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Gastrointestinal disorders

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Related Terms
  • Amputation, biopsy, bone fractures, bone pain, bone scan, bone tumor, chemotherapy, chondrosarcoma, Ewing's sarcoma, metastasized bone cancer, needle biopsy, osteosarcoma, primary bone cancer, radiation, radiation therapy, radiotherapy, sarcoma, secondary bone cancer, surgical biopsy.

Background
  • Bone cancer occurs when bone cells grow uncontrollably. Unlike normal cells, cancer cells do not stop reproducing after they have doubled 50-60 times. These abnormal cells form clumps of tissue, called tumors, inside bones. The first symptom of bone cancer is typically pain in the affected bone(s). Sometimes, a bump either on the bone or in the tissues surrounding the bone may be felt.
  • Primary bone cancer, or cancer that starts in the bone cells, is rare. Fewer than 2,500 Americans are diagnosed with this type of cancer each year. Children are more likely to develop primary bone cancer than adults.
  • Most cases of bone cancer occur when cancer from another part of the body, such as breast, prostate, or lung, has spread to bone cells. This is sometimes called metastatic bone cancer or secondary bone cancer.
  • The most common types of bone cancer are osteosarcoma, chondrosarcoma, and Ewing's sarcoma. These cancers can be primary or secondary cancer.
  • Osteosarcoma: Osteosarcoma, the most common type of bone cancer, primarily develops in growing bones, and it usually affects people between the ages of 10 and 25. This aggressive type of bone cancer often affects the arms and legs, particularly the knees and shoulders of children. In some cases, osteosarcoma spreads to the lungs. About 65% of people with osteosarcoma survive five years after diagnosis.
  • Chondrosarcoma: Chondrosarcoma develops in the cartilage. It often affects the bones in the pelvis and hips. It is most common among people who are 50 years of age or older, and it is slightly more common in males than females. Chondrosarcoma is the second most common bone cancer, accounting for about 25% of all cancerous bone tumors. The five-year survival for the aggressive form of chondrosarcoma is about 30%, and the five-year survival rate for slow-growing tumors is about 90%.
  • Ewing's sarcoma: Ewing's sarcoma develops in the nerve tissue in bone marrow of children who are 4-15 years old. It is very rare in people who are older than 30 years of age. Ewing's sarcoma often develops after a person undergoes treatment, such as radiation or chemotherapy, for another type of cancer. Ewing's sarcoma is the most aggressive bone cancer. It typically affects the middle of the long bones in the arms and legs. The three-year survival rate is about 65%, but this rate is much lower if the cancer has spread to the lungs or other parts of the body.
  • Surgery is often the main treatment for bone cancer. In addition to having bone tumors surgically removed, patients may also undergo chemotherapy, and/or radiation therapy. In some cases, patients may need to undergo a surgical amputation, but this is performed less often today. Specific treatment options depend on the type of bone cancer, as well as its location, size, and stage.
  • In general, the prognosis for patients with bone cancer is based on many factors, including the type of cancer, at what stage the cancer was discovered, and where the tumor is located. For instance, if the tumor is small and limited to a localized area, the patient's prognosis is generally better than if the cancer has spread to other parts of the body.

Integrative therapies
  • Good scientific evidence:
  • Greater celandine: UkrainT, a semisynthetic drug derived from greater celandine (Chelidonium majus), has been studied in clinical trials of various types of cancer with consistently positive outcomes. However, the quality of the research performed to date is inadequate, and higher quality studies are needed.
  • Use cautiously in patients taking amphetamines, morphine, hexobarbital, MAOIs, or dopaminergic or serotonergic drugs, or in patients undergoing radiation therapy. Avoid in patients with liver disease or in pregnant and lactating women.
  • Guided Imagery: Early research suggests that guided imagery may help reduce cancer pain. Further research is needed to confirm these results.
  • Guided imagery is usually intended to supplement medical care, not to replace it, and guided imagery should not be relied on as the sole therapy for a medical problem. Contact a qualified health care provider if mental or physical health is unstable or fragile. Never use guided imagery techniques while driving or doing any other activity that requires strict attention. Use cautiously with physical symptoms that can be brought about by stress, anxiety or emotional upset because imagery may trigger these symptoms. If feeling unusually anxious while practicing guided imagery, or if a history of trauma or abuse, speak with a qualified health care provider before practicing guided imagery.
  • Meditation: There is good evidence that various types of meditation may help improve quality of life in cancer patients. Studies have shown benefits for mood, sleep quality, and the stresses of treatment. The specific effects of meditation are not fully understood. Additional research is needed in this area.
  • Use cautiously with underlying mental illnesses. People with psychiatric disorders should consult with their primary mental healthcare professional(s) before starting a program of meditation, and should explore how meditation may or may not fit in with their current treatment plan. Avoid with risk of seizures. The practice of meditation should not delay the time to diagnosis or treatment with more proven techniques or therapies, and should not be used as the sole approach to illnesses.
  • Psychotherapy: Psychotherapy is an interactive process between a person and a qualified mental health care professional (psychiatrist, psychologist, clinical social worker, licensed counselor, or other trained practitioner). There is good evidence that psychotherapy may enhance quality of life in cancer patients by reducing emotional distress and aiding in coping with the stresses and challenges of cancer. Therapy may be supportive-expressive therapy, cognitive therapy or group therapy. While some patients seek psychotherapy in hopes of extending survival, there conclusive evidence of effects on medical prognosis is currently lacking. Psychotherapy may help people come to terms with the fact that they may die of cancer, which is the 4th stage of dealing with a terminal illness, including denial, anger, bargaining, and acceptance.
  • Psychotherapy is not always sufficient to resolve mental or emotional conditions. Psychiatric medication is sometimes needed. The reluctance to seek and use appropriate medication may contribute to worsening of symptoms or increased risk for poor outcomes. In order to be successful, psychotherapy requires considerable personal motivation and investment in the process. This includes consistent attendance and attention to treatment recommendations provided by the practitioner. Not all therapists are sufficiently qualified to work with all problems. The client or patient should seek referrals from trusted sources and should also inquire of the practitioner's training and background before committing to work with a particular therapist. Some forms of psychotherapy evoke strong emotional feelings and expression. This can be disturbing for people with serious mental illness or some medical conditions. Psychotherapy may help with post-partum depression, but is not a substitute for medication, which may be needed in severe cases.
  • Yoga: Yoga is an ancient system of relaxation, exercise, and healing with origins in Indian philosophy. Several studies report enhanced quality of life in cancer, lower sleep disturbance, decreased stress symptoms and changes in cancer-related immune cells after patients received relaxation, meditation and gentle yoga therapy. Yoga is not recommended as a sole treatment for cancer but may be helpful as an adjunct therapy.
  • Yoga is generally considered to be safe in healthy individuals when practiced appropriately. Avoid some inverted poses with disc disease of the spine, fragile or atherosclerotic neck arteries, risk for blood clots, extremely high or low blood pressure, glaucoma, detachment of the retina, ear problems, severe osteoporosis, or cervical spondylitis. Certain yoga breathing techniques should be avoided in people with heart or lung disease. Use cautiously with a history of psychotic disorders. Yoga techniques are believed to be safe during pregnancy and breastfeeding when practiced under the guidance of expert instruction (the popular Lamaze techniques are based on yogic breathing). However, poses that put pressure on the uterus, such as abdominal twists, should be avoided in pregnancy.
  • Unclear or conflicting scientific evidence:
  • Acupuncture: Acupuncture, or the use of needles to manipulate the "chi" or body energy, originated in China over 5,000 years ago. There has been limited research on acupuncture for cancer pain, and the research that was done was shown to have mixed results. More studies are needed to determine potential benefits. Evidence from several small studies supports use of acupuncture at a specific point on the wrist (P6) to help chemotherapy patients reduce nausea and vomiting. Acupuncture may also reduce the pain associated with cancer.
  • Needles must be sterile in order to avoid disease transmission. Avoid with valvular heart disease, infections, bleeding disorders or with drugs that increase the risk of bleeding (anticoagulants), medical conditions of unknown origin, or neurological disorders. Avoid on areas that have received radiation therapy and during pregnancy. Use cautiously with pulmonary disease (like asthma or emphysema). Use cautiously in elderly or medically compromised patients, diabetics or with history of seizures. Avoid electroacupuncture with arrhythmia (irregular heartbeat) or in patients with pacemakers.
  • Aloe: Transparent gel from the pulp of the meaty leaves of Aloe vera has been used on the skin for thousands of years to treat wounds, skin infections, burns, and numerous other skin conditions. Dried latex from the inner lining of the leaf has traditionally been used as an oral laxative. Preliminary research suggests that aloe may help in the area of cancer prevention or may aid in the regression of cancerous tumors. Additional research is needed in this area.
  • Caution is advised when taking aloe supplements as numerous adverse effects including a laxative effect, cramping, dehydration and drug interactions are possible. Aloe should not be used if pregnant or breast-feeding, unless otherwise directed by a doctor.
  • American pawpaw: Evidence supporting the use of the American pawpaw (Asimina triloba) tree for cancer treatment in humans is largely anecdotal and subjective. However, use in humans has reported minimal side effects, and evidence from animal and test tube studies suggest that American pawpaw extract does have some anticancer activity. Pawpaw standardized extract has been used for 18 months in patients with various forms of cancer. Well-designed studies on the long-term effects of pawpaw extracts are currently lacking. Pawpaw should not be used if pregnant or breast-feeding, unless otherwise directed by a doctor.
  • Antineoplastons: Antineoplastons are a group of naturally occurring peptide fractions, which were observed by Stanislaw Burzynski, MD, PhD in the late 1970s to be absent in the urine of cancer patients. There is inconclusive scientific evidence regarding the effectiveness of antineoplastons in the treatment of cancer. Several preliminary human studies (case series, phase I/II trials) have examined antineoplaston types A2, A5, A10, AS2-1, and AS2-5 for a variety of cancer types. It remains unclear if antineoplastons are effective, or what doses may be safe. Until better research is available, no clear conclusion can be drawn.
  • Avoid if allergic or hypersensitive to antineoplastons. Use cautiously with high medical or psychiatric risk, an active infection due to a possible decrease in white blood cells, high blood pressure, heart conditions, chronic obstructive pulmonary disease, liver disease or damage, or kidney disease or damage. Avoid if pregnant or breastfeeding.
  • Arabinoxylan: Arabinoxylan is made by altering the outer shell of rice bran using enzymes from Hyphomycetes mycelia mushroom extract. Arabinoxylan has been found to improve immune reactions in patients with diabetes and cancer of various types. Arabinoxylan products may contain high calcium and phosphorus levels, which may be harmful for patients with compromised renal (kidney) function. Caution is advised when taking arabinoxylan supplements, as numerous adverse effects including drug interactions are possible. Arabinoxylan should not be used if pregnant or breast-feeding, unless otherwise directed by a doctor.
  • Aromatherapy: Healing with fragrant oils has been used for thousands of years. Aromatherapy is often used in people with chronic illnesses (frequently in combination with massage), with the intention to improve quality of life or well-being. There is currently not enough scientific evidence to form a firm conclusion about the effectiveness of aromatherapy for quality of life in cancer.
  • Essential oils should only be used on the skin in areas without irritation. Essential oils should be administered in a carrier oil to avoid toxicity. Avoid with a history of allergic dermatitis. Use cautiously if driving or operating heavy machinery. Avoid consuming essential oils. Avoid direct contact of undiluted oils with mucous membranes. Use cautiously if pregnant.
  • Art therapy: Art therapy involves the application of a variety of art modalities including drawing, painting, clay and sculpture. Art therapy enables the expression of inner thoughts or feelings when verbalization is difficult or not possible. Limited evidence suggests that art therapy may be of benefit in cancer caregiving for families of cancer patients. Possible benefits include reduced stress, lowered anxiety, increased positive emotions and increased positive communication with cancer patients and health care professionals. Art therapy may also reduce pain and other symptoms in cancer patients. More studies are needed to determine how best to use this form of intervention with this population. Art therapy may also benefit children hospitalized with leukemia during and after painful procedures. Limited available study suggests that art therapy improves cooperation with treatment. Children requested art therapy again when procedures were repeated, and parents reported that children were more manageable after art therapy.
  • Art therapy may evoke distressing thoughts or feelings. Use under the guidance of a qualified art therapist or other mental health professional. Some forms of art therapy use potentially harmful materials. Only materials known to be safe should be used. Related clean-up materials (like turpentine or mineral spirits) that release potentially toxic fumes should only be used with good ventilation.
  • Astragalus: Astragalus (Astragalus membranaceus) has been used in Chinese medicine for centuries for its immune enhancing properties. Although early laboratory and animal studies report immune stimulation and reduced cancer cell growth associated with the use of astragalus, reliable human evidence in these areas is currently lacking. In Chinese medicine, astragalus-containing herbal mixtures are also sometimes used with the intention to reduce side effects of chemotherapy and other cancer treatments. Astragalus-containing herbal combination formulas may also have beneficial effects in aplastic anemia. Due to a lack of well-designed research, a firm conclusion cannot be drawn.
  • Caution is advised when taking astragalus supplements, as numerous adverse effects including drug interactions are possible. Astragalus should not be used if pregnant or breast-feeding, unless otherwise directed by a doctor.
