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Fatty Liver Disease
Nonalcoholic fatty liver disease is an umbrella term for a range of liver conditions affecting people who drink little to no alcohol. As the name implies, the main characteristic of nonalcoholic fatty liver disease is too much fat stored in liver cells.
Nonalcoholic steatohepatitis, a potentially serious form of the disease, is marked by liver inflammation, which may progress to scarring and irreversible damage. This damage is similar to the damage caused by heavy alcohol use. At its most severe, nonalcoholic steatohepatitis can progress to cirrhosis and liver failure
Nonalcoholic fatty liver disease is increasingly common around the world, especially in Western nations. In the United States, it is the most common form of chronic liver disease, affecting an estimated 80 to 100 million people.
Nonalcoholic fatty liver disease occurs in every age group but especially in people in their 40s and 50s who are at high risk of heart disease because of such risk factors as obesity and type 2 diabetes. The condition is also closely linked to metabolic syndrome, which is a cluster of abnormalities including increased abdominal fat, poor ability to use the hormone insulin, high blood pressure and high blood levels of triglycerides, a type of fat.
Symptoms
Nonalcoholic fatty liver disease usually causes no signs and symptoms. When it does, they may include:
Enlarged liver
Fatigue
Pain in the upper right abdomen
Possible signs and symptoms of nonalcoholic steatohepatitis and cirrhosis (advanced scarring) include:
Abdominal swelling (ascites)
Enlarged blood vessels just beneath the skin's surface
Enlarged breasts in men
Enlarged spleen
Red palms
Yellowing of the skin and eyes (jaundice)
Causes
Experts don't know exactly why some people accumulate fat in the liver while others do not. Similarly, there is limited understanding of why some fatty livers develop inflammation that progresses to cirrhosis. Nonalcoholic fatty liver disease and nonalcoholic steatohepatitis are both linked to the following:
Overweight or obesity
Insulin resistance, in which your cells don't take up sugar in response to the hormone insulin
High blood sugar (hyperglycemia), indicating prediabetes or actual type 2 diabetes
High levels of fats, particularly triglycerides, in the blood
These combined health problems appear to promote the deposit of fat in the liver. For some people, this excess fat acts as a toxin to liver cells, causing liver inflammation and nonalcoholic steatohepatitis, which may lead to a buildup of scar tissue (fibrosis) in the liver.
Diagnosis
A diagnosis can be made using many tests including:
Plain ultrasound, which is often the initial test when liver disease is suspected.
Transient elastography, an enhanced form of ultrasound that measures the stiffness of your liver. Liver stiffness indicates fibrosis or scarring.
Liver tissue examination. If other tests are inconclusive, your doctor may recommend a procedure to remove a sample of tissue from your liver (liver biopsy). The tissue sample is examined in a laboratory to look for signs of inflammation and scarring.
If you are concerned you have fatty liver disease or have been diagnosed with fatty liver disease, contact your doctor. You can also call us at 978-459-6737 to request an appointment.
Hepatitis C
Hepatitis C is a viral infection that causes liver inflammation, sometimes leading to serious liver damage. The hepatitis C virus (HCV) spreads through contaminated blood. Until recently, hepatitis C treatment required weekly injections and oral medications that many HCV-infected people couldn't take because of other health problems or unacceptable side effects. That's changing. Today, chronic HCV is usually curable with oral medications taken every day for two to six months. Still, about half of people with HCV don't know they're infected, mainly because they have no symptoms, which can take decades to appear. For that reason, the U.S. Centers for Disease Control and Prevention recommends a one-time screening blood test for everyone at increased risk of the infection. The largest group at risk includes everyone born between 1945 and 1965 — a population five times more likely to be infected than those born in other years.
Symptoms
Long-term infection with the hepatitis C virus (HCV) is known as chronic hepatitis C. Chronic hepatitis C is usually a "silent" infection for many years, until the virus damages the liver enough to cause the signs and symptoms of liver disease. Among these signs and symptoms are:
Bleeding easily
Bruising easily
Fatigue
Poor appetite
Yellow discoloration of the skin and eyes (jaundice)
Dark-colored urine
Itchy skin
Fluid buildup in your abdomen (ascites)
Swelling in your legs
Weight loss
Confusion, drowsiness and slurred speech (hepatic encephalopathy)
Spider-like blood vessels on your skin (spider angiomas)
Your risk of hepatitis C infection is increased if you:
Are a health care worker who has been exposed to infected blood, which may happen if an infected needle pierces your skin
Have ever injected or inhaled illicit drugs
Have HIV
Received a piercing or tattoo in an unclean environment using unsterile equipment
Received a blood transfusion or organ transplant before 1992
Received clotting factor concentrates before 1987
Received hemodialysis treatments for a long period of time
Were born to a woman with a hepatitis C infection
Were ever in prison
Were born between 1945 and 1965, the age group with the highest incidence of hepatitis C infection
Hepatitis C infection that continues over many years can cause significant complications, such as:
Scarring of the liver (cirrhosis). After 20 to 30 years of hepatitis C infection, cirrhosis may occur. Scarring in your liver makes it difficult for your liver to function.
