Gastrointestinal Diseases Overview

Gastrointestinal Diseases

• A list of gastrointestinal diseases was presented:
  • Gastro-Esophageal reflux disease
  • Gastritis
  • Peptic/gastric ulcer
  • Gall bladder and pancreas diseases
  • Constipation
  • Diarrhea
  • Short bowel syndrome (Crohn's disease)
  • Irritable bowel syndrome

Peptic/Gastric Ulcer

• A peptic ulcer is a localized erosion of the stomach or duodenal lining, or lower esophagus.
• This increases the secretion of acidic stomach juices.
• The ulcer causes the stomach lining to be exposed to these damaging juices.
• The stomach lining has a mucus fluid that normally covers and protects it from the acidic juices and digestive enzymes.
• This means that the mucus fluid protects the stomach and intestines from the damaging effects of food items, such as chili and pepper.

Anatomy of the Digestive System

• The digestive system includes:
  • Mouth (oral cavity)
  • Pharynx
  • Esophagus
  • Stomach
  • Pancreas
  • Duodenum
  • Jejunum
  • Ileum
  • Sigmoid colon
  • Rectum
  • Anus
  • Liver
  • Gallbladder

Types of Ulcers

• Ulcers are either benign or malignant.
• Benign ulcers result from increased stomach acid secretion and are easily treatable.
• Malignant ulcers are caused by malignant stomach tumors. These ulcers initially respond to treatment but often resist, requiring surgery.

Symptoms of Gastric Ulcers

• Pain in the middle of the abdomen, potentially radiating to the back and chest.
• Burning sensation in the chest, commonly called 'heartburn'.
• Pain starts 2-3 hours after meals.
• Pain may occur during the middle of the night when the stomach is empty or immediately after consuming large meals.
• Stool discoloration (blackening), potentially indicating blood in the stool during advanced stages.
• Acid vomiting or other digestive discomfort.
• Weight loss
• Loss of the pleasure of eating.
• Nausea
• Pain while eating
• Feeling of tiredness in the stomach
• Burping

Diagnosing Gastric Ulcers

• X-rays of the stomach and duodenum
• Diagnostic endoscopy: A procedure to visualize the stomach and duodenum using a thin, lighted tube with a camera. The doctor gives medication to promote relaxation and allow the tube to pass through the digestive system. Removing a small sample from the tissue for examination under a microscope, a process called biopsy, may also be used.

Complications of Gastric Ulcers

• Red hematemesis (bloody vomit): Vomiting blood, often described as dark red.
• Black stools (melena): Stool containing blood, appearing black.
• Anemia: Low red blood cell count, affecting oxygen transport throughout the body.

Causes of Gastric Ulcers

• Increased hydrochloric acid (HCl) secretion damaging the stomach lining, coupled with a lack of tissue resistance to the acidity of these juices.
• Infection by Helicobacter pylori, often acquired through drinking contaminated water.
• Smoking, which increases stomach acid production and slows down healing.
• Medications like aspirin or sedatives, especially when taken on an empty stomach, can harm the stomach lining.
• Excessive consumption of coffee, strong tea, highly salted foods, chili peppers, and pickles.
• Continuous stress and extreme emotional states like anger and sadness.

Treatments for Gastric Ulcers

• Complete rest (mental, physical, and psychological) to reduce nervousness and tension.
• Medication or surgery, depending on the severity and type of ulcer.
• Dietary therapy.

Drug Treatments

• Antacids: Prevent the stomach from producing excessive acid.
• Antibiotics: Kill bacteria (like Helicobacter pylori).
• Medications to reduce stomach motility and calm nerves (e.g., certain anti-muscarinic drugs)

Surgical Treatments

• Removal or excision of the ulcer.
• Reducing the amount of acid produced by the stomach.

Dietary Treatments

• Proteins: Increased protein intake increases stomach acid production. Milk, however, has a lower impact.
• Proteins RDA and Bleeding: 0.8 g/kg of ideal body weight for general cases, and 1-1.5 g/kg for patients experiencing bleeding.
• Fats: Decrease gastric juice production and coat the ulcer. 120g or two of whole milk/skim milk with butter in a timely manner.
• Carbohydrates: Intake of carbohydrates is important to maintain energy but won't affect HCl production. Small, frequent meals are prescribed to avoid stomach stretching and excessive acid production.
• Stimulants: Alcoholic drinks and aspirin are among damaging stimulators.
• Beverages: Drinks with a pH less than four are generally prohibited (like orange juice). Meat or poultry soup is not recommended.
• Fiber: Fiber-rich foods, including seeds and peels, are typically avoided.

Additional Recommendations

• Avoiding spicy food, alcohol, and carbonated beverages.
• Stopping smoking.
• Weight loss to minimize stress on the digestive system.
• Medications that reduce stomach acid, under medical supervision and follow-up.
• Milk consumption in moderation as an aid for symptom relief.

Additional Considerations

• Bananas are good for ulcer patients due to potassium content, while Vitamin C intake helps reduce nitrosamines (which are linked to stomach cancer) and inhibit the growth of Helicobacter pylori.
• Zinc (30-50 mg/day), Vitamin E (400 IU/day), and Vitamin A (50,000 IU/day, initially, then 10,000-25,000 IU for extended periods) contribute to faster healing.
• Consuming large quantities of food should be avoided.
• Foods rich in flavonoids (like apples, celery, and cranberries) and broccoli (due to sulforaphane) can aid recovery.
• Specific dietary recommendations are presented regarding permitted and prohibited foods.
• Detailed meal schedules throughout the day for different stages are provided.