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Stomach

The stomach is an important part of the digestive system. It lies on the upper part of the abdomen. The food-pipe (esophagus) opens into the stomach, which is a sac or reservoir for ingested food and it is surrounded by thin layers of muscle. The other end of the stomach is connected to the small intestine. 

The functions of the stomach include:

  1. Produce acid: The lining within the stomach produces strong acid which nearly kills most of the bacteria in the food. This acid does not harm the stomach because of its special resistant lining with acid neutralising capabilities.
  2. Absorption of Vitamin B12: The stomach secretes a special protein (known as intrinsic factor) which binds to natural vitamin B12 in the diet and helps in its absorption.
  3. Digestion: The stomach also helps in the digestion of fats through certain enzymes. The muscles surrounding the stomach contact and relax rhythmically resulting into churning of the food within the stomach and breaks it down into small particles. The small particles make it easier for it to be digested in the small intestine later on.
  4. Regulation of hunger and satiety: The stomach stores the food that we eat till it is churned into small particles and passes them onto the intestines. As we eat, and the food reaches the stomach, it expands actively. This is particular for the region of the stomach known as the “fundus”. This phenomenon is called as “accommodation” of the stomach. The level of the hormones that induce hunger like Ghrelin decreases and the hormones producing satiety like Leptin increase after food reaches the stomach. 

The diseases affecting the stomach:

Dyspepsia/ Acidity:

This is one of the commonest problems related to the digestive system. The main symptoms include pain or burning sensation in the upper part of the abdomen. This usually happens after meals but can occur on an empty stomach as well. The severity can vary from a very mild discomfort to severe pain requiring emergency visit to the hospital. The reason maybe inflammation in the inner lining of the stomach from high acid or a compromised defence mechanism of the stomach. Sometimes there maybe presence of ulcers which maybe tiny(erosions) to large in size. This is very common with an infection by a bacteria called as Helicobacter Pylori. It can happen due to infections, a number of other immune related diseases or as side effect of medicines. The symptoms maybe exaggerated with stress, depressed mood and anxiety. An endoscopy is required if such symptoms persist over a long period of time or there are alarming features like weight loss, bleeding, low haemoglobin, old age, family history of cancer etc. The treatment is only required if the symptoms are bothersome. The treatment is usually oriented to decrease the acid production.

Post prandial distress syndrome:

The patients usually complain of a bloating, fullness or a tightness sensation after taking a meal. This is commonly referred to as “gas”. There are a number of reasons for this. It could be due to slowed movements of the stomach leading to accumulation of gas and other content in the stomach or due to incoordination between stomach contraction and its emptying into the small intestine. The symptoms maybe functional, i.e. they occur with a normal functioning stomach. The symptoms maybe exaggerated with stress, depressed mood and anxiety. An endoscopy is required if such symptoms persist over a long period of time or there are alarming features like weight loss, bleeding, low haemoglobin, old age, family history of cancer etc. The treatment is only required if the symptoms are bothersome. The treatment usually includes medicines to make the stomach work faster.

Helicobacter Pylori infection:

This is a bacterium that infects the stomach lining and causes it to lose its defence to the acid. It may or may not cause a high acid output. It can cause dyspepsia and stomach ulcers and rarely cancer as well. This bacterium is very prevalent in India, seen in upto 40-50%. It can be detected on endoscopy, by stool test or by a special breath test. It is treated by a 10-14 day course of antibiotics.

Gastroparesis:

The speed of emptying of the stomach contents into the small intestine is slowed leading to accumulation of food for a prolonged time in the stomach. This leads to feeling of bloating, fullness or a tightness and may lead to vomiting. These patients also may suffer from constipation. The reason for such slowing down include diabetes, previous surgery in the stomach or from unknown reasons. The treatment usually includes medicines to make the stomach work faster.

Impaired relaxation of fundus:

The part of the stomach known as fundus expands actively when food enters that part. It acts as a storage area for food. This phenomenon is known as “accommodation”. This process may get impaired and give rise to feeling of early satiety. The patients typically feel that they are unable to eat their complete meal as they “feel full” prematurely. The exact reason for this impairment in the accommodation is not known. There are medicines available to correct this.

Cancer of the stomach:

It is the second most common cause of cancer related deaths among Indian men and women in the age between 15 and 44.  There is some regional variation in India with high incidence in Mizoram, Tamil Nadu and Bangalore with low incidence in Gujarat. The risk factors for stomach cancer include infection by Helicobacter pylori, smoking and tobacco use, alcohol, and rarely genetic causes. The symptom could range from pain, vomiting to fullness with weight loss, formation of a lump and bleeding. It can be detected by endoscopy. Treatment depends on the stage. Early detection makes cure possible.

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