Identifying the causes of stomach pains

Dr John O’Donohue, Consultant Gastroenterologist at BMI Blackheath Hospital in London, UK, explains some of the causes of gastritis.

Tummy aches – they’re a common theme throughout childhood and often persist into adulthood, but can we know if a pain in the gut is a consequence of too many sweets or a more serious medical condition?

I see many patients at my clinic at BMI Blackheath Hospital in London, which is part of one of the UK’s largest network of private hospitals and one which is particularly suited to international patients.

If you or your child complains of stomach pains after eating, take some time to record how long it takes before the pain occurs. If it is around 10 minutes, then it is likely that the problem is in your child’s stomach. Longer than 10 minutes, then the likelihood is that the problem is happening further along the digestive tract, in the small intestine.

If it's soon after eating, the cause may be an infection of the stomach called Helicobacter pylori. This is usually transmitted in families and children can pass it between each other. It usually causes a pain in the upper abdomen which can either be worsened or made better soon after eating. Left unchecked, it can, in some cases, also go on to cause ulcers and even some stomach cancers. Happily, it is relatively easy to cure, following a diagnosis after a stool test, by antibiotics. If you or your child complains of tummy pains more than twice a week, I would recommend that you see a doctor to ask for a test. Most tummy pains are short-lived, but if not, and you are worried, please see a doctor.

Pain medication is often taken for these symptoms. But beware: some of these may make the problem worse. Ibuprofen or other similar  'anti-inflammatory' drugs, available from pharmacies, can worsen stomach pains. These medicines are often taken by women to soften period pains or, by men and women, for joint pains or headaches, but they can cause ulcers in the stomach or duodenum. 

Around 1% of the population has a medical grade allergy called coeliac disease, an allergic reaction to gluten, which is found in wheat, rye and barley. This is a debilitating condition which needs a medical diagnosis, initially by a simple blood test, and needs very strict exclusion of all gluten-containing foods. As well as abdominal pain, it can cause anaemia, diarrhoea, infertility and in children, delayed growth or short stature.  MIT needs to be tested for. 

Although there is no medical evidence that certain types of food cause gastritis, some people do report that certain foods do cause them problems, particularly if they start 1-2 hours after eating them. Children, as well as adults, can suffer from bloating. This is when the abdomen swells like a balloon with gas. This type of pain comes usually from  the small intestine that carries the digesting food from the stomach towards the bowel. Bloating could be caused by different types of foods, causing fermentation, which can manifest itself as food intolerances. 

If bloating and diarrhoea are the main problem, foods containing FODMAPS may be to blame. Examples of FODMAPS are fructans or polyols which are found in certain foods, for example onions, leeks, garlic, wheat or some leafy green vegetables. Symptoms may also follow eating sugary fruit, dairy products or artificial sweeteners. Lactose in dairy or fructose in apples and pears may be the culprit. We can test for these intolerances by a simple breath test and offer a specialist dietician service to advise on what foods to eliminate.

Pain in the middle of the abdomen and diarrhoea can also be due an overgrowth of the wrong sort of bacteria in the small intestine, and this can be treated with probiotic drinks or, in some cases, antibiotics.

There are also some non-food factors associated with gastritis. Stress and depression can lead to abdominal pain, and it is important to look at the reasons behind the stress and seek a different lifestyle or remove the stressor in order to deal with the pain.

Excessively fatty foods can cause a flare-up of indigestion symptoms, particularly heartburn, as can citrus foods. Spirits and wine can also worsen heartburn, although this is probably a factor for parents, rather than children- worth bearing in mind!

Written by Dr John O'Donohue

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