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Colonoscopy

Definition:
A colonoscopy (koh-luh-NAH-skuh-pee) allows a doctor to look inside the entire large intestine. The procedure enables the physician to see things such as inflamed tissue, abnormal growths, and ulcers. It is most often used to look for early signs of cancer in the colon and rectum. It is also used to look for causes of unexplained changes in bowel habits and to evaluate symptoms like abdominal pain, rectal bleeding, and weight loss.

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What is the colon?
The colon, or large bowel, is the last portion of your digestive tract, or gastrointestinal tract. The colon is a hollow tube that starts at the end of the small intestine and ends at the rectum and anus. The colon is about 5 feet long, and its main function is to store unabsorbed food waste and absorb water and other body fluids before the waste is eliminated as stool.

Preparation for Colonscopy test
You will be given instructions in advance that will explain what you need to do to prepare for your colonoscopy. Your colon must be completely empty for the colonoscopy to be thorough and safe. To prepare for the procedure you will have to follow a liquid diet for 1 to 3 days beforehand. The liquid diet should be clear and not contain food colorings, and may include

*fat-free bouillon or broth
*strained fruit juice
*water
*plain coffee
*plain tea
*diet soda
*gelatin
Thorough cleansing of the bowel is necessary before a colonoscopy. You will likely be asked to take a laxative the night before the procedure. In some cases you may be asked to give yourself an enema. An enema is performed by inserting a bottle with water and sometimes a mild soap in your anus to clean out the bowels. Be sure to inform your doctor of any medical conditions you have or medications you take on a regular basis such as

*aspirin
*arthritis medications
*blood thinners
*diabetes medication
*vitamins that contain iron

The medical staff will also want to know if you have heart disease, lung disease, or any medical condition that may need special attention. You must also arrange for someone to take you home afterward, because you will not be allowed to drive after being sedated.

Procedure
For the colonoscopy, you will lie on your left side on the examining table. You will be given pain medication and a moderate sedative to keep you comfortable and help you relax during the exam. The doctor and a nurse will monitor your vital signs, look for any signs of discomfort, and make adjustments as needed.

The doctor will then insert a long, flexible, lighted tube into your rectum and slowly guide it into your colon. The tube is called a colonoscope (koh-LON-oh-skope). The scope transmits an image of the inside of the colon onto a video screen so the doctor can carefully examine the lining of the colon. The scope bends so the doctor can move it around the curves of your colon.

You may be asked to change positions at times so the doctor can more easily move the scope to better see the different parts of your colon. The scope blows air into your colon and inflates it, which helps give the doctor a better view. Most patients do not remember the procedure afterwards.

The doctor can remove most abnormal growths in your colon, like a polyp, which is a growth in the lining of the bowel. Polyps are removed using tiny tools passed through the scope. Most polyps are not cancerous, but they could turn into cancer. Just looking at a polyp is not enough to tell if it is cancerous. The polyps are sent to a lab for testing. By identifying and removing polyps, a colonoscopy likely prevents most cancers from forming.

The doctor can also remove tissue samples to test in the lab for diseases of the colon (biopsy). In addition, if any bleeding occurs in the colon, the doctor can pass a laser, heater probe, electrical probe, or special medicines through the scope to stop the bleeding. The tissue removal and treatments to stop bleeding usually do not cause pain. In many cases, a colonoscopy allows for accurate diagnosis and treatment of colon abnormalities without the need for a major operation.

During the procedure you may feel mild cramping. You can reduce the cramping by taking several slow, deep breaths. When the doctor has finished, the colonoscope is slowly withdrawn while the lining of your bowel is carefully examined. Bleeding and puncture of the colon are possible but uncommon complications of a colonoscopy.

A colonoscopy usually takes 30 to 60 minutes. The sedative and pain medicine should keep you from feeling much discomfort during the exam. You may feel some cramping or the sensation of having gas after the procedure is completed, but it usually stops within an hour. You will need to remain at the colonoscopy facility for 1 to 2 hours so the sedative can wear off.

Rarely, some people experience severe abdominal pain, fever, bloody bowel movements, dizziness, or weakness afterward. If you have any of these side effects, contact your physician immediately. Read your discharge instructions carefully. Medications such as blood-thinners may need to be stopped for a short time after having your colonoscopy, especially if a biopsy was performed or polyps were removed. Full recovery by the next day is normal and expected and you may return to your regular activities.

For More Information
American College of Gastroenterology
P.O. Box 342260
Bethesda, MD 20827–2260
Phone: 301–263–9000
Fax: 301–263–9025
Email: info@acg.gi.org
Internet: www.acg.gi.org

International Foundation for Functional Gastrointestinal Disorders
P.O. Box 170864
Milwaukee, WI 53217–8076
Phone: 1–888–964–2001 or 414–964–1799
Fax: 414–964–7176
Email: iffgd@iffgd.org
Internet: www.iffgd.org

National Digestive Diseases Information Clearinghouse
2 Information Way
Bethesda, MD 20892–3570
Phone: 1–800–891–5389
TTY: 1–866–569–1162
Fax: 703–738–4929
Email: nddic@info.niddk.nih.gov
Internet: www.digestive.niddk.nih.gov

Sources: http://digestive.niddk.nih.gov/ddiseases/pubs/colonoscopy/index.htm,  http://healthtopics.hcf.com.au/Colonoscopy.aspx

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Deep Breathing For Fast Back Pain Relief

Deep breathing practice is essential to our overall general health. It can provide fast back pain relief for two very important reasons:

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1) It accelerates the intake of oxygen and puts more oxygen into your bloodstream to feed your cells.
2) It helps the lymph system eliminate the waste products produced by the cells.

