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Get compassionate, TRUE Care from our Gastroenterology team.

Wilmington Health Gastroenterology specializes in the diagnosis and treatment of all problems of the digestive system. This includes the stomach, colon, small bowel, liver, pancreas, and gallbladder. Gastroenterology also offers colon cancer screenings and small bowel pill cam endoscopy. All of our physicians are American Board Certified in Internal Medicine and Gastroenterology.

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It’s the type of cancer no one wants to talk about. But according to the American Cancer Society (ACS), cancers of the colon and rectum are among the most common cancers in the United States. (Read about “Cancer: What It Is“) They occur in both men and women and are most often found in people who are over fifty years of age.

The colon and rectum make up the large intestine. During digestion, the colon removes nutrients from food and stores waste until the waste matter passes out of the body. (Read about “Digestive System“) Cancers that occur in either part of the large intestine are termed colorectal cancer.

Risk factors

Our COLORECTAL CANCER RISK ASSESSMENT can help you learn more about your own risk factors, based on guidelines from the National Cancer Institute.

Simply click on the link for the form. Fill it out online to learn more about how specific things affect the risk of developing colorectal cancer. When you’re done, you may want to print it out and share it with your doctor. Any information you enter will NOT be saved once you close the window. This is to protect your privacy. When you’re done, simply close the form window, and continue reading.

It was originally thought that a diet low in fiber put you at a higher risk. But, according to the National Institutes of Health, recent studies have shed some doubt on this theory, although research continues. (Read about “Fiber and Health“) However, the American Medical Association (AMA) says that other lifestyle factors have been linked with a higher risk, including a diet high in fat, calories and alcohol, as well as smoking and obesity. (Read about “Quit Smoking” “Obesity“)

According to the National Cancer Institute (NCI), other known risk factors include the following:

  • Colorectal cancer is more likely to occur as we get older, although it can occur in young people as well.
  • The presence of certain types of polyps (Read about “Colon Polyps“), or benign growths, on the inner wall of the colon or rectum, can indicate an increased risk. In particular, a hereditary condition called familial polyposis (Read about “Genetics“), in which hundreds of polyps form, is considered an important risk factor.
  • Having a personal history of colorectal cancer or certain other types of cancer can put you at a higher risk.
  • Having someone in your family who’s been diagnosed with colorectal cancer can put you at a higher risk. (Read about “Family Health History“)
  • Having a condition called ulcerative colitis (Read about “Ulcerative Colitis“) in which the lining of the colon becomes inflamed also increases your risk.

Reducing your risk

According to NCI, studies are now underway looking into a number of potential ways to reduce the risk of developing colorectal cancer. (Read about “Clinical Studies“) Among the things being examined are smoking cessation, use of dietary supplements, use of aspirin, decreased alcohol consumption and increased physical activity.

Until the results of such studies are known, the strongest weapon against colorectal cancer is early detection. Therefore, it’s important to know the warning signs of colorectal cancer. ACS says these include:

  • changes in bowel habits
  • changes in the stool
  • blood in the stool (Read about “Gastrointestinal Bleeding“)
  • vomiting
  • abdominal discomfort, bloating or cramps
  • unexplained weight loss or excessive fatigue

If you notice such changes, see your doctor right away.

Tests and staging

ACS, the American College of Radiology and the U.S. Multi-Society Task Force on Colorectal Cancer (a group that comprises representatives from the American College of Gastroenterology, American Gastroenterological Association and American Society for Gastrointestinal Endoscopy) say there are different tests that can be used. ACS urges screening for colorectal cancer begin at age 45 for most people. Family history and other risk factors may indicate a need for earlier testing. Tests include:

Tests that detect polyps and cancer:

Tests that primarily detect cancer:

  • Annual guaiac-based fecal occult blood test (gFOBT) with high test sensitivity for cancer
  • Annual fecal immunochemical test (FIT) with high test sensitivity for cancer
  • Stool DNA test (sDNA), with high sensitivity for cancer, every 3 years

These tests work in different ways. For example, a fecal occult blood test can check for hidden blood in the stool. According to the U.S. Centers for Disease Control and Prevention (CDC), studies show a 33 percent drop in deaths from colorectal cancer for people who had an annual fecal occult blood test. (Read about “Laboratory Testing“)

Flexible sigmoidoscopy uses a small lighted tube to inspect the wall of the rectum and part of the colon. The CDC says up to three quarters of polyps and 65 percent of cancers can be detected this way. For people over the age of fifty, even if they have no symptoms or known risk factors other than age, AMA recommends an annual fecal occult blood test and/or flexible sigmoidoscopy at least every five years. Higher risk individuals may need more aggressive screening; ask your doctor.

