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Esophagus

Achalasia is the inability to swallow caused by the inability of the lower esophagus sphincter or LES toopen.

Symptoms of Achalasia

The symptoms of achalasia are:

Difficulty in swallowing

Regurgitation of saliva or food, sometimes involuntarily when sleeping Choking, sometimes at night during

Bad breath

Belching or gas Chest pain and heartburn, even without eating

Weight loss and malnutrition

How is Achalasia Diagnosed?

Your doctor may do the following test to diagnose achalasia:

Barium swallow test Dilation, poor muscle contraction, as well as incomplete emptying of the esophagus are seen inthe barium swallow x-ray images.

Endoscopy This test is a visual examination of the esophagus using a flexible tube with a camera attached.

Esophageal manometry This test measures the muscle contractions in the esophagus.

Achalasia Causes

In achalasia, the LES loses its ability to open by relaxing its contracted muscles. As a result, it stays closed ±liquid and food are trapped in the esophagus, sometimes causing regurgitation.

The inability of the LES to open can be caused by cancer where the stomach meets the esophagus. Thiscancer can impair the nerves that signal the LES to relax and open. In rare cases, achalasia itself can be aprecursor to cancer of the esophagus.

Achalasia Treatment

Treatment of achalasia includes:

Pneumatic dilator A ballon is positioned on the sphincter muscle of the LES and then inflated. This manually forcesthe muscle to open. Although several sessions may be required, this usually brings about apermanent cure.

Botox (botulinum toxin type A) When injected directly to the esophagus, botox acts on the nerve that control the LES, thuscausing the sphincter muscle to relax and open. This treatment is temporary and must berepeated after several months.

Surgery If multiple attempts using the techniques above failed, then the LES muscle can be surgically cut.

The treatments above carry inherent risks. For example, there is a slight risk (estimated at about 2%) of puncturing the esophagus during the pneumatic dilator procedure. Surgical cutting of the LES permanentlydisables the muscle and reduces its ability to prevent stomach acid from entering the esophagus. The long-term risk of botox injection is not known.

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Bleeding varices are bleeding veins in the esophagus, caused by a liver disease.

Symptoms

The symptoms of bleeding varices are:

Blood in the stool or vomit Fainting Dizziness

Cirrhosis of the liver

Diagnosis of Bleeding Varices

Your doctor will look for the following signs of bleeding varices:

Varicose veins in the esophagus, identifiable under endoscopy

Varicose veins in the skin near the navel Hemorrhoids

Incoherent speech, due to toxins in the bloodstream

Causes

Bleeding varices are actually caused by a liver disease called portal hypertension. Here, a scarred or cirrhoticliver can no longer filter blood. As a result, the blood develops a bypass around the liver in form of varicoseveins near the junction between the stomach and the esophagus.

The blood pressure in the varicose vein is great, thus causing the vein to become distended. Sometimes, itis so great that the vein can rupture and bleed profusely.

Treatment for Bleeding Varices

The treatments for bleeding varices include:

Medications Intravenous medications are given to control blood pressure, decrease blood supply to thegastrointestinal tract, and reduce the risk of bleeding.

R ubber band treatment In a technique similar to that used to threat internal hemorrhoid, a rubber band is placed on thevaricose vein to cut off its blood supply. Within a few weeks, the vein will shrivel up and fall off along with the band.

Sclerotherapy A sclerosant, usually a chemical or saline solution, is injected into the varicose vein to induce aclot and block its blood supply. This will cause the vein to shrivel and die.

Transjugular intrahepatic portosystemic shunt A tube or shunt is surgically inserted to for blood to bypass the liver. This relieves the pressure onthe veins in the esophagus.

Sengstaken-Blakemore tube A balloon is inflated against the walls of the esophagus to press against the varices and stop thebleeding.

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Candida esophagitis is a yeast infection of the esophagus, caused by the same culprit that causes vaginalyeast infection and oral thrush.

Symptoms of Candida Esophagitis

The symptoms of candida esophagitis are:

Difficulty swallowing

Pain during swallowing The feeling of food stuck in the throat



Loss of appetite

Nausea

Diagnosis

Your doctor will look for the following signs of candida infection:

Oral thrush A yeast infection of the throat.

Candida plaques White, cheesy patches in the esophagus

The following are tests that your doctor may conduct:

Visual examination of the mouth and throat

Endoscopy to visually inspect the esophagus

Biopsy of the esophageal lining.

Cause of Candida Esophagitis

Candida esophagitis is an opportunistic infection caused by the yeast Candida. It is called an opportunisticinfection because it develops only when the body¶s immune system is weakened by other diseases, such as:

AIDS (Acquired Immunodeficiency Syndrome)

Immune system disorder

Cancer Chemotherapy to treat the cancer

Malnutrition

Diabetes

Drugs or alcohol abuse

Treatments for Candida Esophagitis

The treatments for candida esophagitis are:

Antifungal medications, such as nystatin and clotrimazole in pills or liquid forms.

Intravenous antifungal medications, such as amphotericin B

Unless the underlying conditions are treated, however, the candida infection may recur.

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Cytomegalovirus esophagitis is an infection of the blood vessels underneath the surface lining of the

esophagus.

Symptoms of CMV Esophagitis

The symptoms of cytomegalovirus esophagitis are:


Pain Feeling that food gets stuck after swallowing Nausea

Loss of appetite

DiagnosisYour doctor would look for the following clinical signs of cytomegalovirus esophagitis:

Ulcers and sores in the esophagus

Biopsy or tissue sample showing cytomegalovirus infection

Cytomegalovirus Esophagitis Cause



This skin condition is caused by an opportunistic infection by the cytomegalovirus or CMV. It is called anopportunistic infection because it occurs when the body¶s natural immune system is already in a weakenedstate, caused by a disease such as AIDS or chemotherapy treatment for cancer.

Treatment of CMV Esophagitis

The treatment for cytomegalovirus esophagitis is intravenous administration of ganciclovir or foscarnet.

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Esophageal ring or Schatzki¶s ring is a thin band of tissue that encircles the lining of the esophagus.Sometimes, this band of tissue is thicker and more fibrous, but narrower than a ring ± here, it is called anesophageal web.

Symptoms of Esophageal R ings?

The symptoms of esophageal rings and webs are:


Food becoming dislodged in the throat

Note that these symptoms should be occasional in nature ± if they occur every day, then it is more likelythat they are caused by esophageal stricture instead.

