Beth Israsel Deaconess Hospital - Plymouth

          

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Conditions

Celiac Disease

What is Celiac Disease?

Celiac disease is a genetic autoimmune condition. With autoimmune diseases, a person’s own immune system attacks a healthy part of the body by mistake. Celiac disease mainly affects the small intestine, but it can impact other parts of the body, too.

People with celiac disease cannot eat gluten because it damages the lining of the small intestine and affects digestion. Gluten is the general name for the protein found in wheat, rye, and barley.

Damage to the small intestine can cause inflammation. This irritation makes it more difficult to absorb or take in vitamins and minerals. Strictly avoiding gluten can help reverse the damage and control symptoms, such as gas, bloating, diarrhea, and constipation. But following a strict gluten-free diet (GFD) is tough for many people, and not always effective at treating symptoms.

Diagnosis and Treatment

Sometimes it is difficult to diagnose celiac disease. Our specialists are skilled at ruling out other conditions with symptoms similar to celiac disease. Genetic testing, blood work and endoscopy help diagnose celiac disease.

During an endoscopy, doctors use an endoscope (a thin, flexible tube with a light and camera that is inserted through the mouth) to view the esophagus, stomach, and the first part of the small intestine. Through the endoscope, they take tissue samples (biopsies) from the small intestine to confirm whether the patient has celiac disease.

Colon Polyps

What are Colon Polyps?

Polyps in the colon are growths that may be benign (not cancerous) or pre-cancerous (may develop into cancer if not removed).

Diagnosis and Treatment

Most colon polyps are discovered during routine screening tests such as a sigmoidoscopy or a fecal occult blood test (test for blood in the stool). Treatment for colon polyps is based on the size and the type of the polyp. Polyps that are likely to become cancerous should be removed. Some can be removed safely during a colonoscopy. Others may need to be removed surgically.

Gallstones

What are Gallstones?

Gallstones are hard stones that form in the gallbladder. They consist of cholesterol and other substances from bile. Gallstones range in size from barely measurable to 2.5 inches. Some of the factors that increase the risk of gallstones include being female, being over age 55, being obese, having a family history of gallstones, having multiple pregnancies, being of Native American or Mexican American descent, and taking female hormones such as birth control pills or hormone replacement therapy.

Many people with gallstones do not experience any physical symptoms and do not require any medical treatment. These people have "silent" gallstones. Others feel pain in the abdomen which may be intermittent or continuous, dull or sharp, and is generally located in the upper abdomen, particularly on the right side where the gallbladder is located. If pain is accompanied by a fever, nausea and vomiting, the gallbladder may be infected. In some cases, a gallstone can block the bile duct, which is indicated by symptoms such as fever, jaundice (yellowing of the skin), dark-colored urine and light-colored stools. Gallstones in the bile duct can cause other complications such as pancreatitis.

Diagnosis and Treatment

Tests often used to diagnose gallstones include blood tests, abdominal ultrasound, hepatobiliary (liver and gall bladder bile ducts) scan, and Endoscopic Retrograde Cholangiopancreatogram (ERCP). If the gallbladder is infected, it is usually removed in a procedure called a cholecystectomy. Gallstones sometimes pass into the common bile duct, causing jaundice or inflammation (cholangitis). Treatment for stones in the bile duct is based on the patient's history and the severity of his or her symptoms. Most often, treatment involves utilizing ERCP.

Gastroesophageal Reflux Disease (GERD)

What is GERD?

Gastroesophageal reflux disease is a condition in which the valve between the lower end of the esophagus and the stomach (lower esophageal sphincter, or LES) does not close properly. This causes stomach acid and juices to flow back to the upper esophagus and throat. Symptoms of GERD include heartburn on a regular basis, a bitter or sour taste in the mouth, painful swallowing, difficulty swallowing, nausea, throat problems, and respiratory problems.

Treatment

Treatment for GERD usually begins with dietary changes. Foods such as chocolate, coffee, onions, and peppermint may cause the LES to relax and not close tightly. Other foods can irritate the esophagus once it is affected by GERD. These include spicy foods, tomato products, and citrus fruits. Acid reducers, antacids, or prescription medications may be recommended, as well as simple lifestyle changes such as eating smaller meals and raising the head of the bed while sleeping.

