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The BARRX Procedure for Barrett's Esophagus
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The EsophyX Procedure
The EndoCinch Procedure
Heartburn, Reflux & GERD
Peptic Ulcer Disease
Helicobacter Pylori and Gastritis
Irritable Bowels Syndrome
Lactose Intolerance
Bacterial Overgrowth (SIBO)
Colon Polyps and Cancer
Radiation Change Therapy
Colitis
Constipation
Hemorrhoids
Liver Disorders (e.g. Hepatitis)
Peptic Ulcer Disease
Peptic ulcer disease (PUD) is a very common ailment, affecting one out of eight persons in the United States. The causes of PUD have gradually become clear and with this understanding have come new and better ways to treat ulcers and even cure them
Anatomy and Function of the Stomach
The stomach produces a very strong acid. This acid digests and breaks down food before it enters the small intestine (duodenum). The lining of the stomach is covered by a thick protective mucous layer which prevents the acid from injuring the wall of the stomach.
What Causes Peptic Ulcers?
An ulcer is an open sore in the lining of the stomach or intestine, much like mouth or skin ulcers. Peptic ulcers are eventually caused by acid and pepsin, a digestive stomach enzyme. These ulcers can occur in the stomach, where they are called gastric ulcers. Or they can occur in the first portion of the intestine beyond the stomach. These are called duodenal ulcers.
In the end, it is acid that causes the injury to the bowel wall. However, a revolutionary and startling recent discovery is that most peptic ulcers result from a stomach infection caused by the bacteria, Helicobacter pylori.
Helicobacter Pylori (H. Pylori)This funny-sounding name identifies the basic cause of most peptic ulcers, excluding those caused by aspirin or arthritis drugs. The bacteria has a twisted spiral shape (Helico) and infects the mucous layer lining of the stomach. This is a true infection and produces an inflammation in the stomach wall called gastritis. The body even develops an antibody in the blood against it. The bacteria is probably acquired through ingesting contaminated food or a contaminated drinking glass. It is only after H. pylori bacteria injures the protective mucous layer of the stomach that an ulcer develops.
Aspirin and Arthritis Medications
Arthritis medications include ibuprofen (Advil), Feldene, Naprosyn, Voltaren, Indocin, Lodine, and many others. As with aspirin, they can damage the mucous layer of the stomach, after which the stomach acid causes the final injury.
So, H. pylori and the above drugs are the two major factors that bring on ulcers. There also is a small group of patients that produces very large amount of acid uncontrollably, thereby causing ulcers. A stomach cancer may look and act like a peptic ulcer. Finally, some people get ulcers for unknown reasons.
Symptoms
Ulcers cause gnawing, burning pain in the upper abdomen. These symptoms frequently occur several hours following a meal, after the food leaves the stomach but while acid production is still high. The burning sensation can occur during the night and be so extreme as to wake the patient. Instead of pain, some patients experience intense hunger or bloating. Antacids and milk usually give temporary relief. Other patients have no pain but have black stools, indicating that the ulcer is bleeding. Bleeding is a serious complication of ulcers.
Diagnosis of a Peptic Ulcer
A diagnosis of peptic ulcers can be suspected from the patient's medical history. However, the diagnosis should always be confirmed either by an upper intestinal endoscopy, which allows direct examination of the ulcer through a fiberoptic instrument (endoscope), or by a barium x-ray of the stomach. With endoscopy, a biopsy is usually obtained of a gastric ulcer to determine if it is malignant and requires surgery.
Peptic Ulcer Treatment
Therapy of PUD has undergone profound changes. The first has been the development of drugs which suppress stomach acid (Pepcid, Tagamet, Zantac, Axid) or even stop it altogether (Prilosec). These acid-suppressing drugs have been dramatically effective in relieving symptoms and allowing ulcers to heal. If an ulcer has been caused by aspirin or an arthritis drug, then no subsequent treatment is usually needed. Avoiding these drugs should prevent ulcer recurrence.
The second major change in PUD treatment has been the discovery of the H. pylori infection. When this infection is cleared by antibiotics, the infection and the ulcer do not come back. So, increasingly, physicians are not just suppressing the ulcer with the acid-reducing drugs listed above, but they are also curing the underlying ulcer problem by getting rid of the bacterial infection. If not, the ulcers invariably recur.
There are a number of antibiotic programs available now to treat H. pylori. For example, Pepto-Bismol is an active antibiotic against H. pylori but must be used in conjunction with other drugs. The physician will select the best treatment program for the patient.
