FDA Proposes New Blood Donation Rules for Gay Men

D.C. Week: FDA Proposes New Blood Donation Rules for Gay Men

FDA lifts ban for men who have sex with men, with caveat.

• SAVESAVED

• 
 

• by Joyce Frieden 
  News Editor, MedPage Today

WASHINGTON -- The FDA issued proposed rules to lift the ban on blood donation by men who have sex with men, and the Obama administration clarified rules for birth control coverage as the weather warmed up here in the nation's capital.

FDA Proposes Lifting Ban on MSM Blood Donation

ADVERTISEMENT

The FDA on Tuesday issued draft guidanceproposing to lift the agency's ban on blood donations from men who have sex with men, as long as the donors have abstained for a year.

"Male donors previously deferred because of a history of sex with another man, even one time, since 1977, may be eligible to donate provided that they have not had sex with another man during the past 12 months and they meet all other donor eligibility criteria," the FDA wrote in its "Revised Recommendations for Reducing the Risk of Human Immunodeficiency Virus Transmission by Blood and Blood Products."

In addition, "Male donors [previously] deferred because of a history of sex with another man in the past 12 months may be eligible to donate provided they have not had sex with another man during the [immediate] past 12 months and they meet all other donor eligibility criteria," the guidance stated.

The American Medical Association praised the proposed guidance. "The AMA commends the FDA for taking a step in the right direction to end the lifetime ban that prohibits men who have had sex with men (MSM) from ever donating blood," AMA PresidentRobert Wah, MD, said in a statement.

However, other groups were less enthusiastic. "This policy prevents men from donating life-saving blood based solely on their sexual orientation rather than actual risk to the blood supply," David Stacy, director of government affairs at the Human Rights Campaign, an organization that works for equal rights for lesbian, gay, bisexual, and transgender individuals, said in a blog post. "It simply cannot be justified in light of current scientific research and updated blood screening technology."

Obama Administration Clarifies Birth Control Mandate

Health insurers must cover without cost-sharing all 18 forms of contraception listed in the FDA's birth control guide, the Obama administration said in guidance issued Monday.

"The FDA currently identifies 18 distinct methods of contraception for women, and the ... guidelines are designed to provide women's access to the full range of these contraceptive methods identified by the FDA, as prescribed by a healthcare provider," stated a fact sheet on the guidance, which was issued jointly by the departments of Labor, Treasury, and Health and Human Services. "Thus, plans and issuers must cover without cost sharing at least one form of contraception within each method the FDA has identified."

For example, the fact sheet continued, "For the hormonal contraceptive methods, coverage must include (but is not limited to) all three oral contraceptive methods (combined, progestin-only, and extended/continuous use), injectables, implants, the vaginal contraceptive ring, the contraceptive patch, emergency contraception (Plan B/Plan B One Step/Next Choice), emergency contraception (Ella), and IUDs with progestin. Accordingly, a plan or issuer may not impose cost-sharing on the ring or the patch."

FDA: Smokeless Tobacco Warning Stays

The FDA on Monday denied a petition by two tobacco companies to ease up on the warnings around smokeless tobacco.

R.J. Reynolds and the American Snuff Company had requested that the FDA change one of the four warning statements required for product packages and advertising from "This product is not a safe alternative to cigarettes" to "No tobacco product is safe, but this product presents substantially lower risks to health than cigarettes."

A supplement to the petition suggested "No tobacco product is safe; however, exclusive use of smokeless tobacco products presents substantially less risk to health than cigarettes" as an alternative.

The FDA's response indicated neither change would be made.

Regardless of whether people might read the current label as saying smokeless tobacco isn't a safer alternative, it is factual as written because no tobacco product is safe, the agency argued.

137 Million Can Access Free Preventive Services, HHS Says

About 137 million people with private health insurance now have access to free preventive services as a result of the Affordable Care Act (ACA), the Department of Health and Human Services (HHS) announced Monday.

The ACA requires that insurers offer certain preventive services without costs, including contraception (see story above), obesity screening and counseling, breastfeeding support and supplies, HIV screening, and vaccinations to prevent flu and other diseases. The 137 million who have access to the free services include 15 million blacks, 17 million Latinos, and 8 million Asian-Americans, HHS noted.

