Star Health Magazine Focussing On Gastroenterology

STAR HealthConsult our Expert Doctor For Free Medical Advice on our Toll Free Number 1800 425 2255Now you may also buy Policy online at www.starhealth.in

Printed Matter

STAR Health Consult our Expert Doctor For Free Medical Advice on our Toll Free Number 1800 425 2255

Publisher:Mr. V. Jayaprakash

Printer:Mr. D. Srikanthan,306, Purasawakkam High Road,Chennai – 600010.

Chief Editor:Dr. Asiya Shahima Khan

Editorial Board Members:Dr. S. PrakashDr. C.B. Krishna KumarDr. Jeba Victor

Corporate OfficeStar Health and Allied Insurance Company Ltd,#1, New Tank Street, Valluvar Kottam High Road,Nungambakkam, Chennai – 600034Email: [email protected]

India’s First StandAlone Health Insurance Company has begun its operations in May 2006. Today the

Company’s paid up capital stands at Rs. 303 Crores.Chairman - Emeritus

Mr. Syed Mohamed Salahuddin - Managing Director of ETA ASCON and ETA STAR group of Companies in Dubai, U.A.E.

Our Board of DirectorsMr. V. Jagannathan

Chairman-cum- Managing Director with over 40 years of experience in Insurance Industry.

Padmashri D. R. KaarthikeyanHeld various prestigious positions including Chief of Spe-cial Investigation Team, CBI; Director of Police Academy, Mysore; Chief of Intelligence and Director General of Na-tional Human Rights Commission. He was the Chairman of the Special Task Force instituted by the Government of India in the Rajiv Gandhi assassination case.

Mr. Essa Abdullah Al GhurairMember of the prominent Al Ghurair family in the U.A.E.Dr. M. Y. KhanFormer Chairman of Jammu & Kashmir Bank Ltd.Mr. Mohamed HassanProminent Educationalist and IndustrialistMr. V.P. Nagarajan

Executive Director of ETA Ascon and ETA Star Group of Companies in UAE.

Mr. Dinesh Chandra Gupta Former Finance Secretary, Government of India and Member, MRTP Commission

Mr. K.S. Jangbahadur President – Private Equity, ICICI Venture Funds Management Co. Ltd.

About Your Company

2

03 - Message From CMD04 - Star Unique Health Insurance Policy 09 - Chest Pain

12 - The villain behind gastric ulcer14 - Laryngopharyngeal Reflux Disorder16 - Heart burn and reflux- Advances in Management18 - Are we paying the price for westernization?20 - Obesity

23 - Stomach cancer25 - Fitness section

Feathers in our CapStar Health and Allied Insurance Company has been awarded the prestigious “The Great Mind Challenge

for Business 2010 Award” instituted by IBM under two different categories for its path breaking initiatives in providing paperless processing and settlement of claims in the Kalaignar Kapeettu Thittam, an initiative by the Tamilnadu Government to bring health care to the doorsteps of the poor and under privileged.

1. ‘The Most Innovative Solution implemented using Information Management Software’ 2. ‘The Most Innovative Green IT solution using IBM software’Star Health Specialties A user friendly website with Health tips 200 offices across India with 5000 Employees Cashless treatment facility with over 4900 Network Hospitals across India A full-fledged 24X7 call Centre with a Toll free facility (1800 425 2255) for effective claims handling

24 X 7 Health Information Helpline - Expert Medical Consultation available to all customers at all times

OUR NEXT ISSUE WILL FOCUS ON INFECTIOUS DISEASES,

APART FROM OTHER INFORMATIVE HEALTH ARTICLES

STAR HealthConsult our Expert Doctor For Free Medical Advice on our Toll Free Number 1800 425 2255

FROM CMDMESSAGE

3

My dear policy holder,In the earlier issue I have mentioned about living with diabetes can be sweeter with

Star Health by your side. In this issue the focus is on problems relating to gastroentero logy. You will kindly observe published in this issue that articles are contributed by eminent Doctors and I am sure you can preserve this magazine and it will serve as a guide book for whomsoever when needed.

In Star Health we are always at your service 24 x 7 and you can contact us through Toll free number should you need help over phone for any minor problems. As regards products, we have come out with two new innovative products recently viz., Star Unique Health, covering the pre-existing diseases with certain conditions and another product viz., Star Wedding Gift covering maternity benefits besides regular health cover etc to the couple. It is my humble suggestion that instead of presenting any other gift to the newly wedded couple, Star Wedding Gift policy can be given, which will, in addition to giving medical pro-tection, will also take care of their maternity benefits etc. Of course, terms and conditions can be read from our website.

With your kind support your ‘Star Health’ has crossed Rs.1000 Crores. I would only appeal to you to give us your continued and valuable support in the years to come to serve you better.

To conclude, I would say that Star Health is not in the sky but always at your doorstep to serve you with a lots of smile.

Yours Sincerely

V. Jagannathan Chairman-cum-Managing Director


What is Unique about this policy?Star Health brings you this Unique insur-

ance policy with unique benefits for – cover-age for both future ailments / diseases and for pre existing diseases / conditions. Policy BenefitsHospitalization Cover : In-patient

hospitalisation for a minimum of 24 hours. Expenses covered are: Room rent, Boarding and Nursing

Expenses @ 1% of sum insured subject to a maximum of Rs.3000/- per day.

Surgeon, Anaesthetist, Medical Practi-tioner, Consultants, Specialist Fees.

Anaesthesia, Blood, Oxygen, Opera-tion Theatre charges, Surgical Appliances, Medicines and Drugs, Diagnostic Materi-als and X-ray, Dialysis, Chemotherapy, Radiotherapy, cost of Pacemaker and similar expenses.

Emergency ambulance charges for tran-porting the insured person upto a sum of Rs.750/- per hospitalisation and overall limit of Rs.1500/- per policy period. Pre & Post Hospitalisation Pre-hospitalization medical expenses

upto 30 days prior to the date of admission. P o s t - h o s p i t a l i z a t i o n –

a lumpsum ca lcu lated at 7% of the hospitalization expenses (excluding room charges) subject to a maximum of Rs.5,000/-. Pre Existing Disease/Condition Pre-Existing Disease/ Condition (other

than those diseases / conditions for which specific periods have been mentioned under exclusions) will be covered after 11 months of continuous coverage have elapsed, since inception of this policy with the Company.

NEW ADDITION TOOUR PRODUCT RANGE

Star Unique Health Insurance Policy

HIV positive personsCovers HIV positive persons except for op-

portunistic infections and treatment for HIV / AIDS. The minimum CD 4 count at the time of entry should be 350. Non Allopathic TreatmentsUpto 25% of sum insured subject to a maxi-

mum of Rs.25000 per occurrence, per year of insurance.

