Natural Acid Reflux Cure and Treatment

Heartburn and Acid Reflux Cure Program

Acidity is of the most dangerous problem that not only middle aged or old aged people faces but also the young generation is also facing. Untreated and ill treatment of this disease can lead to even heart stroke. The synthetic anti acidic products available in the market causes more harm in the fast relief process and does cure it holistically so that you do not suffer from it now and then. Here comes the best book on step acid reflux treatment written by Jeff Martin, a well renowned researcher and nutrionist.While these easy process stated in this book allows you to get heal of all types of digestive disorders on a permanent solution basis but in addition to it you get a three months direct counseling from Jeff Martin himself while ordering this product direct from this website. The treatment is so easy to follow and a 100% results is well expected but even then in case on is not satisfied with the results can get even 100 % refund. Indeed one of the cheapest and best ways to get rid of the long lasting digestive disorders especially heart burn in a holistic way without drugs and chemicals. Continue reading...

Heartburn and Acid Reflux Cure Program Summary


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The Acid Reflux Strategy

This product will teach you how you can get rid of acid reflux for good. It will include all the information you need on how to deal with acid reflux and use simple ingredients to battle it. In addition to that, the product will also teach you how acid reflux is a very dangerous thing for your health. As many people point out that it's a simple digestion issue that happens from time to time, the creator of the product will demonstrate how the acid reflux could be a bigger problem than most people think. After getting this information, you are guaranteed to have the best results as you will eliminate all the issues with acid reflux using a few household items. The information is very useful and it's very beginner friendly, you don't need to be a genius to figure it out. The link will redirect you to the page where you will be required to fill out some information then you will get your downloadable information almost immediately. Continue reading...

The Acid Reflux Strategy Summary

Contents: Ebook
Official Website:
Price: $49.00

Gastroesophageal Reflux

The presence of gastroesophageal reflux (GERD) is suggested by heartburn, especially postprandial, that is increased on bending over, lying down, or straining. Confirmatory tests include roentgenographic demonstration of reflux, the finding of acid in the esophagus after instilling hydrochloric acid into the stomach, 24-h monitoring of intraesophageal pH, or Bernstein's test, in which hydrochloric acid is dripped onto the lower esophagus and symptoms are elicited. It has been reported that as many as 45-65 of adults and children with asthma have GERD. The mechanism by which GERD produces asthma appears to involve triggering intraesophageal reflexes by acid stimulation, resulting in cholinergic reflexes into the airways and resultant bronchial constriction. While GERD may be asymptomatic in asthmatics, the strongest association is with nighttime asthma symptoms especially night cough and nocturnal wheezing. GERD should be highly suspect in patients (especially children) with nocturnal...

Prevention And Treatment Of Dyspepsia Associated With Nsaid

Dyspepsia and heartburn are common symptoms among patients who take NSAIDs. They occur daily in approximately 15 of those taking these medications. Within a 6-month period, 5-15 of rheumatoid arthritis patients discontinue a given NSAID because of dyspeptic side effects (1). Symptoms lead to expenditures for administration of cotherapy with antiulcer medications and referrals for endoscopy. Symptom-driven costs are a substantial, albeit poorly quantified, component of the total cost of NSAID therapy. In cross-sectional population-based studies, both aspirin and nonaspirin NSAID consumption was associated with a twofold increased risk of dyspepsia (29). The cause of these symptoms is not known. Acid secretion is not increased in ulcer patients taking NSAIDs, and there is no evidence that NSAIDs effect esophageal clearance or lower esophageal sphincter pressure (30). However, since NSAID dyspepsia can be effectively reduced with acid suppression, gastroesophageal reflux may be...

