Gastric (stomach) cancer occurs when malignant cells form in the lining of the stomach. By far, it is known to be the second most common cause of cancer-related deaths not only in Asia but also worldwide. Though it can affect both male and female populace, it is seen more commonly in men and in people aged 50 years or older.

Type: Gastric cancers can present as one of the following types - 

Adenocarcinoma: Begins in the glandular cells lining the inside of the stomach. This forms a majority of the stomach cancers.
Lymphoma: Begins in immune system cells present in the walls of the stomach. Occurrence of lymphoma, in the stomach, is rare.
Carcinoid Tumor: Begins in hormone producing cells of the stomach.  Occurrence of carcinoid cancer, in the stomach, is rare.
Gastrointestinal Stromal Tumor (GIST): begins in nervous system cells of the stomach. Occurrence of GIST, in the stomach, is rare.
Gender: It affects both male and female populace.

Etiology: The factors that are associated with increased risk of gastric cancer include the following mostly  

 Helicobacter Pylori  bacterial infection in the stomach is a common cause of gastric cancer of both the intestinal (expanding) & diffuse (infiltrative) type. Furthermore, studies indicate that high salt intake is synergistic with H. Pylori infection in the manner that it is likely to increase the risk of gastric cancer that is induced by H. Pylori bacteria.
Smoking, consuming alcohol, red meat, salty/ smoked/ processed foods, low intake of fruits and vegetables, diets rich in nitroso compounds, eating foods contaminated with aflatoxin fungus etc all.
Atrophic gastritis characterized by chronic stomach inflammation is known to increase the risk multi-fold. Chronic gastric inflammation can lead to atrophy of the gastric mucosa, metaplasia, dysplasia and finally carcinoma.
History of pernicious anaemia, gastric ulcers, adenomatous gastric polyp etc all.
Family history of gastric cancer. Several familial syndromes that have been associated with a pre-disposition to gastric cancer include familial adenomatous polyposis, Lynch syndrome, Peutz-Jeghers syndrome and e-cadherin mutation (diffuse type)
Blood group A, Obesity etc all are known to be associated with diffuse or cardia gastric cancer.
Low socioeconomic status - persistent lifestyle issues/ irregularities including high stress coupled with an improper diet/ dietary pattern.
Epidemiological evidence is indicative of a risk or pre-disposition to gastric/ stomach cancer for people suffering from diabetes mellitus (DM).
Very high dose ionizing radiation exposure is an uncommon risk for gastric cancer.
Features: There are often no early stage symptoms. Early stage symptoms, if any, are non-specific and are likely to be ignored, thus delaying the diagnosis most often. Hence, gastric/ stomach cancer is often detected at an advanced stage where the disease is either locally advanced or metastatic. The various presentations (of signs & symptoms), by stage (early or advanced), of gastric cancer are as enumerated below:

Early Stage   can present with one or more of the following non-specific symptoms/ signs -

Dyspepsia (Indigestion),
Stomach/ Epigastric discomfort,
Bloated feeling after eating,
Mild Nausea/ Vomiting,
Blood in Vomit (Haematemesis),
Heartburn,
Weight loss (Cachexia)
Anaemia,
Occult blood in stool/ Melaena,
Advanced Stage   presents with one or more of the following symptoms/ signs -
GI Bleeding with black tarry stools (Melaena),
Persistent Nausea/ Vomiting,
Blood in Vomit (Haematemesis),
Early Satiety,
Anaemia,
Loss of Appetite (Anorexia),
Weight loss (Cachexia),
Persistent pain in the abdomen,
Fluid build-up in the peritoneal cavity (Ascites),
Edema of the lower extremities,
Liver Enlargement (Hepatomegaly)/ Jaundice,
Difficulty swallowing food (Dysphagia)
Screening: Is generally recommended for asymptomatic populations in high incidence areas or as surveillance for high risk individuals. The goal of screening, as usual, is to be able to detect & diagnose gastric cancer at an early stage which is potentially curable. It is mostly endoscopic/ radiologic.
Diagnosis: Following are the diagnostics employed in gastic cancer - 

