Medication and the Ostomate

Contents

· Medications and an Ostomy

· All About Generics

· British NHS Death Rates High

· Bone Facts for Women

· How Long Will You Live?

· The Ostomates Bill of Rights

· Carcinoid Tumors

· Bone Loss for People with Crohn’s

· Survive a Heart Attack Alone

· Medication and the Ostomate

· Blood Pressure

· How the Digestive System Works

· Diet Affects Prostate Cancer

· Appeal Denied Medicare Claims

· Aspirin Can Prevent Polyps

· Generic Drugs

· Bacteria in the Small Intestine

Medications and an Ostomy

By Jill Conwill, MSN, ET, Corpus Christi Ostomy News

There are a variety of forms in which medications are dispersed. Many of the medications prescribed by a physician are done with the knowledge that their patient is a person with an ostomy. With the many specialists in the medical field, it is a good practice to remind your physician that you have an ostomy just in case the medication needs to be dispersed in a more digestible form. The following list discusses some of the forms in which medications are dispersed and how they affect the ostomate:

Chewable means it should be completely chewed. Any fragments left may be found in the effluent—stomal output. If you routinely chew all of your tablets or separate capsules, you may be looking for trouble. Many medications are not meant to be chewed.

Enteric Coated tablets have dissolution delayed. These tablets have diminished or minimal effectiveness for someone with an ileostomy.

Gelatin Coated are less effective than liquids if the person with an ostomy has short bowel syndrome.

Liquids are more rapidly absorbed. If you have difficulty swallowing pills, ask for the medication in a liquid form.

Sustained Release medications take 8 to 12 hours to absorb. These capsules should not be chewed or opened—unless approved by your pharmacist. These capsules are designed to release slowly after they pass through the stomach, not before. Side effects may be exacerbated if directions are not followed.

Sugar Coated tablets do not dissolve completely until the tablet reaches the ileum. Watch for traces of the tablet in the effluent.

Uncoated tablets begin to dissolve in the stomach. But, the complete time taken to dissolve may vary among different products ... always ask your pharmacist to be on the safe side.

Here are some special notes regarding certain medication groups.

Antacids use basic compounds—alkaline—which are used to reduce acidity of the gastric contents. Sodium bicarbonate based antacids are high in salt. Magnesium based antacids have a laxative effect—which means do not take them if you have an ileostomy, irrigate, or have renal failure. Aluminum based antacids delay the emptying time of the stomach; inhibit the absorption of iron; are constipating; and increase the excretion of products in urine like aspirin.

Antibiotics may often result in diarrhea. If so, then increase your fluid intake. Antibiotics alter the normal bacteria found in the large intestine and may result in a fungal—yeast, candida—infection. The large intestine has either bacteria or fungus, it is never “clean”. Make sure you use a micro-granulated anti-fungal powder under your barrier whenever you are taking antibiotics in order to fight off fungal invaders.

Anti-flatulent medications help in the dispersing and prevent the formation of gas—Mylicon or Gas-X. If the flatus is the result of the types of foods; i.e., beans, broccoli, try Beano.

Chemotherapy may cause gastrointestinal tract disturbances. If you are currently irrigating and diarrhea begins, stop until the stool regains consistency. Make sure you inform your doctor about all side effects as well as any vitamins, supplements or medications you are taking. Many react to chemotherapy.

Diuretics may result in fluid and electrolyte imbalances. Ileostomates should not take these—unless seriously researched by your doctor. If you irrigate, you may find you get poor results due to the dehydration of the colon.

Laxatives should never be taken by a person with an ileostomy. Mineral oil should not be taken with a meal ... it delays the emptying time of the stomach. Bulk-forming products—Metamucil—must be taken with sufficient water or it will be constipating. The best way to control output is through diet. Natural laxatives like warm prune juice as well as adding fruits, vegetables and fluids are best.

Odor Control can be obtained by medications that have a bismuth subgallate base—Devrom Tablets. Chlorophyll is in parsley but may be purchased in capsule form. They will turn the stool green.

Pain Medications are constipating so be sure to drink plenty of fluids.

Salt Substitutes reduce sodium and should be avoided by people with ileostomies.

Vitamins are often taken without consulting your physician. Always inform your doctor if you are taking vitamins. There are instances when prescribed medications can interact with vitamins resulting in ineffective absorption or cause adverse reactions.

When starting a new medication, ask what you should expect in the way of side effects related to your ostomy. Most pharmacies present a list of actions and side effects with each prescription. If problems arise, call your physician so that the problem does not get out of hand. Communication with your doctor and your pharmacist will always pay off in the end. Plus, most doctors and pharmacist will have to call the drug manufacturer on some medications because absorption by someone with an ostomy may be obscure.

All About Generics

Researched By The New Outlook

With the costs of medicines escalating, it’s nice to know that you can save money on your medications with generics. Most doctors, in fact, use a combination of generic and brand-name medications to offer the best health care solutions.

Generic equivalents of brand-name drugs have the same active ingredients and potency, are available in the same dosage forms—tablet, liquid or injection—and are demonstrated safe and effective. But note, fillers and dyes can be different and usually are. These other ingredients do sometimes effect the efficacy of a drug.