Gastroesophageal Reflux Disease

There is a widespread notion that obese persons are more likely to develop gastro-esophageal reflux disease (GERD) than leaner subjects, and obese patients who seek medical care for symptoms suggestive of reflux are often recommended by clinicians to reduce their body weight to relieve the symptoms. However, the scientific search for a positive association between BMI and intensity of symptoms has failed to show any correlation. Lagergren et al. (65) have reported that weight reduction may not be justifiable as an antireflux therapy. Even if obesity is a poor predictor of reflux symptoms, this does not necessarily imply that weight reduction will not be of benefit in providing symptom relief. A significant beneficial effect of weight loss on symptoms of gastroesophageal reflux in overweight patients has recently been reported in a small study involving 34 patients (66). In this study, the degree of weight loss was directly correlated with improvement in GERD symptom scores. Elsewhere,...

Surgery for Gastroesophageal Reflux Disease

Introduction Pathophysiology of Gerd Symptoms of Gerd Indications for Surgery Contraindications to Surgery Preoperative Evaluation Gastroesophageal reflux disease (GERD) is one of the most common problems seen in medical practice. Approximately 10 of the U.S. population experiences heartburn daily, and 40 of the population has heartburn monthly. Seven percent of the population (40 million individuals) use over-the-counter antacids, H-2 receptor antagonists, or proton pump inhibitors at least twice weekly to relieve GERD symptoms. Surgical management of GERD is an effective alternative to medical management of GERD, and it is being more commonly employed (1). Antireflux surgery was first performed in the 1950s. Diagnostic modalities and technical details evolved during the ensuing 30 yr, yielding superb results from antireflux procedures. However, these procedures, which necessitated thoracotomy or laparotomy, were usually only employed in the most severe cases refractory to medical...

Problemsspecial considerations

Plasma progesterone concentrations return to non-pregnant values within 24 hours of delivery, and gastroesophageal reflux is considerably reduced within 48 hours of delivery. The period of risk of aspiration thus extends to an ill-defined time after delivery, and appropriate general anaesthetic management in the early postpartum period is thus somewhat controversial.

Recent Developments in Antitussive Therapy

Introduction - Cough is a forceful defensive reflex maneuver that leads to expulsion of irritants, fluids, mucus or foreign material from the respiratory tract. Specifically, the reflex triggers a complex, multiphasic motor pattern characterized by sequential coordination of large increases in motor output to an array of inspiratory and expiratory skeletal muscles. This highly coordinated musculoskeletal activation process consists of three sequential phases, namely deep inspiration, compression (i.e. contraction against a closed glottis) and vigorous expulsion. The expulsion is ultimately attained through the combined forceful contraction of thoracic, abdominal and diaphragm muscles through the generation of rapid airflow (1, 2). While generally beneficial, cough is a prominent pathophysiological feature associated with many airway and lung diseases such as asthma, upper respiratory viral and bacterial infections, post-nasal drip syndrome, gastroesophageal reflux disease, pulmonary...

Clinical Presentation

Abdominal pain is the principle symptom of peptic ulcer and is most commonly felt in the epigastrium. The quality of the discomfort, its pattern, and its associated symptoms such as vomiting may vary from patient to patient. In fact, the sensitivity and specificity of characteristic epigastric discomfort in predicting the presence of a peptic ulcer is actually quite low. Other possibilities in the differential diagnosis of ulcer pain include gastroesophageal reflux disease, angina, nonulcer dyspepsia, small and large intestinal conditions, gallstones, and pancreatic disorders. Furthermore, patients (especially those taking NSAIDs) frequently present with complications such as GI bleeding after a silent course and no pain. Nonetheless, there are classic symptomatic presentations in some patients that are worthy of mention. For example, the classic description of duodenal ulcer pain is a burning or gnawing sensation in the epigastrium, which characteristically occurs IV2-3 hours after...

