Chronic Diarrhea: What You Should Know

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Chronic diarrhea can be caused by a variety of things, including infections, GI disorders, food intolerance, and a reaction to medication. Let’s take a closer look at the condition.

Causes and Risk Factors

Diarrhea is chronic when it occurs three or more times per day for more than two weeks. It has several potential causes. Infection is one main cause. This infection can be parasitic, and from parasites like Giardia or Cyclospora. Infection can also be bacterial, from bacteria like Salmonella and E. coli. Some viral infections cause chronic diarrhea too, like some rhinoviruses and rotoviruses.

Outside of infections, there are several other potential causes. Pancreatic disorders like pancreatitis and cystic fibrosis can be a cause. GI diseases like Chrohn’s and IBS can cause diarrhea as well. Intolerance to foods can be at play too- lactose intolerance and fructose malabsorption are two examples. Additionally, some medications like laxatives and antibiotics can cause chronic diarrhea.

Symptoms of Chronic Diarrhea

As previously mentioned, diarrhea becomes chronic if it occurs three or more times per day for two or more weeks. Diarrhea is characterized by loose, watery stools that occur often more frequently than usual. Other symptoms include abdominal pain, abdominal cramps, bloating, nausea, blood or mucus in stool, and a fever. It also dehydrates you over time. If left untreated, this can be very dangerous. You should always see a doctor for chronic diarrhea.

Diagnosis

Chronic diarrhea itself is simple to diagnose, based on the definition outlined above. When you see a doctor for chronic diarrhea, they will work to diagnose the underlying cause. Depending on your symptoms, medical history, medications, the results of a physical exam, and other factors, they will select the appropriate testing measures. Stool samples can be tested to help identify if parasites, bacteria, or viruses are a cause. Your doctor may also want to do a blood test. If initial testing does not reveal a cause, your doctor may order an x-ray or endoscopy.

Chronic Diarrhea Treatment and Prevention

The cause of the condition dictates its treatment. With any case of diarrhea, fluid replacement is key. You should consume fluids and salts to replace those lost through diarrhea, unless otherwise ordered by your doctor. Some fruit juices and soup can be good options here. If liquids are upsetting your stomach, your doctor may recommend an IV to help rehydrate you.

Diarrhea caused by infection can often be treated with antibiotics or other medications. Your doctor will prescribe the proper medication for you depending on your case. If infection isn’t the cause, it will likely take more time to determine the underlying cause and therefore appropriate treatment. Conditions like IBS, Chrohn’s, fructose malabsorption, and Ulcerative Colitis all have their own treatment approaches. Your doctor will work with you to determine the best treatment options depending on the underlying cause.

Preventing chronic diarrhea involves mitigating risk factors for its various causes. To avoid infections that cause diarrhea, always drink safe, clean, properly-treated water. You should also use good food handling techniques, and practice good hand hygiene after using the bathroom and around food. If some foods trigger diarrhea for you, narrow down what they are and avoid them if possible.

Our experienced team at GHP has years of experience treating GI conditions like chronic diarrhea. We can help establish the best plan of care for your situation. Contact any of our office locations to learn about the options we offer and schedule an appointment today.

What is Esophageal Manometry?

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Esophageal Manometry is a test that helps doctors measure the force and coordination of your esophagus. Here’s what you need to know about the test.

When it is used

Esophageal Manometry tests whether your esophagus is working correctly. Your esophagus is a smooth muscular tube that pushes food and liquid from the mouth to the stomach. Every time you swallow, your esophagus contracts and helps move everything to your stomach. Your esophagus can have trouble functioning correctly if you have certain disorders.

