intestine).
According to some statistics, duodenal ulcer affects 10% of the world's population.
- Perforated peptic ulcer : peptic ulcers are small, well localized lesions that affect the mucosa of the digestive system exposed to the action of gastric juices.
Examples of peptic ulcers are the aforementioned gastric ulcer and duodenal ulcer, and the esophageal ulcer (affecting the lower part of the esophagus).
Peptic ulcers are defined as perforated (or bleeding), when the lesion is so deep that it affects the blood vessels, resulting in hemorrhage.
- Stomach cancer : is a severe malignancy that, in more than 90% of cases, originates from one of the cells of the gastric mucosa and from one of the glands of the latter.
Not always diagnosable at an early stage, stomach cancer is more prevalent among people over the age of 55, among smokers and those who have bad eating habits (smoked foods, excess salt in the diet, little fruit and little vegetables). ).
- The episodes of acute gastroenteritis : acute gastroenteritis is the inflammation of the mucous membrane of the stomach and intestine with rapid and sudden development.
In general, acute gastroenteritis has an infectious origin; however, it can also occur after taking certain drugs and accidental ingestion of certain substances toxic to human health (eg heavy metals or certain plants).
Infectious gastroenteritis may depend on viruses, bacteria or parasites.
- Acute gastritis : mainly caused by the ingestion of irritating or gastrolesive substances (including some foods, if taken in excess, and some drugs), it is the rapid and sudden inflammation of the inner wall of the stomach.
- Chronic gastritis : is the slow and progressive appearance inflammatory process, affecting the inner wall of the stomach. Generally, it has an autoimmune or bacterial origin ( Helicobacter Pylori infection); less commonly, it depends on the intake of some drugs (NSAIDs), bile reflux, stress, kidney failure etc.
- Gallstones (or gall bladder stones or gallstones ): are small solid aggregates that originate inside the gall bladder (or gallbladder), after the anomalous precipitation of some bile constituents (a liquid essential for digestion, produced by the liver but stored in the gallbladder).
Gallstones are often the cause of cholecystitis, which is inflammation of the gallbladder.
In these situations, to determine the cholecystitis is the stagnation of bile inside the gall bladder, due to the obstruction that the gallstones determine at the level of the cystic duct (that is the passage that allows the escape of the bile from the gallbladder).
- Chronic pancreatitis : in medicine, the term "pancreatitis" means "inflammation of the pancreas".
Pancreatitis is chronic, when the inflammatory state that characterizes it arises gradually (if it appears suddenly, pancreatitis would be acute) and lasts a long time.
- Pancreatic cancer : it is a serious malignant neoplasm, highly lethal and difficult to cure successfully, due to often late symptoms, which prevents an early diagnosis.
- The hiatal hernia : it is the protrusion of the stomach through the so-called esophageal diaphragmatic hiatus, that is the hole of the diaphragm in which the esophagus normally enters.
Risk factors for hiatal hernia include: severe abdominal trauma, the presence of abnormalities of the esophageal hiatus at birth, obesity or overweight and chronic cough.
According to a recent statistic, hiatal hernia would affect 15% of Italians.
- Gastroesophageal reflux disease : is the condition that is established when the phenomenon of ascent into the esophagus of the acidic contents of the stomach becomes a chronic disorder.
Also known as GERD, gastroesophageal reflux disease can depend on various causative factors, including: obesity, cigarette smoking, the aforementioned hiatal hernia, asthma and excessive consumption of fatty foods.
Symptoms and Features
This section of the article is dedicated to the description of stomach pain in the individual causal circumstances listed above.
As readers will be able to ascertain, stomachache can have extremely different characteristics from situation to situation, which complicates its correct diagnostic interpretation.
Gastric ulcer
In the presence of gastric ulcer, patients describe stomach pain as a stabbing burning, of variable intensity and generally well localized.
Generally, the stomach pain that characterizes the gastric ulcer arises within the first 30 minutes after the meal; however, it is good to point out that the time of appearance of the aforementioned painful sensation is affected by the position of the ulcerative lesion: the more the latter is close to the pylorus (connecting junction of the stomach with the duodenum), the later onset of the disease of stomach from the end of the meal.
Duodenal ulcer
According to the patients, in the duodenal ulcer stomach pain is a dull and constricting pain, with epigastric site and sometimes in the right side of the abdomen.
Responsible in more than half of the cases of night awakening of the patient, the stomach ache from duodenal ulcer typically appears from an hour and a half to three hours after the meal.
Perforated peptic ulcer
In the presence of perforated peptic ulcer, stomach pain is sudden and violent, and tends to spread to the lower abdomen and, sometimes, even to the shoulder. As a rule, its appearance is accompanied by sweating, tachycardia, nausea and vomiting; moreover, it induces the patient to take a crouched position on his side, because this is a reason for relief.
Finally, it is important to point out that, in cases of more intense stomach pain, the painful sensation is accentuated by palpation and hand release, and that the abdominal wall is rigid (due to the so-called chemical peritonitis ).
Stomach cancer
Very often, unfortunately, stomach cancer goes on for a long time in an asymptomatic or paucisintomatic way (that is with scarcity of symptoms or nuanced symptoms).
However, when the symptoms appear, the resulting stomach ache is a burning sensation that resists anti-gastric acidity and is associated with discomfort and fullness at the epigastrium level, especially after meals .
Clearly, stomach pain is not the only symptom of stomach cancer; this, in fact, also involves: an objective difficulty in eating large quantities of food (especially meat), fever and a sense of general malaise, often associated with anemia, dyspepsia, eructations, presence of blood in the vomit or in the faeces ( which I assume a tarry aspect) etc.
