Pain in middle of upper abdomen in a commonly encountered complain from patients in any hospital.There are vast nuber of causes for it.Many of them are for academic interest.Among the most commonly encountered conditions Acid Peptic disease is one.

Here there is pain in the middle of upper abdomen .This pain may come in empty stomach or after taking food.It is typically colicky in nature,sometimes subsides after taking food or aggravated after taking food.It my appear  seasonally in the winter.Gradually this timing of pain changes  and pain is always felt. There may appear vomiting which may contain freshly eaten food to stale food, blood and bile.Some times there occurs  blood vomiting and passing of black stool.Some times patient may present in the emergency with a complication called perforation of stomach or duodenum.

This disease may be seen in the stomach,duodenum,Lower esophagus or in  a mackel’s  diverticulum.The symptoms and signs may differ according to the site of disease. To-day we will see the disease of stomach and duodenum.

Hydrochloric acid secretion is an integral part of stomach inner layer called gastric mucosa.There in also secretion of protein digesting enzyme called pepsinogen.The digestion of own gastric mucosa hangs on a fine balance between the secretions and mucosal defense. Mucosal defense  rests on the amount of bicarbonate  and  mucus present in the stomach.There are various means to dis-balance it.It my be stress and strain,Ingestion of analgesics and steroid,Severe trauma lading to blood loss and infection by a microbe called H.Pylori. There may occur inflammation to ulcerations in mucosa and may progress to other layers of stomach and duodenum.

The disease can very nicely be diagnosed by  an endoscopy.This can be treated by newer proton pump inhibitor drugs.This drug has left the surgical option for this disease limited  to the complications only.If drug treatment fails nice surgical options are available.

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