January 18, 2014

Stomach: inside and insights
Abdominal pain and dyspepsia

When someone suffers from abdominal pain, the term “dyspepsia” usually comes to mind. Indeed, it seems that most people call stomachaches and other abdominal conditions dyspepsia.

But is it accurate to say that abdominal pain is dyspepsia? Moreover, what are the causes of abdominal pain and what types of pain are signs that you should see your doctor immediately? 

Abdominal pain as a warning

Everyone has experienced abdominal pain, but in many different situations and various forms. The characteristics of abdominal pain cover a range of characteristics: tightening, contracting, squeezing, or just mild. These various kinds of pain are warning signs for a variety of diseases. According to Dr. Siriwat Arnantapunpong, a physician specializing in gastroenterology and hepatology, abdominal pain falls into two broad types based on the area in which it occurs.

  • Upper abdominal pain: above your navel, usually involves the stomach, liver, gallbladder, spleen, and pancreas.
  • Lower abdominal pain: below your navel, usually involves the large intestine, small intestine, appendix, kidney, and uterus.

“When a patient complains of abdominal pain, the first thing the doctor asks is where it hurts so that he can narrow down which organs might cause it,” says Dr. Siriwat.


“Gastroscopy is a favored method because it’s quick and effective. The procedure takes no more than five minutes.”

Dr. Siriwat Arnantapunpong

Two types of disease cause abdominal pain:
“Then the doctor focuses the examination and tests on those areas to promptly diagnose the cause and begin treatment as soon as possible.”

  1. Surgical conditions and diseases, such as appendicitis, leaky gut syndrome, intestinal obstruction, acute peritonitis or intestinal inflammation, intestinal cancer and gallstones. Open surgery or endoscopic surgeries are the only ways to treat these diseases.
  2. Internal medical conditions and diseases, such as dyspepsia, flatulence, excessive stomach gas, chronic constipation, liver diseases, and intestinal infections.

Which kind of abdominal pain is dyspepsia?

Dyspepsia causes tightening, burning, colic pain around the middle of the stomach, above the navel or epigastric region (the upper central area of the abdomen). It can be both acute and chronic pain.

Acute abdominal pain is severe pain that the patient has never felt until now. Doctors exercise caution when diagnosing and treating acute abdominal pain because other diseases, such as gallstones in the gallbladder or pancreatitis, can also cause this unbearable level of discomfort.

Chronic abdominal pain is the most common level of pain. It comes and goes continually for at least a month. This pain is related to when and what people eat, such as feeling discomfort from being hungry or too full. This kind of pain is ordinarily bearable. With proper eating habits or a course of antacids, the condition should improve.
Dr. Siriwat explains that stomach diseases that cause chronic abdominal pain include severe gastritis, peptic ulcer or gastric cancer. Among cases of chronic dyspepsia, they lead to these diseases at a rate of 20 to 25 percent.

The stomach can also suffer from diseases even when there are no physical anomalies in the organ itself. Rather, the diseases and pain come from dysfunctions of the gastrointestinal system. For example, stomach pain can occur when stomach and intestinal contractions are out of synchronization, or there is excessive acid in the stomach, but not enough to be an ulcer. These conditions cause 70 to 75 percent of problems for which patients seek a doctor’s treatment.

Acid-related stomach conditions, however, do not always come with abdominal pain. “Many patients come to see doctors because they vomit blood or have black stools caused by excessive acid, which causes open wounds and bleeding in the stomach. Another situation is heartburn caused by reflux acid in the stomach that inflames esophageal tissue. In some cases, the inflammation rises up to the throat, causing coughing fits. All of these symptoms involve the stomach,” says Dr. Siriwat.

Diagnosis chronic abdominal

To find and diagnose chronic abdominal pain, the doctor reviews the patient’s medical history and performs a regular physical check-up. The most effective and widely used method is gastroscopy. With this method, the doctor collects a tissue sample to find pathological lesions and search for the helicobacter pylori (H. pylori) bacterium, which causes many stomach diseases. The doctor can perform these procedures simultaneously.

“Gastroscopy is a favored method because it’s quick and effective,” Dr. Siriwat says. “The procedure takes no more than five minutes. The doctor gives the patient a safe, short-term sleeping drug before orally inserting the scope into the gastrointestinal tract. This method helps the doctor find the cause swiftly and immediately proceed to treatment.”
Besides gastroscopy, the doctor may include a CT scan and ultrasound in the diagnosis especially if the patient has an acute condition. In addition to gastroscopy, other methods used to find H. pylori are a blood test or breath test, in which the patient simply has to exhale into a device.

Treatment and prevention

For patients with peptic ulcer and gastritis, which are not caused by H. pylori, doctors prescribe antacids to decrease acid in the stomach and help the wound to heal faster. Doctors may also use medicines that protect stomach tissue. H. pylori ailments can be completely cured with a two-week course of antibiotics.

For stomach dysfunction-related dyspepsia doctors sometimes prescribe a drug called prokinetic. Prokinetic supports stomach and intestine movement and helps the stomach and esophagus function better together.

Dyspepsia is not a severe disease. But if the patient neglects it many complications can follow such as stomach bleeding, perforation, and stomach obstruction, some of which can be fatal.

Therefore, Dr. Siriwat advises that people should only eat food that is well cooked, clean, not too spicy, and consumed in moderate amounts. Stress control, alcohol and coffee abstinence, and caution in taking drugs that disturb the stomach are important factors in preventing dyspepsia. Follow this routine and your stomach will not suffer from dyspepsia.

Drugs don't help?

Suspect H. pylori

Helicobacter pylori is the main cause of chronic gastritis, peptic ulcer, gastric ulcer, stomach cancer and gastric lymphoma. Data show that there are over 2 billion people currently infected with these bacteria worldwide.
In Thailand, about 40 percent of dyspepsia patients are infected with this bacterium. Cases occur mostly in the northern and northeastern enough before consumption.


No dawdling for these pains

If you suffer come-and-go abdominal pain for four weeks or more, see your doctor. But if these conditions accompany the pain seek medical attention immediately:
+Abdominal pain with vomiting
+Changing abdominal pain such as burning pain turning into squeezing pain, contracting pain or the pain becomes harsher
+Anemia, possibly from losing blood through stomach wounds
+Yellow eyes
+Weight loss of over 10 percent within 1 to 2 months
+Taking antacids for 1 to 2 weeks but showing no sign of improvement or suffering from other complications
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