Question: "…I am only fifteen years old and recently, just after
eating I started getting pain in my stomach. Can I do
something to make it go away? What can cause this pain? "... "
July 18, 2003
Upper Abdominal Pain
Upper abdominal pain complaint, also know as dyspepsia, is a common
patient’s complain. It includes a variety of clinical presentations
and diagnoses, ranging from mild gastrointestinal infections to perforated
duodenal(upper intestinal) ulcer and pancreatic cancer.
The Gastroesophageal Reflux Disease or GERD is another one of the
most common conditions presenting to the primary care physician
and is also associated with dyspepsia.
Inflammation of the stomach lining or gastritis is not
a single disease and can be caused by drinking too much alcohol,
prolonged use of no steroidal anti-inflammatory drugs (NSAIDs),
or infection with bacteria such as Helicobacter pylori. Patients
after major surgery, traumatic injury, burns, or severe infections
are also prone to developing gastritis.
Diseases such as pernicious anemia, autoimmune disorders, or chronic
bile reflux can also cause gastritis.
Experiencing some of the most common symptoms
such as the abdominal upset or pain after having a meal is never pleasant. Other symptoms are belching,
abdominal bloating, nausea(feeling sick), and vomiting or a feeling of fullness
or burning in the upper abdomen. If there is blood in vomit or
the stools appear black, it may be a sign of bleeding in the stomach,
which may indicate a serious problem requiring immediate medical
Helicobacter pylori, a bacterium, causes
one of the most common infections of the human gastric lining worldwide.
Infection with this bacterium has been established as a causative
factor in the development of peptic ulcer disease and with the development
of gastric malignancies, including gastric adenocarcinomas and gastric
lymphomas (ref. 2)
The epidemiology of this infection reflects a pattern typical of
fecal-oral transmission and is similar to hepatitis A or polio,
prevalent at a young age in developing and poor countries (ref.1)
Pernicious Anemia: About 90% of patients with pernicious
anemia have antibodies against parietal cells of the gastric lining
eventually leading to depleted serum levels and body stores of vitamin
B12 and a megaloblastic anemia. Pernicious anemia is also associated
with other immunologic disorders (e.g., Hashimoto's thyroiditis,
hyperthyroidism, insulin-dependent diabetes mellitus, and vitiligo).
Genetic factors are important in pernicious anemia as family members
of patients have an increased incidence of atrophic gastritis; achlorhydria
(diminished or no production of HCl acid); vitamin B12 malabsorption;
and antibodies to intrinsic factor, a substance secreted by the
gastric lining and important in binding B12 vitamin. Gastric adenocarcinomas
(malignancies) have been reported to occur with increased frequency
with pernicious anemia.
Although most forms of chronic, nonspecific gastritis are clinically
silent, of importance is that these forms of gastritis represent
risk factors for other conditions such as peptic ulcer disease and
gastric cancers. It is widely believed that the most common condition
associated with chronic active, non atrophic gastritis is duodenal
The Rare Forms of Gastritis:
Infectious Gastritis: Gastrointestinal
Cytomegalovirus (CMV) infection usually occurs in the immunocompromised
patient. Patients with CMV infection of the stomach may experience
epigastric pain, fever, and atypical lymphocytosis. Upper gastrointestinal
tract radiographic studies may reveal findings suggestive of an infiltrating
malignancy. Gastric involvement with herpes simplex and varicella/zoster
virus on the other hand is rare. Infected individuals experience the
infection at an early age, and the virus remains dormant until reactivation.
Another form of gastritis, called Phlegmonous gastritis
is a rare bacterial infection of the stomach. Acute necrotizing
gastritis and phlegmonous gastritis have been associated
with recent large intake of alcohol, upper respiratory tract infection,
Emphysematous gastritis is characterized by air
in the wall of the stomach due to invasion by gas-forming microorganisms
such as Clostridium welchii. Predisposing factors are
gastro duodenal surgery, ingestion of corrosive materials, gastroenteritis,
or gastrointestinal infarction. (ref.4)
Gastric tuberculosis usually occurs in association
with pulmonary tuberculosis. Patients typically present with abdominal
pain, nausea and vomiting, gastrointestinal bleeding, fever, and
Gastritis in Syphilis: From the literature surveyed,
it is important to recognize early the features of syphilis in the
stomach as this provides an opportunity for effective antibiotic
therapy to stop the disease's progress and the cause of permanent
The stomach is rarely involved in parasitic or fungal infections and that is mainly in immunocompromised patients.
Gastritis by itself is rarely considered a serious problem.
The treatment of gastritis will depend on its cause. For most types
of gastritis, reduction of stomach acid by medication is often helpful.
Beyond that, a specific diagnosis must be made. Antibiotics are
used in cases of infection. Stopping taking aspirin, NSAIDs or alcohol
is advised when one of these is the problem. For the more unusual
types of gastritis, other treatments are needed.
In some cases, as in young adults, where are no other symptoms but
pain and indigestion associated after intake of meals, simply changing
some eating habits might be extremely helpful.
should include taking regular meals, sitting comfortably at the table while eating food,
and most importantly taking small and manageable
for chewing bites in addition to chewing the food properly and for longer
period of time before swallowing it, and drinking plenty of water with
any meal. These habits should be encouraged in otherwise healthy
children who often complain of stomachache after meals.
In case of GERD the following activities should
be avoided: eating before retiring at night; wearing tight
garments and heavy physical exercise after meals; taking anticholinergic
drugs or consumption of foods or substances that decrease the lower
esophageal sphincter (muscle)tone, such as cigarettes and alcohol;
and direct irritants to the esophagus such as coffee, citrus fruit,
and tomato-based products. (ref.3)
In otherwise healthy adults, starting to experience upper abdominal pain after meal, changing one's eating habits and
adopting the simple measures for healthy life style should be tried
first. In short, good eating habits are worth following, such as
eating nutritious meals regularly, making time for each and every
meal and chewing the food longer before swallowing, and drinking
plenty of water while eating. In addition, avoid activities such
as heavy meal before night rest, consumption of alcohol and cigarette
smoking, and anything else that noticeably upsets one's stomach.