Physical Examination: May be remarkable for palpable abdominal mass, weight loss (cachexia), abdominal distension, ascites, hepatomegaly, lower extremities edema and lymphadenopathy for gastric cancers in the advanced stage. For early gastric cancers, however, physical examination is largely uninformative.
Blood: Hb- may be low, ESR   raised, tumor markers CEA & CA-19-9 could be raised sometimes in adenocarcinoma but are not frequently elevated. Abnormal blood test results may be indicative of malignancy, but a follow-up gastroscopy/ biopsy is always the gold standard for accurate diagnosis.
Stool: Occult blood may be +ve
Barium Meal X-Ray: Could show a filling defect at the site of the carcinoma/ cancer growth.
Gastroscopy/ Biopsy: Clinches the diagnosis.
Endoscopic Ultrasound: Maximizes tumor staging as it helps determine the depth of invasion of the tumor.
CT Scan: Of chest, abdomen & pelvis helps detect metastatic disease, if any, and also helps stage the disease (TNM) appropriately.
Bone Scan: Helps detect osseous metastasis (bone mets), if any.
Treatment: Conventional treatment includes surgery, chemotherapy and radiotherapy as contextually appropriate. Surgery (i.e. gastrectomy either sub-total or total), with an adjuvant chemotherapy and/ or radiotherapy as contextually relevant, is the only treatment that is known to cure the disease in light of the prognostic indicators as briefly enumerated in the section below. Chemptherapy and/ or radiation alone cannot be curative. Mostly, it can improve symptoms, and may prolong survival. Simultaneously, an adjunctive or integrative naturopathic treatment with suitable complementary & alternative medicines (CAM) too can help improve clinical outcomes and facilitate recovery as feasible contextually.
Prognosis: For gastric cancer is variable. Preventive measures, earlier diagnosis and right early treatment is key for an effective therapeutic management & better prognosis. Like most other cancers, the chances of cure for an early stage gastric cancer are more. The cure/ recovery chances are influenced by the grade, stage of cancer, recurrence and the patient s general health & vitality etc all. Distal tumors are known to be cured more often than the proximal ones. Again, intestinal-type gastric cancers are known to have a better treatment outlook in comparison to the diffuse-type gastric cancers.

Prevention: Rightly said, prevention is always a better choice. Although genetic risks are difficult to modify, still an adherence to a relative Mediterranean diet, maintaining an ideal body weight and an active lifestyle with due emphasis on regular exercising, de-stressing and relaxation is highly recommended for reducing the risks of many cancers including gastric cancer. A healthy eating plate comprises essentially a low fat diet, fibre rich foods including whole grain cereals, green leafy vegetables cooked using healthy vegetable oils, fresh fruits of all colours as seasonally available and healthy proteins/ fats including fresh fish, poultry, beans, nuts etc all. The consumption of alcohol, if any, has to be strictly in moderation, and is best avoided in a high risk scenario. Smoking is to be avoided too. Again, red meat, butter, refined grains, sweets, sugary drinks including carbonated beverages and other high calorie foods etc all, if any, are to be taken sparingly. Not only it is important to eat healthy, but also it is equally important to eat properly. Insufficient chewing, eating until full, eating meals within a short time etc all are best avoided so as to ease off digestive burden on the stomach/ other organs in the GI tract. Last but not the least, consumption of clean and filtered water, natural probiotics like freshly prepared yogurt/ butter milk, maintenance of cleanliness & hygiene including oral hygiene etc. all can help guard against H. Pylori infections. Breastfeeding is known to be protective against H. Pylori infections too.

Gastric Cancer - In a Nutshell!

Almost all of us have experienced bloating, gas or an upset stomach. Yet some people experience this problem at a chronic level. Gas occurs in the stomach and intestines due to breakdown of food into energy. All of us pass gas, however some people do more than others. An average person passes gas 5-20 times a day.

An upset stomach can often cause problems and can be a difficult battle for many people. Although the symptoms of gas problems often relate to an improper diet, yet other factors may be also responsible.

Causes and Symptoms of Gas Problems

Swallowing air: The swallowed air which is not burped out, passes through the digestive system and is released through the opening of the anus. Hiccups can also occur if you have swallowed excessive air.
Diet: The reaction of different foods varies from one person to another. Also foods that lead to odorous gas may also vary from person to person. Yet, spicy foods and dairy products are the most common causes of gas. Example - Beans, cabbage, onions, radishes, eggs, carbonated drinks, sugar, packaged foods etc.
Medications: Certain medicines and supplements, including prescription drugs, can lead to gas problems and bloating. Further, medications which change the hormonal balance in the body can also cause bloating.
Medical problems: Certain medical conditions such as Irritable bowel syndrome or bowel obstruction can also lead to an upset stomach.
Common symptoms of gas problems include gas pain, cramping, bloating, diarrhoea and constipation. In the worst of cases, gas and bloating indicate colon cancer. Such people experience rapid weight loss, anaemia and blood in stools.

