Peptic Ulcer Disease (PUD) - Gastrointestinal Disorders - Gastritis

What is Peptic Ulcer Disease (PUD)?

A peptic ulcer is a hole in the gut lining of the stomach, duodenum, or esophagus. A peptic ulcer of the stomach is called a gastric ulcer; of the duodenum, a duodenal ulcer; and of the esophagus, an esophageal ulcer.

The two most common causes of peptic ulcer disease are Helicobacter pylori infection and the use of nonsteroidal anti-inflammatory drugs (NSAIDs). As the prevalence of H. pylori infection decreases and NSAID use increases, the relative contribution of each factor to the incidence of peptic ulcer disease (PUD) will change.

What is H. pylori?

Helicobacter pylori (H. pylori) is a type of bacteria. Researchers believe that H. pylori is responsible for the majority of peptic ulcers.

H. pylori infection is common in the United States. About 20 percent of people under 40 years old and half of those over 60 years have it. Most infected people, however, do not develop ulcers. Why H. pylori does not cause ulcers in every infected person is not known. Most likely, infection depends on characteristics of the infected person, the type of H. pylori, and other factors yet to be discovered.

Researchers are not certain how people contract H. pylori, but they think it may be through food or water.

Researchers have found H. pylori in the saliva of some infected people, so the bacteria may also spread through mouth-to-mouth contact such as kissing.

How does H. pylori cause a peptic ulcer?

H. pylori weakens the protective mucous coating of the stomach and duodenum, which allows acid to get through to the sensitive lining beneath. Both the acid and the bacteria irritate the lining and cause a sore, or ulcer.
H. pylori is able to survive in stomach acid because it secretes enzymes that neutralize the acid. This mechanism allows H. pylori to make its way to the "safe" area—the protective mucous lining. Once there, the bacterium's spiral shape helps it burrow through the lining.

Peptic Ulcer Causes



Normally, the lining of the stomach and small intestines are protected against the irritating acids produced in your stomach. If this protective lining stops working correctly, and the lining breaks down, it results in inflammation (gastritis) or an ulcer.

No single cause has been found for ulcers. However, it is now clear that an ulcer is the end result of an imbalance between digestive fluids in the stomach and duodenum. Ulcers can be caused by:

• Infection with a type of bacteria called Helicobacter pylori (H. pylori)
• Use of painkillers called nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, naproxen (Aleve, Anaprox, Naprosyn, and others), ibuprofen (Motrin, Advil, Midol, and others), and many others available by prescription. Even aspirin coated with a special substance can still cause ulcers.
• Excess acid production from gastrinomas, tumors of the acid producing cells of the stomach that increases acid output; seen in Zollinger-Ellison syndrome.
• Drinking too much alcohol
• Smoking cigarettes or chewing tobacco
• Being very ill, such as being on a breathing machine
• Radiation treatments
• Stress. Although stress per se isn't a cause of peptic ulcers, it's a contributing factor.
  

A rare condition called Zollinger-Ellison syndrome causes stomach and duodenal ulcers. Persons with this disease have a tumor in the pancreas that releases high levels of a hormone, which causes an increase in stomach acid.

Depending on their location, peptic ulcers have different names:

1. Gastric ulcer. This is a peptic ulcer that occurs in your stomach.
2. Duodenal ulcer. This type of peptic ulcer develops in the first part of the small intestine (duodenum).
3. Esophageal ulcer. An esophageal ulcer is usually located in the lower section of your esophagus. It's often associated with chronic gastroesophageal reflux disease (GERD).
   

Peptic Ulcer Symptoms

Small ulcers may not cause any symptoms. Some ulcers can cause serious bleeding.

Abdominal pain is a common symptom but it doesn't always occur. The pain can differ a lot from person to person.

* Feeling of fullness -- unable to drink as much fluid
* Hunger and an empty feeling in the stomach, often 1 - 3 hours after a meal
* Mild nausea (vomiting may relieve symptom)
* Pain or discomfort in the upper abdomen
* Upper abdominal pain that wakes you up at night

Other possible symptoms include:

* Bloody or dark tarry stools
* Chest pain
* Fatigue
* Vomiting, possibly bloody
* Weight loss
* Heartburn

Peptic Ulcer Exams and Tests / Peptic Ulcer Diagnosis

To diagnose an ulcer, your doctor will order one of the following tests:

1. Esophagogastroduodenoscopy (EGD) is a special test performed by a gastroenterologist in which a thin tube with a camera on the end is inserted through your mouth into the GI tract to see your stomach and small intestine. During an EGD, the doctor may take a biopsy from the wall of your stomach to test for H. pylori.
2. Upper gastrointestinal (upper GI) X-ray. Upper GI is a series of x-rays taken after you drink a thick substance called barium.
3. Hemoglobin blood test to check for anemia
4. Stool antigen test. This test checks for H. pylori in stool samples. It's useful both in helping to diagnose H. pylori infection and in monitoring the success of treatment.
5. Breath test. This procedure uses a radioactive carbon atom to detect H. pylori. The advantage of the breath test is that it can monitor the effectiveness of treatment used to eradicate H. pylori, detecting whether the bacteria have been killed or eradicated.
   

Peptic Ulcer Treatment

Treatment involves a combination of medications to kill the H. pylori bacteria (if present), and reduce acid levels in the stomach. This strategy allows your ulcer to heal and reduces the chance it will come back.

Take all of your medications exactly as prescribed.

If you have a peptic ulcer with an H. pylori infection, the standard treatment uses different combinations of the following medications for 5 - 14 days:

• Two different antibiotics to kill H. pylori, such as clarithromycin (Biaxin), amoxicillin, tetracycline, or metronidazole (Flagyl)
• Proton pump inhibitors such as omeprazole (Prilosec), lansoprazole (Prevacid), or esomeprazole (Nexium)
• Bismuth (the main ingredient in Pepto-Bismol) may be added to help kill the bacteria
  

If you have an ulcer without an H. pylori infection, or one that is caused by taking aspirin or NSAIDs, your doctor will likely prescribe a proton pump inhibitor for 8 weeks.

You may also be prescribed this type of medicine if you must continue taking aspirin or NSAIDs for other health conditions.

Other medications that may be used for ulcer symptoms or disease are:

• Misoprostol, a drug that may help prevent ulcers in people who take NSAIDs on a regular basis
• Medications that protect the tissue lining (such as sucralfate)
  

If a peptic ulcer bleeds a lot, an EGD may be needed to stop the bleeding. Surgery may be needed if bleeding cannot be stopped with an EGD, or if the ulcer has caused a perforation.

