GASTRIC GOLD'S BLOG

We've all gotten them at one time or another: gifts of food that were disappointing or misguided, even comical. Sometimes it isn't the gift itself that doesn't work so much as the match between the gift and the recipient.

For example, I was the goofball who, with all the best of intentions, gave a Starbucks gift card to a music teacher at my daughter's school. It didn't occur to me that he might be a Mormon (see No. 7 in the list below).

Here's another example: I was once given dark chocolate as a gift, when anyone who knows me well knows that I prefer milk chocolate. (The giver in this instance happened to be my mother.)

So, with some personal experience and some tongue-in-cheek reflections on gifts from Christmases past, here is my list of 13 food gifts NOT to give:

1. Don't give sugar-free candies or chocolates to someone with IBS (irritable bowel syndrome) or other intestinal issues. The sugar replacement often used in these products is maltitol, which is only partially digested and absorbed. The part that isn't digested tends to ferment in the intestinal tract and attract water. To someone with diarrhea -predominant IBS, having a few pieces of these sugar-free goodies can cause some "intestinal issues". (As someone who has IBS, I can speak from sad experience.) We'll leave it at that.
2. Pay attention that you don't give tea with special properties to someone whom it might offend. The Republic of Tea, for example, makes "Get Lost" tea, described as "herb tea for weight control"; "Get it Going" tea (for regularity); and "Get Gorgeous" tea (for clear skin).
3. Be sure you don't give alcohol to someone who doesn't (or shouldn't) drink. Even if someone has consumed alcohol in the past, they may now be avoiding it for a number of possible reasons.
4. Don't give those tins of stale popcorn to pretty much anyone. If it isn't fresh, it isn't worth the calories.
5. Don't give fruitcake as a food gift, because all the fruitcake jokes known to man are bound to ensue moments after it is unwrapped.
6. Don't give a gift assortment of dark chocolates to someone who is passionate about milk chocolate (or vice versa). The same goes for giving cream-filled chocolates to someone who is wild about nuts and chews.
7. Don't give alcohol or anything with caffeine to a member of the Church of Jesus Christ of Latter-Day Saints. These items are not in line with their beliefs.
8. If you don't know the gift recipient all that well, avoid holiday processed meat gift packs (from gourmet catalogue companies) or other foods containing meat, in case your giftee is a vegetarian.
9. Don't give food gifts that include chocolate, peppermint or spearmint, garlic and onions, coffee, caffeinated tea, citrus, tomato products, or chili peppers, to someone who suffers from acid reflux.
10. Don't give any food containing pork or pork products, or that combines dairy with meat products, to someone who keeps kosher or observes Muslim dietary laws.
11. Don't give peanut brittle, caramel apples, or candy canes to people with braces. According to H. Dixon Taylor, DDS, an orthodontist in Concord, Calif., these are the three worst food gifts for someone with orthodontics. (And about 20% of Taylor's clients happen to be grown-ups.)
12. To that friend of yours who is working hard to lose extra pounds, don't give a gift card to The Cheesecake Factory.
13. Don't give chocolate-covered insects to people who might be "bugged" by it. I'm serious -- this actually happened to an acquaintance's mom, and she was definitely not amused!

Labels: acid reflux, IBS, Irritable Bowel Syndrome

Researchers at the University of Pennsylvania School of Medicine have discovered stem cells in the esophagus of mice that were able to grow into tissue-like structures and when placed into immune-deficient mice were able to form parts of an esophagus lining. The investigators report their findings online this month in the Journal of Clinical Investigation.

"The immediate implication is that we'll have a better understanding of the role of these stem cells in normal biology, as well as in regenerative and cancer biology," says senior author Anil K. Rustgi, MD, the T. Grier Miller Professor of Medicine and Genetics and Chief of Gastroenterology. "Down the road, we will develop a panel of markers that will define these stem cells and use them in replacement therapy for diseases like gastroesophogeal reflux disease [GERD] and also to understand Barrett's esophagus, a precursor to esophageal adenocarcinoma and how to reverse that before it becomes cancer."

Diseases of the esophagus are very common in the United States and worldwide. "Benign forms include GERD and millions are affected," notes Rustgi.

GERD can sometimes lead to inflammation of the esophagus, called esophagitis. "In some of these cases esophagitis can lead to a swapping of the normal lining of the esophagus with a lining that looks more like the intestinal lining and that's called Barrett's esophagus," explains Rustgi. "This can lead to cancer of the esophagus, which is the fastest rising cancer in the US, increasing by 7 to 8 percent a year."

The researchers set out to identify and characterize potential stem cells--those with the ability to self renew--in the esophagus to understand normal biology and how injured cells may one day be repaired.

First, they grew mouse esophageal cells they suspected were adult stem cells. Those cells formed colonies that self renewed. These cells then grew into esophageal lining tissue in a three-dimensional culture apparatus. "These tissue culture cells formed a mature epithelium sitting on top of the matrix," says Rustgi. "The whole construct is a form of tissue engineering."

The investigators then tested their pieces of esophageal lining in whole animals. When the tissue-engineered patches were transplanted under the skin of immunodeficient mice, the cells formed epithelial structures. Additionally, in a mouse model of injury of the esophagus in a normal mouse, which mimics what happens during acid reflux, green-stained stem cells migrated to the injured lining cells and co-labeled with the repaired cells, indicating involvement of the stem cells in tissue repair and regeneration.

Eventually the researchers will develop genetically engineered mouse models to be able to track molecular markers of esophageal stem cells found in a micorarray study. The group has already developed a library of human esophageal cell lines and is looking for human versions of markers already identified in mice.

