GASTRIC GOLD'S BLOG

Indigestion

Indigestion is often a sign of an underlying problem, such as gastroesophageal reflux disease (GERD), ulcers, or gallbladder disease, rather than a condition of its own.

Also called dyspepsia, indigestion is a term used to describe a feeling of fullness or discomfort during or after a meal. It can be accompanied by burning or pain in the upper stomach.

What Are the Symptoms of Indigestion?

The symptoms of indigestion include:

• Bloating (full feeling)
• Belching and gas
• Nausea and vomiting
• Acidic taste
• Growling stomach
• Burning in the stomach or upper abdomen
• Abdominal pain

These symptoms may increase in times of stress.

People often have heartburn (a burning sensation deep in the chest) along with indigestion. But heartburn is caused by stomach acids rising into the esophagus.

Who Is at Risk for Indigestion?

People of all ages and of both sexes are affected by indigestion. It's extremely common. An individual's risk increases with excess alcohol consumption, use of drugs that may irritate the stomach (such as aspirin), other conditions where there is an abnormality in the digestive tract such as an ulcer and emotional problems such as anxiety or depression.

What Causes Indigestion?

Indigestion has many causes, including:

Diseases:

• Ulcers
• GERD
• Stomach cancer (rare)
• Gastroparesis (a condition where the stomach doesn't empty properly; this often occurs in diabetics)
• Stomach infections
• Irritable bowel syndrome
• Chronic pancreatitis
• Thyroid disease

Medications:

• Aspirin and many other painkillers
• Estrogen and oral contraceptives
• Steroid medications
• Certain antibiotics
• Thyroid medicines

Lifestyle:

• Eating too much, eating too fast, eating high-fat foods, or eating during stressful situations
• Drinking too much alcohol
• Cigarette smoking
• Stress and fatigue

Swallowing excessive air when eating may increase the symptoms of belching and bloating, which are often associated with indigestion.

Sometimes people have persistent indigestion that is not related to any of these factors. This type of indigestion is called functional, or non-ulcer dyspepsia.

During the middle and later parts of pregnancy, many women have indigestion. This is believed to be caused by a number of pregnancy-related factors including hormones, which relax the muscles of the digestive tract, and the pressure of the growing uterus on the stomach.

How Is Indigestion Diagnosed?

If you are experiencing symptoms of indigestion, make an appointment to see your doctor to rule out a more serious condition. Because indigestion is such a broad term, it is helpful to provide your doctor with a precise description of the discomfort you are experiencing. In describing your indigestion symptoms, try to define where in the abdomen the discomfort usually occurs. Simply reporting pain in the stomach is not detailed enough for your doctor to help identify and treat your problem.

First, your doctor must rule out any underlying conditions. Your doctor may perform several blood tests and you may have X-rays of the stomach or small intestine. Your doctor may also use an instrument to look closely at the inside of the stomach, a procedure called an upper endoscopy. An endoscope, a flexible tube that contains a light and a camera to produce images from inside the body, is used in this procedure.

What Is the Treatment for Indigestion?

Because indigestion is a symptom rather than a disease, treatment usually depends upon the underlying condition causing the indigestion.

Often, episodes of indigestion go away within hours without medical attention. However, if your indigestion symptoms become worse, you should consult a doctor. Here are some helpful tips to alleviate indigestion:

• Try not to chew with your mouth open, talk while chewing, or eat too fast. This causes you to swallow too much air, which can aggravate indigestion.
• Drink fluids after rather than during meals.
• Avoid late-night eating.
• Try to relax after meals.
• Avoid spicy foods.
• Stop smoking.
• Avoid alcoholic beverages.

If indigestion is not relieved after making these changes, your doctor may prescribe medications to alleviate your symptoms.

How Can I Prevent Indigestion?

