What is Gastroenterology?
What does a Gastroenterologist Do?
Gastroenterology is a subspecialty of internal medicine. However, it is specifically focused on the diagnosis and treatment of ailments and diseases related to digestives system of our body. A gastroenterologist will assist patients with the following conditions:
● Gastroesophageal Rreflux Disease – GERD or severe indigestion
● Ulcer disease
● Colon polyps and colon cancer
● Irritable bowel syndrome – IBS
● Spastic colon
● Crohn’s disease
● Ulcerative colitis
● Chronic liver disease
● Lactose intolerance – also whey from milk
The most common symtoms of GERD or Gastroesophageal Rreflux Disease is severe heartburn, a continuous sour taste in your mouth, nausea, chronic cough, sometimes a prolonged hoarse voice and possibly the onset of asthma.
The digestive system of our body starts from mouth and ends at anus. Structures that come in between mouth and anus are esophagus, stomach, small intestine and large intestine. Liver and pancreas are also part of digestive system as they produce acids (juices) that help in digestive process. Gastroenterology deals with diseases of all these organs.
SYMPTOMS OF GASTRO-INTESTINAL DISEASES
Digestive system is affected by a large number of diseases which include infections, auto-immune diseases, cancers and other diseases. Symptoms of a particular disease depend upon which part of digestive system is involved. Common symptoms for gastrointestinal diseases include
• Decreased appetite which is associated with a number of diseases
• Loose motions occur in diseases of small and large intestine for example, celiac disease, infection of small and large gut, inflammatory bowel disease, cancers of small and large intestine
• Weight loss accompanies a number of diseases for example, tuberculosis of intestine and cancer of gut
• Dyspepsia, indigestion or heart burn commonly occurs in diseases of esophagus and stomach
• Blood in stool is a dangerous symptom that may occur in infection of lower gut, piles, inflammatory bowel disease and cancers of gut
• Blood in vomiting occurs in liver disease or due to ulcers in the stomach
• Abdominal pain occurs in many diseases like hepatitis, gastritis, pancreatitis, cancer, etc.
• Foul smelling stools are a common complaint in patient having problem of malabsorption (food is not properly absorbed in gut)
• Yellowness of eyes and itching appear in diseases of liver, gall bladder and pancreas
TREATMENT OPTIONS IN GASTRO-ENTEROLOGY
Patients with digestive system disease are treated either through medicines or some intervention is performed.
The most common treatment offered to patients having gastro-intestinal disease and liver disease is administration of drugs both oral and inject able. Commonly used drugs for this purpose include,
• Drugs to increase motility of intestinal system
• Drugs to relieve constipation
• Drugs to reduce acidic secretions of stomach for treating dyspepsia and ulcer of stomach,
• Immunosuppressive drugs and steroids for treatment of many auto- immune diseases like ulcerative colitis and crohn’s disease.
• Interferon treatment for Hepatitis B and Hepatitis C
Intervention in gastroenterology
Gastroenterology also provides many interventions for diagnosis and treatment of diseases. Some common interventions used in gastro-enterology are:
Gastrointestinal Endoscopy (gastroscopy and colonoscopy)
Many diseases of esophagus, stomach, upper portion of small gut and large gut can be diagnosed and treated through endoscopy. The gastrointestinal endoscopy procedure allows the physicians to closely examine the interior lining or your entire digestive tract using a micro-video camera. Endoscope has both a camera and light. When it is advanced into stomach or rectum, it displays high quality color images of the internal lining and any internal structures on screen of a monitor. Additionally, it is used to view the inner part of digestive system and can be used to take biopsy of abnormal tissue. The gastrointestinal endoscopy can also be used to inject drugs into diseased tissue or blood vessels that would otherwise be unreachable without surgery.
Esophageal Acid (pH) Testing
The Esophageal Acid test uses a micro sensor which gets positioned in the lower part of your esophagus to measure the direct amount of acid that regurgitates into your esophagus; and will then relate the amount of regurgitation. This is a fairly easy exam and the information obtained may establish the cause of your symptoms without necessitating further medical study.