Since 1984, no generic drug has been approved in the U.S. unless it has been shown to have the same rate and amount of active drug absorbed as the brand name. However, people do have different bodily chemistries, and what may be fine for one person may not even work for another.

As a group, generics have no proven age-related side effects that are different from brand-names and are considered as safe. The FDA allows no drug on the market unless it is proven to meet their stringent safety, efficacy and manufacturing standards. All generics are put through a rigorous multi-step approval process before they are considered brand equivalents.

The FDA can also recall products if they don’t meet production standards and can even stop the manufacture of products until the manufacturing firm shows that it can make and test its’ drugs in a way that meets their high standards.

The laws governing generic substitution vary significantly from state to state. Only a medical doctor upon physical examination can determine which drug may yield the optimal result for the condition being treated.

However, unless the doctor writes, “DAW,NS” (dispense as written, no substitutions) or “Brand Medically Necessary” on the prescription, you have the freedom to choose whether you want the brand name or the generic product. In some states, pharmacies must dispense the generic unless the doctor requests no substitution. In other states, the pharmacy must receive authorization from both the doctor and the patient before a generic equivalent can be dispensed. Most pharmacies will not substitute a generic drug unless you request it, and the generic substitution is in accordance with your state’s laws.

As we always say, discuss this and any other questions you may have with your medical professional. Most doctors and pharmacists will be glad to invest a moment with you discussing alternatives that may be in your best interest.

Britain NHS Death Rates High

By Jo Revill, The Observer

Waiting lists and shortage of doctors blamed for grim mortality figures. Patients who have major surgery in Britain are four times more likely to die than those in America, according to a major new study.

The comparison of care, which reveals a sevenfold difference in mortality rates in one set of patients, concludes that hospital waiting lists, a shortage of specialists and competition for intensive care beds are to blame.

Fresh evidence of a stark contrast between the fate of patients on either side of the Atlantic will re-open the debate over whether NHS reforms are having any impact on survival rates.

Mounting evidence suggests that patients who are most at risk of complications after an operation are not being seen by specialists, and are not reaching intensive care units in time to save them.

This week health Ministers will present the latest figures showing another yearly rise in the number of intensive care beds for those who are critically ill. But Britain lags far behind America in its critical care facilities. An authoritative study to be published later this year will demonstrate that the chances of survival after undergoing a major operation are far greater in an American hospital.

The authors conclude that NHS waiting lists, the lack of specialist-led care and the fact that many patients do not go routinely to intensive care contribute largely to the difference.

The results, which surprised even the researchers, showed that just 2.5% of the American patients died in hospital after major surgery, compared with a whopping 10% of British patients. They found that there was a sevenfold difference in mortality rates when a subgroup of patients—the most seriously ill—were compared.

It is believed that the queue for treatment in the NHS would inevitably mean that British patients were more at risk. Diseases are more advanced in the UK, simply because the waiting lists are longer. It does seem to show a difference in the systems of care, rather than a reflection of some other factor. The provision of intensive-care beds is obviously one of the differences. In America, everyone would go into a critical care bed—they go into a highly monitored environment. That doesn't happen routinely in the UK. Each year, more than three million operations are carried out on the NHS. Around 350,000 of these are emergencies, which carry a higher risk of complications, but there is no routine triage system in Britain for picking out patients before surgery, to determine who is most at risk.

Previous reports looking at deaths that occur within 28 days of surgery have shown that 36 per cent occurred in patients who went directly into ICU after surgery. But a higher mortality rate—42 per cent—is seen among patients who had first been sent to a ward, got into difficulties and then had to be transferred to intensive care. There are substantial number of patients each year who die, who might otherwise have survived had they got the appropriate kind of care after surgery.

There's a crucial six- to eight-hour period when some people need their cardiac output [the amount of blood the heart pumps out each minute] boosted. Even 80-year-olds undergoing heart surgery are far more likely to survive when they receive that care.

Bone Facts for Women

Contributed By Jane Michnik

What you don't know about your bones can hurt you. Bone-thinning osteoporosis is responsible for fractures in one in two women past age 50, yet in many cases, it can be prevented, scientists say. "Many people are surprisingly misinformed or uninformed about how to build healthy bones."

Here are some bone facts you should know. Your calcium needs vary with age: 500 milligrams for ages 1-3; 800 mg for 4-8; 1,300 mg for 9-18; 1,000-1,200 mg for pregnant and lactating women; 1,000 mg for adult women; 1,200 mg for post-menopausal women taking hormones and 1,500 mg for those not on hormone treatment.

Your body cannot absorb more than 500 milligrams at a time, so wait four to six hours between doses or dairy servings. Cottage cheese is a poor source of calcium. Good sources include non-fat yogurt and such hard cheeses as Parmigiano and Swiss. Low-fat dairy products are higher in calcium than whole-milk products.

Foods and beverages that interfere with calcium absorption include heavily salted foods such as bacon, salami, smoked salmon, prepared soups and salty snacks, colas, drinks with caffeine and an excess of alcohol. About 15 minutes of daily sunlight without sunscreen will produce all the Vitamin D you need. Osteoporosis begins in the teen years.

