Joseph R PisegnaMD

The stomach plays a central role in the digestive tract owing in large part to the fact that it is the initial site for gastrointestinal (GI) digestion and that, through the release of peptide mediators, it regulates both secretion and motility. In the twentieth century, key discoveries were made in understanding the hormonal regulation of acid secretion with the discovery of gastrin, secretin, and cholecystokinin (CCK), as well as their receptors. The description of a syndrome linked to the gastric hormone gastrin, Zollinger Ellison (ZE) syndrome, showed a direct cause and effect relationship between this hormone and the development of uncontrolled gastric acid. The discovery of the organism, Helicobacter pylori, and its role in the genesis of peptic ulcerations, came to light late in the twentieth century and has provided new insights into the role of this organism and gastric mucosal host defense mechanisms. Similarly, with the increasing use of nonsteroidal anti-inflammatory drugs (NSAIDs) for the treatment of rheumatologic conditions, the role of these iatrogenic agents in the genesis of peptic ulcer disease (PUD) was appreciated. More recently new developments in the field of inhibition of gastric acid secretion and PUD treatment have improved our ability to cure peptic ulcers. However, despite two centuries of investigations, as well as improved treatments and prevention, PUD has not been completely cured and continues to account for a significant morbidity and mortality. There are separate chapters on H. pylori (see Chapter 23, "Helicobacter pylori and Gastroduodenal Disease"), NSAIDs (see Chapter 24, "Nonsteroidal Anti-Inflammatory Drugs and Gastrointestinal Complications"), and gastrinomas (see Chapter 26, "Gastrinoma"). Peptic ulcer therapy is also discussed in the first two chapters on evidence (see Chapter 1, "Using Evidence-Based Medicine in Patient Care") and on analyses (Chapter 2, "Decision Analysis in the Management of Digestive Diseases").

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Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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