Colonoscopy, which inspects the entire colon, is also used at times. Traditional colonoscopy uses a tube with a camera and lights to inspect the colon. What is called virtual colonoscopy uses imaging techniques. In both colonoscopy and sigmoidoscopy, the doctor can also take samples of tissues for more examination. (Read about “Biopsy“) Doctors can also manually examine the area or use a series of x-rays using a double contrast barium enema to help outline the area on the x-rays. (Read about “X-rays“)

If any of these tests indicates a potential problem, a colonoscopy is likely to be performed to confirm the diagnosis.

The doctor needs to know the stage of the disease to plan treatment. The following stages are used, according to NCI:


  • Stage 0 (Carcinoma in Situ)In stage 0, abnormal cells are found in the innermost lining of the colon only. These abnormal cells may become cancer and spread. Stage 0 is also called carcinoma in situ.
  • Stage IIn stage I, the cancer has spread beyond the innermost lining of the colon to the second and third layers and involves the inside wall of the colon, but it has not spread to the outer wall of the colon or outside the colon.
  • Stage IIIn stage II, cancer has spread to the outer layer of the colon and perhaps through the colon wall and may have spread to nearby tissue.
  • Stage IIIIn stage III, cancer has spread to nearby lymph nodes, but it has not spread to other parts of the body.
  • Stage IVIn stage IV, cancer has spread to other parts of the body, such as the liver or lungs.


  • Stage 0 (carcinoma in situ)In stage 0, abnormal cells are found in the innermost lining of the rectum only. Stage 0 is also called carcinoma in situ.
  • Stage IIn stage I, cancer has spread beyond the innermost lining of the rectum to the second and third layers and involves the inside wall of the rectum, but it has not spread to the outer wall of the rectum or outside the rectum.
  • Stage IIIn stage II, cancer has spread through the rectal wall and may have spread to nearby tissue.
  • Stage IIIIn stage III, cancer has spread to nearby lymph nodes, but it has not spread to other parts of the body.
  • Stage IVIn stage IV, cancer has spread to other parts of the body, such as the liver, lungs or ovaries.


If cancer is present, NCI says surgery to remove the tumor is the most common treatment. Different types of surgery for this cancer include:

  • Local excision – If the cancer is found at a very early stage, the doctor may remove it without cutting through the abdominal wall. Instead, the doctor may put a tube with a cutting tool through the rectum into the colon and cut the cancer out.
  • Radiofrequency ablation – This uses a special probe with tiny electrodes to kill cancer cells. Depending on how the probe is inserted, it may be done under local anesthesia.
  • Cryosurgery – This is a treatment that uses an instrument to freeze and destroy abnormal tissue. This type of treatment is also called cryotherapy.
  • Laparoscopy – Early colon cancer may be removed with the aid of a thin, lighted tube (laparoscope). Three or four tiny cuts are made into your abdomen. The surgeon sees inside your abdomen with the laparoscope. The tumor and part of the healthy colon are removed. Nearby lymph nodes also may be removed. The surgeon checks the rest of your intestine and your liver to see if the cancer has spread.
  • Open surgery – The surgeon makes a large cut into your abdomen to remove the tumor and part of the healthy colon or rectum. Some nearby lymph nodes are also removed. The surgeon checks the rest of your intestine and your liver (Read about “The Liver“) to see if the cancer has spread.

When a section of your colon or rectum is removed, the surgeon can usually reconnect the healthy parts. However, sometimes reconnection is not possible. In this case, NCI says the surgeon creates a new path for waste to leave your body. The surgeon makes an opening (stoma) in the wall of the abdomen, connects the upper end of the intestine to the stoma, and closes the other end. The operation to create the stoma is called a colostomy. A flat bag fits over the stoma to collect waste, and a special adhesive holds it in place. For most people, the stoma is temporary. It is needed only until the colon or rectum heals from surgery. After healing takes place, the surgeon reconnects the parts of the intestine and closes the stoma. Some people, especially those with a tumor in the lower rectum, need a permanent stoma.

