For unknown reasons, persons suffering abdominal pain have higher than average scores for depression, anxiety and other psychiatric disorders. But even if your bellyache seems to get worse during times of stress, what you’re feeling is certainly not in your head and may well signal a medical problem that requires early treatment.

Ulcers have long been linked to stress, but it’s now known that most cases involve a bacterial infection that can be eradicated with antibiotics.

Heartburn is an even more common cause of dyspepsia, affecting about 40 percent of the population at least once a month. But even heartburn, if it’s chronic, can lead to more severe medical problems and should not be taken lightly.

Whether you suffer from ulcers, heartburn or merely bloating and gas, numerous over-the-counter medications are available, but they seldom offer a long-term solution. For a belly ache that persists, you’re better off seeing your doctor.

New View on Ulcers

If you suffer from a gnawing pain in the area between your navel and your breastbone that tends to be worse when your stomach is empty, you may have an ulcer. About one of every 10 Americans suffers from a peptic ulcer, defined as a sore on the lining of the stomach or small intestine.

The pain may last from a few minutes to many hours–often severe enough to awaken you in the middle of the night. The symptoms can usually be relieved by eating food or taking an antacid or acid blocker.

More severe symptoms include vomiting blood (which may be either red or black), dark blood in the stool, nausea, vomiting, unexplained weight loss and pain in the upper back.

For years, patients assumed that their ulcers were a chronic condition brought on by stress and spicy foods. At one time they were even advised to drink milk, which is now known to actually increase the production of acid in the stomach and make matters worse.

In 1982, Australian researchers Barry Marshall and Robin Warren challenged that traditional view with results showing that a bacterial infection–and neither stress nor diet–was the cause of most ulcers. To silence the many skeptics, follow-up studies consistently demonstrated that about 80 percent of stomach ulcers can be linked directly to a helicobacter pylori (H. pylori) infection which can be eradicated in a matter of weeks with a course of antibiotics.

H. pylori is common; about 80 percent of the population in third world countries and about 50 percent of older adults in the United States are infected, possibly because of consuming contaminated food or water at some time during their lives. For reasons unknown, however, only about one of six infected personsdevelops ulcers or other digestive problems.

Ulcers can also be caused by chronic use of aspirin or other nonsteroidal antiinflammatory drugs (NSAIDs) such as ibuprofen, naproxen sodium and ketoprofen.

Rarely if ever does an ulcer require a bland diet or even antacids; it does help, however, to stop smoking. Treatment with antibiotics generally must be accompanied by medications that reduce the amount of digestive acids–usually H2 blockers

(Tagamet, Pepcid, Axid, Zantac) and/or proton pump inhibitors (Prilosec, Prevacid, Aciphex).

Even if you’ve never experienced heartburn yourself, you’ve undoubtedly seen the condition graphically portrayed in TV ads. More than 15 percent of Americans have symptoms of heartburn at least once a month and up to seven percent suffer on a daily basis.

As opposed to the gnawing pain of anulcer, heartburn involves the regurgitation of acids from the stomach into the esophagus, typically resulting in a burning pressure or pain from the breast bone up the throat.

The pain, sometimes lasting several hours at a time,may get even worse right after eating or when you’re lying down or bending over. It’s often severe enough to be mistaken for a heart attack.

Causes of heartburn include overeating, obesity, tight clothing or a malfunction of the muscular valve that controls flow between the esophagus and the stomach. This malfunction in turn can be traced to foods such as coffee, tea, cola, chocolate, alcohol, garlic, onions and fatty foods or to nicotine or certain medications which tend to relax this valve. Positions such as bending over or lying down can also allow stomach acid to flow up the food tube.

When symptoms are severe or when they occur at least twice a week, they may represent what doctors call gastroesophageal reflux disease (GERD), a serious disorder that can lead to even more severe problems.

Chronic inflammation caused by heartburn symptoms can eventually produce bleeding sores in the esophagus. When these sores heal, they often form scars that narrow the tube and make it difficult to swallow.

What doctors call Barrett’s metaplasia involves the growth of abnormal cells in the lower esophagus. These cells are less sensitive to acid–thereby reducing the pain–but they create an elevated risk of cancer of the esophagus, a disease that has been increasing at alarmingly high rates over the past three decades, particularly among white males.

Only two percent of persons with GERD develop sores and scarring. Only two to five percent of those with Barrett’s metaplasia get esophageal cancer. Nevertheless, the risk is high enough that anyone with severe, recurring symptoms of heartburn should not hesitate to see a doctor.

Treatment usually involves lifestyle changes–smoking cessation, weight loss and avoidance of foods that cause the problem–plus antacids, H2 blockers, proton-pump inhibitors, coating agents such as sucralfate (Carafate) and prokinetic agents such as metoclopramide (Reglan). Another prescription prokinetic agent, cisapride [Propulsid], was taken off the market earlier this year because of reports of heart rhythm abnormalities and several deaths.

For severe cases that do not respond to other therapy, surgery may be recommended.

In addition to heartburn, GERD and ulcers, there are many reasons you may experience pain or discomfort in the upper abdomen. These include gall bladder disease, a viral infection, poor digestion of carbohydrates, stomach cancer or an H. pylori infection that has not yet become an ulcer.

Only 25 percent of Americans suffering from dyspepsia go to the doctor, but most of those who do have an identifiable medical disorder that requires treatment.

If you have symptoms that are severe or recurrent, there’s no reason to keep your belly ache to yourself.

REFERENCES:

Wink A. de Boer and Guido N.J. Tytgat, “Treatment of Helicobacter Pylori Infection,” British Medical Journal review article, January 1, 2000.

“Chronic Heartburn May Be a Cancer Risk,” Tufts University Health & Nutrition Letter, May, 1999.

Robert S. Fisher, M.D., and Henry P. Parkman, M.D., “Management of Nonulcer Dyspepsia,” NEJM review article, November 5, 1998.

“GERD: More Than Just Heartburn,” Harvard Men’s Health Watch, March, 2000.

“Heartburn: Trivial Symptoms or Serious Prognosticator?” Family Practice News, July 15, 2000.

“Peptic Ulcers: New Understanding, New Treatments,” Mayo Clinic Health Letter, September, 1999.

Walter L. Peterson, et al, “Helicobacter Pylori-Related Disease,” Archives of Internal Medicine, May 8, 2000.

Malcolm Robinson, et al, “Heartburn Requiring Frequent Antacid Use May Indicate Significant Illness,” Archives of Internal Medicine, November 23, 1998.

Howard M. Spiro, “Peptic Ulcer: Moynihan’s or Marshall’s Disease?” The Lancet, August 22, 1998.

Alexander Williams, et al, “Heartburn Treatment in Primary Care,” British Medical Journal, May 20, 2000.

“High-Tech Hope for Hearburn Sufferers,” FDA Consumer, July, 2000.