All posts in DISEASES

Crohn’ disease  is an inflammatory condition of the digestive tract.

Approximately 80 percent of patients have small bowel involvement, usually in the distal ileum.
Approximately 20 percent have disease limited to the colon.
Approximately 50 percent of patients involvement of both the ileum and colon.
A small percentage have predominant involvement of the mouth or gastroduodenal area.
Approximately one-third of patients have perianal disease.

CAUSES -GENETICS+ ENVIRONMENTAL FACTORS

The current belief is that, in a genetically susceptible person, a trigger leads the body’s immune system to inappropriately cause inflammation in the digestive tract.

SYMPTOMS

Frequent, loose bloody stools
Anemia
Abdominal pain
Weight loss
Low grade fevers
Joint pains
Eye problems
Skin rash
Liver problems
Perianal disease

DIAGNOSIS

Bloody diarrhea in any patient,especially if for long periods should prompt an appropriate work up to diagnose colitis. Blood tests, stool tests, X rays  and  colonoscopy are helpful in making a diagnosis.

COMPLICATIONS 

Stricture  A stricture is a narrowing of the colon or rectum which  can cause a blockage of the colon.
Perforation and fistulae
Bleeding
Toxic Megacolon
Blood Clots
Severe malnutrition
Gallstones
As with ulcerative colitis there appears to be an increased risk of colon cancer in patients with longstanding Crohn’s colitis.

MEDICATIONS

Many different drugs are used to treat Crohn’s disease. The choice of medications will depend upon the area of the digestive tract affected by the disease and the symptoms.
Steroids (such as prednisone and budesonide) can induce remission in patients with active, moderate to severe Crohn’s disease. However, steroids do not prolong remission and there are many serious side effects of long-term steroid use.

Sulfasalazine was one of the first drugs used to treat Crohn’s disease restricted to the colon. Sulfasalazine usually begins to reduce symptoms within a few days, but its full effect may require up to four weeks of treatment.
5-aminosalicylates – The 5-aminosalicylate (5-ASA) drugs (such as Asacol, Lialda  and Pentasa) are similar to sulfasalazine, but are less likely to cause headaches and allergic reactions.
Antibiotics – Antibiotics can reduce the number of bacteria in the intestines, which can in turn reduce inflammation. The antibiotics most frequently used are metronidazole and ciprofloxacin.
Immunomodulator drugs – Immunomodulator drugs decrease the inflammation associated with Crohn’s disease. The most commonly used drugs include azathioprine, 6-mercaptopurine.
Biologic response modifiers (Infliximab (Remicade) , Adalimumab (Humira), Natalizumab (Tysabri), Certolizumab pegol (Cimzia)) are   medications that  used as treatment options in moderate to severe Crohn’s disease who have not responded to other therapies.

SURGERY 
About 80 percent of patients with Crohn’s disease will require an operation at some time, usually to stop bleeding, to close fistulas and bypass obstructions, and often to remove the affected areas of the intestine However, surgery does not cure Crohn’s disease, and recurrence is likely.

COMMONLY USED DRUGS
Sulfasalazine ( Azulfidine)
Mesalamine( Asacol,Lialda,Pentasa,Canasa,Rowasa)
Azathioprine( Azasan,Imuran)
Mercaptopurine ( Purinethol)
Steroids (Prednisone)

For more information, please see

www.nlm.nih.gov/medlineplus/healthtopics.html
www.niddk.nih.gov/
www.cdc.gov/
www.gastro.org
www.acg.gi.org
www.ccfa.org

Constipation refers to bowel movements  that are  too hard or too small, difficult to pass with need to strain, or infrequent. Infrequent may be defined as fewer than three spontaneous bowel movements per week.
CAUSES
Low fiber diet
Medications that can cause constipation
Thyroid disease
Irritable bowel syndrome
Diabetes
Multiple sclerosis
Parkinson’s disease
Spinal cord injuries
Colon cancer

DIAGNOSIS
Clinical symptoms usually lead to a diagnosis of constipation.
Blood tests can detect hypothyroidism, anemia, hypercalcemia  which need further evaluation and treatment.
Colonoscopy is indicated in those with a recent change in bowel habits, blood in the stool, weight loss, or a family history of colon cancer.