In addition to surgery, chemotherapy or radiation may also be used. Biological therapy may also be an option. All treatment plans should be carefully discussed with your doctor. (Read about “Radiation Therapy” “Cancer Treatments“)

As with so many other types of cancer, early detection can increase your chances of surviving colorectal cancer. Unfortunately, many people shy away from discussing this topic, even with their doctor.

More Cancer Information:

    Cancer Check-ups

    Cancer Support

    Cancer Treatments

    Reduce Cancer Risks

    Cancer Glossary

For a list of individual types of cancer, see Cancer: What It Is

All Concept Communications material is provided for information only and is neither advice nor a substitute for proper medical care. Consult a qualified healthcare professional who understands your particular history for individual concerns.

© Concept Communications Media Group LLC

Online health topics reviewed/modified in 2021 | Terms of Use/Privacy Policy

The digestive system is a group of organs joined in a long, twisting tube from the mouth to the anus. It is also called the alimentary canal and the gastrointestinal tract. The major parts of that tube are:

  • mouth
  • esophagus
  • stomach
  • small intestine
    • duodenum
    • jejunum
    • ileum
  • large intestine (also called the colon)
    • cecum
    • ascending colon
    • transverse colon
    • descending colon
    • sigmoid colon
    • rectum

Inside this tube is a lining called the mucosa. The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) says that in the mouth, stomach and small intestine, the mucosa contains tiny glands that produce juices to help digest our food. Other organs that aren’t part of the tube – the liver, gallbladder and the pancreas – produce and store digestive juices that are used in the intestine. In addition, parts of other organ systems (for instance, nerves and blood) play a role in the digestive system.

The large, hollow organs of the digestive system contain muscle that enables their walls to move. The movement of organ walls can propel food and liquid and also can mix the contents within each organ. Typical movement of the esophagus, stomach and intestine is called peristalsis.

After we swallow, food enters the esophagus. At the end of the esophagus, a ring-like valve opens, to let food enter the stomach. The stomach stores the food and liquid, mixes it with digestive juices, and then empties its contents slowly into the small intestine. Food is further digested in the small intestine, where nutrients from the food are absorbed through the intestinal walls. Digestion continues in the large intestine or colon. The waste products of this process then remain in the colon, usually for a day or two, until the feces are expelled by a bowel movement.

The American College of Gastroenterology (ACG) says more than 95 million people in the United States have a digestive problem and over 10 million end up in the hospital each year. Digestive diseases range from the occasional upset stomach (Read about “Indigestion“) to the more life-threatening colon cancer (Read about “Colorectal Cancer“) and encompass disorders of the gastrointestinal tract, the liver, the gallbladder and the pancreas.

The following links will provide you with information on a number of diseases and conditions that can affect the digestive system.

