Stomach

Below are a few common conditions of the stomach, click on the desired conditions to find out more about them.

Gastric ulcer
H.pylori
Stomach Cancer

Gastric ulcer

A stomach or gastric ulcer is a break in the tissue lining the stomach. The term 'peptic ulcer' refers to those that occur in either the stomach or the first part of the small intestine that leads out of the stomach, called the duodenum. It was once commonly thought that stress, smoking and diet were the principal causes of stomach ulcers. However, the Helicobacter pylori (H. pylori) bacterium is now known to be responsible for most duodenal ulcers and 60 per cent of stomach ulcers. The H. pylori bacterium also prompts many symptoms of dyspepsia, or indigestion.

Sometimes different medications, such as aspirin, can cause peptic ulcers. Peptic ulcers are quite common.


WHAT ARE THE SIGNS OR SYMPTOMS?

Sometimes people have peptic ulcers and do not know about it, as they do not have any symptoms. The most common symptom of peptic ulcers is pain. It is described as a gnawing or burning pain and is felt in the middle or upper abdomen. The pain may occur between meals or in the middle of the night and eating often eases the pain. Sometimes peptic ulcers bleed. If the bleeding continues it may lead to a loss of iron from the body causing anaemia, making the person look pale and feel tired. If the bleeding is heavy, blood may appear in vomit or bowel movements making them look dark red and black.


Complications of peptic ulcer

Haemorrhage (bleeding)

As an ulcer corrodes the wall of the stomach or duodenum, blood vessels can also be damaged, which causes bleeding. Ulcers can bleed without causing pain. If the damaged blood vessels are small, the blood may slowly seep into the digestive tract, leading a person to develop anaemia and feel weak, dizzy or tired. A bleeding ulcer may be found when a doctor carries out an endoscopy and the doctor will then cauterise the ulcer to stop it bleeding.

Initial treatment for bleeding ulcers may consist of the replacement of lost body fluids, however, if the bleeding is severe or persistent a blood transfusion may be needed.


Obstruction (pyloric stenosis)

Pyloric stenosis is the name doctors give to the condition where the valve at the bottom of the stomach that allows food to pass on to the duodenum becomes narrowed. This can be due to the build-up over time of scar tissue on ulcers that have formed at the junction of the stomach and the duodenum. This causes a blockage which interferes with the passage of the contents of the stomach into the intestine. Symptoms of this type of obstruction or blockage include increasing abdominal pain, repeated vomiting and a feeling of fullness or bloating. Surgery or endoscopy may be needed to 'unblock' the obstruction, although sometimes ulcer treatment will be enough.


Perforation

This is when the ulcer completely erodes (perforates) the stomach or duodenal wall. This causes the leaking of acidic gastric contents into the abdominal cavity and results in acute peritonitis (infection of the abdominal cavity). When perforation occurs, there is generally a sudden extreme abdominal pain that is worsened by any type of movement. The person will try to lie very still to avoid the pain. Perforation is a medical emergency. If it is not treated then shock can develop and it can be fatal. It needs immediate surgical treatment and intravenous antibiotics.

See your general practitioner immediately if:

your stools are ever bloody, black or tarry looking (take a specimen to the general practitioner with you)

you vomit blood or material that looks like coffee grounds

you become unusually pale or weak

you have diarrhoea with intolerable pain

you have very severe abdominal pain


HOW CAN ULCERS BE TREATED?

Two common tests used to diagnosis peptic ulcers are Barium X-Ray and Endoscopy.

Barium is substance, that when drunk, can be seen on x-ray as it passes through the body.

Endoscopy (sometimes called a gastroscopy). This is a thin tube that is passed into the stomach to look at the lining and to take a sample to test for bacteria.

Common treatment:

Medication such as antacids may ease pain or discomfort. Antibiotics may be used if the ulcer is caused by the bacterium, H pylori.

Diet changes sometimes improve discomfort from ulcers.

Smoking and alcohol can sometimes make the symptoms of peptic ulcers worse, so Quit smoking and reduce the amount of alcohol drunk.

