Total Gastroenterology FAQ’S

What is Barrett’s esophagus?
The esophagus is the tube that connects the mouth to the stomach.  Barrett’s esophagus forms when the normal esophageal lining is replaced by intestinal tissue, a process called intestinal metaplasia.  This usually occurs as a consequence of gastroesophageal reflux disease (GERD).

What is GERD?
Gastroesophageal Reflux Disease (GERD) occurs when acid and other stomach contents flow backward from the stomach into the esophagus with abnormal frequency, often eroding or ulcerating the normal lining of the esophagus.

How does Barrett’s form?
Barrett’s is a defense mechanism, mediated by the body’s own stem cells.  Damage in the body is repaired by stem cells as they have the ability to change to any type of cell to repair damage.  The normal esophageal lining is not very tolerant of acid.  When it is eroded away in certain individuals, stem cells attempt to protect the esophagus by turning into intestinal cells that are more tolerant of the refluxing acid. Genetic changes in the cells are needed to make this change, and it is the accumulation of certain genetic changes over time which seems to predispose these Barrett cells to cancer.

What is the risk of cancer in Barrett’s esophagus?
On average, a person with Barrett’s esophagus seems to have an approximate 8% risk of developing esophageal adenocarcinoma over one’s lifetime. While this risk may seem high, most patients with Barrett’s are more likely to die from factors other than esophageal cancer. Each individuals risk may be different and may depend on a variety of factors, including race, gender, family history, degree of involvement, age and duration of disease. White males seem to be at particular risk. Many factors are poorly understood. For instance, Barrett’s patient’s in Ireland with the earliest form of Barrett’s seem to have a risk of cancer developing at 0.3% per year, while the incidence reported from England is as high as 1% per year. The most widely accepted figure in the U.S is 0.5% per year for the earliest stages, suggesting that over 10 years there is a 5% risk. The later stages which involve “dysplasia” have significantly higher risk. Which patients are most likely to progress from the earliest stages is unclear. However, since these cells are now intestinal cells, the cancer that may occur is adenocarcinoma, or intestinal-like cancer. This is typically harder to treat than the cancer that develops in more normal esophageal cells (ie.: squamous cell carcinoma). Additionally, unlike the rest of the intestine, the esophagus is surrounded by lymphatic ducts that are close to the surface. Thus, cancer cells may penetrate these ducts and pass to other tissues (metastasize) quite early. This has resulted in a rather dismal 8-15% five year survival for patients with invasive adenocarcinoma of the esophagus. Comparatively, the five year survivals in similar staged colon cancer are 66-90%. Thus, early diagnosis and possible treatment may be helpful.

How is Barrett’s esophagus diagnosed?
Currently, upper endoscopy is the best way to diagnose Barrett’s.  Your gastroenterologist collects small pieces of tissue from the lining of the esophagus.  The pathologist performs special stains to determine if these cells have changed to intestinal-like cells.  Additional analysis may help to access the risk of cancer. A variety of techniques may be used to help the endoscopist and pathologist assess risk.

How is Barrett’s treated?
Although most precancerous conditions are treated by removing the pre-cancer and decreasing the risk, we have not had a safe or effective means to remove Barrett’s tissue until recently. We have traditionally followed Barrett’s patients with periodic surveillance endoscopy to check for advancing disease. While this seems appropriate in certain circumstances, there has been no consensus amongst our societies and teaching institutions as there has been little or no data to support the safety of surveillance guidelines. Most authorities agree that aggressive suppression of acid is imperative in protecting the esophagus and helping to decrease the risk of dysplasia and cancer for all stages of Barrett’s esophagus in selected patients. During the last decade, several physicians of Florida Digestive Health Specialists have helped to perfect the technique of Radiofrequency Ablation of Barrett’s (RFA).  There are now over 60 peer-reviewed papers supporting the safety, efficacy and cost effectiveness of RFA for all stages of Barrett’s esophagus in selected patients.This data has helped establish new guidelines for treating and managing Barrett’s patients, and continues to evolve. The physicians of Florida Digestive Health Specialists have contributed and continue to participate in some of the most ground breaking clinical research in this field.

What is Radiofrequency Ablation? 

• • Radiofrequency has been used safely in many fields of medicine for over 75 years.  It is not radiation.  Radiofrequency energy vibrates water molecules rapidly creating heat.  That thermal process can be controlled meticulously in order to remove Barrett’s tissue uniformly and completely with minimal effects to underlying normal tissue.
• How does RFA correct Barrett’s?
  • When Barrett’s tissue is removed, the body’s own stem cells will be summoned to repair the damage.  If they do not experience the impulse to change to intestinal cells (Barrett’s tissue) they will turn into normal esophageal cells.  This is accomplished by taking aggressive acid suppressive medicine throughout the healing process. Amazingly, research has shown that these new cells seem to be completely devoid of the precancerous genetic defects that had been present in the Barret’s tissue. While we cannot be certain that this prevents cancer, the physicians of FDHS are actively participating in studies that will hopefully indicate that in the next few years.

• Is the effect of RFA durable?
  • Recent studies show that over 98% of patients may achieve complete removal of Barrett’s tissue.  At the end of five years, 92% of those have no evidence of recurrence or residual, and of those 8% that did, 100% responded to a single touch up ablation.
• Am I a candidate for RFA?
  • Only a gastroenterologist well versed in RFA can answer that for you.

More Information
For more information about Barrett’s Esophagus visit these websites;

www.TreatBarretts.com

www.LearnAboutBarretts.com

What is Biliary Cancer?
There are two primary types of Biliary (Hepatobiliary) Cancer

• Hepatocellular Carcinoma
• Cholangiocarcinoma

What is Biliary Cancer: Hepatocellular Carcinoma?
Cancer that develops in the liver.

What is Biliary Cancer: Cholangiocarcinoma?
Cancer that develops within the liver’s biliary ducts.

What causes Biliary Cancer?
Patients with primary sclerosing cholangitis, ulcerative colitis, an inflammatory disease of the colon, or a history of gallstones have a higher risk of cholangiocarcinoma.

What are the symptoms of Biliary Cancer?

• Jaundice
• Abdominal Pain
• Itchy skin
• Fever
• Dark Urine
• Diarrhea
• White Stool
• Bile in Stool
• Increased blood cholesterol
• Loss of Appetite
• Weight loss
• Back Pain

How does a physician diagnose Biliary (Hepatobiliary) Cancer?

• Endoscopic Retrograde Cholangiopancreatography (ERCP)
• Endoscopic Ultrasound Scan (EUS)

What is celiac disease?
Celiac disease is an allergic reaction that damages the lining of the small intestine and prevents it from absorbing parts of food that are important for staying healthy. The damage is caused by a reaction to eating gluten.  Gluten is found mainly in foods containing wheat, barley, rye and oats.

