Heartburn (Pyrosis)

Heartburn is the reflux of stomach contents into the esophagus. Heartburn can be harmless, but in the long run, it can also be pathological and indicate reflux disease or cause esophagitis. Read more about the symptoms, causes, therapy, and prevention of heartburn.

Most people are familiar with heartburn (pyrosis) or acid regurgitation (ructus). As a rule, it is uncomfortable – but it also quickly passes and is harmless. Recurring or regular heartburn, on the other hand, should be examined by a doctor. Either the constant reflux of gastric acid into the esophagus is due to the disease and indicates a reflux disease or it injures the esophagus and causes esophagitis (esophagitis). With a few exceptions, heartburn can be treated very well with medication and a change in diet or behavior.

A typical symptom of heartburn is a burning pain in the center of the chest (above the stomach area) that can radiate to the throat, throat, or even face. This often happens after meals (due to overcrowding or acidification of the stomach) or when bending over and changing positions.

Occasionally, stomach acid or digested food gets into the oral cavity with the acidic burping. This leads to an unpleasant burning sensation in the throat and a sour or bitter taste in the mouth. This can cause nausea and, rarely, vomiting.

Heartburn is often accompanied by an unpleasant, sour-smelling bad breath. Heartburn or the pain associated with heartburn are sometimes also perceived as heart pain. In English, heartburn is therefore also called heartburn.

Heartburn Complications

Recurring heartburn puts stress on the esophagus. The result can be inflammation of the esophagus. In turn, esophagitis could increase the risk of esophageal cancer.

Causes

Heartburn is caused by acidic stomach contents flowing back into the esophagus (acid regurgitation). The causes of stomach contents getting back into the esophagus can be very different.

Typically, very large meals trigger heartburn once we’ve eaten enough to fill the stomach. Then a slight pressure – for example by moving – is enough to let the stomach contents get into the esophagus.

As the pregnancy progresses, the child puts pressure on the stomach and can cause stomach contents to enter the esophagus. Heartburn can also indicate conditions such as stomach ulcers, duodenal ulcers, or stomach cancer.

Cause Reflux Disease

Heartburn is the main symptom of acid reflux disease. This is a malfunction of the lower esophageal muscle (lower esophageal sphincter) that separates the esophagus from the stomach. As a result, the weakened sphincter muscle can get stomach contents easily into the esophagus.

Heartburn

Other Causes Of Heartburn

The excessive production of stomach acid and the resulting heartburn can have a variety of other causes:

    • excessive consumption of alcohol, coffee, or cigarettes
    • Obesity
    • nervous stomach
    • Diaphragmatic hernia
    • Use of certain medications such as pain relievers and anti-rheumatic drugs (e.g. acetylsalicylic acid, diclofenac, and ibuprofen), cortisone, and chemotherapy drugs
    • Stress or other psychological stress.

Cause In The Duodenum

In the case of heartburn with bitter and bilious belching, the cause is often in the duodenum. Often the intestine is overactive (so-called motility disorder) or the gastric sphincter (also called gastric gatekeeper or pylorus) does not close properly.

Investigation

The main focus of diagnosing heartburn is finding the cause of the backflow of stomach contents into the esophagus. A frequently used examination method for this is the esophagus and gastroscopy. You will find detailed information on this under gastroscopy.

Treatment

Inhibiting gastric acid production with medication is usually the essential element of medical treatment for heartburn. Different groups of drugs are used.

    • Antacids are drugs with aluminum or magnesium salts such as aluminum hydroxide or magnesium hydroxide. Other active ingredients are Algedrat, Magaldrat or Simeticon. These drugs bind excess stomach acid for heartburn and also relieve the symptoms of inflammation of the stomach lining (gastritis) or a stomach ulcer. The chewable tablets or sachets of suspension are chewed or swallowed approximately one hour after eating and before going to bed. Sometimes it takes 2 chewable tablets or sachets for the heartburn to go away. Suspensions work faster than chewable tablets because the milky solution quickly lines the stomach lining and protects it from acid. Antacids are also useful during pregnancy.
    • H2 blockers are another group of heartburn medication. So-called H2-receptor blockers such as cimetidine, famotidine and ranitidine inhibit the production of stomach acid. For some time now, various H2-receptor blockers have been available in pharmacies without a prescription.
    • Proton pump inhibitors, such as esomeprazole, lansoprazole, omeprazole, pantoprazole, and rabeprazole, are another group of drugs that can be used to treat heartburn. For example, the proton pump inhibitors omeprazole, pantoprazole, or esomeprazole are now freely available (see also below: gastric acid blockers involve risks)
    • Prokinetics such as metoclopramide accelerate the intestinal transit and the further transport of food in the intestine. As a result, less acidic food pulp can get into the esophagus.

Recall Of Drugs Containing Ranitidine

Numerous drugs with the active ingredient ranitidine may no longer be used for the time being since September 2019. A current list of the drugs concerned can be found here: Recall ranitidine drugs due to nitrosamine contamination. Ranitidine belongs to the active substance group of H2 antihistamines and is also mainly used in the following clinical pictures:

    • Anaphylactic shock
    • gastritis
    • Diaphragmatic hernia

The European Medicines Agency ordered the EU-wide recall because impurities had been detected at a manufacturer of the active ingredient in India (Saraca Laboratories Limited). According to the Federal Institute for Drugs and Medical Devices (BfArM), this is N-nitrosodimethylamine (NDMA). These nitrosamines are thought to be potentially carcinogenic.

In 2018, NDMA contaminants had already caused numerous recalls for another group of active ingredients, the sartans. The Central Laboratory of German Pharmacists has now examined 38 preparations and declared them not to be contaminated.

Heartburn Surgery

In rare cases, surgery is needed to get rid of heartburn. Reasons for an operation can be, for example, stomach and duodenal ulcers, stomach cancer, or a rupture of the diaphragm.

Self-Help Against Heartburn

To help yourself with heartburn – assuming no other illnesses – you can usually use the above-mentioned over-the-counter medications or sodium hydrogen carbonate (such as baking soda and Bullrich’s salt). However, this only applies if the heartburn occurs occasionally and another disease is excluded as the cause. In the best-case scenario, discuss any medication with your doctor.

Chamomile, yarrow, or liquorice root in the form of teas or drops, like peppermint, caraway, anise or fennel tea, have a digestive and calming effect on the stomach.

Stomach Acid Blockers Involve Risks

Proton pump inhibitors such as esomeprazole, lansoprazole, omeprazole, pantoprazole, and rabeprazole are among the best-selling drugs in Germany. According to the drug report from the Barmer health insurance company, almost 12 million German proton pump inhibitors were prescribed in 2018. In public perception, gastric acid blockers from the active ingredient group of proton pump inhibitors are considered to be simple and safe drugs. However, two aspects are left out: the side effects and the fact that proton pump inhibitors can be addictive.

Kidney Damage as a Side Effect

The most common side effects of proton pump inhibitors include bone loss (osteoporosis) and magnesium deficiency with an increased risk of cardiac arrhythmias and seizures. These side effects have now been proven by a number of studies. It is even more serious that the medication permanently disrupts the natural regulatory cycle of gastric acid production. After prolonged use, between 14 and 64 percent of patients remain permanently dependent on the medication.

