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Friday, October 27, 2017

New Neuro-Stim Device Lessened Abdominal Pain in Adolescents

I found this article and I thought it was really interesting. It might be a viable, possible treatment for people with gastroparesis. I am not familiar with it, so I apologize for the long article, but I wanted to share it and add it to my blog so that I can reference it later. It makes me happy that doctors are trying to find different treatments to help with gastroparesis and abdominal pain. It is a good step in the right direction. It will also help with pain from fibromyalgia and possibly for migraines as well. I know that it does not work for everyone.
However, I wanted to share the article anyway, to keep it in once place in my blog. Even though it may not work for everyone, I thought it was worth sharing and worth documenting in my blog for future research. The article is below.

"Electrical nerve stimulation introduces a potential non-pharmacologic treatment to address pain in adolescent patients who present with functional gastrointestinal pain disorders.
By Megan Garlapow, PhD With Adrian Miranda, MD, and Gary W. Jay, MD

Administering percutaneous electrical nerve field stimulation (PENFS) with Neuro-Stim, a FDA-cleared device manufactured by Innovative Health Solutions, in an adolescent population whose primary complaint was gastrointestinal pain, appeared to lessen subjective pain scores, according to findings published in The Lancet Gastroenterology and Hepatology.

The researchers were able to demonstrate that abdominal pain—the primary efficacy outcome of a difference from baseline to treatment—improved significantly in patients who underwent PENFS applied to the ear, as compared to those who had the sham treatment.1 The PENFS device must be applied by a licensed clinician.



Source:https://i.pinimg.com/736x/d7/3e/c6/d73ec617c2c77f196837e11f34305ff7--vagus-nerve-damage-electro-shock.jpg




Nerve stimulation device lessens gastrointestinal pain in teens; Efficacy Achieved Using Neuro-Stim for Gastrointestinal Pain


A randomized clinical trial in which 115 pediatric patients, ranging in age from 11-18 years old, who presented with abdominal pain related to a functional gastrointestinal (GI) disorder were treated at a single, out-patient clinic in the midwest.1

'We had heard about similar [favorable] results in other chronic pain conditions, but most results were from anecdotal reports,' said senior author Adrian Miranda, MD, a pediatric gastroenterologist and associate professor at the Medical College of Wisconsin in Milwaukee, 'We had to carry out a randomized controlled trial to properly assess the findings,' for GI pain.

More importantly, our preclinical studies demonstrated a reduction in the firing of neurons in the amygdala and spinal cord using the same technology,2 Dr. Miranda told Practical Pain Management, 'These central areas have been proposed by many to play a critical role in the development and maintenance of chronic pain.'

Functional abdominal pain disorders are a group of conditions, such as irritable bowel syndrome, abdominal migraine, and functional abdominal pain syndrome, in which pain is typically the most prominent complaint and symptoms are not caused by other conditions.




Study Design and Methodology

Patients were enrolled in the trial between June 2015 and November 2016. Researchers administered the non-invasive PENFS procedure via the external ear (n = 60) or a sham with no electrical stimulation (n = 55) for four weeks. The procedure was initiated with the intent to modulate central pain pathways. Patients were randomized equally to each arm with stratification based on sex, and presence or absence of nausea. Patients, caregivers, and researchers were blinded to allocation by group.

An outcomes analysis included 57 patients in the PENFS arm and 47 patients in the sham group after patients were excluded for discontinuation of treatment or for having organic disease.1

The primary efficacy endpoint—change in baseline reported abdominal pain—was assessed with the Pain Frequency Severity Duration Scale (PFSD), a subjective tool used to derive a quantifiable pain score in these young participants.1 The researchers used PFSD scores to assess improvements from the worst abdominal pain score as well as from a composite abdominal pain score.




