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Digestive system diseases list: Digestive Diseases | NIDDK

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9 Common Digestive Conditions From Top to Bottom

4. Crohn’s Disease

Crohn’s disease is part of a group of digestive conditions called inflammatory bowel disease (IBD). Crohn’s can affect any part of the GI tract but most commonly affects the terminal ileum, which connects the end of the small bowel and the beginning of the colon. As many as 780,000 Americans may be affected by Crohn’s, according to the Crohn’s & Colitis Foundation (CCFA).

Doctors aren’t sure what causes the disease, but it’s thought that genetics and family history may play a part. The most common Crohn’s symptoms are abdominal pain, diarrhea, rectal bleeding, weight loss, and fever. “Treatment depends on the symptoms and can include topical pain relievers, immunosuppressants, and surgery,” Dr. Bamji says. Avoiding trigger foods like dairy products, carbonated beverages, alcohol, coffee, raw fruit and vegetables, red meat, and foods that are fatty, fried, spicy, or gas-producing can also help prevent flares.

RELATED: 10 Complementary Therapies for Crohn’s Disease

5. Ulcerative Colitis

Ulcerative colitis is another inflammatory bowel disease that may affect as many as 907,000 Americans, according to the CCFA. The symptoms of ulcerative colitis are very similar to those of Crohn’s, but the part of the digestive tract affected is solely the large intestine, also known as the colon.

If your immune system mistakes food or other materials for invaders, sores or ulcers develop in the colon’s lining. If you experience frequent and urgent bowel movements, pain with diarrhea, blood in your stool, or abdominal cramps, visit your doctor.

Medication can suppress the inflammation, and eliminating foods that cause discomfort may help as well. In severe cases, treatment for ulcerative colitis may involve surgery to remove the colon.

RELATED: How Well Is Your Ulcerative Colitis Treatment Working?

6. Irritable Bowel Syndrome

Is your digestive tract irritable? Do you have stomach pain or discomfort at least three times a month for several months? It could be irritable bowel syndrome (IBS), another common digestive condition.

About 10 to 15 percent of people worldwide suffer from IBS, and of that percentage, up to 45 million people with IBS live in the United States, according to the International Foundation for Functional Gastrointestinal Disorders. Signs of IBS can vary widely from having hard, dry stools one day to loose, watery stools on another. Bloating is also a symptom of IBS.

What causes IBS isn’t known, but treatment of symptoms centers largely on diet, such as eating low-fat, high-fiber meals and avoiding common trigger foods (dairy products, alcohol, caffeine, artificial sweeteners, and foods that produce gas). The low-FODMAP diet, which involves eliminating foods that are high in certain carbohydrates called FODMAPs (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols), has also been shown to reduce IBS symptoms.

Additionally, friendly bacteria, such as the probiotics found in live yogurt, may help you feel better. Stress can trigger IBS symptoms, so some people find cognitive behavioral therapy or low-dose antidepressants to be useful treatments, as well.

RELATED: Mindfulness Meditation Reduces IBS Symptoms and Anxiety, Study Finds

7. Hemorrhoids

Bright red blood in the toilet bowl when you move your bowels could be a sign of hemorrhoids, which is a very common condition. In fact, 75 percent of Americans over age 45 have hemorrhoids, according to the NIDDK.

Hemorrhoids are an inflammation of the blood vessels at the end of your digestive tract that can be painful and itchy. Causes include chronic constipation, diarrhea, straining during bowel movements, and a lack of fiber in your diet.

Treat hemorrhoids by eating more fiber, drinking more water, and exercising. Over-the-counter creams and suppositories may provide temporary relief of hemorrhoid symptoms. See your doctor if at-home treatments don’t help; sometimes a hemorrhoidectomy is needed to remove hemorrhoids surgically.

RELATED: 4 Signs Your Hemorrhoids Warrant a Doctor’s Visit

8. Diverticulitis

Small pouches called diverticula can form anywhere there are weak spots in the lining of your digestive system, but they are most commonly found in the colon. If you have diverticula but no symptoms, the condition is called diverticulosis, which is quite common among older adults and rarely causes problems. By age 50, about half of people have diverticulosis, according to the American Gastroenterological Association. But in about 5 percent of people, the pouches become inflamed or infected, a condition called diverticulitis. Symptoms include fever, chills, nausea, and abdominal pain. Obesity is a major risk factor for diverticulitis.

Mild diverticulitis is treated with antibiotics and a clear liquid diet so your colon can heal. A low-fiber diet could be the cause of diverticulitis, so your doctor may direct you to eat a diet high in fiber — whole grains, legumes, vegetables — as part of your treatment.

If you have severe attacks that recur frequently, you may need surgery to remove the diseased part of your colon.

RELATED: Diverticulitis Diet: Foods to Eat and Avoid for Prevention and Treatment

9. Anal Fissure

Anal fissures are tiny, oval-shaped tears in the lining of the very end of your digestive tract called your anus. The symptoms are similar to those of hemorrhoids, such as bleeding and pain after moving your bowels. Straining and hard bowel movements can cause fissures, but so can soft stools and diarrhea.

A high-fiber diet that makes your stool well formed and bulky is often the best treatment for this common digestive condition. Medication to relax the anal sphincter muscles, as well as topical anesthetics and sitz baths, can relieve pain; however, chronic fissures may require surgery of the anal sphincter muscle.

