Categories
Ailmemts & Remedies

Achalasia

Other Name : Esophageal achalasia

Definition:
Achalasia is a disorder of the tube that carries food from the mouth to the stomach (esophagus), which affects the ability of the esophagus to move food toward the stomach.

Click to see Achalasia Image

At first it may only cause a minor problem, and often goes unnoticed. However, over time someone with achalasia finds it increasingly difficult to swallow food and liquid.

This is because the muscles in the oesophagus (gullet) which move foods and liquids into the stomach stop working properly. This leads to the oesophagus dilating, or stretching, which may lead to choking or coughing fits at night, triggered by food or liquids being regurgitated when a sufferer lies down at night.

Signs and symptoms:

The main symptoms of achalasia are dysphagia (difficulty in swallowing) and regurgitation of undigested food. Dysphagia tends to become progressively worse over time and to involve both fluids and solids.

•Backflow (regurgitation) of food
•Chest pain, which may increase after eating or may be felt in the back, neck, and arms
•Cough
•Difficulty swallowing liquids and solids
•Heartburn
•Unintentional weight loss

Causes:
A muscular ring at the point where the esophagus and stomach come together (lower esophageal sphincter) normally relaxes during swallowing. In people with achalasia, this muscle ring does not relax as well. The reason for this problem is damage to the nerves of the esophagus.

Cancer of the esophagus or upper stomach and a parasite infection that causes Chagas disease may have symptoms like those of achalasia.

Achalasia is a rare disorder. It may occur at any age, but is most common in middle-aged or older adults. This problem may be inherited in some people.

Diagnosis:
Due to the similarity of symptoms, achalasia can be mistaken for more common disorders such as gastroesophageal reflux disease (GERD), hiatus hernia, and even psychosomatic disorders. Specific tests for achalasia are barium swallow and esophageal manometry. In addition, endoscopy of the esophagus, stomach and duodenum (esophagogastroduodenoscopy or EGD), with or without endoscopic ultrasound, is typically performed to rule out the possibility of cancer. The internal tissue of the esophagus generally appears normal in endoscopy, although a “pop” may be observed as the scope is passed through the non-relaxing lower esophageal sphincter with some difficulty, and food debris may be found above the LES.

Barium swallow:
..CLICK & SEE
The patient swallows a barium solution, with continuous fluoroscopy (X-ray recording) to observe the flow of the fluid through the esophagus. Normal peristaltic movement of the esophagus is not seen. There is acute tapering at the lower esophageal sphincter and narrowing at the gastro-esophageal junction, producing a “bird’s beak” or “rat’s tail” appearance. The esophagus above the narrowing is often dilated (enlarged) to varying degrees as the esophagus is gradually stretched over time.[4] An air-fluid margin is often seen over the barium column due to the lack of peristalsis. A five-minute timed barium swallow can provide a useful benchmark to measure the effectiveness of treatment.

Esophageal manometry:
  CLICK & SEE THE PICTURE
Because of its sensitivity, manometry (esophageal motility study) is considered the key test for establishing the diagnosis. A thin tube is inserted through the nose, and the patient is instructed to swallow several times. The probe measures muscle contractions in different parts of the esophagus during the act of swallowing. Manometry reveals failure of the LES to relax with swallowing and lack of functional peristalsis in the smooth muscle esophagus.

Biopsy:
Biopsy, the removal of a tissue sample during endoscopy, is not typically necessary in achalasia, but if performed shows hypertrophied musculature and absence of certain nerve cells of the myenteric plexus, a network of nerve fibers that controls esophageal peristalsis

Treatment:
The approach to treatment is to reduce the pressure at the lower esophageal sphincter. Therapy may involve:

•Injection with botulinum toxin (Botox). This may help relax the sphincter muscles, but any benefit wears off within a matter of weeks or months.
•Medications, such as long-acting nitrates or calcium channel blockers, which can be used to relax the lower esophagus sphincter
•Surgery (called an esophagomyotomy), which may be needed to decrease the pressure in the lower sphincter. Click to see the pictures:
•Widening (dilation) of the esophagus at the location of the narrowing (done during esophagogastroduodenoscopy)
Your doctor can help you decide which treatment is best for your situation.

Alternative medicine:
Temporary improvement of achalasia symptoms in some cases has been reported with acupuncture


Possible Complications:

•Backflow (regurgitation) of acid or food from the stomach into the esophagus (reflux)
•Breathing food contents into the lungs, which can cause pneumonia
•Tearing (perforation) of the esophagus.

