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.

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.

Gluten-Free Corner

Gluten-free dining can be enjoyable, healthy and nutritious. More restaurants and food companies are becoming in tune with the special dietary needs of the Celiac Disease population. Here, you will see a list of some restaurants that provide a “gluten-free” menu; be sure to let your server know that you have a food allergy to wheat, barley, rye and malt. Also included is a healthy gluten-free grocery list.

There are several resources out there to further guide your dietary needs, including the highly-recommended book “Gluten-Free Diet” by Shelley Case, RD.

Enjoy and healthy dining!

Gluten-Free Friendly Restaurants

Here is a list of restaurant in the Miami area that have a gluten-free menu:

  •        Romano’s Macaroni Grill – various locations
  •        BJ’s Brewhouse – The Falls Shopping Center
  •        P.F. Chang’s – various locations
  •        Fleming’s – Coral Gables
  •        California Pizza Kitchen – Coral Gables
  •        Yard House – Coral Gables
  •        Outback Steakhouse – various locations
  •        Carino’s – Doral
  •        Chipotle – various locations
  •        Carrabba’s – various locations
  •        YogurtLand – South Miami
  •        Naked Pizza – Coral Gables
  •        Rosa Mexicano – Brickell
  •        Crave – Coral Gables
  •        Pizza Fusion – Miami Beach
  •        Thrive – Miami Beach

Gluten-Free Grocery List

Bread/Grains

  •        corn tortillas
  •        rice crackers
  •        gluten-free cereal
  •        buckwheat
  •        quinoa
  •        rice
  •        flax

Frozen

  •        vegetables
  •        fruits
  •        gluten-free ice cream or sherbet
  •        gluten-free waffles
  •        gluten-free frozen dinners/pizza

Meat/Protein

  •        fish/shellfish
  •        hot dogs
  •        canned tuna
  •        tofu
  •        poultry
  •        lunch meat
  •        beef

Cans/Jars

  •        vegetables
  •        fruits
  •        Beans
  •        gluten-free soup
  •        apple sauce
  •        pasta sauce
  •        canned milk
  •        nut butters
  •        jam honey

Beverages

  •        coffee/tea
  •        gluten-free beer
  •        juice
  •        water

Dairy

  •        milk
  •        whipped cream
  •        cheese
  •        sour cream
  •        butter/margarine
  •        eggs
  •        yogurt
  •        gluten-free pudding

Snacks

  •        rice cakes
  •        rice or soy crackers
  •        sunflower seeds
  •        popcorn
  •        dried fruit
  •        corn chips
  •        Jell-O

Condiments and Baking

  •        white or red wine vinegar
  •        shortening
  •        olive, canola, or vegetable oil
  •        salad dressing
  •        spices
  •        cornstarch/meal
  •        gluten-free flour
  •        cocoa
  •        syrup
  •        xanthan gum

Fruit/Veggies

  •        fruits
  •        vegetables
  •        herbs

www.FreePrintableGroceryList.com

Pediatric News: Coping with IBD

It is never easy to learn that you have a chronic illness, especially as a child. It can make them feel afraid, sad, nervous, or just “different.”

Children with Inflammatory Bowel Disease (IBD) face the challenge of an unpredictable and potentially embarrassing disease. They may be embarrassed about their symptoms or frequent visits to the bathroom, and they may fear being the target of the “bathroom humor” that is popular amongst children. In addition to the embarrassing symptoms, short stature and delayed puberty, simply having a chronic illness may contribute to feeling “different” from peers.

Participation in school and social activities may be adversely affected. IBD clearly has the potential to impact psychosocial functioning. Children with IBD appear to be at risk for more difficulties in psychosocial functioning than healthy children, although the problem reaches clinical significance in only a subset.

The difficulty experienced by children with IBD is generally similar to that experienced in other chronic health conditions. In the area of behavioral/emotional functioning, mood and anxiety disorders are most common.

Children with IBD are at increased risk for problems in social functioning, but the nature of their social difficulties is unclear. Mixed results have been found in the areas of family dysfunction and body image, and limited research exists in the areas of stress and coping, self-esteem, and eating problems.