  • Baikal skullcap: Although the outcomes of early studies using baikal skullcap for cancer are promising, high-quality clinical studies are needed in this area before a conclusion can be made. Avoid if allergic or hypersensitive to Baikal skullcap (Scutellaria barbata), its constituents, or members of the Lamiaceae family. Use cautiously if taking sedatives and/or operating heavy machinery. Use cautiously if taking antineoplastic (anticancer) agents or agents metabolized by cytochrome P450 enzymes. Avoid if pregnant or breastfeeding. Baikal skullcap is an ingredient in PC-SPES, a product that has been recalled from the U.S. market and should not be used.
  • Bee pollen: Bee pollen is considered a highly nutritious food because it contains a balance of vitamins, minerals, proteins, carbohydrates, fats, enzymes, and essential amino acids. Research has found that bee pollen may reduce some adverse effects of cancer treatment side effects. Additional study is needed before a firm recommendation can be made. Caution is advised when taking bee pollen supplements as allergic reactions may occur in sensitive individuals. Bee pollen should not be used if pregnant or breast-feeding, unless otherwise directed by a doctor.
  • Beta-glucan: Treatment with a beta-glucan, called lentinan, plus chemotherapy (S-1) may help prolong the lives of patients with cancer that has returned or cannot be operated on. More research is needed in this area. Avoid if allergic or hypersensitive to beta-glucan. When taken by mouth, beta-glucan is generally considered safe. Use cautiously with AIDS or AIDS-related complex (ARC). Avoid using particulate beta-glucan. Avoid if pregnant or breastfeeding.
  • Bitter melon: Bitter melon (Momordica charantia) is used in Avurvedic medicine from India to lower blood sugar levels. Research has also found that bitter melon extracts may be beneficial in cancer therapies. MAP30, a protein isolated from bitter melon extract, is reported to possess anti-cancer effects in laboratory studies. Potential anti-cancer effects have not been studied appropriately in humans. Caution is advised when taking bitter melon supplements, as numerous adverse effects including blood sugar lowering and drug interactions are possible. Bitter melon should not be used if pregnant or breast-feeding, unless otherwise directed by a doctor.
  • Black tea: Black tea (Camellia sinensis) is from the same plant as green tea, but the leaves are processed differently. Black tea usually contains more caffeine than green tea. Several studies have explored a possible association between regular consumption of black tea and rates of cancer in several populations. This research has yielded conflicting results, with some studies suggesting benefits, and others reporting no effects. Laboratory and animal studies report that components of tea, such as polyphenols, have antioxidant properties and effects against tumors. However, effects in humans remain unclear, and these components may be more common in green tea rather than in black tea. Some animal and laboratory research suggests that components of black tea may actually be carcinogenic, or cancer causing, although effects in humans are not clear. Overall, the relationship of black tea consumption and human cancer prevention remains undetermined.
  • Avoid if allergic or hypersensitive to caffeine or tannins. Skin rash and hives have been reported with caffeine ingestion. Use caution with diabetes. Use cautiously if pregnant. Heavy caffeine intake during pregnancy may increase the risk of SIDS (sudden infant death syndrome). Very high doses of caffeine have been linked with birth defects. Caffeine is transferred into breast milk. Caffeine ingestion by infants can lead to sleep disturbances/insomnia. Infants nursing from mothers consuming greater than 500 milligrams of caffeine daily have been reported to experience tremors and heart rhythm abnormalities. Tea consumption by infants has been linked to anemia, decreased iron metabolism, and irritability.
  • Bovine cartilage: In early study, bovine tracheal cartilage (preparations such as Catrix® and VitaCarte®) has been studied for the treatment of cancer with encouraging results. High quality clinical research is needed to better determine the effectiveness of bovine tracheal cartilage preparations for cancer treatment.
  • Avoid if allergic or hypersensitive to bovine cartilage or any of its constituents. Use cautiously with cancer, renal (kidney) failure, or hepatic (liver) failure. Avoid if pregnant or breastfeeding.
  • Bromelain: Bromelain is a sulfur-containing digestive enzyme (proteins which help with digestion) that is extracted from the stem and the fruit of the pineapple plant (Ananas comosus). There is not enough information to recommend for or against the use of bromelain in the treatment of cancer, either alone or in addition to other therapies. One small study found that a bromelain supplement decreased tumor size in 12 breast cancer patients. Patients took the supplements for different periods of time, lasting from months to years. Caution is advised when taking bromelain supplements, as numerous adverse effects including blood thinning and drug interactions are possible. Bromelain should not be used if pregnant or breast-feeding, unless otherwise directed by a doctor.
  • Cat's claw: Originally found in Peru, the use of cat's claw (Uncaria tomentosa) has been said to date back to the Inca civilization, possibly as far back as 2,000 years. Cat's claw has anti-inflammatory properties, and several low-quality studies suggest that cat's claw may slow tumor growth. However, this research is early and has not identified specific types of cancer that may benefit; thus, the results are not clear. A few studies suggest that cat's claw may also boost the immune system. Caution is advised when taking cat's claw supplements, as numerous adverse effects including blood thinning and drug interactions are possible. Cat's claw should not be used if pregnant or breast-feeding, unless otherwise directed by a doctor.
  • Chaparral: Chaparral was used by the Native Americans for various health conditions. The chaparral component nordihydroguaiaretic acid (NDGA) has been evaluated as a treatment for cancer but due to risk of toxicity is considered unsafe and not recommended for use. Chaparral and NDGA have been associated with cases of kidney and liver failure, liver cirrhosis, kidney cysts, and kidney cancer in humans. In response to these reports, the U.S. Food and Drug Administration (FDA) removed chaparral from its "generally recognized as safe" (GRAS) list in 1970. Chaparral and NDGA are generally considered unsafe and are not recommended for use.
  • Avoid if allergic to chaparral or any of its components, including nordihydroguaiaretic acid. Use cautiously if taking blood thinners (anticoagulants), blood sugar medication, or drugs that are broken down by the liver (like amiodarone, phenobarbital, valproic acid). Stop use two weeks before surgery/dental/diagnostic procedures with bleeding risk, and do not use immediately after these procedures. Use cautiously if driving or operating heavy machinery. Avoid if pregnant or breastfeeding.
  • Chlorophyll: Preliminary evidence in suggest that chlorophyll may aid in the reduction of side effects associated with photodynamic therapies, such as those used in management of malignant tumors. Further research is required to support the use of chlorophyll as a laser therapy adjunct for cancer treatment.
  • Avoid if allergic or hypersensitive to chlorophyll or any of its metabolites. Use cautiously with photosensitivity, compromised liver function, diabetes or gastrointestinal conditions or obstructions. Use cautiously if taking immunosuppressant agents or antidiabetes agents. Avoid if pregnant or breastfeeding.
  • Chrysanthemum: Early study indicates that hua-sheng-ping (includes Chrysanthemum morifolium, Glycyrrhiza uralensis, and Panax notoginseng) may be beneficial for patients with precancerous lesions. However, more research is needed.
  • Avoid if allergic or hypersensitive to Chrysanthemum, its constituents, or members of the Asteraceae/Compositae family, such as dandelion, goldenrod, ragweed, sunflower, and daisies. Use cautiously if taking medication for gout, cancer, or HIV. Use cautiously with compromised immune systems or if taking immunomodulators. Avoid with photosensitivity or if taking photosensitizers. Avoid large acute or chronic doses of ingested pyrethrin. Avoid pyrethrin with compromised liver function, epilepsy, or asthma. Avoid ocular exposure to pyrethrin. Avoid if pregnant or breastfeeding.
  • Coenzyme Q10: Further research is needed to determine if coenzyme Q10 (CoQ10) may be of benefit for cancer when used with other therapies.
  • Allergy associated with Coenzyme Q10 supplements has not been reported, although rash and itching have been reported rarely. Stop use two weeks before surgery/dental/diagnostic procedures with bleeding risk and do not use immediately after these procedures. Use caution with a history of blood clots, diabetes, high blood pressure, heart attack, or stroke, or with anticoagulants (blood thinners) or antiplatelet drugs (like aspirin, warfarin, clopidogrel (like Plavix®), or blood pressure, blood sugar, cholesterol or thyroid drugs. Avoid if pregnant or breastfeeding.
  • Copper: Copper is a mineral that occurs naturally in many foods, including vegetables, legumes, nuts, grains and fruits, as well as shellfish, avocado, and beef (organs such as liver). Preliminary research reports that lowering copper levels theoretically may arrest the progression of cancer by inhibiting blood vessel growth (angiogenesis). Copper intake has not been identified as a risk factor for the development or progression of cancer. Copper is potentially unsafe when used orally in higher doses than the RDA. Copper supplements should not be used if pregnant or breast-feeding, unless otherwise directed by a doctor.
  • Cranberry: Several laboratory studies have reported positive effects of proanthocyanidins, flavonoid components of cranberry (Vaccinium macrocarpon) and other fruits such as blueberries, grape seed, and pomegranate, on health. Based on early laboratory research, cranberry has been proposed for cancer prevention. Additional study is needed in humans before a conclusion can be made.
  • Avoid if allergic to cranberries, blueberries or other plants of the Vaccinium species. Sweetened cranberry juice may effect blood sugar levels. Use cautiously with a history of kidney stones. Avoid more than the amount usually found in foods if pregnant or breastfeeding.
  • Dandelion: Limited animal research does not provide a clear assessment of the effects of dandelion on tumor growth. Well-conducted human studies are needed to better determine dandelion's effects on cancer.
  • Avoid if allergic to chamomile, feverfew, honey, yarrow, or any related plants such as aster, daisies, sunflower, chrysanthemum, mugwort, ragweed, or ragwort. Use cautiously with diabetes or bleeding disorders, gastroesophageal reflux disease (GERD), kidney or liver diseases, or a history of stroke or electrolyte disorders. Monitor potassium blood levels. Stop use two weeks before surgery/dental/diagnostic procedures with bleeding risk and do not use immediately after these procedures. Avoid if pregnant or breastfeeding.
  • Devil's claw: Devil's claw has been used to treat several types of pain. Early human study indicates it may also be helpful for reducing cancer pain from bone metastases. More research is needed in this area before a conclusion can be drawn.
  • Avoid if allergic to devil's claw and to plants in the Harpagophytum procumbens family. Use caution with stomach ulcers or with a history of bleeding disorders, diabetes, gallstones, gout, heart disease, stroke, ulcers or with prescription drugs used for these conditions. Stop use two weeks before surgery/dental/diagnostic procedures with bleeding risk, and do not use immediately after these procedures. Avoid if pregnant or breastfeeding.
  • Echinacea: There is currently a lack of clear human evidence that echinacea affects any type of cancer. The evidence from a small number of clinical trials evaluating efficacy of echinacea in the treatment of radiation-induced leukopenia (decrease in white blood cells) is equivocal. Studies have used the combination product Esberitox®, which includes extracts of echinacea (Echinacea purpurea and pallida) root, white cedar (Thuja occidentalis) leaf, and wild indigo (Baptisia tinctoria)root. Additional clinical studies are needed to make a conclusion.
  • Caution is advised when taking echinacea supplements, as numerous adverse effects including drug interactions are possible. Echinacea should not be used if pregnant or breast-feeding, unless otherwise directed by a doctor.
  • Essiac®: Essiac® contains a combination of herbs, including burdock root (Arctium lappa), sheep sorrel (Rumex acetosella), slippery elm inner bark (Ulmus fulva), and Turkish rhubarb (Rheum palmatum). The original formula was developed by the Canadian nurse Rene Caisse (1888-1978) and is thought to be effective in cancer therapies, although currently there is not enough evidence to recommend for or against the use of this herbal mixture as a therapy for any type of cancer. Different brands may contain variable ingredients, and the comparative effectiveness of these formulas is not known. None of the individual herbs used in Essiac® has been tested in rigorous human cancer trials, although some components have anti-tumor activity in laboratory studies. Numerous individual patient testimonials and reports from manufacturers are available on the Internet, although these cannot be considered scientifically viable as evidence. Individuals with cancer are advised not to delay treatment with more proven therapies. Caution is advised when taking Essiac® supplements, as numerous adverse effects including drug interactions are possible. Essiac® should not be used if pregnant or breast-feeding, unless otherwise directed by a doctor.
  • Focusing: Focusing (experiential therapy) is a method of psychotherapy that involves being aware of one's feelings surrounding a particular issue and understanding the meaning behind words or images conveyed by those feelings. Early evidence suggests focusing may improve mood and attitude in cancer patients. Firm recommendations cannot be made until well-designed clinical trials are available.
  • Side effect reporting is rare, but patients should consult with a qualified healthcare practitioner before making decisions about medical conditions and practices. Individuals with severe emotional difficulties should not abandon proven medical and psychological therapies but rather choose focusing as a possible adjunct.
  • Folic acid: Folic acid or folate is a form of a water-soluble B vitamin needed for human health. Preliminary evidence suggests that folate may decrease the risk of several types of cancer. Additional research is needed to make a conclusion. Folic acid supplementation may mask the symptoms of pernicious, aplastic, or normocytic anemias caused by vitamin B12 deficiency and may lead to neurological damage.
  • Avoid if allergic or hypersensitive to folate or any folate product ingredients. Use cautiously if receiving coronary stents and with anemia and seizure disorders. It is recommended that pregnant women consume 400 micrograms daily in order to reduce the risk of fetal defects. Folate is likely safe if breastfeeding.
