Soon after Dashain, Hari Bhusal, a resident of Kathmandu who is in his late 20s, started to feel uncomfortable in his stomach. After suffering from unbearable discomfort, inflammation and nausea, he reached out to doctors at Nepal Mediciti Hospital. At the hospital, a team of doctors led by Dr Umid Kumar Shrestha carried out various tests and after a quick video scan followed by a stool test, it was found out that Bhusal had Dyspepsia, a common gastro disease in Nepal.
Dr Shrestha, principal consultant and head of Department of Gastroenterology, Hepatology and Endoscopy at Nepal Mediciti Hospital shares that Dyspepsia is a general upper gastrointestinal (GI) symptom that many Nepalis face. It is a symptom characterised by persistent or recurrent upper abdominal pain or discomfort, accompanied by postprandial fullness, early satiety, nausea, and bloating. According to him, Gastroesophageal Reflux Disease (GERD) is another common upper GI condition presenting itself as heartburn and regurgitation that Nepalis generally face.
According to doctors, Functional or Chronic Dyspepsia has been subclassified into ulcer-like, dysmotility-like, and unspecified dyspepsia, based on dominant symptoms.
"Ulcer-like Functional Dyspepsia is characterised by episodes of epigastric pain that are relieved by antacids or food, whereas dysmotility-like functional dyspepsia is a discomfort that is aggravated by food or associated with early satiety, fullness, nausea, retching, vomiting, or bloating. Patients with unspecified dyspepsia report symptoms that do not fulfill the above criteria," said Dr Shrestha. According to him, Functional Dyspepsia has been reported as one of the most important factors to impact on quality of life for most Nepalis. "However, one has to be careful about the fact that among the patients who have not been worked up, 40 percent may have an organic cause for their dyspepsia," he added.
Dr Anuj Acharya, who is currently pursuing his Doctor of Medicine (MD) in the United Kingdom, said that dietary factors are the potential causes of symptoms in Functional Dyspepsia. "Individuals suffering from Functional Dyspepsia appear to have altered eating patterns as well as food intolerance, which may be associated with fatty food, spicy foods, peppers, chocolate, alcohol, citrus fruits, etc" he mentioned.
Doctors say that psychological factors like a rise in stress levels can be a contributing factor for Chronic Dyspepsia. Also, factors like the intake of medicines for other purposes increase the chances of suffering from dyspepsia in the general public. Regular use of medicines such as pain killers, aspirin, Metformin, iron supplements and steroids for rheumatological diseases can also lead to Dyspepsia.
Similarly, medical research has shown that Helicobacter Pylori, a type of bacteria is the main cause of Organic Dyspepsia. Other organic causes for Dyspepsia include peptic ulcer disease, upper GI cancer, pancreaticobiliary disease, and other co-existing systemic diseases (such as diabetes, coronary artery disease and chronic obstructive lung disease).
Dr Acharya shares that factors, such as medication, foods (caffeine, chocolate, peppermint, alcohol, carbonated beverages, citrus fruits, etc), and lifestyle factors (weight gain, smoking, and eating before recumbency) often lead to Gastroesophageal reflux disease (GERD) like Dyspepsia.
According to doctors, many Nepalis tend to suffer from gastro issues due to an unhealthy diet during festival seasons and people of all age groups can develop GERD and dyspeptic symptoms including children. However, individuals of more than 55 years of age having dyspeptic symptoms are more vulnerable to serious gastrointestinal (GI) issues. "Such people need to undergo a thorough diagnosis including upper GI endoscopy. Moreover, individuals with chronic liver diseases are more vulnerable to complications and need regular check-ups with upper GI endoscopy," said Dr Shrestha.
Many people also experience work stress and become sedentary due to an overindulgence in smartphones and social media which also causes GI issues. If mild ailments occur, they tend to take pain-relievers on their own. "Even after getting some of the alarming symptoms of Dyspepsia including unintentional weight loss, anorexia, early satiety, vomiting, history of GI bleeding such as vomiting blood or black stool, anemia, difficulty and or pain during swallowing, abdominal mass, etc, they often delay seeking medical care," said Dr Shrestha.
Doctors say that having a healthy diet (avoiding fatty, spicy and sugary foods), doing regular physical exercises, release from stress factors, avoiding pain relievers, alcohol and tobacco are important for controlling Dyspepsia.
"Less consumption of caffeine, chocolates, peppermint, alcohol, carbonated beverages and citrus fruits are also necessary in this respect. Similarly, controlling weight gain and eating less before recumbency will also help to get rid of GERD issues," mentioned Dr Acharya.
Treatment of GI ailments is available at most big hospitals in Nepal at present. For instance, Nepal Mediciti Hospital in Bhaisepati, Lalitpur offers almost all sorts of diagnostic and therapeutic endoscopic procedures at the Department of Endoscopy.
The hospital's diagnostic and therapeutic procedures include Endoscopic Retrograde Cholangiopancreatography (ERCP), Endoscopic Ultrasound (EUS) with Fine Needle Aspiration (FNA), and ERCP with sphincterotomy/ sphincteroplasty/ plastic stent/ metallic stent/ common bile duct stone removal and pancreatic stone removal.
Dr Shrestha says GERD treatment and care in Nepal is lagging in terms of infrastructure and human resources. "First of all, the government should prioritise GI-related diseases. The interventional endoscopic procedures are not conveniently available in healthcare institutions in Nepal. Thus, the services should be made accessible to patients of both government and private hospitals and in central, provincial and district levels," he said.
