Download Now you may also buy Policy online at www.starhealth.in

Printed Matter
Now
you may also buy Policy online at www.starhealth.in
Consult our Expert Doctor For Free Medical Advice on our Toll Free Number 1800 425 2255
STAR Health
03 - Message From CMD
04 - Star Unique Health Insurance Policy
09 - Chest Pain
12 - The villain behind gastric ulcer
14 - Laryngopharyngeal Reflux Disorder
Heart burn and reflux- Advanc
16 -Ma
es in nagement
Are we paying the price for
18 -we
sternization?
20 - Obesity
23 - Stomach cancer
25 - Fitness section
About Your Company
India’s First StandAlone Health Insurance Company
has begun its operations in May 2006.Today the
Company’s paid up capital stands at Rs. 303 Crores.
Chairman - Emeritus
Mr. Syed Mohamed Salahuddin - Managing Director of ETA
ASCON and ETA STAR group of Companies in Dubai, U.A.E.
Our Board of Directors
Mr. V. Jagannathan
Chairman-cum- Managing Director with over 40 years of
experience in Insurance Industry.
Padmashri D. R. Kaarthikeyan
Held various prestigious positions including Chief of Special Investigation Team, CBI; Director of Police Academy,
Mysore; Chief of Intelligence and Director General of National Human Rights Commission. He was the Chairman
of the Special Task Force instituted by the Government
of India in the Rajiv Gandhi assassination case.
Publisher:
Mr. Essa Abdullah Al Ghurair
Mr.V. Jayaprakash
Member of the prominent Al Ghurair family in the U.A.E.
Printer:
Dr. M.Y. Khan
Mr. D. Srikanthan,
Former Chairman of Jammu & Kashmir Bank Ltd.
306, Purasawakkam High Road,
Chennai – 600010.
Mr. Mohamed Hassan
Chief Editor:
Prominent Educationalist and Industrialist
Dr. Asiya Shahima Khan
Mr. V.P. Nagarajan
Editorial Board Members:
Executive Director of ETA Ascon and ETA Star Group
Dr. S. Prakash
of Companies in UAE.
Dr. C.B. Krishna Kumar
Dr. Jeba Victor
Mr. Dinesh Chandra Gupta
Former Finance Secretary, Government of India and Corporate Office
Member,
MRTP Commission
Star Health and Allied Insurance Company Ltd,
#1, New Tank Street, Valluvar Kottam High Road,
Mr. K.S. Jangbahadur
Nungambakkam, Chennai – 600034
President – Private Equity, ICICI Venture Funds
Email: [email protected]
Management Co. Ltd.
Feathers in our Cap
Star Health and Allied Insurance Company has been awarded the prestigious “The Great Mind Challenge
for Business 2010 Award” instituted by IBM under two different categories for its path breaking initiatives in
providing paperless processing and settlement of claims in the Kalaignar Kapeettu Thittam, an initiative by the
Tamilnadu Government to bring health care to the doorsteps of the poor and under privileged.
1.‘The Most Innovative Solution implemented using Information Management Software’
2. ‘The Most Innovative Green IT solution using IBM software’
OUR NEXT ISSUE WILL FOCUS
Star Health Specialties
ON INFECTIOUS DISEASES,
 A user friendly website with Health tips
APART FROM OTHER INFORMATIVE
HEALTH ARTICLES
 200 offices across India with 5000 Employees
 Cashless treatment facility with over 4900 Network Hospitals across India
 A full-fledged 24X7 call Centre with a Toll free facility (1800 425 2255) for effective claims handling
 24 X 7 Health Information Helpline - Expert Medical Consultation available to all customers at
all times
2 STAR Health
Consult our Expert Doctor For Free Medical Advice on our Toll Free Number 1800 425 2255
MESSAGE
FROM CMD
My dear policy holder,
In the earlier issue I have mentioned about living with diabetes can be sweeter with
Star Health by your side. In this issue the focus is on problems relating to gastroentero
logy. You will kindly observe published in this issue that articles are contributed by eminent
Doctors and I am sure you can preserve this magazine and it will serve as a guide book for
whomsoever when needed.
In Star Health we are always at your service 24 x 7 and you can contact us through
Toll free number should you need help over phone for any minor problems. As regards
products, we have come out with two new innovative products recently viz., Star Unique
Health, covering the pre-existing diseases with certain conditions and another product viz.,
Star Wedding Gift covering maternity benefits besides regular health cover etc to the couple.
It is my humble suggestion that instead of presenting any other gift to the newly wedded
couple, Star Wedding Gift policy can be given, which will, in addition to giving medical protection, will also take care of their maternity benefits etc. Of course, terms and conditions
can be read from our website.
With your kind support your ‘Star Health’ has crossed Rs.1000 Crores. I would only
appeal to you to give us your continued and valuable support in the years to come to serve
you better.
To conclude, I would say that Star Health is not in the sky but always at your doorstep to
serve you with a lots of smile.
Yours Sincerely
V. Jagannathan
Chairman-cum-Managing Director
Consult our Expert Doctor For Free Medical Advice on our Toll Free Number 1800 425 2255
STAR Health 3
NEW ADDITION TO
OUR PRODUCT RANGE
Star Unique Health Insurance Policy
What is Unique about this policy?
Star Health brings you this Unique insurance policy with unique benefits for – coverage for both future ailments / diseases and
for pre existing diseases / conditions.
 Policy Benefits
 Hospitalization Cover : In-patient
hospitalisation for a minimum of 24 hours.
Expenses covered are:
Room rent, Boarding and Nursing
Expenses @ 1% of sum insured subject to
a maximum of Rs.3000/- per day.
Surgeon, Anaesthetist, Medical Practitioner, Consultants, Specialist Fees.
Anaesthesia, Blood, Oxygen, Operation Theatre charges, Surgical Appliances,
Medicines and Drugs, Diagnostic Materials and X-ray, Dialysis, Chemotherapy,
Radiotherapy, cost of Pacemaker and similar
expenses.
Emergency ambulance charges for tranporting the insured person upto a sum of
Rs.750/- per hospitalisation and overall limit
of Rs.1500/- per policy period.
 Pre & Post Hospitalisation
 Pre-hospitalization medical expenses
upto 30 days prior to the date of admission.
 Post-hospitalization –
a lumpsum calculated at 7% of the
hospitalization expenses (excluding room
charges) subject to a maximum of Rs.5,000/-.
 Pre Existing Disease/Condition
Pre-Existing Disease/ Condition (other
than those diseases / conditions for which
specific periods have been mentioned under
exclusions) will be covered after 11 months
of continuous coverage have elapsed, since
inception of this policy with the Company.
4 STAR Health
 HIV positive persons
Covers HIV positive persons except for opportunistic infections and treatment for HIV /
AIDS. The minimum CD 4 count at the time of
entry should be 350.
 Non Allopathic Treatments
Upto 25% of sum insured subject to a maximum of Rs.25000 per occurrence, per year of
insurance.
Consult our Expert Doctor For Free Medical Advice on our Toll Free Number 1800 425 2255
 Eligibility
Any person aged between 18 years and 65 years residing in India. Renewals would be
accepted upto 70 years.
 Beyond 70 years renewals would be provided under any other health insurance policy
of the company.