"These services can substantially improve the health of families, and in some cases even save lives," HHS Secretary Sylvia Burwell said in a statement. "This can make a tremendous difference in the health of Americans."

Next Week

On Wednesday, the Senate Special Committee on Aging will hold a hearing on "Challenging the Status Quo: Solutions to the Hospital Observation Stay Crisis."

Also on Wednesday, the Alliance for Health Reform will hold a briefing on "Biosimilars in the U.S.: Current and Emerging Issues."

On Thursday, the House Subcommittee on Oversight and Investigations will hold a hearing entitled "What are the State Governments Doing to Combat the Opioid Abuse Epidemic?"

'Viagra for Women' Wins FDA Panel Support Mixed but strong support for so-called 'Viagra for women'

• by Shannon Firth 
  Contributing Writer

WASHINGTON -- An FDA advisory committee voted 18-6 Thursday to recommend approval for flibanserin, a drug meant to treat sexual dysfunction and loss of sexual desire in women.

The "yes" vote at the joint meeting of the Bone, Reproductive and Urologic Drugs Advisory Committee and the Drug Safety and Risk Management Advisory Committee included a requirement for "certain risk management options beyond labeling," such as provider certification and postmarketing studies.

ADVERTISEMENT

Flibanserin, a product of Sprout Pharmaceuticals, is proposed for the treatment of hypoactive sexual desire disorder (HSDD) in premenopausal women. The suggested dose is a 100-mg tablet taken in the evening before bed.

Sprout Pharmaceuticals describes HSDD on its website as "a persistent or recurrent deficiency or absence of sexual fantasies and desire for sexual activity that causes marked distress or interpersonal difficulty." It clarifies that diagnosis is not related to "a medical, substance-related, psychiatric (e.g., depression), or other sexual condition."

Walid Gellad MD, MPH, of the University of Pittsburgh, voted to recommend approval of the drug, but tempered his support saying he saw its benefits as "modest" or "less than modest." "But I think that puts it in good company with other approved drugs."

Gellad supported a risk evaluation and management strategy (REMS) and also supported provider certification.

Michele Orza, ScD, the panel's acting consumer representative and a senior adviser at the Patient-Centered Outcomes Research Institute, in Washington, voted against approving the drug. Orza called the treatment effect "minimal" or "marginal at best" and said she worried that as the FDA considers future products it will find that the standard is "too low and problematic."

If You Drink, Don't

The majority of the committee recommended a REMS strategy as well as other postmarketing studies specifically focused on use of the drug with alcohol, long-term studies to assess the drugs effects on fertility, harm to a fetus, cancer risks, and accidental injury.

In his opening statement, Hylton Joffe, MD, director of the Division of Bone, Reproductive and Urologic Products (DBRUP) acknowledged that there is an unmet need for a drug to treat HSDD. He agreed that the sponsor had met its primary endpoints in three phase III clinical trials.

Missing the Endpoint

All three trials showed "statistically significant improvement" in the number of orgasms and other satisfying sexual events (SSE) and a reduction in sex-related distress in participants taking flibanserin compared with control participants, according to FDA reviewers. The sponsor drug showed a median placebo-corrected increase of approximately 0.5-1.0 SSEs per month, from the median baseline of two to three events per month.

Neither of the first two trials demonstrated a statistically significant improvement in the secondary endpoint of sexual desire, when rated in a daily electronic diary. However, both showed a statistically significant improvement when such desire was rated using the Female Sexual Function Index (FSFI). A third trial, which used the FSFI as a co-primary endpoint for sexual desire, found the endpoint statistically significant:

"From a mean baseline of about 1.8-1.9 on the FSFI desire score, flibanserin resulted in a placebo-corrected mean increase of 0.3-0.4 (the FSFI desire score range is 1.2-6.0)."

"From a mean baseline of 3.2-3.4 on the distress score, flibanserin resulted in a placebo-corrected mean improvement of 0.3-0.4 (on a scale of 0-4)."

But the sponsor and FDA are "not in full agreement that the FSFI is optimized for assessing sexual desire," the staff review noted. At the meeting, Ashley Slagle, MS, PhD, endpoints reviewer for FDA, said the FSFI "specifically includes multi-barrel instruction, making it unclear what components might be driving any score change, so ... if one component [like fantasizing] improves but other components might not improve; it's unclear whether a change in one single element represents meaningful change."

