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stomach ulcer

Stomach and duodenal ulcers are both caused by stomach acid and pepsin, an enzyme that normally breaks down protein. It is not yet clear why these substances produce ulcers in some people and not in others; the probable cause is that active and protective factors are thrown off balance. Factors that protect the mucous membrane include good blood circulation, adequate mucus production and good regulation of stomach acid production. On the other hand certain factors favour ulcer formation; they include overproduction of acid and existing damage to the mucous membrane (for example as a result of the use of alcohol or certain medicines such as aspirin or corticosteroids). Other important factors are heredity (the condition often runs in families), stress and tension. Ulcers also occur more frequently in smokers, in spring and in autumn. Excessive acid and pepsin production often disturbs the balance in the duodenum; in the stomach itself acid production is often normal, and the cause then is usually reduced resistance. The effect of acid on the membrane defect gives rise to the most characteristic symptom: pain in the upper abdomen. The pain is nagging and searing in character, and often radiates to the back and chest, There is a connection with eating: the pain caused by stomach ulcers usually begins 15 to 60 minutes after a meal, when stomach acid content is at its highest. Symptoms are worsened by eating indigestible, highly spiced food or the use of alcohol or ‘fizzy’ drinks containing carbon dioxide (the carbon dioxide released distends the stomach and stretches the ulcer). If the ulcer is in the duodenum, pain begins 2 to 4 hours after eating (not until the ulcer comes into contact with the highly acid stomach content). Sometimes, especially with stomach ulcers, pain is felt before a meal, so-called hunger pain; this can be diminished by eating, and drinking milk is often found to be particularly helpful. The pain symptoms often persist for several weeks and then disappear for some time, but return when the ulcer reappears. Other symptoms include vomiting, heartburn, burping and excessive saliva production. If a stomach ulcer is suspected a barium meal contrast X-ray or direct examination by gastroscopy can confirm the diagnosis; in the latter case a biopsy can also be taken for examination under the microscope. The same test is necessary to distinguish an ulcer from conditions such as stomach cancer, or disorders of the pancreas, gall bladder or colon (spastic colon). The patient can control the symptoms himself by reducing stress, taking regular meals, avoiding alcohol and coffee and giving up smoking. Treatment is needed to ensure recovery and avoid complications. Important complications are stomach perforation, stomach haemorrhage and sometimes pyloric stenosis. Treatment in the first place is with antacids; medication is also prescribed to limit stomach acid production, and to protect the mucous

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