Peptic Ulcer Disease Treatment and Management

Beat Ulcers

The system is all natural and easy to use. You are just minutes away from taking your first steps to having painless days and nights. In less than 2 weeks, you can be totally free from ulcers, living without the pain and feeling free to eat without the thought of pain. All you need do is follow the plan. Beat Ulcers is a step by step guide that shows you how you can eliminate ulcers in as little as 10 days. All you need do is use the readily available natural products in the correct proportions at the correct times. Here is what you will learn in the Beat Ulcers guide: How to Eliminate an Ulcer without the use of medication. How to rid your body of the ulcer causing bacteria and keep it away. How to stop the aching. How to eliminate the burping and bloating. Focus on the root cause of ulcers rather than the symptoms. How to be totally free from pain and sleep soundly at night. How to stop using dangerous medications that are prescribed over and over. Learn the causes of ulcers and how to eliminate them forever.

Beat Ulcers Overview

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Genetic Considerations

While most cases of acromegaly are not inherited, mutations in the GNAS1 gene can cause GH-secreting pituitary adenomas (somatotrophinomas). These can be transmitted in an autosomal dominant pattern. Familial acromegaly may also be a feature of multiple endocrine neoplasia type I (MEN I), an autosomal dominant disorder that includes peptic ulcer disease and pituitary, parathyroid, and pancreas endocrine abnormalities.

How is the harm of a treatment documented

Occasionally, drugs may have serious adverse effects such as allergic reactions, hepatitis, cardiac arrhythmias and gastric ulcer. Despite this, attributing an adverse event to a specific treatment can sometimes be difficult, particularly when the event is rare, unexpected, or appears a long time after the start of treatment. It can also be difficult to recognize an adverse effect when it may occur as part of the natural history of the underlying condition. These challenges are discussed in Chapter 4.

Substrate Selectivity

Common substrates of all OCTs include low-molecular-weight relatively hydrophilic organic cations such as the prototypical cation TEA, the neurotoxin MPP+, and the endogenous compound N-methylnicotinamide (NMN).18'20'32 Several clinically important drugs have been shown to interact with all of the OCTs, including the antidiabetic drug metformin,18 33 and the peptic ulcer drug famotidine,34 demonstrating the broad potential for influence of OCTs on drug disposition and drug action. Figure 2.3 shows the structures of several compounds that interact with OCTs. Table 2.1 lists known substrates and inhibitors of human OCTs.18'20'30'32-38

Treatment Of Bleeding From Esophageal Cancer

Few studies specifically address the use of endoscopic therapy for bleeding from advanced cancers of the esophagus and esophagogastric junction. Nd YAG laser therapy has been used successfully in achieving hemostasis in bleeding tumors (104), with high success rates (90 ) (105), comparable with thermal and injection treatments for peptic ulcer bleeding. PDT has been used to treat bleeding esophageal cancers with good success but the experience is limited (81). In a large study of 215 patients, 31 were treated with PDT for bleeding with or without obstruction. Bleeding was controlled in 29 31 patients (93 ) with one course of PDT (81). One patient required three courses of PDT to control bleeding and obstruction. The other patient failed PDT and was treated with an esophageal stent, primarily for obstruction. Rarely, patients with bleeding tumors have been treated with a covered esophageal stent (48) in an attempt to exert pressure on exposed superficial bleeding tumor vessels.

Adjuvant Radiation Alone for Esophagus Cancer Pre Operative Radiation

This study evaluated postoperative radiation in patients undergoing both curative and palliative resections. Postoperative radiotherapy was associated with increased complications of the intrathoracic stomach including four deaths from bleeding ulcers. The overall median survival was actually decreased in those patients receiving postoperative radiation 8.7 vs 15.2 mo (p 0.02). Radiotherapy did decrease intratho-racic recurrence with a particular benefit seen in patients with residual tumor having a decreased risk of dying from obstruction of the tracheobronchial tree (7 vs 33 , p 0.03). The

Partial Gastrectomy For Benign Disease

The development of carcinoma of the gastric remnant seems to be directly related to the postoperative time interval. Studies have consistently shown no differences between the expected and observed number of cancers occurring within 15 yr after gastric resection. However, the overwhelming majority of these studies do indicate a two- to fourfold increase in the risk of gastric cancer in patients who survived 15 or more years after gastric surgery (54-56). Moreover, an association between initial surgical indication and subsequent risk of stomach cancer has also been shown, with patients, who underwent surgery for gastric ulcer, having a twofold increased risk for stump cancer (54,56).

