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- Abrasions, anal fissure, autolytic debridement, bed sore, Clostridium sp., collagen, collagen matrix, cuts, debridement, decubitus ulcer, diabetic ulcers, electrotherapy, epithelial, epithelialization phase, extravasation, gangrene, gas gangrene, human growth factors, hydrocolloid, hyperbaric oxygen, incision wounds, incontinence, infected surgical wounds, infectious arthritis, inflammatory phase, injuries, laceration, macrophages, mechanical debridement, microvascular, minor injuries, myonecrosis, necrotizing fasciitis, pressure ulcers/wound care, proliferative phase, puncture wound, remodeling phase, scrapes, scratches, sepsis, septic arthritis, skin damage caused by incontinence, skin graft healing (split thickness), skin ulcer, surgical skin flap ischemia, skin wounds, squamous, stitches, superficial, suture, vulnerary, wound care, wound healing.
- A wound is a break in the outer layer of the skin, called the epidermis. Wounds are usually caused by cuts or scrapes. Different kinds of wounds may be treated differently from one another, depending upon how they happened and how serious they are. Other wounds include puncture wounds, lacerations (cuts), pressure sores, anal fissures, extravasations (a drug accidentally going outside of a vein causing tissue damage), skin damage caused by incontinence (lack of bladder control), skin graft healing (split thickness), diabetic ulcers, and surgical skin flap ischemia (lack of blood flow to surgically attached skin).
- Healing is a response to the injury that sets into motion a sequence of events. With the exception of bone, all tissues heal with some external scarring. The object of proper care is to minimize the possibility of infection and scarring.
- There are basically four phases to the healing process: the inflammatory phase, proliferative phase, remodeling phase, and epithelialization phase.
- The inflammatory phase begins with the injury itself. In the inflammatory phase, there is bleeding, immediate narrowing of the blood vessels, clot formation, and release of various chemical substances into the wound that will begin the healing process. Specialized cells (macrophages) clear the wound of debris over the course of several days.
- Next is the proliferative phase in which a matrix or latticework of cells forms. On this matrix, new skin cells and blood vessels will form. It is the new small blood vessels (known as capillaries) that give a healing wound its pink or purple-red appearance. These new blood vessels will supply the rebuilding cells with oxygen and nutrients to sustain the growth of the new cells and support the production of proteins (primarily collagen). The collagen acts as the framework upon which the new tissues build. Collagen is the dominant substance in the final scar.
- The remodeling phase begins after 2-3 weeks. The framework (collagen) becomes more organized making the tissue stronger. The blood vessel density becomes less, and the wound begins to lose its pinkish color. Over the course of six months, the area increases in strength, eventually reaching 70% of the strength of uninjured skin.
- Epithelialization is the process of laying down new skin, or epithelial, cells. The skin forms a protective barrier between the outer environment and the body. Its primary purpose is to protect against excessive water loss and bacteria. Reconstruction of this layer begins within a few hours of the injury and is complete within 24-48 hours in a clean, sutured (stitched) wound. Open wounds may take 7-10 days because the inflammatory process is prolonged, which contributes to scarring. Scarring occurs when the injury extends beyond the deep layer of the skin (into the dermis, which is the second layer of skin).
- Unclear or conflicting scientific evidence:
- Aloe: Transparent gel from the pulp of the meaty leaves of Aloe vera has been used topically for thousands of years to treat wounds, skin infections, burns, and numerous other dermatologic conditions. Study results of aloe on wound healing are mixed with some studies reporting positive results and others showing no benefit or potential worsening of the condition. Early studies suggest that aloe may help heal skin ulcers. High-quality studies comparing aloe alone with placebo are needed.
- Avoid if allergic to aloe or other plants of the Liliaceae family (garlic, onions, tulips). Avoid injecting aloe. Do not apply to open skin, surgical wounds or pressure ulcers. Avoid taking by mouth with diarrhea, bowel blockage, intestinal diseases, bloody stools or hepatitis. Avoid with a history of irregular heartbeat (arrhythmia), electrolyte imbalances, diabetes, heart disease or kidney disease. Avoid taking by mouth if pregnant or breastfeeding.
- Alpha-lipoic acid: Alpha-lipoic acid (ALA) may reduce tissue damage that is often caused by long-term exposure to high levels of oxygen. While early studies are promising, more research is needed to fully understand how ALA might work for wound healing in patients undergoing hyperbaric oxygen therapy.
- Avoid if allergic to alpha-lipoic acid (ALA). Use cautiously with diabetes and thyroid diseases. Avoid with thiamine deficiency or alcoholism. Avoid if pregnant or breastfeeding.
- Arginine: Arginine, or L-arginine, is considered a semi-essential amino acid, because although it is normally synthesized in sufficient amounts by the body, supplementation is sometimes required (for example, due to inborn errors of urea synthesis, protein malnutrition, excess ammonia production, excessive lysine intake, burns, infection, peritoneal dialysis, rapid growth, or sepsis). Arginine has been suggested to improve the rate of wound healing in elderly individuals. A randomized, controlled clinical trial reported improved wound healing after surgery in head and neck cancer patients, following the use of an enteral diet supplemented with arginine and fiber. Arginine has also been used topically (on the skin) to attempt to improve wound healing. Early studies suggest that arginine may also help treat chronic anal fissures. Additional studies are needed.
- Avoid if allergic to arginine, or with a history of stroke, liver, or kidney disease. Avoid if pregnant or breastfeeding. Use caution if taking blood-thinning drugs (like warfarin or Coumadin®) and blood pressure drugs or herbs or supplements with similar effects. Blood potassium levels should be monitored. L-arginine may worsen symptoms of sickle cell disease. Caution is advised in patients taking prescription drugs to control sugar levels.
- Aromatherapy: Aromatherapy is a technique in which essential oils from plants are used with the intention of preventing or treating illness, reducing stress, or enhancing well-being. Preliminary data from one small study suggests aromatherapy may contribute to reduced pain intensity during dressing changes in wound care. Data are insufficient for forming any opinion for or against this application.
- Essential oils should only be used on the skin in areas without irritation. Essential oils should be administered in a carrier oil to avoid toxicity. Avoid with a history of allergic dermatitis. Use cautiously if driving or operating heavy machinery. Avoid consuming essential oils. Avoid direct contact of undiluted oils with mucous membranes. Use cautiously if pregnant.
- Ayurveda: There is some evidence that a traditional Ayurvedic treatment using specially prepared alkaline threads (ksharasutra or Ayurvedic setons) to achieve gradual cauterization may provide an effective alternative to surgery in patients being treated for anal fissures. Further research is needed to confirm these results.
- Ayurvedic herbs should be used cautiously. Some herbs imported from India have been reported to contain high levels of toxic metals. Ayurvedic herbs can interact with other herbs, foods and drugs. A qualified healthcare professional should be consulted before taking. Use guggul cautiously with peptic ulcer disease. User should avoid sour food, alcohol and heavy exercise. Mahayograj guggul should not be taken for long periods of time. Pippali (Piper longum) should be taken with milk and avoided with asthma. Avoid sweet flag, and avoid amlaki (Emblica officinalis) at bedtime. Avoid Terminalia hebula (harda) if pregnant. Avoid Ayurveda with traumatic injuries, acute pain, advanced disease stages and medical conditions that require surgery.
- Bovine cartilage: Reduction in inflammation and edema (swelling) and enhancement of the healing of wounds were effects that appeared in the medical literature of bovine cartilage during the 1950s and 1960s. In a preliminary comparison of potential wound healing effects with a commercially available ointment of 10% powdered bovine cartilage (Catrix® 10 Ointment) or Aquaphor® original formula in post-operative facial skin care with a laser resurfacing agent, Catrix® 10 Ointment was better. However, this study was a pilot study so its results need confirmation by follow-up clinical studies that clearly have the appropriate randomization and are double-blinded, given that such were in absence in this study. Also lacking in this study was a definition of primary outcome that therapeutically differentiated Catrix® 10 Ointment.
- Avoid if allergic or hypersensitive to bovine cartilage or any of its constituents. Use cautiously with cancer, renal (kidney) failure, or hepatic (liver) failure. Avoid if pregnant or breastfeeding.
- Calendula: Calendula (Calendula officinalis), also known as pot marigold, has been widely used on the skin to treat minor wounds, skin infections, burns, bee stings, sunburn, warts, and cancer. Calendula is commonly used topically (on the skin) to treat minor skin wounds. Reliable human research is necessary before a firm conclusion can be drawn regarding the use of calendula for wound healing.
- Avoid if allergic to plants in the Aster/Compositae family, such as ragweed, chrysanthemums, marigolds, and daisies. Use cautiously in patients taking sedatives, blood pressure medications, cholesterol medications, blood sugar-altering agents, and immunomodulators. Use cautiously with diabetes and in children. Avoid if pregnant or breastfeeding.
