Acid Peptic Disease Causes Symptoms & Treatment

About

 Excessive secretion of this acid and pepsin or a weakened stomach mucosal defense is responsible for damage to the delicate mucosa and the lining of the stomach, esophagus and duodenum resulting in ulceration which is known as “Acid Peptic Disease”

 Physiologically, a certain amount of acid is secreted by the gastric cells lining the stomach as a natural mechanism which serves to activate the digestive enzymes and help in the digestion and assimilation of important proteins so that they can be easily absorbed by the body. 

“Acid peptic disease” is a collective term used to include many conditions such as gastro-esophageal reflux disease (GERD), gastritis, gastric ulcer, duodenal ulcer, esophageal ulcer, Zollinger Ellison Syndrome (ZES) and Meckel’s diverticular ulcer.

The commonest ulcers are the gastric and the duodenal ulcer.

Symptoms of peptic ulcers include abdominal pain, nausea, water brash, vomiting, loss of appetite and weight loss. Complications include bleeding, perforation, obstruction in the digestive tract and sometimes cancer.

Peptic ulcer is diagnosed using blood and stool tests, breath tests, and endoscopy and barium radiography. The patient is treated with drugs that reduce acidity and sometimes in addition with certain antibiotics to eliminate the H pylori causing the infection (described below). Surgery may be required in some cases. 

Causes of Acid Peptic Disease

Acid peptic disease is a result of either a decreased gastric mucosal defense or an excessive acid production.

Causes of acid peptic disease include:

Helicobacter pylori: H.pylori is responsible for around 60%-90% of all gastric and duodenal ulcers.

NSAIDs: Prostaglandins protect the mucus lining of the stomach. Non steroidal anti-inflammatory drugs (NSAIDs) such as aspirin, diclofenac and naproxen prevent the production of these prostaglandins by blocking cyclo-oxygenase enzyme leading to ulceration and bleeding.

Smoking, alcohol and tobacco: Cigarettes, alcohol and tobacco cause an instant and intense acid production which acts as though gasoline is poured over a raging fire! 

Blood group O: People with blood group “O” are reported to have higher risks for the development of stomach ulcers as there is an increased formation of antibodies against the Helicobacter bacteria, which causes an inflammatory reaction and ulceration.

Heredity: Patients suffering from peptic ulcer diseases usually have a family history of the disease, particularly the development of duodenal ulcer which may occur below the age of 20.

Steroids/Other medicines: Drugs like corticosteroids, anticoagulants like warfarin (Coumadin), niacin, some chemotherapy drugs, and spironolactone can aggravate or cause ulcers.

Diet: Low fiber diet, caffeinated drinks and fatty foods are linked to peptic ulcer.

Other diseases: Chronic liver, lung and kidney diseases especially tumors of the acid producing cells all predispose to peptic ulcers. Zollinger-Ellison Syndrome (ZES) is a rare pre-cancerous condition which causes peptic ulcer disease. It is a syndrome disorder wherein tumors in the pancreas and duodenum also known as gastrinomas produce a large amount of gastrin which is a hormone that stimulates gastric acid secretion. Endocrine disorders such as hyperparathyroidism are also implicated in the development of peptic ulcers.

Stress: Stress and neurological problems can also be associated with the Cushing ulcer and peptic ulcer.

Symptoms and Signs of Acid Peptic Disease

Symptoms of peptic ulcers include abdominal pain, nausea, water brash, vomiting, loss of appetite and weight loss.

Peptic ulcer disease is usually a chronic problem with a natural history of relapse and remission which can last for over 10 years or even more. Gastric and duodenal ulcers usually have common symptoms such as:

1. Abdominal Pain: A burning pain in the upper part of the abdomen usually related to mealtimes together with fullness, distension of the abdomen, bloating, with or without nausea and generalized discomfort also known as “dyspepsia”.  The pain is usually so sharply localized that the patient can often indicate the exact place with two or three fingers called the “pointing sign”. Gastric ulcer pain is more after the ingestion of meals while duodenal ulcer pain occurs more due to hunger.

2. Nausea, heart burn, vomiting, loss of appetite and weight loss.

3. Gastric outlet obstruction:  The ulcer could heal with scarring and result in narrowing of the gastric or intestinal lumen.  This could cause an obstruction to food being passed forward.

