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What is gastroparesis?

Gastroparesis is a condition where symptoms occur and the stomach empties too slowly. No blockage is evident. The delayed emptying is confirmed by a test.

How common is gastroparesis?

While the incidence and prevalence of gastroparesis are not well-defined, it is estimated to affect up to 5 million individuals in the United States.[1]

What are the symptoms of gastroparesis?

Symptoms usually occur during and after eating a meal. Typical symptoms include:

  • Nausea and/or vomiting
  • Retching (dry heaves)
  • Stomach fullness after a normal sized meal
  • Early fullness (satiety) – unable to finish a meal

There may also be bloating, heartburn, and stomach discomfort or pain. Decreased appetite may result in weight loss.

What causes gastroparesis?

Most often in people with gastroparesis, the cause is unknown and is termed “idiopathic.” Symptoms may begin following a virus infection. Other possible causes include diabetes, surgeries, some medications, and other illnesses.

Diabetes
Gastroparesis may occur as a complication of other conditions. Long-standing diabetes is the most common known cause of gastroparesis, although only a small percentage of people with diabetes develop gastroparesis. The cause of symptoms is probably due to damage to nerves that supply the stomach.

The vagus nerve transmits impulses to the stomach and intestines. Injury to the vagus nerve can impair gastric emptying.

Surgeries
Gastroparesis can also result as a complication from some surgical procedures. Most often these include nerve damage following esophageal or upper abdominal surgeries.

Medications
Less frequently, gastroparesis is seen to occur after the use of certain medications. Some medications can impair motility. Examples include:

  • narcotic pain relievers,
  • anticholinergic/antispasmodic agents,
  • calcium channel blockers,
  • some antidepressants, and
  • some medications for diabetes.

Other Illnesses
Sometimes gastroparesis is seen in association with other illnesses. Systemic illnesses, neurologic diseases, or connective disorders, such as multiple sclerosis, Parkinson’s disease, cerebral palsy, systemic lupus, and scleroderma are associated with gastroparesis. The cause and effect is unclear.

In a small number of people, gastroparesis symptoms appear to develop after onset of an apparent viral infection (post-infectious or postviral gastroparesis). The symptoms usually resolve or improve over time.

Much remains to be learned about what causes gastroparesis. In both idiopathic and diabetic gastroparesis a great deal of interest is being paid to changes in the cells which help control muscular contractions (motility) in the stomach. These are known as the interstitial cells of Cajal (ICCs). These cells probably represent the essential pacemakers of the entire gastrointestinal (GI) tract. In addition to ICCs, scientists are looking at changes in the structure and the number of nerve cells and immune cells as possible contributors to the disease process in gastroparesis.

How do I know if I have gastroparesis?

The symptoms of gastroparesis are similar to those that occur in a number of other illnesses. When symptoms persist over time or keep coming back, it’s time to see a doctor to diagnose the problem. An accurate diagnosis is the starting point for effective treatment.

Diagnosis of gastroparesis begins with a doctor asking about symptoms and past medical and health experiences (history), and then performing a physical exam. Any medications that are being taken need to be disclosed.

Tests will likely be performed as part of the examination. These help to identify or rule out other conditions that might be causing symptoms. Tests also check for anything that may be blocking or obstructing stomach emptying. Examples of these tests include:

  • a blood test,
  • an upper endoscopy, which uses a flexible scope to look into the stomach,
  • an upper GI series that looks at the stomach on an x-ray, or
  • an ultrasound, which uses sound waves that create images to look for disease in the pancreas or gallbladder that may be causing symptoms.

If – after review of the symptoms, history, and examination – the doctor suspects gastroparesis, a test to measure how fast the stomach empties is required to confirm the diagnosis.

Slow gastric emptying alone does not correlate directly with a diagnosis of gastroparesis. (Pasricha PJ, et al. Clin Gastroenterol Hepatol. 2011 July.)

Stomach Emptying Tests

There are several different ways to measure the time it takes for food to empty from the stomach into the small intestine. These include scintigraphy, wireless motility capsule, or breath test. Your doctor will provide details of the one chosen.

Gastric Emptying Study (Scintigraphy)
The diagnostic test of choice for gastroparesis is a gastric emptying study (scintigraphy). The test is done in a hospital or specialty center.

It involves eating a bland meal of solid food that contains a small amount of radioative material so that it can be tracked inside the body. The abdomen is scanned over the next few hours to see how quickly the meal passes out of the stomach. A radiologist will interpret the study at periodic intervals after the meal.

A diagnosis of gastroparesis is confirmed when 10% or more of the meal is still in the stomach after 4 hours.

Other methods for measuring gastric emptying include a wireless motility capsule and a breath test.

Wireless Motility Capsule
The ingestible wireless motility capsule (SmartPill) is swallowed and transmits data to a small receiver that the patient carries. The data collected is interpreted by a radiologist. While taking the test, people can go about their daily routine. After a day or two, the disposable capsule is excreted naturally from the body.

Breath Test
The breath test involves eating a meal that contains a nonradioactive component that can be tracked and measured in the breath over a period of hours. The results can then be calculated to determine how quickly the stomach empties.

How is gastroparesis treated?