An ulcer can occur in both infants and grown adults. An Ulcer in the stomach lining, called a peptic ulcer, is a sore or hole in the lining of either the stomach or the first part of the small intestine (duodenum). Generally, ulcers are caused by an
infection. Spicy foods tend to inflame ulcers and can cause serious irritation. Over 25 million American man and woman will suffer from an ulcer at some point during their life. They are generally very painful and easy to diagnose. The majority of ulcers is caused by an infection with the bacterium “Helicobacter pylori”, and can be easily cured in a few weeks with a course antibiotics. You will need a physician to test for an H. Pylori infection. The test is a simple as blowing into a balloon with a chemical that reacts if it detects H. Pylori in your breath. The most common symptoms of an ulcer is a burning pain in your stomach. If left untreated, the uncle may get bigger, multiply, and cause more burning feeling. Today, ulcers are easily treated.
The conventional endoscope cannot clearly visualize the entire small intestines. The intestine has far too many curves, twists and turns, and lined in many directions. Therefore, to diagnose a disease of the small intestine, a capsule size endoscope is used. The capsule is swallowed through mouth; it has no wire.
The capsule endoscope contains a micro-camera which can take many pictures and images of the internal organs as it follows through your digestive system, the same way a piece of food would travel. Additionally, the endoscope capsule is also capable of taking biopsy from abnormal tissue.
Endoscopic retrograde cholangiopancreaticography is a unique intervention in gastroenterology. This is used to diagnose and treat diseases of biliary tract which include bile duct, hepatic duct and pancreatic duct. Endoscopic retrograde cholangiopancreatography (ERCP) is a technique that combines the use of endoscopy and fluoroscopy. ERCP use has mostly been replaced with the use of magnetic resonance cholangiopancreatography (MRCP) and endoscopic ultrasound for treating gallstones, bile duct infections, internal inflammatory scars and various types of cancers.
What are the most common causes of diarrhea?
Severe diarrhea or Acute diarrhea is usually related to a bacterial, viral, or a parasitic infection. When diarrhea becomes chronic and ongoing, it is typically related to functional disorders such as irritable bowel syndrome or inflammatory bowel disease.
Severe diarrhea is also caused by the following:
• Parasites. One or more Parasites can enter the body through food, water or an injury like a cut on your foot. The parasite then usually settles within the digestive system. There are many Parasites that cause diarrhea, They include Giardia lamblia, Entamoeba histolytica, and Cryptosporidium.
• Bacterial infections. Several types of bacteria which may be consumed through contaminated food or water can cause diarrhea. Common culprits include Campylobacter, Salmonella, Shigella, and Escherichia coli (E. coli). Also, when traveling to foreign countries, you can get diarrhea merely because of the different standards of water purification and potability.
• Viral infections. Many viruses cause diarrhea. Typical Diarrhea causing viruses are rotavirus, Norwalk virus, cytomegalovirus, herpes simplex virus, and viral hepatitis.
Food intolerances and Food Allergies. Some people are unable to digest certain food components such as wheat-celiac disease, lactose—the sugar found in milk, whey-a protein found in milk, eggs, shellfish, nuts-especially peanuts, soy and some artificial sweeteners. While some allergies can be outgrown, like wheat allergies are usually out grown in children, other stay with the patient throughout their life. Patients who suffer from celiac disease should avoid gluten, found in wheat, rye, barley, and sometimes oats
• Reaction to medicines. Antibiotics, blood pressure medications, cancer drugs, and antacids containing magnesium can all cause diarrhea. In addition, certain anti-depressants and other medications can also cause diarrhea.
• Intestinal diseases. Inflammatory bowel disease, Crohn’s disease, Colitis, and Celiac Disease may generally lead to diarrhea.
• Functional bowel disorders. Diarrhea can be a symptom of irritable bowel syndrome.
Some people develop diarrhea after stomach surgery or removal of the gallbladder. The reason may be a change in how quickly food moves through the digestive system after stomach surgery or an increase in bile in the colon after gallbladder surgery.
Crohn’s disease is an ongoing painful disorder that causes inflammation of the gastrointestinal (GI) tract a/k/a Digestive tract. Crohn’s disease typically affects the lower part of the small intestine, called the ileum. As such, Chrons is considered an inflammatory bowel disease. However, Crohns can affect any area of the GI tract including the large intestines, and the swelling extends deep into the lining. The swelling caused by Crohns disease is usually painful and can cause ongoing diarrhea and severe cramping pains. Crohn’s disease is sometimes called ileitis or enteritis.
