GI Illnesses

The gastrointestinal specialists at GI Associates have diagnosed and treated a variety of gastrointestinal problems.

This tool is for informational purposes only and should not be used to self-diagnose potentially serious GI illnesses. 

  • Barrett's Esophagus

    Barrett’s esophagus is a condition in which the lining of the esophagus changes, becoming more like the lining of the small intestine rather than the esophagus.


    What is Barrett's Esophagus?

    Barrett’s esophagus is a condition in which the lining of the esophagus changes, becoming more like the lining of the small intestine rather than the esophagus. This occurs in the area where the esophagus is joined to the stomach.

    It is believed that the main reason Barrett’s esophagus develops is because of chronic inflammation resulting from Gastroesophageal Reflux Disease (GERD). Barrett’s esophagus is more common in people who have had GERD for a long period of time or who developed it at a young age. It is interesting that the frequency or the intensity of GERD symptoms, such as heartburn, does not affect the likelihood that someone will develop Barrett’s esophagus.

    Most patients with Barrett’s esophagus will not develop cancer. In some patients, however, a precancerous change in the tissue, called dysplasia, will develop. That precancerous change is more likely to develop into esophageal cancer.

    At the current time, a diagnosis of Barrett’s esophagus can only be made using endoscopy and detecting a change in the lining of the esophagus that can be confirmed by a biopsy of the tissue. The definitive diagnosis of Barrett’s esophagus requires biopsy confirmation of the change in the lining of the esophagus.

    Am I at risk for esophageal cancer?

    There are two main types of esophageal cancer: squamous cell cancer and adenocarcinoma of the esophagus. Squamous cell cancers occur most commonly in individuals who smoke cigarettes, use tobacco products and drink alcohol. In addition, African Americans are also at increased risk of developing this type of cancer. This cancer is also very common in many areas in Asia. The frequency of squamous cell cancer of the esophagus in the United States has remained the same. Another cancer, adenocarcinoma of the esophagus, occurs most commonly in people with GERD. It is also very common in Caucasian males with increased body weight. Adenocarcinoma of the esophagus is increasing in frequency in the United States.

    The most common symptom of GERD is heartburn, a condition that 20 percent of American adults experience at least twice a week. Although these individuals are at increased risk of developing esophageal cancer, the vast majority of them will never develop it. In a few patients with GERD (about 10 to 15 percent of patients), a change in the lining of the esophagus develops near the area where the esophagus and stomach join. When this happens, the condition is called Barrett’s esophagus. Doctors believe that most cases of adenocarcinoma of the esophagus begin in Barrett’s esophagus.

    How does my doctor test for Barrett's Esophagus?

    Your doctor will first perform an imaging procedure of the esophagus using endoscopy to see if there are sufficient changes for Barrett’s esophagus. In an upper endoscopy, the physician passes a thin, flexible tube called an endoscope through your mouth and into the esophagus, stomach and duodenum. The endoscope has a camera lens and a light source and projects images onto a video monitor. This allows the physician to see if there is a change in the lining of the esophagus. If your doctor suspects Barrett’s esophagus, a sample of tissue (a biopsy) will be taken to make a definitive diagnosis.

    Capsule Endoscopy is another test that has been used to examine the esophagus. In capsule endoscopy, the patient swallows a pill-sized video capsule that passes naturally through your digestive tract while transmitting video images to a data recorder worn on your belt. With capsule endoscopy, the physician is not able to take a sample of the tissue (a biopsy).

    Both of these techniques allow the physician to view the end of the esophagus and determine whether or not the normal lining has changed. Only an upper endoscopy procedure can allow the doctor to take a sample of the tissue from the esophagus to confirm this diagnosis, as well as to look for changes of potential dysplasia that cannot be determined on endoscopic appearance alone. Barrett’s tissue has a different appearance than the normal lining of the esophagus and is visible during endoscopy.

    Taking a sample of the tissue from the esophagus through an endoscope only slightly lengthens the procedure time, causes no discomfort and rarely causes complications. Your doctor can usually tell you the results of your endoscopy after the procedure, but you will have to wait a few days for the biopsy results.

    Who should be screened for Barrett's Esophagus?

    Barrett’s esophagus is twice as common in men as women. It tends to occur in middle-aged Caucasian men who have had heartburn for many years. There is no agreement among experts on who should be screened. Even in patients with heartburn, Barrett’s esophagus is uncommon and esophageal cancer is rare. One recommendation is to screen patients older than 50 years of age who have had significant heartburn or who have required regular use of medications to control heartburn for several years. If that first screening is negative for Barrett’s tissue, there is no need to repeat it. There is a great deal of ongoing research in this area and so recommendations may change. You should check with your doctor on the latest recommendations.

    How is Barrett's Esophagus treated?

    Medicines and/or surgery can effectively control the symptoms of GERD. However, neither medications nor surgery for GERD can reverse the presence of Barrett’s esophagus or eliminate the risk of cancer. There are some treatments available that can destroy the Barrett’s tissue. These treatments may decrease the development of cancer in some patients and include heat (radiofrequency ablation, thermal ablation with argon plasma coagulation and multipolar coagulation), cold energy (cryotherapy) or the use of light and special chemicals (photodynamic therapy).

    It is necessary to discuss the availability and the effectiveness of these treatments with your gastroenterologist to be certain that you are a candidate. There are potential risks from these treatments and they may not benefit the majority of patients with Barrett’s esophagus. There is much research being conducted in this area; you should talk with your doctor about recommendations and guidelines.

    What is dysplasia?

    Dysplasia is a precancerous condition that doctors can only diagnose by examining tissue samples under a microscope. When dysplasia is seen in the tissue sample, it is usually described as being “high-grade,” “low-grade” or “indefinite for dysplasia.”

