What is the most common cause of abdominal pain? When does an aching stomach indicate serious illnesses? When should you visit an endocrinologist? What methods are effective for relieving abdominal pain?
Stomach pain can be caused by various factors. The cause may be, among other things, gastritis, gastrointestinal infections or peptic ulcers. Sometimes, however, there is no organic cause in the gastrointestinal tract. In this case, the condition is called dyspepsia or functional dyspepsia.
Abdominal pain is sometimes not related to the gastrointestinal tract, for example, it is caused by stress or neurological disorders.
Causes of abdominal pain - what does abdominal pain mean?
The content of the article
There are several main causes of abdominal pain:
- Gastritis
. The most common cause of gastritis is infection with the bacterium Helicobacter pylori. This infection is very common. In addition to gastritis, infection with this bacterium is also a risk factor for stomach ulcers and cancer. Gastritis is often asymptomatic, but can also cause abdominal pain. - Hemorrhagic gastropathy.
Another common cause of abdominal pain is acute hemorrhagic gastropathy. This is a type of gastritis with erosions. Abdominal pain occurs after excessive use of painkillers and alcohol, as well as as a result of stress and serious injury. - Foodborne infections
. May also cause pain in the stomach area. Then the pain accompanies infectious diarrhea. The etiological factor of such diarrhea is viruses, bacteria or bacterial toxins. - Dysbacteriosis
. After long-term use of an antibiotic, so-called post-antibiotic diarrhea usually occurs, which consists of a disturbance in the composition of the intestinal bacterial flora. - Peptic ulcer disease
. This condition also produces characteristic pain. The main cause of stomach ulcers is H. pylori infection. Less commonly, ulcers can form as a result of taking non-steroidal anti-inflammatory drugs and steroids. - Dyspepsia in pregnant women
. Dyspepsia, including abdominal pain, is a common complaint among pregnant women. Due to the anatomical changes that occur in a woman's body, heartburn is also a common problem.
Often the cause of ailments mistakenly taken for abdominal pain is pressure on the sensory nerves, for example, with discopathy of the thoracic spine. Then the abdominal pain may be associated with back pain.
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Chronic abdominal pain is a complex diagnostic and treatment problem in pediatrics and, at the same time, one of the main complaints of children and their parents, a common reason for visiting a doctor. Chronic is defined as abdominal pain that lasts more than 3 months. In children, recurrent is more common, which is said to occur in cases where it is repeated at least 3 times within 3 months. and affects the child’s normal activity.
The nature of chronic abdominal pain can be organic and functional.
Organic diseases. Identification of the cause of chronic abdominal pain in children due to organic diseases is based on: 1) anamnesis; 2) physical examination; 3) laboratory research; 4) radiation and endoscopic research methods; 5) assessing the effectiveness of empirical treatment.
Determining the localization of abdominal pain in childhood has its own peculiarities. Thus, up to 3 years of age, children almost always detect pain in the navel area.
Older children localize pain more accurately. Of particular interest is the observation of J. Apley: “The further the pain is located from the navel, the greater the likelihood of an organic disease.”
Help in identifying the cause of chronic abdominal pain can be provided by parents keeping a diary, which records the type of food eaten and the symptoms observed after it for 2 weeks. In this case, it is possible to detect potential causes of some symptoms, for example, lactose intolerance, etc. It is also necessary to record the use of medications and all therapeutic measures. Family history may indicate a predisposition to gastric and duodenal ulcers, pancreatitis, inflammatory diseases of the biliary system, intestines and a number of other diseases.
During the study, fever, complaints of painful sensations in the joints, the presence of a rash, etc. are recorded. The presence of one or more of the listed symptoms suggests the inflammatory or infectious nature of the pain syndrome.
Since there is a connection between abdominal pain, nutrition and the physical development of the child, data on the patient’s height and body weight is required.
A full clinical examination is carried out, followed by focusing on the abdomen. Pain during examination of the abdomen will be indicated by a grimace on the child’s face or a remark. Important findings are enlargement of the liver, spleen, the presence of space-occupying formations, as well as localization of pain. Further diagnostic search is carried out taking into account the obtained data.
