Johns Hopkins Health Alerts - Digestive Health

Alternative Goes Conventional for IBS

Mon, 05 Oct 2009 06:00:00 CDT

If you have irritable bowel syndrome (IBS), you may have tried a variety of alternative therapies -- probiotics, cognitive behavioral therapy, biofeedback, acupuncture, or simple dietary changes -- to reduce your painful symptoms. In this excerpt from a longer article from our Health After 50 newsletter, Linda Lee, M. D., Assistant Professor of Gastroenterology at Johns Hopkins talks about alternative treatment for IBS.

IBS is one of the most commonly diagnosed conditions in the United States. People with IBS generally experience abdominal pain, bloating, constipation, and diarrhea, but symptoms vary greatly. For some patients, IBS is just a mild inconvenience, while others have such severe IBS symptoms they fear leaving the house.

Relief can be hard to find, because IBS is poorly understood; the cause is unknown, and not all people respond to available medications. So many patients, particularly those who already take drugs for other conditions, are turning to nonmedical, alternative strategies to manage IBS.

According to one estimate from the University of Washington, as many as half of IBS patients seek alternative care. The National Institutes of Health has formed the National Center for Complementary and Alternative Medicine to promote research into this area of medicine, and several major medical institutions, including Johns Hopkins, Duke, Harvard, the Mayo Clinic, and Stanford (among others), have joined the Consortium of Academic Health Centers for Integrative Medicine.

While "alternative" implies that patients use natural or nonmedical therapies instead of conventional medicine, in fact, many patients couple these approaches with conventional care under the supervision of medical doctors. This combination is commonly referred to as integrative medicine. For instance, at the Johns Hopkins Integrative Medicine and Digestive Center, patients meet with specialists in complementary medicine and a board-certified gastroenterologist.

While evidence for complementary therapies is inconclusive, Linda Lee, M. D., Assistant Professor of Gastroenterology at Johns Hopkins points out, "Not many data support standard pharmacological interventions for IBS, either. Medicine can treat certain symptoms of IBS, but there isn't a proven cure in either conventional or complementary care. Since these symptoms are highly subjective, an integrative approach may be the best way to control IBS."

The Truth About Food Safety Claims

Mon, 14 Sep 2009 06:00:00 CDT

As germ-laden as your bathroom might seem, there's another room in your house even more likely to make you sick: your kitchen. That's because foodborne illnesses cause 76 million infections -- including 325,000 hospitalizations and 5,000 deaths -- in the United States every year. Fortunately, most foods are safe and contain only small amounts of microscopic agents that are usually harmless. It's only when these organisms are allowed to multiply through improper handling that they become a problem. Here are some tips on keeping your food safe.

The Claim: All produce needs to be washed before eating.

The Truth: Almost. Anything prepacked and marked “prewashed” -- such as bagged salad or spinach -- should be safe as it is. However, as an extra measure of caution, you can wash this type of produce just before you use it. For produce that’s not prebagged, it’s a good idea to remove the outer layers of leafy vegetables like cabbage and lettuce.

Run everything under running water just before eating, cutting, or cooking. This includes food with peels that you don’t eat, like melons. If the peel is contaminated, slicing through it with a knife will spread the problem to the fruit inside. If the produce has a hard, edible surface, like cucumbers or potatoes, use a produce brush. Dry your produce with a paper towel to wipe away additional bacteria.

The Claim: Organic products decrease your risk of a foodborne illness.

The Truth: There haven’t been enough large studies to determine the relative safety of organic meats or produce. But while consumers may think that organic products like chicken harbor fewer bacteria -- because of less crowding and more natural diets that don’t contain pesticide residue, hormones, or antibiotics -- they may, in fact, be even more susceptible.

Organic farmers typically use manure instead of commercial fertilizers, so crops and animals may have more exposure to bacteria. A study conducted by the USDA reported that while commercial chickens processed from 2000 to 2003 had a Salmonella rate of 9% to nearly 13%, a sample of 53 all-natural chickens had a 25% rate of the bacteria; on one particular organic farm, 60% of the chickens tested positive for Salmonella.

The bottom line is that the safety of an organic product depends on the practices of the farm it comes from, which are impossible to know. If you buy organic meat or produce, take the same food preparation precautions that you would with conventional foods.

The Claim: Buying products that are locally grown cuts your risk of contamination.

The Truth: If you consider anything raised in the United States as local, then possibly. Food and water standards are much higher here than in many other countries. Seafood is required to state its country of origin on the label, and packaged fruits often opt to as well, so you can keep an eye out for products that come from the United States.

As for really buying locally and seeking out produce from small farms in your region, you may cut some risk because the food isn’t processed in large facilities that mix products from many farms. But there are no guarantees that the produce is any safer, as smaller farms contend with the same handling issues as larger farms and factories.

Keep in mind that locally grown food is not necessarily organic. Many of your local farms may use conventional farming techniques— so if you’re buying local to avoid pesticides, ensure that the product is labeled organic, too.

Should You Try a Gluten-Free Diet?

Mon, 26 Oct 2009 06:00:00 CDT

People with celiac disease are sensitive to gluten, a component of wheat and other grains. No medication or surgical procedure can cure celiac disease. The only way to treat it is to adopt a completely gluten-free diet: avoiding all food and drink containing wheat, barley, rye, and other grains. But what if you don’t have celiac? Is a gluten-free diet good for your health?

As diagnosis and awareness of celiac disease have increased, a wide variety of gluten-free foods have hit store shelves. While these products are essential for people with celiac disease and gluten sensitivity, their benefit for others is less definitive.

Celiac disease causes intestinal damage that's visible on a biopsy. Gluten sensitivity, meanwhile, may cause some of celiac disease's gastrointestinal (GI) symptoms -- diarrhea, gas, bloating, vomiting, and constipation -- but not intestinal damage. There's no evidence that gluten sensitivity will one day turn into celiac disease, so avoiding gluten is more about reducing present symptoms than preventing future damage.

Gluten alone is not harmful to anyone without celiac disease, but it is present in many unhealthy foods. Refined carbohydrates can make you feel sluggish, but it's probably the spike in blood glucose levels and the lack of fiber -- not the gluten -- that's to blame.

If you have GI symptoms, see your doctor before adopting a gluten-free diet. You may need to be tested for celiac disease, and going gluten free beforehand can make intestinal damage less obvious on a biopsy.

For people without celiac disease or gluten sensitivity, a strict gluten-free diet probably isn't worth any potential health benefits: It can be deficient in some nutrients, such as B vitamins (particularly folic acid).

What Works for Chronic Constipation

Mon, 16 Nov 2009 06:00:00 CST

According to the American College of Gastroenterology, Americans make at least 2.5 million visits to the doctor for constipation each year. Because constipation is so ubiquitous and has been noted since ancient times, there are many widely held beliefs and myths about its treatments and consequences -- beliefs that have persisted, despite the absence of medical evidence to prove they are true.

In an article published in the American Journal of Gastroenterology, digestive disease experts reviewed these long-held beliefs and revealed the current evidence for and against them.

They note that there is no data to show that when stools remain in the body for a long time, which occurs when you’re constipated, that they poison the colon. Likewise, there’s no evidence to prove that cleansing the colon regularly can reverse the symptoms. (For a discussion of colon cleansing, see the article: Colonics: How Risky Are They?)

The reviewers also state that although increasing fiber intake undoubtedly makes stools bulkier and easier to pass, and increases the frequency of bowel movements, the role of fiber in the treatment of constipation has been exaggerated. Indeed, there are no studies to show that a lack of dietary fiber is responsible for chronic constipation. And too much fiber may actually make symptoms worse for some people with constipation.

Likewise, it’s been suggested that a low intake of fluids may lead to constipation, and that drinking more fluids may soften and enlarge hard, small stools, making them easier to expel. But there’s no scientific evidence for this either, and it appears that increasing fluid intake won’t help constipation unless you’re severely dehydrated.

One idea that does hold scientific weight is the link between physical activity and constipation. In elderly and sedentary people, increasing exercise may relieve some of the symptoms of mild constipation. Still, it is unlikely that stepping up activity will have much effect on severe cases of constipation.

Finally, the reviewers note that a number of misconceptions exist about the use of laxatives to relieve constipation. Urban legend says that you can get addicted to laxatives and that frequent use increases the risk of colorectal cancer and nerve damage, but the data show otherwise. When used at recommended doses, laxatives are safe and nonaddicting. Still, if you need to take laxatives for more than a week at a time, you should see your doctor for further advice.

The Promise of Probiotic Yogurt

Mon, 03 Aug 2009 06:00:00 CDT

Evidence suggests that yogurt may help maintain a healthy gastrointestinal tract, and some companies are introducing products with extra bacteria. But are new products like Activia, which is marketed to regulate the digestive system, all they claim to be?

All yogurts contain the starter cultures Lactobacillus bulgaricus and Streptococcus thermophilus -- without them, you'd just have milk. But several manufacturers of yogurt -- and other products -- are beginning to add extra probiotic strains in the hopes of providing extra health benefits.

Dannon Activia was the first yogurt to market itself as "probiotic," meaning that it has added live bacterial cultures. It contains Bifidobacterium animalis DN-173 010, which Dannon trademarked and markets as Bifidus regularis in the United States. This strain has been shown to survive the trip through the digestive tract and reach the colon intact.

Dannon claims that Activia is "scientifically proven to help with slow intestinal transit when eaten daily for two weeks as part of a balanced diet and healthy lifestyle." In other words, it speeds the path of food through your body and may help with constipation.

Prior to Activia's launch in 2006, studies were conducted on B. animalis DN-173 010, all with a certain amount of involvement by Dannon and often at its research facility in France. In a double-blind, crossover study published in Alimentary Pharmacology & Therapeutics, researchers gave three 4-oz servings a day of either normal yogurt or yogurt with B. animalis DN-173 010 to 36 healthy women. During two 10-day treatment periods, transit time (the time it takes for food to travel from the mouth to elimination) was significantly shorter in the B. animalis group. The improvement was more significant in women who normally had a transit time of 40 hours or more.

In another randomized, controlled study, 267 people with constipation-predominant IBS who ate Activia (two 4-oz servings a day) reported less discomfort and bloating and more frequent bowel movements after three and six weeks than those who ate a yogurt that had been heat-treated to kill all helpful bacteria.

Activia is not the only yogurt to contain added live Bifidobacterium, also known as Bifidus. Stonyfield Farm yogurt, Horizon Organic yogurt, and Yo-Plus from Yoplait, among others, contain this probiotic as well. Although these brands have not been studied in randomized, controlled trials like Activia has, the Bifidobacterium in these products may have similar effects.

Bottom line on probiotic yogurt: More research is needed before we can definitively recommend Activia or another probiotic yogurt for promoting regularity. But while the data continue to come in, for most people, it can't hurt to give a probiotic yogurt a try.

Best Practices on Treating GERD With Lifestyle Changes

Mon, 13 Jul 2009 06:00:00 CDT

There are four types of treatments for gastroesophageal reflux disease or GERD: lifestyle measures, medication, surgery, and endoscopic procedures. When it comes to lifestyle measures, research from the Archives of Internal Medicine suggests that some changes are more effective than others.

Treating GERD is important. Untreated GERD can lead to serious complications, such as esophageal ulcers (nonhealing mucosal defects), esophageal strictures, Barrett’s esophagus (a disorder of the cells lining the esophageal mucosa, which may lead to cancer), and esophageal cancer.

Doctors often recommend lifestyle changes as the first-line treatment for GERD. These measures can include elevating the head of the bed during sleep, not eating late at night, and avoiding alcohol or spicy foods. However, a study reported in The Archives of Internal Medicine (Volume 166, page 965) shows that not all of these changes are helpful in relieving GERD symptoms, and some may be unnecessarily restrictive.

Researchers looked at the results of 100 studies conducted on various lifestyle measures for GERD. Only losing weight and elevating the head of the bed showed a clear benefit in well-designed studies.

In comparison, there was little evidence to support avoiding many suspected GERD triggers, such as alcohol, caffeine, chocolate, spicy foods, citrus, carbonated beverages, fatty foods, and mint. The same was true for sleeping on your left side or avoiding food late at night.

Although there was evidence that some of these substances and practices can cause GERD symptoms, evidence was lacking that avoiding them will relieve symptoms. However, if you experience worsening GERD symptoms after eating certain foods or drinking specific beverages you should probably avoid them. In addition, you should certainly give lifestyle changes a chance before trying medication to relieve symptoms.

Probiotics and Hypnosis: Two Promising Complementary Therapies for Irritable Bowel Syndrome

Mon, 22 Jun 2009 06:00:00 CDT

Many people turn to complementary therapies, such as herbs, meditation, or yoga, when they have a disease that is difficult to treat. Irritable bowel syndrome is one of them -- symptoms are distressing, few treatments exist, and the treatments that are available often provide insufficient symptom relief and sometimes life-threatening side effects.

But is there any evidence that complementary therapies are safe and effective for irritable bowel syndrome? Here's what we know about two nontraditional therapies often touted for irritable bowel syndrome.

Probiotics for irritable bowel syndrome: A wide variety of bacteria (called intestinal flora) live in your large intestine. These bacteria help regulate motility, immune function, and fluid secretion in the intestine. But if one type of bacterium starts to proliferate, irritable bowel syndrome symptoms may occur. Probiotics -- supplements that contain live strains of bacteria and yeast -- may help keep your intestinal flora in balance.

Results from one study showed that women with irritable bowel syndrome who took the probiotic Bifidobacterium infantis 35625 for four weeks noticed improvements in their bowel movements: Women who were constipated started having more bowel movements and women with diarrhea started having fewer. Women who took a placebo had no significant improvements.

One commonly used probiotic is Saccharomyces boulardii, a yeast culture in capsule form (Florastor). Another type, Lactobacillus acidophilus, is a bacterium found in yogurt. The most effective dose appears to be 10 billion live L. acidophilusbacteria. Unfortunately, it's not always easy to tell which yogurts contain this amount. Dannon Activia is the first probiotic yogurt on the market; it contains 10 billion live bacteria in a 4-oz serving. If you don't want to eat yogurt, L. acidophilus is also available in capsules (take 1.5 g per day).

Probiotics have few side effects when taken at recommended doses. In the beginning, you may experience some abdominal discomfort or gas, but these side effects usually go away with continued use. Avoid taking L. acidophilus if you have a weakened immune system, intestinal damage, or overgrowth of intestinal bacteria.

