There are many types of stomach ache. Sometimes it is fleeting, and resolves itself with a painkiller, other times it persists, torments and you just don’t understand why. Even gastroenterologists, who deal with the belly every day, do not have an immediate answer and need more information to understand its exact nature.
“It’s a fairly common disorder, but just as complex to pigeonhole,” he confirms Silvio Danese, director of the Gastroenterology and Digestive Endoscopy Unit of the IRCCS San Raffaele Hospital and full professor of Gastroenterology at the Vita-Salute San Raffaele University. “Intensity, duration, frequency and location are precious details for identifying the organ from which the malaise originates and providing useful suggestions”.
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One symptom, many possible causes
If you have a stomach ache after eating, for example, it could simply be the fault of a not very fresh product, expired, or of incorrect cooking. “In these cases it is often a self-resolving pain, but if it recurs constantly it is advisable to see a doctor, who will prescribe blood tests, faeces or an ultrasound” suggests Danese, who to the various Types of Abdominal Pain dedicated a chapter of his latest book, At peace with the belly (Sonzogno publisher). Then there are ailments that depend on the head, that is, on the emotional sphere, in particular from stress.
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“Belly pain is emotional especially if it disappears at night. In this case, it means that it is conditioned by what happens during the day, therefore by stressful thoughts and events, which increase the body’s production of cortisol, a hormone that goes to arm with bacteria capable of slowing down the natural movements of the stomach, opening the way to a slower, more difficult and painful digestion. During sleep, on the other hand, there is a lowering of tension and therefore also of the production of cortisol, thus abdominal pain decreases”.
Similarly, intestinal pains, if neglected, can also affect mental well-being. “When it is well, our belly dispenses joy, in the sense that it produces hormones, such as serotonin, which positively condition the brain. When it is sick, on the other hand, it is a source of molecules that feed anxiety and stress in the central nervous system”.
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The importance of nutrition
In all these cases, a diet rich in fruits and vegetables, cereals and legumes, leaving aside ready-made and highly processed foods for a while, can help restore intestinal balance and relieve pain. “It seems trivial advice, but food is one of the most powerful medicines we have,” Danese points out. “There are studies that have analyzed the intestinal flora of rural populations, with a diet consisting mainly of fruit and vegetables, and have found that the bacterial composition of their intestines is completely anti-inflammatory. A crowded diet of processed foods, on the contrary, populates the microbiota with pro-inflammatory microorganisms “.
The main intestinal pathologies
When unbalanced diet and stress become somehow structural in a person’s life, they can be the source of an uneasiness that does not subside, a potential alarm bell of intestinal diseases. “If the pain improves after going to the bathroom, and is associated with diarrhea or constipation, or the alternation of both, it could be a symptom of IBS. irritable bowel syndrome. Otherwise, if the suffering manifests itself with cramps, it can be a sign of a chronic inflammatory disease, such as Crohn’s disease o la rettocolite ulcerosa. Finally, let’s not forget theHelicobacter pyloria bacterium that causes heartburn, abdominal pain, vomiting, nausea and poor appetite “specifies the gastroenterologist.
IBS, irritable bowel syndrome
In this range of possibilities, IBS, the symptoms of which are linked to impaired intestinal motility and a modification of the bacterial flora, remains one of the most frequent conditions. “About 15 percent of the world‘s population suffer from it, but it is an ever-increasing phenomenon. The reason is not entirely clear: it is a multifactorial disease that affects our lifestyle and the way we eat, but also genetics, so to date no single triggering factor has been identified “.
Drugs and diet Fodmap, a study
Options for treating it range from medications to a specific diet, the Fodmap, which a study published in April in Gut, the journal of the British Society of Gastroenterology. In Europe, IBS is primarily treated with spasmolytic drugs; the Fodmap diet is only prescribed later, and rarely by general practitioners. The experiment, which involved 459 patients for about two months, compared the effects of the drugs with those of the diet, followed as the primary treatment.
More effective feeding of drugs to reduce symptoms
“The novelty is that, although it is well known that Fodmap represents a valid therapeutic choice, there has never been a comparison on its use in the front line. This means going to the general practitioner and, instead of obtaining a prescription for antispasmodics, receive a Fodmap diet, created via a smartphone app “explains Danese. “From the results, it emerged that nutrition is more effective in reducing the symptoms of IBS than treatment with medicines. This totally changes the management of the disease and the first recommendation becomes: eat well and the irritable bowel will improve.”
What is the Fodmap diet
Once the effect on the short term is validated, the experts still do not know the best effects on the long term, because the Fodmap is quite complex to follow and it is not easy to find patients who can manage it correctly for a long time. For a period that can vary from two weeks to two months, in fact, pasta, bread and legumes are abolished, a lot of fruit (except citrus fruits, grapes, melon, zucchini, lettuce, tomatoes, strawberries and carrots), dairy products, honey, some flavorings containing garlic and onion, and the artificial sweeteners of chewing gum. Beer, vodka, whiskey and alcohol in general are also not allowed. Because? Because they all contain sugars that in patients with irritable bowel can be absorbed with difficulty in the intestinal tract and ferment, causing bloating, flatulence and pain. After the withdrawal period, these foods are gradually reintroduced and the doctor evaluates the situation.