Dyspepsia, gut brain and vagus (again)

A few days ago I was lying on a table surrounded by people in masks.

One of them held my head and inserted an object between my teeth to keep the mouth open. A thick rubbery object was then shoved down past my pharynx into the oesophagus. There was much gagging, but I soon got used to it.

Now, dear reader, I don’t know what you’re thinking about the kind of sadomasochistic activity in which I was willingly engaged, but the truth is that I was having a gastroscopy.

The general term for looking into tubes is endoscopy (Greek endon: internal), but yer man didn’t go much further than the pylorus so I’ll stick with gastroscopy. (Actually, Greek gaster meant pretty much anything between chest and pubes, like belly, and I can’t be bothered to find out how it came to be used for the sac where food is digested.)

Boss man, having established that I was not entirely ignorant of medical matters, kept pointing to things on the monitor, telling me where he was and what he could see. This was kind and considerate of him and I would have been eagerly attentive but for the fact that they’d asked me to take off my specs so all I could see was a mass of light pink. It turns out that apart from a somewhat incompetent gastro-oesophageal sphincter leading to reflux, and bit of gastritis with a few erosions, it was all pretty good.

This was a relief. My mother and her father died younger than I am now from abdominal cancer, probably stomach, and in the month or so before the gastroscopy my symptoms (I’ll come to them) had worsened considerably, so in my head I was already rewriting my will and sorting out online passwords for the beloveds. The fact that I consulted the GP speaks volumes.

I’ve only met him once before, a graduate of University College Dublin, so we have mutual acquaintances and had a really good chat about Dublin, Ireland, John Boyne, and life as a non-native in Ireland (me) and England (him). And the state pensions: Ireland’s is much more generous than the UK’s.

For several years I’ve had periodic dyspepsia and belching. Symptoms have gradually worsened and latterly my stomach has taken a great dislike to some foods, sending them back whence they came. My stomach is clearly very clever, since it doesn’t necessarily reject the most recently consumed, but only those it takes exception to. I often feel a queue building up in my oesophagus as if the traffic lights at the pylorus were stuck on red.

Most unpleasant were increasing gassiness, hiccups, and the feeling that unless I made myself vomit – which I had to do frequently – the trapped wind would never get out. Sleep was sometimes delayed and subcutaneous fat lost (no bad thing in itself). There were no signs of liver disease like yellow sclera, pale craps, dark piss, and the latter did not taste sweet so no sugar (not salty either which is astonishing given the amount of salt I consume). But the increasing severity meant that I was no longer able to cope by eating carefully, slowly, little and often, so I was worried. I’m not given to complaining about discomfort: Susan says I’m a stoic and should seek help sooner. But I’m a bloke.

So why such troublesome symptoms in the absence of anything much to account for them?

The GP several times asked me how long this had been going on. Back at home I asked myself when I remembered not having to think about what I ate or how I ate it. 

The answer rather flabbergasted me. It was in Texas just before the great catastrophe of 2015. It is not possible to leave an empty plate at a Texan restaurant, and certainly not Mel’s Country Café in Tomball, if one has belly issues.

Quite astonishingly my symptoms improved from then on – not disappeared, but certainly less aggravating and more manageable. 

Grief, stress, long term niggling anxiety, relief at no evidence of malignancy – all these play a part in the story, together no doubt with food intolerances that have always been there and that I never really noticed because I was so used to them.

Last November I wrote about the vagus nerve: https://ramblingrector.me/2020/11/14/the-vagus-nerve-a-journey/. I mentioned its likely role not only in enabling digestion but also in connecting head brain and gut brain. I alluded to the way in which the psyche and the guts affect one another: gut feelings, gut reactions, feeling gutted, psychiatric state, and more. I never for one moment made that link to account for some of my symptoms until I recalled the last time I didn’t have to be careful about eating. 

On the phone I told the GP of this realization. I asked him if he thought it a likely factor. “Most certainly” he said. “The trouble with you is you know too much. But we’ll do a CT just to make sure there’s nothing sinister further down to account for the weight loss.” 

I am absolutely astonished – and thrilled – at this first hand experience of the importance of the vagus nerve, the nerve of digestion, the nerve of nutrition, the nerve of the yolk sac, and the links between guts and emotions. 

5 thoughts on “Dyspepsia, gut brain and vagus (again)

  1. Perhaps there is scope for a literary fictional exploration of the human body in the tradition of Joyce’s Ulysses.

    • Perhaps so. I must reread “A conspiracy of dunces” in which the protagonist’s pylorus plays a significant part. But maybe I’d start on the basis that we are all merely tubes between two orifices with added bits and pieces. Doughnuts.

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