Medical Blog

Treatment

If the hypothesis of CFS is withheld, it is important that the doctor in an open discussion with the patient explaining the situation, discuss the prognosis and treatment options overflowing.
On the treatment of CFS is also no consensus and there is a lot of experimenting with drugs, supplements, psychotherapy etc.
Some common treatments are:


• Tricyclic antidepressants: in low doses can be helpful for patients with CFS. They are in high doses to patients with a depressed mood by endogenous (ie from the body itself) or reactive factors may cause.
• Amantadine (Amantan) is a drug that was originally used in Parkinson's disease, and lately also in MS patients also with a strong general fatigue may have suffered.
Recently it was shown that the product produces antiviral properties, particularly preventive protection against influenza A infections.
• Calcium channel blockers may be useful for the symptomatic treatment of muscle pains, or 75% of CFS patients.
• There are some indications that the essential fatty acids linoleic acid and alpha linolenic acid forms of protection against viral infections. Administration of these fatty acids in CFS patients would have a beneficial effect.
• Because many symptoms of CFS suggest a disordered immune system, one has tested various forms of immunotherapy, including high doses of immunoglobulins.
• CFS patients are sometimes extremely high doses of vitamins (B12, B6, Vitamin C) and minerals (especially magnesium and zinc) administered on its own initiative or they swallow supplements. The usefulness of this is not scientifically proven, the potential dangers of overdose, however, are clearly demonstrated.
• Psychotherapy and behavioral therapy. From the behavior makes a distinction between the causal factors of CFS (eg viral infections) and the entertaining factors (eg an irregular rest and activity schedule. In cognitive-behavioral based treatment largely to an improved handling of the sustaining factors that often cause the more severe forms aaneemt CFS. The following topics are addressed in therapy:
• treatment of the disease and the disabling aspect;
• seeking to appropriate a lifestyle;
• the physical and psychosocial rehabilitation;
• treatment of sleep disorders and emotional problems may present symptoms such as stress or depression.

In practice, a combination of a causal approach, a symptomatic treatment of the worst symptoms, proper treatment and a supportive accompaniment psychological most to bear fruit. This requires a multidisciplinary approach involving both internists, psychiatrists and neuro-physiotherapists, paramedics, partners and family members a role to play.

Good psychological guidance is important to the feelings of fear, resentment, dissatisfaction, etc. of the patient to absorb. Besides the physical symptoms he suffers is with anger and powerlessness in relation to the loss of his intellectual capacity, problems at work (long-term illness), lack of understanding of the environment, etc.

CVS and lifestyle

Rest and exercise

As one of a hyperactive immune system characteristics of CFS, the patient usually recommended initially for a period rest. Then much to start with the progressive creation of an exercise schedule, the patient must find its limits and gradually learn to shift. The point is the right balance between effort and rest, and great efforts can trigger a flare to avoid.

Work and family

In many cases, the patient should take a long time sick, and / or other working arrangements, like part-time work or home. Unfortunately, not everyone succeeds in it, and see CFS patients are sometimes obliged to work and to make disability to apply.
The care for the household and any children often weighs heavy. Amsterdam is currently experimenting with a buddy system, similar to the AIDS-buddies buddies with both practical help (cooking, shopping, childcare ...) and emotional support.

Nutrition

A healthy, balanced diet is obviously important. An adequate supply of complex carbohydrates is necessary for the hypoglycemieaanvallen who frequent CFS-prevention.
Highly restrictive diets, such as those in alternative medicine often promoted, have not proven their worth, just as the popular anti-candida diet.
CFS patients generally do not tolerate alcohol, and in principle will therefore avoid spontaneous.

Pregnancy

CFS patients can safely continue taking the pill. During pregnancy most women in a notable improvement in their condition determined. Yet this does not necessarily an incentive for CFS patients to become pregnant: after birth, it follows a tiring postnatal period and later, the care of a child quite burdensome.
There is no indication that CFS to the fetus can be passed.

Drive

The reduced cognitive and visual capacity, driving can be dangerous. insurance should be informed of the health problem.
Although as yet no "CVS virus could be identified, allowing the possibility that a virus, or even another transient trauma, a chronic reaction of the immune system. This means that the immune system remains constantly active even when the infection is over. Abnormally high doses of immune-activating factors - some indeed can cause fatigue, would result in the bloodstream and lead to chronic exhaustion.

Moreover Fri recent study has shown that the organ systems in which the patient complains, the majority of the muscles, the immune system, blood system, persistent viruses are found. Pathogenic viruses in healthy individuals are relatively short term (several weeks or months) evacuated, while the viruses in CFS patients a long time, even years after the infection, persist.

Other theories then go in the direction of endocrine disorders, or search for psychological factors.

And finally, it remains possible that CFS is caused by a single, as yet unknown factor.

No yuppie disease


CFS was sometimes used contemptuously "the yuppie disease" because it was thought that she was a young, hardworking, career oriented people hit. It is now evident:
• that most patients between 20 and 50 years old, but the disease also occurs in children aged 7 years;
• that CFS is more common among women (about 1 man 3 women);


• the disease in all socioeconomic groups of songs, but something more teachers and medical and paramedical professions;
• that CFS patients often have a very active, busy and quite stressful lives.

Causes

About the causes of CFS are different theories, but none provides a conclusive proof.