STAR HealthConsult our Expert Doctor For Free Medical Advice on our Toll Free Number 1800 425 2255 5

EligibilityAny person aged between 18 years and 65 years residing in India. Renewals would be

accepted upto 70 years. Beyond 70 years renewals would be provided under any other health insurance policy

of the company. Is there any pre-acceptance medical screening There is no pre acceptance medical screening Policy Period : This is a two year policy The sum insured and sub limits are for each year of insurance

and cannot be cumulated or carried forward. Payment of premium: The premium under the policy can be paid in 2 instalments as indicated. The first instalment is payable at the commencement of the policy. The second instalment

is payable at the beginning of the second year of the policy. Where a claim is made before such instalment falls due then the same would be recovered from the eligible claim amount The policy would lapse if the instalment is not paid on or before the due date. Annual Pol icy Premium (Service Tax Extra)Premium Table to be inser ted Note : The sum insured is for each year of insurance and cannot be cumulated or

carried forward Tax Benefits Payment of premium by any mode other than cash for insurance under this policy is

eligible for relief under section 80D of the Income Tax Act Renewal: The policy is renewable except where it is found that the insured person has

misrepresented / committed fraud. Where the claims ratio under the immediately preceding policy period exceeds 100% then

loading on the premium as per the scales below would apply:Claims ratio > 100% upto 125% - loading on premium 20%Claims ratio > 125% upto 150% - loading on premium 30%

Claims ratio > 150% - loading on premium 50%A grace period of 15 days from the date of expiry of the policy is available for renewal. If re-

newal is made within this this 15 day period continuity of benefits will be allowed, subject to the condition that any claim arising during this break-in period shall not be paid for.

This grace period is applicable for instalment also. Exclusions Treatment of disease/sickness/illness contracted by the Insured Person during the

first 30days from the commencement date of the policy. First two Years exclusions : Cataract, Hysterectomy (abdominal and Vaginal), Dysfunctional

Uterine Bleeding (DUB) Fibroid Uterus, Prolapsed Uterus, Myomectomy, Cystectomy, Treatment of Internal Derangement of Knee (other than caused by an accident), Treatment for Joints (other than caused by an accident), other Arthroscopic procedures, Inter-Vertebral Disc Prolapse (other than caused by accident), Degenerative Vertebral and Disc diseases, Varicose veins and Varicose ulcers, Thyroiditis, Treatment of Goitre, Tympnoplasty, Mastoidectomy Glaucoma.

These are not payable irrespective of whether they are Pre-Existing or not. First year exlusions : Deviated Nasal Septum, Benign Prostate Hypertrophy, Hernia,


Note: Premium figures are excluding Service Tax.

Applicable for offices in Ahmedabad, Bangalore, Mumbai including Thane and New Delhi including Faridabad, Gurgaon & Noida

Sum Insured Options (Rs)

Sub-limit for PED

Cover(Rs)

18yrs-25yrs

26yrs-40yrs

41yrs-55yrs

56yrs-60yrs

61yrs-65yrs

66yrs-70yrs

100000 50000 5880 6720 10080 11760 14170 16100200000 100000 7585 9840 14760 17220 20745 23575300000 150000 10625 13800 20010 22770 23805 26450

Sum Insured Options (Rs)

Sub-limit for PED

Cover (Rs)

18yrs-25yrs

26yrs-40yrs

41yrs-55yrs

56yrs-60yrs

61yrs-65yrs

66yrs-70yrs

100000 50000 4900 5600 8400 9800 12320 14000200000 100000 6320 8200 12300 14350 18040 20500300000 150000 8855 11500 16675 18975 20700 23000

Applicable for offices in rest of India

Hydrocele, Congenital Internal diseases/defects, Fistula in anus, Piles, Fissure in anus, Sinusitis, and related disorders, Nasal Polyps ,Post trauma non union / mal union, Cholecystectomy, Gall Bladder Calculi and Renal Calculi

If any of these are Pre-Existing they will be covered after 24 months of continuous insurance with the Company. During the first 48 months of continuous operation of this Insurance cover the expenses

on Stapedectomy, Bone marrow transplant, Cirrhosis of liver with or without portal Hyperten-sion, Hepatitis, Loss of vision partial / total including Retinopathy, Retinal Detachment, Macular degeneration and Papill Oedema, all types of Cancer, Nephropathy and Chronic Kidney diseases and Implant Removal shall not be payable if these are Pre-Existing at the commencement of this insurance. 30% of each and every admissible claim. Naturopathy treatment Expenses which are purely diagnostic in nature with no positive existence of any disease Expenses which are mainly cosmetic in nature Note : For a detailed list of exclusions please refer policy conditions. Claims Procedure Call the 24 hour help-line for assistance - 1800 425 2255 Inform the ID number for easy reference In case of planned hospitalization inform 24 hours prior to admission in the hospital In case of emergency hospitalization information to be given within 24 hours

after hospitalization Cashless facility can be availed in all net-work hospitals I n non -ne twork hosp i t a l s p aymen t mus t be made up - f ron t a nd t hen

reimbursement will be effected on submission of documents.


Can there be a better gift than the gift of security and protection?

Introducing Star Wedding Gift Insurance Policy – a com-panion which protects you in adversity and supports you in moments of joy.

Policy Benefits

1. Hospitalization Coverl In-patient hospitalization expenses for a minimum of

24 hoursl Room, Boarding, Nursing expenses upto Rs. 4, 000/-

per day.l Surgeon, Anaesthetist, Medical Practitioner,

Consultants, Specialist fees.l Cost of medicines and drugs.l Emergency ambulance charges for transporting the

insured patient to the hospital upto a sum of Rs. 1, 000/- per hospitalization and overall limit of Rs. 1, 500/- per policy period

2. Delivery including Pre Natal and Post Natal Coverl E x p e n s e s f o r d e l i v e r y o f c h i l d

(Caesarean/Normal Delivery – for one delivery only) upto the limits

l Pre and Post natal expenses includedl Po s t d e l i ve r y c o m p l i c a t i o n c ove r f o r

mother

3. Free Benefitl Cost of test incurred for detecting any disorders in

the Foetus upto Rs. 1, 000/- (after a waiting period of 27 months)

4. New Born Baby Carel C o ve r f o r N e w b o r n b a b y ( i n c l u d i n g

Congenital disorders/defects)

5. Non Allopathic Treatmentsl Upto 25% of sum insured per occurrence, subject to

a maximum of Rs. 25, 000/- per policy period

6. Pre Existing Diseasel Pre existing diseases are covered after 48 months of

continuous insurance with the company.

7. Pre & Post Hospitalizationl Pre-hospitalization medical expenses upto 30 days

prior to the date of admission.l Post-hospitalization – a lumpsum calculated at 7%

of the hospitalization expenses (excluding room charges) subject to a maximum of Rs. 5, 000/- is payable.

l Not applicable for child delivery claims.

Is there any pre-acceptance medical screening

l There is no pre acceptance medical screening.

StarWedding

GiftPolicy

7


Policy PeriodPolicy is offered for the following periodsl 1 yearl 2 yearsl 4 years

Eligibilityl Any couple aged between 18 years and 40 years

residing in India can take this insurance.l Renewable upto 45 years.