What causes celiac disease?
The exact cause of celiac disease is unknown. The lining of the intestines contains areas called villi, which help absorb nutrients. When people with celiac disease eat foods or use products that contain gluten, their immune system react by damaging these villi.

People with celiac disease are more likely to have:

• Autoimmune disorders
• Addison’s disease
• Dental Problems
• Down syndrome
• Intestinal cancer
• Intestinal lymphoma
• Lactose intolerance
• Osteoporosis and Osteopenia
• Thyroid disease
• Type 1 diabetes

What are the symptoms of celiac disease?
Although symptoms can vary from person to person some common symptoms include:

• Abdominal pain, bloating, gas or indigestion
• Diarrhea, and less frequently constipation or bloody stools
• Loss of appetite
• Nausea and vomiting
• Psychotic issues
• Skin disorders
• Weight loss

How is celiac disease treated?
A gluten-free diet is the way to treat celiac disease by avoiding foods, beverages, and medications that contain wheat, barley, rye and oats.  Complete abstinence from gluten is necessary, permanently.  A single exposure can affect the intestinal lining for three weeks.

Your doctor may prescribe vitamins to correct nutritional deficiencies. Also, corticosteroids (prednisone) may also be prescribed for short-term use, in severe cases.  After being diagnosed with celiac disease getting help from a registered dietitian who specializes in celiac disease and the gluten-free diet is recommended.

What is cirrhosis?

Cirrhosis is irreversible deterioration of liver function. With an unhealthy liver, the normal cells are replaced by scar tissue which can block the flow of blood through the liver impairing the liver functions necessary for survival such as:

• Controlling infections
• Removing bacteria and toxins from the blood
• Processing nutrients, hormones and drugs
• Making proteins that regulate blood clotting

What causes cirrhosis?

Cirrhosis is caused by a variety of factors, however the most common causes in the United States are heavy alcohol consumption, chronic hepatitis C and Obesity.

What are the symptoms of cirrhosis?

In the early stages of the disease there are no symptoms but as the disease progresses, these common symptoms occur:

• Nausea
• Weakness
• Fatigue
• Loss of appetite
• Weight loss
• Abdominal distension
• Jaundice
• Confusion

How is cirrhosis diagnosed?

The diagnosis of cirrhosis is usually based on a complete thorough evaluation done by a qualified physician. It is important to identify risk factors for cirrhosis, such as alcohol use, viral infection or obesity.

How is cirrhosis treated?

Depending on the cause of cirrhosis, treatment might help slow the progression of scar tissue in the liver and prevent or treat the complications of the disease.

When is a liver transplant indicated for cirrhosis?

If complications can’t be controlled by treatment, a liver transplant may be necessary. Liver transplantation is a major operation in which the diseased liver is removed and replaced with a healthy one from an organ donor.

What are colon polyps?
A colon polyp is a growth on the inside surface of the colon (the large intestine).  Some colon polyps are benign (non-cancerous), and some types may already be potentially precancerous, precancerous or frankly cancerous.

What are the risks of colon polyps?
Anyone can get colon polyps, general risk factors include:

• Family history
• 50+ years of age (earlier risk for smokers, obese individuals or African American)
• Uterine or ovarian cancer or other cancers
• Lifestyle habits like high fat diet, excess alcohol, smoking and lack of exercise
• Inflammatory bowel disorders such as ulcerative colitis or Crohn’s disease

What are the symptoms of colon polyps?
Colon polyps usually do not produce symptoms and are normally discovered during colonoscopy screening or while testing for blood in the stools. Symptoms are usually minimal including visible bleeding from the anus. Since the presence of symptoms such as a change in bowel habits indicates advanced disease or possible cancer, it is best to perform screening before symptoms occur.

How tests are performed to detect colon polyps?

• Colonoscopy – A long, flexible tube with a camera is used to check for polyps or cancer inside the rectum and the entire colon.  This is the method of choice.
• Sigmoidoscopy – A thin, shorter flexible, lighted tube is passed into your rectum and sigmoid colon to look at the last third of your large intestine.  It does not see the upper two-thirds of the colon where many polyps and cancers develop and is not regarded as adequate to screen for polyps and cancer.
• Barium enema – A liquid is put into your rectum, then x-rays of your large intestine are taken.  This test is very inaccurate and is not recommended.
• Computerized tomography (CT) scan – A machine using x-ray and computers creates pictures of the large intestine.  This can miss most small polyps, exposes the patient to high doses of radiation and if a polyp is detected a regular colonoscopy is still needed to remove the polyp/s.
• Stool tests – A sample of stool is tested for blood. This is a very insensitive test and is not recommended as a sole test.

How are colon polyps treated?
In most cases, the doctor removes colon polyps during colonoscopy. The polyps are then tested for precancerous or precancerous changes or cancer and a repeat colonoscopy is done at an appropriate interval based on the number, types, size and locations of the polyps.

What is colorectal cancer?
Colorectal cancer is a cancer which can develop anywhere in the large intestine with the majority of colorectal cancers beginning as polyps inside the colon or rectum.

What causes colorectal cancer?
The exact cause of most colorectal cancers is unknown.  Colon cancer develops due to changes in the colon lining.  These changes may be inherited or develop as the result of mutations occurring during a person’s life, the causes of which are not fully understood. Common risk factors are family history of colorectal polyps or colorectal cancer, personal history of  ulcerative colitis or Crohn’s disease, high fat diet, obesity or smoking.   However, some patients may have none of these risk factors, thus screening all individuals over age 50 years (and African-Americans over age 45 years) is important.

What are the symptoms of colorectal cancer?
Getting screened regularly for colorectal cancer is extremely important because polyps and cancer don’t always show symptoms.  Once symptoms such as blood in the stool, change in bowel habits, abdominal pain and weight loss develop, advanced cancers may be present.

What are the tests used to diagnose colorectal cancer?
Your doctor will help determine which test is appropriate for you.  Test options include:

• Colonoscopy – The doctor uses a thin, flexible, lighted tube to check for polyps or cancer inside the rectum and the entire colon. During the test, the doctor can find and remove most polyps and some cancers.
• Flexible sigmoidoscopy – A short, thin, flexible, lighted tube is inserted the rectum to check for polyps or cancer in the bottom third of the colon and rectum.
• High-sensitivity stool test for blood – This test is performed at home by using a stick to obtain a small amount of stool.  The stool samples are returned to your doctor to be tested for occult blood.  However, stool tests may miss precancerous polyps and cancers and are therefore not a substitute for colonoscopy screening.

