Causes and Treatment of Gastric Ulcers

Beat Ulcers

The system is all natural and easy to use. You are just minutes away from taking your first steps to having painless days and nights. In less than 2 weeks, you can be totally free from ulcers, living without the pain and feeling free to eat without the thought of pain. All you need do is follow the plan. Beat Ulcers is a step by step guide that shows you how you can eliminate ulcers in as little as 10 days. All you need do is use the readily available natural products in the correct proportions at the correct times. Here is what you will learn in the Beat Ulcers guide: How to Eliminate an Ulcer without the use of medication. How to rid your body of the ulcer causing bacteria and keep it away. How to stop the aching. How to eliminate the burping and bloating. Focus on the root cause of ulcers rather than the symptoms. How to be totally free from pain and sleep soundly at night. How to stop using dangerous medications that are prescribed over and over. Learn the causes of ulcers and how to eliminate them forever.

Beat Ulcers Summary


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Surgical Treatment Of Benign Gastric Ulcer

Gastric Ulcer Elective Surgeries

With the recognized importance of H. pylori as a cause of gastric ulcer disease, surgical management should be considered only when the ulcer is refractory to nonsurgical therapy or presents with a complication such as perforation, hemorrhage, or obstruction. Gastric ulceration can be considered refractory to nonsurgical treatment if the ulcer fails to heal with optimal medical management, the patient is noncompliant with or intolerant of the medical management, or early ulcer recurrence supervenes after an initial course of successful treatment. In addition, patients with giant ( 3 cm) gastric ulcers should be subjected to elective surgery because of the high complication rate associated with these lesions as well as the high rate of nonhealing with this condition.1 In the scenario of early recurrence after initial healing, a second course of therapy can be tried, but any patient with a recurrence thereafter should be considered a surgical candidate. In the rare patient in whom an...

Johnson Classification Gastric Ulcer

Johnson Classification Gastric Ulcers

As type IIIgastric ulcers ( 20 ), and because of their common association with gastric acid hypersection, they are assumed to be similar in origin to duodenal ulcers. Csendes et al.l ' recognized a fourth variety of gastric ulcer, which they call type IV. This ulcer occurs high on the lesser curvature near the gastroesophageal junction. It accounts for 25 of gastric ulcers in Chile, where it was first described, and is being seen with increasing frequency in the United States. Because histologic studies have shown that proximal migration of the gastric nonparietal mucosa can occur along the lesser curvature to the level of the gastroesophageal junction, type IV ulcers likely represent very high type I ulcers. Although the Johnson classification has proved useful in helping to understand responses to treatment when other risk factors are excluded, patients who develop gastric ulceration secondary to NSAID use do not conform to this classification. NSAID ulcers typically occur in the...

Glucocorticoid Secretion Under Stressful Conditions

Generally, the stress response, with the resultant elevation of glucocorticoid levels, is meant to last only for a limited duration. The time-limited nature of this process renders its accompanying catabolic and immunosuppressive effects beneficial, with no adverse consequences. Chronic activation of the stress system, however, is detrimental. For example, prolonged exposure to elevated glucocorticoid levels results in suppression of anabolic processes, muscle atrophy, reduced sensitivity to insulin and a risk for diabetes, hypertension, hyperlipidemia, arterial disease, peptic ulcers, amenorrhea, impotence, immunosuppression, and the impairment of growth and tissue repair (Munck et al., 1984). In addition, elevated glucocorticoid levels are associated with psychopathology, neuronal damage, and impaired cognitive function (McEwen, 1994 Tsigos & Chrousos, 1994). An efficient endocrine response to stress is one that is rapidly mobilized in the presence of a threat and ef

Preface to Third Edition

Human diseases (cholera, anthrax, whooping cough, tetanus, botulism, diptheria, clostridial gas gangrenes, severe diseases caused by superantigenic toxins, Helicobacter pylori-associated peptic ulcers and carcinomas, food poisons, etc.). In this respect, the targeting of immune system cells by various toxins led to a better evaluation of both their beneficial effects (for example as immunomodulators in the case of cholera toxin B subunit) and pathophysiolgical effects in certain diseases in connection with the immune system. Finally, the past years witnessed considerable progress on toxin applications in vaccinology, tumor therapy, and new approaches in the treatment of various diseases. Whether some wild-type toxins can be directly used as therapeutic agents, protein engineering permits us to model more specific and efficient molecules or molecules with a novel activity, or to target a restricted subset of cell population. Novel recombinant toxins are already proposed in the...