4. Vomiting or passing blood in stool: Signs of bleeding as vomiting of blood or black tarry color of the stool.

5. Bleeding and perforation from the ulcer: Bleeding from the site of the ulcer with thinning of the wall may result in perforation.

What is the difference between gastric ulcer and duodenal ulcer?

Depending on the duration, peptic ulcers are classified into acute and chronic. Gastric ulcers develop more often in the elderly after the age of 60, while duodenal ulcers occur around the age of 30-40 years. Gastric ulcers are more common in women while men suffer more from duodenal ulcer. Chronic duodenal ulcer rarely develops into cancer while chronic gastric cancers are potentially precancerous. Chronic gastric ulcer is usually seen on the lesser curve of the stomach while the usual area of occurrence in a duodenal ulcer is the first part of the duodenum.

Differential Diagnosis, Complications and Diagnosis of Acid Peptic Disease

Peptic ulcer is diagnosed using blood and stool tests, breath tests, endoscopy and rarely now barium radiography. Complications include bleeding, perforation, obstruction in the digestive tract and sometimes cancer.

Differential Diagnosis or Other Possibilities:

Pain in the upper part of the abdomen is usually seen in the following conditions besides peptic ulcer disease:

1. Pancreatitis
2. Cholecystitis (bile duct inflammation) and biliary colic
3. Hepatitis or hepatic congestion
4. Stomach Cancer
5. Pericarditis (Inflammation of the covering of the heart)
6. Pleurisy (Inflammation of the covering of the lungs)
7. Myocardial infarction or heart attack

Complications:

Besides having sleepless nights due to pain and other dyspeptic symptoms, bleeding, perforation, penetration into other organs and obstruction in the intestines are other complications which can develop due to chronic or acute acid peptic disorders. “Barrett’s esophagus” is a precancerous lesion which develops due to chronic GERD or “gastro esophageal reflux disorder”. GERD is a condition wherein the liquid contents of the stomach regurgitate back into the esophagus. This causes damage to the esophageal lining resulting in esophagitis and Barrett’s esophagus. Infection with H.pylori responsible for peptic ulcer disease can cause an atrophy of the stomach called “atrophic gastritis” which is a precancerous condition. Duodenal cancer is also a complication of the acid peptic disease.

Diagnosis:

Before instituting therapy, it is imperative to diagnose the ulcer disease and the H.pylori infection because treatment protocols are variable for different types of ulcer diseases. The treatment of an NSAID induced ulcer differs from the ulcer caused by H.pylori.

Clinical History: Medical and family history establish whether ulcers are present in the family. Other information such as the misuse of NSAIDs, medicines taken and information regarding the use of alcohol, smoking and tobacco should also be elicited. Also the timing of food in relation to the pain and dyspepsia may help in the diagnosis.

Blood Tests. Blood tests such as an enzyme-linked immunosorbent assay (ELISA) help in the measurement of antibodies to H. pylori. Serum gastrin levels should be measured in patients with multiple ulcers to consider gastrin secreting tumors or Zollinger-Ellison Syndrome. Tests for gastric secretion include the “pentagastrin test”, the “chew and spit test” and the “Hollander insulin test”.

Stool Test. Stool test detects the presence of H. pylori in the feces and also establishes whether there is any recurrence after antibiotic therapy.

Breath Test: The urea breath test (UBT) is helpful in the detection of H.pylori. The patient is made to drink a liquid containing carbon-labeled urea, which is broken down by the bacteria. The patient is subsequently asked to breathe into a sealed bag, which is tested for the presence of labeled carbon.  A positive test indicates the presence of H pylori infection.

Endoscopy: Endoscopy is considered a more accurate test for the diagnosis of “peptic ulcer diseases” and also helps in taking biopsy of the affected area. Gastroscopy or esophagogastroduodenoscopy (EGD) is a kind of endoscopy which is carried out on patients to detect peptic ulcer.

Barium Radiography: X-rays are taken of the stomach, esophagus and duodenum after swallowing barium and the retention of contrast in the ulcer is monitored.

Treatment for Acid Peptic Disease

Acid Peptic Disease is treated with drugs that reduce acidity and sometimes in addition, with certain antibiotics to eliminate the H pylori causing the infection. Surgery may be needed in cases of complication.

Medical Management:

A) Diet: Dietary therapy relates to avoidance of spicy and oily foods which increase acid production and are difficult to digest. Avoid tea and coffee, alcohol, aspirin and other NSAIDs, chocolate, tobacco and cigarettes. Meals should preferably be light and at small intervals.