 Is there any pre-acceptance medical screening
There is no pre acceptance medical screening
 Policy Period :
This is a two year policy The sum insured and sub limits are for each year of insurance
and cannot be cumulated or carried forward.
 Payment of premium:
 The premium under the policy can be paid in 2 instalments as indicated.
 The first instalment is payable at the commencement of the policy.The second instalment
is payable at the beginning of the second year of the policy. Where a claim is made before such
instalment falls due then the same would be recovered from the eligible claim amount
 The policy would lapse if the instalment is not paid on or before the due date.
 Annual Policy Premium (Ser vice Tax Extra)Premium Table to be inser ted
Note : The sum insured is for each year of insurance and cannot be cumulated or
carried forward
 Tax Benefits
 Payment of premium by any mode other than cash for insurance under this policy is
eligible for relief under section 80D of the Income Tax Act
 Renewal:
The policy is renewable except where it is found that the insured person has
misrepresented / committed fraud.
Where the claims ratio under the immediately preceding policy period exceeds 100% then
loading on the premium as per the scales below would apply:
Claims ratio > 100% upto 125% - loading on premium 20%
Claims ratio > 125% upto 150% - loading on premium 30%
Claims ratio > 150% - loading on premium 50%
A grace period of 15 days from the date of expiry of the policy is available for renewal. If renewal is made within this this 15 day period continuity of benefits will be allowed, subject to the
condition that any claim arising during this break-in period shall not be paid for.
This grace period is applicable for instalment also.
 Exclusions
 Treatment of disease/sickness/illness contracted by the Insured Person during the
first 30days from the commencement date of the policy.
 First twoYears exclusions : Cataract, Hysterectomy (abdominal andVaginal), Dysfunctional
Uterine Bleeding (DUB) Fibroid Uterus, Prolapsed Uterus, Myomectomy, Cystectomy,Treatment
of Internal Derangement of Knee (other than caused by an accident),Treatment for Joints (other
than caused by an accident), other Arthroscopic procedures, Inter-Vertebral Disc Prolapse (other
than caused by accident), Degenerative Vertebral and Disc diseases,Varicose veins and Varicose
ulcers,Thyroiditis,Treatment of Goitre,Tympnoplasty, Mastoidectomy Glaucoma.
These are not payable irrespective of whether they are Pre-Existing or not.
 First year exlusions : Deviated Nasal Septum, Benign Prostate Hypertrophy, Hernia,
Consult our Expert Doctor For Free Medical Advice on our Toll Free Number 1800 425 2255
STAR Health 5
Hydrocele, Congenital Internal diseases/defects, Fistula in anus, Piles, Fissure in anus, Sinusitis,
and related disorders, Nasal Polyps ,Post trauma non union / mal union, Cholecystectomy, Gall
Bladder Calculi and Renal Calculi
If any of these are Pre-Existing they will be covered after 24 months of continuous
insurance with the Company.
 During the first 48 months of continuous operation of this Insurance cover the expenses
on Stapedectomy, Bone marrow transplant, Cirrhosis of liver with or without portal Hypertension, Hepatitis, Loss of vision partial / total including Retinopathy, Retinal Detachment, Macular
degeneration and Papill Oedema, all types of Cancer, Nephropathy and Chronic Kidney diseases
and Implant Removal shall not be payable if these are Pre-Existing at the commencement of this
insurance.
 30% of each and every admissible claim.
 Naturopathy treatment
 Expenses which are purely diagnostic in nature with no positive existence of any disease
 Expenses which are mainly cosmetic in nature
Note : For a detailed list of exclusions please refer policy conditions.
 Claims Procedure
 Call the 24 hour help-line for assistance - 1800 425 2255
 Inform the ID number for easy reference
 In case of planned hospitalization inform 24 hours prior to admission in the hospital
 In case of emergency hospitalization information to be given within 24 hours
after hospitalization
 Cashless facility can be availed in all net-work hospitals
 I n n o n - n e t w o r k h o s p i t a l s p ay m e n t m u s t b e m a d e u p - f r o n t a n d t h e n
reimbursement will be effected on submission of documents.
Applicable for offices in Ahmedabad, Bangalore, Mumbai including
Thane and New Delhi including Faridabad, Gurgaon & Noida
Sum Insured
Options (Rs)
Sub-limit
for PED
Cover(Rs)
18yrs25yrs
26yrs40yrs
41yrs55yrs
56yrs60yrs
61yrs65yrs
66yrs70yrs
100000
200000
300000
50000
100000
150000
5880
7585
10625
6720
9840
13800
10080
14760
20010
11760
17220
22770
14170
20745
23805
16100
23575
26450
Applicable for offices in rest of India
Sum Insured
Options (Rs)
100000
200000
300000
Sub-limit
for PED
Cover (Rs)
50000
100000
150000
18yrs25yrs
26yrs40yrs
41yrs55yrs
56yrs60yrs
61yrs65yrs
66yrs70yrs
4900
6320
8855
5600
8200
11500
8400
12300
16675
9800
14350
18975
12320
18040
20700
14000
20500
23000
Note: Premium figures are excluding Service Tax.
6 STAR Health
Consult our Expert Doctor For Free Medical Advice on our Toll Free Number 1800 425 2255
Can there be a better gift than the gift of security and
protection?
Introducing Star Wedding Gift Insurance Policy – a companion which protects you in adversity and supports you in
moments of joy.
Policy Benefits
1.
Hospitalization Cover
In-patient hospitalization expenses for a minimum of
24 hours
l Room, Boarding, Nursing expenses upto Rs. 4, 000/per day.
l Surgeon, Anaesthetist, Medical Practitioner,
Consultants, Specialist fees.
l Cost of medicines and drugs.
l Emergency ambulance charges for transporting the
insured patient to the hospital upto a sum of Rs. 1, 000/- per
hospitalization and overall limit of Rs.1,500/- per policy period
l
2. Delivery including Pre Natal and Post
Natal Cover
Expenses for delivery of child
(Caesarean/Normal Delivery – for one delivery only)
upto the limits
l Pre and Post natal expenses included
l P o s t d e l i v e r y c o m p l i c a t i o n c o v e r f o r
mother
Star
Wedding
Gift
Policy
l
3.
l
4.
l
5.
l
6.
Free Benefit
Cost of test incurred for detecting any disorders in
the Foetus upto Rs. 1, 000/- (after a waiting period of
27 months)
A wedding gift
you would appreciate
when you deliver
your baby
New Born Baby Care
Cover for Newborn baby (including
Congenital disorders/defects)
Non Allopathic Treatments
Upto 25% of sum insured per occurrence, subject to
a maximum of Rs. 25, 000/- per policy period
Pre Existing Disease
l
Pre existing diseases are covered after 48 months of
continuous insurance with the company.
7.
Pre & Post Hospitalization

Is there any pre-acceptance medical
screening
Pre-hospitalization medical expenses upto 30 days
prior to the date of admission.
l Post-hospitalization – a lumpsum calculated at 7%
of the hospitalization expenses (excluding room
charges) subject to a maximum of Rs. 5, 000/- is payable.
l Not applicable for child delivery claims.
l
l
There is no pre acceptance medical screening.