Signs of Difficulty Coping

Watch for any of these behaviors, which may indicate that your child is having trouble transitioning to life with IBD:

• Difficulty sleeping

• Poor eating habits

• Persistent sadness and/or frequent crying

• Lack of interest in usual activities and hobbies

Helping Your Child Cope

If your child seems to be having trouble dealing with his or her IBD, parents and trusted adults can be a great source of comfort and help. Keep the lines of communication open, and be sure to let the child know:

• It’s normal to feel sad or anxious about IBD

• With IBD treatment, most kids lead normal, active lives

• It’s important to talk about your feelings with a parent or a doctor

• Anything you share with a doctor is confidential and private—he or she can’t tell anyone else without your permission

• Kids are different for all kinds of reasons—you’re great the way you are!

myIBD

Pediatric News: Coping with IBDPediatric News: Coping with IBD

A great resource for children and families to track IBD symptoms is “myIBD”. This free app can be downloaded from the app store for use on a handheld device such as iPod/iPad /iPhones or Android Smartphones.

This app has provided a novel way of empowering young patients and their families to come to terms with the diagnosis of IBD. It enables patient-driven learning by engaging children/teenagers and allowing the contemporaneous symptom monitoring and documentation of adherence to prescribed medication. This application has given young patients and their families the opportunity to preview/review the information given during the face-to-face meeting with their physician. The app includes a feature to monitor disease activity and treatment compliance in real time as well as educational videos and links. This has allowed young patients to take control of their symptom reporting, to generate a clinical summary-PDF prior to follow-up in the IBD clinic and to actively prepare for a transition to adult care.

Investigative Overview: Gastroparesis

Gastroparesis can be literally translated to mean “stomach paralysis.” In this disorder, there is an abnormal or absent motility of the stomach. This is a common disorder which is most frequently associated with diabetes. However, in approximately 50% of individuals, other factors may play a precipitating role. For example, underlying medical conditions such as scleroderma and hypothyroidism may be associated with decreased gastric motility. Also, common neuromuscular disorders such as Parkinson’s disease and spinal cord injuries may be associated with gastroparesis. A thorough review of all medication is important given that many medications may lead to decreased gastric and intestinal motility. For example, narcotics, certain anti-hypertensive medications (such as diltiazem and verapamil), hormones (progesterone), and levodopa (used for Parkinson’s disease) have all been associated with decreased gastric motility.

Symptoms

Symptoms of gastroparesis include bloating, nausea, and early fullness particularly with the ingestion of fatty meals and high-fiber foods such as raw fruits and vegetables. Many individuals also experience accompanying upper abdominal pain and reflux symptoms. Vomiting of undigested foods several hours after their ingestion is highly suggestive of underlying gastroparesis. Some individuals may eventually experience weight loss due to malabsorption of nutrients or diminished food intake from their underlying symptoms.

Diagnosis

Due to the fact that the symptoms of gastroparesis are often associated with other upper digestive tract disorders, endoscopic (upper endoscopy) and/or radiologic tests (upper GI series) are often ordered to exclude alternate diagnoses. However, the most commonly ordered exam used to diagnose gastroparesis is a gastric emptying scan. During this exam, which is performed in a nuclear medicine department, a standard meal (usually consisting of an egg substitute) mixed with a small amount of radioactive material is ingested. The emptying of this meal from the stomach over a 4-hour period is determined. The amount of time required for the patient’s gastric emptying is then compared to control population. Of interest, new technologies such as a wireless capsule (SmartPill®) are being used to measure gastric emptying through the use of different information including: pH, temperature and pressure changes.

Treatment

Diet remains one of the mainstays of treatment for gastroparesis regardless of its cause. In general, individuals with gastroparesis should avoid fatty foods and fibrous foods (raw fruits and vegetables) which take a longer time to digest. Also, rather than eating three meals a day, affected persons should eat smaller, more frequent meals. Diabetics must maintain adequate control of their blood glucose whose elevation may lead to a decrease in gastric emptying. Currently, there are three medications that can be used to treat gastroparesis: metoclopramide, domperidone and erythromycin.

Metoclopramide stimulates gastric contraction and also possesses anti-nausea effects. However, it has been linked to severe side-effects including a possibly irreversible facial twitching called tardive dyskinesia. For this reason, its long-term use is minimized or limited.

Domperidone is similar to metoclopramide, but is not associated with neurologic side-effects due to the fact that it does not act on receptors in the brain. Unfortunately, it is not readily available in the United States, but can be found in South America, Canada, and Europe.

Erythromycin is a commonly used antibiotic that binds receptors in the stomach call motilin receptors. Stimulation of these receptors leads to gastric contraction and improved gastric emptying. However, erythromycin is only effective for brief periods of time.