- Chamomile: Chamomile (Matricaria recutita, Chamaemelum nobile) has been used medicinally for thousands of years, and is widely used in Europe. There is promising preliminary evidence supporting the topical use of chamomile for wound healing. However, the available literature is not adequate to support the use of chamomile for this indication.
- Avoid if allergic to chamomile. Anaphylaxis, throat swelling, skin allergic reactions and shortness of breath have been reported. Chamomile eyewash can cause allergic conjunctivitis (pinkeye). Stop use two weeks before surgery/dental/diagnostic procedures with bleeding risk, and do not use immediately after these procedures. Use cautiously if driving or operating machinery. Avoid if pregnant or breastfeeding.
- Chitosan: There is limited evidence on the effects of chitosan in wound healing. Better studies are needed.
- Avoid if allergic or sensitive to chitosan or shellfish. Use cautiously with diabetes or bleeding disorders. Use cautiously if taking drugs, herbs, or supplements that lower blood sugar or increase the risk of bleeding. Chitosan may decrease absorption of fat and fat-soluble vitamins from foods. Chitosan is not recommended during pregnancy or breastfeeding.
- Dimethylsulfoxide (DMSO): Dimethylsulfoxide (DMSO) is a sulfur-containing organic compound. DMSO occurs naturally in vegetables, fruits, grains, and animal products. DMSO applied to the skin may prevent tissue death after extravasation of anticancer agents. It can be applied alone or with steroids. Limited available study also suggests that DSMO improves lack of blood flow in surgical skin flap ischemia. Currently, there is not enough scientific evidence available for the use of topical DMSO for diabetic ulcers.
- Avoid if allergic or hypersensitive to DMSO. Use caution with urinary tract cancer or liver and kidney dysfunction. Avoid if pregnant or breastfeeding.
- Eucalyptus oil: Eucalyptus (Eucalyptus globulus) oil contains 70-85% 1,8-cineole (eucalyptol), which is also present in other plant oils. Limited evidence suggests that eucalyptus essential oil may be beneficial for patients with skin ulcers when combined with antibiotics. More studies are needed to confirm these early findings.
- Case reports describe allergic rash after exposure to eucalyptus oil, either alone or as an ingredient in creams. Avoid if allergic to eucalyptus oil or with a history of seizure, diabetes, asthma, heart disease, abnormal heart rhythms, intestinal disorders, liver disease, kidney disease, or lung disease. Use caution if driving or operating machinery. Avoid with a history of acute intermittent porphyria. Avoid if pregnant or breastfeeding. A strain of bacteria found on eucalyptus may cause infection. Toxicity has been reported with oral and inhaled use.
- Gotu kola: Gotu kola, Centella asiatica (formerly known as Hydrocotyle asiatica), has a long history of use, dating back to ancient Chinese and Ayurvedic medicine. Preliminary study has demonstrated the ability of Centella asiatica extracts to promote wound healing, possibly through the stimulation of collagen synthesis. However, additional human study is needed in this area.
- Avoid if allergic to gotu kola, asiaticoside, asiatic acid, or madecassic acid. Avoid with a history of high cholesterol, cancer, or diabetes. Avoid if pregnant or breastfeeding.
- Honey: Honey is a sweet, viscid fluid produced by honeybees (Apis melliflera) from the nectar of flowers. The primary studied use of honey is for wound management, particularly in promoting rapid wound healing, deodorizing, and debriding necrotic tissue. The types of wounds studied are varied; most are non-healing wounds such as chronic ulcers, postoperative wounds, and burns. Currently, there is insufficient human evidence to support the use of honey for skin graft healing. Although honey has apparent antibacterial effects, more human study is needed in this area.
- Avoid if allergic or hypersensitive to honey, pollen, celery, or bees. Honey is generally considered safe in recommended doses. Avoid honey from the genus Rhododendron because it may cause a toxic reaction. Avoid in infants younger than 12 months of age. Use cautiously with antibiotics. Potentially harmful contaminants (like C. botulinum or grayanotoxins) can be found in some types of honey and should be used cautiously in pregnant or breastfeeding women.
- Hydrotherapy: Hydrotherapy is broadly defined as the external application of water in any form or temperature (hot, cold, steam, liquid, ice) for healing purposes. It may include immersion in a bath or body of water (such as the ocean or a pool), use of water jets, douches, application of wet towels to the skin, or water birth. These approaches have been used for the relief of various diseases and injuries, or for general well being. Hydrotherapy has been used in patients with pressure ulcers, and preliminary research suggests that daily whirlpool baths may reduce the time for wound healing. Better research is necessary in this area before a firm conclusion can be drawn.
- There is a risk of infection from contaminated water if sanitary conditions are not maintained. Avoid sudden or prolonged exposure to extreme temperatures in baths, wraps, saunas, or other forms of hydrotherapy, particularly with heart disease, lung disease, or if pregnant. Avoid with implanted medical devices like pacemakers, defibrillators, or hepatic (liver) infusion pumps. Vigorous use of water jets should be avoided with fractures, known blood clots, bleeding disorders, severe osteoporosis, open wounds, or during pregnancy. Use cautiously with Raynaud's disease, chilblains, acrocyanosis, erythrocyanosis, and impaired temperature sensitivity, such as neuropathy. Use cautiously if pregnant or breastfeeding. Hydrotherapy should not delay the time to diagnosis or treatment with more proven techniques or therapies, and should not be used as the sole approach to illnesses. Patients with known illnesses should consult their physician(s) before starting hydrotherapy.
- Iodine: It is not clear if healing of wounds or skin ulcers is improved with the application of topical iodine solutions. Iodine solutions may assist with sterilization as a part of a larger approach to the wound healing process.
- Reactions can be severe, and deaths have occurred with exposure to iodine. Avoid iodine-based products if allergic or hypersensitive to iodine. Do no use for more than 14 days. Avoid Lugol solution and saturated solution of potassium iodide (SSKI, PIMA) with hyperkalemia (high amounts of potassium in the blood), pulmonary edema (fluid in the lungs), bronchitis, or tuberculosis. Use cautiously when applying to the skin because it may irritate/burn tissues. Use sodium iodide cautiously with kidney failure. Avoid sodium iodide with gastrointestinal obstruction. Iodine is safe in recommended doses for pregnant or breastfeeding women. Avoid povidone-iodine for perianal preparation during delivery or postpartum antisepsis.
- Magnet therapy: The use of magnets to treat illness has been described historically in many civilizations. In modern times, magnetic fields play an important role in Western medicine, including use for magnetic resonance imaging (MRI), pulsed electromagnetic fields, and experimental magnetic stimulatory techniques. Early scientific evidence suggests that the time to heal wounds, including ulcers, may decrease with the use of static magnets. Better quality studies are needed before a firm recommendation can be made for wound healing.
- Avoid with implantable medical devices, such as heart pacemakers, defibrillators, insulin pumps, or hepatic artery infusion pumps. Avoid with myasthenia gravis or bleeding disorders. Avoid if pregnant or breastfeeding. Magnet therapy is not advised as the sole treatment for potentially serious medical conditions, and it should not delay the time to diagnosis or treatment with more proven methods. Patients are advised to discuss magnet therapy with a qualified healthcare provider before starting treatment.
- Pantothenic acid (vitamin B5): Pantothenic acid (vitamin B5) is essential to all life and is a component of Coenzyme A (CoA), a molecule that is necessary for numerous vital chemical reactions to occur in cells. Pantothenic acid is essential to the metabolism of carbohydrates, proteins, and fats, as well as for the synthesis of hormones and cholesterol. In animal research, oral and topical pantothenic acid has been associated with accelerated skin wound healing. However early human study results conflict. Additional evidence is necessary before a clear conclusion can be reached regarding this use of pantothenic acid or dexpanthenol.
- Avoid if allergic or hypersensitive to pantothenic acid or dexpanthenol. Avoid with gastrointestinal blockage. Pantothenic acid is generally considered safe in pregnant and breastfeeding women when taken at recommended doses.
- Papain: Papain is an enzyme that breaks protein bonds and has been used in Africa for treating burns. In standard western medical care, papain-containing debridement agents are commonly used to remove necrotic tissue and slough in burns, postoperative wounds, pilonidal cyst wounds, carbuncles, trauma wounds, infected wounds, and chronic lesions, such as pressure ulcers, and varicose and diabetic ulcers. According to reviews and clinical trials, papain may be very useful for wound debridement and for stimulating wound healing. More high-quality research is needed in this area.
- Use cautiously in patients sensitive to papain. Use cautiously in patients being treated for prostatitis. Use Wobenzym®, which contains papain, cautiously, especially in those with bleeding disorders or taking anticoagulants or antiplatelets. Use cautiously as an adjuvant to radiation therapy. Avoid in patients with gastroesophageal reflux disease. Avoid in patients using immunosuppressive therapy.
