Stomach Acid Reflux: A Review of Causes, Diagnosis, and Treatment

What Is the Main Idea?

Gastroesophageal reflux disease affects 10–30% of the Western population. Patients may dismiss it as “permanent indigestion” and try to cope with home remedies, but there are helpful tests and treatment available. The authors of the open-access research article “The Clinical Spectrum of Gastroesophageal Reflux Disease: Facts and Fictions”, published in the journal Visceral Medicine, aimed to review the diagnosis, classification and treatment of this condition.

What Else Can You Learn?

You can learn more about testing methods for esophagus problems, such as endoscopy. You can read about the anatomy of your gullet and stomach.

Take-Home Message

Gastroesophageal reflux disease can sometimes feel like permanent indigestion. Heartburn-type discomfort can also be a sign of an urgent heart problem, so if you have concerns, it is important to be checked by a healthcare professional. If your heart is fine and you do have gastroesophageal reflux disease, the good news is that personalized treatment strategies can help and improve your quality of life.

What Is Gastroesophageal Reflux Disease?

Gastroesophageal reflux disease, or “GERD” for short, is when the stomach contents backflows into the gullet, causing pain and other problems. There are several different causes, meaning that there are also various treatment options. As well as causing problems with body function, research shows that GERD also reduces the quality of life of those who suffer from it. For example, it can lead to sleep disturbance.

What Is “Gastro” and “Esophageal”?

Gastro is a word that refers to the stomach (also gastric). Esophageal refers to the esophagus, which is your gullet. This is the muscular tube that connects your mouth to your stomach and is what food passes down when you swallow. There are valves at the end of the esophagus. The top valve mostly protects your windpipe (so that food doesn’t go into your lungs). The bottom valve works to stop stomach contents backflowing into the esophagus.

What Is Reflux?

The stomach is an acidic environment, so that food can be digested. Gastroesophageal reflux is when the acidic stomach contents backflows up and into the esophagus. The stomach lining is protected against this acid, in a way that the esophagus is not. Therefore, acid “escaping” in the form of reflux can irritate the esophagus, resulting in damage to the esophagus lining.

What Are the Symptoms of GERD?

GERD symptoms are categorized into two groups:

  • Typical symptoms: These include heartburn, regurgitation, and chest pain (not related to heart problems).
  • Atypical or extra-esophageal: These include asthma and cough, voice problems and a sore throat, and tooth damage. These symptoms result from irritation or damage by the acid.

What Causes GERD?

There are many different causes of GERD. It is also noted that being obese can combine with other problems, to make GERD more likely.

  • Hiatal hernia: This is when weakness in the diaphragm muscle that sits above the stomach allows the stomach to bulge up and through the muscle. The stomach is “squeezed”, and the contents can backflow up the esophagus.
  • Esophageal motor disorders: This refers to a variety of problems with movement of food through the esophagus and down into the stomach. These problems can result in reflux. You can find out more information on these disorders in this The Waiting Room blog post.
  • Impaired acid clearance: Problems in clearing acid once it is in the esophagus, meaning the acid has a longer time to cause irritation.
  • Problems with the esophageal lining and immune processes are also thought to contribute towards the development of GERD.

How Is GERD Diagnosed?

  • Clinical evaluation: Information from the patient about their symptoms and their other health concerns can help draw the conclusion that GERD is present.
  • Endoscopy: This involves looking inside and down the esophagus with a tiny camera on a thin, bendy tube. Medicine is given for sedation and comfort. Pictures can be taken, and also sometimes samples or swabs of the esophagus lining for laboratory testing.
  • Functional tests: The main ones are called pH impedance monitoring and esophageal manometry.

How Are Functional Tests Carried Out?

pH impedance monitoring tests the levels of acid. “pH” is a measurement of how acidic something is. A tiny tube is passed through the nose and down to the stomach. This is painless. The tube stays in position for up to 24 hours and measures acid levels up and down its length. The measurements are sent to a computer and compared to measurements from research studies, so that the level of acid can be correctly assessed.

Esophageal manometry also uses a tiny tube passed through the nose, to measure inside the esophagus and down to the stomach. It measures pressure changes during swallowing and takes about half an hour. It can give information about movement through the esophagus, and muscle and valve control.

What Types of GERD Are There?

GERD is categorized by whether there is damage to the mucus lining of the esophagus.

Non-erosive reflux disease (known as NERD) is reflux without mucosal damage. Acid presence is measured using the above-mentioned pH impedance test. This test is important for diagnosing NERD, since the main feature is acid, rather than mucosal damage.

Erosive esophagitis (known as EE) is reflux with mucosal damage. This is best seen and diagnosed with an endoscopy test.

Are There Further Complications of GERD?

If GERD is not treated, the irritation to the esophagus can result in stricture, blockage, or cancer. Therefore, to avoid these long-term problems, it is important to monitor the condition and treat it correctly.

How Is GERD Treated?

Lifestyle changes are important for reducing GERD. A special diet and weight loss help.

Medicines can also be used. These work by suppressing acid, and can help up to 7 out of 10 patients.

Surgery can be carried out to repair hernias or strengthen or repair the stomach valve.

What Should You Do If You Have Symptoms of GERD?

If you are concerned about your health in any way, you should speak to a healthcare professional. They will complete a personalized assessment and provide you individual advice and treatment. If you experience heartburn, chest pain or other discomfort, it is important to seek help quickly, in case your symptoms are caused by an urgent problem not related to gastroesophageal reflux (such as a heart problem).

Note: One of the authors of this paper makes a declaration about lecture fees, consulting fees, and research support received from pharmaceutical companies. It is normal for authors to declare this in case it might be perceived as a conflict of interest. For more detail, see the Conflict of Interest Statement at the end of the paper.

Endurance Athletes Aged Over 40 Need Regular and Routine Heart Health Screening

What Is the Main Idea?

Sudden death among competitive athletes is most often connected to undiscovered problems with the heart, which are harder to detect in athletes older than 40 years. Most sport-related sudden deaths now occur in this age group.

The authors of the open-access editorial comment “The Challenges of Screening Master Athletes”, published in the journal Cardiology, reported on a study comparing different heart health screening methods for marathon runners (published in the same journal issue). The editorial authors highlighted the difficulties of screening but also described possible ways to reduce the risk of sudden death during exercise.

What Else Can You Learn?

You can learn about heart conditions and tests to discover them.

Take-Home Message

For endurance sports athletes aged over 40 years, careful and detailed medical examination can reveal unknown heart conditions, leading to treatment or emergency action plans that can ultimately help prevent sudden death during exercise.

What Is Sudden Death?

In the context of this article, sudden death refers to when an athlete unexpectedly collapses and dies as a result of an unknown heart problem. Usually this happens during intense exercise, when the heart is most stressed.

What Is Screening?

Screening is medical testing to discover any problems with the body or mind. The benefits of screening are that conditions can be discovered and treated early, or a person can know as much as possible before making a health decision. Many of us may attend regular screening appointments, to test for cancer or other conditions. Screening can also be carried out as a one-off preparation before or after an event such as surgery or childbirth. Testing can be in the form of blood and urine tests, questionnaires, x-ray or other imaging, or other specialist tests. In the case of this article, screening refers to tests carried out before the athletes start a training program, or when they reach a specific age.

What Are Master Athletes?

Master athletes are people over the age of 40 who participate in high-intensity endurance sports, such as running and cycling.

Why Must Master Athletes Be Considered Differently to “Young” Athletes?

The causes of cardiac arrest and sudden death in master athletes are different from that of younger athletes. In master athletes, these causes are most often connected to coronary artery diseases.

Also, the number of people aged over 40 competing in high-intensity endurance sports is increasing. For example, studies have shown that almost half of marathon runners are now over 40 years old. Therefore, heart associations are recognizing this increased need for attention.

What Are Coronary Artery Diseases?

Known in short as CAD, these are diseases that affect the main blood vessels leading to the heart, called coronary arteries (coronary is a term that refers to the heart). The vessels can become narrowed, inflamed, or blocked, causing life-threatening problems if blood cannot get through to the heart. This problem is particularly dangerous during intense exercise, when the heart must work harder and blockages can suddenly occur.

What Type of Screening Do the Authors Recommend for Master Athletes?

  • History and physical examination (e.g., family risk, blood pressure).
  • Blood tests (in particular glucose and lipid (fats) information).
  • Resting electrocardiogram (ECG) – this tests the heart’s electrical function.
  • Exercise testing – this tests the heart’s function during exercise, to see if it changes or if it can “cope”.

What Preventative Measures Are Available?

If a heart problem is identified, the athlete can start treatment, or make a decision about their sport activity and risk of heart problems using the new information. The athlete can also ensure that they have medical care and a plan, should they have an emergency whilst competing.

The authors presented the concept of the Swiss Cheese metaphor, to describe the best preventative approach.

What Is the Swiss Cheese Metaphor?

A slice of Swiss cheese has many holes. When it comes to thinking about preventing a master athlete suddenly dying from a heart problem, these holes represent all the problems that could be screened. Each slice can represent a screening method. If there is only one slice (1 screening method), then there will be a hole, resulting in a medical problem. However, if we line up several slices of cheese (use many screening methods), the holes do not form one “tunnel” but are blocked by other slices of cheese. Joining the slices together is like using many different types of screening to reduce the risk of sudden death. The authors refer to this as “multiple layers of defense”.

What Did This Study Show?

Screening cannot identify every unknown heart disease, or fully predict a heart emergency. This is especially true for master athletes who are more at risk of CAD. However, screening is important because it can discover unknown problems, even in an apparently healthy and fit master athlete. Thus, screening can help to save lives.

Treating Bacterial Infections with Our Natural Microbiome

What Is the Main Idea

Clostridioides difficile (C. difficile) is a bacteria that can lead to mild and serious bowel problems. The authors of the free-access research article “Microbiota-Based Therapeutics as New Standard-of-Care Treatment for Recurrent Clostridioides difficile Infection”, published in the journal Visceral Medicine, discuss developing treatment options and the challenges in producing these medicines for regular use and access.

What Else Can You Learn?

You can learn more about bacteria and bacterial spores. You can also read about the microbiome in our bodies.

Take-Home Message

Classical microbiota-based treatments have emerged as the best way to treat reoccurring C. difficile bacterial infection. However, there are complex logistic and medico-legal procedures that need to be overcome before they can be easily and widely used.

What Is Clostridioides difficile?

If you have spent time in hospital, either visiting or as a patient, you may recognize the name of this bacteria. It is known officially in short as C. difficile but can also be casually known as “C. diff”. More and more, it is becoming a difficult infection to avoid, particularly for those who are weakened, on antibiotic treatment, and exposed to many infections in hospital.

The bacteria C. difficile is present in a safe and normal way in the environment and in our bodies, as part of a microbiome.

What Is the Microbiome?

The microbiome is the name for tiny organisms that live together. These include fungi and viruses as well as bacteria like C. difficile. Microbiomes exist naturally in the environment and help keep us healthy. Microbiomes exist on our skin and inside our body (such as in the gut) and are sometimes called “good bacteria”.

What Are C. difficile Bacteria Spores?

