Common Gastroenterology Conditions

Celiac disease

» 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.
» A person with celiac disease may or may not have symptoms. Common features include iron deficiency anemia, diarrhea, bloating, weight loss, fatigue, arthritis, liver abnormalities, depression and infertility. Symptoms vary depending on a person’s age and degree of small intestinal damage.
» Without treatment, people with celiac disease can develop complications such as osteoporosis, malnutrition, anemia, and cancer.
» Diagnosis involves blood tests and, in most cases, a biopsy of the small intestine during an endoscopy performed by a gastroenterologist.
» 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, consultation with a dietitian is essential.
» If you have unexplained digestive symptoms, anemia, liver abnormalities, osteoporosis or a family history of celiac disease you should be evaluated by a gastroenterologist.

For more information please visit:
http://digestive.niddk.nih.gov/ddiseases/a-z.asp
http://www.americanceliac.org

Barrett’s Esophagus

» In Barrett’s esophagus, the tissue lining the esophagus is replaced by tissue that is similar to the lining of the stomach. A small number of people with Barrett’s esophagus develop a form of esophageal cancer. » Barrett’s esophagus is associated with gastroesophageal reflux disease (GERD); however there are no signs or symptoms associated with Barrett’s esophagus itself. Additionally, patient’s without GERD symptoms can still develop Barrett’s esophagus.
» Improvement in GERD symptoms with acid-reducing drugs may decrease the risk of developing Barrett’s esophagus.
» Barrett’s esophagus can only be diagnosed through an upper gastrointestinal endoscopy and biopsies. It is recommended that adults over 40 who have had GERD for a number of years undergo an initial endoscopy and biopsies to check for the condition.
» People who have Barrett’s esophagus should have periodic surveillance endoscopies and biopsies as there is risk of developing cancer.
» Advanced stages of Barrett’s and even early esophageal cancer can often be treated endoscopically (often avoiding surgery). Thus, it is important to diagnose Barrett’s early and follow it with periodic surveillance endoscopies.

For more information:
http://digestive.niddk.nih.gov/ddiseases/pubs/barretts/index.htm

Cirrhosis

» A chronic condition in which the liver slowly deteriorates and malfunctions due as scar tissue replaces healthy liver tissue.
» Impairs the ability to control infections, remove toxins from the blood, make proteins that regulate blood clotting, and the production and elimination of bile.
» With end-stage cirrhosis, the liver can no longer effectively replace damaged liver cells.
» Causes include alcohol, chronic Hepatitis B and C, fatty liver disease, autoimmune hepatitis, certain metabolic conditions, inherited diseases and drugs, toxins or infections.

For more information:
http://www.liverfoundation.org
http://digestive.niddk.nih.gov/ddiseases/pubs/cirrhosis/index.htm

Crohn’s disease

» Is an inflammatory bowel disease with chronic inflammation of GI tract. It can affect any area of the GI tract, but commonly affects the lower part of the small intestine, called the ileum.
» Swelling extends into the lining of the intestine causing pain and often diarrhea.
» Affects men and women equally with about 20% having a relative with a form of inflammatory bowel disease. Most common between ages of 20 and 30.
» The cause of Crohn’s disease in unknown.
» The most common symptoms of Crohn’s disease are abdominal pain, often in the lower right area, and diarrhea. Rectal bleeding, weight loss, arthritis, skin problems, and fever may also occur.
» A thorough physical exam and a series of tests may be required to diagnose Crohn’s disease. This includes blood tests, x-rays, colonoscopy, endoscopy, and wireless capsule endoscopy.
» 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.

For more information:
http://www.ccfa.org
http://digestive.niddk.nih.gov/ddiseases/pubs/crohns/index.htm

Diarrhea

» Diarrhea is a common problem that usually resolves on its own.
» Diarrhea is dangerous if a person becomes dehydrated.
» Causes include viral, bacterial, parasitic infections, food intolerance, reactions to medicine, intestinal diseases, and functional bowel disorders.
» Treatment involves replacing lost fluid and electrolytes. Depending on the cause of the problem, a person might also need medication to stop the diarrhea or treat an infection.
» Call the doctor if the person with diarrhea has severe pain in the abdomen or rectum, a fever of 102 degrees or higher, blood in the stool, signs of dehydration, or diarrhea for more than 3 days.

Diverticulosis

» Diverticular disease is very common in people as they grow older.
» Diverticular disease affects the colon (the large intestine that helps remove was from your body)
» A low-fiber diet is the most likely cause of the disease.
» Add whole grain foods, high-fiber fruits, and vegetables to your diet.
» Diverticulosis occurs when pouches, called diverticula, form in the colon and bulge out.
» Most people with diverticulosis do not have symptoms. Occasionally people will have cramping, bloating and constipation. Some people will have bleeding, inflammation and fistulas.
» Contact a doctor if you notice symptoms such as fever, chills, nausea, vomiting, abdominal pain, rectal bleeding, or change in bowel habits.

