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Conditions We Treat

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LIVER CANCER & DISEASE

Liver Cancer happens when normal cells in the liver change into abnormal cells and grow out of control. Your liver is a football-sized organ that sits in the upper right portion of your abdomen beneath your diaphragm and above your stomach. When the liver becomes damaged or diseased, the entire body can be greatly affected. Liver disease is a term that includes a range of conditions and disease including cancer.

Liver disease can be inherited (genetic) or caused by a variety of factors that damage the liver such as viruses and alcohol use. Obesity is also associated with liver damage. Over time, damage to the liver results in scarring (Cirrhosis) which can lead to liver failure.

The most common symptoms surrounding liver cancer and liver disease include:

• Loss of weight without trying
• General weakness and fatigue
• Yellowish discoloration of skin or of the whites of your eyes (Jaundice)
• Loss of appetite
• Nausea and vomiting
• Tendency to bruise easily
• Dark urine
• Pale stool color or tarlike bloody stool
• Abdominal pain /swelling
• Swelling of the lower extremities

Liver disease has many causes including:

• Infection
• Hepatitis A,B,C
• Immune System Abnormality = Autoimmune Hepatitis, Primary Biliary Cirrhosis, Primary Sclerosing Cholangitis
• Genetics – An abnormal gene inherited from one or both of your parents can cause substances to build up in your liver.
• Cancer and other growths
• Other common causes of liver disease include = Chronic alcohol abuse and fat accumulating in the liver (non-alcoholic fatty liver disease).

Treatment for liver disease and liver cancer depends on the type of problem in the liver and the extent of the damage to the liver. Treatment may begin with conservative measures (medications) and can lead to other modalities which include surgery, radiation, chemotherapy and a liver transplant.

Some preventative measures for liver disease include drinking alcohol in moderation, maintain a healthy weight, using caution with chemicals, being vaccinated against Hepatitis A and B, and using a safe and clean tattoo / piercing location.

Celiac Disease

What is Celiac Disease?

Celiac disease is a chronic digestive disorder. This multisystem disorder is caused by the body’s immune system reacting to proteins in wheat, rye and barley. The immune reaction damages the lining of the small intestine, causing reduced nutrient absorption. When the intestinal villi in the small intestine are damaged, the body cannot absorb critical vitamins, minerals and calories.

This condition continues as long as these proteins are in the diet.

Three Facts About Celiac Disease 

  • Celiac disease can develop at any time in a person’s life.
  • Currently, the average age of diagnosis is between ages 40 to 50.
  • Approximately one in 100 people in the U.S. are estimated to have celiac disease, yet only a small percentage of individuals are diagnosed.

Are You at Risk?

The main risk factor is having a family member with celiac disease. The disease can affect anyone, but it tends to be more common in those with existing autoimmune diseases (e.g., autoimmune liver disease, type 1 diabetes, rheumatoid arthritis and autoimmune thyroid disease).

Celiac Disease Symptoms

Symptoms of celiac disease can relate to the digestive system or in other parts of the body. From person to person, symptoms can vary a great deal, which can make a definitive diagnosis difficult.

One person may have depression, irritability or fatigue, while another may have diarrhea, constipation, gas, bloating or abdominal pain. These symptoms can also sometimes first appear after an episode of gastroenteritis, severe emotional distress, abdominal surgery, pregnancy or childbirth.

Look for any of the following symptoms:

  • Bloating, gas or abdominal pain
  • Constipation or diarrhea
  • Significant unexplained weight loss
  • Chronic fatigue and weakness
  • Unexplained anemia
  • Premature onset of osteoporosis
  • Itchy skin rash with small blisters
  • Irritability or behavior change
  • Mouth ulcers
  • Tingling or numbness in hands or feet
  • Migraine headaches

Diagnosing Celiac Disease

Could You Have Celiac Disease?

It’s currently estimated that there are more than 2 million people nationwide with celiac disease who have not been diagnosed.

While celiac disease primarily affects the gastrointestinal tract, it is now recognized that the condition can affect other organ systems without showing noticeable gastrointestinal symptoms. This makes diagnosing celiac disease challenging.

Several blood tests are available to screen for celiac disease. The main test used for screening is the tTG-IgA test. Celiac disease blood tests measure for certain antibodies:

  • IgA tissue transglutaminase (tTG) antibody
  • Deamidated gliadin peptide (DGP) antibodies (IgA and IgG)
  • IgA anti-endomysial antibody (used only on occasion)

If the test results are positive, or if the clinical picture suggests celiac disease, an upper endoscopy is performed to get a biopsy from the first part of the small intestine (duodenum).

While a blood test can help detect celiac disease, an endoscopic biopsy is the only way to confirm a definite diagnosis. Up to 10 percent people with celiac disease eating gluten have a “false” normal level of tTG IgA. So if you have pronounced symptoms yet your antibody test results indicate that you do not have celiac disease, an endoscopy and biopsy may be still be performed.

Why You Need A Professional Diagnosis

Celiac disease is not the same as a wheat allergy or gluten sensitivity without intestinal damage (non-celiac gluten sensitivity). The hereditary nature of celiac disease and the risk of nutritional deficiencies, other autoimmune diseases and GI cancers make it important to be properly diagnosed.

Prior to Celiac Disease Diagnosis

It is recommended not to start a gluten-free diet before you are diagnosed. The damage to the small intestine that is caused by gluten in people with celiac disease is reversible, and eliminating gluten from the diet before the biopsy is performed can interfere with obtaining accurate test results. Similarly, the antibody levels will decline once a gluten-free diet is started, making the blood tests less accurate in diagnosing celiac disease.

However, the biopsy can take well over a year or two before it returns to normal, so it is recommended that a biopsy is obtained soon after a patient on a gluten-free diet sees the physician.

Conditions That Can Mimic Celiac Disease

There are other digestive conditions that can cause symptoms from eating wheat and other grains and starches. These conditions are treated differently than celiac disease.

Non-Celiac Gluten Sensitivity

Non-celiac gluten sensitivity (NCGS) is a condition or syndrome that causes digestive symptoms that appear like celiac disease. However, NCGS does not cause intestinal damage or anemia, and the IgA celiac disease antibodies (TTG IgA and DGP IgA) are not typically elevated.

Patients with NCGS are often extremely sensitive to small amounts of gluten. The causes of NCGS are unknown and there are no diagnostic tests that can confirm the diagnosis of this condition.

The absence of the so-called celiac disease susceptibility HLA DQ genes rules out celiac disease and can suggest NCGS in patients with symptoms of celiac disease.

Wheat Starch Intolerance

Another cause of wheat or gluten sensitivity is wheat starch intolerance.

Wheat is made up of proteins (gluten) and carbohydrates (starch) which are found together in baked goods and other wheat products. Some individuals who are intolerant of or sensitive to wheat, like those with irritable bowel syndrome (IBS), are reacting to wheat starch, which can be fermented by bacteria in the intestines (the microbiome).

If you have IBS and are sensitive to fermentable sugars and starches, you may have symptoms such as:

  • Belly bloating
  • Altered bowel habits
  • Excessive gas
  • Other digestive complaints

Help With FODMAP

A low FODMAP diet can be difficult to follow. EPGI gastrointestinal experts can help you with FODMAP and other food intolerances.

