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News Release from Governor Glenn Youngkin: Congratulations Dr. Sandhu!

Thu, 24 Aug 2023 17:00:47 GMT

On July 14, 2023, the Office of the Governor announced the appointment of Richmond Gastroenterology Associates’ Dr. Bimaljit Sandhu to the Virginia Commonwealth University Health System Board of Directors. Dr. Sandhu was sworn in by Governor Glenn Youngkin at the Virginia State Capitol on Tuesday, July 18, 2023.

Practicing at RGA for the past ten years, and serving the Richmond community since 2004, Dr. Sandhu is an advanced, highly skilled physician seeing patients at our West Creek and Bremo Road locations. On behalf of Richmond Gastroenterology Associates, we thank Dr. Sandhu for his relentless hard work and dedication to his patients and the community. Please join us in recognizing him for this distinguished honor.

Learn more about Dr. Bimaljit Sandhu here: https://www.richmondgastro.com/provider/bimaljit-s-sandhu-md

Read Governor Glenn Youngkin’s announcement here: https://www.governor.virginia.gov/newsroom/news-releases/2023/july/name-1010149-en.html

Colorectal Cancer Prevention: Get Screened

Tue, 02 Aug 2022 08:56:03 GMT

Find out why you should be screened for colorectal cancer, what screening options are available, and how you can schedule yours.

Click to view full infographic (PDF)

En español (PDF)

Why screen for colorectal cancer?

Colorectal Cancer is the second leading cause of cancer death. However, if caught early, it has a 90% surival rate. Early detection and regular screening colonoscopies are key. The American Cancer Society recommends an average-risk person begin screening for colorectal cancer at the age of 45.

What screening options are available?

Colonoscopy
Fecal immunochemical test (FIT)
CT Colonography
Cologuard ^®
Capsule endoscopy

What Should I Do?

Ask your GI physician about available CRC screening options!

What is Celiac Disease?

Tue, 02 Aug 2022 08:43:34 GMT

In recent years, there has been an increase in conversation on the topic of gluten, a protein found in wheat, barley and rye.

Celiac disease is an autoimmune disorder that results from genetic, environmental and immunologic components. With celiac disease, gluten causes damage to the small intestine when consumed either through food or beverages. It is worth noting that there is a difference between gluten sensitivity and celiac disease. The information presented here is a specific to celiac disease only.

When people with this disease ingest gluten, their body creates an immune response that attacks the small intestine, limiting the intestine from carrying out proper nutrient absorption. Over time, the inflammation damages the small intestine’s lining, leading to a variety of complications.

While this disease can be hard to diagnose, there are over 200 symptoms that adults with celiac disease may experience.

Some of the more common signs or symptoms include:

Diarrhea
Weight loss
Pale, foul-smelling, fatty stool
Bloating and abdominal pain
Constipation
Vomiting
GERD or chronic acid reflux
Frequent headaches or migraines
Joint pain
Fatigue
Irregular periods
Infertility
Skin rash known as dermatitis herpetiformis
Seizures and neuropathy (numbness and tingling of hands and feet)
Liver disorders
Depression and/or anxiety
Damage to tooth enamel
Canker sores in mouth

Complications of long term malabsorption or disease include:

Vitamin deficiencies including B vitamins and vitamin D
Osteoporosis
Iron deficiency leading to anemia
A small but increased risk for certain cancers including lymphoma and gastrointestinal cancer

There are tests that can help diagnose this autoimmune disorder. Click here to learn more about the challenges of diagnosing Celiac Disease. The only known treatment for this disease is to refrain from eating gluten. A registered dietitian can assist you with creating an eating plan that avoids gluten while maintaining a healthy and nutritious diet. If you think you or a family member may have Celiac Disease, request an appointment with us today.

The Truth About Sugar in Your Diet

Tue, 02 Aug 2022 08:38:57 GMT

Sugar goes by many names including, glucose, fructose, lactose, galactose and sucrose. It is found naturally in many foods, including milk and fruit.

It is also added to certain foods during processing to make them sweeter. Major sources of sugar in the American diet include sweetened beverages like soda or fruit juice and it may even be added to snack foods. People even add it directly to foods by sprinkling it onto cereal, or using it in coffee or tea. The problem with too much sugar, is that it can increase the risk of many chronic disease states, such as diabetes, heart disease, fatty liver and cancer.

You can eliminate excess sugar in the diet by looking at the ingredient list on food packaging. When sugar is listed as one of the first ingredients, consider an alternative. Try to avoid ingredients such as brown sugar, corn syrup, high fructose corn syrup, honey, maple syrup, molasses, sucrose, dextrose, fructose or white granulated sugar. Sugar alcohols and high intensity sweeteners are commonly used to sweeten gum, beverages, and foods without the calorie load and are an alternative to sugar. They are much sweeter, so less is needed to get the desired level of sweetness. They also contain significantly less calories and in many cases are calorie free, when compared to sugar. High intensity sweeteners go by the name saccharin, aspartame, acesulfame potassium, sucralose, and steviol glycosides. Sugar alcohol may also be used to sweeten foods and beverages without the calories. Sugar alcohols commonly recognized include xylitol, mannitol or sorbitol. These additives and substitutes are considered safe when consumed within daily levels established by the US Food and Drug Administration (FDA); however, may contribute to gastrointestinal problems such as diarrhea and gas due to lack of absorption and fermentation in the gut. At the center of every diet recommended for weight loss or disease management, is reducing excess sugar. The US News and World report just released their recommendation on top diets for 2020 after a panel of health experts provided input on 35 possible choices. To be top rated, a diet had to be relatively easy to follow, nutritious, safe and effective for weight loss and protective against diabetes and heart disease. The number one recommended diet overall is the Mediterranean diet, 2nd place was given to the DASH diet and 3rd place was awarded to the Flexetarian diet. One consistent finding amongst all three, was reduction of excess sugars. The Dietary Guidelines for Americans recommend less than 10% of calories come from added sugars. This means out of a 2000 calorie diet, only 100 calories should come from excess sugar! You can eliminate excess sugar in the diet by looking at the ingredient list on food packaging and using recipes without added sugars. When any form of sugar is listed as one of the first ingredients in a food, consider an alternative. Try to avoid ingredients such as brown sugar, corn syrup, high fructose corn syrup, honey, maple syrup, molasses, sucrose, dextrose, fructose or white granulated sugar. Sugar substitutes are considered safe in small amounts but may be poorly tolerated. Fresh fruit is also a great alternative to both to sweeten beverages or other foods like yogurt.

Written by Rachel Sawyers, PA-C, RD

References: Academy of Nutrition and Dietetics. Handouts and Tip Sheets: Eating Right with Less Added Sugars. January 14, 2020. https://www.eatright.org/food/resources/handouts-and-tip-sheets.

Food and Drug Administration: High intensity sweeteners. January 16, 2020. Webpage. https://www.fda.gov/food/food-additives-petitions/high-intensity-sweeteners.

U.S. News Best Diets Rankins for 2019. January 14, 2020. News Release. https://health.usnews.com/best-diet/best-diets-overall .

Easy Gluten Free Stuffing

Tue, 02 Aug 2022 08:32:09 GMT

Thankgiving can be a trying time for those of us struggling with dietary restrictions. We are here to save you with a delicious gluten-free, dairy-free stuffing recipe that will leave you satisfied!

What you'll need:

14 oz. of Gluten-free bread (gluten and dairy-free bread for dairy-free recipe)

2 large eggs

1 tablespoon olive oil

1 cup diced celery

1/2 teaspoon minced garlic

2 cups gluten-free chicken broth

1 teaspoon salt

1 tablespoon onion powder

1 tablespoon thyme

1 tablespoon sage

1 teaspoon rosemary

2.5 quart casserole dish

gluten free cooking spray

* be sure to check all of your labels

Cooking Instructions:

Preheat your oven to 350° F and spray a 2.5-quart casserole dish with gluten-free cooking spray.
Cut the gluten-free sandwich bread into medium-sized cubes and add bread pieces to a large bowl. (photo 1)
Add the olive oil, celery, and minced garlic to a medium-sized skillet and saute over medium/high heat until soft, about 6-8 minutes (photo 2)
Add the spices to a small bowl and stir to combine. Pour seasoning blend and whisked eggs over the bread and stir. (photo 3)
Pour chicken broth over the bread mixture and gently mix until the bread is evenly moistened. (photo 4)
Add sauteed celery and garlic to the bread mixture and stir.
Pour the stuffing mixture into the greased casserole dish. (photo 6)
Bake for 40-50 minutes until the top of the stuffing is golden brown and lightly crisp. (Bake on middle rack for optimal results)
Enjoy! *Keep any leftovers in an air-tight container and refrigerate for up to three days. The stuffing can be easily reheated in the oven or microwave.

Festival of India This Weekend

Tue, 02 Aug 2022 08:26:40 GMT

The 37th Annual Festival of India takes place this weekend! Be sure to visit RGA's booth, hosted by Dr. Sandhu, at this great event!

Saturday, September 21st from 11:00 AM – 9:00 PM through Sunday, September 22nd from 11:00 AM – 8:00 PM. Located at the Greater Richmond Convention Center, 403 N 3rd Street, Richmond, VA 23219.

Enjoy the Pristine beauty of Indian festivals, culture, authentic food, dance, jewelry, clothing, and music! The event is free to attend, so bring you family, friends, or both!

Richmond Gastroenterology Associate’s Dr. Bimaljit Sandhu will be at the festival representing our booth! Click on his name to read more about Dr. Sandhu.

Be sure to visit http://www.thefestivalofindia.org/home.asp for all other the details!

Richmond Gastroenterology Associates Welcomes Dr. Richardson!

Tue, 02 Aug 2022 08:19:22 GMT

We are pleased to welcome Taylor Richardson to Richmond Gastroenterology Associates!

A native Virginian, Dr. Richardson hails from Goochland, Virginia. He received undergraduate degrees in history and economics from the University of Virginia.

He continued his studies at the University of Virginia, where he obtained his medical school degree. Dr. Richardson completed his internship and residency in Internal Medicine at the Vanderbilt University Medical Center in Nashville, Tennessee before being selected for a three-year fellowship in Gastroenterology and Hepatology at the University of Alabama at Birmingham.

He is interested in a wide variety of digestive diseases including: heartburn/reflux, Barrett’s esophagus, swallowing disorders, peptic ulcer disease, celiac disease, inflammatory bowel disease (Ulcerative Colitis and Crohn’s), irritable bowel syndrome, diarrhea, constipation, liver disease, and colon cancer screening. He is skilled in upper endoscopy, esophageal dilation, colonoscopy, colon polyp removal, and video capsule endoscopy. Dr. Richardson is a member of the American College of Gastroenterology, the American Gastroenterology Association, and the American Society for Gastrointestinal Endoscopy. Taylor is married to his wife, Anna, who is a practicing dentist in Richmond. He enjoys long distance running, hiking in the mountains, snow skiing, fly fishing, reading American history, and following UVA athletics. Dr. Richardson practices at our Midlothian Center, located at 223 Wadsworth Drive, North Chesterfield, VA 23236. To schedule an appointment, call 804.330.4021

Increase your water intake for good digestive health & weight loss

Tue, 02 Aug 2022 08:14:10 GMT

Increasing your water intake is a simple and easy way to have a fun and safe summer. There are many health benefits including an improvement in your digestive health. Water is a key component of digestion and ensures the proper absorption of nutrients. Water also keeps food moving through the intestines. If you don’t have enough water in your body, water is reabsorbed from the colon….leading to hard stools and constipation. Drinking water may also help with weight loss.

How do I know how much water to drink?

We lose water during the day just by breathing, sweating and digesting. You must replace the water lost or you will become dehydrated. You may be wondering how much water you need? There is no one answer because the amount of water varies from person to person.

There are many variables that affect daily water requirements including personal differences such as metabolism, physical activity, and medications as well as environmental conditions such as climate. Men usually need more water than women. Pregnant or nursing mothers will also need more water.

The National Academies of Sciences, Engineering, and Medicine have calculated the fluid requirements for an average healthy adult living in a temperate climate: Women:91 ounces (or just over 11 cups) Men: 125 ounces (or just over 15 cups)

Here’s a bit of good news if you are not a big fan of drinking water: not all of the fluid requirements come from water and other fluids. About 20 percent of our daily fluid intake usually comes from food.

Do caffeine drinks and alcohol count as water?

Water is the best way to stay hydrated. Caffeinated drinks (coffee, tea, sodas) can contribute to your daily fluid requirement as long as these drinks are not consumed in excess. A study that was done in the UK compared to water and caffeine intake and found no evidence of dehydration with moderate caffeine intake. However, keep in mind that caffeinated beverages can cause acid reflux and insomnia.

On another hand, alcohol does not contribute to your daily requirement. You should avoid or try to limit alcohol consumption. Alcohol is a diuretic, which gets rid of water from your body and can lead to dehydration.

When is the best time to drink water?

It is best to drink water throughout the day. Start by drinking a cup when you wake up. Be sure to include water at mealtime. Drinking water during or after a meal can help with digestion. It does not dilute the digestive juices or interfere with digestion. Water and other liquids help break down food so that your body can absorb the nutrients. However, if you drink too much water during the meal, it can make you feel too full and prevent you from finishing the meal or may lead to acid reflux.

Tips for staying hydrated

Don’t let thirst be your guide. If you get thirsty, then your body is already dehydrated! Here are some suggestions to help you stay hydrated:

Remember to drink extra water when exercising and/or when you are outside during warmer weather.
For variety, add lemon, lime, honey or flavor packets to your glass of water.
Eat hydrating foods – A quick internet search will give you many “water rich” foods to eat. Good choices include these fruits and vegetables:
- Watermelon

- Strawberries

- Cantaloupe

- Celery

- Bell peppers

- Cucumbers

- Tomatoes

- Spinach

- Broccoli

- Cauliflower
For variety, supplement water with these fluid choices:
- Fruit and vegetable juices (juices have a higher sugar content than water)

- Clear soups

- Herbal teas

How does water help with weight loss?

Many people find that proper hydration can also result in weight loss. Here’s why:

Staying hydrated may boost your metabolism.
Water helps you feel full and may decrease your appetite and calorie intake.
Sometimes it is hard for your body to tell the difference between being hungry and being thirsty. Drinking water instead of snacking often satisfies your hunger.

The providers at Richmond Gastroenterology treat all types of digestive conditions. Contact us to schedule an appointment.

Disclaimer: This blog article is intended to be informative and is not medical advice.

Fireworks on the Appomattox

Tue, 02 Aug 2022 08:10:16 GMT

Come join us this weekend in Hopewell for their Fireworks on the Appomattox this Saturday, June 29th. New this year, they will be having an event before the fireworks from 7:00pm – 9:00pm that will include concessions, games, music, face painting. During this time, we will have an informational booth set up, so stop by and say hello!

Address: John Randolph Medical Center, 411 W. Randolph Road

Activities will be available in JRMC's parking area and the main viewing location will be in the rear parking lot of the hospital. Please note that only street parking is available at this location. The use of tobacco products is prohibited on the grounds of the John Randolph Medical Center. Regular hospital operations will not be impacted by this event.

For more information and details, please visit their website: https://www.hopewellrecandparks.com/fireworks

What is a Hiatal Hernia?

Tue, 02 Aug 2022 07:56:20 GMT

A hiatal hernia is a protrusion of the stomach or esophagus through the diaphragm. The diaphragm is a thin structure that separates the chest cavity from the abdominal cavity. The end of esophagus (swallowing tube) typically joins the top of the stomach underneath the diaphragm in the abdominal cavity. However, in patients with a hiatal hernia, the esophagus, and sometimes the stomach, can partially protrude up through an opening in the diaphragm into the chest cavity. There are two types of hiatal hernias: sliding (most common) and para-esophageal. The types differ based on what part of the stomach and esophagus have herniated through the diaphragm.

What are the symptoms of a hiatal hernia?

Hiatal hernias are very common and many patients don’t have any symptoms at all! If patients do have symptoms, heartburn or acid reflux are the most commonly reported. Some patients also have chest or upper abdominal discomfort, trouble swallowing, belching or nausea.

How are hiatal hernias diagnosed?

Most are found during an upper endoscopy, though some imaging studies such as CT, barium swallow or upper GI series can also diagnose hiatal hernias.

What treatment options are available?

Treatment of hiatal hernias are usually based on the symptoms. If a patient has mild acid reflux, symptoms will typically resolve with dietary and lifestyle modifications and acid lowering medications. A smaller subset of patients with larger hernias or refractory symptoms will undergo a surgical or endoscopic intervention to repair the hernia and tighten the junction between the esophagus and stomach.

Nutrition and Inflammatory Markers in Chronic Pancreatitis

Tue, 02 Aug 2022 07:41:48 GMT

Dr. Sandhu recently published an academic article in the Nutrition Clinical Practice Volume 34 Number 3, called Nutrition in Clinical Practice. The article discusses Nutrition and Inflammatory Markers in Chronic Pancreatitis. To date, there have been a limited number of published investigations of malnutrition and vitamin deficiencies in Chronic Pancreatitis.

By comparing micronutrient antioxidant, bone metabolism, serum protein and inflammatory market levels of CP Patients and in those with no known disease, Dr. Sandhu and the pancreatic study team was able to analyze and evaluate biomarkers among both groups of individuals. The experiment led to the conclusion that CP Patients demonstrated lower levels of selected nutrition and bone metabolism biomarkers than the control group. It also found that while diabetes and alcohol did not impact the nutrition and inflammatory markers, vitamin supplements and pancreatic enzyme replacement therapy improved the biomarkers in CP patients. Read the recently published article to learn more about this clinical research.

Liver Disease: Understanding Causes & Treatment

Tue, 02 Aug 2022 07:33:02 GMT

Millions of Americans have abnormal liver enzymes with the vast majority being due to fatty liver disease and hepatitis C. Fatty liver disease is often caused by excess alcohol intake. For people who do not drink alcohol or drink very small amounts we call their fatty liver disease non-alcoholic steatohepatitis or NASH. With regards to non-alcoholic fatty liver disease, this appears to be an epidemic in our country and is related to obesity, hypercholesterolemia, insulin resistance and diabetes mellitus.

Understanding Liver Disease

In this disorder, the liver cells accumulate excess fat. For the vast majority of patients there is very little inflammation involved and no significant scarring develops. The liver continues to function normally. I often tell patient's that for the vast majority of patients the abnormal liver enzymes makes their doctors worry but really is of no concern. In less than 10% of patients in addition to that deposition of fat in the liver there is significant inflammation and scarring of the liver.

As a hepatologist my primary job is to identify the small percentage of people with Nash who are at risk to develop significant scarring of the liver which can progress to severe scarring a condition we call cirrhosis. Until recently a liver biopsy was necessary to grade the amount of scarring in the liver and the risk of developing cirrhosis. We now have a safe and painless way to avoid a liver biopsy and to identify scarring using a special ultrasound machine called a fibroscan. This test takes a matter of minutes and gives us great information which can accurately predict the amount of scar tissue in the liver. Scarring is graded from a score of F0 meaning absolutely no scar tissue to F4 which means cirrhosis. The scan can also tell us how much fat is in the liver.

Treating Liver Disease

The treatment of fatty liver disease is treatment of high lipid levels, good control of diabetes mellitus and weight loss using a low carbohydrate diet. It is not the fat in the diet that causes fat to be deposited in the liver but rather the amount of carbohydrates we consume in our diet. Limiting carbohydrate means limiting fat deposition. There are many studies now looking for medication which can not only stop the progression of scar tissue but may actually remove scar tissue from the liver. Studies are ongoing at VCU and at the liver Institute of Saint Mary's.

When we evaluate patient with fatty liver and find significant scarring and inflammation we often refer to these 2 institutions for inclusion in these studies. Certainly the treatment of fatty liver disease caused by alcohol ingestion is to stop all alcohol consumption. Our goal is not only to diagnose these patients but also help them find ways to stop drinking.