Consult our Expert Doctor For Free Medical Advice on our Toll Free Number 1800 425 2255
STAR Health 7
 Policy Period
Policy is offered for the following periods
l 1 year
l 2 years
l 4 years
 Eligibility
l Any couple aged between 18 years and 40 years
residing in India can take this insurance.
l Renewable upto 45 years.
 Sum Insured:
Coverage
a. Hospitalization Expenses
b. Child Delivery Expenses
Option 1
Option 2
Rs. 3,00,000/Rs. 5,00,000/Rs. 15,000/- for normal
Rs. 20,000/- for normal
delivery and Rs. 20,000/delivery and Rs. 25,000/for caesarean delivery
for caesarean delivery
c. Pre and Post Natal Expenses (as part of Pre Natal : Rs. 1,500/Pre Natal : Rs. 2,000/Child Delivery Expenses)
Post Natal : Rs. 2,000/Post Natal : Rs. 4,000/d. New Born Baby Cover : Hospitalization
Rs. 30,000/Rs. 50,000/expenses for treatment including congenital
diseases
e. New Born Baby Cover :Lump sum payment
Rs. 60,000/Rs. 1,00,000/for Down’s Syndrome and Cerebral Palsy
f. Post Delivery Complications
Actuals within
Actuals within
Hospitalization Limits
Hospitalization Limits
g. Test for detecting congenital abnormality
Rs. 1,000/Rs. 1,000/in foetus
Note:The coverage limits mentioned in (b) to (f) above, is part of the overall Sum Insured mentioned
under (a) above.
 Policy period for One Year cover
(Service Tax Extra):
Option
Family Size
Option 1
2A
2A + 1C
2A
2A + 1C
Option 2
 Policy period for Two Years cover
(Service Tax Extra) :
Premium (Rs.)
5 months 36 years
– 35 years – 45 years
10305
10740
10535
11305
13960
14680
14470
15310
Option
Family Size
Option 1
2A
2A + 1C
2A
2A + 1C
Option 2
Premium (Rs.)
5 months
36 years
– 35 years – 45 years
18550
19335
18965
20350
25130
26425
26050
27560
 Policy period for Four Years cover (Service Tax Extra) :
Option
Family
Size
Option 1
2A
2A + 1C
2A
2A + 1C
Option 2
8 STAR Health
Premium (Rs.)
5 months – 35 years
36 years – 45 years
43285
45110
44250
47485
58635
61660
60775
65145
Consult our Expert Doctor For Free Medical Advice on our Toll Free Number 1800 425 2255
Chest Pain
Prof. S .Thanikachalam MD, DM
Chairman and Director,
Cardiac Care Center,
Sri Ramachandra University.
C
hest pain is one of the important
symptom which make people nervous, since it is often mistaken for
Cardiac pain - angina. Recurrent
chest pain mimicking angina pectoris can arise from the esophagus.
Esophageal disorders especially gastroesophageal reflux disease (GERD) are probably the most
common cause of non – cardiac chest pain. Nearly
30% of all patients with chest pain undergoing
coronary angiography for coronary artery disease
have normal angiograms and upto 60% may have
esophageal disease for their symptoms. Many patients with esophageal chest pain complain of other
esophageal symptoms when questioned closely, but
10% may have only chest pain as there presenting
complaints.
Let us look into the reason for chest pain due to
esophageal reflux and chest pain due to heart.
The specific mechanisms that produce esophageal chest pain are not well understood. Chest pain
that arises from esophagus has commonly been
attributed to the stimulation of chemo-receptors
(acid, pepsin, bile) or mechano-receptors (distension,
spasms) although thermo-receptors may also be
involved.Acid sensitivity produces pain presumably
or direct stimulation of sensory nerve ending in the
esophagus. Many patients with suspected esophageal
chest pain have esophageal motility disorders which
might cause distal esophageal spasm thus causing
Consult our Expert Doctor For Free Medical Advice on our Toll Free Number 1800 425 2255
STAR Health 9
Chest Pain
inhibition of blood flow for a critical period of time,
leading to myoschemia. This myoischemia might
be the cause of the esophageal chest pain. Studies
suggest the esophageal dysmotility may present an
epiphenomenona of a chronic pain syndrome rather
than the direct cause of complaints.
Other potential causes of esophageal chest pain
include the excitation of temperature receptors or
distension.The ingestion of cold liquids can produce
severe chest pain. Distension of stretch
receptors of distal esophagus by
acute food impaction or carbonated beverages may lead to chest
pain when sensitized to gastroesophageal acid.
The specific mechanism of
chest pain due to heart may be
multiple.The common reason is obstruction to blood flow within blood
vessel reducing in the blood flow to
heart muscle or sudden spasms
of the artery interfering with
the blood supply to heart
muscle or splitting of
blood vessel wall due to
high blood pressure (dissection of aortic wall).
Generally pain due to
heart is precipitated by
exertion; emotion and
intense grief, at times
10 STAR Health
even at rest depending up on
the degree of obstruction in
coronary artery or the no. of
vessels that are affected.
Differentiation of chest
pain due to gastroesophageal
and heart.
Gastroesophageal
Intermittent anterior chest
pain is the sine-qua-non of
this syndrome. Chest pain is
usually described as squeezing
or burning, substernal in location and radiating to the back,
neck, making it sometimes
indistinguishable from cardiac
chest pain. It can be triggered
by ingestion of very hot or
very cold liquids. It frequently
awakens the patient from sleep
and may worsen during periods
of emotional stress.The pain episode may last from
minutes to hours and even persist
intermittently for several days. Symptoms may abate
spontaneously and may be eased with antacids but
relief of severe chest pain may require narcotics
or nitroglycerine. Most patients with esophagitis
have associated other esophageal symptoms (e.g.
epigastric or retrosternal burning sensation, sour
eructation’s, water brash, or regurgitation) when
closely questioned, but about 10% may have chest
pain as their only complaint.
Clues suggesting esophageal origin of chest
pain Diffuse burning, hot acidic sensation in
the chest
‘Open-hand’ presentation in contrast to
the ‘clutched fist (Levine’s sign) in myocardial
ischemia
Pain continues for
hours
Wakes patient from
sleep
Pain that is meal
related
More in recumb e n c y, b e n d i n g o r
straining
Cardiac pain
Further pain localized to one point especially one finger tip size
not spreading to other
Consult our Expert Doctor For Free Medical Advice on our Toll Free Number 1800 425 2255
parts of the chest not aggregated
are induced by exertion is unlikely
to be due to cardiac origin. Depending up on the severity of the
disease the chest pain may happen
at rest or on exertion. Pain is usually not localized spread in wide
area, usually center of the chest
spreading to both sides of the
chest often spreading to left arm
or both arms and occasionally to
the jaw, lasts for 5 to 10 min, often
associated with the sense of fear
or anxiety, fatigue or tiredness
or often afraid to move or walk
since the pain aggravates.At time
it is not pain, more of burning
sensation but spreading on the
chest same way as mentioned
above. This sort of pain coming
on exercise or at rest may not
indicate that it is heart attack. It
is only called angina.