People with wheat starch intolerance and IBS may alleviate symptoms with a low FODMAP diet. A low FODMAP diet consists of avoiding or limiting intake of certain carbohydrates that can be found in many natural and processed foods:

  • Fructose
  • Oligosaccharides
  • Disaccharides
  • Monosaccharides
  • Polyols

Another cause of intolerance of wheat and other starches is due to the overgrowth of friendly bacteria in the small intestine, known as small intestinal bacterial overgrowth, or SIBO.

SIBO can cause several digestive problems including:

  • Food intolerances
  • Diarrhea
  • Altered bowel habits
  • Abdominal pain or discomfort
  • Abdominal bloating
  • Excessive flatulence

In more severe cases, you may experience weight loss, anemia and nutritional deficiencies. The more severe forms of SIBO typically occur in elderly people, after gastrointestinal surgery, and in those who have altered motor function of the digestive tract. However, SIBO can occur in individuals who have a seemingly normal digestive tract, as well as those with IBS, celiac disease, and inflammatory bowel diseases (IBD).

Celiac Disease Treatment

Currently, treatment for celiac disease involves following a lifelong gluten-free diet. This means strictly avoiding:

  • Wheat
  • Barley and rye
  • Foods, drinks and medications that contain gluten.

While maintaining a gluten-free diet can be challenging, it is important to restoring your health and improving quality of life.

CONSTIPATION

Bowel movements that are difficult to pass stool or infrequent in nature are known as the condition constipation. Constipation is one of the most common gastrointestinal problems and occurs in patients of all ages. While most cases of constipation are resolved within a short period of time through simple lifestyle changes, there are causes where constipation may be a chronic problem. Treatment for chronic constipation depends in pate on the underlying cause. However, in some cases a cause is never found.

Symptoms of constipation is not considered to me simply because they do not have a bowel ,movement every single day. If constipation accompanies two or more of the following symptoms, then you may be suffering from the condition.

Signs and symptoms of chronic constipation include:

• Less than three stools per week passed
• Having lumpy or hard stools
• Excessive straining to have a bowel movement
• Feeling incomplete evacuation even after a bowel movement
• Sensations of rectal blockage

Constipation may be considered chronic if you have experienced two or more of these symptoms. If your symptoms are severe, last more than a couple of weeks or you experience unexplained and persistent change in your bowel habits, request an appointment with your doctor.

Medical attention is also required if you experience any of the following symptoms related to constipation:

• Abdominal pain
• Blood in the stool
• Constipation that alternates with diarrhea
• Pain in the rectal area
• Thin stools
• Unexplained weight loss

Causes

Constipation most commonly occurs when waste or stool moves too slowly through the digestive tract or cannot be eliminated effectively from the rectum, which may cause the stool to become hard or dry. Chronic constipation has many other possible causes.

Other causes may include:

• Blockages from the colon or rectum
• Anal fissure
• Colon cancer
• Narrowing (stricture) of the colon
• Other abdominal cancer that presses on the colon
• Rectal cancer
• Rectum bulge through the back wall of the vagina (rectocele)

Other causes of constipation may include neurological conditions, hormonal imbalances and difficulties with the muscles of the rectum.

Risk factors include:

• Being an older adult
• Being a woman
• Being dehydrated
• Eating a low fiber diet
• Getting little or no physical activity
• Certain medications
• Having a mental health condition such as depression or an eating disorder

Complications of chronic constipation include:

• Swollen vein in your anus (hemorrhoids)
• Torn skin in your anus (anal fissure)
• Stool that cannot be expelled (fecal impaction)
• Intestine that protrudes from the anus (rectal prolapse)

Prevention

The following tips can help you avoid developing chronic constipation:

• Include plenty of high-fiber foods in your diet, including beans, vegetables, fruits, whole grain cereals and bran
• Eat fewer food with low amounts of fiber such as processed food and dairy and meat products
• Drink plenty of non-alcoholic fluids
• Stay as active as possible and try to get regular exercise
• Try to manage stress
• Do not ignore the urge to pass stool
• Try to create a regular schedule for bowel movements especially after a meal
• Make sure children who begin to eat solid foods get plenty of fiber in their diets

Crohn’s Disease

Crohn’s Disease (CD) is a chronic, recurrent inflammatory bowel disease (IBD) that primarily affects the digestive or gastrointestinal (GI) tract. Crohn’s inflammation can develop anywhere from the mouth to the anus, and symptoms may vary depending on what part of the GI tract is inflamed. Left untreated, Crohn’s inflammation can worsen and spread to deeper layers of the bowel causing severe pain and sometimes life-threatening complications.

Symptoms

Crohn’s disease symptoms range from mild to severe. They may vary over time and from person to person, depending on what part of the GI tract in inflamed. Because symptoms vary from person to person, the way to gauge what you consider a flare-up of symptoms is relative to what is “normal” for you. Patients can have symptoms for many years prior to diagnosis. Signs and symptoms may include:

  • Fatigue and a feeling of low energy
  • Prolonged diarrhea with abdominal pain and cramping
  • Rectal bleeding — passing small amount of blood with stool
  • Weight loss-loss of appetite
  • Fatigue
  • Fever
  • In children, failure to grow

Crohn’s Disease often affects the anal area where there may be a draining sinus tract called a fistula. Problems outside of the GI tract may also be associated with CD, including arthritis, eye conditions, skin disorders, and kidney stones. Patients with CD may also be deficient in vitamin D and/or vitamin B12.

Causes

While the exact cause of CD remains unknown, it appears to be a result of an interaction of factors:

  • Heredity: You may inherit genes that make you more susceptible to developing Crohn’s Disease.
  • The immune system: When triggered, it affects the GI tract, causing inflammation that contributes to symptoms.
  • Environmental factors: Foreign substances (antigens), such as bacteria or a virus, in the environment may also be a cause of inflammation, or they may stimulate the body’s defenses to produce inflammation that continues without control. CD is believed to be an overreaction of the immune system. Researchers believe people with CD experience an overactive immune response, and as a result, the GI tract becomes raw and inflamed (red and swollen) chronically. This continuous, damaging inflammation occurs in the GI tract and leads to Crohn’s symptoms.

Diagnosis

Your doctor will likely diagnose Crohn’s Disease after ruling out other possible causes for your signs and symptoms. To help confirm a diagnosis, you may have one or more of the following tests and procedures:

  • Blood tests.
  • Stool sample.
  • Flexible sigmoidoscopy.
  • X-ray.
  • CT scan.
  • Computerized tomography (CT) enterography and magnetic resonance (MR) enterography.

 Treatment

Medications that treat Crohn’s Disease strive to help control the inflammation. You may need to try multiple medications before finding the one that works best for you. The medication your doctor prescribes may depend on whether you have mild, moderate, or severe Crohn’s and/or where in your GI tract your disease is active. The goal of treatment is to achieve remission (no signs of disease) and limit further damage to your bowel. Severe cases of Crohn’s that do not respond to treatment may require more significant intervention, including surgical removal of damaged bowel.

Prescription medications that treat Crohn’s

  • Antibiotics

Metronidazole, ciprofloxacin, and other antibiotics may be used when infections occur, or to treat complications of Crohn’s disease.

