Who Can Get Graves Disease ?

This disease is more common in women who are over twenty years of age because of their active hormonal secretions.

Causes of Graves Disease

The immune system usually uses proteins which occur naturally called antibodies and white blood cells which assist in eliminating antigens such as viruses, bacteria, and other foreign substances that could invade your body. In Graves’ disease, the system wrongly attacks the thyroid gland but does not necessarily destroy it, the thyrotropin receptor antibody stimulates the thyroid making it secrete excessive amounts of thyroid hormone which eventually leads to Graves’ disease. Doctors are not too sure why the immune system attacks the thyroid gland, though they believe it could be a combination of reasons such as heredity, sex, age, and stress could be responsible for the development of Graves’ disease.

Symptoms of Graves Disease

Symptoms for Graves’ disease are many and diverse. They include the enlargement of the thyroid gland, frequent bowl movements, very light menstrual periods, increased perspiration, irregular heart beats, fatigue, anxiety, and irritability. Your eyes could also exhibit Graves’ ophthalmopathy which means your eyes bulge out beyond the normal protective orbit causing excessive sensation and tearing of grit or sand in your eyes, as well as swelling of the lids and tissues around the eyes and reddened or inflamed eyes. These are the typical symptoms of Graves’ disease.

Medical Treatments for Graves Disease

It’s hard to stop your immune system from attacking the thyroid gland thus leading to Graves’ disease. Treatment for this disease is only meant to decrease the secretion of thyroxine or block its action. The best medication for this purpose are beta blockers for example propranolol, atenolo, metoprolol and nadolol. These usually help to reduce the hyperthyroid signs and symptoms. These beta blockers are always used with other forms of treatment. Anti-thyroid medications are also used to prevent the production of excessive hormones. The other treatment involves radioactive iodine treatment. The radioactive iodine collects in the thyroid gland and destroys the overactive thyroid cells.

Alternative Treatments for Graves Disease

Apply cool compresses to your eyes for Graves’ ophthalmopathy. This added moisture soothes the eyes. Wearing sunglasses reduces the irritations of your eyes from the wind. Lubricating eye drops also relieves the dryness and scratchiness on the eye surface. Elevation of the head lessens fluid accumulation.

Any signs of enlarged thyroid, protruding eyes, anxiety, intolerance to heat, tremor and weight loss, are very clear signs that you urgently need medical assistance.

Who Can Get Gout?

Gout can be contracted by people who have advanced in age and is more common in males than in females. It is a male disease. The males who suffer from gout include those who have a family history of gout. Those who are obese, have problems of the thyroid, organ transplants, continuous exposure to lead, consumption of foods that have a high content of purine as well as certain medical drugs can cause gout.

Causes of the Disease

Children are the age group that are least affected by gout. Middle aged men are most susceptible to gout. Those in the high risk category include those who are obese, excessive consumers of alcohol, as well as those who have high blood pressure.

Males have higher chances of suffering from gout because their uric acid levels increase during puberty. Females on the other are not likely to suffer from gout until after menopause. Experts reckon that this is because of the action of the estrogen hormone in women. Medications such as aspirin and diuretics increase the chances of suffering from gout. This is especially so among the aged.

Family history as well as obesity increases the chances of suffering from gout. Research shows that people whose family members in the past suffered from gout have high chances of suffering from gout too.

Symptoms of Gout

The most common symptom of gout is swelling of the joints at the big toe. Painful joints, unusual stiffness as well as inflammation are the other symptoms. These symptoms normally occur at different body parts for different age groups. The level of advancement of the disease will more often than not determine the symptoms that one will exhibit. In the early stages gout doesn’t exhibit any symptoms.

Over the Counter Treatments for Gout

Treatments of gout involve use of medications. It is not advisable however to use medication during the early stages of gout. During the early stages it is good to change your diet and try as much as possible to live healthily. Different stages of gout require different methods of treatment. It is advisable that people suffering from gout try a variety of medical drugs to see which works best for them to prevent the severity of acute attacks.

Alternative Treatments for Gout

Alternative treatment for gout has not been proven to be totally effective. It is therefore advisable to use alternative therapy together with conventional treatment methods. Research has proved that vitamin C reduces the level of uric acid thus it is recommended. However, those suffering from kidney disease should consult with their doctors first before consuming vitamin C. Vitamin C might complicate the kidney disease.

The esophagus is the pipeline leading from the mouth to the stomach. In GERD, the lower esophageal sphincter (LES) opens or closes spontaneously and sporadically. The usual symptoms are heartburn, mostly after meals. Meals trigger the stomach to produce digestive fluids or acid that backs up into the esophagus. As meals are a critical part of maintaining body mass, supporting mood and initiating cell growth, frequent and painful reflux can disrupt one’s lifestyle and health. Infrequent acid reflux symptoms do not equal an increased risk of death, however, indicating a benign nature or even a protective nature for the majority of sufferers.

Transient relaxation of the sphincter and frequent episodes of reflux may however, lead to esophagitis or an inflamed lining of the esophagus. The esophagus may become narrow or bleed. The esophagus is easily injured and other consequences include asthma and vocal problems. Precancerous and cancerous conditions may develop. GERD complications may result in surgery or hospitalizations with esophageal adenocarcinoma, esophagitis, Barrett’s esophagus, esophageal ulcer, and esophageal stricture.

