and Ulcers

Professor C.J. Hawkey and Dr N.J.D. Wight Published by Family Doctor Publications Limitedin association with the British Medical Association IMPORTANT
This book is intended not as a substitute for personal medical advice but as a supplement to that advice for the patient who wishes to understand more about his In particular (without limit) you should note that advances in medical science occur rapidly and some information about drugs and treatment contained in this booklet may very soon be out of date.
All rights reserved. No part of this publication may be reproduced, or stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording and/or otherwise, without the prior written permission of the publishers. The right of Professor C.J. Hawkey and Dr N.J.D. Wight to be identified as the authors of this work has been asserted in accordance with the Copyright, Designs and Patents Act 1988, Family Doctor Publications 1999–2006 Family Doctor Publications, PO Box 4664, Poole, Dorset BH15 1NN ISBN-13: 978-1-903474-46-9
ISBN-10: 1-903479-46-9
Professor C.J. Hawkey is
Professor of Gastroenterology
A very common symptom
Virtually everyone has had indigestion at some time, and for most people it’s simply a minor nuisance. More often than not, it happens when you’ve overindulged in food or alcohol or eaten something that doesn’t agree with you, and it lasts for only a relatively short has worked in many hospitals inEngland treating and researching In these situations, you can either wait for the symptoms to subside or treat yourself with a remedy Dr N.J.D. Wight is a specialist
from the pharmacist without needing to see a doctor. For some people, however, the symptoms can be persistent and so severe that they interfere with everyday life. They may be caused by some undiagnosed problem within the digestive system that needs to be properly identified and, if necessary, treated by a This book will help you distinguish between minor symptoms that you can safely treat yourself with theadvice of a pharmacist and those that need furtherinvestigation. The word ‘indigestion’ means different things to • If your indigestion does not get better with simple different people, but mostly it is used to describe over-the-counter remedies, you should make a discomfort in the central upper abdomen related in some way to eating or swallowing. Other commonsymptoms include: Whether or not to see your GP is discussed in detail onpages 13–15. Remember, if self-help doesn’t work, or if you are worried, it is always best to see your GP.
• a burning sensation in the chest (heartburn) often linked with food or liquid coming up into the throat KEY POINTS
or the back of the mouth (known medically asgastro-oesophageal reflux) • belching or burping gas or wind into the mouth.
affecting most people at some time intheir life Treating indigestion
If you get such symptoms only occasionally, you should ask your pharmacist about over-the-countertreatments, which can be used safely to treat the odd bout of indigestion. You should also read the section in this book on lifestyle changes (see page 16) and makeany necessary changes to reduce your chances of ■ This booklet will help you to treat yourself further attacks. Simple measures like these will usually and also help you decide if it is necessary be all that is needed to solve your problem, but in certain circumstances it is best to see your GP: • If you have difficulty swallowing, unintentional weight loss, abdominal swelling, persistent vomitingor vomiting blood, you should make an urgentappointment to see your GP.
• If you have indigestion and are taking certain types of drugs, either prescribed or bought from thechemist, you should make a routine appointment tosee your GP (the types of drugs that may causeindigestion are described in detail on pages 72–4).
The structure of the mouth
The tongue, teeth and saliva work together to start the process
of digestion. There are three pairs of salivary glands that aid the
tasting, chewing and swallowing of food.
How the digestive system works
Many people sometimes have only a vague idea of the size, shape, position and function of the stomach andother digestive organs. This section of the book gives abrief outline of the normal process of digestion andwhat each of the main parts of the digestive systemdoes. If this is all familiar to you, just skip this account and move straight on to page 10, where the maintypes of indigestion are described.
To extract nutrients from the food that we eat we need to digest it. First the food has to be changed into a liquid or semi-liquid form. Then, complex substancessuch as fats and proteins have to be broken down into move food round your mouth to chew it, and it also smaller chemical units that can be absorbed through contains an enzyme called salivary amylase that starts the walls of the intestine into the bloodstream. to digest carbohydrates such as sugars and starches. It is slightly acid and, when you’re not actually eating, The mouth
it goes on being produced and helps to keep your The process of digestion begins in your mouth, where mouth and teeth clean and stop plaque developing on the teeth and tongue chop large pieces of food into your teeth. People who have conditions in which smaller ones. The salivary glands release saliva into the salivary production is reduced often experience a dry mouth to mix with the food. Saliva makes it easier to mouth, difficulty swallowing and increased tooth decay.
The stomach and intestines
The major abdominal organs and digestion
Once the food is chewed and softened in the mouth, Ingested food passes down the oesophagus and into the the tongue pushes it to the back of the throat, where stomach, where it is churned and mixed thoroughly withdigestive juices secreted by the stomach lining. Further digestive muscles propel it down the oesophagus (or gullet). The enzymes are added to the food in the duodenum.
food passes from the oesophagus into the stomachthrough a muscular one-way valve, the lower oeso-phageal sphincter, which prevents the contents of thestomach from being forced back into the chest whenthe stomach contracts or when you lie flat. Functions of the stomachThe stomach is a muscular J-shaped sac that forms thewidest part of the digestive tract. It has three main 1. It acts as a storage container, so that within a
few minutes we can swallow all the food needed 2. It plays a large part in the physical and chemical
processes of digestion. Food in the stomach is churned and crushed, although you notice thisonly when the activity is excessive because yourstomach does not contain the same number ofsensory nerves as other parts of the body, such as the skin. Glands within the stomach lining produce a powerful acid and enzymes that helpbreak down the constituents of food into simpler chemical compounds. The walls of the stomach are normally protected against acid attack by a layer of protective mucus, but, if this is reduced or damaged, it may lead to ulcer formation. Theoesophagus doesn’t have this protective liningand so is more easily damaged by acid.