There are a few scenarios in which this test may be used. If your primary symptoms are pain while swallowing or a difficulty swallowing, your doctor will likely recommend other testing (like an Upper Endoscopy). Your doctor may recommend you undergo Esophageal Manometry if you present symptoms that could be due to an esophageal disorder. These disorders include Scleroderma, Achalasia, and diffuse esophageal spasms. Additionally, if your doctor is considering surgery to treat your GERD, esophageal manometry can help diagnose Achalasia or Scleroderma, both of which can’t be treated surgically. Also, if you are experiencing chest pain unrelated to your heart and are unresponsive to GERD treatment, this test can help identify the cause of the pain.

Preparing for Esophageal Manometry

You should not eat or drink during the 6 hours before the test. This is because an empty stomach helps your doctor perform the safest and most effective test. Additionally, you should discuss any medications you are taking with your doctor. Some medications can affect esophageal pressure, and should be discontinued before the test.

During the test

You will not be under a general anaesthetic during the testing. However, a topical anaesthetic will be used in your nose and a numbing spray will be used in your throat. Your doctor will pass a thin tube (catheter) through one of your nostrils and down into your esophagus. You may gag briefly as this happens. Once the catheter is placed, you may be asked to lie on your back. Next, you will swallow small sips of water as directed by your doctor. The catheter will help measure the pressure your esophagus exerts as you do this. You will need to breathe slowly and smoothly during the test, remaining still and following your doctor’s instructions. The test takes around 30 minutes in total.

After the test

Following the test, there are a few mild symptoms you may experience. These include a sore throat, a nosebleed, and a stuffy nose. These should resolve in a few hours. You can immediately resume normal activities after your testing, unless your doctor tells you otherwise. If you experience any lasting or unusual symptoms, contact your doctor.

Side effects from Esophageal Manometry are very rare. These include aspiration, an irregular heartbeat, and perforation of the esophagus.

Our experienced team at GHP has years of experience performing Esophageal Manometry. We can help establish the best plan of care for your situation. Contact any of our office locations to learn about the options we offer and schedule an appointment today.

Bile Duct Diseases: An Introduction

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Bile ducts are tubes that primarily carry bile from the liver and gallbladder to the small intestine to help digest fats.

Several diseases in the bile ducts can prevent proper bile duct functioning. Read along to find out more.

Bile duct disease

There are several bile duct diseases that can occur. Gallstones are one common issue for bile ducts. These form when deposits of digestive fluid harden in the gallbladder. They can cause inflammation, increasing pressure in the gallbladder and potentially blocking a bile duct. Another common bile duct condition is cholangitis, which is inflammation in the bile duct system. This is often caused by a bacterial infection.

Bile ducts can also have strictures (narrowing). In other cases, they can leak. Cancer can also occur in the bile ducts. Bile duct cancer is rare and aggressive. Additionally, some infants are born with a condition called biliary atresia, in which bile ducts are scarred and blocked. This causes a buildup of bile in the liver and can damage it.

Symptoms of Bile Duct Diseases

Bile duct diseases tend to have some of a group of symptoms. These include abdominal pain, nausea, vomiting, itchy skin, fever, chills, weight loss, loss of appetite, and jaundice. Pain may occur in the upper abdomen and radiate to the back in some cases. Depending on the disease, these symptoms can be at differing levels of severity and present in varied ways. The progression the disease also influences the severity and types of symptoms.

Diagnosis

Doctors diagnose bile duct diseases in a few different ways. Bilirubin blood testing can identify high levels of bilirubin in your bloodstream and can diagnose jaundice. Doctors can perform an Endoscopic Retrograde Cholangiopancreatogram (ERCP) to diagnose diseases. In an ERCP, they can inject contrast dye to help image your bile ducts during an x-ray. They can also perform an Endoscopic Ultrasound (EUS) to examine your bile ducts and make a diagnosis.

Treatment

Treatments vary depending on the type of bile duct disease. ERCP, in addition to helping with diagnosis, can help treat disease. Doctors can pass tools through the endoscope during an ERCP and open blocked ducts, remove or break up gallstones, insert stents, and even remove tumors. Doctors can also help drain bile during an EUS by inserting a stent to help drain into the small intestine or stomach. One other emerging treatment involves using Radiofrequency Ablation for palliative care to treat the symptoms of bile duct cancer. This can be a way to manage pain for long-term cases of cancer.