"The ultimate goal is to identify esophageal stem cells in a patient, grow the patient's own stem cells, and inject them locally to replace diseased tissue with normal lining," says Rustgi.

Penn co-authors are Jiri Kalabis, Kenji Oyama, Takaomi Okawa, Hiroshi Nakagawa, Carmen Z. Michaylira, Douglas B. Stairs, and J. Alan Diehl (Department of Cancer Biology), as well as Jose-Luiz Figueiredo and Umar Mahmood from Massachusetts General Hospital, Molecular Center for Imaging Research, Boston, and Meenhard Herlyn, from The Wistar Institute, Philadelphia.

This work was funded by the National Institute of Diabetes and Digestive and Kidney Diseases and the National Cancer Institute.

This release and a related image can be found at: http://www.uphs.upenn.edu/news/News_Releases/2008/12/esophagus-tissue-growth.html

PENN Medicine is a $3.6 billion enterprise dedicated to the related missions of medical education, biomedical research, and excellence in patient care. PENN Medicine consists of the University of Pennsylvania School of Medicine (founded in 1765 as the nation's first medical school) and the University of Pennsylvania Health System.

Penn's School of Medicine is currently ranked #4 in the nation in U.S.News & World Report's survey of top research-oriented medical schools; and, according to most recent data from the National Institutes of Health, received over $379 million in NIH research funds in the 2006 fiscal year. Supporting 1,700 fulltime faculty and 700 students, the School of Medicine is recognized worldwide for its superior education and training of the next generation of physician-scientists and leaders of academic medicine.

The University of Pennsylvania Health System (UPHS) includes its flagship hospital, the Hospital of the University of Pennsylvania, rated one of the nation's top ten "Honor Roll" hospitals by U.S.News & World Report; Pennsylvania Hospital, the nation's first hospital; and Penn Presbyterian Medical Center. In addition UPHS includes a primary-care provider network; a faculty practice plan; home care, hospice, and nursing home; three multispecialty satellite facilities; as well as the Penn Medicine at Rittenhouse campus, which offers comprehensive inpatient rehabilitation facilities and outpatient services in multiple specialties.

University of Pennsylvania School of Medicine
3535 Market St., Mezzanine
Philadelphia
PA 19104
United States
http:// www.med.upenn.edu

Labels: acid reflux, esophagus

Although irritable bowel syndrome (IBS) is the most common disease diagnosed by gastroenterologists, it's also one of the most misunderstood. That's why updated guidelines addressing the management of the condition are being released by the American College of Gastroenterology.

Through a comprehensive review of the latest medical research and expert consensus, the updated guidelines provide clinicians with a comprehensive and practical set of recommendations for the diagnosis and treatment of IBS.

"The last time the American College of Gastroenterology published guidelines for the management of IBS was in 2002, and the College recognized that in the span of five to six years there has been a remarkable explosion in knowledge that's become available that's helped us to understand the cause and management of IBS," says William Chey, M.D., professor of medicine and director of the Gastrointestinal Physiology Laboratory at the University of Michigan Health System.

Along with Philip Schoenfeld, M.D., also of the U-M Division of Gastroenterology, Chey has helped to develop the new evidence-based recommendations.

IBS is a chronic disorder of the lower intestine that causes cramping, abdominal pain, bloating, constipation and/or diarrhea that affects 10 to 15 percent of the U.S. population. The new recommendations show that "there really are things to do for these patients; it's not a hopeless situation," says Chey.

Some of the most significant evidence-based recommendations from the guideline include:

-- Most patients with typical IBS symptoms and no alarm features such as bleeding, weight loss, or a family history of colon cancer, inflammatory bowel disease or celiac sprue, do not need extensive diagnostic testing before confidently diagnosing IBS.

-- IBS patients with diarrhea or a mixture of diarrhea and constipation should be screened with blood tests for celiac disease, a condition in which one cannot tolerate the gluten protein found in wheat and other grains.

-- When patients with IBS and diarrhea undergo colonoscopy, biopsies should be obtained to rule out a rare disease called microscopic colitis.

-- The use of anti-depressants, tricyclic agents and selective serotonin reuptake inhibitors, can be helpful for some patients with IBS.

"There is a stronger recommendation that tricyclic antidepressants, used in low doses before people go to sleep at night, are an effective medicine for irritable bowel syndrome," says Schoenfeld, associate professor of internal medicine at the U-M Medical School. The agents in these antidepressants can reduce bloating and discomfort by altering brain-gut signaling about motility and distention. He adds that constipation, a side effect of tricyclic antidepressants, is actually beneficial to many people in this population.

-- The drug lubiprostone, a chloride channel activator, benefits a subset of women with IBS and constipation.

-- Evidence suggests that a specific probiotic called Bifidobacter infantis offers benefit to some patients with IBS and diarrhea.

-- The non-absorbable antibiotic called rifaximin has been found to be of benefit for selected patients with IBS, in particular those with bloating and diarrhea.

-- For women with more severe IBS and diarrhea who have not responded to standard therapies, alosetron, a drug which alters an important neurotransmitter called serotonin, can be considered.

IBS usually begins in young adulthood, and women are twice as likely as men to be diagnosed with IBS in the United States. Despite intensive research, the precise cause of IBS is not clear. Suggested contributors to IBS include abnormal contractile activity of the intestines and colon, altered sensation within the gastrointestinal tract, exaggerated reactions to stress or anxiety, and/or problems arising from the interaction between the bacteria and immune system within the intestines and colon.