Bacteria spores are part of a bacteria lifecycle, similar to seeds produced by a plant. If the bacteria itself is damaged or disturbed, the spores can develop into new but dangerous bacteria cells.

How Can C. difficile Infection Be a Problem?

It is not the presence of this bacteria that causes problems, but the presence of the bacteria’s spores. Although C. difficile usually lives normally and safely in our body, it can be damaged or disturbed when we take antibiotic medicine for an illness. This is called disruption of the microbiome. The spores that can then develop produce toxins (“endotoxins”) that result in bowel problems such as diarrhea and colon inflammation. If the spore infection is not treated, the bowel problems could get so bad that they can endanger a person’s life.

How Is C. difficile Infection Treated?

Ironically, although the use of antibiotic medicine often causes this bacterial spore infection, it is other antibiotic medicines that are mostly used to treat it. However, these do not always work well. About 2 in 3 people who have C. difficile infection will get it again and again. This is called recurrent infection, or rCDI. Fortunately, a new type of medicine has been developed. This medicine is not an antibiotic, but instead focuses on helping the disrupted microbiota to recover. This medicine is called a microbiota-based therapy.

What Are Microbiota-Based Therapies?

These new medicines contain microbiota. However, the source of this microbiota might be shocking. The microbiota are sourced from human stool! Live microbes exist in healthy human stool. Samples can be cleaned, microbes collected from them, and turned into a medicine. This might sound quite disgusting, but the approach is similar to that of blood donation. Several countries already have stool donor and storage bank systems in place and these medicines have already passed safety tests in America.

How Good Are Microbiota-Based Therapies at Treating C. difficile Infection?

Many studies have shown that this type of medicine is much better at treating C. difficile infection than antibiotics or probiotic medicines.

What Are Some of the Challenges in Making This Medicine Easily Available?

Each country must decide how to categorize the medicine, and how to make sure that its development is safe. For example, making sure that there are laboratory facilities. There are also legal rules regarding stool donation and sample storage, for example, developing a system that tests donors to make sure they are disease-free.

Since microbiota-based therapies have been proven to be effective at treating C. difficile, and thus saving lives, it is expected that, with time and effort from many people across the world, these challenges can be overcome.

Taking Probiotic Supplements during Pregnancy to Prevent Allergic Disease in the Child

What Is the Main Idea?

It has been suggested that if a woman takes probiotic supplements during pregnancy then this could help reduce the chances of the child developing an allergy. However, there is not enough high-quality research to test or support this theory. The authors of the open-access research article “OFFSPRING: A SPRING Follow-Up Study Assessing the Efficacy of Maternal Probiotics and Allergic Disease in the Child”, published in the journal International Archives of Allergy and Immunology, aimed to find out more.

What Else Can You Learn?

You can learn about common allergic diseases that children experience and also find out about the microbiota and probiotics.

Take-Home Message

If a mother takes probiotic supplements when pregnant, this does not appear to have any health benefit for the child.

What Is Allergic Disease?

Allergic diseases are a type of immune problem. They include asthma (affecting the lungs), allergic rhinitis/hay fever (affecting the nose area), eczema (affecting the skin), and also allergies to foods, insects (such as bee stings), and medicines.

Allergic diseases are some of the most common health problems for children, even though they are not spreadable from person to person. At the moment, about 1 in every 3 children experience an allergic disease. Unfortunately allergic diseases are becoming more common in children all around the world.

What Causes Allergic Diseases?

It is agreed that there are many causes of allergic diseases. These causes include genetics, diet, medicines (such as antibiotic use), and environment problems (such as air pollution or mold in the home). There is some proof that environment problems may affect a baby before it is born (for example, when a pregnant mother breathes polluted air).

What Is the Microbiome?

The microbiome is the name for tiny organisms that live together. These include bacteria, fungi and viruses. Microbiomes are a good thing, and exist naturally in the environment. Microbiomes also exist on our skin and inside our body (such as in the gut) and are sometimes called “good bacteria”. Our microbiome helps to keep our body healthy. Even unborn babies have a microbiome. In fact, research has shown that the “contents” of the microbiome in unborn babies may affect their immunity after they are born.

What Are Probiotics?

Probiotics are supplements (e.g., pills, capsules, liquids) or foods (e.g., some yoghurts and fermented cabbage) that contain live “good” bacteria, like those that are found in the body’s natural microbiome. The probiotics used for the research in this paper contained bacteria from groups called Lactobacillus rhamnosus GG and Bifidobacterium lactis BB12.

Why Take Probiotics during Pregnancy?

Some scientists have suggested the idea that, if a mother takes probiotic supplements when pregnant, this could have a good effect on the baby’s microbiota, which could then help prevent the baby having an allergic disease once born. At the moment, the World Allergy Organization (WAO) recommends this for pregnant women who have a high chance of their baby having an allergic disease.

What Do Researchers Already Know about Taking Probiotics during Pregnancy?

The researchers report that there is a knowledge gap about taking probiotics during pregnancy. This means that there is not enough research to be sure about the positive effects, or to know the details needed for treatment (such as how much to take). The researchers identified an opportunity to explore this theme further.

What Questions Did the Researchers Ask?

Previously, the researchers had studied a group of pregnant women taking probiotics to see if the probiotics reduced the development of a pregnancy complication known as gestational diabetes mellitus. This previous study divided the pregnant women into two groups. One group of women took probiotics and the second group did not (known as placebo). As is normal for this type of research, none of the women knew if they were taking a “real” probiotic supplement or a “fake”, so that psychological factors did not affect the results.1 The babies born to these women had grown up and were between 3 and 7 years old. The researchers could now study information about the children’s health and look for a connection with their mothers taking probiotic supplements or placebo.

How Did They Answer These Questions?

The researchers collected information on the children using internationally accepted scientific ways. They gained permission from the mothers and sent questionnaires to find out about the children’s health. The researchers received information about 107 children (no multiple births such as twins were included in the study).

What Did the Researchers Look for?

The researchers used scientific techniques to look for differences between the children whose mothers took probiotics, and the children whose mothers took no probiotics. They examined information about problems with allergic disease, frequency of other illnesses and hospital visits, and also problems such as autism spectrum disorder (ASD) and attention disorders (ADHD).

What Did the Researchers Find out?

The researchers found no differences between the children whose mothers took probiotics and those whose mothers took no probiotics.

Next Steps

Since this study looked at women who had a low chance of their baby having an allergic disease, the researchers identified that it is important to do further studies on women who have a high chance of their baby having an allergic disease. It is possible that a difference may be found for these women and babies.

Also, they state that studies with a larger number of women need to be done, in order to give stronger results. Similarly, they recommend that future research should aim to explore aspects such as the amount of probiotic taken, and at what stage of pregnancy.

1In the initial study it was concluded that probiotic use during pregnancy did not prevent gestational diabetes mellitus.

The Positive Connection between Helicobacter pylori Infection and Gastric Cancer Treatment Results

What Is the Main Idea?

Helicobacter pylori (H. pylori) is a type of bacteria that can cause infection in the stomach. It is known to be connected to the development of gastric cancer, one of the most common cancers worldwide.

Due to these known connections between H. pylori and the development of gastric cancer, it would be reasonable to think that, for someone with gastric cancer, the presence of H. pylori is undesired and that it might impair treatment and survival. Indeed, current advice focuses on treating H. pylori infection when gastric cancer surgery takes place. However, it is possible that the almost opposite may be true – that the presence of H. pylori infection might in fact be connected with better results for gastric cancer treatment, as shown by the authors of the research paper Helicobacter pylori Infection as a Predictor of Treatment Outcomes of Gastric Cancer: A Systematic Review and Meta-Analysis” published in the journal Digestive Diseases.

What Else Can You Learn?

You can understand how a meta-analysis can be important to answering research questions, and also learn a little about the biology of cancer cells.

Take-Home Message

Patients with gastric cancer who also have H. pylori infection have better survival, regardless of treatment choice. Researchers need to find out more about the connection, and about how it affects treatment choices.

What Did the Researchers Do?

The researchers carried out a meta-analysis to study the effect of H. pylori infection in gastric cancer treatment.

What Is a Meta-Analysis?

A meta-analysis is the use of statistical techniques to combine the results of several research studies.

Why Is a Meta-Analysis Helpful?

Combining results of small studies together can lead to more sound statistics and consequently more confident conclusions.

How Did the Researchers Carry Out This Meta-Analysis?

The researchers identified 21 suitable studies which were found through a scientific process of database searching and criteria-based elimination, and represented 5,787 patients in total.

They examined the survival details of these patients with gastric cancer, comparing those with and without H. pylori infection. They recorded different categories of survival, such as overall survival and disease-free survival. They also analysed details regarding treatment (e.g., surgery, chemotherapy, or a combination).

What Details Did the Researchers Find?

The researchers found that the patients with H. pylori infection had better overall or disease-free survival, thus better results. Specifically, those patients with H. pylori who had surgery combined with chemotherapy (medication) had the best results.

Why Do Patients with Gastric Cancer with H. pylori Infection Have Better Survival?

  • The first possibility is that long-lasting pylori infection leads to high levels of microsatellite instability (MSI). MSI is when a cell loses its ability to self-repair. High MSI in a cancer cell makes it easier for immune cells and immunotherapy to “spot” and respond to these cancer cells, thus increasing treatment effectiveness and prognosis.
  • The second hypothesis is that pylori may influence the immune system to better target gastric cancer cells. In other words, the presence of H. pylori bacteria can result in activation of immune responses that might not otherwise happen.
  • Thirdly, since a higher rate of pylori has been found in early gastric cancer samples compared to advanced gastric cancer samples, the absence of H. pylori may actually indicate a more serious disease, which would have poorer results.
  • Finally, through complex mechanisms, patients with pylori infection respond better to chemotherapy (medication), thus also giving a better result.

Why Are These Findings Important?

For patients with a gastric cancer diagnosis, and their clinicians, the results from this meta-analysis may help them to understand treatment options or make choices. The results may also initiate a positive perspective towards the presence of H. pylori infection, which may previously have been viewed solely as a guilty contributor.

What Are the Next Steps?

For researchers, the next steps are to better understand the mechanisms and interactions between H. pylori and gastric cancer treatment, in particular with regards to decisions on H. pylori eradication treatment and the combining of surgery and chemotherapy.

Note: This post is based on an article that is not open access; i.e., only the abstract is freely available. In order for you to still learn about the outcome, we summarized the content of this article for you.

Hydatid Disease: A Liver Problem Caused by Parasites/Tapeworms

What Is the Main Idea?

We have all probably “had worms” at some point in our life, most likely in childhood. The type of worm infection we have likely experienced mostly results in mild symptoms and is easily treated by taking one dose of medicine. We may also be aware of them being in animals too – perhaps a pet has needed some treatment.

But worm infections can also be more serious. There is a type of worm that can cause a liver problem known as hydatid disease. The World Health Organization (WHO) has listed this disease as “neglected”, meaning that we really need to know more about it, and know better about how to treat it. In response to this, the authors of the open-access review article “Hydatid Disease of the Liver”, published in the journal Visceral Medicine, aimed to summarize what is known about hydatid disease.

What Else Can You Learn?

You can learn simple personal hygiene steps that will help you and your family to avoid passing any type of worms to each other.

