What is Celiac Disease?
Celiac disease is a digestive disease that interferes with absorption of nutrients from food and damages the small intestine. People who have celiac disease are intolerant of gluten, a protein in wheat, rye and barley.

When people with celiac disease eat foods that containing gluten, their immune system responds by damaging or destroying villi - the tiny, fingerlike protrusions lining the small intestine. Villi normally allow nutrients from food to be absorbed through the walls of the small intestine into the bloodstream. Without healthy villi, a person becomes malnourished, no matter how much food one eats.

What are the Symptoms of Celiac Disease?
Each person may experience different symptoms. Symptoms may occur in the digestive system or in other parts of the body. Digestive symptoms are more common in infants and young children and may include:

  • abdominal bloating and pain
  • chronic diarrhea
  • vomiting
  • constipation
  • pale, foul-smelling, or fatty stool
  • weight loss

Adults are less likely to have digestive symptoms and may instead have one or more of the following:

  • unexplained iron-deficiency anemia
  • fatigue
  • bone or joint pain
  • arthritis
  • bone loss or osteoporosis
  • depression or anxiety
  • tingling numbness in the hands and feet
  • seizures
  • missed menstrual periods
  • infertility or recurrent miscarriage
  • canker sores inside the mouth
  • an itchy skin rash called dermatitis herpetiformis

How is Celiac Disease Diagnosed?
Because the symptoms of celiac disease can resemble the symptoms of other conditions, like Crohn's disease or irritable bowel syndrome, our physicians will give you a physical exam and ask questions about your medical history. We may also order a blood test, especially once celiac disease is suspected. Other tests may be needed to confirm the disease, including an upper endoscopy and a biopsy of your small intestine.

How is Celiac Disease Treated?
Currently, the only treatment for celiac disease is a gluten-free diet. For most people, following this diet will stop symptoms, heal existing intestinal damage, and prevent further damage. Improvement begins within days of starting the diet. The small intestine usually heals in three to six months in children but may take several years in adults. A healed intestine means a person now has villi that can absorb nutrients from food into the bloodstream.

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What is Cirrhosis?
Cirrhosis is a late stage of scarring (fibrosis) of the liver caused by many forms of liver diseases and conditions, such as hepatitis and chronic alcohol abuse. The liver is in charge of necessary functions, including detoxifying harmful substances in your body, cleaning your blood and making vital nutrients.

Cirrhosis occurs in response to damage to your liver. The liver damage done by cirrhosis is irreversible. But if liver cirrhosis is diagnosed early and the cause is treated, further damage can be limited.

What are the symptoms of Cirrhosis?
The symptoms of cirrhosis of the liver vary with the stage of the illness. In the beginning stages, there may not be any symptoms. As the disease worsens, symptoms may include:

  • Loss of appetite
  • Lack of energy (fatigue), which may be debilitating
  • Weight loss or sudden weight gain
  • Bruises
  • Yellowing of skin or the whites of eyes (jaundice)
  • Itchy skin
  • Fluid retention (edema) and swelling in the ankles, legs, and abdomen (often an early sign)
  • A brownish or orange tint to the urine
  • Light colored stools
  • Confusion, disorientation, personality changes
  • Blood in the stool
  • Fever

How is Cirrhosis Diagnosed?
Since people with early-stage cirrhosis of the liver usually don't have symptoms, the disease is often first detected through a routine blood test or checkup. We may order one or more tests or procedures to diagnose cirrhosis:

  • Liver and Kidney Function Test
  • Blood Test
  • Magnetic resonance elastography or MRE
  • MRI, CT and ultrasound
  • Biopsy

How is Cirrhosis Treated?
Treatment for cirrhosis will depend on the cause and extent of liver damage. The goals of treatment are to:

  • slow the progression of scar tissue in the liver
  • prevent or treat symptoms and complications of cirrhosis

For cirrhosis caused by alcohol abuse, the person must stop drinking alcohol to halt the progression of cirrhosis. If a person has hepatitis, the doctor may prescribe steroids or antiviral drugs to reduce liver cell injury. Liver transplantation may be needed for some people with severe cirrhosis.

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What is Crohn's Disease?
Crohn's disease is a chronic, inflammatory disease of the gastrointestinal tract. It is an autoimmune disorder, meaning your body's immune system mistakenly attacks healthy tissue in your body.

