Relief at Last for the Millions of Chronic Heartburn Sufferers

Written by an internationally recognized expert on digestive diseases, this much-needed book brings relief to the tens of millions who suffer from the pain of severe heartburn almost daily. If you find yourself dependent on antacids, losing sleep, missing work, or canceling plans because of heartburn discomfort, you may be among those who struggle with gastroesophageal reflux disorder, or GERD. The good news is that your condition is treatable——especially in its early stages. Drawing from his extensive experience diagnosing and treating patients, as well as the latest research from around the globe, Dr. Anil Minocha explains the causes of heartburn——and the potentially serious consequences of leaving it untreated. In addition to providing an overview of the problem, Dr. Minocha offers invaluable information on:

• The latest treatment options–from nutrition and simple lifestyle changes to drugs, surgery, and alternative remedies
• How your diet and weight may be affecting your GERD
• The relationship between stress and heartburn
• Dealing with GERD during pregnancy, and in infants, children, and the elderly

"An in-depth analysis of how to heal heartburn and acid reflux, a problem that afflicts humans across the lifespan, from infancy to old age. . . . A valuable home reference."–Elizabeth D. Tate, F.N.P., M.N., coauthor of Unforgettable Faces: Through the Eyes of a Nurse Practitioner

"Priceless and practical. . . . Easy to read. . . . A must-buy book for all heartburn sufferers."–Joel E. Richter, M.D., F.A.C.P., F.A.C.G., Chairman, Department of Gastroenterology, The Cleveland Clinic Foundation

The discovery and concept that Helicobacter pylori is associated with gastric disease including gastric cancer which is one of the most common and frequently lethal forms of malignancy, heralded a new and rapidly expanding field recognizing the emergence of many new pathogens and disease syndromes in clinical medicine, as well as basic infectious disease research. There is now an extensive and widely known literature of how H. pylori is involved in a wide variety of disease syn dromes. As summarized in the introductory chapter of this volume, many major advances have been made in diagnosis, both serologic and endoscopic in time of the involvement of this organism in patients with upper GI ailments as well as its presence in those who are not clinically ill. The Introduction describes the rapid development of understanding the role of this organism in disease. The basic bacteriology of H. pylori is then described in the second chapter. Diagnostic tests for detecting H. pylori infection is then highlighted, as well as the role of such infection in gastric cancer. Current knowledge concerning risk factors and peptic ulcer pathology associated with H. pylori is then described. Newer information concerning therapy of H. pylori infection and colonization is described in a subsequent chapter as well as one concerning the effects of anti biotics on H. pylori infection. The extensive literature on natural substances with anti-H."

Over two decades an abundance of knowledge has been accumulated focus ing on the understanding of the molecular and cellular pathomechanisms of stressful conditions like systemic inflammation and sepsis. We have learned that there is a clear correlation between the magnitude of the inciting traumatic event and the degree of inflammatory dysbalance. The immunoinflammatory disintegration comprises a simultaneous col lapse of the otherwise very smoothly balanced pro- and antiinflammatory vectors of cytokine regulation. Most recently, we understood that it is predominantly the dysregulation of antiinflammatory mediators that plays a pivotal role for the phenomenon of trauma-induced depression or paralysis of cell-mediated immune responses. The substantial intellectual and logistic investments of numerous investi gators towards understanding the biology of sepsis inevitably lead us towards a rewarding status in terms of reaching spheres of clinical relevance. From the evolutionary collection of a multitude of ex-vivo and in-vivo immuno mechanistic parameters, some were found to represent most significant bio logical markers to support the clinician to characterize better the severity of inflammatory illness and to predict outcome. Chapter one of this book, authored by G. Grass and E.A.M. Neugebauer, analyses elegantly our current knowledge on the assessment of the immuno logical status in terms of risk and prognosis of sepsis.

