Tag: heartburn

Person holding abdomen, appearing in pain, wearing grey sweatshirt

What’s Causing My Abdominal Pain? Common Causes Explained

On By Dr. Scott RennieIn GastrointestinalLeave a comment
shutterstock_152569646Patients who present to the clinic or urgent care with abdominal pain can be some of the most challenging, because of the many different causes.  The job of your primary care or urgent care provider is to determine whether the pain is requiring immediate surgical evaluation. Medical providers must try to determine which patients can safely be observed and their symptoms treated and which patients require further investigation by a specialist such as a surgeon.  This is difficult because abdominal pain is often non-specific and presents with other symptoms very commonly. Triage:  We must urgently investigate abdominal pain in many patients.  Some patients require assessment of their airway, breathing and circulation followed by appropriate resuscitation.   Patients who may need surgery must be transferred to a facility where they can receive that care where appropriate nursing care, laboratory, surgical consultation, and radiology facilities are available. Patients who are having less severe pain or signs on exam may require consultation or referral for further management. Helpful information from patients: 1)   Time course of pain 2)   Location of pain 3)   Radiation of pain 4)   Factors that make the pain worse or better (such as foods or antacids) 5)   Associated symptoms including fever, chills, weight loss, nausea, vomiting, diarrhea, constipation, blood in the stools, jaundice, change in stool or urine color or diameter of the stools. 6)   Past medical history, including history of abdominal surgeries 7)   Family history of bowl disorders 8)   Alcohol intake 9)   Medications – including Tylenol, aspirin, and ibuprofen/aleve 10)  Menstral and contraceptive history in women Surgical abdomen:  Usually defined as a condition with rapidly worsening course without surgical intervention.  Obstructions of the intestines and peritonitis (inflammation/irritation of the inner wall of the abdomen that covers most abdominal organs) are reasons for referral to a surgeon. Sometimes tests will be ordered such as an abdominal radiograph,  CBC, comprehensive metabolic panel with liver enzymes, lipase, a urine analysis and pregnancy test (in women of childbearing potential). Other things we consider in determining the cause of the abdominal pain are the location of the pain and changes in where the pain radiates as well as how rapidly the pain gets worse. Some possible causes of abdominal pain are many – gallstones or gallbladder dysfunction, peptic ulcer, hiatal hernia, pneumonia, heart attack,  pancreatitis, heartburn, lactose intolerance, celiac sprue, pregnancy (including ectopic), endometriosis, sickle cell disease,  appendicitis, ovarian cyst or torsion, UTI, kidney stones, constipation, colitis, diverticulitis, pelvic inflammatory disease, gastroenteritis, intestinal ischemia (decreased blood flow to the intestines), diabetic ketoacidosis, kidney infection, abdominal aortic aneurism, or even trauma. Treatment:  Is tailored to address the cause of the pain.  If no cause can be found at your doctor’s office, the goal is to determine whether it is safe for you to go home with medications to help with the pain, and testing done as an outpatient or whether you need to be transferred to the hospital where further workup can be done immediately.   I hope that you have found this information useful.  Wishing you the best of health,

Scott Rennie, D.O.
Board Certified in Obesity Medicine and Family Medicine

This blog is for educational purposes only and does not constitute individual medical advice. Always consult your own physician before making changes to your health, medications, or treatment plan.

Diagram of esophagus, lower esophageal sphincter, stomach, stomach acid, and acid reflux causing heartburn

