problems with gas

ull of air

Your Health DR GITA MATHAI

If you have dyspepsia: • Eat meals on time, chewing the food well. • Drink around three litres of water a day. Water dissolves gas. • Do not sleep for at least an hour after eating. • Avoid consuming more than 400ml of milk a day. • If you have a sedentary job, stand up and move at least around your desk every hour. • Walk, run or jog for 40 minutes to an hour a day. The movements will tighten your abdominal muscles preventing distension. The chemicals released by the muscles during exercise help to regulate the nervous system • Do yoga. There are specific exercises for dyspepsia. The meditation will relieve stress and calm your mind. Burping, belching, a painful distended abdomen, a feeling of fullness after eating “just a little” — these uncomfortable symptoms of dyspepsia affect 20 per cent of the population at some point in their lives. Many blame dietary indiscretions — a temporary overindulgence in rich food. Since there is no consistent pattern, the patient ends up avoiding more and more food items with less and less satisfactory results. Dyspepsia is predominantly a clinical diagnosis, made when the symptoms mentioned above have been present for three months or more. Thorough investigations are necessary if these symptoms suddenly appear in a person over 55 years old, there is bloodstained vomiting, intractable pain, difficulty in swallowing or significant weight loss. The symptoms of dyspepsia can also be a side effect of certain pain relieving medicines or steroids. They can even be caused by diabetes, lipid abnormalities, thyroid problems or kidney disease. In women, symptoms may be aggravated pre-menstrually or during pregnancy, precipitated by hormonal changes. Angina (forerunner of a heart attack) can also lead to pain in the upper abdomen pain but it is usually accompanied by sweating and can be picked up on an ECG. If investigations rule out all of the above, get an X-ray, ultrasound and CT scan done. This can be followed by endoscopy, if necessary. Endoscopy allows the doctor to see the lining of the stomach clearly; if there are ulcers, they can be sent for biopsy. Eighty per cent of stomach and duodenal ulcers are caused by bacteria calledHelicobacter pylori. The “azole” group of drugs can treat ulcers. Gallstones may be blamed for the symptoms but they are rarely the cause. About half of the population has gallstones but no symptoms. Removal of the gall bladder usually does not cure the symptoms. The good news is that medical tests for most people with dyspepsia return normal results. The bad news is that they still have a disease, a chronic condition that improves and relapses. So if their condition improves after they have eliminated a certain food from their diet, it makes patients erroneously believe that is what has led to an improvement. Self-imposed dietary restrictions may then result in other health problems. Dyspepsia is caused by a malfunctioning gastrointestinal smooth muscle. The nerves that supply the muscle do not work properly, probably because signals from the brain and chemicals released for their action are faulty. This can be confirmed with motility studies. This investigation is expensive, time consuming and done only in specialised centres. The emptying time of the stomach and forward propulsion of food are aggravated by eating too fast, drinking carbonated beverages and overeating. The discomfort results in pain and belching. As the air is expelled there is some relief. In some people belching is a response to any kind of abdominal discomfort, even when there is no excess air. Not much research has been done on dyspepsia since it is not fatal. Response to treatment is difficult to evaluate. A variety of medications have been tried — the “azole” group of drugs, prokinetics such as domperone and periactin. The response is variable, with some patients responding well and others poorly. Better results are sometimes obtained if they are also put on anti-depressants. The medicines work on the transmitter nerves and have a pain relieving effect as well. Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in