All posts in DISEASES

The gut have several mechanisms that help prevent ulcers from developing, including  a protective coating of mucus layer and certain chemicals produced by the stomach  to protect the cells lining the stomach.
If the mucous layer is damaged or if acid neutralizing substances are not present in normal amounts, digestive juices can cause breakdown of the lining stomach or duodenum, causing ulcers to form.

Peptic ulcers affect more than 4 million people each year in the United States.
Most ulcers heal while others can be serious or even life-threatening.

SYMPTOMS

Pain or discomfort (usually in the upper abdomen)
Throwing up blood or passing dark stool
Early sense of fullness with eating
Lack of appetite
Nausea
Vomiting
Anemia

Not everyone with ulcer symptoms has an ulcer.
Similar symptoms can be caused by acid reflux, gallbladder problems, and stomach cancer.

CAUSES

The two most common causes of peptic ulcers are:
Helicobacter pylori, a bacteria that is frequently found in the stomach
Nonsteroidal anti-inflammatory drugs (NSAIDS) such as aspirin
Helicobacter pylori infection
Helicobacter pylori, also known as H. pylori, is the most common chronic bacterial infection in humans. H  pylori is now recognized to be an important cause of gastric and duodenal ulcers.
H pylori disrupts the mucous layer and causes the release of certain enzymes and toxins injure the cells of the stomach or duodenum.
Nonsteroidal anti-inflammatory drugs  such as ibuprofen ,naproxen  etc
The risk of developing an ulcer depends upon the specific type of NSAID, the dose and duration of use, and individual factors

Other factors
Duodenal ulcers patients  are more likely to have family members with duodenal ulcers
Tobacco
Alcohol abuse
Certain viral infections (eg, cytomegalovirus, herpes virus )

DIAGNOSIS

The most common test is an upper endoscopy, in which a small flexible tube with a camera is passed through the mouth to examine the lining of the stomach and the duodenum.

TREATMENT

Most ulcers can be healed with medications.
Surgery is rarely needed, except when complications have developed.
People who have H. pylori are treated with multiple antibiotics and a medication that reduces acid production.
Smoking,NSAIDs   and caffeine-containing foods (such as coffee, tea, and chocolate ) should be discontinued.
For more information , please see

www.nlm.nih.gov/medlineplus/healthtopics.html
www.niddk.nih.gov/
www.cdc.gov/
www.gastro.org
www.acg.gi.org
www.helico.com/

Nonalcoholic steatohepatitis (NASH) is a condition that causes inflammation and accumulation of fat and fibrous tissue in the liver.
It is diagnosed in about 7 to 9 percent of people in the United States.
NASH is seen more often in women than in men.

CONDITIONS ASSOCIATED WITH NASH 

Obesity
Diabetes
Hyperlipidemia
Insulin resistance
Medications such as amiodarone, tamoxifen

SYMPTOMS 

Fatigue can be one of the common symptoms although most people with NASH have no symptoms. Most serious complication of NASH is cirrhosis.

DIAGNOSIS 

NASH is most often discovered on routine blood  or imaging tests.
A liver biopsy is required to confirm NASH.

TREATMENT 

Weight reduction, lipid lowering therapy , insulin sensitizers are commonly used.

For more information please see
      www.gastro.org
      www.acg.gi.org
      www.aasld.org

IBS is the most commonly diagnosed gut condition causing abdominal pain and altered bowel habits such as constipation and/or diarrhea.
10 to 20 percent of people in the general population experience symptoms of IBS.
IBS usually begins in young adulthood.
Women are twice as likely as men to be diagnosed with IBS in the United States.

CAUSES

Many researchers THINK that IBS is caused by increased sensitivity of the intestines to normal sensations so that even  normal amounts of gas or movement are perceived as excessively  painful.

SYMPTOMS 

Abdominal pain 
Abdominal pain is typically crampy, varying in intensity, and located in the lower left abdomen.
Some IBS patients notice an association between pain episodes and their menstrual cycle.

