A First-Of-Its-Kind Magazine On Environment Which Is For Nature, Of Nature, By Us (RNI No.: UPBIL/2016/66220)

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Dr Deepak K Agarwal

TreeTake is a monthly bilingual colour magazine on environment that is fully committed to serving Mother Nature with well researched, interactive and engaging articles and lots of interesting info.

Dr Deepak K Agarwal

Dr Deepak K Agarwal

Dr Deepak K Agarwal

Specialist Corner

Corona blues may lead to upset tummy

Abdominal pain has always been a tricky symptom to assess. And now, during the Covid phase, we are getting a lot more calls from our patients complaining of abdominal symptoms. These may vary from simple gastritis-like pain to acute/severe abdominal pain. These symptoms need to be evaluated and their medical history studied before the diagnosis and appropriate treatment.

            However, we must point out that stress-related digestive troubles are also on the rise as people around the globe worry in the midst of pandemic, experts warn. Stress and anxiety can trigger more frequent or stronger contractions in the GI tract which some may perceive as uncomfortable or even painful. In addition to belly pain, stress can trigger a wide range of other gut symptoms including heartburn, nausea, bloating, a change in bowel pattern, or in rare cases, even rectal pain. Patients who already have irritable bowel syndrome, a chronic condition marked by stomach pain, cramping and a change in bowel habits, may see an uptick in their symptoms.

Stress impacts the gut because each person has a “hard wired connection” between the brain in the head and the nervous system housed within the GI tract called the enteric nervous system. The enteric nervous system lives within the wall of the GI tract and communicates through the spinal cord with the brain. While the enteric nervous system typically runs the GI tract independently, the brain can influence how it behaves. In times of stress, it may send a distress signal that makes the GI system run differently. In addition, stress makes the nerves in the gut overly sensitive so things that normally aren’t even perceived at a conscious level are perceived as unpleasant gut symptoms. It’s normal to get mild, intermittent symptoms with stress or anxiety, and despite their reputation, ulcers aren’t the result of too much stress. Typically, they emerge because of two causes. The first is an infection in the stomach from a bacterium known as H. pylori. The second cause is from medications, with aspirin, ibuprofen and naproxen being the biggest culprits.

However, abdominal discomfort has been identified as one of the less common symptoms of the Covid-19 infection. Recent literature has revealed that about 20% of patients report to the hospital with a digestive symptom, such as diarrhoea, vomiting and/or pain, accompanying their respiratory symptoms. And roughly 5% show up with abdominal complaints alone. A study in China found that a third of the people with mild symptoms experienced diarrhoea that lasted, on an average, five days. It took them longer to clear the virus from their bodies, compared to those without gastrointestinal symptoms.

Any acute abdominal pain could mean that the patient may have an intestinal obstruction, infection or inflammation of the appendix, gallbladder stones causing infection and pus within the biliary tract, intestinal perforations and more. These signs would be intolerable and will limit regular activity or movement. So, when should a patient with abdominal symptoms visit a hospital? If the pain or associated symptoms like vomiting, diarrhoea, bloating or fever show an increasing trend over a few hours since the onset, it is better to consult a specialist.  Diagnosis is a combination of complete history taking and clinical examination with blood tests and radiological tests like USG abdomen or CT abdomen. Once diagnosed, treatment choices are offered which may be medical or surgical in nature.

But during this current situation, I am sure you are probably wondering how safe it is for people to visit the hospital. All hospitals are taking utmost precautions to safeguard the health and safety of their patients and, of course, the healthcare workers. But in the case of an abdominal or a gastrointestinal (GI) emergency, healthcare distancing need not be practised. The best outcomes in all these GI emergencies can be fully achieved if the patient reports early to the hospital. Corona virus transmission from person to person occurs mainly through direct contact or through droplets from an infected person coughing and/or sneezing. However, SARS-CoV-2 nucleic acid has been detected in the stool of Covid-19 patients in multiple studies. Further research also found that some patients remain positive for fecal virus nucleic acids for a long time after viral nucleic acid testing using throat swabs becomes negative. Moreover, some patients will only be positive for SARS-CoV-2 virus nucleic acid in stool. SARS-CoV-2 in feces may be spread mainly through contact with hands or other parts after excretion. In addition, feces may dry to form small particles suspended in the air, which may be inhaled by susceptible persons. Thus, attention should be paid to preventing contact or airborne transmission of the digestive tract secretions of Covid patients. When handling the feces of such patients, strict precautions must be followed, emphasizing the importance of hand hygiene, and hospital sewage should also be properly disinfected.

Digestive tract secretion contact is one of the main transmission routes. Digestive endoscopy can easily stimulate a patient's mouth and pharynx, with secretion and discharge mucus, causing choking, vomiting, or diarrhoea. Therefore, there is a great risk of infection during digestive endoscopy, biopsy, and treatment. When performing necessary digestive endoscopy, medical staff should conduct diagnosis and treatment in a special endoscopic operation room or negative pressure operating room and in accordance with the three-level protection standard. After diagnosis and treatment, the inspection equipment and operation room should be disinfected according to the standard.

In daily life, the toilet lid should be covered and flushed after use, and the toilet paper should not be placed in the trash. The toilet should be kept clean, paying attention to sewers to check for leakage. Overall, people should reduce contact with others, ventilation in living and working places should be strengthened, and daily items should be sterilized regularly.

Digestive problems to watch out for:

Even after recovering from Covid, many patients are experiencing loss of appetite or increased appetite, upper abdominal pain, acidity, diarrhea and vomiting, and these issues can become more serious if not treated at the right time. Complete evaluation, monitoring and healing are required for recovery.

The digestive system involves the gastrointestinal tract (GI) along with the liver, pancreas, and gall bladder which should be taken care of as Covid, apart from interrupting other body parts, affects the GI tract too. It disrupts its functioning and renders it unable to perform its duties of absorbing electrolytes and fluids from the body. Patients can even end up with bleeding in the gastrointestinal tract.

Precautions one should take

Eat immunity-boosting foods. Stick to a well-balanced diet loaded with fresh fruits, vegetables, legumes, and whole grains. Eating junk, spicy, processed, salty and sugary food is not recommended. Avoid eating foods that invite acidity and abdominal bloating like carbonated beverages and cruciferous vegetables. Opt for foods rich in fibre and healthy fats. Eat probiotics for maintaining good gut health. Do not forget to drink water and stay hydrated. Say no to alcohol and smoking. Also, avoid over-consuming herbal drinks.

Chew your food properly. Not chewing the food properly can lead to acidity. So, eat slowly and focus on what goes inside your mouth. Chewing the food slowly also aids proper production of saliva that kickstarts the digestive process in your mouth.

Exercise and stay stress-free. Staying physically active by jogging, running and walking can reduce heartburn, acidity and constipation symptoms. Further, relaxation techniques such as yoga and meditation can elevate the stress on the digestive system.

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