Natural GERD Cure and Treatment

Heartburn and Acid Reflux Cure Program

Acidity is of the most dangerous problem that not only middle aged or old aged people faces but also the young generation is also facing. Untreated and ill treatment of this disease can lead to even heart stroke. The synthetic anti acidic products available in the market causes more harm in the fast relief process and does cure it holistically so that you do not suffer from it now and then. Here comes the best book on step acid reflux treatment written by Jeff Martin, a well renowned researcher and nutrionist.While these easy process stated in this book allows you to get heal of all types of digestive disorders on a permanent solution basis but in addition to it you get a three months direct counseling from Jeff Martin himself while ordering this product direct from this website. The treatment is so easy to follow and a 100% results is well expected but even then in case on is not satisfied with the results can get even 100 % refund. Indeed one of the cheapest and best ways to get rid of the long lasting digestive disorders especially heart burn in a holistic way without drugs and chemicals. Read more here...

Heartburn and Acid Reflux Cure Program Summary


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Clinical evaluation of gastroesophageal reflux disease

The most common symptom of GERD is heartburn, a burning sensation in the epigastric or retrosternal area, often occurring postprandially. Regurgitation, dysphagia, and belching may also occur. B. Hoarseness, nocturnal cough, and wheezing may be caused by chronic reflux, and asthma may be exacerbated by GERD. D. GERD is caused by decreased lower esophageal sphincter (LES) pressure. Sphincter tone can be impaired by consumption of fatty foods and anticholinergic medications.

Gastroesophageal Reflux Disease Gerd

Gastroesophageal reflux disease is an inflammation of the esophageal mucosa caused by reflux of stomach contents into the esophagus. GERD is caused by a malfunction of the esophageal sphincter brought about by smoking and obesity. GERD is treated using common anti-ulcer drugs that neutralize the gastric contents and reduce gastric acid secretion. Once the content is neutralized, the esophageal mucosa has time to heal freeing the patient of symptoms of GERD. There are eight groups of anti-ulcer drugs used to treat GERD. These are

H pylori and gastroesophageal reflux disease

Currently there is no evidence that H. pylori eradication worsen gastroesophageal reflux disease (GERD) in adults 41 . Limited data are also available in children. However, there is a theoretical risk, even though the data are conflicting, that long-term proton pump inhibitor (PPI) treatment could increase the development of H. pylori-associated atrophic gastritis and increase the risk of gastric cancer 42, 43 . Some experts recommend testing and eradicating H. pylori if the child or adolescent is undergoing endoscopy for GERD, but not for those with clinically diagnosed GERD 44 .

Gastroesophageal Reflux

One population survey reported that approximately 10 of all responders reported troublesome symptoms of nighttime reflux (39). A Gallup poll reported that 79 of all people with heartburn had symptoms at night, and approximately 75 of these felt that heartburn impaired their sleep (40). Despite medical therapy, only half of all heartburn patients felt they had adequate control of night-time symptoms. Finally, in an analysis of 15,314 subjects surveyed as part of the Sleep Heart Health Study, 24.9 reported heartburn during sleep (41). Symptoms of nocturnal GER include disrupted sleep, chest discomfort, subster-nal burning, heartburn, and indigestion. With more proximal migration of esophageal acid, patients are more likely to awaken with a sour taste, coughing, and even choking. Nocturnal GER is best diagnosed via esophageal pH monitoring, with an esophageal pH probe positioned in the distal esophagus approximately 5 cm above the LES. Episodes of GER...


Heartburn or acid reflux occurs when hydrochloric acid and pepsin from the stomach seep into the lower part of the esophagus, irritating the lining which is not suited for the strong acids. Sometimes the pain is mistaken for a heart attack. Acids are allowed to pass into the esophagus because of the relaxation of the esophageal sphincter, a small ring-shaped mus cle that opens to let food into the stomach but closes tightly to keep contents in. This muscle can become weakened. A hiatal hernia can develop in this area, which also causes acid reflux. Eating too fast or too much puts pressure on the sphincter muscle, weakening it, as does too much body weight. Eating the wrong foods or food combinations can cause heartburn. Foods that can act as muscle relaxants causing the sphincter muscle to open inappropriately are chocolate, fatty foods, and alcohol. Foods that increase the acidity of the stomach are coffee, beer, milk, and colas. Coffee, citrus foods, hot spicy foods, and tomatoes...