Liver cancer. A small number of people with hepatitis C infection may develop liver cancer.
Liver failure. Advanced cirrhosis may cause your liver to stop functioning.
Diagnosis
Health officials recommend that anyone at high risk of exposure to HCV get a blood test to screen for hepatitis C infection.
Doctors typically use one or more of the following tests to assess liver damage in chronic hepatitis C.
Transient elastography. Another noninvasive test, transient elastography is a type of ultrasound that transmits vibrations into the liver and measures the speed of their dispersal through liver tissue to estimate its stiffness.
Liver biopsy. Typically done using endoscopic ultrasound guidance, this test involves inserting a thin needle through the stomach wall under anesthesia to remove a small sample of liver tissue for laboratory testing.
Treatment
Hepatitis C infection is treated with antiviral medications intended to clear the virus from your body. The goal of treatment is to have no hepatitis C virus detected in your body at least 12 weeks after you complete treatment.
If you think you are at risk of having hepatitis C, call your doctor who can test you very quickly with a simple blood test. If you have hepatitis C, call us at 978-459-6737 to request an appointment. We can talk to you about how to get rid of the virus and manage any damage you may have suffered as a result of infection.
Hepatitis B
Hepatitis B is a serious liver infection caused by the hepatitis B virus (HBV). For some people, hepatitis B infection becomes chronic, meaning it lasts more than six months. Having chronic hepatitis B increases your risk of developing liver failure, liver cancer or cirrhosis — a condition that permanently scars of the liver.
Most adults with hepatitis B recover fully, even if their signs and symptoms are severe. Infants and children are more likely to develop a chronic (long-lasting) hepatitis B infection.
A vaccine can prevent hepatitis B, but there's no cure if you have the condition. If you're infected, taking certain precautions can help prevent spreading the virus to others.
Symptoms
Signs and symptoms of hepatitis B range from mild to severe. They usually appear about one to four months after you've been infected, although you could see them as early as two weeks post-infection. Some people, usually young children, may not have any symptoms.
Hepatitis B signs and symptoms may include:
Abdominal pain
Dark urine
Fever
Joint pain
Loss of appetite
Nausea and vomiting
Weakness and fatigue
Yellowing of your skin and the whites of your eyes (jaundice)
Hepatitis B infection is caused by the hepatitis B virus (HBV). The virus is passed from person to person through blood, semen or other body fluids. It does not spread by sneezing or coughing.
Common ways that HBV can spread are:
Sexual contact. You may get hepatitis B if you have unprotected sex with someone who is infected. The virus can pass to you if the person's blood, saliva, semen or vaginal secretions enter your body.
Sharing of needles. HBV easily spreads through needles and syringes contaminated with infected blood. Sharing IV drug paraphernalia puts you at high risk of hepatitis B.
Accidental needle sticks. Hepatitis B is a concern for health care workers and anyone else who comes in contact with human blood.
Mother to child. Pregnant women infected with HBV can pass the virus to their babies during childbirth. However, the newborn can be vaccinated to avoid getting infected in almost all cases. Talk to your doctor about being tested for hepatitis B if you are pregnant or want to become pregnant.
Having a chronic HBV infection can lead to serious complications, such as:
Scarring of the liver (cirrhosis). The inflammation associated with a hepatitis B infection can lead to extensive liver scarring (cirrhosis), which may impair the liver's ability to function.
Liver cancer. People with chronic hepatitis B infection have an increased risk of liver cancer.
Diagnosis
Your doctor will examine you and look for signs of liver damage, such as yellowing skin or belly pain. Tests that can help diagnose hepatitis B or its complications are:
Blood tests. Blood tests can detect signs of the hepatitis B virus in your body and tell your doctor whether it's acute or chronic. A simple blood test can also determine if you're immune to the condition.
Liver ultrasound. A special ultrasound called transient elastography can show the amount of liver damage.
Liver biopsy. Your doctor might remove a small sample of your liver for testing (liver biopsy) to check for liver damage. During this test, your doctor inserts a thin needle through your skin and into your liver and removes a tissue sample for laboratory analysis.
If you have been exposed or believe you have been exposed to hepatitis B, call your doctor who can test you very quickly with a simple blood test. If you have hepatitis B, call us at 978-459-6737 to request an appointment.
Autoimmune Hepatitis
Autoimmune hepatitis is liver inflammation that occurs when your body's immune system turns against liver cells. The exact cause of autoimmune hepatitis is unclear, but genetic and environmental factors appear to interact over time in triggering the disease.
Untreated autoimmune hepatitis can lead to scarring of the liver (cirrhosis) and eventually to liver failure. When diagnosed and treated early, however, autoimmune hepatitis often can be controlled with drugs that suppress the immune system.
A liver transplant may be an option when autoimmune hepatitis doesn't respond to drug treatments or when liver disease is advanced.