Induction of Anesthesia

Muscle paralysis for tracheal intubation is achieved by most clinicians using a non-depolarizing agent such as rocuronium or vecuronium. No evidence suggests that patients with aSAH are at higher risk of gastroesophageal reflux and aspiration. If rapid sequence induction

Treatment Of Upper Gastrointestinal Symptoms

Rationale for dyspepsia - Drug treatment for patients with functional dyspepsia is still controversial even if antisecretory agents such as histamine antagonists and proton pump inhibitors are the most used agents. For patients with symptoms suggesting upper gastrointestinal (Gl) dysmotility, prokinetics such as cisapride have been largely used and current meta-analyses indicate that they exhibit a potent efficacy (1). Serotonergic agents - The most widely known serotonergic agent used for the treatment of dyspepsia is a mixed 5-HT3 antagonist and 5-HT4 agonist, cisapride (i). Both 5-HT3 and 5-HT4 receptors are involved in the control of gut motility. They are located on afferent nerves pre- or post-synaptically, enhancing the release of acetylcholine (Ach) and substance P (SP) in response to afferent nerve stimulation

Proton Pump Inhibitors

In the ASTRONAUT study (33), patients requiring continuous NSAID therapy were randomized, following ulcer healing, to receive ranitidine (150 mg bid) or omeprazole 20 mg daily. Gastric ulcers recurred in 5.2 of the omeprazole-treated patients versus 16.3 of those in the ranitidine-treated group (p 0.001). For duodenal ulcers, there was a 0.5 versus a 4.2 (p 0.02) rate of recurrence in the two groups, respectively. The OMNIUM study (39) compared omeprazole 20 mg once daily, misoprostol 200 g twice daily, and placebo during 6 months of follow-up. In this study, 32 of patients taking placebo developed a gastric ulcer at relapse compared with 10 in the misoprostol group and 13 in the omeprazole group. Duodenal ulcers developed in 12 of those given placebos, 10 of those given misoprostol, and 3 of those given omeprazole. Omeprazole was not superior in reducing erosions. Omeprazole was superior in the maintenance of overall remission, largely because of its ability to improve...

Barretts Oesophagus

Barrett's oesophagus is known to be a premalignant condition in patients with gastroesophageal reflux disease, and most adenocarcinomas of the distal oesophagus have been shown to arise in Barrett's tissue. Barrett's oesophagus is defined histologically by the presence of specialised columnar epithelium (SCE) with goblet cells. The columnar-lined lower oesophagus can be identified during standard upper endoscopy. SCE is often present in a patchy mosaic contribution within columnar-lined lower oesophagus and can be overlooked by random biopsies, resulting in biop

Adenocarcinoma of Esophagus

Independent of obesity, gastroesophageal reflux disease (GERD) has been associated with esophageal adenocarcinoma and with its metaplastic precursor, Barrett's esophagus (145,148,149). Obesity has been hypothesized to increase the risk of adenocarcinoma of the espophagus indirectly, by increasing the risk of GERD and Barrett's esophagus (150,151). The association between obesity and esophageal adenocarcinoma has been shown in some studies to be independent of reflux (147,152). Thus, obesity might increase the risk of esophageal adenocarcinoma through mechanisms other than, or in addition to, reflux.

Overcoming the Link Between Promotion of Antimicrobial Agents and Emergence of Antimicrobial Resistance in Pathogens

Acid reflux drugs) without attention to the consequences for the broader social environment (including animals and people) can contribute to both the emergence of resistance in pathogens and their spread. But if these promotional messages are shaped so as to take into consideration the specific social, economic and political realities of developing countries, then they could be an important means of mitigating the spread of significant regional and global health problems, such as antimicrobial resistance.

Monoaxenic Culture of AM Fungi

The establishment of in vitro root-organ cultures has greatly influenced our understanding of the AM symbiosis. Root-organ cultures were first developed by White and co-workers (White 1943 Butcher and Street 1964 Butcher 1980). These authors used excised roots on synthetic mineral media supplemented with vitamins and a carbohydrate source. Pioneering work by Mosse and Hep-per (1975) used root cultures obtained from Lycopersicum esculentum Mill. (tomato) and Trifolium pratense L. (red clover) to establish in vitro mycorrhiza with Glomus mosseae Nicolson & Gerd. The authors demonstrated for the first time that spores of an AM fungus could be successfully used to colonize excised roots growing on a mineral-based medium. Later, Strullu and Romand (1986, 1987) showed that it was also possible to re-establish mycorrhiza on excised roots of Fragaria x Ananassa Duchesne (strawberry), Allium cepa L. (onion) and tomato, using the intraradical phase (i.e., vesicles or entire mycorrhizal root...

