Thursday, July 26
Increase in obesity linked to rising numbers of esophageal cancer cases.
For most of his adult life, 49-year-old Jim Bonell suffered from acid reflux, but he never considered the condition dangerous. That is, until he was diagnosed with esophageal cancer.
What Bonell didn't know was that his chronic acid reflux left him with a condition called Barrett's esophagus, which puts people at high risk for esophageal cancer. Barrett's is a condition in which the cells lining the lower esophagus change because of repeated exposure to stomach acid. Normally, the tissue lining the esophagus is similar to the lining in your mouth (squamous mucosa), but with Barrett's, the body replaces the normal esophageal lining with one similar to that found in the intestines.
"There were no symptoms that I had esophageal cancer," says Bonell. "Prior to being diagnosed, my acid reflux was really bad and getting worse. I was a Tums-eater. I'd eat a whole bunch of them."
Esophageal cancer rates are on the rise, and the increase may be due to an increase in obesity, says Mark B. Orringer, M.D. professor and head of thoracic surgery at the University of Michigan Health System. Obesity often causes a hiatus hernia and associated acid reflux.
Esophageal cancer has always carried a terrible prognosis. But thanks to an increasing awareness that heartburn may have serious implications along with earlier detection, improved staging tests and better treatment many patients like Bonell are winning the battle with this initially "silent" cancer.
Bonell has benefited from some of the surgical advances developed and refined at the U-M Health System. Traditionally, patients who needed to have their esophagus removed–either for esophageal cancer or Barrett's esophagus – underwent highly invasive surgery that involved opening the chest and abdomen.
But Orringer and his colleagues developed a procedure, called transhiatal esophagectomy, in which the esophagus is removed through incisions in the abdomen and the neck, without the need to open the chest.
Once the esophagus is removed, the stomach is freed up from attachments holding it in the belly and it is pulled up through the chest. The stomach is then connected to the remaining esophagus in the neck.
The risk of infection is significantly lowered with this procedure because if any leak at the connection in the neck occurs, the resulting infection drains externally rather than in the chest, says Orringer. Further, by avoiding the traditional chest incision, pneumonia after this operation is much less common.
"In a recent study of more than 2,000 patients who have undergone a transhiatal esophagectomy at the University of Michigan, the hospital mortality rate in the last 1,000 patients was 1 percent; that's one death in 100 operations," he notes. "When I began as a faculty member in 1973, the mortality for esophagectomy was as high as 20 percent at many institutions."
This development in surgical treatment is important given the dramatic rise in cancer cases that doctors believe stems from obesity and acid reflux. Twenty years ago, the most common type of esophageal cancer was squamous cancer, which arises from the squamous mucosa that lines the normal esophagus.
But in the past 10 to 15 years, there has been a 350 percent increase in adenocarcinoma of the esophagus, a type of cancer that is related to the cellular changes in the esophagus that are the hallmark of Barrett's. It is now the most common form of esophageal cancer, occurring in 80 percent to 90 percent of patients. This increase in esophageal adenocarcinoma mirrors the rise of the obesity epidemic.
"There's no question that the incidence of esophageal cancer is increasing dramatically. We have an epidemic of obesity in this country," says Orringer. "I can't walk into a social setting where there are not some people who are quite overweight and complain of heartburn or acid indigestion. I think we should be very concerned."
Five tips for preventing Barrett's Esophagus and esophageal cancer
1. Work on losing weight. Obesity leads to hiatus hernia and reflux which are in turn responsible for the increasing rates of esophageal cancer. Talk to your family physician about developing a plan to lose weight by eating well and exercising regularly.
2. Don't lie down after eating. For those with acid reflux, the valve between the esophagus and the stomach doesn't function properly, allowing the contents of the stomach to back up into the esophagus. Lying down can make this problem worse, leading to late-night heartburn. Be sure to eat early to give your stomach time to empty before bedtime.
3. Sleep propped up. Lying down can exacerbate acid reflux. If you have reflux, consider arranging pillows so that your head and upper chest are elevated while you sleep. Stomach acid, like water, does not roll uphill.
4. Take an antacid. Neutralize stomach acid before it backs up into the esophagus with antacids.
5. Talk to your doctor. If you have a long history of severe heartburn or acid indigestion, talk to your doctor about Barrett's esophagus, which increases your risk of developing cancer. Even if your acid reflux symptoms are controlled, you still could be at risk. The only way to diagnose Barrett's is with an endoscopy and biopsy. Esophageal cancer can be cured, if it is diagnosed early.