Treatments are aimed at managing symptoms over a long-term. This involves one or a combination of dietary and lifestyle measures, medications, and/or procedures that may include surgery.

Mild symptoms that come and go may be managed with dietary and lifestyle measures. Moderate to more severe symptoms additionally may be treated with medicines to stimulate stomach emptying and/or reduce nausea and vomiting.

Severe symptoms that are harder to treat may require added procedures to maintain nutrition and/or reduce symptoms.

Dietary and Lifestyle Measures

A nutrition specialist can help design a dietary plan to meet your needs. If you have diabetes, blood glucose levels will need to be controlled as well as possible. Blood glucose levels go up after stomach contents empty into the small intestine, and this is irregular in gastroparesis. Learn more about gastroparesis dietary and lifestyle measures.

Medications

Prokinetic (promotility) agents help the stomach empty more quickly and may improve nausea, vomiting, and bloating. Antiemetic agents are used to treat nausea and vomiting.

Medications are used to try to help reduce symptoms of gastroparesis. The drug categories commonly used are prokinetic (promotility) agents and antiemetic agents.

There is a lack of evidence-based information about what drugs work best for patients with gastroparesis. Drugs are often prescribed off-label by doctors, based on their clinical experience and how the drugs treat similar symptoms in other conditions. Only one drug, metoclopramide, is approved by the U.S. Food and Drug Administration (FDA) for the treatment of gastroparesis.

Off-label use is the permissible practice by doctors to prescribe medications for other than their FDA approved intended indications.

Prokinetic/Promotility Agents
Prokinetic, or promotility, agents directly help the stomach empty more quickly and may improve symptoms such as nausea, vomiting, and bloating.

Metoclopramide, a dopamine antagonist, has been available since 1983. It is the only FDA approved medication that improves stomach emptying. Multiple clinical trials show that it improves symptoms in about 40% of patients. Intolerable side effects are common and 20–40% of patients cannot take this drug.

The most bothersome side effect, tardive dyskinesia, is a rare but serious movement disorder that is often irreversible. The risk of developing tardive dyskinesia increases with the duration of treatment and the total cumulative dose. Treatment with metoclopramide for longer than 12 weeks should be avoided in all but rare cases where therapeutic benefit is thought to outweigh the risk of developing tardive dyskinesia. (More information at this FDA page)

Domperidone, a peripheral dopamine antagonist, is a prokinetic agent that has never been approved by the FDA. It is similar in effectiveness to metoclopramide, but has fewer side effects. It is available in Canada, Mexico, New Zealand, Japan, and Europe. In the U.S. it can be obtained through a doctor under special arrangements (More on this FDA page). An intravenous form of domperidone was removed from the market in 1980 because of some unexpected serious heart problems (cardiac arrhythmias). An electrocardiogram (EKG), which tests electrical activity in the heart, should be done before starting this medication. Follow-up EKG is recommended in those who are taking the drug. Caution should be used in older patients or those with known cardiac disease.

Erythromycin is an antibiotic that is structurally similar to motilin, a hormone that speeds up stomach emptying. Motilin is decreased in people with diabetes. About 40% of people with diabetic gastroparesis will improve with short courses of erythromycin. However, effectiveness of erythromycin often decreases sharply after several weeks of taking the drug. Possible side effects of erythromycin include nausea, vomiting, and abdominal cramps.

Antiemetic Agents
Antiemetic agents are used to treat nausea and vomiting, which are disabling symptoms. These agents do not improve gastric emptying.

These drugs work on a range of receptors in the nervous system in the body. There are a number of these medications, which have been developed for other conditions. For gastroparesis, doctors will make recommendations based on clinical experiences and observations, and individual patient needs. Among these drugs are certain serotonin 5-HT3 receptor antagonists, antihistamines, phenothiazines, low-dose tricyclic antidepressants, and others.

Many of these drugs come in multiple formulations so that they can be taken as an oral tablet, dissolvable tablet, liquid, or intravenously (IV) as required. Possible side effects for each of these drugs should be discussed by the doctor and patient.

Procedural Treatments

Botulinum Toxin Injection
Botulinum toxin (Botox) is a nerve blocking agent. Some initial research studies in small numbers of patients showed modest improvement in gastroparesis symptoms and the rate of gastric emptying following the injections of Botox into the pylorus, the opening from the stomach into the small intestine. However, other more well-designed studies have shown no improvement in symptoms compared to placebo. It is not a generally recommended treatment for gastroparesis, based on randomized controlled trials.

Procedures –Severe symptoms sometimes result in dehydration, loss of essential minerals (electrolyte imbalances), and malnutrition requiring hospitalizations. Special treatment measures to help manage may include:

  • enteral nutrition,
  • parenteral nutrition,
  • gastric electrical stimulation, or
  • other surgical procedures.

Enteral nutrition involves the delivery of liquid food into the digestive tract through a feeding tube. It is used when oral eating does not supply adequate nutrition. Delivery into the small intestine is called a jejunostomy.

Jejunostomy (J-tube) is a surgical procedure that places a feeding tube through the abdominal wall directly into the small intestine, bypassing the stomach. In this procedure, the feeding tube delivers nutrients in a specially formulated liquid food directly into the jejunum, the part of the small intestine where most nutrients are absorbed into the body. (A temporary, nasojejunal, feeding tube should be tried first to test individual toleration of this feeding method.)