If topical diagnosis is not possible at the outpatient stage, the examination is continued in a hospital or in a diagnostic center. Here they carry out endoscopic examination (fibrogastroduodenoscopy, colonoscopy), biopsy (according to indications), sonography, radiography (cholecystography, irrigography), CT, MRI, scintigraphy, acidometry; determination of the enzymatic function of the digestive tract, electrophysiological study, stress tests, study of biochemical parameters of blood and urine, intestinal microbiocenosis, genetic examination, etc.+
Other methods of laboratory examination are used in connection with the characteristics of the data obtained. These include liver enzymes and amylase, serologic testing for H. pylori and amoebiasis, and stool culture and parasite testing. A study for lactose intolerance is carried out if the evaluation of the empirical diet does not produce results. Analyzing the child's body's response to treatment is part of the diagnostic process. For example, taking antibiotics can predispose to the development of intestinal dysbiosis, medications for the treatment of acne can predispose to esophagitis, and tricyclic antidepressants can predispose to constipation.
Main causes of abdominal pain
The most common causes of chronic abdominal pain are: chronic gastritis, duodenitis and gastroduodenitis. There are chronic gastritis type A (autoimmune), gastritis type B (associated with H. pylori) and gastritis type C (chemical or reflux gastritis). Type B gastritis is more common and is accompanied by severe pain that occurs on an empty stomach or 1-2 hours after eating. There is pain and sometimes tension in the abdominal wall in the epigastrium and pyloroduodenal area. Endoscopically, structural and inflammatory changes in the antrum of the stomach are revealed.
Duodenitis and gastroduodenitis are also characterized by pain associated with food intake or its nature (fried, spicy), as well as with long breaks in food. Dyspeptic syndrome is manifested by nausea, vomiting, which brings relief, belching, and heartburn. Symptoms of chronic intoxication and vegetative-vascular dystonia are often observed. Pain in the epigastric region is detected.
Peptic ulcer of the stomach and duodenum in children, unlike adults, often does not have clear clinical symptoms, since it is often characterized by the presence of superficial ulcers. The leading symptom is pain in the epigastrium or pyloroduodenal region, occurring on an empty stomach or 1-3 hours after eating, often at night and more severe than with gastroduodenitis. Eating temporarily relieves the condition. Hidden bleeding is possible. Endoscopic examination is decisive in diagnosis.
Chronic abdominal pain may be associated with esophagitis, which develops due to gastroesophageal reflux. This is characterized by pain behind the sternum during meals, in the epigastric region, a sensation of passing a food bolus, and dysphagia. Belching with a sour smell and heartburn are observed. Relatively rarely, the cause of chronic pain in the upper abdomen can be gastroptosis and hiatal hernia. In this case, pain occurs 2–3 hours after eating, especially in a horizontal position of the child, when bending forward and physical activity. This pathology can be assumed in the absence of effect from therapy for esophagitis and gastroduodenitis.
The cause of chronic abdominal pain can be chronic enteritis, colitis, enterocolitis. In this case, the pain is localized in the navel, hypogastric region on the left and right. It often occurs in the afternoon, sometimes 1.5–2 hours after eating. Its appearance is provoked by the consumption of large quantities of fresh vegetables, fruits, and milk. The pain is accompanied by bloating, rumbling, and intensifies with physical activity. If it is localized on the right, it is necessary to exclude acute appendicitis. Chronic intestinal damage is characterized by stool disorder - alternating diarrhea (with enteritis) and constipation (with colitis).
Nonspecific ulcerative colitis and Crohn's disease are characterized by recurrent abdominal pain, paroxysmal or constant. They are localized throughout the abdomen, to the left, to the right of the navel, but more often in the lower abdomen, intensifying after eating or physical activity. The stool is unstable, diarrhea gives way to constipation, mucopurulent or bloody stools, and the presence of tenesmus are noted.
Diagnosis is relatively simple if there are bloody stools, forced bowel movements at night, the presence of a perianal inflammatory process or a mass formation in the right iliac region (inflammatory bowel changes). Delayed sexual development, anemia, aphthous ulcers in the mouth, chronic hepatitis, synovitis or arthritis of large joints may occur. The diagnosis is established on the basis of irrigography and colonoscopy with biopsy.
When analyzing complaints from a child and his parents, you should pay attention to:
• duration of pain. Short-term is more often associated with motor disorders, long-term (more than 3 hours) - with inflammatory causes;
• connection of pain with the intake and nature of food;
• with defecation;
• presence of symptoms of “upper dyspepsia” - belching, heartburn, nausea, vomiting;
• bowel dysfunction.
