What is achalasia?
Achalasia is a disorder characterized by difficulty swallowing. It is a rare condition that affects only 1 in every 100,000 people.
What causes achalasia?
The esophagus is a tube that carries food from the mouth to the stomach. The esophagus does not function correctly in people with achalasia. In some cases, the lower part of the esophagus is ineffective in moving food into the stomach. In other cases, a circular band of muscle that separates the stomach from the esophagus, called the lower esophageal sphincter (LES), does not relax properly in response to swallowing. When this band of muscle (LES) does not relax, it creates a barrier to food entering the stomach. Damage to the LES can cause large volumes of food and saliva to accumulate in the esophagus.
What are the symptoms of achalasia?
The major symptom of achalasia is difficulty swallowing liquids or solids. Other symptoms include chest pain, heartburn, and a sensation of fullness or a lump in the throat, hiccups or weight loss.
How is achalasia diagnosed?
Your doctor will review your symptoms and may order additional tests such as a chest X-ray or endoscopy. Your doctor may also order a barium swallow test, which involves swallowing a chalky mixture while a radiologist watches the swallow with an X-ray. Esophageal manometry is also frequently used to diagnosis achalasia. Manometry involves placement of a thin tube in the esophagus to measure the pressure throughout the esophagus and LES.
How is achalasia treated?
Many treatment options are available for the symptoms of achalasia; however none can reverse or correct the underlying problem. Your doctor may recommend muscle relaxing drug therapy to help the LES relax and decrease symptoms. Botox injections at the LES may also work to reduce LES pressure. Your doctor may also recommend stretching the esophagus with a balloon during endoscopy or under X-ray. Surgery may also be necessary to directly cut the muscle fibers of the LES.
Seeking medical advice
Many people delay seeking medical attention until symptoms are advanced. Contact your health care providers if you are noticing difficulty swallowing liquids or solids, or if you are experiencing chest pain, frequent heartburn or unexplained weight loss.
What is autoimmune hepatitis?
Doctors have identified two main forms of autoimmune hepatitis:
- Type 1: This type of autoimmune hepatitis can occur in anyone at any age, but it typically affects young women. About half of the people with type 1 autoimmune hepatitis have other autoimmune disorders u such as lupus and rheumatoid arthritis or thyroid disorders.
- Type 2: This type of autoimmune hepatitis is less common, typically affecting children ages 2-14, although it can affect adults too.
What causes autoimmune hepatitis?
One of the jobs of the immune system is to protect the body from viruses and bacteria. But sometimes the immune system attacks things it is meant to protect and this response is called autoimmunity. Researchers think certain bacteria, toxins, drugs and genetics trigger an autoimmune response. Many patients with autoimmune hepatitis may have other immune disorders, including Type 1 Diabetes, Thyroiditis, Celiac Disease and Ulcerative Colitis.
What are the symptoms of autoimmune hepatitis?
Fatigue is probably the most common symptom of autoimmune hepatitis. Other symptoms include:
- An enlarged liver
- Skin rashes
- Joint pain
- Abdominal discomfort
- Spider angiomas, or abnormal blood vessels, on the skin
- Loss of appetite
- Dark urine
- Pale or gray-colored stools
How is autoimmune hepatitis diagnosed?
Your doctor will make a diagnosis of autoimmune hepatitis based on symptoms, blood tests, imaging studies (CT or ultrasound) and liver biopsy. A new technology called magnetic resonance elastography may also be recommended by your doctor.
How is autoimmune hepatitis treated?
The goal of treatment is to slow down an overactive immune system and slow the progress of the disease.
Steroids: Steroid medication often referred to as Prednisone control the inflammation in the liver, which prevents further scarring. The main drawback of prednisone is side effects, which are typically more prominent at higher doses. Side effects may include weight gain, acne, bone loss, elevated blood glucose levels (potentially leading to diabetes), an increased risk of infections, cataracts, high blood pressure, mood and sleep disturbance, and others. People who require long-term prednisone are monitored carefully for these side effects. To minimize the risks of side effects, the lowest possible dose of prednisone is used.
Azathioprine or 6-MP (6-Mercaptopurine): A second medication, such as azathioprine (Imuran®} or 6-mercaptopurine (Purinethol®) and, less commonly, methotrexate or cyclosporine may be recommended in addition to prednisone.
The benefit of adding a second medication is that it may be possible to reduce or eliminate prednisone, helping to minimize the potential side effects of prednisone. However, azathioprine and 6-MP can cause side effects, including allergic reactions, a low white blood cell count, inflammation of the pancreas, nausea, and abnormal liver blood tests. There may be a small increased risk of certain types of cancer (such as lymphoma). Blood tests to monitor for these conditions are performed regularly while taking these medications.
Treatment for autoimmune hepatitis is continued until the disease is in remission, the treatment fails, or the person develops severe side effects from treatment. Remission is defined as a lack of symptoms, near normal levels of liver blood tests, and improvement in the appearance of liver tissue (based upon a biopsy). The initial period of remission generally occurs 12 or more months after treatment begins. Approximately 65 and 80 percent of patients achieve remission by 18 months and three years, respectively.
Approximately 50 percent of patients remain in remission or have only mild disease activity for months to years after treatment is stopped. However, most patients must eventually restart treatment because the disease becomes active again (relapse). Relapse typically occurs within the first 15 to 20 months after treatment is stopped. Relapse is more likely in those who have cirrhosis on the initial evaluation.
Seeking medical advice:
Early signs and symptoms of autoimmune hepatitis can be mild and may resemble those of the flu. See your doctor if you have, persistent fatigue, abdominal discomfort, or joint aches unrelated to exercise. You should contact your doctor immediately if you notice yellowing of your skin and the whites of your eyes or abdominal swelling.
What is Barrett’s esophagus?
The esophagus is a tube that connects the mouth to the stomach. The esophagus is normally lined with squamous cells. When these cells are replaced by intestinal cells it is called Barrett’s esophagus. This is a precancerous condition caused by repetitive damage to the esophagus lining.
What causes Barrett’s esophagus?
The exact cause of Barrett’s is not known, but the condition usually develops in people who have gastroesophageal reflux disease (GERD). Heartburn and acid reflux are the most common symptoms of GERD and result from stomach contents washing back into the esophagus. Risk factors for Barrett’s esophagus also include an age greater than 55, male gender, Caucasian and Hispanic backgrounds and smokers.
What are the symptoms of Barrett’s esophagus?
Barrett’s esophagus itself does not produce symptoms, but most people seek help because of symptoms related to GERD such as heartburn, and less commonly, difficulty swallowing.
How is Barrett’s esophagus diagnosed?
A doctor uses an endoscope to perform an esophagogastroduodenoscopy (EGD). It may also be called a gastroscopy or upper endoscopy. During this procedure the doctor takes small samples (biopsies) of tissue from the esophagus. The biopsies are sent to the pathology laboratory where the pathologist (a physician who specializes in looking at specimens through a microscope) determines if the tissue shows changes at the cellular level in the area of the lower esophagus.
What is the treatment for Barrett’s?
Treatment for Barrett’s esophagus may start with controlling GERD by making a number of lifestyle changes. These actions include losing weight, avoiding foods that aggravate heartburn, smoking cessation if you smoke, taking antacids or stronger acid-blocking medications, and elevating the head of your bed to prevent reflux during sleep, avoiding caffeine in coffee, tea and chocolate and alcohol.
The treatment of Barrett’s esophagus also involves surveillance of the area by repeating an EGD according to national guidelines.
Seeking medical advice
See your doctor if you’ve had long-term trouble with heartburn and acid reflux. Talk to your doctor as soon as possible if you have difficulty swallowing, or are vomiting blood.