Parenteral nutrition bypasses the digestive system. It involves the delivery of fluids, electrolytes, and liquid nutrients into the bloodstream through a tube surgically placed in a vein (intravenous or IV). Parenteral nutrition is a complex therapy, used when no other treatments are working. Long-term use increases risks for infections and other complications. It may be used as a temporary treatment for gastroparesis.

Gastric electric stimulation (GES) uses a battery-operated surgically implanted device (Enterra) on the stomach to try to help reduce symptoms of nausea and vomiting in gastroparesis when other methods have failed. Low voltage pulses are too weak to excite stomach smooth muscles, but are able to excite nerves. Therapy with Enterra is FDA approved through a Humanitarian Use Device exemption. The device can be implanted laparoscopically, which helps minimize chances for complications related to surgery. Once implanted, the settings on the battery-operated device can be adjusted to determine the settings that best control symptoms.

First FDA approved in 2000, the FDA approved a second-generation device (Enterra II) in 2015. The newer device provides physicians with greater system flexibility and ease of use.

Enterra therapy is not a cure and other treatment approaches need to be continued. The device can be removed if the therapy does not work.

Other surgical procedures may sometimes be tried in patients where all other treatments fail. Gastrostomy (a tube into the stomach) venting prevents excess air and fluid from building up in the stomach and may help with severe nausea and vomiting. Pyloroplasty (surgery to widen the lower part of the stomach) or gastrojejunostomy (surgical procedure that connects the stomach to the jejunum part of the small intestine) are attempts to help the stomach empty. Gastrectomy is the surgical removal of part or the whole stomach. The effectiveness of these procedures in the treatment of gastroparesis is still under investigation. These procedures should only be considered after careful discussion and review of all alternatives in selected patients with special circumstances and needs.

Humanitarian Use Device Exemption
The Enterra Therapy system for gastric electrical stimulation to treat chronic nausea and vomiting in gastroparesis is approved by the U.S. Food and Drug Administration (FDA) as a Humanitarian Use Device. What does this mean? The FDA has a specialized process, which was established by Congress for developing treatments for rare disease populations, the Humanitarian Use Device (HUD) process. Devices reviewed and approved through this process receive a Humanitarian Device Exemption (HDE).

Despite the fact that these devices are reviewed and approved by FDA, since they were not approved through the standard process many insurance companies will deem them “investigational” and refuse to cover the procedures. In these cases, the cost of the treatment alone can be enough to significantly restrict patient access. While Enterra is not for everyone, some individuals benefit greatly and can be restored to a productive lifestyle. The fact that individuals seeking Enterra or other beneficial rare disease treatments may be denied access to the treatment by a third-party payer is an issue that needs to be addressed.

Be sure to ask questions so you understand any treatment and options, know the risks as well as benefits, and know what to do if side effects occur or symptoms return.

Keep hydrated and as nutritionally fit as possible. Persistence pays off, as most people with gastroparesis ultimately will do well.

Reference:

1. NIH, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), Gastroparesis Clinical Research Consortium. www.niddkrepository.org/studies/gpcrc (Accessed January 16, 2018)

Copyright © 2019 International Foundation for Functional Gastrointestinal Disorders (IFFGD). All rights reserved.

 

Diverticulosis and diverticulitis are two conditions of diverticular disease. Let’s figure out how they differ from each other. Diverticulosis is the formation of small pockets that are called diverticula in the lining of the bowel. The reason for formation of diverticula concerns increased pressure from gas, waste or liquid on weakened parts of the intestinal walls. It is important to take into account that diverticula vary in number from a single one to hundreds. Also, diverticula can be of different size – from 3 to 10 mm in diameter. Diverticula are formed while straining during bowel movements and persistent constipation. They are more typical for large intestine and frequently the sigmoid colon. Diverticulitis deals with infection and it is considered more serious conditions Sometimes diverticulosis leads to diverticulitis.

 

In most cases diverticulosis is symptom-free. But sometimes people suffer from mild cramps, bloating, gastrointestinal bleeding or constipation. Diverticulitis does have symptoms of abdominal pain, fever, nausea, vomiting, diarrhea or constipation. As diverticulitis is an infection itself, it can bring a person to other severe problems like abscess, perforation, peritonitis, fistula and intestinal obstruction. Since the symptoms describe are similar to some other conditions, the doctor can diagnose diverticular disease after colon examination.

 

Diverticulosis is quite common, especially among older people. Researches admit that about 35% of adults in the US who are 50 years or younger suffer from diverticulosis. At the same time, about 60 % of people over 55 have diverticulosis [2]. Most of the people with diverticulosis will never face serious problems, but one-fourth of patients have an increased risk of diverticulitis development. According to a recent survey, about 200,000 people are hospitalized for diverticulitis annually, and about 70,000 people develop diverticular bleeding each year [4].

Considering a number of patients suffering from this chronic condition, patient education is essential. The primary objective of which is to help you become responsible for your own health and learn how to manage diverticular disease and minimize complications.

The first thing to know for people with diverticular disorders regards the risk factors. People facing risks of diverticular disease can minimize the hazards and improve their health conditions.