  • Aminosalicylates (5-ASAs)

Given either orally or rectally, these drugs work to decrease inflammation in the lining of the intestines and are usually used to treat mild to moderate Crohn’s symptoms. Examples of this type of medication include sulfasalazine (Azulfidine), mesalamine (Asacol HD, Delzicol, others), balsalazide (Colazal) and olsalazine (Dipentum). Which one you take, and whether it is taken by mouth or as an enema or suppository, depends on the area of your colon that’s affected.

  • Corticosteroids (Steroids)

Given orally, as an injection, rectally, or intravenously, these medications help reduce inflammation by suppressing the immune system and are usually given to help with moderate to severe Crohn’s symptoms. Steroids are not intended for long-term use; they are best suited for short-term control of IBD symptoms and disease activity. If not used appropriately, patients can become steroid dependent or resistant.

  • Immune modifiers (Immunomodulators)

Given orally or injected, these medications suppress the body’s immune response so that it cannot cause ongoing inflammation. They do this by suppressing the immune system response that starts the process of inflammation. For some people, a combination of these drugs works better than one drug alone.

These drugs include azathioprine (Azasan, Imuran) and mercaptopurine (Purinethol, Purixan). Taking them requires that you follow up closely with your doctor and have your blood checked regularly to look for side effects, including effects on the liver and pancreas. Another immunosuppressant is cyclosporine (Gengraf, Neoral, Sandimmune). This drug is normally reserved for people who haven’t responded well to other medications. Cyclosporine has the potential for serious side effects and is not for long-term use.

  • Biologic therapies (Biologics)

Given intravenously or injected, this class of drugs suppresses the immune system to reduce inflammation by targeting a specific pathway, and is usually given to people who have not responded to conventional therapy.

  • Infliximab (Remicade) and adalimumab (Humira).These drugs, called tumor necrosis factor (TNF) inhibitors, or biologics, work by neutralizing a protein produced by your immune system. They are for people with severe Crohn’s Disease who don’t respond to or can’t tolerate other treatments.
  • Vedolizumab (Entyvio). This medication was recently approved for treatment of Crohn’s Disease for people who don’t respond to or can’t tolerate other treatments. It works by blocking inflammatory cells from getting to the site of inflammation.
  • Ustekinumab (Stelara). This medication was recently approved for treatment of Crohn’s Disease for people who don’t respond to or can’t tolerate other treatments. It works by blocking specific proteins in the inflammation response, namely IL12 and IL23.

Non-prescription medications

Depending on your Crohn’s disease symptoms, your doctor may recommend over-the-counter (OTC) medications as a supplement to your prescription, such as:

  • Antidiarrheals
  • Pain relievers
  • Nutritional supplements

Alternative medicine

Many people with digestive disorders have used some form of complementary and alternative (CAM) therapy. Make sure you have an honest dialogue with your doctor before using alternative treatments, as they can impact the effects of traditional therapies.

Some commonly used therapies include:

  • Herbal and nutritional supplements. The majority of alternative therapies aren’t regulated by the FDA. Manufacturers can claim that their therapies are safe and effective but don’t need to prove it. What’s more, even natural herbs and supplements can have side effects and cause dangerous interactions. Tell your doctor if you decide to try any herbal supplement.
  • Probiotics. Researchers suspect that adding more of the beneficial bacteria (probiotics) that are normally found in the digestive tract might help combat the disease. Although research is limited, there is some evidence that adding probiotics along with other medications may be helpful, but this has not been proved.
  • Fish oil. Fish oil acts as an anti-inflammatory, and there is some evidence that adding fish oil to aminosalicylates may be helpful, but this has not been proved.
  • Acupuncture. Only one clinical trial has been conducted regarding its benefit. The procedure involves the insertion of fine needles into the skin, which may stimulate the release of the body’s natural painkillers.

Surgery

Treatment with medication is the first therapeutic option for people with Crohn’s disease. However, surgery may be a consideration if the disease doesn’t respond to medication—although surgery is not a cure for Crohn’s disease, as it is sometimes considered to be in ulcerative colitis. In fact, about 60%-75% of Crohn’s patients may require surgery at some point to correct potential complications of Crohn’s disease—such as clearing an intestinal blockage or repairing damage to the intestines. Damage to the intestines can include a perforation or abscess (a pus-filled area caused by infection).

Cancer surveillance

You will need more-frequent screening for colon cancer because of your increased risk. The recommended schedule will depend on the location of your disease and how long you have had it. Your doctor will determine how often a colonoscopy is needed.

Lifestyle and home remedies

Sometimes you may feel helpless when facing Crohn’s Disease, but changes in your diet and lifestyle may help control your symptoms and lengthen the time between flare-ups.

There is no firm evidence that what you eat actually causes inflammatory bowel disease. But certain foods and beverages can aggravate your signs and symptoms, especially during a flare-up.

It can be helpful to keep a food diary to keep track of what you’re eating, as well as how you feel. If you discover that some foods are causing your symptoms to flare, you can try eliminating them. Here are some suggestions that may help:

Foods to limit or avoid

  • Limit dairy products.Many people with inflammatory bowel disease find that problems such as diarrhea, abdominal pain and gas improve by limiting or eliminating dairy products. You may be lactose intolerant — that is, your body can’t digest the milk sugar (lactose) in dairy foods. Using an enzyme product such as Lactaid may help as well.
  • Limit fiber, if it’s a problem food.If you have inflammatory bowel disease, high-fiber foods, such as fresh fruits and vegetables and whole grains, may make your symptoms worse. If raw fruits and vegetables bother you, try steaming, baking or stewing them.

In general, you may have more problems with foods in the cabbage family, such as broccoli and cauliflower, and nuts, seeds, corn and popcorn.

  • Avoid other problem foods.Spicy foods, alcohol and caffeine may make your signs and symptoms worse.

 Other dietary measures

  • Eat small meals.You may find you feel better eating five or six small meals a day rather than two or three larger ones.
  • Drink plenty of liquids.Try to drink plenty of fluids daily. Water is best. Alcohol and beverages that contain caffeine stimulate your intestines and can make diarrhea worse, while carbonated drinks frequently produce gas.
  • Talk to a dietitian.If you begin to lose weight or your diet has become very limited, talk to a registered dietitian.

Stress

Although stress doesn’t cause inflammatory bowel disease, it can make your signs and symptoms worse and may trigger flare-ups.

GASTROESOPHAGEAL REFLUX DISEASE (GERD)

Gastroesophageal Reflux Disease (GERD) occurs when stomach acid 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. Most people can manage the discomfort caused by GERD with life style changes and over the counter medications. Some people with GERD may need stronger medications or surgery to ease the symptoms.

Common symptoms of GERD include:

• A burning in your chest (heart burn)
• Difficulty swallowing
• Chest pain
• Regurgitation of food or liquid
• Sensation of a lump in your throat
• Chronic cough
• Laryngitis
• New or worsening asthma
• Disrupted sleep

Please note, if you have chest pain, this could also be a sign of a heart attack and should be immediately evaluated by a health care provider.

Over time, regular exposure of your esophagus to stomach acid can cause inflammation and narrowing and can even change cell composition, causing a condition called Barrett’s esophagus. With Barrett’s esophagus, the normal cells in your esophagus will change into cells that resemble those found in your small intestine. This cellular change increases your risk of developing esophageal cancer.

