Treatment for Gastrointestinal Disorders

Why Choose HVA Medical Group?

Our board certified gastroenterologists are highly trained physicians with expertise in gastroenterology, endoscopy, hepatology, women’s GI health, genetic diseases, inflammatory bowel disease, and nutritional or absorptive disorders. They focus on the digestive system and its disorders, taking care of the gastrointestinal tract from the mouth to the colon. Our gastroenterologists are committed to providing compassionate and personalized care using the most advanced, cutting edge technology and focus on evidence based medicine. Our mission is to serve our patients and the community utilizing an integrative approach, to build quality relationships, and to offer prompt and accurate diagnoses for those who experience digestive issues, such as:

  • Gastrointestinal reflux disease
  • Constipation and diarrhea
  • Abdominal pain
  • Peptic ulcer disease and gastrointestinal bleeding
  • Irritable bowel syndrome
  • Inflammatory bowel disease (Crohn’s and Ulcerative Colitis)
  • Celiac disease
  • Liver disease including hepatitis
  • Hemorrhoids
  • Problems involving gallbladder and pancreas
  • Difficulty swallowing
  • Women’s GI health

Preventative care is of paramount importance in maintaining proper gastrointestinal health.

The Most Common Procedures

Colonoscopy

A colonoscopy is a procedure that examines the inside of the lower intestinal tract called the colon or large intestine. You will be required to consume a liquid bowel preparation to adequately cleanse your colon the evening before your scheduled procedure. Our office will provide you written instructions on how to best prepare for your colonoscopy. Your doctor will use a thin, flexible tube called a colonoscope, which has its own lens and light source, and will view the images on a video monitor. During the procedure, you will receive anesthesia which will keep you safe and comfortable and your doctor might perform a biopsy (small tissue samples) or polypectomy for further testing. When used as a colon cancer prevention method, colonoscopy can find potentially precancerous growths called polyps and remove them before they turn into cancer. Colorectal cancer is the third leading cause of cancer deaths in the United States. According to the American Cancer Society, approximately 150,000 new cases of colorectal cancer are diagnosed in the United States each year and nearly 50,000 people die from the disease. It has been estimated that increased awareness and screening would save at least 30,000 lives each year.

Common Reasons for Colonoscopy
  • Screening test for colorectal cancer
  • Positive FIT or Cologuard stool tests
  • History of polyps or cancer in your colon
  • Lower intestinal or rectal bleeding
  • Chronic diarrhea
  • Low blood count (anemia) with a low iron level
  • Change in bowel habits
  • Lower abdominal pain

Upper Endoscopy

Upper endoscopy, often referred to as an EGD is a procedure that allows a gastroenterologist to examine the upper part of the gastrointestinal (GI) tract, which includes the esophagus, the stomach, and the duodenum (the first portion of the small intestine). Your doctor will use a thin, flexible tube called an endoscope, which has its own lens and light source, and will view the images on a video monitor. During the procedure, you will receive anesthesia which will keep you safe and comfortable and your doctor might perform a biopsy (small tissue samples) for further testing.

Common Reasons for Upper Endoscopy
  • Heartburn or Gastroesophageal reflux disease (GERD)
  • Unexplained pain or discomfort in the upper abdomen
  • Persistent nausea and vomiting
  • Vomiting blood or blood found in stool coming from the upper part of GI tract
  • Low blood count (anemia) with low iron level
  • Difficulty swallowing
  • Abnormal findings on imaging studies such as x-ray, ultrasound, CT scan or MRI
  • To check the healing or monitor progress of stomach ulcers or tumors.

Capsule Endoscopy

Video capsule endoscopy (VCE) is a procedure performed that allows your gastroenterologist to view images of your upper gastrointestinal tract with a focus on the small intestine. It is performed by you swallowing a small tablet the size of a multivitamin which has a camera lens inside. The images taken are transmitted to a belt recorder that you wear on your waistband and analyzed by your physician. There is no required anesthesia and the capsule is naturally passed in your stool. You will have to perform a light bowel preparation to cleanse your intestinal tract the evening before the procedure. Our office will provide you written instructions on how to best prepare for your capsule endoscopy.

Common Reasons for Capsule Endoscopy
  • Unexplained low blood count (anemia)
  • Detecting polyps, ulcers, small intestine tumors
  • Evaluation for inflammatory bowel disease

Hemorrhoid Treatment

Hemorrhoids are swollen veins in the rectum. Sometimes they can cause itching, bleeding and pain. Hemorrhoids are very common and in some cases, you can see or feel them outside the rectum. In other cases, you cannot see them because they are inside the rectum. We provide an office based, minimally invasive procedure that typically requires 5 minutes to perform. Using a rubber band ligation device, we are able to selectively treat internal hemorrhoids and prevent long term complications. Typically three sessions of treatment are required to produce the most beneficial results.