Recent advances in gastroenterology and hepatology as well as new findings in biliary and pancreatic diseases are presented in the proceedings of the 86th annual congress of the Japanese Society of Gastroenterology. From the hundreds of papers delivered at the congress, 70 were selected for inclusion here. Opening with special lectures on gastroenterology in the new millennium, ulcerative colitis-pathophysiology and therapy, and life style-related diseases and gastroenterology, the volume is divided into sections reflecting the major concerns of researchers in the science of digestive diseases in Japan today: apoptosis in digestive organs, nitric oxide, transcription factors in digestive organs, antigen-presenting cells, pathology of inflammatory bowel disease, NSAID-induced gastric lesions, microcirculation in digestive diseases, hepatic regeneration, and hepatic fibrosis.

Hardly any other part of the human body is of such interdisciplinary interest as the anal, perianal and rectal region. Gastroenterologists, dermatologists, urologists, general practitioners and surgeons specialising in proctology, phlebology, and coloproctological surgery are involved in this region between the ectoderm, transitional zone, and entoderm. Diagnostic procedures, such as endoscopy, radiology, sonography, manometry, electromyography, and histopathology are even more diverse, in particular where the differential diagnosis of non-neoplastic conditions of the anorectal region is concerned. The Falk Symposium No. 118, held in Freiburg, Germany, on October 1-2, 2000, focused on the morphology and function of the pelvic floor and its dysfunction, radiation damage in proctology, haemorrhoidal complaints, and chronic inflammatory rectal diseases, as well as conditions of the anal and perianal region. These proceedings will be of interest to all research physicians and colleagues working in hospitals or in their own practice who are involved in the diagnosis and treatment of anorectal pathologies.

The aetiology of the chronic inflammatory bowel diseases - Crohn's disease and ulcerative colitis - is still enigmatic. The therapeutic approach has therefore traditionally focused on anti-inflammatory principles, including corticosteroids and aminosalicylates. Since a significant proportion of patients is steroid-dependent or refractory and because of the problematic side-effects of long-term systemic steroids, active immunosuppression has gained acceptance in the field. The classical immunosuppressants azathioprine and 6-mercaptopurine have long been evidence-based in IBD, but underused. Recently, methotrexate and cyclosporine have also been proven to be effective in certain situations. Newer drugs like tacrolimus, mycophenolate and others may be similarly useful but their potential is still unclear. Finally, the immune modifiers including IL-10 and TNF-antibodies have been successfully subjected to controlled trials. Other experimental drugs discussed in this book are on the horizon. This volume is the Proceedings of Falk Symposium 119 held in Freiburg-im-Breisgau, Germany, October 3-4, 2000, and covers systematically the field of immunosuppression in inflammatory bowel diseases. It is hoped that it will further the prudent use of these drugs in the proper clinical situations by increasing our understanding of both the mechanisms of action and the clinical benefit to the patient.

"Celiac Disease For Dummies" is the ultimate reference for people with the disease and their family members. The book helps readers identify symptoms of the disease, and explains how doctors definitively diagnose celiac disease. It outlines how celiac disease affects the body, and what its consequences could be if untreated. The authors explain how celiac disease is treated, not only through the elimination of gluten from the diet, but with additional nutritional measures and alternative and complementary therapies. Written by two practicing physicians, the book also offers practical, helpful guidance for parents of children with celiac disease, whose treatment may be a particular challenge.

Diseases of the gastrointestinal tract are common. There is increasing appreciation of the importance of the immune system in the pathogenesis of a number of these diseases. This book covers basic aspects of innate and adaptive immunity in the gastrointestinal tract, oral tolerance, and cellular and molecular mechanisms of acute and chronic inflammation. Specific disease covered include bacterial infections, human immunodeficiency virus (HIV) infection, coeliac disease, and inflammatory bowel disease. Other topics include mucosal immunisation and intestinal transplantation immunology. The readership of this book includes clinicians, scientists, and students interested in the gastrointestinal tract.

