GASTROENTEROLOGY CONDITIONS

 

COLON
Colon Cancer

Colon cancer is cancer in the lowest part of the digestive system, the large intestine or colon. Cancer occurs when cells in the body grow abnormally out of control. Most colon cancers occur when small, noncancerous (benign) clumps of cells called adenomatous polyps on the inner walls of the large intestine change and transform into cancerous (malignant) tumors over time. Identification of these benign polyps before they become cancerous is therefore especially important and can be done by regular screening tests.

Colon cancer cells lead to many complications by invading and damaging healthy tissues in the vicinity. Also, once malignant tumors form, the cancer cells may travel through the blood and lymph systems, eventually spreading to other parts of the body.

Symptoms of colon cancer depend on the size and location of the cancer. There may be no obvious symptoms in the initial stages of the disease. However, symptoms increase in quantity and degree of severity as the disease progresses.

Colon cancer manifests itself in two forms, local (confined to the colon) and systemic colon cancer (cancer has spread to different parts of the body). There is a variation in the signs and symptoms of these two forms.

Local Colon Cancer Symptoms

These symptoms include a change in bowel habits that include constipation or diarrhea, feeling of incomplete bowel evacuation, blood (either bright red or very dark) in stools, “pencil stools” (stools thinner than normal) and persistent abdominal discomfort accompanied by cramps, gas or pain. Consult Dr. Shahzad right away if you are experiencing similar symptoms over a few days.

Systemic Cancer Symptoms

Characteristic symptoms of systemic cancer include unexplained weight loss, loss of appetite accompanied by fatigue or weakness, nausea, anemia and jaundice. If you experience any of these symptoms, you should be seen by your health care provider at the earliest.

Regular colon cancer screenings can detect colon cancer early and potentially save your life. Early detection is advisable as polyps or growths on the lining of the intestine can be found early and removed before they develop into cancer. Colon cancer screening is dreaded by many people as they think it might hurt or they find it embarrassing. It is important to understand that Dr. Shahzad performs these procedures on a regular basis and there is no need to feel embarrassed. You remained covered during the exam and you will be kept comfortable during the procedure with anesthesia.

If your symptoms resemble colon cancer, your doctor will review your medical history and order blood tests. The following procedures may be recommended: 

Colonoscopy

A long and flexible slender tube is attached to a video camera and monitor, and the entire colon is captured on a screen. This helps to detect suspicious areas from where biopsies (tissue samples) can be taken for analysis using surgical tools passed through the tube.Virtual colonoscopy/CT colonography: Multiple CT scan images are combined to create a detailed picture of the inside of your colon. This is usually recommended for people who are unable to undergo colonoscopy.

Your doctor might recommend treatment options taking into account factors such as the stage of cancer (whether it is in the initial or the final stages) and the overall health of the patient. The different treatment options include surgery, chemotherapy and radiation. 

Surgery for IEarly or Initial Stage Cancer:

Your doctor may employ colonoscopy for removing small localized polyps. A procedure called endoscopic mucosal resection may be used for larger polyps. If colonoscopy does not yield the desired result, laparoscopic surgery may be used.Surgery for invasive colon cancer: A procedure called partial colectomy is used if the cancer has moved into or through your colon. This involves removing the cancer containing part of the colon, along with a portion of normal tissue on either side.

Surgery for Advanced Cancer

If the cancer has reached a point of “no cure”, or your general health conditions have dropped considerably, then surgery isn’t done to cure cancer; it is done to bring relief from symptoms such as bleeding and pain.

Chemotherapy

Chemotherapy involves using drugs to destroy cancer cells. It is usually taken up after surgery to relieve the symptoms of cancer that has spread to either lymph nodes or other areas of the body. It can also be used to shrink the cancer before the surgery.

Radiation Therapy

Radiation therapy uses high energy radiation such as X-rays to kill cancerous cells. It is usually employed in later stages of cancer and together with chemotherapy it can reduce the risk of cancer recurrence in specific areas.

Colon Polyps

Colon polyps are extra fleshy growth that develops on the lining of the large intestine (colon) protruding into the intestinal canal. Colon polyps are more common in older individuals. Colon polyps are non-cancerous, but some polyps become cancerous.

Risk Factors

Certain people may have a greater chance of getting polyps which are:

About 50 years of age or older
Family history of polyps
Previous history of polyps
Family history of colon cancer
History of uterine or ovarian cancer

Types

The three most common types of colon polyps are hyperplastic polyps, adenomas, and polyposis syndromes. Hyperplastic polyps refer to abnormal increase in the number of cells in the tissue. Adenomas are most dangerous of developing into colon cancer. They may be sessile or flat and may be removed during colonoscopy or require surgery.

Symptoms

Colon polyps are usually not associated with symptoms. When they occur, symptoms include bleeding from the anus, blood stools, abdominal pain, and mucous discharge, changes in bowel movements, and constipation or diarrhea.

Diagnosis

Your physician will perform the following tests to diagnose colon polyps:

Colonoscopy:

Colonoscopy is a procedure in which a flexible lighted tube is passed through the anus into the rectum and the colon. The colonoscope helps to view the pictures of inside of the rectum and colon.

Sigmoidoscopy

This procedure uses a shorter tube called a sigmoidoscope to transmit images of the rectum and the sigmoid colon (the lower portion of the colon).

Barium Enema X-Ray

In this procedure, X-ray is taken after injecting a contrast material called barium into the colon.

Computerized Tomograpo  in the Rectum.

Using x-rays, images of the large intestine are created.hy (CT) scan:In this procedure a thin, flexible tube is inserted int

Stool test: Stool sample is tested in the laboratory for signs of cancer.

Treatment

In most cases, polyps can be removed during colonoscopy or sigmoidoscopy examination and then tested for cancer. During colonoscopy, polyps can be removed by snaring them with a wire loop passed through the instrument and burning the tissue with electric cautery.

Surgery is required in some polyps that cannot be removed with the instruments because of their size or location. Polypectomy is surgical excision or removal of a polyp.

Prevention

You can reduce the risk of developing colon polyp by having high fiber and low fat diet, by avoiding alcohol and smoking, and by exercising and maintaining your weight.

Diverticular Disease

The intestine is divided into the large and small intestine. The large intestine absorbs nutrients from the food that you eat and pushes the remaining undigested waste towards the anus. High fibrous foods like fruits and vegetables soften the undigested material and help in easy movement of stools. However, low-fiber foods can produce small and hard stools that are expelled with increased strain while passing. This straining can create weak spots in the wall of the intestine leading to diverticular diseases, conditions that cause the development of small sacs or pouches. The conditions include diverticulosis, diverticular bleeding, and diverticulitis.

Diverticulosis

Diverticulosis is a condition where a large number of small pouches, known as diverticula, develop in the lining of the bowel. They can be small or large and are formed with increased strain during bowel movements, or when gas, waste, or liquid put pressure on the weak portions of the walls of the intestine. This is a common condition that can be found in 10% of people above age 40 and 50% of people over the age of 60.

Diverticular Bleeding

Diverticular bleeding occurs when there is an injury to the blood vessels lying adjacent to the diverticula.

Diverticulitis

Inflammation and infection of the diverticula is known as diverticulitis. When waste material blocks the diverticula, they can become inflamed due to bacterial invasion. Increased pressure on the colon wall or a block at the entrance of the diverticula can reduce blood supply and lead to infection and inflammation.

People suffering from diverticulosis do not have any serious symptoms, but when infection or inflammation occurs, the condition is known as diverticulitis and symptoms can be sudden in onset. The common symptoms include:

Abdominal pain and tenderness in the left lower abdomen
Pain worsens while eating and relieves after flatulence or passing stools

Alternating episodes of constipation and diarrhea

Bleeding from the rectum

Abdominal bloating

Alternating diarrhea with constipation

Nausea and vomiting

Fever and chills

Diverticular diseases can lead to other complications:

Peritonitis:rupture of diverticula and leakage of intestinal contents into abdominal cavity
Blockage in colon or small intestine due to scarring
Abscess formed by collection of pus
Fistula:abnormal passage between intestine and abdominal wall or intestine and bladder or vagina

What Are The Methods Of Screening And Diagnosis?

As people with diverticulosis show no symptoms, diagnosis usually occurs during routine screening examinations such as colorectal cancer screening or other intestinal tests.

When you present with symptoms of diverticulitis, your doctor will examine your medical history with relation to your diet, bowel habits, and current medications used, and will perform a physical examination. He/she may also conduct a digital rectal examination, where a gloved and lubricated finger will be inserted into your rectum to check for abnormalities. You may be recommended the following diagnostic tests in order to determine the extent of damage to your intestine:

Imaging Tests like X-rays, ultrasound and CT scans

Sigmoidoscopy: A flexible tube with a camera fitted at one end (sigmoidoscope) is introduced through the anus to visualize the inner lining of the sigmoid colon (lower 1/3rd of the colon) and rectum.

Colonoscopy: A flexible tube with a camera fitted at one end (colonoscope) is introduced through the anus to visualize the entire large intestine.

Blood tests: A sample of your blood is analyzed in the laboratory for infection.

You may also be recommended to undergo angiography to identify the site of bleeding if you have heavy rectal bleeding. Angiography is a procedure performed to visualize blood vessels after injecting a contrast material into the arteries.

You may also be recommended to undergo angiography to identify the site of bleeding if you have heavy rectal bleeding. Angiography is a procedure performed to visualize blood vessels after injecting a contrast material into the arteries.

What Are The Treatment Options?

Treatment for diverticular diseases depends on the severity of symptoms. People showing no symptoms of diverticular diseases are recommended a high-fiber diet to avoid constipation and increased stress on the colonic wall. Your doctor may prescribe medication for pain and antibiotics for infections.

In patients with recurrent episodes of diverticulitis, leading to complications such as abscess, perforation, or fistula, surgical treatment may be recommended. Surgery involves removing the diseased portion of your colon. There are two types of surgery:

Primary bowel resection:During this procedure, the affected portion of your intestine is removed and the healthy ends are reattached using a procedure known as anastomosis. Depending on the extent of damage to your intestine, primary bowel resection can be performed laparoscopically or using an open surgery technique. During an open surgery, your surgeon will create one long abdominal incision, while a laparoscopic procedure can be performed through 3 or 4 small incisions. The recovery process is usually faster with laparoscopic surgery. The advantage of primary bowel resection is that you will be able to have normal bowel movements after the surgery.