Dyspepsia is derived from the Greek dys and peptein, which literally interpret as bad digestion. The term dyspepsia encompasses a variety of symptoms of persistent upper abdominal pain and discomfort. The predominant symptoms may include pain, heartburn, nausea, early satiety, or postprandial fullness or bloating. This is the most common type of functional upper GI disorder, with a prevalence rate in Western countries estimated at 25 , although less than half will seek medical attention. There are subtypes of dyspepsia, which can be better approached by focusing on the predominant symptom. Ulcer-like symptoms are characterized by upper abdominal pain relieved by certain foods or antacids. Reflux-like symptoms include heartburn and acid regurgitation. Many patients with dyspepsia are thought to have a dysmotility-like disorder with less pain but more symptoms of early satiety, postprandial fullness and bloating, or nausea and vomiting. With an exhaustive evaluation, approximately 50 of...

Was breathing movement present How can event be categorized

Are other problems associated with event Fever and symptoms of upper respiratory infection suggest an underlying infectious process. Abnormal eye or body movements suggest seizures. Associated feeding problems may suggest dysphagia, gastroesophageal reflux, or cardiac abnormalities.

Upper Gastrointestinal Evaluation Related to the Pelvic Floor

As with pelvic floor dysfunction, related upper GI disorders often manifest as disorders of motility. They can generally be categorized into esophageal motility disorders, functional dyspepsia, and disorders of biliary spasm or dyskinesia. As with other functional GI disorders, patients with these conditions often show alterations in visceral sensation such as increased sensitivity to balloon disten-tion in various locations in the GI tract. As outlined below, there is often overlap of symptoms and presentation of the conditions.

Esophageal Motility Disorders

Esophageal motility disorders may present with a variety of symptoms including dysphagia, noncardiac chest pain, or heartburn. Dysphagia is the most serious of these symptoms and, under such circumstances, the physician's first priority is to evaluate for related diseases such as esophageal tumor or stricture, which might require urgent intervention. A barium esophagram will adequately evaluate for either tumor or stricture. Endoscopy has become more the first line intervention because it offers the added benefit of evaluating for erosive esophagitis or the precan-cerous condition, Barrett's esophagus. Additionally, endoscopy offers therapeutic dilatation for strictures. For patients with just pain or heartburn, an equally acceptable first diagnostic intervention is a therapeutic trial of a highdose proton pump inhibitor such as omeprazole, 20mg twice a day. For patients who fail to respond to this thera peutic trial, an endoscopy is indicated. Additionally, the American College of...

General Comments

The only significant human exposure to bismuth involves pharmaceutical uses. A number of trivalent and, rarely, pentavalent salts of bismuth have been used orally or intramuscularly over the past two centuries for the treatment of a number of conditions syphilis, malaria, hypertension, warts, stomatitis, upper respiratory tract infections, amebiasis, dyspepsia and diarrhea. Bismuth compounds have also been used as radiocontrast agents in diagnostic testing and as topical astringents having slight antiseptic action (1). With the introduction of more effective therapeutic agents, primarily antibiotics and antimicrobials, the internal use of certain trivalent bismuth salts (subnitrates, subcarbonates, subgallates, tartrates, subcitrates, and subsalicylates) is now limited primarily to oral preparations for the prevention and treatment of gastric and intestinal disorders, such as ulcers and diarrhea. Available as over-the-counter products, the (presumed) insoluble bismuth salts were long...

Immediate Questions

When does cyanosis occur Cyanosis that occurs intermittently is associated with apnea, cold exposure (acrocyanosis), or intermittent airway obstruction. Intermittent cyanosis that occurs with feeding is seen with choanal atresia, esophageal atresia (especially with coughing, sputtering), or severe gastroesophageal reflux. Cyanosis as a result of cardiac disease, respiratory disease, or abnormal hemoglobin usually is present continuously.

Differential Diagnosis

Acute presentation of reflux esophagitis, especially in infants, can diminish oral intake. Pain associated with feeding efforts (secondary to acid reflux) may initially present post-prandially or generalize to food refusal and selectivity. Children taking antireflux medications can experience flare-up of dysphagia if the medication dose is subtherapeutic or intercurrent illness exacerbates acid production in the stomach.

Was the substance truly blood Was it the patients blood

Can result from gastroesophageal reflux disease (GERD). Children with bleeding esophagitis as a result of GERD are more likely to have a neuromuscular disease or hiatal hernia. Other causes of esophagitis include mechanical injury by a foreign body, chemical injury from caustic ingestion, medication (pill esophagitis), or infection (Candida albicans, Aspergillus, herpes simplex virus, cytomegalovirus).

Compensatory Mechanisms

Therapeutic failure can sometimes be corrected by safely administering higher doses. Patients with gastroesophageal reflux, who have the extensive metabolizer polymorphism of CYP2C19, do not raise their gastric pH with standard doses of lansoprazole, a proton pump inhibitor, but can do so with more frequent doses of the drug (Furuta et al., 2001). On the other hand, heterozygotes for a poor metabolizer polymorphism have increased serum gastrin levels, which may increase the risk of atrophic gastritis (Sagar et al., 2000). Thus maintaining high levels of proton pump inhibitors may have harmful as well as beneficial effects.