See the link below for more information on this available treatment option for you.
www.crhsystem.com

Procedure Locations

Englewood Health Medical Center
350 Engle Street
Englewood, NJ 07631

St. Joseph’s University Medical Center
703 Main Street
Paterson, NJ 07503

Surgical and Endoscopy Center of Bergen County
80 Eisenhower Drive
Paramus, NJ 07652

Procedure Information and Instructions

  • Colonoscopy

    What is a Colonoscopy?

    Colonoscopy is used to evaluate the colon (large intestine). A colonoscopy allows the doctor to see inside your entire colon. The procedure involves the use of a long tube (scope) that contains a camera and an instrument used for biopsy and polyp removal or other treatment as needed during the procedure. A polyp is an abnormal growth of the lining of the intestine. They vary in size and shape, and differ in composition. Some polyps may contain cancerous or precancerous cells, and some polyps may eventually become cancer, but it is impossible to tell this just by looking at them. For this reason, polyps are removed by a technique called a polypectomy.

    Indications:

    1. Colonoscopy is mostly done to search for polyps or colon cancer,

    2. Evaluation for blood loss noted on lab reports

    3. Active bleeding per rectum

    3. Undiagnosed abdominal or rectal pain,

    4. Changes in bowel habits

    5. To evaluate abnormalities found on other tests such as CT/MRI or lab work.

    Precautions before the colonoscopy

    1. Certain medications such as aspirin or aspirin-like drugs and coumadin (warfarin) may need to be stopped prior to colonoscopy, so please make sure that you bring it to the attention of doctor Gupta and his staff whether you are taking any blood thinner.

    2. If you have a pacemaker and/or defibrillator for the heart, please let our office know before the procedure.

    Preparation for the Procedure

    You MUST follow the following diet and preparation instructions exactly:

    Diet

    The day before the procedure: CLEAR LIQUIDS for 24 hours before the test. NO breakfast, lunch or dinner one day before the procedure. Again, you may only have clear liquids. The examples of this diet are: water, 7-up, clear broth, tea, ginger ale, apple juice, Gatorade, and any clear liquid that you can see through. Do NOT eat Jello because its presence in the colon can mislead the doctor during the examination.

    On the day of the procedure: Do not eat or drink anything within 8 hours of the procedure except a small amount of water with medicine including the preparation liquid as advised up to 2 hours before the procedure.

    Medication precautions

    You can take all of your meds up to 2 hours prior to the test with a small glass of water. If you are taking insulin, use ½ of your usual dose. Do NOT take any aspirin, Advil, Motrin, Celebrex, etc. for 5 days prior to the colonoscopy. Please inform Dr. Gupta and his staff about the following so that you can be advised appropriately.

    Cleansing Preparation

    One day before the colonoscopy, drink Trilyte/Moviprep/suprep: Mix the Trilyte in a gallon of cold water or less in case of moviprep and suprep as suggested in the package insert, a few hours before you start drinking the prep. Shake it well and refrigerate it. Cold liquid is tolerated better. Do not try to taste it, just swallow it one glass at a time with a 10-15-minute interval in between. Start drinking about 2 to 4 pm and finish ½ of the liquid in 2-3 hours. Drink rest of the prep liquid on the morning of the procedure to finish 2 hrs. before the procedure.

    What happens during the procedure?

    Before the procedure begins, every measure is taken to ensure that you are as comfortable as possible. An intravenous line, or IV, will be placed for the administration of medications. The medication given to you through the IV will make you relaxed and drowsy within a minute, and once the procedure is finished you are fully awake within a few minutes. There is usually little to no discomfort during the procedure. On average the procedure lasts around 15-20 minutes. Afterward, you will be taken to a recovery area until the drowsy effects of the medication have worn off. Then you will be given instructions regarding how soon you can eat and drink, plus other guidelines for resuming your normal routine.

    What are the possible complications?

    Colonoscopy is a safe procedure. Rarely, complications can occur. These include perforation or puncture of the colon walls which could require surgical repair. Also, hemorrhage or bleeding can occur when a polyp is removed or a biopsy is taken. If severe, this could lead to the need for blood transfusion or reinsertion of the scope to correct the problem.

    After the test

    After the procedure, you should plan to relax for the remainder of the day. You will not be allowed to drive yourself home, so arrange for a friend or family member to take you home. Occasionally, minor problems may persist such as bloating, gas, or mild cramping, which should disappear in 24 hours or less. The results generally take a few days to a week or more to come back. We ask that you schedule a follow-up visit so that the results of the test can be reviewed with you and further treatment can be given.

  • Hemorroid Banding

    Rubber Band Ligation Of Hemorrhoids

    It is a procedure in which the hemorrhoid is tied off at its base with rubber bands, cutting off the blood flow to the hemorrhoid.

    To perform the procedure, a doctor inserts a viewing instrument (anoscope) into the anus. The hemorrhoid is grasped with an instrument, and a device places a rubber band around the base of the hemorrhoid. The hemorrhoid then shrinks and dies and, in about a week, falls off.

    A scar will form in place of the hemorrhoid, holding nearby veins so they don’t bulge into the anal canal.

    After the procedure, you may feel pain and have a sensation of fullness in the lower abdomen. Or you may feel as if you need to have a bowel movement.

