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Stomach Inflammation and Ulceration

Key Points (drop down)

Stomach (Peptic) inflammation is an irritation in the stomach caused by the natural protection against stomach acid not working properly. The acid is produced to work on the food not the stomach lining.

Food normally passes down the gullet (oesophagus) into the stomach.

The stomach makes acid so help with digestion. When the acid attacks the stomach lining this causes indigestion

Apart from satisfying hunger it is not normal to be aware of the digestion process taking place in the body.

Commonly asked questions (drop down)

What is Peptic Ulceration?

Peptic inflammation means inflammation caused by stomach acid. Inflammation can occur in the stomach and also in the duodenum (as acid flows in with food). It can also occur in the lower oesophagus if some acid splashes back up. Normally the lining of the stomach, oesophagus and duodenum can cope with the acid by making chemicals, which protect the tissues from being ‘acid burnt’.

Peptic inflammation is when acid breaks through this protection and causes mild acid burns. The lining of the stomach, duodenum and oesophagus is constantly repairing any damage.

The amount of inflammation varies a lot. Some people have occasional indigestion caused by mild small areas of inflammation that heal quickly. Other people develop an ulcer where a small area becomes very inflamed and sore. The most common site for this is the first part of the duodenum, the classic ‘duodenal ulcer’. A lot of people fall somewhere in between. They may have recurrent indigestion (dyspepsia) but not actually develop an ulcer.

It is a common belief that peptic inflammation is due to too much acid. In fact, most people with peptic inflammation have normal amounts of acid. It is normally a breakdown of the protective lining part of the stomach, oesophagus or duodenum that leads to small areas of inflammation.

In people who have duodenal or stomach ulcers, the root cause is commonly due to a germ (bacterium) called H. Pylori. It is thought that this germ affects the lining of the stomach or the duodenum in some way that allows the acid to cause inflammation and ulcers.

What are the symptoms of peptic inflammation?

Symptoms include:

✓ stomach pains,

✓ heartburn,

✓ bloating,

✓ acid taste in the mouth

✓ feeling sick.

Sometimes it is just a discomfort over the stomach. Taking food may relieve the symptoms. Most people will have indigestion at some stage in their life. However, people who have recurring symptoms over a few weeks may be developing peptic inflammation. Many people have variable symptoms having some good and some bad spells.

Is peptic inflammation serious?

Most bouts of inflammation just heal themselves or never become any worse.

If the inflammation does become worse it may develop into an ulcer. However, peptic inflammation and ulcers can usually be treated. Before modern treatments became available the risk from an ulcer was that it might perforate or bleed. This is now uncommon due to effective modern medication.

What can I do to help?

• Lifestyle – the defence to acid is reduced in the stomach and duodenum in people who smoke. If you smoke, stopping may ease the problem and may even cure it. Excess alcohol makes things worse. Alcohol binges are particularly harmful, for further advice on this issue check out the Alcohol Wellbeing Information. (LINK TO ALCOHOL WELLBEING PAGE HERE)

• Diet and weight – some foods cause indigestion in some people. Hot curries, coffee and fatty foods are examples. Avoiding these is highly likely to help. Regular meals at regular intervals are best to constantly neutralise the acid. People who don’t eat all day but have a large meal in the evening are prone to indigestion. Overweight people have a tendency for acid to ‘splash’ back up in the oesophagus causing oesophagitis with heartburn. This may ease if weight is lost.

• Medication – some medicines taken for other conditions may irritate the stomach lining. Sometimes this causes indigestion but may also lead to ulcers forming. The most common examples are anti-inflammatory pain killers such as aspirin, Ibuprofen, Brufen, Nurofen, etc. Tell your doctor if you suspect a medicine is causing the symptoms.

Do I need any tests?

A doctor will usually advise some medication if the symptoms are typical. Tests may be advised if symptoms are not settling, are severe or not typical. This is to confirm the diagnosis and to rule out other stomach problems, which may mimic peptic inflammation.

*A blood test or a breath test may be done to see if the H. Pylori germ is present (see above).

*Endoscopy is sometimes advised. This is more likely in those aged over 45 or people who have non-typical symptoms. A thin, flexible telescope is passed down the oesophagus into the stomach and duodenum to allow a doctor to look inside.

What are the Treatments for Peptic inflammation?

• Antacids – these are commonly used if symptoms only develop now and then. They counteract the stomach acid. They come as tablets or liquids and many brands are available at pharmacies. They can be taken whenever symptoms occur.

• Acid Suppressing Medication – these work by suppressing (reducing) the amount of acid made by the stomach. Once the acid level is reduced the inflamed areas (or ulcer) can heal back to normal. Sometimes a single short course settles symptoms. Some people need repeated courses of medication every so often when symptoms flare up. In a minority of people, the medicine works well, but on stopping it the symptoms return. They may need a regular dose each day.

• Antibiotics – the root cause of duodenal or stomach ulcers in many people is a germ (bacteria) called H. Pylori. It is thought that this germ affects the lining of the stomach or duodenum in some way allowing the acid to cause inflammation and ulcers.

Killing this with antibiotics often cures the ulcer. Many people who have taken acid suppressing medication for long periods may find antibiotic treatment cures their symptoms for good. To work well, antibiotics need to be taken at the same time as an acid suppressing medication for 1-2 weeks. The course has to be taken exactly as prescribed for the best chance of success.

• Surgery – used to be common but now is rarely needed due to modern medication being effective.

Manager Section.

Stomach 'problems' are a common reason for short term absences. This is however usually due to individuals ignoring their known 'triggers' ie eating a curry which they know results in irritation of the stomach lining.

Where an individual has just started to complain of this type of problem, there may be a short period of time where the 'triggers' need to be established and best symptomatic treatment found. Pharmacists are the best source of advice for suitable medications although a GP may need to be consulted if symptoms persist.

Short Term Sickness Absence.

Managersw may consider the following questions::

Do you think your poor attendance is related to your stomach problem?

Have you had a diagnosis by a doctor?

Are you taking any medication?

Have you established what food or drinks irritate your stomach?

Are you paying enough attention to the lifestyle adjustments which you may have been advised to look at eg avoiding certain foods?

Do you need to have a check up with your doctor

Long Term Sickness Absence

All cases of long term sickness must be referred to the OH Consultant for an on-site review.

Manager Options

□ Ask employee to see his GP

□ Use AskLine option to get further advice - click on icon

□ Refer to Occupational Health Consultant - Link to referral paperwork

Further Information Links

Peptic Ulcers Information doctor.co.uk/diseases/facts/pepticulcer.htm

National Health Service .uk

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