An Overview of Diverticulitis

Diverticulitis is a condition where pockets formed in the colon wall (called diverticula) become inflamed. Here’s what you need to know about the condition.

Causes and Risk Factors

Diverticula can form when weak areas of the colon give due to pressure, creating pockets in the colon wall. This pressure can be influenced by many things, including diet. If you do not eat enough fiber, waste can build up in your colon and increase pressure on its walls. If these diverticula tear, they can become infected and inflamed.

There are a few notable risk factors for diverticulitis. As previously mentioned, you are at risk if you do not eat enough fiber in your diet. Not eating enough fruits, vegetables, grains, nuts, and beans can all contribute to low fiber intake. If you have a diet high in fats and red meat your risk increases as well. Exercise is a factor as well- too little regular exercise can increase risk for diverticulitis. NSAIDs like ibuprofen and aspirin can heighten your risk too. Also, people over 40, men, and people who are obese have a higher chance of developing the condition. Overall, this is a very common condition, particularly for people in Western countries as they age.

Symptoms of Diverticulitis

Diverticulitis is characterized by a few symptoms. Abdominal pain in the lower left part of the abdomen is a common symptom. This pain can persist for several days, and may be mild and slowly building or can develop suddenly. Your abdomen may be tender as a result of the pain. Other potential symptoms include nausea, vomiting, constipation, and occasionally diarrhea.

Diagnosis, Treatment and Prevention

Abdominal pain is the most common symptom of this condition, and is associated with many other potential issues. As such, doctors typically perform a number of diagnostic steps to determine the underlying issue. They may ask you about your diet, bowel movements, and symptoms. They may also perform a physical exam to investigate abdominal pain and tenderness. Your doctor might want to run blood and urine tests to check for signs of infection. In some cases, they may want to do a stool test as well. They can also order a CT scan to visualize any inflamed or infected diverticula and illuminate the severity of the diverticulitis.

Treating mild diverticulitis usually involves taking prescribed oral antibiotics. You will also need to rest and switch to a liquid diet while your colon heals. In more severe cases, people with complicated diverticulitis are hospitalized and given intravenous antibiotics. Surgery may be warranted if an abscess (a pocket of infection) forms or if there is a colon puncture or fistula. In surgery, doctors remove diseased parts of the colon and reconnect healthy parts of the organ. If infection is widespread, doctors can perform a colostomy to connect the colon to a hole in the abdomen. Doctors attach a bag to the opening where waste can pass.

You can prevent diverticulitis by eating a fiber-rich diet and exercising regularly. Seek out whole grains, legumes, fruits, and vegetables. Stay in touch with your doctor if you do have a case of diverticulitis, as they may recommend other steps to prevent recurrence.

Our experienced team at GHP has years of experience treating diverticulitis. 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.

Video: Why You Should Get a Colonoscopy After Screening

Did you know you should consider a colonoscopy after screening? Check out our latest video featuring Dr. Sunana Sohi, M.D. to learn more.

 

Click here to watch the video

 

Our experienced team at Gastro Health Partners has years of experience performing colonoscopies. We can help establish the best plan of care for your situation. Visit us online at https://www.gastrohealthpartners.com/ to learn about the options we offer and schedule an appointment today.

Bile Duct Diseases: An Introduction

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

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.

Malabsorption: An Overview

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.

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

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.

Understanding IBD (Inflammatory Bowel Disease)

Inflammatory bowel disease (IBD) is a disorder of the digestive tract that results in chronic inflammation. Ulcerative colitis and Crohn’s disease are the two most common forms of IBD. Ulcerative colitis specifically affects the colon and rectum while Crohn’s disease inflames all areas of the gastrointestinal tract. While a direct cause is not known, inflammatory bowel disease is thought to be a result of an abnormal immune response that causes the immune system to attack the digestive track.

Signs & Symptoms

  • Diarrhea
  • Unexplained weight loss
  • Loss of appetite
  • Blood in stool
  • Fever
  • Fatigue
  • Abdominal pain and cramping
  • Lack of childhood development

While one’s stress and diet may not be directly causing inflammation, lifestyle changes can help to relieve symptoms. Avoid dairy products and other problematic foods to see how they affect your flare-ups. Additionally, while fiber is known to help with bowel issues, it could behaving an adverse effect. Drink plenty of water and experiment with more frequent smaller meals.

Risk Factors

  • Age: Most patients are diagnosed with inflammatory bowel disease before the age of 30.
  • Race & Ethnicity: Caucasians and those of Ashkenazi Jewish decent are at the most risk for inflammatory bowel disease.
  • Family History: Those with a first-degree relative who have suffered from IBD are more likely to develop it themselves.
  • Cigarette Smoking: IBD is most common among smokers.
  • Medications: Anti-inflammatory medicines such as ibuprofen, Advil and Aleve have been known to aggravate IBD.
  • Environment: The disease tends to affect those who live in more urbanized and developed areas as well as northern climates.

Patients who are experiencing signs of IBD or know that they are at an increased risk for developing it should take preventive measures by routinely checking in with a healthcare professional. Having IBD increases your risk for colon cancer and blood clots.

Although there is no cure for inflammatory bowel disease, medication is an effective treatment option for those with ulcerative colitis. However, 70% of those with Crohn’s disease often require surgery in order to relieve their symptoms.

If you or a loved one feels they could have ulcerative colitis or Crohn’s disease, schedule an appointment with one of our fellowship-trained gastroenterologist today.

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