STOMACH AND DUODENUM
The narrow oesophageal passage suddenly balloons out into a strange shape a bit like a football. This is the stomach, and is a repository for all food eaten. It may take a large amount of food, and digestion continues rapidly in this area.
The stomach wall is lined with very important glands which produce two vital chemicals. One is hydrochloric acid, and this is extremely potent. It is similar to the acid plumbers clean metal surfaces with preparatory to soldering. You have all seen the way in which it sizzles and fizzes when it touches the metal, burning away dirt and impurities, cleansing the surface so that the new solder will adhere.
Q. Are you trying to say the G.I. system is a drain pipe?
A. Not really — I am simply pointing out how strong this acid is, for it bears enormous importance to events which commonly produce major internal problems. If you ever vomit (and who hasn't at some stage), notice how hot and burning the feeling is as the acid contents come up the oesophagus and into the mouth. You can feel the discomfort all the way up, and even the mouth and tongue seem on fire. This is due to the burning effect of the powerful hydrochloric acid, or HQ, to use chemical terms.
Q. What is the acid used for?
A. The acid acts on the food, and helps to digest it further. It also kills germs, and is very important in preventing germs which may adversely affect the body from penetrating the bowel where they could cause adverse symptoms and other diseases.
Q. What happens if there is too much acid present?
A. I am glad you asked. The effect may be serious. It can happily attack the food and prepare it for digestion and absorption by the bowel later on. But if there is too much present, then it will attack itself! Imagine this. The stomach wall produces acid to help digest food, but in so doing, it may start to digest itself. It sounds crazy, but this is exactly what takes place. At first only a small part of the stomach lining may be involved, but as time progresses, this may become both more extensive and deeper.
Q. That must mean an ulcer develops.
A. That is correct. Excessive stomach acid production, a condition called hyperchlorhydria, may predispose to the formation of one or more stomach ulcers. These are commonly called peptic ulcers, or gastric ulcers.
Q. What if there is no acid present?
A. In some people, a condition called achlorhydria, is present. This means there is a marked reduction in acid production by the stomach wall glands. It may be entirely absent. These people will never, but never develop ulcers. On the other hand, however, they are more likely to develop other disorders. There is a greater risk of germs passing into the bowel. Also, a vital product called vitamin B12 is not absorbed, and a serious condition called pernicious anaemia may develop. In turn, vitamin B12 deficiency may lead to a serious nervous disorder as the years pass.
Ideally, the stomach walls produce the correct amount of acid so the digestion may proceed in a normal, orderly manner. In the average person in good health, this is generally what happens.
Q. You said another chemical was produced by the stomach walls. What is it called?
A. The other one is called pepsin, and it mixes with the acid. In fact, the acid stimulates the pepsin glands to work and, hand in hand, the two chemicals attack the food, and help to break it down into a form acceptable to the intestinal system a bit further down. Once again, pepsin plays a part in the formation of ulcers.
Q. Do these chemicals cause cancer of the stomach?
A. Cancer of the stomach is a fairly common disease, but doctors do not think it is caused by these chemicals. Certainly a cancer may be associated with a stomach ulcer, but the two are believed to be related by chance.
If a cancer is developing, it may erode the stomach lining and have the appearance of an ulcer, rather than acids chewing into the lining and causing the ulcer. We will talk more about stomach cancer later on, but I must say that it is a serious disease, is often difficult to diagnose early, produces very few early symptoms, and appears to be increasing in frequency in Australia. Fortunately, ulcer symptoms often lead to a full examination where the young cancer is picked up. This is indeed fortunate for otherwise it could be missed until too late. Treated early, there is a good chance of long term survival. If left, it is a one way ticket to doom.
Q. What happens to the food after it rolls around in the stomach for the required period of time?
A. It then proceeds via a narrow canal and valve called the pylorus into the next part of the system called the duodenum. This is simply the next part of the G.I. tract, and is much narrower than the stomach. Here digestion goes a step further, as various other chemicals called enzymes are pumped into it from other organs where they are manufactured. Certain ones are made in the pancreas. Others are made in the liver, stored in the gall bladder and, under stimulation from the duodenum, the gall bladder contracts, and collectively the chemicals come down via a little tube called the common bile duct to spurt into the duodenum and mix with food. You may have heard of the bile salts. These are present in greenish coloured fluid (called "bile"), and the main function is to help break down fats in the food to a form which is readily digested by the intestine lower down.
Q. Is that why some people say they feel liverish?
A. Correct. Some feel "bilious", or "liverish", specially after a big, fatty meal. This is because too many demands are being made on the bile system and the liver to manufacture more, or simply because the system cannot cope with all the fat.