Diverticulitis

» When diverticula (pouches) become inflamed and infected.
» Often pain is felt in the lower part of the abdomen. If you have diverticulitis, you may have fevers, feel sick to your stomach, vomit, or have a change in your bowel habits.
» The cause of diverticulitis is unknown. It is no longer believed that seeds and nuts need to be avoided in order to prevent inflammation.

Peptic Ulcer Disease

» A peptic ulcer is a sore in the lining of the stomach or duodenum.
» Most peptic ulcers are caused by H. pylori or the use of NSAIDs—such as aspirin and ibuprofen—is another common cause.
» Neither stress nor spicy food causes ulcers. Smoking or drinking alcohol, however, each can worsen ulcers and prevent their healing.
» The abdominal discomfort of peptic ulcers feels like a dull or burning pain, occurs when the stomach is empty—and may be briefly relieved by eating food
» A combination of antibiotics and acid-reducing medicines is the most effective treatment for H. pylori-induced peptic ulcers.
» Testing after treatment is needed to be sure the H. pylori infection is gone.

Dyspepsia

» One or more symptoms including a feeling of fullness during a meal, uncomfortable fullness after a meal, and burning or pain in the upper abdomen. This is a form of indigestion.
» Indigestion can be caused by a condition in the digestive tract such as gastroesophageal reflux disease (GERD), peptic ulcer disease, cancer, or abnormality of the pancreas or bile ducts.
» Sometimes a person has indigestion for which a cause cannot be found.
» Some test that can be used to make the diagnosis include: x rays; blood, breath, and stool tests; and an upper endoscopy with biopsies.
» Some people may experience relief from indigestion by making some lifestyle changes and decreasing stress.
» Some medications, including antacids, H2 receptor antagonists (H2RAs), proton pump inhibitors (PPIs), prokinetics, or antibiotics may be used to treat the symptoms of indigestion.

Eosinophilic Esophagitis

» Eosinophilic esophagitis (EE) is a disease characterized by thickening of the lining of the esophagus (the part of the body connecting the throat and the stomach) caused by an allergic white blood cell, the eosinophil. Symptoms of EE can range from severe heartburn, difficulty swallowing, food being stuck in the esophagus, nausea or vomiting to unexplained weight loss. It is not exactly clear what causes EE, although this disease may be related to other allergic diseases, particularly asthma.
» A common approach to dealing with difficulty swallowing is to “dilate”, or stretch, the esophagus. This is usually done through the scope as part of upper endoscopy. Although this may yield some relief in patients with EE, it does not treat the root cause. It should also be noted that dilatation of an esophagus affected with EE yields more trauma and there is an increased risk of perforation.
» There are 6 most common food groups responsible for food allergies when eosinophilic esophagitis is present. These food groups include milk protein, soy, wheat, egg, peanut (and all tree nuts), and all sea food. Unfortunately, allergy testing is not particularly beneficial, and some trial and error is necessary to pinpoint the offending agent. This requires participation of an experienced dietitian to counsel families on proper diet and prevention of inadvertent contamination due to the ubiquitous use of these food proteins in processed foods. A dietician is available at Evanston Hospital and at Glenbrook Hospital to assist you.
» Topical fluticasone, a mild steroid, can be used to suppress the allergic reaction occurring locally in the lining of the esophagus. Unfortunately, this medication is not available in liquid form as required to coat the esophagus. It is, however, widely available as an inhaler for use in asthma. Many patients have found success by swallowing the aerosolized solution instead of inhaling it.

Gallstones

» Gallstones form when bile hardens in the gallbladder.
» Gallstones are more common among older adults; women; people with diabetes; those with a family history of gallstones; people who are overweight, obese, or undergo rapid weight loss; and those taking cholesterol-lowering drugs.
» Gallbladder attacks often occur after eating a meal, especially one high in fat. Symptoms include right sided abdominal pain with radiation to the back.
» Gallstones can cause serious problems if they become trapped in the bile ducts.

Gastroesophageal Reflux Disease (GERD)

» Reflux occurs when acid and stomach contents rise up into the esophagus causing a burning sensation in the chest or throat called heartburn or acid indigestion.
» Occasional GER is common, persistent reflux (more than twice a week) is considered GERD and can lead to more serious health problems.
» Main symptom of GERD is frequent heartburn – burning in the lower part of the mid chest. You can have GERD without heartburn, experiencing a dry cough, asthma symptoms or trouble swallowing.
» The cause of GERD is when the sphincter muscle connecting the esophagus and the stomach inappropriately relaxes or cannot stay closed.
» A hiatal hernia can contribute to GERD. A hiatal hernia occurs when the upper part of the stomach move above the diaphragm allowing acid reflux to occur more easily.
» Other factors that may contribute to GERD include: obesity, pregnancy and smoking
» Common foods that can worsen reflux symptoms include: Citrus fruits, chocolate, caffeine or alcohol, fatty foods, onions, mints, spicy foods, tomato-based foods
» Upper endoscopy will allow the direct visualization of the lining of the esophagus and stomach to look for complications or causes of symptoms. Biopsies can be done to look for injury to the esophagus or complications
» Chronic GERD that is untreated can cause serious complications, including esophageal strictures and esophageal cancer. GERD may worsen or contribute to asthma, chronic cough, and pulmonary fibrosis. Patients with chronic GERD should be closely monitored.