Darifenacin Urinary Incontinence [1518

Darifenacin demonstrates greater effect on tissues in which the predominant receptor type is M3 rather than Ml or M2. In vitro darifenacin inhibits carbachol-induced contractions with greater potency in isolated guinea-pig bladder (M3) than in guinea-pig atria (M2) or dog saphenous vein (Ml). In animal models, it shows greater selectivity for inhibition of detrusor contraction over salivation or tachycardia. The synthesis of darifenacin involves the coupling of 5-(2-bromoethyl)-2, 3-dihydrobenzofuran with as a key step. The latter intermediate is prepared from 3-(R)-hydroxypyrrolidine in a five-step sequence involving N-tosylation, Mitsunobu reaction to introduce a tosy-loxy group in the 3-position with stereochemical inversion, anionic alkylation with diphenylacetonitrile, cleavage of the N-tosyl protecting group with HBr, and conversion of the cyano group to a carboxamide. Darifenacin is supplied as a controlled release formulation, and the recommended dosage is 7.5 mg once, daily....

Prokinetic Agent Target Classes 21 Dopamine D2 receptor antagonists


Itopride 1, which is available on the market in Japan, is a D2 receptor antagonist, which also exhibits acetylcholine esterase inhibition. The compound stimulated GI motility when dosed i.v. to conscious dogs and promoted colonic transit in rats and guinea pigs after oral administration 2 . After 8 weeks treatment in patients with FD, oral itopride t.i.d. was significantly more effective than placebo in reducing self-reported symptom scores including pain and fullness 3 . In a smaller trial in patients with GERD, itopride t.i.d. for 30 days significantly improved acid reflux and symptoms such as heartburn compared to pre-treatment 4 . In both studies, while there was some increase in prolactin levels, no significant adverse events occurred. However, most recent reports indicate that itopride did not meet expectations in clinical phase III studies in FD 5 . Mosapride 2 is a selective 5-HT4 receptor agonist, which is marketed in Japan to treat gastric disturbances. While a close...

Indications for procedure

Gastric Volvulus Organoaxial

The majority of sliding hiatal hernias are asymptomatic. Only when surgical intervention is indicated for GERD should Type I (sliding hiatal hernia) be repaired (see Chapter 3) (2). About 30 of patients with paraesophageal hernia have Type 3 hernia and have symptoms of GERD. Many patients with paraesophageal hernia have no serious symptoms or complications of their condition for years. As the hernia progresses, varying degrees of complaints and severity of symptoms will be directly attributable to the configuration of the hiatal hernia (2).

Safer Antiinflammatories The COX2Specific Inhibitors

Key components of the overall cost of disease management with NSAIDs are physician visits, medication expenditure, and endoscopies related to the development of GI side effects such as dyspepsia. COXIBs appear to cause fewer nuisance GI side effects than traditional NSAIDs, although side effects are more frequent than with placebo. Rofecoxib was noted to cause significantly fewer GI symptoms and less need for GI medication cotherapy in clinical trials of up to 6 months' duration. In general, the incidence of these adverse events and rates of antiinflam-matory drug discontinuation were intermediate between traditional NSAIDs and placebo. A recent analysis confirmed that patients on rofecoxib underwent fewer GI-related procedures compared with the NSAID group (1.25 vs. 1.98 , p 0.057 and had a reduced likelihood of adverse GI experiences. The risk reduction for rofecoxib compared with NSAIDs was 0.42 (p 0.01) (50).

