Causes and Treatment of Gastric Ulcers
The main complications of peptic ulcer disease are perforation, gastric outlet obstruction and bleeding. When perforation occurs, the contents of the stomach escape into the peritoneal cavity, leading to peritonitis. Perforation occurs more commonly in duodenal than in gastric ulcers, and usually in ulcers on the anterior wall. Another complication of peptic ulcer disease is gastric outlet obstruction. Obstruction of the pyloric sphincter at the outlet of the stomach blocks the flow of gastric contents into the duodenum. Nausea, vomiting, gastric pain and abdominal distension are the cardinal features of such obstruction. The gastric pain is aggravated by eating and many patients with gastric outlet Endoscopy should be performed after the stomach has been emptied by a wide-bore nasogastric tube in order to confirm or refute organic obstruction. Barium studies are rarely advisable because they cannot usually distinguish between peptic ulcer or cancer. Moreover, barium remains in the...
In general, ulcer pain is relieved by food, milk or antacids and by belching and vomiting. Relief by vomiting is more typical of gastric ulcer than of duodenal ulcer some patients learn to induce vomiting to gain pain relief. Pain is episodic and may last for several weeks at a time. Between episodes the patient feels perfectly well. Other symptoms, especially during episodes of pain, include waterbrash, heartburn, loss of appetite and vomiting. Occasionally the only symptoms are anorexia and nausea, or a sense of undue repletion after meals. In some patients the ulcer is completely 'silent', presenting for the first time with anaemia from chronic undetected blood loss, as an abrupt haematemesis or as acute perforation in other patients there is recurrent acute bleeding without ulcer pain between the attacks. Although the prevalence of peptic ulcer is decreasing in many Western communities, it still affects approximately 10 of all adults at some time in their lives. The male to female...
HP eradication is the cornerstone of modern therapy for peptic ulcers, as this will successfully prevent relapse and eliminate the need for long-term therapy in the majority of patients. All patients with proven acute or chronic duodenal ulcer disease, and those with gastric ulcers who are HP-positive, should be offered eradication therapy as first-line treatment. Treatment is based upon a proton pump inhibitor taken simultaneously with two antibiotics for a period of seven days. Compliance, side-effects and metronidazole resistance influence the success of therapy. Nurses involved in the care of patients with peptic ulcer disease may include behavioural modification techniques by incorporating the following recommendations At present, the most frequently used medical treatment for the suppression of gastric acid secretion in peptic ulcer disease is the administration of proton pump inhibitors. These inhibitors are effective in decreasing gastric acid by inhibiting the enzyme...
About 15 of infected individuals will develop peptic ulcer (duodenal or gastric) or gastric cancer as a long term consequence of infection. The outcome of infection depends mainly on the severity and topography of histological gastritis, which may be determined by the age at which infection is acquired. Infection in infancy is thought to lead to pangastritis, whereas acquisition in later childhood may lead to a predominantly antral gastritis only. In contrast, pangastritis, with an inflamed corpus, is associated with the loss of acid secreting cells, which leads to an increased risk of gastric ulcer and gastric cancer similar to that seen with autoimmune gastritis in pernicious anaemia.
Duodenal and gastric ulcers and gastric cancer are common and serious diseases but occur in only a minority of people infected with Helicobacter pylori. Mass eradication of H pylori is impractical because of the cost and the danger of generating antibiotic resistance, so we need to know how to target prophylaxis. Knowledge of the mechanisms that lead to ulcer formation or to gastric cancer in the presence of Hpylori infection is therefore valuable. Various factors affect the outcome of Hpylori infection, including the host response and particularly the extent and severity of gastric inflammation and thus the amount of acid secreted by parietal cells. Hpylori can elevate acid secretion in people who develop duodenal ulcers, decrease acid through gastric atrophy in those who develop gastric ulcers or cancer, and leave acid secretion largely unchanged in those who do not develop these diseases.
Peptic ulcer pain is reportedly most frequent at night 4 , being attributable to higher levels of gastric acid production in the afternoon and evening 32 . Disease management might accordingly take the form of evening dosing of an H2-receptor antagonist or morning administration of a single dose of a PPI 4, 19 . The H2-receptor antagonist famotidine has a longer duration of action than cimetidine (10-12 h cf. 4-8 h) 33 . It is accordingly considered more suited for ulcer therapy by decreasing gastric acid secretion for longer periods during night time 19 .
Symptoms may not occur until local disease is advanced. Patients may have symptoms and signs related to secondary spread (principally to the liver) and to the general effects of advanced malignancy, such as weight loss, anorexia, or nausea. Epigastric pain is present in about 80 of patients and may be similar to that from a benign gastric ulcer. If caused by obstruction of the gastric lumen, it is relieved by vomiting. Carcinoma of the gastric cardia may cause dysphagia.
Poultice of fresh leaves can be used to cure furunculosis. The fruit when consumed together with a little salt is stomachic, aperient, and active on dysentery, uterine haemorrhage, cough, coryza, oedema and neuralgia. The root bark has beneficial effects in hypertension, osteodynia and lumbago. 7 The fruit is also used for throat and gum complaints, dysentery and leucorrhoea while the root is used as a cathartic and febrifuge. 29 The processed fruitjuice is also in great demand for various ailments such as diabetes, high blood pressure, headaches, heart disease, AIDS, cancers, gastric ulcers, mental depression, senility, poor digestion, atherosclerosis and drug addiction. 30
Traditional Medicinal Uses The plant is widely used in the form of a decoction in Sri Lankan traditional medicine. 10 The leaves and bark are used for rat and snake bites, rat poisoning and on boils. 1011 The fruits are used for cough, asthma and diarrhoea. 1112 Kernels of the drupe are mixed with milk to treat bilious diseases and jaundice whereas the seed has been used as an insecticide and tonic. 11 The seeds along with other ingredients are employed in preparations for the treatment of itch, piles and typhoid fever, while the bark is also used for gastric ulcers. 10 Its roots act as a coolant and Traditional Medicinal Uses The plant is used in cooling drinks when boiled, for diarrhoea, diuretic, gravel, leprosy treatment, stones, wound healing and as a tonic. 24 It is also part of a mixture to treat colic in Indonesia. 16 The Chinese uses it to improve appetite, aid digestion, treat sores and ulcers. In India, it is used to treat skin, nervous system and blood diseases. 2717 The...
Brillat-Savarin's work reflects interactions with philosophers and physicians of his time. While he remained a bachelor all his life, he had many prominent guests sitting at his table for meals, and he often sat at the best tables of Paris. Among his guests were Napoleon's doctor, Jean-Nicolas Corvisart, the surgeon Guillaume Dupuytren, the pathologist Jean Cru-veilhier, and other great minds. Cruveilhier was such an authority on the stomach that gastric ulcers are referred to as Cruveilhier's disease. Through such interactions, Brillat-Savarin undoubtedly gained knowledge about the chemistry of food and how it relates to the physiology of digestion. So passionate was Brillat-Savarin about food that many people identified him more often as a chef rather than a lawyer.
Patients with suspected cholecystitis should be imaged for 2 major reasons. First, most patients (60 -85 ) referred to exclude cholecystitis have other causes of right upper quadrant pain, including peptic ulcer disease, pancreatitis, hepatitis, appendicitis, hepatic congestion from right-sided heart failure, perihepatitis from pelvic inflammatory disease (Fitz-Hugh-Curtis syndrome), right lower lobe pneumonia, right-sided pyelonephritis, or nephroureterolithiasis. If the patient does not have acute cholecystitis, the clinical workup can be redirected before the patient's clinical condition deteriorates. Secondly, imaging can diagnose severe complications such as emphy-sematous cholecystitis and perforation, which require immediate surgery.37
Helicobacter pylori a bacterial cause of gastritis, peptic ulcer disease and gastric cancer, American Society of Microbiology newsletter 61(1995) 21-26. Walsh, J. H., and W. Peterson. The treatment of Helicobacter pylori infection in the management of peptic ulcer disease, The New England Journal of Medicine 333(15)(Oct. 12, 1995) 984.