A significant group of children with chronic abdominal pain consists of patients with cholepathy. These include diseases of the gallbladder and biliary tract - developmental anomalies, inflammatory, parasitic, tumor diseases, cholelithiasis. The pain is provoked by the nature of the food (spicy, fatty, fried). Characterized by nausea, vomiting that does not bring relief, belching, bitterness in the mouth, changes in stool (constipation, diarrhea), and sometimes uneven coloring of individual stool fragments. With the inflammatory nature of cholepathy, prolonged low-grade fever or febrile body temperature during an attack is possible. There is pallor of the child's skin, sometimes telangiectasia, and subicteric sclera. There is pain in the right hypochondrium. With severe cholestasis, liver enlargement is possible, which disappears after choleretic therapy.
Other forms of damage to the biliary tract (cholelithiasis, developmental abnormalities, tumors, parasitic diseases) do not have specific symptoms and are detected mainly during a paraclinical examination of the child.
Chronic abdominal pain may be associated with pancreatic pathology. Acute pancreatitis, in particular the edematous form, is both an independent disease and a reactive condition against the background of other pathologies of the digestive organs. Destructive forms of pancreatitis in children are rare. Chronic pancreatitis occurs with paroxysmal abdominal pain. Their localization depends on the area of damage to the pancreas. Its total defeat is characterized by intense girdling pain, which is accompanied by severe anxiety of the child, vomiting, which does not bring relief, sometimes indomitable. There is a disorder of the stool - constipation, more often diarrhea. Symptoms of intoxication are expressed.
The cause of chronic abdominal pain in children can be helminthiasis. In this case, the pain does not have any specificity and is accompanied by chronic intoxication, loss of appetite, drooling, and bruxism.
The second group that causes the presence of chronic abdominal pain is diseases of the urinary system: pyelonephritis, nephroptosis, vesicoureteral reflux, cystitis, urolithiasis, dysmetabolic nephropathy and more rare kidney pathology. These diseases are characterized by pain, often not associated with eating. In case of urolithiasis, nephroptosis, attacks can be provoked by hypothermia and physical activity. The pain is localized near the navel, lower abdomen, and lower back.
With vesicoureteral reflux, it is felt along the ureter. In this case, right-sided reflux can simulate acute appendicitis. When the kidneys are fused (horseshoe-shaped, biscuit-shaped, S- and L-shaped), the pain is localized in the epigastric region and is accompanied by dyspeptic disorders. Cystic formations of the kidneys lead to pain in the epigastrium, sometimes to renal colic. Colic is also characteristic of urolithiasis, dysmetabolic nephropathy, nephroptosis, hydronephrosis. With hydronephrosis, a nagging, dull pain in the abdomen is possible, accompanied by flatulence and dyspeptic disorders. With pyelonephritis, prolonged low-grade fever or “unmotivated” rises in temperature are noted. In general, the pathology of the urinary system is characterized by dysuric symptoms.
The group designated as “other diseases”, which may cause chronic abdominal pain in children, is represented by a variety of pathologies, including rare ones. However, gynecological pathology is more often observed in girls - salpingitis, adnexitis, ovarian cysts. The pain is often localized in the lower abdomen, in the mesogastric region, and can be acute, paroxysmal and nagging, aching, constant, radiating to the lower back. In menstruating girls, it is possible in the lower abdomen during the ovulation cycle. Functional diseases. The greatest difficulty is in the interpretation of chronic abdominal pain caused by functional disorders of the digestive system, when examination of the child does not reveal the morphological cause causing the pain. In accordance with the Rome criteria (Rome, 2006), several common signs are identified for functional disorders, regardless of the type of lesion:
• duration of main symptoms is at least 3 months. over the past year;
• absence of organic pathology;
• multiple nature of complaints (not only disorders of the digestive system) with the general good condition of the patient and a favorable course of the disease without noticeable progression;
• the importance of psychosocial factors and neurohumoral regulation disorders in the formation of the main symptoms.
The diagnosis of any functional disorder is a diagnosis of exclusion. It can be diagnosed only after a thorough examination of the patient and exclusion of organic causes that cause pain and other symptoms of the disease. Children should have no “alarm symptoms” - weight loss, loss of appetite, fever, changes in peripheral blood tests, blood in the stool, etc.
