Medical News Today: How do you know if you have pernicious anemia?

Pernicious anemia is an autoimmune condition that leads to a lack of red blood cells. A deficiency in vitamin B-12 causes it.

A person with pernicious anemia may experience:

  • tiredness
  • shortness of breath
  • shiny or smooth, red tongue
  • pale skin
  • chest pain
  • numb feeling in the hands or feet
  • balance difficulties
  • poor coordination
  • slow reflexes
  • confusion
  • depression

Pernicious anemia is a rare condition that 0.1 percent of people are thought to be affected by, with a higher occurrence among those over 60 years of age.

This article explains the symptoms of pernicious anemia, and how it differs from other types of anemia. It also discusses available treatments.

How is it caused?

Tired senior woman who has pernicious anemia
Confusion, tiredness, and pale skin can be symptoms of pernicious anemia.

Pernicious anemia is a type of anemia, which is when a person is unable to make enough red blood cells. Pernicious anemia is the result of a problem with the immune system.

When a person has pernicious anemia, their gut does not absorb vitamin B-12 properly. This causes a vitamin B-12 deficiency. Up to 50 percent of adults with a vitamin B-12 deficiency may have pernicious anemia.

People find vitamin B-12 in the following foods:

  • eggs
  • dairy products
  • poultry
  • meat
  • shellfish

The body needs vitamin B-12 to produce red blood cells. Being deficient in vitamin B-12 means the body is unable to make enough red blood cells.

Red blood cells help carry oxygen around the body, and the body needs oxygen to function properly.

A lack of red blood cells means the body’s tissues do not get enough oxygen. This shortage is what causes the symptoms of pernicious anemia.

Pernicious anemia vs. vitamin B-12 deficiency anemia

Pernicious anemia is one type of vitamin B-12 anemia. It is a condition caused by a problem with the immune system.

There are a number of other types of vitamin B-12 deficiency anemia, which have different causes.

Causes of vitamin B-12 deficiency anemia may include:

  • poor diet
  • gastrectomy, where surgery removes part or all of the stomach
  • celiac disease
  • Crohn’s disease
  • gastrointestinal tract infection
  • long-term use of anti-acid medication

Megaloblastic anemia

Vitamin B-12 deficiency anemia, including pernicious anemia, is a type of megaloblastic anemia.

This name comes from the type of red blood cells or megaloblasts produced when a person is vitamin-B12 deficient. Megaloblasts are an abnormally large type of red blood cell.

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Why does it only happen to certain people?

Doctors think pernicious anemia is due to a problem with the immune system.

A protein called intrinsic factor helps a person absorb vitamin B-12 in the gut. The stomach makes intrinsic factor. However, people with pernicious anemia release an antibody in error. This antibody attacks the cells in the stomach that make intrinsic factor. This autoimmune reaction may reduce or stop its production.

A lack of intrinsic factor means the gut cannot absorb vitamin B-12 from food. The body cannot make enough red blood cells without having sufficient vitamin B-12.


Senior speaking with doctor
To diagnose pernicious anemia, a doctor may carry out different blood tests.

A doctor will ask a person about their symptoms to diagnose pernicious anemia.

They may also ask about:

  • any stomach surgeries
  • any digestive disorders
  • their diet
  • family history of autoimmune conditions
  • family history of anemia

The doctor may also examine the person. They may also carry out tests to reach a diagnosis. These can include the following blood tests:

  • Complete blood count: This checks hemoglobin levels.
  • Reticulocyte count: This measures levels of young red blood cells.
  • Intrinsic factor antibodies: This records levels of intrinsic factor antibodies.

The doctor may also carry out a bone marrow test. The two types of bone marrow test are an aspiration or a biopsy. In both types, the doctor looks for enlarged bone marrow cells, which are a sign of pernicious anemia.

Treatment options

Doctors treat pernicious anemia with vitamin B-12 replacement therapy, which they give via vitamin B-12 shots.

A doctor will inject a vitamin B-12 shot into a person’s muscles. Injections are given on a daily or weekly basis until vitamin B-12 levels return to normal.

Vitamin B-12 oral pills are a less frequently used treatment. A 2016 review, however, found them to be an effective alternative to vitamin B-12 shots. It also noted that people might prefer taking pills.

It is best for people to discuss the various options with their doctor who can recommend the most appropriate treatment for each person.

Symptoms may start to improve a few days or weeks after treatment begins.

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What are the complications?

Pernicious anemia puts additional stress on a person’s heart. This is because it has to work harder to pump oxygenated blood around the body.

The additional stress on the heart may cause:


With the right treatment, the symptoms of pernicious anemia can be well-managed.

As pernicious anemia is an autoimmune condition, people may need life-long treatment to control symptoms.

Doctors can treat the vitamin B-12 deficiency. However, there is not yet a cure for the immune system reaction that causes this deficiency to occur.

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Medical News Today: Is eating tilapia fish safe and healthful?

Tilapia is an easy-to-prepare and relatively inexpensive fish that many people enjoy eating. However, some reports on tilapia farming practices have led to people worrying about whether or not the fish is safe to eat.

In this article, we answer some of the common concerns regarding the farming, safety, breeding, and nutritional value of tilapia.

What is tilapia?

cooked tilapia fish
Tilapia is one of the most popular fish to eat in the United States.

Tilapia is a mild-flavored, lean fish, which is easy to prepare and relatively inexpensive. In 2016, tilapia was fourth on a list of the seafood species that people in the United States are most likely to consume.

Tilapia fish are very adaptable and can survive even in poor-quality water or overcrowded conditions. They grow quickly, so they are a popular choice for farming. The most popular farmed species is native to the Nile river in Northeast Africa.

What are the concerns about tilapia farming?

There are tilapia farms around the world. The fish does not tolerate cold water, so farming usually takes place in warmer climates. Standards for fish farming vary according to the country and farm.

Tilapia is a very successful fish that can survive in a variety of conditions. This can cause problems if any of the fish escape, as they can become an invasive species. In the U.S., tilapia farming takes place in closed tanks to prevent the fish from escaping.

Raising tilapia in cramped conditions can lead to disease and overcrowding. Tilapia eat algae but can survive on a variety of foods. A good-quality diet and a clean, spacious environment will generally produce a healthier fish.