Peptic Ulcer Outlook (Prognosis)

Peptic ulcers tend to come back if untreated. If you follow your doctor's treatment instructions and take all of your medications as directed, the H. pylori infection will be cured and you'll be much less likely to get another ulcer.

Peptic Ulcer Prevention

Avoid aspirin, ibuprofen, naproxen, and other NSAIDs. Try acetaminophen instead. If you must take such medicines, talk to your doctor first. Your doctor may:

• Test you for H. pylori first
• Have you take proton pump inhibitors (PPIs) or an acid blocker
• Have you take a drug called Misoprostol
  

The following lifestyle changes may help prevent peptic ulcers:

• Do not smoke or chew tobacco.
• Limit alcohol to no more than two drinks per day.
• Avoid nonsteroidal anti-inflammatory drugs (NSAIDs).
• Control acid reflux. If you have an esophageal ulcer — usually associated with acid reflux — you can take several steps to help manage acid reflux.
  

Synonyms and Keywords

aspirin, bleeding ulcer, bowel obstruction, digestive diseases, digestive tract, stomach ulcers, dual therapy, duodenal ulcers, duodenum, fecal-oral transmission, gastric ulcers, gastrointestinal tract, GI tract, Helicobacter pylori, H pylori, H pylori infection, intestinal bleeding, intestinal erosion, intestinal obstruction, intestinal perforation, mucous membranes, mucus, gastric juice, stomach acid, abdominal pain, hydrochloric acid, nonsteroidal anti-inflammatory drugs, NSAIDs, peptic ulcer disease, PUD, small intestine, stomach, triple therapy, pepsin, vagotomy, antrectomy, ulcer, ulcers, peptic ulcer, peptic ulcers

resource: medlineplus

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Inflammatory Bowel Disease (Crohn's Disease and Ulcerative Colitis) - Causes, Symptoms, Diagnosis, and Treatment

What is Inflammatory Bowel Disease?

Inflammatory bowel disease is the name of a group of disorders that cause the intestines to become inflamed (red and swollen). Inflammatory bowel disease (IBD) is a chronic, nonspecific inflammation of the gastrointestinal tract.

If you have inflammatory bowel disease, you may have abdominal cramps and pain, diarrhea, weight loss and bleeding from your intestines. Two kinds of inflammatory bowel disease are Crohn's disease and ulcerative colitis. Crohn's disease usually causes ulcers (open sores) along the length of the small and large intestines. Crohn's disease either spares the rectum, or causes inflammation or infection with drainage around the rectum. Ulcerative colitis usually causes ulcers in the lower part of the large intestine, often starting at the rectum.

Inflammatory Bowel Disease (IBD) Causes

The exact causes are unknown (idiopathic disease). The disease may be caused by a germ or by an immune system problem. Researchers believe that a number of factors may be involved, such as the environment, diet, and possibly genetics.

An unknown factor/agent (or a combination of factors) triggers the body’s immune system to produce an inflammatory reaction in the intestinal tract that continues without control. As a result of the inflammatory reaction, the intestinal wall is damaged leading to bloody diarrhea and abdominal pain.

Genetic, infectious, immunologic, and psychological factors have all been implicated in influencing the development of IBD.

Inflammatory bowel disease may also cause a delay in puberty or growth problems for some kids and teens with the condition, because it can interfere with a person getting nutrients from the foods he or she eats.

Inflammatory Bowel Disease (IBD) Signs and Symptoms



Inflammatory bowel disease may also have constipation. With Crohn's disease, this can happen as a result of a partial obstruction (called stricture) in the intestines. In ulcerative colitis, constipation may be a symptom of inflammation of the rectum (also known as proctitis).

Symptoms may range from mild to severe and generally depend upon the part of the intestinal tract involved. They include the following:

* Abdominal cramps and pain

* Bloody diarrhea

* Severe urgency to have a bowel movement

* Fever

* Loss of appetite

* Weight loss

* Anemia (due to blood loss)

* Rectal bleeding

* Skin and eye irritations

Inflammatory Bowel Disease (IBD) Diagnosis

The diagnosis of IBD is based on a combination of exams: endoscopic, X-rays, and blood and tissue tests. Upon diagnosis, IBD patients may need additional tests to monitor the disease and diagnose possible complications or side effects of medications.

Laboratory Tests

1. Stool examination

• A stool examination is done to eliminate the possibility of bacterial, viral, or parasitic causes of diarrhea.
• A fecal occult blood test is used to examine stool for traces of blood that cannot be seen with the naked eye.
  

2. Complete blood count

• An increase in the white blood cell count suggests the presence of inflammation in the body.
• If you have severe bleeding, the red blood cell count may decrease and hemoglobin level may fall (anemia).
  

Endoscopy

Several types of endoscopy are used to determine if the patient has ulcerative colitis or Crohn's disease and how much bowel is affected. All use a thin, flexible tube with a lighted camera inside the tip, which allows doctors to look at the lining of the gastrointestinal (GI) tract. The image is magnified and appears on a television screen. Each procedure is named for the part of the GI tract examined:



1. Sigmoidoscopy.

In this procedure, your health care provider uses a sigmoidoscope (a narrow, flexible tube with a lens and a light source) to visualize the last one-third of the large intestine, which includes the rectum and the sigmoid colon. The sigmoidoscope is inserted through the anus and the intestinal wall is examined for ulcers, inflammation, and bleeding. During this procedure, your health care provider may take samples (biopsies) of the lining of the intestine.

2. Colonoscopy.

A colonoscopy is an examination similar to a sigmoidoscopy, but with this procedure, the entire colon can be examined.

3. EGD (Esophagogastroduodenoscopy)

Examines the lining of the esophagus, stomach (gastro), and duodenum (first part of the small intestine).

4. ERCP (Endoscopic retrograde cholangiopancreatography)

Examines the bile ducts in the liver and the pancreatic duct.

5. Endoscopic ultrasound.

Uses an ultrasound probe attached to an endoscope to obtain deep images of the gut. In IBD, this is most often used to look at fistulas in the rectal area.

6. Capsule endoscopy.

Patients swallow computerized cameras in vitamin-sized capsules to produce images of sections of the small intestine that are beyond the reach of an EGD. Read more on capsule endoscopy.

