This is a summary of a recent article in the Exceptional Parent concerning Gastro-esophageal Reflux in persons with neurodevelopmental disorders.

Gastro-esophageal reflux occurs in a large percentage of persons with neurodevelopmental disorders, especially those with the complication of motor dysfunction. Reflux, which is neurologically based in such patients, causes esophagitis and aspiration in this group of patients. The seriousness of this problem is heightened because of the sequelae of Barrett’s esophagus and the high incidence of esophageal cancer in this patient group.

Symptoms may be subtle in those with cognitive dysfunction or may involve primarily pulmonary symptoms. It is therefore important to be sensitive to subtle changes in behavior or transient episodes of shortness of breath. Gastro-esophageal refux often co-exists with pulmonary aspiration. What makes the problem of esophagitis even more serious is that reflux is suspected in such a small percentage of patients who are later proven to have it based on random screening.

A new technique of measuring intraesophageal pH by placing a radio transmitting capsule in the esophagus offers promise as far as diagnosis. It appears to lack the inconvenience of an indwelling nasal catheter which is particularly bothersome and may distort the results.

Treatment with proton pump inhibitors has been demonstrated to be effective for at least a portion of patients. For those who do not improve on proton pump inhibitors, fundoplication is the current choice, but morbidity is not insignificant.

Regarding the need for additional research, in view of the high incidence of unrecognized reflux and esophagitis and the progression to carcinoma in some patients, would some type of surveillance in patients with an IQ less than 50 be advisable? Lastly, for those patients who fail after proton pump inhibitors and require a fundoplication, would a period of parenteral alimentation prior to surgery reduce morbidity?

www.paralegalcoursesonline.com

This is a question that I am often asked.

One of the reasons may be that you are eating later in summertime.

If you’re prone to heartburn, do not eat within 3 hours of going to bed.

Summer barbeques are o/k in that you are grilling rather than frying which is a plus, but watch those tomatoes and stick with carrots and beans.

Watermelon can be acid-producing so eat only small portions.

Burgers can be acceptable, but use the leanest cuts and dress with guacamole while going lightly with catsup.

If you are taking aspirin, pain meds, antibiotics, or iron, be extra cautious as these can also promote heartburn.

www.fitness-health-beauty.com

In the past, we used to think of acid reflux as just a part of life that we had to put up with, but we now know that it can lead to other conditions the most serious of which is cancer.

Enter the PillCam ESO which is the new way to detect acid reflux disease.

The tiny camera is swallowed, taking 14 pictures a second as it travels down the esophagus.

Minutes later, the information is downloaded for doctors to make a diagnosis.

The procedure is painless and requires no sedation ulike its forerunner — endoscophy.

www.zoomwhiteteeth.com

I thought I would share this item with you by Mark Johnson, Knight Rider Newspapers

Watching professional eater Joey Chestnut struggle to coax down one final mouthful the size of a fist, one had to wonder. During a contest last week in Sheboygan, Wis., his face turned a sickly shade of crimson. His expression: extreme distress.

How much can a stomach take?

After tense moments, the food went down, though it wasn’t enough to give Chestnut, a student at San Jose State University, victory in the Johnsonville Brat-Eating World Championship. He ate 341/2 brats; Sonya “The Black Widow” Thomas ate 35, about 10,000 calories’ worth.

“I didn’t feel too good,” Chestnut said following his second-place finish.

Neither do some doctors at this point.

“It certainly doesn’t set a good precedent that we are promoting and using as entertainment binge eating,” said Joseph P. Regan, a bariatric surgeon and medical director of the Bariatric Center at Columbia-St. Mary’s hospital. “I just think we’re sending the wrong message.”

At a time when obesity has emerged into the public consciousness as one of the nation’s most serious health problems, people are binging for sport, the sports network ESPN is broadcasting the contests, newspapers, including this one, are covering the events, and countless Americans are following them.

Never has the spectacle of over-the-top overeating been more popular than it is today.