Hypnosis for irritable bowel syndrome: The most promising alternative therapy for irritable bowel syndrome is gut-directed hypnosis (also called hypnotherapy). During a series of weekly sessions, a therapist guides you through relaxation exercises. When you reach a state of deep relaxation, the therapist suggests imagery and sensations to help you with specific symptoms. In a recent study, about 70% of 250 people with irritable bowel syndrome had at least a moderate improvement in their symptoms with hypnotherapy. The participants also reported needing less medication and fewer doctor visits. Another study found that 80% of those who responded to hypnotherapy maintained their improvement for up to six years.

Hypnotherapy likely works by relaxing smooth muscles and relieving psychological stress, both of which may alleviate symptoms. If you're interested in hypnotherapy, it's important to find a therapist who specializes in irritable bowel syndrome. Your gastroenterologist may be able to recommend someone, or you can get a referral from one of the following organizations: Society for Clinical and Experimental Hypnosis (www.sceh.us; click on the Referrals link) or the American Society of Clinical Hypnosis (www. asch.net; click on the Referrals link or call 630-980-4740).

Eat More Fiber

Mon, 01 Jun 2009 06:00:00 CDT

If you’re like many Americans, you don't consume enough fiber in your diet. That's a shame because experts now believe that fiber might prevent digestive woes, such as diverticulosis, gastroesophageal reflux disease (GERD), gallstones, and hemorrhoids. Here's research on fiber and four common conditions.

Fiber and diverticulosis. One study divided more than 43,000 men into five groups based on their fiber consumption. Those who ate the most insoluble fiber were nearly half as likely to develop diverticular disease (diverticulosis and diverticulitis) as men who ate the least insoluble fiber.
How does insoluble fiber protect against diverticulosis? This fiber type keeps stools soft and thus easier to pass; straining to pass hard stools is a major cause of diverticulosis.

Fiber and GERD. A high-fiber diet may help protect against GERD, according to a recent study. Researchers assessed the dietary habits of 371 adults, some of whom had GERD symptoms at least weekly. Participants who ate a higher number of calories and servings of fat per day were more likely to have GERD. But people who ate a diet high in fiber were 20% less likely to have GERD, regardless of their weight. Researchers are unsure how fiber protects against GERD.

Fiber and gallstones. Women who eat a high-fiber diet may be at lower risk for gallstones, an analysis of data from the Nurses’ Health Study found. When the women were separated into five groups, those who ate the most total fiber were 13% less likely to need gallbladder surgery than those who ate the least. For insoluble fiber, the reduction in risk was 17%. Gallbladder surgery is needed when gallstones cause pain. Gallstones form when there is too much cholesterol in bile. Fiber probably lowers that cholesterol and thus decreases the chance of gallstone formation.

Fiber and hemorrhoids. A recent metaanalysis found that fiber also may help treat hemorrhoids. Researchers looked at the results of seven studies that included a total of 378 people with hemorrhoids who were randomized to a fiber or placebo group for six weeks to three months. Overall, people in the fiber group were 47% more likely to have their symptoms improve or go away than people in the placebo group. Like diverticulosis, hemorrhoids can be worsened by straining to pass hard stools; a high-fiber diet helps make stools softer and easier to pass.

Bottom line advice: Fiber has benefits for your digestive tract, and fiber is great for your overall health, too, reducing your risk of heart disease, diabetes, and obesity. So keep eating that fiber -- and if you’re like most Americans, you should be eating more than your usual amount. The average American consumes only 5–20 g a day, yet experts recommend 30 g a day for men over 50 years old and 21 g for women over the age of 50.

To get the most benefit, mix up the types of fiber in your diet. Soluble fiber from oats, peas, beans, apples, citrus fruits, carrots, barley, and psyllium is the type that helps lower your blood cholesterol and reduce your risk of diabetes. The other type, insoluble fiber (from whole-wheat flour, wheat bran, nuts, and most vegetables), is best for the digestive tract.

Relieving Your Upset Stomach

Mon, 20 Apr 2009 06:00:00 CDT

Who hasn’t experienced nausea? A queasy stomach and an imminent urge to vomit are common digestive problems. Most often, nausea occurs as the result of ingesting foods or medications or traveling in a moving vehicle. Here's some practical advice on avoiding nausea from Johns Hopkins.

Nausea isn't inevitable, especially when it comes to the most common causes. Here are some no-nonsense precautions to follow:

Eat smaller, more frequent meals, and eat at a slow pace. This will allow your stomach to digest foods at a reasonable rate.

Be careful what you eat, especially while traveling in foreign or tropical locales. Whether you're at home or on vacation, don't eat raw or undercooked meat or seafood, or food that appears to have been sitting out for a long time. Also avoid spicy and fried foods. In countries with poor sanitation, don't drink tap water or consume any fruits and vegetables that you can't peel or boil before eating.

Wash your hands frequently to cleanse away any bacteria or viruses.

Monitor your medication use closely, particularly when you first start taking a drug to see if it causes stomach upset. Many times the nausea goes away after a few days or weeks of taking the medication, but if nausea persists talk to your doctor or pharmacist. He or she may recommend that you change the time of day you take the medication (for example, taking your pills at night so that you'll be asleep when the nausea occurs and less likely to notice it), or take the medication with food. If you're going for cancer treatment, your doctor will typically prescribe anti-nausea drugs to prevent stomach upset and vomiting.

Sit in the front seat of the car if possible, and don't read while riding. If you're on a boat, look at the horizon and stay in the midsection of the ship, where it's most stable. On a train, sit in the same direction that the train is moving.

Medication is also an option, particularly if you've had motion sickness and nausea before, the seas are rough, or you're traveling on windy roads. Non-prescription drugs such as dimenhydrinate (Dramamine) and meclizine (Bonine) or the prescription agent scopolamine, which is available as a patch (Transderm Scop) or pill (Scopace), should be taken half an hour to an hour before you get on the vehicle.

Medications That Can Cause Nausea
Although medications help treat illnesses, a number of them can cause an upset stomach as a side effect:

Chemotherapy and hormonal drugs for cancer

Antidepressants

Antibiotics (particularly erythromycin)

Pain drugs containing opioids such as codeine

Theophylline (a drug for asthma)

Aspirin, ibuprofen (Advil, Motrin), and other nonsteroidal anti-inflammatory drugs (NSAIDs)

Nausea is also common after anesthesia for surgery and following radiation therapy for cancer.

High doses of zinc and potassium supplements as well as fish-oil capsules may also make you feel nauseous.

Do You Have Celiac and Not Know It?

Mon, 30 Mar 2009 06:00:00 CST

Many people don't know they have celiac disease, either because the symptoms they have are mistakenly attributed to another illness or because they don't have symptoms.

Celiac disease is an inherited disorder marked by sensitivity to gluten, a component of wheat and other grains. In people with celiac disease, a protein in gluten produces an immune reaction that compromises the ability of the villi (finger-like projections in the intestines) to absorb nutrients from food. As a result, diarrhea, bloating, weight loss, anemia, and vitamin deficiencies are common and among the first signs of celiac disease. Eventually, long-term damage to the small intestine may result from celiac disease.

The celiac disease was once thought to be rare in the United States, but recent research suggests celiac disease may be relatively common. According to a study published in the Archives of Internal Medicine, about 1 in 100 Americans has celiac disease. The proportion is even higher in people with certain health problems and those who have relatives with celiac disease.

The researchers found that many people don't know they have celiac disease, either because the symptoms they have are mistakenly attributed to another illness or because they don’t have symptoms. Approximately 20% of newly diagnosed cases of celiac disease are found in people age 60 or older, some of whom have had symptoms for many years.

Based on current research, anyone with a relative who has celiac disease should be screened for celiac disease with a blood test. Screening should also be considered for those with a personal history of thyroid disease or type 1 diabetes (these conditions, like celiac disease, are autoimmune disorders), unexplained digestive symptoms, or weight loss.

Screening for celiac disease is easy. A blood sample is tested for three specific antibodies that are present when a person with celiac disease ingests gluten. If these three antibodies are found, a biopsy of the small intestine is usually performed to look for any damaged villi. It's important not to avoid foods that contain gluten before these tests. Avoidance could make blood tests and biopsies appear normal and prevent an accurate diagnosis.

If celiac disease is diagnosed, the only way to treat it is by adopting a gluten-free diet, which eliminates symptoms and reverses damage to the small intestine in 95% of people with celiac disease. For guidelines on a gluten-free diet, see Separating the Wheat From the Teff.

NSAIDs and the Risk of Stomach Woes

Mon, 09 Mar 2009 06:00:00 CST

Do the benefits of aspirin and NSAIDs for your heart outweigh the risks to your gut? Here's advice on how to reduce the risk and what to do if you begin to experience side effects.

Most of the time, over-the-counter and prescription medications are helpful and safe. But sometimes they can cause gastrointestinal side effects. These adverse effects are more likely to occur if you're already at risk for digestive problems or if you don't take the medication exactly as instructed. Fortunately, most of these side effects are not life threatening and disappear soon after the medication is stopped.

Aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn), diclofenac (Cataflam, Voltaren), and ketoprofen (Orudis) cause stomach upset, bleeding in the digestive tract, and ulcers in some people.

NSAIDs have these effects because they disable the stomach's protective mechanisms that shield it from the acidic juices used to digest foods. Older people are most at risk for these NSAID-related stomach problems, since the protective mechanisms operate less well with age. NSAIDs can also cause bleeding in other parts of the body, because they inhibit the blood's ability to clot.

Reducing the Risk of NSAIDs: When taking an NSAID for pain relief, use the safest drugs first. In fact, the first drug to try -- acetaminophen (Tylenol) -- isn't an NSAID at all. If acetaminophen doesn't offer sufficient pain relief, try a nonprescription NSAID such as aspirin, Advil, Motrin, or Aleve. When using these nonprescription NSAIDs, take them with meals and do not exceed the recommended dosage or duration of use listed on the label.

If you need to take a nonprescription pain reliever for longer than 10 days, consult your doctor. When you need to turn to one of these drugs, use the lowest effective dosage, for the shortest time possible. If you are taking an NSAID regularly for pain relief or a daily aspirin to prevent a heart attack or stroke, ask your doctor if you should also take a stomach-protective drug such as sucralfate (Carafate) or a proton pump inhibitor -- esomeprazole (Nexium), lansoprazole (Prevacid), or omeprazole (Prilosec) -- to reduce your risk of ulcers and bleeding.

When NSAID Side Effects Arise: Call your doctor right away if you experience any of the following symptoms of NSAID-related damage: stomach pain; black, tarry, or bloody stools; vomit that contains blood or coffee ground-like material; or weakness, dizziness, chest pain, or shortness of breath. If you're taking aspirin to prevent a heart attack or stroke, don't stop taking it until you speak with your doctor. Stopping aspirin abruptly can actually increase your risk of a heart attack or stroke.

Fact or Fiction: Three Popular Myths About Digestive Disorders

Mon, 16 Feb 2009 06:00:00 CST

Does spicy food cause ulcers? Is colitis "all in your head?" In this Health Alert, Johns Hopkins gastroenterologists dispel myths about the causes of three digestive disorders -- peptic ulcers, inflammatory bowel disease, and gastroparesis.

Before the advent of modern medicine, the average person relied on folklore, old wives’ tales, and remedies handed down from previous generations to treat various ailments of the digestive tract. Today, despite extensive research, misunderstandings about the causes and treatments of many digestive disorders still persist. Here, are three common myths, according to the National Digestive Diseases Information Clearinghouse -- and the real truths based on the latest research findings.

Digestive Disorders Myth #1: Spicy foods and stress cause peptic ulcers.

Truth: Most peptic ulcers are caused by infection with the bacterium Helicobacter pylori (H. pylori) or by frequent use of nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen (Advil, Motrin), and naproxen (Aleve, Naprosyn). Spicy foods, however, can worsen peptic ulcer symptoms in some people, which is why you may want to avoid them if you have a peptic ulcer.

Digestive Disorders Myth #2: Inflammatory bowel disease is caused by psychological problems.

Truth: There’s no evidence to support the notion that Crohn’s disease and ulcerative colitis, collectively known as inflammatory bowel disease (IBD), are caused by stress, anxiety, or any other psychological problem. Instead, most experts believe these diseases are triggered by a virus or bacteria that sets off an abnormal reaction by the body’s immune system that results in inflammation in the intestines. That said, stress does appear to worsen the symptoms of abdominal pain and diarrhea associated with IBD.

Digestive Disorders Myth #3: Diabetes does not affect the digestive tract.

Truth: Both type 1 diabetes and type 2 diabetes put people at risk for digestive disorders due to nerve damage (neuropathy). Neuropathy occurs when high blood glucose (sugar) levels -- which result because the body doesn’t make enough insulin to remove glucose from the blood and usher it into cells -- causes chemical changes and injury to the blood vessels.

For instance, damage to the vagus nerve, which controls the movement of food through the digestive tract, can lead to gastroparesis, in which the stomach empties at a slower than normal rate. Signs and symptoms of gastroparesis include heartburn, nausea, vomiting of undigested food, weight loss, stomach bloating, and spasms of the stomach wall. Neuropathy can also cause diarrhea or constipation if the nerves that control the intestines are damaged.

Botox -- Not Just For Wrinkles

Mon, 05 Jan 2009 06:00:00 CST

Botox is best known for its ability to ease facial lines and make a person appear younger. But before the drug went Hollywood, it was originally developed for a less glamorous purpose: treating strabismus (crossed eyes) and blepharospasm (abnormal blinking). Today, Botox is used off-label to treat many conditions, including some digestive disorders.

Botulinum toxin A, from which Botox is derived, is a highly poisonous bacterial toxin that attacks the nerves and causes muscle paralysis. It is one of the world's most dangerous substances. But the same properties that make this toxin deadly in large doses also help relieve muscle spasms when used carefully in very small amounts.

When injected into the affected muscle, Botox prevents release of a neurotransmitter called acetylcholine from the nerve fibers controlling the muscle. As a result, the muscle loses nervous stimulation and relaxes -- faces stop frowning or eyes stop crossing.

Botox offers several advantages over other treatments: Unlike oral drugs, it doesn't enter the bloodstream and typically remains in the affected muscle only, so side effects are rare. Unlike surgery, it is noninvasive, painless, and quick. Its effects typically fade after a few months, but repeat treatments appear to offer the same benefits as the first injection.