• A possible hypothesis is that CFS is caused by a yet-unidentified virus which activates the immune system constantly.
There are indeed many known viruses during the infection period, a strong fatigue. Of some viruses such as Epstein-Barr virus (better known as mononucleosis or kissing the disease) are known to cause exceptionally a chronic active infection, with persistent fatigue as a result. Correlations between Epstein-Barr and CFS, and between CFS and other known viruses such as Herpes type 6 and HIV and a number of enteroviruses, have been extensively studied, but not a causal link could be established.
• Although so far no "CVS virus could be identified, allowing the possibility that a virus, or even another transient trauma, a chronic reaction of the immune system. This means that the immune system remains constantly active even when the infection is over. Abnormally high doses of immune-activating factors - some indeed can cause fatigue, would result in the bloodstream and lead to chronic exhaustion.
Moreover, very recent research has shown that the organ systems in which the patient complains, the most muscles, the immune system, blood system-persistent viruses are found. Pathogenic viruses in healthy individuals are relatively short term (several weeks or months) evacuated, while the viruses in CFS patients a long time, even years after the infection, persist.
• Other theories go back in the direction of endocrine disorders, or search for psychological factors.
• And finally, it remains possible that CFS is caused by a single, as yet unknown factor.

Diagnosis

There is no test to the diagnosis of CFS can be stated unequivocally.
The doctor will also be good in the first place to listen to his / her patient, and the complaints he / she sets against the standard criteria (see above).

The most common symptoms of CFS are:
• The disease began suddenly, but was usually preceded by an infection (flu-like illness, pharyngitis, gastroenteritis ...);
even a minimal effort causes extreme fatigue in the muscles (myalgia), which we only slowly recovering. Often they also suffer from involuntary muscle contractions;
• one can not, or only part-time work;
• headache
• cognitive disorders such as concentration and attention problems, memory loss, difficulty speaking (mistake in words). Together these symptoms are a reduction of intellectual potential;
• Large fluctuations in the fitness condition: one is not tired all day;
one-to-patient exaggerated physical or intellectual effort may provoke a flare;
• an overactivity of the autonomic nervous system, eg, frequent urination (heart) palpitations, etc.;
• flu-like symptoms that occasionally flare up, with sore throat and painful swollen lymph nodes;
• distorted body with night sweats, cold extremities (fingers, toes ...) and sometimes mild fever and chills;
• sleep disorders (in the initial phase, sleepiness, and then fall asleep and / or sleep);
• poor fine motor skills and balance disorders that worsen at night;
• disorders of the senses to paresthesia (itching and tickling)
• tinnitus (noise observations) and photophobia (photophobia);
• pronounced alcohol intolerance;
• emotional labliteit;
• atypsiche depression (not a true depression), sometimes with depersonalization (self-alienation) and disorientation;
• IBS.

In a second phase, the doctor will try to objectify the complaints by a clinical examination. In most cases, this however, but little result.

• In some patients, they propose that a-true-atypical strep throat and swollen lymph nodes down.
• The neurological examination often shows an abnormal Romberg test to (falter and tendency to fall when we closed feet and eyes straight to it) and sometimes involuntary muscle contractions, other neurological signs are only for when the disease was preceded by an infection that also central nervous system is affected.
• The weakness can be clearly determined by a effort, but not at rest.
• Blood pressure is usually low.
• Usually, the clinical examination supplemented by a number of routine investigations such as laboratory tests of blood, an echocardiogram or rhythm examination of the heart (ECG), an EEG (electro-cardiogram), a radiograph of the chest (RX thorax), a spinal puncture, a brain scan, an MR examination of the brains (magnetic resonance) ...

These and other studies are also useful for other precipitating causes of chronic fatigue (eg MS) to exclude.

A disease with many names

When we talk about CFS or chronic fatigue syndrome ", a lot of different names used interchangeably. This has everything to do with the uncertainty that still exists about the causes, diagnosis and treatment of disease.

ME stands for Myalgic Encephalomyelitis. The term dates from 1956 and indicates a condition of brains and spinal cord with muscle pain and fatigue as a major primary symptoms.

PVFS or Post-Viral Fatigue Syndrome: is based on the assumption that the disease is elicited by the body's immune response against one - unidentified virus.
CFIDS stands for Chronic Fatigue (and) Immune Dysfunction Syndrome: it is assumed that chronic fatigue is caused by a disturbed, and in particular by a hyper-reactive immune system.

CFS stands for Chronic Fatigue Syndrome. This name has the advantage that it does not refer to possible causes or other identifying characteristics except the ever present fatigue. Until the disease is better understood, described and known it is this "neutral" designation may be preferable. The Dutch translation is CFS: Chronic Fatigue Syndrome.

Chronic fatigue or CFS?

Chronic fatigue in medicine is a common complaint: about 2% of the population it could suffer. The majority of these people, the fatigue caused by a psychiatric disorder (depression, psychosomatieke complaints, anxiety ...), organic problems or a combination of psychological, physical and social factors.

However, only one speaks of CFS (Chronic Fatigue) if chronic fatigue no apparent cause. This would imply that the diagnosis only by exclusion can be made. Since 1994, however, a consensus exists that the criteria for CFS as unambiguously as possible fixes.

Criteria


Main Criterion

To speak of CVS, must be an essential criterion and also to 6 to 8 additional criteria are met.
• The main criterion is a clinically defined, unexplained persistent or recurring fatigue or exhaustion 6 months or longer. The fatigue is a certain (sometimes arguably) when life began and was not present. She is not the consequence of great effort. She disappears or does not reduce to rest. It causes a severe drop in physical and mental performance, and has a great impact on the professional, family and social life.
In addition, other illnesses that can cause chronic fatigue are excluded, including:
-Autoimmune chronic inflammatory diseases (eg multiple sclerosis) or cancer;
-Bacterial, parasitic, or fungal infections HIV;
-Chronic lung, heart, stomach, intestine, liver, kidney, blood or endocrine disorders;
-Neuromuscular disorders;
-Known psychiatric disorders or sleep disorders;
-Effects of drugs, abuse of drugs or alcohol;
Exposure to toxic substances.