Coverage Option 1 Option 2a. Hospitalization Expenses Rs. 3,00,000/- Rs. 5,00,000/-b. Child Delivery Expenses Rs. 15,000/- for normal

delivery and Rs. 20,000/- for caesarean delivery

Rs. 20,000/- for normal delivery and Rs. 25,000/- for caesarean delivery

c. Pre and Post Natal Expenses (as part of Child Delivery Expenses)

Pre Natal : Rs. 1,500/-Post Natal : Rs. 2,000/-

Pre Natal : Rs. 2,000/- Post Natal : Rs. 4,000/-

d. New Born Baby Cover : Hospitalization expenses for treatment including congenital diseases

Rs. 30,000/- Rs. 50,000/-

e. New Born Baby Cover :Lump sum payment for Down’s Syndrome and Cerebral Palsy

Rs. 60,000/- Rs. 1,00,000/-

f. Post Delivery Complications Actuals within Hospitalization Limits

Actuals within Hospitalization Limits

g. Test for detecting congenital abnormality in foetus

Rs. 1,000/- Rs. 1,000/-

Note: The coverage limits mentioned in (b) to (f) above, is part of the overall Sum Insured mentioned under (a) above.

Sum Insured:

Policy period for One Year cover (Service Tax Extra):

Option Family Size Premium (Rs.)5 months – 35 years

36 years – 45 years

Option 1 2A 10305 107402A + 1C 10535 11305

Option 2 2A 13960 146802A + 1C 14470 15310

Policy period for Two Years cover(Service Tax Extra) :

Option Family Size Premium (Rs.)5 months – 35 years

36 years – 45 years

Option 1 2A 18550 193352A + 1C 18965 20350

Option 2 2A 25130 264252A + 1C 26050 27560

Policy period for Four Years cover (Service Tax Extra) : Option Family

SizePremium (Rs.)

5 months – 35 years 36 years – 45 yearsOption 1 2A 43285 45110

2A + 1C 44250 47485Option 2 2A 58635 61660

2A + 1C 60775 65145

8


Chest pain is one of the important symptom which make people nerv-ous, since it is often mistaken for Cardiac pain - angina. Recurrent chest pain mimicking angina pec-toris can arise from the esophagus.

Esophageal disorders especially gastroesopha-geal reflux disease (GERD) are probably the most common cause of non – cardiac chest pain. Nearly 30% of all patients with chest pain undergoing coronary angiography for coronary artery disease have normal angiograms and upto 60% may have esophageal disease for their symptoms. Many pa-tients with esophageal chest pain complain of other esophageal symptoms when questioned closely, but

10% may have only chest pain as there presenting complaints.

Let us look into the reason for chest pain due to esophageal reflux and chest pain due to heart.

The specific mechanisms that produce esopha-geal chest pain are not well understood. Chest pain that arises from esophagus has commonly been attributed to the stimulation of chemo-receptors (acid, pepsin, bile) or mechano-receptors (distension, spasms) although thermo-receptors may also be involved. Acid sensitivity produces pain presumably or direct stimulation of sensory nerve ending in the esophagus. Many patients with suspected esophageal chest pain have esophageal motility disorders which might cause distal esophageal spasm thus causing

Chest Pain

Prof. S .Thanikachalam MD, DMChairman and Director,

Cardiac Care Center,Sri Ramachandra University.


inhibition of blood flow for a critical period of time, leading to myoschemia. This myoischemia might be the cause of the esophageal chest pain. Studies suggest the esophageal dysmotility may present an epiphenomenona of a chronic pain syndrome rather than the direct cause of complaints.

Other potential causes of esophageal chest pain include the excitation of temperature receptors or distension. The ingestion of cold liquids can produce severe chest pain. Distension of stretch receptors of distal esophagus by acute food impaction or carbon-ated beverages may lead to chest pain when sensitized to gastro-esophageal acid.

The specific mechanism of chest pain due to heart may be multiple. The common reason is ob-struction to blood flow within blood vessel reducing in the blood flow to heart muscle or sudden spasms of the artery interfering with the blood supply to heart muscle or spl itt ing of blood vessel wall due to high blood pressure (dis-section of aortic wall). Generally pain due to heart is precipitated by exertion; emotion and intense grief, at times

even at rest depending up on the degree of obstruction in coronary artery or the no. of vessels that are affected.

Differentiation of chest pain due to gastroesophageal and heart.

GastroesophagealIntermittent anterior chest

pain is the sine-qua-non of this syndrome. Chest pain is usually described as squeezing or burning, substernal in loca-tion and radiating to the back, neck, making it sometimes indistinguishable from cardiac chest pain. It can be triggered by ingestion of very hot or very cold liquids. It frequently awakens the patient from sleep and may worsen during periods

of emotional stress. The pain episode may last from m i n u t e s t o h o u r s a n d e v e n p e r s i s t intermittently for several days. Symptoms may abate spontaneously and may be eased with antacids but relief of severe chest pain may require narcotics or nitroglycerine. Most patients with esophagitis have associated other esophageal symptoms (e.g. epigastric or retrosternal burning sensation, sour eructation’s, water brash, or regurgitation) when closely questioned, but about 10% may have chest

pain as their only complaint.Clues suggesting esophageal origin of chest

pain Diffuse burning, hot acidic sensation in the chest

‘Open-hand’ presentation in contrast to the ‘clutched fist (Levine’s sign) in myocardial

ischemiaPa i n con t i nue s fo r

hoursWakes patient from

sleepPain that is meal

relatedMore in recum-

bency, bend ing or straining

Cardiac painFurther pain local-

ized to one point espe-cially one finger tip size not spreading to other

Che

st P

ain

10


parts of the chest not aggregated are induced by exertion is unlikely to be due to cardiac origin. De-pending up on the severity of the disease the chest pain may happen at rest or on exertion. Pain is usu-ally not localized spread in wide area, usually center of the chest spreading to both sides of the chest often spreading to left arm or both arms and occasionally to the jaw, lasts for 5 to 10 min, often associated with the sense of fear or anxiety, fatigue or tiredness or often afraid to move or walk since the pain aggravates. At time it is not pain, more of burning sensation but spreading on the chest same way as mentioned above. This sort of pain coming on exercise or at rest may not indicate that it is heart attack. It is only called angina.

But during heart attack since the condition is due to the total block of a vessel supplying the heart muscle depending up on the artery that is involved, the pain is more excruciating or piercing in nature often associated with perfused sweating, palpitation and on many occasions difficulty in breathing. In rare occasions inspite of these differentiating

11

points, the esophageal pain may mimic like angina or angina may mimic and esophageal pain. The age of the patient, sex, associated risk factors like Diabetes, Smoking, Hypertension, High blood cholesterol, marked obesity may give a clue to the cause of chest pain. On many occasions ECG at the time of discomfort or exercise test (Treadmill test) and rarely a non invasive or invasive angiogram may be needed to differ-entiate the pain especially in the presence of risk factors mentioned above. l


What is H Pylori?H. Pylori is a spiral shaped organism that is found

in the stomach of most adults. It adheres to the stomach lining and can cause gastritis, gastric and duodenal ulcers and even stomach cancers.