Didronel etidronate is usually prescribed for Pagets disease Is it ever prescribed for osteoporosis

The treatment of choice for Paget's is a bisphospho-nate. Bisphosphonates Actonel, Fosamax, and Didronel are FDA-approved for the treatment of Paget's. Unlike the longer dosing regimens of other bisphosphonates, Didronel is generally prescribed for only two weeks to three months at a time depending on the dosage, with a rest period off the medication lasting at least three months. This regimen is usually repeated for about two years. Didronel is taken on an empty stomach without eating or drinking for two hours after taking it. Didronel should still be prescribed with caution in those with upper intestinal disorders. The most common side effects include nausea, diarrhea, and flatulence. Medications that cause stomach upset, such as non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, naproxen, or aspirin, can increase the risk for ulcer or heartburn. Table 11 has information on Didronel. GI upset (pain, nausea, acid reflux)

Treatment of Concomitant Diseases and Conditions

Many asthmatics will only respond once their concomitant sinusitis, GERD, thyroiditis, emotional stress, or pregnancy is under control. Moreover, the treatment of asthma requires close attention to concomitant colds, flu, bronchitis, environmental irritant or pollutant inhalation, recreational drug use, and emotional changes. Compliance is a significant problem, both with medication use and allergen avoidance and inhaler techniques. Thus, the physician who treats asthma needs to keep the whole patient in focus, as well as his work and family environment. On the other hand, proper treatment is nearly always effective and can be extraordinarily gratifying. It is common to convert pulmonary cripples into totally functioning humans in a matter of weeks.

Differential Diagnosis Of Asthma

Nonasthmatic conditions associated with wheezing Pulmonary embolism Cardiac failure ( cardiac asthma ) Foreign bodiesa Tumors in the central airways Aspiration (gastroesophageal reflux)a Carcinoid syndrome Laryngo-tracheo-bronchomalaciaa Loffler's syndrome Bronchiectasis Tropical eosinophilia Hyperventilation syndrome Laryngeal edema Vocal cord dysfunction Laryngeal or tracheal obstructiona Factitious wheezing a1-Antitrypsin deficiency Immotile cilia syndrome, Kartagener's syndromea Bronchopulmonary dysplasiaa Bronchiolitis, croupa Overlapping diseases in wheezing infants include bronchopulmonary dysplasia, cystic fibrosis, GERD, and immunoglobulin deficiency.

Disorders of the Esophagus

Heartburn is another symptom of esophageal disorders. This burning pain rises in the chest and can be felt in the neck, throat, or face. Heartburn usually occurs after meals, after taking certain medications, or while lying down. Some people also may feel a burning pain or tightness when swallowing solids or liquids. Heartburn can indicate a problem with a medication or with the lower esophageal sphincter, the muscular valve that prevents stomach acid from rising up into the esophagus. (Heartburn also may be a symptom of coronary artery disease see page 204.) Gastroesophageal Reflux Disease The most common disorder of the esophagus is gastroesophageal reflux disease (GERD). In GERD, the muscle at the bottom of the esophagus, the lower esophageal sphincter, does not close completely, allowing stomach acids and other irritants to flow backward (reflux) into the esophagus. Certain medications can interfere with the action of this muscle, including nitrates, calcium channel blockers,...

Helicobacter pylori

H. pylori-infected patients may develop chronic gastric inflammation that can be asymptomatic. Infection of H. pylori is associated with peptic ulcer disease (Dunn et al., 1997). H. pylori infection is also associated with gastric adenocarcinoma (Oconnor et al., 1996) and mucosa-associated lymphoid tissue (MALT) lymphoma (Isaacson, 1994). The American Medical Association published guidelines for testing and treatment of H. pylori-related disease (Peterson et al., 2000). The panel of experts recommends testing for H. pylori in patients with active ulcers, a history of ulcers, or gastric mucosa-associated lymphoid tissue lymphomas, and young patients with ulcer-like dyspepsia and those with family history should also be tested for H. pylori. Eradication of the infection leads to cure of the ulcers (Dunn et al., 1997). Treatment of the infection with antibiotics includes twice-daily triple


Pneumonia in the newborn can be classified according to the mode of acquiring the infection and the time when the infection takes place. The infection can be acquired in utero by trans-placental route or following intrauterine infection. The pneumonia could be acquired during delivery by aspiration of bacteria that colonize the birth canal. The type of infection contracted after birth is acquired by contact with environmental objects (e.g., a tracheostomy tube) or by human contact. Aspiration can occur in up to 80 of intubated premature infants (32) and is common in newborns with gastroesophageal reflux (33) or those who require general anesthesia (34), or have swallowing dysfunction (35).