Adverse Effects Drug Interactions and Contraindications

Dyspepsia is the most common side effect of zileuton. Liver transaminase levels are elevated in a small percentage of patients taking zileuton. Serum liver transaminase levels should be monitored and treatment halted if significant elevations occur. Zileuton inhibits the metabolism of theophylline. Thus, when these agents are used concomitantly, the dose of theophylline should be reduced by approximately one-half, and plasma concentrations of theophylline should be monitored closely. Caution should also be exercised when using zileuton concomitantly with warfarin, terfenadine, or propranolol, as zileuton inhibits the metabolism of these agents. Zileuton is contraindicated in patients with acute liver disease and should be used with caution in patients who consume substantial quantities of alcohol or have a history of liver disease.

Pentosan Polysulfate Sodium Elmiron

2 to 6 of pentosan polysulfate sodium is excreted unchanged in the urine. The response to treatment varies from 28 to 32 .41,42 The dosage is 100mg three times a day. The medication is generally well tolerated with adverse reaction rates varying from 1 to 4 .43 The most common reported adverse effect is dyspepsia. Other uncommon reactions include reversible alopecia and increased bruising.

The Importance Of Quoting Reporting Rates

Comparing the rates of IMMP (intensified) spontaneous reporting of specific events with the rates from using PEM questionnaires. An-gioedema urticaria, extrapyramidal effects and blood dyscrasias were as likely to be reported spontaneously as with PEM. Conversely, cardiac dysrythmias, dry mouth, dyspepsia, constipation, death and events suggesting immunological disorders were, by comparison, very unlikely to be reported spontaneously. Other events ranged between these two extremes. It needs to be emphasised that this refers to IMMP intensified spontaneous reporting which has a higher rate of reporting than the standard spontaneous reporting programme in NZ. It follows therefore that studies on specific drugs are not comparable unless the reporting rates are similar. Similarly, rates of reporting may provide a guide as to what types of reactions may have been missed.

Poor Intake and Absorption

Edema of the intestinal wall and mucosal surfaces may lead to impaired nutrient absorption and lymphatic drainage. Sondheimer and Hamilton120 reported calorie losses in stools as both proteins and fats, but Menon and Poskitt114 found no significant difference between stool losses of infants with heart disease and control patients. This factor is of importance when aggressive nutritional therapy with supplemental enteral feedings is attempted in these children. Excessive vomiting caused partly by gastroesophageal reflux may reduce the net intake of food.121

Longterm Care and Outcome in Open Myelomeningocele

Overall survival with myelomeningocele after the first 4 years appears to stabilize at approximately 85 6 , although there continues to be a significant mortality. This can be related to many of the associated problems faced by these children, including hind-brain disturbance, causing respiratory distress, apneic spells and gastro-esophageal reflux with tracheal aspiration, shunt malfunction and infection, and bladder and renal problems.

Bisphosphonatesalendronate Fosamax

Patients should take the pill in the morning with 2-3 glasses of water, at least 30 minutes before any food or beverages. No other medication should be taken at the same time, particularly calcium preparations. Patients should not lie down after taking alendronate to avoid gastroesophageal reflux. Contraindicated include severe renal insufficiency and hypocalcemia.

Safety issues 1241 In animals

Earlier human studies carried out by B erven et al. (2000) on overweight and obese subjects, using gel capsules, only reported small adverse events as a result of feeding CLA isomers for 12 weeks. In this study, blood lipids, haematological parameters, blood electrolytes, and liver safety parameters did not change significantly within the groups during the study. However, three subjects in each treatment reported adverse events such as diarrhoea or gastritis heartburn. No adverse events were also reported in the study of Malpuech-Brugere et al. (2004) when feeding pure isomers of CLA in a food matrix. In the study of Gaullier et al. (2005), who fed CLA isomers as free fatty acids (CLA-FFA) or triacylglycerols (CLA-TG) to healthy overweight subjects for 1 year, followed by a dose of 3.4 g CLA day as TG for 1 year, similar adverse events such as gastrointestinal pains were reported. However, serum high-density lipoprotein (HDL) cholesterol decreased in the group previously fed CLA-TG....

Gastrointestinal stimulants

Gastrointestinal stimulants are used to treat nocturnal heartburn caused by GERD and primarily prescribed for patients who do not respond to other drugs or non-drug therapy. Gastrointestinal stimulants increase gastric emptying time preventing acid reflux into the esophagus. Gastrointestinal stimulants also enhance the release of acetylcholine at the mysenteric plexus. Cisapride (Propulsid) is an example of a gastrointestinal stimulant.