But during heart attack since
the condition is due to the total
block of a vessel supplying the
heart muscle depending up on the
artery that is involved, the pain
is more excruciating or piercing
in nature often associated with
perfused sweating, palpitation
and on many occasions difficulty
in breathing. In rare occasions
inspite of these differentiating
points, the esophageal pain may mimic like angina or angina may mimic
and esophageal pain.The age of the patient, sex, associated risk factors
like Diabetes, Smoking, Hypertension, High blood cholesterol, marked
obesity may give a clue to the cause of chest pain. On many occasions
ECG at the time of discomfort or exercise test (Treadmill test) and
rarely a non invasive or invasive angiogram may be needed to differentiate the pain especially in the presence of risk factors mentioned
above.
l
Consult our Expert Doctor For Free Medical Advice on our Toll Free Number 1800 425 2255
STAR Health 11
H.Pylori:
The villain behin
What is H Pylori?
H. Pylori is a spiral shaped organism that is found
in the stomach of most adults. It adheres to the
stomach lining and can cause gastritis, gastric and
duodenal ulcers and even stomach cancers.
What is H Pylori?
 infection is usually associated with poor
hygienic conditions and overcrowding
 bacteria spread from one person to another
mainly in children either through oral-oral contact
or faeco-oral contact.
 In developing countries, it has been found to
infect almost 80 - 90% of the entire population.
What does it do in the body:
l The bacteria produce chemicals that increase
acid production and cause local inflammation (gas-
12 STAR Health
Dr. V. Ramasubramanian
Consultant
Infectious Diseases
Apollo Hospitals
Boosters Immune Clinic
tritis and duodenitis).
l Chronic inflammation can cause changes in
the cell structure and function and lead to abnormal
cells which turn cancerous.
l About 95% of duodenal ulcers are infectd
by H. Pylori and treating the infection will prevent
recurrence.
l Fortunately only 15% of people infected with
H. Pylori develop duodenal ulcers. Gastric ulcers and
gastritis can also occur due to damage by chemicals
induced by the bacteria.
Clinical symptoms
H. Pylori can cause an acute infection associated
with fever and dyspepsia which is self limited. H. Pylori
gastritis can be asymptomatic or may simply cause
upper abdominal discomfort or dyspepsia.
Duodenal ulcers are more common than gastric
ulcers.The characteristic feature is upper abdominal
pain and ‘burning sensation’.The pain characteristically occurs at night and is relieved by antacids.
Nausea may accompany the pain but vomiting is
infrequent even though it may relieve pain. Loss of
appetite and weight may occur with gastric ulcers
and chronic pain is more typical. Sometimes back
pain may result from the ulcer penetrating through
the posterior wall of the stomach. Patients may also
present with blood in vomitus or in the stools and
rarely acute abdominal pain crisis resulting from
perforation of the stomach.
Untreated, the symptoms of stomach ulcer
are periodic with waxing and waning over several
years.
Consult our Expert Doctor For Free Medical Advice on our Toll Free Number 1800 425 2255
nd gastric ulcer
Complications of Peptic Ulcer
Several complications can occur due to peptic
ulcer.
1) Bleeding :Massive bleeding can result in
collapse and death
2) Perforation – The ulcer may erode through
the stomach wall and cause perforation requiring
emergency surgery
3) Gastric outlet obstruction – Scarring of
the stomach when the ulcer heals with deformity
may lead to obstruction to the flow of food into the
intestine.This is manifest as recurrent vomiting and
abdominal distension
Diagnosis
H. Pylori infection can be diagnosed non-invasively either by the urease breath test, blood test for
H. Pylori antibodies or a simple stool test to detect
the antigen. It can also be confirmed by an endoscopy
when gastric biopsies can be done.
All patients with ‘alarm symptoms’ of gastric
ulcers require an endoscopy, especially the elderly.
What are the current treatment guidelines?
Eradication therapy
l Current recommendations advise eradication
therapy for all persons with gastric or duodenal
ulcers.
l Persons with typical symptoms under 55 years
of age who are H. Pylori positive require no further
investigations and can start treatment.
l Older patients mandate an endoscopy.
l Eradication therapies are successful in 90%
of patients.
l failure of eradication can be upto 50% in the
developing countries due to poor compliance of
therapy or drug resistance.
Drugs that can be used:
There are several regimens available for eradication, but usually a combination of omeprazole, clarithromycin and either amoxicillin or metronidazole
is used for a week.
Smoking should be strongly discouraged and a reendoscope at 6 weeks is recommended for patients
with gastric ulcers.
So is it something to fear?
H. Pylori infection is a preventable cause for
gastritis, stomach ulcers and cancers. Good hygiene
in daily activities and food habits and awareness
to detect and treat this infection can minimize the
societal burden of cancers and absenteeism at work
due to stomach ailments. l
Consult our Expert Doctor For Free Medical Advice on our Toll Free Number 1800 425 2255
STAR Health 13
Laryngopharyngeal
Could your indigestion
Authors:
Prof. Mohan Kameswaran DSC, MS, FRCS (Ed), FAMS, FICS, DLO *
Dr. S. Raghunandhan MS, DNB, MRCS (Ed), DOHNS (Eng)*
Consultant ENT Surgeons, Madras ENT Research Foundation
traditionally treated with a multitude
- ENT Surgeon’s View
of drugs including
What is GERD?
l Antacids,
Gastro-Esophageal Reflux Disease (GERD)
is a very common problem, well known to manl Proton Pump inhibitors
kind. In recent years, the incidence of GERD in
l Prokinetic Agents,
our society has expanded manifolds,
l GI Anesthetic
Why is GERD on the increase?
l Lubricant Gels
 modern life style
l Anti-H.Pylori Kit.
 poor food habits
Even though today,this spectrum of medicines for GERD
 work stress
is freely available over the counter,it is judicious to always fol lack of adequate exercise.
low the advice of a specialist before trying self treatment
GERD occurs due to the backflow of acid
Laryngo-pharyngeal Reflux Disorder (LPR):
from the stomach,across the lower oesophageal
GERD and what does it do?
sphincter onto the food pipe upwards.
GERD in the present day has metamorphosized
Treatment for GERD including medicines
from its original form & it has captured the attention of
& surgery. Acid Peptic Disorders have been
ENT surgeons worldwide, due its influences on the upper
aero-digestive tract.This phenomenon of acid reflux across
Causes of Acid Reflux from Stomach
the upper oesophageal sphincter afflicting the larynx (voice
box) & pharynx (food pipe),has been termed as the Laryngopharyngeal Reflux Disorder (LPR).
LPR presents with symptoms
l burning sensation in throat
l hoarseness of voice
l difficulty in swallowing
l dry hacking cough
l no response in spite of conventional treatment for
GERD.
Many patients,who present to a sleep disorder clinic with
complaints of Snoring & Sleep Apnoea, also have significant
contribution to their symptoms from underlying Laryngopharyngeal Reflux Disorder.Hence,a part of their treatment
regimen includes medications for LPR.
LPR & its influence on the Voice
Acid reflux disease of the larynx has been estab14 STAR Health
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Reflux Disorder be something more??
lished as a separate clinical entity, requiring
the nuances of an ENT Specialist, for its
early diagnosis and appropriate management. The Laryngo-pharynx (junction of
wind pipe & food pipe in the throat) is a
dynamic region safe-guarding the airway
from the corrosive influence of gastro-intestinal juices. Malfunction of this laryngopharyngeal sphincter results in chronic
insult to the larynx, resulting in a spectrum
of laryngeal lesions. Clinical presentations
of laryngo-pharyngeal reflux disorder may
vary from features like
l chronic laryngitis,
l indolent laryngeal ulcers
l granulomas
l life-threatening laryngeal stenosis
l laryngeal malignancies very rarely.
