Stomach pain
Stomach pain develops with functional digestive disorders, intestinal infections, gastritis and peptic ulcer. The symptom occurs with foreign bodies and neoplasms of the stomach, pylorostenosis, NSAID-gastropathy. To diagnose the causes of abdominal pain syndrome, instrumental techniques are used — ultrasound, EFGDS, X-ray examination, intragastric pH-metry. To eliminate pain, medications are used: drugs that reduce gastric secretion, antacids, antispasmodics and prokinetics. In acute conditions, gastric lavage, sorbents, and antidotes are prescribed.
Causes of stomach pain
Functional disorders of the stomach
Intestinal infections
Gastritis
Peptic ulcer disease
Pylorostenosis
Diaphragmatic hernia
Neoplasms
Foreign bodies
Diseases of other digestive organs
Myocardial infarction
Complications of pharmacotherapy
Rare reasons
Diagnostics
Treatment
Help before diagnosis
Conservative therapy
Surgical treatment
Prices for treatment
Causes of stomach pain
Functional disorders of the stomach
The most common cause of stomach pain in young and middle-aged people. It occurs 2 times more often in men than in women. Unpleasant aching sensations in the epigastric zone are characteristic, which can turn into sharp pain. The pain syndrome is variable in nature, it appears periodically. Accompanied by belching, nausea, heartburn. Symptoms are provoked by the use of spicy food, fast food, dry food.
Intestinal infections
The defeat of the stomach is more typical for food toxicoinfections, infection with staphylococci. A few hours after eating stale food, severe pains in the epigastric region, nausea and repeated vomiting begin. Often the symptoms are combined with watery diarrhea. Pains throughout the abdomen, including in the stomach, occur with salmonellosis, escherichiosis.
Gastritis
The nature of the painful sensations depends on the type of inflammation. For hyperacid gastritis, intense pain on an empty stomach is specific. They resemble an attack of peptic ulcer, accompanied by heartburn and acid belching. With hypoacid gastritis, a dull pain that occurs after eating worries. It is aggravated by nausea, heaviness in the stomach, decreased appetite.
Peptic ulcer disease
Ulcerative defect of the gastric mucosa is characterized by pain in the epigastrium. With the defeat of the antrum and the body of the stomach, soreness is observed to the left of the central line of the body, and with a defect of the pyloric department — to the right. Pain is often given to the shoulder blade, spine, or to the left side of the chest, simulating pain in the heart.
With gastric ulcer, the appearance of soreness is typical 30-60 minutes after eating. The higher the defect is localized, the earlier the pain is felt. When the duodenum is involved in the pathological process, “hungry” and night pains prevail. They decrease at the end of the meal. The patient’s condition improves after vomiting, when applying a heating pad to the stomach area.
With a complicated course of peptic ulcer disease, the nature of the symptoms changes. The perforation of the ulcer is indicated by a strong “dagger” pain in the stomach, which sometimes causes fainting on the background of pain shock. If the perforation is accompanied by bleeding, the pain decreases. The general symptoms are steadily increasing: there is a protective tension of the abdominal muscles, sharp weakness, pallor, tachycardia.
Pylorostenosis
In the compensated stage of pylorostenosis, dull abdominal pain is observed, which worsens after eating. As a rule, vomiting brings relief to patients. Decompensation of the process is manifested by severity, pronounced soreness in the epigastrium. After each meal, vomiting opens, vomit often contains foods eaten many hours ago. Patients lose weight quickly, complain of constant weakness and drowsiness.
Diaphragmatic hernia
In this disease, the pain is more often localized behind the sternum, but may be located in the projection of the stomach. The pain is very intense, characterized by irradiation into the interscapular region. Pain is bothered after eating, physical activity, when bending the trunk forward. Symptoms decrease after a deep breath, taking water. The second specific sign of a diaphragmatic hernia is dysphagia, which is more common when eating liquid or semi—liquid food.
Neoplasms
For benign gastric polyps, non-intense pain is typical, which usually rarely bothers. Most people don’t attach importance to them. The clinical picture is complemented by discomfort after eating, belching. If the formation on the leg is infringed by the gatekeeper, acute cramping pains appear. At first they are localized in the epigastrium, then they spread throughout the abdominal cavity.
Stomach cancer is characterized by constant moderate pain in the epigastric zone. Discomfort increases at the end of a meal. There is also heaviness in the abdomen, decreased appetite and loss of body weight. A pathognomonic symptom is a sudden change in taste preferences, aversion to meat food. As the process progresses, the pain sensations become very strong, they are not stopped by standard analgesics.
Foreign bodies
Unpleasant sensations are caused by both swallowed objects (buttons, bone fragments, dentures) and stones formed in the body (gallstones, gastric bezoars). With a large foreign body, the patient experiences constant aching or dull pains in the stomach. Symptoms worsen after eating: a feeling of heaviness and bursting in the epigastrium worries.
Diseases of other digestive organs
Pain in the stomach area is often caused by diseases of adjacent organs — the liver and gallbladder, pancreas, intestines. For cholecystitis, localization of pain in the epigastrium and right hypochondrium, the presence of nausea and vomiting after taking fatty food is typical. With pancreatitis, there are shingles in the upper abdomen, which usually radiate into the back.
Myocardial infarction
Epigastric pain is felt in the abdominal form of a heart attack. A person complains of sudden, severe pain with frequent irradiation in the arm and the left half of the trunk. The attack resembles an exacerbation of peptic ulcer or pancreatitis. Nausea and reflex vomiting are observed. Stomach pains are aggravated by sharp weakness, increased pulse rate. The skin is covered with cold sweat.
