Category Archives: Stomach Disorders
What Is Gastroesophageal Reflux Disease (GERD)
Gastroesophageal reflux disease or GERD is a condition in which the esophagus becomes inflamed due to the backward flow of digestive acids and enzymes from the stomach into the esophagus.
- When the lower esophageal sphincter malfunctions, materials from the stomach flow back into the esophagus.
- Heartburn or pain and discomfort felt in the middle of the chest is the common symptom.
- Characteristic symptoms help in diagnosing the condition.
- Drug treatment, as well as avoiding food which aggravate the condition, brings relief.
Stomach is naturally protected from the action of the acids by a tough mucous membrane. But esophagus, which does not have this natural protection, becomes severely damaged when the acids and enzymes from the stomach flows backwards into it.
A ring shaped muscle called lower esophageal sphincter protects the esophagus from reflux. But sometimes the action of the sphincter may not be proper and some of the digestive juices and partially digested food pass through the sphincter into the esophagus. The reflux becomes worse when the person is lying down; but when a person is in an upright position, gravity prevents reflux to a certain extent. A full stomach worsens the reflux because the added volume of food and the extra production of acids make the sphincter less efficient in keeping the contents of the stomach out of the esophagus. Obesity is a risk factor for GERD. Caffeine containing beverages, carbonated drinks, alcohol consumption, chocolate and fatty foods are some of the factors that make the condition worse. Some drugs such as antidepressants and antihistamines, drugs used to treat heart failure such as nitrates and calcium channel blockers and the hormone progesterone also have an adverse effect.
When there is a condition called delayed emptying of the stomach, it may increase the likelihood of reflux. It is common among people who are diabetic. Alcohol, coffee and stimulants also add to the risk.
Symptoms and Complications
Gastroesophageal reflux has typical symptoms such as a severe heart burn felt under the breast bone. The pain may extend to throat, neck and facial region and occasionally regurgitation of food may bring stomach contents even up to the mouth. Some patients express their condition as if having acidic stomach.
The esophagus may become inflamed resulting in a condition called esophagitis. If there is bleeding in the esophagus due to esophagitis, blood may come up in vomit or it may be passed in the stool as a dark substance. Passing of such black tarry stools is called melena.
Constant irritation due to the reflux may trigger the development of ulcers on the walls of the esophagus which can result in pain and bleeding.
Difficulty in swallowing with the steady narrowing of the esophagus caused by gastroesophageal reflux. Wheezing and difficulty in breathing may result, if airways are narrowed. GERD precipitates other symptoms such as sore throat, excessive production of saliva, hoarse voice, feeling of having a lump in the throat etc.
Barrett’s esophagus is a condition in which, the constant irritation caused by the reflux induces an abnormal change in the esophageal lining. The cells of the esophageal lining become precancerous and in some instances it may eventually turn into esophageal cancer.
Diagnosis of Gastroesophageal Reflux Disease
When the characteristic symptoms or GERD are present, the diagnosis is made accordingly, without further testing and treatment with drugs is started straightaway. But if the symptoms are not typical or if the initial treatment with drugs has not produced the desired effect, endoscopic examination of esophagus is done. Other useful tests include x-ray imaging, esophageal pH tests and manometry or pressure measurement test of the lower esophageal sphincter. They can confirm the diagnosis and can also check for other possible complications. Barrett’s esophagus or esophagitis can be detected by endoscopy. It can also detect the presence of cancer of the esophagus. X-ray is taken after the ingestion of radio opaque dye such as barium, which can show very clearly, the abnormalities in the esophagus. The patient is made to lie on a bed tilted back to keep the head at a lower level so that the barium solution refluxes into esophagus from the stomach. A slight pressure exerted on the abdomen may increase the reflux and it can be picked up by an x-ray. In addition to determining the extent of the reflux, the test can also detect the narrowing of the esophagus as well as the presence of ulcers.
A sphincter that is working poorly can be detected by measuring the pressure at the lower esophageal sphincter which indicates the strength of the sphincter. In assessing the need and suitability of surgery, this information can be very useful.
Esophageal pH testing is considered the ideal test for GERD. A narrow flexible tube fitted with a sensor probe is guided into the esophagus through the nose. A monitor worn by the patient is connected to the probe and it records the acid levels detected by the probe over a period of 24 hours. The test can correctly determine the actual amount of reflux occurring in the esophagus. It can also correlate between the reflux and the symptoms and it is very useful for people who have symptoms uncharacteristic of gastro esophageal reflux. People who find it difficult to have a tube in the nose can opt for an implantable pH electrode which can transmit data to a receiver outside.
