Acidity is very common; however, the discovery of a microbe called H plylori has thrown open a world of problems
����I am sorry I cant eat spices I have acidity. My doctor has advised me not to drink alcohol as I have acidity. These oft repeated statements are common parlance today. In addition, most patients attribute their various symptoms from headaches to as distant as urinary burning to acidity. It seems to be a common bogeyman for a host of symptoms and diseases.�
����Acid is secreted in the stomach by parietal cells. The internal lining of the stomach is subject topepsin, bile salts and number of exogenous substances such as alcohol, bacteria and pain killers each with a propensity to damage the stomach lining. The body�s response to the noxious substances is to secrete bicarbonate and mucous to prevent damage to the internal lining of the stomach called mucosa. If the mucosa is breached, the cells bordering the site of injury can migrate to a damaged region to repair and restitute it to normal. It always makes me imagine the wonderful reparative capacity the body has.It is capable of regeneration.�
����Nitric oxide, the wonder chemical of the human body is necessary to maintain the integrity of the stomach lining ,the mucosa.This is also secreted by the lining of the heart arteries and is essential for maintaining heart health.�
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Several manipulations to increase this substance have been tried particularly by anti-aging clinics. A major cause of damage to the stomach lining these days are pain killers. To make pain killers less stomach damaging, the later variety known as COX 2 inhibitors were developed. They have the propensity to decrease tissue inflammation. Sadly, however, they increase the risk of heart disease. As medical students, we thought that all stomach acid diseases, then termed peptic ulcer disease, was from hurry, curry and worry. Back then if you said that peptic ulcer was infectious, you were sure that your exam papers were terminated then and there.�
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True to paradox, in 2005 Barry Marshall and Robin Warren were awarded a Nobel Prize for discovery of a microbe called H pylori. They had extensiveinvestigationinthe1980swhentheinitial work of H pylori was published in a prestigious journal. The medical world laughed at such a concept how could acidity be an infectious disease - they asked. However, we bite our tongues now at the impact of these organism H pylori on the human body. It has been termed a carcinogen by the World Health Organisation and has been associated with cancers of the stomach. In fact, the journey of these two initial researchers has been epic.�
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In January 1983, they identified this organism, called it Campylobacter Pylori but the gastroenterologists society of Australia deemed it amongst the 10% of worst paper submitted and was rejected. It was however accepted in Brussels. In June 1984 when a leading internal medicine journal published their report, it was heavily criticised.To
prove his point Marshall then consumed H pylori and fell ill and treated himself with antibiotics to affect a cure. A New York Times journalist said he had never seen the medical community more defensive or critical of a study in regard to H pylori. H pylori play a massive role in the development of gastric cancer called MALT lymphoma. It is prevalent around the world and thereby its existence depends on the overall hygiene standards of living. In the developing world H pylori affects 80% of the population by age 20. In contrast its prevalence in industrialised countries is 20 to 50%. Transmission of this organism may occur from person to person and is associated with developing countries, domestic crowding, unsanitary living conditions, unclean food and water or exposure to stomach contents of an infected individual.�
����There may be a genetic factor responsible for the infection as well. It can be measured by serology in the blood or by examining the stool for the antigen. Histology and culture and the rapid ureasetest require an endoscope be done and a biopsy taken. Study shows that H pylori is linked to heart disease and stroke as well. Some initial data also suggests an increase in the good cholesterol HDL after treating H pylori with antibiotics. There is also a genetic make up of peptic ulcer disease and first degree relations of duodenal ulcer patients are three times as likely to develop the disease. People with blood group O are also more likely to develop peptic ulcer disease. Smokers in particular are more prone not only to ulcers but also complications of ulcers. Moreover, smoking impairs healing of ulcer. Patients with heart disease, renal failure, chronic lung disease, kidney stones, chronic pancreatic disease and cirrhosis are also prone to peptic ulcers. Peptic ulcers may be in the first part of the intestine called the duodenum. They are very common and do not become cancerous. But stomach ulcers which occur later in life can become cancerous.�
����Pain in duodenal ulcer occurs typically in the upper abdomen, in the middle just below the central chest bone, the sternum. A diet full of spices, H pylori and pain killers are the most causative features of pepticulcer disease. Endoscopy detectsulcers in less than 30% of patients who present with dyspepsia.�
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It is less common to see dreaded complications of ulcers, like bleeding and perforation after the advent of effective acid reducing drugs, which we commonly saw through decades ago Proton pump inhibitors, H2 receptor blockers, antacids, cytoprotective agents makes it easy for therapy to be effective.�
����The important message here is that if you suffer from acid peptic disease, be sure you exclude H pylori as a diagnosis. This small bug may land up causing you serious problems, in other systems of the body, more than what you bargained for.
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ALTAF PATEL�THE GOOD DOCTOR ON MODERN MEDICINE AND AGE-OLD COMMON SENSE
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Acid is secreted in the stomach by parietal cells
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