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Allergist
Introduction Gastritis is an inflammation of the stomach lining. Many things can cause gastritis. Most often the cause is infection with the bacteria Helicobacter pylori, which also causes stomach ulcers. An autoimmune disorder, a backup of bile into the stomach, or long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, can also cause gastritis. In some cases, the stomach lining may be "eaten away," leading to sores (peptic ulcers) in the stomach or first part of the small intestine. Gastritis can occur suddenly (acute gastritis) or gradually (chronic gastritis). In most cases, gastritis does not permanently damage the stomach lining. Signs and Symptoms The most common symptoms of gastritis are stomach upset and pain. Other possible symptoms include: Indigestion (dyspepsia) Heartburn Abdominal pain Hiccups Loss of appetite Nausea Vomiting, possibly of blood or material that looks like coffee grounds Dark stools Causes Gastritis can be caused by infection, irritation, autoimmune disorders (where the body's immune system mistakenly attacks the stomach), or backflow of bile into the stomach (bile reflux). Gastritis can also be caused by a blood disorder called pernicious anemia. Infections can be caused by: Bacteria (usually Helicobacter pylori) Virus (including herpes simplex virus) Parasite Fungus A number of things can cause irritation, including: Long-term use of NSAIDs, such as ibuprofen (Advil, Motrin) or naproxen (Aleve). Up to 20% of people who chronically use NSAIDs develop gastric problems. Alcohol use Cigarette smoking Chronic vomiting Coffee and acidic beverages Too much stomach acid (such as from stress) Eating or drinking caustic or corrosive substances (such as poisons) Trauma (for example, radiation treatments or having swallowed a foreign object) Other causes for gastritis are very rare. These include: Systemic disease (for example, Crohn disease) Sarcoidosis Risk Factors Infection with H. pylori Acquired immunodeficiency syndrome (AIDS) Any condition that requires relief from chronic pain using NSAIDS, such as chronic low back pain, fibromyalgia, or arthritis Alcoholism Cigarette smoking Older age Herpes simplex virus or cytomegalovirus Inflammatory bowel disease Diagnosis Several tests can be used to make a diagnosis. These include endoscopy of the stomach, where a thin tube with a light and a camera on the end is inserted down your throat into your stomach. This allows the doctor to see into your stomach and take samples (called a biopsy) from the lining if needed. The laboratory tests you may need will depend on the cause of your gastritis. Your doctor may use a stool test to check for the presence of blood, or your doctor may take a sample of tissue, called a biopsy, from your esophagus or stomach. A breath test or a biopsy may detect H. pylori. Prevention Making lifestyle changes, such as avoiding the long-term use of alcohol, NSAIDs, coffee, and drugs, may help prevent gastritis and its complications (such as a peptic ulcer). Reducing stress through relaxation techniques, including yoga, tai chi, and meditation, can also be helpful. Treatment Treatment of gastritis depends on the cause of the problem. Some cases of gastritis may resolve by themselves over time, or be relieved when you stop drinking alcohol, smoking cigarettes, or taking NSAIDs. You may need to change your diet, although doctors now know that a bland diet is not required. If your gastritis is due to H. pylori infection, your doctor will prescribe antibiotics. Lifestyle The treatment for gastritis that is caused by irritants is to stop using them. These include: Alcohol Tobacco Acidic beverages, such as coffee (both caffeinated and decaffeinated), carbonated beverages, and fruit juices with citric acid NSAIDS, such as aspirin and ibuprofen. Switch to other pain relievers (like acetaminophen). These steps may also help: Eat a fiber-rich diet. Foods containing flavonoids like apples, celery, cranberries (including cranberry juice), onions, garlic, and tea may stop the growth of H. pylori. Avoid high-fat foods. In animal studies, high-fat foods increase inflammation in the stomach lining. Medications If you have H. pylori, you will probably be prescribed three medications. Doctors commonly use "triple therapy," to treat H. pylori-related gastritis and ulcers, including a proton pump inhibitor to reduce acid production and two antibiotics. Bismuth salicylate (Pepto Bismol) may be used instead of the second antibiotic. This drug, available over the counter, coats and soothes the stomach, protecting it from the damaging effects of acid. Some of the same drugs used for non-H. pylori gastritis as are used for symptoms (like indigestion) due to ulcers: Antacids Available over the counter, they may relieve heartburn or indigestion but will not treat an ulcer. Antacids may block medications from being absorbed and thereby decrease the medicine's effectiveness. Doctors recommend taking antacids at least 1 hour before or 2 hours after taking medications. Ask your pharmacist or doctor for more