Additional reporting by Ashley Welch

Digestive system diseases | Des Moines University

Gastroesophageal Reflux Disease (GERD) –Severe “heartburn” in laymen’s language. Weakness of the valve between the esophagus and stomach may allow stomach acid to reflux (regurgitate, backup) into the esophagus and irritate and inflame the lining. This results in chest pain which can mimic that of angina (pain of cardiac ischemia or an MI).

Jaundice – Literally means “yellow” in French. Yellowing of the skin and whites of the eyes from a backup of bile metabolic by-products from the blood into body tissues. May result from blockage of the ducts draining bile from the liver into the intestines or excessive breakdown of red blood cells. Hemoglobin from destroyed RBCs is broken down, and in part, ends up in bile secretions.

Diverticulosis/diverticulitis – Small pouches may form along the walls of the large intestine called diverticuli which if symptomatic, causing discomfort to the patient, is called diverticulosis. These abnormal outpocketings may collect and not be able to empty fecal material which can lead to inflammation, diverticulitis.

Cirrhosis – Literally, “orange-yellow” in Greek. A degenerative disease of the liver that often develops in chronic alcoholics, but can have other causes. The name refers to the gross appearance of the organ.

Portal hypertension – A potential complication of chronic alcoholism resulting in liver damage and obstruction of venous blood flow through the liver. The rising blood pressure in the veins between the gastrointestinal tract and liver causes engorgement of veins around the umbilicus (navel). The characteristic radiating pattern of veins is called a “caput medusae” (head of Medusa). Medusa was the “snake-haired lady” in Greek mythology.

Esophageal varices – bulging, engorged veins in the walls of the esophagus are often a complication of chronic alcoholism (see portal hypertension). The thin-walled, swollen veins are at risk of tearing resulting in severe, possibly fatal, bleeding.

Dysphagia – Difficulty swallowing. May be related to GERD (see above), esophageal tumor or other causes.

Crohn’s Disease – a chronic inflammatory disease primarily of the bowel. Typical symptoms are abdominal pain, weight loss, diarrhea. There may also be rectal bleeding that can lead to anemia. Special X-rays and tests are needed to differentiate Crohn’s from other diseases with similar symptoms.

Peritonitis – Inflammation of the lining of the abdominal cavity. Before antibiotics, people would die from peritonitis if an inflamed appendix burst. Indications of peritonitis are called “peritoneal signs”: tender abdomen, rebound pain (pain when manual pressure released from examining abdomen), board-like rigidity of abdominal muscles, no bowel sounds (gurgles). The peritoneal membrane is very sensitive to exposure to foreign substances. Contact with blood, bile, urine, pus will cause peritoneal signs.

Diseases and Disorders of the Digestive System

Peritonitis

Peritonitis is an inflammation of the peritoneum, usually caused by an infectious organism that is introduced into the abdominal cavity.

Learning Objectives

Describe the causes and prognosis of peritonitis

Key Takeaways

Key Points
  • Perforation of part of the gastrointestinal tract is the most common cause of peritonitis.
  • The main manifestations of peritonitis are acute abdominal pain, abdominal tenderness, and abdominal guarding.
  • Depending on the severity of the patient’s state, the management of peritonitis may include supportive measures, antibiotics, or surgery.
  • If properly treated, typical cases of surgically correctable peritonitis (e.g., perforated peptic ulcer, appendicitis, and diverticulitis ) have a mortality rate of less than 10%.
Key Terms
  • Spontaneous bacterial peritonitis (SBP): Spontaneous bacterial peritonitis (SBP) is the development of peritonitis (infection in the abdominal cavity) despite the absence of an obvious source for the infection.
  • peritoneal dialysis: A treatment for patients with severe chronic kidney disease in which fluids are exchanged from the blood in the patient’s peritoneum in the abdomen.
  • Blumberg sign: Blumberg’s sign is a sign that is elicited during physical examination in medicine and is indicative of peritonitis. A positive sign shows rebound tenderness, meaning that pressing a hand on the abdomen elicits less pain than releasing the hand abruptly, which will aggravate the pain, as the peritoneum snaps back into place.

Peritonitis is an inflammation of the peritoneum, the thin tissue that lines the inner wall of the abdomen and covers most of the abdominal organs. Peritonitis may be localized or generalized, and may result from infection (often due to rupture of a hollow organ as may occur in abdominal trauma or appendicitis) or from a non-infectious process.

Peritoneum: The peritoneum, colored in blue, is the serous membrane that forms the lining of the abdominal cavity. It covers most of the intra-abdominal, supporting them and serving as a conduit for their blood and lymph vessels and nerves. Peritonitis is an inflammation of the peritoneum often causing abdominal pain and tenderness.

Symptoms and Complications

The main manifestations of peritonitis are acute abdominal pain, abdominal tenderness, and abdominal guarding, which are exacerbated by moving the peritoneum by coughing, flexing one’s hips, or eliciting the Blumberg sign. Diffuse abdominal rigidity (“washboard abdomen”) is often present, especially in generalized peritonitis. Other symptoms include fever, sinus tachycardia, and development of intestinal paralysis, which also causes nausea, vomiting, and bloating.