The Relevance of Considering Integral of Effect as the Outcome Variable

The most obvious applications of PK PD are to describe the time course of a drug effect or clinical response such as changes in blood pressure or pain. However, many clinical responses are more closely related to the cumulative effects of the drug. For example, the healing of a peptic ulcer is the consequence of cumulative inhibition of gastric acid secretion and increase in pH allowing tissue repair. The time course of changes after each dose may be important for acute symptomatic relief of pain, but it is the cumulative effect that leads to the healing response. Another example would be the use of a diuretic to treat acute pulmonary edema. The clinical benefit arises from the cumulative loss of fluid and is not determined by the effect of the drug at particular times after the dose.

How representative are study subjects in clinical trials

A group of Finnish investigators conducted a retrospective chart review.2 The typical eligibility criteria for clinical trials of patients with gastric ulcer were applied to 400 patients hospitalized with the diagnosis of gastric ulcer. Only 29 of the patients met the eligibility criteria and almost all deaths and serious complications such as gastric bleeding, perforation and stenosis during the first five to seven years occurred among those patients who would have been ineligible. Clearly, the testing of H - blockers or other compounds for the prevention of long-term complications of gastric ulcer in low-risk patients should not be generalized to the entire ulcer population.

Nonsteroidal Antiinflammatory Drugs

Several hypotheses have been put forward on the pathophysiology of intestinal damage by NSAIDs 108 , such as, enhanced intestinal permeability, inhibition of cyclooxygenase (COX), enterohepatic recirculation, and formation of adducts. The effects of COX-2 selective inhibitors, which appear to have better gastric tolerability when compared to nonselective NSAIDs, on normal and inflamed intestinal mucosa, as in Crohn's disease or ulcerative colitis, are still largely unexplored. If COX-2 inhibition plays a key role in suppressing the inflammatory process, recent evidence suggests that COX-2 products are involved in maintaining the integrity of intestinal mucosa, in the healing of gastrointestinal ulcers and in the modulation of inflammatory bowel disease (IBD). Animal models of intestinal inflammation have so far yielded conflicting results on the effects of COX-2 selective inhibitors on the intestinal mucosa. It is now clear that NSAIDs do not act through cyclooxygenase inhibition...

Clinical manifestation

Most common in children, who have 25100 red-brown macules or barely elevated papules, usually over the trunk lesion becomes a wheal when rubbed (Darier's sign) solitary mastocytoma usually appears within first month of life rubbery, yellow to brown, plaques, urticate with or without vesiculation after rubbing (bullous urticaria pigmentosa) telangiectasia macu-laris eruptiva perstans brown macules and telangiectasias with erythema, often over upper trunk associated with peptic ulcer disease diffuse mastocytosis bullae in infancy, replaced by doughy skin, with generalized pruritus dermatographism, bullae after minor skin trauma mast cell infiltration of liver, spleen, skeleton, and gastrointestinal tract flushing syndrome, most common in early life

Extreme Mechanism Examples

Most extremophiles are found under unique environmental conditions and are currently not considered significant pathogens or environmental concerns (with the notable exception of Helicobacter and their association with peptic ulcers and survival within the low acid environment of the stomach 61 ). In Helicobacter, two important mechanisms of resistance appear to be active efflux and a urease-mediated production of neutralizing chemicals 6,61 . However, there are other examples of extreme resistance (in addition to dormant forms like endospores discussed previously) that have been linked to product spoilage. Radiation, particularly ionizing radiation, processes based on gamma (g)-rays or electron beams are considered some of the most effective sterilization methods. It was therefore of some surprise to identify nonsporulating gram-positive bacteria that survived an irradiation process in canned products. These bacteria were identified as Deinococcus radiodurans, and other gram-negative...

Patients And Methods

An open, uncontrolled, noncomparative clinical trial was performed in an outpatient gastroenterology unit. Patients of both sexes, aged 18-70 years, with endoscopically diagnosed peptic ulcer of duodenum or aboral stomach, measuring at least 5 mm in size, nonmalignant (Diagnoses 4.9.3. and 3.9.3. of OMED classification), and the presence of H. pylori (confirmed by at least two out of three methods used), were enrolled into the study.

