Fibromyalgia

Fibromyalgia is described as inflammation of the fibrous or connective tissue of the body. Widespread muscle pain, fatigue, and multiple tender points characterize these conditions. Many individuals with fibromyalgia describe the symptoms as similar to the aches and pains of a severe case of the flu. Fibrositis, fibromyalgia, and fibromyositis are names given to a set of symptoms believed to be caused by the same general problem.

Description

Fibromyalgia is more common than previously thought, with as many as 3-6% of the population affected by the disorder. Fibromyalgia is more prevalent in adults than children, with more women affected than men, particularly women of childbearing age.

Causes & symptoms

The exact cause of fibromyalgia is not known. Sometimes it occurs in several members of a family, suggesting that it may be an inherited disorder. People with fibromyalgia are most likely to complain of three primary symptoms: muscle and joint pain, stiffness, and fatigue.


Pain is the major symptom with aches, tenderness, and stiffness of multiple muscles, joints, and soft tissues. The pain also tends to move from one part of the body to another. It is most common in the neck, shoulders, chest, arms, legs, hips, and back. Although the pain is present most of the time and may last for years, the severity of the pain may fluctuate.

Symptoms of fatigue may result from the individual’s chronic pain coupled with anxiety about the problem and how to find relief. The inflammatory process also produces chemicals that are known to cause fatigue. Other common symptoms are tension headaches, difficulty swallowing, recurrent abdominal pain, diarrhea, and numbness or tingling of the extremities. Stress, anxiety, depression, or lack of sleep can increase symptoms. Intensity of symptoms is variable ranging from gradual improvement to episodes of recurrent symptoms.

Diagnosis

Diagnosis is difficult and frequently missed because symptoms of fibromyalgia are vague and generalized. Coexisting nerve and muscle disorders such as rheumatoid arthritis, spinal arthritis, or Lyme disease may further complicate the diagnostic process. Presently, there are no tests available to specifically diagnose fibromyalgia. The diagnosis is usually made after ruling out other medical conditions with similar symptoms.

Because of the emotional distress experienced by people with this condition and the influence of stress on the symptoms themselves, fibromyalgia has often been labeled a psychological problem. Recognition of the underlying inflammatory process involved in fibromyalgia has helped promote the validity of this disease.

The American College of Rheumatology has developed standards for fibromyalgia that health care practitioners can use to diagnose this condition. According to these standards, a person is thought to have fibromyalgia if he or she has widespread pain in combination with tenderness in at least 11 of the 18 sites known as trigger points. Trigger point sites include the base of the neck, along the backbone, in front of the hip and elbow, and at the rear of the knee and shoulder.

Treatment

There is no known cure for fibromyalgia. Therefore, the goal of treatment is successful symptom management. Treatment usually requires a combination of therapies, exercise, and lifestyle adjustments. Adequate rest is essential in the treatment of fibromyalgia. The diet should include a large variety of fruits and vegetables, which provide the body with trace elements and minerals that are necessary for healthy muscles.

Avoidance of stimulating foods or drinks (such as coffee) and medications like decongestants prior to bedtime is advised. A patient’s clear understanding of his or her role in the recovery process is imperative for successful management of this condition.


Treatments found to be helpful include heat and occasionally cold compress applications. A regular stretching program is often useful. Aerobic activities focusing on increasing the heart rate are the preferred forms of exercise over most other forms of exertion. Exercise programs need to include good warm-up and cool-down sessions, with special attention given to avoiding exercises causing joint pain. Hydrotherapy exercises (exercises in a pool or tub) may be useful in providing a low impact exercise environment while soothing muscle and joint pain.

Massage therapy can be helpful, especially when a family member is instructed on specific massage techniques to manage episodes of increased symptoms. Short sessions are most helpful as repetitious movement can aggravate the condition. Specific attention to mental health, including psychological consultation, may also be important, since depression may precede or accompany fibromyalgia.

Relaxation exercises, yoga, aromatherapy, guided imagery, and other relaxation therapies can be useful in easing stress and promoting overall well-being. Acupuncture can be very helpful for symptom relief and in easing the general condition.

Herbalists and aromatherapists may recommend tub soaks or compresses with lavender (Lavandula angustifolia), chamomile (Chamaemelum nobilis), or juniper (Juniperus communis) to soothe muscle and joint pain.

Allopathic treatment

People with fibromyalgia often need a rheumatology consultation (a meeting with a doctor who specializes in disorders of the joints, muscles, and soft tissue) to decide the cause of various rheumatic symptoms, to be educated about fibromyalgia and its treatment, and to exclude other rheumatic diseases. A treatment program must be individualized to meet the patient’s needs. The rheumatologist, as the team leader, enlists and coordinates the expertise of other health professionals in the care of the patient.

If diet, exercise, and adequate rest do not relieve the symptoms of fibromyalgia, medications may be prescribed. Medications prescribed and found to have some benefit include antidepressant drugs, muscle relaxants, and anti-inflammatory drugs.

Expected results

Fibromyalgia is a chronic health problem. The symptoms sometimes improve and at other times worsen, but they often continue for months to years.

Prevention

There is no known or specific prevention for fibromyalgia. However, similar to many other medical conditions, remaining as healthy as possible with a good diet, safe exercise, and adequate rest is the best prevention.

Food poisoning

Food poisoning is a general term for health problems arising from eating food contaminated by viruses, chemicals, or bacterial toxins. Types of food poisoning include bacterial food poisoning, shellfish poisoning, and mushroom poisoning. The medical term for food poisoning is gastroenteritis.