• Additional Criteria

From the second criteria, we distinguish between objective and subjective symptoms. More than 6 + 2 objective subjective symptoms, or at least eight symptoms must be met.

Objective symptoms:
• temperature between 37.5 and 38.6 ° C;
• atypical angina (without inflammation moisture);
• tangible painful neck or armpit lymph nodes.

Subjective symptoms:
• chills or fever;
• sore throat and sore neck or okselkleiren;
• generalized muscle weakness or muscle pain;
• muscle weakness for more than 24 hours after exercise remains (which previously was not present);
• staggered muscle pains without inflammation;
• sleep disorders;
• complex problems arise abruptly (within a range of up to 2 days)
• At least one neuropsychiatric complaints

When these strict criteria are employed, would be only 1 to 2 people in 1000 to suffer from CVS, so about one tenth of all people who feel chronically fatigued.

Non-drug treatment

TENS

Transcutaneous Electrical Nerve Stimulation is a form of symptomatic pain relief with stimulation of nerves is via electrodes applied to the skin. The big advantage is that the patient himself at home after instruction device can use.
A recent technique is acupuncture and percutaneous electrical nerve stimulation. It is somewhat similar to TENS, but the nerves are stimulated via subcutaneous needles made.

Epidural infiltration

For some types of neuropathic pain are targeted infiltration techniques, especially for acute and subacute problems caused by inflammation around the nerve roots in the epidural space. For the really chronic problems infiltrations usually little sense.

Neurostimulation

Neurostimulation (spinal cord stimulation, cortical stimulation, deep brain stimulation ...) is considered invasive therapy when all conventional treatments have failed. Implantation of a neurostimulation system is always preceded by a trial using an external stimulator, preferably at home.

Desensititatietechnieken

In certain patients, so-called desensitisation techniques used: by deliberately touching or stimulating a painful area is that area at the time insensitive. It is very painful in the beginning.

Nerve Blockade

Sometimes, doctors diagnose a nerve block for which a liquid anesthetic into the affected nerve is sprayed or where the nerve using a high temperature "burnt". It is a risk of treatment complications and help these little or no pain. Sometimes it is even more pain than the nerve blockade.

Treatment

Neuropathic pain is difficult to treat. In most patients, a multidisciplinary pain treatment in a designated center.
Often the doctor will turn various means test to determine what may or may not work without too severe side effects.
Non-drug treatments such as neurosurgery, spinal cord and brain stimulation, transcutaneous electrical nerve stimulation (TENS) and psychological therapy are used with varying effect. The efficacy of this is not established in controlled trials.
In some forms of pain may be useful to any tight clothing. In pain after mastectomy gives one time to rest and the affected arm elevation in many cases reduce the pain. Failure to move the arm (eg during long train journey) can also cause back pain. So look for a balance between exercise and rest and try to do relaxation and distraction.

Painkillers

Neuropathic pain usually responds not to the usual analgesics and nonsteroidal anti-inflammatory drugs. Some hybrids can have an impact, but it has not directly with the neuropathic pain component of that network. The classic WHO analgesic ladder with which many doctors are familiar with, has little use for neuropathic pain.
Studies do show a positive (but inter-individually varying) effect of narcotic analgesics (such as fentanyl and tramadol) in cancerous and non-cancerous neuropathic pain. It is not expected immediately, we must therefore continue to take some time to assess the effective and to determine the correct dose. Usually they are experiencing a partial effect.

Antiepileptic drugs

The usefulness of some anti-epileptic drugs in the treatment of certain neuropathic pain, is well documented. Carbamazepine (Tegretol) and phenytoin are effective in diabetic neuropathy. Carbamazepine has also demonstrated efficacy in trigeminal neuralgia. The newer AEDs are gabapentin (Neurontin) and pregabalin (Lyrica) a positive effect in postherpetic neuralgia and diabetic neuropathy demonstrated. The newer anticonvulsants gabapentin and pregabalin in particular have the great advantage that they give quick results, are well tolerated and few side effects. Moreover, pregabalin improves sleep patterns very quickly. The pain is still not under control, but after a few days people feel better because they sleep better and better equipped.

Antidepressants

The (older) tricyclic antidepressants such as amitriptyline, carbamazepine and nortriptyline in low doses among the first choice medication for neuropathic pain, diabetic neuropathy and herpetic neuralgia, even though the leaflet is not always that indication and are not always or only under certain conditions, reimbursement for that indication. Patients should during the first months very well be followed to determine the optimal dosage.

Local treatment

For certain neuropathic pain (for diabetic neuropathy and post-herpetic neuralgia), local healing center to be used, eg chilli cream (capsaicin) or lidocaine cream.

Diagnostic tests for neuropathic pain

The easiest to study neuropathic pain to determine the detection of hyperalgesia and allodynia.
Allodynia is a painful experience in a non-painful stimulus. This can be tested by using a brush or cotton swab to rub the skin. If that is experienced as painful, then there is allodynia. That is very indicative of neuropathic pain.
Hyperalgesia means that an exaggerated pain reaction to a relatively harmless stimulus. This can be tested with an injection needle or a monofilament. That's an interesting little instrument with a flexible pin is placed on the skin. If the pin bends, gives a pressure of 10 grams. Normally this is not painful in people with neuropathy does it hurt. The monofilament is also used to loss of sensation in the feet due to diabetic neuropathy to detect.
What is also very useful for the diagnosis of neuropathic pain is a sensory analysis with ether or acetone to an exaggerated response to cold measure. To test the response to heat, the skin can be touched with a tube of hot water. Usually there will be abnormal sensory responses in the area where the patient indicates pain, which again is very indicative of neuropathic pain.

