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Desert Surgical Associates features fellowship trained surgeons specializing in general surgery, abdominal surgery, gall bladder surgery, hernia surgery, cancer surgery, robotic surgery, weight loss surgery and more.

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Peptic Ulcers

by Desert Surgical Associates on 02/18/18

An “ulcer” is an open sore. The word “peptic” means that the cause of the problem is due to acid. Most of the time when a gastroenterologist is referring to an “ulcer” the doctor means a peptic ulcer.

The two most common types of peptic ulcer are called “gastric ulcers” and “duodenal ulcers”. These names refer to the location where the ulcer is found. Gastric ulcers are located in the stomach (see Figure 1). Duodenal ulcers are found at the beginning of the small intestine (also called the small bowel) known as the duodenum. A person may have both gastric and duodenal ulcers at the same time.


Symptoms

Many people with ulcers have no symptoms at all. Some people with an ulcer have belly pain. This pain is often in the upper abdomen. Sometimes food makes the pain better, and sometimes it makes it worse. Other symptoms include nausea, vomiting, or feeling bloated or full. It is important to know that there are many causes of abdominal pain, so not all pain in the abdomen is an “ulcer”.

The most important symptoms that ulcers cause are related to bleeding.

Bleeding from an ulcer can be slow and go unnoticed or can cause life-threatening hemorrhage. Ulcers that bleed slowly might not produce the symptoms until the person becomes anemic. Symptoms of anemia include fatigue, shortness of breath with exercise and pale skin color.

Bleeding that occurs more rapidly might show up as melena – jet black, very sticky stool (often compared to “roof tar”) – or even a large amount of dark red or maroon blood in the stool. People with bleeding ulcers may also vomit. This vomit may be red blood or may look like “coffee grounds”. Other symptoms might include “passing out” or feeling lightheaded. Symptoms of rapid bleeding represent a medical emergency. If this occurs, immediate medical attention is needed. People with these symptoms should dial 911 or go to the nearest emergency room.

Causes/Risk Factors

The two most important causes of ulcers are infection with Helicobacter pylori and a group of medications known as NSAIDs.

Helicobacter pylori (also called H. pylori or “HP) is a bacterium that lives in the stomach of infected people. The understanding that H. pylori can cause ulcers was one of the most important medical discoveries of the late 20th century. In fact, Dr. Barry Marshall and Dr. J. Robin Warren were awarded the 2005 Nobel Prize in Medicine for this discovery.

People infected with H. pylori are at increased risk of developing peptic ulcers. When a person is diagnosed with an ulcer, testing for H. pylori is often done. There are a number of tests to diagnose H. pylori and the type of test used depends on the situation.

People with ulcers. who are infected with H. pylori. should have their infection treated. Treatment usually consists of taking either three or four drugs. The drug therapy will use acid suppression therapy with a proton pump inhibitor (PPI) along with antibiotic therapy and perhaps a bismuth containing agent such as Pepto-Bismol. H. pylori can be very difficult to cure; so it is very important that people being treated for this infection take their entire course of antibiotics as prescribed.

NSAIDs (Non-Steroidal Anti-Inflammatory Drugs) are a group of medications typically used to treat pain. There are many drugs in this group. A few of these include: aspirin (Bayer®), ibuprofen (Motrin®, Advil®), naproxen (Aleve®, Naprosyn®), ketorolac (Toradol®) and oxaprozin (Daypro®). NSAIDs are also included in some combination medications, such as Alka-Seltzer®, Goody’s Powder® and BC Powder®.

Acetaminophen (Tylenol®) is NOT an NSAID and is therefore the preferred non-prescription treatment for pain in patients at risk for peptic ulcer disease.

NSAID use is very common because many are available over the counter without a prescriptionand therefore they are a very common cause of peptic ulcers. NSAIDs cause ulcers by interrupting the natural ability of the stomach and the duodenum to protect themselves from stomach acid. NSAIDs also can interfere with blood clotting, which has obvious importance when ulcers bleed.

People who take NSAIDs for a long time and/or at high doses, have a higher risk of developing ulcers. These people should discuss the various options for preventing ulcers with their physician. Some people are given an acid suppressing PPI. These drugs can prevent or significantly reduce the risk of an ulcer being caused by NSAIDs.

