OUR PRACTICE

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Anemia is a symptom of an underlying disease or disorder that is characterized by too few circulating red blood cells. This reduction in red blood cells can also lead to smaller concentrations of hemoglobin in the blood. Since oxygen is carried in the hemoglobin, the body tissues now do not receive enough oxygen and the anemic person begins to feel tired, irritable, and weak. Anemia is generally due to a sudden blood loss, destruction of red blood cells due to an underlying disorder, or insufficient production of red blood cells from bone marrow. The most commonly seen types of anemia and their treatments are:

Iron-Deficiency Anemia – Lack of iron due to blood loss (menstrual bleeding, gastrointestinal bleeding, or injury) or inadequate dietary intake. Medical treatment: Stop the bleeding, eat iron rich foods, and prescribe iron supplements.

Pernicious Anemia – Lack of intrinsic factor (a protein normally secreted in the stomach) necessary to absorb vitamin B12 through the stomach or due to the removal of the stomach. Medical treatment: Frequent injections of vitamin B12 to rebuild stores in the body; then once a month, usually for life.

Folic Acid Deficiency Anemia – Poor diet, alcoholism, and cancer can prevent the absorption of folic acid. Medical treatment: Folic acid supplements in foods and vitamins.

Hemolytic Anemia – Unusual destruction of red blood cells generally by the spleen or antibodies in the blood.
Medical treatment: Removal of the spleen, steroid medications, and blood transfusions. Examples: Sickle Cell Anemia and Thalassemia

Aplastic Anemia – Bone marrow does not produce adequate number of blood cells due to unknown causes or due to exposure to toxic substances or drugs. Medical treatment: Blood transfusions, steroid medications, and bone marrow transplants.

Symptoms may include:

  • Fatigue
  • Irritability of mood
  • General body weakness
  • Pale skin, eyelids, gums, and nail beds
  • Rapid heartbeat
  • Lack of appetite
  • Abdominal pain
  • Loss of consciousness (with severe blood loss)

What your doctor can do:

  • Diagnose anemia by asking about your symptoms, doing a physical exam, and ordering laboratory blood tests.
  • Provide treatment as above and as needed based on any underlying conditions.

What you can do:

  • Take all supplements as prescribed by your doctor.
  • Take iron supplements with orange juice because Vitamin C helps with absorption.
  • Increase fluids and fiber in the diet to avoid constipation due to iron.
  • Eat a well balanced diet.
  • DO NOT take iron with milk or milk products. (It prevents absorption.)
  • Avoid alcohol if anemia is due to folic acid deficiency.
  • DO NOT offer cow’s milk to children before their first birthday.

Contact your doctor if symptoms worsen despite receiving treatment or if you experience nausea, vomiting, diarrhea or constipation.

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Ascites is a condition in which excess fluid collects in the abdominal cavity. In most cases, this occurs as a result of advanced liver failure, but it may also be due to heart failure, kidney disease, cancer and other rare medical conditions. Ascites is not really a disease, but a symptom of one of these underlying problems.

In mild cases, there are usually no symptoms. However, as more fluid accumulates, the abdomen begins to swell and may be accompanied by loss of appetite and a feeling of fullness after eating or abdominal pain. Eventually there is marked distension (protruding) of the abdomen that can resemble the later stages of pregnancy. This may cause low back pain, changes in bowel function, weight gain and fatigue. During the day, edema (swelling) may occur in the legs and pelvis as gravity pulls fluid downward. In extreme cases the fluid may extend up into the chest cavity (pleural effusion) and cause difficulty breathing.

Q. How is Ascites treated?

A. Treatment depends on the underlying cause of the fluid accumulation. In the case of advanced liver failure or cirrhosis of the liver, there is no cure, but patients must stop all alcohol consumption as well as drugs that damage the liver, such as high doses of Tylenol.

There are several treatments that may be administered in combination to reduce the amount of accumulated fluid:

  • Restricting sodium (salt) intake
  • Diuretic therapy (“water pills”) to increase urine production and help the body excrete extra sodium and water
  • Therapeutic (“large volume”) paracentesis (using a local anesthetic to insert a needle through the abdominal wall) may be used to draw out as much fluid as possible from patients who do not respond adequately to restricted sodium and diuretic therapy.

Whatever treatment is used, patients will be closely monitored by their physician to track body weight, kidney function and levels of sodium and potassium in the blood.

Q. How is Ascites diagnosed?

A. If your physician suspects ascites, an ultrasound or CT scan can detect small amounts of accumulated fluid even before your abdomen has become distended.

Q. Does anything happen if there is fluid but I have no other symptoms?

A. You physician may perform a diagnostic abdominal paracentesis to draw out a small amount of fluid to be used in lab tests that may help find (or confirm) the source of the Ascites. Depending on the results, these tests may point to liver or heart failure, infection or cancer, bacterial infection, tuberculosis or, in rare cases, pancreatic disease. In the case of infection, lab results also are used to determine the most appropriate antibiotic to use for treatment.

Q. Are there other complications?

A. The symptoms of Ascites can be very distressing and interfere with your quality of life. The condition may also put you at risk for infection and kidney disease.

Q. Is Ascites a serious condition?

A. The accumulated fluid is not life-threatening, but it is an indicator of advanced liver disease or other serious, potentially life-threatening underlying conditions.

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What Is Barrett’s Esophagus?

If you have Barrett’s esophagus, part of the lining of the esophagus near the stomach has changed. This change is caused by the acid reflux that occurs with GERD (gastroesophageal reflux disease). The changed lining is not cancer. But it can lead to esophageal cancer later on.

When You Have GERD

GERD is stomach acid backing up into the esophagus. The esophagus is the tube that carries food and liquid from your mouth to your stomach. Acids in the stomach help break down and digest food.
Normally, the sphincter muscle keeps stomach acid from flowing back into the esophagus. When this muscle is weakened, GERD may occur.

Changes in the Lining

The stomach is protected from its own acid by a special lining. Stomach acid normally stays out of the esophagus. The esophagus does not need the acid-resistant lining. If acid backs up during GERD, it damages the esophagus. To protect itself, the esophagus may develop a more acid-resistant lining. When this happens it is called Barrett’s esophagus. The changed lining is not normal, if the lining continues to change, it may be more likely to become cancer in the future.

Preventing Further Damage

To keep track of the changes in your esophagus, your doctor may suggest regular tests. He or she may also suggest ways for you to control GERD, such as lifestyle changes, medication, or possible surgery. This should help keep your Barrett’s from getting worse.

Symptoms of GERD

  • Heartburn
  • Sour-tasting fluid backing up into your mouth
  • Frequent burping or belching
  • Symptoms that get worse after you eat, bend over, or lie down
  • Coughing repeatedly to clear your throat
  • Hoarseness

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Celiac disease is a digestive disease that damages the small intestine and interferes with absorption of nutrients from food. People who have celiac disease cannot tolerate gluten, a protein in wheat, rye, and barley. Gluten is found mainly in foods but may also be found in everyday products such as medicines, vitamins, and lip balms. When people with celiac disease eat foods or use products containing gluten, their immune system responds by damaging or destroying villi-the tiny, fingerlike protrusions lining the small intestine. Villi normally allow nutrients from food to be absorbed through the walls of the small intestine into the bloodstream. Without healthy villi, a person becomes malnourished, no matter how much food one eats.

Celiac disease is both a disease of malabsorption-meaning nutrients are not absorbed properly-and an abnormal immune reaction to gluten. Celiac disease is also known as celiac sprue, nontropical sprue, and gluten-sensitive enteropathy.

Celiac disease is genetic, meaning it runs in families. Sometimes the disease is triggered-or becomes active for the first time-after surgery, pregnancy, childbirth, viral infection, or severe emotional stress.

What are the symptoms of celiac disease?
Symptoms of celiac disease vary from person to person. Symptoms may occur in the digestive system or in other parts of the body. Digestive symptoms are more common in infants and young children and may include:

  • abdominal bloating and pain
  • chronic diarrhea
  • vomiting
  • constipation
  • pale, foul-smelling, or fatty stool
  • weight loss

Irritability is another common symptom in children. Malabsorption of nutrients during the years when nutrition is critical to a child’s normal growth and development can result in other problems such as failure to thrive in infants, delayed growth and short stature, delayed puberty, and dental enamel defects of the permanent teeth.