7. Upper endoscopy.

If you have upper GI symptoms (nausea, vomiting), an endoscope (narrow, flexible tube with a light source) is used to examine the esophagus, stomach, and the duodenum. The endoscope is inserted through the mouth, and the stomach and duodenum are examined for ulceration. Ulceration occurs in the stomach and duodenum in 5-10% of persons with Crohn disease.

Radiology Tests

Radiologic tests provide information that endoscopy cannot. EGD and colonoscopy can visualize only the stomach, the very upper small intestine (EGD) and the colon and very lower small intestine (colonoscopy). Most of the small intestine cannot be imaged by endoscopy, although Mayo is currently evaluating capsule endoscopy for this purpose. Radiographic tests can image the small intestine.

1. Barium x-ray

• Upper gastrointestinal (GI) tract: This exam uses x-rays to find abnormalities in the upper GI tract (esophagus, stomach, duodenum, sometimes the small intestine). For this test, you are required to swallow barium (a chalky white substance). When barium is swallowed, it coats the inside of the intestinal tract, which can be documented on x-rays. If you have Crohn disease, abnormalities will be seen on barium x-rays.
• Lower gastrointestinal (GI) tract: In this exam, barium is given in an enema that is retained in the colon while x-rays are taken. Abnormalities will be noted in the rectum and colon in persons with Crohn disease and ulcerative colitis.
  

2. Plain X-rays

Plain X-rays without contrast detect blockage in the small or large intestine.

3. X-rays with Contrast

Contrast X-rays are used with endoscopy in monitoring and treating IBD. These X-rays track special liquid contrast, usually barium, as it passes through the intestine, highlighting specific conditions.

4. CT Scan

A CT scanner takes simultaneous X-rays from different angles to reconstruct images of the internal organs.

5. MRI

Magnetic Resonance Imaging (MRI) is used to evaluate perianal fistulas and abscesses in patients with IBD. Other potential uses are being investigated.

6. White Blood Cell Scan

Inflammation of the GI tract is characteristic of ulcerative colitis and Crohn's disease. Leukocyte scintigraphy (tagged white blood cell scan) detects white blood cell accumulation in inflamed tissue.

7. Ultrasound

In general, ultrasound technology is not useful for examining the bowel, although sometimes it is used in combination with other radiological tests.

Inflammatory Bowel Disease (IBD) Treatment

Aminosalicylates:
These types of medications are among the most commonly used to treat IBD and include agents such as sulfasalazine (Azulfidine®) and mesalamine (Asacol®, Pentasa®, Colazal®).

Steroids:
Steroids such as prednisone and methylprednisolone are commonly used to treat patients with both ulcerative colitis and Crohn's disease. These particular types of steroids are called glucocorticoids and work as anti-inflammatory agents. They are different from anabolic steroids, which are known for their use by body builders and athletes.

6-Mercaptopurine and Azathioprine:
6-mercaptopurine (Purinethol®) and azathioprine (Imuran®) work to decrease the activity of the immune system, which then leads to reduced inflammation in the intestines. They are used both in ulcerative colitis and Crohn's disease to bring active disease under control and to maintain disease in remission. They are given orally as pills.

Methotrexate:
Methotrexate is another medication that works to decrease the activity of the immune system. It is used in Crohn's disease both to bring disease into remission and to maintain remission.

Infliximab:
Infliximab (Remicade®) may be used in moderate to severe Crohn's disease. It is a medication that is given intravenously and works on reducing intestinal inflammation by blocking a part of the immune system know as TNF (tumor necrosis factor).


Source:
http://www.emedicinehealth.com/inflammatory_bowel_disease
http://www.mayoclinic.org

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Irritable Bowel Syndrome (IBS)- Causes, Symptoms, Diagnosis, and Treatment

Irritable bowel syndrome (IBS or spastic colon) is a functional bowel disorder characterized by chronic abdominal pain, discomfort, bloating, constipation, diarrhea, gas, and alteration of bowel habits in the absence of any detectable organic cause. In some cases, the symptoms are relieved by bowel movements.

Irritable Bowel Syndrome Causes

The cause of irritable bowel syndrome is currently unknown. Triggers for IBS can range from gas or pressure on your intestines to certain foods, medications or emotions. For example:

* from an interplay of abnormal gastrointestinal (GI) tract movements
* increased awareness of normal bodily functions
* a change in the nervous system communication between the brain and the GI tract. * Abnormal movements of the colon, whether too fast or too slow, are seen in some, but not all, people who have IBS.
* Hormones. Because women are twice as likely to have IBS, researchers believe that hormonal changes play a role in this condition. Many women find that signs and symptoms are worse during or around their menstrual periods.
* Foods. For instance, chocolate, milk and alcohol might cause constipation or diarrhea. Carbonated beverages and some fruits and vegetables may lead to bloating and discomfort in some people with IBS. The role of food allergy or intolerance in irritable bowel syndrome has yet to be clearly understood.

Irritable bowel syndrome has also developed after episodes of gastroenteritis.

It has been suggested that IBS is caused by dietary allergies or food sensitivities, but this has never been proven.

Irritable Bowel Syndrome Symptoms

Irritable bowel syndrome affects each person differently. The hallmark of IBS is abdominal discomfort or pain. The following symptoms are also common:

* Abdominal cramping and pain that are relieved after bowel movements

* Alternating periods of diarrhea and constipation

* Change in the stool frequency or consistency

* Gassiness (flatulence)

* Passing mucus from the rectum

* Bloating

* Abdominal distension

The following are not symptoms or characteristics of IBS:

* Blood in stools or urine

* Vomiting (rare, though may occasionally accompany nausea)

* Pain or diarrhea that interrupts sleep

* Fever

* Weight loss

Irritable Bowel Syndrome Diagnosis and Tests

You must have certain signs and symptoms before a doctor diagnoses irritable bowel syndrome. The most important are abdominal pain and discomfort lasting at least 12 weeks, though the weeks don't have to occur consecutively. You also need to have at least two of the following:

* A change in the frequency or consistency of your stool — for example, you may change from having one normal, formed stool every day to three or more loose stools daily, or you may have only one hard stool every three to four days
* Straining, urgency or a feeling that you can't empty your bowels completely
* Mucus in your stool
* Bloating or abdominal distension

Your doctor may recommend several tests, including stool studies to check for infection or malabsorption problems. Among the tests that you may undergo to rule out other causes for your symptoms are the following:

* Flexible sigmoidoscopy. This test examines the lower part of the colon (sigmoid) with a flexible, lighted tube (sigmoidoscope).