Heartburn and GERD: Answers to Your Common Questions

On By Dr. Scott RennieIn Gastrointestinal1 Comment
shutterstock_74586250I often get questions from patients asking how to treat their heartburn also called gastroesophageal reflux disease or GERD.  It is sometimes confusing to diagnose and can also cause dangerous complications if not treated. GERD is a common condition where acid contents from the stomach go backwards up the esophagus (food tube between your mouth and stomach).  This can irritate and inflame the esophagus causing a burning sensation and other problems.  There is a sphincter/valve at the top of the stomach that helps keep the stomach contents from going backwards, but if the spincter (called the lower esophageal sphincter or LES) doesn’t fully close, liquid contents of the stomach which contain acid can leak back into the esophagus. Risk factors:  Obesity, pregnancy, smoking, hiatal hernia (a problem where part of the stomach moves above the diaphragm), alcohol and medications.  The medication list is extensive and includes: 1)   Non-steroidal anti-inflammatory medications such as ibuprofen, aspirin or aleve 2)   Beta-blockers which are used for high blood pressure 3)   Bronchodilators such as prednisone used for asthma 4)   Calcium channel blockers used for high blood pressure 5)   Dopamine-active medications used for Parkinson’s disease 6)   Sedative medications which are used for insomnia/anxiety 7)   Tri-cyclic anti depressant medications – used for pain/IBS Symptoms of GERD:  Nausea after eating, hiccups, feeling that food is stuck behind breastbone, burning pain in the chest which is increased by bending, stooping, lying down or eating, usually worse at night and relieved by antacids. How do I find out if I have GERD/Heartburn?  There are many different tests that can be used to help diagnose esophageal reflux such as:  a trial of a medication for heartburn such as a GI cocktail (a mixture of Mylanta, viscous lidocaine and donnatol), esophagogastroduodenoscopy(EGD) – which is when a doctor inserts a camera that looks down the esophagus when you are under anesthesia, barium swallow, esophageal pH monitoring, and esophageal manometry.  Sometimes a stool blood test is used to diagnose bleeding that might be coming from the esophagus, stomach or intestines. Helicobacter Pylori, also known as H. pylori is a bacterium that is commonly found in the stomach.  About half of the world’s population has this bacteria and they have no symptoms and will never develop problems.  However, H. pylori can cause stomach ulcers, and much less commonly, stomach cancer.  We really don’t know why some people with H. pylori get these symptoms and others do not. Stomach ulcers can cause symptoms such as pain or discomfort in the upper abdomen, bloating, feel full after eating only a small amount of food, lack of appetite, nausea and vomiting, black or tar-colored stools,  and even low blood count and fatigue. Treatment:  Treatment is tailored toward the individual patient and might include some of the following options: 1)   Treat H. pylori with antibiotics if it is present 2)   Diet modification – avoid a core group of reflux-inducing foods (fatty foods, chocolate, peppermint, excessive alcohol) and spicy foods like citrus fruits, coffee, tomatoes/marinara sauce (found in spaghetti and pizza), garlic, onions, peppers, chili, carbonated beverages 3)   Stop smoking or chewing tobacco 4)   Reduce or stop medicines which can make GERD worse such as NSAIDs (aspirin, ibuprofen, Aleve, Excedrine etc. – see list above) 5)   Refrain from laying in a supine (on your back) after meals and avoid meals right before bedtime 6)   Lose weight – obesity is a risk factor for GERD, erosive esophagitis, and esophageal adenocarcinoma (cancer). 7)   Promotion of salivation by chewing gun, or oral lozenges might be helpful for mild heartburn as saliva neutralizes refluxed acid. 8)   Acid-suppressive medications:
  1. Antacids such as tums
  2. Prescription H2 (such as Zantac) blockers twice a day for mild GERD
  3. Prescription PPI (such as Prilosec) – for more severe GERD
9)    Acid barrier medications:  Sucralfate protects the stomach or ulcer from acid by acting as a barrier It is important to be monitored closely if you are taking medication for heartburn because some of the complications that come with heartburn/reflux and the possibly with the medications used to treat them might be:  Pneumonia, hypergastrinemia, atrophic gastritis, intestinal infections, vitamin B12 malabsorption, iron malabsorbtion, hip fracture and calcium malabsorption, magnesium absorption and drug interactions.   I hope that you have found this information useful.  Wishing you the best of health,

Scott Rennie, D.O.
Board Certified in Obesity Medicine and Family Medicine

This blog is for educational purposes only and does not constitute individual medical advice. Always consult your own physician before making changes to your health, medications, or treatment plan.