OUR resident doctor, Dr Zak Uddin, has this week taken on three reader's abdominal health concerns.

This week I am delighted to share three questions from readers, all regarding abdominal complaints.

As always, my advice is in line with currently agreed guidelines and practice but cannot be a substitute for consulting with your own doctor.


I went for an ultrasound scan because I kept getting urine infections. The scan showed that I was passing urine normally, but they also found a large gallstone. My GP said it was not anything to worry about – Andrea, 51


Dr Zak: Things are often found on scans that perhaps you were not expecting, or indeed looking for in the first place. These are referred to as “incidental findings” and in many cases, are thankfully of no concern.

If you randomly scanned several people, some of them would have gallstones. Of that group, not all would have symptoms of gallbladder disease. This is typically pain in the right upper abdomen, made worse by fatty or rich food.

A larger gallstone is of less worry. Whereas this will likely stay in the gallbladder, smaller stones may slip down the bile duct and into the pancreatic duct. This takes secretions from the pancreas to the small intestine.

If a stone gets lodged here, it may cause pancreatitis, which can be life threatening.

If you are not getting any pain, and your GP is satisfied with your scan, I would be inclined to leave alone. However, if you do develop symptoms, this would be a reason for a referral to a general surgeon.


I was told I had a hiatus hernia. When I press on my breastbone at the bottom, I can feel a lump. Is this it? – Andrew, 53

Dr Zak: The oesophagus (gullet) becomes the stomach when it passes through a hole in the diaphragm, the dome like structure which separates the chest from the abdomen.

A hiatus hernia occurs when a portion of the stomach goes through this hole and enters the chest cavity. This may be a small amount of the stomach. In some cases, the entire stomach may lie in the chest.

The main issue is that the oesophagus and stomach are no longer separated, and acidic contents of the stomach wash up the gullet, causing the typical symptoms of heartburn.

While the stomach is designed to cope with acidic contents, the oesophagus is not, and uncontrolled acid is a risk factor for the development of oesophageal cancer.

In most cases, a hiatus hernia is managed by acid reducing tablets, which often must be taken long term. Surgery is reserved for cases which cannot be controlled with medication, typically if there is a large portion of the stomach in the chest.

You cannot feel a hiatus hernia, as it is inside the body cavity. The tip of the sternum (breastbone) can be felt at top of your abdomen, the ribs forming an arch which meet in the middle. If you have lost a lot of weight, the tip of the sternum sometimes appears more prominent, but is not a cause for concern.


I have been put on Lansoprazole by my GP, after complaining of acid. I am slightly concerned as I read that there is a risk of not only osteoporosis, but also pneumonia with these tablets. My mother had a hip fracture after a fall, and it has always been at the back of my mind. Jean, 71

Dr Zak: There is a slightly increased risk of osteoporosis and pneumonia with regular and/or high dose acid reducing tablets known as Proton Pump Inhibitors (PPI). The most prescribed ones are lansoprazole and omeprazole.

However, this must be balanced against the long-term risk of excess acid on the lining of the oesophagus (gullet).

The greatest concern is the development of oesophageal cancer.

The risk factors for osteoporosis are menopause before age 45, smoking, excess alcohol, being underweight and deficient in calcium and vitamin D.

Certain medications also increase the risk of osteoporosis. With PPIs increased risk is found with long term, high dose use.

If you feel you are at risk, as well as addressing any lifestyle issues, it may be worth discussing your concerns with your routine GP.

They may wish to organise a DEXA (Dual energy x-ray absorptiometry) scan, which will classify you as either normal, having osteopenia, or actual osteoporosis.

Osteopenia is the stage between normal and osteoporosis and you will be advised on how to get enough calcium and vitamin D. If you have osteoporosis, you will be offered medications to increase your bone mineral density and reduce the chances of a fracture.

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