Lets get healthyDr Sanjiv Haribhakti, MS, DNB, MCh (GI Surgery)

Kaizen hospital, 132 ft ring road, Nr helmet circle, Memnagar, Ahmedabad-380052

The digestive system

Effect of aging on digestive system

Esophagus• With age, the strength of esophageal contractions and the

tension in the upper esophageal sphincter decrease, but the movement of food is not impaired by these changes

• However, many older adults are likely to be affected by diseases that interfere with esophageal contractions

Effect of aging on digestive system

Stomach• Stomach lining's capacity to resist damage decreases, which in

turn may increase the risk of peptic ulcer disease, especially in people who use aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs)

• Stomach cannot accommodate as much food (because of decreased elasticity), and the rate at which the stomach empties food into the small intestine decreases

• Aging has little effect on the secretion of stomach juices such as acid and pepsin, but conditions that decrease acid secretion, such as atrophic gastritis, become more common

Effect of aging on digestive system

Small Intestine• Aging has only minor effects on the structure of the small

intestine, so movement of contents through the small intestine and absorption of most nutrients do not change much

• However, lactase levels decrease, leading to intolerance of dairy products by many older adults (lactose intolerance)

• Excessive growth of certain bacteria becomes more common with age and can lead to pain, bloating, and weight loss

• Bacterial overgrowth may also lead to decreased absorption of certain nutrients, such as folic acid, iron, and calcium

Effect of aging on digestive system

Pancreas and Gallbladder• Pancreas decreases in overall weight, and some tissue is replaced

by scarring (fibrosis)

• However, these changes do not decrease the ability of the pancreas to produce digestive enzymes and sodium bicarbonate

• As the gallbladder age, a number of structural and microscopic changes occur

Effect of aging on digestive system

Liver• The color of the liver changes from lighter to darker brown. Its size and blood flow

decrease. However, liver function test results generally remain normal

• The ability of the liver to metabolize many substances decreases with aging. Thus, some drugs are not inactivated as quickly in older people as they are in younger people

• the liver's ability to withstand stress decreases. Thus, substances that are toxic to the liver can cause more damage in older people than in younger people

• Repair of damaged liver cells is also slower in older people.

• The production and flow of bile decrease with aging. As a result, gallstones are more likely to form

Effect of aging on digestive system

Large Intestine & Rectum• The large intestine does not undergo much change with age

• The rectum does enlarge somewhat

• Constipation becomes more common. This may be due partly to a slight slowing in the movement of contents through the large intestine and a modest decrease in the contractions of the rectum when filled with stool

What is Acidity ?

• The stomach normally secretes acid that is essential in the digestive process. This acid helps in breaking down the food during digestion

• When there is excess production of acid by the gastric glands of the stomach, it results in the condition known as acidity

How to avoid Acidity ?

• A suitable diet must be strictly followed avoiding spicy, salty and acidic foods

• Smoking and alcohol consumption must be stopped

• Those with highly nervous and emotional disposition and those involved in high-stress jobs must be encouraged to take lifestyle modifying measures

How is GERD treated ?

Lifestyle changes• Altering eating and sleeping pattern• Eliminate smoking and alcohol consumption• Weight reduction

Drug therapy• Antacids - neutralize stomach acid• PPI - reduce stomach acid production

Surgery• Nissen fundoplication

Helicobacter pylori infection

• H pylori is a type of bacteria that normally infect the stomach

• It can lead to problems such as ulcers developing in the stomach or duodenum

• It is also associated with stomach cancer and an inflammation inside your stomach known as gastritis

Symptoms of H pylori infection

• Abdominal pain

• Excessive burping

• Feeling bloated

• Feeling sick or vomiting

• Losing your appetite

• Losing weight

How to prevent H Pylori infection ?

• Work in ventilated area - allow for fresh air flow

• Wash your hands frequently and properly

• Only drink clean water from a reputable source

• Broccoli sprouts has shown to inhibit H Pylori *

• Eating cranberries, red grapes, and blueberries make H Pylorigrow much more slowly and changes the shape of the bacterium into a coccoid form, so that it is no longer a helicobacter #

* http://www.ncbi.nlm.nih.gov/pubmed/19349290

# http://www.ncbi.nlm.nih.gov/pubmed/19120894

What is constipation ?

• Constipation occurs when bowel movements become difficult or less frequent

• You are considered constipated if you have two or more of the following for at least 3 months: Straining during a bowel movement > 25% of the time Hard stools > 25% of the time Incomplete evacuation > 25% of the time Two or fewer bowel movements in a week

Constipation - when to consult doctor ?

Call your doctor if:• Constipation is a new problem for you• You have blood in your stool• You are losing weight even without dieting• You have severe pain with bowel movements• Your constipation has lasted more than two weeks

How to prevent constipation ?

• Eat a well-balanced diet with plenty of fiber. Good sources of fiber are fruits, vegetables, legumes, and whole-grain bread and cereal (especially bran)

• Drink 12 glasses of water everyday

• Fiber and water help the colon pass stool

• Exercise regularly

Treatment of UC

Lifestyle changes• Limit dairy products• Eat more fibers - vegetables, fruits, bran• Take plenty of liquid• Avoid stress

Drug therapy• Anti inflammatory - sulfasalazine, mesalamine• Immune suppressor - azathioprine, cyclosporin

Surgery• Proctocolectomy

What is hernia ?• A hernia occurs when there is a weakness or hole in the muscular

wall that usually keeps abdominal organs in place - the peritoneum. This defect allows organs and tissues to push through, or herniate, producing a bulge

• Hernias are caused by a combination of muscle weakness and strain

• A hernia can develop quickly or over a long period of time, depending on its cause

Treatment of hernia

• If the hernia is growing larger or causing pain, doctor may decide that it’s best to operate

• Doctor may repair the hernia by patching the hole with surgical mesh

• Hernias can be repaired with either open or laparoscopic surgery

• Laparoscopic surgery uses a tiny camera and miniaturized surgical equipment to repair the hernia using only a few small incisions

• Laparoscopic surgery is less damaging to the surrounding tissue

What are piles ?

