Antibiotics A PILL FOR EVERY ILLNESS Do antibiotics help or hinder M.E patients? Maggie leathely, a former health visitor, considers the evidence. M.E recently grabbed the headlines when a woman who had been seriously ill for five years made an apparently miraculous recovery, (daily express, 25 June) Julie Copley, a former nursery nurse in her early forties, suffered severe Neurol
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Heartburn, gastroesophageal reflux (ger), and gastroesophageal reflux disease (gerd)Heartburn, Gastroesophageal Reflux (GER), and Gastroesophageal Reflux Disease (GERD) National Digestive Diseases Information Clearinghouse
What is GERD?
What are the symptoms of
is a more serious form of gastroesophageal U.S. Department
of Health and
ter (LES) opens spontaneously, for varying NATIONAL
erly and stomach contents rise up into the INSTITUTES
esophagus. GER is also called acid reflux or acid regurgitation, because digestive juices—called acids—rise up with the food. The esophagus is the tube that carries food a dry cough, asthma symptoms, or trouble is a ring of muscle at the bottom of the esophagus that acts like a valve between What causes GERD?
When acid reflux occurs, food or fluid can is still unclear. However, research shows be tasted in the back of the mouth. When that in people with GERD, the LES relaxes refluxed stomach acid touches the lining of while the rest of the esophagus is working. the esophagus it may cause a burning sensa- Anatomical abnormalities such as a hiatal tion in the chest or throat called heartburn hiatal hernia occurs when the upper part of common and does not necessarily mean one diaphragm, the muscle wall that separates the stomach from the chest. Normally, the GERD, and it can eventually lead to more serious health problems. People of all ages rising up into the esophagus. When a hia- tal hernia is present, acid reflux can occur more easily. A hiatal hernia can occur in people of any age and is most often a nor- Other factors that may contribute to GERD What is GERD in children?
feeding. If your child is older, your health care provider may recommend that your child eat small, frequent meals and avoid important. Most infants with GER are happy and healthy even if they frequently spit up or vomit, and babies usually out grow GER by their first birthday. Reflux that continues past 1 year of age may be GERD. Studies show GERD is common • acidic foods like oranges, tomatoes, heartburn, coughing, laryngitis, or respiratory problems like wheezing, may also help. Your health care provider young children may demonstrate irritabil ity or arching of the back, often during or immediately after feedings. Infants with do not work, your health care provider may prescribe medicine for your child. Talk with your child’s health care provider In rare cases, a child may need surgery. if reflux-related symptoms occur regularly Gastroesophageal Reflux in Infants and Gastroesophageal Reflux in Children and such as burping the infant several times Adolescents fact sheets from the National an upright position for 30 minutes after 2 Heartburn, Gastroesophageal Reflux (GER), and Gastroesophageal Reflux Disease (GERD) How is GERD treated?
magnesium, calcium, and aluminum—with hydroxide or bicarbonate ions to neutralize See your health care provider if you have the acid in your stomach. Antacids, how ever, can have side effects. Magnesium salt using antacids or other over-the-counter reflux medications for more than 2 weeks. Your health care provider may refer you to a gastroenterologist, a doctor who treats single product to balance these effects. diseases of the stomach and intestines. Depending on the severity of your GERD, Calcium carbonate antacids, such as Tums, treatment may involve one or more of the Titralac, and Alka-2, can also be a supple following lifestyle changes, medications, mental source of calcium. They can cause Lifestyle Changes
Foaming agents, such as Gaviscon, work by
covering your stomach contents with foam
H2 blockers, such as cimetidine (Tagamet
HB), famotidine (Pepcid AC), nizatidine (Axid AR), and ranitidine (Zantac 75), decrease acid production. They are avail able in prescription strength and over-the short-term relief and are effective for about half of those who have GERD symptoms. Proton pump inhibitors include omepra
(Prevacid), pantoprazole (Protonix), rabeprazole (Aciphex), and esomeprazole Medications
(Nexium), which are available by prescrip tion. Prilosec is also available in over-the over-the-counter antacids or medications counter strength. Proton pump inhibitors are more effective than H2 blockers and can muscles that empty your stomach. You can relieve symptoms and heal the esophageal Prokinetics help strengthen the LES and
make the stomach empty faster. This group Antacids, such as Alka-Seltzer, Maalox,
Mylanta, Rolaids, and Riopan, are usually pramide also improves muscle action in the digestive tract. Prokinetics have frequent side effects that limit their usefulness— fatigue, sleepiness, depression, anxiety, different combinations of three basic salts— 3 Heartburn, Gastroesophageal Reflux (GER), and Gastroesophageal Reflux Disease (GERD) Because drugs work in different ways, com binations of medications may help control symptoms. People who get heartburn after blockers. The antacids work first to neu tralize the acid in the stomach, and then By the time the antacid stops working, the H2 blocker will have stopped acid produc tion. Your health care provider is the best source of information about how to use medications for GERD. • pH monitoring examination involves
the doctor either inserting a small tube into the esophagus or clipping a tiny What if GERD symptoms
there for 24 to 48 hours. While you go about your normal activities, the lifestyle changes or medications, you may • Barium swallow radiograph uses
A completely accurate diagnostic test for • Upper endoscopy is more accurate
consistently shown that acid exposure to your throat to numb it and then, after lightly sedating you, will slide a thin, a reasonable alternative to a lifetime of and search for abnormalities. If you have had moderate to severe symptoms and this procedure reveals injury to the esophagus, usually no other tests are needed to confirm GERD. 4 Heartburn, Gastroesophageal Reflux (GER), and Gastroesophageal Reflux Disease (GERD) Fundoplication is the standard surgical
What are the long-term
complications of GERD?
