- Biliary Tract Disorders
- Celiac Disease
- Colon Polyps
- Crohn’s Disease
- Diverticular Disease
- Eosinophilic Esophagitis (EoE)
- Gastroesophageal Reflux Disease (GERD)
- Gastroparesis
- Helicobacter Pylori (H. Pylori)
- Hepatitis C
- Irritable Bowel Syndrome (IBS)
- Liver Cirrhosis
- Nonalcoholic Steatohepatitis Disease (NASH)
- Nausea & Vomiting
Gallbladder stones are an extremely common disorder and are usually asymptomatic. Your liver makes a digestive juice called bile and your gallbladder stores it between meals.
When you eat, your gallbladder pushes the bile into tubes called bile ducts. They carry the bile to your small intestine. The bile helps break down fat and also helps the liver get rid of toxins and wastes. Different diseases can block the bile ducts and cause a problem with the flow of bile: Gallstones (which can increase pressure in the gallbladder and cause a gallbladder attack), cancer, infections, birth defects such as biliary atresia and inflammation which can cause scarring.
Over time, this can lead to liver failure. The vast majority of patients with gallstones are asymptomatic. Symptomatic gallstones typically present with right upper abdominal pain and often with nausea and vomiting. The pain is often severe, may last for several hours (biliary colic). If the cystic duct obstruction persists, the gallbladder becomes inflamed and the patient develops cholecystitis, an acute inflammation and infection of the gallbladder.
To diagnosis a gallbladder disorder, the test of choice is a right upper quadrant ultrasound, which, in the presence of cholecystitis, typically shows the presence of gallstones, a thickened gallbladder wall, and pericholecystic fluid. In those patients with symptomatic gallstones and a negative ultrasound examination a HIDA scan can be useful in diagnosis.
The primary treatment for symptomatic gallstone disease is gallbladder removal. Most gallbladder removals in the United States are done laparoscopically. Stones can be removed endoscopically before or after gallbladder removal, or surgically at the time of removal. It is estimated that 95% of patients experience relief of pain after gallbladder removal. The remaining patients probably had symptoms not related to gallbladder disease before surgery.
Celiac disease is an autoimmune disorder that can occur when the ingestion of gluten leads to damage in the small intestine.
Celiac disease is a serious autoimmune disorder that can occur in genetically predisposed people where the ingestion of gluten leads to damage in the small intestine. Celiac disease is hereditary, meaning that it runs in families. Celiac disease is also known as coeliac disease, celiac sprue, non-tropical sprue, and gluten sensitive enteropathy.
When people with celiac disease eat gluten (a protein found in wheat, rye and barley), their body mounts an immune response that attacks the small intestine. These attacks lead to damage on the villi, small fingerlike projections that line the small intestine, that promote nutrient absorption. When the villi get damaged, nutrients cannot be absorbed properly into the body.
Celiac disease can develop at any age after people start eating foods or medicines that contain gluten. Left untreated, celiac disease can lead to additional serious health problems. Blood tests can help your doctor diagnose the disease. Your doctor may also need to examine a small piece of tissue from your small intestine.
Celiac disease affects each person differently and the signs and symptoms of celiac disease can vary greatly and are different in children and adults. Symptoms may occur in the digestive system, or in other parts of the body. One person might have diarrhea and abdominal pain, while another person may be irritable or depressed. Some people have no symptoms. The most common signs for adults are diarrhea, fatigue and weight loss. Adults may also experience bloating and gas, abdominal pain, nausea, constipation, and vomiting.
Currently, the only treatment for celiac disease is lifelong adherence to a strict gluten-free diet. People living gluten-free must avoid foods with wheat, rye and barley, such as bread and beer. Ingesting small amounts of gluten, like crumbs from a cutting board or toaster, can trigger small intestine damage.
Colon polyps are growths on the lining of your colon or large intestine and usually protrude into the colon. Colon polyps are very common and most are harmless. Over time, some colon polyps can develop into colon cancer. For that reason, your doctor needs to take out any colon polyps you have.
There are two main categories of polyps, non-neoplastic and neoplastic. Non-neoplastic polyps include hyperplastic polyps, inflammatory polyps and hamartomata’s polyps. These types of polyps typically do not become cancerous. Neoplastic polyps include adenomas and serrated types. These types of colon polyps are far likelier to become cancerous than are others.