How do I know which screening test is right for me?
Your doctor will help determine which tests are right for you based on the benefits and potential risks associated with each screening option.

Are there limitations to colonoscopy?
Studies show that even in expert hands, under good conditions, colon polyps and even colon cancers are occasionally missed during colonoscopy.  A good clean-out of the colon and an experienced gastroenterologist endoscopist are essentials for an accurate examination. Colonoscopy is still the most accurate test and one in which pre-cancers can be removed and prevented from developing into cancers.

What is constipation?
Constipation occurs when bowel movements become difficult or less frequent. The normal length of time between bowel movements varies for each person but going longer than three days without a bowel movement is too long. Signs of constipation are:

• Stools are dry
• Abnormal stool size
• Frequent stomachaches
• Feeling bloated
• Loss of appetite

What causes constipation?
Constipation is usually caused by a bowel function disorder not a structural problem. Causes of constipation include:

• Low fiber diet
• Not drinking enough water
• Lack of exercise
• Stress
• IBS
• Medications

What are the symptoms of constipation?
Symptoms usually consist of infrequent bowel movements or difficulty having bowel movements, abdominal pain and vomiting.

How is constipation diagnosed?
If you have constipation for more than two weeks, you should see a doctor to determine the source of your problem and treat it. Tests include:

• Blood tests if a hormonal imbalance is suspected.
• Colonoscopy to look for obstruction of the colon.

• Barium studies to look for obstruction of the colon.

How is constipation prevented?

• Fiber diet
• Drink plenty of fluids
• Exercise regularly

What is Crohn’s disease?
Crohn’s disease is an inflammatory bowel disease that usually affects the intestines, but may occur anywhere from the mouth to the anus.

What causes Crohn’s disease?
While the exact cause of Crohn’s disease is unknown, the condition is linked to a problem with the body’s immune system response.  With Crohn’s disease the immune system can’t tell the difference between normal body tissue and foreign substances. The result is an overactive immune response that leads to chronic inflammation of the gastrointestinal tract.  Crohn’s disease may involve the small intestine, the large intestine, the rectum or the mouth. It rarely affects the esophagus and stomach.  Immune effects may also act on the skin, eyes and liver.

What are the risk factors with Crohn’s disease?
Family history, smoking and environmental factors are attributed to developing Crohn’s disease.  A person’s genes and environmental factors seem to play a role in the development of Crohn’s disease.

What are the symptoms for Crohn’s disease?

• Cramping or abdominal pain
• Fever
• Loss of appetite
• Pain with passing stool
• Diarrhea
• Weight loss
• Constipation
• Fistulas usually around the rectal area
• Mouth ulcers
• Rectal bleeding
• Skin lumps or sores
• Swollen gums

What tests are performed to diagnose for Crohn’s disease?
Usually during a physical examination abdominal pain, skin rash, swollen joints or mouth ulcers are revealed. Tests include:

• Colonoscopy
• Capsule endoscopy
• CT scan or MRI
• Sigmoidoscopy
• Upper GI series and small bowel x-rays
• Stool studies
• Barium enema
• Hemoglobin
• Liver function tests
• White blood cell count
• Serologic blood tests
• C-reactive protein

How is Crohn’s disease treated?
Non-prescription medications may be used to help control mild symptoms such as, Loperamide (Imodium) to stop the diarrhea, fiber supplements or laxatives to help with constipation and aspirin for the pain.

For more moderate symptoms prescription medications may be prescribed such as, Corticosteroids (prednisone), azathioprine, antibiotics and biologic therapy (Remicade).

If prescribed medications do not work surgery may be necessary.  During surgery the diseased part of the intestine is removed although some Crohn’s patients may need surgery to remove part of the small and large intestines.

Diet does not play a role in causing the inflammation.  However, some dietary restrictions may be recommended to help in certain circumstances such as superimposed lactose intolerance

What is diarrhea?
Diarrhea is loose, watery stools that pass three or more times a day. Acute diarrhea lasts 1 or 2 days and goes away on its own but diarrhea lasting more than 2 days may be a sign of a more serious problem.

What causes diarrhea?
Acute diarrhea is usually caused by a bacterial, viral or parasitic infection. Chronic diarrhea is usually related to a functional disorder such as irritable bowel syndrome or an intestinal disease such as Crohn’s disease. The most common causes of diarrhea are:

• Bacterial infections-bacteria consumed through contaminated food or water.
• Viral infections-such as rotavirus, norovirus, or herpes simplex virus.
• Parasites-enter the body through food or water.
• Functional bowel disorders-symptom of irritable bowel syndrome.
• Intestinal diseases-such as Crohn’s disease or ulcerative colitis.
• Food intolerances-difficulty digesting ingredients like sugar found in milk or milk products (lactose intolerant).
• Reaction to medicines-such as antibiotics or cancer drugs.

When should adults with diarrhea see a doctor?

• Signs of dehydration
• Diarrhea for more than 2 days
• Severe pain in the abdomen or rectum
• Afever of 102 degrees or higher
• Stools containing blood or pus
• Stools that are black and tarry

How is diarrhea diagnosed?

• Medical history and physical exam
• Stool culture
• Blood tests
• Fasting tests
• Sigmoidoscopy or colonoscopy

How is diarrhea treated?
Typically diarrhea is caused by dehydration, by replacing the lost fluids should help treat the problem.  There are over-the-counter medicines that will help stop diarrhea like loperamide (Imodium) and bismuth subsalicylate (Pepto-Bismol and Kaopectate).

What are diverticulosis and diverticulitis?

Many people have small pouches in their colon that bulge outward through weak spots in the colon wall. Each pouch is called a diverticulum. Multiple pouches are called diverticula. Diverticulitis occurs when the pouches become inflamed or infected.

What are the symptoms of diverticulosis and diverticulitis?

• With diverticulosis, some individuals may experience pain or discomfort in the lower abdomen, bloating and constipation. Other conditions such as irritable bowel syndrome and stomach ulcers cause similar problems, so the symptoms do not always mean a person has diverticulosis.

• With diverticulitis the most common symptom is abdominal pain. Usually the pain is severe and comes on suddenly, but it can also be mild and become worse over several days. The intensity of the pain can fluctuate. A person may experience cramping, nausea, vomiting, fever, chills or a change in bowel habits.

What causes diverticular disease?

The traditional theory is that a low-fiber diet causes diverticular disease. Diverticular disease is common in developed or industrialized countries like the United States, England and Australia where low-fiber diets are consumed. However, recent studies completely refute this hypothesis and no one is certain as to why diverticulitis develops or how to prevent complications. More modern theories focus on the type of bacteria in the gut as a potential factor.

How is diverticular disease diagnosed?

