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BRITISH BROADCASTING CORPORATION
RADIO SCIENCE UNIT
CHECK UP 6. - Stomach
RADIO 4
THURSDAY 06/01/05 1500-1530
PRESENTER:
BARBARA MYERS
CONTRIBUTORS:
DAVID EVANS
PRODUCER:
DEBORAH COHEN
NOT CHECKED AS BROADCAST
MYERS
Hello. What does an upset stomach mean to you? Is it heartburn where acid comes up into your throat if you lie down or exercise after a meal? Do you have a feeling of fullness making you want to loosen your belt or your bra? Or is it nausea or even vomiting? Well if you've just had your lunch and ate too fast, too much or a lot of fatty food then you won't be surprised and usually an antacid will do the trick. But if you're having digestive problems that persist or get worse and are unusual for you then there may be a better remedy or more of a problem which does need investigating.
Well call us now with your questions about stomach ache and indigestion - the number 08700 100 444 or you can e-mail us checkup@bbc.co.uk. And you can put your questions to our medical expert today David Evans who's professor of gastrointestinal physiology at Bart's and the London Hospital.
We have our first call waiting to speak to you David and he's Harry, he's called from North Manchester. Go ahead Harry, your question please.
HARRY
I suffer from a very acidic stomach, it's come on in the last five years and I am taking Gaviscon and omeprazole capsules for this and I was wondering if this will ever pass away and any other things that I might take for it.
MYERS
Well we have an expert in acid reflux, so David is this going to get better for Harry, given that he's already taking - well something - Gaviscon he mentioned and omeprazole, I think it was, as well?
EVANS
Hello Harry. Yes you're taking one of the most powerful drugs we have, which is omeprazole, and the Gaviscon is really only to help people with mild reflux. Could I ask you - is it improving your symptoms while you're taking it?
HARRY
Yes, yes it varies actually. Just for the last three - fortnight I've just been taking the Gaviscon once a night.
EVANS
Well ...
HARRY
But intermediately I have these ready and then I may have a period when I need to take the pills - the pills again.
EVANS
Right and your GP prescribed the pills presumably for you?
HARRY
No I went to see a specialist.
EVANS
You did - right, so you're being well looked after by the profession. And it sounds like you've got a chronic reflux problem, which is notorious for coming and going from time to time. It's often related to your lifestyle - the type of food you eat. And if you feel you're sensitive to any particular food I would try and avoid it - that may help. But it's not an uncommon chronic problem that people suffer from in this country, probably about a third of the population I think from time to time. And mostly we would - we would - we'd treat this condition as you're being treated medically and if the omeprazole is helping you I think unless your GP was unhappy that you should have any further investigations then I think probably you might have to put up with it. How old are you Harry?
HARRY
Well I'm over 67.
EVANS
You are, okay well that's quite a young 67 these days, so I wouldn't worry about it but you've not had any investigations at all at the moment?
HARRY
Oh he put the - what now - when I went to see the specialist he put that thing down me throat.
EVANS
You've had a camera down - they've had a good look round and they found nothing sinister ...
HARRY
No.
EVANS
... so I think really sounds like you have got a chronic reflux problem to me and you're taking the right medication for it.
HARRY
And so with time it maybe - might it improve do you think?
EVANS
I hope so - I hope so but at least you're running down the right lines okay.
MYERS
Thanks for that Harry, thanks for setting us off. And you mentioned that powerful class of drugs which suppress the acid and that's really been a big breakthrough, has it not, for clinicians so they have something really helpful to give patients. Of course as long as the patients take it and would that be the point - that if you are diagnosed with this acid reflux you will need to take that medicine perhaps for a length of time - perhaps forever?
EVANS
Yes, there are a number of classes of acid suppressing drugs and the newest ones are known as PPIs - proton pump inhibitors - and they suppress approximately 90% of the acid that the stomach produces. So any reflux or any stomach contents that are going to places where they shouldn't is not damaging the lining of the digestive tract. So they do work very, very well and they really are the mainstay treatment in this type of problem these days.