    In high-grade dysplasia, abnormal changes are seen in many of the cells and there is an abnormal growth pattern of the cells. Low-grade dysplasia means that there are some abnormal changes seen in the tissue sample but the changes do not involve most of the cells, and the growth pattern of the cells is still normal. “Indefinite for dysplasia” simply means that the pathologist is not certain whether changes seen in the tissue are caused by dysplasia. Other conditions, such as inflammation or swelling of the esophageal lining, can make cells appear dysplastic when they may not be.

    It is advisable to have any diagnosis of dysplasia confirmed by two different pathologists to ensure that this condition is present in the biopsy. If dysplasia is confirmed, your doctor might recommend more frequent endoscopies, or a procedure that attempts to destroy the Barrett’s tissue or esophageal surgery. Your doctor will recommend an option based on how advanced the dysplasia is and your overall medical condition.

    If I have Barrett’s Esophagus, how often should I have an endoscopy to check for dysplasia?

    The risk of esophageal cancer developing in patients with Barrett’s esophagus is quite low, approximately 0.5 percent per year (or 1 out of 200 per year). Therefore, the diagnosis of Barrett’s esophagus should not be a reason for alarm. It is, however, a reason to have periodic upper endoscopy examinations with biopsy of the Barrett’s tissue. If your initial biopsies don’t show dysplasia, endoscopy with biopsy should be repeated about every three years. If your biopsy shows dysplasia, your doctor will make further recommendations regarding the next steps.

    F.Y.I.

    Barrett’s Esophagus may be related to GERD (Gastroesophageal Reflux Disease), which occurs when contents in the stomach flow back into the esophagus due to the valve between the stomach and the esophagus not closing properly.

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  • Cancer & Polyps

    Before you begin to worry about colon cancer, let us see if you might be at risk. There really aren’t any physical symptoms to look for so you need to consider your risk factors and make...


    Before you begin to worry about colon cancer, let us see if you might be at risk. There really aren’t any physical symptoms to look for so you need to consider your risk factors and make sure that you have a colonoscopy at intervals suggested to you by your gastroenterologist. Remember, this list merely points out common risk factors and you should talk with a gastroenterologist at the GI Associates Clinic to find out if you are really at risk. If you have concerns about making an appointment, find out what to expect on your first visit

    • Colorectal cancer is more common in men and women over the age of 40 and that risk doubles after you reach 50. Men tend to develop more polyps than women, and there is a higher risk of those polyps developing into colorectal cancer.
    • Having a family history of polyps in the colon puts you at a higher risk.
    • Having an inflammatory bowel disease like ulcerative colitis can also put you at risk.
    • If your diet is high in fat and low in fiber you may be at risk, or if your diet is high in smoked and salt or nitrite-cured foods.
    • Heavy drinkers seem to be more at risk, and this risk increases if you are a smoker as well. Smoking increases the risk of various gastrointestinal cancers including stomach cancer and pancreatic cancer and smokeless tobacco increases the risk of cancer of the mouth, throat and esophagus.
    • Being overweight and/or sedentary puts you at a higher risk.

    Polyps

    During your colonoscopy, or any other colon cancer screening test, the gastroenterologist looks for polyps. A polyp is an abnormal growth that forms on the inner walls of the colon and sticks out into the colon passageway. They can range in size and quantity and can grow anywhere in the colon. The most common place for polyps to grow is the lower part of the colon. If there is a polyp found and it needs to be removed, it will be done during outpatient surgery. Most of the polyps found are not cancerous, however they may be classified as precancerous. Polyp removal is an important tool in preventing colon cancer.

    There are four main kinds of colon cancer screening tests:

    • Digital Rectal Exam should be done every year after the age of 40.
    • Stool Blood Test should be done every year after the age of 40.
    • Proctosigmoidoscopy (when a gastroenterologist inspects the wall of the colon with a lighted tube) should be done every year, but the exams can be done every 3-5 years if you have 2 normal exams.
    • Colonoscopy when your gastroenterologist recommends or at least by the age of 50.

    Pancreatic cancer is another gastrointestinal cancer, though it is not talked about as often. Early detection is necessary for the best treatment outcome and the treatment options range from surgery, radiation, chemotherapy, or medication. Gastrointestinal specialists are making progress in understanding more about pancreatic cancer and how to treat it. The symptoms of pancreatic cancer mimic those of other illnesses making it hard to detect but research has shown that chronic alcoholism and smoking can potentially lead to pancreatic cancer. The best advice is to make an appointment at the GI Associates Clinic to see if you are at risk.

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  • Celiac Sprue

    Celiac sprue is a digestive illness that damages the small intestine, where the most crucial part of digestion takes place. Most of the nutrients in our diet are absorbed for use by our...


    Celiac sprue is a digestive illness that damages the small intestine, where the most crucial part of digestion takes place. Most of the nutrients in our diet are absorbed for use by our bodies in this portion of the intestine. When the system is sensitive or allergic to gluten, then exposed to gluten, the portion of the intestinal wall that absorbs nutrients becomes damaged. This can cause severe health problems over time.

    Celiac Disease is considered an autoimmune disorder, which simply means that the body’s own immune system is turning on itself. People who suffer from it cannot tolerate gluten. Gluten is found in products that contain wheat, barley, rye, and some oat products. The good news/bad news is that with the prevalence of Celiac diagnoses there are many more gluten free items available on the store shelves.

    Because this diet restricts some essential nutrients, it is important to only embark on a gluten free diet under a doctor's supervision. Supplements will be needed to fill in the nutritional gaps.