The Centers for Disease Control and Prevention (CDC) estimates that there are up to 33 million cases of food poisoning in the United States each year. Many cases are mild, and they pass so rapidly that they are never diagnosed. Occasionally, a severe outbreak creates a newsworthy public health hazard, but these instances are rare. Anyone can get food poisoning, but the very young, the very old, and those with compromised immune systems have the most severe and life-threatening cases.

Causes & symptoms

General indications of food poisoning include diarrhea, stomach pain or cramps, gurgling sounds in the stomach, fever, nausea, and vomiting. Dehydration is a common complication, since fluids and electrolytes are lost through vomiting and diarrhea. Dehydration is more likely to happen in the very young, the elderly, and people who are taking diuretics.


Bacterial sources of food poisoning

Bacteria are major causes of food poisoning. Symptoms of bacterial food poisoning occur because foodborne bacteria release enterotoxins, or poisons, as a byproduct of their growth in the body. These toxins often diminish the absorptive ability of the intestines and cause the secretion of water and electrolytes that leads to dehydration. The severity of symptoms depends on the type of bacteria, the amount of bacteria and food consumed, and the individual’s health and sensitivity to the bacteria’s toxin.

SALMONELLA. Symptoms of poisoning begin 12–72 hours after eating food contaminated with Salmonella. Classic food poisoning symptoms, including fever, occur for about two to five days. Salmonella is usually transmitted through the consumption of food contaminated by human or other animal feces. This contamination is mostly due to lack of hand washing by food handlers.

ESCHERICHIA COLI (E. COLI). Symptoms of food poisoning from E. coli 0157:H7 and similar strains of E. coli are slower to appear than those caused by some of the other foodborne bacteria. One to three days after eating contaminated food, the victim begins to have severe abdominal cramps and watery diarrhea that usually becomes bloody. The diarrhea may consist mostly of blood and very little stool, so the condition is sometimes called hemorrhagic colitis. There is little or no fever, the bloody diarrhea lasts from one to eight days, and the condition usually resolves by itself. Food contamination from E. coli O157:H7 has mostly been found in raw or undercooked ground beef. Raw milk has also been a source of food poisoning by E. coli.

CAMPYLOBACTER JEJUNI. C. jejuni infections are most often caused by contaminated chicken, but unchlorinated water and raw milk may also be sources of infection. Classic symptoms of food poisoning, including fever and diarrhea, begin two to five days after consuming food or water contaminated with C. jejuni. The diarrhea may be watery and may contain blood. Symptoms last from seven to 10 days, and relapses occur in about one quarter of the people who are infected.

STAPHYLOCOCCUS AUREUS (STAPH). Staph is spread primarily by food handlers with Staph infections on their skin. However, contaminated equipment and food preparation surfaces may also be at fault. Almost any food can be contaminated, but salad dressings, milk products, cream pastries, and food kept at room temperature, rather than hot or cold, are likely candidates. Classic symptoms of food poisoning appear rapidly, usually two to eight hours after the contaminated food is eaten. Such symptoms usually last only three to six hours and rarely more than two days. Most cases are mild and the victim recovers without any assistance.

SHIGELLA. Symptoms of food poisoning by Shigella appear 36–72 hours after eating contaminated food. These symptoms are slightly different from those associated with most foodborne bacteria. In addition to the familiar symptoms of food poisoning, up to 40% of children with severe infections show neurological symptoms. These include seizures, confusion, headache, lethargy, and a stiff, sore neck. The disease runs its course in two to three days.

CLOSTRIDIUM BOTULINUM. C. botulinum (commonly known as botulism) is the deadliest of the bacterial foodborne illnesses. Sources for adult botulism are often improperly canned or preserved food. Symptoms of adult botulism appear about 18 to 36 hours after the contaminated food is eaten, although there are documented times of onset ranging from four hours to eight days. Unlike other foodborne illnesses, there is no vomiting and diarrhea associated with botulism. Initially, a person suffering from botulism feels weakness, dizziness, and double vision. Symptoms progress to difficulty with speaking and swallowing. The toxins from C. botulinum are neurotoxins—they poison the nervous system, causing paralysis. If the disease proceeds unchecked, paralysis will move throughout the body. Eventually, without medical intervention, the respiratory muscles will become paralyzed and the victim will suffocate.

With infant botulism, the spores of C. botulinum lodge in the infant’s intestinal tract. Honey, especially when consumed by infants younger than 12 months, is sometimes the source of these spores. Onset of the symptoms is gradual. The infant initially has constipation, followed by poor feeding, lethargy, weakness, drooling, and a distinctive wailing cry. Eventually the baby loses the ability to control its head muscles. Paralysis then progresses to the rest of the body.

Fish-associated food poisoning

Ciguatera fish poisoning is caused by toxins accumulated in the tissues of certain tropical fish, including groupers, barracudas, snappers, and mackerel. Signs of poisoning occur about six hours after eating the fish. Around the mouth, there may be numbness and tingling, which may spread to other places including the hands and feet.

There is often muscle pain and weakness, headache, dizziness, joint pain, sensitivity to temperature, heart arrhythmias, dramatic changes in heart rate, and reduced blood pressure. Reef fish contaminated with ciguatoxin are being exported all over the world, occurrence of ciguatera is becoming more likely in colder climates.

Pufferfish, or fugu, is a traditional gourmet dish served mostly in Japan. The skin and other organs of the pufferfish contain a strong poison called tetradotoxin. The first stage of tetradotoxin poisoning is indicated by numbness of the lips and tongue, which may occur 20–180 minutes after eating the fish. This is followed by tingling and numbness of the face, hands, and feet.


