Peptic inflammation refers to inflammation caused by stomach acid. Acid is produced in the stomach as an aid to digestion. After food is swallowed it passes down the oesophagus (or gullet) into the stomach where, after mixing with the stomach juices, it continues on its passage down the gut into the duodenum (the first part of the small intestine). Digestion continues during passage through the small intestine before the various products of digestion are absorbed into the body.
The problem of peptic inflammation is not confined to the stomach - it can occur in the lower part of the oesophagus, when acid is able to splash or 'reflux' back up (Oesophageal Reflux) and also in the duodenum. The contents of the stomach are very acidic - not dissimilar from the acid found in car batteries! It is thus perhaps surprising all of us are not victims of peptic ulceration. In fact, most of us are able to hold this strong acid in our stomachs without suffering any ill effect because the linings of the stomach, oesophagus and duodenum make chemicals which protect the underlying tissues from being damaged. Although people often talk of having "too much acid", most individuals with peptic ulceration have normal amounts of acid and the inflammation results from a breakdown in this protective lining. In some people, particularly those who have developed ulcers in the stomach or duodenum, the underlying cause for this is a bacteria called Helicobacter Pylori.
Peptic inflammation can cause a variety of symptoms from indigestion or stomach pains, heartburn and nausea to a taste of acid or water in the mouth and a tight or bloated feeling in the abdomen (belly). The specific type of symptoms and their severity depends to a certain extent on the part of the gut which is inflamed as well as the degree of inflammation present. Peptic inflammation can therefore cause a whole range of problems from occasional, mild indigestion which settles by itself to recurring bouts of more troublesome pain, which require repeated courses of treatment, to persistent severe symptoms from an ulcer.
Up to about 15-20 years ago the medications available for peptic inflammation were of limited effectiveness and many people developed complications from peptic ulcers such as bleeding or perforation, in which the ulcer extended right through the stomach or duodenal wall thus allowing the acid contents of the gut to spill out into the abdomen. These complications required urgent surgery and many people unfortunately died.
Nowadays if you are troubled with indigestion, as well as trying the old fashioned (but often surprisingly effective) remedy of milky drinks, you can buy several types of anti-indigestion remedies from the pharmacy. If these medications do not cure your symptoms, or if your pharmacist suggests, it would be wise to see your doctor.
Following your doctor's assessment, he/she may advise you to undergo a telescopic camera examination of the oesophagus, stomach and duodenum known as an OGD (Oesophago-Gastro-Duodenoscopy or 'Gastroscopy'). This is performed in hospital, usually under light sedation, and allows a doctor or specially trained nurse to look at the lining of the gut and see whether any ulcers or inflammation are present and, importantly, to hopefully exclude the presence of any cancer. Small pieces of the lining (biopsies) can also be taken at this time to look for Helicobacter Pylori. In general, people who develop indigestion-type symptoms for the first time from the age of 40 are usually referred for this investigation together with younger people who have certain specific symptoms (eg, weight loss, difficulty swallowing or vomiting blood). Younger people with mild symptoms may initially have their symptoms treated without specific investigation, although an OGD may be recommended if symptoms are not settling, severe or not typical. Treatment includes the use of antacids and acid-suppressing medication.
Antacids can be bought over the counter at pharmacies (eg, Gaviscon, Maalox, Mucogel) and can be very useful for mild and/or intermittent symptoms. They help to neutralise the stomach acid and some are especially designed to form a layer on top of this and thus can be particularly helpful against oesophageal reflux. Many people use these on an "as required" basis.
Acid-suppressing medication consists of two types, the H2-receptor antagonists (eg, cimetidine, Tagamet, ranitidine, Zantac) and the proton pump inhibitors (eg omeprazole, Losec, lanzoprazole, Zoton). These medications reduce the amount of acid produced by the stomach and thereby facilitate healing of any inflamed areas or ulcers. It is important to take these medicines as prescribed by your doctor in order to ensure that any inflammation heals completely. If symptoms recur, it may be necessary to take further courses of treatment and in general we now know it is better to use these tablets for short courses if and when symptoms flare up as opposed to on a regular basis (unless this is necessary to keep symptoms at bay).
These days it is unusual to have to undergo any surgery for peptic inflammation.
Apart from medication, the following tips can help reduce indigestion:
Disclaimer: This page is for informational purposes only and should not be considered as medical advice or substituted for professional advice. Always consult your doctor with your questions and concerns.
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