Click here to view the embedded video.

Seven million people in the US suffer from GERD; 60 percent of the population at some time during the year, and 20 to 30 percent weekly. The number of hospitalizations for GERD with a obesity diagnosis has risen by 112 percent while all other hospitalizations increased by only 13 percent.

The age group 18–34 years old is seeing increases of GERD at a rate of 273 percent. The US spent $622 million in 2005 for treatment. The American College of Emergency Physicians states that up to 60 percent of patients with chest pain visits to the emergency room are not related to the heart, but rather to gastrointestinal disturbances. Worldwide symptomology is increasing, in developed countries especially.

The British spelling of esophagus is “oesophagus” so GERD is called GORD in many European countries. GERD is a disease and heartburn is its most common symptom. GERD is a chronic condition and clinically diagnosed with a cluster of symptoms and signs. Significant health-care utilization and diminished quality of life is seen, although little attention is shown to the affliction. The cause or pathogenesis of GERD is yet unknown and no cure is agreed upon. However, lifestyle modifications and medications are effective for almost everyone.

Cause of Gerd

The majority of reflux episodes do not feature highly concentrated acid events. Researchers now believe that acid is not causing as much damage to the esophagus as was previously thought. When scientists dosed animal subject’s esophagus with stomach acid it took weeks to develop esophagitis. For GERD to be caused by the chemical acid, injury would have been seen immediately as acid has acute corrosion. Therefore, GERD is an inflammation to the esophageal mucosa. Inflammatory cells infiltrate and cause epithelial thickening more like that of the stomach or intestine, in order to protect itself from further injury by acid.

Esophageal muscles may also have a lack of tone which causes performance problems in motility. The digestive system can’t clear acids and other gastric contents and they back up into the esophagus. Abnormal muscular movements may delay esophageal motility especially when lying down. Potential drug treatments would aim to increase motility.

Alteration of a microbiome is often seen in GERD patients and not healthy subjects, but researchers are not sure if bacteria is triggering GERD or responding to it. These microbiome communities outnumber other cells in the human body by 10 to 1, yet their effect on physiology is not well understood. While healthy people have a high concentration of Streptococcus, GERD patients have microbiomes dominated by Gram-negative bacteria. New therapies with antibiotics, probiotic bacteria or prebiotics may restore balance.

Finding a genetic cause for GERD and related complications can improve detection, treatment, and quality of life. Twelve genes for mutation analysis have been identified as priority candidates. Three major genes, MSR1, ASCC1, and CTHRC1 account for 11% for GERD associated conditions. This is considered a moderate to high load of genetic susceptibility. In addition, two genes, CDK6 and CDK4 showed expression for the growth of esophageal cancer cells. Targeted therapies to chemically inhibit or block the effect of oncogenes may be developed in the future.

Consequences of GERD

Only a minority of patients develop complications of GERD. These complications include:

• Esophageal erosions – breaks in the lining of the esophagus. Those of an older age, those being of male gender, those with divorced/widowed status and those who have heavy tea consumption habits are also at higher risk.
• Esophageal stricture – scarring and narrowing of the esophagus. A stiff, thin or thick deviation in normal anatomy is seen with circular or linear patterns.
• Esophageal ulcer – a hole, sore, lesion or break in the lining of the esophagus.
• Epithelium Changes – normal esophageal lining or epithelium may be replaced with abnormal cells.
• Barrett’s esophagus – when inflammation and gastric acid causes the normal lining of the esophagus to change. These cell changes are precancerous and may lead to cancer.
• Cancer – survival rates for esophageal adenocarcinoma is 70 percent to 80 percent for early-stage patients. Advanced stage 3 or 4 patients have only a 5 percent to 20 percent survival rate. Most times the cancer has already spread, limiting survival chances. Experts say that esophageal cancer is increasing more rapidly than any other type of cancer. Patients with mild or moderate symptoms of GERD are more likely to be diagnosed with cancer. Those with severe symptoms are more likely to be aggressively treated and screened for precancerous conditions. Those with mild symptoms are unaware of that changes in the cell lining that may be precancerous. These cell changes become Barrett’s esophagus and may transform into cancer. Researchers believe that even patients without severe symptoms should be screened for Barrett’s esophagus to identify it before it becomes cancerous.
• Asthma – some patients with asthma might benefit from treatment of GERD and vice versa. Microaspiration causes gastric droplets to enter the airways and may cause asthma and Chronic Pulmonary Disease (COPD).
• Disordered Sleep – pain when lying down and altered nerve function in upper GI tract  may lead to disordered sleep which creates a vicious cycle leading to symptoms of insomnia. 40-50% of people with GERD report significant impairment in sleep, including arousal from sleep, increased wakefulness and overall poor sleep quality. Insomnia is a known factor for depression and weight gain. Measuring sleep in GERD patients may help in long-term treatment and quality of life.
• Sleep Apnea – people with sleep apnea also have gastrointestinal conditions. Obstructive sleep apnea is a condition where the airway collapses during sleep and blocks airflow. Patients are forced to awake violently in order to get enough air. 84% of sleep apneas patients had some type of pathological gastrointestinal disorder, including hiatus hernia, erosive esophagitis, histological esophagitis, erosive gastritis, duodenal ulcer, and biliary reflux. About 12 million Americans have sleep apnea, and researchers believe that they should also be referred for gastrointestinal evaluation and treatment.
• Obesity – a direct relationship is shown between body mass index and the likelihood of experiencing GERD-related symptoms. Being overweight or obese increases the chance of having heartburn, acid reflux, GERD and related complications. Having these symptoms may also cause a rise in body mass, due to sleep disorders altering the hunger/satiation cycles.
• Pregnancy – heartburn is a common complaint for pregnant women, usually during the first trimester and worsening during the second and third trimesters. Elevated hormones like progesterone, and abdominal pressure from the developing fetus is thought to cause GERD symptoms.
• Children – diagnosis of GERD in children is not as clear as it is in adults. Symptom analysis finds different results and diagnosis should be based on clinical judgment, testing and follow-up studies. The most likely indicator for GERD in infants and children is chronic cough.
• Vocal cords – atypical damage to the throat and vocal cords may result from GERD symptoms. Usually those patients with more severe GERD symptoms develop laryngitis and vocal cord problems.
• Teeth – any type of systemic inflammation can make its way to the mouth and mucous membranes. The inflammation and acidic erosion in the gastrointestinal system sometimes erodes the tooth enamel, wearing them down. Odontoblast cells can be affected by GERD and cause tooth decay.
• Nose and Sinus – chronic rhinosinusitis (CRS) can develop due to GERD. Nose- and sinus-related problems can reduce the quality of life due to deviations in the respiratory process.
• Heartburn Season – for many people regardless of heritage, overindulging at holidays and festivities becomes problematic. Often fatty foods are present and people tend to eat more during holidays.