    Treatment is limited to 1 to 2 hemorrhoids at a time if done in the doctor’s office. Several hemorrhoids may be treated at one time if the person has general anesthesia. Additional areas may be treated at 4- to 6-week intervals.

    What To Expect After Treatment

    People respond differently to this procedure. Some are able to return to regular activities (but avoid heavy lifting) almost immediately. Others may need 2 to 3 days of bed rest.

    Pain is likely for 24 to 48 hours after rubber band ligation. You may use acetaminophen (for example, Tylenol) and sit in a shallow tub of warm water (sitz bath) for 15 minutes at a time to relieve discomfort.

    To reduce the risk of bleeding, avoid taking aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) for 4 to 5 days both before and after rubber band ligation.

    Bleeding may occur 7 to 10 days after surgery, when the hemorrhoid falls off. Bleeding is usually slight and stops by itself.

    Doctors recommend that you take stool softeners containing fiber and drink more fluids to ensure smooth bowel movements. Straining during bowel movements can cause hemorrhoids to come back.

    Why It Is Done

    Rubber band ligation is the most widely used treatment for internal hemorrhoids. If symptoms persist after three or four treatments, surgery may be considered.

    Rubber band ligation cannot be used if there is not enough tissue to pull into the banding device. This procedure is almost never appropriate for fourth-degree hemorrhoids .

    How Well It Works

    Rubber band ligation works for about 7 to 9 out of 10 people who have it. People who have this treatment are less likely to need another treatment compared to people who have coagulation treatments. About 1 out of 10 people may need surgery.

    Risks: Side effects are rare but include:

    Severe pain that does not respond to the methods of pain relief used after this procedure. The bands may be too close to the area in the anal canal that contains pain sensors.
    Bleeding from the anus.
    Inability to pass urine (urinary retention).
    Infection in the anal area.

  • Endoscopy

    What is an Upper GI Endoscopy (EGD)?
    Upper GI Endoscopy, sometimes called EGD (esophagogastroduodenoscopy), is a test that is used to evaluate the esophagus, stomach, and duodenum. An endoscope is a long tube which is a highly advanced digital way of sending the image to a television screen. An endoscopy allows the doctor to identify and/or correct a problem in the upper gastrointestinal tract.

    Such problems include: polyps (abnormal growths), ulcers (which can develop in the esophagus, stomach, or duodenum), tumors of the stomach or esophagus, intestinal bleeding, esophagitis (chronic inflammation of the esophagus due to reflux of stomach acid and digestive juices), gastritis (inflammation of the stomach), and other problems affecting the upper GI tract.

    How do I prepare for the test?
    Good preparation for this test is the key to getting the most accurate result. When you meet with your doctor prior to the procedure, review all of your medical problems, medications, and symptoms. You MUST follow the following diet and preparation instructions exactly.

    Do not eat or drink for 8 hours prior to the procedure. Do not wear lipstick and remove nail polish. You should take all your morning medications, especially heart, blood pressure, and diabetic medications, up to 2 hours prior to the procedure with a small amount of water. If you are taking insulin, use only ½ the usual dose on the morning of the test. If you have asthma and are using a pump, make sure you use it on the morning of the test as well. Stop Coumadin 3 days prior to the procedure. Arrange for a friend or family member to take you home after the test.

    What happens during the procedure?
    Before the procedure begins, every measure is taken to ensure that you are as comfortable as possible. An intravenous line, or IV, will be placed for the administration of medication. The medication given to you through the IV will make you relaxed and drowsy, and prevent you from remembering the procedure. The throat may be coated with a topical anesthetic to suppress the gag reflex. A mouthpiece is placed between the teeth to prevent damage to the scope. As you swallow, the endoscope is guided through the esophagus, stomach, and duodenum. The doctor is able to see the inside of these areas on a monitor. On average the procedure lasts between 6 to 10 minutes.

    Afterward, you will be taken to a recovery area until the drowsy effects of the medication have worn off. Then you will be given instructions regarding how soon you can eat and drink, plus other guidelines for resuming your normal routine. You may experience belching and/or flatulence (gas) for the next 24 hours. Some throat discomfort is also possible.

    What are the possible complications?
    Upper GI Endoscopy is a very safe procedure, and complications are uncommon. One possible complication is excessive bleeding, which can be quite serious. Bleeding may occur after removal of a polyp. In extremely rare cases, a perforation, or tear, in the esophagus or stomach wall can occur. This requires hospitalization and possibly surgery.

    After the test
    After the procedure you should plan to relax for the remainder of the day. You will not be allowed to drive yourself home, so arrange for a friend or family member to take you home. Occasionally, minor problems may persist such as sore throat, bloating, gas, or mild cramping, which should disappear in 24 hours or less. The results generally take a few days to a week or more to come back. Generally, we prefer that you visit the office about one week after the procedure so that results can be discussed in person, all the questions can be answered to your satisfaction and proper treatment and medication can be provided.

  • Capsule Endoscopy

    What is Capsule Endoscopy?