Section through stomach wall
The swallowing process
To allow you to swallow food safely, two involuntary events
occur: the soft palate rises to close off the nasal cavity and the
epiglottis tilts to seal the windpipe.
3. Food may stay in the stomach for several hours,
during which time the acid will destroy most ofthe bacteria and other micro-organisms that may have contaminated it. Very little is absorbed directly into the bloodstream through the stomach walls, apart from a few substances such When the stomach has done its work the liquidised food is then pushed onwards through another valve,the pylorus, into the duodenum – the first few inches of the small intestine. Here further chemicals are addedto neutralise the stomach acid, together with enzymes from the pancreas to help digest carbohydrates, fats and proteins, and bile from the liver to help digest fats.
The digested food then passes into the remaining 20 called gastro-oesophageal reflux and is described in feet (six metres) of small intestine, so called because, although it is long, its diameter is smaller than that Stomach acid may also cause problems if it attacks of the large intestine. The chemical breakdown is the lining of the stomach itself, known as peptic ulcer completed in the small intestine and the chemical disease, described in detail later (see page 61). Our constituents of the meal are absorbed into the blood understanding of peptic ulcer disease has changed greatly in recent years, thanks to the discovery of an The main tasks of the large intestine are to infective agent called Helicobacter pylori – you’ll find reabsorb the water that is used in digestion and to out more about this later (see page 64).
eliminate the undigested food and fibre. The third common cause of indigestion, called non- ulcer dyspepsia, is something of a puzzle. This is the What can go wrong?
diagnosis given to people who have persistent Almost everyone experiences occasional attacks of symptoms of indigestion but in whom the tests for indigestion, which are usually quite brief. We may feel gastro-oesophageal reflux and stomach ulcers are blown out or distended after a large meal, and get normal. Dyspepsia is actually just the medical name for some relief when we bring up wind. Most of the wind indigestion. Some people with this type of indigestion that we bring up is a result of swallowing air as we are eventually found to have a disorder affecting eat, but some is produced by a chemical reaction in another part of the digestive system, such as gallstones the stomach or from carbonated, fizzy drinks. The or the irritable bowel syndrome. In others, the pain is solutions are to eat less, eat more slowly and go easy found to be caused by some disorder of the lower ribs with fizzy drinks. You may have discovered for yourself and muscles of the abdominal wall. Most people with that certain foods – fried onions, for example – give you non-ulcer dyspepsia, however, seem to have sensitive an uncomfortable sensation in the upper abdomen that stomachs that cause symptoms at times of emotional lasts for only an hour or so. Again the answer is obvious: stress. The condition is described in greater detail on don’t eat those foods, or avoid them where possible.
Very occasionally, indigestion may be the first Causes of indigestion
symptom of a more serious condition such as stomach More persistent indigestion is usually linked with the cancer. Stomach cancer is becoming less common than acid produced by the stomach. If the valve at the lower in the past and it occurs far less frequently than peptic end of the oesophagus becomes weak or defective, ulcer disease or gastro-oesophageal reflux. It is the acid juices in the stomach may be pushed back described in greater detail on pages 93–9.
upwards into the oesophagus, causing a burningsensation (heartburn). This is often troublesome atnight, when you lie flat. The underlying condition is KEY POINTS
■ During the normal digestion process, food ■ The stomach produces acid and pepsin to ■ If the lining of the stomach is weakened, or if acid production is altered, thenindigestion can occur Assessing the seriousness of your
Probably three of every four people who suffer from
indigestion never seek medical advice: they relieve their
symptoms by a few changes to their lifestyle and by
taking over-the-counter treatments, such as antacids or
acid-blocking drugs, bought from the chemist every
now and then.
One of the aims of this book is to help you decide whether and when to consult your doctor. You shouldmake an appointment if any of the three followingsituations applies to you.
Sinister symptoms
See your GP without delay if you have any symptoms
of the kind that doctors call ‘sinister’, by which they
mean symptoms that might be caused by a serious
disease such as stomach cancer. Early diagnosis and
treatment give the best chance of a cure, so get
prompt medical advice if you have any of the following
D O Y O U N E E D T O S E E Y O U R D O C T O R ? over-the-counter medicines or if you need to takethese medicines for a prolonged period of time.
Your doctor may need to arrange various tests and investigations before beginning treatment – this iscovered on pages 28–41.
• persistent vomiting• vomiting blood or material that looks like coffee KEY POINTS
• passing altered blood in the motions (this makes Medicine interactions
Make a routine appointment to see your GP if you develop indigestion while taking any of the following • you have vomited blood or material that • certain blood pressure drugs known as calcium channel antagonists (nifedipine, amlodipine and • you have passed altered blood in your • nitrate drugs for treatment of angina (such as • you are over 40 and have indigestion for • your indigestion has not responded to • bisphosphonate drugs used for the treatment of osteoporosis (alendronate and risedronate are • steroid tablets• non-steroidal anti-inflammatory drugs such as Prolonged indigestion
Make a routine appointment to see your GP if your
indigestion does not go away despite the use of


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