GERD Diagnosis

Anyone can get GERD even infants and children. Adults over the age of 40 are most likely to develop symptoms. 50 percent of cases are between the ages of 45-64. People in the age range of 18–34 are seeing the biggest increases in incidence. 30% of all hospitalizations occur among the elderly. Every social class, ethnic group and age is represented in GERD diagnoses, with slightly more cases seen among women. In the US, the Western region had the lowest incidence while the South had the highest incidence. The Midwest region is seeing the largest increase in incidence.

Obesity is a major factor in developing GERD, with a direct link between body mass and heartburn. People with normal weight do not experience heartburn like obese people do. Pregnancy also precipitates heartburn events and GERD. Smoking cigarettes is likely to trigger GERD symptoms as well.

Symptoms

Symptom Indices

Symptom-reflux association analysis (SAA) parameters can help diagnose GERD results with an agreement of these 3 SAA parameters:

• Symptom index (SI) – the percentage of reflux related symptom episodes.
• Symptom sensitivity index (SSI) – the percentage of symptom related reflux episodes.
• Symptom association probability (SAP) – a new type of statistical analysis using a contingency table consisting of four possible combinations of reflux and symptoms.

Common GERD Symptoms

The major factor in identifying symptoms is meals. Meals stimulate the gastric fluids to multiply in order to break down and digest stomach contents. When a person seeks medical treatment, the physician may ask about what was eaten and when. In other cases, a physician may ask if the problem presented when standing upright or lying down. An evaluation of current medication may be conducted as some medications can trigger heartburn. The top 4 typical symptoms for GERD are:

• chest pain – nonspecific, in the mid-chest, and in the mid-abdomen.
• heartburn – a rising, burning sensation behind the breastbone.
• regurgitation – acid or sour contents in the mouth.
• dysphagia – pain or trouble swallowing.

Atypical but common symptoms include:

• anemia – the amount of red blood cells which oxidize cells is reduced.
• vomiting – forced and unintended disgorgement of stomach contents.
• weight loss – an alarming symptom where body mass is reduced in a short amount of time.
• asthma – labored breathing which may induce panic.
• hoarseness/laryngitis- acid can cause inflammation of the back of the throat.
• chronic cough – an irritated airway causing removal of mucous.
• wheezing- an erratic breathing condition sometimes producing a distinct sound like whistling.
• blood in the stool – digestive problems and epithelial erosion may find its way into the excretory system.
• hematemesis – vomiting or coughing up blood.
• nausea – a dizzy, sick feeling preceding vomiting.
• early satiation – feeling not hungry or barely eating and feeling full.
• bloating – feeling full and gaseous as if the stomach and abdomen are big.
• belching – burping or ejecting stomach gases from the mouth.

Differentiating Symptoms

People with non-erosive disease (NERD) differ from patients with erosive esophagitis. Non-erosive esophagitis patients have better sphincter muscle tone, better motility of esophagus contents, less acidic exposure and better nighttime experiences. Cardiac or pulmonary disease also produces symptoms similar to GERD.

Tests

People often visit a hospital with chest pains that turn out to be not related to a heart condition. A gastroenterologist is consulted who is familiar with GERD and its treatment. A series of tests are conducted depending on severity of symptoms and the patient’s discomfort:

• Endoscopy – a thin, flexible tube inspects the lining of the upper gastrointestinal tract. This procedure identifies GERD and is the only way to diagnose Barrett’s esophagus. Other deviations including tumors and cancer may be detected in this way as well.
• Biopsy – a small sample of tissue may be obtained for further analysis.
• Conventional pH monitoring – measures acidity.
• MII-pH monitoring – a device that can detect non-acid reflux without depending on the acidity of the contents that refluxes into the esophagus.
• Esophageal impedance – uses a probe that is placed into the esophagus with a catheter to differentiate between acidic reflux and non-acidic reflux that would not be detected by a pH probe.
• Narrow band imaging – evaluates mucosal surfaces and improves the endoscopic diagnosis of GERD by differentiating between normal mucosa and inflamed mucosa.
• Scintigraphic imaging – uses internal radionuclides to create two-dimensional images. Evaluation of the gastrointestinal system is complicated and imaging techniques may aid in evaluation. Scintography may be more effective than traditional barium X-ray technology.
• Manometry – examines the physical structure and pressure in the esophagus. Peristalsis or the flow of food down the pipeline is measured with a probe inserted through the nose, down the throat, down the esophagus, and into the stomach.

