See barium X-ray examinations.
Function As well as the stomach’s prime role in physically and physiologically breaking down the food delivered via the oesophagus, it also acts as a storage organ – a function that enables people to eat three or four times a day instead of every 30 minutes or so as their metabolic needs would otherwise demand. Gastric secretion is stimulated by the sight and smell of food and its subsequent arrival in the stomach. The secretions, which contain mucus and hydrochloric acid (the latter produced by parietal cells), sterilise the food; pepsin, a digestive ENZYME in the gastric juices, breaks down the protein in food. The juices also contain intrinsic factor, vital for the absorption of vitamin B12 when the chyle – as the stomach contents are called – reaches the intestine. This chyle is of creamy consistency and is the end product of enzymic action and rhythmic contractions of the stomach’s muscles every 30 seconds or so. Food remains in the stomach for varying lengths of time depending upon its quantity and nature. At regular intervals a bolus of chyle is forced into the duodenum by contractions of the stomach muscles coordinated with relaxation of the pyloric sphincter.... stomach
Acute gastritis is an in?ammatory reaction of the gastric mucosa to various precipitating factors, ranging from physical and chemical injury to infections. Acute gastritis (especially of the antral mucosas) may well represent a reaction to infection by a bacterium called Helicobacter pylori. The in?ammatory changes usually go after appropriate antibiotic treatment for the H. pylori infection. Acute and chronic in?ammation occurs in response to chemical damage of the gastric mucosa. For example, REFLUX of duodenal contents may predispose to in?ammatory acute and chronic gastritis. Similarly, multiple small erosions or single or multiple ulcers have resulted from consumption of chemicals, especialy aspirin and antirheumatic NONSTEROIDAL ANTI-INFLAMMATORY DRUGS (NSAIDS).
Acute gastritis may cause anorexia, nausea, upper abdominal pain and, if erosive, haemorrhage. Treatment involves removal of the o?ending cause.
Chronic gastritis Accumulation of cells called round cells in the gastric mucosal characterises chronic gastritis. Most patients with chronic gastritis have no symptoms, and treatment of H. pylori infection usually cures the condition.
Atrophic gastritis A few patients with chronic gastritis may develop atrophic gastritis. With or without in?ammatory change, this disorder is common in western countries. The incidence increases with age, and more than 50 per cent of people over 50 may have it. A more complete and uniform type of ATROPHY, called ‘gastric atrophy’, characterises a familial disease called PERNICIOUS ANAEMIA. The cause of the latter disease is not known but it may be an autoimmune disorder.
Since atrophy of the corpus mucosa results in loss of acid- and pepsin-secreting cells, gastric secretion is reduced or absent. Patients with pernicious anaemia or severe atrophic gastritis of the corpus mucosa may secrete too little intrinsic factor for absorption of vitamin B12 and so can develop severe neurological disease (subacute combined degeneration of the spinal cord).
Patients with atrophic gastritis often have bacterial colonisation of the upper alimentary tract, with increased concentration of nitrite and carcinogenic N-nitroso compounds. These, coupled with excess growth of mucosal cells, may be linked to cancer. In chronic corpus gastritis, the risk of gastric cancer is about 3–4 times that of the general population.
Postgastrectomy mucosa The mucosa of the gastric remnant after surgical removal of the distal part of the stomach is usually in?amed and atrophic, and is also premalignant, with the risk of gastric cancer being very much greater than for patients with duodenal ulcer who have not had surgery.
Stress gastritis Acute stress gastritis develops, sometimes within hours, in individuals who have undergone severe physical trauma, BURNS (Curling ulcers), severe SEPSIS or major diseases such as heart attacks, strokes, intracranial trauma or operations (Cushing’s ulcers). The disorder presents with multiple super?cial erosions or ulcers of the gastric mucosa, with HAEMATEMESIS and MELAENA and sometimes with perforation when the acute ulcers erode through the stomach wall. Treatment involves inhibition of gastric secretion with intravenous infusion of an H2-receptorantagonist drug such as RANITIDINE or FAMOTIDINE, so that the gastric contents remain at a near neutral pH. Despite treatment, a few patients continue to bleed and may then require radical gastric surgery.