    Capsule Endoscopy lets your doctor examine the lining of the middle part of your gastrointestinal tract, which includes the three portions of the small intestine (duodenum, jejunum, ileum). This part of bowel cannot be reached by traditional upper endoscopy or by colonoscopy. Your doctor will give you a pill-sized video camera for you to swallow. This camera has its own light source and takes pictures of your small intestine as it passes through. These pictures are sent to a small recording device you have to wear on your body.

    Your doctor will be able to view these pictures at a later time and might be able to provide you with useful information regarding your small intestine.

    Why is Capsule Endoscopy Done?

    The most common reason for doing capsule endoscopy is to search for a cause of bleeding from the small intestine. It may also be useful for detecting polyps, inflammatory bowel disease (Crohn’s disease), ulcers, tumors or other diseases of the lining of the small intestine.

    How Should I Prepare for the Procedure?

    An empty stomach allows for the best and safest examination, so you should have nothing to eat or drink, including water, for approximately twelve hours before the examination. Your doctor will tell you when to start fasting.

    Tell your doctor in advance about any medications you take including iron, aspirin, bismuth sub-salicylate products and other over-the-counter medications. You might need to adjust your usual dose prior to the examination.

    Discuss any allergies to medications as well as medical conditions, such as swallowing disorders and heart or lung disease.

    Tell your doctor of the presence of a pacemaker or defibrillator, previous abdominal surgery, or previous history of bowel obstructions in the bowel, inflammatory bowel disease, or adhesions.

    Your doctor may ask you to do a bowel prep/cleansing prior to the examination.

    What Happens After Capsule Endoscopy?

    You will be able to drink clear liquids after two hours and eat a light meal after four hours following the capsule ingestion. Avoid vigorous physical activity such as running or jumping during the study.

    What are the Possible Complications of Capsule Endoscopy?

    Although complications can occur, they are rare. If you develop unusual bloating, abdominal pain, nausea or vomiting, fever after the test, have trouble swallowing or experience chest pain, tell your doctor immediately. Be careful not to prematurely disconnect the system as this may result in loss of pictures being sent to your recording device.

  • Bravo pH Study

    An Overview
    This procedure allows us to accurately measure acid reflux for 48 hrs in the esophagus and to correlate the pH (acid level) with your symptoms. This could be very useful specially in patients who have non erosive GERD and LPR (ENT symptoms such as sore throat and chronic laryngitis without much of heartburn or other typical GERD symptoms).

    In this procedure, first an upper Endoscopy (EGD) is performed under sedation in the Endoscopy Suite to look at the esophagus, stomach and duodenum; the correct location for placement of the Bravo capsule is also determined. Then, the Bravo capsule is inserted through the mouth (while you are still sedated) and placed with a tiny pin into the esophageal wall at the correct location; you do not have tubes or wires coming out of your nose or mouth afterwards. This device can then measure acid reflux over 48 hours while you carry on with normal activities. The capsule will come loose and fall off on its own and is disposable (will come out with a bowel movement). No additional preparation is required other than what is needed for the endoscopy.

    What should you expect during and after the procedure?

    You will be sedated during the procedure and may not remember much of it. Afterwards you may be slightly groggy and should therefore have a driver to take you home. Some people have an awareness of “something” in the esophagus (feeding tube in the chest where the capsule is temporarily attached) especially during eating but patients generally tolerate it very well and do not usually have pain from the capsule.

    Instructions after the placement of the pH probe

    We encourage you to carry on with a normal day including eating and drinking normally as well as participating in all your usual activities. We do not want you to avoid things that make your reflux symptoms worse during this time. You will receive an instruction sheet when you are here for the study which will explain more of these things to you. You should not take over-the-counter antacids during the study but you need to decide with your doctor in advance if the test is to be done ON or OFF acid suppressive medications (such as Prilosec, Nexium etc). You should anticipate that you can NOT have an MRI after the capsule has been placed and for 30 days afterwards or until you are sure that the capsule has passed in your stools.

  • H. pylori Breath Test

    The rationale for performing this test is that when we eat certain fruits which contain fructose, up to a certain amount is absorbed by our intestine. People who are deficient in the enzyme for digestion and absorption of fructose in their intestine, the absorption of this sugar is poor and it is passed in the distal small bowel and colon resulting in excessive production of Hydrogen gas. This produces abdominal discomfort with crampy feeling, excessive flatulence.

    The exhaled Hydrogen gas is measured during the test and expressed in the units of parts per million (PPM).

    Instructions before the test

    1.         Fast overnight

    2.         No smoking on the day of the test

    3.         No vigorous exercise before or during test

    4.         Do not eat beans, bran, or high fiber cereals the day before the test

    5.         Do not take any antibiotics for two weeks before the test

    Procedure of the test

    You will be asked to blow through a small mouth piece which is connected to a small detecting device called MicroH2 meter. You will be then asked to ingest the required material and then again asked to blow in to the device a few times. The total procedure can be up to 2 ½ to 3 hrs based on the reading.