Psychosocial factors and social maladaptation are important in the pathogenesis of functional disorders and chronic abdominal pain. It is believed that they may be primary in the development of functional disorders and, in combination with genetic predisposition, determine the formation of the type of motor disorders and visceral hyperalgesia. The interdependence of the central nervous system and all peripheral influences leads not only to direct dysfunction of the gastrointestinal tract, but also to neuropsychological abnormalities. As a result, functional disorders are based on motor dysfunction caused by the failure of regulatory relationships on the brain-gastrointestinal axis.
Intestinal motility disorders in functional disorders can occur as hypotension, atony, or have a mixed nature. In functional disorders accompanied by chronic abdominal pain, in addition to motor disorders, sensory deviations characterized by visceral hypersensitivity (hyperalgesia) are typical. There is a change in the sensitivity of the receptor apparatus to irritants and a decrease in the pain threshold.
Chronic recurrent abdominal pain in children has a variety of causes. To make a correct diagnosis, it is necessary to take into account “symptoms of anxiety” and use targeted diagnostic methods depending on the clinical course and location of the pain syndrome.
Patients describe abdominal pain in functional disorders in different ways - from unpleasant sensations to unbearable, cramping pain without clear localization, occurring for no apparent reason or associated with eating, stress, physical activity, or defecation. In this case, the peculiarity of the pain syndrome is that it occurs in the morning or daytime, when patients are active, and subsides during sleep.
In children in the first months of life, chronic recurrent abdominal pain manifests itself in the form of intestinal colic, which manifests itself as restlessness and crying. To diagnose intestinal colic, the so-called “rule of three” is used - crying for 3 or more hours a day, at least 3 days a week for 3 weeks in a row. Colic appears in a child at the age of 6 weeks and can be observed until 3-4 months. Intestinal colic is caused by the tension of the digestive processes in conditions of physiological immaturity of the infant's gastrointestinal tract and the load on the intestines, which is associated with a large volume of nutrition. At the same time, children gain weight well, maintain a positive emotional mood, appetite, and normal bowel movements.
With functional stomach disorders, pain occurs regardless of food intake - short-term, of varying intensity, localized in the epigastric region. Sometimes pain appears after mental stress and is more often observed in emotionally labile children. The attacks are accompanied by symptoms of autonomic instability. The examination reveals moderate pain in the epigastrium and right hypochondrium. Endoscopic examination is decisive in diagnosis. In this case, the absence of morphological changes and impaired motor function of the upper gastrointestinal tract in the form of spasm or hypotension of the sphincters, impaired peristalsis are revealed.
Pain based on functional disorders is characterized by:
• absence of disease progression;
• the changing nature of complaints;
• the patient's assessment of pain as very severe;
• the presence of numerous complaints concerning other organs and systems;
• short medical history;
• parents’ excessive demands on the child, problems at school;
• emotional stress in the family;
• absence of objective changes during examination.
Pain based on functional disorders is not characterized by:
• local stereotypic pain;
• awakening from pain during sleep;
• special behavior during attacks;
• anorexia;
• vomit;
• persistent constipation or diarrhea;
• presence of chronic gastrointestinal diseases in family members;
• retardation in physical development or loss of body weight;
• fever;
• joint pain;
• blood in the stool.
Biliary dysfunctions . Biliary dyskinesias play a significant role among the causes of chronic abdominal pain. The hypertensive form is characterized by paroxysmal, short-term pain localized in the right hypochondrium, sometimes radiating to the right shoulder and scapula. Vegetative dystonia is pronounced. There is pain in the right hypochondrium. This form of dyskinesia is based on spasm of the sphincter apparatus of the biliary system.
With the hypotonic form of dyskinesia, the pain is often moderate, but longer lasting. The pain is provoked by physical activity, eating fatty foods, and overeating. There is moderate pain in the right hypochondrium, an enlarged but soft liver. This dyskinesia is based on stagnation of bile in the biliary system and a decrease in the motor-evacuation function of the gallbladder.+
Functional disorders of the gallbladder are manifested by impaired contractile function, slower evacuation of bile and stretching of the bladder, which causes pain. Dysfunction of the sphincter of Oddi may be associated with functional, motor, usually spastic disorders of the sphincter of the common bile duct, sphincter of the pancreatic duct or common ampullary duct. Depending on this, symptoms of damage to the biliary tract, pancreas, or joint changes predominate.