Complications of pharmacotherapy
Most often, painful sensations occur due to uncontrolled intake of anti-inflammatory drugs, leading to the development of NSAIDs-gastropathy. It is characterized by moderate pain that occurs at night or on an empty stomach. The symptom is combined with heaviness in the abdomen, nausea, flatulence. Pathology is dangerous because in 50% of people it is asymptomatic, and then it can manifest itself with gastric bleeding. In addition to NSAIDs, stomach discomfort is provoked by glucocorticoids, hypotensive medications.
Rare reasons
Poisoning: poisonous mushrooms and plants, pesticides, heavy metal salts.
Motor disorders: achalasia of the cardiac sphincter, cardia insufficiency, pylorospasm.
Anomalies of the stomach: Menetrier’s disease, congenital diverticula, complete doubling of the organ.
Neurological problems: neurasthenia, masked depression.
Diagnostics
At the initial appointment, a gastroenterologist collects complaints and anamnesis of the disease, conducts a physical examination of the digestive system: superficial and deep palpation of the abdomen, checking peritoneal symptoms. Diagnostic search is aimed at finding out the causes of stomach pain. For this purpose, laboratory and instrumental diagnostic methods are prescribed:
Ultrasound of the abdominal cavity. Sonography is a screening study that detects gastrointestinal motility disorders, inflammatory changes in the stomach wall. The technique does not require special training, it is carried out to make a preliminary diagnosis.
EFGDS. Endoscopic examination of the mucous membrane of the esophagus, stomach, and duodenum is the most informative method. The doctor identifies erosions and ulcerative defects, signs of dysfunction of the gastric sphincters. If suspicious neoplasms are detected, a biopsy is performed for histological analysis of the material.
Radiography. X-ray examination with barium allows you to visualize all parts of the gastrointestinal tract. Stomach damage is indicated by filling defects, a “niche symptom”, deformation of the contours of the organ. To clarify the diagnosis, a CT scan of the abdominal cavity is necessary.
Intragastric pH-metry. The acidity level of the stomach is studied for 24 hours. According to this analysis, the functioning of the exocrine cells of the organ is determined, the type of gastritis is determined. When pathology is detected, intraesophageal pH-metry, measurement of gastrin concentration in the blood are shown.
Laboratory methods. For stomach pains, the results of a coprogram are usually indicative, in which the level of lipids, undigested muscle fibers, and starch are evaluated. A blood test is used to detect the inflammatory process. With chronic gastritis, megaloblastic anemia is often diagnosed.
Treatment
Help before diagnosis
With moderate stomach pain, non-drug treatment is indicated. To reduce the load on the digestive tract, fried, spicy, fatty foods are excluded from the diet. To reduce irritation of the mucous membrane, you should give up strong coffee, spices, carbonated drinks. It is necessary to eat in small portions 5 times a day, chew each piece thoroughly.
In acute gastritis caused by poisoning, it is required to rinse the stomach as soon as possible. Sorbents based on activated carbon, silicon dioxide, and silica gel are used to bind and remove the remaining toxins. If a person has very severe pain, vomiting with streaks of blood, tar-like stools, you should immediately consult a doctor.
Conservative therapy
Most cases of acorn pain are associated with organic pathology, which requires individually selected etiotropic and pathogenetic therapy. In case of drug-induced lesions of the gastric mucosa, it is necessary to cancel the drug that causes unpleasant symptoms. For the treatment of the underlying disease and relief of symptoms , prescribe:
Antisecretory agents. Proton pump inhibitors and H2-histamine receptor blockers are the main drugs for the treatment of high acidity. They inhibit the formation of hydrochloric acid, eliminate its irritating effect on the damaged mucous membrane.
Antacids. The effect of medications is aimed at quickly neutralizing the acidity of gastric juice. They eliminate soreness in gastritis, peptic ulcer disease. Non-absorbable antacids are preferred, which have a long-lasting effect.
Antispasmodics. Medications quickly relieve pain due to the normalization of the tone of muscle fibers and sphincters. They are used as symptomatic therapy to relieve severe pain that is not eliminated by other drugs.
Prokinetics. They are taken to eliminate pathological spasm or atony of the muscular lining of the stomach and its sphincter apparatus. They accelerate the movement of food through the gastrointestinal tract, stimulate active intestinal peristalsis.
Enzymes. Substitution therapy is recommended for concomitant diseases of other digestive organs. Pancreatic enzymes accelerate the digestion of food, prevent the processes of fermentation and putrefaction in the intestine.
Gastroprotectors. Protect the gastric wall from damaging effects, promote the regeneration of the mucous membrane. For this purpose, enveloping drugs, prostaglandins of group E are prescribed, which increase the level of protective factors in the stomach.
If the pain in the stomach area is not provoked by the pathology of the gastrointestinal tract, the patient is selected for treatment by doctors of the appropriate specialties — cardiologist, neurologist, psychiatrist. Taking into account the disease, such patients are shown taking antianginal and antiarrhythmic drugs, sedatives, antidepressants.
Surgical treatment
In case of malignant neoplasms, decompensated or therapeutically resistant forms of gastrointestinal diseases, operations are recommended. The choice of surgical method is determined by the underlying disease. Patients can perform organ-preserving operations (vagotomy, gastrostomy or gastroanastomosis, pyloromyotomy or pyloroplasty, removal of polyps, bezoars), various types of resections, gastrectomy.
