Digestive system during fasting and Fed States

Under normal circumstances, fasting (not eating) is the normal state of feeding and the postpr
andial state is the temporarystate.Overall,duringfastingthereisareduction inthesecretionsandslo
wingintheGITmotility.TheGIT motility at the proximal Gut (stomach + small intestine) in fast
ing has 4-
5 postprandial phases till next meal. The migratorymotorcomplex(MMC)incorporates3phases.
A longnoncontracting30minutes(phaseI).Thisisfollowed by an equally long phase II character
ized by irregular sub maximal contractions in amplitude and frequency and culminating in a s
hort phase II of regular periodicity every 70
90 min. The maximal contractions (frequency &amplitude)arerhythmicatarateof12/min.Thein
crease the lower oesophageal tone, gall bladder tone and bile transit rate. In the fed state (pos
t-
prandial), the MMC cycle terminates abruptly and is replaced by submaximal irregular contra
ctions < 12/min. The LES tone (resemble PhaseII)andthisphaselasts4
5hours.Thisisregulated byneuro-
hormonalcontrolinvolvingthemyentericplexus and several hormones such as insulin, somatost
atin, glucagon, secretin, motilin, gastrin, cholecystokmin, neurostarsin,NO.Theinteractionisve
rycomplexandnot wellunderstood.ThecolondoesnotparticipateinMMC andithasitsindependent
periodicactivity.
Effects of fasting on chronic GI diseases
Gastroesophageal reflux disease (GERD)
After Iftar, the lower esophageal sphincter (LES) pressure is decreased encouraging reflux an
d resulting in increased symptoms. Therefore, it is recommended that no contraindication to f
asting in most cases. Diet should containalowerfatcontentandthemealsaremadesmaller insize.I
ferosivediseaseisevidentbyendoscopy,treatment should be given in the form of proton pump i
nhibitors (PPIs)atiftarandsuhour.Fornon-erosiverefluxdisease


Ramadan fasting has a healing effect on peptic ulcers as it curbs
smoking which is recognised as a precipitating factor for the peptic
ulcer. The whole gastro-intestinal system takes good rest for the
first time in the whole year I feel pity for the stomach. I really feel
pity for the stomach, intestines and infact the whole gastro-
intestinal system. And this is so because the whole year, we never
let this system take rest. Apart from the three main meals, every
few minutes, we pour something in our stomach, be it snacks,
drinks, fruits or other eatables. None of us ever thinks that the food
which we had already sent in before is being digested by the
stomach and right when it has reached halfway, we dump some
more into it only to disrupt the digestive work previously
completed. This of course makes the food stay a longer time in the
stomach which may result in dyspepsia, gastritis, irritable bowel
syndrome etc. In contrast, Ramadan is the only period in which our
gastro-intestinal system takes good rest as the Muslims observe
fasting for the whole month. Digestion is not just the name of
churning movements of the stomach and the absorption by the
intestines, but it is a huge integrated system involving the nervous
system (eg. vagus nerve) as well as hormone secreting glands. So
the whole gastro-intestinal system takes good rest for the first time
in the whole year. As digestion begins in the mouth where the
salivary glands secrete excessive saliva which carries hormones to
act upon the food, the burden on the salivary glands and teeth is
reduced in the month of Ramadan. The oesophagus takes rest
during fasting as there is no food to require its propelling
movements which push the food to the stomach. Similarly, the
stomach and the intestines also take good rest as after completing
the digestion and absorption of food consumed at Sehri time, they
have nothing to do till Iftar time. Even glands like pancreas and gall
bladder which secrete hormones also reduce their secretions as
there is no food to demand their hormones. Hence, there is
substantial reduction in the gastrointestinal hormones like gastric
juice, gastrain, gastric inhibitory peptide (GIP), motilin, vascoactive
intestinal peptide (VIP),neurotension, enteroglucagon,
neuropeptide Y, gallium etc. Lastly, the colon and the liver are also
at ease during fasting. In short, Ramadan lifts the heavy burden
and strain which we have put on our gastrointestinal system and
gives it what can said to be a refreshing annual vacation of 30
days. Now coming to the diagnostic possibilities of Ramadan
fasting, a good number of patients who consult physicians with
abdominal pain, suffer from peptic ulcers. The peptic ulcer can be
gastric or the duodenal type. The occurence of abdominal pain in
both gastric and duodenal ulcers is different in relation to the food
intake. Duodenal ulcer pain, though variable usually occurs when
the stomach is empty and the gastric ulcer creates pain after the
food intake. In normal days, the differentiation of the two entities is
difficult to make as people eat frequently, but in Ramadan, an
individual undergoes two stages. One during the fasting when his
stomach is empty and the other after evening meal when the
stomach is full. If the patient complains of abdominal pain while
fasting, it will point to the possibility of duodenal ulcer and if the
pain occurs after Iftar, then gastric ulcer will be the suspected
diagnosis. The peptic ulcer pain is variable and it may not occur in
some patients. Similarly, in most of the duodenal ulcer cases, as
soon as mild pain starts, the patient eats something due to which
the pain disappears and the disease remains undiagnosed. This
undiagnosed ulcer may later surface with perforation of the ulcer
and haematemesis (vomiting of blood) which has a high mortality.
In Ramadan, while fasting, the duodenal ulcer pain is more likely to
surface and as there is no provision to relieve the pain with food,
the patient may be forced to consult a physician who with the help
of endoscopy can easily clinch the diagnosis. While examining the
abdomen of a patient who is already fasting, a physician can easily
palpate the tenderness as well as feel the oedema around the
peptic ulcer region. Ramadan fasting has a healing effect on peptic
ulcers as it curbs smoking which is recognised as a precipitating
factor for the peptic ulcer. It also has beneficial effects on
inflammatory bowel disease, irritable bowel syndrome, dyspepsia
and gastritis. Last, but not the least, imagine a person who has
fasted for more or less 14-15 hours and is now ready to break his
fast. His taste buds have taken good rest, so at Iftar, the food is
going to taste more pleasant and enjoyable than ever before. This
is yet another bounty of Ramadan. Allah's Messenger Prophet
Muhammad (saws) says: "There are two pleasures for the fasting
person, one at the time of breaking his fast and the other at the
time when he will meet his Lord, then he will be pleased because
of his fasting. By: Dr Muhammad Karim Islamabadi
http://www.quranandscience.com/legislative/271-fasting-soothes-
the-stomach.html 2010.