Acute gastroenteritis
Acute gastroenteritis causes a cramp-like stomach pain (that is, characterized by cramps), typically associated with widespread abdominal pain, vomiting, fever, malaise and diarrhea.
In general, the course of episodes of stomach pain and other symptoms is rather short: as a rule, the patient's condition improves, until complete recovery, within a few days.
Acute gastritis
In acute gastritis, stomach pain is a dull, diffuse, burning type and is often associated with vomiting, which, in the most serious cases, is blood or tar and is smelly.
Chronic gastritis
Unlike acute gastritis, chronic gastritis causes a mild and nuanced stomach pain; in some situations, the painful sensation is even absent.
Biliary calculosis
In people with gallstones and subsequent cholecystitis, stomach pain is a very intense pain, located in the upper region of the abdomen (center or right) and similar - according to the descriptions of most patients - to "a vice that tightens and releases repeatedly ”.
The painful sensation can last up to several hours; in general, it has a constant intensity and tends to migrate towards the back, localizing in the region between the vertebral column and the lower corner of the right scapula.
Very often, in gallstones, the appearance of stomach pain is accompanied by nausea and vomiting; more rarely, a yellowish discoloration of the skin and ocular sclerae ( jaundice ).
Chronic pancreatitis
In the presence of chronic pancreatitis, stomach pain is an initially episodic pain, but then, at a later stage of the pathology, becomes constant and annoying.
As a rule, it affects the upper abdominal quadrants (we speak of a belt distribution), it tends to radiate to the back and worsens after meals (in a period of time ranging from 15 to 30 minutes), especially if these contained a high content of fat.
In some patients, this painful stomach sensation tends to be disabling.
Curiously, some body postures, such as bending the trunk forward or the right lateral position, are of relief; others, instead, such as the supine position (upturned belly), accentuate it.
Pancreatic tumor
In pancreatic cancer, stomach pain has characteristics similar to stomach pain described in chronic pancreatitis. In fact, it is episodic, in a first phase, and annoying, continuous and intense, at a later stage; it involves the upper abdominal quadrants (belt distribution) and has a tendency to radiate to the back and to get worse after meals; finally, it presents a link with the posture assumed by the patient: the supine position accentuates it, while the flexion of the trunk forward, the right lateral position and the compression of the abdomen attenuate it.
All this is associated with a progressive decay of the patient's general health conditions.
Hiatal hernia
In the presence of hiatal hernia, stomach pain localizes in the upper abdominal quadrants and has the characteristics of a burning pain.
In such circumstances, the patient also experiences pain and pressure in the chest, feeling of nausea, vomiting, a sense of bitterness in the mouth, intense salivation and hoarseness
Gastroesophageal reflux disease
In gastroesophageal reflux disease, stomachache is a burning pain, typical of the lower sternum.
Usually, this painful sensation appears after meals and is accompanied by swelling of the stomach, as well as many other symptoms, including: retrosternal pain, halitosis, frequent regurgitations of acid gastric contents, hoarseness, dysphagia, hiccups, pain during swallowing, laryngospasm, chest pain, cough and wheezing.
When to contact the doctor?
In the presence of stomach pain, it is advisable to seek medical attention if:
- The symptoms persist and seem to be independent of eating habits;
- The therapy the patient is following does not improve the painful sensation and other associated symptoms;
- In his vomit or in his regurgitations, the patient recognizes more or less evident traces of blood;
- The feces appear black and sticky, or tarry;
- The picture of symptoms associated with epigastric pain also includes dyspnea (or shortness of breath), fever, unexplained weight loss, weakness or any other sign of general malaise.
Diagnosis
For the diagnosis of the most common stomach pains, physical examination and medical history are generally sufficient.
On the contrary, for the diagnosis of clinically more relevant stomach pains, it is often essential to add more in-depth tests, such as blood tests, radiological examinations, gastroscopy, etc. to the aforementioned investigations in order to obtain a detailed and complete picture of the situation in act.
What should the doctor know?
The doctor's knowledge of elements such as the site of pain, possible triggers, duration of pain, associated symptoms and possible painful irradiation in other sites, contiguous or distant, is essential for diagnostic purposes; therefore, when a stomach ache appears, the patient must pay attention to the aforementioned characteristics, perhaps write them down and then report them scrupulously to the specialist who is taking care of him.
Therapy
In the case of stomach pain, the therapy adopted depends on the triggering causes identified during the diagnosis. So for example:
- If stomach pain is related to the intake of certain foods (eg: foods that are too fat, foods that are poor in fiber and cause constipation, etc.), it is sufficient, many times, to avoid taking these foods;
- If stomach pain is the result of gastroesophageal reflux disease, the treatment plan focuses mainly on a lifestyle modification (preventing symptoms) and medical therapy based on antacid, anti-H2, alginate drugs and / or proton pump inhibitors;
- If stomach pain depends on chronic gastritis sustained by Helicobacter Pylori, treatment involves antibiotic therapy against the causative agent (causal therapy) and symptomatic therapy, based on the aforementioned antacids, anti-H2 and proton pump inhibitors ;
- If stomach pain results from chronic pancreatitis, treatment includes the adoption of a rather rigid diet (eg no alcohol, drastic reduction of fatty foods, etc.), the administration of analgesics, to calm pain, and enzymes pancreatic (eg, pancreatin), to aid digestion;
- If the stomach ache is the result of the presence of a serious hiatal hernia, the treatment envisaged consists of a minimally invasive surgery.
To know more
- Medicines for the treatment of stomach acid;
- Drugs for the treatment of gastroesophageal reflux;
- Medicines for the treatment of peptic ulcers;
- Drugs for the treatment of gastritis;
- Treatment of stomach cancer.
To the aforementioned links, readers can deepen the treatment of stomach pain and other symptoms, which characterize some interesting clinical conditions.