Celiac disease, also known as celiac sprue or gluten sensitive enteropathy, is a digestive disease that causes damage to the small intestine. This sheet is not meant to give exhaustive information about celiac disease, but to give you further resources where you can gain current, helpful information.
What is celiac disease?
For people with celiac disease, eating foods containing gluten causes damage to the lining of the small intestine. Gluten is a very common protein found in wheat, rye, barley and possibly oats. The small intestine normally has many “finger-like” projections called villi where nutrients from food are absorbed into the body. When a person with celiac disease eats gluten, these villi are blunted or cut off. The body is then not able to absorb nutrients properly. This may lead to malnutrition. Celiac disease is relatively common, especially in certain populations. It has a genetic component and can be seen in different members of the same family.
What are the symptoms of celiac disease?
The symptoms of celiac disease vary. The more “classic” signs include diarrhea, difficulty gaining weight or weight loss, abdominal pain or bloating, or other signs of malnutrition. There may also be signs in areas of the body other than the stomach and intestines. Since screening tests have become available, more people have been diagnosed without “classic” symptoms.
How is it diagnosed?
Blood tests can be used to screen for celiac disease and to monitor the results of a gluten-free diet. Results of the blood tests can vary, so your doctor will help interpret the findings. Since treatment requires a life-long dietary change, the diagnosis is not made from the blood tests alone but from an intestinal biopsy using an endoscope. During this procedure, a small tube is passed through the mouth and stomach, and then into the small intestine. Biopsies, or small scrapings of tissue, are removed from the small intestine and sent to a lab where they are examined under the microscope to see if the villi are damaged.
How is celiac disease treated?
The only treatment for celiac disease is a gluten-free diet. By following a strict gluten-free diet, the villi in the lining of the intestine will return to normal and will work properly to absorb nutrients. Since gluten is present in so many foods this diet can be challenging; however, it is also extremely effective in preventing problems associated with celiac disease.
What are the complications of celiac disease?
Short term, celiac disease may significantly affect childhood growth and development. Problems seen with malnutrition, such as anemia (low iron in the blood), can affect people of all ages. Long-term complications include osteoporosis (weakening of the bones), seizures and cancers of the intestine. Miscarriage or birth defects may be more common in women with untreated celiac disease.
What is cirrhosis?
Cirrhosis describes a pattern of damage to the liver usually the result of long-term injury from alcohol, chronic hepatitis, or chronic bile duct obstruction. Damaged and dead liver cells are replaced by fibrous tissues which lead to scarring. As a result of this scarring, liver cells regenerate into abnormal clumps or nodules. The scar tissue and regenerative nodules alter the blood flow through the liver which causes some of the serious complications of cirrhosis. This pattern of damage is usually irreversible but removing the cause can slow or halt further damage.
Basic function of the liver includes bile formation and secretion, processing healthy nutrients, eliminating toxins and making products necessary for blood clotting. The liver has an amazing ability to maintain function until damage is extensive.
Cirrhosis may be easily diagnosed when a person experiences the typical complications, changes in blood tests and has a known underlying liver disease. At times a liver biopsy is necessary.Many people may have few or no symptoms with the early stages of cirrhosis. Early symptoms may include fatigue, loss of appetite, reddish and blotchy palms, and spider angiomas (pin head sized red spots with radiating blood vessels on the upper body and arms). As liver failure progresses, symptoms include fluid accumulation in the abdomen (ascites) and legs (edema), loss of muscle bulk, fatigue, jaundice, and loss of body hair.
What are the complications of cirrhosis?
- Ascites is fluid accumulation in the abdomen
- Portal hypertensionalso causes a backpressure in other blood vessels and structures. Besides causing ascites, portal hypertension causes other complications, such as
- Esophageal and Gastric Varices are varicose veins in the esophagus and stomach. Esophageal and gastric varices can rupture and lead to significant blood loss, possibly even death.
An endoscopy is performed on patients with cirrhosis to look for varices. If the endoscopy does not detect varices, it is repeated periodically.
Mental Impairment/ Hepatic Encephalopathy
In more advanced cases of cirrhosis, changes in mental capacity can occur. This mental impairment (encephalopathy) can range from forgetfulness and trouble concentrating to coma and death. This condition is not fully understood but probably involves some blood bypassing the liver going directly to the brain and the liver’s decreased capacity to breakdown certain toxins. One of the toxins is ammonia. Measurement of the ammonia blood level is not helpful as almost all people with cirrhosis will have abnormal levels but few have encephalopathy.
- Get vaccinated for hepatitis A and hepatitis B if you are not already immune. Blood tests will be used to determine immunity.
- Salt (sodium) restriction is very important to control fluid retention. Aim for less than 2000mg of sodium per day.
- Follow a balanced diet.
- Even if you are not experiencing symptoms or complications of cirrhosis, office visits every six months are recommended to screen for cancer.
- Alcohol should be avoided.
- Acetaminophen (Tylenol) may be used in doses of 2 – 3 grams (four to six 500 mg tablets) per day.
- Avoid aspirin and non-steroidal anti-inflammatory drugs (ibuprofen and naproxen) because these medications can cause fluid retention or kidney dysfunction.
What is a colon polyp?
A colon polyp is an abnormal growth of the tissue in the large bowel (colon). There are different types of colon polyps and not all have the potential to turn into cancer.
- Hyperplastic polyps are generally thought to be harmless. They do not become cancerous
- Adenomatous polyp, or adenoma, is a precancerous polyp and can be distinguished from other types of polyps by a pathologist when tissue samples are examined under a microscope. These polyps have the potential to turn into cancer. Removal of adenomatous polyps prevents them from becoming cancerous.
When will another colonoscopy be necessary?
This depends on the size, number, location, and type of polyp(s) removed. It may also depend if your family history includes family members with a history of colon cancer or colon polyps. A final recommendation may depend on the type of polyp, as determined by the pathologist, as well as an assessment of other risk factors by your gastroenterologist. The responsibility for scheduling and completing your next colonoscopy is yours.
If you experience a persistent change in bowel habits, bleeding, and/or abdominal pain, colonoscopy may be needed sooner than the recommended follow up, call our office at 216-593-7700 to make an appointment with one of our physicians.
What is constipation?
Constipation is defined as infrequent bowel movements, hard to pass stools or straining during bowel movements that is troubling to the individual. Frequency of bowel movements among healthy people varies widely from three bowel movements each day to three bowel movements a week.
What causes constipation?
Many factors can lead to constipation including a diet that is low in fiber, inadequate fluid intake, and low levels of physical activity, medications, and poor bowel habits. Medical problems that can cause constipation include diabetes, hypothyroidism, neurologic and connective tissue disorders, and colorectal cancer. Alterations in bowel motility or the coordination of the muscles involved in having a bowel movement can also cause constipation.
What are the signs and symptoms of constipation?
- Passing stool fewer than 3 times per week
- Abdominal bloating or discomfort
- Straining frequently during bowel movements
- A sensation of incomplete bowel movements
- Having to apply manual pressure to have a bowel movement.
How is constipation diagnosed?
Diagnosing the cause for constipation often requires a medical history and physical exam. Your doctor will determine if an underlying disorder is causing constipation, and treatment will be directed toward the specific causes.
What are the treatment options?
For many people, lifestyle and dietary changes are all that are needed to relieve constipation.
- Dietary: Choose foods that are high in fiber including fruits and vegetables, beans and high fiber cereals and breads. Make sure you drink plenty of non-caffeinated beverages.
- Bowel Habits: Sufficient time should be set aside to allow for undisturbed visits to the bathroom. This is often most productive after breakfast. The urge to have a bowel movement should not be ignored
- Increase physical activity: Try to exercise regularly, including actives such as walking, biking, or swimming
Along with lifestyle changes your doctor may recommend other treatment options including:
- Fiber supplements: Metamucil®or Citrucel® are natural supplements that help make stools softer and are safe to use every day.