Treatments are often combined to reduce the pain and bowel-related symptoms of IBS, and it may be necessary to try more than one combination to find the one that is most helpful, Chey and Schoenfeld note.

Before newer therapies and medications were available, much of the effort to treat IBS symptoms focused on lifestyle, diet and reduction of stress. Some dietary changes that many patients have found helpful:

-- Avoid or limit the amount of gas-producing foods such as beans, onions, broccoli, cabbage or any other foods that will commonly aggravate IBS symptoms.

-- Try to slow down when you eat and avoid overeating.

-- Avoid carbonated drinks. These can introduce gas into the intestines and cause bloating or abdominal discomfort.

-- Intolerance to milk sugar, or lactose, is seen in up to 40 percent of patients with IBS. Avoiding dairy products may be helpful in reducing symptoms of IBS such as gas, bloating, cramping and diarrhea.

-- Avoid large quantities of other sugars such as fructose or sorbitol which can also worsen IBS symptoms

-- The addition of fiber in the form of psyllium can help with constipation related symptoms in IBS patients.

A structured, focused diagnostic evaluation will lead to a confident diagnosis of IBS says Chey. There are some good treatment options for people diagnosed with IBS. With effective counseling, dietary and lifestyle intervention, and use of over-the-counter and/or prescription medications, IBS can be effectively managed in the vast majority of patients, Chey notes.

For a full list of the IBS guidelines please visit http://www.nature.com/ajg/journal/v104/n1s/index.html.

University of Michigan Health System
http://www.med.umich.edu

Labels: IBS, Irritable Bowel Syndrome

Scientists have uncovered vital clues about how to treat serious bowel disorders by studying the behaviour of cells in the colon.

Researchers at the University of Edinburgh believe a chemical messenger that is essential for developing a baby's gut in the womb could hold the key to new treatments for inflammatory bowel disease (IBD), a condition which affects 1 in 250 people in the UK.

The team studied a chain of chemical reactions inside colon cells, called the Hedgehog signalling pathway, which controls the way it behaves and communicates with other cells.

The researchers found that some patients with IBD inherit a defective copy of one of the important links in this chain, a gene called GLI1. This defective GLI1 is only half as active as normal. Additionally, the Hedgehog pathway itself signals at lower levels than normal when the large bowel is inflamed.

The results suggest that the GLI1 protein may calm inflammation within the healthy colon, and that this process appears to go wrong in IBD patients, causing their gut to become inflamed.

The researchers now hope to test whether strengthening this weakened protein will help to prevent or treat inflammatory bowel diseases like Crohn's disease and ulcerative colitis.

Dr Charlie Lees from the University's Institute of Genetics and Molecular Medicine, who led the study, said: "Everybody has billions of bacteria in the gut, the vast majority of which do us no harm. Our body's natural immune responses identify and eliminate harmful bacteria, whilst living in harmony with the healthy bacteria. But in people with inflammatory bowel disease, that response goes wrong and an over-active immune response against these healthy bacteria leads to chronic inflammation in the gut.

"It now seems that the Hedgehog signalling pathway, and specifically the GLI1 protein, is crucial to that response. We think it provides an important signal to certain types of immune cells in the gut wall, instructing them to adopt an anti-inflammatory state. If we can find ways to bolster these responses in people with IBD, we may be able to help prevent the painful attacks which are so devastating to patients."

Labels: IBD, Inflamatory Bowel Disorders

Irritations of the bowel can have genetic causes. Researchers at the Institute of Human Genetics at Heidelberg University Hospital have discovered this correlation. The causes of what is known as irritable bowel syndrome (IBS), one of the most common disorders of the gastrointestinal tract, are considered unclear - making diagnosis and treatment extremely difficult. The results from Heidelberg, which were published in the prestigious journal Human Molecular Genetics, improve the outlook for an effective medication against a disease that is frequently played down as a functional disorder.

In Germany, approximately five million people are affected by IBS, women about twice as often as men. But only around 20 percent of these people even consult a physician. Many patients suffer from constipation, others from severe diarrhea, or a combination of both. The illness affects the general condition and quality of life of these patients and often lasts for months or even years.

Modified receptors lead to overstimulation of the bowel

Serotonin plays an important role in the complex processes in the digestive tract - just as it affects sleep, mood, and blood pressure. Various types of receptors are located in the intestine, to which serotonin attaches according to the lock and key principle and thus transmits cellular signals.

"We have determined that patients who suffer from irritable bowel syndrome with diarrhea show a higher frequency of certain mutations ", ex-plains Dr. Beate Niesler, who investigates the genetic causes of complex diseases with her team in the Department of Human Molecular Genetics (Director: Prof. Gudrun Rappold) at the Heidelberg Institute of Human Genetics. These mutations appear to cause changes in the composition or number of receptors on the cell surface. "The signal transduction in the digestive tract may be disturbed and this may lead to overstimulation of the intestine. Resulting disturbances in fluid balance could explain the occurrence of diarrhea", says Johannes Kapeller, a PhD student in the team.

Medication blocks serotonin receptors

The serotonin receptor blocker Alosetron is only approved in the US where it is effectively used in the treatment of women suffering from diarrhea-predominant IBS, but can only be prescribed with strict limitations due to its side effects. Alosetron inhibits the serotonin receptors in the intestinal tract and thus slows the movement of the bowels.

"Currently, patients with irritable bowel syndrome are treated on a trial and error basis", explains Dr. Beate Niesler. The Heidelberg data could contribute to development and prescription of specific medications for certain genetic mutations in patients.

