By Dr. A. Minocha, author of "How To Stop Heartburn: Simple Ways to Heal Heartburn and Acid Reflux" and "Natural Stomach Care: Treating and Preventing Digestive Disorders with Best of Eastern and Western Therapies"
Dr. Minocha's Series on Digestive Myths & Healthy Realities....
At the same time, I encounter a lot of deep rooted convictions regarding our digestive system among the people I meet. Inability to keep up with the exponentially increasing fund of new medical knowledge and information coming out everyday has even some health care providers overwhelmed and still clinging to the old concepts. This daily series will allow us to cut through the chase and separate some of the facts from the fiction.
WEEK NO. 1 (June 21, 1999-June 27, 1999)
A normal lower GI scope means I do not have colon polyps/cancer ....
The term normal although appears definitive is a relative term in relation to colonoscopy and depends on a variety of factors. As many as one in 20 cancers are missed on colonoscopy. If polyps have been found, a repeat exam may reveal more polyps in as many as 20-30% cases. Missing of important abnormalities occurs due to a variety of factors. These include poorly cleaned colon or increased movements of colon during the examination. Polyps may be hidden behind the large colon folds and not easily visible. This happens especially where the colon makes sharp turns (just like it is easy to miss seeing an object on a winding road than on a straight road).
WEEK NO. 2 (June 28, 1999- July 4,1999)
Scope (gastroscopy/colonoscopy) can not be done without sedatives....
So you have been advised a upper or lower "scope" for your digestive problem. I frequently hear from my patients, "I must be put to sleep for that, otherwise I won’t be able to handle it". The use of sedation for the "scope" tests is practiced primarily in the US and other western countries. It is based on the belief that the scope is easier to perform and is better tolerated by the patient. The scientific data on both these issues is controversial. There is no question that sedation carries risks although they are rare. Use of sedatives also prevents the patients from working that day. I have had a few patients (emphasis on few), who insisted that they not get any sedation because they like to know what is going on with their body and also did not want to take the whole day off for the procedure. Be that as it may, use of sedatives is the standard of care in the US for most scope procedures.
WEEK NO. 3 (July 5, 1999 - July 11, 1999)
Lower GI scope (colonoscopy) is very painful...
I will let you be the judge! Sedatives and not general anesthesia are usually used for the performance of colonoscopy. While there are never any guarantees in life, about 90% of our patients tell us after the test that it was not as bad as they thought. They usually say that the use of laxatives to clean the bowel, and the anxiety about the test are worse than the procedure. As many as 70-80% of the patients (including my father!) do not have any recollection of the procedure. On top of that, most people who have undergone both barium enema as well as colonoscopy tell us that the colonoscopy is easier.
(FROM HERE ON PARTS OF SERIES WILL BE POSTED DAILY INSTEAD OF WEEKLY)
DAY NO.1...
I won�t be able to undergo upper GI scope because I have horrible gag reflex...
I have heard this story from about 80% of my patients and they are not kidding. The cooperation from the patient facilitates the passage of the scope across the throat and in to the food passage. Ultimately, it is a question of mind over matter. In practice, it is relatively easy because we use a local anesthetic to numb the throat and also give intravenous sedatives. Overall, "bad" gag reflex is not a big deal in most instances.
DAY NO. 2 ...
CT scan is better than GI scope (endoscopy) for examining the bowels...
This concept is frequently brought up by my patients when I recommend a colonoscopy or gastroscopy. They are quick to ask, "Why not CT scan or MRI"? Well, every test, howsoever good cannot be good for everything. The CT scan is good for solid structures in the body but is an insensitive method of detecting diseases of the hollow structures such as the the bowels. CT scan may be able to detect abnormalities in latter cases when the disease is severe. In case of cancer, the horse would already be out of the barn by then. However, if we find a cancer on scoping the patient, CT scan is frequently performed to look for spread of cancer to other parts of the body especially solid organs like liver and lungs etc.
DAY NO. 3 ...
The procedure to localize the site for biopsy of liver is standard..
Liver biopsy, like any other procedure, is prone to complications and rarely even death. The needle has to be inserted into the liver through the chest wall. Thus it is important to be sure that it is really the liver underneath the chest wall where needle is being inserted. If wrong, the big needle may be going some where it is not supposed to, e.g. lungs. Many physicians can discern the location of the liver by tapping on the chest wall. The part of the chest overlying lungs sounds hollow because of air in the lungs. The chest wall overlying the liver sounds dull because the underlying liver is a solid structure. Some physicians are not comfortable with the tapping method and have the liver localized by the ultrasound. Still others use fluoroscopy (x rays) to help them with the localization procedure.