 

Thus, the risk factors are the following [1]:

 
  • Low-Fiber diet as fiber eases the transit of wastes through the colon reducing the pressure on the intestine walls.

  • Too much red meat consumed makes a person constipated.

  • Diet high in saturated fats causes waste particles trapped in and further inflammation.

  • Little water intake as dehydration contributes to constipation significantly.

  • Genetics

  • Polycystic kidney disease

  • Obesity can cause chronic intestinal inflammation and be a reason for the presence of harmful bacteria in the gut.

  • Taking some drugs that can bring to gastrointestinal tract injury and damage intestinal tissues.

 

Minimizing risk factors, we can proceed to lifestyle improvement to manage diverticular disease [3]. Here are tips for patients to control their health status:

 
  • Fiber-rich foods intake. Fiber helps to manage unpleasant diverticular symptoms. Women should take at least 25 grams of fiber daily as men should aim for about 40 grams. The following foods are rich in fiber: whole grain bread, pasta, brown rice, beans, fresh fruits and vegetables.

  • Liquid consumption. Intake enough water and drinks. It is recommended to consume clear liquids like drinking water, tea or coffee without milk, broth, fruit juices.

  • Exercising. Have at least 3 hours of workout a week. Running, swimming, cycling, playing tennis are good options for your intestines. Also, walking is a good choice.

  • No straining. Plan daily routine properly. Take time and do not strain when you have a bowel movement.

  • Doctor’s appointment. See the doctor or nurse if you have problems. Keep the results of your abdominal examinations and do not throw the lists of the medicines you are prescribed to control your health.

Remember that you are the best friend of your health. Information delivered to a patient through the patient education scheme can improve the quality of life and keep you from many severe problems.

References:

  1. Böhm S. Risk Factors for Diverticulosis, Diverticulitis, Diverticular Perforation, and Bleeding: A Plea for More Subtle History Taking. Viszeralmedizin. 2015 Apr; 31(2): 84–94.

  2. Peery A. F., Keku T. O., Martin C. F., et al. Distribution and characteristics of colonic diverticula in a United States screening population. Clinical Gastroenterology and Hepatology. 2016 Jul; 14(7): 980-985.

  3. Walter E., Tursi A. Recent advances in the treatment of colonic diverticular disease and prevention of acute diverticulitis. Ann Gastroenterol. 2016 Jan-Mar; 29(1): 24–32.

  4. Wheat C. L., Strate L. L. Trends in hospitalization for diverticulitis and diverticular bleeding in the United States from 2000 to 2010. Clinical Gastroenterology and Hepatology. 2016; 14(1): 96–10

WHAT IS BARRETT’S ESOPHAGUS?

Barrett’s esophagus is a permanent change in the lining of the esophagus which is usually caused by chronic reflux which can lead to esophageal cancer. There are regular flows back of contents from the stomach and small intestine into the esophagus and it leads to irritation. This frequent irritation changes the lining pattern in the esophagus which then makes it similar to the stomach and the intestine.

 

BARRETT’S ESOPHAGUS SYMPTOMS

There are no major signs or symptoms for Barrett’s esophagus. This is as a result of the similarity between Barrett’s esophagus and Gastro-esophageal reflux disease (GERD). Most times, symptoms of GERD are present in Barrett’s esophagus. This symptoms include:

 
  • Regurgitation: This is the process of bring back foods or solid liquid back to the mouth again. 

  • Heartburn: This is a burning sensation that runs from the throat down to the center of the chest. It creates a form of burning which generates serious heat.

  • Trouble swallowing (Dysphagia): In ability to swallow food or liquid substance. Please if you have issues swallowing please seek medical attention.

 

BARRETT’S ESOPHAGUS RISK FACTORS

There are many factors which can make you to be easily prone to v. base on this factors, your medical history and family background has a ;long way to play in this. Your doctor can be able to decide maybe you risk from suffering from Barrett’s esophagus through:

 

  • Age: 55 years is the average age of diagnosis. It is more common among middle-aged and aged people.

  • Gender: Barrett’s esophagus is more common among men which mean they have the likely chances of developing it.

  • Smoking: One of the damages smoking does is to expose smokers to likely development of v.

  • Ethnic background: Research h has shown it the white populations are at the highest risk of suffering from Barrett’s esophagus while the black and Asian people are at the lower side of suffering from it.

  • Chronic heartburn: People who suffer from heart burn for like five years and above are more likely to develop Barrett’s esophagus.

 

BARRETT’S ESOPHAGUS DIAGNOSIS

One of the major ways of detecting Barrett’s esophagus is through the doctor reviewing the patient medical history and family background. To confirm the diagnosis, a test is carried out which is called an Upper Endoscopy or EGD.

Endoscopy test allow a physician to see the deep inside of a stomach and esophagus through the help of a small lightened tube.

Sometimes, the diagnosis of Barrett’s esophagus is challenging due to the difference in patients symptoms.

