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Archive for the ‘Gastrointestinal’ Category

Dec
15

TUMMY TROUBLES: ULCERATIVE COLITIS

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Q. You mentioned that people with ulcerative colitis were more prone to cancer of the large bowel. What is this condition?

A. Ulcerative colitis is an inflammatory condition of the large bowel, the colon and rectum. It is more common in women, especially in the 20-40 year age group. It is more common in western populations.

Q. What are the symptoms?

A. There are recurring bouts of diarrhoea with blood and mucus, usually associated with cramping pains in the lower abdominal region. Often attacks come on causing severe symptoms and considerable ill health.

Q. How is it diagnosed and treated?

A. As with other disorders of the large bowel the doctor resorts to x-rays (in the form of a barium enema which gives a clear picture of the outline of the bowel), the sigmoidoscope and the colonoscope. This allows direct viewing of the bowel. The colonoscope, like the endoscope, is very versatile and may penetrate as far up the intestinal system as desired. The sigmoidoscope is mainly used for the lower bowel, it being shorter and less manoeuvrable. The examining physician gains an incredibly clear view of the bowel lining. Treatment is prescribed for the patient according to the degree of the disorder and symptoms. An adequate diet is prescribed, corticosteroid drugs given usually in the form of an enema, but also orally, and a drug called sulfasalazine is often beneficial. Diarrhoea is controlled by codeine, loperamide and other well known forms of medication. Surgery is used in some severe cases. As recurrences are common, sulfasalazine therapy long-term is often used. Persons with long standing ulcerative colitis (ten years and more) appear to run a higher than average risk of developing bowel cancer.

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Dec
15

THE CAUSES OF ULCERS

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Q. What causes these erosions to take place in a healthy person?

A. The basic cause is too much acid and pepsin in the gastric fluid. At all times, a continual battle is going on in the stomach. On one hand, glands in the walls are actively producing acid, which in turn allows production of pepsin, and these two liquids commence digestion of the food. This means it is broken down into its basic component parts which will allow it to be absorbed by the blood stream further down in the intestinal canal. On the other hand, the mucosal lining has to resist the action of these chemicals on itself, for it is also subject to being digested — a case of the body actually devouring itself! Normally, the two remain in a fairly stable equilibrium, and no harm occurs; food is broken down, and the stomach wall remains intact.

Q. Do ulcer patients produce too much acid and pepsin?

A. In most cases, probably all, the answer must be ‘Yes’. Often this is not so with stomach ulcers, but it has been found that in many cases of duodenal ulcer, acid production is three times that of normal. Imagine that hot burning acid being present in three times the normal volume. We have already pointed out the extremely strong burning nature of hydrochloric acid — as every plumber who solders knows — and this may act for hours on the lining of the intestine. No wonder that little craters and holes develop.

In a particular disorder called the Zollinger-Ellison syndrome, acid production is stimulated to incredibly high levels and as much as eight times normal acid production occurs. Little wonder these patients suffer from serious ulcers.

Q. If there is no acid present, does that mean no ulcers?

A. The reverse holds true. Excess acid and there is a high risk of ulcers. No acid, so called achlorhydria, and there is no chance of an ulcer developing.

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