Is there a link between GERD and fatigue?

Fatigue is different from feeling tired. A tired person who has not slept well may struggle the next day and want to do less than they normally would.

In contrast, fatigue can have a significant impact on day-to-day life.

A person experiencing fatigue will feel that they do not have the energy to complete everyday tasks, and this feeling will continue over an extended period.

While a person can usually identify why they feel tired, fatigue is often a symptom of an underlying health condition that needs to be investigated. A doctor will need to make a diagnosis before the person can be treated.

GERD is one condition that can interfere with sleep patterns and cause fatigue. It occurs when stomach acid flows upward into the food pipe, which is called the esophagus, rather than staying in the stomach and aiding digestion.

There are different reasons why a person with GERD may experience fatigue.

When a person is walking or standing upright, gravity helps to keep stomach contents, including acid, where they belong.

However, when a person lies down, the position prevents stomach contents from moving through the body efficiently and allows stomach acid to rise into the food pipe.

When a person is lying down and trying to sleep, symptoms such as heartburn and coughing may worsen to become painful and disruptive. Heightened symptoms can prevent a person from sleeping properly and may eventually lead to fatigue.

Also, fibromyalgia sometimes occurs alongside GERD, and one symptom is fatigue. Fibromyalgia is a painful condition that can affect every area of the body.

Feeling permanently exhausted and lacking the energy to complete simple tasks is a sign that something is wrong.

Fatigue can be a symptom of various underlying conditions, and it is important to see a doctor, who can rule out unrelated issues.

Anyone experiencing fatigue should make a note of other symptoms.

This will help the doctor make a more quick and accurate diagnosis.

Other conditions that can cause fatigue include:

If GERD symptoms, such as heartburn and coughing, are interrupting a person's sleep, they should seek advice from a medical professional. Treatments a can ease symptoms and help a person to get a better night's rest.

Colonoscopies lead to many more infections than previously thought

"Though patients are routinely told that common endoscopic procedures are safe, we found that post-endoscopic infections are more common than we thought, and that they vary widely from one ASC facility to another," says lead researcher Susan Hutfless of Johns Hopkins University.

Colonoscopy is one of six options suggested by the American Cancer Society for colon cancer screening. The traditional recommendation is that patients be regularly screened starting at 50, but the ACS recently reduced its recommended age to 45.

Upper-GI endoscopies, known as EGDs, can be used to diagnose a number of problems in the upper digestive tract, including heartburn, swallowing issues, and abdominal pain.

Each year in the United States, there are more than 15 million colonoscopies and 7 million EGDs. Both procedures are performed with an endoscope, a reusable optical instrument that gives doctors a view of a patient's gastrointestinal tract. Besides screening and diagnosis, they can be used for procedures such as removing polyps without invasive surgery.

Researchers examined data from six states—California, Florida, Georgia, Nebraska, New York, and Vermont—to track infection-related emergency room visits and unplanned inpatient admissions within seven and 30 days after a colonoscopy or EGD.

Post-endoscopic infection rates were previously believed to be in the neighborhood of one in a million, Hutfless says. The new study found a rate of infection seven or fewer days after a procedure was slightly higher than one in 1,000 for screening colonoscopies and about 1.6 per 1,000 for non-screening colonoscopies. Rates for EGDs within that time were more than three per 1,000.

Patients who had been hospitalized before undergoing one of the procedures were at even greater risk of infection. Since many ASCs lack an electronic medical record system connected to hospital emergency departments, those ASCs are unlikely to learn of their patients' infections, Hutfless says.

"If they don't know their patients are developing these serious infections, they're not motivated to improve their infection control."

Ten tips to help you communicate with a person with dementia and sight loss

There are six sight loss guides in the top tips series. This is the fifth guide of six.