 

BARRETT’S ESOPHAGUS TREATMENT

The major way of treating Barrett’s esophagus is by eliminating acid reflux. The treatment does not depend on your overall health. There are some foods which can worsen reflux. They include:

 

  • Fatty foods

  • Peppermint

  • Caffeine

  • Acidic Juice

  • Alcohol

  • Chocolate

  • Tomato based foods

 

Also, there are some personal behaviors that can increase acid-reflux. They include:

 
  • Going to bed immediately after food

 

  • Lying down immediately after eating

 

  • Eating too much of food

 

The following are lifestyle and home remedies to reduce acid-reflux. They include:

 

  • Quit smoking – smokers are liable to die young

  • Maintain a healthy weight

  • Raise the head of your bed

 

The mainstay of monitoring the progression of Barrett’s esophagus into esophageal cancer is by surveillance. After diagnosis with Barrett’s esophagus, you should have an Upper Endoscopy at least every 3 years. There are subtle changes called dysplasia that indicate Barrett’s esophagus is going through a change towards esophageal cancer.

 

MEDICATIONS

Your doctor might be in the best position to prescribe medications that helps in reducing the amount of acid in your stomach. This is because most of these drugs are not sold over the counter.

 

BARRETT’S ESOPHAGUS COMPLICATIONS

Those with Barrett’s esophagus are at the risk of developing esophageal cancer. The risk is very small, about 1 in 100 people with Barrett’s esophagus will develop esophageal cancer. Majority of the patients with Barrett’s esophagus will not develop esophageal cancer, but compared to those without Barrett’s esophagus, the risk is much higher.

What are Probiotics

 

Probiotics are living microorganisms that boost health when consumed in adequate amounts. There are many different types and you can obtain them from foods or supplements.

In greek, “pro” means “for” and “biotic” means “life”.

The term probiotic refers to dietary supplements (tablets, capsules, powders, lozenges and gums) and foods (such as yogurt and other fermented products) that contain “beneficial” or “friendly” bacteria. The organisms themselves are also called probiotics.

 

What is the purpose of probiotics?

 

Everyone has there own unique microbiome. A microbiome is the community of micro-organisms living together in a particular habitat. Humans, animals and plants have their own unique microbiomes, but so do soils, oceans and even buildings. In humans, our microbiome can have both helpful microorganisms (priobiotics), microorganisms that do not cause disease but don’t help us and harmful microorganisms that cause symptoms and diseases.

With 80% of our immune system cells living in our gastrointestinal tract, a strong immune system begins with a healthy gut. Probiotic supplements are a quick and easy way to keep your immune system on track because they deliver a large dose of live, good bacteria directly to your gastrointestinal tract, supporting the balance of your immune response at its core. This beneficial bacteria colonizes and quickly gets to work helping you stay well.

Probiotics have numerous advantageous functions in human organisms. Their main advantage is the effect on the development of the microbiota inhabiting the organism in the way ensuring proper balance between pathogens and the bacteria that are necessary for a normal function of the organism. Live microorganisms meeting the applicable criteria are used in the production of functional food and in the preservation of food products. Their positive effect is used for the restoration of natural microbiota after antibiotic therapy. Another function is counteracting the activity of pathogenic intestinal microbiota, introduced from contaminated food and environment. Therefore, probiotics may effectively inhibit the development of pathogenic bacteria, such as Clostridium perfringens, Campylobacter jejuni, Salmonella Enteritidis, Escherichia coli, various species of Shigella, Staphylococcus and Yersinia, thus preventing food poisoning. A positive effect of probiotics on digestion processes, treatment of food allergies, candidoses, and dental caries has been confirmed. Probiotic microorganisms such as Lactobacillus plantarum, Lactobacillus reuteri, Bifidobacterium adolescentis, and Bifidobacterium pseudocatenulatum are natural producers of B group vitamins (B1, B2, B3, B6, B8, B9, B12). They also increase the efficiency of the immunological system, enhance the absorption of vitamins and mineral compounds, and stimulate the generation of organic acids and amino acids, Probiotic microorganisms may also be able to produce enzymes, such as esterase, lipase, and co-enzymes A, Q, NAD, and NADP. Some products of probiotics’ metabolism may also show antibiotic (acidophiline, bacitracin, lactacin), anti-cancerogenic, and immunosuppressive properties.

 

What happens when probiotics are low?

 

When things go wrong in the balance of intestinal organisms, the consequences can be tremendous. Negative changes in the intestinal microbiome are firmly associated with chronic diseases that include inflammatory bowel disease, irritable bowel syndrome, cancer, cardiovascular disease, and the metabolic syndrome. We now recognize that allergic disorders, asthma, and even obesity are also related to an unhealthy population of intestinal bacteria.

Due to modern diets and lifestyle, as well as environmental factors such as pollution and the irresponsible overuse of antibiotics, the beneficial bacteria in your microbiome is at risk which can lead to an increased incidence in metabolic and inflammatory chronic diseases. Even simple aging gradually shifts your intestinal bacterial population towards a disease-promoting, rather than a disease-preventing, state.

 

What are prebiotics and synbiotics?

