When chronic diseases cause the liver to become permanently injured and scarred, the condition is called cirrhosis. Cirrhosis is a serious condition that leads to nearly 25,000 deaths each year, making it the seventh leading cause of death by disease.

In cases of mild cirrhosis, the liver can repair itself. When the condition becomes severe, however, the liver can stop functioning.

While alcohol abuse is the most well known cause of cirrhosis of the liver, there are many other causes, such as viral hepatitis, cystic fibrosis, fat accumulation in the liver and various diseases relating to parasites and mineral build-up in your body.

People with cirrhosis may have few symptoms at first. Sometimes physicians discover their patients have the disease during a physical exam or surgery for something else. Eventually however, the liver loses function causing such symptoms as fatigue, weakness, exhaustion, and loss of appetite, often with nausea and weight loss. As the cirrhosis becomes more progressed, a build-up of bile may cause jaundice (yellow skin) and generalized itching.

The most serious problem for people with cirrhosis is portal hypertension, pressure on blood vessels that flow through the liver. When the normal blood flow is blocked, the blood tries to pass through new vessels. Some of these vessels, especially those in the stomach and esophagus, have thin walls and are not able to handle the additional flow. If these vessels burst, the resulting blood loss can be fatal.

Cirrhosis is diagnosed through laboratory tests and physical examination. For example, there may be a change in how your liver feels or how large it is. Blood tests can indicate if liver disease is present. The doctor may decide to confirm the diagnosis by taking a sample of tissue from the liver or inspecting the liver through a laparoscope.

Treatment of cirrhosis is aimed at stopping or delaying its progress, minimizing the damage to liver cells and reducing complications. For example, in alcoholic cirrhosis, the person must stop drinking alcohol to halt progression of the disease. In cases of hepatitis, steroids or antiviral drugs often can reduce liver cell injury.

The symptoms of cirrhosis, such as itching and fluid retention, may be controlled by diet and medications. For advanced cases, laxatives may be given to help absorb toxins and speed their removal from the intestines. In critical cases, surgery or even a liver transplant may be necessary.

While cirrhosis is a serious condition not to be ignored, many patients with cirrhosis live long and healthy lives. Even when complications develop, they usually can be treated. Many patients with advanced cirrhosis undergo successful liver transplantation.

The Facts about Diverticulosis and Diverticulitis

If you’re struggling with abdominal cramps, gas and diarrhea alternating with constipation, you may be one of many people suffering from diverticulosis.

Diverticulosis, a condition in which small pockets or pouches extend out from the inside lining of the large intestine, is very common in people over age 40. In fact, at least one-third of all Americans over age 45 and more than two-thirds of those over age 60 have this condition. Diverticulosis can be present in the intestines for years and never be discovered unless you have a colonoscopy or barium enema X-ray.  Often, people experience no symptoms from the condition and only discover it when they are having an unrelated medical treatment in or around the intestine. However, well over ½ of people with diverticulosis will experience at least mild symptoms from the disease.

This odd-sounding condition may cause mild lower stomach discomfort which usually is not serious. In severe cases, bleeding may occur from the pouches, but this symptom is not common. However, diverticulosis can lead to a more serious condition, diverticulitis, which occurs when the pouches become infected, causing fever and moderate to severe lower abdominal discomfort.  Diverticulitis can cause diarrhea, abdominal pain and cramping with or without fever — symptoms similar to those experienced with Irritable Bowel Syndrome. Only 20 percent of patient cases with diverticulosis advance to diverticulitis.

The exact cause of diverticulosis is still not completely understood. Doctors suspect that the pouches may be caused when colon muscle spasm creates pressure inside the colon which causes small weak spots in the intestine walls to balloon out (herniate), causing the pouches. The actual diverticulum may measure up to ¼ inch in size so they are small but sometimes significant! The walls of the large intestine grow thicker with age, which may be one reason for the added pressure incurred during a bowel movement. Other contributing factors could be stress, irritable bowel or not enough fiber in your diet, which causes the intestine to work harder during digestion.

Once formed, diverticula are permanent, and treatments are mainly dietary. To reduce the risk of developing diverticulitis, people with diverticulosis should eat a high-fiber diet that includes whole grains, fruits and leafy vegetables. It is also beneficial to drink plenty of water and exercise regularly. Recent research indicates that consumption of nuts, seeds and corn does not increase the risk of diverticulosis or diverticular complications as had been commonly believed. So it is safe to try those foods and if they do not cause symptoms, a small to moderate amount is fine.

