New Approach to Anemia and Occult Blood

To treat bleeding that occurs in the patient’s gastrointestinal tract historically has been a difficult challenge. Today, the physicians at Gastro Health have advanced tools and techniques to identify the site of a lesion and treat this potentially dangerous condition. The typical signs of a bleeding problem include anemia, iron deficiency and blood in the […]

Women’s Health

Women and men share many of the same health concerns. However, there are many health issues that are more common in women, including constipation, irritable bowel syndrome, and non-ulcer dyspepsia. Women also have specific gastrointestinal issues, such as fecal incontinence and difficulty having a bowel movement usually caused by the trauma of childbirth.

Throughout the course of our lives, women have continuous hormonal changes that affect us in many ways, including our gastrointestinal system. Typically over time, women become more constipated, a problem that affects many postmenopausal women. Constipation may be a problem for pregnant women, as well.

Fortunately, constipation is easily treated and prescription medications are rarely needed. Most women can address this issue with lifestyle modifications and natural products. However, prescription medications are available for women who need them.

Stress is one of the health issues that affect women just as much as men. However, women tend to channel stress into their GI tracts. For women with irritable bowel syndrome (IBS), stress can worsen the situation, resulting in more abdominal discomfort or cramping, diarrhea, constipation or a combination of these symptoms. Symptoms of IBS may also include nausea and acid reflux.

There are many treatments available to women suffering with IBS, including medications. However, it is important to address the stressors in a woman’s life when medical treatment is initiated. This approach is important, because untreated IBS symptoms could lead to further problems, including peptic ulcer disease, Barrett’s esophagus or hemorrhoids.

In fact, many women suffer from hemorrhoids during pregnancy and childbirth or at some point after delivery. In many cases, hemorrhoids can be treated with over-the-counter and prescription medications. If medications are not successful, the physicians at Gastro Health have a simple in-office procedure for treatment. This treatment, called the CRH-O’Reagan system, involves gently placing a rubber band around the tissue. It is performed by a physician in the office and takes only a few minutes. No preparation is needed and you can return to work immediately after the procedure.

As our society changes, women are called upon to do more and more each day. As a result, we are under increasing amounts of stress and external pressures. Most of the time, treating the gastrointestinal issues that women have requires a complete approach to her as an individual and not just treatment of the symptoms of a disease. Our doctors at Gastro Health understand this and have a complete team available to care for female patients and their specific gastrointestinal conditions.

Nutrition Counselling for IBS

A new diet helps patients with irritable bowel syndrome (IBS) lose weight and feel better.

The FODMAPS Diet is a carbohydrate- restricted diet for patients diagnosed with IBS and other digestive conditions, like Crohn’s Disease or ulcerative colitis, for which traditional therapies have not been successful.

The FODMAPS diet is carefully structured to identify food substances that may be causing digestive problems. First, patients are given a Symptom Rating Checklist and asked to rate their symptoms for one week. Then, the patient starts the diet, beginning with the “elimination” of foods with lactose, fructose, fructans, polyols and galactans for two weeks..

Within those two weeks, patients will be able to tell if they are FODMAPS sensitive and if their symptoms will improve with this change in diet. We provide guidelines for therapy to our patients and review their progress and symptoms.

If the patient’s symptoms do improve, we then go into a “challenge” phase, adding each FODMAPS group back into the diet one at a time. Along the way, our team of nutritionists follows the patient’s progress on a regular basis. This phase lasts six weeks, and allows us to determine which carbohydrate group is a trigger for the digestive symptoms.

In general, our gastroenterologists work closely with our nutritionists to improve symptoms related to patients’ digestive disorders. One of the most common topics involves losing weight. In fact, about 99% of patients want a nutritionist to provide weight loss instruction. Weight loss is also a vital aspect of a treatment plan for other conditions like fatty liver, high cholesterol, hypertension and diabetes.