Crohn's disease is chronic, and may appear and disappear at various times. Initially, it may affect only a small part of your gastrointestinal tract, but the disease has the potential to progress extensively.

Crohn's disease appears early in life; approximately one-sixth of patients have symptoms before 15 years of age. Although the cause is unknown, doctors suspect a genetic influence, since many members of the same family may be affected.

What are the Symptoms of Crohn's Disease?
Crohn's disease often begins in a person's teens or twenties, though some patients experience symptoms even earlier. Most common symptoms include:

  • Abdominal cramps
  • Diarrhea
  • Weight loss
  • Fever
  • Anemia

How is Crohn's Disease Diagnosed?
Our gastroenterologist may suspect Crohn's disease based on your medical history and a review of your symptoms. You may have you undergo several tests and procedures to help determine a diagnosis. These tests and procedures include:

  • Blood test
  • Stool sample
  • Small bowel enteroscopy
  • Colonoscopy
  • CT scan

How is Crohn's Disease Treated?
Treatment for patients with Crohn's Disease include medication, and in severe cases, surgery. Because it is a disorder of the immune system, in which the body attacks cells within the colon, the goals of treatment are to suppress inflammatory episodes (causing the disease to go into remission) and to improve quality of life.

Common treatments for Crohn's Disease include:

  • Medication
  • Surgery
  • Nutrition counseling

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What is Diverticulosis and Diverticulitis?
Diverticulosis is a condition that develops when pouches, called diverticula, form in the wall of the colon.

In diverticulosis, the pouches in the colon wall do not cause symptoms. Diverticulosis may not be discovered until tests are done to find the cause of a different medical problem or during a screening exam.

What are the symptoms of diverticular disease?
Each individual may experience symptoms differently. Some of the more common symptoms may include:

  • Diverticulosis. Diverticulosis may not cause any discomfort or symptoms, but could include mild cramps, bloating, and constipation. These symptoms may be caused by irritable bowel syndrome, stomach ulcers, or other problems, and do not always indicate diverticulosis.
  • Diverticulitis. The most common symptom is abdominal pain and the most common sign is tenderness around the left side of the lower abdomen. When infection is the cause, fever, nausea, vomiting, chills, cramping and constipation may also occur.
  • The symptoms of diverticular disease may resemble other medical conditions or problems. Always consult your doctor for a diagnosis.

How is Diverticulitis Diagnosed?
In addition a complete medical history and physical examination, your doctor may perform one or more of the following tests:

  • rectal examination to feel for tenderness, blockage, or blood.
  • stool sample
  • abdominal ultrasound
  • computerized tomography scan
  • barium enema
  • flexible sigmoidoscopy
  • colonoscopy
  • X-rays

How is Diverticulitis Treated?

Specific treatment for diverticular disease will be determined by your doctor based on:

  • Your age, overall health and medical history
  • Extent of the disease
  • Your tolerance for specific medications, procedures or therapies
  • Expectations for the course of the disease
  • Your opinion or preference

Options for treatment may include:

  • Increasing dietary fiber intake
  • Medication to control pain, inflammation and/or muscle spasms
  • Resting the colon, with liquid diet and bed rest
  • Surgery may be needed in severe cases

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What is Fatty Liver?
Fatty liver or steatosis of the liver, is one of the most common reasons people have abnormal liver blood tests. When the balance in the liver function changes, fat droplets can accumulate in the liver.

Most often fatty liver occurs in persons with obesity or type 2 diabetes. Some medications can cause fatty liver. The most important factor in fatty liver is insulin resistance.

How is Fatty Liver Diagnosed?
There are usually no symptoms that are noticeable to the patient. Fatty liver is frequently uncovered during a routine physical examination. There may be a rise in certain liver enzymes found in the blood, and sometimes the liver is slightly enlarged. Fatty liver may also be discovered while the physician is evaluating a patient for other illnesses.

How is Fatty Liver Treated?
In most instances, treatment of fatty liver requires control of the underlying conditions. This may include:

  • Reducing high blood triglycerides
  • Good control of diabetes
  • Severely limiting alcohol intake
  • In some cases, surgical reversal of intestinal bypass for obesity is required

Since being overweight is by far the most critical factor, weight loss is the key to ridding the liver of fat.