Reduced GI Pain Was Sustained Following Neurostimulation

After three weeks of treatment, patients in the PENFS arm experienced a greater decrease in worst pain compared with patients in the sham arm (median score PENFS 5.0, IQR 4.0 - 7.0; sham 7.0, 5.0 - 9.0). The least-square means estimate of change in worst pain was 2.15 (95% CI: 1.37 - 2.93, P < .0001).1 Median composite scores of PFSD also decreased significantly in the PENFS arm, from 24.5 (IQR 16.8-33.3) to 8.4 (3.2-16.2), compared to the sham arm, which went from 22.8 (8.4-38.2) to 15.2 (4.4-36.8).1 Both worst pain and composite pain effects were reported for a median of 9.2 weeks during follow-up.1 The median worst pain was 2.0 points lower at follow-up in the PENFS arm but only 0.5 points lower in the sham arm (P < .0001). In addition, median composite pain at follow-up was 12.5 points lower in the PENFS arm compared to 6.0 points lower in the sham arm (P=.018). 'I know that ultra-high frequency can cause specific neurochemical changes that decrease pain,' said Dr. Gary W. Jay, MD, a clinical professor in the Headache Division in the Department of Neurology at the University of North Carolina, Chapel Hill. 'While I can at least get some idea as to why the reported pain decreased from this study, we don’t know what the parameters of electronic stimulation were, and they’ve done no testing other than filling out subjective forms, Dr. Jay told Practical Pain Management. Need for Further Understanding of Longterm Benefits

Dr. Miranda shared some additional information on how persistent this therapy might be at reducing abdominal pain.

'I have patients whose symptoms have resolved and are six months out of treatment while others have recurrence at five months,' he said, 'and it may be that a second treatment is needed for those who have recurrence, or perhaps a longer initial trial of six weeks would be required to prevent relapse.'

'It’s too early to tell, and certainly longitudinal studies need to be done,' Dr. Miranda said, 'Perhaps in the future, this therapy can be combined with imaging techniques to better predict the phenotype that will respond to treatment.'

Dr. Jay concurred with the need for imaging studies, particularly as PFSD is susceptible to issues surrounding subjective measurements. Objective, physiological measurements could yield meaningful insights into the biological basis of the results achieved in this study, according to Dr. Jay. He also noted that the study did not provide sufficient detail about the methodology used to employ electrical stimulation.

'The researchers are not giving us any parameters of what they are doing, and they are also not looking at whether there are any physiological changes occurring,' said Dr. Jay. 'You would want to do functional MRIs to see exactly what is this stimulation is doing.'




Conclusions and Future Directions

Dr. Miranda expects transcranial electrical stimulation to hold promise for additional pain disorders.

'I think we have just started to uncover the possibilities of neuromodulation, using peripheral electrical stimulation. The implications for this type of non-invasive neuromodulatory therapy holds promise beyond just functional pain disorders, in my opinion,' said Dr. Miranda, 'and if you think about the central mechanisms that are involved in chronic pain, there is really no reason why this technology couldn’t be applied to many pain disorders.'

Dr. Jay agreed that neuromodulatory electrical stimulation has the potential to improve other disorders characterized by pain.

'Given that some of the animal studies show amygdala or limbic system involvement secondary to the stimulation, which would make sense in certain disorders, I would want to see trials that at this aspect. The limbic system is very highly incorporated into another so-called functional pain syndrome, fibromyalgia,' he told Practical Pain Management.

Dr. Miranda explained the need for creating distinct therapeutic regimens for individual patients and emphasized the importance of understanding which components could form the foundation for such a regimen, including pharmacotherapy, physical reconditioning, and neuromodulation.

'We need to figure out who our responders are for each treatment and tailor our approach for each patient. There is not one treatment that will work for all patients,' said Dr. Miranda. 'Yet we don’t always discuss these components of treatment with our patients because of time constraints, lack of resources, or issues with insurance coverage,' Dr. Miranda said.

The American Neurogastroenterology and Motility Society funded this research. The authors have no other disclosures.



Sources
Kovacic K, Hainsworth K, Sood M, Chelimsky G, Unteutsch R, Nugent M, Simpson P, Miranda A. Neurostimulation for abdominal pain-related functional gastrointestinal disorders in adolescents: a randomised, double-blind, sham-controlled trial. Lancet Gastroenterol Hepatol. 2017;S2468-1253(17:)30253-30254.
Babygirija R, Sood M, Kannampalli P, Sengupta JN, Miranda A. Percutaneous electrical nerve field stimulation modulates central pain pathways and attenuates post-inflammatory visceral and somatic hyperalgesia in rats. Neuroscience. 2017;25;356:11-21."