Understanding Hepatitis C

With regards to hepatitis C. There are approximately 4 million people in the United States with this disease. Certainly we know that intravenous drug use and the sharing of needles is a main cause of infection. Also tattoos where the needle used were not properly sterilized can cause hepatitis C. Transfusion was also a significant cause of hepatitis C in the past but current testing of the blood supply means that the blood is safe from such transmission. With regards to sexual transmission of hepatitis C we think approximately 10% of partners of people infected with hepatitis C will become infected without taking proper precautions such is using condoms. Finally there does not appear to be a serious concern for transmission of the hepatitis C virus from a mother to a newborn child.

Treating Hepatitis C

Approximately 70% of people with hepatitis C will carry the virus for many years. Only 30% of people clear the virus without medication. The good news for patients with hepatitis C is we now have many choices of treatment which are each approximately 95% effective in curing the disease by taking pills for an average of 8-12 weeks. The medications are remarkably well tolerated and effective.

At Richmond Gastroenterology Associates we are happy to provide care for all of those with liver issues.

How To Prepare For Your Colonoscopy

Tue, 02 Aug 2022 07:30:12 GMT

At Richmond Gastroenterology Associates, we specialize in colonoscopy screenings. We created this video to help you prepare for any upcoming colonoscopy appointments. If you have any additional questions, please contact us.

Festival of Punjabi Mela

Tue, 02 Aug 2022 07:17:14 GMT

We are a proud sponsor of the Festival of Punjabi. We invite you to the historic Main Street Station on April 13th to celebrate the vibrant North Indian culture and delicious food. This will be a fun filled day where you can enjoy the delicious Indian food catered by stellar local restaurants and enjoy the exhilarating Bhangra dance competition.

The proceeds from this festival will support the schools of Greater Richmond Area. Keep an eye out for some of our associates in the Bhangra Competition.

GERD Complications: What Is Barrett’s Esophagus?

Tue, 02 Aug 2022 07:11:52 GMT

More than one-third of adults experience gastroesophageal reflux disease , or GERD, at some point during their lives. GERD occurs when the ring of muscle at the end of your food tube, or esophagus, doesn’t work properly and allows stomach acid to flow back into your esophagus to cause irritation. Left untreated, GERD can lead to complications such as Barrett’s esophagus.

Understanding Barrett’s Esophagus

Barrett’s esophagus occurs when the cells lining your esophagus change to resemble those lining your intestine. Research has yet to reveal the exact cause of these changes, but evidence suggests that they may be your body’s way of trying to protect your esophagus from acid exposure. Unfortunately, the presence of Barrett's esophagus is associated with a 30-fold increase in risk of developing esophageal cancer over the general population. Barrett's esophagus is found in about 10% of patients who suffer from chronic GERD.

Risk Factors for Barrett’s Esophagus

Risk factors for development of Barrett's esophagus include age over 50, male sex, Caucasian race, chronic reflux and obesity.

Symptoms of Barrett’s Esophagus

By itself, Barrett’s esophagus causes no symptoms. If present, symptoms are related to underlying reflux and may include heartburn, regurgitation, chest pain, trouble swallowing, chronic cough and hoarseness.

Diagnosing Barrett’s Esophagus

If you have persistent GERD symptoms, you’ll need to schedule an EGD or upper endoscopy. An upper endoscopy involves passing an endoscope — a lighted tube with a camera at the tip — down your throat to check for changes to your esophagus. Normal esophageal tissue is pale and uniform in color. In patients with Barrett’s esophagus, the tissue is a salmon pink color instead.

If the endoscopy reveals evidence of Barrett’s esophagus, your physician will take a biopsy. A biopsy involves removing a small sample of the abnormal tissue for closer inspection under a microscope. The results of this test will help determine the best treatment for your condition and better define your risk for developing cancer of the esophagus.

Treating Barrett’s Esophagus

Treatment for Barrett’s esophagus depends on whether dysplasia is present and to what degree. Dysplasia is a change in the cells that signifies a progression towards cancer. If you have no dysplasia, your physician may recommend antacid medication and lifestyle changes to treat your GERD symptoms. You’ll also require a repeat upper endoscopy and biopsy in one year and then again every three years if no dysplasia occurs. If you have low to high-grade dysplasia, your physician may recommend antacid medications in addition to ablation procedures to remove the abnormal tissue. You will also require more frequent upper endoscopy procedures to monitor the Barrett's esophagus.

The best course of action is working with your doctor to control the symptoms upfront. Contact us if you would like to make an appointment to talk about your GERD and Barrett's esophagus concerns.

Colonoscopy Prep Tips to Ensure a Successful Procedure

Tue, 02 Aug 2022 07:08:05 GMT

The American College of Gastroenterology recommends a colonoscopy screening every 10 years beginning at age 50 to aid in the early detection of colon and rectal cancers. Before the colonoscopy, you will be directed to follow a clear liquid diet and take a preparation medication to cleanse your colon. Let me explain why this is necessary for a successful colonoscopy. I will also offer some tips to make the experience easier.

Why Do I Need To “Prep” For A Colonoscopy?

Before your colonoscopy, you must follow the preparation or “prep” instructions to ensure your colon is completely cleansed. This allows your gastroenterologist to properly view your colon. In a poorly prepped colon, the views of the mucosa can be severely compromised. This means lesions, polyps, or masses may be missed. It also means you may need to repeat the colonoscopy, which is very frustrating. I like to tell my patients that performing a colonoscopy with poor preparation is comparable to driving a car in a snowstorm.

The Clear Liquid Diet

You will follow a clear liquid diet the day prior to your colonoscopy beginning at breakfast. Your physician will provide you with a list of clear liquids. You can also eat ice chips if you want something with crunch. Liquids and Jell-O that contain red or purple dyes should be avoided, as these colors can make colonoscopy results difficult to interpret.

You should continue to consume clear liquids up until 4 hours prior to your colonoscopy.

The Medication

You will take the prescribed “prep” or laxative medication, which causes diarrhea… so your colon can be cleansed. There are many types of medication. Your physician will choose the best “prep” medication for you based on your preferences, prior experience, and cost. You will also be told exactly how and when to take this medication. (Timing of the medication depends on many factors, including the time of your colonoscopy.)

Let me offer some helpful tips to help you in this stage of the process:

Chill the “prep” medicine or solution ahead of time to make it more palatable. (Most “prep” medication is in liquid form.)
Plan to be at home and near the bathroom once you begin drinking the solution.
Drink the medicine through a straw to keep the bulk of the liquid from reaching your taste buds.
If the solution is unflavored, add sugar-free Crystal Light or lemon juice to the solution to improve the taste.
Use flushable wet wipes instead of toilet paper to reduce irritation.
Drink plenty of clear liquids to prevent dehydration. (Be sure to follow instructions for when to stop drinking clear liquids.)
Special note: If you have experienced nausea in the past from the “prep” medication, ask if you can be prescribed nausea medication to take in advance.

Remember, you need to have a responsible adult drive you to and take you home with this procedure. Please do not use taxis or other car services (Uber or Lyft) for your transportation. Someone must be at the facility with you while you have the procedure.

To learn more about what to expect during your colonoscopy, check out this blog post from Dr. Flynn.

Contact Richmond Gastroenterology Associates today to to help protect your health.

Preventing Colon Cancer With A Colonoscopy: Is It Possible?

Tue, 02 Aug 2022 07:04:20 GMT

As the second leading cause of cancer death among men and women in the U.S., colon cancer is something gastroenterologists commonly see. It is estimated that 1 in 20 people will be diagnosed with this cancer in their lifetime. While colon cancer can strike at any age, 90% of these cancers are found in people who are 50 and older.

The good news is that colon cancer is often preventable with the help of your doctor and regular screenings.

*** Prevention is better than cure ***

There are many screening tests to detect colon cancer (once cancer is already present), but the ONLY TEST that can PREVENT COLON CANCER is a COLONOSCOPY.

How Does Colon Cancer Form?

Colon cancer arises from pre-cancerous growths or polyps in the colon. Identifying and removing polyps early eliminates the chance that colon cancer will develop from those polyps.

Finding Polyps With A Colonoscopy

Polyps are discovered by your gastroenterologist with a screening test called a colonoscopy. Not only can a doctor see the polyps during this screening colonoscopy, but they can often be removed at the same time.

Don’t Put Off This Important Screening Test

It is recommend that patients at average risk have their first screening colonoscopy at age 50, and, if everything comes back normal during that first screening, every 10 years after that. Those with colon cancer risk factors, like family history or other gastrointestinal disorders, should speak with their doctor to determine the best time to have the procedure and any subsequent colonoscopies in the future.

As doctors, we often see push-back from patients about getting their first colonoscopy due to the colonoscopy prep that must be done before the screening. The colonoscopy itself is painless and over relatively quickly, but some find the prep to be challenging or annoying. The important thing to remember is that this prep and screening test may save your life!

Colonoscopy Prevents Colon Cancer, Research Says

The American Cancer Society reports that in the last 10 years the rate at which colon cancer is diagnosed in the U.S. has dropped by 30% for those ages 50 and older. Researchers believe this big decrease is due to more people being screened. Our efforts at prevention as well as early diagnosis of colon cancer are paying off with saved lives.

At the end of the day, it’s vital to understand that colon cancer is treatable, beatable, and preventable, but it starts with a colonoscopy.

Want to learn more about how you can prevent colon cancer for yourself or a loved one? Contact us today to learn more about a colonoscopy.

IBS: Understanding triggers & treatment

Tue, 02 Aug 2022 06:59:42 GMT

Labels and abbreviations are commonplace in our techno-centric society. Think of texting: LOL, BFF, etc. In medicine we are just as guilty of using abbreviations and shorthand to describe diagnoses or conditions. In the field of GI one common example is IBS.

IBS is an acronym for Irritable Bowel Syndrome. IBS is a common disorder involving the intestines that leads to crampy abdominal pain, gassiness, bloating and changes in bowel habits. Some people with IBS have constipation (difficulty passing or infrequent bowel movements) while others have diarrhea (frequent loose stools, often with an urgent need to pass their bowels) and some people experience both.

Although IBS is common it is often difficult to make a definitive diagnosis since the diagnosis is made by excluding other conditions such as Crohn's disease, celiac disease, Ulcerative colitis or even malignancies of the GI tract. Often times patients will undergo testing including lab testing, stool testing, x-rays or other radiologic studies as well as a colonoscopy.

While there are no known causes for IBS, there are definitely triggers for these symptoms to flare up. Emotional stress can lead to increased pain sensation and diarrhea via increased gut hormones such as serotonin. This is the so-called “Brain-Gut” Axis. Imagine situations such as making a public speech, travelling or taking an exam where patients with IBS may have the urge to have diarrhea or difficulty with having a bowel movement.

Meal time can often be an inconvenient trigger for IBS symptoms. The colon is normally stimulated about 30-60 minutes after a meal, but in IBS patients this can be much more sudden and urgent with anxiousness about having an accident, or can be greatly delayed leading to bloating and cramping. Researchers have found that the colon muscle of a person with IBS contracts and can go into spasm after only mild stimulation. This is one reason why medications that are anti-spasmodics have been used for many years for this condition during flare ups. It is also why this disorder was once referred to as “spastic colitis.”

IBS treatments include dietary modifications with trigger avoidance, probiotics and some antibiotics, as well as psychological treatments that target the brain-gut connection.

Dietary changes: Avoiding high fat foods, keeping a food journal to target triggers, smaller portions and diets higher in fiber. Insoluble fiber such as psylium can draw water into the stool and promote colonic motility. Think of whole-grain breads, cereals and beans as good sources of fiber. (Caution: too much fiber can create more gas and bloating symptoms).
Probiotics and some antibiotics: This speaks to one of the theories of IBS being a “post infectious” syndrome. Some studies suggest IBS symptoms begin in certain patients after enduring an infectious diarrhea or dysentery that leaves their gut nervous system increasingly sensitive.
Psychological treatments such as stress management, meditation, and in some cases anti-depressant medications can help lessen the symptoms of IBS.

While IBS is not a life threatening condition, it can significantly impact a patient's life and sense of well- being, and therefore is an ongoing area of research.

Congratulations to RGA’s Best Bedside Award Winners

Tue, 02 Aug 2022 06:58:00 GMT

Congratulations to Dr. Flynn and Dr. Sandhu for being recognized on their Bedside manner from Our Health Magazine

To see all of the winners in this area, click here .

We are pleased to be a Platinum Sponsor!

Tue, 02 Aug 2022 06:55:50 GMT

By Dr. Ray Keate

Richmond Gastroenterology Associates (RGA) and the RGA Hanover office are happy to become a Platinum sponsor of the 17th Annual Mechanicsville Rotary Club Casino Night to benefit Hanover Safe Place.

Hanover Safe Place has a vision that freedom from domestic violence and sexual assault is a reality for every resident of Hanover County, Virginia. It provides many services to county residents including a 24 hour hot line, emergency shelter, and safety planning and court advocacy. In addition to these and other services for victims, Hanover Safe Place promotes community awareness of these issues.

There is an association between stress and gastrointestinal symptoms. A simple example to use is the development of nausea or the urge to use the rest room prior to public speaking. There is a direct link between severe GI symptoms, including irritable bowel syndrome (IBS) and its related condition functional dyspepsia, and a history of physical and sexual abuse. In patients with IBS, gastroenterologists are often the first physician to find a link between psychosocial risk factors and their disease. In a study by Drossman ₁ at UNC about half of the women who are seen by gastroenterologists for IBS symptoms have been victims of either physical or sexual abuse as a child or as an adult. The abuse may have happened many years previously. Only a third of these patients have ever spoken about this to anyone and only one eighth of the total had ever spoken of it to a physician –prior to seeing their gastroenterologists.

We commonly ask about abuse history in our patients with IBS. Our professional involvement in this area has included directing referrals to Hanover Safe Place, engaging the services of forensic nursing personnel at local hospitals for evidence collection and working with local law enforcement and the Commonwealth Attorney’s Office. It is for these reasons that RGA has taken a very active role in this event and in Hanover Safe Place.

RGA has a team of physicians and advanced practice professionals who are committed to individual attention to patients with disorders and symptoms of the digestive tract. Gastroenterologists are the best qualified physicians to detect colon cancers and remove precancerous colon polyps. Removal of colon polyps at colonoscopy is the most effective way to prevent colon cancer. RGA has offices throughout greater Richmond. The Hanover Office is currently located in Medical Building III on the campus of Bon Secours Memorial Regional Medical Center.

¹ Drossman,DA, Leseman J, Nachman, G, et. Al. Sexual and Physical Abuse in Women with Functional or Organic Gastrointestinal Disorders. Ann Inten Med 1990; 113:828-33.

Hanover Office

8262 Atlee Road, Suite 202

Mechanicsville, VA 23116

(804) 559-6194

RichmondGastro.com

Your First Colonoscopy: What to Expect

Tue, 02 Aug 2022 06:52:45 GMT

While alternatives are available, colonoscopy remains the best way to prevent colon cancer. The goal of screening colonoscopy is to detect and remove colon polyps as certain polyps (adenomas) have the ability to turn cancerous. Since the majority of colon cancers are found in people who are 50 and older, your first colonoscopy should happen at age 50. Some people may need a colonoscopy sooner .

Many patients say the uncertainty of a colonoscopy is the worst part but there is really nothing to fear. Medical advancements have provided better equipment, sedation, and preps, improving the quality of the entire process. Let’s go through the process so you can understand what’s involved. I hope this alleviates your concerns and answers your questions.

Before the Colonoscopy

Our staff will give you written instructions and a prescription for your bowel preparation when you schedule your colonoscopy. Make sure you review the instructions well in advance so you are prepared to start the bowel preparation process the day before your procedure. When scheduling your colonoscopy, make sure that you have an updated and complete list of medications so that these may be reviewed in detail. You will be given specific instructions about taking your medication during the entire colonoscopy process.

Plan to be off from work the day of the colonoscopy. You will need a driver whom you know personally. This driver will need to stay for the duration of the colonoscopy. You will not be allowed to take a cab.

The day before your colonoscopy, you can go to work as usual if you work regular business hours. One interruption in your daily life is that you are instructed not to eat solid foods. You will need to stay on a clear liquid diet all day. This diet includes water, black coffee, Gatorade, Jell-O, clear broth, and juice. Stay away from orange juice and any Jell-O or Gatorade that is red or orange, because the dye can affect visibility during the procedure.

Follow the instructions provided by your doctor regarding the bowel preparation. The purpose of this stage is to completely clean out your colon of all waste. In most cases, this is usually at the end of the normal work day. You should be at home so you can be close to your bathroom. Remember to drink plenty of clear liquids, including water, to help avoid dehydration and improve your prep quality. A good prep is key to having a good examination. Poorly done preps may result in missed polyps or having to repeat the procedure sooner than would otherwise have been necessary.

The Day of the Colonoscopy

You should continue to consume clear liquids only up until 4 hours prior to your colonoscopy. It’s important that your stomach is empty during the procedure. If you take medication, be sure to follow the instructions our staff provided.

Wear comfortable clothes so that getting dressed afterwards is easy. It is fine to wear your contact lenses if you prefer. Leave your valuables at home (or with your driver during the procedure).

Bring your insurance card, photo ID, specialist co-payment and a list of the medication(s) you take. After you’ve completed paperwork, you’ll go into the exam room and put on a hospital gown. The doctor will speak with you and also review your medical history. You will receive sedation through an IV. The old method of sedation caused a twilight sleep that left patients feeling groggy for the rest of the day. Today’s sedation is quicker acting, and also has a quicker recovery period. The procedure usually takes 10-15 minutes. Since you are asleep, you will not feel any discomfort. You’ll wake up after about 30 minutes and you will get dressed.

Directly After the Colonoscopy

You will receive a report on your colonoscopy findings before you leave the procedure center. If polyps are found, they are removed and sent for testing. You will be notified regarding these results within 5-7 days. Recommendations regarding timing of your next colonoscopy are based on the number, size, and type of polyps removed, as well as your family history.

Your driver will then take you home to rest. You should not drive or work for the rest of the day. It is also recommended that you avoid making any important decisions until the next day.

Many people are concerned that they will experience pain or discomfort after a colonoscopy. You shouldn’t experience any pain, but there might be some gas and/or bloating because air/carbon dioxide is pumped into the colon during the procedure to optimize visualization. Remember that your colon is now empty and it may take 1-3 days to begin having bowel movements again. This is normal.

If you have additional concerns, our staff is available to answer your questions.

If you haven’t scheduled your colonoscopy yet, contact us today .

Under Age 50? Take Steps Now to Prevent Colon Cancer

Tue, 02 Aug 2022 06:50:56 GMT

Colorectal cancer is the second leading cause of cancer death among men and women in the United States. The majority of colon cancer can be prevented with proper screening, early detection and removal of polyps. Screening, specifically via colonoscopy, helps prevent cancer by finding pre-cancerous polyps so they can be removed before they turn into cancer.

Fortunately, there is evidence from national cancer registry data bases that show a significant decline in colon cancer rates in adults age 50 and over. Specifically, the American Cancer Society released data in 2014 showing that colon cancer incidence rates have dropped 30% in the U.S. among adults 50 years and older over the past three decades. The major reason for the decreased incidence is due to an increase in screening efforts.

While we know we are making progress in decreasing the incidence of colorectal cancer in adults over age fifty, unfortunately this is not the case for younger adults. The incidence of colorectal cancer in people under the age of 50 has been steadily increasing at a rate of 2.1% per year from 1992-2012. Researchers are trying to understand why this is happening, and there are likely both behavioral and environmental factors contributing to this trend.

It is important to be informed at any age about colon cancer. If you are under 50, here’s some helpful information about colon cancer prevention.