Diagnosis

Tests to diagnose esophageal rings and webs are:

Meat impaction test A piece of meat is swallowed and monitored by barium swallow test or endoscopy. The lodgedmeat is then dislodged by an endoscope.

Iron-deficiency anemia A cause for esophageal webs.

Spooning of the fingernails and toenails Here, the nails appear sunken.

Cause of Esophageal R ing

Esophageal webs are caused by:

Iron-deficiency anemia

Graft-vs-host disease This is a disease resulting from bone marrow transplantation

Postcricoid cancer A rare form of cancer located in the upper portion of the esophagus.

Esophageal R ing Treatment

Esophageal rings and webs usually respond well to the following treatments:

Bougie A bougie (³boojie´) is a tapered device made of rubber that is used to flatten the tissue of theesophagus and to enlarge its opening.

Pneumatic dilator A balloon is placed on the narrowed portion of the esophagus and then inflated.

Guided wire dilator During endoscopy, a tapered device is threaded through the esophagus with the aid of guidedwire.



Iron replacement If the condition is caused by anemia brought on by iron-deficiency, then treating the underlyingproblem with iron-replacement therapy would help alleviate the symptoms and reduce the chanceof developing postcricoid cancer.

Changing eating habit In some cases, the occasional difficulty in swallowing associated with lower esophageal rings can

be prevented simply by chewing the food more or eating smaller pieces.

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Esophageal spasm is pain and difficulty in swallowing due to abnormal clenching of the muscles in theesophagus.

Symptoms of Esophageal Spasm

The symptoms of esophageal spasm are:

Dull or intense pain under the breast bone

The pain may then radiate to the jaw and arm Difficulty swallowing

Involuntary regurgitation of food

Esophageal spasm can occur by itself or right after a severe gastroesophageal reflux

Esophageal Spasm Diagnosis

Because the symptoms of esophageal spasm are similar to that of a heart attack, your doctor would firstperform test to rule out a heart attack.

Diagnosing esophageal spasm is diff icult, because outside of the spasm attack, the esophagus looksperfectly normal.

Tests for esophageal spasm include:

Biopsy Tissue sample or biopsy of the lower esophagus usually reveals tissue damage due to stomachacid (gastroesophageal reflux).

pH probe This measures the acidity of the area and is used to rule out gastroesophageal reflux as thecause.

Esophageal manometry This test measures muscle contractions in the esophagus

Prevention of Esophageal Spasm

Instances of the spasm can be avoided by:

Swallowing only well-chewed food in small pieces

Avoiding hot food or hot and cold drinks Avoiding relapse of gastroesophageal reflux, if present

Reducing stress.

Treatments for Esophageal Spasm

The treatments for this condition include:

Nitrates Nitroglycerin and isosorbide dinitrate used for treating heart attack can alleviate the spasm andchest pain.

Anticholinergic drugs These are medications that relax the smooth muscle, such as hyoscyamine sulfate, dicyclomine,or propantheline bromide.



Calcium channel antagonists These medicines are commonly used to treat high blood pressure.

Gastroesophageal reflux medications

Psychiatric drugs for panic attack and depression

Pneumatic dilator A balloon is inserted into the esophagus and then inflated to dilate the esophagus.

Bougie A bougie (³boojie´) is a weighted, tapered rubber device which is used to flatten the esophagealtissue and widen the opening.

Esophagomyotomy A surgical cut along the length of the esophagus is done to prevent complete contraction of themuscle in the esophagus.

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Gastroesophageal reflux disease (

GER

D) or acid reflux is a digestive condition where the stomach¶sacid backs up (or ³refluxes´) into and damages the esophagus.

Symptoms of GER D

The symptoms of GERD include:

Frequent heartburn or pain in the chest and stomach, sometimes at night

Vomiting

Belching Bitter or sour taste in the mouth


Water brash or burst of saliva

Sore throat Coughing Wheezing

In many GERD patients, these symptoms are worse at night, when they are lying down, and when they arebending over.

Left untreated, Gastroesophageal reflux disease can lead to Barrett¶s esophagus. Here, the lining of theesophagus become inflamed and adopt a distinct pink color Barrett¶s esophagus is a pre-cancerouscondition, and can lead to esophagus cancer.

How is GER D diagnosed?

Your doctor would look for the following signs of gasteresophageal reflux disease:

Ulcer or damage to the lining of the esophagus

Esophagitis or inflammation of the esophagus

Stricture or narrowing of the esophagus Aspiration pneumonia or pneumonia caused by stomach acid that drips down the lungs

Bronchitis

Causes of GER D

In normal people, the lower esophageal sphincter (LES) muscle, located at the base of the esophagusalways tightens and stays closed to keep the stomach content and acid. It only opens to let swallowed foodand drinks in.

In GERD patients, the LES often fails to remain shut. Stomach acid seeps into the esophagus through theopen LES. Over time, the acid damages the lining of the esophagus, causing inflammation, abnormalnarrowing, and even ulcer.

Another cause of LES failure is hiatal hernia, a condition where the stomach extends through thediaphragm and prevents the LES from properly closing. Hiatal hernia is a very common condition, affectingan estimated of 40% of people in the United Sates. Fortunately, for most people, hiatal hernia does not leadto gastroesophageal reflux disease.



Certain medications can promote reflux ± these include:

Nitrates

Calcium channel blockers

Antidepressants Anticholinergics

Progesterone hormone

Other medicines can irritate the esophagus, and thus worsen GERD symptoms ± these include:

Antibiotics, such as tetracycline and doxycycline Nonsteroidal anti-inflammatory painkiller drugs (NSAIDs)

Quinidine Potassium chloride

Iron supplements

Prevention of GER D

Frequent gastroesophageal reflux disease sufferers can prevent a recurring attack by:

Avoiding certain foods and drinks that worsen GERD, including:

Acidic, spicy and fatty foods Onion

Peppermint and spearmint

Carbonated drinks

Coffee and caffeinated drinks

Alcoholic drinks

Eating smaller portions, more frequently rather than eating large meals.

Not eating 3 to 4 hours before bedtime.

Raising the head of your bed at least 6 inches, thereby using gravity to avoid stomach acid fromseeping into the esophagus.

Losing weight if you are obese, because obesity often prevents the LES from properly closing.

If you are taking NSAID as painkillers, consider other medications that do not irritate theesophagus, such as acetaminophen. Be sure to consult your physician before changingmedications.