    Gastrointestinal specialists are still doing a lot of research on celiac sprue, but they have found that it does seem to be a genetic problem. The problem is usually diagnosed in childhood, but the problem can remain inactive for a long time, becoming active only when there are extreme health problems or severe emotional stress. While many people in America have never even heard of it, it is the most common genetic disease in Europe. Nearly 1 in every 250 people in Italy have it, yet it almost never occurs in Africa, China or Japan. It is unknown how many Americans have celiac sprue because it is often under-diagnosed.

    While it is a genetic disorder, those who are of European descent and people with immune system disorders are at higher risk for developing celiac sprue. Such diseases include type 1 diabetes and rheumatoid arthritis, among others.

    Untreated, celiac can have severe consequences. If you suspect Celiac disease, please contact GI Associates for a complete work-up.

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  • Constipation

    Constipation is an uncomfortable, sometimes painful condition usually caused by lack of fiber and liquids in your diet. Frequency of bowel movements vary in individuals and there really...


    Constipation is an uncomfortable, sometimes painful condition usually caused by lack of fiber and liquids in your diet. Frequency of bowel movements vary in individuals and there really isn't a universal "normal," but stool should be able to pass easily and without pain.

    Occasional constipation is normal and could be a result of stress or changes in your routine. Most occasional constipation can be treated with the gradual addition of fiber and drinking plenty of water each day. 25 - 30 grams of fiber per day is the daily recommendation and adults should be drinking at least 64 ounces of water per day; more if you are working outside or live in a very hot, dry climate. DO NOT immediately resort to an over the counter laxative as these have detrimental long term consequences.

    Chronic contipation is a serious issue that should be addressed with your gastroenterologist. Also, if you notice blood in the stool or the color becomes very dark, you should see a doctor immediately. This may be a symptom of a much more serious condition.

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  • Constipation in Children

    This seems to be one of the most common complaints of children and occurs when there is difficulty passing stool. The frequency of bowel movements varies between children and their diets....


    This seems to be one of the most common complaints of children and occurs when there is difficulty passing stool. The frequency of bowel movements varies between children and their diets. There are several reasons your child could be experiencing constipation. They could be ignoring the urge to have a bowel movement, this is especially common if they have experienced what is called the “pain retention cycle.” This happens when they have experienced a hard, painful stool and then are trying to withhold future stool to avoid the pain. The longer the stool is retained in the rectum, the harder and drier it becomes causing the next bowel movement to be even more painful. This can create a cycle, making the goal of soft, regular stool more difficult to attain. The best treatment requires patience and time.

    Children who have constipation or who soil their clothes (encopresis) do this because they have large amounts of stool in their colon. This must be evacuated before any stool softeners will work. The gastrointestinal specialists at the GI Associates Clinic will be glad to discuss the various options with you to help eliminate the problem.

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  • Crohn's Disease

    There are two types of Inflammatory bowel disease - Ulcerative Colitis and Crohn's


    For more complete information please see Inflammatory Bowel Disease - IBD.

    Crohn's disease can involve any part of the intestine, small or large, and irritate not only the lining, but also deeper layers.

    Crohn's disease may occure at any age, including young children but occurs most often in young adults. Most cases of Crohn's disease are diagnosed before age 30. Crohn's disease tends to occur in families and in certain ethnic groups, such as Eastern European Jews. About 5-8% of patients may have a family member with IBD and about 20-25% of patients may have a close relative with the condition. However, it can occur in any ethnic group and in members of families where no one else is suffering from the disease.

    What Causes Crohn's Disease?

    It is currently believed that Crohn's disease occurs in individuals as a result of genetic and environmental factors. For unknown reasons, the immune system becomes abnormally active against the individual's own system. It targets not only the intestine, but sometimes other organs like the skin, the eyes, or the liver.

    If you are interested in connecting with others, who are living life with Crohn's, please visit Crohnology.

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  • Diarrhea

    Diarrhea is defined as loose, watery, stool that occurs with unusual frequency. Most people will experience occasional diarrhea and find it resolves itself without intervention. Diarrhea...


    Diarrhea is defined as loose, watery, stool that occurs with unusual frequency. Most people will experience occasional diarrhea and find it resolves itself without intervention. Diarrhea in children can turn into a dehydration issue more rapidly than in adults. If your child is experiencing diarrhea for at least 24 hours, please consult your pediatrician.

    In adults, diarrhea can occur as a result of illness or eating contaminated food. If experiencing temporary symptoms, make sure to drink plenty of fluids to avoid dehydration. Consult your doctor if your diarrhea symptoms last more than a few of consecutive days.

    Chronic diarrhea could be a symptom of a gastrointestinal condition that should be properly diagnosed and managed. If you suffer from chronic diarrhea, it is time to make an appointment with one of GI Associates specialists. It is important to be seen by a gastroenterologist, because there are many conditions that list diarrhea as one of it’s symptoms. From the fairly benign lactose intolerance to the more serious Crohn’s Disease, diarrhea could be a signal that something is wrong in your gut. A proper diagnosis and the resulting course of treatment can help you avoid this potentially debilitating issue.

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  • Diverticular Disease

    Diverticulosis is a condition in which there are small pouches or pockets in the wall or lining of any portion of the digestive tract.


    What is diverticulosis?

    Diverticulosis is a condition in which there are small pouches or pockets in the wall or lining of any portion of the digestive tract. These pockets occur when the inner layer of the digestive tract pushes through weak spots in the outer layer. A single pouch is called a diverticulum. The pouches associated with diverticulosis are most often located in the lower part of the large intestine (the colon). Some people may have only several small pouches on the left side of the colon, while others may have involvement in most of the colon.

