February 7, 2017

Gaucher disease is a rare inherited metabolic disorder characterized by anemia, mental and neurologic impairment, yellowish pigmentation of the skin, enlargement of the spleen, and bone deterioration resulting in pathological fractures.

Gaucher disease was initially described in 1882 by French physician Philippe Charles Ernest Gaucher. Normally, the body makes an enzyme called glucocerebrosidase that breaks down and recycles glucocerebroside – a normal part of the cell membrane. People who have Gaucher disease do not make enough glucocerbrosidase. This causes the specific lipid to build up in the liver, spleen, bone marrow and nervous system interfering with normal functioning.

Gaucher disease occurs in about 1 in 50,000 to 1 in 100,000 individuals in the general population. Type 1 is found more frequently among individuals who are of Ashkenazi Jewish ancestry. Type 1 Gaucher disease is present 1 in 500 to 1 in 1000 people of Ashkenazi Jewish ancestry, and approximately 1 in 14 Ashkenazi Jews is a carrier. Type 2 and Type 3 Gaucher disease are not as common.

Types of Gaucher’s Disease

There are five main types of Gaucher disease, each with different manifestations. These types are described below.

Type 1 – Type 1 is the most common form of the disease. It can affect people at any age and its symptoms vary widely from mild to severe.

Type 2 – Type 2 is known as the infantile or acute neuropathic form of Gaucher disease. Symptoms usually appear before age 2 and progress rapidly. Children with type 2 Gaucher disease have some of the symptoms of type 1. These may include enlarged liver and spleen, lowered number of red blood cells (anemia) leading to weakness and tiredness, lowered number of platelets leading to bleeding and bruising, and lung disease.

Type 3 – Type 3 Gaucher disease is known as the juvenile or chronic neuropathic form. Symptoms often begin before age 2, though this is variable. Usually the symptoms associated with type 3 progress more slowly than with type 2. While some people with type 3 Gaucher disease die in childhood, others can live into their 30s or 40s.

Perinatal-Lethal Form – The perinatal-lethal form is a rare but severe form of Gaucher disease. This form usually leads to death in utero or shortly after birth.

Cardiovascular Form – As the name implies, the cardiovascular form of Gaucher disease causes symptoms involving the heart, notably a hardening of the mitral and aortic valves. If this symptom is severe, heart valve replacement may be required.

Causes

Gaucher’s disease is caused by a recessive mutation of the gene called GBA, located on chromosome 1. The GBA gene tells the body to produce glucocerebrosidase. Glucocerebrosidase, an enzyme (protein), breaks down a type of fat (lipid) known as glucosylceramide into sugar and simple fats, which the body uses for energy.

If the GBA gene is faulty there is a deficiency of the enzyme glucocerebrosidase, which leads to an excessive accumulation of glucosylceramide, which starts to collect inside the cells of the brain, bone marrow, lungs, spleen and liver, and interferes with their normal functioning.

Inheritence – A baby inherits Gaucher’s disease in an “autosomal recessive manner”. If a baby inherits a faulty gene from each parent, i.e. has two faulty genes, he/she has Gaucher’s disease. Both parents need to be carriers for their offspring to develop Gaucher’s disease.

If both parents are carriers, each pregnancy has a:

  • 25% chance of producing an offspring with Gaucher’s disease
  • 50% risk of having a child who is a carrier
  • 25% chance the child is neither affected nor a carrier (if he/she inherits a properly-functioning gene from each parent).

Symptoms

A symptom is something the patient feels and describes, such as a headache, while a sign is something others can detect, e.g. a rash.

Most patients describe their first symptom as a swollen stomach. This is usually one of the first warning signs that sends patients to the doctor – an enlarged abdomen. This is because the spleen has swollen.

One of the spleen’s functions is to weed out old blood cells. When the spleen enlarges too much, sometimes to 25 times its normal size, it weeds out too many blood cells, including good ones. This can lead to anemia. Patients with insufficient blood cells suffer from fatigue, because they are not getting enough oxygen and energy. If the spleen has taken out too many platelets, which are essential for coagulation (clotting), the patient will bleed and bruise more.

People with Gaucher’s disease do not all have the same symptoms.

Gaucher’s disease Type 1 – Signs and symptoms may include –

  • Anemia
  • Delayed puberty
  • Fatigue
  • Frequent nosebleeds
  • Hepatomegaly – enlarged liver
  • Osteopenia (bone thinning), bone fractures, and bone pain. Damage to the shoulder or hip joints are common.
  • Osteoporosis – demineralization of the bones
  • Pingueculae – yellow spots in the eyes
  • Splenomegaly – enlarged spleen
  • Thrombocytopenia – low blood platelet numbers, resulting in easy bruising and slow clotting times (easy bleeding)

Type 1 Gaucher’s disease is most prevalent in the Ashkenazi Jewish population.

Gaucher’s disease Type 2 – Signs and symptoms may include:

  • All those possible in Type 1, plus..
  • Mental retardation
  • Apnea – breathing stops temporarily during sleep
  • Dementia
  • Seizures
  • Rigidity

Gaucher’s disease Type 3 – Signs and symptoms may include:

  • All those possible in Type 1, plus..
  • Mental retardation
  • Dementia
  • Convulsions
  • Ocular muscle apraxia – abnormal eye movements
  • Myoclonus – muscle twitches

Perinatal-Lethal Form – Infants with the disease have symptoms including enlarged liver and spleen, lowered number red blood cells and platelets, neurological problems, skin abnormalities, and often distinct facial features.

 

Complications

Gaucher’s disease may increase the risk of –

  • Growth delays in children
  • Gynecological and obstetric problems
  • Parkinson’s disease
  • Cancers such as myeloma, leukemia and lymphoma
  • Organ damage
  • Osteopenia
  • Ruptured spleen
  • Severe swelling (edema)
  • Increased bleeding

Treatment

Enzyme replacement therapy (ERT) – The deficient glucocerebrosidase is replaced with intravenous recombinant glucocerebrosidase (imiglucerase). ERT is more effective for most patients with Type 1, and some with Type 3. ERT can help prevent hepatomegaly (enlarged liver) and splenomegaly (enlarged spleen), improve bone density as well as blood platelet count. ERT does not treat problems with the nervous system (brain damage) in patients with Types 2 and 3.

Substrate reduction therapy (SRT) – The aim here is to reduce the production and buildup of substrate (waste material) within cells. SRT reduces the amount of waste a cell makes so that for patients who are deficient in glucocerebrosidase, the glucocerebrosidase they do have is better able to prevent the waste from building up within cells.

Bone marrow transplant – Also known as stem cell transplant, replaces bone marrow that has been damaged by Gaucher’s with healthy bone marrow stem cells. Bone marrow is a spongy tissue that exists in the hollow centers of some bones. Bone marrow cells produce blood cells, including red and white blood cells, and platelets (which help stop bleeding).

Inhibit production of the problem substances – Oral medications, such as miglustat (Zavesca) and eliglustat (Cerdelga), appear to interfere with the production of the fatty substances that build up in people with Gaucher’s disease. Nausea and diarrhea are common side effects.

Spleen removal – Before enzyme replacement therapy became available, removing the spleen was a common treatment for Gaucher’s disease. Currently, this procedure is typically reserved as a last resort.

Psychological Care – It’s also important to consider the mental and emotional impact that Gaucher disease can place on patients and their families. Professional counseling can help patients better manage the difficulties of their disease and the lifestyle changes that may be required.

Reference –

http://www.orpha.net/consor/cgi-bin/OC_Exp.php?lng=EN&Expert=355

https://www.gaucher.org.uk/

http://www.medicalnewstoday.com/articles/263370.php

http://rarediseases.org/rare-diseases/gaucher-disease/

https://www.genome.gov/25521505

https://www.gauchercare.com/en/patient/about/TypesOfGaucher.aspx

http://ghr.nlm.nih.gov/condition/gaucher-disease

http://emedicine.medscape.com/article/944157-overview

http://www.gaucherdisease.org/

February 7, 2017

Gastritis is inflammation of the lining of the stomach – the gastric mucosa. Gastritis and an ulcer are conditions that affect the stomach and small intestine, and they share many symptoms, such as abdominal pain, nausea, vomiting, loss of appetite and weight loss. There are many differences, though. Gastritis and an ulcer both inflame the stomach lining, but gastritis is a general inflammation, and an ulcer is a patch of eroded stomach lining. Though gastritis and an ulcer share symptoms, an intense, localized pain is much more common with an ulcer, and an ulcer also carries the risk of bleeding, cancer and eventual stomach perforation. Doctors use a variety of techniques to diagnose each specific ailment, and the methods of treatment vary as well.

There are two main types of gastritis: acute and chronic.

  • Acute gastritis – Acute gastritis can cause pain and swelling in the stomach but generally does not last for a long period of time – it stops within a few days.
  • Chronic gastritis – Chronic gastritis is just that – chronic. This refers to it lasting for a long period of time. Someone may have chronic gastritis and not even realize it because symptoms are dull and not severe.

Gastritis can be erosive or nonerosive –

  • Erosive gastritis can cause the stomach lining to wear away, causing erosions—shallow breaks in the stomach lining—or ulcers—deep sores in the stomach lining.
  • Nonerosive gastritis causes inflammation in the stomach lining; however, erosions or ulcers do not accompany nonerosive gastritis.

Depending on the severity of the condition, the mucosal cells may only be partially affected or they may be completely damaged or eroded.

Causes

Gastritis is inflammation of the lining of the stomach.

 

The stomach lining is usually strong enough to withstand acidic and spicy foods, alcohol and more. However, irritation may be caused by excessive alcohol use, chronic vomiting, stress or the use of certain medications such as aspirin or other anti-inflammatory drugs. Gastritis may also be brought on by –

  • Helicobacter pylori (H. pylori) – A bacterium that lives in the mucous lining of the stomach. Without treatment, the infection can lead to ulcers and, in some people, to stomach cancer.
  • Pernicious anaemia – A form of anaemia that occurs when the stomach lacks a naturally occurring substance (intrinsic factor) needed to properly absorb and digest vitamin B12.
  • Bile reflux – A backflow of the contents of the duodenum up into the stomach, where bile in the intestinal fluids may irritate the stomach lining.
  • Infections caused by bacteria and viruses
  • Crohn’s disease, which causes inflammation and irritation of any part of the gastrointestinal (GI) tract.
  • Sarcoidosis, a disease that causes inflammation that will not go away. The chronic inflammation causes tiny clumps of abnormal tissue to form in various organs in the body. The disease typically starts in the lungs, skin, and lymph nodes.
  • Allergies to food, such as cow’s milk and soy, especially in children.