Appendicitis: see Appendicitis
Bowels, incontinence: see Fecal Incontinence
Bowels, constipation: see Constipation
Bleeding: see Gastrointestinal Bleeding
Campylobacter: see Campylobacter
Cancer, colorectal: see Colorectal Cancer
Cancer, esophagus: see Esophagus Cancer
Cancer, head and neck: see Head and Neck Cancers
Cancer, liver: see Liver Cancer
Cancer, oral: see Oral Cancer
Cancer, pancreatic: see Pancreatic Cancer
Cancer, stomach: see Stomach Cancer
Celiac sprue disease: see Celiac Disease (Celiac Sprue)
Cirrhosis: see Cirrhosis
Colitis, ischemic : see Ischemic Colitis
Colitis, ulcerative: see Ulcerative Colitis
Colon cancer: see Colorectal Cancer
Colon polyps: see Colon Polyps
Colorectal cancer: see Colorectal Cancer
Constipation: see Constipation
Crohn’s: see Crohn’s Disease
Cryptosporidiosis: see Cryptosporidiosis
Dehydration: see Dehydration
Diabetes: see Diabetes
Diarrhea: see Diarrhea
Dietary guidelines: see Dietary Guidelines
Diverticulitis: see Diverticular Disease
Diverticulosis: see Diverticular Disease
Dumping syndrome: see Rapid Gastric Emptying
Dyspepsia: see Indigestion (Dyspepsia)
E. coli: see E. coli
Enterobiasis: see Pinworm Infection (Enterobiasis)
Esophagus cancer: see Esophagus Cancer
Fecal incontinence: see Fecal Incontinence
Food safety: see Food Safety
Gallstones: see Gallstones
Gastritis: see Gastritis
Gastroenteritis: see Gastroenteritis
Gastroesophageal reflux disease (GERD): see GERD
Gastrointestinal reactive arthritis: see Reactive Arthritis
Gastroparesis: see Gastroparesis
Giardiasis: see Giardiasis
Head and neck cancers: see Head and Neck Cancers
Heartburn: see Heartburn
Hemorrhoids: see Hemorrhoids
Hepatitis A: see Hepatitis A
Hepatitis B: see Hepatitis B
Hepatitis C: see Hepatitis C
Hepatitis D: see Hepatitis D
Hepatitis E: see Hepatitis E
IBS: see Irritable Bowel Syndrome (IBS)
Incontinence, fecal: see Fecal Incontinence
Indigestion: see Indigestion (Dyspepsia)
Intussusception: see Intussusception
Irritable bowel syndrome (IBS): see IBS
Ischemic colitis: see Ischemic Colitis
Listeriosis: see Listeriosis
Liver: see The Liver
Liver cancer: see Liver Cancer
Ménétrier’s disease: see Ménétrier’s Disease
Norwalk viruses: see Noroviruses
Oral cancer: see Oral Cancer
Pancreatic cancer: see Pancreatic Cancer
Pancreatitis: see Pancreatitis
Peptic ulcers: see Peptic Ulcers
Pinworms: see Pinworm Infection (Enterobiasis)
Polyps, colon: see Colon Polyps
Proctitis: see Proctitis
Rapid gastric emptying: see Rapid Gastric Emptying
Rotavirus: see Rotavirus
Salmonella: see Salmonella
Shigellosis: see Shigellosis
Stomach cancer: see Stomach Cancer
Ulcerative colitis: see Ulcerative Colitis
Ulcers, peptic: see Peptic Ulcers
Whipple’s disease: see Whipple’s Disease

All Concept Communications material is provided for information only and is neither advice nor a substitute for proper medical care. Consult a qualified healthcare professional who understands your particular history for individual concerns.

© Concept Communications Media Group LLC

Online health topics reviewed/modified in 2021 | Terms of Use/Privacy Policy

Gallstones form when liquid stored in the gallbladder hardens into pieces of stone-like material. The liquid, called bile, is used to help the body digest fats. It is made in the liver (Read about “The Liver“), then stored in the gallbladder until the body needs it to digest fat. At that time, the gallbladder contracts and pushes the bile into a tube, called the common bile duct. This carries the liquid to the small intestine, where it helps with digestion.

Bile contains water, cholesterol (Read about “Cholesterol“), fats, bile salts, proteins and bilirubin. If the liquid bile contains too much cholesterol, bile salts or bilirubin, under certain conditions it can harden into stones.

According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), the two types of gallstones are cholesterol stones and pigment stones. Cholesterol stones are usually yellow-green and are made primarily of hardened cholesterol. They account for about 80 percent of gallstones. Pigment stones are small, dark stones made of bilirubin.

According to the American Gastroenterological Association, gallstone disease affects 10 to 15 percent of the population of the United States. Most are unaware of it though, because they have what are called “silent” gallstones, which produce no symptoms.

Some people though have symptomatic gallstones, which can cause pain, hospitalization and even be life threatening. A very dangerous situation occurs when gallstones block the secretions from the pancreas, triggering acute pancreatitis. (Read about “Pancreatitis“) This type of gallstone requires immediate care.

The American Gastroenterological Association says the most typical symptom of gallstone disease is severe steady pain in the upper abdomen or right side, which can last for as little as 15 minutes or as long as several hours. There may also be pain between the shoulder blades or in the right shoulder, as well as vomiting or sweating. (Read about “Sweating“)

Who’s at risk

Certain people or groups are more at risk of developing gallstones. NIDDK says they include:

