GASTRIC GOLD'S BLOG

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.

The researchers concluded that the presence of H. pylori in nearly 16 per cent of the participants with periodontitis suggested that:

"Progression of periodontal pocket and inflammation may favour colonization by this species and that H. pylori infection may be indirectly associated with oral pathological halitosis following periodontitis."

"Although the presence of H. pylori in the mouth does not directly cause bad breath, it is associated with periodontal disease, which does cause bad breath," said Suzuki, who said the team will now be looking into the:

"Relationship between H. pylori in the mouth and in the stomach. We hope to discover the role of the mouth in transmitting H. pylori stomach infections in the near future."

"Detection of Helicobacter pylori DNA in the saliva of patients complaining of halitosis."
Nao Suzuki, Masahiro Yoneda, Toru Naito, Tomoyuki Iwamoto, Yousuke Masuo, Kazuhiko Yamada, Kazuhiro Hisama, Ichizo Okada, and Takao Hirofuji.
J. Med. Microbiol, Dec 2008; 57: 1553 - 1559.
DOI: 10.1099/jmm.0.2008/003715-0

Medicalnews

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