Stomach pain is a symptom people complain of when they experience pain in the upper and middle of the abdomen. A sensation that is quite common and certainly experienced by everyone once or twice in their life. In medical terms it is defined as epigastralgia or epigastric pain (Greek term which means “above the stomach”). In anatomy, in fact, the epigastric region is the highest and most central area of the abdomen, delimited above by the costal cartilages and, below, by the umbilical region. Often the pain is generalized as “stomach ache”, which is incorrect since the latter is more relevant to the abdominal area.
Understanding stomach pain
Most of the time, stomach pain represents a transient disturbance, which regresses spontaneously or thanks to the help of simple behavioral and / or pharmacological interventions; more rarely, however, it represents the indicator of pathological conditions which may require an appropriate, specific and, sometimes, immediate medical intervention. 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 stomach pain, however, is not always simple, given the extreme variability of the potentially responsible conditions. For example, a stomach ache in some people occurs after an argument, grief, personal or work criticism, or sudden psychological distress. In this case, the stimulus is “somatized” on the organ.
The persistence of stress or the chronicity of the aforementioned stimuli does not allow the resolution of the biological response and so the stomach continuously undergoes stimulation of its nervous component. Not surprisingly, pain is often referred to as burning, since nervousness stimulates gastric acid secretion by activating the parasympathetic pathways. These depend on the neurotransmitter acetylcholine. Not surprisingly, the first anti-ulcer drug was pirenzepine, an antagonist of its receptor. Histamine is also a mediator used by the stomach to control the production of hydrochloric acid. The first anti-ulcer drugs, in fact, were H2 antagonists (ranitidine, cimetidine, etc.) which today have been almost completely supplanted by proton inhibitors (such as omeprazole and its derivatives).
According to traditional oriental medicine, there would be differences in the use of these neurotransmitters on the function of the stomach depending on the impending stimulus. Simple nervousness (tension, moodiness) would involve the release of acetylcholine which contracts the muscle fibers of the organ and causes the mucosa to produce hydrochloric acid. In this way the “contracture” type pain associated with burning would arise. In case of quarrels and criticism, it is histamine that takes over and this causes acidity with a sense of burning that can expand towards the thoracic region. If, on the other hand, the nervous tension is expressed as doubt or inhibitions derived from threats, dopamine is the master. This produces a block of digestion and can cause the sensation of vomiting (which can express mental rejection to the constrictions suffered).
Here appears that “weight on the stomach” that everyone reports, which is often associated with reflux. Not surprisingly, dopamine antagonists such as metoclopramide (Levopraid) and domperidone (Peridon) manage to overcome the block and give relief from symptoms. From the above, it is clear, therefore, that the greater the persistence of the emotional stimuli that lead to stomach pain, the greater the time it will take for the body to bring everything back. This translates into taking a symptomatic treatment for weeks to counteract the stressful effects of even a few days. On the other hand, when stomach pain persists regardless of external stimuli, healthy eating habits and the absence of indulgence (e.g. cigarette smoking or alcohol), it is necessary to investigate and investigate with medical examinations.
Causes of minor importance
They are relatively common and include:
- Exaggerated meals: it is not only the quality of the food or “strange” couplings that can create indigestion; it is the quantity that above all makes the difference.
- Meteorism (bloating): the formation of air in the stomach, due to the type of diet that is followed, for having swallowed air in an unconscious way or consequent to “emotional outbursts”, can dilate the gastric walls and lead to an “annoying” stomach pain. Residual nervous tension often aggravates the inability to erupt, causing the classic “knot” in the pit of the stomach.
- Use of pain relievers. Commonly used for headache, back pain or painful menstruation, NSAIDs can cause stomach pain especially if taken on an empty stomach. This is because they block the prostaglandins that the stomach uses to stimulate the mucous membrane to produce protective mucus.
- Anxiety and stress: these are perhaps the causes that have been responsible for widespread stomach pain for a hundred years. Usually we also find ourselves in front of an intestinal somatization that couples it with abdominal pain and other digestive symptoms, as in psychosomatic colitis or irritable bowel syndrome.
Important causes: these are the ones that require medical attention.
- Gastric and duodenal ulcer. It is estimated that nearly 10% of the world population has these conditions; and this is probably the reason why the search for anti-ulcer drugs did not stop at H2 antagonists but evolved with pump inhibitors. These conditions can appear due to perpetrated nervous stress, alcohol abuse, chronic smoking and Helicobacter infection.
- Hiatal hernia. It is the protrusion of the bottom of the stomach through the esophageal diaphragmatic hiatus, that is, the hole in the diaphragm crossed by the esophagus. The risk factors for hiatal hernia include chronic cough, overweight and obesity. Gastroesophageal reflux or reflux disease (GERD) is usually associated with hiatal hernia, the symptoms of which are worsened by a high-fat diet, chronic asthma and heavy smoking (> 20 cigarettes / day).
- Stomach cancer. Gastric cancer is a serious and often fatal condition that should not be underestimated. Generally causes “dull” pain or a sense of weight; only rarely does it give excruciating pain or is painless. It is commonly believed that a symptom of its presence is the sudden onset of nausea towards meat-based foods.
- Pancreatic problems. These are particularly delicate and require immediate medical attention. Whether it is acute pancreatitis or pancreatic cancer, the diagnosis must be made as quickly as possible since these are potentially fatal situations, especially pancreatitis if not recognized immediately.
