Many people suffer from difficulty swallowing (dysphagia) acutely or chronically. Difficulty with swallowing may be a result of a problem anywhere from the lips to the stomach. It may be identified by weight loss, coughing or choking when eating, delayed cough or regurgitation, or outright obstruction. This is more likely to be an issue after a stroke or in elderly and frail individuals. In the inpatient population, symptoms suggesting some level of dysphagia may be as high as 34%. So what do you do if you feel like your swallow isn’t quite right?
This past week, Britain’s Queen Elizabeth II was hospitalized with a “stomach bug”. Gastroenteritis (also called the “stomach flu”) is the second most common illness in the United States. So, chances are good that your family has been affected by gastroenteritis already this year!
What are the symptoms of gastroenteritis?
Gastroenteritis is inflammation of the stomach and intestines causing symptoms of diarrhea, vomiting, cramping, and fever. If a person is not able to keep up with fluid losses from diarrhea and vomiting, then they can become dehydrated. Gastroenteritis occurs year-round and affects people of all ages. Those who are young, old, or have a suppressed immune system are more susceptible to severe gastroenteritis and to dehydration.
What causes gastroenteritis?
The majority of cases are caused by a viral infection (occasionally, a bacterial infection) transmitted through contact with another sick person or contaminated food/drink.
I have gastroenteritis, how can I feel better?
Rest and fluids! Staying hydrated is the most important step to controlling gastroenteritis. Some good options for staying hydrated include sports drinks or oral rehydration solutions (such as Pedialyte in drug and grocery stores).
I typically do not recommend any anti-diarrheal medications as this may even prolong the illness. In addition, antibiotic therapy is not helpful unless a specific bacterial cause is identified.
When should I call my doctor?
If you have questions or concerns you should always call your provider. However, things to watch for if you have gastroenteritis include:
Many people wonder what the treatment for Barrett's Esophagus (BE) is. Treatment for BE without dysplasia consists primarily of controlling esophageal acid exposure, usually with once a day proton pump inhibitor (PPI) medications like omeprazole (Prilosec®). Occasionally, twice a day dosing or even anti-reflux surgery may be necessary to completely control acid reflux. Unfortunately, suppressing acid does not usually cause the Barrett’s tissue to regress or even prevent it from progressing to cancer.
If dysplasia is found on any biopsies, treatment recommendations change:
- Low-grade dysplasia: Close surveillance with endoscopy every 6-12 months or ablation.
- High-grade dysplasia: Endoscopic therapy to destroy Barrett’s tissue or surgery.
- Early cancer: Endoscopic removal of focal cancer followed by tissue destruction or surgery
Experiments performed 20 years ago showed that in most people, once the Barrett’s tissue has been removed or destroyed, normal squamous tissue tends to regrow in the area as long as acid reflux is suppressed.
Endoscopic tissue destruction can be performed many ways:
Many people suffer from chronic diarrhea, not realizing that many times the cause can be found and corrected. Chronic diarrhea is defined as loose stools that last for at least 4 weeks. It usually means more than 3 or 4 loose bowel movements per day. Chronic diarrhea can have a substantial negative impact on quality of life and overall health. Many people with this problem have to stay near a toilet and are afraid to even leave the house because of fear that they will not be able to control their bowel action. It is particularly troubling if there is associated incontinence.
Chronic diarrhea can be caused by intestinal infections, endocrine disorders, inflammatory bowel disease, food sensitivity or allergy and a side effect of medications. These problems can often be diagnosed with a careful history and appropriate diagnostic testing.
There is one particular ..
Heartburn (which was once considered an annoying result of over-eating) has matured into a full-blown medical condition better known as gastro-esophageal reflux or GERD.
GERD, or the sensation of acid or other gastric fluids washing up into the chest or mouth, affects as many as 1 in 5 adults in the US on a monthly basis with up to 6% experiencing symptoms 2 or more times per week. Estimates suggest that about 5% of those who suffer from reflux will develop a potentially pre-malignant condition called Barrett’s esophagus (BE). Named after the British thoracic surgeon who erroneously suggested the condition resulted from a congenitally short esophagus, BE is characterized by “specialized intestinal lining” replacing normal squamous epithelium (ie, wet skin, like the lining of the mouth) in the lower esophagus in response to long-term, repetitive exposure to stomach acid.
While this may seem like a protective adaptation—Barrett’s tissue will not ulcerate and develop scarring the way squamous tissue does—it is inherently unstable and can progress to cancer. The risk for developing adenocarcinoma of the esophagus for people with BE is more than 30 times greater than for people without it.
Luckily, the absolute risk of progression from BE to cancer is relatively low. BE progresses to esophageal cancer at the rate of around 0.2% per year. Further, cancer doesn’t usually develop suddenly. Instead, it progresses through a series of stages termed “dysplasia” meaning bad or unfavorable changes that can be identified on biopsies collected at endoscopy. These changes progress from...
We have come upon the time of year when we reflect back on the events of 2012 and look forward to new beginnings in 2013. About 45% of Americans make New Year’s resolutions every year and frequently these resolutions are health-related.
Why not let 2013 be the year you resolve to be updated on colorectal cancer screening?
Why should I worry about colorectal cancer?
Colorectal cancer is the second leading cause of cancer death in the United States. The average lifetime risk of developing colorectal cancer is about 5%. In the colon, cancer usually arises over time from abnormal polyps, called adenomas. This provides us the rare and life-saving opportunity to intervene and remove polyps to prevent cancer from developing. Pre-cancerous polyps or early cancers do not always cause symptoms, highlighting the need for routine screening.
Simply stated, there are large studies showing that screening for colorectal cancer prevents cancer. Screening saves lives. Screening detects cancer at an early and more treatable stage. How can you argue with that?
Who should be screened for colorectal cancer?
Regardless of your age, you should discuss any GI symptoms you are concerned about with your healthcare team.
If you are without symptoms...
Did you know that the bacteria that live in our intestines account for over two pounds of our body weight? And that there are 10 times the number of bacterial cells in our body than human cells? Some bacteria play a beneficial role in a normal gastrointestinal (GI) tract and are known as probiotics.
Probiotics have a variety of functions in the GI tract including aiding the intestinal immune system and the intestinal nervous system, breaking our food into nutrients, blocking the bad bacteria, and promoting a healthy intestinal lining. With so many important tasks, it is no surprise that probiotics can be used to treat some common GI conditions. Though studies of probiotics are small with considerable variability, there is evidence supporting probiotic use for prevention of diarrhea caused by antibiotic use and treatment of infectious diarrhea, ulcerative colitis, clostridium difficile, and irritable bowel syndrome.
What you should know:
The U.S. FDA considers probiotics as dietary supplements, so their production is not tightly regulated and quality can vary widely. In addition, insurance companies do not cover probiotics, and the cost adds up quickly.
Should I ....