Invisible pain

Gastric pain is the kick in the gut that can change a patient’s lifestyle forever

Managing food and eating right becomes the most important thing for the sufferer of gastric pain

Debapriya Ganguly learnt the hard way never to skip breakfast. When she was just 17, Ganguly started getting what she calls “unbearable pain” in her abdomen and after a visit to the doctor was diagnosed with gastritis. The condition was brought on by her rushed early morning schedule and having just a glass of juice before she went to school. Ganguly is now 28 and follows one rule every day. “As a basic lifestyle change, I started having breakfast regularly,” she said. “No matter how late I am for work, I never skip my breakfast.”

Ganguly, a PhD scholar in sociology at Hyderabad Central University, uses the words “unbearable” and excruciating” to describe what she feels when she has an attack of gastritis. She describes not being able to stand straight when the pain hits. “I just feel like lying on the bed,” she said. “It feels like someone is squeezing my stomach from inside.”

Dipanjan Sinha, a journalist, said he developed gastritis because of his professional life. “In my early 20s, I led a sedentary lifestyle – sitting at one place for several hours, no exercise coupled with a packet of cigarettes and frequent all-night drinking sessions with friends,” he said.“ It was when I was 24, I started waking up feeling that I had embers in my stomach and it was terrible.”

Gastritis is an inflammation of the gut that can be acute ­– an intense but short lived episode. It can also be chronic – a continuous condition over several months and even years. This inflammation causes gastric pain, which people like Ganguly and Sinha often describe as gnawing or burning sensations in the stomach, sometimes accompanied by nausea and vomiting.

Gastritis and the accompanying gastric pain can be caused by a range of triggers like infection by the bacterium Helicobacter pylori, continuous use of non-steroidal anti-inflammatory drugs like ibuprofen or an autoimmune response, with smoking and alcohol generally aggravating the condition. However, many doctors agree that, for most people, bad eating habits cause gastritis.

“A diet rich with fried and oily food is one of the primary reasons why people develop this disease,” said Dr Patankar. This he said was because high-fat food increases chances of inflammation of the stomach lining.

Gastric pain can become chronic at any age but, doctors observe, college students and young professionals seem more vulnerable. “Take for instance the lifestyle of a person working in a call centre,” said Dr Anil Arora of Ganga Ram Hospital in Delhi. “The demands of his or her professional life are such that it is very difficult to maintain a healthy lifestyle. They often work in odd hours and hence go against the circadian rhythm. Sedentary lifestyle is often a trigger for this disease. It hampers your appetite, sleeping hours get disrupted.”

While gastritis caused by Helicobacter pylori infection can be treated with a dose of antibiotics, other forms of gastritis are irreversible. But a healthy diet coupled with proper sleep can keep the illness in check. Dr Jayant Mukherjee, gastroenterologist at AMRI Hospitals in Kolkata, says that a person with gastritis can avoid pain by managing their diet and stress levels. Prolonged gastritis without managing symptoms can lead to the more severe gastric ulcer.

Feeling the pain

The most common way of diagnosing gastritis and finding its cause is through an endoscopy, a non-surgical procedure during which a light and camera is inserted into the digestive tract to get a visual confirmation of damage to the stomach lining. Doctors may also take samples from the stomach lining or ask a patient to undergo a stool test.

But even as gastritis has definite clinical parameters for diagnosis , how does a doctor assess gastric pain?

People with gastric pain often mistake their condition for a common stomach ache. On the other hand, said Patankar, people sometimes conflate bloating, discomfort or acidity with gastric pain.

Pain is a subjective phenomenon, said Mukherjee, and so doctors should accept a patient’s description of it as most accurate. Gastric pain in the absence of any identifiably wrong in the stomach or gut is even more invisible. A patient can suffer gastric pain but exhibit no structural or overtly evident anomaly in the stomach, said Mukherjee. Their pain could be linked to anxiety and aggravated during episodes of stress. “In gastroenterology, pain in the absence of any organic pathology is called non-ulcer dyspepsia,” Mukherjee explained.

Dr Monica Jain from a private hospital in Delhi agrees with Mukherjee. “The abdomen is the most vulnerable part of our body and its functionality is the first to get affected in case of stress or anxiety,” she said.

It’s all about eating right

The lives of patients with gastric pain revolve around food and eating schedules. For young mother Rajrupa Banerjee, who was diagnosed with non-ulcer dyspepsia when she was in college, it means meticulous planning and discipline. “I drink a lot of water and avoid long gaps between meals,” she said. “Besides, I also had to cut down on fried and spicy food. Late night dinners are a strict no-no for me. As for daily life, I have to take extra care of my diet and ensure that I eat at an interval of every two-three hours.”

Journalist Sinha now goes running at least thrice a week. “With waking up early and going for run, heavy breakfast soon became a part of the plan,” he explained. “Also, to avoid the feeling of having embers in my stomach, I have a glass of lime water along with a spoon of honey. This calms down my system.”

Bianca Daw, also a sufferer of gastric pain,follows a diet chart. “In my diet chart, I have something or the other mentioned [to eat] every three hours,” she added.

Daw’s description of gastric pain is slightly different than most others. She said it was a feeling of emptiness in her stomach. “There is no outward manifestation of this pain,” said Daw. “Hence, it makes it very difficult to make others understand what exactly you are going through.”

This is the fourth part of a series on forms of pain that are not understood well or are ignored or dismissed as minor health issues. Read the series here.

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