University of Pennsylvania Health System

Penn Gastroenterology Q&As

Tuesday, January 31, 2012

What Does A Vascular Pattern In The Hepatic Flexure Mean?

Question:
I had a colonoscopy today that was normal. On the comments, the doctor wrote, "A vascular pattern found in the hepatic flexure, transverse colon, descending colon and sigmoid colon."

Answer:
Since your colonoscopy was normal, then the vascular pattern found in the hepatic flexure, transverse colon, descending colon and sigmoid colon are not a cause for concern.

If you would like further explanation of the procedure or a second opinion on your findings, you can schedule an appointment with one of our Penn gastroenterologists specializing in colonoscopies by calling 800-789-PENN (7366) or you can also request an appointment online.

Thursday, January 26, 2012

Does Penn Medicine Have Treatments For Food Allergies?

Question:
Do you test and treat for food allergies such as gluten intolerance?

 
Answer:
Gluten intolerance is a lifelong disorder also known as celiac disease, an inherited, autoimmune disease. Celiac disease occurs when there is damage to the small bowel from consumption of gluten, wheat, barley, rye and possibly oats. In the small bowel there are threadlike projections called villi, which absorb nutrients from food we ingest. If left untreated, these villi become flattened and can not absorb nutrients properly.

 
There are several ways to diagnose celiac disease, such as:

The only treatment for Celiac disease involves elimination of gluten, wheat, barley and rye from your diet. Geoffrey Spencer, MD is a Penn gastroenterologist specializing in the diagnosis and treatment of celiac disease, please call 800-789-PENN (7366) or request an appointment online.

Wednesday, January 25, 2012

What Treatment Options Exist For Patients With Dysphagia?

Question:
A family member is in his early sixties and has not been able to eat for almost two months. He has a feeding tube because he cannot eat anything without food entering his lungs instead of his stomach. Prior to his eating trouble, he discovered he had suffered from two strokes without knowledge of them at the time. He had an episode of fainting because his blood pressure dropped and soon after that his inability to eat began.

He has visited two different hospitals and been hospitalized for six weeks without an answer. He has lost a significant amount of weight and just wants help. Could you tell me what we should do and who we should see at Penn?

Answer:
Difficulty swallowing is a condition also known as dysphagia.

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

Tuesday, January 24, 2012

What Is The Expected Outcome For Patients With Severe Pancreatitis?

Question:
My father has pancreatitis with cysts on the pancreas and a blood clot in his lung. He is in severe pain and being treated with Coumadin®, antibiotics and morphine for pain. What is normally the outcome of such severe pancreatitis, and what should we expect along the road to recovery?

Answer:
Pancreatitis is inflammation of the pancreas – an organ whose function is to release certain hormones and help with digestion. Cysts on the pancreas are a complication of chronic pancreatitis, meaning there is long term inflammation. This inflammation causes irreversible scarring of the pancreas, inhibiting its production of enzymes to digest food. The treatment for chronic pancreatitis is pain medication and rest. Abstaining from solid food gives the pancreas a break from producing the enzymes needed for absorption, which can help relieve severe episodes of pain. In some cases, surgery is required to remove the pancreatic cysts or to remove dead pancreatic tissue. Nuzhat Ahmad, MD and Gregory G. Ginsberg, MD are Penn gastroenterologists who specialize in pancreaticobiliary disease.

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

Thursday, January 19, 2012

Need A Diagnosis For Gastrointestinal Pain

Question:
I've been having a lot of pain on my right side, which a nurse practitioner thinks may be deferred pain from cysts that I have. My ob/gyn doesn't think the cysts are large enough to hurt, so I'm getting another test. Do you think it could be gastrointestinal pain?

Answer:
There are many different problems that could cause pain on your right side, but if you are experiencing severe abdominal pain you should seek prompt medical attention. Tracking the following information will help your doctor form a diagnosis:
  • When you have pain
  • Exactly where the pain is located
  • Type of pain (such as aching, stabbing, throbbing or cramping)
  • How long the pain lasts
  • What triggers the pain
  • What helps relieve the pain
  • How the pain affects you (such as limiting activities or missing work)
Kashyap Panganamamula, MD is a Penn gastroenterologist can evaluate your condition and recommend the best treatment.
To make an appointment, please call 800-789-PENN (7366) or you can also request an appointment online.

Wednesday, January 18, 2012

Does Radnor Penn Medicine Perform Capsule Endoscopies?