- Physical therapy: Physical therapy techniques, such as laser treatment, have been used to clean and heal wounds. Early evidence also suggests that high voltage stimulation or pulsed electrical stimulation may speed the healing of some types of skin ulcers. More research with similar outcome measures is needed to better understand the role of physical therapy for wound care.
- Not all physical therapy programs are suited for everyone, and patients should discuss their medical history with a qualified healthcare professional before beginning any treatments. Physical therapy may aggravate pre-existing conditions. Persistent pain and fractures of unknown origin have been reported. Physical therapy may increase the duration of pain or cause limitation of motion. Pain and anxiety may occur during the rehabilitation of patients with burns. Both morning stiffness and bone erosion have been reported in the literature although causality is unclear. Erectile dysfunction has also been reported. Physical therapy has been used in pregnancy and although reports of major adverse effects are lacking in the available literature, caution is advised nonetheless. All therapies during pregnancy and breastfeeding should be discussed with a licensed obstetrician/gynecologist before initiation.
- Psyllium: Psyllium, also referred to as ispaghula, is derived from the husks of the seeds of Plantago ovata. Psyllium contains a high level of soluble dietary fiber, and is the chief ingredient in many commonly used bulk laxatives. Results from human study suggest that psyllium may reduce the number of surgeries necessary to heal anal fissures. Further evidence is necessary.
- Avoid if allergic or hypersensitive to psyllium, ispaghula, or English plantains (Plantago lanceolata). Avoid in patients with esophageal disorders, gastrointestinal atony, fecal impaction, gastrointestinal tract narrowing, swallowing difficulties, and previous bowel surgery. Avoid ingestion of psyllium-containing products in individuals with repeated or prolonged psyllium exposure who have not manifested allergic or hypersensitive symptoms. Prescription drugs should be taken one hour before or two hours after psyllium. Adequate fluid intake is required when taking psyllium-containing products. Use cautiously with blood thinners, antidiabetic agents, carbamazepine, lithium, potassium-sparing diuretics, salicylates, tetracyclines, nitrofurantoin, calcium, iron, vitamin B12, other laxatives, tricyclic antidepressants (amitriptyline, doxepin, and imipramine), antigout agents, anti-inflammatory agents, hydrophilic agents, and chitosan. Use cautiously with diabetes and kidney dysfunction. Use cautiously if pregnant or breastfeeding.
- Rose hip: Rose hips are the fruits that develop from the blossoms of the wild rose (Rosa spp.). They are typically orange to red in color, but some species may be purple or black. When applied topically, the volatile oils of aromatic plants may have physiological effects that will facilitate wound healing. Rose hips contain several vitamins and minerals, including vitamin C, vitamin B1, vitamin E, calcium, zinc, and carotenoids, which could potentially promote wound healing when applied to the skin. Much larger and high quality clinical trials are needed to establish the therapeutic efficacy of rose hip and rose oil preparations in the topical treatment of surgical wounds and ulcers.
- Use cautiously in patients who are avoiding immune system stimulants. Use cautiously in patients who are taking anticoagulant or anti-platelet aggregating agents, antibiotics, antineoplastics, antiretrovirals, anti-inflammatory agents, "Long-Life CiLi", antilipemics, aluminum-containing antacids, salicylates, or laxatives. Avoid in patients who are allergic to rose hips, rose pollen, its constituents, or members of the Rosaceae family.
- TENS: Transcutaneous electrical nerve stimulation (TENS) is a non-invasive technique in which a low-voltage electrical current is delivered through wires from a small power unit to electrodes located on the skin. Electrodes are temporarily attached with paste in various patterns, depending on the specific condition and treatment goals. TENS is often used to treat pain, as an alternative or addition to pain medications. Therapy sessions may last from minutes to hours. TENS is often used in conjunction with acupuncture therapy. TENS has been tested for its effects on blood flow to skin flaps used in plastic surgery procedures such as breast reconstruction. TENS has also been evaluated in patients with skin ulcers, diabetic foot ulcers, and chronic ulcers of various causes. More research is needed in this area.
- Avoid with implantable devices, like defibrillators, pacemakers, intravenous infusion pumps, or hepatic artery infusion pumps. Use cautiously with decreased sensation, like neuropathy, and with seizure disorders. Avoid if pregnant or breastfeeding.
- Therapeutic touch: Although some studies report an improvement in wound healing with therapeutic touch, others show no benefits.
- Therapeutic touch is believed to be safe for most people. Therapeutic touch should not be used for potentially serious conditions in place of more proven therapies. Avoid with fever or inflammation, and on body areas with cancer.
- Vitamin A: In preliminary study, retinol palmitate significantly reduced rectal symptoms of radiation proctopathy, perhaps because of wound healing effects. Further research is needed to confirm these results.
- Avoid if allergic or hypersensitive to vitamin A. Vitamin A toxicity can occur if taken at high dosages. Use cautiously with liver disease or alcoholism. Smokers who consume alcohol and beta-carotene may be at an increased risk for lung cancer or heart disease. Vitamin A appears to be safe in pregnant women if taken at recommended doses; however, vitamin A excess, as well as deficiency, has been associated with birth defects. Excessive doses of vitamin A have been associated with central nervous system malformations. Use cautiously if breastfeeding because the benefits or dangers to nursing infants are not clearly established.
- Zinc: Although zinc is frequently cited as having beneficial effects on healing of incision wounds, few studies have investigated this use. Further research is needed. There are conflicting findings regarding the potential benefit of zinc for healing leg ulcers. Available studies reported no or few adverse effects.
- Preliminary evidence suggests that topical zinc oxide oil may help manage perianal and buttock skin damage in incontinent patients. Further research is needed to better understand the role of zinc for treatment of skin damage caused by incontinence.
- Zinc is generally considered to be safe when taken at the recommended dosages. Avoid zinc chloride since studies have not been done on its safety or effectiveness. Avoid with kidney disease. Use cautiously if pregnant or breastfeeding.
- Fair negative scientific evidence:
- Aloe: A well-designed human trial found no benefit of topical acemannan hydrogel (a component of aloe gel) in the treatment of pressure ulcers.
- Avoid if allergic to aloe or other plants of the Liliaceae family (garlic, onions, tulips). Avoid injecting aloe. Do not apply to open skin, surgical wounds or pressure ulcers. Avoid taking by mouth with diarrhea, bowel blockage, intestinal diseases, bloody stools or hepatitis. Avoid with a history of irregular heartbeat (arrhythmia), electrolyte imbalances, diabetes, heart disease or kidney disease. Avoid taking by mouth if pregnant or breastfeeding.
- In order to prevent wounds from occurring, healthcare providers recommend that individuals: take care when using sharp objects such as knives, scissors, saws, and trimmers; wear shoes or boots on the feet; use helmets when riding a bicycle; use helmets, kneepads, wrist protectors, and elbow pads when using in-line skates or skateboards; and avoid picking up broken pieces of glass and handling razor blades.
- If bedridden or immobile with diabetes, circulation problems, incontinence, or mental disabilities, healthcare providers recommend that the individual be checked for pressure sores every day. Also, look for reddened areas that, when pressed, do not turn white. Also look for blisters, sores, or craters. In addition, take the following steps: change position at least every two hours to relieve pressure; use items that can help reduce pressure such as pillows, sheepskin, foam padding, and powders from medical supply stores; eat healthy, well-balanced meals; exercise daily, including range-of-motion exercises for immobile patients; and keep skin clean and dry. Incontinent people need to take extra steps to limit moisture.
- Individuals with diabetes should check their feet daily for blisters, sores, or other wounds in order to prevent serious infection and possibly amputation.
- This information has been edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).
- American Academy of Family Physicians. .
- American Academy of Pediatrics. .
- Arnold M, Barbul A. Nutrition and wound healing. Plast Reconstr Surg. 2006;117(7 Suppl):42S-58S.
- Centers for Disease Control and Prevention. .
- Dini V, Bertone M, Romanelli M. Prevention and management of pressure ulcers. Dermatol Ther. 2006;19(6):356-64.
- Langemo D, Anderson J, Hanson D, et al. Nutritional considerations in wound care. Adv Skin Wound Care. 2006;19(6):297-8, 300, 303.
- de Laat EH, Schoonhoven L, Pickkers P, et al. Epidemiology, risk and prevention of pressure ulcers in critically ill patients: a literature review. J Wound Care. 2006;15(6):269-75.
- Natural Standard: The Authority on Integrative Medicine. .
- National Institute of Allergy and Infectious Diseases. .
- Pieper B, Sieggreen M, Nordstrom CK, et al. Discharge knowledge and concerns of patients going home with a wound. J Wound Ostomy Continence Nurs. 2007;34(3):245-53; quiz 254-5.
- Wu SC, Driver VR, Wrobel JS, et al. Foot ulcers in the diabetic patient, prevention and treatment. Vasc Health Risk Manag. 2007;3(1):65-76.
