Hair Pulling Disorder, Trichotillomania, an Unreported Psychological Issue

The hair-pulling disorder is also known as trichotillomania in the medical community. It is a type of impulse control disorder that involves involuntarily pulling of one’s own hair. It is a chronic disease and faces difficulty in its treatment.

The hair-pulling disorder is noticed most commonly in infants. Children age 9 to 12 years are the most common victims of psychological disease. The repercussions include hair loss and consequently a sense of gratification in most cases. However, in some cases, a person is unaware of his actions so it is not necessary that a person suffering from hair pulling disorder is performing the unwanted action to gain a sense of relief or gratification. It runs in the periphery of obsessive-compulsive disorder commonly abbreviated as OCD.


The symptoms are stark. Evident loss of hair is the prime symptom. The most common and the foremost area affected by it is the scalp. The victim later resorts to pulling eyebrow hair, eyelashes, facial hair, the hair on arms and legs, and pubic hair. Even the hair type of such individuals assume a different form altogether. The hair growth is found to be uneven and the ends of the hair may be blunt and broken; some may be tapered. However, no effect is caused on the density of the hair.

A person suffering from trichotillomania exhibits low self-esteem. In many cases, a person feels he is the only victim of this psychological problem. This is mainly due to the fact that most cases of TTM go unnoticed or unreported.

Drastic consequences of this problem include permanent loss of hair. Another consequence is trichophagia. It is an advanced condition of trichotillomania which involves the ingestion of hair by the person after pulling it. This can lead to gastrointestinal problems.

The activity is performed when the person is in a relaxed state of body and mind. This is usually before sleeping i.e. while lying in bed. In some cases, a person pulls his hair while asleep. This condition is termed as sleep-isolated trichotillomania.


The most common reason for hair pulling disorder is the mental stress which an individual undergoes. Anxiety and depression are other related factors. The obstructive compulsive disorder is commonly encountered in such individuals.


The diagnosis of hair-pulling disorder is an uphill task. This owes to the fact that most cases are gone unreported and many times unnoticed. A person suffering from trichotillomania shall actively conceal his problems. Use of wigs, false eyelashes, eyebrow pencils is very common among such people. The diagnosis is not difficult once the problem is detected. A differential diagnosis is impactful and so is a biopsy. It is noteworthy that the hair pull test in such individuals is always negative.


The treatment involves behavior modification programs and counseling. If you would like to look into possible treatment options for you or a loved one, click here. This can be impactful in earlier stages especially during childhood. In extreme cases help from psychologists and psychiatrists is essential. In many cases, medication for the same is also very impactful. Antidepressants are required to cater to the same. Behavioral therapy is another effective treatment for the hair-pulling disorder.

Frequently Asked Questions

Most cases of infant reflux are caused by immaturity of the LES (lower esophageal sphincter) or muscle between the stomach and esophagus.  When working properly, this muscle opens to allow food to pass through into the stomach and closes again once it has.  Most babies with reflux will simply have minor coordination problems with this muscle that will eventually improve in time.

Will this ever go away?

As previously mentioned, more than likely, yes.  Many children will outgrow their reflux within the first few months and by twelve to eighteen months, most of them will have outgrown it.

How do I know if my baby has reflux?

Because infant reflux is so common, many times reflux is diagnosed simply by the symptoms the infant is presenting.  Some doctors prefer to have tests confirm reflux before prescribing medication.

My baby appeared to have been outgrowing their reflux but just recently seems to be getting worse again, is it coming back?

This is where the coined phrase “Reflux Roller Coaster” applies.  It does tend to have ups and downs.  Sometimes it can be attributed to something the child ate not agreeing with them, teething can irritate reflux many times, as can colds, flus, and other common illnesses.  Other times, it can get worse for a day or more with no apparent reason.  The good news is, that just as these lows come, they go again and things do improve.

What is the best formula to use when a baby has reflux?

Every baby is different so it’s difficult to pinpoint one specific formula that is the best for reflux.  If the baby has a milk allergy or sensitivity then soy based or hypoallergenic will likely help the reflux improve. 