TREATMENT
The bowels are most active following meals, and this is often the time when stools will pass most readily
Eating a diet high in fiber is important. The recommended amount of dietary fiber is 20 to 35 grams of fiber per day. For those who do not like high-fiber foods such as fruits, vegetables, and whole grains, psyllium powder mixed in an 8-ounce glass of water or another beverage one to three times daily may be considered. Numerous laxatives with
Various  mechanisms of action, safety, and experience are available .

For more information please see
www.nlm.nih.gov/medlineplus/healthtopics.html
www.cdc.gov/
www.niddk.nih.gov
www.gastro.org

www.ibsgroup.org

An average person has a 5 percent lifetime risk of developing colorectal cancer.
Most colorectal cancers develop from precancerous adenomatous polyps. A small percentage of these polyps become cancerous. This progression takes at least 10 years in most people. Early detection of lesions  increases the chances of successful treatment and decreases the chance of dying as a result of the cancer.

Colon cancer screening tests work by detecting polyps or by finding early stage cancers. Regular screening for and removal of  polyps can reduce a person’s risk of developing colorectal cancer by up to 90 percent.

RISK FACTORS 
Family history of colorectal cancer -Colorectal cancer in a family member increases an individual’s risk of cancer, especially if the family member is a first degree relative (a parent, brother or sister, or child), if several family members are affected, or if the cancers have occurred at an early age (before age 55 years)
Prior colorectal cancer or polyps
Increasing age -90% of  cancers  occur in people older than 50 years of age. Risk increases with age throughout life.
Lifestyle factors -A diet high in fat and red meat and low in fiber , sedentary lifestyle, cigarette smoking
Familial adenomatous polyposis (FAP) is an uncommon inherited condition that increases a person’s risk of colorectal cancer. Nearly 100 percent of people with this condition will develop colorectal cancer during their lifetime, and most of these cancers occur before the age of 50 years.

Hereditary nonpolyposis colon cancer (HNPCC) is another inherited condition associated with an increased risk of colorectal cancer. About 70 percent of people with HNPCC will experience colorectal cancer by the age of 65. Cancer also tends to occur at younger ages and in the part of the colon on the right side of the body.HNPCC is suspected in those with a strong family history of colon cancer; several family members from different generations may have been affected, some of whom developed the cancer relatively early in life. People with HNPCC are also at risk for other types of cancer, including cancer of the uterus, stomach, bladder, kidney, and ovary.
Inflammatory bowel disease- People with Crohn’s disease of the colon or ulcerative colitis have an increased risk of colorectal cancer. The degree of increased risk depends upon the amount of inflamed colon and the duration of disease; pancolitis (inflammation of the entire colon) and colitis of 10 years’ duration or longer are associated with the greatest risk for colorectal cancer. The risk of colon cancer is not increased in people with irritable bowel disease.
Factors that may decrease risk include a high calcium diet ( at least 1000 mg of calcium daily, either through diet or by taking a calcium supplement)

SCREENING TESTS – tests that can detect cancers at an early treatable stage (eg, stool tests), and tests that also detect pre-cancerous polyps (adenomas) and can lead to cancer prevention.

Stool tests – Colorectal cancers often bleed, releasing microscopic amounts of blood and abnormal DNA into the stool. Stool tests can detect blood or abnormal DNA makers. Guaiac testing, when performed once per year, can reduce the risk of dying from colorectal cancer by at least one-third.
Disadvantages -Guaiac testing is less likely to detect polyps than other screening tests.
If the stool test is positive, the entire colon should be examined with colonoscopy

Colonoscopy 
Procedure  – Colonoscopy requires that the patient prepare by cleaning out the entire colon and rectum by  consuming a liquid medication that causes diarrhea temporarily.  After gentle sedation, a thin, lighted tube is used to directly view the lining of the rectum and the entire colon.
Advantages-Only test that can “remove” polyps in the whole colon
Disadvantages –  Colonoscopy leads to serious bleeding or a tear of the intestinal wall in about 1 in 1,000 people.
There is also the possibility of missing polyps or cancer .
CT colonography 
Procedure  – Computed tomography colonography (CTC) is a test that uses a CT scanner to take images of the entire bowel to determine if polyps or cancers are present  

Advantages -It does not require sedation and is non-invasive
The entire bowel can be examined, and polyps can be detected about as well as with traditional colonoscopy.
Disadvantages -CTC requires a bowel prep to clean out the colon.
If an abnormal area is found with CTC, a traditional colonoscopy will be needed to remove a polyp ot biopsy a mass/cancer
Incidental findings  detected on CTC will require further testing.

