Management of Anal Fistulas

Anal fistulas are common conditions that require specialized care by a surgeon well trained in the management of anorectal problems. An anal fistula is a tunnel covered with rectal and skin lining called epithelium that presents either as an acute infection or recurrent pain and passage of purulent secretion. Patients presenting with recurrent abscesses are […]

Cancer of the Stomach

Affecting 25,000  individuals a year and the cause of approximately  11,000 annual deaths, stomach cancer, also known as gastric cancer, is relatively new in the United States.

95% of these cancerous tumors, or adenocarcinomas, are the second most common cause of cancer- related deaths worldwide. They can be divided into two classes, the first being gastric cardia cancer which occurs in the top portion of the stomach near the junction of the esophagus, and the second type is non-cardia gastric cancer which may be found in all other areas of the stomach.

Adenocarcinomas develop in the cells lining the innermost (or mucosal) layer of the stomach making precancerous lesions rarely detected since symptoms are difficult to detect at early stages. Yet, overall gastric cancer has shown a decrease in occurrence, specifically non-cardia gastric cancer because of better diet, better food refrigeration and the use of antibiotics for treatment.

One major cause of gastric cancer is the Helicobacter pylori bacteria infection, specifically distal gastric cancer. It is also associated with gastric mucosa and with lymphoid tissue (MALT) lymphoma, another type of gastric cancer. Men have a higher risk of developing this type of cancer and other risk factors include chronic gastritis, smoking, diet, blood group type, as well as inherited cancer syndromes.

The great majority of people infected with Helicobacter pylori never develop neoplasia, the formation of such tumors. Upper endoscopy (EGO) is the most important diagnostic test for the detection of gastric cancer, as well as endoscopic ultrasonography (EUS) which aids in the diagnosis and staging of gastric cancers. Via these procedures biopsies can be obtained for analysis. The use of the aforementioned modalities such as imaging studies and CT scanning help arrive at a clinical staging of the disease and determination of whether surgery should be considered or not.

Survival rates strongly depend on the extent of how far the cancer has spread at the time of surgery.

Generally, survival rates are reported to be around 30% within the first five years, a modest improvement  over the last couple of decades with initial staging remaining the key factor for such increase. Identification   of   individuals at increased risk, or those with unexplained symptoms should be aggressively evaluated as early endoscopy saves lives.

Probiotics: To Take or Not to Take?

What  are Probiotics? The World Health Organization defines probiotics as live organisms (bacteria or yeast) which, when administered in adequate amounts, confer a health benefit. The public is exposed to pervasive claims for probiotics, by a multi-billion dollar industry, without clear guidance or convincing raw data. Ads promise that probiotics will fortify digestion, strengthen immunity, […]

Barrett’s Esophagus

What is Barrett’s Esophagus?

Barrett’s Esophagus is a pre-cancerous condition of the esophagus. The esophagus is the tube that connects the mouth to the stomach. In Barrett’s Esophagus, the lining of the lower esophagus change in form to look more like the lining of the stomach. This change happens due to years of cell injury from acid reflux into the esophagus from the stomach. The change in the cell lining is a defense mechanism against acid injury because the cells that line the stomach are more resistant to acid injury. Unfortunately, these new cells have a risk of becoming cancerous due to the repeated injury from the acid.

Who is at risk?

Anyone with a long history of heartburn symptoms or GastroEsophageal Reflux Disease (GERD). It is more common in men than in women. It is also more common in people of Caucasian descent, but can occur in any ethnicity. People who smoke are at higher risk than non-smokers.

What are the symptoms?

There are usually no symptoms from the change in the cell lining in Barrett’s Esophagus. Most people diagnosed with Barrett’s Esophagus usually present to their doctor due to symptoms of heartburn, acid reflux or trouble swallowing.

How is it diagnosed?

If you have symptoms of GERD with any risk factors, a gastroenterologist can perform an upper endoscopy. An upper endoscopy is a procedure performed to look inside your esophagus to determine if you have the changes of Barrett’s Esophagus. It is a painless procedure and requires sedation. If necessary, a small piece of the abnormal tissue can be taken (a biopsy) so that it can be studied under a microscope to confirm the diagnosis.

How is it treated?

The most important form of treatment and prevention is to change your diet to avoid foods that cause acid reflux and its symptoms. Common foods to avoid are tomato-based foods and sauces, citric juices, coffee, caffeine, chocolate, alcohol and foods high in fat. Changes in lifestyle are also important. Such changes are to quit smoking, eat smaller meals and not to lie down soon after eating a meal.

The use of medications to reduce acid production from the stomach can also help decrease the injury to the lining of the esophagus. Some of these medications are available without a prescription, but you should still consult a gastroenterologist about their use. In select cases where medications do not help, there may be some surgical procedures than can help.

You may require surveillance of the abnormal lining with periodic upper endoscopy and repeat biopsy.   If pre-cancerous changes are detected on biopsy during endoscopy, then it may be possible to remove or destroy the abnormal tissue during an upper endoscopy. This form of treatment should only be performed by gastroenterologist who has experience with it and performs the treatment regularly.


Barrett’s Esophagus is a chronic, pre-cancerous condition of the esophagus caused by repeated injury to the lower esophagus from acid reflux. It is diagnosed by upper endoscopy and, if present, should be treated early to prevent the formation of esophageal cancer. If you have a long history of heartburn, acid reflux, trouble swallowing or any of the risk factors listed above, please talk to your primary care physician or get referred to a Gastroenterologist to discuss your risk for Barrett’s Esophagus.