University of Pennsylvania Health System

Penn Gastroenterology Q&As

Monday, April 30, 2012

What Are The Treatment Options For Problems With Digesting Fatty Foods?

Question:
Whenever I eat peanut butter, foods with cream sauces, cheese, fried foods or rich desserts like pies or chocolate, I get very runny stool or diarrhea within 24 hours. When I was a child (age 0-13), these foods would give me terrible cramps and make me throw up. Is there something wrong with my gut? Do I have to give up these foods forever or are there treatments to help me?

Answer:
Diarrhea is frequent, loose and runny stool. Diarrhea is common, and can be caused by a variety of things, including viral infection and foods that irritate the stomach. Diarrhea is considered chronic if it continues for more than 4 weeks. It can be caused by foods that irritate the stomach, as diarrhea results from the body's attempt to rid the stomach of the irritant. Greasy, high-fat and fried foods, such as those you have described, commonly cause diarrhea.

To determine the cause of your repeated diarrhea, and to look into possible treatments, I recommend that you consult with a Penn physician. Octavia Pickett-Blakely, MD, provides general gastroenterology consultations. To make an appointment, please call 800-789-PENN (7366) or request an appointment online.

What Are The Treatment Options For IBS?

Question:
I am a 20 year-old female, and heart disease runs in my family. In October 2008, I had very severe sharp pains in my lower abdomen, mostly on my left side, and I was taken to the hospital immediately. I had blood taken and a CT scan and they told me I had an infected and inflamed colon. I was on metronidazole for seven days and saw improvement until the antibiotic ran out and my symptoms came back.
In December 2008, I had a colonoscopy and they diagnosed me with irritable bowel syndrome. I am not satisfied because I continue to have blood and mucus in my stool and recently noticed some new symptoms. I've also been having stomach aches and diarrhea.

Answer:
Irritable bowel syndrome (IBS) is a disorder involving the lower intestinal tract. It involves abdominal pain, as well as alternating constipation and diarrhea. IBS is a common disorder and happens more often in women than men. Although IBS can cause a great deal of discomfort, it does not harm the intestines. No one knows the exact cause and there is no specific test for IBS. However, your doctor may run tests to be sure you don't have other diseases. Most people diagnosed with IBS can control their symptoms with diet, stress management and medicine.


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

Friday, April 27, 2012

What Are The Treatment Options For Lower Abdomen Pain?

Question:
I recently noticed bright red blood after my bowel movement. I also noticed drops of blood on my stool about 6 months ago. I was referred to a gastroenterologist and he diagnosed it as a hemorrhoid and prescribed medication. Six months later, I had this same form of bleeding before it stopped for a while. Now, my problem is that I have pain in my lower left abdomen near my navel off and on. This pain happens after eating and drinking. I am concerned. What could this be?

Answer:
Rectal bleeding is bleeding from the lower colon or rectum. The blood may range in color, and can occur for many reasons. A hemorrhoid is a common cause of rectal bleeding, so it is likely that your bleeding is related to the condition that your physician diagnosed. Further bleeding and pain may indicate further problems. Pain in the lower left abdomen is a common signal of a digestive condition. This may be relatively minor, such as occasional constipation, or indicative of a more chronic condition. It is important to consult with a physician to determine the cause of your pain.

I recommend consulting with a Penn gastroenterologist to determine the best course of treatment for your condition. Anna Buchner, MD, PhD, specializes in motility and bowel disorders and would be happy to meet with you. To make an appointment, please call 800-789-PENN (7366) or request an appointment online.

Wednesday, April 25, 2012

What Are The Treatment Options For A Ventral Hernia?

Question:

I was recently diagnosed with a ventral hernia, which causes constipation. My doctor recommended taking Miralax®. Is this a solution or just a temporary aid?