Patients experiencing abdominal pain from diveriticulosis may benefit from anti-spasmodic drugs. Medication may also be prescribed to help control stress, reduce bloating and stomach problems or relieve diarrhea and constipation. If the condition advances into diverticulitis, bed rest, antibiotics and even hospitalization may be required.

The symptoms of diverticulosis – gas, stomach cramps, pain and diarrhea alternating with constipation – are also common in other, sometimes serious diseases. If you’re suffering from these symptoms, contact us so that we can properly diagnose and treat the source of your problems.

Nonetheless, we have already taken action on a number of fronts to further improve quality across our system based on newly introduced infection control practices. Data from a 2008 pilot study by the Centers for Medicare and Medicaid Services published in the June 9, 2010, issue of The Journal of the American Medical Association (JAMA) highlights a small number of ambulatory surgery centers (68 out of 5,200) that were not compliant with the new guidelines.

The JAMA study in question does have some shortcomings, not the least of which is the failure to document any actual infections. The study focuses on process deficiencies, not outcomes. The study also does not provide comparative data with hospitals. However, GIA generally applauds the efforts of regulators to improve clinical quality.

The study brings to light our goal to achieve 100 percent compliance with infection control measures throughout every procedure, every day. We absolutely agree with the need for continuous improvement in infection control, and are working hard to achieve it.

What it means for patients who have a procedure in our Ambulatory Surgery Centers is that they can rest assured that we are doing our best to comply with all infection control guidelines. The fact that we have never experienced a procedure-related infection in 24 years speaks loudly and clearly about our efforts.

Most people are diagnosed with Crohn’s at around age 20-30, although it can occur at any age. It also is more common in Caucasians, people with a family history of the disease and people who smoke. Cigarette smoking is the most controllable risk factor for developing the disease. Smoking also worsens symptoms and increases the likelihood that a patient will eventually need to have surgery.

Typical symptoms of Crohn’s include persistent diarrhea (which may be bloody), cramping, abdominal pain, fever, loss of appetite and weight loss.

A colonoscopy is usually required to make a diagnosis of Crohn’s.  Other helpful tests often used in the evaluation include blood tests, stool samples, abdomen x-ray or CAT scan, and video capsule endoscopy (Pillcam).   A colonoscopy involves a sedated examination of the entire colon with a flexible, lighted tube with an attached camera. The procedure also provides an opportunity for your doctor to take small tissue samples for laboratory analysis, which may help confirm a diagnosis.

There is no known cure for Crohn’s, although symptoms can be treated with drugs and sometimes surgery. The disease may also go into remission for years at a time.

Living with Crohn’s can be difficult, but patients can help manage the problem of chronic diarrhea by diet and lifestyle changes. If you have Crohn’s, following these tips may lessen your symptoms:

• Take the medications recommended by your gastroenterologist.
• Limit dairy products.
• Eat low-fat foods.
• Avoid gas-producing foods like beans, cabbage and broccoli.
• Limit your intake of raw fruit juices and fruits (especially citrus fruits), spicy food, popcorn, alcohol and caffeinated beverages.
• Eat several small meals throughout the day.
• Drink lots of liquids.
• Avoid stressful situations.
• Reduce stress by exercising, meditating and/or following relaxation techniques.
• If you smoke, quit

If you are experiencing the symptoms of Crohn’s disease and are concerned that you may have the disease, see your doctor.

There are two types of hemorrhoids: Internal, which occur in the rectal tunnel and are associated with rectal bleeding, itching, pain or skin irritation; and external, which occur in or around the anus and are characterized by a hard spot or painful swelling where the blood clot forms.

Hemorrhoids are common in both men and women. In fact, about half the population has them by age 50. They can be caused by a variety of factors, including abdominal disorders, pregnancy, stress, a lifestyle that includes sitting for extended periods of time, obesity, inadequate intake of fiber, lack of exercise, or genetic tendencies.

While home remedies such as creams, suppositories and warm baths may offer temporary relief from the symptoms of hemorrhoids, they often fail to solve the problem.

Despite the lack of long-term relief, far too many people put off seeking treatment. Some are embarrassed to mention their problem; others mistakenly believe that treatment involves surgery and long recovery periods. The good news is that new medical advances make treatment much easier. We offer non-surgical treatments that are quick, easy and virtually pain-free. Most patients are able to resume their normal lifestyle almost as soon as they leave our office.

