Our physicians measure up. Every physician at GIA is board certified by the American Board of Internal Medicine in both internal medicine and gastroenterology. We participate in continuing medical education programs annually to make sure we are on the cutting edge of gastrological procedures and technology. And each of our physicians is credentialed for active staff privileges in at least one area hospital.

Our care measures up. We have implemented quality assurance and performance improvement programs with measurable outcomes in both our practice and our endoscopic ASCs that allow us to continually monitor our care and make any necessary improvements. In the more than 20,000 procedures we performed last year, only 12 resulted in hospitalization, and none required surgery. In more than 13,000 colonoscopies last year, there were no perforated colons. We consistently outperform the national average in all quality measures.

Our staff measures up. An excellent staff is critical to providing quality care. Our highly trained and compassionate medical support staff makes sure your visit meets or exceeds your expectations. Our admissions staff provides patients with all the information they need for a successful appointment. They also make sure new patients are seen as soon as possible – typically within a week of a request – and that emergency patients are seen right away.

Our systems measure up. GIA is the only Knoxville GI practice with three licensed, certified and accredited endoscopic ambulatory surgery centers which allow us to perform procedures in a convenient, timely and cost-saving manner. We utilize electronic medical records and perform external chart and billing audits to ascertain proper documentation, coding and billing. And we are the only local practice to have a GI hospitalist ready to provide immediate response to GI hospital consultations and emergencies.

But who measures quality? Our patients do. We know we measure up because our patient satisfaction rating is excellent over 95 percent of the time. And that is the real test. Our goal at GIA is to continue to provide excellent quality of care that helps us achieve the highest levels of patient satisfaction because patients are our true test of quality.

In order to meet this goal, we are constantly reviewing new technologies and treatments. We have been recognized throughout the country for pioneering the use of photodynamic therapy, radiofrequency ablation and mucosal resection for the treatment of Barrett’s esophagus. In many cases, these therapies can eliminate the need for surgical removal of the esophagus.

We have also been among the first to test the Given capsule, a swallowable “pill” providing video pictures of the small intestine to help visualize and detect disorders of the gastrointestinal tract.

Leading the way in gastrointestinal research and development is not new to GIA. We have long been on the cutting-edge of developing ways to improve patient care. Our work in outpatient endoscopy led to the development of the first licensed and certified endoscopic ambulatory surgery center in the U.S.

In order to help advance the body of knowledge in gastroenterology throughout our industry, we constantly share our techniques and results with our fellow GI practices. We publish our findings in peer-reviewed journal articles. And we have been one of the co-founders of GI Roundtable, a national two-day conference bringing together more than 250 of the nation’s top gastroenterologists and practice managers to share information on improving health care and strengthening quality measures.

Measuring performance to advance quality care is gaining national attention and again we are setting the standard. Our quality assurance programs provide measurable outcomes that allow us to continually track our performance quality to ensure we are providing the best patient care possible. We consistently rate excellent and our performance measures far exceed the national average.

You can rest assured you will be well cared for by nationally recognized team and caring staff. Through research, technology and quality patient care we are setting the standard in gastrointestinal health care at Gastrointestinal Associates.

About the author:

Dr. Bergein “Gene” Overholt, co-founder and president of Gastrointestinal Associates, is a nationally recognized gastroenterologist who developed the flexible fiberoptic sigmoidoscope and colonoscope. Overholt’s work on the fiberoptic sigmoidoscope earned him the prestigious Schindler Award from the American Society for Gastrointestinal Endoscopy.

Vitamin D deficiencies have been linked to an increased risk of inflammatory bowel disease. Inflammatory bowel disease is a name given to a group of chronic digestive diseases of the small and large intestines, including colitis, proctitis, enteritis and ileitis. Typically, doctors divide IBD into two groups: ulcerative colitis and Crohn’s disease.

Ulcerative colitis causes ulcers and inflammation of the lining of the colon (large intestine). It almost always involves the rectum and usually causes a bloody diarrhea.

Crohn’s disease is an inflammation that extends into the deeper layers of the intestinal wall. In about 30 percent of cases the disease is limited to one or more segments of the small intestine, usually the ileum (ileitis); about 50 percent of the time it involves both the ileum and the colon (ileocolitis); and 20 percent of the time it is confined to the colon (Crohn’s colitis). Inflammation may also affect the mouth, esophagus, stomach, duodenum, appendix or anus.

Ulcerative colitis and Crohn’s disease are chronic conditions that may recur over a lifetime. Many people have long periods – sometimes years – when they are symptom-free. Unfortunately, doctors cannot predict with certainty when the disease will go into remission or when the symptoms will return.