Some people develop stomach ulcers or gastritis (irritation of the cells that line the stomach). This occurs in about 2 percent of people who have undergone the Roux-en-Y procedure (it is much more common in people who have undergone gastric banding). Stomach ulcers are generally responsive to medications and rarely require surgical correction.
Peptic ulcer disease (PUD) is the presence or history of ulcers of the stomach or duodenum. Some people with PUD have pain typically this is a gnawing or burning discomfort in the middle of the upper abdomen that may improve with eating. There can be associated nausea, vomiting, poor appetite, and weight loss. Frequently, ulcers are silent and cause no pain or symptoms but may be discovered on an endoscopy. Typically, PUD is not associated with GERD. The confusion about this is because frequently patients with GERD can have the same or similar symptoms to that of someone with an ulcer. The treatment for PUD and GERD can be the same with H2 blockers or PPI medications. Additionally, when patients with GERD have endoscopy or barium studies, an ulcer in the esophagus is commonly found. This is not peptic ulcer disease. Esophageal ulcers are not caused by an H. pylori infection. Esophageal ulcers are caused by
One specialist that may be called on is a gastroenterologist (a specialist in the digestive system and its disorders), also commonly known as a GI doctor. A gastroenterologist may be helpful for people with GI distress such as irritable bowel syndrome that does not respond to traditional therapies. Ideally, the gastroenterologist would screen for other GI conditions such as inflammatory bowel disease or celiac disease (autoimmune disorders that are often genetic), symptomatic diverticulitis (inflamed areas in the intestinal lining), and peptic ulcer disease (caused by erosions to the lining of the digestive system). Many patients who are diagnosed by a gastroenterologist with irritable bowel syndrome find it reassuring that their GI distress is not caused by a malignancy like cancer or any other progressive illness.
If antacids do not work or are not appropriate for my GERD what is the next step or tier ofmedications to try
To recap, there are several ways to stimulate stomach acid production and two effective classes of medications, called H2 blockers and proton pump inhibitors, or PPIs. The benefit of these drugs is they reduce or eliminate stomach acid and are very effective for the treatment of GERD or peptic ulcer disease (stomach or duodenal ulcers). Thus, these medications treat GERD before it happens and prevent it.
Patients with Billroth II gastrectomy jejunostomy are seen worldwide but in Asian countries, they are more frequent due to higher incidence of gastric cancer and peptic ulcer. Cases of Billroth II are some of the more difficult ERCP procedures. In a study involving 185 Billroth II ERCP procedures, the failure rate was 34 .74
The neurochemical mechanisms of needling provide analgesia (pain relief) promote homeosta-sis and tissue healing improve the immune system, digestive system, cardiovascular system, and endocrine system and promote psychologic adjustment for systemic integration. The integrated nature of these mechanisms explains why problems as different as asthma, tinnitus, irritable bowel, and gastric ulcers are all improved in the course of needling treatment for pain management. Needling therapy restores the body's control system and promotes self-healing through a systemic integration that is suppressed during disease or injury.
Diseases and syndromes that various medical studies indicate are less common among heavier people include . . . Comstock et al., Subcutaneous Fatness and Mortality, Am J Epidemiol 83, 548-63 (1966) Krieger et al., An Epi-demiologic Study of Hip Fracture in Postmenopausal Women, Am J Epidemiol 116, 141-48 (1982) Kauffmann and Brille, Bronchial Hypersecretion, Chronic Airflow Limitation, and Peptic Ulcer, Am Rev Resp Dis 124, 646-49 (1981) Hooy-man et al., Fractures from Rheumatoid Arthritis A Population-Based Study, Arth Rheumatism 27, 1353-61 (1984) Tverdal, Body Mass Index and Incidence of Tuberculosis, Eur J Resp Dis 69, 355-62 (1986).
Ascorbate reacts with nitrite forming NO, NO2, and N2, thus preventing the formation of nitrosamines. In addition to ascorbate in foods, there is considerable secretion of ascorbate in the gastric juice, and inhibition of gastric secretion for treatment of gastric ulcers, as well as reducing vitamin B12 absorption (Section 10.9.7), also inhibits this presumably protective gastric secretion of ascorbate (Mowat and McColl, 2001). As a result of secretion in gastric juice, the ratio of ascorbate in gastric juice to that in plasma is normally 4 to 5 1, but infection with Helicobacter pylori reduces this to 1 1. Loss of the protective effect against nitrosamine formation may be part of the mechanism by which H. pylori causes gastric cancer (Banerjee et al., 1994).
Homeless adults also suffer several medical problems due to undernu-trition. Common problems include anemia, dental problems, gastric ulcers, other gastrointestinal complaints, cardiovascular disease, hypertension, hypercholesterolemia, acute and chronic infectious diseases, diabetes, and malnutrition.
Crohn's disease affecting the gastroduodenal region occurs in fewer than 5 of patients and is usually associated with macroscopic disease in other parts of the gastrointestinal tract. Symptoms may resemble that of peptic ulcer disease and include epigastric pain, nausea and postprandial vomiting.
Before the discovery of Hpylori it was known that patients with duodenal ulcers secrete about twice as much acid as controls because they have twice as many parietal cells. Patients with gastric ulcer and those with functional dyspepsia have normal acid output and parietal cell count. Thus there was good evidence that acid played a major role in ulcer formation. Duodenal ulcers did not occur in achlorhydric people or in those secreting
Smoking is a dangerous habit that can result in many health risks. Smoking is associated with many cancers, heart disease, vascular disease, stomach ulcers, and lung disease, to name a few. Some studies have shown a link between smoking and GERD. Even though smoking does not directly cause GERD, it can exacerbate GERD symptoms.
PRV is frequently discovered incidentally when a complete blood count is performed for another reason. When symptoms are present, they are usually nonspecific. Fatigue, headache, and diaphoresis are common. Pruritis, often following a hot shower, is a frequent complaint. Up to 15 of patients may present with a thrombotic episode. Thrombotic cerebrovascular accidents, coronary artery thrombosis, Budd-Chiari syndrome, and pulmonary embolus all occur. Cavernous sinus thrombosis may also occur in untreated or poorly controlled disease. Erythromelalgia is specific to PRV and ET, and it is associated with an elevated platelet count and paradoxical vasodilation. It is characterized by redness, warmth, and a burning pain affecting the digits and responds promptly to aspirin. Gout may be a presenting manifestation of an MPD. There is an increased incidence of peptic ulcer disease in patients with PRV. Iron deficiency may occur and may initially mask the diagnosis. An elevated hematocrit with...
However, even seemingly serious indicators such as substantial weight loss ( 3 kg), anorexia, and nausea are surprisingly common in functional dyspepsia, which, being so much commoner than gastric cancer, accounts for far more cases. Thus, most symptoms are neither specific nor sensitive for any particular condition. Even the classic features of peptic ulcer such as relief of pain by antacids or food and nocturnal pain, though commoner in peptic ulcer (65 ,75 , and 75 respectively) are sufficiently common in functional dyspepsia (60 , 40 , and 43 respectively) to be unhelpful in differential diagnosis.