Disorders that affect multiple parts of the gastrointestinal tract
- Diarrhea: Diarrhea occurs when an individual has loose stools or watery stools. Diarrhea is a symptom of an underlying health problem, such as an infection, that prevents the intestines from properly absorbing nutrients from food. Acute diarrhea lasts a few days and affects nearly everyone at some point in their lives. Chronic diarrhea generally lasts longer than four weeks and may be a sign of a serious condition such as inflammatory bowel disease (IBD) or gastroenteritis.
- Diarrhea is usually caused by a viral, bacterial, or parasitic infection. Diarrhea that is caused by an infection (often called infectious diarrhea) may be passed from person to person. Viruses, such as the Norwalk virus, cytomegalovirus, viral hepatitis herpes simplex virus, and rotavirus are the most likely to cause diarrhea. Infants and young children are most likely to develop diarrhea as a result of a rotavirus infection. If an individual consumes food or water that is contaminated with certain bacteria or parasites, he/she may develop diarrhea. This type of diarrhea is often called traveler's diarrhea because it frequently occurs in people who are traveling to developing countries. Common bacterial causes of diarrhea include campylobacter, salmonella, Escherichia coli (E. coli), Shigelladysenteriae, and Clostridium difficile. Common parasites that are known to cause diarrhea include Giardia lamblia and cryptosporidium.
- Diarrhea may be caused by a number of other factors, including lactose intolerance, certain medications (especially antibiotics and anti-HIV medications called antiretrovirals), artificial sweeteners called sorbitol and mannitol (commonly found in sugar-free products and many types of chewing gum), surgery, or other gastrointestinal disorders (such as irritable bowel syndrome or IBS).
- Symptoms of diarrhea often include frequent and loose stools, abdominal pain or cramping, bloating, fever, excessive thirst, and dehydration. Diarrhea causes dehydration because the body loses water and salts. Infants and young children are at risk of developing severe dehydration as a result of diarrhea. Patient with severe diarrhea may be unable to control the passage of stool, a condition known as fecal incontinence. When a patient experiences frequent, severe, and bloody diarrhea, the condition is often called dysentery.
- Diarrhea usually requires little to no medical treatment. Individuals with diarrhea should drink plenty of water. Patients may also benefit from drinks that contain electrolytes, including Pediatric Electrolyte®, Pedialyte®, or Enfalyte®. Individuals should avoid diuretics, such as caffeine, because they worsen symptoms of dehydration. Certain foods, including rice, dry toast, and bananas may help reduce symptoms of diarrhea. In addition, anti-diarrheal medications, such as bismuth subsalicylate (Pepto-bismol®, Bismatrol®, or Kaopectate®), diphenoxylate atropine (Lomotil®, Lofene®, or Lonox®), or loperamide hydrochloride (Imodium®), may also be taken to reduce diarrhea in patients older than three years of age.
- If diarrhea continues for longer than four days or blood is present in the stool, patients should visit their healthcare providers to determine the underlying cause. If an infection is causing symptoms, an antimicrobial medication may be prescribed. The specific type, dose, and duration of treatment depend on the severity and type of infection.
- Irritable bowel syndrome (IBS): Irritable bowel syndrome (IBS), also called spastic colon, mucous colitis, spastic colitis, nervous stomach, or irritable colon, is a long-term condition that is characterized by abdominal pain, cramping, diarrhea, and constipation. IBS is a functional bowel disorder because the bowel appears normal but does not function properly.
- Although the exact cause of irritable bowel syndrome (IBS) is unknown, researchers believe that poor diet, neurotransmitter imbalances, and infections may contribute to the development of the disorder.
- The colon contracts (colon motility) to move the contents inside the colon toward the rectum. During this passage, water and nutrients are absorbed into the body and waste is excreted as stool. A few times each day, contractions push the stool down the colon resulting in a bowel movement.
- In IBS patients, the muscles of the colon, sphincters, and pelvis do not contract properly. As a result, patients experience constipation or diarrhea. This causes symptoms of abdominal pain, cramping, bloating, and a sense of incomplete stool movement. Symptoms may improve after the patient has a bowel movement.
- Health complications arising from IBS include hemorrhoids (aggravated by diarrhea and/or constipation), depression, weight loss, vitamin and mineral deficiencies, and psychosocial problems.
- Most people can control symptoms of IBS with diet, stress management, lifestyle modification, and prescribed medications. A medication called loperamide (Imodium®) is commonly used to treat IBS patients with diarrhea. Laxatives, such as polyethylene glycol (Miralax®), sorbitol, and lactulose (Cephulac®), may be used. Phosphate enemas (Fleet Phospho-soda®) and emollient enemas (Colace Microenema®) have also been used. Suppositories, such as bisacodyl (Dulcolax®), may also be taken. The most widely studied drugs for the treatment of abdominal pain are a group of drugs called antispasmodics, which cause muscle relaxation. Commonly used antispasmodics include hyoscyamine (Levsin® or Levsinex®), dicyclomine (Bentyl®), and methscopolamine (Pamine®).
- For some patients, however, IBS may be disabling. They may be unable to work, attend social events, or even travel short distances due to urgency to defecate (pass stool) and/or pain in the colon.
- Inflammatory bowel disease (IBD): Inflammatory bowel disease (IBD) refers to two chronic diseases that cause inflammation of the intestines: ulcerative colitis
- The cause of IBD remains unknown. However, current research indicates that IBD most likely involves a complex interaction of factors, including heredity, the immune system, and antigens in the environment.
- The symptoms of these two illnesses are very similar, which often makes it difficult to distinguish between the two. In fact, about 10% of colitis (inflamed colon) cases cannot be diagnosed as either ulcerative colitis or Crohn's disease. When physicians cannot diagnose the specific IBD, the condition is called indeterminate colitis.
- IBD causes chronic inflammation in the gastrointestinal tract and may lead to complications, such as colon cancer. The most common symptoms of both ulcerative colitis and Crohn's disease are diarrhea (ranging from mild to severe), abdominal pain, decreased appetite, and weight loss. If the diarrhea is extreme, it may lead to dehydration, increased heartbeat, and decreased blood pressure. As food moves through inflamed areas of the gastrointestinal tract, it may cause bleeding. Continued loss of blood in the stool may result in low levels of iron in the blood, a condition called anemia.
- In addition, Crohn's disease may also cause intestinal ulcers, fever, fatigue, arthritis, eye inflammation, skin disorders, and inflammation of the liver or bile ducts.
- Ulcers may extend through the intestinal wall creating a fistula (an abnormal opening). If an internal fistula develops, food may not reach the area of the intestine involved in absorption. External fistulas in the anus may result in continuous bowel drainage onto the skin. Fistulas may also become infected, a condition that can be life threatening if left untreated. Symptoms of a fistula may include pain, fever, tenderness, itching, and general feeling of discomfort.
- Toxic megacolon is a rare, but potentially life-threatening complication of severe IBD. Toxic megacolon is characterized by a dilated colon (megacolon), abdominal distension (bloating), and occasionally fever, abdominal pain, or shock. In severe cases, the condition may cause the colon to become paralyzed. Toxic megacolon prevents the individual from having bowel movements. If the condition is not treated, the colon may rupture, resulting in peritonitis, a life-threatening condition that requires emergency surgery.
- Other complications may include dehydration, malnutrition, obstruction, ulcers, and anal fissures.
- Many medications are used to treat IBD. Anti-inflammatories, such as sulfasalazine (Azulfidine®), mesalamine (e.g. Asacol® or Rowasa®), olsalazine (Dipentum®), and balsalazide (Colazal®), help reduce inflammation. Corticosteroids, such as prednisone (Deltasone®), have been shown to effectively reduce inflammation of the gastrointestinal tract in IBD patients. Medications, called immunosuppressants, have been used to treat IBD. Examples include azathioprine (Imuran®), mercaptopurine (Purinethol®), cyclosporine (e.g. Neoral® or Sandimmune®), and infliximab (Remicade®). A fiber supplement, such as psyllium powder (Metamucil®) or methylcellulose (Citrucel®), may help relieve symptoms of mild to moderate diarrhea. Inflammation may cause the intestines to narrow, resulting in constipation. Laxatives may be taken to relieve symptoms of constipation. Oral laxatives such as Correctol® have been used. A qualified healthcare provider may recommend acetaminophen (Tylenol®) to relieve mild pain. Avoid nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil® or Motrin®) or naproxen (Aleve®), as researchers have found a strong relationship between NSAIDs and IBD flare-ups. Therefore, NSAIDs should not be taken.
- If all other treatments fail to relieve symptoms, a qualified healthcare provider may recommend surgery. Surgery is more commonly performed in ulcerative colitis patients because inflammation is limited to the colon. During the procedure, the entire colon and rectum is removed (proctocolectomy).