..

Oxygen Food For Your Body‘s Cells

Oxygen is the most important chemical in the body. Its main function is to purify the cells. It is like a food for the cells.

Amazingly, the body requires about 88 pounds of oxygen a day. Deep breathing recharges the hemoglobin which is the red element in the blood. Hemoglobin, an iron molecule that is magnetic, reacts to vibration to produce the oxygen carrying component of the blood.

We take approximately 21,600 breaths of air each day. It is said that the slower and deeper your breathing, the longer the life span. Deep rhythmic breathing is like a natural tranquilizer and can be used to reduce stress and release pain.

The movement created by deep breathing stimulates the blood throughout the body. With deep breathing, more oxygen is carried into your bloodstream. Then more wastes and toxins are removed. And if you are afflicted with pain, you may experience more relief from your pain.

When the cells are starved for oxygen, they are weak. They do not function enough to eliminate the 70% of the wastes produced your body they were intended.

Also, your cells need a lot of oxygen to create the energy-storing molecule, Adenosine TriPhosphate (ATP), which fuels your body and gives it the energy needed to be healthy.

ATP is the energy source that keeps everything going. It powers virtually every activity of each cell in your body including the mechanical work performed by your muscles.

Without Adenosine TriPhosphate your bodies would shut down. And without oxygen, there would be no Adenosine TriPhosphate.

The Lymph System – “Your Body’s Garbage Removal System”

Your Lymph System circulates all the toxins and waste products in your cells.

Did you know you have 4 times more lymph than you do blood in your body. As you know, you have a heart to pump your blood. But your lymph system has no pump to remove your bodys waste products. The only way lymph moves and is cleansed in your body is by exercising and deep breathing.

According to Dr. Jack Shields, a Lymphologist, deep breathing that moves your diaphragm sucks lymph up through your thoracic tract and stimulates the lymph in your body. He says that deep breathing is 10 times more effective than any other activity in stimulating the lymph system and doing its “garbage removal job” for the cells in your body.

Conclusion
As you can see deep breathing is important to your cell health. It can go a long way to reduce your back pain fast by removing toxins and fueling your cells. However, it does take a bit of practice to do deep breathing correctly.

Most of us do not breathe deeply. We only breathe in the upper chest, and it is in the lower chest where the blood supply is richer and where we can produce more “food” for our cells.

So look for an article in the near future to help you do proper deep breathing. It can change your life – not only to reduce your back pain but also to improve your health in every way.

Sources:http://www.articlesbase.com/health-articles/
why-deep-breathing-for-fast-back-pain-relief-582458.html

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Crohn’s Disease

Endoscopy image of colon showing serpiginous u...Image via Wikipedia

 

Definition:
Crohn’s disease (also known as regional enteritis) is a chronic, episodic, inflammatory bowel disease (IBD) and is generally classified as an autoimmune disease. Crohn’s disease can affect any part of the gastrointestinal tract from mouth to anus; as a result, the symptoms of Crohn’s disease vary among afflicted individuals. The disease is characterized by areas of inflammation with areas of normal lining between in a symptom known as skip lesions. The main gastrointestinal symptoms are abdominal pain, diarrhea (which may be bloody, though this may not be visible to the naked eye), constipation, vomiting, weight loss or weight gain. Crohn’s disease can also cause complications outside of the gastrointestinal tract such as skin rashes, arthritis, and inflammation of the eye.

The disease was independently described in 1904 by Polish surgeon Antoni Lesniowski and in 1932 by American gastroenterologist Burrill Bernard Crohn, for whom the disease was named. Crohn, along with two colleagues, described a series of patients with inflammation of the terminal ileum, the area most commonly affected by the illness. Crohn’s disease affects between 400,000 and 600,000 people in North America. Prevalence estimates for Northern Europe have ranged from 27–48 per 100,000. Crohn’s disease tends to present initially in the teens and twenties, with another peak incidence in the fifties to seventies, although the disease can occur at any age.

Although the cause of Crohn’s disease is not known, it is believed to be an autoimmune disease that is genetically linked. The highest relative risk occurs in siblings, affecting males and females equally. Smokers are three times more likely to get Crohn’s disease.

Unlike the other major types of IBD, there is no known drug based or surgical cure for Crohn’s disease. Treatment options are restricted to controlling symptoms, putting and keeping the disease in remission and preventing relapse.

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The three most common sites of intestinal involvement in Crohn’s disease are ileal, ileocolic and colonic.

Symptoms:
T the symptoms of crohn’s disease vary among individuals. The disorder usually recurs at intervals throughout life. Episodes of the disease may be severe, lasting weeks or several months before settling down to periods with mild or no symptoms. The symptoms include:

· Diarrhea.
· Abdominal pain.
· fever.
· Weight loss.
· General feeling of malaise.

If the colon is affected, symptoms may also include the following:

· Diarrhea, often containing blood.
· Bloody discharge from the anus.

About 1 in 10 people also develops other disorders associated with crohn’s disease. These other conditions may occur even in mold cases of crohn’s disease and include arthritis, eye disorders, kidney disorders, gallstones, and a rash.