* Computerized tomography (CT) scan. CT scans produce cross-sectional X-ray images of internal organs. CT scans of your abdomen and pelvis may help your doctor rule out other causes of your symptoms.

* Lactose intolerance tests. Lactase is an enzyme you need to digest the sugar found in dairy products. If you don't produce this enzyme, you may have problems similar to those caused by irritable bowel syndrome, including abdominal pain, gas and diarrhea. To find out if this is the cause of your symptoms, your doctor may order a breath test or ask you to exclude milk and milk products from your diet for several weeks.

* Blood tests. Celiac disease (nontropical sprue) is sensitivity to wheat protein that also may cause signs and symptoms like those of irritable bowel syndrome. Blood tests may help rule out that disorder.



* Esophagogastroduodenoscopy (Also called EGD or upper endoscopy.) - a procedure that allows the physician to examine the inside of the esophagus, stomach, and duodenum. A thin, flexible, lighted tube, called an endoscope, is guided into the mouth and throat, then into the esophagus, stomach, and duodenum. The endoscope allows the physician to view the inside of this area of the body, as well as to insert instruments through a scope for the removal of a sample of tissue for biopsy (if necessary).

* Abdominal X-Rays - a diagnostic test which uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.

* Abdominal Ultrasound - a diagnostic imaging technique which uses high-frequency sound waves and a computer to create images of blood vessels, tissues, and organs. Ultrasounds are used to view internal organs as they function, and to assess blood flow through various vessels. Gel is applied to the area of the body being studied, such as the abdomen, and a wand called a transducer is placed on the skin. The transducer sends sound waves into the body that bounce off organs and return to the ultrasound machine, producing an image on the monitor. A picture or video tape of the test is also made so it can be reviewed in the future.



* Colonoscopy - a procedure that allows the physician to view the entire length of the large intestine, and can often help identify abnormal growths, inflamed tissue, ulcers, and bleeding. It involves inserting a colonoscope, a long, flexible, lighted tube, in through the rectum up into the colon. The colonoscope allows the physician to see the lining of the colon, remove tissue for further examination, and possibly treat some problems that are discovered.

Irritable Bowel Syndrome Treatment

Home Remedies

* Experiment with fiber. When you have irritable bowel syndrome, fiber can be a mixed blessing. Although it helps reduce constipation, it can also make gas and cramping worse. The best approach is to gradually increase the amount of fiber in your diet over a period of weeks. Examples of foods that contain fiber are whole grains, fruits, vegetables and beans.

* Avoid problem foods. Common culprits include alcohol, chocolate, caffeinated beverages such as coffee and sodas, medications that contain caffeine, dairy products, and sugar-free sweeteners such as sorbitol or mannitol. If gas is a problem for you, foods that might make symptoms worse include beans, cabbage, cauliflower and broccoli. Fatty foods may also be a problem for some people. Chewing gum or drinking through a straw can lead to swallowing air, causing more gas.

* Eat at regular times. Don't skip meals, and try to eat about the same time each day to help regulate bowel function. If you have diarrhea, you may find that eating small, frequent meals makes you feel better. But if you're constipated, eating larger amounts of high-fiber foods may help move food through your intestines.

* Take care with dairy products. If you're lactose intolerant, try substituting yogurt for milk. Or use an enzyme product to help break down lactose. Consuming small amounts of milk products or combining them with other foods also may help. In some cases, though, you may need to eliminate dairy foods completely. If so, be sure to get enough protein, calcium and B vitamins from other sources.

* Drink plenty of liquids. Try to drink plenty of fluids every day. Water is best. Alcohol and beverages that contain caffeine stimulate your intestines and can make diarrhea worse, and carbonated drinks can produce gas.

* Exercise regularly. Exercise helps relieve depression and stress, stimulates normal contractions of your intestines and can help you feel better about yourself. If you've been inactive, start slowly and gradually increase the amount of time you exercise. If you have other medical problems, check with your doctor before starting an exercise program.

* Use anti-diarrheal medications and laxatives with caution. If you try over-the-counter anti-diarrheal medications, such as Imodium or Kaopectate, use the lowest dose that helps. Imodium may be helpful if taken 20 to 30 minutes before eating, especially if you know that the food planned for your meal is likely to cause diarrhea. In the long run, these medications can cause problems if you don't use them appropriately. The same is true of laxatives. If you have any questions about them, check with your doctor or pharmacist.

Medical Treatment

Most people with irritable bowel syndrome have problems only occasionally. A few may experience long-lasting problems and require prescription medications.

* Fiber supplements. Taking fiber supplements, such as psyllium (Metamucil) or methylcellulose (Citrucel), with fluids may help control constipation. This theoretically expands the inside of the digestive tract, reducing the chance it will spasm as it transmits and digests food. Fiber also promotes regular bowel movements, which helps reduce constipation. Fiber should be added gradually, because it may initially worsen bloating and gassiness.

* Stress may cause IBS "flares." Doctors may offer specific advice on reducing stress. Regularly eating balanced meals and exercising may help reduce stress and problems associated with irritable bowel syndrome.

* Smoking may worsen symptoms of IBS, which gives smokers another good reason to quit.

* Since many patients with irritable bowel syndrome report food intolerances, a food diary may help identify foods that seem to make IBS worse.

Medications

* Antispasmodic medicines, such as dicyclomine (Bemote, Bentyl, Di-Spaz) and hyoscyamine (Levsin, Levbid, NuLev), are sometimes used to treat symptoms of irritable bowel syndrome. Antispasmodic medicines help slow the action of the digestive tract and reduce the chance of spasms. However, they may have some side effects and thus are not for everyone. Other treatment plans are available, depending on symptoms and condition.

* Antidiarrheal medicines, such as loperamide (Imodium), a kaolin/pectin preparation (Kaopectate), and diphenoxylate/atropine (Lomotil), are sometimes used when diarrhea is a major feature of IBS. Do not take these on a long-term basis without first consulting a doctor.

* Antidepressants may be very effective in smaller doses than those typically used to treat depression. Imipramine (Tofranil), amitriptyline (Elavil), nortriptyline (Pamelor), and desipramine (Norpramin) are some commonly used medicines that may alleviate irritable bowel syndrome symptoms. Some other antidepressants are more commonly prescribed when depression and IBS coexist.

* Anticholinergic medications. Some people need medications that affect certain activities of the autonomic nervous system (anticholinergics) to relieve painful bowel spasms. These may be helpful for people who have bouts of diarrhea, but can worsen constipation.