Complications of peritonitis include sequestration of fluid and electrolytes, as revealed by decreased central venous pressure, which may cause electrolyte disturbances, as well as significant hypovolemia, possibly leading to shock and acute renal failure. A peritoneal abscess may form and sepsis may develop, so blood cultures should be obtained.

Causes

Perforation of part of the gastrointestinal tract is the most common cause of peritonitis. Examples include perforation of the distal esophagus, of the stomach by a peptic ulcer or gastric carcinoma, of the duodenum, of the remaining intestine by appendicitis, diverticulitis, inflammatory bowel disease (IBD), intestinal infarction, intestinal strangulation, colorectal carcinoma, or of the gallbladder. Other possible reasons for perforation include abdominal trauma, ingestion of a sharp foreign body (such as a fish bone, toothpick or glass shard), perforation by an endoscope or catheter, and internal leakage of a colostomy site. In most cases of perforation of a hollow viscus, mixed bacteria are isolated from the infection; the most common agents include Gram-negative bacilli like E. coli and anaerobic bacteria. Fecal peritonitis results from the presence of feces in the peritoneal cavity. It can result from abdominal trauma and occurs if the large bowel is perforated during surgery.

Disruption of the peritoneum, even in the absence of perforation of a hollow viscus, may also cause infection simply by letting micro- organisms into the peritoneal cavity. Examples include trauma, surgical wound, continuous ambulatory peritoneal dialysis, and intra-peritoneal chemotherapy. Again, in most cases, mixed bacteria are isolated; the most common agents include cutaneous species such as Staphylococcus aureus and coagulase-negative staphylococci, but many others are possible, including fungi such as Candida.

Spontaneous bacterial peritonitis (SBP) is a peculiar form of peritonitis occurring in the absence of an obvious source of contamination. It occurs in patients with excess fluid in their abdomens, particularly in children. Intra-peritoneal dialysis predisposes a patient to peritoneal infection. Systemic infections such as tuberculosis may rarely have a peritoneal localization.

Sterile abdominal surgery, under normal circumstances, causes localized or minimal generalized peritonitis. However, peritonitis may also be caused by the rare case of a sterile foreign body inadvertently left in the abdomen after surgery (e.g., gauze, sponge). Much rarer non-infectious causes may include familial Mediterranean fever, porphyria, and systemic lupus erythematosus.

Treatment

Depending on the severity of the patient’s state, the management of peritonitis may include supportive measures, antibiotics, or surgery. General supportive measures include vigorous intravenous rehydration and correction of electrolyte disturbances. Antibiotics are usually administered intravenously, but they may also be infused directly into the peritoneum. The empiric choice of broad-spectrum antibiotics often consist of multiple drugs, and should be targeted against the most likely agents, depending on the cause of peritonitis; once one or more agents are actually isolated, therapy will of course be targeted on them. Surgery is needed to perform a full exploration and lavage of the peritoneum, as well as to correct any gross anatomical damage that may have caused peritonitis. The exception is spontaneous bacterial peritonitis, which does not always benefit from surgery and may be treated with antibiotics in the first instance.

If properly treated, typical cases of surgically correctable peritonitis (e.g., perforated peptic ulcer, appendicitis, and diverticulitis) have a mortality rate of <10% in otherwise healthy patients, which rises to about 40% in the elderly, and/or in those with significant underlying illness, as well as in cases that present late (after 48 hours). If untreated, generalized peritonitis is almost always fatal.

Mumps

Mumps was a common childhood viral disease, but widespread vaccination has now made it rare in developed countries.

Learning Objectives

Analyze the cause, symptoms, and prevention of mumps

Key Takeaways

Key Points
  • Mumps is a contagious disease that is spread from person to person through contact with respiratory secretions, such as saliva from an infected person. The common symptoms of mumps include inflammation of the salivary glands, pancreas, and testicles; fever; and headache.
  • A physical examination confirms the presence of the swollen glands. Usually, the disease is diagnosed on clinical grounds and no confirmatory laboratory testing is needed.
  • The most common preventative measure against mumps is a vaccination with a mumps vaccine. The vaccine may be given separately or as part of the routine MMR immunization vaccine which also protects against measles and rubella.
  • Like many other viral illnesses, there is no specific treatment for mumps, other than supportive treatment. Death from mumps is very unusual. The disease is self-limiting, and general outcome is good. Known rare complications of mumps include infertility in men and profound hearing loss.
Key Terms
  • orchitis: A painful inflammation of one or both testes.
  • salivary gland: Any of several exocrine glands that produce saliva to break down carbohydrates in food enzymatically.
  • prodromal symptoms: A prodrome is an early symptom (or set of symptoms) that might indicate the start of a disease before specific symptoms occur.
  • parotid gland: Either of a pair of salivary glands located in front of, and below each ear in humans.

Mumps, also known as epidemic parotitis, was a common childhood viral disease caused by the mumps virus. Before the development of vaccination and the introduction of a vaccine in 1949, it was common worldwide, but now, outbreaks are largely confined to developed countries.

Symptoms

Child with mumps: This child with mumps displays the typical swelling of the salivary glands caused by the mumps virus.

