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Gastroenterology Diseases & Procedures

Barrett's Esophagus

Barrett’s esophagus is a rare condition in which the tissue lining in the esophagus changes color and composition as a result of long-term exposure to stomach acid. While most patients with Barrett’s esophagus do not experience any symptoms, this condition most often affects patients with gastroesophageal reflux disease, and as a result may have symptoms such as heartburn, chest pain and difficulty swallowing food. Patients with this condition may have an increased risk of developing esophageal cancer.

Treatment for Barrett’s esophagus depends on the severity of the condition and the overall health of the patient, but may include simply monitoring the condition through regular endoscopies, or surgery to remove the esophagus or the damaged cells. Removing damaged cells can often be done using minimally invasive techniques, such as an endoscopy or photodynamic therapy. Your doctor will help decide which treatment option is best for your individual condition.

Capsule Endoscopy

While recent technology has made examining the upper gastrointestinal tract and colon much easier, the small intestine remains a difficult area to reach without surgery. Although parts of the intestine can be seen during a colonoscopy or upper endoscopy, those procedures do not reach far enough to view the entire area. Barium X-rays have typically been used to diagnose problems of the small intestine, although they are not as accurate and easy as other procedures.

In response to the outdated procedures of this unreachable area, doctors have developed a capsule endoscopy. Also known as a wireless capsule endoscopy, this procedure involves swallowing a video capsule that will rapidly photograph the esophagus, stomach and small intestine on its way down. The video capsule is much larger than a pill and contains one or two video cameras, a light bulb, battery and radio transmitter. The photographs are transmitted to a receiver worn on the waist and then downloaded to a computer about 24 hours after the procedure. The capsule is then passed by the patient.

Although this procedure can provide more accurate and detailed results than X-rays, it is still not as successful as other camera procedures. A capsule endoscopy cannot perform any therapy in the area because the doctor does not control the device. The photographs may be blurred or hard to identify what location they are from. Despite these inaccuracies, capsule endoscopy is a rapidly improving technology that is making abnormalities of the small intestine much easier to diagnose.

Colonoscopy

A colonoscopy is a diagnostic procedure that allows your doctor to visually examine the inside of the colon for closer inspection of irregularities. This is accomplished by inserting a tube with a camera on the end into the anus and through the colon. The images from the camera are viewed either through the instrument or on a display monitor.

Why is a colonoscopy performed?

Colonoscopies are performed to investigate irregularities found on an X-ray or CT scan, abdominal pain, diarrhea or blood in the stool. They may also be performed regularly for people at risk for polyps or colon cancer.

How can I prepare for the procedure?

The colon must be completely clean to achieve accurate results. Patients will usually be given a special cleansing solution to drink before the exam, or may be asked to consume only a clear liquid diet with laxatives or enemas. Most medications can still be taken, although some such as aspirin or blood thinners may require special instructions. Your doctor will instruct you on how to prepare.

What can I expect during a colonoscopy?

Before the procedure, an IV is inserted with medication to make the patient relaxed and sleepy.  The heart, blood pressure and oxygenation of the blood are monitored throughout the procedure. During the colonoscopy, the patient lies on their left side or back as the colonoscope is slowly inserted. It reaches all the way to the tip of the colon and examines the lining of the area as it passes in and out. The procedure takes about 15-60 minutes. A biopsy may be taken during the procedure if an area needs to be examined further.

What happens after a colonoscopy?

After the procedure, patients will be kept under observation for about an hour or two, until the medication wears off. Reflexes and judgment may be impaired for the rest of the day. Some cramping or bloating may be experienced, but should be relieved quickly. Eating and other normal activities can resume immediately.

What are the risks or complications of the procedure?

Complications of a colonoscopy are rare and minor. The procedure is very safe when performed by a trained and experienced professional. If they do occur, complications can include bleeding from the site of the biopsy, perforation of the bowel wall or reactions to the IV medication.

What do abnormal results mean?

Abnormal results of a colonoscopy can be a result of:

  • Inflammatory bowel disease
  • Diverticulosis
  • Lower gastrointestinal bleeding
  • Polyps
  • Tumor

Further diagnostic testing such as X-rays and CT scans may be done to follow up on these results.

Colon Cancer Screening

Colon cancer refers to cancer of the large intestine (colon) while rectal cancer refers to cancer of the last 6 inches of the colon (rectum). Cancers affecting either of these organs are collectively known as colorectal cancer. Colorectal cancer is the third most common cancer in men around the world, and fourth most common for women.