If gastritis is left untreated, it can lead to severe loss of blood, or in some cases it can increase the risk of developing stomach cancer.

Risk Factors

  • Infection with H. pylori
  • Acquired immunodeficiency syndrome (AIDS)
  • Any condition that requires relief from chronic pain using NSAIDS, such as chronic low back pain, fibromyalgia, or arthritis
  • Alcoholism
  • Cigarette smoking
  • Older age
  • Herpes simplex virus or cytomegalovirus
  • Inflammatory bowel disease
  • Coffee and acidic beverages
  • Eating or drinking caustic or corrosive substances (such as poisons)
  • Trauma (for example, radiation treatments or having swallowed a foreign object)

Symptoms

Symptoms of gastritis vary among individuals, and in many people there are no symptoms. However, the most common symptoms include –

  • Nausea or recurrent upset stomach
  • Abdominal bloating
  • Abdominal pain
  • Vomiting
  • Indigestion
  • Burning or gnawing feeling in the stomach between meals or at night
  • Hiccups
  • Loss of appetite
  • Vomiting blood or coffee ground-like material
  • Black, tarry stools

Complications

  • Peptic ulcers may develop when stomach acid damages the lining of the stomach or the first part of the small intestine (called the duodenum). These ulcers can usually be treated with lifestyle changes and medication.
  • Vitamin B12 deficiency and pernicious anemia
  • Chronic gastritis increases the chance of developing benign, or noncancerous, and malignant, or cancerous, growths in the stomach lining.

Treatment

Antacids, such as Alka-Seltzer, Maalox, Mylanta, Rolaids, and Riopan. Many brands use different combinations of three basic salts—magnesium, aluminum, and calcium—along with hydroxide or bicarbonate ions to neutralize stomach acid. Antacids, however, can have side effects. Magnesium salt can lead to diarrhea, and aluminum salt can cause constipation. Magnesium and aluminum salts are often combined in a single product to balance these effects. Calcium carbonate antacids, such as Tums, Titralac, and Alka-2, can cause constipation.

H2 blockers, such as cimetidine (Tagamet HB), famotidine (Pepcid AC), nizatidine (Axid AR), and ranitidine (Zantac 75). H2 blockers decrease acid production. They are available in both over-the-counter and prescription strengths.

Proton pump inhibitors (PPIs) include omeprazole (Prilosec, Zegerid), lansoprazole (Prevacid), dexlansoprazole (Dexilant), pantoprazole (Protonix), rabeprazole (AcipHex), and esomeprazole (Nexium). PPIs decrease acid production more effectively than H2 blockers. All of these medications are available by prescription. Omeprazole and lansoprazole are also available in over-the-counter strength.

Lifestyle – The treatment for gastritis that is caused by irritants is to stop using them. These include –

  • Alcohol
  • Tobacco
  • Acidic beverages, such as coffee (both caffeinated and decaffeinated), carbonated beverages, and fruit juices with citric acid
  • NSAIDS, such as aspirin and ibuprofen. Switch to other pain relievers (like acetaminophen).

These steps may also help:

  • Eat a fiber-rich diet.
  • Foods containing flavonoids like apples, celery, cranberries (including cranberry juice), onions, garlic, and tea may stop the growth of H. pylori.
  • Avoid high-fat foods. In animal studies, high-fat foods increase inflammation in the stomach lining.

Alternative Treatment

Multivitamin – A multivitamin daily, containing the antioxidant vitamins A, C, E, the B vitamins, and trace minerals, such as magnesium, calcium, zinc, and selenium.

Omega-3 fatty acids, such as fish oil, may help decrease inflammation. Fish oil may increase the risk of bleeding.

Glutamine – The amino acid Glutamine helps with maintenance of gut barrier function.

Probiotic supplement or “friendly” bacteria may help maintain a balance in the digestive system between good and harmful bacteria, such as H. pylori. Probiotics may help suppress H. pylori infection, and may also help reduce side effects from taking antibiotics, the treatment for an H. pylori infection.

Vitamin C – Studies show that pharmacological doses of vitamin C may improve the effectiveness of H. pylori-eradication therapy.

Mastic standardized extract. Mastic is a traditional treatment for peptic ulcers and inhibits H. pylori in test tubes.

Peppermint help relieve symptoms of peptic ulcer.

DGL-licorice may help protect against stomach damage from NSAIDs.

Cranberry – Some preliminary research suggests cranberry may inhibit H. pylori growth in the stomach.

Acupuncture may help reduce stress and improve overall digestive function.

 

Reference –

http://bestpractice.bmj.com/best-practice/monograph/816.html

http://www.medicinenet.com/gastritis/article.htm

http://home-cure.net/gastritis/

http://www.nature.com/subjects/gastritis

http://www.dailystrength.org/c/Gastritis/support-group

http://rarediseases.org/rare-diseases/gastritis-chronic-erosive/

https://www.floridahospital.com/gastritis-and-acute-gastritis

http://www.diethealthclub.com/health-issues-and-diet/gastritis/diet.html

http://www.mamashealth.com/stomach/gastritis.asp

http://www.nytimes.com/health/guides/disease/gastritis/overview.html

http://health.vic.gov.au/edfactsheets/downloads/gastritis.pdf

https://www.fairview.org/HealthLibrary/Article/116114EN

February 7, 2017

Gallstones are lumps of solid material that form in the gallbladder. They usually look like small stones or gravel, but can be as small as sand or as large as pebbles, sometimes filling the gallbladder.

The gallbladder is a small, pear-shaped pouch about three to six inches long. It is tucked just under the liver, below the right rib cage and is connected to the intestine and liver by small tubes called bile ducts. Bile ducts carry bile, a yellow-green fluid produced by your liver. Bile contains water, cholesterol, phospholipids and chemicals to aid digestion (bile acids), as well as waste products for excretion via the bowel, such as bilirubin.

Bile is collected and stored in the gallbladder, and released along the bile ducts into the intestine when we eat food. It plays a central role in helping the body digest fat. Bile acts as a detergent, breaking up the fat from food in the gut into very small droplets, so that it can be absorbed. It also makes it possible for the body to take up the fat-soluble vitamins A, D, E and K from the food passing through the gut.

Gallstones develop when cholesterol levels in the bile are too high and excess cholesterol turns into stones. Most gallstones are mixed stones or cholesterol stones, mostly made up of cholesterol. They are usually yellow or green. Another type of gallstones are pigment stones, which are mostly made up of bilirubin and are smaller and darker.

  • Pure Cholesterol Stones – these are the most common type of stone and are made up of cholesterol, which is a type of fat
  • Pure Pigment Stones – these consist of calcium and bilirubin (a pigment from broken down red blood cells) which have solidified
  • Mixed Stones – these are a combination of cholesterol and pigment stones

Gallstones vary greatly in size. Some people may form one large stone, whereas others may have hundreds of tiny stones. Most commonly, gallstones are 5-10 mm in diameter.

About 70 per cent of people who have gallstones do not have noticeable symptoms and are often unaware that they have them. Gallstones may be discovered only during investigations for other problems. For this reason, they are sometimes called ‘silent’ gallstones.

Causes

Gallstones are formed when the different elements which make up the bile become imbalanced. Cholesterol stones form when cholesterol levels in the bile are much greater than the bile acid levels, this causes the cholesterol in the bile to solidify.

 

There is evidence that dietary factors, such as diets high in cholesterol, saturated fat, refined sugar and low in fibre, increase the risk of developing cholesterol gallstones.

Gallstones are more common in women than in men, especially during women’s fertile years and during pregnancy. This is because cholesterol is a component of oestrogen, and at these times fluctuating levels of oestrogen need to be broken down to cholesterol and excreted in bile.

Pigment stones may form when the amount of bilirubin in bile is excessive. This can occur in conditions such as sickle cell disease.

Gallstones can also form when the flow of bile is reduced. This may occur due to –

  • damage to the liver (cirrhosis) or damage to the biliary tract which affects the secretion and flow of bile
  • long periods of fasting during which there is less requirement for bile, leading to bile stasis (decreased flow of bile).

Genetics – Having a family member or close relative with gallstones may increase the risk. Up to one-third of cases of painful gallstones may be related to genetic factors. A mutation in the gene ABCG8 significantly increases a person’s risk of gallstones. This gene controls a cholesterol pump that transports cholesterol from the liver to the bile duct. It appears this mutation may cause the pump to continuously work at a high rate. A single gene, however, does not explain the majority of cases, so multiple genes and environmental factors play a complex role.

Risk Factors

Risk factors for developing gallstones include –

  • Being overweight or obese
  • Being female
  • Being over 40
  • A woman who’s had more than one pregnancy
  • Having cirrhosis of the liver
  • Having Crohn’s disease or IBS ( irritable bowel syndrome)
  • A family history of gallstones
  • Having weight loss surgery or recently having lost weight
  • Being treated with the antibiotic ceftriaxone
  • Being on the Pill
  • Women taking high-dose oestrogen therapy
  • Having type 2 diabetes is suspected of being a risk factor
  • A lack of exercise is also thought to increase the risk of gallstones

Symptoms

Gallstones vary in chemical structure. The two main types of gallstones are:

Cholesterol gallstones

The amount of cholesterol that can dissolve in bile depends on how much bile salt it contains. Too much cholesterol, or too little bile salt, tends to cause gallstones to form in the gallbladder. Approximately 80% of all gallstones are cholesterol stones.

Pigment gallstones

These are formed by calcium and bilirubin and account for approximately 20% of all gallstones.   Pigment stones tend to form in patients with haemolytic anaemias (fragile red blood cells), including sickle-cell disease and thalassaemia.

Most people with gallstones do not experience any symptoms. If symptoms are present, the most common early sign of gallstones is upper abdominal pain. This pain usually occurs in the upper right side of the abdomen, is often severe, and may radiate to the chest, back or the area between the shoulders. Other symptoms that may occur include –

  • Indigestion
  • Nausea or vomiting
  • Jaundice (the yellow appearance of skin and the whites of eyes caused by bilirubin build-up in the blood) when gallstones block the passage of bile
  • Light coloured stools

Symptoms can occur suddenly and may be referred to as biliary colic. This type of pain is commonly set off by eating fatty foods and often occurs in the middle of the night. The symptoms experienced may be so severe that people need to seek immediate medical attention.