Prognosis: The outcomes of surgery and nonsurgical treatments are similar. Sometimes more than one treatment is necessary.

Lifestyle changes:
Both before and after treatment, achalasia patients may need to eat slowly, chew very well, drink plenty of water with meals, and avoid eating near bedtime. Raising the head of the bed or sleeping with a wedge pillow promotes emptying of the esophagus by gravity. After surgery or pneumatic dilatation, proton pump inhibitors can help prevent reflux damage by inhibiting gastric acid secretion; and foods that can aggravate reflux, including ketchup, citrus, chocolate, alcohol, and caffeine, may need to be avoided.

Prevention:
Many of the causes of achalasia are not preventable. However, treatment of the disorder may help to prevent complications.

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.bbc.co.uk/health/physical_health/conditions/achalasia.shtml
http://en.wikipedia.org/wiki/Achalasia
http://www.nlm.nih.gov/medlineplus/ency/article/000267.htm

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Healthy Tips

Regular Moderate Exercise can cut the Risk of Acid Reflux

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For people with chronic heartburn, too much running and jumping can induce acid reflux. However, the right type of exercise may actually improve the condition.

CLICK & SEE

Short bouts of fairly moderate exercise at least a couple of times a week can cut the risk of gastroesophageal reflux disease, or GERD, in part because it reduces body mass index.

The New York Times reports:

“The specific exercise is crucial. Scientists found that aerobic exercises with the highest ‘agitation of the body,’ like vigorous running, consistently induced acid reflux, even in people who did not have chronic heartburn …

Another factor is body position. Bench presses, leg curls or any other exercise that involves lying flat sharply raise the risk of acid reflux.”

What Types of Activities Make Heartburn Worse?
As you might suspect, vigorous jumping, bouncing, running and other activities that cause agitation of your body can make heartburn worse, simply because it makes it easier for your stomach acid to move into your esophagus. For this reason, vigorous aerobics and other agitating exercise routines may exacerbate your symptoms, especially if you eat within two hours of your workout.

That said, heartburn also tends to flare up during other routine activities as well, such as:

•After eating a heavy meal
•Bending over
•Lifting
•Lying down, especially when laying on your back
If you know you have GERD, or even if you suffer from heartburn only occasionally, it makes sense to limit these activities, especially shortly after eating, or at least tailor them so they’re less likely to cause a problem.

For instance, by eating smaller portions at your meals it can help you to avoid overeating, which is a major trigger for heartburn. Likewise, if you wait two or three hours after dinner before lying down in bed, it will also give you some relief.

When you do lie down, elevating the head of your bed may make you more comfortable, as can squatting down when you need to pick something up (instead of bending over).

And just as you can modify these common activities so they don’t make your heartburn worse, you can modify your exercise program to follow suit as well.


But at the same time Exercise is Essential, Even if You Have Heartburn

One of my top recommendations for treating heartburn and GERD is to implement an exercise program.

Physical activity is an important way to improve your body’s immune system, which is imperative to fight off all kinds of infections. What does this have to do with GERD?

Source: New York Times July 26, 2010

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Categories
Ailmemts & Remedies

Esophagitis

Alternative Names: Inflammation – esophagus

Definition:
Esophagitis is a general term for any inflammation, irritation, or swelling of the esophagus, the tube that leads from the back of the mouth to the stomach.

YOU MAY CLICK TO SEE THE PICTURE.……..Eosinophilic esophagitis

Herpes esophagitis

Endoscopic image of peptic stricture showing n...
Endoscopic image of peptic stricture showing narrowing of the esophagus near the junction with the stomach due to chronic gastroesophageal reflux in the setting of scleroderma. (Photo credit: Wikipedia)

Esophagus is  the tube that carries food from the throat to the stomach. If left untreated, this condition can become very uncomfortable, causing problems with swallowing, ulcers and scarring of the esophagus. In rare instances, a condition known as “Barrett’s esophagus” may develop, which is a risk factor for cancer of the esophagus.

Causes:
Esophagitis is frequently caused by the backflow of acid-containing fluid from the stomach to the esophagus (gastroesophageal reflux). You have a higher risk for esophagitis if you have had excessive vomiting, surgery or radiation to the chest (such as in lung cancer), or if you take medications such as aspirin, ibuprofen, potassium, alendronate, and doxycycline.