Safety Concerns

Joffe also highlighted the drug's major safety concerns: hypotension, syncope, and central nervous depression and its "sizable placebo effect."

Some of the panel's safety concerns centered on alcohol use while on flibanserin. The committee noted the data on alcohol use was particularly unhelpful as Sprout's pivotal alcohol study included only two women.

Speakers for the meeting's public hearing portion were divided on the drugs' approval.

Lisa Larkin, MD, a women's health internist who practices in Cincinnati, told the committee "day after day" she sees patients distressed by their sexual health concerns.

"I take real issue with those who suggest that low libido in women is always the result of relationship or situational issues, anxiety, depression, something that can always be addressed in psychotherapy or that pharma has somehow created this disorder as a niche for a drug." She urged those who ascribe to those view to spend a day in her practice.

Sidney Wolfe, MD, founder of Public Citizen's Health Research Group, in Washington, D.C., questioned whether there was any new information on the drug now compared with 5 years ago, "when an FDA advisory committee voted 11-0 that the benefits did not outweigh the risks ... I have concerns about exclusions in the trials and [the drug's] minimal level of effectiveness."

Wolfe noted that hypotension and syncope are not trivial and can result in serious, irreversible, or life-threatening injuries. "If there were clear evidence of a clinically meaningful benefit, accompanied by manageable risk, approval might be appropriate, but neither of these two is the case. I would urge the FDA to reject the drug; it isn't ready for prime time."

LAST UPDATED 06.05.2015

New Test Can Find Just About Every Virus You Ever Caught

Maggie Fox

13 Hours AgoNBC News

A new blood test can find just about every virus you ever caught—in a single drop of blood.

It's not just an interesting historical record—doctors hope the test might be used to find out whether viruses might cause a range of chronic diseases such as diabetes or heart disease, and to see whether infections early in life can affect your immunity later.

Read MoreFDA panel finally backs women's libido drug

"VirScan is a little like looking back in time: using this method, we can take a tiny drop of blood and determine what viruses a person has been infected with over the course of many years," said Stephen Elledge, a Howard Hughes Medical Institute researcher at Brigham and Women's Hospital in Boston, who led the study.

Adam Gault | Getty Images

"Right now, a physician needs to guess what virus might be at play and individually test for it. With VirScan, we can look for virtually all viruses, even rare ones, with a single test."

The test looks for the body's immune response to viruses. It finds antibodies that keep the viruses from coming back, which can stay circulating in the blood for years.

Elledge thinks the test will cost about $25 to run.

More from NBC News:
Crowdfunding can help cure cost of cancer care
Family members could face jail for cheering at graduation
Clinton calls for automatic voter registration

There are thousands of viruses, from rhinoviruses and adenoviruses that cause the common cold, to the human immunodeficiency virus that causes AIDS. A total of 206 different species of viruses are known to infect people, and each species has various strains.

Most blood tests are designed to look for one particular virus at a time. Elledge and his colleagues wanted to design a test that would find all the viruses—a collection called the virome.

Read MoreRate your doctor, and watch them get better?

They developed the test using bacteriophages, which are viruses that attack bacteria. They engineered different bacteriophage to make a little piece of protein from more than 1,000 known viruses.

The test goes into a drop of blood, which is enough to carry all the antibodies trained to recognize a virus that's infected someone—or those activated by a vaccine.

Writing in the journal Science, the team said they tested blood samples from 569 people from the United States, Peru, South Africa and Thailand.

On average, people had antibodies against 10 species of virus. There were a few people who'd been infected with many different viruses—five people had antibodies against 62 species, and two had been infected with 84 different species.

It's well known that viruses can cause disease. The human papilloma virus (HPV), for instance, causes cervical cancer, as well as head and neck cancer and cancers of the genitals. Epstein-Barr virus, which infected 88 percent of the volunteers, is linked to lymphoma and is suspected of causing some cases of stomach cancer. It's also been linked with multiple sclerosis.

Read MoreEbola survivor's eye teeming with virus

Enterovirus D-68, a distant relative of polio, concerned doctors when it made an unusual resurgence last year and appeared to cause a mysterious polio-like syndrome in a few children.