There is good news for southerners, however.

In the study, a group of Boston researchers followed nearly 120,000 female nurses over a 20-year period. At the study’s inception none of the participants had inflammatory bowel disease. Over the course of the study, 284 participants developed Crohn’s disease and 332 developed ulcerative colitis.

Women who lived in southern latitudes at age 30 were about 50 percent less likely to have Crohn’s disease and about one-third less likely to have ulcerative colitis than those who lived in the north. Those born in the South or living in the South at age 15 also fared better, but the findings for that group were not as significant. Sunanda Kane, MD, a gastroenterologist with the Mayo Clinic in Rochester, Minn., said there is no reason to believe the findings would not also apply to men.

Researchers are working to determine cause and effect, and studies are underway to look at whether or not vitamin D supplements will help relieve symptoms of Crohn’s disease. In the meantime, southern women can bask in the knowledge that they have a reduced risk of inflammatory bowel disease.

Is it gallstone disease?

Most gallstones remain confined to the gallbladder and do not produce symptoms. But if you are experiencing unusual abdominal pain, it could indicate gallstone disease. The most typical symptom of the condition is a severe steady pain – lasting from 15 minutes to several hours – in the upper abdomen or right side, and sometimes between the shoulder blades or the right shoulder. Patients may also experience vomiting or sweating. Attacks of gallstone pain may be separated by weeks, months or even years.

Why does it hurt?

It is thought that gallstone pain results from blockage of the gallbladder duct (cystic duct) by a stone. When the blockage lasts more than several hours, the gallbladder may become inflamed. This condition, called acute cholecystitis, may lead to fever, prolonged pain and eventually infection of the gallbladder. Hospitalization is usually necessary for observation, treatment with antibiotics and pain medications, and frequently for surgery.

Is gallstone disease dangerous?

More serious conditions may occur when a gallstone passes out of the gallbladder duct and into the main bile duct. If the stone lodges in the main bile duct, it can lead to a serious bile duct infection. If it passes down the bile duct, it can cause an inflammation of the pancreas, which has a common drainage channel with the bile duct. Either situation can be extremely dangerous. Stones in the bile duct usually cause pain, fever, and jaundice (yellow discoloration of the eyes and skin). Patients with these symptoms should immediately seek treatment.

How do I treat gallstone disease?

Many new approaches to symptomatic gallstone treatment have been tried over the past several years, but surgical removal of the gallbladder (cholecystectomy) remains the most widely used therapy.

Laparoscopic cholecystectomy, used for about 80 percent of all cholecystectomies in the United States, is a technique whereby the surgeon makes several one inch incisions in the abdomen through which a tiny video camera and surgical instruments are passed. Because the abdominal muscles are not cut, patients experience less postoperative pain, quicker healing and better cosmetic results. Patients are typically able to go home from the hospital within a day and resume normal activities within a few days.

When laparoscopic cholecystectomy is not an option because of complications such as a severely inflamed gallbladder, the surgeon removes the gallbladder through a five- to eight-inch incision. This method, known as the open procedure, has been performed for over 100 years and is quite safe, although it usually requires four or five days of hospitalization and several weeks of at-home recuperation.

Can I manage without a gallbladder?

Patients generally do well after surgery and have no difficulty digesting food, even though the gallbladder’s function is to aid digestion.

If you’re suffering from symptoms of gallstone disease, I encourage you to see your physician for a proper diagnosis. Delayed treatment may cause more serious conditions and the need for open surgery rather than the less invasive laparoscopic procedure.

Recently, Gastrointestinal Associates teamed up with Thompson Cancer Survival Center to make this advanced treatment available to gastrointestinal patients in East Tennessee. Two patients have already benefitted from brachytherapy in our first month of offering the treatment.

Brachytherapy (brak-e-THER-uh-pee), sometimes called internal radiation, is a procedure that involves placing high-powered radiation inside your body, right at the site of the cancerous tumor. Unlike conventional radiation therapy which projects a beam of radiation from a machine outside of the body, this therapy allows physicians to deliver higher doses of radiation to more specific target areas with much fewer side effects.

For esophageal cancer, the brachytherapy radiation tube/seeds are placed in the esophagus during an endoscopic procedure while the patient is sedated. The actual radiation time varies between 5-10 minutes and two treatments are given over a 2 week period. For other areas of the body, ultrasound, x-ray and other imaging techniques enable the physician to place the radiation in the most effective position in relation to the tumor.