  • Lactulose Tolerance Test

    This test is performed to detect the presence of active h Pylori infection and also the detect the results of treatment for H Pylori. This test detects the urease enzyme, which secreted by H Pylori in the human stomach.

    Precautions prior to the test

    1. No food or drink for at least 1 hour before the test
    2. Pt should not have taken any antibiotics, PPI such as Prilosec and others in the class or  Bismuth preparations for 2 weeks prior to the performance of the test.
    3. Medications like Pepcid to be stopped at least 48 hrs. before the test
    4. Test should be performed at least 4 weeks after completion of H Pylori treatment.
  • Fructose Tolerance Test

    This test is performed to detect the presence of active h Pylori infection and also the detect the results of treatment for H Pylori. This test detects the urease enzyme, which secreted by H Pylori in the human stomach.

    Precautions prior to the test

    1. No food or drink for at least 1 hour before the test
    2. Pt should not have taken any antibiotics, PPI such as Prilosec and others in the class or  Bismuth preparations for 2 weeks prior to the performance of the test.
    3. Medications like Pepcid to be stopped at least 48 hrs. before the test
    4. Test should be performed at least 4 weeks after completion of H Pylori treatment.

Disease Education

  • Colon Cancer Screening

    Understanding Colon Cancer Screening

    Colorectal cancer affects an equal number of men and women. Many women, however, think of CRC as a disease only affecting men and might be unaware of important information about screening and preventing colorectal cancer that could save their lives, says the American Society for Gastrointestinal Endoscopy.

    Beginning at age 50, all men and women should be screened for colorectal cancerEVEN IF THEY ARE EXPERIENCING NO PROBLEMS OR SYMPTOMS. African American need to be screened beginning at age 45. Also, you may need to begin periodic screening colonoscopy earlier than age 50 years if you have a personal or family history of colorectal cancer, polyps or long-standing ulcerative colitis. Patients with African American background are eligible for colonoscopy at the age of 45 yrs.

    A colonoscopy screening exam is almost always done on an outpatient basis. Sedation is usually given before the procedure and then a flexible, slender tube is inserted into the rectum to look inside the colon. The test is safe and the procedure itself typically takes less than 20 minutes.

    Colorectal cancer is the third leading cause of cancer deaths in the United States. Annually, approximately 150,000 new cases of colorectal cancer are diagnosed in the United States and 50,000 people die from the disease. It has been estimated that increased awareness and screening would save at least 30,000 lives each year.

    Colon cancer is often preventable. Colonoscopy may detect polyps (small growths on the lining of the colon). Removal of these polyps (by biopsy or snare polypectomy) results in a major reduction in the likelihood of developing colon cancer.

  • Gastroesophageal Reflux Disease

    What is GERD?

    Gastroesophageal reflux disease is a disease involving the stomach and the esophagus (the muscular tube that carries food from the mouth to the stomach. Structurally and functionally, the esophagus, lower esophageal sphincter (a specialized sling of muscle at the end of the esophagus, before the stomach begins), and the stomach can be regarded as one unit. This whole unit is responsible for the proper entry of food into the duodenum. The esophagus can be considered as the pump, the LES as the valve, and the stomach as the reservoir. Any dysfunction in any part of the system, such as poor motility of the esophagus, an inappropriate relaxation of the sphincter, poor tone of the sphincter, a poor emptying of the stomach, or an unhealthy or heavy meal (to name some) can result in reflux.

    GERD can result in esophagitis with erosions and other complications, such as stricture, or narrowing, resulting in trouble swallowing. Sometimes the lining of the lower esophagus can become pre-cancerous. This is called Barrett’s esophagus. In about half the patients with GERD there are only symptoms and no finding on endoscopy. This is called non-erosive reflux disease.

    Weakness of the LES may only occur during certain periods of time throughout the day, or it may be a constant problem. It is also common to find a hiatal hernia complicating GERD. With a hiatal hernia, the upper part of the stomach pushes up into the chest through a weakness in the diaphragm. (The diaphragm is a thin, flat muscle that separates the lungs from the abdomen.) This causes stomach acid to be retained in that portion of stomach for a longer period of time and increases the likelihood of reflux into the esophagus.

    What are the symptoms?

    Frequent heartburn is the most common symptom of GERD. It is often described as an uncomfortable, rising, burning sensation behind the breastbone. Other symptoms like difficulty swallowing, regurgitation of sour contents into the mouth, hoarseness, repeated feeling of a need to clear the throat, wheezing or coughing, and sometimes chest pain can occur. Some people with GERD will notice that their symptoms occur or worsen after eating, when bending over, or when lying down.

    How is GERD diagnosed?

    GERD can be suspected when you have the characteristic symptoms. To confirm the diagnosis, several tests may be performed. However, the most useful test is an endoscopy. This exam helps determine the severity of the disease, how much tissue damage is there, and if there are any complications. Certain conditions, such as narrowing or stricture in the esophagus, can usually be corrected during this procedure. A biopsy can be taken during an endoscopy to look for signs of Barrett’s esophagus, a complication of GERD. Sometimes when difficulty swallowing is the main symptom, a barium swallow study may be ordered.

