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The stomach and duodenum are part of the upper gastrointestinal tract. The stomach connects the oesophagus to the duodenum, which is the first part of the small intestine.
The lower oesophageal sphincter is a ring of smooth muscle that controls the entry of food from the oesophagus into the stomach. Once food has passed into the stomach the sphincter closes to prevent the acidic stomach contents from coming back up. In people who have gastrooesophageal reflux it may be faulty.
The pyloric sphincter is also a ring of smooth muscle and it controls the exit of food from the stomach into the duodenum.
- Pain which is worse between meals or in the middle of the night, and eased by eating (duodenal ulcer)
- Pain which is aggravated by eating (stomach ulcer)
- Pain which can last anywhere from a few minutes to hours
- Pain which can disappear for days or weeks at a time
- Other symptoms may include belching, bloating, nausea, vomiting, fatigue and weight loss.
What causes ulcers?
Ulcers form when the moist inner lining (the mucous membrane) of the digestive tract becomes damaged and inflamed. Ulcers in the stomach are called gastric ulcers. When they occur in the duodenum (the first part of the small intestine, which attaches to the bottom of the stomach) they are called duodenal ulcers. Collectively they are called peptic ulcers. Duodenal ulcers commonly occur for the first time between 30–50 years of age, while stomach ulcers are more common in people over the age of 60. Children and teenagers rarely suffer from digestive ulcers.
It used to be thought that peptic ulcers were “lifestyle” diseases brought on by chronic stress and poor diet. Today we know that around 90% of duodenal ulcers and 80% of stomach ulcers result from infection with the Helicobacter Pylori bacteria. The remainder are caused by aspirin or non-steroidal anti-inflammatory drugs (NSAIDs). Lifestyle factors, diet and stress can contribute to poor healing or recurrence of ulcers. You are more likely to develop an ulcer if you use NSAIDs, smoke, drink alcohol, have a relative with a peptic ulcer and/or are over 50 years of age.
The stomach produces hydrochloric acid and pepsin for the digestion of food. Both of these substances are highly irritating to the mucous membranes of the stomach and duodenum. Ordinarily there is a thick mucous layer over the membranes that prevents acid or pepsin from coming into contact with them.
H Pylori b is able to survive in the stomach acid, and make its way through the protective mucous layer to the underlying mucous membranes. Once there, the spiral-shaped bacteria bores into the membrane, causing inflammation and ulceration.
Resection is sometimes a part of a treatment plan, but duodenal cancer is difficult to remove surgically because of the area that it resides in, there are many blood vessels supplying the lower body. Chemotherapy is sometimes used to try and shrink the cancerous mass. Other times intestinal bypass surgery is tried to reroute the stomach to intestine connection around the blockage.
A 'Whipple' is a possible surgery that is tried sometimes with this cancer.
Some patients are fitted with tubes to either add nutrients (feeding tubes) or drainage tubes to remove excess processed food that can not pass the blockage.
The nurse will start an IV in your vein. You will lie on a stretcher and will be hooked up to a heart, blood pressure and breathing monitor. Your throat will then be sprayed with a numbing medicine so you don’t gag. You will be given medicine through your vein to make you sleepy. You will also have a small mouthguard placed between your teeth to protect them from the tube.
Once you are sleepy, the flexible lighted tube will be inserted into your mouth and gently passed into your esophagus. You may be asked to swallow to help the tube pass. Inspection of your esophagus, stomach and duodenum generally takes five to 10 minutes. Air is pumped into your stomach through the tube so the doctor can see. Therefore, you may feel bloated.
The test is not painful. There can be some minimal discomfort when first swallowing the tube. Biopsies (taking tissue samples through the tube) do not hurt as there are no nerves on the inside lining of your esophagus, stomach or duodenum.
If there is a narrowing in your esophagus due to cancer or scarring, this can be gently stretched to improve your swallowing. This can add time to the procedure, and there can be some minimal discomfort associated with stretching the esophagus.
During the procedure, you may hear the nurse ask you to swallow or to take deep breaths. You may also hear the doctor ask for the biopsy forceps (pinchers).
- There is a very small risk of bleeding or infection
- There is a risk of reaction to the medication
- There is a risk of aspiration or swallowing secretions into your breathing tube
- There is a risk of perforation (putting an accidental hole in your esophagus, stomach or duodenum that requires surgery to fix). This is fortunately the rarest complication (risk is less than 1 in 1000 for a standard exam). The risk is slightly higher if your esophagus needs to be stretched (risk is estimated between 3 and 10 in 1000).
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