The advice given here will help you feel confident about talking to a person with dementia and sight loss:

  1. Gain an understanding of the effects of the eye condition(s) and position yourself to minimise their impact
  2. Ensure the 3 C’s - correct, clean, and current glasses are worn
  3. Minimise “visual noise” by wearing block colours and minimal accessories
  4. Gain the person’s attention by saying their name first and/or by a gentle touch on the arm
  5. Introduce yourself and what you do
  6. Tell the person when you are moving away from them or leaving the room
  7. Speak clearly using simple, short sentences, giving only one idea, question or instruction at a time
  8. Follow the OWL principle - Observe, Wait and Listen for responses
  9. Ask if guidance or support is required and provide in a consistent manner
  10. Provide information in an alternative/accessible way such as audio, large print or braille.

Download the Ten tips to help you communicate with a person with dementia and sight loss  as an accessible PDF.

Drug-Free Remission a Possibility in Early SpA

More than half of patients had sustained remission after induction with golimumab.

Patients with very early peripheral spondyloarthritis (SpA) who underwent induction treatment with golimumab (Simponi) had high rates of sustained clinical remission, and more than half were able to achieve drug-free remission, a pilot study found.

In a cohort of 60 patients whose mean symptom duration was approximately 5 weeks, 82% achieved sustained clinical remission, with most reaching this goal by week 24, according to Filip Van den Bosch, MD, PhD, and colleagues from Ghent University in Belgium.

And with at least 18 months of follow-up after stopping the golimumab, 53% remained in drug-free remission, they reported in Arthritis & Rheumatology.

Peripheral SpA is a subtype of spondyloarthritis that includes psoriatic arthritis and non-psoriatic peripheral SpA and is characterized by arthritis, dactylitis, and enthesitis. Therapeutic options in the past were limited, but biologic therapies have dramatically improved outcomes. The tumor necrosis factor (TNF) inhibitors have shown efficacy across the entire spectrum of SpA, including ankylosing spondylitis and psoriatic arthritis.

In addition, in previous studies of axial and nonradiographic SpA, better efficacy has been seen when treatment is introduced early rather than when the disease is established, and ongoing trials are exploring the possibility of treatment withdrawal in axial SpA once remission is achieved. Evidence has been growing in support of an early "window of opportunity" for optimal treatment outcomes in various other inflammatory diseases such as rheumatoid arthritis.

Leaky gut: What is it, and what does it mean for you?

The expression “leaky gut” is getting a lot of attention in medical blogs and social media lately, but don’t be surprised if your doctor does not recognize this term. Leaky gut, also called increased intestinal permeability, is somewhat new and most of the research occurs in basic sciences. However, there is growing interest to develop medications that may be used in patients to combat the effects of this problem.

What exactly is leaky gut?

Inside our bellies, we have an extensive intestinal lining covering more than 4,000 square feet of surface area. When working properly, it forms a tight barrier that controls what gets absorbed into the bloodstream. An unhealthy gut lining may have large cracks or holes, allowing partially digested food, toxins, and bugs to penetrate the tissues beneath it. This may trigger inflammation and changes in the gut flora (normal bacteria) that could lead to problems within the digestive tract and beyond. The research world is booming today with studies showing that modifications in the intestinal bacteria and inflammation may play a role in the development of several common chronic diseases.

Who gets a leaky gut (and why)?

We all have some degree of leaky gut, as this barrier is not completely impenetrable (and isn’t supposed to be!). Some of us may have a genetic predisposition and may be more sensitive to changes in the digestive system, but our DNA is not the only one to blame. Modern life may actually be the main driver of gut inflammation. There is emerging evidence that the standard American diet, which is low in fiber and high in sugar and saturated fats, may initiate this process. Heavy alcohol use and stress also seem to disrupt this balance.

We already know that increased intestinal permeability plays a role in certain gastrointestinal conditions such as celiac disease, Crohn’s disease, and irritable bowel syndrome. The biggest question is whether or not a leaky gut may cause problems elsewhere in the body. Some studies show that leaky gut may be associated with other autoimmune diseases (lupus, type 1 diabetes, multiple sclerosis), chronic fatigue syndrome, fibromyalgia, arthritis, allergies, asthma, acne, obesity, and even mental illness. However, we do not yet have clinical studies in humans showing such a cause and effect.