Treatment
Modifying your lifestyle, in particular your dietary practices, is essential to a healthy recovery.

Avoiding foods such as spaghetti, oats, bran, barley, banana, bread etc. which contain high fibre content is important.
You can opt for over the counter medications after consulting your physician. Homeopathy and Ayurveda can be also opted as alternative forms of treatment.

Chronic Gas Problem - Facts You Should Know About it

Stomach problems are one of the most common issues you face. Irrespective of what your age is, it is highly likely that you have an upset stomach once in while. A stomach upset has a distinguishable characteristic -  that stomach linings as well as the small and large intestines tend to swell. This is called inflammation. The following are the most common causes of an upset stomach.

1. Viruses
Viruses are the most common causes of an upset stomach. It is highly likely that your stomach upset is because of a virus since there are so many types of them.

2. Parasites or bacteria like Salmonella and Escherichia coli
This is also a very common cause of stomach upset. Salmonella infections are usually caused by eating raw eggs, meat and meat products whereas Escherichia coli infections come from raw vegetables as well as milk and dairy products.

3. Allergic reactions
These happen very specifically to people who have a reaction to a certain type of food.

4. Excess alcohol
Most people think that alcohol will only make you pass out or get liver cirrhosis. Many people do not know that alcohol can actually adversely affect your stomach as well.

5. Excess caffeine
Caffeine is also dangerous to your stomach as taking too much of it can cause a stomach upset.

6. Fatty foods
Fatty foods such as cheese, dark chocolates, whole eggs, fatty fish, etc. are dangerous because they are harder to digest than many other types of food. This means that eating even a small amount of fatty foods are enough to cause a stomach upset sometimes.

7. Eating too much
This is also a major cause of stomach upset simply because your stomach can only digest a certain amount of food.

You must also be able to distinguish when you have a stomach infection and when you have Chron's disease as it is basically a chronic stomach upset. Chron's disease causes the whole digestive tract to be inflamed.

Common Causes Of Stomach Problems

Gastroesophageal Reflux Disease (GERD) is a form of digestive disorder, which affects the lower oesophageal sphincters or the muscle ring present between the stomach and the food pipe. GERD incorporates the return of the contents of the stomach back to the oesophagus or food pipe. The functioning of the lower oesophageal sphincter is disrupted.

Causes

Hiatal hernia is a common cause of GERD. An unhealthy lifestyle and diet may also lead to GERD. Intake of an excess amount of chocolates, fried food, coffee or alcohol triggers the chance of a reflux. GERD also occurs in obese people and pregnant women.

Symptoms

Heartburn, also known as acid indigestion, is the primary symptom of GERD. The affected person may feel a burning chest pain which starts from behind the breastbone and reaches up to the throat. The feeling can be defined as food coming back to the throat with a bitter, acidic taste. The burning sensation may last as long as two hours.

Other symptoms include:

    Excess saliva secretion
    Chronic conditions of sore throat
    Laryngitis
    Gum inflammation
    Tooth cavities
    Unpleasant breath

In order to diagnose GERD, several tests may be conducted . They are:

    An X-Ray of the upper part of the digestive system.
    Endoscopy to examine the inner part of the oesophagus.
    Ambulatory acid test for monitoring the amount of acid within the oesophagus.
    An oesophageal impedance test to measure substance movement inside the oesophagus.

Treatment

    A person must make several changes to his daily lifestyle and diet plan for treatment of GERD.
    Food and beverages like chocolates, fatty food, coffee, alcohol and peppermint should be avoided in order to reduce the weakening of the lower oesophageal sphincter. Several food items irritate the damaged oesophageal lining and should also be avoided. They include citrus fruits, tomato and pepper.
    Smoking cigarettes results in weakening of the lower oesophageal sphincter and should be stopped to reduce GERD.
    One should elevate the head of the bed on which he or she sleeps on blocks measuring 6 inches. This reduces the heartburn as gravity minimizes stomach reflux to return to the oesophagus.
    Over the counter medicines can be used to cure GERD. Antacids are a good example and neutralize the acid in the oesophagus and stomach, reducing heartburn. Combining antacids with foaming agents is also effective. A foam barrier is formed over the stomach, preventing the occurrence of acid reflux.
    Medicines for reducing acid in the stomach are prescribed in cases of chronic GERD, which include H2 blockers by the likes of cimetidine, famotidine or nizatidine.