Adults are less likely to have digestive symptoms and may instead have one or more of the following:

  • unexplained iron-deficiency anemia
  • fatigue
  • bone or joint pain
  • arthritis
  • bone loss or osteoporosis
  • depression or anxiety
  • tingling numbness in the hands and feet
  • seizures
  • missed menstrual periods
  • infertility or recurrent miscarriage
  • canker sores inside the mouth
  • itchy skin rash called dermatitis herpetiformis

People with celiac disease may have no symptoms but can still develop complications of the disease over time. Long-term complications include malnutrition-which can lead to anemia, osteoporosis, and miscarriage, among other problems-liver diseases, and cancers of the intestine.

Why are celiac disease symptoms so varied?
Researchers are studying the reasons celiac disease affects people differently. The length of time a person was breastfed, the age a person started eating gluten-containing foods, and the amount of gluten-containing foods one eats are three factors thought to play a role in when and how celiac disease appears. Some studies have shown, for example, that the longer a person was breastfed, the later the symptoms of celiac disease appear. Symptoms also vary depending on a person’s age and the degree of damage to the small intestine. Many adults have the disease for a decade or more before they are diagnosed. The longer a person goes undiagnosed and untreated, the greater the chance of developing long-term complications.

What other health problems do people with celiac disease have?
People with celiac disease tend to have other diseases in which the immune system attacks the body’s healthy cells and tissues. The connection between celiac disease and these diseases may be genetic. They include:

  • type 1 diabetes
  • autoimmune thyroid disease
  • autoimmune liver disease
  • rheumatoid arthritis
  • Addison’s disease, a condition in which the glands that produce critical hormones are damaged
  • Sjögren’s syndrome, a condition in which the glands that produce tears and saliva are destroyed

How is celiac disease diagnosed?
Recognizing celiac disease can be dif. cult because some of its symptoms are similar to those of other diseases. Celiac disease can be confused with irritable bowel syndrome, iron-deficiency anemia caused by menstrual blood loss, inflammatory bowel disease, diverticulitis, intestinal infections, and chronic fatigue syndrome. As a result, celiac disease has long been under diagnosed or misdiagnosed. As doctors become more aware of the many varied symptoms of the disease and reliable blood tests become more available, diagnosis rates are increasing.

Blood Tests – People with celiac disease have higher than normal levels of certain autoantibodies- proteins that react against the body’s own cells or tissues-in their blood. To diagnose celiac disease, doctors will test blood for high levels of anti-tissue transglutaminase antibodies (anti-tTG) or anti-endomysium antibodies (EMA). If test results are negative but celiac disease is still suspected, additional blood tests may be needed.

Before being tested, one should continue to eat a diet that includes foods with gluten, such as breads and pastas. If a person stops eating foods with gluten before being tested, the results may be negative for celiac disease even if the disease is present.

Intestinal Biopsy – If blood tests and symptoms suggest celiac disease, a biopsy of the small intestine is performed to con.rm the diagnosis. During the biopsy, the doctor removes tiny pieces of tissue from the small intestine to check for damage to the villi. To obtain the tissue sample, the doctor eases a long, thin tube called an endoscope through the patient’s mouth and stomach into the small intestine. The doctor then takes the samples using instruments passed through the endoscope.

Screening – Screening for celiac disease means testing for the presence of autoantibodies, in the blood of people without symptoms. Americans are not routinely screened for celiac disease. However, because celiac disease is hereditary, family members of a person with the disease may wish to be tested. Four to 12 percent of an affected person’s first degree relatives will also have the disease.

Dermatitis Herpetiformis – Dermatitis Herpetiformis (DH) is an intensely itchy, blistering skin rash that affects 15 to 25 percent of people with celiac disease. The rash usually occurs on the elbows, knees, and buttocks. Most people with DH have no digestive symptoms of celiac disease.

DH is diagnosed through blood tests and a skin biopsy. If the antibody tests are positive and the skin biopsy has the typical findings of DH, patients do not need to have an intestinal biopsy. Both the skin disease and the intestinal disease respond to a gluten-free diet and recur if gluten is added back into the diet. The rash symptoms can be controlled with antibiotics such as dapsone. Because dapsone does not treat the intestinal condition, people with DH must maintain a gluten-free diet.

How is celiac disease treated?
The only treatment for celiac disease is a gluten-free diet. Doctors may ask a newly diagnosed person to work with a dietitian on a gluten-free diet plan. A dietitian is a health care professional who specializes in food and nutrition. Someone with celiac disease can learn from a dietitian how to read ingredient lists and identify foods that contain gluten in order to make informed decisions at the grocery store and when eating out.

For most people, following this diet will stop symptoms, heal existing intestinal damage, and prevent further damage. Improvement begins within days of starting the diet. The small intestine usually heals in 3 to 6 months in children but may take several years in adults. A healed intestine means a person now has villi that can absorb nutrients from food into the bloodstream.

To stay well, people with celiac disease must avoid gluten for the rest of their lives. Eating even a small amount of gluten can damage the small intestine. The damage will occur in anyone with the disease, including people without noticeable symptoms. Depending on a person’s age at diagnosis, some problems will not improve, such as short stature and dental enamel defects.

Some people with celiac disease show no improvement on the gluten-free diet. The most common reason for poor response to the diet is that small amounts of gluten are still being consumed. Hidden sources of gluten include additives such as modified food starch, preservatives, and stabilizers made with wheat. And because many corn and rice products are produced in factories that also manufacture wheat products, they can be contaminated with wheat gluten.

Rarely, the intestinal injury will continue despite a strictly gluten-free diet. People with this condition, known as refractory celiac disease, have severely damaged intestines that cannot heal. Because their intestines are not absorbing enough nutrients, they may need to receive nutrients directly into their bloodstream through a vein, or intravenously. Researchers are evaluating drug treatments for refractory celiac disease.

The Gluten-free Diet
A gluten-free diet means not eating foods that contain wheat, rye, and barley. The foods and products made from these grains should also be avoided. In other words, a person with celiac disease should not eat most grain, pasta, cereal, and many processed foods.

Despite these restrictions, people with celiac disease can eat a well-balanced diet with a variety of foods. They can use potato, rice, soy, amaranth, quinoa, buckwheat, or bean flour instead of wheat flour. They can buy glutenfree bread, pasta, and other products from stores that carry organic foods, or order products from special food companies. Gluten-free products are increasingly available from mainstream stores.

“Plain” meat, fish, rice, fruits, and vegetables do not contain gluten, so people with celiac disease can freely eat these foods. In the past, people with celiac disease were advised not to eat oats. New evidence suggests that most people can safely eat small amounts of oats, as long as the oats are not contaminated with wheat gluten during processing. People with celiac disease should work closely with their health care team when deciding whether to include oats in their diet.

The gluten-free diet requires a completely new approach to eating. Newly diagnosed people and their families may find support groups helpful as they learn to adjust to a new way of life. People with celiac disease must be cautious about what they buy for lunch at school or work, what they purchase at the grocery store, what they eat at restaurants or parties, and what they grab for a snack. Eating out can be a challenge. When in doubt about a menu item, a person with celiac disease should ask the waiter or chef about ingredients and preparation or if a gluten-free menu is available.

Gluten is also used in some medications. People with celiac disease should ask a pharmacist if prescribed medications contain wheat. Because gluten is sometimes used as an additive in unexpected products-such as lipstick and play dough-reading product labels is important. If the ingredients are not listed on the label, the manufacturer should provide a list upon request. With practice, screening for gluten becomes second nature.

New Food Labeling
The Food Allergen Labeling and Consumer Protection Act (FALCPA), which took effect on January 1, 2006, requires food labels to clearly identify wheat and other common food allergens in the list of ingredients. FALCPA also requires the U.S. Food and Drug Administration to develop and finalize rules for the use of the term “gluten free” on product labels.

The Gluten-free Diet: Some Examples
In 2006, the American Dietetic Association updated its recommendations for a gluten-free diet. This list is not complete, so people with celiac disease should discuss gluten-free food choices with a dietitian or physician who specializes in celiac disease. People with celiac disease should always read food ingredient lists carefully to make sure the food does not contain gluten.
Allowed Foods
Amaranth, legumes, seeds, arrowroot, millet, sorghum, buckwheat, nuts, soy, cassava, potatoes, tapioca, corn, quinoa, teff, flax, rice, wild rice, Indian rice, grass, sago, yucca, Job’s tears
Foods to Avoid
wheat • including einkorn, emmer, spelt, kamut • wheat starch, wheat bran, wheat germ, cracked wheat, hydrolyzed wheat protein, barley, rye, triticale (a cross between wheat and rye)
Other Wheat Products
bromated flour, graham flour, self-rising flour, durum flour, phosphated flour, semolina enriched flour, plain flour, white flour farina
Processed Foods that May Contain Wheat, Barley, or Rye*
bouillon cubes, brown rice, syrup, candy, chips/potato chips, cold cuts, hot dogs, salami, sausage, communion wafers, french fries, gravy, imitation fish, matzo, rice mixes, sauces, seasoned tortilla chips, self-basting turkey, soups, soy sauce, vegetables in sauce

*Most of these foods can be found gluten-free. When in doubt, check with the food manufacturer. Source: Thompson T. Celiac Disease Nutrition Guide, 2nd ed. Chicago: American Dietetic Association; 2006. © American Dietetic Association. Adapted with permission. For a complete copy of the Celiac Disease Nutrition Guide, please visit www.eatright.org.

