Digestion Related Disorders

1. Digestion Related Disorders

2. The digestive system • A collection of organs that work together to digest and absorb food. • Includes mouth, esophagus, stomach, intestines, and accessory organs.

3. What organs are affected? • Digestive related disorders can affect one or more of the digestive organs.

4. Disorders • Gastroesophageal reflux disease (GERD) • Lactose intolerance • Ulcers • Appendicitis • Irritable Bowel Syndrome

5. Gastroesophageal Reflux Disease(GERD) • AKA acid reflux • Chronic digestive disease that occurs due to repeated backflow of stomach acid to the esophagus • Causes irritation of esophagus

6. Symptoms • Heartburn – most common • Regurgitation of food or sour liquid • Coughing • Chest pain • Difficulty swallowing • Nausea

7. Treatments • Lifestyle changes • Dietary changes: avoids certain foods(fatty foods, alcohol, acid-containing foods) • Stop Smoking • Chewing gum • Light exercise after meal • Elevate upper body in bed • OTC medication • Antacids – tums, pepto, milk of magnesia • Histamine antagonists • Proton Pump Inhibitor (PPI) • Surgery • 80% success rate • Risks

8. Current news • Stretta Procedure • Type of endoscopic surgery; AKA Minimally Invasive Surgery(MIS) • Uses radiofrequency waves to strengthen the lower esophageal sphincter • Quick procedure and quick recovery time.

9. Lactose Intolerance • The inability or insufficient ability to digest lactose • Caused by a deficiency of the enzyme lactase • Lactase breaks down lactose into glucose and galactose for absorption by the small intestine • Three causes: • 1) Congenital – absence of lactase from birth due to a mutation; very rare • 2) Secondary – diseases that destroy lactase in the small intestine • 3) Primary(Developmental)– natural decrease in lactase after childhood; most common • can vary among different ethnic groups • almost 100% of Asians • 80% of American Indians • 70% of Blacks • 20% of Caucasians

10. Symptoms • Abdominal pain • Abdominal bloating • Gas • Diarrhea • Nausea • Flatulence (passing gas) • Varies in severity among different people

11. Treatments • Dietary changes • Reduce intake of lactose • Milk substitutes such as soy and rice milk • Ingest milk-containing foods during meals. • Supplements of lactase enzyme • Adaptation • Slowly increasing intake of lactose

12. Current News • There is no cure for lactose intolerance

13. Ulcers * Ulcers are sores/wounds located on your digestive track. * Affect about 4 millions Americans a year. * Esophagus, stomach, duodenum. * duodenal ulcers/peptic ulcer- Ulcers located at duodenum (Commonly found here) * gastric ulcers- Ulcers located in stomach. * esophageal ulcers- Ulcers located in esophagus. *Not often too serious, just stomach pain. Sometimes symptoms may not even show. *Serious ulcers often start to bleed. - Perforation: When ulcers start get bigger and break through stomach area. - Obstruction: Stops food from going into stomach when results to vomiting, nauseousness, and weight-loss.

14. Causes of Ulcers: * Before, doctors mistaken it was due to stress or consuming food with too much acid. Digestive tract can be damaged if theres a large amount of acid in the body or digestive tract is already impaired to begin with. * Stress can contribute to worsening an ulcer but does not produce one. *It may be what you eat that produces ulcers, but it depends on different people. *Drinks/food with caffeine or are decaffeinated are most likely to worsen the pain. *After research, ulcers have been proven to be caused by an infection & by anti-inflammatory medicines. *Caused by infection - Helicobacter pylori/H. Pylori *Caused by anti-inflammatory medicines - Long usage may cause ulcers to produce. - Examples: Aspirin, Ibuprofen (one brand name: Motrin), Naproxen (brand name: Aleve), Ketoprofen (brand names: Actron, Orudis KT) and some prescription drugs for Arthritis.

15. Peptic Ulcers Esophageal Ulcers Gastric Ulcers

16. Symptoms: - After you consume food/drink you start to feel worse about an hour or 2 later - After you consume food/drink you feel worse - Waking up feeling pain in the stomach - Getting full quick - Heavy feeling - Bloating - Stomach feels like it's burning - Vomiting *Vomit food from days before(severe ulcer) - Losing weight

17. Treatment/Medicine: * Eliminating the H. pylori bacteria(triple therapy) - Triple therapy: eliminating H. pylori bacteria with collaboration of two antibiotics bismuth subsalicylate (Pepto- Bismol).Triple therapy lessens acid stomach produces. - Other combinations *H2 blockers & proton pump inhibitors - Lessens acid that your stomach produces. You should feel better within 3 days. *Antacids - acid in stomach gets neutralized. *Sucralfate - covers the ulcer in order to shield it from the acid so it eventuall heals. *Misoprostol - lower down amount of acid in body & shields lining of stomach commonly used by those who need to take anti-inflammatory drugs. * Ulcers go away within 2-3 weeks. If symptoms come back, it is recommended to change in to a another type of medicine or take low dosage regardless if there are no ulcers just to keep it from reappearing.

18. Tips: * Refrain from alcohol & smoking. ( damages digestive tract) * Don't use anti-inflammatory drugs like aspirin & ibuprofen. * Obtain caffeine little as possible. * Don't consume spicy food that causes heart burn.

19. Appendicitis: - inflammation of appendix. - appendix: small pouch connected to large intenstine. * It is possible to live without an appendix. - most common causes of emergency abdominal surgery in U.S. - Causes: * Blockage by stool, a foreign object, or sometimes a tumor(cancer).