Connection Between Proton Pump Inhibitors And Allergies Is Possible

Proton pump inhibitors may increase the risk of allergic diseases. Scientists from the University of Vienna published a study in the specialist magazine “Nature Communications” (August 2019) (see sources) that at least produced a striking statistical connection between the long-term use of proton pump inhibitors and allergic diseases. The scientists had evaluated data from Austrian health insurance companies. They found that the likelihood of prescribing antiallergic drugs increases by up to 300 percent if gastric acid blockers were previously prescribed. This does not necessarily mean that proton pump inhibitors actually trigger or promote allergies. In the opinion of the study authors, however, the connection cannot be dismissed out of hand and suggests that gastric acid blockers should only be used in very dosed quantities.

The German Society for Gastroenterology, Digestive and Metabolic Diseases assessed the study results differently. According to the press release, the specialist society does not see an “obvious connection between gastric acid blockers and allergies”. The design of the Austrian study does not give a corresponding assessment.

Prevention

There are few meaningful studies on the effects of behavior change on heartburn. However, many experiences confirm that, for example, avoiding coffee, alcohol, and smoking relieves heartburn or prevents heartburn from developing in the first place. If you have a tendency to heartburn, you should also take note of the following tips:

    • Avoid very spicy or citrus-acid foods and drinks
    • Avoid fatty foods and chocolate if possible
    • eat in an upright position
    • Keep evening meals as small as possible
    • Avoid being overweight
    • no overly tight clothing and constant sitting
    • Do not bend forward after meals
    • Increase the headboard of the bed if you have heartburn at night.

Metabolic Syndrome

Obesity, high blood pressure, lipid metabolism disorders, and an elevated blood sugar level are the main risk factors for cardiovascular diseases and are known as metabolic syndrome and colloquially as the “fatal quartet”.

The metabolic syndrome is not a clinical picture, but rather the summary term for the most important risk factors that lead to cardiovascular diseases. In English, the metabolic syndrome is called “deadly quartet”. This means the sometimes fatal interplay of

    • Overweight (obesity)
    • Fat metabolism disorders with increased triglycerides and low HDL cholesterol (colloquially good cholesterol)
    • High blood pressure (arterial hypertension) and
    • abnormally high blood sugar level (hyperglycemia).

Metabolic Syndrome

In the scientific literature, metabolic syndrome is sometimes also called Reaven syndrome or Syndrome X. The main criteria for metabolic syndrome are:

    • Trunk-dominated overweight (abdominal obesity) with a waist circumference ≥ 94 cm in men and ≥ 80 cm in women (of European origin, Asians have different normal values)
    • Lipid metabolism disorders with increased triglyceride values> 150 mg / dl (> 1.7 mmol / l) and decreased HDL cholesterol concentration: in men <40 mg / dl (<1.05 mmol / l) and in women <50 mg / dl (< 1.25 mmol / l)
    • High blood pressure (arterial hypertension)> 130/85 mmHg
    • Type 2 diabetes or increased fasting blood sugar value of> 100 mg / dl (> 5.6 mmol / l).

There are no exact figures on the frequency of metabolic syndrome in Germany. From various studies on the individual risk factors, however, it can be deduced that in this country around one in four adults sooner or later meets all four criteria. This doubles the risk of a heart attack or stroke. The likelihood of developing diabetes increases even more: Type 2 diabetes is up to 5 times more common in people with metabolic syndrome than in comparable persons of the same age or gender.

Food Allergy

Food allergies are sometimes confused with food intolerances. The main difference: In a food allergy, the immune system fights parts of the food as foreign bodies. More about it as well as symptoms, causes, and therapy of a food allergy. Around 1 to 2 percent of the population suffers from a real food allergy. In these cases, the immune system is allergic to certain foods. An allergy is a bad reaction of the immune system to actually harmless, foreign substances.

A reaction does not appear until the second contact with the triggering substance (allergen) at the earliest. The first time the so-called sensitization takes place, i.e. the immune system forms antibodies against the apparently hostile substance, which it is supposed to fight off. If the body comes into contact with the allergen again, large amounts of these antibodies are reproduced. They fight the substance and an allergic reaction occurs. Defense cells release various highly effective biochemical substances such as histamine, which are then responsible for the classic symptoms.

Common food allergy triggers are:

    • nuts
    • fish
    • wheat
    • Shellfish
    • Different types of fruit and vegetables
    • Eggs

Causes

Most adults have pollen-associated food allergies in hay fever (cross allergy). The structure of the allergenic molecules in pollen are similar to some structures in some foods. The immune system, so to speak, confuses the molecule and then reacts with an allergy to different foods.

Food Allergy

The symptoms of the allergy range from skin rashes with itching and wheals to gastrointestinal disorders to shortness of breath or, in the worst case, circulatory failure. The most common cross allergies:

    • Birch, alder, hazelnut – nuts, apples, other stone and pome fruits, potatoes
    • Grasses – tomato, peanut, legumes,
    • Mugwort – celery, spices, carrots

A food allergy must be differentiated from food intolerance. There is no immune reaction here. It is triggered, for example, by foods that contain a lot of histamines. In other forms, there is a lack of enzymes that are supposed to break down certain substances in the body (e.g. lactose intolerance). In addition, some dyes or preservatives in the body can cause a direct release of histamine. The symptoms are mostly similar to those of a real food allergy.

Investigation

Identifying the triggering allergen can be very difficult, especially due to today’s variety of convenience foods. The simplest test is the so-called prick test. Various test solutions are stabbed into the skin. If there is an allergy, a wheal will form at this point after approx. 20 minutes. In the case of food, it may be necessary not only to use the test solution but to place the food itself on the skin or to scratch a little and then prick the skin in order to obtain a reliable result. If the allergen cannot yet be found, there is the option of a provocation test. This means that the suspicious food is eaten in low doses under medical supervision in order to provoke an allergic reaction. A blood test, in which the antibodies against a suspected allergen can be detected, can also be helpful.

Treatment

If the allergic reaction is not too strong, drugs that block the histamine in the body (antihistamines) are usually sufficient for therapy. In more severe cases, cortisone is used to suppress the immune response. For patients who have ever had a massive allergic reaction, it is advisable to always have an emergency kit with them, consisting of an antihistamine, cortisone, and an adrenaline supplement, in case a circulatory reaction occurs.

Self Help

The best therapy, of course, is to avoid the offending food. However, some allergens change depending on the preparation, so that, for example, many patients with an apple allergy cannot tolerate the raw apple, but have no problems with the apple in cooked or baked form. Finished products on which the ingredients are not adequately declared can also cause difficulties. It is advisable not to use it.

Fructose Intolerance

Fructose intolerance is the intolerance of fructose in food. Here you will find information on the causes, symptoms, and nutrition of fructose intolerance. Fructose intolerance is one of the food intolerances. In principle, it is a metabolic disorder. People with fructose intolerance cannot digest or break down fruit sugar (fructose) or only to a very limited extent. According to the cause, doctors differentiate between intestinal fructose intolerance and hereditary fructose intolerance.

Intestinal and hereditary fructose intolerance

Intestinal fructose intolerance is by far the most common form. It arises from a previously unknown cause. A high-sugar diet and continued consumption of sugar substitutes may play a role.