When patients are ready, we provide education and recommendations to make a “healthy lifestyle change,” rather than “how to diet.” Of course, the ultimate success of this approach depends on the patient’s commitment to make the change – but we are here to help them succeed in that goal.

The ABC’s of IBD

Inflammatory Bowel Disease (IBD) is a chronic medical condition composed of Crohn’s Disease (CD) and Ulcerative colitis (UC). Both of these entities share a common aspect, which is inflammation. This inflammation appears to be due to an abnormal response of the immune system to bacteria in our gastrointestinal tract. This is influenced by our intestinal flora, environment and certain genetic predispositions. This inflammatory cascade leads to the development of patient symptoms. The estimated prevalence of IBD is 1.4 million people in the USA. Therapies range from topical anti-inflammatories which coat the colon to medications which regulate the immune system.

Crohn’s Disease can affect any part of the gastrointestinal tract, although it more commonly affects the small intestine and colon. The symptoms can include diarrhea, abdominal pain, fever and intestinal bleeding. Poor appetite and weight loss also can occur, the latter from decrease caloric intake and intestinal malabsorption. Symptoms may also extend outside of the intestinal tract to include the skin, joints, eyes and the liver. The diagnosis involves a combination of history and physical examination, blood tests, x-rays and endoscopic evaluation of the intestine. Medications aim to suppress the inflammation and improve symptoms. Complications can include obstruction or blockage of the intestine. Smoking may worsen CD and increase the need for surgery. When surgery is needed, the goal is always to preserve as much intestine as possible and improve the patient’s quality of life.

Ulcerative Colitis is again also characterized by chronic inflammation but is limited to the colon or large intestine. The inflammation usually commences in the rectum and can involve the entire large intestine. Approximately 20% of patients with UC have a close relative with IBD. The first symptom is usually diarrhea, which can be bloody. Abdominal pain, weight loss and rectal discomfort can also occur. As with CD, symptoms can also extend outside of the intestinal tract. Besides a history and physical exam, the diagnosis may include blood tests, stool studies and an endoscopy to look at the colon and sometimes obtain biopsies. Medical therapies again aim to decrease inflammation and improve symptoms. Complications can include severe gastrointestinal bleeding. In approximately 1/3 of patients there is a need for a surgery, which is usually removal of the colon. However, unlike CD the surgery is “curative” as the inflammation is limited to the colon. Colorectal cancer incidence is increased in UC, and to a lesser extent in CD.

IBD is a chronic condition that affects millions of individuals in the United States leading to significant detriment in their daily lives. The goal of therapy is to limit the inflammation and improve the quality of life in our patients. Through research and advances seen in clinical trials this field is rapidly moving forward and novel new medications and treatment options are on the horizon. For further information regarding IBD please refer to the Crohn’s & Colitis Foundation of America at www.ccfa.org.

Got Hemorrhoids?

We are excited to announce that our office is now offering a new hemorrhoid banding treatment. This new system allows the treatment of internal hemorrhoids in an office setting, without surgery or pain. Our innovative technique is safe and effective. It does not require a preparation and, being virtually painless, can be done without anesthesia. […]

What is Fatty Liver?

Non-alcoholic fatty liver disease (NAFLD) is a disease resembling the damage seen in the liver when there is alcohol abuse, but occurring in patients with little or no alcohol consumption. NAFLD is the most common liverdisorder in the Western world. It is a serious public health problem in the United States where an estimated 90 million Americans are affected.

The spectrum of NAFLD includes fatty liver and non-alcoholic steatohepatitis (NASH). Fatty liver represents the build-up or accumulation of fat (triglycerides) in the liver cells.  In NASH, steato refers to fat and hepatitis means inflammation and damage to the liver. Patients with fatty liver have a relatively benign condition.  By contrast, NASH, due to the ongoing inflammation, can cause scarring and hardening of the liver. When it becomes extensive, it is called cirrhosis.