• Piles are swollen blood vessels in or around the anus and rectum

• The haemorrhoidal veins are located in the lowest part of the rectum and the anus

• Sometimes they swell so that the vein walls become stretched, thin, and irritated by passing bowel movements

Why do piles occur ?

• The blood vessels around the anus and in the rectum will stretch under pressure and may swell or bulge

• Inflamed veins (hemorrhoids) can develop when pressure increases in the lower rectum. This may be due to:• Chronic constipation• Chronic diarrhea• Lifting heavy weights• Pregnancy• Straining when passing a stool

How to prevent piles ?

• A change in diet can help keep the stools regular and soft. This involves eating more fiber, such as fruit and vegetables, or switching your cereal breakfast to bran

• losing weight may help reduce the incidence and severity of hemorrhoids

• Try not to strain when you go to the toilet

• Avoid laxatives

• Exercise

Surgery to cure piles• Used for particularly large piles, or grades 3 or 4 hemorrhoids

• Hemorrhoidectomy - the excess tissue that is causing the bleeding is surgically removed. It is the most effective in completely removing piles, but there is a risk of complications, such as difficulties passing stools, as well as UTI

• Hemorrhoid stapling - blood flow is blocked to the tissue of the hemorrhoid. It is usually less painful. However, there is a greater risk of hemorrhoid recurrence and rectal prolapse (part of the rectum pushes out of the anus)

What is cancer ?• Normal cells multiply when the body needs them, and die when the

body doesn't

• Cancer appears to occur when the growth of cells in the body is out of control and cells divide too rapidly

• It can also occur when cells “forget” how to die

• There are many different kinds of cancers

Most common cancers in India

28

1712

7

30

13 12

6 4

0

5

10

15

20

25

30

35

Prostate cancer

Breast cancer Lung cancer Colorectal cancer

Bladder cancer

Uterus cancer

Ovary cancer

Men Women

Most common GI cancers

Colorectal cancer

Esophageal cancer

Pancreatic cancer

Stomach cancer Liver cancer

Risk factors of cancer ?

There are multiple risk factors of cancers, including:• Radiation• UV light• Tobacco• Certain viruses• Benzene• Genetic / Hereditery

Early detection of cancer

• Early detection of cancer greatly increases the chances for successful treatment

• There are two major components of early detection of cancer:• Education to promote early diagnosis• Screening

Education to promote early diagnosis of cancer• Recognizing possible warning signs of cancer and taking prompt

action leads to early diagnosis

• Increased awareness of possible warning signs of cancer can have a great impact on the disease

• Some early signs of cancer include:• lumps• sores that fail to heal• abnormal bleeding per rectum• persistent indigestion• chronic hoarseness• Difficulty in swallowing

Screening to promote early diagnosis of cancer• Screening refers to the use of simple tests across a healthy

population in order to identify individuals who have disease, but do not yet have symptoms• breast cancer screening using mammography• cervical cancer screening using cytology screening methods

including Pap smears• Colorectal cancer screening using colonoscopy• UGI cancer screening using UGI endoscopy

Lifestyle diseases

• Lifestyle Diseases are diseases that are caused partly by unhealthy behaviors and partly by other factors

Today's lifestyle

Abundance of fats & sugar Change in work culture

Lack of Physical Exercise Emotional Distrubances

Most common lifestyle diseases

• CVDs

• Diabetes Mellitus

• COPD

• Cancer

• Asthma

• Disease of Digestive System (Peptic Ulcers, GERD)

• Genitourinary Conditions (Nephritis, CKD)

• Neuro-Psychiatric Disorders (Depression, Anxiety, Stress)

Top 4 Lifestyle Diseases in India

Obesity has reached alarming figures

• More than 25% of Indians are overweight

• More than 3% are Obese (3 crores Indians)

• > 5% of urban adults are obese

• > 15% of urban children are overweight

Complications of obesity

Surgery for morbid obesity

Gastric SleeveGastric Bypass Gastric Band

Planning a meal

• Proportions and timings are important• Portions at each meal should be balanced and proportionate• Eat at regular intervals

08:00 AM 10:30 AM

01:00 PM 04:00 PM 08:00 PM 09:30

PM

Size of circle indicates size of meal

Health benefits of yoga & exercise

• Yoga has been practiced for more than 5000 years

• Speeds up a Sluggish Digestion by massaging surrounding muscles

• Increases Muscle Flexibility, Strength & Endurance

• Relieves Stress & Anxiety

• Boost positive Energy and Mood

• Help normalize Blood Pressure

• Increases feelings of Calm & Wellbeing

Health benefits of meditation

• It can reverse the Stress Response, thereby provides a shield against the effects of Chronic Stress

• Heart Rate and Breathing slows down, Blood Pressure normalizes

• Oxygen can be used more efficiently

• Adrenal glands produce less Cortisol

• Mind ages at a slower rate

• Improves Immune Function

Use Stairs more often

Gardening & Leisurely activities

Self clean the house at least weekly

Stay physically active

Stay physically active

Clean the Car by hand Play with children everyday

Take optimum sleep of 8 hourstoo much sleep can also cause fatigue

stay happystay healthy