What Are Ulcers?

The term ‘ulcer’ means, in the most general sense, a lesion anywhere but more often in the digestive tract. It’s often used, though, as a shorthand term for the phrase ‘peptic ulcer’. The latter isn’t a condition of the colon – the major portion of the large intestine – at all. It affects the stomach usually, but may also occur in the duodenum (the first section of the small intestine), or even the esophagus (the section leading from the throat or pharynx to the stomach).

General ulcers or lesions that occur in the colon are typically part of other IBDs or inflammatory bowel diseases, such as Crohn’s or ulcerative colitis. By contrast, peptic ulcers are sores in the stomach or duodenum lining where the holes cause contact between its contents and inner tissues.

That contact can be both painful and lead to secondary complications. Here’s how…

The digestive system is not, strictly speaking, a closed system with a hole at each end. The epithelial tissue lining it evolved mechanically and biochemically into what is known as a permeable membrane. That is, materials can pass through it selectively, with water and nutrients or vitamins produced in the digestive tract moving into the body.

However, when stomach acid (a type of hydrochloric acid), bile, and actual semi-digested food pass through the stomach or intestines, pain and disease can result. Toxins, for example, then pass directly into the bloodstream rather than being moved down and eliminated. Looking at the other direction, when blood passes out of the surrounding tissues and into the digestive system, the result is pain and abdominal cramping, bleeding, and bloody stools, with resulting anemia.

Both circumstances have serious health consequences and ulcers are the lesions that make such inappropriate movements of material possible. They are the ‘holes’ through which the substances pass.

The causes of ulcerative colitis, Crohn’s and other diseases involving colon lesions are not known. However, in the case of peptic ulcers in the stomach there is very strong evidence about the cause: infection. Once thought to be the result of stress and diet (in the form, for example, of spicy foods), research now strongly favors the view that bacteria are the culprit.

In fact, one organism in particular is thought to be the main culprit in most peptic ulcers: Helicobacter pylori or H. pylori. It lives and multiplies within the mucous layer that lines the stomach and small intestine, a substance that provides it with a ‘good’ growth medium.

There are other possible causes, however, such as overuse of pain relievers. NSAIDs (non-steroidal anti-inflammatory drugs), such as aspirin (Bayer, and others), ibuprofen (Advil, Motrin), and naproxen (Aleve) can produce lesions in the stomach lining or small intestine.

Buffering helps but coated aspirin, for example, only delays dissolving the drug so that it occurs not in the stomach but in the small intestine. That can benefit some, in particular by changing the site at which the drug begins to act, but some individuals are more sensitive in the intestine than the stomach.

Short-term, occasional lesions are a normal occurrence, even when unpleasant, and the body typically heals itself within a day or two. Long-term problems, such as ulcerative colitis, Crohn’s, or chronic peptic ulcers require professional diagnosis and treatment. See your physician for guidance.

Constipation, Causes and Treatments

Constipation – an inability to have a bowel movement, frequently from excessively hard stools – is a normal condition when it occurs rarely or for short periods. Treatments range from doing nothing and allowing the condition to self-correct to use of mild laxatives or a change in diet.

Normally, bowel movements occur 2-3 times daily (typically fewer as individuals age) and without undue strain. When constipation becomes chronic, severe, or long-lived it signals a more serious health issue. The body has to eliminate waste from digestion and the inability to do so leads to numerous complications, with accompanying discomfort or worse. Fewer than one per week is usually a sign of serious trouble.

The causes of constipation are too numerous to list in a single article. They can be anything from inadequate fluid intake and improper salt balance to diverticulitis (an inflammation of the colon due to infection, producing pouches on the outside of the intestine). Irritable bowel syndrome (IBS) is another common cause. Tumors or colorectal cancer can be a cause of severe constipation. Medications or supplements, such as codeine or iron, can be the culprit, too.

Fortunately, treatments are equally wide ranging.

In many cases, as suggested above, time is all that’s required. The body can normally re-balance fluid and salt levels. Constipation resulting from a habit of resisting bowel movements will disappear with a change in habits. Changes in diet, such as consuming additional fiber or cutting down on caffeinated beverages, can restore normal bowel movements.