  • women – the risk of gallstones for women between 20 and 60 years of age is twice that of men
  • people over age 60
  • Native Americans and Mexican Americans
  • pregnant women and women using hormone therapy – Excess estrogen from pregnancy or hormone use appears to increase cholesterol levels in bile and decrease gallbladder movement, both of which can lead to gallstones. (Read about “Healthy Pregnancy“)
  • overweight people and quick-weight-loss dieters – Obesity is an important risk factor for gallstones. (Read about “Obesity“) But paradoxically, NIDDK says people who lose a lot of weight rapidly are also at a great risk for developing gallstones, especially if weight loss occurs on a very low calorie diet or following gastric bypass surgery, in which the size of the stomach is reduced. It’s possible that dieting shifts the balance of bile salts and cholesterol in the gallbladder, in a way that increases the risk of gallstones, according to NIDDK. It’s also possible that fasting may decrease gallbladder contractions and if the gallbladder does not contract often enough to empty out the bile, gallstones may form. (Read about “Losing Weight“)
  • people with liver disease have a higher risk of developing gallstones (Read about “The Liver“)

Symptoms & diagnosis

Symptoms of gallstones can sometimes be confused with the symptoms of other conditions. Some of the common symptoms according to NIDDK are:

  • recurring intolerance of fatty foods
  • colic
  • belching
  • gas
  • indigestion (Read about “Indigestion“)

Some symptoms of gallstones are often called a gallstone “attack” because they occur suddenly. A typical attack can cause:

  • steady pain in the upper abdomen that increases rapidly and lasts from 30 minutes to several hours
  • pain in the back between the shoulder blades
  • pain under the right shoulder
  • nausea or vomiting
  • abdominal bloating

Gallstone attacks often follow fatty meals, and they may occur during the night. People who have the above and any of following symptoms should see a doctor right away.

  • chills
  • low-grade fever
  • yellowish color of the skin or whites of the eyes
  • clay-colored stools

When gallstones are suspected to be the cause of symptoms, the doctor can order tests such as an ultrasound. (Read about “Ultrasound Imaging“) NIDDK calls ultrasound the most sensitive and specific test for gallstones. There are other tests that can help diagnose gallstones and gallbladder problems. They can range from blood tests to CT scans and MRI’s. (Read about “Laboratory Testing” “CT Scan – Computerized Tomography” “MRI – Magnetic Resonance Imaging“)


Silent gallstones are usually left alone and occasionally disappear on their own. Usually only patients with symptomatic gallstones are treated. According to the American Gastroenterological Association, the most common treatment for gallstones is cholecystectomy surgery to remove the gallbladder. Standard surgery, involving an incision through the abdomen, may be used. A less invasive procedure called laparoscopic (so-called “belly button” or minimally invasive surgery) cholecystectomy is more common. In minimally invasive cholecystectomy, an endoscope or thin tube is inserted through a small incision. (Read about “Endoscopy“) The tube has a camera through which the surgeon can watch, while special tools are inserted through other small incisions to remove the gallbladder. If gallstones are in the bile ducts, the surgeon or gastroenterologist may use endoscopic retrograde cholangiopancreatography (ERCP) to locate and remove them before or during the gallbladder surgery. During this procedure, an endoscope – a long, flexible, lighted tube connected to a computer and TV monitor – is used. (Read about “Robotic Surgery“) The doctor guides the endoscope through the stomach and into the small intestine. The doctor then injects a special dye that temporarily stains the ducts in the biliary system.

For patients who cannot undergo surgery, drugs or a procedure called lithotripsy can sometimes be used to break up or dissolve stones in the gallbladder. However, the long-term results in such cases are less predictable, according to NIDDK. Since every case is different, you should discuss all options with your doctor. (Read about “Learn About Your Procedure“)

Related Information:

    Digestive System

All Concept Communications material is provided for information only and is neither advice nor a substitute for proper medical care. Consult a qualified healthcare professional who understands your particular history for individual concerns.

© Concept Communications Media Group LLC

Online health topics reviewed/modified in 2021 | Terms of Use/Privacy Policy

Heartburn is a painful, burning feeling in the chest. It is caused by stomach acid that escapes the stomach and flows back into the esophagus. Heartburn can sometimes be a symptom of indigestion. (Read about “Indigestion“) It is important to note here that sometimes people mistake a heart attack (Read about “Heart Attack“) for heartburn. If you have chest pain, that could be a heart attack, seek immediate medical help. Call 911, do not attempt to drive yourself to the doctor or the hospital.