Bowel resection with colostomy:When you have severe inflammation in your intestine, making it difficult to re-join your colon to your rectum, your doctor may perform bowel resection with colostomy. During a colostomy, your doctor will create a surgical opening (stoma) in your abdominal wall and join the healthy part of your colon to the stoma. Waste from the colon flows through the stoma into a collecting bag (colostomy bag) attached to the stoma. Your surgeon may be able to perform another surgery to re-join your colon and rectum once the inflammation has healed.

Irritable Bowel Syndrome

Irritable bowel syndrome (IBS) is a set of gastrointestinal symptoms such as abdominal pain, discomfort, cramping and bloating occurring together due to the abnormal functioning of the gastrointestinal tract (usually the large intestine).

Anatomy

The gastrointestinal tract is made up of the mouth, esophagus (food pipe), stomach, large and small intestines, and the anus. There are many axillary organs such as the gallbladder, pancreas and liver, which aid in digestion and absorption as food passes from the mouth and wastes exit through the anus. The large intestine is the primary region for food absorption and is lined by a layer of muscle that rhythmically contract and relax to push food particles from the stomach across the intestinal tract.

Causes

The exact cause for IBS is unknown; however, in patients with IBS the contraction of the intestinal muscles becomes stronger or overactive. There are other factors that may be responsible for triggering irritable bowel syndrome. Some of these factors include:

Food Allergy: A wide range of foods such as spices, fats, beans, fruits and cabbage, may lead to IBS.

Stress: Stress plays a major role in increasing the symptoms of IBS. You may notice a steep increase in the symptoms of IBS under stressful situations.

Hormones: Changes in the hormonal levels in your body may also cause IBS. Women are highly prone to hormonal changes during menstruation and are more likely to experience symptoms of IBS at these times.

Other Ilnesses: Other illnesses such as diarrhea, infectious diseases or overgrowth of bacteria in the intestine are also responsible for IBS.

Brain-Gut Signaling: Problems in the nerve signals passing between your brain and intestine can cause IBS.

Impact

IBS is a chronic disease. While it can be mild and manageable for some, for others it can severely affect their quality of life and interfere with daily activities.

Symptoms

The symptoms of IBS include:

Changes in bowel movements
Abdominal pain and cramps
Bloating and gas
Diarrhea
Constipation
Presence of whitish mucus in stools

Diagnosis

If your symptoms continue for at least three times a month for 3 months, your doctor will review your medical history and perform a physical examination of your abdomen (checking abdominal bloating, tenderness and pain) to diagnose IBS. To confirm IBS, your doctor usually rules out the possibility of other conditions with X-rays, CT scan, colonoscopy and flexible sigmoidoscopy of the abdomen, stools test and blood tests.

Untreated

When left untreated, severe constipation and diarrhea can lead to hemorrhoids. IBS can lead to severe cases of GI tract conditions such as gastro esophageal reflux disease and indigestion. In some cases you can also experience problems related to other parts of your body such as joint disorder, chronic pelvic pain, chronic fatigue syndrome, anxiety and depression.

Options

IBS can be treated to relieve symptoms; however, this condition cannot be cured. Your doctor will be able to treat this condition with the help of:

Lifestyle Changes: Bringing about changes to your lifestyle with regular exercises, reducing your stress levels, and getting sufficient sleep can help you to reduce the symptoms gradually.

Dietary Changes: Having meals at regular timely intervals helps reduce IBS symptoms. It is also advisable to drink up to 8 cups of water or fluids per day to soften and ease the passage of stools. Your doctor will also advise you to increase your fiber intake if constipation is one of your main symptoms of IBS.

Medications: Your doctor may prescribe medications that relax the muscles of the gut, increase secretion of fluid in the small intestine, encourage smooth passage of stools, and provide relief to abdominal pain, cramping and constipation. Fiber supplements, antibiotics and antidepressants may also be prescribed.

Others

Since the symptoms of IBS are usually triggered by stress, various therapies to reduce stress are recommended. These may include psychological treatment, hypnosis and behavioral therapy.

Outcome

Although IBS cannot be cured, with effective treatment and regular monitoring of symptoms, the condition can be controlled and your quality-of-life will improve.

CALL Dr. Shahzad to see what treatment options are available for you 281-893-4488

ESOPHAGUS
Difficulty Swallowing

The act of swallowing is governed by the functioning of many nerves and muscles that help move food down the esophagus from the mouth, into the stomach for digestion. The difficulty, or inability to swallow food or liquids with ease is also called dysphagia.

While stress and anxiety can often lead to tightness in the throat, difficulty swallowing is a common symptom of many neurological disorders such as stroke, Parkinson’s disease and multiple sclerosis. It can also occur with many esophageal diseases such as cancer, achalasia (muscle dysfunction), scarring, chest tumor and scleroderma (immune system disorder that attacks the esophagus).

With dysphagia, you may feel like food or liquid is stuck in some part of your throat while swallowing, or experience symptoms such as choking, coughing, chest pain, pressure or heaviness in the neck or chest, reflux of undigested food, heartburn, nausea and a sour taste in the mouth.

If you present to the clinic with difficulty swallowing, your doctor will order a series of tests to look for problems with the muscles, narrowing, blockages or changes in the esophageal lining. An upper endoscopy may be performed, where a thin tube fitted with camera is inserted down your throat to detect abnormalities. Your doctor may order other tests to confirm the diagnosis, such as chest and neck X-rays, barium swallow test (barium solution that is swallowed coats the esophageal and stomach linings and is detected by X-ray imaging), esophageal pH and pressure monitoring, and blood tests.

Treatment involves identifying and treating the underlying condition. You will be advised to modify your diet, and perform exercises to strengthen and improve the coordination of weak facial muscles. Medications may be prescribed to treat underlying condition such as heartburn, gastroesophageal reflux disease (GERD) and infections. Your doctor may recommend dilation of the esophagus to expand any narrowed area. An endoscopy or surgery may be performed to remove obstructions in the esophagus (tumor or achalasia).

Esophageal Cancer

Esophageal Cancer: is a type of cancer that affects the esophagus, a tube that carries food from the mouth to the stomach. Cancer is the uncontrolled growth of abnormal cells. The accumulation of these extra cells forms a mass of tissue called tumor. According to the type of cells that are involved, esophageal cancers are classified as:

Adenocarcinoma of the Esophagus: It is the most common type of esophageal cancer which develops from the cells of mucus-secreting glands in the esophagus.

Squamous Cell Carcinoma: It is a type of cancer which develops from cells which are on the inside lining of the esophagus.

The exact cause of esophageal cancer is not known, however certain factors such as advancing age, gastro-esophageal reflux disease (GERD), obesity, Barrett’s esophagus, diet, smoking, alcohol, chemicals and pollutants may increase your risk of developing esophageal cancer.

In the early stages of esophageal cancer, you may have no symptoms. As the cancer grows you may have weight loss, difficulty swallowing (dysphagia), chest pain, fatigue, frequent choking, indigestion, coughing, and hoarseness.

Your doctor can often detect esophageal cancer by asking you several questions about the symptoms you are experiencing and performing a thorough physical examination. Certain tests may be ordered and could assist in determining the diagnosis and may include:

Barium X-Rays: These are diagnostic x-rays in which barium is used to diagnose tumors or other abnormal areas. You are asked to drink a liquid that contains barium while X-rays are taken. The barium coats the walls of the esophagus and stomach and makes the abnormalities visible more clearly.

Endoscopy: An endoscopy is a procedure in which a long thin flexible tube with a tiny camera is used to examine the lining of the esophagus, stomach, and duodenum.

Biopsy: A small sample of tissue is removed and examined under the microscope to look for abnormal cells.

Esophageal cancer may be treated with chemotherapy, radiotherapy, and surgery. Surgery to remove the portion of your esophagus that contains the tumor and nearby lymph nodes is called esophagectomy. The remaining section of the esophagus is connected again to your stomach.

Gastro-Esophageal Reflux Disease

Gastro-esophageal reflux disease (GERD) is a condition where the stomach contents (food or liquid) rise up from the stomach into the esophagus, a tube that carries food from the mouth to the stomach.

Normally the stomach contents do not enter the esophagus due to constricted LES. But in patients with GERD stomach content travels back into the esophagus because of a weak or relaxed lower esophageal sphincter (LES). Lower esophageal sphincter is a ring of muscle fibers that surrounds the lower-most end of the esophagus where it joins the stomach. LES acts like a valve between the esophagus and stomach preventing food from moving backward into the esophagus.

Heartburn is usually the main symptom; a burning-type pain in the lower part of the mid-chest, behind the breast bone. Other symptoms such as a bitter or sour taste in the mouth, trouble in swallowing, nausea, dry cough or wheezing, regurgitation of food (bringing food back up into the mouth), hoarseness or change in voice, and chest pain may be experienced.

The exact cause of what weakens or relaxes the LES in GERD is not known, however certain factors including obesity, smoking, pregnancy, and possibly alcohol may contribute to GERD. Common foods that can worsen reflux symptoms include spicy foods, onions, chocolates, caffeine containing drinks, mint flavorings, tomato based foods and citrus fruits. Certain medications can also worsen the reflux.

There are several tests that can be performed to diagnose GERD and they include:

Endoscopy: This test allows the doctor to examine the inside of the patient’s esophagus, stomach, and portions of the intestine, with an instrument called an endoscope, a thin flexible lighted tube.

Barium X-Rays: These are diagnostic x-rays in which barium is used to diagnose abnormalities of the digestive tract. You are asked to drink a liquid that contains barium. The barium coats the walls of the esophagus and stomach and makes the abnormalities visible more clearly. Then X-rays are taken to see if there are strictures, ulcers, hiatal hernias, erosions or other abnormalities.

24 Hour pH Monitoring: In this procedure, a tube will be inserted through the nose into the esophagus and positioned above the LES. The tip of the tube contains a sensor which can measure the pH of the acid content refluxed into esophagus. A recorder, strap-like device that can be worn on wrist, will be connected to record the pH of the acid content. The tube will be left in place for 24 hours.

Patients can also go back home and perform their regular activities and can record the pH of the acid content when they experience the symptoms. On the next day the recorder will be connected to a computer and the data will be analyzed.pH Capsule:It is a new method of measuring acid exposure in the esophagus. A small wireless capsule which is introduced into the esophagus by a tube through the nose or mouth. The tube is removed after the capsule is attached to the lining of the esophagus. The pH sensor transmits signals to a computer which collects the data about the acid exposure over the usual 24 hours. The capsule falls off of the esophagus with time and is passed in the stool.