Medical history is reviewed and a physical exam is performed.   The doctor is looking for changes in bowel habits, pain, diet and medications.  Because most people do not have symptoms, diverticulosis is often found through tests ordered for another ailment. If diverticulitis is suspected, the doctor may order one of the following tests:

• Computerized tomography (CT) scan-a noninvasive x-ray that produces cross-section images of the body. The doctor may inject dye into a vein and the person may be given a similar mixture to swallow. The dye helps “light up” the person’s anatomy on the scan to show complications of diverticulitis such as perforations and abscesses.
• Contrast studies such as Barium enema
• Colonoscopy

How is diverticular disease treated?

A high-fiber diet and pain medications usually help relieve symptoms in most cases of diverticulosis. Uncomplicated diverticulitis with mild symptoms usually requires the person to rest, take oral antibiotics and be on a liquid diet for a period of time. Sometimes an attack of diverticulitis is serious enough to require a hospital stay, intravenous (IV) antibiotics, and possibly surgery.

What is fatty liver disease?
Fatty liver disease (FLD) is a certain kind of fat, specifically triglyceride, accumulates in the liver cells through a process called steatosis. Steatosis is the abnormal retention of lipids within a cell.  There are two different kinds of FLD, alcoholic FLD and non-alcoholic FLD.

What causes fatty liver disease?
The main causes are excessive alcohol intake and people with obesity, high fat diet, diabetes mellitus or hereditary cholesterol issues.

What are the symptoms of fatty liver disease?
Most people do not show symptoms and tend to be asymptomatic. FLD is usually discovered accidentally by abnormal liver function tests or another medical condition.

How is fatty liver disease treated?
The cause needs to be identified first.  Then a treatment plan will be based on whatever the cause steatosis is to help reverse it.  A healthier lifestyle should be encouraged with dieting, exercise, good control of blood sugar, and cessation of excessive alcohol consumption.

What is fecal incontinence (FI)?

Fecal incontinence is the inability to hold a bowel movement until reaching a bathroom or accidental leakage while passing gas. Although patients often understandably feel afraid or embarrassed to talk with their physicians about this problem they should realize that it can be caused by several medical conditions which may be treatable.

Who gets fecal incontinence?

About 1 in 12 U.S. adults have FI and it is more common among women.  Risk factors include older age, chronic diarrhea, damage to the nervous system, other chronic illnesses (such as diabetes), pelvic injuries and history of difficult childbirths.

What causes fecal incontinence?

Fecal incontinence occurs when control of the anal sphincter (the “social muscle”) is no longer adequate and stools are passed before ready.   The muscles and nerves of the rectum and anus are supposed to work together to hold and then release stool.  FI may result when the sphincter weakens or the rectal sensation is reduced due to the conditions mentioned above.

How is fecal incontinence diagnosed?

A medical history, physical examination and medical tests will be used to help diagnose FI and identify possible causes.    There are several tests that can help diagnose FI:

Anal manometry – a pressure tube is used to check the sensitivity and function of the rectum and sphincter function.

Magnetic resonance imaging (MRI) – uses detailed pictures of the rectum and anal sphincter muscles.

Anorectal ultrasonography – ultrasound is used to send waves into the anal area which then create pictures of the anal sphincter muscles to detect damage

Proctography – an Xray that shows how much stool the rectum can hold.

Proctosigmoidoscopy – a lighted, flexible tube is inserted into the rectum to examine the end of the large intestine and rectum to determine if there is inflammation, a tumor or scar tissue.

Anal electromyography – this test checks for pelvic and rectal nerve damage.

How is fecal incontinence treated?

Once the underlying problem causing FI is diagnosed, one of the following treatments may be used:

• Medications such as fiber and anti-diarrhea drugs
• Diet and nutrition
• Pelvic exercises
• Bowel training
• Surgery

What are gallstones?

Gallstones typically form within the gallbladder though some stones can form within other areas of the biliary tract.  Gallstones are lumps of hardened, concentrated bile that contain cholesterol, bile pigments bile salts, calcium salts and/or excretory elements from the breakdown of toxins and other chemicals.

When the bile crystallizes, it forms into one big stone or a few smaller stones that block the ducts that carries bile from your gallbladder.

What are the symptoms of gallstones?

The most common symptom is severe pain in the upper abdomen or on the right side under the ribs lasting more than three hours.  Other symptoms may include vomiting, nausea or jaundice.   Usually the pain is triggered from greasy, fatty or starchy foods.

What causes gallstones?

Gallstones are caused by chemical imbalances from cholesterol in the bile.  These imbalances are usually a result of poor diet, excessive drugs, rapid changes in weight or an unhealthy liver.

 How do I know if I have gallstones?

Gallstones can exist quietly in the gallbladder for many years, but are also capable of causing severe abdominal pain.  The pain can also spread to the back, shoulders and the neck.  Ultrasound testing can be used to confirm the presence of gallstones.

How does the gallbladder hold gallstones?

The gallbladder can actually hold up to thousands of small stones.

How are gallstones treated?

If you have multiple gallstones or experience frequent attacks your physician may recommend gallbladder removal.

What is gastritis?
Gastritis is an inflammation of the mucus membrane that lines the stomach caused by a bacterial infection of the stomach or damage from drugs or alcohol.  When the mucus layer becomes damaged the stomach wall or lining is exposed to acid, which causes the inflammation.

Acute gastritis is when the inflammation of the stomach lining occurs suddenly and is severe. Chronic gastritis is when the condition develops gradually although an individual may have chronic gastritis for years without experiencing any symptoms.

What are the symptoms of gastritis?

• Discomfort in the upper abdomen
• Nausea and vomiting
• Bloating
• Fatigue
• Bloody stools

What causes gastritis?
Gastritis can be a sign that there is an imbalance in your system making you susceptible to various diseases.  Lifestyle changes can help, like avoiding alcohol and smoking and to eat a well-balanced diet.

What causes gastritis?
The most common cause of chronic gastritis is the Helicobacter pylori bacterium or H.pylori. H.pylori, is a common bacteria passed from person to person. Non-steroid, anti-inflammatory drugs such as aspirin, ibuprofen, etc, may affect the stomachs ability to protect itself against its own acid.

How is gastritis treated?
Typically gastritis is treated with antacids to reduce the stomach acid in combination with any medications prescribed to treat the underlying cause. While many types of gastritis can be controlled with over-the-counter remedies, if you are experiencing any severe symptoms or any bleeding, it is essential that you contact your doctor.

What is gastroparesis?

