In addition to dietary and lifestyle changes, medication is commonly used to treat heartburn, the most common symptom of reflux disease.

Benefits

  • Reduced stomach acid production
  • Relief from heartburn symptoms
  • Reduced inflammation of the oesophageal lining

Limitations/Risks

  • May not provide adequate symptom relief
  • Does not affect the mechanical cause of reflux disease (LOS)
  • Does not prevent reflux disease
  • Side effects include: headache, diarrhoea, and upset stomach
  • Up to 40% of patients continue to have symptoms while on medication
  • Possible side effects of long-term use of Proton Pump Inhibitors (PPI) including: possible fracture risk, low magnesium levels, and clostridium difficile-associated diarrhoea

Diet Modification

  • Spicy/acidic food
  • Caffeine
  • Chocolate
  • Alcohol and tobacco

Lifestyle Modifications

  • Elevation of head of bed
  • No meals 2 – 3 hours before bed
  • Weight loss in overweight patients

Reflux disease can affect your life beyond the symptoms you feel.

Patients with Reflux Disease Often Experience:

  • Poor quality of sleep
  • Reduced work productivity
  • Dietary compromises to avoid symptoms
  • Concerns about the long-term effects of reflux disease
  • Life-long dependence on reflux medications

Fundoplication surgery involves wrapping the upper part of the stomach around the outside of the oesophagus at the lower esophageal sphincter (LOS) to help prevent reflux.

Benefits

  • Reduced symptoms of heartburn, reflux and bloating
  • May heal damage to the oesophagus
  • May end dependence on medication

Limitations/Risks

  • Difficulty swallowing
  • Inability to belch or vomit when needed
  • Permanently alters the stomach anatomy
  • Typically requires hospital stay of 1-3 days
  • Symptoms may return over time
  • Requires a modified diet for several weeks
  • May limit activity for 2-3 weeks
  • Risks related to surgery and anesthesia

The Royal Marsden is leading a major clinical trial to investigate the best treatment options for patients with gastro-oesophageal cancers.

The Phase II PLATFORM trial aims to establish whether patients who have received chemotherapy will benefit from further ‘maintenance’ treatment, and whether liquid biopsies, using state-of-the-art technologies, can detect early signs of drug resistance.

The trial opened to recruitment at The Royal Marsden earlier this year and is anticipated to recruit 770 patients in up to 90 centres across the UK. Patients whose CT scans show disease stability or reduction following first-line chemotherapy will be randomly assigned to different maintenance treatment options, such as immunotherapy.

The study will also analyse tumour tissue in patients who provide consent for markers that may suggest whether they are likely to respond to treatment. Liquid biopsies will be assessed to see if drug resistance can also be identified from blood samples. This could prevent the overtreatment of patients for whom there is no perceived benefit and limit drug-related side-effects.

The trial protocol was developed by Chief Investigator Professor David Cunningham, Director of the BRC at The Royal Marsden and the ICR.

Professor Cunningham said: “This is one of the first global trials of its kind in this disease setting. There is a real need for more effective treatments, as the average survival rate for people with gastro-oesophageal cancers is just under one year with standard treatment. This is why this research is essential, and is one of the most significant pieces of research in the UK in this disease at the moment.”

Information on the optimal treatment of patients with oesophageal and gastric cancers is badly needed, given that they account for 7,701 and 4,758 deaths per year in the UK respectively, according to Cancer Research UK.

https://www.cancerbrc.org/advance/new-trial-aims-treat-gastro-oesophageal-cancers

Would you like to carry your OPA Restaurant/Toilet Card on your phone instead of in a purse/wallet/bag?

Follow the following quick and easy steps to get set up…

1) Download the OPA Restaurant/Toilet card you require from the downloads page on our website (https://www.opa.org.uk/downloads.html)

2) Once this has downloaded, click on the share button and go to “Save to Files”

3) You will then be asked to choose where you would like to save them, either in “iCloud Drive” or “On My Iphone”, pick which ever one suits you

4) And finally, go to your home screen on your phone and click into the “Files” App and the relevant folder you choose beforehand (iCloud Drive or On My Iphone) and your OPA Restaurant Cards will be ready to click on and use in any restaurant.

A big thank you to Jack and Orsmkirk U11’s football Team who are proud to support the OPA, thank you to this amazing Team. We wish you every success!

SSRIs may activate vagus nerve dependent gut-to-brain serotonin signaling.

When Prozac was introduced in 1987, it made a big splash as the first selective serotonin reuptake inhibitor (SSRI) antidepressant for the treatment of major depressive disorder.

