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Chicago Endoscopy Center

3536 W. Fullerton Ave.
Chicago, IL 60647
Phone: 773-772-1212
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The Stomach

The Stomach


Gastritis


Overview

Gastritis is an inflammation or irritation of the stomach lining and is associated with a variety of conditions. It develops when the stomach's powerful protective layer - the mucous-bicarbonate barrier - is overwhelmed and the stomach lining is exposed to the caustic gastric acids the body uses to break down food.

While gastritis is often caused by a bacterial infection, it can also occur as a result of too much alcohol, long-term use of nonsteroidal anti-inflammatory drugs (such as aspirin), or even stress. It can be a painful condition that, left untreated, may lead to more serious problems such as blood loss, ulcers, or an increased risk of cancer. In most cases, however, patients will see a rapid improvement with the proper medical care.


Symptoms

Gastritis is most commonly associated with recurrent stomach pain and upset. Other symptoms include nausea, vomiting, indigestion, bloating, loss of appetite, and a feeling of fullness or burning in the upper abdomen. More serious signs such as vomiting blood and black or bloody stools indicate that your stomach lining may be bleeding and call for immediate medical attention.


Causes and Risk Factors

A number of conditions can lead to gastritis including:

  • Bacterial infections such as Helicobacter pylori, E. coli, or Salmonella
  • Excessive alcohol consumption or cocaine use
  • Regular or prolonged use of pain relievers and anti-inflammatory drugs
  • Stress
  • Major surgery
  • Severe injury or burns
  • Certain diseases such as pernicious anemia, bile reflux, and autoimmune disorders

Diagnosis

Your physician will discuss your medical history and symptoms with you, which is usually enough to identify gastritis. However, additional testing may be necessary to isolate the underlying cause that is triggering gastritis, particularly to determine if an infection is the root problem. Procedures may include:

  • Blood test
  • Stool culture
  • Upper gastrointestinal X-ray
  • Upper gastrointestinal endoscopy
  • Breath test for H. pylori infection

Treatment

Reducing the amount of acid in your stomach will help alleviate gastritis and allow the stomach lining to heal. Medications such as over-the-counter antacids, prescription acid blockers, and proton-pump inhibitors can all be effective in lowering stomach acid levels. If an underlying infection is triggering gastritis, your doctor may prescribe antibiotics as well. Treating other illnesses that may be causing your gastritis will generally lead to a reduction in your symptoms. You may also find that avoid certain foods, beverages, or medications (such as aspirin) will ease your condition.



Peptic Ulcer Disease


Overview

A peptic ulcer is an open sore on the inner lining of the stomach (gastric ulcer) or upper small intestine/duodenum (duodenal ulcer). It is a common condition that affects one in 10 Americans at some point in their lives. Peptic ulcers develop when the protective barrier of the stomach or intestine breaks down, often due to a bacterium called Helicobacter pylori (H. pylori). This breach allows digestive fluids, which contain strong chemicals like hydrochloric acid and an enzyme called pepsin, to damage the sensitive underlying tissues.

Peptic ulcers can lead to serious complications if left untreated, including internal bleeding, perforation (when the ulcer eats a hole through the stomach wall or intestine), and narrowing and obstruction (when the ulcer occurs where the stomach and duodenum meet and blocks food from leaving the stomach).


Symptoms

A burning abdominal pain, located anywhere from the breastbone to the navel, is the most common symptom of peptic ulcers. This pain may last for minutes or for hours, and is usually experienced a few hours after a meal or during the night when the stomach is empty. The pain can usually be calmed through eating or taking an antacid. You may find that the pain comes and goes over the course of several days or weeks.

Other symptoms include bloating or nausea after eating, vomiting, weight loss, and appetite loss. If you experience bloody vomit, vomit that looks like coffee grounds, or black or bloody stools, seek medical treatment immediately as these could signal a serious condition.


Causes and Risk Factors

Long thought to be caused by stress or spicy food, peptic ulcers are most commonly the result of an H. pylori infection; 80-90% of all ulcer cases can be attributed to this bacterium. Long-term use of anti-inflammatory medications also accounts for some ulcer cases. Smoking, alcohol consumption, and stress can all contribute to the development of ulcers and slow healing, although they are unlikely to cause ulcers on their own.


