Advanced Endoscopy & Treatment Center

19/11/2025

پہاڑوں میں آباد کچے مکان سادہ مگر پرمسرت

19/11/2025

Gluten-Containing Foods

(Sources of wheat, barley, rye, and contaminated oats)

1. Grains & Flours
• Wheat (all forms)
• Barley
• Rye
• Triticale
• Spelt
• Kamut
• Semolina
• Farina
• Durum wheat
• Bulgur
• Couscous
• Wheat bran / wheat germ
• Malt (barley-based)

2. Breads & Baked Goods
• Regular bread
• Toast
• Buns / rolls
• Croissants
• Cakes
• Muffins
• Donuts
• Pastries
• Cookies
• Pizza crust (regular)
• Pita / naan / chapati / paratha (unless GF)
• Biscuits / crackers

3. Pasta & Noodles
• All wheat pasta
• Egg noodles
• Ramen
• Udon
• Spaghetti / macaroni
• Lasagna sheets
• Vermicelli (if wheat-based)

4. Breakfast Foods
• Most cereals (wheat, malt, barley-containing)
• Granola (often contains gluten)
• Pancakes & waffles (non-GF)
• French toast

5. Snacks
• Pretzels
• Normal chips with wheat flavorings
• Trail mixes with granola
• Wheat crackers
• Cookies & wafers

6. Processed Foods (Hidden Gluten)
• Soy sauce (contains wheat unless GF)
• Salad dressings
• Gravies & sauces (thickened with flour)
• Soups (cream soups, packet soups)
• Marinades
• Processed meats (sausages, meatballs, cold cuts with fillers)
• Veggie burgers (wheat binders)

7. Beverages
• Beer
• Ale
• Malt beverages
• Barley tea (mugicha)

8. Other Sources
• Breaded/fried foods (flour coating)
• Tempura
• Seitan (“wheat meat”)
• Stuffings
• Imitation crab (surimi sometimes contains wheat)
• Energy bars with oats (unless certified gluten-free)

Oats
• Naturally gluten-free
• But often contaminated with wheat during processing
• Only safe if labeled “certified gluten-free oats”

18/11/2025

17/11/2025

Recognized Causes of GERD-Like Symptoms (True Mimickers)

1. Esophageal Causes

These are the most clinically recognized mimickers.
• Eosinophilic esophagitis (EoE)
• Achalasia
• Diffuse esophageal spasm
• Hypercontractile (Jackhammer
• Esophageal hypersensitivity
• Functional heartburn
• Esophageal strictures (peptic, caustic, radiation)
• Schatzki ring
• Zenker diverticulum
• Pill-induced esophagitis (doxycycline, bisphosphonates, KCl)
• Infectious esophagitis (Candida, CMV, HSV)
• Esophageal carcinoma
• Rumination syndrome

2. Gastric / Duodenal Causes

All officially known to produce “reflux-type” discomfort.
• Peptic ulcer disease (PUD)
• Functional dyspepsia
• Gastroparesis (diabetic, postsurgical)
• Bile reflux gastritis
• Gastric outlet obstruction
• Helicobacter pylori gastritis

3. ENT–Respiratory Causes

Recognized because they often present first as “heartburn/cough.”
• Chronic sinusitis / post-nasal drip
• Asthma (classic or cough-variant)
• Upper airway cough syndrome (UACS)
• Vocal cord dysfunction (inducible laryngeal obstruction)
• Chronic laryngitis unrelated to acid
• Tracheomalacia

4. Cardiac Causes

These are critical recognized mimickers because they can kill if misdiagnosed.
• Atypical angina
• Myocardial ischemia / ACS
• Pericarditis
• Aortic dissection (rare but can present like tearing chest/epigastric pain)

5. Hepatobiliary & Pancreatic Causes

Also officially known to produce epigastric/chest burning.
• Biliary colic / cholelithiasis
• Chronic cholecystitis
• Acute pancreatitis
• Chronic pancreatitis

6. Medication-Induced Causes

Very well recognized in guidelines.
• NSAIDs
• Bisphosphonates (alendronate, risedronate)
• Doxycycline
• Potassium chloride
• CCBs (nifedipine, amlodipine)
• Nitrates
• Theophylline
• Anticholinergics
• GLP-1 agonists (semaglutide, liraglutide) — delayed emptying
• Iron tablets
• Opioids — gastric stasis

7. Systemic / Other Recognized Causes
• Anxiety / panic attacks
• Pregnancy
• Obesity (functional reflux symptoms)
• Food intolerances (lactose, FODMAPs)
• Hiatal hernia symptoms WITHOUT acid reflux
• Diabetic autonomic neuropathy (slowed motility)

17/11/2025

🛑🛑Both SGLT2 1 and 2 inhibitor

✅✅Inhibiting SGLT1 reduces intestinal absorption of glucose and sodium.

✅✅Inhibiting SGLT2 reduces renal reabsorption of glucose and sodium,

👉👉 Sotagliflozin, a dual SGLT1/SGLT2 inhibitor, was approved in 2023 and is indicated to reduce the risk of cardiovascular death, hospitalization, in adults with heart failure, type 2 diabetes mellitus, chronic kidney disease, or other cardiovascular risk factors.

17/11/2025

شام کے خوبصورت نظارے

17/11/2025

اور اگر تم اللہ کی نعمتوں کو شمار کرنا چاہو تو انہیں پورا شمار نہ کر سکو گے، بیشک اللہ بڑا بخشنے والا نہایت مہربان ہے