Acid Reflux (GERD)
Gastroesophageal reflux disease (GERD) is a condition in which the esophagus becomes irritated or inflamed because of acid backing up from the stomach. The esophagus or food pipe is the tube stretching from the throat to the stomach. When food is swallowed, it travels down the esophagus.

The stomach produces hydrochloric acid after a meal to aid in the digestion of food.

• The inner lining of the stomach resists corrosion by this acid. The cells that line the stomach secrete large amounts of protective mucus.
• The lining of the esophagus does not share these resistant features and stomach acid can damage it.
• The esophagus lies just behind the heart, so the term heartburn was coined to describe the sensation of acid burning the esophagus (see Media file 1).

Normally, a ring of muscle at the bottom of the esophagus, called the lower esophageal sphincter, prevents reflux (or backing up) of acid.

• This sphincter relaxes during swallowing to allow food to pass. It then tightens to prevent flow in the opposite direction.
• With GERD, however, the sphincter relaxes between swallows, allowing stomach contents and corrosive acid to well up and damage the lining of the esophagus.

GERD affects nearly one third of the adult population of the United States to some degree at least once a month. Almost 10% of adults experience GERD weekly or daily. Not just adults are affected; even infants and children can have GERD.

Colorectal Cancer
Cancer of the colon or rectum is called colorectal cancer. The colon and the rectum are part of the large intestine, which is part of the digestive system. Colorectal cancer occurs when tumors form in the lining of the large intestine, also called the large bowel.

Studies show that the following risk factors can increase a person’s chances of developing colorectal cancer: age, polyps, diet, personal history, family history, and ulcerative colitis.

When colorectal cancer first develops, there may be no symptoms at all. But as the cancer grows, it can cause changes that people should watch for. Common signs and symptoms of colorectal cancer include:

• a change in the frequency of bowel movements
• diarrhea, constipation, or feeling that the bowel does not empty completely

Common signs and symptoms of colorectal cancer include:

• either bright red or very dark blood in the stool
• stools that are narrower than usual
  general abdominal discomfort such as frequent gas pains, bloating, fullness, and/or cramps

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Irritable Bowel Syndrom
Irritable bowel syndrome is a disorder characterized most commonly by cramping, abdominal pain, bloating, constipation, and diarrhea. IBS causes a great deal of discomfort and distress, but it does not permanently harm the intestines and does not lead to a serious disease, such as cancer. Most people can control their symptoms with diet, stress management, and prescribed medications. For some people, however, IBS can be disabling. They may be unable to work, attend social events, or even travel short distances.

As many as 20 percent of the adult population, or one in five Americans, has symptoms of IBS, making it one of the most common disorders diagnosed by doctors. It occurs more often in women than in men, and it begins before the age of 35 in about 50 percent of people.

Some people with IBS experience diarrhea, which is frequent, loose, watery, stools. People with diarrhea frequently feel an urgent and uncontrollable need to have a bowel movement. Other people with IBS alternate between constipation and diarrhea. Sometimes people find that their symptoms subside for a few months and then return, while others report a constant worsening of symptoms over time.

Researchers have yet to discover any specific cause for IBS. One theory is that people who suffer from IBS have a colon (large bowel) that is particularly sensitive and reactive to certain foods and stress. The immune system, which fights infection, may also be involved.

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Bleeding
Bleeding in the digestive tract is a symptom of a disease rather than a disease itself. Bleeding can occur as the result of a number of different conditions, some of which are life threatening. Most causes of bleeding are related to conditions that can be cured or controlled, such as ulcers or hemorrhoids. The cause of bleeding may not be serious, but locating the source of bleeding is important.

The digestive or gastrointestinal (GI) tract includes the esophagus, stomach, small intestine, large intestine or colon, rectum, and anus. Bleeding can come from one or more of these areas, that is, from a small area such as an ulcer on the lining of the stomach or from a large surface such as an inflammation of the colon. Bleeding can sometimes occur without the person noticing it. This type of bleeding is called occult or hidden. Fortunately, simple tests can detect occult blood in the stool.

What are the common causes of bleeding in the digestive tract?

Esophagus

• inflammation (esophagitis)
• enlarged veins (varices)
• tear (Mallory-Weiss syndrome)
• cancer
• liver disease

Stomach

• ulcers
• inflammation (gastritis)
• cancer

Small intestine

• duodenal ulcer
• inflammation (irritable bowel disease)
• cancer

Large intestine and rectum

• hemorrhoids
• infections
• inflammation (ulcerative colitis)
• colorectal polyps
• colorectal cancer
• diverticular disease

Call our offices for more information, or use the links on the right.