There are many myths about peptic ulcers. Ulcers are not caused by emotional “stress” or by worrying. They are notcaused by spicy foods or a rich diet. Certain foods might irritate an ulcer that is already there, however, the food is not the cause of the ulcer. People diagnosed with ulcers do not need to follow a specific diet. The days of ulcer patients surviving on a bland diet are a thing of the past.

Diagnosis

The most typical way for ulcers to be diagnosed is by a procedure called an EGD. EGD stands for EsophagoGastroDuodenoscopy. An EGD (also called “upper endoscopy”) is performed by inserting a special lighted camera on a flexible tube into the person’s mouth to look directly into the stomach and the beginning of the small bowel. This flexible camera carefully inspects the most likely areas for ulcers to be located. Ulcers identified during an EGD may be photographed, biopsied and even treated, if bleeding is present.

Another way ulcers were diagnosed in the past was with an x-ray test called an “upper GI series”. An upper GI series involves drinking a white chalky substance called barium, and then taking a number of x-rays to look at the lining of the stomach. Doctors can see the ulcers on the x-rays when they have barium in them.

Today, the preferred method for diagnosing ulcers is with an EGD given the flexible camera is better able to detect even small ulcers and because it allows for potential treatment at that time if the ulcer is bleeding. An upper GI series can miss small ulcers and also does not allow direct treatment of an ulcer.

Treatment

The way that ulcers are treated depends on a number of features. Nearly all peptic ulcers will be treated with a proton pump inhibitor (PPI). PPIs are powerful acid blocking drugs that can be taken as a pill or given in an IV. Often, the potent IV form is used if a patient is hospitalized with a bleeding ulcer. There are six PPIs available in the United States. These are omeprazole (Prilosec®, Zegerid®), lansoprazole (Prevacid®), pantoprazole (Protonix®), rabeprazole (Aciphex®), esomeprazole (Nexium®), and dexlansoprazole (Dexilant®). There are very few medical differences between these drugs.

PPIs require a meal to activate them. Patients should eat a meal within 30 minutes to 1 hour after taking this medication for the acid suppression therapy to work most effectively. Waiting later than this time can decrease the positive effect of this medication. This might delay healing or even result in the failure of the ulcer to heal.

Sometimes duodenal ulcers (not gastric ulcers) will be treated with H2 blockers. H2 blockers are another type of acid reducing medication. Common H2 blockers are ranitidine (Zantac®), cimetidine (Tagamet®), famotidine (Pepcid®) and nizatidine (Axid®).

An important part in treating ulcers is by identifying what caused them Patients with ulcers caused by NSAIDs should talk to their doctor about other medications that can be used to treat pain.

If the person is infected with H. pylori this infection should be treated. Completing the full dose of antibiotics is very important. Just as important, is making sure that the infection is gone. There are number of ways to do this. Generally, a blood test is not a good way to test if the infection is gone. The doctor who treated the infection can recommend the best way to do the “test of cure”.

When someone has an ulcer that has bled significantly, treatment might be done at the time of EGD. There are a number of techniques that can be performed during an EGD to control bleeding from an ulcer. The gastroenterologist might inject medications, use a catheter to cauterize the ulcer (burn a bleeding vessel shut) or place a small clip to clamp off a bleeding vessel. Not all ulcers need to be treated this way. The doctor doing the EGD will decide if treatment is indicated based on the way the ulcer looks. The doctor will usually treat an ulcer that is actually bleeding when it is seen and will also often treat other ulcers if they have a certain appearance. These findings are sometimes called “stigmata of recent hemorrhage” or just “stigmata”. Stigmata will usually get treated during the EGD if they are classified as high-risk. Common high-risk findings include a “visible vessel” and an “adherent clot”.

Most ulcers can be treated and will heal. Often, people with ulcers will have to take PPIs for several weeks to heal an ulcer. It is also important to correct what caused the ulcer. When possible, NSAIDs should be stopped. Patients with ulcers caused by NSAIDs should talk to their doctor about other medications that can be used to treat pain.

If the person is infected with H. pylori, then completing the full dose of antibiotics is very important. Just as important, is making sure that the infection is gone. There are number of ways to do this. Generally, a blood test is not a good way to test if the infection is gone. The doctor who treated the infection can recommend the best way to do the “test of cure”.

People with gastric ulcers (only in the stomach) usually have another EGD several weeks after treatment to make sure that the ulcer is gone. This is because a very small number of gastric ulcers might contain cancer. Duodenal ulcers (at the beginning of the small intestine) usually don’t need to be looked at again.