    Who gets diverticulosis?

    Diverticulosis is a common condition in the United States that affects half of all people over 60 years of age and nearly everyone by the age of 80. As a person gets older, the pouches in the digestive tract become more prominent. Diverticulosis is unusual in people under 40 years of age. In addition, it is uncommon in certain parts of the world, such as Asia and Africa.

    What causes diverticulosis?

    Because diverticulosis is uncommon in regions of the world where diets are high in fiber and rich in grains, fruits and vegetables, most doctors believe this condition is due in part to a diet low in fiber. A low-fiber diet leads to constipation, which increases pressure within the digestive tract with straining during bowel movements. The combination of pressure and straining over many years likely leads to diverticulosis.

    What are the symptoms of diverticulosis?

    Most people who have diverticulosis are unaware that they have the condition because it usually does not cause symptoms. It is possible that some people with diverticulosis experience bloating, abdominal cramps, or constipation due to difficulty in stool passage through the affected region of the colon.

    How is the diagnosis of diverticulosis made?

    Because most people do not have symptoms, diverticulosis is often found incidentally during evaluation for another condition or during a screening exam for polyps. Gastroenterologists can directly visualize the diverticula (more than one pouch, or diverticulum) in the colon during a procedure that uses a small camera attached to a lighted, flexible tube inserted through the rectum. One of these procedures is a sigmoidoscopy, which uses a short tube to examine only the rectum and lower part of the colon. A colonoscopy uses a longer tube to examine the entire colon. Diverticulosis can also be seen by other imaging tests, for example, computed tomography (CT) scan or barium x-rays.

    What is the treatment for diverticulosis?

    Once diverticula form, they do not disappear by themselves. Fortunately, most patients with diverticulosis do not have symptoms, and therefore do not need treatment. When diverticulosis is accompanied by abdominal pain, bloating or constipation, your doctor may recommend a high-fiber diet to help make stools softer and easier to pass. While it is recommended that we consume 20 to 35 grams of fiber daily, most people only get about half that amount. The easiest way to increase fiber intake is to eat more fruits, vegetables or grains. Apples, pears, broccoli, carrots, squash, baked beans, kidney beans, and lima beans are a few examples of high-fiber foods. As an alternative, your doctor may recommend a supplemental fiber product such as psyllium, methylcellulose or polycarbophil. These products come in various forms including pills, powders, and wafers. Supplemental fiber products help to bulk up and soften stool, which makes bowel movements easier to pass. Your doctor may also prescribe medications to help relax spasms in the colon that cause abdominal cramping or discomfort.

    Are there complications from diverticulosis?

    Diverticulosis may lead to several complications including inflammation, infection, bleeding or intestinal blockage. Fortunately, diverticulosis does not lead to cancer. Diverticulitis occurs when the pouches become infected or inflamed. This condition usually produces localized abdominal pain, tenderness to touch and fever. A person with diverticulitis may also experience nausea, vomiting, shaking, chills or constipation. Your doctor may order a CT scan to confirm a diagnosis of diverticulitis. Minor cases of infection are usually treated with oral antibiotics and do not require admission to the hospital. If left untreated, diverticulitis may lead to a collection of pus (called an abscess) outside the colon wall or a generalized infection in the lining of the abdominal cavity, a condition referred to as peritonitis. Usually a CT scan is required to diagnose an abscess, and treatment usually requires a hospital stay, antibiotics administered through a vein and possibly drainage of the abscess. Repeated attacks of diverticulitis may require surgery to remove the affected portion of the colon. Bleeding in the colon may occur from a diverticulum and is called diverticular bleeding. This is the most common cause of major colonic bleeding in patients over 40 years old and is usually noticed as passage of red or maroon blood through the rectum. Most diverticular bleeding stops on its own; however, if it does not, a colonoscopy may be required for evaluation. If bleeding is severe or persists, a hospital stay is usually required to administer intravenous fluids or possibly blood transfusions. In addition, a colonoscopy may be required to determine the cause of bleeding and to treat the bleeding. Occasionally, surgery or other procedures may be necessary to stop bleeding that cannot be stopped by other methods. Intestinal blockage may occur in the colon from repeated attacks of diverticulitis. In this case, surgery may be necessary to remove the involved area of the colon.

    Source: ASGE patient information brochure

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  • Encopresis

    Encopresis is when stool leaks out onto the clothing. It is also known as “soiling.” Usually the child is has no control over the leakage and is unaware of the soiling until it has...


    Encopresis is when stool leaks out onto the clothing. It is also known as “soiling.” Usually the child is has no control over the leakage and is unaware of the soiling until it has already occurred. Most stool accidents are commonly mistaken as diarrhea. Encopresis is more commonly caused by prolonged and often unrecognized constipation.  A hard stool develops and if the child cannot pass this bowel movement, it gets stuck. Future stool leaks out and causes the soiling. The child usually loses normal sensation in the rectum because it is so stretched out from the constipation, which is why the child does not realize they are soiling themselves. Treatment is fairly simple and like regular constipation, it requires patience and time.

    • The first step is to clean out the system. Your gastroenterologist will help you find the best options.
    • After cleaning everything out you will need to use stool softeners. It is important that you use stool softeners and not laxatives because stool softeners can be used safely on a daily basis.
    • Bowel retaining is the most important step. This is when your child learns the normal sensations of having a regular bowel movement and you can resume a regular schedule for bowel movements using positive feedback.
    • The final step is to place the child on a high-fiber diet to ensure normal bowel function.

    The gastrointestinal specialists at the GI Associates Clinic are well trained to work with children who have gastrointestinal problems. Call them today to make an appointment and to get your child back to a normal and healthy life.