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What are Gallstones
Gallstone disease is the most common disorder affecting the biliary system, the body's system of transporting bile. Gallstones are solid, pebble-like masses that form in the gallbladder or the biliary tract (the ducts leading from the liver to the small intestine). They form when the bile hardens and are caused by an excess of cholesterol, bile salts or bilirubin.

What are the symptoms of Gallstones?
As gallstones move into the bile ducts and create blockage, pressure increases in the gallbladder. Symptoms of blocked bile ducts are often called a gallbladder "attack" because they occur suddenly. Gallbladder attacks often follow fatty meals, and they may occur during the night. A typical attack can cause

  • steady pain in the right upper abdomen that increases rapidly and lasts from 30 minutes to several hours
  • pain in the back between the shoulder blades
  • pain under the right shoulder

Notify your doctor if you think you have experienced a gallbladder attack. Although these attacks often pass as gallstones move, your gallbladder can become infected and rupture if a blockage remains.

People with any of the following symptoms should see a doctor immediately:

  • prolonged pain (more than five hours)
  • nausea and vomiting
  • fever or chills
  • yellowish color of the skin or whites of the eyes
  • clay-colored stools

Many people with gallstones have no symptoms; these gallstones are called "silent stones." They do not interfere with gallbladder, liver or pancreas function and do not need treatment.

How are gallstones diagnosed?
Gallstones, especially those that are asymptomatic, are often discovered accidentally during an imaging scan for another problem. Common ways to diagnose gallstones include:

  • Ultrasound
  • CT scan
  • Endoscopic Retrograde Cholangiopancreatography or ERCP
  • Endoscopic Ultrasound or EUS

How are gallstones treated?
If you have gallstones without symptoms, no treatment is required. However, if you are experiencing frequent gallbladder attacks, you may need to have a cholecystectomy (removal of the gallbladder). Surgery to remove the gallbladder - a nonessential organ - is one of the most common surgeries performed on adults in the United States. Each treatment option has different outcomes, depending on your symptoms. The goal of treatment is to relieve the symptoms and prevent complications from developing.

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What is Gastroesophageal reflux or GERD?
GERD is a common condition in which the gastric contents move up into the esophagus. Reflux becomes a disease when it causes frequent or severe symptoms or injury. Reflux may damage the esophagus, pharynx or respiratory tract.

There is a difference between GERD and heartburn. Our gastroenterologist specialists can determine if you have GERD.

What are the Symptoms of GERD?
The main symptom of GERD is heartburn, and regurgitation of sour or bitter liquid to the throat or mouth. The combination of heartburn and regurgitation is such a common characteristic of GERD that formal testing may be unnecessary. Other symptoms of GERD include:

  • Non-burning chest pain, which is usually located in the middle of the chest and radiates to the back
  • Difficulty swallowing (dysphagia)

How is GERD Diagnosed?
A diagnosis of GERD starts with a thorough physical examination during which you describe your symptoms and medical history. If the typical symptoms of reflux disease are present, including heartburn and regurgitation, your doctor may begin treatment without performing specific diagnostic tests.

In some cases, the following test may be needed:

  • Upper endoscopy
  • Reflux testing, or Wireless pH/pH Impedance)
  • Esophageal manometry
  • Barium esophagram

How is GERD Treated?
There are two main approaches to treating GERD.

  • medication
  • surgery

Most patients can effectively use a combination of lifestyle changes and drug therapy to treat their GERD. However, surgery is an option for patients who do not respond to medical treatment.

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What are Hemorrhoids?
Hemorrhoids are veins, normally present in and around the anus and lower rectum, that have become swollen due to stretching under pressure.

Hemorrhoids may develop as a result of repeated straining during bowel movements, pregnancy, heredity, aging, and chronic constipation or diarrhea.

What are the symptoms of Hemorrhoids?
The following are the most common symptoms of hemorrhoids:

  • Bright red blood present on the stool, toilet paper, or in the toilet bowl
  • Irritation and pain around the anus
  • Swelling or a hard lump around the anus
  • Itching

How are Hemorrhoids Diagnosed?
The presence of blood in the stool can be indicative of other digestive disorders, including colorectal cancer, so thorough evaluation and proper diagnosis is important. Diagnosing hemorrhoids may include:

  • Physical examination
  • Digital rectum examination
  • Anoscopy
  • Proctoscopy
  • Sigmoidoscopy
  • Colonoscopy

How are Hemorrhoids Treated?
Medical and surgical treatments are available for hemorrhoids, depending on the individual and severity.