Saturday, July 21
Heartburn in pregnancy is actually quite common. Follow these simple tips to help alleviate your symptoms...
During pregnancy, common everyday ailments tend to feel worse, especially during the first and third trimesters. Heartburn is no different. Heartburn is a common ailment, and during pregnancy it tends to surface even more. Most women experience heartburn in pregnancy at some point during their nine-month journey. However, some can be affected worse than others. Fret not -- there are things you can do to limit the severity of heartburn during your pregnancy.
During the third trimester the baby grows big enough to put pressure on your stomach. This causes the acid in the stomach to reflux. This can be easily avoided, however by avoiding binging and by eating small meals. This will keep acid reflux at bay. Instead of eating three large meals, try to eat five to six smaller meals spread throughout the day.
Your sleeping position can also cause acid to reflux. Sleep with your head and torso elevated to keep the food down in your stomach. Keep yourself comfortable by putting a pillow under your head and your back. Also, try to avoid going to bed within two hours of eating. Wait at least two hours before lying down to give your body some time to digest the food. As a general rule, go to bed two to three hours after you eat to mitigate heartburn in pregnancy.
Watching your posture can help prevent heartburn from occurring. Putting pressure on your stomach can cause heartburn in pregnancy. When you sit, do so in an upright position to keep the pressure off your stomach. When you stand or walk, keep your posture erect for the same reason.
A less common way to alleviate heartburn is to wear loose clothing. (Though you probably do this already.) This will also ease the pressure in your stomach. Wearing tight clothing puts unnecessary strain on your stomach and can encourage acid to come up into your espohagus, causing heartburn in pregnancy.
Perhaps the best way to avoid heartburn all together is to stay away from foods that are known to cause heartburn. For obvious reasons, alcohol should be avoided at all costs during pregnancy. Also on the restricted list are chocolate, citrus fruits, tomato-based foods, soft drinks, coffee and acidic juices.
Sipping water throughout your daily activities as opposed to chugging it occasionally can also help. Avoid fried food, food rich in fat and vinegar as well. Large quantities of water can actually increase heartburn in pregnancy. By eliminating these foods from your daily diet, you can alleviate the symptoms of heartburn in pregnancy.
For other tips on how to get rid of heartburn visit http://www.stopheartburntoday.com We'll help you find relief from your heartburn symptoms through medications for acid reflux and natural remedies as well.
Sunday, July 15
There are some simple rules, some foods to avoid, and a sleeping position that are proven to limit, and even eliminate GERD and the GERD effect.
Rules to follow:
1. Do not eat later than 3 hours before plan to sleep. Generally, try to eat early in the evening, and always make the evening meal a light one.
2. Reduce your weight.
3. Stop smoking
4. Do not wear very tight clothing that could constrict the abdomen
5. Generally do not eat large meals, but smaller ones, and in the evening before reclining, do not eat any food on the restricted list.
6. Before sleeping, spend a few moments at a window and do some deep breathing, inhaling and exhaling deeply.
This will energize your nervous system and can assist in the prevention of GERD if the other measures are also followed.
Dietary Restrictions: The evening meal must not be large, or heavy, and completed no later than 3 hours before your intended sleep.
Saturday, July 7
There are many different medications for the quick relief of acid reflux disease. However, an easy and effective long term solution can be as simple as following an acid reflux diet.
The first thing to do is eat smaller meals more frequently throughout the day. If you do this, your stomach will produce less acid for the smaller amount of food, therefore less acid will be available to enter the esophagus. The type of foods to avoid with acid reflux are foods that are low in fat, all vegetables(not fried), non citrus fruits, decaffinated beverages, and non spicy foods. Foods that would aggrevate or cause reflux and should be avoided are high fat foods(especially fast food), alcohol, chocolate, foods containing caffeine, peppermint and spearmint, Onions, and tomato products.
Friday, July 6
Your doctor may perscribe a stronger medication to help a more serious acid reflux condition if over the counter medications don't help.
One type of medication, called a proton pump inhibitor, stops the production of an enzyme that produces stomach acid. This medication is more effective in stopping acid from being produced than the over the counter Histamine-2 receptor blockers.
Doctors also prescribe promotility agents. This medication strengthens the lower esophageal sphincter to help the food in the stomach empty faster
Monday, July 2
Antacids are a very effective way to help relieve acid reflux symptoms. If you take them 1 hour after meals they neutralize the acid in your stomach making it less likely for acid to reflux into the esophagus.
Histamine-2 receptor blockers are also available over the counter. This medication prevents acid production. These must be taken at least 1 hour before meals since they can only prevent acid from being produced, not eliminate it if it already exists.