Surgery is usually only for people with complications.



H. pylori

Helicobacter pylori. What is it?
Where does it come from?
How common is it?
Symptoms
Diseases due to H. pylori
How is it diagnosed?
Treatment
What to expect after treatment?

Helicobacter pylori. What is it?

Helicobacter pylori is a common bacterial infection that affects the stomach. Its association with disorders of the stomach was first discovered in Australia in the early 1980s, and was a major breakthrough in understanding and treating peptic ulcer.
Until that time, peptic ulcer was thought to be due to too much acid in the stomach. The treatment then was to give drugs that reduced the stomach's acid production.
This is still effective treatment. However, the discovery that eliminating the Helicobacter pylori bacteria cured the ulcer in most people meant that many no longer needed to keep taking drugs to reduce stomach acid.

Where does it come from?

Helicobacter pylori is one of the most common bacterial infections throughout the world.
No one is completely sure how it spreads but it passes between individuals and the most likely route is hand to mouth. It runs in families and is more common in spouses but it is not transmitted by sexual intercourse. It is more common in densely populated areas, affects men and women equally, and occurs in children, especially in developing countries.

How common is it?

In Australia, Helicobacter pylori infection is often acquired in late childhood. By age 30, one in five people have it, and by age 60, almost half the population is affected.

Symptoms

The most common symptom is indigestion. However, having the Helicobacter pylori bacteria doesn't necessarily mean you will have indigestion, and having indigestion due to too much acid doesn't necessarily mean you have the bacteria.
In most people, there are no symptoms. Those who do have symptoms may experience indigestion, abdominal pain, nausea, bloating and burping.
Each of these can also have other causes.

Diseases due to Helicobacter pylori infection

Inflammation of the stomach (gastritis). At the time of infection, there may be acute symptoms of nausea, vomiting and indigestion. Later, when the inflammation becomes chronic, symptoms may be mild or non-existent. The gastritis usually disappears if the infection is successfully treated.

Duodenal ulcer. Helicobacter pylori is the major cause of this disease (in more than 90 per cent of cases). Symptoms include indigestion and upper abdominal pain. Occasionally there may be bleeding. Successful treatment of the Helicobacter pylori infection allows the ulcer to heal and usually prevents recurrence so that other treatment is no longer necessary.

Gastric ulcer. Helicobacter pylori is the main cause of this disease in up to 80 per
cent of cases. The other common causes are drugs used for treating arthritis and aspirin. Symptoms are similar to those of duodenal ulcer.

Stomach (gastric) cancer. Helicobacter pylori is one factor in the development of stomach cancer. Other factors such as family history and diet are also likely to be involved. Even though Helicobacter pylori is common in Australia today, stomach cancer is not. Symptoms may resemble those of ulcer, but there may also be nausea, loss of appetite and weight loss.

Lymphoma. This is a much less common malignancy of the stomach and Helicobacter pylori infection is usually present. Symptoms are similar to those of peptic ulcer. Successful treatment of the Helicobacter pylori infection may cure the lymphoma.

How is it diagnosed?

There are three possible tests: a blood test, a breath test and a biopsy test.

Blood test (serology). This measures an antibody to the Helicobacter pylori bacteria. It doesn't distinguish between ulcers, cancer or inflammation. If the test is positive, you may have no serious problem but you need further investigation. Your doctor will probably recommend a gastroscopy. Blood tests are often used in medical studies to determine how common Helicobacter pylori is in various subsections of the population.

Biopsy test. To obtain a biopsy, a flexible viewing tube is passed through the mouth into the stomach so that the oesophagus, stomach and duodenum can be seen. A small piece of the stomach lining is taken during this procedure, which is done under sedation and is painless. The test is usually done because of symptoms such as indigestion or abdominal pain. The piece of tissue is tested for the bacteria, and a result is usually available within half an hour, although it may take 24 hours. A separate piece of tissue may also be examined under the microscope by a pathologist to confirm Helicobacter pylori infection, and will also detect inflammation, ulcer or cancer.