Correlation with depression and pain

Research of the serotonin system shows interesting correlations serotonin receptors are located on neural transduction pathways involved in pain perception and influence them - which could explain why patients with irritable bowel syndrome often complain of severe pain although no pathological changes such as infections or tumors are present. It has also been noted that persons with modified receptors suffer more frequently from depression.

Labels: IBS, Irritable Bowel Syndrome

A new study led by Spanish researchers has revealed that exposure to certain substances may increase the risk of cancer of the oesophagus. The hotel and restaurant trades, animal handling, mining and carpentry are some of the professions posing the highest risk.

Jesús Vioque, a researcher at the Miguel Hernández University in Alicante, is leading a cases and controls study looking into the relationship between occupations and three types of cancer oesophageal, pancreatic and stomach. The article showing the link between certain professions and the risk of suffering cancer of the oesophagus is the first to have been published.

The study, which appears in the latest edition of the journal Occupational and Environmental Medicine, analyses the two principle types of cancer of the oesophagus, which account for more than 90% of all cases squamous cell cancer (70 - 75%) and adenocarcinoma (15-20%).

"The two major risk factors for this cancer are alcohol and tobacco, but there is an additional number (around 4%-5%) of cases associated with certain occupations," Vioque tells SINC.

The research study, which was carried out in nine hospitals in Valencia and Alicante, involved analysing the cases of 185 men with recently-diagnosed cancer of the oesophagus (147 squamous cell cancer, 38 adenocarcinoma) and 285 healthy controls. All those who took part in the study filled in a questionnaire about their diet, profession and lifestyle. The results were adjusted to take into account factors such as age, educational level and alcohol and tobacco consumption.

For the squamous cell variety, a significant increase in risk was detected among those who worked in the hotel and restaurant trade, mining (stone cutters) and wood-working workshops. With the adenocarcinoma type, the risk rose among those working as carpenters or animal handlers. An increase was also detected among workers involved in construction and electricity, "although these were based upon a very small number of cases".

The study revealed a significant risk of squamous cell cancer resulting from exposure to ionising radiation, and for adenocarcinoma from serious exposure to volatile sulphur and lead compounds. Exposure to other substances such as asbestos could also triple the overall risk of oesophageal cancer, depending upon the level of exposure.

"We are not suggesting that people should give up their jobs, but if they are working in a high-risk profession they should adopt all suitable protection measures (goggles, masks or special machines). This is about trying to educate these workers in order to reduce their alcohol and tobacco consumption, but also to ensure they make use of all appropriate safety measures," says Vioque.

Figures in Spain

Oesophageal cancer represents between 1% and 2% of all cancers. It is the fourth most common tumour of the digestive tract, behind colon, rectal and stomach cancer. It is more common among men than women, and it tends to appear between the ages of 55 and 70, with low numbers of cases among people aged under 40. According to data from the Spanish Society of Medical Oncology (SEOM), Spain has a medium level of incidence of this cancer (approximately 8 men per 100,000 and 1 woman per 100,000) in comparison with the rest of Europe.

Spain reports an annual incidence of 1,500 men and 250 women with oesophageal cancer, with the disease appearing more frequently in the north than in the rest of the country (Basque Country, Asturias and Navarre).

Plataforma SINC
http://www.plataformasinc.es

Labels: Cancer, oesophagus

Labels: Cancer

New research from Japan found bacteria that cause stomach ulcers and cancer living in the mouths of some people with bad breath, even though they did not show signs of stomach illnesses.

The study was the work of Dr Nao Suzuki from Fukuoka Dental College in Fukuoka, Japan and colleagues and is published in the December issue of the Journal of Medical Microbiology.

Scientists recently discovered that infection by the bacterium Helicobacter pylori, which is carried by over 90 per cent of people in the developing world and 20 to 80 per cent of people in the developed world, was a possible cause of peptic ulcers and gastric cancers.

More recent research has also suggested that the human mouth, which is home to over 600 different species of bacteria (some of which cause disease), is a possible reservoir for H. pylori, particularly in the presence of periodontal or gum disease, a known cause of halitosis or bad breath.

Suzuki explained that bad breath or halitosis is common in humans and is mostly caused by gum disease, tongue debris, poor oral hygiene and badly fitted fillings (they trap bacteria).

"Bacteria produce volatile compounds that smell unpleasant, including hydrogen sulphide, methyl mercaptan and dimethyl sulphide. Doctors often measure the levels of these compounds to diagnose the problem. Gastrointestinal diseases are also generally believed to cause halitosis," said Suzuki.

Suzuki and colleagues decided to investigate the prevalence of H. pylori in the mouths of people with bad breath.

"Recently, scientists discovered that H. pylori can live in the mouth," said Suzuki, adding that:

"We wanted to determine whether the bacteria can cause bad breath, so we tested patients complaining of halitosis for the presence of H. pylori."

For the study, the researchers did DNA scans of saliva taken from 326 Japanese people; 251 had actual bad breath or halitosis and 75 did not. None showed any signs of stomach illnesses.

They found H. pylori and other bacteria that occur with periodontal or gum disease, called periodontopathic bacteria, including Porphyromonas gingivalis, Treponema denticola and Prevotella intermedia.

More spefically the results showed that:

• 21 (6.4 per cent) of the participants had H. pylori in their mouths.


• These participants also had higher levels of other markers for periodontal disease, including higher levels of: methyl mercaptan (a bad breath gas); each of the periodontopathic bacteria; tooth mobility; periodontal pocket depth (PPD); and occult blood in the saliva.


