acid-peptic diseases

Conditions associated with the action of gastric (stomach) acid on the lining of the oesophagus (gullet), stomach, or upper sections of the small intestine causing dyspepsia (indigestion), marked by pain (heartburn) or discomfort. The normal stomach secretes hydrochloric acid as part of the digestive process; however, if the acid enters the lower part of the oesophagus (gastro-oesophageal reflux), it can cause pain or actual tissue damage, giving rise to reflux oesophagitis (inflammation of the oesophagus). Reflux oesophagitis is more common in people with a hiatus hernia (a condition in which a part of the stomach has been pushed upwards through the diaphragm). Pregnant women may suffer reflux and heartburn in the later stages of pregnancy due to the pressure of the fetus on the stomach. Peptic ulcers, which most commonly affect the stomach, the lower part of the oesophagus, or the duodenum, may occur when gastric acid is present in abnormally high concentrations but more usually result from other conditions that make the lining of the digestive tract more susceptible to attack by acid. These include the presence of the bacterium Helicobacter pylori and the use of non-steroidal anti-inflammatory drugs and certain other drugs (e.g. corticosteroids). Ulcers may also be caused or exacerbated by stress, smoking, and alcohol. A rare cause of peptic ulceration is the Zollinger-Ellison syndrome, a disorder in which excessive secretion of gastric acid is triggered by the hormone gastrin released by a pancreatic tumour.

Drug treatments for acid-peptic diseases include antacids, proton pump inhibitors, and H₂-receptor antagonists; less commonly cytoprotectant agents or antimuscarinic drugs are used. Helicobacter pylori is eradicated by a combination of two of the following antibiotics – clarithromycin, amoxicillin, metronidazole – and a proton pump inhibitor.

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