Age to Begin Colon Cancer Screening

Most people are recommended to begin screening for colon cancer at age 50. However, some people may need to be screened sooner:

African Americans should begin screening at age 45.
If you have a family history of polyps or colon cancer, you may need to be screened prior to age 50.
If you have a history of certain conditions, such as Inflammatory Bowel Disease (Crohn’s Disease or Ulcerative Colitis), you may need to be screened sooner.

“When to begin screening” is an important discussion to have with your physician. Be sure to share your family history and personal medical history during this discussion.

Be Aware of Colon Cancer Symptoms

The majority of patients with colon cancer, especially those under age fifty, develop new symptoms. However, some patients are busy or think new symptoms aren’t significant and don’t initially discuss these symptoms with their physician. It is important to pay close attention to your body, and confer you’re your physician if you develop gastrointestinal or abdominal symptoms. Some explains of these symptoms include:

A change in your bowel habits, including new diarrhea or constipation, or a change in the consistency or caliber of your stool
Rectal bleeding or blood in your stool
Abdominal discomfort, such as cramps, gas, pain, or feeling bloated
A feeling that your bowel doesn’t empty completely
Weakness or fatigue
Unexplained weight loss

Steps to Lower Your Colon Cancer Risk

No matter how old you are, you can focus on lowering your risk for colon cancer by following these guidelines:

If you are a smoker: quit smoking.
Get at least 30 minutes of physical activity 4-5 times a week.
Eat a healthy diet rich in fruits and vegetables. Limit consumption of red and processed meats.
If you are overweight, try to lose weight.
Limit alcohol consumption.
Consider low dose aspirin therapy (81 mg) after consulting with your physician.

Contact us today if you would like to discuss your colon cancer risk with a physician.

A Resolution for the New Year

Tue, 02 Aug 2022 06:49:12 GMT

Happy New Year! Did you make any New Year’s resolutions for 2019? As a gastroenterologist, I can’t help but notice that most people do not resolve to improve their digestive health. Good digestive health is key to your overall good health. I challenge you to start off 2019 with this simple dietary resolution: eat more fiber! There are many benefits of a high fiber diet, including weight loss.

Benefits of a high fiber diet

Experts estimate that most Americans get only about half of the fiber they need. However, there are very important reasons why they should strive to get more fiber in their diet:

Fiber helps maintain normal bowel movements and relieves constipation.
Fiber may lower your risk for heart disease by lowering cholesterol.
Fiber helps control blood sugar levels.
Fiber aids in weight loss.

We are still not sure if a high fiber diet can reduce your risk of colon cancer. The research is mixed. A recent study failed to reveal a reduction in colon cancer. However, previous smaller studies concluded otherwise. We are watching the research closely.

A word of caution here. For certain people, a high fiber diet is not recommended. If you have any health conditions or diseases, please talk with your doctor before making changes to your diet.

How fiber helps with weight loss

People who eat more fiber seem to have better success with losing weight and maintaining a healthy weight. I encourage patients who want to lose weight to add fiber and also reduce calories. Generally, foods that are good sources of fiber are lower in fat and calories.

A high fiber diet helps people to feel full without the extra calories. When the stomach feels full, receptors are stimulated that tell the brain to stop eating.

Sources of fiber

Fiber is a carbohydrate that can’t be digested. Fiber comes from plants. There are two types: soluble and insoluble. Soluble fiber dissolves in water and helps control cholesterol and glucose levels. Insoluble fiber promotes movement of material through the digestive system. We need both types.

There are many good sources of fiber. Here are a few ideas:

Vegetables: Green peas, broccoli, corn, carrots, potatoes

Fruits: Pears, apples, oranges, berries

Legumes: Kidney beans, black beans, lima beans

Nuts: Almonds, peanuts, pistachios (keep in mind that nuts are calorie-dense, so eat in small quantities)

Whole grains: Oatmeal and oat bran, wheat bran, whole wheat flour, brown rice

A quick internet search will provide many additional food choices and ideas. For starters, see this Mayo Clinic link.

Tips for beginning a high fiber diet

Aim for about 30 grams of fiber a day. The exact requirement depends on your age as well as gender. Men under age 50 need about 38 grams of fiber a day; those over 50 need 30 grams. Women under age 50 need about 25 grams of fiber a day; those over 50 need 21 grams.

Here are some suggestions to get you started:

Gradually add fiber: Some people experience gas and bloating when they begin a high fiber diet. The best approach is to gradually add fiber…..take a few weeks to build up to the required amount.
Drink plenty of water.
Aim for 5: Eat at least 5 fruits and vegetables each day.
Substitute: Brown rice for white rice, whole wheat bread for white bread, whole wheat pasta for white pasta, and/or high fiber cereal (with wheat bran or oat bran) for a low fiber cereal.
Supplements if needed: Food sources are the best source. However, if you are unable to get enough fiber through food, there are fiber supplements available. Popular brands include Metamucil and Citrucel. Be aware that some supplements contain sugar. You may want to choose a sugar-free product. You can look for generic brands which usually are less expensive.

T he providers at Richmond Gastroenterology treat all types of digestive conditions. Contact us to schedule an appointment.

Disclaimer: This blog article is intended to be informative and is not medical advice.

6 Tips to Prevent Heartburn and Acid Reflux From Ruining Your Holidays!

Tue, 02 Aug 2022 06:47:18 GMT

The holiday season can be a difficult time for people suffering from chronic heartburn or reflux, also referred to as GERD. If you are concerned about managing your GERD symptoms, some of these tips may be helpful to you. With just a little planning, you can enjoy this upcoming holiday season!

Nibble!

Nibble your way through the holiday party instead of gorging! Don’t fill up your plate (consider using a small plate). Skip second and third servings. Stop eating when you are full.

Avoid triggers!

Trigger foods can vary from person to person. Common triggers include caffeine, chocolate, citrus juices, tomatoes, soft drinks, coffee, alcohol…. plus fatty and spicy foods. Avoid your trigger foods. Limit or avoid gravy, mashed potatoes and butter. Watch out for stuffing and casseroles that contain onions. You can enjoy the turkey, ham, sweet potatoes and most vegetables. Desserts are a big part of the holiday season. It can be hard to skip desserts, so try lighter desserts, small pieces and minimize chocolate sweets.

Savor!

Slow down and savor the food. You are more likely to get heartburn it you eat too quickly. Take time to enjoy the conversations around the dinner table!

Sip!

Water might be your best choice of beverage with your meal. Alcohol, soft drinks and caffeine are triggers for many people. If you must drink alcohol, limit it to one and avoid refills. The more you drink, the more likely you are to experience heartburn.

Move!

Don’t nap or recline in your favorite chair after the meal. Help clean up or go for a walk! Stay upright and don’t go to bed for at least 3-4 hours.

Plan ahead!

If you take prescription GERD medication, be sure to pack it if you are traveling. Keep antacids handy. Talk to your doctor ahead of time about medications you can take as needed.

Happy Holidays. We hope you have a “heartburn” free season!

The providers at Richmond Gastroenterology Associates diagnose and treat GERD. Contact us to schedule an appointment.

Disclaimer: This blog article is intended to be informative and is not medical advice.

Abdominal Pain: Possible Causes

Tue, 02 Aug 2022 06:42:35 GMT

WHY DOES MY BELLY HURT?

Abdominal pain is a very common complaint in a gastrointestinal (GI) office. Many causes of pain are minor and self-limited, like occasional abdominal cramping after eating or from a viral illness. However, for abdominal pain that progressively worsens over the course of a day or more, or for pain that is recurrent, you should seek medical attention to determine the cause. To help us narrow down possible causes, you will be asked to characterize the pain – location, duration, severity, factors that make it worse or better, and associated symptoms. Below are common GI causes of pain for particular locations of the abdomen. This is not an inclusive list.

UPPER ABDOMEN:

Right upper quadrant (RUQ):

Gallbladder disorders: This includes gallbladder inflammation, gallstones, and a dysfunctional gallbladder. Gallbladder pain can be intense and radiate to the right shoulder, chest, back and mid-upper abdomen. It usually occurs after eating, particularly foods that are fatty. The pain can last several hours before it subsides, but often will recur after other meals. Sometimes the pain occurs at night and is not necessarily related to meals. Associated symptoms may include fever, nausea, vomiting and jaundice.
Liver disorders: Acute hepatitis is a condition that can cause the liver to become inflamed and swollen. This causes stretching of the outer lining, or capsule, resulting in pain. This can occur from viral illnesses like Hepatitis A or Mono, from drinking alcohol, or from taking certain drugs or medications. Usually the pain is accompanied by fatigue, nausea, vomiting, and loss of appetite. Other symptoms may include jaundice and dark urine.

Epigastrium (mid upper abdomen):

Gastritis: This means inflammation of the lining of the stomach. This can occur for many reasons, including acid, alcohol, NSAIDs (Aleve, Advil, Goody’s, BC powders), and infection. Associated symptoms may include heartburn, nausea, and aching or burning pain.
Peptic ulcer disease: Ulcers form in the stomach, sometimes as the result of medications or bacteria called H. pylori. Pain from ulcers is often relieved temporarily by eating.
Gastroparesis: This is a functional disorder of the stomach in which it empties slower than normal. Symptoms include nausea, vomiting, feeling full quickly when eating, and bloating. Common causes of gastroparesis include diabetes, post-infection and post-surgery, but many cases are idiopathic, meaning the cause is not known.
Pancreatitis: This is inflammation of the pancreas, and when acute, presents with rather sudden onset of intense and progressively worsening pain. Symptoms include nausea, vomiting, and fatigue. The pain often radiates into the back. Common causes of pancreatitis include alcohol, gallstones causing obstructions, and high triglycerides. People with recurrent episodes of acute pancreatitis may develop chronic pancreatitis.

Left upper quadrant (LUQ):

Pancreatitis: see above
Spleen disorders: The spleen is not an organ of the GI system, but it is connected to the liver through blood vessels. If there is a disorder of the liver, like cirrhosis, the spleen may become enlarged and painful.

LOWER ABDOMEN:

Right lower quadrant (RLQ):

Appendicitis: This is inflammation and swelling of the appendix, a small structure attached to the beginning of the colon. Pain tends to start around the belly button and then migrate into the RLQ. It usually does not come and go, but rather progressively worsens, and may be accompanied by nausea, vomiting and fever.
Colitis: This refers to inflammation of the colon. While this condition can really present as pain anywhere in the abdomen, depending on the location of the problem, the lower abdomen is the more common location. Pain can vary from dull and aching to sharp and stabbing, and it can come and go. Various things cause colitis, such as infections, chronic bowel disease, and ischemia (poor blood flow). Associated symptoms may include diarrhea, rectal bleeding, fever, nausea and vomiting.

Left lower quadrant (LLQ):

Diverticulitis: Diverticula are pockets that form in the muscle wall of the colon. They are a common anatomical defect. If one of these pockets becomes inflamed and/or infected, that is called diverticulitis. The most common location for pain is the LLQ, though diverticula can occur anywhere in the colon. The pain tends to progressively worsen, rather than come and go. Associated symptoms may include fever, nausea and vomiting.
Colitis: see above

It is important to note that not all abdominal pain stems from the GI tract. For example, urinary tract infections, kidney stones, ovarian cysts, and muscle aches can cause abdominal pain as well. If you aren’t sure whether you need to see a gastroenterologist for your pain, ask your primary care physician for guidance, as you may need to see another type of specialist depending on your particular symptoms.

Our New Location in Prince George is Open

Tue, 02 Aug 2022 06:37:15 GMT

As of June 11, we will be seeing patients in our new Prince George location.

The address for this office is:

Tri-Cities at Prince George
4730 Puddle Dock Road, Suite 100
Prince George, VA 23875
Phone number (804) 520 -5223

The office is located inside the Virginia Cancer Institute office.

Prince George office location

Medicare patients: Bring your new card to next appointment

Tue, 02 Aug 2022 06:33:25 GMT

Medicare will issue new cards between April 2018 and April 2019. They are replacing the social security number with a unique Medicare Beneficiary Identifier number (MBI). There is no change to your coverage.

Virginia residents should receive their new cards in the first scheduled mailing taking place April 2018 – June 2018. Please bring the new card when you come to your next appointment.

This change does not impact Medicare replacement plans.

Please contact our Business Office at (804) 330-4901 if you have any questions on this card change.

“Take Steps” Walk to benefit Crohn’s & Colitis Foundation is April 22

Tue, 02 Aug 2022 04:28:27 GMT

Dr. Robert Flynn is a board member for the Richmond chapter of the Crohn’s and Colitis Foundation. Each year, this foundation holds a fundraising walk called “Take Steps.” This year’s event takes place Sunday, April 22. Join Dr. Flynn by walking and/or donating money to support the 1.6 million Americans suffering from inflammatory bowel disease.

Event details for “Take Steps” Walk

April 22, 2018

3:00 p.m. – Registration & Festival Begins

4:00 p.m. – Walk Begins

Innsbrook, Northshore Commons

4951 Lake Brook Drive

Glen Allen, Virginia, 23060

See map here.

About Crohn’s and Colitis Foundation

The mission of this foundation is to cure Crohn’s disease and ulcerative colitis and to improve the quality of life of children and adults affected by these diseases (which are collectively known as inflammatory bowel disease). This foundation sponsors research and offers a wide range of educational programs for patients and healthcare professionals. The Crohn’s and Colitis Foundation also provides support services to help people cope with these chronic intestinal diseases. All of these programs are supported through donors, grants, fundraising efforts and sponsors.

My doctor found polyps during my colonoscopy: what’s next?

Tue, 02 Aug 2022 04:25:03 GMT

A colonoscopy is a valuable tool in the fight against colon cancer. It can detect cancer, as well as growths on the lining of the colon, which are called polyps. Identifying and removing polyps early eliminates the chance that colon cancer will develop from those polyps. Therefore, by doing timely colonoscopies , most cancers in the colon can be prevented.

There are a few points to keep in mind as we discuss polyps:

Polyps are common.
Polyps usually do not cause symptoms.
Not all polyps will become cancer.
Polyps and colon cancer tend to run in families.
Polyps can be removed.

If you’ve taken the important step of getting a colonoscopy and your doctor has found one or more polyps, there are a number of possible scenarios that could play out. So, what’s the next step?

Removing the Polyps

Your gastroenterologist will most likely remove any polyps found during your colonoscopy. The medical term for removing polyps is polypectomy. Next, your doctor will send the removed tissue to a pathologist, who will test the tissue samples for cancer. You should typically get the pathology results within a week to 10 days.

Identifying the Polyps

Pathology results will tell your doctor what kind of polyp was removed during the colonoscopy. There are different kinds of polyps. The most common are hyperplastic and adenomatous polyps. Hyperplastic polyps do not have the potential to become cancerous. However, some adenomatous polyps can turn into cancer if not removed. Patients with adenomatous polyps have an increased chance of developing more polyps.

Weighing the Risk of Colon Cancer

Most polyps found during a colonoscopy are benign. When colon polyps are identified as being pre-cancerous or dysplastic, your doctor will take these criteria into account to determine your risk for cancer:

Type and number of polyps
Size of the polyp(s) – the larger the polyp, the greater the risk of it being cancerous or pre-cancerous
Location of the polyp(s)
Family history – if members of your family have had polyps or colon cancer, you are at an increased risk

In recent years, certain genetic syndromes have been recognized in which polyps and colon cancers occur at a younger age. These syndromes are called Familial Adenomatous Polyposis (FAP) and Hereditary Non Polyposis Colon Cancer (HNPCC). Patients and their first generation family members need to undergo colon cancer screening earlier and more often compared to the general population.

Your Next Step

If your family has high rates of cancer, genetic testing may be recommended. In some cases, you may require surgery to remove the area of the colon where the polyp was found.

Most likely, surgery will not be required. Based on your pathology results and family history, your gastroenterologist will recommend when you should have your next colonoscopy. This time range can vary from one to ten years.

If you have questions or concerns about your colonoscopy results, Please Call Us!

Should African Americans start screening for colon cancer before age 50?

Tue, 02 Aug 2022 04:14:04 GMT

Colon cancer incidence rates have declined steadily over the last decade. However, when you look at the numbers by race, we see that the colon cancer rate for African Americans is higher than the average. Given this increased risk, many people are asking: should African Americans start screening for colon cancer before age 50?

General recommendations for colon cancer screening

The standard recommendation for “average-risk” individuals is to begin colon cancer screening at age 50 . An average-risk individual is someone who:

Has never had colon cancer or colon polyps.
Does not have diseases that increase the risk of colon cancer, such as inflammatory bowel disease (this includes ulcerative colitis and Crohn’s disease).
Does not have a first-degree relative (mother, father, sibling or offspring) who was diagnosed with colon cancer before the age of 65.

How do we know African Americans are at higher risk for colon cancer?

The CDC (Centers for Disease Control and Prevention) has collected information on colorectal cancer across all races and has determined the African American population to be at higher risk compared to other races. These statistics from the CDC study have remained relatively steady:

Among all men, the average incidence of colon cancer was 67 per 100,000. For African American men, it was 72 out of 100,000.
Among all women, the average incidence of colon cancer was 48 per 100,000 people. For African American women, it was 56 per 100,000.

The CDC data separated the incidence among all races (whites, African Americans, Hispanics and Pacific Islanders). Only the rates for African Americans were above the average. Why is there a difference? Some researchers have theorized there may be a genetic component, but the data so far has not been convincing. Unfortunately, there is no genetic test to determine propensity for colon cancer. There may be differences in access to medical care that might also affect the likelihood of screening or early detection.

Colon cancer screening guidelines for African Americans

Given this data, African Americans stand to benefit from a conversation with their doctor about the best age to begin colon cancer screening. Two of the three gastro-intestinal professional societies (the American Gastroenterological Association, the American Society of Gastroenterology, and the American College of Gastroenterology) recommend that normal risk African Americans begin screening at age 45. Richmond Gastroenterology Associates agrees with this recommendation that African Americans begin screening at age 45.

Colon cancer screening options

No one looks forward to a colonoscopy , but it’s the gold standard among screening methods. A colonoscopy allows a gastroenterologist to thoroughly examine the entire colon. It is the only screening test that can prevent colon cancer from developing. Colon cancer arises from pre-cancerous growths or polyps in the colon. Identifying and removing polyps early eliminates the chance that colon cancer will develop from those polyps.

There are other tests available, such as the Cologuard test, stool tests for blood abnormality, and more. None of these tests approach the reliability of a colonoscopy or provide the preventive measure of polyp removal. Also, a colonoscopy will still be required if abnormalities arise from these other tests.

Steps to lower your colon cancer risk

In addition to screening for colon cancer, there are steps you can take to decrease your risk of colon cancer:

If you are a smoker, quit smoking .
Eat a healthy diet rich in fruits and vegetables. Limit consumption of red and processed meats.
Be sure to include calcium and vitamin D in your diet.
Limit alcohol consumption.
If you are overweight, try to lose weight.
Get at least 30 minutes of physical activity 4-5 times a week.
Consider low dose aspirin therapy (81 mg) after consulting with your physician.

Remember this

Most adults should begin screening for colon cancer at age 50. We recommend that African Americans begin screening sooner at age 45 since they are at higher risk for colon cancer and also have the lowest survival rates once diagnosed.

Is it time for you to be screened for colon cancer? Contact Richmond Gastroenterology Associates to schedule a colonoscopy or to learn more about this important test

Colorectal cancer: Colonoscopy is the best screening test

Tue, 02 Aug 2022 04:09:37 GMT

The American Cancer Society projects that 50,630 people will die from colorectal cancer in 2018. Colorectal cancer includes cancers of the colon and the rectum. This cancer is often preventable through regular screenings, with colonoscopy being the best screening test. However, for health or personal reasons, some people cannot have a colonoscopy and will require an alternate screening test.

You should talk with your doctor about when to start screening for colorectal cancer . Most people of average risk should begin screening at age 50. African Americans should begin sooner at age 45 . People with certain health conditions or family history of colon cancer or polyps may also need to be screened sooner.