• Of the 102 participants with periodontal disease, 16 (15.7 per cent) had H. pylori in their mouths.

Labels: Cancer, stomach ulcer

Researchers in Spain and the United Kingdom are reporting development of a faster test for identifying the food protein that triggers celiac disease, a difficult-to-diagnose digestive disease involving the inability to digest protein called gluten that occurs in wheat, oats, rye, and barley. The finding could help millions of people avoid diarrhea, bloating, and other symptoms that occur when they unknowingly eat foods containing gluten. The study is scheduled for the December 15 issue of Analytical Chemistry, a semi-monthly journal.

In the new report, Alex Fragoso, Ciara O'Sullivan and colleagues note that patients with celiac disease can avoid symptoms by avoiding foods that contain gluten. Doing so can be tricky, however, because gluten may be a hidden ingredient in unsuspected foods, such as soy sauce, canned soups, and licorice candy. Some prepared foods list gluten content on package labels, but identifying its presence remains difficult and time-consuming.

The scientists describe development of a new sensor that detects antibodies to the protein gliadin, a component of gluten. Laboratory tests showed that it is superior to the so-called enzyme-linked immunosorbent assay (ELISA), now the standard test for gliadin. It took the new test barely 90 minutes to detect gliadin in the parts per billion range, compared to 8 hours for the ELISA test. Although both tests were equally accurate, the new sensor would be easier to use at food manufacturing plants, the researchers note.

ARTICLE
"Electrochemical Immunosensor for Detection of Celiac Disease Toxic Gliadin in Foodstuff"
DOWNLOAD FULL TEXT ARTICLE

American Chemical Society

Labels: Celiac, Crohn's disease

Gastroesophageal reflux disease (GERD) is one of the most common gastrointestinal conditions seen in GI and primary care clinics, however physicians who treat the disease primarily rely on empirical trials of medications and their own observations and experience to manage their patients. Therefore, the American Gastroenterological Association (AGA) Institute has published evidence-based guidelines for the management and treatment of suspected GERD. The guidelines, which are the first produced through AGA's innovative guideline development process, are published in Gastroenterology, the official journal of the AGA Institute.

"There are many methods physicians are using to treat their patients with GERD, without knowing which is the best one," according to John I. Allen, MD, AGAF, chair, AGA Institute Clinical Practice and Quality Management Committee. "The AGA Institute developed this medical position statement on GERD to encapsulate the major management issues leading to consultations for the treatment of the disease to help guide physicians in treating their patients."

According to the authors, high-quality clinical trials for GERD management strategies do not exist. The majority of randomized controlled clinical trials are for pharmacologic therapies for esophageal GERD syndromes, especially acute trials for healing esophagitis. Therefore, many of the highest-level evidence-based recommendations in the guideline are for the acute treatment of heartburn or esophagitis. In developing the guidelines, the authors used the Montreal consensus definition for GERD, "a condition which develops when the reflux of stomach contents causes troublesome symptoms and/or complications." Troublesome symptoms are those that adversely affect an individual's well-being.

"As we found in our research, much of the current management of patients with GERD is based on experiences from physicians, uncontrolled trials and expert opinion," according to Peter J. Kahrilas, MD, AGAF, Northwestern University's Feinberg School of Medicine and lead author of the guidelines. "We hope the development of these guidelines will help clinicians better treat patients who present with suspected GERD."

The conclusions of the technical review and medical position statement were based on the best available evidence, or in the absence of quality evidence, the expert opinions of the authors and Medical Position Panel convened to critique the technical review and structure the medical position statement. The technical review and the medical position statement together represent the guideline. The strength of the conclusions were determined using the U.S. Preventive Services Task Force grades. Grade A recommendations, which are "strongly recommended based on good evidence that it improves important health outcomes," according to the AGA Institute, include:

I. Antisecretory drugs for the treatment of patients with esophageal GERD syndromes (healing esophagitis, symptomatic relief and maintaining healing of esophagitis). In these uses, proton pump inhibitors (PPIs) are more effective than histamine receptor antagonists (H2RAs), which are more effective than placebo.

II. Long-term use of PPIs for the treatment of patients with esophagitis once they have proven clinically effective. Long-term therapy should be titrated down to the lowest effective dose based on symptom control.

III. When antireflux surgery and PPI therapy are judged to offer similar effectiveness in a patient with an esophageal GERD syndrome, PPI therapy should be recommended as initial therapy because of superior safety.

IV. When a patient with an esophageal GERD syndrome is responsive to, but intolerant of, acid suppressive therapy, antireflux surgery should be recommended as an alternative.

V. Twice-daily PPI therapy as an empirical trial for patients with suspected reflux chest pain syndrome after a cardiac etiology has been carefully considered.

Other recommendations include grade B - "recommended with fair evidence that it improves important outcomes;" grade C - "balance of benefits and harms is too close to justify a general recommendation;" grade D - recommend against, fair evidence that it is ineffective or harms outweigh benefits;" and grade insufficient - "no recommendation, insufficient evidence to recommend for or against."

To develop the guidelines, a set of 12 broad questions were identified by experts in the field to encapsulate the most common management questions faced by clinicians. To review recommendations and grades, view the AGA Medical Position Statement of the Management of Gastroesophageal Reflux Disease. The guidelines were developed through interaction among the authors, the AGA Institute, the Clinical Practice and Quality Management Committee and representatives from the AGA Institute Council.

