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Common GI Conditions

Common GI Conditions

Celiac Disease

Celiac Disease is an allergy to gliadin, a protein component of gluten, which is found in wheat and other grains. It was originally thought to be a relatively rare disease, primarily of childhood, and in adults presenting with severe diarrhea, weight loss and malnutrition. We now know it to be far more common than previously thought, and is present in 1.3 and 3 million Americans. The symptoms also are not necessarily as obvious as once thought. Although diarrhea is still the most common symptom, patients may present with iron deficiency anemia, abdominal pain, unexplained weight loss or abnormal liver function tests. Celiac disease can be diagnosed with a screening blood test, but biopsy of the small intestine (a simple out-patient procedure) is recommended to confirm the diagnosis. A trial of a Gluten-free diet is not recommended before a firm diagnosis is made, as that diet is very restrictive and expensive, and the response may be subjective. Only when the diagnosis is sure should patients be placed on this difficult diet.

Hepatitis A,B & C

There are three major viruses that  cause viral hepatitis  (inflammation of the liver): A, B and C. Hepatitis A is  what was  referred to as infectious hepatitis many years ago. It is spread by  the  fecal-oral route, meaning it is ingested in foods that have been   contaminated by stool containing the virus, oysters being a common  culprit.  Patients are contagious early in the disease before they turn  yellow. It is  mostly a disease of childhood and many adults are immune  without knowing they  ever had it. It is generally a benign disease in  children, but can be more  severe and even occasionally fatal in adults.  The major symptoms are jaundice  (yellow eyes), fatigue and anorexia.  There are blood tests to diagnose the  acute illness and to check for  prior immunity. The disease never goes  on to any chronic form. There is  no specific treatment once the virus has taken  hold, but an effective  vaccine exists. The vaccine is recommended for adults  who have other  liver problems and could not handle another insult to the liver and  to  people traveling to South America or Asia.

Hepatitis B, the old "serum hepatitis," is spread mostly through   contact with blood or other body fluids. It can, therefore, be spread  sexually  or during childbirth, as well as through needle sticks or  intravenous drugs.  Donated blood is carefully screened for hepatitis B,  so transmission that way  is now extremely rare. The initial symptoms  are quite similar to A, but unlike A,  about 5% of patients develop a  chronic form of the disease, either a chronic  carrier state or ongoing  damage to liver. Long term infection with B may lead  to cirrhosis or  cancer of the liver. There are several treatments available for  chronic  hepatitis B, but more importantly an excellent vaccine exists and it is   recommended all children be vaccinated before starting college.

Hepatitis C represents the greatest problem in the Unites States.  Unlike the  others, the initial infection is often asymptomatic, but 85%  of patients go on  to develop a chronic form of the disease. They often  present later in life when  routine blood tests show abnormal liver  function. Specific blood tests then can  assist the physician in  diagnosing the type of virus and the amount in the  bloodstream. Many  patients contracted C from intravenous drug use, often many  years in  the past, or from blood transfusions years ago. Currently, all donated   blood used is carefully screened (as for B) so this form is no longer  likely.  There are estimated to be 3 million people in the U.S. with C,  and many will go  on to develop cirrhosis or liver cancer, if not  treated. A fairly effective,  though difficult, treatment exists, and  this can be explained to you by an AIG  doctor, all of whom have  extensive experience with this disorder. There is,  unfortunately, no  vaccine for C.

IBS - Irritable Bowel Syndrome

Irritable  Bowel Syndrome (IBS) is a condition in which there is a  disturbance in the function  of the gastrointestinal tract.  Patients   may complain of abdominal pain, bloating, or a change in bowel habits   (diarrhea, constipation, or alternating diarrhea and constipation).  In  contrast to Inflammatory Bowel Disease  (IBD), patients do not have more  severe issues such as weight loss, fever,  bleeding, and anemia.   Irritable Bowel  Syndrome affects one in five Americans and is more  common in women.  The syndrome usually begins in late  adolescence and  does not typically begin for the first time after age 50.

The exact  cause of IBS is not known, but experts believe it is  related to an increased  hypersensitivity or stimulation of nerves of  the gastrointestinal tract.  Many patients find that their IBS is   triggered by emotional stress as well as oral intake.  Greasy or spicy  foods or diary products can irritate the  intestines.  Beverages that  contain  alcohol or caffeine can also aggravate symptoms.