* Antibiotics. It's unclear what role, if any, antibiotics might play in treating IBS. Some people whose symptoms are due to an overgrowth of bacteria in their intestines may benefit from antibiotic treatment. But more research is needed.

Alternative medicine

The following nontraditional therapies may help relieve symptoms of irritable bowel syndrome:

* Acupuncture. Although study results on the effects of acupuncture on symptoms of irritable bowel syndrome have been mixed, some people use acupuncture to help relax muscle spasms and improve bowel function.

* Herbs. Peppermint is a natural antispasmodic that relaxes smooth muscles in the intestines. Peppermint may provide short-term relief of IBS symptoms, but study results have been inconsistent. If you'd like to try peppermint, be sure to use enteric-coated capsules. Peppermint may aggravate heartburn. Before taking any herbs, check with your doctor to be sure they won't interact or interfere with other medications you may be taking.

* Hypnosis. Hypnosis may reduce abdominal pain and bloating. A trained professional teaches you how to enter a relaxed state and then guides you in relaxing your abdominal muscles.

* Probiotics. Probiotics are "good" bacteria that normally live in your intestines and are found in certain foods, such as yogurt, and in dietary supplements. It's been suggested that people with irritable bowel syndrome may not have enough good bacteria, and that adding probiotics to your diet may help ease your symptoms. Some studies have found that probiotics may relieve symptoms of IBS, such as abdominal pain and bloating, but more research is needed.

* Regular exercise, yoga, massage or meditation. These can all be effective ways to relieve stress. You can take classes in yoga and meditation or practice at home using books or videos.

Synonyms and Keywords

IBS, inflammatory bowel disease, IBD, IBS flare, IBS flares, nervous bowel, spastic colon, gastrointestinal disorder, GI disorder, gastrointestinal endoscopy, abdominal cramping, abdominal pain, bowel habits, functional bowel disease, mucous colitis, digestive tract, cramping, diarrhea, bloating, gas, gassiness, flatus, flatulence, constipation, antispasmodic medication, antidiarrheal medication, antidepressants, dicyclomine, Bemote, Bentyl, Di-Spaz, tegaserod, Zelnorm, alosetron, Lotronex, irritable bowel syndrome, anatomy of the digestive tract, anatomy of the digestive system, chronic gastrointestinal disorder, chronic GI disorder, symptoms of IBS, symptoms of irritable bowel syndrome, IBS symptoms, IBS treatment, treatment of IBS

Source:
- emedicinehealth
- Mayo Clinic

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Barrett’s Esophagus - Causes, Symptoms, Diagnosis , and Treatment

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When GERD is left untreated it can create other problems. One possible health consequence of GERD is a condition called Barrett’s Esophagus (BE).

Barrett's esophagus is found in 5-15% of patients who seek medical care for heartburn (gastroesophageal reflux disease, GERD)

Barrett's esophagus Causes

Barrett's esophagus is caused by gastro-oesophageal reflux disease, GORD(USA: GERD), which allows the stomach's contents to damage the cells lining the lower esophagus. Researchers are unable to predict which heartburn sufferers will develop Barrett's esophagus. While there is no relationship between the severity of heartburn and the development of Barrett's esophagus, there is a relationship between chronic heartburn and the development of Barrett's esophagus. Sometimes people with Barrett's esophagus will have no heartburn symptoms at all. In rare cases, damage to the esophagus may be caused by swallowing a corrosive substance such as lye.

The exact cause of Barrett's esophagus isn't known. Most people with Barrett's esophagus have long-standing GERD. It's thought that GERD causes stomach contents to wash back into the esophagus, causing damage to the esophagus. As the esophagus tries to heal itself, the cells can change to the type of cells found in Barrett's esophagus.

Barrett's esophagus Sign and Symptoms

Barrett's esophagus signs and symptoms are usually related to acid reflux and may include:

* frequent and longstanding heartburn
* trouble swallowing (dysphagia)
* vomiting blood
* pain under the breastbone where the esophagus meets the stomach
* unintentional weight loss because eating is painful

Diagnosis of Barrett’s Esophagus

Barrett's esophagus is most often diagnosed in people who have long-term gastroesophageal reflux disease (GERD) — a chronic regurgitation of acid from the stomach into the lower esophagus. Only a small percentage of people with GERD will develop Barrett's esophagus.

Diagnosis of Barrett's esophagus requires an examination called upper endoscopy or EGD (esophagogastroduodenoscopy). A barium x-ray is not accurate for detecting Barrett's esophagus. An EGD is done with the patient under sedation. The physician examines the lining of the esophagus and stomach with a thin, lighted, flexible endoscope.

Your doctor determines whether you have Barrett's esophagus using a procedure called upper endoscopy to:

* Examine your esophagus. Your doctor will pass a lighted tube (endoscope) down your throat. The tube carries a tiny camera that allows your doctor to examine your esophagus. Your doctor looks for signs that the esophageal tissue is changing. A person with Barrett's esophagus has tissue that appears different from normal esophageal tissue.

* Remove tissue samples. Your doctor may pass special tools through the endoscope to remove several small tissue samples. The samples are tested in a laboratory to determine what types of changes are taking place and how advanced the changes are.

Determining the degree of tissue changes

A doctor who specializes in examining body tissue in a laboratory (pathologist) will examine your esophageal tissue samples under a microscope. The pathologist determines the degree of changes (dysplasia) in your cells. Grades of dysplasia include:

* No dysplasia. If no changes are found in the cells, the pathologist determines there is no dysplasia.



* Low-grade dysplasia. Cells with low-grade dysplasia may show small signs of changes.



* High-grade dysplasia. Cells with high-grade dysplasia show many changes. High-grade dysplasia is thought to be the final step before cells change into esophageal cancer.



The type of dysplasia detected in your esophageal tissue determines your treatment options.

Treatments and drugs for Barrett’s Esophagus Patients
By Mayo Clinic staff

Your treatment options for Barrett's esophagus depend on the grade of changes in the cells of your esophagus, your overall health and your own preferences.

Treatment for people with no dysplasia or low-grade dysplasia
If a biopsy reveals that your cells have no dysplasia or that your cells have low-grade dysplasia, your doctor may suggest:

* Periodic endoscopy exams to monitor the cells in your esophagus. How often you undergo endoscopy exams will depend on your situation. Typically, if your biopsies show no dysplasia, you'll have a follow-up endoscopy one year later. If your doctor again detects no dysplasia, you may have endoscopy exams every three years. If low-grade dysplasia is detected, your doctor may recommend GERD treatments and another endoscopy in six months. If you're determined to have high-grade dysplasia, then your doctor may offer other treatment options.

