HOW TO RECOGNIZE GASTRITIS PAIN

Your stomach is up under your ribs on the left side. You are likely to feel gastritis pain in your upper abdomen, in the mid line or on the left.

anatomy upper abdomen

The one symptom that makes us think of gastric causes for pain, is accompanying pervasive nausea.

Any severe pain is likely to be accompanied by nausea, but here the pain is usually not that severe.

Gastritis pain will typically be within an hour of ingesting food.

You are likely to be tender if you dig your fingers into your tummy, under your ribs in the middle or on the left.

SUSPICION OF GASTRIC SYMPTOMS IS ENOUGH TO DECIDE ON A MEDICAL CHECK.

It is important to ensure you don't have a stomach ulcer or cancer, and to check on h pylori infection.

THE PATHOPHYSIOLOGY BEHIND GASTRITIS PAIN AND PEPTIC ULCER

Stomachs are amazing bits of equipment. They don't have stones like a hens' but the lining cells still have to survive as we churn and grind food to a pulp.

As well as the mechanical stress, our stomach lining has to protect itself against very corrosive liquid. Gastric juice readily dissolves tripe.

This hostile environment is intentional, and nearly all the germs on our food succumb.

Helicobactor pylori

helicobacter  source www.hpylori.com.au
Helicobactor pylori4 is an exception like the Bushmen of the Kalahari desert, adapted perfectly for life in a very inhospitable environment.

This germ lives in the tartar on our teeth and in the cells lining our stomach.

H pylori breaks down a waste material always on hand called urea. This produces ammonia which neutralizes the gastric acid and allows the germ to dock at the mucous membrane of the stomach.

Most people who are infected with H pylori don't know they're ill, but become carriers - with chronic gastritis, but no symptoms.

H pylori infection is a common cause of gastric symptoms, even stomach ulcers and stomach cancer.

Testing for this organism is really important if you have gastritis pain.

Urea breath test for h pylori

The urea breath test is a pathology test for active infection of our stomach lining with the germ Helicobactor pylori.

The urea used for the test is tagged with a non-radioactive isotope of carbon, which is released as carbon dioxide at the same time as the ammonia is produced.

This is measured in our breath after the dose of labeled urea is swallowed in a glass of water.

This test does depend on ensuring the urea solution coats the entire stomach, by appropriate positioning. It also depends on the urease production by your particular strain of helicobacter, and the number of the organisms present.

DNA testing by PCR is more sensitive. This shows up the germ's presence in the stools, and should now be the gold standard test, being more frequently correct than traditional histology and culture.

Mycoplasma PCR worth checking too

Korean work published in 200411 very likely applies elsewhere in the world. 23 of 56 people with chronic gastritis had this germ on PCR test of their gastric biopsies, mostly M. faucium.

Gastric cytoprotection v. acid and the rest.

Your stomachs' protective mechanisms include a well-defined mucus layer covering the lining, alkaline bicarbonate secretion under the mucus layer, epithelium without gaps between cells, and a good blood supply.

Your general state of health is very important. Nutrients such as zinc, vitamin C and glutamine are especially so.

In the opposite corner are hydrogen ions, bile salts, ingested drugs such as NSAIDS, and ingested alcohol.

Upset tummy is probably the most common side effect of drugs in general. Our stomach telling us something?

Bile is the bitter yellow material you may have had the misfortune to bring up during an intense bout of vomiting.

Specfic food / chemical intolerance and gastritis

AS with any "itis" anywhere in the body, gastritis may be caused by "allergy." Dr. Arthur Coca wrote...
"...some food-allergic persons come for anti-allergic treatment in a state of malnutrition having lost weight on account of their allergic indigestion (daily vomiting for example, or gastric pain or poor appetite.) These persons in time regain their normal weight..."

Chronic dehydration

Dr. F. Batmanghlidj9 has a very interesting view of the cause, that it is due to chronic dehydration interfering with the gastric cytoprotection mechanism. Drinking more water is a pretty simple thing to try out.

TREATMENT OF GASTRITIS

Aloe vera as a drink, is often useful.

Homeopathic treatments such as Nux vomica-HomaccordR often help gastric symptoms.

The use of ars. alb. for gastritis is a very good example of the general principle of use of homeopathic potencies. Arsenic as a poison, as in Arsenic and Old Lace, causes intense gastritis. In homeopathic potency (much diluted) is it used for treating gastritis.