Complications

Biliary colic – Sometimes the gallstones may pass down through the bile duct into the duodenum. When this happens the patient may experience biliary colic – a painful condition. The pain is felt in the upper part of the abdomen, but can also exist in the center of the abdomen, or a little to the right of it. Pain is more common about an hour after eating, especially if the patient has had a high-fat meal. The pain will be constant and will last a few hours, and then subside. Some patients will have non-stop pain for 24 hours, while others may experiences waves of pain.

Infection – If the gallstones have caused a gallbladder infection the patient may have a fever and experience shivering. In the majority of gallstone infection cases the patient will be hospitalized and have the gallstone surgically removed.

Jaundice – If the gallstone leaves the gallbladder and gets stuck in the bile duct it may block the passage of bile into the intestine. The bile will then seep into the bloodstream and the patient will show signs of jaundice – the skin and the whites of the eyes will be yellow. In most cases this complication will require the surgical removal of the gallstone. Some patients are lucky and the gallstone eventually passes into the intestine.

Pancreatitis – If a small gallstone passes through the bile duct and blocks the pancreatic duct, or causes a reflux of liquids and bile into the duct, the patient may develop pancreatitis.

Treatment

Surgery – Surgery to remove the gallbladder, called cholecystectomy, is one of the most common operations performed on adults in the United States. Surgeons perform two types of cholecystectomy.

  • Laparoscopic cholecystectomy – In a laparoscopic cholecystectomy, the surgeon makes several tiny incisions in the abdomen and inserts a laparoscope—a thin tube with a tiny video camera attached. The camera sends a magni­fied image from inside the body to a video monitor, giving the surgeon a close-up view of organs and tissues. While watching the monitor, the surgeon uses instruments to carefully separate the gallbladder from the liver, bile ducts, and other structures. Then the surgeon removes the gallbladder through one of the small incisions. Patients usually receive general anesthesia.
  • Open cholecystectomy – An open cholecystectomy is performed when the gallbladder is severely infl‑amed, infected, or scarred from other operations. In most of these cases, open cholecystectomy is planned from the start. However, a surgeon may perform an open cholecystectomy when problems occur during a laparoscopic cholecystectomy. In these cases, the surgeon must switch to open cholecystectomy as a safety measure for the patient.

Medication – Ursodiol (Actigall) and chenodiol (Chenix) are medications that contain bile acids that can dissolve gallstones. These medications are most effective in dissolving small cholesterol stones. Months or years of treatment may be needed to dissolve all stones.

Shock wave lithotripsy – A machine called a lithotripter is used to crush the gallstone. The lithotripter generates shock waves that pass through the person’s body to break the gallstone into smaller pieces. This procedure is used only rarely and may be used along with ursodiol.

Lifestyle Changes – Although lifestyle changes cannot eliminate the risk of developing gallstones for everyone, avoiding fatty food and cutting cholesterol and consuming a healthy balanced diet may be recommended.

Losing weight can help reduce the risk of gallstones. However, a gradual approach is better as rapid weight loss can increase the risk of gallstones.

Alternative Treatment

Multivitamins – A daily multivitamin, containing the antioxidant vitamins A, C, E, the B-complex vitamins, and trace minerals, such as magnesium, calcium, zinc, and selenium.

Vitamin C acts as an antioxidant and for immune support.

Phosphatidylcholine, may help dissolve gallstones. It may interfere with some medications, including anticholinergic medications used in the treatment of Alzheimer’s disease and glaucoma, among others.

Magnesium, for nutrient support. Magnesium can potentially react with a variety of medications, including some antibiotics, blood pressure medicines, diuretics, muscle relaxers, and others.

Taurine, for nutrient support. Taurine can potentially interact with lithium.

Globe artichoke, for support of gallbladder and liver function. Due to its ability to increase bile production, globe artichoke could trigger a gallbladder attack if there is bile duct obstruction.

Milk thistle or liver and gallbladder detoxification support.

Dandelion root is another liver tonic.

Acupuncture – Acupuncture may be especially helpful in pain relief, reducing spasm, easing bile flow, and restoring proper liver and gallbladder function.

 

Reference –

http://www.seattlechildrens.org/medical-conditions/digestive-gastrointestinal-conditions/gallstones/

http://patient.info/health/gallstones-leaflet

http://www.livescience.com/34726-gallstones-symptoms-treatment.html

http://www.dailymail.co.uk/health/article-3340198/Irritable-stomach-t-tolerate-gluten-REAL-problem-gallstones-woman-discovered-hand.html

https://my.clevelandclinic.org/health/diseases_conditions/hic_Gallstones

http://www.medicalnewstoday.com/articles/153981.php

http://umm.edu/health/medical/reports/articles/gallstones-and-gallbladder-disease

http://www.webmd.boots.com/digestive-disorders/gallstones

http://www.healthline.com/health/chronic-cholecystitis

http://www.everydayhealth.com/gallbladder/symptoms/

http://www.medicinenet.com/gallstones/article.htm

http://familydoctor.org/familydoctor/en/diseases-conditions/gallstones/treatment.html

http://www.cancer.org/acs/groups/cid/documents/webcontent/003101-pdf.pdf

https://www.med.upenn.edu/gastro/documents/JIntMedgallstones2008.pdf

https://healthwyze.org/reports/206-holistically-and-naturally-treating-gallstones-gallbladder-attacks-and-what-you-can-do-about-them-without-getting-butchered-by-a-surgeon.html

http://www.rapidhomeremedies.com/remedies-for-gallstones.html

http://www.drdavidwilliams.com/bad-gallbladder-natural-treatments/

February 7, 2017

Fecal incontinence is the inability to control bowel movements. This leads to stool (feces) leaking from the rectum at unexpected times. This can be characterized by the occasional leakage of stool with the passage of gas, or complete loss of bowel control.

More than 5.5 million Americans have fecal incontinence. It affects people of all ages-children and adults. Fecal incontinence is more common in women and older adults, but it is not a normal part of aging.

Control of gas and stool is key to organizing everyday activities, and most people don’t consider how important this is until they have a change or loss of control. The ability to control gas and stool is a complex function involving multiple organ systems. The colon, rectum, and anus are parts of the digestive system. They form a long, muscular tube called the large intestine (also called the large bowel). The colon is the first 4 to 5 feet of the large intestine; the rectum is the next six inches, and the anus (opening) makes up the final 1-2 inches.

Partly digested food enters the colon from the small intestine. The colon removes water and nutrients from the food and turns the rest into solid waste (stool). As stool enters the rectum, the rectum relaxes and acts as a reservoir to hold the stool. Meanwhile, the outer muscle that encircles the anus, the external anal sphincter, squeezes to prevent gas or stool leakage.

While the external anal sphincter squeezes, the inner muscle that encircles the anus, called the internal anal sphincter, relaxes to allow stool to enter the anal canal. When stool enters the anal canal, sensory nerves in the anus identify the difference between gas and stool and determine the consistency of the stool (liquid versus solid). Signals are sent to the brain indicating the need to have a bowel movement. Once a socially appropriate time and place to have a bowel movement is found, the anal sphincter muscles, as well as the muscles of the pelvic floor, relax and the abdominal muscles tighten to expel the stool. Loose stools, diseases or injuries to the rectum, the anus, or the nerves controlling the anal muscles, as well as other diseases, can all contribute to fecal incontinence.

There are commonly two terms used when referring to bowel incontinence:

  • Urge bowel incontinence – the individual has a sudden urge to go to the toilet but is unable to get there in time.
  • Passive soiling – nothing is felt to indicate that a bowel movement is about to occur.

Loss of bowel control can be devastating. People who have fecal incontinence may feel ashamed, embarrassed, or humiliated. Some don’t want to leave the house out of fear they might have an accident in public. Most try to hide the problem as long as possible, so they withdraw from friends and family. The social isolation is unfortunate but may be reduced with treatment that improves bowel control and makes incontinence easier to manage.

Types of Fecal Incontinence

  • Flatal incontinence – the inability to control the passage of gas from the rectum.
  • Fecal incontinence – the inability to control the passage of liquid or solid stool from the rectum.
  • Double incontinence – the inability to control both the passage of stool and urine.
  • Rectovaginal fistula – when a connection develops between the vagina and rectum and results in stool being passed uncontrollably through the vagina.

Causes

The sphincter muscles are not working as they should – damage to the sphincter muscles is commonly caused by childbirth (labor). The sphincter muscles can become stretched and torn, especially if forceps are used during delivery, or if the mother had an episiotomy. A complication of bowel or rectal surgery can also result in damage to the sphincter muscles. Some other types of injuries may also damage them.

Diarrhea – if a person has diarrhea it is much more difficult for the rectum to hold the stools. Patients with recurring diarrhea often experience bowel incontinence. Chronic or recurring diarrhea can be caused by Crohn’s disease, irritable bowel syndrome (IBS) and ulcerative colitis. These conditions sometimes result in scarring in the rectum, another cause of bowel incontinence.

Certain foods – susceptible people may find that certain foods cause diarrhea and worsen their fecal incontinence symptoms. Examples may include spicy foods, fatty/greasy foods, cured meats, smoked meats, and dairy products if you are lactose intolerant.

Some drinks – drinks containing caffeine may act as laxatives, as can those with artificial sweeteners.

Constipation can also lead to bowel incontinence – if the solid stool becomes stuck (fecal impaction) the muscles of the rectum can become stretched and weaker, watery stools may then leak around the impacted stool and seep out of the anus. Fecal impaction is a large mass of dry hard stool that gets stuck in the rectum – it is literally so hard that it cannot come out.

Rectal cancer – tumors that develop within the rectum can cause bowel incontinence.

Rectal prolapse – if the rectum drops down into the anus, bowel incontinence can occur.

Rectocele – this is when the rectum protrudes through the vagina.

Hemorrhoids – hemorrhoids can result in incomplete closure of the anal sphincter.

Chronic laxative abuse – individuals who overuse laxatives for a long time have a much higher risk of developing bowel incontinence.

Neurological Conditions – Some diseases affect the nerves in the pelvis that help you control your bowel movements; if these nerves are damaged, fecal incontinence occurs. Diseases that can cause nerve damage include:

  • Multiple sclerosis
  • Parkinson’s disease
  • Spinal cord injury
  • Stroke
  • Dementia
  • Diabetic neuropathy

Infectious Enteritis – This is a temporary condition that may be caused by a virus or bacteria. Treatment with antibiotics often improves your bowel control.