Primary Nursing Diagnosis

Surgery, radiotherapy, and chemotherapy are the major treatment modalities for pancreatic cancer. A distal pancreatectomy, used more often with islet cell tumors than with exocrine cancer, removes only the tail of the pancreas or the tail and part of the body. The spleen is also removed. A total pancreatectomy or a pancreatoduodenectomy (Whipple procedure) is used when cure is the objective. In a total pancreatectomy, the entire pancreas and spleen are removed. The Whip-ple procedure involves removal of the head of the pancreas, distal stomach, gallbladder, pancreas, spleen, duodenum, proximal jejunum, and regional lymph nodes. The procedure induces exocrine insufficiency and insulin-dependent diabetes. A pancreatojejunostomy, hepaticoje-junostomy, and gastrojejunostomy are performed with the Whipple procedure to reconstruct the gastrointestinal (GI) system. A vagotomy is usually done in both procedures to decrease the risk of peptic ulcer.

Surgical Stomach Esophageal and Duodenal Procedures Age 17 with CC

Peptic ulcer disease refers to ulcerative disorders in the lower esophagus, upper duodenum, and lower portion of the stomach. Approxiamtely 4 to 5 million people in the United States 710 Peptic Ulcer Disease have peptic ulcers, which are sharply circumscribed breaks of the mucosa that may extend through the tissue layers of the muscle and serosa into the abdominal cavity. The types of peptic ulcers are gastric and duodenal, both of which are chronic diseases. Stress ulcers, which are caused by a physiological response to major trauma, are clinically distinct from chronic peptic ulcers. Gastric ulcers are less common than duodenal ulcers and usually occur in the lesser curvature of the stomach within 1 inch of the pylorus. The ulcer formation is caused by an inability of the mucosa to protect itself from damage by acid pepsin in the lumen (which is caused by a breakdown of the defensive factors). Duodenal ulcers occur in the proximal part of the duodenum (95 ), are less than 1 cm in...

Gender Ethnicracial And Life Span Considerations

The incidence of duodenal ulcers is highest in people 40 to 50 years old and is equally common in men and women. Gastric ulcers, which occur most often in people 60 to 70 years old, are more common in men. Mortality with gastric ulcer perforation is three times greater than that with duodenal ulcer perforation, partly because of the increased age of the patients. Duodenal ulcers occur in approximately 10 of the population at some time in their lives. More than half of the people who have duodenal ulcers heal spontaneously but have a high incidence of recurrence within 2 years. Hospitalization rates for peptic ulcer disease are highest for African Americans and those with Asian Pacific Islander backgrounds.

Description Medical Red Blood Cell Disorders

Complications caused by pernicious anemia include macrocytic anemia and gastrointestinal disorders. Pernicious anemia impairs myelin formation and thus alters the structure and disrupts the function of the peripheral nerves, spinal cord, and brain. Patients have a high incidence of benign gastric polyps, peptic ulcers, and gastric carcinoma. Low hemoglobin levels and consequent hypoxemia of long duration can result in congestive heart failure and angina pectoris in the elderly. If it is left untreated, pernicious anemia can cause psychotic behavior or even death.

Primary Hyperparathyroidism

Most people are presumably asymptomatic at the time of diagnosis. However, many have physical or neuropsychological disabilities that improve after surgical cure of their hyperparathyroidism (11,16). The classical symptoms related to skeletal and renal complications are rarely seen today. Osteitis fibrosa cystica, with bone cysts and brown tumors of the long bones, is seen in well under 5 of patients (17). Primary hyperparathyroidism is associated with bone loss largely at cortical sites (14). A large study that followed 121 patients prospectively for more than 10 yr showed that bone mineral density (BMD) was stable in most of the patients and in fact improved in patients who underwent parathyroid surgery. However, in a subgroup of patients who did not undergo surgery, BMD decreased by more than 10 in 20 of the patients (18). The data on fracture incidence among patients with primary hyperparathyroidism is conflicting some studies have not shown an increase in fracture incidence,...

Tumor Localization In Patients With Men1

The timing of surgical treatment remains controversial for these patients. The lethality of MEN-1 is felt to be resulting from complications of excess hormone production and the metastatic potential for these tumors. Little controversy exists about surgical resection when patients present with a VIP or insulin secreting NET or when it is greater than 3 cm in size. The timing of surgery in MEN-1 patients with ZES remains controversial because of the use of PPIs, which can control nearly all the acid production and protect patients from the complications related to peptic ulcer disease (32).

