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Gastroesophageal\tReflux\t(GER)\tand\nGastroesophageal\tReflux\tDisease\t(GERD)\tin\tAdults\n\t(website):\t\nhttp://digestive.niddk.nih.gov/;\n\tSong\tet\tal,\n2013.
|
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] |
BOX\t26.4\nIntegrative\tApproaches\tto\tGI\tConditions,\tIncluding\tAcid\nReflux/Heartburn\nAccording\tto\n\tthe\tNational\tHealth\tInterview\tSurvey\t(NHIS),\twhich\tis\tpublished\tevery\t5\tyears,\ncomplementary\tand\tintegrative\tmedicine\t(CIM)\tuse\tis\tmore\tprevalent\tin\tthose\twith
|
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gastrointestinal\t(GI)\tconditions\tversus\tthose\twithout.\tA\tfollow-up\tstudy\tto\tthe\tmost\trecent\treport\nfound\tthat\t42%\tof\trespondents\twith\tGI\tconditions\tsaw\ta\tpractitioner\tfor\tor\tused\tCIM\twithin\tthe\nprevious\tyear,\twhile\tonly\t28%\tof\tthose\twithout\n\tGI\tconditions\tused\tCIM.\tOf\tthose\twho\treported
|
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] |
reflux/heartburn.\tThe\tmost\tcommon\tCIM\tmodalities\tused\twere\tpaired\tinto\n\tgroups\tas\tfollows\n(\nDossett\tet\tal,\t2014\n):\n•\t\nHerbs\tand\tnonvitamin\tnonmineral\tsupplements,\tincluding\tzinc,\tglutamine,\ndeglycyrrhizinated\tlicorice,\tand\taloe\tgel\n•\t\nManipulative\ttherapies:\tchiropractic,\tosteopathic,\tmassage,\tcraniosacral\ttherapy\n•
|
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] |
•\t\nMind-body\ttherapies:\thypnosis,\tbiofeedback,\tmeditation,\timagery,\tprogressive\trelaxation\n•\t\nMind-body\texercise:\tyoga,\ttai\tchi,\tqi\tgong\n•\t\nSpecial\tdiets:\n\tvegetarian\tor\tvegan,\tmacrobiotic,\tAtkins,\tPritikin,\tOrnish,\tor\tdietary\ncounseling\n•\t\nMovement\ttherapy:\tFeldenkrais,\tAlexander\ttechnique,\tPilates,\tTrager\tpsychological\nintegration\n•
|
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] |
integration\n•\t\nOther:\tacupuncture,\tAyurveda,\tchelation,\tenergy\thealing,\thomeopathy,\tnaturopathy,\ntraditional\thealers\nAmong\tthese,\therbs\tand\tsupplements,\tmind-body\ttherapies,\tand\tmanipulative\ttherapies\twere\nthe\ttop\tthree\trespondents\n\treported\tusing\tto\taddress\ta\tGI\tcondition,\tand\t47%\tused\t3\tor\tmore
|
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reported\tusing\tto\taddress\ta\tGI\tcondition,\tand\t47%\tused\t3\tor\tmore\nmodalities.\tOverwhelmingly,\t80%\treported\tthat\tthey\tperceived\tCIM\ttherapy\tto\tbe\thelpful,\tbut\tonly\n70%\tinformed\ttheir\tmedical\tprovider\tabout\tusing\tCIM.\tWhile\tthe\tNHIS\tacknowledges\tsome\nimportant\tdetails\tabout\tthe\tuse\tof\tCIM\tand\tGI\tconditions,\tthe\tdata\tare\tself-reported,\tand\tthe
|
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] |
conditions\twere\tlimited\tto\tthose\tincluded\tin\tthe\tsurvey.\n\tThe\tfollow-up\tstudy\tis\timportant\tbecause\nit\treveals\ta\tsignificant\tnumber\tof\tindividuals\twho\tare\tintegrating\tCIM\tmodalities\twith\ttraditional\ntreatment\tfor\tGI\tdisorders\t(\nDossett\tet\tal,\t2014\n).\nWith\tmany\tpatients\tusing\tintegrative\tmedicine\tto\ttreat\tupper\tGI\tconditions,\tincluding\tacid
|
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reflux/heartburn,\tit\tis\timportant\tfor\tthe\tnutrition\tprofessional\tto\tbe\taware\tof\tthe\tmost\tcommon\nmodalities\tbeing\tused.\n\tAcupuncture,\tmind-body\ttherapies,\therbs\tand\tdietary\tsupplements,\tand\nnutrition\tand\tlifestyle\tinterventions\tare\tall\tpopular\tand\thave\tvarying\tdegrees\tof\tevidence\tto
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support\ttheir\tuse.\tWhile\tacupuncture,\tweight\tloss,\tand\televating\tthe\thead\tof\tthe\tbed\thave\tgood\nevidence,\tthere\tis\talso\treasonable\tevidence\tto\tsupport\tmind-body\tmodalities\tand\tdietary\nmodifications\t(\nDossett\tet\tal,\t2017\n;\t\nEherer\tet\tal,\t2012\n;\t\nJarosz\tand\tTaraszewska,\t2014\n,\t\nMaradey-\nRomero\tet\tal,\t2014
|
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;\t\nJarosz\tand\tTaraszewska,\t2014\n,\t\nMaradey-\nRomero\tet\tal,\t2014\n).\tFurther\tstudy\tis\tneeded,\tand\tspecific\trecommendations\tshould\tbe\ttailored\tto\nthe\tindividual\tby\ta\twell-trained\tprofessional\tusing\tevidence-based\tdata\tfrom\treliable\tsources,\tas\nmany\tpatients\tmay\tlook\tto\tanecdotal\tevidence\tthat\tis\tnot\tfounded\tin\tscientific\tresearch\t(\nCowan,\n2014\n).