Normally, fructose from food is absorbed into the body through the small intestine. The so-called glucose transporters (GLUT) play a central role in this. In the case of intestinal fructose intolerance, the function of GLUT-5 is restricted or there are too few transport proteins. Another cause is damaged mucous membrane in the small intestine, for example during/after acute gastrointestinal inflammation, Crohn’s disease, celiac disease, or taking medication. As a result, the fructose can only be insufficiently absorbed from the food in the small intestine – it is therefore not available to the body – and reaches the large intestine unused. If this happens without symptoms, doctors speak of fructose malabsorption (FM). However, if symptoms such as diarrhea, nausea, abdominal pain, or flatulence are added, the diagnosis is called intestinal fructose intolerance (IFI). Both clinical pictures are diagnosed using a fructose stress test, the so-called fructose hydrogen breath test.

Fructose Intolerance

The very rare hereditary fructose intolerance (HFI) is innate and significantly more dangerous than hereditary fructose intolerance. It must absolutely be excluded before a fructose stress test, otherwise, there is a risk to life for the patient. Because of a genetic change, those affected lack the enzyme aldolase B, which is involved in the breakdown of fructose. As a result, the ingested fructose is not broken down and competes in different ways with the glucose in the blood, the so-called blood sugar. This then results in dangerously low blood sugar levels (hypoglycemia) up to life-threatening shock. Other indicative symptoms of hereditary fructose intolerance are vomiting and bleeding disorders with rapid and frequent bruising.

Treatment

Even healthy people can only tolerate around 50 grams of fructose per meal. With acquired fructose intolerance, this amount continues to decrease. In this way, more and more undigested fructose reaches the large intestine. There the fructose is an ideal breeding ground for bacteria. The gases and fatty acids produced during bacterial fructose digestion cause the typical symptoms of intestinal fructose intolerance. These are above all abdominal pain, gas, diarrhea, or constipation as well as irregular, often mushy stool.

Treatment By Renouncing Fructose

The therapeutic focus is on the elimination of small intestine weakness or small intestine colonization and the restriction/avoidance of fructose. Often other carbohydrates must also be avoided, for example, oligofructose (especially in fruits or prebiotic products), stachyose and raffinose (for example in legumes, leeks, and onions), lactulose (laxative), or sugar alcohols such as sorbitol, mannitol, maltitol, and palatinitol ( in diet products).

The only way to treat hereditary fructose intolerance is to avoid fructose completely. In the first twelve months of life, you should consistently refrain from eating fruit and vegetables; substitution with vitamins is recommended to compensate for this.

Itching (Pruritus)

It can be tormenting, whether after sunburn, insect bites, or allergies: itching (pruritus) is often harmless, but almost always annoying. The itch in itself is less of a disease than a symptom that indicates other diseases or problems. Learn more about the causes and treatment of itching.

Itching (pruritus) is a symptom of many diseases, including above all skin diseases with rashes such as psoriasis, neurodermatitis, or eczema. And scratching often doesn’t make it any better. Severe itching or discoloration of the skin should be examined because itching can indicate various serious diseases such as diabetes or cancer.

Symptoms

Primarily, itching is itself a symptom, and therefore a sign of underlying medical conditions. At first, the skin itches uncomfortably, which leads to scratching. Redness, crusts, and inflammation are the result. Persistent itching often leads to coarsening and thickening of the skin.

Causes

Itching has many different causes. In addition to insect bites, itching of the skin can be due to skin diseases such as psoriasis, neurodermatitis, or allergies, but also to diabetes, cancer, fungal infections, poor liver and kidney function, hypothyroidism, or phlebitis. Itching on the head could be caused by lice. However, itching also occurs without organic causes. In this case, doctors speak of psychogenic pruritus.

Itching

How the itching itself arises has not been scientifically clarified. Essentially, it is assumed that itching is caused by so-called histamines. Histamines are messenger substances that are released in the event of inflammation or allergies.

Examination

Treating itching requires an accurate diagnosis. Since itching can be a symptom of numerous diseases, you should always have a doctor examine the causes of persistent itching. This is especially true when skin changes (e.g. flea-like or star-shaped bleeding) and discoloration of the skin (e.g. yellowing of the skin and mucous membranes) occur.

Treatment

Your doctor will first try to find out what is causing the itchiness and then initiate appropriate treatment. If a fungal infection is the cause of the itching, antimycotics (drugs against fungal infections) can help. Itching caused by lice, fleas, or itch mites is treated with so-called antiparasitic drugs. In the case of a viral infection such as cold sores, virus-inhibiting agents such as acyclovir or virus blockers such as docosanol help.

To relieve the itching in inflammatory and allergic diseases, the doctor can prescribe antihistamines (known as anti-allergic agents) or glucocorticoids (drugs containing cortisone), among other things.

Self-Help Against Itching

Some drugs against itching, for example, allergies, athlete’s foot, herpes, sunburn, or vaginal thrush, are available over the counter in pharmacies. Your pharmacist will advise you on the right choice. Cooling compresses also provide relief. Baths, creams, and ointments with tar, urea, or tannins also have an itch-soothing effect. Itchy insect bites can be treated with tripelennamine or bamipin lactate.

You should definitely refrain from scratching because it worsens the itching and can damage the surface of the skin. Then pathogens can penetrate more easily and trigger new inflammations with new itching. Measures that distract from the itching, such as exercise, tricky brain teasers, or relaxation exercises, are better.

Non-Hodgkin Lymphoma

Non-Hodgkin lymphomas can develop inside and outside of lymph nodes. Why the cells in this type of lymph gland cancer change in a malignant manner, however, cannot yet be clearly answered. You can find more information about the symptoms, causes, and treatment of non-Hodgkin lymphoma here.

The generic term non-Hodgkin’s lymphoma includes malignant diseases of the lymphatic tissue that are not Hodgkin’s lymphomas. In the case of non-Hodgkin lymphoma, a distinction is made between three main forms. The differentiation in this type of lymph gland cancer is based on how the corresponding tissue is composed, how quickly the lymphomas grow, and how quickly they spread. The division is made into:

    • highly malignant non-Hodgkin lymphomas
    • low-grade non-Hodgkin lymphomas
    • Burkitt lymphoma.

Highly malignant non-Hodgkin lymphomas

Highly malignant non-Hodgkin lymphomas are diffuse, large-cell B-cell lymphomas. They often develop in the gastrointestinal tract, bones, skin, or brain. Due to their strong malignancy and aggressiveness, they spread quickly and diffusely in all organs.

Low-Malignant Non-Hodgkin Lymphomas

The low-malignant non-Hodgkin lymphomas include various diseases, for example:

    • Chronic lymphocytic leukemia (CLL): It usually occurs in old age and often begins in the blood, and it often affects the bone marrow, liver and spleen.
    • The plasmacytoma: The plasmacytoma occurs around the age of 40. Enlarged lymph nodes and tumors in the bone and bone marrow are typical. This often leads to bone pain and fractures.
    • follicular lymphoma: This lymphoma tends to affect older people. It spreads to the lymph nodes and bone marrow. Although this lymphoma belongs to the group of low-grade non-Hodgkin lymphomas, it often turns into a very malignant form later on.
    • Rare low-grade non-Hodgkin lymphomas are hairy cell leukemia, extranodal lymphoma of the lymph tissue in the wall of the stomach and intestines, and mycosis fungoides.