Symptoms
Signs and symptoms of autoimmune hepatitis can range from minor to severe and may come on suddenly. Some people have few, if any, recognized problems in the early stages of the disease, whereas others experience signs and symptoms that may include:
Fatigue
Abdominal discomfort
Yellowing of the skin and whites of the eyes (jaundice)
An enlarged liver
Abnormal blood vessels on the skin (spider angiomas)
Skin rashes
Joint pains
In women, loss of menstruation
Diagnosis
Autoimmune hepatitis can be diagnosed through a combination of lab testing as well as by performing a liver biopsy.
If you believe you have autoimmune hepatitis or you have been diagnosed with autoimmune hepatitis, contact your doctor. You can also call 978-459-6737 to request an appointment.
Cirrhosis
Cirrhosis is a late stage of scarring (fibrosis) of the liver caused by many forms of liver diseases and conditions, such as hepatitis and chronic alcoholism. The liver carries out several necessary functions, including detoxifying harmful substances in your body, cleaning your blood and making vital nutrients.
Cirrhosis occurs in response to damage to your liver. Each time your liver is injured, it tries to repair itself. In the process, scar tissue forms. As cirrhosis progresses, more and more scar tissue forms, making it difficult for the liver to function.
Decompensated cirrhosis is the term used to describe the development of specific complications resulting from the changes brought on by cirrhosis. Decompensated cirrhosis is life-threatening.
The liver damage done by cirrhosis generally can't be undone. But if liver cirrhosis is diagnosed early and the cause is treated, further damage can be limited and, rarely, reversed.
Symptoms
Cirrhosis often has no signs or symptoms until liver damage is extensive. When signs and symptoms do occur, they may include:
Fatigue
Bleeding easily
Bruising easily
Itchy skin
Yellow discoloration in the skin and eyes (jaundice)
Fluid accumulation in your abdomen (ascites)
Loss of appetite
Nausea
Swelling in your legs
Weight loss
Confusion, drowsiness and slurred speech (hepatic encephalopathy)
Spiderlike blood vessels on your skin
Redness in the palms of the hands
Testicular atrophy in men
Breast enlargement in men
Complications
Complications of cirrhosis can include:
High blood pressure in the veins that supply the liver (portal hypertension). Cirrhosis slows the normal flow of blood through the liver, thus increasing pressure in the vein that brings blood from the intestines and spleen to the liver.
Swelling in the legs and abdomen. Portal hypertension can cause fluid to accumulate in the legs (edema) and in the abdomen (ascites). Edema and ascites also may result from the inability of the liver to make enough of certain blood proteins, such as albumin.
Enlargement of the spleen (splenomegaly). Portal hypertension can also cause changes to the spleen. Decreased white blood cells and platelets in your blood can be a sign of cirrhosis with portal hypertension.
Bleeding. Portal hypertension can cause blood to be redirected to smaller veins, causing them to increase in size and become varices. Strained by the extra load, these smaller veins can burst, causing serious bleeding. Life-threatening bleeding most commonly occurs when veins in the lower esophagus (esophageal varices) or stomach (gastric varices) rupture. If the liver can't make enough clotting factors, this also can contribute to continued bleeding. Bacterial infections are a frequent trigger for bleeding.
Infections. If you have cirrhosis, your body may have difficulty fighting infections. Ascites can lead to spontaneous bacterial peritonitis, a serious infection.
Malnutrition. Cirrhosis may make it more difficult for your body to process nutrients, leading to weakness and weight loss.
Buildup of toxins in the brain (hepatic encephalopathy). A liver damaged by cirrhosis isn't able to clear toxins from the blood as well as a healthy liver can. These toxins can then build up in the brain and cause mental confusion and difficulty concentrating. Hepatic encephalopathy symptoms may range from fatigue and mild impairment in cognition to unresponsiveness or coma.
Jaundice. Jaundice occurs when the diseased liver doesn't remove enough bilirubin, a blood waste product, from your blood. Jaundice causes yellowing of the skin and whites of the eyes and darkening of urine.
Bone disease. Some people with cirrhosis lose bone strength and are at greater risk of fractures.
Increased risk of liver cancer. A large proportion of people who develop liver cancer that forms within the liver itself have cirrhosis.
Acute-on-chronic liver failure. Some people end up experiencing multiorgan failure. Researchers now believe this is a distinct complication in some people who have cirrhosis, but they don't fully understand its causes.
If you believe you have cirrhosis or you have been diagnosed with cirrhosis, contact your doctor. You can also call 978-459-6737 to request an appointment.
Gastroesophageal Reflux (GERD)
Gastroesophageal reflux disease (GERD) occurs when stomach acid frequently flows back into the tube connecting your mouth and stomach (esophagus). This backwash (acid reflux) can irritate the lining of your esophagus. Many people experience acid reflux from time to time. GERD is mild acid reflux that occurs at least twice a week, or moderate to severe acid reflux that occurs at least once a week.
Most people can manage the discomfort of GERD with lifestyle changes and over-the-counter medications. But some people with GERD may need stronger medications or surgery to ease symptoms.