    What is the treatment?

    Lifestyle changes are the first step in the treatment of GERD. All patients with GERD should follow these recommendations: 1). Avoid eating anything within three hours before bedtime; 2). Stop smoking, nicotine weakens the LES; 3). Avoid fatty foods, milk, chocolate, spearmint, peppermint, caffeine, citrus fruits and juices, tomato products, pepper seasoning, and alcohol; 4). Decrease portions of food at mealtime and avoid tight clothing or bending over after eating; 5). Elevate the head of the bed or mattress 6 to 8 inches. Extra pillows by themselves are not very helpful; 6). Lose weight if you are overweight. This may relieve upward pressure on the stomach and LES.

    When symptoms are bad or GERD is moderate to severe, medications can be prescribed. One class of medications, H2 receptor blockers, includes Axid, Pepcid, Tagamet, and Zantac. Another class of medications, called proton pump inhibitors, includes Aciphex, Kapidex, Nexium, Prevacid, Protonix, and omeprazole (Prilosec and Zegerid). The latter group is typically reserved for very severe or erosive disease.

    Surgery is also an option in strengthening the LES through a procedure called fundoplication. However, this is only considered when all other conventional treatments have failed.

    What are the complications of GERD?

    The chronic inflammation in GERD can result in chronic changes in the lining of the esophagus. One very important complication that can occur is Barrett’s esophagus. Barrett’s esophagus is a condition in which the esophageal lining changes to become similar to the tissue that lines the intestine. It is more likely to occur in people who have had GERD since a young age, or have had a longer duration of symptoms. Dysplasia, a precancerous change in the tissue, can develop in any Barrett’s tissue. To diagnose Barrett’s esophagus, a biopsy is required. Barrett’s esophagus is an irreversible condition, so it is best prevented by early identification and treatment of GERD. If you have Barrett’s esophagus, an endoscopy and biopsy should be repeated every two to three years to check for dysplasia, or cancerous changes.

  • Hepatitis B

    What is Hepatitis B Virus?

    Hepatitis is a general term for inflammation of the liver. As a result of this inflammation, cells are damaged and eventually the function of the liver is altered. Hepatitis B virus (HBV) is a viral infection that causes inflammation of the liver. HBV can be a chronic, life-long infection that leads to complications, or, more commonly, a patient can recover from it completely.

    Hepatitis B virus is spread by contact with the blood or body fluids of someone already infected with HBV. Often it is spread by sexual contact, but can be passed to newborns doing delivery or in breast milk. In a large percentage of cases, it is unknown how the patient contracted the virus.

    Certain groups of people have a higher risk of contracting HBV, and therefore should take extra precautions and preventive measures, including taking the Hepatitis B vaccine: IV drug users, healthcare workers, funeral workers, police, people who live with an HBV infected person, people with multiple sexual partners, resident of nursing homes, hemophiliac and hemodialysis patients, prisoners and prison workers, travelers to underdeveloped countries, and for an ethnic groups such as Asians, Hispanics, American Indians, Alaska Natives, or people from developing countries.

    HBV is highly contagious. It can live outside the body on a dry surface for up to 10 days. It may take up to 6 months for the infection symptoms develop want a person gets the virus. There are three possible scenarios that happen when a person gets the hepatitis B virus: 1) most patients develop acute hepatitis B and recover completely; 2) small percentage becomes HBV carriers; 3) some develop chronic Hepatitis B.

    What are the symptoms?

    Acute hepatitis B can present with symptoms that include loss of appetite, nausea, vomiting, fever, aching muscles or joint pain, tenderness in the right upper abdomen, yellowing of the skin and eyes (jaundice), tea colored urine, and putty-like stool.

    People who are HBV carriers may never feel any symptoms and therefore do not know that they carry the virus. This is also possible with acute hepatitis B. People with chronic hepatitis B may also have no symptoms in the early stages, and any symptoms that develop later in the disease depend upon variety of factors.

    How is Hepatitis B diagnosed?

    When Hepatitis B Infection is suspected, it is diagnosed by a simple blood test. The results of the blood test help determine whether you have acute hepatitis B, chronic hepatitis B, an inactive carrier state, or resolved Hepatitis B.

    Tests such as an ultrasound and additional blood tests may be done to assess the function and condition of the liver. There is also a blood test they can determine which strain of the Hepatitis B virus you have. To assess the extent of liver damage (inflammation and scarring) in chronic HBV, a liver biopsy must be done.

    What is the treatment?

    In acute hepatitis, no specific treatment is needed. Only supportive measures should be taken to help the patient maintain strength and avoid straining the liver. Alcohol should be avoided in all cases, and sometimes certain medications should also be avoided.

    There are several medications approved for the treatment of chronic Hepatitis B infection. These include: Interferon, Peginterferonx alfa-2, Lamivudinex, Adeforvir, Entecavir, Telbivudinex anf Tenofovir. Patients on any of these medications must follow up very closely with the doctor to watch for any side effects or adverse reactions.