Causal Inference Goes Beyond Covariation Tracking

Our consideration shows that, contrary to the causal mechanism view, prior knowledge of noncausality neither precludes nor refutes observation-based causal discovery. Thagard (2000) gave a striking historic illustration of this fact. Even though the stomach had been regarded as too acidic an environment for viruses to survive, a virus was inferred to be a cause of stomach ulcer. Prior causal knowledge may render a novel candidate causal relation more or less plausible but cannot rule it out definitively. Moreover, prior causal knowledge is often stochastic. Consider a situation in which one observes that insomia results whenever one drinks champagne. Now, there may be a straightforward physiological causal mechanism linking cause and effect, but it is also plausible that the relation is not causal it could easily be that drinking and insomnia are both caused by a third variable - for example, attending parties (cf. Gopnik et al., 2004).

Presenting Symptoms And Signs

Epigastric pain, diarrhea, persistent heartburn, and dysphagia ( Table 8-1 ). The majority of patients with ZES (approximately 90 ) are found to have peptic ulceration, with the proximal duodenum as the most commonly involved site. However, a minority of patients still have multiple peptic ulcers or ulcers in unusual locations, such as the distal duodenum (14 ) and jejunum (11 ), or even recurrent ulceration after 5 7 5 surgery. In 7 to 10 of patients, a perforated peptic ulcer may be the initial sign of the disease. Gastric acid hypersecretion also leads to secretory diarrhea, which occurs in up to 40 of patients with ZES and may be the sole presenting complaint in 20 of individuals. In patients with diarrhea, malabsorbtion may manifest itself as weight loss and malnutrition. In approximately 10 of patients, endoscopy shows evidence of lower esophageal inflammation, ulceration, and even stricture if the reflux symptoms are longstanding. As a large primary tumor burden develops or...

Timothy M Farrell John G Hunter

The appropriate role of minimally invasive surgery for diseases of the stomach and duodenum is emerging. The advent of contemporary medical and surgical therapies for the treatment of gastroesophageal reflux (GER) disease and peptic ulcer disease (PUD) has challenged the traditional application of these modalities. Although laparoscopic antireflux surgery has achieved a place in modern treatment algorithms for GER, elective surgical management of PUD remains subordinate to antisecretory and antibacterial strategies. However, patients who are refractory to standard medical regimens or experience complications of PUD such as bleeding or perforation may receive surgical therapy via a minimally invasive approach. Laparoscopy has revitalized debate over the appropriate surgical therapy for morbid obesity refractory to medical and behavioral measures. Several operations from the prelaparoscopic era have been modified to the laparoscopic approach with success, but the appropriate indications...

Contribution of voltagegated sodium channels to the sensitization of visceral afferent neurones

A similar increase in excitability is seen in neurones innervating the stomach after either a mild gastritis induced by administering iodoacetamide in drinking water or by producing gastric ulcers with acetic acid injections into the stomach wall 15, 16 . In these experiments an increase in the peak TTX-resistant current was observed and there was also a decrease in the threshold for activation of this current. Likewise, the sodium channel density increased in neurones labelled from the mouse colon after induction of colitis with TNBS 20 . A more detailed characterization of the sodium currents revealed that this increase was due to a 62 increase in the slow TTX-resistant current (likely mediated by NaV1.8), which also showed a decrease in the activation threshold. There was no significant change in the fast TTX-sensitive currents or in the persistent TTX-resistant current 20 .