Having a test that can look for all sorts of viral infections at once can help researchers tighten up these links, and also help them find possible other links between viruses and long term health.

It's not perfect. Elledge said some viruses didn't turn up as often as they expected.

"For example, the frequency at which we detect influenza (53.4 percent) and poliovirus (33.7 percent) is lower than expected given that the majority of the population has been exposed to or vaccinated against these viruses," they wrote.

Read MoreUS: Bird flu vaccine not good enough for outbreak

It also only found that about 24 percent of the people tested had antibodies to chickenpox, also called varicella, which is far fewer than expected.

But when they tried the test against people who knew they had HIV and hepatitis C, the test was 95 to 100 percent accurate. "We didn't falsely identify people who were negative," Elledge added. "That gave us confidence that we could detect other viruses, and when we did see them we would know they were real."

Rare viruses were appropriately, well, rare.

"Although we detected antibody responses to rare and highly virulent viruses such as Marburg and bat lyssavirus, they were found in less than 0.4 percent of the population," they wrote.

Elledge's team says the test could easily be expanded to include other human pathogens such as bacteria, fungi, and protozoa. The test might also be used to find out if there are consequences of being infected with two or more particular viruses.

8 Dementia Risk Factors

• By Anne Harding

Depression and obesity can increase your risk, but there are still ways to keep your brain healthy as you age.

Shutterstock

Cardiovascular disease, smoking, diabetes, and excessive alcohol consumption may increase your chances of developing dementia.

Age is the single biggest risk factor for dementia. Once you hit age 65, your risk of developing Alzheimer's disease doubles every five years, according to theCenters for Disease Control and Prevention. You can't hold back the clock, but there are many other things you can do to keep your brain healthy as you get older.

Brain cell degeneration — like that seen in Alzheimer's disease — is a key factor in the development of dementia in most people, but changes in the tiny blood vessels responsible for supplying the brain with oxygen and glucose are also important, says Mustafa Husain, MD, vice chair in the department of psychiatry and behavioral sciences and chief of geriatrics at Duke University School of Medicine in Durham, North Carolina. “Most microvascular changes can be related to chronic medical risk factors, which can be addressed,” Dr. Husain says.

“Very much of what applies to prevention and good healthy habits in general applies also to the prevention of dementia,” says Gisele Wolf-Klein, MD, a professor of medicine at Hofstra Medical School and director of geriatric education for the North Shore-LIJ Health System in New York.

Here are eight treatable, and sometimes preventable, health conditions and risk factors that can increase your dementia risk, and what you can do about them.

1. Cardiovascular disease. Experts on the aging brain now agree that while Alzheimer's disease is the most common form of dementia — there are currentlyfive million people with the disease in the United States — heart and blood vessel disease can accelerate the development of Alzheimer's.

“Optimizing cardiovascular health is important to prevent vascular events like heart attack and stroke, but also for maintaining optimal brain health and reducing cognitive decline,” says Deborah Levine, MD, an internist and neurologist at the University of Michigan in Ann Arbor.

Steps you can take to protect your brain — and your heart — include:

• keeping your blood pressure under control
• being physically active
• eating a Mediterranean diet rich in fruits, veggies, nuts, healthy oils, and lean protein, while limiting red meat

One study found that the more closely people stuck to a Mediterranean diet — which is known to be the heart-healthiest eating pattern — the slower their cognitive decline and the lower their Alzheimer's risk.

You don't have to throw yourself into a strenuous exercise regimen to stave off dementia — studies show that just walking more than a couple of blocks a day will reduce dementia risk, according to Dr. Wolf-Klein.

And while keeping blood pressure under control is important, overtreating high blood pressure can be just as harmful as undertreating it, according to Dr. Levine. When blood pressure is too low, she explains, it's harder for our bodies to supply the brain with blood.

2. Diabetes. Middle-aged people with diabetes have a steeper decline in their mental function over time than their non-diabetic peers. The worse their blood sugar control, the sharper the drop in mental capacity, according to a large 2014 study published in the Annals of Internal Medicine.

So if you have diabetes, keeping your blood sugar under good control long-term through diet and exercise — and medication if you need it — is essential for maintaining brain health.