Beginning at age 9, children (particularly girls) perhaps should include calcium in their diet. Cardiovascular exercise such as biking or swimming is better for the heart than for the bones. Engage in weight-bearing exercises such as running, jumping and lifting. When older women lose height, suffer back pain or develop a protruding abdomen or "dowager's hump" on their back, chances are "that's a sign of a vertebral fracture of the spine." Early menopause, amenorrhea (loss of your period, sometimes as a result of too much exercise), estrogen inhibiting birth-control drugs such as Depo-Provera, late puberty, irregular periods or other menstrual disorders put women at higher risk of developing osteoporosis.

Medications that can reduce bone mass include glucocorticoids used to control arthritis and asthma, some anti-seizure drugs, certain sleeping pills, some hormones used to treat endometriosis and certain cancer drugs.

How Long Will You Live

By L. Wruble, M.D

Well, prepare, for good news! There have been only a few long-term studies of the postoperative life of people with an ostomy. The findings that have been made known were mainly done since the 1990’s. What do you think is the ultimate outcome? What may a person with an ostomy expect in terms of health and life expectancy?

The studies that have been done indicate that the health of a person with an ostomy is exactly the same as that of anyone else. And, of more importance, there is no difference in their life expectancy from the general population. Every part of the intestinal tract works in harmony, so it might be expected that the removal of one part, such as the colon, might affect the rest. But the studies reveal no indication of this. Diseases of the intestinal tract such as gallstones and peptic ulcers are not found to be in higher incidence after ostomy surgery. There is, however, an increase in the formation of kidney stones in the ileostomate, possibly because of the increase in the absorption of certain chemicals that stimulate the formation of stones.

There is an enormous amount of data, which indicates that women with ostomies have no more problems with their pregnancies than women without ostomies. The gastroenterologist's major thrust in therapy has always been through the patient's diet. In recent years, however, it has been found that diet really has small value in most gastrointestinal conditions.

According to dietary studies, there is no one food that affects a person with an ostomy out of proportion to other foods. To sum up, I would say that the diet of the person with an ostomy should be a normal diet and that the outlook for his of her health is on a par with that of the population as a whole.

The Ostomate’s Bill of Rights

It is the declared objective of the International Ostomy Association that all ostomates shall have the right to a satisfactory quality-of-life after
their surgery and that this charter shall be realized in all countries of the world.

A Person With An Ostomy Shall:

Receive preoperative counseling to ensure that they are fully aware of the benefits of the operation and the essential facts about living with a stoma.

Have a well-constructed stoma placed at an appropriate site, and with full and proper consideration to the comfort of the patient.

Receive experienced and professional medical support and stoma nursing care in the preoperative and postoperative period both in hospital and in their community.

Receive full and impartial information about all relevant supplies and products available in their country.

Have the opportunity to choose from the available variety of ostomy management products without prejudice or constraint

Be given information about their National Ostomy Association and the services and support which can be provided.

Receive support and information for the benefit of the family, personal care givers, and friends to increase their understanding of the conditions and adjustments, which are necessary for achieving a satisfactory standard of life with a stoma.

Receive assurance that personal information regarding ostomy surgery will be treated with discretion and confidentiality to maintain privacy.

Issued by the IOA coordination committee June 1997.

Survive a Heart Attack ... Alone

By F. Daniel Rochman MD

Let's say it's 6:15 p.m. and you're driving home (alone of course), after an unusually hard day. You're really tired, upset and frustrated. Suddenly, you start experiencing severe pain in your chest that starts to radiate out into your arm and up into your jaw.

You are only about five miles from the hospital nearest your home; unfortunately, you don't know if you'll be able to make it that far. What can you do?

You've been trained in CPR but the guy that taught the course neglected to tell you how to perform it on yourself. Since many people are alone when they suffer a heart attack, this article seemed to be in order. Without help, the person whose heart stops beating properly and who begins to feel faint, has only about 10 seconds before losing consciousness. However, these victims can help themselves by coughing repeatedly and very vigorously.

A deep breath  should be taken before each cough, and the cough must be deep and prolonged, as when producing sputum from deep inside the chest, and a cough must be repeated about every two seconds without let up until help arrives, or until the heart is felt to be beating normally again.

Deep breaths get oxygen into the lungs and coughing movements squeeze the heart and keep the blood circulating. The squeezing pressure on the heart also helps it regain normal rhythm. In this way, heart attack victims can get to a hospital.

Carcinoid Tumors

Macclesfield District General Hospital, Macclesfield, UK.

Carcinoid tumors are often difficult to diagnose because of obscure or non-specific symptoms. Two cases of ileal carcinoid are reported in whom the diagnosis was delayed as the symptoms and small-bowel series were thought to be consistent with Crohn’s disease.

This report emphasizes the difficulties of diagnosing carcinoid by conventional radiological
methods. Ileal carcinoid should be considered in the differential diagnosis of Crohn’s disease, particularly in elderly patients presenting with chronic recurrent symptoms.