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  • Eosinophilic Esophagitis

    Eosinophilic esophagitis is also known as allergic esophagitis or idiopathic esophagitis. Eosinophils are a certain type of white blood cell typically associated with...


    Eosinophilic esophagitis is also known as allergic esophagitis or idiopathic esophagitis. Eosinophils are a certain type of white blood cell typically associated with allergies. This disease is characterized by those eosinophils being deposited in the esophagus.  This deposition of eosinophils in the esophagus leads to inflammation and even tissue damage.

    What are the symptoms?

    Symptoms of eosinophilic esophagitis vary depending on age.

    • Infants tend to demonstrate poor growth, vomiting and feeding refusal. 
    • Older children may complain of heartburn, difficulty swallowing or even getting food items stuck in the esophagus. 

    Males and caucasians tend to be more at risk for this disease for unknown reasons. Children with eosinophilic esophagitis also tend to have other allergic diseases including asthma, allergic rhinitis, and eczema.

    How is it diagnosed?

    Eosinophilic esophagitis is diagnosed by upper endoscopy, which is performed by a pediatric gastroenterologist. The physician may be able to see changes in the esophagus that look abnormal at the time of the procedure. Biopsies or small pieces of tissue obtained at the time of the procedure are used to confirm the diagnosis. There is an overlap of eosinophilic esophagitis with gastroesophageal reflux since both diseases may cause deposition of eosinophils. Therefore, more than one endoscopy noting persistent of eosinophilia while on acid suppression medication or a ph probe study is sometimes needed to confirm the diagnosis.

    How is it treated?

    There are a variety of ways to treat eosinophilic esophagitis. The first form of treatment is dietary modification. This may involve an elimination diet directed by a dietician or elemental formula for younger children. Referral to an allergist for skin prick testing or bloodwork may help identify culprit foods to avoid. Unfortunately, often allergy testing is unable to identify causative foods. Another form of treatment is medications such as steroids and acid suppression. In rare cases, esophageal dilation is needed to treat esophageal narrowing.

    References: Children's Digestive Health and Nutrition Foundation The American Partnership for Eosinophilic Disorders North American Society for Pediatric Gastroenterology, Hepatology and Nutrition

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  • Gas and Bloating

    Burping and passing gas is evidence of air and other gases trapped inside the digestive tract. Everyone passes gas. In fact, most people pass gas on average 14 times per day.

    How...

    Burping and passing gas is evidence of air and other gases trapped inside the digestive tract. Everyone passes gas. In fact, most people pass gas on average 14 times per day.

    How Does Gas or Air Get Inside The Digestive Tract?

    Swallowing air is a common entry point. Chewing gum, sucking on hard candies, smoking, or eating and drinking quickly, all allow air into the stomach. Bacteria in the intestines responsible for breaking down foods can produce gases as a byproduct of digesting certain foods. Foods that commonly cause gas include:

    • Beans, cabbage, brussel sprouts, asparagus.
    • Lactose found in milk and other dairy products and processed foods containing dairy.
    • Fructose, both naturally occurring as in pears and onions, and as a sweetener added to drinks.
    • Sorbitol, also found in pears and other fruits and in many sugar-free candies and gum.
    • Most starches, with the exception of rice, cause gas: potatoes, corn, pasta, and wheat products.
    • Fiber, chiefly soluble fiber, which is found in oat bran, beans, peas, and most fruit. 

    When Should You See A Doctor?

    Bloating and belching are both symptoms of gas build up in the digestive tract. Occasional gas is not a cause for alarm and usually resolves itself with little or no intervention. When gas and bloating become chronic it is time to seek the help of a gastroenterologist to determine the source of the problem. Many conditions and illnesses share gas and bloating as a symptom. Some are easy to treat. Lactose intolerance is a benign condition that responds well to dietary changes and simple over the counter medications. On the other hand, serious conditions such as Crohn’s disease and colon cancer can cause bowel obstructions which, in turn, can cause bloating. Those extremes are the reason to avoid long term self-diagnoses and self-medication, and seek help for symptoms that last longer than two weeks or become incapacitating. 

    The doctor will take a detailed history of your symptoms and depending on the results of a physical exam, may recommend additional testing. Treatment will solely depend on the diagnosis.

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  • Gastrointestinal Reflux in Babies

    When a child can't describe their pain, it can frustrate parents. We can help.


    Adults are not the only ones who deal with gastrointestinal reflux, or heartburn. It is common for babies to spit up and it is usually due to the immaturity of the esophageal sphincter (LES), which is a valve-like structure that opens and closes to allow food into the stomach. Since babies cannot sit up on their own it is easier for the food to come back up through the sphincter instead of digesting properly.

    As long as your baby is gaining weight and growing with no other medical problems then there really is not a problem. The reflux usually goes away on its own when the baby is 12-18 months old. If there is excessive vomiting, there are some conservative treatments you can talk to your gastroenterologist about trying. Be sure to let your gastroenterologist know if your baby is not gaining weight appropriately or if other medical conditions develop. They can let you know what treatments or precautions you can take to help get rid of the problem.

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  • Gastrointestinal Reflux in Children

    All age groups can suffer from reflux. Adults usually have a greater ability to "live with it" than children and infants. When a child suffers from reflux - the whole family can be...


    All age groups can suffer from reflux. Adults usually have a greater ability to "live with it" than children and infants. When a child suffers from reflux - the whole family can be affected. The cause is always the same. The stomach contents come back up into the esophagus creating a burning sensation and occasionally  vomiting. There can be a problem if the reflux is frequent, not only because is it painful, but also because inflammation and damage can occur.