- Laxatives: Laxative is a general term for medications that can promote bowel movements. Some work by stimulating the bowel or rectum while others change the consistency of the stool. An example includes Miralax® which works by drawing water into the colon. Some patients require combinations of medications for their type of constipation.
- Medical Tests: A colonoscopy, a motility study, or even special tests to look at the muscles involved in having a bowel movement may be indicated.
- Biofeedback or Surgery: Rarely, patients with pelvic muscle abnormalities may require biofeedback or surgery.
Seeking medical advice:
You should contact your doctor if you experience an unexplained change in bowel habits or if you have any of the following signs and/or symptoms:
- Pain and straining with bowel movement that does not improve with diet and lifestyle changes
- Blood in your stool
- Rectal pain
- Constipation that alternates with diarrhea
- Thin-pencil like stools
- Unexplained weight loss
- Tissue protruding from the rectum when you bear down.
What is diarrhea?
What are the symptoms of diarrhea?
What are the causes of diarrhea?
- Infection, from viruses, bacteria, and less often, protozoa. Viral infections are common, but the exact type of virus causing the diarrhea can rarely be identified. Bacterial infections include Campylobacter, Salmonella, Shigella, and E. coli O157:H7. Previous antibiotic use or underlying inflammatory bowel disease can be associated with Clostridium Difficile infection. Protozoa include Giardia, Entamoebahistolytica, and Cryptosporidium.
- Medications, including over-the-counter drugs and supplements.
- Irritable bowel syndrome, from disordered motility and erratic fluid absorption.
- Inflammatory bowel disease (ulcerative colitis, Crohn’s disease)
- Ischemic colitis (This results from low blood flow to the colon).
- Microscopic colitis (lymphocytic or collagenous colitis).
- Malabsorption syndromes (from conditions such as lactose intolerance, celiac disease, or chronic pancreatitis, bacterial overgrowth, or previous surgery to the small bowel or colon).
- Post-cholecystectomy (following removal of the gallbladder)
- Diabetes mellitus
- Radiation injury to the small bowel or colon
- Colon cancer
- Neuroendocrine tumors
What type of evaluation can I expect?
What is the treatment?
The treatment of your diarrhea depends on its cause. Mild symptoms can often be treated at home. More severe symptoms may warrant a medical evaluation and occasionally hospitalization.
- Drink plenty of clear liquids such as water, flat ginger ale, or sports drinks
- Avoid caffeine-containing beverages like coffee, because coffee makes the bowel work faster.
- Avoid milk, which can be hard to digest during a bout of diarrhea
- Take certain prescribed medications (such as antibiotics for infection). Don’t take any diarrhea medications without asking your health care provider first.
- Fast (avoid food) or
- Eat a special diet called BRAT (short for bananas, rice, applesauce, and toast) another is
- White rice, boiled chicken and Green Tea
Moderate to severe symptoms such as pain, fever, blood in the stool and dehydration call our office to see one of our physicians by dialing 216-593-7700.
Diffuse Esophageal Spasm
What is diffuse esophageal spasm?
How is diffuse esophageal spasm diagnosed?
Eliminating the possibility of other causes for symptoms such as acid reflux disease, other esophageal motility disorders or narrowing of the esophagus is important to be sure the correct treatment is started.
- Barium swallow studies (thick barium contrast solution is swallowed to see esophagus structures by x-ray and potentially note reflux of stomach contents).
- Esophageal manometry (measures esophageal pressures and swallowing ability).
- A small measuring device (Bravo capsule) can be placed in the lower esophagus by upper endoscopy or through the mouth to record acid events over a 48 hour period. The device has special sensors that measure how often you have acid backing up into your esophagus and how long it stays there. Alternatively, a 24-hour pH monitoring test is also available. During the 24-hour test, a thin tube is placed through the nose and into the esophagus. The tube remains in place for 24 hours and the information is recorded on a small computer monitor.
- Upper endoscopy or EGD (esophagogastroduodenoscopy) is a procedure where a small lighted tube is passed through your mouth into the esophagus, stomach and first portion of the small intestine. This test allows the doctor to see the lining of your upper GI tract and take biopsies (tissue samples) if needed.
What causes diffuse esophageal spasm?
What are the treatments for diffuse esophageal spasm?
Seeking medical advice?
Diverticulosis and Diverticulitis
What is diverticulosis?
What are the symptoms of diverticulosis and diverticulitis?
What causes diverticular disease?
What are the complications of diverticulosis and diverticulitis?
Rarely, complications such as infections, perforations or tears, blockages, or bleeding may occur as a result of diverticulosis. These complications often require treatment. Bleeding is a rare complication. Blood may appear in the toilet or in your stool. Bleeding can be severe; it may stop by itself and not require treatment. Bleeding diverticula are caused by a small blood vessel in a diverticulum that weakens and finally bursts. If you have bleeding from the rectum, you should see your doctor. If the bleeding does not stop, surgery may be necessary.
What is the treatment for diverticular disease?
Increasing the amount of fiber in the diet may reduce symptoms of diverticulosis and prevent complications such as diverticulitis. Fiber keeps stool soft and lowers pressure inside the colon so that bowel contents can move through easily. The American Dietetic Association recommends 20 to 35 grams of fiber each day. The doctor may recommend g a fiber product such as Citrucel® or Metamucil® once a day. These products are mixed with water and provide about 4 to 6 grams of fiber for an 8-ounce glass.
If cramps, bloating, and constipation are problems, the doctor may prescribe a short course of pain medication. However, many pain medications affect emptying of the colon – an undesirable side effect for people with diverticulosis.
Treatment for diverticulitis focuses on clearing up the infection and inflammation, resting the colon, and preventing or minimizing complications. An acute attack with severe pain or severe infection may require a hospital stay, bed rest, a restricted diet, and antibiotics given into a vein. In some cases, however, surgery may be necessary.
What is Dyspepsia?
Dyspepsia means “bad digestion” but is generally used as a label for persistent or recurring upper abdominal pain or discomfort. The term indigestion is often used synonymously with dyspepsia. The pain or discomfort is centered in the upper abdomen and is not accompanied by heartburn or regurgitation (symptoms of gastroesophageal reflux disease – GERD). It is also not generally associated with change in bowel habits. Dyspepsia is very common. It affects almost one fourth of people in the United States and affects both men and women equally. Symptoms may occur regularly for months at a time, or occur intermittently with long symptom free intervals.
In addition to the pain in the upper abdomen described above, dyspepsia may cause bloating, nausea, burping, and a feeling of fullness that occurs soon after eating.
What Causes Dyspepsia?
Causes of dyspepsia may be easy to identify in some people and in other persons, no causes can be detected. Some of the causes include:
- Ulcers – a breakdown in the lining of the stomach or duodenum
- Medications, especially non-steroidal anti-inflammatory drugs (NSAIDS) such as aspirin, ibuprofen and naproxen
- Helicobacter pylori (H. pylori), a stomach infection
- Atypical GERD
- Abnormal motility (muscle function) of the stomach
- Cancer – dyspepsia is very rarely due to cancer
How is Dyspepsia Treated?
You may be asked to:
- Avoid foods high in fat. Fatty foods remain in the stomach longer than proteins or carbohydrates and can cause distention and pain in the stomach
- Take note of foods that seem to bother you; avoid these foods
- If you are overweight, consider losing weight
- Avoid taking non-steroidal inflammatory drugs (NSAIDS) such as aspirin, ibuprofen and others
- Consider the possibility that other drugs you are taking may have a side effect of dyspepsia
Your physician may also prescribe histamine-2 receptor antagonists (H2RAs), such as Zantac (ranitidine), or proton pump inhibitors (PPIs) such as Prevacid (lansoprazole), Prilosec (omeprazole), Aciphex (rabeprazole), Protonix (pantoprazole), Dexilant (dexlansoprazole) or Nexium (esomeprazole).