What is H Pylori? infection is usually associated with poor

hygienic conditions and overcrowding bacteria spread from one person to another

mainly in children either through oral-oral contact or faeco-oral contact. In developing countries, it has been found to

infect almost 80 - 90% of the entire population.What does it do in the body: l The bacteria produce chemicals that increase

acid production and cause local inflammation (gas-

Dr. V. RamasubramanianConsultant

Infectious DiseasesApollo Hospitals

Boosters Immune Clinic

The villain behind gastric ulcerH.Pylori:

tritis and duodenitis). l Chronic inflammation can cause changes in

the cell structure and function and lead to abnormal cells which turn cancerous.l About 95% of duodenal ulcers are infectd

by H. Pylori and treating the infection will prevent recurrence.l Fortunately only 15% of people infected with

H. Pylori develop duodenal ulcers. Gastric ulcers and gastritis can also occur due to damage by chemicals induced by the bacteria.

Clinical symptomsH. Pylori can cause an acute infection associated

with fever and dyspepsia which is self limited. H. Pylori gastritis can be asymptomatic or may simply cause upper abdominal discomfort or dyspepsia.

Duodenal ulcers are more common than gastric ulcers. The characteristic feature is upper abdominal pain and ‘burning sensation’. The pain characteristi-cally occurs at night and is relieved by antacids. Nausea may accompany the pain but vomiting is infrequent even though it may relieve pain. Loss of appetite and weight may occur with gastric ulcers and chronic pain is more typical. Sometimes back pain may result from the ulcer penetrating through the posterior wall of the stomach. Patients may also present with blood in vomitus or in the stools and rarely acute abdominal pain crisis resulting from perforation of the stomach.

Untreated, the symptoms of stomach ulcer are periodic with waxing and waning over several years.

12


The villain behind gastric ulcer

Complications of Peptic UlcerSeveral complications can occur due to peptic

ulcer.1) Bleeding :Massive bleeding can result in

collapse and death2) Perforation – The ulcer may erode through

the stomach wall and cause perforation requiring emergency surgery

3) Gastric outlet obstruction – Scarring of the stomach when the ulcer heals with deformity may lead to obstruction to the flow of food into the intestine. This is manifest as recurrent vomiting and abdominal distension

DiagnosisH. Pylori infection can be diagnosed non-inva-

sively either by the urease breath test, blood test for H. Pylori antibodies or a simple stool test to detect the antigen. It can also be confirmed by an endoscopy when gastric biopsies can be done.

All patients with ‘alarm symptoms’ of gastric ulcers require an endoscopy, especially the elderly.

What are the current treatment guidelines?Eradication therapyl Current recommendations advise eradication

therapy for all persons with gastric or duodenal

ulcers. l Persons with typical symptoms under 55 years

of age who are H. Pylori positive require no further investigations and can start treatment. l Older patients mandate an endoscopy.l Eradication therapies are successful in 90%

of patients. l failure of eradication can be upto 50% in the

developing countries due to poor compliance of therapy or drug resistance.

Drugs that can be used:There are several regimens available for eradica-

tion, but usually a combination of omeprazole, clari-thromycin and either amoxicillin or metronidazole is used for a week.

Smoking should be strongly discouraged and a re-endoscope at 6 weeks is recommended for patients with gastric ulcers.

So is it something to fear?H. Pylori infection is a preventable cause for

gastritis, stomach ulcers and cancers. Good hygiene in daily activities and food habits and awareness to detect and treat this infection can minimize the societal burden of cancers and absenteeism at work due to stomach ailments. l

13


- ENT Surgeon’s View What is GERD? Gastro-Esophageal Reflux Disease (GERD)

is a very common problem, well known to man-kind. In recent years, the incidence of GERD in our society has expanded manifolds,

Why is GERD on the increase? modern life style poor food habits work stress lack of adequate exercise. GERD occurs due to the backflow of acid

from the stomach, across the lower oesophageal sphincter onto the food pipe upwards.

Treatment for GERD including medicines & surgery. Acid Peptic Disorders have been

Causes of Acid Reflux from Stomach

traditionally treated with a multitude of drugs includingl Antacids, l Proton Pump inhibitorsl Prokinetic Agents, l GI Anesthetic l Lubricant Gels l Anti-H.Pylori Kit. Even though today, this spectrum of medicines for GERD

is freely available over the counter, it is judicious to always fol-low the advice of a specialist before trying self treatment

Laryngo-pharyngeal Reflux Disorder (LPR): GERD and what does it do?

GERD in the present day has metamorphosized from its original form & it has captured the attention of ENT surgeons worldwide, due its influences on the upper aero-digestive tract. This phenomenon of acid reflux across the upper oesophageal sphincter afflicting the larynx (voice box) & pharynx (food pipe), has been termed as the Laryngo-pharyngeal Reflux Disorder (LPR).

LPR presents with symptoms l burning sensation in throatl hoarseness of voicel difficulty in swallowingl dry hacking cough l no response in spite of conventional treatment for

GERD. Many patients, who present to a sleep disorder clinic with

complaints of Snoring & Sleep Apnoea, also have significant contribution to their symptoms from underlying Laryngo-pharyngeal Reflux Disorder. Hence, a part of their treatment regimen includes medications for LPR.

LPR & its influence on the Voice Acid reflux disease of the larynx has been estab-

Laryngopharyngeal Reflux Disorder -Could your indigestion be something more??

Authors: Prof. Mohan Kameswaran DSC, MS, FRCS (Ed), FAMS, FICS, DLO *Dr. S. Raghunandhan MS, DNB, MRCS (Ed), DOHNS (Eng)*Consultant ENT Surgeons, Madras ENT Research Foundation


lished as a separate clinical entity, requiring the nuances of an ENT Specialist, for its early diagnosis and appropriate manage-ment. The Laryngo-pharynx (junction of wind pipe & food pipe in the throat) is a dynamic region safe-guarding the airway from the corrosive influence of gastro-in-testinal juices. Malfunction of this laryngo-pharyngeal sphincter results in chronic insult to the larynx, resulting in a spectrum of laryngeal lesions. Clinical presentations of laryngo-pharyngeal reflux disorder may vary from features like l chronic laryngitis, l indolent laryngeal ulcers l granulomasl life-threatening laryngeal stenosis l laryngeal malignancies very rarely.How to diagnose LPR ?The Video Stroboscope, is a ‘cutting-edge’ sensitive

tool to look into the intricacies of the larynx and thereby study the pathological effects of laryngo-pharyngeal reflux in great detail. Video stroboscopy is a simple out-patient endoscopy procedure performed under local anesthesia & it provides a clear picture of the various components of the larynx in motion.

Who is affected by LPR?A large number of professional voice users like teach-

ers, singers & politicians with problems of voice fatigue, inability to raise voice to high pitches & breathy voice, when evaluated by a sensitive tool such as the Video Strobo-scope, have been found to have a significant contribution

due to laryngo-pharyngeal reflux disorder. Also, many established cases of Acid Peptic Disease have subtle, sub-clinical manifesta-tions in the larynx (voice box) which remain masked by the predominant GERD features from the stomach. Early diagnosis and ap-propriate treatment of laryngo-pharyngeal reflux prevails as a vital factor in the manage-ment of various voice disorders.