- A new procedure, known as ileoanal anastomosis, eliminates the need for recovered patients to wear a bag to collect stool. This new procedure involves attaching a pouch directly to the anus, allowing the patient to expel waste normally. However, the patient may have as many as five to seven watery bowel movements a day because there is no longer a colon to absorb water. Between 25 and 40% of patients with ulcerative colitis eventually need surgery.
- Indigestion (non-ulcer dyspepsia): Indigestion, also called non-ulcer dyspepsia (upset stomach), is a general term that describes discomfort in the upper abdomen. Patients who have indigestion typically suffer from several symptoms, including heartburn, bloating, belching, and nausea.
- Indigestion affects nearly everyone from time to time, and it is not considered a serious health condition.
- Indigestion may occur if a patient eats too much of a particular food (especially fatty or spicy foods) or eats too quickly. Alcohol, stress, and anxiety may also contribute to indigestion.
- Because indigestion is such a common condition, it generally does not require a diagnosis. However, patients who frequently experience indigestion should visit their healthcare providers because it may be a symptom of an underlying medical condition, such as acid reflux disease.
- Antacids, such as calcium carbonate (e.g. Tums®, Alka-Mints®, and Rolaids Calcium Rich®), may be taken by mouth to treat symptoms of heartburn and upset stomach. Anti-flatulant medications, such as alpha-galactosidase enzyme (Beano®), simethicone (Gas-X®, Genasyme®, or Mylanta® Gas Relief), may be taken by mouth to prevent and/or treat symptoms of bloating and flatulence (gas).
- Monosodiumglutamate symptom complex (Chinese restaurant syndrome): Monosodium glutamate symptom complex, also called Chinese restaurant syndrome, is a group of symptoms that some patients develop after eating Chinese foods. Symptoms typically include flushing, headache, sweating, facial pain or swelling, numbness or burning around the mouth, and chest pain.
- Although it has been suggested that a food additive in Chinese food, called monosodium glutamate (MSG), may cause the reaction, it has not been proven. Since there is limited scientific data about the condition, it remains unknown if the frequency and amount of MSG exposure increases or decreases an individual's risk of experiencing symptoms.
- Patients generally do not require treatment for monosodium glutamate symptom complex because symptoms are mild and resolve on their own. However, if patients experience chest pain or difficulty breathing, they should seek immediate medical treatment because this may be a sign of a serious allergic reaction called anaphylaxis.
- Diverticulosis and diverticulitis: Diverticulosis refers to small, bulging pouches (diverticula) in any part of the digestive tract. Diverticula are most often found in the large intestine (colon). However, they may also develop in the esophagus, stomach, or small intestine.
- Diverticulosis is a common condition that affects more than half of Americans who are older than 60 years of age. Most patients do not know they have diverticulosis because they do not experience any signs or symptoms of the condition.
- However, if the diverticula become infected or inflamed, the condition is called diverticulitis. Patients with diverticulitis typically experience intense abdominal pain, nausea, bloating, bleeding from the rectum, tenderness in the abdomen, difficulty or pain during urination, fever, and changes in bowel movements.
- Diverticulitis is usually diagnosed after a computerized tomography (CT) scan is performed. A machine produces images of the internal organs in the abdomen. Inflamed diverticula will be apparent if the patient has diverticulitis.
- Mild cases of diverticulitis can be treated with rest, changes in the diet, and antibiotics. Patients should not eat any fiber, including whole grains, fruits and vegetables, for several days. This restricted diet gives the colon time to heal. Antibiotics, such as metronidazole (Flagyl®), moxifloxacin (Avelox®), ciprofloxacin (Cipro®),
amoxicillin/clavulanate (Augmentin®), and Imipenem (Primaxin®) are commonly prescribed to kill the bacteria that are infecting the diverticula.
- Serious cases of diverticulitis may eventually require surgery to remove the infected part of the colon.
- Peptic ulcers: An ulcer is an open sore or break in a body tissue. Peptic ulcers develop on the inside lining of the stomach (gastric peptic ulcer), upper small intestine (duodenal peptic ulcer), or esophagus (esophageal peptic ulcer).
- Researchers have found that a bacterial infection with Helicobacter pylori is the most common cause of gastric and duodenal ulcers. Some medications, including aspirin and nonsteroidal anti-inflammatory drugs (NSAIDS), such as ibuprofen (Motrin® or Advil®), may also cause gastric and duodenal ulcers. In addition, smoking tobacco increases a patient's risk of developing ulcers. It remains unclear whether or not excessive alcohol consumption leads to an increased risk of ulcers.
- Esophageal peptic ulcers are usually associated with acid reflux disease.
- Contrary to popular beliefs, diet and stress do not cause peptic ulcers. However, high levels of stress and acid foods and beverages, such as coffee, may aggravate symptoms of peptic ulcers.
- Peptic ulcers generally cause pain that may be felt anywhere from the chest to the stomach. Pain may last a few minutes to several hours. Symptoms are often the worst when the stomach is empty or at night. They may also come and go for a few days to weeks. Less common symptoms include vomiting blood, dark blood in the stools, nausea, vomiting, and unexplained weight loss.
- Most ulcers are diagnosed after an X-ray is taken of the upper gastrointestinal tract. An endoscopy may also be performed. During the procedure, a thin tube with a camera (endoscope) is inserted into the mouth and into the digestive tract. This allows the healthcare provider to see if ulcers are present.
- Patients take antibiotics, such as amoxicillin (Amoxil®), clarithromycin (Biaxin®), or metronidazole (Flagyl®), if an H. pylori infection is causing peptic ulcers. Patients also take medications called acid-blockers, which reduce the amount of acid in the stomach. As a result, the patient experiences less pain, and the gastrointestinal tract is able to heal. Examples of acid blockers include ranitidine (Zantac®), famotidine (Pepcid®), cimetidine (Tagamet®), and nizatidine (Axid®).
- Patients should take their medications exactly as prescribed. If medication is not taken regularly or stopped too early, the ulcer may not heal properly. Also, during treatment, patients should not smoke, consume alcohol, or take nonsteroidal anti-inflammatory drugs (NSAIDs) because they may worsen symptoms.
- Pyloric stenosis: Pyloric stenosis is a rare condition that occurs when babies are born with abnormally large muscles at the opening at the bottom of the stomach (pylorus). The pylorus connects the stomach to the small intestine.
- Babies with pyloric stenosis are unable to transport food into the small intestine. This may lead to: extremely forceful vomiting (also called projectile vomiting) that may contain blood, weight loss, dehydration, and electrolyte imbalances. Babies are usually hungry after vomiting. They may cry without tears because they are dehydrated.
- The exact cause of pyloric stenosis remains unknown. However, researchers believe that genetics plays a role.
- Most patients are diagnosed and treated when they are three to 12 weeks old. Babies with pyloric stenosis need to have surgery as soon as possible to correct the pylorus. The surgical procedure, called pyloromyotomy, involves reducing the size of the pylorus muscles. Patients typically experience an improvement in symptoms about 24 hours after surgery.
- Colic (infancy): Colic is usually defined as crying for more than three hours a day, three days per week, for longer than three weeks in an otherwise healthy baby.
- It remains unknown what causes colic. However, researchers have suggested that it may be caused by gastrointestinal problems, such as lactose intolerance or an immature digestive system. This is because sometimes a colic episode stops after a baby passes gas or has a bowel movement. Other possible causes include maternal anxiety, differences in the way a baby is fed or comforted, and/or allergies.
- There is currently no treatment that has been proven to be effective for the treatment of colic in babies. Colic typically goes away once the baby reaches three months of age.
- Biliary colic: Biliary colic, also called a gallbladder attack, describes pain and nausea that accompanies many disorders that affect the gallbladder. The gallbladder is an organ that stores digestive fluids that are needed to break down fats in foods.
- Biliary colic may occur when a gallstone moves through the biliary tract towards the small intestine. An attack may also be the result of cholestasis, which occurs when the flow of bile is blocked. Gallbladder attacks may also occur if the gallbladder becomes inflamed.
- Gallbladder attacks generally last one to four hours. Common symptoms include pain on the right side of the abdomen, nausea, vomiting, and bloating. The gallbladder, which is located in the lower right side of the abdomen, is usually tender to the touch. The pain may be dull, sharp, or excruciating. It is common for the pain to radiate to the right shoulder blade.
- A healthcare provider will be able to tell if a patient is having gallbladder attacks after a detailed medical history and physical examination is performed. The next step is to determine the underlying cause of the symptoms.
- Blood tests and liver function tests may be performed to determine if the patient has cholestasis. If the patient's alkaline phosphatase levels are three times higher than normal, cholestasis is indicated.
- A computerized tomography (CT) scan, magnetic resonance imaging (MRI) scan, or ultrasound may also be performed. These tests produce images of the internal organs and may help the healthcare provider detect abnormalities, such as gallstones, that may be causing the condition.