Concept and diagnostic entity

A miscellaneous collection of seemingly unrelated phenomena such as impotence, dental caries, and dyspepsia. Eventually it became clear that the expanding kaleidoscope of symptoms should be managed in a way that made some sense. Beard approached this problem by organizing the symptoms into subtypes of neurasthenia cerebrasthenia (cerebral exhaustion) characterized by symptoms that were directly or indirectly connected with the head myelasthenia (spinal exhaustion) was defined by symptoms related to the involvement of the spinal cord digestive asthenia was characterized by dyspepsia, constipation, and flatulence. As time went on more subtypes were added by other investigators and specific treatment approaches were developed. The first list of symptoms Freud proposed for neurasthenia proper included headache, spinal irritation, dyspepsia with flatulence, and constipation. Later, he added sexual weakness and fatigue.

Miscellaneous Topical Antifungal Agents

A 57-year-old man with extensive onychomycosis (fungal toenail infection) asks you for an evaluation. He requests a prescription for itraconazole for treatment of this problem after seeing a television advertisement for this drug. He has chronic heartburn attributed to gastroesophageal reflux disease and is treated with the proton pump inhibitor omeprazole. He is taking lovastatin for treatment of

Adenocarcinoma of the oesophago SJ Spechlerp Hainaut

Oesophagogastric Junction

In the oesophagus, gastro-oesophageal reflux disease (GERD) is accepted as the cause of intestinal metaplasia (Barrett oesophagus) chronic reflux oesophagitis is a strong risk factor for adenocarcinoma of the oesophagus 1001 . The cancer risk for patients with intestinal metaplasia in the oesophagus appears to be substantially higher than for patients with intestinal metaplasia in the stomach 1797 In contrast to the stomach, infection with H. pyloridoes not appear to play a direct role in the pathogenesis of oesophageal inflammation and metapla- Recent studies indicate that specialized intestinal metaplasia at a normal-looking OG junction carries a much lower rate of malignancy than in Barrett oesophagus 715 . Indeed, intestinal metaplasia at the oesophagogastric junction has been found with similar frequencies in Caucasians with GERD (a high risk group for adenocarcinoma at the junction) and in African Americans without GERD (a low risk group) 269 . Cancers of the gastric cardia...

Oropharynx or Nasopharynx Postnasal drip from allergic or

Patients with either swallowing dysfunction or gastroesophageal reflux can present with cough. Cough is minimal after the cough receptors are desensitized. Cause of Cough in Neonatal Period. As a mnemonic remember CRADLE Cystic fibrosis Respiratory infection Aspiration from tra-cheoesophageal fistula swallowing dysfunction, gastroesophageal reflux Dyskinesia of cilia Lung, airway, vascular malformation Edema, heart failure.

Adverse Reactions Contraindications Interactions

Garlic can cause heartburn, nausea, and loose stools at high doses, especially in those unaccustomed to it. Its most characteristic and troublesome side effect, however, is persisting breath odor, which no amount of tooth brushing will eradicate. Allicin and its odoriferous metabolic products are actually released into the lung alveoli and exhaled. Garlic should be avoided in gastroesophageal reflux disease and peptic ulcer disease. High doses should be avoided in pregnancy. Garlic does pass into breast milk but so far has not been shown to be harmful. Cases of botulism have been reported from chopped garlic or garlic oil left out for long periods at room temperature. Administration of garlic with anticoagulant and an-tiplatelet drugs should be avoided because of the risk of bleeding.

Serous Oligocystic Adenoma

Serous oligocystic adenoma occurs equally in both sexes. Tumors usually affect individuals with a mean age in the fifth decade (26-73 years old), younger than patients with serous microcystic adenoma with a mean age in the seventh decade 31 . Tumors are often identified incidentally during US or CT. Some patients are symptomatic, complaining of abdominal pain or dyspepsia. Patients do not have VHL disease. Serous oligocystic adenomas can develop

Nausea and vomiting

Postoperative nausea and vomiting remain a troublesome and frequent complication of general anesthesia, with an in-hospital incidence varying from 10 to 30 per cent. Predisposing factors include a full stomach (emergency surgery, pregnancy), obesity, gastroschesis, diabetes mellitus, hiatus hernia and or gastroesophageal reflux, type of surgery, phase of the menstrual cycle in women, and choice of anesthetic (particularly those incorporating higher doses of opioid analgesics and inhalational anesthetics). Vomiting itself may be associated with particular medical risks, as outlined in T.a.b e.4 Treatment consists of antiemetic drugs (e.g. droperidol 0.25-0.5 mg intravenously, dimenhydrinate 12.5-25 mg intravenously, ondansetron 4-8 mg intravenously, or a subhypnotic dose of propofol 0.15 mg kg intravenously) and or substitution of alternate opioid or non-opioid analgesics for the treatment of postoperative pain. Undesirable side-effects of many antiemetic drugs include sedation (with...