A path toward a healthier gut

A common initial step some practitioners take is to remove foods that can be inflammatory and could promote changes in the gut flora. Among the most common are alcohol, processed foods, certain medications, and any foods that may cause allergies or sensitivities. In my practice, I often see patients improve significantly when they start eating a healthier diet.

America’s graying population in 3 maps

The U.S. population has changed substantially in the last half century, growing by nearly 63 percent.

Perhaps the two most prominent demographic changes over the past 50 years relate to age. In 1968, the baby boom had just ended, and the oldest members of its cohort were only 22 years old.

As baby boomers age, the nation has substantially aged as well. In 1970, the median age in the U.S. was 28.1. In 2016, it was 37.9.

Demographers and geographers like myself have watched as this aging cohort transformed the U.S., from young children in the 1950s and 1960s to senior citizens today. This graying of America has left a distinctive geographical fingerprint.

Where older Americans live

Unsurprisingly, popular retirement states like Florida and Arizona have high concentrations of older Americans.

What may be more of a surprise is the broad swaths of elderly running through the Midwest and the Appalachians. These regions have aged significantly, as many younger residents headed toward the coasts.

Younger people have also moved out of New England, primarily in search of jobs. Maine, New Hampshire, Vermont and Connecticut are among the seven states with a median age of over 40 in 2010; Pennsylvania, West Virginia and Florida are the others.

Not only is the U.S. aging, but the number of deaths is rising. This trend will accelerate over the next few decades.

Meanwhile, the number of births has declined since 2007. In fact, in 2013, over 30 percent of all U.S. counties experienced a phenomenon known as “natural decrease,” due the greater number of deaths than births. Natural decrease is now most prominent in Maine, the Appalachian region, the Great Plains and the Midwest.

Demographers expect this phenomenon to expand geographically over the coming years, as the general population continues to age.

The country has also become more urban. The percentage of the population living in urban areas increased by about 7 percentage points between 1970 and 2010. Urbanization increased in all states except Oklahoma and Maine.

Despite this trend, many cities are now shrinking – particularly cities in the Northeast and Midwest. More people, particularly young adults, are leaving these places for economic opportunity than are coming in. The percentage of the population living in large cities has declined since 2013, while the percentage living in smaller cities increased from 17.9 to 20.1 percent.

Could Lawn Weed Prevent COPD Exacerbations?

An oral extract of the speedwell (also known as veronica) plant appeared to reduce some symptoms of chronic obstructive pulmonary disease (COPD), researchers reported here.

The peak expiratory flow increased in patients on YPL-001 by about 10%, while the increase in the placebo patients was less than 3%, according to Nathaniel Marchetti, DO, of the Lewis Katz School of Medicine at Temple University in Philadelphia, and colleagues.

"YPL-001 is an oral formulation of an extract from the aerial part of the plant speedwell used in traditional Asian medicine to treat respiratory inflammatory diseases including ... COPD," they explained in a presentation at the American Thoracic Society (ATS) annual meeting.

The phase IIa study was initiated to determine the safety and tolerability of YPL-001, so the trend toward efficacy was encouraging, Marchetti said.

"We found that the treatment with the drug was very well tolerated," he noted. "There were very few side effects other than those commonly seen among COPD patients including exacerbations."

"This is a medication, a herbal product, that has been used for millennia in Asia to treat inflammatory respiratory diseases," he added. "What Yungjin Pharm of Korea is trying to do is to take this herbal, and make it more standardized, so that everyone gets the same dose, and also to figure how not only whether it works, but how it works, so we can use it to treat people in a more systematic way."

Speedwell/veronica is commonly found in the U.S. as well. Plants are sold in garden shops and are also a frequent lawn weed problem.

Gut Bacteria Play Key Role in Anti Seizure Effects of Ketogenic Diet

UCLA scientists have identified specific gut bacteria that play an essential role in the anti-seizure effects of the high-fat, low-carbohydrate ketogenic diet. The study, published today in the journal Cell, is the first to establish a causal link between seizure susceptibility and the gut microbiota — the 100 trillion or so bacteria and other microbes that reside in the human body’s intestines.