Some of the risks of Barrett’s esophagus:

• Overweight or obese
• Heavy alcohol use
• Any tobacco use
• Chronic, long term acid reflux / GERD

Medications can reduce discomfort caused by acid reflux including; antacids, H2 blockers and Proton Pump Inhibitors. If you have persistent acid reflux, you should see one of our specialists for an evaluation. We will perform thorough testing to determine the health of your esophagus, and then plan your custom treatment plan. GERD can often be controlled with medications but if medications do not help, your doctor could recommend procedures such as Fundoplication or LINX device.

No matter what the severity of your GERD symptoms, it is important that you see a gastroenterologist to help manage your symptoms.

H. PYLORI

The “H” in the name is short for Helicobacter. Helico means spiral, which indicates that the bacteria are spiral shaped. H. Pylori is a common type of bacteria that grows in the digestive tract and has a tendency to attach the stomach lining. Most of the time, H. Pylori does not lead to any problems or cause symptoms.

In some people H. Pylori can cause some symptoms which can include:

• Ulcers in the stomach or the duodenum ( the first part of the small intestine)
• Stomach cancer

These conditions can cause pain or discomfort in the upper belly or nausea and vomiting.

Symptoms of H. Pylori may include:

• Pain/discomfort in the upper belly
• Feeling full after eating a small amount of food
• Not feeling hungry
• Nausea and vomiting
• Dark or black stools
• Fatigue

H. Pylori infection could be a precursor to an ulcer, but ulcers can also be caused by other things (for example certain medications). If you have symptoms you should inform your physician. Your doctor can test you for H. Plyori by using blood tests, stool testing, breath tests and a biopsy.

H. Pylori is treated with antibiotics and acid reducing medication. Most regimes include; three or more medications for two weeks. After treatment, doctors will order follow up tests to see that the H. Pylori infection has resolved.

HEMORRHOIDS

Hemorrhoids are swollen veins in your anus and lower rectum like varicose veins. Hemorrhoids may be located inside the rectum (internal hemorrhoids) or they may develop under the skin around the anus (external hemorrhoids). Diagnosis of hemorrhoids may include a visual inspection or a digital examination. Hemorrhoids are very common. Sometimes they do not cause any symptoms bur 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 very painful and sometimes need to be laced and drained.

CAUSES

Veins around your anus tend to stretch under pressure and may bulge or swell.

Swollen veins (hemorrhoids) can develop from increased pressure in the lower rectum due to:

• Straining during bowel movements
• Chronic diarrhea or constipation
• Sitting for long periods of time on the toilet
• Obesity
• Anal intercourse
• Low fiber diet

TREATMENT

Depending on the severity of your hemorrhoids, your doctor may suggest home remedies for mild pain, swelling and inflammation. If your symptoms do not improve, your doctor may suggest over the counter creams, ointments, suppositories or pads. These products contain ingredients such as witch hazel and hydrocortisone and lidocaine which can lessen the pain and itching. In more serious conditions, the doctor may have to place bands at the base of the protruding vein. This is called rubber band ligation.

Other treatments for persistent bleeding or painful hemorrhoids include; injections (sclerotherapy), coagulation (infrared or laser), Hemorrhoidectomy, or Hemorrhoid stapling.

There are many effective options available to treat hemorrhoids. You and your doctor will select which treatment plan best fits your needs.

Hepatitis C Treatment

The Hepatologists (Liver Specialists) at Eastern Pennsylvania Gastroenterology and Liver Specialists, Dr. Adam Peyton and Dr. She-Yan Wong. Are highly trained in the diagnosis and treatment of Hepatitis C.  Both Drs. Peyton and Wong prescribe the latest treatment options available and are passionate about the eradication of the virus.  Treatment is available at both our Allentown and Bethlehem office locations.

What is Hepatitis C?

Hepatitis C is a viral infection that affects the liver, and 75%-80% of the time, it becomes a chronic infection.  Approximately 3.2 million people in the United States are living with chronic hepatitis C infection. Most do not experience any symptoms, feel ill, or know they are infected.

Testing is the only way to know if you are infected.

Who Should Get Tested for Hepatitis C?

Testing for Hepatitis C is recommended for certain groups, including people who:

  • Were born from 1945-1965
  • Received donated blood or organs before 1992
  • Have ever injected drugs, even if it was just once or many years ago
  • Have certain medical conditions, such as chronic liver disease and HIV or AIDS
  • Have abnormal liver tests or liver disease
  • Have been exposed to blood from a person who is infected
  • Are on hemodialysis
  • Are born to a mother who is infected

Why do baby boomers have such a high rate of Hepatitis C?

The reason that baby boomers have high rates of the virus is not completely understood.  Most boomers are believed to have become infected in the 1970s & 1980s when rates of Hepatitis C were the highest.  Since people with the virus can live for decades without symptoms. Many baby boomers are unknowingly living with an infection they got many years ago.

Hepatitis C is primarily spread through contact with blood from an infected person.  Many baby boomers could have gotten infected from contaminated blood and blood  products. Before widespread screening of the blood supply in 1992 and universal precautions were adopted.  Others may have become infected from injecting drugs, even if only once in the past.  Still, many baby boomers do not know how or when they were infected.

How is Hepatitis C Testing Done?

There are several blood tests available to detect the hepatitis C virus (HCV).

What happens if Hepatitis C is left untreated?

Hepatitis C can cause severe liver damage including cirrhosis and liver cancer.

If symptoms are present, what would they be?

Symptoms of the virus include:

  • Fever
  • Fatigue
  • Loss of appetite
  • Nausea
  • Vomiting
  • Abdominal pain
  • Dark urine
  • Clay-colored bowel movements
  • Joint pain
  • Jaundice (yellow color in the skin or eyes)

Is there a cure for Hepatitis C?

Yes!  With the newest, all oral, medication regimens, the cure rate is 97%!

For additional information please visit http://www.cdc.gov/hepatitis/hcv/index.htm.

What Is Hepatitis?

Viral hepatitis are a group of distinct diseases that affect the liver. There are five types of hepatitis and each have different causes, symptoms and treatments. They all infect your liver and cause it to become inflamed. Laboratory tests can determine hepatitis types.

What Causes the Different Types?

The type of virus that’s causing your hepatitis affects how severe your disease is and how long it lasts.

Hepatitis A: You usually get it when you eat or drink something that’s got the virus in it. It’s the least risky type because it almost always gets better on its own. It doesn’t lead to long-term inflammation of your liver. Your liver heals in about 2 months.

Even so, about 20% of people who get hepatitis A get sick enough that they need to go to the hospital. There’s a vaccine that can prevent it.

Hepatitis B:  This type spreads in several ways.You can get it from sex with someone who’s sick, by sharing a needle when using street drugs, or by direct contact with infected blood or the body fluids of someone who’s got the disease. The virus also can pass from a mother to her newborn child at birth or soon afterward. If you’re pregnant and you’ve got hepatitis B, you could give the disease to your unborn child. If you deliver a baby who’s got it, he needs to get treatment in the first 12 hours after birth.

Most adults with hepatitis B recover from it in 6 months, but a small percentage can’t shake the disease and become carriers, which means they can spread it to others even when their own symptoms disappear. Sometimes, it causes a long-term infection that could lead to liver damage. You won’t catch it if you get a vaccine.