Why colonoscopy is the best screening test

As a gastroenterologist, I consider colonoscopy the best screening test for several reasons. A colonoscopy is the only screening test that offers a thorough examination of the entire colon. Also, a colonoscopy is the only screening test that can prevent colorectal cancer because it allows the gastroenterologist to immediately remove polyps. Removing polyps early eliminates the chance that colon cancer will develop from those pre-cancerous growths or polyps.

Alternatives to colonoscopy

If a patient cannot have a colonoscopy, then we recommend stool tests which are safe and fairly easy to do from home. Patients need to understand ahead of time that a positive result means the patient will require a colonoscopy to rule out colorectal cancer. Stool tests are not as sensitive which means you may get a false positive result (the stool test is positive, but we do not find any polyps during the colonoscopy).

There are two categories of stool tests: blood and DNA. The basic stool test checks for blood in the stool. The Cologuard test checks the stool DNA, which makes it more sensitive for detecting colon cancer and pre-cancerous polyps than the basic stool test.

Stool testing is not appropriate when a patient is symptomatic. Symptoms such as rectal bleeding or significant changes in bowel habits require a colonoscopy for further evaluation.

We generally recommend stool tests for these patients:

Patients with certain health conditions : Some patients with underlying heart and lung problems may not be a good candidate for anesthesia. If those patients have no clear risk factors for colon cancer, then a noninvasive stool test would likely be the best choice.
Patients who prefer not to have a colonoscopy : Some people cannot take time off from work for the bowel prep and procedure (one day). Others may have a personal objection to the bowel prep or anesthesia and decline to take the test. In this case, any type of screening is better than none, and therefore this would be a reason for a stool test.
Patients over 80: The cut off age for colonoscopy depends on the health of the patient and the patient’s risk for colon cancer. We generally stop routine screening colonoscopies around the age of 80. However, if an 80 year old is generally healthy and has had pre-cancerous colon polyps in the past, then it would be reasonable to proceed with a colonoscopy.

What you need to know about Cologuard

Cologuard (the DNA stool test) is only appropriate for patients who are at average risk for colon cancer. It has not been studied nor is it recommended for patients who have had colon polyps or colon cancer in the past. It is not recommended for patients with symptoms of rectal bleeding or significant changes in bowel habits.

A positive result means the patient will then need a colonoscopy. In our practice, we have found a high rate of false positive tests with Cologuard.

There are financial concerns for some patients who have a Cologuard test followed by a colonoscopy. Insurance often will cover one colon cancer screening test, whether that is the Cologuard or a colonoscopy within a specified time frame. This varies based on carrier policies. If the patient has a positive Cologuard, then the indication for the subsequent colonoscopy is no longer screening and it becomes a diagnostic service. This often impacts how the insurance will pay for the colonoscopy. In other words, a screening colonoscopy may be covered under a wellness portion of your plan; however, a colonoscopy done after a positive Cologuard may not be. We encourage patients to call their insurance providers to confirm coverage.

Is it time for you to be screened for colon cancer? Contact Richmond Gastroenterology Associates to schedule a colonoscopy or to learn more about this important test.

Disclaimer: This blog article is intended to be informative and is not medical advice.

When to get a colonoscopy: Age, family history, & symptoms

Tue, 02 Aug 2022 04:04:16 GMT

Most will agree that a colonoscopy is the gold standard for colon cancer screening. I am pleased with recent studies which reveal that colon cancer incidence rates have dropped 30% in the U.S. in the last 10 years among adults 50 and older due to an increase in colonoscopy screenings. This leads to the question: when should you get a colonoscopy? While most people should begin at age 50, there are exceptions. Let’s take a look at the factors which determine how soon and how often to get a colonoscopy .

When to get your first colonoscopy screening

A person with average risk for colon cancer should begin screening at age 50 and have screenings once every ten years until about age 80. African Americans should start screenings at age 45 . Recommendations for follow up colonoscopies can change, of course, based on the patient’s health, especially if he or she has significant health issues. Assuming each exam comes back with no worrisome results, this process is fairly simple.

When to get a colonoscopy if you are a high risk patient

Some patients are at a higher risk of developing colon cancer and may require a first colonoscopy earlier than age 50 and/or the next colonoscopy at shorter intervals. People at higher risk include:

Someone who has already been screened and polyps have been found – It’s important that these patients have their next colonoscopy in about five years (or sooner), depending on the size and type of polyp(s) found.
Someone with a family history of cancer, especially colon cancer – Screenings for these patients should begin 10 years prior to the youngest diagnosed case of cancer in the family or age 40, whichever is earlier.
Someone with a first degree (mother, father, sibling) family member who had colon polyps or cancer – Screenings for these patients should begin 10 years prior to the youngest diagnosed case of polyps or cancer in the family or age 40, whichever is earlier.
Someone who has IBD – also called Inflammatory Bowel Disease – The most common types of this disease are Crohn’s Disease and Ulcerative Colitis. If the patient has Crohn’s Disease, the first screening should begin 15 years after initial diagnosis of the condition (or age 50 if that comes first) and then repeated every 1-3 years. If the patient has Ulcerative Colitis, the first screening should begin 8 years after initial diagnosis of the condition (or age 50 if that comes first) and then repeated every 1-2 years.
Someone who has been diagnosed with endometrial cancer at a young age or HIV infection (males only) or someone who has had radiation for prostate cancer – Early studies indicate that these groups of patients may carry a higher risk of developing colon cancer. We are watching the research closely.

When symptoms require a colonoscopy

Even if a patient doesn’t fall into the “high risk” category, there are certain symptoms that would require a diagnostic colonoscopy in order to evaluate colon health. Rectal bleeding, severe abdominal pain, diarrhea, changes in bowel movements and bloating are all red flags. These symptoms could be a sign of something else, such as Inflammatory Bowel Disease, but it is important to rule out colon cancer as a potential cause. You should tell your doctor if you are experiencing these symptoms.

Take steps now to reduce your risk of colon cancer

Ultimately, we do not want to wait for colon cancer symptoms to occur. Proper screening increases the chance that we can identify a polyp before it becomes cancerous or identify colon cancer in the early stages when treatment is most effective.

In addition to regular colonoscopies, there are lifestyle changes you can make to reduce your risk of colon cancer:

Eat a diet rich in fruits and vegetables.
Stay active.
Avoid smoking or if you currently smoke, do all you can to quit.
Drink alcoholic beverages in moderation or if possible, abstain.

Is it time for you to be screened for colon cancer? Contact Richmond Gastroenterology to schedule your colonoscopy.

Disclaimer: This blog article is intended to be informative and is not medical advice.

Dr. Michael Manetas featured in Access Now newsletter

Tue, 02 Aug 2022 04:00:31 GMT

Our physicians are members of Access Now , Richmond’s only volunteer network of physicians who offer free specialty care to residents with no health insurance and limited means to pay for care. Access Now (link to website) was created in 2007 at the request of 11 area clinics and public health departments who could care for patients’ primary care needs, but lacked the resources to provide comprehensive complex care. This network has grown to include more than 880 volunteer physicians and staff who provide more than 40 different specialty care services. This network of volunteer physicians is one of the largest in the nation.

Gastroenterology is the single most requested specialty care service. Dr. Michael Manetas , one of the gastroenterologists in our practice, was recently interviewed by Access Now and featured in their newsletter. Here are some excerpts from Dr. Manetas’ conversation:

I view my role as a physician as a calling to serve others; a way to provide assistance in a time of need. Access Now allows me to provide this care to patients in the Greater Richmond community who have limited resources and are more vulnerable to health crisis. Access Now opens doors to patients in need and identifies a potentially large group of patients in our community that have not received any colon cancer screenings. Given the lack of options for this vulnerable population, we provide screening colonoscopy with sedation to these patients at no cost. Any precancerous polyps are also removed during the colonoscopy.

Some of the most common diagnoses for patients seeking outpatient care are gastrointestinal complaints and symptoms. The demand for GI specialty care is high as evidenced by the number of patients seen by local GI providers in the Access Now network. Whether it’s obesity with fatty liver, GERD, Crohn’s disease and ulcerative colitis, IBS with constipation/diarrhea, dysphagia or cirrhosis/chronic liver disease, we are available to help these patients regardless of their ability to pay.

We are thankful for all of the physicians across Richmond who volunteer their time and talents to Access Now!

Does your sweetheart have GERD? Try these “chocolate free” food ideas this Valentine’s Day

Tue, 02 Aug 2022 03:57:47 GMT

Here’s a little Valentine’s Day trivia: Hershey first began production of “Hershey Kisses” in 1907. According to Wikipedia, the candy was named “kisses” because of the smooching noise the chocolate made as it was manufactured! Are you looking for gift ideas for your loved one this Valentine’s Day? If your “sweetheart” suffers from GERD, we encourage you to think twice before giving Hershey Kisses or any other chocolate candy.

GERD, or gastroesophageal reflux disease , occurs when stomach acid flows back into the esophagus. The most common symptoms are heartburn and acid reflux. There are many foods, including chocolate, which can trigger GERD symptoms . Chocolate is considered a trigger food because it can relax the lower esophageal sphincter, which is the band of muscles which generally keeps stomach acid contained within the stomach.

If you can’t give chocolate as a Valentine’s treat, don’t despair! We challenge you to be creative this Valentine’s Day. Here are “fun food” ideas to get you started!

Breakfast

Get up a little earlier and make breakfast for your sweetie! Use a heart shaped cookie cutter to make “Valentine” pancakes or toast for breakfast. Serve with festive fruit kabobs (strawberries on skewers)!

Lunch

Here’s another use for your heart shaped cookie cutter. Make your loved one a “Valentine” sandwich.

Appetizers

Make time before dinner for conversation and appetizers! Serve cheese and crackers with grilled fruit. Cut the cheese into heart shapes, again using that heart shaped cookie cutter. Grilling the fruit releases the natural sugars and makes it less likely to cause heartburn.

Dessert

Giving up chocolate doesn’t mean giving up dessert! Choose one of these tasty sweet treats:

Red and white frozen yogurt parfait: layer vanilla yogurt with strawberries and raspberries. Serve in glass dishes so you can see the colorful layers!
Yogurt dipped strawberries: freeze strawberries for an hour after the first dip and then dip again for a second coating (to ensure they are extra smooth, creamy and without cracks). These are a great tasting and healthier alternative to the standard chocolate covered strawberries.
Angel food cake topped with strawberry or raspberry sorbet (avoid lemon, lime and pineapple flavors).

We wish you a Happy Valentine’s Day! Please share your own food ideas on our Facebook page !

If you are experiencing GERD symptoms, CONTACT US to schedule an appointment.

Disclaimer: This blog article is intended to be informative and is not medical advice.

Dr. Bimaljit Sandhu appointed to Governor Northam’s Transition Policy Council

Tue, 02 Aug 2022 03:53:18 GMT

RGA is proud to share that one of our physicians, Dr. Bimaljit Sandhu , was recently appointed to serve on the Transition Policy Council on Health and Human Services for Governor Ralph Northam.

The Council is focused on providing insights and perspectives to the Governor in a number of areas including:

Access and expansion of health care coverage for the constituents of the Commonwealth of Virginia.
Guidance in relation to Professional Practice and regulations.
Communications regarding Behavioral Health Services.
Review of data and its use in relation to the constituents of the Commonwealth of Virginia.
Public health issues impacting children and other vulnerable populations in our state.

Congratulations to Dr. Sandhu and the rest of the Council for their hard work!

Microscopic Colitis: The Less Common Inflammatory Bowel Disease

Tue, 02 Aug 2022 03:50:20 GMT

Microscopic colitis is an inflammatory condition of the colon that can cause chronic, watery diarrhea. It is less common than the other inflammatory bowel diseases such as Crohn’s disease and ulcerative colitis. Females and middle age adults (45 years and older) are more likely to get microscopic colitis.

Symptoms of microscopic colitis

The most common symptom is diarrhea. You may also experience a strong urge to have a bowel movement (need a bathroom right away), stool incontinence, abdominal pain and/or weight loss.

Diarrhea is defined as stool that has decreased consistency, increased liquidity, and usually occurs more than 3 times per day. Acute diarrhea usually lasts less than 2 weeks even though it may take 3-4 weeks for your bowels to return to normal. Chronic diarrhea lasts longer than 4 weeks

When to see a doctor for diarrhea

You should see your doctor if you are experiencing diarrhea that lasts longer than 2 weeks. There are many different causes for chronic diarrhea including other forms of colitis, irritable bowel syndrome, overflow diarrhea from constipation, medications, malabsorption syndrome, or malignancy. A medical evaluation is needed to determine the exact cause.

Please note that you should see a doctor sooner if the diarrhea is accompanied by rectal bleeding, rectal pain, severe abdominal pain, high fever or signs of dehydration. Always talk with your doctor if you are concerned about your symptoms.

Diagnosis of microscopic colitis

First steps to determine the cause of diarrhea usually include blood tests and stool analysis. If those do not provide any answers and if symptoms persist, a colonoscopy is required to directly visualize the colon and take biopsies. The colon usually appears normal with microscopic colitis. However, the biopsies will reveal if there is any microscopic inflammation present (hence the name microscopic colitis).

Treatment of microscopic colitis

The goal of treatment is to improve your quality of life and get the diarrhea under control. A common medication used is budesonide that helps decrease the inflammation in your colon. Anti-diarrheal medication can also be used to decrease the amount of stools per day.

Your doctor will review the medications you are currently taking. There are some medications associated with microscopic colitis including NSAIDs (nonsteroidal anti-inflammatory drugs), aspirin, antacids and antidepressants.

Living with microscopic colitis

While microscopic colitis is non-progressive, it is a relapsing and remitting disease. This means that you may have periods of time with no symptoms, followed by a recurrence of symptoms. Here are some tips that may help reduce symptoms:

If you smoke, we recommend that you stop smoking. See these tips to help you quit .
Dietary changes: There is no specific diet for microscopic colitis. However, some people find improvement in symptoms if they avoid excess sugar and caffeine, limit dairy and fatty foods and follow a low fiber diet .
Avoid NSAIDs (nonsteroidal anti-inflammatory drugs) and talk with your doctor to determine if any other medications should be discontinued.

If you are experiencing chronic diarrhea, contact Richmond Gastroenterology to schedule an appointment .

Disclaimer: This blog article is intended to be informative and is not medical advice.

C. Diff Infection: A Growing Health Concern

Tue, 02 Aug 2022 03:45:08 GMT

C. diff is a bacteria that can cause mild to severe diarrhea and inflammation of the colon. It is also referred to as Clostridium difficile. We can’t avoid C. diff because it naturally lives everywhere: in the air, water and feces. Many of us may even have this bacteria in our intestines without any symptoms. C. diff infection is a growing health concern in the medical community.

There are many reasons why doctors worry about C. diff:

The frequency of C. diff infection is on the rise.
We are seeing more severe cases of C. diff infection.
C. diff infections are becoming more difficult to treat as C. diff becomes more resistant to drugs.
C. diff is now more likely to re-occur after the initial infection.

Risk factors for C. diff infection

The CDC estimates that just under 500,000 people a year are diagnosed with a C. diff infection. The most common risk factors include:

Antibiotic use: Most people that have C. diff get the infection after taking antibiotics. These categories of antibiotics are more likely to increase your risk: fluoroquinolones, cephalosporins, penicillins, and clindamycin. When you take antibiotics they can destroy good, helpful bacteria which are protective against a buildup of C. diff bacteria.

Older population: People 65 and older have up to a 10X greater risk than younger people.

Hospitalization: People who are in the hospital or were recently hospitalized are at greater risk.

Long-term care: People in nursing homes are at greater risk.

Certain health conditions: This includes people with a weakened immune system or people diagnosed with colorectal cancer or an inflammatory condition such as IBD.

Previous C. diff infection: The recurrence rate of infection can vary greatly but happens in about 30% of cases.

Of concern to doctors in recent years, is an increase in infections in the community outside of hospitals or nursing homes. Many of these C. diff infections involve people considered low risk: younger, healthier people without a history of antibiotic use.

C. diff symptoms

Symptoms can occur 5-10 days after starting a regime of antibiotics. However, onset can vary greatly… symptoms may not occur until up to 10 weeks.

People with a mild case of C. diff infection will experience watery diarrhea about 3 times a day for several days along with mild cramping. In these cases, the infection may clear up on its own.

More severe cases can cause serious symptoms including:

Diarrhea more than 10 times a day (the diarrhea will have a strong smell)
Abdomal cramping and pain
Fever
Dehydration
Elevated heart rate
Loss of appetite
Nausea
Blood or pus in the stool

Treatment for C. diff

You should seek medical attention if you have taken an antibiotic and are experiencing 3 or more watery stools a day for the previous 2 days. Seek immediate attention if the diarrhea is accompanied by a new fever, severe abdominal pain, and/or blood or pus in the stool. If untreated, some cases can lead to very serious complications and potentially death.

Antibiotics are the main course of action against C. diff infection. This may sound strange since the majority of cases are caused by antibiotics. Different types of antibiotics are prescribed. Probiotics are also prescribed to help restore the balance of good bacteria.

In more serious cases, surgery or a fecal transplant may be required.

Reducing your risk of C. diff infection

There are a few steps you can take to reduce your risk of C. diff infection. Thorough handwashing with soap and water is very important. We are finding that this method is better than hand sanitizing lotions which are becoming resistant to C. diff. Handwashing is especially important if you are in a healthcare setting or have visited one.

Before taking antibiotics, always talk with your doctor or your dentist about the necessity of taking an antibiotic. Find out if there are any other treatment options.

And finally, if you are prescribed medicine on an ongoing basis to reduce stomach acid such as proton pump inhibitors, talk with your doctor about the need as well as alternatives. Recent studies show that these drugs may increase your risk for infections because they suppress acid which could help kill C. diff bacteria.

The providers at Richmond Gastroenterology diagnose and treat C. diff infection. Contact us to schedule an appointment.

Disclaimer: This blog article is intended to be informative and is not medical advice.

Capsule Endoscopy: PillCam SB Offers Many Benefits

Tue, 02 Aug 2022 03:34:58 GMT

Capsule Endoscopy is a procedure that allows gastroenterologists to completely visualize the small intestine. The patient swallows a “capsule” that contains a small, wireless camera that captures images as it passes through the small intestine. The capsule we use is called PillCam SB.

Capsule Endoscopy offers many benefits for patients and doctors. It is non-invasive and allows the patient to carry on with normal activities during the procedure. Doctors consider PillCam SB a great innovation because it picks up abnormalities previously missed by CT and other X-ray studies. Traditional methods of endoscopy (colonoscopy and upper endoscopy) do not easily reach the small intestine.

What is the small intestine?

The small intestine is located between the stomach and the large intestine. It measures about 20 feet long and is also referred to as the small bowel. This is where most of the food you eat is digested and absorbed. A properly functioning small intestine is essential for good health.

When is Capsule Endoscopy recommended?

Capsule Endoscopy is valuable in diagnosing a wide range of gastrointestinal issues including:

Identifying cause of unexplained bleeding of the small intestine (including iron deficiency)
Detecting tumor(s) of the small intestine
Diagnosing Crohn’s disease
Detecting damage from NSAID use (nonsteroidal anti-inflammatory drugs)
Identifying cause of unexplained abdominal pain
Diagnosing involvement of the small intestine by Familial Polyposis

What are the patient benefits of Capsule Endoscopy?

Patients can avoid invasive exploratory surgery and sedation. There is no pain and recovery is immediate. Patients usually do not need to take a day off from work.

Is Capsule Endoscopy Safe?

Capsule Endoscopy is safe for the vast majority of people. To date, over 1.5 million patients have had the PillCam SB procedure. In very rare cases, the capsule can get trapped in the small intestine from a previously undiagnosed stricture.

Gastroenterologists may NOT recommend Capsule Endoscopy for patients experiencing:

Dementia or confusion
Delayed emptying of stomach or gastroparesis
Bowel obstruction
Multiple operations of the abdomen
Esophageal strictures

What can patients expect?