Colorectal cancer occurs when some of the cells that line the colon or the rectum become abnormal and grow uncontrollably. Most cases of colorectal cancer begin as small, benign clumps of cells called polyps. Over time some of these polyps may become cancerous. Polyps may be small and produce few, if any, symptoms.

Regular screening tests can help prevent colon cancer by identifying polyps before they become cancerous. If signs and symptoms of colon cancer do appear, they may include changes in bowel habits, blood in your stool, abdominal pain, bloating, and fatigue.

Constipation

Constipation is a common condition that involves infrequent or hard bowel movements that may occur as a result of insufficient fluid consumption or a diet that does not contain enough fiber. Depending on how often you normally have a bowel movement will determine what is considered to be “infrequent” for each individual patient, but is usually defined as fewer than three stools a week. Patients with irritable bowel syndrome, diabetes or other conditions may be at an increased risk of experiencing constipation.

Although constipation is not usually a serious condition, it can lead to complications such as hemorrhoids, anal fissures, fecal impaction or rectal prolapse. It is important to seek prompt medical attention for persisting constipation.

Most cases of constipation are temporary and can be resolved through changes in diet and fluid consumption or increasing physical activity. Some patients may require medications, such as over-the-counter laxatives, to help treat constipation and encourage bowel movements. Your doctor will inform you on how to prevent constipation and keep stools from accumulating in the future through healthy bowel habits.

GERD

Gastroesophageal reflux disease (GERD), commonly known as acid reflux, is a chronic condition classified by frequent occurrences of heartburn. GERD occurs when the liquid content of the stomach regurgitates or refluxes into the esophagus. A high level of acid in the liquid causes inflammation and damage to the lining of the esophagus.

The cause of GERD is not known, but doctors believe it can be caused by a number of factors. Abnormal movement in the lower esophageal sphincter, which allows the liquid to pass in and out of the esophagus, can cause GERD. A hiatal hernia, which moves the lower esophageal sphincter above the diaphragm and prevents it from stopping acid movement, can also cause the condition.

The most common symptom of GERD is heartburn. Heartburn occurs when the liquid traveling through the esophagus stimulates the nerve fibers and causes a burning pain in the middle of the chest. Other symptoms may include regurgitation, nausea and trouble swallowing. More severe causes may cause ulcers or asthma.

There is no clear test for diagnosing GERD. Many doctors will treat heartburn symptoms with acid suppressors and consider effective treatment to be a confirmation of GERD. However, heartburn can be a symptom of other conditions, so other tests are sometimes used. These tests include:

  • Endoscopy
  • Esophageal acid testing
  • Esophageal motility testing
  • Gastric emptying studies
  • Biopsy
  • X-ray

While GERD is a chronic condition that cannot be cured, most of the symptoms can treated to effectively reduce the severity and frequency. Symptoms of GERD can often be treated through life changes and over-the-counter medication. Surgery may be required for more severe cases. Talk to your doctor today if you suffer from the symptoms of GERD.

Irritable Bowel Syndrome

Irritable bowel syndrome (IBS) is a common functional disorder of the intestines. A functional disorder means that the muscles of the organs are functioning abnormally. IBS affects as many as one in five people in the US. There is no cure for the chronic disorder, but simple treatment methods are often effective in relieving symptoms.

The cause of IBS is not known. It is believed by doctors that some people have extra sensitive muscles within the bowels that contract or stretch too much, causing the typical symptoms of IBS. Stimulants such as certain foods or stress may cause the muscles to react and trigger symptoms. The disorder is most common in females and people under age 35.

The main symptoms of IBS include:

  • Abdominal pain or cramping
  • Feeling bloated
  • Gas
  • Diarrhea or constipation

Since these symptoms are common and characteristic of many other disorders, diagnosing IBS is often difficult. Doctors may consider an IBS diagnosis for symptoms that have remained the same over a long period of time. A lower gastrointestinal series, colonoscopy or blood test may be administered to confirm the diagnosis.

The symptoms of IBS can often be treated simply through life changes. Avoiding foods that trigger reactions such as fast food, milk products, chocolate and alcohol can help prevent symptoms from flaring up. Managing stress and regular exercise are also effective forms of treatment. Medications like laxatives, antispasmodics and antidepressants are also useful for many people with IBS.