Hydrochloric acid is secreted in gastric juice by parietal cells in the stomach lining. This plays an important role in protecting the body from pathogens in food or water. In vivo and in vitro data documenting the bactericidal effects of gastric juice have been reviewed extensively (Smith, 2003 Martinsen et al., 2005). Decreased gastric acidity can occur through a variety of mechanisms. These include acquired disease states (atrophic gastritis) and surgery (vagotomy, gastric resection). However, the most common mechanism for gastric acid reduction is through medications. These include antacids (such as calcium carbonate), histamine H2 antagonists (such as cimetidine), and proton pump inhibitors (such as omeprazole). These are used for a variety of disorders, including peptic ulcer disease and gastroesophageal reflux disease (GERD) (Del Valle, 2005). These medications are very frequently used. A survey of prescription drug use data in the United States from 2000 to 2001 found that...
Peptic ulcer More recently, non-invasive tests for Helicobacter pylori have been suggested lack of Hpylori infection is a good predictor of the absence of peptic ulcer or gastric cancer. A retrospective study examined the effect of screening for Hpylori by serology before endoscopy in patients aged under 45 and not taking non-steroidal anti-inflammatory drugs. It found that positive serology was highly predictive of endoscopic abnormalities, and endoscopy workload would have been reduced by 23 if only the patients seropositive for Hpylori had been investigated. However, recent prospective trials have suggested that in general practices near patient serology tests may lack sufficient accuracy and that the strategy might even increase endoscopic workload. Up to 15 (and higher in some areas such as Glasgow) of dyspeptic patients infected with Hpylori may have peptic ulcer disease, so there is an argument for treating such patients, without first proving the presence of an ulcer by...
Aloe gel is traditionally used for burns, wounds and inflammatory skin disorders. There is good scientific evidence that aloe may be of benefit in these conditions however, the chemical composition of Aloe vera products will vary depending on geographical and processing factors. Traditionally, aloe is also used internally for dyspepsia, gastrointestinal ulcers and IBS. 2007 Elsevier Australia
In general, patients are usually young ( 40 years) and women are affected more than men. Abdominal pain is associated with a variable combination of other 'dyspeptic' symptoms, the commonest being nausea and bloating after meals. Morning symptoms are characteristic and pain or nausea may occur on waking. Direct enquiry may elicit symptoms suggestive of colonic dysmotility, such as pellet-like stools or a sense of incomplete rectal evacuation on defaecation. Peptic ulcer disease must be considered, whilst in older subjects intra-abdominal malignancy is a prime concern.
Initial empiric treatment with antacids or anti-secretory drugs A period of empiric treatment with antacids or H2 receptor antagonists has been the traditional strategy for managing patients with dyspepsia first consulting their doctor. This strategy recognises that most patients' symptoms are episodic and remit spontaneously and that the risk of peptic ulcer bleeding or perforation is extremely low. It also assumes that early diagnosis in the rare patient with malignant disease and no alarm symptoms has little effect on outcome. Investigate all patients by early endoscopy It has been argued that, as most dyspeptic patients end up having some investigation anyway, earlier investigation may prove more cost effective. However, cost effectiveness modelling has shown that if the incidence of peptic ulcer disease in dyspeptic patients is less than 10 , it would take more than five years for the costs of investigation to be recouped in savings from fewer prescriptions. Results of several...
The first description of DNA in plasma or serum was by Mandel and Metais in 1948.9 Using a perchloric acid precipitation method, they detected both DNA and RNA at a concentration of between 0.3 to 1.0mg l of plasma in healthy and sick individuals. This concentration is higher than that reported in more recent studies, probably reflecting both methodological and sample differences. It was not until the 1960s that the field was revisited when high levels of DNA were reported in the serum of patients with systemic lupus erythmatosis.10 Subsequent studies showed increased concentrations of free DNA in plasma or serum from patients with rheumatoid arthritis, pancreatitis, pulmonary embolism, ulcerative colitis, inflammatory bowel disease, peptic ulcer, and other inflammatory conditions.11-14 Increasingly sensitive assays were also able to detect small amounts of free DNA, up to 30 ng of soluble DNA ml, in the serum and plasma of healthy individuals.15
The majority of patients with peptic ulcers are infected with H. pylori (95-100 for DU 75-85 for GU). Although only a small proportion of all H. pylori-positive individuals are found to have peptic ulcer disease (1-6 ), this is a four- to tenfold increase of the number who are H. pylori-negative. The causal relationship between H. pylori infection and ulcers is further supported by the reduction of ulcer recurrence after H. pylori eradication. It is generally accepted, however, that other factors contribute to the pathogenesis of ulcers. It is known that smoking reduces healing and is also associated with peptic ulcer disease. Variations in bacterial strain virulence and host immune response may also be determinants of pathogenicity. Infection with H. pylori results in a chronic, active gastritis in the antrum or the entire stomach. Peptic ulcers have long been associated with a diffuse antral gastritis. Gastritis is not a predominant feature in other forms of peptic ulcer (e.g.,...
Duodenal ulcers are two to three times more common than gastric ulcers. Gastric ulcers are most frequent among those aged 40-70 years, whereas duodenal ulcers are most commonly seen between the age of 25 and 55 years. Thus, complications in gastric ulcers tend to be more severe because they tend to affect older individuals. Ulcer rates are declining rapidly for younger men and increasing for older individuals. Acid secretion patterns differ with the location of the ulcer. Duodenal ulcers are associated with high-acid secretion while proximal gastric ulcers are associated with a low-acid output. Distal gastric ulcers can have a normal- or high-acid output. The difference in acid output is a reflection of the effects of inflammation on the underlying cell types. Inflammation of the antrum and the body is much more pronounced in gastric ulcer than in duodenal ulcer. In addition, there is usually a progression of inflammation in gastric ulcers. As a result, this could
Helicobacter pylori A type of bacteria that can cause digestive illnesses, including inflammation and infection of the stomach lining, and peptic ulcer (sores on the lining of the stomach or small intestine). Experts believe that most such infections produce no symptoms, so a child can have an infection without knowing it. When the bacteria do cause symptoms, they are usually either symptoms of gastritis or peptic ulcer disease. Scientists suspect that H. pylori infection may be contagious, because the infection seems to run in families and is more common where people live in crowded or unsanitary conditions. In children, symptoms of gastritis may include nausea, vomiting, and pain in the abdomen, in addition to stomach ulcers. In older children, the most common symptom of stomach ulcers is a gnawing or burning pain in the abdomen, usually in the area below the ribs and above the navel. This pain typically gets worse on an empty stomach and improves with food, milk, or an antacid...
The histamine H2 receptor antagonists and proton pump inhibitors used to treat gastric ulcers and gastroesophageal reflux act by reducing the secretion of gastric acid considerably. Prolonged use will result in impairment of protein-bound vitamin B12 absorption. A number of studies have shown that even prolonged use of these drugs does not lead to significant depletion of vitamin B12 reserves.
Symptoms Nausea, vomiting, and constipation, often due to food poisoning, stress, stomach ulcers, or gastroenteritis. Other symptoms include a saliva-filled mouth and burning pain in the stomach, or heartburn. Stools are long, ribbonlike, and may be blood-streaked. Ice-cold foods and drinks are craved, but then cause vomiting once they warm up in the stomach. Symptoms better For lying on the right side for eating for cold foods or drinks. Symptoms worse For lying on the left side for stuffy rooms for emotional stress for warm foods or salt.
Lactic acid bacteria are often able to survive acidic gastric conditions and it has therefore been proposed that they may have a beneficial influence during the eradication of H. pylori. It has been reported that both the inhibitory substances produced and the specific strains may influence the survival of Helicobacter, and studies have been conducted, particularly with a L. johnso-nii strain. It has been shown that there is good in vitro inhibition and that fermented milk containing the strain has a positive effect when consumed during Helicobacter eradication therapy. However, more controlled human studies in different populations need be conducted to verify this effect.