Medical treatment of hemorrhoids is aimed at relieving symptoms and may include the following:

  • Sitting in plain, warm water in the tub several times a day
  • Ice packs to reduce swelling
  • Application of hemorrhoidal creams or suppositories
  • Increasing fiber and fluids to soften stools

Several surgical techniques are used to remove or reduce internal and external hemorrhoids. These include the following:

  • Rubber band ligation
  • Sclerotherapy
  • Electrical or laser coagulation or infrared photocoagulation
  • Hemorrhoidectomy

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What is Hepatitis?
Hepatitis is an inflammation of the liver. Hepatitis is caused by a number of things including alcohol, drugs, chemicals and viral infections. If the inflammation of the liver continues at least six months or longer, it is called chronic hepatitis. Chronic hepatitis can lead to scarring.

What are the Symptoms of hepatitis?
Viral hepatitis is difficult to diagnose because the symptoms are vague and similar to a flu-like illness. In other cases, there are no symptoms at all. Some individuals with viral hepatitis experience or develop:

  • Jaundice
  • Fatigue
  • Nausea
  • Vomiting
  • Diarrhea
  • Abdominal discomfort
  • Muscle and joint aches
  • Changes in the color of urine and stools

How is Hepatitis Diagnosed?

  • liver enzymes
  • antibodies to the hepatitis viruses
  • viral proteins or genetic material (viral DNA or RNA)

How is Hepatitis Treated?
Treatment for hepatitis will vary depending on the underlying cause.

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What is Irritable Bowel Syndrome?
Irritable bowel syndrome is a disorder characterized most commonly by cramping, abdominal pain, bloating, constipation, and diarrhea. IBS can cause a great deal of discomfort and distress, but it does not permanently harm the intestines and does not lead to a serious disease. Most people can control their symptoms with diet, stress management and prescribed medications. For some people, however, IBS can be disabling. They may be unable to work, attend social events or even travel short distances.

What are the Symptoms of Irritable Bowel Syndrome?
Abdominal pain, bloating and discomfort are the main symptoms of IBS. However, symptoms can vary from person to person. Some symptoms include:

  • Constipation
  • Straining and cramping when trying to have a bowel movement but cannot eliminate any stool
  • Only being able to eliminate only a small amount
  • Mucus in the stool
  • Diarrhea
  • Constant urge to pass bowel movements

How is Irritable Bowel Syndrome diagnosed?
IBS is generally diagnosed on the basis of a complete medical history that includes a careful description of symptoms and a physical examination.

There is no specific test for IBS, although we may perform diagnostic tests to rule out other problems. These tests may include sigmoidoscopy, colonoscopy, stool sample testing, blood tests, and X-rays.

How is Irritable Bowel Syndrome treated?
Currently, there is no cure for IBS, but there are many options available to treat the symptoms. Our physicians will work together with you to give you the best treatments for your particular symptoms and encourage you to manage stress and make changes to your diet. We may also prescribe various medications to treat IBS, depending on the severity.

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What is Pancreatitis?
Pancreatitis is the inflammation and autodigestion of the pancreas. Autodigestion describes a process whereby pancreatic enzymes destroy its own tissue leading to inflammation. The inflammation may be acute or chronic. Acute pancreatitis usually involves a single "attack," after which the pancreas returns to normal. Severe acute pancreatitis can be life-threatening. In chronic pancreatitis, permanent damage occurs to the pancreas and its function, often leading to fibrosis.

What are the Symptoms of Pancreatitis?
Each individual may experience symptoms differently. Some common symptoms may include:

  • Abdominal pain that may radiate to the back or chest
  • Nausea
  • Vomiting
  • Rapid pulse rate
  • Fever
  • Swelling in the upper abdomen
  • Fluid buildup in the abdominal cavity, called ascites
  • Dropping blood pressure
  • Mild yellowing of the skin and eyes called jaundice

How is Pancreatitis Diagnosed?
In addition to a complete medical history and physical examination, diagnostic procedures for pancreatitis may include the following:

  • Abdominal X-ray
  • Various blood tests
  • Ultrasound
  • Endoscopic retrograde cholangiopancreatography or ERCP
  • CT or CAT scan
  • ECG or EKG
  • Magnetic resonance cholangiopancreatography or MRCP

How is Pancreatitis Treated?
Specific treatment for pancreatitis will be determined by your doctor based on a variety of factors. The overall goal for treatment of pancreatitis is to rest the pancreas and allow it to recover from the inflammation.