While IBS is a common condition that plagues many people either mildly or severe, it is important to talk to your doctor to determine the best treatment method for your symptoms.

Liver Biopsy

A liver biopsy is a diagnostic procedure used to examine liver tissue and determine the cause of any abnormalities.  This procedure is often performed after another test, such as a blood test, indicates a problem within the liver. A liver biopsy can diagnose alcoholic liver disease, hemochromatosis, hepatitis B and C and liver cancer.

The biopsy procedure can be performed in several different ways, but generally takes about 20 minutes and may be performed in your doctor's office or in a hospital. Laparoscopy is often used in a liver biopsy to minimize the incisions needed, while a percutaneous biopsy uses local anesthesia and a needle to take multiple samples. Percutaneous biopsies may also be assisted by imaging techniques to properly guide the needle. A short recovery time of a few hours is needed after a liver biopsy because of the use of anesthesia. 

Lower GI Endoscopy

A lower gastrointestinal (GI) endoscopy is a minimally invasive exam used to evaluate the lower portion of the GI tract to help diagnose conditions such as cancer, polyps or inflammation, as well as determine the cause of bleeding or other abnormalities. This exam may involve a colonoscopy and sigmoidoscopy to allow your doctor to visualize the colon and rectum on a computer monitor.

During a lower GI endoscopy, a thin, flexible tube is passed through the anus into the lower GI tract. Intravenous sedation may be administered to help relieve any anxiety or discomfort about this procedure. The entire exam usually takes about 15-30 minutes, with results available to be discussed with your doctor right away. In addition to its diagnostic indications, lower GI endoscopy can also remove polyps or take tissue samples (biopsy) during the same procedure.

PEG

Percutaneous endoscopic gastrostomy (PEG), more commonly known as a feeding tube, involves the placement of a tube into the stomach to help patients who have difficulty swallowing receive adequate nutrition. Food, liquids and medications can be administered through the tube directly into the stomach to reduce the risk of malnourishment.

This procedure is performed under local anesthetic and intravenous sedation to help patients feel relaxed. The feeding tube is fed through the mouth via endoscopy and into the stomach, where it is properly placed and then attached to the abdominal wall, where an incision is made and the tube exits the body. The entire procedure usually takes 30 to 45 minutes.

Patients will learn how to care for their tube after placement. You may experience mild soreness and some drainage after this procedure, which will subside after a few days. Feeding tubes can usually last for several months before being replaced or removed.

Colon Polyps

Colon polyps are a common condition that affect up to 30 percent of older adults in the US. This condition is characterized by a small cluster of cells that form on the lining of the colon, also known as the large intestine. Most polyps are not cancerous and are simply a result of abnormal cell growth, but some can gradually turn into colon cancer, so regular screening and removal of all polyps is important.

Small polyps do not usually cause symptoms, but larger ones may cause rectal bleeding, bloody stools, constipation, diarrhea or pain. Polyps can form anywhere within the large intestine and are can vary in size and appearance depending on the type. The three main types of colon polyps are:

  • Adenomatous - most common and account for 75% of all colon polyps. If they are larger than about 5 millimeters, there is an increased risk of becoming cancerous
  • Hyperplastic - usually smaller than 5 millimeters and rarely cancerous
  • Inflammatory - may occur as a result of ulcerative colitis or Crohn's disease and are usually benign

Certain factors may put you at a higher risk for developing colon polyps. Some of these factors include being over the age of 50, being male, a family history of polyps, smoking, alcohol consumption and obesity. Regular colon screenings are recommended for people over the age of 50. If any abnormalities are found or you are experiencing signs of colon polyps, your doctor may perform a series of diagnostic tests such as a digital rectal exam, barium enema, sigmoidoscopy or colonoscopy.

If a colon polyp is discovered, it will likely be removed in order to prevent the chance of cancer. Most polyps can be removed during a colonoscopy or sigmoidoscopy, while others may be burned with an electrical current or surgically removed.  Surgical removal can often be performed laparoscopically to minimize scarring and recovery time.

You can help reduce your risk of developing colon polyps and cancer by having regular screenings and maintaining an active and healthy life. Talk to your doctor about different steps you can take.