Classic symptoms of food poisoning are accompanied by other neurological symptoms such as light-headedness, headache, and unsteady gait. The second stage of tetradotoxin poisoning brings on a progressive paralysis. Breathing, talking, and other movement becomes difficult. Cyanosis (bluish or purplish skin discoloration), low blood pressure, and arrhythmias may occur.

Convulsions and mental impairment may happen right before death, or the person may be completely lucid, though unmoving. Death usually occurs four to six hours after ingestion of the fish if there is no proper intervention; that time, however, has been known to be as little as 20 minutes.

Shellfish poisoning is caused by toxins made by certain algae eaten by shellfish. The toxins are then accumulated in the bodies of the shellfish. Cockles, mussels, clams, oysters, and scallops are most often affected. Sometimes the toxin-producing algae multiply to such an extent that they cause the waters they live in to take on the reddish color of their bodies. This phenomenon is known as a red tide.

Warnings are often given against eating shellfish from such areas. Symptoms of food poisoning show up within a half an hour to two hours of eating the shellfish, depending on the amount and type eaten. There may be burning and tingling in the face and mouth, numbness, drowsiness, muscular pain, dizziness, diarrhea, stomachache, confusion, nausea, vomiting, odd temperature sensations, difficulty breathing, and possibly coma. The symptoms may last from a few hours to a few days.

Histamine poisoning can occur from eating fish whose body tissues have begun to produce high levels of histamine. Mackerel, tuna, and mahi mahi are most often the sources. After consumption of the fish, immediate facial flushing and hives may occur, as well as classic symptoms of food poisoning becoming evident a few minutes later. Symptoms usually last less than 24 hours.

Mushroom poisoning

Mushroom poisoning is classified by the effects of the poisons. Protoplasmic poisons result in cell destruction, often in the liver, which progresses to complete organ failure. Neurotoxins cause neurological symptoms such as sweating, convulsions, hallucinations, excitement, depression, coma, and colon spasms.

Gastrointestinal (G/I) irritants rapidly bring on the classic symptoms of food poisoning and then resolve just as quickly. Disulfiram-like poisons are generally nontoxic, except when alcohol is consumed within 72 hours of eating them. In these cases, the poisons cause headache, nausea, vomiting, flushing, and cardiac disturbances for two to three hours.

Other possible sources

Other possible sources of food poisoning include ingestion of green or sprouting raw potatoes, ingestion of fava beans by susceptible persons, and ergot poisoning from ingestion of contaminated grain. Chemical contaminant food poisoning may result from the ingestion of unwashed produce sprayed with arsenic, lead, or insecticides. Food served or stored in lead-glazed pottery cadmium- lined containers may also lead to food poisoning.

Diagnosis

An important aspect of diagnosing food poisoning is the clinical interview. A history of the illness should be thoroughly traced to include ingestion of food, recent travel, and contact with those showing similar symptoms of illness. Because it may take 30 minutes to three days for symptoms to develop, it is not necessarily the most recent food eaten that is the cause of the symptoms. Diagnosis is confirmed with a stool culture.

Other laboratory tests may be used to examine vomitus, blood, or the contaminated food. A blood chemistry panel may be performed to determine the extent of any tissue damage or electrolyte imbalances. Many cases of food poisoning go undiagnosed, and treatment focuses on the short-lived G/I symptoms.

Botulism is usually diagnosed from its distinctive neurological symptoms, since rapid treatment is essential to save the patient’s life. Electromyography, a test analyzing the electrical activity of muscles, may later be done to further confirm diagnosis. The test shows abnormal muscle activity in most cases of botulism.

Treatment

Those suffering from food poisoning should reduce all sugar and normal food for eight to 24 hours, and increase fluids to avoid dehydration. Charcoal tablets, Lactobacillus acidophilus, Lactobacillus bulgaricus, and citrus seed extract are all recommended.

For mild cases of food poisoning, the homeopathic remedies Arsenicum album, Veratrum album, Podophyllum, or Nux vomica are recommended. The remedy should be given in 12c potency every three to four hours until symptoms subside. If a ready-made electrolyte replacement is not available, a homemade one can be made by dissolving exactly 1 tsp (5 ml) of salt and 4 tsp (20 ml) of sugar in 1 qt (1 l) of water.

Cinnamon (Cinnamonum zeylanicum), cloves (Syzigium aromaticum), oregano (Origanum vulgare), and sage (Salvia officinalis) are food herbs that are also strong inhibitors of bacteria. Liberal amounts can be added to foods, especially when traveling. Grapefruit seed extract has a natural antibiotic effect and may be of help. Large amounts of garlic, in food and in supplement form, are also recommended for the same reason.

Allopathic treatment

In serious cases of food poisoning, medications may be given to stop abdominal cramping and vomiting. Medications are not usually given for the diarrhea, since stopping it might keep toxins in the body longer and prolong the illness. Severe bacterial food poisonings are sometimes treated with antibiotics, but their use is controversial.

Washing out the stomach contents to remove the toxic substances may be required. This procedure is called gastric lavage, familiarly known as having the stomach pumped. Neurotoxins often interfere with the breathing process. If the ability to breathe is affected, patients may have to be put on a mechanical ventilator to assist their breathing and are fed intravenously until the paralysis passes.

