DEAR MAYO CLINIC: A 62-year-old man I worked with was diagnosed with stomach cancer earlier this year. He reportedly was feeling full even after eating small meals and experienced stomach pain above his belly button. I am starting to worry because I have recently started to experience similar symptoms. I’m only 38. Is it possible I could have stomach cancer? How do I get screened? What are the treatment options?

ANSWER: Most people diagnosed with stomach cancer, which is also called gastric cancer, are over the age of 60. However, in the U.S., stomach cancers in people under 40 have been steadily rising. Overall, this form of cancer is not very common, but factors that increase your risk include:

• Eating smoked, salted, processed or charcoaled meats, and pickled vegetables.
• Eating few or no fruits and vegetables.
• Alcohol use.
• Previous stomach surgery.
• Helicobacter pylori (H. pylori) infection.
• Inherited cancer syndromes such as: hereditary diffuse gastric cancer, Lynch syndrome (hereditary nonpolyposis colorectal cancer), familial adenomatous polyposis, gastric adenoma and proximal polyposis of the stomach, Li-Fraumeni syndrome, and Peutz-Jeghers syndrome.

Unfortunately, stomach cancer doesn’t always cause symptoms in its early stages, and many symptoms may not happen until the cancer is advanced. Signs and symptoms of stomach cancer may include:

• Difficulty swallowing.
• Belly pain.
• Feeling bloated after eating.
• Feeling full after eating small amounts of food.
• Not feeling hungry when you would expect to be hungry.
• Losing weight without trying.
• Feeling very tired.
• Stools that look black.

If you have signs and symptoms that worry you, you should make an appointment with your healthcare team. Many other conditions can cause symptoms that are similar to stomach cancer. Your healthcare team may recommend testing such as an upper endoscopy, also called an upper gastrointestinal endoscopy, which is a procedure that is used to visually examine your upper digestive system. This can be used to screen for stomach cancer as the cause of your symptoms. An EGD allows the doctor to look at the inside of your stomach. Stomach cancer can appear as an ulcer, a mass or a thickening of the stomach wall. Your physician then can obtain biopsies of the area to determine if you have stomach cancer.

The treatment of stomach cancer depends on the stage. Endoscopic ultrasound, a minimally invasive procedure to assess diseases of the digestive (gastrointestinal) tract and other nearby organs and tissues, CT or PET scan imaging, and a staging laparoscopy are used to determine the clinical stage.

While it is uncommon to find early stomach cancer, treatment for early-stage disease often only requires local treatment. For example, in early stomach cancers that involve only the mucosa, or inner lining of the stomach, and measure less than 2-3 centimeters in size, the stomach cancer can be removed using endoscopic submucosal dissection without the need for surgery or additional treatment. For other early stomach cancers that do not meet these criteria, surgery to remove the stomach cancer and regional lymph nodes is recommended.

However, if the cancer is found to have spread to the lymph nodes at the time of surgery, then the patient is at a higher risk of stomach cancer returning after surgery alone. Therefore, chemotherapy after surgery is often recommended to decrease the risk of cancer recurrence.

Typically, patients are diagnosed with more advanced stomach cancer, which means a deeper involvement of the stomach or spread to regional lymph nodes. In this more common situation, combining chemotherapy and surgery is necessary for the best outcomes. Chemotherapy usually is given before and after surgery in this case.

Finally, if the stomach cancer has been found to have spread outside the stomach and regional lymph nodes, then this is stage 4 cancer. The primary treatment is systemic therapy. Additional testing can be done on the tumor to determine if the stomach cancer might respond to targeted therapy or immunotherapy. In some cases where there is a small amount of tumor spread to the lining of the abdomen, also called the peritoneum, surgery called cytoreductive surgery and hyperthermic intraperitoneal chemotherapy can be used to prolong a patient’s survival.

Treatment options to treat stomach cancer are complex and should be individualized to your particular situation. It is essential to seek out an experienced team to help with the accurate staging of cancer, help with management decisions and for high-quality endoscopic or surgical resection. — Dr. Travis Grotz, Surgical Oncology, Mayo Clinic, Rochester, Minnesota

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Related Articles 

• Mayo Clinic Minute: Stomach cancer concerns

The post Mayo Clinic Q and A: Signs of stomach cancer? Diagnosis and treatment appeared first on Mayo Clinic News Network.

ANSWER: Although irritable bowel syndrome is possible in a 9-year-old, it is very rare. Stomach pain, on the other hand, is quite common in children that age. When stomach pain persists, it should be evaluated. If you have not already done so, make an appointment for your son to see his primary care provider. If necessary, that individual may recommend that he see a gastroenterologist who specializes in caring for children. Even if the exact source of stomach pain cannot be identified, there often are ways it can be effectively managed.

Many children have stomach pain. Usually it is not a symptom of a larger medical problem, and the pain often goes away on its own. But when stomach pain in children lasts, it does become a concern, particularly when it continues to be a problem for three months or more.

