Addressing Reflux Disease Misconceptions
Source: Feignberg School of Medicine
Gastroesophageal reflux disease (GERD) is common, easily treatable, and often mismanaged. For John Pandolfino, MD, GME ’96, professor in medicine-gastroenterology and hepatology, it is the clinical misconceptions surrounding the disorder which prompted his recently published review in Lancet.
The most common gastrointestinal diagnosis in America, GERD results in nearly 10 million outpatient visits a year. The rising prevalence of the disorder has been linked by many to the nation’s increasing rate of obesity.
This paper provides a framework for general practice physicians in regard to the management of GERD,” said Pandolfino, who co-authored the piece with a pair of scientists from the Netherlands. “Although it is easy to treat in the majority of people, many patients are mismanaged due to a poor understanding of the physiological changes associated with the disorder and the overuse of treatment trials using the proton-pump inhibitor (PPI) test.
Minimally Invasive Oesophagectomy for Oesophageal Cancer
Oesophageal cancer represents a major public health problem in the world. Several minimally invasive oesophagectomy techniques have been devised around the world and represent a safe alternative for the surgical management of oesophageal cancer in selected centers with high volume and surgeons experienced in minimally invasive procedures.
Dr. Bessell has been performing thoracoscopically-assisted oesophagectomy for over 10 years, whereby the need to utilise a large incision in the chest is replaced by several small incisions only.
In an article published in the current issue of Cancer Control journal, Dr. Yamamoto and colleagues have reviewed the most recent and largest studies published in the medical literature that reported the outcomes for Minimally Invasive Oesophagectomy techniques. (Cancer Control. 2013;20(2):130-137).
They report that Minimally-Invasive Oesophagectomy has been associated with less blood loss, reduced postoperative pain, decreased time in the intensive care unit, and shortened length of hospital stay compared with the conventional open approaches.
Top 10 GERD Guidelines. Medscape. Apr 30, 2013
Dr. Bessell would be pleased to discuss any of all of these matters with you.
10.Endoscopy is not always required to establish the diagnosis of GORD.
9. Helicobacter pylori testing should not be done in patients with GORD.
8. Weight reduction matters. Size matters, and this is a very strong recommendation.
7. The use of transoral (endoscopic) fundoplication is not warranted by current clinical data supporting it as an alternative to surgery.
6. The diagnosis of laryngopharyngeal reflux cannot be made solely using laryngoscopic findings.
5. Surgery for extraesophageal manifestations of reflux disease will not work unless the patient responds to PPIs.
4. pH testing is okay whether the patient is on or off therapy.
3. Screening for Barrett esophagus should not be routinely done in the absence of high-risk evidence.
2. The relationship between infectious diseases and PPIs showed no evidence that PPIs cause repetitive pneumonia.
1. PPIs can be used in patients with bone density loss.
Surgery or drugs for gastro-oesophageal reflux?
Surgery is more effective, but patients need time to make up their minds preoperatively
No one could complain about a lack of randomised trials looking at the effectiveness of surgery for gastric reflux. Since the development of laparoscopic fundoplication, more than 130 papers, relating to more than 30 separate trials, have been published. But surprisingly, few of these trials have compared surgery with non-surgical treatment. Before the REFLUX trial, whose long term results are published in a linked paper by Grant and colleagues (doi:10.1136/bmj.f1908),1 only four studies had compared surgery with medical treatment. Most trials compared types of fundoplication or instrumentation (open, laparoscopic, or robotic). Comparisons of two ways of doing the same thing are easier, but comparisons of fundamentally different treatment approaches are usually more important.
Gallstones - What are Gallstones?
Source: Medical News
In medicine, gallstones (choleliths) are crystalline bodies formed within the body by accretion or concretion of normal or abnormal bile components.
Gallstones can occur anywhere within the biliary tree, including the gallbladder and the common bile duct. Obstruction of the common bile duct is ''choledocholithiasis''; obstruction of the biliary tree can cause jaundice; obstruction of the outlet of the pancreatic exocrine system can cause pancreatitis. Cholelithiasis is the presence of stones in the gallbladder or bile ducts: ''chole-'' means "bile", ''lithia'' means "stone", and ''-sis'' means "process".
Pre-op treatments boost survival for esophageal cancer patients: Study
Patients with esophageal cancer who receive chemotherapy and radiation before surgery have better outcomes, Dutch researchers report.
The researchers found patients who received chemotherapy before surgery lived an average of four years, while those who went straight to surgery lived an average of two years. More patients in the chemotherapy group had a complete response to treatment and had more of the cancer removed during surgery than those who had surgery alone, the team also noted.