Medications that enhance the motility of the stomach may also be used.
If these therapies do not improve your condition, your physician may order an endoscopy, a procedure in which a flexible tube is passed into your stomach. Biopsies, small samples of tissue that are then examined under a microscope, may also be taken.
What is dysphagia?
If you have a problem swallowing foods or liquids, you may have dysphagia. This means it may take more time and effort to move food or liquid from your mouth to your stomach. Difficulty swallowing may also be associated with pain. In some cases you may not be able to swallow.
What causes dysphagia?
Dysphagia occurs when there’s a problem with any part of the swallowing process.
Dysphagia can be caused by any of the following:
- A problem in the esophagus, such as an ulcer,a stricture (narrowing of the esophagus), or cancer.
- Muscles in your mouth, throat or esophagus that don’t work right.
- A nerve or brain problem (such as stroke) that leaves your mouth, tongue, or throat muscles weak or change how your muscles coordinate.
- Foreign bodies such as a large piece of meat or another object that become lodged in your throat or esophagus.
What are the symptoms of dysphagia?
Symptoms of dysphagia may include:
- A feeling of chest pressure or pain when you swallow.
- Choking or coughing when swallowing.
- Vomiting after eating or drinking.
- Aspirating (inhaling into the lungs) food or liquids when you swallow.
- Fatigue and unexpected weight loss.
- Frequent heartburn.
How is dysphagia diagnosed?
Your doctor will likely perform a physical examination and use a variety of tests to determine the cause of your swallowing problem. These tests could include a barium swallow x-ray, an upper endoscopy (EGD), or an esophageal muscle test (manometry).
How is dysphagia treated?
The treatment options for dysphagia will be based on the particular type or cause of your swallowing disorder.
- Esophagus dilation: Dilation is a procedure that your doctor can use to widen the esophagus and is most often done when a stricture is causing your dysphagia.
- Medications: Your doctor may prescribe medications to neutralize or reduce stomach acids, or to control esophagus muscle spasms.
- Diet modification: Eat slowly, don’t talk while you eat, take small bites, sit in an upright position after meals, use a blender to puree solid foods if needed, thicken liquids with milk, juice, broth, gravy or starch to make swallowing easier.
Eosinophilic Esophagitis (EE)
What is eosinophilic esophagitis (EE)?
Eosinophilic esophagitis is one of many types of esophagitis (inflammation of the esophagus). It is not as common as reflux esophagitis, but has many of the same symptoms. It is caused by an abnormal accumulation of eosinophils in the lining of the esophagus (swallowing tube). Eosinophils are a type of blood cell that can be seen in the esophagus. In this condition they are present at an increased level. The reason for this increased accumulation is unknown. Often individuals with eosinophilic esophagitis have allergies or an allergic disorder (i.e. asthma, allergic rhinitis, urticaria, etc.).
What are the symptoms of eosinophilic esophagitis?
Symptoms often include heartburn and more commonly difficulty in swallowing, or the feeling that food is getting caught or stuck in the esophagus.
How common is eosinophilic esophagitis?
Eosinophilic esophagitis is a rare condition. Of those adults affected with EE, the majority are men in their 20-30s. Children can also be affected.
How do you know if you have eosinophilic esophagitis?
The only way to diagnose eosinophilic esophagitis is by upper endoscopy with biopsies (tissue samples) of the esophagus. Upper endoscopy or EGD (esophagogastroduodenoscopy) is a procedure where a small lighted tube is passed through your mouth into your esophagus, stomach and first portion of your small intestine. The tube that is used has a camera within it and is connected to a computer. This test allows the doctor to see the lining of your esophagus, stomach and first portion of your small intestine. Pictures can be taken and can be part of your medical record. Biopsies can be taken at the time of endoscopy. There is no pain associated with taking biopsies.
Findings at the time of endoscopy can show a normal appearing esophagus or an esophagus that appears to have many rings (somewhat like a spring). Biopsies show an increase in the amount of eosinophils that are present.
How is eosinophilic esophagitis treated?
Treatment involves the use of a steroid inhaler. The treatment can be repeated as necessary. If recurrent use is needed, additional anti-allergy medications can be used. Generally, patients are referred to an allergist for additional testing or treatment.
Unlike inhaled steroids where a spacer is used to help get the medication into the lungs, you are to spray the medication without a spacer. This allows for the medication to be delivered to the back of your throat and swallowed. This brings the medication in direct contact with your esophagus.
Side effects to steroid inhalers can include the development of a fungal infection in the mouth (thrush), esophagus or respiratory tract. Other typical side effects of steroids can occur, but with a lessened incidence as compared to oral medication.
Are there any complications to eosinophilic esophagitis?
The most common complication is food becoming caught in the esophagus. This can lead to erosions (irritation) or ulcerations on the wall of the esophagus.
What is Gastroparesis?
Gastroparesis refers to a delay in emptying of stomach contents into the small intestine. This can be caused by a change in the ability of the nerves to pick up information in the stomach, or the nerves that send information to the stomach telling it to contract or empty. Another cause includes the stomach muscles not being able to contract. This loss of function can be limited to the stomach or can include the esophagus and small intestine.
What causes Gastroparesis?
Gastroparesis can occur spontaneously, or as a result of:
- Thyroid abnormalities
- Diabetes Mellitus,
- An infection,
- Gastro-intestinal surgery,
- Neurological diseases,
- Motion sickness,
- Medications that have side-effects of delayed stomach emptying.
Other causes include: Alcohol, tobacco, marijuana, Total Parenteral Nutrition (TPN), certain muscle disorders, eating disorders (anorexia nervosa, or bulimia nervosa). Symptoms may last a few hours, a few days or be chronic.
What are the Symptoms?
Symptoms of gastroparesis include nausea, vomiting, and full feeling after eating only a few bites or a small amount of what you normally eat. Other symptoms include weight loss, bloating, heartburn and abdominal pain after eating.
How do you know if you have gastroparesis?
The evaluation for gastroparesis includes:
- Blood tests that look at thyroid function, tests that evaluate for Diabetes (blood sugar, hemoglobin A1C) kidney function, electrolytes, and blood tests that look at nutritional status including a blood count, and comprehensive metabolic profile.
Radiological Tests include:
- An Upper GI x-ray. This involves drinking barium that coats the stomach, to evaluate the lining and structure. It can also show if there is something blocking the stomach from emptying.
- Gastric Emptying Study. This is a Nuclear Medicine test that can show how the stomach empties liquid and solid material into the small intestine, and how long it takes to empty. This is then compared to the normal emptying rates to give a result. This test involves eating food that is labeled with a tiny amount of radioactivity that can be seen on the scanner.
How is gastroparesis treated?
Treatment of gastroparesis includes:
- Dietary changes. Eating smaller, more frequent meals is encouraged, as opposed to the 3 meals a day type of diet. A low fat diet is encouraged, as meals higher in dietary fat may cause delay of stomach emptying. A diet low in dietary fiber has also been shown to decrease the symptoms of gastroparesis. Liquids empty more easily from the stomach, so the use of supplements like Boost or Ensure is encouraged.
- Medications that promote gastric emptying called “Prokinetics” are used. There currently are not very many drugs available. These drugs include metoclopramide (Reglan) and erythromycin. Medications that cause delayed gastric emptying should be discontinued if possible. This should be done at the direction of your doctor.
- Feeding Tubes are also used in the treatment of gastroparesis. The tubes can be placed through the nose into the esophagus, stomach and into the small intestine. They may also be placed through the abdominal wall and into the small intestine. The latter procedure would be used for more long-term feeding and is usually placed by a radiologist. The type of feeding is based on individual calorie and nutritional needs, as well as the expected duration of the feeding used.
