Podcasts about Gerd

Manchmal lohnt sich ein Einstieg in der zweiten Halbzeit, vor allem wenn Flo einen Walk On wie im Ally Pally bekommt! Nur schade, dass das Ranking der Biersorten nicht für die Nachwelt hinterlegt wurde. Endlich mal Zeit für die Besprechung von Höhen und Tiefen einer Profikarriere. Inklusive erfolgreicher Revanche gegen einen alten Handball-Rivalen und einem Turniersieg nach wenigen Tagen. Außerdem zeigen Jan Ole, Noah, Gerd und Sebastian, dass ein Workshop oder ein 65er Scolia-Average eine guter Karriereeinstieg sein können. "Game on! Der Darts Podcast" ist eine Produktion der Podcastbande. Neue Folgen gibt's immer dienstags - überall, wo es Podcasts gibt

Co-hosts Ryan Piansky, a graduate student and patient advocate living with eosinophilic esophagitis (EoE) and eosinophilic asthma, and Holly Knotowicz, a speech-language pathologist living with EoE who serves on APFED's Health Sciences Advisory Council, interview Evan S. Dellon, MD, and Elizabeth T. Jensen, PhD, about a paper they published on predictors of patients receiving no medication for treatment of eosinophilic esophagitis. Disclaimer: The information provided in this podcast is designed to support, not replace, the relationship between listeners and their healthcare providers. Opinions, information, and recommendations shared in this podcast are not a substitute for medical advice. Decisions related to medical care should be made with your healthcare provider. Opinions and views of guests and co-hosts are their own.   Key Takeaways: [:52] Co-host Ryan Piansky introduces the episode, brought to you thanks to the support of Education Partners GSK, Sanofi, Regeneron, and Takeda. Ryan introduces co-host Holly Knotowicz.   [1:14] Holly introduces today's topic, predictors of not using medication for EoE, and today's guests, Dr. Evan Dellon and Dr. Elizabeth Jensen.   [1:29] Dr. Dellon is an Adjunct Professor of Epidemiology at the University of North Carolina School of Medicine in Chapel Hill. He is also the Director of the UNC Center for Esophageal Diseases and Swallowing.   [1:42] Dr. Dellon's main research interest is in the epidemiology, pathogenesis, diagnosis, treatment, and outcomes of eosinophilic esophagitis (EoE) and eosinophilic GI diseases (EGIDs).   [1:55] Dr. Jensen is a Professor of Epidemiology with a specific expertise in reproductive, perinatal, and pediatric epidemiology. She has appointments at both Wake Forest University School of Medicine and the University of North Carolina at Chapel Hill.   [2:07] Her research primarily focuses on etiologic factors in the development of pediatric immune-mediated chronic diseases, including understanding factors contributing to disparities in health outcomes.   [2:19] Both Dr. Dellon and Dr. Jensen also serve on the Steering Committee for EGID Partners Registry.   [2:24] Ryan thanks Dr. Dellon and Dr. Jensen for joining the podcast today.   [2:29] Dr. Dellon was the first guest on this podcast. It is wonderful to have him back for the 50th episode! Dr. Dellon is one of Ryan's GI specialists. Ryan recently went to North Carolina to get a scope with him.   [3:03] Dr. Dellon is an adult gastroenterologist at the University of North Carolina at Chapel Hill. He directs the Center for Esophageal Diseases and Swallowing. Clinically and research-wise, he is focused on EoE and other eosinophilic GI diseases.   [3:19] His research interests span the entire field, from epidemiology, diagnosis, biomarkers, risk factors, outcomes, and a lot of work, more recently, on treatments.   [3:33] Dr. Jensen has been on the podcast before, on Episode 27. Holly invites Dr. Jensen to tell the listeners more about herself and her work with eosinophilic diseases.   [3:46] Dr. Jensen has been working on eosinophilic gastrointestinal diseases for about 15 years. She started some of the early work around understanding possible risk factors for the development of disease.   [4:04] She has gone on to support lots of other research projects, including some with Dr. Dellon, where they're looking at gene-environment interactions in relation to developing EoE.   [4:15] She is also looking at reproductive factors as they relate to EoE, disparities in diagnosis, and more. It's been an exciting research trajectory, starting with what we knew very little about and building to an increasing understanding of why EoE develops.   [5:00] Dr. Dellon explains that EoE stands for eosinophilic esophagitis, a chronic allergic condition of the esophagus.   [5:08] You can think of EoE as asthma of the esophagus or eczema of the esophagus, although in general, people don't grow out of EoE, like they might grow out of eczema or asthma. When people have EoE, it is a long-term condition.   [5:24] Eosinophils are a type of white blood cell, specializing in allergy responses. Normally, they are not in the esophagus. When we see them there, we worry about an allergic process. When that happens, that's EoE.   [5:40] Over time, the inflammation seen in EoE and other allergic cell activity causes swelling and irritation in the esophagus. Early on, this often leads to a range of upper GI symptoms — including poor growth or failure to thrive in young children, abdominal pain, nausea, and symptoms that can mimic reflux.   [5:58] In older kids, symptoms are more about trouble swallowing. That's because the swelling that happens initially, over time, may turn into scar tissue. So the esophagus can narrow and cause swallowing symptoms like food impaction.   [6:16] Ryan speaks of living with EoE for decades and trying the full range of treatment options: food elimination, PPIs, steroids, and, more recently, biologics.   [6:36] Dr. Dellon says Ryan's history is a good overview of how EoE is treated. There are two general approaches to treating the underlying condition: using medicines and/or eliminating foods that we think may trigger EoE from the diet.   [6:57] For a lot of people, EoE is a food-triggered allergic condition.   [7:01] The other thing that has to happen in parallel is surveying for scar tissue in the esophagus. If that's present and people have trouble swallowing, sometimes stretching the esophagus is needed through esophageal dilation.   [7:14] There are three categories of medicines used for treatment. Proton pump inhibitors are reflux meds, but they also have an anti-allergy effect in the esophagus.   [7:29] Topical steroids are used to coat the esophagus and produce an anti-inflammatory effect. The FDA has approved a budesonide oral suspension for that.   [7:39] Biologics, which are generally systemic medications, often injectable, can target different allergic factors. Dupilumab is approved now, and there are other biologics that are being researched as potential treatments.   [7:51] Even though EoE is considered an allergic condition, we don't have a test to tell people what they are allergic to. If it's a food allergy, we do an empiric elimination diet because allergy tests aren't accurate enough to tell us what the EoE triggers are.   [8:10] People will eliminate foods that we know are the most common triggers, like milk protein, dairy, wheat, egg, soy, and other top allergens. You can create a diet like that and then have a response to the diet elimination.   [8:31] Dr. Jensen and Dr. Dellon recently published an abstract in the American Journal of Gastroenterology about people with EoE who are not taking any medicine for it. Dr. Jensen calls it a real-world data study, leveraging electronic health record patient data.   [8:51] It gives you an impression of what is actually happening, in terms of treatments for patients, as opposed to a randomized control trial, which is a fairly selected patient population. This is everybody who has been diagnosed, and then what happens with them.   [9:10] Because of that, it gives you a wide spectrum of patients. Some patients are going to be relatively asymptomatic. It may be that we arrived at their diagnosis while working them up for other potential diagnoses.   [9:28] Other patients are going to have rather significant impacts from the disease. We wanted to get an idea of what is actually happening out there with the full breadth of the patient population that is getting diagnosed with EoE.   [9:45] Dr. Jensen was not surprised to learn that there are patients who had no pharmacologic treatment.   [9:58] Some patients are relatively asymptomatic, and others are not interested in pursuing medications initially or are early in their disease process and still exploring dietary treatment options.   [10:28] Holly sees patients from infancy to geriatrics, and if they're not having symptoms, they wonder why bother treating it.   [10:42] Dr. Jensen says it's a point of debate on the implications of somebody who has the disease and goes untreated. What does that look like long-term? Are they going to develop more of that fibrostenotic pattern in their esophagus without treatment?   [11:07] This is a question we're still trying to answer. There is some suggestion that for some patients who don't manage their disease, we very well may be looking at a food impaction in the future.   [11:19] Dr. Dellon says we know overall for the population of EoE patients, but it's hard to know for a specific patient. We have a bunch of studies now that look at how long people have symptoms before they're diagnosed. There's a wide range.   [11:39] Some people get symptoms and get diagnosed right away. Others might have symptoms for 20 or 30 years that they ignore, or don't have access to healthcare, or the diagnosis is missed.   [11:51] What we see consistently is that people who may be diagnosed within a year or two may only have a 10 or 20% chance of having that stricture and scar tissue in the esophagus, whereas people who go 20 years, it might be 80% or more.   [12:06] It's not everybody who has EoE who might end up with that scar tissue, but certainly, it's suggested that it's a large majority.   [12:16] That's before diagnosis. We have data that shows that after diagnosis, if people go a long time without treatment or without being seen in care, they also have an increasing rate of developing strictures.    [12:29] In general, the idea is yes, you should treat EoE, because on average, people are going to develop scar tissue and more symptoms. For the patient in front of you with EoE but no symptoms, what are the chances it's going to get worse? You don't know.   [13:04] There are two caveats with that. The first is what we mean by symptoms. Kids may have vomiting and growth problems. Adults can eat carefully, avoiding foods that hang up in the esophagus, like breads and overcooked meats, sticky rice, and other foods.   [13:24] Adults can eat slowly, drink a lot of liquid, and not perceive they have symptoms. When someone tells Dr. Dellon they don't have symptoms, he will quiz them about that. He'll even ask about swallowing pills.    [13:40] Often, you can pick up symptoms that maybe the person didn't even realize they were having. In that case, that can give you some impetus to treat.   [13:48] If there really are no symptoms, Dr. Dellon thinks we're at a point where we don't really know what to do.   [13:54] Dr. Dellon just saw a patient who had a lot of eosinophils in their small bowel with absolutely no GI symptoms. He said, "I can't diagnose you with eosinophilic enteritis, but you may develop symptoms." People like that, he will monitor in the clinic.   [14:14] Dr. Dellon will discuss it with them each time they come back for a clinic visit.   [14:19] Holly is a speech pathologist, but also sees people for feeding and swallowing. The local gastroenterologist refers patients who choose not to treat their EoE to her. Holly teaches them things they should be looking out for.   [14:39] If your pills get stuck or if you're downing 18 ounces during a mealtime, maybe it's time to treat it. People don't see these coping mechanisms they use that are impacting their quality of life. They've normalized it.   [15:30] Dr. Dellon says, of these people who aren't treated, there's probably a subset who appropriately are being observed and don't have a medicine treatment or are on a diet elimination.   [15:43] There's also probably a subset who are inappropriately not on treatment. It especially can happen with students who were under good control with their pediatric provider, but moved away to college and didn't transfer to adult care.   [16:08] They ultimately come back with a lot of symptoms that have progressed over six to eight years.   [16:18] Ryan meets newly diagnosed adult patients at APFED's conferences, who say they have no symptoms, but chicken gets caught in their throat. They got diagnosed when they went to the ER with a food impaction.   [16:38] Ryan says you have to wonder at what point that starts to get reflected in patient charts. Are those cases documented where someone is untreated and now has EoE?   [16:49] Ryan asks in the study, "What is the target EGID Cohort and why was it selected to study EoE? What sort of patients were captured as part of that data set?"   [16:58] Dr. Jensen said they identified patients with the ICD-10 code for a diagnosis of EoE. Then they looked to see if there was evidence of symptoms or complications in relation to EoE. This was hard; some of these are relatively non-specific symptoms.   [17:23] These patients may have been seeking care and may have been experiencing some symptoms that may or may not have made it into the chart. That's one of the challenges with real-world data analyses.   [17:38] Dr. Jensen says they are using data that was collected for documenting clinical care and for billing for clinical care, not for research, so it comes with some caveats when doing research with this data.   [18:08] Research using electronic health records gives a real-world perspective on patients who are seeking care or have a diagnosis of EoE, as opposed to a study trying to enroll a patient population that potentially isn't representative of the breadth of individuals living with EoE.   [18:39] Dr. Dellon says another advantage of real-world data is the number of patients. The largest randomized controlled trials in EoE might have 400 patients, and they are incredibly expensive to do.   [18:52] A study of electronic health records (EHR) is reporting on the analysis of just under 1,000. The cohort, combined from three different centers, has more than 1,400 people, a more representative, larger population.    [19:16] Dr. Dellon says when you read the results, understand the limitations and strengths of a study of health records, to help contextualize the information.   [19:41] Dr. Dellon says it's always easier to recognize the typical presentations. Materials about EoE and studies he has done that led to medicine approvals have focused on trouble swallowing. That can be relatively easily measured.   [20:01] Patients often come to receive care with a food impaction, which can be impactful on life, and somewhat public, if in a restaurant or at work. Typical symptoms are also the ones that get you diagnosed and may be easier to treat.   [20:26] Dr. Dellon wonders if maybe people don't treat some of the atypical symptoms because it's not appreciated that they can be related to EoE.   [20:42] Holly was diagnosed as an adult. Ryan was diagnosed as a toddler. Holly asks what are some of the challenges people face in getting an EoE diagnosis.   [20:56] Dr. Jensen says symptoms can sometimes be fairly non-specific. There's some ongoing work by the CEGIR Consortium trying to understand what happens when patients come into the emergency department with a food bolus impaction.   [21:28] Dr. Jensen explains that we see there's quite a bit of variation in how that gets managed, and if they get a biopsy. You have to have a biopsy of the esophagus to get a diagnosis of EoE.   [21:45] If you think about the steps that need to happen to get a diagnosis of EoE, that can present barriers for some groups to ultimately get that diagnosis.   [21:56] There's also been some literature around a potential assumption about which patients are more likely to be at risk. Some of that is still ongoing. We know that EoE occurs more commonly in males in roughly a two-to-one ratio. Not exclusively in males, obviously, but a little more often in males.   [22:20] We don't know anything about other groups of patients that may be at higher risk. That's ongoing work that we're still trying to understand. That in itself can also be a barrier when there are assumptions about who is or isn't likely to have EoE.   [23:02] Dr. Dellon says that in adolescents and adults, the typical symptoms are trouble swallowing and food sticking, which have many causes besides EoE, some of which are more common.   [23:18] In that population, heartburn is common. Patients may report terrible reflux that, on questioning, sounds more like trouble swallowing than GERD. Sometimes, with EoE, you may have reflux that doesn't improve. Is it EoE, reflux, or both?   [24:05] Some people will have chest discomfort. There are some reports of worsening symptoms with exercise, which brings up cardiac questions that have to be ruled out first.   [24:19] Dr. Dellon mentions some more atypical symptoms. An adult having pain in the upper abdomen could have EoE. In children, the symptoms could be anything in the GI tract. Some women might have atypical symptoms with less trouble swallowing.   [24:58] Some racial minorities may have those kinds of symptoms, as well. If you're not thinking of the condition, it's hard to make the diagnosis.   [25:08] Dr. Jensen notes that there are different cultural norms around expressing symptoms and dietary patterns, which may make it difficult to parse out a diagnosis.   [25:27] Ryan cites a past episode where access to a GI specialist played a role in diagnosing patients with EoE. Do white males have more EoE, or are their concerns just listened to more seriously?   [25:57] Ryan's parents were told when he was two that he was throwing up for attention. He believes that these days, he'd have a much easier time convincing a doctor to listen to him. From speaking to physicians, Ryan believes access is a wide issue in the field.   [26:23] Dr. Dellon tells of working with researchers at Mayo in Arizona and the Children's Hospital of Phoenix. They have a large population of Hispanic children with EoE, much larger than has been reported elsewhere. They're working on characterizing that.   [26:49] Dr. Dellon describes an experience with a visiting trainee from Mexico City, where there was not a lot of EoE reported. The trainee went back and looked at the biopsies there, and it turned out they were not performing biopsies on patients with dysphagia in Mexico City.   [27:13] When he looked at the patients who ended up getting biopsies, they found EoE in 10% of patients. That's similar to what's reported out of centers in the developed world. As people are thinking about it more, we will see more detection of it.   [27:30] Dr. Dellon believes those kinds of papers will be out in the next couple of months, to a year.   [27:36] Holly has had licensure in Arizona for about 11 years. She has had nine referrals recently of children with EoE from Arizona. Normally, it's been one or two that she met at a conference.   [28:00] Ryan asks about the research on patients not having their EoE treated pharmacologically. Some treat it with food avoidance and dietary therapy. Ryan notes that he can't have applesauce, as it is a trigger for his EoE.   [28:54] Dr. Jensen says that's one of the challenges in using the EHR data. That kind of information is only available to the researchers through free text. That's a limitation of the study, assessing the use of dietary elimination approaches.   [29:11] Holly says some of her patients have things listed as allergies that are food sensitivities. Ryan says it's helpful for the patients to have their food sensitivities listed along with their food allergies, but it makes records more difficult to parse for research.   [30:14] Dr. Dellon says they identify EoE by billing code, but the codes are not always used accurately. Natural Language Processing can train a computer system to find important phrases. Their collaborators working on the real-world data are using it.   [30:59] Dr. Dellon hopes that this will be a future direction for this research to find anything in the text related to diet elimination.   [31:32] Dr. Jensen says that older patients were less likely to seek medication therapy. She says it's probably for a couple of reasons. First, older patients may have been living with the disease for a long time and have had compensatory mechanisms in place.   [32:03] The other reason may be senescence or burnout of the disease, long-term. Patients may be less symptomatic as they get older. That's a question that remains to be answered for EoE. It has been seen in some other disease processes.   [32:32] Dr. Dellon says there's not much data specifically looking at EoE in the older population. Dr. Dellon did work years ago with another doctor, and they found that older patients had a better response to some treatments, particularly topical steroids.   [32:54] It wasn't clear whether it was a milder aspect of the disease, easier to treat, or because they were older and more responsible, taking their medicines as prescribed, and having a better response rate. It's the flip side of work in the pediatric population.   [33:16] There is an increasingly aging population with EoE. Young EoE patients will someday be over 65. Dr. Dellon hopes there will be a cure by that point, but it's an expanding population now.   [33:38] Dr. Jensen says only a few sites are contributing data, so they hope to add additional sites to the study. For some of the less common outcomes, they need a pretty large patient sample to ask some of those kinds of questions.   [33:55] They will continue to follow up on some of the work that this abstract touched on and try to understand some of these issues more deeply.   [34:06] Dr. Dellon mentions other work within the cohort. Using Natural Language Processing, they are looking at characterizing endoscopy information and reporting it without a manual review of reports and codes. You can't get that from billing data.   [34:29] Similarly, they are trying to classify patient severity by the Index of Severity with EoE, and layer that on looking at treatments and outcomes based on disease severity. Those are a couple of other directions where this cohort is going.   [34:43] Holly mentions that this is one of many research projects Dr. Jensen and Dr. Dellon have collaborated on together. They also collaborate through EGID Partners. Holly asks them to share a little bit about that.   [34:53] Dr. Jensen says EGID Partners is an online registry where individuals, caregivers, and parents of children affected with EGIDs can join.   [35:07] EGID Partners also needs people who don't live with an EGID to join, as controls. That gives the ability to compare those who are experiencing an EGID relative to those who aren't.   [35:22] When you join EGID Partners, they provide you with a set of questionnaires to complete. Periodically, they push out a few more questionnaires.   [35:33] EGID Partners has provided some really great information about patient experience and answered questions that patients want to know about, like joint pain and symptoms outside the GI tract.   [36:04] To date, there are close to 900 participants in the registry from all over the world. As it continues to grow, it will give the ability to look at the patient experience in different geographical areas.   [36:26] Dr. Dellon says we try to have it be interactive, because it is a collaboration with patients. The Steering Committee works with APFED and other patient advocacy groups from around the world.    [36:41] The EGID Partners website shows general patient locations anonymously. It shows the breakdown of adults with the condition and caregivers of children with the condition, the symptom distribution, and the treatment distribution.   [37:03] As papers get published and abstracts are presented, EGID Partners puts them on the website. Once someone joins, they can suggest a research idea. Many of the studies they have done have come from patient suggestions.   [37:20] If there's an interesting idea for a survey, EGID Partners can push out a survey to everybody in the group and answer questions relatively quickly.   [37:57] Dr. Dellon says a paper came out recently about telehealth. EoE care, in particular, is a good model for telehealth because it can expand access for patients who don't have providers in their area.   [38:22] EoE is a condition where care involves a lot of discussion but not a lot of need for physical exams and direct contact, so telehealth can make things very efficient.    [38:52] EGID Partners surveyed patients about telehealth. They thought it was efficient and saved time, and they had the same kind of interactions as in person. In general, in-state insurance covered it. Patients were happy to do those kinds of visits again.   [39:27] Holly says Dr. Furuta, herself, and others were published in the Gastroenterology journal in 2019 about starting to do telehealth because patients coming to the Children's Hospital of Colorado from out of state had no local access to feeding therapy.   [39:50] Holly went to the board, and they allowed her to get licensure in different states. She started with some of the most impacted patients in Texas and Florida in 2011 and 2012. They collected data. They published in 2019 about telehealth's positive impact.   [40:13] When 2020 rolled around, Holly had trained a bunch of people on how to do feeding therapy via telehealth. You have to do all kinds of things, like make yourself disappear, to keep the kids engaged and in their chairs!   [40:25] Now it is Holly's primary practice. She has licenses in nine states. She sees people all over the country. With her diagnosis, her physicians at Mass General have telehealth licensure in Maine. She gets to do telehealth with them instead of driving two hours.   [40:53] Dr. Jensen tells of two of the things they hope to do at EGID Partners. One is trying to understand more about reproductive health for patients with an EGID diagnosis. Only a few studies have looked at this question, and with very small samples.   [41:15] As more people register for EGID Partners, Dr. Jensen is hoping to be able to ask some questions related to reproductive health outcomes.   [41:27] The second goal is a survey suggested by the Student Advisory Committee, asking questions related to the burden of disease specific to the teen population.   [41:48] This diagnosis can hit that population particularly hard, at a time when they are trying to build and sustain friendships and are transitioning to adult care and moving away from home. This patient population has a unique perspective we wanted to hear.   [42:11] Dr. Jensen and Dr. Dellon work on all kinds of other projects, too.   [42:22] Dr. Dellon says they have done a lot of work on the early-life factors that may predispose to EoE. They are working on a large epidemiologic study to get some insight into early-life factors, including factors that can be measured in baby teeth.   [42:42] That's outside of EGID Partners. It's been ongoing, and they're getting close, maybe over the next couple of years, to having some results.   [43:03] Ryan says all of those projects sound so interesting. We need to have you guys back to dive into those results when you have something finalized.   [43:15] For our listeners who want to learn more about eosinophilic disorders, we encourage you to visit apfed.org and check out the links in the show notes below.   [43:22] If you're looking to find specialists who treat eosinophilic disorders, we encourage you to use APFED's Specialist Finder at apfed.org/specialist.   [43:31] If you'd like to connect with others impacted by eosinophilic diseases, please join APFED's online community on the Inspire Network at apfed.org/connections.   [43:41] Ryan thanks Dr. Dellon and Dr. Jensen for joining us today. This was a fantastic conversation. Holly also thanks APFED's Education Partners GSK, Sanofi, Regeneron, and Takeda for supporting this episode.   Mentioned in This Episode: Evan S. Dellon, MD, MPH, Academic Gastroenterologist, University of North Carolina School of Medicine   Elizabeth T. Jensen, MPH, PhD, Epidemiologist, Wake Forest University School of Medicine, University of North Carolina at Chapel Hill   Predictors of Patients Receiving No Medication for Treatment of Eosinophilic Esophagitis in the United States: Data from the TARGET-EGIDS Cohort   Episode 15: Access to Specialty Care for Eosinophilic Esophagitis (EoE)   APFED on YouTube, Twitter, Facebook, Pinterest, Instagram Real Talk: Eosinophilic Diseases Podcast apfed.org/specialist apfed.org/connections apfed.org/research/clinical-trials   Education Partners: This episode of APFED's podcast is brought to you thanks to the support of GSK, Sanofi, Regeneron, and Takeda.   Tweetables:   "I've been working on eosinophilic gastrointestinal diseases for about 15 years. I started some of the early work around understanding possible risk factors for the development of disease. I've gone on to support lots of other research projects." — Elizabeth T. Jensen, MPH, PhD   "You can think of EoE as asthma of the esophagus or eczema of the esophagus, although in general, people don't grow out of EoE, like they might grow out of eczema or asthma. When people have it, it really is a long-term condition." — Evan S. Dellon, MD, MPH   "There are two general approaches to treating the underlying condition, … using medicines and/or eliminating foods from the diet that we think may trigger EoE. I should say, for a lot of people, EoE is a food-triggered allergic condition." — Evan S. Dellon, MD, MPH   "I didn't find it that surprising [that there are patients who had no treatment]. Some patients are relatively asymptomatic, and others are not interested in pursuing medications initially or are … still exploring dietary treatment options." — Elizabeth T. Jensen, MPH, PhD   "We have a bunch of studies now that look at how long people have symptoms before they're diagnosed. There's a wide range. Some people get symptoms and are diagnosed right away. Other people might have symptoms for 20 or 30 years." — Evan S. Dellon, MD, MPH   "EGID Partners is an online registry where individuals, caregivers, and parents of children affected with EGIDs can join. EGID Partners also needs people who don't live with an EGID to join, as controls." — Elizabeth T. Jensen, MPH, PhD

