What is gastroparesis?
Gastroparesis is a challenging condition characterised by delayed stomach emptying, which can lead to various symptoms and complications. It is a condition where the stomach muscles are unable to propel food into the small intestine at the normal rate, leading to delayed digestion and emptying.
What are the causes of gastroparesis?
There are several known causes of gastroparesis, and the most common ones are listed below.
- Diabetes: Gastroparesis is commonly associated with diabetes, particularly when it's poorly controlled, as high blood sugar levels can damage nerves that control stomach function.
- Stomach Surgery: Previous stomach surgeries, such as gastric bypass or removal of portions of the stomach, can disrupt normal stomach motility.
- Vagus Nerve Injury: The vagus nerve plays a crucial role in controlling stomach function. Injury or damage to this nerve, which can occur due to trauma or surgery, can lead to gastroparesis.
- Post-Infectious/Post-Viral: In some cases, gastroparesis may develop following a viral infection or gastrointestinal illness, though the exact mechanisms are not fully understood.
- Idiopathic: The most common category of gastroparesis, where no specific cause can be identified despite thorough evaluation.
What are the symptoms of gastroparesis?
- Nausea and Vomiting: Persistent or recurrent nausea, sometimes accompanied by vomiting, especially after eating.
- Feeling Full Quickly: Sensation of fullness or bloating even after consuming small amounts of food.
- Abdominal Pain: Discomfort or pain in the upper abdomen, often described as burning or gnawing.
- Heartburn or Acid Reflux: Backflow of stomach acid into the oesophagus due to delayed emptying.
- Fluctuating Blood Sugar Levels: In diabetic individuals, gastroparesis can lead to unpredictable changes in blood sugar levels due to delayed absorption of carbohydrates.
- Malnutrition and Weight Loss: In severe cases, inadequate nutrition and unintended weight loss may occur due to difficulty in eating and absorbing nutrients.
How is gastroparesis diagnosed?
Diagnosis typically involves a combination of medical history, physical examination, and tests such as gastric emptying studies, upper endoscopy, and imaging studies. Dr Peerbaccus will put all the information together to make the diagnosis.
How is gastroparesis treated?
Management of gastroparesis aims to alleviate symptoms, improve nutritional status, and enhance quality of life. Treatment options may include dietary modifications, medications to stimulate stomach motility or control symptoms, botulinum toxin injections, or in severe cases, surgical interventions such as gastric electrical stimulation or pyloroplasty.
Gastroparesis requires comprehensive management and ongoing monitoring by healthcare professionals to address symptoms and prevent complications. Individualised treatment plans are essential, considering the underlying cause, severity of symptoms, and the patient’s overall health status.
What is peptic ulcer disease?
Peptic ulcer disease manifests as the formation of ulcers, or open sores, within the lining of the digestive tract. The term “peptic” denotes its connection to digestion, derived from “pepsin,” a primary digestive enzyme produced in the stomach. Pepsin, along with stomach acid, comprises the active components of gastric juices, crucial for breaking down food chemically. These digestive juices, including pepsin and acid, transit into the initial segment of the small intestine, the duodenum, and possess potent corrosive properties.
Throughout the gastrointestinal tract, a protective mucous lining shields it from internal substances. This protective layer is particularly robust in the stomach and duodenum. However, in peptic ulcer disease, this safeguard mechanism falters, leading to the corrosion of the lining by digestive juices.
An ulcer develops when erosion breaches through all three layers of the mucous lining (mucosa). Predominantly, peptic ulcers arise in the stomach or duodenum, where gastric juices exhibit heightened activity. Although less frequently, they may also manifest elsewhere along the gastrointestinal tract.
What are the different types of peptic ulcers?
Peptic ulcer disease primarily targets the stomach and duodenum, with duodenal ulcers comprising nearly 80% and stomach ulcers making up about 20% of all cases. However, under uncommon circumstances where stomach juices traverse unusual parts of the gastrointestinal tract, peptic ulcers can develop elsewhere. For instance:
- Oesophageal ulcer: Prolonged acid reflux, where stomach acid ascends into the oesophagus, may lead to the erosion of the oesophageal mucous lining, resulting in an ulcer. The oesophageal lining is less fortified against acid compared to the stomach lining.
- Jejunal ulcer: An ulcer can form in the jejunum, the middle segment of the small intestine, because of surgery linking the stomach to the jejunum (known as gastrojejunostomy). This condition is also referred to as a stomal ulcer, marginal ulcer, or anastomotic ulcer.
How common is peptic ulcer disease?
Peptic ulcer disease (PUD) is estimated to afflict between 5% and 10% of individuals globally over the course of their lives. While it can occur at any age, it tends to be more prevalent among middle-aged adults. It is also more common in males.
What are the symptoms of peptic ulcers?
Up to 70% of individuals with peptic ulcer disease remain asymptomatic. However, the most frequently reported symptoms are epigastric pain (located centrally in the upper abdomen) and indigestion, which persistently fluctuate.
Indigestion encompasses a cluster of symptoms occurring post-meal and during digestion. It manifests as epigastric pain characterised by a pronounced burning sensation, accompanied by a sensation of fullness that ensues shortly after eating and may persist for an extended duration. This burning sensation is indicative of stomach acids and enzymes eroding the gastrointestinal lining, often likened to a “gnawing” feeling, sometimes localised (“focal” abdominal pain).
