The Burden of Constipation
Constipation is one of the commonest cases a clinician or doctor comes across, especially in the developed countries. The main reason of exceedingly common occurrence of constipation in the developed countries is the consumption of less dietary fibers. Constipation is not as common in developing countries as it is in developed countries due to the food habit, which includes the whole grains and lots of vegetables and fruits in developing countries. Western diet is mainly include refined and processed foods with little if any fiber, which leads to constipation. The only permanent solution to chronic constipation in absence of any underlying serious pathophysiology, is to change lifestyle (regular aerobic physical activity) and food habit permanently.
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Causes of Chronic Diarrhea
Diarrhea lasting for more than 4 weeks is considered as chronic diarrhea and need to be evaluated to exclude serious underlying pathology. Chronic diarrhea is one of the common cause of bad health state of many persons. In contrast to acute diarrhea, most of the causes of chronic diarrhea are generally noninfectious. The following are the causes of chronic diarrhea: * Secretory causes of chronic diarrhea: Excessive use of stimulant laxatives, chronic ingestion of alcohol, certain drugs and toxins, endogenous laxatives like bile acids, idiopathic secretory diarrhea; bowel resection, disease, or fistula (reduced absorption), certain bacterial infections, Addison's disease, congenital electrolyte absorption defects, partial bowel obstruction which may be due to fecal impaction, hormone-producing tumors (carcinoid, medullary cancer of thyroid, mastocytosis, gastrinoma, colorectal villous adenoma) are the secretory causes of chronic diarrhea.
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Colon Cleansing: An Overview
Colon cleansing is part of alternative medicine and covers broad areas of removing toxins (that are not clearly identified) from gastrointestinal tract and removal of fecal waste from GIT. Colon cleansing is also sometimes called colon hydrotherapy, as it uses colonic irrigation with enema. But colon cleansing is also done with oral therapy. Generally herbs of medicinal value are added to the water which is used as enema for purpose of cleansing the gastrointestinal tract of toxins (can be called detoxification) and fecal waste.
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How to Diagnose Indigestion?
Diagnosis of the cause of indigestion may pose a problem. Proper history (a thorough interview) with a thorough physical examination may be essential for diagnosis of indigestion. Most of the cases of indigestion are generally due to GERD and functional dyspepsia. Gastroesophageal reflux disease (GERD) produces heartburn, that is exacerbated by meals and may even awaken the patient in the night. Individuals with functional dyspepsia have epigastric pain as the main symptom. As most of the cases of indigestion are due to gastroesophageal reflux disease and functional dyspepsia, the general principle of diagnostic testing are directed at diagnosing gastroesophageal reflux disease and functional dyspepsia.
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Differential Diagnosis of Indigestion
Many other diseases cause symptoms of indigestion and it is important to find out the actual disease that is causing indigestion. Sometimes it becomes difficult to find out the actual disease which is causing indigestion and health state of the patient can not be improved much.
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The Global Burden of Diarrhea
Diarrhea is extremely common health problem all over the world, including in the developed countries. In the developing countries diarrhea is one of the leading cause of mortality and morbidity, especially among infants of below one year of age and children below five years. Diarrhea exerts an enormous toll in terms of mortality, morbidity, social inconvenience, loss of work and productivity, and utilization of medical resources of a nation. In developing countries acute infectious diarrhea is one of the common cause of mortality, especially among children below five years of age and estimated to cause 2-3 million deaths every year. Diarrhea is one of the common cases faced by doctors in developing countries.
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Indigestion and its Causes
Indigestion is a nonspecific term that covers a variety of upper abdominal complaints such nausea, vomiting, heartburn, regurgitation, dyspepsia (the presence of symptoms thought to originate in the gastro-duodenal region) etc. which affect patients’ health state in a negative way. Dyspepsia may be reported by some individuals as epigastric burning, gnawing discomfort in abdomen, or abdominal pain. Some individuals with dyspepsia experience a constellation of symptoms such as postprandial fullness (feeling of fullness of stomach for long time after meal), early satiety (an inability to complete a meal due to premature fullness), bloating, eructation or belching and anorexia.
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Causes of Nausea and Vomiting
The causes of nausea and vomiting can be divided into three broad categories namely intra-peritoneal, extra-peritoneal and due to medications/metabolic disorders.
Intra-peritoneal (due to some pathology inside peritoneum) causes:
- Obstructing disorders like obstruction of pyloric part of stomach, obstruction of small bowel, obstruction of colon and superior mesenteric artery syndrome.