What Else Can Be Done?The above factors have altered the approach to ulcers in a dramatic way. Still, many other factors are still important:
In Summary...
The new era of peptic ulcer disease is at hand. With a firm understanding of how ulcers occur, with the potent acid -suppressing drugs now available, and with the knowledge that peptic ulcers caused by H. pylori can now be cured, the future is indeed bright for patients with ulcers. The physician now has the tools to deal very effectively with this old disease.
Additional Reference Material
Anatomy and Function of the Stomach
The stomach produces a very strong acid. This acid digests and breaks down food before it enters the small intestine (duodenum). The lining of the stomach is covered by a thick protective mucous layer which prevents the acid from injuring the wall of the stomach.
What Causes Peptic Ulcers?
An ulcer is an open sore in the lining of the stomach or intestine, much like mouth or skin ulcers. Peptic ulcers are eventually caused by acid and pepsin, a digestive stomach enzyme. These ulcers can occur in the stomach, where they are called gastric ulcers. Or they can occur in the first portion of the intestine beyond the stomach. These are called duodenal ulcers.
In the end, it is acid that causes the injury to the bowel wall. However, a revolutionary and startling recent discovery is that most peptic ulcers result from a stomach infection caused by the bacteria, Helicobacter pylori.
Helicobacter Pylori (H. Pylori)This funny-sounding name identifies the basic cause of most peptic ulcers, excluding those caused by aspirin or arthritis drugs. The bacteria has a twisted spiral shape (Helico) and infects the mucous layer lining of the stomach. This is a true infection and produces an inflammation in the stomach wall called gastritis. The body even develops an antibody in the blood against it. The bacteria is probably acquired through ingesting contaminated food or a contaminated drinking glass. It is only after H. pylori bacteria injures the protective mucous layer of the stomach that an ulcer develops.
Aspirin and Arthritis Medications
Arthritis medications include ibuprofen (Advil), Feldene, Naprosyn, Voltaren, Indocin, Lodine, and many others. As with aspirin, they can damage the mucous layer of the stomach, after which the stomach acid causes the final injury.
So, H. pylori and the above drugs are the two major factors that bring on ulcers. There also is a small group of patients that produces very large amount of acid uncontrollably, thereby causing ulcers. A stomach cancer may look and act like a peptic ulcer. Finally, some people get ulcers for unknown reasons.
Symptoms
Ulcers cause gnawing, burning pain in the upper abdomen. These symptoms frequently occur several hours following a meal, after the food leaves the stomach but while acid production is still high. The burning sensation can occur during the night and be so extreme as to wake the patient. Instead of pain, some patients experience intense hunger or bloating. Antacids and milk usually give temporary relief. Other patients have no pain but have black stools, indicating that the ulcer is bleeding. Bleeding is a serious complication of ulcers.
Diagnosis of a Peptic Ulcer
A diagnosis of peptic ulcers can be suspected from the patient's medical history. However, the diagnosis should always be confirmed either by an upper intestinal endoscopy, which allows direct examination of the ulcer through a fiberoptic instrument (endoscope), or by a barium x-ray of the stomach. With endoscopy, a biopsy is usually obtained of a gastric ulcer to determine if it is malignant and requires surgery.
Peptic Ulcer Treatment
Therapy of PUD has undergone profound changes. The first has been the development of drugs which suppress stomach acid (Pepcid, Tagamet, Zantac, Axid) or even stop it altogether (Prilosec). These acid-suppressing drugs have been dramatically effective in relieving symptoms and allowing ulcers to heal. If an ulcer has been caused by aspirin or an arthritis drug, then no subsequent treatment is usually needed. Avoiding these drugs should prevent ulcer recurrence.
The second major change in PUD treatment has been the discovery of the H. pylori infection. When this infection is cleared by antibiotics, the infection and the ulcer do not come back. So, increasingly, physicians are not just suppressing the ulcer with the acid-reducing drugs listed above, but they are also curing the underlying ulcer problem by getting rid of the bacterial infection. If not, the ulcers invariably recur.
There are a number of antibiotic programs available now to treat H. pylori. For example, Pepto-Bismol is an active antibiotic against H. pylori but must be used in conjunction with other drugs. The physician will select the best treatment program for the patient.
What Else Can Be Done?The above factors have altered the approach to ulcers in a dramatic way. Still, many other factors are still important:
- CAFFEINE AND ALCOHOL - Both of these stimulate the secretion of stomach acid and should be avoided in the acute phase of an ulcer.