Persons with weakened immune systems due to HIV and certain medications (such as corticosteroids) may develop infections that lead to esophagitis. Esophageal infection may be due to viruses such as herpes or cytomegalovirus, and fungi or yeast (especially Candida infections).

The infection or irritation may cause the tissues to become inflamed and occasionally form ulcers. You may have difficulty when swallowing and a burning sensation in the esophagus.

Esophagitis is caused by an infection or irritation in the esophagus. An infection can be caused by bacteria, viruses, fungi or diseases that weaken the immune system. Infections that cause esophagitis include:

*  Candida. This is a yeast infection of the esophagus caused by the same fungus that causes vaginal yeast infections. The infection develops in the esophagus when the body’s immune system is weak (such as in people with diabetes or HIV). It is usually very treatable with antifungal drugs.

* Herpes. Like Candida, this viral infection can develop in the esophagus when the body’s immune system is weak. It is treatable with antiviral drugs.

Irritation causing esophagitis may be caused by any of the following:

* GERD
* Vomiting
* Surgery
* Medications such as aspirin and anti-inflammatories
* Taking a large pill with too little water or just before bedtime
* Swallowing a toxic substance
* Hernias
* Radiation injury (after receiving radiation for cancer treatment)

You may click to see the related topics below:
Gastroesophageal reflux disease
Esophagitis Candida
Esophagitis CMV
Esophagitis herpes
Symptoms:
Symptoms of esophagitis include:

* Difficult and/or painful swallowing
* Heartburn (acid reflux)
* Mouth sores
* A feeling of something of being stuck in the throat
* Nausea
* Vomiting
*Oral lesions (herps)
If you have any of these symptoms, you should contact your health care provider as soon as possible.

Diagnosis:
Once your doctor has performed a thorough physical examination and reviewed your medical history, there are several tests that can be used to diagnose esophagitis. These include:

* Upper endoscopy . A test in which a long, flexible lighted tube, called an endoscope, is used to look at the esophagus.

* Biopsy. During this test, a small sample of the esophageal tissue is removed and then sent to a laboratory to be examined under a microscope.

* Upper GI series (or barium swallow). During this procedure, x-rays are taken of the esophagus after drinking a barium solution. Barium coats the lining of the esophagus and shows up white on an x-ray. This characteristic enables doctors to view certain abnormalities of the esophagus.

Treatment:
Treatment depends on the specific cause. Reflux disease may require medications to reduce acid. Infections will require antibiotics. Possible treatments include:

* Medications that block acid production, like heartburn drugs
* Antibiotics, antifungals or antivirals to treat an infection
* Pain medications that can be gargled or swallowed
* Corticosteroid medication to reduce inflammation
* Intravenous (by vein) nutrition to allow the esophagus to heal, to reduce the likelihood of malnourishment or dehydration
* Endoscopy to remove any lodged pill fragments
* Surgery to remove the damaged part of the esophagus

While being treated for esophagitis, there are certain steps you can take to help limit discomfort.

* Avoid spicy foods such as those with pepper, chili powder, curry and nutmeg.
* Avoid hard foods such as nuts, crackers and raw vegetables.
* Avoid acidic foods and beverages such as tomatoes, oranges, grapefruits and their juices. Instead, try imitation fruit drinks with vitamin C.
* Add more soft foods such as applesauce, cooked cereals, mashed potatoes, custards, puddings and high protein shakes to your diet.
* Take small bites and chew food thoroughly.
* If swallowing becomes increasingly difficult, try tilting your head upward so the food flows to the back of the throat before swallowing.
* Drink liquids through a straw to make swallowing easier.
* Avoid alcohol and tobacco.

Click for Herbal and Alternative Treatment:->.(1).…..(2)…..(3)……(4)

You may click to learn more
Prognosis:-
The disorders that cause esophagitis usually respond to treatment.

Possible Complications :-
If untreated, esophagitis may cause severe discomfort, swallowing difficulty to the extent of causing malnutrition or dehydration, and eventual scarring of the esophagus. This scarring may lead to a stricture of the esophagus, and food or medications may not be able to pass through to the stomach.

A condition called Barrett’s esophagus can develop after years of gastroesophageal reflux. Rarely, Barrett’s esophagus may lead to cancer of the esophagus.

When to Contact a Medical Professional
Call your health care provider if you have symptoms that suggest esophagitis.