Constipation
Constipation is defined as having a bowel movement fewer than three times per week. With constipation stools are usually hard, dry, small in size, and difficult to eliminate. Some people who are constipated find it painful to have a bowel movement and often experience straining, bloating, and the sensation of a full bowel.

Some people think they are constipated if they do not have a bowel movement every day. However, normal stool elimination may be three times a day or three times a week, depending on the person.

Constipation is a symptom, not a disease. Almost everyone experiences constipation at some point in their life, and a poor diet typically is the cause. Most constipation is temporary and not serious. Understanding its causes, prevention, and treatment will help most people find relief.

Can constipation be serious?

Sometimes constipation can lead to complications. These complications include hemorrhoids, caused by straining to have a bowel movement, or anal fissures (tears in the skin around the anus) caused when hard stool stretches the sphincter muscle. As a result, rectal bleeding may occur, appearing as bright red streaks on the surface of the stool. Treatment for hemorrhoids may include warm tub baths, ice packs, and application of a special cream to the affected area. Treatment for anal fissures may include stretching the sphincter muscle or surgically removing the tissue or skin in the affected area.

Sometimes straining causes a small amount of intestinal lining to push out from the anal opening. This condition, known as rectal prolapse, may lead to secretion of mucus from the anus. Usually eliminating the cause of the prolapse, such as straining or coughing, is the only treatment necessary. Severe or chronic prolapse requires surgery to strengthen and tighten the anal sphincter muscle or to repair the prolapsed lining.

Constipation may also cause hard stool to pack the intestine and rectum so tightly that the normal pushing action of the colon is not enough to expel the stool. This condition, called fecal impaction, occurs most often in children and older adults. An impaction can be softened with mineral oil taken by mouth and by an enema. After softening the impaction, the doctor may break up and remove part of the hardened stool by inserting one or two fingers into the anus.

Ulcers & H. pylori
What is a peptic ulcer?

A peptic ulcer is a sore on the lining of the stomach or duodenum, which is the beginning of the small intestine. Peptic ulcers are common: One in 10 Americans develops an ulcer at some time in his or her life. One cause of peptic ulcer is bacterial infection, but some ulcers are caused by long-term use of nonsteroidal anti-inflammatory agents (NSAIDs), like aspirin and ibuprofen. In a few cases, cancerous tumors in the stomach or pancreas can cause ulcers. Peptic ulcers are not caused by stress or eating spicy food, but these can make ulcers worse.

What is H. pylori?

Helicobacter pylori (H. pylori) is a type of bacteria. Researchers believe that H. pylori is responsible for the majority of peptic ulcers.

H. pylori infection is common in the United States: About 20 percent of people under 40 years old and half of those over 60 years have it. Most infected people, however, do not develop ulcers. Why H. pylori does not cause ulcers in every infected person is not known. Most likely, infection depends on characteristics of the infected person, the type of H. pylori, and other factors yet to be discovered.

Researchers are not certain how people contract H. pylori, but they think it may be through food or water.

Researchers have found H. pylori in the saliva of some infected people, so the bacteria may also spread through mouth-to-mouth contact such as kissing.

Diarrhea
What is diarrhea?
Diarrhea—loose, watery stools occurring more than three times in one day—is a common problem that usually lasts a day or two and goes away on its own without any special treatment. However, prolonged diarrhea can be a sign of other problems. People with diarrhea may pass more than a quart of stool a day.

Diarrhea can cause dehydration, which means the body lacks enough fluid to function properly. Dehydration is particularly dangerous in children and the elderly, and it must be treated promptly to avoid serious health problems.

People of all ages can get diarrhea. The average adult has a bout of diarrhea about four times a year.

What causes diarrhea?

Diarrhea may be caused by a temporary problem, like an infection, or a chronic problem, like an intestinal disease. A few of the more common causes of diarrhea are

• Bacterial infections. Several types of bacteria, consumed through contaminated food or water, can cause diarrhea. Common culprits include Campylobacter, Salmonella, Shigella, and Escherichia coli.
• Viral infections. Many viruses cause diarrhea, including rotavirus, Norwalk virus, cytomegalovirus, herpes simplex virus, and viral hepatitis.
• Food intolerances. Some people are unable to digest some component of food, such as lactose, the sugar found in milk.
• Parasites. Parasites can enter the body through food or water and settle in the digestive system. Parasites that cause diarrhea include Giardia lamblia, Entamoeba histolytica, and Cryptosporidium.
• Reaction to medicines, such as antibiotics, blood pressure medications, and antacids containing magnesium.
• Intestinal diseases, like inflammatory bowel disease or celiac disease.
• Functional bowel disorders, such as irritable bowel syndrome, in which the intestines do not work normally.