B) Eradication of H.pylori: The three way approach to eradicate H.pylori involves diagnosis, treatment and confirmation of the cure of H.pylori infection. The standard protocol to eradicate H.pylori involves the use of two or three antibiotics (e.g., amoxicillin, tetracycline, clarithromycin, metronidazole) and the use of a proton pump inhibitor (e.g., esomeprazole, omeprazole, lansoprazole, rabeprazole, pantoprazole) with or without a bismuth compound for around 2-3 weeks and repeated if there is recurrence.

C) Avoid NSAIDs or the concurrent use of a prostaglandin analogue (misoprostol) may be prescribed to prevent peptic ulceration due to NSAIDs.

D) The use of antacids or H₂ receptor antagonist (H₂RAs) such as cimetidine, ranitidine, famotidine, and nizatidine which help in the reduction of gastric acid secretion and in turn increase the gastric pH and reduce the secretion of pepsin.

E) The treatment of peptic ulcer complications include a blood transfusion for hematemesis and melena, the use of antacids and H2 receptor antagonists for pain, the treatment of peritonitis in case of perforation of peptic ulcer disease.

Maintenance with H2 receptor antagonists is usually effective and relatively safe.

Surgery

Surgical treatment of ulcer may be indicated for patients with failure to respond to medical line of treatment or with complications such as increased pain, bleeding, obstruction and perforation.