In mild cases, light therapy can help up to 75 percent of those afflicted. It may be combined with a psoralen, a substance that makes skin more sensitive to light. Exposure times should be increased only gradually, and soothing, moisturizing ointments should be applied. Moderate cases of psoriasis are treated with dithranol or coal-tar ointments, corticosteroids, or vitamin D analogs. Severe cases may be treated with cytotoxic drugs such as methotrexate, which retards cell division. This may cause serious side-effects such as abnormal bleeding or a decreased resistance to infection. Nonsteroidal anti-inflammatory drugs may be used to treat psoriasis, but they may cause digestive problems, even stomach ulcers.
Anti-ulcer activity A number of in vivo studies have identified antiulcer activity for ginger extract and several of its isolated constituents. The orally administered acetone extract of ginger at a dose of 1000 mg kg and zingiberene, the main terpenoid in this extract, at 100 mg kg significantly inhibited gastric lesions by 97.5 and 53.6 , respectively. Additionally, the pungent principle, 6-gingerol at 100 mg kg, significantly inhibited gastric lesions by 54.5 . These results suggest that both zingiberene and 6-gingerol are important constituents responsible for ginger's anti-ulcer activity (Yamahara et al 1988). Other constituents demonstrating antiulcer properties in gastric ulcer models in rats include beta-sesquiphellandrene, beta-bisabolene, ar-curcumene and shogaol (Sertie et al 1992, Yoshikawa et al 1994).
H. pylori was once grouped with the campylobacter species of bacteria, Campylobacter pylori. Medical researchers have now placed H. pylori in its own category, noting its role in causing gastritis, stomach ulcers, and possibly two types of stomach cancer. In industrialized countries, the infection is rare in children, although risk of infection is higher for persons who live in overcrowded or unsanitary conditions. gle antibiotic, a combination of antibiotics may be given. The doctor will probably also prescribe antacid medication and medicine to block production of stomach acid. If a child has symptoms of bleeding from the stomach or small intestine, these symptoms will be treated in a hospital. Over time, with proper treatment H. pylori gastritis and stomach ulcers (especially ulcers in the duodenum, a portion of the small intestine) can often be cured.
Salicylates tannins (AHP, 1997). Commission E reports for oral use of bark, contraindications, adverse effects, and interactions on theoretical grounds similar to those of the salicylates (AEH). (All plants contain salicylates.) In view of the lack of toxicological data, excessive use, especially during lactation and pregnancy, should be avoided. Individuals with aspirin hypersen-sitivity, asthma, diabetes, gastrosis, gout, hemophilia, hepatosis, hypothrombinaemia, nephrosis, and peptic ulcers should be cautious with salicylates. Alcohol, barbiturates, and oral sedatives may potentiate salicylate toxicity. Beware of salicylate interaction with oral anticoagulants, methotrex-ate, metoclopramide, phenytoin, pronebecid, spironolactone, and valproate. Salicylates excreted in breast milk reportedly can cause macular rashes in breast-fed babies. Salicylate toxicity may cause dermatosis, gastrosis, hematochezia, nausea, nephrosis, tinnitus, and vomiting (CAN). Excessive use of the...
As mentioned, H. pylori causes peptic ulcer disease and is a risk factor for stomach cancer. Because of these risks treatment is recommended for patients with documented H. pylori infection. The treatment, however, is somewhat complicated. Usually, when a patient has an infection, such
Thus distribution of Hpylori gastritis determines acid secretion and the clinical outcome of Hpylori infection, be that duodenal ulcer, gastric ulcer, gastric cancer, or asymptomatic infection. Positive feedback may perpetuate the different patterns of gastritis for example, suppression of acid with a proton pump inhibitor diminishes antral gastritis but allows Hpylori to colonise the corpus, which then becomes inflamed. This shows that acid secretion normally protects the corpus from Hpylori infection. This effect has several important consequences
For patients who present with duodenal ulcers a proton pump inhibitor is an appropriate maintenance treatment. For patients with multiple erosions misoprostol is appropriate if tolerated. On current data there is little to choose between proton pump inhibitors and misoprostol with regard to efficacy in preventing gastric ulcers, but proton pump inhibitors are better tolerated.
If symptoms don't rapidly subside, however, they should be further investigated. Cost benefit analysis suggests that, although investigation is initially expensive, it increases patient satisfaction and is cheaper over the long term ( 2 years) by reducing prescription costs and reconsultation rates. Testing for Hpylori should be the first step, since a negative result allows one to exclude peptic ulcer with 90 confidence, provided that use of non-steroidal anti-inflammatory drugs is excluded.
Endoscopy and barium meal are the principal investigations. Endoscopy allows direct visualisation and biopsy of the carcinoma. Differentiation between benign and malignant gastric ulcers at endoscopy can be difficult, and several biopsies are therefore taken (ideally six) from all parts of the ulcer. Diagnostic accuracy approaches 100 if 10 samples are taken. A benign gastric ulcer is probably not a premalignant condition.
The devil is in the detail, and a careful detailed appraisal of a patient's history with a judicious approach to testing is necessary. Older patients or those with alarm features warrant prompt referral for endoscopy and further investigations as required. Testing for Hpylori infection will help in guiding management in the remainder between 20 and 60 of those with Hpylori infection will have peptic ulcer disease. For patients with Hpylori infection, one course of action is to refer them for endoscopy to determine who has peptic ulcer disease or functional dyspepsia (the two main considerations) and plan treatment accordingly (the test and endoscope strategy). Alternatively, a reasonable course of action is to treat infected patients with appropriate antibiotics and observe the clinical course (the test and treat strategy). Although treatment of infection may not cure functional dyspepsia (see below), it will usually eliminate the peptic ulcer diathesis and hence will often relieve...
FD functional dyspepsia, Oes oesophagitis and reflux without oesophagitis, DU duodenal ulcer, GU gastric ulcer, IBS irritable bowel syndrome, GS gallstone disease, ARD alcohol related dyspepsia, GCa gastric cancer. *Significant difference from other diseases FD functional dyspepsia, Oes oesophagitis and reflux without oesophagitis, DU duodenal ulcer, GU gastric ulcer, IBS irritable bowel syndrome, GS gallstone disease, ARD alcohol related dyspepsia, GCa gastric cancer. *Significant difference from other diseases dyspepsia and irritable bowel syndrome. Gastric ulcer, gastro-oesophageal reflux, gastric cancer, and gall stones account for 5-10 each, and rarer diseases such as diverticular disease, small intestinal Crohn's disease, colon cancer, and pancreatitis make up the rest.
The incidence of distal gastric carcinoma has fallen in the West, probably because of decreasing rates of infection with Helicobacter pylori, but it remains one of the main causes of death from malignancy worldwide. The incidence of proximal gastric cancer seems to be rising. These two gastric cancers depend on the distribution and severity of Hpylori gastritis, as discussed in the earlier chapter on the pathophysiology of duodenal and gastric ulcers and gastric cancer.1
Helicobacter pylori is a small, curved, highly motile, Gram negative bacillus that colonises only the mucus layer of the human stomach. Since its discovery in 1984, it has been recognised as the principal cause of peptic ulcer disease and as the main risk factor for the development of gastric cancer. However, most infected people ( 70 ) are asymptomatic. We therefore need to discover how infection is acquired, why ulcers or cancer occur in so few of those infected, and how this subgroup can be identified and treated.
If an antrectomy is being performed for gastric ulcer or a vagotomy and antrectomy is being performed for duodenal ulcer, the dissection is usually begun proximally and extends distally towards the duodenum, the opposite approach from a cancer operation. The reason for this difference is that the duodenum may be quite scarred in an ulcer operation, and dividing the stomach proximally allows the distal stomach to be lifted up and manipulated, providing better circumferential exposure of the duodenum.