Bone Loss in Patients with Crohn’s

Forwarded By Dave Rudzin

Osteopenia is highly prevalent in patients with Crohn's disease, particularly those who have had the disease for the longest duration. But, it is not due to steroid use, according to a Canadian study.

Crohn's disease is associated with a number of musculoskeletal complications. However, the precise nature and incidence of these events is still unknown. Osteoporosis occurs in 30% to 50% of patients with Crohn's disease and the pathogenesis is thought to be multifactorial.

Previously, researchers proposed that corticosteroid therapy and prolonged chronic inflammation affect the risk of osteoporosis. To determine whether patients with Crohn's disease ultimately become osteopenic and how steroid use and disease duration are related to bone loss, scientists evaluated the relationship between steroid dose, duration of disease and development of osteopenia in patients with Crohn's disease.

Their study included 11 women and 17 men with a mean age of 40.7 years who were diagnosed with Crohn's disease. Notably, all but two patients were in clinical remission. The researchers assessed patients' bone mineral density and levels of several bone-related factors and analyzed these measurements with respect to cumulative steroid dose. The mean standardized dose in this cohort was 17.2g of prednisone. Osteopenia of the spine was detected in 19 patients.

The researchers also found that disease duration had a significant effect on z-scores. A greater z-score means greater bone density for ones particular profile. A z-score under 0 reflects bone loss. Patients who had Crohn's disease more than two years also had a significantly lower lumbar spine and femoral neck z-scores than those with shorter disease duration. No correlation was found between cumulative steroid dose and bone density or steroid dose and biochemical markers of bone turnover. Steroid dose was not associated with a risk of vertebral fracture.

The researchers conclude from this study that patients with Crohn's disease have a reduced bone mineral density, which is due not simply to steroids, but is significantly correlated with disease duration. Also, the chronic inflammatory process and the nature of the disease itself are important with respect to loss of bone mineral density and need further exploration.

An additional notice on this subject especially for people who had ulcerative colitis.

Background & Aims:

Although patients with inflammatory bowel disease (IBD) have reduced bone mass, there is controversy whether there is an increased risk of fracture. This study examines the risk of fracture and its predictors in patients with IBD.

Methods:

In a primary care-based nested case-control study, 231,778 fracture cases and 231,778 age- and sex-matched controls were recruited. A history of IBD was assessed from medical records.

Results:

The prevalence of IBD was 156 and 282 per 100,000 for Crohn's disease (CD) and ulcerative colitis (UC), respectively. Patients with IBD had an increased risk of vertebral fracture (odds ratio [OR], 1.72; 95% confidence interval [CI], 1.13-2.61) and hip fracture (OR, 1.59; 95% CI, 1.14-2.23). The risk of hip fracture was greater in patients with CD (OR, 1.86; 95% CI, 1.08-3.21) compared with UC (OR, 1.40; 95% CI, 0.92- .13).

Disease severity, assessed by the number of symptoms, predicted fracture even after adjusting for corticosteroid use (OR, 1.46; 95% CI, 1.04-2.04). Only 13% of patients with IBD who had already sustained a fracture were on any form of antifracture treatment.

Conclusions:

Patients with IBD have a higher risk of fracture due to both disease activity and use of oral corticosteroids. However, few of these patients are receiving optimal bone-sparing therapy, highlighting the importance of increasing awareness of osteoporosis in those managing these patients.

Medication and the Ostomate

--Metro Maryland

Because of special problems medication may pose for ostomates, we should be aware of both those

that are beneficial and those that are harmful.

Sigmoid colostomates have fewer problems absorbing medication, but ileostomates and transverse colostomates may not absorb some formulations as well, and therefore may not get full benefits from the medication.

· Liquid medicines are rapidly absorbed.

· Chewable tablets allow dissolution of the drug when the tablet is swallowed, provided it is chewed correctly; otherwise, fragments may be found in the effluent.

· Uncoated tablets begin to dissolve in the stomach, but the complete time taken to dissolve may vary among products.

· Gelatin capsules are less effective than liquids but are still effective. They may be

ineffective for ostomates who have a short bowel.

· Enteric-coated capsules have delayed dissolution. Such tablets may be only partially effective when used by certain types of colostomates. They should probably be avoided by ileostomates and those with short bowel syndrome.

· Sustained-release medication takes eight to 12 hours for absorption and should be avoided by ileostomates, transverse colostomates and those with short bowels.

· Pain medications can cause constipation.

· Diuretics should be avoided by ileostomates. They waste potassium.

· Antibiotics may cause diarrhea and are not well absorbed; ostomates may receive less benefit than needed.

· Laxatives should never be used by ileostomates or transverse colostomates. Mineral oil, psylium or other bulk producing products may be helpful to sigmoid colostomates. Mineral oil may also be instilled into the stoma of a sigmoid colostomate before irrigation.

· Vitamins other than B-12 should be taken in chewable or liquid varieties. B- 12 is usually only usable when given by injection.

· Antacids which contain calcium, should be avoided by urostomates because of the possibility of stone formation. Calcium and magnesium products should be avoided by ileostomates because of their laxative effect. Aluminum compounds like Amphogel have an anti-diarrhea effect, and can be used even when a person has diarrhea.