Some studies have suggested that acid reflux is hereditary. If this is a problem that you also find yourself dealing with, you can visit IES Medical Group to learn more about what long-term solutions are available to you.

I am breastfeeding but am wondering if this is making my baby worse, should I switch to formula?

The short answer is definitely not.  Unless your doctor specifically tells you otherwise, breast milk is the best thing for reflux.  It’s proteins are more hypoallergenic than that of formula and it’s much more easily digested than formula. If there is a concern about the baby having a reaction to breast milk, try eliminating milk and milk products from the diet first.  Also, it may be beneficial to eliminate other foods that can make reflux worse.

How do I get my baby to sleep?

This is truly the million dollar question for most parents with refluxers.  Babies with reflux are notoriously poor sleepers.  Propping them can be helpful, small frequent meals and try not to feed them too close to bedtime.  If they are on medications, administering the meds a half hour or so before bed may be helpful.

I’ve been told since my baby is gaining weight that his reflux is nothing to worry about but he/she cries all day.  What can I do?

Read our tips for getting taken seriously, getting a diagnosis and try some of the tips we mention.  If that doesn’t work, try videotaping the infant or keeping a dairy of the crying.

Are there any support groups in my area?

PAGER would likely be the best place to start to look for local support groups.  Otherwise, we have a member who has been discussing starting one in Hawaii, contact us for information on that, or try posting on our message boards…some of our members may know of local groups.

We started adding rice cereal to the formula to thicken it but it seems to make things worse.  What next?

Some babies have reactions to rice that can make their reflux worse.  In these cases adding oatmeal instead has proved to work.  Speak to the pediatrician about trying this option.

I heard that Goat’s milk would be digested better with acid reflux, so we tried it and the baby was able to digest it much better than her other formula. However, the doctor said it could ruin the baby’s kidneys. What is the truth?

Actually, both are right. Goat’s milk can be easier to digest and many babies can do better on it than cow’s milk formula. In the UK you can even get Goat’s Milk based infant formula.

The problem with Goat’s Milk is that there are certain aspects of it that are not nutritionally complete or even safe for a baby. The protein is too high which can create too much work for the kidneys and damage them, as well, there are certain deficiencies in some vitamins and minerals. It can be safe if properly diluted and mixed, but it’s not safe to give it to a baby as it’s sold in stores.

Gestational Diabetes: What You Should Know

Diabetes—the body’s failure to convert sugar to energy—usually strikes people in their later years. However, some women are also liable to develop a temporary form of diabetes while carrying a baby. This type, which occurs in about 1 out of 25 pregnancies, has been labeled gestational diabetes. It occurs most frequently in the final 3 months before delivery. Like other forms of the disease, gestational diabetes is caused by either a shortage of the natural hormone insulin or the body’s inability to use whatever insulin is available. When insulin fails to do its work, sugar builds up in the blood—and excess sugar can be very harmful to the baby. For this reason, it’s essential to control your blood sugar level if you develop this disease. Although gestational diabetes usually goes away a few weeks after delivery, the problem may return later in life.


Hormones released by the placenta (the tissue in the uterus that connects mother and baby) tend to interfere with insulin. Gestational diabetes is more likely to result if you are overweight or over 30 years old, have had a previous stillborn delivery, or have a family history of diabetes. It’s also more likely if the baby is unusually large (more than 9 pounds at birth).


  • Hunger
  • Thirst
  • Frequent urination
  • Blurred vision
  • Excess weight gain during your pregnancy


  • If the diabetes is mild, you may be able to keep your blood sugar down by following a special diet recommended by your doctor.
  • If the diabetes is serious enough, you may need to make regular checks of the sugar in your blood and give yourself insulin shots. You might be hospitalized for tests and treatment.
  • Keep insulin, syringes, and a fast-acting sugar (such as hard candy) with you when away from home in case you have an attack of low or high blood sugar.

Call Your Doctor If…

  • You think your baby is not moving as much as usual.