Gastrinoma and Zollinger-Ellison syndrome are suspected in a patient with recurrent or refractory peptic ulcer disease and unexplained secretory diarrhea. In such patients, fasting gastrin level 100 pg ml is highly suspicious of this diagnosis (Jensen, 1996). Other common causes of gastric hypersecretion should be excluded, which includes treatment with proton pump inhibitors (PPI), atrophic gastritis and pernicious anemia. Approximately 25 of patients will present with diarrhea as primary manifestation without peptic ulcer disease (Perry and Vinik, 1995). Gastrinomas have a strong predilection for a gastrinoma triangle that includes the pancreatic head, first two-thirds of the duodenum and the porta hepatis (Howard et al., 1990). A significant proportion of gastrinomas are malignant, with up to one-third of patients presenting with liver metastases (Mittendorf et al., 2006). PPI therapy is highly effective for initial symptom management and somatostatin analogues have also shown...
The action of P. emarginatus seed hexanic crude extract (500 mg kg, p.o., for 6 days) in mouse paw edema induced by different stimuli was investigated (Carvalho etal., 1999). Inhibitions in the formation of granulomatous tissues by 10 , and of approximately 43 on neutrophil migration, were observed when compared to the control group. Similar results were found in a recent study by our group (Dutra et al., 2009a), in which EO (500, 300, and 100 mg kg) could prevent, in a dose-dependent manner, the number of ulcers and ulcer index in three different models ethanol, non-steroidal anti-inflammatory drug, and hydrochloric acid (HCl) ethanol-induced ulcer in mouse. P. emarginatus seed oil presented a similar protective action when compared to ranitidine (60 mg kg) in the first and second evaluated models. Figure 129.4 demonstrates the EO effect at the lower tested concentration (100 mg kg, p.o.) compared with the control (vehicle) and ranitidine (60 mg kg) in the ethanol-induced gastric...
Several In vivo studies have Identified anti-inflammatory and antinociceptive activity for feverfew extracts and parthenolide. When feverfew extracts were orally administered, or pure parthenolide was injected IP, significant dose-dependent antiinflammatory and antinociceptive effects were observed in animal models (Jain & Kulkarni 1999). Similarly, when feverfew extracts and parthenolide from Tanacetum vulgarewas administered orally in a rat model, gastric ulcer index was significantly reduced (Tournier et al 1999).
Helicobacter pylori is known to be an etiologic agent of gastritis and peptic ulcer disease in humans. Human LF supported full growth of the II pylori in media lacking other iron sources, but neither human TF, bovine LF, nor hen ovoTF served as a source for iron (Husson et al., 1993). Since hLF is found in significant amounts in human stomach resections with superficial or atrophic gastritis, the iron acquisition system of H. pylori by the hLF receptor system may play a major role in the virulence of H. pylori infection. Most H. pylori strains also seem to produce extracellular siderophores (Illingworth et al., 1993).
The classic symptom of ulcer is dyspepsia, a burning epigastric pain usually occurring 2-3 h after meals and at night (between 11.00 p.m. and 2.00 a.m.) when acid secretion is maximal. Relief often occurs with ingestion of food and alkali. Although suggestive of peptic ulcer, dyspepsia is not a sensitive or specific measure of peptic ulcer. Only about 50 of DU patients have the typical symptom of dyspepsia. Some ulcer patients develop a stomach that is easily irritated by food, mechanical distention, or other chemical stimuli. The sensitivity of radiography for the diagnosis of ulcers ranges from 50 to 90 , depending on the technical skill of the radiographer and the size and location of the ulcer. Fiberoptic endoscopy is a sensitive, specific, and safe method for diagnosing peptic ulcers. It gives the advantage of direct visualization and access to tissue for biopsy. Data from placebo-controlled trials show that untreated peptic ulcers can heal within 4 weeks in 30 of GU and 40 of DU...
Water extracts and methanol extracts of eight herbs of the Zingiberaceae were examined in intact unanesthetized rabbits for their effects on gastric secretion. Oral administration of either water or methanol extracts caused a significant decrease in gastric secretion. Since one possible cause of gastric ulcers is high acid output, water extracts of Zingiberaceae should be a rational therapy (14). Ginger extract was shown to improve gastroduodenal motility (56). Ginger contains pungent ingredients such as 6-gingerol and 6-paradol, which also have tumor antipromotion and antiproliferative effects (57).
The antibacterial effects of ITCs have been described on a number of occasions. The inhibitory effects of arylalkyl ITCs on the bacteria Escherichia coli and Bacillus subtilis are attributed to their reaction with cellular thiol groups disrupting cellular homeostasis. Indeed, the inhibition of polypeptide synthesis in the cell-free system of E. coli was attributed to the inactivation of ribosomes (43). In a study by Ono et al. identification of the active antimicrobial component in wasabi 6-methylsulfinylhexyl isothiocyanate was shown to have strong activity toward E. coli and Staphylococcus aureus (44). A comparison of the antibacterial properties of allyl isothiocyanate (AITC) with several antibacterial agents such as streptomycin, penicillin, and poly-mixin B has also been described. AITC induced a significant reduction in viability associated with the loss of membrane integrity in the bacteria S. montevideo, E. coli, and Listeria monocytogenes and was comparable to antibiotic...
In this rare disorder a gastrin secreting neuroendocrine tumour of the pancreas ('gastrinoma') is present with recurrent duodenal ulceration and diarrhoea. It accounts for only about 0.1 of all cases of duodenal ulceration (Misiewicz and Punder 2000). The syndrome occurs in either sex at any age, although it is most common between 30 and 50 years. Patients with Zollinger-Ellison syndrome present with pain as the predominant symptom from peptic ulcer disease they also have diarrhoea and steatorrhoea. Peptic ulcers are often multiple and severe and there is a poor response to standard ulcer medical therapy. The history is usually short bleeding and perforations are common.
Perforation of the gastrointestinal tract can occur in the oesophagus, stomach or duodenum. It can be the result of trauma, underlying pathology, ingestion of a foreign body, increased intraoesophageal pressure or mechanical trauma during upper endoscopy. Oesophageal perforation during therapeutic upper endoscopy most commonly occurs during dilatation of oesophageal strictures. It can also be the result of instrument trauma during an endoscopic procedure, caused by the instrument, dilators or biopsy forceps. Gastric perforation is less common than oesophageal perforation and is usually related to peptic ulcer disease.
NSAIDs, such as indomethacin and ibuprofen, are effective anti-inflammatory agents which damage the gastric mucosal barrier and are important causal factors in gastric ulcers (Misiewicz and Punder 2000). These drugs also reduce the integrity of the duodenal mucosa but are probably responsible for only a small proportion of duodenal ulcers. They greatly increase the risk of bleeding or perforation from pre-existing gastric and duodenal ulcers. past history of peptic ulcer
Underlying diseases have been investigated extensively as risk factors for foodborne illnesses on many occasions. However, the interaction between the humans and pathogens is dynamic and not static, so ongoing surveillance is necessary. For example, although gastric acid inhibitors may increase the number of people susceptible to enteric infections, antimicrobial treatment of peptic ulcer disease caused by H. pylori may decrease gastric acid inhibitor use. On the other hand, gastric acid inhibitor use may become more widespread, because histamine H2 antagonists are available without a prescription. The number of people with HIV infections or AIDS has increased, but HAART administration and antibiotic prophylaxis have decreased the number of HIV-infected people with opportunistic infections, including foodborne illnesses the impact of resistance to antiretroviral therapies on foodborne infections among AIDS patients is not yet understood (Vella and Palmisano, 2005). Exposure to...