  • Gamma linolenic acid (GLA): GLA is an omega-6 essential fatty acid. Some laboratory and human studies indicate that GLA may have anti-tumor activity and may be used as a cancer treatment adjunct. Additional research is needed in this area.
  • Caution is advised when taking GLA supplements, as numerous adverse effects including an increased risk of bleeding and drug interactions are possible. GLA should not be used if pregnant or breast-feeding, unless otherwise directed by a doctor.
  • Garlic: Preliminary human studies suggest that regular consumption of garlic (Allium sativum) supplements may reduce the risk of developing several types of cancer. Some studies use multi-ingredient products so it is difficult to determine if garlic alone may play a beneficial role in cancer prevention. Further well-designed human clinical trials are needed to conclude whether eating garlic or taking garlic supplements may prevent or treat cancer.
  • Caution is advised when taking garlic supplements, as numerous adverse effects including an increased risk of bleeding and drug interactions are possible. Garlic should not be used if pregnant or breast-feeding, unless otherwise directed by a doctor.
  • Ginseng: Early studies report that ginseng taken by mouth may be of benefit in cancer prevention, especially if ginseng powder or extract is used. Weak studies suggest that ginseng in combination with other herbs may improve cell activity, immune function, and red and white blood cell counts in patients with aplastic anemia; however, other studies have found decreases in blood cell counts. Early studies suggest that ginseng may decrease radiation therapy side effects and may be used as a chemotherapy adjunct to improve body weight, quality of life, and the immune response. There is currently not enough evidence to recommend the use of Panax ginseng or American ginseng for these indications. Study results are unclear, and more research is needed before a clear conclusion can be reached.
  • Caution is advised when taking ginseng supplements, as numerous adverse effects including an increased risk of drug interactions are possible. Ginseng should not be used if pregnant or breast-feeding, unless otherwise directed by a doctor.
  • Goji: Polysaccharide constituents, such as alpha- and beta-glucans from a variety of plants, are reported to have immune system enhancing properties. In clinical study, Lycium barbarum polysaccharides (LBP) demonstrated a synergistic effect in various cancer treatments, when administered in conjunction with powerful immune stimulating drugs.
  • Use cautiously in patients who are taking blood-thinning medications, such as warfarin. Use cautiously in asthma patients and in patients with sulfite sensitivities. The New York Department of Agriculture has detected the presence of undeclared sulfites, a food additive, in two dried goji berry products from China. Avoid in patients who are allergic to goji, any of its constituents, or to members of the Solanaceae family.
  • Grape seed: There is currently little information available on the use of grape seed extract in the treatment of human cancer. Further research is needed before a recommendation can be made.
  • Avoid if allergic or hypersensitive to grapes or other grape compounds. Use cautiously with bleeding disorders or if taking blood thinners such as warfarin, aspirin, non-steroidal anti-inflammatory drugs (NSAIDS), or anti-platelet agents. Use cautiously with drugs processed using the liver's cytochrome P450 enzyme system. Use cautiously with blood pressure disorders or if taking ACE inhibitors. Avoid if pregnant or breastfeeding.
  • Green tea: Green tea is made from the dried leaves of Camellia sinensis, a perennial evergreen shrub. Green tea has a long history of use in health and longevity, dating back to China approximately 5,000 years ago. Although used for centuries to help prevent diseases, the relationship of green tea consumption and human cancer in general remains inconclusive. Evidence from well-designed clinical trials is needed before a firm conclusion can be made in this area.
  • Caution is advised when taking green tea supplements, as numerous adverse effects including an increased risk of drug interactions are possible. Green tea should not be used if pregnant or breast-feeding, unless otherwise directed by a doctor.
  • Healing touch: Preliminary data suggests that healing touch (HT) may increase quality of life in cancer. However, due to weaknesses in design and the small number of studies, data are insufficient to make definitive recommendations. Studies with stronger designs are needed. HT should not be regarded as a substitute for established medical treatments. Use cautiously if pregnant or breastfeeding.
  • Hoxsey formula: "Hoxsey formula" is a misleading name, because it is not a single formula, but rather is a therapeutic regimen consisting of an oral tonic, topical (on the skin) preparations, and supportive therapy. The tonic is individualized for cancer patients based on general condition, location of cancer, and previous history of treatment. An ingredient that usually remains constant for every patient is potassium iodide. Other ingredients are then added and may include licorice, red clover, burdock, stillingia root, berberis root, pokeroot, cascara, Aromatic USP 14, prickly ash bark, and buckthorn bark. A red paste may be used, which tends to be caustic (irritating), and contains antimony trisulfide, zinc chloride, and bloodroot. A topical yellow powder may be used, and contains arsenic sulfide, talc, sulfur, and a "yellow precipitate." A clear solution may also be administered, and contains trichloroacetic acid.
  • Well-designed human studies available evaluating the safety or effectiveness of Hoxsey formula are currently lacking. Caution is advised when taking the Hoxsey formula supplements, as numerous adverse effects including an increased risk of drug interactions are possible. Hoxsey formula should not be used if pregnant or breast-feeding, unless otherwise directed by a doctor.
  • Hydrazine sulfate: Hydrazine is an industrial chemical marketed as having the potential to repress weight loss and cachexia (muscle wasting) associated with cancer, and to improve general appetite status. However, in large randomized controlled trials, hydrazine has not been proven effective for improving appetite, reducing weight loss, or improving survival in adults. The National Cancer Institute (NCI) sponsored studies of hydrazine sulfate that claimed efficacy in improving survival for some patients with advanced cancer. Trial results found that hydrazine sulfate did not prolong survival for cancer patients. The U.S. Food and Drug Administration (FDA) has received requests from individual physicians for approval to use hydrazine sulfate on a case-by-case "compassionate use" basis on the chance that patients with no other available effective cancer treatment options might benefit from this therapy. The overall controversy in the use of hydrazine sulfate is ongoing, and relevance to clinical practice is unknown. The use of hydrazine sulfate needs to be evaluated further before any recommendations can be made.
  • Hydrazine sulfate may cause cancer. Avoid if allergic or hypersensitive to hydrazine sulfate or any of its constituents. Use cautiously with liver or kidney problems, psychosis, diabetes or seizure disorders. Avoid if pregnant or breastfeeding. Side effects have been reported, including dizziness, nausea, and vomiting.
  • Iodine: Iodine is an element (atomic number 53), which is required by humans for the synthesis of thyroid hormones (triiodothyronine/T3 and thyroxine/T4). The potential role of non-radioactive iodine in cancer care remains unknown. Antioxidant and anti-tumor effects have been proposed based on laboratory research. In contrast, some scientists have asserted that tumors may uptake more iodine than normal tissues. It has been suggested that high rates of gastric (stomach) cancer or low rates of breast cancer in coastal Japan may be due to high iodine intake, although this has not been demonstrated scientifically. Povidone-iodine solutions have been used as a part of alternative cancer regimens, such as the Hoxsey formula. Preliminary study has also indicated povidone-iodone solution as a potential rectal washout for rectal cancer. Overall, no clear conclusion can be drawn based on the currently available evidence.
  • Reactions can be severe, and deaths have occurred with exposure to iodine. Avoid iodine-based products if allergic or hypersensitive to iodine. Do no use for more than 14 days. Avoid Lugol solution and saturated solution of potassium iodide (SSKI, PIMA) with hyperkalemia (high amounts of potassium in the blood), pulmonary edema (fluid in the lungs), bronchitis, or tuberculosis. Use cautiously when applying to the skin because it may irritate/burn tissues. Use sodium iodide cautiously with kidney failure. Avoid sodium iodide with gastrointestinal obstruction. Iodine is safe in recommended doses for pregnant or breastfeeding women. Avoid povidone-iodine for perianal preparation during delivery or postpartum antisepsis.
  • Jiaogulan: Preliminary evidence indicates that gypenosides extracted from Gynostemma pentaphyllum may decrease cancer cell viability, arrest the cell cycle, and induce apoptosis (cell death) in human cancer cells. Immune function in cancer patients has also been studied. Additional study is needed in this area.
  • Avoid if allergic or hypersensitive to jiaogulan (Gynostemma pentaphyllum), its constituents, or members of the Cucurbitaceae family. Use cautiously with blood disorders or taking anticoagulants or anti-platelet drugs (blood thinners). Use cautiously with diabetes. Avoid if pregnant or breastfeeding.
  • Lavender: Perillyl alcohol (POH), derived from lavender (Lavendula officinalis), may be beneficial in the treatment of some types of cancer. Preliminary small studies in humans, involving the use of POH suggest safety and tolerability, but effectiveness has not been established.
  • Avoid if allergic or hypersensitive to lavender. Avoid with a history of seizures, bleeding disorders, eating disorders (anorexia, bulimia), or anemia (low levels of iron). Avoid if pregnant or breastfeeding.
  • Lutein: Currently, there is insufficient available evidence to recommend for or against the use of lutein for cancer. Available evidence in humans is conflicting.
  • Avoid if allergic or hypersensitive to lutein or zeaxanthin. Use cautiously if at risk for cardiovascular disease or cancer. Avoid if pregnant or breastfeeding.
  • Lycopene: High levels of lycopene are found in tomatoes and in tomato-based products. Tomatoes are also sources of other nutrients such as vitamin C, folate, and potassium. Several laboratory and human studies examining tomato-based products and blood lycopene levels suggest that lycopene may be associated with a lower risk of developing cancer and may help stimulate the immune system. However, due to a lack of well-designed human research using lycopene supplements, its effectiveness for cancer prevention remains unclear.
  • Avoid if allergic to tomatoes or to lycopene. Due to a lack of conclusive data, avoid if pregnant or breastfeeding.
  • Maitake mushroom: Maitake is the Japanese name for the edible mushroom Grifola frondosa. Maitake has been used traditionally both as a food and for medicinal purposes. Early studies in the laboratory as well as in humans suggest that beta-glucan extracts from maitake may increase the body's ability to fight cancer. However, these studies have not been well designed, and better research is needed before the use of maitake for cancer can be recommended.
  • Caution is advised when taking maitake supplements, as numerous adverse effects including an increased risk of bleeding and drug interactions are possible. Maitake should not be used if pregnant or breast-feeding, unless otherwise directed by a doctor.
  • Meditation: Not enough research has shown meditation to be of benefit in cancer prevention. More studies are needed.
  • Use cautiously with underlying mental illnesses. People with psychiatric disorders should consult with their primary mental healthcare professional(s) before starting a program of meditation, and should explore how meditation may or may not fit in with their current treatment plan. Avoid with risk of seizures. The practice of meditation should not delay the time to diagnosis or treatment with more proven techniques or therapies, and should not be used as the sole approach to illnesses.
  • Melatonin: There are several early-phase and controlled human trials of melatonin in patients with various advanced stage malignancies. There is currently not enough definitive scientific evidence to discern if melatonin is beneficial as a cancer treatment, whether it increases (or decreases) the effectiveness of other cancer therapies, or if it safely reduces chemotherapy side effects.
  • Melatonin is not to be used for extended periods of time. Caution is advised when taking melatonin supplements, as numerous adverse effects including drug interactions are possible. Melatonin is not recommended during pregnancy or breastfeeding unless otherwise advised by a doctor.
  • Milk thistle: Milk thistle (Silybum marianum) has been used medicinally in China for over 2,000 years, most commonly for the treatment of liver and gallbladder disorders. There are early reports from laboratory experiments that the components silymarin and silibinin found in milk thistle may reduce the growth of human cancer cells. However, effects have not been shown in high-quality human trials.
  • Caution is advised when taking milk thistle supplements, as numerous adverse effects including an increased risk of bleeding and drug interactions are possible. Milk thistle should not be used if pregnant or breast-feeding, unless otherwise directed by a doctor.
  • Mistletoe: Mistletoe is one of the most widely used unconventional cancer treatments in Europe. Mistletoe extracts have been studied for a variety of human cancers as well as melanoma and leukemia. However, efficacy has not been conclusively proven for any one condition. In fact, some studies have shown lack of efficacy of certain preparations for a variety of cancers. Larger, well-designed clinical trials are needed.
  • Caution is advised when taking mistletoe supplements, as numerous adverse effects including nausea, vomiting, and drug interactions are possible. Mistletoe should not be used if pregnant or breast-feeding, unless otherwise directed by a doctor.
  • Moxibustion: Moxibustion is a healing technique employed across the diverse traditions of acupuncture and oriental medicine for over 2,000 years. Moxibustion uses the principle of heat to stimulate circulation and break up congestion or stagnation of blood and chi. Moxibustion is closely related to acupuncture as it is applied to specific acupuncture points. Preliminary evidence suggests that moxibustion may reduce side effects of chemotherapy or radiation therapy. More studies are needed.
  • Use cautiously over large blood vessels and thin or weak skin. Avoid with aneurysms, any kind of "heat syndrome," cardiac disease, convulsions or cramps, diabetic neuropathy, extreme fatigue and/or anemia, fever, inflammatory conditions, over allergic skin conditions or ulcerated sores, or skin adhesions. Avoid if pregnant or breastfeeding. Avoid areas with an inflamed organ, contraindicated acupuncture points, face, genitals, head, inflamed areas in general, nipples, and skin adhesions. Avoid in patients who have just finished exercising or taking a hot bath or shower. Use cautiously with elderly people with large vessels. It is considered not advisable to bathe or shower for up to 24 hours after a moxibustion treatment.