The common symptoms of mumps include inflammation of the salivary glands, pancreas, and testicles; fever, and headache. Swelling of the salivary glands, specifically the parotid gland, is known as parotitis, and it occurs in 60–70% of infections and 95% of patients with symptoms. Parotitis causes swelling and local pain, particularly when chewing. It can occur on one side but is more common on both sides in about 90% of cases. Painful inflammation of the testicles in mumps in known as orchitis. Other symptoms of mumps can include dry mouth, sore face and/or ears and occasionally, in more serious cases, loss of voice. In addition, up to 20% of persons infected with the mumps virus do not show symptoms, so it is possible to be infected and spread the virus without knowing it. Fever and headache are prodromal symptoms of mumps, together with malaise and loss of appetite.

Causes

Mumps virus: This transmission electron micrograph (TEM) shows the ultrastructure of the mumps virus. It is a roughly spherical particle made up of layers of fatty lipids, large protein molecules, and nucleic acids. The virus is dotted with large protein “spikes” that enable it to gain entry to host cells. Inside lies a core of a single, long molecule of RNA wrapped up in protein that is released into the host cell.

Mumps is a contagious disease that is spread from person to person through contact with respiratory secretions, such as saliva from an infected person. When an infected person coughs or sneezes, the droplets aerosolize and can enter the eyes, nose, or mouth of another person. Mumps can also be spread by sharing food and drinks. The virus can survive on surfaces and then be spread after contact in a similar manner. A person infected with mumps is contagious from approximately six days before the onset of symptoms until about nine days after symptoms start. The incubation period can be anywhere from 14–25 days, but is more typically 16–18 days.

Diagnostics

A physical examination confirms the presence of the swollen glands. Usually, the disease is diagnosed on clinical grounds, and no confirmatory laboratory testing is needed. If there is uncertainty about the diagnosis, a test of saliva or blood may be carried out. An estimated 20–30% of cases are asymptomatic. As with any inflammation of the salivary glands, the level of amylase in the blood is often elevated.

Prevention

The most common preventative measure against mumps is a vaccination with a mumps vaccine. The vaccine may be given separately or as part of the routine MMR immunization vaccine which also protects against measles and rubella. The MMR vaccine is given at ages 12–15 months and then again at four to six years.

Treatment and Complications

Like many other viral illnesses, there is no specific treatment for mumps. Symptoms may be relieved by the application of intermittent ice or heat to the affected neck/testicular area and by the acetaminophen or ibuprofen for pain relief. Warm salt water gargles, soft foods, and extra fluids may also help relieve symptoms. Patients are advised to avoid acidic foods and beverages, since these stimulate the salivary glands, which can be painful.

Death from mumps is very unusual. The disease is self-limiting, and general outcome is good, even if other organs are involved. Known complications of mumps include:

  • In teenage males and men, complications from orchitis such as infertility or sub-fertility are rare, but present.
  • Spontaneous abortion in about 27% of cases during the first trimester of pregnancy.
  • Mild forms of meningitis in up to 10% of cases.
  • Profound hearing loss is very rare, but mumps was the leading cause of acquired deafness before the advent of the mumps vaccine.

After the illness, life-long immunity to mumps generally occurs; re-infection is possible but tends to be mild and atypical.

Lactose Intolerance

Lactose intolerance is the inability to digest lactose, a sugar found in milk, due to a lack of the enzyme lactase.

Learning Objectives

Analyze lactose intolerance and tolerance

Key Takeaways

Key Points
  • Symptoms of lactose intolerance include abdominal bloating and cramps, flatulence, diarrhea, nausea, borborygmi (rumbling stomach), and/or vomiting after consuming significant amounts of lactose. Individuals may be lactose intolerant to varying degrees, depending on the severity of these symptoms.
  • Most mammals normally become lactose intolerant after weaning, but some human populations have developed lactase persistence, in which lactase production continues into adulthood. These populations (northern Europe, India, and a few groups in Africa) are dairying cultures.
  • Lactase deficiency has a number of causes, and is therefore classified as one of three types: primary, secondary, or congenital. Primary lactase deficiency is genetic and normal as most adults worldwide do not maintain lactase production.
  • Secondary/acquired/transient lactase deficiency is caused by an injury to the small intestine. Congenital lactase deficiency prevents lactase expression from birth, making nourishment from breast milk impossible.
  • Lactose intolerance is not an allergy, because it is not an immune response, but rather a problem with digestion caused by lactase deficiency. Milk allergy is a separate condition, with distinct symptoms that occur when the presence of milk proteins trigger an immune reaction.
  • Primary lactase deficiency is genetic, secondary/acquired/transient lactase deficiency is caused by an injury to the small intestine, and congenital lactase deficiency prevents lactase expression from birth.
Key Terms
  • lactose: The disaccharide sugar of milk and dairy products, C12h32O11, (a product of glucose and galactose) used as a food and in medicinal compounds.
  • lactose intolerance: The inability to fully metabolize lactose.
  • lactase: A β-galactosidase enzyme that is involved in the hydrolysis of the disaccharide lactose into constituent galactose and glucose monomers.

Examples

Those who are lactose intolerant can be more tolerant of traditionally made yogurt than of milk because it contains lactase produced by the bacterial cultures used to make the yogurt. Frozen yogurt, if cultured similarly to its unfrozen counterpart, will contain similarly reduced lactose levels. However, many commercial brands contain milk solids, increasing the lactose content.