Double contrast Barium enema and  flexible sigmoidoscopy  are also used for screening although less commonly than other modalities

PLEASE DISCUSS THE APPROPRIATE SCREENING MODALITY WITH YOUR PHYSICIAN
Average risk of colorectal cancer 
 People with an average risk of colorectal cancer should begin screening at age 50.
Increased risk of colorectal cancer 
 People who have one first-degree relative (parent, brother, sister, or child) with colorectal cancer or adenomatous polyps at a young age (before the age of 60 years), or two first-degree relatives diagnosed at any age, should begin screening for colon cancer earlier, typically at age 40, or 10 years younger than the earliest diagnosis in their family, whichever comes first. Screening usually includes colonoscopy, which should be repeated every five years.
People who have one first-degree relative (parent, brother, sister, or child) who has experienced colorectal cancer or adenomatous polyps at age 60 or later, or two or more second degree relatives (grandparent, aunt, uncle) with colorectal cancer should begin screening at age 40, and screening should be repeated as for average risk people.
 People with a second-degree relative (grandparent, aunt, or uncle) or third-degree relative (great-grandparent or cousin) with colorectal cancer are considered to have an average risk of colorectal cancer
Familial adenomatous polyposis — People with a family history of familial adenomatous polyposis should consider genetic counseling and genetic testing to determine if they carry the affected gene. People who carry the gene or do not know if they carry the gene should begin screening with sigmoidoscopy once every year, beginning at puberty.Colectomy is the only way to prevent colorectal cancer in people with FAP.
Hereditary nonpolyposis colon cancer — People with a family history of hereditary nonpolyposis colon cancer should consider genetic counseling and genetic testing to determine if they carry the affected gene. People who carry the gene or who do not know if they carry the gene should be screened with colonoscopy because HNPCC is associated with cancers of the right-sided colon (which cannot be seen during sigmoidoscopy).
Depending upon the family history and what is found, colonoscopy is usually repeated every one to two years between age 20 and 30 years, and every year after age 40
Inflammatory bowel disease — In people with ulcerative colitis or Crohn’s disease of the colon, the optimal screening plan depends upon the amount of colon affected and the duration of the disease.
For more information please see

      www.nci.nih.gov
      www.cancer.net/portal/site/patient
      www.nccn.org/patients/patient_gls.asp
      www.cancer.org
      www.nlm.nih.gov/medlineplus/healthtopics.html
      www.gastro.org
      www.acg.gi.org

What are colon polyps?

A polyp is extra tissue that grows inside your body. Colon polyps grow in the large intestine. The large intestine, also called the colon, is part of your digestive system. It’s a long, hollow tube at the end of your digestive tract where your body makes and stores stool.

Are polyps dangerous?

Most polyps are not dangerous. Most are benign, which means they are not cancer. But over time, some types of polyps can turn into cancer. Usually, polyps that are smaller than a pea aren’t harmful. But larger polyps could someday become cancer or may already be cancer. To be safe, doctors remove all polyps and test them.

Who gets polyps?

Anyone can get polyps, but certain people are more likely than others. You may have a greater chance of getting polyps if

• you’re over 50. The older you get, the more likely you are to develop polyps.
• you’ve had polyps before.
• someone in your family has had polyps.
• someone in your family has had cancer of the large intestine.

You may also be more likely to get polyps if you

• eat a lot of fatty foods
• smoke
• drink alcohol
• don’t exercise
• weigh too much

What are the symptoms?

Most small polyps don’t cause symptoms. Often, people don’t know they have one until the doctor finds it during a regular checkup or while testing them for something else.

But some people do have symptoms like these:

• bleeding from the anus .You might notice blood on your underwear or on toilet paper after you’ve had a bowel movement.
• constipation or diarrhea that lasts more than a week.
• blood in the stool. Blood can make stool look black, or it can show up as red streaks in the stool.

.

Who should get tested for polyps?

Talk to your doctor about getting tested for polyps if

• you have symptoms
• you’re 50 years old or older
• someone in your family has had polyps or colon cancer

How are polyps treated?

The doctor will remove the polyp. Sometimes, the doctor takes it out during sigmoidoscopy or colonoscopy. The polyp is then tested for cancer.

If you’ve had polyps, the doctor may want you to get tested regularly in the future.

How can I prevent polyps?