DAY NO. 4 ...
Changing the medication from pill to solution form does not affect digestion...
This is a very popular misconception, even among many health care providers. The pill/capsule form has the active drug and some inactive compounds used in formulating the pill or capsule. In contrast, many of the solutions or suspensions of the drugs are prepared in sweeteners like sorbitol. Sorbitol is a poorly absorbed sugar and can act as a laxative leading to diarrhea.
DAY NO. 5 ...
Fiber is good for constipation and not diarrhea...
Fiber is equated with a "laxative" among lay people because of its benefits in constipation. Little known fact is that the increased fiber intake may be prescribed for diarrhea also. Fiber adsorbs water from the liquid stool. This results in solidification of loose stools and improvement of diarrhea.
DAY NO. 6 ...
There are two types of fibers, soluble and non-soluble. Cellulose is a type of insoluble fiber and it increases the bulk of stool. Diet in Asian and African countries is rich in non-soluble fiber. Soluble fibers , some of them synthetic, are viscous, bind water, and have a laxative ability. This occurs by increasing osmotic pressure as well as increasing the stool bulk. In addition, the bacterial breakdown of these carbohydrates produces substances that have laxative action. Metamucil containing psyllium and fiberCon containing calcium polycarbophil are examples of commercially available soluble fibers.
DAY NO. 7 ...
While the primary function of antacids is to neutralize the acid in the stomach, they can have variable actions on the rest of the bowel depending on the type of antacid. For example, antacids containing calcium (Tums), and aluminum (AlternaGel) have a constipating effect on the bowel. In contrast, the magnesium containing antacids (mylanta, malox) have a laxative effect. For my patients, I usually suggest using these two types alternately so that the opposing effects of different antacids on the bowel can offset each other. This minimizes the side effects while providing the required antacid effect. Do not forget that calcium containing antacids are a source of much needed calcium in many people.
DAY NO. 8 ...
Antibiotics that treat infections do not affect digestion..
Indeed antibiotic related diarrhea is fairly common. The spectrum of diarrhea related to antibiotics is very diverse. Frequently it is mild and goes away on its own.. On occasions, it can be very severe and have bleeding associated with it. This occurs due to a toxin produced by a bacteria called Clostridium difficile and the entity is called C. difficile colitis or pseudomembranous colitis. Antibiotics targeted specifically at C. difficile are then required for treatment.
All fat deposited in the body is same metabolically....
Fat deposited in the abdomen (increasing your waist line) poses more medical problems than that deposited in the hips. However, this belly fat is also the one that is metabolically more active and thus it is the first one to disappear when we lose weight. In the evolutionary context, the hip fat was meant as a food storage warehouse to be used in times of need and thus important for survival of life.
DAY NO. 10 ...
Most overweight people were overweight as kids....
While most kids who are overweight will go on to be overweight as adults, most of the overweight problem occurs among those who used to have normal weight during the childhood.
DAY NO. 11 ...
If overeating is an addiction, it should be easier to handle than smoking....
In the context of addiction, overeating can be more difficult to overcome than the smoking. In case of smoking, once you quit you are done with it. On the other hand, the overeating person has to live with the eating process while avoiding overeating. It may thus be equated with a chronic illness to be battled constantly.
DAY NO. 12 ....
It is a well known fact that obesity leads to a higher risk for a variety of medical problems including diabetes, high blood pressure etc. Many people don’t undertake weight reduction program because they feel that they won’t be able to lose all the excess weight and not derive the medical benefits. In contrast to popular misconception, even a modest 10-15% reduction in weight in overweight patients can lead to tremendous medical benefits like improvement of blood pressure, diabetes etc.
DAY NO. 13 ....
Exercise alone is sufficient to lose weight...
I frequently hear my patients say, "I work out a lot, still I am not losing weight". While good for physical health and well being, exercise by itself is a very poor method of weight reduction. It is difficult to do the enormous amount of exercise required to affect meaningful weight reduction. In addition, the increased exercise is frequently accompanied by an increased appetite and a meal of burger/fries etc. which more than offsets the calories lost during the exercise. Exercise however, is an excellent method for maintaining a particular weight once a desired level has been accomplished.
