A New Way of Looking at Stomach Aches

In evaluating stomach upsets, the physician should not only focus on hyperacidity.

New developments in research have changed the way gastric distress is diagnosed. Physicians must consider not only the possibility of hyperacidity but he or she should also examine how healthy is the patient's gastrointestinal motility.

The doctor must look into these possibilities: is stomach upset due to excess acid or a motility disorder in the esophagus, stomach and small intestine? Is there a malfunction in the way food is stored, processed and moved along the digestive tract?

So the next time you run to a doctor complaining of stomach ache that will not go away with simple medication, make sure you are checked for motility problems along with other suspected abnormalities in the digestive tract.

In dyspepsia or stomach distress, especially in the absence of any underlying disease, ulcer-like symptoms could easily suggest hyperacidity. But that is not always the case.

Dr. Olaf Nyren of the University Hospital in Uppsala, Sweden, one of a group of experts that has exhaustively studied dyspepsia, found that although functional cases (those without underlying diseases) may have ulcer-like symptoms, these may not be due to the excessive secretion of stomach juices.

The truth is, only a handful of patients with functional dyspepsia actually have hyper secretion (high gastric acid output). The majority have normal secretions.

The idea that functional dyspepsia differs from one caused by too much stomach acid has been proven in two ways by Nyren.

He did this by showing that factors other than gastric acid are responsible for the pain in functional dyspepsia. In fact, the more severe the problem is in functional dyspepsia, the lower the acid output. Thus, a reduction of acid secretion is not always effective in relieving the condition.

With this in mind, patients complaining about stomach upsets should not always be treated for hyperacidity. To the dismay of Nyren, however, many physicians, particularly general practitioners, are not aware of this and still treat patients with acid-reducing drugs.

Dr. JR Malagelada of the Mayo Clinic, another dyspepsia expert, added that approximately 50 percent of patients with functional dyspepsia have some type of motility disorder – the most common of which is reduced gastric emptying caused by slow contractions in the antral region of the stomach and increased resistance to the flow of food into the small intestine.

Although studies of gastrointestinal motility disorders have not fully told us what causes the symptoms of dyspepsia, they have helped focus attention away from abnormalities in gastric juice secretion and organic lesions as the primary causes of stomach upsets.

The bottom line? Doctors should discard the time-worn practice of prescribing antacids for every case of stomach upset. The right thing to do if you have a stomach ache is to have your gut motility checked. This will save you a lot of money and distress.