When dizziness is treated with
physical therapy, it is referred to as
vestibular rehabilitation. Dizziness
often occurs due to conditions that
affect the inner ear where the vestibular system
is housed.
There are exercises that are designed to
improve or completely resolve problems involving
dizziness and balance deficits. Depending on
the cause of your dizziness, this may occur in as
few as two to three visits.
At first, a physical therapist will perform a
complete evaluation of your visual, vestibular
and balance systems to help determine the cause
of your dizziness. After the evaluation, the therapist
will develop a plan to help address your
dizziness. Treatment will include a home program
for exercises, which is the key to recovery
from dizziness. |
Any discussion of Barrett’s esophagus
should begin with a brief anatomy
lesson, which follows. At the lower
end of the esophagus, where the
esophagus enters the stomach, there is a strong
muscular ring called the Lower Esophageal
Sphincter (LES) that is supposed to remain tightly
closed except to allow food and liquid to pass into
the stomach. Heartburn occurs when the LES
opens at the wrong time and acid refluxes up into
the esophagus. This happens to everyone at one
time or another, but reflux that is severe or that
occurs frequently over a long period of time can be
harmful. This is known as Gastroesophageal Reflux
Disease (GERD.)
The cells lining the esophagus differ from those
lining the stomach or intestines. The border
where the esophagus ends and the stomach begins
is called the Z-line and is almost always readily
identifiable with endoscopy. Barrett’s esophagus is
the abnormal growth of intestinal-type cells above
this border. Barrett’s is also commonly referred to
as “intestinal metaplasia.”
Longstanding acid reflux is the single leading
cause of Barrett’s mucosa, and an estimated
10 percent of patients with chronic GERD will
develop the condition. Barrett’s esophagus is
especially common in patients who have had
reflux for more than five years and are over the
age of 50. It is also three times more likely to be
found in men than in women. Over time, the
Barrett’s cells can sometimes develop abnormal
changes known as dysplasia, a pre-cancerous
condition that can progress to a malignancy. For
this reason, it is important to identify Barrett’s
esophagus early. The good news is that intestinal
metaplasia progresses to cancer very rarely.
The diagnosis of Barrett’s esophagus usually
requires an upper endoscopy or EGD (esophagogastroduodenoscopy.)
The procedure is typically
performed with sedation. While the patient
is sedated, the physician examines the lining of
the esophagus and stomach with a thin, lighted,
flexible endoscope. If Barrett’s is suspected, a tissue
sample is taken. If intestinal metaplasia is found,
endoscopic “surveillance” biopsies are typically
performed every three to five years to look for dysplasia.
If dysplasia is found, surveillance biopsies are
performed at least once a year. In certain patients, a
surgical procedure called a Nissen fundoplication is
recommended to tighten the LES.
Unfortunately, there are no medications that have been shown to reverse Barrett’s esophagus.
Therapy is generally aimed at reducing GERD
symptoms and preventing GERD-related complications
such as strictures. Most patients are
prescribed strong acid-reducing medications
called “proton pump inhibitors” including Prilosec
(omeprazole), Prevacid, Protonix, Aciphex
and Nexium. For the most part, these medications
are all equally effective at controlling acid
reflux. Patients themselves can also do a number
of things to help reduce gastroesophageal reflux.
These include not eating within three hours before
bedtime, avoiding tobacco products, eating smaller
meals and reducing the consumption of fatty foods,
milk, chocolate, caffeine and alcohol (especially
red wine.) We also recommend that patients
avoid acidic foods such as citrus fruits and tomato
products. |
