Is There A Way To Transfer A Patient With Achalsia To The GI Department At Penn Medicine?

Question:
My father is in the hospital because he is unable to eat or hold down much of anything. He may be released as they cannot find the cause. His problem seems to be more in the esophagus than stomach or other organs, as he regurgitates within minutes of eating even a few bites. This hospital has sent him for physical rehabilitation twice, only to be sent back each time with infections. My father's symptoms started in spring 2008 and lasted for three month before going into remission until November.

In December, he had catheter ablation and a bladder stone removed. During this time he has been either in the hospital or physical rehab, growing weaker due to not being able to eat. Your article on achalasia seems to match his problem, but his hospital has never mentioned or tested for it. Is there a way to transfer him to Penn where your GI department has more resources?

Answer:
The esophagus is the tube that carries food, liquids and saliva from the mouth to the stomach. There are a number of possible esophagus disorders including:

• Esophageal spasm – muscle contractions.
• Esophageal stricture – narrowing of the esophagus.
• Esophagitis – inflammation, irritation, or swelling of the esophagus.
• Achalasia– a rare disorder involving the muscular ring where the esophagus and stomach come together.
• Esophageal cancer

Treatment depends on the problem. Some get better with medications or changes in diet. Others may need surgery. David Metz, MD, is a Penn gastroenterologist who specializes in motility and bowel disorders.

To schedule an appointment with Dr. Metz, please call 800-789-PENN (7366) or you can also request an appointment online.

Does Prevalite Help Patients With Chronic Diarrhea?

Question:
My 78 year-old mother was prescribed Prevalite® for chronic diarrhea. Since Prevalite® is a cholesterol-lowering drug that can cause constipation, I question its use to treat daily loose bowels.

Answer:
Prevalite® is a cholesterol-lowering drug, but it also is used to treat patients who have diarrhea related to excess fecal bile acids. It is used because it has the ability to bind the acids in bile, which relieves chronic diarrhea. A Penn gastroenterologist can give a second opinion and prescribe treatment for your mother.

Please call 800-789-PENN (7366) or request an appointment online.

What Are The Treatment Options For Bowel Incontinence?

Question:
I have symptoms that started with gas and bloating, and have progressed to feces escaping uncontrollably – sometimes loose, sometimes solid. I have acid reflux and take Nexium®. I am also anemic. I had a colonoscopy and celiac has been ruled out. They found mild inflammation, but nothing they could pinpoint as anything specific. I've tried both Dicetel® and Modulon® with no real improvement. Can you make any suggestions?

Answer:
Short-term diarrhea and loss of bowel control (bowel incontinence) are commonly associated with the flu or food poisoning. Persistent bowel incontinence can be the result of a number of causes including constipation and damage to the muscles that control bowel movements. Chronic diarrhea – loose or frequent stools lasting more than four weeks – can be an indication of a more serious condition.

If celiac disease has been ruled out, your gastroenterologist may choose to administer an endoscopy test for inflammatory bowel disease (IBD) – another common cause of chronic diarrhea. IBD is usually accompanied by abdominal pain. David Metz, MD, is a Penn gastroenterologist who specializes in motility and bowel disorders.

To schedule an appointment with Dr. Metz, please call 800-789-PENN (7366) or you can also request an appointment online.

What Are The Treatment Options for Colonic Intertia?

Question:
I have been diagnosed with colonic inertia and a sphincter problem. I have seen multiple GI doctors and surgeons — no one seems to have an answer to this other than an ileostomy. I am looking for another route. I have been to sphincter therapy at Penn Medicine Radnor. They tell me my sphincter is working, but the biofeedback checks "holding in" and not "pushing out." My quality of life has been greatly affected for the past two years. Any suggestions would be greatly appreciated.