Prevention and Treatment
Certain lifestyle changes as well as drug treatment may help relieve gastroesophageal reflux. Sleeping with head raised about 6 inches (15 cms) can prevent backward flow of acid into the esophagus. Drugs and foods which are known to cause the reflux should be avoided. Patients are advised to quit smoking. Drugs such as metoclopramide or bethanechol can help close the lower sphincter tightly.
Substances which trigger extra acid production and those which delay the emptying of the stomach, such as coffee, cola drinks, orange juice and vinegar, in addition to alcohol, should be avoided.
Proton pump inhibitors are found to be extremely effective in treating gastroesophageal reflux because they inhibit acid production. Since, acid in very small amounts also can result in severe symptoms; these drugs work better than antacids which help to neutralize the acid already produced. However, antacids when taken at bed time offer some relief, especially by relieving pain due to ulcers in the esophagus. Because of the slow healing of the ulcers, active reduction of the stomach acid level for an extended period of one to three months is required to achieve reasonable relief. However, ulcers may reappear any time. After healing too, narrowed esophagus is a possibility.
In addition to drug treatment, dilations of the narrowed esophagus can be done repeatedly, with the use of balloons or by increasing the size of dilators gradually, to correct the condition to a satisfactory level, thereby enabling the patient to eat normally.
The disappearance of symptoms because of the treatment does not mean that Barrett’s esophagus is completely cured. People who have Barrett’s esophagus need to get an endoscopic examination once in 2 or 3 years to make sure that they are not developing cancer due to their condition.
When drug treatment has not brought enough relief from symptoms or when esophagitis has not cleared even after relief from symptoms has been achieved through treatment, surgical option is considered. Surgery can also help avoid the need for long years of drug treatment. A laparoscopic procedure which is minimally invasive is an option but 30% of those who opt for this procedure are found to be developing a difficulty to swallow as well as discomfort in stomach following meals.
GERD Video Summary
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Diagnosis And Treatment Of Peptic Ulcers (Duodenal, Gastric)
Diagnosis Of Peptic Ulcer
Peptic ulcer is suspected when a person complains of the typical kind of pain associated with the condition. Usually, treatment is initiated without further tests and if the symptoms subside with the treatment, it is assumed that the peptic ulcer has been cured.
If the symptoms still persist after several weeks of treatment, further tests are done to determine the exact cause. If weight loss also occurs with the symptoms of peptic ulcer in people over 45 years, tests are conducted to rule out stomach cancer which may produce the same symptoms. When ulcers occur in unusual places, or in unusually high numbers, or if they seem resistant to treatment, overproduction of acids is suspected to be the cause. Further investigations are undertaken to detect the cause of the overproduction.
Endoscopic examination done with the help of a camera attached flexible tube may give a good picture of the condition inside the stomach and duodenum. X-rays taken after the ingestion of a radio opaque dye such as barium provides an outline of the interior wall of the stomach. But endoscopy is preferred over barium contrast x-rays as it is more reliable and also safe for people who have had a gastrectomy surgery. It is also possible to do a biopsy with the endoscope so that the tissue can be checked for Helicobacter pylori bacteria as well as cancer. Bleeding from the ulcer can be stopped with the help of the endoscope.
However, barium contrast x-rays can often give a better idea about the size and severity of an ulcer which may be missed by the endoscope or those ulcers which are hidden by a tissue fold. Ulcers deep down in the duodenum are also detected by barium x-ray.
Treatment Of Peptic Ulcer
Antibiotics often become an integral part of the treatment because of the high incidence of ulcer due to the infection with Helicobacter (H) pylori bacteria. Bismuth subsalicylate is also used along with antibiotics for treatment of h pylori. Drugs that help to neutralize the acids produced or those which reduce the production of acids, when taken for a month or two, often heal the condition. Bland diets which reduce the acid production are often recommended, but there is no proof of their effectiveness in healing the ulcers or preventing their recurrence. However, people are encouraged to avoid those items of food which trigger bloating and pain, as well as NSAIDs and other substances such as nicotine and alcohol which may irritate the stomach.