Organizing the Paragraph

Thoughts in a paragraph must be presented in an orderly fashion, not jumbled like a bag of toys. Sentences can be arranged in a chronology of what happens. I used this in the preceding paragraphs moving from topic sentence, to examples, to conclusion. Or you may decide to order sentences by rank of importance. In describing causes of a low back pain, you might mention lumbosacral strain (the most common cause) first, then herniated lumbar disc (less common, but very important), followed by less common causes such as spinal abscess, metastatic cancer, and so forth. An alternative method of ordering sentences within a paragraph might be a reverse ranking order In this setting you might describe the medications currently used to treat peptic ulcer disease, briefly describing the least expensive or the least effective ones first, and then spending most of the space on today's popular remedy, the protein pump inhibitors. Or sometimes the rational order is nothing more than a simple list....

Additional Information

99mTc-DTPA has been used for studies of gastroesophageal reflux and gastric emptying. In this case, scintigraphy is performed after oral administration of 99mTc-DTPA (10-20 MBq, 0.3-0.6 mCi) in a suitable liquid (300 ml), according to local practice. Sequential scintigraphy and static imaging may be performed. The patient's stomach is imaged at 5 and 10 min after drinking the liquid, and then every 5-15 min until the stomach activity has reached half the original value. The gastric emptying half-time is determined from a plot of percent activity versus time. Normal values are 10-15 min delayed emptying is observed with gastric ulcers, pyloric stenosis, vagotomy, and in the case of malignancy (Chadhuri 1974).

The Roles of Inductive and Deductive Thinking in the Scientific Mind

Once a rule is discovered, scientists can extrapolate from the rule to formulate theories of the observed and yet to be observed phenomena. One example is using inductive reasoning in the discovery that a certain type of bacterium is a cause of many ulcers (Thagard, 1999). In a fascinating series of articles, Thagard documents the reasoning processes that Marshall and Warren went through in proposing this novel hypothesis. One key reasoning process was the use of induction by generalization. Marshall and Warren noted that almost all patients with gastric enteritis had a spiral bacterium in their stomachs and formed the generalization that this bacterium is the cause of many stomach ulcers. There are numerous other examples of induction by generalization in science, such as Tycho Brahe induction about the motion of planets from his observations, Dalton's use of induction in chemistry, and the discovery of prions as the source of mad cow disease. Many theories of...

Functional genomics of bacterial pathogens 21 Comparative genomics

In contrast to M. tuberculosis, Helicobacter pylori, a bacterium able to persist in the human stomach, is a genetically diverse species. In most cases, this bacterium causes asymptomatic infections. However, in a small proportion of individuals, H. pylori causes severe diseases, such as peptic ulcer disease and gastric adenocarcinoma 31 . A comparison of the full genome sequences of two H. pylori strains demonstrated that many of the genes present in both strains are highly conserved, but also identified 200 genes that are present in one genome but not the other. The

Case study 1 eradication of H pylori in nonulcer dyspepsia

Pylori Eradication

H. pylori is a bacterium that inhabits the stomach and has been linked to the development of peptic ulcer eradication of the bacterium with antibiotics is an effective cure for most ulcer disease. H. pylori is also considered to have a possible causal role in the development of non-ulcer dyspepsia. A meta-analysis of the five relevant trials reported a small reduction in dyspepsia rates 12 months after eradication, which was just statistically significant.19 The effect measure used in the published analysis was the relative risk of remaining dyspeptic 12 months after eradication. This was chosen as it was thought to be the most clinically relevant outcome and had been pre-stated in the review protocol. No alternative effect measures were considered.

Robert C Moesinger Charles J

Duodenal ulcer is a pervasive illness, and our understanding of its pathophysiology and treatment has undergone dramatic changes through history. The first documented case of perforated peptic ulcer is of a man of the Western Han Dynasty who died in 167 B.C. and whose body was preserved by immersion in a Chinese herbal solution in a thick wooden coffin. The body was found in 1975 by archaeologists and extensively studied. The cause of death was diffuse peritonitis secondary to perforation of a prepyloric ulcer.1 ' 1 ' Baille in 1799 described a patient who died from a perforated duodenal ulcer just distal to the pyloric ring.1 ' In 1843, Edward Crisp reported 50 cases of perforated peptic ulcer and included the following appraisal, Once the perforation has occurred, the case must be considered hopeless. In Surgery's present state, the idea of cutting open the abdomen and closing the opening would be too quixotic to mention 1 ' Perforated ulcers were treated exclusively nonoperatively...

