Among common medical problems, gastrointestinal (GI) disorders are leaders of the pack; unfortunately, they can leave you feeling like you’re lagging behind. And unlike other more silent problems like hypertension and diabetes—conditions that you may not even know you’re living with—GI troubles are everyday problems that tend to impair quality of life. Fortunately, most of these issues are harmless—but others can lead to larger problems if left untreated.

“Slight changes in bowel habits are common in everybody every day,” explains Thomas J. Amrick, MD, FACP, chief of Overlook Hospital’s gastroenterology section. “Some things seem very minor but are significant. Other times, trivial symptoms are just that: there’s no disease, nfo tumor. But that’s why proper care starts with a primary care physician, who may refer you to a GI doctor.”

Still, understanding when to ride out your symptoms, when to pick up a drugstore remedy, and when to consult a doctor can be confusing. One rule of thumb: “If you’re depending on medicines and your symptoms are progressing, or if symptoms persist beyond several weeks, it’s prudent to get further testing,” cautions gastroenterologist John Franzese, MD. “With accessibility to over-the-counter medicines, what patients should recognize is that when symptoms aren’t responding, they should consult with primary care physicians and specialists who can guide them to relief.”

Excluding colon cancer, which occurs in men and women in equal numbers (Amrick describes it as “an equal-opportunity killer”), differences between the sexes do play a role in GI disorders. Explains gastroenterologist and hepatologist Amber Khan, MD, “Women need to be a little more aware of the fact that their bodies are different anatomically and physiologically from men’s bodies. There are differences in gender expectations, too: Women tend to blow off symptoms more frequently. As a result, we see worse presentations of symptoms in women than in men.” Khan further points out that women are more prone to visceral sensitivity. Therefore, symptoms related to gas are perceived more strongly in women. Also, the senses of taste (for bitter and sweet foods) and smell are stronger, which may explain why women are more prone to nausea and vomiting. Gender aside, when GI trouble strikes, it’s important to take symptoms seriously.

The word on GERD

Gastroesophageal reflux disease (GERD) occurs when stomach acid backs up into the esophagus. Symptoms include regurgitation, difficulty swallowing, and coughing or wheezing at night. Unexpected or involuntary weight loss, GI bleeding, and anemia may be signs that you have more than a minor case. Taking over-the-counter medications may make you feel better, but if you find that you’re increasing the amount of medicine you’re taking, you could be masking signs of severe reflux, Amrick cautions.

Travel-related illnesses

You’ve spent a couple of days enjoying the sunny, sandy beaches of Mexico—and then a few more trapped in your hotel bathroom. Or you spent a week at sea, and came back with more than you bargained for. Among the most common GI ailments is traveler’s diarrhea—but you don’t have to jet off to exotic locales or third-world nations to contract pathogenic bacteria, Amrick explains. Most bouts of traveler’s diarrhea resolve on their own within 72 hours of returning home. If not, consult your physician; bacterial infections sometimes require antibiotics, and parasitic infections like giardia can present with symptoms that come and go and persist for months.

Sufficiently self-absorbored?

Certain digestive disorders, like Crohn’s disease (an inflammatory disease of the digestive system) and Celiac disease (the inability to digest foods containing gluten), leave the body unable to absorb essential nutrients. “When these diseases fly under the radar,” says Amrick, “they can have serious long-term effects. If you don’t absorb iron, for example, you develop anemia. If you don’t absorb calcium, particularly for women, you develop osteoporosis. A B12 deficiency can even affect brain function.”

What’s stopping you?

If you’ve ever been constipated, you understand the discomfort—even pain—associated with it. For many people, constipation is simply the passing of infrequent stools. But for others, constipation can mean hard stools, difficulty passing stools (straining), or a sense of incomplete emptying after a bowel movement. For many people, this is the result of poor diet and a lack of water; adding fiber, exercise, and adequate fluid intake to your lifestyle should be enough to cure what ails you. In cases of long-standing chronic constipation, Khan explains, the most common cause in women is a problem with the pelvic floor: “When there is a lack of coordination between rectal pressure and the internal anal sphincter, the person is unable to expel. She feels pressure in the rectum, but she is unable to evacuate. When you relax your external sphincter, the internal sphincter should relax; in some women, the internal sphincter contracts instead.” Biofeedback, in which patients are able to visualize their muscle responses on a video screen, can aid in “retraining” these muscles.
In cases of slow motility, however, little can be done. “Constipation is an area where we are frustrated because we do not have many good prescription medications,” says Khan. “In the past ten years, several medications have been pulled back because of cardiovascular side effects.” But if constipation is a sudden-onset symptom that persists, Khan warns that you should see a doctor immediately; it could be a sign of an anatomical problem, like a stricture, abscess, or tumor.

An irritated state

The causes of Irritable Bowel Syndrome (IBS) are largely unknown, but its sufferers usually complain of chronic abdominal pain, irregular bowel habits, and bloating. It is often described as a sensitivity to irritants in the GI tract. Other physicians attribute it to dismotility of the GI tract. Explains Khan: When normal GI wave patterns occur at the same time as abnormal patterns, pockets of gas are created, making it easy for liquids and foods to become trapped. Another theory is increased visceral hypersensitivity, in which people are extremely sensitive to gas and food distending the gastrointestinal tract. “There are a lot of nerves on the outside of the GI tract,” says Khan, “so anything blowing up the GI tract stretches and irritates those nerves, and you feel cramping and pain.” Unfortunately, there is no test for IBS; diagnosis occurs by excluding other conditions. “Don’t just live with a diagnosis of IBS,” cautions Khan. “You have to rule out other issues, like colitis, lactose intolerance, Celiac disease, cancer, or gallbladder disease.”