A word of caution: Rectal bleeding is a common side-effect of hemorrhoids, but it also can indicate a more serious problem. It is important to seek medical attention if: You are over age 40 or have a family history of colon cancer; your hemorrhoids don’t improve with self-care; you have pain or bleed frequently or excessively; you develop bleeding between bowel movements; and/or the onset of your hemorrhoids occurs along with a marked change in bowel habits.

Whatever your political persuasion and feelings about health care reform, the legislation passed by Congress and signed by the President will be a fact that we’ll all have to deal with in the coming months.

As the dust settles on the issue, some aspects of the legislation are clear, but others will take some time to understand and implement.

I can assure you on three important fronts:

• First, at Gastrointestinal Associates, we will continue to be a practice that patients can depend on for accurate and comprehensive information about the health care practices that affect them.
• We also will work very hard to reinforce the bond between patient and physician. To us, that relationship is sacred, and we do not believe that government or anyone else should interfere with the long-standing relationship that exists there.
• And finally, we will continue to provide the highest level of gastrointestinal care and expertise to our patients.

The American medical system, despite its flaws, is still the best in the world, and our physicians represent the best of that system.

This isn’t the first time, and it won’t be the last, that we all will have to deal with change in health care policy, but the points above are our pledge to our patients.

And in a world of change, you can count on that.

The study observed the outcomes of nearly 16,000 colonoscopies performed by 315 gastroenterologists from across the country over a four-week period. Results have shown a definite correlation between colonoscopy withdrawal times, or the length of the procedure, and the detection rates for colon polyps.

Previously, the standard of care model suggested a withdrawal time of at least six minutes during a screening colonoscopy. The study provided clear evidence to support the importance of this minimum time frame to the discovery of colon polyps, the primary cause of colon cancers.

Our physicians are continuously participating in ongoing research and analysis, and our patients benefit from this practice. In seeking new and better medical treatments, our doctors keep abreast of the latest ways to diagnose and treat your gastrointestinal conditions. This results in more thorough examinations, earlier diagnosis and the most effective treatments available.

Particularly when it comes to colon cancer, the best way to prevent or cure the disease is through early detection through screening colonoscopies. This latest study confirms that a withdrawal time of six minutes or longer significantly increases the chances of discovering colon polyps. It is a standard we employ at GIA, and one that will help our patients prevent colon cancer.

Preventing colon cancer is the primary goal of a regularly scheduled screening colonoscopy and the aim of our entire staff of board-certified physicians. We consider it a privilege to be involved in ongoing, specialized training and cutting-edge research in the field of gastroenterology, primarily because it benefits our patients.

The absolute best way to prevent and detect colorectal cancer is with a screening colonoscopy. We recommend that everyone be screened at the age of 50, earlier if there is a family or personal history of cancer, and at regular intervals after that. For African-Americans, screenings should begin at age 45.

While there are other tests being developed to detect colorectal cancers, only a screening colonoscopy can help you prevent cancer before it happens. Most colon cancers begin in benign colon polyps, or abnormal tissue growths. A benign polyp usually takes several years to become cancerous. During that time, there is a “window of opportunity” to find it and remove it before it turns cancerous. Any polyps found during a screening colonoscopy are removed and tested.

With removal of polyps, we can prevent colorectal cancers. When a cancer that is found early over ninety percent of cases can be treated and cured. We look forward to the day when colorectal cancer is no longer a life-threatening disease because individuals are taking steps toward prevention.

There is a pre-screening cleansing procedure to follow, but the actual screening procedure takes only about 15-30 minutes. With minor sedation, the procedure is actually painless.

Let’s work together to win the fight against colorectal cancer. Schedule your screening colonoscopy today.

Celiac disease is an inherited, autoimmune disease in which the lining of the small intestine is damaged from eating gluten, which is found in wheat containing foods such as bread, pasta, cookies, pizza crust and many other foods containing barley, rye and possibly oats. When a person with Celiac disease eats gluten, the body responds by damaging the small intestine. This leads to an inability for the body to absorb essential nutrients.

If left untreated through a gluten-free diet, Celiac disease can cause anemia and stunted growth in children; loss of calcium and bone density; lactose intolerance from intestinal damage; intestinal cancers; and even disorders of the nervous system such as seizures and nerve damage.