Points to Remember

  • People with celiac disease cannot tolerate gluten, a protein in wheat, rye, and barley.
  • Untreated celiac disease damages the small intestine and interferes with nutrient absorption.
  • Without treatment, people with celiac disease can develop complications such as osteoporosis, anemia, and cancer.
  • A person with celiac disease may or may not have symptoms.
  • Diagnosis involves blood tests and, in most cases, a biopsy of the small intestine.
  • Since celiac disease is hereditary, family members of a person with celiac disease may wish to be tested.
  • Celiac disease is treated by eliminating all gluten from the diet. The gluten-free diet is a lifetime requirement.
  • A dietitian can teach a person with celiac disease about food selection, label reading, and other strategies to help manage the disease.

Hope through Research
The National Institute of Diabetes and Digestive and Kidney Diseases conduct and support research on celiac disease. Researchers are studying new options for diagnosing celiac disease, including capsule endoscopy. In this technique, patients swallow a capsule containing a tiny video camera that records images of the small intestine. Several drug treatments for celiac disease are under evaluation. Researchers are also studying a combination of enzymes-proteins that aid chemical reactions in the body-that detoxify gluten before it enters the small intestine. Scientists are also developing educational materials for standardized medical training to raise awareness among health care providers. The hope is that increased understanding and awareness will lead to earlier diagnosis and treatment of celiac disease.

Participants in clinical trials can play a more active role in their own health care, gain access to new research treatments before they are widely available, and help others by contributing to medical research. For information about current studies, visit www.ClinicalTrials.gov.

For More Information:
American Celiac Disease Alliance 2504 Duxbury Place Alexandria, VA 22308
Phone: 703-622-3331 Email: info@americanceliac.org Internet: www.americanceliac.org

Celiac Disease Foundation 13251 Ventura Boulevard, #1 Studio City, CA 91604
Phone: 818-990-2354 Fax: 818-990-2379 Email: cdf@celiac.org Internet: www.celiac.org

Gluten Intolerance Group of North America 31214 124th Avenue SE Auburn, WA 98092-3667
Phone: 253-833-6655 Fax: 253-833-6675 Email: info@gluten.net Internet: www.gluten.net

National Foundation for Celiac Awareness P.O. Box 544 Ambler, PA 19002-0544
Phone: 215-325-1306 Email: info@celiaccentral.org Internet: www.celiaccentral.org

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There are several different types of Colitis, all of which are characterized by an inflammation of the large intestine (the large intestine is also known as the colon). Each type can include abdominal pain, diarrhea, dehydration, abdominal bloating, increased intestinal gas and bloody stools. Colitis is one of two types of illness that constitute irritable bowel disease. The other is Crohn’s disease.

The disease can be identified by a flexible sigmoidoscopy or a colonscopy, both of which involve the insertion of a flexible tube into the colon, allowing the physician to visually examine specific areas of the colon and collect samples of tissue. Barium enemas, CT scans, MRIs and X-rays of the abdomen are also commonly employed in the evaluation process.

Q. What causes Colitis?
A. The specific source of inflammation depends on the type of colitis diagnosed. Depending on the form of the disease, inflammation can be caused by acute and chronic infections, primary inflammatory disorders (ulcerative colitis, Crohn’s colitis, lymphocytic and collagenous colitis), lack of blood flow (ischemic colitis), or a history of radiation to the large bowel.

Q. How many different types of Colitis are there?
A. There are several types of Colitis; a few common types are mentioned below:

  • Clostridium difficile or pseudomembranous colitis
  • Crohn’s disease (affects any part of the gastrointestinal tract)
  • Ulcerative colitis (affects only the colon, also known as the large intestine)
  • Ischemic colitis (lack of sufficient blood supply to the colon)
  • Infectious enterocolitis
  • CMV colitis (a viral infection of the colon)

Q. How is Colitis treated?
A. Treatment depends on the underlying cause of the disease, which can be infection, inflammation, or a lack of blood flow, among others. There are no “cures,” but there are several medications used to heal the affected areas of the colon and relieve symptoms. Surgery may be an option when medical therapy does not produce satisfactory results

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A colon polyp is a benign (non-cancerous) growth, shaped like a grape on a stalk, projecting from the lining of the intestine or rectum. Polyps can occur alone or in groups. Risk factors include a positive family history of intestinal polyps and increasing age. The larger the polyp, (greater than 1/2 inch), the greater the chance of malignancy (cancer).

Symptoms may include:

  • Often, there are no symptoms
  • Painless rectal bleeding
  • Mucous discharge from the rectum
  • Cramping, abdominal pain, or spasms of the bowel
  • Fatigue

What your doctor can do:
Diagnose the problem by asking about your symptoms, taking a medical history, and performing a physical exam.

Diagnostic tests:

  • Laboratory blood studies – Primarily a blood count to detect for anemia (low blood count)
  • Stool guaiac – Testing the stool for blood
  • Sigmoidoscopy – A flexible tube-like scope to examine the rectum and lower part of the colon
  • Colonoscopy – A flexible tube-like scope to examine the entire colon
  • Biopsy – Removal and study of a small amount of tissue
  • Barium enema – Placing barium in the rectum so an X-ray will show the colon

Treatment includes:
Polypectomy – Surgical removal of the polyps with a colonoscope, especially with larger polyps (greater than ½ inch in diameter) If there are multiple polyps, a portion of the large intestine may be removed.

What you can do:
There is no known preventative measure. However, a diet low in fat and high in fiber is associated with lower risk and incidence. If you are at high risk, see your doctor for regular stool and blood tests.

What you can expect:
Generally, there are no complications with polyps smaller than 1/2 inch in diameter. Your doctor may recommend a sigmoidoscopy or colonoscopy every 3-5 years. Recurrence of polyps – Especially polyps greater than 1/2 inch in diameter, have been associated with cancer.

Contact your doctor if you have rectal bleeding or mucous discharge from your rectum.

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Constipation refers to changes in stool frequency, size, consistency, and ease of passage which results in an overall decrease in the amount of stool. Common causes include insufficient fiber and liquid in the diet, decreased activity level, rectal disorders (e.g., painful hemorrhoids, or tears in the anal tissue) that may cause pain with bowel movements, loss of nerve supply to the colon or rectum, rectal or colon tumors; and medical tests that require the use of barium. Occasional constipation may accompany any change in routine, such as when traveling. Risk increases with decreased activity for any reason (e.g., surgery, long illness), decreased fluid or fiber in the diet, chronic or long-term use of laxatives, certain disorders with accompanying nerve damage, and the use of some drugs including certain prescription pain medications, blood pressure medications called calcium channel blockers, tricyclic antidepressants, and drugs to treat Parkinson’s disease.

Symptoms may include:

  • An inability or difficulty in normal passage of stool
  • Abdominal discomfort, pain or cramps
  • Bloating or a sense of fullness in the rectum and lower abdomen.

What your doctor can do:

  • Diagnose the problem by asking about your symptoms, doing a physical exam, possibly ordering laboratory blood tests and x-rays.
  • Treat any underlying problem.
  • For constipation with no underlying disease, treatment includes increasing fluids, especially water, to at least 8 glasses a day and increasing daily intake of dietary fiber.

What you can do:
For both treatment and prevention of constipation:

  • Increase your fluid intake, especially of water, to at least 8 glasses daily.
  • Increase your fiber intake to include whole grain cereals and breads; fresh, unpeeled fruits and vegetables; and beans and peas.
  • Avoid foods that tend to increase constipation including cheese and other dairy products.
  • Schedule regular daily bowel movements, preferably shortly after a meal. Even if you do not have an urge for a BM, sit no less than 10 minutes at your scheduled time. The bowels tend to respond to routine.
  • Keep as active as you can; regular exercise improves bowel function.
  • A stool softener may be used for simple constipation.
  • Avoid the use of laxatives unless prescribed by your doctor. Laxatives can be habit-forming; causing dependence that can make constipation worse in the long run.