· Stool softeners may be needed by a sigmoid colostomates.

· Oral contraceptives are sometimes absorbed in the small bowel. An ileostomate who elects to take them might require an inject able form. Some oral forms will not

be absorbed by ileostomates. Ask you pharmacist to be sure.

· Sulfa must only be used by a urostomate when large amounts of water are also consumed. This is to minimize crystallization. If ascorbic acid, vitamin C, is being

taken, it should be discontinued while sulfa is being used.

· Salt substitutes reduce sodium intake and should be avoided by ileostomates.

Blood Pressure

--The Johns Hopkins Medical Letter

Physicians in the past diagnosed high blood pressure (BP) based on diastolic pressure. The bottom number in a BP finding—the diastolic value—is the pressure in the arteries as the heart relaxes between beats. Elevated diastolic BP is strongly associated with increased risk of death from heart disease and stroke. However, beginning at around age 60, diastolic BP often begins to plateau and may even decline. Simultaneously, systolic BP often starts to rise. The top number in a finding—the systolic value—is the pressure of the blood in the arteries when the heart contracts. BP is expressed as millimeters of mercury (mmHg).

Until recently, rising systolic BP was considered normal. But research shows that systolic elevations are strongly linked with death from stroke, heart attack, congestive heart failure, or kidney failure—even when diastolic BP is relatively low. The phenomenon is so widespread that it is recognized as a bona fide medical condition known as isolated systolic hypertension (ISH).

About 5% of adults develop ISH by age 60, and about a quarter of those in their 80's have it. Recognition of the importance of ISH began to emerge in 1991 with completion of the landmark Systolic Hypertension in the Elderly Program.

When researches used low-dose diuretic medications to control ISH in more than 4,500 elderly patients, the incidence of stroke dropped 35% and the risk of heart failure was cut in half. For subjects who had experienced a heart attack before entering the study, heart failure risk fell by 80%. Other research has borne out these results—notably, a study of 3,600 hypertensive patients published in the journal Hypertension.

ISH is diagnosed based on established categories similar to those used when both diastolic and systolic values are elevated (stages 1, 2 and 3 hypertension). Like all types of hypertension, ISH should be treated more aggressively when coronary heart disease (CHD) or CHD risk factors—smoking, high cholesterol, diabetes, or a family history of early CHD—are present. Age is also a factor—more aggressive treatment is required for men after age 60 and for women after menopause.

Treatment usually begins with diuretics such as hydro-chlorothiazide (Hydrodiuril) and ferosemide (Lasix). Other medications that may be considered include:

· Beta-blockers, which are often used for people who have had a heart attack, as well as for stage 2 and stage 3 hypertension;

· Angiotensin-converting enzyme (ACE) inhibitors, which are especially appropriate for patients who also have diabetes or heart failure, and often for those who have had a heart attack;

· Angiotenin II receptor blockers, which can be used if ACE inhibitors have to be discontinued because of a dry cough or other side effects:

· Long-lasting calcium channel blockers, which are often particularly effective for ISH—short-acting formulations can cause heart damage and should not be used.

Most people who require drug therapy can be managed with one medication, but about 40% need combination treatment. Lifestyle measures—not smoking, limiting alcohol consumption, exercising, maintaining a healthy diet and losing weight—are also important.

A Blueprint for Treatment

Optimal blood pressure is 120/80 mmHg or below. Though values of around 130/85 are still considered normal, they are classified as "high normal" and should not be ignored. ISH is diagnosed when systolic findings are consistently 140 or above and diastolic findings are consistently below 90.

Isolated systolic values between 140 and 159 are considered mild to moderate; values over 160 are considered moderate to severe. Treatment should be guided by the following criteria, established by the Joint National Committee on Prevention, Evaluation and Treatment of High Blood Pressure for state 1 (140-159/90-99), stage 2 (160-179/100-109), and stage 3 (180/110 and above) hypertension. When systolic and diastolic values fall into different categories, the higher finding should generally guide treatment.

How the Digestive System Works

Adapted By The New Outlook

The digestive system is a series of hollow organs joined in a long, twisting tube from the mouth to the anus. Inside this tube is a lining called the mucosa. In the mouth, stomach and small intestine, the mucosa contains tiny glands that produce juices to help digest food.

There are also two solid digestive organs, the liver and the pancreas, which produce juices that reach the intestine through small tubes. In addition, parts of other organ systems; i.e., nerves and blood, play a major role in the digestive system.

Why is Digestion Important?

When we eat such things as bread, meat and vegetables, they are not in a form that the body can use as nourishment. Our food and drink must be changed into smaller molecules of nutrients before they can be absorbed into the blood and carried to cells throughout the body. Digestion is the process by which food and drink are broken down into their smallest parts so that the body can use them to build and nourish cells and to provide energy.

How is Food Digested?

Digestion involves the missing of food, its movement through the digestive tract, and chemical breakdown of the large molecules of food into smaller molecules. Digestion begins in the mouth, when we chew and swallow and is completed in the small intestine. The chemical process varies somewhat for different kinds of food.