Answer:
Colonic inertia is a type of functional constipation caused by a decrease in muscle activity in the colon. Functional constipation means that the bowel is healthy but not working properly. It stems from problems in the structure of the anus. These abnormalities result in an inability to relax the anal sphincters – the rectal and anal muscles that allow stool to exit. An ileostomy procedure is a type of ostomy surgery in which a surgeon removes the colon and rectum, and attaches the bottom of the small intestine to the stoma (an opening in the abdomen), bypassing the bowel. David Metz, MD, is a Penn gastroenterologist who specializes in motility and bowel disorders.

To schedule an appointment with Dr. Metz, please call 800-789-PENN (7366) or you can also request an appointment online.

What Are The Treatment Options For Severe Bloating And Flatulence?

Question:
I get really bad gas, bloating and flatulence almost every afternoon and into the night. I was originally diagnosed with constipation so I changed to a high fiber diet and also started taking the supplements Metamucil® and miraLAX®.

Now, I usually have a bowel movement every morning without a problem, but the high fiber diet gave me more gas and bloating. The laxatives originally worked, but then they gave me diarrhea. Now I have stopped with the high fiber diet and the laxatives. I still get the bloating and gas in the afternoons and I do not know what to do. Can you recommend a prescription or test for me?

Answer:
Most people produce one to four pints of gas a day and pass gas about 14 times a day. Passing gas through the mouth is called belching or burping. Passing gas through the rectum is called flatulence. Most of the time, gas does not have an odor. The odor comes from bacteria in the large intestine that release small amounts of gases that contain sulfur.

Gas in the digestive tract comes from two sources: air that you swallow and the breakdown of undigested food by bacteria in the large intestine. Certain foods may cause gas, including many fruits and vegetables. Foods that produce gas in one person may not cause gas in another. For people with lactose intolerance, avoiding milk products will help. For most people, changing their diet and using a prescription or over-the-counter medication helps alleviate excessive gas. A Penn gastroenterologist can help you with diet and medication decisions related to chronic gas and bloating.

To schedule an appointment, call 800-789-PENN (7366) or request an appointment online.

What Are The Treatment Options For Abdominal Pain In Patients With Type 1 Diabetes?

Question:
I am a type 1 diabetic and have been since 1972. For years I have had minor pain in my lower left abdomen, but not enough to mention. Now, ever since I had the intestinal bug that was going around, I have been having pretty bad pains. I want to get checked out but don't know what doctor to request. Can you help?

 

Answer:
Pain in the abdomen doesn't always mean a serious problem but if it lasts more than a week, you should see a health care provider. Seek medical help immediately if you experience any of the following:

• abdominal pain that is sudden and sharp
• additional pain in your chest, neck or shoulder
• a stiff, hard abdomen that is tender to the touch
• blood in your stool or vomit
• inability to move your bowels (especially if you are also vomiting)

I recommend starting with your primary doctor as that person knows you best. If you have abdominal pain, your primary doctor may well consider referring you to a Penn gastroenterologist after evaluating your history, physical tests and an appropriate examination. If you are over 50 or have a family history of colorectal cancer, you should also think about having a colorectal cancer screening performed. David Metz, MD, is a Penn gastroenterologist who specializes in motility and bowel disorders.

 

To schedule an appointment with Dr. Metz, please call 800-789-PENN (7366) or you can also request an appointment online.

Why am I Having Trouble Swallowing after Recieving a Fundoplication Surgical Procedure?

Question:
I had fundoplication surgery for Barrett's esophagus in 2003 at Penn Presbyterian Medical Center. I get a routine endoscopy every year to check the Barrett's. However, I am noticing that I am having trouble swallowing again even with liquids. What does this mean?

Answer:
There are many possible causes for difficulty swallowing. If you don't already take medication, this may be something that can help. If you do take medication, it may need to be adjusted. It would be beneficial for you to see a gastroenterologist who can evaluate your new symptoms as well as your medical history. Gary Falk, MD, is a renowned gastroenterologist in Barrett's esophagus and medical and surgical therapy. Dr. Falk is joining Penn Medicine in January 2010, and he can evaluate your case and recommend a course of treatment.