Crohn’s disease is generally difficult to diagnose because the symptoms of Crohn’s disease are similar to many other GI and intestinal disorders such as irritable bowel syndrome and ulcerative colitis. In Crohn’s disease, all the layers of the intestine may be involved, while a healthy sections can be found between sections of diseased bowel. On the other hand, with Ulcerative colitis, you can find inflammation and ulcers in the top layer of the lining of the large intestine. The differences are hard to diagnose without actually visualizing and sampling the intestinal tract. Roughly 20 percent of people diagnosed with Crohn’s disease have a family member with the same or similar diagnosis. Crohn’s disease appears to genetically run in family lines.
What causes Crohn’s disease?
There are many theories regarding the exact causes Crohn’s disease, but none are conclusive. However, most people with Chrohn’s disease have several common factors which include the patients inherited genes, the quality of the patients’ immune system itself, and environmental factors such as antigens. Generally, most doctors surmise that Chron’s disease is an abnormal reaction which occurs in the body’s immune system that incorrectly treats bacteria, foods, drinks and other substances as being foreign and dangerous. The immune system’s confused response is to attack these foods and other bacteria as bad invaders, instead of treating it like the food it is. This error in judgment causes a plethora of white blood cells to accumulate in the lining of the intestines, producing a chronic inflammation, which leads to ulcerations and bowel injury. Most recently, doctors have to believe that a particular protein produced by the immune system, called anti-tumor necrosis factor (TNF), may cause the GI track inflammation that is generally associated with Crohn’s disease.
What are the symptoms of Crohn’s Disease?
To begin with, Crohn’s disease is very painful. Typically, you would feel frequent abdominal pain which is generally focused in the lower right area or your abdomen. Additionally, Crohn’s patients suffer from frequent diarrhea. Other symptoms include rectal bleeding, weight loss, arthritis, skin problems, and sometimes fevers. The rectal bleeding may be serious and persistent at times which could lead to anemia, requiring hospitalization. While the different patients suffer from a range or ailments, it is common for children who have Crohn’s disease could possibly suffer delayed development and stunted growth. Therefore, especially in children, get the medical attention you need if you have any of the symptoms of Crohn’s disease.
What are the complications of Crohn’s disease?
One of the most painful complications often found in Crohn’s disease patients is an intestinal blockage. Patients who suffer from Crohn’s disease may also have stomach or intestinal sores (ulcers-as pictured above) that can extend into surrounding tissues like the bladder or vagina. AN intestinal blockage usually occurs as a result of the disease causing the intestinal walls to thicken with swelling and scar tissue. This causes a narrowing of the intestinal passage which can also extend to areas around the anus and rectum. The pathways or tunnels, called fistulas, are a common complication and often become infected. While simple fistulas are treated with medications, more severe fistulas require surgery. Moreover, small tears called fissures can also develop in the lining of the mucus membrane of the anus adding to the complications of Crohn’s disease.
Additional symptoms of Crohn’s disease include malabsorption of nutrition, deficiencies and lack of protein intake, deficiencies in calories, and vitamins as well. These deficiencies may be caused by inadequate dietary intake and poor ability to absorb the nutrients and proteins normally found in food. Additionally, Crohn’s disease patients frequently suffer from arthritis, skin problems, inflammation in the eyes or mouth, kidney stones, gallstones, or other diseases of the liver and biliary system.
What is the treatment for Crohn’s disease?
Treatment may include drugs, nutrition supplements, surgery, or a combination of these options. The goals of treatment are to control inflammation, correct nutritional deficiencies, and relieve symptoms like abdominal pain, diarrhea, and rectal bleeding. At this time, treatment can help control the disease by lowering the number of times a person experiences a recurrence, but there is no cure. Treatment for Crohn’s disease depends on the location and severity of disease, complications, and the person’s response to previous medical treatments when treated for reoccurring symptoms.
Some people have long periods of remission, sometimes years, when they are free of symptoms. However, the disease usually recurs at various times over a person’s lifetime. This changing pattern of the disease means one cannot always tell when a treatment has helped. Predicting when a remission may occur or when symptoms will return is not possible.