 

The prebiotic comes before and helps the probiotic, and then the two can combine to have a synergistic effect, known as synbiotics. A prebiotic is actually a nondigestible carbohydrate that acts as food for the probiotics and bacteria in your gut. The definition of the effect of prebiotics is the selective stimulation of growth and/or activities of one or a limited number of microbial species in the gut microbiota that confer health benefits to the host. The health benefits have been suggested to include acting as a remedy for gastrointestinal complications such as enteritis, constipation, and irritable bowel disease; prevention and treatment of various cancers; decreasing allergic inflammation; treatment of nonalcoholic fatty liver disease and fighting immune deficiency diseases. There has also been research showing that the dietary intake of particular food products with a prebiotic effect has been shown, especially in adolescents, but also tentatively in postmenopausal women, to increase calcium absorption as well as bone calcium accretion and bone mineral density. The benefits for obesity and type 2 diabetes are growing as recent data, both from experimental models and from human studies, have shown particular food products with prebiotics have influences on energy homeostasis, satiety regulation, and body weight gain.

Most of the prebiotics identified are oligosaccharides. They are resistant to the human digestive enzymes that work on all other carbohydrates. This means that they pass through the upper GI system without being digested. They then get fermented in the lower colon and produce short-chain fatty acids that will then nourish the beneficial microbiota that live there. Oligosaccharides can be synthesized or obtained from natural sources. These sources include asparagus, artichoke, bamboo shoots, banana, barley, chicory, leeks, garlic, honey, lentils, milk, mustards, onion, rye, soybean, sugar beet, sugarcane juice, tomato, wheat, and yacón. The health benefits from these oligosaccharides is a topic of ongoing research.

 

What are the therapeutic roles of probiotics?

 

What are the benefits of taking probiotics? Bacteria have a reputation for causing disease, so the idea of tossing down a few billion a day for your health might seem — literally and figuratively — hard to swallow.

Studies have shown probiotic supplementation to be effective for the following gastrointestinal conditions:

 

Antibiotic associated diarrhea

Clostidium dificile diarrhea

Helicobacter pylori infection

Hepatic encephalopathy

Infectious diarrhea

Irritable bowel syndrome

Lactose intolerance

Pouchitis

Ulcerative colitis

 

Are probiotics dangerous?

 

Probiotics already reside in the human body, so conventional wisdom should tell us that taking a probiotic supplements should be safe. However, there are instances where that may not be true.

Probiotic supplements can initiate an allergic reaction when you begin taking them. This is usually characterized by gas bloating and diarrhea. This usually goes away after the first week. This is fairly common.

People with immune deficiency, who are critically ill or have had recent surgery should probably not take probiotic supplements.

Children and pregnant women should always consult with there doctor prior to starting any new medicine or supplement and that includes probiotic supplements.

 

Foods that have natural probiotics

 

Kimchi: A fermented Korean vegetable dish with strains of lactic acid bacteria, such as Lactobacillus brevi, which helps heal your gut and might even promote weight loss.

Sauerkraut: “Rich in bacteria that boosts your immune system and healthy gut flora. The bacteria on the cabbage leaves ferment the natural sugars into lactic acid. Sauerkraut is also high in vitamin C.”

Kombucha: Fermented with bacteria and yeast known as SCOBY. Kombucha can prevent too much candida yeast in the gut, promotes digestion, and the influx of good bacteria

Whole fat, organic, or grass-fed yogurt: Full of bacteria that help the gut. The microbes in yogurt alter the lactose, the natural sugar found in dairy, allowing the milk to thicken and the lactic acid to build up. It’s best to avoid sugary yogurts and buy the plain flavor with live active cultures.

Kefir: Can reduce bloating and gas that is brought on by consuming dairy. The bacteria in this fermented milk drink have been found to colonize in the intestinal tract, which gives healing benefits to the gut.

Miso: The fungus in miso, like the soup you get at a Japanese restaurant or the paste you find in supermarkets, stimulates the digestive system and supports the immune system

 

Probiotic supplements

 

There are many probiotics available, but not all have the ingredients that you need. Probiotic supplements are not regulated by the FDA, so the ingredients may be inaccurate. Also, since probiotics are frequently viewed as a natural or healthy alternative to prescription medicines, certain companies prey on desperate patients by making an expensive product that is not very effective. I recommend sticking to ones that I have found to be legitimate and effective. They are listed below.

On a final note, do not get caught up in the number of billions of colony forming units. More is not necessarily better. Stick with the probiotics above or make sure you know you’re getting what you’re paying for.

 

FODMAP foods for IBS, definition, and facts

  • FODMAP stands for Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols, which are short chain carbohydrates and sugar alcohols that are poorly absorbed by the body, resulting in abdominal pain and bloating.
  • FODMAPs occur in some foods naturally or as additives.
  • If you eat a lot of these foods you may have symptoms and signs like:
    • Gas
    • Pain
    • Bloating
    • Abdominal distention
    • Abdominal pain
    • Diarrhea
  • A list of examples of certain foods and drinks that should be avoided on a low-FODMAP diet are some vegetables and fruits, beans, lentils, wheat, dairy products with lactose, high fructose corn syrup, and artificial sweeteners.
  • A list of examples of foods and drinks to eat on a this diet are certain vegetables and fruits, lactose free dairy, hard cheeses, meat, fish, chicken, eggs, soy, rice, oats, quinoa, non-dairy milks, and small servings of nuts and seeds.
  • This diet cuts out many common foods that may contain high FODMAP foods. They are eliminated or severely limited for 3-8 weeks, then gradually reintroduced into a low-FODMAP diet to see if they cause symptoms (elimination diet). It is not meant to be a permanent solution because it is very restrictive, but it may work well enough to be a treatment for people with gastrointestinal (GI) problems.
  • This type of dietary meal plan often is used to help with digestive symptoms from many different conditions, including, irritable bowel syndrome (IBS), small intestinal bacterial overgrowth (SIBO), and other functional GI disorders.

