Health Resources

Gastroenterology

Gastroenterology is a medical branch focused on maintaining the proper function of the human digestive system and alleviating any issues that may present there. Called gastroenterologists, physicians who practice in this branch of medicine specialize in the diagnosis and treatment of patients with ailments of the esophagus, stomach, small intestine, colon (also called the large intestine) and rectum, pancreas, gallbladder, bile ducts, and liver. Common conditions treated by gastroenterologists include hepatitis, heartburn/gastroesophageal reflux, colon polyps and cancer, peptic ulcer disease, colitis, gallbladder and biliary tract disease, nutritional problems, irritable bowel syndrome (IBS), and pancreatitis.

Appendicitis is a condition that occurs when the appendix — a tube-like, finger-shaped organ that is attached to the large intestine in the lower-right portion of the abdomen — becomes blocked, leading to inflammation and/or infection. This often leads to pain that can start out centered around the belly button and is relatively mild, then becomes progressively worse and moves to the lower-right side of the patient’s belly.

If appendicitis is left untreated, the inflamed appendix can burst, causing sudden and severe pain. When this happens, bacteria can spread throughout the abdominal cavity and cause a serious, sometimes-fatal infection known as peritonitis. For this reason, appendicitis is considered a medical emergency, and affected patients should see a physician as soon as possible.

While the appendix serves as an aid to the immune system in young children, it serves no known purpose in older patients. So when appendicitis strikes, which typically happens in patients between the ages of 10 and 30, the standard treatment is to surgically remove the failing appendix via a procedure known as an appendectomy. 

Colon polyps are small clumps of cells that can form on the lining of the large intestine or in the rectum. While the growths are typically harmless, over time some colon polyps can develop into colon cancer — which can be fatal when it isn’t discovered until its later stages. Further, while the presence of colon polyps can result in symptoms such as blood in the stool, changes in bowel habits and/or fatigue caused by blood loss over time, the growths often present no symptoms in patients who have them. For these reasons, regular screening via testing methods such as colonoscopies, sigmoidoscopies, stool tests or CT scans is highly recommended, especially for patients at higher risk for colon polyps and colon cancer. Leading risk factors include being over age 50, being overweight, smoking, and having a family history of colon polyps and/or colon cancer. When found, colon polyps are typically removed to prevent them from developing into colon cancer, then tested via a biopsy to determine their number, size and type, as well as any need for additional treatment and how frequently additional screenings might be needed. 

Also known as CRC, colorectal cancer is a disease of the colon and/or rectum (which together make up the large intestine) that most often affects patients ages 45 or older. A highly treatable condition when detected in its early stages, colorectal cancer can often develop without presenting symptoms — making early screening for the disease critical. (Most colorectal cancer begins with an abnormal growth in the colon or rectum called a polyp, which can be removed and prevented from developing into cancer when discovered early.)

Cancers that occur in either part of the large intestine (the colon and/or rectum) are referred to as colorectal cancer. While any patient can develop the condition, factors that can increase one’s risk for developing colorectal cancer include inflammatory bowel diseases, a family history of colorectal cancer or colorectal polyps, genetic syndromes such as familial adenomatous polyposis and Lynch syndrome, and lifestyle factors such as a high-fat diet, heavy alcohol consumption, smoking and obesity. 

When symptoms of colorectal cancer do develop, they can include blood in the stool, unexplained weight loss, prolonged stomach pain, aches and/or cramps, vomiting, and persistent constipation, diarrhea or other unusual bowel movements. Surgical removal of any present tumors is the most common treatment used when colorectal cancer is discovered, with surgical options here including local excision, radiofrequency ablation, cryosurgery (which freezes and destroys the abnormal tissue), laparoscopy and open surgery. Additional treatment options include chemotherapy, radiation and biological therapy.

A type of inflammatory bowel disease (IBD), Crohn’s disease is a chronic condition that can cause swelling in the tissues of the gastrointestinal (digestive) tract. Most commonly affecting the small intestine but sometimes involving other areas of the digestive tract, too, the condition can lead to symptoms such as cramping and pain in the abdomen, severe diarrhea, fatigue, and eventually malnutrition and weight loss. While the cause of Crohn’s disease is unknown and there is currently no cure for the condition, it can be successfully managed with therapies and treatments such as dietary changes, medications, bowel rest (periods of going without food and drink to give the intestines time to heal) and, in extreme cases, surgery to address complications such as intestinal perforations, blockages or bleeding.

Also known as the alimentary canal and the gastrointestinal tract, the digestive system is a group of organs that the body uses to break down the foods that humans consume in order to provide nutrients and energy to the body. The system, which runs along a long, twisting tube from the mouth to the anus, also processes and eliminates waste products from the body. Major components of the digestive system include the mouth, esophagus, stomach, small intestine (which includes the duodenum, jejunum and ileum), large intestine (which is also called the colon and includes the ascending colon, transverse colon, descending colon, sigmoid colon), cecum (which connects the small intestine to the colon), and rectum.