|
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] |
Cowan,\n2014\n).\nSurgery\tof\tthe\tesophagus\nThe\tprimary\tindication\n\tfor\tan\t\nesophagectomy\n\tis\tesophageal\tcancer\tor\tBE\twith\thigh-grade\ndysplasia.\tA\tpatient\tundergoing\tesophagectomy\toften\tpresents\twith\tdysphagia,\tdecreased\tappetite,\nside\teffects\tfrom\tchemotherapy,\tand\tweight\tloss.\tEsophagectomy\trequires\tthat\tthere\tbe\tanother
|
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] |
conduit\tin\tplace\tto\ttransport\tfood\tfrom\tthe\toropharynx\tto\tthe\trest\tof\tthe\tGI\ttract\tfor\tdigestion\tand\nabsorption.\tPlacement\tof\tan\tenteral\tfeeding\n\ttube\tpreoperatively,\tor\tat\tthe\ttime\tof\tsurgery,\tprovides\nenteral\taccess\tfor\tpatients\twho\twill\texperience\teating\tchallenges\tand\ta\tslow\ttransition\tback\tto\ta
|
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] |
normal\tdiet.\tThe\tenteral\troute\tof\tnutrition\tis\tpreferred;\thowever,\tif\tthe\tGI\ttract\tis\tnot\tfunctional,\nparenteral\tnutrition\t(PN)\tmust\tbe\tprovided\t(see\t\nChapter\t12\n).\nMedical\tnutrition\ttherapy\nNutrition\tassessment\tof\tan\tesophagectomy\tcandidate\n\tincludes\tevaluation\tof\ttreatment\tplans,\thistory
|
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includes\tevaluation\tof\ttreatment\tplans,\thistory\nof\tweight\tloss,\tand\tthe\tability\tto\tswallow\tsolid\tfoods\tand\tliquids.\tGenerally,\tthe\tonly\tesophagectomy\npatients\tscreened\tat\tlow\tnutrition\trisk\tpreoperatively\tare\tthose\twith\tBE\twith\thigh-grade\tdysplasia,\nor\tthose\twho\tare\tasymptomatic.\nPreoperative\tphase.\nSwallowing\tdifficulty\t(\ndysphagia
|
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0.09960951656103134,
0.009828216396272182
] |
Preoperative\tphase.\nSwallowing\tdifficulty\t(\ndysphagia\n)\tis\tthe\tcommonly\tidentified\tproblem\tin\tpatients\tawaiting\tan\nesophagectomy.\tDietary\tmodifications\tmay\trange\tfrom\tregular\tfood\twith\tadequate\tchewing\tand\tslow\neating\tto\tsoft\tfoods\tor\tto\tpureed\tor\tblenderized\tfoods.\tPatients\tmay\talso\tbenefit\tfrom\tthe\taddition\tof
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nutrient-dense,\thigh-protein\tsmoothies\tand\tnutritive\tbeverages\tmade\tfrom\twhole\tfoods\tand\thealthy\nfats\tto\tmaximize\tenergy\tand\tprotein\tintake\tbefore\tsurgery.\tIf\tthe\toral\tdietary\tmodifications\tdo\tnot\nprevent\n\tfurther\tweight\tloss,\tnutrition\tsupport\tfrom\ta\tnasoenteric\tfeeding\ttube\tinserted\tin\tthe\npreoperative\tpatient\tmay\tbe\tnecessary.
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] |
Postoperative\tphase.\nA\t\ngastric\tpull-up\n\tprocedure\t(\nFig.\t26.4\n)\tinvolves\tremoval\tof\ta\tsegment\tof\tor\tthe\tentire\tesophageal\ntract\tand\treplacing\tit\twith\tthe\tstomach\ttissue.\tComplications\tafter\tthis\tprocedure\tinclude\tincreased\nrisk\tof\taspiration,\tdysphagia,\tanastomosis\tleak,\n\twound\tinfection,\tand\tstricture\tat\tthe\tanastomosis
|
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] |
wound\tinfection,\tand\tstricture\tat\tthe\tanastomosis\nsite.\tA\tjejunostomy\tfeeding\ttube\tmay\tbe\tplaced\tat\tsurgery\tto\tprovide\tpostoperative\tnutrition\tuntil\nadequate\toral\tintake\tis\tachieved.\tThe\ttube\tfeeding\tschedule\tis\tchanged\teventually\tfrom\tcontinuous\nto\tcyclical\tfeedings\tat\tnight\tas\tthe\tpatient\tis\ttransitioned\tto\tan\toral\tdiet\tduring\tthe\tday.
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] |
FIG.\t26.4\nGastric\tpull-up.\n\t\nSource:\n\t(Cleveland\tClinic,\tCleveland,\tOhio.)\nTransition\tto\toral\tintake\tpostoperatively\tproceeds\tfrom\tclear\tliquids\tto\ta\tsoft,\tmoist\tfoods\tdiet.\tThe\npatient\tis\tadvised\tto\teat\tsmall\tfrequent\tmeals\twith\tlimited\tfluids\tat\tmealtimes.\tSome\tpatients\tmay
|
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] |
experience\tdumping\tsyndrome\tif\tfood\tpasses\tinto\tthe\tsmall\tintestine\ttoo\tquickly.\tThe\tsymptoms\tof\ndumping\tsyndrome\tinclude\n\tabdominal\tpain,\tnausea,\tdiarrhea,\tweakness,\tand\tdizziness.\t\nBox\t26.5\n\tlists\ndietary\tguidelines\tafter\tesophageal\tsurgery\tto\tprevent\tdumping\tsyndrome\t(see\t\nDumping\tSyndrome\nlater\tin\tthis\tchapter\tfor\tmore\tdetails).\nBOX\t26.5
|
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] |
Dumping\tSyndrome\nlater\tin\tthis\tchapter\tfor\tmore\tdetails).\nBOX\t26.5\nNutrition\tGuidelines\tAfter\tEsophagectomy\n1.\t\nEnteral\tnutrition\tis\tprovided\tthrough\ta\tjejunostomy\tfeeding\ttube\tafter\tesophagectomy.\n2.\t\nA\tpatient\tcannot\teat\tor\tdrink\tanything\n\tby\tmouth\tuntil\tinstructed\tby\tthe\tdoctor.\n3.