How does one manage LPR?H2-blockers are very effective in treat-

ing GERD patients by “turning the acid down”, but this is not sufficient treatment for many patients with LPR. The acid needs

to be virtually “turned off”, since the larynx is far more susceptible to injury from the acidic reflux than the esophagus. Laryngeal mucosa lacks the protective mechanism and barrier that the esopha-geal mucosa has to prevent damage from acid and pepsin exposure.

After a meticulous analysis of the Larynx & Laryngopharynx with Video Stroboscopy, the di-agnosis of Laryngopharyngeal Reflux Disorder is confirmed. All such patients are started on a stand-ardized 12 weeks regimen of anti-reflux medica-tions (Proton Pump Inhibitors + Prokinetic Agents) and are followed up for a period of 6 months, with sequential video-stroboscopic assessment at regular intervals. They are also symptomatically graded based on their symptomatic improvement & relief from reflux features as per Reflux Symptom Index (RSI) Score.

Majority of patients, (95%) respond well to the treatment

Conclusion: Is LPR manageable?Laryngopharyngeal Reflux Disorder is a unique

entity under the confluence of symptoms broadly termed as GERD, silently growing in incidence in recent times, due to the fast paced life of our present day society. Early diagnosis & appropriate management of LPR, by an ENT Specialist is most essential. lStroboscopic Pictures: Manifestations of Acid Reflux on the Larynx (Voice Box)

Laryngopharyngeal Reflux Disorder -Could your indigestion be something more??


HEART BURN AND REFLUX

What is Gastroesophageal Reflux Disease (GERD)?

Gastroesophageal reflux occurs when contents in the stomach flow back into the esophagus. This hap-pens when the valve between the stomach and the esophagus, known as the lower esophageal sphincter, does not close properly.

What are the symptoms of Gastroesopha-geal Reflux Disease?

Common symptoms of Gastroesophageal reflux disease are heartburn and/or acid regurgitation, unexplained chest pain, wheezing, sore throat and cough, among others.

How is Gastroesophageal Reflux Disease diagnosed? Upper GI endoscopy Impedance pH-metry

2. Prior to surgery to tighten the LES valve3. Chest pain with a normal heart unction4. Regurgitation5. Lack of response to medical therapy

The information acquired from this test will show:1. how frequently acid refluxes into the esophagus,2. what activities cause the reflux, 3. how long it stays in the esophagus, 4. What symptoms occur during these episodes (such as heartburn, belching, acid taste in the mouth, chest pain).

The study may give the physician useful infor-mation which can aid in medical treatment for the patient’s problem.

ADVANCES IN MANAGEMENTDr.V.G.Mohan Prasad.M.D.,D.M.,(Gastro)Chairman,VGM Hospital, Institute of GastroenterologyCoimbatore

pH , Manometry Test & 24-hour pH Study: 24-hour pH studies measure acid exposure

in the esophagus over a 24-hour period. This test can accurately measure whether or not Gastroesophageal reflux disease (GERD) is present.

The indications are:1. Chest burn

High resolution impedence pH metry: Impedence pH metry (MII-pH) launched for

the first time in the three southern states of Tamil Nadu, Kerala and Karnataka is a boon to detect no-acid reflux. While the conventional pH can detect only a reflux of acid from stomach into foodpipe.

But Impedence pH-metry can detect non-acid

16


ADVANCES IN MANAGEMENTGastroenterologist’s

View

reflux in the form of bile, gas or food, since many reflux episodes in human beings are composed of less acidic and gaseous mixtures.

How to reduce reflux?Avoiding these items may reduce your discom-

fort: Coffee, citrus drinks, tomato-based products,

carbonated beverages, chocolate, peppermint, fatty or spicy foods, eating within three hours of bedtime, smoking, excess alcohol consumption, excess weight gain.

Propping up the head of the bed with 6 inches wooden block at night may be helpful.

How to treat reflux?Effective medicines are available. However

surgery should be considered in patients with well-documented reflux disease who cannot tolerate medications or continue to have regurgitation as a primary symptom. If symptoms persist despite medi-cal treatment, a comprehensive evaluation should be completed prior to considering surgery. The surgery for treating reflux disease is known as fundoplication can be done via a laparoscope.

What are the complications of GERD?The complications of GERD can be prevented by

appropriate medical or surgical therapy.The following are the long term complications of

reflux disease:1. Barrett’s esophagus2. Esophageal stricture3. Ulceration

4. Hemorrhage5. Rare PerforationWhat is Barrett’s Esophagus?Barrett’s esophagus is a condition in which the lin-

ing of the esophagus changes, becoming more like the lining of the small intestine rather than the esophagus. This occurs in the area where the esophagus joins the

stomach. Barrett’s esophagus develops is because of chronic inflammation resulting from Gastroesopha-geal Reflux Disease (GERD).

Newer Therapy for Barrett’sRadio frequency ablation (RFA) is a simple endo-

scopic method of destroying the abnormal mucosa in the lower end of esophagus. l

17


Are we paying the price for westernization?

18

Inflammatory Bowel disease – Rare Gastrointestinal disease is on the risein India.Factors for IBD

l Westernization l Environmental factors contri

bute to the etiology. l I can quote an example to sup-

port this fact. Leicester is a small city in United Kingdom with a very high Indian population. The studies from this city show that the incidence of the inflammatory bowel disease is equal or higher than the native British population.

Signs and symptoms: R e c u r re n t l o n g s t a n d i n g diarrhea with or without blood in the stools Chronic abdominal pain, Weight loss Loss of appetite Anemia Recurrent mouth ulcers. This disease can also affect skin, joints and eyes. Children can present with growth retardation along with or without much gastrointestinal symptoms.

The exact etiology of the disease is unknown, but complex interplay of environmental factors and immuno-logical changes can trigger the onset of the disease in a genetically susceptible host. As we are exposed to more stress, urbanization and western type of diet, our gut brain axis is disrupted to a larger extent triggering dysregulation of the immune reactions.

1. NIMESULIDE - for children below 12 years - used for fever, body ache and joint pain2. CISAPRIDE - Used for Acidity and heart burn 3. PHENYLPROPANOLAMME – used in the composition of

cough syrup4. SIBUTRAMINE – Used for weight reduction and Obesity and5. Medicines containing HUMAN PLACENTAL EXTRACT

PLEASE BE AWARE THAT RECENTLY the following drugs have been banned under Section 26A of the Drugs and Cosmetics Act.

Ulcearations of the gastrointestinal tract

In the past few years of this modern era we are encountering allergic and immune mediated disorders affecting the body than the infective diseases .Our Gastrointestinal tract (GIT), which is considered as the longest organ of the body is also not spared from the immune mediated attack. I will be discussing about

the emergence of a new type of immune mediated disease affecting the GI tract in India called Inflammatory Bowel disease. It can be a chronic and debilitating disease.