Symptoms
Common signs and symptoms of GERD include:
A burning sensation in your chest (heartburn), usually after eating, which might be worse at night
Chest pain
Regurgitation of food or sour liquid
Sensation of a lump in your throat
If you have nighttime acid reflux, you might also experience:
Chronic cough
Laryngitis
New or worsening asthma
Disrupted sleep
Longstanding reflux can cause many problems including Barrett’s esophagus, esophagitis, and even esophageal cancer.
Diagnosis
At Integrated Gastroenterology Consultants, we have a full complement of diagnostic tools to diagnose GERD including 24-hour pH-impedence testing, BRAVO wireless pH probe, and upper endoscopy.
Treatment
If you do have GERD, be aware that longstanding proton pump inhibitor (PPI) use – such as omeprazole, Nexium, or Prilosec – has been associated with dementia, kidney failure, pneumonia, GI infections, and more. We are one of only a few centers in Massachusetts offering endoscopic non-surgical methods for controlling reflux to minimize or even eliminate the need for anti-acid medication such as transoral incisionless fundoplication.
If you have uncontrolled GERD or wish to pursue options that may eliminate the need for medications, call us at 978-459-6737 to request an appointment.
Esophageal Cancer
Esophageal cancer is cancer that occurs in the esophagus — a long, hollow tube that runs from your throat to your stomach. Your esophagus helps move the food you swallow from the back of your throat to your stomach to be digested.
Esophageal cancer usually begins in the cells that line the inside of the esophagus. Esophageal cancer can occur anywhere along the esophagus. More men than women get esophageal cancer.
Esophageal cancer is the sixth most common cause of cancer deaths worldwide. Incidence rates vary within different geographic locations. In some regions, higher rates of esophageal cancer cases may be attributed to tobacco and alcohol use or particular nutritional habits and obesity.
Signs and symptoms of esophageal cancer include:
Difficulty swallowing (dysphagia)
Weight loss without trying
Chest pain, pressure or burning
Worsening indigestion or heartburn
Coughing or hoarseness
Early esophageal cancer typically causes no signs or symptoms.
Make an appointment with your doctor if you have any persistent signs and symptoms that worry you. You can also call us at (978) 459-6737 to request an appointment.
Diarrhea
Everyone occasionally has diarrhea — loose, watery and possibly more-frequent bowel movements.
In most cases, diarrhea lasts a couple of days. But when diarrhea lasts for weeks, it can indicate a serious disorder, such as a persistent infection, inflammatory bowel disease, or a less serious condition, such as irritable bowel syndrome.
Symptoms
Signs and symptoms associated with diarrhea may include:
Loose, watery stools
Abdominal cramps
Abdominal pain
Fever
Blood in the stool
Nausea
Urgent need to have a bowel movement
If you suffer from severe or chronic diarrhea, call your doctor. You can also call us at 978-459-6737 to request an appointment.
Hemorrhoids
Hemorrhoids (HEM-uh-roids), also called piles, are swollen veins in your anus and lower rectum, similar to varicose veins. Hemorrhoids have a number of causes, although often the cause is unknown. They may result from straining during bowel movements or from the increased pressure on these veins during pregnancy. Hemorrhoids may be located inside the rectum (internal hemorrhoids), or they may develop under the skin around the anus (external hemorrhoids).
Hemorrhoids are very common. Nearly three out of four adults will have hemorrhoids from time to time. Sometimes they don't cause symptoms but at other times they cause itching, discomfort and bleeding. Occasionally, a clot may form in a hemorrhoid (thrombosed hemorrhoid). These are not dangerous but can be extremely painful and sometimes need to be lanced and drained. Fortunately, many effective options are available to treat hemorrhoids. Many people can get relief from symptoms with home treatments and lifestyle changes.
Symptoms
Signs and symptoms of hemorrhoids may include:
Painless bleeding during bowel movements — you might notice small amounts of bright red blood on your toilet tissue or in the toilet
Itching or irritation in your anal region
Pain or discomfort
Swelling around your anus
A lump near your anus, which may be sensitive or painful (may be a thrombosed hemorrhoid)
Hemorrhoid symptoms usually depend on the location.
Don't assume rectal bleeding is due to hemorrhoids, especially if you are over 40 years old. Rectal bleeding can occur with other diseases, including colorectal cancer and anal cancer. If you have bleeding along with a marked change in bowel habits or if your stools change in color or consistency, consult your doctor. These types of stools can signal more extensive bleeding elsewhere in your digestive tract.
If you believe you suffer from hemorrhoids, call your doctor. You can also call us at 978-459-6737 to request an appointment.
Difficulty Swallowing
Difficulty swallowing (dysphagia) means it takes more time and effort to move food or liquid from your mouth to your stomach. Dysphagia may also be associated with pain. In some cases, swallowing may be impossible. Occasional difficulty swallowing, which may occur when you eat too fast or don't chew your food well enough, usually isn't cause for concern. But persistent dysphagia may indicate a serious medical condition requiring treatment.