What you can expect:

  • Constipation can become a chronic problem if the underlying cause is not removed.
  • Possible complications include fecal impaction (a hard, immovable mass of stool that can cause obstruction of the intestine); intestinal rupture, fatal rupture of the heart muscle while straining to have a bowel movement in a person who has had a recent heart attack, rectal prolapse (protrusion outside the body of the rectum), and aggravation of hemorrhoids.

Contact your doctor if your normal bowel pattern changes, if constipation occurs while under treatment for other conditions, or if symptoms of fecal impaction occur. If you are over 40 and develop unexplained constipation, blood in your stool (stools that look very dark), ribbon-like stools, or unexplained weight loss, contact your physician for an evaluation of the colon to check for polyps or a tumor.

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Crohn’s disease is an inflammation (swelling, irritation) and ulceration (sores that do not easily heal) of the deep lining of the intestine. It usually affects the ileum (the lowest section of the small intestine) but may affect any part of the digestive tract. It can prevent water and nutrients from being properly absorbed into the bloodstream, and lead to bleeding and other problems. The cause is not known but there are several theories. Risk increases if another family member also has it, but this is not always the case. It may also be related to changes in the immune system (the body’s defense system) and diet. Furthermore, stress can also aggravate Crohn’s disease although it does not appear to cause it. It is most common in adolescents, young adults, and adults over 60.

Symptoms may include:

  • Diarrhea
  • Abdominal cramping and pain
  • Bleeding from the rectum and bloody stools (dark-colored, “tarry”, or with bright red blood)
  • Weight loss, loss of appetite, nausea, and vomiting
  • Fatigue and a fever
  • Signs of dehydration (lethargy, sunken eyes, decreased urination, rapid weight loss or dry skin)

What your doctor can do:

  • Diagnose the disease by asking about your symptoms and medical history, performing a physical exam and ordering laboratory blood and stool tests.
  • Perform special X-rays or an endoscopy (use a long, thin, flexible tube with a light and optics to view and take tissue samples from the intestinal lining).
  • Prescribe medications to decrease the inflammation and reduce the diarrhea.
  • Perform a nutritional assessment and prescribe a special diet to help relieve your symptoms and to help you get the nutrition you need.
  • Refer you to a registered dietician for nutritional counseling.
  • Treat complications such as bleeding and infection.
  • Recommend hospitalization when symptoms are severe. It may be necessary to let the digestive tract rest and have an intravenous (IV) line to provide fluids and nutrition.
  • Recommend surgery if the disease is severe or to treat complications.

What you can do:

  • Work closely with your doctor to determine the treatments that are best for you.
  • Take the medicines prescribed by your doctor. Let your doctor know if you are having uncomfortable side effects. Do not stop your medicines without talking to your doctor first.
  • Different foods and diets are best for different people with Crohn’s disease. Foods you may need to avoid include caffeine (coffee, tea, and colas), spicy foods, milk products, and raw fruits and vegetables. Talk to your doctor about which diet best works for you.
  • Try eating several small meals a day instead of three large ones.
  • Keep appointments for regular check-ups even if you are not having symptoms.
  • Contact the Crohn’s and Colitis Foundation toll-free 1-800-932-2423 for more information.

What you can expect:

  • Crohn’s disease is a chronic disease with remissions (times when there are no symptoms) and relapses (times when the symptoms flare up again).
  • Treatment can delay or control symptoms, but there is no cure.
  • Complications may include severe blood loss, malnutrition, or obstruction of the bowel.

Contact your doctor if your symptoms worsen, you develop fever and chills, or if you have side effects from the treatment.

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Diarrhea is an excessive amount of fluid in the stool. It is a common problem and is usually not serious. Some of the most common causes are viruses, bacterial infection, food allergies, food poisoning, different medicines, artificial sweeteners and alcohol abuse. It is also associated with Crohn’s disease and ulcerative colitis.

Q. Should I call a doctor if I have Diarrhea?
A. Medical advice is recommended if it lasts more than two or three weeks. You should also contact a physician if you experience a change in bowel habits after taking a new drug. If you also have severe cramping, fever that lasts more than 24 hours or if you are vomiting and becoming dehydrated you should see a doctor.

Q. What is the best treatment for Diarrhea?
A. There are simple things you can do when diarrhea first occurs that may reduce the symptoms. Taking only
liquids by mouth and avoiding solid food and milk may be helpful. You can also try over-the-counter treatments like Pepto-Bismol®, Kaopectate® or Imodium®.

Q. What if my Diarrhea doesn’t go away after a few days?
A. Your physician may recommend obtaining blood and stool samples or X-rays and ultrasound. In some cases, a sigmoidoscopy or colonoscopy is required to visually inspect the colon with a lighted, flexible tube. However, most cases do resolve themselves within several days.

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Diverticulosis is the presence of abnormal small pouches (diverticula) on weak areas of the intestinal wall. There are usually no symptoms. Diverticulitis is the inflammation (swelling, tenderness, irritation) of these pouches. The diverticula may be present in any part of the intestine but most occur in the sigmoid colon, the lowest section of the large intestine before the rectum. Diverticulosis is common in adults >40, if there is a family history, or if the person follows a low-fiber diet. Constipation may be a contributing factor.

Symptoms of Diverticulitis may include:

  • Abdominal pain and tenderness, especially in the lower left side
  • Diarrhea or constipation
  • Bleeding from the rectum
  • Fever and chills

What your doctor can do:

  • Diagnose the disease by asking about your symptoms and medical history, performing a physical exam and ordering laboratory tests.
  • Perform special X-rays or a colonoscopy (use a long, thin, flexible tube with a light and optics to view and take tissue samples from the colon).

Treatment will depend on the severity of the disease and may include:

  • For mild cases, a stool softener and liquid diet.
  • For more severe cases, it may be necessary to let the colon rest and have an intravenous (IV) line to provide fluids and nutrition for several days to several weeks.
  • Prescription medications including antispasmodics, anti-inflammatory meds, and antibiotics
    Surgery may be recommended if the disease is severe, recurrent or to treat complications
  • A high-fiber diet is recommended to prevent recurrence. A bulk laxative, such as Metamucil®, may also be ordered.

What you can do:

  • Take the medicines prescribed by your doctor. Let your doctor know if you are having uncomfortable side effects. Do not stop your medicines without talking to your doctor first.
  • Increase fluids (especially water) in your diet to at least 8 glasses a day
  • Increase the bulk in your diet with high fiber foods. This includes whole grain breads and cereals, beans and peas, and fresh, raw fruits and vegetables. To prevent abdominal bloating and gas, increase fiber slowly rather than all at once.
  • Avoid laxatives other than what your doctor recommends.

It used to be recommended that patients with diverticulosis avoid nuts. It was believed nuts might block the diverticul (pouch) and cause infection. This theory has since been discredited and avoidance of nuts is no longer necessary.

What you can expect:

  • Most cases are mild and respond to treatment.
  • The chance of recurrence is less if a high-fiber diet is followed.
  • Possible complications include a tear in the wall of the intestine (perforation) or development of a fistula (a tube-like passageway). Either situation may cause severe infection or bleeding.

Contact your doctor if symptoms worsen despite treatment or return after treatment, if new symptoms develop, or if you develop fever or severe rectal bleeding.

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Cancer is often discussed as if it is one disease but there are actually over 100 different diseases referred to as
cancer. All of these diseases do have one thing in common, however: the uncontrolled growth of abnormal cells and the spread of those cells. This is the definition of cancer. This uncontrolled growth can begin in many different parts of the body and behaves differently depending on where it starts. Cancer that spreads to another part of the body, still looks like and acts like the original cancer. As an example, if breast cancer spreads to the lungs, it is still breast cancer; it is not lung cancer.

Cancer of the esophagus (the tube connecting the mouth to the stomach) is relatively rare in the United States though it is more common elsewhere. Of cancers that begin in the esophagus (primary), about half are found in the middle section. Cancers found in the lower esophagus (where it passes through the chest) are almost always from stomach tissue that has traveled to the esophagus. Cancers of the upper esophagus are the most difficult to treat. Esophageal cancer occurs most often in males age 50 and over, but also occurs in females and in younger males. The cause is often unknown. It is not inherited. Risk increases with any activity that damages the lining of the esophagus. This includes smoking, excess alcohol consumption, hiatal hernia, strictures of the esophagus, and chronic gastric reflux. Iron deficiency and a history of other head and neck cancers also increase the risk. This cancer can spread rapidly to other organs. Early diagnosis is critical.