Someone with Crohn’s disease may need medical care for a long time, with regular doctor visits to monitor the condition.
Anti-Inflammation Drugs. Most people are first treated with drugs containing mesalamine, a substance that helps control inflammation. Sulfasalazine is the most commonly used of these drugs. Patients who do not benefit from it or who cannot tolerate it may be put on other mesalamine-containing drugs, generally known as 5-ASA agents, such as Asacol, Dipentum, or Pentasa. Possible side effects of mesalamine-containing drugs include nausea, vomiting, heartburn, diarrhea, and headache.
Cortisone or Steroids. Cortisone drugs and steroids—called corticosteriods—provide very effective results. Prednisone is a common generic name of one of the drugs in this group of medications. In the beginning, when the disease it at its worst, prednisone is usually prescribed in a large dose. The dosage is then lowered once symptoms have been controlled. These drugs can cause serious side effects, including greater susceptibility to infection.
Immune System Suppressors. Drugs that suppress the immune system are also used to treat Crohn’s disease. Most commonly prescribed are 6-mercaptopurine or a related drug, azathioprine. Immunosuppressive agents work by blocking the immune reaction that contributes to inflammation. These drugs may cause side effects like nausea, vomiting, and diarrhea and may lower a person’s resistance to infection. When patients are treated with a combination of corticosteroids and immunosuppressive drugs, the dose of corticosteroids may eventually be lowered. Some studies suggest that immunosuppressive drugs may enhance the effectiveness of corticosteroids.
Infliximab (Remicade). Remicide is a controversial drug in treating patients with Crohn’s disease. On one hand, it can block the body’s inflammation response but may at the same time lower your ability to fight off infections. The medicine is not without substantial risk. The FDA has formally approved the drug for the treatment of moderate to severe Crohn’s disease which does not respond to the standard treatments and therapies such as mesalamine substances, corticosteroids, immunosuppressive agents) and for the treatment of open, draining fistulas.
Infliximab is the first medicine based treatment that the Food and Drug Administration has approved specifically for Crohn’s disease. However, it is a TNF substance. As such, the manufactures of Remicide have reported that serious side effects may occur. Among the side effects is the possibility of a rare form of fatal lymphoma. According to the manufacturers website “Unusual cancers have been reported in children and teenage patients taking TNF-blocker medicines. A rare form of fatal lymphoma has occurred mostly in teenage or young adult males with Crohn’s disease or ulcerative colitis who were taking REMICADE® and azathioprine or 6-mercaptopurine. For children and adults taking TNF blockers, including REMICADE®, the chances of getting lymphoma or other cancers may increase”. Therefore, you should discuss the benefits and risks with of taking Remicade with your physician before you use it for any treatment.
Antibiotics. Crohn’s disease patients are commonly treated with antibiotics to treat the bacterial overgrowth in the small intestine which is caused by stricture, fistulas, or prior surgeries. The most common antibiotics prescribe are ampicillin, sulfonamide, cephalosporin, tetracycline, or metronidazole. In some cases, more than one antibiotic will be used in a treatment regime.
Anti-Diarrheal and Fluid Replacements. Diarrhea and the painful cramping often associated with diarrhea can usually be relieved with anti-inflammation medications. Several antidiarrheal medications, including immodium could also be used to stop the diarrhea as wellother meds like diphenoxylate, loperamide, and codeine. Patients with diarrhea also risk being dehydrated and should immediately be treated with fluids and electrolytes.
In some patients, Crohn’s disease subsides for certain periods of time and inflame in other times. Doctors still do not understand the Crohn’s schedule but some say that living with Crohn’s disease is so stressful that the stress itself can trigger an attack. Patients often require long periods of medication, dietary restrictions and, on occasion, may require hospitalizations. However, the majority of patients who get treatment for Crohn’s disease can live a somewhat normal life and raise families, maintain employment and can live with the disease virtually unnoticed by outsiders. While doctors do not know of any foods that cause Crohn’s disease bulky grains, hot spices, alcohol, and milk products tend to increase the amount of cramping and diarrhea in patients suffering from Crohn’s disease.