Answer:

A hernia is a sac formed by the lining of the abdominal cavity that pushes through a weak area in the abdominal wall. A ventral hernia is a protrusion in the lower abdomen caused by internal organs pushing on the abdominal wall. Surgery is the only treatment that will permanently fix a hernia. Miralax® is a medication used to treat occasional constipation, and not related to treatment of hernias.



To determine the best treatment options given your conditions, I recommend that you see a Penn gastroenterologist. Kashyap V. Panganamamula, MD provides general GI consultations and would be happy to meet with you. To make an appointment, please call 800-789-PENN (7366) or request an appointment online.

Monday, April 23, 2012

What Are The Benefits Of Using A Proton Pump Inhibitor?

Question:
I recently had a pH probe and impedance test. My doctor told me to continue on the proton pump inhibitor therapy that I was already doing. The test came back negative. It showed I only refluxed sixteen times. Should I have stopped the proton pump inhibitor?

Answer:
Proton pump inhibitors (PPIs) are medications prescribed for patients suffering from gastroesophageal reflux disease (GERD). PPIs work by blocking excess gastric acid production. pH probe and impedance testing are both used to diagnose and monitor reflux conditions and the effectiveness of treatment, such as PPIs. It is important to consult with a physician to determine next steps after your favorable test result. I do not recommend changing your course of medication without consulting a physician.

A Penn gastroenterologist would be happy to consult with you to determine the most appropriate treatment. Gary W. Falk, MD, specializes in acid-peptic disorders and would be happy to meet with you. To make an appointment, please call 800-789-PENN (7366) or request an appointment online.

Wednesday, April 18, 2012

Can Acid Reflux Create Angina-Like Symptoms When Exercising?

Question:
This past year, I have had chest pain while jogging that fits the description of angina. I have reason to believe that it might be acid reflux and not a problem with my arteries. Can acid reflux create angina like symptoms when jogging?

Answer:
Acid reflux and angina are two vastly different conditions, but in some cases the same symptoms are described for both. Acid reflux, also known as heartburn, occurs when stomach acid washes back into the esophagus. It can cause a burning sensation radiating from the stomach through the chest and throat. Angina occurs when blood flow to the heart is blocked by the narrowing or hardening of the arteries. It causes mild to severe pain behind the breastbone and can also feel like indigestion or heartburn. That being said, although acid reflux shares some of the same symptoms of angina, it is important that you see a doctor to determine which of these conditions you're experiencing.

David C. Metz, MD, is a Penn gastroenterologist who can review your symptoms and recommend a course of action. To schedule an appointment, please call 800-789-PENN (7366) or request an appointment online.

Monday, April 16, 2012

What Are The Symptoms Of A Hiatal Hernia?

Question:
In addition to a certain amount of reflux after most meals, I have an abnormal amount of gas. Are these associated? If so, with what? I do have a hiatal hernia.

Answer:
Gas or flatulence is a natural part of the digestive process. Though it may seem abnormal, it is rare to actually produce excessive amounts of gas. Reflux and gas are associated in that they can both be moderately controlled with changes in your diet. To reduce the amount of gas your body produces, try these methods: Avoid beans, cabbage, and carbonated beverages. Avoid chewing gum. Chew your food thoroughly. Eat more slowly. Relax while you eat. Walk for 10 to 15 minutes after eating.

To help with your reflux, avoid foods that irritate the lining of your esophagus, such as: Fried or fatty foods. Peppermint. Coffee. Citrus fruit or juice. Tomato products. Chocolate. Generally, a hiatal hernia does not contribute to excess gas, but it can definitely contribute to your reflux. If you would like to schedule an appointment with a Penn gastroenterologist specializing in acid-peptic disorders, please call 800-789-PENN (7366) or request an appointment online.

What Are The Symptoms Of Z-E Syndrome?

Question:
I started having a burning sensation in my lower stomach but no acid reflux. I have been on Prilosec®/Nexium® for the last 10 years. I have seen several specialists to find the cause of this. The specialists have performed endoscopies and did not find any issues. I am being told that my body is producing more acid that normal and I should keep taking the medication. My primary care doctor checked for gastrin level and found it to be high (700). Could this be Z-E syndrome?