Birth Trauma/Injury – Birth trauma is the most common cause of fecal incontinence in young women. During a very difficult vaginal delivery or during a delivery that requires use of forceps, vacuum or episiotomy, a partial tear in the muscles of the anal sphincter can happen. If this tear doesn’t heal properly, it can cause incontinence. This is called a chronic third/fourth degree laceration. This tear may also cause a rectovaginal fistula and causes incontinence because stool can pass inadvertently from the rectum into the vagina.

Risk Factors

A number of factors may increase your risk of developing fecal incontinence, including –

  • Age – Although fecal incontinence can occur at any age, it’s more common in middle-aged and older adults.
  • Being female – Fecal incontinence is slightly more common in women. One reason may be that fecal incontinence can be a complication of childbirth. But most women with fecal incontinence develop it after age 40, so the connection with pelvic floor injury during childbirth is unclear. However, it’s possible that the injury doesn’t cause symptoms for many years.
  • Nerve damage – People who have long-standing diabetes or multiple sclerosis — conditions that can damage nerves that help control defecation — may be at risk of fecal incontinence.
  • Dementia – Fecal incontinence is often present in late-stage Alzheimer’s disease and dementia.
  • Physical disability – Being physically disabled may make it difficult to reach a toilet in time. An injury that caused a physical disability also may cause rectal nerve damage, leading to fecal incontinence. Also, inactivity can lead to constipation, resulting in fecal incontinence.

Symptoms

Most adults who experience fecal incontinence do so only during an occasional bout of diarrhea. But some people have recurring or chronic fecal incontinence. They may be unable to resist the urge to defecate, which comes on so suddenly that they don’t make it to the toilet in time. This is called urge incontinence. Another type of fecal incontinence occurs in people are not aware of the need to pass stool. This is called passive incontinence.

Fecal incontinence may be accompanied by other bowel problems, such as –

  • Diarrhea
  • Constipation
  • Gas and bloating

Complications

Untreated, fecal incontinence can contribute to –

  • Urinary tract infections
  • Skin rashes and skin ulcers around the anus
  • Lack of sleep
  • Social withdrawal
  • Depression
  • Low self-esteem
  • Falls and fractures
  • Sexual problems

Treatment

Medication – Sometimes taking medications to change the consistency of the stool can provide relief, since a person can usually control stool better when it is firm rather than loose or liquid form. Stool consistency can be improved by using bulking agents such as fiber supplements (Citrucel, Metamucil). Stool frequency can be decreased with over-the-counter anti-diarrheal medications including Imodium.

Biofeedback – Patients with bowel incontinence related to physical limitations or change in mental function will likely benefit from scheduled or timed trips to the restroom. Furthermore, biofeedback training for bowel incontinence involves putting a pressure probe in the anus and a sensing electrode on the abdomen. These devices are attached to a visual or sound display to tell the patient when the proper anal muscles are being used. Biofeedback helps a patient improve the strength and coordination of the anal muscles that help control bowel movements, and heightens the sensation related to the rectum filling with stool.

Exercise – Muscle-strengthening exercises (called Kegel exercises or pelvic floor exercises) can be very helpful in treating bowel incontinence. To do Kegel exercises, contract the muscles of the anus, buttocks, and pelvis, hold as hard as possible for a slow count of five, and then relax. Imagine you are trying to stop the flow of stool or trying not to pass gas. A series of 30 of these exercises should be done three times daily. In a few weeks, the pelvic floor muscles will be stronger and often the incontinence improves or resolves.

Surgery – Patients who continue to experience bowel incontinence despite other treatments may require surgery to regain control. Surgery may especially be needed for patients who have experienced anal muscle injuries (as can occur during childbirth).

  • Sphincteroplasty – Rectal sphincter repair is the most common procedure used to correct a defect in the sphincter muscles.
  • Muscle transfer – During this procedure, gluteal (buttock) or gracilis (inner thigh) muscles are used to encircle and strengthen the anal canal.
  • Colostomy – In rare and very difficult cases, the only alternative may be a colostomy, a surgically created opening in the abdominal wall through which the colon passes, and where a bag is fitted to collect stool.

Complementary & Alternative Treatment

L-Glutamine eases gastrointestinal pain.

Pancreatic enzyme before eating helps break down fats, relieving symptoms of irritable bowel.

Probiotics are friendly bacteria that help gut health.

Multivitamin/minerals with food ensures your daily requirements of nutrients.

Lobelia is a useful antispasmodic remedy.

Activated charcoal treats diarrhea.

Psyllium relieves both constipation and diarrhea.

Aloe Vera juice helps ease discomfort of irritable bowel.

Antimonium crudum treats indigestion after a big meal. Alternation between constipation and diarrhea.

Argentum nitricum is indicated in the treatment of gastrointestinal conditions accompanied by anxiety. Emotional diarrhea caused from stress or eating sweets. The patient is impulsive and in a hurry to do things.

Arsenicum album treats intolerable abdominal pain. The patient is restless with excessive thirst for small quantities of water. The remedy is indicated in the treatment of psychosomatic ailments.

Cantharis relieves intestinal colic. Burning sensation in the intestinal tract, burning diarrhea. The person has a disgust for food.

Bryonia for gastric affections and constipation. The stool is hard and dry, it looks as if burnt.

Colocynthis is indicated in the treatment of irritable bowel syndrome. Symptoms include severe colic pains, ameliorated doubled over Intestinal colic, stabbing abdominal pains, ameliorated by hard pressure.

Ignatia produces a calming effect in the body. It treats stress-related health conditions.

Staphysagria treats irritable bowel syndrome caused from suppressed anger.

Veratum album treats watery diarrhea accompanied by cold sweats, worse after eating fruits or drinking cold fluids.

Lycopodium is indicated in the treatment of gastrointestinal problems. Symptoms include indigestion, nausea, abdominal pain, and an urge to stool without success.

Mercurius corrosivus treats intestinal inflammation, burning diarrhea, and rectal tenesmus.

Nux vomica treats intestinal inflammation caused from food poisoning or excessive alcohol consumption.

Plumbum is indicated when one is unable to digest food. Symptoms include acute pain, spasm of the anal sphincter, constipation. The stools are hard, black balls that look like sheep poop.

Acupuncture for Incontinence – An acupuncturist can correct imbalances in the flow of vital energy, or qi. Urinary incontinence, for example, is thought to result from a deficiency of qi in the kidney.

 

Reference –

https://www.nice.org.uk/guidance/cg49

https://www.fascrs.org/patients/disease-condition/fecal-incontinence-expanded

http://www.tena.us/fecal-incontinence/fecal-incontinence,en_US,pg.html

http://uvahealth.com/services/womens-health/women-continence-pelvic/pelvic-conditions/fecal-incontinence

http://www.radiologyinfo.org/en/info.cfm?pg=fecal-incontinence

http://www.niddk.nih.gov/health-information/health-topics/digestive-diseases/fecal-incontinence/Pages/facts.aspx

http://www.mayoclinic.org/diseases-conditions/fecal-incontinence/home/ovc-20166830

http://www.webmd.com/digestive-disorders/bowel-incontinence

https://umm.edu/health/medical/ency/articles/bowel-incontinence

http://www.healthinaging.org/aging-and-health-a-to-z/topic:fecal-incontinence/

http://www.embarrassingproblems.com/problem/faecal-incontinence

http://www.canadiancontinence.ca/EN/treatment-of-fecal-incontinence.php

http://www.aboutincontinence.org/

February 7, 2017

Esophageal varices are swollen blood vessels in the tube that carries food from your mouth to your stomach (the esophagus), and in the upper part of the stomach. Varices cause no symptoms unless they rupture and bleed, which can be a medical emergency.

The esophagus is the tube that lies between the pharynx (at the top of the throat) and the stomach. The esophagus has prolific veins at the base for delivering blood to the liver for detoxification or nutrient removal from the body.

Varices most often occur because of problems with blood flow in the liver that are caused by chronic liver disease. Normally, a blood vessel called the portal vein carries blood from the digestive organs to the liver. But with liver disease, blood flow can become blocked because of scarring of the liver. This increases the blood pressure in the portal vein (a condition known as portal hypertension). Blood then backs up in nearby veins in the esophagus and stomach, causing varices. Varices are a serious and life-threatening problem. Treatment is needed to prevent them from rupturing and bleeding. If bleeding occurs, it can be fatal.

A number of drugs and medical procedures can help prevent and stop bleeding from esophageal varices.

Causes

Increased pressure in the veins that deliver blood to the liver is known as portal hypertension. The increased pressure causes blood to back up into other smaller vessels, including those of the esophagus. This leads to the formation of esophageal varices.

The medical conditions that lead to the development of portal hypertension and esophageal varices include –

  • Cirrhosis of the liver
  • Blood clots of the splenic, portal, or hepatic veins
  • Arterial-portal venous fistula—abnormal connections between arteries and veins in the liver or spleen
  • Certain infections
  • Severe heart failure
  • Hodgkin’s disease
  • Sarcoidosis

Risk Factors

  • High portal vein pressure -The risk of bleeding increases with the amount of pressure in the portal vein (portal hypertension).
  • Large varices – The larger the varices, the more likely they are to bleed.
  • Red marks on the varices – When viewed through an endoscope passed down the throat, some varices show long, red streaks or red spots. These marks indicate a high risk of bleeding.
  • Severe cirrhosis or liver failure – Most often, the more severe the liver disease, the more likely varices are to bleed.
  • Continued alcohol use

Symptoms

Esophageal varices usually don’t cause signs and symptoms unless they bleed. Signs and symptoms of bleeding esophageal varices include –

  • Vomiting blood
  • Black, tarry or bloody stools
  • Shock (in severe case)
  • Yellow coloration of your skin and eyes (jaundice)
  • A cluster of tiny blood vessels on the skin, shaped like a spider (spider nevi)
  • Reddening of the skin on the palm of your hands (palmar erythema)
  • A hand deformity known as Dupuytren’s contracture
  • Shrunken testicles
  • Swollen spleen
  • Fluid buildup in your abdomen (ascites)

Complications

  • Encephalopathy (sometimes called hepatic encephalopathy)
  • Esophageal stricture after surgery or endoscopic therapy
  • Hypovolemic shock
  • Infection (pneumonia, bloodstream infection, peritonitis)
  • Return of bleeding after treatment

Treatment

Medications – These may be prescribed to lower the blood pressure inside the enlarged veins. This reduces the risk of bleeding. Beta-blockers are the most common medication used.

