tonometry

Esophagus disorders are problems with how your esophagus works. The esophagus is the tube that carries food from your mouth to your stomach. You usually don't notice it unless you swallow something too big, hot, or cold. You might also notice it if something is wrong. When that happens, you might feel pain or have trouble swallowing (dysphagia).

The cause depends on the type of disorder. Some run in families. Others are linked to allergic reactions to food or substances in your environment. Sometimes, the cause is unknown.

You may be more likely to develop an esophagus disorder if you:

• Are overweight or have obesity
• Are pregnant
• Take certain medicines
• Have had radiation treatmentt to your neck or chest
• Smoke or are around secondhand smoke

The most common esophagus problem is gastroesophageal reflux disease (GERD). This happens when the muscle at the bottom of your esophagus doesn't close properly. Stomach acid can move back up and irritate the esophagus.

Other esophagus disorders include:

• Heartburn is a burning feeling in your chest or throat. It is often caused by acid reflux.
• Barrett's Esophagus happens when the lining of your esophagus changes. It is often caused by chronic (long-term) GERD.
• Achalasia is a problem where the lower muscle in your esophagus doesn't relax like it should.
• Esophageal Spasms are muscle contractions that cause chest pain or swallowing problems.
• Eosinophilic Esophagitis (EoE) is a rare condition where certain white blood cells (eosinophils) build up in the esophagus, causing swelling, pain, and trouble swallowing.
• Esophageal Cancer is a type of cancer that starts in the tissues of the esophagus.

Symptoms can be different for each condition but may include:

• Pain in your chest, abdomen (belly), or back
• A cough or sore throat that doesn't go away
• Trouble swallowing or feeling like food is stuck
• A hoarse voice or wheezing
• Heartburn or a burning feeling in your stomach
• Tasting acid or food in the back of your mouth
• Food or liquid coming back up into your mouth (regurgitation)
• Losing weight without trying

Get medical help right away if you have chest pain with shortness of breath, or pain in your jaw or arm. These could be signs of a heart problem.

Your health care provider will ask about your symptoms and medical history. They may order one or more tests, such as:

• Upper gastrointestinal (GI) endoscopy. This test uses a tiny camera to look inside your esophagus and stomach.
• Biopsy. This test takes a small tissue sample to check.
• Barium swallow. This test uses imaging to see how you swallow.
• Esophageal manometry. This test checks how well your esophagus moves food to your stomach.
• Esophageal pH test. This test measures how often acid backs up into your esophagus and how long the acid stays there.

Treatment depends on what's causing the problem and your overall health. Some esophagus disorders get better with over-the-counter medicines, diet changes, or lifestyle changes. Others may need prescription medicine or surgery.

Without treatment, some disorders may lead to other problems, such as pneumonia, from food entering the windpipe. GERD, Barrett's esophagus, and achalasia can also raise your risk for esophageal cancer.

You can help prevent or reduce symptoms by:

• Not smoking and limiting alcohol
• Eating smaller meals
• Avoiding eating close to bedtime
• Wearing loose-fitting clothes
• Sleeping on your left side or raising the head of your bed
• Maintaining a healthy weight

NIH: National Institute of Diabetes and Digestive and Kidney Diseases

Sometimes, after eating a large meal or lying down too soon after eating, you might feel acid coming up into your throat. This is called gastroesophageal reflux (GER). It happens when the muscle at the end of your esophagus (the tube that carries food from your mouth to your stomach) doesn't close properly. Stomach contents can then move back up and irritate the esophagus.

Having reflux occasionally is common. But if you have symptoms two or more times a week or if they cause damage to the lining of your esophagus, you may have gastroesophageal reflux disease (GERD). GERD is a chronic (long-lasting) condition that can cause discomfort and, over time, lead to other health problems.

Anyone can have GERD, including infants and children.