GERD Treatment

Treatment for GERD consists of suppressing acid, however new theories implicate inflammation as the cause for GERD, with anti-inflammation medications and lifestyle changes recommended. Nutritional choices become important including avoiding certain foods and beverages.  Home treatments like antacids for heartburn may not work as the esophagus suffers repeated damage from acidic events, and medical treatment and long-term management becomes necessary.

Pain management becomes an issue for GERD sufferers and they often want to know if there is anything else they can do to relieve pain. Patients may be only eating small, bland meals, avoiding alcohol and taking their medications but still be suffering from pain. When lifestyle changes and medications don’t work in severe cases, surgery is an option. Surgery won’t cure the acidic or inflammatory conditions or the underlying problem, but surgery can mechanically fix the esophagus to some extent.

Click here to view the embedded video.

Medication 

Anti-Inflammatory

GERD may be an immune-mediated injury, where cytokines attract inflammatory cells to the esophagus and start an inflammatory process which causes the injury in the first place. Medications would consist of anti-inflammatory agents, nonsteroidal anti-inflammatory drugs (NSAIDs). Aspirin, ibuprofen, and naproxen are common over the counter medications which reduce pain and inflammation. COX-2 inhibitors are often prescribed for long-term conditions because they may be safer for the stomach.

Acid Suppression

Proton pump inhibitors (PPI) are generally safe medicines which can serve to achieve and maintain remission. Patients must continue to take the drug as a high rate of relapse is seen upon stopping treatment. Proton pump inhibitors may take hours or days to reach their full effect. Active healing of the esophagus may take a considerable time after acid suppression is realized. While most people do continue take their medications, long-term outcomes may be reduced due to a lack of compliance with medication.

• Esomeprazole – 92 percent of people who take esomeprazole remained in remission. Esomeprazole, brand name Prilosec and Nexium, suppresses acid secretion by inhibiting the functioning of ATPase enzyme in gastric parietal cells. Physicians may use this drug to both diagnosis GERD and prescribe initial treatment. During an endoscopy the physician may administer the drug to see if acid suppression is successful.
• Rabeprazole – brand name Pariet, also works to reduce the production of stomach acid. Sometimes it is used with antibiotics to eliminate harmful bacteria and treat ulcers.
• Lansoprazole – brand name Prevacid, works to prevent the stomach from secreting gastric acid. This medication can be taken naso-gastrically for those who cannot swallow pills.
• Dexlansoprazole – brand names Kapidex, Dexilant, has a dual release technology. One dose is released about an hour after ingestion in the proximal duodenum and the second release about four hours later in the small intestine.

The downside of chronic and long-term use of PPIs may cause one to be asymptomatic even when the esophagus and gastrointestinal system is still being damaged. Other complications associated with PPIs:

• vitamin B12, iron and calcium malabsorption – alteration of the gastric pH may produce defects in absorption of nutrients.
• fractures in postmenopausal women – increased rates of hip fractures, possibly related to altered calcium absorption.
• bacterial infections in many patients – acid suppressors alter gastrointestinal and respiratory bacteria, increasing the likelihood of an infection.
• pneumonia – hospitalized patients who use PPIs have a 30% greater incidence of pneumonia. Acid suppressive medications exposed patients to acquiring pneumonia while admitted to the hospital. Suppressing acid is thought to modify respiratory bacteria. Acquiring pneumonia while in the hospital may lead to an extended stay in the hospital and increases the risk of death.
• body weight – 71% of patients may gain an average of 3.5 kg. or 8 lbs. Patients who take PPIs are encouraged to lead a balanced lifestyle including exercise to prevent weight gain.

Alternative Methods of Treatment

The Linx system

Proton Pump inhibitors are commonly used but often do not prevent reflux. The Linx system is an alternative treatment after trying medication, but before trying surgery. A small, flexible band of titanium beads similar to a bracelet is placed laparoscopically around the lower esophagus. A magnetic core holds the beads in place and together they act to support the natural sphincter action of the esophagus.

Multipolar Electrocoagulation

Some researchers insist that all GERD patients be screened for Barrett’s esophagus. Treatment of Barrett’s esophagus aims to reduce the amount of abnormal lining in the esophagus. Ablation therapy is a safe and effective method to remove unwanted tissue in order that new healthy tissue may grow. Different types of ablation may be used including radiofrequency ablation, multipolar electrocoagulation, argon plasma coagulation, and cryotherapy. Ablation can also be used in conjunction with medication and surgery.

