Talking from the gut in East and West
[T]he stomach cramm’d from every dish,
A tomb of roast and boil’d, of flesh and fish,
Where bile and wind, and phlegm and acid jar.
And all the man is one intestine war.
It has been the season to be jolly and to over-eat. A number of people I know, including yours truly, have had stomach ailments of various kinds this season. These events now send me back into the gut, a trip best done on e-paper.
Indigestion, bellyaches, crises de foie, upset stomachs are some of the names we use when telling our doctors about ongoing abdominal bloating, heartburn, burping, nausea, vomiting or midriff pain.
Historian James Whorton explains that Scottish writer Thomas Carlyle, who was the “most eminent of Victorian dyspeptics,” compared his stomach ache to “a rat gnawing at the pit of the stomach.”
Treating this ailment is boggled by a lack of understanding of what the gut might be trying to say. But little steps of progress are being made and one standard treatment could add to those steps.
Stomach aches are one of the most common disorders that general physicians hear about in their practices. Gastroenterologist Paul Moayyedi at McMaster University in Hamilton in Ontario, Canada points out that roughly one in 20 visits to primary care doctors involves these types of symptoms.
Letting doctors peer into one’s innards by swallowing a tube in a diagnostic procedure called endoscopy, leads to “a normal result” in 80 percent of all cases, says Moayyedi in his invited commentary in the Archives of Internal Medicine.
Functional dyspepsia is the name given to the ailment this large group of people suffer from: stomach aches without a discernable cause.
Diagnosing what might be at the root of a bellyache is trouble because there are so many potential causes. The stomach may have difficulty emptying or it might be secreting high levels of acid — genetics and environmental factors such as stress and diet play a role, too.
A typically prescribed drug is a proton pump inhibitor, which blocks stomach acid production. But it only works when a stomach ache is caused by an atypical type of acid reflux. Prokinetic agents work on the small intestines and “may” help, but larger studies are not confirming the smaller studies, Moayyedi says.
In addition to these drugs, in China and Japan, doctors dispense herbal medicines such as xiaoyao san and rikkunshito to treat functional dyspepsia.
According to Moayyedi there is a “paucity of effective therapies” for functional dyspepsia, which is hardly good news everyone with a pained belly.
This class of indigestion can mean short-term or lifelong pain, another reason why a better understanding of the ailment is needed. A Vanderbilt University School of Medicine study with children and teens between 8 and 16 who were followed for 15 years found patients who had been diagnosed young with a painful condition called esophagitis had a lower quality of life as young adults and were at increased risk for anxiety as well as chronic indigestion.
Doctors also tend to prescribe antibiotics to people with functional dyspepsia. The idea is to rid the body of the bacterium that causes ulcers, Helicobacter pylori. The bacterium can be sometimes detected in people who have stomach ache symptoms. Some patients get relief from this treatment.
The microbe is not equally distributed throughout the world. Studies suggest it plays a larger role in the Chinese population than in Western populations. According to a study from Singapore, wiping out H. pylori in patients with chronic stomach aches may be “more significant” in the Asian region.
The benefits have to be weighed against what one study calls the high financial burden of the treatment as well as the risk of antibiotic resistance.
Treating with antibiotics helps “only a relatively small number of patients,” Moayyedi writes. Those patients, however, could help physicians and researchers in many countries solve if and how H. pylori play a role in functional dyspepsia. Understanding what wiping out H. pylori does, might explain more about the ailment.
Moayeddi believes that H. pylori infection could be causing inflammation of the stomach lining. Yet the bacterium might not “the main culprit,” because inflammation is detectable in patients with functional dyspepsia and who are not infected with H. pylori.
Perhaps the antibiotics are killing other microorganisms that cause the inflammation. If those microbes could be identified, that would help with finding the most efficient treatment, he surmises. We are only beginning to understand the complex relationship that we have with our gut flora and how that interaction can either promote health or cause disease,” writes Moayyedi.
“The understanding of FD [functional dyspepsia] is still incomplete and is evolving over time,” write the authors of an Asian consensus report on functional dyspepsia in the Journal of Gastroenterology and Hepatology. The paper with authors from institutions in six Asian countries summarizes findings in order to give doctors indications about treatments for functional dyspepsia.
This so common ailment is still a trial-and-error treatment game for which efficient medicines are lacking.
Jin X, Li YM. Systematic review and meta-analysis from Chinese literature: the association between Helicobacter pylori eradication and improvement of
functional dyspepsia. Helicobacter 2007; 12: 541-6.
Miwa, H. et al. Asian consensus report on functional dyspepsia, Journal of Gastroenterology and Hepatology, DOI: 10.1111/j.1440-1746.2011.07037.x
Moayyedi P., Heliobacter pylori eradication for functional dyspepsia, What are we treating?
Archives of Internal Medicine.Vol. 171 (No. 21), Nov 28, 2011
Moayyedi P, Soo S, Deeks J, et al. Systematic review: antacids, H2-receptor
antagonists, prokinetics, bismuth and sucralfate therapy for non-ulcer
dyspepsia. Alimentary Pharmacology & Therapeutics. 2003;17(10):1215-1227.
Rippel, S.W. et al. Pediatric Patients with Dyspepsia Have Chronic Symptoms, Anxiety, and Lower Quality of Life as Adolescents and Adults. Gastroenterology. Jan 5, 2012.
Posted on January 16, 2012, in digestive tract, Medicine and tagged antibiotics, digestion, indigestion, McMaster University, stomach aches, Vanderbilt University School of Medicine, xiaoyao san. Bookmark the permalink. 1 Comment.