What Is Hydatid Disease?

Hydatid disease affects the liver, and sometimes the lungs. Cysts develop and grow. Cysts are “pockets” inside the body. Their growth can cause problems with body function, or they can become infected and make someone dangerously ill.

The authors report that, for a long time, hydatid disease was thought to be a problem only in underdeveloped countries such as India and the continent of Africa, but recently it has been increasing in developed countries such as Australia, New Zealand and Central Europe. It has not yet been found in North America.

What Causes Hydatid Disease?

Hydatid disease is caused by a tapeworm parasite known as Echinococcus. (For this reason, the disease is also known as echinococcosis.) There are many types of Echinococcus tapeworms, but the two types that cause disease in humans are called Echinococcus granulosus and Echinococcus multilocularis.

What Is a Parasite?

A parasite is a living thing that can only survive if it “attaches” to another living thing. It lives on or in this other living thing, known as a host. The worms that get into our bodies are parasites and we are the hosts. There are many types, including threadworm (the type that commonly affects children) and tapeworm (sometimes causing hydatid disease or other diseases). In hydatid disease, the tapeworms attach to the intestine and lay eggs. The eggs hatch larvae, which travel to other body organs, resulting in the cysts.

How Is Hydatid Disease Identified?

A blood test can show whether a person is infected with the Echinococcus tapeworm, but not the specific type. An ultrasound scan can show cysts in the liver, but not the cause of these cysts. An ultrasound is a painless, harmless way of “seeing” inside the body using soundwaves to create a computer picture.

Sometimes, a person has no symptoms, and it is only discovered by chance, such as when they have a blood test or have their liver tested or scanned for other problems. Other times, a person has a growing cyst causing problems because it is pressing on body organs. Or a person may have an infected cyst, causing them to be unwell because of the infection or the cyst bursting.

How Is Hydatid Disease Treated?

Hydatid disease is best treated with a combination of taking a medicine and having the cysts drained and cleaned. Sometimes a bigger operation is needed, if the cyst is very large or complicated.

The medicine used is called albendazole. This medicine is considered safe for long-term use and has no serious side effects.

If the cysts need draining, this happens as a minor operation. This technique is known as PAIR, which is a word that represents 4 steps:

  • Puncture of the cyst wall: A needle syringe is passed through the stomach skin and into the cyst. Ultrasound is used to guide where to go.
  • Aspiration of contents: The cyst is drained, or the contents “sucked out” using the needle.
  • Installation of scolicidal agent: The cyst is cleaned by flushing it out with cleaning fluid (called scolicidal agent).
  • Reaspiration of scolicidal agent: The cyst is emptied of the cleaning fluid.

If the cyst is very large, infected, or burst, then a bigger operation is needed. The person may be quite unwell at this point, so the surgery is important for recovery.

How Can We Avoid Getting Hydatid Disease?

The authors of the paper describe the process of how the worms that cause hydatid disease are passed between humans and animals and advise that personal hygiene is important. The WHO also recommend this to avoid getting any form of worms. We should wash our hands before eating and after using the toilet so that eggs cannot be transferred. Since animals can carry or pass on worms and their eggs, we should also be careful to wash our hands after touching animals.

Take-Home Message

Hydatid disease is becoming more common across the world to the point that the WHO has identified it as a disease in need of more research. It is currently best treated using a combination of medicine and surgery, but more research will help to find out better techniques and details. It is best prevented by washing our hands before eating and after using the toilet or having contact with animals.

From the Throat to the Stomach: Tests and Treatment for Swallowing Problems

What Is the Main Idea?

Esophageal motility disorders (EMDs) are problems with the swallowing system and organs. As well as causing difficulty with swallowing, they can also cause pain. There are several tests that can be done to diagnose EMDs to help plan the best treatment. The authors of the free-access review article “Esophageal Motility Disorders: Diagnosis and Treatment Strategies”, published in the journal Digestion, aimed to summarize diagnosis and treatment for EMD.

What Else Can You Learn?

You can learn about the normal swallowing process, including the body parts involved in swallowing. Also, some of the tests described are used to test for a variety of problems, so this information may be helpful in understanding a different condition.

What Happens during Normal Swallowing?

When we chew food, our mouth and tongue forms this into a lump shape, called a bolus. When we swallow, the bolus passes through the throat (pharynx) and travels down a tube called the esophagus, into the stomach (sometimes you can feel this when you swallow something too big or hard). The esophagus actually moves to help pass the bolus down. These movements are muscle contractions that coordinate like waves. They are known as esophageal or peristaltic contractions. Also, so that the food travels in the right direction, at the top and bottom of the esophagus there are valve-like parts, called sphincters. Since they are at the top and bottom, they are called upper and lower sphincters. When food passes the throat, it sets off nerve messages that open or close the sphincter “valves” for the food to pass down to the stomach.

What Are Esophageal Motility Disorders?

Esophageal motility disorders, or EMDs for short, are problems with the movement of food through the esophagus. Esophageal refers to the esophagus food tube and motility refers to movement.

EMDs fall into two categories:

  1. Primary EMDs are caused by problems with the nerve messaging that controls the esophagus movements or esophagus sphincters. This is the type that the authors focused on.
  2. Secondary EMDs are caused by, for example, cancer blocking the esophagus, and require other specialist diagnosis and treatment.

What Are the Symptoms of an EMD?

There are no specific symptoms that definitely say a person has EMD unless they also have some tests. Doctors need to know about a person’s other health concerns and recognize warning signs. These can be:

  • difficulty swallowing,
  • pain in the chest area,
  • past stomach or bowel surgery,
  • the use of some medications.

If you have chest pain, you should seek medical help in case it has a serious cause. Since there are many body parts in the chest area, it is difficult to pinpoint pain as it tends to be inexact. Chest pain can be caused by mild problems such as heartburn or a pulled muscle through to serious problems such as a heart attack.

What Screening Tests Are Used When an EMD Is Suspected?

First, screening tests should be carried out. These include testing for heart problems (that might be causing the chest pain) and also for problems such as acid reflux (heartburn). Screening tests are easily available in most countries, and can also help diagnose a different cause of a person’s symptoms.

Endoscopy is a screening test where a tiny camera is passed down the esophagus, to view inside and see what is going on. Small samples can also be taken, and then examined in a laboratory. The patient is given medications so that they are drowsy and comfortable throughout.

Barium swallow is a test where the patient swallows a thick drink with barium in it. Barium shows up on x-rays. A moving (film) x-ray or a still image x-ray will be taken, so that the esophagus and other body parts, and the food movement are viewed. However, a barium swallow cannot exactly show the movement problems that happen with EMD, so the test can only help by showing up other causes of the symptoms. The authors describe some possible variations to barium swallow that could help with better EMD diagnosis. These include swallowing a rice ball with barium (rather than a drink), taking timed x-rays to compare food movements, and researching results with different amounts and thickness of the barium drink.

What Specific Tests Are Used to Diagnose EMD?

High-resolution manometry (HRM) is a specific test for EMD where a thin tube (catheter) is passed down the esophagus through the nose and throat and the patient swallows a drink or something thick. The patient stays alert so that they can swallow, but receives some numbing medicine in the throat so that this is comfortable. This tube contains many pressure sensors, which measure the esophagus muscle contractions (strength, speed, location and so on) during swallowing. The measurements can be made during both lying down and sitting up, which gives even more information to help diagnosis and plan treatment.

How Is EMD Treated?

The tests will show what type of movement problem there is, such as the esophagus muscles being too strong or weak, or their coordination badly timed. Treatment can then be planned. For example, medicines can be given to help the esophagus muscle to contract better or move more smoothly. Or, a small operation can be done to either increase the size of the esophagus (pneumatic dilation (PD)) or create a new tube entrance in the stomach that “bypasses” muscles that contract too much (per-oral endoscopic myotomy (POEM) and laparoscopic Heller myotomy (LHM)).

Is Treatment Successful?

The authors describe some statistics for treatment success. For most types of EMD the surgery treatments were more successful than the medicine treatments, with roughly 3 out of 4 people experiencing improvement. However, for some types of EMD, the best treatment was to simply change the type of food or eating position.

Take-Home Message

The authors state that, since there is still a lot to learn about EMDs, diagnosis should be thorough and confident before any operations are carried out. Also, it is very important that any chest pain is properly checked to ensure it is not a heart problem.

Sugary Soft Drinks Can Increase the Risk of Gastrointestinal Cancer

What Is the Main Idea?

Does drinking sugary drinks lead to cancer of the digestive system? Studies have been completed to find an answer to this question, but, so far, the results have not been clear. The authors of the research article “Consumption of Sugar-Sweetened Soft Drinks and Risk of Gastrointestinal Cancer: A Systematic Review and Meta-Analysis of Observational Studies”, published in the journal Oncology, aimed to gather together all of the information from previous studies, and see whether the combined information could give clearer answers.

What Else Can You Learn?

You can learn about different types of digestive system cancer and also about how drinking sugary drinks can affect the body.

What Is Gastrointestinal Cancer?

Gastrointestinal cancer, or GI cancer for short, refers to cancer in the eating and digestive organs of the body. This includes the esophagus (our gullet, or food tube from mouth to stomach), the stomach, the liver and pancreas (both organs which produce digestive “juice”), and the intestines (including our bowel).

How Common Is Gastrointestinal Cancer?

GI cancer happens often, and people can often die from it. The authors report that, in 2020, across the world, 1 in 4 people becoming ill with cancer had GI cancer, and 1 in 3 people who died from cancer had GI cancer. In different parts of the world, these number facts vary. For example, in Asia it is higher: 1 in 3 people becoming ill with cancer had GI cancer and 1 in 2 people who died from cancer had GI cancer. But in Northern America this is lower: 1 in 10 people becoming ill with cancer had GI cancer, and 1 in 4 people who died from cancer had GI cancer. Number facts for the regions of Latin America and the Caribbean, Africa, Oceania, and Europe fit between Asia and Northern America.

What Are Sugar-Sweetened Soft Drinks?

Sugar-sweetened soft drinks (referred to as SSSDs) are drinks that are sweetened with sugar. This sugar can be high-fructose corn sweetener (HFCS), honey, household sugar (sucrose), and others. HFCS is a manufactured sugar that has been used since the 1970s.

Why Are Sugar-Sweetened Soft Drinks a Health Problem?

The authors describe some research showing that regularly consuming HFCS resulted in problems with weight and other body processes. This connects with cancer, because unhealthy body processes such as inflammation and keeping a good balance of hormone production (such as insulin) can be the start of a cell-changing process (pathway) towards cancer.

Why Does Combining Information from Many Studies Give Better Answers?

The studies the authors found used simple research techniques and/or had few study subjects. By combining all the information from all the studies, the authors were able to look at the “big picture” and use complex and better research and statistical techniques to make a more confident conclusion.

Since studies on animals and on laboratory samples show it is likely that SSSDs can increase cancer risk, the authors predicted (hypothesized) that they would see a link after combining all the human studies together.

How Did the Authors Combine and Examine the Information from Previous Studies?