Brendel, Gerd www.deutschlandfunkkultur.de, Studio 9

Brendel, Gerd www.deutschlandfunkkultur.de, Studio 9

Are you swallowing your truth… and feeling it burn?In this episode of The Mind Change Podcast emotional drivers series, Heather McKean uncovers the subconscious patterns behind GERD and acid reflux—symptoms often blamed on food, stress, or “just getting older,” but rooted much deeper in the mind.Heather breaks down how unspoken anger, guilt, fear of rejection, people-pleasing, and lifelong self-silencing can create the internal “acid” the body can no longer cool on its own. She shares the story of “Naomi,” a woman who learned early that speaking up meant losing love—so she stayed quiet, compliant, and responsible for everyone but herself. When her body finally pushed back through chronic reflux, Mind Change work helped her safely process the emotions she once swallowed whole.You'll explore powerful questions to help you identify: • What you can no longer “stomach” in your life • The truths you keep holding in to stay safe or accepted • Where guilt, resentment, or pressure may be creating internal burn • How to begin rewiring your emotional responses around expression and boundariesIf GERD has been your body's way of speaking for you, this episode reveals how Mind Change techniques can help you reclaim your voice, restore safety around self-expression, and cool the emotional fire from the inside out.Tune in and discover what your body has been trying to tell you.

The best biotech and pharmaceutical innovations mean nothing if they can't be protected—and protected fast. Our next guest, Josh Goldberg, is solving this challenge as co-managing partner at Nath, Goldberg & Meyer, the #1 ranked patent law firm for biotech and pharmaceutical technologies. With nearly three decades of IP law experience and a unique background as a lab researcher, Josh brings an insider's understanding of how innovation actually happens. He's helped industry leaders like Amgen, Takeda, and GlaxoSmithKline turn breakthrough treatments into patent-protected portfolios—often in under a year instead of the typical four-year timeline. Driven by a passion for focus and strategic IP timing, Josh shares his pioneering approach to biotech and pharmaceutical patent prosecution. Join us to discover how smart IP strategy drives licensing power, regulatory success, and company valuation. Let's go!Episode Highlights:Focus drives success – Companies fail by trying to do everything at once; staying deliberate and focused is key to making real impactOne-year patent timelines vs. four years – Josh uses USPTO's Track 1 program to secure patents in record time, improving fundraising and M&A positioningClient-centered approach wins – Listening to unique client needs instead of one-size-fits-all strategies earned the firm its #1 rankingDiagnostic patents are back – New USPTO Director signals the patent office is "open for business" again after a decade of restrictionsScientist turned patent attorney – Josh's lab background gives him insider understanding of how innovation actually happensAbout our Guest: Joshua is the patent attorney innovation-driven pharmaceutical companies call when they need to turn complicated technologies into protected assets in record time.As co-managing partner at Nath, Goldberg & Meyer—the #1 ranked patent law firm for biotech and pharmaceutical technologies in both 2024 and 2025—Joshua leads IP efforts across industries like biotech, pharma, agriculture, renewable energy, and advanced materials. Whether it's a blockbuster acne treatment like DUAC, a vitamin D analog lotion like Sorilux, OTC solutions like Salonpas and Germagic, or a leading drug used to reduce stomach acid and treat conditions like GERD, ulcers, and heartburn—like Protonix—Joshua helps turn high-stakes R&D into patent-protected portfolios, often in under a year instead of the typical four-year timeline.Though his climate and agricultre IP expertise has made him famous as the “green patent guy,” Joshua moves between disciplines skillfully and has helped industry leaders like Amgen, Takeda, Guilford Pharmaceuticals, Mayne, and Stiefel Laboratories (which was acquired by GlaxoSmithKline) build pharma portfolios that hold up under investor, acquirer, and FDA scrutiny.His journey didn't begin in IP law, but in the lab, researching experimental pharmaceutical delivery systems. It gave him an edge most attorneys don't have: understanding how innovation actually happens, and how to protect it without slowing a business down. Links Supporting This Episode: Nath, Goldberg & Meyer Website: CLICK HEREJoshua Goldberg LinkedIn page: CLICK HERENath, Goldberg & Meyer LinkedIn: CLICK HEREMike Biselli LinkedIn page: CLICK HEREMike Biselli Twitter page:...

Brendel, Gerd www.deutschlandfunkkultur.de, Studio 9

Brendel, Gerd www.deutschlandfunkkultur.de, Fazit

Brendel, Gerd www.deutschlandfunkkultur.de, Studio 9

Brendel, Gerd www.deutschlandfunkkultur.de, Studio 9

Aus Köln Ehrenfeld. Mit dem Blogger und InDunbio Moderator Gerd Buurmann (https://x.com/Buurmann) Wir besprechen Steinmeiers Demokratiepropaganda-Rede und die staatliche Diskriminierung durch neomarxistische Gleichmacherei, behinderte Orwell-Stiftungen, Transwahnsinn bei der Polizei und keine US-Visa für Fatties. Escape the Matrix. Finde Aethervox Ehrenfeld überall: https://linktr.ee/AethervoxEhrenfeld