In general, the larger a polyp, the greater the risk of cancer, especially with neoplastic polyps. But a doctor who specializes in analyzing tissue samples (pathologist) usually must examine polyp tissue under a microscope to determine whether it’s potentially cancerous. Anyone can develop colon polyps. You’re at higher risk if you’re 50 or older, are overweight or a smoker, or have a personal or family history of colon polyps or colon cancer.
Colon polyps often don’t cause symptoms. You might not know you have a polyp until your doctor finds it during an examination of your bowel. Only a small proportion of polyps cause symptoms or signs. When they do, the symptoms and signs usually are the result of bleeding from the polyp and may include:
- Rectal bleeding
- Red blood mixed with stool
- Red blood on the surface of stools
- Black stools
- Weakness
- Light-headedness
- Fainting
- Change in bowel habits
- Pain
- Iron deficiency anemia
- Pale skin
It’s important to have regular screening tests, such as a colonoscopy, because colon polyps found in the early stages can usually be removed safely and completely.
The best prevention for colon cancer is regular screening for polyps. Colon polyps are diagnosed by endoscopic colonoscopy, virtual colonoscopy, barium enema, and flexible sigmoidoscopy. Colon polyps are treated by endoscopic removal and occasionally by surgery. Follow-up surveillance of patients with colon polyps depends on the presence of a family history of cancer, the number of polyps that are found, the size of the polyps, and the polyps’ histology, and can vary between three and ten years.
Crohns is a chronic inflammatory bowel disease affecting the lining of the digestive tract.
Crohn’s disease belongs to a group of conditions known as inflammatory bowel diseases (IBD) and is a chronic inflammatory condition of the intestines. Crohn’s most commonly affects the end of the small bowel (the ileum) and the beginning of the colon, but it may affect any part of the gastrointestinal (GI) tract, from the mouth to the anus.
The inflammation caused by Crohn’s disease often spreads deep into the bowel walls and can involve different areas of the digestive tract in different people leaving normal areas in between patches of diseased intestine. Crohn’s disease can be both painful and debilitating, and sometimes may lead to life-threatening complications.
Crohn’s is a chronic disease, so this means patients will likely experience periods when the disease flares up and causes symptoms, followed by periods of remission when patients may not notice symptoms at all.
The exact cause of Crohn’s disease remains unknown. A number of factors, such as heredity and a malfunctioning immune system, likely play a role in its development. Signs and symptoms usually develop gradually, but sometimes will come on suddenly, without warning. They can range from mild to severe and may include: diarrhea, fever, fatigue, abdominal pain and cramping, blood in your stool, mouth sores, reduced appetite and weight loss, (fistula). Only proper testing performed by your doctor can render a diagnosis.
There is no single ideal therapy for IBD—treatment must be tailored to each person’s needs. Treatment for Crohn’s can include the use of medication, alterations in diet and nutrition, and sometimes surgical procedures to repair or remove affected portions of your GI tract. With proper treatment over time, periods of remission can be extended and periods of symptom flare ups can be reduced.
Diverticular disease consists of three conditions that involve the development of small sacs or pockets in the wall of the colon, including diverticulosis, diverticular bleeding, and diverticulitis. The condition can lead to more serious issues including perforation (the formation of holes), stricture (a narrowing of the colon that does not easily let stool pass), fistulas, and bleeding.
Diverticula, which can range from pea-size to much larger, are formed by increased pressure on weakened spots of the intestinal walls by gas, waste, or liquid. Diverticula can form while straining during a bowel movement, such as with constipation. Diverticulosis is very common.
Diverticulitis occurs when there is inflammation and infection in one or more diverticula. This usually happens when outpouchings become blocked with waste, allowing bacteria to build up, causing infection. Most people will have no or few symptoms from diverticula.