Gastroparesis, also called delayed gastric emptying, is a disorder that slows or stops the movement of food from the stomach to the small intestine. Normally, the muscles of the stomach, which are controlled by the vagus nerve, contract to break up food and move it through the gastrointestinal (GI) tract. The GI tract is a series of hollow organs joined in a long, twisting tube from the mouth to the anus. The movement of muscles in the GI tract, along with the release of hormones and enzymes, allows for the digestion of food. Gastroparesis can occur when the vagus nerve is damaged by illness or injury and the stomach muscles stop working normally. Food then moves slowly from the stomach to the small intestine or stops moving altogether.

What causes gastroparesis?

Most people diagnosed with gastroparesis have idiopathic gastroparesis, which means a health care provider cannot identify the cause, even with medical tests. Diabetes is the most common known cause of gastroparesis. People with diabetes have high levels of blood glucose, also called blood sugar. Over time, high blood glucose levels can damage the vagus nerve. Other identifiable causes of gastroparesis include intestinal surgery and nervous system diseases such as Parkinson’s disease or multiple sclerosis. For reasons that are still unclear, gastroparesis is more commonly found in women than in men.

What are the symptoms of gastroparesis?

The most common symptoms of gastroparesis are nausea, a feeling of fullness after eating only a small amount of food, and vomiting undigested food-sometimes several hours after a meal. Other symptoms of gastroparesis include

• gastroesophageal reflux (GER), also called acid reflux or acid regurgitation-a condition in which stomach contents flow back up into the esophagus, the organ that connects the mouth to the stomach
• pain in the stomach area
• abdominal bloating
• lack of appetite

Symptoms may be aggravated by eating greasy or rich foods, large quantities of foods with fiber-such as raw fruits and vegetables-or drinking beverages high in fat or carbonation. Symptoms may be mild or severe, and they can occur frequently in some people and less often in others. The symptoms of gastroparesis may also vary in intensity over time in the same individual. Sometimes gastroparesis is difficult to diagnose because people experience a range of symptoms similar to those of other diseases.

How is gastroparesis diagnosed?

Gastroparesis is diagnosed through a physical exam, medical history, blood tests, tests to rule out blockage or structural problems in the GI tract, and gastric emptying tests. Tests may also identify a nutritional disorder or underlying disease. To rule out any blockage or other structural problems, the health care provider may perform one or more of the following tests:

• Upper gastrointestinal (GI) endoscopy. This procedure involves using an endoscope-a small, flexible tube with a light-to see the upper GI tract, which includes the esophagus, stomach, and duodenum-the first part of the small intestine. The test is performed at a hospital or outpatient center by a gastroenterologist-a doctor who specializes in digestive diseases. The endoscope is carefully fed down the esophagus and into the stomach and duodenum. A small camera mounted on the endoscope transmits a video image to a monitor, allowing close examination of the intestinal lining. A person may receive a liquid anesthetic that is gargled or sprayed on the back of the throat. An intravenous (IV) needle is placed in a vein in the arm if general anesthesia is given. The test may show blockage or large bezoars-solid collections of food, mucus, vegetable fiber, hair, or other material that cannot be digested in the stomach-that are sometimes softened, dissolved, or broken up during an upper GI endoscopy.
• Upper GI series. An upper GI series may be done to look at the small intestine. The test is performed at a hospital or outpatient center by an x-ray technician, and the images are interpreted by a radiologist-a doctor who specializes in medical imaging. Anesthesia is not needed. No eating or drinking is allowed for 8 hours before the procedure, if possible. If the person has diabetes, a health care provider may give different instructions about fasting before the test. During the procedure, the person will stand or sit in front of an x-ray machine and drink barium, a chalky liquid. Barium coats the small intestine, making signs of gastroparesis show up more clearly on x rays. Gastroparesis is likely if the x ray shows food in the stomach after fasting. A person may experience bloating and nausea for a short time after the test. For several days afterward, barium liquid in the GI tract causes stools to be white or light colored. A health care provider will give the person specific instructions about eating and drinking after the test.
• Ultrasound. Ultrasound uses a device, called a transducer, that bounces safe, painless sound waves off organs to create an image of their structure. The procedure is performed in a health care provider’s office, outpatient center, or hospital by a specially trained technician, and the images are interpreted by a radiologist; anesthesia is not needed. The images can show whether gallbladder disease and pancreatitis could be the cause of a person’s digestive symptoms, rather than gastroparesis.
• Gastric emptying scintigraphy. The test involves eating a bland meal-such as eggs or an egg substitute-that contains a small amount of radioactive material. The test is performed in a radiology center or hospital by a specially trained technician and interpreted by a radiologist; anesthesia is not needed. An external camera scans the abdomen to show where the radioactive material is located. The radiologist is then able to measure the rate of gastric emptying at 1, 2, 3, and 4 hours after the meal. If more than 10 percent of the meal is still in the stomach at 4 hours, the diagnosis of gastroparesis is confirmed.
• SmartPill. The SmartPill is a small electronic device in capsule form. The SmartPill test is available at specialized outpatient centers. The images are interpreted by a radiologist. The device is swallowed and moves through the entire digestive tract, sending information to a cell-phone-sized receiver worn around the person’s waist or neck. The recorded information provides a detailed record of how quickly food travels through each part of the digestive tract.
• Breath test. With this test, the person eats a meal containing a small amount of radioactive material; then breath samples are taken over a period of several hours to measure the amount of radioactive material in the exhaled breath. The results allow the health care provider to calculate how fast the stomach is emptying.

How is gastroparesis treated?

Treatment of gastroparesis depends on the severity of the person’s symptoms. In most cases, treatment does not cure gastroparesis, which is usually a chronic, or long-lasting, condition. Gastroparesis is also a relapsing condition-the symptoms can come and go for periods of time. Treatment helps people manage the condition so they can be as comfortable and active as possible.

Eating, Diet, and Nutrition
Changing eating habits can sometimes help control the severity of gastroparesis symptoms. A health care provider may suggest eating six small meals a day instead of three large ones. If less food enters the stomach each time a person eats, the stomach may not become overly full, allowing it to empty more easily. Chewing food well, drinking noncarbonated liquids with a meal, and walking or sitting for 2 hours after a meal-instead of lying down-may assist with gastric emptying.

A health care provider may also recommend avoiding high-fat and fibrous foods. Fat naturally slows digestion and some raw vegetables and fruits are more difficult to digest than other foods. Some foods, such as oranges and broccoli, contain fibrous parts that do not digest well. People with gastroparesis should minimize their intake of large portions of these foods because the undigested parts may remain in the stomach too long. Sometimes, the undigested parts form bezoars.