Surgery may also be necessary in some cases. For example, with patients who have bile duct cancer, surgery can help to remove tumors. If tumors are very large, doctors may need to remove the liver and perform a liver transplant.

Our experienced team at GHP has years of experience treating conditions including bile duct diseases. We can help establish the best plan of care for your situation. Contact any of our office locations to learn about the options we offer and schedule an appointment today.

A Quick Summary of Esophagitis

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Esophagitis is an inflammation of the esophagus. Here’s what you need to know about the condition.

Causes

Esophagitis can be caused by various things. One of the most common causes is reflux. Reflux occurs when stomach acid backflows into the esophagus. A condition called GERD (gastrointestinal reflux disease) causes this to happen recurrently, and is a likely culprit for esophagitis in many cases. GERD can cause chronic inflammation over time. Infection can also cause esophagitis in rarer cases, mostly in people with diminished immune system function.

Oral medications can also cause inflammation in the esophagus if they are incontact with the esophagus for too long. This can happen if you take oral medications without enough liquid, oral medications that are irregularly shaped or large, if you take medications immediately before sleeping, or if you take them lying down. These medications include pain relievers like ibuprofen and aspirin, and some antibiotics.

Symptoms of Esophagitis

Several symptoms occur with this condition. These include difficulty swallowing, heartburn, chest pain occurring with eating, acid regurgitation, and a sore throat. Over time, irritation can cause tissue damage and ulcers can form. Additionally, strictures can occur with continued irritation. Strictures are a narrowing of the esophagus caused by a buildup of scar tissue. This leads to further difficulties with swallowing.

Diagnosing Esophagitis

There are a few different tests doctors use to diagnose esophagitis. They often perform a physical examination and review your medical history to identify symptoms that could indicate the condition. Additionally, they may perform a barium x-ray. For this test, patients drink a solution containing barium that coats the esophagus and makes it visible for imaging. Then, doctors take an x-ray to visualize the esophagus and identify any abnormalities. They may perform an endoscopy to look at the esophagus and biopsy tissue for a diagnosis. Biopsy tests can diagnose infections and identify any precancerous or cancerous cells.

Treatment and Prevention

Treating esophagitis involves treating symptoms, lowering the risk of complications, and treating the underlying cause. In cases of reflux esophagitis, some over the counter medications can help reduce acid production and heal the esophagus. There are also prescription medications available, including some proton pump inhibitors, H-2 receptor blockers, and prokinetics. Surgery may also be required in some cases. This involves wrapping part of the stomach around the lower esophageal sphincter to strengthen it and help prevent acid reflux. Last, in cases where a stricture has formed, doctors can perform an esophageal dilation to widen the esophagus.

For cases of drug-induced esophagitis, avoiding the drug causing the inflammation and changing the way you take medication can help. There are also alternative drugs you can take that won’t cause inflammation. Plus, by simply drinking water with medication and standing or sitting upright for 30 minutes after taking a pill, you can avoid causing some inflammation. Last, in cases of infectious esophagitis, doctors can prescribe medications to treat the underlying cause of infection.

Our experienced team at GHP has years of experience treating conditions including esophagitis. We can help establish the best plan of care for your situation. Contact any of our office locations to learn about the options we offer and schedule an appointment today.

Pancreatitis: An Overview

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Pancreatitis is an inflammation of the pancreas. It can be either acute or chronic, and has several potential causes. Here’s what you need to know about the condition. 

Pancreatitis Causes and Risk Factors

Pancreatitis occurs when digestive enzymes are activated while in the pancreas, irritating cells and causing inflammation. It can be acute or chronic. Repetitive acute cases can cause permanent damage to the pancreas and lead to chronic issues. 