Antacids: Antacids do not play a direct role in healing the ulcers, but they relieve symptoms and increase the pH level of the stomach, indirectly helping with the healing process by providing an environment that is conducive to the healing of the ulcer. They also help in avoiding a recurrence. Antacids are available as over the counter drugs and both tablets and liquid suspensions can be purchased without a doctors’ prescription. But, if the person is taking other drugs, the possibility of drug to drug interactions should be discussed with a doctor or qualified pharmacist.
Baking soda or Sodium bicarbonate as well as calcium carbonate, are strong, quick-acting antacids which can be taken occasionally, but regular use may cause headache and nausea as a result of those substances making the blood alkaline. Use of antacids should be limited to a few days at a time, and it should be completely avoided by people who have hypertension or heart failure, because they are high in salt.
Aluminum hydroxide is a milder antacid which can be safely used by those who are on low-sodium diet, but they cause reduction of calcium and phosphate levels in the blood leading to loss of appetite and weakness. People who have kidney disease and those on dialysis may suffer severe side effects from aluminum hydroxide. It may precipitate constipation too.
Magnesium hydroxide does not cause constipation but if more than 4 doses taken in a day, it may result in diarrhea. Since it is more effective compared to aluminum hydroxide, it is commonly used for fast and effective neutralization of acids. The downside is that magnesium gets absorbed by the blood, which may be harmful for people who have kidney damage. Sometimes a combination of aluminum hydroxide and magnesium hydroxide is used as an antacid. As a general rule, people who have disorders such as high blood pressure, heart disease or kidney disorder should consult a doctor, to help them choose the antacid which may be least harmful to them.
Acid-reducing Drugs: Some drugs help in relieving the symptoms of peptic ulcer and promote the healing of the condition by inhibiting the production of acids. Proton pump inhibitors belong to that group, and they also happen to be the most effective in accelerating the healing process. Zollinger-Ellison syndrome, which causes overproduction of stomach acids, also can be effectively treated with histamine-2 blockers.
Histamine-2 (H2) blockers reduce the amount of acids produced by the stomach. Most of the H2 blockers such as, famotidine, andranitidin, nizatidine, are found to be without any serious side effects except for cimetidine which is known to cause confusion in older people, in addition to interfering with the elimination of asthma drug theophylline, anticoagulant warfarin and anti seizure drug phenytoin.
A protective layer formed at the base of the ulcer by Sucralfate is found to accelerate the healing of the ulcers. This is especially beneficial to those who cannot take an antacid due to other reasons. Since this drug is not absorbed by the blood, it has fewer side effects, though it causes constipation. Also, sucralfate is known to make other drugs less effective.
Misoprostol is another effective drug which reduces the acid production of the stomach, while it also makes the lining of the stomach resistant to the action of the acid. It also protects against development of ulcers in the stomach and in the duodenum due to the damaging effect of NSAIDs. People who take corticosteroids and aspirin find misoprostol beneficial, especially if they are prone to developing ulcers as a result taking those drugs. It is of benefit to the older people too.
However, misoprostol is not suitable for pregnant women, as it is known to cause spontaneous abortions. 30% of people who take this drug have side effects such as diarrhea. People taking aspirin, NSAIDs, or corticosteroids can substitute misoprostol with proton pump inhibitors, if the side effects of misoprostol are unpleasant.
Surgery: With the availability of effective drugs to cure peptic ulcers, surgery is no longer considered a treatment of choice. It is possible to stop the bleeding of an ulcer using endoscope. But surgery may become necessary, if peptic ulcer has perforated the wall or if edema due to ulcers have caused blockage to the smooth passage of food. When cancer is detected or when there is severe bleeding from several ulcers, surgical procedures are resorted to. But as in any other surgery, possible risks due to surgery should be carefully weighed against the benefits.
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What Is Peptic Ulcer And Can You Highlight Its Causes And Symptoms
What is Peptic ulcer ? Peptic Ulcer is a sore resulting from the mucosal erosion of the wall of the stomach or that of the duodenum, due to the action of strong digestive acids and enzymes or due to infections.
- Helicobacter pylori infection and drugs which irritate the stomach and intestinal lining may cause peptic ulcers.
- Stomach pain and discomfort are the usual symptoms, which appear intermittently.
- The characteristic symptoms of the disease help in diagnosis. Endoscopic examination of the stomach can confirm it.