Our staff will fully explain diet, medication and supplement instructions to follow prior to the procedure. See full instructions here .

The morning of the procedure, you should wear a shirt from natural fibers such as cotton. After arrival, you will swallow the PillCam SB capsule with water. This capsule is about the size of a large vitamin pill and is easy to swallow. You will be fitted with a sensor belt and a data recorder. You can then leave our office and resume your normal daily activities. (You should avoid strenuous activities and/or exercise.) You can drink two hours after swallowing the pill and eat a light lunch four hours after swallowing the pill.

The procedure takes 8 hours. You will be asked to return the sensor belt and recorder to our office at the end of the day. The images will then be downloaded to a computer and your gastroenterologist will review the pictures.

The capsule will pass normally through your body with a bowel movement (usually 1 – 3 days).

Richmond Gastroenterology offers PillCam technology. Contact us to schedule an appointment.

Disclaimer: This blog article is intended to be informative and is not medical advice.

Don’t Let Heartburn and Acid Reflux Ruin Thanksgiving!

Tue, 02 Aug 2022 03:28:19 GMT

Thanksgiving can be a difficult time for people suffering from chronic heartburn or reflux, also referred to as GERD . If you are concerned about managing your GERD symptoms, some of these tips may be helpful to you. With just a little planning, you can enjoy this upcoming holiday!

Practice moderation

Nibble your way through Thanksgiving instead of gorging! Don’t fill up your plate (consider using a small plate). Skip second and third servings. Stop eating when you are full.

Avoid your trigger foods

Trigger foods can vary from person to person. Common triggers include onions, chocolate, citrus juices, tomatoes, soft drinks, coffee, alcohol….plus fatty and spicy foods.

Avoid your trigger foods. Limit or avoid gravy, mashed potatoes and butter. Watch out for stuffing and casseroles that contain onions. You can enjoy the Thanksgiving turkey, sweet potatoes and most vegetables. It can be hard to skip desserts, so try lighter desserts and avoid chocolate sweets.

Take your time

Slow down and savor the food. You are more likely to get heartburn it you eat too quickly. Take time to enjoy the conversations around the dinner table!

Sip, don’t guzzle

Don’t nap after your big meal

Don’t nap or recline in your favorite chair after the meal. Help clean up or go for a walk! Stay upright and don’t go to bed for at least 3-4 hours.

Don’t forget your medication

Plan ahead. If you take prescription GERD medication, be sure to pack it if you are traveling. Keep antacids handy. Talk to your doctor ahead of time about medications you can take as needed.

Happy Thanksgiving. We hope you have a “heartburn” free day!

The providers at Richmond Gastroenterology Associates diagnose and treat GERD. Contact us to schedule an appointment.

Disclaimer: This blog article is intended to be informative and is not medical advice.

The Great American Smokeout is Thursday, November 16

Tue, 02 Aug 2022 03:23:37 GMT

The American Cancer Society sponsors the “Great American Smokeout” each year to raise awareness about the dangers of smoking. Smoking is widely known to increase risks for heart disease, lung disease, pregnancy complications, and diabetes. Did you know that smoking may also increase your risk for conditions and diseases of the digestive system including colon cancer? If you smoke, quitting is a huge step you can take to improve your overall health. We offer resources below to get you started.

Reasons to quit smoking

Cigarette smoking is responsible for more than 480,000 deaths per year in the United States, including nearly 42,000 deaths resulting from secondhand smoke exposure. On average, smokers die 10 years earlier than non-smokers.

Here are 10 reasons why we encourage our patients who smoke to quit smoking:

Smoking increases the risk of cancers of the mouth, esophagus, stomach, and pancreas. (For certain cancers, especially esophageal cancer, smoking along with alcohol use increases the risk even more.)
Research suggests that smoking may increase the risk of cancers of the liver, colon, and rectum.
Smoking increases the risk of developing colon polyps.
Smoking increases the risk of heartburn and gastroesophageal reflux disease (GERD). Nicotine, a key part of tobacco, is thought to relax the ring of muscle in the lower esophagus that keeps acid in the stomach, where it belongs. When that ring relaxes, acid can trickle up and cause a burning sensation.
Smoking increases the risk of peptic ulcers.
Smoking may worsen some liver diseases, including primary biliary cirrhosis and nonalcoholic fatty liver disease (NAFLD).
Smoking increases the risk of developing Crohn’s disease.
Smoking increases the risk of developing pancreatitis.
Some studies suggest that smoking may increase the risk of developing gallstones.
Smoking also depresses appetite, so you may not be getting all the nutrients your body needs to function properly.

Resources to help you quit

It is not easy to quit smoking. We encourage our patients to seek help. Here are a few ideas.

The American Cancer Society has a variety of tools and resources to help, including online and in-person support. Getting help through counseling or medications can double or triple the chances of quitting smoking for good. Click here to learn more .

Quit Now Virginia is a toll-free tobacco cessation phone counseling service that is provided to Virginia residents aged 13 and older 24 hours a day, seven days a week. Callers may receive one-on-one cessation counseling, information and self-help materials. Click here to learn more .

If you’re looking to help a loved one or friend quit, the American Cancer Society also has tips to best support them. Click here for ways to help your friends and family quit .

Start today!

Stop smoking and you will begin to see health benefits after one day!

If you are 50 or older, another important step you can take is to be screened for colon cancer. (90% of colon cancers are found in people who are 50 and older.) A Screening Colonoscopy test is one of the best ways to prevent colon cancer.

The providers at Richmond Gastroenterology treat all types of digestive conditions. Contact us to schedule an appointment.

Disclaimer: This blog article is intended to be informative and is not medical advice.

When to see a doctor: Don’t ignore these GI symptoms

Tue, 02 Aug 2022 03:16:59 GMT

Many people postpone seeing a doctor for worrisome or painful digestive symptoms. Our lives are busy and we may not want to take time off from work. Sometimes we are embarrassed because of the nature of the symptoms. However, “putting off” a visit to the doctor may not be wise. Symptoms can be an indicator that something serious is happening. In this article, we offer guidance for deciding when to see a doctor for your GI symptoms.

Here’s our list of ten GI (gastrointestinal) symptoms you should NOT ignore. This list is not complete and should serve only as a guide for when to seek medical attention. It is best to be proactive where your health is concerned. If you are in doubt, its best to talk with your doctor.

Difficulty swallowing

Many people experience the occasional sensation of food getting stuck in the esophagus. If this happens repeatedly, even if it isn’t every day, it needs to be evaluated.

Abdominal pain

Not all abdominal pain indicates that something is terribly wrong. Sometimes the intestines cramp and cause generalized discomfort, typically after eating. However, certain types of abdominal pain can point to a specific problem and should not be ignored. Pain that is persistent, meaning it will not go away, should be evaluated immediately. In particular, pain in the right lower abdomen could be appendicitis. Pain in the left lower abdomen could be diverticulitis. Pain in the upper mid abdomen could be pancreatitis.

Abdominal distention

Not to be confused with bloating, abdominal distention is an enlarged abdominal girth that feels firm and is not variable based on eating. This requires medical attention.

Weight loss without trying

Many people want to lose weight and if lost on purpose, there are no worries. However, weight loss that occurs without trying, without a change in diet or physical activity, and that cannot be explained needs medical attention.

Vomiting blood

Blood in vomit can be bright red, dark red or even look like black coffee grounds. For any amount of blood in vomit, seek prompt medical attention.

Diarrhea

Not all diarrhea is concerning. Viral infections are very common and are generally self-limited, meaning that the infection runs its course within days to 2 weeks. Any diarrhea lasting longer than that should warrant a trip to the doctor. Please note that if diarrhea is accompanied by rectal bleeding, weight loss, and/or severe abdominal pain, you should seek medical attention immediately rather than waiting for it to resolve on its own.

Constipation

The medical definition of constipation is less than three bowel movements per week, or bowel movements that are small, hard, dry and painful or difficult to pass. Often the first recommendation is to increase the amount of fiber in your diet or to take fiber supplements. There are several types of laxatives that can also be tried. However, if constipation persists despite conservative measures, then medical attention is needed.

Black stools

Stool that is black and sticky like tar can indicate bleeding in the stomach or intestines. If black stool cannot be explained by reasons such as taking iron supplements or Pepto-Bismol or eating a lot of greens, then it needs to be checked out by a doctor.

Rectal bleeding

Rectal bleeding may appear as bright red, dark red or maroon in color. Blood may appear only on the toilet paper in small amounts or larger amounts in the toilet water. There are many causes of bleeding and some are serious. For any rectal bleeding, especially bleeding that is recurrent or persistent, seek prompt medical attention.

Jaundice

Jaundice is a condition that causes yellowing of the skin and the whites of the eyes. It is caused by a backup of a waste product called bilirubin into the bloodstream, which then gets deposited throughout the body. Associated symptoms can include itchiness and dark brown urine. Jaundice indicates that the liver is not functioning properly or that there is a blockage somewhere in the liver or bile ducts. Jaundice requires medical attention.

The providers at Richmond Gastroenterology treat all types of digestive conditions. Contact us to schedule an appointment.

Disclaimer: This blog article is intended to be informative and is not medical advice.

Probiotics: Do they work?

Tue, 02 Aug 2022 03:13:17 GMT

Probiotics are live microorganisms that are found in some foods and dietary supplements. They are frequently referred to as “good bacteria” and are the same or similar to microorganisms that already exist in your body. In theory, probiotics can help restore or maintain healthy digestion and also boost immune function. According to the National Institutes of Health (NIH), “Although some probiotics have shown promise in research studies, strong scientific evidence to support specific uses of probiotics for most health conditions is lacking.”

At this point in time, the medical community is optimistic about probiotics and watching the research closely.

Gastrointestinal (GI) Benefits of Probiotics

Probiotics may provide gastrointestinal (GI) benefits for some patients with these conditions:

IBS (Irritable Bowel Syndrome): May alleviate bloating and/or diarrhea.
Acute diarrhea from antibiotic use or infections (including C. diff.): May shorten the duration of symptoms.

There is no conclusive research data to prove the effectiveness of probiotics for IBS or acute diarrhea; however, we find that some patients experience an improvement in certain symptoms. We are unable to predict who will and who will not benefit. Many patients suffering with these difficult symptoms are willing to try probiotics since they usually do not have negative side effects or worsen symptoms. They are in the realm of “unlikely to cause harm and can be of some help.”

Sources of Probiotics

Probiotics can be found in fermented foods including yogurt with live and active cultures, kefir, aged cheese, sauerkraut and kimchi.

Probiotics are also found in supplements. There are many different supplements available. Each supplement contains a different type(s) or strain of bacteria. The type of supplement and dosage will vary depending on the health concern.

You should talk with your doctor before taking probiotic supplements. In rare cases, these supplements are not safe for people with serious health conditions.

Future of Probiotics

There is much we do not understand about the gut microbiome, which includes trillions of bacteria living in our intestines. Promising research suggests that these bacteria may have a strong influence on our overall health. As we learn more, we are hopeful that we can tailor individual therapies in the future to treat diseases such as obesity. It is possible that probiotics may play a role in future targeted therapies but “the jury is still out.”

The physicians at Richmond Gastroenterology treat all types of digestive conditions. Contact us to schedule an appointment.

Disclaimer: This blog article is intended to be informative and is not medical advice.

Diagnosing Celiac Disease: The Challenges

Tue, 02 Aug 2022 03:02:33 GMT

Celiac disease is an autoimmune disease that is triggered by eating gluten. Over 2 million people in the U.S. are living with celiac disease and experts estimate that up to 80% of these people have not been diagnosed. This is alarming because of the long-term health consequences of untreated celiac disease. Symptoms can vary greatly from patient to patient which sometimes makes diagnosis challenging for doctors.

Gluten is a protein found in wheat, rye, barley and some oats. When a person with celiac disease eats gluten, the immune system attacks the lining of the small intestine. Damage to this lining leads to decreased absorption of nutrients necessary for optimum health.

Celiac disease can be difficult to diagnose

There are many reasons why we believe celiac disease is underdiagnosed. Each person may have different symptoms as well as a different number of symptoms. There are over 200 symptoms which may occur anywhere in the body. Not all of these symptoms are related to the digestive tract. To further complicate diagnosis, some people exhibit very mild or even no symptoms (these people are still at risk of developing long-term complications including a small chance of developing intestinal lymphoma and gastrointestinal cancers).

Celiac disease can often be confused with other conditions. For example, many of the symptoms mimic symptoms of IBS, Crohn’s disease or food intolerance.

The age of onset varies greatly. We often see different symptoms in children when compared to adults.

Symptoms of celiac disease in adults

Children are more likely to experience digestive symptoms than adults. Less than one-half of adults will have digestive symptoms that indicate malabsorption: diarrhea, weight loss and pale, foul-smelling stool. Adults are more likely to have mild digestive symptoms and other unrelated symptoms.

As mentioned above, there are over 200 symptoms that adults with celiac disease may experience. Some of the more common symptoms include:

Diarrhea
Weight loss
Pale, foul-smelling, fatty stool
Bloating and abdominal pain
Constipation
Vomiting
GERD or chronic acid reflux
Anemia due to iron deficiency
Vitamin B deficiency
Bone loss (osteoporosis or osteopenia)
Frequent headaches or migraines
Neurological problems including seizures and peripheral neuropathy (numbness and tingling of hands and feet)
Joint pain
Fatigue
Irregular menstruation
Unexplained infertility or more than one miscarriage
Skin rash called dermatitis herpetiformis
Depression and/or anxiety
Liver disorders
Damage to tooth enamel
Canker sores in the mouth

Testing for celiac disease

Talk with your physician if you are concerned that you may have celiac disease. Tell your physician about all symptoms as well as your personal medical history. Also share your family history. If you have a first-degree relative (parent, sibling, child) who has celiac disease, then you will need to be tested because you are at increased risk of also developing the disease.

The only way to know if you have celiac disease is to be tested. DO NOT follow a gluten-free diet prior to testing. You must be eating gluten in order for the testing to be accurate. A blood test is usually the first step. If the blood test suggests celiac disease, then your physician may recommend an endoscopic biopsy of the small intestine to confirm the diagnosis. This endoscopy will be performed by a gastroenterologist.

Treatment for celiac disease

If diagnosed with celiac disease, you must follow a gluten-free diet and also avoid medications, supplements and products that may contain gluten. Your physician will guide you on getting started. A consult with a dietician is usually recommended. You can also search online to learn more. Here are a few helpful links:

Celiac Disease Foundation

Beyond Celiac

Eatright: Academy of Nutrition and Dietetics

The physicians at Richmond Gastroenterology Associates diagnose and treat celiac disease. Contact us to schedule an appointment.

Disclaimer: This blog article is intended to be informative and is not medical advice.

Congratulations to Best Bedside Manner Winners!

Tue, 02 Aug 2022 02:56:00 GMT

Our Health magazine has announced the annual Best Bedside Manner Awards . We are excited to have three winners this year! Congratulations to who won first place and who won Honorable Mention. Congratulations also to who won first place in the Physician Assistant category. They are featured in the December issue of magazine

Should You Eat Gluten-Free: The Truth About Celiac Disease

Tue, 02 Aug 2022 02:55:20 GMT

Dr. Shweta Joshi was featured in the September issue of Richmond Family Magazine . Her article is timely since September is Celiac awareness month.

Gluten-Free Options Everywhere

As you walk down the aisles in a grocery store (and Richmond has plenty of those!), gluten-free signs and labels are everywhere. Many restaurants are offering gluten-free dishes. Your friends tell you they feel great on a gluten-free diet. But will you? Should you be eating gluten-free, too? How about your family?

A gluten-free diet is a diet that does not contain any gluten, a protein found in wheat, rye, barley, and sometimes oats. People who have been diagnosed with celiac disease should be on a gluten-free diet. When someone with celiac disease eats even a small amount of gluten, the immune system attacks the lining of the small intestine. The small intestine is responsible for absorption of food and nutrients. So damaging the lining of the small intestine leads to decreased absorption of nutrients.

Celiac Disease Signs & Diagnosis

Classic symptoms of celiac disease are diarrhea, weight loss, anemia, osteoporosis, and vitamin B and D deficiencies. With milder disease, people can have abdominal pain, bloating, iron deficiency, or osteopenia (or decreased bone density). In children, it can cause slow growth and development. It is associated with other autoimmune disorders including type I diabetes, autoimmune thyroid disease, and certain skin rashes.

Celiac disease affects 1 percent of Americans. One in 133 people have celiac disease, and most are undiagnosed. It is primarily reported in people of European ancestry. However, celiac disease has also been found in people of Northern Africa, the Middle East, India, and Northern China. There is a genetic component. If you have celiac disease, members of your immediate family have a 10 to 15 percent risk of developing the disease. It affects both men and women of all ages.

Celiac disease is diagnosed with a blood test, as well as a small bowel biopsy done during an endoscopy. It is important to get evaluated before avoiding gluten in your diet because that will affect the test results.

Treatment for Celiac Disease

The only treatment currently available for celiac disease is to abstain from eating foods with any amount of gluten. Strict adherence to a gluten-free diet is very important to avoid symptoms as well as long-term complications including lymphoma and gastrointestinal cancers.

Non-celiac gluten sensitivity is when people develop symptoms after the ingestion of gluten-containing products; however, there is no damage to the small intestine evident on blood tests or biopsy. Despite the discomfort that might result, small amounts of gluten can be ingested without the concern for long-term complications that are associated with celiac disease. The prevalence of non-celiac gluten sensitivity is not known, and there are no tests for it. It may be associated with sensitivity to other components in the grains, irritable bowel syndrome, or adverse reaction to fermentable oligosaccharides, disaccharides, monosaccharides and polyols (or FODMAPs). They are non-absorbable or poorly absorbed sugars and carbohydrates that draw water into the intestines as well as cause fermentation with gas production leading to bloating, flatulence, and diarrhea.

If you are concerned about gluten sensitivity or celiac disease, please see a doctor to have testing done for celiac disease, as well as to evaluate for other causes. Starting a gluten free diet before any testing can affect testing and delay diagnosis. Furthermore, eliminating gluten from your diet can be an unnecessary and costly measure if you haven’t been diagnosed with a disorder that requires you to do so. Eating gluten-free does not provide general benefits for people looking to eat in a more healthy and nutritious fashion.

If you would like to schedule an appointment with one of our providers about Celiac disease or gluten sensitivity, please contact us .

Italian Roasted Red Potatoes

Tue, 02 Aug 2022 02:50:30 GMT

We wanted to share some great recipes that are gluten-free as well as lactose-free that showcase fresh ingredients. This week we have a Italian roasted red potatoes recipe.

Peach and Black Bean Salad Recipe

Tue, 02 Aug 2022 02:39:56 GMT

We wanted to share some great recipes that are gluten-free as well as lactose-free that showcase fresh ingredients. This week we have a peach and black bean salad recipe.

Fire & Ice Watermelon Salsa

Tue, 02 Aug 2022 02:34:01 GMT

We wanted to share some great recipes that are gluten-free as well as lactose-free that showcase fresh ingredients. This week we have a fire and ice watermelon salsa recipe.

Chili Roasted Sweet Potatoes

Tue, 02 Aug 2022 02:27:56 GMT

We wanted to share some great recipes that are gluten-free as well as lactose-free that showcase fresh ingredients. This week we have a chili roasted sweet potatoes recipe.

Corn & Avocado Salad Recipe

Tue, 02 Aug 2022 02:25:54 GMT

We wanted to share some great recipes that are gluten-free as well as lactose-free that showcase fresh ingredients. This week we have a corn and avocado salad recipe.

What is a Gluten-Free Diet?