Ulcerative Colitis

Ulcerative colitis is a chronic disease that involves inflammation and sores in the lining of the rectum and colon.  These sores, known as ulcers, can flare up and cause painful symptoms and can eventually lead to colon cancer.  Ulcerative colitis is a form of inflammatory bowel disease and is similar to Crohn's disease.

Ulcerative colitis most frequently begins between the ages of 15 and 30, although many people over the age of 50 also develop the disease. The cause of ulcerative colitis is not known, but may be associated with immune system abnormalities.  While stress and other environmental factors are not causes, they may trigger symptoms when the condition exists.

Symptoms of ulcerative colitis occur in flare-ups that can be sudden and severe or begin gradually with mild symptoms.  Although each person experiences the disease differently, common symptoms include:

  • Abdominal pain
  • Bloody diarrhea
  • Fever
  • Fatigue
  • Loss of appetite
  • Joint pains
  • Anemia

Treatment for ulcerative colitis depends on the severity of the disease, but can include drug therapy to induce and maintain remission, hospitalization to treat severe symptoms or surgery to remove the colon and rectum. Many people with ulcerative colitis eventually need their colons removed because of excessive bleeding and a high risk of cancer.

People with ulcerative colitis may experience periods of remission that last months or even years, but symptoms will usually return unless surgery is performed. Your doctor can help you decide which treatment option is best for you.

Ulcers

Ulcers are sores or lesions found on the skin or within the mucous membranes of the body. Most ulcers occur in the gastrointestinal area and are known as peptic ulcers. These ulcers affect almost 5 million people each year. Peptic ulcers are found either in the stomach, known as gastric ulcers, or in the duodenum (part of the intestines), known as duodenal ulcers.  Duodenal ulcers are the most common.

About 80% of ulcers are caused by a bacteria infection known as Helicobacter pylori (H. pylori). However, it is unknown how H. pylori enters the body. Life factors such as smoking, caffeine, alcohol, stress and extreme use of nonsteroidal anti-inflammatory agents (NSAIDs) can increase the risk of an ulcer. 

The most common symptom of an ulcer is a gnawing or burning pain sensation in the abdomen. Other symptoms may include:

  • Back pain
  • Loss of appetite
  • Bloating
  • Nausea
  • Weakness

People suffering from these symptoms should see their doctor right away to determine if they are caused by an ulcer. Your doctor will perform a medical examination and then a series of tests to diagnose an ulcer. These tests include X-rays of the gastrointestinal series, an endoscopy, a series of H. pylori tests and a biopsy.

After an ulcer is diagnosed, it can usually be treated quickly and effectively. Treatment for an ulcer caused by an H. pylori infection usually includes antibiotic medication, acid suppressors and stomach protectors. Life changes can also help treat and prevent ulcers. Unresponsive ulcers can be the result of serious complications such as stomach cancer.

Upper GI Endoscopy

An upper endoscopy is a diagnostic test used to examine the upper digestive system - the esophagus, stomach, and first part of the small intestine, known as the duodenum. The procedure is done by inserting a thin tube with a light and camera at the end through the mouth and into the esophagus. The images from the camera are viewed on a display screen during the procedure.

Why is an upper endoscopy performed?

An upper endoscopy is used to determine the cause of digestive system symptoms such as abdominal pain, nausea and vomiting, heartburn, bleeding and swallowing disorders. It is frequently used to diagnose gastroesophageal reflux disease, as well as ulcers and tumors.

How can I prepare for an upper endoscopy?

In order to achieve accurate results, you must have an empty stomach before the procedure. You should not eat or drink anything for at least six hours before an upper endoscopy.  Tell your doctor about any conditions or medications you take and he or she will instruct you on how to prepare.

What can I expect during the procedure?

Before the procedure, a local anesthetic will be applied to the back of the throat to relieve pain in the area. An IV with sedation medication may also be used to relax the patient. A mouthpiece is also inserted to keep the mouth open during the procedure. The patient will lie on his or her left side and the doctor will insert the endoscope into the mouth and all the way down to the stomach. A biopsy may be taken during the procedure to further examine a certain area. The procedure usually takes 15-30 minutes.

What happens after the procedure?

After the procedure, the patient will be kept under observation for about 30 minutes while the medication wears off. Temporary soreness of the throat may occur but is usually relieved quickly. Most doctors require that patients are driven home because of the use of sedation. Complications from an upper endoscopy are rare, but if you experience severe abdominal pain, cough, fever, chills or nausea and vomiting, call your doctor immediately.

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