Symptoms may include:

  • Swallowing difficulty or pain
  • Rapid weight loss
  • Chest, back or neck pain or spitting up bloody mucus
  • Difficulty in swallowing is often the only symptom, and should always be checked promptly by your doctor

What your doctor can do:

  • Diagnose cancer of the esophagus by use of an endoscope (a long, thin, flexible tube with a light and optics is used to view and take tissue samples inside the body) and biopsy (removal and study of some tissue) of the tumor.
  • Order X-rays or CT scans in some cases.

Treatment usually includes:

  • Radiation, chemotherapy, or both for the purpose of shrinking the tumor. By shrinking the tumor you will be able to eat and gain strength for possible surgical removal of the tumor. Additional nutritional support may also be needed. This can be done either intravenously (IV, through the bloodstream) or by a feeding tube placed in the stomach.
  • Surgery can be most effective with cancer of the lower esophagus. In this case, the lower portion of esophagus may be removed and the stomach pulled up and connected to the remaining esophagus.
  • Pain medications can be prescribed. Tranquilizers to reduce anxiety are sometimes ordered.
  • Anticholinergic or calcium-channel blocker medications may be helpful in relieving muscle spasms of the esophagus.

What you can do:

  • Soft to liquid food is recommended.
  • Chocolate, alcohol and fats should be avoided.
  • You may meet with a registered dietician to discuss diet in detail.

What you can expect:

  • If treatment does not begin immediately, esophageal cancer can spread rapidly to the lungs and liver.
  • Cancer in the upper esophagus is very difficult, and sometimes impossible, to remove.
  • In some cases, treatment will be focused on pain relief and relief of symptoms only.
  • Scientific research into causes and treatment continues, so there is hope for increasingly effective treatment and cure

 

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Fatty liver is just what its name suggests: the build-up of excess fat in the liver cells. It is normal for your liver to contain some fat. But if fat accounts for more than 5-10% of your liver’s weight, then you have fatty liver and you may develop more serious complications.

What causes fatty liver?

A. Eating excess calories causes fat to build up in the liver. When the liver does not process and break down fats as it normally should, too much fat will accumulate. People tend to develop fatty liver if they have certain other conditions, such as obesity, diabetes, or high triglycerides. Most (but not all) fatty liver patients are middle-aged and overweight. Alcohol abuse, rapid weight loss and malnutrition may also lead to fatty liver. However, some people develop fatty liver even if they have none of these conditions – so everyone should know about it.

What are the consequences of fatty liver?

A. Fatty liver may cause no damage, but sometimes the excess fat leads to inflammation of the liver. This condition, called steatohepatitis, does cause liver damage. Sometimes, inflammation from a fatty liver is linked to alcohol abuse; this is known as alcoholic steatohepatitis. Otherwise the condition is called nonalcoholic steatohepatitis, or NASH. An inflamed liver may become scarred and hardened over time. This condition, called cirrhosis, is serious and often leads to liver failure. NASH is one of the top three leading causes of cirrhosis.

What are the symptoms of fatty liver?

A. Fatty liver produces no symptoms on its own, so people often learn about their fatty liver when they have medical tests for other reasons. NASH can damage your liver for years or even decades without causing any symptoms. If the disease gets worse, you may experience fatigue, weight loss, weakness and confusion.

How is fatty liver diagnosed?

A. Your doctor may see something unusual in your blood test or notice that your liver is slightly enlarged during a routine checkup. These could be signs of a fatty liver. To make sure you don’t have another liver disease, your doctor may ask for more blood tests, an ultrasound, a CT scan or an MRI. If other diseases are ruled out, you may be diagnosed with NASH. The only way to know for sure is to get a liver biopsy. During a liver biopsy the radiologist removes a sample of liver tissue with a needle and sends it to a pathologist to look at under a microscope. Liver biopsies are only recommended for patients suspected of having severe fatty liver or to rule out other diseases.

How is fatty liver disease treated?

A. There are no medical or surgical treatments for fatty liver. If you have fatty liver, and in particular if you have NASH, you should:

  • Lose weight
  • Lower your triglycerides through diet, medication or both
  • Avoid alcohol
  • Control your diabetes, if you have it
  • Eat a balanced, healthy diet
  • Increase your physical activity

What potential new treatments are being studied?

A. If you have fatty liver, you should know that scientists are studying whether various medications can help reduce the inflammation on your liver, including new diabetes medications that may help you even if you don’t have diabetes.

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Chronic gastritis is an inflammation (swelling, irritation, redness, or warmth) of the stomach lining that occurs gradually over time. There are many possible causes including bacterial infection (especially Helicobacter pylori); irritation from aspirin, non-steroidal anti-inflammatory medications, cigarette smoke, alcohol, and other drugs or environmental substances; reflux of bile or pancreatic secretions into the stomach from the upper portion of the small intestine (duodenum). The latter occurs most frequently following surgery or with peptic ulcer disease. It may also occur with certain disease states including pernicious anemia and diabetes. Chronic gastritis is seen most often in the elderly but may occur at any age.

Symptoms may include:

Often there are no symptoms associated with chronic gastritis:

  • Burning or gnawing sensation in the upper part of the stomach, stomach cramps or indigestion that may worsen especially after eating
  • Nausea, vomiting, and diarrhea
  • Burping and acid taste in the mouth
  • Black stools due to bleeding
  • Decreased appetite

What your doctor can do:

  • Diagnose chronic gastritis by asking about your symptoms, doing a physical exam, and ordering laboratory blood tests, x-rays and gastroscopy (using a long, thin, flexible tube with a light and optics to view and take tissue samples of the stomach lining )
  • Order a laboratory antibody test to check for Helicobacter pylori (H. pylori)
  • Order X-rays in which you are asked to drink a substance that makes it easier to see the digestive system (barium swallow)
  • Further tests may be ordered if the underlying problem is not identified

Treatment will depend on the underlying cause and the severity of symptoms:

  • Antibiotics to treat bacterial infections (H. pylori)
  • Antacids to neutralize gastric acids
  • Vitamin B-12 injections to correct pernicious anemia
  • Surgery if symptoms are severe and dietary changes

What you can do:

  • Avoid aspirin and non-steroidal anti-inflammatory medications (e.g. ibuprofen, naprosyn). Your doctor may identify and discontinue any other medications that may cause irritation.
  • Limit alcoholic beverages, caffeine (coffee, some teas, colas) and spicy foods.
  • Stop smoking. Ask your doctor if you need help.
  • Eat small frequent meals to help reduce symptoms

What you can expect:

  • Treatment combined with good self-care and lifestyle changes is generally effective.
  • Possible complications include bleeding (severe) and an increased risk of gastric cancer.

Contact your doctor if symptoms do not improve with treatment, symptoms worsen, or recur.

Seek immediate medical assistance if you start vomiting blood or material that looks like coffee grounds, if your stools are black, tarry, foul-smelling or contain blood!

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Gastroesophageal reflux disease, or heartburn, refers to the backward flow of acid-containing stomach contents into the bottom part of the esophagus, the tube that carries food from the mouth to the stomach. About 1 out of every 3 Americans suffers from heartburn at least occasionally. The small muscle (sphincter), located where the esophagus meets the stomach, normally stays contracted (closed) except when food is swallowed. It then relaxes and allows the food to pass into the stomach. If the sphincter relaxes at other times, stomach contents, including stomach acids, move into the esophagus. Some common triggers of this sphincter relaxation are increased pressure on the abdomen, certain food products including caffeine, chocolate, fatty foods, and peppermint; alcohol; birth control pills and some other medications; and smoking. Constrictive clothing, especially at the waist; overeating, pregnancy, or obesity may also cause increased pressure on the abdomen.

Symptoms may include:
Symptoms often occur right after a meal and are often worse when you lie down, bend over, or exercise

  • A dull ache or burning discomfort in the chest
  • A burning feeling in the upper abdomen and throat
  • An unpleasant taste in the mouth
  • Painful swallowing

What your doctor can do:

  • If self-treatment as below is not effective or heartburn is severe, medication may be prescribed to help
    decrease stomach acid or to prevent sphincter relaxation.

What you can do:

  • Avoid those foods or medications that make heartburn worse.
  • Talk with your doctor about alternatives to any prescription medicines that may be causing a problem.
  • Try to eat several small meals a day rather than a large meal all at once
  • Avoid eating anything within 2 hours of bedtime.
  • Stop smoking, avoid alcohol, and lose weight if necessary.
  • If heartburn is very severe, you can elevate the head 3 to 4 inches of your bed to prevent stomach acid from flowing backward when lying down.
  • Antacids, taken as directed, can help neutralize stomach acid.