Tue, 02 Aug 2022 02:22:07 GMT

Gluten is a protein found in wheat, rye, barley, and oats. Gluten acts like a “glue” to hold food together. Most people can eat foods with gluten without any problems. However, for some, gluten can cause injury to the cells of the bowel wall (small intestine) which leads to incomplete digestion and malabsorption of nutrients. This also creates symptoms of gas, bloating, abdominal pain and diarrhea.

Who needs a gluten-free diet?

A gluten-free diet is recommended for people diagnosed with Celiac disease and also those who are sensitive to gluten.

Celiac disease is an autoimmune disease that affects about 1 in 100 people worldwide. This disease is also known as celiac sprue and non-tropical sprue. To make a diagnosis, the doctor will order tests which may include a blood test and an endoscopy with a biopsy of the duodenum (small bowel). People with Celiac disease must completely avoid gluten to control symptoms and prevent serious complications.

There are some people who do not have Celiac disease, but find that symptoms improve with a gluten-free diet. These people may have Non-Celiac gluten sensitivity and can tolerate small amounts of gluten and follow a diet that is very low in gluten.

What is a gluten-free diet?

A gluten-free diet means you cannot eat any food containing wheat, rye, barley, and oats. This includes flour, breads, crackers, muffins, baking mixes, pasta, pastries, cereal, processed meats and substitutes, beer, ale, lager, and malt vinegar.

There are many gluten-free food choices! You can eat rice, corn, potatoes, quinoa, millet, buckwheat, soybean and flours made from these. You can also eat gluten-free pastas, fruits, vegetables, meat, and seafood.

If you are just beginning a gluten-free diet, you should seek help from your doctor and if possible, a dietitian who can help you develop a plan to ensure you follow a healthy diet with all of the nutrients you need. A dietitian can also point out hidden gluten in some foods, food additives, medications and vitamins. Eatright.org is a great internet resource.

There are many websites and books with delicious gluten-free recipes! See two of my favorite gluten-free recipes below: Banana Bread Pancakes and Cherry Vanilla Bars !

If you would like to schedule an appointment with one of our providers about Celiac disease or gluten sensitivity, please contact us .

Gastrointestinal (GI) bleeding: When to See a Doctor

Tue, 02 Aug 2022 02:17:48 GMT

What is gastrointestinal bleeding?

Gastrointestinal (GI) bleeding refers to any loss of blood from your gastrointestinal tract. Blood loss may be overt (visible) or occult (undetectable to the naked eye). If visible, bleeding may manifest in several ways. Very commonly, patients may see blood on the toilet paper after wiping or small drops of blood in the toilet bowl. This type of bleeding is usually associated with bright red blood (fresh blood). Bleeding may also be of larger volume and maroon (dark red) or black in color. It may contain blood clots as well. The volume, color, and associated symptoms (abdominal pain, etc) offer clues regarding the cause of bleeding and are important details to relay to your physician.

What are the causes of GI bleeding?

Hemorrhoids (both internal and external) – the most common cause of bleeding, it is typically small volume, bright red, and often associated with defecation.
Anal fissures – also typically small in volume and bright red, but associated with very painful passage of stool through the anal canal. Both hemorrhoidal and bleeding from anal fissures may occur at any age.
Diverticulosis – much more common over the age of 50, it is associated with very large volume bright red or maroon stools and is not associated with abdominal pain.
Colitis – a generic term that refers to inflammation of the colon, this may be caused by infections (viruses, bacteria), ischemia, or inflammatory bowel disease (Crohn’s or ulcerative colitis). Bleeding may vary in quantity and color, but is most often maroon or bright red. Mucus may also be seen. Abdominal pain is often present.
Polyps and colorectal cancers – Depending on the location, bleeding may be of any color (bright red, maroon or black) and is usually not associated with pain.
Arteriovenous malformation (AVM’s) – benign little blood vessels that lie on the surface of the intestine, they often cause bleeding that is not visible (occult).
Ulcers – bleeding ulcers typically cause black stools and may be associated with upper abdominal pain or nausea.

When should I seek medical attention for my gastrointestinal bleeding?

Any gastrointestinal bleeding, whether overt or occult, should be evaluated by a medical professional as it may represent a serious underlying condition. Bleeding that is small volume, bright red, or intermittent should be assessed but does not represent an emergency. Bleeding that is larger volume, frequent, black or maroon, or associated with other symptoms (abdominal pain, nausea, etc.) requires urgent evaluation.

It is very important to tell your doctor about any GI bleeding you may be experiencing as soon as possible. Do not attempt to diagnose yourself. Pending evaluation, your doctor may suggest an imaging study (CT), endoscopy or colonoscopy.

Contact us if you would like to make an appointment with one of our physicians at Richmond Gastroenterology.

Does H. pylori Cause Ulcers?

Tue, 02 Aug 2022 02:10:56 GMT

H. pylori is a spiral-shaped, microaerophilic and gram-negative bacterium. It’s a common bacterium that grows in the digestive tract. An estimated 50% of the world’s population is affected with this bug, with infection more frequent and acquired at an earlier age in developing countries compared with industrialized nations. It is thought that infected people transmit H. pylori to others through contact with their saliva or other body fluids. Most people infected with H. pylori will not experience any symptoms.

What is Peptic Ulcer Disease?

About 10% of people infected with H. pylori develop peptic ulcer disease which is a general term for ulcers, or painful sores, that are found in the lining of the stomach or of the duodenum (upper part of the small intestine). An estimated four million Americans have peptic ulcer disease. (Note: while H. pylori is the main cause of peptic ulcers, there are other causes such as long-term use of NSAIDs such as aspirin, ibuprofen or naproxen.)

How Does H. pylori Cause Peptic Ulcers?

After H. pylori enters your body, it attacks the lining of your stomach, which usually protects you from the acid your body uses during digestion. Once the bacteria have done enough damage, acid can get through the lining, which leads to ulcers.

Symptoms of Peptic Ulcer Disease

Not everyone with peptic ulcer disease will have symptoms. However, if symptoms are present, people will experience some or all of these symptoms:

• Upper abdominal pain or discomfort. Many describe this as gnawing or burning. The pain is worse when the stomach is empty. Some people find relief by eating and taking antacids.
• Heartburn, acid reflux, burping
• Bloating
• Nausea or vomiting
• Anemia due to low iron levels

You should talk with your provider if you think you may have a peptic ulcer and are experiencing the symptoms above.

In rare cases, the symptoms are severe due to bleeding, perforation, or obstruction. You should seek immediate medical attention if you experience the following:

• Black stools or red blood coming from the rectum
• Vomiting blood or black material
• Severe pain

Diagnosis of Peptic Ulcer Disease

There are different ways to find out if someone has a peptic ulcer. A gastroenterologist may view your stomach and duodenum by doing a test called upper endoscopy or EGD. The patient will first receive an anesthesia medication, and then the doctor will insert a thin, lighted scope/tube with a camera at the tip through the mouth and into the stomach and upper small bowel to look for an ulcer. Biopsies can be taken and treatment performed at the same time for complex ulcers. This is the preferred diagnostic test, since it can detect even small ulcers and allows for potential treatment at the same time.

Other ways to look for peptic ulcers include a barium test or a CT scan. However, these tests are less effective than an endoscopy to diagnose an ulcer.

If an ulcer is found, the doctor will test the patient for H. pylori. This test is important because treatment for an ulcer caused by H. pylori is different from treatment for an ulcer caused by NSAIDs. H. pylori is diagnosed through blood, breath, stool, and tissue tests.

Treatment for Peptic Ulcers

It is important to treat peptic ulcers because they usually will get worse if not treated. A combination of antibiotics to kill the H. pylori and other drugs to reduce stomach acid is the most effective treatment for H. pylori peptic ulcers. Your doctor may also encourage you to avoid alcohol and stop smoking (if you smoke).

If you are experiencing symptoms of a peptic ulcer, contact Richmond Gastroenterology to make an appointment.

Colon Cancer and Family History: Lynch Syndrome

Tue, 02 Aug 2022 02:07:59 GMT

We ask our patients about family history when screening for colon cancer because there are a number of inherited syndromes that can increase your risk of developing colon cancer. Lynch Syndrome is by far the most common of these inherited syndromes.

Lynch Syndrome Increases your Risk for Cancer

Lynch Syndrome is also referred to as Hereditary Nonpolyposis Colorectal Cancer. Families with Lynch Syndrome have more instances of colon and rectal (colorectal) cancer, and cancers tend to occur at an earlier age, younger than age 50. We do not know exactly how many colorectal cancers are caused by Lynch Syndrome, but researchers estimate that it causes at least three percent of colorectal cancers. People with Lynch Syndrome are also at higher risk of other cancers including uterine/endometrial, ovarian, stomach, small bowel, pancreas, urinary tract, kidney, brain and skin cancer.

Lynch syndrome is hereditary, meaning that it is caused by inherited genetic mutations that can be passed from parents to children. Several genes have been identified that are linked to Lynch syndrome: MLH1, MSH2, MSH6, PMS2 and EPCAM. A mutation, or alteration, in any of these genes gives a person an increased risk of developing colorectal cancer and other related cancers during their lifetime. It is important to note, however, that not everyone with a mutation in these particular genes will develop cancer.

Normally, every cell has two copies of each gene: one inherited from the mother and one inherited from the father. Lynch Syndrome follows an autosomal dominant inheritance pattern, which means a mutation needs to happen in only one copy of the gene for the person to have an increased risk of getting that disease. A child whose parent has a mutation will have a 50% chance of inheriting that mutation. A brother, sister, or parent of a person who has a mutation also has a 50% chance of having the same mutation.

Diagnosis of Lynch Syndrome

These medical and family factors may lead me to suspect Lynch Syndrome:

A patient is diagnosed with colorectal cancer and is younger than age 50 .
A female patient is diagnosed with endometrial cancer (especially before age 50).
A patient has several family members with colorectal or other cancers associated with Lynch syndrome.
A patient has a family member with Lynch syndrome.

In some cases, I may ask my patient to complete a written questionnaire to give me more detailed information about his or her family history. I will refer potential Lynch Syndrome patients to a genetic counselor for further testing. The purpose of genetic testing is to determine a patient’s risk of developing cancer or cancers.

Lynch Syndrome Patients are Monitored Closely

Once identified, many of the Lynch Syndrome associated cancers can be prevented or detected early when treatment is most effective. Your genetic counselor will work closely with you and your doctors to determine the best course of action.

I monitor my patients with Lynch Syndrome very closely for colon cancer. This means a screening colonoscopy will be performed at a younger age than recommended for the average person. Repeat colonoscopies will also be performed more frequently.

Learn more about Lynch Syndrome from Lynch Syndrome International or take a hereditary cancer quiz from Myriad Genetics .

Do you think you may have Lynch Syndrome or are you concerned about your family history and risk for colon cancer? Contact Richmond Gastroenterology Associates today if you would like to schedule an appointment.

Following a Lactose-Free Diet

Tue, 02 Aug 2022 01:57:55 GMT

Lactose intolerance is a common condition affecting over a quarter of American adults. As people grow older, they may find themselves less able to properly digest milk and dairy products. In this article, we explain lactose intolerance, its symptoms, and how to manage the condition with dietary changes.

What is Lactose and Lactose Intolerance?

Lactose is a sugar found in milk and dairy products. Normally, lactose is broken down by lactase, an enzyme in the small intestine, so it can be absorbed. Most infants are born with this enzyme so they can digest breast milk. Over time, some people produce less lactase which means that lactose is no longer broken down properly when consumed. This leads to lactose intolerance. Note that lactose intolerance is not an allergy to milk or other dairy products — it is the lack of the enzyme necessary to break it down in the body.

In some cases, lactose sensitivity or intolerance may be mild to moderate and may be managed with supplements, medication, or dietary changes. However, in more severe cases, a completely lactose-free diet may be the best option.

Symptoms of Lactose Intolerance or Sensitivity

Typical symptoms of lactose intolerance include abdominal cramping, bloating, gas, and/or diarrhea. These symptoms most often occur thirty minutes to two hours after ingesting a food or drink containing lactose.

Many people experiencing these abdominal symptoms may choose to cut out dairy products either partially or completely. A physician or specialist can evaluate to see if the symptoms are being caused by lactose intolerance or by another condition, as these symptoms are also associated with many other gastrointestinal conditions. You may be asked to reduce dairy products in your day as an early recommendation to determine if symptoms are related to lactose intake. Lactose-intolerant patients often find quick relief from symptoms after reducing lactose intake.

Recommendations for a Lactose-Free Diet

If you are suffering from gastrointestinal distress after consuming dairy products, you may want to consider a lactose-free diet for 4-6 weeks to see if symptoms improve.

A lactose-free diet is one in which no lactose is consumed, either from dairy products or other sources. Lactose is most often found in dairy products such as milk and cheese, but it can also be hidden in many processed foods such as breads, baked goods, and cereal. When following a lactose-free diet, it is important to read labels carefully, as many processed foods may have hidden lactose present.

There are many milk and dairy substitutes available on the market, such as nut milk, rice milk, soy milk, and Lactaid products. Many hard cheeses (such as cheddar and Swiss) have a lower lactose count and can sometimes be enjoyed by those with lactose sensitivity. Lactose reduced products are also available.

Lactase enzyme supplements are available on the market and are intended to be consumed with meals containing lactose; however, there is not significant research to support its efficacy in those with lactose intolerance.

Most people with lactose intolerance may be able to handle a small amount of lactose and can experiment with adding dairy products back into their diet over a period of weeks. Those with more severe symptoms may have to avoid lactose indefinitely.

If you have been experiencing the symptoms of lactose intolerance and are looking for relief, make an appointment with Richmond Gastroenterology Associates.

Although finding alternatives to dairy milk is a lot easier these days, it is also possible to make your own milk, yogurt, and ice cream using nuts or seeds. It can be time intensive, but well worth it for the final product. Here are some of my favorite recipes (adapted from My New Roots by Sarah Britton):

March Is National Colon Cancer Awareness Month!

Tue, 02 Aug 2022 01:47:00 GMT

Colon cancer should be taken seriously because it is the second leading cause of cancer death in the U.S. This cancer does not discriminate! It affects both men and women of all racial and ethnic backgrounds. Follow us on Facebook this month to learn more about colon cancer and how you can help prevent this deadly disease.

What is Crohn’s Disease? Symptoms, Causes & Treatment

Tue, 02 Aug 2022 01:30:54 GMT

Approximately 700,000 people in the U.S. suffer from Crohn’s disease. This condition can be difficult to diagnose because the symptoms often overlap with other diseases. While there is no cure for Crohn’s disease, there are successful treatment options which can make huge differences in day to day life.

Definition and Symptoms of Crohn’s Disease

Crohn’s disease is a chronic condition of the digestive tract causing inflammation in the lining of the intestinal tract. It is one of a group of diseases called Inflammatory Bowel Disease or IBD (ulcerative colitis is another type of Inflammatory Bowel Disease). It causes ulcerations of the small and large intestines, but can affect any area of the digestive system from the mouth to the anus. It is considered an autoimmune disease because it occurs as a result of an abnormal immune response.

Symptoms will vary from person to person. Common symptoms of Crohn’s disease include:

Abdominal pain
Nausea
Diarrhea
Blood in the stool
Unintended weight loss

In more severe cases, Crohn’s disease can also affect other organ systems outside the gastrointestinal tract and cause additional symptoms, including:

Swelling in the joints or arthritis
Rashes
Eye and vision issues

The symptoms of Crohn’s disease are similar to other digestive conditions including irritable bowel syndrome (IBS) , food allergies, and lactose intolerance.

Causes and Risk Factors for Crohn’s Disease

The precise causes of Crohn’s disease are still unknown. Because it is more common in Western societies and less common in developing countries, researchers believe there may be an unidentified environmental or causal agent behind the development of the disease.

One such theory (the “hygiene hypothesis”) is that insufficient exposure to gut pathogens and bacteria at a young age may be a trigger for the disease in Western Europe and America. Many people moving to the West from developing countries see an increased risk of developing Crohn’s, which supports this hypothesis.

We do not see a difference in the incident rate between men and women. There is a higher incidence of Crohn’s disease in some Jewish populations, which is mostly linked to genetics. Diet may play a role in the development of Crohn’s disease, but the research is not yet conclusive.

Other factors which may contribute to the development of Crohn’s disease include:

A family history of the disease (usually a parent, sometimes a sibling)
A family member with other autoimmune diseases outside of Crohn’s disease, such as lupus
Age – Crohn’s is most often identified in young people. Cases do occur in pediatrics, but most cases occur in either the late teens or early twenties.

Diagnosis of Crohn’s Disease

Because Crohn’s can be difficult to diagnose, symptoms may go on for a long time before the disease is recognized. You will need to see a gastroenterologist to make a definite diagnosis.

Diagnosis often involves testing which may include X-ray, colonoscopy and/or upper endoscopy. Unfortunately, blood tests are not particularly effective at diagnosing Crohn’s disease. A biopsy of the small intestine or colon may reveal ulcers in the area which often indicate Crohn’s disease. In some cases, a CT scan may reveal a type of inflammation consistent with Crohn’s disease.

Long-Term Treatment

Crohn’s is a chronic and often unpredictable disease. The severity of symptoms will wax and wane, with occasional flare-ups and periods of remission. Your gastroenterologist may prescribe medication that can suppress the immune system and put the disease into a remission state. You will also be encouraged to reduce stress and avoid smoking. With medication and lifestyle changes, many Crohn’s sufferers can manage their disease and live a normal, active life.

If you’ve experienced one or more of the symptoms discussed above and think you may have Crohn’s disease, contact Richmond Gastroenterology Associates to schedule an appointment for an evaluation.

Constipation Causes & Treatment Options

Mon, 01 Aug 2022 09:49:47 GMT

Most people have experienced constipation. Commonly, constipation is uncomfortable yet short-lived. However, some people experience ongoing or chronic constipation which may be a sign of something more serious.

Let's talk about the causes of constipation and when you should seek medical attention.

Defining Constipation and Its Symptoms

Constipation is defined as “a disordered movement of the stool.” This can manifest in many ways, including:

Fewer than three bowel movements per week
Lumpy or hard stools
A feeling of incomplete evacuation or obstruction
Straining during evacuation more than twenty-five percent of the time
Using manual manipulation to complete evacuation

Chronic constipation occurs when these symptoms occur for three out of six months. About 15% of the population experiences chronic constipation.

Possible Causes of Constipation

Improper diet is the most common cause of constipation, mainly associated with water and fiber intake. The average person requires 20-35 grams of fiber and 64 ounces of water per day to have normal bowel function. Many people (particularly younger people) consume less than the minimum. If you are constipated, eating more fiber and drinking more water is a common and often effective solution.

Most constipation is idiopathic, meaning it can arise spontaneously from unknown causes. There are three basic types of idiopathic constipation:

Irritable Bowel Syndrome ( IBS ) characterized by altered bowel movements and increased pain during defecation. IBS is more common in women than men.
Dyssynergic defecation , a condition where the nerves and muscles of the pelvic floor do not work as they should.
Slow transit , or the unusually slow passage of waste through the intestines.

Some common causes of constipation include:

Obstructive lesions, such as colon cancer, colon polyps or other blockage.
Medical issues such as diabetes, hypothyroidism, anorexia nervosa, multiple sclerosis, or spinal cord injuries
Side-effects from medications such as narcotics, antihistamines, antidepressants, iron or calcium supplements and medications containing aluminum
Decreased physical activity
Age (constipation tends to increase in patients over 65)

4 Treatments To Try Before Consulting a Doctor

Before consulting a medical professional, there are at-home treatments that may help with constipation:

Adding high-fiber foods to your diet and drinking more water.
Increasing your physical activity level.
Adding over-the-counter fiber supplements to your diet.
Taking over-the-counter laxatives, such as Miralax. (Please note: If you find yourself requiring regular use of over-the-counter laxatives to achieve bowel movements, consult a physician.)