Altered bowel habits 
These include diarrhea, constipation, or alternating diarrhea and constipation.
Diarrhea-often with mucus, is often preceded by a sense of extreme urgency and followed by a feeling of incomplete evacuation.

DIAGNOSIS 

There is no single diagnostic test for IBS.
A comprehensive medical history, physical exam and simple blood tests are done to rule out Colitis.

TREATMENT 

Try eliminating foods that may aggravate IBS.
Avoid lactose containing products , gas-producing foods are legumes (such as beans) and cruciferous vegetables (such as cabbage, cauliflower, and broccoli) to see if it helps.
Increasing dietary fiber can relieve symptoms in  those with who have constipation.

Medications 
Many drugs are available primarily  to relieve symptoms.
Antidepressants relieve pain and depression in many IBS patients.
Anticholinergic (Dicyclomine (Bentyl) and hyoscyamine (Levsin) help to reduce severe cramps and irregular contractions of the colon.
Lubiprostone (Amitiza) is available for treatment of severe constipation and irritable bowel syndrome in women >18 years who have not responded to other treatments. It works by increasing intestinal fluid secretion.

Commonly used drugs
Hyoscyamine (Anaspaz, Levbid, Levsin/SL, Levsinex, Levsin, NuLev)
Dicyclomine ( Bentyl)

For more information , please see

      www.nlm.nih.gov/medlineplus/healthtopics.html
      www.niddk.nih.gov/
      www.cdc.gov/
      www.gastro.org
      www.acg.gi.org
      www.iffgd.org

About 2.7 million people in the United States have hepatitis C.
Chronic hepatitis C is the most common chronic liver disease and accounts for 8,000 to 13,000 deaths each year.
The majority of liver transplants performed in the US are done for people with chronic hepatitis C.

TRANSMISSION 

The virus is spread by contact with blood such as blood transfusions and  unprotected intercourse.
Hepatitis C transmission can occur by sharing household items that carry the virus such as toothbrushes and razors.
Please note that there is 5 to 6 % risk of transmitting virus to fetus during pregnancy.

SYMPTOMS 

Many people with chronic hepatitis C have no symptoms, even if there is significant liver damage.
Nonspecific symptoms such as  fatigue , nausea, lack of appetite and weight loss are seen.
20 percent of people will develop cirrhosis 20 years after becoming infected.

DIAGNOSIS

Hepatitis C is diagnosed with a blood test because a person has risk factors for the infection such as

Anyone who was given donated blood or organs before July 1992 or blood clotting factors before
1987
Recent exposure to blood infected with HCV (eg, an accidental needle stick)
Being HIV positive
Past or current sexual partner of a person with HCV
Previous or current use of IV drugs
Previous or current use of hemodialysis for kidney failure

TREATMENT

1. Avoid using alcohol and hepatotoxic drugs
2. Vaccinate against hepatitis A and B unless already immune
3. Influenza vaccination is recommended once per year
4. Pneumococcal vaccine is recommended every five years
5. Diphtheria and tetanus booster immunizations every ten years
6. Pegylated interferon and ribavirin

For more information please see
      www.gastro.org
      www.acg.gi.org
      www.aasld.org
      www.cdc.gov

There are 300 million carriers of the hepatitis B virus in the world, with over 500,000 dying annually from liver disease.
The prevalence of HBV carriers varies from 0.1 to 2 % in low prevalence areas such as the US to 10 to 20 % in high prevalence areas such as southeast Asia  and  China.

TRANSMISSION 

In the US  the virus is most commonly transmitted by needle sharing during injection drug use or by unprotected sexual intercourse.
In regions of the world where hepatitis B is prevalent, perinatal transmission (transmission from a mother to her baby) is the most common type of transmission.
Hepatitis B transmission can occur through close personal contact and by sharing household items that carry the virus such as toothbrushes and razors.
Organ transplantation and blood transfusion are uncommon modes of transmission.