Approaches to Preventative Iron Supplementation

Iron Transport Gastrointestinal Tract

reset its set point for iron absorption every 3 to 4 days because a new crop of crypt cells migrates up to the tip of the villus, the large doses of iron given on days 2 and 3 are wasted and may in fact result in oxidative damage and mucosal injury. To test this hypothesis, a number of studies in developing countries have compared the efficacy of daily doses compared to an intermittent dose in correcting iron deficiency anemia in adolescents, reproductive age women, pregnant women, and children. The daily dosage approach had a faster response, but with lower compliance, than did the intermittent oral iron dose. The end result in terms of correcting the anemia was similar in nearly all studies, with the exception of pregnancy, where daily iron therapy clearly provided a greater benefit (40). Cleary, blood loss from the body is the single largest cause of increased or altered iron requirements. Bleeding ulcers, lesions, and leaking inflammatory states in the gut will all be associated...

Perception of Emotion Laden Content

In yet another early study comparing cognitive reactions of hypertensive and normotensive patients, Weiner, Singer, and Reiser (1962) found that hypertensives responded to the presentation ofThe-matic Apperception Test cards with avoidance of emotional content more than normotensive volunteers or patients with peptic ulcers. Although hypertensives actively resisted efforts from the test examiner to consider the emotional content of the stimuli, when they were forced to explore the emotional content, increased blood pressure responses were observed. In a study comparing hypertensive and normotensive patients, Handkins and Munz (1978) found that self-reported ratings of stress varied directly with the level of intimacy of the personal topic being discussed among normotensives. However, no relation between ratings of stress and levels of intimacy regarding the topic were observed among hypertensives, suggesting that hypertensives 'denied' emotional content of the topic as well as...

Heart Valve Replacement

Pulmoanry Valve Replacement

The biggest disadvantage of the mechanical heart valves is that most patients need to take an anticoagulant, also referred to as a blood thinner, to prevent blood clots from forming on the valve itself. The most common anticoagulant is coumadin, otherwise known as warfarin. Patients who take coumadin need to get their blood tested periodically. When coumadin treatment is first started, the blood is tested every day or two, but after a few weeks, it is usually tested every couple of months to make sure the level of anticoagulation is appropriate. If the anticoagulation is too great, the patient is more prone to develop bleeding problems, which can include bleeding into the stomach, intestines, brain, or kidneys. A person with bleeding ulcers would be prone to bleed more. If you were cut, you would have a problem with abnormal bleeding. The coumadin treatment can be reversed in an emergency situation if necessary.

What Are The Possible Routes By Which Bacteria May Enter The Peritoneum

The most common causes of bacterial peritonitis were perforations of ulcers of the upper gastrointestinal tract or the rupture of abdominal viscera, usually the appendix. Although perforations of the gastrointestinal tract may be silent clinically, they are rarely so, and even when silent they usually exhibit pneumoperitoneum. Despite the greater prevalence of peptic ulcer in cirrhotic patients than in non-cirrhotic patients, in none of the patients reviewed or reported here was there clinical or postmortem evidence of such perforations, and in none of those studied was free air found in the peritoneum radiologically.

Sandra L Wong Susan Galandiuk

PCI can also be classified as primary (idiopathic) or secondary, the latter being associated with a wide variety of both gastrointestinal and nongastrointestinal lesions ( Table 32-1 ). PCI of the left side of the colon is usually idiopathic, whereas PCI of the small bowel or ascending colon is usually secondary. 1 I 1 Secondary PCI accounts for about 85 of reported cases and has been described in association with chronic obstructive pulmonary disease, high positive-pressure ventilation, necrotizing enterocolitis, pseudomembranous enterocolitis, diverticulitis, intestinal strangulation, appendicitis, gallstones, volvulus, pyloric stenosis, peptic ulcers, Crohn's disease, ulcerative colitis, esophageal stricture, tuberculous enteritis, scleroderma, blunt abdominal trauma, diaphragmatic hernia, jejunoileal bypass, steroid use, chemotherapy,