Eight years after the International Federation of Competitive Eating formed, the professional circuit it spawned has 100 events: everything from Spam to watermelon and cheesecake to chili.

There is even debate as to whether the person who scarfs down two pounds of candy bars in six minutes can be considered an athlete.

“Without any question I think of it as a sport. The issue is, does everybody accept it as such and I would grant you that not everybody does,” said George Shea, IFOCE chairman. “But (eating contests) have been around for hundreds of years, and in my belief we are more fundamental and basic and essential than many other sports, such as tennis, which in my opinion is somewhat frivolous.”

James W. Smith, head of gastroenterology at the Ochsner Clinic Foundation in New Orleans, was surprised to find ESPN broadcasting competitive eating and even more surprised to hear the eaters described as athletes.

“Oh that’s preposterous,” Smith said. “It’s something that you may have to train for, but I hate to give the word athletic to it. It seems repulsive to call it that.”

He added: “If you have a healthy gastrointestinal tract, you should treasure it.”

Shea said that many of the top competitive eaters, including Thomas and Rich “The Locust” LeFevre are not overweight, but rather quite slim.

Thomas spends an hour a day on the treadmill. LeFevre and his wife, Carlene, another competitive eater, are fruit and vegetable fanatics, except on contest days.

On its Web site, the IFOCE says it “will not sanction or promote any events that do not adhere to the highest safety regulations. … The IFOCE urges all interested parties to become involved in sanctioned events — do not try speed eating at home.”

And so far no medical studies have documented serious injuries from competitive eating.

This may be testament to the stomach’s elasticity and resilience.

“The stomach in its native form has a tremendous capacity and can be stretched over time with practice,” said Regan at Columbia St. Mary’s.

But some doctors worry that stretching the organ over and over may diminish its ability to function.

“I’ll bet if we studied some of these people we’d find their stomach doesn’t empty too well,” said Smith.

After repeated stretching, he said, the stomach may no longer return to its normal size.

This could result in food staying in the stomach longer than usual and could lead to vomiting and nausea and promote acid reflux in the esophagus.

Doctors also cite short-term health concerns.

Vomiting, in particular, worries Christian Stone, a gastroenterologist and director of the Inflammatory Bowel Disease Center at Barnes-Jewish Hospital in St. Louis.

“From repeated or forceful vomiting there’s a chance that you could tear the esophagus,” Stone said. “In the most severe case, if you tore the esophagus deep enough you will perforate all the way through the esophagus.”

Such a perforation can cause food to leak out from the esophagus, leading to infection.

However, four professional eaters interviewed during the brat contest said vomiting is rare.

Thomas said she has never vomited though she had to make frequent trips to the bathroom after consuming 11 pounds of cheesecake in 10 minutes.

Tim Janus, a rookie on the circuit known as “Eater X,” said he has never vomited after a competition.

“Sometimes I’ve wanted to,” he said. “But no.”

A good burp, he said, often relieves the sick feeling.

Hope you enjoyed this story.

www.paralegalcoursesonline.com

Below are comments from a recent edition of the Manilla Bulletin which may be of interest to heartburn sufferers.

Heartburn is a harsh burning sensation in the upper abdomen that radiates through the chest and into the throat and neck. It’s a symptom of Gastroesohageal Reflux Disease or GERD, a condition in which stomach reflux or acids surge upward to the esophagus. The common signs are vomiting, difficulty in swallowing, chronic coughing or wheezing, hoarseness, sore throat, or sleeping difficulty,” said Dr. Rolando Mendiola, an expert on laparoscopic surgery at Asian Hospital.

Dr. Mendiola explained that a high-pressure zone at the bottom of the esophagus called the “lower esophageal sphincter,” acts like a valve to the stomach. It remains close until swallowing forces the valve to open. Normally the sphincter closes immediately after swallowing to prevent reflux. But when it fails to close, it allows stomach acids to surge back into the esophagus thus irritating the lining and causing a burning sensation.