Botox for the Digestive Tract -- Several digestive disorders caused by muscle spasms are candidates for Botox treatment. Achalasia was the first to benefit from Botox; now it's used for anal fissures, gastroparesis, constipation, and dysphagia. Although the U.S. Food and Drug Administration (FDA) has not approved Botox for any of these conditions, some insurance companies will cover its use.

Botox for Constipation. One of the common causes of constipation is when the pelvic floor muscles contract too much or don't relax enough during a bowel movement. A study in The American Journal of Gastroenterology found that Botox may help correct these muscle problems.

Italian researchers injected Botox into two sites on either side of the puborectalis muscle in 24 people with chronic constipation. Two months later, 19 participants had significant improvement, and the other five experienced symptom relief after a second set of injections. None of the participants experienced any significant side effects, and after an average of three years, all of them remained constipation free.

These results are surprising, given that the effects of Botox injections usually wear off after a few months. Although the study did not include a control group, the results suggest that Botox is a promising treatment that warrants more research.

How Excess Pounds Can Lead to GERD

Mon, 15 Dec 2008 06:00:00 CST

Eating too much food once in a while might give you occasional heartburn, but eating too much on a regular basis may give you gastroesophageal reflux disease (GERD). Johns Hopkins doctors explain why this happens.

With both obesity and GERD on the rise in the United States, medical researchers have wondered if a link exists between the two. The answer to this question appears to be "yes." An article in The American Journal of Gastroenterology examined the results of 20 studies involving more than 18,000 people with GERD. Overall, people who were overweight were 50% more likely to have GERD than normal-weight people; obese individuals were more than twice as likely.

Several theories may explain the link between GERD and obesity. For example, extra fat in the abdomen may increase pressure on the stomach and cause the lower esophageal sphincter to relax, allowing stomach contents to flow back up into the esophagus. In addition, body fat may release chemicals that decrease pressure in the lower esophageal sphincter or slow the clearance of acid from the esophagus.

Another possibility: Estrogen levels may play a role in the connection between obesity and GERD. One study found that obese women were more likely than obese men to have GERD; the risk was highest in premenopausal women and in postmenopausal women taking estrogen.

Whatever may be causing the increased risk of GERD in obese people, losing weight seems to help. An article in Archives of Internal Medicine found that losing weight and elevating the head of the bed were the only lifestyle measures that helped relieve GERD symptoms.

How much weight loss is enough? According to a study in The New England Journal of Medicine, decreasing BMI by 3.5 points (the equivalent of losing about 20 lbs) may significantly improve your GERD symptoms.

Separating the Wheat From the Teff

Mon, 24 Nov 2008 06:00:00 CST

Although people with celiac disease need to avoid many common grains such as wheat, a wide variety of grains are safe for people who require a gluten-free diet. In this Health Alert, Johns Hopkins reviews safe grains and food ingredients for people with celiac.

A diagnosis of celiac disease -- intolerance to the protein gluten -- means that patients must avoid all foods that contain gluten, including all products made with wheat, barley, rye, and related grains. A diet without these common ingredients may seem restrictive at first, yet there are many alternative grains, such as teff (a cereal grain native to northeastern Africa), that do not have any naturally occurring gluten and can be used safely as gluten substitutes.

Below is a list of acceptable and unacceptable grains and food ingredients for people who eat a gluten-free diet. However, there are some caveats. The first deals with oats: Recent research suggests that pure oats do not contain gluten and appear to be safe for people with celiac disease, but obtaining oats that have not been contaminated with gluten during the food-manufacturing process is difficult. Therefore, experts currently recommend that people with celiac disease avoid oats and all derivatives of oats, including oat bran, oat fiber, and oat gum.

The second caveat deals with alcohol: Although many spirits such as gin, vodka, and whiskey are made with grains that contain gluten, research has demonstrated that gluten doesn't survive the distilling process and is undetectable in the final product. Because of this finding, the Canadian Celiac Association and the Celiac Disease Foundation in the United States say that such spirits are acceptable for people with celiac disease.

Ask your doctor or dietitian if it's safe for you to drink gin, vodka, and whiskey. Also, check that a product's label says "gluten free" or verify with the manufacturer that a product is gluten free before consuming it. Many otherwise gluten-free products come into contact with gluten during processing, causing contamination. Last, check with the product's manufacturer regarding the following ingredients to ensure that their sources do not contain gluten: caramel, hydrolyzed plant protein (HPP), hydrolyzed vegetable protein (HVP), malt and its derivatives, modified food starch, monosodium glutamate (MSG), and textured vegetable protein (TVP).

Safe Ingredients: • amaranth • arrowroot/arrowroot corn • bean/whole-bean flour • besan • buckwheat/buckwheat groats • calrose • cassava • channa • chickpea • corn/corn flour/corn gluten/corn malt/cornmeal/cornstarch • cottonseed • fava bean • flax/flaxseed • gram flour (do not confuse with "graham flour") • hominy/hominy grits • kasha • millet • modified corn starch • modified tapioca starch • nuts/nut flour • pea flour • potato/potato flour/ potato starch/ potato starch flour • quinoa • rice • saffron • sago • sorghum • soy/soybean • starch • tapioca • teff

Ingredients To Avoid: • barley • bulgur • couscous • dinkel/dinkle • durum/durum flour • emmer • farina • gluten flour • graham flour (do not confuse with "gram" flour) • kamut • rye • seitan • semolina • spelt (German wheat) • triticale • wheat/wheat bran/wheat germ/wheat starch

Sequential Therapy Works

Mon, 22 Sep 2008 06:00:00 CDT

New data reported in the Annals of Internal Medicine suggest that sequential drug therapy works better – and is less expensive -- than the standard 10-day drug therapy to cure peptic ulcers and gastritis.

The most common way to treat peptic ulcers and gastritis is by eradicating Helicobacter pylori ( H. pylori) from the stomach. H. pylori is found in feces, and ingesting food or water contaminated with H. pylori can result in a lifelong infection that irritates and inflames the stomach and lining and leads to overproduction of gastric acid.

As antibacterial resistance continues to increase, H. pylori is becoming more difficult to combat. Now a study reported in the Annals of Internal Medicine (Volume 146, page 556) suggests that when the standard treatment of 10-day triple-drug therapy fails, sequential therapy might be more effective.

Researchers randomly assigned 300 people with peptic ulcers or gastritis to either the standard 10-day therapy with the proton pump inhibitor pantoprazole (Protonix) and the antibiotics clarithromycin (Biaxin) and amoxicillin or a sequential treatment of five days of Protonix, amoxicillin, and placebo followed by five days of Protonix, Biaxin, and the antibiotic tinidazole (Tindamax). Participants took breath tests to detect the presence of H. pylori four and eight weeks after the treatment ended.

People taking sequential therapy were more likely to have complete eradication of H. pylori -- from 89–93% of the group -- vs. 79% of those taking standard therapy. The researchers aren't sure whether the improved success rate was a result of the order of the medications or the addition of a second antibiotic. But they assert that since sequential therapy is more successful and less expensive than standard therapy, it should be considered as a first-line treatment.

Surgery Offers Hope for Patients With Early-Stage Pancreatic Cancer

Mon, 03 Nov 2008 06:00:00 CST

Pancreatic cancer is sometimes called a "silent disease" because there are few symptoms at its early stages. Often by the time symptoms appear, the cancer has spread and is difficult to treat. Now there's good news for those patients fortunate enough to discover their cancer at an early stage.

Pancreatic cancer is the growth of malignant cells in the pancreas, a pear-shaped organ located just below and behind the stomach. The pancreas makes digestive enzymes that flow through the pancreatic duct to the small intestine. These enzymes, along with bile from the gallbladder, break down food for use as energy by the body. The pancreas also makes insulin and glucagon, hormones that help regulate blood glucose (sugar) levels. Pancreatic cancer impairs the digestive process and may block the bile duct as it grows.

Pancreatic cancer is extremely difficult to diagnose and has usually spread by the time symptoms appear, so cures are uncommon. Now there's good news for those patients fortunate enough to discover their cancer at an early stage. A study published in the Annals of Surgery (Volume 246, pages 173 and 181) reports that patients who are treated with surgery for early pancreatic cancer have a 30% survival rate after five years, compared with less than 5% for people who don’t undergo surgery.

But nearly 40% of people with early-stage pancreatic cancer aren’t even offered the surgery by their doctors, according to the study. Researchers studied information from the National Cancer Data Base for 1995-2004. During that time, 9,559 people were diagnosed with pancreatic tumors that were potentially operable, but 3,644 of them (38%) were not presented with the option. Patients that were least likely to be offered surgery were over age 65, black, less educated, had lower incomes, were on Medicare or Medicaid, and were treated at small or community hospitals.

The authors say the underutilization of surgery may be due to lack of access to centers experienced in the procedure or to the long-held view that pancreatic cancer -- and surgery to treat it -- have poor long-term outcomes. However, mortality rates for the procedure have fallen from 25% in the 1960s to less than 3% at some high-volume centers today. The importance of offering and encouraging surgery for all people with early pancreatic cancer must be emphasized, since it is the best hope for long-term survival.

Should You Take GERD Medication Over the Long Term?

Mon, 01 Sep 2008 06:00:00 CDT

If you have gastroesophageal reflux disease (GERD) and take medication to control your symptoms, you're probably wondering what the long-term effects are. In this article Dr. Sergey V. Kantsevoy and his team of gastroenterologists at Johns Hopkins answer the question: What are the risks of taking reflux medication over the long term?

The contents of your stomach are emptied into the small intestine, but sometimes they flow backwards into your esophagus. This phenomenon, known as gastroesophageal reflux, happens to everyone from time to time. It usually produces no symptoms other than occasional heartburn -- a burning sensation behind the breastbone. When gastroesophageal reflux occurs frequently, however, you may begin to experience significant discomfort related to the acid reflux -- then, it is considered gastroesophageal reflux disease (GERD).

GERD is a serious condition because the acid and digestive enzymes from the stomach can damage tissues in the esophagus as well as in adjacent organs such as the mouth, pharynx (throat), larynx (voice box), trachea (windpipe), and lungs.

Medications for GERD like proton pump inhibitors and H2-blockers are generally very safe. But as with any drugs, their beneficial effects are often offset by some negative consequences. The most serious potential complications of GERD medication result from the reduction of stomach acid that actually protects your body from bacteria and viruses that may be present in food. Without sufficient acid levels, stomach bacteria are allowed to grow—and travel up or down the digestive tract.

For example, there’s a small chance that stomach bacteria may enter your trachea and upper airways, resulting in pneumonia. Or you may not have enough acid to fight off a serious intestinal infection from a bacterium like Clostridium difficile (C. difficile), which causes colitis, diarrhea, and cramps. Your body also needs stomach acid to help digest vitamin B12. Without sufficient levels of stomach acid, you could develop low vitamin B12 levels and, subsequently, anemia.

Bottom line advice on GERD medications: All of these potential complications are rare and treatable, so for most people, taking GERD medication does more good than harm -- especially if you have esophagitis or Barrett’s esophagus. If your GERD isn’t severe, talk with your doctor about taking your medication as needed, rather than continuously.

What Should You Eat If You Have Diverticulosis?

Mon, 11 Aug 2008 06:00:00 CDT

If you have diverticulosis, which foods should you eat … and which foods should you avoid? Johns Hopkins experts answer these common questions and offer bottom-line advice.

As we age, most of us develop small pouches (diverticula) that bulge outward through weak points in the wall of the large intestine -- a condition called diverticulosis. The condition is present in about half of Americans ages 60-80 and in virtually everyone older than age 80. A disorder called diverticulitis, an infection or inflammation of diverticula, develops in about 10–25% of people with diverticulosis.

It was once thought that people with diverticulosis should avoid seeds and nuts because they can become lodged in diverticula, the pea-sized pouches in the intestinal wall that characterize this condition, and may often lead to more serious inflammation and infection known as diverticulitis. But it’s now understood that some of the very foods that were once thought inappropriate for diverticulosis may actually be beneficial.

Diverticulosis is strongly associated with a low-fiber diet. Stool formed from refined grains and fatty foods moves slowly through the intestine and leads to constipation. The increased pressure required to keep stool moving can prompt the formation of diverticula. Fiber bulks up the stool, encourages it to move through the intestine, and helps prevent constipation. Therefore, adequate fiber intake of 20-30 g a day may prevent diverticula from developing as well as existing pouches from worsening or progressing from diverticulosis to diverticulitis.

Fruits and vegetables, including ones with small seeds like tomatoes, strawberries, and raspberries, pose no problems for people with diverticulosis and are good sources of fiber, as are whole grains. Be sure to chew foods well. If you need to increase your fiber intake, do so gradually -- a quick increase can cause gas and bloating. You can also use a psyllium-containing bulk-forming laxative (such as Metamucil and others). And be sure to drink about 64 oz of fluid a day.

Treating Constipation

Mon, 09 Jun 2008 06:00:00 CDT

When should you use a laxative to treat your constipation? In this excerpt from our Health After 50 newsletter, Dr. H. Franklin Herlong, Associate Professor of Medicine at Johns Hopkins, offers advice.

The National Institutes of Health defines constipation as having bowel movements less than three times a week; however, frequency isn’t as important as whether you experience constipation symptoms, such as painful stools, bloating, or cramping.

Drinking more water, eating foods rich in fiber, and exercising more can usually help alleviate chronic constipation. If not, you can try laxatives for constipation. There are four different types of laxatives, some available over the counter, others only by prescription. Bulk, lubricant, and hyperosmotic laxatives make stools easier to pass by absorbing water into the stool. Over-the-counter types of bulk, lubricant, and hyperosmotic laxatives include Metamucil, Epsom salts, and Miralax (previously a prescription product and now available over the counter). Stimulant laxatives prompt intestinal contractions -- Ex-Lax is an over-the-counter type of this laxative. While bulk laxatives are safe for long-term use without significant side effects, lubricant, hyperosmotic, and stimulant laxatives should be used under a physician’s supervision.

Recently, the medication Amitiza (lubiprostone) was approved to treat chronic constipation. But H. Franklin Herlong, M.D., Associate Professor of Medicine at Johns Hopkins, says, "Since the long-term safety of this drug isn’t established, it should be considered only after other therapies have failed."

