Apollo Hospitals International, Ahmedabad

An important property of blood is its degree of acidity/ alkalinity. Body acidity increases when level of acidic compounds in body rises (through increased intake/ production or decreased elimination) or when level of basic (alkaline) compounds in body falls (through decreased intake/ production or increased elimination). Body alkalinity increases with reverse of these processes. The body's balance between acidity & alkalinity is referred to as acid-base balance. Further, the acidity/ alkalinity of any solution including blood is indicated on pH scale.

Acidosis and Alkalosis are the two abnormalities of acid-base balance.

Acidosis: The blood has too much acid (or too little base), resulting in decrease in blood pH

Alkalosis: The blood has too much base (or too little acid), resulting in an increase in blood pH.

Acidosis & alkalosis are not diseases but are rather result of wide variety of disorders. The presence of acidosis/ alkalosis provides an important clue to doctors that a serious problem exists.

Acidosis and alkalosis are categorized as metabolic or respiratory, depending on their primary cause. Metabolic acidosis & metabolic alkalosis are caused by:

• Imbalance in the production of acids or bases
• Their excretion by the kidneys

Respiratory acidosis & respiratory alkalosis are caused primarily by changes in carbon dioxide exhalation due to lung/ breathing disorders.

Blood pH

Acidity & alkalinity are expressed on the pH scale, which ranges from 0 (strongly acidic) to 14 (strongly basic, or alkaline). A pH of 7.0 is neutral. Blood is normally slightly basic, with pH range of 7.35 to 7.45. To function properly, body should maintain pH of blood close to 7.40.

Oesophagus is about 25 cms long & allows food you swallow to get to the stomach. When food is swallowed, the muscles along the length of oesophagus tighten & relax in a ‘wave’ downwards, moving food into the stomach. The oesophagus has 2 sphincters, which ia a narrowing caused by contracted (tightened) muscles. These muscles remain contracted until body sends a message for muscles to relax. When the muscles of sphincter relax, this again allows things to pass.

One sphincter is at top of the oesophagus. The other is where oesophagus meets stomach known as gastro-oesophageal junction. Lower sphincter controls movement of food into stomach & prevents stomach acid from going up into oesophagus (gastro-oesophageal reflux).

The lining of oesophagus is very different to that of stomach and stomach acid causes it to become inflamed & sore if reflux does occur. This soreness is pain felt by those with ‘ heartburn’.

Stomach is subject to both acute & chronic disorders. There are numerous chronic disorders of stomach that are quite common. As a rule it can be considered that they are different stages of the same condition. That condition is irritation resulting from abuse through wrong selection of food & from wrong eating habits (from abnormal condition of chemistry within body (toxemia and acidosis) that stops cells of stomach from being properly nourished).

Gastric Hyperacidity

It is a condition in which gastric juice is secreted in excessive amounts.

Causes:

Among the leading causes of this condition include:

• Too much food
• Highly seasoned, hot & spiced foods
• Alcoholic drinks
• Worry grief & other detrimental emotional conditions
• Mental over activity
• Diseases of the liver
• Gallbladder and gall-duct
• Chronic appendicitis
• Inflammation of other abdominal organs

Sometimes it also seems to be solely due to:

• Some spinal lesion (either bony, muscular or ligaments)

Symptoms:

The symptoms are:

• Pain below breastbone an hour or so after eating
• Gas & sour eructation’s
• Headache
• Dizziness
• Melancholia
• Aggravation of pain by intake of sugars and starches
• Relief of pain by protein foods which utilize the acid

Dyspepsia

It is a term commonly applied to this condition. Although dyspepsia may mean variety of digestive disorders, it usually means abnormal stomach digestion and is in a large measure discarded now in general use.

Chronic Gastritis

It is usually a chronic gastric catarrh.

