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General Questions & Answers
1) When should I see a gastroenterologist?
Gastroenterology is a subspecialty of Internal Medicine. A gastroenterologist must complete three years of additional training, pass a standardized board examination, and meet continuing education requirements to maintain licensure and Board Certification. This specialized training makes the gastroenterologist the most qualified medical professional to diagnose and treat diseases and disorders of the esophagus, stomach, small intestine, colon, and rectum, as well as diseases of the liver and pancreas.
Gastroenterologists use state-of-the-art medical technology — including endoscopy, colonoscopy, radiology, and ultrasound—to assist them in making the correct diagnosis. The goal is to rule out, diagnose and treat a digestive disease in it earliest stage. Although these tests may sound uncomfortable, none of them is particularly painful or unpleasant. In many cases, patients are sedated and often recall little or nothing of the procedure. Some relatively simple screening exams can often prevent colon cancer. Please discuss these tests with your physician. They could make a world of difference for you and your loved ones.
For additional information, please visit the American College of Gastroenterology website.
2) Is Barrett's Esophagus the same as cancer?
No, Barrett's is not cancer. In simple terms, Barrett's Esophagus is a reaction to longstanding esophageal damage that is caused by corrosive stomach acid back splashing upward. After many years of heartburn, the cells in the lower esophagus begin to transform into a different type of cell resembling that of the intestines. In a small percentage of patients, the cells go on to form so-called dysplasia, or early pre-cancerous changes. Some of these cells progress further to high-grade dysplasia, which is closer to cancer and thus more serious.
It is true that the risk of esophageal cancer is higher if you have Barrett's - about 40 times normal. But the usual risk of esophageal cancer in the general population is extremely small. Even when multiplied 40 times, the overall risk in those with Barrett's is only a few percent. Of course, if you are one of those, numbers make no difference. And the incidence of esophageal cancer is on the rise in the US. Follow-up is important, especially for those with dysplasia.
3) Can I get ulcers from spicy food?
No. This is a common misconception. For many years, it was believed that peptic ulcers of the stomach and duodenum were caused by
what you ate or how you felt. Scientific research over the past decade now has proven spicy foods, emotional stress, and even family history, turn out not to be major causes of ulcer disease. Most ulcers in the stomach or duodenum are caused by one of two things:
Anti-inflammatory drugs like aspirin, ibuprofen, and other prescription drugs for arthritis
A bacteria called Helicobacter pylori, commonly called the "ulcer bacteria."
Ulcers in the esophagus are different because they are usually caused by the backsplash of powerful stomach acids up into the lower esophagus. If you have ulcers or take aspirin-type drugs on a regular basis, switching to a different medication may allow the ulcers to heal and prevent future problems.
We now know that the majority of ulcers are caused by the Helicobacter infection, H. pylori, for short. Antibiotic treatment has a high success rate in eliminating the infection and curing ulcers for a lifetime.
4) What is the difference between diverticulosis and diverticulitis?
Diverticulosis is a condition, rather than a disease. The majority of adults have some degree of diverticulosis. It affects the large intestine, or colon. A normal colon is strong and relatively smooth. A colon affected by diverticulosis has weak spots in the walls. These defects allow the development of balloon-like sacs or out-pouches - much like a bubble forming on a worn inner tube. These hollow pouches, called diverticulae, occur when the inner intestinal lining has pushed through weakened areas of the colon wall. A single pouch is called a diverticulum. The presence of these pouches on the colon is called diverticulosis. When the pouches are inflamed or infected, it is called diverticulitis, a more serious ailment. Most individuals with diverticulosis never develop diverticulitis.
5) What is a hiatal hernia?
It simply means that your stomach organ is slipping upward into your chest. The diaphragm is a tough flat muscular membrane that separates your chest from your abdomen. Your stomach organ is normally below the diaphragm in the abdomen. To connect with your stomach, your esophagus must come down the middle of your chest and pass through a hole in the diaphragm called the hiatus.
In simple terms, some people's hiatus weakens and opens up. This allows the esophagus to "pull the stomach up" into the chest cavity. Since part of the stomach herniates, or pushes through the opening, this condition has been termed a hiatal hernia.
A hiatal hernia is a common finding in adults and may cause no symptoms at all. Sometimes it is associated with a weakness in the lower esophageal valve and can worsen symptoms of acid reflux, or GERD.
Some slip up into the chest one day and back down into the abdomen another. This is called a sliding hiatal hernia.
When they become large and permanently stuck above the diaphragm, they are called a fixed hiatal hernia.
6) Does red blood in my stool mean I have cancer?
Many patients ask this question. The answer is sometimes, but usually not. There are many non-cancerous reasons to have blood in the stool such as hemorrhoids, polyps, or fissures.
However, any adults who see blood in their bowel movements should consult their doctor for an examination. You can't tell what the cause is without having a look inside.
If the doctor does not suspect a serious problem, a simple exam such as a flexible sigmoidoscopy might be sufficient. If there is any concern about trouble further inside, a full colonoscopy is usually advised.
The point is that all bleeding in adults must be evaluated. In most cases, no serious problem is found.
7) What are the warning signs of colon cancer?