Surgery is the best treatment for obesity...
"Why not just undergo operation for obesity rather than put up with rigid diet control programs". Surgery has only a restricted role for treatment of weight problems and should be undertaken after a lot thoughtful discussions between the patient, the family, and the physician. Like other treatments of obesity, the long term success is depends upon the motivation of the patient and his/her determination to make appropriate life style changes. An unmotivated patient is a perfect recipe for a failed surgery.
Fiber in diet does not have any side-effects..
I frequently hear this common misconception even among many health care providers. Many soluble fibers are broken down by the bacteria in the colon. This produces gas which can be troublesome. The bowel usually adapts well to the increased gas within a few days in most patients. The fiber can also bind to nutrients in the gut e.g. calcium, iron and zinc. This may cause decreased absorption of these minerals. Some types of fibers may also bind to the drugs ingested e.g. digoxin and prevent their absorption. Sometimes, the fiber may just form a big glob of stool mass unwilling to move and produce a situation mimicking obstruction. Allergic reactions have been reported extremely rarely with plant gums. Nevertheless, in most cases, the benefits of fiber intake would far outweigh the risks. Putting it in proper context, the fiber supplements appear to have the least toxic potential among the laxatives.
Fruit juices don�t produce gas because they don't have fiber...
Fruit juices contain various kinds of sugars, some of which are not digested and absorbed. These unabsorbed sugars reach the colon where they are attacked by bacteria and broken down. This produces gas. Apple, pears and grapes produce much more gas than orange and pineapple. Remember, it is not the fiber per say, but the carbohydrate (sugars) reaching the colon that are subject to breaking down by bacteria and causing gas production.
I cannot do anything to help my acid reflux. Only my doctor can...
Of course you can do a lot! Most patients with reflux actually never see a doctor and even fewer see a digestive disease specialist. Changes in lifestyle are important and have a positive impact on acid reflux disease. Dietary changes include avoidance of heavy meals, chocolate, mint, onions, peppers etc. In short, anything that is good to the palate may be bad for the reflux. Not eating for at least two hours before bedtime and avoiding bedtime snack are other important dietary measures. Raising the head end of the bed (use 6" block under the bed) further prevents acid reflux during sleep. Smoking is generally bad for everything and that includes reflux disease.
A cup of coffee after drinking alcohol will sober me up...
Although coffee is a stimulant, it does not have a significant role in sobering up after drinking alcohol. Drinking coffee late in the day should be avoided if you have difficulty in falling asleep. Coffee should also not be used as a stimulant to do exercise. Exercise itself is an excellent stimulant.
Smoking increases risk of cancer of lung only...
Smoking is bad and places the people at higher risk for cancers of the head and neck region as well as the cancers of digestive tract. For example, smoking increases the risk of cancer of esophagus but when combined with chronic alcohol use, the increase in risk is exponential. Use of more than 120 g of alcohol (12 oz of 86 proof alcohol) when combined with more than 3 packs per day of cigarette smoking increases the relative risk of cancer of the esophagus by 156 times.
DAY NO. 20 ...
Heart burn is due to excess acid...
This popular belief is buttressed by the fact that we frequently treat heartburn or abnormal acid reflux by antacids and acid blocking medications. Heartburn is not due to excess acid in most instances. In fact, the actual amount of acid in the stomach is normal. However, the acid is at the wrong place, i.e. it is going up from the stomach to the esophagus. Because of lack of effective drugs aimed at the underlying factors promoting acid reflux, the treatment is targeted at the acid instead.
The origins of this myth go back several decades when bland diets were instituted as a substitute for starvation diet for the treatment of ulcer disease. However, we now know that the ulcers are primarily related to infection in the stomach as well as to the use of certain drugs that may injure stomach wall. Stomach acid is less important. Bland diet thus does not have a significant role in healing the ulcers although we do "feel good" because we are actively participating in the healing process beyond the use of drugs.
Difficulty in swallowing is "all in my head"...
Difficulty in swallowing, technically known as dysphagia may occur due to a variety of causes. One cause of dysphagia involves problems of the nerves and muscles of the throat. This prevents a coordinated transfer of food from the throat to the food pipe. The other type is an abnormality of the esophagus not pushing food down to the stomach. The abnormality may be an obstruction to the flow in downward direction or may involve abnormal functioning of the muscles of the esophagus. Stress does not cause dysphagia but may worsen it especially when the functioning of the nerves/muscles are involved.