Prescription of homeopathics requires a lot of information about things like personality, likes and dislikes, fears and anxieties, temperature and weather preferences, etc.

Any life event that happened at the start of the gastritis pain, as well as major events in life which left a profound influence on you, are also valuable information for this purpose.

Prescription of high potency homeopathics is not something to try on oneself generally. It requires a lot of knowledge and skill.

Low potency complexes as above, and Schusslers biochemic tissue salts are useful for self treatment.

Fenugreek seed infusion is worth a try. 1 teaspoon seeds, steeped in a cup of boiling water; add 1 teaspoon honey - drink the fluid only.

Siberian pine (bread tree) nut oil is used for gastritis. For information see reference7 at bottom of gastritis pain page.

HELICOBACTOR PYLORI CONTROL

Mastic resin8 can be taken to help eradicate h pylori infection.

Sodium chlorite + citric acid, as well as being a permitted food additive, is useful therapeutically in h pylori infection.

Anything to boost poor immunity may help

One trial1 of this plus lactoferrin and a probiotic, showed more success with fewer side effects, than with triple therapy alone. Two recent meta-analyses5,6 have supported this use of lactoferrin.

Broccoli sprouts worked in 3 of 9 people in a small enzymes trial2. They contain an isothiocyanate called sulforaphane, which stimulates the cells to produce protective antioxidant10

The "test and treat approach" for dyspepsia lasting more than 4 weeks recommends simply testing for and treating Helicobactor instead of doing endoscopy first.

It's used in people under 45 years age, with stable weight (no red flags), not taking NSAID drugs and not also suffering from acid reflux.

From gastritis pain to acid reflux

More on the role of zinc nutrition in health

Ulcers and pylorospasm

Pre pyloric ulcers generally behave like duodenal ulcers.

Gastric ulcers must be considered as possible stomach cancers. It is very important therefor to verify complete healing with a repeat gastroscopy.

The pyloric sphincter, where the stomach joins the start of your small intestine, is subject to severe spasm at times. This is an extremely painful, recurrent condition - much more severe than gastritis pain. I've seen a young woman with this need large doses of intravenous pethidine (meperidine or demerol,) for relief.

Dyspepsia plus bad breath

In a study3 of patients with dyspepsia + halitosis + Helicobactor, followed up for an average of 55 months after eradication of the infection, 16 of 18 lost their bad breath.

Bloating after meals - the zinc connection

When someone tells me of bloating in their upper abdomen after meals, I always think zinc.

Lack of zinc, that is.

In my book, bloating equates with hypochlorhydria - inadequate gastric acid.

The major problem here is that people unable to get their gastric juice pH low enough, produce a lot more acid - lower quality, greater quantity.

Faced with symptoms like burning discomfort, and relief from antacids, people naturally assume they have too much acid.As in the old song, "It ain't necessarily so."

An acid supplement such as 1/2 glass of unsweetened pineapple juice before meals, may help as much as antacids - and more physiological (better for us) as well.

More on this on acid reflux page of this site.

And see below for more on more severe hypochlorhydria

Gastric motility and delayed emptying

The nerves in the stomach wall can be damaged by disease, partly paralysing the organ.

Nausea, vomiting, abdominal pain and bloating can be caused by this gastroparesis.

A good start to learn about this is at www.digestivedistress.com.

Genuine excess of gastric acid - pre pyloric and duodenal ulcer.

Note About Genuine Excess of Gastric Acid

The other pattern of infection is "multifocal atrophicgastritis," of the antrum and body of the stomach. Individuals who develop gastric carcinoma and gastric ulcers usually have this pattern.

If the gastric antrum alone is infected with Helicobactor, the stomach may make too much acid of correct strength, with pH <3.

The switching off mechanism has been disabled, but nothing is wrong with the acid production from the body of the stomach.This "antral predominant gastritis" is usual in people with duodenal ulcers.

The increased duodenal acid load may precipitate and wash away bile salts, which normally reduce the growth of H pylori. Damage to the duodenum allows H pylori to grow there and cause ulcers.

And genuine lack of gastric acid - from atrophic gastritis

This used to cause "pernicious anaemia" due to vitamin B12 not being absorbed.

My old partner and teacher, Dr. Alister Hinchley, wrote...