    A last resort in the treatment of chronic Hepatitis B is a liver transplant. This is reserved for very severe cases that have not responded to medications and/or that have severe liver damage or liver failure.

    Are there long-term complications of this disease?

    Long-term complications result from many years of chronic HBV. Ultimately chronic hepatitis B will lead to liver failure if untreated. There is also an increase of liver cancer, called hepatocellular carcinoma.

    Additional information

    Persons who have knowingly been exposed to the blood or body fluids of someone known to have hepatitis B should receive an injection of hepatitis B immune globulin as soon as possible, within two weeks of exposure. This will provide short-term protection for 3 to 6 months.

    As always, prevention is the best treatment. The hepatitis B vaccine provides for long term (possibly lifelong) protection and it’s available to anyone at risk for getting hepatitis B. It is also very important to take everything to avoid contact with blood and body fluids of anyone, especially HBV infected persons.

  • Hepatitis C

    What is Hepatitis C Virus?

    Hepatitis is a general term for inflammation of the liver. As a result of this inflammation, cells are damaged and eventually the function of the liver is altered. Hepatitis C is a viral infection that causes inflammation of the liver. HCV is usually a chronic, life-long infection that leads to complications, but rarely, can a patient recover from it completely. HCV is able to persist in the body because it is able to evade the immune system by changing its form. Hepatitis C patients do develop antibodies to the virus, but this immune response is inadequate to rid the body of the virus.

    Hepatitis C virus is spread by direct contact with the blood or by sometimes body fluids of someone already infected with HCV. The primary methods of HCV transmission are though infected blood, blood products and needles. Prior to the late 1980s, people were at most risk for contracting the disease through blood transfusions. Today all blood and blood products are tested for HCV, so the risk of transmission this way is very low. Currently, the most common people at risk are IV drug users who share needles. HCV can be spread by sexual contact, but the rest is much less than other viruses. & a large percentage of cases, it is known how the patient contracted the virus. There was no evidence that kissing, hugging, sneezing, coughing, sharing food, water, eating utensils or drinking glasses, casual contact, or other contact without blood exposure is associated with any significant transmission of the hepatitis C virus.

    What are the symptoms?

    Most patients with hepatitis C have no symptoms, especially early in the disease. Symptoms that occur are usually mild, such as flu-like symptoms, nausea, and fatigue. However, it is not uncommon for a person to have no symptoms even as the disease is progressing. The lack of symptoms does not mean the infection is under control.

    How is Hepatitis C diagnosed?

    The search for hepatitis C (and other hepatitis viruses) usually begins either on a routine testing of blood on a particular population or when routine blood tests show an elevation in certain liver enzymes, specially ALT.

    Tests such as an ultrasound and additional blood tests may be done to assess the function and condition of the liver. More blood tests will be needed after your visit to our office before request can be made for the approval of appropriate medication for you.

    What is the treatment?

    At this time, we have extremely effective medications with minimal side effects without the need for any injections as was the case in recent past. Only after your evaluation appropriate medication will be prescribed and request sent to insurance for approval of the drug.

    Life style modification is quite important. Weight loss and avoidance of smoking and alcohol are strongly suggested.

    Be vaccinated against Hepatitis A and B. Also get a Pneumococcal (pneumonia) vaccine along with yearly influenza vaccines. Review all of your prescription and over-the-counter medications with your doctor because some may worsen damage to the liver in HCV patients.

    A last resort in the treatment of chronic hepatitis C is a liver transplant. This is reserved for very severe cases that have not responded to medication and/or that have severe liver damage and liver failure.

    Are there long -term complications of this disease?

    It may take anywhere from 10 to 40 years of HCV infection to develop serious liver damage. Some patients will develop cirrhosis, or scarring, of the liver. As the degree of cirrhosis increases, it becomes more difficult for the liver to perform its function. In patients with cirrhosis, a small percentage will go on to develop liver cancer called hepatocellular carcinoma.

    Additional Information

    There is no vaccine currently available to prevent HCV infection. Therefore, precautions should always be taken to prevent a possible spite of the virus. This includes not sharing anything that is likely to hold and transmit blood (razors, manicure tools, toothbrushes, and specially IV drug needles). Avoid ear piercing and tattooing in places were sterile conditions are questionable always avoid contact with blood and body fluids from infected individuals.

  • Colonic Polyps

    What are colon polyps?

    Colon polyps, which are usually found on a colonoscopy, are abnormal growths of the tissue that lines the colon, or large intestine. Polyps can occur elsewhere in the digestive tract, but the colon is the most common location. They vary in size and shape, and a person may have multiple polyps.

    Polyps are very common in adults, and the chance of polyp formation increases with age. It is still unclear what causes polyps to form, however, in some cases there appears to be a genetic factor. Some risks associated with polyp formation include: age 50 or older, family history of polyps or colon cancer, and personal history of previous polyp(s) or colon cancer.