Sometimes when endoscopy is repeated, no evidence of Barrett's esophagus is detected. This may not mean that the condition has gone away. The affected portion of the esophagus could be very small, and it may have been missed during the endoscopy. For this reason, your doctor will still recommend follow-up endoscopy exams.

* Continued treatment for GERD. If you're still struggling with chronic heartburn and acid reflux, your doctor will work to find medications that help you control your signs and symptoms. Surgery to tighten the sphincter that controls the flow of stomach acid may be an option to treat GERD. This procedure is called Nissen fundoplication. Treating acid reflux can reduce your signs and symptoms, but it doesn't treat the underlying Barrett's esophagus.

Treatment for people with high-grade dysplasia.

High-grade dysplasia is thought to be a precursor to esophageal cancer. For this reason, doctors sometimes recommend more-invasive treatments, such as:

* Esophagectomy. Surgery to remove the esophagus. During an esophagectomy, the surgeon removes most of your esophagus and attaches your stomach to the remaining portion. Surgery carries a risk of significant complications, such as bleeding, infection and leaking from the area where the esophagus and stomach are joined. When esophagectomy is performed by an experienced surgeon, there's a reduced risk of complications. Still, because of the potential complications of this major operation, other treatments are usually preferred over surgery. One advantage to surgery is that it reduces the need for periodic endoscopy exams in the future.

* Removing damaged cells with an endoscope. Endoscopic mucosal resection is used to remove areas of damaged cells using an endoscope. Your doctor guides the endoscope down your throat and into your esophagus. Special surgical tools are passed through the tube. The tools allow your doctor to cut away the superficial layers of the esophagus and remove damaged cells. Endoscopic mucosal resection carries a risk of complications, such as bleeding, tearing of the esophagus and narrowing of the esophagus.

* Using heat to remove abnormal esophageal tissue. Radiofrequency ablation involves inserting a balloon filled with electrodes in the esophagus. The balloon emits a short burst of energy that burns the damaged esophageal tissue.

* Destroying damaged cells by making them sensitive to light. Before this procedure, called photodynamic therapy (PDT), you receive a special medication through a vein in your arm. The medication makes certain cells, including the damaged cells in your esophagus, sensitive to light. During PDT, your doctor uses an endoscope to guide a special light down your throat and into your esophagus. The light reacts with medication in the cells and causes the damaged cells to die. PDT makes you sensitive to sunlight and requires diligent avoidance of sunlight after the procedure. Complications of PDT can include narrowing of the esophagus, chest pain, difficulty swallowing and vomiting.

If you undergo treatment other than surgery to remove your esophagus, there's a chance that Barrett's esophagus can recur. For this reason, your doctor may recommend continuing to take acid-reducing medications and having periodic endoscopy exams.

Medication and Drugs for Barrett’s Esophagus

The doctor may also prescribe medications to help. Those medications may include:

* Antacids to neutralize stomach acid.
* H2 blockers that lessen the release of stomach acid.
* Promotility agents -- drugs that speed up the movement of food from the stomach to the intestines.
* Proton pump inhibitors that reduce the production of stomach acid.


Lifestyle and home remedies for Barrett’s Esophagus Patients
By Mayo Clinic staff

Most people diagnosed with Barrett's esophagus experience frequent heartburn and acid reflux. Medications can control these signs and symptoms, but changes to your daily life also may help. Consider trying to:

* Maintain a healthy weight. If your weight is healthy, work to maintain that weight. If you're overweight or obese, ask your doctor about healthy ways to lose weight. Excess pounds put pressure on your abdomen, pushing up your stomach and causing acid to back up into your esophagus.

* Eat smaller, more frequent meals. Three meals a day, with small snacks in between, will help you stop overeating. Continual overeating leads to excess weight, which aggravates heartburn.

* Avoid tightfitting clothes. Clothes that fit tightly around your waist put pressure on your abdomen, aggravating reflux.

* Eliminate heartburn triggers. Everyone has specific triggers. Common triggers such as fatty or fried foods, alcohol, chocolate, peppermint, garlic, onion, caffeine and nicotine may make heartburn worse.

* Avoid stooping or bending. Tying your shoes is OK. Bending over for a long time to weed your garden may not be, especially soon after eating.

* Don't lie down after eating. Wait at least three hours after eating to lie down or go to bed.

* Raise the head of your bed. Place wooden blocks under your bed to elevate your head. Aim for an elevation of six to eight inches. Raising your head by using only pillows isn't a good alternative.

* Don't smoke. Smoking may increase stomach acid. If you smoke, ask your doctor about strategies for stopping.

Source: mayoclinic

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Laryngopharyngeal Reflux ( LPR )- Definition, Symptoms, Diagnosis, and Treatment

Definition of Laryngopharyngeal Reflux (LPR).

There are two sphincter muscles located in the esophagus: The lower esophageal sphincter (LES) and the upper esophageal sphincter (UES). When the lower esophageal sphincter is not functioning properly, there is a back flow of stomach acid into the esophagus. If this happens two or more times a week, it can be a sign of gastroesophageal reflux disease, or GERD.

But what happens when the upper esophageal sphincter doesn't function correctly either?

As with the lower esophageal sphincter, if the upper esophageal sphincter doesn't function properly, acid that has back flowed into the esophagus is allowed into the throat and voice box. When this happens, it's called Laryngopharyngeal Reflux, or LPR.

It usually occurs without heartburn, less than 15% of people with this problem have heartburn. The larynx, trachea, bronchi and lungs are much more susceptible to damage from the stomach juices than the esophagus.

The esophagus is better able to handle the acid than the larynx and pharynx because it has built in protective mechanisms. It also means that it takes even smaller amounts of stomach juices to do the damage.

Digestive juices can get into the upper throat at night as with regular acid reflux or GERD, but more people with LPR have damage occur during the day than at night.

How is LPR different from GERD?