Seek Care Immediately If…

  • If you have hypoglycemia (low blood sugar): Quickly drink one-half to 1 cup of fruit juice or non-diet cola, or quickly eat some hard candy, sugar pills, or sweet syrup, then call 911 for help. Signs of hypoglycemia are:
  • Blurred or double vision
  • Confusion
  • Fainting
  • Hunger
  • Quick heart rate
  • Quick, shallow breathing
  • Shaking
  • Sweating
  • If you have hyperglycemia (high blood sugar): Take insulin based on your blood sugar level, then call your doctor immediately. If you cannot reach your doctor, have someone drive you to the nearest emergency room or call 911. Signs of hyperglycemia are:
  • Abdominal pain
  • Fast breathing
  • “Fruity” smelling breath
  • Headache
  • Fast, weak pulse
  • Nausea and vomiting
  • Frequent urination
  • Reddened, dry skin
  • Sleepiness
  • Thirst


What to Expect While You’re There

You may encounter the following procedures and equipment during your stay.

  • Taking Vital Signs: These include your temperature, blood pressure, pulse (counting your heartbeats), and respirations (counting your breaths). A stethoscope is used to listen to your heart and lungs. Your blood pressure is taken by wrapping a cuff around your arm.
  • Fetal Heart Monitoring: A loose-fitting belt may be placed around your abdomen to measure your baby’s heart rate. The belt holds a small metal disc attached to a machine with a TV-like screen that shows a tracing of the baby’s heartbeat.
  • Urine Sample: A doctor may ask for a sample of your urine. It will be tested to determine the number of ketones (KEE-tones) and sugar it contains. (When the body has excess sugar, some of it appears in the urine.) The results can alert the doctor to the need for more tests.
  • Blood Tests: You’ll probably have your blood sugar level tested. The blood can be drawn from a vein in your hand or from the bend in your elbow. Several samples may be needed.
  • IV: A tube placed in your vein for giving medicine or liquids. The IV will be capped or have tubing connected to it.
  • Strict Intake/Output: Your doctor may need to know the amount of liquid you are taking in versus the amount you lose in your urine. This is often called an “I&O.”
  • Unless told otherwise, drink 6 to 8 large glasses of water each day. Keep a record of exactly how much liquid you drink.
  • Your output of urine may have to be measured. Ask your doctor whether it’s OK to use the toilet.
  • Ultrasound: This painless test uses sound waves to scan internal organs such as the uterus. Pictures of the organs show up on a TV-like screen.
  • Insulin: If your blood sugar level is very high, you’ll be given insulin to bring it under control. The insulin may be given as a shot many times a day or may be delivered through your IV. You’ll later be taught how to give the insulin shots to yourself.

Besides gestational diabetes, there are also a number of gastrointestinal conditions that may arise during pregnancy such as GERD, gallstones, and constipation. If you are experiencing any of these complications, consider looking into the types of endoscopy procedures that could be beneficial to you.

Diabetic Ketoacidosis: What You Should Know

Ketoacidosis (KEY-toe-ASS-ih-DOE-sis) is one of the many dangerous complications of diabetes. The problem develops when the body is unable to get enough energy from blood sugar and begins to use fat. As a byproduct of this process, chemicals called ketones flood the bloodstream. Together with excess sugar, the extra ketones can build up to dangerous, even life-threatening levels. This condition needs immediate care from your doctor.


The body needs insulin in order to process blood sugar efficiently and prevent the excessive breakdown of fats; so diabetic ketoacidosis is often the result of a diabetic’s failure to take enough insulin, or to take any insulin at all. The problem may also be triggered by infection, injury, and emotional stress. Often, doctors can find no immediate cause.


Early signs include excessive thirst, frequent urination, headache, nausea, and vomiting. The breath may begin to take on a fruity odor, and you may develop rapid deep breathing, sleepiness, and fatigue. Other symptoms include weight loss and a feeling of fullness or pain in the stomach.