Beginning in 1970, the International Bile Acid Meeting has taken place every two years and each time new progress in our understanding of the complex role of bile acids in many metabolic processes of the liver and the intestine has been revealed by a selected group of leading scientists from all over the world. Although originally mainly physiological data on bile acid synthesis and transport were emphasized, and later on also the therapeutic benefit of bile acids in gallstone disease and cholestasis was discovered, we have come now to the molecular biology and genetic era with major discoveries in transport defects and related diseases. This book is the proceedings of Falk Symposium No. 120, held in The Hague, The Netherlands, on October 12-13, 2000 - the 16th International Bile Acid Meeting. One of the main discoveries recently has been the identification of nuclear receptors for bile acids, which gives them a much broader perspective than previously anticipated. It even suggests that bile acids can regulate their biosynthesis and enterohepatic circulation transcriptionally. It will therefore not be surprising that this topic, together with the molecular regulation of cholesterol 7alpha-hydroxylase and cholesterol homeostasis, has a dominant place in these proceedings. Another important topic is the progress in our molecular understanding of hepatic (both at the basolateral and canalicular sites), cholangiocytic and intestinal bile acid transport processes. Further insights into genetic defects causing cholestasis or intestinal malabsorption in animal models and in human diseases are also discussed by a number of well-known authors. Finally the last section deals with new findings on the role of bile acid therapy in cholestatic syndromes or chemoprevention and with the potential benefit of bile acid inhibitors. All contributors provide an update on the most recent developments in their field.

Clinical experts synthesize for the practicing physician all the important developments that have occurred recently in the diagnosis and treatment of acid-related diseases. They address the evaluation of patients suspected of harboring both peptic ulcers and ulcers from other causes, with emphasis on novel aspects of H. pylori infection. New information is also provided to assist clinicians in efficiently managing patients with dyspepsia and in the diagnosis and treatment of gastroesophageal reflux disease (GERD), including its extraesophageal manifestations and upper gastrointestinal bleeding. Authoritative and highly readable, Diseases of the Gastroesophageal Mucosa: The Acid-Related Disorders distills a wealth of cutting-edge clinical practice into one readable volume that will help every clinician manage patients with today's best diagnostic and treatment practice.

The gastrointestinal tract has a number of unique features. Its extensive surface is formed by a single layer of rapidly renewing cells, the intestinal epithelial cells. These cells are in contact with a number of other cell populations, including the largest part of the immune system, and with an excessive luminal antigen load, including vast numbers of bacteria. Furthermore two more organs, namely liver and pancreas, are part of the system. The rapid renewal of the epithelial layer, the interactions of different cell types, and the balance between cell proliferation and death, have been fascinating subjects of studies in recent years. Much has been learned, and cytokines have emerged as important mediators for all these interactions and homeostatic systems. This book, the proceedings of the Falk Symposium 113 on `Cytokines and Cell Homeostasis in the Gastrointestinal Tract', held in Regensburg, Germany, 16-18 September 1999, provides a forum for basic scientists and interested clinicians to exchange ideas, to discuss concepts and to plan further studies.

Although the first description of patients with what we now call Crohn's disease or ulcerative colitis was published well before 1900, both disorders seem to be diseases of the twentieth century. At the very start of the twenty-first century, it therefore seems appropriate to look back and at the same time look forward and to assess what knowledge has been gained during the last 100 years and in what direction research and thereby clinical practice will go in the future. This book, the proceedings of Falk Symposium No. 111 held in Freiburg, Germany, on June 19-20 1999, contains contributions from experienced senior scientists on the state of the art in pathophysiology, diagnosis and treatment, together with unpublished and new findings from young researchers. Basic scientists and clinicians are thereby involved in an exchange of information which will lead to new directions for future research and clinical management of inflammatory bowel diseases.

In the last decade, some outstanding progress has been made in the field of neurogastroenterology, a term which has been introduced to account for the crucial role of the enteric, autonomic and central nervous system in the regulation of gastrointestinal functions in health and disease. These proceedings of Falk Symposium No. 112 on Neurogastroenterology - From the Basics to the Clinics, held in Freiburg, Germany, on 21-22 June 1999, reviews and discusses the fast-growing knowledge in this field in order to initiate more interdiscliplinary discussions along with new research. Contributors include basic scientists, clinicians of various specialities, morphologists, physiologists, molecular biologists, embryologists, pharmacologists, surgeons, gastroenterologists and behavioural scientists interested in the central and the autonomic nervous system in relation to the gastrointestinal tract.