information. Antacids include: Aluminum hydroxide (Amphojel, AlternaGEL) Magnesium hydroxide (Phillips' Milk of Magnesia) Aluminum hydroxide and magnesium hydroxide (Maalox, Mylanta) Calcium carbonate (Rolaids, Titralac, Tums) Sodium bicarbonate (Alka-Seltzer) H2 blockers Reduce gastric acid secretion. They include: Cimetidine (Tagamet) Ranitidine (Zantac) Nizatidine (Axid) Famotidine (Pepcid) Proton pump inhibitors Decrease gastric acid production. They include: Esomeprazole (Nexium) Lansoprazole (Prevacid) Omeprazole (Prilosec) Pantoprazole (Protonix) Rabeprazole (AcipHex) Nutrition and Dietary Supplements Doctors used to recommend eating bland foods with milk and only small amounts of food with each meal. Researchers now know that such a diet is not required to treat gastritis or ulcers. Following these nutritional tips may help reduce symptoms: Foods containing flavonoids, like apples, celery, cranberries (including cranberry juice), onions, garlic, and tea may inhibit the growth of H. pylori. Eat antioxidant-rich foods, including fruits (such as blueberries, cherries, and tomatoes), and vegetables (such as squash and bell peppers). Eat foods high in B vitamins and calcium, such as almonds, beans, whole grains (if no allergy), dark leafy greens (such as spinach and kale), and sea vegetables. Avoid refined foods, such as white breads, pastas, and sugar. Eat lean meats, cold-water fish, tofu (soy, if no allergy) or beans for protein. Use healthy oils, such as olive oil. Reduce or eliminate trans fatty acids, found in commercially-baked goods, such as cookies, crackers, cakes, French fries, onion rings, donuts, processed foods, and margarine. Avoid beverages that may irritate the stomach lining or increase acid production including coffee (with or without caffeine), alcohol, and carbonated beverages. Drink 6 to 8 glasses of filtered water daily. Exercise at least 30 minutes daily, 5 days a week. Identify and eliminate food allergies. The following supplements may help with digestive health: A multivitamin daily, containing the antioxidant vitamins A, C, E, the B vitamins, and trace minerals, such as magnesium, calcium, zinc, and selenium. Omega-3 fatty acids, such as fish oil, may help decrease inflammation. Fish oil may increase the risk of bleeding. If you take aspirin or other anticoagulants (blood thinners), talk to your doctor before taking fish oil. Probiotic supplement (containing Lactobacillus acidophilus). Probiotics or "friendly" bacteria may help maintain a balance in the digestive system between good and harmful bacteria, such as H. pylori. Probiotics may help suppress H. pylori infection, and may also help reduce side effects from taking antibiotics, the treatment for an H. pylori infection. Some probiotic supplements need to be refrigerated for best results. People who have weakened immune systems, or who are taking immune-suppressive drugs, should take probiotics only under the direction of their physician. Vitamin C. Studies show that pharmacological doses of vitamin C may improve the effectiveness of H. pylori-eradication therapy. Speak with your physician about what dose might be appropriate for you.  
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Plastic surgeon
Ischemic heart disease is a condition of recurring chest pain or discomfort that occurs when a part of the heart does not receive enough blood. This condition occurs most often during exertion or excitement, when the heart requires greater blood flow. Ischemic heart disease, also called coronary heart disease, is common in the United States and is a leading cause of death worldwide. Ischemic heart disease develops when cholesterol particles in the blood begin to accumulate on the walls of the arteries that supply blood to the heart. Eventually, deposits called plaques may form. These deposits narrow the arteries and eventually block the flow of blood. This decrease in blood flow reduces the amount of oxygen supplied to the heart muscle. The signs and symptoms of ischemic heart disease may develop slowly as arteries gradually become blocked, or they may occur quickly if an artery suddenly becomes blocked. Some people with ischemic heart disease have no symptoms at all, while others may have severe chest pain (angina) and shortness of breath that can pose a risk of heart attack. Fortunately, ischemic heart disease can be treated successfully with lifestyle changes, medicines, and surgical procedures. Even better, you can reduce your risk of ischemic heart disease by following heart-healthy practices, such as eating a low-fat, low-sodium diet, being physically active, not smoking, and maintaining a healthy body weight. Left untreated, ischemic heart disease may lead to severe heart damage. Heart damage can result in heart attack and shock and may be life threatening. Seek immediate medical care (call 911) for serious symptoms, such as difficulty breathing, which may be accompanied by pale or blue lips, rapid heart rate (tachycardia), and severe chest pain. Seek prompt medical care if you are being treated for angina but have mild symptoms that recur or are persistent.