    There are two main types of polyps: hyperplastic and adenomatous (which could be range from tubular adenoma, to tubulovillous ademona, to villous adenoma with the increasing potential for malignancy in that order). The only way to tell the difference between these two types is to remove and biopsy the polyp. After it is removed, the polyp is sent to the laboratory where it is closely examined under a microscope for evidence of cancer.

    What are the symptoms?

    Most polyps cause no symptoms. Large polyps can cause blood to appear in the stool, either visibly or microscopically, and can sometimes interfere with stool passage. Because most polyps cause no symptoms, the only way to detect them is by screening via colonoscopy.

    How are colon polyps diagnosed and removed?

    Most polyps found during colonoscopy can be completely removed (called polypectomy). Removal typically involves severing or burning them with a wire loop at the base of the polyp. The polyp is then sent to the laboratory for evaluation. Removal of polyps does not cause discomfort.

    Removal of colon polyps carries a slight risk of complications, which occur very rarely. Possible complications include: bleeding from the polypectomy site, and perforation, or tear, in the colon wall. Bleeding from the polypectomy site can be immediate or delayed for several days. Persistent bleeding can usually be stopped by treatment during a colonoscopy. Perforations usually require surgery to repair.

    How often do I need a colonoscopy if I have polyps removed?

    Patients who have had polyps removed require more frequent follow-up than those who never had any polyps. Colonoscopy is usually to be repeated after two to three yrs based on the type, number and size of the polyp removed.

    Additional Information

    Something to remember: Screening for colon polyps is screening for colon cancer! Because some polyps may later develop into colon cancer, routine colonoscopies are the key to the prevention and early detection colon cancer.

    Screening should begin earlier if you have a personal or family history of colorectal cancer, polyps, rectal bleeding, or long standing inflammatory bowel disease such as ulcerative colitis or Crohn’s disease.

  • Diverticulosis

    What is diverticulosis?

    Diverticulosis is a condition involving the formation of small pockets (diverticuli) extending out from the colon, or large intestine. The colon starts in the right lower abdomen, goes across the upper abdomen, and down the left side to the sigmoid colon. The sigmoid colon is a high pressure section of the colon that moves stool into the rectum. It is here that most diverticuli occur. Diverticuli occur at weak points in the bowel wall and develop over a long period of time. Prevalence of diverticulosis increases from less than 20% at age 40 to 60% by age 60.

    What are the symptoms?

    There are few noticeable symptoms with diverticulosis. Except for an occasional intermittent spastic discomfort in the lower abdomen, there are usually no symptoms unless a complication occurs. When diverticulosis is extensive, the lower colon can become fixed, distorted, or narrowed. This may result in pain, and/or a change in stool form or bowel habits. Constipation and diarrhea can occur in this situation, and stool can be thin or pellet-shaped. At times, bleeding can occur from a ruptured blood vessel in diverticuli.

    How is diverticulosis diagnosed?

    The diagnosis might be suspected if you are having pain in the lower abdomen. Uncomplicated diverticulosis is usually an incidental finding that is seen during a colonoscopy, which is done for routine screening or to diagnose a problem. In the test a long tube containing a camera is inserted into the rectum, allowing the doctor to visualize the inside of the colon. A barium study can be done to diagnose and determine the extent of the disorder, although it is not done frequently. This test involves administration of an enema containing dye, and images are taken as it moves through the colon.

    What is the treatment?

    All along it has been believed that diverticulosis may be prevented by a diet high in fiber, bran, roughage, and water content. The recommended daily intake of bran and fiber is about 20 to 30 grams. Stool bulking agents, such as psyllium and methylcellulose, are useful in creating a larger and softer stool that is easier to pass. There has been a practice of avoiding seeds and nuts in diverticulosis, but there is no proof that this practice reduces incidence of diverticulitis. These treatments may be beneficial when diverticulosis already exists, because they can prevent further progression of the problem. Sometimes, a medication is needed to relieve bowel spasms that can increase pressure in the colon, leading to diverticula formation.

    Are there long term complications of this disease?

    There are many bacteria that naturally live in your digestive tract and perform functions that are beneficial to the digestive process. Occasionally these “good” bacteria or other disease-causing bacteria can cause an infection inside of the diverticuli. This infection, termed diverticulitis, can cause pain in the left lower abdomen. This is diagnosed by clinical examination and usually confirmed by a CT scan of the abdomen. Diverticulitis requires a treatment of antibiotics and temporary avoidance of food until healing begins. In severe cases of diverticulitis, a patient may need to be hospitalized. If untreated, diverticulitis can lead to a rupture of the diverticuli, spilling the infectious contents into the abdomen. This is a severe complication, and surgery is typically needed in this setting.

    Additional Information

    Diverticulosis alone is not a major cause for concern. Many people have diverticuli in their colon and do not realize it. Prevention is the best treatment for diverticulosis. By maintaining a diet high in fiber, bran, roughage, and water over a long period of time, you may help to prevent the formation of new diverticuli. Also, such a diet will help prevent constipation, which contributes to diverticuli formation. If you have frequent constipation, you should discuss this with your doctor to find the appropriate treatment.

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