Some people are born with a naturally weak sphincter. Dr. Mendiola suggests to control the intake of food and beverages that easily weaken the sphincter’s muscles and damage the lining of the esophagus like chocolate, peppermint, coffee, softdrinks, tomato products, and pepper.

For others, fatty and spicy foods, certain types of medication, tight clothing, heavy smoking and alcohol intake, vigorous exercise or changes in the body position (bending over or lying down), may also cause heartburn.

If left untreated, heartburn may lead to serious complications, such as inflammation of the esophagus, ulcer bleeding, tissue scars, or even cancer. Some people may also experience asthma, chronic cough, swallowing difficulty, and pulmonary fibrosis.

Normally, heartburn can be treated through lifestyle changes that include changing diet, losing weight, altering eating and sleeping patterns, and over-the-counter antacids. But if heartburn symptoms still persist, long-term drug therapy may be required such as H2 Blockers and Proton-Pump Inhibitors or PPI.

www.zoomwhiteteeth.com

I forgive you if you have not heard of a Laparoscopic Nissen Fundoplication ….it was also new to me, but on September 7, 2005 at 4 pm EDT, Alexander Rosemurgy, MD, FACS, Professor of Surgery at the University of South Florida and a surgeon at Tampa General Hospital, will present live over the internet a Laparoscopic Nissen Fundoplication.

This procedure is an excellent long-term treatment option for acid reflux, commonly referred to as ‘heartburn.’

With the patient under general anesthesia, surgeons use 5 half-inch incisions to enter the abdomen through cannulas (narrow tube-like instruments).

The laparoscope, which has a tiny video camera, is inserted through a small incision allowing the surgeon to view the patient’s internal organs on a TV screen.

During the procedure the stomach is configured to form a ring around the esophagus ( similar to the placement of a napkin ring) which will function as a valve between the esophagus and the stomach.

Prior to the development of this laparoscopic procedure, surgeons had to make a large abdominal incision and recovery time was extensive. The Laparoscopic Nissen Fundoplication reduces recovery time and in the vast majority of cases eliminates the need for acid reflux medication.

Sounds like interesting viewing.
Program preview and doctors’ comments,
www.or-live.com/tgh/1332 now

www.zoomwhiteteeth.com

Easing Nighttime Heartburn/Acid Reflux

Almost eight in 10 heartburn sufferers experience symptoms at night.

If you do not relish the thought of staying up all night, these suggestions from the American Gastroenterological Association should help:
Eat your big meal at lunch instead of at night. …(Also good for weight control) That way, your stomach will not still be working on that big meal when you go to bed.
It may also be helpful to eat a number of smaller meals spread throughout the day rather than load up at night.

www.zoomwhiteteeth.com

When I first started investigating Acid Reflux disease, I must admit that I was surprised that it was also a problem for children.
This report from Dr. Herschel R. Lessin, medical director of the Children’s Medical Group outlines this problem
Gastro-esophageal reflux disease — commonly called GERD — occurs in people of all ages, including infants. As you are probably aware, when we all eat, the food travels through the tube called the esophagus into the stomach. This is supposed to be a one-way trip. There is a muscle where the esophagus joins the stomach called a sphincter. In some people, this muscle is not as tight as it should be, and it allows stomach contents to enter the esophagus. In its mildest form, adults experience this as “heartburn.” The acid contents of the stomach cause a burning feeling in the esophagus.

In infants, the esophagus is not that long and there is not much distance between the stomach and the mouth. Therefore, when there is reflux in young infants, it often manifests itself as “spitting up.” Spitting up is not the same a vomiting. Vomiting is forceful and usually distresses the patient. Spitting up is not forceful and the baby usually doesn’t seem too bothered by it. I wish mom could say the same thing.

In its mildest forms in infants, the baby spits up a bit and no one much cares. As the amount of spitting increases, however, it gets to be a much bigger problem. The infant is losing a lot of her food intake to spitting. The parent is cleaning up messes all the time. The acid contents of the stomach can irritate a baby’s esophagus in the same burning way as that of an adult. If it goes on too long, reflux can damage the lining of the esophagus, causing ulcerations or cellular changes.