RELATED: 11 Early Signs of Dementia

But because sugar fuels the brain, overtreatment of diabetes can be damaging, too. “Research suggests that episodes of low blood pressure and low sugar from overtreatment of high blood pressure and diabetes is significantly associated with cognitive decline, particularly in the elderly, and in fact episodes of hypoglycemia increase the risk of developing dementia,” Levine says.

3. Depression. Depression and dementia have a complex, intertwined relationship.Depression can be an early sign of Alzheimer's, while symptoms of depression like apathy and difficulty concentrating can mimic dementia.

People who are depressed often withdraw from social contact, which can accelerate mental deterioration, Wolf-Klein points out. “Isolation that is the result of depression can be very detrimental to the health of the brain,” she says.

In fact, one study found that depression doubled dementia risk. Being depressed and having a stroke increased dementia risk more than five-fold. Furthermore, people with depression who got a new diagnosis of high blood pressure were at triple the risk of dementia.

Fortunately, many of the things that keep depression at bay — socializing with friends and family, and pursuing hobbies, and being physically active — also help keep mental function sharp, Dr. Husain says.

4. Head injury. Kids aren't the only ones who should be protecting their brains by wearing a helmet while biking, skiing, or engaging in other risky activities. Head injury may be even riskier for aging adults, a 2014 study in JAMA Neurologysuggests. People aged 55 and older who sustained traumatic brain injury were at significantly increased risk of developing dementia, while even mild brain injury increased dementia risk in the 65 and older group.

But there's also evidence that cognitive reserve — think of it as extra mental strength and flexibility — helps protect people from accelerated mental decline after brain injury. Higher IQ, higher levels of educational and occupational attainment, engagement in leisure activities, and strong social networks can all help build cognitive reserve, according to Columbia University researchers.

5. Sleep problems. Getting enough rest is a challenge for many of us, especially as we age, but evidence is mounting that it's crucial for maintaining a healthy brain. And sleep disordered breathing — in which a person wakes up several times during the night, gasping for breath — may be especially harmful to cognitive function. Several studies have linked this condition, also known as sleep apnea, in older people to increased mental impairment.

Other research suggests that the brain washes out harmful proteins and other potentially damaging waste products during sleep. Investigators first reported on this cleansing mechanism — which they dubbed the glymphatic system — in mice. While it's tougher to peer inside the human brain, continuing research by these investigators is suggesting that people have a similar plumbing system that flushes out brain waste while we sleep — yet another reason to aim for a good night's rest.

6. Midlife obesity. Studies of the relationship between obesity and cognitive function have had mixed results, but there is evidence that excess weight can boost the risk of future mental decline. A 2014 study in more than 4,000 twin pairs found that being obese in one's forties quadrupled future dementia risk, while being overweight nearly doubled it. Another study found that people who were obese and had metabolic abnormalities at the study's outset, such as high blood pressure or high cholesterol, had the sharpest decline in cognitive function.

“There is evidence that obesity, extra weight, can lead to increased chances of developing dementia,” Wolf-Klein says. “We have to continually remind ourselves and our children that good weight control is certainly a good approach to better life ... and diminishing the possibility of so many chronic conditions, including dementia.”

7. Smoking cigarettes. If you smoke cigarettes, you're 30 percent more likely to develop dementia, according to an analysis of 37 different studies including close to a million people. The research review also found that the more you smoke, the higher your risk. But here's the good news: this study also showed that if you quit, your dementia risk is the same as if you'd never smoked.

8. Heavy alcohol consumption. Most studies have not found a relationship between light-to-moderate alcohol consumption — generally defined as one drink a day for women, and two per day for men — and dementia. A few have even suggested that light drinking can protect the brain. But heavy drinking and binge drinking are both linked to stroke and dementia. In fact, people who reported consuming more than five bottles of beer in one sitting, or one bottle of wine, in midlife were three times as likely as non-binge drinkers to have dementia by age 65.

Last Updated: 5/21/201
5

Insulin for Type 2 Diabetes: When, Why, and How

Most people with type 2 diabetes will eventually require insulin, and the transition is easier than you might think.

Blood sugar control is one of the most important parts oftype 2 diabetes management.

