Is It an Ulcer…or Worse?
Use this cheat sheet to help differentiate between garden-variety
abdominal pain and something more serious
Like many successful guys in their forties, Jeff Ingalls, a
Houston-based commercial real-estate broker, knew how
to celebrate a deal (a rib-eye and a bottle of Bordeaux) and
how to treat heartburn (Tums and a glass of water). So when
he felt a dull ache in his belly at a recent party, he didn’t think
much of it—he just eased up on the wine. But at 3 A.M., the pain became
searing and a fever kicked in. He assumed he had food poisoning and
wanted to soldier on through the night, but his wife persuaded him to go
to the emergency room.
Abdominal pain is the number one reason for all visits to the E.R.,
according to the National Center for Health Statistics, but the actual
cause of the pain is tough to pin down. “The E.R. can be a fast,
practical option for rapid evaluation,” says Mark Moyad, MD, director
of preventative and alternative medicine at the University of Michigan
Medical Center. “Abdominal pain should be taken seriously, because
it can be fatal.” An ultrasound determined that Ingalls had diverticulitis,
an infection of the large intestine that required immediate surgery.
Here’s how to determine the severity of abdominal pain and how to
prevent it. CURTIS PESMEN
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1 I SYMPTOMS: Searing pain at the base of the
esophagus and pressure in the upper abdomen
What it is: HEARTBURN
What to do: Take an OTC antacid (Zantac or
Pepcid) or a proton-pump inhibitor (Prilosec). But
these should be taken only occasionally, says
the Cleveland Clinic’s Raul Seballos, MD. If pain
persists, see a doctor.
Prevent it: Losing t wo pounds or an inch off
your waist can really help, says Dr. Moyad. He
also advises taking a 500-milligram calcium
carbonate supplement daily, such as Os-Cal.
Another strategy is to eat six small meals a day,
says Nancy Rao, ND, a naturopathic physician in
2 I SYMPTOMS: Burning pain in the central
abdominal area. May flare up when you lie down or
when your stomach is empty.
What it is: PEPTIC ULCER
What to do: See your doctor, who will likely
prescribe antibiotics, antacids, or proton-pump
inhibitors. The majority of ulcers are linked to
the bacterium Heliobacter pylori and are not
caused by diet or stress. However, spicy foods,
stress, alcohol, and smoking can exacerbate
ulcers, as can nonsteroidal anti-inflammatory
drugs (NSAIDS) such as aspirin, ibuprofen, and
Prevent it: Limit alcohol, don’t smoke, and
take NSAIDs with food or replace them with
3 I SYMPTOMS: A sharp, sudden pain that
grabs you just below the ribs, in the upper-right
What it is: GALLSTONE
What to do: See your doctor. Though painful,
gallstone attacks are usually caused by normal
digestive processes run amok due to dehydration
and the overeating of fatty foods, eggs, onions, and
garlic. In severe cases, physicians may prescribe
drugs to dissolve the gallstone.
Prevent it: Lose weight and avoid all fried and
fatty foods, while increasing your consumption
of fruits, vegetables, unprocessed grains,
monounsaturated oils, and water, says Rao.
4 I SYMPTOMS: A dull ache in the lower-left
quadrant that becomes increasingly sharper
What it is: DIVERTICULITIS
What to do: Go to the emergency room.
Diverticulitis requires immediate treatment with
antibiotics. It occurs when marble-size pouches
form along the walls of the large intestine and
fill with waste, leading to infection. Surgery is
required in acute cases.
Prevent it: “Eat a high-fiber diet: vegetables,
nuts, fruits, beans, bran cereals, and whole
grains,” says Dr. Moyad. “Aim for 30 to 40 grams
of fiber a day.”
5 I SYMPTOMS: Incisive pain that starts at the
navel and migrates to the lower-right quadrant,
becoming more intense
What it is: APPENDICITIS
What to do: Rush to the E.R. “Acute lower-right
quadrant pain signals something grave,” says Dr.
Seballos. The cause is unclear, but it is typically an
obstruction or infection, and it requires surgery.
NOTE: Head to the emergency room within four hours if
your abdominal pain is accompanied by fever, vomiting,
blood in the stool or urine, dizziness, or shortness of breath.
Steven Lamm, MD, is
a professor of medicine
at New York University Medical Center.