To make an appointment, please call 800-789-PENN (7366) or request an appointment online.

Need Diagnosis for Bloating and Irregular Bowel Movements

Question:
I'm constantly bloated. I have irregular bowel movement and there is a lump formed by the left side of my pelvis. What could be the problem?

Answer:
I recommend starting with your primary doctor. The lump may or not be the result of a gastrointestinal problem. Your doctor knows you best and based on the details of your symptoms, he or she can help diagnose the problem and if necessary, refer you to Penn Gastroenterology.

Can a Gastric MALT Lymphoma be Treated with Lasers?

Question:
I have recently been diagnosed with a gastric MALT lyphoma (4cm mass). I have recently finished a three-week course of antibiotics and will soon go for my next endoscopy. I am interested in getting a second opinion on my treatment, depending on the results of the scope.

I still have symptoms — upset stomach and pressure in my throat. Can the mass be treated with lasers? Are there any other treatment options? Also, have you seen many MALT patients with a history of celiac? My mother has celiac, but so far I have tested negative.

Answer:
Cancer affecting the mucosa-associated lymphoid tissue (MALT) in the stomach, or “gastric MALT lymphoma,” is a rare type of non-Hodgkin lymphoma characterized by B lymphocytes, a type of immune cell, that slowly multiply in the stomach lining. MALT lymphomas account for approximately 4 percent of all cases of lymphoma. It is caused by a Helicobacter pylori bacteria infection. Even when fully developed, treating the infection with antibiotics can cause the lymphoma to shrink or even completely disappear.

Often, however, these lymphomas recur after apparently successful antibiotic treatment, and chemotherapy or radiation therapy is then needed. The antibiotic Rituxin is another option. Beginning in 2009, the Roberts Proton Therapy Center at the Perelman Center for Advanced Medicine will provide state-of-the-art proton radiation therapy for gastrointestinal cancer patients. Proton therapy is more accurate and the side effects are less severe than conventional radiation therapy.

To schedule a second opinion consultation with a Penn gastroenterologist, please call 800-789-PENN (7366) or request an appointment online.

Is There A Test That Can Examine The Motility Of Air And Food Being Trapped In The Stomach And Colon?

Question:
I have chronic belching coming from my stomach. I have horrible chest pains, but when I push my chest forward it seems to release the gas and relieve some of the pressure.

I have been to five gastroenterologists and have had a colonoscopy, barium swallow, endoscopy, Helicobacter pylori test, pH study, abdominal CT scan, heart stress test and pulmonary test –- all with normal results. Is there a test that can watch the motility of air and food being trapped in my stomach and colon?

Answer:
David Ingis, MD is a Penn gastroenterologist who can evaluate your symptoms and recommend next steps. To make an appointment, please call 800-789-PENN (7366) or request an appointment online.

What Are The Treatment Options For Esophageal Varices?

Question:
My sister was diagnosed with esophageal varices for which she had banding done to stop the bleeding. Since then, she has been in and out of the hospital for tests and abdominal pain. Her platelet levels have been low ever since and she was told she will never be able to have children, because it would kill her. She takes Nadolol® 20mg daily. Is there something she can do?

Answer:
Esophageal varices are abnormally enlarged veins in the lower part of the esophagus, usually caused by liver disease. Esophageal varices develop when normal blood flow to the liver is blocked, and backs up into the esophagus. Patients experience abnormal bleeding. There are a number of conditions that can cause esophageal varices, so I recommend that your sister consult with a physician to determine the cause of this disorder and to look into treatment options in addition to medication to stop the bleeding.

A Penn gastroenterologist would be happy to consult with your sister. Maarouf Hoteit, MD, specializes in esophageal varices and can provide a consultation. To make an appointment, please call 800-789-PENN (7366) or request an appointment online.