University of Pennsylvania Health System

Penn Gastroenterology Q&As

Monday, October 31, 2011

Why Would A Video Capsule Endoscopy Produce No Useful Pictures?

Question:
My husband recently had a video capsule endoscopy and the report says it took only 14 minutes to pass through his small intestine and no useful pictures were produced. He did a colon prep the night before, but did not have any diarrhea that day. Can this be accurate? What would cause this to happen?

Answer:
Video capsule endoscopies or "wireless" endoscopies are a relatively new procedure introduced in 2001 to help diagnose small bowel diseases or disorders. It is performed by swallowing a capsule, which contains a tiny camera. The patient wears a data recorder and as the capsule makes its way through the digestive system, it transmits up to two pictures per second.

The capsule can transmit information for up to eight hours and the capsule is excreted normally and painlessly usually within 10 to 48 hours of ingesting. Certain situations can cause difficulty transmitting pictures, but it is unlikely that the capsule passed through the small bowel in just 14 minutes. David Jaffe, MD and Nuzhat Ahmad, MD are both Penn gastroenterologists who perform capsule endoscopies.

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

Thursday, October 27, 2011

Do Physicians At Penn Medicine Use The MRCP Test?

Question:
My wife has a GI problem and we are having a hard time getting a diagnosis. She is allergic to contrast dye so we are looking at the MRCP test. She has appointment at Penn in June. Do you use the MRCP test?

Answer:
Abdominal magnetic resonance imaging (MRI) is sometimes used as a diagnostic test alternative for patients who have iodine-related allergic reactions. An abdominal MRI provides detailed pictures of the belly area from many different views. MRCP (magnetic resonance cholangiopancreatography) is a type of MRI that provides a view of the bile ducts, pancreatic duct and gallbladder. Your wife's Penn gastroenterologist will work with you to determine what testing is most appropriate for her condition.

Wednesday, October 26, 2011

Do Physicians At Penn Medicine Use The Double-Balloon Endoscopy?

Question:
I have read that the double-balloon endoscopy gives doctors greater ability to diagnose and treat GI disorders. Does Penn use the double-balloon endoscopy?

Answer:
Yes, Penn Gastroenterology uses the double-balloon endoscopy (DBE). A technique similar to an upper endoscopy and colonoscopy, DBE has the added benefit of inserting a scope down through the mouth or up from the colon. Two balloons help anchor the scope to the intestine as it inches along – allowing it to travel a greater distance. DBE allows us to visualize most, if not all of the small intestine and assists with intervention as well.

Monday, October 24, 2011

What Tests Should Be Done For Patients With High Serotonin Levels?

Question:
What tests should be done when one has a high serotonin level? Is a gastroenterologist the right specialist to be consulted?

Answer:
The serum serotonin blood test – used to measure the serotonin level in the body – can fluctuate, but may indicate a carcinoid tumor. Additional blood and/or urine tests are used to diagnose this condition. Carcinoid tumors are rare, but if left untreated, can lead to carcinoid syndrome – a form of cancer. Carcinoid tumors usually develop in the gastrointestinal tract, but can also develop in the lungs and in very rare cases, the ovaries. A Penn gastroenterologist can evaluate your condition and risk factors for carcinoid tumors. As with all potential cancers, early diagnosis is important.
To schedule an appointment, please call 800-789-PENN (7366) or you can also request an appointment online.

Friday, October 21, 2011

Are Penn Physicians Familiar With Performing Esophageal Strictures?

Question:
Are any Penn physicians familiar with using stents to widen a stricture in the esophagus? I have been told by my doctors that it would be risky to use the balloon dilation in my case because the tissue has been radiated and chance of perforation to the esophagus would be high. I had radiation from tonsil cancer and a neck dissection about eight years ago.

The stricture is approximately 8 - 10 mm wide and I eat mostly creamed soups - it takes about an hour for each meal and I feel like I may choke at least once a day. What risks would be involved trying to dilate with a stent and do you think the risks would outweigh the benefits for me? I am now in remission and would like to better my quality of life.

Answer:
An esophageal stricture – or narrowing of the esophagus – can be caused by several conditions, including radiation treatment. Esophageal dilation is a procedure that stretches a narrowed area of the esophagus. Various techniques are used for this procedure and advances in stent technology and balloon dilation provide new options for treatment. A Penn gastroenterologist can evaluate your condition and recommend the best treatment, as well as advise you of the risks involved.

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

Tuesday, October 18, 2011

Is A Calcified Granuloma In The Liver Harmful?

Question:
Is a calcified granuloma in the liver harmful? Can it become cancerous?

Answer:
A calcified granuloma located in the liver, known as a hepatic granuloma, indicates it has been there for a significant amount of time. A granuloma can be located anywhere in your body and it consists of built up scar-tissue. Hepatic granulomas can be caused by infection, liver disorders, systemic disorders or drugs and do not typically lead to cancer. Diagnosis of the underlying cause of the granuloma can be achieved through a liver biopsy or through cultures, lab tests, imaging tests and tissue specimens. Karen Krok, MD, is a Penn hepatologist specializing in liver diseases who can evaluate, diagnose and appropriately treat a hepatic granuloma.

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

Monday, October 17, 2011

Can A Patient With Hepatitis B Develop Hepatitis C Antibodies Without Having the Virus?

Question:
If someone has had hepatitis B, is it more likely for hepatitis C antibodies to be present without necessarily having the hepatitis C virus?

Answer:
Hepatitis B and hepatitis C are both diseases of the liver that cause irritation and swelling. When your body identifies this type of virus, it builds a specific antibody to fight off the infection. Liver damage associated with hepatitis B results mainly from antibody cells that can cause liver inflammation. Hepatitis C often does not cause symptoms until the liver has been permanently scarred – this is known as cirrhosis. It can be detected in routine physical or medical procedure blood tests.

