Gastrointestinal Bleeding After Stroke May Increase Risk Of Death
0 comments Monday, August 11, 2008

People who have gastrointestinal (GI) bleeding after a stroke are more likely to die or become severely disabled than stroke sufferers with no GI bleeding, according to a study published in the August 6, 2008, online issue of Neurology®, the medical journal of the American Academy of Neurology.

"This is an important finding since there are effective medications to reduce gastric acid that can lead to upper gastrointestinal bleeding," said study author Martin O'Donnell, MB, of McMaster University in Hamilton, Ontario. "More research will be needed to determine whether this is a viable strategy to improve outcomes after stroke in high-risk patients."

The study involved 6,853 people who had ischemic strokes. The most common type of stroke, ischemic strokes occur when blood flow to the brain is reduced or blocked. Of those, 829 people died during their hospital stay and 1,374 had died within six months after the stroke.

A total of 100 people, or 1.5 percent, had gastrointestinal bleeding, or bleeding in the stomach or intestines, while they were in the hospital from the stroke. In more than half of the cases, the GI bleeding occurred in people who had mild to moderate strokes.

The people with GI bleeding were more than three times more likely to die during their hospital stay or be severely dependent on others for their care at the time they left the hospital than people who did not have GI bleeding. A total of 81 percent of those with GI bleeding died in the hospital or were severely dependent, compared to 41 percent of those without GI bleeding.

Those with GI bleeding were also 1.5 times more likely to have died within six months after the stroke than those without GI bleeding. Of those with GI bleeding, 46 percent had died within six months, compared to 20 percent of those without GI bleeding. This relationship remained even after researchers adjusted for other factors, including other conditions such as pneumonia and heart attack.

The study was supported by the Canadian Stroke Network, the Ontario Ministry of Health and Long-term Care, the Canadian Institutes of Health Research, the Institute for Clinical Evaluative Sciences and the University Health Network Women's Health Program in Toronto.

The American Academy of Neurology, an association of more than 21,000 neurologists and neuroscience professionals, is dedicated to improving patient care through education and research. A neurologist is a doctor with specialized training in diagnosing, treating and managing disorders of the brain and nervous system such as stroke, Alzheimer's disease, epilepsy, Parkinson's disease, and multiple sclerosis.

For more information about the American Academy of Neurology, visit http://www.aan.com.

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The Link Between Gastric Reflux And Asthma
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Researchers at Duke University Medical Center appear to have solved at least a piece of a puzzle that has mystified physicians for years: why so many patients with asthma also suffer from GERD, or gastroesophageal reflux disease.

Clinicians first noted a relationship between the two diseases in the mid-1970s. Since then, studies have shown that anywhere from 50 to 90 percent of patients with asthma experience some aspect of GERD. But can GERD cause asthma, or, is it the other way around? Perhaps there is some shared mechanism at the root of both disorders causing them to arise together. Physicians could make a case for each scenario, but until now, the exact nature of the relationship was not clear.

Working in laboratory experiments with mice, Dr. Shu Lin, an assistant professor of surgery and immunology at Duke, discovered that inhaling tiny amounts of stomach fluid that back up into the esophagus - a hallmark of GERD - produces changes in the immune system that can drive the development of asthma.

In the experiments, researchers inserted miniscule amounts of gastric fluid into the lungs of mice (mimicking the human process of micro-aspiration, or breathing in tiny amounts) over a period of eight weeks. They compared these animals' immune systems with those of mice that were exposed to allergens but not the gastric fluid.

The immune systems of the two sets of mice responded very differently. Those that had the gastric fluid in their lungs developed what researchers call a T-helper type 2 response, a type of immune system reaction characteristic of asthma. The other mice responded in a more balanced manner, mounting an immune reaction consisting of both T-helper type 1 and T-helper type 2 responses.

"This is the first experimental evidence in a controlled, laboratory setting linking these two very common conditions in humans," says Lin, the senior author of the study published online in the European Journal of Clinical Investigation. "These data suggest that chronic micro-aspiration of gastric fluid can drive the immune system toward an asthmatic response."

"This does not mean that everyone with GERD is going to develop asthma, by any means," says William Parker, an assistant professor of surgery at Duke and a co-author of the study. "But it may mean that people with GERD may be more likely to develop asthma. If there is an upside to this, it is that developing GERD is something we can pretty much treat and control."

