The Frequency Of Gastritis Increases With The Level Of Stress

 what symptoms do patients most often see a gastroenterologist?

Pain, heaviness, discomfort, sometimes nausea, vomiting, diarrhea, bad breath. These are all stomach complaints. Other complaints are irregular bowel movements, blood, mucus in the stool - characteristic of the lower digestive tract.

Sometimes there are patients who are keenly interested in what is written on the Internet and come with "ready diagnoses". Not a small percentage of them, reading, recognize their complaints in various symptoms described in publications on the web and come with doubts, which fortunately we more often reject.

- When are the listed symptoms a sign not of a temporary illness, but of a serious illness?

If a person has any problems with the gastrointestinal tract, it is good to consult a gastroenterologist. In order not to miss something serious. An example in this regard is the presence of blood and mucus or just blood in the stool. In this case, very often the patient alone or on the advice of a relative decides that it is hemorrhoids and does not need to be examined. And this is dangerous. Sometimes such symptoms are a manifestation of advanced cancer. In such cases, we can only diagnose and provide palliative care, but permanent treatment is not guaranteed. This is difficult for everyone - both for patients and for us.

- What is the leading cause of cancer of the gastrointestinal tract and when is it good to start prevention?

Heredity combined with environmental factors is an important factor in the development of gastrointestinal cancer. If there is a mother, father, grandmother, grandfather in the family with any malignant oncological disease of the digestive tract, prevention is especially important - the earlier it starts, the better. It is currently possible to perform a number of genetic tests to determine the risk of genetic variants.

Usually, if there is a diagnosis of cancer in the family at the age of 50 and under 50, then the next generation must be tested and it is imperative to start these tests at an earlier age - for example 40 years and even earlier.

- And when the heredity factor is missing?

Worldwide, prevention begins at age 40. Then it is good to perform the first colonoscopy - examination of the colon. No less important is regular gastroscopy, which remains the most accurate method for diagnosing serious diseases of the stomach, duodenum and esophagus.

In the presence of polyps, for example, follow-up may be more frequent - every year. If all goes well, the European standard advises that we be tested every 5 years, but preferably every 3 years.

- Is every polyp on the lining of the colon a harbinger of cancer?

No. There are different classifications of polyps. Adenomatous polyps are mainly malignant, so it is very important that each polyp is examined histologically. Depending on its type, it is already known how to monitor the patient further. Because there are also hyperplastic polyps, inflammatory, which are not disturbing.

In all cases, however, a polyp left to grow - without being removed and examined, is a time bomb.

- Lifestyle and diet - usually in the evening, shock and abundant, are they directly related to diseases of the gastrointestinal tract?

Definitely lifestyle affects the gastrointestinal tract. But before eating comes the stress - we live in a complex environment, everyone is subjected to daily stress, the air we breathe is extremely polluted, and some foods we eat also have risk components. So all this can not but affect the gastrointestinal tract.

The reason for this sensitivity is that the gastrointestinal tract is very strongly innervated and reacts to any change in the external environment. If a person is more emotional, it further affects the gastrointestinal tract.

The digestive system is extremely precise, but we must find ways to cope, because that is the reality in which we live. There is no way to avoid stress and external stimuli. Yoga, sports, nature walks, more time with family, with friends - all these are ways to exclude from everyday life.

- Does the concept of "nervous stomach" exist in medical science then?

Concept - no, but by "nervous stomach" we mean everything I described, related to stress, bad air, food and other external stimuli.

- And irritable bowel syndrome? Another common complaint from patients.

This is a violation of intestinal motility - peristalsis, and in some cases inflammatory and neurological changes, microbial factors (diversity and composition of the intestinal flora). Manifested by recurrent pain, cramps, flatulence (increased flatulence), constipation or diarrhea, mucus, but without the presence of visible changes in the mucosa.

Most often, the basis of this syndrome are changes in the tone of the autonomic nervous system of the intestine as a result of which spasms of its smooth muscles occur, accompanied by painful symptoms. The most commonly recommended means of controlling the unpleasant condition is diet - a certain regime, as well as some medications and supplements.

- Why do we explain almost every pain with gastritis? And how common is the disease?

