Gastroenterology

Your Healthy Gastrointestinal System

When you think ‘digestive system’ you probably think ‘stomach,’ but your gastrointestinal system, which breaks down what you eat and drink into nutrients that your body can absorb (and shuttles out the waste), is made up of several organs which are joined together. The main organs of the digestive tract include the mouth, esophagus, stomach, small intestine, large intestine (also known as the colon), rectum and anus. In the upper part of your digestive tract (your mouth, stomach and small intestine) tiny glands produce fluids that help you digest food. In the lower part, a layer of smooth muscle helps break down food and move it through your system. Digestion actually starts in your mouth and finishes in the small intestine, where most digested food, as well as water and minerals, are absorbed.

Your liver and pancreas produce digestive juices and are linked to the small intestine through ducts, or small tubes. The gallbladder stores your liver’s digestive juices until they are needed. A few major hormones, which are released by the cells in your stomach, control the functioning of your digestive system and your body produces other hormones (gherlin, leptin) which help regulate your appetite. Nerves also help control your digestive system, allowing food and digestive juices to travel through the GI tract or slow and stop digestion.

Gastrointestinal Diseases

GERD

Gastroesophageal reflux disease, a.k.a. GERD, occurs when the lower esophageal sphincter (LES) muscle at the end of your esophagus fails to close properly or opens spontaneously, allowing the contents of your stomach to rise back up into the esophagus. GERD is also sometimes called acid reflux or heartburn, because the stomach acids can irritate the esophagus and cause a burning sensation in the chest or throat. Primary symptoms include frequent, burning pain in the lower part of the mid chest. In some cases (often in children under age 12) GERD may cause a dry cough, asthma symptoms or trouble swallowing.

Signs and Symptoms

Primary symptoms include frequent, burning pain in the lower part of the mid chest. In some cases (often in children under age 12) GERD may cause a dry cough, asthma symptoms or trouble swallowing. If symptoms last for more than two weeks despite treatment with antacids or other over-the-counter medications, talk to your doctor. Certain lifestyle changes and medications (see treatment, below) can help reduce symptoms but if they do not improve, additional tests may help your doctor reach a more definitive diagnosis. Barium x-rays can help spot problems such as a hiatal hernia or other structural issues. An endoscopy can also allow your doctor to search for abnormalities along the surface of the esophagus. If medicine and lifestyle changes do not make a difference, surgery may provide longer-term relief. Long-term complications of GERD can include chronic inflammation of the esophagus, which can make swallowing difficult. Some people also develop Barrett’s esophagus, which can lead to esophageal cancer.

Treatment Options

Prescription medications such as H2 blockers and proton pump inhibitors work to reduce production of stomach acid, while other medications can help strengthen the LES and make the stomach empty faster. Over-the-counter antacids can relieve heartburn and other mild GERD symptoms.

But changing some diet and lifestyle habits are key:

  • Avoid smoking.
  • Skip or minimize citrus fruits, chocolate, drinks with caffeine or alcohol, fatty or fried foods, garlic, onions, mint flavorings, spicy foods and tomato-based foods like spaghetti sauce, pizza or salsa)—they all can make symptoms worse.
  • Eat small, frequent meals and avoid lying down for at least three hours after a me

Stomach Ulcers

Also known as peptic ulcers, a stomach ulcer is a sore in the lining of your stomach (also called a gastric ulcer) or duodenum (the first part of the small intestine; also called a duodenal ulcer). About a half-million people in the U.S. develop a peptic ulcer at some point. The most common symptom is a burning pain in your stomach that starts between meals or during the night. The pain often comes and goes for several days or weeks and can last anywhere from a few minutes to several hours. It typically goes away for a short time when you eat or take antacids. These ulcers are caused when the acids inside the stomach, which break down food, damage the walls of the organ. Peptic ulcers are often caused by an infection from the Helicobacter pylori (H. pylori) bacteria. Long-term use of nonsteroidal anti-inflammatory medications (NSAIDs) such as aspirin or ibuprofen, can also cause ulcers. Although spicy foods and stress don’t create ulcers, they can make symptoms worse, as can smoking and drinking alcohol.

Signs and Symptoms

The most common symptom is a burning pain in your stomach that starts between meals or during the night. The pain often comes and goes for several days or weeks and can last anywhere from a few minutes to several hours. It typically goes away for a short time when you eat or take antacids.

Your doctor may test your blood, breath or stool to see if you have an H. pylori infection. If symptoms are severe, your doctor may order an endoscopy, a procedure in which a thin tube with a camera is inserted into through your mouth and into your stomach and duodenum so your doctor can more examine the area more closely. If you frequently take NSAIDs, your doctor may recommend that you stop taking them, reduce the dosage or switch to another medication.