I have another article that I have researched and written on the vagus nerve. You can find it here: http://www.emilysstomach.com/2016/07/information-about-vagus-nerve.html

There is another article I wrote about the vagus nerve stimulator, which can be found here: http://www.emilysstomach.com/2017/06/the-vagus-nerve-stimulator.html

Sunday, October 1, 2017

Thrush and Gastroparesis

Thrush is terrible. I have had it on my tongue and down my esophagus, and I'm not the only one. People in my support groups have had the same. I wanted to look up why this happens more frequently to Gastroparesis Warriors. I mean, I know why thrush happens. It is caused by an imbalance of good and bad bacteria in your body.



Image Credit: https://www.globalhealingcenter.com/natural-health/wp-content/uploads/2015/06/whatscandidaBLOG-300x200.jpg



According to Healthline (https://www.healthline.com/health/candida-esophagitis#outlook9,

"Esophageal Thrush (Candida Esophagitis)
Written by April Kahn and Rachel Nall
Medically Reviewed by Nancy Choi, MD on August 17, 2017


What is esophageal thrush?

Esophageal thrush is a yeast infection of the esophagus. The condition is also known as esophageal candidiasis.
Fungi in the family Candida cause esophageal thrush. There are about 20 species of Candida that can cause the condition, but it’s usually caused by Candida albicans.




Causes:


How does esophageal thrush develop?

Traces of the fungus Candida are normally present on the surface of your skin and within your body. Normally, your immune system can regulate these good and bad organisms in your body. Sometimes, though, a shift in the balance between the Candida and your healthy bacteria can cause the yeast to overgrow and develop into an infection.


Risk factors:



Who is at risk?

If you’re healthy, it’s unlikely you will develop this condition. People with compromised immune systems, such as those with HIV, AIDS, or cancer, and older adults are at a higher risk. Having AIDS is the most common underlying risk factor. According to the Centers for Disease Control and Prevention (CDC), 20 percent of all people with cancer develop the condition.

People with diabetes are also at an increased risk of developing esophageal thrush, especially if their sugar levels are not well controlled. If you have diabetes, there’s often too much sugar present in your saliva. The sugar allows the yeast to thrive. More importantly, uncontrolled diabetes also hurts your immune system, which allows for candida to thrive.

Babies who are born vaginally can develop oral thrush if their mothers had a yeast infection during delivery. Infants can also develop oral thrush from breastfeeding if their mother’s nipples are infected. Developing esophageal thrush this way is uncommon.
There are other risk factors that make someone more likely to develop this condition.



You’re more at risk if you:
smoke
wear dentures or partials
take certain medications, such as antibiotics
use a steroid inhaler for conditions like asthma
have a dry mouth
eat lots of sugary foods
have a chronic disease


Symptoms:


The symptoms of esophageal thrush include:

white lesions on the lining of your esophagus that may look like cottage cheese and may bleed if they’re scraped
pain or discomfort when swallowing
dry mouth
difficulty swallowing
nausea
vomiting
weight loss
chest pain

It’s also possible for esophageal thrush to spread to the inside of your mouth and become oral thrush.



Image Credit: https://www.globalhealingcenter.com/natural-health/wp-content/uploads/2015/06/whatscandidaBLOG-300x200.jpg




The symptoms of oral thrush include:

creamy white patches on the inside of the cheeks and on surface of the tongue
white lesions on the roof of your mouth, tonsils, and gums
cracking in the corner of your mouth
Breastfeeding moms can experience Candida infection of the nipples, which they can pass on to their babies.


The symptoms include:
especially red, sensitive, cracking, or itchy nipples
stabbing pains felt deep within the breast
significant pain when nursing or pain between nursing sessions


If you experience these conditions, you should watch your baby for signs of infection. While babies can’t say if they’re feeling bad, they may become more fussy and irritable. They can also have the distinctive white lesions associated with thrush.



