topics: Stomach acid blockers - Opportunity or risk?; Heartburn - Expert interview; Surgery for heartburn; Acupressure - Fast relief for everyday complaints;... a cool school or have a nice me or a good night's sleep but you can't because you're suffering from heartburn then you came to the right place for three reasons first this is seriously nick a me from being in berlin the second i'm going to meet dr mark johnson and third this is in good shape. good luck and i hope. no one has to suffer from heartburn for a long time we have great medications and surgical options was good long term results. it's nice to have a strict facet it helps to i just did expect. too much gastric as it is not good because the pain cause heart. berthe. there are medications to answer it but recent studies suggest that they might be dangerous. for twelve years peter schmeichel has been suffering from heartburn also known as acid reflux after eating he often experiences acidic belching in a burning esophagus he also suffers from an irregular heartbeat it's all a source of stress. whenever i eat something i'm just worried that it will start back up. and so i don't really have a big appetite anymore it was an upbeat it made some instant. to reduce the symptoms he started taking medication called proton pump inhibitors p.p.r. yes they suppress them like acid production by blocking certain enzyme but he soon found himself battling with side effects. after a few days i started feeling really on while i had diarrhea and stomach aches and my digestion just wasn't working anymore. these are common side serious conditions like heart attacks or dementia. dr vulcan shep is an expert in the field. he thinks patients shouldn't worry about taking p.p.i. . he says the evidence against them is insufficient. decision. taking proton pump inhibitors is very very safe compared to all the other drugs used in medicine. of the there is some indication that there might be an issue. and he was the quote there is no evidence that would make us withdraw the medication from patients who need it and that just wouldn't make any sense vic to me than is obvious. and some patients do desperately need it. stephanie batman suffered a painful narrowing of the esophagus it had to be dilated and since then she's had to take medication. if she doesn't the stomach acid rises up through the esophagus and causes inflammation. yet i prefer to relieve the inflammation with medication now rather than to think maybe i'll get dementia or in a few years time. whatever other side effects there are demands of a mad dash to a need that seems less important to me right now is for me. what matters is that i have a cure now moment yet sed now that in. studies have revealed one dangerous side effects the risk of infection from clostridium difficile a bacterial species also known as c. diff with reduced stomach acid the microbe can spread more easily through the digestive tract to desmond's are content with a patient comes to the clinic with clostridium difficile colliders which is a life threatening diarrhea condition that's an indication to check the proton pump inhibitors very thoroughly and of possible discontinue the medication me to come into up does it via. peter stop taking p.p.i. is two months ago he'd rather not expose himself to the risks. that is if you're desperate it does say on the package leaflet that you can take the tablets as a one off but it would be better if i didn't have to take them at all in the misdemeanor. stephanie batman doesn't have that option she'll probably have to take proton pump inhibitors for the rest of her life. when i was a medical student i had a surgical professor who told me if those medications are medications from hell because they can make you impotent and we doctors should stick to surgery this is why i'm here in the operating room of the. he'll use clinic even from being in doolin and meeting the head of the department for surgery begins and thanks for having me today how critical should we be concerning this medication we are facing a huge discussion about complications of the of these medications like this or function. however the evidence is very low and if the indication for these tablets is good it can be given regularly let's talk a little bit about heartburn why so many people suffer from heartburn is caused by the west and last. for example obesity smoking drinking alcohol or eating a lot a huge amount in the evening and i know many many patients who suffer from heart burn sometimes and i think many of us do suffer from it too so when do you need to see you doctrine is it dangerous it's not dangerous immediately you don't need to go to the doctor directly in most of the cases it's probably enough to change your lifestyle and sometimes it's also a good idea to take these kind of may become and for short periods of time like fourteen days for example and do you have to be concerned about say that this is a tumor developing out of the cancer. the risk of developing cancer due to. very low it's approximately four out of ten thousand people but if the mood of the years of those changes habits like developing a so-called barrett's recalls are the risk of developing cancer is much more higher therefore you have to go to doctor have a gastroscopy and in this case is the risk of developing cancer is about one point . point one percent per year very low with them so it's totally safe to do some self medications and to go for some over the counter drugs first yes it's possible to do so with medication. be aware that you only take these medications for a short period of time what are the problems if you take it for a longer period of time if the indication is good and confirmed by a medical doctor you can take these medications lifelong some patients wanted to discontinue the medications and they have problems afterwards so is it a problem to stop those medications it's a it's not a problem for gastric acid cures and b. as a franchise has really cures these protests these patients benefit probably from an operation speaking about surgery when those medications don't help any more then a small intervention could be very helpful. since dr feeds an ultra thin tube through his nose and down into his throat this tiny sensors will determine whether his a soffit is still functions properly when he swallows. it turns out that the muscle valve leading into the stomach has become slack. my despise the work of my esophagus had suffered a lot of damage when i was sleeping on my back or standing ready i'm a tiler by trade which means working on my knees or sitting like that i experienced severe heartburn and belching it was really bad a team of experts germany's