Noticing any changes in your bowel habits? When patients visit, they often describe troublesome abdominal pain and bowel movements that don’t seem quite right.  A quick web search for these symptoms will turn up conditions such as Irritable Bowel Syndrome (IBS) and Inflammatory Bowel Disease (IBD), which includes Crohn’s Disease and Ulcerative Colitis.  Naturally, many patients are concerned about the possibility that they may have one of these conditions. What are the differences between these two?

IBS and IBD sound similar, but are quite different in the ways they affect patients. IBS is a non-inflammatory condition. While a specific cause is not known, we do know that it is linked to increased intestinal movement and nerve sensitivity.  Patients with IBS commonly have symptoms such as cramping or bloating abdominal pain along with either looser stools or constipation or both. IBS can sometimes become worse with eating and get better after bowel movements. IBS can also appear after having had an infection.

IBD, which includes both Crohn’s Disease and Ulcerative Colitis, is an inflammatory bowel condition. The specific cause of IBD is not known. What we do know is that it is an autoimmune condition. In patients with IBD, there are antibodies and other immune response cells that see the intestinal lining as a foreign invader and try to eliminate it from the intestinal tract.  This creates an inflammatory response that can cause significant damage over time. We can see the damage in imaging studies and when we look directly at the tissue during colonoscopy. IBD can also affect other areas of the body, for example, causing mouth sores or joint pain.

Crohn’s Disease and Ulcerative Colitis differ in that Crohn’s Disease can affect the entire intestinal tract in multiple areas at the same time, usually the small intestine and the colon. Ulcerative Colitis affects only the colon. Take a look at the follow symptoms of these conditions.

IBS

Short periods of diarrhea and/or constipation

Short periods of cramping or bloating abdominal pain

IBD

Persistent abdominal pain

Persistent diarrhea

Bloody diarrhea

Mucous in stool

Bloody mucous in stool

Fever

Weight loss

Anal pain

Mouth sores

Achy joints

Eye discomfort

Fatigue

If you are experiencing any symptoms of IBS or IBD, an accurate diagnosis is always critical. We urge you to call our office, 215-402-0800, for an examination.

Colorectal cancer is one of the most common cancers worldwide, and is easily preventable by routine screening. At Hillmont GI, we are committed to breaking down barriers to colorectal cancer screening. We offer ‘open access’ scheduling so patients do not need to come in for an office visit before a procedure, as well as a free shuttle for patients with difficulty finding transportation. There are several options to consider for screening. See below for characteristics, advantages, and disadvantages of each!

Colonoscopy- A thin, flexible scope is inserted through the rectum and goes through to the end of the small intestine to check for polyps (growths in the colon that can be cancerous or precancerous).

• Advantages-
  • Yields best results, providing direct visualization of the entire colon.
  • Polyps can be removed completely during the procedure.
  • Covered by insurance for routine purposes; we further work to minimize costs by using an ambulatory surgical center, which may end up costing up to $1,000 less through insurance compared to a hospital.
• Disadvantages-
  • The procedure is done under anesthesia, which can be risky for some patients such as the very elderly and those with severe heart and lung disease.
  • Patients will need to be accompanied, as they cannot drive the day of the procedure due to anesthesia. If this is an issue, Hillmont GI offers a free shuttle service for transportation to and from the patient’s residence.
  • Typically involves a laxative bowel preparation beforehand; we work with patients to offer low volume bowel preps and almost no prep at all in some instances.
• Frequency- Repeat colonoscopies are recommended at 10 year intervals for ‘average risk’ patients, meaning no personal or family history of colon cancer or polyps. The interval may be less depending on the patient’s history and colonoscopy results.

CT colonography/”Virtual Colonoscopy”- CT scan images are used to evaluate the bowel for polyps.

• Advantages
  • Non-invasive.
  • Visualizes the entire bowel.
  • No anesthesia is needed, which is helpful for patients with other severe health conditions.
• Disadvantages
  • A colonoscopy to remove polyps may still be needed if polyps are detected.
  • A laxative bowel preparation is still required.
• Frequency- Repeat testing is needed every 5 years.