Increasing fiber is easy by consuming more of the right kinds of fruits and vegetables. Oat bran is justly well-known as a good source of fiber. Fiber adds needed bulk to stools as well as naturally absorbing water that helps soften them. One common mild side effect, though, may be increased abdominal gas. The bacteria present in the colon partially digest the fiber that humans can not (for lack of the right enzyme). Their resulting digestion produces flatus, or gas.

Laxatives, whether in the form of supplements or as pills or liquid, should be taken with care and only for short periods. Saline laxatives (like Milk of Magnesia) are one type. Stimulant laxatives (Ex-Lax, and others) work by stimulating the muscles that produce bowel movements. Apart from the risk of the other extreme – diarrhea – excessive reliance on laxatives can lead to irregularity and dependence. Bowel movements, in so far as possible, should occur naturally except for brief periods of needed treatment.

There are exceptions, such as prescription laxatives like sorbitol and polyethylene glycol (Miralax), which are regarded as safe for long term use. But these are intended for treating medical conditions, not for relief of constipation that can be eliminated by changes in diet and lifestyle.

As with any severe health condition and proposed treatment, consult your physician for professional advice. Self-treatment that results in temporary relief is fine for temporary conditions. Long term self-treatment may mask, to a point, more serious underlying disease that warrants a professional diagnosis.

What is Crohn’s Disease?

Crohn’s disease is one among many digestive disorders in which the lining becomes inflamed. That inflammation produces ulcers (lesions or open sores in the lining) that produce abdominal pain and diarrhea. It is often progressive and leads to even more serious health consequences.

The cause(s) of the disease are not known, but an abnormal immune system response to a bacterium (known as MAP or Mycobacterium avium subspecies paratuberculosis) is suspected. Despite the lack of a clear cut culprit several risk factors are known. Diet and stress can affect the course and impact of the disease but have been ruled out as causes.

Genetics is near the top of the list, not surprisingly given the immune system response aspect of the disease. Roughly 20% of those with Crohn’s have a parent or close relative similarly afflicted. Those with an affected sibling are 30 times more likely to develop Crohn’s than the general population. Unlike many diseases, Crohn’s tends to occur in younger people, usually between the ages of 20-30.

The intestinal inflammation of the disease produces diarrhea by causing cells to secrete large amounts of salt and water. The colon is unable to absorb all this fluid (part of its natural role in the digestive system). The result is diarrhea.

One effect is swelling of the intestinal tissue and scaring as the ulcers heal. That results in less efficient movement of the chyme (the semi-fluid mass of digested food) through the colon. The effects are felt as cramping and abdominal pain. In more advanced or severe cases nausea and vomiting are common. Bloody stool is common, as well, as moving chyme causes inflamed tissue to rupture, allowing blood to flow into the colon. The ulcers can become enlarged, moving deep into intestinal tissue, worsening the problem.

The net result, apart from the pain, is often reduced appetite and unhealthy weight loss. The symptoms lead to a desire not to eat, but the weight loss is exacerbated by less efficient digestion of food. In extreme circumstances such low intake and absorption of calories and nutrients leads to many secondary consequences.

Diagnosis is fairly straightforward. Blood tests check for anemia and during a colonoscopy a physician can see the distinctive signs directly. A biopsy (tissue samples that can be removed during the procedure) are used to confirm the presence of Crohn’s.

A less invasive procedure known as a flexible sigmoidoscopy uses a lighted tube to examine only the lower two feet of the colon and rectum while a colonoscopy involves inserting a tube all the way into the intestine. It takes only a few minutes to complete.

A physician may recommend a barium enema as well. A safe, mildly radioactive barium fluid is introduced into the colon where it provides a contrast dye for an X-ray. The fluid coats the lining of the intestine to create a silhouette of the colon and rectum. In a variation, X-rays can also be taken if the patient ingests the barium fluid.

A more modern diagnostic procedure, known as capsule endoscopy, involves swallowing a tiny camera in the form of a pill, which makes its way down the digestive tract. It takes photos along the way, which the physician examines.

Unfortunately, there is no cure known for Crohn’s disease as yet, but drug therapy to reduce inflammation is a common treatment. Surgery has helped many afflicted by removing ulcerated tissue (sometimes sections of the bowel), reducing symptoms. Unlike ulcerative colitis, Crohn’s infected tissue may occur in spots with healthy tissue in between, not throughout an entire length. That allows for a more targeted repair of affected tissue.