Burkitt Lymphoma

Most people in West Africa develop Burkitt’s lymphoma. In Europe it occurs very rarely, if it does – it often accompanies AIDS.

The Lymphatic System

The lymphatic system is part of the body’s own defense system. It consists of pathways that run through the whole body and the lymphatic organs (lymph nodes, spleen, tissues in the gastrointestinal tract, thymus gland, and tonsils). The cells in the lymphatic system are called lymphocytes. They belong to the group of white blood cells (leukocytes). A distinction is made between two forms, the B and T lymphocytes. Both types of lymphocytes have different functions in the defense against pathogens.

80 percent of non-Hodgkin lymphomas develop from B lymphocytes, and only about 20 percent of all cases develop from T lymphocytes. Non-Hodgkin lymphomas can basically occur anywhere in the body and also in any organ. Most often, however, they develop in lymph nodes.

The incidence of non-Hodgkin lymphoma has been increasing for many years. The reasons for this are not known. According to the Malignant Lymphoma Competence Network, the annual incidence (frequency of new cases per year) is estimated at 10 to 15 cases per 100,000 people. According to the Robert Koch Institute, around 19,200 men and women contracted non-Hodgkin lymphoma in 2017. With 10,649 new cases, men were more frequently affected than women (8,550). In men, the average diagnosis is made at the age of 70, in women the mean age of onset is 72 years. Non-Hodgkin lymphomas can occur at any age.

Symptoms

The symptoms of non-Hodgkin lymphoma are variable. They depend on where the lymphoma is located. Non-Hodgkin lymphomas also attract attention at different rates:

  • Low-malignant non-Hodgkin lymphomas develop slowly and cause symptoms late.
  • Highly malignant non-Hodgkin lymphomas are quickly noticeable.

A typical symptom of non-Hodgkin lymphoma is in any case a painless enlargement of the lymph nodes, which occur most frequently on the head and neck. In addition, there are often general symptoms such as:

    • fever
    • night sweats
    • Fatigue, tiredness and weakness
    • declining efficiency
    • unwanted weight loss
    • Nausea/loss of appetite
    • Bloating
    • heartburn
    • Anemia
    • Skin changes (e.g. redness, paleness)
    • itching
    • depressed mood
    • increased susceptibility to infections
    • Headache or bone pain.

Depending on where the non-Hodgkin lymphoma develops, other symptoms such as abdominal pain, shortness of breath or nerve failure are possible.

The exact causes of non-Hodgkin lymphoma are still unknown. But there are factors that increase the risk of developing non-Hodgkin lymphoma. Risk factors for non-Hodgkin lymphoma are:

    • Chromosome changes that occur in the course of life (e.g. due to radioactive radiation)
    • Immunodeficiency, e.g. advanced HIV infection. The risk of the disease is particularly increased in the case of highly malignant lymphomas, which also affect the central nervous system.
    • Infections with the human T-cell leukemia virus HTLV-I specifically increase the risk of T-cell lymphomas.
    • Viral infections with the Epstein-Barr virus: The Epstein-Barr virus is one of the herpes viruses and triggers Pfeiffer’s glandular fever in younger people. The infection is primarily responsible for the development of the highly malignant Burkitt’s lymphoma, which occurs mainly in Africa.
    • Colonization with Helicobacter pylori: In many people, the gastric mucosa is colonized with the bacterium Helicobacter pylori, which can lead to chronic gastric mucosal inflammation. Then there is an increased risk of gastric mucosal lymphoma (MALT lymphoma).
    • Chemical substances such as benzene or certain insect or pesticides generally favor non-Hodgkin lymphomas.
    • Smoking: Smokers are more likely to develop non-Hodgkin lymphoma.
    • Older age: As you get older, the risk of developing non-Hodgkin lymphoma increases.

Examination

Your doctor will first examine your body for possible enlarged lymph nodes and other changes (such as enlarged spleen or liver). With a blood sample, various blood cell and organ values ​​can be determined. With an extended blood count (differential blood count) the distribution of the leukocytes – including the lymphocytes – can be determined. Sometimes malignant lymphocytes can also be directly detected in the blood.

To confirm the diagnosis of non-Hodgkin lymphoma, tissue from an affected lymph node or other affected lymphatic tissue is usually removed and examined. Using special methods, it is then possible in the laboratory to precisely analyze the cells and thus identify the type of lymphoma.

Non-Hodgkin Lymphoma

Further Investigations

Once a diagnosis of non-Hodgkin lymphoma has been made, further tests will need to be done to determine if the disease has spread. This includes ultrasound (sonography) of all visible lymph nodes, x-rays of the lungs as well as computer and magnetic resonance tomographies of various body regions. It may also be necessary to have a mirror image of the chest or abdomen and, if there is suspicion of bone or bone marrow involvement, a detailed examination of the skeleton or bone marrow may be necessary. The doctor also checks the cranial nerves and examines the testicles in men.

Positron emission tomography is a very sensitive method for discovering the exact distribution of malignant cells. The patient is injected with a radioactive substance that is distributed throughout the body and takes part in the metabolism. These processes can be made visible with a special camera. Since tumor cells have a different metabolism than other cells, they can be recognized by the changed image pattern.

Treatment

How non-Hodgkin lymphomas are treated depends on the aggressiveness of the tumor. Therapy is also based on the age of the patient, the spread of the cancer cells, the chances of a cure for the respective lymphoma and the concomitant diseases.

Small, localized lymphomas can possibly be surgically removed. In the case of very slow growing tumors, it may be justifiable to wait and see and regularly check the disease. Doctors call this form of therapy watch and wait.

Chemotherapy for non-Hodgkin lymphoma

In the case of highly malignant lymphomas – even in more advanced stages – good results can be achieved with chemotherapy. Chemotherapy usually combines several substances in order to achieve the greatest possible effect. The cell-killing drugs are injected into the vein in several cycles, each lasting around 2 to 4 weeks. In the case of lymphomas in the brain, it is possible to administer the chemotherapeutic agents directly into the nerve water (liquor) so that they can work directly on the spot. The duration of therapy depends on the type and extent of the disease.

Possible side effects are hair loss, nausea, vomiting, tiredness, increased susceptibility to infections and anemia as well as permanently damaged fertility in men and women.

Irradiation For Non-Hodgkin Lymphoma

If the tumor is limited to a certain region of the body, local irradiation can also take place. Radiation is also an option if previous chemotherapy has failed. Low-malignant non-Hodgkin lymphomas generally respond better to radiation.

Radiation treatments also have side effects. As with chemotherapy, these include nausea and vomiting as well as hair loss. In addition – depending on the location of the irradiation – inflammation of the skin and mucous membranes, dry mouth or changes in taste can occur.

Antibody Therapy

Some non-Hodgkin lymphomas have cells with specific features on their surface. For some of them there are antibodies. These antibodies then attach themselves to the cells and mark them as malignant for the body’s own defense system. This stimulates the body’s own defense system to destroy the cancer cells. In some cases, the antibody can also be loaded with a radioactive substance, which then destroys the tumor cell itself (so-called radioimmunotherapy).

Interferon

In some cases, therapy with interferon can be useful. Interferon supports the body’s defenses in the fight against cancer cells.