- Enterra therapy is a newer therapy that involves the placement of a generator beneath the skin of the abdomen. Electrodes (coated wires with sensors) are then placed with one end in the muscle of the stomach and the other into the generator. The Enterra generator is similar in size and function to a cardiac pacemaker. It works by stimulating the stomach muscles to empty the stomach, and often lessens symptoms.
Are there any complications to gastroparesis?
The main complications of gastroparesis involve alteration in nutrition which can lead to weight loss and malnutrition. Discomfort is a major problem for some people. Inability to eat normally may cause emotional and social distress.
What kind of follow up will I need?
Once an appropriate treatment plan is made for you, follow-up will be determined by your response to it. Some individuals have symptoms lasting only a few weeks or months, while others have symptoms for years. Some have success with medication and need only yearly follow-up. Others with feeding tubes can be followed by their primary physician.
Bacteria and Foodborne Illness
What are foodborne illnesses?
What causes of foodborne illnesses?
Harmful bacteria are the most common cause of foodborne illnesses. Some bacteria may be present on foods when you purchase them. Raw foods are the most common source of foodborne illnesses because they are not sterile; examples include raw meat and poultry that may have become contaminated during slaughter. Seafood may become contaminated during harvest or through processing. One in 10,000 eggs may be contaminated with Salmonella inside the egg shell. Produce such as spinach, lettuce, tomatoes, sprouts, and melons can become contaminated with Salmonella, Shigella, or Escherichia coli (E. coli) O157:H7. Contamination can occur during growing, harvesting, processing, storing, shipping, or final preparation. Sources of produce contamination are varied as these foods are grown in soil and can become contaminated during growth or through processing and distribution. Contamination may also occur during food preparation in a restaurant or a home kitchen. The most common form of contamination from handled foods is the Norwalk-like virus.
What are the symptoms of foodborne illnesses?
In most cases of foodborne illnesses, symptoms resemble intestinal flu and may last a few hours or even several days. Symptoms can range from mild to serious and include
- abdominal cramps
- diarrhea, which is sometimes bloody
What are the risk factors of foodborne illnesses?
What are the complications of foodborne illnesses?
Some micro-organisms, such as Listeria monocytogenes and Clostridium botulinum, cause far more serious symptoms than vomiting and diarrhea. They can cause spontaneous abortion or death.
In some people, especially children, hemolytic uremic syndrome (HUS) can result from infection by a particular strain of bacteria, E. coli O157:H7 and can lead to kidney failure and death. HUS is a rare disorder that affects primarily children between the ages of 1 and 10 years and is the leading cause of acute renal failure in previously healthy children. A child may become infected after consuming contaminated food or beverages, such as meat, especially undercooked ground beef; unpasteurized juices; contaminated water; or through contact with an infected person.
The most common symptoms of HUS infection are vomiting, abdominal pain, and diarrhea, which may be bloody. In 5 to 10 percent of cases, HUS develops about 5 to 10 days after the onset of illness. This disease may last from 1 to 15 days and is fatal in 3 to 5 percent of cases. Other symptoms of HUS include fever, lethargy or sluggishness, irritability, and paleness or pallor. In about half the cases, the disease progresses until it causes acute renal failure, which means the kidneys,are unable to remove waste products from the blood and excrete them into the urine. A decrease in circulating red blood cells and blood platelets and reduced blood flow to organs may lead to multiple organ failure. Seizures, heart failure, inflammation of the pancreas, and diabetes can also result. However, most children recover completely.
See a doctor right away if you or your child has any of the following symptoms with diarrhea:
- High fever – temperature over 101.5°, measured orally
- Blood in the stools
- Diarrhea that lasts more than 3 days
- Prolonged vomiting that prevents keeping liquid down and can lead to dehydration
- Signs of severe dehydration, such as dry mouth, sticky saliva, decreased urination, dizziness, fatigue, sunken eyes, low blood pressure, or increased heart rate and breathing rate
- Signs of shock, such as weak or rapid pulse or shallow breathing
- Confusion or difficulty reasoning
How are foodborne illnesses diagnosed?
How are foodborne illnesses treated?
Most cases of foodborne illnesses are mild and can be treated by increasing fluid intake, either orally or intravenously, to replace lost fluids and electrolytes. People who experience gastrointestinal or neurologic symptoms should seek medical attention.
How are foodborne illnesses prevented?
GERD (Gastroesophageal Reflux Disease)
What is GERD (Gastroesophageal Reflux Disease)?
To understand GERD, we need to understand how our digestive system works. Normally when we eat, our food is chewed into small pieces that are easy to swallow. As we swallow the food it travels down our esophagus (tube between our mouth and stomach) to the stomach.Near the top of our esophagus is an area of muscle called the upper esophageal sphincter (UES). When we swallow, the UES relaxes and allows food to pass into the esophagus. The food then travels down the esophagus to another area of specialized muscle tissue called the lower esophageal sphincter (LES). The LES is located at the junction of the esophagus and the stomach. The job of the LES is to act as a one-way valve, allowing food to enter the stomach and prevent it from coming back up into the esophagus.
GERD occurs when the LES is too relaxed and does not prevent stomach fluids (stomach acid) and food from backing up into the esophagus. The lining of our esophagus is not protected from stomach acid, unlike the stomach’s lining. The acid contact with the esophagus causes inflammation, and may cause irritation of the esophageal tissue. This leads to the symptoms of GERD.
What are GERD symptoms?
Heartburn–this is a burning sensation felt under the breastbone. The frequency of this varies from person to person. It can be 1-2 times a month or even a daily occurrence. Acid regurgitation–this is the sensation that acid and food contents within the stomach is backing up into the esophagus and at times, even into the mouth, causing a bitter or sour taste.Hoarse or scratchy voice, coughing, some types of asthma, sinus problems, and dental erosions–these symptoms can be caused by the stomach acid backing up into the esophagus and traveling into the breathing tube causing irritation of the voice box (larynx) or vocal cords which can lead to changes in voice. The acid can also travel further down our airway (trachea) and cause spasms of the airways, which can cause asthma symptoms such as wheezing or coughing. The acid can even travel up into the sinuses, which can lead to sinus problems. The stomach acid can also break down tooth enamel.
Difficulty swallowing or food becoming stuck in the esophagus–this is often caused by stomach acid backing up into the esophagus. If this occurs frequently and over long periods of time, it can cause irritation and inflammation of the tissue and lead to a narrowing of the esophagus, making the passage of food difficult.
How common is GERD?
Over 60 million Americans have GERD. About one fourth of these individuals have symptoms every day. Factors contributing to the incidence of GERD include pregnancy, being overweight and older age.
How is GERD diagnosed?
There are a number of tests that are used to diagnose GERD. They include the following:
Manometry: is a test where a thin tube is placed through the nose into the esophagus. This tube has special sensors to measure pressure in the esophagus. This test is used to evaluate your swallows. It can show the strength and the coordination of your swallows. The tube is left in place for a short period of time while you are instructed to swallow, drink, and/or cough.
How is GERD treated?
Initial treatment of GERD involves lifestyle changes. Other treatments include: medications, endoscopic treatment of the esophagus, and surgery.
Avoid foods that cause symptoms, that cause the lower esophageal sphincter to relax or that are irritating to the GI tract and may cause an increase in acid production. These foods include: caffeinated drinks (coffee, some teas, colas, and other sodas high in caffeine) chocolate, tomato based products (spaghetti, lasagna, pizza, and chili), spicy foods, citrus, garlic, onions, peppers, fatty foods, and mint/peppermint.
Are there any complications from GERD?
The main gastrointestinal complications related to GERD include Barrett’s esophagus and swallowing problems.