Some potential causes include gallstones, alcoholism, infections, cystic fibrosis, genetic disorders, obesity, cancer, and abdominal injuries. Acute cases are most often caused by gallstones. Chronic cases are most often a result of heavy alcohol use or genetic disorders. 

There are several risk factors for pancreatitis. Heavy alcohol use and smoking are both risk factors. Heavy drinkers- people drinking 4-5+ drinks each day- have an increased risk. Smokers are around 3x more likely to develop the condition, and people who quit smoking decrease their risk by about half. 

Symptoms

The most common symptom of pancreatitis is upper abdominal pain that can spread to your back. In acute cases, the pain usually begins in the upper abdomen and sometimes spreads to the back. It can last for a few days and can be mild to severe. People with acute cases may also have a fever and a swollen abdomen, and experience nausea, vomiting, and a fast heartbeat. 

In chronic cases, people also usually feel pain in their upper abdomen that sometimes spreads to the back. However, in some cases people may not feel any symptoms if the condition is not advanced. If it does become advanced, the pain can become severe and constant, becoming worse after eating. Other symptoms in these cases can include nausea, vomiting, diarrhea, weight loss, and greasy stools. Severe chronic and acute cases require medical attention.

Diagnosing Pancreatitis

An array of tests can help diagnose pancreatitis. Doctors often use blood tests to check for elevated pancreatic enzyme levels. In chronic cases, stool tests can help identify high levels of fat that indicate malabsorption. Plus, CT scans and abdominal ultrasounds can identify gallstones and the amount of pancreatic inflammation. MRIs can also look for issues in the pancreas, gallbladder, and ducts. Also, doctors can use endoscopic ultrasounds to identify blockages and inflammation in the pancreatic or bile ducts. 

Treatment and Prevention

Treating pancreatitis usually begins with a few steps in the hospital. Usually, patients fast for a few days to rest the pancreas. Doctors may place an IV to prevent or treat dehydration. Medications can help with pain as well.  

After these initial steps, doctors work to treat the underlying cause of pancreatitis. Sometimes, this can mean gallbladder surgery to remove the gallbladder if gallstones are a factor. In other cases, it may mean surgery on the pancreas to drain fluid or remove diseased tissue. An ERCP can help diagnose and treat causes like bile and pancreatic duct problems as well. 

If heavy alcohol use is a factor, reducing alcohol consumption is an important step to prevent serious complications. Additionally, in chronic cases of pancreatitis, ongoing pain management may be necessary. This can include a combination of medications, surgery, and endoscopic ultrasounds to relieve pain. Also, dietary changes (pursuing low-fat, high-nutrient diets) can also help in chronic cases.

Our experienced team at GHP has years of experience treating conditions including pancreatitis. We can help establish the best plan of care for your situation. Contact any of our office locations to learn about the options we offer and schedule an appointment today.

Malabsorption: An Overview

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Malabsorption is a condition in which a person has difficulty digesting and/or absorbing nutrients from food. Here’s what you need to know. 

Causes of Malabsorption

Malabsorption can be caused by various diseases. Typically, malabsorption involves difficulty absorbing nutrients like vitamins, fats, proteins, or sugars. Any disease that hinders the body’s ability to absorb nutrients can cause this condition. Common diseases that cause it include cystic fibrosis, lactose intolerance, celiac disease, whipple disease, crohn’s disease, an infection affecting the pancreas, HIV and AIDS, parasitic infection, and some genetic disorders. Some medications can cause the condition as well. Additionally, malabsorption can occur as a side effect of radiation treatments and surgeries that remove part of the small intestine or pancreas. 

Symptoms

Several symptoms can accompany malabsorption. These include bloating, gas, abnormal stool, and chronic diarrhea. Children with the condition may have a weight or rate of weight gain that is much lower than average, and may not grow and develop at expected rates. Adults can experience weight loss, weakness, and difficulty thinking. 