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.medicinenet.com/esophagitis/article.htm
http://www.nlm.nih.gov/medlineplus/ency/article/001153.htm

Categories
Ailmemts & Remedies

Belching

Definition:Belching is the act of bringing up air from the stomach with a typical sound.A normal process to relieve distention from the air that accumulates in the stomach. The upper abdominal discomfort associated with excessive swallowed air may extend into the lower chest, producing symptoms suggesting heart or lung disease.

Burps or belches are simply the sound of gas leaving your body. When you scarf down food or even nibble on it, you also swallow air. You’d be amazed at how much air you’re really sucking down your throat. If you’re drinking pop with your meal, you’re also swallowing another gas – carbon dioxide which is full of bubbles. Those bubbles in your body don’t just float around. They need to go somewhere.

Extra gas escapes from the stomach, travels up the esophagus and comes out the mouth. It doesn’t usually leave slowly. Gas can quickly escape which is why we can’t always cover our mouth in time. Burps have little to do with farts. Farts are the sounds and smells of gas that get out through the anus. Farts may only take 30 to 45 minutes to travel through your body, but burps travel even faster. During the day you probably burp or fart at least 10 to 15 times. Stinky!

CLICK & SEE

Alternative Names :Burping; Eructation; Gas – belching

Causes:

The ability to belch is almost universal. Belching, also known as burping, is the act of expelling gas from the stomach out through the mouth.

The usual cause of belching is a distended (inflated) stomach caused by swallowed air. The distention of the stomach causes abdominal discomfort, and the belching expels the air and relieves the discomfort.

The common reasons for swallowing large amounts of air (aerophagia) are gulping food or drink too rapidly, anxiety, and carbonated beverages. People are often unaware that they are swallowing air.

“Burping” infants during bottle or breast feeding is important in order to expel air in the stomach that has been swallowed with the formula or milk.

Excessive air in the stomach is not the only cause of belching. For some people, belching becomes a habit and does not reflect the amount of air in their stomachs. For others, belching is a response to any type of abdominal discomfort and not just to discomfort due to increased gas.

Everyone knows that when they have mild abdominal discomfort, belching often relieves the problem. This is because excessive air in the stomach is often the cause of mild abdominal discomfort. As a result, people belch whenever mild abdominal discomfort is felt-whatever the cause.

Belching is not the simple act that many people think it is. Belching requires the coordination of several activities. The larynx must be closed-off so that any liquid or food that might return with the air from the stomach won’t get into the lungs.

This is accomplished by voluntarily raising the larynx as is done when swallowing. Raising the larynx also relaxes the upper esophageal sphincter so that air can pass more easily from the esophagus into the throat. The lower esophageal sphincter must open so that air can pass from the stomach into the esophagus.

While all this is occurring, the diaphragm descends just as it does when a breath is taken. This increases abdominal pressure and decreases pressure in the chest. The changes in pressure promote the flow of air from the stomach in the abdomen to the esophagus in the chest.

One unusual type of belching has been described in aerophagic individuals who swallow air. It has been demonstrated that during some of their belches room air enters the esophagus and is immediately expelled, giving rise to a belch. This in and out flow of air also is likely to be the explanation for the ability of many people to belch at will, even when there is little or no air in the stomach.

If the problem causing the discomfort is not excessive air in the stomach, then belching does not provide relief. When belching does not ease the discomfort, the belching should be taken as a sign that something may be wrong within the abdomen and the cause of the discomfort should be sought.

Belching by itself, however, does not help the physician determine what may be wrong because belching can occur in virtually any abdominal disease or condition that causes discomfort.

In discussing bloating, it is important to distinguish between bloating and distention.

Bloating is the subjective sensation (feeling) that the abdomen is larger than normal. Thus, bloating is a symptom akin to the symptom of discomfort.

In contrast, distention is the objective determination (physical finding) that the abdomen is actually larger than normal. Distention can be determined by such observations as the inability to fit into clothes or looking down at the stomach and noting that it is clearly larger than normal.

In some instances, bloating may represent a mild form of distention since the abdomen does not become physically (visibly or measurably) enlarged until its volume increases by one quart.

Nevertheless, bloating should never be assumed to be the same as distention.

There are three ways in which abdominal distention can arise. The causes are an increase in air, fluid, or tissue within the abdomen.

The diseases or conditions that cause an increase of any of these three factors are very different from one anther. Therefore, it is important to determine which of them is distending the abdomen.

There are two types of distention; continuous and intermittent.