|
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by\tmouth\tuntil\tinstructed\tby\tthe\tdoctor.\n3.\t\nOnce\tan\toral\tdiet\tis\tallowed,\tpatient\tis\tprovided\twith\tspecific\tguidelines\ton\thow\tto\ttaper\nthe\ttube\tfeedings\tand\tadvance\tthe\toral\tdiet\t(from\tsips\tof\tclear\tliquids\tto\tvery\tmoist,\ttender\nfoods).\n4.\t\nIt\tmay\ttake\tseveral\tweeks\tto\ttaper\tthe\ttube\tfeedings\tand\tadjust\tto\toral\tdiet.\tWhen\ttube
|
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-0.017801672220230103,
0.08282041549682617,
0.01708119735121727,
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0.11524797976016998,
0.02080829069018364,
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0.0011122386204078794,
0.05739955976605415,
0.043227218091487885,
-0.025569427758455276
] |
feeding\tis\tdiscontinued,\tthe\tpatient\tshould\tcontinue\tto\tflush\tthe\n\tjejunostomy\ttube\tdaily.\tA\npatient\twill\tcontinue\tto\tadjust\tto\toral\tfeedings\tfor\tabout\t3\tmonths.\n5.\t\nDuring\tthe\t3-month\ttransition:\n•\t\nEat\tsix\tsmall\tmeals\tper\tday\tand\tinclude\tsources\tof\tprotein\tand\tfat\tat\tevery\tsmall\nmeal.\n•
|
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] |
meal.\n•\t\nChoose\tvery\ttender,\tmoist\tfoods\tthat\tcan\tbe\teasily\tcut\twith\tthe\tside\tof\tfork\tor\tspoon\nand\tuse\tsauces\tor\tgravies\tto\tmoisten\tfood.\n•\t\nGradually\tincrease\tthe\tvolume\tand\tvariety\n\tof\tfoods\tat\teach\tmeal.\n•\t\nAvoid\tskins,\tseeds,\tnuts,\ttough\tor\tdry\tmeats,\tbreads\tand\trolls,\tpeanut\tbutter,\tfried
|
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] |
and\tgreasy\tfoods,\traw\tvegetables,\tcooked\tcorn\tand\tpeas,\tand\traw\tfruits.\n•\t\nAvoid\titems\tthat\tcan\tcause\theartburn\tand\tstomach\treflux\tsuch\tas\tcaffeine,\tcitrus\nfruits,\tpineapples,\ttomatoes,\tcarbonated\tbeverages,\tmints,\tand\talcohol.\n•\t\nDrink\tno\tmore\tthan\t4\tfluid\tounces\tof\twater\tor\tother\tliquids\n\twith\tmeals.\tDrink\tfluids
|
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] |
with\tmeals.\tDrink\tfluids\nabout\t30\tminutes\tbefore\tor\tafter\tthe\tmeal\tand\tsip\tslowly.\n•\t\nAvoid\tconcentrated\tsweets\tand\tsugars.\n•\t\nEat\tslowly\tand\tchew\tfoods\tthoroughly.\n6.\t\nAfter\t3\tmonths,\tmore\tfood\tshould\tbe\tadded\tback\tinto\tthe\tdiet.\tTry\tone\tnew\tfood\tor\nbeverage\tat\ta\ttime.\n7.
|
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] |
beverage\tat\ta\ttime.\n7.\t\nAfter\t6\tmonths,\ta\tpatient\tshould\tbe\teating\tnormally.\tIt\tis\tstill\tadvised\tto\teat\tfrequent\tsmall\nmeals.
|
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] |
Head\n\tand\tneck\tcancer\nPathophysiology\nCancers\tof\tthe\tupper\taerodigestive\ttract,\tcollectively\treferred\tto\tas\thead\tand\tneck\tcancers,\tcomprise\nmalignancies\tof\tthe\toral\tcavity\t(lips\tand\tinside\tof\tthe\tmouth,\tincluding\tthe\tfront\tportion\tof\tthe\ntongue\tand\tthe\troof\tand\tfloor\tof\tthe\tmouth),\tthe\toropharynx\t(back\tportion\tof\tthe\ttongue\tand\tthe\tpart
|
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] |
of\tthe\tthroat\tbehind\tthe\toral\tcavity),\tthe\tlarynx,\tand\tthe\tesophagus.\n\tThe\tpatient\tdiagnosed\twith\thead\nand\tneck\tcancer\tfaces\tunique\tchallenges\tin\tmaintaining\tadequate\tnutrition.\tThe\tdisease\tand\tthe\ntreatments,\tespecially\tsurgery\tand\tchemo-\tand\tradiation\ttherapy,\thave\tsignificant\timpact\ton\tupper
|
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digestive\ttract\tfunction,\tand\toral\tintake\tis\toften\tinsufficient\tduring\tand\tafter\ttherapy.\tApproximately\n35%\tto\t60%\tof\tall\tpatients\twith\thead\tand\tneck\tcancer\tare\tmalnourished\n\tat\tthe\ttime\tof\tdiagnosis\tdue\nto\tintake\tdifficulties,\ttumor\tburden,\tand\tcachexia\t(\nAlshadwi\tand\tNadershah,\t2013\n).\tDysphagia\tis\ta
|
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Alshadwi\tand\tNadershah,\t2013\n).\tDysphagia\tis\ta\nhallmark\tof\thead\tand\tneck\tcancer;\tit\toccurs\tas\ta\tresult\tof\tmechanical\tobstruction,\tsensory\nimpairment,\tor\t\nodynophagia\n\t(painful\tswallowing).\tIn\tthese\tpatients\tthere\tis\ta\thigh\tprevalence\tof\nalcohol\tabuse\tand\tlong-term\ttobacco\tuse,\twhich\tare\talso\tassociated\twith\tchronic\tmalnutrition\n(
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] |
(\nSchoeff\tet\tal,\t2013\n).\nMedical\tnutrition\ttherapy\nDepending\ton\tthe\ttumor\tsite,\tthe\tsurgical\tprocedure\tmay\tsignificantly\talter\tthe\tanatomy\tand\tlead\tto\nscarring\tthat\tcan\tnegatively\taffect\tswallowing.\tThe\tpatient\tis\tlikely\tto\tbe\trestricted\tfrom\toral\tintake\nwhile\thealing\tfrom\tthe\tsurgery.\tPlacement\tof\ta\tgastrostomy\ttube\tis\tthe\tmost\tcommon\tapproach\tto
|
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ensure\tsafe\tdelivery\tof\tadequate\tnutrition,\n\tbut\tthe\toptimal\ttiming\tis\tnot\tdefined.\tMany\tclinicians\tmay\nplace\tthem\tprophylactically\tbefore\tthe\tstart\tof\tradiation\tor\tsurgical\tresection\tto\tprevent\ncomplications\tfrom\tmalnutrition\t(\nMarian\tet\tal,\t2017\n).\tAlthough\tthe\tgoal\tis\teventual\ttransition\tto\toral
|
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).\tAlthough\tthe\tgoal\tis\teventual\ttransition\tto\toral\nfeeding,\tsome\tpatients\twill\trequire\tadditional\tenteral\tnutrition\t(EN)\tbecause\tof\tstructural\tand\nsensory\tdeficits.\nAggressive\tprophylactic\tswallowing\n\ttherapy\tis\ta\trecent\tdevelopment\tin\tthe\ttreatment\tof\tdysphagia
|
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] |
therapy\tis\ta\trecent\tdevelopment\tin\tthe\ttreatment\tof\tdysphagia\nin\tpatients\twith\thead\tand\tneck\tcancer.\tThis\tapproach\tfocuses\ton\tmaintaining\tor\tregaining\tfunction\nrather\tthan\tsimply\taccommodating\tdysfunction\t(reliance\ton\tfeeding\ttube)\tand\tempowers\tpatients\tto\nprogress\tcarefully\twith\toral\tintake\tdespite\timperfect\tswallowing\t(\nSchoeff\tet\tal,\t2013\n).