High-dose chemotherapy with bone marrow / stem cell transplantation

Sometimes it is not possible to completely destroy the malignant cells in non-Hodgkin’s lymphoma or there is a relapse. Then high-dose chemotherapy with subsequent transfer of bone marrow and the precursor cells of all blood cells (stem cells) contained therein can be tried. To do this, healthy stem cells are first taken from the patient’s blood or bone marrow in order to freeze them. Those affected then receive another high-dose chemotherapy – sometimes combined with whole-body radiation – to destroy all of the malignant cells in the bone marrow. During this time, those affected are at high risk of infection because their immune system is practically switched off by the medication.

After chemotherapy, patients then get their healthy, stored cells back into the bloodstream via an infusion. From there, the cells migrate to the bone marrow and start producing new blood. In rare cases, foreign material is used for the transfer (i.e. cells from strangers). Then, after the transplant, drugs must be taken for a long time to prevent these cells from being rejected.

The previous aggressive chemotherapy leads in most cases to permanent infertility. The risk of developing another form of cancer later on also increases. If irradiation was carried out at the same time, the risk of clouding of the lens in the eye (so-called radiation cataract) increases.

Forecast

Life expectancy and the chance of recovery depend on the type of non-Hodgkin lymphoma. The later the treatment starts, the worse the chances of recovery. If left untreated, highly malignant non-Hodgkin lymphomas can, in the worst case, be fatal after just a few months. In addition, highly malignant lymphomas tend to recur despite aggressive therapy.

Low-grade non-Hodgkin lymphomas are cured by radiation, especially in the early stages. In more advanced stages, however, a cure is hardly possible.

Prevention

Non-Hodgkin lymphoma cannot be prevented with certainty. In any case, it is beneficial not to smoke and to avoid exposure to radiation. HPV vaccination significantly reduces the risk of human papilloma virus infections – and thus combats one of the risk factors for non-Hodgkin’s lymphoma.

Inflammation Of The Pericardium (Pericarditis)

An inflammation of the pericardium – known in medicine as pericarditis – usually causes sharp pain in the chest. Find out more about the symptoms, causes, and treatment of pericardial inflammation here.

Doctors refer to pericarditis as pericarditis. The pericardium (pericardium) encloses the heart and on the one hand, delimits it to a certain extent from the free chest cavity. On the other hand, the pericardium is filled with fluid that forms a sliding layer for the movements of the underlying heart muscle (myocardium).

Pure pericardial inflammation is rather rare. Most of the time, the heart muscle itself is also affected. Cardiologists refer to this as perimyocarditis if only the upper layers of the heart are affected. Deeper-reaching inflammations involving the inner lining of the heart (endocardium) are called pancarditis.

Symptoms

Pericarditis often begins as a dry form. Doctors speak of pericarditis sicca. This is usually shown by stabbing pain behind the breastbone, which is particularly pronounced when the patient is exerted (coughing, deep breathing), but also when lying down.

Often – but not necessarily – a so-called pericardial effusion then follows. This swelling occurs when the volume of fluid in the pericardium increases due to inflammation. Doctors then speak of damp pericardial inflammation or exudative pericarditis.

The pain subsides and the heartbeat becomes quieter. Fever, panting due to shortness of breath, and severe inefficiency are further characteristic symptoms of pericarditis.

Inflammation Of The Pericardium

Cause Of Pericardial Inflammation

The cause of pericardial inflammation cannot always be identified. In up to 80 percent of cases, they are likely to be a long-term consequence of not completely cured viral infections, colds, or the flu. However, there are also non-infectious causes, for example as a result of heart attack, autoimmune diseases, radiation, or allergic reactions.

Treatment

In most cases, pericarditis is treated with medication. The focus is on anti-inflammatory drugs from the group of non-steroidal anti-inflammatory drugs (NSAIDs) such as indomethacin and ibuprofen, high-dose acetylsalicylic acid (ASA), and the autumn crocus alkaloid colchicine. Glucocorticoids such as prednisone and prednisolone or triamcinolone are used if the inflammation persists.

To relieve the heart, dehydrating drugs (diuretics such as furosemide and torasemide) and the ACE inhibitors ramipril and captopril are used.

If bacteria are responsible for pericarditis, antibiotics such as tetracycline, erythromycin, and ampicillin help. In the case of non-infectious causes, the triggering disease must be treated specifically.

High Blood Pressure

The increased pressure in the arterial blood vessels is called high blood pressure (hypertension). Doctors refer to the disease as “arterial hypertension” or hypertension. The opposite of this is mostly harmless low blood pressure (hypotension).

This is how blood pressure is created

The blood is expelled from the heart through the aortic valve into the arteries. The pressure of the flowing blood on the walls of the blood vessels (arterial walls) is called blood pressure. The level of blood pressure depends on the pumping capacity of the heart and the diameter of the vessels.

With physical exertion or excitement, blood pressure rises, while at rest it falls again. Within certain limits, this is completely normal and also desirable. Permanently high blood pressure, that is, even at rest, is unhealthy. The definition of when blood pressure is too high is set by the World Health Organization (WHO).

Measure blood pressure: systolic value and diastolic value

The blood pressure is given in numbers, for example, 120/80 mm Hg (millimeters of mercury), speaking 120 to 80.

    • The systolic value (the first, higher, value, m example 120) results when the heart contracts and the blood presses into the arteries, i.e. during the pumping phase.
    • Diastolic pressure (the second, lower value) occurs when the heart relaxes and the heart chambers refill with blood. Doctors speak of the recovery phase.

When is blood pressure too high?

Hypertension according to WHO values ​​The specification for the definition of hypertension comes from the WHO, the World Health Organization. Currently (as of 2021), according to the WHO, a systolic value of at least 140 mm Hg and a diastolic blood pressure value equal to or more than 90 mm Hg are considered hypertonic – blood pressure above 140/90 mm Hg is therefore elevated. According to this definition, however, the increase in blood pressure must be permanent and not just temporary.

Experts: Limits for blood pressure values ​​are arbitrary

Some scientists point out that the WHO hypertension values ​​are set arbitrarily. Whether a blood pressure is too high or not can only be determined by taking an overall view of the patient’s state of health. Essentially, however, the WHO perspective has prevailed in conventional medicine.

Symptoms

Increased blood pressure is often not noticeable at first. The people affected often feel particularly fit and alert. Only very high blood pressure sometimes causes symptoms. Typical symptoms of hypertension are headache (often in the morning), dizziness, nausea, flushing of the face, nosebleeds, insomnia, fatigue, and ringing in the ears (tinnitus).

High Blood Pressure Crisis (hypertensive crisis)

Extremely high blood pressure values ​​(over 230/130 mmHg) lead to a high blood pressure crisis. Then it becomes critical. High blood pressure crises cause shortness of breath and seizures, consciousness is clouded, in the worst case the affected people fall into a coma. There is also the risk of organ damage (such as acute heart failure, myocardial infarction or pulmonary edema) or brain damage (e.g. stroke and high-pressure encephalopathy), and rarely even the main artery tears (aortic dissection).

High Blood Pressure As A Risk Factor For Numerous Diseases

Longstanding hypertension can have serious consequences or complications. For example, high blood pressure is a recognized risk factor for atherosclerosis. High blood pressure in connection with being very overweight, diabetes or lipid metabolism disorders also significantly increases the risk of developing cardiovascular diseases. These diseases include:

Every second German now dies prematurely from cardiovascular disease.