type of this procedure, called Nissen fundoplication, is performed. During the Nissen Chronic GERD that is untreated can cause serious complications. Inflammation of the esophagus from refluxed stomach acid can ulcers—also called esophagitis. Scars from tissue damage can lead to strictures— formed using a laparoscope, an instrument swallowing difficult. Some people develop that is inserted through tiny incisions in Barrett’s esophagus, in which cells in the instruments that hold a camera to look at shape and color. Over time, the cells can lead to esophageal cancer, which is often by experienced surgeons, laparoscopic fun fatal. Persons with GERD and its compli doplication is safe and effective in people cations should be monitored closely by a of all ages, including infants. The proce dure is reported to have the same results as the standard fundoplication, and people can leave the hospital in 1 to 3 days and Endoscopic techniques used to treat
For information about Barrett’s esophagus, see the Barrett’s Esophagus fact sheet from Stretta system. These techniques require the use of an endoscope to perform the anti-reflux operation. The EndoCinch and NDO Plicator systems involve putting stitches in the LES to create pleats that help strengthen the muscle. The Stretta system uses electrodes to create tiny burns on the LES. When the burns heal, the scar tissue helps toughen the muscle. The long-term effects of these three procedures are unknown. 5 Heartburn, Gastroesophageal Reflux (GER), and Gastroesophageal Reflux Disease (GERD) Points to Remember
• Frequent heartburn, also called acid Hope through Research
research is under way to explore risk factors diseases of the stomach and intestines.
Participants in clinical trials can play a more active role in their own health care, gain access to new research treatments before they are widely available, and help others by contributing to medical research. For information about current studies, visit 6 Heartburn, Gastroesophageal Reflux (GER), and Gastroesophageal Reflux Disease (GERD) For More Information
American College of Gastroenterology
Publications produced by the Clearinghouse are carefully reviewed by both NIDDK scientists and outside experts. This Fennerty, M.D., Oregon Health and Science University, and American Gastroenterological Association
4930 Del Ray Avenue Bethesda, MD 20814 Phone: 301–654–2055 International Foundation for Functional
Phone: 1–888–964–2001 or 414–964–1799 Fax: 414–964–7176 Email: [email protected] or company names appearing in this North American Society for Pediatric Gas-
troenterology, Hepatology and Nutrition
Flourtown, PA 19031 Phone: 215–233–0808 Fax: 215–233–3918 Email: [email protected] Internet: www.naspghan.org Pediatric/Adolescent Gastroesophageal
P.O. Box 7728
Silver Spring, MD 20907
Email: [email protected]
7 Heartburn, Gastroesophageal Reflux (GER), and Gastroesophageal Reflux Disease (GERD) National Digestive Diseases
2 Information WayBethesda, MD 20892–3570Phone: 1–800–891–5389TTY: 1–866–569–1162Fax: 703–738–4929Email: nd[email protected]: www.digestive.niddk.nih.gov The National Digestive Diseases Information Clearinghouse (NDDIC) is a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). The NIDDK is part of the National Institutes of Health of the U.S. Department of Health and Human Services. Established in 1980, the Clearinghouse provides information about digestive diseases to people with digestive disorders and to their families, health care professionals, and the public. The NDDIC answers inquiries, develops and distributes publications, and works closely with professional and patient organizations and Government agencies to coordinate resources about digestive diseases.
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Evaluation DAO-deficiency patients migraine. Carmen Vidal1, Feliu Titus2 y Rafael Guayta-Escolies3 1 Professor of Nutrition and Bromatology at University of Barcelona, Barcelona (Spain); Member of honour in the Spanish Society of Neorology, Madrid (Spain) and Scientific assessor in the Spanish Association of Patients with Headache (AEPAC), Valencia (Spain); Assessor in th