The Ocean Wise scheme labels fish sources according to their sustainability. This takes into account the long-term survival of the species, its health, environmental pollution, and the impact of fishing on the wider ecosystem.

Examples of non-sustainable sources of tilapia include pond farms in China and Taiwan and open-net pen farms in Colombia.

Sustainable sources of tilapia include:

  • tilapia pond farms in Ecuador
  • blue tilapia raceway farms in Peru
  • Nile tilapia open-net pen farms in Mexico, Honduras, and Indonesia
  • tilapia recirculating aquaculture system (RAS) farms in the U.S.

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Is tilapia safe to eat?

When farms rear the tilapia in good conditions, the fish are safe to eat. The U.S. Food and Drug Administration (FDA) list tilapia as one of the best choices for pregnant or breast-feeding women and children over the age of 2 years. This is due to its low mercury and contaminant content.

Is tilapia genetically engineered?

check tilapia fish label for gm
As of July 2018, the FDA have not approved any genetically engineered tilapia in the U.S.

Selective breeding has led to changes in the genes of most farmed animals and fish over time. The species in farms often look different to those in the wild.

Selective breeding can increase the amount of meat from an animal, or make a species easier to farm. This usually has no adverse effects for people eating the meat or fish.

However, people may want to check food labels for the following terms:

  • genetically modified (GM)
  • genetically engineered (GE)
  • bioengineered (BE)

These terms mean that scientists have altered the DNA of an animal or plant in the laboratory. This is a common way to make plants resistant to disease, pests, or chemicals, such as glyphosate.

The first GE fish that the FDA approved for sale in the U.S. was the AquAdvantage salmon that AquaBounty Technologies produced. This fish grows more quickly than it would in the wild as a result of higher levels of growth hormone. These GE salmon may also have more antibiotics and food dyes in their feed.

After an investigation, the FDA decided that the AquAdvantage salmon was safe to eat and did not pose a threat to the environment, despite many organizations and experts raising concerns. The FDA have not yet approved any GE tilapia, although AquaBounty Technologies are currently developing GE trout, catfish, and other fish, which they intend to sell commercially.

The U.S. Department of Agriculture (USDA) are creating a new scheme for labeling GM foods. This will make it easier for consumers to know which foods are GM.

Does tilapia contain dioxins?

Dioxins are toxic chemicals that pollute the environment and are harmful to health. They can be present in the tissue of animals, fish, and shellfish, which people might eat. Most countries check food for dioxin contamination.

Contaminated animal feed is a common source of dioxins. As long as farms use feed that meets safety standards, it is unlikely to contain harmful levels of dioxins.

Tilapia is no more likely to contain dioxins than any other type of fish.

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What nutrition does tilapia provide?

cooked tilapia fish with lemon
Tilapia contains essential fatty acids and is a source of protein.

Tilapia is a source of protein and is relatively low in fat. Eating fish is generally a more healthful way to consume protein than fried, processed, or red meat. Tilapia is also lower in sodium, calories, and total fat than bacon and other processed meats, and, unlike them, it does not contain nitrates that can potentially cause cancer.

Tilapia contains the essential fatty acids omega-3 and omega-6. Omega-3 fatty acids contribute to heart health, vision, and joint strength. Omega-6 fatty acids can be less beneficial to health if people consume them in excess, as they may cause or worsen inflammation.

There are more omega-6 fatty acids in tilapia than omega-3 fatty acids. However, the total fat content in a tilapia fillet is low, so a person will only consume a small quantity of omega-6 when they eat the fish.

Due to its higher ratio of omega-6 to omega-3, tilapia is less healthful than salmon. However, it still provides more omega-3 than most meats. Research in 2018 found that giving tilapia fish enriched feed raises their omega-3 content further.

What are the health benefits of tilapia?

People can eat lean fish at least twice a week as part of a healthful diet. Tilapia is an excellent source of omega-3 fatty acids and protein, both of which are important for good health.

Choosing tilapia from a responsible source can reduce the risks to health. Consumers can look for the country of origin or the Ocean Wise symbol to check the source of their fish.

What are the alternatives to tilapia?

Lean fish contains a relatively small amount of fat and calories, making it a healthier choice. Tilapia is a lean fish, but other fish contain more omega-3 fatty acids.

There are other lean, low-mercury fish with good omega-3 content that can be a healthier option than tilapia. These include:

  • salmon
  • cod
  • trout
  • red snapper
  • mackerel
  • sardines
  • herring

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Many people enjoy eating tilapia, which is low in fat and a good source of protein. There are tilapia farms around the world. If these farms maintain good conditions, their fish is safe to eat.

Choosing tilapia from a responsible source ensures that the fish a person is eating is safe, healthful, and sustainable. Consumers can look for the country of origin or the Ocean Wise symbol to check the source of their fish.

When eating fish, it is best to choose a low-mercury fish that contains more omega-3 than omega-6 fatty acids, such as sardines or salmon. However, non-GE tilapia is still a better choice than red meat and processed meats, such as bacon, hot dogs, and burgers.

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Medical News Today: How to cope with a depressive episode

A depressive episode in the context of a major depressive disorder is a period characterized by low mood and other depression symptoms that lasts for 2 weeks or more. When experiencing a depressive episode, a person can try to make changes to their thoughts and behaviors to help improve their mood.

Symptoms of a depressive episode can persist for several weeks or months at a time. Less commonly, depressive episodes last for over a year.

According to the Anxiety and Depression Association of America, approximately 16.1 million adults in the United States experienced at least one major depressive episode in 2015.

Read on to learn more about the symptoms of a depressive episode and 12 tips for coping with one.


man in bed with a depressive episode
Symptoms of a depressive episode may include anxiety, frustration, feeling hopeless, fatigue, and a loss of interest in things once enjoyed.

Symptoms of a depressive episode are more extreme than normal periods of low mood and may include:

  • feeling sad, hopeless, or helpless
  • feeling guilty or worthless
  • anxiety
  • irritability or frustration
  • fatigue or low energy
  • restlessness
  • changes in appetite or weight
  • loss of interest in things once enjoyed, including hobbies and socializing
  • trouble concentrating or remembering
  • changes in sleep patterns
  • moving or talking more slowly than usual
  • loss of interest in living, thoughts of death or suicide, or attempting suicide
  • aches or pains that do not have an obvious physical cause

For a diagnosis of depression, people must experience several of these symptoms for most of the day, almost every day, for at least 2 weeks.