Hepatitis C:  You get this type if you have contact with contaminated blood or needles used to inject illegal drugs or draw tattoos.  You can also catch it by having sex with somebody who’s infected, but that’s less common. If you had a blood transfusion before new screening protocols were put in place in 1992, you are at risk for hepatitis C. If not, the blood used in transfusions today is safe. It gets checked beforehand to make sure it’s free of the virus that causes hepatitis B or C.

Sometimes you don’t get any symptoms, or just mild ones. About 80% of those with the disease get a long-term infection. It can sometimes lead to cirrhosis, a scarring of the liver. There’s no vaccine to prevent it.

Hepatitis D: This occurs only if you’re already infected with hepatitis B. It tends to make that disease more severe.

It’s spread from mother to child and through sex.

Hepatitis E: This virus mainly spreads in Asia, Mexico, India, and Africa. The few cases that show up in the U.S. are usually in people who return from a country where there are outbreaks of the disease.

Like hepatitis A, you usually get it by eating or drinking something that’s been contaminated with the virus.

What Are the Symptoms of Hepatitis?

The most common symptoms for all types are:

  • Dark urine
  • Stomach pain
  • Yellowing of skin or eyes
  • Pale or clay-colored stool
  • Low-grade fever
  • Loss of appetite
  • Fatigue
  • Feeling sick to the stomach
  • Lack of nutrition

If you have hepatitis B, you may also have achy joints.

See your doctor as soon as possible if you have any of these symptoms.

Can Hepatitis Be Treated?

If you have hepatitis A, your doctor will carefully see how well your liver is working, but there aren’t any treatments to cure it.

There are several drugs that treat long-term hepatitis B, such as:

  • Adefovir (Hepsera)
  • Entecavir (Baraclude)
  • Interferon
  • Lamivudine (Epivir, Epivir HBV)
  • Telbivudine (Tyzeka)
  • Tenofovir (Viread)

For hepatitis C, some people improve if they get a combo of the drugs peginterferon alpha and ribavirin. But there are side effects to this treatment, including severe anemia (low red blood cells) and birth defects.

Your doctor may also suggest other drugs for hepatitis C, which cure more people and may be better tolerated, including:

  • Daclatasvir (Daklinza)
  • Elbasvir /grazoprevir (Zepatier)
  • Ledipasvir-sofosbuvir (Harvoni)
  • Ombitasvir-paritaprevir-ritonavir (Technivie, Viekira Pak)
  • Sofosbuvir (Sovaldi)
  • Sofosbuvir /velpatasvir (Epclusa)

 

How Do You Prevent Hepatitis B and C From Spreading?

To help keep a hepatitis B or C infection from spreading:

  • Get vaccinated (if you haven’t already been infected). There are vaccines available for hepatitis A and B, but not C.
  • Use condoms every time you have sex.
  • Wear gloves when you clean up after others, especially if you have to touch bandages, tampons, and linens.
  • Cover all open cuts or wounds.
  • Don’t share razors, toothbrushes, nail care tools, or pierced earrings with anyone.
  • Don’t share chewing gum, and don’t pre-chew food for a baby.
  • Make certain that any needles for drugs, ear piercing, or tattoos — or tools for manicures and pedicures — are properly sterilized.
  • Clean up blood with one part household bleach and 10 parts water.

Who Should Get the Hepatitis B Vaccine?

All newborn babies should get vaccinated. You should also get the shot if you:

  • Come in contact with infected blood or body fluids of friends or family members
  • Use needles to take recreational drugs
  • Have sex with more than one person
  • Are a health care worker
  • Work in a day care center, school, or jail

What’s the Prognosis for Hepatitis B?

Your doctor will know you’ve recovered when you no longer have symptoms and blood tests show:

  • Your liver is working normally
  • You have hepatitis B surface antibody

But some people don’t get rid of the infection. If you have it for more than 6 months, you’re what’s called a carrier, even if you don’t have symptoms. This means you can give the disease to someone else through:

  • Unprotected sex
  • Contact with your blood or an open sore
  • Sharing needles or syringes

Doctors don’t know why, but the disease does go away in a small number of carriers. For others, it becomes what’s known as chronic. That means you have an ongoing liver infection. It can lead to cirrhosis or hardening of the organ. It scars over and stops working. Some people also get liver cancer.

If you’re a carrier or are infected with hepatitis B, don’t donate blood, plasma, body organs, tissue, or sperm. Tell anyone you could infect — whether it’s a sex partner, your doctor, or your dentist — that you have it.

INFLAMMATORY BOWEL DISEASE

Inflammatory bowel disease (IBD) is a term used to describe disorders that involve chronic inflammation of your digestive tract.

Types of IBD include:

• Ulcerative colitis. This condition causes long-lasting inflammation and sores (ulcers) in the innermost lining of your large intestine (colon) and rectum.
• Crohn’s disease. This type of IBD is characterized by inflammation of the lining of your digestive tract, which often spreads deep into affected tissues.

Crohns Disease can affect any portion of the intestinal tract from the mouth to the anus. Both ulcerative colitis and Crohn’s disease usually involve severe diarrhea, abdominal pain, and fatigue and weight loss.

IBD can be debilitating and sometimes leads to life-threatening complications. See your doctor if you experience a persistent change in our bowel habits or if you have any of the signs and symptoms of inflammatory bowel disease.

Symptoms

Inflammatory bowel disease symptoms vary, depending on the severity of inflammation and where it occurs. Symptoms may range from mild to severe. You are likely to have periods of active illness followed by periods of remission.

Signs and symptoms that are common to both Crohn’s disease and ulcerative colitis include:

• Diarrhea
• Fever and fatigue
• Abdominal pain and cramping
• Blood in your stool
• Reduced appetite
• Unintended weight loss

Causes

The exact cause of inflammatory bowel disease remains unknown. Previously, diet and stress were suspected, but now doctors know that these factors may aggravate but don’t cause IBD.

One possible cause is an immune system malfunction. When your immune system tries to fight off an invading virus or bacterium, an abnormal immune response causes the immune system to attack the cells in the digestive tract, too. Heredity also seems to play a role in that IBD is more common in people who have family members with the disease. However, most people with IBD don’t have this family history.

Diagnosis

To help confirm a diagnosis of IBD, you may have one or more of the following tests and procedures:

Blood tests

• Tests for anemia or infection
• Fecal occult blood test

Endoscopic procedures

• Sigmoidoscopy exam
• Colonoscopy
• Flexible sigmoidoscopy
• Upper endoscopy
• Capsule endoscopy
• Balloon-assisted enteroscopy

Imaging Procedures

• X-ray
• Computerized tomography (CT) scan
• Magnetic resonance imaging (MRI)

Treatment

The goal of inflammatory bowel disease treatment is to reduce the inflammation that triggers your signs and symptoms. In the best cases, this may lead not only to symptom relief but also to long-term remission and reduced risks of complications. IBD treatment usually involves either drug therapy or surgery.
• Anti-inflammatory drugs
• Immune system suppressors
• Antibiotics
• Other medications and supplements

In addition to controlling inflammation, some medications may help relieve your signs and symptoms, but always talk to your doctor before taking any over-the-counter medications.