The presence of stones in the gall bladder does not mean that symptoms are necessarily caused by them. As many as 10% of the western population has gall stones. However, the incidence of symptoms due to gall stones is very low. One study suggested an incident rate of symptomatic gall stones to be 2 percent. Neither age, sex, nor the number or size of gall stones may predict who will develop symptoms.
Removal of gall bladder does not cause problems long term..
While most patients who undergo cholecystectomy (removal of gall bladder) feel better with respect to their symptoms, as many as 5% may suffer more severe symptoms. As many as one-fourth to one-third of the patients may suffer persistent discomfort in the region of their gall bladder that has been removed. These problems may start soon after the operation or may occur years later. They occur more commonly among women and in those in whom there was no significant abnormality of gall bladder found upon operation. Some patients may also develop chronic diarrhea.
Every person with gall stones should have gall bladder removed..
Gall stones are a very common condition and usually do not cause problems. The management of gall stones that are not causing symptoms is "to do nothing". People who may not have access to adequate health care for prolonged periods e.g. sailors and missionaries may be an exception. It used to be thought that patients with diabetes should have prophylactic cholecystectomy (gall bladder removal). Such is no longer the case. Is there a risk of cancer of gall bladder if gall bladder is allowed to remain? Although the risk is always there, it is so small that the risks of surgery outweigh the benefits. An exception to this rule would be if the gallbladder is calcified.
Gallstones can be effectively treated with non-surgical methods...
My patients frequently ask me, "What about treating gall stones without surgery". Surgical removal of gallbladder is the treatment of choice for gallstones causing symptoms. The medical treatment of symptomatic gall stones is generally not recommended because of high cost, poor efficacy. In addition, stones tend to come back after the treatment is stopped. Non-surgical treatment is a viable alternative in patients who are high surgical risk or refuse surgical treatment. Patients with small stones that are not calcified are the best candidates.. Shock-wave lithotripsy (breaking of stones by ultrasound shock waves) is a safe and effective method of breaking down the gall stones into small pieces. Again, results are best seen in stones less than 2 cm in diameter. Results are poor if several stones are present. This form of treatment does not get rid of the fragments of the stones from the gall bladder. When lithotripsy is combined with medications in appropriately selected patients, it may result in a stone free period of 12 months in as many as 80-90% of the patients.
Gall stones are very common and of course, gas in bowels is ubiquitous. Therefore, it is not surprising that many people with gas problems also have gall stones. It is true that people with gall stones have greater feeling of gassiness and bloating. These symptoms may or may not improve after the removal of gallbladder. However, the bowel gas is not associated with the problems related to gall stones.
The gas I pass as flatus comes from swallowed air...
Did you really believe that! Only a small component of gas passed as flatus is derived from the swallowed air. Most of the air we swallow is actually absorbed across the bowel wall into the blood stream. Very little of this reaches the rectum. Surprise! Surprise!! Most of the flatus is actually a result of breaking down of unabsorbed carbohydrates reaching the colon. This breaking down occurs as a result of the attack by the bacteria present in colon. Diet high in certain kinds of carbohydrates as well fiber in the diet are excellent sources of gas and consequently flatus production.
DAY NO. 29 ...
"Gas" is a big social issue and inappropriate revelation can make the person butt of jokes, no pun intended. We must however understand that gas is an important part of normal digestive processes. Different foods may produce different amounts of gas. However, producing gas is not an abnormality although it can be a social embarrassment. Everyone produces and passes gas everyday. Even the Presidents and the First ladies. Wow! Isn't that cool!
It is abnormal when flatus gases light up...
Have you heard of the flatus being ignited? It is not uncommon in college dorms that some prankster would light up a match close to anus and then pass flatus which lights up. This occurs because the expelled air contains certain combustible gases which burn on exposure to source of fire.
Composition of flatus is the same among different people
While the basic gases are the same, there can be some qualitative and quantitative differences. Approximately one third of the world’s population has methane producing bacteria that lead to production of methane gas. The aroma/odor of the flatus also depends upon the relative proportion of certain pungent gases.
Reports of explosions occurring in bowel are false...