Image Credit: https://image.slidesharecdn.com/candidiasis-120131033954-phpapp01/95/candidiasis-14-728.jpg?cb=1327986257




Diagnosis:


Esophageal thrush: Testing and diagnosis:

If your doctor suspects you might have esophageal thrush, they will do an endoscopic exam.
Endoscopic exam

During this exam, your doctor looks down your throat using an endoscope. This is a small, flexible tube with a tiny camera and a light at the end. This tube can also be lowered into your stomach or intestines to check the extent of the infection.




Image Credit: http://www.candidainstool.com/wp-content/uploads/2016/12/Candida-Esophagitis-3.jpg




Treating esophageal thrush:

The goals of treating esophageal thrush are to kill the fungus and prevent it from spreading.

Esophageal thrush warrants systemic antifungal therapy, and an antifungal medication, such as itraconazole, will likely be prescribed. This prevents the fungus from spreading and works to eliminate it from the body. The medication can come in a variety of forms, such as tablets, lozenges, or a liquid that you can swish in your mouth like mouthwash and then swallow.




Image Credit: http://images.slideplayer.com/34/10174302/slides/slide_42.jpg




If your infection is slightly more severe, you may receive an antifungal medication called fluconazole delivered intravenously in the hospital.

People with late-stage HIV might need a stronger medication, such as amphotericin B. Most importantly, treating the HIV is important for controlling the esophageal thrush.

If your esophageal thrush has compromised your ability to eat, your doctor may discuss nutritional options with you. This can include high-protein shakes if you can tolerate them or alternative feeding options, such as a gastric tube in severe situations.



Preventing esophageal thrush:

You can reduce your risk of developing esophageal thrush in the following ways:

Eat yogurt whenever you take antibiotics.
Treat vaginal yeast infections.
Practice good oral hygiene.
Go to your dentist for regular checkups.
Limit the amount of sugary foods you eat.
Limit the amount of foods you eat that contain yeast.


Even though those with HIV and AIDS are at greater risk for esophageal thrush, doctors rarely prescribe preventive antifungal medicines. The yeast could become resistant to treatments. If you have HIV or AIDS, you can reduce your risk of an esophageal thrush infection by taking prescribed antiretroviral therapy (ART) medications.




Future health complications:

The risk for complications after the development of esophageal thrush is higher in people with comprised immune systems. These complications include thrush that spreads to other areas of the body and an inability to swallow.

If you have a compromised immune system, it’s very important to seek treatment for thrush as soon as you notice symptoms. Thrush can easily spread to other parts of your body, including your:

lungs
liver
heart valves
intestines
By receiving treatment as quickly as possible, you can reduce the likelihood that thrush will spread.



Outlook for esophageal thrush:

Esophageal thrush can be painful. If it’s left untreated, it can become a severe and even life-threatening condition. At the first signs of oral thrush or esophageal thrush, talk to your doctor. Esophageal thrush is highly prone to spreading. The more areas of the body affected, the more severe the infection can be. Medications are available to treat esophageal thrush, including antifungal medicines. Prompt and careful treatment can reduce your pain and discomfort.



References:
Candida infection. (2014). http://www.oralcancerfoundation.org/complications/candida-infection.php
Candidiasis: (Thrush). (2014). http://www.aidsinfonet.org/fact_sheets/view/501
Oral thrush: Symptoms. (2014). http://www.mayoclinic.com/health/oral-thrush/DS00408/DSECTION=symptoms
Oropharyngeal/esophageal candidiasis (thrush). (2014). http://www.cdc.gov/fungal/diseases/candidiasis/thrush/definition.html
Copyright © 2005 - 2018 Healthline Networks, Inc. All rights reserved. Healthline is for informational purposes and should not be considered medical advice, diagnosis or treatment recommendations."



