Acid reflux or gastroesophageal reflux (not disease) occurs sporadically in a healthy person and has no long term consequences. As discussed under What is Acid Reflux, the alimentary tract has means of dealing with small amounts of stomach acid that occasionally enters the esophagus. However, in cases of persistent or recurrent acid reflux, the extent of the mucosal damage can lead to a complex of signs and symptoms, as well as other long term complications. This is a more severe and chronic form of acid reflux known as gastroesophageal reflux disease (GERD or GORD) and should be investigated and treated appropriately. Acute acid reflux however, is temporary and may pass with no treatment.
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Acid reflux is the backward flow of the acidic stomach contents (food + acid + other secretions) up into the esophagus. It is not uncommon for every healthy person to experience acid reflux occasionally but in certain cases, this retrograde flow may become persistent or recurrent. Prolonged exposure to the stomach acid irritates or damages the lining of the esophagus (esophagitis) and causes a range of signs and symptoms that are collectively referred to as gastroesophageal reflux disease (GERD, GORD ~ UK).
A stomach polyp or gastric polyp is a mass or growth in the layers of the stomach that protrudes above the surface of the surrounding mucosa (stomach lining). A stomach polyp has the potential to become cancerous – most will remain benign but in a minority of cases it will progress into cancer.
Overall, a stomach polyp is a rare condition when compared to other gastric conditions. Most stomach polyps are less than 1 centimeter in diameter and due to inflammation or hyperplasia (explained below). Larger stomach polyps, greater than 1.5 centimeters in diameter, are associated with a greater risk of malignancy (cancer) and if the polyp is larger than 2 centimeters in diameter, it is usually removed immediately.
Stomach bloating may refer to a sensation of fullness or pressure, typically after eating, and/or excessive gas accumulation within the gastrointestinal tract. Typically these symptoms are associated with indigestion, however, there are various other causes that may or may not be related to the gastrointestinal tract (gut).
With stomach bloating, there may be little or no enlargement of the abdomen (distension). Common causes of a visible bulging or protrusion of the stomach may be due to fluid (ascites), feces (constipation), fat (abdominal fat/central obesity), fetus (pregnancy), flatus (gas accumulation). This is is discussed further under :
Stomach cramps is a general term used to describe mild discomfort (stomach ache) to pain (gastric pain) in the stomach. It is usually difficult to isolate the pain as originating from the stomach itself. Often any focal or diffuse abdominal pain is attributed to the stomach (refer to stomach location) but may arise from other parts of the gastrointestinal tract, surrounding abdominal structures or referred from elsewhere in the body.
Although the stomach is a muscular sac, there is no conclusive indication that the pain described as stomach cramps is due to actual spasms of the stomach muscles. Stomach cramp is a subjective term that could be attributed to pain elsewhere in the region.
Stomach acid is the collection of gastric secretions secreted by the lining of the stomach and contained with the stomach cavity. It is a combination of hydrochloric acid (HCl), pepsin and intrinsic factor and due to the presence of HCl, the overall pH of the solution is low meaning that it is acidic.
The stomach secretes about 1.5 liters of juices per day which includes digestive enzymes, mucus and water. Every liter of stomach secretions (juices) contain about 160 millimoles of HCl resulting in a pH of 1 to 2, although it can be as low as 1.8 or as high as 3.
Stomach acid is necessary for digestion because it chemically breaks down foods. The acidity also activates other digestive enzymes which contribute to chemical digestion as well. Apart from its role in digestion, the stomach acid is the first major line of defense against invading microorganisms that enter the gut with food or drink.
The production of stomach acid and the stimulation and inhibition of its secretion is discussed further under Gastric Acid.
Dietary management for gastritis and peptic ulcer disease has limited benefit without other therapeutic measures like medication. Despite that fact that certain foods and drinks may exacerbate the pain of both gastritis and peptic ulcers, most cases are due to H.pylori infection or the long term use of NSAIDs (non-steroidal anti-inflammatory drugs). Diet therefore cannot be the solitary approach to treating and preventing either condition. Instead, the focus of diet in the management of gastritis or peptic ulcers should rather be directed at providing some symptomatic relief for the patient.
Peptic ulcers are a common complication of chronic gastritis and even if the ulcer heals, the gastritis has to be treated and managed in the long term. If conservative management is to be considered, the focus should not be solely on diet, but rather on diet AND lifestyle. While these measures may be helpful, the treatment of gastritis and peptic ulcers with medication should not be bypassed.
Stomach ulcers, or gastric ulcers, are open sores that occur on the stomach lining often as a result of chronic gastritis. The integrity of the stomach lining is compromised to the extent that the gastric secretions, particularly hydrochloric acid and pepsin, can erode small portions of the superficial layers of the stomach. In severe cases, the ulcer can lead to a bleeding ulcer (stomach bleeding) or perforation. Chronic gastric ulcers have been linked to stomach cancer.
Most stomach ulcers occur on the lesser curvature of the stomach near the junction between the body and antrum and may penetrate as deep as the muscularis mucosa. Refer to the picture below on the location and depth of stomach ulcers. These ulcers are usually large measuring more than 5 millimeters in diameter. In severe cases, these ulcers can extend up to 25 mm in diameter and may extend beyond the muscularis mucosa.