When you have heartburn, it’s tempting to reach for an over-the-counter pill or tablet to make the symptoms go away. But as with any drug, heartburn remedies are not for everyone. According to the Food and Drug Administration (FDA), even though many are now sold over-the-counter, you still need to take precautions.

For example, FDA says some heartburn drugs interact with other medications. (Read about “Drug Interaction Precautions“) Others should be avoided by those with certain medical conditions, such as high blood pressure. (Read about “Hypertension: High Blood Pressure“) Therefore, it’s important to read the label and consult with your healthcare provider before taking these medications, especially if you find the symptoms of heartburn are recurring regularly. Constant heartburn can be an indication of a much more serious condition called gastroesophageal reflux disease or GERD. (Read about “GERD“)

Types of medications

According to the National Digestive Diseases Information Clearinghouse (NDDIC), heartburn medications generally work by either reducing the amount of stomach acid produced by your body or by neutralizing it.

Your doctor may recommend over-the-counter antacids, which you can buy without a prescription, or medications that stop acid production or help the muscles that empty your stomach. They can include any of the following:

  • Antacids are usually the first drugs recommended to relieve heartburn, according to NDDIC. Many brands on the market use different combinations of three basic salts – magnesium, calcium and aluminum – with hydroxide or bicarbonate ions to neutralize the acid in your stomach. (Read about “Vitamins & Minerals“) Antacids, however, have side effects. Magnesium salt can lead to diarrhea (Read about “Diarrhea“), and aluminum salts can cause constipation. Aluminum and magnesium salts are often combined in a single product to balance these effects. Calcium carbonate antacids can also be a supplemental source of calcium. (Read about “Calcium“) They can cause constipation as well. (Read about “Constipation“)
  • Foaming agents work by covering your stomach contents with foam to prevent reflux. These drugs may help those who have no damage to the esophagus.
  • H2 blockers, such as cimetidine, famotidine, nizatidine and ranitidine, impede acid production. They are available in prescription strength and over-the-counter. These drugs provide short-term relief, but over-the-counter H2 blockers should not be used for more than a few weeks at a time, according to NDDIC. Many people benefit from taking H2 blockers at bedtime in combination with a proton pump inhibitor.
  • Proton pump inhibitors include omeprazole, lansoprazole, pantoprazole, rabeprazole and esomeprazole. They are available in prescription strength and some are available over-the-counter. NDDIC says proton pump inhibitors are more effective than H2 blockers and can relieve symptoms in almost everyone. FDA, however, warns that long-term and/or high-dose use of proton pump inhibitors can increase your risk of bone fractures. (Read about “Bone Fractures“) You should discuss the benefits and risks of any medication with your doctor.
  • Prokinetics is another group of drugs. They help strengthen the sphincter and make the stomach empty faster. This group includes bethanechol and metoclopramide. Metoclopramide also improves muscle action in the digestive tract, but these drugs have frequent side effects that limit their usefulness.

Because drugs work in different ways, combinations of drugs may help control symptoms. People who get heartburn after eating may take both antacids and H2 blockers. The antacids work first to neutralize the acid in the stomach, while the H2 blockers act on acid production. By the time the antacid stops working, the H2 blocker will have stopped acid production. Your doctor is the best source of information on how to use medications for heartburn.

Again, although these products are familiar on drug store shelves, they should not be taken lightly. For example, FDA says that if you’re on a salt-restricted diet, it’s important to consult with your doctor before taking antacids. (Read about “Sodium“) Depending on the active ingredient, various antacids may lead to kidney problems, constipation, or weakened bones, as well as other problems. Antacid pills or tablets can also interact with other medications you may be taking, so always use precaution before considering these products. (Read about “Medicine Safety“)


Given the complications that can result from misuse of heartburn medications, probably the best way to deal with heartburn is to avoid it in the first place. The American Academy of Family Physicians has these suggestions:

  • cut back on acidic foods
  • avoid caffeine and alcohol
  • don’t lie down right after eating
  • don’t eat just before going to bed
  • avoid clothing that’s too tight around the waist

And if you seem to be getting heartburn regularly, see a doctor. Your symptoms could indicate a more serious underlying problem that needs medical care.

Related Information:

    Medication and Digestion

    Digestive System

    Stomach Cancer

    Gastroesophageal Reflux Disease

All Concept Communications material is provided for information only and is neither advice nor a substitute for proper medical care. Consult a qualified healthcare professional who understands your particular history for individual concerns.