Source:
Aimee Frank
American Gastroenterological Association

Labels: GERD

For many people, Thanksgiving is about having family near and celebrating, sometimes in excess. That's because for some holiday revelers, perhaps the amount of time spent watching football on the tube is only surpassed by a second activity: eating. And with the turkey, sweet potatoes and pumpkin pie comes heartburn, but how do you know if you have a simple case of it, or something more serious? Simply put, if the heartburn you have affects your quality of life, you may have gastro-esophagael reflux disease, more commonly known as GERD.

"If a person has a burning feeling down in their gut that goes up into the chest, made worse by eating, or exercising or lying down, and this happens several times a week, then that's affecting their life and there's a good chance they have GERD,"said gastroenterologist Joel Richter, M.D., chair of the Department of Medicine at Temple University School of Medicine. "The next step is to see a doctor and have the condition evaluated because there is actually "good" and "bad" GERD."

And how doctors treat the two types are very different. Richter says "good" GERD is the most common; about 80 to 90 percent of patients have it. This group may have occasional to daily heartburn symptoms, but nothing more serious, such as esophageal damage by endoscopy or problems with swallowing.

"For this group, more medication may not be the answer. Rather," says Richter. "Those with intermittent symptoms need to modify their lifestyle by losing weight,reducing their fat intake and not eating late at night before going to bed."

And while they can take proton pump inhibitors, (PPI's) which ease heartburn by alleviating excess stomach acid that flows back into the esophagus, Richter recommends that many will only need to take these pills as needed when their symptoms are bothersome. But for the second group of sufferers who have "bad" or more serious GERD symptoms, a lifetime drug therapy regimen can not only improve their quality of life, but can be life-saving.

"About 10 to 15 percent of GERD patients suffer from a more severe form, in which they have scarring on the esophagus, problems swallowing, and may even have Barrett's Esophagus, in which the cells lining the esophagus can turn cancerous," said Richter. "So, even though PPI's pose the risk of side effects, they are very effective for this group and the benefits of using them far outweigh the risks."

Patients who rely on these drugs when they're not needed put themselves at unnecessary risk for side effects when used long-term, which include an increase in bacterial pneumonia, gastrointestinal infections, and hip fractures, especially in women. Richter warns that before a patient starts self-medicating with PPI's, it's crucial that they find out which type of GERD they're suffering from. The best way to do that is through a set of consults with a doctor. An initial visit will consist of an endoscopy and a review of the patient's medical history to determine what type of pill a patient should be on. A follow up visit to evaluate the patient's response to the drug determines which type of GERD they have.

"These visits are the two pieces to the puzzle when diagnosing someone with GERD," said Richter.

Temple University
301 University Services Bldg.1601 N Broad St.
Philadelphia
PA 19122
United States
http://www.temple.edu

Labels: GERD, Heartburn

caAccording to the American Cancer Society (ACS), more than 16,000 new esophageal cancer cases are diagnosed each year in the U.S. Unfortunately the survival rate in these cases is only 10 percent. This alarming statistic is due largely to the fact that by the time the majority of cases are diagnosed, the cancerous tumors have grown to the point of inoperability. Raising patient awareness about potential conditions that, if left untreated, could progress into esophageal cancer, will encourage patients to seek the appropriate care through their physician.

Many people are aware that tobacco use increases the risk of developing esophageal cancer; however, there are several other common contributing risk factors including:

- Excessive alcohol consumption;
- Obesity;
- Lye ingestion; and,
- Gastroesophageal reflux disease (GERD), also known as acid reflux or heartburn.

A recent ACS Gallup poll revealed that 44 percent of adults in the U.S. have heartburn at least once per month and that approximately 30 percent of esophageal cancer cases can be linked to GERD. GERD is a condition in which acid (with some pepsin and bile) splashes up from the stomach into the esophagus. These three fluids are potentially dangerous to the sensitive esophageal tissue, as they can inflame and damage the lining of the esophagus, a condition known as esophagitis.

If GERD becomes a chronic condition, it can develop into Barrett's esophagus, a precursor to esophageal cancer. Barrett's esophagus is a condition in which the color and composition of the cells lining the lower esophagus change due to repeated exposure to stomach acid. Only a small percentage of people with GERD develop Barrett's esophagus, but once it is diagnosed, patients should be sure to meet with their physician regularly as they are at a greater risk of developing esophageal cancer.

Symptoms of advanced GERD or the presence of Barrett's esophagus include:

- Frequent heartburn. A burning-type pain in the lower part of the mid-chest, behind the breast bone, and in the mid-abdomen.
- Difficulty swallowing. Often, a narrowing of the esophagus (esophageal stricture) leads to trouble swallowing or dysphagia.
- Bleeding. A person may vomit red blood or blood that looks like coffee grounds, or your stools may be black, tarry or bloody.
- Weight loss and loss of appetite.

According to the ACS, prevention of Barrett's esophagus can begin with controlling GERD by making some simple lifestyle changes, such as:

- Losing weight. Obesity increases abdominal pressure, which can then push stomach contents up into the esophagus;
- Eating a diet full of fruits and vegetables, eating smaller and more frequent meals and not eating two to three hours prior to bedtime;
- Smoking cessation, as nicotine relaxes the esophageal sphincter and smoking also stimulates the production of stomach acid;
- Discontinuing the consumption of alcohol.

People with severe GERD and Barrett's esophagus often require aggressive treatment and prevention methods including medications, other nonsurgical medical procedures such as endoscopic therapies, or even laparoscopic and open surgeries. Often times, swallowing difficulty (known as dysphagia) and other symptoms can be treated if identified early.