Stool Testing- Includes Cologuard, which tests for blood and DNA markers, and FOBT (fecal occult blood test) or FIT (fecal immunochemical test), which test only for blood.

• Advantages-
  • Non-invasive and done at home.
• Disadvantages-
  • Depending on coverage, Cologuard may cost hundreds of dollars with commercial insurance.
  • A colonoscopy may still be needed if polyps are detected; the out-of-pocket cost of the colonoscopy may be increased since it would no longer be billed as ‘screening’.
  • Not appropriate for patients with any personal or family history of colon cancer or polyps.
  • Higher rate of “false positives” than any other screening options.
• Frequency- Repeat every 1 year for testing for FOBT or FIT, and 3 years for Cologuard.

Health care providers at Hillmont GI will consider a patient’s unique circumstances to determine which option is best for them. At the end of the day, the best choice is the one that gets done!

Fatty liver is called hepatic steatosis. It simply means an excess buildup of fat in the liver. The liver is very important to a healthy body by both manufacturing necessary proteins and cleansing harmful substances from the body. Excess fat in the liver can interfere with normal liver function.

Excess fat buildup in the liver can be caused by several factors. The most common cause is still probably due to excessive alcohol use and this is called alcohol induced fatty liver. Other common causes are the presence of diabetes, obesity, high lipid/cholesterol levels and side effects of certain medications. This is non-alcohol fatty liver and is referred to as NAFLD (non-alcoholic fatty liver disease). Fatty liver from any cause can lead to liver damage and scar tissue and ultimately cirrhosis of the liver.

At the present time the best treatment for fatty liver from any condition is to improve that condition. That means, in the case of alcohol, limiting or avoiding alcoholic beverages. With the nonalcoholic causes, one should try and maintain proper body weight, control high cholesterol, adequately control blood sugar in the case of diabetes or avoid the medications that cause fatty liver.

For the non-alcoholic causes of fatty liver there are a number of medications that are being developed for treatment but I’m not yet on the market. At Hillmont G.I. we are participating in research studies for some of these medications and we are also providing our patients with the best noninvasive diagnostic techniques for fatty liver, including the newest technology of fibroscan.

Some of the more common complaints that I see in my office patients are of bloating, abdominal discomfort, and excessive gas. Treating these patients is often very challenging, as these symptoms are very nonspecific and may be caused by many different problems. One of the more common causes, however, is a condition called SIBO. SIBO stands for Small Intestinal Bacterial Overgrowth. When SIBO is present, the levels of bacteria in the small intestine, which are normally very low, become significantly elevated. The excessive levels of bacteria will interfere with the normal digestive and absorptive processes of the small bowel. The nutrients which are normally broken down and absorbed by your gut are instead metabolized by the bacteria, producing excess gas, diarrhea, and pain. In severe cases patients may develop severe malabsorption with deficiencies in essential vitamins such as vitamin D and B12, fatty or greasy stools, and weight loss.

Many different conditions can lead to SIBO, such as diabetes, prior bowel surgery, Crohn’s disease, lack of stomach acid, and aging to name a few. I suspect it in any patient with chronic abdominal pain, bloating, gas, or diarrhea whether or not they have an obvious predisposing condition. If suspected, SIBO can be tested for in my office. We use a procedure called a breath test to make the diagnosis. Breath testing is based on the fact that when gut bacteria break down carbohydrates, gases such as hydrogen and methane are produced. These can be detected by measuring their levels in the exhaled breath. We administer a test amount of a carbohydrate such as glucose and then measure the hydrogen and methane produced over the next two hours. If elevated levels are found, then the patient has SIBO. The test is completely noninvasive, painless, and safe.

Once SIBO is found, it can be treated. The most effective treatment is with a course of an antibiotic. I prefer to use a medication called rifamixin, which is very safe, effective, and has few side effects. A ten day course is typically given, which can usually produce long lasting improvement. Sometimes stopping medications that reduce stomach acid or administering pancreatic enzyme supplements can be helpful as well. But unless SIBO is suspected and tested for, it can’t be helped.