Endoscopic therapy – These are treatments for enlarged or bleeding veins that are done with the help of an endoscope. With ligation, small rubber bands are placed around the veins to close them off and stop any bleeding. With sclerotherapy, clotting medication is injected into the veins to cause scarring and shrink them.

Balloon tamponade – This is a procedure in which a tube with a balloon is guided down into the esophagus and stomach. The balloon is then inflated with air. This applies pressure on enlarged or bleeding veins to control bleeding. This is a temporary method to control bleeding until other treatments are available.

Surgery – This may be done to place a stent (tubelike device) in the liver. The stent helps reroute blood flow in the liver to lower the blood pressure in enlarged veins. Sometimes, the enlarged veins may be connected to other nearby veins to reroute blood flow. In severe cases, a liver transplant may be needed. This is to replace the diseased liver with a healthy donor liver.

Alternative & Complementary Treatment

Alternative treatments are aimed at preventing the development of progression of cirrhosis of the liver. By halting the hardening of liver tissue, this approach serves to maintain the best hepatic circulation possible, ultimately reducing the risk of bleeding esophogeal varices. However, once a patient has reached the bleeding stage, standard medical intervention is required. Some popular alternative treatments to prevent liver disease progression include:

Herbal Supplements – The use of herbs is a time-honored approach to strengthening the body and treating disease. Herbs, like medications, contain active substances capable of triggering side effects and interacting with other herbs, supplements or medications. Therefore, herbs should be taken with a physician’s consent. Milk thistle is one of the most reputed herbs for supporting the liver and preventing cirrhosis progression.

Acupuncture – According to a 1997 Consensus Statement by the National Institutes of Health, acupuncture is an effective adjunct treatment for addiction, including alcoholism. For a person with alcohol-related cirrhosis, anything to help maintain abstinence is a sound preventative method. In addition, this centuries old therapy has been shown to increase hepatic circulation and decrease blood pressure.

Dietary Counseling – Malnutrition is typically a problem for people with cirrhosis. Because the liver processes and is affected by everything we ingest, eating a healthy diet is an important part of treatment for cirrhosis. A dietician or nutritionist can guide a person to change their diet and consume foods that will benefit their particular body.

 

Reference –

http://www.mountsinai.org/patient-care/health-library/diseases-and-conditions/esophageal-varices\

http://www.liver.ca/liver-disease/types/cirrhosis/variceal-bleeding.aspx

https://clinicaltrials.gov/ct2/show/NCT00006398

http://www.drugs.com/health-guide/esophageal-varices.html

http://www.webmd.com/digestive-disorders/bleeding-varices

http://www.nytimes.com/health/guides/disease/bleeding-esophageal-varices/overview.html

http://alcoholrehab.com/alcoholism/esophageal-varices/

https://lahey.org/Departments_and_Locations/Departments/Endoscopy_Unit/Ebsco_Content/Esophageal_Varices.aspx?chunkiid=35547

http://www.merckmanuals.com/professional/gastrointestinal-disorders/gi-bleeding/varices

http://www.earthclinic.com/cures/esophageal-stricture.html

http://www.hepatitiscentral.com/hcv/liver/esophageal/varices/

February 7, 2017

Esophagitis is an inflammation of the lining of the esophagus. In this condition, the lining of the esophagus becomes inflamed because of an infection or an irritation of the lining. Esophagitis is called acute when it occurs suddenly. It is called chronic when it lasts for a long time.

The esophagus is a muscular tube that connects the throat to the stomach and may be thought of as a food pipe. Esophagitis is an inflammation (swelling) of the esophagus that causes pain and discomfort with swallowing, or gives you the sensation of a lump in the throat. Esophagitis is a common side effect of cancer treatment that can be caused by radiation therapy or chemotherapy.

If diagnosed rapidly and treated properly, the prognosis for esophagitis is usually good. Prognosis also depends on the underlying disease process.

Causes

Esophagitis has several common causes –

Acid reflux — By far the most common cause of esophagitis is acid reflux (also called gastroesophageal reflux disease or GERD). It is a backflow of digestive acid from the stomach, resulting in a chemical burn of the esophagus.

Eating disorders — Similar to acid reflux, frequent vomiting can cause acid burn in the esophagus. Esophagitis sometimes is seen in people with eating disorders such as bulimia.

Medications — Some common medications also can cause a chemical burn in the esophagus. Pills that are most likely to cause esophagitis include –

  • aspirin
  • doxycycline
  • iron supplements
  • nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin) or naproxen (Aleve, Naprosyn)
  • osteoporosis medications such as alendronate (Fosamax) or risedronate (Actonel)

Chemotherapy and radiation therapy for cancer — Some of these treatments can injure the esophagus lining, resulting in esophagitis.

Infections — Infections in the esophagus also can cause esophagitis. They usually occur in people with a weak immune system. Esophagitis from infections is common in people who have HIV infection, use steroid medicines long-term, have had organ transplants, or have been treated with chemotherapy for cancer.

Only a few types of infection are common in the esophagus, such as –

  • yeast
  • herpes virus (HSV)
  • cytomegalovirus (CMV)

Even in someone who already has a herpes infection in the mouth, it rarely spreads down to the esophagus if the immune system is normal.

Risk Factors

People are at risk if they –

  • Are pregnant
  • Smoke
  • Are obese
  • Are an elderly adult
  • Consume a lot of alcohol, coffee, chocolate, fatty foods, or spicy foods
  • Use certain medicines, including NSAID pain relievers, nitrates, and beta blockers
  • Have a spinal cord injury
  • Have had radiation therapy for chest tumors
  • Swallow medicine with too little water or get a pill stuck in your throat
  • Have scleroderma, an autoimmune disease

Symptoms

A symptom is something the patient feels and describes, such as dizziness, pain, or anxiety. A sign is something other people, apart from the patient, can also detect, such as a rash, pallor, or weight loss.

These are both the signs and symptoms most commonly linked to esophagitis –

  • Abdominal pain
  • Adynophagia – pain when swallowing
  • Dysphagia – difficulty swallowing
  • Food gets stuck in the esophagus
  • Lack of appetite
  • Nausea, and possibly vomiting
  • Cough
  • Pain when eating, heartburn
  • Mouth sores

Feeding difficulties, and subsequently possible failure to thrive in young children and babies. At this age, most patients are too young to describe their symptoms

Complications

Left untreated, esophagitis can lead to changes in the structure of the esophagus. Possible complications include –

  • Narrowing of the esophagus (esophageal stricture)
  • Barrett’s esophagus, characterized by changes to the cells lining the esophagus, increasing your risk of esophageal cancer

Treatment

Treatment depends on the cause of esophagitis.

Acid reflux — Lifestyle changes help reduce reflux –

  • Lose weight if necessary
  • Eat smaller meals
  • Don’t lie down right after eating
  • Discover and avoid foods that cause symptoms

Acid blocking medications, including H2-blockers and proton-pump inhibitors, are usually prescribed. For persistent esophagitis, your doctor may recommend surgery to tighten the lower esophageal sphincter.

Pill esophagitis — Drinking a full glass of water after taking a pill can help. Usually, if esophagitis has occurred, it is necessary for you to stop the medicine at least temporarily while you heal. Since acid can worsen esophagitis caused by medications, your doctor also may prescribe an acid-blocking medication to speed healing.

Infections — The choice of treatment depends upon the infectious agent causing the esophagitis. Some esophagus infections are difficult to treat with swallowed pills or liquids, so medicines may be given intravenously (into a vein).

Surgery – Fundoplication may be used to improve the condition of the esophagus if other interventions don’t work. A portion of the stomach is wrapped around the valve separating the esophagus and stomach (lower esophageal sphincter). This strengthens the sphincter and prevents acid from backing up into the esophagus.

Alternative & Complementary Treatment

Antioxidants have been shown to be protective in numerous diseases, such as Esophagitis, GERD, gastric ulcers, and GI cancers. Oxidative stress of the esophageal mucosa is a contributing factor in the pathology of GERD. Antioxidant dietary supplement containing melatonin, Ltryptophan, vitamin B6, folic acid, vitamin B12, methionine, and betaine, proves effective for this condition.

D-limonene is a monoterpene in citrus oil. Numerous studies have shown that D-limonene exerts anti-cancer, antimicrobial, and anti-inflammatory effects. In particular, studies have shown that this constituent of citrus oil is protective against GI cancers, including cancers of the stomach and colon, decreasing both growth and metastasis

Licorice Root – Historically, licorice root has been used for stomach ulcer. It contains a compound called glycyrrhizin and has soothing and healing properties.

Minerals – Calcium carbonate, magnesium, aluminum, and phosphate salts are frequently used in overthe-counter antacids. Studies have indicated that antacids are effective for treating esophagitis.

Digestive enzymes – Supplemental digestive enzymes may reduce esophagitis symptoms.

Zinc carnosine has been shown to speed healing in many types of esophagitis.

L-Glutamine is an amino acid utilized as an energy source by intestinal epithelium. Research has shown that supplementation with glutamine prevented the development in induced esophagitis.

IV treatment – To allow the esophagus to heal during treatment and to ensure proper nutrition and reduce the risk for malnutrition and dehydration, some patients require parenteral feeding (e.g., nutrition administered through a vein [IV]).

 

Reference –

http://www.medicinenet.com/esophagitis/article.htm

http://www.patienteducationcenter.org/articles/esophagitis/

http://www.oncolink.org/treatment/article.cfm?c=157&id=554

https://www.activeforever.com/articlelist-all/a-esophagitis

http://www.healthline.com/health/esophagitis#Overview1

http://www.mayoclinic.org/diseases-conditions/esophagitis/basics/complications/con-20034313

http://www.patienteducationcenter.org/articles/esophagitis/

http://www.nytimes.com/health/guides/disease/esophagitis/overview.html

http://www.lungcanceralliance.org/what-if-i-am-diagnosed/side-effect-management/throat-soreness-(esophagitis).html

http://www.hopkinsmedicine.org/healthlibrary/conditions/digestive_disorders/esophagitis_134,170/

http://www.hopkinsmedicine.org/healthlibrary/conditions/digestive_disorders/esophagitis_134,170/

February 7, 2017

Encopresis is a problem that children age four or older can develop due to chronic (long-term) constipation. With constipation, children have fewer bowel movements than normal, and the bowel movements they do have can be hard, dry, and difficult to pass. The child may avoid using the bathroom to avoid discomfort. Stool can become impacted (packed into the rectum and large intestine) and unable to move forward. The rectum and intestine become enlarged due to the hard, impacted stool. Eventually, the rectum and intestine have problems sensing the presence of stool, and the anal sphincter (the muscle at the end of the digestive tract that helps hold stool in) loses its strength. Liquid stool can start to leak around the hard, dry, impacted stool, soiling a child’s clothing. Encopresis affects 1 to 3 percent of children and these cases are split into two types:

  • Retentive encopresis – About 80 to 95 percent of all encopresis cases are retentive encopresis. Their stool accidents are mostly involuntary and are not of normal or healthy consistency. Children with this disorder have an underlying medical reason for soiling.
  • Non-retentive encopresis – As stated at the end of the retentive encopresis article, the remaining 5 to 20% of encopresis cases have no physical condition that bars normal toileting behaviors. These children aren’t constipated and don’t seem to have any significant medical problems. They usually soil their diapers or pants almost every day and have normal, mostly voluntary bowel movements.