In dieser True Dog Story begleitest Du Kalle vom turbulenten Bauernhofstart bis zum entspannten Familienhund. Du erlebst entscheidende Wendepunkte: der Hühner-Schreck, der Weg zu mehr Gelassenheit im Alltag, erste Freilauf-Momente und Einblicke in den Schulhund-Alltag. Nah dran, mitfühlend erzählt und ohne Anleitungen – eine Geschichte über Bindung, Verständnis und gute Entscheidungen zur richtigen Zeit.Profitiere von unsren Frühbucherrabatten:HundeheldenclubTrainerInnen ClubWebinar „Rückruf meistern“Infos für das Einreichen deiner True Dog-StoryWir freuen uns sehr, wenn du deine persönliche Geschichte mit uns teilst und Teil unseres „True Dog Story Podcast“ wirst. Damit wir deine Erzählung bestmöglich umschreiben und vorstellen können (Sylvia erzählt Gerd deine Geschichte, ohne dass er weiß, was ihn erwartet), bitten wir dich, folgende Punkte zu beachten:Erzähle uns, warum du dich entschieden hast, einen Hund zu adoptieren oder anzuschaffen.Berichte, warum es genau dieser Hund geworden ist – was hat dich an ihm besonders angesprochen?Teile deine Vorstellungen und Erwartungen: Wie hast du dir das Leben mit deinem Hund vorgestellt?Beschreibe ehrlich, was tatsächlich passiert ist – sowohl positive als auch herausfordernde Erfahrungen.Berichte, wo du Kompromisse eingehen oder dich komplett umstellen musstest.Schreibe aus deiner persönlichen Sicht über deine Gefühle, Erlebnisse und Entwicklungen.Halte deine Geschichte bitte auf maximal 2,5 DIN A4 Seiten.Füge 4 bis 6 Fotos bei, die wir mit deiner Erlaubnis veröffentlichen dürfen.Schreibe uns ob wir die echten Vornamen und Tiernamen verwenden dürfen oder ob wir Personen oder dich selbst umbenennen sollen.Sende deine Geschichte und Fotos per E-Mail an hundegesabbel@dog-geeks.de mit dem Betreff „True Dog Story Podcast“. Wir freuen uns darauf, deine einzigartige Erfahrung zu hören und mit unserer Community zu teilen!

In dieser True Dog Story begleitest Du Kalle vom turbulenten Bauernhofstart bis zum entspannten Familienhund. Du erlebst entscheidende Wendepunkte: der Hühner-Schreck, der Weg zu mehr Gelassenheit im Alltag, erste Freilauf-Momente und Einblicke in den Schulhund-Alltag. Nah dran, mitfühlend erzählt und ohne Anleitungen – eine Geschichte über Bindung, Verständnis und gute Entscheidungen zur richtigen Zeit.Profitiere von unsren Frühbucherrabatten:HundeheldenclubTrainerInnen ClubWebinar „Rückruf meistern“Infos für das Einreichen deiner True Dog-StoryWir freuen uns sehr, wenn du deine persönliche Geschichte mit uns teilst und Teil unseres „True Dog Story Podcast“ wirst. Damit wir deine Erzählung bestmöglich umschreiben und vorstellen können (Sylvia erzählt Gerd deine Geschichte, ohne dass er weiß, was ihn erwartet), bitten wir dich, folgende Punkte zu beachten:Erzähle uns, warum du dich entschieden hast, einen Hund zu adoptieren oder anzuschaffen.Berichte, warum es genau dieser Hund geworden ist – was hat dich an ihm besonders angesprochen?Teile deine Vorstellungen und Erwartungen: Wie hast du dir das Leben mit deinem Hund vorgestellt?Beschreibe ehrlich, was tatsächlich passiert ist – sowohl positive als auch herausfordernde Erfahrungen.Berichte, wo du Kompromisse eingehen oder dich komplett umstellen musstest.Schreibe aus deiner persönlichen Sicht über deine Gefühle, Erlebnisse und Entwicklungen.Halte deine Geschichte bitte auf maximal 2,5 DIN A4 Seiten.Füge 4 bis 6 Fotos bei, die wir mit deiner Erlaubnis veröffentlichen dürfen.Schreibe uns ob wir die echten Vornamen und Tiernamen verwenden dürfen oder ob wir Personen oder dich selbst umbenennen sollen.Sende deine Geschichte und Fotos per E-Mail an hundegesabbel@dog-geeks.de mit dem Betreff „True Dog Story Podcast“. Wir freuen uns darauf, deine einzigartige Erfahrung zu hören und mit unserer Community zu teilen!

Gumo ihr Lieben, eine neue Folge BoWa tröpfelt wohlig in eure Tassen. Heute mit vielfach eingesandten Topmeldungen, die bowacorer nicht sein könnten: Alles über Hollywood beim führenden Tischtennisanbieter Berlins. Sowie die filmreiche Geschichte der Kuh Mücke und ihre unwahrscheinliche Reise. Wie immer mit Segen und der Chance aufs große Glück! Zum Gerd-Rubenbauer-Überraschungspaket! Zum BoWa-Discord! Unsere neue Homepage! Hol dir jetzt den exklusiven  NordVPN-Deal unter https://nordvpn.com/wachmacher Learn more about your ad choices. Visit megaphone.fm/adchoices

Constipation, diarrhea, hemorrhoids, GERD, food sensitivities and more on this week's show with Prairie Doc Jill Kruse.

你是否曾經歷持續的腹部悶脹，疼痛，或是月經週期突然變得混亂？這些看似普通的症狀，背後可能隱藏一個常見的婦科問題 -- 卵巢囊腫(水瘤)。究竟生水瘤是否一定要開刀切除？還是有方法令水瘤自然消失？這一集Afreen和Piano將帶大家全面認識卵巢囊腫(水瘤)，從識別警號到積極預防！

Brendel, Gerd www.deutschlandfunkkultur.de, Religionen

Brendel, Gerd www.deutschlandfunkkultur.de, Fazit

Brendel, Gerd www.deutschlandfunkkultur.de, Rang 1

Hey there, wonderful listeners of The Armor Men's Health Show!

Patreon.com/SlopQuest for full episodes, a backlog of hundreds of hours of other podcasts with Ryan and Andrew and much, much more! Comedian Ryan O’Neill and Illustrator Andrew DeWitt bring you the dumbest takes on news, movies and ridiculous business ideas every week on Slop Quest! This episode Ryan loses his voice at the same time as Andy. Ryan for mysterious reasons and Andy because of a massive onion based GERD attack. Andy has to paint a commission of Godzilla with boobs and a dong. Then they pitch the GERD National Championship where Andy faces off against Steve Ranazizi. Andy keeps getting slapped awake by the corner of his fitted sheet around 2 am every night. Then they come up with a plan to stop men from taking dick pics on the toilet with a new invention. Then Andy tries to whisper sweet nothings into his wife’s ear while he’s gerding. Then they pitch a History Chanel show “Decoding The Past: With Ryan O’Neill”. Andy gets sent to Fat Space Camp. Then Andy’s mom laments buying him a Starter Jacket.

Michalek, Gerd www.deutschlandfunk.de, Sonntagsspaziergang

Ethiopia's Grand Ethiopian Renaissance Dam (GERD) is Africa's biggest hydroelectric project. It is a great step forward for Ethiopia's development, but it is also a source of conflict with Egypt and Sudan, which depend on the Nile River for almost all of their water. In this episode of Down to Business English, Skip Montreux and Samantha Vega talk about how the GERD was built, why Ethiopia needs it, and why its neighbors are worried about its impact. They also look at how the project could bring both opportunities and risks to East Africa's energy and business sectors. Skip and Samantha's conversation will help you understand how business, development, and international relations are connected — while improving your Business English vocabulary. Key points of their discussion include: What the Grand Ethiopian Renaissance Dam is and why it is important. How Ethiopia raised most of the money for the dam without foreign loans. How the dam could help Ethiopia sell electricity to other countries. Why this project may cause conflict with neighboring countries. Do you like what you hear? Become a D2B Member today for to access to our -- NEW!!!-- interactive audio scripts, PDF Audio Script Library, Bonus Vocabulary episodes, and D2B Member-only episodes. Visit d2benglish.com/membership for more information. Follow Down to Business English on Apple podcasts, rate the show, and leave a comment. Contact Skip, Dez, and Samantha at downtobusinessenglish@gmail.com Follow Skip & Dez Skip Montreux on Linkedin Skip Montreux on Instagram Skip Montreux on Twitter Skip Montreux on Facebook Dez Morgan on Twitter RSS Feed

Brendel, Gerd www.deutschlandfunk.de, Kultur heute

Brendel, Gerd www.deutschlandfunkkultur.de, Studio 9

Brendel, Gerd www.deutschlandfunkkultur.de, Studio 9

Brendel, Gerd www.deutschlandfunkkultur.de, Studio 9

Brendel, Gerd www.deutschlandfunkkultur.de, Fazit

Brendel, Gerd www.deutschlandfunkkultur.de, Studio 9

Brendel, Gerd www.deutschlandfunkkultur.de, Studio 9

Popping an antacid might work for occasional heartburn. For many people though, acid reflux is a daily battle that affects sleep, diet and quality of life. Ali Zakaria, M.D., Gastroenterologist and Pial Hope, D.O., General Surgeon, both of Rapid City Hospital, discuss why gastroesophageal reflux disease (GERD) may require more than over-the-counter solutions. The duo explains the cause of chronic symptoms and elaborate on their collaborative approach to diagnosis and treatment. They explore advanced care options including transoral fundoplication and robotic surgery, address concerns about long-term medication use and explain why proper diagnosis is crucial before any intervention. Hosted on Acast. See acast.com/privacy for more information.