Irritable bowel syndrome . The most common and best studied among functional disorders of the digestive canal. The disease is manifested by abdominal pain, impaired bowel movements, and flatulence. Due to the lack of a clear conceptual apparatus in young children, it is difficult to clarify subjective sensations that are pathognomonic for establishing this diagnosis in strict accordance with the Rome criteria. Symptoms that can be used to diagnose irritable bowel syndrome are:
• stool frequency less than 3 times a week;
• stool frequency more than 3 times a day;
• hard or bean-shaped stool;
• thin or watery stool;
• straining during defecation;
• imperative urge to defecate (impossibility of delaying defecation);
• feeling of incomplete bowel movement;
• secretion of mucus during bowel movements;
• feeling of fullness, bloating or transfusion in the abdomen.
A significant role in the pathogenesis of irritable bowel syndrome belongs to the psycho-emotional status of the patient, as well as the presence of autonomic dysfunction. Psychopathological disorders in such children are characterized by a shallow level of damage (neuroses, neurotic reactions). The close connection between depression and chronic abdominal pain is explained by general biochemical processes, and primarily by the insufficiency of monoaminergic (serotonergic) mechanisms. This is supported by the effectiveness of antidepressants, especially serotonin reuptake inhibitors, in the treatment of abdominal pain.
There are two main forms of irritable bowel syndrome—hypertensive and hypotonic.
The hypertensive form is characterized by periodic cramping pain of uncertain localization or in the left iliac region. In this case, the abdomen is swollen, spastic contraction and soreness of the descending and sigmoid colon are determined by palpation. Constipation is common. After defecation, the pain decreases.
The hypotonic form is characterized by a feeling of discomfort, distension, bloating with moderate and intermittent pain. After defecation, the pain usually disappears.
The diagnosis of irritable bowel syndrome is a diagnosis of exclusion, requiring a thorough analysis of complaints, anamnesis, clinical laboratory and biochemical blood tests, instrumental studies to exclude organic intestinal pathology (ultrasound, colonoscopy, irrigography, parasitological studies, etc.). An etiological treatment for this syndrome has not yet been developed. Currently used therapy is aimed at individual known links in pathogenesis. One of them is the normalization of the microbial composition of the intestine. Correction of dysbiotic disorders, as well as prevention of their development, can be achieved with the help of functional nutrition. The use of myotropic antispasmodics is recommended. Since one of the leading mechanisms of the pathogenesis of irritable bowel syndrome is autonomic dysfunction and neuropsychiatric disorders, therapy includes drugs that correct these disorders.
Functional abdominal pain syndrome . Abdominal pain without intestinal dysfunction is classified as a separate category. This syndrome is defined as constant, almost constant or often recurrent abdominal pain, which is characterized by the following features:
• last for at least 6 months;
• are not associated with specific physiological factors (food intake, defecation, menstrual cycle, etc.);
• accompanied by a decrease in physical activity;
• characterized by a non-progressive course;
• do not have signs that would allow these pains to be attributed to other functional disorders of the gastrointestinal tract.
Functional abdominal pain syndrome is observed in prepubertal age with two frequency peaks. The first corresponds to the age of 5–7 years, is observed in 5–8% of children and often coincides with their sending to school. The second peak occurs in almost 25% of children and is observed at the age of 10–12 years with the highest frequency in girls. This syndrome is considered as a biopsychosocial disease. In this case, pain is caused by amplification (strengthening) of the perception of pain in the cerebral cortex due to excessive afferent impulses (to a lesser extent) and its insufficient descending suppression (to a greater extent). The process of amplification of pain is facilitated by mental stress - the death of parents, previous operations, the anniversary of a tragic event, etc.
Much attention in the development of functional abdominal pain syndrome is paid to episodes of physical or sexual coercion of children. Anamnesis-wise, they are detected in adolescence in 64% of patients with this syndrome (2.8 times more often than in children with organic diseases). The presence of such episodes causes patients to desire diagnostic tests, prompts them to frequently consult a doctor, and causes resistance to prescribed treatment. It is characteristic that patients, as a rule, do not tell the doctor about such episodes, and identifying them requires delicate formulation of questions.
In functional abdominal pain syndrome, the latter is not associated with physical activity and in most cases is accompanied by vegetative signs (pallor, nausea, dizziness, malaise, etc.). There is often a family history of a predisposition to functional bowel diseases.
