Digestive System

Several disorders of the esophagus are esophagitis, esophageal spasm, and esophageal cancer. Esophagitis (heartburn) is an inflammation of the esophagus usually caused by the reflux of gastric acids into the esophagus and is treated with (alkalis) antacid. Esophageal spasm is also caused by acid reflux and is sometimes treated with nitroglycerine placed under the tongue. Esophageal cancer can be caused by smoking and is generally fatal.

Disorders of the stomach include hiatal hernia, ulcers, and gastric cancer. A hiatal hernia occurs when a portion of the stomach extends upwards into the thorax through a large opening in the diaphragm. It is a condition that commonly occurs to people over the age of 50. Stomach ulcers are sores that form in the lining of the stomach. They may vary in size from a small sore to a deep cavity, surrounded by an inflamed area, sometimes called ulcer craters. Stomach ulcers and ulcers that form in the esophagus and in the lining of the duodenum are called peptic ulcers because they need stomach acid and the enzyme pepsin to form. Duodenal ulcers are the most common type. They tend to be smaller than stomach ulcers and heal more quickly. Ulcers that form in the stomach lining are called gastric ulcers. About four million people have ulcers and 20% of those have gastric ulcers. Those people who are at most risk for ulcers are those who smoke, middle-age and older men, chronic users of alcohol, and those who take anti-inflammatory drugs, such as aspirin and ibuprofen.

Until 1993, the general belief in the medical community concerning the cause of stomach ulcers was that there were multiple factors responsible for their development. By 1993 there was mounting evidence that an S-shaped bacterium, Helicobacter pylori, could be one of the factors causing ulcers. Helicobacter pylori live in the mucous lining of the stomach near the surface cells and may go undetected for years. Researchers argued that irritation to the stomach caused by the bacteria weakened the lining, making it more susceptible to damage by acid and resulting in the formation of ulcers.

Barry Marshall, an Australian gastroenterologist, was the chief proponent of the theory that stomach ulcers are caused by H. pylori infections, rather than a multiple factor explanation, such as stress or poor diet. Although Marshall was discouraged by his colleagues from pursuing this line of research, he demonstrated his hypothesis by swallowing a mixture containing H. pylori. Marshall soon developed gastritis, which is the precursor condition to ulcers.

The treatment of ulcers has undergone a radical change with Marshall's discovery that stomach ulcers are caused by H. pylori infections. Ulcer patients today are being treated with antibiotics and antacids rather than special diets or expensive medicines. It is believed that about 80% of stomach ulcers may be caused by the bacterial infection, while about 20% may be from other causes, such as the use of anti-inflammatory medicines.