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Twelve tips for dealing with a depressive episode

Tackling depression as soon as symptoms develop can help people recover more quickly. Even those who have experienced depression for a long time might find that making changes to the way they think and behave improves their mood.

The following tips may help people deal with a depressive episode:

1. Track triggers and symptoms

Keeping track of moods and symptoms might help a person understand what triggers a depressive episode. Spotting the signs of depression early on may help them avoid a full-blown depressive episode.

Use a diary to log important events, changes to daily routines, and moods. Rate moods on a scale of 1 to 10 to help identify which events or activities cause specific responses. See a doctor if symptoms persist for 14 days or more.

2. Stay calm

Identifying the onset of a depressive episode can be scary. Feeling panicked or anxious is an understandable reaction to the initial symptoms of depression. However, these reactions may contribute to low mood and worsen other symptoms, such as loss of appetite and disrupted sleep.

Instead, focus on staying calm. Remember that depression is treatable and the feelings will not last forever.

Anyone who has experienced depressive episodes before should remind themselves that they can overcome these feelings again. They should focus on their strengths and on what they have learned from previous depressive episodes.

Self-help techniques, such as meditation, mindfulness, and breathing exercises can help a person learn to look at problems in a different way and promote a sense of calmness. Self-help books and phone and online counseling courses are available.

3. Understand and accept depression

Learning more about depression can help people deal with the condition. Depression is a widespread and genuine mental health disorder. It is not a sign of weakness or a personal shortcoming.

Accepting that a depressive episode may occur from time to time might help people deal with it when it does. Remember, it is possible to manage symptoms with treatments, such as lifestyle changes, medication, and therapy.

4. Separate yourself from the depression

A condition does not define a person; they are not their illness. When depression symptoms begin, some people find it helpful to repeat: “I am not depression, I just have depression.”

A person should remind themselves of all the other aspects of themselves. They may also be a parent, sibling, friend, spouse, neighbor, and colleague. Each person has their own strengths, abilities, and positive qualities that make them who they are.

5. Recognize the importance of self-care

Self-care is essential for good physical and mental health. Self-care activities are any actions that help people look after their wellbeing.

Self-care means taking time to relax, recharge, and connect with the self and others. It also means saying no to others when overwhelmed and taking space to calm and soothe oneself.

Basic self-care activities include eating a healthful diet, engaging in creative activities, and taking a soothing bath. But any action that enhances mental, emotional, and physical health can be considered a self-care activity.

6. Breathe deeply and relax the muscles

woman deep breathing and meditating at work
Inhaling and exhaling slowly has psychological benefits.

Deep breathing techniques are an effective way to calm anxiety and soothe the body’s stress response. Slowly inhaling and exhaling has physical and psychological benefits, especially when done on a daily basis.

Anyone can practice deep breathing, whether in the car, at work, or in the grocery store. Plenty of smartphone apps offer guided deep breathing activities, and many are free to download.

Progressive muscle relaxation is another helpful tool for those experiencing depression and anxiety. It involves tensing and relaxing the muscles in the body to reduce stress. Again, many smartphone apps offer guided progressive muscle relaxation exercises.

We have reviewed some meditation apps that can help with depression and anxiety.

7. Challenge negative thoughts

Cognitive behavioral therapy (CBT) is an effective therapy for those with depression and other mood disorders. CBT proposes that a person’s thoughts, rather than their life situations, affect their mood.

CBT involves changing negative thoughts into more balanced ones to alter feelings and behaviors. A qualified therapist can offer CBT sessions, but it is also possible to challenge negative thoughts without seeing a therapist.

Firstly, notice how often negative thoughts arise and what these thoughts say. These may include “I am not good enough,” or “I am a failure.” Then, challenge those thoughts and replace them with more positive statements, such as “I did my best” and “I am enough.”

8. Practice mindfulness

Take some time every day to be mindful and appreciate the present moment. This may mean noticing the warmth of sunlight on the skin when walking to work, or the taste and texture of a crisp, sweet apple at lunchtime.

Mindfulness allows people to fully experience the moment they are in, not worrying about the future or dwelling on the past.

Research suggests that regular periods of mindfulness can reduce symptoms of depression and improve the negative responses that some people with chronic or recurrent depression have to low mood.

9. Make a bedtime routine

Sleep can have a huge impact on mood and mental health. A lack of sleep can contribute to symptoms of depression, and depression can interfere with sleep. To combat these effects, try to go to bed and get up at the same time each day, even at weekends.

Establish a nightly routine. Start winding down from 8 pm. Sip chamomile tea, read a book, or take a warm bath. Avoid screen time and caffeine. It may also be helpful to write in a journal before bed, especially for those whose racing thoughts keep them up.

10. Exercise

Exercise is extremely beneficial for people with depression. It releases chemicals called endorphins that improve mood. An analysis of 25 studies on exercise and depression reports that exercise has a “large and significant effect” on symptoms of depression.

11. Avoid alcohol

Alcohol is a depressant, and alcohol use can trigger episodes of depression or make existing episodes worse. Alcohol can also interact with some medications for depression and anxiety.

12. Record the positives

Often, depressive episodes can leave people focusing on the negatives and discounting the positives. To counteract this, keep a positivity journal or gratitude journal. This type of journal helps to build self-esteem.

Before bed, write down three good things from the day. Positives include regular meditation, going for a walk, eating a healthful meal, and so much more.

Asking for help

Mother and daughter chatting over coffee
Asking for help is an important step in dealing with a depressive episode.

Dealing with depression can be daunting, but no one has to do it alone. One of the most important steps in dealing with a depressive episode is asking for help.

Seek help from:

  • Family and friends. People experiencing depression should consider telling family and friends how they are feeling, and asking for support where they need it.
  • A doctor. It is essential to speak to a doctor who can make a diagnosis and recommend treatments. Research suggests that tailoring early treatment to the individual offers the best possible outcomes.
  • A therapist. Talking to a counselor or psychotherapist can be beneficial. Talk therapy can help address low moods and negative thoughts. A therapist can also teach coping skills to help people deal with future depressive episodes.
  • Support groups. Look for a local support group for people with depression. It can be beneficial to talk to others who are experiencing the same thing.

Support lines and crisis hotlines are another way that people with depression can reach out to others. Save important numbers to a cell phone, so they are easily accessible in times of need.