Some people develop diarrhea after stomach surgery or removal of the gallbladder. The reason may be a change in how quickly food moves through the digestive system after stomach surgery or an increase in bile in the colon that can occur after gallbladder surgery.

In many cases, the cause of diarrhea cannot be found. As long as diarrhea goes away on its own, an extensive search for the cause is not usually necessary.

People who visit foreign countries are at risk for traveler’s diarrhea, which is caused by eating food or drinking water contaminated with bacteria, viruses, or, sometimes, parasites. Traveler’s diarrhea is a particular problem for people visiting developing countries. Visitors to the United States, Canada, most European countries, Japan, Australia, and New Zealand do not face much risk for traveler’s diarrhea.

Hepatitis C
Hepatitis (HEP-ah-TY-tis) makes your liver swell and stops it from working right.

You need a healthy liver. The liver does many things to keep you alive. The liver fights infections and stops bleeding. It removes drugs and other poisons from your blood. The liver also stores energy for when you need it.

Hepatitis C is a virus and spreads by contact with an infected persons blood.

Many people with hepatitis C don’t have symptoms.

However, some people with hepatitis C feel like they have the flu.

So, you might

• feel tired
• feel sick to your stomach
• have a fever
• not want to eat
• have stomach pain
• have diarrhea

Some people have

• dark yellow urine
• light-colored stools
• yellowish eyes and skin

If you have symptoms or think you might have hepatitis C, go to a doctor.

EGD
Esophagogastroduodenoscopy

EGD (Esophagogastroduodenoscopy) is a procedure in which a flexible lighted tube is slowly passed through the mouth into the esophagus, stomach and upper portion of the small intestine for direct examination of those parts of the GI system.

• With Biopsy – EGD in which a specimen of tissue is removed for examination by a pathologist.
• With Removal of foreign body – EGD in which a foreign body is removed.
• With polyp removal – EGD in which an abnormal growth is removed.
• With balloon dilation – EGD in which a balloon is inflated to dilate or open a narrowed portion of the esophagus.
• With Control of bleeding – EGD in which medication or heat is used to stop bleeding.

What to expect:

At the beginning of the procedure, a local anesthetic (numbing medicine) may be applied to you throat, and your doctor may give you medication through a vein to help you relax and better tolerate any discomfort from the procedure. The procedure will begin with you lying on your left side. The scope will be passed through your mouth into the throat, stomach and small intestine. The procedure usually takes 30-45 minutes. If something abnormal is found, the physician may take a biopsy specimen or may use medication or heat treatment to stop any bleeding. Remember that biopsies are taken for many reasons and do not necessarily mean that cancer is suspected. The instrument used for the procedure will not interfere with your breathing. Because air is introduced through the tube, you may feel some bloating during and after the procedure. You may resume your usual diet unless instructed otherwise. Your throat may feel scratchy or sore after the procedure.

Preparation:

For the best possible examination, you need to have a completely empty stomach. This means you will need to have nothing by mouth for at least 6-8 hours and preferably overnight before the procedure. Be sure to inform your doctor about any medication you take and the physician can direct you about which medicines you should take. You will also need to refrain from taking blood thinners or any medication containing aspirin or ibuprofen for 5 days before your procedure. If you receive any sedation, you will need for someone to take you home since it would not be safe your you to drive.

Sigmoidoscopy
Flexible Sigmoidoscopy is a procedure in which a flexible lighted tube is passed through the anus into the rectum and lower part of the large bowel (colon) for direct examination.

What To Expect:

Flexible sigmoidoscopy is well tolerated and rarely causes much discomfort. There is often a feeling of pressure, bloating, or cramping at times during the procedure. You will be lying on your side or back while the scope is advanced slowly through the lower portion of the large intestine (colon). The scope is then slowly withdrawn and the lining of the intestine is examined. The procedure usually takes about 5-10 minutes. If the scope shows something abnormal the physician may take a biopsy specimen. Remember that biopsies are taken for many reasons and do not necessarily mean cancer is expected.

Preparation:

The lower part of the colon must be completely clean for the procedure to be accurate and complete. Your physician will give you detailed instructions about diet and the cleansing routine to be used. This usually consists of a laxative and enemas. Be sure to follow the instructions carefully, or the examination may need to be repeated. You will also need to refrain from taking any blood thinners or any medication containing aspirin or ibuprofen for 5 days before your procedure.