Q. What about ulcers in the duodenum?
A. Once more this tube is affected by excessive amounts of acid and pepsin that come through from the stomach. Its walls are very sensitive to the savage attacks, and duodenal ulcers (which also go under the general name of peptic ulcers) are common in Australia. In fact, duodenal ulcers are one of the most common causes of serious recurring abdominal pain in this country. What is more, they may lead to important consequences if left untreated. But more of that later on.
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SYMPTOMS OF PEPTIC ULCERS
Q. Let us now become very specific. What are the most likely symptoms of peptic ulcer? In short, what could a person look for in coming to this diagnosis?
A. The two most common and constant symptoms are abdominal pain and vomiting. Others may occur with varying degrees, such as nausea, heartburn, regurgitation of the acid contents of the stomach into the food pipe, weight loss (although some notice a weight gain because they take more food to ease the pain); constipation. Often there is tenderness of the abdomen just near the ulcer.
Q. Let's look at these symptoms a bit more closely. Pain. What kind of pain, and is there any typical way in which it occurs?
A. The answer is that pain and tenderness are nearly always present. It is often very explicit, and frequently the patient can point to the exact spot with his finger. 'It is right there,' he will say dogmatically, pointing to a small circumscribed area. This is usually the midline, in a place doctors call the epigastrium. This is just below the lower end of the breast-bone, and between this and the navel. It is usually central, but may be a bit to the left or right. It is often extremely tender if pressed — the patient will give a yelp as the doctor's examining hand presses deeply and firmly into the part.
However, there are wide variations, and some complain of a more general kind of pain which may be anywhere from the line of the nipples down to the groin.
Q. Is the pain present all the time?
A. Typically the pain sets in about 30 minutes to three hours after a meal. It is often relieved by taking antacids (mixtures, tablets or powders), milk or more food. Very commonly it comes on during the night, and will often wake the patient with gnawing discomfort. In times past, ulcer patients traditionally took a glass of milk and had this at the bedside in case they awoke with the ulcer pain.
What is more, the ulcer pain characteristically waxes and wanes. It may be present for some time, then wane for no obvious reason, only to recur again weeks or months later. Usually, the worse the pain, the deeper and more serious the ulcer. Sometimes it will completely penetrate the stomach or duodenal wall, and affect adjacent organs. It will then often produce pains produced by interference with the nerves supplying that organ also. Often the pain will radiate to the back between the shoulder blades. But if the pancreatic gland (located close by) is involved, the pain may develop in the lower part of the back.
Q. What causes the pain?
A. I suppose it is much like any pain occurring when the normal surface is broken. Mouth ulcers are painful; an ulcer on the skin is also sore. In the gut system, acids touching the delicate nerve endings will make the pain even more severe. In the main, ulcer pain is usually deep seated, related to food intake, occurs at night and waxes and wanes over a period of time. I might add that with successful treatment, pain is the first symptom to vanish. It is often magical. However, this does not mean the ulcer has suddenly healed for it usually takes up to six weeks for this to occur, even though pain may disappear within a few days.
Many patients under treatment are often lulled into a false sense of security believing that magic (and the pills) has suddenly cured them, when this is often just the beginning. Some foolishly stop medication, only to find the entire set of symptoms recur again fairly quickly. So, ulcer patients, do not be fooled.
Q. What about vomiting? You said this was also a fairly common symptom with ulcer patients.
A. Most ulcer patients suffer from vomiting, and this may occur from various causes and at various times. Often it will develop suddenly, probably when the abdominal pain is at its worst. Often it will produce some relief, and the patient frequently feels much better. The reason is not clear, but it may be due to a sudden cleaning out of the stomach, including removal of the large build up of irritating acid and pepsin.
Q. Do some people try and initiate vomiting because they realise this will bring some kind of relief?
A. Most certainly. Induced vomiting is well known. I hardly blame the person. If I had a horrid pain gnawing at my inside, and I knew it would vanish if I simply stuck my fingers down my throat and had a good vomit, I think I would be tempted to try it. Who wouldn't. We are all human!
Q. Are there other causes for the vomiting?
A. Certainly. Sometimes the ulcer develops at the far end of the stomach, near the narrow canal called the pylorus where food travels to the duodenum. As this heals, fibrous tissue forms, and as this contracts, the canal may become much more narrow than normal. In fact, the canal may almost completely close over. In short, the patient develops an obstruction to the normal passage of food. It simply cannot pass normally, or at least at the normal rate. So, it simply flows back in a reverse direction, in the form of vomiting.
I well recall a patient, an older man who had been in the RAAF during the war and had suffered a great deal of stress. Unbeknown to anyone, he suddenly developed vomiting, sudden weight loss, and became very ill. By the time he came for treatment — like many ex-servicemen, he rarely sought treatment — he was drawn and thin, and looked nigh unto death. An x-ray examination showed that the pyloric canal was virtually non existent. He had endured a symptom free stomach ulcer near the canal. On healing, this had caused the canal to almost entirely close over. Hence the vomiting, and weight loss for he was not absorbing his food.