A type of cancer that develops in the esophagus — the long, hollow tube that moves food from the throat to the stomach after it is swallowed — esophageal cancer is much more common in male patients than in female patients. This type of cancer can present anywhere in the esophagus, and it typically begins in the cells that line the muscular tube’s interior. Most patients with esophageal cancer don’t notice its symptoms, which can include difficulty swallowing, throat and/or chest pain, persistent coughing/hoarseness, indigestion or heartburn that progressively worsens, and unintentional weight loss, until the cancer has advanced and spread.

Leading risk factors for esophageal cancer include tobacco use, heavy alcohol consumption, being overweight/obese, having gastroesophageal reflux disease (GERD), having chronic heartburn or acid reflux, occupational exposure to certain chemicals (such as dry cleaning solvents), and a history of cancer of the neck or head. Once diagnosed via testing options such as an endoscopy or PET scan, treatment options for esophageal cancer include radiation therapy, chemotherapy and surgery to remove cancerous tissue from the body. 

Formed when a digestive fluid called bile hardens in the gallbladder (a small, pear-shaped organ located just below the liver), gallstones are stone-like deposits that can range in size from as tiny as a grain of sand to as big as a golf ball. Gallstones can form on their own or in groups, and they often present no signs or symptoms. But when they become lodged in a duct and lead to a blockage, they can result in sudden abdominal pain that quickly intensifies, as well as nausea and/or vomiting, sweating, and pain in the upper back and/or right shoulder. The pain’s duration can last for several minutes or for hours at a time. In some cases, gallstones can block pancreatic secretions — leading to a serious condition called acute pancreatitis that necessitates immediate care. Other complications can include inflammation of the gallbladder, blockage of the common bile duct and (rarely, and typically in patients with a history of gallstones) gallbladder cancer.

When gallstones are symptom-free, they are often left alone and frequently disappear on their own. But when symptoms persist, gallstones are commonly treated with a surgical procedure called cholecystectomy, which is performed to remove the gallbladder. In other cases, medications or a procedure called lithotripsy can be used to break up or dissolve any existing gallstones.

Characterized by a painful burning sensation in the chest, heartburn is experienced by patients when stomach acid escapes into the esophagus, the tube that runs alongside the heart and is used for swallowing. The condition, often a symptom of indigestion, is typically at its worst following meals, in the evening, when lying down or when bending over.

While occasional heartburn is common in many patients and presents no cause for alarm, more persistent heartburn may be a sign of gastroesophageal reflux disease (GERD), which should be treated by a healthcare provider. Occasional heartburn is typically treated with over-the-counter medications and lifestyle adjustments, with prescription medications sometimes used for more severe, persistent cases. Medication options for heartburn include antacids (which work to neutralize the stomach acid that escapes into the esophagus), foaming agents (which help prevent reflux by covering the stomach’s contents with foam), H2 blockers and proton pump inhibitors (which are used to impede the production of stomach acid) and prokinetics (which help strengthen the lower esophagus’s sphincter to prevent acid release from the stomach, plus work to make the stomach empty faster). Further, heartburn can be prevented by cutting back on acidic foods, reducing the consumption of caffeine and/or alcohol, avoiding meals just before bed and not lying down just after eating.

Hepatitis is a broad term used to describe a swelling of the liver, which can lead to symptoms such as pain or bloating in the abdomen, dark urine, yellowed skin or whites of the eyes (also known as jaundice), pale or clay-colored stool, loss of appetite, low-grade fever, itching, fatigue, weight loss, and nausea/vomiting. While liver inflammation is typically a response to irritation or injury — and it can be caused by a range of things including excessive alcohol consumption, certain health conditions and the intake of some medications — viral infections are the leading cause of hepatitis.

The five viruses that cause the varying forms of viral hepatitis are:

●      Hepatitis A: Caused by an infection with the Hepatitis A (HAP) virus and preventable via vaccination, this type of hepatitis typically presents no complications and does not lead to a long-term disease. While Hepatitis A can cause occasional deaths due to liver failure, these are rare, and the liver usually heals from a Hepatitis A infection within a few months.

●      Hepatitis B: Hepatitis B is caused by infection with the Hepatitis B virus (HBV), and it can be prevented with a vaccination. While approximately 95% of adults who get Hepatitis B recover fully and avoid chronic infection, some cases — typically when the virus is contracted by a patient at an early age — lead to a lifelong condition. Those infected with Hepatitis B can also spread it to others without showing any symptoms.