MYERS
Well I guess we'll hear from others, in fact David Hooper wants to speak to us from Reading and I think is taking an acid suppressant. Suiting you or not David - is it doing the trick?
HOOPER
Yeah, it does suit me and I vary the dose according to the severity of the reflux. The thing I wondered about was that I wonder whether diet could play a part in this and reducing reliance on the drug or perhaps even do without it?
MYERS
Are you one of these - and there are many of us - who would prefer not to take medicine if we can do something about it ourselves, is that what you're getting at?
HOOPER
Yes definitely, yeah.
MYERS
And this is about sort of something you could take - I mean I have had an e-mail suggesting that the trick is to drink sliced ginger and boiling water, which works in 20 minutes, according to Jackie.
HOOPER
Oh right.
MYERS
And Joan, another one, has said that she was put on to a Turkish drink, when on holiday, and that contains plain yoghurt, water and a pinch of salt and she's found it very helpful for excess acid, it has a name it's called arrian [phon.]. How does this play with you David, as the expert?
EVANS
Well I think the two points are that diet is important and I think a lot of the dyspeptic problem these days, particularly in our Western societies, with processed foods and a whole range of available foods on the - in the - on the supermarket shelves that we never had before can play a role in this type of problem.
MYERS
Any in particular that you're thinking of?
EVANS
Well in classes of food the classic ones are spicy food, which people feel they may be sensitive to, and this is possible due to the capsaicin in the curries that plays a role in the normal stomach function. Fatty foods are particularly - it's noticed - that cause a problem as well because fat's handled by the stomach in a different way to protein and carbohydrate in that it takes rather a longer time to digest it and if the stomach takes a longer time to digest something it remains there for a longer time and perhaps more acid is produced than necessary. So I would advocate a healthy diet, which has got a good balance of protein, fat and carbohydrate, without overdoing any of it and that may help. I'd also say to you David that if there's any particular food that you feel you're sensitive to just stop taking it and that's a lot easier than taking constant medication.
MYERS
And what about things though you might take if you've got symptoms - like the ginger if you like - any others that you've heard of that seem to work for people?
EVANS
Oh I think there are - there are hundreds of medications of this type and I'm fairly pragmatic about that, I think if you feel it helps you and as long as it's not poisonous or toxic you should carry on with it. But in general if we look at the classes of drugs that we use for treating this type of problem they're usually somehow related to suppressing the amount of acid you produce, or to getting your stomach to - kicking your stomach into action and make it empty more quickly.
MYERS
Well we'll see if anymore remedies are on offer but David thank you very much for that question. Theresa wants to speak to us, Theresa in Bedfordshire, hello?
THERESA
Oh hello, good afternoon.
MYERS
And your question please.
THERESA
I turned the terrible 40 the back end of last year having never suffered from any indigestion or gastric problems at all and in the last three to four months I've suddenly begun to suffer from indigestion, heartburn, sort of every one to two weeks. Sometimes it's very mild, sometimes it's more severe. I haven't changed my diet, or my routines and I'm just wondering why this is happening, is it just an age thing because I'm getting older, is there anything I can do to help and really should I go and see my doctor because it's just started occurring?
MYERS
Well I'm so sorry to hear you talking about getting older at 40 but anyway is there something in this - is indigestion known to be in any way age related would you say David?
EVANS
There's no real evidence that there's any particular - that the onset comes at any particular age and in fact I see patients who are as young as two to three months old or even premature babies, right up to octogenarians. So - but there does seem to be a bump in the frequency of this problem at around the middle ages. That's probably not surprising because we probably tend to be more affluent, perhaps our diet changes to a slightly richer type of foodstuff when we get to that sort of age, maybe we don't exercise quite as much as we did. What I would say is that dyspepsia and reflux type symptoms, which you have, are multifactorial and if we said there was seven or eight risk factors and maybe you were born with one or two and then you acquired a couple when you were in your teens and your early adult life and then you acquired another one or two and as you get to 40 suddenly you become symptomatic and it's difficult to stop that process then.
MYERS
So what would be risk factors then for perhaps getting indigestion more than perhaps just the obviously big meal that you've eaten rather too quickly, which can cause anybody to have a bit of pain and discomfit?