Glossary

Anemia – A low red blood cell count. Symptoms of anemia include feeling tired, shortness of breath, weakness and poor exercise tolerance.

Duodenal – referring to the beginning of the small intestine or duodenum.

EGD – EsophagoGastroDuodenoscopy, also called “upper endoscopy” is a medical procedure where a flexible lighted tube with a camera is inserted through the person’s mouth and into the stomach and duodenum to diagnose or treat disease.

Erosion – a very shallow sore, similar to an abrasion or a scrape. These are usually not very important and very rarely cause symptoms.

Gastric – referring to the stomach.

H2 blocker – H2 blockers significantly lower the production of acid in the stomach. They are sometimes used to treat duodenal (not gastric) ulcers. They are also often used to treat heartburn and GERD. Common H2 blockers are ranitidine (Zantac®), cimetidine (Tagamet®), famotidine (Pepcid®) and nizatidine (Axid®).

Helicobacter pylori – sometimes called H. pylori or HP is a bacterium that causes ulcers. H. pylori is also a risk factor for stomach cancer. If prescribed, it is very important to complete an entire course of antibiotics for H. pylori.

Melena – black very sticky stool, often compared to roof tar. This is a common symptom of a bleeding ulcer. Black stool that looks like melena can be caused by taking iron medications and by drugs like Pepto-Bismol®.

NSAIDs - (Non-Steroidal Anti-Inflammatory Drugs) are a group of medications typically used to treat pain. There are many drugs in this group. A few of these include: aspirin (Bayer®), ibuprofen (Motrin®, Advil®), naproxen (Aleve®, Naprosyn®), ketorolac (Toradol®) and oxaprozin (Daypro®). NSAIDs are also included in some combination medications, such as Alka-Seltzer®. Acetaminophen (Tylenol®) is NOT an NSAID and is therefore the preferred non-prescription treatment for pain in patients at risk for peptic ulcer disease.

Peptic – caused by acid.

PPIs – Proton Pump Inhibitors. Powerful acid blocking drugs that can be taken as a pill or given in an IV. PPIs are frequently used to treat ulcers, and also heartburn and GERD. There are six PPIs available in the United States. These are omeprazole (Prilosec®, Zegerid®), lansoprazole (Prevacid®), pantoprazole (Protonix®), rabeprazole (Aciphex®), esomeprazole (Nexium®) and dexlansoprazole (Dexilant®). There are very few medical differences between these drugs. It is important to know that PPIs require a meal to activate them. Patients should eat a meal within 30 minutes to 1 hour after taking this medication for the acid suppression therapy to work properly.

Stigmata of recent hemorrhage – sometimes just called “stigmata” are findings during an EGD that indicate a higher risk of bleeding or re-bleeding. Stigmata are usually treated during the EGD when they are found. This treatment reduces the chance of bleeding.

Ulcer – an open sore. Ulcers are deeper than erosions.

Author(s) and Publication Date(s)

Sean P. Caufield, MD, Lieutenant Commander, Medical Corps, U.S. Navy, Gastroenterology Fellow, Naval Medical Center, San Diego, CA, and Theodore W. Schafer, MD, FACP, FACG, Captain, Medical Corps, U.S. Navy, Associate Professor of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD – Updated December 2012.

Theodore W. Schafer, MD, FACP, Commander, Medical Corps, U.S. Navy, Uniformed Services University of the Health Sciences, Bethesda, MD – Published November 2007.

 

Disclaimer: The views expressed in this article are those of the authors and do not reflect the official policy or position of the Department of the Navy, Department of Defense, or the United States Government.

THE NEW SCIENCE SHOWING FIBER IS CRUCIAL FOR LOWERING INFLAMMATION

by Desert Surgical Associates on 01/28/18

You probably already know that fiber is pretty essential for keeping your digestive track in check. But its good-for-you benefits don’t stop at keeping things, er, moving. According to new research, the nutrient can help lower inflammation, too. As the New York Times so aptly put, people who eat high-fiber diets have lower odds of dying.

According to Fredrik Bäckhed, a biologist at University of Gothenburg in Sweden, his team of scientists have found that the good bacteria in the gut feeds off of fiber. And when your microbiome is healthy, it’s a good indicator that the rest of your body is, too. The Times also reports on a separate study in the journal Cell Host and Microbe, which found that mice on a low-fiber diet didn’t have as high of a population of good bacteria in their gut as their fruit- and veggie-eating counterparts.