People who show any signs of botulism poisoning must receive immediate emergency medical care. Both infants and adults suffering from food poisoning by C. botulinum require hospitalization, often in the intensive care unit. A botulism antitoxin is given to adults, if it can be administered within 72 hours after symptoms are first observed. If given later, it provides no benefit. Nasogastric intubation is recommended for the feeding of infants with active botulism. As well as supplying nutrition, it will stimulate peristalsis, helping in the elimination of C. botulinum.

Treatment of food poisoning that is usually not an emergency situation may include drugs such as ipecac syrup to induce vomiting or laxatives to empty the intestines. Intravenous fluids containing salts and dextrose may be given to correct dehydration and electrolyte imbalances. Pain medications are given for severe stomach pain.

Atropine is given for muscarine-type mushroom poisoning. If illness comes on after eating unidentified mushrooms, vomiting should be induced immediately, and the vomitus saved for laboratory testing. Intravenous mannitol is sometimes used to treat severe ciguatera poisoning. Antihistamines may be effective in reducing the symptoms of histamine fish poisoning. In 2001, Japanese scientists made a synthetic version of ciguatoxin, an important step in developing an antibody to help diagnose ciguatera.

In mild cases of food poisoning, dietary modifications are often the only treatment necessary. During periods of active vomiting and diarrhea, people with food poisoning should avoid solid food for eight to 24 hours, and should increase fluids. Clear liquids should be consumed in small quantities. Once active symptoms stop, a diet of bland, easily digested foods such as broth, eggs, rice and other cooked grains, and toast is recommended for two to three days. Milk products, spicy food, alcohol, sweets, raw vegetables, and fresh fruit should be avoided.

Expected results

Many cases of food poisoning clear up on their own within a week without medical assistance. There are usually few complications once possible dehydration has been addressed. Fatigue may continue for a few days after active symptoms stop, however.

In the more severe types of poisoning, especially those involving neurotoxins, the respiratory muscles may become paralyzed. In such cases, death will result from asphyxiation unless there is medical intervention. Deaths due to food poisoning are rare and tend to occur in the very young, the very old, and in people whose immune systems are already weakened.

C. botulinum, is likely to cause serious illness or fatalities, even when ingested in very small quantities. Children affected by food poisoning from E. coli often need to be hospitalized. In some cases, E. coli toxins may be absorbed into the blood stream where they destroy red blood cells and platelets, which are important in blood clotting. About 5% of victims, regardless of age, develop hemolytic uremia syndrome, which results in kidney failure.

Prevention

Eighty-four percent of adults surveyed in 2001 were unaware that feces on beef and poultry was the main carrier of salmonella, campylobacter, and E. coli. Other than informing the public, food poisoning prevention efforts include:

• hot foods should be kept hot, and cold foods should be kept cold
• meat should be cooked to the recommended internal temperature; eggs should be cooked until no longer runny
• leftovers should be refrigerated promptly and food should never be left to stand at room temperature
• contact of utensils and surfaces with the juices of raw meats should be avoided
• fruits and vegetables should be washed before using
• unpasteurized dairy products and fruit juices should be avoided
• bulging or leaking canned foods or any food that smells spoiled should be discarded
• hands should be washed with soap before food preparation and after using the bathroom
• food preparation surfaces should be sanitized regularly
• infants under 12 months should not be fed honey, which may contain spores of C. botulinum
• proper canning and adequate heating of home-canned food before serving are essential (boiling for three minutes is recommended)

Taking Lactobacillus acidophilus or L. bulgaricus may help prevent food poisoning, especially when traveling. Populating the intestines with these bacteria will make it less likely that harmful bacteria are able to gain a foothold.

Gallstones

Gallstones are solid crystal deposits that form in the gallbladder, a pear-shaped organ that stores bile until it is needed to help digest fatty foods. These crystals can migrate to other parts of the digestive tract, causing severe pain and life-threatening complications. Gallstones vary in size and chemical structure. They may be as tiny as a grain of sand, or as large as a golf ball.

Description

Gallstones usually develop in adults between the ages of 20 and 50. The risk of developing gallstones increases with age. Young women are up to six times more likely to develop gallstones than men in the same age group. In patients over 50, however, the condition affects men and women with equal frequency. Native Americans develop gallstones more often than any other segment of the population, and Mexican Americans have the second highest incidence of this disease. Gallstones tend to be passed down genetically in families.

Eighty percent of gallstones are composed of cholesterol. They are formed when the liver produces more cholesterol than the digestive juices can liquefy. The remaining 20% of gallstones are composed of calcium and an orangeyellow waste product called bilirubin, which gives urine its characteristic color and sometimes causes jaundice.


People who have gallstones may remain without symptoms for an extended period, especially if the stones remain in the gallbladder. In most cases, medical treatment is only deemed necessary if the individual is experiencing symptoms. When symptoms do appear, it is usually because the stones have left the gallbladder and are stuck somewhere else within the biliary system, blocking the flow of bile. If gallstones remain stuck in the biliary system, there can be damage to the liver, pancreas, or the gallbladder itself.

Gallstones bring on several disorders including:

• Cholelithiasis: Gallstones within the gallbladder itself. Pain is caused by the contractions of the gallbladder around the stone. 
• Choledocholithiasis: The presence of gallstones within the common bile duct, which is the passage between that empties into the small intestine. Once discovered, common duct stones need to be removed in order to avoid further problems. 
• Cholecystitis: A disorder marked by inflammation of the gallbladder. It is usually caused by the passage of a stone from the gallbladder into the cystic duct, which connects the gallbladder to the common bile duct. Cholecystitis causes painful enlargement of the gallbladder and is responsible for 10–25% of all gallbladder surgery.