Causes

The exact cause of neuropathic pain is still unknown. There are theories that focus on an error in the pain or an abnormal conduction of certain parts of the nervous system responsible for pain conduction. Neuropathic pain, is there something wrong somewhere: when receiving the incentive, the pass to the brains or the translation.

There are many causes of neuropathic pain.

• an infection, shingles (postherpetic neuralgia)
• prolonged alcohol abuse or exposure to toxic substances,
• Multiple Sclerosis
• Chemotherapy
• Diabetic neuropathy is a frequent complication of diabetes, with sustained dysesthesieën and pain (usually on the feet and / or hands), which occurs depends on the duration and severity of hyperglycemia.
• an accident or surgery. Typical examples are glands in the armpits operations (such as after breast surgery), neck or groin. Even after a back surgery, heart surgery and lung surgery are known. Also known is the phantom pain after amputation.
• A special form of neuropathic pain, complex regional pain syndrome type 1 (also known as post-traumatic dystrophy or reflex sympathetic dystrophy or Sudeck syndrome). This is usually an affected limb. The pain usually occurs after an accident or surgery. Often this is accompanied by color and temperature changes, swelling and changes in the diet (trophic changes). Often there is excessive sweating of the arm or leg.
• trigeminal neuralgia is a special form of facial pain caused by pressure on the ganglion of Gasser.
• pinched nerve in the hand (carpal tunnel syndrome) or foot (tarsaletunnelsyndroom)

Neuropathic pain is a form of chronic pain whose exact cause has not yet been identified. The definition of the International Association for the Study of Pain (IASP) is neuropathic pain is limited to pain from a primary injury or dysfunction of the peripheral and central nervous system. In general, this involves an injury or a malfunction of the nerves . Occurs somewhere in the nervous system disorder in the conduction of signals, spontaneous pain stimuli may arise. Light as a stimulus that normally is experienced sudden severe pain. Nodules may also occur in the nerve scar and there will be disruption rather than the sympathetic (involuntary) nervous system.
Neuropathic pain is common. Estimates range from 1 to 2% of the general population, and even 8% in persons over 55 years.

Complaints


Neuropathic pain varies in intensity but usually stays continuously present. Often takes the pain sensation during sleep off. Often including mood disorders, sleep disturbances and fatigue.
Sometimes you may see symptoms typical of nerve pain. - Burning and sometimes stabbing pain (a sensation of pins and needles, electric shocks, stabbing) - numbness around the painful area, such extremities that "sleep" or hypersensitive,

• pain from a normally non-painful stimulus such as rubbing of clothing on the skin, a cloth on the feet.
• exaggerated pain response to a relatively harmless stimulus (hyperalgesia),
• feeling that the 'cushions' runs
• pain in cold or heat (eg during a shower)
• Feeling that ants walk on and under the skin, unpleasant tickling.

DN4 questionnaire for the diagnosis of neuropathic pain
DN4 interview

Question 1: Does the pain one or more of the following characteristics?
1. Burning
2. Painful cold sensation
3. Electric shock

Question 2: Is the pain in the same area associated with one or more of the following symptoms?
4. Tickling
5. Tingling
6. Insensibility
7. Itching.

A score of 3 to 7 is very indicative of neuropathic pain.

DN4 clinical research

Question 3: Is the pain localized in one particular area where research indicates
8. hypoesthesia to touch
9. hypoesthesia with a prick

Question 4: the pain is caused or exacerbated by
10. rub

A score of 4 to 10 on both questionnaires together, enhances the sensitivity of the test.

Good for healing

The discovery that Helicobacter pylori is usually at the root of an ulcer, for a true revolution in the treatment provided. What used to be an ulcer could hardly be treated with appropriate drugs today he can at a couple of days are finally healed.

Because this good news has not fully penetrated the population, the major associations of doctors and pharmacists their heads put together and is currently being campaigned for everyone aware of this new, simple approach.

This is not only important for people who suffer an ulcer, but also for the health insurance that pays loads of money so far for various treatments and hospitalizations of patients with an ulcer. In addition, many people, once they feel the stomach rise, on their own remedies take many, many acid-neutralizing tablets. These agents may soften the pain equally, but the cause and thus take the ulcer away. Instead of limping for weeks with stomach problems, you are therefore advised to visit your doctor to resign.

Once declaring that it was indeed an ulcer is caused by an infection with Helicobacter pylori, the new therapy can eradicate the bacteria. And the cause, disappears also the risk that the ulcer coming back.

These "eradication therapy is in practice a combination of three drugs: two antibiotics that kill the microbe and a cure for heartburn. For seven consecutive days must be this "triple therapy" promptly take. Those who meet the requirements of the physician holds must be confident that the ulcer after this week once and forever gone.

This medication has diet for ulcer completely suppressed in the background. Place on a milk diet, there is certainly no more milk and excessive use should rather be avoided.

Should patients with gastric ulcer or simply does not diet?

There are a number of products that can, logically, better avoided during the first day that pops up and ulcer pain. We think mostly to alcohol, tobacco and spices. Some people will feel better by the first day mostly small, light meals using less raw vegetables and eating less fiber and heavy and greasy foods to avoid.

In an acute stomach ulcer will suffice for one week during the nutrition measures to comply. Current drugs are so rapid and powerful that the patient is within a few days back the old feeling. If not, then something is not right and needs to a physician. It would be said to be a complication that causes the ulcer otherwise be addressed.

Want more information? Please consult your doctor or pharmacist. They have patients with leaflets explaining the new approach of gastric ulcers.