Here’s where the inflammation-fighting properties come in: When the microbiome is populated with good bacteria, it boosts the immune system, helping fight infections ranging from the common cold to more serious ailments, such as immune disorders and IBS. So you definitely want to make sure you’re feeding ’em plenty of fiber. Yet another reason to pile more fruits, vegetables, lentils, and grains on your plate. Quinoa bowl for dinner anyone

https://www.wellandgood.com/good-food/fiber-inflammation-connection/?utm_source=Well%2BGood&utm_campaign=e138003248-1-4-18_EE_Cobranded+Renewyear&utm_medium=email&utm_term=0_b430628ea3-e138003248-395152037



What Causes the Valve in the Esophagus to Malfunction?

by Desert Surgical Associates on 01/21/18

In some people, the lower esophageal sphincter relaxes at the wrong time or becomes weakened. This allows stomach contents to escape and travel up the esophagus. This causes burning, irritation, and pain. 

Surprisingly, not everyone who has acid reflux experiences a burning sensation. Other times, burning in the area of the chest and abdomen is caused by a condition other than reflux. Sometimes chest pain may occur due to a heart attack or other serious conditions. Acid reflux is the main symptom of gastroesophageal reflux disease (GERD), but GERD is associated with other symptoms like nausea, dry cough, hoarseness, sore 

throat, trouble swallowing, and a feeling of a lump in the throat. See your doctor if you experience pain, burning, or irritation in your chest or abdomen

Functions of the small intestine

by Desert Surgical Associates on 12/10/17

Functions of the small intestine. The small intestine is the part of the 
intestines where 90 per cent of the digestion and absorption of food occurs, the other 10 per cent taking place in the stomach and large intestine. The main function of the small intestine is absorption of nutrients and minerals from food.

BILE DUCT OBSTRUCTION

by Desert Surgical Associates on 12/03/17

Bile duct obstruction is a blockage in the tubes that carry bile from the liver to the gallbladder and small intestine. Bile is a liquid released by the liver. It contains cholesterol, bile salts, and waste products such asbilirubin. Bile salts help your body break down (digest) fats. Bile passes out of the liver through the bile ducts and is stored in the gallbladder. After a meal, it is released into the small intestine.

When the bile ducts become blocked, bile builds up in the liver, and jaundice (yellow color of the skin) develops due to the increasing levels of bilirubin in the blood.

The possible causes of a blocked bile duct include:

Cysts of the common bile duct

Enlarged lymph nodes in the porta hepatis

Gallstones

Inflammation of the bile ducts

Narrowing of the bile ducts from scarring

Injury from gallbladder surgery

Tumors of the bile ducts or pancreas

Tumors that have spread to the biliary system

Liver and bile duct worms (flukes)

The risk factors include:

History of gallstones, chronic pancreatitis, or pancreatic cancer

Injury to the abdominal area

Recent biliary surgery

Recent biliary cancer (such as bile duct cancer)

The blockage can also be caused by infections. This is more common in persons with weakened immune systems.

Symptoms



Abdominal pain in the upper right side

Dark urine

Fever

Itching

Jaundice (yellow skin color)

Nausea and vomiting

Pale-colored stools

Treatment

The goal of treatment is to relieve the blockage. Stones may be removed using an endoscope during an ERCP.

In some cases, surgery is required to bypass the blockage. The gallbladder will usually be surgically removed if the blockage is caused by gallstones. Your health care provider may prescribe antibiotics if an infection is suspected.

If the blockage is caused by cancer, the duct may need to be widened. This procedure is called endoscope or percutaneous (through the skin next to the liver) dilation. A tube may need to be placed to allow drainage.

 

Call us or go online with questions, for more information or to schedule an appointment

3196 S Maryland Pkwy • Ste 101A • Las VegasNV 89109

Phone: 702.369.7152         Fax: 702.369.7153          www.DesertSurgicalAssociates.com


 

Desert Surgical Associates
Desert Surgical Associates   
3196 S Maryland Pkwy  Ste 101A   •  Las Vegas, NV 89109
2851 N Tenaya Way, Ste 103 • Las Vegas, NV 89128
Phone: 702.369.7152      •      Fax: 702.369.7153
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