How to diagnose LPR ?
The Video Stroboscope, is a ‘cutting-edge’ sensitive
tool to look into the intricacies of the larynx and thereby
study the pathological effects of laryngo-pharyngeal reflux
in great detail.Video stroboscopy is a simple out-patient
endoscopy procedure performed under local anesthesia
& it provides a clear picture of the various components
of the larynx in motion.
Who is affected by LPR?
A large number of professional voice users like teachers, singers & politicians with problems of voice fatigue,
inability to raise voice to high pitches & breathy voice,when
evaluated by a sensitive tool such as the Video Stroboscope, have been found to have a significant contribution
Stroboscopic Pictures: Manifestations of Acid Reflux on the Larynx (Voice Box)
due to laryngo-pharyngeal reflux disorder.
Also, many established cases of Acid Peptic
Disease have subtle, sub-clinical manifestations in the larynx (voice box) which remain
masked by the predominant GERD features
from the stomach. Early diagnosis and appropriate treatment of laryngo-pharyngeal
reflux prevails as a vital factor in the management of various voice disorders.
How does one manage LPR?
H2-blockers are very effective in treating GERD patients by “turning the acid
down”, but this is not sufficient treatment
for many patients with LPR.The acid needs
to be virtually “turned off”, since the larynx is far
more susceptible to injury from the acidic reflux
than the esophagus. Laryngeal mucosa lacks the
protective mechanism and barrier that the esophageal mucosa has to prevent damage from acid and
pepsin exposure.
After a meticulous analysis of the Larynx &
Laryngopharynx with Video Stroboscopy, the diagnosis of Laryngopharyngeal Reflux Disorder is
confirmed.All such patients are started on a standardized 12 weeks regimen of anti-reflux medications (Proton Pump Inhibitors + ProkineticAgents)
and are followed up for a period of 6 months,
with sequential video-stroboscopic assessment
at regular intervals.They are also symptomatically
graded based on their symptomatic improvement
& relief from reflux features as per Reflux Symptom
Index (RSI) Score.
Majority of patients, (95%) respond well to
the treatment
Conclusion: Is LPR manageable?
Laryngopharyngeal Reflux Disorder is a unique
entity under the confluence of symptoms broadly
termed as GERD, silently growing in incidence
in recent times, due to the fast paced life of our
present day society. Early diagnosis & appropriate
management of LPR, by an ENT Specialist is most
essential.
l
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STAR Health 15
HEART BURN AND REFLUX
ADVANCES IN
Dr.V.G.Mohan Prasad. M.D.,D.M.,(Gastro)
Chairman,
VGM Hospital, Institute of Gastroenterology
Coimbatore
What is Gastroesophageal Reflux Disease
(GERD)?
Gastroesophageal reflux occurs when contents in
the stomach flow back into the esophagus.This happens when the valve between the stomach and the
esophagus, known as the lower esophageal sphincter,
does not close properly.
What are the symptoms of Gastroesophageal Reflux Disease?
Common symptoms of Gastroesophageal reflux
disease are heartburn and/or acid regurgitation,
unexplained chest pain, wheezing, sore throat and
cough, among others.
How is Gastroesophageal Reflux Disease
diagnosed?
 Upper GI endoscopy
 Impedance pH-metry
2. Prior to surgery to tighten the LES valve
3. Chest pain with a normal heart unction
4. Regurgitation
5. Lack of response to medical therapy
The information acquired from this
test will show:
1. how frequently acid refluxes into the esophagus,
2. what activities cause the reflux,
3. how long it stays in the esophagus,
4.What symptoms occur during these episodes (such
as heartburn, belching, acid taste in the mouth, chest
pain).
The study may give the physician useful information which can aid in medical treatment for the
patient’s problem.
pH , Manometry Test & 24-hour pH Study:
24-hour pH studies measure acid exposure
in the esophagus over a 24-hour period.This test can
accurately measure whether or not Gastroesophageal
reflux disease (GERD) is present.
The indications are:
1. Chest burn
High resolution impedence pH metry:
Impedence pH metry (MII-pH) launched for
the first time in the three southern states of Tamil
Nadu, Kerala and Karnataka is a boon to detect noacid reflux.While the conventional pH can detect only
a reflux of acid from stomach into foodpipe.
But Impedence pH-metry can detect non-acid
16 STAR Health
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MANAGEMENT
reflux in the form of bile,gas or food,since many reflux
episodes in human beings are composed of less acidic
and gaseous mixtures.
How to reduce reflux?
Avoiding these items may reduce your discomfort:
 Coffee, citrus drinks, tomato-based products,
carbonated beverages, chocolate, peppermint, fatty
or spicy foods, eating within three hours of bedtime,
smoking, excess alcohol consumption, excess weight
gain.
Propping up the head of the bed with 6 inches
wooden block at night may be helpful.
How to treat reflux?
Effective medicines are available. However
surgery should be considered in patients with welldocumented reflux disease who cannot tolerate
medications or continue to have regurgitation as a
primary symptom. If symptoms persist despite medical treatment, a comprehensive evaluation should be
completed prior to considering surgery.The surgery
for treating reflux disease is known as fundoplication
can be done via a laparoscope.
What are the complications of GERD?
The complications of GERD can be prevented by
appropriate medical or surgical therapy.
The following are the long term complications of
reflux disease:
1. Barrett’s esophagus
2. Esophageal stricture
3. Ulceration
ogist’s
nterol
Gastroe
View
4. Hemorrhage
5. Rare Perforation
What is Barrett’s Esophagus?
Barrett’s esophagus is a condition in which the lining of the esophagus changes, becoming more like the
lining of the small intestine rather than the esophagus.
This occurs in the area where the esophagus joins the
stomach. Barrett’s esophagus develops is because of
chronic inflammation resulting from Gastroesophageal Reflux Disease (GERD).
Newer Therapy for Barrett’s
Radio frequency ablation (RFA) is a simple endoscopic method of destroying the abnormal mucosa
in the lower end of esophagus. l
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STAR Health 17
Are we paying the pric
Inflammatory Bowel disease – Rare Gastr
I
n the past few years of this modern era we are encountering
allergic and immune mediated disorders affecting the body than
the infective diseases .Our Gastrointestinal tract (GIT),which is
considered as the longest organ of the body is also not spared
from the immune mediated attack. I will be discussing about
the emergence of a new type of immune mediated disease affecting the
GI tract in India called Inflammatory Bowel disease. It can be a chronic
and debilitating disease.
Inflammatory bowel disease is a chronic,often re occurring inflammatory disorder of the gastrointestinal tract.
Mechanism:
Our own body’s immunity becomes dysregulated to cause damage
to the lining of the gastrointestinal tract leading to severe ulceration
and bleeding.
Classified as
l Crohn’s disease (which can affect any part of the GI tract) and
l Ulcerative colitis (which affects only large bowel).
These disorders have a higher prevalence in the western world and
were thought to be relatively uncommon in Asian countries.