The authors carried out what is called a systematic review and meta-analysis. They searched research databases for all research on the use of SSSDs and risk of GI cancer. There are international guidelines for how to do this in the best way: such as using special databases, using particular search words, and following logical processes to carefully review and categorize what is found. Much of the article is devoted to explaining the processes and statistical calculations in detail. The authors ended up with information from 27 studies.

What Did the Authors Find out?

The authors had a main result and some sub-results. The main result was about the link between consumption of SSSDs and risk of GI cancer. The sub-results looked at information broken down into subsections such as region, gender, and type of study.

  • For the main result, the authors found that, yes, there is a definite link between drinking SSSDs and increased risk of developing GI cancer.
  • For the sub-results, this main result was clearest in studies with an approach of analyzing people who consumed SSSDs (cohort studies), rather than studies that analyzed people who already had GI cancer (case control studies).

The authors also found that the risk is particularly connected to developing colorectal cancer (cancer of the bowel). However, they didn’t find any connection between gender (male/female).

Another interesting statistical test that the authors did, was to consider SSSDs as a medicine, and see how the body reacts, called a dose–response analysis. Usually, this kind of statistical test is done to see if a medicine is effective and/or safe. In this situation, the authors were looking for safety issues for SSSDs. The test results also showed the authors that SSSDs do have a safety issue in terms of the risk of developing GI cancer.

How Can Sugar-Sweetened Soft Drinks Affect the Body?

The authors explained some possible reasons for why consuming SSSDs may increase the risk of GI cancer:

  1. High consumption of SSSDs can lead to becoming overweight, and being overweight is a well-known risk factor for developing GI cancer.
  2. Consumption of SSSDs can lead to an increase in fat around the body’s organs (which is different to fat that lies under the skin). Known as visceral adiposity, studies show that this can affect the way the body’s cells work and lead to the development of cancer.
  3. SSSDs have a high glycemic index. This means that, after consumption, the sugar levels in the blood rise and fall rapidly, which can trigger unhealthy changes in the body’s cell processes, leading to the development of cancer.
  4. SSSDs also contain chemicals for coloring and flavoring. Some of these chemicals have been classified by the International Agency for Research on Cancer as possibly cancer-causing

Take-Home Message

Consumption of sugar-sweetened soft drinks is connected to an increased risk of developing GI cancer. Although the authors used detailed statistical techniques to make this conclusion, they describe some weaknesses of their study and suggest that future research could look deeper into the sub-result themes and connections.

Although the authors do not specifically say how much sugar-sweetened soft drinks we can drink, it is common advice from nutritionists and dieticians that we should aim to avoid sugary and fatty diets. Each person should also speak with their health professional for individualized diet advice.

Note: This post is based on an article that is not open-access; i.e., only the abstract is freely available.

Scalp Seborrheic Dermatitis: What Do We Know So Far?

What Is the Main Idea?

Scalp seborrheic dermatitis is a long word, but, simply described, it means an itchy scalp. It affects many people to a greater or lesser extent. The authors of the free access research article “Scalp Seborrheic Dermatitis: What We Know So Far”, published in the journal Skin Appendage Disorders, aimed to summarize the main points of practical interest for doctors.

What Else Can You Learn?

You can learn about some similar scalp conditions and how you might tell the difference.

What Is Scalp Seborrheic Dermatitis?

Scalp seborrheic dermatitis, or SSD for short, is a type of eczema on the scalp (the skin on the head). The scalp becomes scaly and red with some inflammation (a bit like swelling). The authors say that this condition is the most common cause of an itchy scalp. It can last for a long time, and come and go: sometimes bad, sometimes barely there.

SSD happens most often to newborn babies (up to 3 months old) and adults aged 30 to 60 years old. When it happens to babies, it is known as cradle cap. Men are more often affected than women. It affects all ethnicities equally.

SSD happens more to people with immune system problems (those who are immunosuppressed). Because of this, scientists think that the immune system is involved with causing the problems.

What Isn’t SSD?

There are some scalp problems that are quite similar, but are in fact different conditions and causes, which need different treatment.

  1. Dandruff (known as pytiriasis sicca) happens to many people. It involves a scaly scalp, but, unlike SSD, there is no inflammation.
  2. Psoriasis is a skin condition that happens not only to the scalp but to skin all over the body. The skin has thick, silvery scales which could be mistaken for SSD if on the scalp.
  3. Sebopsoriasis is another skin condition which overlaps between SSD and psoriasis.
  4. Tinea capitis causes scaly, red, raised patches on the head but, unlike SSD, they are ring-shaped, and caused by ringworm.

To be sure what the skin problem is, the scalp and hair can be examined in close-up using a special handheld video camera.

How Did the Authors Gather the Required Information?

The authors performed a literature search to gather as much information as they could about SSD. A literature search involves searching through published medical reports and research results. This could take quite some time, if it was done manually, and important information could easily be missed. Fortunately, there are computer and internet systems and resources to make this easier. There are also official scientific methods of going about a literature search to make sure that nothing is missed, and all information is fairly treated.

In this case the authors looked for SSD studies that explored causes, the relation to skin microbiota, hair and new treatments. They found 19 articles, 4 of which were also review articles like theirs, 4 of which were clinical trials (high-quality scientific tests on people with the condition), and the others were minor types of research such as information on an individual patient (case reports).

Next, the authors divided the information found into 2 themes for their paper. In the first section they describe what they found about the causes and symptoms of SSD and in the second section they describe treatments.

What Did the Authors Say about the Causes of SSD?

Like so many health problems, the authors described how many issues can mix together to result in SSD. These include:

  1. Changes in the skin microbiome. The microbiome is the normal mix of fungi and bacteria found on the skin. There is a skin fungus called Malassezia spp. that, although always in healthy skin, can become too strong. It interacts with the skin cells (called keratinocytes) and the immune system to result in changes to the skin’s natural lipid (fat) balance. This then results in changes to the skin.
  2. Hormone problems can also cause SSD. It was discovered that people who have Parkinson’s disease are usually affected by SSD. Parkinson’s disease is a brain condition that affects movement and is due to not making enough of a hormone called dopamine. Also, SSD can start at puberty, which is an additional clue that hormones are part of the cause.
  3. Not eating enough zinc can contribute to the inflammation part of SSD. Zinc is found in fruit and vegetables.
  4. Environmental conditions such as high humidity, cloudy days, and low temperatures have also been linked to SSD.

Is There Treatment for SSD?

Yes, there are some treatments. Treatments depend on how bad the SSD is.

Treatment for mild SSD is called topical treatment, meaning that the treatment goes directly on the affected scalp skin area. This is in the form of creams, shampoos or lotions. They can reduce the levels of fungus or bacteria (antifungal and antibacterial), reduce the inflammation (corticosteroid), or reduce the skin thickness (keratolytics).

Treatment for severe or large areas of SSD is done with medicine taken by mouth (oral medicine). The medicine has similar effects to the topical medicine, but in different strengths and with different lasting effect. For example, some can stay in the body for up to two weeks, which can really help a bad case of SSD to improve (compared to a cream, which may rub off quickly).

Take-Home Message

If you are worried about your scalp skin health, you should ask a doctor to confirm what the problem is. For SSD there are treatments available. If the SSD is severe or complex, then testing of the scalp skin and hair can help guide treatment.

What Works Best for Treating Helicobacter pylori Infection?

What Is the Main Idea?

Helicobacter pylori infection in the stomach affects half of the population worldwide. Common treatments involve combining different types of medicine, some of which are antibiotics. However, some of these combinations are becoming less effective for treating Helicobacter pylori infection, due to antibiotic resistance.

The authors of the open-access research article “Efficacy and Safety of Vonoprazan and Amoxicillin Dual Therapy for Helicobacter pylori Eradication: A Systematic Review and Meta-Analysis”, published in the journal Digestion, aimed to find out if a different medicine combination might work better.

What Else Can You Learn?

You can also learn about the general concept of combining different types of medicines to treat one problem, and how researchers review past research in a scientific manner.

What Is Helicobacter pylori?

Helicobacter pylori is a type of bacteria that causes inflammation (swelling) in the stomach. The discovery of this bacteria in the 1980s was a major scientific breakthrough, and it is now known to be connected to many stomach problems such as ulcers (sores in the stomach lining) and cancer. Helicobacter pylori is written in short form as H. pylori.

Getting rid of H. pylori will allow the stomach to heal and reduce symptoms such as pain and digestion problems. It can also lower the risk of future complications that might happen if it was left untreated.

How Can It Be Treated?

It is recommended that anyone with H. pylori takes medicine to get rid of it (and the symptoms), unless there is a medical reason not to.

The authors report that there are three things that can make treatment work the best:

  1. Making sure that the natural stomach acid is controlled
  2. Making sure there is enough antibiotic medicine to kill the bacteria
  3. Taking medicine for a long enough time to prevent the infection coming back (up to 14 days)

It is necessary to take a combination of medicines to meet these three requirements. This is known as dual, triple, or quadruple therapy (depending on the exact number of medicine types and combinations taken—two, three, or four).

What Are the Types of Medicine Needed?

  1. Medicine that controls the stomach acid. These are known as a proton pump inhibitor medicines (PPI), such as omeprazole and vonoprazan.
  2. Medicine to kill the bacteria. These are known as antibiotics, such as clarithromycin or amoxicillin.

However, the more that antibiotics are used for bacterial infections (sometimes incorrectly used), the harder it can be to kill bacteria effectively. This is known as antibiotic resistance. Common treatments for H. pylori are now not working so well, because the antibiotic medicine is not as effective. This is especially the case for the antibiotic called clarithromycin, which is commonly used to treat H. pylori. The authors wanted to find out if using an alternative antibiotic or other PPI combinations might work just as well, or better.

What Alternative Medicine Did the Authors Investigate?

The authors investigated the combination of vonoprazan (a PPI) and amoxicillin (an antibiotic). This combination is known as “vonoprazan and amoxicillin dual therapy” or VA for short.

How Did the Authors Compare the Treatments?

The authors carried out what is called a systematic review and meta-analysis. They searched research databases for all research on H. pylori and the specific medicine names. There are international guidelines for how to do this in the best way: such as using special databases, using particular search words and following logical processes to carefully review and categorize what is found.

The authors found five suitable studies. These five studies included 1,852 patients in total. They used statistical methods to compare their chosen VA dual therapy with results from other medicine combinations for H. pylori, with a focus on clarithromycin combinations.

What Were the Results?

There were lots of possible combinations to compare, because the authors were comparing both the PPI and the antibiotic medicine combination possibilities. The authors used statistical methods to make the comparisons, considering many different factors about how the stomach works, what happens during an infection, and how a person’s individual health status may affect treatment.

After completing statistical calculations, the authors reported:

  1. The VA combination was no worse than treatments using other antibiotics. But it was better than treatments using other PPIs.
  2. For pylori infections that were resistant to clarithromycin (the commonly used antibiotic), the VA combination was better. However, the VA combination did not work better for infections without resistance.
  3. The VA combination had lower side effects, especially the incidence of diarrhea.

What Does This Mean for Future Medicine Combination Options?