Parker says poor diet, a lack of exercise and obesity all contribute to the development of GERD, and that rising rates of reflux disease are part of a "perfect storm" of environmental and behavioral factors driving escalating rates of asthma, particularly in Western cultures. "People should avoid the risk factors for GERD. We strongly believe that the rise in asthma, particularly among adults in the country, is in large measure due to lifestyle choices that can be changed."

Lin and Parker agree that much more work needs to be done to fully understand the cellular and molecular mechanisms involved in the relationship between reflux disease and asthma, but both feel their study offers new directions for developing additional treatment options for both problems.

Lin says patients who already have GERD can minimize gastric reflux - and thereby lessen their chances of developing asthma - by following a few simple guidelines: Eat smaller meals and eat several hours before going to bed; raise the head of the bed a few inches; maintain a healthy weight; and limit fatty foods, coffee, tea, caffeine and alcohol - they can relax the esophageal sphincter and make reflux more likely.

Source: Michelle Gailiun
Duke University Medical Center

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Predator Virus Attacks Lethal E. Coli At Source
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Researchers at The Evergreen State College in collaboration with the U.S. Department of Agriculture at Texas A&M have been working to increase food safety by reducing the populations of E. coli in the guts of sheep and cattle. The goal of the research is to increase understanding of the complex predator-prey relationship between bacteria (the prey) and bacteriophages (the viral predator). The research could lead to safer food.

E. coli O157:H7 is a dangerous bacterial food pathogen that occurs naturally in the guts of livestock without making them sick. E. coli is easily passed from farm animals to humans. The bacterium causes food poisoning, sickness, and sometimes death in people who eat tainted meat or contaminated produce or water.

Andrew Brabban and Betty Kutter, microbiologists at Evergreen State College in Olympia, Washington, have been studying tiny E. coli predators known as bacteriophages, which attack E. coli bacteria. The Evergreen State phage biology lab was established in 1973 and together Kutter and Brabban have more than six decades of research experience on phages.

Brabban, Kutter, and colleagues have uncovered bacteriophages that attack various strains of E. coli naturally in cattle or sheep's stomach. Recent results appeared under the title "Prevalence of Escherichia coli O157 and O157:H7-infecting bacteriophages in feedlot cattle feces" in the October issue of Letters in Applied Microbiology. The research is funded by the U.S. National Institutes of Health, Phage Biotics, the National Cattlemen's Beef Association and the U.S. Department of Agriculture.

By using phage as a natural predator, it may be possible to better target and tame E. coli and increase the safety of food. Using bacteriophages provides a potentially cheap and broadly applicable way to treat cattle that offers advantages over traditional antibiotics.

Phage treatment is more specific to E. coli, which means it is less likely to encourage resistance in other harmful bacteria and less likely to kill useful bacteria. Also, much like the bacteria, the bacteriophage is easily transferred from one infected individual to another, resulting in a more robust solution to E. coli infections.

Economic impacts could also be significant. "E. coli contamination results in waste of meat, and ultimately wasted meat costs consumers," says Brabban. "Hundreds of millions are also spent to treat E. coli infections," he adds.

But while economics are important, healthier food is the top priority of the research. "It would be very rewarding if we could come up with an increased understanding or an application that leads to safer food down the line," says Brabban. "We all would like food to be safer."

The Evergreen State College
http://www.evergreen.edu

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Pre-Cancerous Condition Linked To Chronic Acid Reflux Faces Several Hurdles
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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

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Top 10 Heartburn Foods
0 comments Thursday, July 24, 2008

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

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IBS Symptoms Relieved By Home-Based Cognitive Behavioral Therapy
0 comments Tuesday, July 1, 2008

Persons with irritable bowel syndrome (IBS) can relieve their symptoms as effectively by following a self-administered, at-home cognitive behavioral program as they can by undergoing a 10-week in-office program administered by a trained therapist, a new pilot study has shown. The findings are important because there are no reliable medicines available to treat successfully the full range of symptoms of this chronic, often debilitating, disorder that affects an estimated 14-24 percent of women and 5-19 percent of men in the U.S.

The study is posted online on the Clinical Gastroenterology and Hepatology's Web site and will be published in the journal's July 2008 issue.

Jeffrey M. Lackner, Psy.D., assistant professor in the Division of Gastroenterology in the University at Buffalo School of Medicine and Biomedical Sciences and director of its Behavioral Medicine Clinic at the Erie County Medical Center, is first author.


"The value of this study is that it shows that patients can learn relatively simple self-care skills to take control of symptoms that are resistant to existing medical treatments," said Lackner. "This is a dramatic example of the complexity of brain-gut interactions."