When questioning patients, it is possible to identify a number of features of the pain syndrome: pain exists for a long time (months, years) and is localized in various parts of the abdomen; often diffuse, emotionally described as very intense, constant, having no connection with food intake and the act of defecation. Patients often say that “if it weren’t for pain, life would be wonderful.” They insist on various diagnostic studies and surgical interventions.
An objective examination of some patients reveals postoperative scars on the anterior abdominal wall, indicating operations, sometimes performed without objective indications. It is possible to identify a “closed eyes symptom” - when palpating the abdomen, the patient closes his eyes, while a patient with acute abdominal pain due to organic causes watches the doctor with open eyes, fearing increased pain. The “phonendoscope symptom” is known - pressing with a phonendoscope on the anterior abdominal wall during functional abdominal pain syndrome does not cause increased pain, whereas in pain associated with an acute surgical disease, this manipulation turns out to be very painful.
The diagnosis of functional abdominal pain syndrome should be a diagnosis of exclusion. It is legitimate to place it only after a thorough examination, including not only laboratory testing of blood, urine, feces, but also echography of the abdominal organs, endoscopic (FGDS, colonoscopy) and, if necessary, radiation research methods (x-ray, CT, MRI, scintigraphy, etc. .). In cases where the diagnosis still remains unclear, the issue of performing laparoscopy is discussed.
Chronic abdominal pain may be due to cyclic vomiting syndrome (abdominal migraine), described by J. Gee in 1882 under the name “periodic syndrome.” The disease is characterized by episodic attacks of nausea, abdominal pain, vomiting, usually starting at night or in the morning and lasting from 6 to 48 hours with subsequent intervals of well-being (weeks, months). Most children experience autonomic disorders (pallor, diarrhea, weakness, tachycardia, etc.). Treatment consists of prescribing antiemetics or migraine medications. Yuri ABAEV , Professor of the Department of Pediatric Surgery of BSMU, Doctor of Medicine. Sciences Medical Bulletin, August 7, 2008
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Symptoms of abdominal pain - when to contact a gastroenterologist?
Symptoms of abdominal pain
You need to make an appointment with a gastroenterologist if the place where you feel abdominal pain is the upper abdomen, that is, the area under the lower edge of the sternum. Pain in this area may also indicate pathology located in other organs, for example, in the duodenum, intestines, or pancreas.
Pain can be of different natures. With stomach and duodenal ulcers, the pain is burning. She is strong and persistent, but does not interfere with her main activities. Stomach pain occurs at certain times, such as at night or early in the morning. It most often occurs on an empty stomach, a few hours after eating, and decreases after eating or taking antacids.
On the other hand, when a gastric ulcer perforates, patients experience very severe stabbing pain in the abdomen, reminiscent of a knife prick.
In the case of indigestion, that is, dyspepsia, stomach pain is accompanied by pressure in the stomach, a feeling of fullness and nausea. Heartburn, belching and flatulence are also common. Symptoms often appear, mainly after eating.
Symptoms of a foodborne infection usually appear several hours to several days after exposure. The predominant symptom is diarrhea, but gastrointestinal pain and vomiting may also occur.
Get emergency medical help if abdominal pain is accompanied by symptoms such as:
- significant weight loss in a short time;
- abdominal pain that interferes with normal functioning or, for example, sleep;
- gastrointestinal bleeding, manifested as vomiting blood or bloody stools;
- difficulty swallowing;
- palpable swelling in the upper abdomen;
- jaundice;
- signs of severe dehydration such as fainting.
How to help digestion?
To compensate for the lack of digestive enzymes of the pancreas, pancreatin enzyme preparations can be used. They help improve food digestion. Helping with fat digestion is especially important. The required enzyme for this is lipase, which is produced only by the pancreas. At other stages of digestion, except for the intestines, it is simply not there2. Therefore, when choosing an enzyme preparation, its quantity is so important. How to figure it out?
The most common and familiar drug for improving digestion is pancreatin in tablet form3. Pancreatin is the active ingredient of an enzyme preparation to improve digestion, but this does not mean that pancreatin preparations are all the same.
Since we started with the lipase content in the drug, it is worth noting that tablet forms of pancreatin can contain from 25 units (IU) of lipase. There are a number of drugs in which this amount may be higher: 3500–4500 IU of lipase. The optimal amount of lipase that should be contained in an enzyme preparation in case of dietary errors is recognized to be 10,000 units4.
But the most important thing in choosing a drug is not even the amount of lipase. The defining property is the release form5,6.