Gastroesophageal reflux (GER) refers to symptoms and events that result from abnormal regurgitation of gastric contents into the esophagus. GER is a common clinical problem that affects large segments of the general population. The spectrum of problems associated with GER is now known to also involve extra-esophageal sites. Respiratory diseases, in particular bronchial asthma, can be exacerbated by multiple triggers, including GER. The relationship between the occurrence of gastroesophageal disorders and changes in respiratory function has been known for over a century, but the mechanism by which intraesophageal acid regurgitation can produce respiratory symptoms is still debated. The reasons for these concurrent pathological events are also not fully understood. Determining, for instance, whether reflux itself initiates or exacerbates asthma, or whether asthma or its treatment primarily causes GER is a matter of current investigation.

This Trends in Inflammatory Bowel Disease Therapy Symposium was held in Vancouver, British Columbia, Canada, 27 29 August 1999. This is the seventh international symposium, sponsored by Axcan Pharma Canada Inc., since the first symposium in 1986. The Canadian Association of Gastroenterology has co-sponsored these symposia since 1990. Each symposium has been published, and reflects and updates the extensive research and education, and the understanding of the mechanisms and treatment of inflammatory bowel disease. From the beginning, Canadian and international experts have been involved, maintaining a consistently high quality, both in their presentations, during discussions, and the subsequent publication of their work. There have been major advances since the symposium held two years ago, and these are presented in this book. In keeping with modern educational practice, objectives are provided, and all presentations were subject to written independent evalu ation. All participants are asked to declare any conflicts of interest. MOCOMP and educational credits are available."

Digestive Disease Week-Japan (DDW-Japan) was held successfully in Yokohama April 15-18, 1998, under the management of Prof. Yoshiki Hiki, Chairman of the Steering Committee. DDW-Japan was carried out with the cooperation and participa tion of gastroenterological societies in Japan. Because the participat ing congresses each dealt with topics characteristic of particular fields, all participants could enjoy a rewarding experience and could gather relevant, up-to-date information about a wide variety of subjects in basic and clinical medicine. Prof. Rikiya Fujita, Chairman of the International Relations Com mittee, planned and conducted the International Symposium working together with researchers from foreign countries, thus making DDW Japan in 1998 a great success. The symposium provided a fascinating insight into the global situation, and the papers that were present ed are being published in this monograph, Recent Advances in Gastroenterology. As we all know, the world soon is going to enter the third millen nium. Therefore, treatments and medicines should not be limited to any single country or small area; instead, medical knowledge must be shared as a global resource, without regard to nationality, way of life, or social system. I hope that this monograph will playa useful role in the develop ment of gastroenterology all over the world, and I very much appre ciate the tremendous contribution of all authors for this publication.

This book, Mechanisms in the Pathogenesis of Enteric Diseases 2, is an out come of the Second International Rushmore Conference on Mechanisms in the Pathogenesis of Enteric Diseases, held September 3D-October 3, 1998 in Rapid City, South Dakota, USA. Its chapters represent many of the reviews and papers presented at the conference. The meeting was organized by members of the North-Central Regional Research Committee "NC-62," a consortium of researchers of bovine and swine enteric diseases from land-grant institutions supported by the United States Department of Agriculture. The Rushmore Conferences were conceived as a forum for an interdiscipli nary discussion of mechanisms of infectious enteric diseases. It was intended that such a discussion would stimulate cross-pollination of ideas, and nurture synergistic collabora tions among scientists who might otherwise not interact. Enteric diseases are caused by widely divergent pathogens and parasites in broadly different settings, and affect multi ple organ systems. Some enteric diseases affect a single species, while others may affect multiple species, perhaps including human beings. Some enteric diseases were present in antiquity, while others have recently emerged. Knowledge regarding a particular disease or pathogen has frequently proven useful in understanding another disease or pathogen, because common themes in pathogenesis exist. As this knowledge base grows, strategies in the prevention and control of various enteric diseases often converge. Cross-discipli nary discussions and collaborations facilitate growth of this knowledge base, as well as development of tools for disease interdiction."