SYMPTOMS

Many infected people have no specific symptoms for many years.
Fatigue, loss of appetite, nausea, jaundice are common in acute infection while  fluid accumulation in the abdomen and legs, bleeding and  mental confusion are seen in chronic stage.
All persons who have chronic infection with hepatitis B are at increased risk of developing complications such as cirrhosis and liver cancer.

DIAGNOSIS 

Generally  based upon medical history, physical examination, and the results of diagnostic tests.
Special hepatitis markers found in the blood can confirm hepatitis B infection.
Liver biopsy is used for monitoring the progression of liver damage in people with chronic hepatitis and for detecting cirrhosis or liver cancer.

TREATMENT 

1. Avoid using alcohol and hepatotoxic drugs
2. Vaccinate against hepatitis A unless already immune
3. Influenza vaccination is recommended once per year
4. Pneumococcal vaccine is recommended every five years
5. Diphtheria and tetanus booster immunizations every ten years
6. Antivirals  such as lamivudine, adefovir, entecavir, telbivudine, interferon-alpha, and pegylated interferon-alpha

For more information please see
      www.gastro.org
      www.acg.gi.org
      www.aasld.org
      www.cdc.gov/ncidod/diseases/hepatitis/index.htm

Helicobacter pylori is a bacterium that causes ulcers in stomach and  upper small bowel as well as gastric cancers.

It is present in approximately one-half of the world’s population.
In the United States and other developed countries, infection is unusual during childhood but becomes more common during adulthood. However, in developing countries, most children are infected with H. pylori before age 10.

RISK FACTORS 

H. pylori is probably spread by consuming food or water contaminated with fecal matter. Children living in developing countries may become infected after swimming in contaminated pools, streams, or rivers, by drinking contaminated water, or by eating uncooked vegetables.

SYMPTOMS 

Most individuals with  this infection have no symptoms.
Some people develop more serious problems, including stomach or duodenal ulcers. Common complaints include pain or discomfort (usually in the upper abdomen), bloating, feeling full after eating ONLY a small amount of food, and dark or tar-colored stools.
People who live in countries in which infection occurs at an early age are at greatest risk of stomach cancer.

DIAGNOSIS
 
Blood tests 
Blood tests can detect specific antibodies (proteins) that the body’s immune system develops in response to the infection.
Blood tests are not recommended for follow up testing as  the antibody detected by the blood test often remains in the blood long time treatment, even if the infection is eliminated.
Breath tests 
Urea breath tests
Stool tests 
 Tests are available that detect H. pylori proteins in stool.
Endoscopy  
During an endoscopy, a flexible tube is inserted through the mouth into the esophagus, stomach, and upper region of the small intestine. The tube contains a light and camera, which can be used to examine the various areas. Small tissue samples (biopsy samples) can be taken from the stomach, which are then tested for H. pylori.

WHO SHOULD BE TESTED?

Patients with symptoms 
Diagnostic testing for H. pylori infection is done for people with active gastric or duodenal ulcers and those with a past history of ulcers.
Patients without symptoms
Generally not recommended.
Considered for those with a family history or concern about stomach cancer, particularly individuals of Chinese, Korean, or Japanese descent who have a  higher incidence of stomach cancer.

TREATMENT
 
 Patients with a history of peptic ulcer disease, active gastric ulcer, or active duodenal ulcer associated with H. pylori infection should receive treatment for the infection.
 Treatment involves taking several medications for 7 to 14 days.