Causes

In the majority of hypertensive patients, no clear cause of the increased blood pressure can be determined. Doctors call this high blood pressure “essential hypertension”. If another disease causes high blood pressure, it is called “secondary hypertension”. Increased blood pressure is also common during pregnancy (for example in pregnancy poisoning).

Risk Factors For Essential Hypertension

Essential hypertension can be triggered by a variety of factors. In addition to a genetic component, lifestyle also plays a major role. The following factors increase the risk of essential hypertension:

    • Obesity
    • Sedentary lifestyle
    • high salt consumption
    • smoking
    • excessive alcohol consumption
    • stress
    • Lipid metabolism disorders (e.g. increased cholesterol level)
    • hereditary predisposition.

The diagnosis “essential hypertension” can only be made if other causes for the increased blood pressure have been ruled out.

High Blood Pressure

Causes of Secondary Hypertension

Conditions that commonly cause high blood pressure include:

    • Kidney disease (such as glomerulonephritis, cyst kidney, diabetic nephropathies, or narrowing of the renal arteries)
    • Vascular diseases (such as arteriosclerosis or congenital malformations of the main artery)
    • Hormonal disorders (such as Cushing’s syndrome, adrenal cortex disorders, pheochromocytoma, or diabetes)
    • Sleep apnea syndrome.

Medicines such as hormonal contraceptives (birth control pills) or cortisone can also cause high blood pressure.

Examination

To avoid consequential damage and complications from high blood pressure, therapy for hypertension should begin as early as possible. High blood pressure is easily detected with a first and second blood pressure reading. If hypertension is suspected, blood pressure is measured 24 hours a day. In the further course blood tests, eye and urine tests, an electrocardiogram (EKG), and an ultrasound examination of the heart, as well as the neck and leg vessels, should be arranged.

In order to rule out other diseases as the cause of hypertension, imaging methods such as CT or MRI also help. Of course, the full spectrum of these examination methods is not always necessary for the diagnosis of high blood pressure.

Treatment

So-called antihypertensive drugs are given for drug therapy of hypertension. There are a number of antihypertensive drugs that work differently. In Germany, more than 15 million men and women take medication for high blood pressure every day.

Medicines Containing Contaminated Valsartan

In 2018, one of these active ingredients made headlines in particular. Many drugs containing the active ingredient valsartan have been withdrawn from the market because they are contaminated with the substance N-nitrosodimethylamine (NDMA). Manufacturers who obtain their valsartan from the production of the Chinese supplier Zhejiang Tianyu are affected. Here is the list of affected valsartan preparations. Later, even the smallest amounts of NDMA were detected in another active ingredient from the group of sartans. Losartan from the Indian supplier Hetero Labs is affected. The drugs with this active ingredient were immediately withdrawn from the market.

In the meantime, the European Medicines Agency completed a risk assessment process for the sartans candesartan, irbesartan, losartan, olmesartan, and valsartan in summer 2019. The impurities can form during the production of sartans with a certain ring structure (tetrazole ring) under certain conditions and when certain solvents, reagents, and other starting materials are used. Additionally, it is possible that contaminants were present in some sartans because the manufacturers accidentally used contaminated equipment or reagents in the manufacturing process.

Do sartan users have to expect an increased risk of cancer?

NDMA is classified as likely to cause cancer in humans by the International Agency for Research on Cancer of the WHO and the EU. About 900,000 people in Germany take valsartan. Whether the long-term intake of valsartan contaminated with NDMA actually increases the risk of cancer cannot yet be reliably answered. Danish researchers published a study in September 2018 [1]. It looked at data from more than 5,000 people who took valsartan between 2012 and 2017. These were men and women who had received either contaminated valsartan (approx. 11,900 patient-years) or uncontaminated valsartan (7,300 patient-years).

After analyzing the data, the scientists came to the conclusion that Valsartan contaminated with NDMA may not increase the general risk of cancer. But it is still too early for a reliable result. They also point out that in the group with NDMA contamination, a slightly higher rate of cases of colon cancer and uterine cancer was registered.

Sartans: What Should Patients Do Now?

Important for patients taking candesartan, irbesartan, losartan, olmesartan, and valsartan:

    • Not all candesartan, irbesartan, losartan, olmesartan, and valsartan medicines are affected.
    • Please do not interrupt the intake on your own.
    • If you have any questions about your treatment, talk to your pharmacist, who can tell you whether your medicine is being recalled.
    • If the medicine you are taking is affected, your doctor may prescribe a different medicine with an active ingredient that is not affected by the contamination.
    • If you are in a clinical study with valsartan and have any questions, speak to the doctor in charge of the study.
    • The sartans azilsartan, eprosartan, and telmisartan are not affected by the impurities due to their chemical structure.

Active ingredients against high blood pressure

The selection of the appropriate medication depends, among other things, on age, previous and concomitant illnesses as well as the response of blood pressure to the medication. The following antihypertensive drugs are given individually or in combination:

Dehydrating agents

So-called diuretics such as thiazide diuretics, loop diuretics, potassium-sparing diuretics and aldosterone antagonists remove water from the body. This reduces the blood volume. When less blood flows through the veins, the pressure in the blood vessels decreases, and the blood pressure automatically drops. In addition, the heart is relieved and fluid accumulations in the tissue (edema) are flushed out.

Beta-blockers such as metoprolol, propranolol, or pindolol

These drugs block so-called beta-adrenaline receptors and thus reduce the effects of the stress hormone adrenaline and the neurotransmitter noradrenaline. As a result, blood pressure drops and the heart rate drops at rest.

Calcium channel blockers

Active ingredients of the dihydropyridine type such as amlodipine, lercanidipine, or nifedipine prevent the influx of calcium into heart muscle cells, cells of the stimulus-conduction system, and muscle cells of the blood vessels. Calcium is required for the tension of the muscle walls. If there is less calcium available, the muscle walls can constrict less, and muscle contraction decreases. The blood vessels in the heart and in the body widen and the blood pressure drops accordingly.

ACE inhibitors

The antihypertensive ACE inhibitors such as captopril, enalapril, lisinopril, and ramipril act on the blood pressure regulation system (RAAS for short). They inhibit an enzyme (angiotensin-converting enzyme, ACE for short) that is required for the formation of angiotensin II from angiotensin I. Angiotensin II is the most powerful substance produced by the body. It directly increases blood pressure and indirectly inhibits the excretion of water. Without this conversion enzyme ACE, less angiotensin II is formed and the blood pressure increases less sharply.

AT-1 receptor antagonists and renin antagonists

AT-1 receptor antagonists are, for example, the sartans such as valsartan, losartan, and irbesartan: These drugs neutralize the blood pressure-increasing effect of angiotensin II (see above).

Renin antagonists such as aliskiren intervene in the blood pressure regulation system RAAS. You start at the very beginning of this cascade. This is how the hormone-like enzyme renin is bound. Renin is required for the conversion of angiotensinogen into angiotensin I. Less angiotensin I also means less angiotensin II. And the lower the angiotensin II concentration, the lower the increase in blood pressure.