Symptoms:

• Loss of appetite
• Pain after meals
• Eructations
• Loss of weight to an appreciable extent
• Constipation
• Considerable mental uneasiness until one becomes neurasthenic

In this condition there is often failure of stomach-gland activity & circulation in parts involved that leads to ulceration development.

Ulcer

Ulcer of stomach is comparatively common & more or less serious disease of stomach.  It often follows prolonged dyspepsia/ hyperacidity.  It results from same causes that are responsible for hyperacidity. 

Causes:

• Emotional state of depressing nature
• Worry
• Anxiety
• Grief

Hypopepsia

This is a condition in which there is reduction of digestive secretions of the stomach.  It is usual in condition of simple dyspepsia. Additional causes are:

• Chronic catarrh condition of stomach/ chronic gastritis (neurons as neurasthenia and hysteria)
• Prolonged worry, anxiety & suspense
• Severe anemia and toxemia (such as from certain types of goiter)

Nervous Disease of Stomach

Usually considered neuroses, these may involve nerves/ secretions/ motor activity of the stomach.  Hypopensia, in fact, usually is a gastric neurosis.  The symptoms of these neuroses are slight/ extreme, depending considerably upon nervousness of patient. 

Peptic Ulcer

It may be either in stomach or in duodenum, just beyond the outlet of stomach.  The causes of ulcers in these two locations are much the same and treatment followed will be the same. Symptoms preceding a peptic ulcer are:

• Dyspepsia
• Sour eructation’s
• Heartburn
• More or less severe gnawing stomach pains before meals

A Helicobacter pylori infection seems to be cause of most stomach cancer. Vague abdominal discomfort, weight loss, and weakness are some symptoms of this disease. The best diagnostic procedure is an endoscopy but survival rate is low because cancer tends to spread early to other sites.
Surgery is performed to eliminate cancer or relieve symptoms. About 95% of stomach cancers are adenocarcinomas (originating from glandular cells of stomach lining).

Causes and Risk Factors

• Adenocarcinoma of stomach often begins at a site where stomach lining is inflamed. It is commonly believed that infection with bacterium Helicobacter pylori is cause of most stomach cancer.
• Adenocarcinoma of stomach is particularly likely to develop if polyps consist of glandular cells and are larger than ¾ inch (2 centimeters), or if several polyps exist.

Rare Stomach Cancers

Lymphoma

It is cancer of lymphatic system and can develop within the stomach. Bacterium Helicobacter pylori plays a role in development of some lymphomas of stomach and surgery is often initial treatment. Chemotherapy & radiation therapy are more successful in treating lymphoma than adenocarcinoma.

Leiomyosarcoma

Also called stromal cell tumor/ spindle cell tumor, it is a cancer present in the smooth muscle of the stomach. It is best treated with surgery. In cases where cancer has already spread (metastasized) to other parts of body by the time leiomyosarcoma is found, then chemotherapy may lead to slightly longer survival.

Symptoms:

• Early symptoms may mimic peptic ulcer disease with burning abdominal
• Feeling of fullness after small meal
• Weight loss or weakness
• Anemia characterized by fatigue, weakness
• Light-headedness
• Vomiting large amounts of blood (hematemesis)
• Passing black tarry stools (melena)

Adenocarcinoma

Symptoms:

• Yellowish discoloration of skin and whites of the eyes (jaundice)
• Fluid accumulation
• Swelling in abdominal cavity (ascites)
• Cancerous skin nodules

Diagnosis:

Endoscopy (an examination in which flexible tube is used to visualize inside of the digestive tract). It allows a doctor to:

• View stomach directly, to check for Helicobacter pylori
• Remove tissue samples for examination under microscope (biopsy)
• If cancer is found, computed tomography (CT) scan of the chest & abdomen is done to determine extent to which tumor has spread to other organs
• If CT scan does not show tumor spread, doctors usually perform endoscopic ultrasound (which shows the lining of digestive tract more clearly because probe is placed on tip of the endoscope) for determining depth of tumor & involvement of nearby lymph nodes