Proton pump inhibitors in palliative care

Y oung women) was to test both the short-term and long-term effects of a series of three suberythemal UV radiation (UVR) exposures on the VitD status and well-being of young healthy women during winter in a repeat measure design. These medications are effective to reduce painful symptoms associated with GERD, acid reflux, dyspepsia, acid peptic disease and certain ulcers.

From 400 screened patients with chest pain and heartburn, 54 (age 44.5 ± 8.8 years and 74% females) had abnormal manometry and underwent acid exposure measurement. Frequencies of the EH disorder were classic NE (EH(3 cm)) found in 29 (40.8%) patients, diffuse (EH(3,8 cm)) in 30 patients (42.3%), and upper segmental (EH(8 cm)) in 12 patients (16.9%). [47] . Although treatment of NCCP is difficult because of its variety of sources and expressions, GERDrelated NCCP responds to a high dose of proton-pump inhibitor, which is an effective way to confirm actually, if not make, the GERD diagnosis [48].

There is growing evidence about the value of psychological intervention in patients with NCCP in the form of cognitive behavioral therapy or hypnotherapy. Noncardiac chest pain (NCCP) affects approximately 1 quarter of the adult population in the United States. The pathophysiology of the disorder remains to be elucidated fully. Identified underlying mechanisms for esophageal pain include gastroesophageal reflux disease (GERD), esophageal dysmotility, and visceral hypersensitivity.

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Against assumptions of current etiological models, heartbeat perception was not enhanced in patients with NCCP. Chest pain characteristics and particularly their appraisal as threatening might be more relevant to NCCP than the perceptional accuracy of cardiac sensations and should be focused in psychological interventions. However, associations with chest pain impairment suggest cardiac interoception to influence the course of NCCP. Heartbeat perception was not more accurate in patients with NCCP, compared to patients with cardiac chest pain and healthy controls. However, in patients with NCCP, the error score (Schandry task) was significantly associated with stronger chest pain impairment, and the response bias (Brener-Kluvitse task) was associated with lower chest pain intensity.

The pilot study on healthy young women with predominantly Fitzpatrick skin types II and III showed the feasibility of our schedule with three escalating suberythemal UVR exposures to improve the VitD status not only acutely but also for a longer time, as all twenty participants received every predefined UVR without significant adverse skin reactions. To our knowledge there are no systematic studies investigating the effects of UVR exposures on the VitD status, and different aspects of well-being in patients with clear psychiatric diagnosis of major/minor depression or seasonal affective disorder but without medical comorbidity in parallel. On the other hand, differences in reported findings in studies with VitD supplementation in patients with depression are likely not only to be affected by study population and dosage schemes, but by choice of diagnostic criteria also, screening tools and self-report questionnaires used. In our opinion, the choice of a suitable self-rating test to detect possible mood changes seems to present a problem.

Our sample of women with good well-being und functioning despite the majority having low 25(OH)D levels have limited our ability to detect clear positive effects of UVR exposure on the affective state. The BDI seems insufficient as an instrument for measuring these changes if the study participants are of generally good health. As indicated from our findings with POMS, the possible relationship between psychometric measures and VitD metabolites is less simple than frequently assumed.

In patients with persistent chest pain despite short-term PPIs trial the next step is to perform 24-h distal esophageal pH monitoring or 48-h wireless distal esophageal pH monitoring off PPI therapy to provide objective evidence whether acid reflux is present. After excluding acid reflux, the next step is to perform esophageal manometry to determine whether a major esophageal motility abnormality may be causing the chest pain such as achalasia, esophagogastric junction outflow obstruction, jackhammer esophagus, diffuse esophageal spasm, or absent peristalsis. After exclusion of acid reflux, eosinophilic esophagitis, or esophageal motility abnormality, the diagnosis of non-cardiac chest pain due to visceral hypersensitivity (functional chest pain) can be made. Treatment options of functional chest pain include theophylline, low-dose antidepressants (imipramine, trazodone, sertraline, or venlafaxine), or psychological interventions such as cognitive behavioral hypnotherapy or therapy. The epidemiology of NCCP is poorly described, and the available data are conflicting.

Furthermore, it should also be taken into consideration that the production of neuroactive factor classes other than VitD related compounds is also affected by UVR. From immunoregulatory molecules Aside, neuropeptides, neurotrophins, and neurotransmitters, the CRH-POMC-system (corticotropin-releasing hormone-Pro-opiomelanocortin-system) for example is strongly influenced and regulated by UVR [ 75 ]. supplementation (5,000 IU/day) [ 18 ].

Those likely to have NCCP should, if possible, be identified early, to prevent the all-too-common scenario of patients continuing for years to present to primary and secondary healthcare professionals and remaining limited in their ability to perform physical activities or to work. Gastro-oesophageal reflux disease is a common cause of NCCP, occurring in up to 50% of patients. If there are any red flag signs, a gastroscopy should be performed to rule out upper gastro-intestinal pathology. Oesophageal dysmotility, including achalasia and diffuse oesophageal spasm, are rare causes, while visceral hypersensitivity is common.

gerd stachowiak
gerd stachowiak

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