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Peptic Ulcer Disease

Peptic ulcer disease is a term used to refer to ulceration of the gastric or duodenal mucosa aggravated by penetration of the mucosal barrier by acid and pepsin ( Figs. 34.1 and 34.2 ). The natural history of peptic ulcer disease was dramatically revised with the discovery of H 2 inhibition of acid secretion and then proton pump acid inhibition. The discovery that Helicobacter pylori is…

Gastritis: General, Erosive, and Acute

Gastritis Gastritis is inflammation of the gastric mucosa, submucosa, or muscularis ( Fig. 33.1 ). A gastritis classification proposed in 1991 by an international convention in Sydney, Australia, has not gained support in the past two decades, reflecting the clinical confusion in this area. However, the basic pathologic entity of “inflammation in the mucosa” is considered gastritis. It may be acute or chronic, or it may…

Helicobacter pylori Infection

Helicobacter pylori is a gram-negative, spiral, flagellated bacterium that inhabits the mucous layer of the stomach. Warren and Marshall first described H. pylori as a pathogen in humans and clearly documented and correlated the organism's association with gastritis and peptic ulceration. The prevalence of H. pylori varies greatly. Approximately 40% of persons in developed countries are affected, and as many as 85% are affected in underdeveloped…

Dyspepsia, Functional Dyspepsia, and Nonulcer Dyspepsia

Dyspepsia is pain or discomfort centered in the upper abdomen. Associated disease may cause the symptom. As a functional disorder, the term dyspepsia is used when the discomfort or pain is chronic, lasts at least 12 weeks during the preceding 12 months, and is accompanied by no evidence of biochemical, metabolic, or organic disease. Dyspepsia is common. Approximately 25% of adults experience such discomfort, but only…

Diverticula of the Duodenum

Asaccular “true” diverticulum can originate from any part of the duodenum ( Fig. 30.1 ). It is rare in the first part and usually develops in the second part in the region of the ampulla of Vater. Diverticula have been reported in approximately 6% of barium studies but in as many as 27% of endoscopy studies and in 23% of autopsy evaluations. They have been noted…

Diverticula of the Stomach and Gastrointestinal Prolapse

Gastric diverticula are rare and are found in 0.02% of autopsy specimens. Almost all are located on the posterior wall of the cardia and to the left of the esophagus ( Fig. 29.1 ). They are thought to be congenital but occur at the structural weakness of the longitudinal muscles on the posterior surface. Usually, the diverticula contain all layers of the muscle wall and are…

Hypertrophic Pyloric Stenosis

Hypertrophic pyloric stenosis is an obstruction in the pylorus caused by hyperplasia of the circular muscle surrounding the pyloric outlet channel ( Fig. 28.1 ). It is more common in infants than adults and actually is rare in adults. The incidence is approximately 3 in 1000 live births; boys are affected more often than girls by a ratio of 4 : 1 to 5 : 1. The disorder is more…

Nausea and Vomiting

Nausea and vomiting are nonspecific but clinically important symptoms associated with numerous causes. Nausea is variously described as a sick feeling, a tightness in the throat, a sinking sensation, or a feeling of imminent vomiting. It generally precedes vomiting and may be associated with retching when the stomach is empty. Although associated with any disease, acute nausea and vomiting are most often associated with infectious disease,…

Pyloric Obstruction and the Effects of Vomiting

Pyloric obstruction occurs when the outlet of the stomach narrows to the point of serious interference with gastric emptying ( Fig. 26.1 ). In Western countries, tumors are the most common cause of pyloric obstruction in adults. Duodenal ulcer was once a common cause but is now rarely encountered because of the high cure rate of Helicobacter pylori and the use of H 2 -antagonist and…

Gastroparesis and Gastric Motility Disorders

Gastroparesis is defined as delayed emptying of the stomach. The most common causes of this motility disturbance of the stomach encountered in clinical practice are the association with diabetes mellitus and idiopathic forms ( Fig. 25.1 and Box 25.1 ). Gastroparesis affects persons of almost any age, with no gender predilection. Open full size image Fig. 25.1 Gastroparesis and Gastric Motility Disorders. Box 25.1 Causes of…

Aerophagia and Eructation

Aerophagia is characterized by excessive swallowing of air that results in repeated belching. Air may be swallowed unconsciously by the patient; when it results in repeated eructation, it becomes a clinical problem ( Fig. 23.1 ). Open full size image Fig. 23.1 Aerophagia and Eructation. Patients with aerophagia report frequent, uncontrollable belching, or eructation, which often is loud and disturbs family or coworkers. The condition may…

Effects of Drugs on Gastric Function

Many of the pharmacologic agents widely used in medical therapy adversely affect the upper gastrointestinal (GI) tract ( Fig. 20.1 ). Therefore every patient with symptoms referable to the esophagus, stomach, or duodenum should be questioned carefully regarding the recent use of drugs. Drugs may also adversely affect the liver (see Section IX ), pancreas (see Section VII ), and other organs. This chapter discusses specific…

Anatomy of the Stomach and Duodenum

Anatomy of the Stomach: Normal Variations and Relations The stomach is a J -shaped reservoir of the digestive tract in which ingested food is soaked in gastric juice containing enzymes and hydrochloric acid and then is released spasmodically into the duodenum by gastric peristalsis. The form and size of the stomach vary considerably, depending on the position of the body and the degree of filling. Special…