What kind of follow up will I need?
If you have GERD with no other problems, you can follow with your primary physician. Most, if not all, primary physicians are comfortable treating individuals who have GERD once the diagnosis has been made. If you wish to follow with our clinic, we will want to see you once a year to evaluate how you are doing, discuss any new treatment options as well as review lifestyle modifications. It is at this time that you will be given an updated prescription.
If you have Barrett’s esophagus, we will want to see you for follow up on a yearly basis and will want to do an upper endoscopy every 1 to 3 years to evaluate for the risk of cancer.
What are hemorrhoids?
Hemorrhoids are swollen veins in the lower portion of the rectum or anus that may be internal (located inside the lower rectum) or external (under the skin around the anus).
What causes hemorrhoids?
- Straining to move your bowels
- Sitting too long on the toilet
- Pregnancy and childbirth
What are the signs and symptoms of hemorrhoids?
- Painless bleeding
- Itching or pain in the anal region
- Protrusion of internal hemorrhoid through the anus
Treatment options and prevention
In many cases treating hemorrhoids involves steps you can take on your own.
- More Fiber: Eat more fresh fruits, leafy vegetables, and whole-grain breads and cereals and drink 6-8 glasses of water every day. Your doctor may also recommend a fiber supplement.
- Good Hygiene: Cleanse the anal area gently after each bowel movement. Avoid excessive wiping
- Comfort measures: Consider cold packs, tub baths or warm soaks (a warm sitz bath)
- Avoid long periods of standing or sitting
- Avoid straining
- Go to the bathroom as soon as you feel the urge
In cases where internal hemorrhoids have fallen outside of the anus (prolapsed) or bleed excessively, your doctor may recommend procedural treatments such as:
- Band ligation
- Increased medical therapy
Seeking medical advice
See your doctor if your hemorrhoids don’t improve with self-care, cause pain or bleed frequently or bleed excessively.
What is hepatic encephalopathy?
Hepatic encephalopathy is a complication of liver disease that occurs when blood flow bypasses the liver (called portal hypertension) and enters into the rest of the circulation. This unfiltered blood carries toxins that enter the brain and affects normal function. This toxic effect on the brain is called encephalopathy which can be seen as altered level of consciousness, altered intellectual function or changes in personality/behavior. Muscle and reflex abnormalities are also present. These changes can range from mild to severe (which includes coma).
Some symptoms include poor memory, confusion, and sleepiness, being awake during the night and sleeping during the day, irritability and tremor. Encephalopathy is most commonly a complication of cirrhosis but can also occur in some other conditions.
How is hepatic encephalopathy treated?
The toxins that enter the brain are byproducts of the foods we eat and are also produced by the normal bacteria in the large intestine. Thus treatment is aimed at decreasing the amount of toxins that can be absorbed from the large intestine. Lactulose (a common brand name is Kristalose) alters the acidity in the colon which prevent absorption of ammonia, one of the toxins.
The correct dose of lactulose varies from one person to the next and it may change from day to day for each individual. The correct dose will cause 3 to 4 loose bowel movements per day. Depending on what you eat, it may be necessary to alter the dose each day.
Having loose stools every day can interfere with daily activities. Lactulose may also have the side effects of bloating, increased gas and abdominal discomfort. Despite these side effects, it is important to keep up with the lactulose to properly treat the encephalopathy.
Rule of thumb: If you or someone around you notices symptoms of encephalopathy, take another dose of lactulose. If symptoms continue with use of lactulose, contact your health care provider.
Hepatitis C is the most common blood-borne infection in the U.S. Approximately 2.7 million Americans are infected. Transmission of the virus occurs through contaminated blood through such activities as blood transfusion before 1991, intravenous drug use, occupational exposure, sexual contact, and possibly intranasal drug use, tattoos or body piercings.
Most people have no symptoms and are surprised when they are informed of the diagnosis. Abnormal lab tests during routine physical examination, insurance applications or blood donations often prompt the hepatitis C investigation. People with symptoms most commonly have fatigue, muscle and joint pains, and right upper quadrant discomfort.
The virus is diagnosed by blood tests. The most common screening test detects the hepatitis C antibody. If this test is positive, it means there has been past exposure to the virus (only rarely is the test falsely positive). Most people exposed to the virus have a chronic infection, as our body does not eradicate the virus by its own defenses very well.
Blood tests performed to confirm current presence of the virus are called polymerase chain reaction (PCR) tests. This method is sensitive to detect the virus, determine the genotype and quantify the viral level. The genotype and viral level do not correlate with the severity of infection. In this part of the country, most people have genotype 1 (75%), followed by genotype 2 (15%) and genotype 3 (10%). Genotype 4 is most common in North Africa and the Mediterranean. Genotype 6 is found in East Asia.
Liver damage as a result of hepatitis C can most accurately be determined by a liver biopsy. Liver blood tests, such as ALT and AST, can reflect cell injury or irritation. The albumin (protein produced in the liver) level and INR (blood clotting measurement) can assess liver function. These tests can be influenced by multiple factors and their results cannot replace the liver biopsy to determine damage to the liver as a result of the virus.
The liver biopsy is an outpatient procedure performed by a gastroenterologist or radiologist. It is performed by several different methods and may involve a pre-procedure pain reducing medication. There may be some discomfort, but usually does not last long and the procedure is generally well tolerated. Liver biopsy risks include bleeding, puncture of other organs or unexpected pain. Results of the biopsy guide recommendations for treatment.
Recommendations for living with Hepatitis C
1. Diet: There is no particular diet that must be followed. Protein is commonly misconceived as being harmful to the liver, but does not need to be avoided. Vitamin supplements are not necessary if a well-balanced diet is consumed. If vitamins are used, they should not contain additional iron. There is no research evidence that natural or herbal remedies fight the virus or preserve liver function. Safety of many of these products has not been established. Over-the-counter products such as acetaminophen (Tylenol), ibuprofen, and aspirin can be used in recommended doses.
2. Alcohol: Alcohol is the one chemical known to alter the course of the hepatitis C virus. Alcohol has been shown to speed the rate of liver damage with hepatitis C. Unfortunately, it is not known what a safe amount per day or week is. If some alcohol easily leads to more alcohol, it may be best to abstain altogether.
3. Daily living: Hepatitis C is spread through contaminated blood, so cover open wounds and disinfect spilled blood. Do not share personal hygiene items such as razors and toothbrushes. The virus is rarely spread through sexual contact, however condoms are recommended as a precaution. If your partner is concerned, they can be tested. If a person with hepatitis C is in a long-term monogamous relationship, no special preventative precautions need to be used in sexual relations.
4. Vaccination: Vaccination for hepatitis A and hepatitis B are recommended if you are not immune. You are at no higher risk for hepatitis A and hepatitis B, but it would be more serious for your liver if you contract these viruses.
Please check the Center for Disease Control website at:
The HCV Advocate
The Hepatitis Support Project. Available at:
What is a hiatal hernia?
A hernia occurs when part of the body bulges into another. Your chest and abdomen are separated by your diaphragm – a large dome-shaped muscle that is responsible for a major part of breathing. A hiatal hernia occurs when the top portion of the stomach pushes through a weakened opening in the diaphragm where the food pipe (esophagus) joins your stomach (called the hiatal opening).
What causes a hiatal hernia?
The exact cause of hiatal hernias is not known. Some people develop hiatal hernias after an injury to the chest or abdomen. But anything that puts intense pressure on your abdomen – including pregnancy, straining while going to the bathroom, severe coughing, vomiting, or lifting heavy objects – can contribute to a hernia.
What are the symptoms of a hiatal hernia?
Most small hiatal hernias don’t cause problems and you may never know you have a hiatal hernia unless your doctor discovers it while checking for another condition. But a large hiatal hernia can allow food and stomach acid to back up into your esophagus, leading to heartburn, chest pain, belching and nausea.