- Treatment focuses on reducing the acidity in the stomach. Antibiotics are used to treat Helicobacter pylori infection.
Ulcers can form as a result of gastritis. They can grow deep into the stomach lining or into the lining of the part of small intestine called duodenum. According to the location of the ulcer and the reason for its origin, different names are given to peptic ulcers.
Those ulcers which develop in the duodenum are called duodenal ulcers; they are the most frequently occurring peptic ulcers. Usually duodenal ulcers are restricted to the first two or three inches of the small intestine.
Gastric ulcers form inside the stomach, usually on the upper curve, but they are not as common as the duodenal ulcers. When partial gastrectomy is done, ulcers may form where the rest of the stomach joins the intestine and they are called marginal ulcers.
Stress ulcers resulting from acute stress gastritis, due to severe burns or prolonged illness or traumatic injury, can develop not only in the stomach, but also in the duodenum or in both at the same time.
Causes Of Peptic Ulcer
Bacterial infections and certain drugs act as irritants and disrupt the normal tissue repair and renewal process of the lining of stomach and the small intestine. This weakens the protective mucous lining and makes it susceptible to the damaging action of the strong digestive acids and enzymes.
Helicobacter pylori which survive in the highly acidic environment of the stomach and upper part of the small intestine, is found to be a major cause of peptic ulcer. Prior to the development of antibiotics to tackle Helicobacter pylori, the incidence of this bacterial infection used to be as high as 90% in people having ulcers in the duodenum. The new treatments available have significantly lowered it down to around 50%.
Regular use of aspirin and frequent use of other NSAIDs such as ibuprofen and the use of corticosteroids are known to cause irritation to the protective layer of mucous which lines the inner wall of the digestive tract. When the mucous lining is damaged, the strong acids and enzymes produced by the digestive glands eat into the wall of stomach and small intestine causing ulcers. Not everyone who takes these drugs get peptic ulcer; some people are at a greater risk of developing it due to their inherent nature. Those in the higher risk group are advised to take NSAIDs belonging to the group called COX-2 inhibitors or coxibs instead of the other NSAIDs which are known irritants. But the greater risk of stroke and heart attack associated with coxibs make them unsuitable for long term use. As an alternative to coxibs, especially for those have other risk factors for stroke and heart attack, the usual NSAIDs along with a proton pump inhibitor which prevents the production of stomach acids can be taken.
Smoking is found to have an adverse effect on gastric health; not only that smokers are more prone to developing ulcers, but that their ulcers take longer to heal also.
Emotional stress is not considered a risk factor for developing peptic ulcer even though it is known to enhance the production of stomach acids.
Zollinger Ellison syndrome is a rare cancerous condition which results in the increased production of stomach acids and the development of ulcers due to it. These ulcers may be cancerous and the usual treatment for noncancerous peptic ulcers may not work for them even though the symptoms may appear similar.
Symptoms Of Peptic Ulcer
The symptoms of peptic ulcer appear intermittently because the ulcers keep appearing ad disappearing. There may be pain free periods in between episodes of painful flare ups. Peptic ulcers in older people as well as in children may be asymptomatic till other complications due to the ulcers start appearing.
Some people have the characteristic symptoms of duodenal ulcers such as a burning or soreness felt right below the breastbone. The steady pain felt by some people may be severe or mild but others may have a feeling of hunger or an empty feeling instead. Pain may not be felt early in the morning but gradually develops as the day progresses. Often temporary relief may be achieved by food and drink, especially milk, which neutralizes the acids or by taking antacids. The pain may return after a few hours, though. Occasionally, pain may be severe enough to wake a person up at night. After a period of pain and discomfort, the symptoms may disappear completely without any treatment, only to return after several weeks to a few years later. Many people with the disease can often predict when a flare up can happen. Episodes are usually more frequent in spring as well as in fall. Periods of stress, either physical or emotional, also may trigger an episode. But half the people with duodenal ulcer may not have any of these symptoms.
No characteristic pattern can be observed in the symptoms produced by gastric ulcers or marginal ulcers. Stress ulcers also do not have any typical symptoms. Food intake may either bring relief or make the pain worse. If edema due to gastric ulcers extends into the duodenum, it may obstruct the passage of food from the stomach, resulting in nausea and vomiting after a meal. Persistent bleeding or rupture of the peptic ulcers may cause fainting or light headedness as a consequence of the low blood pressure precipitated by the severe loss of blood.