Helpful numbers in U.S. include:

Support groups and helplines similar to these are also available in other countries.

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Types of depression

Major depressive disorder is the most common form of depression. Other types of depression have similar symptoms and can also cause depressive episodes. These include:

  • Persistent depressive disorder lasts for a minimum of 2 years. During this period, symptoms may vary in severity but are always present. Approximately 1.5 percent of adults in the U.S. may experience persistent depressive disorder in any one year.
  • Psychotic depression causes symptoms of psychosis as well as severe depression. A person may experience delusions and hallucinations. Approximately 4 in every 1,000 people may develop psychotic depression.
  • Bipolar disorder is a mood disorder similar to major depressive disorder. Someone with bipolar disorder may also experience periods of extreme highs, called mania or hypomania. According to the National Institute of Mental Health (NIMH), approximately 2.8 percent of adults in the U.S. might develop bipolar disorder each year.
  • Postpartum depression causes major depression symptoms during pregnancy or after delivery. This condition affects nearly 15 percent of new mothers and typically requires treatment.
  • Seasonal affective disorder (SAD) causes symptoms of depression during the winter months. According to the American Academy of Family Physicians, between 4 and 6 percent of people are estimated to have SAD, while another 10 to 20 percent have a milder form of the disorder.

Possible triggers

Depression is a complex condition with many possible causes. Even though a person may be more susceptible to depression than someone else, they usually only experience a depressive episode when a stressful event triggers the condition.

Possible triggers include:

  • changes in daily routines
  • disrupted sleep
  • poor eating habits
  • stress at work, home, or school
  • feeling isolated, alone, or unloved
  • living with abuse or mistreatment
  • medical problems, such as Alzheimer’s disease, stroke, or erectile dysfunction
  • some medications, including certain antibiotics and blood pressure drugs
  • a significant life event, such as a bereavement or divorce
  • a traumatic incident, such as a car accident or sexual assault

However, it is important to note that not every depressive episode will have an obvious or identifiable trigger.

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Medical News Today: What is hypochlorhydria?

Hypochlorhydria is the medical term for a low level of stomach acid. People with hypochlorhydria may experience digestive issues, nutritional deficiencies, and gastrointestinal infections, but prompt treatment can prevent serious complications.

An individual with hypochlorhydria is unable to produce enough hydrochloric acid (HCL) in the stomach.

Stomach acid, along with several enzymes, helps to break down food. Other functions of this acid include:

  • aiding the body in absorbing certain nutrients, such as protein and vitamin B-12
  • killing bacteria and other pathogens in the stomach to prevent infection

In this article, we describe the symptoms and causes of hypochlorhydria. We also explore the treatment options.


Woman with hypochlorhydria<!--mce:protected %0A-->
Bloating, burping, and gas may be symptoms of hypochlorhydria.

Common causes of hypochlorhydria include:


The stomach can produce less acid as a result of aging.

According to a 2013 review, hypochlorhydria is the main change in the stomach of older adults. People over the age of 65 have the highest risk.


While everyday stress may not have much effect on the production of stomach acid, chronic stress can contribute to hypochlorhydria.


Long-term use of antacids or other medications for acid reflux or heartburn may decrease the body’s production of stomach acid.

Doctors often prescribe medications called proton pump inhibitors to treat acid reflux, and these can cause hypochlorhydria.

Bacterial infection

Over 50 percent of people worldwide are infected with a bacteria called Helicobacter pylori (H. pylori). This infection can contribute to low levels of stomach acid and gastric ulcers.

Zinc deficiency

Zinc is necessary for the production of stomach acid. A lack of this mineral can contribute to hypochlorhydria.

Stomach surgery

Some surgical procedures, including gastric bypass surgery, can reduce the amount of acid the stomach produces.

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Symptoms of hypochlorhydria can include:

  • bloating
  • burping
  • diarrhea
  • gas
  • hair loss
  • heartburn
  • intestinal infections
  • nausea while taking supplements
  • nutrient deficiencies, including deficiencies in iron and vitamin B-12
  • undigested food in the stool
  • upset stomach
  • weak fingernails

There is also a link between hypochlorhydria and several other medical issues, such as:

Risk factors

Senior man holding his stomach due to hypochlorhydria
Being 65 or older is a risk factor for developing hypochlorhydria.

Certain factors can increase the risk of developing hypochlorhydria, such as:

  • taking medications to reduce the production of stomach acid
  • being 65 or older
  • having high levels of stress on an ongoing basis
  • eating a diet that lacks zinc or having poor zinc absorption
  • having an H. pylori infection
  • having undergone stomach surgery

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To diagnose hypochlorhydria, a doctor will typically take a person’s medical history and perform a physical exam.

They can also test the acidity of the stomach with a small capsule that contains a transmitter. The person swallows the capsule, and the transmitter reports the amount of acid in the gastrointestinal tract.

Doctors measure acidity using the pH scale. A pH value of 3–5 suggests hypochlorhydria, while a pH level of less than 3 indicates normal levels of stomach acid.

If the pH value is greater than 5, this suggests an almost complete absence of stomach acid, which is termed achlorhydria.

If the results show hypochlorhydria or achlorhydria, the doctor may take blood tests to check for a deficiency in iron or other nutrients.

A doctor may prescribe HCL supplements to confirm a diagnosis. If a person feels better when taking the supplements, low stomach acid is likely the cause of symptoms.


Treatment for hypochlorhydria depends on the underlying cause. Options include:

Antibiotics for H. pylori

An H. pylori infection requires antibiotic treatment.

A doctor will usually prescribe at least two antibiotics to take at the same time. Taking a combination of antibiotics prevents the bacteria from developing a resistance to one of the drugs.

The doctor may need to check whether the H. pylori bacteria are still present after 4 weeks of treatment. If they are, the doctor may prescribe a different combination of medications.

Reviewing medication use

Long-term use of antacids and proton pump inhibitors can result in hypochlorhydria. A doctor may recommend stopping the use of the drugs or switching to a different treatment.

Always speak with a doctor before changing or stopping medications.

Digestive enzymes and HCL supplements

A person may benefit from taking an HCL supplement and a pepsin enzyme to increase stomach acidity. This treatment option may be especially beneficial for older adults experiencing a natural decline in levels of stomach acid.