Other red flags associated with stomach pain that should be evaluated include chronic diarrhea, fever, frequent vomiting, bloody or black tarry stools, sudden or severe pain, and bowel movements in the middle of the night. If a child who has stomach pain is not growing at a typical rate, or if a child is losing weight, that also could signal an underlying medical issue that needs assessment.

The first step in evaluating chronic stomach pain in a child typically is a detailed discussion about the child’s medical history, including a review of family history. It is important for your son’s doctor to know the specifics of his condition, including when the pain started, how long it usually lasts and any other symptoms he may have.

In particular, symptoms such as swollen joints, red or painful eyes, headaches and skin rashes may help point to an underlying cause. A physical exam usually comes next. X-rays and blood tests can be useful, too. Endoscopy (a test that involves passing a lighted tube or scope into the colon or the stomach and upper small bowel) may be used in some cases as well. If a doctor notices a suspicious area of tissue during endoscopy, a sample of the tissue may be removed and analyzed to see if it could be part of and help diagnose the problem.

If no other specific medical condition can be found, irritable bowel syndrome, or IBS, could be considered. IBS affects the intestine and often causes stomach pain, along with cramps, bloating, gas, and diarrhea or constipation. It is important to note, however, that although IBS is rarely diagnosed in the teenage years, true cases of IBS are small in children under 10.

In many younger children with chronic stomach pain, a specific cause of the pain cannot be identified. That can be very frustrating for the children and their families. Even when stomach pain cannot be explained, though, there are steps that can be helpful. For example, making diet changes, lowering stress, using relaxation techniques and getting regular physical activity all can be useful in managing stomach pain.

After a thorough evaluation, if the source of your son’s stomach pain still cannot be identified, talk to his doctor about steps you can take to help ease your son’s symptoms. With time and behavior changes, chronic stomach pain in children frequently improves. — William Faubion, M.D., Gastroenterology, Mayo Clinic, Rochester, Minn.

The post Tuesday Q & A: Stomach pain common in children, but exact source not always easy to identify appeared first on Mayo Clinic News Network.

"INFLAMMATORY BOWEL DISEASE (ULCERATIVE COLITIS/CROHN'S DISEASE) IS CAUSED BY PSYCHOLOGICAL PROBLEMS."

This Saturday Dr. William Faubion and Dr. Joseph Murray will discuss their research regarding gastroenterological issues that afflict millions of children in third world countries. Drs. Faubion and Murray will also address questions about inflammatory bowel diseases and other GI conditions.

Listen Saturday 9 - 10 am CST http://radio.mayoclinic.org/ or on I Heart Radio 
Follow #mayoradio and tweet your questions during the show.

Listen here to this week’s Medical News Headlines. (right click for MP3)

Medical Edge Weekend is a weekly one-hour radio program that highlights health and medical information from Mayo Clinic specialists. Audio Demo

The post FRIDAY MYTH OR MATTER-OF-FACT appeared first on Mayo Clinic News Network.

ANSWER: Heartburn, or acid reflux, happens when stomach acid backs up into your esophagus. It is a common problem. About 40 percent of people in the United States have some symptoms of heartburn, which is usually described as a burning pain in the chest after eating.  

Treatment of heartburn depends on two issues. First, how much the symptoms bother you, and second, whether these symptoms signal an underlying esophageal injury that is happening because of the reflux. These can be two different issues, as the intensity of heartburn does not necessarily correspond to esophageal injury. In fact, people with severe esophageal injuries — such as esophagitis, where tissue in the esophagus becomes inflamed, or Barrett’s esophagus, a precancerous condition — often have mild symptoms or no symptoms at all.  

Fortunately, heartburn usually does not lead to esophageal damage from reflux. Most people with heartburn just have to deal with symptoms. But it is important to identify who needs to have their reflux symptoms evaluated. In general, the people with reflux symptoms who are most at risk for injury to the esophagus are Caucasian men, older than 50, who have had heartburn longer than five years, with symptoms happening at least three times a week and symptoms that occur at night.  

If you fit into this category, talk to your doctor about your heartburn. If you are not in a high-risk group, lifestyle changes, with or without over-the-counter medications, can be a good first step in heartburn treatment.

There have been many recommendations over the years about decreasing heartburn by avoiding specific foods, particularly those that contain acid. Examples include acidic juices such as orange or grapefruit juice, caffeinated beverages, chocolate and mints. Many doctors also have recommended avoiding high-fat meals, as they may make reflux worse. 

But as scientists have come to understand acid reflux better, it is now clear that there is no need to completely avoid these foods unless their acid content directly leads to symptoms. In other words, if it causes you heartburn, avoid it.  

Beyond that, other steps you can take to reduce symptoms include eating small meals, eating slowly, and allowing four to five hours between eating and bedtime. Eating smaller meals slowly helps because reflux is worsened when your stomach is stretched quickly to full capacity. Lying down also increases heartburn. That’s why it is important to allow plenty of time between eating and going to bed.