Hormonal Responses to Emotional Stress

GAS may be brought about by any stressful situation, including chronic physical stress (e.g., from exposure to extreme cold or in times of real physical danger), but it also may occur as a result of continual psychological stress. As originally described by Selye, the physical correlates of GAS include enlarged adrenal glands, with a marked increased in size of the adrenal cortex as its cells respond to the actions of ACTH and attempt to produce ever larger quantities of the glucocorticoids, as well as a shrunken thymus, weight loss, and gastric ulcers. Gastric ulcers are caused by chronic decrease in blood flow to the gut. Substantial rates of blood flow are necessary for maintenance of the mucosal lining that protects the stomach from the digestive acids. As a consequence of chronic activation of the body's stress response, the gut's blood flow is so decreased that its mucosal lining deteriorates, and the stomach's hydrochloric acid produces ulcers.

Could Amyotrophic Lateral Sclerosis Be Caused By A Spirochete

Could have a bacterial etiology is no longer novel since it has been shown that helicobacter is the agent that causes stomach ulcers. I have proposed an explanation for the biology (Koch, 2003b) of ALS that builds further on Mattman's ideas. She reported that spirochetes have been cultured from 18 cases of ALS. This point needs experimental clarification. This idea suggests that, on the first detection of symptoms, antibiotics be administered to patients in the earliest stages of the disease.

James P Dolan Jeffrey A Norton

In 1955, Zollinger and Ellisonr1i first reported the occurrence of unusual jejunal peptic ulcer disease associated with gastric acid hypersecretion and islet cell tumors of the pancreas in two patients. After vagotomy, antrectomy, and hemigastrectomy, these patients subsequently developed recurrent peptic ulceration that required total gastrectomy for control of symptoms. In consideration of the patients' initial and eventual presentations, they postulated that the pancreatic tumor was the cause of the peptic ulcer diathesis. We now know that the Zollinger-Ellison syndrome (ZES) is caused by a pancreatic or duodenal neuroendocrine tumor called a gastrinoma that elaborates excessive and unregulated amounts of the hormone gastrin. functional tumors are gastrinomas. Although the precise incidence is unknown, it is estimated that one to three persons per 1 million develop gastrinomas each year. Furthermore, gastrinomas are the underlying cause in approximately 0.1 to 1 of patients with...

Moderately Curved Bacterial Rods

The helicobacteria are of special interest here because of the analytical chemistry that has been done on their most famous member Helicobacter pylori. It is most well-known because of its involvement with stomach ulcers. The genus contains a group of bacteria closely related to the campy-lobacters that are Gram-negative and to various degrees are helical or are curved rods. Its murein is classified as A1y like the murein of E. coli and that of the Gram-positive, B. subtilis. H. pylori, during growth, varies from a bent rod to a loosely coiled helix of two to three turns or less. During growth other helicobac-ters have a range of tightness of their helical structures from almost none to very tight (5-7 turns per cell). In the stationary phase, H. pylori appearance becomes coccoidal or spherical. The organisms are motile with four to eight sheathed external flagella. There are internal flagella that may support and indeed may have created the helical structure. These have been detected...

Spirulina And Its Antibacterial Activity

Spirulina contains vitamin A, important in preventing eye diseases iron and vitamin Bi2, useful in treating hypoferric anemia and pernicious anemia y-linolenic acid, appropriate in treatment of atopic child eczema therapy, to alleviate premenstrual syndrome, and in immune system stimulation.77 Edible microalgae such as Spirulina are rich in protein, lipid, polysaccharide, fiber, microelements, andbioactive substances.78 It has also been reported to have health and pharmacological properties that can help to prevent and cure peptic ulcer and anemia, enhance immunity, as well as antitumor, antiradiation, antipathogenic activities against microorganisms, it can decrease blood lipid and some may act as antiarteroclerosis agents.79-84

