Ask the doctor: I don’t think I have IBS, but my stomach is often sick and bloated. What could this be?

Dr Grant replies: It sounds like you may be suffering from gastritis or inflammation in the lining of the stomach, as this tends to present with unexplained discomfort/pain in the upper abdomen, nausea and/or vomiting. You mentioned some of the typical triggers such as caffeine, chocolate (also contains caffeine), nicotine from smoking and rich food. If your symptoms started suddenly and have been going on for only for a short time, this is called “acute” gastritis. Chronic gastritis is described when the symptoms persist for months to years. One of the most common causes of gastritis is due to a bacterial infection known as Helicobacter pylori (H. pylori). Other causes can be related to the immune system and in many cases the exact cause of the gastritis is unknown. Of course, some medications, especially nonsteroidal anti-inflammatory drugs (NSAIDs) are known for causing gastritis as a side effect.

H. pylori gastritis has been associated with iron deficiency anaemia and can lead to symptoms of fatigue, due to low iron, and vitamin B12 deficiency, due to chronic atrophic gastritis resulting in hypochlorhydria and vitamin B12 malabsorption. Routine blood tests along with thyroid function test can help rule out these common conditions. The best way to diagnose H. pylori infection is during a camera test into the stomach (known as a gastroscopy or OGD) when biopsy specimens are taken from up to five different sites for optimal assessment of both gastritis and H. pylori status. During a gastroscopy, the whole upper digestive tract is assessed including the oesophagus (the tube that connects the mouth to the stomach), the stomach, and the duodenum (the first part of the small intestine). There are two other ways to test for H. pylori — by stool antigen assay (providing a stool sample) and after ingesting a special liquid to measure for a substance called urease in your breath. These two tests are often used as proof of eradication of H. pylori following appropriate antibiotic treatment.

It is important to ask if your weight has been stable and your appetite remains good. If you have experienced a reduction in one or both of these (weight/appetite), and stomach pain or bloating, or feeling full after eating a small amount of food (known as early satiety), then an urgent gastroscopy would be advised. Other symptoms of gastric ulcer include vomiting blood, vomiting a coffee-ground appearing substance or having black-coloured/tar-like stool during a bowel movement. Gastric or duodenal ulcers, and possibly gastric cancer, need to be ruled out as soon as possible.

A condition called ‘functional dyspepsia’ that is very like IBS, but it affects the upper GI tract only (namely, the stomach and oesophagus/food pipe). It causes symptoms like indigestion, nausea and abdominal bloating and can have many triggers such as caffeine or ice-cold drinks. Much like IBS, it is a diagnosis of exclusion, as other, more serious things like Helicobacter pylori stomach infection, gastric ulcer, infection of the colon, coeliac or thyroid disease should be ruled out first. Regular exercise, good quality sleep, caffeine and alcohol cessation, stress management and minding your mental health is also very important.

Given your symptoms, you should attend your GP with a one- or two-week diary of your food intake (documenting everything you eat and drink), alongside a symptom severity diary, to ascertain what may be triggering your GI symptoms. Your doctor can give you guidance on what dietary changes to make and arrange some investigations. If you fail to improve, then your doctor will most likely refer you to a consultant gastroenterologist for further assessment.

Dr Jennifer Grant is a GP with Beacon HealthCheck