Clinical features of peptic ulcers

The most common clinical presentation is recurrent abdominal pain, which is localised to the epigastric region, is related to the intake of food and has an episodic pattern. Pain is referred to the epigastrium and is often so sharply localised that the patient can indicate its site with two or three fingers (the 'pointing sign'). Pain occurs intermittently during the day, often when the stomach is empty, such that the patient identifies it as 'hunger pain' and achieves relief by eating. Night...

Pathophysiology of GORD

Occasional episodes of GORD are common in health, particularly after eating. Gastro-oesophageal reflux disease develops when the oesophageal mucosa is exposed to gastric contents for prolonged periods of time, resulting in symptoms and, in a small proportion of cases, this leads to oesophagitis. Abnormalities of the lower oesophageal sphincter related to GORD In health the lower oesophageal sphincter is tonically contracted, relaxing only during swallowing. Some patients with GORD have reduced...

Control of pancreatic juice secretion

The control of exocrine secretion of the acinar cells of the pancreas is via peptides, such as the hormones secretin and cholecystokinin, and somatostatin, which acts mainly as a paracrine factor, and via neurotransmitters. The main hormones involved in stimulating secretion of pancreatic juice are secretin, which stimulates the secretion of the alkaline aqueous component, and cholecystokinin (CCK), which stimulates the secretion of the enzyme component. These hormones are produced in the...

Types of Crohns disease

The commonest symptoms of extensive colonic involvement are diarrhoea and general malaise, often associated with anorexia and weight loss. Unlike the pattern in small intestinal Crohn's disease, obstructive symptoms are uncommon, though vague persistent abdominal discomfort is often a feature. Left-sided disease is commoner in older patients and symptoms can mimic diverticular disease, with attacks of pain in the left lower abdominal quadrant and intermittent diarrhoea. Crohn's colitis may be...

Conclusion

Crohn's disease and ulcerative colitis are potentially serious and even life-threatening chronic conditions that have remitting and relapsing natures. The causes of these conditions remain obscure and the search for environmental factors has only made limited progress. Lack of understanding may lead to distress, anxiety, exclusion, loss of self-esteem and impaired health-related quality of life for people with IBD. Further information for sufferers of Crohn's disease is available from Patient...

Clinical features of GORD

The most common symptoms of oesophageal reflux are dyspepsia, heartburn and regurgitation, which can be provoked by bending, straining or lying down. Waterbrash, which is salivation due to reflex salivary gland stimulation as acid enters the gullet, is often present. A history of weight gain is common. Some patients are woken at night by choking as refluxed fluid irritates the larynx. Other less common symptoms include dysphagia (difficulty swallowing), odynophagia (pain on swallowing), and...

Bile pigments in the gastrointestinal tract

After delivery to the intestines most conjugated bilirubin is excreted in the faeces. This is due to the intestinal mucosa not being very permeable to the conjugated bile pigment. However, some bilirubin may be deconjugated by the action of bacteria in the intestines and the free bilirubin formed can be partially absorbed. Intestinal bacteria can also convert bilirubin to colourless derivatives known as urobilinogens, which can be absorbed into the portal blood. These are then secreted in bile...

Management of IBS

Despite the development of several new drugs, current pharmacological treatments have limited value in the management of IBS. Pharmacological options tend to focus upon the predominant IBS symptom(s) and generally treatment is empirical patients may need to receive a number of different agents. Drugs currently recommended by the British Society of Gastroenterology (2000) are summarised in Table 6.4. Non-pharmacological interventions psychological Although it is unlikely that psychological...

Complications of peptic ulcer disease

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. Although perforation may be the first sign of an ulcer, there is commonly a history of recurrent epigastric pain. The most striking symptom is sudden, severe pain its...

Investigation of peptic ulcer

Diagnosis can be made by double-contrast barium meal examination or by endoscopic investigation. Endoscopy is the preferred investigation because it is more accurate and has the enormous advantage that suspicious lesions and HP status can be concurrently evaluated by biopsy. For those with a duodenal ulcer seen at barium meal, urea breath testing will accurately define the HP status. In gastric ulcer disease endoscopy must be repeated after suitable treatment to confirm that the ulcer has...