Although you may be able to treat the condition with lifestyle changes, such as exercise and weight loss, and with oral medications at first, most people with type 2 diabetes eventually need to take insulin.

"There are two times to start insulin for type 2 diabetes," explained Alaleh Mazhari, DO, an assistant professor of endocrinology at Loyola University Heath System in Chicago.

"The first is any time blood sugar is significantly out of control and a patient has symptoms," said Dr. Mazhari. "In these cases, the need for insulin may be short-term. The second time is when type 2 diabetes has progressed over many years and the pancreas can no longer make enough insulin to respond to other diabetes medications."

Here's what you need to know about taking insulin in both scenarios.

Insulin for Short-Term Blood Sugar Control

Doctors use a blood test called a hemoglobin A1C test to measure average blood sugar control over a two- to three-month period. The A1C measures the amount of sugar in red blood cells.

The treatment target for most people with diabetes is an A1C of 7 percent or less; those with higher levels may need a more intensive medication plan. "The American Association of Clinical Endocrinologists recommends starting a person with type 2 diabetes on insulin if their A1C is at or above 9 percent and they have symptoms," said Mazhari.

Symptoms could include thirst, hunger, frequent urination, and weight loss.

Research published in the journal The Lancet Diabetes & Endocrinology reviewed several studies on the temporary use of insulin to restore sugar control in people with type 2 diabetes. About two-thirds of the 559 patients studied were able to go off insulin and maintain good blood sugar control after a brief, three-month course of insulin.

Insulin for Long-Term Blood Sugar Control

"After 10 to 20 years, almost all patients with type 2 diabetes will need insulin," Mazhari said. "Once they lose most of the cells in the pancreas that make insulin, no other diabetes medication can help. They may have been on one, two, or three diabetes medications, but their A1C can no longer be kept in a safe range."

Switching from numerous diabetes medications to insulin can streamline your efforts.

"I always warn my patients that type 2 diabetes is a progressive disease and that treatment plans will change," said Harlene Pearlman, RN, a certified diabetes educator on the Loyola team. "When we can't meet blood sugar control goals despite our best efforts, insulin is the next step."

The change can have upsides. "Some patients have been on a complicated regimen of three or four medications, with lots of side effects," Pearlman said, "and it is actually a lot easier to be on insulin."

The Switch to Insulin

"Making the transition is much easier than it used to be," Pearlman noted. "Most patients are started on a long-acting insulin that does not need to be matched with food intake.

"Insulin pens that are preloaded are replacing insulin that needs to be drawn up into a syringe. Patients may still be worried about giving themselves injections, but once they see how tiny the needle is, they adjust quickly," Pearlman said.

The key to an easy transition is education. "Patients need to know how their insulin works, how to give it, and what side effects to look for," Mazhari said. "Most patients will be starting with one shot a day at bedtime. The dose will be adjusted over time depending on blood sugar readings."

Here are important insulin basics:

• Your dosing schedule and insulin type will depend on how advanced your diabetes is, your weight, your age, your physical activity, and your diet. "There is no 'standard dose' for insulin," said Pearlman.
• Work with your diabetes team to come up with a blood sugar testingschedule at home. You may be instructed to check your blood sugar three or four times per day during the adjustment period. Your health care team will use information about your fasting, pre-meal, and post-meal blood sugar levels to make changes to your insulin regimen.
• Learn the symptoms of low blood sugar, or hypoglycemia, and what to do if you have them. The warning signs include feeling cold, shaky, dizzy, or confused. "The symptoms come on suddenly, and patients should know to drink a half-glass of juice, eat some hard candies, or chew some [glucose] tabs," Pearlman said.
• During the transition, stay in close contact with your treatment team. People starting insulin are often advised to meet with their health care providers on a weekly basis until blood sugars stabilize and the appropriate insulin dose is determined.

"The goal of type 2 diabetes treatment is early blood sugar control to prevent complications and halt progression," said Mazhari. "Control trumps everything because you only have a limited window of opportunity. Once you have complications, the damage may not be reversible. That means using whatever medications it takes, including insulin."

Plus, don't forget that a healthy lifestyle is always part of the treatment plan. "Obesity increases insulin resistance, so maintaining a healthy weight with exercise and diet means less need for insulin and less problems with type 2 diabetes," Mazhari added.