When To Seek Medical Treatment for Constipation

If you have tried the solutions above and see no positive results within 2-4 weeks — or if you have experienced constipation for three of the last six months — talk to your doctor. Certain symptoms may be a sign of more serious conditions. If you experience any of these “alarm symptoms,” you should seek medical attention.

Blood in stool or pencil-thin stool.
Sudden weight loss of 10 pounds or more without any weight loss effort.
Chronic constipation combined with a family history of colon cancer or bowel disease
Anemia or iron deficiency
Severe abdominal pain, particularly when eating

Further Constipation Treatment Options

Because there are many kinds of constipation, medical treatment will vary. Your doctor will start by identifying the underlying cause of the constipation. A physical examination, your medical history, and blood work (to identify conditions like diabetes or thyroid disease) will all help identify the root of the problem.

Your doctor may begin by adding fiber supplements (like Metamucil or Benefiber) to your diet. Stronger laxatives may be prescribed if required. If that proves ineffective, or if there are the “alarm symptoms” as mentioned above, a colonoscopy may be required . Additional treatment options your doctor may prescribe include:

An osmotic laxative such as miralax and lactulose are poorly absorbed or nonabsorbable sugars that increase stool frequency.
A stimulative laxative (for slow transit or IBS) that stimulates intestinal motor activity.
Medications, such as Linzess, a minimally absorbed peptide and Amitiza, a locally active chloride channel activator, which can soften stool and decrease straining.
Biofeedback (for dyssynergic defecation) to retrain the muscles to work properly.
In some cases of severe constipation, surgery can be considered.

If you have concerns about constipation, please contact us to make an appointment to see a physician at Richmond Gastroenterology Associates.

Dietary Changes for IBS: Low FODMAP Diet

Mon, 01 Aug 2022 09:45:54 GMT

About 10-15% of people in the U.S. suffer from IBS or irritable bowel syndrome. IBS symptoms include abdominal pain/discomfort, gas, bloating and changes in bowel habits. Some people may experience constipation or diarrhea or both.

A person with IBS experiences:

Abdominal pain or discomfort for at least 3 days per month in the past 3 months.
Onset of the symptoms at least 6 months prior.
At least 2 of the following: improvement in pain/discomfort after a bowel movement, onset associated with change in frequency of stool, or onset associated with change in form of stool.

IBS is not a life threatening condition but it is uncomfortable and negatively impacts quality of life. It is important to note at this point that not everyone who experiences these symptoms has IBS. Your provider will need to make this diagnosis. Treatment for IBS can vary from patient to patient and can include dietary changes, medications, and stress management. Let’s look at dietary changes that work for many patients to alleviate IBS symptoms.

Dietary Changes to Alleviate Symptoms

Dietary modifications often help to alleviate IBS symptoms. Patients may be asked to increase their intake of fiber and also drink more water. They may also be asked to avoid high fat foods and also those that produce a lot of gas such as onions, garlic, cabbage and beans. Eliminating caffeine and alcohol is also helpful.

Recent research suggests that avoiding certain carbohydrates can also minimize the symptoms of IBS. More and more providers are recommending the Low FODMAP Diet . While this diet does not work for all patients, it does offer substantial relief for many.

What is a Low FODMAP Diet?

FODMAPs are carbohydrates (sugars) that are found in certain foods: fermentable oligo-, di-, monosaccharides and polyols. These carbs are not bad and do not cause problems for most people. However, some people are sensitive to them. The FODMAPs include:

Fructose: Fruit, honey, high-fructose corn syrup, agave
Lactose: Dairy
Fructans: Wheat, onions, garlic
Galactans: Beans, lentils, soybeans
Polyols: Sugar alcohols and fruits that have pits or seeds

FODMAPs are not absorbed in the small bowel and travel to the large bowel (colon) where they serve as food for naturally occurring gut bacteria. This causes the sugars to ferment, releasing gas which causes bloating, distension, and pain. Reducing FODMAPs decreases the fermentation process and unnecessary gas, which can offer relief for many people with IBS symptoms.

Food Choices on the Low FODMAP Diet

You can eat eggs, meats, poultry and fish. There are many good fruits and vegetables available on this diet; however, there are many that you will avoid. The Low FODPMAP Diet overlaps with other popular diets in some ways. It has elements of lactose avoidance (avoid cow’s milk, ice cream, some cheeses) and gluten avoidance (avoid wheat, barley and rye). You will be limiting fiber since many higher fiber foods are high in FODMAPs. This link offers food guidelines for the Low FODMAP Diet : http://www.ibsgroup.org/brochures/fodmap-intolerances.pdf

At the end of this article, you will find two delicious recipes from “The Low-FODMAP Diet Cookbook “ by Sue Shepherd, PhD.

How Long Do I Follow the Low FODMAP Diet?

You will be asked to strictly follow the diet for 4-6 weeks. There are many food options on this diet; however, you must be willing to do a lot of label reading and planning. Many people find that a dietician can offer help with meal planning and nutritional guidelines. After the initial 4-6 weeks, the higher FODPMAP foods will be slowly re-introduced. Your provider will guide you during this phase. The re-introduction of carbs is a process that may take some time. The good news is that we often see that patients are sensitive to just one or two of the FODMAP carbs; not all of them.

The Benefits of the Low FODMAP Diet

The Low FODMAP Diet may be a big life-style change, but its potential is also just as great. For patients that have long suffered chronic or recurring IBS symptoms, this diet is worth a try considering the good results that many receive from following it. If you try the diet with no success, do not give up. Your provider will continue to work with you to find the best treatment plan.

If you have concerns about your IBS symptoms, contact Richmond Gastroenterology today .

Try these recipes from “The Low-FODMAP Diet Cookbook” by Sue Shepherd, PhD.

Diagnosing and Treating Esophageal Disorders

Mon, 01 Aug 2022 09:41:31 GMT

Affecting more than 15 million adults in the U.S., esophageal disorders can severely affect quality of life. They can cause symptoms such as heartburn, difficulty swallowing, and regurgitation of undigested food. Let's discuss the different types of esophageal disorders, how each is diagnosed, and what your doctor can do to help you treat a diagnosis.

Types of Esophageal Disorders

There are several types of esophageal disorders, but the most common include:

Achalasia occurs when the muscles that line the esophagus lose their ability to squeeze food down. The lower esophageal sphincter (LES), the muscular ring that closes off the esophagus from the stomach, fails to relax normally.
Gastroesophageal reflux disease (GERD) causes the stomach contents to flow backwards from the stomach into the esophagus.
Esophageal spasms occur when the esophagus does not contract or relax properly.

Each of these disorders includes its own treatment path, often dependent on the cause, so it's important that your pain and symptoms are properly diagnosed.

Diagnosing Esophageal Disorders

If your doctor suspects that you have an esophageal disorder, you may need certain diagnostic tests or consultations with other specialists, such as radiologists, speech pathologists, and ENT surgeons. Tests useful in diagnosing esophageal disorders include manometry and impedance monitoring.

Manometry

Manometry measures the pressure in your esophagus. It involves passing a small plastic tube into your esophagus through your nose and measuring the pressure in your esophagus during swallowing. In patients with achalasia, esophageal contractions are weak or absent and the LES is subject to sustained high pressure. Using manometry, a doctor may be able to determine whether achalasia is present.

pH Testing (Bravo clip)

If your doctor suspects GERD , you may require an esophageal pH test . This often involves temporarily attaching a Bravo clip to the lining of your esophagus to monitor the amount of acid that flows back in from your stomach over a 48-hour period. The clip contains a radio transmitter that relays data to a receiver worn on your waistband.

24 Hour Impedance Monitoring Combined with pH Testing for Reflux

Impedance monitoring measures liquid movement from your stomach into your esophagus using a probe, which is inserted into the esophagus with a catheter. Patients with GERD suffer increased backward flow of food and acid from the stomach into the esophagus, and impedance monitoring can detect this issue. The patient wears the probe for a 24 hour period of time.

Treating Esophageal Disorders

Treatment for esophageal disorders depends on the cause. Effective treatments include myotomy, a surgical procedure in which the LES is cut and the upper section of the stomach is wrapped around the esophagus to help prevent reflux; esophageal dilation, during which the LES is widened with a tube-shaped device; and Botox injections, in which Botox is injected to relax the LES.

Early diagnosis and treatment are important to prevent the complications of esophageal disorders. Contact us today to make an appointment to discuss your esophageal concerns.

What Are The Risk Factors For Colon Cancer?

Mon, 01 Aug 2022 09:32:14 GMT

Colon cancer is the second leading cause of cancer death in the U.S. Thankfully, with proper screening, this cancer is preventable.

My patients often ask me about the risk factors for colon cancer. A risk factor is anything that affects your chance of developing a particular disease. If you have a risk factor, it does not mean you will get the disease.

Colon Cancer Risk Factors

The following factors may increase your chance of developing colon cancer:

Age: While colon cancer can strike at any age; 90% of all colon cancers are found in people who are 50 and older.

Race : African Americans are at higher risk for developing colon cancer than other races.

Gender: Men get colon cancer more often than women. More than half of the 132,700 new cases that occur each year are in men.

Diet: Red and processed meats have been linked with colon cancer. According to recent research, eating more than 100 grams of red or processed meat per day can increase the risk of colon cancer by 17 percent. Consuming a variety of high-fiber foods, such as fruits and vegetables, may offer some protection.

Smoking & Alcohol Use: Long-term smokers and people who drink heavily for many years are also more likely to develop colon cancer.

Activity level : Sedentary people are at higher risk of developing colon cancer.

Medical History : Many conditions and diseases are associated with a higher incidence of colon cancer, including diabetes and obesity. If you’ve had ulcerative colitis or Crohn’s disease for more than 10 years, you may be at an increased risk. People with long-term immunosuppression as a result of childhood cancer or radiation may also be more likely to develop colon cancer later in life. Kidney cancer and also certain kinds of colon polyps increase your chance of developing cancer, particularly if you’ve had polyps more than once.

Family History As A Colon Cancer Risk Factor

It is important to know your family history. If someone in your family has had colon cancer or precancerous polyps, you may be at increased risk. If a close relative had colon cancer, it is recommended that you start colon cancer screenings 10 years before you reach the age at which your sibling or parent developed the cancer.

Inherited syndromes, including Lynch syndrome, also increase the risk of colon cancer.

Controlling Your Risk Factors and Preventing Colon Cancer

You can control some risk factors, such as lifestyle risk factors. Take steps now to exercise regularly, follow a healthy diet, stop smoking, and limit alcohol use.

Talk with your doctor to determine when you should have a colonoscopy to screen for colon cancer. It is important to share your family history with your physician. Most people should begin regular screening at age 50 and once every ten years after that. However, some people need to be screened earlier and/or more often .

Is it time for your colonoscopy? Contact us today to schedule a colonoscopy .

What Is Fecal Incontinence? Understanding This Common Diagnosis

Mon, 01 Aug 2022 09:18:34 GMT

Fecal incontinence is the accidental passing of solid or liquid stool from the rectum. It is usually caused by a physical problem with a part of the body that controls the bowel.

Prevalence of Fecal Incontinence

Fecal incontinence is more common than you might think. Approximately 18 million adults in the U.S. experience this condition, with women affected more often than men. Estimates suggest that about one in 10 women have fecal incontinence. Factors that increase the risk of fecal incontinence include increasing age, pelvic floor dyssynergia, injuries to the anus and rectum caused by childbirth or surgery, chronic constipation, and poor overall health.

Diagnosing Fecal Incontinence

Fecal incontinence can be distressing but treatment is available. The biggest roadblock to treatment is not talking about fecal incontinence. It is normal to feel anxious when discussing something so private but treatments are available to those who seek help. If you suspect you may have fecal incontinence, your first step to treatment is consulting with a doctor. Health care professionals skilled in diagnosis and treatment of this disorder typically have well trained staff to put you at ease in this discussion.

If your doctor suspects you have fecal incontinence, you may need to schedule an anorectal manometry . This test uses a catheter with pressure sensors and a balloon at the tip to measure the strength and coordination of your anal sphincter and pelvic floor muscles, as well as the sensation in your rectum. A small balloon is inserted in the rectum by the nurse. Once the balloon is placed, most patients have no sensation of discomfort or pain.

This test is especially useful for revealing weak anal sphincters. Other tests commonly used to diagnose fecal incontinence include endoscopic ultrasound , which uses a device, called a transducer, to produce images that allow your doctor to examine the structure of the anal sphincter, and MRI defecography, which uses an MRI scanner to obtain images that allow your doctor to assess the function of your pelvis at various stages of defecation. The MRI may be done with some contrast placed in the rectum via an enema. It is otherwise non-invasive.

Treating Fecal Incontinence

Treatment for fecal incontinence depends on the cause as well as any symptoms you are experiencing. Three types of treatment are available for fecal incontinence: medical therapy, physical therapy, and surgery.

Medical therapy includes injectable bulking agents that help strengthen the anal sphincter to reduce or eliminate fecal leakage.

Physical therapy involves using biofeedback techniques and pelvic floor exercises to help improve the function of the pelvic floor and anal muscles.

Surgery is usually recommended only after other treatments have failed. The most common surgical procedure for fecal incontinence is sphincteroplasty, which repairs an anal sphincter torn by injury.

In summary:

Fecal incontinence is common, particularly in women, and becomes more common as you age.
We encourage patients to become comfortable discussing this potentially embarrassing subject with their doctor with a goal of achieving diagnosis and treatment.
Early diagnosis and treatment of fecal incontinence are important to improve your quality of life and avoid complications. A number of treatments are available.

At Richmond Gastroenterology Associates we focus on evaluation and non-surgical management. We will refer to surgical specialists (colorectal or gynecological) when we deem appropriate.

Contact us if you would like to make an appointment with one of our physicians at Richmond Gastroenterology to discuss Fecal Incontinence.

Properly Treating Simple and Acute Diverticulitis

Mon, 01 Aug 2022 09:15:44 GMT

Diverticulitis occurs when weakened areas of the colon become infected, usually when stool becomes trapped. Diverticulitis can be divided into simple and acute types, depending on the severity of the episode. Each type has distinctive symptoms and treatment options.

Simple Diverticulitis

Most cases, approximately 75 percent, are classified as simple diverticulitis. The symptoms of simple diverticulitis include abdominal pain, tenderness in the lower abdomen, and sometimes mild nausea. Simple diverticulitis usually settles within a week. It is treated with oral medications and a modified diet that includes reducing the amount of solids and fiber you eat.

Acute Diverticulitis

Acute diverticulitis is a more complicated form of the condition and is diagnosed when there are abscesses, a fistula, peritonitis, and/or sepsis. Abscesses are pus-filled, infected areas that occur around areas of inflammation. A fistula is a connection between two organs that should not occur. For example, in diverticulitis, a fistula may form between the colon and bladder. Peritonitis is an inflammation of the area surrounding the intestines. Severe infection may cause sepsis, which means an infection has reached the blood stream and other organs.

Acute diverticulitis requires admission to the hospital for treatment. If you are admitted to the hospital, you cannot eat or drink and will be given intravenous antibiotics until your condition improves.

Surgery for Acute Diverticulitis

In approximately 15 percent of acute diverticulitis cases, surgery is required. The type of surgery you need will depend on the underlying problem. For example, if you have an abscess, the first-line treatment is to use a drainage tube to remove the infection. If this is not successful, surgery is the next treatment. Surgery is also needed if you experience a persistent fistula. Peritonitis requires emergency surgery.

Most patients that have surgery will have a temporary colostomy . During the procedure, part of the colon is brought up through the skin of the abdomen. A bag is attached to the colostomy to collect waste. Once the infection has cleared, the colon is reattached to the large intestine. The reattachment usually occurs after four to six months of having a colostomy.

In elective situations where the patient is eating and the infection has cleared, the surgeon may remove the infected portion of the intestines and connect the two healthy ends together. This is usually performed in a single operation.

To determine the best course of action for your diverticulitis case, contact Richmond Gastroenterology Associates and make an appointment.

Do I Have Diverticulitis? Understanding the Symptoms

Mon, 01 Aug 2022 09:13:33 GMT

Diverticulitis has various symptoms that can mimic other conditions. With a thorough evaluation of your symptoms and testing, your gastroenterologist can reach a diagnosis and start a treatment plan for you.

Understanding Diverticulosis and Diverticulitis

Before you understand diverticulitis , you must first understand it occurs from a related condition, diverticulosis. Diverticulosis occurs when there are weak spots in the wall of the colon. These weak spots are called diverticula. When the weakened areas become infected or inflamed, sometimes due to trapped stool, the condition is called diverticulitis. A flare-up of diverticulitis occurs when symptoms return after a period of no symptoms.

Symptoms of Diverticulitis

Diverticulitis symptoms include pain or discomfort in the abdominal area, most commonly in the left lower quadrant. Constipation, diarrhea, fever and painful urination can occur. In severe flare-ups, nausea and vomiting are present. You should go to the ER if you experience symptoms of diverticulitis with a fever of 100.1F or more, worsening or severe abdominal pain, or if you are unable to tolerate fluids. Many of the symptoms associated with diverticulitis can mimic other conditions. Therefore, you will need medical tests for a definitive diagnosis.

Diverticulitis can be divided into simple and acute types, depending on the severity of symptoms.

Diagnosing Diverticulosis and Diverticulitis

Diverticulosis typically has no symptoms and is usually found during imaging tests to diagnose other gastrointestinal problems. Diverticulitis is diagnosed based on symptoms, laboratory tests, and an abdominal CT scan. A complete blood count (CBC) is a laboratory test used to check for an elevated white blood cell count, which can signal infection or inflammation. A urinalysis helps rule-out stones in the urinary tract. If you are a woman, a gynecological exam can rule-out ovarian or uterine growths, which can cause similar symptoms. An abdominal CT confirms a diagnosis of diverticulitis. Once a diagnosis is made, patients stay on a restricted diet varying from nothing at all by mouth to clear liquids along with antibiotics.

Risk Factors for Diverticulosis and Diverticulitis

Constipation and eating a highly-processed and low-fiber diet appear to increase the risk of developing diverticulosis. The risk of developing diverticulosis also increases as you age. Aside from constipation and having diverticulosis, there are no other known risk factors for developing diverticulitis.

Diverticulosis can be associated with large amounts of bleeding, with or without a bowel movement. Call for emergency assistance or visit the ER if you experience significant bleeding. Most episodes of bleeding resolve spontaneously but still require medical attention. A CT angiogram helps determine the site and cause of bleeding. A colonoscopy may be used to aid in diagnosis. You should always consult your doctor if you experience bleeding, with or without a bowel movement, since no amount of bleeding is normal.

Living with Diverticulitis

For those who have previously experienced a diverticulitis flare-up, one-third never have another attack, one-third may have milder attacks that do not progress to another full-blown attack, and one-third will progress to a more advanced form of diverticulitis. If you experience bleeding, you have a higher risk for subsequent bleeding episodes.

Previously, patients were mistakenly encouraged to stay away from nuts, seeds, and corn after resolution of a diverticulitis flare-up. There is no proof these foods contribute to flare-ups and this dietary change is no longer recommended. In fact, the recommendation remains a diet high in fiber once the acute attack has resolved.

Concerned your symptoms may be a diverticulitis flare-up? Contact us at Richmond Gastroenterology Associates and schedule an appointment.

How Is GERD Diagnosed?

Mon, 01 Aug 2022 08:51:30 GMT

GERD, or gastroesophageal reflux disease, is a condition that affects up to one third of the U.S. population, with symptoms including heartburn, indigestion, regurgitation of food and drink into the chest or throat, difficulty swallowing, hoarseness and dry cough. Any of these symptoms, experienced on a semi-regular basis, warrant a trip to the gastroenterologist. GERD can potentially cause a wide spectrum of physical damage including precancerous conditions.

Diagnosing GERD

I will initially talk with my patient and ask him or her to explain the symptoms in detail. There are a number of considerations at play based on the subtleties of what the patient is experiencing.