GERD is a digestive disorder, which causes disruption in digestion, as reflux from the stomach is returned to the oesophagus. Proper treatment measures should be taken.


Gastroesophageal Reflux Disease (GERD)

Lactose intolerance is a condition wherein you are not able to digest lactose, which is a sugar found in milk. Other foods that contain lactose include cheese and ice-cream. Inadequate production of the lactase enzyme in children causes lactose intolerance. This enzyme is produced in the intestine that helps in the digestion of lactose.


Lactose intolerance is often confused with milk intolerance. The symptoms are similar but they do not share the same cause. Milk allergy is an adverse reaction towards milk and it is a problem of the immune system, whereas lactose intolerance involves the digestive system.


Symptoms-
The symptoms of lactose intolerance are:
Bloating; on consumption of milk over a period of time
Diarrhea is also very common
Stomach pain
Nausea


Diagnosis-
It is self -diagnosable; just strike out foods containing lactose from your child s diet and see if the symptoms get better with time. If the symptoms happen to fade away gradually, then it certainly must ve been lactose intolerance.
However, it can be tricky as many non-dairy products also contain lactose.
If the child is lactose intolerant, then he/she might have to undergo a lactose breath test. This is used to test the levels of hydrogen in the child s breath after the child consumes a lactose solution. Usually, hydrogen levels are low in one s breath. However, if the lactose solution is not digested properly, then it will lead to a temporary increase in the levels of hydrogen in the breath, thus indicating lactose intolerance.


Treatment-
This disorder does not have a cure; so in case your child has lactose intolerance, you need to adjust his/her diet accordingly. Over-the-counter lactase is also available that helps in digesting lactose based foods. You can also go for the  lactose- free  milk variety for your child.


Lactose Intolerance in Kids

A Gastroenterologist is a physician with dedicated training and unique experience in the management of diseases of the gastrointestinal tract and liver. If you are planning to visit one, you most likely have a problem in one or many organs like esophagus, stomach, small intestine, colon and rectum, pancreas, gallbladder, bile ducts and liver. 

Visit your doctor to understand the severity of your condition and the course of treatment, as it is obvious that during this time you must be suffering from anxiety and you may not ask the questions arising in your mind. That is why you need to prepare in advance for your first visit with a gastroenterologist. Being an active partner in the doctor patient relationship is bound to have its benefits. Here are some handy tips:

1. Come mentally prepared: Don't let the anxiety get to you. If you need some extra help calming down, try yoga or meditation. You can simply go out on a walk alone to help you focus your thoughts. This is just like any other doctor visit. The good part is that you are taking the first step in easing your discomfort and starting treatment, so go with a positive mind.

2. Maintain a diary of symptoms: It is likely that you are experiencing discomfort from past few days or weeks before you finally realize the need to seek out a specialist. Try to remember as much as possible about the symptoms you experienced in a chronological order. Write down any over the counter medicines you've tried or anything unusual that you may have consumed in the past week. 

3. Take stock of your medical history: It is likely that your doctor may want to know about any historic conditions you've suffered that may or may not relate to your present condition. Many ask you to fill out forms during your first time patient registration which includes many minor details about your medical past. List down any allergies, especially food allergies you have. 

4. Take stock of your recent medical tests: Bring your latest blood tests and imaging tests (X-rays, ultrasounds, MRIs, and CT scans) with you for the doctor's visit. If you have a pre-existing condition like diabetes, thyroid or you suffer from other chronic conditions like increased uric acid, carry your most recent medical reports with you. 

5. Make a list of questions for the doctor: In most cases, the first visit is a crucial factor in determining whether you want to continue the course of treatment with a particular doctor. This comes out of your ability to trust the doctor, his knowledge and diagnosis and an overall comfort level that comes with how well he handles your questions. Start by making a list of questions you want to ask about your specific condition and course of treatment and see if you get satisfactory answers. 

6. Brace yourself: If you want to suggest a treatment option, make sure you read up all about it before you tell the doctor.

6 Tips For Your First Visit With A Gastroenterologist

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