Some people worry that laxatives are addictive, but that’s not exactly the case. Dr. Herlong states, "Many individuals believe that a daily bowel movement is necessary for ‘good health’ and may use laxatives to maintain a regular schedule even if they're not constipated. As a result, the natural urge for defecation may wane, and these people end up taking laxatives most of the time.”

Targeting H. Pylori for Stomach Discomfort

Thu, 28 Aug 2008 06:00:00 CDT

If you have chronic stomach discomfort, your first line of attack should be the ulcer bacterium Helicobacter pylori, according to a recent study.

Chronic dyspepsia -- discomfort in the upper abdomen that is sometimes accompanied by nausea and vomiting -- requires treatment. A study reported in the American Journal of Gastroenterology (Volume 101, page 1200) finds that testing for -- and eradicating -- the ulcer bacterium Helicobacter pylori may be helpful.

Typically, acid reflux or an H. pylori infection is to blame for dyspepsia. Thus, the usual treatment is a proton pump inhibitor (to reduce acid) or antibiotic therapy (to eradicate H. pylori).

In the study, researchers used three treatment strategies: 222 people were treated with the proton pump inhibitor esomeprazole (Nexium), 250 were tested for H. pylori and given antibiotics if the results were positive, and 250 were given Nexium and then tested for H. pylori if their symptoms improved. One year later, those given Nexium only were 36% more likely to eventually need upper endoscopy, compared with 22–28% of those in the two test-and-eradicate groups. Also, H. pylori–positive participants in the test-and-eradicate groups had more symptom-free days, used less medication, and were more satisfied with their treatment than H. pylori–negative participants.

Bottom-line advice: If you have dyspepsia, it might be worthwhile to get tested for H. pylori infection. If the test comes back positive, you should consider undergoing antibiotic therapy to eradicate the infection.

More Myths About Digestive Disorders

Mon, 19 May 2008 06:00:00 CDT

Here's a discussion of common myths about heartburn, constipation, and diverticulosis. For more digestive disorders myths, see Three Popular Myths About Digestive Disorders.

Before the advent of modern medicine, the average person relied on folklore, old wives’ tales, and remedies handed down from previous generations to treat various ailments of the digestive tract. Today, despite extensive research, misunderstandings about the causes and treatments of many digestive diseases still persist. Here, then, are three common myths, according to the National Digestive Diseases Information Clearinghouse -- and the real truths based on the latest research findings.

Digestive Disorders Myth #1: Smoking a cigarette relieves heartburn.

Truth: The opposite is true: Cigarette smoking exacerbates heartburn by relaxing the lower esophageal sphincter -- the muscle between the esophagus and the stomach -- which allows stomach acid to travel backwards and enter the esophagus.

Digestive Disorders Myth #2: Constipation can increase the risk of colon cancer.

Truth: Some alternative health practitioners believe that feces that remain in the colon for too long produce toxins, which are then absorbed by the body and can cause colon cancer and other diseases. That’s why these practitioners recommend the regular use of laxatives, enemas, colonics, or fasts to cleanse the colon of feces. But according to mainstream medical experts, there is no evidence that feces produce toxins or that using laxatives and other colon-cleansing techniques to speed the elimination of fecal matter will reduce the risk of colon cancer or other diseases.

Digestive Disorders Myth #3: Diverticulosis is a serious but uncommon problem.

Truth: Diverticulosis, a digestive disease in which small sacs or pouches called diverticula develop in the wall of the colon, is actually a very common disorder in people over age 60. In fact, more than half of all people between the ages of 60 and 80 have diverticulosis, and nearly everyone over age 80 has the condition.

Fortunately, few people develop symptoms from diverticulosis, unless the diverticula become infected or inflamed (a condition called diverticulitis), bleed, or perforate the colon.

Dietary Changes and GERD

Mon, 28 Apr 2008 06:00:00 CDT

Archives of Internal Medicine suggests that contrary to common advice, dietary changes alone will not improve symptoms of GERD, such as heartburn or acid reflux.

If you have gastroesophageal reflux disease (GERD) you know these unpleasant feelings -- heartburn, indigestion, nausea, and sometimes vomiting. Acid from the stomach can even regurgitate into organs connected to the esophagus, such as the larynx, trachea, and lungs.

One of the first things doctors tell people with GERD is to change their diet to reduce heartburn. This advice often means eliminating chocolate, spicy foods, mint, citrus fruits and juices, fatty foods, carbonated beverages, coffee and other caffeinated products, alcohol, and late-night meals.

Now a review of over 100 studies of these dietary and other lifestyle measures has found that, while consuming these foods and beverages may make GERD symptoms worse, there’s no scientific evidence that banning them from your diet will improve heartburn or fix the underlying problem of acid reflux.

What will work for GERD, according to the review, is sleeping with the head of your bed elevated and losing weight if you’re overweight. These strategies reduce heartburn symptoms and lower acid levels in the esophagus. Of course, if you experience heartburn after eating a certain food, common sense dictates that you avoid that food to see if your symptoms improve. If the symptoms don’t improve, see a doctor about taking medication for GERD, which will likely do more for your symptoms than dietary restrictions. [This study was reported in the Archives of Internal Medicine (Volume 166, page 965).]

Advice on Treating GERD

Mon, 25 Feb 2008 06:00:00 CST

Recent research suggests that some lifestyle changes are more helpful than others for treating the symptoms of GERD.

There are four types of treatments for gastroesophageal reflux disease (GERD): lifestyle measures, medication, surgery, and endoscopic procedures. Treating GERD is important. Untreated GERD can lead to serious complications, such as esophageal ulcers (nonhealing mucosal defects), esophageal strictures, Barrett’s esophagus (a disorder of the cells lining the esophageal mucosa, which may lead to cancer), and esophageal cancer.

Doctors often recommend lifestyle changes as the first-line treatment for GERD. These measures can include elevating the head of the bed during sleep, not eating late at night, and avoiding alcohol or spicy foods. However, a new study reported in The Archives of Internal Medicine (Volume 166, page 965) shows that not all of these changes are helpful in relieving GERD symptoms, and some may be unnecessarily restrictive.

Researchers looked at the results of 100 studies conducted on various lifestyle measures for GERD. Only losing weight and elevating the head of the bed showed a clear benefit in well-designed studies.

In comparison, there was little evidence to support avoiding many suspected GERD triggers, such as alcohol, caffeine, chocolate, spicy foods, citrus, carbonated beverages, fatty foods, and mint. The same was true for sleeping on your left side or avoiding food late at night.

Although there was evidence that some of these substances and practices can cause GERD symptoms, evidence was lacking that avoiding them will relieve symptoms. However, if you experience worsening GERD symptoms after eating certain foods or drinking specific beverages you should probably avoid them. In addition, you should certainly give lifestyle changes a chance before trying medication to relieve symptoms.

Relief for IBS

Mon, 07 Apr 2008 06:00:00 CDT

Good news for IBS patients. Studies show that people who suffer with bloating and flatulence due to IBS may get relief from an antibiotic used to treat diarrhea.

Irritable bowel syndrome (IBS) is one of the most common -- and frequently misunderstood -- digestive disorders. One in five adults in the United States have symptoms of IBS, yet only a small number of people with symptoms seek treatment. In a recent poll of 201 women who had not been diagnosed with IBS but had symptoms of the disorder, 88% had heard of IBS but 21% had not talked to a doctor about their symptoms because they didn’t think it was a real medical condition -- and 14% didn’t think there was any treatment for IBS.

Gas-related symptoms, such as bloating and flatulence, can be a problem for people with IBS. According to a study reported in the American Journal of Gastroenterology (Volume 101, page 326), an antibiotic used to treat diarrhea may offer some relief.

The study included 124 people with gas symptoms; more than half met the diagnostic criteria for IBS. Some participants received the antibiotic rifaximin (Xifaxan) for 10 days; the rest received a placebo. The participants also had breath tests and kept a symptom diary. After 10 days, 41% of people in the Xifaxan group had a significant decrease in their symptom severity, compared with 23% in the placebo group. Ten days after stopping treatment, symptoms were still reduced in 29% of the Xifaxan group and in 12% of the placebo group. Among the participants who had IBS, 41% were helped by 10 days of Xifaxan, while 18% improved while taking the placebo. Also, the breath tests showed that people taking Xifaxan had significant drops in hydrogen excretion, suggesting that their colons were fermenting less gas.

More studies are needed to determine whether Xifaxan is safe over the long term. Researchers expect it to be, because the antibiotic is not absorbed by the body and thus has no side effects.

Bleeding in the Digestive Tract

Mon, 04 Feb 2008 06:00:00 CST

Blood in your stool could be a sign of a serious condition, or something more benign, like a hemorrhoid. Johns Hopkins reviews common causes of bleeding in the digestive tract.

Vomiting blood or finding it in your stool can be frightening, because it is a sign that you are bleeding somewhere in your digestive tract and you may have a digestive disorder. But not all causes of gastrointestinal bleeding are ominous. For instance, bleeding from the rectum can be caused by hemorrhoids, which are uncomfortable but definitely not life threatening.

In addition, taking iron supplements or the antidiarrhea medication bismuth subsalicylate (Pepto Bismol) or consuming foods such as beets can all make your stool look like it has blood in it when, in fact, it doesn’t. Still, all cases of suspected bleeding in the digestive tract should be evaluated by your doctor, so that the underlying problem can be identified and treated if necessary.

Bleeding Symptoms -- Bleeding in the digestive tract doesn’t always produce obvious signs --it depends on where the bleeding is occurring and how severe it is. For instance, colon cancers bleed only intermittently and typically produce small amounts of blood that can only be detected on special stool tests.

Other times, bleeding is obvious -- bright red or darker red blood in the stool, in the toilet bowl, or on the toilet paper when you wipe your anus. Bright red blood is a sign of active bleeding in the rectum or large intestine (colon). When the blood is a darker red, the bleeding is occurring higher up in the colon or in the lower portion of the small intestine.

If your stools are black and tarry, the bleeding is taking place in the esophagus, stomach, or upper portion of the small intestine. The dark color of the blood results when blood is exposed to the acid, enzymes, and bacteria in the stomach and intestines.

Blood may also be visible in vomit, when bleeding is occurring in the esophagus, stomach, or upper small intestine. The blood is bright red when vomiting occurs soon after bleeding begins. If you see coffee grounds-like material in your vomit, this means the blood has been in your digestive tract for awhile -- long enough to be partially digested by the acid in your stomach.

Here’s a list of some of the common causes of bleeding in the digestive tract:
Bleeding in the Esophagus:

Ulcer

Inflammation (esophagitis)

Rupture of enlarged veins (varices)

A tear in the esophageal lining (Mallory-Weiss syndrome)

Cancer

Bleeding in the Stomach:

Ulcer

Inflammation (gastritis)

Rupture of enlarged veins (varices)

Benign tumors

Cancer

Bleeding in the Small Intestine:

Ulcer

Inflammation (Crohn’s disease)

Polyps

Cancer

Bleeding in the Large Intestine, Rectum, and Anus:

Infections

Inflammation (ulcerative colitis or Crohn’s disease)

Polyps

Cancer

Diverticular disease

Hemorrhoids

Anal fissures

Diagnosing Constipation

Mon, 14 Jan 2008 06:00:00 CST

Researchers find that there’s little evidence to support most diagnostic tests for constipation.

Nearly everyone has had a bout of constipation -- infrequent bowel movements and difficulty passing stool -- at some point in their life. Constipation is not a disease, but rather a symptom that can stem from a number of medical conditions. Constipation becomes more common with age and occurs in at least 25% of people over age 65. In most cases, constipation is not a serious condition, and can be treated with lifestyle measures, such as increasing your intake of dietary fiber and level of physical activity or the short-term use of laxatives. In rare cases, surgery may be necessary to relieve symptoms of constipation.

When someone complains of chronic constipation, a gastroenterologist may perform a number of tests to identify the underlying cause of the constipation and the best way to treat it. But according to a study reported in the American Journal of Gastroenterology (Volume 100, page 1605), many of these tests are unnecessary.

To assess the value of various tests used to investigate constipation, researchers performed a search of the medical literature from 1966-2004. They found little or no evidence to support the routine use of blood tests, abdominal x-rays, sigmoidoscopies, colonoscopies, or barium enemas in people with constipation who do not have red-flag symptoms (such as rectal bleeding or unexplained weight loss).

There was, however, some evidence for the use of colonic transit tests (which measure the amount of time it takes for stool to move through the colon), anorectal manometry (which measures pressure in the rectum and anus), and balloon expulsion tests (which measure the ability of the rectum to expel feces). The researchers found that these three tests can reveal physical abnormalities that can lead to constipation. Still, no single test can identify the underlying cause of constipation in all patients, and several tests may be required to determine the exact cause of constipation and how to treat it.

When Your Stomach Stops

Mon, 24 Dec 2007 06:00:00 CST

Delayed emptying of the stomach, called gastroparesis, has several possible causes but usually is a complication of diabetes.

Gastroparesis -- literally “paralyzed stomach” -- is a serious condition manifested by delayed emptying of stomach contents into the small intestine after a meal. There is no cure for gastroparesis, but treatment can speed gastric emptying and relieve gastrointestinal symptoms such as nausea and vomiting.

Who Gets Gastroparesis? Gastroparesis most often occurs in people with diabetes, especially in those who have had diabetes for a long time. But diabetes is not the only cause of gastroparesis. Other possible culprits include the following:

postviral syndromes

anorexia nervosa

surgery on the stomach or vagus nerve

medications that slow contractions in the intestine, particularly anticholinergics and narcotics

smooth muscle disorders, such as amyloidosis and scleroderma

nervous system diseases, including abdominal migraine and Parkinson’s disease

metabolic disorders, including hypothyroidism

What Are the Symptoms? The symptoms of gastroparesis include a feeling of fullness early after a meal, bloating, heartburn, upset stomach, nausea, and vomiting. These symptoms may be constant or may flare up from time to time with periods of relief in between.

Some patients have no overt symptoms of gastroparesis, and, in people with diabetes, the only sign of gastroparesis may be difficulty controlling blood glucose. If the gastroparesis remains untreated, it can lead to additional complications including malnutrition, dehydration, and electrolyte imbalances.