Inflammatory Bowel disease was considered very rare in India.But
recent statistics shows that the disease is increasing in India.
PLEASE BE AWARE THAT RECENTLY the following drugs have
been banned under Section 26A of the Drugs and Cosmetics Act.
1. NIMESULIDE - for children below 12 years - used for fever,
body ache and joint pain
2. CISAPRIDE - Used for Acidity and heart burn
3. PHENYLPROPANOLAMME – used in the composition of
cough syrup
4. SIBUTRAMINE – Used for weight reduction and Obesity and
5. Medicines containing HUMAN PLACENTAL EXTRACT
18 STAR Health
Factors for IBD
l Westernization
l Environmental factors contri
bute to the etiology.
l I can quote an example to support this fact. Leicester is a small city
in United Kingdom with a very high
Indian population. The studies from
this city show that the incidence of
the inflammatory bowel disease is
equal or higher than the native British
population.
Signs and symptoms:
 Recurrent long standing
diarrhea with or without blood in
the stools
 Chronic abdominal pain,
 Weight loss
 Loss of appetite
 Anemia
 Recurrent mouth ulcers.
 This disease can also affect skin,
joints and eyes.
 Children can present with growth
retardation along with or without
much gastrointestinal symptoms.
The exact etiology of the disease
is unknown, but complex interplay of
environmental factors and immunological changes can trigger the onset of
the disease in a genetically susceptible
host.As we are exposed to more stress,
urbanization and western type of diet,
our gut brain axis is disrupted to a
larger extent triggering dysregulation
of the immune reactions.
Ulcearations of the gastrointestinal tract
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ce for westernization?
rointestinal disease is on the risein India.
Dr.M.Ganesh M.D, MRCP (UK), CCST gastro (UK), PG Dip gastro (UK).
Chief consultant Gastroenterologist and Inflammatory Bowel Disease Specialist,
KMCH, Coimbatore, South India. [email protected]
WHY this rise in IBD only
now in India???
In the last two decades the hygiene of the
Indian subcontinent has increased to a greater
extent. The incidence of parasitic infections
(worm infections) of the gut is decreasing.
Presence of worms in the gut and exposure
to child hood infections induces immune tolerance and reduces the incidence of inflammatory bowel disease. Decreasing incidence of
common GI infections is indirectly contributing
to the raise in incidence of the inflammatory
70
60
50
40
30
20
10
0
crohn's
disease
ulceartive
colitis
Between Jan 2009 to September 2010 (Coimbatore)
bowel disease – hygiene hypothesis.To support
this fact we see higher incidence of this disease
in Kerala where hygiene levels are comparatively higher than other states in India. Sometimes
being very hygienic is also a problem!!!
This is a multifactorial disease: certain
factors
l Environment,
l Genetic factors also play a major role.
l The genes are the basic building blocks of
the human body.Any abnormal changes in the
genetic material (called as mutation) can affect
the body functions. There is a genetic predisposition for the inflammatory bowel disease
predominantly in the western world.
Personal experience as apracticing
gastroenterologist:
In the past 2 years of my practice in
South India I have identified 87 cases of
inflammatory bowel disease in a South
Indian city called Coimbatore.Out of the
two form of the disease,ulcerative colitis
is considered to be more prevalent than crohn’s in India. But
to my surprise this is also changing with higher incidence of
crohn’s than ulcerative colitis in my city.
In my personal experience the incidence of this disease is
increasing in India. In many situations I have seen patients suffering from this condition for many years without a diagnosis,
due to lack of awareness and resources. Recent advances in
the technology and awareness about this disease is helping
doctors to identify this disease early. It’s important to identity
this condition early and treat appropriately. Longstanding
disease without appropriate treatment can cause severe
complications.The quality of the life is affected very severely
in untreated patients.
The gold standard test to identify the disease is to do endoscopic examination of the gastrointestinal tract,taking tissue
sample from the affected segment of the bowel and analyzing
it under the microscope to confirm the diagnosis.The latest
technology called Narrowband imaging helps us to identify the
inflamed sites to do appropriate tissue sampling.
Synopsis: In conclusion many immune mediated diseases
are now increasing in the Indian sub continent. Along with
this, inflammatory bowel disease is also increasing in India.
Why is this so?
l Complex interaction between genetics
l Environmental factors,
l Unhealthy fat rich diet
l Dysregulated immune response to intestinal flora
l Urbanization
l Westernization is contributing to the raising incidence
of this disorder.
How can one prevent IBD?
Avoiding stress and reducing the consumption of western type of high fatty and fast food may help some extent
to decrease the incidence of this disease. In contrast to
boosting the immune system to fight against disease, immune suppressive drugs are used to control the immune
mediated damage in this condition. It’s very important to be
aware about this disease and early treatment can reduce the
complications.
l
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STAR Health 19
O
besity is a medical condition in which excess
body fat has accumulated to the extent that
it may have an adverse affect on health. Body
mass index (BMI) is a simple index of weightfor-height that is commonly used in classifying
overweight and obesity in adult populations and individuals. It
is defined as the weight in kilograms divided by the square of
the height in meters (kg/m2).The World Health Organization
(WHO) defines “overweight” as a BMI equal to or more than
25, and “obesity” as a BMI equal to or more than 30.WHO further projects that by 2015, approximately 2.3 billion adults will
be overweight and more than 700 million will be obese. Once
considered a problem only in high-income countries,overweight
and obesity are now dramatically on the rise in low- and middle-income countries, particularly in urban settings hence by
adding on the health care costs.
What causes obesity and overweight?
The fundamental cause of obesity and overweight is an
energy imbalance between calories consumed on one hand,
and calories expended on the other hand. Global increases in
overweight and obesity are attributable to a number of factors
including:
 a global shift in diet towards increased intake of energydense foods that are high in fat and sugars but low in vitamins,
20 STAR Health
minerals and other micronutrients; and
 a trend towards decreased physical activity due to the increasingly sedentary nature of many forms of work, changing modes of transportation,and increasing
urbanization.
What are common health consequences of overweight and obesity?
Obesity is no more a cosmetic issue
alone. It’s infact a disease .Overweight
and obesity lead to serious health consequences. Risk increases progressively
as BMI increases. Raised body mass index
is a major risk factor for chronic diseases
such as:
 Cardiovascular disease (mainly
heart disease and stroke) - already the
world’s number one cause of death, killing
17 million people each year.
 Diabetes – which has rapidly
become a global epidemic.WHO projects
that diabetes death will increase by more
than 50% worldwide in the next 10 years.
 Musculoskeletal disorders –
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Prof. C Palanivelu
MS, MCh, MNAMS, FRCS(Ed), FACS.
Chairman of the Institute and
Director of GEM Hospital
BESITY
especially osteoarthritis.
 Some cancers (endometrial, breast, and
colon).
Childhood obesity is associated with a higher
chance of premature death and disability in adulthood.
How can the burden of overweight and
obesity be reduced?
Overweight and obesity, as well as their related
chronic diseases, are largely preventable.
At the individual level, people can:
 Achieve energy balance and a healthy
weight;
 Limit energy intake from total fats and shift
fat consumption away from saturated fats to unsaturated fats;
 Increase consumption of fruit and vegetables,
as well as legumes, whole grains and nuts;
 Limit the intake of sugars; and
 Increase physical activity - at least 30 minutes
of regular, moderate-intensity activity on most days.