  • Oleander: Laboratory studies of oleander (Nerium oleander) suggest possible anti-cancer effects, although reliable research in humans is not currently available. There are reports that long-term use of oleander may have positive effects in patients several types of cancer. More research is needed.
  • Caution is advised when taking oleander supplements, as numerous adverse effects including drug interactions are possible. Oleander should not be used if pregnant or breast-feeding, unless otherwise directed by a doctor.
  • Omega-3 fatty acids: Omega-3 fatty acids are essential fatty acids found in some plants and fish. A balance of omega-6 and omega-3 fatty acids is advised for health. Several population studies report that dietary omega-3 fatty acids or fish oil may reduce the risk of developing several different types of cancer. Well conducted clinical trials are necessary before a clear conclusion can be drawn regarding the use of omega-3 fatty acids for cancer prevention.
  • Caution is advised when taking omega-3 fatty acid supplements, as numerous adverse effects including an increase in bleeding and drug interactions are possible. Omega-3 fatty acid supplements should not be used if pregnant or breast-feeding, unless otherwise directed by a doctor.
  • Para-aminobenzoic acid: N-butyl-p-aminobenzoate (BAB) has been shown to be a lipid-soluble local anesthetic. Early study found significant pain relief in patients with intractable cancer pain after an epidural injection of BAB suspension. Larger scale clinical study is needed to confirm these findings.
  • Avoid with known hypersensitivity to PABA or its derivatives. Avoid oral use in children and pregnant or nursing women. Use cautiously in patients with renal disease, bleeding disorders or taking anticoagulants, diabetics or patients at risk for hypoglycemia. Discontinue use if rash, nausea, or anorexia occurs. Pharmaceutical doses of PABA and its derivatives should only be taken under appropriate medical supervision. PABA should not be given concurrently with sulfonamides.
  • Perillyl alcohol: Perillyl alcohol has been used to treat cancer. However, high quality scientific studies are lacking. Further research is required before recommendations can be made.
  • Avoid if allergic/hypersensitive to perillyl alcohol. Avoid use in the absence of medical supervision. Use cautiously in patients under medical supervision. Avoid if pregnant or breastfeeding.
  • Prayer: Initial studies of prayer in patients with cancer (such as leukemia) report variable effects on disease progression or death rates when intercessory prayer is used. Better quality research is necessary before a firm conclusion can be drawn.
  • Prayer is not recommended as the sole treatment approach for potentially serious medical conditions, and should not delay the time it takes to consult with a healthcare professional or receive established therapies. Sometimes religious beliefs come into conflict with standard medical approaches, and require an open dialog between patients and caregivers. In clinical study, patients certain that they were receiving intercessory prayer had a higher incidence of complications following cardiac bypass surgery than those who did not know they were being prayed for.
  • Reiki: Reiki may contribute to reduced perception of pain, improved quality of life, and reduced fatigue in cancer patients. More studies are needed.
  • Reiki is not recommended as the sole treatment approach for potentially serious medical conditions, and should not delay the time it takes to consult with a healthcare professional or receive established therapies. Use cautiously with psychiatric illnesses.
  • Reishi mushroom: Reishi (Ganoderma lucidum) has been shown to have antineoplastic and immunomodulatory effects in animal studies. Human studies exist of advanced cancer patients using Ganopoly®, a Ganoderma lucidum polysaccharide extract. Results show improved quality of life and enhanced immune responses, which are typically reduced or damaged in cancer patients receiving chemotherapy and/or radiation therapy. Well-designed long-term studies are needed confirm these results and to determine potential side effects.
  • Caution is advised when taking reishi supplements, as numerous adverse effects including an increased risk of bleeding and drug interactions are possible. Reishi should not be used if pregnant or breast-feeding, unless otherwise directed by a doctor.
  • Resveratrol: The effects of resveratrol cannot be adequately assessed from trials using foods, wine, or combination products containing resveratrol and other substances. Well-designed clinical trials of resveratrol alone are needed before a recommendation can be made in regards to cancer prevention and/or treatment.
  • Avoid if allergic or hypersensitive to resveratrol, grapes, red wine or polyphenols. Resveratrol is generally considered safe and is commonly found in food and beverages. Use cautiously with bleeding disorders, abnormal blood pressure. Use cautiously with drugs that are broken down by the body's cytochrome P450 system or digoxin (or digoxin-like drugs). Avoid if pregnant or breastfeeding.
  • Seaweed: Bladderwrack (Fucus vesiculosus) is a brown seaweed that grows on the northern coasts of the Atlantic and Pacific oceans, and the North and Baltic seas. Bladderwrack appears to suppress the growth of various cancer cells in animal and laboratory studies. However, reliable human studies to support a recommendation for use in cancer are currently lacking.
  • Caution is advised when taking bladderwrack supplements, as numerous adverse effects including an increased risk of drug interactions are possible. Bladderwrack should not be used if pregnant or breast-feeding, unless otherwise directed by a doctor.
  • Selenium: Selenium is a trace mineral found in soil, water, and some foods. It is an essential element in several metabolic pathways. Several studies suggest that low levels of selenium (measured in the blood or in tissues such as toenail clippings), may be a risk factor for developing cancer. Population studies suggest that people with cancer are more likely to have low selenium levels than healthy matched individuals, but in most cases it is not clear if the low selenium levels are a cause or merely a consequence of disease. It currently remains unclear if selenium is beneficial for cancer prevention or cancer treatment.
  • Avoid if allergic or sensitive to products containing selenium. Avoid with a history of nonmelanoma skin cancer. Selenium is generally regarded as safe for pregnant or breastfeeding women. However, animal research reports that large doses of selenium may lead to birth defects.
  • Shark cartilage: For several decades, shark cartilage has been proposed as a cancer treatment. Studies have shown shark cartilage or the shark cartilage product AE-941 (Neovastat®) to block the growth of new blood vessels, a process called "anti-angiogenesis," which is believed to play a role in controlling growth of some tumors. There have also been several reports of successful treatments of end-stage cancer patients with shark cartilage, but these have not been well-designed and have not included reliable comparisons to accepted treatments. Many studies have been supported by shark cartilage product manufacturers, which may influence the results. In the United States, shark cartilage products cannot claim to cure cancer, and the U.S. Food and Drug Administration (FDA) has sent warning letters to companies not to promote products in this way. Without further evidence from well-designed human trials, it remains unclear if shark cartilage is of any benefit in cancer and patients are advised to check with their doctor and pharmacist before taking shark cartilage.
  • Shark cartilage available in Asian grocery stores and restaurants should not be eaten due to declining populations of sharks. Caution is advised when taking shark cartilage supplements, as numerous adverse effects including an increased risk of drug interactions are possible. Shark cartilage should not be used by patients who are pregnant or breast-feeding, unless otherwise directed by a doctor.
  • Shiitake mushroom: Shiitake (Lentinus edodes) has been taken by mouth for boosting the immune system, decreasing cholesterol levels, and for anti-aging. Lentinan, derived from shiitake, has been injected as an adjunct treatment for cancer and HIV infection. Laboratory, animal and human studies of lentinan have shown positive results in cancer patients when used as a chemotherapy adjunct. Further well-designed clinical trials on all types of cancer are required to confirm these results.
  • Caution is advised when taking shiitake supplements, as numerous adverse effects including an increased risk of bleeding and drug interactions are possible. Shiitake should not be used if pregnant or breast-feeding, unless otherwise directed by a doctor.
  • Slippery elm: Slippery elm is found as a common ingredient in a purported herbal anticancer product called Essiac® and a number of Essiac-like products. These products contain other herbs such as rhubarb, sorrel, and burdock root. Currently, there is not enough evidence to recommend for or against the use of this herbal mixture as a therapy for any type of cancer. Avoid if allergic or hypersensitive to slippery elm. Avoid if pregnant or breastfeeding.
  • Sorrel: Early evidence suggests that herbal formulations containing sorrel, such as Essiac®, do not shrink tumor size or increase life expectancy in patients with cancer. However, currently there is a lack of studies evaluating sorrel as the sole treatment for cancer. A conclusion cannot be made without further research.
  • Avoid with a known allergy or hypersensitivity to sorrel. Avoid large doses due to reports of toxicity and death, possibly because of the oxalate found in sorrel. Many tinctures contain high levels of alcohol and should be avoided when driving or operating heavy machinery. Sorrel formulations may cause nausea or vomiting when taken with the prescription drugs metronidazole (Flagyl®) or disulfiram (Antabuse®). Avoid if pregnant or breastfeeding.
  • Soy: Soy (Glycine max) contains compounds which have been reported to be effective as a cancer treatment. Genistein, an isoflavone found in soy, has been found in laboratory and animal studies to possess anti-cancer effects, such as blocking new blood vessel growth (anti-angiogenesis), acting as a tyrosine kinase inhibitor (a mechanism of many new cancer treatments), or causing cancer cell death (apoptosis). In contrast, genistein has also been reported to increase the growth of pancreas tumor cells in laboratory research. Until reliable human research is available, it remains unclear if dietary soy or soy isoflavone supplements are beneficial, harmful, or neutral in people with various types of cancer.
  • Caution is advised when taking soy supplements, as numerous adverse effects including an increased risk of drug interactions are possible. Soy should not be used if pregnant or breast-feeding, unless otherwise directed by a doctor.
  • Spiritual healing: Cancer patients, especially those who fear recurrence or are unhappy with their physicians, commonly use prayer and spiritual healing. More research is needed to address the effects of spiritual healing on anxiety, depression, and quality of life in patients with cancer.
  • Spiritual healing should not be used as the only treatment approach for medical or psychiatric conditions, and should not delay the time it takes to consider more proven therapies.
  • Sweet annie: Certain constituents found in sweet annie show promise for use in cancer when used in combination with standard chemotherapy. However, currently there is not enough scientific evidence in humans to make a strong recommendation for this use.
  • Avoid if allergic or hypersensitive to sweet annie (Artemisia annua), its constituents, or members of the Asteraceae/Compositae family such dandelion, goldenrod, ragweed, sunflower, and daisies. Use cautiously in patients who are pregnant, taking angiogenic agents, or recovering from surgery or other wounds. Use cautiously if taking cardiotoxic or neurotoxic agents or with compromised cardiac or neural function. Use cautiously if taking immunostimulants or quinolines. Avoid if pregnant or breastfeeding.
  • Transcutaneous electrical nerve stimulation (TENS): Transcutaneous electrical nerve stimulation (TENS) is a non-invasive technique in which a low-voltage electrical current is delivered through wires from a small power unit to electrodes located on the skin. Although TENS has been used with some success in cancer pain, there is not enough reliable evidence to draw a firm conclusion in this area. TENS is often used in combination with acupuncture.
  • Avoid with implantable devices, like defibrillators, pacemakers, intravenous infusion pumps, or hepatic artery infusion pumps. Use cautiously with decreased sensation, like neuropathy, and with seizure disorders. Avoid if pregnant or breastfeeding.
  • Thiamin (Vitamin B1): Thiamin deficiency has been observed in some cancer patients, possibly due to increased metabolic needs. It is not clear if lowered levels of thiamin in such patients may actually be beneficial. Currently, it remains unclear if thiamin supplementation plays a role in the management of any particular type(s) of cancer.
  • Thiamin is generally considered safe and relatively nontoxic. Avoid if allergic or hypersensitive to thiamin. Rare hypersensitivity/allergic reactions have occurred with thiamin supplementation. Skin irritation, burning, or itching may rarely occur at injection sites. Large doses may cause drowsiness or muscle relaxation. Use cautiously if pregnant or breastfeeding.
  • Thymus extract: Preliminary evidence suggests that thymus extract may increase disease-free survival and immunological improvement in several types of cancer. Additional study is needed in this area.
  • Avoid if allergic or hypersensitive to thymus extracts. Use bovine thymus extract supplements cautiously due to potential for exposure to the virus that causes "mad cow disease." Avoid with an organ transplant or other forms of allografts or xenografts. Avoid if receiving immunosuppressive therapy, with thymic tumors, myasthenia gravis (neuromuscular disorder), untreated hypothyroidism, or if taking hormonal therapy. Avoid if pregnant or breastfeeding.
  • Traditional Chinese Medicine (TCM): The ancient Chinese philosophy of Taoism provided the basis for the development of Chinese medical theory. TCM uses over 120 different herbs in cancer treatment, depending on the type of cancer and its cause according to Chinese medical theory. Studies have reported significant benefits include reducing tumors, reducing treatment side effects and improved response to treatment. More studies of stronger design are needed before TCM can be recommended with confidence as an adjunct to cancer treatment, although centuries of traditional use in cancer cannot be discounted.
  • Chinese herbs can be potent and may interact with other herbs, foods or drugs. Consult a qualified healthcare professional before taking. There have been reports of manufactured or processed Chinese herbal products being tainted with toxins or heavy metal or not containing the listed ingredients. Herbal products should be purchased from reliable sources. Avoid ma huang, which is the active ingredient in ephedra. Avoid ginseng if pregnant or breastfeeding.
  • Turmeric: Turmeric (Curcuma longa) is commonly used for its anti-inflammatory properties. Several early animal and laboratory studies report anti-cancer (colon, skin, breast) properties of curcumin. Many mechanisms have been considered, including antioxidant activity, anti-angiogenesis (prevention of new blood vessel growth), and direct effects on cancer cells. Currently it remains unclear if turmeric or curcumin has a role in preventing or treating human cancer. There are several ongoing studies in this area.
