Upper Gut 上腸胃

香港人生活緊張，工作繁忙，應酬多，但賺到錢不代表可以食餐好，因不少都市人均有不同程度的胃病。最常見的問題是胃氣，胃脹，胃灼痛，火燒心和經常飽飽滯滯的感覺。跟其他都市病相同之處，就是生活習慣是致病的其中一個主要原因。我們的生活節奏急速，食飯時間既不定時又經常「三扒兩撥」地進食，都對胃部健康有不良影響。再者，精神緊張，少運動，經常坐著工作，多進食高脂，高熱量和刺激性食物令腸胃狀況每況愈下。香港常見的胃病有胃酸倒流，由幽門螺旋菌（Helicobacter pylori) 引起的胃病，以及功能性消化不良。

「胃酸倒流」是指過多的胃酸由胃部逆流到食道。患者通常會有火燒心的感覺（即是胸口覺得灼熱或灼痛），病情嚴重者胃酸可倒流至咽喉引致聲音嘶啞，咳嗽或哮喘徵狀，口腔帶酸味或口臭。亦有患者因胸口痛錯誤以為自己有心臟病。當中的成因與生活習慣有密切關係，包括經常食太飽，進食後不久便仰臥或睡覺，肥胖，吸煙和飲酒等等。這些因素導致「食道下端括約肌」鬆弛和腹壓上升，從而引發胃酸倒流。如果沒有適當醫治，食道會有機會潰瘍，收窄，出現癌前病變（Barrett’s esophagus)及食道癌。假若經常晚上發病，可能會引起長期失眠及其他情緒問題。

幽門螺旋菌是一種只存活於胃壁的細菌，但全球約一半人口都已受感染。對於此細菌的傳播途徑，醫學界還沒有定案，但相信是在兒童時期受感染的。幽門螺旋菌引發的胃病可輕可重，他可引發慢性胃炎，胃潰瘍，十二指腸潰瘍及甚至胃癌。可幸是此細菌的發病率只是約10%，即大部分受感染人士都沒有病徵。而因為香港居住環境衛生有所進歩，受感染人口已由過往的50%下降至約30%，年輕一代的感染率應該更低。

功能性消化不良患者會出現胃脹，胃痛，胃氣或食慾不振，但患者沒有腸胃器官疾病或結構性問題。功能性消化不良的成因不明，但多發病於城市人身上，很可能與生活節奏，不良飲食習慣，吸煙，酗酒，缺乏運動和精神緊張有關。

People living in Hong Kong often have a tight life, busy work, and a lot of social events. Though, making much money does not equal having a good diet, as many metropolitans have different degrees of stomach problems. The most common problems are having stomach gas, bloating, heartburn, heartburn, and . Similar to other urban diseases, lifestyle habit one of the main causes of illness. Our fast-paced life, irregular and the habit of wolfing down the food, all these contribute to adverse effects on the health of the stomach. In addition, mental stress, lack of exercise, often sitting and working, eating food with high fat and calories and irritating foods also worsen the condition of our digestive system. Common gastric diseases in Hong Kong include acid reflux, gastric diseases caused by H. pylori, and indigestion.

“Acid reflux” refers to the reflux of excess gastric acid from the stomach to the esophagus. Patients usually have a feeling of heartburn (that is, a burning pain in the chest). In severe cases, stomach acid can flow back to the throat, causing hoarseness, coughing or asthma symptoms, sour mouth or bad breath. There are also patients who mistakenly think that they have heart disease because of chest pain. The causes are closely related to lifestyle habits, including overeating, lying on your back or sleeping shortly after meals, obesity, smoking and drinking, etc. These factors lead to relaxation of the sphincter muscle of the lower esophagus and increased abdominal pressure, which triggers acid reflux. Without proper treatment, the esophagus may become ulcerated and narrowed. This may also lead to precancerous lesions (Barrett’s esophagus) and esophageal cancer. If the symptoms often happen at night, it may cause long-term insomnia and other emotional problems.

H. pylori is a type of bacteria that only lives in the stomach wall, and about half of the world’s population has been infected. t is believed that the infection started in childhood. Stomach disease caused by H.pylori can be mild or severe. It can cause chronic gastritis, gastric ulcer, duodenal ulcer and even gastric cancer. Fortunately, the incidence of the diseases caused by this bacterium is only about 10%, that is, most infected people are asymptomatic. With the improvement of the living environment and hygiene in Hong Kong, the infected population has dropped from 50% in the past to about 30%, and the infection rate of the younger generation should be lower.

