Thursday, September 23, 2010

7.(5-6) Stomach, Esoph, Duoden/GERD/Ulcer/Cancer

Physician's Notebooks 7  - - See Homepage

Also has Chapter 6 on peptic ulcer of stomach and duodenum. Scroll down for it. Update 22 December 2018
5. Gastro-Esophageal (G-E) Reflux
“Reflux” causes "heartburn" due to stomach contents going back into lower esophagus. During certain times of life, it gets paid attention to as Gastro-Esophageal Reflux Disease (GERD). It gives mid chest discomfort that may go to rib, collarbone, shoulder or armpit on either side and also may be felt in upper and mid back, and may give early morning strangling cough when stomach juice gets in windpipe. With aging, almost everyone experiences the symptom. Episode of GERD follows an overfilled stomach. I have found it is worsened by the sitting position just after eating, and much improved to disappeared by lying down for an hour. Probably this is because when you lie down your neutral stomach juices dilute the acid reflux in the upper stomach and in lower esophagus.  
   In middle age it tends to worsen and may catch attention, at first making one think heart disease because pain in chest. Time is spent worrying on it and some get surgery. The Barrett’s esophagus, a micropathologic diagnosis of biopsies from GERD esophagitis is often reported and has increased cancer risk. It should not be worried over.
   Watch what you eat to see what foods cause it. If you note a symptom of it, get up and drink a glass of cold water. The Reflux is more bother than danger to life; it has low complication rate. Preventives are smaller meals and avoiding food servings that you note cause it. I actually find that, counter-intuitively, lying completely flat prevents it while sitting in chair sleepily after eating is the worst for it. Where simple remedies do not work a one-month course of Omepral, the proton pump inhibitor pill, is useful but don't take it indefinitely.
Warning: An analysis of data on German patients, published by the American journal JAMA Neurology, found that the patients who regularly use proton pump inhibitors were 44 percent more likely to develop dementia compared with patients who were not receiving those medications.
Do not get complicated tests and do not try surgery unless the GERD is connected with a hiatal hernia.
   I notice GERD but it does not worry me. The discomfort is in chest and upper back especially waking from sleep in chair. I note it at times after sandwiches – ham and egg, potato salad and cheeses. Milk seems to cause it too. Rice is a sometime offender. Foods that do not cause symptoms are spaghetti without strong sauces and cooked oatmeal sans milk. Honey is better than sugar. An esophago-gastroscopy is worth getting once only to allay cancer fears. Basically GERD should be the least of anyone's old age worries

6. Peptic Ulcer and Stomach Cancer
Stomach cancer rate is down in USA. Why? 1) Less cigarettes; 2) Potent anti-histamine-2 receptor medication like Zantac or proton-pump inhibitor (PPI) med. like Omepral; and 3) the fiber-optic, laser-lighted, upper GI scope and rapid, earlier diagnosis of stomach lesion with it.
   Stomach disease causes right upper and mid abdominal pains most typical at night in bed and starts with gastritis due to fecal-oral infection with bacteria Helicobacter pylori (HP) or due to excessive use of aspirin or NSAID's. The bacterial gastritis, untreated, aggravated by bad food, medicines, alcohol or cigarettes, and in presence of high acid stomach secretion, leads to chronic gastritis and then to peptic ulcer in stomach and duodenum (and lower esophagus if reflux).
   Preventing stomach and duodenum disease starts as child and with hand-asshole-mouth hygiene: Wash hand! Wash hand! Wash hands! 
   Avoid or limit aspirin or related NSAID's but acetaminophen is OK.
Get upper GI Scopy if you get symptoms. And be sure to get tested for Helicobacter pylori and if test positive get course of antibiotic.
   Complications of peptic ulcer are perforation or hemorrhage, or obstruction from scarred Gastro-Duodenal sphincter. Perforation of stomach or duodenal wall does not need book l’arnin’; the pain is immediate and extreme and even the municipal moron will be banging at emergency door within hour. An Upper GI hemorrhage is another story. When it is massive and sudden, you see red blood in vomit or in bleeding from anus and are carted off to hospital with no delay. But when bleeding is slow, the telltale sign – denied or ignored – is tarry black, bad-smell feces. Taking Pepto Bismol or iron can give black feces that does not smell bad. If you see itget to emergency room and test for bleeding. I have seen cases that sat at home, days, bleeding out life despite warning sign of black feces.
   An overlooked cause of stomach bleed is the iron tablets (ferrous sulfate) that are often overdosed for persons with anemia. Do not take iron pill on empty stomach and better several-time-a-day low dose than once-a-day high dose pill. Also be sure you need iron pills by checking blood test iron Fe level. When iron med is very important and not tolerated by mouth, it can be given by injection IV or IM.
   Obstruction due to chronic scarring on G-D sphincter from peptic ulcer is late complication. It makes too much, too prolonged stomach fullness after eating and eventually bad vomiting. Diagnosis is easy and treatment is surgical.
   Stomach and esophageal cancer are diseases mostly of smoker and heavy drinker. Gastric ulcer should get biopsy because of the 4% incidence of cancer in gastritis type ulcers.
End of Chapter. To read next now, click 7.7 Hernia/AP/GB/Frenzy/Transfusion

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