|
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] |
Schoeff\tet\tal,\t2013\n).\nThe\tstomach\nThe\tstomach\taccommodates\tand\tstores\n\tmeals,\tmixes\tfood\twith\tgastric\tsecretions,\tand\tcontrols\nemptying\tinto\tthe\tduodenum.\tGastric\tvolume\tis\tapproximately\t50\tmL\twhen\tempty\tbut\tcan\texpand\tto\napproximately\t4\tL.\tGastric\t\nparietal\tcells\n\t(acid-producing\tcells)\tproduce\t1.5\tto\t2\tL\tof\tacid\tdaily,
|
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] |
(acid-producing\tcells)\tproduce\t1.5\tto\t2\tL\tof\tacid\tdaily,\nresulting\tin\ta\tpH\tbetween\t1\tand\t2\t(see\t\nChapter\t1\n\tfor\ta\tdetailed\tdiscussion\tof\tnormal\tstomach\nfunction).\nThe\tmucosa\tof\tthe\tstomach\tand\tduodenum\tis\n\tprotected\tfrom\tproteolytic\tactions\tof\tgastric\tacid\tand
|
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gastroduodenal\tmucosa\tby\tstimulating\tthe\tsecretion\n\tof\tmucus\tand\tbicarbonate\tand\tmaintaining\nblood\tflow\tduring\tperiods\tof\tpotential\tinjury.\nDyspepsia\tand\tfunctional\tdyspepsia\nPathophysiology\nDyspepsia\n\t(indigestion)\trefers\tto\tnonspecific,\tpersistent\tupper\tabdominal\tdiscomfort\tor\tpain.\tIt
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affects\tan\testimated\t20%\tto\t40%\tof\tthe\tgeneral\tpopulation\tand\tsignificantly\treduces\tquality\tof\tlife\n(\nFord\tand\tMoayyedi,\t2013\n).\tThe\tunderlying\tcauses\tof\tdyspepsia\n\tmay\tinclude\tGERD,\tpeptic\tulcer\ndisease,\tgastritis,\tgallbladder\tdisease,\tor\tother\tidentifiable\tpathologic\tconditions.
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] |
Functional\tgastrointestinal\tdisorders\t(FGIDs),\tnow\tknown\tas\tdisorders\tof\tgut-brain\tinteraction\n(DGBI),\thave\tbeen\tdiagnosed\tand\tclassified\tusing\tstandards\tdefined\tby\tthe\tRome\tcriteria\tsince\tits\ninception\tin\tthe\tlate\t1980s.\tThe\tmost\trecent\tupdate\tusing\tcurrent\tscientific\tdata\twas\n\treleased\tin\nMay\t2016\tand\tis\tknown\tas\tthe\t\nRome\tIV\tcriteria
|
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] |
released\tin\nMay\t2016\tand\tis\tknown\tas\tthe\t\nRome\tIV\tcriteria\n.\tAccording\tto\tthese\tcriteria,\t\nfunctional\tdyspepsia\n(FD)\tis\tdefined\tas\tan\tumbrella\tterm\tto\tinclude\tpatients\twith\tpostprandial\tdistress\tsyndrome\t(PDS)\nand\tepigastric\tpain\tsyndrome\t(EPS)\t(\nSchmulson\tand\tDrossman,\t2017\n).\tSymptoms\tcan\tinclude
|
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Schmulson\tand\tDrossman,\t2017\n).\tSymptoms\tcan\tinclude\npostprandial\tfullness\tand\tearly\tsatiety,\tbut\talso\tmay\tcause\tpatients\tto\tperceive\tepigastric\tdiscomfort\nand/or\tburning\tafter\tmeals.\tThe\tsyndromes\tcan\toverlap\tand\tare\tconsidered\tgastroduodenal\ndisorders\tthat\toccur\tin\tthe\tabsence\tof\tany\torganic,\tsystemic,\tor\tmetabolic\tdisease\tlikely\tto\texplain
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] |
the\tsymptoms\t(\nTalley\tand\tFord,\t2015\n).\tThe\tword\tdiscomfort\tis\timportant\tto\temphasize,\tas\tmany\npatients\twill\tnot\tcomplain\tof\tpain\tbut\trather\tof\tburning\tand\tpressure\tor\tfullness\tin\tthe\tepigastric\narea,\twith\ta\tfrequent\n\tcomplaint\tof\tearly\tsatiety.\tBelching,\tabdominal\tbloating,\tand\tnausea\tcan\talso
|
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] |
be\tpresent\tin\tboth\tsyndromes,\tbut\tvomiting\tis\tconsidered\tan\tunusual\toccurrence\t(\nSchmulson\tand\nDrossman,\t2017\n).\nMedical\tnutrition\ttherapy\nCurrent\ttreatments\tfor\tFD\thave\tgenerally\tignored\tthe\tpotential\trole\tof\tdiet.\tThe\tpossible\teffect\tof\nspecific\tfoods\tand\tmacronutrients\tand\tother\tdietary\thabits\tto\tinduce\tor\texacerbate\n\tFD\tsymptoms\thas
|
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FD\tsymptoms\thas\nbeen\tpoorly\tstudied,\tand\toften\tthere\tare\tconflicting\tresults\t(\nLacy\tet\tal,\t2012\n).\tHowever,\tone\tmore\nrecent\tstudy\tdemonstrated\tspicy,\tpickled,\tand\thigh-fat\tfoods\tas\tcatalysts,\tinducing\tsymptoms\tthe\nmost\tin\tpatients\twith\tthis\tcondition\t(\nAkhondi-Meybodi\tet\tal,\t2015\n).\tUsing\ta\tfood\tand\tsymptom\tdiary
|
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Akhondi-Meybodi\tet\tal,\t2015\n).\tUsing\ta\tfood\tand\tsymptom\tdiary\nduring\ta\tclinical\tevaluation\tof\ta\tpatient\twith\tFD\tand\tassessing\tsymptoms\tassociated\twith\n\teating
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patterns\tis\tuseful.\tDietary\tmodifications\tsuch\tas\tconsuming\tsmaller\tmeals\twith\ta\treduction\tin\tdietary\nfat\tmay\tbe\tpromising\tin\tFD\ttherapy.\tHelping\tthe\tpatient\tidentify\tproblematic\tfoods\talso\tcan\tbe\nhelpful.\nGastritis\tand\tpeptic\tulcers\nPathophysiology\nGastritis\n\tis\ta\tnonspecific\tterm\tliterally\tmeaning\tinflammation\tof\tthe\tstomach.\tIt\tcan\tbe\tused\tto
