Dr. Jeff Larsen

Gastritis and its associate, ulcers, are common causes of upper abdominal pain. In their early incarnations, they are frequently the culprits causing what is often described as “heartburn.” In more serious and advanced stages of both these diseases, severe illness and even death can occur. The conditions are different, but in many ways related. They are related enough to review in the same discussion.

Gastritis and ulcers both cause pain between the bellybutton and the bottom of the breastbone. This region is referred to as the “epigastrium” in medical terms. The symptoms of both may improve by eating some foods and taking antacid pills. Gallbladder disease hurts in the same area when it begins, but is not made better by food or antacids. In their final stages, ulcers and gastritis can both cause severe and life-threatening bleeding and ruptured bowels.

Why do we get ulcers and gastritis and what are they? Normally, the stomach contains strong acid to help us digest our foods. After we eat, food enters the stomach from the esophagus (the food tube that connects the mouth to the stomach) and acids in the stomach start to break down the foods so they can ultimately be absorbed into the body. The stomach contains a thick layer of mucus that protects it from its own acid. After the food leaves the stomach, the body neutralizes the acid with secretions from other organs, which keeps the bowels (small intestine) from being eaten up by the acid.

Anything that breaks down normal functioning of this portion of the body can lead to gastritis and ulcers. Gastritis is irritation of the lining of the stomach. Ulcers are areas of deeper inflammation that makes holes in the stomach and bowels. When these holes get deep enough, they can cause the stomach or small bowel to rupture. Ulcers can eat into blood vessels, causing bleeding that can kill within minutes or hours.

What are the things that cause ulcers and gastritis? Some of the things that may do this are:

•  Medications, specifically NSAIDs, that is, things like ibuprophen, asprin, Naproxen, “Goody’s powders,” “BC powders,” etc.;

• Stress;

• Things we consume like coffee, excessive alcohol, spicy foods, etc.;

• Medical illness;

• Infections of the stomach;

• Tobacco products;

• Some illegal drugs;

• Poor nutrition;

• Unusual conditions in which the body produces too much acid.

If you have symptoms that make you wonder if you have ulcers or gastritis what should you do? First do the things you can on your own. Avoid stress (that is hard to do!). Avoid taking too many NSAIDs. Avoid foods and habits that may cause ulcers.

Taking over-the-counter antacid medications for a week of two may be helpful to determine if the problem is more likely to be one of these two culprits or something else. You should not continue to take these medications for more than a few weeks without consulting with your doctor. If these things don’t work, you need to see your doctor. If your doctor thinks you have ulcers or gastritis, she or he will likely start you on medication and possibly run labs or obtain other tests.

It is possible that you may be referred to a specialist who can perform a test called an “esophagogastroduodenoscopy.” That word is a mouthful, so it is usually called an “EGD” or upper endoscopy for short. An EGD allows direct camera evaluation of the stomach and the area of the small bowel where ulcers are. It is the best test to diagnose problems of the lining of the stomach and the part of the small bowel were most ulcers live. It tells us with certainty that we have ulcers or gastritis. It allows the identification of infections that may be causing these conditions. An EGD is painless and very safe.

What happens if you have ulcers or gastritis and don’t treat them? In the past, no doubt, many people had miserable digestive problems and died untimely deaths from both these conditions. In the generation before acid reduction medications and EGDs were available, many people still died from the complications of ulcers and gastritis. The treatment was large, debilitating operations that removed parts of the stomach and cut the nerves to the stomach that control acid production. Now, with the advent of modern medical care and the knowledge of risk factors, most people can simply go to their doctor, review risks factors, possibly have some tests, take prescription medications, and sometimes see a specialist to have an EGD.

Alaska is a place known for strong individualism. It is a place where a person can choose to live, or find themselves living, as people did before the advent of modern medical care. It is a place that naturally provides us with many of the risk factors for gastritis and ulcers. All these factors come together to have many Alaskans in a situation not much different from the time when people died regularly from gastrointestinal problems. If you have pains in your upper abdomen, nausea, vomiting, vomiting of blood, weakness or dark bowel movements, it may be ulcers or gastritis. Go to your doctor. It could save your life.

Well, it is time for me to close for today and go learn something new about fishing — there is a lot more to fishing up here than when I was a kid catching catfish on a cane pole!

Good health to everyone!

Jeffrey A. Larsen, MD, is a board certified general surgeon who practices in the Specialty Clinic at Providence Kodiak Island Medical Center in Kodiak.

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