Every stomach ache is “sui generis”, that is it depends on the individual causes but also on the pain sensitivity of each one. In the case of gastric ulcer it is referred to as pungent and acute, which often appears about half an hour after the conclusion of the main meals. In the case of duodenal ulcer, however, the pain is dull and constricting and often wakes up those affected at night. It is not uncommon for the pain to manifest itself as cramps that last a few minutes, disappear and recur within a few minutes. If this type of pain is common, you are surely faced with gastric ulcer, gastritis or reflux disease.
Gastric cancer, as mentioned before, has variable symptoms: along with the pain may appear inappetence, belching, difficulty in digesting even small quantities of food and later anemia appears (from continuous micro-hemorrhages of the malignant tissue). In the case of pancreatitis, the pain that appears is defined as “band”, it is intense and immobilizes the patient in his position; it may radiate to the back and vomiting may be associated with it. The pain in this case worsens in the supine position and subsides when sitting or curled up on the right side. In the case of a hiatus hernia with reflux, symptoms include chest tightness, belching, digestive difficulties, coughing (occasionally with hiccups), and profuse salivation.
Gastric pain is generally manageable and can pass spontaneously or with some antacid and sedative in case of nervous origins. If the symptomatology lasts more than two weeks without having any links with recognizable causes, it is necessary to consult the doctor and undergo tests. They generally include simple radiography (preferably with barium contrast), abdominal ultrasound and finally gastroscopy. During the latter it is possible to perform biopsies of the mucosa (case of Helicobacter).
How stomach pain is treated
Generally removing the temporary cause leads to a quick resolution of the problem. If it is a question of unbalanced meals, just correct the diet; or if it depends on cigarette smoking, just reduce the amount of cigarettes per day. Just as if the emotional state is compromised by tensions, anger and clashes, where possible it is enough to manage the specific situation. Therefore, it is clear how important it is to first identify the triggering cause that led to the onset of the disorder.
Setting up a corrective lifestyle is essential in the search for a triggering cause. This concerns nutrition, alcohol and tobacco abuse, inappropriate emotional behaviors and various personal habits. For example, for those suffering from stomach pain and digestive disorders, it was always recommended to take a walk after lunch and never go to bed immediately after dinner. Also never take at will coffee, chocolate, alcohol and other stimulants of acid secretion. In case of overweight and outright obesity, weight reduction certainly helps for another reason as well: fat meals are irritating to the stomach due to gallbladder bile discharge. Bile acids have a caustic effect on damaged mucous membranes and only exacerbate the pain.
For those who love natural cures, excellent digestive and antispasmodic herbal teas for the stomach are those based on laurel and chamomile, while in the case of esophageal reflux those of sage and calendula are indicated. For acute gastritis pain it is advisable to take licorice as herbal tea, dry root or pure extract. The polyphenols in licorice stimulate the gastric mucosa and produce mucus, which normally protects against the corrosive action of hydrochloric acid. For slow digestion, herbal teas based on mint, gentian or verbena are the most suitable.
The main drugs used to treat stomach acid are the so-called antacids. These drugs perform their activity through the temporary neutralization of excessive acidity in the stomach, but without altering the production of hydrochloric acid. For this reason, this type of drug is mostly useful in sporadic cases of stomach acid, perhaps caused by excessively large meals or the consumption of foods that are difficult to digest. If you want to intervene naturally, sometimes a pinch of bicarbonate or magnesium salts will be enough to soothe or neutralize the underlying acidity (whether of digestive origin or not). It is not recommended to take bicarbonate for a long time given its possible rebound effect (increased acidity). The same goes for antacids based on calcium carbonate: the calcium ion is a stimulant of acid secretion and in the long term these antacids can cause constipation. Then, depending on the underlying pathology, it is possible to set up a targeted medical therapy.
Gastritis and stomach ulceration
In these cases, in the past, the key drugs were H2 antagonists (famotidine, ranitidine and cimetidine), while today proton pump inhibitors such as omeprazole, lansoprazole and derivatives are practically universal. Their effectiveness is very good and they manage to control the symptoms in almost 100% of cases.
If the stomach pain is the result of gastroesophageal reflux disease, the treatment plan revolves around a lifestyle modification (nervousness, alcohol abuse, etc.) and a therapy based on antacids, gastroprotectors (sucralfate, alginates) and lansoprazole or pantoprazole for a period of at least 3 months. Digestive symptoms can benefit from motility stimulants (domperidone and metoclopramide).
Helicobacter pylori gastritis
If the gastric biopsy during gastroscopy has given a positive result for the presence of Helicobacter, the doctor will initiate antibiotic therapy alongside the pump inhibitors. Fluoroquinolones (such as ciprofloxacin) are usually used for no less than 2 weeks. Effective alternative antibiotics are metronidazole (Flagyl), tetracyclines (eg Minocin) and clarithromycin (Klacid).
Stomach pain caused by nervousness generally responds well to antispasmodics such as octylonium bromide (Spasmomen), and if it is associated with inability to digest it suffers well from domperidone. The conducting physician then associates a short period of intake of pump inhibitors. If the pain is due to somatization (e.g. psychosomatic colitis), a combination of diazepam and octylonium or papaverine (Rilaten), is among the most frequent medical prescriptions. The preparations containing extracts of valerian and passion flower have a discrete and variable effect from case to case.
- Edited by Dr. Gianfrancesco Cormaci, PhD, specialist in Clinical Biochemistry.