your hottest days ling clinic discuss what course of action to take until recently gastroesophageal reflux disease had been underestimated and is even linked to a higher risk of cancer a third of people in europe in north america suffer from reflux in many cases prescribing a pill is not effective. hoover hansen's doctors recommended surgery the aim is to implant a pacemaker that stimulates the muscle valve that closes the bottom of the esophagus these are the big advantages this is suffered your pacemaker is that's the wires implanted in the muscles are extremely thin. it builds up an electrical field that exercises the muscle and makes it stronger as a result the food being digested can no longer rise up or it's like. in the case of nina back maya the doctors chose a new solution placing a chain with magnetic beads around the esophagus the chain reinforces the muscle value in similar style to a rubber band in the process restoring the balance natural function the surgery takes just twenty minutes. for and that had to finish what's changed for me is that i'm finally rid of heart after twenty five years it had always been a burden but i don't see developed a chronic cough and was constantly clearing my throat because of the feeling of pressure. right after waking up post-surgery i noticed that permanent feeling of constriction was completely gone and i've had no heartburn since that day when i can talk to. nina back my are can now indulge in a bit of coffee and cake treats that used to be a major problem due to reflux minimally invasive solutions now offer patients genuine hope for the future. so returning ships to medications this is difficult pacemaker and consisting of containing beats so what do you think of those interventions. we should be careful in using this kind of new techniques because there is no evidence and no long term results concerning this techniques but there are long term results for other kinds of surgeries like these full duplications. do you think. this operation is the standard procedure in patients after having medical treatment what we do is copy procedure this procedure. has two steps we are just removing the years off or goes into the up common we are closing the gap of the diaphragm and we're placing. placation of the fullness of the stomach around the goes so you taking the stomach into pulling it down and replacing it into the afternoon here is one cause of reflux. is her nya in through the doctors of the other for girls and what we know is that the us should be in the optimum which. to reduce the risk of said reflux so if this intervention only helpful in patients with hiatus hernia this is the primary indication for this kind of operation however some patients suffer from ongoing heartburn and large volume reflux and these patients can also be treated by operation and what are the results. the results are good what we see is that in ongoing studies we have. primary. success of ninety percent. recurrence of heartburn in only ten percent in ten years so if i don't want to take any medication and i don't want to go for surgery is there anything i can do for prevention here prevent to get will be don't smoke drink only if you are call and don't eat in the late evening but i do have some patients who are quite slim and they don't drink any alcohol at all but they still do have. one additional cost for this problem is family history of heart so also young patients without obesity can have this disease but what role does stress play in the development of heartburn or stress play with no main role in developing the heart the main cause is obesity and food intake thanks to answer all my questions well i don't know what you're doing i'm still here in the operating room but wait i know what you're doing because he watches the show but after the show you can take some time and simply all your questions. on our coming show we'll be looking at facial connective tissue that encloses muscles and internal organs type things that can be a root cause of pain so how can the problem be treated if you have questions send them to in good shape that d.w. dot com write things back in the subject line we look forward to hearing from you. what do you think give us three thousand years do you think that surgery will still look the same like it does today i doubt it but on the other hand there are some healing methods which are quite good old take asian pressure for instance. it looks like a back massage and feels like one feels like a massage. in terms of the hand techniques it's a bit similar in. in fact stephanie moore hunter is being treated with an ancient healing method acupressure in order to relieve her of a frustrating and debilitating problem. traditionally been suffering from extreme sleep disorder for quite a while first ten years at least and i needed a really long time to fall asleep and i also work up a loss she's been trying out acupressure for two months now it includes a range of different techniques. compressing massaging pinching stroking. the aim is to stimulate over three hundred fifty points on the body the same points used in acupuncture according to traditional chinese medicine the body is crisscrossed with a network of invisible pathways called meridian lines and these meridians serve as a channel through which vital energy or chief flows if that flow is interrupted the body reacts with symptoms and then you can place your index finger and middle finger on it and you can feel a slight depression when you press down and. this is not. stimulating the right point aims to loosen up the blockage causing the symptoms enabling the cheek to continue flowing. at the point regardless of whether we press the point or insert a needle the result is a local inflammatory process. that in turn increases the blood flow which relieves the blockage that thanks to the body's own healing power. but. i can hike have to. dr forward hemas says acupressure can help compliment a conventional medical treatments although he doesn't believe it can replace them. i see limits with acupressure and acupuncture where the underlying sickness has not been properly diagnosed. and patients should definitely have had diagnostic checks to rule out other more serious underlying illnesses. and then if they are ruled out these methods are appropriate. dr g. hung jiang studied medicine and china and germany she sent stephanie for a blood test sent ultrasound scans to try to pinpoint the root of her sleep disorder but the results were ok i. just think hundred of us might might be connected to my kids they used to keep me awake vitally often we did not want days mrs more and dad is the type of person who tends to get worked