Questions to the gastroenterologist that you were embarrassed to ask

The chief freelance gastroenterologist of the Moscow Healthcare Department, Doctor of Medical Sciences, answered questions from Antenna and Woman’s Day readers. Dmitry Bordin.

– There are functional diseases of the gastrointestinal tract (GIT), which are not based on inflammation or oncology, but a violation of the control of the digestive system by the central nervous system. Their other name is psychosomatic diseases, “diseases from the nerves.” Anxiety, stress, depression are reflected in how the brain regulates the work of the digestive system. The minimal effects in the gastrointestinal tract, which are usually imperceptible, begin to be perceived as significant, since the threshold of sensitivity decreases, and a sensation of pain appears. In this case, abdominal pain, in turn, increases anxiety, and anxiety contributes to the maintenance of pain. A pathological vicious circle arises. In this condition, the quality of life is reduced.

– This is our domestic feature – to have tablets with enzymes in a woman’s purse. As a rule, these are stout ladies who often dream of losing weight. When we overeat, we feel discomfort, then the urge to stool may occur, removing excess and unnecessary substances. Enzyme preparations can really help in eliminating discomfort, but at the same time they help digestion of food and promote the absorption of excess calories. But after all, in fact, the body signals that when overeating it is not good, and strives to develop a stereotype: if you overeat, it will be bad, which means you need to limit yourself. Instead, a person thinks: I drink the enzyme – and the problem will be solved. As a result, the body all the time receives extra nutrients that it does not need, which naturally leads to gaining excess weight. It is not right. If a person eats more than the norm once or twice a year on holidays, when discomfort appears, it is better to take an antacid drug (phosphalugel, almagel, maalox, pepsan-R or others) or prokinetic (itoprid, domperidone).

– If you have problems swallowing food, this may be a symptom of one of the neuromuscular diseases of the esophagus, for example, achalasia of the cardia. Therefore, the child must be shown to a pediatrician or gastroenterologist. If, during the examination, the pathology is not found, and the girl is just more comfortable eating, then this is normal. Our digestive organs are able to adapt to different conditions.

– The active ingredient of duphalac, like normal or portolac, is lactulose, a polysaccharide obtained from lactose (milk sugar). Lactulose has practically no side effects, it effectively eliminates constipation, maintains intestinal microflora and is an excellent component for a long daily diet. In some countries, it is specially added to food. If it helps, take it without fear.

– Heartburn (a burning sensation in the upper abdomen or behind the breastbone, which feels like spreading upward) is a big problem, it worries more than 23% of adults in Moscow and more than 13% of the population in other cities. The main cause of heartburn is the throwing of aggressive stomach contents, and these are enzymes and acid necessary for digesting food, into the esophagus. In 60-70% of cases, heartburn is the only manifestation of a disease that reduces the quality of life, but in about a third it is a signal of inflammation and erosion in the esophagus. These injuries require treatment. It feels impossible to tell if there is inflammation, so if you have heartburn, see your doctor. You don’t need to endure heartburn. Before contacting a doctor, you can use antacids that chemically neutralize the acid (phosphalugel, almagel, maalox) or alginates that remove acid from the esophagus and form a barrier against it (gaviscon). You should not use your favorite folk remedy soda.

– Kinking of the gallbladder may be accompanied by the symptoms you described, but they are usually associated with food intake, especially fatty and fried foods. You do not have this dependence, so the bend may be an anatomical feature that is not the cause of pain. In any case, an additional examination is required to clarify the diagnosis. You can contact our Moscow Clinical Research Center. In 2012, the Central Research Institute of Gastroenterology merged with the neighboring 60th Hospital and became a large multidisciplinary center, in which traditionally powerful gastroenterology is now duplicated by surgery of the digestive organs, oncological and oncohematological directions are developing, a women’s health clinic, a number of departments of internal diseases such as endocrinology, rheumatology, pulmonology, cardiology. Take a referral from a therapist at the clinic and come for an examination. You need to have a federal compulsory health insurance policy and a passport of a citizen of the Russian Federation. On our website you can see detailed information. We accept patients from all over Russia.

– Conservative treatment with ursodeoxycholic acid preparations, which can dissolve stones, possibly if they are cholesterol and do not reach 10 millimeters. If they are larger than 10 millimeters, occupy more than a third of the volume of the gallbladder, there are signs of the presence of calcium in the stone (this can be seen on ultrasound), the contractility of the organ is impaired, then you cannot do without removing the gallbladder. Now this is a simple operation, which is performed using laparoscopic technique through tiny incisions, after which there are practically no traces, and rehabilitation is quick. If there is an indication for an operation, then it must be done. Gallstones can cause acute inflammation of the pancreas (acute pancreatitis), which can even lead to death. And without a gallbladder, you can live happily ever after. There are often no problems. Sometimes pains appear in the right hypochondrium, loosening of the stool, but doctors know how to fix this with the help of diet and drugs. Most importantly, stick to frequent split meals.

– To put “chronic pancreatitis”, you need a clear set of diagnostic criteria. Unfortunately, they are not always taken into account, and it happens that the diagnosis is made unreasonably. Chronic pancreatitis is a progressive disease, so the doctor prescribes treatment and diet that slow down this process. Alcohol and smoking should be strictly excluded, because they themselves are the cause of pancreatitis, cause inflammation of the pancreas, and if it is already there, then intensify it. If you are lucky and chronic pancreatitis has not yet manifested itself, you should not exchange the lucky ticket. The pancreas is a very important organ. If most of it is damaged, the production of enzymes for digesting food is disrupted, which creates serious problems. Another consequence of pancreatitis is the loss of insulin-producing cells, which leads to diabetes mellitus.

– By themselves, polyps do not hurt. The doctor must conduct a morphological assessment of the polyp, which determines further tactics. With such small hyperplastic polyps, they really do nothing, only observe once or twice a year. The pain may be associated with inflammation, which is most often caused by the bacteria Helicobacter pylori. It also promotes the growth of polyps. It is imperative to get rid of Helicobacter. In adults, there is practically no re-infection, therefore, most likely, it is not the bacteria that comes back, and the previous therapy did not help. Modern treatment regimens consist of 3-4 drugs – two antibiotics, a bismuth drug and an agent that blocks acid production. Duration of admission is 14 days. Shorter courses of treatment have lost their effectiveness. 30 days after the end of the drug intake, it is imperative to check whether you have been cured. The best way to evaluate the effectiveness of treatment is the 13C-urease breath test. There are wonderful doctors in Novosibirsk and this test.

– If one of the family members is found to have Helicobacter pylori, then we suggest the rest to be tested. The best method, the 13C-urease breath test, is available in Kazan. The infection is spread from person to person and is one of the most common. In Moscow, about 60% of the population is infected, and in some regions of Siberia – up to 90%. It is now recognized that everyone who has H. pylori has gastritis. In some, it may not manifest itself for a long time, but in others it contributes to the development of peptic ulcer and even stomach cancer. Infection usually occurs during childhood, and diseases caused by infection begin to manifest in adulthood. However, it is not at all necessary that you also find the bacterium. At a recent symposium, it was discussed whether it is possible to get infected by kissing, and it was noted that it is unlikely. The main route of transmission is through dirty hands. The bacteria is present in feces. If hygiene is observed in the family, everyone wash their hands after using the toilet, use cleanly washed dishes, thermally process food, then the possibilities of infection are limited.