Treatment for GER D

Treatments for gasteroesophageal reflux disease include:

Over-the-counter antacids (Maalox, Mylanta, Rolaids, and Tums)These medications neutralize acid and provide fast relief for heartburn. However, they do not healthe damaged or inflamed esophagus, and can only offer temporary protection from stomach acid. Note that antacids that cause magnesium can cause diarrhea, whereas those that containaluminum can cause constipation as side-effects.

Over-the-counter histamine receptor blockers (Pepcid AC, Tagamet, and Zantac)These medications block the H2 receptor that stimulate the secretion of stomach acid, therebycausing less acid to be produced in the stomach.

Prescription medications Prescription GERD drugs include:

H2 receptor blockers Usually the same active ingredients as the over-the-counter version, but at higher doses.

Proton pump inhibitors These medicines turn off acid production in the stomach and can be a very effectivetreatment for chronic heartburn.



Prokinetic medicines Some of these drugs strengthen the LES to keep acid from seeping into the esophagus,whereas others speed up digestion, thereby shortening the period of high acid content inthe stomach.

Mucosal protectors These drugs protect and soothe the irritated lining of the esophagus.

Surgery For severe cases of GERD, a surgical procedure called the Nissen fundoplication can beperformed. Here, the fundus or top of the stomach is wrapped around the esophagus,thereby creating a one-way valve to prevent acid from refluxing.

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Neurogenic dysphagia or preesophageal dysphagia is difficulty in swallowing food caused by disease orimpairment of the nervous system.

Symptoms of Neurogenic Dysphagia

The symptoms of neurogenic dysphasia are:

Difficulty in swallowing food

Feeling that food is lodged on the throat Coughing or choking when swallowing Drooling, because of inability to swallow saliva

Food or liquid backing up through the nose

These symptoms may come and go ± some people may not have these symptoms for weeks or months at atime, only to have them recur.

Some people do not realize that they have these symptoms, because they automatically chew their food orcut their food to smaller sizes to make it easier to swallow.

Diagnosis

Your doctor will look for the following signs of neurogenic dysphagia:

Decreased gag reflex Decreased ability to cough

Malnutrition or dehydration Fever caused by infection of the lungs caused by food going into them

Depression

Tests for neurogenic dysphagia include:

Cine-esophagramAn imaging test that shows the sequential muscle movements during swallowing

Barium swallow test

Causes of Neurogenic Dysphagia

Neurogenic dysphagia can be caused by:

Alzheimer¶s disease

Stroke Parkinson¶s disease

Multiple sclerosis Lou Gehrig¶s disease or amyotrophic lateral sclerosis (ALS) Huntington¶s disease

Head injury Guillain-Barré syndrome

Chronic meningitis

Poliomyelitis

This neurological condition can also be made worse by:



Anesthetics

Anti-convulsive drugs

Sedatives

Neuroleptic medications Corticosteroids

Lipid-lowering medications

Treatments of Neurogenic Dysphagia?

As neurogenic dysphagia may be a symptom of the underlying disease, such as Parkinson¶s disease,medications for that disease may improve the patient¶s ability to

Therapy to learn how to swallow easier can also treat neurogenic dysphagia. Here, a speech-languagetherapist can show the patient:

Postures and strategies to swallow betterFor example, muscle weakness due to stroke may require tilting the head a certain way

Techniques to protect the airway when swallowing

Modification to diet to include more thick liquids, as they are easier to swallow than solid food.

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R adiation-induced esophagitis is an injury to the esophagus caused by radiation therapy designed totreat cancer.

The injury can take the forms of:

Stricture or narrowing of the esophagus

Perforation or rupture

Fistula or a hole in the tissue

In some cases, radiation-sensitizing drugs designed to make cancer cells more susceptible to the radiationtherapy, can also worsen the radiation damage to the esophagus.

Symptoms of R adiation-Induced Esophagitis

The symptoms of radiation-induced esophagitis are:


Pain during swallowing Vomiting food or blood

Chest pain

Inflammation of the esophageal lining

Diagnosis

Your doctor may perform the following tests to diagnose radiation-induced esophagitis:

Endoscopy

Barium swallow test

The tell-tale sign of this form of esophagitis is inflammation.

Treatment of R adiation-Induced Esophagitis

If eating or drinking difficulty is present, then a temporary feeding tube to the stomach or an intravenousline may be inserted until the injury heals.

Otherwise, treatment for radiation-induced esophagitis depends on the type of injury:

Stricture This abnormal narrowing of the esophagus can be treated by manual dilation or enlargement by:



Bougie A bougie (³boojie´) is rubber device used to flatten the lining of the esophagus and toenlarge its opening.

Pneumatic dilator A balloon is placed and inflated to enlarge the narrowed portion of the esophagus.

Guided wire dilator During an endoscopic procedure, a tapered device is threaded through the esophagus byusing a guided wire

Perforation and fistula Surgery may be required to treat these injuries

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Systemic scleroderma is an autoimmune disorder, where the body mistakenly attacks itself,characterized by thickening of the skin and formation of scar tissues on the internal organs.

One of the symptoms of systemic scleroderma is abnormal functioning of the smooth muscle of the

esophagus, in a condition called esophageal scleroderma or scleroderma of the esophagus.

Symptoms of Esophageal Scleroderma

The symptoms of scleroderma of the esophagus are:

Heartburn or acid reflux


Feeling of food stuck in the throat

Chest pain Weight loss and malnutrition

Acid reflux is a particularly common symptom of esophageal scleroderma. Over time, the smooth muscle of

the lower esophagus loses its ability to contract and stomach acid seeps into the esophagus.

Esophageal Scleroma Diagnosis

Your doctor would perform the following tests:

Endoscopy Signs: abnormality in the tone and function of the smooth muscle in the lower esophagus anddamage in its lining due to acid reflux.

Manometry Signs: weakened contractions in the lower sphincter of the esophagus.

R adionuclide transit test

Treatment of Scleroderma of the Esophagus

There is no cure for systemic scleroderma ± instead, the treatment focus is to reduce the risks of acid refluxfrom damaging the esophagus:

Eating small meals frequently, rather than a single large meal.

Standing or sitting up for 1 to 3 hours after eating to keep stomach content and stomach acid frombacking up into the esophagus.

Avoiding things that can aggravate acid reflux, such as eating spicy and fatty food, as well asdrinking alcohol and caffeine.

Chewing food well

Taking heartburn medications, including proton pump inhibitors to reduce stomach acid formation.



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Esophageal stricture or stenosis is the narrowing of the esophagus caused by a scar or cancer.