Diagnosis

In addition to a medical history and symptom interview, diagnostic tests for peptic ulcer disease might include:

  • Upper GI, or gastrointestinal, series (also known as a barium swallow)
  • Endoscopy (which will sometimes include a biopsy)

Once an ulcer has been discovered, it is important for your physician to pinpoint its underlying cause in order to determine the best course of treatment. Testing the blood, breath, or biopsied stomach tissue can detect presence of H. pylori


Treatment

If H. pylori is found to be contributing to your ulcers, your doctor will prescribe a combination of two antibiotics found to be effective in eradicating the organism. It generally takes about two weeks for the antibiotics to get rid of the infection. It is important that you follow dosing instructions precisely in order for the treatment to work.

Medications such as H2 blockers, proton pump inhibitors, and antacids, are another component of treatment. They will help lower the levels of stomach acids and promote healing of the affected area. For those patients who have ulcers without the presence of H. pylori, you doctor will advise you to stop taking nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin and naproxen, which can sometimes cause ulcers with prolonged use. All people will ulcers should consider lifestyle changes that will promote healing, such as quitting smoking, limiting caffeine and alcohol, and avoiding stress.

While most ulcers respond to medication quickly and heal completely, some ulcers resist initial treatment. If your condition fails to heal, your physician may increase your dosage or try new medications. In extreme cases, surgery is sometimes necessary if the ulcers resist aggressive drug treatments.



Helicobacter Pylori


Overview

Helicobacter Pylori (H. Pylori) is a spiral-shaped bacterium found in the stomach and duodenum (the upper small intestine found just under the stomach). It lives in the thick layer of protective mucus that lines the stomach and intestine, weakening this defensive barrier and exposing the sensitive lining below to harsh and corrosive digestive fluids. This damage can lead to gastritis and peptic ulcer disease. In fact, researchers believe that H. Pylori is responsible for the vast majority of peptic ulcers (80% of gastric ulcers and 90% of duodenal ulcers). Research also indicates that the presence of this bacterium leads to a significant increase in the risk of stomach cancer.

H. Pylori is common, appearing in about 50% of people over 50 years of age and 20% of people under 40 in the United States. It is thought that people contract the bacteria through food and drink, although it has been found in the saliva of infected people and may spread through mouth-to-mouth contact (such as kissing).


Diagnosis

H. Pylori commonly diagnosed through blood tests, and can also be detected through breath tests. Other diagnostic tools include stool cultures and tissue tests using biopsy samples taken from the affected areas during an endoscopy.


Treatment

The most effective current treatment for H. Pylori is a triple therapy that combines two antibiotics with either an acid suppressor or a drug that shields the lining of the stomach and intestine. This therapy does require patients to follow a precise dosing schedule with sometimes up to 20 pills per day. However, it has been found to be the most successful at eradicating the infection. Because some strains of H. Pylori are resistant to antibiotics, it is important to test for the bacterium after you have finished your course of treatment to ensure that all traces of it are gone from your system.



Stomach Polyps


Overview

Stomach polyps are small growths on the lining of the stomach. They occur infrequently, showing up in less than 1% of patients who undergo an upper gastrointestinal endoscopy. Because they don't often generate any symptoms, they are usually only discovered during other procedures such as endoscopies. While stomach polyps are generally benign, some types can be a precursor to stomach cancer.


Symptoms

Stomach polyps usually do not present any symptoms, but if they grow quite large they may cause pain, bleeding, nausea, or vomiting. The polyps may also develop ulcers on their surfaces or block the opening between the stomach and small duodenum.


Causes and Risk Factors

Gastritis, and the damage it can cause to the stomach lining, may contribute to the development of some types of stomach polyps. Another factor may be an autoimmune condition that leads to vitamin B-12 deficiency anemia, which is found in many patients with stomach polyps. Age certainly plays a role, as most cases are found in people over 60 years old.