Lastly, Iberogast is a liquid herbal supplement that has been used in Europe for over 4 decades and has been shown to improve gastric motility is small studies. Rarely, individuals may need to consider invasive procedures such as a gastric pacemaker that has been shown in some studies to improve the symptoms.

In summary, gastroparesis is a common condition leading to altered gastric motility. Although diabetes is its most common cause, other contributing causes should not be excluded. Diet and various medications often lead to marked symptomatic improvement.

What Can Remicade Do For You?

So your GI doctor says to you, “I think we should use Remicade to treat your IBD (Inflammatory Bowel Disease). We can set you up to do convenient in-office infusions.”  Your brain suddenly goes into overdrive. You have so many questions! What is Remicade? How is it given? What is an in-office infusion? What are the side effects?  Don’t fret. Read on and you will find the answers to all of these questions, and more.

Remicade (Infliximab) is an immunosuppressive prescription drug used to treat autoimmune diseases, such as Crohn’s Disease, Ulcerative Colitis, Rheumatoid Arthritis, Psoriatic Arthritis and Anklylosing Spondylitis.  This autoimmune response is caused by too much of a protein called tumor necrosis factor-alpha (TNF-alpha) circulating in the body. High levels of this protein cause the body’s immune system to mistakenly attack and destroy cells in the body.

In the case of Ulcerative Colitis (UC), the attack occurs in the large intestines. In Crohn’s disease, the gastrointestinal tract from the mouth to the anus is assaulted causing inflammation. This can lead to symptoms of diarrhea, abdominal pain and GI bleeding. Remicade blocks the TNF-alpha protein produced by the immune system. This reduces inflammation and puts the Crohn’s and UC into remission. Remicade has been used to treat over 1 million patients with autoimmune diseases and has been studied for over 17 years.

Remicade is given by intravenous (IV) infusion, which means it is administered directly into a vein in the arm or hand. For over 10 years, Gastro Health has been performing safe, efficient and cost effective in-office Remicade infusions. The Remicade is administered by experienced infusion Registered Nurses who provide not only the treatment and patient education but also act as a patient advocate, helping the patient navigate through the healthcare system.

The infusion takes approximately two hours. The first three infusions (the induction doses) are given within a six-week period. After that, the maintenance infusions are every eight weeks. The physician can alter this schedule depending on the response to treatment. Most patients see symptom improvement after the first three infusions, but some patients see results after the very first infusion.

Upon arriving to the infusion center, the patient will be registered and escorted to the infusion room where there are comfortable lounge chairs. This can be a time to meet other people with a similar diagnosis, support each other and make new friends. A general health assessment will be performed along with the monitoring of vital signs. The dose of Remicade will be calculated by the RN based on the patient’s weight, and then an IV will be started in the hand or arm. The medication will be mixed once the IV has been started, and the IV bag containing the Remicade will be connected and infused via the IV. Vital signs will be monitored throughout the infusion. During the infusion and for a period of time afterwards, the nurse will also closely monitor for signs of any problems.

At the conclusion of the infusion, the IV will be removed from the arm or hand. The patient can schedule the next infusion prior to leaving the infusion center.  The infusion is non-sedating, so once the infusion is complete the patient can enjoy the rest of their day.

Although the commitment to receiving Remicade infusions maybe long-term, most patients are very happy that they have this treatment available to them and have had significant improvement in their quality of life. So if your doctor recommends Remicade infusions, don’t fret – look forward to being taken care of in a supportive environment by your very own patient advocate, an opportunity to meet folks that have the same disease you have and most importantly, look forward to an improved quality of life.

Dealing with Gas and Bloating

Functional gastrointestinal disorders such as Irritable Bowel Syndrome (IBS) are very common, ranking second in the causes of absence from work or school. Bloating is one of the most common manifestations of IBS, caused by distension of the gut lumen by gas leading to pain, the sensation of bloating and visible abdominal distension. The amount of gas in your gut depends on the amount of air you swallow and bacterial production in the distal small and proximal large bowel. Increased production can be the result of bacterial digestion of carbohydrates incompletely digested by enzymes in the intestines allowing bacteria to digest them, as occurs with lactose intolerance. However, most people who complain of excessive gas and bloating do not produce more gas than the average person – they are just more aware of it because of increased sensitivity to gas, one of the hallmarks of IBS.

