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Show 1144: New Ways to Heal Your Digestive Tract

We talk with two eminent experts about how to heal your digestive tract. Dr. Shaheen treats Barrett's esophagus. Dr. Bretthauer treats C diff.
Nicholas Shaheen, MD
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New Ways to Heal Your Digestive Tract

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Heartburn is a common problem. Many people take powerful acid-suppressing drugs like Nexium or Prilosec every day to treat gastro-esophageal reflux disease or GERD. If untreated, chronic irritation of the swallowing tube can lead to Barrett’s esophagus. Do you have to take medications forever to treat this condition? Are there better ways to heal your digestive tract?

How Often Do You Need Colonoscopy?

Dr. Nicholas Shaheen has written about finding the right balance of endoscopy so that intestinal cancers are detected early enough for treatment and patients are not exposed to undue risks from overly-frequent screening. Colonoscopy is effective for detecting colon polyps before they become cancerous. Having colonoscopies at the correct interval can prevent or greatly reduce the risk of colorectal cancer. What interval is correct for you?

In the esophagus, chronic exposure to stomach acid can lead to changes doctors call Barrett’s esophagus. This is a pre-cancerous condition. How often does someone with this disorder need upper GI endoscopy to screen for esophageal cancer? Just what is the risk of esophageal cancer?

New Ways to Heal Your Digestive Tract from Barrett’s Esophagus:

When gastroenterologists perform endoscopies and discover the beginnings of a tumor in the esophagus, they can remove it then and there. The procedure is called endoscopic mucosal resection. A new technique, ablation, to heal Barrett’s esophagus shows great promise. It may often reverse the problem indefinitely. Find out how you can deal with heartburn and how you can heal your digestive tract if you have chronic reflux.

How Can You Heal Your Digestive Tract from C Diff?

Antibiotic treatment can frequently disrupt the balance of bacteria in the colon. The consequence may be a C diff infection that can cause severe diarrhea. The usual treatment for C diff is additional antibiotic therapy, but that isn’t always effective. The FDA has approved fecal transplants for treating C diff infections. What are they, and how do they work? What other conditions might respond to fecal transplants designed to re-establish a normal microbial balance in the digestive tract?

This Week’s Guests:

Nicholas J. Shaheen, MD, MPH, is the Bozymski-Heizer Distinguished Professor of Medicine at the University of North Carolina School of Medicine, and Chief of the Division of Gastroenterology and Hepatology at UNC. Dr. Shaheen is a recognized expert in esophageal diseases and endoscopy. He is author of multiple treatment guidelines for gastrointestinal illnesses. The photograph is of Dr. Shaheen. His article on “Less Is More: A Minimalist Approach to Endoscopy” was published in Gastroenterology in May 2018.

Michael Bretthauer, MD, PhD,is Professor of Medicine at the Institute of Health and Society at the University of Oslo and the Department of Transplantation Medicine in Oslo University Hospital, Oslo, Norway. He is also President of the Frontier Science Foundation in Brookline, MA. Hi article on “Fecal Microbiota Transplantation for Primary Clostridium difficile Infection” was published in the New England Journal of Medicine on June 28, 2018.

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About the Author
Terry Graedon, PhD, is a medical anthropologist and co-host of The People’s Pharmacy radio show, co-author of The People’s Pharmacy syndicated newspaper columns and numerous books, and co-founder of The People’s Pharmacy website. Terry taught in the Duke University School of Nursing and was an adjunct assistant professor in the Department of Anthropology. She is a Fellow of the Society of Applied Anthropology. Terry is one of the country's leading authorities on the science behind folk remedies. .
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Joe and Terry
Dr. Shaheen seemed excited about the future of treatments “on the horizon” these new treatments fixed the anatomical problem with acid reflux, so one would not have to take PPIs. He did not name specific procedures.
What are these procedures?