*Continuous distention may be caused by the enlargement of an intra-abdominal (within the abdomen) organ, an intra-abdominal tumor, a collection of fluid around the intra-abdominal organs (ascites), or just plain obesity.
*Intermittent distention is usually due to the occasional accumulation of gas and/or fluid within the stomach, small intestine, or colon.

Causes flatulence:

Flatulence, also known as farting, is the act of passing intestinal gas from the anus.

Gas in the gastrointestinal tract has only two sources. It is either swallowed air or it is produced by bacteria that normally inhabit the intestines, primarily the colon.

Swallowed air is rarely the cause of excessive flatulence. The usual source is the production of excessive gas by intestinal bacteria. The bacteria produce the gas (hydrogen and/or methane) when they digest foods, primarily sugars and polysaccharides (e.g., starch, cellulose), that have not been digested during passage through the small intestine.

Sugars that are commonly poorly digested (maldigested) and malabsorbed are lactose, sorbitol, and fructose.

Lactose is the sugar in milk. The absence of the enzyme lactase in the lining of the intestines, which is a genetic trait, causes the maldigestion. Lactase is important because it breaks apart the lactose so that it can be absorbed.

Sorbitol is a commonly used sweetener in low calorie foods. Fructose is a commonly used sweetener in all types of candies and drinks.

Starches are another common source of intestinal gas. Starches are polysaccharides that are produced by plants and are composed of long chains of sugars.

Common sources of different types of starch include wheat, oats, potatoes, corn, and rice.

Rice is the most easily digested starch and little undigested rice starch reaches the colon and the colonic bacteria. Accordingly, the consumption of rice produces little gas.

In contrast, the starches in wheat, oats, potatoes, and, to a lesser extent, corn, all reach the colon and the bacteria in substantial amounts. These starches, therefore, result in the production of appreciable amounts of gas.

The starch in whole grains produces more gas than the starch in refined (purified) grains. Thus, more gas is formed after eating foods made with whole wheat flour than with refined wheat flour.

This difference in gas production probably occurs because the fiber present in the whole grain flour slows the digestion of starch as it travels through the small intestine. Much of this fiber is removed during the processing of whole grains into refined flour.

Finally, certain fruits and vegetables, for example, cabbage, also contain poorly digested starches that reach the colon and result in the formation of gas.

Most vegetables and fruits contain cellulose, another type of polysaccharide that is not digested at all as it passes through the small intestine.

However, unlike sugars and other starches, cellulose is used only very slowly by colonic bacteria. Therefore, the production of gas after the consumption of fruits and vegetables usually is not great unless the fruits and vegetables also contain sugars or polysaccharides other than cellulose.

Small amounts of air are continuously being swallowed and bacteria are constantly producing gas.

Contractions of the intestinal muscles normally propel the gas through the intestines and cause the gas to be expelled. Flatulence (passing intestinal gas) prevents gas from accumulating in the intestines.

However, there are two other ways in which gas can escape the intestine.

First, it can be absorbed across the lining of the intestine into the blood. The gas then travels in the blood and ultimately is excreted in the breath.

Second, gas can be removed and used by certain types of bacteria within the intestine. In fact, most of the gas that is formed by bacteria in the intestines is removed by other bacteria in the intestines.

Causes of intermittent abdominal bloating/distention :
Excessive production of gas:

Excessive production of gas by bacteria is a common cause of intermittent abdominal bloating/distention. Bacteria can produce too much gas in three ways.

* First, the amount of gas that bacteria produce varies from individual to individual. In other words, some individuals may have bacteria that produce more gas, either because there are more of the bacteria or because their particular bacteria are better at producing gas.
*Second, there may be poor digestion and absorption of foods in the small intestine, allowing more undigested food to reach the bacteria in the colon. The more undigested food the bacteria have, the more gas they produce. Examples of diseases of that involve poor digestion and absorption include lactose intolerance, pancreatic insufficiency, and celiac disease.
* Third, bacterial overgrowth can occur in the small intestine. Under normal conditions, the bacteria that produce gas are limited to the colon. In some medical conditions, these bacteria spread into the small intestine. When this bacterial spread occurs, food reaches the bacteria before it can be fully digested and absorbed by the small intestine. Therefore, the bacteria in the small intestine have a lot of undigested food from which to form gas. This condition in which the gas-producing bacteria move into the small intestine is called bacterial overgrowth of the small intestine (bowel).

Excessive production of gas by bacteria is usually accompanied by more flatulence. Increased flatulence may not always occur, however, since gas potentially can be eliminated in other ways-absorption into the body, utilization by other bacteria, or possibly, by elimination at night without the knowledge of the gas-passer.