Are the symptoms the same for both diseases? Can people suffer from Laryngopharyngeal Reflux (LPR) without having any symptoms of Acid Reflux (GERD)? Can LPR occur without any heartburn at all? This is totally possible. Some of the people who suffer from LPR do not suffer from heartburn at all! How is this possible? Heartburn occurs when the acids stays in the esophagus and burns the surface. But in LPR, these stomach acids are not staying in the esophagus long enough to cause heartburn. In this case, acid goes past the esophagus and rests in the person’s throat or voice box. As the throat is more sensitive than esophagus, this will result in Laryngopharyngeal Reflux symptoms and not heartburn associated with GERD.

Symptoms of Laryngopharyngeal Reflux are:

* Hoarseness
* Chronic throat-clearing, excessive mucous
* Chronic cough
* Stridor (noisy breathing)
* Difficulty swallowing
* “Lump in the throat “(globus)
* Reactive airway disease (wheezing)
* Chronic bronchitis
* Chronic airway obstruction
* Wheezing
* Apnea
* Aspiration pneumonia
* Nasal obstruction
* Ear pain
* Chronic nasal congestion
* Sore throat
* Gagging

These symptoms are also related to many conditions thought to be aggravated or caused by LPR. These conditons include:

* Otitis media (ear infections)
* Sinusitis
* Chronic nasal congestion
* Vocal cord nodules
* Chronic laryngitis
* Laryngomalacia
* Apnea
* Subglottic stenosis
* Arytenoid fixation
* Laryngospasm
* Recurrent pharyngitis
* Chronic cough
* Exacerbation of asthma or reactive airway disease

Diagnosis of Laryngopharyngeal Reflux

Most often, your doctor can diagnose LPR by examining your throat and vocal cords with a rigid or flexible telescope. The voice box is typically red, irritated, and swollen from acid reflux damage. This swelling and inflammation will eventually resolve with medical treatment, although it may take a few months.

At other times, you may have to undergo a dual-channel pH probe test to diagnose your condition. This involves placing a small tube (catheter) through your nose and down into your swallowing passage (esophagus). The catheter is worn for a 24-hour period and measures the amount of acid that refluxes into your throat. This test is not often necessary, but can provide critical information in certain cases.

Your doctor may do one of the following tests to determine if you have LPR:

* Laryngoscopy
This procedure is used to see changes of the throat and voice box.

* 24-hour pH testing
This procedure is used to see if too much stomach acid is moving into the upper esophagus or throat. Two pH sensors are used. One is located at the bottom of the esophagus and one at the top. This will let the doctor see if acid that enters the bottom of the esophagus moves to the top of the esophagus.

* Upper GI Endoscopy
This procedure is almost always done if a patient complains of difficulty with swallowing. It is done to see if there are any scars or abnormal growths in the esophagus, and to biopsy any abnormality found. This test will also show if there is any inflammation of the esophagus caused by refluxed acid.

Treatment of Laryngopharyngeal Reflux

Treatment for LPR is generally the same as that for GERD. Laryngopharyngeal reflux can be managed effectively with proper treatment.

Lifestyle modifications that may be prescribed include:

* Elevation of the head of the bed four to six inches
* Avoiding alcohol, chocolate and caffeine
* Avoiding overeating
* Eating or drinking nothing two to three hours before bed
* Avoiding greasy, fatty foods
* Losing weight

Medical treatments may include one or a combination of the following:

* Antacids to neutralize excess stomach acid
* Anti-secretory medications that decrease acid production by the stomach
* Surgery to tighten the junction between the stomach and esophagus. The most commonly performed surgery is called the Nissen Fundoplication. It is done by wrapping the top part of the stomach around the junction between the stomach and esophagus and sewing it in place.

Sources:
Charles N. Ford, MD, "Evaluation and Management of Laryngopharyngeal Reflux." JAMA. 2005;294:1534-1540.. The Journal of the American Medical Association. 11 Sep 2007 http://heartburn.about.com/od/gastrictractdisorders/a/whatis_LPR.htm

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Acid Reflux & Oesophagitis

Understanding the Oesophagus and Stomach

When we eat, food passes down the oesophagus (gullet) into the stomach. Cells in the lining of the stomach make acid and other chemicals which help to digest food. Stomach cells also make mucus which protects them from damage from the acid. The cells lining the oesophagus are different and have little protection from acid.

There is a circular band of muscle (a 'sphincter') at the junction between the oesophagus and stomach. This relaxes to allow food down, but then normally tightens up and stops food and acid leaking back up (refluxing) into the oesophagus. In effect, the sphincter acts like a valve.

What are Reflux and Oesophagitis?

* Acid reflux is when some acid leaks up (refluxes) into the oesophagus.
* Oesophagitis means inflammation of the lining of the oesophagus. Most cases of oesophagitis are due to reflux of stomach acid which irritates the inside lining of the oesophagus.

The lining of the oesophagus can cope with a certain amount of acid. However, it is more sensitive to acid in some people. Therefore, some people develop symptoms with only a small amount of reflux. However, some people have a lot of reflux without developing oesophagitis or symptoms.

Gastro-oesophageal reflux disease (GORD)

This is a general term which describes the range of situations - acid reflux, with or without oesophagitis and symptoms.

What are The Symptoms of Acid Reflux and Oesophagitis?

* Heartburn is the main symptom. This is a burning feeling which rises from the upper abdomen or lower chest up towards the neck. (It is confusing as it has nothing to do with the heart!)

* Other common symptoms include: pain in the upper abdomen and chest, feeling sick, an acid taste in the mouth, bloating, belching, and a burning pain when you swallow hot drinks. Like heartburn, these symptoms tend to come and go, and tend to be worse after a meal.

* Some uncommon symptoms may occur. If any of these symptoms occur it can make the diagnosis difficult as these symptoms can mimic other conditions. For example:

• A persistent cough, particularly at night sometimes occurs. This is due to the refluxed acid irritating the trachea (windpipe). Asthma symptoms of cough and wheeze can sometimes be due to acid reflux.
• Other mouth and throat symptoms sometimes occur such as gum problems, bad breath, sore throat, hoarseness, and a feeling of a lump in the throat.
• Severe chest pain develops in some cases (and may be mistaken for a heart attack).
  

What Causes Acid Reflux and Who Does It Affect?

The sphincter at the bottom of the oesophagus normally prevents acid reflux. Problems occur if the sphincter does not work very well. This is common, but in most cases it is not known why it does not work so well. In some cases the pressure in the stomach rises higher than the sphincter can withstand. For example, during pregnancy, after a large meal, or when bending forward. If you have a hiatus hernia (when part of the stomach protrudes into the chest through the diaphragm), you have an increased chance of developing reflux. (See separate leaflet called 'Hiatus Hernia'.)