SurgeryFor GERD

Some patients do not respond to medication, are reluctant to take long-term medication, suffer medication side effects and/or may prefer to have anti-reflux surgery. 85 percent of patients who elect surgery achieve long-term remission of GERD. Some types of surgery include:

• Laparoscopic Nissen Fundoplication – major surgery to mechanically fix the anatomical problem by wrapping part of the stomach around the lower end of the esophagus to help keep acid from getting back up into the esophagus.
• Laparoscopy – Laparoscopic anti-reflux surgery (LARS) is a minimally invasive surgery that accomplishes the goals of major surgery. This procedure requires 1 to 5 port holes for the insertion of medical instruments, but has the same internal incisions and scarring seen in major surgery.
• TIF procedure – Transoral Incisionless Fundoplication is a minutely invasive surgery that accomplishes the goals of major surgery without an external or internal incision. The procedure is accomplished trans-orally or through the mouth. The procedure recreates the anti-reflux barrier between the esophagus and stomach by using part of the stomach to create a valve.

Click here to view the embedded video.

Strategies during Pregnancy

Pregnant women often develop heartburn and GERD related symptoms usually during the first trimester and worsening during the second and third trimesters. Physicians recommend that pregnant women try to solve the problem first through lifestyle and dietary changes. Dietary recommendations are the same as for non-pregnant people. These tips however apply just to pregnant women:

• Tight fitting clothes serve to further restrict the abdomen and put pressure on the lower esophageal sphincter.
• Consult your doctor before taking any medication including antacids to relieve heartburn symptoms. Antacids should be used cautiously during pregnancy. Antacids containing aluminum or calcium are considered safe. Antacids containing magnesium-or sodium bicarbonate should be avoided.
• Zantac was found to be effective in reducing the symptoms of heartburn and acid regurgitation with no adverse effects on the fetus.
• The proton pump inhibitor Lansoprazole, brand name Prevacid is reported safe for pregnant women, however should be reserved for more severe cases. Newer PPIs have limited data about safety during pregnancy.

Nutrition

Foods to Avoid

GERD sufferers may have a restricted diet or bland diet which becomes unsatisfying and difficult to maintain. Some foods may irritate while others may not. Individuals are encouraged to experiment and discover for themselves which foods trigger symptoms. The situation may be fluid in that some foods may become more acceptable at a later time. Fasting for a day or two to clear all food and then introducing foods one at a time may help to identify triggers. A food diary is also a good idea to track GERD events. Consultation with a nutritionist is recommended to identify culprits and ensure a well-balanced and satisfying diet. Some foods and beverages thought to trigger GERD symptoms:

• fatty foods
• greasy food
• spicy food
• chocolate
• peppermint
• tomato sauces
• caffeine
• carbonated drinks
• citrus fruits
• garlic
• onions
• curry
• alcohol

Sleep

Sleep is an important physiological process but GERD sufferers may face problems with sleeping:

• Don’t lie down after eating because it’s easier for acid to back up into the esophagus while lying down.
• Wait at least 3 hours after eating before going to bed because when you go to bed with a full stomach, acid is more readily available to back up into the esophagus.
• Large meals may produce heartburn in some people.
• Raise the head off of the bed 4 to 6 inches with a pillow. Sleeping with the head and shoulders elevated may reduce acid build-up.

Exercise/Weight Loss

As GERD may be an immune system deficiency maintaining a healthy immune system through exercise is important. Exercise also works to maintain a low body mass which may reduce GERD symptoms. As many obese people have GERD, weight loss is encouraged. PPI’s may increase the risk of weight gain so patients are best served by maintaining a healthy weight through exercise.

Emerging Possibilities

Ecabet Sodium

Esophageal mucosa may benefit from the protective effects of ecabet sodium (ES). Prevention of reflux esophagitis may be realized with the administration of ES. This mucoprotective agent inhibits the epithelial thickening of the lower and middle esophagus. ES may have uses as a prophylactic to prevent GERD, or to speed healing.

Novel Diagnosis

New methods to diagnose GERD offer improved sensitivity, specificity, and are not expensive or invasive. Exhaled breath condensate analysis and electronic nose technology are new methods undergoing trials.

• Exhaled breath condensate analysis (EBC) can determine airway inflammation. Sampling of pH, nitrogen oxides (NOx), and leukotriene B4 (LTB4) markers can discover inflammatory airway diseases and GERD biomarkers.
• Electronic nose technology can diagnose multi-microbial problems and is used to sense medical, animal and plant diseases. The instrument measures electrical resistance changes to fingerprint volatile compounds.

Sound Device

Differentiation between a GERD event and coughing is made easier with a sound device to precisely measure the timing and sounds. A reflux event has a different sound than coughing. Coughing, especially in infants and children, is the most recognizable symptom of GERD. A custom-built validated recording device and microphone was used and integrated with software and an audiovisual display. The data is also being used to identify how a cough interacts with or results from a reflux event.

Related Conditions

Barrett’s esophagus – cells change, harden or thicken in reaction to erosive acid. This condition is thought to be pre-cancerous. Patients may have Barrett’s esophagus, but may not be aware of it, if their symptoms are not severe. Researchers recommend that all GERD sufferers be screened for Barrett’s as treatment is available, and because it may be a precursor for cancer.

Obesity – people who are overweight or obese commonly have GERD, much more so than in the normal weight population. Hospitalization for GERD symptoms has seen a three fold increase in obese patients.