Dysphagia can occur at any age, but it's more common in older adults. The causes of swallowing problems vary, and treatment depends on the cause. Fortunately, we have all the diagnostic and treatment tools necessary for the diagnosis and treatment of almost all diseases causing dysphagia at Integrated Gastroenterology Consultants.
Symptoms
Signs and symptoms associated with dysphagia may include:
Having pain while swallowing (odynophagia)
Being unable to swallow
Having the sensation of food getting stuck in your throat or chest or behind your breastbone (sternum)
Drooling
Being hoarse
Bringing food back up (regurgitation)
Having frequent heartburn
Having food or stomach acid back up into your throat
Unexpectedly losing weight
Coughing or gagging when swallowing
Having to cut food into smaller pieces or avoiding certain foods because of trouble swallowing
Some of the causes of esophageal dysphagia include:
Achalasia. When your lower esophageal muscle (sphincter) doesn't relax properly to let food enter your stomach, it may cause you to bring food back up into your throat. Muscles in the wall of your esophagus may be weak as well, a condition that tends to worsen over time.
Diffuse spasm. This condition produces multiple high-pressure, poorly coordinated contractions of your esophagus, usually after you swallow. Diffuse spasm affects the involuntary muscles in the walls of your lower esophagus.
Esophageal stricture. A narrowed esophagus (stricture) can trap large pieces of food. Tumors or scar tissue, often caused by gastroesophageal reflux disease (GERD), can cause narrowing.
Esophageal tumors. Difficulty swallowing tends to get progressively worse when esophageal tumors are present.
Foreign bodies. Sometimes food or another object can partially block your throat or esophagus. Older adults with dentures and people who have difficulty chewing their food may be more likely to have a piece of food become lodged in the throat or esophagus.
Esophageal ring. A thin area of narrowing in the lower esophagus can intermittently cause difficulty swallowing solid foods.
GERD. Damage to esophageal tissues from stomach acid backing up into your esophagus can lead to spasm or scarring and narrowing of your lower esophagus.
Eosinophilic esophagitis. This condition, which may be related to a food allergy, is caused by an overpopulation of cells called eosinophils in the esophagus.
Scleroderma. Development of scar-like tissue, causing stiffening and hardening of tissues, can weaken your lower esophageal sphincter, allowing acid to back up into your esophagus and cause frequent heartburn.
Radiation therapy. This cancer treatment can lead to inflammation and scarring of the esophagus.
Diagnosis
Your doctor will likely perform a physical examination and may use a variety of tests to determine the cause of your swallowing.
Tests may include:
Dynamic swallowing study. You swallow barium-coated foods of different consistencies. This test provides an image of these foods as they travel through your mouth and down your throat. The images may show problems in the coordination of your mouth and throat muscles when you swallow and determine whether food is going into your breathing tube.
A visual examination of your esophagus (endoscopy). A thin, flexible lighted instrument (endoscope) is passed down your throat so that your doctor can see your esophagus. Your doctor may also take biopsies of the esophagus to look for inflammation, eosinophilic esophagitis, narrowing or a tumor.
Esophageal muscle test (manometry). In manometry (muh-NOM-uh-tree), a small tube is inserted into your esophagus and connected to a pressure recorder to measure the muscle contractions of your esophagus as you swallow.
If you suffer from dysphagia, contact your doctor. You can also call us at 978-459-6737 to schedule a consultation.
Gastrointestinal Bleeding/Anemia
Anemia from gastrointestinal (GI) bleeding can have multiple causes. Upper GI bleeding is caused by ulcers, inflammation of the stomach lining or stomach cancer. Bleeding in the lower GI tract can be attributed to intestinal polyps, abnormal blood vessels, colorectal cancer, hemorrhoids, infectious diarrhea and inflammatory bowel disease.
The symptoms of GI bleeding.
Gastrointestinal bleeding has a number of symptoms, including blood in the stool or on toilet paper as well as stools that are black or very dark. Sometimes, slow GI bleeding can be "silent," without any noticeable change in bowel movement or stool. These people are often anemic and display pale skin color, shortness of breath and weakness.
Anemia can have serious consequences.
Losing blood means losing red blood cells, which contain the substance hemoglobin that carries life-giving oxygen. A deficiency of hemoglobin leads to a lack of sufficient oxygen to the organs and other tissues, which can have a wide range of consequences to your health. So gastrointestinal bleeding must be identified and diagnosed so it can be treated and stopped.
At Integrated Gastroenterology Consultants, our board-certified GI specialists provide comprehensive diagnosis of suspected gastrointestinal bleeding and anemia backed by years of advanced training and hands-on experience. We offer these and other diagnostic procedures:
Upper endoscopy to evaluate the esophagus, stomach & duodenum
Capsule endoscopy to diagnose problems in the small intestine
Colonoscopy to evaluate for bleeding in the lower digestive tract
We perform most scope procedures in our state-of-the-art endoscopy center, where we can get you in quickly, cater to your comfort and protect your privacy and give you the specialized, compassionate care you deserve. Call us today.