The incidence of gastritis increases with the level of stress. The more stressed we are, the more frequent the complaints. It is no exaggeration to say that almost everyone has, to a greater or lesser extent, gastritis at different times in their lives, precisely because of their lifestyle. There are very few people who eat right - breakfast, lunch and dinner at certain hours, without overdoing it. There are many reasons why this is difficult to do and if there is a complaint - the first association is gastritis.

Gastritis is an inflammation of the stomach, the causes of which are complex. It is good that with the development of medicine, today we have modern medicines that can alleviate the complaints and help the mucosa to recover. However, the most important thing is to know whether this gastritis is due to infection with the bacterium Helicobacter pylori or not.

- It is estimated that over 50% of the world's population are carriers of Helicobacter pylori - the culprit for the development of gastritis and peptic ulcer disease. Are the statistics really like that and why?

This is the most common infection, so it is very important that a patient with severe symptoms must be examined. If the microorganism is left untreated for a long time, it affects the epithelium of the stomach lining, then leads to ulcers and even the problem can worsen to MALT - lymphoma-malignant disease. According to various authors, if Helicobacter pylori is spread in the antrum - this most often leads to duodenal ulcer, and if it is in the corpus, it can lead to stomach cancer. Therefore, the bacterium must be treated.

Gastroscopy is performed to determine the condition of the lining of the stomach, duodenum and esophagus - whether there is already an ulcer or not, and biopsies are taken for the presence of Helicobacter pylori. What we at Alexandrovska Hospital are doing, and I think is the best, is a microbiological examination of mucosal material with an antibiogram. Because in recent years we have many cases of resistance to the main drug for the treatment of Helicobacter pylori.

That's why we take a biopsy for microbiology and do an antibiogram - so once we have proven Helicobacter pylori, we get the exact combination with which the bacterium should be treated. What can be noticed is that in recent years the number of patients resistant to the main drugs for the treatment of the bacterium has drastically increased. Blind treatment without an antibiogram can put the patient in an endless, vicious circle of antibiotic treatment that will not work. 

Modern therapy for Helicobacter pylori involves a triple combination of drugs, the first of which suppresses stomach acidity, and the second and third are two antibiotics. Additionally, another drug is included - bismuth oxide.

- How is the bacterium transmitted?

It is believed that by contact-household way - dirty hands, utensils, food, close contact. Anyone can be infected. But it is very important to pay attention to other methods of diagnosing Helicobacter pylori, because there are many mistakes.

Along with gastroscopy, with which we take a biopsy for pathohistology, microbiology and urease test, there are also laboratory methods. These are a fecal test - with very high sensitivity and a breath test - also with high sensitivity, but more complicated to perform. The breath test requires serious preparation, while the fecal test can be done at any time and is accurate because the antigen is being tested.

The most inaccurate and widespread is the blood test, which tests antibodies produced by the immune system to fight bacteria. The problem here is that many patients are treated first - tested or not, and immediately after antibiotic treatment do a blood test. This can lead to inaccurate results. Because when the antibiotic kills the bacteria, many antibodies remain after that, and it takes some time to normalize them. This test is acceptable between 6 months and one year after therapy.

- Gastroscopy and colonoscopy remain the two main diagnostic methods - both particularly stressful for patients?

This is the gold standard. There are several new, modern studies, such as capsule endoscopy. An interesting method in which a capsule is swallowed, which passes through the entire gastrointestinal tract and this is captured. The problem with capsule endoscopy is that it is firstly expensive and secondly, it can be used to see finds, but they cannot be biopsied, and then basic research is done again.

Many people say that gastroscopy is a painful examination, but there is no real pain. There is intolerance to swallowing, which makes the procedure unpleasant. Therefore, I advise patients to do the examination under anesthesia - so the patient has no unpleasant memory of the study, and we, the doctors work calmly. Colonoscopy has pain from bloating and the procedure without anesthesia is traumatic and stressful for everyone.

- What is the problem you most often encounter in your practice and worries you?

That patients come to us too late. The prevention of a number of malignancies, including those of the gastrointestinal tract, is neglected. Many patients, unfortunately, come at a late stage for various reasons, including the lack of mandatory tests in pre-hospital care.

Of course, there are people who underestimate the problems, worry, do not know who to turn to or self-medicate. In these cases, the condition may worsen. Therefore, my appeal to everyone is to take care of their health and to be examined regularly.