In the past several years much progress has been made in understanding the basic mechanisms of pancreatic physiology and the pathogenesis, diagnosis, and treatment of pancreatic disease. A symposium took place in Munich on 18-19 September 1998 that aimed at summarizing current knowledge of the exocrine pancreas and giving di rection to future research. It targeted all practitioners and scientists working in the field of exocrine pancreatic disease. The symposium was also designed to stimulate young persons embarking on a career in this area. It was an exciting meeting for all of us. We wish to extend our thanks to all participants for their prompt submission of manuscripts and to Springer Verlag for speedy publication, providing us with an up-to-date volume on pancreatic research. We would also like to thank G. Beyendorff-Hajda and W. Glockner, as well as D. Kriiger, representatives of Knoll Deutschland GmbH, for their organiza tional assistance and Knoll itself for its generous sponsorship, which enabled colleagues from other countries to participate and made publication of the symposium possible."

This revised and updated second edition of the popular and comprehensive guide to the study of gastroenterology The revised second edition of Essentials of Gastroenterology provides a highly practical and concise guide to gastroenterology. The text covers every major disorder likely to be encountered during both GI training and in clinical practice. It also offers a handbook for preparing for Board examinations (e.g., USMLE and Internal Medicine Board examinations) as well as a handy clinical consultation tool. Fully updated to reflect the latest scientific information and practice guidelines, each section of the book covers a specific area of the gastroenterology tract and follows a standard outline: general information, normal physiology, etiology and pathophysiology, clinical presentation, diagnosis, differential diagnosis, complications, prognosis, and treatment. The text provides easy-to-assimilate information on each disorder and includes the key facts, concise, bulleted paragraphs, and a structure that lends itself to accessibility and point-of-care use in a busy clinical setting. In addition, Internal Medicine Board-style multiple choice questions allow users to self-assess their knowledge, a photo gallery provides a great visual element, and clinical cases throughout allow readers to identify with real-life clinical scenarios. Essentials of Gastroenterology is the hands-on guide that: - Covers the whole of gastroenterology in one highly practical volume - Presents updated pedagogic features to help achieve rapid clinical understanding, such as case studies, practice points, key weblinks and potential pitfalls boxes - Includes more than 100 Internal Medicine Board-style multiple choice questions ideal for self-assessment - Contains comparison of major society (BSG, ASG, ACG, UEGF, etc.) guidelines for all main GI conditions Designed for us by gastroenterologists and GI trainees, Essentials of Gastroenterology is therevised and improved edition of the popular manual that is filled with up-to-date information on all the GI disorders. Trainees will learn the essentials of their specialty, as well as providing the seasoned gastroenterologist with a useful refresher tool.

The application of molecular techniques to gastroenterology continues to yield important advances in the development of drugs to treat gastrointestinal disorders. Important new drugs have emerged through the collaborative and complementary efforts of basic scientists, clinicians, and clinical researchers in academia and the pharmaceutical industry. The challenge has been exciting, with a few surprises along the way. Consider peptic ulcer disease as an example. The discovery of H receptors and the availability of potent and 2 selective H-receptor antagonists signaled the beginning of a new era 2 in the treatment of gastric hypersecretory states and peptic ulcers. Introduction of proton pump inhibitors offered another therapeutic option. Though H-receptor antagonists and proton pump inhibitors 2 are important and useful drugs, the discovery of the link between H. pylori infection and peptic ulcer disease has led to even more effective pharmacotherapeutic regimens. Our intent in Drug Development: Molecular Targets for GI Diseases is to bring together hands-on experts to review promising areas of gastrointestinal pharmacology. The contemporary topics covered, from a mechanistic viewpoint, are relevant to gastrointestinal inflammation and motility disorders. Authoritative opinions are offered on both future research directions and potential applications for new therapies.