For more information or to schedule an appointment, call your doctor or call us today at 978-459-6737.
Diverticulitis
What is diverticulitis?
Diverticulosis happens when pouches form in the wall of the colon. If these pouches get inflamed or infected, it is called diverticulitis. Diverticulitis can be very painful.
What causes diverticulitis?
Doctors aren't sure what causes diverticula in the colon (diverticulosis). But they think that a low-fiber diet may play a role. Without fiber to add bulk to the stool, the colon has to work harder than normal to push the stool forward. The pressure from this may cause pouches to form in weak spots along the colon. Bacteria grow in the pouches, and this can lead to inflammation or infection.
What are the symptoms?
Symptoms of diverticulitis may last from a few hours to a week or more. Symptoms include:
Belly pain, usually in the lower left side, that is sometimes worse when you move. This is the most common symptom.
Fever and chills.
Bloating and gas.
Diarrhea or constipation.
Nausea and sometimes vomiting.
Not feeling like eating.
How is diverticulitis diagnosed?
Your doctor will ask about your symptoms and will examine you. He or she may do tests to see if you have an infection or to make sure that you don't have other problems. Tests may include:
Blood tests, such as a complete blood count (CBC).
Other tests, such as an X-ray or a CT scan.
If you believe you suffer from diverticulitis, call your doctor immediately. In conjunction with the physicians at Integrated Gastroenterology Consultants, you can receive the highest level of care to treat your diverticulitis.
Constipation
Being constipated means your bowel movements are tough or happen less often than normal. Almost everyone goes through it at some point. Although it’s not usually serious, you'll feel much better when your body is back on track. The normal length of time between bowel movements varies widely from person to person. Some people have them three times a day. Others have them just a few times a week. Going longer than 3 or more days without one, though, is usually too long. After 3 days, your poop gets harder and more difficult to pass.
What Are the Symptoms?
You may have:
Few bowel movements
Trouble having a bowel movement (straining to go)
Hard or small stools
A sense that everything didn’t come out
Belly bloating
Why Does It Happen?
Some causes of constipation include:
Changes to what you eat or your activities
Not enough water or fiber in your diet
Eating a lot of dairy products
Not being active
Resisting the urge to poop
Stress
Overuse of laxatives
Some medications (especially strong pain drugs such as narcotics, antidepressants, and iron pills)
Antacid medicines that have calcium or aluminum
Eating disorders
Pregnancy
Problems with the nerves and muscles in your digestive system
Neurological conditions such as Parkinson's disease or multiple sclerosis
Underactive thyroid (called hypothyroidism)
Occasionally, constipation can be the result of colon cancer.
Diagnosis
We can help diagnose the cause of your constipation by performing a colonoscopy to rule out colon cancer as well as other motility disorders through a test called anorectal manometry.
If you suffer from constipation, call your doctor or call us at 978-459-6737 to make an appointment.
Colon Cancer
Colon cancer is cancer of the large intestine (colon), which is the final part of your digestive tract. Most cases of colon cancer begin as small, noncancerous (benign) clumps of cells called adenomatous polyps. Over time some of these polyps can become colon cancers.
Polyps may be small and produce few, if any, symptoms. For this reason, doctors recommend regular screening tests to help prevent colon cancer by identifying and removing polyps before they turn into cancer.
Symptoms
Signs and symptoms of colon cancer include:
A change in your bowel habits, including diarrhea or constipation or a change in the consistency of your stool, that lasts longer than four weeks
Persistent abdominal discomfort, such as cramps, gas or pain
A feeling that your bowel doesn't empty completely
Weakness or fatigue
Unexplained weight loss
Many people with colon cancer experience no symptoms in the early stages of the disease. When symptoms appear, they'll likely vary, depending on the cancer's size and location in your large intestine.
When to see a doctor
If you notice any symptoms of colon cancer, such as blood in your stool or an ongoing change in bowel habits, do not hesitate to make an appointment with your doctor.
Talk to your doctor about when you should begin screening for colon cancer. Guidelines generally recommend that colon cancer screenings begin at age 50. Your doctor may recommend more frequent or earlier screening if you have other risk factors, such as a family history of the disease.
Clostridium Difficile Infection (C. Diff)
Clostridium difficile is a very serious infection, and the incidence is on the rise throughout the world. The CDC reports that approximately 347,000 people in the U.S. alone were diagnosed with this infection in 2012. Of those, at least 14,000 died. Some estimates place that number in the 30,000 to 50,000 range, if the U.S. used the same cause of death reporting methods as most of the rest of the world.
Fecal Microbiota Transplant (FMT) is a procedure in which fecal matter, or stool, is collected from a tested donor, mixed with a saline or other solution, strained, and placed in a patient, by colonoscopy.