The authors wrote in detail about the need for a fine balance between medicine combinations and how they interact in the body. For example, the acidity of the stomach can affect how well an antibiotic works, but the acidity is also affected by the PPI medicine, so the situation is constantly changing. Ideally, a person should be tested, to know exactly what kind of H. pylori bacteria they have. A person should also be examined to determine other lifestyle or medical issues that may impact their health and the chosen treatment.

What Is the Take-Home Message?

Vonoprazan and amoxicillin dual therapy treatment can be a good option, or even the best option, for some people with H. pylori infection, but it depends on their personal health situation and their health professional’s clinical decision-making. As is often the case, the authors report that more studies should be conducted to work out the best amount of medicine to be taken, and the length of time that it should be taken for.

Vision Complications due to Premature Birth Are Connected with Lower Visual Motor Integration Skills

What Is the Main Idea?

Children born prematurely are more likely to have problems with their development than those born after a typical length pregnancy. In general, this is because they are born before their body has finished growing and getting ready for the outside world, but also because the life-saving medical treatment they receive can have side effects. Some examples of problems are the development of the eyes and vision, the development of learning abilities, and the development of movement skills. In the open-access research article entitled “Impact of Retinopathy of Prematurity on Visual Motor Integration”, published in the journal Neonatology, the connection between an eye problem (retinopathy of prematurity (ROP)) and the coordination of vision and movement (visual motor integration (VMI)) was investigated.

What Else Can You Learn?

You can learn about the role of visual motor integration in children’s life skills development. You can find out what a standardized test is.

What Is Retinopathy of Prematurity (ROP)?

ROP is an eye problem for babies born prematurely. The blood vessels in the eye grow abnormally. Across the world, about 32,300 children have vision problems as a result of ROP. Since more and more children are surviving premature birth, ROP is also increasing. There are different stages of ROP. Sometimes it can get fully better, but sometimes it can cause vision problems or complete blindness.

What Is Visual Motor Integration (VMI)?

VMI is the combined ability of seeing and processing visual information and then coordinating a movement. For example:

  • writing and drawing (seeing a letter, moving the pencil to write the correct shape);
  • kicking a ball (seeing a ball coming towards you, moving the foot to kick it);
  • tying shoelaces (seeing the lace position, moving the fingers to tie the knot).

Is There a Connection between Learning Ability and VMI?

Developing VMI skills is an important everyday task for children as they grow up. It is a separate skill to cognitive (learning) ability. In this paper, the authors explain that some prematurely-born children with normal learning ability can have poor VMI, and it is the poor VMI that causes them to struggle at school and home, not poor cognitive ability. However, children with learning difficulty will also have VMI difficulties. To help children do their best when they start school, it is important to know what problems to look out for.

What Did the Article Investigate?

The main aim of the study was to investigate how different stages of ROP (mild to severe) might affect a child’s VMI ability when they start school (age 5).

The authors tested 353 children aged 5 years old, who had been born prematurely. Firstly they read their medical notes to find out about whether they had ROP (137 children), and if so, the stage. Then, they tested the children’s VMI skills using standardized tests. They then compared the standardized test results against the ROP information.

What Is a Standardized Test?

Standardized means that the test has been carried out on many children of different ages with all of their results compared using statistical and mathematical methods. This then makes it possible to work out what is “normal” or typical, or what is low or high ability for a child at any age. To test VMI, the researchers used a test called the Beery-Buktenica Developmental Test of Visual Motor Integration (Beery VMI).

What Were the Results?

The authors worked out that children with ROP had lower VMI abilities than those who did not have ROP. (In fact, the children without ROP had almost normal VMI scores.) They also noted that children with a more severe stage of ROP had much worse VMI ability than those with mild ROP.

The researchers note that, because ROP is a problem that affects the smallest and sickest of babies, it is difficult to understand how much the children’s VMI difficulties can be directly connected to their ROP problems. In other words, due to being so premature and ill, the children’s brains will be affected in multiple and complex ways. This will affect their VMI skills alongside other parts of their development. However, the researchers did use statistical methods to try and account for these factors.

Take-Home Message

Children who have ROP have lower VMI skills than those who do not have ROP. This means that those with ROP should have special assessment and support when they start school, to give them the best chance to develop school and life skills. The researchers also recommend more research in this area, especially testing children with ROP as they grow up and progress through school.

What You Eat and How You Exercise Make a Big Difference to Cancer Treatment Success

What Is the Main Idea?

Malnutrition is a very common problem for people who have cancer, even before diagnosis. It can lead to loss of weight and muscle mass, and generally worse results throughout their cancer journey (to cure or end of life). Malnutrition is frequently underrecognized and therefore also undertreated. This is despite it being known that cancer is a complex disease requiring a mixed type of medical and social care that includes support for nutrition.

An international group of healthcare providers (experts in cancer, nutrition, exercise, and general medicine) participated in a virtual scientific roundtable to discuss gaps and opportunities in cancer nutrition care. The panel wrote the open-access review article “Examining Guidelines and New Evidence in Oncology Nutrition: a Position Paper on Gaps and Opportunities in Multimodal Approaches to Improve Patient Care”, published in the journal Kompass Nutrition & Dietetics. The authors aimed to raise awareness of nutritional care for people with cancer and summarize information on assessment and treatment.

What Else Can You Learn?

You will learn that nutrition and weight goals are not just about having healthy amounts of body fat, but also about having healthy muscles. Linked to this, you will read about the importance of exercise during cancer care.

What Is Malnutrition?

Malnutrition is undernutrition, or not having enough nutrients (energy and protein) required for healthy body function. It can result from poor intake or poor uptake of nutrients, or both. Intake refers to getting nutrients into the body, for example, through eating and drinking. Uptake refers to how the body uses and stores the nutrients once they are inside the body. Approximately 7 out of 10 people with cancer develop malnutrition. It is more common and more severe among older people with cancer, and those with stomach, head and neck, and lung cancers.

What Does Malnutrition Lead to?

Malnutrition can cause loss of muscle (called low muscle mass or myopenia), and loss of weight (called cachexia).

Low muscle mass is a central feature of cancer, affecting 4 out of 10 people. Malnutrition, low levels of physical activity, general cancer effects and cancer treatment can all contribute to low muscle mass.

Cachexia is unintentional weight loss and is also known as cancer-associated malnutrition. It affects up to 8 out of 10 people with cancer. It is characterized by loss of appetite and general body inflammation, which create the wrong balance between energy and protein, leading to dangerous weight loss and muscle wasting. Cachexia can be with or without fat loss, and is not a good type of weight loss. Therefore, if it happens to people with a too-high weight before cancer diagnosis this is just as big a problem as it is for people of a healthy or too-low weight. Cachexia cannot be fully reversed by standard nutrition treatments and can worsen with cancer treatment.

How Do Low Muscle Mass and Cachexia Cause Problems for Cancer Care?

These conditions can occur once cancer starts but before it is diagnosed, as well as during or after treatment. If untreated, they are associated with reduced daily life physical ability, reduced quality of life, reduced ability to tolerate cancer medicines (and therefore receive effective treatment), increased risk of complications with surgical treatment, and reduced survival.

In addition, they strain healthcare and economic resources, extending hospital length of stay and increasing the risk of unplanned hospital stays.

What Did the Panel of Experts Recommend?

  • Firstly, the panel stressed the importance of healthcare workers from all professions working together for nutrition care in people with cancer (multidisciplinary care). They reported the need to build nutrition care in every layer and stage of cancer care, making it something that all healthcare professionals are involved with. The paper gives examples of scientific studies that show a positive connection between multidisciplinary nutrition care and better cancer care outcomes.
  • Secondly, the panel of experts listed principles for nutritional care during cancer treatment. These covered the importance of testing for problems and how best to treat identified problems.

How Do We Test for Malnutrition and Low Muscle Mass?

When? Throughout the cancer care journey. All clinical nutrition societies and several cancer societies recommend screening for malnutrition risk at diagnosis and during and after treatment.

How? Body measurements can be made and compared during the cancer journey. Several scientific assessments are available; however, many have not been fully explored in terms of how they work for people with cancer. Scientists and researchers are currently working on developing assessments that are directly suitable for people with cancer.

How Is Malnutrition Treated?

As soon as a problem is detected, even if it is small, the cancer care team should give additional energy and protein to improve nutrition and prevent serious problems. The cancer care team should use the person’s weight to calculate how much to prescribe. Additional nutrition can be through eating or drinking special supplements, through feeding tubes that go direct to the stomach or bowel, or infusions that go directly into the blood. Each individual should also receive education and advice, according to their specific situation.

The paper gives examples of scientific studies that show that nutrition therapy improves things such as a person’s weight status, ability to tolerate cancer treatment, and survival of cancer.

Why Is Exercise Also Important?

Exercise during cancer treatments preserves or improves a person’s fitness, muscle mass and strength. In turn, this preserves or improves quality of life during cancer treatment and treatment results. Exercise includes general fitness as well as muscle strength training. In fact, exercise recommendations for most people with cancer are similar to those for healthy adults. Of course, care must be taken to support the additional energy needs of those with malnutrition or who have some particular cancers or conditions (for example, bone cancer). Specifically, it has been found that exercise before cancer surgery or a course of cancer medicine is safe and actually helps to improve results.

For people with cancer, the experts recommend:

  • 150 minutes per week of moderate to vigorous fitness exercise (more than 2 hours, but not all in one session).
  • At least two sessions a week of muscle strength training.

Take-Home Message

People with cancer, and healthcare professionals treating people with cancer, should at every stage of the cancer journey be considering nutrition and checking for problems. It is best to prevent nutrition problems, or treat them early, rather than deal with complications at a later stage. Because nutrition has an impact on muscle health, it is important for people with cancer to carry out regular fitness and muscle strength training. Worldwide, societies are building nutrition care principles into their standard cancer care recommendations and treatment plans.

Note: The authors of this paper make a declaration about honoraria, paid consultancy, and/or funding received from companies. Two of the authors are employed by a company focusing on nutrition. It is normal for authors to declare this in case it might be perceived as a conflict of interest.

Childhood Skin Reactions and Allergies to Antibiotics

What Is the Main Idea?

Antibiotic medicines help to fight infection in the body; however, some people can be allergic to them. This is often found out during childhood when a child first takes an antibiotic medicine. The type of antibiotics most likely to result in an allergic reaction are beta-lactam (BL) antibiotics. If a child is allergic to BL antibiotics, it is important to discover this so that they can take a different type of medicine.

A small number of children experience a mild problem with their skin after taking a BL antibiotic – a mild skin reaction. An even smaller number of children have a more severe reaction, requiring treatment from a doctor. However, these reactions don’t always mean a child is allergic. A skin reaction can also be caused by the infection or other reasons. Many children are therefore misdiagnosed, or mislabeled as having an allergy when they don’t.

The authors of the research article “Risk Factors of Challenge-Proven Beta-Lactam Allergy in Children with Immediate and Non-Immediate Mild Cutaneous Reactions”, published in the journal International Archives of Allergy and Immunology, aimed to find out more about what a BL antibiotic allergy is like, and what clues there might be that a child will be allergic to BL antibiotics.

What Else Can You Learn?

You can learn about different types of allergy testing and also why it is important to prescribe the correct antibiotic.

What Are Beta-Lactam Antibiotics?