GERD can happen when the muscle at the bottom of your esophagus becomes weak or relaxes at the wrong time. You are more likely to have GERD if you:

• Are overweight or have obesity
• Are pregnant
• Smoke or are around secondhand smoke
• Have a hiatal hernia (when part of the stomach pushes up into the chest)

Certain foods, drinks, or medicines can also make GERD worse.

The most common symptom of GERD is heartburn. This is a burning feeling in your chest or throat. You can also have GERD without having heartburn. Other symptoms may include:

• Tasting acid or food in the back of your mouth
• A dry cough or hoarse voice
• Asthma-like symptoms
• Trouble swallowing

Get medical help right away if you have chest pain with shortness of breath, or pain in your jaw or arm. These can be signs of a heart problem.

Your health care provider will ask about your symptoms and medical history. They may recommend tests such as:

• Upper GI endoscopy to look at the esophagus and stomach lining with a tiny camera.
• Biopsy to check a small tissue sample.
• X-Ray to take pictures of the upper digestive system.
• Esophageal pH test to measure how often acid backs up the esophagus and how long the acid stays there.
• Esophageal manometry to check how well your esophagus moves food when you swallow.
• Transnasal esophagoscopy to look for damage to the esophagus by using a small tube with a camera.

Most people can manage GERD with lifestyle changes and medicine. In rare cases, surgery is needed.

Lifestyle changes can include:

• Eating smaller meals and avoiding lying down for at least 2-3 hours after eating
• Avoiding foods that trigger symptoms, such as spicy foods, chocolate, caffeine, or fatty foods
• Losing weight if needed
• Raising the head of your bed
• Quitting smoking

Medicines can include:

• Over-the-counter medicines, such as antacids
• Prescription medicines

If not treated, GERD can cause problems like inflammation of the esophagus, scarring, or changes in the tissue lining (Barrett's esophagus). It can also worsen asthma or cause chronic (long-term) cough or hoarseness.

You may be able to improve symptoms of GERD by:

• Avoiding alcohol and trigger foods
• Eating smaller meals
• Not eating close to bedtime
• Wearing loose-fitting clothes
• Sleeping on your left side or raising the head of your bed
• Maintaining a healthy weight

NIH: National Institute of Diabetes and Digestive and Kidney Diseases

Glaucoma is a group of diseases that can damage the optic nerve of one, or both, of your eyes. This can result in vision loss. There are different types of glaucoma, but the most common type is open-angle glaucoma. Other less common types include angle-closure glaucoma, and congenital glaucoma.

You may not have any symptoms of glaucoma. Regular eye exams by an eye care provider can check for glaucoma and other eye problems to help protect your vision. Treatments that lower eye pressure help slow the disease. Without treatment, glaucoma can eventually lead to blindness.

Medical experts aren't sure what causes glaucoma, but the most common types usually happen when the fluid pressure inside your eye slowly rises, damaging the optic nerve. Other types of glaucoma may be caused by medical conditions, or a baby may be born with it.

Not everyone with high eye pressure develops glaucoma. Some people may even get glaucoma with normal eye pressure. The amount of pressure your optic nerve can handle is different for each person. Getting regular dilated eye exams helps your provider figure out what level of eye pressure is normal for you.

Often there are no symptoms of glaucoma at first. Or symptoms may start so slowly that you may not notice them. Without treatment, you slowly lose your peripheral (side) vision. It may seem like you're looking through a tunnel. Over time, your straight-ahead vision may decrease until no vision remains.

If you have sudden symptoms of intense eye pain, blurry vision, red eyes, or an upset stomach (nausea), you need to go to your eye care provider or an emergency room right away. These could be symptoms of angle-closure glaucoma. This less common type of glaucoma causes fluid to build up quickly in your eye.