Lactose intolerance, also called lactase deficiency and hypolactasia, is the inability to digest lactose, a sugar found in milk and, to a lesser extent, in milk-derived dairy products. Lactose intolerant individuals have insufficient levels of lactase, the enzyme that metabolizes lactose into glucose and galactose, in their digestive system. In most cases, this causes symptoms such as abdominal bloating and cramps, flatulence, diarrhea, nausea, borborygmi (rumbling stomach), and/or vomiting after consuming significant amounts of lactose. Some studies in the U.S. and elsewhere suggest that milk consumption by lactose intolerant individuals may be a significant cause of irritable bowel syndrome.

Lactose: Lactose, a disaccharide of β-D-galactose and β-D-glucose, is normally broken down by the enzyme lactase into its component monosaccharides. Individuals who suffer from lactose intolerance have insufficient levels of lactase to break down the lactose in milk and dairy products.

Most mammals normally become lactose intolerant after weaning, but some human populations have developed lactase persistence, in which lactase production continues into adulthood. It is estimated that 75% of adults worldwide show some decrease in lactase activity during adulthood. The frequency of decreased lactase activity ranges from 5% in northern Europe through 71% for Sicily to more than 90% in some African and Asian countries. This distribution is now thought to have been caused by recent natural selection favoring lactase persistent individuals in cultures that rely on dairy products. While it was first thought that this would mean that populations in Europe, India, and Africa that had high frequencies of lactase persistence shared a single mutation, it has now been shown that lactase persistence is caused by several independently occurring mutations.

Causes

Primary lactase deficiency is genetic, only affects adults, and is caused by the absence of a lactase persistence allele. It is the most common cause of lactose intolerance as a majority of the world’s population lacks these alleles. Secondary, acquired, or transient lactase deficiency is caused by an injury to the small intestine, usually during infancy, from acute gastroenteritis, diarrhea, chemotherapy, intestinal parasites, or other environmental causes. Congenital lactase deficiency is a very rare, autosomal recessive genetic disorder that prevents lactase expression from birth. It is particularly common in Finland. People with congenital lactase deficiency who are unable to digest lactose from birth are unable to digest breast milk.

Effects on Nutrition

While dairy products can be a significant source of nutrients in some societies, there is no evidence that lactose intolerance has any adverse impact on nutrition where consumption is the norm among adults. Congenital lactase deficiency (CLD), where the production of lactase is inhibited from birth, can be dangerous in any society because of infants’ nutritional reliance on breast milk during their first months. Before the 20th century, babies born with CLD were not expected to survive, but these death rates can now be lowered using soybean-derived infant formulas and manufactured lactose-free dairy products. Beyond infancy, individuals affected by CLD usually have the same nutritional concerns as any lactose-intolerant adult.

Lactose cannot be directly absorbed through the wall of the small intestine into the bloodstream so, in the absence of lactase, it passes intact into the colon. Bacteria in the colon are able to metabolize lactose and the resulting fermentation produces copious amounts of gas (a mixture of hydrogen, carbon dioxide, and methane) that causes the various abdominal symptoms. The unabsorbed sugars and fermentation products also raise the osmotic pressure of the colon, resulting in an increased flow of water into the bowels (diarrhea).

Assessment and Treatment of Lactose Intolerance

To assess lactose intolerance, intestinal function is challenged by ingesting more dairy products than can be readily digested. Clinical symptoms typically appear within 30 minutes, but may take up to two hours, depending on other foods and activities. Substantial variability in response (symptoms of nausea, cramping, bloating, diarrhea, and flatulence) is to be expected, as the extent and severity of lactose intolerance varies among individuals.

It is important to distinguish lactose intolerance from milk allergy, an abnormal immune response (usually) to milk proteins. This may be done in diagnosis by giving lactose-free milk, producing no symptoms in the case of lactose intolerance, but the same reaction as to normal milk if it is a milk allergy. An intermediate result might suggest that the person has both conditions. Since lactose intolerance is the normal state for most adults worldwide, it is not considered a disease and a medical diagnosis is not normally required, although tests are available if confirmation is necessary.

Lactose intolerance is not considered a condition that requires treatment in societies where the diet contains relatively little dairy. However, those living among societies that are largely lactose-tolerant may find lactose intolerance troublesome. Although there are still no methodologies to reinstate lactase production, some individuals have reported that their intolerance varies over time, depending on health status and pregnancy. About 44% of lactose intolerant women regain the ability to digest lactose during pregnancy. This might be caused by slow intestinal transit and intestinal flora changes during pregnancy.

Peptic Ulcer Disease

A peptic ulcer, also known as peptic ulcer disease, is an erosion in the wall of the stomach, duodenum, or esophagus.