Kenric M Murayama Thomas A Miller

Although discussions of gastric ulcer are frequently lumped together with those of duodenal ulcer under the broad heading of acid-peptic disease, a number of features distinguish these two entities, justifying separate consideration. Although it is true that both types of ulcer require a luminal acid milieu to develop, the overnight acid output in the typical patient with a gastric ulcer is usually in the range of 1.2 mEq hr, whereas in the average patient with a duodenal ulcer outputs approximately 4.0 mEq hr.1 Furthermore, the incidence of gastric ulcer has remained relatively constant during the past two decades, whereas the incidence of duodenal ulcer has clearly decreased. Patients who develop a gastric ulcer are usually older than their duodenal ulcer counterparts, often by as much as 15 to 20 years, with the peak incidence being between 55 and 65 years of age. Duodenal malignancy may present as a distinct duodenal ulcer, but this circumstance is exceedingly rare in contrast,...

Control of Brain Stem Autonomic Centers by Higher Areas

In Chapters 58 and 59, it is pointed out also that many of our behavioral responses are mediated through (1) the hypothalamus, (2) the reticular areas of the brain stem, and (3) the autonomic nervous system. Indeed, some higher areas of the brain can alter function of the whole autonomic nervous system or of portions of it strongly enough to cause severe autonomic-induced disease such as peptic ulcer of the stomach or duodenum, constipation, heart palpitation, or even heart attack.

Hereditary Sensory and Autonomic Neuropathies

Recurrent vomiting is common in the early years. Several gastrointestinal abnormalities have been identified megaesophagus, pylorospasm, gastric ulcer, jejunal distention, and megacolon. Corneal abrasions may occur secondary to corneal insensitivity, whereas neuropathic or Charcot's joints may occur secondary to pain insensitivity. About half of the patients develop kyphosis, scoliosis, or both. Pulmonary complications, profound hypotension, and prolonged respiratory depression from the administration of anesthesia have been reported. '331


Although driven by anti-infectives development, microarray technology has had many spin-off benefits. Microarrays are, for example, utilized for the development of pathogen diagnostic kits. These kits are employed in measuring strain-specific mRNA profiles. Related technologies are increasingly used for the identification of the genotype of bacterial strains by hybridizing genomic DNA on microarrays carrying oligonucleotides that cover the full genome sequence of the reference strain of the pathogen. This technique was performed for Helicobacter pylori 67 , a bacterium that was discovered in 1982 by Marshall and Warren (for which they were awarded the Nobel Prize in 2005) as the infectious agent responsible for gastric ulcer disease 68 . Helicobacter pylori is distributed in at least half of the world's population with the many genomic variants of this bacterium determining pathogenesis and drug susceptibility 69 . The identification of bacterial polymorphisms allows a prediction of...

Gastric Analysis

Gastric secretion analysis and the direct measurement of gastric acid are limited to the evaluation patients with elevated serum gastrin levels and suspected hypersecretory syndromes. The practice of measuring gastric acid pH and basal acid output (BAO) has a very limited role in the management of patients with peptic ulcer disease. In the past, many patients were tested after partial gastrectomies to assess the


On the basis of anatomic location in the stomach, presumed cause, and association with duodenal ulcers, Johnson has classified gastric ulcers into three types ( Table 6-1 and Fig. 6-1 ). Type I gastric ulcers represent the most common variety (50 to 60 ) and can occur anywhere in the body of the stomach proximal to the prepyloric antrum. They commonly occur along the lesser curvature in the region of the incisura angularis. Ulcers that arise secondary to duodenal ulcer disease in which pyloric emptying is perturbed secondary to the activity of the ulcer or coincident with a scarred duodenum are called type IIgastric ulcers ( 20 ). Ulcers that arise in the pyloric channel or in the prepyloric region are classified