Doctors don’t know of any one sure way to prevent polyps. But you might be able to lower your risk of getting them if you

• eat more fruits and vegetables and less fatty food
• don’t smoke
• avoid alcohol
• exercise every day
• lose weight if you’re overweight

Eating more calcium and folate can also lower your risk of getting polyps. Some foods that are rich in calcium are milk, cheese, and broccoli. Some foods that are rich in folate are chickpeas, kidney beans, and spinach.

Also known as Ulcerative colitis (UC)

Ulcerative colitis (UC) is a disease in which the lining of the large intestine becomes inflamed. The immune system inappropriately targets the lining of the colon, causing inflammation, ulceration, bleeding and diarrhea.
Ulcerative colitis is a chronic condition and has no cure.

UC affects men and women equally.
The peak incidence of UC occurs between the ages of 15 and 30.

CAUSES  – Genes+Environmental factors

Ulcerative colitis tends to run in families.
About 10 to 25 percent of affected people have a first-degree relative (either a sibling or parent) with inflammatory bowel disease.
Environment —  Gut infections are suspected of triggering UC in people who have a genetic susceptibility.

SYMPTOMS

Frequent, loose bloody stools
Anemia
Abdominal pain
Weight loss
Low grade fevers
Joint pains
Eye problems
Skin rash
Liver problems

COMPLICATIONS 

Stricture   A stricture is a narrowing of the colon or rectum which  can cause a blockage of the colon.
Bleeding
Toxic megacolon   Severe  inflammation in the colon causes it to dilate, causing the walls to become thin  and eventually to rupture. Surgery is usually advised if this condition does not respond to medical treatment within about 72 hours.
Patients with ulcerative colitis have an increased risk of colorectal cancer. The risk begins to increase about 8 to 10 years after the symptoms of ulcerative colitis first appear. There is a 5 to 10 percent risk of cancer after 20 years and a 12 to 20 percent risk after 30 years of ulcerative colitis.
Colonoscopy is recommended 8 to 10 years after symptoms appear in people with extensive colitis, and  15 years after symptoms appear in people with left-sided colitis. Thereafter, colonoscopy should be repeated every one to three years. If advanced precancerous changes or cancer are discovered, surgical removal of the colon is usually recommended.

DIAGNOSIS

Bloody diarrhea in any patient,especially if for long periods should prompt an appropriate work up to diagnose colitis. Blood tests, stool tests and  colonoscopy are helpful in making a diagnosis.

TREATMENT

The symptoms of ulcerative colitis can fluctuate over time.
“Flare” is used to describe periods in which the disease becomes more active.
“Remission” is used to describe periods of quiescence.

Patients with abdominal cramps and diarrhea may notice relief when they reduce their intake of fresh fruit and vegetables, caffeine, carbonated drinks, and sorbitol-containing products.

Rectal inflammation  is treated with one or more medications that are given as an enema or a suppository or foam.
Some patients also require treatment with oral medications such as sulfasalazine (Azulfidine) and an 5-aminosalicylate (5-ASA).
Continuous treatment with a 5-ASA-containing drug is usually recommended, although it is often possible to taper the dose of medication.
Extensive disease  Patients with moderate /  severe symptoms may require temporary treatment with a steroid either as an outpatient or given  through the vein  in the hospital. Once remission is achieved, patients usually continue to take one of the oral 5-ASA drugs.
Refractory ulcerative colitis occurs when a person’s disease does not respond or responds poorly to the medical treatments used to treat the disease.
Most patients are treated with drugs that suppress the immune system. The most commonly used drugs are 6-mercaptopurine and azathioprine, and more recently biologic response modifiers such as  infliximab.
Surgical removal of the colon may be required if medical treatments are unsuccessful , if complications develop andif there is cancer.
Vitamins and medications — It is reasonable to take a multivitamin daily. People who take sulfasalazine should take a folic acid supplement.

COMMONLY USED DRUGS

Sulfasalazine ( Azulfidine)
Mesalamine( Asacol,Lialda,Pentasa,Canasa,Rowasa)
Azathioprine( Azasan,Imuran)
Mercaptopurine ( Purinethol)
Steroids (Prednisone)

For more information , please see

www.nlm.nih.gov/medlineplus/healthtopics.html
www.niddk.nih.gov/
www.cdc.gov/
www.gastro.org
www.acg.gi.org
www.ccfa.org

Cirrhosis is the term used to describe a liver that has been severely scarred, and is no longer able to perform its normal functions.