EVANS
I think long term risk factors are things like hiatus hernia, weak sphincter valve which prevents acid coming back from the stomach into the oesophagus, obesity I'm afraid - weight gain is certainly a factor which we would try and get to grips with because weight gain tends to improve - increase the pressure in the stomach, in the stomach region and tend to push things up rather than allow them to go down.
MYERS
Smoking and drinking do they ...?
EVANS
I think alcohol will play a part because it's an irritant to the stomach wall. Smoking - I think the jury's out a bit on that one, I don't think there's any hard evidence but there are - there is some evidence that suggests that some of the metabolites of smoking may play a role as well.
MYERS
Theresa, you phoned and I'm glad you did for information and a bit of advice but is that reassuring enough or are you thinking well I'm not - I know me and this isn't me and should I do more?
THERESA
Well I mean sort of from a weight gain point of view I haven't really changed my weight really much in the last 10 years or so. I mean I suppose, as you said, you do get slightly more affluent as you get older and I suppose progressively I sort of do eat slightly more rich foods and perhaps drink a little bit more than I used to which may well be a factor. But yes it doesn't seem to sort of explain perhaps why it's come on quite so suddenly and why it's quite so severe.
MYERS
So what would be the next step for Theresa or others who continue to be concerned, maybe they make a few dietary changes, maybe it will make a difference, maybe it won't - visit to the doctor, a test?
EVANS
... visit to the doctor's the next thing. Have you seen your GP at all?
THERESA
No, no I haven't, I've just been sort of hoping it would go away I suppose.
EVANS
I think now's the time to go and visit your GP because he's the route - he or she will be the route to specialists like myself. The normal routine would be he would refer you to a gastroenterologist at your local hospital, who would almost certainly do - perform an endoscopy on you to have a look, down with a camera to see whether there's anything that we should be concerned about.
MYERS
And this is generally to rule things out rather than rule them in is it?
EVANS
It is indeed. If that all comes back as negative he'd probably put you on a course of one of these new drugs - these proton pump inhibitors - unless you've been on them already and then after that you might get to see somebody like me, to see whether you've got an underlying weakness which we should be thinking about dealing with in another way.
MYERS
Alright, that's much further down the line though, so we'll leave it at that but thanks for the call Theresa. You mentioned there David treating and seeing very young babies and children with reflux disease, Christopher Owen joins us now from Ringwood. Christopher, I think this has been your experience from being a child you've had a problem? Can you explain?
OWEN
Well yes since I was 10 years old I suppose I've had this hyper-acidity all my life, so I've been on these - I've been taking this antacid tablets, which work for a short time, they're fine. I've had a couple of endoscopies and the most recent one was a couple of months ago and then I was put on zoton - this gastro-suppressant. And that works beautifully and for the first time in my life I've got a sort of a normal stomach, except I can't drink white wine, that's the only thing I can't drink.
MYERS
Oh never mind.
OWEN
Red wine's fine.
MYERS
So really that's a success story you're saying.
OWEN
Yes, but how long can I go on - the question I was going to ask was how long can I go on taking these safely - these zotons?
EVANS
Oh is it Christopher?
OWEN
Yes.
EVANS
Could I ask your age Christopher?
OWEN
Fifty eight.
EVANS
Fifty eight. The experience we have with this class of drug is that we've had patients on them for many years now - 20 years, one of them's been around. They appear to be very safe but clearly we do not like patients to be on drugs indefinitely. If you've had a problem since you were 10 it is highly likely that you have a - some form of possibly congenital weakness in that area and you may like it to be investigated a little further. You've had endoscopies I hear and anything found there?
OWEN
No, nothing at all ...
EVANS
Nothing at all.
OWEN
... only a bit of slight inflammation but nothing more than that.
EVANS
Yes, which is probably caused by acid reflux. But one of the things I do is to investigate people like yourself and there are a few centres around the country who can do that for you and you're in Hampshire I think aren't you?
OWEN
Yes.