Diagnosis

Diagnosing malabsorption can involve several types of exams and tests. Doctors evaluate a patient’s medical history and symptoms to gather initial evidence. They then may pursue different testing approaches. Stool tests can measure the amount of fat in a patient’s stool to diagnose the malabsorption of fat, one of the most common symptoms of the condition. Stool samples can also be examined under a microscope to identify any undigested food fragments or parasites. Doctors may also perform blood or urine testing to detect high levels of undigested substances like Vitamin B-12 or lactose. 

Once malabsorption is diagnosed, identifying the underlying cause is an important next step. Biopsies, imaging testing (including x-rays and CT scans), and pancreatic function tests can all help identify the underlying cause. 

Treating and Preventing Malabsorption

Treatment involves both treating symptoms and treating the underlying cause of malabsorption to ensure proper nutrient absorption. Medication can treat symptoms like diarrhea. Nutrient and fluid replacement can treat nutrient deficiency and dehydration. Additionally, high-calorie diets can help the body absorb more nutrients. These diets can include varying amounts of proteins, fats, carbohydrates, and key vitamins and minerals. Injections of vitamins and minerals can also sometimes help. There are also some medications that can slow down the digestion process in the small intestine. This allows food to be in the small intestine for a longer time. 

Prevention measures vary based on the underlying cause of the condition. When diseases like cystic fibrosis or celiac are a factor, managing those diseases is an important way to prevent malabsorption issues. Additionally, since some antibiotics and laxatives can cause malabsorption, you should use them carefully. Follow your doctor’s instructions to manage and treat the condition and prevent it from becoming severe. 

Our experienced team at GHP has years of experience treating conditions including malabsorption. We can help establish the best plan of care for your situation. Contact any of our office locations to learn about the options we offer and schedule an appointment today.

Cirrhosis: What You Need to Know

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Cirrhosis is a condition in which your liver is scarred and suffers permanent damage. Here’s what you need to know about the condition. 

Causes and Risk Factors

When the liver is damaged, it attempts to repair itself and scar tissue forms. Over time, this scar tissue builds up and makes it difficult for the liver to function. Cirrhosis is the term for late stage damage. Damage can be caused by various conditions and diseases. These include chronic alcohol abuse, syphilis, chronic viral hepatitis, some genetic disorders, and nonalcoholic fatty liver disease. 

Risk factors for cirrhosis include excessive alcohol consumption, having viral hepatitis, and being overweight. Each of these factors can lead to some of the diseases and conditions listed above, which can damage the liver and lead to cirrhosis over time. 

Symptoms of Cirrhosis

There are several potential symptoms of cirrhosis. In the early stages of disease, many people do not experience any symptoms. Symptoms and complications often occur in later stages of disease, when it is more severe. These include severely itchy skin, fatigue, nausea, loss of appetite, jaundice, easily bleeding and bruising, and fluid accumulation on the abdomen. 

Diagnosis

In cases of early-stage cirrhosis, most people do not have symptoms, and diagnosis is likely to be incidental through a routine blood test or doctor’s visit. In general, doctors diagnose cirrhosis through a combination of physical exams, blood tests, medical history, and symptoms. Often, doctors will order additional testing to confirm a diagnosis. They may do this through blood testing, imaging tests, or biopsy. Imaging tests and biopsies can help determine the extent of cirrhosis, and blood testing can help identify the underlying cause of the condition. For example, blood testing may help identify elevated bilirubin levels, creatinine levels, or hepatitis infection. 

Treating Cirrhosis

Treatment approaches for cirrhosis vary based on the extent and cause of liver damage. Typically, treatment will focus on preventing or treating any symptoms and slowing the rate of scar tissue buildup on the liver. If doctors catch cirrhosis early, the underlying cause may be treatable to reduce any further damage. For example, if someone has developed it as a result of chronic alcohol abuse, their doctor will likely recommend they quit drinking. They may be encouraged to join an alcohol addiction program if quitting is difficult.