Irritable Bowel Syndrome

» IBS is a disorder that interferes with the normal functions of the colon. The symptoms may include crampy abdominal pain, bloating, constipation, and diarrhea.
» IBS is a common disorder found more often in women than men.
» People with IBS have colons that are more sensitive and reactive to things that might not bother other people, such as stress, large meals, gas, medicines, certain foods, caffeine, or alcohol.
» IBS is a diagnosis of exclusion, usually diagnosed by its signs and symptoms and by the absence of other diseases.
» Most people can control their symptoms by taking medicines such as laxatives, antidiarrheal medicines, antispasmodics, or antidepressants; reducing stress; and changing their diet.
» IBS does not harm the intestines and does not lead to cancer. It is not related to Crohn’s disease or ulcerative colitis.
» People with symptoms that may suggest Irritable Bowel Syndrome, should be evaluate to ensure that there is not another more serious or treatable condition.

Nonalcoholic Steatohepatitis (NASH)

» NASH is fat in the liver with resulting inflammation and damage.
» NASH occurs in people who are middle-aged and overweight or obese. Often seen with diabetes, hypertension and hyperlipidemia.
» People who have NASH may feel well and may not know that they have a liver disease.
» NASH can lead to cirrhosis, a condition in which the liver is permanently damaged and cannot work properly.
» NASH may be suspected if blood tests show high levels of liver enzymes or if scans show fatty liver.
» NASH is diagnosed by excluding other causing of liver disease and often requires a liver biopsy taken through
» People who have NASH should reduce their weight, eat a balanced diet, engage in physical activity, and avoid alcohol and unnecessary medications.
» No specific therapies for NASH exist. Experimental therapies being studied include antioxidants and antidiabetes medications.

Pancreatitis

» Pancreatitis is inflammation of the pancreas, causing digestive enzymes to become active inside the pancreas and damage pancreatic tissue.
» Pancreatitis has two forms: acute and chronic.
» Common causes of pancreatitis are gallstones and heavy alcohol use.
» Sometimes the cause of pancreatitis cannot be found.
» Symptoms of acute pancreatitis include abdominal pain, nausea, vomiting, fever, and a rapid pulse.
» Treatment for acute pancreatitis includes intravenous (IV) fluids, antibiotics, and pain medications. Surgery is sometimes needed to treat complications.
» Acute pancreatitis can become chronic if pancreatic tissue is permanently destroyed and scarring develops.
» Symptoms of chronic pancreatitis include abdominal pain, nausea, vomiting, weight loss, diarrhea, and oily stools.
» Treatment for chronic pancreatitis may involve IV fluids; pain medication; a low-fat, nutritious diet; and enzyme supplements. Surgery may be necessary to remove part of the pancreas.

Polyps

» A colon polyp is a growth on the surface of the colon, or large intestine.
» Most colon polyps are benign, which means they are not cancer. Within this category, some have a risk to grow into cancer if not removed.
» Some types of polyps may already contain cancer within them, and still not yet be invasive.
» Colon polyps can be raised or flat.
» Flat polyps can be smaller and harder to see and are more likely to be cancer than raised polyps.
» Most people with colon polyps do not have symptoms.
» Symptoms of more advanced polyps may include weight loss, abdominal pain, constipation or diarrhea for more than a week, or blood on your underwear, on the toilet paper, or in your stool.
» During a Colonoscopy, Gastroenterologists remove most colon polyps. All tissue removed is tested for cancer.
» How to get screened for colonoscopy? Get a colonoscopy. Talk with your doctor about getting tested for colon polyps if you’re 50 years of age or older, or earlier if you have symptoms or someone in your family has had polyps or colon cancer.

Ulcerative Colitis

» Inflammation and ulcers in the lining of the rectum and colon.
» Is an inflammatory bowel disease (IBD), sometimes can be very similar to Crohn’s disease.
» Can occur at any age, usually between 15 and 30. More common in Whites and people of Jewish descent.
» Symptoms include diarrhea, anemia, fatigue, weight loss, rectal bleeding, joint pain and skin lesions.
» The cause of ulcerative colitis is not known. It may be an abnormal reaction of the body’s immune system to bacteria in the digestive tract.
» Ulcerative colitis is diagnosed with blood tests and a colonoscopy or sigmoidoscopy.
» Treatment depends on the severity of the disease. It can include chronic use of medications or surgery.

Our thanks to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) for supporting materials used in the compilation of the above reference materials.