Natural digestive enzymes are also available in health stores and drugstores. These often contain extracts of papaya and pineapple, which can stimulate the production of stomach acid.

A variety of digestive enzyme supplements are also available to purchase online.

Consult a doctor before taking an HCL supplement.

Stress management

three people sitting cross legged with palms pressed together meditating on yoga mats
Practicing yoga can help to reduce chronic stress.

Reducing chronic stress can restore digestive function. The following lifestyle changes can help:

  • managing and reducing sources of stress
  • exercising regularly
  • learning deep breathing and progressive muscle relaxation techniques
  • practicing meditation and mindfulness
  • practicing yoga
  • attending therapy

Changing eating habits

Making some dietary changes can help to improve symptoms of hypochlorhydria.

Avoid foods that are difficult to digest, such as those that are fatty and fried. Also, chew each bite thoroughly to break the food down and allow it to mix with the digestive enzymes in the mouth. Smaller food particles are more easily digested in the stomach.

It is a good idea to avoid eating for at least 3 hours before bedtime. This allows the body to fully digest before sleeping, and it can reduce the risk of nighttime heartburn.

Do not lie down immediately after a meal, and do not eat while lying down.

Addressing nutrient deficiencies

For the stomach to produce HCL, the body needs to absorb zinc from the diet. Zinc-rich foods include:

  • pumpkin seeds
  • oysters and crabs
  • beef and pork
  • fortified breakfast cereals
  • baked beans
  • cashews

A low level of stomach acid can result in other deficiencies, such as a lack of iron, vitamin B-12, and calcium. A doctor or a dietician can help. They may recommend taking supplements or increasing dietary intake of these nutrients, especially once a person regains a regular level of stomach acid.

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If left untreated, hypochlorhydria can negatively impact a person’s health and well-being. It is important for people to report associated symptoms and undergo testing.

Once a doctor determines why a person’s level of stomach acid is low, they can recommend ways to relieve or prevent symptoms. Prompt treatment also reduces the risk of complications.

Treatment options include making dietary and lifestyle changes, taking supplements, and altering the course of medications.

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Medical News Today: What causes a blocked tear duct in infants?

Blocked tear ducts are common among babies. Most blocked tear ducts will get better on their own, and others will generally respond well to treatment.

The American Academy of Ophthalmology report that as many as 20 percent of babies are born with a blocked tear duct, which is also called a nasolacrimal obstruction.

Tears come from tear glands, which sit above a person’s eyes on the side furthest from the nose. The tears drain through the tear ducts into the nose. Blockages can develop in the tear ducts and prevent tears from draining normally.

Tears play a significant role in people’s vision. They help to maintain the health of the eyes by keeping them moist and supplying them with oxygen. They also protect the eyes by coating their surface with natural antibiotics and washing away irritating or harmful substances.

Symptoms of a blocked tear duct in a baby

baby rubbing its eyes
Blocked tear ducts normally improve without treatment.

According to leading ophthalmologists, blocked tear ducts are the most common disorder of the tear duct system in infants.

Infants with this condition will typically display the following signs:

  • tearing, which is worse in chilly or windy conditions or if the infant has a cold
  • excessive watering of the eyes, or epiphora
  • discharge from the eyes, also known as mattering or rheum, which can be either watery or a combination of mucus and pus, depending on the location of the blockage
  • pressure on the inner corners of the lower eyelids may increase the discharge
  • blocked tear ducts affect both eyes about 30 percent of the time

These signs may begin to show by the time a baby is 3 weeks old.

Even though their eyes may be full of tears, a blocked tear duct does not usually cause a baby much discomfort. If a baby with tearing and eye discharge seems to be uncomfortable, it is best to take them to see a doctor.

What are the causes?

The most common cause of a blocked tear duct in a baby is a tear duct system that has only partially developed.

This can lead to the following issues:

  • the valve at the end of the tear duct does not open correctly
  • the openings in the eyelids (punta) that tears usually flow through have not developed properly
  • the tear ducts are too narrow

Less common causes

The following causes of a blocked tear duct in a baby are less common:

  • infections causing swelling in the face, which puts too much pressure on the tear ducts
  • the nasal bone blocking the path that tears would typically follow into the nose
  • nasal polyps
  • cysts or tumors
  • injury to the tear ducts

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concerned mother with baby at doctors
A doctor will check that other conditions are not causing the symptoms.

The symptoms of a blocked tear duct in a baby begin developing early and will typically always be present before the baby is 3 months old.

Doctors look for the following signs to make a diagnosis:

  • excessive tearing
  • a swollen pool of tears below the eyes, known as a lacrimal lake
  • discharge from the eyes
  • crusty eyes or eyelashes after sleeping
  • a bump near the corner of the eye
  • swelling, soreness, or tenderness near the nose

A doctor will thoroughly examine the baby to ensure that other conditions are not responsible for the symptoms.

They will check the eye pressure and corneal health in case of infantile glaucoma. They will also look for redness, swelling, and irritation of the eyes to rule out conjunctivitis.


The majority of blocked tear ducts resolve without treatment within the first year of the baby’s life.

As a result, doctors tend to recommend conservative treatment only, while carefully monitoring the infant’s health. This should clear 90 percent of tear duct blockages.

Conservative treatment methods

Some doctors may suggest massaging the tear sac. This forces fluid through the tear ducts which can remove the blockages.

They may also prescribe antibiotic eye drops if the baby’s eyes are producing a lot of discharge, but this will not fix the underlying problem.

More invasive treatment methods

In some cases, a tear duct will not unblock with time and conservative treatment, and the doctor will need to use a different treatment method.

The most common approach is surgical probing, where the doctor inserts a medical instrument into the tear duct to remove the obstruction. For infants aged 6 months or younger, surgical probing will generally take place in the doctor’s office without anesthesia. Slightly older children are more likely to undergo the procedure in an operating room under general anesthesia.

The procedure generally takes about 10 minutes and has an 80 percent success rate.

If probing does not entirely resolve the problem, additional treatment options may include:

  • using stents to keep the ducts open
  • using a balloon catheter to widen the ducts
  • altering the structure of the nasal cavity to promote drainage
  • using nasal endoscopy to remove cysts from the tear duct
  • using surgery to establish a new opening into the nasal cavity, although this is more common in adults

It can take up to 7 days after any of these procedures for the baby’s symptoms to begin to improve.