How one small organ adds up to big problems

If you’ve never had a problem with your gallbladder, you probably don’t even know where it’s located (under the liver) or what it does (it puts out enzymes to aid in fat digestion). But when it’s not functioning properly, it causes all sorts of problems—everything from nausea, dizziness, gas, and bloating, to pain, headaches, and vomiting. Gallbladder disease affects women two to three times more often than it affects men (after age 60, however, the numbers are about equal), perhaps because the gallbladder contracts more slowly in women (especially during pregnancy), allowing gallstones to form more easily. Slower contraction is caused by the female hormone prolactin; also, estrogen and progesterone affect cholesterol metabolism, and 90 percent of gallstones are cholesterol. When stones remain in the gallbladder, they tend not to pose much of a problem. But once they enter the bile ducts and pass into the duodenum, they cause great pain.

Khan reports that when she was in medical school, gallbladder disease was characterized by four F’s: female, forty, fat, and flatulent. These days, she says, the “female” part remains overwhelmingly true, but she’s seeing much younger women—even children—and thin women complaining of gallbladder-related symptoms. If your doctor suspects gallbladder disease, he or she will likely order an ultrasound to check for gallstones. If no stones are detected, he or she may request an MRI or a CCK/HIDA scan, a nuclear-medicine test in which the gallbladder is stimulated hormonally to determine how much of it is functioning properly. Fortunately, more than 60 percent of patients afflicted with gallbladder disease will not need to have the organ removed. “But if the symptoms are hindering your life,” Khan says, “you’re better off without a gallbladder.”

When it’s not your stomach

“The role of a gastroenterologist is a hard one,” says Amrick. “We have to ferret out some small symptoms among some big players. We often pick up disease processes that may not be GI problems.” He explains that because a lot of the evaluation involved in the abdominal system also goes to another organ system, he has referred patients to other specialists for such disease states as diabetes, myasthenia gravis, neurological disorders, and prostate cancer. Even cardiac disease can be expressed through the stomach. “A good number of folks having cardiac problems will have abdominal pain—not chest pain—as a primary symptom,” he cautions. “Certain types of heart attacks have nausea and vomiting as primary symptoms.”

Says Amrick, “GI doctors do a particularly great job as detectives. We try to cover it all. It’s a tall order, but we have a lot of tools.”

For a referral to a gastroenterologist, call (888) 294-5066.

Picture This - Beyond endoscopy and colonoscopy

If your doctor tells you she needs a better view of what’s going on inside your gastrointestinal tract, she may suggest one of the following tests. These may seem sci-fi in nature, but the technology is here now. Pat Schaedel, RN, and Vicky Schmidt, RN-BSN, coordinators of the Endoscopy Department’s Digestive Disease Center, explain the ins and outs.

CAPSULE ENDOSCOPY
The small intestine is traditionally a “blind area”—there aren’t many conventional ways to look at it. But if your doctor is searching for signs of bleeding, a capsule endoscopy may be just what the doctor orders. It’s basically a pill-cam: The patient goes to the Digestive Center in the morning, is hooked up to a recorder pack, and swallows a capsule no bigger than a large vitamin. Over the course of the next several hours, the capsule sends feedback to the recorder until it hits the colon. The patient returns the recording device that same day; there is no need to return the capsule, which passes naturally through the digestive system. “The visual images are amazing,” says Schaedel. “The capsule provides living-color video images that doctors have never been able to see before.”

BRAVO CAPSULE
Everyone has a certain amount of stomach acid, but for a patient waging a serious battle against gastroesophagal reflux disease (GERD), the wireless Bravo capsule provides a 48-hour reading of any changes in pH in the esophagus, sending readings to a recorder. During a standard upper endoscopy, the GI doctor hooks the Bravo on to a small part of the esophagus using a bit of suction and a little pin. As the patient eats and swallows over the next few days, the capsule loosens, falls down, and passes easily through the digestive tract.

ESOPHOGEAL MOTILITY STUDY
This test for swallowing difficulties is common among the elderly but may also be ordered if a patient is experiencing a high degree of GERD and is having a procedure to fix the esophageal sphincter, or if a doctor suspects a hiatal hernia. It’s performed by inserting a catheter with sensors through the nose, down the esophagus, and into stomach. The catheter is then removed one centimeter at a time to get markings and pressure readings from the upper esophageal sphincter. The patient is awake because of the need to follow swallowing instructions. “It’s a little uncomfortable,” says Schmidt, “but we get a lot of information.”

PELVIC FLOOR LAB
The Pelvic Floor Lab at Overlook Hospital is one of only four such labs in the state. Here Schaedel and Schmidt work with colorectal surgeons to do tests of the lower digestive tract, including tumor staging. A trans-rectal ultrasound determines how deep a tumor has spread, which helps to determine a patient’s course of treatment for chemotherapy, radiation, and surgery. Other tests at the lab include evaluations of rectal muscles for constipation and incontinence. Through a series of seven or eight biofeedback sessions, patients are able see on a video screen how these muscles respond, and learn to make adjustments. “In some people, this is very beneficial,” says Schaedel. “There’s a real improvement in quality of life.”

For more information on the Digestive Disease Center, call (888) 296-1506.

The Digestive Disease Center is participating in a colon cancer screening seminar, featuring lectures by gastroenterologist Amber Khan, MD, and gastrointestinal surgeon Julie Lorber, MD, March 28 at Overlook Hospital. For more information, call (888) 298-4460.