A comprehensive eye exam can tell if you have glaucoma. This would include:

• A dilated eye exam. This involves getting eye drops that dilate (widen) your pupils. This allows more light to enter your eye. Your eye care provider examines your eyes using a special magnifying lens. This provides a clear view of important tissues at the back of your eye to check for glaucoma or other eye problems. For a few hours after the exam your vision may be blurry and sensitive to light, so you will need someone to take you home.
• Visual field testing. This check of your peripheral (side) vision allows your eye care provider to find out how well you can see objects off to the side of your vision without moving your eyes.
• Tonometry. This measures the pressure inside your eye.

If you're at higher risk for glaucoma, you should get comprehensive eye exams every one to two years. You're at higher risk if you:

• Are Black or African American and over age 40
• Are over age 60, especially if you're Hispanic or Latino
• Have a family history of glaucoma

You're also at higher risk if you have high blood pressure or diabetes and should get a dilated eye exam at least once a year. Talk with your provider about your risk and how often you should get your eyes checked.

Early treatment can help protect your eyes against vision loss. There is no cure, but glaucoma can usually be controlled. Without treatment it can eventually cause blindness. Treatments can include:

• Prescription eye drops are the most common treatment to lower the pressure in your eye and prevent damage to your optic nerve.
• Other treatments may include oral medicines, laser treatment, and/or surgery.

A combination of these treatments may be used to lower eye pressure and help drain the fluid out of your eye.

There is no way to prevent glaucoma. Eye exams can help find glaucoma or other eye problems before they can affect your vision. If you have glaucoma, be sure to continue with treatment to prevent your vision from getting worse.

NIH: National Eye Institute

Bowel incontinence is the inability to control your bowels. When you feel the urge to have a bowel movement, you may not be able to hold it until you get to a toilet. Millions of Americans have this problem. It affects people of all ages - children and adults. It is more common in women and older adults. It is not a normal part of aging.

Causes include:

• Constipation
• Damage to muscles or nerves of the anus and rectum
• Diarrhea
• Pelvic floor disorders

Treatments include changes in diet, medicines, bowel training, or surgery.

NIH: National Institute of Diabetes and Digestive and Kidney Diseases

A bowel movement is the last stop in the movement of food through your digestive tract. Your stool passes out of your body through the rectum and anus. Another name for stool is feces. It is made of what is left after your digestive system (stomach, small intestine, and colon) absorbs nutrients and fluids from what you eat and drink.

Sometimes a bowel movement isn't normal. Diarrhea happens when stool passes through the large intestine too quickly. Constipation occurs when stool passes through the large intestine too slowly. Bowel incontinence is a problem controlling your bowel movements. Other abnormalities with bowel movements may be a sign of a digestive problem.

NIH: National Institute of Diabetes and Digestive and Kidney Diseases

Eye care is about keeping your eyes healthy through good daily habits, regular checkups, and treatment when needed. Your eyes are an important part of your health. You rely on them every day to see and understand the world around you. Some eye diseases can lead to vision loss without early warning signs, so it's important to catch them as soon as possible. Get your eyes checked as often as your health care provider recommends, or if you notice new vision problems. Just like caring for the rest of your body, it's important to keep your eyes healthy.

There are many things you can do to protect your eyes and see your best:

• Give your eyes a rest. Spending long hours on a computer or other digital screens can make you blink less, causing dryness and tired eyes. To reduce eyestrain, try the 20-20-20 rule: Every 20 minutes, look away about 20 feet in front of you for 20 seconds.
• Wear sunglasses.Sun exposure can damage your eyes and raise your risk of cataracts and age-related macular degeneration. Protect your eyes by using sunglasses that block out 99 to 100% of both UV-A and UV-B radiation.
• Wear protective eyewear. To prevent eye injuries, you need eye protection when playing certain sports, working in jobs such as factory work and construction, and doing repairs or projects in your home.
• Avoid rubbing your eyes. Rubbing your eyes can transfer dirt and bacteria that may cause irritation or lead to an infection.
• Use good lighting. Brighten your space to reduce strain and help you see comfortably.
• If you wear contacts, take steps to prevent eye infections. Wash your hands before you put in or take out your contact lenses. Also follow the instructions on how to properly clean them and replace them when needed.