The best way to prevent indigestion is to avoid the foods and situations that seem to cause indigestion. Keeping a food diary is helpful in identifying foods that cause indigestion. Here are some other suggestions:

• Eat small meals so the stomach does not have to work as hard or as long.
• Eat slowly.
• Avoid foods that contain high amounts of acids, such as citrus fruits and tomatoes.
• Reduce or avoid foods and beverages that contain caffeine.
• If stress is a trigger for your indigestion, re-evaluating your lifestyle may help to reduce stress. Learn new methods for managing stress, such as relaxation and biofeedback techniques.
• Smokers should consider quitting smoking, or at least not smoking right before or after eating, as smoking can irritate the stomach lining.
• Cut back on alcohol consumption because alcohol can irritate the stomach lining.
• Avoid wearing tight-fitting garments because they tend to compress the stomach, which can cause its contents to enter the esophagus.
• Do not exercise with a full stomach. Rather, exercise before a meal or at least one hour after eating a meal.
• Do not lie down right after eating.
• Wait at least three hours after your last meal of the day before going to bed.
• Raise the head of your bed so that your head and chest are higher than your feet. You can do this by placing 6-inch blocks under the bedposts at the head of the bed. Don't use piles of pillows to achieve the same goal. You will only put your head at an angle that can increase pressure on your stomach and make heartburn worse.

When Should I Call the Doctor About Indigestion?

Because indigestion can be a sign of a more serious health problem, call your doctor if you have any of the following symptoms:

• Vomiting or blood in vomit (the vomit may look like coffee grounds).
• Weight loss.
• Loss of appetite.
• Black, tarry stools or visible blood in stools.
• Severe pain in upper right abdomen.
• Pain in upper or lower right abdomen.
• Discomfort unrelated to eating.

Symptoms similar to indigestion may be caused by heart attacks. If indigestion is unusual, accompanied by shortness of breath, sweating, or pain radiating to the jaw, neck or arm, seek medical attention immediately.

webmd

Labels: GERD, Heartburn, indigestion

Researchers have identified a protein that plays an important role in the development of stomach cancers and that could one day be a target for new treatments for the disease, according to research published in the British Journal of Cancer.

Scientists based at the Chinese University of Hong Kong explored the role of a protein called RAMP in stomach cancer cell lines and tissues, finding that it is more common in these cells compared to surrounding normal tissues.

The increased presence of RAMP suggests that this protein may play a pivotal role in the multi-step development of stomach cancer. Higher levels of the protein were seen in the very early stages of stomach cancer and were also present throughout the development of the disease. To add further evidence to RAMP's role in this cancer they found that the protein also encouraged cells to grow, fuelling the disease further.


Source
Cancer Research UK
This is the first study to establish a possible link between RAMP and stomach cancer and could help doctors to gain a better understanding of the disease, leading to more effective treatments.

Next the scientists proceeded to 'knock out' RAMP's function in two human gastric cancer cell lines. This slowed down the growth of the cancer in these cell lines and even led to cell death.

It is hoped that these findings could be the first step to developing a new approach to treating stomach cancer by developing treatments that 'switch off' RAMP. This could halt the growth of these tumours and even reduce tumour size.

Study author Dr WK Leung said: "We have established for the first time the role that RAMP plays in stomach cancer. Working out a role for RAMP in stomach cancer gives us more information about the common, but poorly understood steps that lead to the development of this cancer.

"We're very excited about with these results. The next stage of our research will aim to discover more about RAMP's specific role in stomach cancer and begin exploring the possibility of developing new drugs that can stop RAMP in its tracks."

Dr Lesley Walker, director of cancer information at Cancer Research UK, said: "This interesting study helps us understand more about the mechanisms behind the development of stomach cancer. One of the reasons that survival rates for stomach cancers remain low is because they are often at an advanced stage when diagnosed, so making it harder to treat successfully. We welcome new research that could one day help those with stomach cancer face a better prognosis."

In the UK more than 7,700 people are diagnosed with stomach cancer each year, with 95 per cent of cases among the over 50's. Over the last 25 years five-year survival rates have tripled in the UK, but the disease remains very difficult to treat successfully and five year survival is still low at around 15 per cent.