Image Credit:
https://cdn2.curejoy.com/content/wp-content/uploads/2017/04/Oral-Thrush_Internal-Causes-Of-Angular-Cheilitis-Due-To-Systemic_Other-Medical-Conditions.jpg>https://cdn2.curejoy.com/content/wp-content/uploads/2017/04/Oral-Thrush_Internal-Causes-Of-Angular-Cheilitis-Due-To-Systemic_Other-Medical-Conditions.jpg



According to Medical News Today (https://www.medicalnewstoda
y.com/articles/178864.php,

Oral Thrush: Causes, Symptoms, and Treatments
By Christian Nordqvist
Reviewed by University of Illinois-Chicago, School of Medicine





"Oral thrush, also known as oral candidiasis, is a yeast/fungi infection of the genus Candida that develops on the mucous membranes of the mouth.

It is most commonly caused by the fungus Candida albicans, but may also be caused by Candida glabrata or Candida tropicalis.

In this article, we will cover all aspects of oral thrush, including the causes, symptoms, and treatment.

Contents of this article:


Causes
Symptoms
Treatment
Risk factors
Diagnosis
Fast facts on oral thrush
Here are some key points about oral thrush. More detail and supporting information is in the main article.


Oral thrush is a common condition, but for most, it does not cause major problems

Individuals with a reduced immune system are worst affected by oral thrush

Oral thrush can occur more regularly after chemotherapy or radiotherapy to the head and neck

It is more common in people who are taking steroids, wear dentures, or have diabetes
The most obvious symptom of oral thrush is creamy or white-colored deposits in the mouth




What is oral thrush?


Oral thrush is caused by species of Candida fungus.

Oral thrush causes thick white or cream-colored deposits, most commonly on the tongue or inner cheeks. The lesions can be painful and may bleed slightly when they are scraped. The infected mucosa (membrane) of the mouth may appear inflamed and red.

Oral thrush can sometimes spread to the roof of the mouth and the back of the throat.

For the majority of individuals, oral thrush does not cause any serious problems. However, this is not the case for people with a weakened immune system, whose signs and symptoms may be much more severe.

People with poorly controlled diabetes, those taking steroids (especially long-term), as well as individuals who wear dentures, have a higher risk of developing oral thrush with more severe symptoms.

Long-term antibiotic therapy can increase the risk of developing oral thrush. Some medications, especially those that dry out the mouth, can cause oral thrush to develop. Oral thrush is more common among patients who receive chemotherapy or radiotherapy to the head and neck.

The outcome for oral thrush is generally very good. Most people respond well to treatment. However, oral thrush tends to reappear, especially if the causal factor (smoking, for instance) is not removed.




Image Credit: https://i.ytimg.com/vi/5JFURRsBo_8/hqdefault.jpg




Causes of oral thrush:

Tiny quantities of Candida fungus exist in various parts of our body, including the digestive system, skin, and mouth, causing virtually no problems to healthy individuals. In fact, C. albicans is carried in the mouths of up to 75 percent of the world's population.

However, people on certain medications, with reduced immune systems, or certain medical conditions are susceptible to oral thrush when C. albicans grows out control.




Symptoms of oral thrush:

Oral thrush in adults generally appears as thick, white or cream-colored deposits (spots) on the mucous membrane of the mouth (wet parts of the inside of the mouth).

The mucosa (mucous membrane) may appear swollen and slightly red. The spots may be raised. There may be discomfort or a burning sensation.

If the cream or white-colored deposits are scraped, bleeding may occur.

The white spots may join together to form larger ones, also known as plaques; these may then take on a grayish or yellowish color.

Occasionally, the affected area simply becomes red and sore, with no detectable white spots.

Individuals who wear dentures may have areas that are constantly red and swollen under a denture. Poor oral hygiene, or not taking the dentures out before going to sleep may increase the risk.




Oral thrush is sometimes divided into three groups based on appearance, although the condition can sometimes sit between categories:

A Doctor checks a patient's throat
Oral thrush is typically diagnosed after an oral examination.
Pseudomembranous - the classic and most common version of oral thrush.
Erythematous (atrophic) - the condition appears red raw rather than white.
Hyperplastic - also referred to as "plaque-like candidiasis" or "nodular candidiasis" due to the presence of a hard to remove solid white plaque. This is the least common variant; it is most often seen in patients with HIV.

