Beyond ‘gastric’: Identifying the warning signs of stomach disease

 

IN Malaysia, many people use the word ‘gastric’ as a catch-all for any discomfort in the upper abdomen.

However, according to Sunway Medical Centre consultant general, upper gastrointestinal & bariatric surgeon Dr Sou Jing Kim, that is actually a medical myth as there is no such thing as ‘gastric pain’.

“Gastritis is a term that refers to inflammation seen under a microscope, not a diagnosis you can make from symptoms alone,” he noted.

Instead, doctors distinguish between functional dyspepsia, indigestion symptoms without structural problems and organic causes like peptic ulcers or even early stomach cancer.

Functional discomfort usually presents as bloating, early satiety, belching or nausea but when symptoms involve unexplained weight loss, poor appetite, persistent upper abdominal pain, vomiting, or anaemia, it should never be brushed off.

Lifestyle choices matter more than you think

(Image: Pexels/RDNE Stock project)

While many cases of indigestion are harmless, lifestyle habits can worsen discomfort and raise cancer risk.

Preserved and pickled foods, salted fish, charred or barbecued meats, and high intake of processed foods are common culprits. Smoking and alcohol add further strain to the stomach lining.

According to Dr Sou, gastric is not just due to spicy food as many Malaysians have come to believe: “The bigger picture is overall diet, smoking, alcohol, and whether H. pylori infection is present. Those are the real risk factors,” he explained.

Helicobacter pylori (H. pylori) is a bacterium that infects the stomach lining and is recognised as a class I carcinogen, meaning it can contribute to gastric cancer. Globally, up to half the population may carry it, though prevalence is lower in Malaysia, which is around 20 to 30%.

“H. pylori by itself doesn’t directly cause cancer. But chronic infection triggers inflammation, which can slowly damage the stomach lining, leading to atrophic gastritis, precancerous changes, and eventually cancer,” Dr Sou clarified.

The infection is typically diagnosed either through an endoscopy with biopsy (the gold standard) or non-invasive options like a urea breath test or stool antigen test.

“The good news is H. pylori is treatable. Doctors prescribe a two-week combination of antibiotics with acid suppression. In some cases, follow-up tests are needed to ensure eradication,” Dr Sou elaborated.

The rule of thumb: if typical ‘gastric” symptoms don’t improve after two weeks of medication, or if alarming features appear, it’s time for an endoscopy.

When to stop guessing and get scoped

In Malaysia, many patients delay endoscopy out of fear. Yet modern scopes are thinner than a centimetre, sedation is routine, and the procedure takes less than 10 minutes.

“Most patients are surprised at how comfortable it is. They often tell me afterwards they didn’t even feel it,” said Dr Sou.

Beyond diagnosis, endoscopy also allows doctors to biopsy suspicious areas and even treat certain ulcers directly. Advanced tools such as AI-assisted imaging, already widely used in Japan and Korea, are gradually entering Malaysian practice to enhance early detection.

Meanwhile, Sunway Medical Centre consultant clinical oncologist Dr Vance Koi Yung Chean noted that these countries’ population-wide endoscopy programmes have proven effective in catching gastric cancer early.

“In Malaysia, the focus is on high-risk groups, those with a strong family history, long-standing H. pylori infection, or chronic gastric issues,” he pointed out.

Why stomach cancer can often be mistaken for just “gastric”

Despite being a recognised disease, gastric cancer does not rank among Malaysia’s top 10 cancers. That makes it less of a screening priority compared with breast, colorectal, and lung cancers. Still, when it does occur, it is often detected late.

“Gastric cancer is sometimes called a silent killer because the symptoms are non-specific, and by the time it’s properly checked, the disease is already advanced,” Dr Koi said.

While surgery remains the cornerstone of treatment for localised gastric cancer, recent advancements such as minimally invasive techniques like laparoscopic or robotic surgery, enhances patient safety and also allow faster recovery in selected patients.

But to Dr Koi, oncology is no longer about surgery alone. “My role is to support surgical treatment with systemic therapy and that includes chemotherapy, targeted therapy, and immunotherapy, either before or after surgery, to improve long-term outcomes and achieve patient satisfaction,” he explained.

He added that newer tools like molecular profiling can identify biomarkers, allowing oncologists to personalise treatment with targeted drugs. While such options may not yet be routine in all Malaysian settings, they represent the future of care.

Don’t dismiss persistent stomach pain

Asian young man suffers from stomachache and abdominal pain, signaling digestive discomfort. Studio shot isolated on white, emphasizing health and medical issues.

Both specialists agree on one thing: don’t dismiss persistent stomach discomfort as ‘gastric’.

“Self-medicating with antacids may mask symptoms but won’t solve the root problem. If you keep getting pain, or if you have weight loss, anaemia or vomiting, please get checked,” warned Dr Sou.

Dr Vance echoed this from the cancer care perspective: “Early detection and proper treatment mean patients can live better, longer lives. Families should not feel alone and treatment today is far more advanced and supportive than it used to be.” ‒  Focus Malaysia