How Is It Diagnosed? The gold standard for diagnosing gastroparesis is a test called solid-phase gastric scintigraphy. During this study, patients have their stomach scanned after ingesting solid food containing a radioactive substance to observe how quickly the radioactive isotope leaves the stomach. Other tests to detect delayed gastric emptying include a radioisotope breath test (to detect levels of carbon dioxide in the breath), electrogastrography (which uses electrodes placed on the skin over the stomach to measure the electrical activity of the stomach’s muscles), and an upper gastrointestinal series (in which x-rays are taken of the stomach after drinking a barium-containing liquid).

How Is It Treated? Treatment of gastroparesis is often twofold. Doctors aim first to improve gastric emptying and control symptoms and second to treat the underlying disease causing gastroparesis, if present.

Doctors recommend that people with gastroparesis eat a diet low in fat and fiber. Fat slows the emptying of the stomach, and some high-fiber foods can remain in the stomach for a long time. (High-fiber foods to avoid include apples, berries, brussels sprouts, coconuts, green beans, figs, and oranges.) Also, eating six small meals a day, rather than three large ones, may allow the stomach to empty its contents easier.

A number of medications are somewhat effective in promoting gastric emptying and relieving the nausea and vomiting of gastroparesis. These medications include metoclopramide (Reglan and other brands) and erythromycin (Erythrocin and other brands) for gastric emptying and prochlorperazine (compro) for nausea.

The Benefits of Fiber

Mon, 12 Nov 2007 06:00:00 CST

Johns Hopkins Health Alerts | Digestive Health |

The Benefits of Fiber

If you’re like many Americans, you should increase your consumption of fiber to help your digestive system – and your overall health, too.

Experts now believe that fiber does not protect against colorectal cancer, but fiber might prevent other digestive woes -- diverticulosis, gastroesophageal reflux disease (GERD), gallstones, and hemorrhoids.

Fiber and diverticulosis. One study divided more than 43,000 men into five groups based on their fiber consumption. Those who ate the most insoluble fiber were nearly half as likely to develop diverticular disease (diverticulosis and diverticulitis) as men who ate the least insoluble fiber.

How does insoluble fiber protect against diverticulosis? This fiber type keeps stools soft and thus easier to pass; straining to pass hard stools is a major cause of diverticulosis.

Fiber and GERD. According to one study, a high-fiber diet may help protect against GERD, according to a 2005 study. Researchers assessed the dietary habits of 371 adults, some of whom had GERD symptoms at least weekly. Participants who ate a higher number of calories and servings of fat per day were more likely to have GERD. But people who ate a diet high in fiber were 20% less likely to have GERD, regardless of their weight. Researchers are unsure how fiber protects against GERD.

Fiber and gallstones. Women who eat a high-fiber diet may be at lower risk for gallstones, an analysis of data from the Nurses’ Health Study found. When the women were separated into five groups, those who ate the most total fiber were 13% less likely to need gallbladder surgery than those who ate the least. For insoluble fiber, the reduction in risk was 17%. Gallbladder surgery is needed when gallstones cause pain. Gallstones form when there is too much cholesterol in bile. Fiber probably lowers that cholesterol and thus decreases the chance of gallstone formation.

Fiber and hemorrhoids. One metaanalysis found that fiber also may help treat hemorrhoids. Researchers looked at the results of seven studies that included a total of 378 people with hemorrhoids who were randomized to a fiber or placebo group for six weeks to three months. Overall, people in the fiber group were 47% more likely to have their symptoms improve or go away than people in the placebo group. Like diverticulosis, hemorrhoids can be worsened by straining to pass hard stools; a high-fiber diet helps make stools softer and easier to pass.

The Bottom Line: Fiber has benefits for your digestive tract, and fiber is great for your overall health, too, reducing your risk of heart disease, diabetes, and obesity. So keep eating that fiber -- and if you’re like most Americans, you should be eating more than your usual amount. The average American consumes only 5–20 g a day, yet experts recommend 30 g a day for men over 50 years old and 21 g for women over the age of 50.

To get the most benefit, mix up the types of fiber in your diet. Soluble fiber from oats, peas, beans, apples, citrus fruits, carrots, barley, and psyllium is the type that helps lower your blood cholesterol and reduce your risk of diabetes. The other type, insoluble fiber (from whole-wheat flour, wheat bran, nuts, and most vegetables), is best for the digestive tract.

Johns Hopkins Health Alerts | Digestive Health |

The Benefits of Fiber

Fiber and Your Digestive Tract

Wed, 18 Jul 2007 15:08:52 CDT

Johns Hopkins Health Alerts | Digestive Health |

Fiber and Your Digestive Tract

Fiber probably doesn't protect your colon or rectum against cancer, but it might prevent other digestive woes, such as diverticulosis and GERD.

Experts now believe fiber does not protect against colorectal cancer or constipation. But that doesn’t mean you can cross off high-fiber foods (like vegetables, fruits, and whole grains) from your grocery list. In fact, there are still plenty of reasons -- both digestive and not -- to get your daily fill of fiber.

The results of research studies on fiber consumption and colorectal cancer are mixed. Some show a protective effect, while others show no relationship at all. To add to the confusion, a recent study found a protective effect in men but not in women. Some studies have even reported that a high fiber diet may increase the risk of colorectal cancer.

The theories behind a possible protective effect of fiber on the colon and rectum seemed logical. For instance, fiber may dilute carcinogens in fecal matter, it may help remove carcinogenic bile acids from the body, and it may prompt the body to produce short-chain fatty acids, which help fight off cancer cells. But even if fiber does all of these things, it doesn’t seem to protect against colorectal cancer.

That was the conclusion of a meta-analysis, published in the Journal of the American Medical Association (JAMA). The researchers pooled data from 13 observational studies, containing information on the dietary habits of more than 725,000 men and women who were followed for six to 20 years. During that time, more than 8,000 of them were diagnosed with colorectal cancer.

The study participants were divided into five groups based on their fiber intake. In the initial analysis, those who ate the most fiber had a 16% lower risk of colorectal cancer than those who ate the least fiber. But after adjusting for other risk factors for colorectal cancer -- such as red meat consumption and alcohol intake -- the protective effect disappeared.

Still searching for a link between fiber and colorectal cancer, the researchers examined whether the source of the fiber was important. But neither fiber from cereals nor that from fruits or vegetables had an effect on colorectal cancer risk.

Fiber Probably Won’t Keep You Regular

The JAMA study came on the heels of a review article that dispelled the commonly held belief that fiber helps prevent constipation. While the reviewers don’t deny that increasing fiber intake makes stools bulkier and easier to pass and increases the frequency of bowel movements, they argue that the role of fiber in constipation is exaggerated. In fact, no studies show that a lack of dietary fiber is responsible for chronic constipation. And for some people with constipation, too much fiber can actually make symptoms worse.

Johns Hopkins Health Alerts | Digestive Health |

Fiber and Your Digestive Tract

Try Biofeedback Instead

Mon, 01 Oct 2007 06:00:00 CDT

Johns Hopkins Health Alerts | Digestive Health | Try Biofeedback Instead

If modifications in your diet and laxatives don't work, you might try biofeedback for constipation.

Nearly everyone has had a bout of constipation -- infrequent bowel movements and difficulty passing stool -- at some point in their life. Constipation is not a disease but rather a symptom that can stem from a number of medical conditions. Constipation becomes more common with age and occurs in at least 25% of people over age 65. In most cases, constipation is not a serious condition and can be treated with lifestyle measures, such as increasing your intake of dietary fiber and level of physical activity or taking a laxative. In rare cases, surgery may be necessary to relieve symptoms.

Now a study reported in the journal Gastroenterology (Volume 130, page 657 ) finds that biofeedback can be a much more effective and longer-lasting treatment than laxatives for a certain type of constipation.

Researchers studied constipation caused by pelvic floor dyssynergia -- the inability to relax the pelvic floor muscles while trying to pass stool. Fifty-four people with the condition attended five weekly 30-minute biofeedback sessions in which they were taught to strain more effectively, coordinate their breathing, and identify and relax their pelvic floor muscles. A control group of 55 people with pelvic floor dyssynergia took laxatives and attended five weekly counseling sessions on preventing constipation. Six months later, 80% of the biofeedback group reported that their constipation had improved, compared with 22% of the laxative group. People in the biofeedback group also reported less straining, abdominal pain, and laxative use. Two years later, the improvements in the biofeedback group were still present.

This type of biofeedback has not been shown effective for people with constipation caused by other factors. It’s also more expensive and less readily available than laxatives. But for people with pelvic floor dyssynergia, biofeedback may be worth pursuing.

Johns Hopkins Health Alerts | Digestive Health | Try Biofeedback Instead

GERD Without Heartburn? It's less common, but it does happen.

Mon, 10 Sep 2007 06:00:00 CDT

Johns Hopkins Health Alerts | Digestive Health | GERD Without Heartburn

Asthma, cough, laryngitis, heartburn, even chest pain could signal GERD, a common digestive disorder that affects more than 56 million Americans.

By far, the most common symptom of gastroesophageal reflux disease (GERD) is heartburn, which occurs when the acidic contents of the stomach reflux (flow backwards) into the esophagus. But about 10–15% of people with GERD do not have heartburn. Instead, they experience asthma, a chronic cough, chest pain, or laryngitis.

These symptoms result when stomach acid refluxes into organs connected to the esophagus, such as the larynx, trachea, and lungs. The chance of developing these nonheartburn symptoms of GERD increases with age. Nonheartburn symptoms make GERD more difficult to diagnose, because acid reflux is not the most common cause of them.

In fact, the only way to find out for sure whether these symptoms are due to GERD is to try a proton pump inhibitor—such as esomeprazole (Nexium), lansoprazole (Prevacid), omeprazole (Prilosec), pantoprazole (Protonix), or rabeprazole (Aciphex)—to suppress acid production in the stomach. If the symptoms go away within three months of treatment with a proton pump inhibitor, GERD was the problem. If not, it’s back to the drawing board to find the cause.

So if you are wondering whether those bouts of asthma, that nagging cough, those episodes of chest pain, or that hoarse voice could be GERD, do not hesitate to call your doctor. Many of the same treatments for heartburn -- lifestyle measures, medications, and surgery -- may relieve the non-heartburn symptoms of GERD as well.

Johns Hopkins Health Alerts | Digestive Health | GERD Without Heartburn

Your Aging Digestive System

Mon, 30 Jul 2007 06:00:00 CDT

Johns Hopkins Health Alerts | Digestive Health | Your Aging Digestive System

If you have a digestive disorder, you’re certainly not alone. More than 56 million Americans report symptoms of GERD, 20.5 million suffer from gallstones, 14.5 million from peptic ulcer, and 3.1 million from constipation.

You can develop a digestive disorder at any age, but the chances are much greater as you get older. Nearly 40% of all older adults have one or more digestive disorder symptoms each year, largely due to the changes that occur in the digestive tract with age.

Digestive disorders of the mouth and esophagus. Swallowing can become difficult as a result of dry mouth or tooth decay. A stroke, dementia, or neurodegenerative diseases (such as Parkinson's disease) also can lead to swallowing difficulties. The esophagus and lower esophageal sphincter become weaker as we age, although these changes do not seem to contribute to the greater likelihood of heartburn and gastroesophageal reflux disease (GERD) in older adults.

Digestive disorders of the stomach. With age, the stomach takes longer to empty into the small intestine, making older adults more vulnerable to ulcers and bleeding from medications such as nonsteroidal anti-inflammatory drugs (NSAIDs). The longer these drugs are in the stomach, the more likely they are to cause these problems. The stomach also becomes less elastic and can hold less food, meaning that older adults feel full more quickly.

Digestive disorders of the small intestine. The small intestine does not seem to change dramatically with age, although it does become less able to absorb certain vitamins and minerals (such as vitamin D, vitamin B12, and calcium). Bacterial overgrowth can occur as well, which can cause diarrhea and unintentional weight loss in older adults.

Digestive disorders of the large intestine. In the large intestine, a loss of muscle strength can result in diverticulosis (small pouches that bulge outward through weak points in the intestinal wall). Undigested food components take longer to move through the large intestine, leading to constipation. Polyps and colon cancer are more common in older adults, although it’s unclear what effect age has on the development of these benign and cancerous growths.

Other digestive disorders. The liver becomes less able to metabolize medications, so it is more susceptible to damage. The gallbladder produces less bile, which may lead to gallstones. The pancreas, however, does not seem to change much with age.

Johns Hopkins Health Alerts | Digestive Health | Your Aging Digestive System

Colon Cancer Proteins Show Promise For Blood Test

Mon, 09 Jul 2007 06:00:00 CDT

Johns Hopkins Health Alerts | Digestive Health | Colon Cancer Proteins Show Promise For Blood Test

This article on new colon cancer biomarkers comes from a recent Johns Hopkins Medicine Press Release.

Searching for less invasive screening tests for cancer, Johns Hopkins scientists have discovered proteins present in blood that accurately identify colon cancer and precancerous polyps.

Initial studies of the proteins, CCSA-3 and CCSA-4, suggest they could be used to develop a blood test to identify individuals at-risk for colon cancer.

"The reality is that many people are not getting regular screening colonoscopies," says cancer researcher Robert Getzenberg, Ph.D. "So, ideally we'd like to identify those with some molecular fingerprint for colon cancer and really need them."

Current colon cancer screening guidelines for healthy people call for a baseline colonoscopy at age 50, followed by re-screening at least every five to 10 years. Colonoscopy is not foolproof; colon cancer can develop between screenings.

First discovered by Getzenberg and colleagues at the University of Pittsburgh through a protein scan, the two blood-dwelling proteins are thought to be remnants of cellular debris castoff from dead cancer cells. Although the proteins' roles are not entirely clear, the Johns Hopkins scientists say they are part of the scaffolding that supports structures within a cell's control center, the nucleus.

Alteration of such nuclear scaffolding is a hallmark of cancer cells that is easily detectable under the microscope as a misshapen and discolored nucleus. That led Getzenberg to the notion that "there must be something at the molecular level that would form a molecular flag for cancer via a blood test."

To find the flag, Getzenberg's team drew blood samples from 107 apparently healthy individuals the day before their scheduled colonoscopies, and from 28 colorectal cancer patients.