Can you imagine a blast occurring inside the colon. No kidding! Actually explosions have occurred in the bowel during procedures when electric cautery is applied. When stool is present in the colon, there is fermentation of unabsorbed carbohydrates by the bacteria. Gases are produced as a result of these breaking down process. Many of these gases are explosive and combustible. Exposure to electric current may result in explosion in the colon (just like a bomb literally) and such cases have been reported in scientific literature. Therefore, during lower GI scope (colonoscopy), we do not use electric current if the colon has not undergone adequate cleansing using cathartics/enemas etc.
Frequency of flatus is proportional to the amount of gas in the colon...
The frequency of flatus is variable and so is the amount of gas passed. Some people pass small amounts frequently. Others may pass large amounts of gas but fewer number of times. Frequently, the complaint of excess gas implies the foul odor with its associated social embarrassment and not so much as the amount. It is also possible that some people especially those with irritable bowel syndrome are more sensitive to the presence of gas. They sense more distress in response to the amounts of gas that are not bothersome to others.
Older people produce more gas...
The amount of gas produced is not significantly changed as we grow older. However, our bowel wall is more rigid and less distensible or elastic. Thus, the bowel is more sensitive to the presence of smaller amounts of gas. As such, as we grow older, we are less able to hold the gas in the rectum and pass small amounts of gas more frequently.
All onions are created the same as far as gas is concerned.
The amount of gas produced in the colon and thus expelled as flatus varies with the type of onions ingested. Thus the italian onions produce 2-3 times the gas as compared to the Dutch onions. Thus choice of onions for your meal does matter. The same explanation would apply to foods of other types.
Men produce more gas than the women...
How many times have we heard that? Popular culture especially the ladies and the beer drinking guys would have us believe that. One study actually examined this issue and found that men pass flatus more frequently and also the odor is more offensive. However, this study was not very well designed. The subjects themselves rated their flatus and there were no objective parameters measured. Thus the jury is still out on this issue.
It is harmful to hold the gas...
It is not bad for health but may gradually grow into a habit. This holding of gas can give rise to feeling of gassiness and discomfort.
Foul odor of flatus indicates disease of the bowel...
The bad odor of the flatus is rarely related to the disease of the digestive tract. It is usually related to the types of foods ingested. Garlic, onions, herbs, and spices are more likely to lead to the bad smell of the flatus. Rarely however, it may be a bowel disease. For example, blood in the intestines when passed in feces has a unique and very offensive odor. Diseases of pancreas may also lead to foul smelling flatus. Generally speaking, however, foul odor is a benign process (may be malignant socially) and is related to our food habits.
Floating stool is a sign of indigestion and malabsorption...
This was the common teaching in medical schools until not too distant past. It was thought that the floating stools imply fat in stool as a result of fat malabsorption. This however, is not entirely true. A much more common cause of floating stools is the air trapped in the stool. This trapped air allows the stools to float.
Occasional blood in stool does not require medical attention ...
A very commonly heard expression is, "Oh I just had blood once!" Blood in stool can be due to simple causes like hemorrhoids. It may also be a signal of more ominous problems like polyps or cancer. Polyps and cancer usually do not bleed continuously. Rather, intermittent bleeding is the rule. Similarly the amount of blood should not be a deciding factor and you should always talk to your doctor. The same reasoning applies if you are given stool cards to check for inapparent blood in stools. Usually a three pack is given. Not infrequently, only one or two of those three may be positive for blood. Whether it is one, two or all the three cards, the management is generally the same.
I have constipation because I am getting old..
Constipation is a very common bowel problem. As many as 2% of the US population is affected. It accounts for about 3 million physician consultations each year. Almost half a billion dollars is spent each year on laxatives alone. The prevalence of constipation increases as we grow older and it increases exponentially as we go past our sixties. There are multiple reasons for this increase. These include use of constipating medications, decreased exercise as well as simultaneous occurrence of non-digestive diseases affecting the gut. The maturing process by itself is not a significant contributor.
It is possible to pinpoint a specific cause for constipation after tests...
Constipation is just a symptom and may occur due to a variety of disorders. Before treating, it is important to identify the underlying cause. Although we are good at investigating many of the well known causes, in as many as 50% of cases, we are unable to identify a particular cause despite extensive investigation. So much for the advances in medical knowledge! Treatment in such cases is directed at alleviating the symptom. Be that is it may, I would rather have no cause found than to be found to have a tumor blocking my colon and causing constipation!.
Irritable bowel syndrome and diverticulosis are the same...