●      Hepatitis C: One of the United States’ most common causes of liver disease, Hepatitis C is caused by infection with the Hepatitis C virus (HCV) and leads to chronic liver infection in roughly 80% of patients who contract it. No vaccine is yet available to prevent Hepatitis C, and it often does not show any symptoms.

●      Hepatitis D: A rare form of hepatitis, Hepatitis D is seen only in patients who have already been infected with the Hepatitis B virus. Those who are vaccinated against Hepatitis B are also protected from getting Hepatitis D.

●      Hepatitis E: A waterborne disease caused by exposure to the Hepatitis E virus (HEV), Hepatitis E is most commonly encountered in areas with poor sanitation practices in place. It typically results from ingesting water and/or food that has been contaminated with fecal matter. While vaccines against Hepatitis E exist, they are often unavailable in the areas where poor sanitation practices put the population at the greatest risk of contracting the disease.

Hepatitis is considered a serious health concern because, while many recover from the disease, it can lead to a range of issues in those who become infected, including the deterioration of liver tissue, a weakened immune system, liver failure, liver cancer and (in rare cases) even death. While there is no treatment or cure for Hepatitis A, the other forms of hepatitis can be successfully treated with medication.

A relatively common condition affecting roughly 10% to 15% of Americans, irritable bowel syndrome (IBS) causes uncomfortable and/or painful abdominal symptoms in the stomach and/or intestines of affected patients. Common symptoms of the chronic gastrointestinal disorder — which can often be triggered by food or stress — include cramping, abdominal pain, bloating, gas, diarrhea and constipation. The condition, which does not cause damage to the digestive tract or raise one’s risk for colorectal cancer, produces severe symptoms in only a small number of the patients who have it, and its symptoms can often be controlled via careful management of diet, lifestyle and/or stress.

While the exact cause of IBS is not known, common factors that seem to play a role in its presentation and longevity include abnormal muscle contractions in the intestines, issues with nerves in the digestive system, severe gastrointestinal infections, stressful events during one’s early childhood and changes in gut microbes. Treatment options for controlling IBS can include dietary changes such as eating more fiber, avoiding caffeine, limiting dairy consumption, drinking more water and adding supplements; activity changes such as exercising more, eating smaller meals and avoiding smoking; and medications such as probiotics and drugs designed to control diarrhea, constipation and abdominal pain.

A condition diagnosed in about 1% of men and women in the U.S. over the course of their lifetimes, liver cancer is a life-threatening disease of the liver — a roughly football-sized organ in the upper abdomen that, among other things, helps break down and store nutrients, filter and process ingested chemicals, and remove waste products from the body. As one of the fastest-growing cancer types in the U.S., liver cancer comes in two main forms: primary liver cancer, which starts in the cells of the liver, and secondary liver cancer, which starts elsewhere and spreads to the liver.

In its early stages, liver cancer often goes unnoticed due to a lack of symptoms that can be seen or felt. As the cancer grows larger, though, it often presents more noticeable symptoms such as a swollen abdomen, discomfort in the upper abdomen, jaundice (yellowing of the skin and the whites of the eyes), a hard lump below the rib cage on the right side of the abdomen, back and/or shoulder pain, dark-colored urine, easy bruising and/or bleeding, abnormal fatigue, loss of appetite, nausea/vomiting, and unintentional weight loss.

Leading risk factors for liver cancer include heavy alcohol consumption, being overweight or obese, smoking, being diabetic, having a prolonged Hepatitis B or C infection, and having fatty liver disease. Liver cancer’s treatment options include surgical removal of the diseased part(s) of the liver, liver transplant, chemotherapy, radiation therapy, immunotherapy and targeted therapy.

Pancreatic cancer, the United States’ third-leading cause of cancer death, is a form of cancer that arises in the tissues of the pancreas. Found behind the lower stomach, this organ produces digestion-aiding enzymes, along with the hormones insulin and glucagon, each of which plays a role in managing blood sugar in the body. The most common type of pancreatic cancer, known as pancreatic ductal adenocarcinoma, begins in the lining of the ducts that carry digestive enzymes out of the pancreas.

Because pancreatic cancer rarely produces noticeable symptoms in its early stages, when it is most curable, it is much more frequently discovered after it has advanced and spread to other organs in the body. Symptoms that often present at this later disease stage include dark-colored urine, light-colored stool, jaundice (yellowing of the skin and the whites of the eyes), upper abdominal pain, middle back pain, fatigue, itching, nausea/vomiting, a diminished appetite, gas and bloating, blood clots, unintentional weight loss, and new-onset diabetes. Common risk factors for the disease include smoking, being overweight or obese, having diabetes (especially Type 2), heavy exposure to certain chemicals such as pesticides and petrochemicals, and chronic pancreatitis.