Although parents may find it frustrating, encopresis is very rarely thought to be caused by a child misbehaving. They usually can’t help it and some children may not even realise they’ve had an accident. Children who have this problem may feel ashamed, guilty, frustrated or angry, and may act secretively to try to hide the problem.

Causes

The main causes of encopresis are constipation and emotional stress. Accumulated stool in the colon can affect the nerves that control the bowel, leading to accidental soiling.

Constipation – Prolonged or chronic constipation is the common cause of encopresis. Irregular bowel movements enlarge and harden the stool, making it painful to pass. The anticipation of pain may cause a child to avoid the toilet, worsening the problem. A lack of exercise, poor hydration, a diet low in fiber and certain food allergies can cause constipation. Fighting the body’s natural signals to pass stool also leads to constipation. Children sometimes hold stool when they are in an unfamiliar environment, or simply forget to go because they are too engaged in activity.

Emotional stress – Factors that create emotional anxiety or stress in children may interrupt their regular bowel routine and cause constipation. Events that lead to stress include parental dispute, birth of a sibling, challenges at school or moving to a new home. Children who are not toilet trained or are toilet trained too early may feel emotional and social distress. Other known childhood/adolescence emotional disorders that can trigger encopresis include oppositional defiant disorder and conduct disorder.

Food Allergies – For babies with troublesome constipation, the most common cause is a cow’s milk protein intolerance. Studies show that 80% of constipation in the first year of life is due to a cow’s milk reaction. In older children, the most common cause for constipation is gluten sensitivity.

Without treating the underlying food intolerance, the only treatment is more laxatives.

Gender – For reasons that are not known, boys are six times more likely to develop encopresis.

Risk Factors

Any child who has long-term (chronic) constipation may develop encopresis. Risk factors for constipation include –

  • Eating a high-fat, high-sugar, junk-food diet
  • Drinking mostly soft drinks and sugary drinks
  • Not drinking enough water and fruit juices
  • Lack of exercise
  • Not wanting to use public bathrooms
  • Feeling stressed with family, with friends, or at school
  • Being too busy playing to take time to use the bathroom
  • Having a change in bathroom routine. This includes starting a new school year, when a child has fewer bathroom breaks.

Symptoms

The main symptom of encopresis is that the child has bowel movements in inappropriate places, such as in clothing or on the floor. This soiling is not caused by taking laxatives or other medications, and is not due to a disability or physical defect in the bowel. Other symptoms of encopresis may include –

  • Avoidance of bowel movements
  • Secretive behavior associated with bowel movements.
  • Leakage of stool or liquid stool on your child’s underwear. If the amount of leakage is large, you may misinterpret it as diarrhea
  • Scratching or rubbing the anal area due to irritation from watery stools
  • Constipation with dry, hard stool
  • Passage of large stool that clogs or almost clogs the toilet
  • Loss of appetite
  • Abdominal pain
  • Decreased interest in physical activity
  • Withdrawal from friends and family

Complications

  • Megacolon – A portion of the colon may stretch out of proportion under the repeated volume and pressure of impacted stools. Doctors call this “megacolon”. This larger-than-normal colon holds even more feces than usual, and can result in bowel movements that are quite impressive for a small child. The worse the deformation is, the less it is reversible. In extreme cases, this may require surgery.
  • If encopresis is not treated, the child may have low self-esteem and problems making and keeping friends.
  • If encopresis is not corrected, the child may develop chronic constipation.

Treatment

Colon emptying – Prior to teaching healthy bowel habits, a variety of methods are used to clear compacted fecal matter from the colon. Enemas that flush out fecal matter or laxatives (oral or rectal suppository) that trigger a bowel movement force out the stool. Other methods help by softening hard stools (stool softeners) or lubricating the stool/colon contact points (mineral oil).

Diet – Once the colon is relieved from constipation, a change in diet helps maintain regularity. Proper hydration and eating fruits, vegetables, whole grains and other high-fiber foods will help to produce soft, regular bowel movements. Some children may benefit from avoiding fatty foods and dairy.

Toilet routine – A toilet routine ensures regular attempts at having a bowel movement, with the goal of building healthy habits. This may include a predetermined schedule for using the toilet and various positive incentives to reinforce successes. Negative incentives (punishment for soiled clothes) are counterproductive and may impede progress.

Psychotherapy – Psychotherapy helps address the underlying emotional causes of encopresis. It will also help children cope with depression, anger and other negative psychological consequences of encopresis.

Alternative Treatment

Probiotics – Giving a child probiotics on a regular basis can help in re-establishing a healthy gut flora, which can have a positive impact on transit.

Flaxseeds is an effective bulk laxative

Glucomannan has been shown to be safe and effective in children with this condition.

Magnesium is effective in encopresis. It is used to soften the stool. These oral stool softeners work by pulling water into the stool and are well-tolerated for long periods of time without the child becoming dependant on them

Fiber – Increase fiber intake by encouraging whole grains, fruits, vegetables, peanut butter, dried fruits, and salads. In addition, give at least two Fiber Servings every day

 

Reference –

http://www.massgeneral.org/conditions/condition.aspx?id=557

http://www.cincinnatichildrens.org/health/e/encopresis/

https://umm.edu/health/medical/ency/articles/encopresis

http://www.innerbody.com/diseases-conditions/encopresis

http://www.hopkinschildrens.org/chronic-constipation-clinic.aspx

http://www.nytimes.com/health/guides/disease/encopresis/overview.html

http://www.rch.org.au/uploadedFiles/Main/Content/kidsinfo/Encopresis_diary.pdf

http://www.med.umich.edu/yourchild/topics/encopre.htm

http://www.encopresis.com/

http://raisingchildren.net.au/articles/encopresis.html

http://www.aafp.org/afp/1999/0415/p2171.html

http://www.medicinenet.com/encopresis/article.htm

https://www.healthychildren.org/English/health-issues/conditions/emotional-problems/Pages/Soiling-Encopresis.aspx

http://www.stanfordchildrens.org/en/topic/default?id=encopresis-90-P01992

http://emedicine.medscape.com/article/928795-overview

February 7, 2017

Diverticulitis occurs when small, bulging sacs or pouches that form on the inner wall of the intestine (diverticula) become inflamed or infected. Most often, these pouches are in the large intestine (colon).

Diverticula, which can range from pea-size to much larger, are formed by increased pressure on weakened spots of the intestinal walls by gas, waste, or liquid. Diverticula can form while straining during a bowel movement, such as with constipation. They are most common in the lower portion of the large intestine (called the sigmoid colon).

This disorder results when portions of the digestive tract called diverticula get infected or inflamed. Diverticula are small bulges or pouches that can form in the intestines, esophagus and stomach — anywhere within the digestive system. The condition of having diverticula — which occur most commonly in the large intestine, or colon — is known as diverticulosis. Diverticula usually develop in response to pressure on weak spots in the colon or other parts of the digestive tract. Doctors aren’t sure, though, why these pouches get inflamed or infected.

Diverticulosis is very common in Western populations and occurs in 10 percent of people over age 40 and in 50 percent of people over age 60. The occurrence of diverticulosis increases with age, and it affects almost everyone over age 80.

Causes

Most diverticula occur in the left colon; they also occur elsewhere, but not in the rectum. The common hypothesis is that relatively high pressures generated within the colon by muscular contractions force the inner mucosa to penetrate through the path of small blood vessels within the colon wall and to bulge beyond the serosa. The muscle layer along the site of left colon diverticula is commonly thickened, lending credibility to the notion of high intracolonic pressure. The result may be rows of bulges along the colon at the sites of the penetrating arteries.

Why such this may occur in one-half the North American and European populations and not the other half is a mystery. Perhaps the great prevalence in Western populations is related to the relative lack of dietary fiber consumed by these populations. Low dietary fiber results in small stools, and an undistended colon may generate more pressure within the colon. Whatever the cause, the presence of colonic diverticula – often discovered during the course of a barium enema x-ray, colonoscopy, or surgery – is almost always of no significance.

Risk Factors

  • Aging – The incidence of diverticulitis increases with age.
  • Obesity – Being seriously overweight increases your odds of developing diverticulitis. Morbid obesity may increase the risk of needing more-invasive treatments for diverticulitis.
  • Smoking – People who smoke cigarettes are more likely than nonsmokers to experience diverticulitis.
  • Lack of exercise – Vigorous exercise appears to lower your risk of diverticulitis.
  • Diet high in animal fat and low in fiber, although the role of low fiber alone isn’t clear.
  • Certain medications – Several drugs are associated with an increased risk of diverticulitis, including steroids, opiates and nonsteroidal anti-inflammatory drugs, such as ibuprofen (Advil, Motrin IB, others) and naproxen (Aleve).

Symptoms

Divericulitis causes uncomfortable or painful symptoms in most people who have it. Common diverticulitis symptoms include:

  • Abdominal pain (usually in the lower left side)
  • Blood in the stool or accompanying the stool
  • Constipation
  • Fever and chills
  • Nausea and vomiting

In very severe cases of diverticulitis, the wall of the intestine may become so infected and inflamed that it perforates, leading to peritonitis and life-threatening or fatal complications.

Complications

Serious complications can occur as a result of diverticulitis. Most of them are the result of the development of a tear or perforation of the intestinal wall. If this occurs, intestinal waste material can leak out of the intestines and into the surrounding abdominal cavity, causing the following problems –

  • Peritonitis (a painful infection of the abdominal cavity)
  • Abscesses (“walled off” infections in the abdomen)
  • Obstruction (blockages of the intestine)

Infection can lead to scarring of the colon, and the scar tissue may cause a partial or complete blockage. A complete blockage requires emergency surgery, although a partial blockage does not.

