Gastrointestinal

Diseases Related to Stomach Acid

Stomach acid-related diseases are generally a group of conditions that develop due to excess stomach acid or a disruption of the stomach’s protective barrier. The most common of these is Gastroesophageal Reflux Disease (GERD), in which stomach acid flows back into the esophagus; gastritis, which is characterized by inflammation of the stomach’s inner lining; ulcers, which develop due to damage to the mucosa of the stomach or duodenum; and Zollinger-Ellison Syndrome, which is characterized by excessive acid production.

Gastroesophageal Reflux Disease (GERD)

is a condition caused by the backflow of stomach acid into the esophagus, leading to symptoms such as heartburn and regurgitation.

In addition to retrosternal burning and regurgitation, it may present with respiratory symptoms such as cough, hoarseness, and pharyngitis, or with chest pain. Gastroesophageal reflux disease is recognized as one of the most common chronic conditions among adults in our country, just as it is worldwide. A study conducted in our country found that 23% of the population has reflux disease. Although it is mostly treated with PPI-class medications, these drugs only temporarily relieve symptoms, and some patients experience these symptoms for the rest of their lives.

Gastritis

It is an inflammation of the stomach lining. Tissue damage does not extend beyond the mucosa. In an ulcer, however, the damage extends through the submucosa and reaches the muscularis layer. Gastritis can develop for various reasons.

• Infection (H. pylori),
• Medication use (aspirin, NSAIDs),
• Excessive alcohol consumption,
• Advanced age,
• Stress,
• Major surgeries, accidents, burns, serious infections,
• Cancer treatment,
• Autoimmune conditions (such as Hashimoto’s thyroiditis and type 1 diabetes) and other causes (HIV, Crohn’s disease, celiac disease, sarcoidosis, and parasitic infections) can be cited.

As a result of a compromised mucosal barrier, epithelial irritation develops due to the effects of acid. It is generally asymptomatic. Epigastric pain, loss of appetite, nausea and vomiting, and, rarely, gastrointestinal bleeding may occur.

Eradication of H. pylori is recommended in all patients with evidence of gastritis. Empirical use of PPIs is effective in alleviating symptoms.

Peptic Ulcer

Peptic ulcer remains one of the leading causes of lost workdays and economic losses worldwide.

A peptic ulcer (PU) is tissue loss caused by stomach acid and pepsin that extends beyond the mucosal layer into the muscle layer of the stomach and duodenum. Typically occurring in the stomach and duodenum, the disease’s typical symptoms include epigastric burning, pain occurring after meals or on an empty stomach, and waking up at night due to pain. It generally results from excessive secretion of stomach acid or a disruption in the stomach cells’ defense mechanisms. The most significant known risk factors are a bacterium called H. pylori, nonsteroidal anti-inflammatory drugs (NSAIDs), and smoking.

The prevalence of H. pylori varies across regions in Turkey; some studies have reported rates of around 40–60%.

NSAID-associated ulcers, on the other hand, represent a significant public health issue, particularly among the elderly.

The most serious complication of ulcers is bleeding. Treatment involves the use of acid-suppressing medications. In cases where H. pylori is detected, antibiotic therapy is administered to prevent ulcer recurrence.

Dyspepsia

Indigestion (dyspepsia) can be defined as a feeling of fullness after eating, or pain or a burning sensation in the upper abdomen. One or both of these symptoms may be present simultaneously. Indigestion is a very common complaint. In Turkey, the prevalence of dyspepsia among patients seeking care at primary care facilities was found to be 44%.

Diagnosis depends on ruling out other diseases that could cause these symptoms, and the relevant investigations should be conducted by a gastroenterologist.

• Polyuria: Urinating more frequently than normal (especially at night).
• Polydipsia: Excessive thirst and a sensation of dry mouth.
• Polyphagia: Increased appetite or a constant feeling of hunger.
• Fatigue: Weakness caused by the body’s inability to produce energy from sugar.
• Delayed Healing: Wounds that heal more slowly than normal and recurrent infections.

Diagnostic Criteria for Functional Dyspepsia (Rome IV 2016)

1. One or more of the following must be present.

• Postprandial fullness (discomfort)
• Early satiety (discomfort)
• Epigastric pain (discomfort)
• Epigastric burning (discomfort)

2. There is no evidence of an underlying structural disease that would explain the symptoms. Upper gastrointestinal (GI) endoscopy should be normal.

(Symptoms must have begun at least 6 months prior to diagnosis, and diagnostic criteria must have been present at least once a week for the past three months.)

Indigestion may be treatable with medication. Empirical PPIs, tricyclic antidepressants, and prokinetics are used in treatment; in treatment-resistant cases, repeated courses of medication and psychiatric support may be required.

Zollinger-Ellison Syndrome:

Zollinger-Ellison Syndrome involves a gastrin-secreting tumor (gastrinoma). It is a rare condition caused by tumors in the pancreas or duodenum that force the stomach to produce excessive amounts of acid. An ulcer-like presentation develops, but it does not respond to standard treatments. It causes widespread ulcers in the digestive system.

Treatment for Zollinger-Ellison syndrome is primarily based on controlling excessive stomach acid and managing the gastrinoma tumors. The first and most important treatment is high-dose acid suppression with proton pump inhibitors (PPIs). While localized tumors are removed surgically, chemotherapy or targeted therapies are also used in cases of metastasis.