CAUSES
Longstanding alcohol abuse
Chronic hepatitis (B or C )
Non-alcoholic steatohepatitis (a condition in which fat and scar tissue accumulate in the liver)
Hemochromatosis ( iron overload  in the body)
Autoimmune hepatitis (a condition in which the body’s immune system recognizes the liver as foreign)
Primary sclerosing cholangitis (a disease of the large bile ducts)
Primary biliary cirrhosis (a disease of the small bile ducts)
Wilson’s disease (a rare disease of copper metabolism)
SYMPTOMS
Fatigue
Malnutrition
Jaundice (yellowing of the skin and eyes)
Variceal bleeding ( Varices are abnormal dilated veins in any part of gastrointestinal tract)
Fluid  accumulation in the legs (edema) and abdomen (ascites)
Spontaneous bacterial peritonitis-infection in ascitic fluid
Easy bruising and bleeding ( secondary to decreased platelets and clotting factors)
Hepatic encephalopathy -confusion, delirium, and even coma
People with cirrhosis are at increased risk for developing liver cancer (hepatocellular carcinoma).
DIAGNOSIS
Laboratory tests often reveal abnormal blood chemistries, low albumin level and  platelet counts, and increased bilirubin.
Special blood tests help determine the exact cause of cirrhosis.
Imaging studies such as CT scan, ultrasound, or MRI show small shrunken liver and associated findings such as varices , ascites.
Liver biopsy is the definitive test to diagnose cirrhosis.
TREATMENT
Abstinence from alcohol and avoidance of medications that can hurt the liver are of primary importance in preventing further damage to the liver
Early diagnosis and treatment of the underlying cause of liver damage  can reverse cirrhosis.
Liver transplantation, a procedure in which the diseased liver is replaced with a new healthy liver is a major advance in treatment of Cirrhosis / End stage Liver disease

Measures to decrease complications include
beta blockers to reduce the pressure inside varices to decrease the risk of variceal bleeding
Early diagnosis and treatment of  spontaneous bacterial peritonitis
vaccinations against hepatitis A and B
pneumococcal vaccine and yearly influenza vaccine
For more information please see
www.liverfoundation.org
www.nlm.nih.gov/medlineplus/healthtopics.html
www.gastro.org/wmspage.cfm?parm1=681
www.hepnet.com
www.hepb.org

Celiac disease ( also known as gluten sensitive enteropathy, celiac sprue, nontropical sprue) is a condition in which the immune system reacts abnormally to a protein called gluten which  is found in wheat, rye and barley. In celiacs exposure to gluten damages the inner lining of the small intestine causing malabsorption.
Genetic factors are  important since celiac disease occurs primarily in certain groups of people, specifically whites of northern European ancestry. People who inherit specific genes that regulate the immune response (HLA DQ2 and HLA DQ8) have a higher risk of celiac disease than people without these genes

Overall prevalence is approximately 1 in 125 to 250 people in the United States.

SYMPTOMS

Anemia
Abdominal discomfort
Excessive gas
Diarrhea
Weight loss
Osteoporosis
Short stature
Mood problems
Symptoms due to nutrient malabsorption of iron, folic acid, vitamin B12, calcium, vitamin D, or vitamin K.

Associated conditions include

Dermatitis herpetiformis
Neuropsychiatric problems
Down syndrome
Selective IgA deficiency
Type I diabetes mellitus
Thyroid disease
Infertility
Cardiomyopathy
Myocarditis
Arthritis
Kidney disease
Glossitis
Pancreatitis
Liver disease.

Complications of Celiac disease include

Refractory sprue
Lymphoma

DIAGNOSIS
Celiac disease can be difficult to diagnose because the signs and symptoms are similar to other gut ailments.
Blood tests -IgA tissue transglutaminase antibody levels are high in > 98 % of patients with this disease.
Before having this test, it is important to eat a normal diet, including foods that contain gluten.
Endoscopy reveals loss of proximal small bowel  folds, visible fissures, nodular or mosaic appearance or the folds may be scalloped.
Small intestine biopsy shows loss of villi.

TREATMENT

Complete elimination of gluten (wheat, rye, and barley) is the mainstay of treatment.
Oats should be avoided unless the package specifically indicates that the product is gluten free and was processed in a gluten free facility. Soybean or tapioca flours, rice, corn, buckwheat, and potatoes are safe.
For more information please see
www.nlm.nih.gov/medlineplus/healthtopics.html
www.celiac.org
www.csaceliacs.org
www.celiac.com
www.glutenfree.com/
www.gfutah.org

The most common cause of Barrett’s esophagus is longstanding acid reflux disease.
Barrett’s esophagus occurs when the normal  squamous cells that line the lower part of the esophagus are replaced by an abnormal, intestinal-type epithelium

In those with chronic GERD symptoms- long segment Barrett’s esophagus ( > 3cms in length)  is  seen in 3 to 5 percent and  short-segment Barrett’s esophagus ( < 3 cm) in 10 to 15 percent .
Barrett’s esophagus is a predisposing factor for esophageal adenocarcinoma.