Puasa Ramadhan memiliki efek penyembuhan pada tukak lambung karena
mengekang merokok yang diakui sebagai faktor pencetus untuk ulkus peptikum.
Sistem pencernaan adalah sistem yang bekerja terus menerus dalam mencerna
makanan, berapapun jumlahnya, kapanpun makanan itu dimakan, dan dalam
bentuk apapun. Pola makan yang tidak teratur akan menganggu keteraturan
proses pencernaan dimana makanan yang baru dimakan dan makanan yang
sudah berada di dalam lambung bertumpukan dapat menyebabkan dispepsia,
gastritis, sindrom iritasi usus dan penyakit pencernaan lainnya. Selama
berpuasa, sistem pencernaan dapat dikatakan mendapatkan istirahat yang
layak. Pencernaan bukan hanya seputar gerakan perut dan penyerapan oleh
usus, tetapi merupakan sistem yang terintegrasi besar yang melibatkan sistem
saraf (misalnya saraf vagus) serta hormon mensekresi kelenjar. Dimulai di mulut
dimana kelenjar ludah mengeluarkan air liur berlebihan yang membawa hormon
untuk bertindak atas makanan, beban pada kelenjar ludah dan gigi berkurang di
bulan Ramadhan. Esofagus lebih rileksselama puasa karena tidak ada makanan
untuk membutuhkan gerakan peristaltik berlebihan yang mendorong makanan
ke perut. Demikian pula, lambung dan usus juga lebih rileks seperti setelah
menyelesaikan proses pencernaan dan penyerapan makanan yang dikonsumsi
pada waktu sahur. Bahkan kelenjar pankreas seperti dan kandung empedu yang
mengeluarkan hormon juga mengurangi sekresinya karena tidak ada makanan
untuk menuntut hormon mereka. Oleh karena itu, ada pengurangan substansial
dalam hormon pencernaan seperti asam lambung, gastrain, lambung
penghambatan peptida (GIP), motilin, peptida usus vascoactive (VIP),
neurotension, enteroglucagon, neuropeptide Y, dan galium.Terakhir, usus besar
dan hati yang juga nyaman selama berpuasa. Singkatnya, Ramadhan
meringankan beban sistem pencernaan kita dan dapat dikatakan sistem
pencernaan mendapatliburan tahunan menyegarkan selama 30 hari. Jika pasien
mengeluh nyeri perut saat puasa, maka akan menunjuk ke kemungkinan ulkus
duodenum dan jika sakit terjadi setelah berbuka, maka curigai tukak lambung.
Nyeri ulkus peptikum adalah variabel dan mungkin tidak terjadi pada beberapa
pasien. Dalam Ramadhan, sementara puasa, rasa sakit ulkus duodenum lebih
mungkin ke permukaan dan karena tidak ada ketentuan untuk meringankan rasa
sakit dengan makanan, pasien mungkin terpaksa untuk berkonsultasi dengan
dokter yang dengan bantuan endoskopi dapat dengan mudah meraih diagnosis.
oleh: Dr Muhammad Karim Islamabadi
http://www.quranandscience.com/legislative/271-puasa-menyejukkan-the-
stomach.html 2010.

Cara berpuasa:
http://www.thestar.com.my/Lifestyle/Health/Nutrition/2013/07/10/Fasting-
tips-for-those-with-gastritis-and-peptic-ulcer-disease-during-Ramadan/
Wednesday July 10, 2013 MYT 8:00:00 AM
By: PROF MADYA DR RAJA AFFENDI RAJA ALI

After Iftar, the lower esophageal sphincter (LES)
pressure is decreased encouraging reflux and resulting in
increased symptoms. Therefore, it is recommended that
no contraindication to fasting in most cases. Diet should
contain a lower fat content and the meals are made smaller
in size. If erosive disease is evident by endoscopy, treatment
should be given in the form of proton pump inhibitors
(PPIs) at iftar and suhour. For non-erosive reflux disease
(NERD) or GERD diagnosed by symptoms only, a single
daily dose of PPI should be adequate before Iftar.

Setelah berbuka, tekanan lower esophageal sphincter akan menurun yang akan
menyebabkan refluks yang memperburuk gejala. Karena itu, makanan yang
dikonsumsi harus rendah lemak dan dalam porsi yang kecil. Jika ditemukan kelainan
organik lewat endoskopi, penatalaksanaan harus diberikan proton pump inhibitors
(PPI) ketika sahur dan berbuka. Untuk kelainan fungsional NERD atau GERD yang
didiagnosa berdasarkan gejala saja, dapat diberikan PPI satu kali sehari sebelum
berbuka.

Patients with dyspepsia should be evaluated for peptic ulcer disease
and if diagnosed should be treated before Ramadan fasting. However,
those without any dyspeptic symptoms may fast during Ramadan.

Pasien dengan riwayat dispepsia harus diperiksa untuk mengetahui
kemungkinan adanya tukak peptik. Bila sudah terdiagnosis maka harus
diobati sebelum bulan puasa dimulai.