Gastrointestinal Disorders & Diseases

Celiac disease is an autoimmune disorder that causes damage to the lining of the small intestine when foods with gluten are ingested. Gluten is a protein in wheat, barley, rye and oats. When a person with Celiac disease eats gluten, the immune system attacks the lining of the small intestine making it hard for the body to absorb nutrients.

Celiac disease occurs in approximately one out of 133 people in the U.S and affects nearly 2 million people in this country. There is a genetic component. If you have Celiac disease, first degree relatives (parent, sibling or child) have a 10 to 15 percent risk of developing the disease.

Common symptoms in adults may include diarrhea, abdominal pain and bloating, fatigue and anemia. Without treatment, people with celiac disease may develop complications like malnutrition, osteoporosis, infertility, neurological conditions and intestinal cancers.

Diagnosis may involve a blood test and an endoscopic small bowel biopsy. It is important to be evaluated before avoiding gluten in your diet because that can affect test results.

The only treatment of Celiac disease is to follow a gluten-free diet, including avoiding any medications or supplements that contain gluten. Adherence to a gluten-free diet is important to avoid symptoms and long term complications.

For more information, please visit the Celiac Disease Foundation. www.celiac.org

A change in bowel habits is often a short term issue but if it persists, referral and diagnostic evaluation may be indicated. Patients may develop bowel habit changes associated with medications, diet and activity levels. A persistent change in bowel habits with the onset of diarrhea, constipation or a change in the caliber of your stools should be discussed with your healthcare provider.

Crohn’s Disease is a chronic inflammatory condition of the gastrointestinal tract. It is a type of Inflammatory Bowel Disease, or IBD (which includes ulcerative colitis). Crohn’s most commonly affects the last portion of the small bowel (ileum) and the colon but it may affect any part of the gastrointestinal system from the mouth to the anus. The lining of the bowel wall can become ulcerated and the bowel wall thickened.

Crohn’s disease affects approximately 700,000 people in the United States. Symptoms may include abdominal pain, persistent diarrhea, rectal bleeding, weight loss and malnutrition. In severe cases, Crohn’s can affect other organ systems outside the gastrointestinal tract and cause symptoms which may include joint pain, rashes and vision problems.

The cause of Crohn’s disease is not completely understood but there is evidence of a genetic link. If you or a close relative have the disease, your family members have an increased chance of developing Crohn’s. Diet and stress may aggravate Crohn’s Disease, but do not cause the disease on their own. Recent research suggests genetics and/or environmental factors contribute to the development of Crohn’s disease.

Crohn’s disease is a chronic condition and many patients have periods of flare ups and periods of remission. Medical therapy generally will control the symptoms and progression of the disease process, although in some cases, surgery may ultimately be necessary. Most people receiving maintenance medications are free of symptoms, feel well, and live a normal active life.

For more information, please visit the Crohn’s and Colitis Foundation website. www.crohnscolitisfoundation.org

Diverticulosis is a condition in which small pouches form in the lining of your digestive tract, most often in the lower part of the large intestine. These small pouches, called diverticula, bulge outward through the colon and are more common as people get older. The condition is believed to be due in part to a low fiber diet. A low fiber diet leads to constipation which increases pressure in the digestive tract with straining during a bowel movement. The combination of pressure and straining over many years likely leads to diverticulosis.

Diverticulosis may be preventable with a high fiber diet. Fibrous foods can provide a bulkier, softer stool that is easier to pass and helps decrease the pressure in the bowel.

Diverticulitis is a condition in which the pouches become inflamed or infected. The symptoms of diverticulitis may include abdominal pain or tenderness in lower abdomen, fever, nausea, vomiting, chills, or constipation. Mild diverticulitis can be treated with antibiotics, modifying your diet and rest. Severe or recurring diverticulitis may require admission to a hospital for treatment and possibly surgery.

Acid reflux refers to stomach acid refluxing back up into the esophagus. It may lead to heartburn because it can cause an uncomfortable burning sensation in the center of your chest. In normal digestion, the lower esophageal sphincter (LES) opens to allow food to pass in to the stomach and closes to prevent food and stomach acid from flowing backward in to the esophagus. Reflux occurs when the LES is not functioning properly and over time, normal esophageal tissue can be damaged and replaced by intestinal type tissue – a condition known as Barrett’s esophagus. Barrett’s esophagus is a risk factor for esophageal cancer.

Patients who experience frequent reflux, especially if associated with alarm symptoms such as swallowing difficulties, should undergo a diagnostic upper endoscopy. This exam will evaluate for significant change such as esophagitis resistant to therapy, stricture amenable to dilation, Barrett’s esophagus, or even more serious pathology such as esophageal cancer.

If Barrett’s esophagus with additional precancerous changes called dysplasia is diagnosed, a non-surgical treatment called radiofrequency ablation (RFA) can remove the precancerous tissue before it progresses to cancer.

Irritable bowel syndrome is a disorder of the large intestine, or colon, that may cause abdominal pain, bloating, gas, and change in bowel habits. Some people with IBS have constipation or diarrhea and some experience both. IBS affects about 10-15 % of adults and women are more likely to suffer from this disorder.