EVANS
Certainly your local hospitals would be able to organise it - best done through your specialist who probably did the endoscopy for you.
OWEN
Right, I mean my grandmother had the same problem almost - she used to live on, as far as I can remember, these sort of tablets and so I've probably inherited it.
EVANS
Quite possibly.
MYERS
So you're a bit luckier though Christopher because these PPI - these proton pump inhibitors - are a new class of drug, I guess she didn't have, so it would have been just literally taking the antacids - the bicarb of soda ...
OWEN
All that kind of old fashioned ...
EVANS
Cold milk.
MYERS
Yes, but - so what's behind your question is this idea that you will be taking them indefinitely?
OWEN
Well are they safe to take indefinitely and what sort of tests have been done on them and what's the out - I don't know ...?
EVANS
Well as I say these drugs appear to be very safe but I think what the profession is concerned about is having people on long term acid suppression indefinitely because obviously your stomach produces acid for a reason and it does help the digestive process, it does - it does act as a bacteria [indistinct word], it kills the bacteria in the food. So without that you are at slight risk to bacterial infections and the like. So even your doctor might just say to you well maybe it's time to think of something else at some stage if you've been on these drugs for perhaps, I don't know, five, sometimes 10 years. So it is something - nothing sinister - but something to bear in mind for the future. Fifty eight's rather young these days, so now you've got quite a few years ahead of you ...
OWEN
Oh thank you.
EVANS
...so the time to make decisions about whether you want to do anything further - don't wait till you're 75 or 80 because we may offer you an operation you might not be suitable for one at that age.
MYERS
Alright Christopher we'll leave it there if we may and move to South Yorkshire - Pat Barkworth wants to speak to David Evans, our expert today. Pat, hello.
BARKWORTH
Hello.
MYERS
And your question please.
BARKWORTH
Thank you. Hello David. I've been diagnosed for quite a long time now with a hiatus hernia and take Gaviscon liquid as prescribed. But I do find now that I'm waking up in the night with reflux and needing to take another dose of Gaviscon. So would one of these acid suppressants help?
MYERS
And before you answer that David just for the ignorant among us, just say a little bit about hiatus hernia, so we understand what's going on here with Pat, I'm sure Pat you could do it as well, because it's your problem, but let me ask.
EVANS
Yes Pat, as you probably know, hiatus hernia is a defect at the level of the diaphragm where your oesophagus enters your stomach. And it is a condition that's associated with reflux or acid heartburn. So those with a hiatus hernia, which is of course a mechanical defect, are more prone to this problem. Now there is an operation to repair the hiatus hernia, which in the past has had rather a bad press I think because it involved opening the chest to make the repair. But for the last 10 or so years it's now being performed keyhole surgery, which is making the surgery rather less traumatic for the patient and in selected patients - and the selection process is very carefully done - that operation might be offered to somebody like yourself if your physician felt you would be appropriate. Now the appropriateness of that condition is usually derived by some rather specialised tests, which is what I do basically, which is to examine the function of your lower oesophagus and also to see exactly how much acid reflux you're getting, particularly at night with you because it's obviously happening when you're asleep and when you're lying down.
BARKWORTH
Yes I find it's worse if I lie on my right side, I can't lie - when I first go to bed I can't lie on my right side at all. But as the evening progresses, you know as it goes through the night, I do tend to turn over and that's sometimes when I get the reflux. But also I can sometimes lie on my right side quite safely later on but certainly not when I first go to bed.
EVANS
Yes. I think I probably would advise you to pursue this a little bit further, you've had a long time and could I ask your age?
BARKWORTH
Sixty seven.
EVANS
Right and of course at 67 keyhole surgery is - certainly would be appropriate for you as well. But we would only do that on a very, very small percentage of patients.
BARKWORTH
Yes I understood that doctors were a bit reluctant to perform this operation.
EVANS
Yes.
MYERS
Well you have the word from David that it's worth pursuing, whether or not you're entirely suitable will be down to your specialist when it comes to it. But thanks for the call Pat. It gives us a chance to just talk about lying down, going to bed after a meal and the tendency is of course if you're at all prone to this then you're going to get acid reflux, perhaps burning right through up into the throat. I do wonder whether the acid reflux is actually doing real damage - it's quite unpleasant, it's quite uncomfortable - is there a real problem with what it's doing to the lining of the gullet for example?