Treatment Options

Ulcers caused by H. pylori are treated with antibiotics to kill the bacteria. These and other ulcers are also treated with proton pump inhibitors and/or histamine receptor blockers to reduce stomach acid and help the ulcers start to heal. Bismuth subsalicylate (Pepto-Bismol) can also help to coat the ulcer and protect the area from stomach acid. Antacids can help reduce stomach pain but in the case of H. pylori they will not kill the bacteria. Ulcers can recur if the infection is still present, and less commonly stomach cancer can also develop.

Gallbladder Disease

Your gallbladder’s main job is to store bile, a fluid produced by your liver which helps your body absorb fats and certain vitamins as well as eliminate waste. As food is digested, your liver releases bile through a duct which links the gallbladder and liver to the small intestine.
The most common gallbladder disease is gallstones, which can block the flow of bile through the duct. Gallstones are typically created if the liver secrets too much cholesterol, which can come together to form these crystals. About 20 percent of people in the U.S. above age 65 develop gallstones, and they’re more common in women, as well as those who have a family history of the condition. Most people with gallstones—about 80 percent—don’t have any symptoms. But sometimes the blockages cause the gallbladder to swell, creating severe upper abdominal pain that can last for hours at a time.

Signs and Symptoms

If you develop severe pain in the upper abdomen, your doctor may order an imaging test such as an ultrasound to determine whether the gallbladder is swollen or inflamed. Other diagnostic tests, such as MRI or CTs, may be done to detect blockages or determine other disorders.

Treatment Options

If you don’t have symptoms, no treatment is necessary. Some medications can help dissolve small gallstones in about 6 months; larger stones may take up to 1 or 2 years to dissolve. This treatment only works when the stones are made of cholesterol and the opening of the gallbladder is not blocked. About half of all people with gallstones do develop them again within five years.

If gallstones cause continuing episodes of pain, your doctor may advise removing your gallbladder. This surgery can be done using a flexible viewing tube called a laparoscope, and does not require large incisions.

Irritable Bowel Syndrome

Irritable Bowel Syndrome (IBS) is a group of symptoms that occur together, caused by changes or disruption to the GI tract. The GI tract itself is not damaged. Symptoms usually include abdominal pain or discomfort, along with diarrhea, constipation, or a combination of both. IBS affects about twice as many women as men, and most often affects people younger than age 45. Anywhere from 10 to 20 percent of Americans have IBS, but less than one-third consult their doctor for a diagnosis.

There are four main subtypes of IBS.  Each of these may require a different type of treatment:

  • IBS with constipation (hard or lumpy stool at least 25 percent of the time; loose or watery stool less than 25 percent of the time)
  • IBS with diarrhea (loose or water stools at least 25 percent of the time; hard or lumpy stools less than 25 percent of the time).
  • Mixed IBS (hard or lump stools at least 25 percent of the time; loose or watery stools at least 25 percent of the time)
  • Unsubtyped IBS (hard or lumpy stools less than 25 percent of the time; loose or watery stools less than 25 percent of the time).

Signs and Symptoms

If you’ve experienced abdominal pain or discomfort at least three times per month for the last three months—without any other disease or injury that could explain the pain—you may have IBS. Your doctor will likely do a physical exam and take a complete medical history. Additional tests may also include checking and testing your stool, a series of x-rays, a flexible sigmoidoscopy (views of just the rectum and colon) or a full colonoscopy (views of the rectum and the entire colon).

Treatment Options

Although there is no known cure for IBS, certain medications can help control muscle spasms, reduce pain, constipation and diarrhea. These lifestyle changes can also help:

  • Eat more frequent, smaller meals. Making sure that they’re low in fat and high in carbohydrates (such as pasta, rice, fruit and vegetables) can may help.
  • Avoid certain foods. Milk products, alcohol, caffeine, artificial sweeteners, high-fat foods and foods that cause gas (such as beans or cabbage) can exacerbate symptoms. Foods that are high in dietary fiber may help reduce constipation, but only increase your intake by 2 or 3 grams per day to reduce gas and bloating. Aim for a total of 20-35 grams of fiber per day.
  • Consider probiotics. These “good” bacteria can help improve symptoms of IBS.
  • Manage stress. Your brain and gut are closely linked through many nerves which control the normal contractions of the colon and can cause abdominal pain. So it’s important to take measures to reduce stress. Exercise, relaxation therapies, and making sure you get enough sleep can help minimize symptoms.