What you eat and how you take care of your body can have a big impact on your eyes and vision:

• Eat a healthy, balanced diet. Your diet should include plenty of fruits and vegetables, especially dark leafy green vegetables like spinach, kale, or collard greens. Eating fish high in omega-3 fatty acids, such as salmon, tuna, and halibut can also help your eyes.
• Maintain a healthy weight. Being overweight or having obesity increases your risk of developing diabetes. Having diabetes puts you at higher risk of getting diabetic retinopathy or glaucoma.
• Get regular exercise. Exercise may help to prevent or control diabetes, high blood pressure, and high cholesterol. These diseases can lead to some eye or vision problems. Regular exercise helps lower your risk.
• Avoid smoking. Smoking increases the risk of developing age-related eye diseases such as macular degeneration and cataracts and can damage the optic nerve.
• Know your family medical history. Some eye diseases are inherited (passed down through families), so it is important to find out whether anyone in your family has had them. This can help you determine if you are at higher risk of developing an eye disease.
• Know your other risk factors. As you get older, you are at higher risk of developing age-related eye diseases and conditions. It is important to know your risk factors because you may be able to lower your risk by changing some behaviors.

Everyone needs their eyesight tested to check for vision and eye problems. Children usually have vision screening, also called an eye test, in school or at their provider's office during a checkup. This is a brief test that mainly checks how well you can see things up close and far away. Adults may also get vision screenings during their checkups. But many adults need more than a vision screening. They need a comprehensive dilated eye exam.

Getting comprehensive dilated eye exams is especially important because some eye diseases may not have warning signs. The exams are the only way to detect these diseases in their early stages, when they are easier to treat.

The eye exam includes several tests:

• Test your side (peripheral) vision with a visual field test. Losing peripheral vision may be a sign of glaucoma.
• Check how well you see at various distances with a visual acuity test, where you read an eye chart about 20 feet away.
• Follow an object with your eyes during an eye muscle function test to check for problems with the muscles that control your eyes.
• Shine a light into your eyes with a pupil response test to see how your pupils react to light.
• Measure the pressure inside your eyes with tonometry. This test helps to detect glaucoma.
• Dilate (widen) your pupils with special eye drops allows more light to enter the eye. Your eye care provider then uses a special magnifying lens to clearly see important tissues at the back of your eye, including the retina, macula, and optic nerve.

If you have a refractive error and are going to need glasses or contacts, then you will also have a refraction test. When you have this test, you look through a device that has lenses of different strengths to help your eye care professional figure out which lenses will give you the clearest vision.

How often you need eye exams depends on your age, race, risk factors, and overall health. For example, Black/African American adults are at higher risk for glaucoma and may need to start exams earlier. If you have diabetes, you should have an exam every year. Check with your provider about when you need these exams.

See an eye care specialist right away if you have symptoms like sudden loss of vision, double vision, blurred vision with eye pain, flashes of light, black spots or halos around lights. These symptoms may represent a serious medical or eye condition.

If you have a swallowing disorder, you may have difficulty or pain when swallowing. Some people cannot swallow at all. Others may have trouble swallowing liquids, foods, or saliva. This makes it hard to eat. Often, it can be difficult to take in enough calories and fluids to nourish your body.

Anyone can have a swallowing disorder, but it is more common in older adults. It often happens because of other conditions, including:

• Nervous system disorders, such as Parkinson's disease and cerebral palsy
• Problems with your esophagus, including GERD (gastroesophageal reflux disease)
• Stroke
• Head or spinal cord injury
• Cancer of the head, neck, or esophagus

Medicines can help some people, while others may need surgery. Swallowing treatment with a speech-language pathologist can help. You may find it helpful to change your diet or hold your head or neck in a certain way when you eat. In very serious cases, people may need feeding tubes.

NIH: National Institute on Deafness and Other Communication Disorders