These proceedings of Falk Symposium 110 on `Intestinal Mucosa and its Diseases - Pathophysiology and Clinics' held at Titisee/Black Forest, Germany, 16-17 October 1998, comprehensively review salient clinical as well as scientific aspects - pending or settled - of the main intestinal diseases. In particular, chapters deal with infectious and neuroendocrine diarrhoeas, coeliac sprue, allergic enteropathy, intestinal lymphomas, colorectal carcinomas, and chronic inflammatory bowel diseases, in terms of clinical presentation as well as underlying mechanisms. This book therefore aims to bridge the gaps between basic science and clinics for the eventual treatment of patients afflicted with these diseases.

Gastrointestinal motility has evolved from an esoteric laboratory tool into a sophisti cated diagnostic technique that is now widely used clinically to guide in management of complex gastrointestinal problems. Today, it is the most rapidly growing subspecialty within gastroenterology. Previously, many of the gastrointestinal motility problems were either ignored or attributed to a disturbance of "psyche." But with the growing knowledge and understanding of how a dysfunction of the gastrointestinal muscle and nerves can cause disease, we are at the threshold of a revolution in our approach to the diagnosis and treatment of gastrointestinal motility disorders. The purpose of this book is to serve as a useful, up-to-date reference manual and guide for the diagnostic and therapeutic approach towards common adult and pediatric gastrointestinal motility problems. In order to enhance the understanding of these disor ders, a problem-oriented approach has been chosen, and wherever possible the authors have provided clinical case scenarios to illustrate their message. The emphasis has been on how to diagnose and treat motility disorders rather than to provide an encyclopedic infor mation. The reference list at the end of each chapter should enable the enthusiast to seek further information. Some of the material presented in this book has been derived from the proceedings of the annual University ofIowa College of Medicine GI Motility Symposia."

This monograph contains a description of the discovery and development of a antisecretory therapy in the treatment of acid-related diseases: omeprazole, the first proton pump inhibitor. Overviews compare this and other proton pump inhibitors and discuss their pharmacology, including the mechanism of action, the effect on Helicobacter pylori infection, and the consequences of profound inhibition of gastric acid secretion. The pharmaceutic delivery system is described since it constitutes a special problem with this class of drugs. The clinical experience with proton pump inhibitors in acid-related diseases is reviewed with focus on gastro-esophageal reflux disease and peptic ulcer diseases including Helicobacter pylori and NSAID-induced ulcerations and Zollinger-Ellison syndrome. Finally, an overview is presented on the socio-economic impact of proton pump inhibitors in acid-related diseases emphasizing the important aspect of quality of life. The monograph is aimed at a broad readership with an interest in the development problems of this, at present, most commercially successful drug; the pharmacology of a "tailor-made" drug for a specific target; the therapeutic strategies in acid-related diseases; and the dramatic changes in the long-term outcome results of the treatment of peptic ulcer diseases where most patients now can be cured from the disease after only one week of drug therapy.

Chronic inflammatory bowel diseases represent an important medical problem, since they have a devastating impact on the quality of life and require longstanding medical care. Many medical disciplines are involved in tackling the immensely complex studies on pathogenesis, clinical expression and treatment possibilities. This book, the proceedings of the Falk Symposium 105 on Innovative Concepts in Inflammatory Bowel Diseases', held in Rostock, Germany, on April 30 - May 2, 1998, brought together experts from different fields of science to allow a unified view on clinical and basic research. The main themes of the meeting were genetics, animal models, immunology, epithelial cells, endotoxin, diagnostic procedures, malignancy, medical therapies, and surgery. In each section of the book experts present state-of-the-art reviews with the very latest developments in the respective research areas followed by chapters on different aspects of inflammatory bowel diseases. They provide suggestions concerning future research and clinical management of patients with inflammatory bowel diseases.