Call your doctor when you first notice early signs. You may need to be hospitalized for tests and treatment. If the condition is left untreated, it could lead to coma and death.

You can also visit IES Medical Group to learn more about your options for treatment procedures.

What You Should Do

  • To keep from losing too much water from your body, drink 1 to 2 glasses of fluid (soda-can sized) every hour, or sip 1 tablespoon of liquid every 10 to 15 minutes.
    • If you can’t eat, alternate between drinking fluids with sugar (soda, juices, flavored gelatin, or ice) and salty fluids (broth or bouillon).
    • If you can eat, follow your usual diet and drink sugar-free liquids (water or diet drinks).
  • Be sure to take your usual daily dosage of insulin, even if you can’t eat.
  • Continue to monitor your blood or urine glucose every 3 to 4 hours around the clock. Set your alarm clock or have someone awaken you. If you are too sick, have someone do the test for you.
  • Your doctor will tell you the safe range for your blood or urine glucose levels. If either measure higher than that level, you will need to test for ketones.
  • Rest and avoid exercise.

Call Your Doctor If…

  • You have ketones in your urine or your blood sugar is over the level your doctor considers safe. You may need extra insulin.
  • You cannot keep any liquids down.
  • You have been vomiting for more than 1 hour.
  • You develop any of the more advanced symptoms of ketoacidosis (fruity breath, rapid breathing, extreme sleepiness).

Seek Care Immediately If…

  • You have signs of dehydration:
    • Decreased urination.
    • Increased thirst.
    • Light-headed feeling.

Your blood or urine glucose measurement remains higher than the level judged safe by your doctor even when you take 2 extra doses of insulin per 24 hours.

Diabetes and Impotence

Being diabetic can often lead to quite a few complications if your blood glucose goes up and down and if your HBA1C is repeatedly over 7.5.

Impotence is one of the most common diabetic complications, but doctors and diabetic nurses seldom talk about it. Perhaps they are ashamed to bring it up, or they simply don’t know where to start the discussion. Luckily for you, our team here at is not shy to speak about how diabetes can lead to impotence, how you can improve your erections, and which treatments you can choose between.

Why do so many diabetics suffer from impotence?

Erections may sound simple, but in reality, it’s a complex process. When getting aroused, the body’s own nerves, blood vessels, and muscle cells must interact. When having diabetes type 1 or 2, you are more likely to get complications affecting the nerves and blood vessels. High blood glucose simply makes the blood vessels clog, making it harder to get an erection. If you are overweight and smoke at the same time, while doing too little exercise – the risk of erectile dysfunction (ED) increases drastically. There are also many different medications that can give ED as a side effect.

How to improve your erectile function?

If you have a healthy lifestyle and steady blood glucose, you are way less likely to discover erection problems. Some of the tips below might be obvious, while others might come as a surprise:


  • Avoid smoking: While smoking can increase the risk of stroke, heart attacks, and lung cancer, it is also one of the major reasons people get impotence. However, if you quit smoking early it’s often possible to reverse the damage to some extent.
  • Exercise: Daily walks, jogging, or going to the gym a few times a week can increase blood flow and help maintain stronger erections. The body also produces testosterone when doing exercise, which is essential for hard erections.
  • Antioxidants: Powerful antioxidants found in dark fruits such as blackberries can help to attack the free radicals, before they try to lower your nitric oxide levels, according to research from Indiana University.
  • Eat less fat & red meat: Too much red meat and fat can lead to high cholesterol and cardiovascular diseases, which is often closely related to erectile dysfunction.
  • Cut down on drinking: Drinking too much alcohol can also have a negative effect on your erectile function.

How many male diabetics suffer from impotence?

According to some statistics, over 40 % of men with diabetes suffer from some form of erectile dysfunction. It’s common to get the first signs of impotence 10 or 15 years earlier than men who do not suffer from diabetes. The good thing is that poor erectile function can often be reversed if you keep good control of your diabetes.

Impotence treatments for men with diabetes

There is a wide range of medical treatments for those diabetics suffering from erection problems.