If you eat too fast, gulp liquids, drink lots of carbonated beverages, chew gum, smoke or swallow saliva constantly, you can end up swallowing too much air. Fortunately, most swallowed air can be eliminated when sitting up by belching. Eating peppermint, chocolate and fats relax the lower esophageal sphincter and may help. However, if lying down some of the gas tends to pass into the intestine which can cause excessive passage of gas. This swallowed air is mainly nitrogen together with the byproducts of the digestion of carbohydrates by the intestinal flora like carbon dioxide, hydrogen and methane, which are odorless. Traces of sulfur compounds are responsible for the occasional unpleasant odor.

Most people with gas and bloating do not need to have any testing unless there are alarm symptoms such as diarrhea, weight loss, abdominal pain, anemia, blood in the stool, lack of appetite, fever or vomiting. If this is the case you should see a gastroenterologist to get further testing such as a blood test for celiac disease, a hydrogen breath test for lactose and/or fructose intolerance or even an endoscopic evaluation of your gastrointestinal tract.

Restrictions of dietary components that can lead to luminal distension, due to poor proximal absorption and subsequent fermentation by bacteria more distally in the intestines, form the basis of the low FODMAP diet approach to the management of functional gastrointestinal symptoms.

FODMAP stands for:

Fermentable

Oligosaccharides (fructans and galactans)

Disaccharide (lactose)

Monosaccharide (fructose) And

Polyols (sorbitol)

Food lists are available emphasizing suitable alternatives, and the best outcomes are achieved in a one-to-one setting with a dietitian. Although there are no controlled studies supporting efficacy, several OTC medications are available to help reduce bothersome gas such as simethicone (which breaks up bubbles), activated charcoal (adsorbent), Beano (breaks down complex carbohydrates) and bismuth (reduce odor).

What is Celiac Disease?

Celiac disease is a condition in which a protein found in certain foods – gluten – causes the immune system to damage the small intestine. The small intestine is responsible for absorbing food and nutrients. However, when the lining of the small intestine is damaged this can cause problems with absorbing nutrients which is referred to as malabsorption. Gluten is found in wheat, barley, rye and several condiments, sauces and spreads. It is not clear what exactly causes celiac disease, but there is a combination of environmental and genetic factors. Celiac disease can affect both male and females of any age. Although there is no cure for celiac disease, avoiding gluten can stop the damage to the lining of the small intestine.

What are the common symptoms?

The symptoms of celiac disease can vary from person to person. Some people may have no symptoms, yet exhibit signs of malabsorption detected on blood tests. Others can develop a variety of gastrointestinal complaints. The most common symptoms experienced are abdominal discomfort, diarrhea, bloating, weight loss and decreased energy. There can also be other signs and symptoms of vitamin and nutrient deficiencies that can cause anemia, bone loss, nervous system disorders and skin rash. Children with celiac disease can have a poor appetite, slow growth and have difficulty gaining weight.

How is Celiac Disease Diagnosed?

Celiac disease can be difficult to diagnose because its signs and symptoms can resemble other conditions. However, there are blood tests available which can help make the diagnosis. These blood tests look for proteins (antibodies) that can become elevated in people with celiac disease. It is important to continue eating gluten while being tested because avoiding it can cause these proteins to become normal. If the blood test is positive for celiac disease, the diagnosis is confirmed by obtaining a sample of the small intestine. The sample (known as a biopsy) is obtained by performing an upper endoscopy and the sample is viewed under a microscope to see if there has been any damage to the lining of the small intestine. An upper endoscopy is a procedure performed by a gastroenterologist during which a small flexible tube with a camera is introduced through the mouth and a small piece of tissue from the small intestine is removed.

How is Celiac Disease Treated?

The cornerstone of treatment for celiac disease is elimination of gluten from the diet.  This can be overwhelming initially because many foods that we eat and even condiments that we cook with contain gluten. Therefore, consulting with an experienced dietician can help you learn how to eat, shop and prepare a gluten-free diet.  Most patients will notice an improvement in their symptoms within two weeks. Rarely, patients fail to have improvement in symptoms despite adherence to a gluten-free diet. This is considered refractory celiac disease and requires medications which suppress the immune system (like steroids). It is important to remain on a strict gluten-free diet despite feeling well to prevent nutritional deficiencies and certain types of gastrointestinal cancer. Families should be aware of their increased risk of developing celiac disease and anyone with symptoms should be tested. Various local and national support groups help increase awareness and make living a gluten-free lifestyle achievable.