While I find most of your radio shows very informative and a genuine service to the public, I was not impressed with the advice from Nicholas J. Shaheen, MD, MPH. Your show normally focuses on prevention, yet Dr. Shaheen had no idea how to prevent colon issues and, instead focusing on expensive procedures (Colonoscopy) which, from what I’ve learned, is not as benign as doctors would suggest. Many people have incurred visual impairments after the use of anesthesia, and the idea of injecting chemicals prior to the procedure I’m sure comes with a risk. Furthermore, I would have an issue having polyps cut out without my prior consent. It’s like having surgery without consent. Inspecting is one thing, cutting is another. And IF the polyp is cancerous, by attempting to cut it out, haven’t you now caused the cancer to spread, similar to doing biopsy’s and the known risk of needle track seeding? Nope, I’ll NEVER have a Colonoscopy. When my doctor suggested it, I told him, “I don’t eat beef, never smoked, keep my weight at 130, eat only organic foods and exercise routinely at 66 years old. Why would I be a risk for colon cancer?” He couldn’t provide me with an answer. The subject was dropped. Instead of pushing expensive, chemical based colonoscopy’s, I’d like to see the medical field focus more on prevention. I’m fed up with a medical industry that focuses only on “money making” treatments and procedures, rather than prevention, and I have developed a very low trust for such an industry.

The discussion of treating c-diff infections and other chronic bowel disorders with microbes from a healthy person’s fecal matter is fascinating (though ‘yukky’). It reminded me of hearing of an African folk remedy for intestinal upsets, including colic in babies, which consisted of a tea made from fresh elephant dung. I had also heard, years ago, that there was a folk remedy for colic used in rural America and elsewhere, in times before modern medicine developed, which was a tea made from sheep dung. Both these folk remedies would be consistent with the idea of introducing desirable microbes into the digestive system of ailing patients. Needless to say, I am not advocating trying this as a home remedy! But I wonder whether it has been noted and investigated by modern medical researchers as a potential source of new treatments.

I was diagnosed with Barrett’s a year ago. My GI doc said to come back in 5 years to have another endoscopy. Isn’t that too long to wait? I have never had acid reflux or at least I don’t know I have it. I also have microscopic colitis. Is 5 years too long to wait for another endoscopy?

I second the suggestion that a program on LPR would be beneficial.

My mother has had repeated bouts of C-diff since 2016, with multiple episodes over this past summer. Vancomycin did the trick, temporarily, but when it returned again after just one week of being off the medication I was feeling desperate. Then I found a journal article recommending doing a Vancomycin taper, with the rationale being a taper would help the “good” bacteria repopulate while keeping the c-diff at bay. So, far, after 6 weeks it is working. We’ll soon be done with the treatment, as at this point she is taking a small dose every three days. Fingers crossed that we will be done with it. The only other thing we added is a small glass of Kefir once a day to add some good bugs. Maybe this could be helpful for some folks.

I moved to a small town in Texas shortly before my first colonoscopy was due, so I had no one to accompany me to my procedure as required because of the anesthesia. After repeatedly telling my doctor this, I finally asked if I could have the procedure without anesthesia. It turned out I could. It was a piece of cake — much easier than the prep the day before — and I was able to drive and do whatever I pleased afterward. I highly recommend getting the colonoscopy without anesthesia to anyone who doesn’t have any existing issues, like irritable bowel syndrome.

Decades ago, after a lifetime of GERD, even as a toddler, I had an upper GI. As I suspected, I had an esophogeal sphincter that wouldn’t close (like my granddad before me and my niece since). I also had a polyp removed, but never heard a thing about followup. Fortunately, soon after, Prilosec became an over the counter solution that worked for me, so I’ve been a MUCH happier woman since.

Regarding C. difficile, my dad got that when he was in and out of the hospital following a kidney transplant in the years before he died of MRSA pneumonia. I don’t know if fecal transplants would be available to transplant patients on immunosuppressants, but it certainly would have made my dad’s last years a little less fraught.

Great information on reflux. How about having Dr. Shaheen back to address laryngopharyngeal reflux (LPR)? I had never heard of this, until it first affected me a year ago.

1 December 2018
Joe and Terry
Your program today, 1 December 2018, was terrific; “Five Stars”. But there must be a followup program dedicated to prevention. May I suggest as guest experts Justin and Erica Sonenburg PhDs, authors of the Good Gut. I would further like to suggest the program be entitled “Good Carbs”. (Yes, I am serious.)

This is a very interesting show — I wish you would ask one of your medical guests in the near future, why antibiotics don’t kill C-Diff, since it’s not a yeast. They always say, dismissively, that the antibiotics “kill off the good bacteria,” leaving the bad bacteria to proliferate, but that’s not logical. Antibiotics were designed to kill bad bacteria, and the loss of good bacteria is a result of the indiscriminate nature of broad spectrum antibiotics. We all know why yeast or fungals might proliferate, but what allows C-Diff–a bacteria itself–to not only resist antibiotics but to benefit? Please ask one of your guests to address this important conundrum: the answer might tell us a lot about key nuances in digestive health!

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