This condition (cirrhosis) may develop in up to 25% of patients and can lead to complications such as liver cancer, liver failure and liver-related death or the requirement for liver transplantation. In fact, rates of transplantation performed for NASH have increased in the USA over the past 10 years, rising from 0.1% in 1966 to 4.7% in 2007.

Conditions frequently associated with NASH include being overweight or obese, type 2 diabetes mellitus and hyperlipidemia (high blood triglycerides and/or cholesterol). NASH is also closely associated with “metabolic syndrome”, which is a risk factor for cardiovascular disease. Therefore, it is not surprising that cardiovascular disease is a leading cause of death in subjects with NAFLD.

Most people with NASH have no symptoms and it is often discovered during routine laboratory testing when liver enzymes (AST/ALT) are found to be elevated.  Imaging studies like ultrasound and CT scan can assist to evaluate the presence of NASH. Usually a liver biopsy is required to confirm the diagnosis as well as to determine the severity of the disease. This procedure is safely done, under local anesthesia, by an expert radiologist. While guided by an ultrasound machine, the radiologist introduces a slender needle into the liver to obtain a sample that is then examined under a microscope.

Other causes of chronic liver disease (e.g. viral hepatitis B & C, medications, etc.) should also be excluded during the evaluation of these patients.

Treatment is focused on weight loss through exercise and decreased caloric intake; consultation with a nutritionist can help achieve this goal. Also good control of blood sugar in diabetic patients, as well as decreasing blood triglyceride and cholesterol levels when elevated, will help in the treatment of this condition.

 

The Pill Camera

What is it?

Capsule endoscopy refers to a relatively new technology that gastroenterologists use to examine the deepest portions of the digestive tract. In 1981, an Israeli engineer named Dr. Gavriel Iddan began work on designing a disposable pill-sized camera that could be swallowed and would pass directly through the intestine. In 2001, after twenty years of research and development, the FDA approved the Given Diagnostic Imaging System called

Capsule EndoscopyHow does it work?

An “endocapsule” is a miniature video camera that has been incorporated into a capsule-shaped device along with a light source, transmitter and battery. It has a biocompatible coating which allows it to be safely swallowed and pass undigested through the intestinal tract. During this journey, it transmits over 50,000 color images via radio frequency to a recorder worn on a belt on a patient’s hip or waist. The pill weights only 1/7th of an ounce and is about the size of a large vitamin. Once swallowed, the capsule moves through the intestine, naturally aided by the muscular contractions of the intestine.

What does it do?

Since the advent of capsule endoscopy, gastroenterologists have been able to make diagnoses not previously made using conventional methods. For example, in disease such as Celiac Sprue and Crohn’s disease, the endocapsule has assisted in visualizing areas that were previously unreachable without major surgery. Additionally, capsule endoscopy has played a major role in advancing the diagnosis and treatment of obscure gastrointestinal bleeding. Additionally, it has been helpful in identifying tumors of the small intestine and evaluating polyposis syndromes. Subsequent development of an esophageal capsule also provides a modality to monitor GERD (gastroesophageal reflux disease) non-invasively.

What to expect

Typically, patients undergoing an endocapsule study will have a preparation that will consist of a brief fasting period. Some physicians may also recommend a bowel prep to cleanse the small intestine before the study. This outpatient procedure will begin in your doctors office. After a brief orientation, you will swallow the endocapsule and be asked to wear a small data recorder around your waist during the test.  You will be able to drink clear liquids and eat a light meal about two hours after the pill has been swallowed. Approximately 8 hours later, you will be asked to return to your doctor’s office so the data recorder can be removed and the images downloaded to a computer for physician viewing. The capsule will then be eliminated from your body normally in your feces during a bowel movement.