Irritable  Bowel Syndrome is a functional disorder. There is no  underlying anatomical abnormality. Although IBS is uncomfortable and  inconvenient, it is not life  threatening. To diagnose IBS, your  doctor  will want to rule out more serious conditions. This process may entail  blood tests, X-rays, and/or endoscopy.

The treatment of IBS is based on the  patient’s particular symptoms.  Keeping  a diary of symptoms will help guide the specific regimen. Often  increasing the amount of fiber and  fluids in addition to avoiding  triggers in your diet can relieve symptoms. If necessary, fiber  supplements or anti-spasmotic  medications can be used. The key to   successful treatment of IBS is to establish and maintain a good  treatment plan  with your gastroenterologis.

Crohn's and Colitis

The term Inflammatory Bowel Disease  (IBD) represents two diseases:  ulcerative colitis and Crohn’s disease. Both conditions involve  inflammation of the  gastrointestinal tract that can cause weight loss,  abdominal pain, bleeding and  diarrhea. Frequently, IBD presents  during  adolescence, but people of any age can be afflicted. The exact cause of  IBD is not known, but  there are definite genetic and environmental  factors.

In ulcerative  colitis (UC), inflammation is limited to the colon and  rectum. Patients often complain of diarrhea and  passing blood and  mucus in their stool. UC is diagnosed with a colonoscopy.

Treatment for ulcerative colitis  includes medications given by mouth  or by suppository/enema to control the  inflammation. For more  aggressive  disease, treatment involves the use of steroids that are  given by mouth or  intravenously while in the hospital.

In contrast  to ulcerative colitis, Crohn’s disease can affect any  part of the  gastrointestinal tract, mouth to anus. Patients may  complain of abdominal pain, nausea, vomiting, diarrhea and  weight loss.  In order to diagnose  Crohn’s disease (and distinguish between  ulcerative colitis or even irritable  bowel syndrome (IBS)), patients  may require blood tests, colonoscopy, and/or  barium X-rays.

Similar  to ulcerative colitis, treatment of Crohn’s disease consists of   anti-inflammatory medications, sometimes including steroids or other   agents. In cases that fail to respond  to medications, occasionally  surgery is necessary.

Peptic Ulcer Disease

Peptic Ulcer Disease is a common cause of abdominal pain and   gastrointestinal bleeding. Patients may present with burning epigastric   discomfort (that may improve with food), black stool, vomiting blood or  very  dark material or simply iron deficiency anemia. After evaluation  by a  gastroenterologist, an upper endoscopy may be performed to make  the diagnosis.  Under sedation, a flexible endoscope is passed through  the mouth and the  esophagus, stomach and first portion of the small  intestine or duodenum, which  are examined carefully.

The vast majority of ulcers are caused by a bacteria  known as  Helicobacter pylori, which can be found in at least 50% of patients over   the age of 60 in the United States. The gold standard for diagnosing  H. pylori  is by taking a biopsy at the time of endoscopy, although less  sensitive and specific  blood and breath tests are available. The use  of aspirin and NSAIDs  (non-steroidal anti-inflammatory drugs such as  ibuprofen and naprosyn) are the  other most common causes of ulcers. An  extremely small proportion of gastric  ulcers are malignant. Treatment  of peptic ulcer disease includes acid  suppression (typically with a  class of medications known as proton pump  inhibitors), eradication of  H. pylori, if present, (with a two week course of  antibiotics) and  discontinuation of NSAIDs, if medically possible.  Severe  gastrointestinal bleeding may be  controlled at the time of endoscopy  with electrocautery or injections of  medication. Your physician can  discuss other details regarding diagnosis,  treatment and the  appropriate follow-up with you in the office.

Hemorrhoids

Hemorrhoids are swollen blood vessels in the anal region.  The blood  vessels usually become swollen by straining during bowel movements.   Hemorrhoids can develop both inside and outside the rectum and are  usually  painful, accompanied with some bleeding. Other symptoms of  hemorrhoids include  itching and a change of the stool shape or caliber.

Hemorrhoids are more common in women (particularly after  pregnancy)  and usually after the age of 30.   They are commonly seen in people who  are constipated, but also can occur  in people without any bowel  problems.

Treatment of hemorrhoids includes sitz bath (warm bath  for more than 20  minutes), topical ointments and creams and regulating bowel   movements.  High fiber diets, increasing  fluid intake, fiber  supplements and stool softeners can correct constipation  and straining.  Twenty to thirty grams of fiber are recommended daily.  Chronically  painful or bleeding hemorrhoids  may need to be treated with banding or  surgery. Consult your physician with  questions or problems.

