Gastric Pain



Gastric Pain

Gastric pain is a term often used to describe a pain in the middle of upper abdomen. Sometimes it is simply referred to as “gastric” by people in Singapore. The word “gastric” means “of the stomach”. The stomach is a digestive organ located in the upper abdomen that follows the esophagus. It is responsible for mixing food before further digestion. While most of the pain in the middle of the upper abdomen is indeed from problem arising from the stomach, some of the pain may originate from other organs such as gallbladder, bile duct, pancreas, small intestine (duodenum) or even the liver. “Epigastric pain” is a more accurate term that healthcare professions use to describe the pain in the middle of the upper abdomen.

Causes Of Epigastric Pain

There are many causes of epigastric pain. The different causes of epigastric pain has different characteristics.

Pain caused by stomach or duodenal ulcer usually last for weeks. It comes on and off and often is worse when you are hungry. Some may get relieve with food. The pain tends to be mild to moderate in severity and does not have a clear time of onset. It usually does not wake a person from sleep. Occasionally the pain may also be felt at the back at the same time. Pain similar to stomach ulcer sometimes can be caused by medication such as pain killers or even just drinking too much alcohol.

Pain caused by gallstone is quite different. Sometimes this pain can be felt more to the right side of the upper abdomen. The pain has a clear time of onset: meaning the person usually can tell you quite clearly that the pain started at a particular time. The pain can last anywhere from one to six hours, after which the pain will subside. It is usually more severe compared with the pain caused by stomach ulcer. This pain often happens in the middle of the night where a person wakes up with pain and goes back to sleep a few hours later when the pain subsides. Sometimes, the pain may be accompanied by vomiting and heavy sweating. Usually the person is well before the onset of pain and on the next day. This pain is termed “biliary colic” and it is caused by gallstone that is temporarily stuck at the neck of the gallbladder.

Pain caused by pancreas inflammation (pancreatitis) is very severe. Usually the person will bend over in pain and prefers to lie still. The pain goes to the back. 

Pain caused by cancer often may not be severe. The main characteristic of the pain is its persistence over weeks. These pain are usually worse at night when there is nothing to distract us. Other symptoms that may suggest the diagnosis of cancer such as weight loss, difficulty swallowing, change of bowel habit, blood in stool or black stool may or may not be present.

One of the questions that the doctor often ask is whether your stool is black. The reason why this is asked is that when bleeding occurs in the stomach, the blood would be digested and passed out as a black, sticky stool that almost looks like tar. This stool as a very peculiar fishy smell. If your stool is dark brown (and not truly black and sticky) the answer to the question: “Do you have black stool?” is “No, my stool is dark brown”. Black in this context is as black as tar. 

Severe sudden abdominal pain that is worse with movement and with pressing the abdomen is termed “surgical abdomen”. It means that something serious that may need immediate surgery may have happened. One should seek help at the hospital emergency immediately. If you are not sure: visit your neighbourhood family clinic. The general practitioner are trained to detect a “surgical abdomen” and send the appropriate cases to the emergency department.

Sometimes the cause of the epigastric pain is not apparent. All the investigations may be normal. Some of these pain may be related to stress and some of it may be related to abnormal motility and function of the stomach. Some other rare diseases may have similar pain as well.

In actual fact, determining the cause of the pain may not be a simple process. It often takes an experience specialist to do the detective work. Various investigation may be necessary to help arrive at the most probable diagnosis. 

When To Seek Specialist Care

Epigastric pain that persist after simple treatment by your family doctor usually needs further investigations.

This is especially true for those older than 35 years of age and those with alarm symptoms such as recurrent vomiting, loss of weight, loss of appetite, black stool, difficulty swallowing and change in bowel habit. 

Those with family history of stomach cancer and pancreatic cancer should also be investigated earlier. 

Investigations For Epigastric Pain

Common investigation would be a gastroscopy or upper gastrointestinal tract endoscopy. Ultrasound of the hepatobiliary system would be useful for the biliary type of pain. CT scan is useful as well to detect the presence of cancer of the pancreas. Rarely, MRI or endoscopic ultrasound may be needed.

Who Does The Investigations

The specialist doctor of the digestive tract would be the most appropriate doctor to do so. The name of the specialty is called gastroenterology and the specialist is a gastroenterologist.  

Cost Of Healthcare And How To Choose

In Singapore, a good proportion of the cost of investigation are covered with medisave deduction regardless of whether you go to a government or private hospital. 

Private health insurance and many company health insurance actually do cover the entire cost of investigations in most cases even in private hospital or specialist clinics. Many people are not aware of the healthcare benefit offered by their own company: you should check yours.

The charges of the various private hospitals and clinics are also not the same. You should do some homework to compare prices before deciding.

Different private doctors also charges different fees for the same procedure depending on their level of experience and the demand for their services. You can and should check their fees against the published “Total Operation Fees” from the ministry of health web page. Financial counselling is always done prior to any surgical procedure.

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