EVANS
Well it can be, in fact there are two classes of reflux - we call it non-erosive and erosive disease - erosive merely means that it causes inflammation and non-erosive means that it doesn't do that but it still gives symptoms. But the erosive type of reflux certainly will damage the lining of the oesophagus, however it's - with a bit of help usually from these antacid preparations the oesophagus is well capable of renewing the lining because that happens as part of normal life anyway. But I think if this continues over a long period and we're really talking about years rather than months it would be advisable to perhaps perform some of these investigations, certainly have an endoscopy because of the worry that things may go on to something a little more sinister, in a very, very small proportion of people who have this problem, but it's certainly worth getting checked out over the long term.
MYERS
Okay, thank you very much for that call and for that answer. And to Chichester now, Peter Mosedale, hello Peter.
MOSEDALE
Hello.
MYERS
And your question please.
MOSEDALE
Well all my life I've suffered from occasional very severe attacks of bloat - I think that's the word for it.
MYERS
Bloating - feeling very distended, yes.
MOSEDALE
Bloating yes. And it's always very painful and I'm told that it can be quite dangerous. But the best treatment I ever had for it was in Australia where I had a bad attack - I was loaded flat out into the back of a station wagon - taken to a doctor, who gave me a pill and said if this doesn't work in 10 minutes we shall have to stick you as we would a bloated cow, which certainly encouraged me. But the result of the pill was immediate and spectacular and in fact I was more or less jet propelled out of the surgery. I'd love to know what this was, I've never been able to find out and I wonder if you have any thoughts at all on the best treatment for this.
EVANS
Well it's a difficult one that because bloating can be caused by many things. It could be caused by obstruction of the bowel, which of course is very dangerous, or it could be simply just part of the digestive process and the gases that are produced by the stomach are not being relieved. It sounds as though you had a rather - an acute event of something. I've been thinking about what that pill might have been, it sounds like a rather miraculous cure to me, and there are two types of treatment we use for - certainly for chronic bloating, yours was rather an acute variety. One is to degas the stomach by the use of drugs we call anti-flatulence, and they've usually got things like carbon in them or the like. Or another one is to make the stomach work more efficiently to try and dispel the gas from the stomach. But bloating is rather a common additional symptom in most types of dyspeptic problem and it's usually related to the dyspepsia, rather than a single underlying cause. I hope that's a little helpful for you.
MOSEDALE
Yes, I seem to get it with infection or eating something strange.
MYERS
Well we'd like to take another call very quickly because ...
MOSEDALE
Thank you so much.
MYERS
Thank you for that, I hope that was helpful. Matthew, very quickly, I think you've got another problem which causes you some concern which is ...which is what?
MATTHEW
Oh hello. Basically the last eight months I've started burping a lot [line breaking up] ... carries on burping irrelevant of what I'm eating or what time of day it is.
MYERS
Okay we've got a very bad line Matthew but I think we heard the key word - burping -- and I know that has come through in some e-mails. So very quickly in the last few seconds, what do we do about burping?
EVANS
Burping is again a very common problem, it's quite normal in most people, if it becomes excessive it may be an indicator that you have some type of dyspeptic problem in the stomach and I'm afraid it's just one of those things that we would normally treat symptomatically with the other types of condition. And I wouldn't be over-worried about it, if you don't have any other sinister symptoms.
MYERS
So really something more antisocial than problematic really.
EVANS
And I think in some countries seen to be good.
MYERS
Okay, thank you very much, we have to leave it there. Just time today to thank Professor David Evans and to thank our callers, our e-mailers and our listeners to this and all our other programmes over the past few weeks. If you need more information you can call our help line, it's free, it's confidential, the number is 0800 044 044. You can also go to our website at bbc.co.uk where you can listen again to this and our other topics. I'll be back with a new series on the 24th February - hope you'll join me then.
ENDS
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