IBS (irritable bowel syndrome) is characterized by symptoms of pain and abnormal bowel habit. The bowels do not show any evidence of structural abnormalities that would explain the symptoms. Diverticulosis on the other hand implies presence of diverticulum or diverticula (pockets) in the gut. These outpouchings or pockets do not cause symptoms in most instances.
Seeds and nuts are bad for diverticulosis (Dietary Restrictions for Diverticulosis )...
Dietary restrictions of nuts, seeds, corn or roughage are not required. Adequate fiber supplementation is believed to be helpful for painful diverticular disease.
Polyp merely means a protuberance on the lining of the bowel wall. The benign or cancerous nature can only be determined by its structure as seen under the microscope. The polyp may be benign or it may contain cancer. Some types of benign polyps have a high risk to change into cancer in future and thus are called premalignant.
Surgery is not an option, once colon cancer has spread beyond colon...
In not too distant past, this concept used to be felt as true. But there have been a lot of technologic advances in surgery lately, especially liver surgery. These days, a limited amount of spread to the liver does not preclude surgery as an option to treat colon cancer. However, this is not a viable option if the extent of cancer is widespread.
Ischemic colitis usually requires surgery...
Ischemic colitis is inflammation of the colon as a result of reduction of blood flow to a particular part of the colon. This is similar to a heart attack. In most cases, it is mild and gets better without treatment and without any long term problems. In a minority of patients, the inflammation may become life threatening and may require surgery.
Once affected, ischemic colitis keeps coming back...
Ischemic colitis occurs due to a disease process causing a reduction of blood supply to colon. It therefore seems reasonable that the attacks of ischemic colitis should keep recurring. However, what makes sense is not necessarily always true. In most cases, the attacks of ischemic colitis do not recur.
Ulcerative colitis and Crohn’s disease are diseases of the young...
These two conditions form a part of what is known as inflammatory bowel disease. The peak incidence of these conditions occurs in the second and third decade of life. However, there is a second peak of incidence that is observed among the senior citizens. This is also coincident with the increased use of aspirin like arthritis medications which can cause inflammation and ulcers in any part of the bowel.
Hemorrhoids are abnormal veins...
This used to be the conventional thinking until recently. However, now it is believed that hemorrhoids are "cushions" of blood vessels at the junction of rectum and anal canal. One of the functions ascribed to them is the "continent function" i.e. allowing the person to hold the passage of stool or gas when it may be socially inappropriate. These hemorrhoids are present in all of us and become medical problems in some of us.
Hemorrhoids arise as we become older and operation is the best treatment...
Hemorrhoids or the vascular (blood vessel) cushions as described above are present in all of us at birth. The prevalence of problems due to hemorrhoids increases as we grow older. Most hemorrhoidal problems are treated medically. Injection of drugs into hemorrhoids, local application of lasers and electric current have been tried but the results are variable. Surgery may be helpful in severe cases, but does have significant risk for complications.
Appendicitis is a disease of the young...
It is true that as many as two thirds of the cases occur primarily in the second and third decades of life. However, this also means that as many as one thirds occur at other ages. Given the overall prevalence of appendicitis to be 6% in the general population, one third of 6% is 2%. Thus 2% of the general population is a large number of people. Of course, folks beyond forty are not immune. As we grow older, appendicitis presents much less with typical signs and symptoms. In fact, older patients delay seeking medical attention and as many as one in four delay it as many as 72 hours. This delay in diagnosis and treatment makes the patient more prone to complications and death.
Pancreatitis is a benign condition...
Pancreatitis is the inflammation of pancreas and most of these cases are related either to gall stones or alcoholism. It is true that most (85-90%) cases have a mild course and good outcome. However, some people develop severe pancreatitis which can be life threatening. Physicians can usually predict which of the patients are likely to have a bad outcome based on their clinical status and certain laboratory tests.
HIV/AIDS occurs only in young folks...
How many times have you heard the expression," I am too old to get HIV". Folks, no one is immune. While more common in young folks, it is not uncommon to see HIV among people in their fifties and beyond. HIV can of course affect the digestive tract in a variety of ways including but not limited to infections, diarrhea, malnutrition and pancreatitis etc.
Angina occurs only in heart and not in the gut...