Labels: Cancer, stomach ulcer

Using the Vienna classification system, it has been shown in clinic-based cohorts that there can be a significant change in disease behavior over time, whereas disease location remains relatively stable. Clinical and environmental factors as well as medical therapy might be relevant in predicting disease behavior change in patients with CD. In previous studies, early age at diagnosis, disease location, perianal disease and, in some studies, smoking were associated with the presence of complicated disease and surgery.

The combined effect of markers of disease phenotype (e.g., age, gender, location, perianal diesease) and medical therapy (steroid use, early immunosupression) on the probability of disease behavior change were, however, not studied thus far in the published literature.

A research article published in the World Journal of Gastroenterology addresses this problem. Members of the Hungarian IBD Study Group led by Dr Peter Laszlo Lakatos from the Semmelweis University investigated 340 well-characterized, unrelated, consecutive CD patients (M/F: 155/185, duration: 9.4 ± 7.5 years) with a complete clinical follow-up. Medical records including disease phenotype according to the Montreal classification, extraintestinal manifestations, use of medications and surgical events were analyzed retrospectively. Patients were interviewed on their smoking habits at the time of diagnosis and during the regular follow-up visits.

They found that perianal disease, current smoking, prior steroid use, early azathioprine or azathioprine/biological therapy are predictors of disease behavior change in CD patients.

The new data with easily applicable clinical information as presented in the article may assist clinicians in practical decision-making or in choosing the treatment strategy for their CD patients.


Source:
Lai-Fu Li
World Journal of Gastroenterology

Labels: Crohn's disease

ecently, the number of patients with GERD has increased in Japan. However, there have been few reports about the pathological findings in the esophageal squamous epithelium, and there are differing opinions among pathologists about the findings considered characteristic of chronic reflux esophagitis.　

Dr. Daisuke Asaoka and his colleagues from Juntendo University (Japan) used a rat model of chronic acid-reflux esophagitis to explore the esophageal mucosal damage macroscopically and microscopically throughout the entire esophagus, including the upper esophagus close to the hypopharynx, and to investigate the protective effects of ecabet sodium (ES) on the esophageal mucosa. This was published in the World Journal of Gastroenterology.

Their research revealed that epithelial thickening occurs at the same time as inflammatory cell infiltration in the middle to lower esophagus in chronic acid-reflux esophagitis. Furthermore, they demonstrated that inflammatory cells infiltrated the epithelium of the upper esophagus close to the hypopharynx, where there was no evidence of ulcers. These findings suggested that the reflux of gastric juice can extend to the upper esophagus close to the hypopharynx.

Moreover, the research also demonstrated that ES inhibited the epithelial thickening of the lower and middle esophagus, which suggested that ES may play a useful defensive role in the prevention of reflux esophagitis.


Source:
Lai-Fu Li
World Journal of Gastroenterology

Labels: esophagitis, GERD

Is your heartburn triggered by running, aerobics, or other forms of exercise?

You exercise to feel the burn -- but not that kind of burn. Muscles, yes. Stomach, no. But when you go running, do aerobics, or go to a spinning class, there it is: heartburn. It's not just your legs that are churning, it's your last meal as well, churning right up into your throat. Your exercise heartburn has even made you hesitate to work out and made you wonder: What's going on here?
What Causes Exercise Heartburn?

Exercise can trigger heartburn if the LES muscle (the lower esophageal sphincter) is weak or too relaxed, and food or stomach acid "burps" back up from your stomach into your esophagus.

Exercise-induced heartburn can also be triggered by certain foods -- especially spicy foods like tomato sauce, acidic foods like orange juice, carbonated sodas, coffee, chocolate, and alcohol. These are the most common triggers for heartburn, according to the American Gastroenterological Association (AGA).
6 Tips When Exercise Triggers Heartburn

You don’t need to give up exercise to avoid heartburn. Instead, try these tips:

1. Problem-solve your diet. Do some simple problem-solving, says Tara O'Brien, PharmD, a pharmacy manager at Pharmaca in Seattle, a national, integrative pharmacy combining Western medicine with self-care. "Specifically, do you eat relatively quickly before going for a run? And what types of food?" Cut out the offending foods -- and hold the triple mochas before running.