- An endoscopic retrograde cholangiopancreatography (ERCP) may be performed at the hospital to check for problems in the liver, gallbladder, bile ducts, and pancreas. During the procedure, a thin, flexible tube with a camera is inserted through the mouth into the small intestine. The tube then hooks into the bile duct, allowing the healthcare provider to see the biliary tract.
- Treatment of gallbladder attacks depends on the underlying cause. For instance, a gallstone may need to be surgically removed if it is causing symptoms. Antibiotics may be prescribed if an infection is the cause. If a medication is the suspected cause, a healthcare provider may recommend an alternative medication.
- Gastroenteritis: Gastroenteritis describes inflammation of the stomach and intestine that causes diarrhea, vomiting, and cramps.
- Gastroenteritis is often mistaken for the stomach flu or food poisoning because it causes similar symptoms. Although some doctors may call gastroenteritis the flu, gastroenteritis is not caused by any of the influenza viruses.
- An infection in the digestive tract may cause gastroenteritis. This may happen if patients consume foods or beverages that contain disease-causing bacteria, viruses, or parasites. In some cases, the food itself may irritate the patient's digestive tract. For instance, if a lactose intolerant patient consumes a dairy product, the stomach and intestines become irritated, which may lead to gastroenteritis. In addition, some mediations, including aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), some antibiotics, caffeine, laxatives, and steroids, may cause gastroenteritis.
- Most patients recover quickly from gastroenteritis. However, babies and the elderly have a greatest risk of developing life-threatening complications, such as dehydration and poor nutrition.
- If an infection is causing gastroenteritis, patients take medications called antimicrobials to kill the disease-causing organisms. Commonly prescribed antimicrobials include ciprofloxacin (Cipro®), trimethoprim/sulfamethoxazole (Bactrim®), and rifaximin (Xifaxan®, RedActiv®, or Flonorm®). Adults may also take medications, called antiemetics, which reduce vomiting. Commonly prescribed antiemetics include promethazine (Phenergan® or Anergan®), prochlorperazine (Compazine®), or ondansetron (Zofran®). Anti-diarrheals, such as diphenoxylate atropine (Lomotil®, Lofene®, or Lonox®) or loperamide hydrochloride (Imodium®), may also be taken to reduce diarrhea in patients older than three years old.
- Gaucher's disease: Gaucher's disease is a rare, inherited disorder that occurs when a fatty substance called glucocerebroside accumulates in the spleen, liver, lungs, and bone marrow. In some cases, it also affects the functioning of the brain.
- Patients with Gaucher's disease are born with low levels of a digestive enzyme called glucocerebrosidase, which breaks down glucocerebroside. This deficiency causes glucocerebroside to build up in the body.
- There are three types of Gaucher's disease: Type I, Type II, and Type III. Type I is the most common form. It causes enlargement of the liver (hepatomegaly) and spleen (splenomegaly) and it may also affect the lungs and kidneys. When fat develops in the liver, it is often called hepatic steatosis. Type I may develop at any age. Type II is a fatal condition that develops during infancy and causes severe brain damage. Most children with Type II Gaucher's disease die by the age of two years old. Type III causes the liver and spleen to enlarge and brain damage gradually occurs over time. Type III usually occurs in children and adolescents.
- Gaucher's disease is diagnosed after a blood test. Patients with the disorder will have low levels of glucocerebrosidase in their blood.
- There is currently no cure for Gaucher's disease. Patients with Type I and Type III Gaucher's disease take enzyme replacement therapy, which has been proven to effectively manage symptoms. However, there is no effective treatment to manage the symptoms of Type II.
- Gastroesophageal reflux disease (GERD): Gastroesophageal reflux disease (GERD), also called acid reflux disease, occurs when liquid from the stomach backs up (regurgitates) into the esophagus. This liquid may contain stomach acids and bile. In some cases, the regurgitated stomach liquid can cause inflammation (esophagitis), irritation, and damage to the esophagus.
- It remains unknown exactly what causes GERD. Several factors, including hiatal hernias (when the stomach pushes up through a hole in the diaphragm muscle), abnormally weak contractions of the lower esophageal sphincter, and abnormal emptying of the stomach after a meal, have been associated with GERD.
- Common symptoms of GERD include a burning sensation in the chest that may spread to the throat (heartburn), chest pain (especially when lying down), difficulty swallowing (dysphagia), regurgitating food or sour liquid, coughing, hoarseness, sore throat, and wheezing.
- Several factors may worsen symptoms of the condition. For instance, spicy foods, fatty foods, chocolate, caffeine, tomato sauce, carbonated beverages, mint, alcoholic beverages, large meals, lying down after eating, some medications (e.g. sedatives, tranquilizers, or blood pressure drugs), and cigarette smoking may worsen symptoms of GERD.
- Most cases of GERD can be diagnosed based on the patient's symptoms.
- GERD is usually a lifelong condition because there is no cure for the disorder. Patients must take medications for the rest of their lives to manage symptoms. In addition, patients should not smoke because it may increase the amount of stomach acid and worsen symptoms.
- Patients with mild cases of GERD may be able to manage their symptoms with over-the-counter medications and changes in the diet. Patients may experience improvements in symptoms if they eat smaller meals and eliminate foods that are known to cause heartburn.
- Antacids, such as Gelusil®, Rolaids®, Mylanta®, Maalox®, or Tums®, may neutralize stomach acid and provide quick relief of GERD symptoms. However, they will not help the esophagus heal. Patients who take antacids frequently may experience diarrhea or constipation.
- Some over-the-counter H-2 receptor blockers, such as cimetidine (Tagamet HB®), famotidine (Pepcid AC®), nizatidine (Axid AR®), and ranitidine (Zantac 75®), may also help provide quick relief of symptoms. These medications reduce the amount of stomach acid that is produced. Side effects of H-2 receptor blockers, which are uncommon, may include changes in bowel movements, dry mouth, dizziness, or drowsiness. Proton pump inhibitors, such as omeprazole (Prilosec®), may also be taken short-term to help the esophagus heal. Patients should not take these medications long term unless they talk with their healthcare providers first.
- Patients with persistent GERD may require prescription-strength medications to manage symptoms and prevent esophageal damage. H-2 blockers, such as Axid®, Pepcid®, Tagamet®, and Zantac®, are commonly prescribed. Examples of prescription-strength proton pump inhibitors include esomeprazole (Nexium®), lansoprazole (Prevacid®), omeprazole (Prilosec®), pantoprazole (Protonix®), and rabeprazole (Aciphex®).
- Achalasia: Achalasia is a rare disease that occurs when the muscles of the esophagus are unable to relax. The esophageal sphincter, which is the muscle between the lower esophagus and stomach, is unable to relax enough to allow food to pass into the stomach. Also, the lower half of the esophagus does not contract and relax properly. As a result, the food is not properly pushed down into the stomach, and patients have difficulty swallowing food (dysphagia).
- The exact cause of achalasia remains unknown. Researchers believe that several factors, including infections, genetics, and abnormalities in the immune system, may contribute to the development of the condition.
- The most common symptom of achalasia is difficulty swallowing solid foods and liquids. Some patients experience heavy sensations in the chests after eating that feels like chest pain. If food collects in the esophagus, it may cause irritation and lead to esophagitis (inflamed esophagus). Some patients may regurgitate their food if it is trapped in the esophagus. If regurgitated food enters the windpipe (trachea), it may cause infections such as pneumonia.
- Since patients have difficulty swallowing and consuming foods and beverages, they typically experience weight loss. Other complications may include malnutrition and dehydration.
- Achalasia is usually diagnosed after a video-esophagram is performed. During the procedure, the patient drinks a barium solution and video X-rays are taken of the esophagus. The healthcare provider is able to see if the barium enters the stomach properly. If the patient has achalasia, the barium will stay in the esophagus longer than normal. In addition, the lower end of the esophagus will be very narrow.
- Some patients may experience an improvement in symptoms if they eat slowly, take small bites, and chew their food thoroughly.
- In addition, patients with achalasia usually take nitrates, such as isosorbide dinitrate (Isordil®), and calcium-channel blockers, such as nifedipine (Procardia®) or verapamil (Calan®), to relax the muscles of the esophagus. These medications provide short-term relief of symptoms.
- A procedure called forceful dilation, or stretching of the lower esophageal sphincter, is often needed to open the esophagus and allow food to enter the stomach. During the procedure, a tube with a balloon at the end is inserted into the patient's esophagus. The balloon is placed across the sphincter and inflated. As a result, the sphincter stretches out. Forceful dilation successfully treats 65-90% of patients with achalasia. The most serious complication of forceful dilation is rupture of the esophagus, which occurs in about five percent of patients. If a rupture occurs, antibiotics and/or surgery may be required. Forceful dilation is generally quicker and less expensive than surgery.