Peptic Ulcer Video Summary
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What Is Gastritis and What are its Causes, Symptoms and Treatment
Gastritis is the inflammation of the inner lining of the stomach.
- Stomach infections, and injury caused by the action of digestive acids, enzymes and drugs on the lining of the stomach, or auto-immune disorders, may be the cause of inflammation.
- Gastritis may be either asymptomatic or there may be pain and discomfort in the abdominal area and occasionally nausea and vomiting too.
- Typical symptoms of gastritis help doctors to diagnose the condition, but sometimes an endoscopic examination may be required to confirm the diagnosis.
- Antacids, which neutralize the action of stomach acids, are used as the first line of treatment.
Normally, the lining of the stomach is equipped with the capacity to withstand the action of strong digestive acids, but if the lining of the stomach gets irritated, inflammation results, precipitating gastritis.
Causes Of Gastritis
Injury to the lining of the stomach resulting from infections, or from the regular use of drugs such as aspirin, may be the cause of gastritis. Auto immune diseases that attack the stomach lining may also cause this condition.
Helicobacter pylori bacteria, which colonize the stomach, may be a major contributor to gastritis. Other bacterial, viral or fungal infections can also cause gastritis. People with an immune system that is impaired due to AIDS or by the use of immunosuppressant drugs, as well as those who have cancer or prolonged illnesses are particularly prone to gastritis.
Along with inflammation, if the stomach lining is wearing away too, such a condition is called erosive gastritis. Regular intake of aspirin and frequent use of NSAIDs or nonsteroidal anti-inflammatory drugs such as ibuprofen may irritate the lining of the stomach, resulting in erosive gastritis. Ingestion of chemicals which are corrosive in nature and infections due to viruses and bacteria as well as Crohn’s disease are known to cause erosive gastritis. Generally, this condition develops gradually and often affects people who are healthy in all other aspects.
A sudden injury, or a severe illness, elsewhere in the body, can cause a type of erosive gastritis called acute stress gastritis; the reason for which is unknown. It is assumed that the stress to the body caused by severe burns, or heavy blood loss, may be impairing the ability of the lining of the stomach to renew and repair itself, because of the reduced blood flow to the stomach due to its more urgent demand elsewhere.
Damage caused to the lining of the stomach, due to radiation which is delivered to the mid-area of the torso, for investigative or treatment purposes can result in radiation gastritis.
After a gastrectomy surgery to remove a part of the stomach, inflammation often develops in the area around the sutures, leading to a condition called postgastrectomy gastritis. It is assumed that postgastrectomy gastritis is caused either due to the stomach lining being exposed to large amounts of bile produced by the liver, or due to the temporary disruption in the blood flow to the lining, caused by the surgery.
When there is thinning of the inner lining of the stomach, with the consequent loss of digestive acid and enzyme producing cells in the lining, such a condition is called atrophic gastritis. It may occur in people who have undergone partial gastrectomy and in those who have chronic Helicobacter pylori infection. A condition called autoimmune gastritis results, when the lining of the stomach is attacked by the antibodies produced by the body itself.
Sometimes, white blood cells called eosinophils crowd on the walls of the stomach as an immune response to an irritant, usually a round worm infestation, resulting in eosinophilic gastritis.
When another kind of white blood cells called lymphocytes crowd in the stomach walls, it results in lymphocytic gastritis. A malabsorptive disorder called celiac sprue is known to be caused by the accumulation of lymphocytes in the upper part of the small intestine.
Ménétrier’s disease is a peculiar kind of gastritis in which the wall of the stomach becomes riddled with thick folds, enlarged digestive glands and cysts with fluid accumulation in them. The cause is assumed to be a chronic infection by Helicobacter pylori bacteria or an auto immune response.
Symptoms and Complications
Gastritis may be asymptomatic or symptoms such as discomfort and pain in the upper abdomen or a feeling of nausea and vomiting, may be present, which are generally attributed to indigestion. If a peptic ulcer develops due to gastritis, symptoms are more severe.
Ménétrier’s disease and erosive gastritis often cause nausea and occasional vomiting. These symptoms can also develop due to lymphocytic gastritis and radiation gastritis too. Acute stress gastritis causes a very mild form of dyspepsia or indigestion. Radiation gastritis, atrophic gastritis, erosive gastritis and postgastrectomy gastritis can cause severe dyspepsia, due to the reduced production of digestive enzymes by the damaged lining of the stomach.