Impedance Study: This test is similar to pH test but requires two probes; one is placed in the stomach and the other just above the stomach. The dual sensor helps to detect both acidic and alkaline reflux.Antacids are over-the-counter medicines that provide temporarily relief to heartburn or indigestion by neutralizing acid in the stomach. Other medications such as proton pump inhibitors and H2 antagonists may be prescribed to reduce the production of acid in the stomach.

Surgery may be an option for patients whose symptoms do not go away with the medications. Nissen’s fundoplication is a surgical procedure in which the upper part of the stomach is wrapped around the end of your esophagus and esophageal sphincter, where it is sutured into place. This surgery strengthens the sphincter and helps prevent stomach acid and food from flowing back into esophagus.

Endoluminal gastroplication or endoscopic fundoplication technique requires the use of an endoscope with a sewing device attached to the end, known as EndoCinch device. This instrument place stitches in the stomach below the LES to create a plate which helps reduce the pressure against the LES and help strengthen the muscle.

Chronic GERD left untreated can cause serious complications such as inflammation of the esophagus, esophageal ulcer, narrowing of the esophagus, chronic cough, and reflux of liquid into the lungs (pulmonary aspiration). Some people develop Barrett’s esophagus, in which there is changes in the esophageal lining that can lead to esophageal cancer.

General measures the patient can take to reduce reflux are:

Avoid eating before going to bed as this may decrease the acid production
Eat smaller and more frequent meals
Lose weight if you are over weight
Elevate the head of the bed
Eliminate the foods that increases the reflux
Avoid smoking and use of alcohol
Check with the physician regarding side effects of prescription medications

Barrett's Esophagus

The esophagus is the muscular pipe that carries food from the mouth to the stomach. Barrett’s esophagus is a condition characterized by changes in the cells lining the lower esophagus. Barrett’s esophagus is closely associated with gastro-esophageal reflux disease (GORD), a condition where the stomach’s contents rise from the stomach into the esophagus. Food mixed with the stomach’s digestive acids can irritate and damage the esophagus. Recurrent entry of these liquids leads to the changes in the esophageal lining called dysplasia. Barrett’s esophagus is a pre-cancerous condition however, it can occasionally lead to esophageal cancer.

Barrett’s esophagus usually doesn’t cause specific symptoms. People with GORD may experience a variety of symptoms including heartburn, a bitter or sour taste in the mouth, trouble swallowing, nausea, dry cough or wheezing, regurgitation of food, hoarseness or change in voice and chest pain.

An endoscopic examination of the esophagus is recommended for people with severe gastro-esophageal reflux symptoms. Endoscopy allows the doctor to examine the inside of your esophagus, stomach and portions of the intestine with an instrument called an endoscope, a thin flexible telescope. The diagnosis of Barrett’s esophagus is based on the presence of pink coloured tissue lining the lower esophagus. A biopsy (sample of tissue studied under the microscope) may show dysplastic changes in the cells lining the lower esophagus.

The treatment options for Barrett’s esophagus include

GORD treatment:
Antacids: over-the-counter medicines that provide temporary relief to heartburn and indigestion by neutralizing acid in the stomach
Other medications: PPI (Proton pump inhibitors) drugs reduce the production of acid in the stomach
Surgery: Fundoplication
Surveillance or Monitoring: If you have been diagnosed with Barrett’s esophagus, your doctor may advise you to undergo endoscopy and biopsy at frequent intervals to monitor the condition.
Surgery: Esophagectomy refers to the removal of the affected part of the esophagus.
Other treatments include laser therapy, radiofrequency ablation and photodynamic therapy (PDT).

LIVER & GALL BLADDER
Autoimmune Liver Diseases

The immune system protects the body by attacking and destroying foreign and harmful substances. However, in autoimmune liver diseases, the body’s immune system attacks its own liver (liver cells and bile duct cells), causing inflammation and liver damage. Untreated autoimmune liver disease can progress into cirrhosis, liver failure and cancer.

Early symptoms of autoimmune liver diseases may include joint pain, abdominal discomfort, unexplained rash, dark colored urine, light or grey colored stool, vomiting and decreased appetite. With the progression of the disease your skin and eyes may turn yellowish in color (jaundice), along with more severe joint pain, vomiting and weight loss. In due course, as the liver weakens, you may notice symptoms of cirrhosis.

Autoimmune liver diseases can be diagnosed with a series of blood tests. Your doctor may recommend a biopsy of the liver to rule out other conditions.

Treatment involves medications for suppressing the activity of the immune system (immunosuppressants) and to decrease swelling (steroids). Most cases can be controlled especially if the condition is diagnosed early. The disease is usually put into remission within 3 years, in most cases. Advanced cases of autoimmune liver diseases may require liver transplantation.

Biliary Tract Diseases

Liver is the largest organ of the body, located in the upper right portion of abdomen. It is a vital organ with many important functions.

The liver functions are:

Secretes bile for digestion of fats

Replaces damaged cells
Detoxifies blood
Converts glucose to glycogen which is stored in liver cells and reconversion of glycogen to glucose when required
Stores nutrients and vitamins
Stores iron for red blood cell (RBCs) production
Secretes cholesterol and produces amino acids

Liver Disease Is Any Condition That Affects Liver Function.

Some Of The Diseases Of Liver Are:

Hepatitis: Is the inflammation of the liver caused by viruses. Hepatitis A is caused by hepatitis A virus (HAV), spread primarily through food or water contaminated by stool from an infected person. Hepatitis B caused by hepatitis B virus, and spreads by contact with an infected person’s blood, semen and other body fluids. Hepatitis C caused by hepatitis C virus spreads through contact with the infected person’s blood and through sex and from mother to baby during childbirth. There is no specific treatment for hepatitis and resolves themselves.

Cirrhosis: It is a chronic liver disease characterized by abnormal structure and function of the liver. Healthy liver tissue is replaced by scar tissue, partially blocking the flow of blood through the liver. Treatment includes avoidance of alcohol, nutritional therapy and other therapies. Cirrhosis when not controlled by treatment, liver transplantation is considered. It is the final option for patients with liver failure. It is a major surgery in which the diseased liver is removed and replaced with a healthy liver from a donor.

Cancer: It is a cancer arising from the liver and results from the abnormal growth of the cells in the liver. It is also known as hepatocellular carcinoma. Early cancers can be treated by surgery or a liver transplantation. The treatment options for liver cancer are:

Partial Hepatectomy: is surgery wherein affected part of the liver is removed along with some of the healthy tissue around it. Total hepatectomy is surgical removal of entire diseased liver and replacing it with the healthy donated liver.

Radiofrequency Ablation: is another method wherein special probes with tiny electrodes are used to kill the cancer cells. High energy radio waves coming from the probe destroy the cancer cells.

Treatment

Cryosurgery: Is a type of surgery that uses an instrument to freeze and destroy the cancerous cells.

Laser Treatment: Is like radiofrequency ablation procedure, but uses lasers instead of radio waves to destroy the tumors.

Hemochromatosis: it is an inherited liver disease associated with abnormal accumulation of iron in multiple organs, leading to organ toxicity. The first step in the treatment is to get rid of excess iron from the body.

Phlebotomy; is withdrawal of blood from the arm veins every one to two weeks. It is done by incising or cutting a vein and just letting the blood flow into a container. This procedure improves the liver function, and prevents the development of liver cirrhosis and liver cancer.

Jaundice: Is not a disease, but rather a symptom of liver diseases. It is yellow discoloration of skin due to high levels of bilurubin in the blood

Hepatitis C

Hepatitis C is a liver infection caused by hepatitis C virus. The virus causes swelling and inflammation of the liver. You can contract hepatitis C if you come in contact with blood of an infected person. Viral transmission can occur by any of the following ways:

Unprotected sex with an infected person
Acupuncture or getting a tattoo with an unclean needle
Sharing drug needles
From mother to baby

Hepatitis C symptoms do not show in its early stages. When symptoms do occur they include abdominal pain and swelling, fever, tiredness, itchy skin, dark colored urine, appetite loss, jaundice (yellowish eyes and skin), vomiting and nausea. Sometimes, chronic hepatitis C does not show any symptoms until cirrhosis (scarring) forms in the liver.

Your doctor diagnoses hepatitis C with the help of blood tests. To detect the type of hepatitis C, your doctor may perform genetic testing. Liver damage may be determined with albumin level, liver function tests, prothrombin time and liver biopsy.

Based on the diagnosis, your doctor will prescribe the appropriate antiviral medication. You are advised to avoid alcohol and over-the-counter medication that can hasten liver damage. A liver transplant may be recommended for liver cancer and cirrhosis.

HCV cannot be spread by casual contact, such as touching, kissing, coughing or sneezing, breastfeeding, or sharing utensils. There is no vaccine currently for hepatitis C.

Hepatitis C can be easily avoided by not sharing needles or syringes with others and not having unprotected sex with an infected person.

Liver Cirrhosis

Overview

Cirrhosis is an abnormal condition where healthy tissue of the liver is replaced by scar tissue. The formation of scar tissue is irreversible and it eventually blocks the flow of blood through the liver. Cirrhosis is a slow progressing condition that occurs over years of liver damage. Cirrhosis, if not diagnosed early, can lead to advanced cirrhosis and liver cancer which can be life-threatening.

Symptoms

Cirrhosis is often dormant until extensive damage of the liver occurs, which determines the severity of symptoms. Some of the symptoms include fatigue, easy bleeding and bruising, ascites (accumulation of fluid in the abdomen), jaundice (yellowing of the eyes and skin), nausea, loss of appetite, weight loss, and leg swelling and itchy skin.

Complications

Cirrhosis of the liver can lead to portal hypertension (high blood pressure in blood vessel connecting liver to digestive organs), which can cause bleeding in other blood vessels. Hepatic encephalopathy (high concentration of toxins in the blood) may also occur, secondary to the inability of the liver to detoxify the body. Some of the other complications include infections, kidney failure, diabetes, and alteration in blood counts, enlargement of breasts in men, loss of muscle volume, premature menopause, and reduced oxygen in the blood.