When a person has severe symptoms, a liquid or puréed diet may be prescribed. As liquids tend to empty more quickly from the stomach, some people may find a puréed diet helps improve symptoms. Puréed fresh or cooked fruits and vegetables can be incorporated into shakes and soups. A health care provider may recommend a dietitian to help a person plan meals that minimize symptoms and ensure all nutritional needs are met.
When the most extreme cases of gastroparesis lead to severe nausea, vomiting, and dehydration, urgent care may be required at a medical facility where IV fluids can be given.

Medications
Several prescription medications are available to treat gastroparesis. A combination of medications may be used to find the most effective treatment.

Information was provided by National Digestive Diseases Information Clearinghouse (NDDIC)

What is heartburn?
Heartburn is an uncomfortable feeling of burning or warmth in the chest caused by too much stomach acid.

What is stomach acid?
The stomach produces stomach acid to help protect us against bacteria parasites.  It aids in helping with the absorption of iron, calcium and magnesium. When the acid backs up into the esophagus it can burn and cause heartburn or gastroesophageal reflux disease.

What is the esophagus?
The esophagus is the muscular tube that stretches between the mouth and the stomach. All the foods you eat and the liquids you drink go down the esophagus into the stomach.

Why does the acid back up into the esophagus?
A muscle called the lower esophageal sphincter (LES) at the bottom of the esophagus normally prevents foods and acid from backing up. This muscle acts like a tight drawstring to close off the opening between the esophagus and stomach when you are not eating. Heartburn happens when the lower esophageal sphincter does not close all the way or relaxes inappropriately.

Why doesn’t the lower esophageal sphincter close all the way?

• Certain foods and drinks loosen the lower esophageal sphincter such as chocolate, caffeine, fatty foods and alcohol.
• Body positioning affects the lower esophageal sphincter, it’s easier for stomach acid to flow back into the esophagus if you are lying down or bending over.
• Any pressure on the stomach can force acid backward and cause heartburn such as lifting, coughing, tight clothing, obesity or pregnancy.

Do spicy foods cause heartburn?
Many substances directly irritate the lining of the esophagus and can contribute to heartburn. Spicy foods, citrus fruits and juices, tomatoes and tomato sauces, cigarettes, carbonated drinks and late night meals can also increase the production of stomach acid and decrease the LES pressure, leading to heartburn.

What is Helicobacter pylori?
Helicobacter pylori (H. pylori) are a type of bacteria that infects the inner lining of the stomach. The bacteria spread from eating contaminated water or food. Overcrowding can also help the spread of bacteria.

It is theorized that houseflies might be a factor in spreading the bacteria from place to place.

What are the symptoms of H. pylori infection?
There are no digestive tract symptoms, although those infected with H. pylori are more likely to develop peptic ulcers, which can cause burning pain in the upper stomach. H. pylori has also been implicated in certain types of gastric malignancies. Acute infection can present as nausea/vomiting, stomach upset and diarrhea.

How is H. pylori diagnosed?
Blood or stool samples are tested for the bacteria and analyzed for the enzyme that produced by the bacteria.  They may also be noted on biopsy specimens obtained during an upper endoscopy.

How is H. pylori treated?
Antibiotics and other medications are usually needed to eliminate H. pylori infection.
Antibiotic therapy is used to help get rid of these bacteria from the GI tract.  A combination of antibiotics and proton pump inhibitors like Prilosec along with bismuth preparation (Pepto-Bismol®) are usually prescribed for several weeks.

What are hemorrhoids?
Hemorrhoids are swollen and inflamed veins around the anus or in the lower rectum.
External hemorrhoids are located under the skin around the anus. Internal hemorrhoids develop in the lower rectum and may protrude through the anus. Hemorrhoids are not dangerous or life threatening.

What causes hemorrhoids?
Hemorrhoid veins are preset in everyone and normally act to cushion the anal area.  The swelling in the anal or rectal veins causes hemorrhoids.  Common factors are chronic constipation or diarrhea, straining during bowel movements or a lack of fiber in the diet.  Hemorrhoids are also caused by the weakening of the connective tissue in the rectum and anus that occurs with age.  Pregnancy can also cause hemorrhoids by increasing pressure in the abdomen, which may enlarge the veins in the lower rectum and anus, but typically disappears after childbirth.

What are the symptoms of hemorrhoids?
The most common symptom of internal hemorrhoids is bright red blood on stool, on toilet paper, or in the toilet bowl after a bowel movement. Internal hemorrhoids that are not prolapsed are usually not painful.  However prolapsed hemorrhoids often cause pain, discomfort and anal itching. Bleeding as described can’t be assumed to be hemorrhoids.  Studies show that when rectal bleeding seems typically hemorrhoidal, 40% of the time it is coming from a different cause.

How are hemorrhoids diagnosed?
Your doctor can perform a physical exam to look for visible hemorrhoids or a digital rectal exam with a gloved, lubricated finger and an anoscope can also be used.
Additional exams (colonoscopy, sigmoidoscopy or barium enema x-ray) may be used to rule out other causes of bleeding, especially in people age 40 or older.

How are hemorrhoids treated?
Lifestyle changes can often reduce the swelling of hemorrhoids and relieve hemorrhoid symptoms. A fiber diet can make stools softer and easier to pass, reducing the pressure on hemorrhoids caused by straining. Other changes that may help relieve hemorrhoid symptoms are drinking plenty of fluids, warm baths, regular exercise and avoid straining during bowel movements.

Over-the-counter creams and suppositories may temporarily relieve the pain and itching.  If lifestyle changes and at home therapies do not relieve symptoms, medical treatments may be needed. Outpatient treatments can be performed in a doctor’s office or a hospital. Treatments for internal hemorrhoids include:

• Rubber band ligation- a special rubber band is placed around the base of the hemorrhoid to cut off circulation, causing the hemorrhoid to shrink.
• Sclerotherapy-a chemical solution is injected into the blood vessel to shrink the hemorrhoid.
• Infrared coagulation-heat is used to shrink the hemorrhoid tissue.

If external and internal hemorrhoids do not respond to other treatments, surgery may be necessary to remove the hemorrhoids.

What is hepatitis?
Hepatitis means inflammation of the liver. Toxins, certain drugs, some diseases, heavy alcohol use and bacterial and viral infections can all cause hepatitis. The most common types are Hepatitis A, Hepatitis B and Hepatitis C.

What is the difference between Hepatitis A, Hepatitis B, and Hepatitis C?
Hepatitis A, Hepatitis B, and Hepatitis C are diseases caused by three different viruses. Although each can cause similar symptoms, they have different modes of transmission and can affect the liver differently. Hepatitis A appears only as an acute or newly occurring infection and does not become chronic. People with Hepatitis A usually improve without treatment. Hepatitis B and Hepatitis C can also begin as acute infections, but in some people, the virus remains in the body, resulting in chronic disease and long-term liver problems. There are vaccines to prevent Hepatitis A and B; however, there is not one for Hepatitis C. If a person has had one type of viral hepatitis in the past, it is still possible to get the other types.