Gastric ulcer Gastric ulcers were common in young women during the 19th century, markedly fell in frequency in many western countries during the ?rst half of the 20th century, but remained common in coastal northern Norway, Japan, in young Australian women, and in some Andean populations. During the latter half of this century, gastric ulcers have again become more frequent in the West, with a peak incidence between 55 and 65 years.
The cause is not known. The two factors most strongly associated with the development of duodenal ulcers – gastric-acid production and gastric infection with H. pylori bacteria – are not nearly as strongly associated with gastric ulcers. The latter occur with increased frequency in individuals who take aspirin or NSAIDs. In healthy individuals who take NSAIDs, as many as 6 per cent develop a gastric ulcer during the ?rst week of treatment, while in patients with rheumatoid arthritis who are being treated long term with drugs, gastric ulcers occur in 20–40 per cent. The cause is inhibition of the enzyme cyclo-oxygenase, which in turn inhibits the production of repair-promoting PROSTAGLANDINS.
Gastric ulcers occur especially on the lesser curve of the stomach. The ulcers may erode through the whole thickness of the gastric wall, perforating into the peritoneal cavity or penetrating into liver, pancreas or colon.
Gastric ulcers usually present with a history of epigastric pain of less than one year. The pain tends to be associated with anorexia and may be aggravated by food, although patients with ‘prepyloric’ ulcers may obtain relief from eating or taking antacid preparations. Patients with gastric ulcers also complain of nausea and vomiting, and lose weight.
The principal complications of gastric ulcer are haemorrhage from arterial erosion, or perforation into the peritoneal cavity resulting in PERITONITIS, abscess or ?stula.
Aproximately one in two gastric ulcers heal ‘spontaneously’ in 2–3 months; however, up to 80 per cent of the patients relapse within 12 months. Repeated recurrence and rehealing results in scar tissue around the ulcer; this may cause a circumferential narrowing – a condition called ‘hour-glass stomach’.
The diagnosis of gastric ulcer is con?rmed by ENDOSCOPY. All patients with gastric ulcers should have multiple biopsies (see BIOPSY) to exclude the presence of malignant cells. Even after healing, gastric ulcers should be endoscopically monitored for a year.
Treatment of gastric ulcers is relatively simple: a course of one of the H2 RECEPTOR ANTAGONISTS heals gastric ulcers in 3 months. In patients who relapse, long-term inde?nite treatment with an H2 receptor antagonist such as ranitidine may be necessary since the ulcers tend to recur. Recently it has been claimed that gastric ulcers can be healed with a combination of a bismuth salt or a gastric secretory inhibitor
for example, one of the PROTON PUMP INHIBITORS such as omeprazole or lansoprazole
together with two antibiotics such as AMOXYCILLIN and METRONIDAZOLE. The long-term outcome of such treatment is not known. Partial gastrectomy, which used to be a regular treatment for gastric ulcers, is now much more rarely done unless the ulcer(s) contain precancerous cells.
Cancer of the stomach Cancer of the stomach is common and dangerous and, worldwide, accounts for approximately one in six of all deaths from cancer. There are marked geographical di?erences in frequency, with a very high incidence in Japan and low incidence in the USA. In the United Kingdom around 33 cases per 100,000 population are diagnosed annually. Studies have shown that environmental factors, rather than hereditary ones, are mainly responsible for the development of gastric cancer. Diet, including highly salted, pickled and smoked foods, and high concentrations of nitrate in food and drinking water, may well be responsible for the environmental effects.
Most gastric ulcers arise in abnormal gastric mucosa. The three mucosal disorders which especially predispose to gastric cancer include pernicious anaemia, postgastrectomy mucosa, and atrophic gastritis (see above). Around 90 per cent of gastric cancers have the microscopic appearance of abnormal mucosal cells (and are called ‘adenocarcinomas’). Most of the remainder look like endocrine cells of lymphoid tissue, although tumours with mixed microscopic appearance are common.