Diagnosis

Because people with stomach polyps rarely present symptoms, they are most often discovered during other procedures, such as upper GI endoscopies or x-rays.


Treatment

Polyps are usually easy to treat: they are removed and biopsied during an endoscopy with no further treatment necessary most of the time. However, if gastritis is a contributing factor to your polyps, your doctor will determine whether H. Pylori, a bacterium that commonly causes gastritis, is present. If so, you should also undergo antibiotic treatment to eradicate the infection and reduce the chance of developing more polyps in the future.



Stomach Cancer


Overview

Stomach (or gastric) cancer is a disease in which malignant cells or tumors develop in the stomach. The stomach is a core component of the digestive system, the place where foods are broken down, nutrients are processed, and waste products are passed on to be eliminated from the body. The stomach wall consists of five layers; most tumors begin in the innermost layer and spread to the outer strata as they grow. Researchers also believe that stomach cancers develop slowly over the course of several years, beginning as precancerous changes to the lining of the stomach that show few initial symptoms.

Any form of cancer is a serious disease, and stomach cancer is no different. Although rates of stomach cancer have declined significantly in the United States, over 21,000 Americans will be diagnosed with this disease in 2007, according to the American Cancer Society. Recovery from stomach cancer is certainly possible, and the odds of that increase the earlier the cancer is detected. Early detection is also important to halt stomach cancer from metastasizing, or spreading to nearby organs such as the liver or to the lymph system.


Symptoms

Stomach cancer may cause symptoms such as indigestion, abdominal discomfort, bloating, nausea, weight loss, diminished appetite, dysphagia, and jaundice. Because it causes microscopic internal bleeding, signs might also include black or bloody stools as well as the vomiting of blood. People with stomach cancer may also feel fatigued from anemia caused by the internal bleeding.

These symptoms are also caused by other diseases, so it is important to work with your physician to determine their cause. If you have any of the risk factors listed below and your symptoms are persistent, your doctor will want to check for stomach cancer as a possibility. Any sign of internal bleeding should receive immediate medical attention.


Causes and Risk Factors

An exact cause of stomach cancer is not known. However, there are several risk factors that been linked to increased rates of gastric cancer including:

  • Age (two-thirds of people diagnosed with stomach cancer are over age 65)
  • Dietary choices such as eating large amounts of red meat and smoked & salted foods or not eating enough fruits, vegetables, and fiber
  • Alcohol and tobacco use
  • Obesity
  • Prior stomach surgery
  • Helicobacter pylori infection of the stomach (as sometimes seen with gastritis or peptic ulcers)
  • A family history of stomach or related cancers
  • A history of stomach polyps
  • Type A blood
  • Gender (men are twice as likely to develop stomach cancer)
  • Pernicious anemia

Diagnosis

After taking a complete medical history and discussing your symptoms, your physician may order the following tests:

  • Upper gastrointestinal endoscopy
  • Upper gastrointestinal x-ray series (sometimes known as a barium swallow)
  • Blood chemistry tests and blood counts
  • Fecal occult blood test (to test the stool for microscopic amounts of blood)

Once a stomach cancer diagnosis has been established, further tests may be required in order to determine the extent of the cancer including diagnostics such as endoscopy ultrasounds, computerized tomography (CT) scans, magnetic resonance imaging (MRI), and chest x-rays.


Treatment

Treatment protocols for stomach cancer will depend on the stage of the cancer and whether or not the tumors have metastasized, or spread to other parts of the body. Standard options include:

  • Surgery (which may involve removing part or all of the stomach)
  • Chemotherapy (cancer-fighting drugs)
  • Radiation (high-energy rays that kill or shrink cancer cells)

Chemoradiation, which combines chemotherapy and radiation to increase the effectiveness of both treatments, may also be a treatment option. Drug therapy has been approved by the FDA for certain forms of stomach cancer and may be an alternative depending on the type of tumor you have.

For patients with advanced stage gastric cancer, clinical trials offer experimental treatments such as new surgical interventions, new drugs, and gene therapy. While these novel treatments are not guaranteed to be successful, they are monitored by the FDA and are based on some evidence that the new therapy may prove useful.

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