Distinguishing between a stomach ulcer and a duodenal ulcer might be challenging, yet certain cues aid in identification. A stomach ulcer typically exacerbates shortly after meals (within 30 minutes), coinciding with peak gastric juice secretion. Conversely, a duodenal ulcer may alleviate shortly after eating but exacerbate about two to three hours later, coinciding with the arrival of food and digestive juices in the duodenum. Some interpret this sensation as hunger since eating provides relief.
Individuals with duodenal ulcers commonly experience nocturnal awakening due to pain, a phenomenon also observed with jejunal ulcers. Jejunal pain typically manifests slightly lower, closer to the belly button. Oesophageal ulcers may evoke sensations akin to heartburn, often peaking during nocturnal hours.
Additional symptoms associated with peptic ulcer disease encompass a bloated stomach, burping or belching, loss of appetite, and nausea and vomiting.
What are the symptoms of complications of peptic ulcers?
In some cases, individuals may not experience symptoms until complications arise from untreated peptic ulcer disease. If left untreated for an extended period, ulcers can lead to additional complications such as bleeding or perforation of the gastrointestinal (GI) tract.
Symptoms of upper gastrointestinal bleeding may manifest as:
Presence of blood in stool, dark tarry stool, vomiting resembling coffee grounds, feelings of dizziness or faintness, paleness in complexion and elevated heart rate.
Symptoms indicating a gastrointestinal perforation (hole) may include:
Sudden, intense abdominal pain, abdominal swelling with tenderness upon touch, and fever accompanied by chills.
Prolonged untreated peptic ulcer disease can result in recurring cycles of ulcer healing and reoccurrence. Severe scarring or swelling caused by untreated ulcers in the GI tract can impede or obstruct the passage of food.
Symptoms of gastrointestinal obstruction may include:
Abdominal bloating accompanied by swelling and pain, nausea, and vomiting, decreased appetite leading to weight loss and reduction or absence of bowel movements possibly resulting in constipation.
What causes peptic ulcer disease?
The mucous lining of the gastrointestinal tract is inherently resilient, built to withstand the corrosive effects of digestive acids and enzymes while possessing the ability to self-repair, particularly within the stomach and duodenum. However, peptic ulcer disease (PUD) arises when factors disrupt these natural defences.
Two primary causes identified by scientists contribute to most PUD cases:
- H. pylori infection: This common bacterial infection resides in the stomach or duodenum of nearly half the global population. While typically benign, excessive growth of H. pylori can disturb the microbial balance, triggering chronic inflammation in the gastrointestinal lining. This chronic inflammation depletes the lining’s resources for self-repair, and the bacteria may actively attack the lining.
- Overuse of NSAIDs (nonsteroidal anti-inflammatory drugs): These readily available pain relievers, such as aspirin and ibuprofen, are often taken without medical advice. Prolonged or excessive use of NSAIDs can alter the stomach and duodenum’s internal chemistry, inhibiting prostaglandins responsible for repairing gastrointestinal lining damage.
Less common causes of PUD include:
Other infections, ischemia (blood supply loss), severe physiological stress, typically stemming from life-threatening illnesses or injuries, chemotherapy or radiation therapy, Zollinger-Ellison syndrome, Crohn’s disease, and stomach cancer.
Peptic ulcers can also develop in the jejunum, the middle section of the small intestine, following gastric bypass surgery that directly connects the stomach to the jejunum, bypassing the protective lining of the duodenum.
In the oesophagus, chronic inflammation (oesophagitis) can lead to ulceration of the lining. Chronic acid reflux is the primary cause, though infections, medications, and autoimmune diseases can also contribute.
What are the risk factors for developing peptic ulcer disease?
The likelihood of developing peptic ulcer disease increases if you have an H. pylori infection or regularly use NSAIDs, especially if both risk factors are present. Even if H. pylori hasn’t reached excessive levels or NSAID use hasn’t been excessive, the combination of these factors can precipitate PUD.
Additional factors that may contribute include smoking, alcohol consumption, and other medications you may be taking. While these factors alone may not be sufficient to cause PUD, when combined with H. pylori infection or NSAID use, they can heighten the risk of developing peptic ulcer disease.
How is peptic ulcer disease diagnosed?
If you exhibit symptoms or risk factors indicative of peptic ulcer disease, Dr Peerbaccus will conduct examinations to locate ulcers within your gastrointestinal (GI) tract. Testing for an H. pylori infection may also be necessary, either separately or concurrently, typically performed during an endoscopy examination.
Detailed imaging techniques such as a CT scan (computed tomography scan) or GI series X-ray exam can identify larger ulcers but not always and can be missed on these imaging. Tests for H. pylori infection may include a urea breath test or stool test, which might be conducted alongside other diagnostic evaluations while your symptoms are being assessed.
For many individuals, an upper endoscopy examination provides the definitive diagnosis. This procedure, also known as an OGD test, involves inserting a slender tube equipped with a tiny camera into the upper GI tract. During an endoscopy, Dr Peerbaccus can visually inspect the area and even obtain stomach biopsies to test for H. pylori.
Endoscopy offers a comprehensive assessment as it not only provides visual images of the organs but also enables direct access through the tube, allowing for immediate treatment if ulcers require intervention to halt bleeding.
What are the available treatments for peptic ulcer disease?
The primary treatment approach for peptic ulcer disease involves a combination of medications aimed at reducing gastric acid levels and promoting tissue protection and repair. Antibiotics are also prescribed if there’s an underlying infection, such as H. pylori.
In most cases, medications suffice to manage peptic ulcers. However, additional treatment may be necessary if complications arise, such as bleeding or perforation. Minor medical procedures, such as endoscopy, are often employed to address these complications effectively.