However, due to the aggressive nature of the disease, the majority of patients who have esophageal cancer are not surgical candidates. In these situations, the primary focus becomes palliative care - providing comfort measures to help maintain quality of life. This includes treating the dysphagia and restoring the patient's ability to swallow food and drink liquids by opening the stricture within the esophagus.

To open the barriers caused by tumor in-growth physicians use an esophageal metal stent. Prior to the stent placement the patient may require dilation of the stricture to allow room for the stent to be positioned, thereby expanding the lumen of the esophagus. Traditionally, the placement of the stent can be a painful process for the patient, yet new technologies are making this procedure easier on the patient and physician.

New, innovative delivery systems enable accurate deployment and recapturability of the stent. This reduces the stent from moving or migrating into the stomach and thus the need for repeat procedures to replace or reposition the stent, one of the more common complications in traditional esophageal stenting.

Raising awareness about the primary pre-cursors to esophageal cancer - GERD and Barrett's esophagus - will encourage patients with these conditions to consult their physicians for the necessary screenings and treatment options. However, when palliative care becomes the primary option for patients with esophageal cancer, recent advancements in medical device technologies enable physicians to more easily implant an esophageal stent and in turn improve patients' quality of life.

Medicalnews

Labels: Cancer, Esophageal, Gastrointestinal, GERD

Labels: Gastrointestinal

Labels: asthma, GERD

A pre-cancerous condition linked to chronic acid reflux often gets overlooked. Can the medical community do a better job intervening? Researchers from the Hutchinson-MRC Research Centre in Cambridge think so.

In a review published in the inaugural issue of Disease Models & Mechanisms (DMM), experts on a disease known as "Barrett's oesophagus" discuss how "Barrett's" presents unique challenges in diagnosis and treatment. They cite key factors which make this illness difficult to detect, and suggest how scientists and doctors can team up to improve the odds of intervention.

Doctors want to understand more about this condition because patients with Barrett's have 30 to 125 times increased risk of an often fatal cancer of the oesophagus. One of the most common indicators of Barrett's is severe and chronic acid reflux. The authors of the review article discuss several reasons why most Barrett's cases are undiagnosed. The wide-spread availability of over-the-counter antacid medications may contribute by suppressing symptoms such that only the most severe and persistent cases of acid reflux are recommended for screening. Additionally, in order to screen for Barrett's, the oesophagus must be examined with a small light and camera (endoscope) which is not a routine procedure.

The biological basis of Barrett's is an abnormal change, or dysplasia, in the oesophagus. Normally, the oesophagus is lined with flat-shaped cells known as squamous cells. However, in patients with Barrett's, the cell lining consists of rectangular-shaped columnar cells. This process of normal cells morphing into abnormal cells is common to several types of cancer, not just oesophageal cancer. Thus, a greater understanding of Barrett's can also lead to potential therapies for similar pre-cancerous conditions.

In order to advance the diagnosis of Barrett's oesophagus, researchers recommend identifying standardized indicators which can be used to identify the presence of Barrett's as well as predict the likelihood that it will progress into cancer. Additionally, they recommend developing less costly screening methods to allow routine checks for Barrett's in patients with acid reflux. They point out the need for developing laboratory animal models of this disease in order to study the underlying molecular mechanisms of Barrett's, as well as to test potential novel therapies.

The review was written by Massimilian di Pietro, Christopher J. Peters and Rebecca C. Fitzgerald of the Hutchinson-MRC Research Centre in Cambridge, UK. The report was published in the inaugural July/August issue of a new research journal, Disease Models & Mechanisms (DMM), published by The Company of Biologists, a non-profit based in Cambridge, UK.

The DMM website is located at: http://dmm.biologists.org

Labels: acid reflux, Cancer

You know it all too well. Heartburn. That fiery sensation that grabs hold of your lower chest after you eat something you know you shouldn't have. What often follows is that sour or bitter taste of acid reflux in your throat and mouth that can last minutes (if you are lucky) or hours (if you are not).

Yes, millions of us are familiar with the discomfort of heartburn, a condition in which stomach acids back up into the esophagus. The good news is that heartburn is largely avoidable if you steer clear of the top 10 heartburn foods. It also helps to avoid certain classic heartburn-inviting situations.

From coffee and liquor to tomatoes and grapefruit, experts tell WebMD that certain foods are known heartburn triggers.

Here's what you need to know about the top 10 heartburn foods.

Heartburn and Tangy Citrus Fruits

Oranges, grapefruits and orange juice are classic heartburn foods. "These are very acidic," says Robynne Chutkan, MD. Chutkan is the founder of the Digestive Center for Women in Chevy Chase, Md. and a gastroenterologist at Georgetown Hospital in Washington, D.C. "As a result of being so acidic," she says, "they are likely to cause heartburn, especially when consumed on an otherwise empty stomach."

Heartburn and Tomatoes

While they might be chockfull of healthy nutrients like lycopene, Chutkan tells WebMD that tomatoes are also highly acidic and likely to cause heartburn in those who are prone to it.

The acid antidote may be a sour ball, according to Daniel Mausner, MD. Mausner is the section head of gastroenterology at Mercy Medical Center in Rockville Center, N.Y. "Things that promote saliva -- like sour balls -- are good for acid reflux," he says, "because saliva neutralizes the acid that comes up from your stomach."