Learning Objectives

List the causes of and treatments for peptic ulcer disease

Key Takeaways

Key Points
  • 70–90% of peptic ulcers are associated with Helicobacter pylori, a spiral-shaped bacterium that lives in the acidic environment of the stomach.
  • Diagnosis is mainly established based on the characteristic symptoms. Stomach pain is usually the first signal of a peptic ulcer.
  • Treatment of H. pylori usually leads to clearing of infection, relief of symptoms, and eventual healing of ulcers.
  • Gas in the peritoneal cavity, shown on an erect chest x-ray or supine lateral abdominal x-ray, is an omen of perforated peptic ulcer disease, which requires emergency surgery.
  • Gastrointestinal bleeding is the most common complication. Sudden large bleeding can be life-threatening. It occurs when the ulcer erodes one of the blood vessels, such as the gastroduodenal artery.
  • Most bleeding ulcers require endoscopy urgently to stop bleeding with cautery, injection, or clipping.
  • During the active phase, the base of the ulcer shows 4 zones: inflammatory exudate, fibrinoid necrosis, granulation tissue and fibrous tissue.
  • A gastric peptic ulcer is a mucosal defect which penetrates the muscularis mucosae and muscularis propria, produced by acid-pepsin aggression.
  • Ulcers are not purely an infectious disease and that psychological factors do play a significant role.
  • Diagnosis is mainly established based on the characteristic symptoms. Stomach pain is usually the first signal of a peptic ulcer.
  • Gastric ulcers are most often localized on the lesser curvature of the stomach.
  • Gas in the peritoneal cavity, shown on an erect chest X-ray or supine lateral abdominal X-ray, is an omen of perforated peptic ulcer disease.
  • Gastrointestinal bleeding is the most common complication. Sudden large bleeding can be life-threatening. It occurs when the ulcer erodes one of the blood vessels, such as the gastroduodenal artery.
  • Burning or gnawing feeling in the stomach area lasting between 30 minutes and 3 hours commonly accompanies ulcers.
  • Typical ulcers tend to heal and recur and as a result the pain may occur for few days and weeks and then wane or disappear.
Key Terms
  • prostaglandin: Any of a group of naturally occurring lipids derived from the C20 acid prostanoic acid; they have a number of physiological functions and may be considered to be hormones.
  • NSAID: Any drug of the non-steroidal anti-inflammatory class used as a pain reliever.
  • gastrin: A hormone that stimulates the production of gastric acid in the stomach.
  • gastritis: Inflammation of the lining of the stomach, characterized by nausea, loss of appetite, and upper abdominal discomfort or pain.

A peptic ulcer, also known as peptic ulcer disease, is an erosion in the wall of the stomach, duodenum, or esophagus. As many as 70–90% of such ulcers are associated with Helicobacter pylori, a spiral-shaped bacterium that lives in the acidic environment of the stomach. Ulcers can also be caused or worsened by drugs such as aspirin, ibuprofen, and other NSAIDs.

Symptoms

Deep gastric ulcer: This image, acquired via endoscope, shows a deep gastric ulcer.

Symptoms of a peptic ulcer include abdominal pain, classically near the stomach with severity relating to mealtimes, about three hours after eating a meal; bloating and abdominal fullness; nausea; copious vomiting; loss of appetite and weight loss; vomiting of blood; and melena, which are tarry, foul-smelling feces due to oxidized iron from hemoglobin. Rarely, an ulcer can lead to a gastric or duodenal perforation, which leads to acute peritonitis. This is extremely serious and requires immediate surgery.

Causes

A major causative factor of ulcers is chronic inflammation due to Helicobacter pylori that colonizes the mucosa. The immune system is unable to clear the infection, despite the appearance of antibodies. Thus, the bacterium can cause a chronic active gastritis, resulting in a defect in the regulation of gastrin production by that part of the stomach. Gastrin secretion can either be increased, or as in most cases, decreased, resulting in a too basic or too acidic stomach environment, respectively. A decrease in acid can promote H. pylori growth and an increase in acid can contribute to the erosion of the mucosa and therefore ulcer formation.

Another major cause is the use of NSAIDs. The gastric mucosa protects itself from gastric acid with a layer of mucus, the secretion of which is stimulated by certain prostaglandins. NSAIDs block the function of cyclooxygenase 1 (cox-1), which is essential for the production of these prostaglandins.

Researchers also continue to look at stress as a possible cause, or at least complication, in the development of ulcers. There is debate as to whether psychological stress can influence the development of peptic ulcers. Burns and head trauma, however, can lead to physiologic stress ulcers, which are reported in many patients who are on mechanical ventilation.

Diagnosis

The diagnosis is mainly established based on the characteristic symptoms. Stomach pain is usually the first signal of a peptic ulcer. In some cases, doctors may treat ulcers without diagnosing them with specific tests and observe whether the symptoms resolve, this indicating that their primary diagnosis was accurate.

Gastric ulcer: This endoscopic image shows a gastric ulcer, which upon biopsy was shown to be gastric cancer.

Confirmation of the diagnosis is made with the help of tests such as endoscopies or barium contrast x-rays. The tests are typically ordered if the symptoms do not resolve after a few weeks of treatment. Tests are also given when first appear in a person who is over age 45 or who has other symptoms such as weight loss, because stomach cancer can cause similar symptoms. Also, when severe ulcers resist treatment, particularly if a person has several ulcers or the ulcers are in unusual places, a doctor may suspect an underlying condition that causes the stomach to overproduce acid.

An esophagogastroduodenoscopy (EGD), a form of endoscopy, also known as a gastroscopy, is carried out on patients in whom a peptic ulcer is suspected. By direct visual identification, the location and severity of an ulcer can be described. Moreover, if no ulcer is present, EGD can often provide an alternative diagnosis.