Early gastric cancer may be symptomless and, in countries like Japan with a high frequency of the disease, is often diagnosed during routine screening of the population. In more advanced cancers, upper abdominal pain, loss of appetite and loss of weight occur. Many present with obstructive symptoms, such as vomiting (when the pylorus is obstructed) or di?culty with swallowing. METASTASIS is obvious in up to two-thirds of patients and its presence contraindicates surgical cure. The diagnosis is made by endoscopic examination of the stomach and biopsy of abnormal-looking areas of mucosa. Treatment is surgical, often with additional chemotherapy and radiotherapy.... stomach, diseases of
German Chamomile tea. ... nervous stomach
Ultrasound scanning, CT scanning, and MRI are commonly used.
Radionuclide scanning may reveal cysts and tumours and show bile excretion.
X–ray techniques include cholangiography, cholecystography, and ERCP (endoscopic retrograde cholangiopancreatography).
In these procedures, a contrast medium, which is opaque to X-rays, is introduced to show abnormalities in the biliary system.
Angiography reveals the blood vessels in the liver.... liver imaging
Most lung disorders can be detected by chest X-ray.
CT scanning and MRI play an important role in detecting the presence and spread of lung tumours.
Ultrasound scanning is sometimes used to reveal pleural effusion.
Radioisotope scanning is used to detect evidence of pulmonary embolism.... lung imaging
Symptoms (non-specific). Loss of appetite, anaemia, weight loss; pain in abdomen, especially stomach area. Vomit appears as coffee grounds. Occult blood (tarry stools).
Causes. Alcohol, smoking cigarettes, low intake of fruits and vegetables. Foods rich in salt and nitrites including bacon, pickles, ham and dried fish. (Cancer Researchers in Digestive Diseases and Sciences) Long term therapy with drugs that inhibit gastric acid secretion increase risk of stomach cancer.
Of possible value. Alternatives:– Tea. Mixture. Equal parts: Red Clover, Gotu Kola, Yarrow. Strong infusion (2 or more teaspoons to each cup boiling water; infuse 15 minutes. As many cups daily as tolerated.
Formula. Condurango 2; Bayberry 1; Liquorice 1; Goldenseal quarter. Mix. Dose: Powders: 750mg (three 00 capsules or half a teaspoon). Liquid extracts: 1 teaspoon. Tinctures: 1-2 teaspoons. Thrice daily in water or honey.
Traditional. Rosebay Willowherb. Star of Bethlehem.
Chinese green tea. Anti-cancer effects have been found in the use of Chinese green tea extracts. Clinical trials on the therapeutic effects against early stomach cancer were promising. (Chinese Journal Preventative Medicines 1990. 24 (2) 80-2)
Chinese Herbalism. Combination. Oldenlandia diffusa 2 liang; Roots of Lu (Phragmites communis) 1 liang; Blackened Ginger 1 ch’ien; Pan-chih-lien (Scutellaria barbarta 5 ch’ein; Chih-tzu (gardenia jasminoides) 3 ch’ien. One concoction/dose daily. Follow with roots of Bulrush tea.
William H. Cook, MD. “Mullein greatly relieves pain, and may be used with Wild Yam and a little Water- Pepper (Polygonum Hydropiper).” The addition of Water-Pepper (or Cayenne) ensures diffusive stimulation and increased arterial force. Burns Lingard, MNIMH. Inoperable cancer of the stomach. Prescribed: Liquid Extract Violet leaves and Red Clover, each 4 drachms; Liquid Extract Cactus grand., 2 drops. Dose every 4 hours. Woman lived 30 years after treatment attaining age of 70.
Arthur Barker, FNIMH. Mullein sometimes helpful for pain.
Wm Boericke MD. American Cranesbill.
George Burford MD. Goldenseal.
Maria Treben. “After returning from a prison camp in 1947 I had stomach cancer. Three doctors told me it was incurable. From sheer necessity I turned to Nature’s herbs and gathered Nettle, Yarrow, Dandelion and Plantain; the juice of which I took hourly. Already after several hours I felt better. In particular I was able to keep down a little food. This was my salvation.” (Health Through God’s Pharmacy – 1981) Essiac: Old Ontario Cancer Remedy. Sheila Snow explored the controversy surrounding the famous cancer formula ‘Essiac’. This was developed by Rene Caisse, a Canadian nurse born in Bracebridge, Ontario, in 1888. Rene noticed that an elderly patient had cured herself of breast cancer with an Indian herbal tea. She asked for the recipe and later modified it. Rene’s aunt, after using the remedy for 2 years, fully recovered from an inoperable stomach cancer with liver involvement, and other terminal patients began to improve.