What is Hepatitis B?
Hepatitis B is a contagious liver disease that ranges in severity from a mild illness lasting a few weeks to a serious, lifelong illness. It results from infection with the Hepatitis B virus. Hepatitis B can be either “acute” or “chronic.”

Acute Hepatitis B virus infection is a short-term illness that occurs within the first 6 months after someone is exposed to the Hepatitis B virus. Acute infection can — but does not always — lead to chronic infection.

Chronic Hepatitis B virus infection is a long-term illness that occurs when the Hepatitis B virus remains in a person’s body.

What is hepatitis C? 
Hepatitis C is a liver disease caused by the hepatitis C virus (HCV), which is found in the blood of persons who have this disease. HCV is spread by contact with the blood of an infected person. 
What blood tests are available to check for hepatitis C?

• Who should get tested for hepatitis C?
  • persons who ever injected illegal drugs, including those who injected once or a few times many years ago
  • persons who were treated for clotting problems with a blood product made before 1987 when more advanced methods for manufacturing the products were developed
  • persons who were notified that they received blood from a donor who later tested positive for hepatitis C
  • persons who received a blood transfusion or solid organ transplant before July 1992 when better testing of blood donors became available
  • long-term hemodialysis patients
  • persons who have signs or symptoms of liver disease (e.g., abnormal liver enzyme tests)
  • healthcare workers after exposures (e.g., needle sticks or splashes to the eye ) to HCV-positive blood on the job
  • children born to HCV-positive women

What is the next step if you have a confirmed positive anti-HCV test? 
Measure the level of ALT ( alanine aminotransferase, a liver enzyme) in the blood. An elevated ALT indicates inflammation of the liver and you should be checked further for chronic (long-term) liver disease and possible treatment. The evaluation should be done by a healthcare professional familiar with chronic hepatitis C. 
Can you have a normal liver enzyme (e.g., ALT) level and still have chronic hepatitis C? 
Yes. It is common for persons with chronic hepatitis C to have a liver enzyme level that goes up and down, with periodic returns to normal or near normal. Some persons have a liver enzyme level that is normal for over a year but they still have chronic liver disease. If the liver enzyme level is normal, persons should have their enzyme level re-checked several times over a 6 to 12 month period. If the liver enzyme level remains normal, your doctor may check it less frequently, such as once a year.

• How is HCV spread from one person to another? 
How could a person have gotten hepatitis C? 
HCV is spread primarily by direct contact with human blood. For example, you may have gotten infected with HCV if:
  • • you ever injected street drugs, as the needles and/or other drug “works” used to prepare or inject the drug(s) may have had someone else’s blood that contained HCV on them.
    • you received blood, blood products, or solid organs from a donor whose blood contained HCV.
    • you were ever on long-term kidney dialysis as you may have unknowingly shared supplies/equipment that had someone else’s blood on them.
    • you were ever a healthcare worker and had frequent contact with blood on the job, especially accidental needlesticks.
    • your mother had hepatitis C at the time she gave birth to you. During the birth her blood may have gotten into your body.
    • you ever had sex with a person infected with HCV.
    • you lived with someone who was infected with HCV and shared items such as razors or toothbrushes that might have had his/her blood on them.

  Is there any evidence that HCV has been spread during medical or dental procedures done in the United States?
Medical and dental procedures done in most settings in the United States do not pose a risk for the spread of HCV. There have, however, been some reports that HCV has been spread between patients in hemodialysis units where supplies or equipment may have been shared between patients. 
Can HCV be spread by sexual activity? 
Yes, but this does not occur very often. See section on counseling for more information on hepatitis C and sexual activity. 
Can HCV be spread by oral sex? 
There is no evidence that HCV has been spread by oral sex. See section on counseling for more information on hepatitis C and sexual activity. 
Can HCV be spread within a household? 
Yes, but this does not occur very often. If HCV is spread within a household, it is most likely due to direct exposure to the blood of an infected household member.

What is irritable bowel syndrome?
Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder of the colon (large intestine) that causes abdominal pain, bloating, constipation and diarrhea.  No structural or biochemical cause can be found to explain the symptoms, therefore IBS is diagnosed often after other possible digestive disorders and diseases have been ruled out.

What causes IBS?
Muscles in the colon normally contract many times a day; moving feces along and ultimately resulting in a bowel movement. With IBS these muscles are exceptionally sensitive to certain stimuli or triggers.  Researchers are not certain exactly why the muscles in the colon of a person with IBS are more sensitive but do know that IBS is not caused by stress or strong emotions.

What are the symptoms of IBS?
The symptoms of IBS can include:  gas, pain, bloating, nausea, vomiting, mucus in the stool, constipation and diarrhea. Cramps are often relieved by a bowel movement, but some people with IBS may have cramps and be unable to pass anything. Severity of symptoms varies, and could be anywhere from a mild annoyance to debilitating. IBS does not lead to Crohn’s disease or ulcerative colitis, or any type of bowel cancer.

How is IBS diagnosed?
IBS is often diagnosed after excluding organic diseases such as infection or other causes of the symptoms.  Testing includes:

• Blood tests-to determine the white blood ell count or if anemia is present.
• Fecal occult blood test-to detect bleeding from anywhere in the digestive tract.
• Stool culture-is collected and tested for bacteria, parasites and white blood cells
• Barium enema-uses barium sulfate and air to outline the rectum and colon, abnormalities will appear as dark silhouettes on the x-ray
• Sigmoidoscopy-a flexible, lighted tube is used to determine inflammation.
• Colonoscopy-a flexible, lighted tube is used to view the whole colon, the lower small bowel and sample tissue

Some gastroenterologists use a pattern of symptoms called Rome criteria to aid in the diagnosis of IBS.  In low risk circumstances with typical symptoms, these may help limit testing to the most necessary studies.

What medications are used to treat IBS?
Medications are used to lessen IBS symptoms such as diarrhea, cramping, pain or constipation.

What is lactose intolerance?
If you are lactose intolerant your body is unable to digest lactose, the sugar in dairy products.

What causes lactose intolerance?
Lactose intolerance is caused by either a deficiency of lactase in the body. Lactase is the enzyme needed to break down lactose into smaller components for digestion.
If your intestine is deficient in lactase, your own gut bacteria break down the lactose, generally giving off hydrogen as a bi-product.  This can cause bloating, cramps and diarrhea.  Lactose is the most sensitive enzyme on the intestinal surface.  It can be shed with an event as simple as a viral infection, and it may never recover.  Thus, a person can be lactose tolerant one day and intolerant over the next few weeks or months.  In rare cases, Lactose Intolerance can occur permanently. Approximately 60% of Caucasian adults and 90% of African American adults are lactose intolerant.

