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.
-Alexander Pope

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.

It might not just be from the lovely dinner. Image: Smathur80 via Wikimedia Commons

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.