A surgical operation almost immediately cured the problem and within a few weeks he was back to normal. Weight gain and a happy disposition replaced the thin, wan appearance, and feeling of malnourished gloom and doom.
Q. Is it possible to differentiate between a G. U. and a D. U. on the symptoms?
A. Not really, and there is little point in trying to find out. Often the pain after food is longer in coming on with the D.U. patient, probably because the food, acid and pepsin have longer to travel. Generally, the D.U. patient tends to vomit less, and is more favourably affected by therapy. But, there is not a great deal between the two. Many ulcers do not cause any symptoms at all, whilst about one in four produces symptoms that are not typical. It is a strange disorder.
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FACTS ABOUT ULCERS
Q. So many people we know complain about their ulcers. How common are they in the community?
A. All kinds of statistics have been quoted over the years. Several studies carried out in Britain show that by the age of 55 years, between 6 and 20% of people have suffered from one. At any given time, in Australia, it is believed that between 2 and 4% of the population suffer from them. Many have an ulcer and are unaware of it, or have minimum symptoms. This covers about 25%. About 50% have fairly severe symptoms, but with treatment manage reasonably well, and live a fairly normal life.
The remaining 25% endure severe symptoms often with complications which make life difficult.
Q. Does it affect men more than women?
A. Peptic ulcer seems to trouble men more commonly. In the general world scene, stomach ulcer is 2-3 times more common in men, and duodenal ulcer 3-5 times more common in males, although in Australia, according to some doctors, gastric ulcer is more common in women.
Q. When is the most likely age for these to develop?
A. Peptic ulcers may occur at any time from youth to old age. However, the most common age for duodenal ulcers is around 30 years, and gastric ulcers about 40 years of age.
Q. Are they inherited?
A. Like many disorders, the tendency is believed to be inherited. Just as with heart disease and diabetes, there is an increased risk if the parents suffered with the disorder. One of these days, it may be possible to predetermine if a person will develop ulcers.
At present the researchers are carrying out an intriguing activity called 'gene mapping'. Here, they are able to locate on the chromosome the extact spot or locus in which a certain disease is inherited. So, by mapping baby's genes before birth, it may be possible to tell if he is predestined to develop heart disease, cancer, diabetes, peptic ulcers ... and some claim that his potential for developing into a criminal may also be told. Others dispute this, but it is definitely in the pipe line.
Q. We often hear the claim that successful businessmen are more prone to develop ulcers. Is this fact or fantasy?
A. The current view is that it is fallacy. Duodenal ulcers seem just as common in any social group. Some British claims say that stomach ulcers are more likely in those of lower social standards.
A. I live and work in an area where there is a lot of industry. I see many of the workers, plus many of the executives of these companies. It often seems that the greater the pressure on a person, mentally speaking, the greater chance he has of developing an ulcer. It may be a figment of my imagination. But I figure that the more mental anxiety and stress the person is subjected to, the greater the number of impulses racing to the acid producing glands of the stomach. And the greater amount of acid pumped out. So, an increased ulcer risk.
Q. Don't you relate this to your treatment of some people with medical hypnotherapy?
A. As you know, I have also been practising medical hypnotherapy — or relaxation therapy as I prefer to call it — for fifteen years or so. This aims at completely relaxing the system, specially the nervous system and the areas to which the nerves travel.
For many years I have noticed that folk who are tense, anxious and pent up, the very ones with a knot in the stomach, too much acid, tummy upsets, ulcers, are the very ones who seem to respond well to relaxation treatment. I figure out that less tension, less impulses travelling to the acid glands, less acid produced, leads to a reduced risk of stomach upsets and probably a reduced risk of ulcers. Certainly I am not claiming a cure for ulcers, but it appears to help in conjunction with other treatment.
However, this is purely a personal note injected for good measure, for I feel it is relevant. Anxious, stress ridden individuals can often help themselves, of that there is little doubt in my mind.
But, generally speaking, the experts today do not relate ulcers to specific social or economic situations apart from those mentioned.
Q. What about the relationship of ulcers to other conditions. Is this likely?
A. Some time ago it was found that peptic ulcers seemed more common in people with blood group O, and also those with the liver disease called cirrhosis. I might add that cirrhosis, or destruction of the normal liver tissue and its replacement with useless fibrous tissue, is more common in heavy, chronic drinkers.
