Wednesday 17 January 2018

Upset tummies in adults and a frequently sick toddler

Ask the GP

If heartburn or stomach pain persists it is likely your doctor will refer you for further tests
If heartburn or stomach pain persists it is likely your doctor will refer you for further tests

Nina Byrnes

Advice from our GP on the treatment of stomach pain and on how you can expect your toddler to pick up ilnesses at crèche as it takes until the start of school years for a rock-solid immune system to develop.

Question: I have had pain in my stomach everyday for nearly a month now. It seems to be worse at night or after food. Antacid helps but it comes back. Should I be worried?

Dr Nina replies: Stomach pain is a very common complaint. In most cases it comes and goes for hours or days and then settles. Any pain that reoccurs over a number of weeks is worth taking note of.

It sounds like you may have gastritis or oesophageal reflux. The pain is due to acid irritating either an inflamed stomach lining or the lining of the oesophagus. Under normal circumstances the stomach is filled with acid, which aids the digestive process. The lining of a normal stomach can tolerate the acid and protect the surfaces below. The end of the oesophagus closes tights preventing acid from flowing upwards towards the throat and mouth.

If the opening of the lower oesophagus doesn't close tight, acid can reflux back up causing discomfort and irritation. This is classically worse when lying down or stooping due to the anti-gravity effect.

If there is inflammation or erosion of the lining of stomach, acid irritates the layers below causing discomfort and pain. This pain may be made worse by spicy foods and alcohol and sometimes relieved by milky products.

If symptoms are occasional and related to a specific event it is worth trying over-the-counter antacids. If they solve the problem quickly then it is reasonable to just keep an eye on things.

If you are over 55 and symptoms occur for the first time or if you are below 55 and symptoms reoccur or last longer than a month it is worth seeking medical advice. If you have difficulty swallowing food or if you experience weight loss or other symptoms you should seek early medical advice whatever your age.

Medicines, such as aspirin or anti-inflammatories, blood thinners or some antidepressants can also increase the risk of stomach inflammation and these may need to be changed or stopped.

There are a number of over-the-counter medicines that may help. Simple antacids will provide short-term relief of symptoms. These act to neutralise stomach acid. Medicines that block acid production are more effective. These should be taken once daily.

Stronger versions are available from your doctor on prescription. Simple gastritis will often heal by taking one daily for a month.

If heartburn or stomach pain persists it is likely your doctor will refer you for further tests. This may involve a simple breath test to check for infection with Helicobacter pylori. This common bacterium can cause inflammation and ulcers. It is treated with a one or two-week course of two antibiotics and antacid medicine.

If Helicobacter isn't the cause, or if more serious inflammation is suspected, you will require a gastroscopy. This test is often performed under sedation and allows a specialist to view the oesophagus and stomach lining directly to identify and ulcers or inflammation.

Most gastritis or reflux responds to medicines that block acid. You may need to take these regularly for a period of time or take them as required on an ongoing basis.This should always be under medical advice.

Question: My one-year-old started crèche a few months ago and seems to be picking up all kinds of illnesses. I’m at the doctor’s every month. Should I be concerned? Is there something wrong with his immune system?

Dr Nina replies: Many parents worry that there is something wrong with their child in the toddler years but thankfully this is rarely the case.

Antibodies and immunity are passed from the mother to the baby during pregnancy and at birth. Around the age of six months to a year this passively acquired immunity starts to wane. This leaves the baby’s immune system bare with little memory for the over 200 bugs and viruses that it may be exposed to in the early years. This also often coincides with the start of crèche attendance, providing the perfect storm for challenges to a toddler’s immune system.

Toddlers are unable to blow their nose, wash their hands or be aware of how germs are transferred. Enter any wobbler or toddler room and you will find them climbing over each other, sharing toys, food and drool and generally interacting in close proximity on a prolonged basis. Any virus or infection will pass easily from child to child in this environment. Those at home often become exposed to bugs brought home by older siblings and visitors.

It has been shown that preschool children can expect to suffer from six to 12 infections a year. If your child seems to be getting bugs but continues to eat well, grows and gains weight then it is unlikely there is any serious underlying illness. It is certainly worth checking out the hygiene and illness policy of your crèche. Are surfaces regularly cleaned and sanitised? Are children with contagious illness excluded from crèche until 24 hours after they have improved?

There is a light at the end of the tunnel. Toddlers exposed to bugs develop a rock-solid immune system by the time they start school.

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