Treatment of Hypocalcemia

Although most individuals with disorders of blood calcium concentration are asymptomatic, sometimes serum calcium measurement is indicated. Individuals should be screened for hypercalcemia in the setting of nephrocalcinosis and nephrolithiasis, with evidence of osteopenia at sites of predominantly cortical bone, as well as for signs and symptoms suggesting hypercalcemia. Although these are uncommon or nonspecific, they include band keratopathy, anorexia, constipation and abdominal pain, possibly peptic ulcer disease, and pancreatitis, as well as a variety of nonspecific neuropsychiatry symptoms. It seems reasonable to monitor serum calcium periodically in patients taking calcium or vitamin D supplements and in persons taking medications that can potentially alter blood calcium concentrations.

TetanusDRG Category 423

When the tetanus bacteria enter an open wound, they multiply and produce a potent neurotoxin called tetanospasmin, which enters the bloodstream and acts on the spinal ganglia and central nervous system by interfering with the function of the postsynaptic inhibitory potentials. The anterior horn cells become overstimulated, thus resulting in excessive muscle contraction. Toxins may also act directly on skeletal muscle and cause muscle contraction. Complications include lung disorders such as pneumonia, pulmonary emboli, atelectasis, cardiac dysrhythmias, gastric ulcers, and flexion contractures. Tetanus results in approximately 5 deaths per year in the United States death usually results from autonomic dysfunction such as extremes in blood pressure, cardiac dysrhythmia, or cardiac arrest.

Hydrocarbons Solvents Pahs And Similar Compounds

Alcohols, including glycols, are much stronger CNS depressants than aliphatics are and slightly more irritating. As carbon chain length increases, irritation decreases but lipophi-licity increases, as does systemic toxicity. Methanol is less inebriating than ethanol but has the unusual property of destroying the optic nerve. Fifteen milliliters can cause blindness. As with ethanol, it is metabolized by a zero-order rate mechanism, but at one-seventh the rate. Ethanol acts as an irritant by dehydrating protoplasm. An initial stimulant effect is caused by depression of control mechanisms in the brain. Pain sensitivity is greatly reduced. Cutaneous (skin) blood vessels become dilated. The resulting increased heat loss can be dangerous in cold weather. It increases gastric secretion, which can aggravate stomach ulcers. It causes fat accumulation and cirrhosis in the liver. The latter can be fatal itself or can cause progression to cancer. Ethanol increases urine flow through a mechanism...

Clinical Examination And Screening Techniques To Identify The Patient At Risk Of Foot Ulceration

The goal of wound debridement is the complete removal of all necrotic, dysvascu-lar, and nonviable tissue in order to achieve a red, granular wound bed. Sharp surgical debridement using sharp instruments, such as a scalpel blade is ideal (81) (Fig. 6). Using this technique all nonviable tissue are removed until a healthy bleeding ulcer bed is produced with saucerization of the wound edges. Ulcerations with redundant hyper-keratotic rim should be aggressively debrided to remove this hyperkeratotic tissue. This will help to reduce pressure on the wound when the patient ambulates. It will also facilitate better visualization of the wound for a more thorough evaluation. The bacterial

Fecal Occult Blood Tests 321 Guaiac Based Stool Tests

The American College of Physicians has published comprehensive guidelines for fecal occult blood testing (FOBT) and interpretation with review of the data (7,8). FOBT has been estimated to detect around 90 of cancers with repeated testing over several years (9). However, a one-time FOBT (three samples) has an estimated sensitivity for advanced neo-plasia of only 23.9 (10). FOBT is most commonly performed using a guaiac-based test for peroxidase activity. Therefore, it is important that patients avoid other substances with peroxidase or pseudoperoxidase activity, such as rare red meat and some fruits and vegetables (e.g., turnips and horseradish). False-positive results can also occur as a result of other sources of gastrointestinal bleeding (e.g., hemorrhoids, peptic ulcer, and gum disease). False-negatives can result from tumors,

MICs of Macrolides on H pylori

Pylori Mutation

With regard to bitherapies, different populations seem to have different response rates. For example, northern Europeans tend to have higher eradication rates than southern Europeans. Because clarithromycin can inhibit omeprazole metabolism and therefore improve the treatment efficacy, one hypothesis is that there is some variability in this interaction between populations. An interesting report is that clarithromycin given alone, despite an unsatisfactory eradication rate, was able to heal ulcers (27) and even perform better than antisecretory drugs with regard to pain relief. Obviously, such data need to be confirmed, but if they are, it would be additional proof of the infective nature of peptic ulcer disease.