For more information , please see

      www.nlm.nih.gov/medlineplus/healthtopics.html
      www.niddk.nih.gov/
      www.cdc.gov/
      www.gastro.org
      www.acg.gi.org
      www.helico.com/

The gallbladder is a pear-shaped muscular organ that is 3 to 6 inches long, located in the right upper side of the abdomen .
It  stores and concentrates bile – a green colored fluid needed to digest fats.
Gallstones are formed secondary to imbalance in bile composition, or sluggish gallbladder contractions.
One million Americans are diagnosed with gallstones every year.
Gallstones are of 2 types-
1.Cholesterol gallstones account for approximately 80 percent of gallstones in developed countries, including the United States.
3.Pigment stones, composed mainly of bile pigments and other compounds, account for  the rest

RISK FACTORS 

Gender – Gallstones are more common in women.
Ethnicity – Gallstones occur more frequently in Native Americans, Pima Indians, and Chileans.
Family history -Studies of family histories indicate that cholelithiasis runs in certain families.
Pregnancy
Use of estrogen preparations (such as birth control pills)
Obesity
Rapid weight loss (including patients who have surgical weight loss treatments)
Diabetes mellitus
Sickle cell disease
Cirrhosis

SYMPTOMS

Most  people who have gallstones do not have symptoms –NO TREATMENT IS NECESSARY.
When gallstones begin to cause symptoms such as pain, fatty food intolerance,nausea then surgery is considered.
Complications can develop if gallstones migrate and block the common bile duct causing jaundice or infection of the bile ducts that causes pain, chills, and fever. Acute pancreatitis can also occur.

DIAGNOSIS .

Gallstones are commonly detecting using ultrasound.
HIDA scan is used to diagnose cholecystitis.

TREATMENT 

Gallstones that do not cause any symptoms usually do not require treatment.
Cholecystectomy is surgical removal of the gallbladder. Removing the gallbladder generally has little or no effect on digestion.
Laparoscopic cholecystectomy uses small instruments /  a small video camera, inserted into the abdomen through three or four small incisions,to remove the gallbladder. Patients may be able to go home the same day as the surgery or may stay in the hospital for one night. Patients are usually able to return to work in one to two weeks.

Gallstone prevention 
Exercising for at least 30 minutes five days per week to maintain normal body weight.
Eating  three well-balanced meals daily, with each meal containing some fat to ensure gallbladder emptying .
Diet high in fiber, calcium and low in saturated fats.

For more information , please see

      www.nlm.nih.gov/medlineplus/healthtopics.html
      www.niddk.nih.gov/
      www.cdc.gov/
      www.gastro.org
      www.acg.gi.org

Dyspepsia is a recurrent or persistent pain that is mostly located in the upper abdomen.
About 25 percent of people in the United States  have symptoms of dyspepsia.

CAUSES 

Digestion of   food involves series of events that require coordination of the nerves and muscles of the digestive tract. Abnormalities in this system may lead to delayed emptying of the stomach contents resulting in nausea and vomiting, an early sense of fullness with eating, and bloating. Increased sensitivity to pain, psychological factors and Helicobacter pylori infection might play a role as well.

SYMPTOMS

Bloating  
Discomfort or pain in the abdominal area
Early sense of fullness with meals  
Nausea /  vomiting

DIAGNOSIS

Generally based on detailed medical history and physical examination.
The American Gastroenterological Association recommends upper endoscopy for those older than 55 or with serious symptoms, such as repeated vomiting, weight loss, difficulty swallowing, or anemia.

TREATMENT

Avoiding fatty foods which can slow the emptying of the stomach as well as eating small frequent meals are the cornerstones of treatment. Acid reducing medications and antidepressants can be  helpful. Few patients with functional dyspepsia improve following treatment of H. pylori.

For more information , please see

      www.nlm.nih.gov/medlineplus/healthtopics.html
      www.niddk.nih.gov/
      www.cdc.gov/
      www.gastro.org
      www.acg.gi.org
      www.iffgd.org

A diverticulum is a sac-like protrusion that forms in the muscular wall of the colon.
Diverticular disease is a common problem in western world that affects men and women equally.

CAUSES
 
Environmental and lifestyle factors may have a role in the development of diverticular disease . High wall tension secondary to low fiber diet  is thought to increase the risk of developing diverticula.
High fiber diet increases stool bulk and  thereby decreases the tension in the wall of the colon.