Depending on the severity of your IBD, your doctor may recommend one or more of the following:

 Anti-diarrheal medications.
 Pain relievers.
 Iron supplements.
 Calcium and vitamin D supplements.
 Nutritional support

Surgery

If diet and lifestyle changes, drug therapy, or other treatments don’t relieve your IBD signs and symptoms, your doctor may recommend surgery.
• Surgery for ulcerative colitis
• Surgery for Crohn’s disease.

Sometimes you may feel helpless when facing inflammatory bowel disease. But changes in your diet and lifestyle may help control your symptoms and lengthen the time between flare-ups.

Diet

There’s no firm evidence that what you eat actually causes inflammatory bowel disease. But certain foods and beverages can aggravate your signs and symptoms, especially during a flare-up.

Other dietary measures:

• Eat small meals. You may find you feel better eating five or six small meals a day rather than two or three larger ones.
• Drink plenty of liquids. Try to drink plenty of fluids daily. Water is best. Alcohol and beverages that contain caffeine stimulate your intestines and can make diarrhea worse, while carbonated drinks frequently produce gas.
• Consider multivitamins. Because Crohn’s disease can interfere with your ability to absorb nutrients and because your diet may be limited, multivitamin and mineral supplements are often helpful. Check with your doctor before taking any vitamins or supplements.
• Talk to a dietitian. If you begin to lose weight or your diet has become very limited, talk to a registered dietitian.

Smoking Elimination

Smoking increases your risk of developing Crohn’s disease, and once you have it, smoking can make it worse. People with Crohn’s disease who smoke are more likely to have relapses and need medications and repeat surgeries.

Smoking may help prevent ulcerative colitis. However, its harm to overall health outweighs any benefit, and quitting smoking can improve the general health of your digestive tract, as well as provide many other health benefits. Nicotine patches have been used to treat ulcerative colitis, but the results have been disappointing.

Stress Reduction

The association of stress with Crohn’s disease is controversial, but many people who have the disease report symptom flares during high-stress periods.

Although living with IBD can be discouraging, research is ongoing, and the outlook is improving.

Symptoms of inflammatory bowel disease may first prompt a visit to your family doctor or general practitioner. However, you may then be referred to a doctor who specializes in treating digestive disorders (gastroenterologist).

IRRITABLE BOWEL SYNDROME (IBS)

Irritable Bowel Syndrome (IBS) is a common disorder that affects the large intestine. Signs and symptoms include abdominal pain, cramping, bloating gas and diarrhea and/or constipation, and mucous in the stool. IBS is a chronic condition which does not cause changes in the bowel tissue or increase your risk of colorectal cancer. For most people with IBS, there are times that signs and symptoms are worse than others and they can improve significantly or disappear completely.

The cause of IBS is unknown. Factors that may play a role include the muscles in the intestine, the nervous system, infection of the intestine, and inflammation and changes in the bacteria of the gut. As the exact cause of IBS is unknown, you should see your physician if you experience persistent changes in bowel habits or other signs and symptoms of IBS.

Pancreatitis

Pancreatitis is the inflammation or irritation of the pancreas, a large gland behind the stomach that helps the body digest food and makes two important hormones, insulin and glucagon.

This organ secretes enzymes into a part of the intestine called the duodenum, which, in combination with bile from the liver, help digest foods.

The pancreas can become damaged if its own digestive enzymes attack the pancreas before the enzymes are released into the duodenum. These enzymes are usually not active until they get into the duodenum.

There are two types of pancreatitis: acute pancreatitis and chronic pancreatitis.

Acute Pancreatitis
Each year, approximately 210,000 patients with acute pancreatitis are hospitalized in the United States.1

Acute pancreatitis is the sudden inflammation of the pancreas. With treatment, it usually goes away in a matter of days. However, it can be life threatening and carries with it potentially serious complications. Two common causes of acute pancreatitis include gallstone disease (gallstones irritate the pancreas as they move through the bile duct), and heavy alcohol use. Additional causes are infections, tumors, medicines, stomach trauma and genetic problems with the pancreas.

Chronic Pancreatitis
Chronic pancreatitis is long term inflammation and scarring of the pancreas. It can result in abdominal pain, malnutrition and weight loss, as well as diabetes if the pancreas can no longer produce enough insulin.

The most common cause of chronic pancreatitis is heavy alcohol use over a long period. Also,  an episode of acute pancreatitis with damage to the pancreatic duct can trigger chronic pancreatitis.

Chronic pancreatitis is also caused by:

  • Medications
  • Hereditary conditions of the pancreas, including cystic fibrosis
  • Hypercalcemia (too much calcium in the bloodstream)
  • Autoimmune disorders, such as systemic lupus erythematosis
  • Other unknown factors

Symptoms of Acute Pancreatitis

The symptoms of acute pancreatitis begin with sudden or gradually increasing pain in the upper stomach area. Pain is also sometimes felt in the back area. Other symptoms include:

  • Nausea and vomiting
  • Rapid pulse

Complications of severe acute pancreatitis include:

  • Low blood pressure
  • Dehydration
  • Heart, lung, and/or kidney failure
  • Bleeding in the pancreas
  • Shock
  • Death

Symptoms of Chronic Pancreatitis

Some patients with chronic pancreatitis have no symptoms, while others may have the symptoms listed below:

  • Oily or greasy stools
  • Oily diarrhea
  • Nausea and vomiting
  • Unintentional weight loss
  • Periodic or constant abdominal pain that is worse with drinking or eating
  • Difficult-to-control diabetes

People who have the symptoms of acute or chronic pancreatitis should see their doctor or go to an emergency room to get medical attention.

Diagnosis of Acute and Chronic Pancreatitis

Your doctor will do a physical exam and ask questions about your medical history. Your doctor may also order tests to help diagnose the problem, including:

  • Computerized tomography (CT) scan: In this x-ray procedure, the patient lies on a table that is completely surrounded by the CT scanner. The table moves into and out of the machine, taking multiple x-rays that a computer processes into three-dimensional images of the body. This scan can show the presence of gallstones and damage of the pancreas.
  • Endoscopic ultrasound (EUS): After numbing the patient’s throat, the doctor inserts an endoscope (a thin, flexible tube) into the mouth, esophagus, stomach and duodenum. An ultrasound attachment on the endoscope emits sound waves, which create pictures of the bile ducts and pancreas.
  • Magnetic resonance cholangiopancreatography (MRCP): This test uses magnetic resonance imaging (MRI) to create cross-sectional pictures of the body part being studied. The patient lies down inside a large tube that creates a magnetic field and pulses of radio wave energy to make pictures of structures inside the body.
  • Ultrasound, abdominal: The patient lies on a table and a technician moves a small device that emits sound saves over the abdomen. The sound waves bounce off the organs, and the echoes make a picture (sonogram) on a video display. The sound waves allow the doctor to see the pancreas, gallbladder, liver and other nearby organs, as well as any gallstones that are present.

Treatments

Treatment of Acute Pancreatitis
The treatment for acute pancreatitis fasting, intravenous fluids, pain relief and general supportive care. Patients are often admitted to the hospital for this treatment.

Treatment of Chronic Pancreatitis
Treatment includes pain management, use of digestive enzymes for maldigestion, and management of diabetes, if needed.