Peptic ulcer disease – a hole in the lining of the stomach or duodenum can form from imbalanced digestive fluids, bacteria, and aspirin-type drugs.

Hiatal hernia – part of the stomach may distend through the diaphragm and into the chest. Symptoms of GERD are present as the hernia interferes with the esophageal sphincter.

Functional dyspepsia – is a common upper GI condition with abdominal pain pressure or discomfort in the upper abdomen. Upset stomach can develop from a medical problem or food issue.

Conclusion

GERD is a clinical diagnosis for chronic events relating to esophagus malfunctioning. Specifically, the valve at the end of the esophagus leading to the stomach does not close properly. Digestive fluids and acids back up into the esophagus and cause gastrointestinal distress. These fluids are meant to be sealed into the stomach to digest food and nutrients. When the acid is allowed back into the esophagus where it does not belong, people experience discomfort.

The main symptoms are nonspecific chest pain in the mid-chest, and in the mid-abdomen. Sometimes this symptom is mistaken for a heart related event, and people commonly visit the emergency room at the hospital when they experience this kind of pain. Heartburn is another main symptom causing a rising, burning sensation behind the breastbone. Regurgitation of stomach contents into the mouth or having an acid or sour taste in the mouth is the third main symptom. Dysphagia is having pain or trouble swallowing and is the fourth and final main symptom of GERD.

Other symptoms may be present and these symptoms, combined with an individual’s medical history and diagnostic tests may lead to a diagnosis of GERD. Once a diagnosis is reached, acid suppressive therapy with the use of PPI’s is the commonly accepted treatment. However, new evidence supports a treatment approach based on providing anti-inflammatory agents to stop inflammation and speed healing. For those with GERD, lifelong medication may be necessary, as relapse is common when stopping medication.

For some however, medication does not work, so surgery is an available option. New kinds of surgery go beyond even “minimally invasive” laparoscopic techniques. Incision-less surgery is possible to mechanically fix the malfunctioning valve at the base of the esophagus.

Most people can achieve remission with lifestyle changes, medication or surgery. For some though, complications can result including cancer. All patients with GERD are advised to get a thorough screening, even if they do not have severe symptoms. Those with mild symptoms may not undergo a complete evaluation and precancerous and cancerous conditions may be present. Finding a cancerous condition at an advanced stage does not give a good outcome.

Basic lifestyle recommendations are the same for GERD patients as for the general population. Exercise serves to keep body mass normal. Nutrition provides raw energy production and supports the immune system. Avoidance of fatty and sugary foods is good advice for everyone, especially GERD patients. Proper sleep plays a critical role in keeping weight down and maintaining a healthy immune system.

References

http://www.eurekalert.org/pub_releases/2011-02/wjog-nho020511.php

http://esciencenews.com/articles/2009/08/10/characteristic.pathological.findings.reflux.esophagitis

http://www.medicalnewstoday.com/releases/85647.php

http://www.utsouthwestern.edu/utsw/cda/dept37389/files/563743.html

http://www.snm.org/index.cfm?PageID=9746

http://www.physorg.com/news189161994.html

http://www.eurekalert.org/pub_releases/2011-07/jaaj-rig072211.php

http://www.pulmonaryfibrosis.org/node/622

http://www.sciencedaily.com/releases/2011/05/110518151818.htm

http://www.urmc.rochester.edu/news/story/index.cfm?id=3204

http://www.upmc.com/MediaRelations/NewsReleases/2011/Pages/Esophageal-Cancer-Risk-Higher-in-GERD-Patients.aspx

http://www.ncbi.nlm.nih.gov/pubmed/21811465

http://www.acg.gi.org/media/releases/10ACG_Gerd&Sleep.pdf

http://www.ncbi.nlm.nih.gov/pubmed/21793907

http://www.ncbi.nlm.nih.gov/pubmed/21709949

http://www.ncbi.nlm.nih.gov/pubmed/21706321

http://www.ncbi.nlm.nih.gov/pubmed/21782769

http://www.ncbi.nlm.nih.gov/pubmed/21768433

http://www.ncbi.nlm.nih.gov/pubmed/21725507

http://www.ncbi.nlm.nih.gov/pubmed/21699806

http://www.ncbi.nlm.nih.gov/pubmed/21725507

http://www.ncbi.nlm.nih.gov/pubmed/21822991

http://www.ncbi.nlm.nih.gov/pubmed/21793632

http://www.ncbi.nlm.nih.gov/pubmed/21782770

http://www.ncbi.nlm.nih.gov/pubmed/21780890

http://www.ncbi.nlm.nih.gov/pubmed/21811465

Who Can Get Genital Warts?

Genital warts can be transmitted through sexual contact. Those who are sexually active are at a higher risk of getting genital warts especially if they have had multiple partners and don’t use protection during sex. The virus can also be spread through anal sex. A newborn child may contract the disease through the birthing process if the mother has been infected. Such a child will develop warts of the throat and nasal passages.

Causes of the Disease

The Human Papilloma Virus is the sole agent of Genital Warts. The Human Papilloma Virus {HPV} is a collection of viruses. There are more than a hundred types of HPV. The various viruses cause different types of warts. For example the virus that causes warts of the feet are totally different from those that cause warts of the genital organs.

