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Sunday, August 17, 2025

Stomach ache


Stomach Ache (Abdominal Pain)

A stomach ache, also known as abdominal pain, is a very common symptom that can range from mild discomfort to severe, disabling pain. It can be caused by a wide variety of conditions affecting the gastrointestinal tract, abdominal wall, or even organs outside the digestive system. The severity, location, duration, and associated symptoms of stomach ache help guide diagnosis and management.

Causes of Stomach Ache

Gastrointestinal Causes

  • Indigestion (dyspepsia): Often due to overeating, eating spicy/fatty foods, or alcohol.

  • Gastritis and peptic ulcer disease: Caused by Helicobacter pylori infection, excessive NSAID use, or alcohol.

  • Gastroesophageal reflux disease (GERD): Burning pain in the upper abdomen and chest due to acid reflux.

  • Gastroenteritis (stomach flu): Viral or bacterial infection causing crampy abdominal pain, diarrhea, and vomiting.

  • Constipation: Triggers bloating, cramping, and diffuse abdominal discomfort.

  • Irritable bowel syndrome (IBS): Functional bowel disorder with abdominal pain, bloating, diarrhea, or constipation.

  • Inflammatory bowel disease (IBD): Crohn’s disease or ulcerative colitis causing chronic abdominal pain, bloody diarrhea, and weight loss.

  • Appendicitis: Sudden pain beginning near the belly button and shifting to the lower right abdomen, often with fever and nausea.

  • Diverticulitis: Pain usually in the lower left abdomen with fever and bowel habit changes.

Other Abdominal Causes

  • Gallstones or gallbladder disease: Sharp right upper abdominal pain after fatty meals, sometimes radiating to the shoulder.

  • Pancreatitis: Severe upper abdominal pain radiating to the back, often associated with alcohol or gallstones.

  • Liver disease or hepatitis: Right upper abdominal discomfort, jaundice, nausea.

  • Hernias: Localized pain and swelling, worse on exertion.

Non-Gastrointestinal Causes

  • Urinary tract infections (UTI): Pain in the lower abdomen with burning urination.

  • Kidney stones: Severe flank pain radiating to groin.

  • Gynecological causes in women: Ovarian cysts, ectopic pregnancy, or menstrual cramps.

  • Cardiac causes: Rarely, heart attack may cause upper abdominal discomfort.

Symptoms to Monitor

  • Location: upper, lower, left, right, or generalized.

  • Onset: sudden vs. gradual.

  • Associated features: fever, vomiting, diarrhea, blood in stool, jaundice, urinary symptoms.

  • Aggravating/relieving factors: eating, movement, rest.

Diagnosis

Evaluation depends on severity and persistence of pain:

  • History and physical examination by a clinician.

  • Blood tests: Complete blood count, liver function tests, pancreatic enzymes.

  • Urine analysis: To rule out infection or stones.

  • Stool tests: For infection, occult blood.

  • Imaging: Ultrasound, X-ray, CT scan, or endoscopy depending on suspected cause.

Treatment

Treatment depends on the underlying cause:

General Symptomatic Relief

  • Analgesics (pain relief):

    • Paracetamol (acetaminophen) 500–1000 mg every 6–8 hours as needed (max 4 g/day).

    • Avoid NSAIDs like ibuprofen if peptic ulcer disease or gastritis is suspected, as they can worsen symptoms.

  • Antispasmodics: Used for cramping pain.

    • Hyoscine butylbromide (Buscopan) 10–20 mg orally three times daily.

    • Dicyclomine 10–20 mg up to four times daily.

For Indigestion and Acid-Related Conditions

  • Antacids: e.g., aluminium hydroxide + magnesium hydroxide, taken after meals and before bed.

  • Proton pump inhibitors (PPIs):

    • Omeprazole 20 mg once daily.

    • Esomeprazole 20–40 mg once daily.

  • H2 receptor blockers:

    • Ranitidine (no longer widely used due to safety concerns).

    • Famotidine 20 mg twice daily.

For Constipation

  • Laxatives:

    • Lactulose 10–20 mL orally once or twice daily.

    • Macrogol (polyethylene glycol) as directed.

For Gastroenteritis

  • Rehydration therapy: Oral rehydration salts (ORS).

  • Antiemetics:

    • Ondansetron 4–8 mg every 8 hours as needed.

For Infections (Bacterial)

  • Antibiotics are prescribed only when a bacterial cause is confirmed (e.g., H. pylori eradication regimen with amoxicillin, clarithromycin, and omeprazole).

For IBS

  • Dietary modification (low FODMAP diet).

  • Antispasmodics (e.g., hyoscine, dicyclomine).

  • Loperamide 2 mg as needed for diarrhea.

  • Fiber supplements for constipation.

For Gallstones

  • Surgical removal (cholecystectomy) if recurrent pain or complications occur.

For Appendicitis or Surgical Emergencies

  • Immediate hospital admission and surgery are required.

When to Seek Medical Help

Seek urgent care if abdominal pain is:

  • Sudden, severe, or worsening.

  • Associated with fever, persistent vomiting, blood in vomit or stool.

  • Accompanied by jaundice or unexplained weight loss.

  • Localized (e.g., right lower abdomen suggesting appendicitis).

Lifestyle and Preventive Measures

  • Eat balanced meals, avoid overeating.

  • Limit fatty, fried, and spicy foods.

  • Avoid excessive alcohol and caffeine.

  • Stay hydrated.

  • Exercise regularly to maintain bowel health.

  • Manage stress, as it can aggravate IBS and indigestion.




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