Brachytherapy for certain cancers has been shown to be as effective as surgery or external radiation and even more effective when used in combination with the other therapies. Since this procedure reduces radiation exposure and damage to healthy tissue near the tumor, it causes fewer side effects than conventional therapy. The treatment time is also usually shorter with brachytherapy.

Brachytherapy is an effective treatment for many types of cancer, particularly small or locally advanced tumors. It has been most commonly used to treat cervical, prostate, breast and skin cancers. Now we are able to add esophageal cancer to the list.

With new systems in place to reduce the risk of unnecessary radiation exposure to both the operator and patients, and new imaging technologies that make placement more precise, this procedure is an important tool in treating esophageal cancer.

We are pleased to be able to offer the benefits of brachytherapy to our patients at GIA.

Pancreatitis has some very characteristic symptoms. Upper abdominal pain, sometimes going into the back, and nausea and vomiting are quite common. The pain can be very severe. These symptoms can be caused by other diseases such as gallbladder and ulcer disease.

Pancreatitis is often seen in people with associated ailments including gallbladder disease and gallstones, elevated triglycerides, excessive alcohol usage, or elevated blood calcium. It has been associated with smoking, the use of some prescription medications, and some infections.

Anytime you notice the symptoms listed above you should seek medical attention. Sometimes this requires a trip to the emergency room and hospitalization. Patients with pancreatitis most often recover, but severe cases can take a long time to get better, and rarely this disease can be fatal. So do not hesitate to get input from your doctor.

Pancreatitis can be hereditary, a first symptom of pancreatic cancer, or associated with a number of other causes. Sometimes, no cause is found.

Generally, physicians do not screen patients to try to prevent pancreatitis. If in evaluating a patient, we come across risk factors for pancreatitis, we certainly try to address those to prevent its occurrence. For example, if we discover gallstones that seem to be at risk for causing pancreatitis we would recommend their removal. Or if a patient has very high triglycerides we would want to lower them to prevent pancreatitis. There are recommendations for screening the pancreas for cancer; but that’s another blog.

Every gastroenterologist has patients with warning signs that, if heeded, might help prevent an episode of pancreatitis. Perhaps the most common example is associated with gallstones. Gallstones are not removed just because they are found. But if they cause pain after eating, in the upper abdomen, even intermittently (referred to as biliary colic); then they should be removed. Ignoring these symptoms may put the patient at risk for gallstone pancreatitis, which can be very severe.

To treat pancreatitis, we try to remove any cause for the occurrence (such as remove a gallstone, lower triglycerides, or stop any offending drugs) and then support the patient while healing takes place. Treatment can be as simple as bed rest, intravenous fluids and medications. But severe pancreatitis can entail prolonged hospitalization, endoscopic procedures, and even surgery. Unfortunately, doctors have had a difficult time coming up with significant improvements in the treatment of this disease.

Prevention, when possible, is best. If you feel you might be experiencing symptoms of pancreatitis, talk to your doctor. If your triglycerides are up, get them down. If you drink too much alcohol, stop that. This is a disease worth preventing.

Bisphosphonate, an ingredient in medications such as Boniva, Actonel and Fosamax, has been linked to stomach pain, heartburn and ulcers. A recent Oxford University Study has revealed that taking these drugs could possibly double your chances of esophageal cancer, indicating that the risk of esophageal cancer increases slightly after just one dose of a bisphosphonate-containing medicine.

To date, the connection between bisphosphonates and esophageal cancer has not been confirmed by the Food and Drug Administration, nor has the FDA ordered label warnings for these medications. However, there is an increased incidence of gastrointestinal discomfort with these drugs.

Common side effects like stomach pain, heartburn and ulcers, though non-life-threatening, can negatively impact your day-to-day life. However, if you follow the manufacturer’s instructions, these side effects can sometimes be lessened or avoided. The manufacturer advises:

• Drink a full glass of water before taking medication
• Take medication on an empty stomach
• Sit upright and don’t drink or eat for at least 30 minutes after taking medication

If you are taking drugs that contain bisphosphonates and your symptoms cannot be controlled through these measures, talk with your doctor about alternative treatment options.

As medical practitioners, we were able to share new methods and technologies that make our practices run more smoothly and improve patient experiences. We discussed everything from practice integration and data exchange to the use of blogging and websites to keep patients informed.

We were also pleased to have former Senate Majority Leader Bill Frist, Sr., MD, as our keynote speaker. He brought us his perspective on health care reform as well as information from the federal government’s point of view. There are many new initiatives which are affecting the practice of medicine, from electronic medical records and new rate structures to breakthrough technologies and medicines.

But the most important take-away for patients from this great forum was the universal emphasis on patient outcomes and quality of care. Through new and better methods of communication, streamlining procedures and information, and more patient involvement in follow-up care, new processes are aimed at better patient care.