Physical obstruction:

An obstruction (blockage) can occur virtually anywhere from the stomach to the rectum. When the blockage is temporary or partial, it can cause intermittent abdominal bloating/distention.

For example, scarring of the pylorus (pyloric stenosis) can obstruct the opening from the stomach into the intestines, thereby blocking the complete emptying of the stomach.

After meals, the stomach is normally filled with food and swallowed air. Then, during the next hour or two, the stomach secretes acid and fluid, which mix with the food and assist in digestion.

As a result, the stomach distends further. When the obstruction is incomplete, the food, air, and fluid eventually pass into the intestines and the bloating/distention resolves.

An obstruction in the small bowel, which is most commonly due to adhesions from a previous surgery, is another cause of intermittent abdominal distention.

To make matters worse, the distention that is caused by the physical obstruction stimulates both the stomach and intestines to secrete fluid, which adds to the distention.

Finally, severe constipation or fecal impaction (hardened stool in the rectum) can also obstruct the flow of the intestinal contents and result in distention.

In this case, however, the bloating/distention is usually constant and progressive and is relieved by bowel movements or removal of the impacted stool.

Functional obstruction:

A functional obstruction is not caused by an actual physical blockage, but rather by the poor functioning of the muscles of the stomach or intestines that propel the intestinal contents.

When these muscles are not working normally, the intestinal contents will accumulate and distend the abdomen.

Examples of functional obstruction include:

*gastroparesis (paralysis of the stomach) of diabetes;
*chronic intestinal pseudo-obstruction, an unusual condition in which the muscles of the small intestine do not work normally; and
*Hirschprung’s disease, in which a small stretch of colonic muscle does not contract normally due to missing nerves.

There is accumulating scientific evidence that some patients with abdominal bloating and distention due to gas may have a functional abnormality of the intestinal muscles that prevents gas from being normally transported through the intestine and expelled.

Instead, their gas accumulates in the intestine. Among patients with irritable bowel syndrome(IBS) with bloating as an important symptom, the gas accumulates in the small intestine and not the colon. The gas accumulates during the day and is greatest in the evening.

Fats in food have an effect on the intestine that mimics a functional obstruction. Dietary fat reaching the small intestine causes transport of digesting food, gas, and liquid within the intestines to slow. This can promote the accumulation of food, gas, and liquid and lead to bloating and/or distention.

Intestinal hypersensitivity:

Some people appear to be very sensitive (hypersensitive) to distention of their intestines, and they may feel bloated even with normal amounts of digesting food, gas, and fluid in the intestine after a meal. The bloating may be aggravated or even progress to distention if the meal contains substantial amounts of fat.

How are belching, bloating/distention, and flatulence evaluated?

A patient’s medical history is important because it directs the evaluation. If the bloating/distention is continuous rather than intermittent, then enlargement of abdominal organs, abdominal fluid, tumors, or obesity are probable causes.

If the bloating/distention is associated with increased flatulence, then bacteria and excessive gas production are likely factors. If a diet history reveals the consumption of large amounts of milk or dairy products (lactose), sorbitol or fructose, then the maldigestion and malabsorption of these sugars may be the cause of the distention.

When individuals complain of flatulence, it may be useful for them to count the number of times they pass gas for several days. This count can confirm the presence of excessive flatulence since the number of times gas is passed correlates well with the total amount (volume) of passed gas.

As you might imagine, it is not easy to measure the amount of passed gas. It is normal to pass gas up to 20 times a day. (The average volume of gas passed daily is estimated to be about ¾ of a quart.)

If an individual complains of excessive gas but passes gas fewer than 20 times per day, the problem is likely to be something other than too much gas.

For example, the problem may be the foul odor of the gas (usually due to sulfur-containing foods), the lack of ability to control (hold back) the passing of gas, or the soiling of underwear with small amounts of stool when passing gas.

All of these problems, like excessive gas, are socially embarrassing and may prompt individuals to consult a physician. These problems, however, are not due to excessive gas production, and their treatment is different.

Simple abdominal X-rays: Simple X-rays of the abdomen, particularly if they are taken during an episode of bloating or distention, can often confirm air as the cause of the distention since large amounts of air can be seen easily within the stomach and intestine.

Moreover, the cause of the problem may be suggested by noting where the gas has accumulated. For example, if the air is in the stomach, emptying of the stomach is likely to be the problem.