20. Symptoms: • It varies. However, its harder to cure when it comes to children, the elderly , and older women who are trying to have kids. • First symptom is usually around the belly button that becomes more severe if not treated. • When pain gets more severe it migrates to right lower abdomen and above the appendix (McBurney's point). • Could get peritonitis(inflammation of abdominal cavity) • Other symptoms that occur later: Fever, Nausea, Vomiting, Loss of Appetite, Diarrea, Constipation, Chills, Shaking

21. Tests: • Doctors test to see if you have Appendicitis by putting pressure to where your belly button is located. • Usually they can tell by symptoms you indiciate. Abdominal CT scan: x-ray images of the abdomen.     • Abdominal ultrasound: Diagnostic laparoscopy (surgery to look directly) • Before they also used a drug called NeutroSpec, but it was eliminated due to severe side effects.

22. Treatment: •  Appendectomy (removing appendix) • Removing appendix even if its okay to look into your abdomen for other explanations of pain • Get treated for infection from having abscess (dead neutrophils) after rupture of appendix and then getting your appendix removed. • * rupture causes patient to heal slowly

23. Irritable Bowel Syndrome(IBS)

24. What is IBS? • Chronic problem with the large intestine • Food moves through intestines too quickly or too slowly • Causes discomfort and emotional distress • Does not damage large intestine

25. Symptoms of IBS • Bloating and Gas • Mucus in the stool • Constipation • Diarrhea after eating or first thing in the morning • Alternating between Constipation and Diarrhea • Feeling like you need to have bowel movement after just having one • Feeling strong urges to have bowel movement • Abdominal pain and cramping that goes away after bowel movement

26. Diagnosing/Treating IBS • IBS is can only be diagnosed by a doctor • Your doctor will ask you questions regarding common IBS symptoms and if the pattern of symptoms appear in a pattern, it is most likely IBS • If the symptoms have only recently begun, the causes for the symptoms may be from something else • There is no cure for IBS • You can manage your symptoms by eating a healthy diet and avoiding foods that make you feel worse • Find ways to handle your stress

27. Ways to calm IBS • Fiber • Watch your diet • Manage your stress

28. Fiber ! • Fiber • Soluble fiber helps both diarrhea and constipation. It dissolves in water and forms a gel-like material. Many foods, such as apples, beans and citrus fruits, contain soluble fiber. Psyllium, a natural vegetable fiber, is a also a soluble fiber. You can buy psyllium supplements (some brand names: Fiberall, Metamucil, Perdiem) to drink and you can add it to other foods. • Insoluble fiber helps constipation by moving material through your digestive system and adding bulk to your stool. Insoluble fiber is in whole grain breads, wheat bran and many vegetables.

29. Diet • Foods do not cause IBS, but certain foods may cause symptoms to appear and make you feel worse. • Keep track of foods that bother you, common foods are: • Drinks with caffeine, such as coffee, tea or soda • Milk products • Alcohol • Chocolate • Wheat, rye or barley

30. Manage your stress • Stress can trigger symptoms of IBS • Ask your doctor about handling stress • Relaxation training or even expressive writing • Talk to a counselor on problems that are bothering you

31. Severe IBS • In severe cases of IBS, the doctor may prescribe medication to lessen the symptoms • Different problems require different medications • Diarrhea: Loperamide • Cramping: Antispasmodic medicines

32. Long term effects of IBS • IBS does not get worse over time • IBS will never go away • It will recur later even if you think it has gone away • It does not cause cancer, require surgery, or shorten your life

33. Citations • Spiegel, B. M, R Bolus, L Harris, S Lucak, W Chey, G Sayuk, E Esrailian, A Lembo, H Karsan, K Tillisch, J Talley, and L Chang. "Characterizing Abdominal Pain in IBS: Guidance for Study Inclusion Criteria, Outcome Measurement and Clinical Practice." Alimentary Pharmacology & Therapeutics, 32.9 (2010): 1192-1202. • Weinland, Stephan, Sharon Jedel, Ashley Messina, and Douglas Drossman. "S1336 a Qualitative Examination of Irritable Bowel Syndrome (IBS) Symptom Episode Experience Via Online Survey." Gastroenterology, 138.5 Supplement 1 (2010): . • Halpert, Albena, Denis Rybin, and Gheorghe Doros. "Expressive Writing is a Promising Therapeutic Modality for the Management of IBS: A Pilot Study." American Journal of Gastroenterology, 105.11 (2010): 2440-2448. • Ayazi S, Hagen JA, Chan LS, et al. (August 2009). "Obesity and gastroesophageal reflux: quantifying the association between body mass index, esophageal acid exposure, and lower esophageal sphincter status in a large series of patients with reflux symptoms". J. Gastrointest. Surg. • Kahrilas, PJ (2008). "Clinical practice. Gastroesophageal reflux disease.". New England Journal of Medicine. 359 (16): 1700–1707. • Flatz G (1987). "Genetics of lactose digestion in humans". Adv. Hum. Genet.16: 1–77 • G.D. Smith et al., Lactase persistence-related genetic variant: population substructure and health outcomes. European Journal of Human Genetics, 2008. • Hobler, K. (Spring 1998). "Acute and Suppurative Appendicitis: Disease Duration and its Implications for Quality Improvement"Permanente Medical Journal • Kurata Ph.D.,M.P.H., John H.; Nogawa, Aki N. M.S. (Jan 1997). "Meta-analysis of Risk Factors for Peptic Ulcer: Nonsteroidal Antiinflammatory Drugs, Helicobacter pylori, and Smoking