Causes:
The exact cause of Crohn’s disease is unknown. However, genetic and environmental factors have been invoked in the pathogenesis of the disease. Research has indicated that Crohn’s disease has a strong genetic link. The disease runs in families and those with a sibling with the disease are 30 times more likely to develop it than the normal population. Ethnic background is also a risk factor. Until very recently, whites and European Jews accounted for the vast majority of the cases in the United States, and in most industrialized countries, this demographic is still true.

Mutations in the CARD15 gene (also known as the NOD2 gene) are associated with Crohn’s disease and with susceptibility to certain phenotypes of disease location and activity. In earlier studies, only two genes were linked to Crohn’s, but scientists now believe there are over eight genes that show genetics play a crucial role in the disease.

A handful of cases of Crohn’s disease cases were reported at the turn of the 20th century, but since then, the disease has continued to increase in prevalence dramatically. Some argue that this increase has been the result of a genetic shift in the population caused by conditions favoring individuals carrying the genes linked with the disease. These conditions could be a lower infant mortality rate or better health care in the nations that have the highest incidence of disease (industrialized nations).

Others argue that Crohn’s disease is caused by a combination of environmental and genetic factors. Many environmental factors have also been hypothesized as causes or risk factors for Crohn’s disease. Proven environmental risk factors include living in an industrialized country, smoking, and living in an urban area. Diets high in sweet, fatty or refined foods may also play a role. A retrospective Japanese study found that those diagnosed with Crohn’s disease had higher intakes of sugar, fat, fish and shellfish than controls prior to diagnosis. A similar study in Israel also found higher intakes of fats (especially chemically modified fats) and sucrose, with lower intakes of fructose and fruits, water, potassium, magnesium and vitamin C in the diets of Crohn’s disease sufferers before diagnosis, and cites three large European studies in which sugar intake was significantly increased in people with Crohn’s disease compared with controls. Certain chemicals in the diet, known as microparticles, are also hypothesized as a risk factor for the disease, as well as a poor imbalance of omega-6 to healthy omega-3 fatty acids that emerging research shows helps to improve all types of inflammatory disease. The most common forms of microparticles include titanium dioxide, aluminosilicates, anatase, calcium phosphate, and soil residue. These substances are ubiquitous in processed food and most toothpastes and lip glosses. Soil residue is found on fresh fruits and vegetables unless carefully removed.

Smoking has been shown to increase the risk of the return of active disease, or “flares”. The introduction of hormonal contraception in the United States in the 1960’s is linked with a dramatic increase in the incidence rate of Crohn’s disease. Although a causal linkage has not been effectively shown, there remain fears that these drugs work on the digestive system in similar ways to smoking.

Additionally, many in the scientific community believe that early childhood exposure to illness is necessary to the creation of a proper immune system for those with the genetic susceptibility for Crohn’s Disease. Higher incidences of Crohn’s Disease are associated with cleaner living conditions. Throughout the early and mid-20th century in the United States, the disease was strongly associated with upper-class populations, and today the disease does not yet exist in the many Third World countries, despite the fact that it occurs in all races. CD is also associated with first born and single children (because they would have less exposure to childhood illness from siblings) and in populations that have low incidences of gastric cancer. Gastric cancer is most often caused by the bacterium Helicobacter pylori that flourishes in cramped and unsanitary conditions.

Abnormalities in the immune system have often been invoked as being causes of Crohn’s disease. It has been hypothesized that Crohn’s disease involves augmentation of the Th1 of cytokine response in inflammation. The most recent gene to be implicated in Crohn’s disease is ATG16L1, which may reduce the effectiveness of autophagy, and hinder the body’s ability to attack invasive bacteria.

A variety of pathogenic bacteria were initially suspected of being causative agents of Crohn’s disease. However, the current consensus is that a variety of microorganisms are simply taking advantage of their host’s weakened mucosal layer and inability to clear bacteria from the intestinal walls, both symptoms of the disease. Some studies have linked Mycobacterium avium subsp. paratuberculosis to Crohn’s disease, in part because it causes a very similar disease, Johne’s disease, in cattle. The mannose bearing antigens, mannins, from yeast may also elicit pathogenic anti saccharomyces cerevisiae antibodies. Newer studies have linked specific strains of enteroadherent E. coli to the disease but failed to find evidence of contributions by other species.

Diagnosis:
The diagnosis of Crohn’s disease can sometimes be challenging, and a number of tests are often required to assist the physician in making the diagnosis. Even with a full battery of tests it may not be possible to diagnose Crohn’s with complete certainty; a colonoscopy is approximately 70% effective in diagnosing the disease with further being less effective. Disease in the small bowel is particularly difficult to diagnose as a traditional colonoscopy only allows access to the colon and lower portions of the small intestines; recent introduction of Capsule endoscopy aid in endoscopic diagnosis.

Endoscopy
A colonoscopy is the best test for making the diagnosis of Crohn’s disease as it allows direct visualization of the colon and the terminal ileum, identifying the pattern of disease involvement.

Radiologic Tests
A small bowel follow-through may suggest the diagnosis of Crohn’s disease and is useful when the disease involves only the small intestine. Because colonoscopy and gastroscopy allow direct visualization of only the terminal ileum and beginning of the duodenum, they cannot be used to evaluate the remainder of the small intestine.