The purpose of fecal transplant is to replace good bacteria that has been killed or suppressed, usually by the use of antibiotics, causing bad bacteria, specifically Clostridium difficile, or C. diff., to over-populate the colon. This infection causes a condition called C. diff. colitis, resulting in often debilitating, sometimes fatal diarrhea.
If you suffer from C. diff, call us at 978-459-6737 for an appointment.
Incontinence
Fecal incontinence is the inability to control bowel movements, causing stool (feces) to leak unexpectedly from the rectum. Also called bowel incontinence, fecal incontinence ranges from an occasional leakage of stool while passing gas to a complete loss of bowel control. Common causes of fecal incontinence include diarrhea, constipation, and muscle or nerve damage. The muscle or nerve damage may be associated with aging or with giving birth. Whatever the cause, fecal incontinence can be embarrassing. But don't shy away from talking to your doctor. Treatments are available that can improve fecal incontinence and your quality of life.
Symptoms
Most adults who experience fecal incontinence do so only during an occasional bout of diarrhea. But some people have recurring or chronic fecal incontinence. They may be unable to resist the urge to defecate, which comes on so suddenly that they don't make it to the toilet in time. This is called urge incontinence. Another type of fecal incontinence occurs in people are not aware of the need to pass stool. This is called passive incontinence.
Fecal incontinence may be accompanied by other bowel problems, such as:
Diarrhea
Constipation
Gas and bloating
Diagnosis
At Integrated Gastroenterology Consultants, we use state-of-the-art technology such as anorectal manometry and colonoscopy and work in conjunction with the radiology department at Lowell General Hospital to help diagnose and treat your condition.
If you suffer from incontinence, call your doctor. You can also call us at 978-459-6737 to request an appointment.
Acid Reflux
Gastroesophageal reflux disease (GERD), also called acid reflux, is very common and can cause many symptoms.
Common symptoms of acid reflux are:
Heartburn: a burning pain or discomfort that may move from your stomach to your abdomen or chest, or even up into your throat
Regurgitation: a sour or bitter-tasting acid backing up into your throat or mouth
Other symptoms of acid reflux disease may include:
Bloating
Bloody or black stools or bloody vomiting
Burping
Dysphagia -- the sensation of food being stuck in your throat
Hiccups that don't let up
Nausea
Weight loss for no known reason
Wheezing, dry cough, hoarseness, or chronic sore throat
Your doctor may recommend an antacid medication to relieve your symptoms. They may also recommend additional testing such as an upper endoscopy or a pH study to better diagnose and treat your symptoms.
Bloating
Bloating is a common digestive issue that causes a full or swollen sensation in the belly, often accompanied by gas. Understanding the primary causes and effective treatments can help alleviate discomfort and improve your quality of life.
Causes of Bloating
Visceral Hypersensitivity: This is the main cause of bloating for many individuals. Visceral hypersensitivity occurs when the body unusually reacts to normal amounts of gas in the gut, leading to a bloated feeling even when gas levels are not high. It's crucial to recognize that this heightened sensitivity is often behind the discomfort experienced from bloating.
Excess Gas in the Colon: Less commonly, bloating can result from too much gas in the colon. This condition is typically due to the consumption of hard-to-digest foods or carbonated beverages, which increase gas production and accumulation in the digestive tract.
How to Manage and Treat Bloating
Avoid Common Dietary Triggers: Try avoiding common trigger foods, such as gluten, dairy, and carbonated beverages (fizzy drinks).
Follow a Low FODMAP Diet: Implementing a low FODMAP diet can be highly effective in reducing bloating. This diet minimizes the intake of certain carbohydrates that cause gas and discomfort. Foods commonly high in FODMAPs include onions, garlic, beans, and certain grains. Our IGIC nutritionist can provide guidance on adapting to this dietary approach.
Address Constipation, if Present: Some people who have bloating may have constipation. If so, treating constipation can significantly reduce bloating. Strategies include increasing water intake, incorporating fiber gradually, and maintaining regular physical activity. Sometimes, laxatives or prescription medications might be necessary under medical guidance.
Treatment Options for Visceral Hypersensitivity:
Medications: Neuromodulators such as duloxetine, tricyclic antidepressants, and gabapentin have been effectively used to retrain the gut-brain connection that leads to the sensation of bloating.
Psychological Therapies: Gut-directed hypnotherapy and cognitive behavioral therapy (CBT) are commonly used for chronic gut pain disorders. These also retrain the gut-brain connection that leads to the sensation of bloating.
Bloating and Abdominophrenic Dyssynergia: Why Do I Look Pregnant if There Isn’t Excess Gas?
You might have noticed that when you feel very bloated, your abdomen is distended, making you look pregnant even though you’re not. You might be experiencing a lesser-known condition called abdominophrenic dyssynergia. This condition is characterized by a coordination issue between the diaphragm and abdominal muscles.
Abdominophrenic dyssynergia can cause significant bloating without the presence of too much gas. This condition leads to the distension of the abdomen due to improper synchronization between your diaphragm, which is crucial for breathing, and the muscles in your abdomen. The resulting effect can make your belly extend outward, resembling a pregnant belly, which can be confusing and uncomfortable for those affected.