Infection Secrets of Ebola Explained

By attacking the body's first responders, the Virus cripples the immune system before it can mount an effective defense
  often describe the battle between the Ebola virus and the humans it occasionally infects as a race—one that people win only if their immune systems manage to pull ahead before the virus destroys too many of their internal defenses. What they may not know is that the virus is a cheat.
The Ebola virus gives itself a head start when it first slips into a human body by disabling parts of the immune system that should be leading the charge against the invader. It hijacks the functions of certain defense warriors known as dendritic cells—whose primary function is to alert the immune system to the incoming threat. Other targets include monocytes and macrophages, types of white blood cells whose job is to absorb and clear away foreign organisms.
These are the first cells Ebola infects and bends to the process of making more Ebola viruses. The maneuver is the viral version of invading a country by hypnotizing the army and turning it against its own people. Then, having kicked the immune system’s feet out from under it, Ebola takes off in a run.
Seven Deadly Genes
Although it contains only seven genes, Ebola is an exquisitely effective killer of humans and other primates once it enters a body. Unlike the spiky sea urchin that is influenza, or the golf-ball shaped poliovirus, Ebola resembles noosed ropes under the electron microscopes used to capture viral images.
Classified as a filovirus, Ebola is one of two members of that family; the other is Marburg virus, named after the German city where it was first seen in researchers who caught it from imported non-human primates. Both pathogens are among the most lethal viruses that afflict people, but it is Ebola that has become the recognized and dreaded face of the filovirus family.
Decoy Strategy
Meanwhile, Ebola employs a second dastardly trick, another cheat. It releases large amounts of something called secreted glycoprotein – sGP – into the bloodstreams of its victims. A decoy, sGP looks like the glycoprotein on the exterior of the virus, GP, which should be the immune system’s chief target. By tricking the immune system into seeing it, not GP as the invader, sGP undermines the system’s ability to react effectively to stem the infection.
As the amount of virus in a person’s system starts to rise, symptoms begin to appear. They start with low-grade fever, which can come and go, and is sometimes missed. Severe headache and abdominal pain are followed by vomiting and diarrhea, ­which lead to profound loss of fluids.
Doctors at Emory University Hospital, who have treated four repatriated medical workers infected with Ebola in the current outbreak, found at times their patients excreted between six and eight liters of diarrhea a day – a loss that triggers electrolyte imbalances, says Marshall Lyon, an infectious disease physician on the Emory Ebola team. It has been known for some time that keeping Ebola patients hydrated is the main battle to be waged ­– at least until drugs proven to be effective are available. But the experience at Emory and other hospitals treating med-evaced health-care workers also suggests that when patients have profound diarrhea, replenishing electrolytes such as potassium may be something doctors should consider, even in low-resource settings where laboratory support is minimal and electrolyte levels cannot be monitored.
Back in the body, the accumulating damage in the liver leads to something called disseminated intravascular coagulation or DIC, where blood over-coagulates in some locations, but cannot thicken in others, creating a situation where blood vessels become leaky. That is what results in the bleeding – mostly internal – for which Ebola is known.
The leakiness of blood vessels compromises blood supply to key organs like the liver and the kidneys. Bausch employs the analogy of trying to use a hose full of holes to water your garden – the water does not get to where it is needed. Likewise, bacteria from the gastrointestinal tract can slip into the bloodstream, causing sepsis. The result in the worst cases: blood pressure plummets, vital organs begin to fail, the patient goes into shock and dies.
Where and How Much?
The speed and degree to which Ebola manages to overcome an individual depends on a couple of factors, scientists who study the virus say. If you are unlucky enough to be infected with Ebola, the amount (or dose) of virus to which you are exposed and the route by which the virus makes its way into your body could mean the difference between whether you live or die.
In the world of Ebola, less is better but even a very little is bad. Scientists have differing views on the sometimes cited claim that a single virion – just one virus – is sufficient to trigger infection. While that may, or may not be the true figure for the minimum infectious dose for humans, it is likely that infection can occur from contact with small amounts of virus, Bausch says.
"We think that it's very low — a little dab will do you,” he notes, playing on a 1960s advertisement for a men’s hair pomade, Brylcreem. “You don't need much of this virus to get infected.” Nevertheless, a low-dose exposure may prove less lethal if it allows the immune system to get into gear before the viruses have a chance to disable too many of the early responders.
How you get infected likely also plays a role in how sick you become. An exposure  that delivers the virus into the blood stream ­– for example a needlestick injury, dreaded in the filovirus research world ­– is more damaging than when viruses are introduced via the mucus membranes surrounding the eyes, nose and in the mouth. Onset of symptoms is quickest with direct-to-blood exposures; they typically account for the short end of the incubation period range, two to 21 days. Most infections become apparent within eight to 10 days of exposure.
 “If you get a direct injection with a lot of virus particles, I don’t think anything’s going to save you, because you’re just overwhelmed,” says Thomas Geisbert, a microbiologist at the University of Texas Medical Branch at Galveston. Geisbert notes that in the 1976 Ebola epidemic that brought the disease to the attention of the world, 85 people were known to have been infected through the reuse of contaminated syringes. All 85 died, along with nearly 200 others in and around Yambuku, in the former Zaire (now the Democratic Republic of Congo).
Two other features that may play into the outcome of the life or death struggle between humans and Ebola are age and genetic predisposition. A recently published study which tracked case outcomes in Sierra Leone during the current West African outbreak showed a higher survival rate for patients under the age of 21 compared to those over the age of 45. Earlier, a study done based on blood samples from people who had been infected during a 2000 outbreak of Ebola Sudan in Uganda found that certain people were more likely to have milder disease and survive. Another recently published paper looking at the spectrum of disease in mice also suggests genetics play a role in survival.
Geisbert is one of the discoverers of an Ebola species known as Ebola Reston, unique among the five types of the viruses because it does not originate in Africa   and so far it has not been seen to sicken people. Reston viruses come from the Philippines; on six occasions research monkeys imported from that country have triggered animal outbreaks. It has also been found in pigs, though the animals do not show signs of infection. Ebola Reston is   lethal in primates.
Research done after animal outbreaks shows that several people have developed antibodies (or "seroconverted") to Ebola Reston, but did not become noticeably ill. Still, it is too soon to assume Reston is harmless in humans, Geisbert says. “Some people have seroconverted but we don’t really know much about that. All you can say is there hasn’t really been any human that has gotten really sick or died from it. But the ‘n’ [number infected] is quite small.”
The other species of Ebola are: Zaire, the most lethal and the virus responsible for the current West African outbreak,  Sudan, Bundibugyo and Ivory Coast (sometimes called Tai Forest). The fatality rates for the first three range from 70 percent to 90 percent, about 50 percent and 25 percent, respectively. The Ivory Coast virus has only been seen once, in 1994. The infected person survived, but was very ill.
Geisbert works with a variety of bad bugs. But it is Ebola and the Marburg strain responsible for the 2004 outbreak in Uije, Angola – case fatality rate, 90 percent – that make him extra cautious. “It’s always in the back of your mind that you’re working with something that can kill you.” 

In Diabetes, a Complex of Causes and Its Treatment

Diabetes is usually a lifelong (chronic) disease in which there is a high level of sugar in the blood.