• By Chris Iliades, MD
 
• Reviewed by Niya Jones, MD, MPH

Seriously Bloated: Warning Signs You Shouldn’t Ignore

By Everyday Health Guest Columnist

Published Oct 29, 2013

By Robynne Chutkan, MD, FASGE, Special to Everyday Health

These days we’re seeing a virtual epidemic of bloating. The causes range from benign yet bothersome conditions like lactose intolerance to serious diagnoses like cancer. But how do you know whether your bloating is a nuisance or a sign of something more worrisome? You’re seriously bloated when your symptoms are caused by a condition that requires immediate medical attention. It’s important to be familiar with the warning signs and symptoms that might indicate something ominous, as well as the ten diagnoses associated with serious bloating.

Warning Signs and Symptoms

Weight loss is one of the main warning signs for serious bloating. If you find yourself losing more than a few pounds without changing your diet or starting a new exercise regimen, that should be cause for concern, especially if it’s 10 percent or more of your body weight. Weight loss can be caused by tumors that press on the intestines, making you feel full after just a small amount of food, or from substances secreted by tumors that suppress your appetite.

Ascites is an abnormal buildup of fluid in the abdomen or pelvis and it can cause bloating, weight gain and a rapidly expanding waistline. Ascites is usually caused by liver disease, but about 10 percent of the time cancer is the culprit. A large amount of ascites can make you look and feel like you’re several months pregnant. The combination of bloating and jaundice, which turns the eyes and skin yellow, can be a sign of cancer that’s spread to the liver, although it can also occur with more benign forms of liver disease like hepatitis.

Severe abdominal pain and bloating that occur suddenly, especially if you also have nausea and vomiting, may be a sign of a bowel obstruction from scar tissue or a tumor pressing on the bowel. Immediate medical attention is a must to avoid complications like bowel perforation that can be fatal. Obstructions are painful because the bowel above the blocked area stretches as it fills with food and digestive juices. The pain is intense and may occur in waves as the bowels try to push their contents through the obstructed area.

Blood in your stool, vaginal bleeding in between periods, or postmenopausal vaginal bleeding can all be associated with serious bloating. Fortunately, the most common causes of these symptoms (hemorrhoids, an irregular menstrual cycle, fibroids, endometrial atrophy) aren’t the most serious, but bleeding should always be evaluated because it can be a sign of cancer, particularly colon or uterine cancer.

Fever that accompanies bloating is usually due to infection or inflammation. If there’s also an elevated white blood cell count, infection needs to be immediately excluded, particularly from a pelvic, urinary, or gastrointestinal source.

10 Causes of Serious Bloating You Need to Know About

Ovarian cancer isn’t the most likely, but it is one of the most lethal. Although ovarian cancer is only the fifth most common cancer in women, it causes more deaths than any other reproductive cancer, mostly in women over 50. Risk factors include never having children or having them late in life, obesity, a family history of ovarian cancer, certain genetic abnormalities, and long-term treatment with hormone replacement therapy. Persistent bloating, feeling full faster, and pelvic pain are typical symptoms.

Uterine cancer. In addition to bloating, uterine cancer can cause abnormal vaginal bleeding, a watery or blood-tinged vaginal discharge, pelvic pain, or pain with intercourse or urination. Important risk factors include taking estrogen supplements in the absence of progesterone, tamoxifen, radiation therapy, a family history of uterine cancer, or a family history of a form of inherited colon cancer called Lynch syndrome.

Colon cancer can block the inside of the colon, causing progressive bloating. If the cancer is located at the end of the colon in the rectum or sigmoid, there is usually bleeding and a history of worsening constipation, but for cancers higher up in the colon, bloating may be the only initial symptom. Colon cancer is the second most common cause of cancer deaths in non-smokers in the U.S. and is mostly preventable through lifestyle changes and regular screening colonoscopies. Some studies have shown that switching to a plant-based, nutrient-rich diet can cut your risk of colon cancer in half.

Pancreatic cancer is one of the most dreaded forms of cancer because it tends to be very aggressive with low survival rates. Bloating associated with jaundice, weight loss, poor appetite, and upper abdominal pain that radiates to the back may indicate pancreatic cancer and is a worrisome constellation of symptoms. New-onset of diabetes in association with bloating, weight loss and abdominal pain may also be a sign of pancreatic cancer.

