Most of us associate any pain in the abdominal area as stomach ache. But is it really a stomach ache?
“Stomach ache is a common complaint by patients, so much so that it is quite dangerous for us clinicians when we hear this, as it can mean 101 possible things.
“For most laymen, the stomach is anywhere below the ribs and above the pelvis – it’s a huge area.
“But when you talk about stomach ache, then the pain should be just below the ribcage on the left side, which is where the stomach is located.
“We have to differentiate whether the pain is really coming from the stomach or another site so that we can treat accordingly,” says consultant general surgeon Dr G.C. George.
You could experience gastritis symptoms such as bloating, cramping and temporary loss of appetite, due to the pain.
However, when there is progressive weight loss, then you need to get checked because it could be something more sinister like stomach cancer.
Dr George says, “With stomach cancer, the site of discomfort or pain is always the same – the stomach.
“One association is early satiety – the patient feels full easily and his appetite drops significantly, resulting in weight loss.
“Initially, stomach cancer has very little or no symptoms, so we advocate certain groups of individuals to routinely get an endoscopy and biopsy done.
“By the time the symptoms come about, it is already quite late.”
Some patients may have stools that are blackish and tarry-looking (clinically called melaena) – this contains decomposing blood and is usually an indication of bleeding in the upper part of the digestive tract.
“Seek urgent treatment if you see this,” he advises.
Age, diet, obesity, smoking and certain stomach diseases can affect the risk of developing stomach cancer.
The risk is higher among those with a family history of this cancer, are older, or have a high intake of pickled, preserved, fermented, salted and smoked food.
A diet high in fresh foods and vegetables may reduce the risk.
If your work involves usage of food additives or paints that use nitrogen-based chemicals, then you are also at risk.
Treating Helicobacter pylori
Stomach cancer or gastric cancer, begins when cancer cells form in the inner lining of the stomach and grow into a tumour.
It progresses slowly over many years. It is the second highest cause of death from cancer in the world.
In Malaysia, it is the sixth commonest cancer among men and the 10th commonest cancer among women.
According to Mayo Clinic in the United States, for the past several decades, rates of cancer in the main part of the stomach (stomach body) have been falling worldwide.
One of the reasons is the earlier detection of the Helicobacter pylori bacteria, which is the strongest known risk factor for stomach cancer.
The bacteria can reside for years in the stomach without any symptoms.
Left untreated, it can cause gastritis and progress into peptic ulcer and stomach cancer.
When the infection leads to an ulcer, symptoms include abdominal pain, especially when your stomach is empty at night or a few hours after meals.
“Since we are able to pick up the H. pylori bacteria via an endoscopy or a urea breath test early, treatment can commence quickly,” says Dr George, who has an interest in upper gastrointestinal surgery.
H. pylori can be picked up from unhygienic food practices, water or utensils, and through contact with the saliva or other body fluids of infected people.
It is usually treated with a regime of antibiotics for a minimum of two weeks.
He adds, “After the treatment, we will advise patients to do another urea breath test. The results will show negative, borderline or positive.
“If it is still positive, we need to see why the infection didn’t respond to the regime that was given.
“Is there antibiotic resistance or did the patient not take the medicine properly?
“We may give him another regime and if the results come back negative, then he is considered cleared.”
However, there is always a possibility the bacteria can return, so the patient has to be careful with his food.
“The constant irritation and trauma to the lining of the stomach wall is the reason why we develop stomach cancer.
“It comes from multiple exposure, not one single episode.
“Often when we biopsy, we find that the ulcer is cancerous and the lining also has the H. pylori bacteria.
“We immediately treat the infection and proceed with surgery to remove the tumour to not waste time,” says Dr George, adding that no long-term drugs are required for stomach cancer patients.
While stomach cancer rates have fallen, the same period has seen a rise of cancer in the area where the top part of the stomach (cardia) meets the lower end of the swallowing tube (oesophagus).
This area of the stomach is called the gastroesophageal junction.
Gastroesophageal junction cancer is associated with having gastrointestinal reflux disease (Gerd), obesity and smoking.
Gerd is a condition caused by frequent backflow of stomach acid into the oesophagus.
Reflux is associated with obesity, diets high in caffeine and fatty foods, and smoking.
When stomach acid goes back up, there is constant irritation and erosion in the area, which may lead to ulcers.
Once diagnosis is established after the endoscopy and biopsy of the ulcer or tissue, the surgeon will look at whether the cancer has spread beyond the junction to the lungs and bone.
Dr George explains, “In the early stage, surgery is the best treatment, and if done correctly, you may not need chemotherapy.
“However, since patients usually present towards the later stages (of cancer), we advise them to go for chemotherapy and see if it works before deciding on the next step.
“Generally though, chemotherapy doesn’t work well for stomach cancers.
“If they are actively bleeding or the tumour has grown to a stage where it is blocking the channel and they cannot eat, then we decide whether to do surgery to remove a big bulk or the whole stomach, put a stent or do a bypass for food to flow through.”
As there is limited or no more reservoir for food to be stored, food travels faster down the small intestines, so patients are advised to take small portions regularly.
Eventually, the body will learn to adapt and they can eat close to what they were able to eat prior to surgery, although they have to avoid salty, preserved, fried and fast foods.
On using herbs to battle cancer, Dr George says, “Patients will have a feel-good factor for a while because most of these herbs contain steroids.
“They may provide some relief, but the cancer is still there. So far, I haven’t seen any natural remedies that work.”
For those who eat tons of unhealthy food, popping supplements doesn’t prevent the bad effects either.
“The body is smart. The mind may cheat, but you are actually traumatising the stomach.
“It’s like stabbing the stomach with a knife and hoping that drinking lots of water will heal the wounds automatically.
“It doesn’t work that way,” he cautions.
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