Movement of Food Through Our System

The large, hollow organs of the digestive system contain muscle that enables their walls to move. The movement of organ walls can propel food and liquid and also mix the contents within each organ. Typical movement of the esophagus, stomach and intestine is called peristalsis. The action of peristalsis looks like an ocean wave moving through the muscle. The muscle of the organ produces a narrowing, and then propels the narrowed portion slowly down the length of the organ.

The first major muscle movement occurs when food or liquid is swallowed. Although we are able to start swallowing by choice, once the swallow begins, it becomes involuntary and proceeds under the control of the nerves.

The esophagus is the organ into which the swallowed food is pushed. It connects the throat above with the stomach below. At the junction of the esophagus and stomach, there is a ring-like valve closing the passage between the two organs. However, as the food approaches the closed ring, the surrounding muscles relax and allow the food to pass.

The food then enters the stomach, which has three mechanical tasks to do. First, the stomach must store the swallowed food and liquid. This requires the muscle of the upper part of the stomach to relax and accept large volumes of swallowed material. The second job is to mix up the food, liquid and digestive juice produced by the stomach. The lower part of the stomach mixes these materials by its muscle action. The third task of the stomach is to empty its contents slowly into the small intestine.

Several factors affect emptying of the stomach, including the nature of the food—mainly its fat and protein content—and the degree of muscle action of the emptying stomach and the next organ to receive the stomach contents—the small intestine. As the food is digested in the small intestine and dissolved into the juices from the pancreas, liver and intestine, the contents of the intestine are mixed and pushed forward to allow further digestion.

Finally, all of the digested nutrients are absorbed through the intestinal walls. The waste products of this process include undigested parts of the food, known as fiber, and older cells that have been shed from the mucosa. These materials are propelled into the colon, where they remain, usually for a day or two, until the faces are expelled by a bowel movement.

Production of Digestive Juices

Glands of the digestive system are crucial to the process of digestion. They produce both the juices that break down the food and the hormones that help to control the process.

The glands that act first are in the mouth—the salivary glands. Saliva produced by these glands contains an enzyme that begins to digest the starch from food into smaller molecules.

The next set of digestive glands is in the stomach lining. They produce stomach acid and an enzyme that digests protein. One of the unsolved puzzles of the digestive system is why the acid juice of the stomach does not dissolve the tissue of the stomach itself. In most people, the stomach mucosa is able to resist the juice, although food and other tissues of the body cannot.

After the stomach empties the food and its juice into the small intestine, the juices of two other digestive organs mix with the food to continue the process of digestion. One of these organs is the pancreas. It produces a juice that contains a wide array of enzymes to break down the carbohydrates, fat and protein in our food. Other enzymes that are active in the process come from glands in the wall of the intestine or even a part of that wall.

The liver produces yet another digestive juice—bile. The bile is stored between meals in the gallbladder. At mealtime, it is squeezed out of the gallbladder into the bile ducts to reach the intestine and mix with the fat in our food. The bile acids dissolve the fat into the watery contents on the intestine, much like detergents that dissolve grease from a frying pan. After the fat is dissolved, it is digested by enzymes from the pancreas and the lining of the intestine.

Absorption and transport of Nutrients

Digested molecules of food, as well as water and minerals from the diet, are absorbed from the cavity of the upper small intestine. The absorbed materials cross the mucosa into the blood, mainly, are carried off in the bloodstream to other parts of the body for storage or further chemical change. As noted above, this part of the process varies with different types of nutrients.

Carbohydrates

Some of our most common foods contain mostly carbohydrates. Examples are bread, potatoes, pastries, candy, rice, spaghetti, fruits and vegetables. Many of these foods contain both starch, which can be digested, and fiber, which the body cannot digest.

The digestible carbohydrates are broken into simpler molecules by enzymes in the saliva, in juice produces by the pancreas and in the lining of the small intestine. Starch is digested in two steps: First, an enzyme in the saliva and pancreatic juice breaks the starch into molecules called maltose; then an enzyme in the lining of the small intestine splits the maltose into glucose molecules that can be absorbed into the blood. Glucose is carried through the bloodstream to the liver, where it is stored or used to provide energy for the work of the body.

Sugar is another carbohydrate that must be digested to be useful. An enzyme in the lining of the small intestine digests sugar into glucose and fructose, each of which can be absorbed from the intestinal cavity into the blood. Milk contains yet another type of sugar, lactose, which is changed into absorbable molecules by an enzyme called lactose, also found in the intestinal lining.

Protein

Foods such as meat, eggs and beans consist of giant molecules of protein that must be digested by enzymes before they can be used to build and repair body tissues. An enzyme in the juice of the stomach starts the digestion of swallowed protein. Further digestion of the protein is completed in the small intestine, Here, several enzymes from the pancreatic juice and the lining of the intestine carry out the breakdown of huge protein molecules into small molecules called amino acids. These small molecules can be absorbed from the hollow of the small intestine into the blood and then be carried to all parts of the body to build the walls and other parts of cells.