© Concept Communications Media Group LLC

Online health topics reviewed/modified in 2021 | Terms of Use/Privacy Policy

A peptic ulcer is a sore on the lining of the stomach, esophagus or duodenum (the beginning of the small intestine). This kind of ulcer is common. According to the National Institutes of Health, one in every ten Americans will have an ulcer at some point. The American Academy of Family Physicians (AAFP) says peptic ulcers can be categorized by location. A peptic ulcer in the stomach is called a gastric ulcer; in the duodenum, a duodenal ulcer; and in the esophagus, an esophageal ulcer.

Stomach pain can indicate a number of other problems. (Read about “Indigestion“) But the type of pain associated with peptic ulcers has certain distinct characteristics. According to the American Gastroenterological Association:

  • it’s like a dull, gnawing ache
  • it comes and goes for several days or weeks
  • it occurs 2 to 3 hours after a meal
  • it occurs in the middle of the night (when the stomach is empty)
  • it’s relieved by food

Other symptoms include weight loss, loss of appetite, bloating, burping, nausea and vomiting.

Causes of peptic ulcers

Contrary to some long-held beliefs, experts now say that peptic ulcers are not caused by stress or spicy foods. (Read about “Stress“) According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), the main cause of peptic ulcer is a bacterial infection. (Read about “Microorganisms“) Researchers have discovered that a type of bacteria called Helicobacter pylori (H. pylori) is a primary cause of peptic ulcers. This bacterium is very common, but most people infected with it do not develop ulcers.

We may come into contact with H. pylori through food or water. Basically, the bacteria weakens the stomach’s lining, allowing acid to get through, causing irritation and ultimately letting a sore develop.

In addition to the most common bacterial cause, the American Gastroenterological Association says the second most common cause of ulcers is long-term use of nonsteroidal anti-inflammatory agents (NSAIDs), such as aspirin and ibuprofen, as can happen with people with certain chronic conditions such as arthritis or chronic pain. (Read about “Arthritis and Rheumatic Diseases” “Chronic Pain“) In a few cases, cancerous tumors in the stomach or pancreas can cause ulcers. (Read about “Stomach Cancer” “Pancreatic Cancer“)

Getting help

If you suspect an ulcer, it’s important to see your doctor right away. If an ulcer is suspected, the doctor can test you for H. pylori. Testing for H. pylori can be done with a blood test, a breath test or a stool test. (Read about “Laboratory Testing“) An upper gastrointestinal (GI) x-ray (Read about “X-rays“) may be used to examine the digestive tract. Upper esophagogastroduodenal endoscopy (Read about “Endoscopy“) is another procedure that can be used in diagnosing ulcers. The Centers for Disease Control and Prevention (CDC) say that during endoscopy, biopsy (Read about “Biopsy“) specimens of the stomach and duodenum are obtained and the diagnosis of H. pylori can be made. Testing is important because treatment for an ulcer caused by H. pylori is different from that for an ulcer caused by NSAIDs.

NIDDK says that H.pylori peptic ulcers are usually treated with a combination of drugs. Among the types of drugs that can be used are:

  • antibiotics to kill the bacteria (Read about “Antibiotics“)
  • drugs called H2 blockers to reduce stomach acid
  • proton pump inhibitors (PPIs) to inhibit acid secretion
  • drugs to protect the stomach lining

If H.pylori is not present, H2 blockers or PPIs may be used without antibiotics to reduce acid secretions. Changes in any identifiable causes of the ulcer, such as overuse of NSAIDs, would need to be considered as well. During treatment, it’s important to follow your doctor’s directions exactly.

AAFP says it’s also important to contact your doctor if you develop any of the following emergency symptoms:

  • sharp sudden stomach pain
  • bloody or black stools
  • bloody vomit or vomit that looks like coffee grounds
  • you feel cold, clammy, weak or dizzy
  • you keep losing weight for no reason

These could be signs of a serious problem such as bleeding (Read about “Gastrointestinal Bleeding“), obstruction or perforation, which require immediate medical care. The bleeding could also result in anemia (Read about “Anemia“) with other resultant health problems.

Related Information:

    Digestive System

All Concept Communications material is provided for information only and is neither advice nor a substitute for proper medical care. Consult a qualified healthcare professional who understands your particular history for individual concerns.

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