Pain in the gut

We all suffer from digestive problems. Tan Bee Hong finds out more from an expert

DR. Kwan Keat Leong walks the talk. The consultant general and gastrointestinal surgeon at Tropicana Medical Centre in Kota Damansara, Selangor, doesn’t smoke or drink coffee and tea.  And though he says he loves everything delicious, he only occasionally eats hot, spicy and sour foods.

After all, these are what he’s always telling his patients not to do, especially those with gastric problems. He knows what they are experiencing as he himself has had gastritis too.

“Frequent use of painkillers, stress, increased stomach acidity and helicobacter pylori can also cause gastritis and peptic ulcers,” he says.

These conditions are just two of the many gastrointestinal problems, which may be divided into upper and lower digestive disorders. Apart from the two named, the former also includes gallstone, gastroesophageal reflux disease (GERD) and helicobacter pylori infection while the latter includes piles, haemorrhoids, colorectal cancer and constipation.

Abdominal pain can range in intensity from a mild stomach ache to severe acute pain. Often, the pain is nonspecific and as mentioned, can be due to a number of reasons.

But what effect does smoking have on the gut? “When smokers inhale, some of the smoke gets to the stomach and, like alcohol, it destroys the lining of the stomach,” explains Dr Kwan, 42.

GASTRIC AND PEPTIC ULCER

“Stomach or gastric acid is actually very concentrated with a pH of 1.35 to 3.5 and can burn if you take a drop and put on your hand. But our stomach cells are protected by a layer of mucous. When this layer is compromised, the acid attacks the stomach cells,” he adds.

It used to be that patients with gastrointestinal problems were aged 30 and above but these days, says Dr Kwan, patients are getting younger. He’s even had a patient in the teens.

He blames it on the changing diet and lifestyle and the trend of western-style diets that emphasises on meat rather than vegetables.

Gastritis is not only about abdominal pain. Some patients have a high tolerance for pain, he says, adding that other symptoms include bloating, wind and feelings of indigestion. He advises seeking medical attention early to avoid the condition turning into peptic ulcer. “I’ve had patients who come in with gut pain and when we do a scope, we find they already have peptic ulcer.”

He advises gastric patients to abstain from hot, spicy and sour food, gassy drinks, coffee, tea (including green tea). “Caffeine in coffee and tea affects stomach acidity. If you must have these, have it in moderation,” he says, adding that decaffeinated coffee and tea is permissible.

GERD

Gastroesophageal reflux disease happens when there is backflow of stomach content. The three symptoms are heartburn, excessive burping and acid brash (feeling of sour taste in the mouth). Obesity and pregnancy are common causes, says Dr Kwan, but there are others such as late, heavy dinners. “Imagine eating and then going to bed. The food has not digested, so when you lie down, it can backflow,” he says.

Dr Kwan advises eating small, frequent meals instead of large meals. “By all means eat the basic three meals but don’t overeat,” he says. “Then if you feel hungry in between, have a small snack instead.”

H. PYLORI

This is a nasty bacteria that lives in the gut. It’s able to survive in the highly acidic conditions because it actually twists and buries its way into the mucous layer. This damage leads to gastric, peptic ulcers and increases the risk of stomach cancer.

“H. pylori itself does not cause cancer,” stresses Dr Kwan who adds that a blood test is the best way to detect H. pylori but it’s not always conclusive.

H. pylori infections often occur in childhood when kids grab and put all kinds of stuff or food in their mouths. Overcrowded living conditions and sharing of food (a la Chinese style) are risk factors as is infection between spouses.

GALLSTONE

This is one condition that is often mistaken for gastritis, says Dr Kwan. “Patients often complain of gastric-like symptoms of pain in the upper belly and bloating after a meal. But the difference is that the pain will be more concentrated on the right side,” he says.

Dr Kwan adds, that there are two categories of gallstone conditions. Asymptomatic gallstone is when the patient feels no pain. Patients with symptomatic gallstone will require surgery.

Gallstone, caused by the supersaturation of bile, is different from kidney stone. “You can’t take medication to shrink gallstones,” he says. “In any case, the size of the stones doesn’t matter. Small stones can be just as harmful as big ones.  
Bile is necessary to emulsify fat but when it’s very saturated, it crystallises and turns to stone. “Gallstone surgery is not complicated and can be done via keyhole surgery.

LOWER DIGESTIVE DISORDERS

Of all the lower digestive disorders, constipation is the most common and we all suffer from this at one time or another. The answer to constipation, says Dr Kwan, is five-a-day. This means five servings of fruit and vegetables. Not only that but we have to drink lots of water too.

But just because you don’t empty your bowels every day, it does not mean you suffer from constipation. “Some people only go every other day. But if you pass motion only once or twice a week, do seek medical attention as it may be a sign of something serious,” he advises, adding that we should also check our stools before flushing.

Some people find it repulsive but stools can tell a lot about our inner health. Bleeding, changes in bowel movement, colour and condition (loose or hard) of the stools and mucous are early symptoms of colorectal cancer. Dr Kwan says it is imperative to get an early diagnosis and the proper treatment. At stage one and two, chances of survival are better but it also depends on the location of the cancer.

“When they are diagnosed with colorectal cancer, one of the first reactions is fear — fear of death and fear of having to wear an ileostomy bag. But this is not so, unless the cancer is very near the anus and we have to close up the anus during the surgery,” says Dr Kwan.

Piles is another common condition and Dr Kwan says he sees an average of one or two new patients daily. “About one in four persons have piles but they usually suffer in silence as most feel embarrassed to talk about it,” he adds.

Treatment, he says, is stage directed and differs from individual to individual. Stage one is when the piles is inside. Stage two is when piles come out when the patient passes motion but these recede on their own. In stage three, the piles do not recede back on their own and have to be pushed back in by hand. In stage four, the piles may come out at anytime of the day.

What causes piles? “Bad toilet habits,” he stresses. Those who read when sitting on the toilet bowl tend to sit for long periods of time and this places undue stress on the rectum muscles as the centre part of the bum is not supported.

Those who squat a lot or carry weights daily are at high risk too.

Dr Kwan advises going to the toilet only when you feel the urge. “Just because you think you have to pass motion daily, you sit on the toilet and strain. This is bad and is proven to cause piles.
 

If you have gastritis, it is best to avoid spicy food

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