What are FODMAPs?

FODMAPs are short chain carbohydrates and sugar alcohols that are poorly digested by the body. They ferment in the large intestine (bowel) during digestion, drawing in water and producing carbon dioxide, hydrogen, and methane gas that causes the intestine to expand. This causes GI symptoms such as bloating and pain that are common in disorders like IBS.

FODMAPs are in some foods naturally or as additives. They include fructose (in fruits and vegetables), fructans (like fructose, found in some vegetables and grains), lactose (dairy), galactans, (legumes), and polyols (artificial sweeteners).

These foods are not necessarily unhealthy products. Some of them contain fructans, inulin, and galactooligosaccharides (GOS), which are healthy prebiotics that help stimulate the growth of beneficial gut bacteria. Many of them are otherwise good for you, but in certain people, eating or drinking them causes gastrointestinal symptoms.

What is a low FODMAP diet?

A low FODMAP diet cuts out many common products that contain certain foods. The principle behind the diet is to give the gut a chance to heal, especially if you have GI problems like IBS. People with GI disorders may use this diet as part of their treatment.

This diet may be difficult to follow, and it is advisable to contact your health care professional or a dietician to make sure that you are on the right track and getting enough dietary nutrients that you can consume.

Will a low FODMAP diet help IBS or other diseases?

  • Low-FODMAP diets are often used to help with digestive problems from many different conditions, including IBS.
  • These foods cause irritable bowel syndrome, but they also may aggravate IBS symptoms. A low FODMAP diet often is recommended for IBS treatment.
  • Small intestinal bacterial overgrowth (SIBO)
  • Functional GI disorders other than IBS

It isbelieved that a meal plan that includes low FODMAPs also may help ease symptoms from other health conditions, such as:

  • Autoimmune diseases:
    • Rheumatoid arthritis
    • Multiple sclerosis
    • Eczema
  • Fibromyalgia
  • Migraines triggered by eating certain products

After your doctor makes the diagnosis of your bowel disease or syndrome, (for example, IBS, IBD, or microscopic colitis), he or she may suggest a low FODMAP diet.

Symptoms and signs that you may be eating too many high FODMAP foods

FODMAPs are not absorbed well in the small intestine. They increase the amount of fluid in the large intestine (bowel) and they produce more gas.

Symptoms and signs that suggest you may be eating products high in these short chain carbohydrates are:

  • Gas
  • Pain
  • Bloating
  • Abdominal distention
  • Abdominal pain
  • Diarrhea (similar to IBS symptoms)
  • A feeling of fullness after eating or drinking only a small amount of food or liquid.

A diet low in FODMAPs may help relieve these problems, particularly in people with IBS.

What’s Triggers Your IBS Symptoms?

IBS or irritable bowel syndrome is a recurrent disorder of the colon. IBS triggers include:

  • Stress
  • Anxiety
  • Antibiotics
  • Antidepressants
  • Menstrual pain
  • High FODMAP foods

List of low FODMAP foods to eat

A list of common low FODMAP foods that are good to eat on a low FODMAP diet include:

  • Vegetables
    • Alfalfa sprouts
    • Bean sprouts
    • Bell pepper
    • Carrot
    • Green beans
    • Bok choy
    • Cucumber
    • Lettuce
    • Tomato
    • Zucchini
    • Bamboo shoots
    • Eggplant
    • Ginger
    • Chives
    • Olives
    • Parsnips
    • Potatoes
    • Turnips
  • Fresh fruits
    • Oranges
    • Grapes
    • Honeydew melon
    • Cantaloupe
    • Banana
    • Blueberries
    • Grapefruit
    • Kiwi
    • Lemon
    • Lime
    • Oranges
    • Strawberries
  • Dairy that is lactose-free, and hard cheeses, or ripened/matured cheeses including (If you are not lactose intolerant, you may not need to avoid dairy with lactose.)
    • Brie
    • Camembert
    • Feta cheese
  • Beef, pork, chicken, fish, eggs
  • Avoid breadcrumbs, marinades, and sauces/gravies that may be high in FODMAPs
  • Soy products including tofu, tempeh
  • Grains
    • Rice
    • Rice bran
    • Oats
    • Oat bran
    • Quinoa
    • Corn flour
    • Sourdough spelt bread
    • Gluten-free bread and pasta
  • Gluten is not a FODMAP, but many gluten-free products tend to be low in FODMAPs.
  • Non-dairy milks
    • Almond milk
    • Rice milk
    • Coconut milk
  • Drinks
    • Tea and coffee (use non-dairy milk or creamers)
    • Fruit juice not from concentrate
    • Water
  • Nuts and seeds
    • Almonds
    • Macadamia
    • Peanuts
    • Pine nuts
    • Walnuts (fewer than 10-15/serving for nuts)
    • Pumpkin seeds

In some cases, portion sizes make a difference as to whether a product has enough high FODMAPs to cause symptoms. For example, a serving of almonds is a good choice that is in these short chained carbohydrates, but eat more, and you could have too many.