Men1 3ps parathyroid pancreas and pituitary tumors

Gastrinomas, leading to Zollinger-Ellison syndrome, account for most of the morbidity and mortality in patients with MEN-1 (3). By age 50 yr, approximately 50 of affected patients with MEN-1 develop gastrinomas. They are often small, multifocal, and metastatic at diagnosis, with 15 progressing to an aggressive malignancy (5), thus making surgical resection difficult. G-cells, the precursor cells of gastrinomas, are normally present in the fetal pancreas but gastrinomas in MEN-1 are ectopic tumors most often located in the duodenum. Excess gastrin secretion by the tumors causes prolific production of gastric acid, with patients developing multiple ulcers in the duodenum and jejunum (7). Diarrhea also develops. Some patients remain asymptomatic despite an elevated gastrin level. Hypercalcemia (primary hyperparathyroidism) may cause an elevation of the serum gastrin level and exacerbate the symptoms of Zollinger-Ellison syndrome. Also, the hypergastrinemia seen in primary...

Clinical Presentation

Headaches, visual disturbances, irrational behavior, confusion, drowsiness Abdominal pain, peptic ulcer disease, diarrhea, reflux esophagitis Necrolytic migratory erythema, Gastrinomas produce symptoms as a result of excess gastrin production. Hypersecretion of this hormone drives excess gastric acid production leading to peptic ulcer disease, abdominal pain, and diarrhea. Although the approach to hypergastrinemia cannot be exhaustively reviewed in this chapter, it is essential to establish the diagnosis of gastrinoma with appropriate biochemical testing prior to studies for tumor localization such as EUS.

Gastrinoma and the Zollinger Ellison Syndrome ZES

Gastrinomas produce the ZES, named by the surgeons who described the clinical disorder resulting from excessive gastric acid production. The tumor should be suspected after recognition of the constellation of clinical symptoms that include ulcer-like abdominal pain (dyspepsia) with associated diarrhea. The endo-scopic findings of peptic ulcer disease and concomitant esophagi-tis are a clue to the diagnosis. Profound acid hypersecretion leads to ulcerations throughout the upper gut, and the peptic ulcers may be in atypical locations such as the second, third, and fourth portions of the duodenum and jejunum (15). Most gastrinomas present as solitary tumors (75 ). Approximately 25 of patients with gastrinomas present as part of a familial syndrome, most commonly the MEN-1. This situation should be excluded by obtaining a serum calcium level reflecting the absence of associated parathyroid disease. The diagnosis of gastrinoma is based on an elevated serum gastrin level (generally levels...

Buckbean

It used to be a Highland remedy for all kinds of stomach pains, and herbalists still give the leaf decoction for stomach disorders, loss of appetite and the like (Schauenberg & Paris), an interesting usage, for the Kwakiutl Indians of the Pacific north-west of America use the water from the boiled roots for some kind of stomach trouble, briefly translated as when the pit of our stomach is sick (Boas). Even stomach ulcers were treated, in Scotland, successfully apparently, with infusions from this plant (Beith). They even used it for constipation on South Uist. They took the root, cleaned it and boiled it in water all day until the juice was dark and thick. It was strained, and a teaspoonful given to the patient it was even given to calves for the same complaint (Shaw), though the dose must have been increased.

Chickweed

Gypsies use a leaf infusion to cure coughs and colds (Vesey-Fitzgerald), and it is an old Irish remedy for whooping cough (O Suilleabhain), while in Skye the feet and ankles of a fever patient were at one time washed in warm water in which chickweed had been put, as a means of getting the patient to sleep (Martin). The plant is used by herbalists in the treatment of stomach ulcers, and as an aid to digestion (Conway). A lotion made of chickweed and rose leaves is used in Somerset for sore eyes (Tongue. 1965), or it could be used with unsalted lard as an ointment. There is a strange usage from Japan an infusion of the leafy shoot with sugar is given internally to stop a nosebleed (Perry & Metzger). The name Chickweed has a fairly obvious derivation. Chickens like it - chickens and birds love to pick the seed thereof (Coles). It is, in fact, a rich iron tonic, long given to cage birds, too.

Stomach

Carbonic anhydrase is present in high concentrations in the gastric epithelium, where it plays a major role in gastric acid secretion. Inhibition of this enzyme has been shown to inhibit basal and stimulated gastric acid secretion in both experimental animals and in humans. In fact, acetazolamide has been used in the treatment of patients with peptic ulcer with a reported response rate of greater than 90 . In parietal cells, protons derived from water molecules are secreted into the gastric lumen via the H-K ATPase, while the corresponding hydroxyl ions, via carbonic anhydrase, are converted to HC03. The bicarbonate ions exit the basolateral surface of the cell in exchange for chloride. Chloride is secreted into the lumen by way of a KCL symporter. Potassium ions secreted on the symporter are largely recycled across the apical membrane in exchange for protons via the apical H-K ATPase. Carbonic anhydrase is also found in non-acid-secreting cells of the stomach. These cells secrete...