Symptoms of Stricture or Stenosis of the Esophagus

The symptoms of stricture are:

Difficulty and discomfort in swallowing

The feeling that food is stuck on the throat

At first, the patient may not realize that they have difficulty in swallowing, as they automaticallycompensate by chewing the food more or eating smaller pieces.

Diagnosis of Esophageal Stricture

Tests for stricture include:

Upper Endoscopy A flexible tube with an attached camera or imaging lens is used to observe the physical narrowingof the esophagus.

Barium swallow test

Biopsy

Cause of Esophageal Stricture

Causes of esophageal stricture include:

Gastroesophageal reflux disease

Esophageal stricture commonly develops after gastroesophageal reflux disease or GERD, causedby chronic tissue injury because of stomach acid backing up into the esophagus.

Toxic or caustic chemicals Swallowing toxic or caustic chemicals can cause injury to the tissue which heals with a fibrousscar tissue.

Side effects and complications of medications

Side effects of a sclerotherapy treatment Sclerotherapy is a medical treatment where sclerosing or scarring agent is injected to destroytissues locally. In some cases, scar tissue develops at the site of injection.

Chronic or severe infection

Scars from previous surgery

Esophageal cancer

Treatments of Esophageal Stricture

To treat stricture, various techniques below are used to enlarge the narrowed opening of the esophagus:

Bougie A bougie (³boojie´) is a tapered rubber device that flattens the tissue and enlarges the opening of the esophagus.

Pneumatic dilator A balloon is placed on the narrowed portion and then inflated.

Guided wire dilator Here, a tapered dilator is threaded through the esophagus with the aid of guided wire duringendoscopy.



Note that several treatments may be required, as scar tissues are naturally difficult to eliminate and thestricture itself may recur even after the esophagus opening is widened.

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Immediate symptoms of swallowed foreign objects are:

Pain in the esophagus or chest Choking


A few hours later, the following symptoms may develop:

Vomiting Nausea

Pain in the stomach Blood in the stool

Fever (if the object is trapped in the lower intestines)

Who Often Swallows Foreign Objects?

Small children, as well as adults suffering from drugs and alcohol abuse, those with stroke, psychiatric andneurological illnesses are prone to swallowing foreign objects. Surprisingly, denture wearers are alsosusceptible to accidentally swallowing bones and other items. This is because dentures eliminate much of the feeling or tactile sensation in the mouth.

How Can It Be Prevented?

For small children, care should be done to remove objects smaller than a quarter, and put away householdchemicals and cleansers, as well as breakables.

Denture wearers need to be aware of the danger of accidentally swallowing small bones, toothpicks, and

other small items.

What Are Its Treatments?

If the swallowed foreign object blocks the airways, emergency care such as a Heimlich maneuver needs tobe immediately performed.

In about 80% of the cases, the foreign object passes through without any intervention. In the 20% of thecases, the object has to be removed with an endoscopic procedure. In less than 1%, surgery is required.

Small batteries are increasingly becoming a choking and accidental-swallowing hazard, especially for smallchildren. Batteries need to be immediately removed, as they can corrode and release caustic chemicals thatcan injure the esophagus and stomach. Children that swallowed battery need to be taken to the emergency

room immediately.

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StomachGastritisPeptic UlcerStomach Cancer (Gastric Cancer)Zollinger-Ellison Syndrome (Gastrinoma)

Gastritis is the inflammation of the lining of the stomach. This condition can be an acute (with rapid onset,short period, and usually severe intensity) or a chronic condition.

The two most common forms of gastritis:

Erosive gastritis



Non-erosive gastritis

Gastritis Symptoms

The symptoms of gastritis are:

Pain or burning sensation in the stomach, especially between meals or at night Upset stomach

Blood in stool

In some people, gastritis does not have any symptoms.

How is Gastritis Diagnosed?

Your doctor may perform the following tests to diagnose this condition:

Upper endoscopy Here, an endoscope or a flexible tube with a camera is carefully threaded into the stomach to

see the signs of gastritis. In erosive gastritis, there are visible tiny, superficial abrasions, erosions or holes in the stomachlining. In non-erosive gastritis, the stomach lining may be red or inflamed but there are no erosions. Insome people, the lining may appear completely normal and a biopsy or tissue sample need to betaken, and further tests need to be performed.

Blood test For non-erosive gastritis, blood test may be done to see the presence of Hel iobact er pyl or i (H.

pyl or i ) infection. Vitamin B12 level can also be tested, to confirm or rule out perniciousanemia as one of the cause.

Causes of Gastritis

The causes of gastritis include:

H. pylori infection

Non-steroidal anti-inflammatory drugs (NSAIDs) These are painkillers that can reduce the protective nature of the stomach lining against thedigestive acids and enzymes in the stomach.

Drinking alcoholic beverages Alcohol stimulates the production of stomach acid and large doses of alcohol can damage andinflame the stomach.

Autoimmune disorder Here, the body¶s immune system mistakenly attack the stomach lining. In this form of gastritis,the body is no longer able to absorb vitamin B12 thus resulting in a condition called perniciousanemia.

Immune response to other diseases Gastritis may also be caused by improper immune responses to other diseases such as Crohn¶sdisease and syphilis.

Treatment for Gastritis

Gastritis is treated with:

Antibiotics If H. pyl or i is present, antibiotics are prescribed to eliminate this bacteria.

Medications to reduce stomach acid These include:

Histamine or H2 blockers, which prevents the histamine receptors from stimulating theproduction of stomach acids



Proton pump inhibitors, which stop stomach acid production

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Peptic ulcer is a painful ulcer (lesion or crater) in the lining of the stomach or small intestines.

Symptoms of Peptic Ulcer

The symptoms of peptic ulcer are:

Pain or burning sensation in the stomach, especially at night or between mealsThis pain may go away (or in some people, worsen) when eating.

Heartburn or pain in the chest or upper abdomen, especially at night

Nausea

VomitingThe vomit may look like mucous, blood or coffee grounds (where the blood is mixed with stomach

acid and becomes coagulated or clotted).

Blood in the stool

Black-colored, tar-like or dark-reddish stool

Peptic Ulcer Diagnosis

Your doctor would do the following tests to diagnose peptic ulcer:

Physical exam Tenderness as the doctor pushes into the stomach with his fingers, or immediately after he liftshis fingers.

Endoscopy A flexible tube with camera attached to it is inserted into the stomach to visualize the whitishlesions of peptic ulcer. Usually a biopsy (or tissue sampling) is performed during an endoscopicprocedure, especially if the ulcer is located in the stomach as lesions may also be indicative of stomach cancer.

