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Lyme gi talk for md

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a talk given in July 2011 on the gastrointestinal manifestations of Lyme, Bartonella, Mycoplasma and other tic borne diseases.

a talk given in July 2011 on the gastrointestinal manifestations of Lyme, Bartonella, Mycoplasma and other tic borne diseases.

Published in: Health & Medicine

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  • 1. GASTROINTESTINAL TIC BORNE INFECTIONS Martin D. Fried, MD, FAAP Pediatric Gastroenterology Physician Nutrition Specialist 3200 Sunset Ave Suite 100 Ocean, NJ 07712
  • 2. Gastrointestinal Complaints abdominal pain vomiting blood in stool constipation heartburn chest pain soiling diarrhea mouth sores MULTISYSTEM difficult swallow Skin rashes
  • 3. Apthous Ulcers
  • 4. Canker Sore
  • 5. Erythema Nodosum
  • 6. Psoriasis
  • 7. Ulcers
  • 8. Colitis
  • 9. Rectal Fissure
  • 10. Skin Tag vs Granuloma
  • 11. Psoriasis with Granuloma
  • 12.  
  • 13.  
  • 14. Bartonella Borrelia burgdorferi H pylori Mycoplasma Salmonella, EBV Clostridium difficile
  • 15. SINGLE INFECTIONS 30
  • 16. COINFECTIONS = 20
  • 17. TRIPLE INFECTIONS = 6
  • 18. 80 PATIENTS, 88 INFECTIONS
  • 19. Heartburn, Abdominal Pain, Skin Rash, Gastritis, and Duodenitis Bartonella henselae
  • 20.
    • Cat Scratch Fever
    • Lymphandenopathy
    • hepatitis-elevated liver enzymes
    • Splenitis
    • Pneumonitis
    • Fever Unknown Origin
  • 21. Gastrointestinal Bartonella
    • Hepatosplenic Abscess
    • Abdominal Pain-burning
    • Mesenteric Adenitis-mimic Appendix
  • 22. GI Presentation
    • Heartburn
    • Abdominal Pain
    • Skin Rash-striae –stretch marks
    • Enlarged Lymph nodes
  • 23. VIOLACEOUS RASH
  • 24. NEW BLOOD VESSELS
  • 25.  
  • 26. GI Infections
    • tic bite
    • No prior GI complaints
    • No steroid use
    • No abrupt weight gain
  • 27. Infection and or Diet
    • Pain not resolved by antacids, Histamine blockers, PPI
  • 28. Skin Rash
    • Violaceous- deep reddish purple
    • Serpinginous- “snake like”
    • Breast or lower back
    • Groin or back knee
    • Periumbilical (belly button)
    • Inner thigh
    • stretch marks are different
  • 29.  
  • 30.  
  • 31. Mesenteric Adenitis
    • CT Abdomen
    • Lymph Nodes > 1cm in diameter
    • May mimic appendicitis
  • 32. Endoscopy and Biopsy
    • Assess the GI mucosa
      • H. pylori
      • Bartonella by PCR
      • Borellia burgdorferi PCR
      • Mycoplasma PCR
      • Ehrlichia and Babesia PCR
  • 33. Bartonella Pathology
    • Chronic Gastritis and or duodenitis
    • No Ulcer
    • No evidence of allergy (eos)
    • No Acute Inflammation (polys)
  • 34. Bartonella Rashes
    • Maculopapular
    • Urticarial
    • Erythema Nodosum (crohns also)
    • Granuloma Annulaire (ringworm)
    • Thrombocytopenic Purpura
    • Leukoclastic Vasculitis
  • 35.  
  • 36.  
  • 37. Striae
    • Endothelial Proliferation
    • Differentiate from stretch marks
    • in obese or steroid using patients
  • 38. Bartonella GI Inflammation
    • An Association Shown
    • IL-2, IL-6, IL-10, Elicited
  • 39. Interleuken 6
    • Multipotent cytokine
    • Elicited by Infections
    • Induces inflammation
    NEOVASCULARIZATION
  • 40. NEOVASCULARIZATION NEW BLOOD VESSELS
  • 41.  
  • 42. STEROID EFFECT
  • 43. STEROID EFFECT
  • 44. SERPINGINOUS RASH = INFECTION
  • 45. SNAKE LIKE = INFECTION
  • 46. Bacteria Infects humans only Transmitted - human to human Helicobacter pylori
  • 47. H. pylori
    • Irritant to stomach lining
    • Cause of gastric, duodenal ulcers
    • Lifelong infection unless treated
    • Predispose to stomach cancer
    • due to chronic irritation
  • 48.  
  • 49. H pylori breath test
  • 50. Helicobacter pylori
    • Nodularity Gastritis
  • 51. Eradication of H. pylori Two antibiotics for two weeks Clarithromycin Amoxacillin Proton pump inhibitor for a month intracellular death of infection
  • 52. Mycoplasma
    • Intracellular infection
    • Rarely in the blood
    • Worsens Lyme, Bartonella symptoms
    • Fibromyalgia, CFS, RA, and Gulf War
  • 53. Mycoplasma protein
    • Stimulates immune cells
    • Proinflammatory cytokines
    • TNFalpha, IL-1, IL-6
    • GI may resemble Crohn’s
  • 54. Chronicity of Mycoplasma
    • Surface antigenic variation
    • Supress host immune responses
    • Slow growth rates
    • Intracellular locations
    • Can take 3 years to eradicate
    • Can follow IgM and IgG titers
  • 55. Celiac vs Food Intolerance
    • Celiac is Autoimmune to wheat, rye, barley
    • Gluten, Genetics and Environment
    • Intolerance is IgE or non IgE mediated
  • 56. Inflammation causes permeable gut Foreign proteins to immune system Crohn’s, Colitis, Celiac
  • 57.  
  • 58. Treatment complications
  • 59. Candida Albicans
  • 60. Candida Albicans
    • Normal Flora Yeast
    • Antibiotics kills Normal Flora
    • Yeast overgrowth occurs
    • Diet to produce lactobacillus, bifidobacteria
    • Short chained fructooligosaccharides (FOS)
    • Not a casein or gluten related problem
  • 61. Clostridium difficile
    • C. difficile is normal bacterial flora
    • Antibiotics kill lactobacilli, bifidobacter
    • C. difficile overgrowth occurs
    • C. difficile elicits – Toxin A and Toxin B
    • Pseudomembranous colits
    • Treat with Metronidazole and probiotics
    • However, prebiotics help L and B multiply
  • 62. Pseudomembranous Colitis
  • 63.  
  • 64. Foods with sc FOS
    • Banana onions
    • garlic asparagus
    • Barley wheat
    • Tomatoes leeks
  • 65.  
  • 66. Conclusions
    • Lyme, Bartonella, Mycoplasma occur in the GI tract of children 5-21 yrs
    • PCR biopsies to document infection
    • Consider Coinfections
    • Prevent yeast, c. difficile overgrowth with prebiotics and probiotics