2. Eat something soothing before exercise. "Some people eat a yogurt before a run and don't experience any problems, while the next person may eat yogurt and experience the worst heartburn ever," says O'Brien. "Experiment with foods to see if one thing aggravates it more than another." Good places to start? A banana, yogurt, small bowl of whole-grain cereal or toast.

3. Eat two to three hours before working out. Play with how long before you exercise to eat your light snack -- a half-hour, hour, 2 hours before -- and see which works best. Maybe you can eat a small snack an hour before exercise with no problem. Or you may need to eat two to three hours before working out to give your stomach time to empty.

4. Rethink your workout. Certain kinds of exercise may trigger heartburn for some people more than others. Experiment to see whether certain workouts trigger heartburn more or less for you. Maybe you can take a spinning class or go hiking if high-impact aerobics or running hurt. Crunches and core work on a full stomach may have to go. Headstands and Downward Dog in yoga, which reverse the natural gravity of digestion, can also trigger heartburn; ask your teacher how to modify these inverted poses.

5. Try baking soda. Taking something for symptoms wouldn't hurt, says O'Brien. Several natural remedies exist, although they only provide temporary relief. Baking soda added to water can help neutralize and wash away stomach acids. Because baking soda may add more salt to your diet, it's best to speak to your doctor first before trying this remedy.

6. Try over-the-counter relief. In your local pharmacy, look for an antacid with calcium -- that's the ingredient that neutralizes stomach acid. "Chewing a Tums or taking a calcium-based antacid is very safe, so it would be worth a try," says O'Brien. Although these are fast-acting, symptom-relief antacids, it can't hurt to try one as a preventive measure before exercise.

You exercise to feel the burn -- but not that kind of burn. Muscles, yes. Stomach, no. But when you go running, do aerobics, or go to a spinning class, there it is: heartburn. It's not just your legs that are churning, it's your last meal as well, churning right up into your throat. Your exercise heartburn has even made you hesitate to work out and made you wonder: What's going on here?
What Causes Exercise Heartburn?

Exercise can trigger heartburn if the LES muscle (the lower esophageal sphincter) is weak or too relaxed, and food or stomach acid "burps" back up from your stomach into your esophagus.

Exercise-induced heartburn can also be triggered by certain foods -- especially spicy foods like tomato sauce, acidic foods like orange juice, carbonated sodas, coffee, chocolate, and alcohol. These are the most common triggers for heartburn, according to the American Gastroenterological Association (AGA).
6 Tips When Exercise Triggers Heartburn

You don’t need to give up exercise to avoid heartburn. Instead, try these tips:

1. Problem-solve your diet. Do some simple problem-solving, says Tara O'Brien, PharmD, a pharmacy manager at Pharmaca in Seattle, a national, integrative pharmacy combining Western medicine with self-care. "Specifically, do you eat relatively quickly before going for a run? And what types of food?" Cut out the offending foods -- and hold the triple mochas before running.

2. Eat something soothing before exercise. "Some people eat a yogurt before a run and don't experience any problems, while the next person may eat yogurt and experience the worst heartburn ever," says O'Brien. "Experiment with foods to see if one thing aggravates it more than another." Good places to start? A banana, yogurt, small bowl of whole-grain cereal or toast.

3. Eat two to three hours before working out. Play with how long before you exercise to eat your light snack -- a half-hour, hour, 2 hours before -- and see which works best. Maybe you can eat a small snack an hour before exercise with no problem. Or you may need to eat two to three hours before working out to give your stomach time to empty.