CT and MRI scans are useful for evaluating the small bowel with enteroclysis protocols.They are additionally useful for looking for intra-abdominal complications of Crohn’s disease such as abscesses, small bowel obstruction, or fistulae. Magnetic resonance imaging (MRI) are another option for imaging the small bowel as well as looking for complications, though it is more expensive and less readily available.

Blood Tests
A complete blood count may reveal anemia, which may be caused either by blood loss or vitamin B12 deficiency. The latter may be seen with ileitis because vitamin B12 is absorbed in the ileum. Erythrocyte sedimentation rate, or ESR, and C-reactive protein measurements can also be useful to gauge the degree of inflammation.[48] It is also true in patient with ilectomy done in response to the complication. Another cause of anaemia is anaemia of chronic disease, characterized by its microcytic and hypochromic anaemia. There are reasons in anaemia, including medication in treatment of inflammatory bowel disease like azathioprine can lead to cytopenia and sulfasalazine can also result in folate malabsorption, etc. Testing for anti-Saccharomyces cerevisiae antibodies (ASCA) and anti-neutrophil cytoplasmic antibodies (ANCA) has been evaluated to identify inflammatory diseases of the intestine and to differentiate Crohn’s disease from ulcerative colitis.

Treatment:
Crohn’s is a chronic inflammatory disease of the bowel and treatment is focused on reducing inflammation. Treatment options include medications, nutritional supplements and surgery—either alone or in combination. Complementary and alternative treatments are used to help relieve symptoms in conjunction with other therapies. Treating Crohn’s disease effectively is complex – goals of therapy are to alleviate symptoms and to prevent flare-ups. It is important to develop a strong partnership with your gastroenterologist and nutritionist.

Medications: Aminosalicylates (sulfasalazine, mesalamine, balsalazide, and olsalazine) are given orally or rectally to reduce inflammation in the intestine. Corticosteroids (prednisone, methylprednisolone, hydrocortisone) reduce inflammation and are used short-term for acute flareups. Budesonide, one of a new class of nonsystemic steroids, targets the intestine rather than the whole body. Immunomodulators (azathioprine, 6-mercaptopurine, cyclosporine A, tacrolimus, methotrexate ), usually associated with organ transplants and used to decrease the risk of rejection. Increasingly, they’re being used to treat autoimmune diseases and used to treat people with Crohn’s disease. Usually prescribed for moderate to severe cases, immunomodulators are also used when fistulas develop or corticosteroids are no longer effective. Crohn’s is not caused by an infection, but antibiotics (metronidazole and ciprofloxacin) may help minimize symptoms and heal fistulas and abscesses. Biologics (infliximab (Remicade), adalimumab (Humira) are genetically engineered drugs that combat inflammation by neutralizing proteins in the immune system like tumor necrosis factor (TNF), which can cause inflammation. The advantage in using biologics is that they act selectively rather than suppressing the entire immune system.

Nutritional Support: Nutritional support for people with Crohn’s is a complex endeavor. Malnutrition is a common complication of the illness. Children need to increase their intake of calories and protein by as much as 150% of the recommended amounts for their age and height. It’s also important to increase fluids, proteins (especially fatty fish like tuna and salmon), complex carbohydrates, and potassium-rich foods like bananas, orange juice, potatoes and avocados. Supplements like fish oils, probiotics and liquid nutritional support (Ensure) may help, so be sure to consult your health professionals for the best plan for you or your child.

Complementary and Alternative Therapies:Many people are interested in nontraditional approaches to healing, especially when standard treatments produce intolerable side effects or aren’t able to provide an improvement. To address this interest, the National Institutes of Health established the National Center for Complementary and Alternative Medicine (NCCAM), which provides guidance and research.

Most complementary and alternative therapies don’t simply address a problem with the body. Instead, they focus on the entire person – body, mind and spirit. As a result, they can be especially effective at reducing stress, alleviating the side effects of conventional treatments and improving quality of life.

Studies have found that more than half the people with either Crohn’s disease or ulcerative colitis have used some form of complementary or alternative therapy. The most common complementary therapies tried were herbal and nutritional supplements, probiotics and fish oil. Side effects and ineffectiveness of conventional therapies are primary reasons for seeking alternative care. Only about two-thirds report their alternative or complementary therapy use to their doctors, however.

The majority of these therapies aren’t regulated as medications by the Food and Drug Administration. Manufacturers can claim that their therapies are safe and effective but don’t need to prove it. Because even natural herbs can have side effects and cause dangerous interactions, be sure to let your doctor know before you try any alternative or complementary therapies.

NCCAM’s findings are available on its Web site. You can also talk to information specialists at the center’s clearinghouse by calling 888-644-6226 between 8:30 a.m. and 5 p.m. Eastern time.

Moderate, regular exercise and stress management techniques like meditation, relaxation practices and cognitive therapy may help reduce the severity of symptoms.

Click to see also:>Alternative strategy better for Crohn’s Disease

Ayurvedic Recommended Therapy: Basti

Homeopathy – Crohn’s Disease And It’s Treatment…………..(1)…….(2)

Crohn’s Disease as related to Cat’s Claw

Lifestyle changes:
Certain lifestyle changes can reduce symptoms, including dietary adjustments, proper hydration and smoking cessation.