Causes & symptoms

Gallstones are caused by an alteration in the chemical composition of bile, which is a fluid that helps the body break down and absorb fats. It is widely held that a diet high in fats and processed foods, and low in fiber and whole foods, is a strong contributor to gallstone formation. High levels of estrogen, insulin, or cholesterol can increase a person’s risk of developing gallstones. If left untreated, the risk of developing anemia is also increased.

Gallbladder attacks usually follow a meal of rich foods, typically high in fat. The attacks often occur in the middle of the night, sometimes waking the patient with such intense pain that the episode ends in a visit to the emergency room. Pain often occurs on the right side of the body.

The pain of a gallbladder attack begins in the abdomen and may radiate to the chest, back, or the area between the shoulders. Other symptoms of gallstones include inability to digest fats, low fever, chills and sweating, nausea and vomiting, indigestion, gas, belching, and clay-colored bowel movements.

Pregnancy or the use of birth control pills slow down gallbladder activity and increase the risk of gallrestones, as do diabetes, pancreatitis, and celiac disease. This is due to an individual’s higher levels of cholesterol, insulin, or estrogen from oral contraceptives.

Other factors that may encourage gallstone formation are:

• infection 
• anemia 
• obesity 
• intestinal disorders 
• coronary artery disease 
• multiple pregnancies 
• a high-fat, low-fiber diet 
• smoking 
• heavy drinking 
• rapid weight loss

Diagnosis

When gallstones are suspected, blood tests for liver enzyme levels are often given. The levels are usually elevated when the stone cannot pass through the cystic duct or bile duct. Test results, taken together with symptom history (see above) and a physical exam, are simple and relatively inexpensive for diagnosing the presence of gallstones. However, ultrasound is the method of choice for a definite diagnosis. It has a high degree of accuracy, except in diagnosing cholecystitis (a stone in the cystic duct). Cholescintigraphy is an alternative method of diagnosis, in which radioactive dye is injected and photographed as it passes through the biliary system.

Treatment

An allergic reaction to certain foods may contribute to gallbladder attacks. These foods should be identified and removed from the diet, or at least seriously limited. Foods that might possibly bring on allergic reactions include eggs, pork, onions, chicken, milk, coffee, citrus, corn, nuts, and beans.

Other dietary changes may help relieve the symptoms of gallstones. Generally, a vegetarian diet is protective against the formation of gallstones. Recurrent attacks can be diminished by maintaining a healthy weight and a healthy diet.

Choleretic herbs encourage the liver to secrete bile. They help maintain the appropriate chemical composition of bile so that it does not form stones. These herbs include:

• A tincture of dandelion (Taraxacum officinale), 2–6 ml once daily. 
• Milk thistle seeds (Sylibum marianum), a dose equivalent to 70–210 mg of silymarin. 
• Artichoke leaves (Cynara scolymus), 150 mg three times per day. 
• Turmeric (Curcuma longa), used as a spice; 150 mg three times per day.

Use of the above herbs cause some possible reactions, such as gas, diarrhea, nausea, and indigestion.

Other therapeutic approaches that have been found to be helpful in treating gallstones include homeopathy, traditional Chinese herbal medicine, and acupuncture. Knowledgeable practitioners should be consulted.

Allopathic treatment

Watchful waiting

One-third of all patients with gallstones never experience a second attack. For this reason, many doctors advise an attitude of “wait and see” after the first episode. Changing the diet or following a sensible weight loss plan may be the only treatments required. A person having only occasional mild gallstone attacks may be able to manage them by using non-prescription forms of acetaminophen, such as Tylenol or Anacin. A doctor should be notified if pain intensifies or lasts for more than three hours; if the fever rises above 101°F (38.3°C); or if the skin or whites of the eyes have a yellowish cast.

Surgery

Surgical removal of the gallbladder, called cholecystectomy, is the most common conventional treatment for recurrent or worsening gallstone attacks. However, surgery is unecessary in most cases where the gallstones remain without symptoms. Laparoscopic cholecystectomy is the technique most widely used. It has mostly replaced traditional open surgery because of a shorter recovery time, decreased pain, and reduced scarring. However, the open surgery procedure is still used in about 5% of cases because of various complications.

Nonsurgical therapy

If surgery is considered inappropriate, gallstones can be dissolved in 30–40% of patients by taking bile acids in tablet form. Dissolution of gallstones by this method may take many months or years depending on the size. Unfortunately, though, recurrence of stones is common after cessation of the medication.

Lithotripsy uses high-frequency sound waves directed through the skin to break up the stones. The process can be combined with the use of bile acid tablets. However, lithotripsy requires special equipment and is not always readily available.

Direct cholangiography can be used to remove gallstones by contact dissolution. The procedure is used to insert a catheter to inject medication into the gallbladder. Stones are often dissolved within a few hours by this method.

Expected results

Forty percent of all patients with gallstones have “silent gallstones” that do not require treatment. If symptoms develop, however, medical intervention may become necessary. Gallstone problems requiring treatment may also develop infections that require antibiotics. In rare instances, severe inflammation can cause the gallbladder to burst, causing a potentially fatal situation. The gallbladder is not an organ that is required to retain health. It can be successfully removed, with no recurrence of stones. Fat digestion, however, becomes more difficult after surgery, since the gallbladder is no longer there to store and release bile as needed.

Prevention

It is easier, in general, to prevent gallstones than to reverse the process. The best way to prevent gallstones is to minimize risk factors. Since gallstones seem to develop more often in people who are obese, eating a balanced diet, exercising, and losing weight may help keep gallstones from forming. In addition, a diet high in dietary fiber and low in fats, especially saturated fats, is recommended. Processed foods should be replaced by complex carbohydrates, such as whole grains.