- If forceful dilation is unsuccessful, a surgical procedure, called esophagomyotomy, may be performed. During the procedure, the sphincter is cut, which expands the esophagus and makes it easier for the patient to swallow. The procedure is more effective than forceful dilation. An estimated 80-90% of patients are treated successfully with esophagomyotomy. However, in some cases, dysphagia may return. The most common side effect of esophagomyotomy is GERD. In order to prevent GERD, the esophagomyotomy may be modified so that it does not completely cut the sphincter or the esophagomyotomy may be combined with anti-reflux surgery. Regardless of which surgery is performed, some healthcare providers recommend lifelong treatment with GERD medications, such as Axid®, Pepcid®, Tagamet®, or Zantac®. Other doctors only recommend lifelong treatment if GERD is diagnosed 24 hours after surgery.
- Botox injections in the lower sphincter are the newest treatment for achalasia. The botulinum toxin is injected to weaken the sphincter. The effects of treatment usually last for several months. Patients may require additional injections. Patients who are elderly or unable to undergo surgery typically receive this treatment. It may also be performed to help patients gain weight and improve their nutritional status before surgery.
- Esophageal spasms: Patients may experience spasms in the esophagus. Esophageal spasms may cause difficulty swallowing, painful swallowing, sensation that something is stuck in the throat, heartburn, and chest pain.
- The exact cause of spasms remains unknown. However, eating hot or cold foods may contribute to the condition. Also, gastroesophageal reflux disease (GERD) or heartburn may also play a role in the development of esophageal spasms.
- Patients typically take nitrates, such as isosorbide dinitrate (Isordil®), or calcium-channel blockers, such as nifedipine (Procardia®) or verapamil (Calan®), to relax the muscles.
Acute abdomen and stomach disorders
- Appendicitis: Appendicitis occurs when an organ in the lower right-side of the abdomen, called the appendix, becomes inflamed and filled with pus.
- The cause of appendicitis is not always clear. In some cases, appendicitis may occur if food waste or a solid piece of stool becomes trapped in an opening near the appendix. It may also occur after an infection.
- The most common symptom of appendicitis is severe pain in the lower right-hand side of the abdomen. Additional symptoms may include nausea, vomiting, loss of appetite, low-grade fever, constipation, bloating or inability to pass gas, diarrhea, and abdominal swelling.
- Patients with appendicitis will have high levels of white blood cells in their blood. Imaging studies are also performed to determine if the appendix is enlarged.
- Patients with appendicitis must have their appendix surgically removed as quickly as possible. Since the appendix has no known purpose, the patient's life is unaffected after the appendix is removed.
- If the appendix is not removed quickly, it may break open or rupture. If the appendix ruptures, it may lead to an infection in the lining of the abdominal cavity. Infections may cause a condition called peritonitis, which occurs when the abdominal lining becomes inflamed. If the appendix ruptures, the patient may start to feel better. However, soon after, the abdomen may swell because it becomes full of gas and fluid. At this point, the abdomen usually feels hard, tight, and tender to the touch. Severe pain also develops throughout the entire abdomen. Patients may be unable to pass gas or have a bowel movement. Additional symptoms of peritonitis include fever, thirst, and decreased urination.
- Patients who have symptoms of peritonitis should seek immediate medical treatment. Even if the condition is treated quickly, it may be fatal. Patients will receive aggressive treatment with intravenous antibiotics. Surgery is necessary to remove the burst appendix. Patients will also receive all fluids and nutrition through injections until their condition is improved.
- Stomach inflammation (gastritis): Stomach inflammation, also called gastritis, may develop suddenly (acute) or gradually over a longer period of time (chronic).
- Most cases of gastritis are caused by an infection with the same bacterium (Helicobacter pylori) that causes stomach ulcers. Gastritis may also be caused by traumatic injury or surgery, excessive alcohol consumption, and regular use of nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Motrin® or Advil®) or naproxen (Aleve®).
- A condition called bile reflux disease may also cause, or occur simultaneously with, gastritis. Bile reflux occurs when bile, a fluid that helps digest fats, flows upward from the small intestine into the stomach and esophagus. Bile reflux has also been found to be common after gallbladder removal, or as a result of complications from gastric surgery which may damage the pyloric valve (a ring of muscle that separates the stomach from the duodenum) such as gastrectomy, or gastric bypass. Further inflammation and damage to the lining of the stomach and esophagus may occur as a result.
- In rare cases, gastritis may occur when the body's own immune cells attack the stomach. It remains unknown what triggers this autoimmune reaction. The acid in the stomach may worsen symptoms of gastritis.
- Symptoms of gastritis generally include a burning pain or aching in the upper abdomen that may worsen when food is eaten, nausea, vomiting, loss of appetite, bloating, feeling of fullness in the upper abdomen after eating, and weight loss. In some cases, gastritis may cause stomach bleeding. Symptoms of stomach bleeding include blood in the vomit and black or dark-colored stools.
- In some cases, gastritis may lead to ulcers and an increased risk of stomach cancer.
- In most cases, patients fully recover quickly once treatment is started. Patients typically take antacids, such as Tums®, Mylanta®, or Rolaids®, to help neutralize the stomach acid. This helps reduce symptoms of gastritis quickly. Acid blockers, such as cimetidine (Tagamet®), ranitidine (Zantac®), nizatidine (Axid®), or famotidine (Pepcid®), may be taken to reduce the amount of stomach acid that is produced. Proton pump inhibitors, such as omeprazole (Prilosec®), lansoprazole (Prevacid®), rabeprazole (Aciphex®), and esomeprazole (Nexium®), may also be taken to reduce the amount of stomach acid produced.
- If an infection with H. pylori is causing gastritis, patients generally receive a combination of antibiotics and proton pump inhibitors. Commonly prescribed antibiotics include amoxicillin (Amoxil®), clarithromycin (Biaxin®), and metronidazole (Flagyl®).
- Hypochlorhydria (low stomach acid): Hypochlorhydria occurs when patients have low levels of stomach acid, also called hydrochloric acid. The body needs stomach acid in order to break down foods so that they can be absorbed in the intestines.
- Natural aging, a poor diet, chronic use of certain medications, and past infection with the Helicobacter pylori bacteria may limit a patient's ability to produce hydrochloric acid.
- Hypochlorhydria may also be a symptom of an underlying medical condition such as Addison's disease, depression, asthma, eczema, gallstones, hepatitis, osteoporosis, psoriasis, thyroid disease, and autoimmune disorders.
- If there is low acidity in the stomach, patients may only be able to partially digest food. This may lead to malnutrition. Symptoms of hypochlorhydria may include bloating, gas, belching, burning or dryness of the mouth, heartburn, multiple food allergies, rectal itching, redness or dilated blood vessels in the cheeks and nose, adult acne, hair loss (in women), iron deficiency, undigested foods in the stool, yeast infection, as well as diarrhea or constipation. Patients with hypochlorhydria also have an increased risk of developing infections in the gastrointestinal tract because it provides an ideal environment for disease-causing organisms, such as bacteria.
- Patients with hypochlorhydria take betaine hydrochloride or glutamic acid hydrochloride with meals and snacks. These medications increase the amount of stomach acid, which helps the body properly break down and digest foods.
- Ileus: Ileus occurs when the small and/or large intestine is partially or completely blocked. Ileus is a non-mechanical blockage. Unlike mechanical blockages, which occur when the bowel is physically blocked, a non-mechanical blockage occurs when the rhythmic contractions that move material through the bowel, called peristalsis, stops.
- Ileus is usually associated with an infection of the peritoneum, which is the membrane that lines the abdomen. This is most common in infants and children. Intestinal surgery may lead to temporary ileus that lasts two to three days. Ileus may also be a complication of surgery on other body parts, such as the chest or joints. Other medical conditions, including kidney disease and heart disease, may cause ileus. Some chemotherapy drugs, such as vincristine (Oncovin®, Vincasar PES®, or Vincrex®) or vinblastine (velban® or Velsar®), may cause ileus.
- Symptoms of ileus may include abdominal distention, abdominal cramping, nausea, vomiting, bloating or failure to pass gas, and difficulty having bowel movements.
- Patients with ileus must receive nutrition and fluids intravenously to give the intestines time to heal. If an infection is causing the condition, antibiotics are prescribed. Other medications, including cisapride and vasopressin (Pitressin®), may be prescribed to stimulate the intestines to contract and relax.
- Celiac disease (non-tropical sprue): Celiac disease, also called non-tropical sprue, is a digestive disorder that occurs when an individual's immune system overreacts to gluten, a protein found in wheat, rye, barley, and oats.
- When a patient with the disease eats food that contains gluten, the immune cells flood to the stomach and intestine to destroy the gluten. However, among these immune cells are autoantibodies that attack the lining of the intestine by mistake. As a result, the intestinal lining becomes damaged.