1. Viagra

The effect usually starts within 30-45 minutes and may last up to 6 or 8 hours. However, if you consume fatty food a few hours before taking the Viagra pill, it might reduce the effect or it might take longer to get any effect at all. In general, Viagra is a safe medication, unless you use any pharmaceuticals containing nitrates. Side effects are usually limited to headache, dizziness, temporary flushing, or short time visual disturbances.


You can buy Viagra from regulated online clinics such as euroClinix, which apart from the UK also serves Sweden and other Scandinavian countries where diabetes is very spread out. If living in the UK, you can of course always find a health service near you at the NHS website.


2. Cialis

While this usual medication starts to work within 20-30 minutes, it often lasts for up to 36 hours. In other words, you don’t need to take this potency pill as often as the others. Among the other advantages, you find that anything can be eaten with Cialis, while it still gives the same effect. The most common side effects include headache, indigestion, back pain, flushing, or a stuffy nose. You can order Cialis from the usual places or from your nearest pharmacy after speaking to your doctor.


3. Levitra

Vardenafil, the active ingredient in Levitra, has been efficient enough to help diabetic men get an erection within 20-30 minutes when they are aroused. This pill lasts for about 10 hours and is one of the fastest-growing medicines to treat impotence.  Headaches, dizziness, visual changes, sleepiness, or increased heart rate are among the possible side effects. However, Levitra is said to have among the least side effects of all potency pills and is often the medication of choice for men with diabetes and for men over 50.


4. Natural remedies

If you are looking for alternative, herbal remedies for impotence treatment, you might consider Gingko, Horny Goat Weed, Ginseng, or Spanish fly. While it may enhance vitality and erection among some men, many claim the natural remedies are nothing compared to the prescription medications mentioned above.

Besides problems with impotence, another common condition associated with diabetes is obesity. If you are seeking medical treatment for these conditions, consider visiting IES Medical Group for a beneficial endoscopic procedure.

Maladies & Diseases

Nausea and Vomiting

Nausea and vomiting can occur in association with infectious and noninfectious GI disorders, pregnancy and motion sickness. They can also follow the administration of many drugs including cancer chemotherapy, antibiotics, narcotic pain medications and nonsteroidal anti-inflammatory drugs such as ibuprofen. There is a vomiting center in the brain that receives signals from multiple sites and once stimulated causes the natural motility of the stomach to be reduced so that gastric reflux occurs. Vomiting results when the stomach relaxes, the passage from the stomach to the intestine constricts and the contractions of surrounding muscles cause expulsion of the gastric contents.

Several chemicals in the body are involved in the transmission of information passing into and out of the vomiting center. Drugs used to block these chemicals are used to treat nausea and vomiting. The chemicals being blocked are involved in many other bodily functions, so many drugs used to treat nausea and vomiting have other uses. For example, drugs categorized as major tranquilizers, antihistamines, antianxiety agents, and corticosteroids are often effective. Transderm Scop® (Novartis Pharmaceuticals) contains an antihistamine substance in a patch formulation. It is used to prevent motion sickness and is applied to the skin at least 4 hours before travel. Tetrahydrocannabinol (from Cannabissativa) is sometimes used for the relief of nausea and vomiting from cancer chemotherapy. Due to the ability of causing physical and psychological dependence and hallucinations, it is reserved for patients who have not responded to other forms of treatment.

Bismuth subsalicylate preparations including Pepto Bismol® are available OTC and are helpful in some cases of nausea and vomiting due to their local antiinfective actions, direct mucosal protective effects, and weak antacid properties.

Herbal supplements or teas containing ginger are often used to decrease nausea and vomiting. The mechanism by which it acts is unclear. Ginger increases saliva formation and stimulates movements in the intestine but it does not seem to effect stomach emptying. A component of ginger, galanolactone, blocks one of the chemicals involved in stimulating vomiting. As with other herbal supplements, there is currently no standardized measure to compare the potency or ingredient content of products that contain ginger so the effectiveness of preparations can vary widely. Another natural product sometimes used to decrease nausea and vomiting, particularly when associated with pregnancy, is vitamin B6 (pyridoxine).


