Frequent Gastric Spasms: If your stomach feels twisted and painful - Incheon Gastric Spasm

It's not a leg cramp, but your stomach feels like it's cramping?

Hello. This is Baeknokdam Korean Medicine Clinic.

Have you ever experienced your stomach twisting in pain after a meal, or sudden, intense pain that makes you clutch your abdomen when on an empty stomach?

“I thought it was gastritis, but my endoscopy was clean.”

However, if such pain recurs, it might not simply be an issue with the gastric mucosa. Today, we will discuss gastric spasms – what we commonly refer to as 'a cramp in the stomach' – delving into its pathophysiology and context.

What are Gastric Spasms? – A Cramp Occurring Within the Stomach

The stomach is also composed of muscle. It repeatedly contracts and relaxes to propel food downwards. However, if these contractions occur suddenly, intensely, and without coordination, they manifest as spasmodic pain. This is a phenomenon where the smooth muscles of the stomach contract strongly and involuntarily, much like experiencing a cramp in your calf. Since the stomach is not externally visible, it feels like an 'invisible cramp'.

Pathophysiology – It's Not the Contraction Itself, But a Problem with the Contraction System

Gastric spasms are not simply a matter of contractions occurring. The real issue lies within the system that regulates these contractions.

• Firstly, Interstitial Cells of Cajal (ICC) are crucial for establishing the stomach's rhythm; if this rhythm becomes hyperexcitable, contractions become excessively strong or irregular.
• Secondly, when the balance of the autonomic nervous system is disturbed, the regulation of gastric muscles falters. Accumulated stress or anxiety can lead to excessive sympathetic nervous system activity, resulting in reduced gastric blood flow and contractile imbalance.
• Thirdly, increased internal gastric stimuli, such as excessive stomach acid, food distension, or gas accumulation, can trigger abnormally strong reflex contractions, leading to pain.

Timing of Onset Provides Clues to Pathophysiology

When gastric spasms occur is a crucial clue for understanding their underlying pathology.

• If spasms frequently occur on an empty stomach, it might be related to excessive gastric acid, mucosal irritation, or a 'cold' constitutional type.
• If they occur immediately after a meal, gastric distension, delayed gastric emptying, or gastroparesis is suspected.
• If pain occurs 1-2 hours after a meal, it may be linked to the peak timing of gastric acid secretion, pyloric muscle tension, or gastroesophageal reflux disease (GERD).
• If they recur at night or during sleep, a failure in autonomic nervous system transition, specifically nocturnal sympathetic hyperactivity, may be involved.

Gastric Spasms and Indigestion Share a Common Origin

If gastric spasms recur, they might need to be considered not merely a pain issue, but a form of functional dyspepsia (FD). If accompanied by symptoms like early satiety, bloating, burping, and nausea, this signals that both the stomach's rhythm and sensory systems are compromised. In essence, a gastric spasm is the body's warning: 'Your digestive rhythm is disrupted.'

Management Strategy – When and How the Pain Occurs Matters

The core of treatment is not 'how to relieve the pain?' but rather 'why did it contract in that manner?' Pathology-specific interventions, tailored to the timing of onset, are crucial – such as gastric acid control for empty stomach pain, distension relief and assistance with gastric emptying after meals, and autonomic nervous system stabilization for nocturnal occurrences. Moreover, merely taking medication to relax the stomach cannot prevent recurrent spasms. Gastric rhythm restoration, autonomic nervous system regulation, mucosal protection, and dietary habit correction must all be addressed concurrently.

The Expression 'Having a Cramp in My Stomach' Was Not Wrong

Gastric spasms are not merely a sign of stomach pain; they are the stomach signaling how much it is struggling. Moreover, it's a structural warning sent from a state where its rhythm is lost, blood flow is reduced, and sensations are hypersensitive. Therefore, instead of simply suppressing it with painkillers, we must collectively investigate 'why has this stomach deteriorated to such an extent?' Do not lightly overlook the painful rhythm your stomach is sending.

Thank you.

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