Metabolic imaging for esophageal cancer patients can increase life expectancy
For those with esophageal cancer, initial staging of the disease is of particular importance as it determines whether to opt for a curative treatment or palliative treatment. Research presented in the June issue of The Journal of Nuclear Medicine shows that physicians using positron emission tomography (PET)/computed tomography (CT) can discern incremental staging information about the cancer, which can significantly impact management plans.
How to strengthen your lower esophageal sphincter
The lower esophageal sphincter (LES) muscle is situated between the stomach and the esophagus (throat). It opens to allow food to pass from the esophagus into the stomach. It closes to keep food and acid from flowing up from the stomach into the esophagus. Acid is produced in your stomach to help break down food for digesting. When the lower esophageal sphincter muscle is weak, acid flows up into the esophagus and can irritate and burn inner parts of the body.
Hiatal hernias and heartburn often go hand-in-hand
The term hiatal originally denoted a physical gap or opening, while a hernia is a condition in which part of an organ is displaced and protrudes through the wall of the cavity containing it.
The esophagus, a tube that leads through a hole in the diaphragm and into the stomach, propels food downward by muscular contractions.
Within the tube are several mechanisms that prevent food and stomach acid from coming back up toward the mouth. The upper esophageal sphincter (UES) and lower esophageal sphincter (LES) are valves that play a role in this function.
When there are functional or anatomic disturbances to the esophagus, such as a hiatal hernia, — an enlarged opening of the diaphragm where the esophagus goes through it — symptoms of gastroesophageal reflux disease (GERD) can occur.
Precancerous condition associated with reflux disease triggered by bile - not acid
Source - Medical NewsToday
For many people with gastroesophageal reflux disease or GERD, acid reflux drugs are the answer to their woes, curbing the chronic heartburn and regurgitation of food or sour liquid characteristic of the disorder. But when it comes to Barrett's esophagus, a condition commonly found in people with GERD, acid control may be less important than beating back another bodily fluid - bile.
A new study published in the Annals of Surgery shows that bile - a digestive fluid that leaks backwards from the stomach into the esophagus along with acid in patients with GERD - plays a critical and previously unrecognized role in the development of Barrett's esophagus. Study authors say the findings provide new avenues for the prevention and treatment of the condition, which is the only known cause of a rare but often deadly type of cancer called esophageal adenocarcinoma.
Acid reflux? Beat the Heartburn with few lifestyle changes
Source - healthnews18.com
The acid reflux medication only minimizes the symptoms of heartburn, but doesn’t cure it completely. The doctors suggest some changes in the lifestyle such as dietary and exercise habits can help minimizing the acid reflux symptoms such as sour burps and chest pain.
Heartburn reflux damages teeth
Source - health24
If you have chronic heartburn, it's not only your oesophagus that you should be worried about. New research reveals how the condition known as gastroesophageal reflux disease, or GERD, can severely damage your teeth thanks to an influx of acid into the mouth.
The study, which followed patients over six months, found that almost half of those with the condition suffered much worse tooth wear and erosion than healthy people. The disease can ultimately lead to thin, sharp and pitted teeth.
Diagnostic tests to detect gallbladder disease
Source - Gallbladder Symptoms
A large number of people all over the world are affected by gallbladder disease. Among them, many require Cholecystectomy or the removal of gall bladder as a treatment. Hence several diagnostic methods have been created that diagnose various gallbladder problems but with varying degrees of success. Given below are the types of gallbladder diseases and the methods used to diagnose them.
Pain and gallbladder disease
Source - Focus on Health
Gallbladder pain has become a very common condition nowadays, mainly due to unhealthy lifestyle and unhealthy eating habits. The gallbladder is an organ that is directly under the liver. It is connected to the liver, and upper portions of the small intestine via a duct system of the gallbladder bile stores, which is produced by the liver. Bile is a fluid that helps digest fats and lipids, gallbladder can store about 50 milliliters of bile. Pain in the gall bladder is usually caused due to the presence of gallstones, which are cholesterol deposits. When excess cholesterol in the body, it causes these calculations must be formed. The stones are not always formed because of cholesterol, they may be due to calcium and bile salts. These stones block the flow of bile from the gallbladder Rather, causing excruciating pain that ends up.
Hernias difficult to diagnose in women
Source: Jewish Journal.com
Hernias, which occur when part of an internal organ or fatty tissue pushes through a hole in a muscle, are far more common in men than in women. As a result, many doctors don’t consider a hernia diagnosis when faced with a female patient.