- CIGARETTES - Nicotine will delay the healing of an ulcer. There are many other good reasons to stop cigarette smoking. Healing an ulcer is one of them.
- ANTACIDS - These agents purchased over the counter can be used for relief of peptic ulcer symptoms. Except for Pepto-Bismol, they do not help heal ulcers.
- STRESS - In the past, stress and emotion were felt to be a major cause of ulcers. Now it is known that, by itself, stress rarely causes an ulcer although it probably can aggravate the symptoms.
- SURGERY - Surgery used to be a major form of ulcer treatment. Now, it is the exceptional patient who needs surgery for an ulcer complication such as perforation, obstruction or uncontrolled hemorrhaging.
In Summary...
The new era of peptic ulcer disease is at hand. With a firm understanding of how ulcers occur, with the potent acid -suppressing drugs now available, and with the knowledge that peptic ulcers caused by H. pylori can now be cured, the future is indeed bright for patients with ulcers. The physician now has the tools to deal very effectively with this old disease.
Additional Reference Material
Swallowing Difficulty Related and Unrelated to GERD
Everyone occasionally has heartburn. This occurs when stomach acid flows backward into the esophagus, the food pipe that carries food to the stomach. People usually experience heartburn after meals as a burning sensation or pain behind the breast bone. Often, regurgitation of food and bitter-tasting stomach acid accompanies heartburn. Antacids or milk temporarily relieves heartburn for most people.Why Does Heartburn Occur?To understand heartburn, let us look at the body's anatomy. The esophagus carries food and liquid to the stomach. A sphincter, or muscular valve, is located at the end of the esophagus at the border between the esophagus and stomach. Known as the lower esophageal sphincter (LES) this muscle contracts much the same as the anus does. The sphincter should maintain a certain pressure to keep the end of the esophagus closed so that stomach juices are not admitted. The LES muscle should only open when food is passed into the stomach.
However, the LES muscle does not always work perfectly. It is felt that the problem is with inappropriate, transient relaxations of this sphincter valve that result in reflux. Sphincter function can be easily overcome by a number of factors, the most common being eating a large meal. Along with swallowed air, a large meal causes an upward pressure in the stomach to rise, thereby overpowering the LES muscle. Other factors that reduce the LES pressure and allow reflux are:
- Nicotine (cigarettes)
- Fried or fatty foods
- Chocolate
- Coffee
- Citrus fruits and juices
- Peppermint
- Pregnancy
- Lying flat
- Hiatus hernia
- Certain prescription medications
Swallowing difficulty, medically termed dysphagia, can arise for a variety of reasons. Firstly, reflux alone can disturb the muscular contraction or motility of the esophagus and interfere with the passage of liquids and solids. Often, when reflux is controlled, these symptoms will disappear.
The inflammatory response of the esophagus from chronic reflux can lead to the formation of a ring of scar tissue at the end of the esophagus where it meets the stomach, an area know as the gastroesophageal junction (the location of the LES), that can lead to a mechanical obstruction causing difficultywith swallowing solids. This entity is known as an esophageal ring or a Schatzki Ring. In some cases the ring needs to be disrupted in order to resolve the blockage.
Of course with chronic reflux comes the risk of esophageal cancer and although the risk is low, it is very real. Such tumors can cause significant blockage and bleeding. The cancers are diagnosed most often by way of video upper endoscopy. A person presenting with new-onset swallowing trouble, a history of reflux, bleeding, and weight loss should seek a medical evaluation immediately.
There are a variety of primary esophageal motility disorders that cause swallowing trouble. Achalasia is a disorder that can be quite insidious and involves that loss of motility in the body of the esophagus and the lower esophageal sphincter (LES)fails to relax. The physical presentation can look like reflux because the patient does not clear contents of the esophagus and those materials can backwash into the upper esophagus and mimic GERD. The diagnosis of Achalasia is made by way of esophageal manometry whereby the wave forms of the esophagus are measured to make the diagnosis. Achalasia can be treated surgically (laparoscopically) or by balloon dilation of the lower sphincter.
There are other esophageal motility disorders that can be described by esophageal manometry and they include diffuse esophageal spasm that is often associated wit noncardiac chest pain, the Nutcracker esophagus, and Ineffective Esophageal Motility. Esophageal motility studies ( manometry) will require the passage of a small caliber tube into the esophagus through a nasal passage. The test takes about 20-30 minutes to complete and is well-tolerated. It is performed as an out-patient.
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