Gallstones

Gallstone disease is one of the most common of  all digestive  diseases. Ultrasound provides a rapid and risk free method to  diagnose  gallstones.  For the majority  of patients, gallstones are found  incidentally when radiographic imaging is  performed for another reason.  Twenty percent of patients with incidental  gallstones will develop  symptoms over the next fifteen years. Overall,  approximately ten  percent of the population have gallstones, which is more  prevalent in  females and older age groups. People who develop symptoms are  likely to  develop recurrent symptoms. Symptoms are referred to as biliary colic  –  moderately severe right upper quadrant pain radiating to the back and  right  shoulder with associated nausea.   Symptomatic disease is seen  more frequently in diabetics, gastric bypass  patients, patients with  rapid weight loss and pregnant women. Patients with  symptoms should  seek medical attention.

Colon Polyps and Colon Cancer

Colon cancer is the second leading cause of cancer death in  the  United States and affects men and women equally. However, colon cancer  is  one of the most preventable and curable forms of cancer.  Colon cancers  almost always begin with polyps. Polyps are small growths  of fleshy tumors that  occur on the inside lining of the colon. Colon  polyps start out as benign  tumors and are very slow growing. However,  over the course of years, as they  enlarge, the risk of cancer  increases. Colon cancer can be prevented by  removing polyps during a  colonoscopy.

There are certain risk factors for the development of colon  cancer,  which include: age over 50, a family history of colon cancer or polyps,   polyposis syndromes and inflammatory bowel disease (Crohn’s disease and   ulcerative colitis). Other possible risk factors include obesity,  significant  alcohol use, smoking, diabetes, physical inactivity and a  diet high in animal  sources (low in fiber).

The best way to prevent colon cancer is to screen for it and  remove  polyps before they become cancerous. Screening tools include: stool   tests to detect occult (hidden) blood, sigmoidoscopy, barium enema and   colonoscopy. Colonoscopy is the “Gold Standard” for prevention,  detection and  removal of polyps and colon cancer.

Anyone over the age of 50 should be screened and those  with risk  factors should begin screening in their 30’s or 40’s. Colon cancer is   preventable. Ask you doctor what is appropriate for you today.

Barrett's Esophagus

Barrett’s esophagus is a condition in which the  lining of the  esophagus (swallowing tube) changes, becoming similar to the  tissue  that lines the intestine. Barrett’s is a complication of   gastroesophageal reflux disease (GERD) and is more likely to occur in  patients  who either experienced GERD at a young age or have a longer  duration of  symptoms. Barrett’s esophagus is diagnosed at the time of  an upper endoscopy  and confirmed by biopsies taken during the  endoscopy. There is a small but not  insignificant risk of developing  esophageal cancer in patients with Barrett’s  esophagus (approximately  0.5 percent per year). Dysplasia, which is  discovered via  biopsy obtained during endoscopy, is a precancerous condition in   patients with long term Barrett’s and may progress to esophageal  cancer.Therefore,  patients with Barrett’s should be screened every 2 – 3  years with endoscopies  to prevent the progression to esophageal  cancer. Those with dysplasia are  monitored more closely. There is no  cure for Barrett’s, although it has been  suggested that treating GERD  symptoms with medication may prevent the  progression of the disease.

Gastroesophageal Reflux Disease (G.E.R.D.)

GERD (gastro-esophageal reflux disease) is a  common condition  affecting approximately 20 million Americans. It is caused by   inappropriate relaxations of the muscle between the stomach and  esophagus  (lower esophageal sphincter), which allows stomach acid to  come up into the  esophagus. GERD may be either erosive (causing  esophagitis or damage to the  lining of the esophagus) or non-erosive.  The major symptom of GERD is  heartburn. Almost everyone may have  occasional heartburn, but when it occurs  more than twice a week, causes  nocturnal awakening or is associated with  difficulty swallowing or  bleeding, medical attention is necessary. There are  also so-called  extra-esophageal symptoms of GERD including cough, hoarseness,  sore  throat, asthma or chest pain. All these symptoms may have other causes  and  proper diagnosis is important. The physicians of Affiliates in  Gastroenterology  are all skilled in the latest modalities in the  diagnosis and  treatment of GERD.