Because pancreatic cancer is resistant to many commonly used cancer drugs, it is notoriously hard to treat. And while pancreatic cancer’s survival rate is low, with early detection and treatment, complete remission is a possibility. Treatment options include chemotherapy, radiation therapy, targeted therapy, and surgical removal of all existing cancer cells.

Peptic ulcers — also known as duodenal ulcers, gastric ulcers and stomach ulcers — are open sores that form on the lining of the stomach or the upper part of the small intestine (also called the duodenum). Developing when digestion-aiding acids eat away at the walls of the stomach or the duodenum, the sores are typically the result of excessive stomach acid or a decrease in the protective mucus that coats the digestive tract. These conditions can be caused by infection with the H. pylori bacterium, prolonged use of nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen, or taking other medications along with NSAIDs such as steroids or anticoagulants. Other risk factors for peptic ulcers can include smoking, heavy alcohol consumption, untreated stress and eating spicy foods.

While some patients experience no symptoms at all, the most common symptom of peptic ulcers is burning stomach pain, which can be worsened by stomach acid and exaggerated when the stomach is empty. Other symptoms can include feelings of fullness or bloating, belching, heartburn, nausea, and an intolerance of fatty foods. Less frequently, more severe symptoms can arise, including nausea, vomiting, bloody stools, feelings of faintness, appetite changes and unexpected weight loss. Treatment options include medications to heal the ulcers, reduce the amount of acid in the stomach and/or kill the H. pylori bacterium (if present), and surgery may be required if the ulcer causes a tear or any heavy bleeding cannot be stopped using less-intrusive methods.

Also known as gastric cancer, stomach cancer — a cancer that originates in the stomach — is one of the most prevalent types of cancer worldwide. While stomach cancer can originate in any part of the stomach, in most of the world, it most often appears in the stomach body, the organ’s main part. But in the United States, where the cancer is rarer than in other parts of the world, the cancer is most likely to form in the gastroesophageal junction, where the esophagus meets the stomach. Further, more than 90% of the time, stomach cancer forms in the stomach lining. Then, if left untreated, it can slowly progress into the stomach’s walls and even into nearby organs such as the pancreas and the liver.

Some of the leading symptoms of stomach cancer include appetite loss, difficulty swallowing, severe stomach pain, nausea and vomiting (and sometimes vomiting blood), dark, sticky stool, feeling bloated even after eating small meals, and unintentional weight loss. Top risk factors for stomach cancer include a family history of the disease, infection with the H. pylori bacterium, smoking, drinking too much alcohol, a diet high in fatty, salty, smoked and/or pickled foods, a diet deficient in fruits and vegetables, a history of stomach ulcers or stomach polyps, gastroesophageal reflux disease (GERD), obesity, and certain genetic conditions that increase the risk of cancer.

Once stomach cancer is diagnosed via testing methods such as an endoscopy, radiologic testing or blood tests, treatment options can include surgery to remove precancerous or cancerous cells, chemotherapy, radiation, targeted drug therapy and immunotherapy.

Ulcerative colitis is a chronic inflammatory bowel disease (IBD) that sees inflammation and ulcers develop in the rectum and/or on the inner lining of the colon (also known as the large intestine). Caused by abnormal immune system reactions and able to develop at any age (though most prevalent in patients between the ages of 15 and 30), the condition is characterized by symptoms such as abdominal pain and cramping, diarrhea, and passing blood with the stool. It can also cause rectal pain and bleeding, urgent needs to defecate (sometimes followed by an inability to defecate), weight loss, fever, skin rashes, joint pain and fatigue. In most patients, the symptoms tend to develop slowly over time.

Once diagnosed with testing such as imaging scans, blood tests, stool tests, colonoscopy, endoscopy or flexible sigmoidoscopy, the condition can be treated using methods such as medications meant to reduce inflammation, or in more extreme cases, surgery (such as a colectomy) to treat the condition or associated complications such as heavy bleeding.

A peptic ulcer is an open sore on the lining of the stomach, esophagus or the upper portion of the small intestine. Classified by location, these sores are called gastric ulcers when presenting in the stomach, duodenal ulcers in the upper small intestine and esophageal ulcers in the esophagus. The condition is common, appearing in one in 10 Americans at some point in their lives, according to the American Academy of Family Physicians.

Peptic ulcers, which typically require the attention of a physician, are primarily caused by a bacterial infection. They often lead to a dull, gnawing pain that typically appears two to three hours after eating and can come and go in affected patients for several days or weeks. Other symptoms can include loss of appetite, bloating, burping, weight loss, nausea and vomiting. Peptic ulcers are typically treated with a mix of medications, including antibiotics to kill the bacteria that usually cause them, H2 blockers to impede the production of stomach acid, proton pump inhibitors to cut the secretion of stomach acid, and drugs aimed at protecting the lining of the stomach.