Surgery:
Most people with Crohn’s disease eventually need some type of surgery. Half of all children diagnosed with Crohn’s need surgery within 5 years. Surgery is used to remove damaged portions of the digestive tract or scar tissue or repair fistulas. Strictureplasty involves insertion of a ballon to widen narrow segments of intestine without having to remove any portion. Resection of the colon is done to remove damaged intestine. Subtotal colectomy removes part of the colon. Proctocolectomy removes the entire colon. An ileostomy is the creation of a stoma through which feces is passed and collected in a bag which must be emptied several times per day. Emergency surgery is sometimes required for bowel perforations, obstructions, intestinal bleeding, or severe fistulas.

Prospective Treatments:
Researchers at University College London have questioned the wisdom of suppressing the immune system in Crohn’s, as the problem may be an under-active rather than an over-active immune system: their study found that Crohn’s patients showed an abnormally low response to an introduced infection, marked by a poor flow of blood to the wound, and the response improved when the patients were given sildenafil.

Recent studies using helminthic therapy or hookworms to treat Crohn’s Disease and other (non-viral) auto-immune diseases seem to yield promising results.

A single, small, uncontrolled trial of patients with mild Crohn’s on stable medications suggested improvement with low dose naltrexone therapy.

Prognosis:
Crohn’s disease is a chronic condition for which there is currently no cure. It is characterized by periods of improvement followed by episodes when symptoms flare up. With treatment, most people achieve a healthy height and weight, and the mortality rate for the disease is low.

Crohn’s disease is a recurring disorder. Most affected people learn to live reasonably normal lives, but 7 in 10 people eventually need surgery. Complications and repeated surgery can occasionally reduce life expectancy. Crohn’s disease may increase the risk of colorectal cancer, and, for this reason, your doctor may advise you to have regular checkups that include colonoscopy.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.
Resources:
http://www.healthline.com/humiracontent/crohn’s-disease-advanced-treatments
http://www.charak.com/DiseasePage.asp?thx=1&id=108
http://en.wikipedia.org/wiki/Crohn’s_disease
http://www.mayoclinic.com/health/crohns-disease/DS00104/DSECTION=11

Behcet’s Disease

Other Nemes: Behçet’s syndrome, Morbus Behçet, Behçet-Adamantiades syndrome, or Silk Road disease.

Definition:
Behcet’s  disease (BD), is a chronic form of vasculitis (inflammation of the blood vessels) involving four primary symptoms: oral and genital ulcers, ocular inflammation, and arthritis.

The inflammation of Behcet’s disease leads to numerous symptoms that may initially seem unrelated. The signs and symptoms of Behcet’s disease — which may include mouth sores, eye inflammation, skin rashes and lesions, and genital sores — vary from person to person and may come and go on their own.

The exact cause of Behcet’s is unknown, but it may be an autoimmune disorder, which means the body’s immune system mistakenly attacks some of its own healthy cells. Both genetic and environmental factors may be responsible for Behcet’s disease.

Description:
Behçet’s disease (BD) was named in 1937 after the Turkish dermatologist Hulusi Behçet, who first described the triple-symptom complex of recurrent oral aphthous ulcers, genital ulcers, and uveitis. As a systemic disease, it can also involve visceral organs such as the gastrointestinal tract, pulmonary, musculoskeletal, cardiovascular and neurological systems. This syndrome can be fatal due to ruptured vascular aneurysms or severe neurological complications.

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In the 1930s Hulusi Behçet observed the three classic symptoms (oral and genital ulcers and eye inflammation) now define this complex condition. BD also has a unique ability to affect all sizes of blood vessels, including arteries and veins. Symptoms related to vasculitis, such as inflammation of joints, gastrointestinal areas, or the central nervous system, are also common.

Symptoms of this disease may have been described by Hippocrates in the 5th century BC, in his 3rd Epidemion-book. Its first modern formal description was published in 1922.

Some sources use the term “Adamandiades  syndrome” or “Adamandiades-Behçet syndrome”, for the work done by Benediktos Adamantiades. However, the current World Health Organization/ICD-10 standard is “Behçet disease”.

In 1991, Saudi Arabian medical researchers discovered “neuro-Behcet’s disease”, a neurological involvement in Behcet’s disease, considered one of the most devastating manifestations of the disease

Demographics:
Incidence of BD is very rare in the United States with approximately five in 100,000 people developing the syndrome. In Middle Eastern and Asian countries between Iran and Japan (known as the “Old Silk Route”), BD is quite prevalent. Incidence in these countries is double that of the United States.

More than twice as many females are diagnosed with BD than males in the United States. However, in Middle Eastern and Asian areas, significantly more men are affected than females.

Causes:
No one knows why the immune system starts to behave this way in Behçet ‘s disease. It is not because of any known infections, it is not hereditary, it does not have to do with ethnic origin, gender, life-style, or age, where someone has lived or where they have been on holiday. It is not associated with cancer, and links with tissue-types (which are under investigation) are not certain. It does not follow the usual pattern for autoimmune diseases.

Behçet disease is normally caused by an autoimmune response that triggers inflammation of the blood vessels. Researchers have discovered a gene, HLA-B51, which predisposes an individual to BD. However, not all individuals with this gene develop the disease. The specific event leading to onset of BD is not known, but there are speculations that it may be related to the following:

*herpes simplex virus infections

*frequent infections of Streptococcus bacteria

*environmental factors

Diagnosis & Symptoms:
Behçet disease is diagnosed based on a set of guidelines established by an international group of physicians. A physician observes clinical signs and symptoms during patient examination. The most recent and accepted guidelines for a positive diagnosis include the presence of recurring oral ulcers (three or more times in one year) and at least two of four secondary symptoms, including recurring genital ulcers, uveitis, skin lesions, a positive pathergy test.