Prozac and Sarafem are brand names for a drug called “fluoxetine,” which was first discovered by Eli Lilly in 1972. Since the patent for this drug expired in 2001, fluoxetine is available as a generic FDA-approved prescription for depressionobsessive-compulsive disorderpanic attacks, and some eating disorders.

Source: metamorworks/Shutterstock
Source: metamorworks/Shutterstock

Historically, most experts and consumers thought fluoxetine worked by inhibiting the reuptake of serotonin in the brain, and that the antidepressant effects of this drug occurred solely from the “neck up.” However, there is still a surprising amount of uncertainty about how SSRIs actually work.

Because 90 percent of the human body’s serotonin is produced in the gut, one current theory is that fluoxetine might boost the amount of serotonin produced “below the neck.”

While the 21st-century debate about SSRIs rages on, a drug-free alternative for treatment-resistant depression called “vagus nerve stimulation (VNS)” was approved by the FDA in 2005 for severe unipolar and bipolar depression. VNS typically involves a small, silver-dollar sized device that is surgically implanted below the skin near the collar bone and works like a pacemaker to stimulate the vagus nerve.

Source: Alila Medical Media/Shutterstock

In recent years, researchers at McMaster University’s Brain-Body Institute (Canada) have been investigating a possible link between SSRI antidepressant medications, serotonin levels in the gut, and the role that vagus nerve stimulation might play in boosting gut-to-brain transport of serotonin, which appears to rely on the vagus nerve.

Notably, after a vagotomy—which surgically cuts off gut-to-brain communication via the vagus nerve—SSRIs lose their ability to relieve depression-like symptoms in mice.

As part of the bidirectional gut-brain axis, afferent vagal nerves send signals from the bottom-up. There is reason to believe that these vagus nerve pathways might serve as a type of “serotonin superhighway” between the gut and the brain.

A few days ago, the team at McMaster University—who’ve been conducting research in mice about how SSRIs and the vagus nerve might work in tandem—published a study, “Oral Selective Serotonin Reuptake Inhibitors Activate Vagus Nerve Dependent Gut-Brain Signalling,” in the journal Scientific Reports. The title of this paper sums up the main takeaway of this research: SSRIs may activate the vagus nerve in a way that facilitates gut-brain serotonin signaling.

The authors (McVey Neufeld et al., 2019) describe the context and significance of their findings:

“The vagus nerve is the tenth cranial nerve and is the main afferent pathway connecting the gut to the brain. The vagus nerve can transmit signals to the brain resulting in a reduction in depressive behavior as evidenced by the long-term beneficial effects of electrical stimulation of the vagus in patients with intractable depression.

The vagus is the major neural connection between gut and brain, and we have previously shown that ingestion of beneficial bacteria modulates behaviour and brain neurochemistry via this pathway. Given the high levels of serotonin in the gut, we considered if gut-brain signaling, and specifically the vagal pathway, might contribute to the therapeutic effect of oral selective serotonin reuptake inhibitors (SSRI).”

In a recent interview with Canadian Press published on October 4, 2019, first author Karen-Anne McVey Neufeld said, “This [research] opens the door for examining the gut and the continuous communication that happens between the gut and the brain.” She also said that her team’s findings “suggest the gut may play a larger role in depression than previously believed and the latest research hints at new treatment possibilities in the future.”

Interestingly, McVey Neufeld also told the Canadian Press reporter that another class of antidepressants called “noradrenaline reuptake inhibitors (NRIs)” did not appear to have the same activating effect on the vagus nerve as SSRIs.

“Our results lend weight to the possibility that the vagal pathway connecting gut to brain may provide a novel opportunity for treatment of some psychiatric disorders,” the authors write in the paper’s conclusion. “While further study is both necessary and ongoing, we believe that these findings may point towards a newly invigorated approach in the continuing search for new drugs, dietary supplements or bacteria to beneficially modulate these conditions through their effects on vagal afferent communication.”

The next step for McVey Neufeld and colleagues at McMaster’s Brain-Body Institute is to identify specific gut microbiome factors that may play into mental health and psychological well-being using vagus nerve gut-to-brain signaling.

Why Is the Vagus Nerve Also Called the Wandering Nerve?

If a picture is worth a thousand words, this early anatomical drawing of the vagus nerve (below) speaks volumes. As you scroll down this narrow-and-long image, try visualizing how your vagus nerve facilitates communication along your gut-brain axis as part of a bidirectional feedback loop.