- Symptoms of diverticulitis may include:
- Alternating diarrhea and constipation
- Painful cramps or tenderness in the lower abdomen
- Chills or fever
Diverticulosis may be diagnosed during screening tests such as a colonoscopy. A CT scan of the abdomen and pelvis may be used to confirm the diagnosis of diverticulitis. People who have diverticulosis without symptoms or complications do not need specific treatment, yet it is important to adopt a high-fiber diet to prevent the further formation of diverticula. Laxatives should not be used to treat diverticulosis and enemas should also be avoided or used infrequently.
Most cases of diverticulitis can be treated with antibiotics in pill form or intravenously (IV). A history of multiple attacks may result in a patient deciding to undergo surgery to prevent future attacks. Surgery for diverticular disease usually involves removal of the affected part of the colon. It may or may not involve a colostomy or ileostomy (intestine brought out through the abdominal wall to drain into a bag). A decision regarding the type of operation is made on a case-by-case basis.
Eosinophilic Esophagitis (ee-uh-sin-uh-fil-ik) or EoE is a disorder of the esophagus that has been going on for a long time (chronic). An allergic swallowing disorder, EoE affects the esophagus and occurs when a type of white blood cell called eosinophil collects in the esophagus.
The eosinophils then cause inflammation in the esophagus. Eosinophils are not normally present in the esophagus.
- Common symptoms of EoE include:
- Reflux-like symptoms or GERD
- Vomiting
- Trouble swallowing
- Food impaction (when food gets stuck in throat).
While EoE symptoms are often triggered by food, it may also be triggered by pollen as well.
Treatment Options: Many people with EoE respond well to changes in the diet, though not all do. Most EoE can be treated with topical steroids. Topical means the patient swallows doses of inhaled steroids, the same dose that is used for daily control of asthma. Patients with EoE may need more endoscopies to check how the esophagus is responding to treatment.
Symptoms are not a reliable way to monitor one’s EoE. Repeat biopsies are necessary to directly see how individuals respond to treatment. EoE can be frustrating in that it may come and go and EoE is not like an infection that can be treated with antibiotics.
EoE is a lot like asthma, in that it may not go away for several years, however, it may not always be active, either. No one knows exactly for how long someone must be treated to get rid of EoE.
Gastroesophageal reflux disease (GERD) occurs when stomach acid frequently flows back into the tube connecting your mouth and stomach (esophagus). This backwash (acid reflux) can irritate the lining of your esophagus.
Many people experience acid reflux from time to time. GERD is mild acid reflux that occurs at least twice a week, or moderate to severe acid reflux that occurs at least once a week. You may feel a burning in the chest or throat called heartburn. Sometimes, you can taste stomach fluid in the back of the mouth. You can also have GERD without having heartburn.
Your symptoms could include a dry cough, asthma symptoms, or trouble swallowing. If you have nighttime acid reflux, you might also experience: Chronic cough, Laryngitis, New or worsening asthma, Disrupted sleep. GERD can worsen and turn into other conditions if left untreated. There are several possible tests to diagnose GERD.
Many people can improve their symptoms by:
- Avoiding alcohol and spicy, fatty or acidic foods that trigger heartburn
- Eating smaller meals
- Not eating close to bedtime
- Losing weight if needed
- Wearing loose-fitting clothes
- Quitting smoking
- Reducing stress
Treating GERD may involve the use of protein pump inhibitors, antacids, and other medications, as well as lifestyle changes. GERD will often be treated with medications before attempting other lines of treatment. Proton pump inhibitors are one of the main pharmaceutical treatment options for people with GERD.
Gastroparesis is a digestive disorder in which the motility of the stomach is abnormal or absent. When Gastroparesis is present the stomach is unable to contract normally and therefore cannot crush food nor propel food into the small intestine.
There are many causes of gastroparesis including diabetes, infections, autoimmune disorders and neuromuscular disorders. Medications such as narcotics, antidepressants, calcium channel blockers, lithium and nicotine can also cause gastroparesis.
Symptoms include bloating, nausea, early fullness, heartburn and epigastric pain. Gastroparesis can be diagnosed with endoscopy as well as gastric emptying study. Treatment for gastroparesis can be challenging including diet changes as well as a trial of medications.
Helicobacter pylori is a bacterium that causes chronic inflammation (infection) in the stomach and duodenum. Helicobacter pylori (H. pylori) infection occurs when a type of bacteria called Helicobacter pylori (H. pylori) infects your stomach.