I may order a test or procedure to help with a definitive diagnosis and proper treatment. There are a number of tests available including a Barium Test, an Upper Endoscopy and Acid Measurement.

Barium Test

An x-ray study called a barium study is the most common test. The patient swallows a substance with a paint-like consistency and a technician x-rays the patient to see where the liquid goes. Does it go all the way into the stomach and come back up into the esophagus? If so, GERD is likely. One disadvantage of this type of testing is that it doesn't give an idea of the degree of damage already present from stomach acid. Another is that it is not always accurate. A patient could have acid reflux but the mechanism might not have been triggered by the barium solution. The benefit to this test is that it is completely outpatient and does not take very long.

Upper Endoscopy

An Upper Endoscopy is also referred to as an EGD. An endoscopic examination is more complicated than a barium study. The patient first fasts and then is sedated so that I can insert an endoscope that reaches down into the esophagus. This gives me the ability to look at the esophagus in great detail, with the goal of identifying physical damage. This test can give evidence of a GERD problem, show physical deformities like scars, and discover the development of precancerous changes. An endoscopic examination allows me to intervene if there is great physical damage.

Acid Measurement

There is also a way to evaluate the ph or amount of acid moving in the wrong direction (into the esophagus from the stomach). I can place a small device in the esophagus (at the time of an Upper Endoscopy procedure) to measure the amount of acid coming up from the stomach.

If you are suffering from GERD symptoms, it's time to see a gastroenterologist to make sure no further damage occurs and to find treatment that brings relief. Make an appointment today .

Pancreatic Cancer Awareness Month

Mon, 01 Aug 2022 08:48:30 GMT

November is National Pancreatic Cancer Awareness Month. This cancer is the “number 4” cancer killer of men and women in the U.S. (the first three are lung, colorectal and breast cancers). Unfortunately, a cure does not exist and survival has not improved that much in the last 25 years. Over 39,000 people died from Pancreatic Cancer in 2014.

Several studies show that a certain type of pancreatic cyst can progress to pancreatic cancer. In addition, you are more likely to get pancreatic cancer if you have a family history of this cancer, if you smoke, if you are obese, or if you have chronic pancreatitis.

Research is focusing on new drugs for managing pancreatic cancer and disease as well as genetic testing to help screen people before cancer develops. Dr. Bimaljit Sandhu is a nationally recognized expert on pancreatic disease and cancer. Prior to joining our practice, he served on the VCU faculty and served as Director of Pancreatic Disorders. Throughout his career, he has actively participated in pancreatic research in an effort to improve treatments.

Below are links to a few of his studies / publications:

Chronic pancreatitis pain pattern and severity are independent of abdominal imaging findings

Mechanisms of CFTR functional variants that impair regulated bicarbonate permeation and increase risk for pancreatitis but not for cystic fibrosis

Common genetic variants in the CLDN2 and PRSS1-PRSS2 loci alter risk for alcohol-related and sporadic pancreatitis

Recurrent flares of pancreatitis predict development of exocrine insufficiency in chronic pancreatitis

IBS vs. IBD: Breaking Down the Difference

Mon, 01 Aug 2022 08:44:10 GMT

IBS and IBD are both conditions that affect the gastrointestinal tract. Many people confuse the names, but while they do have some small similarities, the two conditions are very different. Having a better understanding of the symptoms of each can help you gain a stronger grasp of why you are experiencing GI symptoms and how you can best treat them.

The Basics of IBS and IBD

Irritable bowel syndrome , or IBS, is a term for a collection of different symptoms, including abdominal pain, bloating, and changes in bowel habits including both constipation and diarrhea (or alternating between the two). Inflammatory bowel disease , or IBD, is an umbrella term for Crohn’s disease and ulcerative colitis and is more closely related to inflammation of the intestines. Both are chronic conditions that tend to come and go over time, with some bouts being more severe than others. The periods when symptoms are the worst are called flare-ups. Because they both affect your intestines and bowel movements, they can have adverse effects on the quality of your life.

Key Differences Between IBS and IBD

The two have many of the same symptoms, including abdominal pain, bloating, and changes in bowel habits, but patients with IBD may also experience weight loss, fever, rectal bleeding and other symptoms. It can be difficult to distinguish between the two because the symptoms alone often don’t provide an evaluative answer.

Both IBS and IBD are common conditions that many people suffer from. IBS is more prevalent in females, but IBD is found equally in both genders.

Causes of IBS and IBD

IBD is classified as an autoimmune disorder. This means that the immune system is targeting the intestines, which can lead to abdominal pain, diarrhea and occasional bleeding among other symptoms. If you have a family member who has suffered from IBD, you have an increased risk of eventually being diagnosed with IBD. We don’t know the causes that make the intestines susceptible to this disorder, but IBD is gaining prevalence and is very common in Europe and North America.

IBS, on the other hand is thought to be caused by increased sensitivity of the nerves in the intestines. These nerves send messages to the brain that translate this message into pain in your abdominal area and often bloating and other symptoms. Stress is one main factor that has been pinpointed as a trigger of IBS. In general, IBS seems to be more related to diet and lifestyle than IBD.

How Are IBS and IBD Diagnosed?

It often takes multiple tests to properly diagnose IBD. It can sometimes be diagnosed with a colonoscopy, which uses a flexible tube inserted into the rectum to look at the lining of the colon for signs of Crohn’s disease or ulcerative colitis. Biopsies, CT scans, and MRIs can also be used to help make a diagnosis; small bowel x-rays or upper endoscopies can be helpful as well.

For IBS, it’s more of a diagnosis that takes place by process of elimination. If you are having abdominal pain, a colonoscopy can rule out other problems. Additional tests can rule out celiac disease and other issues that mimic the symptoms for IBS. Once other conditions have been ruled out, it’s easier to move forward with treatment for IBS.

Treatment for IBS vs. IBD

Treatment for IBS generally involves dietary changes, such as high-fiber diets that help soften the stool. Over-the-counter laxatives and prescription medications can also be helpful. A physician can look at your diet to see if there are certain food triggers that your body finds harder to digest or break down; eliminating these foods can alleviate symptoms. Introducing exercise and other stress-relieving activities into your lifestyle can be beneficial; some patients respond well to antidepressants, which lower stress levels as well.

Treatment for IBD is notably different because it’s a chronic disease. For IBD, it’s important to intervene earlier with medication that targets the immune system’s response to the intestine. These can be drugs that are in pill form or other injectable or infusion options and will help to avoid having to undergo surgery down the road. It’s especially important to avoid dietary triggers as well as over-the-counter drugs like ibuprofen and naproxen that can aggravate your condition.

IBS and IBD both cause uncomfortable digestive issues that can interfere with your quality of life. Make an appointment with us today to help you properly diagnose your symptoms and get your life back on track.

7 Things to Know About GERD Medications

Mon, 01 Aug 2022 08:39:24 GMT

GERD , or Gastroesophageal Reflux Disease, is a condition that causes the contents of the stomach to back up into the esophagus, causing heartburn, gas, sour breath and more. Sometimes GERD can be controlled by changes to diet and lifestyle, smoking cessation or stopping medications that cause GERD. In other cases, it is necessary to take medication to control GERD. It depends on the types of symptoms you have, how long those symptoms have been present, and a number of other factors.

The magnitude of GERD is huge. Almost 60 percent of the adult population will experience some type of gastroesophageal reflux disease (GERD) within a 12 month period and 20 to 30 percent will have weekly symptoms. There are approximately 64.6 million prescriptions written for GERD medications in the U.S. on an annual basis ¹ .

Let's take a look at 7 things you should know about GERD medications:

1. Who needs GERD medications?

People who have heartburn almost every day. While heartburn is certainly a common symptom of GERD, it is not the only one. GERD sufferers can experience bloating, gas, a dry cough that interrupts sleep and other symptoms.

2. Medication is not the only recommendation.

GERD medication helps with symptoms, but it's important for a patient to make diet and lifestyle changes to avoid and/or eliminate triggers.

3. Some GERD medications are available OTC.

There are three subgroups of OTC (over-the-counter) GERD medications. One is the typical antacid, like TUMS, that neutralizes the acids in the stomach. The next is the H2 receptor blocker, like Zantac/Pepcid, that cuts down on acid secretion. The third is a stronger drug, like Prilosec OTC/Nexium 24 Hr, which shuts down acid secretion even more.

4. Some people may need prescription-strength GERD medications.

If OTC (over-the-counter) medications fail to provide relief, there are prescription doses available of the third type of drug, such as a prescription-strength Prilosec, Prevacid, Protonix, Dexilant, Zegerid, Nexium etc. These are prescribed when the OTC medications only provide partial relief, when the symptoms come back, or fail to improve. The strongest type of prescribed GERD medication is called a proton pump inhibitor, and prevents acid from being released into the stomach.

5. Your doctor will find the right prescription GERD medication for you.

There are many prescription-level medications available. A doctor will prescribe what he/she believes will work best for each individual case. The doctor must also consider which medications the patient's insurance plan will cover.

6. Sometimes there can be drug interactions with your GERD medication.

Because of the potential for drug interactions, it's imperative to tell your doctor about all other prescription and non-prescription drugs that are regularly taken. Some GERD drugs can decrease the concentrations of other medications, so it is crucial to reach medication reconciliation with the doctor. Amphetamines, anti-viral medications, osteoporosis medications, heart medications like blood thinners, and anti-anxiety medications are all prone to interactions with GERD medications.

7. You may need further testing if the GERD medications are not working.

When GERD medications aren't working, or development of alarm symptoms like inability to swallow, blood in vomiting, or weight loss, the doctor will recommend an Upper Endoscopy (also referred to as an EGD) to see what is going on in the stomach and esophagus. If the reflux symptoms are present for a long time, it can predispose the patient to develop pre-cancerous changes in the esophagus called Barrett's esophagus. People with obesity, a family history of esophageal cancer, and smokers are at an increased risk, so they should be screened to rule out damage.

Contact us to make an appointment if you think you have GERD and are concerned about your symptoms.

1 Digestive Diseases Statistics for the United States – National Digestive Diseases Information Clearinghouse. (n.d.). Home – National Digestive Diseases Information Clearinghouse.

Will My GERD Symptoms Improve With Diet Changes?

Mon, 01 Aug 2022 08:36:58 GMT

GERD, or gastroesophageal reflux disease , occurs when stomach acid flows up out of the stomach and into the esophagus, causing symptoms generally described as heartburn. More than one third of adults experience GERD symptoms at some point during their lives. You should not be discouraged by this statistic because these symptoms can often be prevented by making a few changes to your diet and/or lifestyle.

Let’s take a look at some common triggers for GERD symptoms and what changes you can make to manage your GERD.

Common GERD Trigger Foods

Certain foods are more likely to trigger GERD symptoms. GERD triggers can be very individual, and this is by no means an all-inclusive list. Chocolate is one trigger because it can relax the lower esophageal sphincter, which is the band of muscles which generally keeps stomach acid contained within the stomach. Alcohol, spicy foods, and caffeine can also cause acid reflux in some GERD sufferers. Highly acidic foods and drinks such as tomatoes, citrus fruits, and carbonated beverages can increase the amount of acidity in the stomach and make symptoms worse. You might find that not all of these trigger foods affect you, though some people are affected by them all.

Lifestyle Changes That Can Help

The timing of your meals can also affect your GERD symptoms. Try to avoid eating just before you go to bed, as lying down after you eat can allow acid to leak out into your esophagus. Overweight GERD sufferers may see tremendous benefit from losing weight, so try starting a healthier diet and exercise routine. Decreasing consumption of fatty foods can help with weight loss and with increasing the speed at which the stomach empties, potentially reducing symptoms.

Identifying Your Own Triggers

We are all different and triggers that affect one person might not be a problem for another. Keeping a food diary for a few weeks can help you keep track of the foods you eat and the symptoms you experience. This should help you to identify which foods are your biggest GERD triggers so you can avoid them in the future. Please note that symptoms might not occur immediately after you eat a trigger food; it could take a few hours for acid to rise in your stomach.

Moderation Is Key

Moderation is the key to a GERD diet. Eating smaller portions of food can improve your symptoms. In addition, many people are able to tolerate small amounts of their trigger foods. This means you may not have to completely give up your favorite treats… you just have to restrict yourself to a few pieces of chocolate rather than the entire bar!

Seeking Help with GERD

Many people find that seeking professional help makes it easier for them to develop and stick to a diet which can improve their GERD. As a result, their symptoms often become easier to manage.

Do you need help managing your GERD symptoms? Call Richmond Gastroenterology Associates today to schedule an appointment.

5 Common Causes of GERD

Mon, 01 Aug 2022 08:33:02 GMT

GERD, or gastroesophageal reflux disease , is a condition that plagues up to one third of the U.S. population at one point or another. Sometimes GERD is caused by common digestive upsets, but at other times it is an indication of an underlying problem. Let’s briefly review what GERD is, its symptoms, and common causes.

What is GERD?

In normal, healthy digestion, the food or drink we consume travels in one direction. It moves from the mouth to the stomach via the esophagus, sits in the stomach long enough to allow the body’s natural acids to break it down, and then travels through the rest of the digestive tract. This process is necessary for the body’s processing of what we eat or drink.

The stomach has a lining to protect it from all of the digestive acids that break down the food we eat. The esophagus, however, does not have this lining. With GERD, the contents of the stomach travel up through the esophagus, causing damage and pain because the esophagus is not protected from the acid.

Symptoms of GERD (also called acid reflux) include heartburn, indigestion, regurgitation of food and drink into the chest or throat, difficulty swallowing, hoarseness and dry cough. Any of these symptoms, experienced on a semi-regular basis, warrant a trip to your physician to find out what’s going on.

Common Causes of GERD

The main cause of GERD is a failure of normal mechanisms that keep what we eat or drink going in one direction. There is a sphincter (like a trap door) between the esophagus and the stomach that opens to allow food and drink to travel to the stomach and closes after. A prominent mechanism in GERD patients causes the trap door to stay open when it is not supposed to. Hence, the stomach contents can go back in the wrong direction, and the acid from the stomach can damage the esophagus.

Here are five common conditions that can cause this experience:

When people have a large amount of food or drink in the stomach, the sphincter can stay open.
The integrity of the sphincter can be impaired by genetics or food sensitivities. The high levels of estrogen present during pregnancy can cause GERD, and certain foods like caffeine and chocolate might as well.
The strength of the sphincter varies in certain people. Someone who is overweight, for example, may have weaker muscle strength in the sphincter. In some cases, the anatomic position of the stomach and esophageal muscles might diminish the integrity of the sphincter.
A hiatal hernia, which is an anatomical defect that disturbs the normal position of the stomach, has a high correlation with acid reflux or GERD. The stomach is actually closer to the mouth than normal in this circumstance.
Certain medications predispose people to GERD, especially those that have an anticholinergic property. Some steroids and antibiotics can also irritate the esophagus.

Rarer is GERD caused by a connective tissue disease like scleroderma.

Some of these situations are preventable or treatable. Getting off medications that irritate the stomach and keeping weight down can help some people, but others need more help. In order to diagnose GERD definitively, it’s important to see a doctor.

If you’re concerned you may have GERD, contact us today to make an appointment .

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Mon, 01 Aug 2022 08:30:46 GMT

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Colonoscopy 101: What you need to know

Mon, 01 Aug 2022 08:30:08 GMT

March is Colon Cancer Awareness Month. I want to take this opportunity to help you better understand colon cancer and the role colonoscopy can play in prevention of this cancer.

Why should I be screened for colon cancer? Colon cancer is cancer of the large intestine. An estimated 1 in 20 Americans are at risk of developing this cancer in their lifetime. Screening for colon cancer is extremely important because we can find and treat problems before cancer develops or spreads. Screening may reduce the risk of death caused by colon cancer.

Who needs to be screened? All men and women should be screened. Screening should begin at 50 for most men and women. Some people may require earlier screening. You should ask your physician if you need to be screened before age 50.

What’s the best screening test for colon cancer? Colonoscopy , with a good preparation, provides the best method of screening for colon cancer. It is the only screening test that allows me to immediately remove polyps that may be pre-cancerous.

What is a polyp? A colon polyp is a clump of cells that forms on the lining of the colon. Polyps come in many varieties. Hyperplastic polyps have no cancer potential and do not require close follow up. Polyps that are adenomatous have the potential of developing into cancer. These come in several types: serrated, tubular and villous.

Can a colonoscopy detect other problems? Yes. A colonoscopy can also detect other abnormalities such as inflammation, diverticulosis, hemorrhoids and other lesions. It is a useful and accurate tool to evaluate some abdominal complaints.

How do I prepare for my colonoscopy? We will prescribe a bowel “prep” and also give you exact instructions to follow. The colon needs to be completely clean prior to the colonoscopy to allow the physician to thoroughly examine the entire colon. “Preps” are much easier than they used to be 10-20 years ago. You will need to follow a clear liquid diet 24 hours prior to the procedure. I recommend that your bowel “prep” be split dose. This means you will take one half of the “prep” and then the second half hours later. Ideally, the second dose should be started 5-6 hours before the colonoscopy. Currently, there are several smaller volume “preps” on the market that make the preparation easier (if your insurance will cover).

Will I need a repeat colonoscopy? If you have a normal colonoscopy or if only hyperplastic polyps are found, you will need a repeat colonoscopy in 10 years. There are several exceptions:

If you develop symptoms.
If you have a first degree relative with colon cancer, then you may need a repeat study every 5 years since your risk is twice the risk of the general population.
If adenomatous polyps are identified, you may need your repeat colonoscopy sooner to ensure there is no re-growth or development of new adenomas.

Why should I choose a gastroenterologist to perform my colonoscopy? Recent studies reveal that gastroenterologists are more effective at preventing colon cancer by colonoscopy than other physicians, including surgeons. This likely represents more complete colonoscopies and higher rates of detection of adenomatous polyps. Our physicians are all board certified and adhere to the guidelines of the American Gastroenterological Association and the American College of Gastroenterology.

How do I schedule a colonoscopy? Scheduling a colonoscopy is easy. Contact us today!

Have GERD? Try these 10 lifestyle changes.

Sun, 31 Jul 2022 20:00:44 GMT

If you have been told you have GERD…you are not alone. Some experts estimate that 20% of adults in the U.S. suffer from this uncomfortable and sometimes painful condition.

GERD is defined as gastroesophageal reflux disease. The most common symptoms are heartburn and regurgitation. You may also have chest pain, difficult or painful swallowing, hoarseness, sore throat, a lump in your throat, chronic cough, or asthma exacerbations.

GERD occurs when stomach contents reflux or wash back into the esophagus and cause symptoms or damage the esophagus. This most often occurs after eating because the stomach is distended. It is more common if you: have a hiatal hernia, are overweight or are pregnant.

The diagnosis of GERD can be based on symptoms alone if you are experiencing typical symptoms. Sometimes, an upper endoscopy (EGD) may be necessary to rule out complications.

Treatment options will depend on your situation. In many cases, lifestyle changes may first be recommended to reduce the severity of your symptoms.

Here are 10 suggestions I offer my patients:

Lose weight if you are overweight
Eat smaller (and more frequent) meals
Avoid late night eating and do not eat within 2-3 hours of bedtime
Elevate the head of your bed 6 — 8 inches
Quit smoking if you are a smoker
Avoid spicy and also greasy foods
Avoid beverages with alcohol and caffeine
Avoid tomato-based sauces
Avoid citrus fruits and juices
Avoid chocolate and also peppermint.

If these lifestyle changes don't help, your healthcare provider may recommend a medication known as a histamine antagonist (such as Pepcid, Zantac or Tagamet). If symptoms persist despite a histamine antagonist, you may need a PPI medication (Prilosec, Prevacid, Nexium, Protonix, Aciphex, or Dexilant). PPI's should be taken once a day, 30 minutes before breakfast. Treatment should then be re-evaluated after eight weeks. If lifestyle changes and medication do not offer enough relief, you will need to discuss this with your healthcare provider.