COMPLICATIONS

Diverticulitis  ( 15 to 25% )
Diverticular bleeding ( 5 to 15 % )
SYMPTOMS
Most people with diverticulosis have no symptoms and will remain symptom free for the rest of their lives.
The symptoms of diverticulitis  include pain in the lower abdomen, fever and urinary symptoms. Most cases resolve with antibiotics but about 25% will need surgery for abscess, fistula , sepsis.
Diverticular bleeding usually causes painless bleeding from the rectum.
DIAGNOSIS 
Diverticulosis is often found during tests performed for other reasons, such as routine screening for colon cancer or imaging studies such as CT scans done for evaluation of abdominal pain or rectal bleeding.

TREATMENT

Diverticulosis 
Most patients have no  symptoms and  do not require specific treatment.
Fiber supplements, can help to bulk the stools and possibly prevent the development of new diverticula, diverticulitis, or diverticular bleeding. Fruits and vegetables are a good source of fiber and can be particularly helpful in preventing and/or treating.

In the past patients with diverticular disease were advised to avoid whole pieces of fiber (seeds, and nuts) because of concern that the undigested  nuts  could become lodged within a diverticulum, causing inflammation or bleeding.  Currently most gastroenterologists do not subscribe to this view.

For more information , please see

      www.nlm.nih.gov/medlineplus/healthtopics.html
      www.niddk.nih.gov/
      www.cdc.gov/
      www.gastro.org
      www.acg.gi.org

Acute  diarrhea  is ≤14 days in duration  and is commonly due to infections with viruses and bacteria .
Most cases are self limited ,but work up is indicated in the following instances:
Profuse watery diarrhea with signs of hypovolemia
Passage of many small volume stools containing blood and mucus
Bloody diarrhea
Temperature ≥38.5ºC (101.3ºF)
Passage of ≥6 unformed stools per 24 hours or a duration of illness >48 hours
Severe abdominal pain
Recent use of antibiotics or hospitalized patients
Diarrhea in the elderly (≥70 years of age) or the immunocompromised

Stool cultures on initial presentation in the following groups of patients:
Immunocompromised patients
Patients with more severe, inflammatory diarrhea (including bloody diarrhea)
Patients with underlying inflammatory bowel disease
Some employees, such as food handlers, occasionally require negative stool cultures to return to work
Treatment
General measures such as hydration and alteration of diet.
Boiled starches and cereals ( potatoes, rice ) with salt, crackers, bananas, soup, and boiled vegetables are indicated in patients with watery diarrhea.
Secondary lactose malabsorption is common following infectious enteritis and temporary avoidance of lactose-containing foods may be reasonable.
Antimotility agent loperamide (Imodium) can  be used for the symptomatic treatment of patients with acute nonbloody diarrhea in whom fever is absent

Antibiotic therapy is not required in most cases since the illness is usually self-limited.

Chronic diarrhea, defined as the production of loose stools with or without increased stool

frequency for more than 4 weeks, is a common symptom that has prevalence in the United

States of approximately 3%–5%.

CAUSES
Irritable bowel syndrome
Inflammatory bowel disease   ( Crohn’s  and Ulcerative colitis)
Infections –   Clostridium difficile, Camyplobacter, Giardia, Amebae
Medications

DIAGNOSIS

A detailed medical history often points to the underlying cause of chronic diarrhea.

Blood tests and stool evaluation should be done prior to endoscopic evaluations

TREATMENT
Treat the underlying cause ( such as Colitis)
Relieve the diarrhea (peptobismol, psyllium, Loperamide, Lomotil)
Address any complications that result from long-standing or severe diarrhea

For more information please see
www.nlm.nih.gov/medlineplus/healthtopics.html
www.cdc.gov/
www.niddk.nih.gov
www.gastro.org
www.ccfa.org
www.ibsgroup.org
www.aboutibs.org