Barium X-R ay A solution of barium is given to the patient to swallow before an X-ray is taken. This allows thedoctor to see shadows of the peptic ulcer lesion.

Stool examination Blood in the stool may indicate a bleeding ulcer.

Blood tests Your doctor may look for the presence of:

Hel iobact er pyl or i (h. pyl or i ), a bacteria that commonly cause peptic ulcer

Elevated level of gastrin, which may indicate gastrinoma or Zollinger-Ellison

syndrome.

Causes of Peptic Ulcer?

In normal stomach, a thick layer of mucus that coats the lining of the stomach prevents the gastric juicesfrom damaging the stomach. In peptic ulcer, this mucus layer is compromised and a lesion or crater isformed.

There are two main causes of peptic ulcer:

Nonsteroidal anti-inflammatory drugs (NSAIDs)These are the active ingredients of the common painkillers aspirin, ibuprofen, and naproxen.

H. pyl or i bacteria

Despite common belief, stress and eating spicy foods do not cause peptic ulcer.



Forms of Peptic Ulcer

Depending on the location, peptic ulcer is categorized into two forms:

Gastric ulcer or stomach ulcer

Duodenal ulcer or ulcer found in the small intestinesAccounting for almost 80% of the cases, it is the most common form of peptic ulcer.

Who Gets It?

Peptic ulcer is a very common condition ± it is estimated that approximately 4 million people in the UnitedStates have it. This condition is usually found in people above the age of 50 years old. Approximately350,000 new cases of peptic ulcer are diagnosed every year.

Prevention of Peptic Ulcer

Prevention of peptic ulcer includes:

Avoid taking NSAIDs for painkillers.Instead, use alternatives such as acetaminophen, which does not irritate the stomach lining. If you are taking aspirin every day, consider instead:

Taking baby aspirin Taking it with meals instead on an empty stomach

Taking the enteric-coated form, which dissolves in the small intestine and not the stomach

Avoid taking alcoholic beverages Stop smoking

If you are taking iron or potassium supplement, take enteric-coated forms.

Be sure to consult your doctor before changing your prescription or how you take the pills.

Treatment for Peptic Ulcer?

Peptic ulcer treatments include:

Prescription medicines, including:

Antibiotics, if you are diagnosed with H. pylori infection.

Histamine or H2 blockers This blocks the histamine receptors that signals the stomach to produce more acid.

Proton pump inhibitors This stops the acid production in the stomach.

Prescription antacids Some forms of prescription antacids can also coat the stomach and promote healing of the peptic ulcer.

Surgery In very rare cases, a surgery is required to remove the ulcer or to tie off an artery that causebleeding ulcer. If H2 blockers or proton pump inhibitors do not work, your doctor may order asurgery to cut or even remove a nerve at the base of the stomach that stimulates the productionof digestive juices.

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Stomach or gastric cancer is a malignant tumor or abnormal growth in the lining of the stomach.

Symptoms of Stomach Cancer

The symptoms of stomach cancer are:

Chronic indigestion



Pain while eating

Blood in stool

Black, tar-like stool

Vomiting, may also vomit blood Loss of appetite Halitosis or bad breath

Malnourishment or weight loss

Fatigue Excessive gas or flatulence Difficulty swallowing

Belching

The feeling of fullness even after eating only a little amount of food

Many patients subsequently diagnosed with stomach cancer are asymptomatic (have no symptoms at all).

Diagnosis of Gastric Cancer

Your doctor would perform the following tests to diagnose stomach cancer:

Stool sample Blood in stool is a sign of stomach cancer.

Gastrointestinal (GI) Endoscopy A flexible tube with camera and light attached called an endoscope is inserted carefully into thedigestive tract to see ulcers or lesions in the stomach lining. A tissue sample or biopsy is taken tosee if the ulcer is cancerous or if it¶s just a peptic ulcer.

Barium X-R ay

The patient is given a solution of barium before an X-ray is taken. Large tumors would show up asshadows in this test.

Blood test A blood test positive for anemia or low amount of red blood cells is indicative (but not aconclusive) sign of stomach cancer.

Computed Tomography or CT Scan A CT scan may be ordered if cancer is found, to see if it has spread.

Causes of Stomach Cancer

The following factors seem to increase the risk of developing stomach cancer:

Certain digestive disorders Left untreated, the following diseases can lead to stomach cancer:

Gastritis or inflammation of the stomach lining Pernicious anemia, a chronic condition caused by the body¶s inability to absorb vitamin

B12 Polyps and ulcers in the stomach

Infection of the bacteria Hel iobact er pyl or i (h. pyl or i ) Previous injury to the stomach lining

Family history of stomach cancer

Eating smoked, pickled, salted food, especially those with high nitrates content Excessive alcohol intake

Previous stomach surgery

Who Gets It?

Approximately 23,000 new stomach cancer cases are diagnosed every year in the United States. Thiscondition is roughly twice more commonly found in African American, Hispanic, and Native Americanpopulation than in Caucasians and affects more men than women.

In the United States, the incidence of stomach cancer has been steadily declining over the past severaldecades, from 30 per 100,000 individuals in the 1930s to 8 per 100,000 individuals in the 1980s. It isthought that refrigeration and decreased use of salting and smoking as methods of food preservationcontributed to this decline.



The incidence of stomach cancer is particularly high in Japan, China, Korea, Chile, and Ireland for someunknown environmental factor.

Treatment for Stomach Cancer?

Surgery is required to eliminate stomach cancer. Here, a technique called gastrectomy or the removal of

parts or all of the stomach is performed. In a new procedure called neoadjuvant chemotherapy, chemicalagents that destroy cancer tissue is given at the time of surgery and may help improve the cure rate forstomach cancer.

Cancer that has spread to the lymph nodes and other parts of the body require radiation therapy orchemotherapy.

Prognosis

If caught early, stomach cancer has a very good cure rate of 90%. However, once the cancer hasmetastasized or spread, the 5-year survival rate is less than 20%

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Zollinger-Ellison syndrome is a rare digestive disorder caused by a tumor of the pancreas calledgastrinoma.

Symptoms of Gastrinoma

The symptoms of Zollinger-Ellison syndrome are:

Chronic diarrhea Recurrent diarrhea is the only symptom of this condition in about 30% of patients. This symptommay also precede the development of Zollinger-Ellison syndrome by several years.

Pain in the stomach and esophagus, especially at night or between meals.This pain may go away or worsen with eating.