Adding to the problem, the most common type of hernia is in the groin area, and their symptoms mirror other pelvic problems that tend to plague women.
Adding to the difficulty of diagnosing hernias in women, Towfigh says, is that they are often smaller than those seen in men. When a man with a hernia lies down, for instance, the hernia can generally be seen in the form of a bulge. But because of the differences in women’s bodies, a hernia may not be as prominent or even visible at all.
Bilateral hernias should be repaired simultaneously, data indicate
Source: General Surgery News
A large Swiss study has shown that bilateral total extraperitoneal (TEP) inguinal hernia repair has a risk profile comparable with that of unilateral hernia repair, a finding that suggests there is no value in delaying the second repair
Overall, the evidence shows that “for patients with bilateral inguinal hernia, a simultaneous endoscopic approach represents an .excellent therapeutic option,” the authors wrote.
An easier way to remove gallstones
For more than 100 years, the traditional treatment for the painful growths called gallstones has been removal of the gallbladder, or cholecystectomy. But a new device, patented in China, promises to make removing the entire organ unnecessary. A group of scientists from the Second People's Hospital of Panyu District and Central South University in China have developed an endoscope specially designed for locating and clearing out gallstones and other gallbladder lesions.
A tiny ultrasonic probe at the tip of the endoscope locates gallstones, even small ones embedded in the organ's lining.
Stress and weight gain - a vicious circle
Source: Medical News Today
Stress can make you fat - and being obese can create stress. A new hypothesis seeks to explain how.
Diet and lack of exercise are not sufficient to explain the worldwide rise in obesity. Stress is one of many other factors which could contribute, according to human biologist Brynjar Foss from the University of Stavanger.
The researchers review a number of studies, which show that weight gain and cortisol (the stress hormone) levels are noticeably higher in people who became fatter because of stress.
A new study published this month finally answers the question of how best to treat people with cancer of the oesophagus. Australian researchers found that there is a better chance of survival if patients have chemotherapy and radiation therapy given together just before surgery, than surgery alone.
The analysis, carried out by the Australasian Gastro-Intestinal Trials Group (AGITG), Sydney, was published in the prestigious medical journal Lancet Oncology earlier this month. It analysed data from many clinical trials and its findings are set to finally establish the standard treatment approach to localised oesophageal cancer, around the world.
"Cancer of the oesophagus is a difficult disease with poor long-term survival rates. At present only 20 percent of people who have surgery survive to five years," Associate Professor Mark Smithers, lead AGITG surgical author and Brisbane based oesophageal surgeon explained. "It was clear that although surgical practices have improved over the years, we had to do more to improve the odds
for our patients."
A recent poll of Australian hospitals showed that patients have been treated with a variety of regimens including: surgery alone, chemotherapy before surgery or a combination of chemotherapy and radiation therapy before surgery. "Doctors just simply weren’t certain which treatment regimen was best for their patients," A/Prof. Smithers said.
"The AGITG analysis is the first to conclusively show that there is a 14 percent improvement in survival if patients receive concurrent chemotherapy and radiation therapy before surgery to help prevent the spread of cancerous tumours in their oesophagus, compared to surgery alone," A/Prof. Smithers said. "If they are unfit for radiation therapy, chemotherapy alone before surgery also gives a lower but improved survival rate than surgery alone."
Internationally there have been seven research groups, in addition to the AGITG, who have conducted clinical studies to answer the question of the role of concurrent chemotherapy and radiation therapy before surgery in localised oesophageal cancer without any conclusive results. Associate Professor Val Gebski, lead author of this analysis and AGITG Group Statistician, explained that "over the last 25 years there have been many small clinical trials, including our own, trying to answer the question of what is the best treatment standard for oesophageal cancer, but each was too small to reach any definitive conclusions."
"We gathered and combined all the available data from eighteen of these small clinical comparisons and analysed them to find that there were real benefits from administering chemotherapy and concurrent radiation therapy just before surgery.
Chemotherapy sensitised the cancer cells and together with the radiation therapy produces a more effective way to kill them. This resulted in shrinkage of the tumour, making surgery more successful and thus leading to a longer life expectancy for the patient. This finding, from the detailed data analysis, is a truly significant break-through in our understanding of the optimal treatment of patients with oesophageal cancer," A/Prof. Gebski said.
The AGITG will continue to explore key unanswered questions to develop improved treatment practices by trialling new and more targeted chemotherapy agents to further improve treatment results in patients with oesophageal cancer. Please visit www.gicancer.org.au