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] |
describe\tsymptoms\trelating\tto\tthe\tstomach,\n\tan\tendoscopic\tappearance\tof\tthe\tgastric\tmucosa,\tor\ta\nhistologic\tchange\tcharacterized\tby\tinfiltration\tof\tthe\tepithelium\twith\tinflammatory\tcells\tsuch\tas\npolymorphonuclear\tcells\t(PMNs).\tAcute\tgastritis\trefers\tto\trapid\tonset\tof\tinflammation\tand
|
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] |
symptoms.\tChronic\tgastritis\tmay\toccur\tover\ta\tperiod\tof\tmonths\tto\tdecades,\twith\treoccurring\nsymptoms.\tSymptoms\tinclude\tnausea,\tvomiting,\tmalaise,\tanorexia,\n\themorrhage,\tand\tepigastric\tpain.\nProlonged\tgastritis\tmay\tresult\tin\tatrophy\tand\tloss\tof\tstomach\tparietal\tcells,\twith\ta\tloss\tof\tHCl
|
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] |
secretion\t(achlorhydria)\tand\tintrinsic\tfactor,\tresulting\tin\tpernicious\tanemia\t(see\t\nChapter\t31\n).\nHelicobacter\tpylori\n\tgastritis\nHelicobacter\tpylori\n\tis\ta\tgram-negative\tbacteria\tthat\tis\tsomewhat\tresistant\tto\tthe\tacidic\nenvironment\tin\tthe\tstomach.\t\nH.\tpylori\n\tinfection\n\tis\tresponsible\tfor\tmost\tcases\tof\tchronic\tinflammation
|
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] |
infection\n\tis\tresponsible\tfor\tmost\tcases\tof\tchronic\tinflammation\nof\tthe\tgastric\tmucosa\tand\tpeptic\tulcer,\tgastric\tcancer,\tand\t\natrophic\tgastritis\n\t(chronic\tinflammation\nwith\tdeterioration\tof\tthe\tmucous\tmembrane\tand\tglands),\tresulting\tin\tachlorhydria\tand\tloss\tof\nintrinsic\tfactor\t(\nDos\tSantos\tand\tCarvalho,\t2015\n).\nH.\tpylori
|
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] |
intrinsic\tfactor\t(\nDos\tSantos\tand\tCarvalho,\t2015\n).\nH.\tpylori\n\tis\ta\tknown\tunderlying\tcause\tof\tnoncardia\tgastric\tcancer\tand\tresponsible\tfor\tdeaths\tfrom\npeptic\tulcer\t(\nAxon,\t2014\n).\tAn\tupdated\tclassification\tof\tgastric\tcancers\twas\tadopted\tin\tpart\tbecause\nof\tthe\trole\tof\t\nH.\tpylori,
|
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of\tthe\trole\tof\t\nH.\tpylori,\n\twhich\tis\ta\tstrong\trisk\tfactor\tfor\tnoncardia\tgastric\tcancer.\tTraditionally,\ngastric\tcancer\twas\tconsidered\ta\tsingle\tdisease,\tbut\tscientists\tnow\tclassify\tit\tby\tits\tlocation\tin\teither\nthe\ttop\tinch\tof\tthe\tstomach\tnear\tthe\tesophagus\t(gastric\tcardia)\tor\tthe\trest\tof\tthe\tstomach\n(noncardia).
|
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] |
(noncardia).\nDeveloped\tcountries\thave\tseen\ta\tdecrease\tin\t\nH.\tpylori\n\tinfections\tin\trecent\tyears\tbecause\tof\nincreased\tinformation,\ttesting,\tand\teffective\ttreatment.\tRisk\tfactors\tfor\tthis\tinfection\tare\thigher\tin\nless-developed\tcountries\twith\tlower\tstandard\tof\tliving,\tpoor\teducation,\tand\treduced\tlifespan.\tIn
|
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] |
these\tcommunities,\tthe\tprevalence\tof\treinfection\tis\talso\thigher,\tleading\tto\tan\tongoing\tpublic\n\thealth\nproblem.\tThe\trevelation\tthat\ttreating\t\nH.\tpylori\n\tinfection\tdecreases\tthe\trisk\tfor\tsome\tcancers\tbut\tmay\nincrease\tthe\trisk\tof\tother\tcancers\t(esophageal)\tis\talso\tprompting\tmore\tresearch\tand\tknowledge\tthat\ntreatment\tmust\tbe\tmore\twidespread\t(
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treatment\tmust\tbe\tmore\twidespread\t(\nAxon,\t2014\n).\nWhile\tprevalence\tof\t\nH.\tpylori\n\tinfection\tcorrelates\twith\tgeography\tand\tsocioeconomic\tstatus\tof\tthe\npopulation\tand\tbegins\tduring\tchildhood,\tit\n\tis\toften\tnot\tdiagnosed\tuntil\tadulthood.\t\nH.\tpylori\n\tis\tspread
|
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is\toften\tnot\tdiagnosed\tuntil\tadulthood.\t\nH.\tpylori\n\tis\tspread\nthrough\tcontaminated\tfood\tand\twater\tand\tis\tcorrelated\twith\tlower\tlevels\tof\thygiene.\tMore\tthan\thalf\nof\tthe\tworld\tpopulation\tis\tinfected\tand\tprevalence\tranges\tfrom\tas\tlow\tas\t18.9%\tin\tSwitzerland,\tto\n24.6%–35.6%\tin\tthe\tUnited\tStates\tand\tAustralia,\tto\tas\thigh\tas\t87.7%\tin\tNigeria\t(
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Hooi\tet\tal,\t2017\n).\t\nH.\npylori\n\tinfection\tdoes\tnot\tresolve\tspontaneously,\n\tand\trisks\tof\tcomplications\tincrease\twith\tthe\tduration\nof\tthe\tinfection.\tOther\trisk\tfactors\tcontributing\tto\tpathology\tand\tdisease\tseverity\tinclude\tpatient\tage\nat\tonset,\tspecific\tstrain\tand\tconcentration\tof\tthe\torganism,\tgenetic\tfactors\trelated\tto\tthe\thost,\tand
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the\tpatient’s\tlifestyle\tand\toverall\thealth.\nIn\tthe\tfirst\tweek\tafter\t\nH.\tpylori\n\tinfection,\tmany\tPMNs\tand\ta\tfew\teosinophils\tinfiltrate\tthe\n\tgastric\nmucosa.\tThese\tare\treplaced\tgradually\twith\tthe\tmononuclear\tcells.\tThe\tpresence\tof\tlymphoid\tfollicles\nis\tcalled\t\nmucosa-associated\tlymphoid\ttissue\t(MALT)\n.\tMALT\tmay\tbecome\tautonomous\tto\tform\ta