Celiac disease is often misdiagnosed because the symptoms are common and resemble several other conditions like irritable bowel syndrome, gastric ulcers and Crohn’s disease. Those with Celiac disease may experience intermittent diarrhea, abdominal pain, bloating, upset stomach, irritability, depression, joint pain, muscle cramps or anemia. Dental and bone disorders, unexplained weight loss, or tingling of the legs and feet may also be indicators of malabsorption from Celiac disease.

Although Celiac disease can affect anyone, people with a family history of the condition are at a much greater risk. Also commonly affected are people with diabetes, Down’s syndrome, autoimmune thyroid disease and microscopic colitis.

With a gluten-free diet, people with Celiac disease can effectively manage the condition and live pain-free. It is not always easy; many foods and even some medications contain gluten. But with the growing number of gluten-free products on the market, even pizza lovers can avoid gluten. A registered dietitian who is experienced in teaching the gluten-free diet can offer advice on how to best maintain the nutritional quality of your diet and help sufferers come up with gluten-free alternatives and achieve a healthy lifestyle.

Once gluten is removed from the diet, inflammation in the small intestine subsides, and the organ will begin to repair itself. People generally begin feeling better in just a few days, though extensive damage may require some vitamin and mineral supplements to correct deficiencies.

On March 1, 2010, results of an international study out of London were released indicating scientists have identified new genetic links to Celiac disease. Their findings could speed the search for better ways to diagnose and treat Celiac disease and possibly even related autoimmune diseases like Type 1 diabetes.

If you are experiencing symptoms and suspect Celiac disease, see your doctor. The best treatment is a strictly followed gluten-free diet, but do not begin a gluten-free diet before you see a physician. If you stop eating foods that contain gluten before being tested, the test results may not be accurate.

Heartburn affects many of us. In fact the American Gastroenterological Association reports that more than 60 million Americans experience symptoms at least once each month.

The burning sensation you feel is actually stomach acid splashing up into your esophagus. A valve at the end of the esophagus, called the lower esophageal sphincter (LES), normally prevents this. But factors such as overeating, pregnancy or even stress can keep the valve from shutting properly. When that happens, stomach acid can be pushed back up into the esophagus, causing pain along with a sour or bitter taste in the mouth.

Occasional heartburn is normally nothing to worry about and can easily be treated with over-the-counter antacids. However, frequent heartburn may indicate a more serious problem. Over time, stomach acid can damage the wall of the esophagus and, if left untreated, can lead to narrowing of the esophagus, bleeding and trouble swallowing, a condition called Barrett’s esophagus, and even cancer of the esophagus. Prolonged heartburn may also indicate more serious problems such as acid reflux disease, gastroesophageal reflux disease (GERD), gastritis, hiatal hernia or peptic ulcer.

There are several lifestyle changes you can make to help avoid heartburn:

• Avoid trigger foods such as chocolate; coffee; peppermint; spicy or greasy foods; tomato products; and alcoholic beverages.
• Eat smaller , more frequent meals.
• Don’t go to bed with a full stomach. Give food 2-3 hours to digest before going to bed.
• Stop smoking or using tobacco in any form. Tobacco inhibits saliva, the natural protection for your esophagus and the nicotine in tobacco increases acid secretion and relaxes the LES.
• Shed some pounds. Losing weight can help relieve symptoms.
• Eat high-protein, low-fat meals.
• Drink plenty of water during exercise to keep from being dehydrated.
• Avoid tight clothes and belts.

If you still experience heartburn, antacids usually give fast, short-term relief. Look for antacids that contain both magnesium hydroxide and aluminum hydroxide to reduce the chance of diarrhea or constipation. If your symptoms worsen when lying down, raising the head of your bed so that your head and chest are higher than you feet may help.

If symptoms persist or occur frequently, speak to your doctor. Continuous heartburn may indicate a serious problem, and sudden chest pain may be mistaken for heartburn when it is really a sign of heart disease. Your physician may suggest prescription medication or testing such as x-rays to check for ulcers, pH tests to check for acid in the esophagus, or endoscopy to look for other conditions. Seek medical attention when the following symptoms occur:

• Difficulty or pain when swallowing
• Vomiting blood
• Black or bloody stools
• Shortness of breath
• Lightheaded or dizziness
• Neck or shoulder pain
• Heartburn more than 2-3 times per week for more than 2 weeks.

If heartburn is becoming a more frequent problem, keep a heartburn record. Track how often you experience the symptoms, what time of day and what you are eating or doing when the symptoms occur. That will help you get a clearer picture of when it is time to seek medical care and help your doctor more effectively diagnose and treat your condition.