Upper gastrointestinal hemorrhage above the lower ileum

Upper Gastrointestinal Hemorrhage

Reflux esophagitis is another common cause of esophageal bleeding. This diagnosis is suspected when guaiac-positive stools or small amounts of melena are discovered in a patient experiencing frequent bouts of heartburn, particularly when in a recumbent position. The disorder results from repeated reflux and retention of acid-peptic gastric contents in the esophagus as a result of both reduced resting pressure at the level of the inferior esophageal sphincter and delayed esophageal emptying. While the inflammatory process is usually mild and bleeding is slight, actual mucosal dysplasia (Barrett epithelium) leading to ulcers and strictures may occur in severe chronic cases. In immunocompromised patients in particular, several types of mycoses (especially candidiasis) or viral infections may cause extensive esophagitis and dysphagia, usually with minor bleeding. These disorders are generally responsive to specific chemotherapeutic drugs. Cancer of the esophagus is unlikely to cause major...

Gcp Ii Inhibitors In The Clinic

Based on the preclinical efficacy of GCP II inhibitors in models of stroke, ALS and peripheral neuropathy, a potent and selective GCP II inhibitor was chosen to be administered to 77 individuals in three Phase I clinical trials. In the first trial, doses of up to 1500 mg were administered to volunteers. Oral bioavailability of the drug, particularly in the fasted state, was very good. Plasma levels were achieved that were above those needed to produce effects in animal models of diabetic neuropathy and neuropathic pain. The compound was safe and well tolerated at all doses without any CNS effect (EEG, visual tracking, coordination, etc). Gastrointestinal complaints constituted the most common category of adverse event, with dyspepsia being most commonly reported.

Treatment For Infections Caused By Cestodes

Cestodes that parasitize humans have complex life cycles, usually requiring development in a second or intermediate host. Following their ingestion, the infected larvae develop into adults in the small intestine. Although most patients remain symptom free, some have vague abdominal discomfort, hunger pangs, indigestion, and anorexia, and vitamin B deficiency may develop. In some cestode infections, eggs containing larvae are ingested the larvae invade the intestinal wall, enter a blood vessel, and lodge in such tissues as muscle, liver, and eye. Symptoms are associated with the particular organ affected.

Metoclopramide Hydrochloride

Improved gastric emptying will frequently alleviate symptoms in patients with diabetic, postoperative, or id-iopathic gastroparesis. Since metoclopramide also can decrease the acid reflux into the esophagus that results from slowed gastric emptying or lower esophageal sphincter pressure, the drug can be used as an adjunct in the treatment of reflux esophagitis.

Cisapride and Tegaserod

Cisapride (Propulsid) and tegaserod (Zelnorm) are both serotonin-4 (5-HT4) receptor agonists that stimulate GI motility. Cisapride appears to act by facilitating the release of acetylcholine from the myenteric plexus. It has no antiadrenergic, antidopaminergic, or choliner-gic side effects. Following oral administration, peak plasma levels occur in 1.5 to 2 hours the drug's half-life is 10 hours. Cisapride has been successfully used to treat gastroparesis and mild gastroesophageal reflux disease. The most frequent side effect has been diarrhea. A few patients had seizure activity that was reversible after medication was discontinued. Cisapride was pulled from the U. S. market after deaths from drug-associated cardiac arrhythmias, including ventricular tachycardia, ventricular fibrillation, torsades de pointes, and QT prolongation.

Perioperative Feeding Considerations

In addition to planning for access for nutrition support preopera-tively, it is also important to discuss transition back to an oral diet. Upper gastrointestinal surgical resection may be associated with significant postoperative morbidity, including dumping syndrome, delayed gastric emptying, prolonged ileus, obstruction, gastroesophageal reflux and post-gastrectomy syndrome (dumping, fat maldigestion, gastric stasis and lactose intolerance) 91, 92 . Manifestation of these complications can lead to weight loss, malnutrition and increased mortality 93 . Preoperative education to inform patients of normal and abnormal postoperative events can assist them to play an active role in their recovery.

On Adult Presentations

Breathing with dry mouth and throat, morning headaches, gastroesophageal reflux, sweating (may suggest increased work of breathing), stereotypic movements complaints suggestive of seizure or movement disorders (including parasomnias and restless legs syndrome) Glaucoma (87), end-stage renal disease (88,89), and gastroesophageal reflux disease (90,91) have been reported to occur with OSA, but the specificity of the associations are not established.

