"stomachache" before, during and after a meal, gastroenterologist: corresponding to 5 different diseases
The typical symptoms are epigastric pain during fasting, chronic atrophic gastritis during eating, most chronic gastritis lack specific symptoms, and some have varying degrees of upper abdominal pain, postprandial fullness, acid regurgitation and other dyspeptic symptoms. However, the epigastric pain in patients with chronic atrophic gastritis with mucosal erosion is more obvious. 0.5-1 hour postprandial pain gastric ulcer is caused by the weakening of gastric mucosal defense ability, resulting in obvious postprandial pain. Postprandial gastroesophageal reflux disease can cause retrosternal pain, discomfort or burning sensation due to the decrease of esophageal defense mechanism. Patients with postprandial fullness functional dyspepsia often have recurrent epigastric pain, epigastric burning, postprandial fullness and early satiety. The visceral hypersensitivity of patients with functional dyspepsia often makes them more prone to epigastric discomfort, and paroxysmal pain often indicates spasm or obstructive disease in the hollow organs. Biliary ascariasis is often characterized by intermittent upper abdomen, mostly mild inflammation and ulcers of the gastrointestinal tract.
Stomachache is a common uncomfortable symptom in daily life, which is often related to eating. Some people suffer from severe pain when they are hungry, while others get worse after eating. In fact, different pain times may indicate different diseases.
Abdominal pain should be distinguished before and after meals.
In the department of gastroenterology, epigastric pain is a very common symptom, although it is pain, but the causes of pain before, during and after meals are very different.
Pre-meal pain
Duodenal ulcer
Duodenal ulcers are common at the turn of autumn, winter and spring. The typical symptoms are upper abdominal pain on an empty stomach, and may also occur at night, which can be relieved after eating.
This is due to the increased secretion of gastric acid and pepsin, and the imbalance between the ability of destruction and the defense ability of the duodenal mucosa, resulting in self-digestion, resulting in ulcers. On an empty stomach, because there is no food to neutralize stomach acid, part of the stomach acid spills into the duodenum, stimulating the ulcer surface, the pain will be stronger.
After eating, stomach acid into the duodenum has been fully mixed with food, reducing the acidity, less stimulation to the ulcer surface, the pain will be relieved.
It hurts when you eat.
Chronic atrophic gastritis
Most chronic gastritis lack specific symptoms, some may have no symptoms, and some may have varying degrees of upper abdominal pain, postprandial fullness, acid regurgitation and other dyspeptic symptoms. But chronic atrophic gastritis with mucosal erosion of epigastric pain is more obvious, often repeated attacks, appear during or after meals.
It hurts 0.5 hour after meal.
Gastric ulcer
Gastric ulcer is caused by the weakening of gastric mucosal defense, and most of the patients are accompanied by Helicobacter pylori infection.
After eating, there is friction between the food and the gastric mucosa, stimulating the ulcer site, and the gastric peristalsis is enhanced, which will cause traction to the ulcer; in order to digest food, the gastric acid secretion increases, and the mucosal damage is even greater. Some spicy irritating foods will also aggravate this stimulation, leading to obvious postprandial pain in patients, which can last from several minutes to several hours.
Have a burning sensation after a good meal
Gastroesophageal reflux disease (GERD)
Due to the decline of the patient's esophageal defense mechanism, increased gastric acid secretion after eating, coupled with reflux stimulation, can cause retrosternal pain, discomfort or burning sensation.
Fullness after a meal
Functional dyspepsia
Patients often have recurrent epigastric pain, epigastric burning, postprandial fullness and early satiety.
At present, it is believed that the disease is related to visceral hypersensitivity, gastrointestinal motility disturbance, infection, mental psychology and other factors. Visceral hypersensitivity in patients with functional dyspepsia often makes them more prone to epigastric discomfort and more sensitive after meals than on an empty stomach.
Different "pain" corresponds to different diseases.
In addition to the time of occurrence of abdominal pain, you can also speculate the cause behind the stomachache according to the difference of "pain".
Distending pain
The degree of pain is mild, mostly caused by the passive expansion of the visceral peritoneum, such as gastrointestinal indigestion, intestinal obstruction, intestinal paralysis, cholecystitis and so on.