Ketika perut terasa nyeri, kembung, atau terasa panas seperti terbakar akibat asam lambung naik, kita membutuhkan solusi yang cepat dan efektif. Jus ramuan herbal kilat ini dirancang khusus untuk meredakan gejala tersebut dengan cepat. Terbuat dari campuran bahan alami seperti madu, lidah buaya, jahe, kunyit, sereh, dan daun pandan. Jus ini bekerja dengan cara menenangkan perut, mengurangi peradangan, dan menstabilkan asam lambung. Madu berfungsi melapisi dinding lambung agar tidak teriritasi, sementara lidah buaya membantu menyejukkan dan memperbaiki jaringan lambung yang meradang.Jahe dan kunyit berperan sebagai antiinflamasi alami yang mengurangi rasa nyeri dan perih, sedangkan sereh dan pandan membantu menenangkan saraf dan mengurangi ketegangan. Selain cepat meredakan gejala, jus herbal ini juga mudah dibuat dan aman dikonsumsi saat kondisi darurat. Jika asam lambung mendadak naik atau perut tiba-tiba terasa sakit, cukup minum segelas jus herbal hangat ini untuk mendapatkan efek menenangkan dan meredakan rasa tidak nyaman. Ramuan ini tidak hanya efektif untuk mengatasi gejala GERD, tetapi juga membantu memperlancar pencernaan dan mencegah kambuhnya gangguan lambung. Dengan rutin mengonsumsinya, tubuh akan terasa lebih nyaman, dan aktivitas sehari-hari pun bisa dilanjutkan tanpa gangguan.

Epi 332What do most bariatric surgeons NOT tell you about reflux, GERD, and hidden hernias?

Friedrich, Uwe www.deutschlandfunkkultur.de, Fazit

Update your approach to the evaluation and management of GERD with Dr. James Callaway. Learn when to consider ambulatory reflux monitoring and how to determine if someone has an indication for long-term PPI therapy.  Claim CME for this episode at curbsiders.vcuhealth.org! Patreon | Episodes | Subscribe | Spotify | YouTube | Newsletter | Contact | Swag! | CME Show Segments Intro Case Definitions and symptoms Reflux mechanisms and triggers Medications for Acid suppression  Endoscopy and Ambulatory Reflux Monitoring  Stopping the PPI  Additional etiologies of reflux symptoms  Outro Credits Written and Produced by: Elena Gibson MD  Infographic and Cover Art:Elena Gibson MD  Hosts: Matthew Watto MD, FACP; Paul Williams MD, FACP    Reviewer: Sai S Achi MD, MBA, FACP Showrunners: Matthew Watto MD, FACP; Paul Williams MD, FACP Technical Production: PodPaste Guest: James Callaway MD  Disclosures Dr. Callaway reports no relevant financial disclosures. The Curbsiders report no relevant financial disclosures.  Sponsor: Panacea Financial  Schedule a free consultation today and make sure your career stays more treat than trick. Get started at Panacea.Legal Sponsor: Mint Mobile Ready to say yes to saying no? Make the switch at MINTMOBILE.com/CURB Sponsor:  Continuing Education Company Visit CMEmeeting.org/curbsiders  and use promo code Curb30 to get 30% off all online courses and webcasts.

Are you tired of chasing your acid reflux symptoms with PPI's, annoying food restrictions like the GERD diet, or hyper-vigilance about when and how much food you eat? When you ask your doctor if there's ANYTHING else you can do to help your acid reflux, do they tell you that you just need to pop another antacid, avoid trigger foods, or sleep on a wedge pillow? Do you wish there was a solution to acid reflux that was permanent, so you could eat late at night without worrying about a reflux flare, or that you could eat your favorite foods again without feeling punished for it later? If you said yes to any of these questions, then this episode is for you. On today's episode, my goal is to lay out acid reflux in one MASTER episode so that, by the end of it, you can have a map for exactly how to find, and deal with, the root cause(s) of your acid reflux. In this episode, I'm talking about: The real causes of acid reflux and GERD symptoms (and why it's not “too much acid”)The difference between acid reflux, GERD, LPR, and silent reflux — and why this episode can help ALL of these diagnosesWhy standard acid reflux drugs (PPIs, acid reducers) give quick relief but cause long-term problemsHow the acid reflux diet and GERD diet miss the root causeAnd, most importantly, 2 steps to reversing your acid reflux (for good!) If you're tired of relying on medication to manage your acid reflux and want freedom from your stomach terror - then this episode is for you. TIMESTAMPS:00:00 - Introduction to Acid Reflux Struggles 00:56 - Understanding Acid Reflux and GERD 01:44 - Welcome to the Better Belly Podcast 04:27 - The Anatomy and Symptoms of Acid Reflux 08:16 - Diagnosing Acid Reflux 10:24 - Causes of Acid Reflux 13:00 - Pressure Systems and Acid Reflux 25:49 - Conventional Treatments for Acid Reflux 28:25 - The Impact of Low Stomach Acid on Nutrient Absorption 29:32 - The Vicious Cycle of PPIs and Acid Reflux 31:29 - Steps to Reverse Acid Reflux 33:37 - Identifying Pathogens and Their Effects 40:09 - The Role of Histamine in Acid Reflux 40:49 - Fascial Restrictions and Their Impact 44:53 - Testing for Low Stomach Acid 48:05 - Comprehensive Testing and Treatment Plan 51:22 - Client Success Stories and Testimonials 53:08 - Conclusion and Next Steps EPISODES MENTIONED:47// The Gut-Sinus Connection233// H. Pylori: Symptoms of H. Pylori, How to Interpret H. Pylori Test Results, and Why H. Pylori Treatments Fail40// Reduce Acid Reflux with the Magic Power of Zinc68// 10 Markers on Your Bloodwork Linked to Acid Reflux

Festen, jobbintervjun eller kalaset vad missade du? Lyssna på alla avsnitt i Sveriges Radio Play. Ett nyfiket och underhållande aktualitetsprogram med lyssnaren i fokus.Fredric åkte till fel stad för en jobbintervju, Gerd missade en begravning som hon skulle spela på och Jessica missade dotterns dop efter att hon hade råkat baka ”magsjuketårtor”!I extramaterialet diskuterar vi om man kan klara sig utan en kamera i kylskåpet. Och så berättar Erika om när hon nästan missade sitt bröllop och hennes nu långvariga personliga vendetta med Göteborgsvarvet.

Gerd Schuster lebte als Punk auf der Straße. Als ein Hund für ihn da war, fand er nicht nur den Weg zurück in die Gesellschaft, sondern auch seinen Beruf: Er ist Hundetrainer. Der Nürnberger ist bei Tom Viewegh zu Gast.