Gastric Acid Related Disorders

Gastric acid-related disorders include heartburn, gastric and duodenal ulcers, symptomatic gastroesophageal reflux disease (GERD), erosive esophagitis, and pathological hypersecretory conditions such as ZollingerEllison syndrome. The conventional treatment for these acid-related disorders is the suppression of gastric acid secretion by H2 blockers and proton pump inhibitors (PPIs). PPIs are currently the drugs of choice in the management of acid-related disorders. The use of antisecretory agents in combination with antibiotics is beneficial in the healing of H-pylori related peptic ulcers. The approved H2 blockers in the United States include cimetidine, ranitidine, famotidine, and nizatidine. Approved PPIs include omeprazole, esomeprazole (enantiomer of omeprazole), pantoprazole, lansoprazole, and rabeprazole.

Peripheral Neuropathy

Polysomnographic investigation for most of these patients should be routine. Patients should be considered for hypoventilation syndromes and as such end tidal CO2 measurements may be helpful. Patients must be observed in REM sleep for a complete evaluation. Esophageal reflux can also cause some of the apneic episodes in patients with autonomic nervous system dysfunction (67). Severe patients may require significant assistance with some activities of daily living.

H2Receptor Antagonists

The histamine receptor antagonists (H2 blockers) marketed in the United States are cimetidine (Tagamet), ranitidine (Zantac), famotidine (Pepcid), and nizatidine (Axid). These agents bind to the H2-receptors on the cell membranes of parietal cells and prevent histamine-induced stimulation of gastric acid secretion. After prolonged use, down-regulation of receptor production occurs, resulting in tolerance to these agents. H2-blockers are approved for the treatment of gastroesophageal reflux disease, acute ulcer healing, and post-ulcer healing maintenance therapy. Although there are substantial differences in their relative potency, 70 to 85 of duodenal ulcers are healed during 4 to 6 weeks of therapy with any of these agents. The incidence of healing of gastric ulceration after 6 to 8 weeks of therapy approaches 60 to 80 with the use of cimetidine or raniti-dine. Since nocturnal suppression of acid secretion is particularly important in healing, nighttime-only dosing can be used. Most...

Postoperative Granuloma after Stapedectomy Is It Destiny or Avoidable

Objective The aims of this study were (1) to investigate the pathophysiological characteristics of the middle ear mucoperiosteum against the caustic nature of the gastric content (GC), which consists largely of acid and pepsin components, and (2) to investigate the possible role of gastroesophageal reflux and postoperative vomiting (POV) in the etiology of post-stapedectomy granuloma. Methods 40 Spraque-Dawley rats of either sex and with a body weight of 200-300 g were used, and divided into different study groups group 1 GC administration to the middle ear (n 8) group 2 phosphate-buffered saline administration to the middle ear (n 8) group 3 GC (pH 2) administration in the presence of a Teflon piston (TP) (n 6) group 4 phosphate-buffered saline administration in the presence of a TP (n 6) group 5 GC administration in the presence of a wired piston (WP) (n 6) group 6 phosphate-buffered saline administration in the presence of a WP (n 6). GC was administrated to the middle ear cavities...

Issues In Minimally Invasive Surgery

The first laparoscopic cholecystectomy (gall bladder removal) was performed on a human patient in 1987 (Mouret, 1991 see also Reddick et al., 1989). Just over one decade later, almost all abdominal surgical procedures are performed laparoscopically. For such surgery, the patient requires general anesthetic, and as with Mrs. Sanders' case, the abdomen is insufflated with carbon dioxide. Small keyhole-size incisions are made for ports of entry of the camera and surgical instruments. These are inserted with the operative ends inside the abdominal cavity and the handles the surgeons use to control the instruments outside the patient's abdomen. Laparoscopic cholecystectomy has gained universal acceptance as the procedure of choice for gall bladder removal because of a high rate of success and rapid recovery in most cases. MIS procedures are used frequently for appendectomies, inguinal hernia repairs, and Nissen fundoplications, a procedure to alleviate severe heartburn. Compared to...

Eat Fruit Alone

If there are any fruits that have always given you indigestion in the past, try eating them first thing in the morning when your stomach is typically completely empty. Chew very well. You may be surprised at how well your body receives this meal. Many diets advise the limitation of fruit to one or two small portions a day. If you follow the rule to always eat fruit on an empty stomach, you may find that there needn't be such a limitation on fruit intake, unless you eat so much fruit that other important foods end up excluded due to a lack of hunger or appetite. Fruits are wonderful foods, and should not be minimized by nutritional counselors unaware of the manner required by fruit to be properly digested. Also, fruits should only be eaten raw, which further promotes digestion, since the natural enzyme content in the fruit hasn't been destroyed or severely limited by the cooking process, preserving process, or canning packaging process. Processed fruits, especially those with added...