Other causes

The use of painkillers derived from acetylsalicylic acid (aspirin and several anti-rheumatic agents such as Feldene, Voltaren, Indocid, Brufen) makes the stomach and small intestinal mucosa fragile, so the stomach acid has an adverse affect them.

Anyone who ever had an ulcer, this must always tell your doctor or pharmacist if it prescribes a painkiller. The daily use of a "children's aspirin for the prevention of cardiovascular disease, is no problem in people who have never faced an upset stomach. In patients with a history of ulcer and / or gastrointestinal bleeding, the pros and cons of chronic aspirin use with the doctor discussed.

The days when ulcers were considered a difficult to treat debilitating condition is happily behind us. With the increased understanding of this disease and the development of new drugs, you are now a mere seven days time your problem redeemed.

An ulcer or ulcer is caused by damage to the normal lining of the stomach or the first part of the small intestine. Easy sake we talk about an "ulcer", although in most cases the term "intestinal ulcer" correctness.

Causes

An ulcer is caused by the action of the stomach to the lining of the stomach or small intestine. Every human stomach produces about 2 liters per day, which is necessary for the digestion of food. Yet develops (fortunately) not everyone a "ulcer". In other words, there are facilitating factors that make one person though, and the other person does not "swear" gets.

Previously it was generally accepted that peptic ulcer disease was a typical welfare, including a result of stress and an inadequate diet. It was almost considered a status symbol for hurried businessmen. But then an annoying symbol.

A stomach ulcer, so ran the theory, was caused by an excessive production of stomach acid. That did not seem illogical. Our food is after swallowing in a bath of acid, a highly corrosive fluid in the stomach that aids digestion of food. In people who eat too fast, much drinking at or just after meals - especially alcoholic beverages and coffee, which are very fat or very high protein food or a lot spicy sauces, etc. would be too much stomach acid formed. Smoking, stress, etc. would lead to an excessive production of that corrosive stuff.

Normally the intestinal wall that resists the action of acid, but too much is too much. Result: the stomach acid eats away at the intestinal wall and there is a known ulcer. Athans, so people thought.

Anyway 20 years ago, two Australian scientists discovered almost accidentally in the stomach of patients with gastric ulcer bacterium with an exotic name 'Helicobacter pylori'. Around the same time was the Belgian doctor G. Tytgat - who has been working in Amsterdam - the bacteria on the track. To prove their theory, even infecting the two Australian doctors themselves, and they were promptly sick ...

Initially, this discovery came on a lot of disbelief from colleagues, but today is evidence that gastric ulcers in nine cases out of ten are caused by the microbe. Duodenal ulcers are always even by those bacteria causes.

Whence comes the bacterium is still a mystery. It is thought that it is transmitted from human to human, possibly during childhood.

Peptic ulcers are very common: about one in 10 Belgians has to do with it. A peptic ulcer refers literally a hole in the lining of the stomach or duodenum. This causes a burning, painful, gnawing feeling in the upper abdomen or below the chest that temporarily can be illuminated with milk or drugs that inhibit gastric acid production. The food does not taste and after dinner we will sit down with a bloated feeling, or you feel nauseous and vomit.

Sometimes an ulcer may lead to serious complications such as stomach bleeding, a perforation of the stomach, etc. And an ulcer (or Helicobacter pylori) is one of the main causes of gastric cancer.

Because they did not know better, we tried once the excessive production of stomach acid to slow down. A disgusting diet based mainly on milk and various papjes, an absolute prohibition of alcohol, coffee and almost any normal diet, was often considered necessary. In combination with acid-reducing pills and potions. And if none of that helped, was a part of the stomach removed. But after a few months, the ulcer usually returned.

At the end of the seventies led a new generation of acid-blocking drugs for a first mini-revolution. With these drugs the ulcer disappeared after a few weeks. But within the year, he usually returns. With the result that the (expensive) drugs should remain almost constantly swallow, and then came back often ulcer.

Treatment (medicine - surgery)
1.Geneesmiddelen

There are different views about the best treatment for GERD. There is agreement that must first be attempted through dietary measures, raising the head of the bed, weight loss, etc. to address the complaints.
If not or insufficiently help then medicines.
There are three main groups: acid-depleting agents, antacids and drugs that affect muscle function.
Usually starts with an acid-depleting agent (antacid) and if that medication is, it switches to an acid inhibitor. Increasingly, however, abandoned this method and is rather a 'step down' approach. A recent review article in the British Medical Journal (September 29, 2001) indicates in this connection the following schedule:

GERD Treatment schedule

Mild form of GERD (mild to moderate symptoms, no or mild esophagitis): 'step-up strategy
• Start with antacids
• If it does not work: an H2 acid inhibitor (for 4 to 6 weeks)
• PPI acid inhibitor only when the symptoms do not improve
• possibly can immediately start with PPI acid inhibitor, where the dose gradually reduced to the smallest possible effective dose ('step down' strategy).

Severe GERD (severe esophagitis, sometimes associated with bleeding, esophageal stricture &): 'step-down strategy
• Start with PPI acid inhibitor for 8 weeks.
• Try to adjust the dose.
• Evolution should be followed by endoscopy

atypical symptoms (such as breathing problems, nose and throat and ear problems):
• immediately start PPI acid inhibitor
• pH measurement and monitoring with pH test

Acid Breaking resources

Acid-busting drugs or Antacids (eg Rennie ®, Muthesa ®, Maalox ®, Mylanta ®, ® & Regla pH) can in most people with hygiene measures are not sufficient, in many cases the symptoms under control. Products in powder form or a liquid product is preferred.
Take these drugs immediately after a meal, but wait at least an hour so the time for the stomach acid.
Most of these products are freely on sale in pharmacies. Do not abuse, however. If you regularly suffer from heartburn, consult your doctor to see if there are no other measures.