Another complication of diverticulitis is the formation of a fistula. A fistula is an abnormal connection between two organs, or between an organ and the skin. The most common type of fistula is between the bladder and colon. This requires surgery to remove the fistula and affected part of the colon.

Treatment

Medications – Mild cases of diverticulitis can generally be treated by the patient himself/herself. A doctor may prescribe antibiotics, plus paracetamol (acetaminophen, Tylenol) for the pain. It is important that all patients complete their whole course of antibiotics; even if they feel better half-way through. Some people may experience drowsiness, nausea, diarrhea, and/or vomiting while they are taking their antibiotics. Antibiotics may include ciprofloxacin (Cipro), metronidazole (Flagyl), cephalexin (Keflex), and doxycycline (Vibramycin).

Surgery – Patients who have at least two diverticulitis episodes may benefit from surgery. Studies indicate that such patients are significantly more likely to have subsequent episodes, as well as complications if they do not have surgery. Colon resection removes part of the affected colon, and joins the remaining healthy parts together. Immediate surgery may be necessary when the patient has other complications, such as perforation, a large abscess, peritonitis, complete intestinal obstruction, or severe bleeding. In these cases, two surgeries may be needed because it is not safe to rejoin the colon right away.

Alternative Treatment

Probiotics, such as Lactobacillus acidophilus, Lactobacillus plantarum, Saccharomyces boulardii, and bifidobacteria help maintain the health of the intestines.

Omega-3 fatty acids, such as those found in fish oil, may help fight inflammation. (On the other hand, some omega-6 fatty acids, found in meats and dairy products, tend to increase inflammation.)

Glutamine is an amino acid found in the body that helps the intestine function properly. While there is no evidence that glutamine helps reduce symptoms of diverticular disease, it may be beneficial for overall intestinal health.

Acidophilus – Helps support a healthy intestinal tract (gut) and replaces the flora in the small intestine, primarily to improve assimilation.

Proteolytic Enzymes – Aids in digestion & reduces inflammation in the colon.

Fiber – Helps prevent constipation. Also prevents infection.

Vitamin C – Anti-inflammatory and boosts immunity.

Alfalfa – Natural source of vitamin K and essential minerals that most people with intestinal disorders are lacking. Also contains chlorophyll, which aids in healing.

Garlic – Aids in digestion and is a natural antibiotic.

Flaxseed may be helpful in treating diverticulosis. It contains fiber and works as a bulk forming laxative, softening stool and speeding transit time through the intestine.

Slippery elm is a demulcent (protects irritated tissues and promotes healing)

Licorice can reduce spasms and inflammation in the gastrointestinal tract.

Acupuncture may help relieve pain and other symptoms. Acupuncturists treat people with diverticular disease based on an individualized assessment of the excesses and deficiencies of qi (or energy) located in various meridians. Acupuncture and Chinese medicine in general may promote gastrointestinal health.

 

Reference –

https://my.clevelandclinic.org/health/diseases_conditions/hic_Diverticular_Disease

http://www.merckmanuals.com/home/digestive-disorders/diverticular-disease/diverticulitis

http://www.webmd.boots.com/digestive-disorders/understanding-diverticulitis-symptoms

http://www.drweil.com/drw/u/ART00345/Diverticulitis.html

http://www.nhs.uk/conditions/Diverticular-disease-and-diverticulitis/Pages/Introduction.aspx

http://www.mayoclinic.org/diseases-conditions/diverticulitis/basics/definition/con-20033495

http://www.webmd.com/digestive-disorders/tc/diverticulitis-topic-overview

http://www.healthline.com/health/diverticulitis

https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/diverticulosis-and-diverticulitis

http://patients.gi.org/topics/diverticulosis-and-diverticulitis/

http://www.everydayhealth.com/diverticulitis/diet/

http://www.drweil.com/drw/u/ART00345/Diverticulitis.html

http://www.nytimes.com/health/guides/disease/diverticulitis/overview.html

http://colorectal.surgery.ucsf.edu/conditions–procedures/diverticulitis.aspx

https://www.fascrs.org/patients/disease-condition/diverticular-disease

February 7, 2017

Disorders that affect the digestive (gastrointestinal) system are called digestive disorders. Some disorders simultaneously affect several parts of the digestive system, whereas others affect only one part or organ. Digestive symptoms can vary greatly in character and severity depending on the underlying disease, disorder or condition. Depending on the cause, digestive symptoms can last briefly and disappear quickly, such as symptoms that occur during a single episode of indigestion. Digestive symptoms can also persist or recur over a longer period of time, such as when due to colorectal cancer or inflammatory bowel disease.

In digestion, food and drink are broken down into small parts (called nutrients) that the body can absorb and use as energy and building blocks for cells. The digestive tract is made up of the esophagus (food tube), stomach, large and small intestines, liver, pancreas, and the gallbladder.

The first sign of problems in the digestive tract often includes one or more of the following symptoms –

  • Bleeding
  • Bloating
  • Constipation
  • Diarrhea
  • Heartburn
  • Incontinence
  • Nausea and vomiting
  • Pain in the belly
  • Swallowing problems
  • Weight gain or loss

A digestive disease is any health problem that occurs in the digestive tract. Conditions may range from mild to serious. Some common problems include cancer, irritable bowel syndrome, and lactose intolerance.

Other problems include –

  • Gallstones, cholecystitis, and cholangitis
  • Rectal problems, such as anal fissure, hemorrhoids, proctitis, and rectal prolapse
  • Esophagus problems, such as stricture (narrowing) and achalasia
  • Liver problems, such as hepatitis B or hepatitis C, cirrhosis, liver failure, and autoimmune and alcoholic hepatitis
  • Pancreatitis and pancreatic pseudocyst
  • Intestinal problems, such as polyps and cancer, infections, celiac disease, Crohn’s disease, ulcerative colitis, diverticulitis, malabsorption, short bowel syndrome, and intestinal ischemia
  • Gastroesophageal reflux disease (GERD), peptic ulcer disease, and hiatal hernia

Accessory organs are not part of the digestive tract itself, but they facilitate the process of digestion. These organs include the tongue, teeth, salivary glands, liver, gallbladder, and pancreas. The appendix is not exactly an accessory organ, but it likely played a role in digestion of food sometime in the past. It is now vestigial, meaning it has lost that original function.

Causes

Stress Stresses of all kinds, physical, emotional and mental, are primary causes of poor digestion. All unconscious activity in the human body, including both our reactions to stress and digestion, are controlled by the autonomic nervous system.

Antibiotics – Antibiotics can kill a high percentage of the naturally occurring beneficial bacteria that we need for digestion. They affect these necessary bacteria as well as the pathogenic bacteria they are designed to protect us against.

Poor Diet

  • Processed food consumption – In the refining process, sugar and flour (refined carbohydrates) are stripped of dozens of essential nutrients and fiber.
  • Low fiber diets – Fiber is a non nutritive food component necessary to move residue through the intestines.
  • Not enough raw food – Food enzymes help digest food and they are supplied (aside from supplementation) solely by raw foods. Cooking at high temp over 116 degrees destroys food enzymes.
  • Food allergies – Including those to dairy, wheat and fruits.
  • Junk foods – These (often high fat, high refined cartbohydrate and or high sugar) foods are high in calories but almost completely devoid of nutritional value.

Eating Habits

  • When food is swallowed after only a few short chews, those food particles are harder for the body to digest and can result in gas, bloating and indigestion.
  • Fruits should be eaten alone. Since they are high in enzymes, they take only 20-30 minutes to travel through the system and for their nutrients to be absorbed. When eaten with other foods which need much longer transit time, fruit will ferment in the transit process causing gastric distress.
  • Combining proteins with heavy starches like pasta and potatoes stress the digestive system.

Drugs – All drugs and chemicals are basically toxins to the digestive system. Many drugs directly affect the digestive organs and digestion itself. Over-the-counter, prescription drugs and recreational drugs that can affect digestion include: antacids, antihistamines, NSAIDS, birth control pills, laxatives, steroids, alcohol, caffeine, tobacco, marijuana, cocaine and many others. Anti-inflammatory drugs such as aspirin, acetaminophen and ibuprofen can directly irritate the lining of the stomach impairing digestion leading to infection.

Environmental Toxins – Modern life is full of environmental toxins including chemicals, radiation, solvents, food additives, air/water pollution, mercury and other metals. When exposed to them, the body naturally reacts to detoxify, which uses large amount of energy that leaves little energy for proper digestive function.

Genetics – As with all functions and organs genetics plays an important role in digestive functioning and our ability to withstand stress and resist digestive problems and diseases.

Problems experienced by family members can be clues to our own genetic strengths and weaknesses as we learn more about this subject and move in the direction of improved health.

Symptoms

Digestive symptoms may be accompanied by symptoms in other body systems depending on the underlying disease, disorder or condition. Other symptoms that may occur along with digestive symptoms include –

  • Chest pain or pressure
  • Chills
  • Dizziness
  • Easy bleeding or bruising
  • Flu-like symptoms (fatigue, fever, sore throat, headache, cough, aches and pains)
  • Jaundice (yellowing of skin and eyes)
  • Pale skin
  • Referred shoulder pain
  • Weakness (loss of strength)
  • Weight loss, malabsorption, and vitamin deficiencies

In some cases, digestive symptoms may occur with other symptoms that might indicate a serious or life-threatening condition that should be immediately evaluated in an emergency setting. These include –

  • Change in level of consciousness or alertness, such as passing out or unresponsiveness
  • Dizziness
  • High fever (higher than 101 degrees Fahrenheit)
  • Pulsating mass in abdomen
  • Rapid pulse
  • Respiratory or breathing problems, such as shortness of breath, difficulty breathing, labored breathing, wheezing, not breathing, or choking
  • Severe abdominal pain
  • Vomiting blood, major rectal bleeding or bloody stool
  • Yellow skin and eyes (jaundice)

Conditions of Digestive Disorders

  • Acute Pancreatitis
  • Cholangiocarcinoma
  • Chronic Pancreatitis
  • Constipation
  • Crohn’s Disease
  • Diarrhea
  • Enterocutaneous Fistula
  • Gallstones
  • Gastroparesis
  • Heartburn
  • Intestinal Failure
  • Irritable Bowel Syndrome
  • Obesity
  • Primary Sclerosing Cholangitis
  • Ulcerative Colitis
  • Ulcers
  • Ventral Hernia
February 7, 2017

Crohn’s Disease is a condition that causes inflammation of the digestive system or gut. Crohn’s can affect any part of the gut, though the most common area affected is the end of the ileum (the last part of the small intestine), or the colon. It primarily affects the small and large bowel, but can occur anywhere in the digestive tract. The inflammation causes uncomfortable and bothersome symptoms and may result in serious damage to the digestive tract. Abdominal pain, diarrhea and weight loss are the most obvious symptoms. Making a definitive diagnosis is difficult, possibly requiring many different tests performed over a long period of time.