If hepatitis causes cirrhosis, there are medications that can treat the virus to prevent further liver damage. If it develops due to nonalcoholic fatty liver disease, focusing on weight loss and controlling blood sugar can help. Additionally, there are often medications that can help treat symptoms and complications like pain, itching, and osteoporosis. In late-stage cases, when the liver has too much damage to function, a liver transplant may be the only option. 

Prevention

Preventing and managing cirrhosis entail several lifestyle behaviors. Avoiding alcohol, practicing safe sex, exercising regularly, eating a healthy diet, and using over the counter medicines carefully are good prevention measures. 

Our experienced team at GHP has years of experience treating conditions including cirrhosis. We can help establish the best plan of care for your situation. Contact any of our office locations to learn about the options we offer and schedule an appointment today.

 

What is Jaundice?

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Jaundice causes the whites of the eyes, skin, and mucous membranes to turn yellow as a result of heightened levels of bilirubin. Here’s what you need to know about the condition.  

Causes and Risk Factors

Jaundice is ultimately caused by bilirubin levels that are too high. Bilirubin is a yellow chemical in hemoglobin, the part of red blood cells that carries oxygen. The body builds new red blood cells when old ones break down, and the liver processes the old cells. When the liver is unable to process these old cells properly, bilirubin builds up in the blood and deposits in the skin. The yellow color of bilirubin is what causes the yellowing of skin in jaundice. 

Jaundice is relatively common in newborns- many babies develop it in their first week of life, and it often goes away without issue. In adults, jaundice can be a sign of various problems. These include liver diseases (like alcoholic liver disease, cirrhosis, and hepatitis), blood diseases, infections, blocked bile ducts, and viruses. 

Symptoms of Jaundice 

There are several symptoms of jaundice that people can experience at different levels of severity. Some people may not even have any symptoms. Ultimately, the symptoms a person experiences will depend upon underlying causes and the speed at which disease develops. In short-term cases, often caused by infections, symptoms typically include fever, abdominal pain, chills, flu-like symptoms, yellowed skin and eye whites, dark urine, and clay-colored stool. If a case is not caused by infection, symptoms can include weight loss and itchy skin. Abdominal pain is also common when pancreatic or bile duct cancers cause jaundice. 

Diagnosis

Jaundice is diagnosed through a few different steps. Doctors first perform physical exams to check for signs of liver disease. These signs include yellowing and bruising of the skin, spider angiomas (blood vessels that collect near the skin surface), and palmar erythema (red coloration in the fingertips and palms). They also perform urinalysis to check bilirubin levels in the urine, which can indicate jaundice. They often perform serum testing to confirm findings from urinalysis as well. Additionally, they may want to pursue imaging of the liver through an MRI, CT, or ultrasonography to further confirm any diagnosis. 

Treatment and Prevention for Jaundice

Treatment for jaundice entails treating the underlying causes and complications of the condition, as well as any symptoms. For instance, if acute viral hepatitis is a cause, it will go away as your liver heals.  Treatment may entail treating the hepatitis symptoms. Surgery can help unblock bile ducts in cases of blocked ducts. A drug called cholestyramine can be used to limit itching if itchy skin is a symptom. 

Preventing jaundice entails preventing the various underlying causes. This means that limiting alcohol intake, avoiding hepatitis infection, and maintaining a healthy weight and cholesterol levels can all reduce your risk. 

Our experienced team at GHP has years of experience treating conditions including jaundice. We can help establish the best plan of care for your situation. Contact any of our office locations to learn about the options we offer and schedule an appointment today.

 

Coronavirus and the GI system: What does the evidence tell us?

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The coronavirus continues to have an enormous impact on the way we live. Over the past several months, we have begun to learn more and more about the virus. We’ve learned about how it spreads, its symptoms, how to detect it, and potential approaches for vaccines. Crucially, the virus has several documented impacts and features related to the gastrointestinal system. Let’s take a look at the evidence. 