    There are several theories as to why gastrointestinal reflux occurs in children; the failure of the sphincter separating the stomach and the esophagus, or the stomach emptying too slowly are two of the main theories. If your child is complaining of symptoms that sound like heartburn you should seek the help of a pediatric gastroenterologist. There are treatments that can help to stop the hurt.

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  • GERD - Acid Reflux

    If you are experiencing daily heartburn, plus other symptoms such as nausea or vomiting; it might be acid reflux. Call us today for help with your acid reflux!


    Occasional heartburn should not be confused with gastroesophageal reflux disease or GERD. If  you suffer from frequent heartburn (2-3 times weekly) you need to seek professional help.

    Reflux occurs when acid from the stomach backs up, or refluxes, into the esophagus. Unlike the lining of the stomach, the lining of the esophagus is not acid resisitant and the contact causes pain. Repeated bouts of reflux can cause ulcers, bleeding, and scarring to develop in the esophagus, adding to the pain and distress of the disease.

    Simple Methods To Control GERD

    While many people may be able to just cut back on smoking, drinking or eating the foods that cause discomfort, others may have to avoid them entirely. Losing weight, especially belly fat, is also helpful in controling GERD symptoms. If you experience gastrointestinal reflux, you might find that cutting back or avoiding these foods may help:

    • Fatty, greasy and fried foods
    • Chocolate
    • Citrus drinks (especially orange and grapefruit)
    • Tomato products
    • Spearmint or peppermint
    • Alcohol
    • Coffee

    Underlying Causes

    It is important to rule out any significant underlying causes for your frequent indigestion. Some sypmptoms of reflux are the same as some cardiac issues, especially in women. Therefore, we strongly urge that you do not postpone being evaluated by a board certified gastroenterologist. There are tests that can be performed and significant advancements have been made in the treatment of GERD. 

    Important Note

    In early December 2012, The American College of Physicians released a statement regarding the overuse of Upper GI's in GERD patients and calling for new guidelines to be used by physicians performing those procedures. Our practice follows the guidelines set out by American Society for Gastrointestinal Endoscopy (ASGE); and those guidelines are within the scope called for by the American College of Physicians. Our interest in our patients has always been to provide answers and relief - not to perform unnecessary procedures. Dr. Reed Hogan explains why GI Associates follow these guidelines, "...overuse of endoscopy is common in the US and following appropriate guidelines for indications is going to be less risky to the consumers and certainly save health care dollars…"

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  • H. Pylori

    H. pylori is a bacterial (Helicobacter pylori) infection that occurs in as many as half of the people worldwide. It is normally contracted in childhood and does not cause any problems in...


    H. pylori is a bacterial (Helicobacter pylori) infection that occurs in as many as half of the people worldwide. It is normally contracted in childhood and does not cause any problems in the majority of those people.

    In some people, the H. pylori bacteria can cause peptic ulcers. If you show symptoms of ulcers, your doctor will test you for H. pylori; if positve, it is successfully treated with antibiotics.

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  • Hiatal Hernia

    The leading cause of reflux is the presence of a Hiatal hernia.


    A hiatal hernia is the pushing up of the stomach into the chest cavity through a hole in the diaphragm. The presence of a hiatal hernia may hinder the action of the LES. Almost all persons who have hiatal hernias will experience some degree of gastroesophageal reflux, thus it is the leading cause of reflux. If the esophageal hiatus is too wide, part of the stomach may bulge above the diaphragm. This bulge is called a hernia. If the LES is not tight, stomach acid may move up into the esophagus.

    Read more about reflux.

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  • Hemorrhoids

    Constipation and hemorrhoids are two of the most common gastrointestinal problems and are often interrelated. Hemorrhoids, more common among men and women ages 30-55, is the result of...


    Constipation and hemorrhoids are two of the most common gastrointestinal problems and are often interrelated. Hemorrhoids, more common among men and women ages 30-55, is the result of increased pressure in the veins of the anus or rectum. This pressure can be caused by constipation. Pregnant women are also likely to get hemorrhoids because of the increased pressure in the pelvic area from the growing child. They usually disappear once the child has been born.

    Unless the underlying problem continues to persist, small hemorrhoids usually pose no major problems and go away on their own. If the underlying cause of hemorrhoids is long-term, they can become large and painful, causing bleeding and increased discomfort. Sometimes, it is necessary to have the hemorrhoids removed. There are a number of different treatment options and the gastrointestinal specialists at GI Associates can help find a plan that is right for you.

    How Can I Avoid Hemorrhoids?

    The best way to avoid hemorrhoids is to prevent constipation. In order to avoid constipation you need to make sure you are drinking enough water, about 6-8 glasses a day, and getting enough fiber in your diet. The recommended amount of fiber intake is 30-40 grams. If you are not used to eating a lot of fiber in your diet you will want to gradually add it in, otherwise you will end up with diarrhea. Please see the resource page for more information on high fiber diets.

    What Can I Do If I Have Hemorrhoids?

    Make an appointment with one of the gastrointestinal specialists at GI Associates if you are having chronic constipation, hemorrhoids or if you have any questions. They are equipped with many tools to help ease your pain.

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  • Hepatitis

    Hepatitis is an inflammation of the liver that can cause harm or death of liver cells and is spread by fecal contamination, contaminated water and contact with infected blood or body...


    Hepatitis is an inflammation of the liver that can cause harm or death of liver cells and is spread by fecal contamination, contaminated water and contact with infected blood or body fluids. There are many different kinds of hepatitis and some can be mild and can go unnoticed while others can be severe and life threatening. Sometimes a person's immune system can eliminate some of the hepatitis viruses, and some can be controlled using medication.