Causes of Peptic Ulcers
Any cause of inflammation of the stomach or duodenal lining can lead to peptic ulcer formation. This also applies to other parts of the alimentary tract. However, the two main mechanisms by which most peptic ulcers occur include :
- Natural protective mechanisms that protect the lining of the stomach and duodenum are compromised. In the stomach, mucus secreted by the stomach lining protects it, while in the duodenum, bicarbonate ions and water from the pancreatic ducts neutralize the stomach acid.
- Increased gastric acid volume and acidity (lower pH). This is usually controlled by digestive hormones and nervous regulation as explained under Stomach Nerves.
While the stomach and duodenum have protective mechanisms to counteract the effects of hydrochloric acid and pepsin, the esophagus and other sections of the small intestine are unable to do so. Despite this, the stomach and duodenum are most prone to peptic ulcers.
A peptic ulcer can be acute or chronic but even if an acute ulcer heals, there is a risk of it recurring. Peptic ulcers are the most common complication of chronic gastritis, irrespective of the cause. The two most common causes of peptic ulcers are due to H.pylori infection and NSAIDs (non-steroidal anti-inflammatory drugs). Both cause an ulcer by one or both of the mechanisms explained above. However, not every person who uses NSAIDs or has an H.pylori infection will suffer with peptic ulcers.
A peptic ulcer is an open sore in the lining of the stomach or duodenum (first part of the small intestine). Although less common, it can occur in the lower esophagus (in the event of acid reflux) or even extend as far as the jejunum or ileum of the small intestine (in cases of a Meckel diverticulum). Duodenal ulcers are more common than stomach ulcers and in most cases there is a solitary (single) ulcer.
A peptic ulcer appears as a round to oval punched-out sore in the lining. The bases of the ulcer is smooth and underlying tissue or even blood vessels may be visible upon an upper GI endoscopy. Most peptic ulcers are small shallow ulcers measuring less than 3mm (millimeters) in diameter. Deeper ulcers tend to be large, often over 6mm in diameter.
Stomach gas bloating or gas accumulation within the bowels after eating a meal may be due to a number of factors, some of which are related to disease processes. Gas in the gut is produced as a result of air swallowing, gas intake in carbonated drinks, byproduct of chemical digestion and the action of bacteria in the gut. In most people who suffer with stomach bloating, the enlargement is visible anywhere between 20 or 30 minutes to an hour after eating. However, there are cases where eating leads to stomach bloating immediately after the meal.
Infants, both breastfed and bottle fed, have a tendency to regurgitate milk for various reasons, many of which are not due to any disease process. This effortless regurgitation or spitting up of milk is known as possetting. With vomiting, the regurgitated contents are pushed out with force. A list of causes of vomiting in infants and toddlers is discussed under Baby Vomiting.
In cases where the vomiting is persistent or recurrent and accompanied by other problems like the inability to gain weight and thrive, listlessness, fever, diarrhea, difficulty breathing or signs of dehydration needs to be investigated and managed by a medical professional.
Abdominal distension (enlargement of the abdomen) is most commonly due to one of the following :
Bloating that is transient and may come on suddenly and pass just as quickly is more likely due to gas accumulation within the gut. While fluid may also cause bloating, often the term ‘bloat’ is associated with gas while abdominal swelling is attributed to fluid accumulation (ascites).
Normal Stomach Noises
Noises within the stomach and bowels are a normal part of gastrointestinal physiology. Most of the time these noises are inaudible to the human ear but when hungry or after eating, bowel sounds may be audible to the person or even others in the near vicinity. This is not abnormal. However loud and excessive bowel sounds (audible and hyperactive) should be investigated, especially if it is persistent or accompanied by other signs and symptoms.
Stomach noises may be described as growling, gurgling or even rumbling. All these noises are medically known as borborygmi (singular ~ borborygmus). Despite the descriptive terms attributed to the various types of stomach noises, it is difficult to isolate the exact cause behind each type of sound. In most cases, the sounds are so similar that these terms are used interchangeably.
The reasons for the various stomach and bowel noises are due to :
- movement of food and chyme through the alimentary tract as the muscle contractions of the gastrointestinal wall pushes it through the gut as well as churning and breaking it down to aid with digestion
- stomach gas and intestinal gas, which is produced by chemical digestion and bacterial action
- indigestible foods and hard substances within the gut
Although a baby cannot express the symptoms like nausea, stomach ache and cramps associated with excessive gastrointestinal gas, it is only logical to assume that the level of discomfort expressed by crying is related to these sensations. Gas problems in babies are not just a uncomfortable experience for the child but due to the neediness of an infant, especially a newborn baby, a gas problem can put undue stress on the parent.
Excess gastrointestinal gas in babies is a common phenomenon and in most cases, it is not a sign of a digestive problem. Gas buildup in the gut may present with signs like excessive belching, flatulence, abdominal distension (bloating) and crying.
Baby Gas Problems – Causes
Gas accumulation or production within the gut of a baby occurs for the same reasons as in an adult – air swallowing, byproducts of chemical digestion and bacterial action. However, in babies the contributing factors resulting in excess gas being trapped or produced within the gut may be unique in that it may not be seen in other age groups. Swallowed air will be passed out as belches although some of the air could travel down the gut and mix with other gases to be passed out as flatus.
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