Patients with functional dyspepsia may experience bloating, stomach pain, stomach gas or loss of appetite, though there may not be any sign of gastrointestinal diseases nor structural issues for the stomach. The cause of functional dyspepsia is unknown for patients but it occurs frequently in urban people. It is likely to be related to the pace of life, poor eating habits, smoking, alcoholism, lack of exercise and mental stress.

胃酸倒流的成因是「食道下端括約肌」鬆弛和腹壓上升。進行上消化道內視鏡（照胃鏡）檢查時，可能發現下食道有潰瘍。嚴重者有機會出現食道收窄，癌前病變，甚至食道癌。如果照胃鏡未能確診，可進行24小時食道酸鹼度測試，紀錄食道下段的酸度，來確定胃酸倒流的頻率和持續的時間。要減輕病情，一定要對自己的生活習慣作出改變。進食時，一定不能太飽，進食後，亦不能躺著。所以晚飯時間和睡覺時間要相隔至少3至4小時。吸煙，飲酒，油膩的食物，巧克力，芝士，薄荷，咖哩，洋蔥，咖啡等等都會增加胃酸倒流。最後，當然是需要減細肚腩以降低腹壓。醫生也可處方抑壓胃酸藥物如 H2 receptor blockers 和 proton pump inhibitors 幫助減輕病情。

幽門螺旋菌可引發慢性胃炎，胃潰瘍，十二指腸潰瘍及胃癌。可幸是香港受感染人口已下降至約30%。照胃鏡及抽取胃壁組織檢查可準確診症。對於非胃癌高危人士，C13吹氣測試是相對較方便的檢查來確認患者是否有感染幽門螺旋菌。治療方法是使用包括 proton pump inhibitors 的藥物減低胃酸及服用針對幽門螺旋菌的抗生素，服用七至十四曰後，清除幽門螺旋菌的機會率約百分之九十，患者可在服藥後最少四個星期再進行C13吹氣測試，以確認是否仍有病菌。病菌清除後翻發機會低於1%，而且清除病菌是有效防止胃潰瘍或胃癌的方法。

功能性消化不良的成因不明，而患者沒有腸胃器官疾病或結構性問題，但會出現胃脹，胃痛，胃氣或食慾不振。部分患者同時亦受到幽門螺旋菌染，清除病菌可幫助一些患者減輕病情。醫生可在病發時處方中和胃酸劑和抑制胃酸劑。但患者亦需要放慢生活節奏，放鬆心情及戒除不良習慣如暴飲暴食，吸煙，酗酒和缺乏運動，方可控制病情。

The causes of acid reflux are relaxation of the “lower esophageal sphincter” and increased abdominal pressure. During the upper gastrointestinal endoscopy (gastroscopy), ulcers may be found in the lower esophagus. In severe cases, there may be narrowing of the esophagus, precancerous lesions, and even esophageal cancer. If the diagnosis cannot be confirmed by gastroscopy, a 24-hour esophageal pH test can be performed to record the acidity of the lower esophagus to determine the frequency and duration of acid reflux. To alleviate the condition, you must make changes of your own living habits. When eating, you must not overeat or lie down after eating. So there should be at least 3 to 4 hours between dinner time and bedtime. Smoking, drinking, greasy food, chocolate, cheese, mint, curry, onion, coffee, etc. will increase acid reflux. Finally,

Of course, it is necessary to lose your belly to reduce abdominal pressure. Doctors can also prescribe anti-gastric acid drugs such as H2 receptor blockers and proton pump inhibitors to help relieve the condition.

H. pylori can cause chronic gastritis, gastric ulcer, duodenal ulcer and gastric cancer. Fortunately, the infected population in Hong Kong has dropped to about 30%. Gastroscopy and gastric wall tissue examination can accurately diagnose. For people who do not have , the C13 breath test is a relatively convenient test to confirm whether the patient has H. pylori infection. The is to use drugs including proton pump inhibitors to reduce stomach acid and take antibiotics against H. pylori. After 14 days of treatment, the chance of clearing H. pylori is about 90%. Patients can perform a C13 test 4 weeks after to confirm whether there are still . After the H. pylori , the chance of recurrence is less than 1%, and is an effective way to prevent gastric ulcer or gastric cancer.

The cause of indigestion is , and the patients do not have gastrointestinal diseases or structural problems, but they may experience bloating, stomach pain, stomach gas or loss of appetite. Some patients who are also infected with H. pylori, clearing the bacteria can help them to relieve their condition. Doctors can prescribe gastric acid neutralizers and gastric acid suppressants at the time of illness. However, patients also need to slow down the pace of life, relax their mood and quit bad habits such as overeating, smoking, alcoholism and lack of exercise in order to control the condition.