Using a particular concentration of scaffold-proteins as a marker for colon cancer, the Johns Hopkins team -- which did not know the colonoscopy results in advance -- were 100 percent accurate in identifying the 28 existing colon cancers. Using the same protein markers, investigators also correctly identified 51 of 53 individuals (96.2 percent) with normal colons and 14 of 18 (77.8 percent) people with advanced precancerous polyps, which Getzenberg says are the most important to detect through routine screening.

When researchers combined samples, they correctly identified 42 of 46 (91.3 percent) containing both colon cancers and advanced precancerous polyps. Protein levels were accurate in correctly assessing additional blood samples from 125 people with benign conditions and other cancers.

"These proteins seem very good at separating normal samples from cancerous ones and identifying other groups with pre-cancers at high risk for disease as well," says Getzenberg, who is a professor of urology and director of research at Johns Hopkins' Brady Urological Institute. Results are published in the June 15 issue of Cancer Research.

The researchers are planning larger studies at several hospitals over the next several months. It may take several years to complete the full range of testing.

Getzenberg and the University of Pittsburgh hold a patent for the technology described above, which is licensed to Onconome Inc. Funding for the study described in this article was provided by Onconome Inc. and the National Cancer Institute. Under a licensing agreement between Onconome Inc. and University of Pittsburgh, Getzenberg is entitled to a share of royalty received by the University on sales of products described in this article. Getzenberg also is a paid consultant to Onconome Inc. which has a licensing agreement with The Johns Hopkins University covering CCSA-3 and -4 related technologies. The terms of this arrangement are being managed by The Johns Hopkins University in accordance with its conflict of interest policies.

Additional authors are Eddy S. Leman, Grant W. Cannon, Lori J. Sokoll, and Daniel W. Chan at Johns Hopkins; and Robert E. Schoen and Joel L. Weissfeld at the University of Pittsburgh Cancer Institute.

Johns Hopkins Health Alerts | Digestive Health | Colon Cancer Proteins Show Promise For Blood Test

The Effects of Smoking on Your Digestive Tract

Mon, 18 Jun 2007 06:00:00 CDT

Johns Hopkins Health Alerts | Digestive Health | The Effects of Smoking on Your Digestive Tract

Looking for more good reasons to quit smoking? Johns Hopkins explains how cigarette smoke can lead to serious digestive disorders.

No doubt you’ve heard about the deleterious effects smoking can have on your lungs and heart, but did you know smoking also increases your risk of certain digestive disorders?

Smoking irritates the digestive tract, boosting the chances that you’ll suffer from heartburn, peptic ulcers, Crohn’s disease, and colon polyps.

Smoking and Heartburn: This burning sensation in the chest is the result of acid reflux -- the back flow of the stomach’s acidic contents into the esophagus. Smoking decreases the strength of the lower esophageal sphincter, the valve at the bottom of the esophagus that helps prevent this acid reflux. In addition, smoking may make stomach acid more damaging because it appears to promote the movement of bile salts (substances used in the digestion of fat) from the small intestine into the stomach.

Smoking and Peptic Ulcers: Smoking raises the risk of developing a peptic ulcer -- an open sore in the lining of the stomach or the duodenum (the first portion of the small intestine). Smokers are particularly prone to ulcers in the duodenum, and when a smoker gets a peptic ulcer, the ulcer heals more slowly and is more likely to cause death than in a nonsmoker. It also appears that smoking may increase the amount of stomach acid you produce, and interfere with the ability of the body to neutralize that acid.

Smoking and Crohn’s Disease: Smoking increases the risk of developing Crohn’s disease, an inflammation in the lining of the intestines. Smoking also increases the risk of symptom flare-ups after treatment, the need for repeat surgeries to remove sections of the intestines, and the need for aggressive treatment with immunosuppressive drugs. It’s been hypothesized that smoking might cause these negative effects by impairing blood flow or the immune response in the intestines. Smoking may also prompt changes in the immune system that lead to inflammation.

Smoking and Colon Polyps: Two studies have found that smoking increases the chances of developing polyps (precancerous growths) in the colon; smokers are also more likely to have a greater number of polyps than nonsmokers, and to have larger polyps. The risk of polyps increases by 4% for every year you smoke. Researchers are uncertain why smoking might increase the risk of colon polyps.

Quitting smoking is one of the best things you can do for your health -- including your gastrointestinal health. By quitting, you can often reverse the damage to your body, no matter how long you’ve smoked. And remember, you’re never too old to quit smoking. In fact, studies show that people over age 65 are more likely to succeed in quitting than younger people.

For more Alerts and Special Reports, please visit the Digestive Disorders Topic page.

Johns Hopkins Health Alerts | Digestive Health | The Effects of Smoking on Your Digestive Tract

Tips on Avoiding and Treating Nausea

Mon, 28 May 2007 06:00:00 CDT

Johns Hopkins Health Alerts | Digestive Health | Tips on Avoiding and Treating Nausea

When is nausea a simple digestive problem or a sign of something more serious? Johns Hopkins specialists explain the important differences.

Who hasn’t experienced nausea? A queasy stomach and an imminent urge to vomit is a common digestive problem. Luckily, in most cases nausea is not a sign of anything serious. And mercifully, nausea typically only lasts for a few hours (although that’s often plenty long enough) and requires no medical treatment.

Many different kinds of digestive disorders can lead to nausea, including gastroesophageal reflux disease (GERD), peptic ulcers, gallbladder problems, hepatitis, and pancreatitis. An upset stomach can also accompany migraine headaches as well as more serious conditions like brain tumors and strokes. Sometimes, nausea may develop in reaction to intense stress, anxiety, or fear. Most commonly, though, nausea occurs as the result of ingesting certain foods or medications or traveling in a moving vehicle. Nausea isn’t inevitable, especially when it comes to the most common causes.

If a bout of nausea happens to strike, here are some actions you can take:

Rest. Activity can worsen nausea. If you’re having an attack of motion sickness, stay as still as possible and try to get out of the vehicle as soon as you can. For other bouts of nausea, stop whatever you’re doing and get some rest.

Drink fluids to settle the stomach. Ginger ale and chamomile, lemon balm, or ginger tea are good choices for nausea. If you’re also vomiting, suck on ice cubes and drink water, broth, or sports drinks such as Gatorade to prevent dehydration.

Avoid strong food odors. Many odors can worsen nausea, so don’t cook while you’re feeling sick or go out grocery shopping or to a restaurant.

Eat crackers or toast to absorb excess stomach acid. You should also avoid fatty or spicy foods, which can upset the stomach further.

Take antacids (Maalox, Rolaids, Tums) to neutralize stomach acid or bismuth subsalicylate (PeptoBismol) to coat the stomach.

When To Call Your Doctor: See a doctor if nausea lasts for longer than 72 hours and you haven’t been able to eat or drink very much, or if nausea is accompanied by abdominal pain, intense dizziness, or a severe headache. Also see a doctor if you experience nausea and you’ve recently suffered a head injury, have a fever, blurred vision or eye pain, confusion, or a stiff neck.

Nausea can also be a sign of a stroke or heart attack. If nausea is accompanied by numbness on one side of the body or trouble seeing, speaking, or moving, you might be having a stroke and should call 911 immediately, even if the symptoms go away after a few minutes. If nausea occurs with chest pain that lasts longer than 10 minutes, it could be a heart attack and you should also call 911 right away.

For more Alerts and Special Reports, please visit the Digestive Disorders Topic page.

Johns Hopkins Health Alerts | Digestive Health | Tips on Avoiding and Treating Nausea

Pancreatic Cancer – Serious and Deadly

Mon, 22 Oct 2007 06:00:00 CDT

Johns Hopkins Health Alerts | Digestive Health | Pancreatic Cancer

Evidence that weight control and exercise may protect against another serious disease -- pancreatic cancer.

Pancreatic cancer, the fourth leading cause of cancer-related death in the United States, is notoriously difficult to detect. In addition, mortality is high; only 4% of patients are still alive five years after diagnosis. Until recently, smoking cigarettes or cigars was the only known, controllable risk factor for pancreatic cancer. However, recent research indicates that some of the lifestyle measures proven to reduce the risk of heart disease, diabetes, and cancers of the breast, prostate, colon, and rectum may also help prevent pancreatic cancer. These measures are especially important for people with a family history of pancreatic cancer.

Symptoms of pancreatic cancer don’t usually appear until the tumor obstructs nearby bile ducts, leading to jaundice, or grows large enough to cause abdominal pressure or pain. Other symptoms of pancreatic cancer can include back pain, nausea, loss of appetite, weight loss, and weakness. Because the pancreas is located deep within the abdomen, tumors cannot usually be palpated (felt upon examination). Furthermore, there are no screening tests to detect pancreatic cancer in its early stages. Thus, pancreatic cancer is generally detected only after symptoms develop and cancer cells have metastasized (spread) to other parts of the body. Occasionally, a tumor that develops near the common bile duct causes jaundice, and this allows early diagnosis. However, 90% of all pancreatic cancers are not diagnosed until the tumor has spread beyond the pancreas.

Risk factors for developing pancreatic cancer include:

smoking -- a two- to threefold increase

age -- more than 80% of new cases develop between the ages of 60 and 80

race -- pancreatic cancer is more common in blacks than in whites

gender -- pancreatic cancer is more common in men

family history -- having more than one close relative with pancreatic cancer increases the risk 18-fold

chronic pancreatitis (inflammation of the pancreas), diabetes, and cirrhosis of the liver are also associated with an increased risk of pancreatic cancer, as is a diet high in meats and fried foods.

Researchers recently examined data from two large population studies (the Health Professionals Follow-Up Study and the Nurses' Health Study) to learn what physical characteristics and lifestyle factors might influence the development of pancreatic cancer. The studies followed 163,689 men and women for 10 to 20 years. During that time, 350 participants were diagnosed with pancreatic cancer. Two new modifiable risk factors emerged: excess weight and physical inactivity.

The likelihood of developing pancreatic cancer was 72% higher in participants who were obese (body mass index, or BMI, of 30 or higher) compared with those who were leaner (BMI of less than 23). Moderate exercise (walking or hiking for about 1.5 hours per week) was associated with a 50% reduction in pancreatic cancer risk. This benefit, which was noted only in those who were overweight, did not require vigorous activity such as running.

It's important to note that these studies are retrospective (based on the recollections of participants) and population based (participants were not randomized to different groups). Therefore, they cannot prove a cause-and-effect relationship. However, since these studies involved large numbers of people and long-term follow-up, the associations are credible and strongly suggest that weight control and exercise may protect against yet another deadly illness.

For more Alerts and Special Reports, please visit the Digestive Disorders Topic page.

Johns Hopkins Health Alerts | Digestive Health | Pancreatic Cancer

Can You Have a Pain-Free Endoscopy?

Mon, 16 Apr 2007 06:00:00 CDT

Johns Hopkins Health Alerts | Digestive Health | Capsule Endoscopy

Endoscopy is done to find the cause of any number of gastrointestinal symptoms, such as nausea, vomiting, bleeding, abdominal pain, or acid reflux. Traditional endoscopy involves inserting a flexible tube, with a tiny camera at one end, down the esophagus and into the stomach and duodenum (the first part of the small intestine). Endoscopy is uncomfortable and requires sedation. The sedation necessitates a one to two hour recovery period at the clinic or hospital. And, although the risk is slight, sedation carries cardiopulmonary risks, especially for people with heart disease.

During capsule endoscopy there is a risk of capsule retention in the small intestine due to obstruction or narrowing, and surgery may be needed to remove the capsule. For that reason, capsule endoscopy is not for people with gastrointestinal obstructions, strictures, or fistulas. Patients with pacemakers or implantable cardioverter defibrillators (ICDs) cannot undergo capsule endoscopy, as the signals the camera sends to the recording device may disrupt the operation of the cardiovascular implant. Patients with swallowing disorders also cannot undergo capsule endoscopy.

For more Alerts and Special Reports, please visit the Digestive Disorders Topic page.

Johns Hopkins Health Alerts | Digestive Health | Capsule Endoscopy

Research Update on GERD

Mon, 26 Mar 2007 06:00:00 CST

Johns Hopkins Health Alerts | Digestive Health |

Research Update on GERD

GERD Update #1: Causes of Nighttime Heartburn

Many people, including up to 79% of those with gastroesophageal reflux disease (GERD), suffer from heartburn that awakens them during the night. Research reported in the journal Chest (Volume 127, page 1658) shows that people who are overweight, drink a lot of carbonated beverages, snore, experience daytime sleepiness or insomnia, have high blood pressure or asthma, or use anti-anxiety medications (such as diazepam [Valium]) are most likely to experience this problem.

The subjects were part of the Sleep Heart Health Study, a national trial that enrolled 15,314 people to investigate the link between breathing problems during sleep and cardiovascular disease. The subjects completed a survey that included the question “In the past year, how often, on average, have you been awakened during the night with heartburn or indigestion?” The responses indicated that one quarter, or 3,806 people, in this group reported the symptom at least twice a month. People with nighttime heartburn are at greater risk for more serious esophageal problems such as erosive esophagitis, Barrett’s esophagus, and esophageal cancer.

If you experience nighttime heartburn on a regular basis, talk with your doctor. In addition, try to control the risk factors identified in this study -- for example, keep your weight and blood pressure under control and cut down on your soda intake.

GERD Update #2: Fatty Diet Increases GERD Risk

The more calories and fat you eat, especially saturated fat, the more likely you are to have symptoms of GERD, such as heartburn and regurgitation of acid into the throat, according to a study reported in the journal GUT (Volume 54, page 11).

Three hundred and seventy one employees of the Houston Veterans Affairs Medical Center were asked to fill out GERD symptom and dietary consumption questionnaires. One hundred and sixty four of them also agreed to have an upper endoscopy to detect erosion of the esophagus, which occurs in people with GERD when stomach acid refluxes into the esophagus. Erosive esophagitis was found in 24% of those who had an upper endoscopy, and it was associated with a high-fat, high-protein diet.

People with GERD symptoms had significantly higher intakes of total fat, saturated fat, and cholesterol than those without symptoms. GERD sufferers also tended to eat more calories overall and get more of their calories from fat. Fat portions also tended to be larger among GERD sufferers, and the more calories and fat they ate, the more symptoms they had. It was unclear, however, whether high dietary fat intake directly caused GERD or whether people who have a high-fat diet tend to be overweight and these excess pounds increase their risk of GERD. Regardless of the explanation, eating fewer calories and reducing fat intake may lower your risk of GERD.