If a peptic ulcer perforates, air will leak from the inside of the gastrointestinal tract (which always contains some air) to the peritoneal cavity (which normally never contains air). This leads to “free gas” within the peritoneal cavity. If the patient stands erect, as when having a chest x-ray, the gas will float to a position underneath the diaphragm. Therefore, gas in the peritoneal cavity, shown on an erect chest x-ray or supine lateral abdominal x-ray, is an omen of perforated peptic ulcer disease.

Treatment

Benign gastric ulcer: This gastric ulcer was found in tissue removed during a gastrectomy.

Younger patients with ulcer-like symptoms are often treated with antacids. The ability of antacids to neutralize acidity by increasing the pH or blocking the secretion of acid by gastric cells is critical in reducing acidity in the stomach. Patients who are taking NSAIDs may also be prescribed a prostaglandin analogue in order to help prevent peptic ulcers by replacing the prostaglandins whose formation is blocked by NSAID use.

When H. pylori infection is present, the most effective treatments are combinations of two antibiotics, such as Clarithromycin, Amoxicillin, Tetracycline, and Metronidazole; and one proton pump inhibitor, sometimes in combination with antacids. In complicated, treatment-resistant cases, three antibiotics may be used together with a proton pump inhibitor. Treatment of H. pylori usually leads to clearing of infection, relief of symptoms and eventual healing of ulcers. Recurrence of infection can occur and retreatment may be required, if necessary with other antibiotics.

Perforated peptic ulcer is a surgical emergency and requires surgical repair of the perforation. Most bleeding ulcers require endoscopy urgently to stop bleeding with cautery, injection, or clipping.

Digestive System Pathologies

2. Gallstones Form When Substances in the Bile Harden

Gallstones are pieces of solid material that can form from stored bile in the gall bladder. They range from tiny specks to the size of golf balls. During digestion, gallstones can block the flow of fluid through the bile ducts. Signs of a gallstone attack include nausea, vomiting, or pain in the abdomen, back, or just under the right arm.

3. Straining to Have a Bowel Movement Can Cause Hemorrhoids

Hemorrhoids are swollen, inflamed veins around the anus or lower rectum. Straining for bowel movements can cause hemorrhoids. Pregnancy, diarrhea, and chronic constipation are contributing factors. They can develop under the skin around the anus (as external hemorrhoids) or inside the anus (as internal hemorrhoids). Further straining or irritation when passing stool can damage a hemorrhoid’s surface and cause it to bleed.

4. Ulcerative Colitis Causes Inflammation and Sores in the Colon and Rectum

Ulcerative colitis is an inflammatory bowel disease that affects the large intestine. It causes inflammation and sores (ulcers) in the innermost lining of the colon and rectum. This leads most often to abdominal pain or to diarrhea with blood and pus. Ulcerative colitis is a chronic condition characterized by alternating periods of flare-up and remission, when the symptoms of the disease disappear.

5.

GERD is a Common Diagnosis of Recurring Heartburn

Gastroesophageal reflux disease (GERD) is a chronic disease of the digestive system. GERD usually occurs when the lower esophageal sphincter, a muscle at the end of the esophagus, does not close properly. This allows stomach acid to leak back, or reflux, into the esophagus and irritate it. Symptoms include heartburn, regurgitation, and the taste of stomach fluid in the back of the mouth.

6. Diverticulosis Occurs When Pouches Form in the Large Intestine. Diverticulitis Is the Inflammation or Infection of These Pouches

Diverticulosis occurs when small pouches form in the wall of the large intestine. Most people with diverticulosis don’t have symptoms. However, if feces get trapped in the pouches and bacteria grow, inflammation and infection result. This is called diverticulitis. Most often it causes abdominal pain. Other symptoms include fever, nausea, and constipation.

3 Rare Gastrointestinal Disorders You Probably Haven’t Heard Of

Posted by San Antonio Gastro on 10/17/2019

It’s highly likely that you have heard of acid reflux, constipation, and diarrhea. These are gastrointestinal issues that most people have experienced at one time or another. You may have even heard of digestive disorders like Crohn’s disease and celiac disease because approximately 70,000 people are diagnosed with the condition each year. But what about the super rare GI conditions that you haven’t heard of? Just because a condition is rare, doesn’t mean you are immune. If you are struggling with various forms of digestive distress and more common ailments have been ruled out, you may want to consider the possibilities on this list and talk to a gastroenterologist:

 

Eosinophilic Enteropathy

Eosinophilic enteropathy is characterized by an excess of eosinophils, or toxin-releasing white blood cells, in any part of the digestive tract. While the exact cause of EE is unknown, it is most often seen in patients with food allergies and/or atopy, which is asthma, hay fever, or eczema, since eosinophils are produced as a part of the body’s immune response to allergens. When there are too many eosinophils in the digestive tract, they can cause inflammation, ulcers, polyps, and tissue breakdown.

 

Endoscopic examination with biopsy is the only way to diagnose eosinophilic enteropathy. There is not a known cure for eosinophilic enteropathy, but food allergy testing is generally recommended, followed by eliminating the offending food from the patient’s diet.