|
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] |
.\tMALT\tmay\tbecome\tautonomous\tto\tform\ta\nlow-grade,\tB-cell\tlymphoma\tcalled\tMALT\tlymphoma.\t\nH.\tpylori\n\tcan\tcause\tduodenitis\tif\tit\tcolonizes\ngastric\ttissue\tthat\tmay\tbe\tpresent\tin\tthe\tduodenum.\nTreating\t\nH.\tpylori\n\twith\tantibiotics\tcan\tcause\tPMNs\n\tto\tdisappear\twithin\ta\tweek\tor\ttwo,\tbut\ta\tmild
|
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] |
to\tdisappear\twithin\ta\tweek\tor\ttwo,\tbut\ta\tmild\ngastritis\tcan\tpersist\tfor\tseveral\tyears,\tas\tthe\treduction\tin\tmononuclear\tcells\tis\tslow.\tIn\tcountries\nwhere\t\nH.\tpylori\n\tis\tcommon,\tso\tis\tgastric\tcancer.\tBecause\t\nH.\tpylori\n\tcan\tcause\tpeptic\tulcer\tand\tgastric\ncancer,\tantibiotic\ttreatment\tis\tfavored\twhen\tit\tis\tdiagnosed.\t\nBox\t26.6
|
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] |
Box\t26.6\n\tincludes\tinformation\tabout\nintegrative\tapproaches\tfor\t\nH.\tpylori\n.\nBOX\t26.6\nIntegrative\tApproaches\tto\t\nHelicobacter\tPylori\n\t\nand\tAssociated\nGI\tDisease\nTypical\tmedical\ttreatment\tfor\t\nH.\tpylori\n\tis\twith\t“triple\ttherapy”\t(TT)\tthat\tcombines\ttwo\nantimicrobial\tdrugs\t(clarithromycin\tand\tamoxicillin\tor\tmetronidazole)\twith\tproton\tpump\tinhibitor
|
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] |
(PPI)\tfor\t1\tto\t2\tweeks\twith\tan\t80%\tto\t85%\tsuccess\trate\t(\nSarkar\tet\tal,\t2016\n;\t\nOh\tet\tal,\t2016\n).\nUnfortunately,\tadverse\tevents\tsuch\tas\t\nClostridium\n\tdifficile\n\tinfection\t(CDI)\tor\tpseudomembranous\ncolitis\tcan\toccur\twith\tthe\tchange\tin\tgut\tflora\tdue\tto\tTT\ttreatment.\tOne\tsmall\trandomized
|
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to\tbe\tdue\tto\tlowered\nimbalance\tof\tmicrobiota\tduring\ttreatment,\tthus\tleading\tto\tbetter\ttolerated\ttreatment\tcompletion\n(\nOh\tet\tal,\t2016\n).\tWhereas\tthis\tparticular\tstudy\twas\tvery\tsmall,\ta\tmuch\tlarger\tmeta-analysis\nreviewed\tsimilar\tcomparison\tdata\tfrom\t6997\tparticipants\tfrom\t45\tRCTs\tto\tfind\teradication\trates
|
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of\t82.31%\tin\tthe\tprobiotic\tgroup\tversus\t72.08%\tin\tthe\tcontrol\tgroup\t(\nZhang\tet\tal,\t2015\n).\nProbiotics\n\tspecies\t(\nLactobacillus,\tBifidobacterium\n)\thave\tbeen\tstudied\tfor\tprevention,\nmanagement,\tand\teradication\tof\t\nH.\tpylori\n\t(\nZhu\tet\tal,\t2014\n).\tFurther\tstudy\ton\tspecific\tstrains\tand
|
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] |
H.\tpylori\n\t(\nZhu\tet\tal,\t2014\n).\tFurther\tstudy\ton\tspecific\tstrains\tand\nlarger\tclinical\ttrials\tis\twarranted\tto\tinvestigate\tthe\trole\tof\tprobiotic\ttherapy\tand\twhether\tit\tshould
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] |
be\tincluded\tas\ta\tstandard\tof\tcare\tin\tmedical\ttreatment\tmoving\tforward.\nFood\talso\tprovides\tan\tinteresting\talternative\tto\n\tstandard\ttherapy.\tEmerging\tresearch\ton\tthe\nsynergy\tof\tfood\tcombinations\tthat\tmay\tinhibit\tthe\tgrowth\tof\t\nH.\tpylori\n\tsuggests\tthat\tgreen\ttea,\nbroccoli\tsprouts,\tblack\tcurrant\toil,\tand\tkimchi\t(fermented\tcabbage)\thelp\twith\t\nH.\tpylori
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H.\tpylori\neradication\t(\nKennan\tet\tal,\t2010\n).\tRecent\tstudies\thave\talso\tdemonstrated\tanti–\nH.\tpylori\n\tpotential\nand\tsignificant\tinhibition\tof\tthe\tbacteria’s\tgrowth\tby\tn-3\tpolyunsaturated\n\tfatty\tacids\t(PUFAs)\tin\nboth\tin\tvitro\tand\tin\tvivo\tmodels.\tA\tdecrease\tin\tgrowth\tand\tassociated\tinflammation\tof\t\nH.\tpylori
|
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] |
H.\tpylori\nhas\tbeen\tshown\twith\tadministration\tof\tdocosahexaenoic\tacid\t(DHA).\tAlthough\tsome\tresults\nshowed\tfish\toil\tas\tless\teffective\tthan\taspects\tof\tTT\ttreatment,\tand\tomega-3s\twould\tnot\tbe\ta\nstandalone\ttherapy,\tdata\tsuggests,\twhen\tcombined\twith\tstandard\tTT\ttreatment,\tthat\tPUFAs\tand\nDHA\tcould\n\thave\tpotential\tto\tdamper\trecurrence\trates\t(
|
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] |
DHA\tcould\n\thave\tpotential\tto\tdamper\trecurrence\trates\t(\nPark\tet\tal,\t2015\n).\nBecause\tof\tthe\tknown\trelationship\tbetween\t\nH.\tpylori\n\tand\tpeptic\tulcers,\teradication\tof\tthe\nbacteria\tis\ta\tprimary\tfocus\tof\ttreatment\tfor\tthose\twho\ttest\tpositive\tfor\tit.\tDietary\tpolyphenols\tare
|
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0.029439173638820648,
0.09275306761264801,
-0.0034762145951390266,
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0.10003600269556046,