Breath test. The principle of this test is that the Helicobacter pylori bacteria contain an enzyme which breaks down a special chemical solution that you have swallowed.
Carbon dioxide is produced, absorbed from the stomach, passes through the lungs and is expired in the breath. After breathing into a machine, the quantity of gas can be measured and confirms the presence or absence of the Helicobacter pylori bacteria.
This test is useful to check whether treatment to eradicate the bacteria has been successful. The breath test is done after fasting and takes about an hour.
It is usually done 4 weeks after the end of treatment. Blood tests are useless at this stage as they give positive results for many months even though the bacteria have been eradicated.

Treatment

There are several ways to treat Helicobacter pylori infection. The two common choices are with bismuth (De-Nol) or potent acid-lowering drugs in combination with two antibiotics (usually metronidazole plus one of several antibiotics such as tetracycline, amoxycillin or clarithromycin).

No one drug is successful in treating Helicobacter pylori infection. Treatment is complex and involves taking all the medications for up to two weeks. The greatest success is achieved with at least three medications (triple therapy).

Side-effects occur in one in three people, however, these are usually not severe. They may include some nausea, vomiting, diarrhoea and thrush.

Rarely, a more severe diarrhoea associated with colitis may occur. In clinical studies, less than 5 per cent of people withdrew from treatment because they were unable to tolerate side-effects. There are fewer side-effects with a combination of only two medications but this therapy is less successful.

Adding a potent acid-lowering drug to bismuth triple therapy may reduce the side-effects and increase the success. This is known as quadruple therapy.
After treatment, you will need tests to check that the treatment has been successful. This is usually by a breath test or another gastroscopy.
If treatment is unsuccessful, you may need a further course, perhaps using a different combination of drugs or for a longer period.
In Australia, the risk of reinfection with Helicobacter pylori infection is low.

What to expect after treatment

Duodenal ulcer. Eradicating Helicobacter pylori infection will permanently cure the ulcer in more than 90 per cent of people. If the symptoms were due to other co-existing conditions such as acid reflux, they may persist and need continuing therapy with acid-reducing drugs.

Gastric ulcer. Eradicating Helicobacter pylori infection will permanently cure most gastric ulcers. As gastric ulcers can also be due to taking aspirin and anti-inflammatory drugs, eradicating the Helicobacter pylori will not cure ulcers caused by these drugs.

Gastritis. Symptoms may not disappear after treatment for Helicobacter pylori. It is not possible to predict who will respond to therapy. Treatment is usually offered to all because even though symptoms may not improve, eradication of the bacteria may prevent development of ulcers and eliminate one risk factor for stomach cancer.

Stomach cancer

Most stomach cancers develop in the epithelial cells that line the mucosa and are called adenocarcinoma of the stomach. Other types of stomach cancer are:

lymphoma: cancer of lymphatic tissue

gastric stromal tumours: cancer of muscle or connective tissue

carcinoid tumours: cancer of hormone-producing cells.

These less common cancers are not discussed in this information.

Stomach cancer develops slowly. It may develop for many years before any symptoms are felt.
Stomach cancer can grow through the stomach's layers and into organs near the stomach-like the liver, pancreas or colon-or spread via the lymphatic system or the bloodstream to other parts of the body. The cancer can also grow along the stomach wall into the oesophagus or small intestine.


What causes stomach cancer?

It is not known what causes stomach cancer.

Some risk factors make it more likely that a person will develop stomach cancer. These risk factors include:

smoking

a diet high in smoked, pickled and salted foods and low in fresh fruit and vegetables

alcohol abuse

infection with helicobacter pylori

age over sixty

a family history of stomach cancer

partial gastrectomy for ulcer disease (after about twenty years).

Having one or more of these risk factors does not mean that you will develop stomach cancer. However these factors are seen in people who have stomach cancer.

How common is stomach cancer?

About five hundred and thirty Victorians develop stomach cancer each year. It is more common in people over the age of sixty, but it can sometimes occur in young people. Stomach cancer is about twice as common in men as in women.

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