Physicians refer to IBS as a functional disorder that may be due to oversensitivity of the muscles and nerves in the intestines. Irritable Bowel Syndrome can cause uncomfortable digestive issues that can interfere with your quality of life, but it does not lead to serious disease or harm.

A definitive diagnosis of IBS is often made after excluding other conditions such as Crohn’s disease, Ulcerative Colitis and Celiac disease. Treatment may include dietary changes, medications and stress management.

Liver disease is a term used to describe many conditions that can affect the proper functioning of the liver. The liver sits just under your ribcage on the right side of your abdomen and is the largest organ in the body. It helps in the digestion of foods and stores energy. The liver makes many chemicals required by the body to function normally such as clotting factors that allow blood to clot, and also breaks down medications and drugs.

Symptoms of liver disease may include nausea and vomiting, upper right side abdominal pain, jaundice (yellowing of the eyes and skin due to high concentrations of the bile pigment bilirubin), chronic itchy skin, loss of appetite, unexplained fatigue, confusion and weight loss.

Liver diseases include viral hepatitis (Hepatitis B and C), cirrhosis, fatty liver, alcoholic liver disease, autoimmune liver disorders, genetic liver diseases, and liver cancer. Some medications may also cause liver damage. Treatments for liver conditions depend on the type of disease and any complications associated with the disease.

For more information, please visit the American Liver Foundation. www.liverfoundation.org

The pancreas is a gland that sits lies behind the stomach in the upper abdomen. It produces juices and enzymes that flow into the intestine, where they mix with food and help digest fat, protein and carbohydrates to be absorbed in the intestine. The pancreas also produces insulin which is important in regulating the amount of sugar in the blood.
Pancreatitis is an inflammation of the pancreas. Acute pancreatitis occurs when the pancreas becomes acutely inflamed and with proper management is often short term. Pancreatitis symptoms include upper abdominal pain that may radiate to the back, nausea and vomiting, fever and weight loss. Causes include gallstones, alcohol use, certain medicines, and genetic disorders. Chronic pancreatitis may occur in certain settings such as chronic alcohol induced disease.

Chronic pancreatitis may require treatment with enzyme preparations taken by mouth to replace those that are no longer being made by the pancreas.

Pancreatic cancer is the third leading cause of cancer death. Symptoms may include upper abdominal pain, jaundice and weight loss. Treatment may include surgery, chemotherapy, radiation or a combination of these. Endoscopic Ultrasound (EUS) is often used to help diagnose and stage the extent of pancreatic cancer.

Rectal bleeding may be a sign of a serious problem or it may be associated with a minor problem such as hemorrhoids or an anal fissure. It is important that the specific cause of rectal bleeding be identified to exclude colorectal cancer or other serious problems such as Ulcerative Colitis or Crohn’s disease. The cause of rectal bleeding is most commonly minor and the diagnosis can be established with a good history and diagnostic evaluation, with appropriate treatment to follow.

Swallowing problems with difficulties to solid food and liquids are very common and generally associated with esophageal reflux or other benign causes. However, patients with swallowing difficulties should seek out medical attention as a more serious issue may be present.
The evaluation may include a barium study or direct visualization with endoscopy. Esophageal dilation can often be performed, leading to resolution of the swallowing issue.

Ulcer disease is a common problem, affecting up to 10-15 % of the population. It may be associated with the use of gastric irritants such as aspirin or other arthritis medications. We now know that a bacteria called H. pylori may be involved in the formation of ulcers.

Ulcers may be diagnosed with barium x-ray or with direct visualization with upper endoscopy. Effective treatment is available which may include the use of acid suppression medications and/or antibiotics to eradicate H. pylori.

Ulcerative Colitis is a chronic inflammatory condition that affects the lining of the large intestine, or colon, and rectum. It is a type of Inflammatory Bowel Disease, or IBD, which includes Crohn’s disease. The chronic inflammation can cause ulcerations leading to diarrhea and rectal bleeding. Ulcerative colitis usually begins in the rectum and lower colon, but it may involve the entire colon.

Ulcerative Colitis affects approximately 700,000 people in the United States. Symptoms may include abdominal pain, persistent diarrhea, blood and/or mucous in stool, an urgency to have a bowel movement and weight loss. Liver, skin, eye or joint problems occasionally occur. Colon cancer is a concern in patients when the disease begins in childhood, has been present for 8-10 years, or when there is a family history of colon cancer. In these situations, regular surveillance colonoscopy may be performed to obtain tissue biopsies.

The cause of ulcerative colitis is not completely understood but may include genetics, an inappropriate reaction by the body’s immune system, and something in the environment that triggers the immune system. When your immune system tries to fight off invading bacteria or a virus, an abnormal response causes the immune system to attack the cells in the lining of the colon too.

Ulcerative colitis is a chronic condition and most patients have periods of flare ups and periods of remission. Taking maintenance medication can significantly decrease flare ups and between flare ups, most people are free of symptoms, feel well, and live a normal active life.

For more information, please visit the Crohn’s and Colitis Foundation website. www.crohnscolitisfoundation.org