Note: As the medical and public health understanding of the coronavirus continues to evolve, there’s a lot we still don’t know for certain. It’s important to recognize the difference between evidence-based conclusions, emerging evidence without sufficient peer review, and speculation. We will carefully frame each point based on the amount and kinds of evidence supporting it. 

Coronavirus Symptoms Associated with the Gastrointestinal System

The coronavirus can cause a range of symptoms, from a fever to a loss of smell and a headache. We do know that it can cause gastrointestinal symptoms in some cases. These well-documented GI symptoms include loss of appetite, nausea, vomiting, and diarrhea. However, not everyone with coronavirus will experience these symptoms. 

Some interesting emerging research suggests that there may be clusters of symptoms. One of these clusters involves gastrointestinal symptoms. Researchers at King’s College London studied data from around 1,600 COVID-19 patients who logged their symptoms to the research group’s COVID Symptom Study app in March and April. They found six distinct clusters of symptoms from the data: 

  1. Flu-like with no fever. Headache, loss of smell, muscle pains, cough, sore throat, chest pain, no fever.
  2. Flu-like with fever. Headache, loss of smell, cough, sore throat, hoarseness, fever, loss of appetite.
  3. Gastrointestinal. Headache, loss of smell, loss of appetite, diarrhea, sore throat, chest pain, no cough.
  4. Severe level one, fatigue. Headache, loss of smell, cough, fever, hoarseness, chest pain, fatigue.
  5. Severe level two, confusion. Headache, loss of smell, loss of appetite, cough, fever, hoarseness, sore throat, chest pain, fatigue, confusion, muscle pain.
  6. Severe level three, abdominal and respiratory. Headache, loss of smell, loss of appetite, cough, fever, hoarseness, sore throat, chest pain, fatigue, confusion, muscle pain, shortness of breath, diarrhea, abdominal pain.

As you can see, the gastrointestinal cluster includes GI symptoms like diarrhea and loss of appetite. Other clusters also contain GI symptoms. Each cluster was also associated with differing proportions of patients who required hospitalization and breathing support. The escalating severe clusters had the largest percentage of patients requiring significant medical support. 

It’s important to note that while the researchers have replicated their findings with a second 1,000 person data set from June, the research is not peer-reviewed yet. However, this is certainly something to keep an eye on as more data trends emerge. 

Sewage: A Potential Method for Measuring Infection Spread

Early on in the pandemic, evidence emerged from multiple studies showing that people infected with the coronavirus shed viral particles in their poop. Whether the disease can spread through feces is still undetermined. However, there has been growing interest in sampling sewage to determine the extent of disease spread. 

This has been particularly appealing because of the lack of adequate testing in many countries. This has led to a significant undercounting of actual infection numbers. A cross-sectional CDC study conducted across multiple states used serological testing on a convenience sample with people of all ages to identify how many had developed antibodies to the disease. This gave a more accurate picture of how many people have been infected, since the presence of antibodies indicates that a person had been or was currently infected. The study found that actual infection numbers were likely 10 to 12 times higher than reported through testing. Note that large-scale seroprevalence studies like this one are continuing to be conducted to identify likely infection rates, so the results here are preliminary. 

With such a disparity between reported and actual case counts, wastewater sampling offers a convenient and accessible way to identify disease spread in a particular area. Importantly, results are quicker than those from viral and serological tests. This is helpful, timely data that can inform decisions about disease containment in the event of a flare-up. Additionally, it can help researchers see the viral ancestry of the disease, tracking different strains, viral changes over time, and spreading patterns and paths. 

There are drawbacks, though. This kind of sampling can’t prove that an entire population is completely clear of the virus. Another drawback is that we still don’t know how many copies of viral RNA need to be present in a sample for disease to be detected. This means false negatives are possible, as we don’t know the minimum number of copies that trigger detection. A lower count of copies could go undetected with an improper assumption about a minimum. 