Causes

Any damage to the liver can lead to cirrhosis. Viral infections such as hepatitis B, C or D, chronic alcohol abuse, and non-alcoholic steato-hepatitis (fatty liver disease) linked to diabetes and obesity are the most common causes of cirrhosis. Other causes may include:

Primary biliary sclerosis and primary sclerosing cholangitis that lead to damaged bile ducts (tubes that connects liver to intestine)
Hemochromatosis, where excessive amounts of iron is deposited in the liver
Wilson’s disease, where excessive amounts of copper is deposited in the liver
Sugar metabolism diseases like diabetes
Long-term dependence on prescription drugs
Cystic fibrosis (inherited disease of sweat glands and mucus)

Diagnosis

Cirrhosis is often first detected during routine blood work. The usual diagnosis for cirrhosis may include liver function tests using blood samples, imaging studies (MRI, CT, and ultrasound), and biopsy where a sample of the liver is obtained and analyzed under a microscope. Periodic imaging and blood tests are recommended to detect liver cancer.

Treatment
The primary treatment for cirrhosis is to keep progression of liver damage in check, and treat the underlying cause. Severe cirrhosis may require you to be hospitalized. You will be instructed to stop drinking or enroll into a de-addiction program if your cirrhosis is because of alcohol dependency. You will need to control your blood sugar levels and lose weight if you are suffering from cirrhosis caused due to fatty liver disease. Your doctor will prescribe medication to treat hepatitis and other symptoms.

Your doctor may recommend the following approaches to treat complications of cirrhosis:

Fluid build-up in the body can be managed by medications and following a low-sodium diet. In severe cases, surgery may be required.

High blood pressure can be controlled with blood pressure medications, and bleeding varices (abnormally bulged blood vessel) can be managed surgically by band ligation procedures.
Infections can be treated with antibiotics.

Hepatic encephalopathy (build-up of toxins in the body) can be controlled with medications.

Liver transplant surgery can be performed when the cirrhosis progresses to an extent where the liver ceases to function. Liver transplant is a procedure where the diseased liver is replaced wholly or partially with a healthy liver.

Prevention

Cirrhosis can be prevented by:

Avoiding or limiting alcohol intake

Eating a plant-based healthy diet and avoiding fried and fatty foods
Maintaining healthy weight
Reducing the risks of developing liver diseases, such as hepatitis

Liver Disease

Liver is the largest organ of the body, located in the upper right portion of abdomen. It is a vital organ with many important functions.

The Liver Functions Are:

Secretes bile for digestion of fats
Replaces damaged cells
Detoxifies blood
Converts glucose to glycogen which is stored in liver cells and reconversion of glycogen to glucose when required
Stores nutrients and vitamins
Stores iron for red blood cell (RBCs) production
Secretes cholesterol and produces amino acids

Liver Disease Is Any Condition That Affects Liver Function.

Some Of The Diseases Of Liver Are:

Hepatitis: Is the inflammation of the liver caused by viruses. Hepatitis A is caused by hepatitis A virus (HAV), spread primarily through food or water contaminated by stool from an infected person. Hepatitis B caused by hepatitis B virus, and spreads by contact with an infected person’s blood, semen and other body fluids. Hepatitis C caused by hepatitis C virus spreads through contact with the infected person’s blood and also through sex and from mother to baby during childbirth. There is no specific treatment for hepatitis and resolves themselves.

Cirrhosis: It is a chronic liver disease characterized by abnormal structure and function of the liver. Healthy liver tissue is replaced by scar tissue, partially blocking the flow of blood through the liver. Treatment includes avoidance of alcohol, nutritional therapy and other therapies. Cirrhosis when not controlled by treatment, liver transplantation is considered. It is the final option for patients with liver failure. It is a major surgery in which the diseased liver is removed and replaced with a healthy liver from a donor.

Cancer: It is a cancer arising from the liver and results from the abnormal growth of the cells in the liver. It is also known as hepatocellular carcinoma. Early cancers can be treated by surgery or a liver transplantation. The treatment options for liver cancer are:

Partial Hepatectomy: is surgery wherein affected part of the liver is removed along with some of the healthy tissue around it. Total hepatectomy is surgical removal of entire diseased liver and replacing it with the healthy donated liver.

Radiofrequency Ablation: is another method wherein special probes with tiny electrodes are used to kill the cancer cells. High energy radio waves coming from the probe destroy the cancer cells.

Jaundice: Is not a disease, but rather a symptom of liver diseases. It is yellow discoloration of skin due to high levels of bilirubin in the blood.

Treatment

Cryosurgery: Is a type of surgery that uses an instrument to freeze and destroy the cancerous cells.

Laser treatment: Is similar to radiofrequency ablation procedure, but uses lasers instead of radio waves to destroy the tumors.

Hemochromatosis: it is an inherited liver disease associated with abnormal accumulation of iron in multiple organs, leading to organ toxicity. The first step in the treatment is to get rid of excess iron from the body.

Phlebotomy: is withdrawal of blood from the arm veins every one to two weeks. It is done by incising or cutting a vein and just letting the blood flow into a container. This procedure improves the liver function, and prevents the development of liver cirrhosis and liver cancer.

PANCREAS
Pancreatic Cancer

The pancreas is a dual functioning gland of the digestive system made up of two types of cells: one produces digestive juices and the other releases hormones that help regulate blood sugar levels. The abnormal growth of pancreatic cells can lead to pancreatic cancer.

Most pancreatic cancers are formed in the cells that produce digestive enzymes, causing yellowing of the skin and whites of the eyes (jaundice), upper and middle abdominal pain, back pain, unexplained weight loss, appetite loss, fatigue, dark colored urine and light colored stools. You are at an increased risk of developing pancreatic cancer if you are a smoker, overweight, have diabetes, or have family history of pancreatitis (inflammation of the pancreas) or pancreatic cancer.

Pancreatic cancer can be diagnosed by reviewing your medical history and performing a thorough physical examination. Your doctor may order blood tests and other imaging tests such as MRI, CT scan, ultrasound, endoscopic ultrasound, and endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous trans-hepatic cholangiogram (PTC). Your doctor may also perform a biopsy to confirm the diagnosis.

Treatment involves surgery to remove the cancer cells completely. However, if the cancer is in advanced stages and has spread to other parts of the body, treatment involves managing symptoms for the best quality of life.

Pancreatic Cysts

The pancreas is a dual functioning gland of the digestive system made up of two types of cells: one produces digestive juices and the other releases hormones to regulate blood sugar levels. Pancreatic cysts are sac-like pockets of fluid or semisolid matter made up of damaged tissue or debris located on or within the pancreas. They can be noncancerous (pseudo cysts) or cancerous (malignant). The cause of pancreatic cysts is often not very clear. Some cysts can result from a rare genetic disorder known as von Hippel-Lindau disease.

Pancreatic cysts can be asymptomatic or produce moderate to severe symptoms such as persistent and severe abdominal or back pain, bloating, nausea and vomiting. Complications of pancreatic cysts include infection, rupture of the pseudocyst or hemorrhage (bleeding) and high blood pressure of the splenic or portal vein.

Pancreatic cysts are diagnosed with imaging tests such as ultrasound, CT scan of the abdomen, MRI, magnetic resonance cholangiopancreatography (MRCP), endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP). Most often, pseudocysts resolve without the need for treatment. However, if your symptoms are severe and the cysts are growing larger, your doctor may recommend drainage of the cysts. The cysts may be drained through an endoscopy procedure where a long thin tube with a needle is inserted to drain the cyst, percutaneous catheter drainage (a hollow tube is inserted into the body) or surgical drainage through open (long incision is made on the abdomen) or laparoscopic (3 to 4 small incisions are made on the abdomen) techniques.

Pancreatitis

The pancreas, located in the abdomen, is responsible for the production of digestive juices and the hormones insulin and glucagon. Inflammation of the pancreas leads to a condition called pancreatitis. Pancreatitis can be acute or chronic. Acute pancreatitis is usually a milder form of pancreatitis, characterized by sudden and severe abdominal pain. Other symptoms include fever, vomiting, nausea, sweating, swelling in the abdominal region, and feeling of fullness due to gas, mild jaundice and clay-colored stools.
Acute pancreatitis is most often caused by excessive intake of alcohol, genetic factors, autoimmune problems, blockage of the pancreatic duct or common bile duct, which drains digestive enzymes from the pancreas into the intestine, other conditions such as cystic fibrosis and certain medications such as estrogens and corticosteroids. Acute pancreatitis affects men more often than women.

Acute pancreatitis is diagnosed by various laboratory tests that measure the levels of pancreatic enzyme, and imaging techniques, such as CT scan, MRI and ultrasound, which indicate inflammation of the pancreas.
Treatment of acute pancreatitis is directed towards reducing the inflammation and treating the underlying cause of the condition. Mild cases may require hospital admission, where you will be given pain medication and intravenous fluids, and closely monitored for recovery from your symptoms. Your doctor will stop food and fluid through the mouth to limit the activity of the pancreas. In severe cases, antibiotics may be administered and surgery performed to remove the infected and damaged pancreas, and remove the obstruction blocking the pancreatic ducts.
Once there is improvement in the attack, one should completely avoid smoking, alcoholic drinks, and fatty foods.

RECTUM
Hemorrhoids

Hemorrhoids, commonly known as piles refer to a condition in which the veins around the anus or in the rectum become swollen and inflamed. Majority of people may suffer from hemorrhoids at some point in their life time. It is more common in individuals aged between 45 and 65 years and in pregnant women. External hemorrhoids occur on the skin around the anus whereas internal hemorrhoids develop in the rectum. Internal hemorrhoids tend to protrude out through the anus.

Several factors are considered to as the causes for hemorrhoids and some of them include:

Chronic constipation and diarrhea
Excessive straining during bowel movement
Diet which lacks fibrous food
Aging (weak connective tissue in the rectum and anus)
Pregnancy (increased pressure in the abdomen)
Symptoms
Internal hemorrhoids: The most common symptom is passage of bright red blood with the stools. If the hemorrhoids have prolapsed, it causes pain, discomfort and itching around the anus.

External hemorrhoids: Blood clots may form in the swollen veins causing bleeding, painful swelling or a hard lump.

Diagnosis

Your doctor will perform physical examination which involves digital rectal exam with a gloved, lubricated finger and an anoscope. Additional diagnostic tests may be ordered to rule out other causes of bleeding.

Colonoscopy: Colonoscopy is a procedure in which a flexible lighted tube is passed through the anus into the rectum and the colon. The colonoscope helps to view the pictures of inside of the rectum and colon.

Sigmoidoscopy: This procedure uses a shorter tube called a sigmoidoscope to transmit images of the rectum and the sigmoid colon (the lower portion of the colon).

Barium Enema X-Ray: This procedure involves taking an X-ray after injecting a contrast material called barium into the colon.