  • Caution is advised when taking turmeric supplements, as numerous adverse effects including an increased risk of bleeding and drug interactions are possible. Turmeric should not be used if pregnant or breast-feeding, unless otherwise directed by a doctor.
  • Vitamin C (ascorbic acid): Dietary intake of fruits and vegetables high in vitamin C has been associated with a reduced risk of various types of cancer in population studies (particularly cancers of the mouth, esophagus, stomach, colon, or lung). However, it is not clear that it is specifically the vitamin C in these foods that is beneficial, and vitamin C supplements have not been found to be associated with this protective effect. Experts have recommended increasing dietary consumption of fruits and vegetables high in vitamin C, such as apples, asparagus, berries, broccoli, cabbage, melon (cantaloupe, honeydew, watermelon), cauliflower, citrus fruits (lemons, oranges), fortified breads/grains/cereal, kale, kiwi, potatoes, spinach, and tomatoes. Vitamin C has a long history of adjunctive use in cancer therapy, and although there have not been any definitive studies using intravenous (or oral) vitamin C, there is evidence that it has benefit in some cases. Better-designed studies are needed to better determine the role of vitamin C in cancer prevention and cancer treatment.
  • Avoid if allergic or sensitive to vitamin C product ingredients. Vitamin C is generally considered safe in amounts found in foods. Vitamin C supplements are also generally considered safe in most individuals if taken in recommended doses. Large doses (greater than 2 grams) may cause diarrhea and gastrointestinal upset. Avoid high doses of vitamin C with glucose 6-phosphate dehydrogenase deficiency, kidney disorders or stones, cirrhosis (inflammation of the liver), gout, or paroxysmal nocturnal hemoglobinuria (bleeding disorder). Vitamin C intake from food is generally considered safe if pregnant or breastfeeding. It is not clear if vitamin C supplements in doses higher than Dietary Reference Intake recommendations are safe for pregnant or breastfeeding women. Vitamin C is naturally found in breast milk.
  • Vitamin D: Limited research suggests that synthetic vitamin D analogs may play a role in the treatment of human cancers. However, it remains unclear if vitamin D deficiency raises cancer risk, or if an increased intake of vitamin D is protective against some cancers. Until additional trials are conducted, it is premature to advise the use of regular vitamin D supplementation for cancer prevention.
  • Avoid if allergic or hypersensitive to vitamin D or any of its components. Vitamin D is generally well-tolerated in recommended doses; doses higher than recommended may cause toxic effects. Use cautiously with hyperparathyroidism (overactive thyroid), kidney disease, sarcoidosis, tuberculosis, and histoplasmosis. Vitamin D is safe in pregnant and breastfeeding women when taken in recommended doses.
  • Vitamin E: Reliable scientific evidence that vitamin E is effective as a cancer treatment is currently lacking.
  • Caution is merited in people undergoing chemotherapy or radiation, because it has been proposed that the use of high-dose antioxidants may actually reduce the anti-cancer effects of these therapies. This remains an area of controversy and studies have produced variable results. Patients interested in using high-dose antioxidants such as vitamin E during chemotherapy or radiation should discuss this decision with their medical oncologist or radiation oncologist. Caution is advised when taking vitamin E supplements, as numerous adverse effects including an increased risk of bleeding and drug interactions are possible. Avoid if allergic or hypersensitive to vitamin E. Avoid with retinitis pigmentosa (loss of peripheral vision). Use cautiously with bleeding disorders or if taking blood thinners. Avoid above the recommended daily level in pregnant women and breastfeeding women.
  • Fair negative scientific evidence:
  • Apricot: Available clinical trials on the use of whole apricots for cancer are currently lacking. However, some research has been conducted on "LaetrileT," an alternative cancer drug marketed in Mexico and other countries outside of the U.S. LaetrileT is derived from amygdalin found in apricot pits and nuts such as bitter almond. There are multiple animal studies and initial human evidence to suggest that LaetrileT is not beneficial in the treatment of cancer. Based on a phase II trial in 1982, the U.S. National Cancer Institute concluded that LaetrileT is not an effective chemotherapeutic agent. Nonetheless, many people still travel to use this therapy outside the U.S.
  • Multiple cases of cyanide poisoning, including deaths, have been associated with LaetrileT therapy. Avoid if allergic to apricot, its constituents or members of the Rosaceae family, especially the Prunoideae subfamily of plants. Avoid eating excessive amounts of apricot kernels (about 7 grams daily, or more than ten kernels daily). Use cautiously with diabetes. Use cautiously when taking supplements containing beta-carotene, iron, niacin, potassium, thiamine or vitamin C. Use cautiously when taking products that may lower blood pressure. Avoid if pregnant or breastfeeding.
  • Beta-carotene: While diets high in fruits and vegetables rich in beta-carotene have been shown to potentially reduce certain cancer incidences, results from randomized controlled trials with oral supplements do not support this claim.
  • There is some concern that beta-carotene metabolites with pharmacological activity can accumulate and potentially have cancer-causing (carcinogenic) effects. A higher, statistically significant incidence of lung cancer in male smokers who took beta-carotene supplements has been discovered. Beta-carotene/vitamin A supplements may have an adverse effect on the incidence of lung cancer and on the risk of death in smokers and asbestos exposed people or in those who ingest significant amounts of alcohol. In addition, high-dose antioxidants theoretically may interfere with the activity of some chemotherapy drugs or radiation therapy. Therefore, individuals undergoing cancer treatment should speak with their oncologist if they are taking or considering the use of high dose antioxidants. Beta-carotene in the amounts normally found in food does not appear to have this adverse effect. Avoid if sensitive to beta-carotene, vitamin A or any other ingredients in beta-carotene products.
  • Bitter almond: "Laetrile" is an alternative cancer drug marketed in Mexico and other countries outside of the United States. Laetrile is derived from amygdalin, found in the pits of fruits and nuts such as the bitter almond. Early evidence suggests that laetrile is not beneficial in the treatment of cancer. In 1982, the U.S. National Cancer Institute concluded that laetrile was not effective for cancer therapy. Nonetheless, many people still travel to use this therapy outside the United States.
  • Multiple cases of cyanide poisoning, including deaths, have been associated with laetrile therapy. Avoid if allergic to almonds or other nuts. Use cautiously if driving or operating machinery. Avoid if pregnant or breastfeeding because of the risk of birth defects.
  • Hypnotherapy, hypnosis: Hypnosis did not reduce radiotherapy side effects such as anxiety and did not improve quality of life in patients undergoing curative radiotherapy in early high-quality studies.
  • Use cautiously with mental illnesses like psychosis/schizophrenia, manic depression, multiple personality disorder or dissociative disorders, or with seizure disorders.
  • Iridology: There is currently limited available data supporting iridology as a tool for cancer diagnosis. Additional study is needed.
  • Iridology should not be used alone to diagnose disease. Studies of iridology have reported incorrect diagnoses, and thus, potentially severe medical problems may go undiagnosed. In addition, research suggests that iridology may lead to inappropriate treatment. Iridology is therefore not recommended as a sole method of diagnosis or treatment for any condition.
  • Vitamin E: Recent evidence from well-conducted clinical study reports no reduction in the development of cancer with the use of natural-source vitamin E taken daily. Previously, there have been laboratory, population, and other human trials examining whether vitamin E is beneficial in general cancer prevention, including that for prostate, colon, or stomach cancer. Results of these prior studies have been variable. At this time, based on the best available scientific evidence, and recent concerns about the safety of vitamin E supplementation, vitamin E cannot be recommended for cancer prevention.
  • Avoid if allergic or hypersensitive to vitamin E. Avoid with retinitis pigmentosa (loss of peripheral vision). Use cautiously with bleeding disorders or if taking blood thinners. Avoid above the recommended daily level in pregnant women and breastfeeding women.

Prevention
  • There are currently no known ways to prevent blue rubber bleb nevus syndrome (BRBNS). However, several treatments exist that may help manage the symptoms of BRBNS.

Author information
  • This information has been edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

Bibliography
  1. Children's Hospital Boston. .
  2. Dobru D, Seuchea N, Dorin M, et al. Blue rubber bleb nevus syndrome: case report and literature review. Rom J Gastroenterol. 2004 Sep;13(3):237-40.
  3. Fishman SJ, Smithers CJ, Folkman J, et al. Blue rubber bleb nevus syndrome: surgical eradication of gastrointestinal bleeding. Ann Surg. 2005 Mar;241(3):523-8.
  4. Kassarjian A, Fishman SJ, Fox VL, et al. Imaging characteristics of blue rubber bleb nevus syndrome. AJR Am J Roentgenol. 2003 Oct;181(4):1041-8.
  5. Liu Q, Chen YP, Li YM. Blue rubber bleb nevus syndrome: a report of one case associated with recurrent epistaxis. Chin Med J (Engl). 2007 Apr 20;120(8):731-3.
  6. Mittal RR, Pureet. Blue rubber bleb nevus syndrome. Indian J Dermatol Venereol Leprol. 2001 Jan-Feb;67(1):41-2.
  7. National Center for Biotechnology Information. .
  8. Natural Standard: The Authority on Integrative Medicine. .

Disorders that affect multiple parts of the gastrointestinal tract
  • Diarrhea: Diarrhea occurs when an individual has loose stools or watery stools. Diarrhea is a symptom of an underlying health problem, such as an infection, that prevents the intestines from properly absorbing nutrients from food. Acute diarrhea lasts a few days and affects nearly everyone at some point in their lives. Chronic diarrhea generally lasts longer than four weeks and may be a sign of a serious condition such as inflammatory bowel disease (IBD) or gastroenteritis.
  • Diarrhea is usually caused by a viral, bacterial, or parasitic infection. Diarrhea that is caused by an infection (often called infectious diarrhea) may be passed from person to person. Viruses, such as the Norwalk virus, cytomegalovirus, viral hepatitis herpes simplex virus, and rotavirus are the most likely to cause diarrhea. Infants and young children are most likely to develop diarrhea as a result of a rotavirus infection. If an individual consumes food or water that is contaminated with certain bacteria or parasites, he/she may develop diarrhea. This type of diarrhea is often called traveler's diarrhea because it frequently occurs in people who are traveling to developing countries. Common bacterial causes of diarrhea include campylobacter, salmonella, Escherichia coli (E. coli), Shigelladysenteriae, and Clostridium difficile. Common parasites that are known to cause diarrhea include Giardia lamblia and cryptosporidium.
  • Diarrhea may be caused by a number of other factors, including lactose intolerance, certain medications (especially antibiotics and anti-HIV medications called antiretrovirals), artificial sweeteners called sorbitol and mannitol (commonly found in sugar-free products and many types of chewing gum), surgery, or other gastrointestinal disorders (such as irritable bowel syndrome or IBS).
  • Symptoms of diarrhea often include frequent and loose stools, abdominal pain or cramping, bloating, fever, excessive thirst, and dehydration. Diarrhea causes dehydration because the body loses water and salts. Infants and young children are at risk of developing severe dehydration as a result of diarrhea. Patient with severe diarrhea may be unable to control the passage of stool, a condition known as fecal incontinence. When a patient experiences frequent, severe, and bloody diarrhea, the condition is often called dysentery.
  • Diarrhea usually requires little to no medical treatment. Individuals with diarrhea should drink plenty of water. Patients may also benefit from drinks that contain electrolytes, including Pediatric Electrolyte®, Pedialyte®, or Enfalyte®. Individuals should avoid diuretics, such as caffeine, because they worsen symptoms of dehydration. Certain foods, including rice, dry toast, and bananas may help reduce symptoms of diarrhea. In addition, anti-diarrheal medications, such as bismuth subsalicylate (Pepto-bismol®, Bismatrol®, or Kaopectate®), diphenoxylate atropine (Lomotil®, Lofene®, or Lonox®), or loperamide hydrochloride (Imodium®), may also be taken to reduce diarrhea in patients older than three years of age.
  • If diarrhea continues for longer than four days or blood is present in the stool, patients should visit their healthcare providers to determine the underlying cause. If an infection is causing symptoms, an antimicrobial medication may be prescribed. The specific type, dose, and duration of treatment depend on the severity and type of infection.
  • Irritable bowel syndrome (IBS): Irritable bowel syndrome (IBS), also called spastic colon, mucous colitis, spastic colitis, nervous stomach, or irritable colon, is a long-term condition that is characterized by abdominal pain, cramping, diarrhea, and constipation. IBS is a functional bowel disorder because the bowel appears normal but does not function properly.
  • Although the exact cause of irritable bowel syndrome (IBS) is unknown, researchers believe that poor diet, neurotransmitter imbalances, and infections may contribute to the development of the disorder.
  • The colon contracts (colon motility) to move the contents inside the colon toward the rectum. During this passage, water and nutrients are absorbed into the body and waste is excreted as stool. A few times each day, contractions push the stool down the colon resulting in a bowel movement.
  • In IBS patients, the muscles of the colon, sphincters, and pelvis do not contract properly. As a result, patients experience constipation or diarrhea. This causes symptoms of abdominal pain, cramping, bloating, and a sense of incomplete stool movement. Symptoms may improve after the patient has a bowel movement.
  • Health complications arising from IBS include hemorrhoids (aggravated by diarrhea and/or constipation), depression, weight loss, vitamin and mineral deficiencies, and psychosocial problems.