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0.072999969124794,
0.0718134418129921,
0.08765501528978348,
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] |
bioactive\tcompounds\tare\tonly\ta\tstarting\tpoint\tfor\tthe\tdirection\tof\tfuture\tresearch\tand\tclinical\ntrials\tneeded\tto\tdetermine\tthe\trole\tof\tfood\tas\ta\tpart\tof\tthe\ttreatment\tfor\tpeptic\tulcer\tdisease\n(\nFarzaei\tet\tal,\t2015\n).\nNon-\nhelicobacter\tpylori\n\tgastritis\nAspirin
|
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0.051775988191366196
] |
(\nFarzaei\tet\tal,\t2015\n).\nNon-\nhelicobacter\tpylori\n\tgastritis\nAspirin\n\tand\tnonsteroidal\tantiinflammatory\tdrugs\t(NSAIDs)\tare\tcorrosive;\tboth\tinhibit\tprostaglandin\nsynthesis,\twhich\tis\tessential\tfor\tmaintaining\tthe\tmucus\tand\tbicarbonate\tbarrier\tin\tthe\tstomach.\tThus
|
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chronic\tuse\tof\taspirin\tor\tother\tNSAIDs,\tsteroids,\talcohol,\terosive\tsubstances,\ttobacco,\tor\tany\ncombination\tof\tthese\tfactors\tmay\tcompromise\tmucosal\tintegrity\tand\tincrease\tthe\tchance\tfor\nacquiring\tacute\tor\n\tchronic\tgastritis.\tEosinophilic\tgastroenteritis\t(EGE)\talso\tmay\tcontribute\tto\tsome
|
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] |
cases\tof\tgastritis.\tPoor\tnutrition\tand\tgeneral\tpoor\thealth\tmay\tcontribute\tto\tthe\tonset\tand\tseverity\tof\nthe\tsymptoms\tand\tcan\tdelay\tthe\thealing\tprocess.\nMedical\ttreatment\nTreatment\tfor\tgastritis\tinvolves\tremoving\tthe\tinciting\tagent\t(e.g.,\tpathogenic\torganism,\tNSAIDs).\nNoninvasive\tmethods\tfor\tdiagnosing\t\nH.\tpylori\n\tinclude\ta\tblood\ttest\tfor\t\nH.\tpylori
|
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H.\tpylori\n\tinclude\ta\tblood\ttest\tfor\t\nH.\tpylori\n\tantibodies,\ta\turea\nbreath\ttest,\tor\ta\tstool\tantigen\ttest.\t\nEndoscopy\n\tis\ta\tcommon\tinvasive\tdiagnostic\ttool\t(see\t\nFocus\tOn:\nEndoscopy\tand\tCapsules\n\tfor\tmore\tdetails\tabout\tthis\tprocedure).\tAntibiotics\tand\tPPIs\tare\tthe\tprimary\nmedical\ttreatments.
|
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medical\ttreatments.\nSide\teffects\tof\tchronic\tacid\tsuppression\teither\tfrom\tdisease\tor\tchronic\tuse\tof\tPPIs\tare\ta\tcurrent\ntopic\tof\tinterest\tin\tmedical\n\tresearch.\tFirst\tapproved\tin\t1989,\tPPIs\treduce\tgastric\tacid\tproduction\tby\nbinding\tirreversibly\tto\tthe\thydrogen/potassium\tATPase\tenzyme\ton\tgastric\tparietal\tcells\tand\tare\tnow
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one\tof\tthe\tmost\tcommonly\tprescribed\tmedications\tin\tthe\tUnited\tStates.\tWhile\tthey\tare\tgenerally\nwell-tolerated\tmedications\tand\tare\tconsidered\tsafe,\tthere\thave\tbeen\tsome\temerging\tconcerns\nregarding\tlong-term\tuse\tover\tthe\tpast\n\tseveral\tyears.\tThis\tis\tespecially\ttrue\tfor\tthose\ttaking\tthe
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several\tyears.\tThis\tis\tespecially\ttrue\tfor\tthose\ttaking\tthe\nmedication\tfor\tlonger\tthan\tintended,\tor\twhen\tno\tlonger\tindicated,\tas\tthey\tare\tnow\twidely\tavailable\nover\tthe\tcounter.\tA\tMayo\tClinic\treview\tfound\tthat\tthe\tassociation\tbetween\teach\tof\tthe\thealth\nconcerns\tand\tlong-term\tPPI\tuse\tvaries\tbetween\tlikely\tcausative,\tunlikely\tcausative,\tand\tunclear
|
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0.014407534152269363
] |
association.\tFor\thypomagnesemia,\tvitamin\tB\n12\n\tdeficiency,\n\tand\tsmall\tintestinal\tbacterial\tovergrowth\n(SIBO)\tthe\tassociation\tis\t\nlikely\tcausative,\n\twhereas\tcommunity\tacquired\tpneumonia\t(CAD)\tis\t\nunlikely\ncausative,\n\tand\tbone\tfractures,\t\nClostridium\tdifficile\n\tinfection,\tchronic\tkidney\tdisease,\tand\tdementia\nhave\tan\t\nunclear\tassociation\n\t(
|
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] |
have\tan\t\nunclear\tassociation\n\t(\nNehra\tet\tal,\t2018\n).\tSee\t\nAppendix\t13\n\tfor\tnutrients\tof\tconcern\tfor\tthose\ntaking\tthese\tmedications.\nPeptic\tulcers\nEtiology\nNormal\tgastric\tand\tduodenal\tmucosa\tis\tprotected\tfrom\tthe\tdigestive\tactions\tof\tacid\tand\tpepsin\tby\nthe\tsecretion\tof\tmucus,\tthe\tproduction\tof\tbicarbonate,\tthe\tremoval\tof\texcess\tacid\tby\tnormal\tblood
|
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flow,\tand\tthe\trapid\trenewal\tand\trepair\tof\tepithelial\tcell\tinjury.\t\nPeptic\tulcer\tdisease\n\toccurs\twhen\nopen\tsores\t(peptic\tulcers)\tform\tas\ta\tresult\tof\tthe\tbreakdown\tof\tthe\tnormal\tdefense\tand\trepair\nmechanisms,\n\tand\tare\tdifferentiated\tas\teither\tgastric\tor\tduodenal,\tdepending\ton\tlocation.\tTypically,
|