That being said, hepatitis B and hepatitis C are two separate diseases. Previously having hepatitis B would not make it more likely for hepatitis C antibodies to be produced. If hepatitis C antibodies are present, it would mean that at some point you were infected with hepatitis C. Thomas Faust, MD is a Penn hepatologist specializing in diseases of the liver.

To schedule an appointment with Dr. Faust, please call 800-789-PENN or request an appointment online.

Thursday, October 13, 2011

Do Liver Hemangiomas Ever Shrink On Their Own?

Question:











I have a 7-centimeter liver hemangioma. Do these ever shrink on their own?











Answer:











A hepatic hemangioma, or hemangioma of the liver, is a noncancerous liver tumor consisting of dilated blood vessels. It is believed to be a birth defect and is usually not discovered until medical pictures are taken of the liver for some other reason. In rare cases, hemangiomas may cause bleeding or interfere with organ function, depending on their location.











Most hepatic hemangiomas are treated only if there is persistent pain. No medical therapy is known to reduce the size or eliminate hepatic hemangiomas — surgical removal is the only treatment. A Penn hepatologist, a physician specializing in diseases of the liver, can evaluate your condition.











To schedule an appointment, please call 800-789-PENN or request an appointment online.

Wednesday, October 12, 2011

What Are The Treatment Options For Patients With High Cholesterol?

Question:
My husband is 42 years old, overweight and was taking Lipitor®. Due to liver function test results, he was taken off the medicine last year. He's been off of it for over eight months and his levels are still high. He had a CT scan of the abdomen and pelvis – the contrast was normal. His doctor doesn't know why the levels are still high. Do you have any suggestions as to what can be going on? What is the next step?

Answer:
Lipitor® is an atorvastatin medication. It is used together with lifestyle changes (diet, weight-loss and exercise) to reduce the amount of cholesterol and other fatty substances in the blood. Atorvastatin works by slowing the production of cholesterol in the body. For a small number of patients, atorvastatin can cause liver problems. There are a number of liver function blood tests used to diagnose liver problems. It is important to diagnose liver disease early, as beginning stages may show no noticeable symptoms to the patient. Your husband's doctor may consider referring him to a Penn gastroenterologist for further testing.

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

Monday, October 10, 2011

Are There Physicians At Penn Medicine Who Specialize In Liver Tumors?

Question:
I am a 43-year-old female with an asymptomatic liver hemangioma, which has grown over the past five years. It has been suggested that I be evaluated by a gastrointestinal liver specialist. Is there a physician in your practice that specializes in evaluation of liver tumors – specifically hemangioma?
Answer:
A hepatic hemangioma is a noncancerous liver tumor made of dilated blood vessels. Believed to be a birth defect, it is the most common noncancerous tumor of the liver. Hepatic hemangiomas can occur at anytime, but are most common in women age 30 to 50. Most hepatic hemangiomas are treated only if there is persistent pain, bleeding or interference with other organ functions. Dr. Faust is a Penn gastroenterologist who specializes in liver disease. He sees patients at the Hospital of the University of Pennsylvania and at Penn Medicine Radnor.

You can schedule an appointment with Dr. Faust by calling 800-789-PENN (7366) or you can also request an appointment online.

Thursday, October 6, 2011

What Are The Treatment Options For Diarrhea And Intestinal Cramping?

Question:
I have had diarrhea preceded by intestinal cramping for the last two weeks. I am 60 and have no history of cancer in my family and no nausea at all. My general physician took a stool sample, which was negative for both parasites and blood. Normally I have two to three episodes during the night, but remain asymptomatic all day. I limit my food to bananas, Gatorade® and toast, and I avoid dairy. During the day, I can perform regular functions.

Answer:
Diarrhea that does not improve after two weeks is considered chronic. The biggest risk of chronic diarrhea is dehydration, so make sure you drink a lot of water and stay as hydrated as possible. I recommend you see a gastroenterologist if your problem does not improve. There are many possible causes of chronic diarrhea and a gastroenterologist can review your symptoms, run further tests, diagnose and treat the cause. If you would like to schedule an appointment with a Penn gastroenterologist, David Ingis, MD can consult with you and recommend next steps.

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

Tuesday, October 4, 2011

Are There Physicians At Penn Medicine Who Specialize In Gastroparesis?

Question:
After a gastric emptying scan, my son was diagnosed with gastroparesis. I am unable to find a gastroenterologist who can treat it. I am from the New Jersey/Pennsylvania area, but I currently live in Florida. We tried another prominent health care organization, but it was quite a disappointment. Do you have any suggestions?

Answer:
Penn gastroenterologists evaluate and treat patients with motility disorders like gastroparesis. David Metz, MD is a Penn gastroenterologist specializing in motility disorders. Dr. Metz sees patients at the Perelman Center for Advanced Medicine.

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

Saturday, October 1, 2011

What Are The Treatment Options For Patients With Chronic Constipation Following A Total Abdominal Colectomy?

Question:
I am a 30 year-old female who had a total abdominal colectomy done for colonic dysmotility. Since the surgery, I have had chronic constipation to the point that I've needed a hemorrhoidectomy and sphincterotomy. I have abdominal pain all of the time. I've tried high fiber, medication, enemas and so on. Do you have any suggestions?

Answer:
With such an involved medical history, it is difficult to say what might reduce your abdominal pain. David C. Metz, MD is a Penn gastroenterologist specializing in motility and bowel disorders. He can review your case and recommend treatment for your condition.

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