Although many infected individuals have no symptoms, other infected individuals may have occasional episodes of belching, bloating, nausea, vomiting, abdominal pain, decreased appetite, diarrhea, heartburn and bad breath.
H. pylori is contagious; however, some individuals may be simply having the bacteria in their gut, and the bacteria causes no symptoms of disease. The diagnosis of H. pylori infection includes tests for antibodies in blood, a urea breath test, tests for antigens in stool, and endoscopic biopsies. However, recommendations to help prevent ulcers include: Reduce or stop alcohol intake and quit smoking. Use acetaminophen (Tylenol and others) instead of NSAIDs, for example, aspirin, ibuprofen (Advil, Motrin).
H. pylori infections are usually treated with at least two different antibiotics at once, to help prevent the bacteria from developing a resistance to one particular antibiotic. Your doctor also will prescribe or recommend an acid-suppressing drug, to help your stomach lining heal.
Hepatitis C is a viral infection that causes liver inflammation, sometimes leading to serious liver damage. The hepatitis C virus (HCV) spreads through contaminated blood. Today hepatitis C is usually curable with oral medications taken every day for two to six months.
Many people with HCV don’t know they’re infected because they have no symptoms. Symptoms may take decades to appear. For that reason, the U.S. Centers for Disease Control and Prevention recommends a one-time screening blood test for everyone at increased risk of the infection. The largest group at risk includes baby boomers born between 1945 and 1965 who are five times more likely to be infected than those born in other years.
Risk Factors
- Are a health care worker who has been exposed to infected blood
- Injecting or inhaling illicit drugs
- HIV
- Piercings or tattoos done in an unclean enviromnent using unsterile equipment
- Blood transfusion or organ transplant before 1992
- Clotting factor concentrates before 1987
- Hemodialysis treatments for a long period of time
- Born to a woman with a hepatitis C infection
- Incarceration
- Born between 1945 and 1965
Testing
If you have risk factors for hepatitis C, ask your healthcare provider to test you. Testing is done by drawing a small amount of blood to test for the hepatitis C antibody. If the initial blood test shows that you have been exposed to hepatitis C, additional blood tests will need to be drawn. A viral load will measure the amount of the hepatitis C virus in your blood. A genotype will determine what type of hepatitis C you have. A liver biopsy, scan of your liver (fibroscan), or a blood test can determine how much damage to the liver has occurred.
Treatment
Hepatitis C infection is treated with oral antiviral medications intended to clear the virus from your body. The goal of treatment is to have no hepatitis C virus detected in your body at least 12 weeks after treatment has been completed. Cure rates are greater than 90% today. Although there is no vaccine for hepatitis C, your doctor will likely recommend that you receive vaccines against the hepatitis A and B viruses. These are separate viruses that also can cause liver damage and complicate the course of hepatitis C.
Complications:
Hepatitis C can cause scar tissue (fibrosis) to accumulate in the liver. Left untreated, hepatitis C can cause advanced liver disease and cirrhosis. Once cirrhosis has developed and the liver no longer functions properly, a liver transplant may be necessary.
What can a person with hepatitis C do to take care of his or her liver?
- Get vaccinated for hepatitis A and B.
- A void drinking alcohol because it can cause additional liver damage
- A void medications that can potentially damage the liver
- A void using illicit drugs
Irritable Bowel Syndrome (IBS) is a chronic condition of the digestive system. Symptoms include abdominal pain and altered bowel habits. IBS is the most commonly diagnosed GI condition and is second only to the common cold as a cause for missing work.
One common theory suggests that IBS is caused by abnormal contractions in the colon which is why it is sometimes called “spastic colon”. Stress and anxiety are known to affect the intestines and therefore this can make IBS worsen. Some of the treatments for IBS include diet changes, increasing fiber intake, reducing stress and anxiety, and antispasmodic medications.
Cirrhosis is a condition in which the liver does not function properly due to long-term damage. Typically, the disease comes on slowly over years where long-term, continuous damage to the liver occurs.
When healthy liver tissue is destroyed and replaced by scar tissue, the condition becomes serious and we call that cirrhosis. Each time your liver is injured, it tries to repair itself. In this process, scar tissue forms. As cirrhosis progresses, more and more scar tissue forms, making it difficult for the liver to function.