Home remedies

baby having eyes tested
The American Optometric Association recommend a full eye examination at 6 months.

Soak a soft cloth or cotton ball in warm water and use it gently to clean the crusty matter and dried discharge from the baby’s eyes.

This is particularly important to do before using prescription antibiotic eye drops.

Always wipe the infant’s eye from the inside, near the nose, toward the outside. Use a fresh cotton ball or a different part of the cloth for each eye if necessary.


Massage is the home treatment that doctors most commonly recommend for a blocked tear duct. An ophthalmologist or doctor can show people how to use this procedure on themselves or their child to open up the tear duct.

The American Academy of Ophthalmology suggest massaging the ducts using 10 strokes twice a day. For a baby, it is best to do the blocked tear duct massage during a diaper change.

Experts frequently recommend using a cotton swab rather than a finger, because the swab’s smaller size makes it easier to target the tear sac.

Hot compresses

People can place hot compresses, such as a warm, moist washcloth, gently over the eyes to help relieve the symptoms of a blocked tear duct.

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When to see a doctor

The American Optometric Association recommends a full eye examination for all infants at 6 months, even if no problems are evident. If there are concerns about the health of a baby’s eyes, it is advisable to see a doctor right away.

Prompt treatment of an infant with a blocked tear duct, even conservative treatment, can reduce the risk of infection and the need for more invasive procedures at a later date.


Blocked tear ducts in babies generally resolve themselves.

It is essential to see a doctor if an infant has very watery eyes, discharge, or appears to be tearing an unusual amount without any apparent cause. In addition, as a blocked tear duct in a baby will not typically cause a child pain, it is advisable to seek medical advice if the baby is showing signs of discomfort or is unusually sensitive to light.

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Medical News Today: ‘Unseen’ stool blood may predict mortality risk

According to a study recently published in the BMJ journal Gut, the presence of “invisible blood” in one’s stool may indicate a higher risk of all-cause mortality.
blood test
A simple stool blood test may predict how long you’ll live.

The new research was led by first author Gillian Libby, of the Ninewells Hospital and Medical School in Dundee in the United Kingdom.

The corresponding author of the study is Robert Steele, a professor in the Division of Cancer at Ninewells Hospital and Medical School.

The presence of blood in the stool is a well-known test of colorectal cancer.

Perhaps less known is the fecal occult blood test (FOBT), which is a laboratory test used to detect occult, or hidden, traces of blood in a person’s stool.

The test is commonly used to screen for colorectal cancer in seniors, or to detect adenomas, which are a precursor of colorectal cancer.

As Libby and colleagues explain in their paper, previous studies have found a correlation between the presence of blood in one’s stool and the risk of premature mortality independently of bowel cancer.

But the magnitude of this link was not studied properly, and these previous studies did not account for factors such as gender, age, the use of certain drugs that may raise the risk of internal bleeding, or levels of socio-economic deprivation.

To correct this, Libby and team examined drug prescription, bowel cancer, and death registry data for almost 134,000 people followed clinically in 2000–2016.

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Death risk raised by 58 percent

During the 16-year period, Libby and team found that 2,714 participants from the study sample tested positive for “unseen” blood in their stool.

The researchers followed their survival from the moment when they first took this test, which yielded positive results, to their death or the end of the study period.

The study found that old age, high levels of socio-economic deprivation, and being male all raised the chances of receiving a positive test result. Being prescribed drugs such as aspirin also raised the likelihood of testing positive for “unseen” blood.

Compared with those who tested negative, people who tested positive were almost eight times more likely to die from colorectal cancer.

However, the most surprising finding was that a positive test result also increased all-cause mortality risk by 58 percent.

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More specifically, a positive FOBT was “significantly associated with increased risk of dying from circulatory disease, respiratory disease, digestive diseases (excluding [colorectal cancer]), neuropsychological disease, blood and endocrine disease.”

This risk remained high even after adjusting for being male, older, and coming from a deprived social background.

The authors do caution that theirs is an observational study, with no immediate explanation for causality.

However, they suggest that generalized inflammation — which tends to manifest in the gut and through bleeding — may be the missing link.

“Although increased [unseen stool blood] cannot be a cause of death, it may reflect the reason why male gender, age, and deprivation are such strong risk factors,” the authors write.

In a commentary accompanying the study, Prof. Uri Ladabaum — of the Stanford University School of Medicine in California — writes that the FOBT may offer unique insights into a person’s general health.

“Perhaps more importantly,” he states, “if occult blood in feces is a predictor of life expectancy and multiple [non-bowel cancer] causes of death, the inevitable next questions concern the implications for organized [bowel cancer] screening programs or opportunistic [bowel cancer] screening.”

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Medical News Today: What to know about sex and yeast infections

Yeast infections occur because of an overgrowth of a type of fungus known as Candida, which lives in the body harmlessly most of the time. It is possible to have sex with a yeast infection, but it can be painful and has other risks.

According to the Centers for Disease Control and Prevention (CDC), vaginal yeast infections are the second most common kind of vaginal infections after bacterial infections of the vagina.

Symptoms of a vaginal yeast infection can include:

  • vaginal pain or soreness
  • pain during urination
  • itching or burning
  • pain during sex
  • thick, white vaginal discharge

Can you have sex if you have a yeast infection?

Couple in embrace in bed.
Doctors recommend avoiding sex until a yeast infection has gone away.

While it is possible for a person with a yeast infection to have sex, most doctors do not recommend having sex until the infection has cleared up.

Also, because many of the symptoms are uncomfortable, individuals may choose to refrain from sexual activity while they have a yeast infection to minimize pain and itching.

As well as being painful or uncomfortable, a person who has sex while they have a yeast infection may cause the infection to last longer, cause symptoms to return if they have recently cleared up following treatment, and increase their partner’s risk of developing a yeast infection as well.

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Transmission during sex

Sexual partners can transmit yeast infections. However, the likelihood of transmission is small.

When a woman has sex with another woman, there is some evidence to suggest they can transmit a yeast infection. However, one study found no evidence supporting the transmission of the infection from woman to woman through sex.

While yeast infections in men are rare, it is possible for a man to get an infection by having sex with a person who has a vaginal yeast infection. Uncircumcised men are more susceptible to developing a yeast infection.