2nd choice antihypertensive drugs

In addition to the drugs described, there are also second-choice active ingredients. This includes:

    • Alpha-blockers (like prazosin and tamsulosin): These drugs affect the autonomic nervous system. In this nervous system – which we cannot deliberately influence – two nerve cords act: the sympathetic and the parasympathetic. The sympathetic nervous system is active when aroused and in dangerous situations, the parasympathetic nervous system in the resting state and the recovery phase. The sympathetic nervous system is stimulated via different receptors called alpha or beta receptors. Alpha-blockers block the alpha receptors. This reduces the stimulation of the sympathetic nervous system and lowers blood pressure.
    • Potassium channel openers (such as minoxidil and diazoxide): Medicines in this group are used when other antihypertensive drugs are no longer working properly. They open the potassium channel and thus reduce the influx of potassium ions into the cells. As a result, the excitation of vascular muscle cells is reduced. The blood vessels relax and widen, and blood pressure drops.
    • Alpha-2 agonists (such as clonidine): Alpha-2 agonists or alpha-2 sympathomimetics only attack alpha-2 receptors. In this way, they dampen the activity of the sympathetic nervous system and the blood pressure drops.
    • NO donors (such as nitroglycerin and molsidomine): These organic nitrates reduce the tension in the vascular muscles. As a result, the larger arteries widen and blood pressure decreases.

Handle high blood pressure medication properly

If you have very high blood pressure, in particular, it is very helpful if you regularly check your blood pressure yourself. If you do not want to or cannot do this yourself, your pharmacist will be happy to assist you, for example. Of course, nursing services also take on this task. Ideally, you should keep a blood pressure diary in which you record the measured values ​​for systolic and diastolic blood pressure on a daily basis. In the pharmacy, you can also get blood pressure monitors that automatically record the course of the blood pressure values.

Strictly observe the dosage regulations: In order for antihypertensive drugs to work reliably, it is necessary that you strictly adhere to the intake instructions. This applies to both the dosage and the time of day. Even if your blood pressure is normal, you may not change the dosage yourself or even discontinue your antihypertensive drug. Without the medication, blood pressure could rapidly rise again and sometimes cause life-threatening cardiac arrhythmias.

Disclose complete medication: It is not uncommon for drug interactions to lead to health-endangering complications. Antihypertensive drugs are often involved, if only because they are prescribed in such large numbers. It is imperative that you disclose to your doctor or physicians if you are taking any other medication.

Medicines do not eliminate the cause

As a rule, drugs do not eliminate the cause of hypertension, but only help to keep high blood pressure within healthy limits. In addition, antihypertensive drugs have a number of side effects and interactions. It is therefore recommended that the dose of the medication be kept as small as possible.

Prevention

The best of all is not to let high blood pressure develop in the first place. You can contribute to this with simple rules of conduct, namely:

    • Do not start or stop smoking in the first place.
    • You should only drink alcohol in moderation.
    • Watch your weight and lose weight if you are overweight.
    • Make sure you have a balanced lifestyle with enough exercise and a fresh, healthy, and balanced diet.
    • Limit your salt consumption.
    • Treat or avoid lipid metabolism disorders.
    • Avoid stress and high tension and learn relaxation techniques such as autogenic training, progressive muscle relaxation, yoga or tai chi.
    • As a diabetic, you should ensure that your blood sugar level is well controlled.

Blood Poisoning (Sepsis)

Sepsis is the technical term for blood poisoning. Sepsis must be treated quickly so that it does not prove fatal. Find out more about the signs, symptoms, and treatment of blood poisoning.

Sepsis is the technical term for blood poisoning. Without rapid emergency therapy, blood poisoning is almost always fatal. Therefore, an emergency doctor should be called immediately if there is the slightest suspicion of sepsis.

Sepsis is a very dangerous, sometimes life-threatening condition. In the course of blood poisoning, more and more vital organs fail. Such multi-organ failure is often fatal if left untreated. Even with maximum intensive care medicine, about 30 percent of those affected do not survive sepsis. According to the Sepsis Competence Network, 154 people die of sepsis every day in Germany. According to this, blood poisoning is the third most common cause of death after diseases of the cardiovascular system and cancer. An early start of treatment in an intensive care unit can significantly improve the prognosis.

Doctors differentiate between four degrees of severity of sepsis:

    • Systemic Inflammatory Response Syndrome (SIRS)
    • Sepsis (SIRS with proven infection)
    • severe sepsis
    • septic shock

Frequency

The frequency of fatal blood poisoning cannot be determined precisely because sepsis itself is sometimes not recorded as the cause of death, but rather as a consequence of blood poisoning. According to the Sepsis Competence Network, there are at least 154,000 cases of blood poisoning in Germany. More than a third of them (36.4 percent) are fatal. This means that 154 people die of sepsis every day in Germany. Even if the study on which this frequency is based was published in 2007, experts continue to assume this size of deaths from blood poisoning.

Blood Poisoning

Symptoms

In sepsis, the functionality of several organs is always life-threatening impaired. That is why the symptoms are diverse. First of all, however, the following symptoms indicate sepsis:

    • Body temperature rise or fall (fever above 38 degrees Celsius or low body temperature below 36 degrees Celsius)
    • Racing heart
    • increased breathing rate
    • falling blood pressure
    • Restlessness, disorientation
    • Impaired consciousness
    • increased drowsiness
    • Bleeding in the skin and mucous membrane
    • lack of urine production.

Causes

Doctors understand sepsis as an inflammation that usually proceeds very quickly and is caused by bacteria and bacterial toxins, fungi, parasites, or viruses.

Treatment

The emergency doctor should be alerted immediately if there is the slightest suspicion of sepsis. Because: The earlier treatment is started, the greater the chances of recovery.

Red streaks on the skin do not indicate blood poisoning

Many people have had a clear picture of the thought of blood poisoning since childhood. A fine red stripe that extends from a wound, often following the course of a blood vessel. And the fear becomes great when the streak spreads towards the heart. The fear is unfounded: the red stripe does not indicate blood poisoning. Rather, a lymphatic system has become inflamed there. It is true that this inflammation should be examined by a doctor. The family doctor can do this in peace. The rescue service does not have to be alerted.

Forecast

The chance of survival in sepsis depends primarily on rapid treatment and the general condition. Blood poisoning often occurs in weakened patients. Then the forecast is below average. The average survival rate in Germany is a good 64 percent. According to the Sepsis Competence Network, Germany is well below the sepsis prognosis for Europe (73.5 percent).

Acute Inflammation Of The Pancreas

Acute inflammation of the pancreas (pancreatitis) is a serious illness that can be life-threatening and requires urgent treatment. In most cases, the extremely severe abdominal pain causes those affected to seek help quickly. More about symptoms, causes, diagnosis, treatment, and prevention of acute pancreatitis.  Acute pancreatitis is an acute inflammation of the pancreas. The pancreas is the Latin name for pancreas, hence the disease name pancreatitis. Chronic pancreatitis is distinguished from acute pancreatitis.

The most common cause of acute inflammation of the pancreas is biliary tract diseases such as gallstones. For example, if a stone clogs the end of the bile duct, it creates a blockage of bile in the direction of the liver and, at the same time, a blockage of digestive secretion in the pancreas. The digestive secretion cannot drain away, it accumulates there, irritates, and damages the tissue. Inflammation is the result. This is when the pancreas begins to digest itself.

Acute pancreatitis can be life-threatening. The earlier the – often intensive medical – treatment begins in a hospital, the better the chances of recovery.