Answer:
Zollinger-Ellison syndrome occurs when a small tumor called a gastrinoma forms in the pancreas or small intestine. This tumor releases gastrin, a hormone that prompts the stomach to create more acid than necessary. To diagnose Zollinger-Ellison syndrome, several laboratory and imaging studies need to be done. Studies include a fasting check of gastrin levels on at least three occasions, MRI and somatostatin receptor scintigraphy – a test to detect tumors.

It is difficult to say whether or not your symptoms positively indicate Zollinger-Ellison syndrome without further testing. In the meantime, continue taking the medication recommended by your primary doctor. Prilosec OTC® and Nexium® are both proton-pump inhibitors, which reduce the amount of acid in your stomach.

David C. Metz, MD, is a Penn gastroenterologist who specializes in acid-peptic disorders and ZE syndrome. To schedule an appointment with Dr. Metz, please call 800-789-PENN or request an appointment online.

Thursday, April 12, 2012

Can Acid Reflux Turn Into Cancer?

Question:
I have acid reflux. I don't take my Nexium® regularly, because some days I have heartburn and some days I don't. Is it possible that this condition could turn into cancer?
Answer:
Acid reflux – the reflux of stomach acid into your esophagus – is a condition that if left untreated, can lead to more serious problems in the future. Untreated acid reflux over a long period of time can develop into bleeding ulcers, chronic cough, hoarseness, asthma and even esophageal strictures – narrowed areas in the esophagus that can make swallowing difficult.

Nexium® is an acid reflux treatment that reduces the amount of acid in your stomach. Though acid reflux does not necessarily mean you are at a greater risk for cancer, it is still important to treat the condition because of the future health risks.
If you would like to schedule an appointment with Yu-Xiao Yang, MD, a Penn gastroenterologist specializing in acid-peptic disorders, please call 800-789-PENN (7366) or request an appointment online.

Wednesday, April 11, 2012

Can A Hiatal Hernia Cause Nausea?

Question:
I have been suffering from constant nausea for two years. I have had many tests and scans that returned normal, except for a barium x-ray that recently showed a hiatal hernia. I already take antacid medications, so could this hernia be the cause of my nausea? My research says they don't usually operate on hiatal hernias and that the operation itself can leave you with nausea. Any suggestions?

Answer:
A hiatal hernia is a common condition that may cause reflux (backflow) of gastric acid from the stomach into the esophagus. By itself, a hiatal hernia rarely causes symptoms — though some pain, discomfort and nausea can be attributed to the reflux of gastric acid, air or bile. Reflux occurs more easily when there is a hiatal hernia.
Hiatal Hernia Reducing the backflow of stomach contents into the esophagus (gastroesophageal reflux) relieves symptoms in most cases. Medications that neutralize stomach acidity, decrease acid production or strengthen the lower esophageal sphincter (the muscle that prevents acid from backing up into the esophagus) may be prescribed. If these measures fail to control the symptoms, or if complications arise, surgical repair of the hernia may be necessary.

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

Monday, April 9, 2012

Can Surgery Help Alleviate Symptoms Of GERD And A Hiatal Hernia?

Question:
I suffer from hiatal hernia and GERD and have had persistent nausea and reflux for over two years. Despite many tests to find the cause, the only recent diagnosis is my hiatal hernia. I have been treated with reflux medications and lifestyle changes, but the nausea persists. A friend of mine had a similar problem, which was fixed by fundoplication. My doctor and the surgeon he referred me to will not perform the surgery because they don't believe it will help and it can have many complications, including making the nausea worse. Can you give me any advice or comment on my doctor's opinion?