Inflammatory bowel disease is a chronic, often re occurring inflam-matory disorder of the gastrointestinal tract.

Mechanism:Our own body’s immunity becomes dysregulated to cause damage

to the lining of the gastrointestinal tract leading to severe ulceration and bleeding.

Classified asl Crohn’s disease (which can affect any part of the GI tract) and l Ulcerative colitis (which affects only large bowel). These disorders have a higher prevalence in the western world and

were thought to be relatively uncommon in Asian countries.Inflammatory Bowel disease was considered very rare in India. But

recent statistics shows that the disease is increasing in India.


Are we paying the price for westernization?Dr.M.Ganesh M.D, MRCP (UK), CCST gastro (UK), PG Dip gastro (UK).

Chief consultant Gastroenterologist and Inflammatory Bowel Disease Specialist,KMCH, Coimbatore, South India. [email protected]

19

Inflammatory Bowel disease – Rare Gastrointestinal disease is on the risein India.

WHY this rise in IBD only now in India???

In the last two decades the hygiene of the Indian subcontinent has increased to a greater extent. The incidence of parasitic infections (worm infections) of the gut is decreasing.

Presence of worms in the gut and exposure to child hood infections induces immune toler-ance and reduces the incidence of inflamma-tory bowel disease. Decreasing incidence of common GI infections is indirectly contributing to the raise in incidence of the inflammatory

In the past 2 years of my practice in South India I have identified 87 cases of inflammatory bowel disease in a South Indian city called Coimbatore. Out of the two form of the disease, ulcerative colitis is considered to be more prevalent than crohn’s in India. But to my surprise this is also changing with higher incidence of crohn’s than ulcerative colitis in my city.

In my personal experience the incidence of this disease is increasing in India. In many situations I have seen patients suf-fering from this condition for many years without a diagnosis, due to lack of awareness and resources. Recent advances in the technology and awareness about this disease is helping doctors to identify this disease early. It’s important to identity this condition early and treat appropriately. Longstanding disease without appropriate treatment can cause severe complications. The quality of the life is affected very severely in untreated patients.

The gold standard test to identify the disease is to do en-doscopic examination of the gastrointestinal tract, taking tissue sample from the affected segment of the bowel and analyzing it under the microscope to confirm the diagnosis. The latest technology called Narrowband imaging helps us to identify the inflamed sites to do appropriate tissue sampling.

Synopsis: In conclusion many immune mediated diseases are now increasing in the Indian sub continent. Along with this, inflammatory bowel disease is also increasing in India. Why is this so?l Complex interaction between geneticsl Environmental factors,l Unhealthy fat rich dietl Dysregulated immune response to intestinal floral Urbanization l Westernization is contributing to the raising incidence

of this disorder. How can one prevent IBD?

Avoiding stress and reducing the consumption of west-ern type of high fatty and fast food may help some extent to decrease the incidence of this disease. In contrast to boosting the immune system to fight against disease, im-mune suppressive drugs are used to control the immune mediated damage in this condition. It’s very important to be aware about this disease and early treatment can reduce the complications. l

0

10

20

30

40

50

60

70

crohn'sdisease

ulceartivecolitis

Between Jan 2009 to September 2010 (Coimbatore)

bowel disease – hygiene hypothesis. To support this fact we see higher incidence of this disease in Kerala where hygiene levels are comparative-ly higher than other states in India. Sometimes being very hygienic is also a problem!!!

This is a multifactorial disease: certain factors l Environment, l Genetic factors also play a major role. l The genes are the basic building blocks of

the human body. Any abnormal changes in the genetic material (called as mutation) can affect the body functions. There is a genetic predis-position for the inflammatory bowel disease predominantly in the western world.

Personal experience as apracticing gastroenterologist:


Obesity is a medical condition in which excess body fat has accumulated to the extent that it may have an adverse affect on health. Body mass index (BMI) is a simple index of weight-for-height that is commonly used in classifying

overweight and obesity in adult populations and individuals. It is defined as the weight in kilograms divided by the square of the height in meters (kg/m2). The World Health Organization (WHO) defines “overweight” as a BMI equal to or more than 25, and “obesity” as a BMI equal to or more than 30. WHO fur-ther projects that by 2015, approximately 2.3 billion adults will be overweight and more than 700 million will be obese. Once considered a problem only in high-income countries, overweight and obesity are now dramatically on the rise in low- and mid-dle-income countries, particularly in urban settings hence by adding on the health care costs.

What causes obesity and overweight?The fundamental cause of obesity and overweight is an

energy imbalance between calories consumed on one hand, and calories expended on the other hand. Global increases in overweight and obesity are attributable to a number of factors including: a global shift in diet towards increased intake of energy-

dense foods that are high in fat and sugars but low in vitamins,

minerals and other micronutrients; and a trend towards decreased physi-

cal activity due to the increasingly seden-tary nature of many forms of work, chang-ing modes of transportation, and increasing urbanization.

What are common health conse-quences of overweight and obesity?

Obesity is no more a cosmetic issue alone. It’s infact a disease .Overweight and obesity lead to serious health con-sequences. Risk increases progressively as BMI increases. Raised body mass index is a major risk factor for chronic diseases such as: Cardiovascular disease (mainly

heart disease and stroke) - already the world’s number one cause of death, killing 17 million people each year. Diabetes – which has rapidly

become a global epidemic. WHO projects that diabetes death will increase by more than 50% worldwide in the next 10 years. Musculoskeletal disorders –

20


Prof. C PalaniveluMS, MCh, MNAMS, FRCS(Ed), FACS.

Chairman of the Institute and Director of GEM Hospital

BESITYespecially osteoarthritis. Some cancers (endometrial, breast, and

colon).Childhood obesity is associated with a higher

chance of premature death and disability in adult-hood.

How can the burden of overweight and obesity be reduced?

Overweight and obesity, as well as their related chronic diseases, are largely preventable.

At the individual level, people can: Achieve energy balance and a healthy

weight; Limit energy intake from total fats and shift

fat consumption away from saturated fats to unsatu-rated fats; Increase consumption of fruit and vegetables,

as well as legumes, whole grains and nuts; Limit the intake of sugars; and Increase physical activity - at least 30 minutes

of regular, moderate-intensity activity on most days. More activity may be required for weight control.

But the above mentioned recommendations hold good for overweight individuals and early obesity (BMI<35).the next step in management is obesity re-duction surgery, technically called bariatric surgery.

Bariatric surgery, also known as weight loss surgery, refers to the various surgical procedures performed to treat obesity by modification of the gastrointestinal tract to reduce nutrient intake and/or absorption. The term does not include procedures for surgical removal of body fat such as liposuction or abdominoplasty.