4. Rethink your workout. Certain kinds of exercise may trigger heartburn for some people more than others. Experiment to see whether certain workouts trigger heartburn more or less for you. Maybe you can take a spinning class or go hiking if high-impact aerobics or running hurt. Crunches and core work on a full stomach may have to go. Headstands and Downward Dog in yoga, which reverse the natural gravity of digestion, can also trigger heartburn; ask your teacher how to modify these inverted poses.

5. Try baking soda. Taking something for symptoms wouldn't hurt, says O'Brien. Several natural remedies exist, although they only provide temporary relief. Baking soda added to water can help neutralize and wash away stomach acids. Because baking soda may add more salt to your diet, it's best to speak to your doctor first before trying this remedy.

6. Try over-the-counter relief. In your local pharmacy, look for an antacid with calcium -- that's the ingredient that neutralizes stomach acid. "Chewing a Tums or taking a calcium-based antacid is very safe, so it would be worth a try," says O'Brien. Although these are fast-acting, symptom-relief antacids, it can't hurt to try one as a preventive measure before exercise.

webmd

Labels: Heartburn

Study Shows Food-Borne Infections Are Linked to Risk of Inflammatory Bowel Disease

Salmonella or campylobacter food poisoning triples the risk of inflammatory bowel disease (IBD) -- for at least 15 years.

IBD typically refers to Crohn's disease and ulcerative colitis. It's not clear exactly what causes IBD. Genetics, environment, diet, abnormal blood vessels, infections, immune-system overreaction, and psychological factors all have been blamed.

To see whether infections play a role, Henrik Nielsen, MD, of Aalborg Hospital in Denmark took advantage of his nation's system of tracking citizen's health records.

The system allowed Nielsen and colleagues to look at whether people who've been treated for certain infections are at higher risk of developing IBD.

The researchers looked at two kinds of food poisoning: salmonella and campylobacter. They identified 13,149 people treated for either infection and compared their health records to those of people who never suffered these infections.

People who had one or the other kind of food-borne infection had a 1.2% risk of getting IBD over the next 15 years. Those who never had either infection had only a 0.5% risk of IBD. Statistical analysis showed that the food-borne infections tripled IBD risk for at least the next 15 years.

"If we can reduce and prevent the spread of food bacteria and infections, we may reduce or even largely eliminate IBD in the long term," Nielsen says in a news release.

Nielsen reported the findings in a presentation to this week's Digestive Disease Week (DDW), held May 30 to June 4 in Chicago. DDW is an annual conference sponsored by the American Gastroenterological Association, the American Association for the study of Liver Diseases, the American Society for Gastrointestinal Endoscopy, and the Society for Surgery of the Alimentary Tract.

Labels: Inflamatory Bowel Disorders

There are many good reasons to quit smoking. They range from curing your bad breath to reducing your risk of cancer, heart disease, and lung disease. But here's another reason to add to that long list: tobacco -- not just in cigarettes, but in cigars, pipes, chew, and snuff -- can cause heartburn.

"Tobacco makes acid reflux worse," says David Carr-Locke, MD, director of endoscopy, Brigham and Women's Hospital, Boston. "It's definitely a risk factor."

And unlike a heightened risk of serious diseases -- which might seem rather abstract, especially when you're young -- heartburn is a consequence of tobacco use that you can feel right now. And chronic heartburn, due to gastroesophageal reflux disorder (GERD), can cause more than serious pain; it can disrupt your sleep and interfere with your life. Sleeping With Heartburn Carries Cancer Risks.
Healing the Heartburn

According to some experts, there's a simple solution to the heartburn/tobacco equation, although you've probably heard it before: quit.

"For some people, quitting tobacco use can be the difference between having GERD and not having it," says Lawrence J. Cheskin, MD, co-author of Healing Heartburn and associate professor at Johns Hopkins School of Medicine in Baltimore. "If you stop, your symptoms will probably get better quickly. It also really lowers the risks of having further complications down the road."

However, not everyone thinks that quitting tobacco use will necessarily have a dramatic effect on heartburn.

