A Normal Gastrointestinal Tract Is One That Has Not Been Scoped

A woman of forty walks into my OPD. She complains of “gases.” Some acidity, she says, a little heartburn, the odd burp that will not come up and will not go down. She has had this for years. It comes and goes with worry, with weddings, with festival food. Nothing about her story is alarming. But someone, somewhere, tells her she must have an endoscopy, “just to be sure.” She agrees. Who would not, when the word cancer hangs unspoken in the room?

The scope goes in. It comes out. And the report says: Grade I esophagitis. Mild antral gastritis. Duodenitis. A small hiatus hernia. Prominent gastric folds.

She reads this at home, alone, with a mobile phone open to Google. By evening she is convinced she has a serious stomach disease. She has not slept. She has not eaten. The very symptoms that were mild and occasional are now constant and frightening, because now they have a name.

Here is the truth that few tell her: almost every stomach in India would show the same report. Grade I esophagitis is not a disease. It is a finding, and a common one, seen in people who eat spicy food, drink tea, sit for long hours, or simply grow older. Mild gastritis is seen in the healthy and the sick alike. A small hiatus hernia is present in a third of adults who have never had a single symptom. These are not verdicts. They are footnotes on a normal body.

Years ago, as a young physician, I presented a journal club one Friday morning in the seminar room of the old hospital building. I no longer remember the journal, or the exact title, but its message has stayed with me for decades: a normal gastrointestinal tract, it said, is one that has not yet been scoped.

The same story plays out in the adjacent building of the hospital, in the newly renovated orthopaedics. A man of fifty comes in with a backache. He lifted something heavy, or he did not. The pain sits in one place, in the lower back, and it improves when he rests. This is the story of an ordinary, muscular backache, the kind that gets better on its own in a few weeks. But instead of rest and reassurance, he is sent for an MRI. Not of the painful part alone, but of the whole spine, neck to tailbone.

The report comes back long and alarming. Disc desiccation at L4-L5. A bulging disc at L3-L4. Osteophytes at multiple levels. Mild facet arthropathy. Loss of normal lumbar lordosis. A nerve root “touching” but not compressed. Mild canal narrowing.

He does not understand a word of it, but he understands enough to be afraid. He carries this report from doctor to doctor like a wound. He believes something inside him is crumbling.

Yet every word in that report can be found in the spine of a fit young athlete with no pain at all. Studies of completely healthy people with zero back pain show disc bulges in more than half, disc degeneration in most, and osteophytes in almost everyone past forty. A spine, like a face, gathers lines with age. We do not call wrinkles a disease. We should not call an aging spine one either, unless it is truly pressing on a nerve and causing weakness or loss of control, which is rare.

This is the quiet epidemic of our time: overdiagnosis. H. Gilbert Welch’s book, Overdiagnosed: Making People Sick in the Pursuit of Health, spends hundreds of pages on this modern malady, and I believe every doctor should read it. It shows, again and again, how tests meant to help end up doing harm instead.

We are not making people sicker with germs or poisons. We are making them sicker with words. A grade, a percentage, a Latin term dropped into a report turns a well person into a worried one. The disease is invented, but the suffering is real.

And once the worry begins, the machinery of medicine does not know how to stop. The patient, now anxious, returns with new complaints. The first doctor sends him to a second. The second orders more tests to rule out what the first test raised as a doubt. A proton pump inhibitor is added for the stomach. A painkiller and a muscle relaxant for the back. Perhaps a vitamin injection, because it cannot hurt and it feels like something is being done. Calcium and Vitamin D. Gabapentine. The file grows thick. The wallet grows thin. The symptoms, oddly, do not go away — because they were never really about acid or a disc. They were about fear, and fear does not respond to a tablet.

In time, tired of the endless queue and the endless uncertainty, many drift towards alternative medicine. Not because it is proven, but because it offers what allopathy in this rush too often forgets to give: time, a patient ear, and the comfort of being taken seriously. The symptoms still do not disappear. New ones are added. The patient now has no diagnosis and no peace, only a longer story.

What did this patient need at the very start? Not a scope. Not a scan. A good conversation. A doctor willing to sit for ten minutes, ask the right questions, examine properly, and then say with confidence: “There is nothing dangerous here. This is common. It will settle.” That sentence, said with conviction, is a more powerful medicine than any tablet we can write. Reassurance, given honestly and after due care, is not a lesser form of treatment. It is treatment.

Tests have their place. When symptoms are severe, when warning signs are present — blood loss, unexplained weight loss, weakness in a limb, loss of bladder control — investigate without delay. But for the ordinary heartburn, the everyday backache, restraint is the harder and better skill. It takes more courage to withhold a test than to order one. It takes more wisdom to read a normal-sounding abnormal report correctly than to be frightened by it.

We must learn, as doctors and as patients, that a body is not a machine to be scanned into submission. It ages, it creaks, it complains a little, and mostly it is fine. The kindest thing medicine can sometimes do is look a worried person in the eye and simply say: you are well. Go home.