It was exciting to have leaders in gastrointestinal medicine here in Knoxville for this event. I appreciate all the information we shared and the opportunity to discuss the newest and best ways to operate an effective practice.

Our health care industry is continually changing. As long as we keep our focus on our patients, we will be headed in the right direction.

Those suffering with Celiac disease, however, are not alone. With one in 133 Americans suffering from the disease, that adds up to almost 3 million people. Although nearly 97 percent of cases go undiagnosed, increasing awareness and diagnoses of Celiac disease means the gluten-free community is growing larger every day.

Consequently, more and more gluten-free products are appearing on the shelves of major chains and neighborhood grocery stores. These new products provide better quality and more flavorful food, and variety and flexibility to a gluten-free diet.

In addition to food choices, Celiac patients are now finding a variety of other tools to help them adapt to the dietary change. Online recipes, gluten-free cookbooks, and support groups, as well as newsletters and magazines devoted to living and thriving on a gluten-free diet are often helpful.

What is gluten?

So what does the label “gluten-free” actually mean? In general, gluten-free is anything that doesn’t include wheat, rye, barley or possibly oats. Gluten is not a chemical added to foods but actually a natural part of most grains and flour.  Fresh fruits and vegetables do not contain gluten. Being gluten-free means eliminating traditionally prepared foods like breads, cakes, candy, cereal, condiments, cookies, pasta, pizza, pretzels and soups.

Fortunately for Celiac patients, many companies now produce gluten-free products. With these products and some easy substitutes and recipes, a gluten-free diet doesn’t have to restrict all your favorite foods. Here are just a few tips to make following a gluten-free diet easier.

Bread – In place of wheat bread, use almond bread or rice bread which can be found at in the health food section of many grocery stores or online.
Baking – Make your favorite cakes and candies with a flour alternative such as potato starch flour, tapioca flour, soy flour, corn starch, corn flour, cornmeal, white or brown rice flour.
Condiments – Hellman’s mayonnaise and many of Annie’s brand salad dressings (http://anniesnaturals.com) are gluten-free.
Ice cream – Both Cold Stone Creamery and Ben & Jerry’s ice creams are gluten-free and some flavors of Baskin Robbins are gluten-free.
Websites – Many websites are devoted exclusively to gluten-free products, such as http://www.glutino.com, http://www.glutenfree.com, http://www.liveglutenfreely.com and http://www.glutenfreemall.com.
Dining out – Guidebooks are available at websites like http://www.triumphdining.com to point you to restaurants that will accommodate gluten-free diners.
Recipes – Your local bookstore will likely have gluten-free cookbooks and websites like http://www.glutenfreeda.com provide recipes for a gluten-free diet.
Labels – When checking labels for gluten at the grocery store, be aware that gluten can be hidden in caramel coloring, modified food starch and “flavor enhancers.”
Support groups – Blogs, forums and support groups provide advice for the gluten-free diet. Use the experiences of others living on a gluten-free diet as a helpful resource.
Vitamin and Mineral deficiencies – This may be avoided with increased intake of fresh fruits and vegetables. However, supplements may be needed to maintain healthy levels of Vitamin D, B Complex, Folic Acid, Calcium, Iron, and Magnesium. Phosphorus and Potassium is found in adequate amounts in most foods. Consult your physician before adding any supplements.

Being gluten free seems like a huge problem. But as awareness grows and many companies produce more and more gluten free food items, a gluten free lifestyle is getting better all the time.

The best way to control rising health care costs is through prevention. If we can catch something early, before it requires surgery or becomes life-threatening, we can generally avoid large medical bills down the road.

Colorectal cancer is the second-leading cause of cancer-related deaths in the United States, but it can also be the most preventable, treatable and beatable disease. The best defense is to find it early, often before you even notice any symptoms. A screening colonoscopy is the absolute best way to detect and prevent colorectal cancer, one of the deadliest forms of cancer.

During this painless procedure, a physician can find and remove colon polyps, or abnormal tissue growths in the colon. Most polyps are benign, meaning non-cancerous, but can develop into cancer over time. Nearly all colorectal cancers begin in polyps. By removing these growths before they become malignant, we can actually prevent cancer from developing.

Our gastroenterologists recommend 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, screening should begin at age 45.

By removing the co-pay and deductible, this important procedure becomes more affordable for Medicare patients. The Medicare Preventive Services program will make a variety of other tests available to Medicare enrollees without a co-pay or deductible as well. So check with your healthcare provider to see how you can stay healthy and save money in the New Year.