"The only symptom or sign in association with achlorhydria that I know of is diarrhoea.
Achlorhydric diarrhoea as I have seen it, responds like magic.
Some people had low acidity, full stop. Some of these had chronic diarrhoea and mist. Ac. HCl dil. was effective, certainly in some I remember, almost in hours.
You have to order a lot of it and the patient drinks it usually with great revulsion, with the meal in a tumbler of water.
None of the achlorhydric patients I can remember had any upper abdominal signs or symptoms. If they did, it was a vague uncharacteristic syndrome.
Should a therapeutic trial be indicated there are no contraindications except distaste. It does not spoil the meal, or the appetite, and can be tolerated."

Gastroscopy, biopsy, CLO test (rapid urease test) for gastritis pain

If a look at your stomach is warranted, a CLO test for Helicobacter pylori is also warranted.

Also it can look perfectly normal and yet have gastritis on examination under the microscope, with or without helicobacter.

I have people with minimal gastritis, only found on the biopsy, but with definite symptoms. Sometimes the gastritis has been sufficiently mild on the biopsy, for the gastroenterologist to have not mentioned it. You may need to ask.

It is also worth knowing where in the stomach the gastritis has been found, as the causes and management probably should be different for the two ends of your stomach.

The appearance under the microscope is also useful for distinguishing likely helicobacter infection from likely reflux into your stomach, of alkaline duodenal content.

There are a lot more inflammatory cells with helicobacter, and more evidence of repair after injury with alkaline bile relux.

Autoimmune gastritis

In pernicious anemia, T and B lymphocytes attack the H+K+ATPase enzyme, causing atrophic gastritis. Serum anti-parietal cell and anti-intrinsic factor antibodies are involved, and are used as a test for this condition.

Intrinsic factor is essential for the absorption of vitamin B12, so this becomes deficient, causing the pernicious anaemia.

Sore tongue, loss of appetite with moderate weight loss and occasionally diarrhea may result from megaloblastic changes of the epithelial cells.

From gastritis pain page, to home page

References for Gastritis Pain

1. de Bortili et al Am J Gastroenterol 2007 May 102(5) p951-6

2. Galan M V et al Dig Dis Sci 2004 Aug 49 (7-8) 1088-90

3. Katsinelos et al Med Princ and Prac 2007 Feb 16: p 119

4. picture from hpylori.com.au, where you can read about Dr. Barry Marshall, the co-discoverer.

http://www.helico.com is the Helicobacter foundation, who recommend for dyspepsia with helicobacter, to...

"start treatment gradually with the least toxic combination first. For example, omeprazole....then amoxicillin...then metronidazole or clarithromycin as the patient settles (this may be a week or two)."

Barry Marshall tells his interesting story in discover magazine at http://discovermagazine.com/2010/mar/07-dr-drank-broth-gave-ulcer-solved-medical-mystery


These next two appeared in The Journal of Complementary Medicine 2009 8(4) p 36

5. A. Sachdeva et al Aliment Pharmacol Ther 2009: 29(7) pp 720-30

6. J. Zou et al Helicobacter 2009: 14(2) pp 119-27

7. http://www.pinenutoil.org/siberian-pine/bread-tree.php

8. Farhad Huwez et al, NEJM Dec. 1998<br/>

Mastic gum 1 gm per day for two weeks can cure peptic ulcers.<br/>

This study showed it kills Helicobacter

9. Water for Health, for Healing, for Life. p 133-4

10. http://www.ncbi.nlm.nih.gov/pubmed/21548875

11. http://onlinelibrary.wiley.com/doi/10.1111/j.1349-7006.2004.tb03208.x/abstract;jsessionid=85EB1B2FA97DB6221D7F8369017BCA1E.d04t03

Useful sites for gastritis pain page

Dr. Ron Kennedy's site has a good article on hypochlorhydria.

http://www.food-allergy.org/root2.html has a very good run-down on digestion. They mention betaine hydrochloride and have got it right about heartburn and inadequate gastric acid.

page contents

Symptoms
Causes
Helicobacter
Food intolerance
Dehydration
Treatment
Pylorospasm
Bad breath
Acid deficit
Delayed emptying
Acid excess
Acid deficit
Autoimmunity
References
Useful sites

PCR stands for "polymerase chain reaction", the process by which traces of DNA specific to this germ can be replicated and so amplified to allow detection. See http://www.genome.gov/10000207

Samuel Hahnemann in the 18th century, devised treatment based partly on the "principle of similars" (like cures like.)

Thymus derived (T) and bursa or bone marrow derived (B) lymphocytes are part of our immune system. T cells come in different varieties - helper (Th1, Th2 and Th17,) suppressor and natural killer.