Ulcers also seem related to some other medical conditions, such as the Zollinger-Ellison syndrome in which a diseased pancreatic gland causes an enormous over-secretion of acid in the stomach. Sometimes a rare disease of the parathyroid glands (which are located in the thyroid gland in the neck) may play a part; Cushing's syndrome, a disease of the supra-renal glands which sit on top of the kidneys may be associated with a reduced ulcer risk, although if there is too much cortisone-like hormones in the blood stream, this may delay ulcer healing.
Q. What about drugs. Can these upset the lining and cause ulcers to form?
A. The picture is a bit confused, although many doctors believe they play an important part. It has been found that people with ulcers tend to take excessive analgesics such as aspirin products, and smoke more heavily than those with no ulcer. Therefore, the two are often linked, but others claim this does not necessarily say one causes the other. In short, 'they probably have little effect,' says one prominent Sydney-based ulcer expert. He also says that 'there is no convincing evidence that stress or anxiety play any role in the causation and natural history of chronic peptic ulcer, or that any personality type predisposes to peptic ulcer.'
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RECTUM AND ANUS
Q. So we come to the final part of the intestinal system — the rectum and anus.
A. Correct. The rectum is simply a continuation of the large bowel or colon, and is the storehouse of the remnants of the food we have eaten, minus the nutrients and water which have been sucked up by the blood stream and used by the system. Material will remain in the rectum until a convenient time arises when it may be eliminated. This is termed defaecation, and the material excreted is technically referred to as faeces, or stools. It is interesting to note that faeces comes from an ancient Latin word which means "the dregs" — for correctly, it represents the dregs which were useless to the system. It is also commonly known by a more euphonious word stools, which comes from an ancient Anglo-Saxon word "stol" which means seat — for most Australians use a seat when defaecating — although in many eastern countries they still squat.
This, in reality, is a more natural method of elimination, and allows the muscles to work far more normally and naturally. Some eastern toilets are a cultural shock to Australians who travel abroad. Foot plates are present, so is a hole in the floor, but no seat — you simply squat down and hope for the best!
Q. Isn't cancer becoming a major hazard with the large bowel?
A. The answer is a very definite 'Yes'. In fact, many doctors claim that numerically speaking, cancers in this situation are growing quicker than in any other organ. Cancer, or carcinoma (to use the doctor's term) is fairly common in the colon, as well as the next part of the bowel, the rectum. It is more likely in older people, specially those 45 years and more. That is the bad news. The good news is that we have on hand extremely effective methods of diagnosis today. We use x-rays, plus an ingenious device called the colonoscope. This enables rapid, early diagnosis, and it also enables effective treatment which in many early cases is extremely effective and definitely life-saving.
Q. What about diverticulosis. We seem to hear a great deal about this today.
A. That is another disorder of the large bowel. It means that small outcroppings like little balloons occur along the walls of the colon. The condition is called diverticulosis. Sometimes, if food and germs are trapped in the pockets, they become infected. These may produce considerable pain, a bit like appendicitis. Early diagnosis and treatment are effective, but it may be recurring and cause a lot of discomfort. I might add that the modern day use of unprocessed bran — chook food (as I call it), or fibre, which sounds much more euphonious, is often effective in checking symptoms from developing.
A. The rectum leads into a narrow tube called the anal canal, at the end of which is the anal sphincter or valve. This opens and closes voluntarily, so that material may be excreted under one's conscious will. Sometimes if the contents are very watery, and there is excessive bowel activity (called peristalsis) such as with severe bowel infections, it may be difficult to control the valve and accidents may take place.
This is also common in infants, and it takes babies some time — usually around 18 to 30 months — to develop voluntary control over the anal valve. Incidentally, there is a great deal of social one-upmanship on baby's bowel actions. Many young mothers claim they have "trained" their infants by the age of six months. But they are really fooling themselves. Simply because they manage to place a potty under little Sean just as he defaecates, this is not an indication of successful training. His nervous system has not developed to this point before at least the time span given above. So, good though these efforts are, little Sean will be like most of the other little fellows in the neighbourhood, and will learn proper bowel control when Nature decrees!
Q. So that is the story of the G.I. system, and some of the events that take place on a regular basis.
A. Correct. It is a wondrous system. The remarkable fact is that despite the way in which it is abused by the owners, it will continue to function in a magical manner. Heave down a terrible array of foodstuffs and fluids, and it will continue to stoically perform year in and year out. Finally it may rebel, but usually only when major abuse takes place for many years. In the main, it functions smoothly.
Q. Well, what now?
A. We plan to discuss some of the more common and more important disorders of this wondrous system. Because it affects so many people, it is our plan to concentrate for some time on the stomach and duodenum, and speak specifically about peptic ulcers. So, stay with us, for if you are an average Australian, there are very high chances that you will be an ulcer victim. It may only be a matter of time. In fact, you — the person reading this booklet right now — probably have an ulcer gnawing at your vitals!
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