Treatment

Lifestyle modifications and dietary changes often are helpful in reducing the symptoms of hemorrhoids. A diet having high fiber content soften the stools and helps to pass them easily thereby avoids straining. Fruits, vegetables and cereals serve as a good source of dietary fibers. Fiber supplements such as methylcellulose or stool softeners can be taken. Drinking plenty of water (8-ounce glasses) and adequate exercise helps prevent constipation. Over-the-counter creams and suppositories help relieve the pain and itching. However, these are short time remedies as long-term use can cause damage to the skin.

Medical Treatment

Outpatient treatments are provided for internal hemorrhoids and include the following:

Rubber band Ligation: This procedure involves placement of a special rubber band around the base of the hemorrhoid. This band obstructs the blood circulation causing the hemorrhoid to shrink.

Sclerotherapy: This involves injecting a chemical solution into the blood vessel so that the hemorrhoid shrinks.

Infrared Coagulation: In this procedure, the hemorrhoid tissue is shrunk using heat. 

Surgical removal becomes necessary when the hemorrhoids are large enough and do not respond to conservative treatment.

Dr. Shahzad performs minimally invasive /minimal discomfort Hemorrhoid treaments in his office. Call 281-893-4488 to be evaluated

Rectal Bleeding

Rectal bleeding refers to the passage of blood through the anus along with the stools. The rectum is the last part of the large intestine present just above the anus. Rectal bleeding is referred to as bright red to dark maroon colored blood passing along with stools through the anus. The amount of blood loss varies from mild traces to severe life-threatening bleeds. Bleeding can occur from any part of the gastrointestinal tract due to various causes.

Common Causes Of Rectal Bleeding:

Piles (hemorrhoids): These are the swollen blood vessels found in and around the rectal region. These can cause bleeding when passing stools and irritate the surrounding skin making you feel uncomfortable.

Anal Fissure: Is a small painful tear in the tissue lining of the anus.

Angiodysplasia: This issue of the colon is related to aging and occurs due to enlarged blood vessels in the colon.

Gastroenteritis: Viral or bacterial stomach infection causing bloody diarrhea with abdominal cramps and vomiting.

Diverticula: Refers to tiny bulges that develop on the intestinal lining. The deteriorated blood vessels in the diverticula may burst or bleed.
Other conditions such as stomach ulcers, ulcerative colitis, Crohn’s disease and cancer of the colon or rectum may also cause rectal bleeding.

The color of blood and consistency of stools varies depending on the location and the cause of bleeding in the gastrointestinal tract. The color of stool may vary from bright red to maroon to dark red or black. A stool blood test may be required in cases of mild bleeding that is invisible to the naked eye.

Abdominal pain, visible blood clots or bleeding without pain are the typical symptoms associated with rectal bleeding. You may also experience weakness, chest pain, dizziness, shortness of breath, or blood pressure variations based on the amount of blood loss.

Do not ignore any type of bleeding in the stools. Rectal bleeding can occur due to a mild condition like piles or a more severe condition that may require immediate intensive treatment to control it.

The diagnosis of rectal bleeding depends to a large extent on the patients’ age and medical history. Your doctor may ask questions about the bleeding such as the color of blood, amount of blood loss or other associated symptoms. A physical examination of the anus can confirm the presence of anal fissures or hemorrhoids and helps to rule out other associated diseases.

Some Diagnostic Tests May Be Ordered To Determine The Cause Of Rectal Bleeding

Test Include:

Fecal occult Blood Test: To check for small traces of blood present in the stools which is invisible to the naked eye. Changes in the color of stool after adding a certain chemical to the test sample indicates the presence of blood in the stool.

Anoscopy: Is an evaluation of the rectum in which a lubricated flexible tube (anoscope) is inserted into the rectum through the anus to detect abnormalities such as hemorrhoids and anal fissures.

Flexible Sigmoidoscopyuses: A flexible sigmoidoscope to examine the sigmoid colon and the rectum.

Colonoscopyis: A procedure to evaluate the colon for polyps, cancer, ulcerative colitis and Crohn’s disease.

Radionuclide Scans: Used to determine the location of gastrointestinal bleeding. A radioactive substance is injected and a nuclear camera is used to scan the stomach. The area affected with Meckel’s diverticulum will concentrate the radioactive substance and show up on the scan. Another method involves attaching the radioactive substance to the blood of the patient and injecting the blood back into the veins. The tagged blood cells will leak into the bleeding area of the gastrointestinal tract and appear on the scan.

Visceral Angiogramuses: X-rays to study the blood vessels of the digestive tract. This is an accurate test to locate rapid bleeding in the digestive tract.

Rectal bleeding can effectively be treated depending upon the related cause and underlying diagnosis.

Treatment of Anemia

Your doctor will treat anemia and decreased blood volume caused due to severe rectal bleeding by injecting intravenous fluids or by blood transfusions. Iron supplements will be prescribed to build up your iron levels.

Hemorrhoidal creams and stool softeners may be prescribed to treat rectal bleeding associated with anal fissures or hemorrhoids.

Medications to relieve pain or vasoconstrictors (decreases the size of blood vessels) to stop bleeding.

Endoscopy can be used to stop bleeding by constricting or cauterizing the actively bleeding blood vessels.-

Constriction is achieved by infusion of medications through the endoscopic needle at the site of bleeding.

Cauterization during endoscopy is usually accomplished by inserting a cautery probe through the endoscope.

Surgery may be recommended to remove polyps, hemorrhoids, or tumors.

Prevention

The most effective preventive measures of rectal bleeding include:

Increase intake of fluids and eat a high fiber diet to avoid constipation.
Avoid excessive alcohol consumption.

You should seek immediate medical care if you notice blood in your stools. 281-893-44884

SMALL INTESTINE
Celiac Disease

The digestive system is composed of organs that are involved in the digestion of food and absorption of vital nutrients needed for growth and good health. The small intestine is one of the most important parts of the digestive system, and is lined by millions of microscopic, finger-like projections known as villi. These are involved in the absorption of minerals, vitamins, electrolytes and fluids in the body.

Celiac disease is an autoimmune disease in which the body’s immune system acts against gluten (protein found in rye, barley, wheat, and grains) causing inflammation of the small intestine, and damage or destruction of the villi. The body’s capacity to absorb food soon declines leading to the risk of malnutrition and malabsorption.

Causes

The exact cause of celiac disease remains unknown but one of the main causes is the destruction of the villi by the body’s own immune system, which results in malnourishment of the body. It has been seen that people having a family history of this disease have more chance of getting this disorder. It is more common in Caucasians, Europeans and women. People suffering from autoimmune disorders like rheumatoid arthritis, systemic lupus erythematosus, Sjogren’s syndrome, Addison’s disease, and those with Down syndrome are more susceptible to celiac disease. Similarly, disease conditions, such as intestinal cancer or lymphoma, lactose intolerance, and people suffering from thyroid disease or type 1 diabetes, are more likely to develop this disease

Ileitis

Ileitis is a condition characterized by irritation or inflammation of the ileum, the last part of the small intestine that joins the large intestine. Symptoms include weight loss, diarrhea, cramping or pain in the abdomen, or fistulas (abnormal channels that develop between parts of the intestine). Ileitis can be caused by many conditions, Crohn’s disease being the most common. Other causes include infections, effects of NSAIDs, ischemia and abnormal growths.

Diagnosis of the exact cause of ileitis is critical to timely treatment and the treatment plan decided by your doctor. Your doctor will review your medical history and perform a thorough physical examination. A series of tests may also be ordered to confirm the diagnosis which may include stool analysis, X-rays, barium X-rays of the small intestine, CT scan, colonoscopy (narrow lighted tube is inserted into the anus for a close examination) and biopsy.

Based on the results of the diagnostic tests, ileitis may be treated with medications including antibiotics, corticosteroids, anti-inflammatories, antidiarrheal and immune-suppressing medications, as well as dietary supplements to reduce inflammation and manage associated symptoms. Surgery is indicated if symptoms are not controlled with medications or complications develop. Surgery is performed to remove the diseased part, correct blockages, intestinal bleeding and perforations in the intestine. You need to maintain a healthy lifestyle, exercise regularly, eat well and avoid smoking

Inflammatory Bowel Disease

Inflammatory bowel disease (IBD), as the name implies, refers to inflammatory condition of the bowel or gastrointestinal (GI) tract. It is a group of disorders characterized by inflammation of bowel or any part of the GI tract. Though the exact cause of the condition remains unknown, the genetic and non-genetic or environmental factors are thought to play a part. All these factors may impair the normal functioning of the immune system and the body’s defense mechanism attacks body’s own tissue causing inflammation of the mucosal lining.

Though IBD is an umbrella term for group of diseases, the two major sub-types include ulcerative colitis and Crohn’s disease. In both the conditions, the inflammation may persist for longer time and have waxing and waning course in severity as well the intensity of disease.

Ulcerative Colitis

Ulcerative colitis is an inflammatory disease condition that causes diarrhea (frequent, loose stools) and ulcers in the lining of the colon and rectum. It can occur at any age and is more common among people of the age group between 15 and 30 years. It has a tendency to run in families. The most common symptoms of ulcerative colitis are pain in the abdomen and blood stained diarrhea. There may also be symptoms such as anemia, tiredness, loss of appetite, rectal bleeding, sores on skin, and pain in the joints. Growth failure may occur in children with this disease. In most of the cases, the symptoms of ulcerative colitis are very mild, but when it is severe it causes frequent fever, nausea and painful cramps in the abdomen.

Crohn’s Disease

Crohn’s disease is a chronic inflammatory disorder causing inflammation of the tissue lining the digestive system with characteristic symptoms such as abdominal pain and diarrhea. It most commonly involves the lower part of the small intestine, the ileum and therefore also known as ileitis or enteritis. It is a hereditary disease and can occur in people of all age groups while more common in people aged between 20 and 30 years.

The symptoms of Crohn’s disease may be mild to severe, intermittent with a flare-up period. Abdominal cramps usually in the lower right area and frequent loose stools are the common symptoms. Other symptoms include rectal bleeding, loss of appetite, weight loss, fever, pain in the joints, and skin sores or lumps. Children suffering from Crohn’s disease may have a stunted growth.

The major difference between Crohn’s disease and ulcerative colitis is the part of GI tract affected. Crohn’s disease causes inflammation and ulcers anywhere from mouth to anus whereas ulcerative colitis is more confined to the colon. The common symptoms of both the conditions are diarrhea and abdominal pain.