The ketogenic diet has numerous health benefits, including fewer seizures for children with epilepsy who do not respond to anti-epileptic medications, said Elaine Hsiao, UCLA assistant professor of integrative biology and physiology, and senior author of the study. However, there has been no clear explanation for exactly how the diet aids children with epilepsy.

Researchers in Hsiao’s laboratory hypothesized that the gut microbiota is altered through the ketogenic diet and is important for the diet’s anti-seizure effects. Hsiao’s research team conducted a comprehensive investigation into whether the microbiota influences the ability of the diet to protect against seizures and if so, how the microbiota achieves these effects.

Trials Support Emicizumab as Standard Tx in Hemophilia A


$448,000 annual price would actually reduce per-patient costs.

Prophylactic treatment with emicizumab (Hemlibra) could soon replace the current standard treatment for hemophilia A patients without factor VIII inhibitors, and at a largely reduced treatment schedule, results of the manufacturer-sponsored HAVEN 3 and HAVEN 4 trials suggested.

The trials showed that emicizumab prevented or significantly reduced bleeds in these patients. Compared with no prophylaxis, emicizumab every week or 2 weeks yielded 96% and 97% reductions in bleeds requiring treatment (P<0.0001 for both), reported Michael Callaghan, MD, of Children's Hospital of Michigan in Detroit, and colleagues.

In addition, bleeds were reduced by 68% among patients who previously received standard of care factor VIII prophylaxis (P<0.0001).

"In the long run, as long as there aren't any unexpected safety events ... I think this will be the standard of care," Callaghan told MedPage Today.

Results of both trials were presented at the World Federation of Hemophilia's World Congress in Glasgow.

During the study period, 55.6% of patients on the once-weekly emicizumab schedule (95% CI 38.1-72.1) and 60% of those on the every 2-week schedule (95% CI 42.1-76.1) experienced no bleeds. None of the patients randomized to no prophylaxis were free from bleeds.

Callaghan said he did not see many hurdles in terms of emicizumab becoming the preferred first-line therapy for hemophilia A. While the price of the drug is high, annual cost-effectiveness estimates place it lower than current factor VIII prophylaxis.

Hotel Pools and Hot Tubs Are Major Sources of Waterborne Illness Outbreaks, CDC Says

You may want to think twice before taking a dip on your next vacation, according to the results of a new report from the Centers for Disease Control and Prevention (CDC).

Between 2000 and 2014, the CDC recorded 493 disease outbreaks related to treated recreational water, resulting in more than 27,000 illnesses and eight deaths. And in almost a third of those outbreaks, the infections could be traced back to hotel pools, hot tubs and spas, the CDC says. In hotels, pools were a major culprit, but 65 cases stemmed from hot tubs or spas.

Of the outbreaks with a confirmed cause, the vast majority — 94% — were due to pathogens, while the remaining outbreaks were caused by chemicals. Cryptosporidium (also called Crypto) — which is a parasite that causes diarrhea and other gastrointestinal issues — caused 212 outbreaks and more than 21,700 illnesses over the 14 years. It’s typically spread when a person swims while they have diarrhea, putting others at risk of swallowing contaminated water. Legionella, which causes the serious pneumonia-like illness Legionnaires’ disease, as well as the less-severe Pontiac fever, was responsible for 57 outbreaks and 624 illnesses. (At least six of the eight deaths were caused by Legionella, the CDC says.) Pseudomonas, which results in swimmer’s ear or a skin condition known as “hot tub rash,” caused 47 outbreaks and 920 infections.

Outbreaks spiked during June, July and August, but they were observed all year long throughout the study period.

The prevalence of waterborne disease outbreaks highlights how difficult they can be to prevent, the report says. Crypto, for example, can survive even in properly maintained and chlorinated pools, and Pseudomonas and Legionella thrive in slimy areas in hot tubs, pools and water playgrounds. While hotels, water parks and public pools can minimize these risks through adequate maintenance, much of the burden of prevention falls on swimmers, especially when it comes to keeping Crypto out of the water.