Paroxysmal pain
It often means that the hollow organs have spasms or obstructive diseases, such as mechanical intestinal obstruction, ureteral calculi, etc.; biliary ascariasis often shows intermittent upper abdominal "drill-top" sharp pain.
Dull pain
The symptoms are not specific and are mostly mild inflammation and ulcers of the gastrointestinal tract, such as gastritis, gastric ulcer, colitis and so on.
Spastic pain
The common causes of pain caused by gastrointestinal spasm are gastrointestinal inflammation, ulcers and so on, which sometimes need to be distinguished from the pain caused by kidney stones or ureteral stone obstruction.
Severe colic
The gastrointestinal tract is sensitive to the pain of ischemia. If there is extremely severe abdominal pain, abdominal organ ischemia can be considered, such as superior mesenteric artery embolism, gallbladder necrosis, acute pancreatitis, intestinal obstruction or abdominal hernia incarceration leading to intestinal ischemia, etc., the condition is critical, need to see a doctor as soon as possible.
In addition, peptic ulcer disease often shows typical chronic, rhythmic, periodic epigastric pain; gastric and duodenal perforation is often sudden severe knife-like pain and cauterization-like pain in the middle and upper abdomen; acute appendicitis is first manifested as upper abdominal pain, followed by right lower abdominal pain, that is, metastatic pain.
Abdominal pain, don't stop the pain blindly
According to the priority of onset and course of disease, abdominal pain can be divided into acute abdominal pain and chronic abdominal pain.
Acute abdominal pain
The onset of the disease is urgent and the degree of pain is more serious, which often indicates that there are serious problems in health and need timely treatment so as not to cause serious consequences.
The causes of acute abdominal pain are complex, including gastrointestinal diseases, cholangiopancreatic diseases, abdominal aortic diseases, abdominal organ rupture, gynecological and obstetrical diseases and so on. Sometimes intrathoracic organ diseases can also lead to abdominal pain, such as pleurisy, pericarditis, acute myocardial infarction and so on.
Chronic abdominal pain
If the pain lasts for more than 3 months, the pain can persist or occur intermittently and repeatedly.
The pain degree of chronic abdominal pain is generally lighter than that of acute abdominal pain, and it is more related to chronic diseases. The common causes include inflammatory bowel disease, functional gastrointestinal disease and so on.
Temperature changes, heavy drinking, intake of too much greasy or unclean food, trauma, overwork, lack of sleep and other factors may induce abdominal pain, most of the cases are not serious, some of them can be relieved by themselves.
If the abdominal pain is severe, cannot be relieved or occurs repeatedly, you should go to the hospital in time.
Especially when severe abdominal pain is accompanied by fever, black stool or bloody stool, uncontrollable vomiting and / or hematemesis, anuria, syncope or coma, or pain in other parts (such as chest pain) extending to the abdomen, it is necessary to see a doctor urgently.
When you see a doctor, you should accurately and comprehensively describe to the doctor how painful it is:
The onset of ◎ abdominal pain (how long ago the abdominal pain began, what did you do before the abdominal pain occurred, what food did you eat before the abdominal pain, and whether you experienced trauma).
The nature of ◎ abdominal pain (colic or dull pain, labor pain or persistent pain).
◎ the location of abdominal pain (upper abdomen or lower abdomen, whether the pain site has changed).
◎ the severity of abdominal pain.
The duration of abdominal pain in ◎.
Whether ◎ has concomitant symptoms (such as fever, vomiting, abnormal stool, urine changes, etc.).
After the occurrence of ◎ abdominal pain, what pain relief measures have you taken (such as what drugs you have taken)?
Need to be reminded that the treatment of abdominal pain first need to find the cause, blind pain relief will cover up the condition, increase the difficulty of diagnosis, and may even lead to misdiagnosis. So don't take painkillers by yourself before you go to a doctor for sudden abdominal pain. Temporary fasting to avoid aggravating some diseases, such as acute gastrointestinal bleeding, pancreatitis, intestinal obstruction and so on.
Data: popular science in China
Editor: Weng Yu