up quickly and she takes a lot of issues and stress on board. strengths of this in the that's what i think the cause was. in china i.q. pressure is used widely to treat all manner of symptoms they can be applied at any time and anywhere with a few exceptions in mind caught in the case of an acute infection with fever or if you have a skin disease or burns on your skin then you can't use acupressure at. this patient has been suffering for years from a different problem or. i get message cuffs nansen on i had recurring headaches and really bad migraines after there were lots of weekends where i had nonstop headaches from friday to sunday. be gone in the week but that happened often a message. natalie heck decided to have acupuncture treatments to relieve her intense headaches but because she would otherwise have to make the trip to the doctor every time she was given the option of treating herself with acupressure she can now stimulate the points on her own whether at work or at home. is finished and so how do i find the points how do i recognize them. pressed down with your firm and you feel a large depression. generally each point is massaged for between one and three minutes although very gently in the case of severe symptoms for chronic symptoms you can apply a little more pressure. to stronger mattresses i did notice that things got better and the intensity of the headaches has decreased i can say i don't get any headaches but they have decreased. sufyan from it's definitely improved i now feel longer and deeper and i fall asleep quicker. there's a clock now when i leave a session i mediately feel that my condition is going to be really good that's day . acupressure is helping patients around the world to alleviate pain and improve their wellbeing. always humans are so proud of our erect gait but it also has its disadvantages like headache stomach ache back pain and even riots all this can be caused by a vessel which gets washed by or erect posture and this syndrome is called africa syndrome nutcrackers as we know them but there's also a health complication named after them nutcracker syndrome but what is it exactly for something psychological when a person is really close to you want to make them open up. my friend said before i can't quite remember but i've definitely come across it before. i don't know what the syndrome is but i do know what a nut cracker is all of us needs. is a twenty six year old student a few years ago she developed a stomach ache which kept getting worse sitting for any length of time was agony and cycling became torture us she suffers from endometriosis a condition that causes the tissue that normally lines the uterus to grow outside it. so she presumed that was to blame. and that it was the first i thought endometriosis must be the cool since it's a chronic illness so i didn't think much of it but after three years i went to my local endometriosis clinic and they realize that the problem lies lie elsewhere. the doctors found that the endometriosis couldn't be affecting the areas where sabrina was experiencing pain that made them suspect nutcracker syndrome. nutcracker syndrome describes what happens when the renal vein coming from the left kidney becomes compressed by the superior messenger rick harder and the aorta. just as it can affect both men and women the condition stops blood flowing normally through the vein this can lead to it flowing backwards into the pelvis via the ovarian or testicular vein this disrupt circulation and can cause varicose veins the exact cause isn't known. to shits actually unfortunately there are no typical symptoms of nutcracker syndrome some women experience chronic pain some people find blood in their urine which is called humor turia. nutcracker syndrome isn't especially well known within the medical community either there's a guy in a logical exam won't reveal anything untoward and only very experienced professionals can identify varicose veins in the pelvis. of we don't yet know how prevalent not cracker sent wrong as our guess is that it's high because the symptoms aren't always obvious and doctors don't always think of it. it would be good if more medical personnel considered not cracker syndrome as a potential cause of chronic pain. but varicose veins showing up on an ultrasound isn't enough for a diagnosis. an m.r.i. scan unable doctors to identify the angle and positioning of the relevant veins and arteries they also examine the blood flow for signs of renal compression and these images reveal the presence and severity of any varicose veins in the pelvic area. used in certain cases of nutcracker syndrome surgery is an option. it's generally performed by a radiologist the patient is put under local anaesthetic the surgeon dilates the renal vein and inserts a stent which keeps the vessel open. this kind of intervention isn't suitable for everyone. that's how fond i said about standing but i think the treatment is suitable for patients who meet certain criteria chronic lower abdominal pain a compressed renal nerve and a back flow of blood identified on an m.r.i. it's fine if the success rate is high patients are generally relieved of their symptoms within a few days. after the stent is inserted the patient needs to take blood thinners to prevent clotting in the stent. sabrina had the operation a year and a half ago and will soon be able to stop taking medication. she no longer has any problems working out for her the minor surgery was a major success. see the next three and then let's all try to stay in good shape. . germany state by state. the most colorful. the last lear struck. the most traditional find it all at any time. check in with a web special. take a tour of germany state by state on d w dot com. the people of the world over information may provide the opinions they want to express g.w. on facebook and twitter go up to date and in touch follow us. earth home to millions of species the home worth saving. google ideas tell. stories of creative people and innovative projects around the world like to use the protect the car that boost clean energy solutions and reforestation. using interactive content to inspire people to take action the indians the series of global three thousand on t.w. and online. slap. them from people make fun about their own social economic and political problems. in mozambique we say that you have to laugh so you don't write it's all people because we think they do it all. as a joke i often talk about this topic in that banks and let's look at him and i actually stack my day by checking all all those jokes finding out what people are talking about what is moving them. my father taught me how to ask uncomfortable