Causes

Insulin is a hormone produced by the pancreas to control blood sugar. Diabetes can be caused by too little insulin, resistance to insulin, or both.
To understand diabetes, it is important to first understand the normal process by which food is broken down and used by the body for energy. Several things happen when food is digested:

• A sugar called glucose enters the bloodstream. Glucose is a source of fuel for the body.
• An organ called the pancreas makes insulin. The role of insulin is to move glucose from the bloodstream into muscle, fat, and liver cells, where it can be used as fuel.
  
   

People with diabetes have high blood sugar because their body cannot move sugar into fat, liver, and muscle cells to be stored for energy. This is because either:

• Their pancreas does not make enough insulin
• Their cells do not respond to insulin normally
• Both of the above

There are two major types of diabetes. The causes and risk factors are different for each type:

• Type 1 diabetes can occur at any age, but it is most often diagnosed in children, teens, or young adults. In this disease, the body makes little or no insulin. Daily injections of insulin are needed. The exact cause is unknown.
• Type 2 diabetes makes up most diabetes cases. It most often occurs in adulthood. But because of high obesity rates, teens and young adults are now being diagnosed with it. Many people with type 2 diabetes do not know they have it.
• There are other causes of diabetes, and some patients cannot be classified as type 1 or type 2.

Gestational diabetes is high blood sugar that develops at any time during pregnancy in a woman who does not have diabetes.
Diabetes affects more than 20 million Americans. Over 40 million Americans have pre-diabetes (which often develops before type 2 diabetes). If your parent, brother or sister has diabetes, you may be more likely to develop diabetes.

Symptoms

High blood sugar level can cause several symptoms, including:

• Blurry vision
• Excess thirst
• Fatigue
• Hunger
• Urinating often
• Weight loss

Because type 2 diabetes develops slowly, some people with high blood sugar have no symptoms.
Symptoms of type 1 diabetes develop over a short period. People may be very sick by the time they are diagnosed.
After many years, diabetes can lead to other serious problems. These problems are known as diabetes complications and include:

• Eye problems, including trouble seeing (especially at night), light sensitivity, blindness in the future
• Painful sores and infections of the leg or foot, which if left untreated, leads to removal of the foot or leg 
• Nerves in the body can become damaged, causing pain, tingling, and a loss of feeling, problems digesting food, erectile dysfunction
• Kidney problems, which can lead to kidney failure
• Weakened immune system, which can lead to more frequent infections
• Increased chance of having a heart attack or stroke

 

Exams and Tests

A urine analysis may show high blood sugar. But a urine test alone does not diagnose diabetes.
Your health care provider may suspect that you have diabetes if your blood sugar level is higher than 200 mg/dL. To confirm the diagnosis, one or more of the following tests must be done.
Blood tests:

• Fasting blood glucose level -- diabetes is diagnosed if it is higher than 126 mg/dL twice. Levels between 100 and 126 mg/dL are called impaired fasting glucose or pre-diabetes. These levels are risk factors for type 2 diabetes.
• Hemoglobin A1c test --
  • Normal: Less than 5.7%
  • Pre-diabetes: 5.7% - 6.4%
  • Diabetes: 6.5% or higher
• Oral glucose tolerance test -- diabetes is diagnosed if glucose level is higher than 200 mg/dL 2 hours after drinking a glucose drink. (This test is used more often for type 2 diabetes.)

Screening for type 2 diabetes in people who have no symptoms is recommended for:

• Overweight children who have other risk factors for diabetes, starting at age 10 and repeated every 2 years
• Overweight adults (BMI greater than 25) who have other risk factors
• Adults over age 45, repeated every 3 years 

Treatment

With type 2 diabetes, the disease may be reversed with lifestyle changes, especially losing weight through exercising and eating healthier foods.  Also, some cases of type 2 diabetes can be improved with weight-loss surgery.
There is no cure for type 1 diabetes.
Treating both type 1 diabetes and type 2 diabetes involves medicines, diet, and exercise to control blood sugar level.
Getting better control over your blood sugar, cholesterol, and blood pressure levels helps reduce the risk of kidney disease, eye disease, nervous system disease, heart attack, and stroke.
To prevent diabetes complications, visit your health care provider at least two to four times a year. Talk about any problems you are having. Follow your health care provider's instructions on managing your diabetes.