Gastric pain or gallstones?

MOST of us refer to pain or discomfort in the epigastric area (the upper abdominal area between the bottom of the breastbone and the umbilicus (navel) as gastric pain.

This is a very common problem and is one of the top reasons people visit their general practitioner.

Most often, this pain or discomfort originates in the stomach, the duodenum (the first part of the small intestine) or the gall bladder.

Less common are cases where the large intestine or the pancreas are involved.

Gastritis occurs when the lining of the stomach is irritated. This can be due to irregular or missed meals and the consumption of spicy or citrus foods. The discomfort is frequently accompanied by a bloating sensation and/or burping.

Occasionally, gastritis is caused by bacteria called Helicobacter pylori (discovered by an Australian doctor who eventually won the Nobel Prize for Medicine as this discovery led to effective medical treatment for millions of sufferers).

Gall bladder stones cause similar symptoms of bloating, burping and epigastric discomfort. Frequently, the symptoms are worse after the consumption of fatty or oily foods.

The gall bladder's function is to digest the fat in your diet and eating food with a high fat content causes it to contract vigorously.

When the gall bladder is functioning normally, these contractions are not felt. When stones are present in the gall bladder (there are multiple causes), however, the wall can become irritated (this is known as chronic cholecystitis and the irritation results in more prominent symptoms like gastric pain and bloating).

Interestingly, 20 to 40 per cent of all people have stones in the gall bladder, but most of these do not cause problems. Asymptomatic gallstones (which don't cause problems) are usually left alone.

Symptomatic gallstones (which cause problems) usually lead to removal of the gall bladder using key-hole surgery.

As both gallstone disease and gastritis have similar symptoms, the first step in diagnosis is to analyse the patient's symptoms and obtain his/her thorough medical history.

A gastroscopy is my choice of initial investigation. This is a very safe procedure where a camera on a tube is passed through the mouth into the stomach. This is because if gastritis or bacteria are found, the treatment mostly requires just medication.

If the gastroscopy is negative, then an ultrasound scan of the gall bladder is required. If the steps are reversed, there is a risk of undergoing surgery to remove the gall bladder for asymptomatic gallstones, when actually the cause of the problem is the stomach.

Dr Sujit Singh Gill is a vascular and general surgeon in private practice. He can be contacted at sujitsinghgill@me.com

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