Fats

Fat molecules are a rich source of energy for the body. The first step in digestion of a fat such as butter is to dissolve it into the watery content of the intestinal cavity. The bile acids produced by the liver act as natural detergents to dissolve fat in water and allow the enzymes to break the large fat molecules into smaller molecules, some of which are fatty acids and cholesterol. The bile acids combine with the fatty acids and cholesterol and help these molecules to move into the cells of the mucosa. In these cells, the small molecules are formed back into large molecules, most of which pass into vessels—called lymphatics—near the intestine. These small vessels carry the reformed fat to the veins of the chest, and the blood carries the fat to storage depots in different parts of the body.

Vitamins

Another vital part of our food that is absorbed from the small intestine is the class of chemicals we call vitamins. There are two different types of vitamins, classified by the fluid in which they can be dissolved: water-soluble vitamins—all the B vitamins and Vitamin C—and Fat-soluble vitamins—Vitamins A, D, and K.

Water and Salt

Most of the material absorbed from the cavity of the small intestine is water in which salt is dissolved. The salt and water come from the food and liquid we swallow and the juices secreted by the many digestive glands. In a healthy adult, more than a gallon of water containing over announce of salt is absorbed from the intestine every 24 hours.

How is the Digestive Process Controlled?

Hormone Regulators

A fascinating feature of the digestive system is that it contains its own regulators. The major hormones that control the functions of the digestive system are produced and released by cells in the mucosa of the stomach and small intestine. These hormones are released into the hollow of the digestive tract, travel back to the heart and through the arteries and return to the digestive system, where they stimulate digestive juices and cause organ movement. The hormones that control digestion are gastrin, secretin and cholecystokinin (CCK):

· Gastrin causes the stomach to produce an acid for dissolving and digesting some foods. It is also necessary for the normal growth of the lining of the stomach, small intestine and colon.

· Secretin causes the pancreas to send out a digestive juice that is rich in bicarbonate. It stimulates the stomach to produce pepsin, an enzyme that digest protein, and it also stimulates the liver to produce bile.

· CCK causes the pancreas to grow and to produce the enzymes of pancreatic juice, and it causes the gallbladder to empty.

Nerve Regulators

Two types of nerves help to control the action of the digestive system. Extrinsic—outside—nerves come to the digestive organs from the unconscious part of the brain or from the spinal cord. They release a chemical called acetylcholine and another called adrenaline. Acetylcholine causes the muscle of the digestive organs to squeeze with more force and increase the "push" of food and juice through the digestive tract. Acetylcholine also causes the stomach and pancreas to produce more digestive juice. Adrenaline relaxes the muscle of the stomach and intestine and decreases the flow of blood to these organs.

Even more important, though, are the intrinsic—inside—nerves, which make up a very dense network embedded in the walls of the esophagus, stomach, small intestine and colon. The intrinsic nerves are triggered to act when the walls of the hollow organs are stretched by food. They release many different substances that speed up or delay the movement of food and the production of juices by the digestive organs.

Diet Affects Prostate Cancer

Fred Hutchinson Cancer Research Center researchers have found high fat and high calcium consumption may fuel prostate cancer from a localized to an advanced disease. Researchers examined intake of calories, fat, calcium and vitamin D among 1,200 Seattle-area men ages 40 to 64. More than 60 percent of the participants were under age 60. Half of the men recently had been diagnosed with prostate cancer while the rest were cancer free.

Researchers found the men whose fat intake accounted for no more than 30 percent of their daily calories had half the risk of late-stage cancer than men who consumed more fat. There were no associations of fat intake with early-stage disease, however. The researchers also found the risk of advanced prostate cancer was 112 percent higher among men who consumed the most calcium—more than 1,200 milligrams per day, equivalent to four or more glasses of milk—compared to those who got fewer than 500 mg. It did not matter whether the calcium came from food or supplements, researchers said.

Aspirin Can Prevent Polyps

Contributed By Ellen Credille

Taking one aspirin a day can prevent the development of precancerous polyps in patients at increased risk for colorectal cancer, according to a study published in the New England Journal of Medicine. Aspirin’s protective effect was so significant that the study was stopped early.

Aspirin had a significant protective effect. It clearly reduced the formation of polyps in this study of high-risk individuals, which is good news because it provides a new way to lower the risk of recurrence in patients who have had colon cancer.

An aspirin a day reduced the occurrence of adenomas, precancerous polyps in the colon, by about one-third in patients with a history of colorectal cancer. Patients on aspirin who did get polyps took longer to develop them, and they had fewer polyps than those who did not take aspirin.

This suggests that aspirin and similar anti-inflammatory drugs may help prevent this disease in average-risk individuals. Although, there are definitely risks associated with taking these drugs. Many people already take a daily aspirin to prevent cardiovascular disease. Now we have one more reason to consider recommending aspirin for prevention in patients with no contraindications.

Researchers are not, not suggesting that even those with increased cancer risk take aspirin until they have discussed it with their doctors. For those who have had polyps or previous colon cancer, regular colonoscopy and polyp removal remain the first step in prevention, possibly supplemented by aspirin.

The initial trails involved patients at extremely high risk, those with a genetic disorder known as familial adenomatous polyposis or FAP. People with FAP get hundreds of polyps that always progress to cancer. Celebrex, and anti-inflammatory drug similar to aspirin, reduced the development of polyps in patients with FAP by 28%. Also, a study found that a lower dose, 80mg instead of 325mg, was more effective for patients with previous polyps.