General Principles

Most patients who present for reoperation on the stomach had the initial surgery for a benign condition, such as gastroesophageal reflux, morbid obesity, or peptic ulcer. Although each of these conditions can indubitably lead to death in a certain percentage of the population (e.g., from adenocarcinoma of the esophagus, heart disease, or upper gastrointestinal GI bleeding, respectively), the individual patient usually had the original surgery for symptomatic relief. It is therefore regrettable that for a portion of these patients, surgical therapy is destined to fail, or they will become disabled by an operation that was intended to improve their quality of life. This is sometimes due to an ill-conceived or improperly performed operation. Medical progress has led to new operations for certain patient groups (e.g., laparoscopic fundoplication for intractable gastroesophageal reflux disease), and fewer operations for others (e.g., intractable peptic ulcer). Young surgeons recently out...


Derived from Greek roots meaning difficult digestion, dyspepsia has long served as a synonym for indigestion, one of the most common - and etiologically varied - of human miseries. It has also been regularly employed to label symptoms of diverse organic disorders, with the result that some gastroenterologists find the word uselessly elastic. Most practitioners, however, have reached a consensus to use dyspepsia to denote either the ailment of functional indigestion or the symptoms of peptic ulcer.

Who Cares

When I was in private practice three decades ago, we often recommended that patients with peptic ulcer disease drink plenty of whole milk. Yes, things have changed. Nevertheless, it seemed that many patients with peptic ulcer disease reported not liking milk more often than expected. I thought of doing a study and writing it up. I asked my colleagues about this idea, and learned, to my dismay, that they really didn't care. I never did the study.

[71 i72

Remainder of cases, no diagnosis was made. The likelihood that varices will be the source of acute gastrointestinal hemorrhage in a patient known to have cirrhosis is controversial. Merigan et al. evaluated 158 patients with cirrhosis with upper gastrointestinal bleeding and found that 53 bled from esophageal varices, 22 bled from gastritis, and 20 bled from peptic ulcer disease. Although


The persistence of nonspecific symptoms eventually precipitates a diagnostic workup. Fiberoptic endoscopy is the diagnostic method of choice. It allows direct visualization and inspection of the entire gastric mucosal surface. Multiple biopsies of all suspicious lesions should be obtained to reduce the likelihood of sampling error. All gastric ulcers should be considered to be malignant until proven to be benign by biopsy and subsequent follow up. Features associated with, but not specific for, malignant gastric ulcerations include an irregular ulcer base, irregular border, associated mass, and irregular mucosal folds at the periphery of the ulcer.


Cytomegalovirus (CMV) infection is the most commonly described viral infection following transplantation for FHF.2,5 The range of clinical presentation varies from asymptomatic to invasive disease presenting with fever, pneumonia, hepatitis, gastrointestinal ulcers, enteritis or colitis.


Most hemangiomas are asymptomatic and are discovered incidentally. The prevalence of symptoms is usually associated with larger tumor size. In a review of the Mayo Clinic experience, investigators reported that 90 of patients with hemangiomas larger than 10 cm were symptomatic, compared with only 15 of patients with lesions smaller than 10 cm. The most common symptoms are nonspecific and include abdominal pain or fullness, early satiety, nausea, vomiting, or fever. Many of these symptoms may ultimately be attributed to other disease processes, such as biliary colic or peptic ulcer disease, and these findings confirm that the hemangioma was an incidental finding. Less commonly, patients may present with obstructive jaundice, gastric outlet obstruction, or intra-abdominal hemorrhage from spontaneous rupture.


Splenic rupture secondary to underlying splenic pathology is much more common. All types of infectious agents that may involve the spleen have induced rupture. In the United States, infectious mononucleosis is thought to be of particular importance, but reported data indicate that risk is a small fraction of 1 of cases of this disease. Other causes of pathologic rupture include the following vascular, thrombotic, and hemostatic disorders splenic neoplasms (primary and metastatic) infiltrative conditions (e.g., sarcoidosis, amyloidosis, Gaucher's disease) hemolytic anemias and some external factors (erosion associated with gastric ulcer, pancreatitis). Few patients are diagnosed preoperatively, but a greater awareness of predisposing conditions may improve diagnostic accuracy.