Early anatomical drawing of the “wandering” vagus nerve. Source: Wellcome Library/Public Domain
Many readers have told me that the vagus nerve illustration above triggered an Aha! moment of realizing—and visualizing for the first time—how the vagus nerve wanders along the gut-brain axis.

The vagus nerve is also called the “wandering nerve” because it’s the longest nerve in the human body and has countless branches that wind their way from the brainstem all the way down to the lowest part of the intestines, touching most major organs along the way. The vagus nerve modulates the parasympathetic nervous system, which counterbalances the fight-or-flight stress response by eliciting the so-called “relaxation response.”

Over the years, I’ve written dozens of Psychology Today blog posts about the vagus nerve. In 2017, I wrote a 9-part series, “The Vagus Nerve Survival Guide to Combat Fight-or-Flight Urges.” Earlier this year, I wrote a widely-read post, “Longer Exhalations Are an Easy Way to Hack the Vagus Nerve.”

Every time you exhale, your vagus nerve squirts some acetylcholine (also known as “vagusstoff” or “vagus substance”) onto your heart. Vagusstoff acts as a tranquilizer-like substance to slow down beat-to-beat intervals and improves heart rate variability (HRV). Robust vagal tone and higher HRV go hand in hand and are markers for overall psychological and physical well-being.

LinkedIn Image Credit: fizkes/Shutterstock

References

Karen-Anne McVey Neufeld, John Bienenstock, Aadil Bharwani, Kevin Champagne-Jorgensen, YuKang Mao, Christine West, Yunpeng Liu, Michael G. Surette, Wolfgang Kunze & Paul Forsythe. “Oral Selective Serotonin Reuptake Inhibitors Activate Vagus Nerve Dependent Gut-Brain Signalling.” Scientific Reports (First published: October 3, 2019) DOI: 10.1038/s41598-019-50807-8

Article from – Psychology Today https://www.psychologytoday.com/us/blog/the-athletes-way/201910/the-vagus-nerve-may-carry-serotonin-along-the-gut-brain-axis

Epigastric pain is felt in the middle of the upper abdomen, just below the ribcage. Occasional epigastric pain is not usually a cause for concern and may be as simple as a stomach ache from eating bad food.

There are many common digestive problems associated with epigastric pain, as well as a range of other underlying conditions that can cause pain in that area.

Serious cases may be life-threatening, and it is important to work with a doctor to understand the difference between a simple cause of epigastric pain and a more serious underlying condition.

Ten causes of epigastric pain

Epigastric pain is a common symptom of an upset stomach, which can be due to long-term gastrointestinal problems or just the occasional bout of indigestion.

1. Indigestion

Indigestion usually occurs after eating. When a person eats something, the stomach produces acid to digest the food. Sometimes, this acid can irritate the lining of the digestive system.

Indigestion can cause symptoms such as:

  • burping
  • bloating in the abdomen
  • feeling full or bloated, even if the portion size was not big
  • nausea

These symptoms are often felt alongside epigastric pain. While indigestion happens to everyone from time to time, it may be a sign that a person is intolerant of something they have recently eaten.

2. Acid reflux and GERD

Acid reflux occurs when the stomach acid used in digestion gets backed up in the food pipe (esophagus). Acid reflux usually causes pain in the chest and throat, which is commonly known as heartburn. This feeling may accompany epigastric pain or be felt on its own.

Other common symptoms of acid reflux include:

  • indigestion
  • burning or aching chest pain
  • feeling like there is a lump in the throat or chest
  • an acidic or a vomit-like taste in the mouth
  • a persistent sore throat or hoarse voice
  • a persistent cough

Ongoing acid reflux can damage the food pipe and may cause gastroesophageal reflux disease, or GERD. People with GERD experience epigastric pain and symptoms of indigestion frequently and may require treatment and dietary changes to manage the condition.

Some cases of GERD can lead to a condition called Barrett’s esophagus, where the tissue of the food pipe starts to look like the tissue in the intestines.

3. Overeating

The stomach is very flexible. However, eating more than necessary causes the stomach to expand beyond its normal capacity.

If the stomach expands considerably, it can put pressure on the organs around the stomach and cause epigastric pain. Overeating can also cause indigestion, acid reflux, and heartburn.

4. Lactose intolerance

Lactose intolerance can be another cause of epigastric pain. People who are lactose intolerant have trouble breaking down lactose, a sugar found in milk and other dairy products.