List of high FODMAP foods to avoid

Many foods considered high in FODMAPs are healthy foods otherwise, but they can cause symptoms in some people with a sensitive gut; particularly people with IBS or other bowel diseases and disorders like SIBO.

Print both of these lists of foods and drinks for easy reference.

A list of common foods that you should avoid (especially if you have IBS) include:

  • Some vegetables
    • Onions
    • Garlic
    • Cabbage
    • Broccoli
    • Cauliflower
    • Snow peas
    • Asparagus
    • Artichokes
    • Leeks
    • Beetroot
    • Celery
    • Sweet corn
    • Brussels sprouts
    • Mushrooms
  • Fruits, particularly “stone” fruits like:
    • Peaches
    • Apricots
    • Nectarines
    • Plums
    • Prunes
    • Mangoes
    • Apples
    • Pears
    • Watermelon
    • Cherries
    • Blackberries
  • Dried fruits and fruit juice concentrate
  • Beans and lentils
  • Wheat and rye
    • Breads
    • Cereals
    • Pastas
    • Crackers
    • Pizza
  • Dairy products that contain lactose
    • Milk
    • Soft cheese
    • Yogurt
    • Ice cream
    • Custard
    • Pudding
    • Cottage cheese
  • Nuts, including cashews and pistachios
  • Sweeteners and artificial sweeteners
    • High fructose corn syrup
    • Honey
    • Agave nectar
    • Sorbitol
    • Xylitol
    • Maltitol
    • Mannitol
    • Isomalt (commonly found in sugar-free gum and mints, and even cough syrups)
  • Drinks
    • Alcohol
    • Sports drinks
    • Coconut water

What is a FODMAP elimination diet?

  • This diet consists of severely restricting or eliminating those particular foods and drinks, but only for a short period of time because it may not meet all the nutritional dietary requirements you need. It can be very restrictive and it is not recommended as a permanent diet.
  • This meal plan may not provide any benefits for healthy people, and because it restricts many healthy foods it should only be tried if medically necessary, and prescribed by your doctor or other health care professional.
  • For 3-8 weeks, foods and drinks that contain FODMAPs are limited or avoided. After that, individual foods can be introduced back into the diet, one at a time, to see whether that particular food or drink causes symptoms. If it does, you know you need to avoid that type of product. If no symptoms occur after consuming a particular food or drink for a week, it may be considered safe to continue to eat.

Colon Cancer

First of all, most colon cancers begin as a then precancerous polyp which is found in the colon. In addition, polyps can vary in size as well as type. Most importantly, they can then vary in their propensity to turn into colon cancer. Consequently, screening tests such as colonoscopy allow Gastroenterologists to then remove these potentially cancerous polyps.

Who is at risk of developing colon polyps/cancer?

Approximately a quarter of patients age 50 years old have high-risk colon polyps. Therefore, this risk increases in those with a family history of colon polyps as well as colon cancer. In addition, some patients have genetic syndromes which then increase their risk of cancer. Consequently, aside from family history as well as genetic syndromes, there are also other factors which increase your risk of developing colon polyps as well as subsequent colon cancer:

  • African American Ethnicity

  • Age > 50 Years Old

  • Male Gender

  • Diet High in Fat and Red Meat

  • Obesity

  • Tobacco and Alcohol Use

  • Chronic Constipation

When should you be screened for colon cancer?

So, it is recommended that people 50 years old or African Americans at the age of 45, undergo colon cancer screening. Therefore, patients with a family history of colon polyps as well as colon cancer should be screened at age 40. In addition, patients who are 10 years younger than the afflicted relative should also be screened. Lastly, if there is established as well as suspected genetic syndromes, they may then need unique as well as more intensive screening protocols. Finally, this should happen at an earlier age.

What screening options are available?

A variety of screening options are available. However, colonoscopy then remains the gold-standard screening modality. In addition, this is the diagnosis as well as the treatment of colon polyps. In addition, this includes cancer. Finally, other tests include fecal DNA tests. This is in addition to blood DNA tests as well as virtual CT colonography.

Symptoms

Firstly, it is important to understand that polyps generally do NOT cause symptoms alerting you of their presence. Consequently, very large colon polyps as well as cancer can manifest with symptoms of unintentional weight loss. In addition, this includes change in bowel habits including constipation as well as diarrhea. Also this includes occult or even overt bleeding with anemia as well as abdominal pain.

Decreasing Risk

In addition to a healthy diet and exercise plan, eliminating risk factors, supplementing your diet with fruits and fibers can decrease one’s risk. In addition this includes foods with high anti-oxidant content. Consequently, these have been shown to decrease one’s risk of developing colon polyps as well as subsequent cancer. Lastly, the removal of colon polyps during colonoscopy remains the most effective way to decrease your risk of colon cancer.

Treatment

Finally, during a colonoscopy, colon polyps are removed using a variety of endoscopic techniques. In addition, gastroenterologists are able to biopsy polyps as well as remove them as they are in the colon. Consequently, if colon cancer is diagnosed, various treatment options are available. Lastly, these include surgery, chemotherapy as well as radiation. Furthermore, this depends on the stage.

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