How is a hiatal hernia diagnosed?
Your doctor may find a hiatal hernia during an endoscopy (EGD) or barium swallow x-ray while trying to determine the cause of heartburn, chest pain or upper abdominal pain.
How is a hiatal hernia treated?
Hiatal hernias that don’t cause symptoms probably will not require treatment. However, if you experience frequent gastroesophageal reflux (GERD), your doctor may recommend the following treatments:
- Weight loss: Losing weight alone may relieve your symptoms.
- Medications: Over-the-counter antacids (Maalox, Mylanta, Tums); Acid reducing medications called H-2 blockers (Pepcid, Tagamet, Zantac, Axid); Acid blocking medications called proton pump inhibitors (Prevacid, Prilosec, Dexilant, Nexium, Protonix, Zegerid, Aciphex)
- Diet Modification: Avoid fatty, spicy foods, caffeine, chocolate, onions and citrus. Eat smaller meals. Avoid eating 3 hours before bed.
- Surgery: Few people require surgery to repair a hiatal hernia. This option is usually considered only when medications and lifestyle changes fail to reduce reflux symptoms.
- Seeking medical advice for hiatal hernia?
If your symptoms are severe, occur often or are accompanied by coughing, wheezing, asthma, a sore throat, difficulty swallowing or chest pain, contact your health care provider.
Inflammatory Bowel Disease (IBD) – Adult
What is Inflammatory Bowel Disease?
Inflammatory Bowel Disease (IBD) is a group of disorders that includes ulcerative colitis and Crohn’s disease. These conditions frequently produce symptoms of abdominal pain and diarrhea. These conditions can often be difficult to diagnose due to their similarity to other conditions.
Is an ongoing disorder that causes inflammation of the gastrointestinal (GI) tract. Crohn’s disease can affect any area of the GI tract, from the mouth to the anus, but it most commonly affects the lower part of the small intestine, called the ileum.
Is a disease that causes inflammation and sores, called ulcers, in the lining of the rectum and colon. It occurs in continuous stretches of the colon, unlike Crohn’s disease, which occurs in patches anywhere in the digestive tract.
Depending on the level of severity, treatment may require immunosuppression to control the symptom, such as prednisone, anti-TNF drugs,azathioprine (Imuran), methotrexate, or 6-mercaptopurine. More commonly, treatment of IBD requires a form of mesalamine. Often, steroids are used to control disease flares and were once acceptable as a maintenance drug. In use for several years in Crohn’s disease patients and recently in patients with ulcerative colitis, biologicals have been used such as TNF inhibitors. Severe cases may require surgery, such as bowel resection, strictureplasty or a temporary or permanent colostomy or ileostomy. Alternative medicine treatments for bowel disease exist in various forms; however such methods concentrate on controlling underlying pathology in order to avoid prolonged steroidal exposure or surgical excisement.
Usually the treatment is started by administering drugs with high anti-inflammatory effects, such as prednisone. Once the inflammation is successfully controlled, the patient is usually switched to a lighter drug to keep the disease in remission, such as Asacol, or Lialda®, a group of drugs called mesalamines. If unsuccessful, a combination of the aforementioned immunosuppression drugs with a mesalamine (which may also have an anti-inflammatory effect) may or may not be administered, depending on the patient.
For more advanced treatment, we have an infusion center in our main office location for the administration of infliximab (Remicade®) and certolizumab pegol (Cimzia®)which are biological anti-inflammatory treatments used to induce and maintain IBD remission. For outpatient therapy, patients can self-inject adalimumab (Humira®) on a weekly schedule to maintain remission.
For More Information contact the Crohn’s and Colitis Foundation of America see: http://www.ccfa.org
Irritable Bowel Syndrome (IBS)
What is irritable bowel syndrome (IBS)?
Irritable bowel syndrome, or IBS is a condition associated with symptoms such as abdominal pain, bloating, and altered bowel function (constipation, diarrhea, or alternating pattern of constipation and diarrhea). Doctors call IBS a functional disorder. This means there is not a structural abnormality in bowel. Instead it is a problem with the way the bowels work. In IBS the nerves that control contractions in the bowels are extra sensitive to certain kinds of food, hormones, or stress.
How is IBS diagnosed?
There are defined criteria for the diagnosis of IBS. The diagnosis is based on a patient’s symptoms and how long and how often the symptoms are present. The key clinical symptoms of IBS include abdominal pain that is associated with a change in frequency or consistency of the stool.
Your doctor will check to be sure that the symptoms are not due to other causes, if further work-up is needed. Various blood tests, x-rays, and examinations, such as sigmoidoscopy or colonoscopy may be done, but may not always be required.
Who is affected by IBS?
The impact of these symptoms is significant. In America, 1 in 5 adults (40 million people) may suffer from these symptoms. IBS is the second leading cause of work-related absenteeism
What is the relationship with stress?
The gut has its own nervous system. There is a brain-gut interaction and psychological stress may cause or increase symptoms. This brain-gut connection confirms there is a physical basis for the relationship between emotions (such as stress) and IBS symptoms. This is why doctors try to help IBS patients deal with psychological stress.
How is IBS treated?
Mild symptoms may be treated by eliminating food and drink that make the symptoms worse. Avoiding coffee/caffeine, alcohol, fatty foods, and dairy products may be helpful. If something seems to make it worse, eliminating it from the diet may be effective. Some medications may cause symptoms as well. Check with your doctor to help determine if medications may be a part of the problem.
Moderate symptoms that interfere sometimes with work, school, or social life may require keeping a diary. Keeping a list of your symptoms and associating what you are doing at the time of the symptoms can be very helpful in assessing the problem. Behavioral treatment for moderate to severe symptoms may include relaxation therapy, hypnosis, biofeedback, and cognitive-behavioral treatment. These kinds of treatment are recommended to help you cope better with your symptoms.
Severe symptoms may require treatment with antidepressants. These drugs act as pain relievers. They work by blocking or reducing pain sensations in your gut from reaching the brain.
Lactose intolerance is the inability to digest significant amounts of lactose, the major sugar found in milk and dairy products.
What causes lactose intolerance?
Lactose intolerance results from a shortage of the enzyme lactase. Lactase breaks down milk sugar into simpler forms that can be absorbed into the blood stream. When there is not enough lactase to digest the amount of lactose consumed, the results are not dangerous, but the symptoms of lactose intolerance can be uncomfortable.
What are the signs and symptoms of lactose intolerance?
Common symptoms may range from mild to severe including nausea, cramps, bloating, gas, and diarrhea. Symptoms begin about 30 minutes to 3 hours after eating or drinking foods containing lactose. The severity of symptoms depends on many factors, including the amount of lactose a person can tolerate and a person’s age, ethnicity, and digestion rate.
How is lactose intolerance diagnosed?
A common test used to measure the absorption of lactose in the digestive system is the hydrogen breath test. This test measures the level of a gas called hydrogen in your breath. Hydrogen is produced by bacteria in the colon (large intestine) in response to undigested lactose. Hydrogen is carried through the blood stream to the lungs, where it is breathed (exhaled) out. High levels of hydrogen in your breath means that lactose is not being digested properly.
Treatment Options and Prevention
Lactose intolerance is relatively easy to treat. The amount of lactase enzyme that the body produces cannot be increased, but symptoms can be controlled through diet. Many children and adults do not need to avoid lactose completely, but individuals differ in the amounts of lactose they can handle.
To reduce symptoms of lactose intolerance:
Seeking medical advice
If you have signs and symptoms of lactose intolerance, call 216-593-7700 to schedule an appointment with one of our physicians.
What is microscopic colitis?