To date, well over a million endocapsules have been used in clinical practice and demonstrated the overall safety of this technology. Complications are extremely rare, especially when performed by specialists who have extensive experience with the endocapsule. Wireless capsule endoscopy is a safe, reliable, and noninvasive technology that can be very useful in the diagnosis and treatment of disorders of the esophagus and small intestine. If you are interested in this exam or think that it may be beneficial to your treatment, ask your physician for more information.

Are you gluten sensitive?

Celiac disease is a chronic intestinal disease that is caused by the body’s heightened sensitivity to gluten, a protein found in wheat, barley, and rye. Although the earliest known reports of celiac disease date back to the first century AD, celiac disease is now being diagnosed with increasing frequency due to improved testing and heightened public awareness.

Although most people with Celiac disease do not have clear symptoms, they often suffer from gastrointestinal complaints, such as gas, bloating, and flatulence. Other signs of Celiac disease are related to the body’s difficulty in absorbing food, resulting in diarrhea, abdominal pain, and weight loss.

Celiac disease may also create symptoms outside the gastrointestinal tract, such as rashes (dermatitis herpetiformis) and anemia due to deficiencies of iron, folic acid, B12, calcium, magnesium, zinc or other needed nutrients. In young children, Celiac disease can result in developmental problems.

Celiac disease is an inherited disease associated with certain chromosomal markers. That means it’s important to review your family history to see if parents or siblings have suffered from these types of problems. In many cases, screening of the blood looking for certain antibodies may assist in making a diagnosis of Celiac disease. Confirming this condition may require taking biopsies from the duodenum during an upper endoscopy.

The treatment of Celiac disease requires lifelong strict adherence to a gluten-restricted diet. This can be difficult due to the widespread use of gluten in many food products. However, an increasing number of grocery stores, bakeries and restaurants are now aware of Celiac disease and offer patrons gluten-free foods. Consultation with a registered nutritionist is also often recommended and usually proves quite helpful in the successful treatment of this condition.

In rare instances, specific nutritional therapies and corticosteroids may be necessary to manage Celiac disease. In any case, regular follow-up care with a gastroenterologist is advised to manage potential complications, including malignancies of the GI tract and other associated conditions.

If you suspect that you or a loved one may have signs and symptoms of celiac disease, the physicians and nutrition staff at Gastro Health can assist in the diagnosis and management of the condition.

Attention Baby Boomers

CDC issues new guidelines for Hepatitis C screening for the “Boomer” Generation (1945-1965)

In August 2012, the Centers for Disease Control issued new guidelines for screening of the Chronic Hepatitis C infection. The previous guidelines had targeted only persons thought to be at high risk, such as those who received a blood transfusion prior to 1992, used intravenous illicit drugs, were on hemodialysis, had HIV disease, known exposure to the virus, or born to a mother with known hepatitis C. However, now the new recommendations state that any person born between 1945 and 1965 should be screened once, regardless of risk factors.

The new guidelines were adopted for several reasons. Firstly, 75% of those with hepatitis C were born in those years. Also, more than half of people with hepatitis C are unaware that they have it. Complications and deaths from chronic hepatitis C are on the rise. It has been shown that screening is cost-effective and saves lives. Finally, new treatments can cure up to 75% of chronic hepatitis C cases.

Screening involves a simple blood test performed only once. Normal results of so-called liver function blood tests do not rule out hepatitis C. Up to 50% of persons infected can actually have normal results of these tests.

Hepatitis C is a virus that attacks the liver. It is mainly transmitted through contaminated blood. Hepatitis C can be present and actually cause no symptoms for many years, even decades, and has therefore been called the “silent epidemic.” Up to 20% of those infected will develop severe scarring and liver impairment known as cirrhosis of the liver and a significant percentage of these will develop primary liver cancer. Chronic hepatitis C is the most common indication for liver transplantation in the United States. It is the cause of up to 15,000 yearly deaths, with the number expected to rise.

So, if you were born between 1945 and 1965 and wish to be screened, please call a screening hotline or be sure to set up an appointment with Gastro Health by calling (305)468-4180.