- GENERAL INFORMATION
The stomach is the largest part of the digestive tract below the diaphragm, located at the upper left of the abdominal cavity. The stomach is located between the esophagus and duodenum. The shape of the stomach is affected by many factors. These factors include stomach content, body position, age of the person, tonus of the stomach muscle. The stomach has a capacity of 1000-1500 ml. The content of the stomach is acidic. This not only helps digesting food but also plays a role in body defense by killing many bacteria from outside. Also, it secretes many fluids including especially secretions for protein digestion and vitamin B12 absorption. Stomach has storage function, mixing function of foods, intestinal transmission functions for digestion and absorption. The stomach is the largest organ of the digestive tract and stores the food taken. To digest foods, it is necessary to mix and react with the stomach fluid. The foods are mixed with the peristaltic movements of the stomach. When the stomach is full, it makes a peristaltis every 20 seconds to mix the solid and the liquid, and this mixture is called “chyme”. The emerging mixture slowly passes through the pylorus to the duodenum. Liquids leave the stomach faster than solid foods and the period is about 20 minutes. Chyme leaves the stomach in one and a half hour.
- SYMPTOMS OF STOMACH DISEASES
Heartburn and pain in the stomach are the most common symptoms. Also, nausea, vomiting, and acerbic water in the mouth can be seen. Sometimes indigestion, swallowing difficulty, bad mouth odor may also be a sign of stomach illness.
- EXAMINATION AND DIAGNOSIS
Abdominal examination is performed first. But examination is usually not enough for the diagnosis of stomach diseases. The most effective method is the endoscopy. It allows diagnosis, biopsy, and treatment of lesions such as polyps, if any. Ultrasound and computed tomography assist in the evaluation of the stomach and surrounding tissues. In cancer patients, information about metastasis can be obtained by PET CT.
- BENIGN DISEASES OF THE STOMACH AND THEIR TREATMENTS
- Gastritis: Gastritis is a disease that can be seen in anyone regardless of age, and is the result of inflammation of the mucous layer inside the stomach. Gastritis is a very common disease, but it has more superficial damage than ulcer. However, untreated and advanced gastritis may progress down to depth and lead to cancer or ulcer disease.
Causes of gastritis
The most important cause of the disease is an infection called chronic pylori. Environmental factors, nutrition and lifestyle play important roles in the development of the disease. Compared to others, gastritis is particularly more common in those with irregular eating habits, smokers and those who consume ready-to-eat food and drink alcohol. Especially in people who smoke too much and drink acidic beverages besides cigarette, the stomach acid increases and concentrates, and this acid causes the formation of gastritis in time. Stress is among the causes of gastritis, as it is the main cause of many illnesses.
Treatment of Gastritis
Regular and healthy eating, a lifestyle free from stress and exercise will keep out the disease a bit. The cause of the disease is checked before the treatment of gastritis. If stomach acids lead to the formation of the disease, acid-suppressing drugs are given to the person first to remove the acids found in the stomach. This drug is used to relieve stomach acid. If gastritis is caused by a bacterium called H. pylori, antibiotic therapy is recommended. If aspirin and anti-rheumatic drugs are used by the person with gastritis, he or she may have to discontinue these medications or re-examine the necessity of use.
- Ulcer: The ulcer is a deep injury that causes tissue loss in the wall of the stomach or duodenum, mainly due to the stomach acid. In our country, duodenal ulcer is more commonly seen than the stomach ulcer, and duodenal ulcer is generally 3 times more common in males than females. Male ulcer patients are often seen between the ages of 30 and 50.
Cause: The most common discomfort in ulcer patients is the feeling of aching and burning pain in the upper abdomen, which usually appears in the patients between meals. In addition, especially duodenal ulcer patients can wake up from sleep at any time of the night. In addition to this, the symptoms such as nausea, urge to vomit when there is pain and relief from vomiting, loss of appetite and weight loss can also be seen as well as the increase of pain in autumn and spring periods.
Helicobacter pylori is the most common cause of ulcer disease. In addition, the factors such as genetic predisposition, persistent and extreme stress, use of cortisone drugs, alcohol and cigarette, coffee drinking habit and environmental pollution can lead to ulcer.
Disorders that can occur as a result of ulcer: The disorders caused by ulcer are;
Bleeding: Most of the bleedings in the upper digestive tract are due to ulcers. These bleedings occurring in the upper digestive system can also be seen in people who have never had gastric complaints. Vomiting, feeling of faint before black colored feces and cold sweat are the signs of gastrointestinal bleeding, and a doctor should be consulted immediately if any of these occur.
Gastric Perforation: The perforation that occurs when the depth of the ulcer is increased significantly and the entire stomach or duodenum layer is passed, is called gastric perforation. The patient’s stomach is getting harder, and he/she is unable to move from the pain. The patient should be operated immediately.
Obstruction: It means the narrowing and obstruction of the passage allowing the passage of food, drink, etc. as a result of edema in duodenum and pyloric canal due to acute ulcer and formation of scar tissue due to long-term ulcer. In such cases, the person having obstruction vomits the material that accumulates and cannot go forward in the stomach, and there is a constant vomiting in the patient for the same reason. In such cases, the patient must be operated immediately.