Antibiotics are medicines used to treat infections caused by bacteria. They do not help infections caused by viruses. One type of BL antibiotic is called penicillin, and other types are called cephalosporins. BL antibiotics are the medicine given the most to children and are also the most common cause of medicine reactions in children.

What Are Skin Reactions?

A skin reaction is a problem with the skin such as itchiness, a rash or swelling. It can be caused by different things:

  • Allergy to a BL antibiotic.
  • Result of an infection (from bacteria or a virus).
  • A combined situation where an infection can be from a virus, and the virus can interact with medicine to cause a skin reaction.

Why Is It Important to Be Sure about an Allergy Diagnosis?

Parents/caregivers may notice that their child has a skin reaction at the time of being unwell with an infection and being given BL antibiotics. Then, whenever the child needs antibiotics in the future, they may mention this to the doctor, and it is incorrectly noted in the child’s medical records as an allergy.

The next time the child is sick, even though they may not have an allergy to BL antibiotics, the doctor may choose to give the child an alternative antibiotic.

However, alternative antibiotics may not be as specific for treating an infection, meaning they can be less effective. This results in a cycle of poorer health and higher medical costs, both for the child and, on a larger scale, the general community.

Therefore, the authors report it is essential to know if a child really is allergic to BL antibiotics.

How Do You Confirm Allergy?

A suspected allergy can be tested for by finding out about the child’s medical history and completing some medical tests. These tests usually involve giving a small amount of the substance and seeing how the body reacts. This can be by putting some on the skin (a skin prick test (SPT) or intradermal test (IDT)) or eating some (oral challenge test (OCT)). For BL antibiotic allergy, the best test is an OCT. Recent research recommends that if a child has already had a mild skin reaction, it is sensible to complete an OCT.

How Did the Authors Test for the Allergy?

The authors tested 214 children who had experienced mild skin reactions after taking BL antibiotics. They carried out both skin tests and an OCT on all the children and observed the reactions.

What Were the Results of the Allergy Tests?

It was discovered that 23 of the 214 children (10.7%) had a BL allergy. In other words, the remaining 191 children did not have an allergy, even though they had a skin reaction at the time of taking the BL antibiotics.

How Did the Authors Examine the Risk Factors?

The authors then wanted to try and find out whether they could predict the allergy in ways that would avoid doing the testing. They examined the nature of the reactions, such as whether they happened immediately or non-immediately, and the type of reaction, such as rash, itchiness, or something severe that made the child unwell. They also recorded information on family history of allergy, the child’s gender, and the child’s personal health history.

They used statistical methods to work out what might be a risk factor. This included comparing the children with proven BL allergy to the children who had a mild skin reaction but no allergy. The only factor that made the children with a BL allergy stand out was if they also had confirmed allergies to other medication. The other factors were the same for children with and without BL allergy.

What Did This Study Show?

In this study, BL allergy was confirmed in 10.7% of children who described a mild skin reaction related to BL antibiotics. This means that the true rate of BL allergy resulting in a mild skin reaction is lower than that reported by parents. It also means that BL allergy is often wrongly diagnosed when only a child’s skin reaction type and timing is used to make a decision.

In other words, mild skin reactions in children with suspected BL allergy are likely to be due to viral infections or a combined situation where a virus can interact with medicine to cause a skin reaction. Therefore, an allergy test is required to be sure about – and mostly likely rule out – BL allergy.

Take-Home Message

If a child has a skin reaction after taking BL antibiotics, it is likely that they are not allergic to the antibiotic. They need to have an allergy test to be sure. However, if the child already has confirmed allergies to other medications, this increases the chance that they may also be allergic to BL antibiotics.

Note: This post is based on an article that is not open-access; i.e., only the abstract is freely available.

Can Bathing in a Mineral Lake Reduce Uneven Skin Pigmentation?

What Is the Main Idea?

There is anecdotal evidence that bathing in the Blue Lagoon near Grindavik, Iceland, might reduce uneven skin pigmentation. The authors of the research article “Blue Lagoon Algae Improve Uneven Skin Pigmentation: Results from in vitro Studies and from a Monocentric, Randomized, Double-Blind, Vehicle-Controlled, Split-Face Study”, published in the journal Skin Pharmacology and Physiology, aimed to scientifically validate these reports.

What Else Can You Learn?

You can learn about how skin pigmentation is determined and what affects it over a person’s lifetime. You can learn about the scientific study techniques used when testing treatments on humans.

Bathing in the Blue Lagoon in Iceland

The Blue Lagoon is a man-made geothermal outdoor pool near Grindavik, Iceland. Constructed as a cooling basin for a nearby geothermal power plant, about 35% of the lagoon water is warm freshwater and the remaining 65% is seawater. Soon after the power plant was opened in 1976, lake bathers with a skin condition called psoriasis reported that the water was helping their symptoms. These observations have since been confirmed in clinical studies and it is now generally accepted that bathing in the Blue Lagoon is beneficial for people with psoriasis.

Why Does Bathing in the Blue Lagoon Help Skin Problems?

The lake has a high silica content, a moderate temperature of 37 °C, a salinity (saltiness) of 2.7%, and a unique geothermal microbial ecosystem. In summertime the lake is full of algae known as Cyanobacterium (C.) aponinum. Studies have shown that extracts prepared from the algae can regulate the biological functions of human skin cells such as epidermal keratinocytes (which form 90% of our top-layer skin cells) and dermal fibroblasts (found in a deeper skin layer). Both the silica from the lake and the algae extracts induced expression of genes relevant to the formation of the keratinocytes and fibroblasts.

It has also been proposed that the algae can have a positive impact on skin conditions caused by immune system problems. The algae can stimulate and regulate the immune system cells, which regulate inflammation responses and thus help an inflammatory skin condition.

Why Might Bathing in the Blue Lagoon Help Skin Pigmentation Specifically?

Skin pigmentation is determined by the amount of a substance in the skin called melanin. Melanin is produced by cells in the skin called melanocytes. The melanocytes then transfer the melanin to the keratinocytes (the cells in the top skin layer) where it is used to protect them from UV damage. Sun exposure and inflammation results in more production of melanin; thus, uneven skin pigmentation can develop in response to these damaging factors. Since studies have already shown that Blue Lagoon bathing can affect both keratinocytes and inflammation, it was a logical step for the researchers to explore the impact on skin pigmentation.

How Did the Researchers Test These Anecdotal Reports?

Effect of Algae Extract on Melanin Production

The researchers first tested the effect of algae extract on melanin production in a laboratory setting. They did this to see if it was worth carrying out a more complicated trial with humans.

To do this, they exposed human melanocyte cells to different strengths of the algae extract. They then tested the cell samples to see how much melanin-producing activity they had. The authors describe this experiment in detail, explaining the substances (known as markers) they were looking for and why presence of these markers indicate melanin-producing activity.

The researchers found that the algae significantly decreased the presence of these markers, which meant that the algae was likely having an effect on reducing the production of melanin in the cells.

Effects of the Blue Lagoon Water on Humans with Uneven Skin Pigmentation

The researchers conducted a clinical trial to assess the effects of the Blue Lagoon water on humans with uneven skin pigmentation. The algae extract and Blue Lagoon minerals were formed into a cream (active cream), and another cream was made without algae extract (inactive). 50 participants applied both creams, one on each side of the face, twice a day for 12 weeks (which is a common time period for cosmetic skin studies). The skin was assessed before, during and after the 12-week period using specialist imaging.

The authors describe the study as having many scientific features. These included it being single-center (in one location only), randomized (random allocation of participants and treatment), double-blind (neither the researchers nor the study subjects knew which cream was active or inactive; this was only available through encryption), vehicle-controlled (use of a cream to apply the algae) and intra-individual (both active and inactive cream tested on each participant).

Photographs and other images of the skin were taken and compared. A specialist assessment of the photos was carried out so that there was a quantitative (number-based) score for the comparisons.

What Were the Results of the Cream Trial?

There was a reduction of skin pigment spots where the active cream was applied, but not where the inactive cream was applied. In fact, the authors observed an increase of spots where the inactive cream was applied. They suggest that this means that the use of the active cream might also prevent the formation of new pigment spots.

Should I Book a Holiday to the Blue Lagoon If I Have Skin Pigmentation?

Although there is a Blue Lagoon spa resort which you can enjoy for relaxation, there are several reasons to be cautious about these results and thus not get your hopes up for an effect on uneven skin pigmentation.

  • Firstly, the authors point out that the study had inclusion criteria meaning that it was carried out on mainly women aged older than 60 years with either East Asian (Japanese, Chinese, Korean) or Caucasian background. Therefore, the results may not be relevant to those of other ages, sex, or skin classification.
  • Also, the authors did not include people taking medications that affect the skin, or those with current skin health problems (aside from the uneven pigmentation).
  • Finally, since the study period was 12 weeks, it is not possible to determine whether skin pigmentation may change as a result of the yearly seasons. The authors state that more studies are required.

Note: This post is based on an article that is not open-access; i.e., only the abstract is freely available. Furthermore, some of the authors of this paper make a declaration about funding, consultancy work, and being employed by a company conducting research. It is normal for authors to declare this in case it might be perceived as a conflict of interest.

How Does Our Nose Protect Us from Getting Sick?

What Is the Main Idea?

What’s it like inside your nose? Is snot good? How does our nose protect us from getting sick or having an allergic reaction? It’s all to do with the inside lining: the epithelial barrier.

The authors of the open-access review article “Epithelial Barrier in the Nasal Mucosa, Related Risk Factors and Diseases”, published in the journal International Archives of Allergy and Immunology, aimed to give a detailed overview of what’s inside our nose—including snot—and how it works to protect us from disease and allergens.

What Else Can You Learn?

The authors also briefly report on some new treatments that might be able to help our nose fight allergies and sinusitis.

What Is the Nasal Epithelial Barrier?

An epithelial barrier is a lining of cells that separates and protects our body from our environment. When the epithelial barrier doesn’t work properly, it exposes us to disease. Simply speaking, our skin is an epithelial barrier on the outside of our body. But we also have epithelial barriers inside our body. They are a little bit different to skin (yet still linings of sort) and are in our digestive, our reproductive and our nose/respiratory systems. This paper focuses on the nasal (nose) epithelial barrier.

But first, let’s examine the four features of the nasal epithelial barrier, as described by the authors. These four features work together to form the nose’s protection against external risk factors and the body’s immune response.

The Physical Barrier

A physical barrier is created from cells touching cells, dividing the internal and external environment. These are called cell junctions, which the authors describe in detail, alongside some other cell functions. They are important for protection against allergens, disease and other irritants. The junctions are in charge of immune surveillance and prevent the invasion of foreign particles into lower, deeper layers of the barrier lining.

The Chemical Barrier

This is where snot plays a role! Snot, or mucus, is a chemical barrier. Mucus is the main component in the chemical barrier. It protects the nasal epithelium from drying, preserves the local wetness, and humidifies the inhaled air. It is the first place where inhaled allergens and germs will land. The mucus traps them and prevents their invasion. Mucus can exchange molecules, transfer, and remove foreign particles, cleaning as it goes and forming a mucosal protective layer. It works alongside cilia, which are tiny protrusions from the epithelial cells that beat in a coordinated manner, conveying mucus to drainage sites such as the nostril or throat. When there is an infection or allergic response, the normal structure and function of the cilia are altered, thus weakening this clearance function.