Treatment for these inflammatory conditions includes the drug therapy with corticosteroids and immunomodulator or the surgical resection of the affected part.

STOMACH
Gastritis

Food in the stomach is broken down by digestive juices. The stomach itself is protected from these digestive juices by a mucous lining. Gastritis is a common condition of the gastrointestinal system, characterized by inflammation or irritation of the stomach’s lining caused by weakness in the mucous lining. Gastritis can be caused by stress, excess alcohol consumption, certain medicines and bacterial/viral infections.

Gastritis can be chronic (develop over time) or acute (occur suddenly). The symptoms may include bloating, indigestion, loss of appetite, burning or gnawing feeling in the stomach, nausea, vomiting, abdominal pain and a feeling of fullness in the upper abdomen.

Your Doctor May Recommend Some Diagnostic Tests To Confirm The Cause Of Gastritis.

TESTING

Stool Test: To determine the presence of blood in stools and the presence of Helicobacter pylori infection.

Blood Test: To determine the presence of Helicobacter pylori infection and red blood cell count.

Barium upper GI Series: You will be asked to swallow a white liquid (barium) that coats your digestive tract. A series of X-ray images of the upper gastrointestinal tract are captured to assess for abnormalities.

Endoscopy: A thin tube with a tiny camera (endoscope) is inserted through the mouth and advanced into the stomach to check for inflammation in the lining.

The treatment of gastritis is aimed at treating the underlying cause. Your doctor may prescribe medications such as antacids or proton pump inhibitors to lower the levels of acid (neutralize) in the stomach. Antibiotics may be prescribed if gastritis is caused due to infection. Your doctor may advice you to avoid caffeine, alcohol, certain medicines and some foods that may increase the symptoms of gastritis.

Stomach Cancer

Stomach cancer is the cancer that develops from the cells of the inner layer of the stomach. Cancer is the uncontrolled growth of abnormal cells. The accumulation of these extra cells forms a mass of tissue called tumor. Cancer can occur in any part of the stomach.

Stomach cancer are of different types depending on the cells of the stomach from which they originate such as hormone making cells, cells of the inner lining or the immunological cells of the stomach. Gastric cancers can spread to the other parts of the body (malignant). They first spread from the stomach to the lymph nodes and then further spread through the lymphatic system. In latter stages, it may spread to other organs such as liver, bones and lungs through blood.

Lymph nodes are the small kidney shaped structures which are the sites for formation of body’s defense cells lymphocytes. Lymph is a clear fluid that flows through lymph vessels and lymph nodes. The interstitial fluid (fluid found between the cells) bathes all the cells and carries excretory products, bacteria and viruses from the cells and helps remove them from the body’s tissues.

Gastric cancer treatment depends on the type and the stage or spread of the cancer. Your age and general state of health is also important consideration by the doctor in determining the treatment modality. Treatment involves surgery, chemotherapy and radiation therapy. Surgery is the most common treatment for gastric cancer.

Surgery

Gastric cancer can spread to other tissues and organs therefore removal of the cancerous tissue is a must. Three kinds of surgeries are used to treat gastric cancer. The type of surgery depends on where the cancer is located and how deep the cancer cells have invaded the area in the stomach. The three types of surgery for gastric cancer are:

Endoscopic Mucosal Resection: It is done only when the cancer is detected at an early stage, where the chance of it spreading to lymph node is very less. In this procedure cancerous tissue is removed from the stomach using endoscope, a long flexible tube with the camera at the end. During the procedure an endoscope is passed through the mouth into the stomach and surgical tools are also passed through it to remove the cancerous tissue. The surgery is done using these tools and does not involve any cuts on the body.

Subtotal Gastrectomy: As the name suggests in this surgery a part of the stomach is removed. It is mostly used when the cancer is only in the lower part of the stomach or the upper part of the stomach. During the procedure only part of the stomach is removed, sometimes a part of the esophagus is also removed along with it. Nearby lymph nodes may also be removed. The remaining part of the stomach is then reattached.

Total Gastrectomy: In this surgery the whole stomach is removed along with nearby lymph nodes. And new stomach is recreated by the small intestine. This is usually done when the cancer has spread to the whole of stomach. Sometimes nearby organs are also removed if the cancer has spread to them.

Chemotherapy and radiation may also be given after the surgery to kill the few cancer cells that may have left after the surgery and to prevent the recurrence of the disease.

Possible complications of surgery for stomach cancer include bleeding, formation of blood clots, and damage to nearby organs. You may also develop frequent heartburn, abdominal pain (especially after eating), and vitamin deficiencies.

After the surgery follow up is very important since the recurrence of the disease is a possibility. In case of any suspicion the doctor will ask for certain tests to confirm his findings. Absorption of vitamin B12 occurs through upper part of the stomach. If upper part of the stomach is removed by surgery Vitamin B12 levels are closely monitored and Vitamin B12 injections are given when required. The doctor may refer you to a nutritionist to plan your diet and you need to eat more often and small meals as the size of the new stomach is small.

Ulcers

Peptic ulcer or commonly called as ulcer is erosion of the mucosal layer lining the stomach, esophagus and the duodenum. Peptic ulcer of the stomach is gastric ulcer, esophagus is esophageal ulcer and duodenum is duodenal ulcer.

Most peptic ulcers are caused by an infection with bacteria Helicobacter pylori (H. pylori). Another common cause is the regular use of non-steroidal anti-inflammatory drugs (NSAIDs). Smoking, drinking excessive alcohol and uncontrolled stress may increase the risk of developing peptic ulcers.

Small peptic ulcers do not cause any symptoms. Some ulcers can result in bleeding, peritonitis and scar tissue formation that can obstruct the passage of food through the digestive tract.

The most common symptom of an ulcer is a burning pain in your stomach. The pain may be felt anywhere between the breastbone and belly button. You will often feel the pain when the stomach is empty, and is relieved on eating or by taking medications. Pain may sometime wake you in the middle of the night. Other symptoms of peptic ulcers may include nausea, vomiting, loss of appetite, and unexplained loss of weight. Blood may appear in the vomit or stool.

Peptic Ulcer Disease Can Be Diagnosed By Certain Tests Such As:

Esophagogastroduodenoscopy: Esophagogastroduodenoscopy (EGD) is an examination of the stomach and small intestine using an endoscope, a thin tube with a camera on the end. The endoscope is inserted down your throat and into your esophagus, stomach and small intestine. During EGD, your doctor may take tissue samples to check for the presence of pylori

X-ray of Upper Digestive System: A series of X-rays are taken after you swallow a preparation containing barium which coats the wall of the upper digestive tract and makes an ulcer more visible

Hemoglobin Blood Test: This test measures the amount of hemoglobin, a protein in red blood cells that carries oxygen, to check for anemia

Stool Guaiac Test: This test determines blood in the stool which is not commonly visible

Peptic ulcers can be treated using various medications and in some cases with surgical correction. Antibiotics may be used to eradicate H. pylori, anti-ulcer medications are used to inhibit the acid secretions and to heal the ulcers, and some medications help protect the mucosal layer. In cases of bleeding ulcers, EGD may be performed and surgery is recommended when EGD fails to stop the bleeding or in cases of perforated ulcers.

Your physician may advise to quit smoking, avoid or limit the alcohol consumption and avoid overuse of NSAID’s to prevent the development of peptic ulcers.

OTHER GI CONDITIONS
Abdominal Pain

Abdominal pain, as the name suggests it is the pain or discomfort in your abdominal region, the region between your chest and groin. Abdominal pain is so common that almost every one of us may experience it at some point of time in our lives. Abdominal pain is not a condition or disease by itself, rather is a symptom of many of the gastrointestinal (GI) conditions in any of the abdominal organs including end of the esophagus, stomach, small and large intestines, liver, gallbladder, pancreas, the appendix, kidneys and spleen. Pain may even start from your chest or pelvic area.

Severity of pain is not a parameter to assess the severity of the condition. We may experience severe or intolerable pain even for mild conditions such as bloating, cramps or viral gastroenteritis or we may have no pain/mild pain even in cases of serious conditions such as colon cancer or early stages of appendicitis. Therefore do not neglect your abdominal pain and immediately seek the medical intervention.

Abdominal pain may be described as generalized when it is present in more than half portion of your stomach and is because of a viral infection, indigestion or gas. More severe pain may be caused because of intestinal blockage. Pain will be localized to one area of your stomach if it is because of problem in one of your abdominal organs. Cramps or spasm like pain are likely to occur because of gas or bloating and is often followed by diarrhea. Another type of pain described as colicky pain starts and ends suddenly and is more severe. This type of belly pain occurs when there is a kidney stone or a gall stone.

Medical Conditions

Appendicitis
Bowel obstruction
Inflammation of the gallbladder with or without gallstones
Chronic constipation
Diverticulitis
Food allergy, food poisoning or viral gastroenteritis
Heartburn, indigestion or reflux disease
Inflammatory bowel disease (Crohn’s disease or ulcerative colitis)
Irritable bowel syndrome
Kidney stones
Lactose intolerance
Lack of enough blood supply to the gut
Pancreatitis
GI tumors or cancers
Ulcers
Urinary tract infections

In cases of mild abdominal pain, sipping on water or clear fluids may help. Also, it is better to avoid solid foods for the first few hours and then eat small quantity of soft foods such as rice. Antacids may provide relief if the pain starts soon after meals. Your doctor will check for the cause of your abdominal pain from medical history and physical examination. During physical examination, your doctor will find out whether the pain is localized or spread out and also watch for signs of inflammation (peritonitis). Based on the diagnosis, appropriate treatment will be recommended.

Often, Abdominal Pain Can Be Prevented By Changing Your Food Habits,

Dietary Changes

Avoiding high fat foods
Drinking more water and fluids
Eating frequent small meals
Avoiding foods likely to produce gas
Eating a balanced diet, high in fiber
Eating plenty of fruits and vegetables

Anal Fissure

An anal fissure is a tear in the skin around the opening of the anus (the last part of the digestive tract that controls the removal of stools). An anal fissure is associated with pain and bleeding during bowel movements. Although anyone can experience it; it is more commonly seen in infants.

Anal fissures can be caused because of trauma or injury to the anal canal while passing hard or large stools, constipation, straining during bowel movements or childbirth. It can occur independently or in association with other conditions like chronic diarrhea, HIV, anal cancer, tuberculosis and herpes.