For more Alerts and Special Reports, please visit the Digestive Disorders Topic page.

Johns Hopkins Health Alerts | Digestive Health |

Research Update on GERD

Research on IBS

Mon, 05 Mar 2007 06:00:00 CST

Johns Hopkins Health Alerts | Digestive Health | Research on Irritable Bowel Syndrome (IBS)

Symptoms That Help Distinguish Irritable Bowel Syndrome From Crohn’s Disease

Many patients with irritable bowel syndrome (IBS), and some with Crohn’s disease (a form of inflammatory bowel disease), suffer from non-gastrointestinal symptoms in addition to their digestive problems, according to new research. The study of 400 people with irritable bowel syndrome or Crohn’s disease was reported in the Canadian Journal of Gastroenterology (Volume 19, page 231).

All of the patients completed a questionnaire that asked them about a wide variety of symptoms. The results revealed that irritable bowel syndrome patients were more likely than those with Crohn’s disease to have headaches, urinary problems, chronic fatigue syndrome, fibromyalgia, or depression or anxiety. Crohn’s patients were more likely than irritable bowel syndrome patients to experience weight loss or night sweats.

Both irritable bowel syndrome and Crohn’s patients said that they suffered from sleep problems. The patients with Crohn’s, however, typically linked their sleep problems to digestive disturbances during the night, especially diarrhea and abdominal pain. The authors note that their study was limited by the fact that all of the participants came from a single gastroenterology practice, which might bias the results. However, they also note that their findings are consistent with those previously reported in other studies.

Melatonin Eases Pain From Irritable Bowel Syndrome

Taking melatonin supplements can help to relieve abdominal pain in people with irritable bowel syndrome (IBS) and sleep disturbances, according to a study reported in the journal GUT (Volume 54, page 1136). Melatonin is a hormone that promotes sleep but also helps regulate sensations in the gut and the movement of food through the digestive tract.

Researchers in Singapore randomly assigned 40 people with irritable bowel syndrome and sleep disturbances to receive either 3 mg of melatonin or a placebo at bedtime for two weeks. Those who took the melatonin supplements reported significant reductions in abdominal pain, rectal pain, and the sensation of urgently needing to have a bowel movement. The treatment did not have an effect on bloating, stool type or frequency, or anxiety or depression scores.

Surprisingly, melatonin did not improve sleep in irritable bowel syndrome patients -- whether it was measured objectively or by subjects’ own assessments of their sleep. The authors theorize that this was because the subjects were not awakened at night by their abdominal pain, and thus their sleep problems must have been related to another cause. This is the first study to look at melatonin in irritable bowel syndrome patients with sleep disturbances. Thus, more research is needed to confirm this result in a larger group of people, as well as to determine the optimal dose and length of treatment with melatonin.

For more Alerts and Special Reports, please visit the Digestive Disorders Topic page.

Johns Hopkins Health Alerts | Digestive Health | Research on Irritable Bowel Syndrome (IBS)

Colonics: How Risky Are They?

Thu, 28 Dec 2006 06:00:00 CST

Johns Hopkins Health Alerts | Digestive Health | Risks of Colonics

Johns Hopkins doctors advise against colonics because of concerns about the potential for side effects.

Do most diseases begin in the colon? Is your bowel a cesspool? Does it harbor toxins that are harmful to your health? Some alternative health practitioners would have you believe that the answer to these questions is “yes.”

Treatments such as colonics are touted to detoxify the body and to ease the symptoms of conditions as wide ranging as asthma, arthritis, sinus problems, chronic fatigue, and constipation. But the medical truth is that colonics have never been rigorously tested in clinical trials.

Colonics -- What’s involved. During a colonic, a colon hydrotherapist inserts a rubber tube through the rectum and into the colon, sometimes as far as 30 inches. Up to 20 gallons of warm or cool water—possibly supplemented with soap, herbs, coffee, enzymes, minerals, or other substances—is then pumped into the rectum and allowed to sit for a few seconds to a few minutes while the stomach is massaged to loosen feces that are believed to have hardened in the colon (and are claimed to be the source of the toxins). The water is then drained out of the body through a second tube, bringing the fecal matter with it. This process is typically repeated several times to completely cleanse the bowel.

Colonics -- The risks. While removing hardened feces from your colon may sound like a reasonable way to improve your health, the risks of colonics should give you pause— particularly if you are over age 65 or have a bowel disease such as diverticulitis, Crohn’s disease, or ulcerative colitis, all of which increase your chances of experiencing a complication from the procedure.
In general, the dangers of undergoing colonics can be placed into four categories:

during a colonic the bowel wall can be perforated by the tip of the rubber tubing or by the use of too much water pressure and can lead to a potentially life-threatening infection;

you can have an allergic reaction to the nozzle at the tip of the rubber tubing (in particular, if you are allergic to latex) or to one of the cleansing substances added to the water;

you can develop an imbalance in electrolytes such as potassium and sodium, since colonics rinse away minerals that are normally absorbed into the bloodstream from the large intestine;

you can be infected with bacteria and viruses if the equipment is not properly sterilized between treatments. (Most colon hydrotherapists use disposable, sterile tubing, so this is less of a risk than in the past.)

The bottom line on colonics. Today, experts in the medical community—including doctors at Johns Hopkins—look on colonics as a questionable procedure, and advise against its practice because of concerns about the potential for side effects of colonics. While we are not opposed to alternative and complementary health practices that have been proven to be safe and effective, we do not advise colonics because it goes against a basic medical principle: First, do no harm.

Johns Hopkins Health Alerts | Digestive Health | Risks of Colonics

Three Popular Myths About Digestive Disorders

Wed, 27 Sep 2006 12:56:09 CDT

Johns Hopkins Health Alerts | Digestive Health | Myths About Digestive Disorders

The truth about the causes of peptic ulcers, inflammatory bowel disease, and gastroparesis

Before the advent of modern medicine, the average person relied on folklore, old wives’ tales, and remedies handed down from previous generations to treat various ailments of the digestive tract. Today, despite extensive research, misunderstandings about the causes and treatments of many digestive disorders still persist. Here, then, are three common myths, according to the National Digestive Diseases Information Clearinghouse—and the real truths based on the latest research findings.

Digestive Disorders Myth #1: Spicy foods and stress cause peptic ulcers.

Truth: Most peptic ulcers are caused by infection with the bacterium Helicobacter pylori (H. pylori) or by frequent use of nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen (Advil, Motrin), and naproxen (Aleve, Naprosyn). Spicy foods, however, can worsen peptic ulcer symptoms in some people, which is why you may want to avoid them if you have a peptic ulcer.

Digestive Disorders Myth #2: Inflammatory bowel disease is caused by psychological problems.

Truth: There’s no evidence to support the notion that Crohn’s disease and ulcerative colitis, collectively known as inflammatory bowel disease (IBD), are caused by stress, anxiety, or any other psychological problem. Instead, most experts believe these diseases are triggered by a virus or bacteria that sets off an abnormal reaction by the body’s immune system that results in inflammation in the intestines. That said, stress does appear to worsen the symptoms of abdominal pain and diarrhea associated with IBD.

Digestive Disorders Myth #3: Diabetes does not affect the digestive tract.

Truth: Both type 1 diabetes and type 2 diabetes put people at risk for digestive disorders due to nerve damage (neuropathy). Neuropathy occurs when high blood glucose (sugar) levels— which result because the body doesn’t make enough insulin to remove glucose from the blood and usher it into cells—causes chemical changes and injury to the blood vessels.

For instance, damage to the vagus nerve, which controls the movement of food through the digestive tract, can lead to gastroparesis, in which the stomach empties at a slower than normal rate. Signs and symptoms of gastroparesis include heartburn, nausea, vomiting of undigested food, weight loss, stomach bloating, and spasms of the stomach wall. Neuropathy can also cause diarrhea or constipation if the nerves that control the intestines are damaged.

Johns Hopkins Health Alerts | Digestive Health | Myths About Digestive Disorders

7 Steps to Help Lower Your Risk of Esophageal Cancer

Fri, 27 Oct 2006 06:00:00 CDT

Johns Hopkins Health Alerts | Digestive Health | Help Lower Your Risk of Esophageal Cancer

Focus on your controllable risk factors, such as smoking cigarettes and drinking heavily.

Esophageal cancer is still a relatively uncommon disease—but it is also the fastest rising cancer in the United States. According to the latest statistics, esophageal cancer has increased six-fold over the past 30 years.

Esophageal cancer occurs when cells in the innermost layer of the lining of the esophagus (the tube that moves food and liquid from the throat to the stomach) begin to grow uncontrollably and spread outward through the multiple layers of the esophageal lining. The cancer can start in the squamous cells—the thin, flat cells that line the esophagus. This type of cancer is called squamous cell carcinoma, and the number of cases is actually on the decline in the United States. Adenocarcinoma—where the cancer first grows in the glandular cells lining the esophagus—is the type that is increasing dramatically.

What puts you at risk for esophageal cancer?

Like most cancers, there are some risk factors for esophageal cancer over which you have no control, for instance, being older than age 40, being male or black, or having had cancer in the head and neck area. But other risk factors are well under your control, such as smoking cigarettes, chewing tobacco, drinking alcohol heavily and regularly, being overweight, and having gastroesophageal reflux disease (GERD).

Protecting yourself from esophageal cancer is all about focusing on the controllable risk factors we’ve just mentioned. Here are seven essential steps you can take to lower your risk.

Quit smoking and don’t use smokeless tobacco products. Nicotine contains numerous cancer causing agents and can worsen GERD. The longer you use nicotine products, the greater your risk of esophageal cancer.

Reduce alcohol intake.Alcohol in moderation (up to one drink a day for women and up to two for men) is fine, but heavy consumption of liquor, beer, and wine over many years has been proven to increase the risk of esophageal cancer.

Avoid very hot liquids. Drinking exceptionally hot liquids on a regular basis can also damage the lining of the esophagus, increasing the risk of esophageal cancer (particularly the squamous cell type).

Eat more fruits and vegetables. Researchers have found that people who eat a diet low in vitamins A, C, B1(riboflavin), and beta-carotene, and the mineral selenium, have a higher risk of esophageal cancer.

Don’t ignore heartburn. There is no reason to suffer the symptoms of frequent heartburn or GERD, especially when refluxed acid from the stomach can damage the esophagus and predispose you to Barrett’s esophagus and esophageal cancer.

Manage your weight. Being overweight by 20 lbs. or more—in particular, being obese—raises the risk of esophageal cancer (as well as other diseases).

Have an upper endoscopy on a regular basis if you are at high risk. If you have strong risk factors for esophageal cancer, such as GERD or Barrett’s esophagus, you should have an upper endoscopy on a regular basis to look for cancerous changes in the cells that line the esophagus.

Johns Hopkins Health Alerts | Digestive Health | Help Lower Your Risk of Esophageal Cancer

Is Your Stomach Depressed?

Tue, 28 Nov 2006 06:00:00 CST

Johns Hopkins Health Alerts | Digestive Health |

Stomach Problems and the Enteric Nervous System

New research suggests that there is a kind of “brain in the belly” – called the enteric nervous system – that responds to psychological distress.

For a long time, psychological problems were believed to cause many stomach problems. But the relationship may be just the reverse -- physical problems of the stomach can cause psychological distress. New research suggests that there is a kind of brain in the belly. This “brain” is called the enteric nervous system (ENS). What’s more, treatments for psychological disorders may also help ease stomach problems.

The Enteric Nervous System and Stomach Problems

The ENS is composed of a vast network of neurons located throughout the gastrointestinal (GI) tract. This neuron network communicates with the brain and spinal cord. There are as many neurons in the small intestine as in the spinal cord, and the same hormones and chemicals that transmit signals in the brain have been found in the gut, including serotonin, norepinephrine, nitric oxide, and acetylcholine. The brain and the ENS communicate constantly, and their functions sometimes overlap. For example, both “brains” control emptying of the stomach. Still, it appears that more messages are sent from the ENS. The ENS warns the brain about any toxins in the stomach so that both brains can coordinate an appropriate response. It also sends the brain signals of hunger and satiety.

Stomach Problems

Until the bacterium Helicobacter pylori was identified as the culprit in most cases of peptic ulcer -- a discovery that recently won the Nobel Prize -- doctors usually blamed stress and anxiety for ulcers. Now many researchers believe that the pain produced by ulcers produces the stress. The ENS may also be behind irritable bowel syndrome (IBS), which can cause diarrhea and constipation without detectable physical abnormalities. A recent study published found that people with IBS have significantly lower levels of serotonin in cells lining the stomach. Although serotonin is best known for its role as a mood-boosting brain chemical, it is also involved in many digestive functions and in the perception of pain. In fact, more serotonin is found in the stomach than in the brain, and the GI tract is very sensitive to changes in its serotonin level. The researchers concluded that IBS may arise from abnormalities in serotonin levels responsible for digestive functions.

Targeting The ENS

The fact that the ENS and the brain use the same chemicals and hormones may be why drugs designed to affect the brain can improve certain digestive diseases. Low doses of antidepressants -- for example, Paxil (paroxetine), Prozac (fluoxetine), and Zoloft (sertraline) -- can improve the symptoms of Crohn’s disease and IBS for many people. Some of the newer drugs for IBS are geared toward balancing serotonin levels in the digestive system. Although these drugs have some serious side effects, they are a great leap forward in the treatment of digestive disorders, because they specifically target the ENS. Research into the workings of the “brain in the belly” is still preliminary. But as we learn more about the ENS, more effective treatments for digestive diseases will undoubtedly be discovered, though the wait may be a decade or more.

Johns Hopkins Health Alerts | Digestive Health |

Stomach Problems and the Enteric Nervous System

How to Avoid Food Poisoning

Thu, 01 Feb 2007 06:00:00 CST

Johns Hopkins Health Alerts | Digestive Health | How to Avoid Food Poisoning

Food poisoning is estimated to cause 76 million infections, 300,000 hospitalizations, and 5,000 or more deaths annually – but there are many ways to prevent food poisoning!

The most common forms of foodborne illnesses are infections caused by microscopic agents that thrive in or on food that has not been properly handled. Unwashed, raw, or undercooked foods are the most vulnerable to this type of contamination. In this country, the usual contaminants are bacteria (including various species of Shigella, Salmonella, and Staphylococcus; Campylobacter jejuni, Bacillus cereus, and certain strains of Escherichia coli) and viruses (most commonly the Norwalk or Norwalk-like viruses).