The Heroes of Asgard by Annie and Eliza Keary - part 17: Fairest Gerd ★ Support this podcast on Patreon ★

In this episode, hosts Drs. Temara Hajjat and Jenn Lee talk to Dr. Jordan Whatley, Assitant Professor of Pediatrics at the Medical University of South Carolina and pediatric gastroenterologist at Shawn Jenkins Children's Hospital in Charleston, South Carolina. We discuss how multi-specialty clinics focusing on children with tracheostomy and ventilator dependence can improve clinical care.Learning Objectives:Describe the reasons children may require a tracheostomy and home mechanical ventilation.Explain multidisciplinary structure and purpose of an aerodigestive clinic in managing complex pediatric patients. Describe the gastroenterologist's role in evaluating and managing GERD, feeding intolerance, and nutritional needs in children with trach/vent dependence. Support the showThis episode may be eligible for CME credit! Once you have listened to the episode, click this link to claim your credit. Credit is available to NASPGHAN members (if you are not a member, you should probably sign up). And thank you to the NASPGHAN Professional Education Committee for their review!As always, the discussion, views, and recommendations in this podcast are the sole responsibility of the hosts and guests and are subject to change over time with advances in the field.Check out our merch website!Follow us on Bluesky, Twitter, Facebook and Instagram for all the latest news and upcoming episodes.Click here to support the show.

Bill Snyder, CEO and Founder of Cylinder, is addressing the high prevalence of digestive health issues using a virtual care model to provide access to a coordinated care team, including dieticians and health coaches, to offer personalized care plans. GI conditions are complex and involve a combination of genetic predisposition, environmental factors, and dietary influences. There are strong correlations between the gut and brain, as well as digestive health and various physical and mental conditions. Cylinder fills a gap in traditional GI care, where physicians often lack extensive nutritional training. Bill explains, "First and foremost, we think about the patients that we serve, and the patients that we serve come to us from across the country. We serve patients in every state across the US, and they suffer from a variety of GI-related conditions. That's things like ulcerative colitis, Crohn's disease, irritable bowel syndrome, and GERD. It's also a large population who don't have a formal diagnosis, but are symptomatic of GI conditions. So they may have chronic bloating, chronic constipation, and chronic heartburn, and they may not know what the underlying cause is. And then we also reach those members through our clients, which are large self-funded organizations and health plans. People traditionally gain access to Cylinder as part of their employee benefits package." "But there's also a lot that we continue to understand in terms of our overall digestive health system connection. The gut-brain axis, which serves as a bilateral feedback loop between the gut and the brain, is where we found that your digestive health often correlates with your mental health, and vice versa. So we know that some of the reasons for the onset of these conditions can be genetic, but to your point, we're also seeing a lot of impact from our environment and certainly from the foods we eat. And so as you think about the American diet, and as you think about how that's changed over the past several decades, we're seeing an increase in the incidence of these conditions and an increase in people who are presenting with these symptoms and not really sure where to go or what to do." #CylinderHealth #GIhealth #digestivehealth #cylinderhealth #GIcare #virtualhealth #employeebenefits  cylinderhealth.com Download the transcript here

Bill Snyder, CEO and Founder of Cylinder, is addressing the high prevalence of digestive health issues using a virtual care model to provide access to a coordinated care team, including dieticians and health coaches, to offer personalized care plans. GI conditions are complex and involve a combination of genetic predisposition, environmental factors, and dietary influences. There are strong correlations between the gut and brain, as well as digestive health and various physical and mental conditions. Cylinder fills a gap in traditional GI care, where physicians often lack extensive nutritional training. Bill explains, "First and foremost, we think about the patients that we serve, and the patients that we serve come to us from across the country. We serve patients in every state across the US, and they suffer from a variety of GI-related conditions. That's things like ulcerative colitis, Crohn's disease, irritable bowel syndrome, and GERD. It's also a large population who don't have a formal diagnosis, but are symptomatic of GI conditions. So they may have chronic bloating, chronic constipation, and chronic heartburn, and they may not know what the underlying cause is. And then we also reach those members through our clients, which are large self-funded organizations and health plans. People traditionally gain access to Cylinder as part of their employee benefits package." "But there's also a lot that we continue to understand in terms of our overall digestive health system connection. The gut-brain axis, which serves as a bilateral feedback loop between the gut and the brain, is where we found that your digestive health often correlates with your mental health, and vice versa. So we know that some of the reasons for the onset of these conditions can be genetic, but to your point, we're also seeing a lot of impact from our environment and certainly from the foods we eat. And so as you think about the American diet, and as you think about how that's changed over the past several decades, we're seeing an increase in the incidence of these conditions and an increase in people who are presenting with these symptoms and not really sure where to go or what to do." #CylinderHealth #GIhealth #digestivehealth #cylinderhealth #GIcare #virtualhealth #employeebenefits  cylinderhealth.com Listen to the podcast here

Have feed back, suggestions, or questions? CLICK HERE to Send us a Message.Mind Pilot Episode 86When you only have one way to cope, injury, schedule changes, or a moved away friend can leave you stranded. In this episode, Dr. Jana Price-Sharps teaches how to diversify your coping, pick strategies that truly lower anxiety, and avoid helpers that accidentally inflame it. You will hear why calling an anxious friend can escalate panic, how a glass of wine can turn into a bottle after a rough day, and what to try instead, from happy playlists and favorite photo albums to getting outside, mowing the lawn, fishing, or crafting. Use a simple three by five card to list five or six reliable options, then reach for it when your brain is spinning, so your body can recalibrate and your sleep, mood, and digestion improve. Topics Covered COPING PORTFOLIO: Why one strategy is risky and how to diversify your calm SMART SUPPORT: How to choose centered friends and avoid anxiety amplifiers HEALTHY DISTRACTIONS: Music, photos, nature, hobbies, chores, and movement that reset the system STRESS AND BODY: How high stress fuels GERD, IBS, poor sleep, irritability, and what a daily plan can change Support the show

In this episode of The Horn, Alan is joined by Crisis Group's Africa Program Director, Murithi Mutiga, to discuss the inauguration of the Grand Ethiopian Renaissance Dam (GERD), Africa's largest hydroelectric dam. They trace the project's development during a tumultuous period for the region and explore its economic and political significance for Ethiopia. They examine why the project has raised tensions with the downstream Nile countries, Egypt and Sudan, why mediation efforts failed before completion, and to what extent concerns about GERD are justified. Finally, they discuss whether the dam can deliver the economic transformation Ethiopia hopes for, what it would take for Ethiopia, Egypt and Sudan to avert a future crisis, and how the dispute over the dam could still drive regional tensions for years to come.For more, check out our Ethiopia and Horn of Africa pages. Hosted on Acast. See acast.com/privacy for more information.

Send us a textThat burning sensation creeping up your chest after a delicious meal isn't just uncomfortable—it's your body sending you an important message. Dr. Holly Thacker breaks down the crucial differences between occasional acid reflux and chronic GERD, a condition affecting one in three adults that shouldn't be ignored.Drawing from decades of clinical experience, Dr. Thacker explains how your lower esophageal sphincter functions as the gatekeeper between your stomach and esophagus, and why factors like age, pregnancy hormones, certain medications, and lifestyle choices can compromise this important barrier. You'll learn why that burning sensation happens and how it can lead to more serious complications when left untreated.Whether you experience occasional heartburn or struggle with chronic reflux, this comprehensive guide provides the knowledge you need to take control of your digestive health. Subscribe to our podcast for more expert insights that help you Be Strong, Be Healthy, and Be in Charge!Support the show