Heartburn and Garlic and Onion

Bonnie Taub-Dix, MA, RD, says, "Some people with heartburn do not do well with either garlic or onion." Taub-Dix, a spokeswoman for the American Dietetic Association, is a nutritionist in private practice in New York City and Woodmere, N.Y. "It's all very individual," she says. For avoiding heartburn, she offers the following suggestion: "Keep a food log to help you track the foods that are your heartburn offenders, and try to develop a list of safe foods." Foods like broiled chicken, baked sweet potatoes, toast, or cottage cheese, she says, are on the safe side of the heartburn food list.

Heartburn and Spicy Foods

Pepper, Mexican food, chili, and any other food that is loaded with pepper or other spices can trigger heartburn, says Deepa A. Vasudevan, MD. Vasudevan is an assistant professor of family medicine at The University of Texas Medical School at Houston. He tells WebMD that avoiding heartburn isn't necessarily a matter of all or nothing. "If spicy food triggers your heartburn, avoid it. Then slowly reintroduce milder versions of whatever you like."

Heartburn and Peppermint

Chutkan says that while many people think peppermint is soothing for the tummy, it is actually a heartburn trigger food. Her advice? Skip the after-dinner mints -- especially after a rich meal. "They may be good for your breath on a date," she says, "but they are not so good if you are prone to heartburn."

Peppermint may increase your chances of heartburn because it relaxes the sphincter muscle that lay between the stomach and esophagus. This allows stomach acids to flow back into the esophagus.

Heartburn and Cheese, Nuts, Avocadoes, and a Juicy Rib Eye

What do these foods have in common? They are all high in fat, according to Chutkan. "These foods may not get as much press as acidic foods when it comes to heartburn," she says, "but they can be major triggers." Here's why: Fat slows down the emptying of the stomach, so there is more opportunity for a big distended stomach -- which increases pressure on the esophageal sphincter -- to make heartburn more likely.

Chutkan says that doesn't mean you can never have those foods again. "Don't have a cheese plate at the end of a meal," she suggests. "Instead, eat it early in the day when you are not already full." Remember, a serving of cheese is roughly the size of two dice.

Heartburn and Alcohol

Wine, beer, or your favorite cocktail can all trigger heartburn, says Chutkan, especially when they are imbibed with a large meal. "If you have a meal of steak, creamed spinach, and lobster bisque and then alcohol on top of that," she says, "you may be in for it."

Taub-Dix agrees. "A glass of red wine may not be a big deal on its own," she points out. "But if you also have tomato sauce on your pasta and a glass of orange juice in the morning on an empty stomach, it could be a problem." Like peppermint, alcohol opens the sphincter, allowing the acid free range.

Heartburn and Caffeine

Coffee, soda, tea, iced tea, and any other food or beverages that contain caffeine are big offenders. But java junkies don't have to give up their Joe forever, Chutkan tells WebMD. "It's not 'no coffee ever' if you have heartburn. It's about cutting down and paying attention to portion sizes. A Starbucks tall," she explains, "which is their version of a small, is like three cups of coffee. Some people tell me they drink two cups of coffee a day and that they get it at Starbucks. That's like six cups a day."

If you have heartburn, you can likely consume a 3- or 4-ounce cup of coffee each morning with no problem. But if you guzzle coffee all day long, then, yes, heartburn is a consequence

Heartburn and Chocolate

Sure, it can be loaded with caffeine, but chocolate can also be a heartburn food in and of itself. "Pack up all of your chocolate and give it to your gastroenterologist for safekeeping if you have heartburn," Chutkan says. Chocolate relaxes the sphincter, allowing stomach acids to flow back into the esophagus, she says.

Heartburn and Carbonated Beverages

"Carbonated beverages cause gastric distension," Mausner says. And if your stomach is distended, this increases pressure on the esophageal sphincter, promoting reflux." He tells WebMD that people with heartburn may be wise to steer clear of pop and other carbonated beverages.

Heartburn Foods: Find Your Triggers

Taub-Dix's advice is to use the above list as a guide to help you figure out your heartburn foods and heartburn trigger situations. And remember, she cautions, even if your favorites are not on this list, you don't necessarily have a free pass. "Too much of any food can trigger heartburn," she says. It's not just what you eat; it's how much you eat and when you eat it. "Consuming a large meal right before you lie down," she says, "will likely cause heartburn even if it doesn't include any of these heartburn foods."

source: WebMd

Labels: Heartburn

Labels: IBS, Irritable Bowel Syndrome

Labels: acid reflux, GERD

Labels: pancreatitis

Pancreatitis is an inflammation of the pancreas. The pancreas is a large gland behind the stomach and close to the duodenum. The duodenum is the upper part of the small intestine. The pancreas secretes digestive enzymes into the small intestine through a tube called the pancreatic duct. These enzymes help digest fats, proteins, and carbohydrates in food. The pancreas also releases the hormones insulin and glucagon into the bloodstream. These hormones help the body use the glucose it takes from food for energy.

Normally, digestive enzymes do not become active until they reach the small intestine, where they begin digesting food. But if these enzymes become active inside the pancreas, they start "digesting" the pancreas itself.

Acute pancreatitis occurs suddenly and lasts for a short period of time and usually resolves. Chronic pancreatitis does not resolve itself and results in a slow destruction of the pancreas. Either form can cause serious complications. In severe cases, bleeding, tissue damage, and infection may occur. Pseudocysts, accumulations of fluid and tissue debris, may also develop. And enzymes and toxins may enter the bloodstream, injuring the heart, lungs, and kidneys, or other organs.

Labels: pancreatitis

Labels: acid reflux