Heartburn or pain in the chest and upper abdomen

Nausea Vomiting of blood, mucus, coffee-ground like vomit (digested blood)


Sore throat, coughing, and wheezing

Sour or bitter taste in the mouth

Blood in the stool Black, tar-like or deep-red colored stool Steatorrhea, or froty, oily stool with particularly bad odor (evidence of malabsorption of nutrients)

Malnourishment

How Is It Diagnosed?

Your doctor would perform the following tests to diagnose Zollinger-Ellison syndrome:

Endoscopy A flexible tube with camera mounted at the end, called an endoscope, is inserted through theesophagus, stomach, and small intestine. Persistent and chronic ulcer, or an ulcer at a rarelocation such as the end of the small intestine may be signs of this condition.

Stomach acid test Elevated levels of acid in the stomach is a sign of this condition.

Blood test

Elevated levels of the hormone gastrin in the blood is a sign of Zollinger-Ellison syndrome.

In a test called secretin stimulation test, an injection of the hormone secretin is performed before theblood test to check the level of gastrin.

The location of the tumor is identif ied by the following tests:

Computed Tomography or CT Scan

Magnetic Resonance Imaging or MRI



Causes of Zollinger-Ellison syndrome?

Zollinger-Ellison syndrome is caused by a tumor (or tumors) called gastrinoma that affects commonly thepancreas. In rare cases, this tumor is also found in the stomach, liver, small intestine, and ovaries. Thetumor produces a high amount of the hormone gastrin, which cause over-production of stomach acid.

It is though that there is a strong genetic component to this condition. People with a history of chronicpeptic ulcer or cancer of the pituitary glands and parathyroid are at increased risk of developing this disease.

Zollinger-Ellison syndrome may also be a part of a larger condition called multiple endocrine neoplasia-I,an inherited form of cancer with tumors not only in the digestive tract, but also the pituitary glands andparathyroid.

Treatment for Zollinger-Ellison syndrome?


Medications Prescription medicines, such as proton pump inhibitors that stop the production of stomach acid

can treat the symptoms of Zollinger-Ellison syndrome.

Chemotherapy

Surgery Elimination of the tumor may require the removal of part of the stomach, intestines, pancreas,and liver. In very rare cases, total stomach removal or gastrectomy may be necessary, althoughin most cases, prescription proton pump inhibitors are sufficient.

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Small Intestine

Crohn's DiseaseBowel ObstructionLactose IntoleranceMeckel's DiverticulumMesenteric IschemiaShort Bowel Syndrome

.> Crohn¶s disease is an inflammation of the digestive tract, thought to be caused by an abnormal immunereaction to food, bacteria, or even the lining of the intestines or colon.

Symptoms of Crohn's DiseaseCommon symptoms of Crohn¶s disease are:

Diarrhea

Abdominal pain

Blood in the stool

Black, tar-like stool Fever

Weight loss and malnutrition Anal fissures or fistulas

Because of the abnormal immune response in Crohn¶s disease, patients may also experience the followingless common symptoms:

Joint aches or pain

Eye¶s sensitivity to light

Mouth ulcers

Crohn¶s Disease Diagnosis

Your doctor would perform the following tests to diagnose Crohn¶s disease:



Endoscopy A flexible tube with camera and lights is carefully inserted into the digestive tract to observe thetell-tale signs of Crohn¶s disease:

Swelling or edema of the intestine and colon

Cobblestone inflammation or tiny bumps in the intestine Ulcers

Stricture or narrowing of digestive tract due to scar tissue formation Fistula or abnormal connection that develops between the loops of the bowel or with

outside organs

A biopsy or tissue sample of the inflamed area is taken to check for the presence of immune cells.

Blood test Signs of anemia because of deficiency in vitamin B12 and/or blood loss, as well as abnormallevels of electrolytes are observed in this test.

Stool test Stool is cultured to test the presence of bacteria, such as Clostridium difficile, and parasites torule out digestive disorders that have symptoms similar to that of Crohn¶s disease.

Who Gets Crohn¶s Disease?

Although the exact cause of Crohn¶s disease is unknown, it is thought that there is a genetic predispositionto developing this disease. Approximately 10 to 15% of patients have a family history of this disorder oranother inflammatory bowel disease called ulcerative colitis.

In some early onset Crohn¶s disease, the symptoms begin in teenage or young adulthood. In most cases,however, Crohn¶s disease develops between the ages of 20 to 40 years.

Management of Crohn's Disease

If you have Crohn¶s disease, you can reduce the symptoms and prevent malnutrition by:

Eating a diet rich in nutrients and proteins in small portions more frequently (5 or 6 small meals aday, instead of the usual 3 large meals a day)

Avoiding food that is spicy or hard to digest

Avoiding caffeine, lactose, and alcohol

Drinking plenty of fluids to avoid dehydration because of diarrhea

Treatment for Crohn¶s Disease

There is no cure for Crohn¶s disease, and the treatment for this condition varies according to its severity andsymptoms.

Treatments for Crohn¶s disease include:

Medications, such as anti-inflammatory and antibiotic prescriptions.Research into Crohn¶s disease suggests that medications that suppress the immune system mayhelp ± however, these may have the side effects of making the body more susceptible toopportunistic infections.

Nutritional and vitamin supplements

Alternative feeding, such as enteric feeding (liquid diet) and parenteral nutrition (intravenousfeeding).

Surgery Patients that have advanced cases of Crohn¶s disease, such as those with recurrent bowel

obstruction, abscesses, strictures or narrowing of the digestive tract, may require the surgicalremoval of the bowel.

Nearly half of all people suffering from Crohn¶s disease will require surgery ± usually 8 to 10 years after theinitial appearance of the symptoms

>>Bowel obstruction happens when stool is mechanically or functionally blocked from progressing downthe digestive tract. Bowel obstruction can also cause blood supply to the bowel to become completely oralmost completely stopped, thus causing tissue damage and even tissue death.



Bowel Obstruction Symptoms

The symptoms of bowel obstruction are:

Abdominal pain Vomiting

Lack of bowel movement as well as the urge to have bowel movement Inability to pass flatus gas or to fart Indigestion

Bad breath

Causes of Bowel Obstruction

Bowel obstruction is caused by:

Hernia Here, part of a bowel protrudes through an abnormal hole and becomes trapped.

Intussusception

In infants and small children, one segment of the intestine can slip onto another segment andbecomes blocked.

Cancer

Granulomatous processesIn this condition, abnormal tissue growth can block the passage of intestinal content.

Impacted feces Hard stool can become lodged in the large bowel.