Indeed, blood flow is important for the intestines just as it is important for the heart. Reduction in blood flow results in pain in both these organs, except that the location is different. Angina of the heart is called angina pectoris and is associated with chest pain. In contrast, angina of the bowels is called intestinal angina and results in belly pain. In intestinal angina, there is pain upon eating and thus fear of eating and weight loss. Obviously, just like in angina of the heart, intestinal angina is more common as we grow older and depends on the severity of atherosclerosis.
The damage to the bowel occurs during the period of reduced blood supply and improves when the blood flow is restored...
You would think that the damage to bowel wall should occur primarily during period of reduced blood supply and would improve with restoration of blood flow. Actually, the damage to the bowel due to reduced blood flow is worsened when the blood flow resumes after a period of reduced blood flow. This is known as reperfusion injury and the damage to the bowel is actually worse than that during the period of reduced blood flow.
Injury due to spasm of arteries occurs in heart and not the gut...
Contraction of the arteries (vasospasm) is an important factor responsible for the worsening the damage to the bowel which occurs due to reduced blood flow. Sometimes this localized contraction or spasm of the blood vessels may persist long after the blood flow to the bowel has been restored. This results in a prolonged period of damage to the bowel wall.
Diabetes does not affect digestive health...
Diabetes mellitus affects the blood vessels to the digestive system and thus may cause blood flow problems to the bowel. In addition, diabetic diarrhea is a very common condition in patients with long standing diabetes. Patients with diabetes are more prone to develop infections of the digestive tract. Diabetes effects the entire body including eyes, kidneys, heart etc. and the digestive system is no exception.
Gluten free diet is only good for gluten sensitive enteropathy or celiac sprue...
Celiac sprue is a fairly common intestinal condition where the lining of the gut is damaged because of sensitivity to gluten. Gluten is a chemical contained in wheat, barley, rye and possibly oats but not in rice, corn or soya beans. The treatment of course is complete avoidance of gluten. Lay media as well as the internet is full of messages stating that "digestive symptoms improved upon cessation of gluten intake, therefore I must have celiac sprue". Intake of gluten containing breads can lead to formation of large amount of gas in the gut. Therefore, patients whose bowel wall is sensitive to distention e.g. irritable bowel syndrome, feel much better on taking gluten free diet. This improvement in symptoms upon cessation of gluten does not equate with the celiac disease or celiac sprue.
Atherosclerosis affects the heart, brain etc. and not the gut...
Atherosclerosis, a disease of the narrowing of blood vessels affects the blood supply to the digestive system just as it affects other organs. Therefore, similar to the ischemic heart disease affecting the heart, there is the ischemic bowel disease affecting the digestive system. It occurs more so in older folks or those with generalized diseases like diabetes. Just like heart attack causes damage to the heart and even death, the ischemic bowel disease can damage or even cause death of bowel wall. In some cases, the situation may become life threatening.
Diverticula occur only in colon...
Although colon is the most frequent site, diverticula or outpouchings may occur in any part of the digestive tract. Diverticula in the esophagus may lead to difficulty in swallowing. When they occur in stomach, they are usually asymptomatic. Diverticula in the small intestine may result in pain as well as growth of bacteria leading to malabsorption of the nutrients by the gut. However, most common location for diverticula is colon.
When I have a bowel movement during or soon after a meal, it means that ingested food is coming out without digestion...
The digestive tract is very long and it would be highly unusual for food to traverse the entire food pipe during or soon after eating. What actually happens is that the stomach and colon are connected by nerve-reflexes. The richer the food, the more the stimulation of the colon. This stimulated colon starts to act up, shaking things up inside the colon and the result is bowel movement. That is why many people drink warm water or coffee in the morning so as to facilitate the onset of bowel movement. Coffee or warm water in such cases is acting as a stimulant for the colon.
Irritable bowel syndrome (IBS) means I am irritable...
IBS is also known as the spastic colon. it is a poorly understood condition characterized by pain and altered bowel habit like constipation or diarrhea or alternating diarrhea and constipation. Routine tests do not show any abnormalities. Stress tends to accentuate the symptoms. Gut has a mind of its own! It is believed that these patients are much more sensitive to the provoking stimulus that may not cause symptoms in other individuals. However, pain is just not in the head! The pain is real and is felt as such.
Reflux of acid from the stomach to the esophagus is an abnormal phenomenon...
Contrary to this widely believed myth, the reflux of acid from the stomach up into the esophagus is a normal phenomenon. It normally occurs transiently, especially after meals. When the amount of reflux is excessive, it is considered abnormal and gives rise to gastroesophageal reflux disease or GERD.