- Inflammatory diseases such as cholecystitis (inflammation of gall bladder and inflammation is generally due to infection), hepatitis (infection/inflammation of liver), pancreatitis (infection/inflammation of pancreas), appendicitis (infection/inflammation of appendix) etc.
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Symptoms & Diagnosis of Peptic Ulcer
Peptic ulcer is a chronic disease with spontaneous remission and relapses which can last for decades or in some cases may last life-long. There is a popular saying among medical fraternity (doctors) “once you are ulcer patient, you are life-long ulcer patient” (which means it is very difficult to cure ulcer permanently and relapses are common, so peptic ulcer should be suppressed adequately).The commonest symptom of peptic ulcer is recurrent pain in upper abdomen or epi-gastric part of abdomen. The pain is felt about 2 to 3 hours after food depending on the location of ulcer. Sometimes pain may be felt on empty stomach and patient may mistake it as “hunger pain” as the pain is relieved by eating. Patient of peptic ulcer may wake up in the middle of night from sleep due to pain and if this symptom is present it is diagnostic of peptic ulcer (no other disease has this type of long standing pain which wakes up the patient during sleep).
Another important symptom of peptic ulcer is the periodicity of symptoms, mainly abdominal pain. The abdominal pain lasts for about one to three weeks at a time, three to four times a year. Between the episodes of abdominal pain patient feels perfectly well. There may be other symptoms of peptic ulcer like heartburn, vomiting, loss of appetite etc. It is difficult to distinguish gastric ulcer and duodenal ulcers by symptoms only.
Diagnosis of peptic ulcer:
Peptic ulcer can be diagnosed with endoscopy (with endoscopy diagnosis can be almost 100% accurate) and double contrast barium meal examination. Endoscopy is preferred diagnostic procedure for peptic ulcer due to its certain advantages. Advantages of endoscopy are the direct visualization of the ulcer (accurate diagnosis due to direct visualization) and sample for biopsy can be collected (gastric ulcers may turn malignant though rarely and biopsy is must for gastric ulcers). In case of gastric ulcer endoscopy must be repeated after proper treatment to confirm that the ulcer has healed and to obtain further biopsies if it has not healed. For duodenal ulcers repeat endoscopy is not necessary. In case of duodenal ulcer during endoscopy biopsy is taken to do histological examination to confirm presence of H. pylori (90% of duodenal ulcers are due to H. pylori).
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What is Peptic Ulcer & Causes of Peptic Ulcer
What is an ulcer and what is peptic ulcer?
Before we define peptic ulcer, we should know what an ulcer is. Ulcer is a break in the epithelial lining in skin or mucosa, which is more than 3 millimeter in diameter. If ulcer is situated in the lower esophagus, stomach, duodenum, in jejunum, or in ileum near Meckel’s diverticulum it is called peptic ulcer. But generally by peptic ulcer we understand ulcer in the stomach or duodenum or combination of both together. Gastric ulcer or duodenal ulcer (peptic ulcer) can be either acute or chronic.
Causes of peptic ulcer:
There is a balance between protective mechanisms and ulcer causative mechanism. As part of protective mechanism there is production of bicarbonates by gastric Chief cells which neutralizes the gastric acid produced by the gastric Parietal cells. And there is also increased blood supply which can cause prompt healing if there is ulcer due to any imbalance between the two opposing forces.
The epithelial lining of stomach and duodenum like any other mucosal lining is constantly replaced by new epithelium and there is a balance between regeneration of epithelium and normal destruction of epithelial lining. Anything that can tip this fine balance can cause peptic ulcer. The commonest and most important cause which can tip this balance and cause peptic ulcer is infection of H. pylori. There are also other causes of peptic ulcer like common medicines aspirin (excess and irrational use) and other NSAIDs (non-steroidal anti inflammatory drugs – commonly known as painkillers), smoking, alcohol, mental stress (e.g. before exam for students, day to day due to serious disease etc.) as well as physical stress like major surgical procedure or major trauma and many more factors can cause peptic ulcer.
Helicobacter pylori (discovered in 1984 and responsible for 90% of duodenal ulcers and 70% of gastric ulcers) enters the antrum of stomach through contaminated drinking water or via food and cause antral gastritis (inflammation of antrum) and this inflammation cause excess production of gastric acid from gastric Parietal cells (Parietal cells are responsible for production hydrochloric acid in stomach). This excess gastric acid can cause ulcer in the stomach itself or it may pass to duodenum and attack the duodenal epithelial lining and cause duodenal ulcer.
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