Complex Foods

Many beans naturally combine significant percentages of both protein and carbohydrate, and many people do not comfortably digest them. Certainly, the guidelines in this chapter are not intended to have you ignore your body and the signals it might be giving you. If a food always gives you gas or indigestion, regardless of when or how well you process it, then avoid it. Not all foods naturally occurring in nature are well tolerated by everybody. Some people will actually have superior digestive abilities over others for a given food. For example, some people have the enzyme lactase that can directly break down the lactose in milk, but other people are completely deficient in this enzyme and intolerant to all milk and milk products. Genetically, we all have our own unique ancestral roots, and our digestive systems will typically digest the foods that our direct lineal ancestors ate better than other types of foods.

Starch Breakdown

The breakdown of starch begins in the mouth, with salivary amylase. It is often assumed that as this is swallowed into an acid stomach the enzymic carbohydrate breakdown is then stopped (although acid hydrolysis may still occur) because salivary amylase is inhibited by a pH below 4. However, starch and its end products and

Gastric dilatation

Acute gastric dilatation is a common occurrence after multiple trauma. Gastric dilatation is the result of increased aerophagia due to agitation or pain, reflex gastric ileus by visceral and somatic nerve stimulation, or intubation or ventilatory problems. It may lead to vomiting, aspiration with subsequent pneumonia, and shock. Physical examination, ultrasound investigation, and diagnostic peritoneal lavage are hindered by gastric dilatation, and should be postponed until a nasogastric tube is inserted. The use of muscle relaxants at intubation can provoke esophageal reflux this should be foreseen, and the cervical esophagus should be compressed manually (Sellick maneuver).

Other drugs

Amantadine, which also has antiviral actions, is able to increase the release of dopamine in the basal ganglia, which diminishes the release of acetylcholine. It may improve acute dystonias, akathisia, akinesia, parkinsonism, and tardive dyskinesia. It has also been reported to improve sexual function and decrease weight gain due to neuroleptic drugs. It may cause increased arousal, agitation, and indigestion, however. The usual oral dose is 100 to 400 mg day.

Treatment Planning

Pathways are important for a consistent and efficient hospital recovery. The presence of both the extirpative and reconstructive surgeon guiding the preparation of the operative patient can facilitate team efforts later in the operative day. In those patients who will endure a prolonged period of enteral feedings, percutaneous or open gastrostomy tube placement is prudent for maximizing preoperative nutritional status and obviating the need for a nasogastric feeding tube. This is generally more comfortable for the patient and decreases the incidence of sinusitis, gastroesophageal reflux, and pharyngeal swelling (25). All of these factors can potentially inhibit return of post-operative deglutition. The myriad of preoperative appointments is best coordinated for the patient by a dedicated patient care coordinator.


Coronal PET CT images obtained from a middle-aged male with a history of gastroesophageal reflux and biopsy-proven esophageal carcinoma. These images show intense tracer uptake in the primary lesion located at the gas-troesophageal junction and extending downward into the stomach. No metastatic disease is identified. (A) CT scan. (B) Fused PET CT image. (C) Attenuation corrected PET image. (D) Nonat-tenuation corrected PET image. figure 33.3. Coronal PET CT images obtained from a middle-aged male with a history of gastroesophageal reflux and biopsy-proven esophageal carcinoma. These images show intense tracer uptake in the primary lesion located at the gas-troesophageal junction and extending downward into the stomach. No metastatic disease is identified. (A) CT scan. (B) Fused PET CT image. (C) Attenuation corrected PET image. (D) Nonat-tenuation corrected PET image.

Suggested Reading

Pathophysiology of functional dyspepsia. Gut 2002 51(suppl 1) i63-i66. 3. Talley NJ. Dyspepsia management guidelines for the millennium. Gut 2002 50(suppl IV) iv72-iv78. 4. Talley NJ, Janssens J, Lauritsen K, Racz I, Bolling-Sternevald E. Eradication of Helicobacter pylori in functional dyspepsia randomized double blind placebo controlled trial with 12 months' follow up. The Optimal Regimen Cures Helicobacter Induced Dyspepsia (ORCHID) Study Group. BMJ 1999 318 833-837.

Chris Good

Based on new active substances are first categorized as prescription only until sufficient information and experience have been gained regarding their safety. Whether or not the cost of their prescription is covered by the state depends on not only medical but also political considerations of their perceived personal and social benefits. Some examples may clarify this. The antifungal imidazoles clotrimazole and ketoconazole were strictly limited prescription only medicines when they were marketed in the early 1970s for topical fungal infections. They are now available OTC for the self-treatment of thrush and dandruff, ketoconazole being regularly promoted on the radio. Peptic ulceration was generally treated surgically when simple antacids failed to relieve symptoms. Increasingly sophisticated forms of highly selective vagotomy were practised by gastric surgeons to try and separate the acid-suppressing effects of such an operation from its considerable undesirable adverse effects....