Unfortunately, when colon cancer develops, there are usually few, if any, early warning symptoms. In many cases, patients have had no symptoms at all until it is too late. That is the problem. Colon cancer is a silent disease. A polyp can be in your colon for many years without symptoms. Even after a polyp turns into a small cancer, it may not produce symptoms. This is why doctors recommend periodic checkups of all adults before they have any symptoms. It is much better to prevent a colon cancer than to find one.
Eventually, when a cancer is so big that it either begins to bleed or block the passageway, it can cause such symptoms as:
rectal bleeding
abdominal pain
weight loss
change in bowel habits.
If you have any of these symptoms, you should schedule an examination right away.
8) What are the risk factors for colon cancer?
There are some factors that alone, or in combination, make people more prone to developing colon cancer.
- Family members with colon cancer or colon polyps
- Family members with colorectal cancer syndromes (a genetic trait)
- Ethnic background - Jews of Eastern European descent and African Americans have a higher rate of colon cancer.
- You have had colorectal cancer
- You have a history of colon polyps
- You have a history of chronic inflammatory bowel disease (IBD)
- Aging – the risk increases significantly after age 50
- A diet high in fat, especially from animal sources
- Physical inactivity
- Obesity
- Diabetes
- Smoking
- Heavy use of alcohol
- Night shift work.
9) What tests are used to screen for colon cancer?
All colorectal screening tests are not equal. It is important to know your options so you can discuss with your physician what is best for you. The goal is to get the best possible view of the inside of the entire colon to identify and remove pre-cancerous lesions, such as polyps
or growths, before they become life threatening. The reliability of these examinations depends on the experience and expertise of your physician. This is why it is important to be seen by a specialist, or gastroenterologist.
Four types of tests are typically used:
Sigmoidoscopy - Usually performed in your doctor’s office, this test involves the insertion of a flexible tube into the rectum, which allows the doctor to directly visualize the inside of the lower third of the colon. If abnormalities are found during a sigmoidoscopy examination, a colonoscopy is peformed so that the entire colon can be checked.
Barium X-ray - This test is less sensitive than either a flexible sigmoidoscopy or a colonoscopy. It involves the use of a barium enema and is performed in the radiology department of a hospital or outpatient center. Because the barium creates a “contrast,” details of the colon can be seen on an x-ray. The American College of Gastroenterology has found that this test only detects about 50 percent of polyps. If polyps are identified, a colonoscopy must be performed to confirm these results and to remove the growth(s).
Fecal Occult Blood Test - This is the most common and least expensive colon cancer-screening test. It involves examining a stool sample for the presence of hidden blood. According to studies published in the Journal of the American Medical Association, these stool tests are only 30 percent effective in detecting early colon cancer. To be effective, this test should be combined with either a colonoscopy, sigmoidoscopy, or barium x-ray examination. This test does not identify pre-cancerous lesions or polyps.
10) What is irritable bowel syndrome (IBS)?
IBS is a somewhat common disorder in which the nerves and muscles in the bowel are very sensitive and do not function normally. While it is not a disease, it can be a difficult condition to live with. It is characterized by abdominal pain, constipation, or diarrhea. Changes in diet, plus medications and stress reduction can help people deal with the disorder.
11) What is inflammatory bowel disease (IBD)?
IBD or colitis is a chronic disorder of the gastrointestinal tract involving inflammation of the intestine that results in abdominal pain, persistent diarrhea (often with blood and mucus), and fever. Ulcerative colitis is a serious chronic inflammation and ulceration of the lining of the colon and rectum.
Crohn’s disease is another form of colitis that includes thickening of the intestinal wall. The disease typically occurs in the small intestine near the point where it joins the colon, but other parts of the gastrointestinal tract can be affected. Drug treatment is effective for most patients, but others require surgery.
12) When does diarrhea require a doctor's attention?
Everyone gets a little “stomach bug” from time to time and develops a bit of diarrhea. The cause is not usually known. Sometimes it’s due to emotional stress, or a virus. Often the cause is unrecognized food poisoning. Some cases are a reaction to the use of antibiotics. Whatever the cause, most cases are mild and disappear in a few days. Don’t try to stop diarrhea as soon as it develops. Diarrhea is the body’s way of getting rid of whatever food, virus, or bug that is causing it.
If the diarrhea is not severe and there is no fever, rectal bleeding, severe abdominal pain, simple measures are usually effective. This might include going on a BRAT diet for 48 hours and replacing lost fluids. BRAT refers to, Bananas, Rice, Apple Sauce and Tea.
Initially, the main initial concern is dehydration, especially in young children and the elderly. Symptoms of dehydration include fatigue, weakness, dry mouth, dark urine, decreased urine flow. Authorities recommend drinking at least 8 to 10 glasses of fluid daily while the symptoms are active. Don’t drink plain water, but instead use a solution such as Gatorade, which also contains needed minerals such as sodium and potassium.
If the diarrhea does not respond to fluid and diet changes in a day or two, try one of the over-the-counter anti-diarrheal medicines such as Kaopectate, Pepto-Bismol (will blacken bowel movements), or Imodium AD. Simply follow the label instructions. Rarely diarrhea is a sign of a more serious infection or ailment.
You should call your doctor for the following reasons:
- Diarrhea after recent antibiotic therapy
- The diarrhea is severe
- Bloody diarrhea
- Fever over 101 degrees
- Severe or persistent abdominal pain
- Symptoms lasting longer than 72 hours
- Decreased urine production or dark urine.