Stomach Disorders

Stomach disorders describe a multiplicity of maladies either restricted to the stomach or emanating from the stomach, affecting contiguous portions of the gastrointestinal tract or other organ systems. The many disorders of the stomach can be categorized into several broad classifications, including conditions due to acid peptic disease with or without reflux; conditions of a neoplastic nature (tumor); conditions due to dysmotility; and conditions relating to gastric hemorrhage.

Acid peptic disease encompasses gastric disorders from the most mild (dyspepsia) to severely erosive gastritis with frank ulceration (with or without perforation) and/or erosive esophagitis with ulcerations and premalignant mucosal changes. Dyspepsia is defined as a heartburn type of pain and patients may report upper abdominal bloating in the epigastrium (upper central abdomen) that is recurrent. If dyspepsia occurs more than once weekly the patient is said to be presenting with gastroesophageal reflux disease (GERD) unless proven otherwise. Obviously the diagnostic features of the two conditions overlap, thus making the clinical diagnosis difficult to document.

The overall medical management of dyspepsia includes life-style modification (alcohol, nicotine, and caffeine cessation). This may significantly decrease dyspepsia symptoms and this requires patient adherence to the program. The prescribing of H2 antagonists will suppress the production of stomach acid, thus increasing the pH of the stomach (making the pH more alkaline).

While proton pump inhibitors (PPI) are more potent, will suppress the acid much more completely and are considered the drugs of choice by most gastroenterologists, the cost of these drugs makes them unaffordable to many patients. This is due to some insurance companies refusal to pay for the PPI's until the patient has failed to obtain relief from over-the-counter omeprazole (PPI) and highest doses of generic H2 antagonist, generally over the course of four to six weeks.

A test for H. pylori (helicobacter pylori) bacteria is performed by a breath ammonia test, serologic H.pylori testing, or possibly a stool antigen test. This bacteria can cause ulcers to develop and if the test is positive, treatment with one of several regimens (PPI and Amoxicillin [or clarithromycin if penicil-lin-allergic], and bismuth, for example) will generally eradicate the bacteria and increase the likelihood that treatment for the dyspepsia will be effective and prevent ulcers.

If the patient fails to obtain relief from the dyspepsia over the course of two weeks, many authorities recommend an upper gastrointestinal endoscopy although there is debate over the yield of endoscopy in young patients (younger than 55) due the rarity of adenocarcinoma in the younger population. Upper GI endoscopy is a direct visualization of the esophagus, stomach, and upper portion of the duodenum through a fiberoptic tube with the patient under conscious sedation. Abnormal tissue (tumors, ulcers, etc.) can be identified and, [Page 1616]with the aid of flexible biopsy forceps, tissue samples can be obtained for pathological analysis. If generalized erythema (redness) of the gastric mucosal lining is observed, then gastritis is the reason for the dyspepsia and the H2antagonists or PPI's are continued.

An X-ray of the gastrointestinal tract, where a multiplicity of maladies can occur from stomach disorders.

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