Most people have heartburn at some time, perhaps after a large meal. However, about 1 in 3 adults have some heartburn every few days, and nearly 1 in 10 adults have heartburn at least once a day. In many cases it is mild and soon passes. However, it is quite common for symptoms to be frequent or severe enough to affect quality of life. Regular heartburn is more common in smokers, pregnant women, heavy drinkers, the overweight, and those aged between 35 and 64.

What Tests Might Be Done?

Tests are not usually necessary if you have typical symptoms. Many people are diagnosed with 'presumed acid reflux' when they have typical symptoms, and the symptoms are eased by treatment. Tests may be advised if symptoms: are severe, or do not improve with treatment, or are not typical of GORD.

* Endoscopy is the common test. This is where a thin, flexible telescope is passed down the oesophagus into the stomach. This allows a doctor or nurse to look inside. With oesophagitis, the lower part of the oesophagus looks red and inflamed. However, if it looks normal it does not rule out acid reflux. Some people are very sensitive to small amounts of acid, and can have symptoms with little or no inflammation to see. Two terms that are often used after an endoscopy are:

• Oesophagitis. This term is used when the oesophagus can be seen to be inflamed.
• Endoscopy-negative reflux disease. This term is used when someone has typical symptoms of reflux but endoscopy is normal.

* A test to check the acidity inside the oesophagus may be done if the diagnosis is not clear.

* Other tests such as heart tracings, chest X-ray, etc, may be done to rule out other conditions if the symptoms are not typical.

What Can I Do to Help with Symptoms?

The following are commonly advised. However, there has been little research to prove how well these 'lifestyle' changes help to ease reflux.

* Smoking. The chemicals from cigarettes relax the sphincter muscle and make acid reflux more likely. Symptoms may ease if you are a smoker and stop smoking.

* Some foods and drinks may make reflux worse in some people. It is thought that some foods may relax the sphincter and allow more acid to reflux. It is difficult to be certain how much foods contribute. Let common sense be your guide. If it seems that a food is causing symptoms, then try avoiding it for a while to see if symptoms improve. Foods and drinks that have been suspected of making symptoms worse in some people include: peppermint, tomatoes, chocolate, spicy foods, hot drinks, coffee, and alcoholic drinks. Also, avoiding large volume meals may help.

* Some drugs may make symptoms worse. They may irritate the oesophagus, or relax the sphincter muscle and make acid reflux more likely. The most common culprits are anti-inflammatory painkillers (such as ibuprofen or aspirin). Others include: diazepam, theophylline, nitrates, and calcium channel blockers such as nifedipine. But this is not an exhaustive list. Tell a doctor if you suspect that a drug is causing the symptoms, or making symptoms worse.

* Weight. If you are overweight it puts extra pressure on the stomach and encourages acid reflux. Losing some weight may ease the symptoms.

* Posture. Lying down or bending forward a lot during the day encourages reflux. Sitting hunched or wearing tight belts may put extra pressure on the stomach which may make any reflux worse.

* Bedtime. If symptoms recur most nights, the following may help:

• Go to bed with an empty, dry stomach. To do this, don't eat in the last three hours before bedtime, and don't drink in the last two hours before bedtime.
• If you are able, try raising the head of the bed by 10-20 cms (for example, with books or bricks under the bed's legs). This helps gravity to keep acid from refluxing into the oesophagus. If you do this do not use additional pillows, because this may increase abdominal pressure.
  

What are the Treatments for Acid Reflux and Oesophagitis?

Antacids

These are alkali liquids or tablets that neutralise the acid. A dose usually gives quick relief. There are many brands which you can buy. You can also get some on prescription. You can use antacids 'as required' for mild or infrequent bouts of heartburn.

Acid-suppressing drugs

If you get symptoms frequently then see a doctor. An acid-suppressing drug will usually be advised. Two groups of acid-suppressing drugs are available - proton pump inhibitors (PPIs) and histamine receptor blockers (H2 blockers). They work in different ways but both reduce (suppress) the amount of acid that the stomach makes. Proton pump inhibitors include: omeprazole, lansoprazole, pantoprazole, rabeprazole, and esomeprazole. H2 blockers include: cimetidine, famotidine, nizatidine, and ranitidine.

In general, a proton pump inhibitor is used first as these drugs tend to work better than H2 blockers. A common initial plan is to take a full dose course of a proton pump inhibitor for a month or so. This often settles symptoms down and allows any inflammation in the oesophagus to clear. After this, all that you may need is to go back to antacids 'as required' or to take a short course of an acid suppressing drug 'as required'.

However, some people need long-term daily acid suppressing treatment. Without medication, their symptoms return quickly. Long-term treatment with an acid-suppressing drug is thought to be safe, and side-effects are uncommon. The aim is to take a full dose course for a month or so to settle symptoms. After this, it is common to 'step-down' the dose to the lowest dose that prevents symptoms. However, the maximum full dose taken each day is needed by some people.

Prokinetic drugs

These are drugs that speed up the passage of food through the stomach. They include domperidone and metoclopramide. They are not commonly used but help in some cases, particularly if you have marked bloating or belching symptoms.

Surgery

An operation can 'tighten' the lower oesophagus to prevent acid leaking up from the stomach. It can be done by 'keyhole' surgery. In general, the success of surgery is no better than acid-suppressing medication. However, surgery may be an option for some people whose quality of life remains significantly affected by their condition and where drug treatment is not working well or not wanted long-term.

Are There Any Complications from Oesophagitis?

* Stricture. If you have severe and long-standing inflammation it can cause scarring and narrowing (a stricture) of the lower oesophagus. This is uncommon.

* Barrett's oesophagus. In this condition the cells that line the lower oesophagus become changed. The changed cells are more prone than usual to become cancerous. (About 1 or 2 people in 100 with Barrett's oesophagus develop cancer of the oesophagus.)

* Cancer. Your risk of developing cancer of the oesophagus is slightly increased compared to the normal risk if you have long-term acid reflux.

It has to be stressed that most people with reflux do not develop any of these complications. Tell your doctor if you have pain or difficulty (food 'sticking') when you swallow which may be the first symptom of a complication.

References

• Dyspepsia - proven gastro-oesophageal reflux disease, Clinical Knowledge Summaries (June 2008)
• The management of dyspepsia in primary care, MeReC Briefing, No 32, 2006.
• Dyspepsia: Managing dyspepsia in adults in primary care, NICE Clinical Guideline (2004)

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