Thickening up the food

For very mild reflux, the mainstay of treatment is thickened, upright feedings. Basically, you are using gravity as your friend. It is harder for formula to reflux if you are in an upright position. It is also important not to “jostle” the baby or burp the baby too vigorously, as this makes it easier for formula to escape the stomach and come back up.

We will often recommend thickening up feedings with cereal. This is simply a mechanical method of thickening the stomach contents. When feedings are “gloppier,” it is harder for them to reflux up the esophagus. For many infants, this type of positioning and thickening of feedings is all the treatment needed. In some, however, there is a large amount of spitting that doesn’t respond well to this conservative treatment. The baby is often irritable and seems to be in pain. Therefore, the next level of treatment is a medication, such as Zantac and many others, which suppress stomach acid. This helps relieve the irritability and for some reason, also seems to reduce the amount of spitting up.

If symptoms still do not respond, there are other medications that increase the muscle tone of the sphincter. These have significantly more side effects than drugs like Zantac, which are generally quite safe.

If reflux is severe and results in poor growth, ulcerations and pain, the last resort is a surgical procedure that wraps part of the stomach around the lower esophagus, tightening the junction between the two and eliminating the reflux condition. Obviously, this is a serious operation and used only in the most severe of cases.

The more severe cases of gastro-esophageal reflux disease in children need to be treated by a pediatric gastroenterologist and may require invasive procedures such as endoscopy, where a flexible tube is inserted through the mouth, down the esophagus, and into the stomach to visualize that anatomy and the pathology in the area. Fortunately, this is rarely needed, and easy treatments such as thickened upright feedings with or without Zantac-type drugs suffice to provide relief to the infant and her family.

Dr. Herschel R. Lessin is medical director of the Children’s Medical Group, with offices in Poughkeepsie, Hopewell Junction, Fishkill, Rhinebeck, Modena and Newburgh. Send questions to oncall@childrensmedgroup.com

www.profitcourse.com

Regular readers will recall a recent post in which I mentioned that Acid Reflux problems are often the result of a lack of stomach acid rather than an excess.

This Red Nova article caught my eye which once again brings up this aspect of acid reflux disease and I quote it below.

“So, eating foods that contain acids that mimic the stomach acids- -such as grapefruit–might, in theory, help the body digest foods and therefore prevent heartburn. But, let’s note: No studies exist showing that eating grapefruit helps cure heartburn, and, in fact, many doctors recommend eliminating citrus completely (along with tomatoes, another high-acid fruit) if you have a problem with heartburn. ”

www.paralegalcoursesonline.com

I know that most people reading this are nowhere near Elk Grove Village, but just in case, I thought it was worth reporting this note from Red Nova News
Acid Reflux Focus of Class Free Seminar to Offer News of Treatments, Cause of Disease.
Do you have heartburn, a sour taste in your mouth or abdominal pain?
If so, stop by Elk Grove Village-based Alexian Brothers Hospital Network’s free seminar called “Gastroesophageal Reflux Disease: Burning New Issues in the Treatment of Heartburn” at 7 p.m. Monday at the Elk Grove Village Library, 1001 Wellington Ave. in Elk Grove Village.
Mitchell Bernsen, a board certified gastroenterologist, will discuss symptoms, causes and medical treatments.
Gastroesophageal reflux disease is a digestive disorder caused by gastric acid flowing from the stomach into the esophagus.
It’s commonly referred to as GERD or acid reflux.
If left untreated, the problem could evolved into a condition far more serious, Bernsen said.
“The people who are untreated end up having burnt scar tissue in the esophagus,” Bernsen said.
In some cases, the condition leads to cancer, he said.
Heartburn, a burning pain in the chest, is the most common symptom of the condition.
About 10 percent of the population experiences it at least once per week, according to the Maryland-based American Gastroenterological Association.
For more information or to register, call (866) 253-9426.
Source: Daily Herald; Arlington Heights, Ill.

www.zoomwhiteteeth.com

www.paralegalcoursesonline.com