The typical symptoms of an anal fissure include pain during and several hours after bowel movements. The severe pain may make patients avoid defecation, which further aggravates the condition. Other symptoms include:

Blood in the stools
Cracked anal skin
Itchy fissures
Yellow discharge that has an unpleasant odor

Most anal fissures can be diagnosed by report of symptoms and by viewing the anal region. In some cases diagnosis is done by digital rectal examination or using an instrument called an anoscope. Digital rectal examination involves inserting a gloved finger into the anal canal. The anoscope is a short instrument with a lighted tube which can help your doctor view and examine the fissure.

In most patients, an anal fissure heals on its own in a few days or weeks (acute), but in cases when it doesn’t heal even after 6 weeks (chronic), medical treatment or surgery may be recommended.

Adopting simple self-help measures for making stools easier to pass is helpful in healing existing fissures and also reduces your chances of developing fissures in the future. These measures include:

Increasing fiber intake by eating foods rich in fiber, like whole grain breads, fruits, vegetables, etc.
Drinking plenty of water and exercising regularly.

Constipation

Constipation is one of the common gastrointestinal symptoms where an individual may have difficulty in passing stools or experience infrequent bowel movements. Infrequent bowel movements may vary from person to another, where some pass three stools in a week or more severely some pass out one stool in a week. Individuals who have constipation find it painful while passing stool and may experience straining or feeling of incomplete empty of stool.

Some of the causes of constipation include poor dietary habits such as low fiber diet, hormonal and central nervous system disorders, lack of physical activity, pregnancy, use of certain medications, ignoring the urge to have a bowel movement and dehydration.

Your doctor may collect the medical history, perform physical examination and may order certain tests to confirm the cause for the condition. Some of the tests performed include blood tests, abdominal X-ray, barium enema, defecography and colonic transit (marker) studies.

Barium enema: It is an X-ray procedure where liquid barium is administered through the anus into rectum and colon and the X-rays of these structures are obtained. The barium outlines the colon and helps in visualizing the abnormality more clearly.

Defecography: Thisprocedure is modified procedure of barium enema. In this method thick paste of barium is inserted through the anus into the rectum and the patient will be asked to pass out (defecate) barium. An X-ray captures images of the pelvic floor muscles while patient is defecating. It enables the doctor to look for any abnormalities of rectum and pelvic floor muscles during defecation.

Colonic transit (marker) studies: It is an X-ray procedure that evaluates the movement of food through the lower gastrointestinal tract or intestine. In this procedure an individual will be advised to swallow a capsule for one or more days that contains small plastic pieces which are released in intestine and appear on X-ray. The X-ray will be taken after 5 to 7 days. In normal condition, all of the plastic pieces released from the capsule will be excreted in the stool. But in constipated individuals the plastic material remains in colon or rectum which concludes the abnormality in colon (colonic inertia) or pelvic floor dysfunction, respectively.

Constipation Is A Common Condition And Can Be Treated Effectively. There Are Several Treatment Options To Treat Constipation And They Include:

High-fiber diet: Fibers binds to the intestine, absorb water and retain water within the intestine that softens the stool and also adds volume to the stool. The best way to administer fibers is through fiber-rich food such as fruits, vegetables, wheat or oat bran, and synthetic agents. Fluids such as water and juice will help to prevent dehydration and constipation. Individuals who are having constipation must avoid caffeine, alcohol and cola drinks as they may worsen the condition by casing dehydration.

Laxatives: Laxatives may be prescribed to loosen the stool and is recommended in individuals for whom dietary modification showed no improvement. Different types of laxatives used for constipation include:

Lubricative laxatives: These laxatives containing mineral oil remain in intestine, coat the particle of the stool and prevent the retention of water from the stool making the stool soft and defecate easily.

Stool softeners (emollient laxatives): They contain a wetting agent, docusate, which facilitate the entry of more water in the colon into the stools and soften the stool.

Hyperosmolar laxatives: These are indigestible and unabsorbable compounds which remain within the colon and help to retain water in the colon resulting in a softer stool.

Saline laxatives: These agents contains non-absorbable ions which remain in the colon and act as a sponge which help the colon to absorb water and make the stools easier to pass.

Stimulant laxatives: Stimulant laxatives stimulate the movement of intestinal muscles and push the stools rapidly. They also increase the water in stool by reducing absorption of water in the colon or by causing secretion of water in small intestine.

Biofeedback: This method is often recommended for individuals with pelvic floor dysfunction. In this method certain exercises are taught to the patients to improve the movements of pelvic floor muscles that will help the patients learn relaxing and contracting muscles for proper defecation. During training, a pressure-sensing catheter will be placed in the rectum which measures the pressure generated by contraction of muscles. The pressure may be recorded and used as reference to teach the patients the way of relaxing and contracting muscles during defecation.

Surgery: Surgery is performed in individuals who have intestinal disorders such as colonic inertia. During surgery, entire colon is removed except a part of the colon, the rectum. The cut ends of the small intestine are attached to the remaining rectum.

Constipation may cause certain complications such as hemorrhoids because of strain; anal fissures which are tears in the skin around anus that may cause bleeding and rectal prolapse where the rectum protrudes into the anus because of strain exerted during defecation.

It may also cause fecal impaction a condition where the hard stool may pack itself inside the intestine and rectum such that pushing does not help in passing the stool.

Although these complications are worrisome several treatment options are available to treat these complications.

Chron's Disease

Crohn’s disease is a chronic inflammatory disorder causing inflammation of the tissue lining the digestive system presented with characteristic symptoms such as abdominal pain and diarrhea. It is one of the condition among “inflammatory bowel diseases”. It most commonly involves the lower part of the small intestine, the ileum and may also be called ileitis or enteritis. It is a hereditary disease and can occur in people of all age groups but is common in younger people between the ages of 20 and 30.

The exact cause for Crohn’s disease is unknown, except for theories that suggest the mechanism of the disease. One of the theories suggests that it is an autoimmune disorder or abnormal functioning of immune system that attacks the normal microbial flora in the intestine and body’s own tissues. As a result of white blood cells (WBCs) get accumulated in the intestinal lining causing chronic inflammation and ulceration. However it is not clear whether autoimmune disorder is a cause or a result of the Crohn’s disease.

The symptoms of Crohn’s disease may be mild to severe, intermittent with a flare-up period. Abdominal cramps usually in the lower right area and frequent loose stools are the common symptoms. Other symptoms include rectal bleeding, loss of appetite, weight loss, fever, pain in the joints, and skin sores or lumps. Children suffering from Crohn’s disease may have a stunted growth.

Physicians diagnose the condition based on careful physical examination and diagnostic tests such as blood tests to check for anemia, WBC count, and stool test to check for blood in the stools (rectal bleeding). Barium enema may be ordered in which patient may be asked to drink barium solution following which X-rays will be taken. The barium is absorbed by the lining of the small intestine and appears white on X-ray, so that any abnormality in the intestine can be identified. Your doctor may also perform a sigmoidoscopy or a colonoscopy test to visualize and examine the intestinal lining to check for any inflammation or bleeding. A biopsy sample tissue may be taken from the intestinal lining for examination under a microscope.

The objectives of treatment for Crohn’s disease are to relieve symptoms of inflammation such as pain, diarrhea, rectal bleeding and to make up for the nutritional deficiencies. The treatment options include medications, nutritional supplements, and surgery.

Medications: Medications such as anti-inflammatory drugs, corticosteroids, immunomodulator, antibiotics, and antidiarrheal agents may be prescribed to relieve the symptoms.

Nutrition Supplementation: Your doctor may recommend intake of high calorie liquid formula, particularly for children with growth retardation.

Surgery: Surgical treatment is considered as an option if the symptoms do not resolve with medical therapy and if complications such as intestinal blockage, perforation, abscess or bleeding occur. Surgery involves removal of the affected part of the intestine. In conditions where the large intestine is affected, surgical removal of the entire colon is performed by a procedure called colectomy. Because of the tendency to recur even after surgical treatment, the risks and benefits of surgery will be compared with other treatment options before making up the decision for surgery.

In most of the cases, the treatment includes combinatorial approach and for longer periods with regular follow-up visits.

Diarrhea

Diarrhea is a symptom of many gastrointestinal (GI) conditions where an individual may pass loose watery stools and also the frequency may be more, more than three times a day. The stool becomes watery because of increased water in the stool and the causes may be many.

Excessive liquid may accumulate in the colon because of increased secretion of water into colon from stomach, pancreas, and the intestine; faster movement of liquid or undigested food into the small intestine and colon; poor absorption of water in distal intestine and colon; or the combination of one or more of these conditions.

Diarrhea is of two types; acute and chronic diarrhea. Acute diarrhea is a condition of watery stools that lasts for few days and chronic diarrhea may last for more than a week.

Some of the causes of diarrhea include infection by microorganisms which cause inflammation of the lining of small intestine or produces toxins which secretes more fluid from intestinal walls, intolerance to certain foods or medicines, intestinal diseases such as Crohn’s and ulcerative diseases, mal-absorption, certain types of cancers, hyperthyroidism, diabetes, and alcohol abuse.

Often patients with diarrhea may also have other symptoms such as cramps, abdominal pain, dehydration, urgency to pass a bowel, irritation in the anus, nausea and vomiting. These are considered as uncomplicated symptoms. However diarrhea accompanied by fever, loss of weight, or bloody stool is considered complicated and require immediate medical intervention.

Acute diarrhea may not require diagnosis, but chronic diarrhea may require diagnosis to identify the exact cause and thereof for appropriate treatment. Some of the diagnostic tests include stool culture to examine microorganisms or other signs of infection. Blood tests to check to confirm other disease responsible for diarrhea. Your doctor may ask you to avoid certain foods such as lactose, carbohydrates, wheat or others to check for the response of the body. Your physician may also order for special tests such as sigmoidoscopy or colonoscopy where a thin, flexible and lighted tube will be passed into the colon and rectum. It enables the doctor to look for inflammation in the colon and rectum or check for other intestinal abnormalities.

Treatment for diarrhea depends on the cause of the condition. Certain over-the-counter anti-diarrhea medications may be prescribed to treat mild diarrhea. However, these should be avoided by patients passing bloody stools.

If the diarrhea is caused by infection, antibiotics may be prescribed. Absorbents may also be prescribed by the doctor. These help by binding the water in the small intestine and colon and make the stool harder.