  • Most people can control symptoms of IBS with diet, stress management, lifestyle modification, and prescribed medications. A medication called loperamide (Imodium®) is commonly used to treat IBS patients with diarrhea. Laxatives, such as polyethylene glycol (Miralax®), sorbitol, and lactulose (Cephulac®), may be used. Phosphate enemas (Fleet Phospho-soda®) and emollient enemas (Colace Microenema®) have also been used. Suppositories, such as bisacodyl (Dulcolax®), may also be taken. The most widely studied drugs for the treatment of abdominal pain are a group of drugs called antispasmodics, which cause muscle relaxation. Commonly used antispasmodics include hyoscyamine (Levsin® or Levsinex®), dicyclomine (Bentyl®), and methscopolamine (Pamine®).
  • For some patients, however, IBS may be disabling. They may be unable to work, attend social events, or even travel short distances due to urgency to defecate (pass stool) and/or pain in the colon.
  • Inflammatory bowel disease (IBD): Inflammatory bowel disease (IBD) refers to two chronic diseases that cause inflammation of the intestines: ulcerative colitis and Crohn's disease.
  • The cause of IBD remains unknown. However, current research indicates that IBD most likely involves a complex interaction of factors, including heredity, the immune system, and antigens in the environment.
  • The symptoms of these two illnesses are very similar, which often makes it difficult to distinguish between the two. In fact, about 10% of colitis (inflamed colon) cases cannot be diagnosed as either ulcerative colitis or Crohn's disease. When physicians cannot diagnose the specific IBD, the condition is called indeterminate colitis.
  • IBD causes chronic inflammation in the gastrointestinal tract and may lead to complications, such as colon cancer. The most common symptoms of both ulcerative colitis and Crohn's disease are diarrhea (ranging from mild to severe), abdominal pain, decreased appetite, and weight loss. If the diarrhea is extreme, it may lead to dehydration, increased heartbeat, and decreased blood pressure. As food moves through inflamed areas of the gastrointestinal tract, it may cause bleeding. Continued loss of blood in the stool may result in low levels of iron in the blood, a condition called anemia.
  • In addition, Crohn's disease may also cause intestinal ulcers, fever, fatigue, arthritis, eye inflammation, skin disorders, and inflammation of the liver or bile ducts.
  • Ulcers may extend through the intestinal wall creating a fistula (an abnormal opening). If an internal fistula develops, food may not reach the area of the intestine involved in absorption. External fistulas in the anus may result in continuous bowel drainage onto the skin. Fistulas may also become infected, a condition that can be life threatening if left untreated. Symptoms of a fistula may include pain, fever, tenderness, itching, and general feeling of discomfort.
  • Toxic megacolon is a rare, but potentially life-threatening complication of severe IBD. Toxic megacolon is characterized by a dilated colon (megacolon), abdominal distension (bloating), and occasionally fever, abdominal pain, or shock. In severe cases, the condition may cause the colon to become paralyzed. Toxic megacolon prevents the individual from having bowel movements. If the condition is not treated, the colon may rupture, resulting in peritonitis, a life-threatening condition that requires emergency surgery.
  • Other complications may include dehydration, malnutrition, obstruction, ulcers, and anal fissures.
  • Many medications are used to treat IBD. Anti-inflammatories, such as sulfasalazine (Azulfidine®), mesalamine (e.g. Asacol® or Rowasa®), olsalazine (Dipentum®), and balsalazide (Colazal®), help reduce inflammation. Corticosteroids, such as prednisone (Deltasone®), have been shown to effectively reduce inflammation of the gastrointestinal tract in IBD patients. Medications, called immunosuppressants, have been used to treat IBD. Examples include azathioprine (Imuran®), mercaptopurine (Purinethol®), cyclosporine (e.g. Neoral® or Sandimmune®), and infliximab (Remicade®). A fiber supplement, such as psyllium powder (Metamucil®) or methylcellulose (Citrucel®), may help relieve symptoms of mild to moderate diarrhea. Inflammation may cause the intestines to narrow, resulting in constipation. Laxatives may be taken to relieve symptoms of constipation. Oral laxatives such as Correctol® have been used. A qualified healthcare provider may recommend acetaminophen (Tylenol®) to relieve mild pain. Avoid nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil® or Motrin®) or naproxen (Aleve®), as researchers have found a strong relationship between NSAIDs and IBD flare-ups. Therefore, NSAIDs should not be taken.
  • If all other treatments fail to relieve symptoms, a qualified healthcare provider may recommend surgery. Surgery is more commonly performed in ulcerative colitis patients because inflammation is limited to the colon. During the procedure, the entire colon and rectum is removed (proctocolectomy).
  • A new procedure, known as ileoanal anastomosis, eliminates the need for recovered patients to wear a bag to collect stool. This new procedure involves attaching a pouch directly to the anus, allowing the patient to expel waste normally. However, the patient may have as many as five to seven watery bowel movements a day because there is no longer a colon to absorb water. Between 25 and 40% of patients with ulcerative colitis eventually need surgery.
  • Indigestion (non-ulcer dyspepsia): Indigestion, also called non-ulcer dyspepsia (upset stomach), is a general term that describes discomfort in the upper abdomen. Patients who have indigestion typically suffer from several symptoms, including heartburn, bloating, belching, and nausea.
  • Indigestion affects nearly everyone from time to time, and it is not considered a serious health condition.
  • Indigestion may occur if a patient eats too much of a particular food (especially fatty or spicy foods) or eats too quickly. Alcohol, stress, and anxiety may also contribute to indigestion.
  • Because indigestion is such a common condition, it generally does not require a diagnosis. However, patients who frequently experience indigestion should visit their healthcare providers because it may be a symptom of an underlying medical condition, such as acid reflux disease.
  • Antacids, such as calcium carbonate (e.g. Tums®, Alka-Mints®, and Rolaids Calcium Rich®), may be taken by mouth to treat symptoms of heartburn and upset stomach. Anti-flatulant medications, such as alpha-galactosidase enzyme (Beano®), simethicone (Gas-X®, Genasyme®, or Mylanta® Gas Relief), may be taken by mouth to prevent and/or treat symptoms of bloating and flatulence (gas).
  • Monosodiumglutamate symptom complex (Chinese restaurant syndrome): Monosodium glutamate symptom complex, also called Chinese restaurant syndrome, is a group of symptoms that some patients develop after eating Chinese foods. Symptoms typically include flushing, headache, sweating, facial pain or swelling, numbness or burning around the mouth, and chest pain.
  • Although it has been suggested that a food additive in Chinese food, called monosodium glutamate (MSG), may cause the reaction, it has not been proven. Since there is limited scientific data about the condition, it remains unknown if the frequency and amount of MSG exposure increases or decreases an individual's risk of experiencing symptoms.
  • Patients generally do not require treatment for monosodium glutamate symptom complex because symptoms are mild and resolve on their own. However, if patients experience chest pain or difficulty breathing, they should seek immediate medical treatment because this may be a sign of a serious allergic reaction called anaphylaxis.
  • Diverticulosis and diverticulitis: Diverticulosis refers to small, bulging pouches (diverticula) in any part of the digestive tract. Diverticula are most often found in the large intestine (colon). However, they may also develop in the esophagus, stomach, or small intestine.
  • Diverticulosis is a common condition that affects more than half of Americans who are older than 60 years of age. Most patients do not know they have diverticulosis because they do not experience any signs or symptoms of the condition.
  • However, if the diverticula become infected or inflamed, the condition is called diverticulitis. Patients with diverticulitis typically experience intense abdominal pain, nausea, bloating, bleeding from the rectum, tenderness in the abdomen, difficulty or pain during urination, fever, and changes in bowel movements.
  • Diverticulitis is usually diagnosed after a computerized tomography (CT) scan is performed. A machine produces images of the internal organs in the abdomen. Inflamed diverticula will be apparent if the patient has diverticulitis.
  • Mild cases of diverticulitis can be treated with rest, changes in the diet, and antibiotics. Patients should not eat any fiber, including whole grains, fruits and vegetables, for several days. This restricted diet gives the colon time to heal. Antibiotics, such as metronidazole (Flagyl®), moxifloxacin (Avelox®), ciprofloxacin (Cipro®), amoxicillin/clavulanate (Augmentin®), and Imipenem (Primaxin®) are commonly prescribed to kill the bacteria that are infecting the diverticula.
  • Serious cases of diverticulitis may eventually require surgery to remove the infected part of the colon.
  • Peptic ulcers: An ulcer is an open sore or break in a body tissue. Peptic ulcers develop on the inside lining of the stomach (gastric peptic ulcer), upper small intestine (duodenal peptic ulcer), or esophagus (esophageal peptic ulcer).
  • Researchers have found that a bacterial infection with Helicobacter pylori is the most common cause of gastric and duodenal ulcers. Some medications, including aspirin and nonsteroidal anti-inflammatory drugs (NSAIDS), such as ibuprofen (Motrin® or Advil®), may also cause gastric and duodenal ulcers. In addition, smoking tobacco increases a patient's risk of developing ulcers. It remains unclear whether or not excessive alcohol consumption leads to an increased risk of ulcers.
  • Esophageal peptic ulcers are usually associated with acid reflux disease.
  • Contrary to popular beliefs, diet and stress do not cause peptic ulcers. However, high levels of stress and acid foods and beverages, such as coffee, may aggravate symptoms of peptic ulcers.
  • Peptic ulcers generally cause pain that may be felt anywhere from the chest to the stomach. Pain may last a few minutes to several hours. Symptoms are often the worst when the stomach is empty or at night. They may also come and go for a few days to weeks. Less common symptoms include vomiting blood, dark blood in the stools, nausea, vomiting, and unexplained weight loss.
  • Most ulcers are diagnosed after an X-ray is taken of the upper gastrointestinal tract. An endoscopy may also be performed. During the procedure, a thin tube with a camera (endoscope) is inserted into the mouth and into the digestive tract. This allows the healthcare provider to see if ulcers are present.
  • Patients take antibiotics, such as amoxicillin (Amoxil®), clarithromycin (Biaxin®), or metronidazole (Flagyl®), if an H. pylori infection is causing peptic ulcers. Patients also take medications called acid-blockers, which reduce the amount of acid in the stomach. As a result, the patient experiences less pain, and the gastrointestinal tract is able to heal. Examples of acid blockers include ranitidine (Zantac®), famotidine (Pepcid®), cimetidine (Tagamet®), and nizatidine (Axid®).
  • Patients should take their medications exactly as prescribed. If medication is not taken regularly or stopped too early, the ulcer may not heal properly. Also, during treatment, patients should not smoke, consume alcohol, or take nonsteroidal anti-inflammatory drugs (NSAIDs) because they may worsen symptoms.
  • Pyloric stenosis: Pyloric stenosis is a rare condition that occurs when babies are born with abnormally large muscles at the opening at the bottom of the stomach (pylorus). The pylorus connects the stomach to the small intestine.
  • Babies with pyloric stenosis are unable to transport food into the small intestine. This may lead to: extremely forceful vomiting (also called projectile vomiting) that may contain blood, weight loss, dehydration, and electrolyte imbalances. Babies are usually hungry after vomiting. They may cry without tears because they are dehydrated.
  • The exact cause of pyloric stenosis remains unknown. However, researchers believe that genetics plays a role.
  • Most patients are diagnosed and treated when they are three to 12 weeks old. Babies with pyloric stenosis need to have surgery as soon as possible to correct the pylorus. The surgical procedure, called pyloromyotomy, involves reducing the size of the pylorus muscles. Patients typically experience an improvement in symptoms about 24 hours after surgery.
  • Colic (infancy): Colic is usually defined as crying for more than three hours a day, three days per week, for longer than three weeks in an otherwise healthy baby.
  • It remains unknown what causes colic. However, researchers have suggested that it may be caused by gastrointestinal problems, such as lactose intolerance or an immature digestive system. This is because sometimes a colic episode stops after a baby passes gas or has a bowel movement. Other possible causes include maternal anxiety, differences in the way a baby is fed or comforted, and/or allergies.
  • There is currently no treatment that has been proven to be effective for the treatment of colic in babies. Colic typically goes away once the baby reaches three months of age.
  • Biliary colic: Biliary colic, also called a gallbladder attack, describes pain and nausea that accompanies many disorders that affect the gallbladder. The gallbladder is an organ that stores digestive fluids that are needed to break down fats in foods.
  • Biliary colic may occur when a gallstone moves through the biliary tract towards the small intestine. An attack may also be the result of cholestasis, which occurs when the flow of bile is blocked. Gallbladder attacks may also occur if the gallbladder becomes inflamed.
  • Gallbladder attacks generally last one to four hours. Common symptoms include pain on the right side of the abdomen, nausea, vomiting, and bloating. The gallbladder, which is located in the lower right side of the abdomen, is usually tender to the touch. The pain may be dull, sharp, or excruciating. It is common for the pain to radiate to the right shoulder blade.
  • A healthcare provider will be able to tell if a patient is having gallbladder attacks after a detailed medical history and physical examination is performed. The next step is to determine the underlying cause of the symptoms.
  • Blood tests and liver function tests may be performed to determine if the patient has cholestasis. If the patient's alkaline phosphatase levels are three times higher than normal, cholestasis is indicated.
  • A computerized tomography (CT) scan, magnetic resonance imaging (MRI) scan, or ultrasound may also be performed. These tests produce images of the internal organs and may help the healthcare provider detect abnormalities, such as gallstones, that may be causing the condition.