Increased intake of fluids will dilute the bile and inhibit gallstone formation. Six to eight glasses of water should be consumed daily, along with plenty of herbal teas and diluted juices.

Recent studies indicate that consumption of about two tablespoons of olive oil per day, which can be mixed with food, helps reduce cholesterol levels in the bloodstream and the gallbladder. However, large amounts of olive oil, taken as a so-called liver flush, should be avoided. This method can stress the gallbladder and lead to an emergency situation.

Gas

Gas, or flatus, is produced when naturally occurring bacteria in the gastrointestinal tract begin to break down, or digest, food. When an excess of air builds up in the tract from swallowing air or a disorder that prevents digestion, it is released as gas. Gastrointestinal gases include methane, carbon dioxide, nitrogen, and hydrogen.

Description

Gas production is an essential, normal function of the gastrointesinal tract, and most healthy individuals pass up to 1,200 cc (over 40 oz) of gas each day. However, when gas causes excessive pain and cramping (colic) then evaluation and treatment are appropriate.

Causes & symptoms

Gastrointestinal gas production can be increased by certain foods, illnesses, and some medications. Common causes of excessive gas include:

• Gas-producing foods. Onions, beans, the cabbage family, and other fibrous foods can cause excessive gas or intestinal spasms in some individuals. 
• Gastrointestinal diseases and disorders. Increased flatulence is a defining symptom of irritable bowel syndrome, diverticulitis, lactose intolerance, malabsorption problems, dysbiosis (digestive problems), and other gastrointestinal disorders. 
• Air swallowing. Swallowing too much air while eating or chewing gum can introduce extra gas to the gastrointestinal tract. 
• Medications. Certain prescription and over-the-counter medications may cause gas as a side-effect. 
• Stress and food allergies can also cause gas. 

Symptoms of excessive gas production include:

• flatulence 
• belching, or burping 
• abdominal cramping, or colic 
• abdominal pain

Diagnosis

A thorough medical and dietary history and physical examination performed by a healthcare professional can usually identify the cause of gas pains resulting from changes to diet or medication. Gas problems triggered by gastrointestinal disease may be harder to diagnose, and will typically require additional medical testing such as colonoscopy, barium enema, or an upper and/or lower gastrointestinal (GI) series.

Treatment

For excessive gas caused by a particular food or beverage, adjustments to diet can relieve most symptoms. Gas caused by air swallowing can be alleviated by eating more slowly and avoiding gum chewing.

An herbalist or naturopathic healthcare professional may recommend a preparation of a carminative (gas reducing) herb such as valerian (Valeriana officinalis), or peppermint (Mentha piperita), which may be helpful in eliminating discomfort and gas-related bloating.

Homeopathic remedies for excessive intestinal gas include Carbo vegetabilis, Nux vomica, and Chamomilla. The prescription of a specific homeopathic remedy will depend on an individual’s overall symptom picture, mood, and temperament, and should only be prescribed by a qualified homeopathic physician.

Hydrotherapy, acupressure, acupuncture, yoga, reflexology, and mild exercise can also help to relieve the pain and discomfort of excessive gas.

Allopathic treatment

Over-the-counter preparations of the enzyme alpha- D-galactosidase (Beano) can alleviate gas symptoms caused by ingestion of certain foods in some individuals. These preparations are typically available in liquid or tablet form. Other non-prescription medications such as Gas-X, Phazyme, and Mylanta contain the ingredient simethicone, which can reduce gas bubbles within the gastrointestinal tract.

Expected results

Mild excess gas is typically easy to treat, especially that triggered by dietary causes. Gas caused by gastrointestinal disease may be more difficult to manage, and successful treatment depends on the type and severity of the disorder.

Prevention

Avoiding fermented foods, drastic increases in fiber intake, and excessive air intake can prevent gas in some individuals. Lactose intolerant individuals should avoid dairy products.

Gastritis

Gastritis commonly refers to inflammation of the lining of the stomach, but the term is often used to cover a variety of symptoms resulting from this inflammation, as well as symptoms of burning or discomfort. True gastritis comes in several forms and is diagnosed using a combination of tests. In the 1990s, scientists discovered that the main cause of most gastritis is infection by a bacterium called Helicobacter pylori.

Description

Gastritis should not be confused with common symptoms of upper abdominal discomfort. It has been associated with ulcers, particularly peptic ulcers, and in some cases, chronic gastritis can lead to more serious complications.

Nonerosive H. pylori gastritis

Under current theory, the main cause of true gastritis is H. pylori infection, which is found in an average of 90% of patients with chronic gastritis. H. pylori is a bacterium whose outer layer is resistant to the normal effects of stomach acid in breaking down bacteria. The resistance of H. pylori means that the bacterium may remain in the stomach for long periods of times, even years, and eventually cause symptoms of gastritis or ulcers when other factors are introduced, such as the presence of specific genes or the use of nonsteroidal anti-inflammatory drugs (NSAIDs).


Studies of the role of H. pylori in the development of gastritis and peptic ulcers have disproved the former belief that stress leads to most stomach and duodenal ulcers. The newer findings have resulted in improved treatment and reduction of stomach ulcers. H. pylori is most likely transmitted between humans, although the specific routes of transmission are still under study. Studies were also underway to determine the role of H. pylori and resulting chronic gastritis in the development of gastric cancers.