What you can expect:

  • Heartburn that continues for a long time can cause damage to the esophagus and pain with swallowing.
  • There have been cases of serious damage to the esophagus which required surgery, but this is not very
    common.

Contact your doctor, if the heartburn persists despite having treatment, if you vomit blood, or if your pain
worsens.

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Heliobacter pylori (H. pylori), an intestinal bacterium, causes the majority of ulcers in the stomach and duodenum (first part of the small intestine). Normally the high acid concentration in the digestive tract prevents bacteria from surviving in this environment. H. pylori, however, lives in the digestive tract lining where it is protected from the body’s defense system. The inflammation (swelling, pain, redness, and warmth) of the tissues caused by H. pylori then contributes to the breakdown of the lining. This breakdown eventually produces an ulcer. Researchers believe that the bacteria are most likely transmitted orally by contact with food or water sources that are contaminated with feces. Risk increases with a family history of ulcers; exposure to contaminated sources; poor sanitation; and crowded living conditions.

Symptoms may include:

  • Sometimes none
  • Abdominal pain, a burning sensation in stomach, heartburn and increased burping
  • Pain that is often mistaken for heartburn, indigestion, or hunger
  • Pain immediately or hours after eating; intermittent; or wakes person from sleep
  • Poor appetite, nausea, vomiting and weight loss
  • Pain relief after eating, drinking milk or taking antacids.
  • Internal bleeding, blood in the stools (black, tarry-looking), vomiting blood, and chest pain

What your doctor can do:

  • Diagnose the disease by asking about your symptoms, doing a physical exam, and ordering laboratory blood tests, stool cultures and an endoscopy (using a long, thin, flexible tube with a light and optics to view and take tissue samples of the digestive tract lining)
  • Order additional tests like a breath test and x-rays with radioactive isotopes (radioactive substances that may be taken orally or injected into the blood stream.) to detect H. Pylori.
  • Prescribe antibiotics with bismuth (Pepto Bismol®) to cure the H. Pylori infection and various other anti-ulcer medicines like Antacids (neutralize excess acid), Histamine Antagonists (decrease acid production), and Protective Agents (cover the ulcer site to allow healing).

What you can do:

  • Finish all the antibiotics and take the ulcer medicines as directed by your doctor even if you start feeling better. Remember that ulcers can recur in the future without proper treatment.
  • Practice good hand washing especially after using the bathroom and prior to handling food.
  • Stop smoking and avoid caffeine (e.g., coffee, colas, caffeinated teas) and alcohol.
  • Eat small, frequent meals instead of 3 large or heavy meals.
  • Do not use aspirin or non-steroidal anti-inflammatory medicines. Use acetaminophen (Tylenol®) for fever symptoms or minor discomfort.
  • Contact the Centers for Disease Control and Prevention at 1-888-MY-ULCER (1-888-698-5237) for more information.

What you can expect:

  • Most people recover within a 2-3 weeks after starting antibiotic therapy.
  • Some medicines may cause side effects like nausea; diarrhea; or a black tongue and stools.
  • Possible complications may include a tear in the lining, peritonitis, excessive bleeding, an obstruction in the small intestine, chronic ulcers, and even stomach cancer.

Contact your doctor if you develop symptoms of an ulcer, if you suffer symptoms of an infection (fever, increased pain), or if you start to vomit blood or notice blood in your stool.

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Hemorrhoids are dilated veins of the rectum or anus. They can cause bleeding. They can be painful and cause problems when passing stool. External hemorrhoids are present at the anal opening and internal hemorrhoids are inside the anus near the opening of the anal canal. They are caused by increased pressure in the anal and rectal veins. You are more likely to develop hemorrhoids with a sedentary life style, routinely sitting or standing for prolonged periods of time, obesity, pregnancy, previous rectal surgery, anal intercourse, colon cancer, or frequent constipation and straining. A diet low in fiber may make the stool more difficult to pass thus increasing the incidence of hemorrhoids.

Symptoms may include:

  • Rectal bleeding or blood in stools
  • Pain during bowel movements
  • Itching around the anus
  • Inflammation and swelling around the anus
  • A feeling that the rectum is not empty after a bowel movement

What your doctor can do:

  • Diagnose hemorrhoids with a physical exam.
  • Possibly order an endoscopy (exam of the rectum and lower colon with a fiber optic, flexible scope).
  • Treat hemorrhoids that do not respond to home treatment with any of several procedures. These include ligation (tying off of the hemorrhoid), hemorrhoidectomy (removal requiring surgery), and cryosurgery (freezing the hemorrhoid with liquid nitrogen).

What you can do:

  • Eat a high fiber diet and increase your intake of fluid, especially water, to decrease constipation
  • Lose weight if you are overweight
  • Avoid other risk factors listed above when possible
  • Take sitz baths several times a day for 10-15 minutes at a time
  • Apply ice packs to the anal area
  • Use corticosteroid creams to reduce pain and swelling

What you can expect:

  • You may have hemorrhoids for many years with no symptoms or very infrequent symptoms that are easily treated at home.
  • Medical treatment is sometimes necessary.
  • Possible complications of hemorrhoids include anemia from prolonged loss of blood; pain and discomfort, especially with bowel movements; and complications of surgery.

Contact your doctor if your hemorrhoids do not improve with treatment.

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Hepatitis A is a viral infection affecting the liver. There are several types of hepatitis viruses, type A (HAV) generally causing the least serious liver infection. The virus is spread by inadequate hygiene, in contaminated food or water, or by infected food handlers. It is commonly spread in day care settings with young children, as hand washing may not be consistent. It may be spread through sexual contact. The disease is contagious before any symptoms develop, which may take 2-3 weeks.

Symptoms may include:

  • Low grade fever
  • Nausea with or without vomiting
  • Diarrhea
  • Abdominal pain
  • Decreased appetite
  • Fatigue
  • Dark-colored urine and light-colored stools.
  • Jaundice (yellowing of the eyes or skin).

What your doctor can do:

  • Diagnose hepatitis A by asking about your symptoms, doing a physical exam and ordering laboratory blood tests.
  • Treatment is directed at relieving symptoms and limiting spread of the disease.
  • Give an injection with gamma globulin for those in close contact with you. This can help prevent the disease.

What you can do:

  • Rest as much as possible.
  • Maintain a bland diet and drink plenty of liquids.
  • Avoid alcohol since it can further inflame and irritate the liver.
  • To prevent the spread of disease to others, do not share eating utensils.
  • Avoid handling or preparing food for others if possible.
  • Everyone in the family should wash their hands frequently, especially those who handle food.
  • For more information contact the Hepatitis Foundation International @ 1-800-891-0707.

What you can expect:

  • The illness generally lasts a few weeks with the liver returning to normal by 2 months

Contact your doctor if you have symptoms of dehydration from vomiting or diarrhea, and if you are unable to drink fluids for longer than one day.

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Hepatitis B is a viral infection of the liver. There are several types of hepatitis virus, type B (HBV) causing some of the most serious infections. The virus is spread through contact with blood and body fluids, usually by sexual activity or intravenous drug use. An infected mother can also spread it to her baby during pregnancy. Your risk of contracting the disease is increased if you use drugs, receive kidney dialysis, are a health care worker exposed to blood and body fluids, or if you have sexual relations with any high-risk persons. It is contagious before any symptoms appear, which may take from 1 to 6 months.

Symptoms may include:

  • Low grade fever and fatigue
  • Nausea with or without vomiting
  • Diarrhea
  • Decreased appetite
  • Abdominal pain
  • Joint pain
  • Jaundice (yellowing of the eyes or skin)
  • Dark urine and light-colored stools

What your doctor can do:

  • Diagnose hepatitis B by asking about your symptoms, doing a physical exam, and ordering laboratory blood tests.
  • Prescribe an injection with gamma globulin for those in close contact with you.
  • This disease must be reported to local health department authorities.

What you can do:

  • Rest as much as possible.
  • Eat a bland diet and drink plenty of fluids.
  • Avoid alcohol and acetaminophen (Tylenol®) since these can further inflame and irritate the liver.
  • Avoid sexual activity or use condoms consistently to prevent spreading it to others.
  • Avoid sharing eating utensils with others.
  • Everyone in the family should wash their hands frequently.
  • All sexual partners should be tested, even if they are without symptoms.
  • For more information contact the Hepatitis Foundation @ 1-800-891-0707.