A yeast infection is not a sexually transmitted infection (STI). However, some prevention methods, such as condoms, can help reduce the risk of spreading a yeast infection to a partner.

How long should you wait after treatment?

Having sex while undergoing treatment for a yeast infection may slow down the healing process.

Also, if a person’s partner develops a yeast infection, it is possible that the infection will get passed back and forth. A person should generally avoid sexual activity until all the symptoms clear up.

Yeast infections usually clear relatively rapidly once a person begins treatment. Many over-the-counter (OTC) treatment options require up to 7 days to clear up the infection.

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Woman on public transport looking stressed and anxious.
Stress may increase the risk of developing a yeast infection.

The fungus Candida causes yeast infections. This fungus lives in and on various parts of the human body, including the skin, the mouth, and the vagina.

In the vagina, the Lactobacillus bacteria typically keeps Candida numbers in check.

If there is a shortage or imbalance of Lactobacillus compared to Candida, a yeast infection may occur.

Some common causes of a bacterial imbalance in the vagina include:

  • uncontrolled diabetes
  • immunosuppression, such as having HIV
  • a hormone imbalance
  • stress
  • pregnancy
  • excessive sugar consumption
  • taking antibiotics

Most yeast infections are easy to treat. However, if a person experiences multiple, recurring yeast infections, they should speak to a doctor as Candida may not be the underlying cause or OTC remedies may be ineffective.


Symptoms of a yeast infection include:

  • pain during sex
  • burning sensation during sex or urination
  • itchiness
  • redness
  • a rash
  • swelling of the labia
  • white, clumpy discharge

When left untreated, the symptoms will typically get worse. However, some mild yeast infections may get better without treatment.

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When to see a doctor

People can often treat a yeast infection at home using OTC remedies. These treatments usually contain one of the following ingredients:

  • butoconazole (Gynazole)
  • miconazole (Monistat)
  • terconazole (Terazol)

When a person develops a yeast infection for the first time, they should see a doctor to ensure they receive the correct diagnosis and treatment.

People should also seek medical advice if OTC treatments are not effective. A doctor may recommend alternative treatments, including oral medication.

Finally, a person should seek medical attention if they:

  • have four or more yeast infections in a year
  • are pregnant
  • have severe symptoms
  • have a compromised immune system

Once the treatment is complete, and the symptoms are gone, a person can return to their regular sex life.

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Medical News Today: How does perimenopause affect periods?

The pattern of a person’s menstrual periods changes during perimenopause. Cycles can become longer or shorter, and sometimes, people may skip periods altogether.

The lead-up to menopause is called perimenopause. Changing hormone levels during this time can alter the frequency, symptoms, and regularity of a person’s periods.

How do periods change during perimenopause?

sanitary pad and tampon for perimenopause periods
Menstrual cycle changes will vary between individuals.

Each person’s experience of perimenopause is different, and changes to the menstrual cycle vary between individuals.

When people are approaching menopause, hormonal shifts cause their bodies to ovulate less frequently. When the ovary does not release an egg, the uterus lining does not shed, and the person does not have a period.

The most common shift in the menstrual cycle is that a person begins to have fewer monthly periods.

Because ovulation is not occurring cyclically during perimenopause, the body produces smaller amounts of a hormone called progesterone. This can cause the lining of the uterus to build up for longer than usual, which makes periods less frequent and heavier.

Because of these hormonal fluctuations, people may notice the following changes in their periods during perimenopause:

  • Less frequent periods. This occurs because people are ovulating less often.
  • Longer, heavier periods. This happens because the lining of the uterus has time to grow thicker and takes longer to shed.
  • Lighter periods. People may experience lighter periods when their estrogen levels are low. This is because estrogen increases the thickness of the uterus lining.
  • Irregular periods. People may have irregular periods, spotting between periods, or both, when the uterus lining grows thicker than usual.
  • Changing menstrual symptoms. People may also notice an increase or decrease in their menstrual cramps and other symptoms.

The time between monthly periods can also vary greatly. Some people’s periods may change unpredictably from month to month. For example, their period may be heavy one month and absent the next.

In general, people experience lighter and less frequent periods as they go through perimenopause. If someone experiences, longer, heavier, and more frequent periods they should see their doctor to discuss possible reasons for this.

Over time, perimenopause will cause a person’s periods to become less frequent and eventually to stop altogether. Typically, doctors consider the transition into menopause as complete when an individual has gone 1 year without a period.

After 1 year, people should talk to their doctor about any vaginal bleeding.

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Managing periods during perimenopause

If people notice that their menstrual symptoms are becoming more uncomfortable during perimenopause, they can try:

  • taking over-the-counter pain relievers or specific medicines for period symptoms
  • exercising to reduce bloating and help with cramps
  • practicing meditation to help relieve stress, pain, or mood swings
  • applying heat to the back or stomach to help with cramps and muscle pain

People who experience irregular or painful periods might find relief from using hormonal birth control.

Many people report other symptoms during perimenopause, including mood swings, hot flashes, vaginal dryness, and exhaustion. Doctors often prescribe hormone replacement therapy (HRT) to help manage these symptoms.

Hormones can help with many symptoms, but people should note that they can carry health risks, including an increased risk of:

The risk is usually small and depends on the person’s overall health and the specific treatment used. So, always discuss the benefits and risks with a doctor.

The American College of Obstetricians and Gynecologists noted that certain herbs, including soy and black cohosh, may help with some perimenopause symptoms. Always talk to a doctor before trying new remedies, including these supplements, which are available over-the-counter.

Some people believe that soy helps perimenopause symptoms because it mimics estrogen.

According to a 2017 study, eating a diet rich in soy products may help people regulate their hormones. The researchers found that certain soy supplements can reduce the number of menopause symptoms a person experiences.

Because most people still have periods during perimenopause, it is still possible to get pregnant during this time. Those who already use hormonal birth control should continue taking it if they want to avoid pregnancy.

Diet tips

various dairy products to avoid on ibs diet including cheese milk cream and butter
Dairy products can help to prevent osteoporosis.

Some dietary changes can help a person stay healthy during this transition.

Diet tips include:

  • Eating a varied, nutritious, and healthful diet. Many people find that their metabolism slows down during this stage of life, causing more weight gain than usual.
  • Including calcium and vitamin D in the diet to prevent osteoporosis and broken bones. Dairy products and dark leafy greens are rich in these nutrients. Some people also choose to take a supplement.
  • Drinking plenty of water to avoid dehydration. This may also help with dry skin and vaginal dryness.