Although many people assume that all foodborne illnesses are “food poisoning,” food poisoning is only one type of foodborne illness. True food poisoning is caused by a harmful contaminant, such as a toxin or a chemical. For example, food poisoning can result from deadly toxins produced by poisonous mushrooms or by the bacterium Clostridium botulinum (which results in botulism).

Food-related infections can also be caused by parasites, but such infections are more likely to be encountered abroad in areas where food-handling practices are less stringent than in the United States.

Preventing Food Poisoning at Home

Proper food-handling practices and personal hygiene are key to preventing foodborne illness and food poisoning. Here are some prevention tips you should follow when choosing, storing, preparing, and serving food.

Food Poisoning Prevention Tip #1: Shopping

Avoid packaging that is ripped or leaky when buying perishable products.

Select perishable items last.

Choose items that have not reached their expiration date.

Pass up cans that are bulging or dented.

Do not purchase fresh, pre-stuffed, whole poultry.

Drink only pasteurized milk and juice.

Check fresh food for mold.

Food Poisoning Prevention Tip #2: Storage

Refrigerate food at 40° F or below; freeze food at 0° F or below.

Refrigerate oils containing garlic or herbs.

Store raw meat, poultry, and seafood away from other foods to prevent bacteria from spreading; seal these foods in containers or bags to prevent raw juices from dripping onto other foods.

Avoid overstuffing the refrigerator, so that air may circulate.

Save cooked leftovers for no more than four days.

Freeze or cook fresh poultry, seafood, and ground meat within two days of purchase. Freeze or cook whole cuts of meat within three to five days.

Food Poisoning Prevention Tip #3: Preparation

Wash hands thoroughly with soap and water for 20 seconds before and after handling food.

Thaw frozen foods in the refrigerator (never at room temperature), then cook immediately. For faster thawing, use the microwave or submerge foods in cold water in a sealed container; cook immediately afterwards.

Always refrigerate food that is being marinated.

Avoid cross-contamination: Use one cutting board and set of utensils to prepare any raw meat, fish, poultry, or eggs for a meal. Use a separate cutting board and utensils for all other ingredients (such as vegetables or bread).

Use strict sanitary procedures when home canning. Boil home-canned food before eating, if possible, to destroy any potential microbes.

Clean fruits and vegetables thoroughly with water before eating.

Sanitize cutting boards and countertops with a solution of 1 teaspoon of chlorine bleach in 1quart of water.

Food Poisoning Prevention Tip #4: Cooking

Thoroughly cook meat, poultry, seafood, and eggs. (Cook eggs until the yolk is firm.) Use a meat thermometer to ensure proper internal cooking temperatures of meat, poultry, and casseroles; insert the thermometer into the thickest part of the food, as far as possible from bone, fat, or gristle.

Do not serve raw or lightly cooked sprouts. Avoid them or cook them thoroughly.

Reheat foods to an internal temperature of 165°F.

Cook steaks, roasts, and chops of beef, veal, and lamb to an internal temperature of 145°F; all cuts of pork, to 160°F.

Cook whole poultry, as well as poultry thighs and wings, to an internal temperature of 180°F; breasts, to 170°F.

Cook ground meat to an internal temperature of 160°F; ground poultry, to 165°F.

Food Poisoning Prevention Tip #5: Serving

Hold hot foods at 140°F or higher and cold foods at 40°F or lower.

Use warming trays and chafing dishes to serve hot foods at a buffet; hold cold foods on ice.

Serve food on clean plates that have not touched raw meat, fish, poultry, or eggs.

Refrigerate foods promptly after serving. Discard perishables left at room temperature for two hours or more; one hour if the room or outdoor temperature is 90°F or above.

Never give honey to a baby because of the potential for botulism poisoning.

Johns Hopkins Health Alerts | Digestive Health | How to Avoid Food Poisoning

When Heartburn Raises a Red Flag

Tue, 30 May 2006 09:59:31 CDT

Johns Hopkins Health Alerts | Digestive Health | Symptoms of Heartburn and GERD

Occasional heartburn can be treated with over-the-counter antacids. But if you have any of these symptoms, talk to your doctor to rule out more serious problems.

From time to time, everyone experiences heartburn—a burning sensation in the chest caused by the reflux of stomach contents into the esophagus. Mild symptoms associated with heartburn include belching and a bitter or acidic taste in the mouth. Occasional heartburn is usually not serious and can be treated with over-the-counter medications such as antacids.

Sometimes heartburn can represent a more serious problem, however. Chronic heartburn may signal gastroesophageal reflux disease (GERD), and associated symptoms such as difficulty swallowing or blood in the stool may signal an esophageal ulcer, stricture, or even cancer. Any of these symptoms should prompt you to call your doctor:

heartburn that occurs several times a week or wakes you up at night;

heartburn that persists after taking over-the-counter or prescription medication;

difficulty swallowing;

vomiting, especially blood or black material;

black stools (may indicate gastrointestinal bleeding);

weight loss;

loss of voice;

severe hoarseness or wheezing.

Other symptoms related to heartburn may be caused by a heart attack— meaning you should seek medical help immediately:

a feeling of pain, squeezing, fullness, or pressure in the center of the chest that lasts longer than a few minutes;

pain radiating into the shoulder, arm, or jaw, particularly on the left side of the body;

chest pain accompanied by shortness of breath, a cold sweat, nausea, fainting, dizziness, paleness, or light-headedness;

palpitations or an increase in heart rate;

fatigue, weakness, or anxiety of no known cause.

Johns Hopkins Health Alerts | Digestive Health | Symptoms of Heartburn and GERD

Diverticulitis -- Reducing the Risk of Recurrence

Fri, 28 Jul 2006 10:10:48 CDT

Johns Hopkins Health Alerts | Digestive Health |

Diverticulitis Treatment Options

About one third of people who have an episode of diverticulitis will experience another attack.

Diverticulitis is thought to occur when bacteria or hardened stool becomes trapped in small, bulging pouches (diverticula) in the colon wall and trigger infection or inflammation. Diverticula develop in most people as they age—a condition called diverticulosis. About 10% to 25% of those with diverticulosis eventually suffer an episode of diverticulitis.

People with diverticulitis are usually hospitalized and treated with intravenous antibiotics to eradicate infection. Surgery may be necessary for those with diverticulitis who fail to respond adequately to medical therapy (about 20% of patients). In such cases, the affected area of the colon is removed and the remaining sections of the colon are joined together.

About one third of people who have an episode of diverticulitis will experience another attack. Because recurrent attacks of diverticulitis are less likely to respond to medical therapy and have a high mortality, surgical resection of the affected portion of the colon is usually recommended after a second attack of divericulitis.

To reduce the risk of a recurrence of diverticulitis, patients should eat a diet that is high in fiber and low in total fat and red meat. Once you’ve recovered from your attack of diverticulitis, gradually increase your dietary fiber intake over a period of weeks. Exercise may help, too. In addition, some studies show that long-term treatment with Asacol (mesalamine), an anti-inflammatory drug, and Xifaxan (rifaximin), an antibiotic, also might be protective.

Johns Hopkins Health Alerts | Digestive Health |

Diverticulitis Treatment Options

Celiac Disease -- Not So Rare After All

Tue, 29 Aug 2006 10:05:56 CDT

Johns Hopkins Health Alerts | Digestive Health | The Prevalence of Celiac Disease

Many people don’t know they have celiac disease, either because the symptoms they have are mistakenly attributed to another illness or because they don’t have symptoms.

Celiac disease is an inherited disorder marked by sensitivity to gluten, a component of wheat and other grains. In people with celiac disease, a protein in gluten produces an immune reaction that compromises the ability of the villi (finger-like projections in the intestines) to absorb nutrients from food. As a result, diarrhea, bloating, weight loss, anemia, and vitamin deficiencies are common and among the first signs of celiac disease. Eventually, long-term damage to the small intestine may result from celiac disease.

The celiac disease was once thought to be rare in the United States, but recent research suggests celiac disease may be relatively common. According to a study published in the Archives of Internal Medicine, about 1 in 133 Americans has celiac disease. The proportion is even higher in people with certain health problems and those who have relatives with celiac disease.

The researchers found that many people don’t know they have celiac disease, either because the symptoms they have are mistakenly attributed to another illness or because they don’t have symptoms. Approximately 20% of newly diagnosed cases of celiac disease are found in people age 60 or older, some of whom have had symptoms for many years.

Based on current research, anyone with a relative who has celiac disease should be screened for celiac disease with a blood test. Screening should also be considered for those with a personal history of thyroid disease or type 1 diabetes (these conditions, like celiac disease, are autoimmune disorders), unexplained digestive symptoms, or weight loss.

Screening for celiac disease is easy. A blood sample is tested for three specific antibodies that are present when a person with celiac disease ingests gluten. If these three antibodies are found, a biopsy of the small intestine is usually performed to look for any damaged villi. It’s important not to avoid foods that contain gluten before these tests—avoidance could make blood tests and biopsies appear normal and prevent an accurate diagnosis.

If celiac disease is diagnosed, the only way to treat it is by adopting a gluten-free diet—which eliminates symptoms and reverses damage to the small intestine in 95% of people with celiac disease.

Johns Hopkins Health Alerts | Digestive Health | The Prevalence of Celiac Disease

The Power Of Friendly Bacteria—Probiotics For Ulcerative Colitis And Irritable Bowel Syndrome

Fri, 14 Apr 2006 12:53:22 CDT

Johns Hopkins Health Alerts | Digestive Health |

Probiotics For Ulcerative Colitis And Irritable Bowel

Two controlled trials have found that the probiotic E. Coli—a harmless form of the common intestinal bacterium Escheria coli—achieved results comparable to standard drugs used to treat ulcerative colitis.

Evidence is accumulating that "friendly" bacteria called probiotics can safely treat a variety of digestive disorders, including ulcerative colitis and irritable bowel syndrome (IBS). The digestive tract plays host to hundreds of microorganisms, which are termed flora. While some cause disease, most perform valuable functions.

Among the potential benefits: Two controlled trials have found that the probiotic E. Coli—a harmless form of the common intestinal bacterium Escheria coli—achieved results comparable to standard drugs used to treat ulcerative colitis. In another study presented at a Digestive Disease Week meeting, probiotic therapy with Lactobacillus acidophilus and Bifidobacteria infantis (given alone or in combination with antibiotics) significantly improved symptoms and quality of life in patients with irritable bowel syndrome. Both of these microbes use sugar as a food source and in turn generate lactic acid, which inhibits the growth of harmful bacteria.

Other benefits of probiotics exist for treating infectious diarrhea in children and diarrhea associated with antibiotics, and for preventing bacterial infections after surgery.

Because probiotics do not permanently colonize the gastrointestinal tract, they would probably need to be taken indefinitely to maintain any beneficial effects. Although there is a small chance that probiotics could cause an infection, especially in people at high risk for opportunistic infections or in cases where the gastrointestinal tract is badly damaged, the probiotic strains that have been tested appear to be very safe.

However, more research is needed to identify the best probiotic—and the optimal dose—for managing a particular condition. And many experts believe that better regulation of probiotics is needed to ensure that the over-the-counter products now widely available contain viable microorganisms in the amounts stated.

If you want to try probiotic supplements for a few weeks to see if they help with your gastrointestinal symptoms, check with your doctor first. A variety of capsules, liquids, and powders are available. Powders can be stirred into food but shouldn’t be added to food warmer than room temperature because heat will kill the bacteria.

Another option is to add probiotic-containing foods to your diet. These foods include yogurt, kefir (a cultured-milk beverage), tempeh (which is made from soybeans), and kimchi (a Korean fermented cabbage dish). It is unclear whether they contain enough probiotics to have any effect, however.

Johns Hopkins Health Alerts | Digestive Health |

Probiotics For Ulcerative Colitis And Irritable Bowel

Don't Rely On Virtual Colonoscopy For Colon Cancer Screening

Wed, 28 Jun 2006 12:29:48 CDT

Johns Hopkins Health Alerts | Digestive Health | Virtual Colonoscopy for Colon Cancer Screening

Biopsy samples cannot be taken with a virtual colonoscopy, and polyps cannot be removed as they can during a standard colonoscopy.

A colonoscopy is considered the gold standard as a screening test for colon cancer. The test requires the insertion of a long flexible viewing tube—a colonoscope—through the entire colon and, at times, the lower portion of the small intestine. By means of the colonoscope, a gastroenterologist can view the inside of the colon and also take biopsy samples and remove any abnormal growths that may develop into colon cancer.

Although patients undergoing colonoscopy are sedated, colonoscopy can cause abdominal cramping, bloating, and a need to pass gas. Patients must also wait until the sedation wears off, which can take an hour, and someone must drive them home. Serious complications of colonoscopy are rare, but can include perforation of the colon.

It is understandable that a “virtual” colonoscopy—a relatively new technology—sounds more appealing. Patients are not sedated, and the procedure is much less invasive. A tube is inserted into the patient’s rectum and the colon is filled with air so that its entire length can be viewed using computed tomography (sometimes called a CT or CAT scan).

However, patient preparation is the same as it is for a conventional colonscopy: A mainly liquid diet must be followed for up to three days before the colonoscopy and a strong laxative must be taken the evening prior to the test to ensure the colon is cleansed for viewing. And although virtual colonoscopy is quicker, safer, and cheaper than traditional colonoscopy—and nearly as accurate in detecting “clinically relevant” polyps—a number of drawbacks make virtual colonoscopy an undesirable option for most people.

For example, biopsy samples cannot be taken with a virtual colonoscopy. If any abnormalities are detected, patients still require a standard colonoscopy for confirmation of the diagnosis. In addition, polyps cannot be removed as they can during a standard colonoscopy. Also, in a survey of screenings at nine major hospitals, virtual colonoscopy proved significantly less capable than standard colonoscopy of detecting small polyps (6 mm or less).

In the future this test will be most useful for people at low risk for colon cancer. Currently, a virtual colonoscopy is not recommended for routine colon cancer screening purposes. You are an appropriate candidate for virtual colonoscopy only if you have a medical condition that makes a standard colonoscopy risky or physically difficult.

Johns Hopkins Health Alerts | Digestive Health | Virtual Colonoscopy for Colon Cancer Screening