More activity may be required for weight control.
But the above mentioned recommendations hold
good for overweight individuals and early obesity
(BMI<35).the next step in management is obesity reduction surgery, technically called bariatric surgery.
Bariatric surgery, also known as weight loss
surgery, refers to the various surgical procedures
performed to treat obesity by modification of the
gastrointestinal tract to reduce nutrient intake and/or
absorption. The term does not include procedures
for surgical removal of body fat such as liposuction
or abdominoplasty.
For individuals who have been unable to achieve
significant weight loss through diet modifications and
exercise programs alone,bariatric surgery may help to
attain a more healthy body weight.There are a number
of surgical options available to treat obesity, each
with its advantages and pitfalls. In general, bariatric
surgery is successful in producing (often substantial)
weight loss, though one must consider operative
risk (including mortality) and side effects before
making the decision to pursue this treatment option.
Usually, these procedures can be carried out safely.
Weight-loss surgery is not just a cosmetic surgery; it
is a life-changing surgery. It is not a medical cure. It is
intended for those who are morbidly obese and have
weight related health problems (diabetes, hypertension, cardiac diseases, breathing problems etc) and
also for the prevention of these disorders.
Who Is A Candidate for Bariatric Weight
Loss Surgery?
 Typically, to qualify for bariatric surgery you
must be ‘morbidly obese’, which usually means being overweight by 100 pounds (man) or 80 pounds
(woman) with a Body Mass Index (BMI) of 40+.
 Alternatively, bariatric surgery may be appropriate if you are 80 pounds overweight (BMI 35+)
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STAR Health 21
and have a serious obesity-related condition like type 2 diabetes or lifethreatening cardio-pulmonary problems such as severe sleep apnea or
obesity-related heart disease.
Are The Health Risks Of Bariatric Surgery Greater Than
The Risks Of Obesity?
For most patients suffering from morbid obesity (BMI 40+), superobesity (50+) or end stage obesity syndrome (BMI 60+), the big question
is, do the benefits of bariatric surgery outweigh its risks? The answer is
yes. Severe obesity is a chronic, frequently progressive, life threatening
disease, and the known health risks associated with morbid obesity far
outweigh the risks associated with surgery. Published studies indicate
that someone who is 100 percent above his/her ideal weight has a risk
of mortality ten times higher that of a person of normal weight. Recent
evidence from around the world have also proved beyond doubt that
obese patients undergoing obesity surgery live longer than the others.
Before
After
How Does Bariatric Surgery Affect The Digestive Process?
Before Surgery
Food is chewed in the mouth, then swallowed, passing through the
esophagus to the stomach, (roughly the size of a melon) where stomach
acids dissolve it into smaller particles.The liquid (chyme) then passes into
the small intestine where enzymes and bile continue the digestive process.
The first section is the duodenum, the shortest section. Here, calcium,
iron and a few vitamins are absorbed.The second and third sections are
the jejunum and ileum, both about ten feet in length. Here, the bulk of
food nutrients (vitamins and minerals) and calories are absorbed.
After Surgery
During both main types of obesity surgery, the size of the stomach
22 STAR Health
is reduced by up to 90 percent,
to the size of an egg or even
the size of a thumb.Typically, its
capacity is 3-4 tablespoons of
food. This stomach reduction
drastically reduces the quantity
of food which can be consumed
in one sitting and speeds up satiety. During bypass surgery, the
digestive tract below the stomach is also altered.After leaving
the small stomach pouch, food
is re-routed to bypass most of
the duodenum and is directed
into the final part of the jejunum. Because the food passes
along a much reduced length of
small intestine, and comes into
contact with smaller amounts
of digestive enzymes, fewer
calories and nutrients are absorbed.
What is Metabolic
Surgery?
This concept of Surgery
has been extended to treat
patients with uncontrollable
diabetes and patients with high
cholesterol levels referred to as
Metabolic Syndrome , even for
patients with normal body mass
index .This new technique has
been referred to as metabolic
surgery (Ileal transposition surgery/Duodenojejunal Bypass)
wherein the intestinal anatomy
is rearranged hence by inducing
certain hormonal changes beneficial for cure of Diabetes and
High Cholesterol levels hence
by completely curing diabetes
and increased cholesterol permanently in more than 90% of
patients. Reports from around
the world has shown excellent
results with regard to diabetes
control and the day is not far
enough when the requirement
of insulin and other related
medications would become
trivial. l
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Stomach cancer
Dr. C.B. KRISHNAKUMAR MD (Internal Medicine)
Medical Advisor – Star Health and Allied Insurance Co Ltd.,
Corporate Office, Chennai
G
astric cancer, commonly referred to as stomach cancer,
can develop in any part of the
stomach and may spread throughout the
stomach and to other organs;particularly the esophagus,lungs,lymph nodes,and
the liver. Stomach cancer causes about
800,000 deaths worldwide per year.
Signs and symptoms
Stomach cancer is often asymptomatic or causes only nonspecific
symptoms in its early stages. By the
time symptoms occur, the cancer has
often reached an advanced stage, which
is one of the main reasons for its poor
prognosis. Stomach cancer can cause
the following signs and symptoms:
Stage 1 (Early)
l Indigestion or a burning
sensation (heartburn)
l Loss of appetite, especially
for meat
l Abdominal discomfort or
irritation
Stage 2 (Middle)
l Weakness and fatigue
l Bloating of the stomach,
usually after meals
Stage 3 (Late)
l Abdominal pain in the
upper abdomen
l Nausea and occasional
vomiting
l Diarrhea or constipation
l Weight loss
l Bleeding (vomiting blood or
having blood in the stool) which will
appear as black.This can lead to anemia.
l D y s p h a g i a ; t h i s f e a t u re
suggests a tumor in the cardia or extension of the gastric tumor
in to the esophagus.
Note that these can be symptoms of other problems such as a
stomach virus, gastric ulcer or tropical sprue. Diagnosis should be
done by VG endoscopy, Biopsy, and HPE.
Causes
Infection by Helicobacter pylori is believed to be the cause of
most stomach cancer while autoimmune atrophic gastritis,intestinal
metaplasia and various genetic factors are associated with increased
risk levels.The clinical medical reference states that diet plays no role
in the genesis of stomach cancer. However, the following dietary
risks, for stomach cancer are reported. “Smoked foods, salted fish
and meat, and pickled vegetables (appear to increase the risk of
stomach cancer.) Nitrates and nitrites are substances commonly
found in cured meats. They can be converted by certain bacteria,
such as H. pylori, into compounds that have been found to cause
stomach cancer.On the other hand,eating fresh fruits and vegetables
that contain antioxidant vitamins (such asA and C) appears to lower
the risk of stomach cancer.”
H. pylori is the main risk factor in 65–80% of gastric cancers, approximately ten percent of cases show a genetic component.
A very important but preventable cause of gastric cancer is
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STAR Health 23
tobacco. Smoking increases the risk of developing
gastric cancer considerably.
Another lifestyle cause of gastric cancer besides
smoking is consumption of alcohol.
Alcohol as cause of cancer along with tobacco
smoking as cause of cancer increase the risk of developing other cancers as well.