Small intestinal X-rays: X-rays of the small intestine, in which barium is used to fill and outline the small intestine, are particularly useful for determining if there is an obstruction of the small intestine.

Gastric emptying studies: These studies measure the ability of the stomach to empty its contents.

For gastric emptying studies, a test meal that is labeled with a radioactive substance is eaten and a Geiger counter-like device is placed over the abdomen to measure how rapidly the test meal empties from the stomach. A delay in emptying of the radioactivity from the stomach can be caused by any condition that reduces emptying of the stomach (e.g., pyloric stenosis, gastroparesis).

Ultrasound, CT scan, and MRI: Imaging studies, including ultrasound examination, computerized tomography (CT), and magnetic resonance imaging (MRI), are particularly useful in defining the cause of distention that is due to enlargement of the abdominal organs, abdominal fluid, and tumor.

Maldigestion and malabsorption tests: Two types of tests are used to diagnose maldigestion and malabsorption; general tests and specific tests. The best general test is a 72 hour collection of stool that measures fat in the stool. If maldigestion and/or malabsorption exist because of pancreatic insufficiency or diseases of the lining of the small intestine (e.g., celiac disease), the amount of fat in the stool will increase.

Specific tests can be done for maldigestion of individual sugars that are commonly maldigested, including lactose (the sugar in milk) and sorbitol (a sweetener in low calorie foods).

The specific tests require ingestion of the sugars followed by hydrogen/methane breath testing.

The sugar fructose, a commonly used sweetener, like lactose and sorbitol, also may cause abdominal bloating/distention and flatulence.

However, the problem that can occur with fructose is different from that with lactose or sorbitol. Thus, as already discussed, lactose and sorbitol may be poorly digested by the pancreas and small intestine.

On the other hand, fructose may be digested normally but may pass so rapidly through the small intestine that there is not enough time for digestion and absorption to take place.

Hydrogen/methane breath tests: The most convenient way to test for bacterial overgrowth of the small intestine is hydrogen/methane breath testing. Normally, the gas produced by the bacteria of the colon is composed of hydrogen and/or methane.

For hydrogen/methane breath testing, a non-digestible sugar, lactulose, is consumed. At regular intervals following ingestion, samples of breath are taken for analysis.

When the lactulose reaches the colon, the bacteria form hydrogen and/or methane. Some of the hydrogen or methane is absorbed into the blood and eliminated in the breath where it can be measured in the samples of breath.

In normal individuals, there is one peak of hydrogen or methane when the lactulose enters the colon.

In individuals who have bacterial overgrowth, there are two peaks of hydrogen or methane. The first occurs when the lactulose passes and is exposed to the bacteria in the small intestine. The second occurs when the lactulose enters the colon and is exposed to the colonic bacteria.

Hydrogen breath testing for overgrowth also may be done utilizing glucose as the test sugar.

Treatment:
The treatment of excessive intestinal gas depends on the cause. If there is maldigestion of specific sugars-lactose, sorbitol, or fructose–the offending sugars can be eliminated from the diet. In the case of lactose in milk, an alternative treatment is available. Enzymes that are similar to intestinal lactase can be added to the milk in order to break down the lactose prior to its ingestion so that it can be absorbed normally

Some people find that yogurt, in which the lactose has been broken down partially by bacteria, produces less gas than milk.

There also are certain types of vegetables and fruits that contain types of starches that are poorly digested by people but well digested by bacteria.

These include beans, lentils, cabbage, brussel sprouts, onions, carrots, bananas, apricots, and prunes.

Reducing the intake of these vegetables and fruits, as well as foods made from whole grains, should reduce gas and flatulence. However, the list of gas-producing foods is rather long, and it may be difficult to eliminate them all without severely restricting the diet.

When maldigestion is due to pancreatic insufficiency, then supplemental pancreatic enzymes can be ingested with meals to replace the missing enzymes.

If maldigestion and/or malabsorption is caused by disease of the intestinal lining, the specific disease must be identified, most commonly through a small bowel biopsy. Then, treatment can be targeted for that condition.

For example, if celiac disease is found on the biopsy, a gluten-free diet can be started.

An interesting form of treatment for excessive gas is alpha-D-galactosidase, an enzyme that is produced by a mold. This enzyme, commercially available as Beano, is consumed as either a liquid or tablet with meals.