Erosive and hemorrhagic gastritis

After H. pylori, the second most common cause of chronic gastritis is the use of NSAIDs. These commonly used pain killers, including aspirin, fenoprofen, ibuprofen and naproxen, can lead to gastritis and peptic ulcers. Other forms of erosive gastritis are caused by alcohol or corrosive agents, or by injuries to the stomach tissues from the ingestion of foreign bodies.

Other forms of gastritis

Clinicians differ on the classification of the less common and specific forms of gastritis, particularly since there is so much overlap with H. pylori in development of chronic gastritis and complications of gastritis.

Other types of gastritis that may be diagnosed include:

• Acute stress gastritis. This is the most serious form of gastritis. It usually occurs in critically ill patients, such as those in intensive care. Stress erosions may develop suddenly as a result of severe trauma or stresses on the stomach lining. 
• Atrophic gastritis. This form of gastritis results from chronic gastritis. It is characterized by atrophy, or a decrease in size and wasting away of the gastric lining. Gastric atrophy is the final stage of chronic gastritis and may be a precursor of gastric cancer. 
• Superficial gastritis. This term is often used to describe the initial stages of chronic gastritis. 
• Uncommon specific forms of gastritis include granulomatous, eosiniphilic, and lymphocytic gastritis.

Causes & symptoms

Nonerosive H. pylori gastritis

H. pylori gastritis is caused by infection from the H. pylori bacterium. It is believed that most infection occurs in childhood. Clinicians think that there may be more than one route for the bacterium. Its prevalence and distribution differs in nations around the world.

The presence of H. pylori has been detected in 86–99% of patients with chronic superficial gastritis. Physicians are still learning about the link of H. pylori to chronic gastritis and peptic ulcers, since many patients with H. pylori infection do not develop symptoms or peptic ulcers. H. pylori is also seen in 90–100% of patients with duodenal ulcers.

The symptoms of H. pylori gastritis include abdominal pain and reduced acid secretion in the stomach. The majority of patients with H. pylori infection, however, suffer no symptoms, even though the infection may lead to ulcers and resulting symptoms. Ulcer symptoms include dull, gnawing pain, often two to three hours after meals; and pain in the middle of the night when the stomach is empty.


Erosive and hemorrhagic gastritis

The most common cause of this form of gastritis is the use of NSAIDs. Other causes may be alcoholism or stress from surgery or critical illness. The role of NSAIDs in development of gastritis and peptic ulcers depends on the dose level. Although even low doses of aspirin or other nonsteroidal anti-inflammatory drugs may cause some gastric upset, low doses generally will not lead to gastritis.

However, as many as 10–30% of patients on higher and more frequent doses of NSAIDs, such as those with chronic arthritis, may develop gastric ulcers. Patients with H. pylori already present in the stomach who are treated with NSAIDs are much more susceptible to ulcers and other gastrointestinal effects of these pain killers.

Patients with erosive gastritis may also show no symptoms. When symptoms do occur, they may include anorexia nervosa, gastric pain, nausea, and vomiting.

Other forms of gastritis

Less common forms of gastritis may result from a number of generalized diseases or from complications of chronic gastritis. Any number of mechanisms may cause various less common forms of gastritis and they may differ slightly in their symptoms and clinical signs. However, they all have inflammation of the gastric mucosa in common. Research recently found that severe gastritis may occur rarely as a result of infectious mononucleosis.

Diagnosis

Nonerosive H. pylori gastritis

H. pylori gastritis is easily diagnosed through the use of the urea breath test. This test detects active presence of H. pylori infection. Other serological tests, which may be readily available in a physician’s office, may be used to detect H. pylori infection. Newly developed versions offer rapid diagnosis.

New stool antigen tests were developed and made available in 2002. The choice of test will depend on cost, availability and the physician’s experience, since nearly all of the available tests have an accuracy rate of 90% or better. Endoscopy, or the examination of the stomach area using a hollow tube inserted through the mouth, may be ordered to confirm the diagnosis. A biopsy of the gastric lining also may be ordered.

Erosive or hemorrhagic gastritis

The patient’s clinical history may be particularly important in the diagnosis of this type of gastritis, since its cause is most often the result of chronic use of NSAIDs, alcoholism, or abuse of other substances.

Other forms of gastritis

Gastritis that has developed to the stage of duodenal or gastric ulcers usually requires endoscopy for diagnosis. It allows the physician to perform a biopsy for possible malignancy and for H. pylori. Sometimes, an upper gastrointestinal x-ray study with barium is ordered. Some diseases such as Zollinger-Ellison syndrome, an ulcer disease of the upper gastrointestinal tract, may show large mucosal folds in the stomach and duodenum on radiographs or in endoscopy. Other tests check for changes in gastric function.

Treatment

Some alternative treatments for gastritis follow mainstream medical practice in distinguishing between gastritis and other digestive disorders; others treat all disorders originating in the stomach in similar fashion.

Dietary supplements

Of all the alternative treatments for gastritis, dietary supplements of various types are the most likely to have been tested in clinical research. Some alternative practitioners have used the following supplements:

• Capsaicin. Capsaicin is the active ingredient in chili peppers. One study in human subjects indicates that capsaicin offers some protection against gastritis caused by aspirin. 
• Antioxidants. Vitamin C and beta-carotene given in combination appear to be beneficial to most patients with chronic atrophic gastritis. 
• Amino acids. Several studies indicate that cysteine speeds healing in bleeding gastritis related to NSAIDs and in atrophic gastritis. Glutamine appears to protect against the development of stress-related gastritis. 
• Vitamins. Preliminary research suggests that large doses of vitamin A may reduce or eliminate erosive gastritis. Vitamin B12 is helpful for patients with prenicious anemia related to atrophic gastritis. 
• Gamma oryzanol. In one study, 87% of patients with various types of gastritis reported at least some improvement from a daily dose of 300 mg of gamma oryzanol.