    A  survey released by the AGA last year provides some alarming statistics concerning Hepatitis C and Baby Boomers. The survey showed that 74% of Boomers have either never been tested for Hep C or are unsure if they have ever been tested. Also, 80% of those surveyed believe that they are not in any risk of developing the disease and 83% have never even discussed the issue with their doctor.

    The other side of the statistical coin is that it is estimated that nearly 5 million Americans have the disease and that 82% of those are Baby Boomers. The real problem is that it is estimated that 75% of those infected are unaware that they have the disease.

    Those are startling statistics. Do you know the risk factors for Hep C?  According to the Mayo Clinic the risk factors are:

    • Are a health care worker who has been exposed to infected blood
    • Have ever injected illicit drugs
    • Have HIV
    • Received a piercing or tattoo in an unclean environment using unsterile equipment
    • Received a blood transfusion or organ transplant before 1992
    • Received clotting factor concentrates before 1987
    • Received hemodialysis treatments for a long period of time
    • Were born to a woman with a hepatitis C infection

    There is no reason to panic but we recommend you discuss Hepatitis C with your doctor and evaluate if you should be tested. This is a case of what you don't know can hurt you.

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  • Inflammatory Bowel Disease - IBD

    IBD should not be confused with the less serious condition known as IBS. Ulcerative colitis and Crohn's Disease should always be treated by a gastroenterologist.


    Inflammatory bowel disease is also referred to as IBD. It is a chronic inflammatory disease of the digestive system. There are two types: Crohn’s disease and ulcerative colitis. Crohn’s disease can affect any part of the digestive tract while ulcerative colitis only affects the colon. About 25% of individuals with IBD are diagnosed during childhood. We don’t precisely understand what causes IBD. As a parent, there is nothing that you could have done to prevent your child from developing IBD.

    Symptoms

    IBD has a variety of symptoms including abdominal pain, diarrhea, bloody stools, fever, weight loss, and even delayed puberty. There also may be symptoms not related to the digestive tract such as arthritis and rashes.

    How is it diagnosed?

    Bloodwork and stool tests are usually the first line of investigation to exclude other digestive disorders such as infections. Upper endoscopy and colonoscopy with biopsies will be needed to establish the diagnosis. Radiographic studies such as x-rays and CT scans are sometimes needed.

    How is it treated?

    Medications such as corticosteroids, aminosalicylates, immunosuppressants, antibiotics and biologic therapies are typically used. Nutritional therapy is another consideration. Rarely, surgery is needed. Your gastroenterologist will tailor therapy to your child. It is our goal at GI Associates to help children with IBD feel well and lead active lives.

    References:

    Information in this article comes from The Crohn's and Colitis Foundation of America.

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  • Irritable Bowel Syndrome

    Irritable Bowel Syndrome (IBS) is one of the most common gastrointestinal problems and affects about 20% of adults. IBS usually begins during early adulthood, rarely beginning after the...


    The symptoms can range from mild to severe and IBS may be worse for people who have stress or mood disorders, like anxiety and depression.

    Doctors are still studying what causes IBS but one study found that people who have IBS have colon tissue that is more sensitive than normal, which may contribute to the problem. There are many things you can do to help minimize your IBS flare-ups:

    • If you know of specific foods that cause symptoms then try to avoid them.
    • Avoid chewing gum and drinking carbonated beverages because they can cause gas.
    • Avoid caffeine and nicotine, and some people find that cutting out alcoholic beverages helps too.
    • Provide regular mealtimes that allow you to eat slowly. Eating in the car or when you are hurried causes you to gulp food and swallow air, which can trigger an IBS flare-up.
    • Exercising, relaxing and getting the right amount of sleep are not only good for your gastrointestinal problems, but they have many other health benefits for your body.

    Making these lifestyle and diet changes can help reduce flare-ups. Pairing these changes with developing good sleeping habits can help to reduce anxiety and in turn relieve bowel symptoms. Your gastroenterologist may also be able to talk to you about various medications that might make living with IBS more tolerable, and they may suggest counseling to help with anxiety and depression.

    Many gastrointestinal specialists find  IBS stubborn to diagnose and treat because the symptoms can be similar to other illnesses. The disease is considered chronic, but some people never have a reoccurrence after being treated. Treatments can range from diet changes to medications. Keeping a positive attitude and staying in touch with your gastroenterologist and others who have similar diseases help make living with a chronic IBS much more bearable.

     Most people assume that IBS is just something they will have to deal with all their life and up to 75% do not seek medical advice! You do not have to go another day with the pain and you should always make sure your symptoms are not something more serious.

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  • Lactose Intolerance

    Do milk, cheese, yogurt and other dairy products cause uncomfortable side effects? Read on...


    Lactose is the complex, natural sugar found in milk and milk products. Some people have difficulty digesting lactose and are diagnosed as being "lacotse intolerant." It may be caused by a lack of the amino acid lactase. The body can produce varying amounts of lactose - from sufficent supply to none at all. Depending on the level of deficiency the symptoms can mild or cause major discomfort.This deficiency may be naturally occuring or be caused by certain medications.

    The symptoms worsen if the deficiency increases. Discomfort can begin as early as thirty minutes after eating something with lactose in it and as late as eight hours. Lacotse intolerance can be treated with dietary changes and medications.

    Lactose intolerance is the inability to digest lactose- the complex, natural sugar found in milk and milk products. It can be caused by having an inadequate amount of lactase, a deficiency of lactose, or can be caused by taking certain medications. 