The bottom line when it comes to diet modification to treat reflux is to use good judgment. If you have a small piece of chocolate cake, it probably won’t be a problem. On the other hand, a piece of chocolate cake following a dinner of steak and French fries with a beer eaten quickly is bound to cause heartburn symptoms if you are prone to acid reflux.  

In addition, one of the most the most important and healthiest steps you can take to lower heartburn symptoms is not smoking. The nicotine in cigarettes causes weakening of the lower esophageal sphincter, the valve that separates the stomach from the esophagus. It is critical for that valve to work properly because it protects the esophagus from stomach acid. Smoking also is more highly associated with esophagitis and esophageal cancer from reflux. If you don’t smoke, don’t start. If you do, stop. If you need help, talk to your doctor about smoking cessation programs in your area.  

If these lifestyle changes do not help reduce your symptoms, if heartburn becomes bothersome enough to interfere with your daily activities or if reflux becomes more frequent, talk to your doctor about other possible treatment options for persistent acid reflux. — David Katzka, M.D., Gastroenterology, Mayo Clinic, Rochester, Minn.

The post TUESDAY Q & A: Lifestyle Changes are a Good First Step in Heartburn Treatment appeared first on Mayo Clinic News Network.

"Our findings emphasize that physicians and patients must be vigilant for these complications, which can occur without causing abdominal pain,” says co-author Eric Matteson, M.D., rheumatology chairman at Mayo Clinic in Rochester. “Especially stopping smoking and reducing the use of corticosteroids would appear to be important in reducing the risk of major lower GI complications.”

For more details click here 

The post Rheumatoid Arthritis Patients Can Face Serious Lower Gastrointestinal Disease appeared first on Mayo Clinic News Network.

Researchers at Mayo Clinic are conducting a research study on the effects of two FDA-approved medications to treat stomach symptoms that occur after eating. The purpose is to see whether these medications help people with these symptoms.

Dr. Rick Locke and study coordinator Vickie Silvernall describe the study:
http://www.youtube.com/watch?v=u0UETsvh8NY
Learn more about the dyspepsia study and see a complete list of study centers here on ClinicalTrials.gov. Mayo Clinic patients also may visit this page on Mayo's research Web site.

For more background, see this video about functional dyspepsia and this video about the medications being tested.

The post Mayo Clinic Leads NIH-Funded Study on Indigestion appeared first on Mayo Clinic News Network.

Medical Edge Weekend 4-10-2010

The post Dr. G. Richard Locke III on Irritable Bowel Syndrome appeared first on Mayo Clinic News Network.

Medical Edge Weekend 10-10-09

The post Dr. James Swain on Bariatric Surgery appeared first on Mayo Clinic News Network.

Once my wife and I made the decision to explore the possibility of a colectomy, we decided that we should research having it done at the Mayo Clinic. From the moment that I sent the very first contact email to Mayo, everyone with whom I have come in contact has been nothing less than wonderful, genuine, kind and knowledgeable.

My wife and I first visited the doctors of Mayo in January of 2006. Arriving in Rochester in January wasn’t the best decision we’ve ever made, but going to Mayo was certainly one of the best. It became very clear from the moment we arrived that Mayo is not your average hospital, and these are not your average health care professionals. Everyone from receptionists to surgeons were absolutely wonderful. Never once did we feel ignored or unimportant.

Read the rest of Daniel's story in the January "Share Your Mayo Clinic Story" open comment thread.

Share your story in the February thread!

The post Featured Comment: Week of 1/25/09 appeared first on Mayo Clinic News Network.

Crohn’s disease is an inflammatory disorder of the gastrointestinal tract that affects an estimated 500,000 people in the United States. Symptoms include abdominal pain, fever, nausea, vomiting, weight loss and diarrhea. Crohn’s disease has no known medical cure.

“Historically, patients with Crohn’s disease have been treated sequentially with steroids, then azathioprine, then monoclonal antibodies such as infliximab. The study definitively demonstrates that infliximab-based strategies are more effective than azathioprine,” says William Sandborn, M.D., the lead author and a gastroenterologist at Mayo Clinic. “Clinicians should consider a shift in practice to incorporate this new data.”

The study, conducted at more than 130 sites, included 508 patients who have moderate to severe Crohn’s disease. Researchers found that 57 percent of patients who received combination therapy with infliximab and azathioprine achieved steroid-free remission after 26 weeks. This is compared to 44 percent of patients who achieved remission with infliximab monotherapy and 30 percent with azathioprine alone. Both the infliximab combination therapy and infliximab monotherapy groups were statistically superior to the azathioprine group. In addition, 61 percent of patients who received the combination therapy of infliximab and azathioprine also experienced healing of the bowel demonstrated by colonoscopy (mucosal healing).

Dr. William Sandborn, a Mayo Clinic gastroenterologist and the lead researcher on the study, provides background on the disease and describes the study purpose and findings below.

The post Crohn’s Disease Study on Infliximab, Azathioprine appeared first on Mayo Clinic News Network.