Diarrhea has many causes. It is associated with diseases of inflammation (Crohn’s), bacteria, viruses, fungi, and parasites. It can also be caused by food poisoning, chemical poisons, and drugs – such as magnesium-containing antacids and some antibiotics. Acute diarrhea is usually self-limiting and resolves within 24 hours. Prolonged episodes of diarrhea can cause dehydration and electrolyte disorders and require medical attention. Some forms of diarrhea are treated by the use of prescription drugs that slow GI motility (Lomotil®, Imodium®) but these drugs are generally not used in cases of poisoning, diarrhea caused by toxin-producing bacteria and with an infectious condition called pseudomembranous colitis.

Several over-the-counter (OTC) drugs for uncomplicated diarrhea are available. Pepto-Bismol® (bismuth subsalicylate) has antiinfective actions, a protective effect on the gastric lining, and weak antacid activity. It is sometimes used to prevent traveler’s diarrhea. Kaopectate® (attapulgite) is thought to act by absorbing bacteria and toxins, and reducing water loss. Lactobacillus containing preparations may be used to prevent and treat uncomplicated diarrhea associated with antibiotic use. These products act to maintain the normal bacterial content of the intestinal tract.


Constipation is an infrequent passage of usually dry, hardened stools. It has a number of causes including infection, neurological disorder, and many different disease states. Dehydration and lack of exercise are contributing factors. Medications can also cause constipation, including narcotics, antihistamines, some antidepressants, iron and calcium.

There are many types of laxative available over-the-counter. Psyllium containing products are bulk-forming laxatives and are the agents of choice as initial therapy for most forms of constipation. They are also generally the safest laxative agents and have been shown to reduce cholesterol in patients with high cholesterol. Stool-softeners increase the water content of the stool, while irritant/stimulant laxatives have direct action on the intestinal mucosa. Laxatives such as mineral oil are oral and rectal lubricants that retards colonic absorption of fecal water and softens the stool. Chronic use of laxatives, except the psyllium containing preparations, may result in loss of normal bowel function and dependence. Laxatives should be avoided in people with GI obstruction, acute abdominal pain, vomiting or appendicitis as their use can worsen these conditions. Fecal impactions, particularly in the elderly and debilitated population, may require medical treatment.


Hemorrhoids are enlarged veins in the mucous membrane inside or outside of the rectum. Pain does not usually occur with internal hemorrhoids unless a complication such as a fissure also exists. External hemorrhoids can cause pain and itching, and may be accompanied by bleeding. Surgery may be indicated in some cases of hemorrhoids.

Several drug treatments provide symptomatic relief of hemorrhoids. Preparation H suppositories® combine cocoa butter and shark liver oil to form a physical barrier and lubricate the rectal area. In addition to these ingredients, Preparation H creme and ointment® contain glycerin and petrolatum that act as physical barriers and lubricants, and phenylephrine that constricts local blood vessels thus reducing the swelling and itching. Use of topical astringents, such as witch hazel pads, is sometimes soothing. Topical corticosteroids are used to reduce inflammation, itching and swelling. One preparation combines the corticosteroid hydrocortisone with bismuth. The bismuth provides a protective barrier to the irritated area and prevents water loss from the skin. Many products contain local anesthetics such as benzocaine and pramoxine, and are available in multiple forms including foams, suppositories, sprays, creams and ointments. Some products, including some prescription treatments for hemorrhoids, combine an anesthetic with a corticosteroid.

Gallstones (cholelithiasis)

Gallstones are formed in the gallbladder and are made primarily of cholesterol or bilirubin (a byproduct of blood breakdown). They can block the ducts of the gall bladder that lead into the intestine, and can affect gallbladder, liver or pancreatic function. Symptoms may not be present. When symptoms are present, they include sharp right-sided pain up near the rib cage often with associated nausea and vomiting. Surgery is often indicated, although a few oral preparations may assist in the dissolution of the gallstones.