A pathergy test is a skin-prick test to see if a red bump will form at the injection site. If there is a reaction, the test is positive. This test may be given to patients suspected of BD, but it is not an indicator for the disease. Only a small percentage of patients diagnosed with BD actually test positive.

It is diagnosed clinically by specific patterns of symptoms and repeated outbreaks. Other causes for these symptoms have to be ruled out before making the diagnosis. The symptoms do not have to occur together, but can have happened at any time.

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There are three levels of certainty for diagnosis:

1.International Study Group diagnostic guidelines (very strict for research purposes)

2.Practical clinical diagnosis (generally agreed pattern but not as strict)

3.’Suspected’ or ‘Possible’ diagnosis (incomplete pattern of symptoms)

International Study Group diagnostic guidelines:
Must have

*oral (aphthous) ulcers (any shape, size or number at least 3 times in any 12 months),
along with 2 out of the next 4 “hallmark” symptoms:

*genital ulcers (including anal ulcers and spots in the genital region and swollen testicles or epididymitis in men),

*skin lesions (papulo-pustules, folliculitis, erythema nodosum, acne in post-adolescents not on corticosteroids),

*eye inflammation (iritis, uveitis, retinal vasculitis, cells in the vitreous),

*pathergy reaction (papule >2 mm dia. 24-48 hrs or more after needle-prick).

Practical clinical diagnosis:

Must have

*mouth ulcers,
along with 1 of the 4 hallmark symptoms above and with 2 of the symptoms below:

*arthritis/arthralgia,

*nervous system symptoms,

*stomach and/or bowel inflammation,

*deep vein thrombosis,

*superficial thrombophlebitis,

*cardio-vascular problems of inflammatory origin,

*inflammatory problems in chest and lungs,

*problems with hearing and/or balance,

*extreme exhaustion,

*changes of personality, psychoses,

*any other members of the family with a diagnosis of Behcet disease

CLICK & SEE THE PICTURES.

Mouth ulcer with Behcet’s Disease.

Aphthous ulcer in a patient with Behcet Disease.

…. .
Aphthous ulcer in a patient with Behcet Disease.

‘Suspected’ or ‘Possible’ diagnosis:

Usually given when someone does not have mouth ulcers or has mouth ulcers but does not have 1 of the 4 hallmark symptoms but has other symptoms and signs of inflammation and other causes for these have been ruled out.

CLICK TO SEE THE TESTS FOR DIAGNOSIS

CLICK  TO SEE THE RISK FACTORS

Treatment:
Current treatment is aimed at easing the symptoms, reducing inflammation, and controlling the immune system. Anti-TNF therapy such as infliximab has shown promise in treating the uveitis associated with the disease. Another Anti-TNF agent, Etanercept, may be useful in patients with mainly skin and mucosal symptoms.

Interferon alfa-2a may also be an effective alternative treatment, particularly for the genital and oral ulcers as well as ocular lesions. Azathioprine, when used in combination with interferon alfa-2b also shows promise, and Colchicine can be useful for treating some genital ulcers, erythema nodosum, and arthritis in women, and arthritis in men.

Thalidomide has also been used due to its immune-modifying effect. Dapsone and rebamipide have been shown, in small studies, to have beneficial results for mucocutaneous lesions.

A different orientation could be explored in Behçet Disease, especially with genetic linkage to HLA-B51 antigen, just like the prevalence of HLA-B27 in ankylosing spondylitis. Ankylosing spondylitis is not due to an ‘oveactive’ immune system; instead it is a true autoimmune disease caused by molecular mimicry of the Osp (outer surface protein) with the Klebsiella pneumoniae germ (2 enzymes produced by this normally non-virulent pathogen), which is always present as a sub-clinical infection, typically at the ileocecal junction. The combination of antibiotics targeted to this specific germ, and dietary controls (elimination or severe restriction of all starches) could therefore potentially provide the most effective treatments, but such treatments have not yet been proven or generally approved. At the current time, a similar infectious origin has not yet been confirmed that leads to Behçet disease, but certain strains of Streptococcus sanguis has been found to have a homologous antigenicity.

Prognosis:
For most patients, the prognosis of Behçet disease is good. Individuals typically experience periods of active symptoms followed by periods of remission in which there are no symptoms. The length of these intervals varies, with ulcerous outbreaks lasting a few weeks and other symptoms occurring for longer durations. With proper treatments and medication, patients can continue to lead active lifestyles in most cases.

Development of vascular or neurological complications often indicates a poorer prognosis. Blindness due to ocular inflammation is also prevalent in patients with BD.

Recovery and rehabilitation:
Unlike most diseases, BD has symptoms that periodically flare up and then disappear for a period of time. As a result, patients may have long intervals with no complications. After treatment for active symptoms, patients usually require rest due to fatigue. Moderate exercise is also recommended to improve circulation and muscle strength.

Click to learn more about:->Behcet’s Disease

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose

Resources:
http://en.wikipedia.org/wiki/Behcet%27s_disease
http://www.healthline.com/galecontent/behet-disease
http://www.visualsunlimited.com/browse/vu425/vu425957.html
http://vasculitis.med.jhu.edu/typesof/behcets.html
http://www.visualsunlimited.com/browse/vu425/vu425958.html

Gastroparesis

What is gastroparesis?