    Lactose intolerance affects up to 75% of the adult population. People who are of northern European descent are least likely to develop an intolerance to lactose. The severity of the symptoms depends also on the amount and type of food eaten. For instance, if you are lactase deficient, the more lactose you take in, the worse symptoms will be. Symptoms occur after eating any lactose-laden food that cannot be digested well. Discomfort usually begins 30 minutes to two hours after eating, but may be delayed as long as eight hours after eating. Usually the symptoms are gas, bloating, nausea, diarrhea and abdominal pain.

    There are diet changes and medications that can help make lactose intolerance easier to deal with. One of the easiest ways to avoid discomfort is to read labels. A food label will always tell you how much calcium is in a particular food. The ingredients to look for are milk, milk by-products, milk solids, nonfat dry milk powder, whey, curds, caseinate, or lactoglobulin. Some of the most common foods lactose intolerant people need to avoid are milk and milk products such as ice cream, butter and cheese. Less commonly known is the fact that about 20% of prescription drugs and 6% of over-the-counter drugs use lactose as a base ingredient. Be sure to ask your gastroenterologist about what medications you are currently taking and when in doubt, ask your pharmacist! Many times, there are hidden sources of lactose in foods such as:

    • Sauces
    • Dried mixes (cakes, pancakes, biscuits, cookies)
    • Candies
    • Processed sandwich meats
    • Bread & other baked goods
    • Processed breakfast cereals
    • Instant potatoes
    • Soups
    • Breakfast drinks
    • Margarine
    • Lunchmeats
    • Salad dressings

    There are over-the-counter products available that contain lactase, the enzyme needed to digest lactose, which allows people to slowly add lactose back into the diet. Your gastroenterologist can help determine whether these products would work for you and can help you make diet changes to ease the discomfort. Calcium is an important tool in keeping the body strong and bones strong so it’s important to talk with your gastroenterologist about other ways to get those nutrients and keep your body healthy.

    While it may be easy to pinpoint lactose intolerance as the culprit of your pain, it is important to discuss any gastrointestinal problems with your gastroenterologist. There could be underlying problems that can create more problems if they are ignored. Many of these disorders have similar symptoms and the best way to diagnose and treat your gastrointestinal problems is know for certain what your problem is. There are specific tests that can be done to help determine if lactose intolerance is a problem for you, take the first step to relief and make an appointment with GI Associates today.

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  • NAFLD – Non-alcoholic Fatty Liver Disease

    NAFLD can be divided into two categories. The first is simply a fat build up in the liver that causes no real symptoms and has no accompanying inflammation. This benign condition is often...


    Your physician has diagnosed you with NAFLD, Non-alcoholic Fatty Liver Disease, what comes next?

    The first step in any new diagnosis is to ask questions of your physician, make sure that you understand the diagnosis.  What is NAFLD?  How can it be treated? How will it affect my life?

    It is important to understand that there is a separate condition that affects the liver found in people who drink too much alcohol. That is why doctors are careful to differentiate between liver diseases caused by excessive drinking and those that are found in patients who are either do not drink at all or just occasionally. NAFLD is not caused by alcohol consumption.

    NAFLD can be divided into two categories. The first is simply a fat build up in the liver that causes no real symptoms and has no accompanying inflammation. This benign condition is often diagnosed “accidentally”; for example, during an ultrasound of the gall bladder doctors may see the fat build up in the liver. Your doctor will discuss with you the steps you can take to protect your liver from further damage.

    The second category is a more serious condition known as NASH. Non-alcoholic steatohepatitis is also characterized by the build up of fat in the liver and is accompanied by inflammation.  It is often found in patients who are overweight, have diabetes or high blood sugar, and/or have high cholesterol. These conditions need to be addressed directly as part of your treatment.  Taking control of your weight, blood sugar, and cholesterol can have positive effects not only on your liver, but also throughout your body.

    Once you have been diagnosed with NASH you should see your gastroenterologist/hepatologist for regular check-ups to monitor your liver.  Most patients live their lives without developing any additional symptoms, NASH can, at times, cause scarring of the liver called cirrhosis. If you have been diagnosed with NASH and begin to have trouble breathing, swelling in your legs, or are unusually tired contact your doctor immediately.

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  • Pancreatitis

    Pancreatitis is an inflamed or infected pancreas. Damage to the pancreas happens when its own digestive enzymes attack the pancreas itself, a process called autodigestion. We do not...


    Pancreatitis is an inflamed or infected pancreas. Damage to the pancreas happens when its own digestive enzymes attack the pancreas itself, a process called autodigestion. We do not completely understand what actually triggers this process. Those digestive enzymes usually work outside of the pancreas, in the intestine, to help digest food.

    In addition to the pancreatic enzymes attacking the pancreas, the autodigestive process seems to stimulate other enzymes, which also start digesting the pancreas. In severe cases, bleeding, the development of cysts, serious tissue damage or death of tissue in the pancreas may occur. The enzymes and toxins released during that process may enter the bloodstream and cause serious damage to the kidneys, heart, lungs and other organs.

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  • Peptic Ulcers

    An ulcer that occurs at any point along the gastrointestinal tract.


    Peptic ulcer disease is when ulcers occur in the lining of any part of the gastrointestinal tract. These ulcers are not normally dangerous, however they are very painful and can occasionally be cancerous. One in ten Americans will have an ulcer at some point in their life and most ulcers tend to occur between the ages of 20 and 50. The ulcers have a tendency to return so it is important to stay in contact with your gastroenterologist. Symptoms range from heartburn and indigestion, to a loss of appetite, nausea, vomiting, diarrhea or constipation.

    See also, H.Pylori

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  • Ulcerative Colitis

    For more information, please read Inflammatory Bowel Disease - IBD


    For more information, please read Inflammatory Bowel Disease - IBD

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