Swallowed objects Foreign objects that are accidentally swallowed can become lodged in the intestines.

Inflammatory diseases, such as Crohn¶s disease and ulcerativie colitis

Toxic megacolon In this disease, the colon is enlarged to the point that the smooth stomach muscle does not workanymore.

Volvulus or a twist in the colon

Gallstone ileus A large gallstone, often with diameter of 1 inch or larger, erodes through the gallbladder andbecomes lodged in the intestine.

Side effect from previous surgery, such as:

Ileus A side effect of intestinal surgery or infection, ileus is the condition where the bowel stopsworking temporarily.

Adhesion The opening of the bowel is narrowed due to a previous abdominal surgery.

Treatment of Bowel Obstruction

The treatments for bowel obstruction depend on the severity of the condition and the cause of theobstruction:

Surgery Emergency surgery to remove the obstruction may be required, especially if tissue damage ordeath is present or imminent. Surgery may mean temporary or permanent colostomy, where anartificial opening in the colon is made to pass stool.

Barium-guided endoscopy, enema, or x-ray In cases of volvulus or twisted bowel and intussusception, this procedure may be able to undo theblockage.



Decompression of dilated colon For cases of functional blockage, such as ileus, resting of the bowel may help. Here, the stomachcontent is removed by pumping or suction and the patient is forbidden to eat or drink. Anendoscopic procedure to decompress the dilated bowel may also be necessary.

>>Lactose, fructose and sucrose intolerance is the body¶s inability to absorb these basic sugars. Of these three, the most common is lactose intolerance.

Causes of Lactose Intolerance

Lactose intolerance is caused by deficiency in the enzyme lactase. This enzyme is produced by the lining of the small intestine, and is responsible in breaking down sugars into absorbable forms.

Without the enzyme, bacteria that normally l ive in the digestive tract ferment them into gasses that cancause uncomfortable symptoms.

Symptoms of Lactose Intolerance

The symptoms of lactose intolerance include:

Diarrhea

Bloating Flatulence

Excess gas or burping

These symptoms usually appear 2 to 6 hours after consuming lactose-containing food or drink.

What Foods Have These Sugars?

Fructose is commonly found in:

Fruits, such as grapes, apples, and pears Fruit juices

Honey

Nuts and figs

Soft drinks

Sucrose is found in:

Table sugar

Fruits

Sugar cane

Lactose is found in:

Milk

Dairy products

Some foods also contain small amounts of lactose that are ³hidden´, i.e. not listed in their list of ingredients.These include:

Breads Cereals

Cookies and biscuits Prepared foods, such as instant soups and mashed potatoes

Coffee creamers

Diagnosis of Lactose Intolerance

The following tests are often used to diagnose lactose intolerance:

Hydrogen breath test Hydrogen is not normally present in the breath. In people with lactose intolerance, however,bacteria in the digestive tract convert the undigested sugars into various gasses, includinghydrogen. This gas is absorbed into the bloodstream, circulated to the lungs, and exhaled.



Lactose tolerance blood test Blood glucose level is taken before and after lactose consumption. In normal people, lactose is broken down and converted into glucose (and another sugar calledgalactose). This causes the blood glucose level to rise. In lactose intolerant people, however, since lactose is not broken down, the blood glucose level

does not change.

Stool acidity test This test is usually done to diagnose lactose intolerance in infants and young children. In cases of lactose intolerance, the sugar is fermented by bacteria in the colon into lactic acid, which ismeasurable in stool.

Who Gets It?

Lactose intolerance is actually very common ± approximately 50 million people in the United States have it.This condition is more prevalent in people of the following ethnicities:

Asians (about 90% of Asian adults are lactose intolerant!)

African Americans Jewish Native Americans

Hispanics

This condition usually develops over years or decades ± however, some children are born with congenitallactose intolerance.

Temporary lactose intolerance is common after a stomach infection, food poisoning, and after takingantibiotics.

Treatment for Sugar Intolerance?

If you are lactose intolerant, take lactase enzyme supplement before consuming milk or lactose-containingfood (remember that many foods contain small yet ³hidden´ amounts of lactase). You can also substituteregular milk for lactose-free or soy milk.

If you are fructose or sucrose intolerant, the only thing that works is avoiding foods that contain thesesugars.

>>Meckel¶s diverticulum is an abnormal growth of a small pouch (or a diverticulum) about the size of your thumb (2 inches or so) on the wall of the lower part of the small intestine. It is a congenital defect,meaning that it is present since birth as a leftover from the umbilical cord and intestines that is notreabsorbed during fetal development.

In approximately half of the cases, gastric tissue is present in the pouch ± in essence, stomach tissue isabnormally growing in the small intestine! When inflamed, an ulcer may develop or the intestine can becomeblocked.

How Common Is It?

Meckel¶s diverticulum occurs in approximately 1 in 50 people or 2% of the population. Most of these peoplehave no symptoms.

Symptoms of Meckel's Diverticulum

In children, the most common symptoms of meckel¶s diverticulum are:

Rectal bleeding

Blood in stool

In adults, the symptoms include:

Abdominal pain

Vomiting

Rectal bleeding

Blood in stool



Fever

Constipation

Swelling of the stomach

Tiredness and other symptoms of anemia and blood loss

Some people who have Meckel¶s diverticulum have no symptoms at all. Others may have symptoms similarto that of Crohn¶s disease, appendicitis, and peptic ulcers, thus making diagnosis of Meckel¶s diverticulum

tricky.

Left untreated, Meckel¶s diverticulum can cause the following complications:

Hemorrhage or bleeding

Perforation of the small intestine Peritonitis or the inflammation of the membrane that lines the stomach Intussusception, a condition where a segment of the intestine prolapses or ³slips´ onto another,

thus causing blockage.

Meckel¶s Diverticulum Diagnosis

Your doctor would perform the following tests:

Stool blood test for evidence of rectal bleeding

Barium X-ray A solution of barium is given orally before an X-ray of the stomach is taken. This allows yourdoctor to see the pouch.

Nuclear scan A radioactive isotope that is injected will accumulate at the site of bleeding in the stomach.

Treatment for Meckel¶s Diverticulum?

A Meckel¶s diverticulum that is causing problems needs to be removed. Here, surgery is performed undergeneral anesthesia to remove the segment of the small intestine that has the pouch. The prognosis isexcellent.

>>Mesenteric ischemia is the damage to the tissue of the intestine caused by acute or sudden as well aschronic lack of blood supply to the specific area. It can be though of as the intestinal equivalence of a heartattack, caused by blood clots in the arteries that supply blood to the heart.