There are a number of other lesions that can also appear with oral thrush. Sometimes, these lesions might be due to other types of bacteria that are also present in the area.



These can include:

Angular cheilitis - inflammation and/or splitting in the corners of the mouth
Median rhomboid glossitis - a large, red, painless mark in the center of the tongue
Linear gingival erythema - a band of inflammation running across the gums



Treatment of oral thrush:

Doctors will usually prescribe anti-thrush drugs, such as nystatin or miconazole in the form of drops, gel, or lozenges. Alternatively, the patient may be prescribed a topical oral suspension which is washed around the mouth and then swallowed.

Oral or intravenously administered antifungals may be the choice for patients with weakened immune systems. If treatment is not working, amphotericin B may be used; however, this will only be used as a last resort due to the negative side effects which include fever, nausea, and vomiting.



Risk factors for oral thrush:


Adult oral thrush is more likely to become a problem for the following groups:

People who wear dentures - especially if they are not kept clean, do not fit properly, or are not taken out before going to sleep.

Antibiotics - people who are on antibiotics have a higher risk of developing oral thrush. Antibiotics may destroy the bacteria that prevent the Candida from growing out of control.

Excessive mouthwash use - individuals who overuse antibacterial mouthwashes may also destroy bacteria which keep Candida at bay, thus increasing the risk of developing oral thrush.

Steroid medication - long-term use of steroid medication can increase the risk of oral thrush.

Weakened immune system - people with weakened immune systems are more likely to develop oral thrush.

Diabetes - people with diabetes, especially if it is poorly controlled, are more likely to have oral thrush.

Dry mouth - people with less than normal quantities of saliva (xerostomia) are more prone to oral thrush.

Diet - malnutrition predisposes people to oral thrush; this could be caused by a poor diet or a disease that affects the absorption of nutrients. In particular, diets low in iron, vitamin B12, and folic acid appear to affect infection rates.

Smoking - heavy smokers are more at risk, the reasons behind this are unclear.



Diagnosis of oral thrush:

In the vast majority of cases, the doctor can diagnose oral thrush by looking into the patient's mouth and asking some questions about symptoms.

The doctor may scrape some tissue from the inside of the mouth for analysis.

If the doctor believes the oral thrush is being caused by a medication or some other underlying cause, that cause must be dealt with. Treatments in such cases depend on the underlying cause.



References
Amphotericin B (intravenous route, injection route). (2015, December 1). Retrieved from http://www.mayoclinic.org/drugs-supplements/amphotericin-b-intravenous-route-injection-route/side-effects/drg-20061771

Awatif Y. Al-Maskari, Masoud Y. Al-Maskari, Salem Al-Sudairy. (2011, May). Oral manifestations and complications of diabetes mellitus. Sultan Qaboos University Medical Journal. 11(2): 179–186. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3121021/

Fran├žois L. Mayer, Duncan Wilson, Bernhard Hube. (2013, February 15). Candida albicans pathogenicity mechanisms. Virulence. 4(2): 119–128. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3654610/

Oral thrush in adults. (2014, August 14). Retrieved from http://www.nhs.uk/Conditions/Oral-thrush---adults/Pages/Introduction.aspx

Oropharyngeal/esophageal candidiasis ("thrush"). (2014, February 2013). Retrieved from https://www.cdc.gov/fungal/diseases/candidiasis/thrush/

Treatments for oral thrush. (2014, August 14). Retrieved from http://www.nhs.uk/Conditions/Oral-thrush---adults/Pages/Introduction.aspx#treatment


I also found some natural recipes to help with thrush until you can see your doctor:

Image Credit: https://image.slidesharecdn.com/thrush-140605173056-phpapp02/95/thrush-11-638.jpg?cb=1401989495


I had a suspicion that my Gastroparesis was causing it, with all of vomiting, but had no idea that other chronic illnesses caused this. So, I think the constant vomiting of stomach acid brought on mine. It probably did through off my pH. I learned a lot of new things today and I hope it well help others.