| B.
SECONDARY HYPERACIDITY
I. REFLUX
OESOPHAGITIS
The disorder may be defined as damage
to the esophageal mucosa due to reflux of gastric contents.
Etiology: Increased reflux
of gastric contents into the esophagus from reduced pressure in
the lower oesophageal sphincter and an increased number of transient
relaxation of the sphincter are the main factors in the development
of reflux esophagitis.
Clinical Features
/ Symptoms:
-
Heartburn: This is a sensation of
burning or burning pain located high in the epigastria
or behind the lower end of the sternum often radiating upwards
behind the sternum. It occurs after meals and is characteristically
brought on by lifting or straining due to an increase in the
abdominal pressure. Heartburn may also occur on lying down in
bed at night, preventing sleep or awakening the patient several
hours after the onset of sleep.
It is sometimes precipitated immediately
by acid food or drink – tomatoes, orange, cola, and alcohol.
-
Painful Dysphagia: The usual
cause is the bolus of food passing through an inflamed segment
of esophagus.
-
Regurgitation of gastric contents
into the mouth may occur during bending, after large meal or
at night. The patient becomes aware of the regurgitation because
of a bitter taste in the mouth.
-
Sore throat, Globus sensation
(‘lump in throat’), and hoarseness are other
consequences.
Management:
-
Weight reduction
-
Stopping cigarette smoking
-
Meals should be of small volume
-
Alcohol, fatty food, and caffeine should be avoided
-
No snacks must be taken after evening meal to prevent
nocturnal regurgitation
-
Heavy stooping or bending at the waist should be
avoided especially after meals
-
Head in the bed should be elevated by 15 cm.
II. PEPTIC
ULCER
The term ‘peptic ulcer’ refers
to an ulcer in the lower esophagus, stomach, or duodenum.
Etiology:
Following factors play a role
Pathology:
An ulcer forms when there is an imbalance between aggressive forces,
i.e., the digestive power of acid and pepsin, and defensive factors
i.e., the ability of the gastric and duodenal mucosa to resist this
digestive power. However, in the majority of patients acid secretion
is within normal limits or is moderately raised. In these individuals,
damage to the gastric mucosal barrier is necessary to facilitate
the damaging effect of acid and pepsin. The initial damage results
from Helicobacter pylori, NSAID’s, and smoking.
Clinical Features
/ Symptoms:
-
Epigastric pain: Pain is
referred to the epigastrium and is often so sharply localized
that the patient can indicate its site with two or three fingers-the
‘pointing sign’.
-
Hunger pain: Pain occurs intermittently
during the day, often when the stomach is empty, so that the
patient identifies it as ‘hunger pain’ and obtains
relief by eating.
-
Night pain: Pain wakes the
patient from sleep and may be relieved by food, a drink of
milk, or antacids; this symptom when present is virtually
pathognomonic for ulcer.
-
Water brash: This is a sudden filling
of mouth with saliva which is produced as a reflex response
to a variety of symptoms from the upper GIT, e.g., peptic
ulcer pain
-
Heartburn
-
Loss of appetite
-
Vomiting
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