"I think that quitting only has a modest impact on GERD symptoms," says J. Patrick Waring, MD, a gastroenterologist at Piedmont Hospital in Atlanta. But he still strongly encourages anyone who uses tobacco to kick the habit.
How Does Tobacco Affect GERD?

When you eat, a muscular ring between the end of the esophagus and the entrance to the stomach -- called the lower esophageal sphincter (LES) -- relaxes to let food in. Once it has closed again, the stomach releases acids and enzymes to break down the food.

Usually, these acids stay put in the stomach. But in people with GERD, the sphincter may stay relaxed or relax at the wrong time. This allows stomach contents containing acids and enzymes to wash back up, irritating the tissue of the esophagus.

Experts believe tobacco might worsen heartburn in a number of ways, including:

* Impairing the function of the LES. "The nicotine in tobacco seems to lower the pressure in the lower esophageal sphincter," says Cheskin. The reduced pressure could allow stomach acids and enzymes to back into the esophagus.
* Increasing acidity. Nicotine increases the production of stomach acid, says Carr-Locke.
* Harming the esophagus. Tobacco smoke seems to directly irritate the esophagus lining, says Cheskin.
* Reducing saliva production. This causes two problems. When you swallow, saliva helps push acid down, out of the esophagus and into the stomach. Saliva also contains bicarbonate, which is a mild acid neutralizer, says Cheskin. So a reduction in saliva can make your acid reflux worse.

Only the effects of smoked tobacco have been seriously studied on GERD symptoms, say experts. But anything with nicotine is likely to worsen GERD. Waring says that chew might pose specific problems.

"Smoking a cigarette only takes a few minutes," he says. "But people use chewing tobacco all day. That could lead to more irritation."

By the same token, nicotine gum could also pose a risk, say experts. "I don't know of any studies on nicotine gum and GERD," says Cheskin. "But I would worry that anything with nicotine would increase the risk of acid reflux."

Tobacco use also increases the long-term risks of GERD. Acid reflux is more likely to damage the esophagus in people who use tobacco than in people who don't. The damage will heal more slowly too, Cheskin says. Over time, tobacco users are more likely to face complications of GERD. These include chronic inflammation of the esophagus and even esophageal cancer.
Quitting: Will It Help Your Heartburn?

Cheskin says that cutting out tobacco will almost certainly ease heartburn symptoms.

"I think most people would feel the benefit of quitting within a few days," says Cheskin. He says that it's possible that cutting down your tobacco use -- rather than stopping cold turkey -- might help. But he strongly encourages people to quit.

Yet not everyone is sure that quitting makes a big difference.

"It's true that people with GERD who smoke tend to have symptoms that are more pronounced than people who don't smoke," says Waring. But there isn't good evidence that symptoms improve when people quit using tobacco, he says.

"I think tobacco only plays a minor role in acid reflux," he tells WebMD.

The results of research have been mixed. One 2004 study published in the journal Gut found that smoking tobacco had a strong cumulative effect on GERD symptoms. For instance, the study found that people who smoked everyday for twenty years were 70% more likely to have GERD than those who smoked daily for less than a year.

But a 2006 analysis published in the Annals of Internal Medicine found that while there was a connection between smoking and GERD, quitting didn't necessarily help resolve the symptoms.

So cutting out tobacco use may not cure you. Even if you ditch the cigarettes or chew, you might still have heartburn symptoms. But these may be controlled by other lifestyle changes or medicine.
Getting Control of Your Heartburn

Obviously, quitting tobacco isn't easy. Talk to your doctor about different strategies. You'll certainly need the support of your family and loved ones. You might also consider joining a support group to help you cope.

But just remember that while quitting is tough, you will probably feel a lot better for it. While many people might think of heartburn as an occasional discomfort, people with GERD know how painful and debilitating it can be. Quitting tobacco use could be a first and important step in getting control of your condition.

"If there already weren't enough reasons for you to quit smoking," says Cheskin, "resolving your heartburn is one that you can really feel."

WebMd

Labels: Heartburn, Tabacco