The liver damage done by cirrhosis generally cannot be reversed. If liver cirrhosis is diagnosed early and the cause is treated, further damage can be limited. Early on, there are often no symptoms. As the disease worsens, a person may become tired, weak, itchy, have swelling in the lower legs, develop yellow skin, bruise easily, have fluid buildup in the abdomen, or develop spider-like blood vessels on the skin.
Alcohol abuse, viral hepatitis B and C, and Fat accumulating in the liver (nonalcoholic fatty liver disease) are the most common causes of cirrhosis, although there are many other causes. Diagnosis of cirrhosis can be suggested by history, physical examination and blood tests, and can be confirmed by liver biopsy.
Treatment of cirrhosis is designed to prevent further damage to the liver, treat complications of cirrhosis, and preventing or detecting liver cancer early. Transplantation of the liver is an important option for treating patients with advanced cirrhosis. The life expectancy is more than 12 years for a person with cirrhosis and no major complications.
There is no cure for cirrhosis of the liver, and for some people the prognosis is poor. The life expectancy for advanced cirrhosis is 6 months to 2 years depending on complications of cirrhosis. If no donor is available for liver transplantation, the life expectancy for people with cirrhosis and acholic hepatitis can be as high as 50%. In early cirrhosis, it may be possible to minimize damage to the liver by treating the underlying cause.
Nonalcoholic steatohepatitis disease (NASH) is a term for a range of liver conditions affecting people who drink little to no alcohol and is often referred to as fatty liver. The main characteristic of NASH is too much fat stored in liver cells.
Having some amount of fat in the liver is normal and rarely causes damage to the liver. NASH can be a temporary or long-term condition, and is not harmful itself, but may indicate some other type of problem.
If left untreated, NASH can progress to permanent scarring of the liver and eventual liver failure. In many cases, NASH has no symptoms and it doesn’t usually cause permanent damage unless it progresses. If there are symptoms, they can include: enlarged liver, fatigue, appetite loss, nausea, vomiting, abdominal pain, and jaundice.
NASH is a reversible condition that can often be resolved with lifestyle modifications. Treatment involves correcting the condition that caused NASH. Common causes of NASH include: Obesity, Diabetes, High blood sugar (hyperglycemia), High levels of fats (hyperlipidemia), and side effect of certain medications, including: aspirin, steroids, tamoxifen and tetracyclines.
Patients are advised to have a healthy balanced diet and exercise regularly in order to lose weight and maintain a normal body weight. They are advised to avoid alcohol and unnecessary medications. Diabetics and those with other conditions like high cholesterol, high blood pressure etc. need to be treated individually for the same.
Nausea is an uneasiness of the stomach that often comes before vomiting. Vomiting is the forcible voluntary or involuntary emptying (“throwing up”) of stomach contents through the mouth.
Nausea and vomiting are not diseases, but they are symptoms of many conditions such as:
- Motion sickness or seasickness
- Early stages of pregnancy
- Medication-induced vomiting
- Intense pain
- Emotional stress (such as fear)
- Gallbladder disease
- Food poisoning
- Infections (such as the “stomach flu“)
- Overeating
- Gastroparesis or slow stomach emptying (a condition that can be seen in people with diabetes)
- Ingestion of toxins
- Excessive amounts of alcohol
You should seek immediate medical care if any of the following situations occur with vomiting:
- There is blood in the vomit (bright red or “coffee grounds” in appearance)
- Severe headache or stiff neck
- Lethargy, confusion, or a decreased alertness
- Severe abdominal pain
- Rapid breathing or pulse
Treatment for vomiting includes: Drinking gradually larger amounts of clear liquids and avoiding solid food until the vomiting episode has passed.
There are several ways to try and prevent nausea from developing:
- Eat small meals throughout the day instead of three large meals
- Eat slowly, avoid hard-to-digest foods
- Consume foods that are cold or room temperature if you nauseated by the smell of hot or warm foods
- Rest after eating with your head elevated about 12 inches above your feet
- Drink liquids between meals rather than during meals and try to eat when you feel less nauseated