For individuals who have been unable to achieve significant weight loss through diet modifications and exercise programs alone, bariatric surgery may help to

attain a more healthy body weight. There are a number of surgical options available to treat obesity, each with its advantages and pitfalls. In general, bariatric surgery is successful in producing (often substantial) weight loss, though one must consider operative risk (including mortality) and side effects before making the decision to pursue this treatment option. Usually, these procedures can be carried out safely. Weight-loss surgery is not just a cosmetic surgery; it is a life-changing surgery. It is not a medical cure. It is intended for those who are morbidly obese and have

weight related health problems (diabetes, hyperten-sion, cardiac diseases, breathing problems etc) and also for the prevention of these disorders.

Who Is A Candidate for Bariatric Weight Loss Surgery? Typically, to qualify for bariatric surgery you

must be ‘morbidly obese’, which usually means be-ing overweight by 100 pounds (man) or 80 pounds (woman) with a Body Mass Index (BMI) of 40+. Alternatively, bariatric surgery may be ap-

propriate if you are 80 pounds overweight (BMI 35+)

21


and have a serious obesity-related condition like type 2 diabetes or life-threatening cardio-pulmonary problems such as severe sleep apnea or obesity-related heart disease.

Are The Health Risks Of Bariatric Surgery Greater Than The Risks Of Obesity?

For most patients suffering from morbid obesity (BMI 40+), super-obesity (50+) or end stage obesity syndrome (BMI 60+), the big question is, do the benefits of bariatric surgery outweigh its risks? The answer is yes. Severe obesity is a chronic, frequently progressive, life threatening disease, and the known health risks associated with morbid obesity far outweigh the risks associated with surgery. Published studies indicate that someone who is 100 percent above his/her ideal weight has a risk of mortality ten times higher that of a person of normal weight. Recent evidence from around the world have also proved beyond doubt that obese patients undergoing obesity surgery live longer than the others.

is reduced by up to 90 percent, to the size of an egg or even the size of a thumb. Typically, its capacity is 3-4 tablespoons of food. This stomach reduction drastically reduces the quantity of food which can be consumed in one sitting and speeds up sa-tiety. During bypass surgery, the digestive tract below the stom-ach is also altered. After leaving the small stomach pouch, food is re-routed to bypass most of the duodenum and is directed into the final part of the jeju-num. Because the food passes along a much reduced length of small intestine, and comes into contact with smaller amounts of digestive enzymes, fewer calories and nutrients are ab-sorbed.

What i s Metabo l i c Surgery?

This concept of Surgery has been extended to treat patients with uncontrollable diabetes and patients with high cholesterol levels referred to as Metabolic Syndrome , even for patients with normal body mass index .This new technique has been referred to as metabolic surgery (Ileal transposition sur-gery/Duodenojejunal Bypass) wherein the intestinal anatomy is rearranged hence by inducing certain hormonal changes ben-eficial for cure of Diabetes and High Cholesterol levels hence by completely curing diabetes and increased cholesterol per-manently in more than 90% of patients. Reports from around the world has shown excellent results with regard to diabetes control and the day is not far enough when the requirement of insulin and other related medications would become trivial. l

How Does Bariatric Surgery Affect The Digestive Process?Before SurgeryFood is chewed in the mouth, then swallowed, passing through the

esophagus to the stomach, (roughly the size of a melon) where stomach acids dissolve it into smaller particles. The liquid (chyme) then passes into the small intestine where enzymes and bile continue the digestive process. The first section is the duodenum, the shortest section. Here, calcium, iron and a few vitamins are absorbed. The second and third sections are the jejunum and ileum, both about ten feet in length. Here, the bulk of food nutrients (vitamins and minerals) and calories are absorbed.

After SurgeryDuring both main types of obesity surgery, the size of the stomach

AfterBefore

22


Gastric cancer, commonly re-ferred to as stomach cancer, can develop in any part of the

stomach and may spread throughout the stomach and to other organs; particular-ly the esophagus, lungs, lymph nodes, and the liver. Stomach cancer causes about 800,000 deaths worldwide per year.

Signs and symptomsStomach cancer is often asymp-

tomatic or causes only nonspecific symptoms in its early stages. By the time symptoms occur, the cancer has often reached an advanced stage, which is one of the main reasons for its poor prognosis. Stomach cancer can cause the following signs and symptoms:

Stage 1 (Early)l Indigestion or a burning

sensation (heartburn)l Loss of appetite, especially

for meatl Abdominal discomfort or

irritationStage 2 (Middle)l Weakness and fatiguel Bloating of the stomach,

usually after mealsStage 3 (Late)l Abdomina l p a i n i n t he

upper abdomenl Nausea and occas iona l

vomitingl Diarrhea or constipationl Weight lossl Bleeding (vomiting blood or

having blood in the stool) which will appear as black. This can lead to anemia.l Dysphag ia ; th i s fea ture

Stomach cancerDr. C.B. KRISHNAKUMAR MD (Internal Medicine)Medical Advisor – Star Health and Allied Insurance Co Ltd.,

Corporate Office, Chennai

suggests a tumor in the cardia or extension of the gastric tumor in to the esophagus.

Note that these can be symptoms of other problems such as a stomach virus, gastric ulcer or tropical sprue. Diagnosis should be done by VG endoscopy, Biopsy, and HPE.

CausesInfection by Helicobacter pylori is believed to be the cause of

most stomach cancer while autoimmune atrophic gastritis, intestinal metaplasia and various genetic factors are associated with increased risk levels. The clinical medical reference states that diet plays no role in the genesis of stomach cancer. However, the following dietary risks, for stomach cancer are reported. “Smoked foods, salted fish and meat, and pickled vegetables (appear to increase the risk of stomach cancer.) Nitrates and nitrites are substances commonly found in cured meats. They can be converted by certain bacteria, such as H. pylori, into compounds that have been found to cause stomach cancer. On the other hand, eating fresh fruits and vegetables that contain antioxidant vitamins (such as A and C) appears to lower the risk of stomach cancer.”

H. pylori is the main risk factor in 65–80% of gastric cancers, ap-proximately ten percent of cases show a genetic component.

A very important but preventable cause of gastric cancer is

23


tobacco. Smoking increases the risk of developing gastric cancer considerably.

Another lifestyle cause of gastric cancer besides smoking is consumption of alcohol.

Alcohol as cause of cancer along with tobacco smoking as cause of cancer increase the risk of devel-oping other cancers as well.

Gastric cancer shows a male predominance in its incidence as up to three males are affected for every female. Estrogen may protect women against the

development of this cancer form. DiagnosisTo find the cause of symptoms, the doctor asks

about the patient’s medical history, does a physical exam, and may order laboratory studies. The patient may also have one or all of the following exams:l Gastroscopic exam is the diagnostic method

of choice. This involves insertion of a fiber optic camera into the stomach to visualize it.l Upper GI series (may be called barium roent-

genogram)l Computed tomography or CT scanning of

the abdomen may reveal gastric cancer, but is more useful to determine invasion into adjacent tissues, or the presence of spread to local lymph nodes.

Abnormal tissue seen in a gastroscope examination will be biopsied by the surgeon or gastroenterologist. A biopsy, with subsequent histological analysis, is the only sure way to confirm the presence of cancer cells.