Reflux Esophagitis

Gastroesophageal reflux disease (GERD) is a very common disorder, causing monthly symptoms in up to 36 of the U.S. population (29). GERD occurs as a result of an abnormally prolonged exposure of the esophageal mucosa to gastric acid and pepsin. Reflux esophagitis occurs in a subset of patients with GERD in whom esophageal inflammation is visible as erosions or ulcerations (Fig. 2) it is found in 2-4 of the U.S. population (30). (32). In several series, reflux esophagitis accounted for only 2-5 of all cases of acute upper GI bleeding, occurring less commonly than peptic ulcer disease (57-75 ), esophageal varices (7-9 ), or Mallory-Weiss tears (19,20,33,34). However, in one recent study, reflux esophagitis accounted for 14.6 of overt upper GI tract bleeding (35). The bleeding associated with acid reflux is not typically massive. In two large series, there were no deaths attributed to bleeding from reflux esophagitis (19,20).


In most series, 10 of patients have dysphagia, poor gastric emptying, recurrent hernia, and GERD leading to suboptimal outcome after paraesophageal hernia repair. Recurrence of the paraesophageal hiatal hernia can occur and be asymptomatic. This may be caused by an inability to close the hiatus in a tension-free fashion. Several authors have recommended placement of a prosthesis at the hiatus. However, cicatricial involvement of the esophagus by a piece of mesh can lead to significant complications (3,6).

Malignant Neoplasm

Endoscopically, esophageal carcinoma appears as a mucosal mass lesion that is often exophytic and ulcerated (Fig. 4). There are clinical characteristics of squamous cell carcinoma and adenocarcinoma, however, that may help influence clinical suspicion prior to the interpretation of biopsies. The most common site of squamous cell carcinoma is the midesophagus, whereas adenocarcinoma is frequently located in the distal esophagus. Although both cancers increase in incidence with age and male gender, specific risk factors for squamous cell carcinoma include African-American race and tobacco and alcohol use. Adenocar-cinoma is more prevalent among Caucasians, with the primary risk factors being Barrett's esophagus and GERD. Although both are relatively uncommon cancers, the incidence of esophageal adenocarci-noma is rapidly increasing.


Although these diagnostic studies are helpful in identifying ulcers, the appropriate type of patient with ulcer-like dyspepsia in which they should be done remains controversial. Only a small minority of those with dyspepsia (45 years old) with new-onset dyspepsia because the incidence of gastric cancer increases with Empiric treatment of H. pylori without first documenting an ulcer remains controversial since most dyspeptic individuals have nonulcer dyspepsia, for which treatment of H. pylori is only occasionally helpful (11). Also, selecting age 45 rather than an older age as the cutoff to recommend EGD is debatable. For example, in a recent study from Scotland, 90 of patients younger than 55 years subsequently diagnosed with gastric cancer had at least one sinister symptom (dysphagia, weight loss, persistent vomiting, anemia, family history of upper GI cancer, bleeding, previous gastric surgery, or palpable mass) (12). Only five individuals in this age group had simple dyspepsia...

Emotions and health

Emotion can be involved in any medical condition. For example, a broken leg can lead to anger and frustration, anxiety, fear, sadness, and so on. Or it may be that one's emotional condition was a precipitating factor in whatever led to the leg being broken in the first place. But the most problematic circumstance comes with the idea of psychosomatic disorders, in which the disorder is clearly physical (migraine, skin rashes, indigestion, peptic ulcers, asthma, genito-urinary conditions, and so on) but the causative factors seem to be emotional. The emotion most commonly implicated is anxiety. The extent of the emotional is hard to determine, one view being that all illness has an emotional component, causa-tively. For example, long-term stresses may well have a deleterious impact on the efficacy of the immune system and thus leave a person more vulnerable to infection.