An ulcer patient must quit smoking. In addition, aspirin and aspirin-like rheumatic medicines and alcohol use should be avoided by ulcer patients. Drug therapy is usually applied in ulcer treatment and patients are usually recovered with this treatment method.
- Stomach polyps: Stomach polyps are cell masses that form on the inner surface of the mucosa-covered stomach. Stomach polyps, that are also called gastric polyps, are rare.
Mostly they do not cause any symptoms or complaints. They are usually noticed during screening for other diseases or in tests made for the stomach.
Most stomach polyps do not cause cancer, but some types may increase future stomach cancer risk. They may also cause bleeding and anemia. For this reason, some stomach polyps that look harmless can remain, while others which appear to be risky are removed.
CAUSES: Stomach polyps develop as a reaction to an inflammation or other injury that develops in the stomach wall, and form swollen structures. As the age increases, the likelihood of occurrence increases. It is accepted that some stomach medications that are used for long periods cause polyps. The most common types of stomach polyps are:
- Hyperplastic polyps: It occurs as a reaction to the chronic inflammation that occurs in the cells of the inner surface of the stomach. Hyperplastic polyps are more common in people with gastritis. This is thought to be due to Helicobacter pylori (H. pylori) bacteria, which causes infection on the surface of the stomach. Most hyperplastic polyps do not have risk of stomach cancer. However, hyperplastic polyps with a diameter of about 2 cm or greater have a greater risk of cancer.
- Fundus gland polyps: These polyps also originate gland cells of inner surface of the stomach. Such polyps occur in people with a rare inherited syndrome called “adenomatous polyposis”. Fundus gland polyps are removed because of the risk of cancer.
Fundus polyps are more common among people who regularly take certain medications to reduce stomach acid (proton pump inhibitors). Unless the diameter is greater than 1 cm, the fundus gland polyps is not of concern. In such large polyps, the risk of cancer is minimal, but some doctors recommend cutting off proton pump inhibitors or removing polyps.
- Adenomas: At the same time, they arise from inner lining gland cells of the stomach. Adenomas are the least common type of stomach polyps but the riskiest group in terms of causing stomach cancer. Adenomas are mostly associated with gastric inflammation and hereditary “adenomatous polyposis”.
Diagnosis: Some of the tests and procedures used to diagnose stomach polyps are as follows:
- Esophagus and interior of the stomach are displayed with endoscopy.
- Tissue specimens (biopsies) taken from suspicious sites or from polyps during endoscopy are sent to the laboratory for analysis.
TREATMENT AND MEDICATIONS
The treatments applied depending on the type of polyps are as follows:
- Small non-adenomatous polyps do not require treatment, because such polyps do not cause any signs and symptoms and they rarely lead to cancer. Periodic endoscopy is usually recommended for monitoring gastric polyps in such patients. It will be suggested to remove the polyps that are growing and starting to cause complaints.
- Large stomach polyps need to be removed. In order to remove polyps, most polyps are treated and removed during endoscopy.
- Adenomas are usually removed during endoscopy.
- Polyps associated with hereditary adenomatous polyposis are also often removed as they carry a risk of cancer.
Treatment of H. pylori infection
If gastritis caused by H. pylori bacteria is detected in your stomach, antibiotic therapy will probably be recommended. The initiation of treatment for H. pylori infection will ensure that hyperplastic polyps get out of the way and prevent polyps from recurring. Antibiotic treatment may need to be continued for several weeks to completely kill H. pylori bacteria.
“Every year around 900,000 people die due to stomach cancer worldwide .”
Stomach cancer, where eating habits play an important role, is more common in places where salt intake is more than adequate and vegetables and fruit intake are inadequate. Burned or undercooked red meat consumption is also among these reasons. Stomach cancer risk is higher in those who have smoking habit, Helicobacter pylori infection, excessive weight and stomach cancer stories in their family. Patients particularly at this risk group need to have endoscopy.
- A palpable mass is felt in half of the patients.
- Pain in the stomach area and feeling of stomach throbbing
- Loss of appetite and resulting weight loss (severe and emerges in a short time)
- Discomfort after eating and stomach swelling,
- Nausea, vomiting,
- A large proportion of people with stomach cancer also have anemia.
- Bleeding in the stomach or intestine (may progress in secret).
The most definitive diagnostic method is endoscopy. Both tumor location and size are detected and biopsy is performed. A biopsy is inevitable for definitive diagnosis. Barium stomach x-rays may show tumors but are not enough to make a definite diagnosis. Staging TNM classification is used. For this purpose, computerized tomography, PET CT and MR can be used.
Surgical intervention in gastric cancer is the most important and most determinative therapeutic measure. Any treatment method does not substitute for surgery in conformity with the procedure. In particular, early gastric cancer can only be completely treated with surgery. Laparoscopic surgery (closed surgical technique) applied by experienced physicians provides both successful outcomes and has serious advantages such as less pain, immediate recovery, less infection and risk of hernia. In addition, chemotherapy (drug treatment) and radiation treatment (radiotherapy) are also applied in some cases.