A minimum of thirty different types of HPV cause genital warts. Transmission of genital warts from mother to baby is very rare though it occurs. Young adults are the most vulnerable to genital warts. This may be because they usually have multiple sexual partners and don’t use adequate protection.

Symptoms of Genital Warts

People who have genital warts may not know about it. The reason why many people are not aware that they have genital warts is because it doesn’t itch nor does it hurt. However some people may develop visible warts in the genital region. Doctors normally conduct a detailed examination of the skin to determine whether someone has the disease or not. However, presence of a wart is a sign that the human papilloma virus is active thus it can be easily transmitted to the next person.

There are various types of human papilloma virus that can cause cancer in both males and females. In males the human papilloma virus normally causes the cancer of the penis and anal cancer. In females the human papilloma virus may cause cancer of the vulva as well as vaginal cancer.

Over the Counter Treatment

The other conditions which are caused by the human papilloma virus have treatments while there is currently no treatment for genital warts. Genital warts can only heal if your immune system is very strong. People who have genital warts which are visible to the naked eye can be prescribed topical medications. Cancer of the cervix is treatable only if it is diagnosed early through a PAP smear test where a swab sample is taken of the cells lining the cervix.

Who Can Get Genital Herpes?

As mentioned earlier, genital herpes is a sexually transmitted disease. This means that for one to get the disease, he or she must have had sexual intercourse with an already infected person without using the necessary protection. There is no other possible means that genital herpes may be transmitted other than through sexual intercourse.

Causes of Genital Herpes

Genital herpes is a viral disease. This means that it is caused by a type of virus known as herpes simplex virus. Herpes simplex viruses are of two types which are type 1(HSV-1) and type 2 (HSV-2). However type two of the herpes simplex virus is more known for causing the genital herpes disease.

Symptoms of Genital Herpes

The most common symptoms and signs of genital herpes is blisters in the private parts which then burst into very painful wounds. These wounds however heal within a short period, usually between two weeks to one month. The blisters may then re occur but the second occurrence will be less severe and the trend continues with each re occurrence decreasing in severity.

Treatment for Genital Herpes

There are specified drugs that are sold over the counter to reduce the severity of the blisters and the wounds caused by genital herpes. The drugs are of various types and they vary depending on the stage of advancement of the disease.

The most common treatment available for the genital herpes disease are the various drugs available at pharmacies and chemists. It is worth mentioning at this point that genital herpes is an incurable disease and all the drugs administered only serve to reduce the severity and or the strength of the disease.

Administration of drugs for the genital herpes and indeed any other disease is most preferable at the earliest stage possible. Upon realization that one has the disease, it is wise to administer the relevant drugs as soon as possible to prevent the disease from growing and becoming unmanageable.

As already mentioned earlier, the genital herpes disease has no cure. However, being a viral disease, there are antiviral drugs that can be administered. These drugs do not cure the disease but instead suppress the virus to prevent frequent re occurrence of blisters and sores that characterize the genital herpes disease. Daily therapy by the doctors also plays a key role in suppressing the viral disease. The means by which genital herpes is transmitted as already mentioned is through sexual intercourse. This means that prevention of this disease is quite simple through the use of protection (condoms) during sexual intercourse. This will prevent bodily fluids from coming into contact with each other thus preventing transmission. Alternatively, one may abstain from engaging in sexual intercourse.

Who Can Get Gastroenteritis

This disease is mainly prevalent in babies and children who are below the age of five years. Surveys conducted showed that this disease was responsible for not less than five million deaths of children world wide some years back. This number must be higher now that there are more children than before especially in the developing world. Though common in babies, adults also do get it especially those that live in places that have very poor hygienic standards especially in the developing world.

Causes of Gastroenteritis

Though this disease is mainly viral in nature, it has nothing to do with influenza though it’s caused by other types of viruses and bacteria that happen to be very contagious in nature and spread quite fast mainly in food and drinking water. Viruses are the major causes of gastroenteritis while bacteria are less prevalent. One gets infected through poor hygienic standards such as not washing hands after using the toilets then handling food with the dirty hands or living in very dirty places that have plenty of these viruses that get in contact with food and cause the disease. Norovirus is the one responsible for the food borne gastroenteritis. The bacteria such as salmonella, E. coli and shigellia do cause gastroenteritis though they are less common than the viral one. Drinking contaminated water and eating poorly cooked food coupled with poor sanitation greatly contribute to the spread of this disease.

Symptoms of Gastroenteritis

This disease is characterized by several symptoms but the most common ones are stomach pains, diarrhea and vomiting. These are the clinical signs that one is likely suffering from gastroenteritis though most people usually mistake it for food poisoning. The other symptoms for it may include blood stained stools, severe abdominal pains, loss of appetite, cramps in the abdomen, feeling weak to the extend of fainting due to dehydration.

Over the Counter Treatments for Gastroenteritis

Regardless of the causes, the most recommended treatment for gastroenteritis is rehydration. Since the patient tends to lose so much water through vomiting and diarrhea, getting the fluids replaced is the most logical thing one has to consider as a priority. The rehydration process can be done both orally and intravenously. Pedialyte, Ricelyte, or Resol are best recommended for children. The dosage varies with age, the younger ones getting the least while adults getting the most according to the doctors advice. Adults can also use clear fluids such as water for the first 24 hours.