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more\tthan\tone\tof\tthe\tmechanisms\tmust\tbe\tmalfunctioning\tfor\tsymptomatic\tpeptic\tulcers\tto\tdevelop.\nPeptic\tulcers\ttypically\tshow\tevidence\tof\tchronic\tinflammation\tand\trepair\tprocesses\tsurrounding\tthe\nlesion.\nThe\tprimary\tcauses\tof\tpeptic\tulcers\tare\t\nH.\tpylori\n\tinfection,\tgastritis,\tuse\tof\taspirin,\tother\tNSAIDs\nand
|
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H.\tpylori\n\tinfection,\tgastritis,\tuse\tof\taspirin,\tother\tNSAIDs\nand\n\tcorticosteroids,\tand\tsevere\tillness\t(see\t\nStress\tUlcers\n\tlater\tin\tthis\tchapter\tand\t\nPathophysiology\nand\tCare\tManagement\tAlgorithm:\n\tPeptic\tUlcer\n).\tLife\tstress\tmay\tlead\tto\tbehaviors\tthat\tincrease
|
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] |
Peptic\tUlcer\n).\tLife\tstress\tmay\tlead\tto\tbehaviors\tthat\tincrease\npeptic\tulcer\trisk.\tAlthough\texcessive\tuse\tof\tconcentrated\tforms\tof\tethanol\tcan\tdamage\tgastric\nmucosa,\tworsen\tsymptoms\tof\tpeptic\tulcers,\tand\tinterfere\twith\tulcer\thealing,\talcohol\tconsumption\tin\nmoderation\tdoes
|
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] |
moderation\tdoes\n\tnot\tcause\tpeptic\tulcers\tin\thealthy\tpeople.\tUse\tof\ttobacco\tproducts\talso\tis\tlinked\nwith\tpeptic\tulcer\trisk\tbecause\ttobacco\tdecreases\tbicarbonate\tsecretion\tand\tmucosal\tblood\tflow,\nexacerbates\tinflammation,\tand\tis\tassociated\twith\tadditional\tcomplications\tof\t\nH.\tpylori\n\tinfection.
|
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] |
H.\tpylori\n\tinfection.\nOther\trisk\tfactors\tinclude\tgastrinoma\tand\tZollinger-Ellison’s\tsyndrome\t(see\t\nChapter\t28\n).\n\t\nFocus\tOn
|
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] |
Endoscopy\tand\tCapsules\nThe\tesophagogastroduodenoscopy\t(EGD)\tprocedure\tallows\tthe\tmucosa\tof\tthe\tupper\ngastrointestinal\t(GI)\ttract\tto\tbe\tviewed,\tphotographed,\tand\tbiopsied.\tAlso\tknown\tas\tan\tendoscopy,\nthe\tprocedure\tinvolves\tinsertion\tof\ta\tflexible\ttube\tinto\tthe\tesophagus\twith\ta\tlight\tand\tcamera\ton
|
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] |
the\tdistal\tend.\tIt\tcan\tbe\tpassed\tthrough\tthe\tesophagus\tand\tinto\tthe\tstomach\tor\tupper\tsmall\nbowel.\tInflammation,\terosions,\tulcerations,\tchanges\tin\tthe\tblood\tvessels,\tand\tdestruction\tof\nsurface\tcells\tcan\tbe\tidentified.\tThese\tchanges\tcan\tthen\tbe\tcorrelated\twith\tchemical,\thistologic,
|
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] |
and\tclinical\tfindings\tto\tformulate\ta\tdiagnosis.\tThis\tmay\tbe\tuseful\twhen\tphysicians\tsuspect\tcertain\nconditions,\tsuch\tas\tcomplicated\tgastroesophageal\treflux\tdisease\t(GERD)\tstrictures,\tBarrett’s\nesophagus\t(BE),\n\tesophageal\tvarices,\tor\tgastroduodenal\tulcers\tor\tceliac\tdisease.
|
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esophageal\tvarices,\tor\tgastroduodenal\tulcers\tor\tceliac\tdisease.\nEGD\talso\tcan\tbe\tused\tfor\ta\tnumber\tof\ttherapeutic\tpurposes,\tsuch\tas\tcauterization\tat\tulcer\tsites,\ndilation\tor\tdeployment\tof\tstents\tin\tareas\tof\tstricture,\tand\tplacement\tof\tpercutaneous\tfeeding\ntubes.\tEndoscopy\tmay\tbe\tused\tin\tlong-term\tmonitoring\tof\tpatients\twith\tchronic\tesophagitis\tand
|
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] |
to\tpass\tthrough\tdifferent\tsegments\tof\tthe\tGI\ttract.\tIn\tthis\tprocedure,\tcapsules\tcontaining\ta\nminiaturized\tvideo\tcamera,\tlight,\tand\tradio\ttransmitter\tthat\tcan\tbe\tswallowed\n\tand\tthe\tsignal\ntransmitted\tto\ta\treceiver\tworn\ton\tthe\twaist\tof\tthe\tpatient,\tallowing\twireless\tcapsule\tendoscopy.
|
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] |
The\tprocedure\tis\tless\tinvasive\tthan\tnormal\tendoscopy\tand\tprovides\tthe\tadvantage\tof\tbeing\table\tto\nobserve,\trecord,\tand\tmeasure\tGI\tfunction\tas\tthe\tpatient\tis\tambulatory.\nUnfortunately,\tthe\timages\tfrom\tcapsule\tendoscopy\tcan\tbe\tblurred\tby\trapid\tintestinal\ttransit\tor\nlimited\tin\tnumber\tafter
|
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limited\tin\tnumber\tafter\n\tbattery\tfailure\tin\tcases\tof\tslow\ttransit.\tIn\taddition,\treviewing\tthe\nthousands\tof\timages\tobtained\tafter\teach\tcapsule\tendoscopy\tcan\tbe\tvery\ttime\tconsuming.\nPrototypes\tof\tthe\tnewest\tgeneration\tof\tcapsule\tendoscopy\tallow\tthe\tphysician\tto\tmagnetically
|
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] |
guide\tthe\tcapsule\tto\ta\tspecific\tlocation\tby\thaving\tthe\tpatient\tlie\ton\ta\tspecial\ttable.\tFuture\ngenerations\tof\tcapsule\tendoscopy\tare\ton\tthe\tdrawing\tboards\n\tto\thopefully\tallow\ttherapeutic\nmeasures\tto\tbe\taccomplished\tin\tthe\tsmall\tbowel\tvia\tcapsule\tendoscopy.
|
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] |
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