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If you are like most people, you take your digestive system for granted. As long as it is working well, you seldom think of it. Actually, your digestive system is really a wonderful piece of work. It is a strong dependable work horse - the body's Clydesdale. It is always waiting patiently for the next batch of food to come down the pipe. It never sleeps or stops to take a break, and none of this requires any conscious action on your part. It makes it possible for you to feast on fried chicken or three-alarm chili without having to understand anything about the complex science of digestive chemistry. Our topic in this issue is the stomach...

First of all, we are not talking about your abdomen, but rather, the actual stomach organ that lies within. Like most unseen internal organs, the stomach is largely unappreciated. On a basic level, it is simply a hollow pear-shaped "pouch" that expands as you eat - serving as a short-term storage facility. Empty, the volume of your stomach is less than one-half cup. As you eat, its muscular wall can relax and expand to hold about three pints of sustenance. This enables you to eat a large meal quickly and then digest it over the next several hours while you move on to another task. How well do you know your stomach? Well, it's time you got better acquainted. Read about ten common myths below:

1. You digest your food in your stomach - FALSE

Only water, alcohol, and certain drugs seem to be absorbed by the stomach; most food absorption takes place in the small intestine. Your stomach's main job is to prepare the food for digestion by pulverizing it into small particles. About every twenty seconds, muscular contractions called peristaltic waves ripple through your stomach squeezing gently in the upper part, more powerfully lower down. This churning motion mixes the food particles with powerful hydrochloric acid and the enzyme, pepsin. Enzymes are like crowbars that break apart other large molecules. Produced by the stomach, these strong chemicals convert the food to about the consistency of cream of potato soup. Eventually, the now liquefied food termed chyme is squirted a little bit at a time through a one-way pylorus valve and into the small intestine, where most digestion occurs.

2. Dieting will shrink your stomach - FALSE

Like all internal organs, your stomach grows larger as you become an adult. But, once an adult, the overall size of your stomach pretty much stays the same - expanding and contracting with each meal. Eating less food and dieting will not cause your stomach to actually shrink, but you can reset your appetite to lower levels.

3. Thin people have smaller stomachs - FALSE

Weight has nothing to do with the size of your stomach. Using gastroscopy, I have examined thousands of stomachs over the past 30 years, and surprisingly, they are all about the same size. You would expect an 85-pound woman to have a smaller stomach than a 350-pound man, but once you are inside they all look about the same - unless you have gastric bypass surgery which intentionally makes it smaller.

4. You can shrink your stomach with exercise - FALSE

Again, not true if this refers to the stomach organ and not the abdomen. While dieting and exercise can burn away external fat and tighten the muscles in your abdomen, no exercise can change the size of an internal organ.

5. Most stomach ulcers are caused by stress - FALSE

This was a common myth twenty-five years ago, but in 1982, Australian researchers Barry Marshall and Robin Warren discovered spiral-shaped bacteria in the stomach, later named Helicobacter pylori (H. pylori). After closely studying H. pylori's effect on the stomach, they proposed that the bacteria were the underlying cause of ulcers, or painful sores that eat their way into the inner lining of the stomach. The lining of the stomach is made of pretty tough stuff, but when infection sets in, the acid in the stomach can start eating away the lining. In their studies, 80 percent of patients with stomach ulcers had the bacteria. The 20 percent of patients with stomach ulcers who did not have H. pylori were those who had taken NSAIDs (such as aspirin and ibuprofen) which are the second most common cause of stomach ulcers. Drugs such as aspirin are inexpensive and do wonderful things. They are good for the joints and good for the heart, but hard on the stomach. Even if you take a baby aspirin a day to protect your heart, it can result in ulcers. Very few, if any, ulcers are actually caused by stress. This is good news for chronic ulcer suffers since most ulcers can now be cured for life with a short course of special antibiotics.

6. Spicy foods cause ulcers - FALSE

For years doctors told patients to avoid coffee, and acidic fruit, as well as spicy foods since they could increase stomach acid and cause ulcers. Many individuals were put on a bland diet of baby food, heavy cream, and milk every hour. However, a study published in the Archives of Internal Medicine in May 2006 showed that none of these myths hold true. What ulcer sufferers eat has very little significance and we now tell them to eat everything except those foods that repeatedly bother them. As mentioned above most ulcers are caused either by the H. pylori bacteria or NSAIDS, not by food. Another myth put to rest.

7. Milk at bedtime will settle your stomach- FALSE

A lot of people try drinking milk to ease acid stomach before sleep. But often, milk ends up causing an acid stomach during sleep. To understand the whole situation, we have to realize that everything you eat stimulates more stomach acid. Eating a big meal at dinner causes excess stomach acid production. Drinking milk could be a quick fix to the acid stomach problem. Unfortunately, milk has a rebound action and would eventually encourage secretion of more stomach acid, which causes the acid stomach. To solve the problem, it is best to adjust one's diet by eating a small meal at dinner and not eating within 3 hours of bedtime.

8. Stomach cancer is common - FALSE

Common is a relative term, of course. But, many patients I see fear that they have stomach cancer and they usually do not. While we may find several cases of colon cancer a week in our practice, we only see stomach cancer a few times a year. In the United States, stomach cancer (also called gastric cancer) now ranks only 14th of all cancers. For reasons that are unclear, the U.S. incidence has drastically decreased since 1930. Although stomach cancer has greatly decreased in the United States, on a worldwide scale its incidence is still high and is still a leading cause of cancer death. Its highest incidence is in East Asia (e.g.-Japan, China), presumably because of a diet consisting of heavily smoked, salted, and pickled foods. Diets rich in fruits, vegetables, and dietary fiber are associated with a decreased risk of stomach cancer.

9. Stomach polyps cause cancer - FALSE

Many adults are familiar with the association of colon polyps to colon cancer. In fact, it is believed that almost all colon cancers originate from tiny polyps - a process that may take many years. The same cannot be said for other parts of the body. Polyps commonly occur in the nose and are not considered pre-cancerous. Often, during a gastroscopy "stomach scope" exam, we will find a few small polyps on the inner lining of the stomach and take a biopsy. They may be more common in patients on acid reducing medications such as Prilosec or Nexium. However, most of these are hyperplastic or fundic polyps and NOT associated with stomach cancer. Rarely, adenomatous, or pre-cancerous, polyps are found and must be removed.

10. Frequent Burping is a sign of stomach ulcers - FALSE

We all pass gas. It is a normal part of digestion. Gases are created by the many bacteria inside our colon in a process called fermentation - much like making beer or champagne. The average person passes gas from below about 14 times a day. Passing gas from above, or a burp - also called a belch - is also normal. However, the air that you burp is NOT created inside your body. It must first be swallowed. Whenever you eat or drink, you don't just swallow food or liquid. You also swallow a little bit of air each time. Sometimes when you swallow this air, it just needs to get out. That's where burping comes in! Extra gas is forced out of the stomach, up through the esophagus and out of the mouth as a burp. Everybody burps occasionally. Some individuals just can't seem to stop. This is most often due to frequent swallowing of excessive saliva that may occur with smoking, gum chewing, or sinus drainage. Individuals with a hiatal hernia or acid reflux, may experience more burping due to a weak valve between their esophagus and stomach. Without that normal barrier, air can just rise upward without your conscious control.

Sometimes, air swallowing is just a nervous habit that is done unconsciously. Termed "aerophagia," or "air-eater," this condition is harmless, but embarrassing to the individual. The attacks can be aborted temporarily by simply putting a pencil between your teeth which prevents swallowing. If you can't swallow air, you can't burp.