Nutrition Science and Everyday Application - beta v 0.1

DISORDERS OF THE GI TRACT 155
• Quit smoking and avoid secondhand smoke, if needed.
• Lose weight, if needed.
Over-the-counter medications like antacids (Maalox, Mylanta, Rolaids) can also help with
occasional heartburn. If symptoms are persistent and frequent, it’s wise to see a doctor to
be checked out for GERD and to discuss other treatment and medication options. 1,2
PEPTIC ULCERS
Peptic ulcers are sores on the tissues lining the esophagus, stomach, or duodenum (the
first section of the small intestine). They occur when the mucous coating the GI tissues is
damaged, exposing the tissue to pepsin and hydrochloric acid. This further erodes away the
tissues, causing pain if it damages a nerve and bleeding if it damages a blood vessel. Ulcers
are most serious if they perforate the wall of the GI tract, which can cause a serious infection.
Peptic ulcers cause stomach pain, often when the stomach is empty, and may go away when
you eat or take antacids. In the most serious cases, blood may be seen in vomit and/or the
stool, and the patient may have very sharp and persistent stomach pain.
Figure 3.16. Peptic ulcers. (A) The location of a peptic ulcer in the stomach. (B) A photo from an
endoscopy of a patient with an ulcer in the duodenum.
Doctors used to believe that stress and excessive stomach acid caused peptic ulcers, so
they would recommend a bland diet, stress reduction, and acid-suppressing medications
as treatment. However, these treatments often didn’t work, because they weren’t actually
treating the root cause of the ulcers. We now know that there are two main causes of peptic
ulcers. The first and most common cause is infection with a bacteria called Helicobacter pylori
(H. pylori). H. pylori infection is very common, with about 50% of the population worldwide
harboring the bacteria, most of them living without any symptoms. It’s not certain how
people are infected with H. pylori or why they cause ulcers in some people and not in others.
However, understanding the link between H. pylori and ulcers was an important discovery,
because it led to effective treatments. The H. pylori bacteria are able to survive the acidic
environment of the stomach, and they damage the mucous coating of the GI tract, leaving
it vulnerable to further damage from acid and pepsin. Ulcers caused by H. pylori infection
are treated with antibiotics to kill the bacteria, with the addition of an acid-suppressing
medication to allow the tissue to heal.
The second major cause of peptic ulcers is long-term use of nonsteroidal anti-inflammatory
drugs (NSAIDs), such as aspirin or ibuprofen. One of the side effects of NSAIDS is that