Treatment may include:

  • Hospitalization for observation and intravenous feeding
  • Endoscopic retrograde cholangiopancreatography or ERCP
  • Surgery
  • Antibiotics
  • Avoiding alcohol if the pancreatitis is caused by alcohol abuse
  • Pain management
  • Frequent blood tests to monitor electrolytes and kidney function
  • No food by mouth for several days
  • Bed rest or light activity only
  • Placement of a tube inserted into the nose that ends in the stomach, called a nasogastric tube

Individuals with chronic pancreatitis may also require:

  • Enzyme supplements to aid in food digestion
  • Insulin, if diabetes develops
  • Small high-protein meals
  • Medications (for example, H2-blockers) to decrease gastric acid production in the stomach

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What are Swallowing Disorders?
Swallowing occurs without us even thinking about it, yet it is a complex and vital function. It is very important to eating and social interaction. Swallowing disorders may result from a lack of coordination of the nerves or muscles, or sometimes from tumors. Dysphagia, or trouble with swallowing, refers to two problems:

  • An awareness of difficulty in swallowing
  • Any swallowing disorder, such as painful swallowing, coughing during or after swallowing, or vomiting or regurgitation after swallowing

What are the Symptoms of Swallowing Disorders?
Our experienced gastroenterologist is specially trained to help diagnose all types of swallowing disorders. It is important to make an appointment with a gastroenterologist if you are having any of these symptoms:

  • Dysphagia, a sense of food "sticking" on the way down and difficulty passing food or liquid from the mouth to the esophagus to the stomach
  • Coughing during or immediately after swallowing
  • Choking, a feeling of food or liquid sticking in the throat or esophagus followed by coughing
  • Regurgitation
  • Nasal regurgitation
  • Sore throat
  • Hoarseness
  • Shortness of breath
  • Chest discomfort or pain

How are Swallowing Disorders Diagnosed?
Our physicians have years of experiencing diagnosing and treating all types of swallowing disorders. Diagnostic procedures your doctor may order include:

  • Endoscopy
  • Barium esophagram
  • Esophageal manometry
  • Wireless pH testing
  • 24-hour pH impedance

How are Swallowing Disorders Treated?
Treatment for swallowing disorders needs to be individualized because they encompass a wide variety of conditions and causes. Our physicians will create a specific treatment plan based on the severity of your symptoms and how they affect your quality of life.

Once we diagnoses the exact type of swallowing disorder you have, an individualized treatment plan can begin immediately. Treatment options include:

  • Medication
  • Swallowing retraining
  • Botulinum toxin
  • Dilation
  • Enteral feeding
  • Esophageal stent placement
  • Surgery

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What is Ulcerative Colitis?
Ulcerative colitis is an inflammatory bowel disease that causes long-lasting inflammation and ulcers in your digestive tract. Ulcerative colitis affects the innermost lining of your large intestine and rectum. In most cases, symptoms develop over time, rather than suddenly. The combination of inflammation and ulceration can cause abdominal discomfort and frequent emptying of the colon.

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

What are the Symptoms of Ulcerative colitis?
Most people with ulcerative colitis have mild to moderate symptoms. The symptoms can vary, depending on the severity of inflammation and where it occurs. Depending on the severity and location, patients may experience the following symptoms:

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


How is Ulcerative Colitis Diagnosed?
Your doctor will make a diagnosis based on your medical history, a physical examination, and a series of tests. To help confirm a diagnosis of ulcerative colitis, you may have one or more of the following tests and procedures:

  • Blood tests
  • Stool sample
  • Colonoscopy
  • Flexible sigmoidoscopy
  • X-ray
  • CT scan

How is Ulcerative Colitis Treated?
The primary goal in treating ulcerative colitis is to help patients regulate their immune system better. While there is no known cure for ulcerative colitis, a combination of treatment options can help you stay in control of your disease.

Treatment for ulcerative colitis is multifaceted and may include:

  • Anti-inflammatory drugs
  • Immune system suppressors
  • Other medications such as anti-diarrheal medications, pain relievers
  • Diet and nutrition management
  • Removal of the colon called colectomy

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