Anti-motility medications may be given to relax the muscles of the small intestine and colon and create more time for the water to be absorbed. If there is narrowing of the intestinal muscles (cramps) anti-motility medications may also help in relaxing the muscles

At home, you may have to avoid taking caffeine and foods that are high in fiber and sweet as they may worsen the condition. If you are allergic to lactose, then yoghurt is considered to be a better option and may help you to recover fast.

Food Intolerance

Food intolerance is characterized by difficulty in digesting particular foods. Food contains proteins, vitamins, carbohydrates, fats and natural chemicals that add to its flavor and smell. Some of these can trigger symptoms of food intolerance. Food intolerance differs from food allergy, where even a small amount of the allergic food can cause a mild to severe immune response. Food intolerance usually develops gradually and may occur when you consume too much of the particular food, too often.

The symptoms caused by food intolerance include fatigue, dark circles under the eye, joint pain, night sweats, diarrhea, vomiting, bloating, irritable bowel and skin-related symptoms such as rashes and eczema.

Food Intolerance Is Specific To You, And Is Caused By Foods That Are Normally Safe For A Majority Of Others.

Common Causes Include:

Lack of enzymes specific for the breakdown of certain foods

Certain naturally occurring chemicals such as caffeine

Some foods such as kidney beans or chickpeas that exert a toxic effect when undercooked

Food containing histamines such as fish that has been stored poorly

Salicylates in certain fruits, vegetables, herbs and spices

Wide variety of artificial additives, preservatives and coloring agents used in processed foods

The pattern and type of symptoms help to distinguish food intolerance and differentiates it from allergic reactions. Keeping an accurate record of your food intake and resulting symptoms, helps to identify the foods that may cause these reactions.

Once the triggering food is determined, you are advised to temporarily eliminate it from your diet under controlled conditions. You are then observed for improvement or relief from symptoms. Following this, the trigger is reintroduced into your diet to confirm on the diagnosis. This is carried out under the supervision of a dietitian who will substitute the eliminated food with similar food, ensuring that nutrition is maintained.

Heartburn

Heartburn also called as acid indigestion is a not a life threatening disorder, but is a symptom causing discomfort or burning sensation in the chest. It is caused when the acid in the stomach flows backward into the food pipe or the esophagus. Often many individuals experience heart burn and condition may not be bothersome unless if it is the symptom of gastro esophageal reflux disease (GERD).

When the food is swallowed, it passes down the esophagus and enters stomach. The distal end of esophagus is guarded by muscle tissue, lower esophageal sphincter, which allows the movement of food content down into stomach and prevents the re-entry of stomach content into esophagus. Improper functioning of LES because of any abnormalities or conditions may cause entry of acid-mixed food from stomach into esophagus causing heart burn.

Heart burn may become worse when you are lying down because it is easier for the stomach acid to enter the esophagus. Patients with diabetes and hiatal hernia may have more chances of having heartburn.

Other symptoms accompanying heart burn include difficulty in swallowing, chronic cough, pain, sore throat, dizziness and formation of ulcers in the esophagus. In more severe cases heartburn may result in loss of weight, dehydration and you may vomit blood or observe small amount of blood in the stool.

When the acid travels beyond the esophagus, it may result in bitter and sour taste, which is called as regurgitation which is commonly observed when you lie down or bend.

Exact cause for heart burn may be diagnosed using various tests such as upper gastrointestinal (GI) endoscopy, upper GI series, esophageal manometry and 24-hour pH monitoring.

In upper GI endoscopy, a special instrument called endoscope is passed into the esophagus and stomach. The tiny camera attached to end of the endoscope enables to check for damage and infection.

In an upper GI series you may be asked to swallow a liquid which coats the stomach and esophagus and series of X-ray images are captured to check for abnormalities.

Esophageal manometry is a procedure done to measure the weakness of LES muscle. It is recommended when the endoscopy reveals no abnormalities and patients still experience the heart burn. Endoscopy procedures may not show abnormal sphincter activity.

24 pH Monitoring – In this procedure, a tube will be inserted through the nose into the esophagus and positioned above the LES. The tip of the tube contains a sensor which can measure the pH of the acid content refluxed into esophagus. A recorder, strap-like device that can be worn on wrist, will be connected to record the pH of the acid content. The tube will be left in place for 24 hours. Patients can also go back home and perform their regular activities and can record the pH of the acid content when they experience the symptoms. On the next day the recorder will be connected to a computer and the data will be analyzed.

Treatment

Antacids help in neutralizing the acid. It is prescribed if the heartburn is caused by foods and certain physical activity.

Histamine-2 receptor blockers are also prescribed which help in decreasing the amount of acid produced by the stomach.

Antiemetic and gastroprokinetic agents which help to empty the food and acid from the stomach so that the acid may not be available to flow back to the esophagus.

Proton pump inhibitors which help in preventing the production of acid in the stomach.

Surgery is the last treatment option considered if the medications are not providing heartburn relief. The surgery is called as fundoplication. This procedure involves tightening the LES muscle which prevents the acid from traveling backward to esophagus.

Lifestyle Changes

Avoid smoking and intake of alcohol
Lose weight if you are obese
Ensure that you do not lie down immediately after eating
Avoid wearing tight-fitting clothes as it may apply pressure on the stomach causing acid to flow backward
Avoid taking foods that will cause heartburn such as chocolate, fried fatty foods, and caffeine
Eat limited food and do not overeat

Hiatial Hernia

A hernia is an abnormal opening in the wall of a tissue, muscle or membrane that holds an organ in place. The stomach lies below the diaphragm. Hiatal hernia is a condition in which part of the stomach slides through the hiatus, an opening in the gm, and protrudes into the chest. Hiatal hernia is a common condition and commonly affects people over 50 years of age.

Types

Sliding Hitial Hernia: Most common type of hiatal hernia where the stomach slides in and out of the hiatus.

Fixed Hiatal Hernia (paraesophageal hernia):The stomach moves up into the chest cavity and stays.

Sometimes the hernia may get strangulated, blocking the blood flow to the stomach. This is a medical emergency.

Causes

It is not exactly clear what causes a hiatal hernia. Some of the possible causes may include weakening of the supporting tissues due to an injury, or increased pressure in the abdomen from coughing, vomiting, lifting heavy objects and straining during a bowel movement. The condition may also occur due to a congenital defect where the hiatus is unusually large.

Symptoms

Hiatal hernia may not have any symptoms. Some of the commonly observed symptoms of hiatal hernia include chest pain, heart burn, belching and difficulty swallowing.

Diagnosis

Your doctor may order the following tests to diagnose hiatal hernia:

Barium swallow test: Involves swallowing a barium preparation, which can be detected through X-rays

Endoscopy: Allows the doctor to examine the inside of your esophagus and stomach with an instrument called an endoscope, a thin flexible lighted tube

Treatments

Treatment may not be necessary if the patient is not experiencing symptoms. Treatment is usually started when symptoms occur such as in cases of severe heartburn, when the esophagus gets inflamed due to acid reflux, the hiatus narrows or lungs are inflamed. Your doctor prescribes medications and life style changes to treat heartburn and acid reflux. Surgery is recommended if medications do not work, although it is rare. A hernia repair surgery is usually performed as an open or keyhole (laparoscopic) surgery, where the bulge is pushed back into place, the hiatus is tightened and the stomach is secured into place with sutures.

In open hernia repair, a large incision is made on the chest or abdomen. Laparoscopic hernia surgery is a surgical procedure in which a laparoscope (fiber optic tube with a camera attached) is inserted into the abdomen through a small incision to perform the surgery.

Ulcerative Colitis

Ulcerative colitis is an inflammatory disease condition that causes diarrhea (frequent, loose stools) and ulcers in the lining of the colon and rectum. It can occur at any age and is more common among people of the age group between 15 and 30 years. It has a tendency to run in families. The most common symptoms of ulcerative colitis are pain in the abdomen and blood stained diarrhea. There may also be symptoms such as anemia, tiredness, loss of appetite, rectal bleeding, sores on skin, and pain in the joints. Growth failure may occur in children with this disease. In most of the cases, the symptoms of ulcerative colitis are very mild, but when it is severe it causes frequent fever, nausea and painful cramps in the abdomen.

The exact cause of ulcerative colitis is not known. Immune system abnormality is common in patients with ulcerative colitis, but whether it causes the disease or occurs as a result of the disease is not clearly understood. It is believed that the body’s immune system may react in an abnormal way to the microbial flora in the digestive tract. Your physician may order few diagnostic tests after routine physical examination.

Blood Tests: Blood tests are done to check anemia which suggests bleeding in the colon or rectum. An increased white blood cell count indicates inflammation in the body.

Stool Sample: A stool sample may be examined to detect presence of blood and also to reveal white blood cells, bacteria or viruses.

Colonoscopy or Sigmoidoscopy: These endoscopic tests are the most accurate methods to diagnose ulcerative colitis and rule out other conditions. Your doctor inserts an endoscope (long, flexible tube with a light and camera at one end which is connected to computer and a TV monitor) into the anus to see for any bleeding, inflammation or ulcer on the colon wall and at the same time, a tissue sample may be taken from the colon wall. This biopsy tissue is further examined under a microscope.

Barium Enema or CT scans: These tests are also used to diagnose ulcerative colitis and its complications.

Treatment

Drug Therapy: The goal of drug therapy is to alleviate symptoms and improve the quality of life. Medications such as anti-inflammatory drugs, corticosteroids, and immunomodulator are used to reduce inflammation. Pain relievers and anti-diarrhea medications may also be prescribed to relieve symptoms. In patients with severe bleeding and severe diarrhea that causes dehydration, replenishment of lost blood and fluids is done through intravenous administration.

Surgery

Surgical removal of the colon will be recommended if the medical treatment is unable to cure or in conditions such as massive bleeding, rupture of the colon, or risk of colon cancer. Surgical procedure to remove the colon and rectum is known as procto-colectomy and is performed by either an ileostomy or ileoanal anastomosis technique.

Ileostomy: In this technique, surgeon makes a small opening or stoma in the abdomen and attaches the ileum (end portion of the small intestine) to it. Waste products will be excreted through this stoma. A pouch which collects waste is worn over the stoma.

Ileoanal Anastomosis: In this technique, the colon and the inner part of the rectum are removed, leaving behind the outer muscles of the rectum. Then the ileum is attached to the inside of the rectum and anus to create a pouch where waste is stored until it is excreted through anus in a normal way.

THE WOODLANDS

 (281) 742-4932)

(281) SHAHZAD

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26103 Interstate 45, Suite 100

THE WOODLANDS, TX 77380