For people with lactose intolerance, eating dairy can cause epigastric pain and other symptoms, including:

  • stomach pains
  • cramps and bloating
  • gas
  • nausea or vomiting
  • diarrhea

5. Drinking alcohol

Moderate drinking is usually not enough to upset the stomach or intestines. However, drinking too much alcohol at once or excess alcohol over long periods of time can cause inflammation in the lining of the stomach. This inflammation can lead to epigastric pain and other digestive issues.

6. Esophagitis or gastritis

Esophagitis is inflammation of the lining of the food pipe. Gastritis is inflammation of the lining of the stomach. Esophagitis and gastritis can be caused by acid reflux, infections, and irritation from certain medications. Some immune system disorders may also cause inflammation.

If this inflammation is left untreated, it can create scar tissue or bleeding. Other common symptoms include:

  • acidic or vomit-like taste in the mouth
  • persistent cough
  • burning in the chest and throat
  • trouble swallowing
  • nausea
  • vomiting or spitting up blood
  • poor nutrition

7. Hiatal hernia

A hiatal hernia occurs when part of the stomach pushes up through the diaphragm and into the chest. This may be due to an accident or weakened diaphragm muscles.

In addition to epigastric pain, other common symptoms of hiatal hernias include:

  • sore throat
  • irritation or scratchiness in the throat
  • trouble swallowing
  • gas or especially loud burps
  • chest discomfort

Hiatal hernias typically affect older people and may not cause epigastric pain in every case.

8. Peptic ulcer disease

Peptic ulcer disease is when the lining of the stomach or small intestine has been damaged by a bacterial infection or by taking too much of certain medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs).

Symptoms of peptic ulcer disease can include epigastric pain and signs of internal bleeding, such as stomach pain, fatigue, and shortness of breath.

9. Gallbladder disorder

Issues with the gallbladder may also cause epigastric pain. Gallstones may be blocking the opening of the gallbladder, or the gallbladder may be inflamed. Specific gallbladder symptoms can include:

  • intense pain near the upper right side of the stomach after eating
  • clay-colored stool
  • jaundice or yellowing skin
  • loss of appetite
  • gas and bloating

10. Pregnancy

It is very common to feel mild epigastric pain during pregnancy. This is commonly caused by acid reflux or pressure on the abdomen from the expanding womb. Changes in hormone levels throughout pregnancy can also aggravate acid reflux and epigastric pain.

Severe or persistent epigastric pain during pregnancy can be a sign of a more serious condition, so a woman should visit her doctor if experiencing any unusual symptoms.

Diagnosis

Diagnosing the cause of epigastric pain is essential to ensure proper treatment. A healthcare professional will likely ask a series of questions about the pain and any additional symptoms.

If the cause is unclear, they may order tests, including:

  • imaging tests, such as X-rays, ultrasound, or an endoscopy
  • urine tests to check for infections or bladder disorders
  • blood tests
  • cardiac tests

Treatment

Treating epigastric pain will vary according to the cause. For instance, if overeating frequently causes epigastric pain, a person may wish to eat smaller portions and ensure they are eating filling foods, such as lean proteins. They may also want to avoid foods that cause gas.

Conditions such as GERD, peptic ulcers, and Barrett’s esophagus may require long-term treatment to manage symptoms. A person should work with their doctor to find a treatment plan that works for them.

If a doctor thinks that taking certain medications is causing the condition, they may recommend switching to a new drug or reducing the dosage.

Over-the-counter or prescription antacids to help reduce frequent acid reflux and epigastric pain caused by stomach acid may be helpful.

When to see a doctor

Occasional epigastric pain is not usually a cause for concern, but anyone with severe or persistent epigastric pain should see their doctor.

Symptoms that last more than a few days or that occur more than twice a week on a regular basis would be considered persistent.

A visit to the emergency room may be necessary in some cases. Signs of severe complications that require prompt treatment include:

  • difficulty breathing or swallowing
  • intense pressure or squeezing pain in the chest
  • coughing up blood
  • blood in the stool
  • nausea, vomiting, or diarrhea lasting more than 24 hours in adults
  • high fever
  • extreme fatigue or loss of consciousness

Many cases of epigastric pain can be treated and prevented by making small changes in the diet or lifestyle. Even chronic symptoms can be managed well with medications and dietary changes.

This article is from Medical News Today – https://www.medicalnewstoday.com/articles/320317.php#when-to-see-a-doctor- Pinterest

 

CT scans and MRI scans are two different medical imaging methods that create detailed images of internal body parts, such as bones, joints, and organs.

