Gastroenterologist Alexey Paramonov: Most modern people have stomach pains not because of malnutrition, but because of anxiety and multitasking

Gastroenterologist Alexey Paramonov: Most modern people have stomach pains not because of malnutrition, but because of anxiety and multitasking

Gastroenterologist Alexey Paramonov: Most modern people have stomach pains not because of malnutrition, but because of anxiety and multitasking

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“If the stomach hurts, then it’s definitely gastritis” – who can argue? We get used to this idea from childhood. They also learned by heart that all problems with the gastrointestinal tract are due to malnutrition (for example, dry food) and harmful foods. Well, if you already grabbed it, then you definitely need to sit on cereals and lean-boiled-paren.

“For the most part, all these ideas … are not true. Serious scientific studies, the data of which have accumulated to date, show a completely different picture, ”surprises the gastroenterologist, therapist, candidate of medical sciences, expert TV channel “Doctor” Head of the Center for Evidence-Based Medicine “Rassvet” Alexey Paramonov. Why do we really suffer and how to improve the work of the digestive tract? We talked with a specialist about modern approaches, the effectiveness of which is confirmed by science.


– Alexey Dmitrievich, what diseases of the gastrointestinal tract are now the most common?

– In the first place by a huge margin – functional diseases of the gastrointestinal tract. This is a violation of the work of certain organs of the gastrointestinal tract, not directly related to their damage, inflammation, etc. Most often, we are faced with functional dyspepsia syndrome (it is often mistaken for gastritis. – Ed.), irritable bowel syndrome, functional heartburn, and belching. In general, there are about 30 such diseases. But the ones I listed make up about 70% of all gastrointestinal diseases combined.

Among the remaining third – gastritis, fatty liver disease (details about it – in the “Health” section on – Ed.), chronic inflammatory bowel disease, IBD (ulcerative colitis, Crohn’s disease). IBD are not so common, but many have heard about them and are very afraid, often unreasonably. By the way, the number of cases of gastritis, that is, chronic inflammation of the gastric mucosa, is significantly decreasing every year. Because doctors are actively fighting the bacterium Helicobacter, the main provocateur of gastritis.


Contrary to the slogan “all diseases of the gastrointestinal tract are due to malnutrition,” most digestive problems occur for a different reason, explains Doctor Paramonov.

– Functional disorders are very closely related to anxiety. At least 80% of patients with irritable bowel syndrome and functional dyspepsia syndrome show signs of anxiety, says the doctor. – Often this condition gives rise to the urban pace of life. Here is this everyday fuss: you need to do everything, run, keep everything in your head, not forget anything and go everywhere. For our brain, such multitasking is a serious stress.

It is multitasking, which introduces the brain into a state of stress, leads to malfunctions of the nervous system, experts explain. And since the brain and the peripheral nervous system control all our organs, a disorder occurs, including in the work of the gastrointestinal tract. At the same time, the principle “where it is thin, there it breaks” applies. In some, the stomach begins to “jump” faster, in others the intestines, and in others there are problems with the gallbladder. At the same time, a violation of the work of one of the organs of the gastrointestinal tract affects the rest. Therefore, in especially severe cases, problems may appear with the stomach, intestines, and other parts of the digestive system.


How the intestines fell victim to the despot boss

– I had a patient with irritable bowel syndrome, a middle manager in a large company, – Alexey Paramonov gives an example from practice. – Due to problems with the gastrointestinal tract, he could not fully work, hold meetings, go to meetings. Because during one meeting I had to “absent as needed” several times. He had to equip a personal toilet in his office.

The treatment was carried out according to all protocols, but did not improve the patient’s quality of life. Everything changed only when he quit his job and moved to another company. Moreover, the height of the position held and the level of responsibility have not changed. But! There was a radically different atmosphere in the new place. Very friendly. And, very importantly, there was no top leadership with despotic inclinations. In a short time, the work of the gastrointestinal tract was completely adjusted in the patient and there was no need to take drugs at all.


– Usually, if you come to the district clinic and complain of stomach pains, they send you for a gastroscopy. Is it always required? Can’t you replace it with anything?

– Gastroscopy is the gold standard. In some cases, there is no equivalent alternative for the diagnosis of stomach diseases. At the same time, today gastroscopy can be done in a dream (a certain drug is administered to the patient) – in 15 minutes and without experiencing discomfort. There is a myth that endoscopic examinations (gastro- and colonoscopy) performed in a dream can be unsafe. It is not true. On the contrary, the risks are reduced: the person is asleep, does not twitch, there is no threat of perforating the esophagus or intestine. And you can consider everything in much more detail.

But there is another problem. Due to the excessive attention to gastritis in our country, gastroscopy is often prescribed when it is not needed at all.

– For example?

– In most cases, gastroscopy is needed for people after 45 years. The exception is when there are “red flags”, that is, alarming symptoms. If present, gastroscopy may be required at any age. These are the symptoms:

* the treatment prescribed by the doctor does not help, there is no relief;

* a person is not on a diet, but is losing weight;

* the patient has a constantly elevated temperature;

* Decreased hemoglobin.


– If the patient is under 45, there are no “red flags” and there are complaints of pain in the upper abdomen, then the doctor may prescribe a study for Helicobacter (the pathogen that provokes gastritis. – Ed.), – Dr. Paramonov continues. – Gastroscopy is not required here. A procedure called “13C-urea breath test” is enough.

He is somewhat unusual for a patient. You need to blow into the bag on an empty stomach. It is hermetically sealed. Then they give you a drink of a reagent, which is usually disguised as orange juice. Half an hour later, they ask you to blow into another bag. Then both packages are sent to the study apparatus of the mass spectrometer. What is the trick? The reagent contains urea labeled with a 13C carbon atom. While in most of the compounds around us – the carbon atom is 12C. And you can determine: did the reagent appear in the exhaled air? Humans do not have an enzyme to break down urea. And Helicobacter has it. If he destroyed this urea labeled with the 13C carbon isotope, then we will know for sure that there is Helicobacter pylori in the patient’s body. Then, if symptoms are present, treatment against gastritis is prescribed.


How to determine the most common cause of problems with the gastrointestinal tract

– In the vast majority of cases, the cause of trouble in the upper abdomen is different types of functional dyspepsia. It can cause pain, swelling, nausea, – says Alexey Paramonov. – Once upon a time, functional dyspepsia was a “diagnosis of exclusion.” That is, the person was first examined for other known diseases that matched the set of symptoms, and made sure that they were not.

Now it’s not like that. There are Rome criteria (guidelines for the diagnosis and treatment of functional disorders of the gastrointestinal tract. – Ed.). Based on them, we look for certain symptoms, check for red flags. And without unnecessary examinations, we diagnose functional dyspepsia. Additional examinations are prescribed in cases where something contradicts the concept of a functional disorder. For example, the temperature rises or hemoglobin is lowered.

To be continued. In the second part of the interview, the expert will tell you whether diets are so important for the treatment of the gastrointestinal tract, whether the stomach will go bad without soup, and whether it is useful to drink mineral water with a slice of lemon in the morning.

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