 

Hirschprung’s disease

Hirschprung’s disease affects the colon, also known as the large intestine. People afflicted with this disorder lack the proper nerves to signal the muscle contractions required to pass stools, and they often suffer from constipation and bowel obstruction. Most of the diagnoses, about 80 percent, are considered “short-segment” disease, which means that only a small portion of the bowel is affected. Fifteen to 20 percent of cases are categorized as “long-segment” disease, which means it spreads over a large enough area to affect the sigmoid colon, which is the lower section of the large intestine that connects to the rectum. In 5 percent of cases, the entire large intestine is affected by the disease.

 

The only known treatment for Hirschprung’s disease is to remove the affected portion of the colon. In some cases, intestinal transplantation may be an appropriate treatment option.

 

Whipple Disease

Whipple disease is caused when rare bacteria (Tropheryma whipplei) infects the lining of the small intestine. The bacteria cause the intestinal villi (small finger-like structures) to become abnormally shaped, interfering with their ability to absorb nutrients.

 

It’s not known how exactly the bacteria is transmitted, but it is usually found in soil and sewage/waste water. It is not spread person-to-person. This disease is seen most often in Caucasian men between the ages of 40 and 60, but it can infect anyone. The infection can spread throughout the body, and if left untreated, become life-threatening.

 

If you’re experiencing uncomfortable digestive issues, let the board-certified gastroenterologists at San Antonio Gastroenterology Associates help you reach a diagnosis. Even if your problem isn’t clear-cut, there are a variety of endoscopic procedures available to assess your symptoms and develop a treatment plan.

Upper GI vs. Lower GI Diseases

The gastrointestinal (GI) system goes all the way from the mouth to the anus, and for medical evaluation and treatment purposes it’s divided into two main sections: the upper and lower gastrointestinal tract. There are various ailments that can afflict the upper and/or lower GI tract.

Let’s discuss everything you need to know about the upper and lower GI tracts and the diseases associated with them. 

Upper GI Tract Conditions

The upper GI tract is made up of the mouth, esophagus, stomach, and duodenum (the first part of the small intestine). When we eat, the food and liquid travels from our throat through our esophagus to our stomach.

The valve at the base of the esophagus, known as the lower esophageal sphincter, prevents food and stomach acids from flowing back up into our esophagus. The food you ate begins to digest and turns into a liquid in your stomach.

(If the sphincter suddenly fails, it can allow food to flow back upward into the esophagus. This causes acid reflux.)

After that, it travels from your stomach to the duodenum, where bile and digestive enzymes – which are produced by the gallbladder (with assistance from the liver and pancreas) – further break down the liquefied food. This is how your body is able to absorb the nutrients.

When there are issues with the upper GI tract, symptoms can include gas, bloating, stomach pain, and heartburn. These symptoms can be quite unpleasant, but can also be a sign of a more serious underlying condition.

Diseases of the Upper GI Tract

Health conditions of the upper GI tract include:

  • Anemia
  • Barrett’s esophagus
  • Celiac disease
  • Eosinophilic esophagitis
  • Esophagitis and esophageal stricture
  • Gallstones
  • Gas and bloating
  • Gastritis
  • Gastroenteritis (stomach flu)
  • Gastroesophageal reflux disease (GERD)
  • Gastroparesis
  • Heartburn
  • H. pylori bacterial infection
  • Hiatal hernia
  • Lactose intolerance
  • Pancreatitis
  • Peptic ulcers
  • Swallowing disorders

Lower GI Tract Conditions

The lower GI tract consists of the small intestine, large intestine (colon), rectum, and anus. Most of the nutrients from our food are absorbed in the small intestine; what’s left in the small intestine is waste, which then travels to the large intestine.

As the waste products move through our colon, water is absorbed, and the particles become solid – which is what forms into stool.

The stool then moves into the lower part of the colon, followed by the rectum and anal canal. There, it passes out of the body as a bowel movement.

When there are issues with the lower GI tract, symptoms can include diarrhea, constipation, and hemorrhoids. These symptoms can be quite painful and should not be ignored, as they could indicate a more serious underlying condition.

Diseases of the Lower GI Tract

Conditions of the lower GI tract include:

  • Anal fissure, abscess, and fistula
  • Anemia
  • Colon polyps
  • Colon cancer
  • Constipation
  • Crohn’s disease
  • Diarrhea
  • Diverticulosis and diverticulitis
  • Hemorrhoids
  • Irritable bowel syndrome (IBS)
  • Rectal bleeding
  • Ulcerative colitis

How Are GI Diseases Diagnosed?

To find out whether you have a GI condition, your gastroenterologist will perform diagnostic tests. For upper GI issues, the doctor may conduct an endoscopy or an upper GI series/barium swallow. For lower GI issues, the tests may include a colonoscopy, enteroscopy, or lower GI series/barium enema.

Treatment usually begins with recommended changes to your diet and/or lifestyle. Treatment may also include medication or surgery to help alleviate your symptoms and to improve your quality of life.

South Central Pennsylvania Gastroenterology

Our board-certified and fellowship-trained gastroenterologists at Carlisle Digestive Disease Associates have years of experience in diagnosing and treating upper and lower GI conditions. We offer comprehensive diagnosis and treatment, as well as the highest quality of care.

If you have any questions or would like to schedule an appointment, call us today at (717) 245-2228 or use our secure online appointment request form. We are happy to serve you – and to help you feel much, much better.

Gastrointestinal Disturbances – Find Relief From Gastrointestinal Disorders In Fort Collins