Ayurvedic Medicine

The foremost characteristic of the vata metabolic type is changeability. People of this type are active, energetic, moody, imaginative, and impulsive prone to erratic sleep patterns, intestinal problems, nervous disorders, and premenstrual syndrome. There is a sensitivity to cold and dry and their vulnerable season is autumn. Pitta types are predictable, aggressive, intense, efficient, articulate, moderate in daily habits, short-tempered, and impatient. They tend to perspire more and may be open to poor digestion, ulcers, skin inflammations, hemorrhoids, and heartburn. In summer they are sensitive to the sun and heat. Kapha is relaxed, stable, conservative, with a tendency to laziness and procrastination. They sleep long and move, eat, and digest food slowly. There is an inclination toward overweight, allergies, sinus, and lung congestion and they are highly susceptible to the cold of winter.

EGI disorders

May cause excessive crying, as well as frequent regurgitation or vomiting, failure to thrive, hiccups, episodes of stiffening or arching or head tilting associated with feedings (Sandifer syndrome), recurrent wheezing or pneumonia, stridor, and obstructive apnea.

General principles

It is precisely because of this relatively delicate balance between the proper digestion of foods and the potential rotting of those foods that food combining principles are so important. If you research these concepts further on your own, you will also find that food combining has its very vocal critics. Of course, every health recommendation has its supporters and critics. I would advise you to let your body be your guide. If, after combining your foods properly, you find that your gas, belching, bloating, heartburn, and flatulence are lessening (or even disappearing ) for the first time in memory, I doubt that you'll be very interested in giving much consideration to what the critics of food combining have to say.


Egd Children Antrum Pictures

Tage of being able to detect upper gastrointestinal pathology including the complications of H. pylori infection such as nodular gastritis, peptic ulcer disease, gastric cancer, and MALT lymphoma. In pediatrics, the primary indication for upper GI endoscopy is the presence of persistent, severe upper abdominal symptoms and not simply the presence of H. pylori 33 . It is difficult to differentiate symptoms secondary to the complication of H. pylori infection such as peptic ulcer disease and functional dyspepsia. The most common endoscopic finding in children with H. pylori infection is nodular gastritis, which is seen most commonly in the antrum with an irregular (cobblestone) appearance, which is highlighted with blood from a bleeding biopsy site. When nodular gastritis is found, it has high specificity (98 ) for H. pylori infection, and therefore a high predictive indicator for H. pylori infection, but it has low sensitivities (44 ) 17, 74 . In naive patients, antral biopsy had the...

Peptic ulcer disease

On examination, at least half of the patients initially suspected of having peptic ulcer disease do not have evidence of an ulcer. (59 Among patients with non-ulcer dyspepsia, psychiatric comorbidity is high. Magni reported that 87 per cent of patients with non-ulcer dyspepsia have one or more anxiety disorders compared with 25 per cent of those with dyspepsia where there is endoscopic evidence of ulcer. (51 To date, studies have not demonstrated that behavioural or psychopharmacological interventions in patients with non-ulcer dyspepsia are efficacious. (52)


Diseases in the GI-tract may affect different factors important for drug absorption, and the effect on the overall pharmacokinetics is not always predictable. Inflammatory bowel diseases, such as Crohn's or ulcerative colitis, affect the absorption surface area and there are several reports on altered absorption in patients suffering from these conditions 6 . In celiac disease, associated with stunted small intestinal villi and alteration of gastric emptying and pH, the intestinal CYP3A4 content was decreased 7 . Changes in pH (e.g., achlorhydria or AIDS gastropathy) might delay and reduce the absorption of pH-dependent drugs such as ketoconazole 6 . Changes in GI-motility, by e.g., irritable bowel syndrome (small intestine), diabetes mellitus and nonulcer dyspepsia (stomach), and idiopathic constipation (colon), may affect the absorption of orally administered drugs by changing the rate of delivery, bioavailability, or mucosal absorption. For poorly absorbed drugs both...


Physical changes during pregnancy, including abdominal distension, fetal movement, bladder distention, urinary frequency, backache, and heartburn, all contribute to increased sleep fragmentation and decreased REM sleep. Weight gain may precipitate or worsen pre-existing sleep apnea. Conversely, increased minute ventilation, preference for the lateral sleep position, and decreased REM sleep time during pregnancy can decrease the risk for OSA (71).

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