What you can expect:

  • The initial infection usually lasts 2-3 weeks, with full recovery of the liver in about 4 months.
  • While most people recover fully, hepatitis B causes death in about 1% of cases.
  • Some people do not have any symptoms until years after infection, when complications develop.
  • Hepatitis B may become a chronic illness, causing symptoms for years, and some people may be chronic carriers, free of illness but able to spread the virus.

Contact your doctor if your symptoms remain after 2-3 weeks or if you are at high risk for hepatitis B and have not been immunized.

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Hepatitis C is a viral infection of the liver. There are several types of viral hepatitis, type C (HCV) causing a serious, chronic liver infection. The hepatitis C virus is transmitted in blood and body, usually by blood transfusions, sexual contact, or intravenous drug use. An infected mother can also spread it to her baby during pregnancy. Your risk of contracting the disease is increased if you use drugs, if you received blood or blood products prior to 1992, if you receive kidney dialysis, if you are a health care worker exposed to blood and body fluids, or if you have sexual relations with any high-risk persons.

Symptoms may include:

  • Usually none
  • Fatigue
  • Decreased appetite
  • Jaundice (yellowing of the eyes or skin)

What your doctor can do:

  • Diagnose hepatitis C by asking about your symptoms, doing a physical exam and laboratory blood tests.
  • Occasionally, a liver biopsy (taking a tissue sample for closer study) may be necessary for diagnosis.
  • Treat a chronic infection with regular injections of alpha-interferon

What you can do:
To prevent Hepatitis C:

  • Avoid sharing needles; avoid needle use in any situation where the needle may not be sterile. This includes ear and body piercing and tattooing, as well as IV drug use.
  • Avoid sexual activity with persons of uncertain health status. For some protection, use condoms correctly and consistently.
  • If you are a health care worker, follow routine precautions and handle needles safely.
  • Avoid sharing toothbrushes, razors, or other personal care articles that may be contaminated with blood or body fluids.

If you have been diagnosed with Hepatitis C:

  • Have regular check-ups with your doctor, and report any medication use.
  • Avoid drinking alcohol.
  • Be immunized against hepatitis A if your liver is damaged from hepatitis C.
  • For more information contact the Hepatitis Foundation @ 1-800-891-0707.
  • To prevent infecting others, do not share needles, avoid unprotected sex, and do not share personal articles that may be contaminated with blood: toothbrush, razor, etc.

What you can expect:

  • Most people (about 85%) who become infected with hepatitis C carry the virus for the rest of their lives.
  • Not all of these people will have symptoms, but most will have some liver damage. There is currently no
    vaccine available.

Contact your doctor if you belong to any of the high-risk groups mentioned above and have not been tested for hepatitis C.

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Irritable bowel syndrome has many names including spastic colon, colitis, IBS, functional colitis, irritable colon, nervous indigestion, mucous colitis, and laxative colitis. It is a disorder of the intestines causing abdominal pain, increased bowel movements, and gas. It is usually brought on by increased emotional stress. The intestines are not able to regulate how quickly food passes through. They then over or under compensate, causing diarrhea or constipation. Females, age 20-30, are most often affected.

Symptoms may include:

  • Abdominal pain, tenderness, cramping, or rectal pain following meals and often relieved by bowel movements
  • Mucous covered, bloody, or black and tarry stools
  • Bloating, fullness or gas; possible nausea and vomiting
  • Diarrhea or a combination of diarrhea and constipation
  • Depression, anxiety, headache, fatigue and difficulty concentrating

What your doctor can do:

  • Diagnose the disease by asking many questions about your symptoms, performing a physical exam, ordering lab tests (blood and stool), X-rays, and other tests as needed.
  • Perform a sigmoidoscopy or colonoscopy (a flexible tube-like scope to examine either the rectum and lower colon or the entire colon).
  • Rule out many other possible conditions for diagnosis. Often, no abnormalities are found.

What you can do:

  • Treatment is that which prevents the colitis from occurring. Identify triggers so that you may avoid them, and reduce stress.
  • Reduce stress with relaxation, counseling, or lifestyle changes.
  • Avoid laxatives, multiple medications, and any unnecessary medications.
  • Eat a low fat, high fiber diet in small, frequent meals.
  • Avoid spicy food, caffeine, and alcohol.
  • Keep a food diary to help you know and avoid foods that trigger colitis.
  • Stop smoking, which is very irritating to the digestive tract. Talk to your doctor if you need help. There are many possible aids if you are ready to quit.
  • Take prescribed antispasmodics and/or tranquilizers as needed.
  • Exercise regularly and avoid fatigue. Poor physical fitness can worsen the condition.

What you can expect:

  • Symptoms can usually be reduced or eliminated with lifestyle changes and self-treatment outlined above.
  • Possible complications include chronic abdominal discomfort or tenderness, chronic depression or anxiety, dehydration or malnutrition from food passing too quickly and not being absorbed.

Contact your doctor if you have fever, vomiting, bloody or tarry black stools; if you lose more than 10 pounds in a short period of time or have a change in your bowel habit lasting more than 10 days.

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Lactose intolerance is the inability to digest lactose, a sugar found in milk and other dairy products. The problem is caused by a deficient production of the enzyme lactase. It is common for lactose intolerance to run in families, and it frequently occurs temporarily after bouts of severe diarrhea. Persons of African, Asian and Mediterranean descent are more likely to have lactose intolerance.

Symptoms may include:

  • Diarrhea
  • Bloating, gas, abdominal cramps or vomiting after ingesting milk or dairy products
  • Poor growth and weight gain in children
  • Watery diarrhea in infants

What your doctor can do:

  • Diagnose lactose intolerance by asking about your symptoms, performing a physical exam, and ordering or performing a breath hydrogen test.
  • Order laboratory tests of the stool of infants and young children.

What you can do:

  • Modify your eating habits in order to avoid having symptoms.
  • Consume milk products in small amounts, or avoid completely.
  • Substitute rice or soymilk for cow’s milk.
  • Check ingredients of processed foods for lactose.
  • Try cheeses or yogurt. These foods sometimes do not cause problems.
  • Ask your doctor about taking enzyme supplements or lactase-containing foods.

What you can expect:
This usually is a permanent condition that requires life-long treatment.

Contact your doctor if symptoms do not improve or worsen; or if your baby is not taking formula or food, or is not gaining weight.

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Pancreatic cancer is a malignancy (cancerous tissue) affecting the pancreas, the organ that produces digestive enzymes and insulin (controls the blood sugar). It is most commonly seen in male’s 35-70 years old and is the 4th leading cause of cancer deaths in the US. It is not known what causes pancreatic cancer. People of African heritage and those living in certain areas (United States, Israel, Sweden, and Canada), have a higher than normal incidence. Risk is also increased with a history of chronic pancreatitis, diabetes, certain chemical exposure (urea, napthalene, and benzidine), use of alcohol and tobacco.

Symptoms may include:

  • Usually none, in early stages
  • Pain in the back or abdomen, may be relieved by leaning forward
  • Jaundice (yellowing of the skin and eyes)
  • Unexplained rapid weight loss
  • Blood clots in veins of the extremities
  • Itching
  • Depression

What your doctor can do:

  • Diagnose cancer of the pancreas by asking about your symptoms, doing a physical exam, laboratory tests, and x-rays.
  • Order x-rays of the abdomen, liver and gallbladder.Arrange to obtain biopsies (tissue samples for closer study) of the liver or pancreas.
  • Schedule a laparotomy (exploratory abdominal surgery).
  • Order angiography (X-rays of blood vessels).
  • Order pancreatic ultrasound and abdominal CT scan.
  • Arrange for ERCP (procedure using endoscope and x-ray dye to view the pancreatic duct).
  • Arrange for PTC (x-ray dye is injected into the liver to view pancreatic ducts).
  • Prescribe any of several medications to relieve pain or other symptoms.
  • Recommend surgical removal of the tumor if it is small, or surgery to relieve bile duct or bowel obstruction.
  • Recommend chemotherapy or radiation treatment.
  • For further information, you can contact: American Cancer Society toll-free at 1-800-ACS-2345

What you can expect:

  • Surgical cure of pancreatic cancer may be successful if the tumor is small and has not spread to other parts of the body.
  • Most often, since early symptoms are uncommon, it has already spread by the time of detection. It is unusual to survive for more than a few years after diagnosis.
  • Complications can occur, including diabetes, inflammation or infection of the pancreas, and hemorrhage.

Contact your doctor if you develop symptoms of pancreatic cancer..