Gastroparesis, also called delayed gastric emptying, is a disorder in which the stomach takes too long to empty its contents. Normally, the stomach contracts to move food down into the small intestine for digestion. The vagus nerve controls the movement of food from the stomach through the digestive tract. Gastroparesis occurs when the vagus nerve is damaged and the muscles of the stomach and intestines do not work normally. Food then moves slowly or stops moving through the digestive tract.

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What causes gastroparesis?

The most common cause of gastroparesis is diabetes. People with diabetes have high blood glucose, also called blood sugar, which in turn causes chemical changes in nerves and damages the blood vessels that carry oxygen and nutrients to the nerves. Over time, high blood glucose can damage the vagus nerve.

Some other causes of gastroparesis are

  • surgery on the stomach or vagus nerve
  • viral infections
  • anorexia nervosa or bulimia
  • medications—anticholinergics and narcotics—that slow contractions in the intestine
  • gastroesophageal reflux disease
  • smooth muscle disorders, such as amyloidosis and scleroderma
  • nervous system diseases, including abdominal migraine and Parkinson’s disease
  • metabolic disorders, including hypothyroidism

Many people have what is called idiopathic gastroparesis, meaning the cause is unknown and cannot be found even after medical tests.

What are the complications of gastroparesis?

If food lingers too long in the stomach, it can cause bacterial overgrowth from the fermentation of food. Also, the food can harden into solid masses called bezoars that may cause nausea, vomiting, and obstruction in the stomach. Bezoars can be dangerous if they block the passage of food into the small intestine.

Gastroparesis can make diabetes worse by making blood glucose control more difficult. When food that has been delayed in the stomach finally enters the small intestine and is absorbed, blood glucose levels rise. Since gastroparesis makes stomach emptying unpredictable, a person’s blood glucose levels can be erratic and difficult to control.

How is gastroparesis diagnosed?

After performing a full physical exam and taking your medical history, your doctor may order several blood tests to check blood counts and chemical and electrolyte levels. To rule out an obstruction or other conditions, the doctor may perform the following tests:

  • Upper endoscopy. After giving you a sedative to help you become drowsy, the doctor passes a long, thin tube called an endoscope through your mouth and gently guides it down the throat, also called the esophagus, into the stomach. Through the endoscope, the doctor can look at the lining of the stomach to check for any abnormalities.
  • Ultrasound. To rule out gallbladder disease and pancreatitis as sources of the problem, you may have an ultrasound test, which uses harmless sound waves to outline and define the shape of the gallbladder and pancreas.
  • Barium x ray. After fasting for 12 hours, you will drink a thick liquid called barium, which coats the stomach, making it show up on the x ray. If you have diabetes, your doctor may have special instructions about fasting. Normally, the stomach will be empty of all food after 12 hours of fasting. Gastroparesis is likely if the x ray shows food in the stomach. Because a person with gastroparesis can sometimes have normal emptying, the doctor may repeat the test another day if gastroparesis is suspected.

Once other causes have been ruled out, the doctor will perform one of the following gastric emptying tests to confirm a diagnosis of gastroparesis.

  • Gastric emptying scintigraphy. This test involves eating a bland meal, such as eggs or egg substitute, that contains a small amount of a radioactive substance, called radioisotope, that shows up on scans. The dose of radiation from the radioisotope is not dangerous. The scan measures the rate of gastric emptying at 1, 2, 3, and 4 hours. When more than 10 percent of the meal is still in the stomach at 4 hours, the diagnosis of gastroparesis is confirmed.
  • Breath test. After ingestion of a meal containing a small amount of isotope, breath samples are taken to measure the presence of the isotope in carbon dioxide, which is expelled when a person exhales. The results reveal how fast the stomach is emptying.
  • SmartPill. Approved by the U.S. Food and Drug Administration (FDA) in 2006, the SmartPill is a small device in capsule form that can be swallowed.The device then moves through the digestive tract and collects information about its progress that is sent to a cell phone-sized receiver worn around your waist or neck. When the capsule is passed from the body with the stool in a couple of days, you take the receiver back to the doctor, who enters the information into a computer.

How is gastroparesis treated?

Treatment of gastroparesis depends on the severity of the symptoms. In most cases, treatment does not cure gastroparesis—it is usually a chronic condition. Treatment helps you manage the condition so you can be as healthy and comfortable as possible.

Medication

Several medications are used to treat gastroparesis. Your doctor may try different medications or combinations to find the most effective treatment. Discussing the risk of side effects of any medication with your doctor is important.

  • Metoclopramide (Reglan). This drug stimulates stomach muscle contractions to help emptying. Metoclopramide also helps reduce nausea and vomiting. Metoclopramide is taken 20 to 30 minutes before meals and at bedtime. Side effects of this drug include fatigue, sleepiness, depression, anxiety, and problems with physical movement.
  • Erythromycin. This antibiotic also improves stomach emptying. It works by increasing the contractions that move food through the stomach. Side effects include nausea, vomiting, and abdominal cramps.
  • Domperidone. This drug works like metoclopramide to improve stomach emptying and decrease nausea and vomiting. The FDA is reviewing domperidone, which has been used elsewhere in the world to treat gastroparesis. Use of the drug is restricted in the United States.
  • Other medications. Other medications may be used to treat symptoms and problems related to gastroparesis. For example, an antiemetic can help with nausea and vomiting. Antibiotics will clear up a bacterial infection. If you have a bezoar in the stomach, the doctor may use an endoscope to inject medication into it to dissolve it.