Radiation gastritis and erosive gastritis often lead to the formation of ulcers which may start bleeding, resulting in hematemesis or vomiting of blood or melena (having stools of black color due to the blood content in them). Ulcers are most common in acute stress gastritis and they typically start bleeding in the first few days following a critical injury or severe illness. On the other hand, ulcers due to erosive gastritis or radiation gastritis cause bleeding gradually, over a period of time.
Prolonged bleeding due to the ulcers caused by gastritis can precipitate anemia, and its typical symptoms such as weakness, dizziness and fatigue. If an ulcer perforates the wall of the stomach, the contents from inside the stomach may enter the abdominal cavity, setting off peritonitis, which is the inflammation of peritoneum that lines the abdominal cavity. A suddenly worsening abdominal pain may be an indication, of the inflammation of peritoneum or the possible development of infections.
Gastritis can cause the narrowing of the outlet from the stomach, which can result in frequent vomiting accompanied by a persistent feeling of nausea. This is typical of eosinophilic gastritis, and occasionally, it may be caused by radiation gastritis too.
In Ménétrier’s disease, edema may result from fluid retention due to the inflammation of the stomach lining. The risk of developing stomach cancer is high in people with Ménétrier’s disease, with about 10% of people with this condition developing it within a few years. People who have atrophic gastritis are prone to developing metaplasia, a condition in which precancerous cells develop in the lining of the stomach; it has the potential to cause stomach cancer in some people. Severe fatigue due to anemia, is found in people with atrophic gastritis as well as postgastrectomy gastritis, because, absorption of Vitamin B12 becomes impaired due o the absence of the intrinsic factor which binds to B12, facilitating its absorption and use in RBC production.
Diagnosis
Gastritis is suspected when people complain of nausea, pain and discomfort in the upper part of the abdomen. Without further tests, treatment with antacids is started, but if the symptoms persist, endoscopic examination is conducted to get a better picture of the interiors of the stomach. A biopsy of the tissue taken from the lining of the stomach may also be done, if required.
Treatment Of Gastritis
The first line of treatment focuses on relieving the symptoms rather than curing the cause. When the symptoms are mild, antacids to neutralize the stomach acid are prescribed. The drugs which contribute to gastritis are discontinued or substituted by safer ones. But antacids need to be taken frequently, and they have side effects too; they cause either diarrhea or constipation. Drugs such as proton pump inhibitors and histamine-2 (H2) blockers are found to be more convenient and effective than antacids, but the former is reserved for severe cases of gastritis. Antibiotics are given too, if there is some infection along with the inflammation. Sucralfate, which reduces irritation, is often prescribed along with the other drugs. Surgical correction of the wall of the stomach may be necessary, if an ulcer has perforated it.
NSAIDs which irritate gastric lining should be avoided by those who have erosive gastritis, and COX-2 inhibitors such as celecoxib may be taken instead, when necessary. They should be used sparingly though, as long-term use of coxibs is a risk factor for stroke as well as heart attack. Often, proton pump inhibitors or misoprostol are given as they afford some protection to the lining of the stomach.
Acute stress gastritis may eventually resolve by itself, once the injury that has caused it, is brought under control. But, people who are still critically ill, several days after the injury, have a high risk of dying from bleeding caused by acute stress gastritis. To avoid this dangerous situation, drugs which decrease the production of acid and prevent ulcers from developing, are routinely given to post operative patients and those in the intensive care unit following severe injuries. Several other attempts at overcoming the risk of death due to bleeding ulcers, such as blood transfusion or cauterization of the ulcers while performing an endoscopy, have not been successful. Surgical removal of the stomach may be the only available option, to save the life of the patient, if bleeding persists.
When anemia is caused by malabsorption of vitamin B12 due to atrophic gastritis, lifelong injections of B12 are the only remedy, as this condition is incurable. Postgastrectomy gastritis also does not have any cure, the same as atrophic gastritis.
If eosinophilic gastritis causes blockage of the outlet from the stomach, treatment with corticosteroids is tried, but if it is not successful, surgical correction may be necessary. In the absence of any effective treatment with drugs, surgical removal of all or part of the stomach is the remedy for Ménétrier’s disease.
Gastritis Video Summary