This condition is also known as vascular or menteric bowel disorder.

Symptoms of Mesenteric Ischemia

The symptoms of acute mesenteric ischemia are:

Severe pain and cramps in the abdomen

Blood in the stool Nausea and vomiting

Diarrhea

Constipation

The symptoms of chronic mesenteric ischemia are:

Chronic pain in the abdomen after eating Weight loss

Diarrhea

Constipation

Fear of eating, because of the associated pain after eating

Diagnosis

Your doctor may order the following tests to diagnose mesenteric ischemia:

Physical examination Inflammation of the bowel or diffuse peritonitis can cause extreme tenderness of the abdomen.



Blood pressure inspection Low and unstable blood pressure is a medical emergency and is indicative of shock due to thiscondition.

Blood test Abnormal metabolic levels are present in patients with mesenteric ischemia.

Angiogram This test can reveal clot or blockage in the arteries.

X-ray and CT scan Tissue damage due to lack of blood flow to the abdomen is revealed by these tests.

Causes of Mesenteric Ischemia

Mesenteric ischemia is caused by intestinal tissue damage due to lack of blood supply to the area. Blood flowis interrupted by plaques or clots that form in the arteries ± which may cause an acute or sudden and severeloss of flow, or a chronic condition where the blood flow is severely reduced.

The process of plaque or clot formation, called artherosclerosis, is quite complex and involves many

factors including genetics, diets, cholesterol and triglycerides levels.

Treatment of Mesenteric Ischemia


Surgery If the angiogram shows a specific clot or blockage, then an emergency surgery may be required.Surgery may also be necessary if significant tissue d amage has already occurred.

Angioplasty A baloon is threaded through the artery and is inflated at the location of the blockage to restoreblood flow.

Vasodilator medication Medicines that dilate the arteries, such as papaverine, is given intravenously to open the clot.

As with heart attack, immediate treatment of menteric ischemia is very important ± call your doctor or go tothe emergency room immediately if you suspect that you have this condition.

>>Short bowel syndrome is the extreme loss of small intestine or its function due to disease or surgery,to the extent that there isn¶t enough of it left to absorb nutrients.

Symptoms of Short Bowel Syndrome

The symptoms of short bowel syndrome are:

Diarrhea

Pain in the stomach or abdomen, or under the right ribcage Steatorrhea or foul-smelling stool

Stool that ³floats´ or are oily and sticky

Indigestion and other symptoms of peptic ulcer

Fluid retention

Fatigue and weakness Severe weight loss

Malnutrition

Because of the body can¶t absorb enough nutrients, patients with short bowel syndrome often exhibitsymptoms of nutrient and vitamin deficiencies, such as:

Anemia due to iron, folic acid, and/or vitamin B12 deficiency Skin rashes and scaling of the skin or hyperkeratosis due to vitamin A deficiency

Bruising and blood in urine, due to vitamin K deficiency Muscle spasm and bone pain, due to vitamin D and calcium deficiency

Osteoporosis due to calcium deficiency

Children diagnosed with short bowel syndrome are also often slow in growth or development, due to lack of nutrition.



How Is It Diagnosed?

Your doctor would perform the following tests to diagnose this condition:

Medical history A history of bowel surgery or digestive ailments may point to the cause of short bowel syndrome.

Physical examination Jaundice, loss of muscle mass and wasting, visible signs of skin scaling and rashes, anddiminished sensation in the hands and feet due to vitamin deficiencies are diagnosed by physicalexamination.

Blood tests Elevated liver enzymes, abnormal levels of electrolytes and potassium are observed in bloodtests.

Stool examination

Causes of Short Bowel Syndrome

Short bowel syndrome can be caused by:

Surgeries These include:

Bypass surgery for extremely obese patientsHere, the small intestine is shortened to reduce its ability to absorb nutrients. It is nolonger performed because of potential side effects and complications, such as short bowelsyndrome.

Surgical removal of the small intestine damaged by disease or cancer.

Crohn¶s disease

This digestive disorder is marked by inflammation of the digestive tract (anywhere between themouth and the anus). If the small intestine walls are inflamed, then it may lead to short bowelsyndrome.

Necrotising enterocolitis Reduced blood supply to the walls of the small intestine lead to dead tissues that have to besurgically removed. This condition commonly affects prematurely-born babies and is the leadingcause of short bowel syndrome in infants.

Volvulus A spontaneous tangling or twisting of the small intestine, where the blood supply to thesurrounding tissue is cut off, thus causing damage or death to the intestinal tissue.

Tumor and cancer of the small intestine

Trauma

How Much Small Intestine Can Be "Lost"?

The small intestine is approximately 20-feet long and in most cases, short bowel syndrome does not appearuntil it is only 6 feet in length. This means that a person can lose up to about 70% of his small intestinewithout becoming malnourished.

The lining of the small intestine is covered with millions of finger-like projections called villi. Theseprojections provide a large surface area to absorb nutrients. In a process called intestinal adaptation,

when a portion of the small intestine is surgically removed, villi from the remaining part grow larger tocompensate for the lost organ. Peristalsis, or the movement of the food through the small intestine, is alsoslowed to give the bowel more time to absorb nutrients.

Treatment for Short Bowel Syndrome?

short bowel syndrome treatments include:



Diarrhea medicine In cases of severe diarrhea, intravenous hydration may be required to prevent dehydration.

Vitamin, iron, folic acid, and protein supplements To treat vitamin and nutrient deficiencies, your doctor may prescribe water-soluble supplementsthat are easier to absorb.

Lactase supplement Because the small intestine produces the enzyme that digests lactose, many short bowelsyndrome patients also have lactose intolerance.

Medications to reduce stomach acid In patients with short bowel syndrome, acid-inhibiting peptides normally present in the smallintestine are missing. To reduce the amount of stomach acid produced, your doctor mayprescribe:

Histamine or H2 receptor blocker These medicines block the histamine receptors that signal the stomach to make moreacid.

Proton pump inhibitors

These are drugs that directly disable the acid pumps in the stomach.

Antacids Some prescription-strength antacids coat the stomach and promote healing of lesionscaused by peptic ulcer.

Medications to bind bile-salt

Surgery, including small intestine transplant Short bowel syndrome caused by intestinal bypass surgery can usually be reversed by furthersurgery. In rare cases, small intestine or small bowel transplant may be required. This procedure hasmixed success, and carries with it the risk of organ rejection and infection.

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