Inflammatory Bowel Disease

Inflammatory Bowel Disease (IBD) is actually two different conditions: Crohn’s disease and ulcerative colitis. Both cause chronic inflammation of the GI tract and can also involve other organs beyond the intestines, causing a variety of symptoms. IBD is a lifelong disease, but typically patients have active cycles— when they have symptoms—and inactive cycles, known as remission.

  • Crohn’s disease: Crohn’s disease is inflammation along any part of the gastrointestinal tract, although the most commonly affected areas are the lower part of the small intestine and the colon. Several layers of the intestinal wall can be affected, leading to complications such as an abscess, a stricture (a narrowing that can lead to intestinal blockage), or a fistula (an abnormal connection between the intestine and other organs). Symptoms can include diarrhea, rectal bleeding, abdominal cramps and pain, fever, weight loss, nausea and vomiting.
  • Ulcerative colitis: Ulcerative colitis is inflammation only in the colon (large intestine) and it affects the innermost lining of the intestinal wall. Usually this inflammation starts in the rectum, the lowest part of the colon, and extends upward. Sometimes only the rectum is involved; in other cases portions of the colon or the entire organ is inflamed. Symptoms include diarrhea, rectal bleeding, abdominal cramps, pain, fever and weight loss.

Signs and Symptoms

If you are experiencing any of the symptoms above, see your doctor, who will take a full medical history and do a physical exam. The exact cause of IBD is still unknown, but experts think it involves immune cells in the lining of the intestines. Usually these cells fight harmful substances like bacteria and viruses, which pass through the digestive tract. In IBD, an initial trigger (either an infection, an environmental cause or a dietary element) activates your immune system but then your immune system doesn’t become inactive once the harmful element is eliminated. The result is out-of-control inflammation that attacks normal cells in your intestines. There is a genetic risk of developing IBD, with about 10-20% of all patients having one or more family members affected by the disease.

Your doctor may give you a blood test to examine blood cell counts and nutrient levels, while stool samples can also rule out intestinal infections. However the most definitive way to diagnose IBD is through endoscopy, a special tube that allows your doctor to see any inflammation in the large intestines. Special x-rays, such as barium x-rays, allow doctors to see the inside of the small intestine. A CT scan can also be used to look for abscesses in the abdomen.

Treatment Options

Both Crohn’s disease and ulcerative colitis are considered chronic ailments, meaning they require long-term treatment with medication with the hopes of bringing (and keeping) the condition into remission. Prescription medications such as aminosalicylates can help treat mild to moderate inflammation in the colon, usually with minimal side effects. In more severe cases, your doctor may prescribe oral steroids to help reduce inflammation. Other medications target the immune system to help bring the disease under control. In some cases, surgery may be required.

Chronic Pelvic Pain

Chronic pelvic pain is pain in your pelvic area that can be constant or come and go, happening at certain times such as after you eat, go to the bathroom or have sex. The discomfort may be caused by a variety of conditions, either gynecological or relating to your urinary tract or bowel. Some women may have several conditions that contribute to their pain, and in some cases, no cause is found.

Signs and Symptoms

If you have pelvic pain that lasts for six months or longer, see your doctor who will take a medical history and do an overall physical exam as well as a pelvic exam. Some tests that may be performed to help pinpoint a diagnosis include an ultrasound, laparoscopy, cystoscopy, colonoscopy and sigmoidoscopy (a lighted tube is placed in the rectum and lower colon). Your healthcare provider may also refer you to another specialist, such as a gastroenterologist (a doctor who specializes in digestive issues) or a urogynecologist (a gynecologist who focuses on urinary and related problems).

Treatment Options

Treatment depends on what specific diagnosis is made, but there are ways you can minimize discomfort, including:

  • Exercise
  • Pain-relieving medication. Non-steroidal anti-inflammatory drugs (ibuprofen, acetaminophen, naproxen sodium) can help relieve discomfort. Be sure to talk to your doctor because long-term use of these drugs can lead to side effects, including damage to your stomach lining.
  • Acupuncture, acupressure and physical therapy can also help relieve pain.

How North Shore-LIJ Can Help

The Division of Gastroenterology, part of the Department of Medicine, within North Shore-LIJ Health System is a team of providers who are recognized nationally and internationally for their clinical, technical and research expertise in all aspects of gastroenterological and liver diseases. Our gastroenterologists integrate their diagnostic skills with the latest medical technologies to develop and provide specific therapies tailored to the needs of our individual patients. Among our team are providers with special interest in women’s health issues in gastroenterology, liver disease and nutrition. Women are provided exceptional medical care as well as offered education to embrace healthy lifestyles to promote wellness and disease prevention.

Meet the North Shore-LIJ gastroenterology specialists here.