Disorders of the Stomach and the Duodenum

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Most digestion of food occurs in the stomach and duodenum. This portion of the digestive tract produces and receives from other organs a wide range of chemicals to break down food for nutrient absorption. The stomach uses both mechanical means and chemicals (such as hydrochloric acid and pepsin) to break down food. The duodenum releases hormones that stimulate the pancreas to ensure the proper release of enzymes to digest carbohydrates, proteins, and fats. The duodenum releases another hormone to stimulate the gallbladder to contract and release bile (which is made in the liver and stored in the gallbladder) into the duodenum to digest fats. This tremendous concentration of powerful chemicals accounts for many of the problems that can occur in the stomach and duodenum.

Common Symptoms
Almost everyone has experienced indigestion (also known as an upset stomach or dyspepsia). This painful, burning sensation in the upper abdomen is often accompanied by nausea, bloating, belching, and sometimes vomiting. Indigestion is usually a symptom of a digestive disorder, such as an ulcer. However, some people have persistent indigestion that has no identifiable cause; this is called functional indigestion or nonulcer indigestion. Smoking, drinking too much alcohol, taking certain medications, or being exhausted or stressed can cause or worsen indigestion.

If you frequently experience indigestion, see your doctor so that he or she can examine you, determine the cause of your symptoms, and provide treatment. Contact your doctor promptly if your indigestion is accompanied by vomiting, weight loss, lack of appetite, blood in vomit or stool, pain when you eat, or severe pain in the upper abdomen. Symptoms of indigestion accompanied by shortness of breath, sweating, or pain radiating to the jaw, neck, or left arm can be warning signs of heart disease or a heart attack.

As with heartburn, you should not rely on antacids to treat indigestion. You may find that certain foods or situations (such as exercising too soon after eating) are related to your indigestion. Smoking, especially just before meals, often causes or aggravates indigestion.

Peptic Ulcer
A peptic ulcer is a hole or a break in the mucous membrane that lines the digestive tract, allowing digestive acids to come in contact with cells in the lining, injuring them. Peptic ulcers most often occur in the first few inches of the duodenum (duodenal ulcers) or in the stomach (gastric, or stomach, ulcers). While stomach ulcers occur more frequently in women than in men and generally develop after age 60, duodenal ulcers are the most common type of ulcer among both men and women and usually first occur between ages 30 and 50.

Many people who have a peptic ulcer have no symptoms, but most experience a burning or gnawing pain in the abdomen. Pain caused by a duodenal ulcer tends to follow a consistent pattern: pain is absent on awakening, appears by midmorning, is relieved by eating, recurs 2 to 3 hours after each meal, and wakes the person during the night. This pattern continues for a week or more, but the pain may disappear without treatment and then recur months or even years later. With gastric ulcers, eating causes rather than relieves the pain. Other symptoms of both types of peptic ulcers include feeling bloated, belching, nausea, vomiting, and weight loss. If the ulcer is bleeding, blood will appear in vomit or stool. Blood in vomit may appear as red streaks or brownish black and look like coffee grounds. Blood in feces causes black, sticky stool. Talk to your doctor immediately if you see signs of blood in your vomit or stool.

Contrary to popular belief, peptic ulcers are not caused by eating spicy foods or by stress. However, long-term use of painkillers such as aspirin or ibuprofen can interfere with the stomach’s natural ability to protect itself against exposure to stomach acid and other digestive juices and can lead to ulcer formation. If you develop an ulcer from taking painkillers regularly, your doctor will recommend that you stop using them immediately and will probably prescribe ulcer-healing medication (such as cimetidine, famotidine, or ranitidine) to decrease the amount of acid in your stomach or medication (such as sucralfate) to protect the stomach lining from digestive juices. The ulcer should heal.

Over-the-counter antacids may provide temporary relief from symptoms of heartburn, indigestion, and excess stomach acid, but they also may mask symptoms of a more serious underlying disorder. Always use caution when self medicating with over-the-counter antacids, and talk to your doctor if you use antacids regularly.

The most common cause of peptic ulcer is a bacterium called Helicobacter pylori (H pylori). These corkscrew-shaped bacteria burrow into the protective lining of the stomach or small intestine and attach to underlying cells. The bacteria then release chemicals that further damage the mucous membrane and expose the cells to the damaging effects of hydrochloric acid and pepsin. This usually causes inflammation of the stomach (gastritis) and can lead to formation of an ulcer. Helicobacter pylori may be responsible for more than 80 percent of all stomach ulcers and more than 90 percent of all duodenal ulcers.

If you have symptoms of an ulcer, see your doctor. He or she will probably recommend an examination of your stomach and duodenum using either an upper gastrointestinal (GI) series or endoscopy (see “Diagnostic Procedures,” Post). If an ulcer is found, tissue collected during endoscopy will be examined for H pylori. Blood tests also can be used to detect H pylori.

If the ulcer is caused by H pylori, your doctor will probably recommend treatment for 2 to 3 weeks with antibiotics (usually two different drugs) and ulcerhealing medication to decrease the amount of acid in your stomach or medication to protect the stomach lining. This “triple therapy” kills the bacteria and promotes healing of the ulcer.

The following self-help measures can help you deal with a peptic ulcer:

• Quit smoking.
• Avoid drinking alcohol, coffee, or tea.
• Avoid using nonsteroidal anti-inflammatory drugs such as aspirin or ibuprofen regularly.
• Try eating five or six small meals a day instead of three large meals.

If untreated, an ulcer can cause serious health problems. For example, as an ulcer eats away at the stomach or duodenal wall, blood vessels may be damaged and may bleed into the digestive tract. This can lead to anemia, which causes symptoms such as dizziness, weakness, and fatigue. If a large blood vessel is damaged, the bleeding is life-threatening and requires immediate medical treatment. Symptoms of damage to a large blood vessel include weakness or dizziness when standing, vomiting blood, and fainting. The bleeding usually can be stopped in a procedure using an endoscope (viewing tube), but general surgery may be required.

Over time, an untreated ulcer may cause a perforation (hole) in the wall of the stomach or duodenum. This allows bacteria and partially digested food to leak into and infect the sterile abdominal cavity, which, in turn, can lead to peritonitis (inflammation of the peritoneum, the membrane that lines the wall of the abdominal cavity and covers the abdominal organs). A perforated ulcer causes sudden, sharp, severe abdominal pain. A peptic ulcer that has perforated, is bleeding, or has not responded to treatment with medication usually requires surgery to correct the problem. The type of surgery depends on the size and location of the ulcer and whether there are complications (such as perforation).
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