More chronic cases of GERD may require more extensive testing and treatment. An endoscopy may be performed to look for possible complications of GERD such as swelling, bleeding or strictures in the esophagus.

Crohn’s Disease

What is Crohn’s Disease?

Crohn's disease is a chronic disorder of unknown origin characterized by inflammation of the gastrointestinal (GI) tract. Although any part of the GI tract can be affected by Crohn's disease, from the mouth to the anus, the area where the small intestine (terminal ileum) and colon (cecum) meet is the site most commonly involved. Inflammation can affect all the layers of the bowel wall and can lead to a variety of symptoms, including:

  • Abdominal pain
  • Diarrhea
  • Intestinal bleeding
  • Weight loss

These symptoms are non-specific and can be present in many other disorders, including ulcerative colitis and gastrointestinal infection.

Diagnosis and Treatment

A physician will make the diagnosis of Crohn's disease after speaking with and examining the patient, and performing a number of diagnostic tests: blood tests, X-rays, and often a colonoscopy.

Once a diagnosis of Crohn's disease is made, patients are treated with a variety of medications, often immunomodulators or biologics (drugs that affect the immune system), with the goal of controlling the patients' symptoms and making them feel well.

There is no cure for Crohn's disease; it is a chronic illness, so the goals of therapy are to get the patient feeling back to normal, keeping the patient feeling normal, and reducing the number of recurrent flares. The hope is that by achieving those goals patients are able to live normal lives without any limitations related to their disease; however, in a number of situations, surgery is required.

Because Crohn's is a chronic disease, patients need to take an active role in their treatment. Most importantly, they should not be afraid to ask questions.

Ulcerative Colitis

What is Ulcerative Colitis?

Ulcerative colitis is a disease characterized by chronic inflammation of the colon (large intestine) accompanied, in severe cases, by ulcers in the lining of the colon. It is most often diagnosed in people between the ages of 15 and 30, although it can develop at any age, in both children and adults.

The majority of patients have inflammation in their rectum, which spreads along the colon to varying extents. The inflammation may be limited to the:

  • rectum (proctitis)
  • rectum and sigmoid colon (distal colitis)
  • rectum, sigmoid and descending colon (left-sided colitis)

When more than just the left colon is affected, it is termed "extensive colitis." "Pancolitis" is the term used when the entire colon is inflamed.

Ulcerative colitis is a chronic condition in which individuals experience both periods of active disease (flares/relapses) and periods of mild or inactive disease (remission). Typical symptoms include:

  • Frequent loose and often bloody stools
  • Abdominal pain or cramping
  • Nighttime awakenings
  • Urgency
  • Incontinence

Diagnosis and Treatment

The most accurate way to diagnose ulcerative colitis is by examining the colon with a fiber-optic endoscope inserted into the rectum. A sigmoidoscopy examines the lower third of the colon and requires minimal preparation. A colonoscopy examines the full colon and requires a thorough bowel cleansing to ensure complete visualization of the lining of the colon. When ulcerative colitis is present, the lining of the colon appears swollen and inflamed, with surface bleeding and ulcers (if severe enough) usually in a continuous pattern. Tiny samples (biopsies) of the lining of the colon are taken during the procedure, so that a pathologist may examine them under the microscope for inflammatory changes (histology).

The majority of patients diagnosed with ulcerative colitis respond to conventional medical therapy. Typical treatments involve anti-inflammatory medications (5-aminosalicylates) or immunomodulators (medications that modulate or suppress the immune system). Occasionally, medical treatment fails and surgical removal of the diseased colon becomes necessary.

Irritable Bowel Syndrome

What is Irritable Bowel Syndrome?

Irritable bowel syndrome is a common condition. Its symptoms include abdominal pain or discomfort associated with diarrhea, constipation, or both symptoms alternating.

The cause of irritable bowel syndrome is not known. In some cases, irritable bowel syndrome begins after an intestinal infection or a significant life stressor.

Diagnosis and Treatment

The diagnosis of irritable bowel syndrome often requires tests such as blood tests, colonoscopy, and imaging studies to exclude other causes of chronic pain and diarrhea.

Treatment for irritable bowel syndrome may include dietary changes, exercise, stress management, and medications to control symptoms and reduce pain, and alternative therapies.

BID-Plymouth
275 Sandwich Street
Plymouth, MA 02360
(508) 746-2000

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