Endocytoscopy involves ultra-high magnification to visualize cellular structure to better determine areas of dysplasia. Other gastroscopic modalities such as optical coherence tomography are also being tested investigationally for similar applications.

A number of cutaneous conditions are associ-ated with gastric cancer. A condition of darkened hyperplasia of the skin, frequently of the axilla and groin, known as acanthosis nigricans, is associated with

intra-abdominal cancers such as gastric cancer. Other cutaneous manifestations of gastric cancer include tripe palms (a similar darkening hyperplasia of the skin of the palms) and rapid development of skin lesions known as seborrheic keratoses.

Various blood tests may be done; including: Com-plete Blood Count (CBC) to check for anemia. Also, a stool test may be performed to check for blood in the stool.

HistopathologyGastric adenocarcinoma is a malignant epithelial

tumor, originating from glandular epithelium of the gastric Histopathologyl Gastric adenocarcinoma is a malignant epithe-

lial tumor, originating from glandular epithelium of the gastric mucosa. Stomach cancers are overwhelmingly adenocarcinomas (90%).l Around 5% of gastric malignancies are lymphomas l Carcinoid and stromal tumors may also oc-

cur.Management1. Surgerya. Surgery is the most common treatment. The

surgeon removes part or all of the stomach, as well as the surrounding lymph nodes, with the basic goal

of removing all cancer and a margin of normal tissue. b. Endoscopic mucosal resection (EMR) is a

treatment for early gastric cancerc. Endoscopic submucosal dissection (ESD) is

a similar technique 2. Chemotherapy3. Radiation4. Multimodality therapyl Combinations of surgery, chemotherapy and

radiation therapy l

Advanced Cancer – Bleeding growth

Early Cancer Stomach

24


W hen we h e a r gastroin-test ina l problems the first t h i n g

which stuck every one’s mind is Constipa-tion ,Peptic ulcers and gastrointestinal gas .But there are also other conditions like colon cancer , cholelithiasis, diverticular disease, appendicitis, celiac disease

The most common gastrointestinal complaint is constipation. Constipation happens when our body waste remains in the colon for too long and too much water is absorbed into the intestine leaving a hard dry stool. This can be prevented which is the best form of relief

The major part played in constipation is improper diet and no exercises .In diet there are some food which relieves constipation and some which promotes constipation

Foods like Almond dried apricot ,beans celery ,coconut ,raisins , dates , figs ,grapes ,mangoes ,olive, papaya , parsleys ,pineapple , prunes , soybeans , turnips, green vegetables, oats, yogurt, cabbage, peas, sweet potatoes, castor oil, asparagus, horse gram,

Ragi, millets, bitter gourd, gua-va, cauliflower, plantains and off course 8 glasses of water per day minimum will helping the treatment of constipation naturally. As these foods are rich in fiber which provides roughage

and promotes bowel move-ment

Now that we know w h i c h f o o d

helps to get relief from constipation it be-comes very important to know which food has to be avoided they are Ice cream, cheese, meat,

Chips, pizza, proc-essed food such as mashed potatoes or frozen food, refined sugar and diet rich in animal fat

A lack of exercises can also lead to con-stipation .Exercises like walking, pelvic floor exercises helps to strengthen and tone the colon muscles, it helps in eliminating toxins by sweat, reduces the stress and stimulates the colon wall cell structure to increase metabolic rate, and thus overall it improves the function

Mild to moderate intensity exercises plays a protective role where as strenu-ous exercises may provoke some symp-toms which can be due to dehydration and in direct it can lead to gut ischemia .It is always recommended to hydrate one before, during and after the work out. Severe constipation

would require physician help as they get to know the underlying causes of constipa-

tion .With the help of doctor, proper diet and exercises its easy to obtain constipation relief. l

FITNESS SECTION

S. NiranjaniPhysiotherapist &Fitness Consultant

25

The first thing someone notices about a fit body is the flat stomach. Certainly those flat abs turns head .But to get those flat abs its not going to be easy through any TV abs machine advertisement. Make

sure that you do cardio with abs workout of 6 or 8 vari-ation three days a week

The next thing which hits everyone is why not daily do abs exercises? What’s harm? maybe I will get flat abs faster but the truth is you will not. Just like every other part of your body needs rest for a day to overcome the strain so do the abs muscles Training them every day will not make them tauten at all. It’s just a waste of time and energy. Doing cardio and abs for three days is enough

What you eat shows out is your tummy, so diet plays a big role along with exercises to give you the desired results. Avoid eating out and have a limit in what you eat because anything you eat more than your limit is not good for the body. Stick to 5 to 6 small meals instead of the regular breakfast, lunch and dinner. Keep healthy snacks like fruits and nuts. A handful of nuts and dry fruits will work wonder when you feel like hungry. How much ever crunches you do to get the result you have to stick to low fat diet .At the same time make sure you increase the intensity of your workout or else the muscles will get use to the same exercise intensity and will not show much results in inches.

So pack yourself for the exercises and get self mo-tivated which will keep you going. Enjoy every step you take towards your exercises as Sky is not the limit but weight has limit and get those FAB ABS

Enjoy the OATS Soup recipe for healthy well being

GET THOSEFABABS

Oats SoupIngredients

Oats - 1 cupOnion - 1/2 (finely chopped)Green Chilly - 1 (finely chopped)Garlic - 1 clove (minced)Salt - to tastePepper powder - a pinchWater- 1 cupMilk - 1 cupOil - 2 tspcoriander leaves- for garnish

Method1. Heat oil in a pan and sauté onions, green chilly

and garlic till they begin to sweat. 2. Now add the oats and fry along with it for few

2 minutes.3. Add salt and water and let it come to a boil. 4. Now add the milk and pepper powder to it and

bring to a boil. 5. Garnish the rich and creamy oats soup with

cilantro and serve hot.

26 STAR Health Consult our Expert Doctor For Free Medical Advice on our Toll Free Number 1800 425 225526

Consult our Expert Doctor For Free Medical Advice on our Toll Free Number 1800 425 2255 27STAR HealthConsult our Expert Doctor For Free Medical Advice on our Toll Free Number 1800 425 2255

I t has been ou r mo t to t o ensu re p reven t i ve ca re infomation and assistance for good health and as a back stop provide financial indemnity though insurance cover. To

address the magazine and the new initiative is 24x7 free expert medical consultation over phone.

When do you utilize this service

Whenever you fee l l i ke v is i t ing a doctor, say, for a common ai lment v iz , cold, cough or body pain, before proceeding, what you have to do is to call our Toll free number. The Medical personnel will take the details from you and you

will be advised simple preventive steps, over the counter medicines or suggest you to go for a

medical consultation. our Toll free number is 1800 425 2255 and it is mentioned in the

policy document.

Language: t he rece i ve r o f the ca l l w i l l converse in Tami l , Hindi, Malayalam and of couse in English. We wil l be thankful to receive your communication on any suggestions to make the system better and more effective to the editor of this Magazine.

27

Star Health Magazine Focussing On Gastroenterology

Documents

Transcript of Star Health Magazine Focussing On Gastroenterology