The Immune Barrier

An immune barrier is formed with molecules called immunoglobulins (Igs) and antimicrobial proteins and peptides (AMPs). These are given out by cells in the nasal lining. The authors describe the detailed role that Igs play in immune response and in suppressing inflammation and allergic reactions. This is a frontline defense mechanism of the respiratory tract. Defense molecules, including AMPs, don’t just inhibit inflammation but also promote repair of the epithelial lining. They are also a first-line response for the body’s immune system because they have antibacterial effects: They inhibit bacterial multiplication and capture and kill germs.

The Microbiological Barrier

The microbiological barrier is the microbiota that colonize the nasal mucosa. Microbiota are often known as “good” bacteria. The microbiota play a protective and regulatory role in the mucosal immune system. They are usually grown in infancy and continuously remodeled by environmental exposure as an infant grows up. When the microbiota move beneath the epithelium, the immune system is stimulated, and the inflammatory process is promoted, thus helping protect and defend.

What Can Cause Problems with the Epithelial Barrier?

Allergens Containing Proteases

Protease-containing allergens include house dust mites, pollen, pet dander, insects, and fungi. It is known that they can induce immune reactions and break down the epithelial barriers.


Although good bacteria (the microbiota) are needed for a healthy epithelium, some other bacteria can have a damaging effect on the physical and chemical barriers.


Viral infections cause impairment to the physical barrier and increase the permeability of the epithelial cells, allowing germs to enter the body. Human rhinovirus (HRV) infection is one of the most common viral infections in the nasal mucosa.

Particulate Matter and Diesel Exhaust Particles

Numerous studies have confirmed that these substances are connected to the prevalence of nasal diseases. These particles can undermine the integrity of the physical barrier and also affect the chemical barrier.

Cigarette Smoke

This compromises the physical, chemical, and immune barriers of the nasal epithelium, stimulating and exacerbating the nasal mucosal immune response.

Inflammatory Cytokines

Inflammatory cytokines are signaling proteins produced during immune reactions. They can further induce and exacerbate damage to the epithelial barrier. For example, by impairing cell junctions.

Approaches for Restoring Epithelial Barrier in Nasal Diseases

The epithelial barrier is the first line of defense against disease. The most common problems caused by issues with the nasal epithelial barrier are allergic rhinitis (AR) and what is commonly known as sinusitis (chronic rhinosinusitis (CRS)).

AR is a chronic, noninfectious inflammatory disease and essentially a hypersensitivity reaction, primarily caused by environmental allergens that disrupt the epithelial barrier. After repeated exposure to the same allergen, many allergic chemical mediators (histamine, prostaglandin, etc.) are produced, which induce a range of nasal allergic symptoms such as sneezing, nasal itching, and a watery nose. Recently, it was found that people with AR tend to develop CRS.

Restoring the epithelial barrier could result in improvement of both AR and CRS symptoms. However, the research is only just beginning. Most studies have limited participants and variable methods. In addition, current studies have not yet sought the ideal dose and timing for treatment, or whether there are adverse effects.

There is still a lot of unclear information on the processes (pathways) that lead to epithelial problems. Some studies have confirmed that drugs with histone deacetylase (HDAC) inhibitors can restore the nasal epithelial physical and chemical barriers. Corticosteroid drugs have also been shown to have a positive effect on the physical barrier. Also, natural plant products have a protective and repairing effect. For the microbiological barrier, there is increasing evidence suggesting that nasal administration of probiotics such as Lactobacilli can have a protective effect.

Take-Home Message

Although there are still deficiencies and challenges to overcome in the future, restoring the epithelial barrier may be a promising strategy for the development of nasal disease therapies.

Electric Nerve Stimulation Can Help Reduce Spasticity and Improve Walking in Multiple Sclerosis

What Is the Main Idea?

Multiple sclerosis (MS) is a common neurological disorder which, among other things, causes problems with muscle control. This leads to difficulties in movement, balance, and walking. Although there are some medications for multiple sclerosis, these do not help so much with the muscle problems, and can also have side effects which outweigh any benefit. However, as an alternative to medications, there is evidence that neuro-rehabilitation techniques can also help the muscle symptoms.

The authors of the open-access research article “The Effects of Neuromodulators on Spasticity, Balance, and Gait in Patients with MS: A Systematic Review and Meta-Analysis Study”, published in the journal European Neurology, aimed to systematically assess the research that has investigated neuro-rehabilitation techniques, to determine the benefits.

What Else Can You Learn?

The authors briefly describe some of the neuroanatomy and disease processes for multiple sclerosis. However, this is only in the context of neuro-rehabilitation techniques.

Tell Me More about the Symptoms of Multiple Sclerosis

The most common symptoms of MS are postural and balance problems, gait (walking) and movement difficulties, spasticity, and fatigue. These symptoms reduce independence, increase the risk of falls, and decrease the quality of life.

MS results in these symptoms because it is a disease that affects the nervous system controlling the muscles. Nerve fibers in the brain and body are usually surrounded by a protective sheath, known as the myelin sheath. In MS, the body’s immune system damages this sheath, or the cells that produce and maintain it. When the sheath is damaged, messages cannot be passed along the nerves, hence leading to muscle control problems. The term sclerosis means scarring, because multiple areas of scarring form where the nerve sheath has been damaged.

What Is Spasticity?

Spasticity is a term used to describe muscles that have high tone (are tight) or are contracted. It can affect the postural and limb muscles as well as speaking and eating muscles. It is not possible for a person to voluntarily control spasticity, as it is caused by problems with the brain and nerves that control the muscles. Normal muscle control means that we can voluntarily and involuntarily tighten and relax our muscles to move our body. But muscles with spasticity cannot be fully relaxed, meaning that a person cannot move their body in a typical way, if at all. The exact level of spasticity can vary, depending on other factors. Severe spasticity can be painful, energy-consuming, and result in permanent problems with joint stiffness and muscle weakness.

How Is Spasticity Treated?

There is evidence that the MS damage to the nerve pathways leads to spasticity. Specifically, damage to a pathway known as the corticospinal tract can lead to hyper-excitability of the messages that tell muscles to contract, and thus to spasticity. There are devices that can control – or modulate – this neuro-excitability, called neuromodulators.

How Do Neuromodulators Work?

Neuromodulator devices are used for treatment of many different neurological conditions. They work by stimulating or activating the nerve cells in the brain with small amounts of electric signals. The signals are sent through electrodes placed on the skin from a battery-powered device. They can have a lasting effect, even after the device is switched off and the electrodes removed. In terms of treatment for MS, the authors of this paper were interested in two types of neuromodulators: transcranial direct-current stimulation (tDCS) and transcranial magnetic stimulation (TMS).

How Did the Authors Carry Out Their Research?

The authors carried out a systematic review and meta-analysis. They searched research databases for all research on MS and neuromodulators. There are international guidelines for how to do this in the best way: such as using key search words to find suitable papers and using logical processes to categorize the different types of research. The authors selected only the best and most relevant research, using international guidelines and statistical methods to compare the research. They ended up with sufficient information from seven studies.

What Were the Results of the Review and Analysis?

Of the final seven studies, four studies used the tDCS technique and three studies used the TMS technique.

With so few studies, the authors briefly described each study and stated that it was difficult to compare them due to their differing number of treatment sessions (i.e., one treatment session or multiple sessions). However, their statistical methods helped them to conclude the following:

  • For impact on balance and gait (walking): A single session of tDCS technique neuromodulator treatment definitely does not help but multiple sessions of tDCS have led to lasting changes and improvements.
  • For impact on spasticity: Multiple sessions of the TMS technique were helpful in decreasing spasticity.

Take-Home Message

With so few studies, the authors report that further studies are required before it is possible to have a definite result on the specific effects of neuromodulators and different neuromodulator treatment strategies. However, they remain hopeful: Where they identified that multiple treatment sessions can help, they believe that further studies on the use of multiple treatment sessions could only strengthen this conclusion.

Note: This post is based on an article that is not open-access; i.e., only the abstract is freely available.

A Combination of Lifestyle Changes and Hypoglycemic Medications Can Help Psoriasis

What Is the Main Idea?

Psoriasis is an inflammatory skin problem from which more than 125 million people worldwide suffer. Over the past 20 years, researchers have tested different medicines for the treatment of psoriasis. However, there has not yet been an overall examination combining all the test results. The authors of the research article “Effect of Different Types of Hypoglycemic Medications on Psoriasis: An Analysis of Current Evidence”, published in the journal Dermatology, aimed to find out whether a specific type of medicine can help psoriasis by carrying out an overall review of past research.

What Else Can You Learn?

Psoriasis and its treatment are connected to the symptoms and treatment of diabetes mellitus and cardiovascular conditions.

What Is Psoriasis?

Psoriasis is a problem with the skin, caused by over-production of the skin cells that sit on the very outside of the skin (keratinocytes). The skin becomes thick and scaly (known as plaque), silvery-red in color, and can have pinpoint bleeding (known as Auspitz’s sign). It most often affects the elbow, but can happen in any part of the skin, including the nails, palms and soles, and genitalia. Known fully as psoriasis vulgaris, it is a chronic, recurring, multisystem, inflammatory disease. This means that it lasts longer than a few weeks, can come and go in severity, and affects many parts of the body due to an underlying inflammation problem (in the case of psoriasis this inflammation leads to the skin cell over-production).

What Are Hypoglycemic Medications?

In people with psoriasis these medications help improve the body’s metabolism, which is how it processes glucose and lipid (sugar and fat). If the body’s metabolism doesn’t work properly, the body can become hypoglycemic (known as hypoglycemia) and, amongst other things, inflammation and immunity processes are affected.

What Is Diabetes Mellitus and How Is It Connected to Psoriasis?

Hypoglycemia is also a symptom of diabetes. Psoriasis is connected with diabetes because diabetes is more common in people with psoriasis. Known fully as diabetes mellitus (DM), it is a metabolic disease that can damage the blood vessels, nerves, eyes, and kidneys, leading to serious complications and possible death. Most people with diabetes have type 2 (T2DM), which must be treated with changes to diet and exercise and also, like psoriasis, medicines that help hypoglycemia.

Unfortunately, for people with psoriasis, the risk of T2DM and also cardiovascular problems increases as the disease worsens. Therefore, psoriasis researchers are focusing on treatments that help the body’s metabolism, reduce inflammation, and improve immunity.

How Is Psoriasis Treated?

Both external medicines (such as creams and oils) and medicines taken by mouth have been used to treat psoriasis. However, they have not been very helpful. In the past 20 years, there have been many tests using hypoglycemic medicines. The authors reviewed all the tests using these medicines, to see how effective they can be. This has never been done before.

How Do Researchers Compare so Many Different Tests?

The authors carried out a systematic review and meta-analysis. They searched research databases for all research on hypoglycemic medicines and psoriasis. There are international guidelines for how to do this in the best way: such as using key search words to find suitable papers and using logical processes to categorize the different types of research.