Doctors order CT scans or MRI scans to help diagnose a wide range of medical conditions. Both types of scan have similar uses, but they produce images in different ways. A CT scan uses X-rays, whereas an MRI scan uses strong magnetic fields and radio waves.

CT scans are more common and less expensive, but MRI scans produce more detailed images.

In this article, we look at the differences between CT scans and MRI scans, as well as their uses, procedures, and safety.

What are they?

Both CT scans and MRI scans allow doctors to see internal body parts.

CT scans and MRI scans are two different ways of creating detailed images of internal body parts. Doctors can then analyze the images to detect abnormalities, such as fractures in bones, tumors on organs, or joint damage.

Some people refer to a CT scan as a CAT scan, which stands for computerized axial tomography. During a CT scan, a person lies down in a large X-ray machine called a CT scanner. The scanner sends images to a computer.

MRI stands for magnetic resonance imagery. This type of scan uses radio waves and magnets to create images. During an MRI scan, a person lies down in an MRI scanner, which is a machine that creates a constant magnetic field and uses radio waves to bounce off water molecules and fat cells in the body. The scanner also sends images to a computer.

CT scans are more common and less expensive than MRIs. However, MRI scans produce a better image than CT scans.

What are their uses?

The uses of CT and MRI scans are very similar. CT scans are more common because they are less expensive and still provide good detail. A doctor may order an MRI scan when they need to create more accurate, detailed images of the body.

Common uses for a CT scan include examining or looking for:

  • tumors
  • bone fractures
  • internal bleeding
  • cancer development and response to treatment

Doctors commonly use MRI scans to diagnose issues with bones, organs, and joints, including those that affect the:

  • ankles
  • breasts
  • brain
  • heart
  • joints
  • wrists
  • blood vessels

Procedure

A person will need to lie down for a CT scan or an MRI.

Both scans usually require the person to lie down on a bed that then moves into the scanner. They will need to remain very still during the scan so that the machines can take clear images.

In both cases, the technicians will leave the room during the scan, but the person can talk to them via an intercom link.

The CT machine takes several X-ray images of the body from different angles. The machine is relatively quiet.

MRI scanners are very noisy, and a technician may offer a person earplugs or headphones to help dull the noise.

Are they safe?

CT scans and MRI scans are both very safe procedures. They may, however, pose slight risks, which differ between the types of scan.

During a CT scan, a person receives a very small dose of radiation, but doctors usually do not consider this harmful.

CT scans use ionizing radiation, which has the potential to affect biological tissues. According to the National Institute of Biomedical Imaging and Bioengineering, the risk of developing cancer from exposure to radiation is generally small.

CT scans and X-ways may not be safe during pregnancy, so doctors might recommend MRI scans or ultrasound scans instead. However, they may still avoid using MRI scans, especially during the first trimester, as a precaution.

MRI scans do not use radiation. They do, however, use strong magnetic fields. People must let their technicians know if they have any form of medical implant, such as a pacemaker, insulin pump, or cochlear implant.

MRI scans produce loud sounds, so people usually wear earplugs or headphones to dull the noise. Individuals with claustrophobia may find MRI scanners difficult to tolerate, although several types of open MRI scanner now exist to get around this problem.

For both CT scans and MRI scans, a doctor may recommend using a contrast dye to make the images clearer. Some people may react badly to certain types of dye.

Choosing the right scan

A doctor will recommend the most helpful and effective imaging procedure.

The uses of MRI and CT scans are very similar. A doctor will decide which scan is appropriate based on a range of factors, such as:

  • the medical reason for the scan
  • the level of detail that is necessary for the images
  • whether a woman is pregnant
  • whether a person has claustrophobia or other factors that might make MRI scans difficult for them to tolerate

MRI scans produce a more detailed image of soft tissue, ligaments, or organs. Problems that may be easier to see with an MRI scan include soft tissue damage, torn ligaments, and herniated disks.

Doctors may use a CT scan for creating a generalized image of a body part or for getting images of organs or head fractures.

Summary

CT scans and MRI scans are two methods of imaging internal body parts. They have similar uses but produce pictures in different ways. CT scans use X-rays while MRI scans use strong magnets and radio waves.

A CT scan is generally good for larger areas, while an MRI scan produces a better overall image of the tissue under examination. Both have risks but are relatively safe procedures. A doctor will recommend which scan is right for a person depending on a range of factors.

This article is from Medical News Today – https://www.medicalnewstoday.com/articles/326839.php