Chronic Epigastric Pain and Discomfort: Why You Should Check the 'Small Intestine' Instead of the Stomach (SIBO Connection) | Incheon Epigastric Pain

Is this perhaps a long-standing concern of yours? Especially after meals, and appearing without fail whenever you're stressed, this unpleasant feeling has likely led you to undergo gastroscopy multiple times. However, the results are always just 'nervous dyspepsia' or 'mild gastritis'. Even after taking the prescribed stomach medication, the discomfort is only temporarily relieved, and the frustrating thought, 'Why am I the only one suffering like this?' only grows.

While everyone is looking solely at the 'stomach (胃)', have you ever considered that the real problem might be occurring just below it, in the 'small intestine (小腸)'?

Hello

I'm Choi Yeon-seung, a doctor of Korean medicine who, for 15 years, has been fundamentally treating persistent epigastric discomfort that couldn't be explained by endoscopy, by identifying its root causes in 'SIBO (Small Intestinal Bacterial Overgrowth)' and 'Damjeok (痰積)'.

If you read this article to the end today, you will discover the true culprit behind the persistent discomfort that has plagued you. And I promise you will find a new solution that no longer relies solely on stomach medications.

Is the culprit really the 'stomach'? Shift your focus downwards

It's natural to suspect the 'stomach' first when experiencing epigastric discomfort. Indeed, gastritis, gastric ulcers, and reflux esophagitis are typical causes that trigger epigastric pain and discomfort. However, if you find yourself in the following situations, it's time to shift your focus a little further downwards.

• You've been told 'no specific abnormalities' in multiple gastroscopic examinations.
• You've been diagnosed with 'nervous gastritis' or 'functional dyspepsia' by a doctor.
• The discomfort persists even after taking prescribed medications such as acid suppressants and gastrointestinal motility enhancers.

If stomach medications are ineffective and endoscopy shows nothing, it's highly likely that the 'stomach' is not the culprit. Though the 'crime scene' is near the epigastrium (stomach), the real culprit might be hidden on the floor below, in the 'upper small intestine (duodenum, jejunum)'.

Invisible Pressure: 'Small Intestinal Gas' Presses on the Epigastrium (feat. SIBO)

The true culprit behind the epigastric discomfort, invisible to endoscopy and unresponsive to medication, is 'gas produced in the small intestine'. And the fundamental cause producing this gas is 'SIBO (Small Intestinal Bacterial Overgrowth)'.

"But isn't it strange? The problem is in the small intestine, so why is the discomfort felt in the epigastrium?"

Imagine a 'balloon inflated on the lower floor,' and it becomes easy to understand. Consider a two-story house. Imagine a huge balloon (gas) being inflated not on the second floor (stomach), but on the first floor's (small intestine's) ground. As the balloon expands, the structure that serves as the first floor's ceiling and the second floor's base (stomach, diaphragm) is subjected to intense pressure from below. The problem actually originates on the first floor, yet the discomfort and pressure are felt on the second floor.

The gas generated in the upper small intestine due to SIBO acts exactly like this 'balloon'. The pressure created by this gas pushes the stomach upwards from below, causing a constant, choked-up feeling as if something is stuck in the epigastrium. Furthermore, because it obstructs the passage of food from the stomach to the small intestine, symptoms like 'early satiety' (feeling full after eating only a small amount) and increased post-meal discomfort appear. Ultimately, the discomfort you felt was not the 'stomach' screaming, but rather its painful groans, crushed by the gas pressure from the small intestine below.

The Reality of 'Damjeok (痰積)', a Diagnosis in Korean Medicine

The previously described 'invisible pressure from the lower floor'. In fact, this phenomenon precisely matches a very important pathological concept in Korean medicine, which boasts thousands of years of history. That is 'Damjeok (痰積)'.

The sensation patients complain of – "It feels like a stone is stuck in my epigastrium" or "I always feel completely blocked" – is a typical symptom of 'Damjeok', which is identified by palpating hardened tissues during abdominal examination (腹診).

So, what exactly is Damjeok? In our Korean medical clinic, we don't simply view Damjeok as a 'hardened mass'. Damjeok is defined as:

1. Chronic gas pressure due to SIBO,
2. Inflammation of the intestinal mucosa induced by it, and
3. A pathological condition combining sticky waste products (담음, phlegm-fluid) resulting from inflammation.

In other words, SIBO serves as a crucial clue that allows us to examine the phenomenon of 'Damjeok' through the lens of modern science and measure it with objective values, such as gas volume.

Tracing the Root of the Problem

In conclusion, your epigastric discomfort was not a malfunction of the stomach (2nd floor) itself, but a signal of distress sent by the 'gas balloon (SIBO)' in the small intestine (1st floor) below, pressing on the floor above. Essentially, you've been knocking on the door of the wrong floor for a long time.

Only by correctly identifying the true site of the problem can the right solution begin to emerge. Now we know that the problem's site is the 'small intestine'. So, shall we delve a step deeper?

What, in the first place, caused the 'gas balloon' to form on the 'lower floor' of the small intestine? Surprisingly, the starting point of all problems often returns to the 'stomach (胃)'. It is often from the breakdown of the 'stomach acid (胃酸) defense barrier' that all misfortune begins.

Your long-standing discomfort, its end is now beginning to appear.

#SIBO #EpigastricPain #EpigastricDiscomfort