  • An endoscopic retrograde cholangiopancreatography (ERCP) may be performed at the hospital to check for problems in the liver, gallbladder, bile ducts, and pancreas. During the procedure, a thin, flexible tube with a camera is inserted through the mouth into the small intestine. The tube then hooks into the bile duct, allowing the healthcare provider to see the biliary tract.
  • Treatment of gallbladder attacks depends on the underlying cause. For instance, a gallstone may need to be surgically removed if it is causing symptoms. Antibiotics may be prescribed if an infection is the cause. If a medication is the suspected cause, a healthcare provider may recommend an alternative medication.
  • Gastroenteritis: Gastroenteritis describes inflammation of the stomach and intestine that causes diarrhea, vomiting, and cramps.
  • Gastroenteritis is often mistaken for the stomach flu or food poisoning because it causes similar symptoms. Although some doctors may call gastroenteritis the flu, gastroenteritis is not caused by any of the influenza viruses.
  • An infection in the digestive tract may cause gastroenteritis. This may happen if patients consume foods or beverages that contain disease-causing bacteria, viruses, or parasites. In some cases, the food itself may irritate the patient's digestive tract. For instance, if a lactose intolerant patient consumes a dairy product, the stomach and intestines become irritated, which may lead to gastroenteritis. In addition, some mediations, including aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), some antibiotics, caffeine, laxatives, and steroids, may cause gastroenteritis.
  • Most patients recover quickly from gastroenteritis. However, babies and the elderly have a greatest risk of developing life-threatening complications, such as dehydration and poor nutrition.
  • If an infection is causing gastroenteritis, patients take medications called antimicrobials to kill the disease-causing organisms. Commonly prescribed antimicrobials include ciprofloxacin (Cipro®), trimethoprim/sulfamethoxazole (Bactrim®), and rifaximin (Xifaxan®, RedActiv®, or Flonorm®). Adults may also take medications, called antiemetics, which reduce vomiting. Commonly prescribed antiemetics include promethazine (Phenergan® or Anergan®), prochlorperazine (Compazine®), or ondansetron (Zofran®). Anti-diarrheals, such as diphenoxylate atropine (Lomotil®, Lofene®, or Lonox®) or loperamide hydrochloride (Imodium®), may also be taken to reduce diarrhea in patients older than three years old.
  • Gaucher's disease: Gaucher's disease is a rare, inherited disorder that occurs when a fatty substance called glucocerebroside accumulates in the spleen, liver, lungs, and bone marrow. In some cases, it also affects the functioning of the brain.
  • Patients with Gaucher's disease are born with low levels of a digestive enzyme called glucocerebrosidase, which breaks down glucocerebroside. This deficiency causes glucocerebroside to build up in the body.
  • There are three types of Gaucher's disease: Type I, Type II, and Type III. Type I is the most common form. It causes enlargement of the liver (hepatomegaly) and spleen (splenomegaly) and it may also affect the lungs and kidneys. When fat develops in the liver, it is often called hepatic steatosis. Type I may develop at any age. Type II is a fatal condition that develops during infancy and causes severe brain damage. Most children with Type II Gaucher's disease die by the age of two years old. Type III causes the liver and spleen to enlarge and brain damage gradually occurs over time. Type III usually occurs in children and adolescents.
  • Gaucher's disease is diagnosed after a blood test. Patients with the disorder will have low levels of glucocerebrosidase in their blood.
  • There is currently no cure for Gaucher's disease. Patients with Type I and Type III Gaucher's disease take enzyme replacement therapy, which has been proven to effectively manage symptoms. However, there is no effective treatment to manage the symptoms of Type II.

Esophageal disorders
  • Gastroesophageal reflux disease (GERD): Gastroesophageal reflux disease (GERD), also called acid reflux disease, occurs when liquid from the stomach backs up (regurgitates) into the esophagus. This liquid may contain stomach acids and bile. In some cases, the regurgitated stomach liquid can cause inflammation (esophagitis), irritation, and damage to the esophagus.
  • It remains unknown exactly what causes GERD. Several factors, including hiatal hernias (when the stomach pushes up through a hole in the diaphragm muscle), abnormally weak contractions of the lower esophageal sphincter, and abnormal emptying of the stomach after a meal, have been associated with GERD.
  • Common symptoms of GERD include a burning sensation in the chest that may spread to the throat (heartburn), chest pain (especially when lying down), difficulty swallowing (dysphagia), regurgitating food or sour liquid, coughing, hoarseness, sore throat, and wheezing.
  • Several factors may worsen symptoms of the condition. For instance, spicy foods, fatty foods, chocolate, caffeine, tomato sauce, carbonated beverages, mint, alcoholic beverages, large meals, lying down after eating, some medications (e.g. sedatives, tranquilizers, or blood pressure drugs), and cigarette smoking may worsen symptoms of GERD.
  • Most cases of GERD can be diagnosed based on the patient's symptoms.
  • GERD is usually a lifelong condition because there is no cure for the disorder. Patients must take medications for the rest of their lives to manage symptoms. In addition, patients should not smoke because it may increase the amount of stomach acid and worsen symptoms.
  • Patients with mild cases of GERD may be able to manage their symptoms with over-the-counter medications and changes in the diet. Patients may experience improvements in symptoms if they eat smaller meals and eliminate foods that are known to cause heartburn.
  • Antacids, such as Gelusil®, Rolaids®, Mylanta®, Maalox®, or Tums®, may neutralize stomach acid and provide quick relief of GERD symptoms. However, they will not help the esophagus heal. Patients who take antacids frequently may experience diarrhea or constipation.
  • Some over-the-counter H-2 receptor blockers, such as cimetidine (Tagamet HB®), famotidine (Pepcid AC®), nizatidine (Axid AR®), and ranitidine (Zantac 75®), may also help provide quick relief of symptoms. These medications reduce the amount of stomach acid that is produced. Side effects of H-2 receptor blockers, which are uncommon, may include changes in bowel movements, dry mouth, dizziness, or drowsiness. Proton pump inhibitors, such as omeprazole (Prilosec®), may also be taken short-term to help the esophagus heal. Patients should not take these medications long term unless they talk with their healthcare providers first.
  • Patients with persistent GERD may require prescription-strength medications to manage symptoms and prevent esophageal damage. H-2 blockers, such as Axid®, Pepcid®, Tagamet®, and Zantac®, are commonly prescribed. Examples of prescription-strength proton pump inhibitors include esomeprazole (Nexium®), lansoprazole (Prevacid®), omeprazole (Prilosec®), pantoprazole (Protonix®), and rabeprazole (Aciphex®).
  • Achalasia: Achalasia is a rare disease that occurs when the muscles of the esophagus are unable to relax. The esophageal sphincter, which is the muscle between the lower esophagus and stomach, is unable to relax enough to allow food to pass into the stomach. Also, the lower half of the esophagus does not contract and relax properly. As a result, the food is not properly pushed down into the stomach, and patients have difficulty swallowing food (dysphagia).
  • The exact cause of achalasia remains unknown. Researchers believe that several factors, including infections, genetics, and abnormalities in the immune system, may contribute to the development of the condition.
  • The most common symptom of achalasia is difficulty swallowing solid foods and liquids. Some patients experience heavy sensations in the chests after eating that feels like chest pain. If food collects in the esophagus, it may cause irritation and lead to esophagitis (inflamed esophagus). Some patients may regurgitate their food if it is trapped in the esophagus. If regurgitated food enters the windpipe (trachea), it may cause infections such as pneumonia.
  • Since patients have difficulty swallowing and consuming foods and beverages, they typically experience weight loss. Other complications may include malnutrition and dehydration.
  • Achalasia is usually diagnosed after a video-esophagram is performed. During the procedure, the patient drinks a barium solution and video X-rays are taken of the esophagus. The healthcare provider is able to see if the barium enters the stomach properly. If the patient has achalasia, the barium will stay in the esophagus longer than normal. In addition, the lower end of the esophagus will be very narrow.
  • Some patients may experience an improvement in symptoms if they eat slowly, take small bites, and chew their food thoroughly.
  • In addition, patients with achalasia usually take nitrates, such as isosorbide dinitrate (Isordil®), and calcium-channel blockers, such as nifedipine (Procardia®) or verapamil (Calan®), to relax the muscles of the esophagus. These medications provide short-term relief of symptoms.
  • A procedure called forceful dilation, or stretching of the lower esophageal sphincter, is often needed to open the esophagus and allow food to enter the stomach. During the procedure, a tube with a balloon at the end is inserted into the patient's esophagus. The balloon is placed across the sphincter and inflated. As a result, the sphincter stretches out. Forceful dilation successfully treats 65-90% of patients with achalasia. The most serious complication of forceful dilation is rupture of the esophagus, which occurs in about five percent of patients. If a rupture occurs, antibiotics and/or surgery may be required. Forceful dilation is generally quicker and less expensive than surgery.
  • If forceful dilation is unsuccessful, a surgical procedure, called esophagomyotomy, may be performed. During the procedure, the sphincter is cut, which expands the esophagus and makes it easier for the patient to swallow. The procedure is more effective than forceful dilation. An estimated 80-90% of patients are treated successfully with esophagomyotomy. However, in some cases, dysphagia may return. The most common side effect of esophagomyotomy is GERD. In order to prevent GERD, the esophagomyotomy may be modified so that it does not completely cut the sphincter or the esophagomyotomy may be combined with anti-reflux surgery. Regardless of which surgery is performed, some healthcare providers recommend lifelong treatment with GERD medications, such as Axid®, Pepcid®, Tagamet®, or Zantac®. Other doctors only recommend lifelong treatment if GERD is diagnosed 24 hours after surgery.
  • Botox injections in the lower sphincter are the newest treatment for achalasia. The botulinum toxin is injected to weaken the sphincter. The effects of treatment usually last for several months. Patients may require additional injections. Patients who are elderly or unable to undergo surgery typically receive this treatment. It may also be performed to help patients gain weight and improve their nutritional status before surgery.
  • Esophageal spasms: Patients may experience spasms in the esophagus. Esophageal spasms may cause difficulty swallowing, painful swallowing, sensation that something is stuck in the throat, heartburn, and chest pain.
  • The exact cause of spasms remains unknown. However, eating hot or cold foods may contribute to the condition. Also, gastroesophageal reflux disease (GERD) or heartburn may also play a role in the development of esophageal spasms.
  • Patients typically take nitrates, such as isosorbide dinitrate (Isordil®), or calcium-channel blockers, such as nifedipine (Procardia®) or verapamil (Calan®), to relax the muscles.

Acute abdomen and stomach disorders
  • Appendicitis: Appendicitis occurs when an organ in the lower right-side of the abdomen, called the appendix, becomes inflamed and filled with pus.
  • The cause of appendicitis is not always clear. In some cases, appendicitis may occur if food waste or a solid piece of stool becomes trapped in an opening near the appendix. It may also occur after an infection.
  • The most common symptom of appendicitis is severe pain in the lower right-hand side of the abdomen. Additional symptoms may include nausea, vomiting, loss of appetite, low-grade fever, constipation, bloating or inability to pass gas, diarrhea, and abdominal swelling.
  • Patients with appendicitis will have high levels of white blood cells in their blood. Imaging studies are also performed to determine if the appendix is enlarged.
  • Patients with appendicitis must have their appendix surgically removed as quickly as possible. Since the appendix has no known purpose, the patient's life is unaffected after the appendix is removed.
  • If the appendix is not removed quickly, it may break open or rupture. If the appendix ruptures, it may lead to an infection in the lining of the abdominal cavity. Infections may cause a condition called peritonitis, which occurs when the abdominal lining becomes inflamed. If the appendix ruptures, the patient may start to feel better. However, soon after, the abdomen may swell because it becomes full of gas and fluid. At this point, the abdomen usually feels hard, tight, and tender to the touch. Severe pain also develops throughout the entire abdomen. Patients may be unable to pass gas or have a bowel movement. Additional symptoms of peritonitis include fever, thirst, and decreased urination.
  • Patients who have symptoms of peritonitis should seek immediate medical treatment. Even if the condition is treated quickly, it may be fatal. Patients will receive aggressive treatment with intravenous antibiotics. Surgery is necessary to remove the burst appendix. Patients will also receive all fluids and nutrition through injections until their condition is improved.
  • Stomach inflammation (gastritis): Stomach inflammation, also called gastritis, may develop suddenly (acute) or gradually over a longer period of time (chronic).
  • Most cases of gastritis are caused by an infection with the same bacterium (Helicobacter pylori) that causes stomach ulcers. Gastritis may also be caused by traumatic injury or surgery, excessive alcohol consumption, and regular use of nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Motrin® or Advil®) or naproxen (Aleve®).
  • A condition called bile reflux disease may also cause, or occur simultaneously with, gastritis. Bile reflux occurs when bile, a fluid that helps digest fats, flows upward from the small intestine into the stomach and esophagus. Bile reflux has also been found to be common after gallbladder removal, or as a result of complications from gastric surgery which may damage the pyloric valve (a ring of muscle that separates the stomach from the duodenum) such as gastrectomy, or gastric bypass. Further inflammation and damage to the lining of the stomach and esophagus may occur as a result.
  • In rare cases, gastritis may occur when the body's own immune cells attack the stomach. It remains unknown what triggers this autoimmune reaction. The acid in the stomach may worsen symptoms of gastritis.