This enzyme is able to break down some of the difficult-to-digest polysaccharides in vegetables so that they may be absorbed. This prevents them from reaching the colonic bacteria and causing unnecessary production of gas. Beano has been shown to be effective in decreasing the incidence of intestinal gas.

Two other types of treatment have been promoted for the treatment of gas;

*simethicone and
*activated charcoal.

It is unclear if simethicone has an effect on gas in the stomach. However, it has no effect on the formation of gas in the colon.

Moreover, in the stomach, simethicone would be expected only to affect swallowed air, which, as previously mentioned, is an uncommon cause of excessive intestinal gas.

Nevertheless, some individuals are convinced that simethicone helps them. Activated charcoal has been shown to reduce the formation of gas in the colon, though the way in which it does so is unknown.

If there is a physical obstruction to the emptying of the stomach or passage of food, liquid, and gas through the small intestine, then surgical correction of the obstruction is required.

If the obstruction is functional, medications that promote activity of the muscles of the stomach and small intestine are given. Examples of these medicines are erythromycin or metoclopramide (Reglan).

Bacterial overgrowth of the small bowel is usually treated with antibiotics. However, this treatment is frequently only temporarily effective or not effective at all.

When antibiotics provide only a temporary benefit, it may be necessary to treat patients intermittently or even continuously with antibiotics. If antibiotics are not effective, probiotics (e.g., lactobacillus) can be tried although their use in bacterial overgrowth has not been studied. This condition may be difficult to treat.

Click to see Natural Home Remedies.………...(1).…….(2)

.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/
http://www.kidzworld.com/article/756-the-ins-and-outs-of-burping
http://www.elderlynursing.com/bloating_detail.htm

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Fruit And Veg May Slash Gullet Cancer Risk

An increased intake of fruit and vegetables may cut the risk of Barrett’s oesophagus, a precursor to oesophageal cancer, suggests a new study form California.
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Healthy dietary habits, rich in fruit and vegetables, was associated with a 65 per cent reduction in the occurrence of Barrett’s oesophagus, according to the new study involving 913 people and published in the American Journal of Epidemiology.

The study, by researchers from Kaiser Permanente Northern California and the University of California, also heaps more pressure on the Western diet pattern, high in fast food and meat, with the data indicating an adverse effect on the risk of Barrett’s oesophagus

Barrett’s oesophagus is cause by acid reflux, and although it can occur early in life, most sufferers are in their 40s and 50s. Although it has been reported to be a precursor to oesophageal cancer, 90 per cent of patients are said to never develop into cancer, and although some speculation as to dietary and drug history, the reason why this is so is not really known.

The new study, which recruited 296 people with Barrett’s oesophagus, 308 people with gastroesophageal reflux disease but no Barrett’s oesophagus, and 309 healthy controls, used a 110-item food frequency questionnaire to evaluate dietary patterns.

Lead author Ai Kubo and co-workers report that two major dietary patterns were observed amongst the participants, with subjects classified as eating either the Western or “health-conscious” diet. The latter was characterised by being high in fruits, vegetables, and non-fried fish.

The researchers report that strong adherence to the health-conscious diet was associated with a 65 per cent reduction in the risk of developing Barrett’s oesophagus.

Moreover, while an increased risk was suggested by stronger adherence to the Western diet pattern, no dose-effect relation was reported by Kubo and co-workers.

“Results suggest strong associations between a diet rich in fruits and vegetables and the risk of Barrett’s oesophagus,” concluded Kubo.

The study does have limitations, most notable is the use of the FFQ to establish dietary patterns. Such questionnaires are susceptible to recall errors by the participants, and may no reflect dietary changes. Significant further research is needed. A mechanistic study to elucidate the bioactive constituents of the fruit and vegetables which may be responsible for the benefits is also necessary.

The “five-a-day” message is well known, but applying this does not seem to be filtering down into everyday life. Recent studies have shown that consumers in both Europe and the US are failing to meet recommendations from the WHO to eat 400 grams of fruit and vegetables a day.

A report from the European Union showed that global fruit and vegetable production was over 1,230 million tonnes in 2001-2002, worth over $50 bn (€41 bn). Asia produced 61 per cent, while Europe and North/Central America both producing nine per cent.

Source: American Journal of Epidemiology
Published online ahead of print, doi:10.1093/aje/kwm381
“Dietary Patterns and the Risk of Barrett’s Esophagus”
Authors: A. Kubo, T. R. Levin, G. Block, G.J. Rumore, C.P. Quesenberry Jr, P. Buffler, D.A. Corley