Genetic Engineering

One major and legitimate concern is that genetic engineering not be used as yet another tool for augmenting productivity at the expense of animal welfare. Thus, for example, in the early 1980s, pigs* were genetically engineered to produce leaner meat, faster growth, and greater feed efficiency. While this was accomplished, the negative effects of the genetic engineering were unexpected and striking, with the animals suffering from kidney and liver problems, diabetes, lameness, gastric ulcers, joint disease, synovitis, heart disease, pneumonia, and other problems.

Cyp3a5

Achieve the safe and effective use of the drug. Pharmacogenetics and pharmacogenomics are the sciences of understanding the correlation between an individual patient's genetic makeup (genotype) and their response to drug treatment. They already have influenced therapeutics. For a drug that is primarily metabolized by CYP2D6, approximately 7 of Caucasians will not be able to metabolize the drug, but the percentage for other racial populations is generally far lower. Similar information is known for other pathways, prominently, CYP2C19 and -acetyl transferase. For example, codeine is metabolized to its active molecule, and about 10 of the population are rapid metabolizers and only need a much smaller dose for the same pharmacodynamic outcome. Omeprazole, used to treat peptic ulcers, is poorly metabolized related to SNPs in the CYP2C19 liver enzyme in 2.5-6 of Caucasians and 15-23 of Asians. For thiopurine, an antimetabolite used in cancer chemotherapy, the dose is 1 10 for the poor...

Absorption

Patients with gastroesophageal reflux disease, gastric ulcer, and duodenal ulcer. Gastrointestinal motility is influenced by sex hormones (51,52), implying that gender-based disparity in motility may exist and that the transit time in women may vary throughout pregnancy and the menstrual cycle. Estrogen and its equivalents may inhibit gastric emptying (53,54), whereas the effects of progesterone depends on its concentration (55,56). Gastric transit time has been demonstrated by many researchers to be slower in females than males (57-61).

Ulcers

LEEK poultices were put on them (Physicians of Myddfai). A Somerset treatment used MALLOW leaves, either by an infusion, or simply by using the leaves as a poultice (Tongue. 1965). Green CABBAGE leaves were a favourite Irish country way to treat an ulcer, by poultice, perhaps But not necessarily, for the leaves could simply be applied (Logan). Herbalists prescribe cabbage juice for stomach ulcers (Thomson. 1978), for which BUCKBEAN infusions were given in Scotland, successfully, apparently (Beith). Another Scottish remedy, from the Highlands, was to use ROSEROOT on ulcers (Fairweather). An ointment has been made from WOAD to heal ulcers (Brownlow), and gypsies used the juice of fresh COLTSFOOT leaves in making such an ointment (Vesey-Fitzgerald). GOOSE-GRASS is traditionally used to soothe wounds and ulcers (Schauenberg & Paris). In Ireland a whole mass of the herb would be applied, while the juice was given internally at the same time (Moloney).

Adenocarcinoma

Type II early gastric cancers are relatively flat lesions with elevated, superficial, or protruded components. These lesions may be manifested on double-contrast studies by plaque-like elevations, mucosal nodularity, shallow ulcers, or some combination of these findings (61). Occasionally, these lesions can be quite extensive, involving a considerable surface area of the stomach without invading beyond the submucosa. Type III early gastric cancers usually appear on double-contrast studies as shallow ulcer craters with nodularity of the adjacent mucosa and clubbing or fusion of radiating folds resulting from infiltration of the folds by tumor (60). Careful analysis usually permits differentiation from benign gastric ulcers, which have different radiographic features (62). Although some lesions with a suspicious appearance are found to be benign, endo-scopy is required for all lesions with equivocal radiographic findings in order to avoid missing early cancers (62). Some authors believe...

Gastritis

Gastric ulcer or cancer The two forms of atrophic gastritis are the conditions potentially associated with gastric cancer. Multifocal atrophic gastritis predominates in patients with intestinal-type gastric cancer. It involves the antrum and body and there are multiple foci of IM. The finding is especially common on the lesser curve near the angularis. H. pylori is an important causative factor but there are likely to be other significant cofactors such as diet and genetics. Gastric acid secretion is reduced and both gastric ulcer and gastric cancer may develop.