Alternative Treatments for Gastroenteritis

Alternative treatments for gastroenteritis can be achieved by altering the diet to help the patient cope with the disease. Herbal remedies as well as homeopathy such as arsenicum album or nux vomica can really help. The use of meadowsweet can help the reduction of nausea as well as stomach acidity. To calm the digestive tract after taking care of the worst symptoms, slippery elm is highly recommended.

When is Medicinal Treatment Necessary?

Gastroenteritis is a disease that could prove fatal if not properly taken care of. When one starts vomiting blood or having blood stained stools, it’s time to visit your family doctor who will take care of the problem.

The best recommended medical care for this illness is bismuth subsalicylate. Promethazine or zofran are also good remedies.

Who Can Get Gastritis?

Anyone who consumes a lot of alcohol has a high risk of suffering from gastritis. Those who prolong the use of certain dugs that are anti-inflammatory in nature also have high chances of suffering from this condition. Bacterial infection as well as usage of such drugs as Ibuprofen and Aspirin can also cause this disease.

Causes Of Gastritis

Use of anti- inflammatory drugs for unreasonably long periods of time can lead to gastritis condition. Major surgical operations can sometimes lead to this condition. Not only that, but there are other instances in which traumatizing injury, burns as well as extreme infections can lead to gastritis.

Symptoms of Gastritis

Abdominal upsets or abdominal pains are some of the symptoms of this disease. Burning in the upper abdomen, belching, nausea, abdominal bloating as well as a feeling of fullness are the other symptoms of gastritis. Traces of blood found within vomit might be a confirmation of a serious medical condition. It is thus advisable that you seek urgent medical attention.

Different methods of examination

Before you proceed to get medication at a pharmacy it is important to seek professional advice from a qualified doctor. Examination before diagnosis by the doctor will involve examination of the stomach linings. This is done by the help of an instrument that has camera like features and can show the condition of the stomach lining. If there is inflammation of the stomach lining then this could be a confirmation of the disease. A series of other tests can also be conducted for example blood tests to find out whether you are anemic or not. Anemia is a deficiency disease evidenced by low red blood cell count within blood at a particular time. A sample of your stool may also be taken to check whether it has traces of blood in it. Traces of blood may be a confirmation of Helicobacter pylori in your system.

Over The Counter Treatment

Over the counter treatment is through taking of prescribed drugs from a pharmacy. These drugs have the effect of reducing the acidic levels of the stomach. They thus stop the continued inflammation of the stomach lining hence commencing the healing process.

Alternative Treatment for Gastritis

Avoiding or better still, stopping completely the consumption of food substances that increase the acidic level of the stomach. Antibiotics can also be prescribed to treat an infection caused by Helicobacter pylori.

If you are used to excessive alcohol intake you should check yourself into a rehabilitation center. The other forms of alternative treatment that are used are herbs. It is however advised that if you are taking herbs you should use herbs alone. You should not take herbs while at the same time using over the counter drugs. If you mix the treatment methods you might suffer from complications that could be very dangerous.

Who Can Get Gallstones?

Research indicates that the people who are at a great risk of developing gallstones are those suffering from ferrochelatase enzyme deficiency, a disorder commonly referred to as Erythropoietic protoporphyria. Pregnant mothers are also at a risk due to the increase of the estrogen hormone resulting in an increase in the cholesterol levels found in bile with little or no movement at the gall bladder, hence the formation of the gallstones.

Causes of Gallstones

A research conducted indicates that gallstones are formed as a result of several factors. Diet could be a contributing factor to the formation of gallstones. The movement of gallbladder has also been said to be a cause of the disease. Other causes are the body mass or weight of a person. Cholesterol gallstones are a result of accumulation of cholesterol in the bile. Another contributory factor to the formation of gallstones is the failure to empty the gall bladder frequently and also the failure to empty the bladder completely. Researchers have also attributed the formation of gallstones to the proteins found in the bile that act as a catalyst to gallstone formation. Doctors have also warned that instantaneous loss of weight may be a key factor in the formation of gallstones. Insufficient meals, constipation and lack of important minerals like calcium and magnesium may also cause gallstones. Whole grain bread and wine plays a key role in decreasing the chances of gallstone formation.

Symptoms of Gallstones

The very first symptom of gallstones is intense discomfort and pain on the upper abdomen which lasts for a considerably long time. Vomiting and nausea together with back pain which extends to the right shoulder are other symptoms of gallstones. Bloating of the stomach, belching and indigestion are also symptoms associated with gallstones. Other symptoms to look out for are a change in skin pigmentation to a yellow color and fever.

Over The Counter Treatment for Gallstones

A glass of water works well to eliminate the pain caused by gallstones. Alternatively, a patient of gallstones may take coffee or magnesium or any other bitter drink to relieve the pain.

Alternative Treatment For Gallstones

The most common alternative treatment is taking apple juice, a quantity not less than 4 glasses together with lemon juice and olive oil. In addition apple fruits are also very helpful. This ought to be done for at least five consecutive days.

When Is Medicinal Treatment Necessary?

Medicinal treatment should be administered at the earliest possible stage of the disease. This prevents the stones from building up and getting larger in size.

Medical Treatment for Gallstones

Ursodeoxycholic acid is one of the drugs that can be used to breakdown gallstones. However, the condition reoccurs upon ceasing the medication. Alternatively, a patient may undergo surgical operations to remove the gallstones.