Treating Hemorrhoids

Hemorrhoids are a normal part of the human anorectal anatomy. They do not constitute a disease unless they become symptomatic. The prevalence of symptomatic hemorrhoids in the United States is reported to be 4.4%, affecting men and women equally. Hemorrhoid disease accounts for 3.2 million ambulatory care visits, 306,000 hospitalizations and the issue of over 2 million prescriptions a year. Hemorrhoids, when symptomatic, can be treated successfully. Treatment can be divided into four different steps:

Step 1: Dietary and Lifestyle Modification

Constipation is one of the most common causes of symptomatic hemorrhoid disease. Dietary management with increased fiber and water intake is the primary noninvasive mean to treat constipation.

– Psyllium is the principal fiber supplement used in concert with water to add moisture to the stool, ameliorating constipation.

-Other alternative medications include witch hazel, horse chestnut, ginger root, butchers broom, rutin, hesperidin and diosmin – all mainly used in homeopathic medicine.

Step 2: Topical Agents

Most of the creams, ointments and suppositories prescribed for the treatment of symptomatic hemorrhoids contain corticosteroids. They are good for the short-term treatment of the hemorrhoid flare, but its chronic use is discouraged do to the possibility of permanent damage to the perianal skin. They could also promote opportunistic infections such as fungal dermatitis. Some creams are mixed with local anesthetics such as lidocaine and pramoxine, which could give short-term relief. Other alternative medications that are used locally are astringents such as Witch Hazel (Hammamelisvirginiana), Aloe Vera and phenylephrine.

Step 3: In-Office Procedures

The goal of in-office procedures is to ablate the vessels involved and fix the sliding hemorrhoidal tissue back onto the muscle wall of the anal canal with minimal pain. These procedures include:

Sclerotherapy: indicated for grade 1 and 2 internal hemorrhoids. It involves a submucosal injection of a sclerosant at the apex of the hemorrhoid and usually causes thrombosis of the vessels with shrinkage and fixation.

Rubber Band Ligation: the most commonly used in-office procedure, indicated for internal hemorrhoids grades 1, 2 and 3. Ligators deploy a rubber band around a hemorrhoid pedicle. The procedure is usually painless and takes only a few minutes to perform. The ligated tissue usually necroses and sloughs in 3-4 days, causing elimination of the redundant tissue and fixation.

Infrared Coagulation (IRC):  produces an infrared light which penetrates the tissue and converts to heat, promoting coagulation of the vessels and fixation. It is usually indicated for small bleeding internal hemorrhoids, grade 1.

Electrocoagulation and Bipolar Coagulation: indicated for small bleeding internal hemorrhoids, relies on coagulation and fixation as other techniques. It is somehow less effective and more painful than RBL and IRC.

Direct-Current Electrotherapy (Ultroid):  is similarly applied through a probe placed via an anoscope into the mucosa at the apex of the hemorrhoid. It is a lengthy procedure and reapplications to the same site are sometimes required.

Thrombectomy: usually indicated for the therapy of small thrombosed external hemorrhoids. The procedure usually does not excise the involved hemorrhoid complex, but rather evacuates the blood clot beneath the anal skin, relieving the tension and pain immediately.

Step 4: Surgical treatment

Several options and techniques are available for the surgical treatment of symptomatic hemorrhoids. They include:

Doppler Guided Hemorrhoidal Artery Ligation: using a Doppler transducer, the hemorrhoidal arteries are identified and ligated. It causes less pain than a traditional surgical hemorrhoidectomy, but sometimes, the large prolapse of grade 4 internal hemorrhoids or the prolapsing of large external hemorrhoids are difficult to address.

Excisional Hemorrhoidectomy: several techniques exist to excise the hemorrhoid tissue, including: the closed or Ferguson, the open or Milligan-Morgan, the Nd-YAG laser, and the use of energy instruments such as the Harmonic Scalpel and Ligasure. Postoperative pain and prolonged healing time are some main disadvantage. Long-term results are usually excellent.

Stapled Hemorrhoidectomy:  also known as PPH (procedure for prolapsed hemorrhoids), thought to decrease the amount of postoperative pain. A portion of the rectal mucosa and submucosa close to the apex of the hemorrhoid pedicle is excised and stapled again. The hemorrhoids are re-suspended and brought back into the anal canal. A major drawback of this technique is that the procedure does not treat the large external hemorrhoids and associated tags sometimes present. The use of PPH is limited to patients with large grade 3 and 4 internal hemorrhoids.

Evidence Points to Colonoscopy in Preventing Colorectal Cancer

Colorectal Cancer, also known as Colon Cancer, is the third most common occurring cancer and the second leading cause of cancer-related deaths worldwide. There are two basic ways to screen for colorectal cancer. FULL ARTICLE