Endoscopy with biopsy of the abnormal looking area is required to make a definitive diagnosis.

Also see ACID REFLUX

For more information please see
www.barrettsinfo.com
http://digestive.niddk.nih.gov/ddiseases/pubs/barretts/index.htm

The pancreas is an elongated organ that lies in the back of the mid-abdomen that is responsible for producing digestive juices and certain hormones, including insulin.
Acute pancreatitis refers to inflammation of the pancreas, causing a sudden onset of severe abdominal pain.
Most attacks of acute pancreatitis do not lead to complications.
In a small proportion of people, acute pancreatitis  can be serious needing hospitalization.

CAUSES

Gallstones and  heavy alcohol consumption are the common causes in US.
Other causes include medications, genetic diseases, infectious agents, endoscopic procedures involving the pancreatic and bile ducts etc.

SYMPTOMS

Sudden, constant pain associated with nausea and vomiting  in the upper part of the abdomen is the  hallmark of acute pancreatitis.

DIAGNOSIS

Based on medical history, physical examination, and the results of specific diagnostic tests such as serum amylase and lipase.
Computed tomography scan is a good test for diagnosing acute pancreatitis
TREATMENT
Treatment usually requires hospitalization for at least a few days. The specific treatment measures used depend upon whether a person has mild or moderate to severe pancreatitis.

Antibiotics, drugs to control the pain and intravenous fluids are commonly used.

Laparoscopic cholecystectomy is recommended to prevent   recurrence of gallstone pancreatitis.

For more information please see
www.gastro.org
www.acg.gi.org
www.pancreasfoundation.org

The esophagus is a tube like structure approximately 10 inches long. It is  made of tissue and muscle layers that expand and contract to propel food  into the stomach . At the lower end of the esophagus, there is a circular ring of muscle that acts like a valve called the lower esophageal sphincter (LES). After swallowing, this valve relaxes to allow food to enter the stomach and then contracts to prevent the back-up of food and acid into the esophagus. Acid reflux occurs when the LES is weak, allowing  stomach acid to wash back into the esophagus.

Acid reflux  ( defined  as at least once a week  heartburn and/or acid regurgitation) is seen in  10 to 20 percent  of people in the western world.

Symptoms
Heartburn / Regurgitation
Non-burning chest pain
Difficulty or painful swallowing
Hoarseness of voice
Persistent sore throat
Chronic cough
New onset asthma, or asthma only at night
Sense of a lump in the throat
Worsening dental disease
Recurrent pneumonia
Chronic sinusitis

Diagnosis
GERD is usually diagnosed based upon symptoms and the response to treatment with acid blockers.

Endoscopy is indicated in those with:
Longstanding acid reflux ( especially whites >50 yrs of age)
Difficulty or pain with swallowing (feeling that food gets “stuck”)
Unexplained weight loss
Bleeding (vomiting blood or dark-colored stools)

Other tests include ambulatory esophageal pH study ( directly measures esophageal acid exposure) and  esophageal manometry ( measures the muscle contractility in esophagus)
Treatment
In people who have symptoms of reflux but no evidence of complications, a trial of treatment with lifestyle changes and medications, are often recommended. Available medications include antacids, histamine antagonists, proton pump inhibitors. Surgery – usually a Nissen fundoplication- is indicated in some patients.

COMMONLY USED DRUGS
H2 RECEPTOR ANTAGONISTS
Cimetidine (Tagamet)
Ranitidine (Zantac)
Famotidine (Pepcid)
Nizatidine (Axid)

PROTON PUMP INHIBITORS

Omeprazole ( Prilosec )
Esomeprazole (Nexium)
Pantoprazole (Protonix)
Rabeprazole  (Aciphex)
Lansoprazole ( Prevacid)

For more information please see
www.gastro.org/public/digestinfo.html
www.niddk.nih.gov/health/digest/pubs/heartbrn/heartbrn.htm

www.gerd.com

http://www.acg.gi.org/acg-dev/patientinfo/frame_giproblems.html