What are the symptoms of lactose intolerance?
Symptoms of lactose intolerance vary with the degree of lactase deficiency. A very mild deficiency may not experience any symptoms at all but a greater lactase deficiency can lead to bloating, loose stools and crampy abdominal pain.

How is lactose intolerance diagnosed?
The first step is to eliminate cow’s milk from your diet to see if the symptoms go away.  If symptoms persist there are several diagnostic tests to determine lactose intolerance.

• Lactose intolerance test-requires fasting and then drinking a liquid that contains lactose. Several blood samples are then taken to measure the person’s blood glucose (blood sugar) level.
• Hydrogen breath test-a lactose beverage is given, after digesting the beverage hydrogen levels are tested which indicate improper digestion of lactose.
• Stool acidity test-measures the amount of acid in the stool.

What is Liver Cancer?
Liver Cancer is the growth and spread of unhealthy cells in the liver.

What causes Liver Cancer?

• Cirrhosis
• Long term hepatitis B and hepatitis C infection
• Obesity
• Diabetes

What are the symptoms of Liver Cancer?
Signs and symptoms of liver cancer tend not to be felt or noticed until the cancer is well advanced.

• Jaundice
• Abdominal pain
• Unexplained weight loss
• Fatigue
• Nausea and Vomiting
• White, chalky stools

How is liver cancer diagnosed?
Liver cancer can be diagnosed by a physical examination or by imaging tests. To confirm a diagnosis of liver cancer, physicians may use blood tests, ultrasound tests, computer tomography (CT) scans, magnetic resonance (MRI), and angiograms. Your physician may also have to perform a liver biopsy.

What is Pancreatitis?
Pancreatitis is the inflammation of the pancreas.
What are the two types of Pancreatitis?

• Acute
• Chronic

What is Acute Pancreatitis?
Acute Pancreatitis is a sudden attack causing inflammation of the pancreas and is usually associated with severe upper abdominal pain. The pain may be severe and last several days.

What causes Acute Pancreatitis?

• Gallstones
• Excessive Alcohol Consumption
• Viral and Bacterial Infections
• Hereditary Conditions
• Trauma
• Medications
• Infections
• Electrolyte Abnormalities
• High Lipid Levels
• Hormonal Abnormalities

What are the symptoms of Acute Pancreatitis?

• Severe Abdominal Pain (Below the ribs). It usually builds up quickly (over a few hours) and may last for several days.
• Nausea
• Vomiting
• Diarrhea
• Bloating
• Fever

What is the treatment for Acute Pancreatitis?
The treatment for Acute Pancreatitis depends on how bad your attack may be. In most cases, Acute Pancreatitis settles over a few days, although symptoms can get worse before getting better.

What is Chronic Pancreatitis?
Chronic Pancreatitis is the progressive disorder associated with the destruction of the pancreas. The disease is more common in men and usually develops in persons between 30 and 40 years of age.

What causes Chronic Pancreatitis?

• Chronic Alcohol Consumption
• Cystic Fibrosis
• Hereditary Disorders of the Pancreas
• A significant number of patients have no known cause

What are the symptoms of Chronic Pancreatitis?

• Upper Abdominal Pain
• Diarrhea
• Over time patients can develop malnutrition and weight loss

What is the treatment for Chronic Pancreatitis?
The treatment for Chronic Pancreatitis depends on the symptoms. Most therapies center on pain management and nutritional support. Oral pancreatic enzyme supplements are used to aid in the digestion of food. Patients who develop diabetes require insulin to control blood sugar. The avoidance of alcohol is central to therapy.

What is rectal bleeding?
Rectal bleeding is blood from the rectum, which may appear on the stool, on the toilet paper or in the toilet bowl. Continuous passage of significantly greater amounts of blood from the rectum or stools that appear black, tarry or maroon in color can signify other diseases.

What are the possible causes of rectal bleeding?

• Hemorrhoids
• Anal fissures
• Proctitis (inflammation of the rectum) or colitis
• Polyps
• Colon or anal cancer
• Rectal ulcers
• Diverticulosis

What are hemorrhoids?
Hemorrhoids are swollen blood vessels in the anus and rectum that become engorged from increased pressure. Hemorrhoids are the most common cause of minor rectal bleeding, and are typically not associated with pain.  Treatments include warm baths, over-the-counter creams or a suppository.

What are anal fissures?
Anal fissures are tears that occur in the lining of the anus and are commonly caused by constipation. Anal fissures may also cause a lot of pain during and immediately after bowel movements. Treatment includes fiber supplements, stool softeners and warm baths.  Measures that relax the anal sphincter may also help healing.

What is proctitis?
Proctitis is the inflammation of the lining of the rectum caused by previous radiation therapy for various cancers, medications, infections or inflammatory bowel disease.

What are colon polyps?
Polyps are benign growths within the lining of the large bowel. It is important to remove polyps to prevent turning into colon cancer.

What is colon cancer?
Colon cancer starts in the large intestine and is the second most common cause of cancer deaths in the United States. It is a slow-growing cancer that can be cured if detected early.

What are rectal ulcers?
Rectal ulcers are an uncommon condition that is associated with long-standing constipation and prolonged straining during bowel movement.

What is Ulcerative colitis?
Ulcerative colitis affects the colon and the rectum, causing inflammation and ulcers in the lining of the large intestine.

What causes Ulcerative colitis?
The exact cause is unknown.  Some think ulcerative colitis might be caused by the immune system overreacting to normal bacteria in the digestive tract.

What are the symptoms?

• Loss of appetite
• Loss of weight
• Diarrhea
• Rectal bleeding
• Abdominal pain

How is ulcerative colitis diagnosed?
Your doctor will rule out other problems that can cause similar symptoms, such as irritable bowel syndrome or Crohn’s disease through these tests:

• Colonoscopy- an image of the lining of the colon examined for any abnormalities.
• Blood test-look for infection or inflammation
• Stool sample-looking for blood, infection and white blood cells

How is ulcerative colitis treated?
Typically, medicines are used for treatment unless symptoms are severe.  Medicines are used to reduce or stop symptoms and prevent flare-ups.  Steroids can also be used temporarily to help reduce or stop symptoms.
You may need surgery to remove part or all of your colon if severe symptoms persist and medicines do not work.  While colectomy is usually not necessary, total removal of all colon tissue is curative of ulcerative colitis and will prevent colon cancer, which occurs at significantly higher frequency in individuals with chronic ulcerative colitis.