Because of the low lipid and high energy values, bananas are recommended for obese and geriatric patients. Bananas are useful for people with peptic ulcers, for treatment of infant diarrhea, and for celiac disease and colitis. The potential of dried unripe plantain or banana pulp powder in the treatment of ulcers has been noted (Dunjic et al., 1993). Plantains contain vitamin A and thus can act as an aid to digestion. The juice from the male bud provides an apparent remedy for stomach problems in many people. The ripe fruit has also been noted for use in the treatment of asthma and bronchitis.
On the negative side, the chief side effect of many muscle relaxants is gastrointestinal distress, such as stomach pain and diarrhea. This gastrointestinal problem may range from mild to severe, depending on the particular drug and the particular patient. At the extreme end of side effects, muscle relaxants can damage the stomach, as with gastritis (an inflammation of the stomach) or even stomach ulcers or duodenal (small intestine) ulcers.
Eventually, though, after a series of questions about her diet and about whether she had had any history of stomach ulcers, she again became aggressive, even shouting at the doctor about there never having been anything like that in her family. And so it went on after they had admitted her. Each day, she would spend some time being almost obsequiously pleasant to some people, getting them clearly on her side, but then would round on them, throwing back any act of kindness shown to her in an almost vicious way.
Helicobacter pylori has been one of the most studied pathogens in recent times. Literature searches will yield nearly 22,000 results for studies and papers published on the subject. The excitement began in 1983, the year Drs. J.R. Warren and B. Marshall published their findings concerning an ''unidentified curved bacilli on gastric epithelium'' 1 . Their description was quite thorough and made a case for the association of this bacterium with gastric inflammation. Salient features were pointed out, such as their near ubiquity in active chronic gastritis yet absence when there was no inflammation and their distribution in relation to the mucous layer and adjacent to the gastric epithelial cells. Twenty-three years later, what is most compelling about the initial publication is the last sentence, which reads, ''They may have a part to play in other poorly understood, gastritis associated diseases'' (i.e., peptic ulcer and gastric cancer). Warren and Marshall were awarded the 2005 Nobel...
What determines the timing of suicide among substance abusers Substance abusers often accumulate interpersonal problems throughout their drinking or drug-use careers, but one-third of those who commit suicide sustain a major interpersonal disruption (such as separation or divorce) within the six weeks preceding their deaths. They often are unemployed, living alone, and unsupported by family and friends at the time of this final and most severe disruption. In contrast, only 3 percent of nonalcoholics with depression suffer such a loss in the period before they commit suicide. Beyond psychiatric diagnoses, the strongest indicator of suicide risk in substance abusers is such an interpersonal loss. Beyond these actual losses, anticipated losses, such as impending legal, financial, or physical demise may also increase the risk of suicide among substance abusers. Among alcoholics, those who develop serious medical problems, such as liver disease, pancreatitis, or peptic ulcers, are...
Although symptoms are neither sensitive nor specific, including demographic details will improve matters. The ratio of organic to functional disease steadily increases with increasing age, since malignancy is very rare under the age of 45 (none in most case series), while the incidence of peptic ulcer increases linearly with age because of the increasing incidence of H pylori infection. Smoking is also associated with an increased risk of peptic ulcer and gastric cancer. Sex may also be a useful indicator men are about twice as likely as women to have duodenal ulcer or gastric cancer, whereas women have a 50-60 increased risk of having irritable bowel syndrome and gallstone disease. Surprisingly, time taken off work from functional dyspepsia is as great or greater than it is from organic disease.
The attribution of these patients' illness to hypo-glycemia had its origins in the early 1950s with the appearance, in the US, of a book by Drs Abrahams and Pezet entitled 'Body, Mind and Sugar.' Other American practitioners, notably John Tintera, founder of the Hypoglycemia Foundation Inc., Stephen Gyland, Harry Saltzer and, others, including the medical writer Carlton Fredericks, publicized the concept. This led to 'hypoglycemia' being held, by a large section of the public, responsible for such diverse diseases as coronary artery disease, allergy, asthma, rheumatic fever, susceptibility to viral infections, epilepsy, gastric ulcer, alcoholism, suicide, and even homicide, as well as for a whole galaxy of symptoms in their own right. 'Hypoglycemia' was treated as though it were a disease entity and asserted by its advocates to be 'one of the most common illnesses in the United States' and that because of it 'thousands of Americans have forgotten, or perhaps never known, what it is...
220.127.116.11 Bismuth in the treatment of peptic ulcer A new aspect to ulcer therapy with bismuth compounds was given by the discovery in the early 1980s that the intestinal bacterium Helicobacter pylori probably plays a major role in the induction of gastric ulcers, and even gastric cancer. Bismuth is itself bacteriocidal, but its effect is weak, however, combination of bismuth with antibiotics such as amoxicillin or tetracycline can raise the success rate for ulcer therapy to about 80 , i.e. by about four times that achievable with bismuth alone.
Physicians have divided pains into three general categories. The first, and most common, is termed somatic pain. This results from tissue injury, such as a broken leg, metastases in the bone from cancer, muscle pulls, or ligament sprains. The second is termed visceral pain, which results from activation of pain fibers in internal organs, typically in the abdomen or chest. This category includes discomfort associated with gall bladder disease, peptic ulcers, or pancreatitis, to name a few. Unlike somatic pain, visceral pain is poorly localized. The most difficult pain to understand and to treat is deafferentation, or neuropathic pain, which is a consequence of injury to nerves. It is difficult for patients to describe these sensations, but they often use terms such as burning, shooting, or elec-triclike.'' This type of pain is commonly seen in cancer patients where tumors invade nerve bundles. It also is seen with mild damage to nerves. The most common class of injury is the peripheral...
Mucilage, a word that is cognate with mucus, is extremely soothing to any inflamed part of the body, both outside and within. This includes dry coughs, colds, gastrointestinal upsets, stomach ulcers, and urinary tract infections. As one herbalist notes, when you cannot even swallow water, you can take a mallow tea. Further, it is very safe, in any quantity.
WO3) Epilepsy (f KAP) Erysipelas (f CRC EGG) Erythema (f12 X15857459) Escherichia (1 NP9(2) 8) Fever (f DEP GHA VOD NP9(2) 8) Flu (1 NP9(2) 8) Fracture (1 RCP7(1)) Frostbite (f12 APA PH2 WHO NP9(2) 8) Fungus (1 AAB APA MPI PH2) Gastrosis (f CRC VOD WO3) Gingivosis (f WO3) Glaucoma (f WHO) Glioma (1 X15747063) Glossosis (f JLH) Gonorrhea (f JFM) Headache (f GHA VOD) Hemorrhoid (f APA CRC WHO) Hepatosis (f1 BEJ CRC DEP RCP6(1)) Herpes (12 AAB PH2 NP9(2) 8 RCP7(1)) High Cholesterol (1 WO3 X14598919) High Triglycerides (1 JAC7 405) HIV (1 WO3) Hysteria (f CRC VOD) IBD (12 X15043514) Immune Deficiency (1 CAN PNC) Impotence (f NP9(2) 8) Indigestion (1 WAM) Infection (f1 APA BEJ PH2 NP9(2) 8) Infertility (1 CRC MPI) Inflammation (f1 CAN CRC GHA PH2 VOD WHO NP9(2) 8 X15182910) Intoxication (1 X8937458) Ischemia (1 PH2) Itch (f DAA) Jaundice (f CRC KAB) Klebsiella (1 NP9(2) 8) Leprosy (f KAB) Leukemia (f CRC JLH) Leukorrhea (f JFM) Lumbago (f KAB) Measles (1 NP9(2) 8) Mouth Sores (f1 CAN EGG)...
Ulcers usually form in the duodenum, the upper part of the small intestine a peptic ulcer is in the stomach as well as the duodenum and is so called because of the involvement of pepsin, a digestive enzyme. Ulcers are sores that can bleed. They form when there is too much acid for the mucosal lining to tolerate. They are often caused by an infection of the bacteria, Helicobacter pylori food allergies are also a possibility. It is believed that this bacteria releases acids into the area and may also be the cause of gastritis. Antibiotics are necessary for its eradication.