Drugs that affect muscle function

A prokinetic agent, a drug that muscle movements (peristalsis) of the esophageal sphincter and promotes doing more tension, can sometimes be helpful (eg, metoclopramide, domperidone ...).

Antacids

For persistent or recurrent complaints, serious complaints, proven damage to the esophagus and respiratory symptoms, the doctor may prescribe an acid inhibitor. These are drugs that produce gastric acid suppression and very effective in reducing the heartburn. They are also effective against other symptoms associated with GERD (such as respiratory problems, throat problems ...)

Here are two classes:

• H2 (histamine) - receptor blockers (famotidine, cimetidine (Tagamet ®), ranitidine ®, nizatidine ...)
• acid pump inhibitors or PPIs (omeprazole, lansoprazole, pantoprazole ...). The PPI's are clearly the most active.

Problem with these antacids is that they can hide symptoms of an ulcer. Moreover, the long-term effects of a permanent suppression of gastric acid with still insufficiently known.

2. Surgery

For severe symptoms not responding to drugs, surgery may be appropriate. Even in infants and young children with severe reflux problems, surgery may be necessary.
The most common technique is the so-called fundoplication in which the upper part of the stomach as a whole or partial ring around the bottom of the esophagus is turned. This intervention, which often can be performed via laparoscopy, creates a higher pressure in the lower part of esophagus and reflux is impossible.

Prevent

The approach of heartburn varies from person to person. One should carefully examine the circumstances in which the symptoms occur and what are the additional pressures. When trying to find himself clear precipitating factors (eg eating habits, drugs &), is taking a few precautions often suffices for a positive result. Quitting smoking is at least advisable.


Sleep Posture

• Raise the head of your bed to an angle of about 30 ° (approx. 15 cm) for example by placing blocks under the legs. Only the head by elevating an extra pillow, increases the risk of reflux.
• If you have an afternoon nap after a meal, then preferably in a sitting position
• Avoidance of intra-abdominal pressure increases
• In cases of obesity (overweight) is essential to weight loss
• Avoid multiple presses (eg constipation counteracted by a high-fiber diet)
• Do not wear tight clothing (such as corsets, tight belts &)
• Avoid fitness exercises involve tightening the abdominal muscles, especially in supine position.

Nutrition

According to some studies with dietary measures alone would almost half the cases the symptoms can be resolved. Which foods and which do not have an effect, is not always clear and may differ from person to person.

• Avoid copious meals. Better to eat one too many times more than once.
• Avoid high-fat meals. Think also of the hidden fats in many processed ready meals such as cakes, biscuits, sausages, etc.
• Avoid chocolate
• Avoid peppermint, onion, garlic, clove and spicy foods in general
• A protein-rich foods (eg, lean meats, skim milk products) has a more beneficial effect on reflux and heartburn. Carbohydrate-rich products (such as bread, cereals, fruits and vegetables) have a neutral effect.
• If the symptoms occur particularly at bedtime or at night, it is important to have dinner not too late to participate. In principle, it could at least 3 hours before bedtime nothing to eat.
• With tendency to constipation (constipation) is a high-fiber diet is recommended.
• Do not smoke after eating.
• About chewinggum opinions differ. According to some studies is the frequent use of chewing gum is not recommended, not only because they often peppermint is processed, but also because of the stimulatory effect on gastric secretion and the fact that chewing is often air ingestion, leading to deportation of the stomach may lead. Chewinggum the other hand stimulates saliva, making the effect of acid is neutralized.

Beverages

• Moderate your alcohol intake and avoid especially spirits, especially at bedtime
• Avoid fizzy drinks.
• Avoid very hot or very cold drinks
• Even though they have no direct effect on reflux, you should avoid citrus juices if they give rise to complaints. The same goes for coffee. Decaffeinated coffee, no more or less effect on reflux than regular coffee.
• Lean and half fat milk drinks are recommended.
• Soups and broths are free to use lean

Causes

In general, anything that makes the stomach expand and the pressure in the abdomen increases, an increase in the number of spontaneous relaxations of the lower esophageal sphincter damage, and thus increases the risk of reflux.
Also all the movements of the esophagus or affect the operation of the esophagus sfinkterspier shutdown may lead to reflux symptoms.


It may involve a failure of the muscles themselves (eg aging) and by external causes.

Hernia

To reach the stomach to the esophagus through an opening in the diaphragm pass. This opening is called hiatus. Sometimes protrudes the upper part of the stomach through the hole above the diaphragm or diaphragm out. This is called a gastric rupture (hernia or hiatus hernia).
Such a hernia is very common. Sometimes such a hernia congenital or the result of an injury, but usually no obvious cause can be demonstrated. About half of the over-60s would be sufferers.
Chronic or repeated situations of increased pressure in the abdomen caused by obesity, many pregnancies, often pressing, etc. work the formation of a hernia in his hand. With age also occurs a relaxation of the muscle tension, making a hernia may occur.
In itself such a hernia is not serious. It can cause absolutely no complaints and never noticed.

Other gastrointestinal disorders

Several other gastrointestinal disorders may lead to reflux, such as Crohn's disease, peptic ulcer, cancer ... Obviously, these conditions are treated first.
There is a presumption that Helicobacter pylori, a bacterium that is held responsible for stomach ulcers, may play a protective role against GERD. The systematic eradication of H. Erected with antibiotics would therefore eventually lead to a sharp increase in the number of GERD cases.