Prevention of Pancreatitis
Some steps can be taken to prevent pancreatitis (by type):

  • Any type of pancreatitis: Avoid high-fat food; eat vegetable-rich diet; drink enough fluid
  • Gallstone pancreatitis: Surgically remove gall bladder
  • Alcohol- or tobacco-induced pancreatitis: Do not consume alcohol or tobacco products
  • Drug-induced pancreatitis: Avoid taking specific drug that induces pancreatitis
  • Hypertriglyceridemia: Take medication that lowers blood lipid (fat) levels

PEPTIC ULCER DISEASE

Ulcers

Peptic ulcers are open sores that develop on the inside lining of your stomach and the upper portion of your small intestine. The most common symptom of a peptic ulcer is stomach pain.

Peptic ulcers include:

• Gastric ulcers that occur on the inside of the stomach
• Duodenal ulcers that occur on the inside of the upper portion of your small intestine (duodenum)

The most common causes of peptic ulcers are infection with the bacterium Helicobacter pylori (H. pylori) and long-term use of aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs) (Advil, Aleve, others). Stress and spicy foods do not cause peptic ulcers. However, they can make your symptoms worse.

Symptoms

• Burning stomach pain
• Feeling of fullness, bloating or belching
• Fatty food intolerance
• Heartburn
• Nausea

The most common peptic ulcer symptom is burning stomach pain. Stomach acid makes the pain worse, as does having an empty stomach. The pain can often be relieved by eating certain foods that buffer stomach acid or by taking an acid-reducing medication, but then it may come back. The pain may be worse between meals and at night.

Nearly three-quarters of people with peptic ulcers don’t have symptoms.

Less often, ulcers may cause severe signs or symptoms such as:

• Vomiting or vomiting blood — which may appear red or black
• Dark blood in stools, or stools that are black or tarry
• Trouble breathing
• Feeling faint
• Nausea or vomiting
• Unexplained weight loss
• Appetite changes

When to see a doctor

See your doctor if you have the severe signs or symptoms listed above. Also see your doctor if over-the-counter antacids and acid blockers relieve your pain but the pain returns.

Causes

Peptic ulcers occur when acid in the digestive tract eats away at the inner surface of the stomach or small intestine. The acid can create a painful open sore that may bleed.

Your digestive tract is coated with a mucous layer that normally protects against acid. But if the amount of acid is increased or the amount of mucus is decreased, you could develop an ulcer.

Common causes include:

• A bacterium.
• Regular use of certain pain relievers.
• Other medications.

Risk factors

In addition to taking NSAIDs, you may have an increased risk of peptic ulcers if you:

• Smoke: Smoking may increase the risk of peptic ulcers in people who are infected with H. pylori.
• Drink alcohol: Alcohol can irritate and erode the mucous lining of your stomach, and it increases the amount of stomach acid that’s produced.
• Have untreated stress.
• Eat spicy foods.

Alone, these factors do not cause ulcers, but they can make them worse and more difficult to heal.

Complications

Left untreated, peptic ulcers can result in:

• Internal bleeding.
• Infection.
• Obstruction.
.
Prevention

You may reduce your risk of peptic ulcer if you follow the same strategies recommended as home remedies to treat ulcers.

It may also be helpful to:

• Protect yourself from infections.
• Use caution with pain relievers.

Diagnosis

Endoscopy

In order to detect an ulcer, your doctor may first take a medical history and perform a physical exam.

You then may need to undergo diagnostic tests, such as:

• Laboratory tests.
• Endoscopy.
• Upper gastrointestinal series.

Treatment

Treatment for peptic ulcers depends on the cause. Usually treatment will involve killing the H. pylori bacterium, if present, eliminating or reducing use of NSAIDs, if possible, and helping your ulcer to heal with medication.

Medications can include:

• Antibiotic
• Medications that block acid production and promote healing.
• Medications to reduce acid production.
• Antacids that neutralize stomach acid.
• Medications that protect the lining of your stomach and small intestine.

Follow-up after initial treatment

Treatment for peptic ulcers is often successful, leading to ulcer healing. But if your symptoms are severe or if they continue despite treatment, your doctor may recommend endoscopy to rule out other possible causes for your symptoms.

If an ulcer is detected during endoscopy, your doctor may recommend another endoscopy after your treatment to make sure your ulcer has healed. Ask your doctor whether you should undergo follow-up tests after your treatment.

Preparing for your appointment

Make an appointment with your regular doctor if you have signs or symptoms that worry you. Your doctor may refer you to a specialist in the digestive system (gastroenterologist).

Ulcerative Colitis

Ulcerative colitis (UL-sur-uh-tiv koe-LIE-tis) is an inflammatory bowel disease (IBD) that causes long-lasting inflammation and ulcers (sores) in your digestive tract. Ulcerative colitis affects the innermost lining of your large intestine (colon) and rectum. Symptoms usually develop over time, rather than suddenly.

Ulcerative colitis can be debilitating and can sometimes lead to life-threatening complications. While it has no known cure, treatment can greatly reduce signs and symptoms of the disease and even bring about long-term remission.

Symptoms

Ulcerative colitis symptoms can vary, depending on the severity of inflammation and where it occurs. Signs and symptoms may include:

  • Diarrhea, often with blood or pus
  • Abdominal pain and cramping
  • Rectal pain
  • Rectal bleeding — passing small amount of blood with stool
  • Urgency to defecate
  • Inability to defecate despite urgency
  • Weight loss-loss of appetite
  • Fatigue
  • Fever
  • In children, failure to grow

Most people with ulcerative colitis have mild to moderate symptoms. The course of ulcerative colitis may vary, with some people having long periods of remission.

Types

Doctors often classify ulcerative colitis according to its location. Types of ulcerative colitis include:

  • Ulcerative proctitis.
  • Left-sided colitis.
  • Acute severe ulcerative colitis.

When to see a doctor

See your doctor if you experience a persistent change in your bowel habits or if you have signs and symptoms such as:

  • Abdominal pain
  • Blood in your stool
  • Ongoing diarrhea that doesn’t respond to over-the-counter medications
  • Diarrhea that awakens you from sleep
  • An unexplained fever lasting more than a day or two

Although ulcerative colitis usually isn’t fatal, it’s a serious disease that, in some cases, may cause life-threatening complications.

Causes

The exact cause of ulcerative colitis remains unknown. Previously, diet and stress were suspected, but now doctors know that these factors may aggravate but don’t cause ulcerative colitis.

One possible cause is an immune system malfunction. When your immune system tries to fight off an invading virus or bacterium, an abnormal immune response causes the immune system to attack the cells in the digestive tract, too.

Heredity also seems to play a role in that ulcerative colitis is more common in people who have family members with the disease. However, most people with ulcerative colitis don’t have this family history.

Risk factors

Ulcerative colitis affects about the same number of women and men. Risk factors may include:

  • Ulcerative colitis usually begins before the age of 30. But, it can occur at any age, and some people may not develop the disease until after age 60.
  • Race or ethnicity.Although whites have the highest risk of the disease, it can occur in any race. If you’re of Ashkenazi Jewish descent, your risk is even higher.
  • Family history.You’re at higher risk if you have a close relative, such as a parent, sibling or child, with the disease.