NSAID-induced ulcers are more commonly gastric ulcers. The prevalence of ulcers is more than 15 among chronic NSAID users and less than 4 among those using NSAIDs for less than 1 year. Gastritis or H. pylori infection is not a prerequisite for NSAID-induced ulcers. The damaging effect of NSAIDs is thought to be due to their effect on pros-taglandin synthesis. Endogenous prostaglandin aid in maintaining gastric mucosal blood flow and epithelial integrity and promote epithelial regeneration. NSAIDs reduce prostaglandin synthesis thus reducing the effect of prostaglandin in mucosal defense.
Metabolic alkalosis may be caused either by the excessive loss of acid or intake of alkali. The latter may be iatrogenic or factitious, with the excessive intake of prescribed antacids (such as sodium bicarbonate for heartburn or peptic ulcer disease) - the 'milk-alkali' syndrome. The loss of acid-rich gastric secretions in severe vomiting, for example, in cases of gastric outlet obstruction (due to pyloric stenosis, or a consequence of peptic ulcer disease), also leads to alkalosis. Compensation is by reducing ventilation to promote retention of CO2 and thus balance the Henderson-Hasselbalch equation. Treatment is of the underlying condition rather than by administration of acid.
Alcohol is not a nutrient, but 80 percent of consumed alcohol is absorbed in the small intestine. The other 20 percent is absorbed into the stomach. Alcohol is absorbed by simple diffusion, which explains why gastric ulcers are not uncommon in people who drink excessively.
Polysaccharides derived from dong quai have been found to have a protective effect on colon injury in acetic acid-induced rat colitis, through promotion of growth factors, decreasing oxygen free radicals and some anti-inflammatory effects (Liu et al 2004), as well as relieving the inflammation reaction and colon injury in immunological colitis in rats (Liu et al 2003a,b). A polysaccharide containing extract of dong quai was also shown to promote migration and proliferation of normal gastric epithelial cells and enhance gastric ulcer healing in animal models (Ye et al 2003).
Despite a vast amount of research, the only evidence based indications for eradication of Hpylori are for patients with duodenal ulcer or gastric ulcer who are not taking NSAIDs and for patients with the extremely rare MALT lymphoma. Low dose triple therapy given for one week will cure most patients of their infection failures are due to bacterial resistance or poor compliance. The importance of Hpylori in NSAID associated ulceration is uncertain. Although Hpylori is strongly associated with gastric cancer, there is no proof that eradication treatment decreases an individual's risk of that disease. Gastric ulcers not due to NSAIDs Duodenal or gastric ulcers due to NSAIDs The endoscopic image of benign gastric ulcer is reproduced with permission of Gastrolab Image Gallery.
As with duodenal ulcer, eradication of Hpylori leads to healing of gastric ulcer and markedly decreases the incidence of relapse. Eradication of Hpylori also seems to reduce the complications associated with gastric ulcer, but the supporting evidence is less strong than for duodenal ulcer. Maintenance treatment with antisecretory drugs should therefore be started after successful eradication of Hpylori in those patients with gastric ulcer who have a history of haemorrhage or perforation until complete healing of the ulcer is confirmed at endoscopy.
Most dyspeptic patients have no clinically significant abnormalities on investigation. Up to 20 may have endoscopic reflux oesophagitis, and 15-20 may have peptic ulcer disease, including duodenitis. A declining proportion, currently around 2 , will have a gastric or oesophageal cancer, with other alarm symptoms such as dysphagia or weight loss usually being present. Whether dyspepsia is becoming more common is unclear, but general practice consultations for non-ulcer dyspepsia have been increasing. In contrast, morbidity and mortality resulting from peptic ulcer disease is declining mortality from oesophageal cancer has now overtaken mortality from gastric cancer, which has declined steeply over the past 50 years.
Non steroidal anti-inflammatory drugs and peptic ulcers facts and figures multiply, but do they add up BMJ 1990 300 278-84. Figure 8.7 Rofecoxib and celecoxib, selective COX-2 inhibitors, can relieve pain and inflammation without risking gastric ulceration Figure 8.7 Rofecoxib and celecoxib, selective COX-2 inhibitors, can relieve pain and inflammation without risking gastric ulceration
Figures 9.1,9.2., 9.3 Endoscopic stigmata associated with high risk of further gastrointestinal bleeding. Top left an active, spurting haemorrhage from a peptic ulcer is associated with an 80 risk of continuing bleeding or rebleeding in shocked patients. Top right a non-bleeding, visible vessel represents either a pseudoaneurysm of an eroded artery or a closely adherent clot, and 50 of such patients rebleed in hospital. Left large varices with red spots are also strongly associated with bleeding Figures 9.1,9.2., 9.3 Endoscopic stigmata associated with high risk of further gastrointestinal bleeding. Top left an active, spurting haemorrhage from a peptic ulcer is associated with an 80 risk of continuing bleeding or rebleeding in shocked patients. Top right a non-bleeding, visible vessel represents either a pseudoaneurysm of an eroded artery or a closely adherent clot, and 50 of such patients rebleed in hospital. Left large varices with red spots are also strongly associated with...
When the critical balance between generation of free radicals and other ROS or RNS and the antioxidant defenses is unfavorable, oxidative damage can accumulate. Oxidative stress is defined as a condition that is characterized by accumulation of non-enzymatic oxidative damage to molecules that threaten the normal function of the cell or the organism (Blomhoff, 2005). Compelling evidence has emerged in the past two decades demonstrating that oxidative stress is intimately involved in the pathophysiology of many seemingly unrelated types of disease. Thus, oxidative stress is now thought to make a significant contribution to all inflammatory diseases (arthritis, vasculitis, glomerulonephritis, lupus erythematosus, adult respiratory distress syndrome), ischemic diseases (heart disease, stroke, intestinal ischemia), cancer, hemochromatosis, acquired immunodeficiency syndrome (AIDS), emphysema, organ transplantation, gastric ulcers, hypertension and pre-eclampsia, neurologic diseases...
Common cold prevention A 12-week, double-blind randomised study involving 146 people demonstrated that allicin-containing garlic preparations significantly reduce the incidence of colds and accelerate recovery compared with placebo (Josling 2001). More specifically, the number of symptom days in the placebo group was 5.01 compared with 1.52 days in the garlic treated group. Additionally, garlic reduced the incidence of developing a second cold whereas placebo did not. Helicobacter pylori infection It has been suggested that gastrointestinal lesions, such as gastric ulcers, duodenal ulcers and gastric cancers, are strongly associated with H. pylori infection (Scheiman & Cutler 1999). Medical treatment consisting of 'triple therapy' has a high eradication rate, yet is associated with side-effects and has started to give rise to antibiotic resistance. Since garlic intake has been associated with a lowered incidence of stomach cancer, researchers have started investigating whether garlic...
Although no clinical studies are available, one study using an animal model of aspirin-induced gastric ulceration has identified significant antiulcer activity for the fresh juice from the whole plant of Bacopa monniera (Rao et al 2000). The study found that brahmi had a beneficial influence on the natural mucosal defensive factors, such as enhanced mucin secretion, mucosal glycoprotein production and decreased cell shedding, thereby reducing ulceration (Rao et al 2000). A follow-up in vivo study in various gastric ulcer models further confirmed brahmi's ability to increase the body's Brahmi 140 prophylaxis and treatment of gastric ulcers (Sairam et al 2001). In addition, brahmi was shown to reduce lipid peroxidation. An in vitro study demonstrated that B. monniera significantly inhibited Helicobacter pylori and the effect was comparable to that of bismuth subcitrate, a known H. pylori growth inhibitor (Goel et al 2003).