• Nutrition
• High-fat meals cause a decrease in sfincterspanning and often causes heartburn and reflux.
• A protein-rich diet improves contrast, the pressure at the lower oesophageal sphincter and is therefore beneficial.
• Carbohydrates have little effect.
• Certain herbs can reduce the sfincterwerking. That is the case with peppermint, garlic, onion and cloves. The same goes for chocolate.
• Citrus drinks, spicy food, prepared with tomatoes and coffee, all food that often the finger be pointed out, however, have no direct effect on the LES pressure and therefore no reflux. But if the esophagus is already irritated or inflamed by frequent reflux, then these products can lead to complaints by the additional irritation they cause.

Alcohol

Alcohol relaxes the muscles of the esophagus and can also irritate the lining of the esophagus. Furthermore, alcohol increases the acidity of the stomach.

Smoking

GERD is more common in smokers. Smoking increases the acid secretion, prevents the secretion of saliva which helps to neutralize the acid and slows down muscles of the esophagus. It is not yet clear whether these effects are caused by nicotine or other substances in the smoke.

Obesity

According to some studies, more frequent and more severe GERD in obese, but this is contradicted by other studies.

Medicines

Some medicines increase the risk of GERD:
• Non-steroidal anti-inflammatory drugs (aspirin, ibuprofen ...). Prolonged use of these drugs, the risk of GERD (and ulcer) and severe complications.
• cardiovascular drugs (calcium blockers to treat high blood pressure)
• some asthma and allergy medications
• medicines for cramps
• sedatives and hypnotics
• antibiotics
• Bisphosphonates (used for osteoporosis).

Technical studies

A simple test to determine whether it was indeed a problem of acid fire going, is to the patient for several weeks to give a high dose omeprazole. This is a drug that inhibits stomach acid production (see below). If the symptoms stop this, it is almost certain that it is GERD.




Endoscopy

An endoscopy is the most appropriate method to study the condition of the lining of the esophagus, possibly. bleeding, strictures, etc. to investigate. It is a narrow tube on which a camera is mounted through the mouth into the esophagus slid under local anesthesia. Possibly. is simultaneously a part of the mucosa to be removed (biopsy) to investigate the presence of certain microbes or tumors.
With an endoscopy is of course not the acid burn themselves to consider but only a pos. effects on the mucosa can be detected.
Endoscopy is the most appropriate method for the evolution of Barrett's esophagus (see below) closely.

Acid Test

To measure the acid fire itself is a special acid test or 24 hours pH-metry. It is through a tube that is inserted through the nose for 24 hours the acidity in the esophagus recorded.

Is it bad?

Reflux into the esophagus is not a serious problem. When this occurs repeatedly or prolonged, however, complications may arise that could be serious.
Reflux esophagitis
This is an irritation and inflammation of the esophageal mucosa from exposure to stomach acid. This can cause internal bleeding and narrowing of the esophagus (stricture) cause. This, in turn, severe swallowing problems.
There is no correlation between the severity of the complaints and, if necessary. damage to the esophagus wall. Oesophagitis may occur without symptoms.

Barrett's esofagus

In severe esophagitis may be so damaged the normal mucosa, which is developing a new type of lining that resembles the gastric mucosa. This is called Barrett's esofagus. This new lining is an important risk factor of esophageal cancer. Most cases of Barrett's esophagus begin as esofagus.
The risk of GERD is evolving into a Barrett's esofagus is limited. The risk is greatest in people who at a young age with GERD are geconfrontreerd and when the symptoms are severe and last long.

Respiratory Problems

• Asthma.
Asthma and GERD often occur together. About half of asthma patients could also suffer from GERD. It is not clear what is cause and effect. According to some theories, the typical asthma symptoms (coughing, sneezing ...) give rise to pressure changes in the chest, which reflux can occur. Conversely, the stomach acid stimulate the respiratory system, leading to an asthma reaction could result.

• sleep apnea.

GERD is often associated with sleep apnea during sleep where breathing briefly and repeatedly interrupted. This can indicate certain heart problems. It is not clear whether GERD is the basis of the apnea, or vice versa. The fact is that GERD is usually more intense when it is accompanied by apnea.

• other throat problems

GERD also causes many other throat and respiratory symptoms such as hoarseness, coughing, dry and irritated throat which is associated with repetitive cough, a lump sensation in the throat, etc. For unexplained throat symptoms should always think of a possible heartburn problem.

Heart problems

Heart Cramp (angina pectoris) and GERD often occur together. It is thought that in people with vascular disease reflux may trigger an angina pectoris could temporarily disrupt the blood flow to the heart.

Dental Problems

Erosion of tooth enamel is a common problem by the ravages of stomach acid into the mouth.

When we swallow food, it goes through the esophagus to the stomach. At the end of the esophagus is a sphincter or sphincter, which just opened when we swallow and then again hermetically closed. A good barrier between the esophagus and stomach is necessary to prevent the food in the wrong direction and to prevent stomach acid comes into contact with the esophagus, which is not corrosive acid that file.
Occasionally flows somewhat accidentally stomach contents back into the esophagus, at a full stomach, for example. Such acid reflux or heartburn is not so bad. It only becomes annoying when you frequently suffer from this acid flowing back. In that case we speak of gastro-esophageal reflux disease (GERD).
By the repeated action of the stomach to the esophagus wall, the esophagus over time show an inflammatory irritation: it is called reflux esophagitis.
One in ten adults has at least once a week suffer from heartburn, one of three at least once a month.
Pregnant women, especially during the third trimester, are extra-susceptible to heartburn by the increased pressure of the uterus against the stomach.
People who suffer from asthma, also have an increased risk of heartburn.
Oesophageal sphincter in children has not yet completed, so frequent reflux. Only around the age of 12 months is entirely developed oesophageal sphincter.