Crohn’s disease is one of the two major types of inflammatory bowel disease (IBD), the other being ulcerative colitis. The main difference between the two conditions is that, whereas Crohn’s disease can affect any part of the digestive tract, ulcerative colitis affects only the large bowel and the rectum.

Crohn’s disease is a disease where the body’s immune system begins attacking healthy cells in the GI tract, causing inflammation. Because it is a disease of the immune system, Crohn’s is classified medically as an autoimmune disorder. This means that the body is producing antibodies that work against itself.

What is GI Tract?

The GI tract actually starts at the mouth. It follows a twisting and turning course and ends, many yards later, at the rectum. In between are a number of organs that all play a part in processing and transporting food through the body The first is the esophagus, a narrow tube that connects the mouth to the stomach. Food passes through the stomach and enters the small intestine. This is the section where most of our nutrients are absorbed. The small intestine leads to the colon, or large intestine, which connects to the rectum. The principal function of the colon is to absorb excess water and salts from waste material (what’s left after food has been digested). It also stores solid waste, converting it to stool, and excretes it through the anus. When inflammation occurs, the primary functions are affected, including the absorption of water. As a result, diarrhea can be a very common symptom during flares of Crohn’s disease.

Approximately 1.6 million Americans have either Crohn’s disease or ulcerative colitis. Males and females appear to be affected equally. This illness usually appears early in life; about one-sixth of patients present before the age of 15 and often with severe disease. The average age at diagnosis is 27 years. The cause of Crohn’s disease is unknown, although strong genetic influences are suggested by the occurrence of this disease in families, with a higher incidence in Jews than in the general population. Genetic influences are more prominent in the younger onset subgroup of patients than those who present after the age of 40.

Causes

The exact cause of Crohn’s disease is unknown. Researchers believe the following factors may play a role in causing Crohn’s disease –

  • Autoimmune reaction – Scientists believe one cause of Crohn’s disease may be an autoimmune reaction—when a person’s immune system attacks healthy cells in the body by mistake. Normally, the immune system protects the body from infection by identifying and destroying bacteria, viruses, and other potentially harmful foreign substances. Researchers believe bacteria or viruses can mistakenly trigger the immune system to attack the inner lining of the intestines. This immune system response causes the inflammation, leading to symptoms.
  • Genes – Crohn’s disease sometimes runs in families. Research has shown that people who have a parent or sibling with Crohn’s disease may be more likely to develop the disease. Researchers continue to study the link between genes and Crohn’s disease.
  • Environment – Some studies suggest that certain things in the environment may increase the chance of a person getting Crohn’s disease, although the overall chance is low. Nonsteroidal anti-inflammatory drugs, antibiotics, and oral contraceptives may slightly increase the chance of developing Crohn’s disease. A high-fat diet may also slightly increase the chance of getting Crohn’s disease.

Symptoms

Most people with Crohn’s disease are diagnosed during late adolescence and early adulthood (15-30 years of age), with a second spike in numbers occurring between the ages of 60 and 70 years, mainly in women.

Symptoms depend on the location and severity of the inflammation. Unpredictable symptomatic flare-ups and remissions characterise the long-term course of the disease.

Typical symptoms in a person with Crohn’s disease are chronic diarrhoea and abdominal pain and tenderness. Other Crohn’s disease symptoms include:

  • Rectal bleeding
  • Fever
  • Weight loss, and loss of appetite
  • Nausea, vomiting
  • Malnutrition, and vitamin deficiencies
  • Tiredness, lethargy
  • Bone loss (osteoporosis)
  • Depression, anxiety (associated with coping with the condition)
  • Stunted growth in children (which may occur many years before digestive symptoms appear).

Additionally, the area around the anus may be affected by ulcers, abscesses, fissures (small ulcerated cracks) or fistulas (small abnormal holes in the wall of the intestines or rectum).

In addition to having symptoms in the GI tract, some people also may experience a variety of symptoms in other parts of the body associated with Crohn’s disease. Signs and symptoms of the disease may be evident in:

  • Eyes (redness, pain, and itchiness)
  • Mouth (sores)
  • Joints (swelling and pain)
  • Skin (tender bumps, painful ulcerations, and other sores/rashes)
  • Bones (osteoporosis)
  • Kidney (stones)
  • Liver (primary sclerosing cholangitis, hepatitis, and cirrhosis)—a rare development

All of these are known as extraintestinal manifestations of Crohn’s disease because they occur outside of the digestive system. In some people, these actually may be the first signs of Crohn’s disease, appearing even years before the bowel symptoms. In others, they may coincide with a flare-up of intestinal symptoms.

Types of Crohn’s Diseases

The following are five types of Crohn’s disease –

Crohn’s (granulomatous) colitis – Affects the colon only.

Gastroduodenal Crohn’s disease – Affects the stomach and duodenum (the first part of the small intestine).

Ileitis – Affects the ileum.

Ileocolitis – The most common form of Crohn’s affecting the colon and ileum (the last section of small intestine).

Jejunoileitis – Produces patchy areas of inflammation in the jejunum (upper half of the small intestine).

Treatment

Conventional Treatment

Medicines – Therapeutic regimens are based upon the severity of Crohn’s disease and the extent of gastrointestinal tract involvement. These factors may vary during the course of the disease but accurate assessment of both is crucial in determining treatment. The severity of the disease impacts the use of anti-inflammatory drugs and risk of future complications. The extent of disease is relevant in the determination of what kind of therapy will be most efficacious, e.g., topical or targeted therapy. The aims of therapy include the treatment of active disease followed by maintenance of remission.

Aminosalicylates – These include medications that contain 5-aminosalicylic acid (5-ASA). Examples are sulfasalazine, mesalamine, olsalazine, and balsalazide.These drugs are not specially approved by the Food and Drug Administration (FDA) for use in Crohn’s. However, they can work at the level of the lining of the GI tract to decrease inflammation. They are thought to be effective in treating mild-to-moderate episodes of Crohn’s disease and useful as a maintenance treatment in preventing relapses of the disease. They work best in the colon and are not particularly effective if the disease is limited to the small intestine.

Corticosteroids – These medications affect the body’s ability to launch and maintain an inflammatory process. In addition, they work to keep the immune system in check. Corticosteroids are used for people with moderate-to-severe Crohn’s disease. They are effective for short-term control of flareups; however, they are not recommended for long-term or maintenance use because of their side effects.

Immunomodulators – This class of medications modulates or suppresses the body’s immune system response so it cannot cause ongoing inflammation. Immunomodulators generally are used in people for whom aminosalicylates and corticosteroids haven’t been effective or have been only partially effective. They may be useful in reducing or eliminating the need for corticosteroids. They also may be effective in maintaining remission in people who haven’t responded to other medications given for this purpose. Immunomodulators may take several months to begin working.

Biologic therapies – These medications represent the latest class of therapy used for people with Crohn’s disease. These medications are antibodies grown in the laboratory that stop certain proteins in the body from causing inflammation.

Antibiotics – Antibiotics may be used when infections—such as abscesses—occur in Crohn’s disease. They can also be helpful with fistulas around the anal canal and vagina.

Alternative Treatment

Zinc, folic acid, vitamin B12 – The body uses these vitamins and minerals to repair cells in the intestine. In addition, drugs such as sulfasalazine and methotrexate may cause levels of folic acid in the body to drop, so that you need a supplement.

Vitamin D – The body needs vitamin D to maintain strong bones. People with Crohn disease, especially those who take corticosteroids, often have low levels of vitamin D putting them at risk for osteoporosis.

Calcium – Calcium is also needed for strong bones. Ask your doctor if you need a calcium supplement.

Omega-3 fatty acids – These fats may help fight inflammation and reduce the chances of recurrence, but studies have been mixed. The study with the most positive results used a special type of fish oil, “enteric coated free fatty acid form,” that is not sold commercially.

Probiotics – One small study indicated that this type of “friendly” bacteria helped people with Crohn’s disease reduce the incidence of diarrhea.

N-acetyl glucosamine (NAG) – Preliminary research suggests that N-acetyl glucosamine supplements or enemas may improve symptoms of inflammatory bowel disease, but more studies are needed to determine whether glucosamine would have any effect on Crohn disease.

Glutamine – Glutamine is an amino acid found in the body that that helps the intestine function properly. While there is no evidence that glutamine specifically helps reduce symptoms of Crohn disease, it may be good for overall intestinal health. It is best to take glutamine on an empty stomach.

Herbs

Slippery elm is a demulcent (a substance that protects irritated tissues and promotes their healing).

Marshmallow (Althaea officinalis) is a demulcent and emollient (a substance that soothes mucous membranes). Marshmallow may interact with lithium. It may also interfere with drugs taken by mouth.

Curcumin or turmeric shows anti-inflammatory properties in test tubes. One small study found that people with inflammatory bowel disease who took curcumin reduced their symptoms and their need for medicines.

Cat’s claw may make leukemia, as well as autoimmune disorders, worse, and may worsen low blood pressure.

Boswellia (Boswellia serrata) has anti-inflammatory properties, and a few small studies suggest that it may help treat Crohn disease.

Complementary Treatment

Acupuncture has long been used in Traditional Chinese Medicine to treat inflammatory bowel disease. One study in Germany found that acupuncture and moxibustion were effective specifically for treating Crohn disease.

 

Reference

http://www.ccfa.org/what-are-crohns-and-colitis/what-is-crohns-disease/?referrer=https://www.google.co.in/

http://www.corecharity.org.uk/images/information_pdfs/CrohnsDisease.pdf

http://www.niddk.nih.gov/health-information/health-topics/digestive-diseases/crohns-disease/Pages/facts.aspx#8

http://www.nhs.uk/Conditions/Crohns-disease/Pages/Causes.aspx

https://www.southerncross.co.nz/AboutTheGroup/HealthResources/MedicalLibrary/tabid/178/vw/1/ItemID/523/Crohns-disease-symptoms-diagnosis-treatment.aspx#signs_and_symptoms

http://www.hopkinsmedicine.org/gastroenterology_hepatology/_pdfs/small_large_intestine/crohns_disease.pdf

https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/crohns-disease-and-ulcerative-colitis