Since its description in 1983, H. pylori has been implicated as a causative agent of gastritis, gastric adenocarcinomas, gastric B cell lymphoma, and peptic ulcer disease. In developed countries, the prevalence increases with age, whereas in developing countries, most children are infected by the age of 10 years. Transmission is believed to be by person-to-person spread, although the means of spread is unclear. Intrafamilial transmission is suggested by several epidemiologic studies. Acute infection with H. pylori induces a neutro-philic gastritis accompanied by transient hypo-chlorhydria. Chronic infection results in a chronic superficial gastritis characterized by neutrophils, eosinophils, and B and T lymphocytes. Inflammation is a result of bacterial products (e.g., VacA, CagA) and factors produced by gastric epithelial cells (e.g., cytokines). Most individuals with chronic infection remain asymptomatic. One in six chronically infected individuals will develop peptic ulcer disease....
Nausea, or the feeling of a need to vomit, is not necessarily followed by vomiting, the involuntary expulsion of the contents of the stomach, but the causes of the two are the same. Nausea and vomiting may be symptoms of digestive disorders caused by eating fatty foods, drinking too much alcohol, food poisoning, or infections such as gastroenteritis (see below). Stress, migraine, or the hormonal changes associated with menstruation or pregnancy (see page 262) may also trigger these conditions. Nausea and vomiting may also indicate more serious ailments, many of which are digestive disorders, such as a peptic ulcer (erosion of areas of the digestive tract by acidic gastric juices) or cancer of the stomach, but some of which are connected to the brain and nervous system. Self-help treatments are not appropriate in these cases. SELF-HELP Drink small amounts of cooled, boiled water frequently and avoid solid foods. If you smoke, stop. CAUTION If vomiting persists for more than 48 hours,...
Indigestion is a blanket term for a number of symptoms that include excessive burping, stomachaches, and heartburn (see below). It may be caused by the defective production or flow of digestive enzymes, fluids, or hormones, or by something more serious such as a peptic ulcer. Alternatively, it may result simply from eating too much, or eating the kinds of food that the digestive system finds difficult to process. Indigestion tends to worsen with stress and with age.
Peptic ulcers can result from autodigestion, which occurs when the natural defences, such as the protective mucous lining of the stomach and duodenum, are breached. The various drugs prescribed for peptic ulcer disease promote healing by reducing gastric acid secretion, buffering secreted gastric acid and or enhancing intrinsic mucosal defences. The classes of drugs used for these purposes include antacids, H2 blockers, proton-pump inhibitors, anticholinergic agents and prostaglandins. Antacids have been discussed earlier in this chapter. H2 blockers include cimetidine and ranitidine. They reduce the secretion of gastric acid by blocking histamine's action on the H2 receptors in the parietal cells. H2 blockers may also reduce gastric acidity in patients with upper gastrointestinal bleeding that stems from a peptic ulcer. Prostaglandins (i.e. misoprostal) have an antisecretory effect. They may be used to prevent gastric ulcers and mucosal injury that are associated with the use of...
Helicobacter pylori, which is known to predispose to peptic ulcer disease, has also been linked to gastric carcinoma. HP infection may be responsible for 6070 of cases and acquisition of infection at an early age may be important. Although the majority of HP-infected individuals have normal or increased acid secretion, a few become hypo- or achlorhydric and these people are thought to be at greatest risk (www.helico.com accessed 8 May 2004).
Peptic ulcers can develop in the oesophagus, stomach or duodenum. Around 80 of all peptic ulcers are duodenal ulcers (Misiewicz and Punder 2000). Duodenal ulcers are most common in men aged between 20 and 50 years and in individuals who have type O blood. It is now well recognised that Helicobacter pylori, a spiral Gram-negative bacteria, is present in the stomach of over 80 of individuals who present with gastric or duodenal ulcers. The presence of Helicobacter pylori leads to impairment of the function of the protective mucosal membrane. In peptic ulcer disease, erosion of the affected mucosa can lead to haemorrhage, perforation and peritonitis. The typical clinical presentation of duodenal ulcers includes gnawing or burning epigastric pain occurring shortly after meals, heartburn and nocturnal pain. The epigastric pain can be exacerbated by certain foods (i.e. fatty food) but relieved by others (i.e. milk).
Chronic gastritis is common in adults and may be associated with a number of conditions including gastric ulcers and Helicobacter pylori (HP). It usually involves the gastric body and antrum of the stomach. Most patients are asymptomatic and do not require any treatment. At present there is no indication for widespread use of HP eradication therapy in patients with chronic gastritis but without evidence of peptic ulcer disease. Chronic gastritis can be classified as
Anticholinergics are commonly given as premedication, in order to dry bronchial and salivary secretions. These drugs have an antimuscarinic activity, with a depressant action on the vomiting centre and an antispasmodic action on the gastrointestinal tract. Hyoscine and atropine are examples of anticholinergics. Side-effects include dilation of the pupils, dry mouth and drowsiness. Anticholinergics may also be used in the treatment of peptic ulcer disease, irritable bowel syndrome, pancreatitis, gastritis and diffuse oeso-phageal spasm. Anticholinergic medications are contraindicated in older patients, who may be more susceptible to the central anticholinergic side-effects of dizziness, glaucoma and urinary retention.
Acute gastritis often produces no symptoms but may cause dyspepsia, anorexia, nausea or vomiting, haematemesis or melaena. Many cases resolve quickly and do not merit investigation in others endoscopy and biopsy may be necessary to exclude peptic ulcer, cancer or bleeding. Treatment should be directed to the underlying cause. Acute gastritis almost always responds to conservative therapy with oral antacids.
Chronic illnesses are chronic simply because, as yet, there is no cure. An acute illness like strep throat used to be chronic or even deadly because scientists had not isolated the bacteria causing the illness and had not developed the antibiotics to cure the illness. In the past scarlet fever, which is a consequence of strep throat, was a death sentence for millions. Now, it is just an inconvenient day away from work and school and a trip to the pharmacy. More recently, gastric ulcers were a cause of significant lifelong suffering. Patients were told to reduce stress in their lives, and this sometimes included quitting their jobs and leaving their families. They also were encouraged to avoid spicy foods and drink more milk. All of these therapies were largely ineffective. In some cases, people with long-standing gastric ulcers died from the bleeding in their gastrointestinal tract. In the late 1900s, a cure was found. Now people with gastric ulcers take a breath or blood test,...
Emotion can be involved in any medical condition. For example, a broken leg can lead to anger and frustration, anxiety, fear, sadness, and so on. Or it may be that one's emotional condition was a precipitating factor in whatever led to the leg being broken in the first place. But the most problematic circumstance comes with the idea of psychosomatic disorders, in which the disorder is clearly physical (migraine, skin rashes, indigestion, peptic ulcers, asthma, genito-urinary conditions, and so on) but the causative factors seem to be emotional. The emotion most commonly implicated is anxiety. The extent of the emotional is hard to determine, one view being that all illness has an emotional component, causa-tively. For example, long-term stresses may well have a deleterious impact on the efficacy of the immune system and thus leave a person more vulnerable to infection.
Balance can vary from time to time and person to person within one disorder. For example, a stomach ulcer might have its main cause in the food eaten or it might have its main cause in living a stressful life. Whatever the balance of causes, it remains a stomach ulcer. So, to say to someone 'It's just psychological' or 'It's all in your mind' is nonsense.
Imagine the body attacking and damaging its own tissues. When a person has a gastric or peptic ulcer, the hydrochloric acid in the stomach attacks the walls of the stomach, damages the mucosa, and may lead to severe bleeding that compromises the body's ability to deliver adequate oxygen to tissues. This bleeding results in severe anemia.