- It has not been determined what triggers this reaction in celiac patients. However, celiac disease is associated with autoimmune disorders, such as lupus. Autoimmune disorders occur when the patient's immune system mistakenly identifies body cells as harmful invaders, such as bacteria. As a result, the immune cells in celiac patients attack the patient's intestinal cells when gluten is consumed.
- Celiac disease causes symptoms of abdominal pain and bloating after consuming gluten.
- Additionally, complications, including poor absorption, may occur if the patient continues to eat gluten-containing foods. When the intestinal lining is damaged, patients have difficulty absorbing nutrients. Symptoms of poor nutrition include weight loss, diarrhea, abdominal cramps, gas, bloating, fatigue, foul-smelling or grayish stools that may be oily (steatorrhea), stunted growth in children, and osteoporosis (hollow, brittle bones).
- If celiac disease is suspected, blood tests will be performed to determine whether or not the patient has autoantibodies associated with the disease. If autoantibodies are present, a positive diagnosis is made.
- Although there is currently no cure for celiac disease, the condition can be managed with a gluten-free diet. Patients should avoid all foods that contain gluten. This includes any type of wheat (including farina, graham flour, semolina, and durum), barley, rye, bulgur, Kamut, kasha, matzo meal, spelt, and triticale. Therefore, foods such as bread, cereal, crackers, pasta, cookies, cake, pie, gravy, and sauce should be avoided unless they are labeled as gluten-free. In general, patients who strictly follow a gluten-free diet can expect to live normal, healthy lives. Symptoms will subside several weeks after the diet is started, and patients will be able to absorb food normally once they avoid eating gluten. A dietician or certified nutritionist may help a patient with celiac disease develop a healthy diet. Patients with celiac disease may also find gluten-free cookbooks to be a helpful resource. Many products, including rice flour and potato flour, can be used as substitutes for gluten-containing flour.
- Menke's kinky hair disease: Menke's kinky hair disease, also called Menke's disease, is an inherited disorder that decreases the body's ability to absorb copper. Cells in the body need copper to function properly. The disease is characterized by sparse and coarse hair, short stature, and progressive deterioration of the nervous system.
- Symptoms develop during infancy. Babies with Menke's kinky hair disease show slightly slowed development for two to three months after birth. The baby's condition will worsen after this time and he/she will lose previously developed skills. Other symptoms include silver or colorless hair, seizures, and osteoporosis (hollow and brittle bones).
- There is currently no cure for Menke's kinky hair disease. Patients may receive injections of copper. However, patients typically die by the age of ten.
- Acrodermatitis enteropathica: Acrodermatitis enteropathica is an inherited condition that occurs when the body is unable to absorb zinc. This trace element is necessary for the functioning of over 300 different enzymes and plays a vital role in an enormous number of biological processes.
- The exact cause of acrodermatitis enteropathica remains unknown. However, researchers believe that genetics may play a role.
- Symptoms of acrodermatitis enteropathica may include red and swollen patches of dry and scaly skin, crusted or pus-filled blisters on the skin, swollen skin around the nails, mouth ulcers, red and glossy tongue, impaired wound healing, as well as hair loss on the scalp, eyelashes, and eyebrows. Additional symptoms may include pinkeye, sensitivity to light, decreased appetite, diarrhea, irritability, failure to grow, and depressed mood.
- A zinc deficiency can be diagnosed after a blood test.
- Although there is no cure for the disorder, zinc supplements taken by mouth daily have been shown to effectively manage symptoms. Without treatment, acrodermatitis enteropathica will lead to death. Skin lesions usually heal one to two weeks after treatment is started. Other symptoms begin to improve within 24 hours.
- Hemorrhoids: Hemorrhoids are inflamed veins in the anus and rectum. Hemorrhoids may develop inside or outside of the rectum, depending on the specific veins that are affected.
- Hemorrhoids are common, affecting nearly half of individuals who are older than 50 years of age.
- Hemorrhoids develop when there is increased pressure in the veins of the anus and rectum. This is often due to straining during constipation, sitting or standing for extended periods of time, pregnancy, childbirth, and diarrhea. Obese patients have an increased risk of developing hemorrhoids.
- Internal hemorrhoids are not painful because pain nerves are not present inside the membranes of the rectum. However, internal hemorrhoids may cause bleeding when stools are passed. External hemorrhoids are usually painful. The veins outside of the rectum are swollen and may itch. Bleeding may occur, especially when straining to move the bowels.
- External hemorrhoids can be diagnosed after observing the inflamed veins. If internal hemorrhoids are suspected, a healthcare provider may examine the rectum with an anoscope, proctoscope, or sigmoidoscope.
- Mild cases of hemorrhoids are usually treated with over-the-counter creams or ointments, such as Preparation H®. Warm baths may also help improve symptoms.
- If a blood clot forms in a hemorrhoid, a healthcare provider can make a surgical incision to remove the clot.
- Rubber band litigation may be used to treat severe or persistent cases of hemorrhoids. During the procedure, small rubber bands are inserted around the base of the hemorrhoids. This cuts off the blood supply in the vein until the hemorrhoid falls off.
- During a procedure called sclerotherapy, a chemical is injected near the hemorrhoid to shrink the inflamed vein.
- If these therapies are ineffective, the hemorrhoids may be surgically removed in a process called hemorrhoidectomy.
- Rectal prolapse: Rectal prolapse occurs when the inner lining of the rectum, called the rectal mucosa, protrudes from the anus. Rectal prolapse occurs when the tissues that normally support that rectal mucosa become loose and allow the tissue to slip down through the anus.
- Without treatment, the condition may worsen and a large part of the rectum may protrude from the body through the anus. When this happens, the condition is called a complete prolapse. Most patients do not realize that they have rectal prolapse until it reaches this stage. Initially, the rectum may protrude during certain activities, such as coughing or laughing. Eventually, the prolapsed rectum may protrude more frequently or permanently.
- Patients may be able to feel the tissue protruding out of the anus. Common symptoms of rectal prolapsed include pain during bowel movements, mucus or bleeding from the protruding tissue, and inability to control bowel movements.
- Most patients with rectal prolapsed require surgery. The surgeon reattaches the rectum to the backside of the inner pelvis. Surgery may be performed through the abdomen or the perineum.
- Stool softeners, such as calcium docusate (Surfak®) or sodium docusate (Colace®), may help reduce pain and straining during bowel movements.
- Rectal inflammation (proctitis): Rectal inflammation, also called proctitis, occurs when the lining of the rectum (rectal mucosa) becomes swollen. Patients with proctitis often experience rectal bleeding, anal and rectal pain, frequent urge to have a bowel movement, passing mucus through the rectum, feeling of rectal fullness, and diarrhea.
- There are many potential causes of proctitis. The most common cause is sexually transmitted diseases, which are acquired through anal or oral-anal intercourse. Other causes may include inflammatory bowel disease (IBD) and bacterial infections, such as streptococcus. Less common causes include chemicals (such as hydrogen peroxide enemas), injury to the rectum, radiation therapy that is applied near the rectum (for conditions such as prostate or cervical cancer), and medications or objects that are inserted into the rectum.
- Several tests may be performed to diagnose the underlying cause of proctitis. Blood tests may be performed to detect possible infections. A colonoscopy may be performed to examine the inside of the colon for abnormalities. Healthcare providers may also use a swab to collect a sample of fluid from the rectum or urethra. The sample is then tested for STDs.
- Most cases of proctitis are effectively treated and patients experience a full recovery. Treatment depends on the underlying cause of proctitis. If a bacterial infection is present, antibiotics, such as ciprofloxacin (Cipro®), levofloxacin (Levaquin®), penicillin, amoxicillin (Amoxil® or Trimox®), azithromycin (Zithromax®), clarithromycin (Biaxin®), or clindamycin (Cleocin®), may be taken. If a viral infection (e.g. herpes) causes proctitis, antivirals, such as such as acyclovir (Zovirax®), may be taken. Corticosteroids may be taken if radiation therapy is causing proctitis. If IBD is causing symptoms, anti-inflammatories, such as sulfasalazine (Azulfidine®) or anti-diarrheals, such as psyllium powder (Metamucil®), may be taken.
- Laxative-induced colon damage: Laxatives are medications that are used to stimulate bowel movements. They are primarily used to treat constipation. Patients who overuse laxatives may develop colon damage. Long-term use of laxatives may cause the muscles in the colon to become weak from lack of use. The nerves in the lining of the colon may also become damaged. As a result, this may slow intestinal mobility and cause constipation.
- Symptoms of laxative abuse include weight loss, hair loss, vomiting, abdominal pain, low energy, dehydration, dry eyes, headaches, mood swings, and bone pain.
- Therefore, patients should not take laxatives more frequently than the packaging label suggests. If symptoms persist, patients should consult their healthcare providers to diagnose and properly treat the underlying cause.
Copyright © 2011 Natural Standard (www.naturalstandard.com)
The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.