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Other causes for period changes

The regular monthly period is not the only reason why people may bleed.

Because a person’s periods are often irregular during perimenopause, they should pay extra attention for any abnormal symptoms — particularly as some uterus-related conditions are more common during and after perimenopause.

People may bleed because of:

  • Endometrial atrophy. Low estrogen in perimenopause and menopause can cause the tissue of the uterus to get very thin, which can cause irregular bleeding.
  • Uterine polyps. These are benign growths that can grow inside the uterus and cervix. Polyps do not always cause symptoms, but some people notice bleeding after sex.
  • Endometrial hyperplasia. Hormonal shifts can cause the lining of the uterus to thicken in perimenopause. When the body has too much estrogen without enough progesterone, this thickness may cause bleeding. Bleeding is its most common symptom. Endometrial hyperplasia is treatable but can increase a person’s risk of cancer.
  • Uterine Cancer. Uterine cancer happens when abnormal or atypical cells progress into cancer. Though rare, it generally presents with heavy bleeding or postmenopausal bleeding.

When to see a doctor

Perimenopause is not a disease and does not require treatment. It can, however, increase people’s risk of developing certain diseases. Moreover, the menstrual cycle can change for reasons other than perimenopause.

Anyone experiencing changes in their menstrual cycle should see a doctor for a diagnosis.

People going through perimenopause should see a doctor if:

  • they experience side effects associated with hormone treatments
  • they bleed after 1 year without a period
  • they experience bleeding that is very heavy, very painful, or that soaks through more than a pad or tampon an hour
  • hormone therapy stops helping with perimenopause symptoms
  • they experience pain or bleeding during or after sex

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The transition to menopause is different for everyone, both physically and psychologically.

People should discuss their symptoms with a healthcare provider they trust.

Support from loved ones, support groups, or a therapist can help with the emotional side effects of perimenopause.

Though dealing with the changes can be difficult, this new stage in life can be a time of growth and reflection that offers new purpose and meaning.

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Medical News Today: What is gaming disorder?

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Medical News Today: What to know about macrocephaly

Macrocephaly is the term for an unusually large head. An infant with macrocephaly will have a larger head than most other infants of the same age and sex.

In many cases, this condition is benign or harmless. In other cases, it may indicate an underlying medical condition, such as a genetic syndrome or a brain tumor.

In this article, learn about the causes of macrocephaly and how doctors diagnose and treat the potential underlying medical conditions.

What is macrocephaly?

A child with an unusually large head may have macrocephaly
A child with an unusually large head may have macrocephaly.

Macrocephaly means big head, and it is the name for a condition in which an infant or child has an abnormally large head size.

For a doctor to diagnose macrocephaly, the measurement of the head around its widest part needs to be larger than the 98th percentile.

Macrocephaly may sometimes be a sign of an underlying condition that requires treatment.

In other cases, it may occur due to genetics, including a family history of macrocephaly. If this is the case, the condition will be harmless.

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Genes are responsible for many cases of macrocephaly. When an infant with a large head has a family history of larger-than-average head sizes, doctors will diagnose them with benign familial macrocephaly.

Infants with benign familial macrocephaly will not experience any symptoms other than a large head and will have no additional health concerns.

However, there are several potential causes of macrocephaly that require medical attention, one of which is a fluid buildup on the brain. Extra fluid can put pressure on the brain, increasing the risk of many health complications.

The severity of the condition depends on the amount of fluid present. When there is a significant fluid buildup in the brain, which is called hydrocephalus, the underlying cause is likely to require treatment to prevent further problems.

Other causes of macrocephaly include:

  • bleeding in the brain
  • brain tumors
  • certain metabolic conditions
  • some types of infection
  • Alexander disease
  • Greig cephalopolysyndactyly syndrome
  • Sotos syndrome
  • chronic hematomas and other lesions
  • other genetic syndromes

Signs and symptoms

macrocephaly is often harmless
While macrocephaly is often harmless, it can lead to a buildup of fluid in the brain.

The primary sign of macrocephaly is an unusually large head. In cases of benign familial macrocephaly, this will be the only symptom.

If an infant has an underlying condition that is causing the macrocephaly, they will present with additional symptoms. These may include:

  • delays reaching developmental milestones
  • a fast-growing head
  • comorbidity with other conditions, such as autism
  • mental disorders

A doctor will typically continue to monitor the infant after the diagnosis. The doctor will also ask parents or caregivers to watch for the following signs:

  • excessive sleepiness
  • unusual eye movement
  • poor feeding
  • vomiting
  • a bulging soft spot
  • excessive irritability

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Doctors can usually diagnose macrocephaly during a routine physical examination.

As part of a physical examination for a baby or young child, the doctor will measure the head circumference. They will do this at each checkup, and any time there is a concern. If the doctor notes a rapid increase in head size over time, this can lead to a diagnosis.

If a doctor thinks that an infant has macrocephaly, they will often order imaging tests, such as a CT scan, ultrasound, or MRI.

These tests will help the doctor to determine if there is a fluid buildup in the brain, which could cause pressure and other complications.

Some symptoms of increased pressure on the brain include:

If a child with macrocephaly has additional symptoms, these may help the doctor to diagnose other health conditions. Other symptoms may include:

  • vision problems
  • bulging veins
  • a bulging soft spot on the top of the head


Speech and language therapy can help children with macrocephaly
Speech and language therapy can help children whose macrocephaly stems from a genetic condition.

The treatment for macrocephaly will vary depending on the underlying cause. An infant with benign familial macrocephaly will not usually require any treatment.

Infants whose macrocephaly stems from a genetic condition may require life-long treatment and support, including:

  • occupational therapy
  • behavioral therapy
  • speech and language therapy
  • physical therapy

An infant who has a fluid buildup or bleeding in the brain will often require prompt surgery to reduce the pressure and prevent further complications.

Doctors may use a variety of methods to treat a brain tumor, including:


The outlook largely depends on the underlying condition causing the macrocephaly. Infants with benign familial macrocephaly have a good outlook and will not usually experience any complications.

A child who has macrocephaly as a result of an underlying condition, such as a brain tumor or a genetic syndrome, will require an individualized treatment plan.

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