Heartburn is a pain in the chest near the area of the heart but actually results from the esophagus being irritated by stomach acid that is refluxed back into the esophagus. It is referred to as gastroesophageal reflux disease (GERD). It usually occurs after meals or while lying down. Several different treatments both over-the-counter and prescription are available to adequately treat this condition. Antacids neutralize the gastric acid, while other drugs block or decrease gastric acid production. Continuous symptoms indicate the need for medical treatment because the long-term consequences of untreated GERD may be serious.

Peptic Ulcer Disease (PUD)

Peptic ulcer disease (PUD) is a breakdown of the lining of the stomach or the duodenum allowing the underlying tissue to be damaged by gastric acid. Although the cause of the disease is not always known, the bacteria Helicobacter pylori or use of the nonsteroidal anti-inflammatory drugs (NSAIDs) have been shown to be involved in many cases. Symptoms are diverse and often relieved by food or antacids, although in some people eating may make the pain worsen. There are several effective drugs available to treat to this disease. In cases where H. pylori is involved, antibiotic treatment is used. Other drugs decrease gastric acid secretion or act by forming a protective cover over the ulcer. Antacids may be used for symptomatic treatment.

Lactose Intolerance

Lactose is a sugar present in dairy products that requires an enzyme called lactase to break it up so it can be absorbed and used by the body for energy. Many people lack the enzyme lactase. In fact, 75% of African-Americans, 90% of Asian-Americans and an estimated 30-50 million North Americans are lactose intolerant. When a person does not have this enzyme, drinking milk or eating lactose-containing products will cause diarrhea, and possibly nausea, vomiting and cramps. Symptoms can be avoided by maintaining a lactose-free diet or ingesting commercially prepared lactase prior to eating lactose-containing foods.

Gastroesophageal Reflux Disease (GERD)

See heartburn.

Crohn’s Disease

Crohn’s disease (CD) is a type of inflammatory bowel disease (IBD) that can affect both the small and large intestine. The lesions are patchy and involve the entire thickness of the intestine most often in the ileum. CD is a chronic condition that may recur at irregular intervals. The most common symptoms are abdominal pain and diarrhea along with generalized weakness, fever, loss of appetite and weight loss. There are several drugs available that can help control CD. These include oral or rectal forms of aminosalicylates such as sulfasalazine and mesalamine, corticosteroids, immune modifiers such as azathioprine and methotrexate, and certain antibiotics. Certain patients with resistant forms of CD may require surgery.

Infliximab (Remicade®, Centocor) is new treatment sometimes used for people with moderate to severe CD that is resistant to the traditional forms of therapy. It may also be used in CD complicated by the presence of fistulas. Infliximab is given by an intravenous infusion and contains antibodies to TNF-alpha. TNF-alpha is involved in the inflammatory process and appears to be elevated in people with CD. The long-term safety of this treatment has not been established.

Maintenance of proper nutrition is important in the medical treatment of CD because poor absorption in the presence of a decreased appetite may lead to depletion of nutrients. Although people with UC may require chronic drug treatment, they generally lead a normal, productive life. There is no cure currently available, however research into new forms of treatment offers hope for improved therapy.

The presence of CD increases the risk for colon cancer. An annual colonoscopy is often recommended as a screening mechanism depending on other risk factors, particularly any evidence of precancerous tissue. There is a currently great research effort to define chemopreventive agents for colon cancer as well as many other types of cancer. Chemoprevention is the attempt to use natural and synthetic compounds to interfere at the early stages of cancer, before invasive disease begins.

Ulcerative Colitis

Ulcerative colitis (UC) is a type of inflammatory bowel disease (IBD). Diagnosis is generally made by history, visualization of the intestine through sigmoidoscopy or colonoscopy, and examination of tissue biopsies by a pathologist. In UC only the lining of the colon (the mucosa) is inflamed and the lesions are symmetric in the affected area. Clinical manifestations of IBD are diarrhea (sometimes bloody), malaise, cramping, abdominal pain and sporadic fever. Treatment consists of aminosalicylates (given orally or rectally) such as sulfasalazine and mesalamine, corticosteroids, and immune modifiers such as cyclosporine and azathioprine. Occasionally nicotine patches or enemas are used in the treatment of UC. IBD resistant to drug treatment may require surgery.