Overall, there’s certainly a lot we still have to learn about the coronavirus and the GI system. However, as scientists conduct more and more research, we have a better opportunity to make data-informed decisions at public health, medical, governmental, interpersonal, organizational, and individual levels. 

Our experienced team at GHP has years of experience helping patients with a variety of diseases and conditions. We can help establish the best plan of care for your situation. Contact any of our office locations to learn about the options we offer and schedule an appointment today.

Endoscopic Retrograde Cholangiopancreatogram (ERCP): A Brief Overview

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An Endoscopic Retrograde Cholangiopancreatogram (ERCP) is a therapeutic endoscopic procedure that helps diagnose and treat diseases in the liver, gallbladder, pancreas, and bile system. Here’s what you need to know about the procedure. 

When an ERCP is used

There are several reasons your doctor may perform an ERCP. One common reason is to diagnose and treat gallstones that are trapped in the bile duct. They may also perform an ERCP to identify the source of persistent upper right side abdominal pain, to identify a cause of pancreatitis, or to relieve bile duct obstruction caused by tumors. Often, doctors will inject a dye in the bile ducts during an ERCP to assist with X-ray imaging.

Preparing for an ERCP

There are a few important steps to prepare for an ERCP. You will need to discuss any medications you are taking with your doctor. Blood-thinning medications like Coumadin (warfarin), Eliquis (apixaban), Lovenox (enoxaparin), Plavix (clopidogrel), Pradaxa (dabigatran), and Xarelto (rivaroxaban) are especially important to discuss. These can increase the risk of severe bleeding during the procedure, and you should stop taking them before the ERCP. Also, if you use insulin, you may need to adjust timing or dosage on the day of the procedure. Your doctor will also need to know if you have any allergies to medications. Additionally, you will need to fast starting the midnight prior to your procedure. This means avoiding eating from that time until your procedure. 

During the Procedure

Prior to the ERCP procedure, you will go to a pre-op area where nurses will place an IV and take your medical information. You will also speak with an anesthesiologist about the sedation used during the procedure. 

Once you have moved to the procedure room, you will be connected to machines that monitor your vitals during the ERCP. You will be sedated during the procedure. Your doctor will feed the endoscope through your mouth and perform the procedure. The specific techniques and treatments they use will depend on your situation, and include opening blocked ducts and inserting stents. They may also take X-rays during the procedure. Contrast dye is injected through the endoscope to assist in developing X-ray imaging of your bile ducts. In total, the ERCP should take around 30-40 minutes. 

After the Procedure

After the ERCP, you will go to a post-op area to recover from sedation and the procedure and will be monitored for complications. Once you have recovered, your doctor will discuss the results with you, though any biopsies will take a few days to return. You should not operate machinery, drive, or make important decisions for 24 hours after your procedure due to sedative effects. 

It’s common to have a sore throat immediately after the procedure; throat lozenges can help treat soreness. You should follow a clear liquid diet after the ERCP, eventually transitioning to bland foods. 

The procedure has a few uncommon risks. Around 7% of patients experience pancreatitis, an inflamed pancreas. This requires hospitalization to rest the pancreas and manage inflammation. In very rare cases, this can be severe and lead to surgery, organ failure, or death. 

In very rare cases, perforation occurs during the procedure. Most of the time, this can be managed with hospitalization, bed rest, antibiotics, and bowel rest. Rarely, you may need surgery to repair the perforation. 

There is a low risk of bleeding as well, which occurs in around 0.5% of cases. When managed during the procedure, it can be stopped. Delayed bleeding requires patients to return to their doctor for treatment. 

Our experienced team at GHP has years of experience performing ERCPs. We can help establish the best plan of care for your situation. Contact any of our office locations to learn about the options we offer and schedule an appointment today.