The Wine Guys return to Germany for their first German red on the show, the 2023 Gerd Anselmann Pfalz Dornfelder. What starts with jammy blackberries, blueberries, and plum on the nose quickly turns into one of the most unusual tasting experiences they have had all season. Freshness, juiciness, bitterness, and earth all fight for attention in a wine that feels like two different bottles in one sip.The crew dives into Dornfelder's backstory too. Bred in 1955, this crossing has already climbed to become Germany's second most planted red grape. They talk through the two styles you're most likely to run into and where this Pfalz bottle falls. The chat drifts into serving temp, what foods it begs for like lamb or a charcuterie board, and how the wine's unexpected weight and flavor keep throwing them curveballs To close things out, the Wine Vibes game makes another appearance, distilling Dornfelder into pure vibes instead of tasting notes. Weird, surprising, but enjoyable, this wine sparks one of the most curious conversations yet.Connect with the show. We would love to hear from you!Stop Wasting Your Wine on Instagram⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.instagram.com/stopwastingyourwine/⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Stop Wasting Your Wine on YouTube⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.youtube.com/@StopWastingYourWine⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠The Stop Wasting Your Wine Website⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://stopwastingyourwine.com/⁠⁠⁠⁠⁠⁠Chapters: 00:00 - Intro02:40 - What we are drinking. 05:33 - Wine Discussion: Smells and Flavors14:26 - Wine Drops: Learning Segment23:28 - Wine Review30:29 - Game: Wine Vibes34:39 - Outro

Episode Notes Welcome to another special edition of NHA Today, the official podcast of the National Health Association. As part of our guest host series, this episode is led by Chuck Carroll, host of The Exam Room Podcast from the Physicians Committee for Responsible Medicine (PCRM). Chuck is joined by Dr. Will Bulsiewicz (“Dr. B”), The Gut Health MD, for a wide-ranging conversation on gut health, healing, and lifestyle medicine. Together they explore: Why heartburn and GERD are really gut motility issues The role of diet, fiber, and the microbiome in supporting long-term health The risks of long-term reliance on reflux medications How stress, sleep, and exercise influence digestion through the gut-brain axis The importance of community, including Dr. B's Gut Health Collective Insights from his upcoming book Plant Powered Plus This episode delivers practical strategies and empowering science for anyone looking to improve their gut health and overall well-being.   Links & Resources

Dr Sudarshan Jadcherla visits the studio as we consider gastroesophageal reflux in babies. We explore the difference between GER and GERD, including their symptoms, diagnosis, and management. We hope you can join us!

Contributors: Travis Barlock MD, Jeffrey Olson MS4 Feel free to use the cases below for your own practice. All of the scenarios are completely made up and designed to hit several teaching points. Case 1 25 M, presents to the ED with chest pain. Stabbing, started a few hours ago, substernal. Thinks it is GERD. After 2-3 minutes, pain worsens and radiates to the back. VS: BP 125/50 (Right arm 190/110). HR 120. RR of 18. Sat 98% on RA. Additional VS: Temp of 37.2, height of 6'5”, BMI of 18. PMH: None, doesn't see a doctor. Meds: None FH: Weird heart thing (Mitral Valve Prolapse), weird lung thing (spontaneous pneumothorax), tall family members with long fingers and toes Physical Exam: Cards: Diastolic decrescendo at the RUSB, diminished S2. UE pulses are asymmetric, LE pulses are asymmetric, carotid pulses are asymmetric, BP is asymmetric MSK: Knees, elbows, and wrists are hypermobile. Imaging: CXR #1 normal, #2 widened mediastinum (no read yet but shows widened mediastinum), POCUS shows small effusion CTA/MRA doesn't come back until after the case.  ECG: Sinus Tach Labs: NT-proBNP 500 pg/mL D-Dimer: 7000 ng/L CBC: Hemoglobin: 13.5 g/dL, WBC: 20,000/µL, Platelets: 250,000/µL Chem 7: Na 138, K, 5.7, Cl 102, Bicarb 17, BUN 45, Creatinine: 3.5 mg/dL, Glucose: 180 LFTs: Albumin 2.4, Total protein 5.5, ALP: 140, AST: 3500, ALT: 2800, TBili: 3.2, DirectBili: 2.4, Ca: 7.8 LDH: 2200 PT: 20.5, INR: 2.2, Fibrinogen: 170 5th gen High-Sensitivity Troponin:

In this episode, Vera and Renae explore bulimorexia—a term used for people who oscillate between restriction and binge/purge behaviors—and how this mixed pattern might help explain stubborn relapse rates across eating disorders and food addiction. Dr. Norton shares her clinical lens on risks (medical and psychological), why some traditional programs may miss the mark, and what a holistic, skills-based, harm-reduction treatment can look like (family involvement, gentle re-feeding, DBT/EMDR, food quality, and relapse prevention). Note: Some views expressed are the guest's opinions and experience. This episode is educational and not medical advice. Please consult your care team. What we cover Defining “bulimorexia”: alternating restriction with binge/purge; how it differs from anorexia nervosa and bulimia nervosa; why it's easier to hide than classic anorexia. Continuum vs. categories: where binge eating disorder fits; overlap with food addiction. Why relapse is common: risks of aggressive refeeding; short-stay residential models; lack of individualized care; missing family systems support. Medical risks (high-level): cardiac arrhythmias and hypotension, esophageal tears/GERD, laxative misuse and constipation, electrolyte disturbance, kidney strain, dental/enamel erosion, parotid swelling, menstrual disruption and fertility concerns. Psychological load: anxiety/OCD traits, depression, social avoidance; the “addiction to restricting” and the short-term ‘high' of hunger. Treatment principles Dr. Norton uses: Gentle, stepwise re-feeding (small, frequent meals; stabilize blood sugar; avoid triggering extremes). Skills over meal plans (shop, prep, and eat whole foods; mindful interoception). DBT for arousal regulation, plus EMDR and trauma work as indicated. Family-based involvement (Maudsley-style boundaries and support). Movement re-entry: slow, safe progression; curbing compulsive exercise. Relapse prevention: strong parent/caregiver alignment, food routines, anxiety skills, and ongoing monitoring. Contested terrain: ultra-processed food, additives, and differing regulations by region; the guest's emphasis on “clean/organic” sourcing. Intermittent fasting cautions: for restrict-prone folks, it can mask restriction; prefer regular, structured eating. What recovery can look like: decreased self-hatred, restored relationships, school/work re-engagement, and more flexible functioning. Resources from the guest: forthcoming book Below the Radar: What They're Not Telling You About Your Food; wellness tools she finds helpful. Suggested chapter markers 00:00 Welcome & guest intro 02:20 What is “bulimorexia”? How it differs from AN/BN 10:55 Why relapse stays high; critique of standard programs 18:30 Medical complications: heart, GI, dental, endocrine 28:15 Psychological patterns: anxiety, OCD traits, depression 34:40 Treatment pillars: re-feeding, DBT/EMDR, family work 45:05 Food quality and UPFs: guest's perspective & debate 53:10 Intermittent fasting cautions; safe movement 58:20 Relapse prevention & outcomes 1:04:10 Advice to clinicians, families, and society 1:08:00 What's next for Dr. Norton & closing Key takeaways (listener-friendly) Mixed patterns (restricting and binge/purge) may be under-recognized and can carry high medical risk. Slow, individualized re-feeding plus emotion-regulation skills (DBT) and family involvement improve safety and engagement. If you're prone to restriction, consistent meals beat fasting. Recovery gains include less self-hatred, more connection, and functional life goals—progress over perfection. Sensitive content note This episode discusses eating-disorder behaviors (restriction, purging, laxatives, insulin manipulation) and medical complications. Please use discretion and support. Links & mentions Dr. Renae Norton — Norton Wellness Institute / Mind, Weight & Wellness Pro Book (forthcoming): Below the Radar: What They're Not Telling You About Your Food Maudsley/Family-Based Treatment (FBT) overview DBT skills resources (distress tolerance, emotion regulation, interpersonal effectiveness) If you need help now: NEDA (US), BEAT (UK), local crisis lines, or your clinician. For clinicians Screen for mixed presentations (restrict + purge), including non-vomit purging (laxatives, insulin manipulation). Prioritize medical monitoring (vitals, electrolytes) during re-feeding; avoid one-size-fits-all calorie jumps. Integrate DBT skills, caregiver coaching, and regular eating structure; track arousal and urge patterns.   The content of our show is educational only. It does not supplement or supersede your healthcareprovider's professional relationship and direction. Always seek the advice of your physician or other qualified mental health providers with any questions you may have regarding a medical condition, substance use disorder, or mental health concern.