IBS is characterized by chronic abdominal pain and discomfort, diarrhea and/or constipation. Cognitive behavioral therapy (CBT) has been shown to improve symptoms, quality of life and psychological stress, but there is a shortage of trained CBT therapists, which has created long waiting lists.

The treatment also is expensive and time consuming, requiring 10-12 in-office sessions, a schedule many patients are unable or unwilling to maintain. In addition, IBS specialty clinics are rare, so patients are deprived of the state-of-the-art treatment available at UB.

To help solve these problems, Lackner and colleagues designed a primarily self-administered treatment program that patients can learn at home, using self-study materials, supplemented by four in-office counseling sessions.

"Patients can follow a program like this at their own pace and on their own time," Lackner noted, "and perhaps most important, they can learn these skills in the environment where symptoms are most likely to occur. It also requires less travel, which makes it convenient for patients with busy lifestyles and for those in underserved and rural areas."

The researchers tested the program's effectiveness in a pilot study involving 75 IBS-diagnosed patients who were randomized to one of three groups: a standard 10-session therapist-administered cognitive therapy group (CBT); a "minimal-contact" CBT group (MC-CBT) that included the home-based program and a wait-list group (WL). This last group simply monitored their gastrointestinal symptoms daily.

All participants were interviewed two weeks after the end of the 10-week treatment period to gather information on overall relief of symptoms and improved quality of life.

Patients in both therapy groups reported clinically significant relief of symptoms: 60.9 percent in the CBT group and 72 percent for MC-CBT. Only 7.4 percent of the wait-list group reported improvement. Patients in both treatment groups also reported significant improvement in quality of life.

"The finding that a self-administered approach can be successful in reducing IBS symptoms is important at this point in time, when few validated therapies are available for patients," said Lackner.

"Further research is needed to establish the therapeutic potential of this novel approach to managing IBS, as well as to understand how these treatments work and the conditions under which they are most likely to achieve the desired effects."

Source: Lois Baker
University at Buffalo

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New Test Could Aid Children Suffering From Reflux Disease
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A nuclear medicine imaging test was used to confirm that children with respiratory problems may be more likely to develop gastroesophageal reflux disease, according to researchers at SNM's 55th Annual Meeting. The nuclear imaging technique, known as scintigraphy, was also shown to be more effective in detecting the disease in these children than traditional barium X-ray technology. The results indicate that scintigraphy could become an important diagnostic tool for detecting reflux disease, a serious condition that can lead to chronic chest pain, vomiting, weight loss and lung impairment in children who suffer from it.

"Unfortunately, reflux disease is a common problem in children, especially for those with respiratory problems," said Wajiha Nasir, a researcher at the Nuclear Medicine Oncology and Radiotherapy Institute (NORI), Islamabad, Pakistan. "If left untreated, the disease can seriously impede children's health, growth and development, not to mention their quality of life. Our results show that scintigraphy is highly effective at safely diagnosing the condition."

Reflux disease occurs when the esophagus becomes irritated or inflamed by stomach contents. The stomach produces hydrochloric acid after a meal to aid in the digestion of food. Normally, a ring of muscle at the bottom of the esophagus, called the lower esophageal sphincter, prevents the acid from going back up the esophagus. With reflux disease, however, the sphincter relaxes between swallows, allowing stomach contents and corrosive acid to well up and damage the lining of the esophagus.

The chronic condition affects up to a third of adults, and many infants and children also suffer from it. Some of these children outgrow the condition as their digestive systems mature, but many do not. Researchers have long suspected that children who have respiratory problems such as asthma might also be more susceptible to reflux disease.

Scintigraphy is a diagnostic test in which a two-dimensional picture is obtained through detection of a radiation emitted by a radioactive source given to the body. In this study, 55 children aged six months to 12 years who had asthma or lower respiratory tract infections were orally administered a commonly used radioactive imaging agent that was then detected through scintigraphy technology.

The test detected reflux disease in 66.6 percent of the children, revealing a strong association between reflux disease and respiratory disease. In addition, scintigraphy proved more effective at detecting the disease than traditional barium x-rays. Children in the study who exhibited reflux disease were given medication to treat reflux. At a three-month follow-up visit, most of the children's symptoms had improved after receiving the medication.

"Scintigraphy is one of the simplest radionuclide tests to administer, with a very low radiation burden," said Nasir. If performed routinely for children suffering from bronchial asthma and recurrent respiratory tract infections, this test could get children the treatment they deserve."


Source: Amy Shaw
Society of Nuclear Medicine

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