Gastric cancer shows a male predominance in its
incidence as up to three males are affected for every
female. Estrogen may protect women against the
Early Cancer Stomach
development of this cancer form.
Diagnosis
To find the cause of symptoms, the doctor asks
about the patient’s medical history, does a physical
exam, and may order laboratory studies.The patient
may also have one or all of the following exams:
l Gastroscopic exam is the diagnostic method
of choice.This involves insertion of a fiber optic camera
into the stomach to visualize it.
l Upper GI series (may be called barium roentgenogram)
l Computed tomography or CT scanning of
the abdomen may reveal gastric cancer, but is more
useful to determine invasion into adjacent tissues, or
the presence of spread to local lymph nodes.
Abnormal tissue seen in a gastroscope examination
will be biopsied by the surgeon or gastroenterologist.A
biopsy,with subsequent histological analysis,is the only
sure way to confirm the presence of cancer cells.
Endocytoscopy involves ultra-high magnification
to visualize cellular structure to better determine
areas of dysplasia.Other gastroscopic modalities such
as optical coherence tomography are also being tested
investigationally for similar applications.
A number of cutaneous conditions are associated with gastric cancer. A condition of darkened
hyperplasia of the skin, frequently of the axilla and
groin,known as acanthosis nigricans,is associated with
24 STAR Health
intra-abdominal cancers such as gastric cancer.Other
cutaneous manifestations of gastric cancer include
tripe palms (a similar darkening hyperplasia of the skin
of the palms) and rapid development of skin lesions
known as seborrheic keratoses.
Various blood tests may be done; including: Complete Blood Count (CBC) to check for anemia.Also,
a stool test may be performed to check for blood in
the stool.
Histopathology
Gastric adenocarcinoma is a malignant epithelial
tumor, originating from glandular epithelium of the
gastric Histopathology
l Gastric adenocarcinoma is a malignant epithelial tumor,originating from glandular epithelium of the
gastric mucosa.Stomach cancers are overwhelmingly
adenocarcinomas (90%).
lAround 5% of gastric malignancies are lymphomas
l Carcinoid and stromal tumors may also occur.
Management
1. Surgery
a. Surgery is the most common treatment.The
surgeon removes part or all of the stomach, as well
as the surrounding lymph nodes, with the basic goal
Advanced Cancer – Bleeding growth
of removing all cancer and a margin of normal tissue.
b. Endoscopic mucosal resection (EMR) is a
treatment for early gastric cancer
c. Endoscopic submucosal dissection (ESD) is
a similar technique
2. Chemotherapy
3. Radiation
4. Multimodality therapy
l Combinations of surgery,chemotherapy and
radiation therapy
l
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F
I
T
N
ES
SE
SC
T
I
O
N
W
hen we
h e a r
gastrointestinal
problems
the first
t h i n g
which stuck every one’s mind is Constipation ,Peptic ulcers and gastrointestinal gas
.But there are also other conditions like colon
cancer , cholelithiasis, diverticular disease,
appendicitis, celiac disease
The most common gastrointestinal
complaint is constipation. Constipation
happens when our body waste remains in
the colon for too long and too much water
is absorbed into the intestine leaving a hard
dry stool.This can be prevented which is the
best form of relief
The major part played in constipation is
improper diet and no exercises .In diet there
are some food which relieves constipation
and some which promotes constipation
Foods like Almond dried apricot ,beans
celery ,coconut ,raisins , dates , figs ,grapes
,mangoes ,olive, papaya , parsleys ,pineapple
,prunes ,soybeans ,turnips,green vegetables,
oats, yogurt, cabbage, peas, sweet potatoes,
castor oil, asparagus, horse gram,
Ragi, millets, bitter gourd, guava, cauliflower, plantains and
off course 8 glasses of water
per day minimum will helping
the treatment of constipation
naturally.As these foods are rich
in fiber which provides roughage
and promotes bowel movement
Now that
we know
which
food
helps to get relief from
constipation it becomes very important
to know which food
has to be avoided they
are Ice cream, cheese,
meat,
Chips, pizza, processed food such as
S. Niranjani
mashed potatoes or
Physiotherapist
&
frozen food, refined
Fitness
Consultant
sugar and diet rich in
animal fat
A lack of exercises can also lead to constipation .Exercises like walking, pelvic floor
exercises helps to strengthen and tone the
colon muscles, it helps in eliminating toxins
by sweat, reduces the stress and stimulates
the colon wall cell structure to increase
metabolic rate, and thus overall it improves
the function
Mild to moderate intensity exercises
plays a protective role where as strenuous exercises may provoke some symptoms which can be due to dehydration and
in direct it can lead to gut ischemia .It is always
recommended to hydrate one before,during
and after the work out. Severe constipation
would require physician help as they get to
know the underlying causes of constipation .With the help of doctor, proper
diet and exercises its easy to obtain
constipation relief. l
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STAR Health 25
T
he first thing someone notices about a fit
body is the flat stomach.Certainly those
flat abs turns head .But to get those flat
abs its not going to be easy through any
TV abs machine advertisement. Make
sure that you do cardio with abs workout of 6 or 8 variation three days a week
The next thing which hits everyone is why not daily
do abs exercises? What’s harm? maybe I will get flat abs
faster but the truth is you will not. Just like every other
part of your body needs rest for a day to overcome the
strain so do the abs musclesTraining them every day will
not make them tauten at all. It’s just a waste of time and
energy. Doing cardio and abs for three days is enough
What you eat shows out is your tummy,so diet plays
a big role along with exercises to give you the desired
results.Avoid eating out and have a limit in what you eat
because anything you eat more than your limit is not
good for the body. Stick to 5 to 6 small meals instead
of the regular breakfast, lunch and dinner. Keep healthy
snacks like fruits and nuts.A handful of nuts and dry fruits
will work wonder when you feel like hungry. How much
ever crunches you do to get the result you have to stick
to low fat diet .At the same time make sure you increase
the intensity of your workout or else the muscles will
get use to the same exercise intensity and will not show
much results in inches.
So pack yourself for the exercises and get self motivated which will keep you going. Enjoy every step you
take towards your exercises as Sky is not the limit but
weight has limit and get those FAB ABS
Enjoy the OATS Soup recipe for healthy well being
GET
THOSE
FAB
ABS
26 STAR Health
Oats Soup
Ingredients
Oats - 1 cup
Onion - 1/2 (finely chopped)
Green Chilly - 1 (finely chopped)
Garlic - 1 clove (minced)
Salt - to taste
Pepper powder - a pinch
Water- 1 cup
Milk - 1 cup
Oil - 2 tsp
coriander leaves- for garnish
Method
1. Heat oil in a pan and sauté onions, green chilly
and garlic till they begin to sweat.
2. Now add the oats and fry along with it for few
2 minutes.
3.Add salt and water and let it come to a boil.
4.Now add the milk and pepper powder to it and
bring to a boil.
5. Garnish the rich and creamy oats soup with
cilantro and serve hot.
Consult our Expert Doctor For Free Medical Advice on our Toll Free Number 1800 425 2255
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Consult our Expert Doctor For Free Medical Advice on our Toll Free Number 1800 425 2255
STAR Health 27
STAR Health
Consult our Expert Doctor For Free Medical Advice on our Toll Free Number 1800 425 2255