Dietary Changes

Changing your eating habits can help control gastroparesis. Your doctor or dietitian may prescribe six small meals a day instead of three large ones. If less food enters the stomach each time you eat, it may not become overly full. In more severe cases, a liquid or pureed diet may be prescribed.

The doctor may recommend that you avoid high-fat and high-fiber foods. Fat naturally slows digestion—a problem you do not need if you have gastroparesis—and fiber is difficult to digest. Some high-fiber foods like oranges and broccoli contain material that cannot be digested. Avoid these foods because the indigestible part will remain in the stomach too long and possibly form bezoars.

Feeding Tube

If a liquid or pureed diet does not work, you may need surgery to insert a feeding tube. The tube, called a jejunostomy, is inserted through the skin on your abdomen into the small intestine. The feeding tube bypasses the stomach and places nutrients and medication directly into the small intestine. These products are then digested and delivered to your bloodstream quickly. You will receive special liquid food to use with the tube. The jejunostomy is used only when gastroparesis is severe or the tube is necessary to stabilize blood glucose levels in people with diabetes.

Parenteral Nutrition

Parenteral nutrition refers to delivering nutrients directly into the bloodstream, bypassing the digestive system. The doctor places a thin tube called a catheter in a chest vein, leaving an opening to it outside the skin. For feeding, you attach a bag containing liquid nutrients or medication to the catheter. The fluid enters your bloodstream through the vein. Your doctor will tell you what type of liquid nutrition to use.

This approach is an alternative to the jejunostomy tube and is usually a temporary method to get you through a difficult period with gastroparesis. Parenteral nutrition is used only when gastroparesis is severe and is not helped by other methods.

Gastric Electrical Stimulation

A gastric neurostimulator is a surgically implanted battery-operated device that releases mild electrical pulses to help control nausea and vomiting associated with gastroparesis. This option is available to people whose nausea and vomiting do not improve with medications. Further studies will help determine who will benefit most from this procedure, which is available in a few centers across the United States.

Botulinum Toxin

The use of botulinum toxin has been associated with improvement in symptoms of gastroparesis in some patients; however, further research on this form of therapy is needed.

What if I have diabetes and gastroparesis?

The primary treatment goals for gastroparesis related to diabetes are to improve stomach emptying and regain control of blood glucose levels. Treatment includes dietary changes, insulin, oral medications, and, in severe cases, a feeding tube and parenteral nutrition.

Dietary Changes

The doctor will suggest dietary changes such as six smaller meals to help restore your blood glucose to more normal levels before testing you for gastroparesis. In some cases, the doctor or dietitian may suggest you try eating several liquid or pureed meals a day until your blood glucose levels are stable and the symptoms improve. Liquid meals provide all the nutrients found in solid foods, but can pass through the stomach more easily and quickly.

Insulin for Blood Glucose Control

If you have gastroparesis, food is being absorbed more slowly and at unpredictable times. To control blood glucose, you may need to

  • take insulin more often or change the type of insulin you take
  • take your insulin after you eat instead of before
  • check your blood glucose levels frequently after you eat and administer insulin whenever necessary

Your doctor will give you specific instructions for taking insulin based on your particular needs.

Hope Through Research

The National Institute of Diabetes and Digestive and Kidney Diseases’ Division of Digestive Diseases and Nutrition supports basic and clinical research into gastrointestinal motility disorders, including gastroparesis. Among other areas, researchers are studying whether experimental medications can relieve or reduce symptoms of gastroparesis, such as bloating, abdominal pain, nausea, and vomiting, or shorten the time the stomach needs to empty its contents following a meal.

Points to Remember

  • Gastroparesis is the result of damage to the vagus nerve, which controls the movement of food through the digestive system. Instead of moving through the digestive tract normally, the food is retained in the stomach.
  • Gastroparesis may occur in people with type 1 diabetes or type 2 diabetes. The vagus nerve becomes damaged after years of high blood glucose, resulting in gastroparesis. In turn, gastroparesis contributes to poor blood glucose control.
  • Symptoms of gastroparesis include early fullness, abdominal pain, stomach spasms, heartburn, nausea, vomiting, bloating, gastroesophageal reflux, lack of appetite, and weight loss.
  • Gastroparesis is diagnosed with tests such as x rays, manometry, and gastric emptying scans.
  • Treatment includes dietary changes, oral medications, adjustments in insulin injections for people with diabetes, a jejunostomy tube, parenteral nutrition, gastric neurostimulators, or botulinum toxin.

For More Information

American College of Gastroenterology
P.O. Box 342260
Bethesda, MD 20827–2260
Phone: 301–263–9000
Internet: www.acg.gi.org

American Diabetes Association
1701 North Beauregard Street
Alexandria, VA 22311
Phone: 1–800–342–2383
Email: AskADA@diabetes.org
Internet: www.diabetes.org

International Foundation for Functional Gastrointestinal Disorders
P.O. Box 170864
Milwaukee, WI 53217
Phone: 1–888–964–2001 or 414–964–1799
Fax: 414–964–7176
Email: iffgd@iffgd.org
Internet: www.iffgd.org

Sources:http://digestive.niddk.nih.gov/ddiseases/pubs/gastroparesis/index.htm