Determine the serum pepsinogen group I level (PG I), and the ratio between PG I and PG II in predicting the presence of stomach cancer in participants in an endoscopic screening programme (Kitahara et al., 1999). However, the sensitivity of this approach is not sufficient to detect all tumour cases. Additional variables must be identified before a focused screening programme can be used to identify high-risk subjects in low-risk Western settings. These might include two or more of the following (1) firstgeneration migrants from countries with high rates of gastric cancer (2) a high H. pylori antibody level (3) persons with a strong history of stomach cancer among close family relatives (4) smokers with a history of stomach ulcer (5) persons who have had a partial resection of the stomach 17 or more years previously and (6) persons who have received radiation treatment to the upper abdomen prior to age 30. Japanese studies of patients with untreated early cancer suggest that...

Nasogastric tube

Peptic ulcer disease Retracing science's journey through the gut. Postgrad. Med., 102 158, 1997. 4. Flynn, W.E. Managing the emotional aspects of peptic ulcer and ulcerative colitis. Postgrad. Med., 47 119, 1970. 5. Kraemer, M. A new antacid for peptic ulcers. Postgrad. Med., 2 431, 1947. 6. Christensen, A., Bousfield, R., and Christiansen, J. Incidence of perforated and bleeding peptic ulcers before and after the introduction of H2 -receptor antagonists. Ann. Surg., 207 4, 1988. 7. Mulholland, M. W., and Debas, H. T. Chronic duodenal and gastric ulcer. Surg. Clin. North Am., 67 489, 1987. 8. Soll, A.H. Pathogenesis of peptic ulcer and implications for therapy. N. Engl. J. Med., 822 909, 1990. 23. Sucralfate for peptic ulcer A reappraisal. Med. Lett., 26 43, 1984. 25. Watkinson, G., and Akbar, F.A. Misoprostol in peptic ulcer disease. Prostaglandins, 33(Suppl.) 79, 1987. 26. Burden, W.R., and O'Leary, J.P. The vagus nerve, gastric secretions, and their relationship to...

James Marsh MD

Because this is a very potent drug that dissolves clots anywhere in the body, bleeding is one possible side effect of tPA. Therefore, patients must be carefully selected to have minimal risk for bleeding. It cannot be used in patients who have had a recent stroke, in patients with severe high blood pressure, or in patients with bleeding stomach ulcers. However, when it is given to carefully selected patients in the first six to twelve hours after the onset of a heart attack, it can definitely improve their outcome.

Boolean Searching

Boolean logic, named for British-born Irish mathematician George Boole, refers to relationships between search terms. Fundamentally, it allows you and me to search the Web for the commonality, or maybe the lack thereof, of two possibly related items. It's not difficult. In a Boolean search, you will use one of three words to link two (or more) items. The words are AND, NOT, and OR. As an example, let's assume that I want to look up current information about the treatment of migraine headaches. I would first enter the terms migraine AND treatment. This will give me only articles about migraine therapy, and not information about the aura or the treatment of peptic ulcer disease. If I ask for migraine headache NOT treatment, I should get a list of articles about epidemiology, classification, symptoms, diagnosis, and so forth all except therapy. And if I request migraine headache OR treatment, I should get it all.


Of duodenal ulcers in men and women has equalized. Duodenal ulcer patients as a group are younger than gastric ulcer patients. 1 2 2 58 Despite the improvement in the treatment of duodenal ulcer, it remains an enormous health problem. Approximately 25 million Americans will have an ulcer in their lifetime.1 ' 1 ' Each year, 500,000 to 850,000 new cases of ulcer disease develop, and approximately 1 million ulcer-related hospitalizations occur.1 ' At any given time, approximately 2 of the U.S. population has symptomatic peptic ulcer disease.1 ' Duodenal ulcer is not explicable by a single clearly defined process but instead involves complex interactions of multiple factors. The most important factors are the presence of H. pylori, abnormalities in gastric acid secretion, and the breakdown of mucosal defenses, usually as the result of pharmacologic agents. In addition, cigarette smoking doubles the risk of peptic ulcer disease.