Herbal therapy

Herbs that have been recommended for gastritis include:

• Licorice. Licorice is a traditional remedy for stomach inflammation. It also appears to inhibit the growth of H. pylori. People who gain water weight or develop high blood pressure as side effects of taking licorice can be treated with licorice that has had the glycyrrhizin removed. 
• Goldenseal. This herb contains berberine, a compound with antibiotic properties. There is some evidence that berberine is active against H. pylori. 
• Chamomile. Chamomile contains apigenin, a bioflavonoid that inhibits H. pylori, and chamazulene, a compound that counteracts free radicals. 
• Marsh mallow and slippery elm. These herbs have demulcent properties, which means that they soothe irritated mucous membranes. 
• Echinacea and geranium. These herbs are recommended by some practitioners for their antiseptic and analgesic (pain-relieving) properties.

Naturopathic practitioners also advise patients with gastritis to eat certain categories of food separately. Patients are advised to eat protein foods by themselves or with green leafy vegetables; to eat fruits alone; and to avoid combining proteins and starches.

Acupuncture/acupressure

One source recommends applying gentle pressure to a point on the abdomen known as CV (conception vessel) 12, midway between the navel and the breastbone. Pressure should be applied when the stomach is empty. Trained acupuncturists treat stomach problems by releasing energy from the spleen and from other energy points associated with digestion.

Yoga

The Bow Pose is recommended by some teachers of yoga for stomach disorders because it puts pressure on a number of acupoints on the abdomen associated with the digestive process and with the stomach meridian. Chinese herbal medicine The Chinese traditionally use a tea made from ginger (Zingiber officinale) as a stomachic, to improve digestive functions.

Reflexology

A trained reflexologist will gently massage the stomach reflexes located on the hands and feet. On the hands, the stomach reflexes are on the palms, below the pads of the middle and index fingers. On the feet, the stomach reflexes are located on the sole just below the pad of the big toe.

Allopathic treatment

H. pylori gastritis

The discovery of H. pylori’s role in the development of gastritis and ulcers has led to improved treatment of chronic gastritis. Since the infection can be treated with antibiotics, the bacterium can be completely eliminated up to 90% of the time. The treatment, however, may be uncomfortable for patients and relies heavily on patient compliance. No single antibiotic has been found that would eliminate H. pylori on its own, so various combinations of antibiotics have been prescribed to treat the infection.

TRIPLE THERAPY. As of early 1998, triple therapy was the preferred treatment for patients with H. pylori gastritis. This treatment regimen usually involves a twoweek course of three drugs. An antibiotic such as amoxicillin or tetracycline, and another antibiotic such as clarithromycin or metronidazole are used in combination with bismuth subsalicylate, a substance that helps protect the lining of the stomach from acid. However, this treatment often fails due to poor patient compliance and quadruple therapy is required.

DUAL THERAPY. Dual therapy involves the use of an antibiotic and a proton pump inhibitor. Proton pump inhibitors help reduce stomach acid by halting the mechanism that pumps acid into the stomach. Dual therapy has not been proven to be as effective as triple therapy, but may be ordered for some patients who can more comfortably handle the use of fewer drugs.

OTHER TREATMENTS. Scientists have experimented with quadruple therapy, which adds an antisecretory drug, or one that suppresses gastric secretion, to the standard triple therapy. One study showed this therapy to be effective with only a week’s course of treatment in more than 90% of patients. The goal is to develop the most effective therapy combination that can work in one week of treatment or less.

Treatment of erosive gastritis

Patients with erosive gastritis may be given treatments similar to those for H. pylori, especially since some studies have demonstrated a link between H. pylori and NSAIDs in causing ulcers. The patient will most likely be advised to avoid NSAIDs.

Other forms of gastritis

Specific treatment will depend on the cause and type of gastritis. These may include prednisone or antibiotics. Critically ill patients at high risk for bleeding may be treated with preventive drugs to reduce the risk of acute stress gastritis. Sometimes surgery is recommended, but is weighed against the possibility of surgical complications or death. Once heavy bleeding occurs in acute stress gastritis, mortality is as high as 60%.

Expected results

The results expected from alternative treatments for gastritis include accelerated healing from some of the dietary therapies, and some symptomatic relief from acupressure, yoga, and reflexology.

The discovery of H. pylori has improved the prognosis for patients with gastritis and ulcers. Since treatment exists to eradicate the infection, recurrence is much less common. The prognosis for patients with acute stress gastritis is much poorer, with a 60% or higher mortality rate among those bleeding heavily. Recent studies have shown that infection with H. pylori and resulting gastritis may lead to such complications as chronic gastritis or as serious as gastric adenoma, a form of stomach cancer.

Prevention

The widespread detection and treatment of H. pylori as a preventive measure in gastritis has been discussed but not resolved. Until more is known about the routes through which H.pylori is spread, specific prevention recommendations are not available.

It was estimated in late 2002 that the organism was present in 80% of middle- aged adults in developing countries and about 20% of those in industrialized countries. Erosive gastritis from NSAIDs can be prevented with cessation of use of these drugs. An education campaign was launched in 1998 to educate patients, particularly an aging population of arthritis sufferers, about the risk of developing ulcers from NSAIDs and alternative drugs.