Answer:
Fundoplication is a surgical procedure where the upper portion of the stomach, called the fundus, is wrapped around the lower portion of the esophagus so that there is a small passageway from the esophagus into the stomach. This restricts the backflow of gastric acid into the esophagus so that the pain, discomfort and nausea of GERD is alleviated. During the same procedure, the surgeon can repair your hiatal hernia. Fundoplication is performed when GERD symptoms, likely caused in part by a hiatal hernia, are not controlled well by medication. There are risks to any surgical procedure, but the greatest risks after fundoplication surgery are difficulty swallowing, excess gas, and the return of symptoms. David C. Metz, MD is a Penn gastroenterologist specializing in the treatment of GERD who can review your individual case and recommend his course of action.

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

Thursday, April 5, 2012

What Are The Treatment Options For Lactose Intolerance?

Question:
I have had heartburn for over a year and a half now. I have taken every over-the-counter medicine and my clinic provided me with Nexium®, but nothing seems to work long term. My symptoms started over two years ago with lactose intolerance. They now vary from diarrhea to occasional vomiting. Is there another course of action available to me?

Answer:
If you have heartburn more than twice a week, you may have gastroesophageal reflux disease (GERD). It is best to be examined by a gastroenterologist because the long-term effects of GERD can cause Barrett's esophagus, esophageal ulcers or strictures. Nexium® is a brand name esomeprazole medication used to treat the symptoms of GERD, allowing the esophagus to heal and prevent further damage. Chronic diarrhea is a condition that could have a variety of causes. It may indicate the need to adjust your diet or that there is a more serious underlying problem. A Penn gastroenterologist who will be able to evaluate all of your symptoms and recommend the best course of treatment.
To make an appointment, please call 800-789-PENN (7366) or request an appointment online.

Wednesday, April 4, 2012

Need Diagnosis To Alleviate Symptoms Of Hypothyroidsim

Question:
I have been on omeprazole for several years. Recently, I started experiencing severe belching and gagging after eating followed by nausea, weakness and dizziness. I also have hypothyroidism with nodules on the thyroid, for which I take Synthroid®. I wonder if all this creates more difficulty swallowing. Where can I go for a diagnosis to alleviate this?

Answer:
Omeprazole is an antisecretory prescription medication designed to inhibit gastric acid production. It is used to treat ulcers, gastroesophageal reflux disease (GERD) and erosive esophagitis.

Omeprazole is in a class of medications called proton-pump inhibitors. Omeprazole has a handful of possible side effects, including nausea, coughing and dizziness. A number of recent studies have examined the possibility that long-term therapy with this class of agents may cause other problems, though these risks are small. The general approach should be to use the lowest effective maintenance dose of therapy to control symptoms.

Gagging is a more serious side effect. You should see the doctor prescribing the medication as soon as possible. Your dosage may need to be adjusted or you may need to have a structural study – an upper endoscopy or barium X-ray – performed. If your symptoms change or worsen, you should contact your primary care physician.

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

Monday, April 2, 2012

Which Physicians At Radnor Can Diagnose Barrett's Esophagus?

Question:
I was just diagnosed with Barrett's esophagus. No dysplasia was present. I am a 42-year-old white female and have been on Nexium® for approximately 8 years. In the last 2 months, my symptoms got worse – which is why I saw a doctor. I would like a second opinion. Is there a physician at the Radnor site I could see?

Answer:
Barrett's esophagus is a disorder in which the lining of the esophagus becomes damaged – in most cases, from prolonged acid reflux symptoms of gastroesophageal reflux disease (GERD). Nexium® is a brand name esomeprazole medication used to treat the symptoms of GERD, allowing the esophagus to heal and prevent further damage. When medication is ineffective, an anti-reflux operation may help patients who have persistent symptoms despite treatment. There are also new therapies available that can be performed through an endoscope. Mark Osterman, MD, David Katzka, MD, Sanford Herold, MD, David Jaffe, MD and Joanne Linevsky, MD are Penn gastroenterologists that see patients at Penn Medicine Radnor. They would be happy to provide you with a second opinion.

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