Complaints

There are two typical symptoms of gastro-esophageal reflux disease (GERD) who almost always present:

Acid Burn: brash or bitter-tasting fluid in mouth and throat.
• occurs primarily after a heavy meal
• When bending over
• When you must lift a heavy weight
• when (the back) lie
• is more at night.

Dyspepsia or indigestion: an uncomfortable, full of feeling, sometimes with nausea and vomiting.

Other possible symptoms:
• nausea
• sharp pain behind the breastbone that sometimes radiates into the throat. In English this is called "heartburn" because it's a bit like as if the chest is on fire and can easily be confused with a heart attack. In case of reflux, the discomfort, however, especially after meals or when lying down.
• Swallowing problems
• Respiratory problems (chronic cough, wheezing, even asthma-like symptoms), especially at night
• Hoarseness, repeated sieges ...
• stuffy nose, earache, ringing ...

The appendix is an appendix of the cecum, at the bottom of the stomach in the transition from the small to the large intestine. The appendix is between 2 and 20 cm long, about as thick as a pencil and consists mainly of lymphoid tissue. The function of the appendix is not clear, perhaps that function in the course of our evolution lost. Possibly plays a role in the development of our immune system.

The appendix can become inflamed - we can speak of an appendicitis - and he should be removed. This disease affects approximately 7% of the population. It affects all ages, but especially between 5 and 24 years, with a peak around 6 years.

Symptoms

The symptoms of an inflamed appendix can vary widely and are not always clearly recognizable. Careful screening is important, however, especially in an acute appendicitis that threatens to burst open (perforate). Approximately 5 holes at 100 run is fatal. Fortunately they are rare.
Sometimes one suspects appendicitis but that is not there and people are needlessly operated. This is also an unfortunate situation. Each operation takes is a small but real risk.
The problem is that people with appendicitis early intervention, but at the same time that people should avoid unnecessary under the knife pass.

• The inflammation causes severe abdominal pain, initially near the umbilicus, later in the lower right abdomen. Sometimes the appendix is located at a new place and the pain may emerge elsewhere.
• Other symptoms include nausea, sometimes vomiting, mild fever and diarrhea. After several hours, pain also occurs when touching the abdomen.

If the doctor suspects appendicitis, he will exhaust other possible causes of abdominal pain (pregnancy, intestinal infection ...) and try to exclude any conduct additional tests, including:
• Blood tests to determine whether an infection is
• Urinalysis for other reasons (pregnancy, bladder infection, etc.) to exclude
• An ultrasound: this is a safe technique, with one very focused on the location of the pain can investigate. An ultrasound is difficult for overweight people or when there is a lot of intestinal gas.
• X-rays: is often performed but is usually unnecessary if an ultrasound is done
• CT scan: only indicated if ultrasound is inconclusive
• A laparoscopy: This procedure may be viewing tube through a small incision across the abdomen inspected. This is especially interesting for the study of women because some complaints unrelated to an alleged to have appendicitis, but the result of such disorders of the ovaries, uterus or other pelvic problems.

Especially in children in whom the disease can progress very rapidly in the elderly whose symptoms are less distinct, and in pregnant women, the diagnosis may be difficult.

Treatment

Once it is established that the appendix is inflamed, it must be surgically removed. This should usually soon after the emergence of the first symptoms occur, especially in children, to avoid the appendix wall breaks open and their contents into the abdominal cavity chain. This can be a life-threatening inflammation of the peritoneum cause.
Depending on the severity of inflammation, the surgeon operating a classic look or a surgery. After four to five days one can normally leave the hospital. The recovery can take up to several weeks.

Operation

At surgery, the cecum searched, cleared and removed. The operation itself can, through a small incision in the right lower abdomen or through an exploratory operation to be performed. When in doubt, also a cut in the middle of the abdomen are used. It may be a possible alternative cause of pain are detected and treated. Which method will be chosen depends on many factors including the severity of inflammation, the preference of the surgeon, et cetera.

However, sometimes around the inflamed appendix has a lot of adhesions and bowel caused by hedging. This is sometimes the examination as a resistance in the right lower abdomen to feel. This is called a appendiculair infiltrate (this usually occurs after a few days ill and is a natural reaction of the body). In such case, the inflammatory infiltrate and cool down and "relax" prior to surgery if necessary to proceed (after several weeks of bed rest, antibiotics and possibly gradual recovery for six to eight weeks, and decreased resistance). This gradually relax and restore the appendix and the infiltrate may be followed by the BSE at certain times to determine and leucocyte count. This will decrease. Also at different times of the stomach examined.

Possible complications

The development of complications often depends on the severity of inflammation. General complications such as wound infection and bleeding are possible. Sometimes there is delayed healing and delayed recovery of bowel movements. In severe inflammation and abdominal fluid, antibiotics are administered. In wound abscesses, the skin wound may open again, so good drainage of the pus is possible. The recovery usually takes longer. Also some weeks after discharge a short period cramping pain be felt. This is sometimes caused by adhesions in the abdomen through which the bowel movements may increase. If this pain, the doctor will be alerted. Sometimes there after an operation for appendicitis abscess in the abdomen. In some cases, disappears through the anus, occasionally must be treated surgically or can be punctured under imaging control.

After surgery

After surgery, the patient (e) an infusion for fluid and drug administration. The bowel movements are gradually resumed and the power is gradually expanded. In general, you can take a few days returned to normal washing and showering. After four to five days the patient (e) are usually released, often over the normal diet possible again.

After about seven days, the stitches will be removed. With true acute inflammation with pus or free fluid in the abdomen is sometimes left open skin wound. This healing takes slightly longer than in general.

Recovery usually takes a couple of weeks. After that the normal work and the work resumed.