  • Symptoms of gastritis generally include a burning pain or aching in the upper abdomen that may worsen when food is eaten, nausea, vomiting, loss of appetite, bloating, feeling of fullness in the upper abdomen after eating, and weight loss. In some cases, gastritis may cause stomach bleeding. Symptoms of stomach bleeding include blood in the vomit and black or dark-colored stools.
  • In some cases, gastritis may lead to ulcers and an increased risk of stomach cancer.
  • In most cases, patients fully recover quickly once treatment is started. Patients typically take antacids, such as Tums®, Mylanta®, or Rolaids®, to help neutralize the stomach acid. This helps reduce symptoms of gastritis quickly. Acid blockers, such as cimetidine (Tagamet®), ranitidine (Zantac®), nizatidine (Axid®), or famotidine (Pepcid®), may be taken to reduce the amount of stomach acid that is produced. Proton pump inhibitors, such as omeprazole (Prilosec®), lansoprazole (Prevacid®), rabeprazole (Aciphex®), and esomeprazole (Nexium®), may also be taken to reduce the amount of stomach acid produced.
  • If an infection with H. pylori is causing gastritis, patients generally receive a combination of antibiotics and proton pump inhibitors. Commonly prescribed antibiotics include amoxicillin (Amoxil®), clarithromycin (Biaxin®), and metronidazole (Flagyl®).
  • Hypochlorhydria (low stomach acid): Hypochlorhydria occurs when patients have low levels of stomach acid, also called hydrochloric acid. The body needs stomach acid in order to break down foods so that they can be absorbed in the intestines.
  • Natural aging, a poor diet, chronic use of certain medications, and past infection with the Helicobacter pylori bacteria may limit a patient's ability to produce hydrochloric acid.
  • Hypochlorhydria may also be a symptom of an underlying medical condition such as Addison's disease, depression, asthma, eczema, gallstones, hepatitis, osteoporosis, psoriasis, thyroid disease, and autoimmune disorders.
  • If there is low acidity in the stomach, patients may only be able to partially digest food. This may lead to malnutrition. Symptoms of hypochlorhydria may include bloating, gas, belching, burning or dryness of the mouth, heartburn, multiple food allergies, rectal itching, redness or dilated blood vessels in the cheeks and nose, adult acne, hair loss (in women), iron deficiency, undigested foods in the stool, yeast infection, as well as diarrhea or constipation. Patients with hypochlorhydria also have an increased risk of developing infections in the gastrointestinal tract because it provides an ideal environment for disease-causing organisms, such as bacteria.
  • Patients with hypochlorhydria take betaine hydrochloride or glutamic acid hydrochloride with meals and snacks. These medications increase the amount of stomach acid, which helps the body properly break down and digest foods.
  • Ileus: Ileus occurs when the small and/or large intestine is partially or completely blocked. Ileus is a non-mechanical blockage. Unlike mechanical blockages, which occur when the bowel is physically blocked, a non-mechanical blockage occurs when the rhythmic contractions that move material through the bowel, called peristalsis, stops.
  • Ileus is usually associated with an infection of the peritoneum, which is the membrane that lines the abdomen. This is most common in infants and children. Intestinal surgery may lead to temporary ileus that lasts two to three days. Ileus may also be a complication of surgery on other body parts, such as the chest or joints. Other medical conditions, including kidney disease and heart disease, may cause ileus. Some chemotherapy drugs, such as vincristine (Oncovin®, Vincasar PES®, or Vincrex®) or vinblastine (velban® or Velsar®), may cause ileus.
  • Symptoms of ileus may include abdominal distention, abdominal cramping, nausea, vomiting, bloating or failure to pass gas, and difficulty having bowel movements.
  • Patients with ileus must receive nutrition and fluids intravenously to give the intestines time to heal. If an infection is causing the condition, antibiotics are prescribed. Other medications, including cisapride and vasopressin (Pitressin®), may be prescribed to stimulate the intestines to contract and relax.

Intestinal disorders
  • Celiac disease (non-tropical sprue): Celiac disease, also called non-tropical sprue, is a digestive disorder that occurs when an individual's immune system overreacts to gluten, a protein found in wheat, rye, barley, and oats.
  • When a patient with the disease eats food that contains gluten, the immune cells flood to the stomach and intestine to destroy the gluten. However, among these immune cells are autoantibodies that attack the lining of the intestine by mistake. As a result, the intestinal lining becomes damaged.
  • It has not been determined what triggers this reaction in celiac patients. However, celiac disease is associated with autoimmune disorders, such as lupus. Autoimmune disorders occur when the patient's immune system mistakenly identifies body cells as harmful invaders, such as bacteria. As a result, the immune cells in celiac patients attack the patient's intestinal cells when gluten is consumed.
  • Celiac disease causes symptoms of abdominal pain and bloating after consuming gluten.
  • Additionally, complications, including poor absorption, may occur if the patient continues to eat gluten-containing foods. When the intestinal lining is damaged, patients have difficulty absorbing nutrients. Symptoms of poor nutrition include weight loss, diarrhea, abdominal cramps, gas, bloating, fatigue, foul-smelling or grayish stools that may be oily (steatorrhea), stunted growth in children, and osteoporosis (hollow, brittle bones).
  • If celiac disease is suspected, blood tests will be performed to determine whether or not the patient has autoantibodies associated with the disease. If autoantibodies are present, a positive diagnosis is made.
  • Although there is currently no cure for celiac disease, the condition can be managed with a gluten-free diet. Patients should avoid all foods that contain gluten. This includes any type of wheat (including farina, graham flour, semolina, and durum), barley, rye, bulgur, Kamut, kasha, matzo meal, spelt, and triticale. Therefore, foods such as bread, cereal, crackers, pasta, cookies, cake, pie, gravy, and sauce should be avoided unless they are labeled as gluten-free. In general, patients who strictly follow a gluten-free diet can expect to live normal, healthy lives. Symptoms will subside several weeks after the diet is started, and patients will be able to absorb food normally once they avoid eating gluten. A dietician or certified nutritionist may help a patient with celiac disease develop a healthy diet. Patients with celiac disease may also find gluten-free cookbooks to be a helpful resource. Many products, including rice flour and potato flour, can be used as substitutes for gluten-containing flour.
  • Menke's kinky hair disease: Menke's kinky hair disease, also called Menke's disease, is an inherited disorder that decreases the body's ability to absorb copper. Cells in the body need copper to function properly. The disease is characterized by sparse and coarse hair, short stature, and progressive deterioration of the nervous system.
  • Symptoms develop during infancy. Babies with Menke's kinky hair disease show slightly slowed development for two to three months after birth. The baby's condition will worsen after this time and he/she will lose previously developed skills. Other symptoms include silver or colorless hair, seizures, and osteoporosis (hollow and brittle bones).
  • There is currently no cure for Menke's kinky hair disease. Patients may receive injections of copper. However, patients typically die by the age of ten.
  • Acrodermatitis enteropathica: Acrodermatitis enteropathica is an inherited condition that occurs when the body is unable to absorb zinc. This trace element is necessary for the functioning of over 300 different enzymes and plays a vital role in an enormous number of biological processes.
  • The exact cause of acrodermatitis enteropathica remains unknown. However, researchers believe that genetics may play a role.
  • Symptoms of acrodermatitis enteropathica may include red and swollen patches of dry and scaly skin, crusted or pus-filled blisters on the skin, swollen skin around the nails, mouth ulcers, red and glossy tongue, impaired wound healing, as well as hair loss on the scalp, eyelashes, and eyebrows. Additional symptoms may include pinkeye, sensitivity to light, decreased appetite, diarrhea, irritability, failure to grow, and depressed mood.
  • A zinc deficiency can be diagnosed after a blood test.
  • Although there is no cure for the disorder, zinc supplements taken by mouth daily have been shown to effectively manage symptoms. Without treatment, acrodermatitis enteropathica will lead to death. Skin lesions usually heal one to two weeks after treatment is started. Other symptoms begin to improve within 24 hours.

Anorectal disorders
  • Hemorrhoids: Hemorrhoids are inflamed veins in the anus and rectum. Hemorrhoids may develop inside or outside of the rectum, depending on the specific veins that are affected.
  • Hemorrhoids are common, affecting nearly half of individuals who are older than 50 years of age.
  • Hemorrhoids develop when there is increased pressure in the veins of the anus and rectum. This is often due to straining during constipation, sitting or standing for extended periods of time, pregnancy, childbirth, and diarrhea. Obese patients have an increased risk of developing hemorrhoids.
  • Internal hemorrhoids are not painful because pain nerves are not present inside the membranes of the rectum. However, internal hemorrhoids may cause bleeding when stools are passed. External hemorrhoids are usually painful. The veins outside of the rectum are swollen and may itch. Bleeding may occur, especially when straining to move the bowels.
  • External hemorrhoids can be diagnosed after observing the inflamed veins. If internal hemorrhoids are suspected, a healthcare provider may examine the rectum with an anoscope, proctoscope, or sigmoidoscope.
  • Mild cases of hemorrhoids are usually treated with over-the-counter creams or ointments, such as Preparation H®. Warm baths may also help improve symptoms.
  • If a blood clot forms in a hemorrhoid, a healthcare provider can make a surgical incision to remove the clot.
  • Rubber band litigation may be used to treat severe or persistent cases of hemorrhoids. During the procedure, small rubber bands are inserted around the base of the hemorrhoids. This cuts off the blood supply in the vein until the hemorrhoid falls off.
  • During a procedure called sclerotherapy, a chemical is injected near the hemorrhoid to shrink the inflamed vein.
  • If these therapies are ineffective, the hemorrhoids may be surgically removed in a process called hemorrhoidectomy.
  • Rectal prolapse: Rectal prolapse occurs when the inner lining of the rectum, called the rectal mucosa, protrudes from the anus. Rectal prolapse occurs when the tissues that normally support that rectal mucosa become loose and allow the tissue to slip down through the anus.
  • Without treatment, the condition may worsen and a large part of the rectum may protrude from the body through the anus. When this happens, the condition is called a complete prolapse. Most patients do not realize that they have rectal prolapse until it reaches this stage. Initially, the rectum may protrude during certain activities, such as coughing or laughing. Eventually, the prolapsed rectum may protrude more frequently or permanently.
  • Patients may be able to feel the tissue protruding out of the anus. Common symptoms of rectal prolapsed include pain during bowel movements, mucus or bleeding from the protruding tissue, and inability to control bowel movements.
  • Most patients with rectal prolapsed require surgery. The surgeon reattaches the rectum to the backside of the inner pelvis. Surgery may be performed through the abdomen or the perineum.
  • Stool softeners, such as calcium docusate (Surfak®) or sodium docusate (Colace®), may help reduce pain and straining during bowel movements.
  • Rectal inflammation (proctitis): Rectal inflammation, also called proctitis, occurs when the lining of the rectum (rectal mucosa) becomes swollen. Patients with proctitis often experience rectal bleeding, anal and rectal pain, frequent urge to have a bowel movement, passing mucus through the rectum, feeling of rectal fullness, and diarrhea.
  • There are many potential causes of proctitis. The most common cause is sexually transmitted diseases, which are acquired through anal or oral-anal intercourse. Other causes may include inflammatory bowel disease (IBD) and bacterial infections, such as streptococcus. Less common causes include chemicals (such as hydrogen peroxide enemas), injury to the rectum, radiation therapy that is applied near the rectum (for conditions such as prostate or cervical cancer), and medications or objects that are inserted into the rectum.
  • Several tests may be performed to diagnose the underlying cause of proctitis. Blood tests may be performed to detect possible infections. A colonoscopy may be performed to examine the inside of the colon for abnormalities. Healthcare providers may also use a swab to collect a sample of fluid from the rectum or urethra. The sample is then tested for STDs.
  • Most cases of proctitis are effectively treated and patients experience a full recovery. Treatment depends on the underlying cause of proctitis. If a bacterial infection is present, antibiotics, such as ciprofloxacin (Cipro®), levofloxacin (Levaquin®), penicillin, amoxicillin (Amoxil® or Trimox®), azithromycin (Zithromax®), clarithromycin (Biaxin®), or clindamycin (Cleocin®), may be taken. If a viral infection (e.g. herpes) causes proctitis, antivirals, such as such as acyclovir (Zovirax®), may be taken. Corticosteroids may be taken if radiation therapy is causing proctitis. If IBD is causing symptoms, anti-inflammatories, such as sulfasalazine (Azulfidine®) or anti-diarrheals, such as psyllium powder (Metamucil®), may be taken.
  • Laxative-induced colon damage: Laxatives are medications that are used to stimulate bowel movements. They are primarily used to treat constipation. Patients who overuse laxatives may develop colon damage. Long-term use of laxatives may cause the muscles in the colon to become weak from lack of use. The nerves in the lining of the colon may also become damaged. As a result, this may slow intestinal mobility and cause constipation.
  • Symptoms of laxative abuse include weight loss, hair loss, vomiting, abdominal pain, low energy, dehydration, dry eyes, headaches, mood swings, and bone pain.
  • Therefore, patients should not take laxatives more frequently than the packaging label suggests. If symptoms persist, patients should consult their healthcare providers to diagnose and properly treat the underlying cause.

Copyright © 2011 Natural Standard (www.naturalstandard.com)


The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.

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