 Possible complications of ulcerative colitis include:

  • Severe bleeding
  • A hole in the colon (perforated colon)
  • Severe dehydration
  • Liver disease (rare)
  • Bone loss (osteoporosis)
  • Inflammation of your skin, joints and eyes
  • An increased risk of colon cancer
  • A rapidly swelling colon (toxic megacolon)
  • Increased risk of blood clots in veins and arteries

Diagnosis

Your doctor will likely diagnose ulcerative colitis after ruling out other possible causes for your signs and symptoms. To help confirm a diagnosis of ulcerative colitis, you may have one or more of the following tests and procedures:

  • Blood tests.
  • Stool sample.
  • Flexible sigmoidoscopy.
  • X-ray.
  • CT scan.
  • Computerized tomography (CT) enterography and magnetic resonance (MR) enterography.

 Treatment

Ulcerative colitis treatment usually involves either drug therapy or surgery.

Several categories of drugs may be effective in treating ulcerative colitis. The type you take will depend on the severity of your condition. The drugs that work well for some people may not work for others, so it may take time to find a medication that helps you. In addition, because some drugs have serious side effects, you’ll need to weigh the benefits and risks of any treatment.

Anti-inflammatory drugs

Anti-inflammatory drugs are often the first step in the treatment of ulcerative colitis. They include:

  • 5-aminosalicylates.Examples of this type of medication include sulfasalazine (Azulfidine), mesalamine (Asacol HD, Delzicol, others), balsalazide (Colazal) and olsalazine (Dipentum). Which one you take, and whether it is taken by mouth or as an enema or suppository, depends on the area of your colon that’s affected.
  • These drugs, which include prednisone and hydrocortisone, are generally reserved for moderate to severe ulcerative colitis that doesn’t respond to other treatments. Due to the side effects, they are not usually given long term.

Immune system suppressors

These drugs also reduce inflammation, but they do so by suppressing the immune system response that starts the process of inflammation. For some people, a combination of these drugs works better than one drug alone.

Immunosuppressant drugs include:

  • Azathioprine (Azasan, Imuran) and mercaptopurine (Purinethol, Purixan).These are the most widely used immunosuppressants for treatment of inflammatory bowel disease. Taking them requires that you follow up closely with your doctor and have your blood checked regularly to look for side effects, including effects on the liver and pancreas.
  • Cyclosporine (Gengraf, Neoral, Sandimmune).This drug is normally reserved for people who haven’t responded well to other medications. Cyclosporine has the potential for serious side effects and is not for long-term use.
  • Infliximab (Remicade), adalimumab (Humira) and golimumab (Simponi).These drugs, called tumor necrosis factor (TNF) inhibitors, or biologics, work by neutralizing a protein produced by your immune system. They are for people with severe ulcerative colitis who don’t respond to or can’t tolerate other treatments.
  • Vedolizumab (Entyvio).This medication was recently approved for treatment of ulcerative colitis for people who don’t respond to or can’t tolerate other treatments. It works by blocking inflammatory cells from getting to the site of inflammation.
  • Tofacitnib (Xeljanz). This is an oral medication, called a Janus kinase (JAK) inhibitor. It is used to treat adults with moderately to severely active ulcerative colitis.

Other medications

You may need additional medications to manage specific symptoms of ulcerative colitis. Always talk with your doctor before using over-the-counter medications. He or she may recommend one or more of the following.

  • Anti-diarrheal medications.
  • Pain relievers..
  • Iron supplements.

 Surgery

Surgery can often eliminate ulcerative colitis. But that usually means removing your entire colon and rectum (proctocolectomy).

In most cases, this involves a procedure called ileal pouch anal anastomosis. This procedure eliminates the need to wear a bag to collect stool. Your surgeon constructs a pouch from the end of your small intestine. The pouch is then attached directly to your anus, allowing you to expel waste relatively normally.

In some cases a pouch is not possible. Instead, surgeons create a permanent opening in your abdomen (ileal stoma) through which stool is passed for collection in an attached bag.

Cancer surveillance

You will need more-frequent screening for colon cancer because of your increased risk. The recommended schedule will depend on the location of your disease and how long you have had it. Your doctor will determine how often a colonoscopy is needed.

Lifestyle and home remedies

Sometimes you may feel helpless when facing ulcerative colitis. But changes in your diet and lifestyle may help control your symptoms and lengthen the time between flare-ups.

There’s no firm evidence that what you eat actually causes inflammatory bowel disease. But certain foods and beverages can aggravate your signs and symptoms, especially during a flare-up.

It can be helpful to keep a food diary to keep track of what you’re eating, as well as how you feel. If you discover that some foods are causing your symptoms to flare, you can try eliminating them. Here are some suggestions that may help:

Foods to limit or avoid

  • Limit dairy products.Many people with inflammatory bowel disease find that problems such as diarrhea, abdominal pain and gas improve by limiting or eliminating dairy products. You may be lactose intolerant — that is, your body can’t digest the milk sugar (lactose) in dairy foods. Using an enzyme product such as Lactaid may help as well.
  • Limit fiber, if it’s a problem food.If you have inflammatory bowel disease, high-fiber foods, such as fresh fruits and vegetables and whole grains, may make your symptoms worse. If raw fruits and vegetables bother you, try steaming, baking or stewing them.

In general, you may have more problems with foods in the cabbage family, such as broccoli and cauliflower, and nuts, seeds, corn and popcorn.

  • Avoid other problem foods.Spicy foods, alcohol and caffeine may make your signs and symptoms worse.

Other dietary measures

  • Eat small meals.You may find you feel better eating five or six small meals a day rather than two or three larger ones.
  • Drink plenty of liquids.Try to drink plenty of fluids daily. Water is best. Alcohol and beverages that contain caffeine stimulate your intestines and can make diarrhea worse, while carbonated drinks frequently produce gas.
  • Talk to a dietitian.If you begin to lose weight or your diet has become very limited, talk to a registered dietitian.

Stress

Although stress doesn’t cause inflammatory bowel disease, it can make your signs and symptoms worse and may trigger flare-ups.

Alternative medicine

Many people with digestive disorders have used some form of complementary and alternative (CAM) therapy.

Some commonly used therapies include:

  • Herbal and nutritional supplements.The majority of alternative therapies aren’t regulated by the FDA. Manufacturers can claim that their therapies are safe and effective but don’t need to prove it. What’s more, even natural herbs and supplements can have side effects and cause dangerous interactions. Tell your doctor if you decide to try any herbal supplement.
  • Researchers suspect that adding more of the beneficial bacteria (probiotics) that are normally found in the digestive tract might help combat the disease. Although research is limited, there is some evidence that adding probiotics along with other medications may be helpful, but this has not been proved.
  • Fish oil.Fish oil acts as an anti-inflammatory, and there is some evidence that adding fish oil to aminosalicylates may be helpful, but this has not been proved.
  • Aloe vera.Aloe vera gel may have an anti-inflammatory effect for people with ulcerative colitis, but it can also cause diarrhea.
  • Only one clinical trial has been conducted regarding its benefit. The procedure involves the insertion of fine needles into the skin, which may stimulate the release of the body’s natural painkillers.
  • Curcumin, a compound found in the spice turmeric, has been combined with standard ulcerative colitis therapies in clinical trials. There is some evidence of benefit, but more research is needed.
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