Structure And Function Of The Pancreas

The pancreas is located across the upper abdomen on the posterior abdominal wall. It is around 15 centimeters long and weighs around 100 grams. Medical professionals divide the pancreas into the head, body, and tail. The head of the pancreas is adjacent to the duodenum, and the tail of the pancreas is adjacent to the spleen. Very close to the pancreas are the colon, liver, gallbladder, stomach, and kidneys.

The pancreas produces up to 2 liters of digestive secretion every day, which it releases into the small intestine. The digestive secretion consists of enzymes such as protein-splitting proteases (for example trypsin and chymotrypsin), starch-splitting amylases, and fat-splitting lipases. These enzymes are needed to absorb food components from the small intestine into the blood. The secretion also contains alkaline bicarbonate, which neutralizes the acidic gastric juice as soon as it enters the intestine.

In addition to the enzymes, the pancreas produces important hormones, for example, insulin, which lowers blood sugar, and its counterpart, glucagon, which increases blood sugar levels. Both hormones are produced in the so-called islets of Langerhans.

Frequency

The incidence of acute pancreatitis is around 5 to 10 cases per 100,000 population. Inflammation of the pancreas is most common between the ages of 40 and 60. Women are more often affected because they more often suffer from biliary tract diseases.

Symptoms

The main symptom of acute pancreatitis is a sudden, belt-shaped, severe pain in the upper abdomen. Often this pain radiates to the back, sometimes to the chest. The pain can last for minutes. Many of those affected describe it as the pain of annihilation. Relief is often only brought about by a gentle posture with knees drawn up while sitting or lying down.

Another symptom of acute inflammation of the pancreas is what doctors refer to as the “elastic, elastic belly”. The stomach feels similar to an inflated air mattress. The abdominal wall is tense, but not very hard.

If the bile ducts are also affected, which often happens due to the proximity of both organs, the skin and mucous membranes (especially the conjunctiva) turn yellow. Doctors call this jaundice. In addition, the urine turns dark and the stool light.

Other typical symptoms of acute pancreatitis are:

    • fever
    • Nausea and vomiting
    • Low blood pressure (hypotension) up to circulatory shock
    • Fear of death or fear of not being able to survive the pain.

Complications

If pancreatic tissue dies due to inflammation and the dead tissue is then colonized by bacteria, accumulations of pus in the abdomen or even blood poisoning (sepsis) are the result. In severe cases, the heart, lungs, and kidneys can fail completely.

Acute Inflammation Of The Pancreas

Causes

Gallstones are the leading cause of pancreatitis.

Alcohol consumption is the cause of acute pancreatitis in a good 30 percent. It does not have to be alcoholism or alcohol abuse. Not all heavy drinkers develop pancreatitis. But the other way round also applies: In correspondingly sensitive people, even small amounts of alcohol can trigger acute pancreatitis.

Rare causes of pancreatitis

    • certain medications (such as pain relievers, diuretics, beta-blockers, ACE inhibitors, lipid-lowering drugs, antibiotics, and cytostatics)
    • Smoking and other drugs
    • Viral infections (e.g. mumps), bacteria (e.g. salmonella), and worm diseases (e.g. ascariasis and clonorchiasis)
    • Lipid metabolism disorders (especially increased triglyceride levels)
    • Overactive parathyroid glands.

A certain genetic component is also discussed. In some people, however, no cause of acute pancreatitis can be determined.

Examination

Rapid diagnosis of acute pancreatitis is particularly important because the inflammation is severe and can be fatal. The typical severe pain usually quickly steers the suspicion in the right direction. The suspected diagnosis after the first physical examination and the taking of the medical history is followed by further diagnostic procedures.

For example, blood tests are used to check whether certain enzyme levels and/or the number of white blood cells is increased. If a gallstone triggers the inflammation, increased bilirubin, ASAT, gamma-GT, and alkaline phosphatase values ​​can be detected. In severe cases, an increased blood sugar concentration is noticeable.

Urine and stool examinations can further substantiate the diagnosis of acute pancreatitis. As a rule, increased enzyme concentrations can be detected in the urine. The amount of the enzyme elastase is usually measured in the stool. A noticeably decreased amount of enzyme suggests that the pancreas is no longer producing enough digestive enzymes.

Cholangiography And Other Imaging Tests

The suspected diagnosis of acute pancreatitis is confirmed almost exclusively with imaging diagnostics. These primarily include ultrasound and X-ray examinations of the chest and abdomen. Computed tomography can determine the severity of the inflammation.

If gallstones cause pancreatitis, endoscopic retrograde cholangiography (ERC) can provide more precise information. An endoscope is pushed through the esophagus to the small intestine. Contrast media in the bile ducts make constrictions or blockages, for example, due to stones, visible. The bile and pancreatic ducts can also be assessed with magnetic resonance cholangiopancreatography (MRCP).

Treatment

Acute pancreatitis can be difficult, and sometimes life-threatening. That is why the therapy will be carried out in an inpatient setting, i.e. in a clinic. Often it is even necessary to stay in the intensive care unit.

Medical Therapy

The main aim of drug therapy for acute pancreatitis is to relieve severe pain and combat inflammation. Pain relievers such as tramadol, buprenorphine, piritramide, and pethidine as well as antibiotics such as metronidazole, carbapenems, and fluoroquinolones are used. In addition, those affected usually receive plenty of fluid through the veins in order to stabilize the circulation.

If the pancreas can no longer produce enough insulin due to acute pancreatitis, this deficiency is also compensated with medication in order to avoid hypoglycemia or diabetes.

Remove Gallstones

Various surgical procedures can be considered for the removal of gallstones. If possible, gallstones are now removed with an endoscopic procedure. A tube is inserted into the abdominal cavity through a small incision, through which the surgeon grabs the gallstones with a pair of pliers and pulls them out. Large gallstones can be shattered with sound waves during this procedure.

But there are also gallstones that cannot be reached or removed with this minimally invasive procedure. Then the abdominal cavity has to be opened in the classic way (laparotomy). More about gallstone treatment

Rinse Out Sources Of Inflammation

Sometimes the cavities in the pancreas also become inflamed. Pancreatic secretions and pus can accumulate there. The doctor can remove such foci of inflammation during an endoscopy via a thin connecting tube between the cavity and the small intestine or the stomach. In addition, an irrigation catheter can be inserted from the outside under an X-ray view. In this way, the cavities are emptied (drained). Sometimes an operation is also necessary.

Food Abstinence In Acute Pancreatitis

In the case of acute pancreatitis, the patient is not allowed to eat anything; absolute so-called food abstinence must be observed. Of course, drinking alcohol or smoking is also not allowed. If necessary, artificial food must be given through the veins or through a tube that opens directly into the small intestine. When the signs of inflammation subside, a careful diet is built up with easily digestible foods.

Prevention

Basically, to prevent pancreatitis, a healthy lifestyle with sufficient exercise and a varied, healthy diet is recommended. The following also applies:

    • Have triggers eliminated, for example, surgical removal of gallstones or a gallbladder containing stones
    • Refrain from alcohol and nicotine, especially if you have a family predisposition to pancreatitis
    • reduce increased blood lipid levels
    • Get treatment for parathyroid disorders
    • Have your doctor replace drugs that promote pancreatitis with other drugs.