Stress Management

Muscles tighten as stress starts, often causing intense headaches, backaches, and gastrointestinal problems. Stress also can cause testosterone levels to decrease and blood vessels in the penis to constrict, often resulting in erection problems. The rush of hormones caused by a stressful situation can bring on an asthma attack in a person with a history of asthma. Stress also draws the blood supply away from the abdominal area and encourages overproduction of acids in the digestive system, often leading to indigestion and other gastrointestinal problems. Other problems related to stress include insomnia and irritability.


Obesity may lead to asthma not directly, but through its role in other disease processes. For example, obesity increases the risk of both gastroesophageal reflux disease (GERD) and sleep-disordered breathing (SDR). An increased prevalence of asthma has been observed in subjects with each of these conditions furthermore, subjects undergoing surgical induced weight loss showed improvements not only in asthma but also in GERD and sleep apnea. Consequently, there has been speculation that obesity leads to asthma through its effects on these other conditions. Two recent studies have examined the interrelationships between these conditions. Multivariate logistic regression in data from more than 16,000 participants in the European Community Respiratory Health Survey demonstrated that the relationship between obesity and the onset of asthma was unaffected by adjustment for GERD or habitual snoring (31). Similarly, Sulit et al. demonstrated that adjustment for SDB and asthma did not...


All three macrolides have good oral bioavailability and diffuse into most tissues. However, they do not have as good CSF penetration as the beta-lactam antibiotics. Erythromycin has a short plasma half-life of around 90 minutes hence it is generally dosed four times daily. Clarithromycin and azithromycin both have much longer half-lives. Azithromycin is converted in the liver to an active metabolite, and persists in tissues at high concentrations thus it has the advantage of being able to be given as a single dose for some infections, allowing for directly observed therapy and assurance that the patient has taken the appropriate treatment. Azithromycin capsules need to be taken on an empty stomach, and should be dosed separately from iron or indigestion remedies. Azithromycin tablets are also available these are 500mg (as opposed to 250mg) capsules, and do not have any food restrictions. All three macrolides are excreted in the bile.

Hiatal Hernia Repair

The history of surgery for hiatal hernia and gastroesophageal reflux disease (GERD) has paralleled our gradual understanding of the physiological features of the esophagus. The association between GERD and esophagitis was not established until the 1940s, and much controversy arose concerning the relationship between hiatal hernia and GERD. Initial attempts at simply reducing the hernia by closing the crura proved to have unac-ceptably high failure rates. The Allison repair, introduced in 1951, involved mobilization of the distal esophagus with placement of the gastroesophageal junction within the abdomen and repair of the crura. This operation had a high recurrence rate, and subsequently several attempts were made at both fixing the gastroesophageal junction within the abdomen and wrapping the gastric fundus around the distal esophagus (fundoplication) to create an antireflux valve (1). The most commonly performed hiatal hernia repair is the Nissen fundoplication. This was first...

Viral Esophagitis

Presentation of herpes esophagitis in the immunocompetent host is similar to that of the immunocompromised patient, but it is less common and the course is typically less severe. In a retrospective review of 38 cases of HSV esophagitis in otherwise healthy hosts, 76 presented with odynophagia, 50 with heartburn, and 45 with fever (46). Only 21 displayed concurrent oropharyngeal lesions. The endoscopic appearance was similar to that of immunocompromised hosts, including friability (84 ), numerous ulcers (87 ), distal esophageal distribution (64 ), and whitish exudates (40 ). Only 68 of histologic examinations detected characteristic findings, further demonstrating the need for concurrent viral cultures, which were positive in 96 of those tested. Immune serologies were consistent with primary infection in 21 of

Iatrogenic Causes

The relationship of nasogastric intubation and GERD in the development of esophagitis has already been discussed. However, independent of acid reflux, the presence of a nasogastric tube itself may lead to significant esophageal erosions over time (37,97). These lesions, secondary to mechanical trauma, are more likely to be located in the proximal esophagus and appear to be linear in nature. If possible, the nasogastric tube should be removed. There are reports of vascular esophageal fistula development causing massive hemorrhage secondary to nasogastric tube use, but this complication is very rare (98).

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