Microscopic colitis includes collagenous colitis and lymphocytic colitis and is characterized by chronic diarrhea caused by inflammation in the colon. Collagenous colitis and lymphocytic colitis are two types of bowel inflammation that affect the colon (large intestine). They are not related to Crohns disease or ulcerative colitis, which are more severe forms of inflammatory bowel disease (IBD). These conditions are not life-threatening and there is no increased risk of cancer.
This condition is known as “microscopic” colitis because physicians can’t see the inflammation without a microscope. Instead, tissue samples from the colon must be examined under a microscope to make the diagnosis. When looked at through an endoscope during a colonoscopy or sigmoidoscopy, the colon appears entirely normal.
What causes microscopic colitis?
The exact cause of collagenous colitis or lymphocytic colitis is unknown. There is a strong association with a wide variety of medications, especially non-steroidal anti-inflammatory drugs (NSAIDs). You should carefully review all of your medications with a gastroenterologist to see if there is an association with microscopic colitis.
What are the symptoms of microscopic colitis?
The symptoms of collagenous colitis and lymphocytic colitis are similar–chronic watery, non-bloody diarrhea. The diarrhea may be continuous or episodic. Abdominal pain or cramps may also be present.
How is microscopic colitis treated?
Treatment for collagenous colitis and lymphocytic colitis varies depending on the symptoms and severity of the cases. The diseases have been known to resolve spontaneously, but most patients have recurrent symptoms.
When possible, it is a good idea to start with avoiding potentially offending medications. You should speak with your provider before discontinuing any medications, as some should not be stopped suddenly.
Some patients benefit from the use of antidiarrheal agents, Imodium and Lomotil. However, many patients require medicines, such as budesonide (Entocort), bismuth subsalicylate (PeptoBismol), or mesalamine (Asacol). Stronger medications, such as immunosuppressants, are rarely necessary.
Primary Biliary Cirrhosis
What is primary biliary cirrhosis (PBC)?
Primary biliary cirrhosis (PBC) is an inflammation of the bile ducts in the liver. This inflammation narrows the ducts and blocks the bile flow. This backing up of the bile (called cholestasis) can gradually damage the ducts and ultimately the liver itself.
What causes PBC?
PBC falls into a broad class of diseases called autoimmune conditions. Theses can affect different systems in the body, but are thought to be the result of the immune system working against the body itself, in the same way it would work against a foreign object like bacteria. The ongoing inflammation causes the tissue damage and resulting symptoms.
What are the symptoms of PBC?
Frequently, there are no symptoms. Most often, people are sent to a gastroenterologist for further evaluation because liver testing shows some abnormality. Fatigue and itching are common. Other possible complications may be bone loss and vitamin deficiencies. Patients with PBC may also have other autoimmune conditions.
How is PBC diagnosed?
Blood work, specific to the liver, is done. High alkaline phosphatase, antimitochondrial and antinuclear antibody, are usually seen in PBC. Definitive diagnosis is usually made by liver biopsy. This not only confirms the diagnosis, but allows for assessment of the amount of damage to the liver.
How is PBC treated?
There is no cure for PBC. Treatment is with a medication called Ursodiol. This may slow the progress of the disease if given early in its course. Treatments are directed at controlling the symptoms. For example, medications can be given to decrease itching, or to slow bone loss. Some studies indicate that smoking can hasten the progression of the disease, so smoking cessation is very important. Alcohol should also be avoided.
The progression of the disease varies greatly. In some, it is quite slow. In others, it may result in cirrhosis and compromised liver function. Those with advanced cases may be candidates for liver transplant.
Seeking medical advice for PBC:
Most patients are sent by their regular doctor for further assessment when liver tests are abnormal. Once a diagnosis is made, there are regular follow up visits. You should also be seen if symptoms such as itching become bothersome.
Primary Sclerosing Cholangitis
What is primary sclerosing cholangitis (PSC)?
PSC is a chronic disease that damages the bile ducts of the liver. Inflammation and scarring cause the bile ducts to become blocked. The blockage causes bile to accumulate in the liver which may lead to scarring or damage of the liver cells. Over time, damage of the liver cells can lead to cirrhosis. PSC usually advances slowly. People with PSC may experience episodes of infection in the liver and increased risk of cancer in the bile ducts.
What causes primary sclerosing cholangitis?
The cause of this disease is not known. It is possible the disease is related to a problem with the immune system and there may be a genetic role. PSC is more commonly found in men than women. Intestinal diseases called ulcerative colitis and Crohn’s disease are often associated with PSC.
What are the symptoms of primary sclerosing cholangitis?
Many people do not have symptoms at the time of diagnosis. However, if symptoms occur, they may include jaundice (yellowing of the skin and eyes), fatigue, and pruritus (itching of the skin). Symptoms may come and go, or gradually worsen over time.
How is primary sclerosing cholangitis diagnosed?
Often findings of abnormal liver tests lead to further testing and the diagnosis of PSC. Diagnosis is usually made by X-ray tests, MRCP (magnetic resonance cholangiopancreatography), or a specific endoscopic procedure to evaluate the bile duct called EUS/ERCP (endoscopic ultrasound, endoscopic retrograde cholangiopancreatography).
How is primary sclerosing cholangitis treated?
There is no cure for PSC. Research is not clear if a medication (ursodiol) may help slow the progression of the disease. Treatment is aimed at relieving symptoms. Itching is able to be treated with medications. PSC generally involves increased liver damage and liver transplant may be needed. ERCP may also be used to place stents to open up the bile ducts.
Additional Resources for primary sclerosing cholangitis:
What is Wilson’s disease?
Wilson’s disease is a rare inherited disorder that causes excess copper accumulation in the body. This may lead to damage of the liver, brain, kidneys, eyes, and other organs.
What causes Wilson’s disease?
Wilson’s disease is caused by inheritance of abnormal copies of the ATP7B gene from both parents. This occurs in about 1 in 40,000 people, affecting men and women equally. Diagnosis is usually made before the age of 30.
What are symptoms of Wilson’s disease?
Patients with Wilson’s disease may present with symptoms of liver disease, eye problems, kidney problems, osteoporosis, behavioral, or psychiatric changes. Copper usually accumulates in the liver first, causing symptoms of fatigue, yellowing of the eyes or skin, swelling of the legs, swelling of the abdomen, and easy bruising. If there is copper build-up in the brain, patients may have problems with speech, difficulty swallowing, poor coordination, stiffness, or personality changes. Eye changes include a brown pigment around the cornea, referred to as Kayser-Fleischer rings.
How is Wilson’s disease diagnosed?
Diagnosis of Wilson’s disease may be made through physical exam and lab testing. Patients may initially present with elevated liver tests or signs of liver disease. If there is suspicion for Wilson’s disease, copper levels are often checked in the blood, urine, or liver. Most patients will have low ceruloplasmin in the blood and elevated copper levels in the urine. A 24 hour urine test will also show increased copper. Routine eye exam may also reveal Kayser-Fleischer rings. Copper build-up is also seen on liver biopsy.
How is Wilson’s disease treated?
The goal of treatment is to reduce excess copper and prevent copper build-up in the future. Medicines such as d-penicillamine (Cuprimine®) and trientene hydrochloride(Syprine®)are often prescribed to reduce copper build-up in the organs. Zinc is often given to block the digestive tract from absorbing copper from food. Patients are also instructed to avoid foods that contain a large amount of copper. These include liver, shellfish, nuts, chocolate, mushrooms, organ meats, dried peas and beans, dried fruit, bran, and avocados.
What is the long-term outcome?
With early diagnosis and treatment, most patients will have a normal life expectancy. Those who present in later stages may have problems related to liver damage or cirrhosis and sometimes require a liver transplant. Seeking medical treatment for Wilson’s disease is important. If left untreated, Wilson’s disease is always fatal.
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