Maintenance of proper nutrition is important in the medical treatment of UC because poor absorption in the presence of a decreased appetite may lead to depletion of nutrients. Although people with UC may require chronic drug treatment, they generally lead a normal, productive life.

Chronic ulcerative colitis increases the risk for colon cancer. Annual colonoscopy is often recommended as a screening mechanism depending on other risk factors, particularly any evidence of precancerous tissue. There is a currently great research effort to define chemopreventive agents for colon cancer as well as many other types of cancer. Chemoprevention is the attempt to use natural and synthetic compounds to interfere at the early stages of cancer, before invasive disease begins. (See colon cancer below.)

Cancers of the Gastrointestinal System


Colorectal cancer is very common, usually occurring after the age of 50. The existence of polyps (protrusions of tissue from the wall of the bowel into the lumen) generally precedes the development of colorectal cancer. Polyps are painless but can bleed, causing blood to be present in the stool. The progression to cancer usually does not occur until after the age of 40 unless there is a genetic-linked familial disorder. Routine medical examination helps detect colorectal cancer at early stages, thereby improving the likelihood of successful treatment. Simple tests to chemically detect small amounts of blood in the stool that are not visible to the eye can be easily performed in the home.

Both polyps and colon cancer occur much more frequently in Western societies where the diets are low in fruits, vegetables, protein from vegetable sources and fiber. Smoking and drinking alcoholic beverages appear to increase the risk of polyp formation. Evidence suggests that diets high in calcium, folic acid and fiber act as chemopreventive agents, reducing the risk of colorectal cancer. There is evidence that use of some nonsteroidal anti-inflammatory drugs (NSAIDs) prevents polyp progression to cancer in certain people. Other drugs are being tested as chemopreventive agents against colon cancer including urosodiol, a bile acid used in the prevention and treatment of gallstones.


Esophageal cancer is relatively rare in the United States. It is more common in men than in women. The most common presenting symptom is difficulty swallowing. People who regularly consume alcohol or smoke (or both) are at increased risk for the development of esophageal cancer. Untreated gastroesophageal reflux disease (GERD) resulting in chronic irritation to the lower esophagus makes the cells more susceptible to cancer development.


Risk for gastric (stomach) cancer increases with age. Evidence suggests that high salt intake, a diet low in fresh fruits and vegetables, and infection with H. pylori are associated with an increased risk of gastric cancer; whereas diets high in whole grain cereals, carotene, and green tea are associated with a reduced risk of this cancer.

Early detection is often difficult because the symptoms are often vague. They include weakness, fatigue, decreased appetite, indigestion, abdominal pain and bloating. The detection of blood in the stool may indicate gastric cancer, but can also be caused by many other things. People with continuous gastric symptoms should seek medical attention. The IES Medical Group treats a variety of gastric problems with state-of-the-art technology, consider booking an appointment with them today if this is something that interests you.


Pancreatic cancer is more common among males than females, with the peak incidence occurring at 60 years of age. The cause is not known. Cigarette smoking and long-term exposure to some chemicals such as dry cleaning fluids, gasoline or metallurgic fumes, appear to increase the risk of this cancer.

Symptoms of pancreatic cancer are often not present at the early stages. When they occur they are usually generalized such as nausea, loss of appetite, weight loss, and weakness. If cancer has spread to the nearby bile duct, jaundice may be seen as yellowing of the whites of the eyes and skin.

Although pancreatic cancer is generally difficult to treat at this time, research aimed at developing early detection techniques and novel forms of therapy are underway. Other research is aimed at determining the effectiveness of a pancreatic cancer vaccine used in combination with chemotherapy and radiation therapy.