The authors selected only the best and most relevant research, using the international guidelines and statistical methods to compare the research. This resulted in information on 223 patients within 14 studies, described in 18 papers.

How Did They Measure the Treatment Efficacy?

The authors identified different ways to measure whether a hypoglycemic medicine helped psoriasis. The first was that some studies used specialist scoring systems for skin symptoms. These were the psoriasis area and severity index (PASI) score, and dermatology life quality index (DLQI) score. The authors could then take these scores and use formulas to work out whether a treatment helped or not.

The next two methods the authors used were chosen in order to account for the interaction between psoriasis, diabetes and cardiovascular problems (inflammation, immunity and metabolism problems). They looked for scores that represented metabolic health and cardiovascular health. These included information on waist circumference, body mass index (BMI), levels of cholesterol and blood pressure. As for the skin symptom scores, by using these measurements and applying statistical methods the authors could then determine how effective a treatment was.

What Did the Authors Find?

The authors found that all the hypoglycemic medications studied could reduce psoriasis to varying degrees. They also found that the hypoglycemic medications could reduce some of the signs of poor metabolic and cardiovascular health (e.g., waist circumference, cholesterol, and blood pressure).

It is worth noting that none of the included studies involved patients taking a different type of medicine often used to treatment psoriasis, known as biologics. The authors mention that further studies could explore taking a combination of medicines.

Take-Home Message

The authors were excited to see that the use of hypoglycemic medicines may help the treatment of psoriasis alongside symptoms of diabetes or cardiovascular diseases. However, they reported that it is very important that people with psoriasis do not rely just on medicines, but instead also change their diet and exercise.

Note: This post is based on an article that is not open-access; i.e., only the abstract is freely available.

Preventing and Treating Blood Problems during Pregnancy and Birth

What Is the Main Idea?

When a person undergoes non-emergency major surgery, existing or new blood problems such as unusual clotting or too much bleeding can be life-threatening. However, blood problems can usually be detected before surgery, and the medical team can plan treatment to prevent or counteract a complication. This process is known as “patient blood management” (PBM). The PBM process has been successfully used for surgery and is now being applied to other areas of medical care, such as pregnancy and birth. The authors of the open-access review article “Patient Blood Management in Pregnancy”, published in the journal Transfusion Medicine and Hemotherapy, aimed to review and describe treatment protocols for blood problems during pregnancy, birth and the post-birth period.

What Else Can You Learn?

The authors write within the context of pregnancy, birth and the post-birth period. However, their descriptions can help you understand blood problems outside of this context, as the causes and treatments can be similar.

Why Is Patient Blood Management Relevant to Pregnancy and Birth?

Up to 40% of pregnant woman experience the blood problem of anemia and iron deficiency. This can lead to the mother feeling unwell and to serious pregnancy complications. It is also connected to poor post-birth health for both mothers and babies.

Severe bleeding during and after childbirth is called postpartum hemorrhage (PPH). This life-threatening emergency accounts for up to one-third of birth-related deaths in both developing and developed countries. Women who survive can have permanent reproductive disability. Furthermore, the number of at-risk mothers continues to rise (due to reasons such as increased use of Caesarean delivery, effects of fertility treatment and increased age of mothers).

What Are the Stages of Patient Blood Management during Pregnancy and Birth?

PBM is a multidisciplinary and individualized treatment approach:

  • Firstly, during early pregnancy for at-risk mothers, early screening and treatment of anemia and iron deficiency occurs.
  • Secondly, during delivery, steps to minimize blood loss are taken.
  • Thirdly, in the event of anticipated or unexpected high blood loss, a blood transfusion of either donor or the mother’s salvaged blood can be used.

What Is Iron Deficiency Anemia and How Is a Pregnant Woman Treated?

Anemia in pregnancy is a blood condition where there are not enough red blood cells, or not enough hemoglobin inside the red blood cells. Hemoglobin is a protein inside red blood cells that helps them work properly. The leading cause of anemia during and after pregnancy is iron deficiency.

A pregnant woman with iron deficiency anemia may experience fatigue, weakness or dizziness. It also affects thermoregulation, immune function, neurologic function, and enzymatic function, which is why it can place a woman at-risk of complications during pregnancy and birth. Additionally, it can affect the unborn baby’s growth and development.

Iron levels can be tested with a blood test. The authors discussed expected test results for pregnant women (different to non-pregnant women). They also reported the following treatment options that are safe for pregnancy:

  • Iron tablets are the gold standard for mild to moderate iron deficiency anemia but take a few weeks for full results. Unfortunately, there can be gastrointestinal side effects. However, these can be helped by taking tablets on alternate days.
  • If tablets do not help, then after the second trimester iron can be given with an intravenous drip. This is also an option for anemia that requires rapid normalization.
  • A third option is to give recombinant erythropoietin (rhEPO). This medication stimulates the production of red blood cells. However, it requires the presence of enough iron in the blood before it can work; therefore is often given alongside an iron drip (see above). This combination can be the best treatment for severe anemia or when a woman does not want to receive a blood transfusion.

How Can Blood Loss during Pregnancy and Birth Be Minimized?

Some bleeding and blood loss during and after birth is normal. However, too much (more than 500 ml) is classified as post-partum hemorrhage (PPH) and can be life-threatening. There are four leading causes of PPH: uterine atony, trauma, placental disorders and blood clotting defects. These are known as the four Ts: tone, trauma, tissue and thrombin. More than one cause can happen together, and treatment also addresses several causes simultaneously.

The authors list medications, delivery techniques, surgical options and diagnostic tests to reduce bleeding. Although they cannot describe everything in detail, they stress the importance of professionals working together, following a sequence of treatment protocols. The authors highlight a high-quality research trial where the medication tranexamic acid (TXA) was identified as significantly reducing the number of women who die from PPH. This is given as soon as bleeding starts and at further time stages according to a planned protocol. They also report on how the use of some quick-result blood tests is connected with better outcomes, because they enable individualized treatment.

What Is a Blood Transfusion?

If a person loses too much blood, they may need their blood replacing. An allogenic blood transfusion uses blood from a donor. An autologous blood transfusion uses the patient’s own blood and is known as cell salvage. The authors report on the use of cell salvage within the context of birth and specifically Caesarean delivery. They describe safety reviews that identified cell salvage as a safe option so long as steps such as filtering the blood from amniotic fluid were carried out. Cell salvage also results in healthier mothers post-birth and shorter hospital stay.

Take-Home Message

Pregnancy and birth result in normal changes to the blood. Iron deficiency anemia, although potentially serious, can often be easily treated with tablets. However, sometimes the blood changes can put a mother or baby at high risk of complications. If a woman is assessed as high-risk in early pregnancy, then her healthcare providers can follow a protocol of prevention and treatment. There are many treatment options that can be individualized to the mother and baby, including medication, birth techniques, surgical techniques and blood tests. Using all of these preventative and treatment options together, in a collaborative and individualized way, gives mothers and babies the best chance of survival and optimal post-birth health.

Note: The authors of this paper make a declaration about grants, research support, consulting fees, lecture fees, etc. received from pharmaceutical companies. It is normal for authors to declare this in case it might be perceived as a conflict of interest.

Acute Mesenteric Ischemia: Quality of Life after Emergency Surgery

What Is the Main Idea?

Acute mesenteric ischemia (AMI) is an emergency problem with the bowel that can often be life-threatening. If a person becomes unwell with AMI, they and their doctor must make quick decisions about treatment. To help make these choices, it is important that the sick person knows as much as possible about their survival chances, and what their life might be like after treatment. However, there is very little information about quality of life for survivors of AMI. The authors of the open-access research article “Acute Mesenteric Ischemia: Preexisting Comorbidity Determines Short-Term Outcome and Quality of Life in Long-Term Survivors”, published in the journal Visceral Medicine, aimed to find out more.

What Else Can You Learn?

Quality of life after recovery can be affected not just by a disease or its treatment but by how healthy the person is prior to becoming ill or receiving treatment.

What Is Acute Mesenteric Ischemia (AMI)?

Acute mesenteric ischemia (AMI) mostly affects the elderly population and is caused by poor blood flow in the bowel, which leads to inflammation, pain, infection, and permanent damage. Parts of the bowel can die, becoming gangrenous and resulting in a life-threatening situation. Usually, emergency surgery is required, but successful recovery is difficult to predict and many people do not survive long after surgery.

What Is Quality of Life?

Quality of life (QoL) is a term used to describe a person’s satisfaction with their life. Each person views different life aspects positively and negatively. Examples of areas that can affect QoL are physical and psychological health, productivity, spirituality, independence, and relationships.

Measuring QoL is a very common way to understand how a disease or treatment affects a person, and can be used to guide decisions about a treatment. A high QoL score means that a person experiences a high QoL.

Until now, QoL for people who have had AMI and survived up to 4 years after surgery has not been investigated.

How Might Quality of Life Be Affected for a Survivor of Acute Mesenteric Ischemia?

After surgery for AMI, a person may not be able to eat or digest food. They may need to be “fed” through a tube connected to a vein, or they may have had a stoma fitted, which is a tube leading from the stomach or bowel to a waste collection bag outside the body. The researchers thought that these changes might result in lower QoL for long-term survivors.

How Did the Researchers Investigate Their Idea?

Quality of life can be measured in various ways. In this paper the authors used a questionnaire called the EQ-5D, to assess QoL in long-term survivors of AMI. There were questions on mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. The scoring system is designed to reflect a person’s age and gender, particularly important since the people they assessed were in the elderly range, the typical age range for AMI.

Then, the researchers compared the survivors’ scores with the scores from people with a similar life situation but who had not had AMI.

Finally, rather than just look at QoL after survival, the authors took a step further. They also looked at health problems the patients had prior to becoming ill with AMI such as diabetes, heart and kidney problems, or use of medicines such as blood thinners. They used statistical methods to assess if there was a connection between these preexisting health problems and the level of QoL.

What Did This Study Show?

It is the first time that information on QoL for survivors of AMI up to 4 years after surgery has been reported.

  • Firstly, the researchers found that long-term survivors did have a lower QoL score than people with a similar life situation but who have not had AMI. However, this was for different reasons than what the researchers expected. The lower QoL could not have been due to complications because none of the long-term survivors had these complications.
  • Secondly, the researchers found that long-term survivors had fewer preexisting health problems than those who did not survive.

The researchers connected these two findings to conclude that survival and long-term QoL is affected by a combination of preexisting health problems rather than one single factor such as age or post-surgery complications.

Take-Home Message

When making treatment decisions for AMI and informing about the possible outcome, a person’s preexisting health should be considered an important factor affecting survival and QoL after recovery.

Fiona Beck

Fiona Beck is an alumnus of the University of Queensland, Australia, where she gained a bachelor’s degree in occupational therapy. After honing her clinical skills in Australia and the UK, she stepped into writing for health communications and research.

When explaining medical matters in everyday language she writes with empathy, as if the reader is her own patient. When writing on behalf of clinicians, she is honored to help them effectively communicate their research.

Fiona has lived in several countries and discovered herself to be a keen linguist. Observing how medical English is used between native and non-native speakers, professionals and laypeople, has been a fascinating and unexpected dimension that inspires her work.

Photo: Amanda Joy Photography Basel