Studies are currently underway to see if Vioxx or Celebrex drugs similar to aspirin but with fewer side effects, can prevent the growth of polyps in people with normal risk. Previous studies using drugs, dietary fiber or vitamin supplements to prevent adenomas have not had a significant effect.

Aspirin and these newer drugs inhibit an enzyme known as COX-2 that controls inflammation. COX-2 is expressed early and at high levels in colon tumors, where it leads to increased cell proliferation, increased capacity to invade normal tissue and the stimulation of new blood vessels.

Generic Drugs

--South Nevada Town Karaya

Most of us have scanned the shelves of our pharmacy trying to decide if it is worth the extra money to purchase the brand name drug or whether its generic counterpart will do the trick. To set the record straight, a generic drug is simply a drug with active ingredients identical; i.e., exactly the same, to those of its brand name counterpart. Generics are manufactured usually by a different company and often cost less.

When a brand new drug is introduced, the manufacturer is allowed exclusive rights to sell or license that drug for the life of the patent—typically 17 years. Afterwards, other companies may copy the same exact drug and market it under their own name.

Many consumers are skeptical of the quality of generic drugs because they associate them with the quality of generic food products, which have greatly varying quality differences. However, pharmaceu-ticals are marketed under the scrutiny of the FDA, which mandates specific quality controls.

Although pharmaceutical companies spend millions of dollars to influence consumers and physicians, there are often few differences in how a brand name drug and its generic equivalent function in the body. There are certain cautions that must be taken. Certain drugs may exhibit subtle differences across brands.

This is caused not by the active ingredients, which are exactly the same, but by the inactive ingredients or carriers. Your body may react differently with different carriers. Many times the carrier in a generic drug will actually work better for you than the brand name drug. There may be specific instances where it would be advantageous to select one brand over another.

One brand may have carriers that allow a drug to be absorbed rapidly into the bloodstream and achieve high levels of concentration, and then disappear rapidly from the bloodstream. Another brand may have carriers that allow a drug to be absorbed slowly and provide lower levels of absorption over a longer period of time, even though it contains an equal amount of the same active ingredient.

Pharmacists are well trained to understand the nuances between various generic brands. They can explain how they work in the body. If fact, if one brand isn’t working for you, sometimes another brand of the same drug will work great. It may just depend on the carriers. Several well-known medications that vary across generics include blood thinners, heart medications and hormones. While you can often save money by using generic drugs, you should discuss any changes in your medication with your pharmacist and physician.

Bacteria in the Small Intestine

--Great Smokies Diagnostic Laboratory

Bacterial overgrowth of the small intestine can be a hidden, unsuspected cause of chronic bowel problems such as indigestion, bloating, abdominal pain, gas, and irregularity.

Normally, far fewer bacteria inhabit the small intestine than the ample growth found in the colon. The secretion of gastric acids and the rapid movement of digested foodstuffs through the intestine (called "intestinal motility") normally keep the small intestine relatively free of bacteria.

A wide range of abnormalities and malfunctions, however, can encourage bacteria to multiply in the small intestine. There, the bacteria ferment carbohydrate, producing gases such as hydrogen and methane. These gases cause the gas and bloating seen in individuals with carbohydrate intolerances and, over time, can lead to irritations of the intestinal lining.

The most common causes of bacterial overgrowth of the small intestine usually relate to a decrease in gastric acidity or digestive enzymes, which create an unsterile environment for the small intestine. Other possible causes of bacterial overgrowth of the small intestine include intestinal obstructions caused by Crohn's disease, adhesions, radiation damage and lymphoma.

Treating bacterial overgrowth of the small intestine has been shown to significantly alleviate chronic symptoms, such as diarrhea and abdominal pain, in patients with Irritable Bowel Syndrome. For this reason, healthcare experts recommend that a laboratory evaluation for small bowel bacterial overgrowth be performed in patients with IBS, when indicated by their history.

The “Bacterial Overgrowth of the Small Intestine Breath Test” measures breath hydrogen and methane gases in response to a lactulose challenge. Because both gases may be produced in the intestine, testing for both hydrogen and methane is considered more sensitive for detecting small bowel bacterial overgrowth than testing for hydrogen only.

Without proper detection and treatment, bacterial overgrowth of the small intestine can eventually go on to cause health problems more serious than chronic indigestion. By inhibiting proper nutrient absorption, bacterial overgrowth of the small intestine can lead to systemic disorders such as altered permeability, anemia and weight loss, osteomalacia and vitamin deficiency.

The incidence of bacterial overgrowth of the small intestine increases with age, particularly in people aged 80 and older. Elderly patients may develop malabsorption secondary to bacterial overgrowth. It has been suggested as the major cause of clinically significant malabsorption in the elderly and linked to the "failure to thrive syndrome" seen in older patients.

Editor’s Note: Normally, there are 300-400 types of bacteria in the colon, at a concentration of roughly 1 trillion bacteria for every milliliter of stool. However, the small intestine should have less than 1,000 bacteria per milliliter of stool.

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