It's important to note that abdominophrenic dyssynergia is a benign condition and does not pose serious health risks. Treatment often focuses on managing symptoms and may include physical therapy to improve muscular coordination and breathing techniques. In some cases, targeted exercises or interventions to strengthen core muscles and enhance diaphragmatic function may be recommended by healthcare providers.
If you suffer from bloating, call us at (978) 459-6737 to schedule an appointment.
Bloody or Dark Stool
Gastrointestinal Bleeding/Anemia
Anemia from gastrointestinal (GI) bleeding can have multiple causes. Upper GI bleeding is caused by ulcers, inflammation of the stomach lining or stomach cancer. Bleeding in the lower GI tract can be attributed to intestinal polyps, abnormal blood vessels, colorectal cancer, hemorrhoids, infectious diarrhea and inflammatory bowel disease.
The symptoms of GI bleeding.
Gastrointestinal bleeding has a number of symptoms, including blood in the stool or on toilet paper as well as stools that are black or very dark. Sometimes, slow GI bleeding can be "silent," without any noticeable change in bowel movement or stool. These people are often anemic and display pale skin color, shortness of breath and weakness.
Anemia can have serious consequences.
Losing blood means losing red blood cells, which contain the substance hemoglobin that carries life-giving oxygen. A deficiency of hemoglobin leads to a lack of sufficient oxygen to the organs and other tissues, which can have a wide range of consequences to your health. So gastrointestinal bleeding must be identified and diagnosed so it can be treated and stopped.
At Integrated Gastroenterology Consultants, our board-certified GI specialists provide comprehensive diagnosis of suspected gastrointestinal bleeding and anemia backed by years of advanced training and hands-on experience. We offer these and other diagnostic procedures:
Upper endoscopy to evaluate the esophagus, stomach & duodenum
Capsule endoscopy to diagnose problems in the small intestine
Colonoscopy to evaluate for bleeding in the lower digestive tract
We perform most scope procedures in our state-of-the-art endoscopy center, where we can get you in quickly, cater to your comfort and protect your privacy and give you the specialized, compassionate care you deserve. Call us today.
For more information or to schedule an appointment, call your doctor or call us today at 978-459-6737.
Barrett’s Esophagus
In Barrett's esophagus, tissue in the tube connecting your mouth and stomach (esophagus) is replaced by tissue similar to the intestinal lining.
Barrett's esophagus is often diagnosed in people who have long-term gastroesophageal reflux disease (GERD) — a chronic regurgitation of acid from the stomach into the lower esophagus. Only a small percentage of people with GERD will develop Barrett's esophagus.
Barrett's esophagus is associated with an increased risk of developing esophageal cancer. Although the risk is small, it's important to have regular checkups for precancerous cells (dysplasia). If precancerous cells are discovered, they can be treated to prevent esophageal cancer.
Risk factors
Factors that increase your risk of Barrett's esophagus include:
Chronic heartburn and acid reflux. Having GERD that doesn't get better when taking medications known as proton pump inhibitors or having GERD that requires regular medication can increase the risk of Barrett's esophagus.
Age. Barrett's esophagus can occur at any age but is more common in older adults.
Being a man. Men are far more likely to develop Barrett's esophagus.
Being white. White people have a greater risk of the disease than do people of other races.
Being overweight. Body fat around your abdomen further increases your risk.
Current or past smoking.
Complications
Esophageal cancer
People with Barrett's esophagus have an increased risk of esophageal cancer. The risk is small, even in people who have precancerous changes in their esophagus cells. Most people with Barrett's esophagus will never develop esophageal cancer.
Diagnosis
Endoscopy is generally used to determine if you have Barrett's esophagus. A lighted tube with a camera at the end (endoscope) is passed down your throat to check for signs of changing esophagus tissue. Normal esophagus tissue appears pale and glossy. In Barrett's esophagus, the tissue appears red and velvety. Your doctor will remove tissue (biopsy) from your esophagus. The biopsied tissue can be examined to determine the degree of change.
Screening for Barrett's esophagus
Barrett's esophagus diagnosis
The American College of Gastroenterology says screening may be recommended for men who have had GERD symptoms at least weekly that don't respond to treatment with proton pump inhibitor medication, and who have at least two more risk factors, including:
Being over 50
Being white
Having a lot of abdominal fat
Being a current or past smoker
Having a family history of Barrett's esophagus or esophageal cancer
While women are significantly less likely to have Barrett's esophagus, women should be screened if they have uncontrolled reflux or have other risk factors for Barrett's esophagus.
Treatment
If you have evidence of precancerous changes in the esophagus, we are the only center in the Merrimack Valley that offers radiofrequency ablation, which uses heat to remove abnormal esophagus tissue. Radiofrequency ablation may be recommended after endoscopic resection.
If you are at risk of having Barrett’s esophagus or have been told you have Barrett’s esophagus, contact your doctor. You can also call us at 978-459-6737 to request an appointment.