Rene’s request to be given the opportunity to treat cancer patients in a larger way was turned down by Ottawa’s Department of Health and Welfare. She eventually handed over the recipe to the Resperin Corporation in 1977, for the sum of one dollar, from whom cancer patients may obtain the mixture if their doctors submit a written request. However, records have not been kept up.
In 1988 Dr Gary Glum, a chiropractor in Los Angeles, published a book called ‘Calling of an Angel’: the true story of Rene Caisse. He gives the formula, which consists of 11b of powdered Rumex acetosella
(Sorrel), 1 and a half pounds cut Arctium lappa (Burdock), 4oz powdered Ulmus fulva (Slippery Elm bark), and 1oz Rheum palmatum (Turkey Rhubarb). The dosage Rene recommended was one ounce of Essiac with two ounces of hot water every other day at bedtime; on an empty stomach, 2-3 hours after supper. The treatment should be continued for 32 days, then taken every 3 days. (Canadian Journal of Herbalism, July 1991 Vol XII, No. III)
Diet. See: DIET – CANCER. Slippery Elm gruel.
Note: Anyone over 40 who has recurrent indigestion for more than three weeks should visit his family doctor. Persistent pain and indigestion after eating can be a sign of gastric cancer and no-one over 40 should ignore the symptoms. A patient should be referred to hospital for examination by endoscope which allows the physician to see into the stomach.
Study. Evidence to support the belief that the high incidence of gastric cancer in Japan is due to excessive intake of salt.
Note: A substance found in fish oil has been shown experimentally to prevent cancer of the stomach. Mackerel, herring and sardines are among the fish with the ingredient.
Treatment by or in liaison with hospital oncologist or general medical practitioner. ... cancer – stomach and intestines
cavities; it may be red or yellow. Red bone marrow is present in all bones at birth and is the factory for most of the blood cells. During the teens, red bone marrow is gradually replaced in some bones by less active yellow marrow. In adults, red marrow is confined chiefly to the spine, sternum, (breastbone), ribs, pelvis (hip-bones), scapulae (shoulderblades), clavicles (collarbones), and bones of the skull.
Stem cells within the red marrow are stimulated to form blood cells by the hormone erythropoietin.
Yellow marrow is composed mainly of connective tissue and fat.
If the body needs to increase its rate of blood formation, some of the yellow marrow will be replaced by red.
Sometimes marrow fails to produce sufficient numbers of normal blood cells, as occurs in aplastic anaemia (see anaemia, aplastic) or when marrow has been displaced by tumour cells.
In other cases, marrow may overproduce certain blood cells, as occurs in polycythaemia and leukaemia.... bone imaging
scanning gives images of the brain substance; it gives clear pictures of the ventricles (fluid-filled cavities) and can reveal tumours, blood clots, strokes, aneurysms, and abscesses. is especially helpful in showing tumours of the posterior fossa (back of the skull). and scanning are specialized forms of radionuclide scanning that use small amounts of radioactive material to give information about brain function as well as structure. They enable
blood flow and metabolic activity in the brain to be measured.
Ultrasound scanning is used only in premature or very young babies since ultrasound waves cannot penetrate the bones of a mature skull.... brain imaging
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Echocardiography is useful for investigating congenital heart defects and abnormalities of the valves or heart wall. An ultrasound technique using the Doppler effect allows measurement of blood flow through valves. Radionuclide scanning and CT scanning provide information about the efficiency of heart function. Angiography may be used to show the heart chambers and to assess the condition of the coronary arteries and valves. High-quality images of the heart can be obtained by MRI.... heart imaging
There may also be other symptoms indistinguishable from those of peptic ulcer.
Diagnosis is usually made by gastroscopy or by a barium X-ray examination.
The only effective treatment is total gastrectomy.
In advanced cases in which the tumour has spread, radiotherapy and anticancer drugs may prolong life.... stomach cancer
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