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People often link rectal bleeding with cancer even though it can also be the result of any of several non-cancerous conditions. It is always a sign that something is wrong. If you experience this type of bleeding, it is important to check with your physician to identify its specific cause and start appropriate treatment.

Q. Should I be concerned if I bleed from an area only once?
A. Any bleeding should be taken seriously. Be sure to call your physician.

Q. What can cause rectal bleeding?
A. The main causes of rectal bleeding are:

  • Hemorrhoids — these are dilated blood vessels or veins in the anal or rectal area. They can occur on the outside where they are felt as small bumps when wiping; or they may be on the inside where they are usually painless. They are quite common and are associated with chronic constipation and with pregnancy.
  • Fistulas — a fistula is an abnormal channel that usually runs from the rectum to the skin around the anus. It often will drain a white-colored discharge, but it can also bleed. While it is usually just a local problem, a fistula can be associated with chronic inflammation in other parts of the intestinal tract, which is called Crohn’s disease.
  • Fissures — the passage of a hard stool or severe diarrhea may tear the lining tissue of the anus. Nerve endings and blood vessels are exposed so that pain and bleeding may occur with bowel movements.
  • Diverticulosis — Diverticula are pockets or sacs that project from the bowel wall. They balloon out over the years due to recurrent, high-pressure spasms in the colon. When they do occasionally bleed, they can produce a large amount of blood.
  • Proctitis and Colitis — the rectum, colon, or both can become inflamed and ulcerated. This can be accompanied by rectal urgency, cramps or diarrhea associated with the bleeding. When the inflammation is restricted to the rectum, the condition is call proctitis. When the colon is involved, it is called colitis. It is important to identify the specific cause of the inflammation so that appropriate treatment can be started.
  • Polyps and Cancer – Polyps are benign growths in the colon. When polyps, which can be associated with colon cancer, reach a large size they can bleed.
  • Protrusion of the Rectum – Some older people will have weakened rectal support tissues. Part of the rectum then can project from the anus and bleed. It can be felt as an abnormal bulging from the rectum when wiping.

Q. What types of diagnosis are used to determine the exact cause of rectal bleeding?
A. There are four ways your doctor typically can identify the cause:

  • Your medical history
  • A Visual and Digital Exam — your physician will inspect the anal area looking for tears and hemorrhoids. A finger exam can provide information when there is tenderness or a tumor inside. In men, the prostate is also examined.
  • Endoscopy — there are several types of endoscopes used to view the colon. In the office, the physician may perform an exam called flexible sigmoidoscopy. A more thorough exam is accomplished with a colonoscope, allowing the physician to view the entire five- to six-foot long colon. Sedation is usually given for this exam.
  • Barium Enema X-ray — Liquid barium is inserted by enema into the rectum. X-rays will then highlight abnormal shadows, such as tumors, diverticuli and colitis.

Q. What are the treatments for rectal bleeding?
A. Treatments depend on the specific cause of the bleeding. They can range from simple over-the-counter and at-home remedies to prescription medicines and surgery.

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An ulcer refers to the breakdown of the internal lining that covers the organs of the digestive tract. It often develops in the duodenum (first part of the small intestine) or stomach. Heliobacter pylori (H. Pylori), an intestinal bacterium, causes the majority of ulcers. They may also develop from increased gastric acid levels in the digestive tract, defects in the lining, or from excessive use of aspirin and non-steroidal inflammatory agents such as ibuprofen (Advil®, Motrin®, or Nuprin®). Anyone can develop an ulcer, but it is common in men over the age of 50. Your risk increases with cigarette smoking, alcohol abuse, a positive family history for ulcers, chronic gastritis, and having a certain blood type (Type A & O). Ulcers are not cancerous or contagious. The development of an ulcer is also known as Peptic Ulcer Disease (PUD).

Symptoms may include:

  • Sometimes none
  • Abdominal pain, a burning sensation in stomach, heartburn and increased burping
  • Pain that is often mistaken for heartburn, indigestion, or hunger
  • Pain immediately or hours after eating
  • Intermittent pain that may also wake the person from sleep
  • Poor appetite, nausea, vomiting and weight loss
  • Pain relief after eating, drinking milk or taking antacids.
  • Internal bleeding, blood in the stools (black, tarry-looking), vomiting blood, and chest pain

What your doctor can do:

  • Diagnose the disease by asking about your symptoms, doing a physical exam, and ordering laboratory blood tests, stool cultures and an endoscopy (using a long, thin, flexible tube with a light and optics to view and take tissue samples of the digestive tract lining)
  • Order additional tests like a breath test to detect H. Pylori and x-rays with radioactive isotopes (radioactive substances that may be taken orally or injected into the blood stream.)
  • Prescribe antibiotics with bismuth (Pepto Bismol®) to cure the H. Pylori infection and various other ulcer medicines like Antacids (neutralize excess acid), Histamine Antagonists (decrease acid production), and Protective Agents (cover the ulcer site to allow healing).

What you can do:

  • Finish all the antibiotics and take the ulcer medicines as directed by your doctor even if you start feeling better. Remember that ulcers can recur in the future without proper treatment.
  • Stop smoking, avoid caffeine (e.g., coffee, colas, and caffeinated teas), and alcohol.
  • Eat small, frequent meals instead of 3 large or heavy meals.
  • DO NOT use aspirin or non-steroidal anti-inflammatory medicines. Use acetaminophen (Tylenol®) for fever symptoms or minor discomfort.
  • Although there are no diet restrictions, avoid food that upsets your stomach.

What you can expect:

  • Most people recover within 1 to 3 months after starting therapy.
  • Some medicines may cause side effects like nausea; diarrhea; or a black tongue and stools.
  • Possible complications may include a tear in the lining, peritonitis, excessive bleeding, an obstruction in the small intestine, and chronic ulcers.

Contact your doctor if you develop symptoms of an ulcer, if you suffer symptoms of an infection (fever, increased pain), or if you start to vomit blood or notice blood in your stool.

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Ulcerative colitis is an inflammation (swelling, tenderness, warmth) of the lining of the large intestine (colon). The inflammation can prevent water and nutrients from being properly absorbed into the bloodstream, create sores (ulcerations), or lead to bleeding and other problems. The cause is not known but there are several theories. It may occur if another family member also has it, but this is not always the case. It may be related to changes in the immune system (the body’s defense system) or diet factors. Although stress can aggravate ulcerative colitis, it does not appear to cause it. It is most common in ages 15-40.

Symptoms may include:

  • Diarrhea, usually watery with blood or mucous
  • Abdominal cramping, weight loss, and loss of appetite
  • Bleeding from the rectum, body fatigue, and fevers
  • Signs of dehydration (lethargy, sunken eyes, less urination, rapid weight loss or dry skin)

What your doctor can do:

  • Diagnose the disease by asking about your symptoms and medical history, performing a physical exam and ordering laboratory blood and stool tests.
  • Perform special X-rays or an endoscopy (use a long, thin, flexible tube with a light and optics to view and take tissue samples from the colon).
  • Prescribe medications to decrease the inflammation and reduce the diarrhea.
  • Perform a nutritional assessment and prescribe a special diet to help relieve your symptoms and to help you get the nutrition you need.
  • Treat complications such as bleeding and infection.
  • Recommend hospitalization when symptoms are severe. It may be necessary to let the colon rest and have an intravenous (IV) line to provide fluids and nutrition.
  • Recommend surgery if the disease is severe or to treat complications.

What you can do:

  • Work closely with your doctor to determine the treatments that are best for you.
  • Take the medicines prescribed by your doctor. Let your doctor know if you are having uncomfortable side effects. DO NOT stop your medicines without talking to your doctor.
  • Different foods and diets are best for different people with ulcerative colitis. Foods you may need to avoid include caffeine (coffee, tea, colas), spicy foods, milk products, and raw fruits and vegetables. Learn what type of diet works best for you.
  • Try eating several small meals a day instead of three large ones.
  • Contact the Crohn’s and Colitis Foundation at toll-free 1-800-932-2423 for more information.

What you can expect:

  • Ulcerative colitis is a chronic disease with remissions (times when there are no symptoms) and relapses (times when the symptoms flare up again).
  • Treatment can delay or control symptoms, but there is no cure.
  • Complications may include severe blood loss, malnutrition, or obstruction of the bowel.
  • The risk of colon cancer is greater for those with ulcerative colitis.

Contact your doctor if your symptoms worsen, you develop fever and chills, or you have side effects from the treatment. Keep appointments for regular check-ups even if you are not having symptoms.

This material has been provided by your physician as an educational tool and is not meant to take the place of professional care. Please consult your physician for any questions, concerns or changes in your condition.