Question:
Do you perform capsule endoscopies at Penn Medicine Radnor?

Answer:
Unfortunately, capsule endoscopies are not done at our Radnor location. David Jaffe, MD is a Penn gastroenterologist who performs capsule endoscopies at the Hospital of the University of Pennsylvania. Capsule endoscopies are also performed at Penn Presbyterian Medical Center.

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

Monday, January 16, 2012

How Can I Alleviate Problems Resulting From Gastrostomy Tube Usage?

Question:
I had a G-tube put in two weeks ago. Now I experience mental fatigue and confusion constantly, which gets worse when I use the tube. I have tried varying supplements and amount of food and calorie intake. I've even tried continuous feeding. My symptoms improve somewhat when the time between meals is greatest and get worse whenever food enters the stomach. I don't understand what is happening or how to correct the problem. How can this be remedied? Are there sub-specialists who deal with such issues?

Answer:
The gastrostomy tube (G-tube) is a type of feeding tube insertion in which a tube passes through the skin and the stomach wall, directly into the stomach. A feeding tube transports liquid nutrition to the stomach. The G-tube is a more permanent type of feeding tube and is used for many patients that have difficulty swallowing. Following a G-tube insertion, the stomach and abdomen generally heal in 5 to 7 days.

In most cases, pain is managed with medications. If you are taking new medications for pain, check with your doctor about any possible adverse reactions to the medications you are already taking. Alternatively, the symptoms you describe may be caused by not getting enough nutrition from your feedings or the feeds may be causing the dumping syndrome characterized by sweating, belly discomfort, low blood sugar and diarrhea. Dumping is caused by undigested sugars flooding the small bowel and may occur with highly concentrated feedings being delivered too quickly.

Check with your gastroenterologist to ensure your G-tube is functioning correctly and you are using the correct type and amount of nutritional formula. Penn gastroenterologists are experienced in both the insertion of feeding tubes and care for patients with feeding tubes.

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

Friday, January 13, 2012

Need Diagnosis For Frequent Bowel Movements.

Question:
I have an issue with bowel movements. Whenever I eat, within 15 to 20 minutes of starting the meal, I have to run to the bathroom. I usually will go 2 or 3 times within the hour. I have had blood work, an endoscopy and a colonoscopy. All the tests came up with nothing. I am a 24-year-old female and this problem is causing my quality of life to suffer. Any suggestions?

Answer:
Altered bowel movements are usually caused by bacteria, viruses, parasites, certain medicines, food intolerances and diseases that affect the stomach, small intestine or colon. If this is a chronic problem, you should see a gastroenterologist, as this may be an indication of a more serious problem. If you experience abdominal pain in addition to the symptoms you describe, you may have irritable bowel syndrome (IBS). As many as 55 million Americans – the majority women – suffer from IBS. Mark Osterman, MD, MSCE is a Penn gastroenterologist who specializes in motility and bowel disorders, including inflammatory bowel conditions.

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

What Treatment Options Exist For Pain Caused By A Hernia?

Question:
I was diagnosed with a transmesenteric hernia after a colonoscopy and CT scan showed a compression on the transverse colon. I actually saw the bulge on the screen and felt severe pain on my left side when it was pressed during the procedure. My GI doctor said there's no reason to fix the hernia because it's not obstructing anything. I've had chronic pain for several years – it has been continuous and very bad for one and a half years. Do you think I should just live with it and try to ignore it, or get another opinion?

Answer:
A hernia occurs when part of an internal organ or body part protrudes through an opening into another area where it ordinarily should not be located. There are many different types of hernias. A transmesenteric hernia is a type of internal abdominal hernia. These hernias are rare and more difficult to diagnose. Although not all hernias need to be operated on, hernias that cause symptoms or that become larger should be repaired by a surgeon. Significant pain at the site of a hernia can be the first sign that it is incarcerated or strangulated. A Penn gastroenterologist can evaluate your condition and provide a second opinion.

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

Tuesday, January 10, 2012

What Treatment Options Exist For Esophageal Spasms?

Question:
My mom has a condition where her esophagus is always having spasms. She's had the Botox® injections, with no relief, and also had the esophagus dilated twice and still had no relief. Is there anything else that can be done for this condition?