Studying the necessary conditions for the effective operation of the enzyme preparation, scientists came to the conclusion: the preparation must have small particles of the active substance. And the size of these particles should not exceed 2 mm5,6.
The tablet form is recognized as the least effective for an enzyme preparation, since it does not allow the drug to work physiologically6,7, which means to precisely integrate into an already working system and get to where the enzymes work in natural conditions.
Diagnosis of stomach pain - what tests should be performed?
When diagnosing abdominal pain, a carefully collected medical history is important. The primary diagnosis is made by when symptoms continue, when they occur, and then when they disappear. The rhythm of bowel movements and possible changes in the appearance of the stool are important. You should also tell your doctor about the warning symptoms mentioned earlier.
A blood test, including a complete blood count, may provide some information about gastrointestinal bleeding or nutritional deficiencies.
It is important to check for H. pylori infection. For this purpose, blood tests, stool tests, or a sample taken during a gastroscopy are most often performed. Gastroscopy is a key method for diagnosing peptic ulcers, as well as some inflammations of the gastric mucosa.
In case of abdominal pain, imaging tests, primarily ultrasound, are mandatory. They allow you to confirm or exclude, for example, gallstones or kidney stones. If symptoms do not go away and all organic diseases of the gastrointestinal tract are excluded, functional diseases of the digestive system, which can cause stomach pain, should be diagnosed. These include, for example, pain in the epigastrium.
Diagnosis of functional disorders is difficult, since during their course nervous pain in the stomach is possible. Therefore, a consultation with a psychiatrist may also be required.
Stomach pain - treatment
Treatment for stomach pain depends on the underlying cause. In the case of an active H. pylori infection, it is necessary to kill the bacteria using a combination of antibiotics and proton pump inhibitors (PPIs). The neutralizing effect of PPIs is also used in the treatment of peptic ulcers.
People with peptic ulcers or inflammation of the gastric mucosa are not recommended to use non-steroidal anti-inflammatory drugs such as ibuprofen, diclofenac, ketoprofen and others. They can worsen symptoms and add new ones due to side effects.
On the other hand, in case of pain, paracetamol and diastolic drugs, for example, drotaverine drugs, can be used.
In the treatment of functional dyspepsia, prokinetic drugs that improve the functioning of the digestive system may be useful. Because some cases of abdominal pain can be caused by stress, the help of a therapist may be needed. Antidepressants such as amitriptyline are used to treat such conditions.
Home remedies for stomach pain
Home Remedies for Stomach Pain
Self-monitoring is very important when treating stomach pain. You should eat small portions and monitor how your stomach reacts to certain foods. Excluding or including certain ingredients for several days helps with this.
Anyone with peptic ulcers, gastritis or functional disorders should avoid smoking, drinking alcohol and drinking coffee. Coffee does not interfere with the healing of stomach ulcers, but after drinking coffee or drinking alcohol, stomach pain may intensify.
Some home remedies for stomach pain, such as baking soda, are also not recommended. Sodium bicarbonate neutralizes stomach acid to some extent, which helps with peptic ulcers or reflux disease, but excessive sodium intake is harmful, especially for people with cardiovascular disease.
Lozenges containing neutralizing agents based on calcium and magnesium salts can be used in limited quantities. But herbal medicines are not mentioned in official recommendations for the treatment of these causes of abdominal pain. In case of peptic ulcer and H. pylori infection, only pharmacotherapy is key and should not be replaced by herbs.
There are isolated reports in the scientific literature about the effectiveness of some herbs for functional dyspepsia. Turmeric, licorice root, peppermint, and celandine are mentioned. The capsaicin found in chili peppers is believed to reduce the transmission of pain in the abdominal organs. Because some cases of functional dyspepsia are caused by stress, herbal medications with a sedative effect, such as lemon balm or valerian, may be helpful. But any herbs cannot replace drug treatment, so they are taken only in combination with medications, and only as prescribed by a doctor.
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Often, rare and short-lived pain in the upper abdomen is the result of a violation of the diet and errors in diet. To eliminate this unpleasant symptom, it is recommended to regulate the frequency and timing of meals, observing the appropriate rules of eating behavior. Fractional meals in small portions, 4–6 times a day, have worked well. Dinner should take place at least 3 hours before bedtime. You should also limit your intake of foods that are difficult to digest and maintain fluid balance (drink water on an empty stomach and between meals).
