Gastrointestinal diseases in Pakistan

Dr Muhammad Naseer, a gastroenterologist at Shifa International Hospital Islamabad, talks about common gastrointestinal diseases in Pakistan

SN: When we talk about gastroenterological problems; do we just refer to stomach diseases?sni

Gastroenterology is a vast field. It includes management of diseases of the oesophagus, stomach, small and large intestine and liver. It also includes treatment of pancreas and gallbladder diseases and nutrition related issues.sni

SN: Which are the most common gastrointestinal diseases in Pakistan?sni

Liver disease due to hepatitis C is the most common gastrointestinal disease in our country. It is dangerous because it has no symptoms at the initial stage. Despite being a silent disease initially, it continues to damage liver slowly. When symptoms start to appear, the disease has already reached an advanced stage. By this time the liver becomes weak and treatment becomes difficult. Therefore, for timely diagnosis, people need to get tested for the disease.sni

Previously treatment of hepatitis C was with injections. They had lots of side effects and were not very effective. But now treatment in the form of tablets is available. This is very effective with minimum side effects. The treatment is also affordable and readily available. So hepatitis C treatment has improved significantly.sni

Other than this, hepatitis B is also common. It is another form of chronic viral infection of liver. Patients with chronic hepatitis B need to be under care of a specialist. It is usually a lifelong disease and not everyone needs medicines for it. Stomach and intestinal diseases are also prevalent here, which include ulcers, inflammation of stomach and H. pylori infection. Gastrointestinal infections are very common in our country. People often experience upset stomach and vomiting usually due to contaminated water.sni

Liver disease due to hepatitis C is the most common problem in our country. It  has no symptoms at the initial stage

SN: Is boiling the water a solution to preventing disease?sni

Drinking boiled water can prevent many stomach and intestine infections.The source of water should also be clean. Boiling would kill most germs but will not get rid of toxic chemicals present in water. Therefore, the source should be tested initially to make sure the water is free of any potential toxic chemicals as well. Keep water boiling for one to two minutes after it comes to a boiling point.sni

People commonly believe that contaminated water is the cause of hepatitis B and C. But this is not true. These infections are not transmitted this way. These are blood-borne diseases and have nothing to do with contaminated water or food. Hepatitis A & E are however water borne diseases and transmitted through drinking water or raw food contaminated with these viruses.sni

SN: What should be the immediate steps in case of diarrhea?sni

Ensure that the patient does not get dehydrated. So, water or fluid intake should be increased. Drinking however, becomes difficult in case diarrhea is accompanied by vomiting. Medical help may need to be sought in such condition as IV fluids (drips) may be required. Usually diarrhea occurs without vomiting. So water intake is not much of a problem. Prefer ORS especially for kids and elderly. Healthy and young people can drink water by adding salt and or sugar in it.sni

Diarrhea which lasts for a day or two does not need to be treated with antibiotics. The patient usually feels alright in a day or two. But if stool frequency is more and consistency is watery along with fever, weakness and bloody stool then medical help should definitely be sought. And in such cases patients may require antibiotic treatment.sni

SN: What causes belching (khattay dikaar), heartburn and acidity?sni

All these come under the same category and are known as dyspepsia and reflux. It causes a group of symptoms that occur in the upper part of the tummy which include pain, burning, gas, acidity, belching, muh karwa hona, nausea, heart burn and sometimes vomiting. Acidity, a common complaint, is usually caused due to spicy and fatty foods. These foods lead to increase acid in the stomach causing such problems. Some patients also develop a chronic infection called H. pylori. It also causes increased production of acid stomach.sni

Diet modification is the solution to most of these stomach related problems. Also, follow proper meal timings and do not over eat. Consult a doctor if the issue persists for more than few weeks as very occasionally these symptoms may be due to serious disease especially if they start after the age of 50.sni

Diarrhea which lasts for a day or two does not need to be treated with antibiotics. The patient usually feels alright in a day or two

SN: What is the healthy gap between meals?sni

We eat when we are hungry! So eat when you are hungry. Two meals a day with a snack in between is a healthy habit. Eating three big meals a day is overeating and not good for stomach and health in general. Important thing is to follow regular timings and eating healthy food.  Eating a lot at one time makes it difficult for the stomach to handle and hence produces acidity, heartburn, gas and other stomach related issues.sni

Moreover, eating healthy means including variety of foods and not just eating one kind of food daily. Reduce the quantity of oil/fat and spices as well. Another common habit in our society is people tend to eat late at night and then go to sleep. This is not good for the stomach. Dinner should be light and eaten two to three hours before going to bed. A 15-20 minute walk after evening meal is also good for digestion and stomach.sni

SN: Why causes bloating?sni

This is also a common problem. When unabsorbed food residue reaches the large intestine it starts to breakdown further resulting in gas production. It is normal to have gas in belly. However, some people tend to produce more of it due to various reasons mostly diet related. Sugary foods or drinks, some lentils and vegetables also cause this problem. Irritable bowel syndrome is a problem which causes people to have frequent trips to the toilet or some even experience constipation. It is manageable with the help of medicines and dietary modifications.sni

SN: Is green tea intake good for the stomach?sni

It is a healthy drink and is free from unnecessary ingredients, especially if taken with small amount of sugar. Though I do not have scientific evidences but traditionally it has been thought to be good for stomach. Coffee is scientifically proven to be good for the liver. However, patients with dyspepsia should avoid drinking excessive amounts of strong tea especially on empty stomach. It promotes acidity.sni

It is normal to have gas in belly. However, some people tend to produce more of it due to various reasons mostly diet related

SN: Does stress or anxiety affect the stomach?sni

Yes, anxiety indirectly affects the stomach. It can aggravate symptoms in people with stomach problems particularly those with gaseous problems, dyspepsia or irritable bowl.sni

SN: Any tips for keeping the stomach healthy?sni

Eat healthy and have a healthy lifestyle that involves exercise. Exercising makes you hungry and prevents problems like constipation. Drink plenty of clean water. Avoid fizzy drinks and spicy and oily foods. Eat variety of foods. Vegetables and fruits provide a mix of vitamins and minerals required by the body. Prefer white meat as it is a healthier option. If you do not have any major health issue then eating small portions of red meat two to three times a week is alright.sni

SN: Well, anything left that you would like to add at the end?sni

People need to know more about hepatitis C. It is very common in Pakistan and is a silent killer. Everyone should be tested for it. The test is simple and cheap. In case of a positive result, consult a gastroenterologist. Treatment for the disease has revolutionized and is economical, easy and effective.sni

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