Answer:
Esophageal spasms occur when the muscles in the esophagus irregularly contract. This causes difficulty swallowing food or drink and can sometimes cause severe chest pain. The cause of esophageal spasms is unknown, but eating very hot or very cold foods can trigger them, as well as an esophageal disease, like GERD (gastroesophageal reflux disease) or achalasia.

Achalasia is a rare motility disorder of the esophagus that can present with spasms and difficulty swallowing. Achalasia can be diagnosed by barium X-ray but the best test is an esophageal manometry which should always be done before considering dilation or Botox® injections. In very rare cases, surgery can become necessary.

The surgery options are a myotomy or an esophagectomy. A myotomy is performed to weaken the contraction of the muscles in the esophagus, whereas an esophagectomy is removal of part, or all, of the esophagus. This is an extreme measure and all other treatments should be exhausted before coming to this decision. I recommend your mom see one of our esophageal specialists – David Metz, MD or Geoffrey Spencer, MD – for further evaluation.

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

Saturday, January 7, 2012

Are Foods Always the Trigger for Eosinophilic Esophagitis?

Question:
I have recently been diagnosed with eosinophilic esophagitis (EE) and have been trying to avoid the trigger foods as recommended. However, I have now lost 15 lbs. in a month and still am having chest pains, which was the reason for having the endoscopy that led to the diagnosis of EE. Are foods always the trigger for EE? Do you have anyone on staff who has experience treating adults with EE?

Answer:
Eosinophils, a type of white blood cell, are a part of the immune system, helping our bodies fight off certain types of infections. When a large number of eosinophils occur in the body without a known cause, an eosinophilic disorder may be present. Many different problems, including gastrointestinal disorders, can cause high numbers of eosinophils in the blood.

Eosinophilic esophagits is a recently recognized disorder that is thought to stem from an allergic response to ingested foods. Although an elimination diet is often helpful, many adult patients also require immunosuppressive therapy to reduce the immune response that causes the eosinophils to infiltrate the esophagus. Pediatric patients are sometimes treated with an elemental diet which is often difficult to tolerate. Many gastroenterologists treat EE with swallowed asthma inhalers containing steroids (rather than inhaling the medication as designed for asthma). Since you are losing weight and still have symptoms, I suggest you consider seeing one of our esophageal specialists – David Metz, MD or Geoffrey Spencer, MD.

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

Friday, January 6, 2012

Is There a Connection Betwen Having a Colonoscopy Procedure and Developing a Spigelian Hernia?

Question:
Is there a connection between having a colonoscopy procedure and then developing a spigelian hernia?

Answer:
A colonoscopy is an internal examination of the colon and large intestine, using an instrument called a colonoscope (a small camera attached to a flexible tube). The colonoscope is inserted through the rectum and advanced to the other end of the large intestine. Bleeding and puncture of the colon are rare but possible complications of colonoscopy.

A spigelian hernia — named for the Flemish anatomist Adrian van der Spieghel — is located just below the navel, to the side of the abdominal muscles. This type of hernia is relatively uncommon and tends to occur in patients around 50 years of age. This is no known connections between the colonoscopy and a spigelian hernia. In fact, there is usually no obvious cause of a hernia, although they are sometimes associated with heavy lifting.

To schedule an appointment with a Penn gastroenterologist who can evaluate your hernia and recommend the best course of treatment, please call 800-789-PENN (7366) or request an appointment online.

Wednesday, January 4, 2012

What is the Cause of Gurgling Noise in Intestines?

Question:
Last year, I turned 50 and had a colonoscopy. Since then, my stomach is always making gurgling noises – as though liquid is rushing through my intestines. I'm in great shape for my age. Can the colonoscopy procedure stretch or relax your intestines? Could my hormones be causing this? Is there a medical reason to have this checked out?

Answer:
A colonoscopy is an internal examination of the colon and large intestine, using an instrument called a colonoscope – small camera attached to a flexible tube. The colonoscope is inserted through the rectum and advanced to the other end of the large intestine. Bleeding and puncture of the colon are rare but possible complications of colonoscopy – this is accompanied by severe abdominal pain and rectal bleeding. It is usually to your advantage to have any gastrointestinal changes checked by a physician. A Penn gastroenterologist can evaluate your symptoms and recommend a treatment plan if necessary. It is important for anyone over 50 — or younger if you have a family history of colon cancer — to have a screening colonoscopy. Penn gastroenterologists perform this important test at several locations, including Penn Medicine Radnor.

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