Stomach cancer is usually asymptomatic early on, or causes vague symptoms like bloating, indigestion, and a feeling of fullness in the upper abdomen. Like pancreatic cancer, it may have already reached an advanced stage at diagnosis, in which case there will likely be additional symptoms of weight loss, nausea and abdominal pain. Infection with the bacteria Helicobacter pylori is felt to be the most important risk factor for the development of stomach cancer, and nitrates and nitrites in smoked and processed meats are also risk factors.

Liver disease is often benign however, the liver is also a common site for cancer from distant organs to spread to because when cancer cells get into the bloodstream, they eventually get filtered through the liver. Bloating accompanied by ascites (fluid in the belly) and jaundice (yellowing of the eyes and skin) may be a sign of cancer that’s spread to the liver or of primary liver cancer, which can develop in people with a history of hepatitis or heavy alcohol use.

Diverticulitis usually causes a combination of bloating, fever, and abdominal pain and tenderness accompanied by diarrhea or constipation. Bowel rest with a liquid diet is standard treatment, plus antibiotics if there’s fever, lots of tenderness or an elevated white blood cell count. Severe tenderness may prompt a CAT scan to exclude an abscess, a complication that may require surgical intervention or drainage. Once the acute episode of diverticulitis is over, a high-fiber diet can help keep you regular and avoid future complications.

Pelvic inflammatory disease (PID) occurs when the uterine lining, Fallopian tubes, or ovaries become infected, usually from sexually transmitted diseases like Chlamydia or Gonorrhea. It can also occur during childbirth, abortion, or miscarriage, or with insertion of an intrauterine device (IUD). Bloating accompanied by fever, pain, and tenderness in the pelvic area plus a vaginal discharge is very suggestive of PID. A pelvic exam and treatment with antibiotics are essential, especially since untreated PID can lead to infertility and ectopic (tubal) pregnancies.

Crohn’s disease is an autoimmune disease that affects the GI tract, usually in the small intestine or colon. The lag between initial symptoms and diagnosis can be years, and bloating is one of the early symptoms. Crohn’s can cause narrowing of the intestines and ultimately lead to a bowel obstruction, resulting in severe bloating, weight loss, and nausea and vomiting after meals. Diarrhea with blood in the stools is typical when Crohn’s occurs in the colon. There may be other symptoms present outside of the GI tract, including mouth ulcers, joint pain, skin lesions and inflammation in the eyes.

The good news is that most people with bloating don’t have cancer, infection, or inflammation. If you’re not sure whether you’re bloating is serious or not, it’s always better to err on the side of seeking medical attention rather than ignoring it and hoping for the best.

Robynne Chutkan, MD, FASGE, is the author of the recently published book Gutbliss. She received her bachelor’s degree from Yale University and her medical degree from Columbia College of Physicians and Surgeons in New York, where she also did her internship and residency in internal medicine and served as Chief Resident. She completed her fellowshi p in gastroenterology at Mount Sinai Hospital in New York. Dr. Chutkan has been an assistant professor at Georgetown University Hospital in Washington DC since 1997. In 2004 she founded the Digestive Center for Women, an integrative practice that incorporates nutritional optimization, exercise physiology, biofeedback and stress reduction as part of the therapeutic approach to digestive disorders. A regular guest on the Dr. Oz Show, Dr. Chutkan is also a member of their medical advisory board. In addition to regular local network appearances, she has also made national appearances on The Today Show, The Early Show, and The Doctors.

Posted in: Digestive Health

40 Comment

COMMENTS (40) See All 40 Comments or add your own!

Tình Hình MERS

Tổ chức Y tế Thế giới (WHO) cho hay tổng số ca nhiễm MERS trên thế giới hiện là 1.150 và ít nhất 427 người nhiễm MERS đã tử vong. Theo AFP, Hàn Quốc là quốc gia có nhiều ca nhiễm MERS nhất ngoài khu vực Trung Đông.
Theo AFP, hầu hết những người nhiễm MERS có triệu chứng chứng sốt, ho, khó thở hay các biến chứng nghiêm trọng hơn, chẳng hạn như viêm phổi và suy thận.