Only patients with acid reflux disease may have increased risk for cancer of esophagus...
Conditions associated with increased risk for cancer of esophagus include head and neck cancers, use of alcohol and tobacco, Barrett�s esophagus, achalasia, celiac sprue, asbestos exposure, lye ingestion, Plummer-Vinson syndrome and Tylosis etc. Tylosis is a very rare inherited disorder characterized by thickening of skin of palms and soles.
Esophagus does not get infected...
Infections of esophagus though uncommon can occur especially in patients whose immune systems are suboptimal. They include patients with AIDS, diabetes etc. Type of infections include fungus as well as viral organisms. In a small fraction of patients with infected esophagus, no apparent abnormality of immune system can be identified.
A source of bleeding from digestive tract can always be identified...
It is not rare to be unable to identify the exact source of bleeding. Despite extensive investigations including endoscopies and a variety of scans, we may not be able to find the source in as many as 5-10% of the cases.
I can get cancer at only one site in colon...
A colon that is prone to have polyps is prone to have cancer and the colon with cancer is prone to more cancers. Thus it is not uncommon to find more polyps and in 10% of cases, another site of cancer in the colon within the same patient.
Removal of tonsils and appendix is inconsequential for digestive system...
Appendix and tonsils are full of lymphoid tissue that is involved in the immune system of the body. Their location is very strategic too. The tonsils are located at the gateway of entry into the digestive tract while the appendix is at the port of entry into the colon. Traditionally, it has been felt that their removal is inconsequential for digestive health. Preliminary evidence suggests that removal of tonsils or tonsillectomy is associated with decreased prevalence of Helicobacter pylori infection of the stomach. Similarly, appendectomy is felt to be protective against development of ulcerative colitis. The underlying mechanisms are not known and are under investigation.
Normal color stool means I do not have bleeding from the digestive tract...
Small amount of slowly oozing blood may go unnoticed for a very long time. Such small amounts of blood may not change the color of stool at all and the patient may continue to lose blood very slowly and without developing any symptoms of blood loss for a long time. It is not uncommon to detect blood in the stool on routine screening physical examination. I once saw a 60 year old who appeared very pale because he had been chronically losing blood and his hemoglobin was only 2g% (normal greater than 13g% depending on the lab).
Bright red blood from rectum means that bleeding is from colon or rectum...
While this presentation is typical for bleeding from colon or rectum, a massive bleed from upper digestive tract e.g. esophagus, stomach and small bowel may masquerade as lower source of bleeding. This occurs because large amount of blood acts as a cathartic causing a rapid passage of blood down the food pipe and out through the rectum. Historical details can provide important clues regarding the site of bleeding but are not infallible. Thus, a patient may on rare occasions undergo an emergent colonoscopy only to find that the source is higher up and then needs upper endoscopy.
Black stools means I am bleeding from the stomach...
Black stools may result from a variety of causes including bleeding from the digestive tract. Interaction of hemoglobin with the acid in stomach gives rise to black stools which are tarry. Black stools however may occur as a result of bleeding from any part of the digestive tract. The bleeding from colon is likely to result in black stools without tarry character or maroon/red color. Black stools may also result from ingestion of medications like iron and peptobismol.
More than one cause for bleeding is rare...
When it rains, it pours! As many as 30% of the subjects with upper gut bleeding may have more than one source of bleeding.
Cancer of esophagus is usually detected in an early stage...
Cancer of the esophagus is a very bad cancer to suffer from. Unfortunately, it is usually detected at an advanced stage. Even though progress has been made in medical therapies and surgical options, the overall outcome is not good in most cases. The effect of cancer is further devastating because, on top of the cancer, the patient is frequently unable to eat, thus affecting the quality of remaining life.
Which patients with upper gut bleeding are likely to rebleed is unpredictable...
While there are no certain methods of prediction, certain criteria can be used to predict the risk of rebleeding. For example, in cases of bleeding ulcers, the characteristics of ulcer as seen on endoscopy are good predictors as to whether the patient is likely to rebleed soon. Similarly, as many as one third of the patients bleeding from varices (engorged veins in esophagus and stomach due to liver disease) will rebleed within 30 days. Other characteristics of the veins as seen on endoscopy that predict risk of rebleeding include the size of varix etc. Thus estimation of the risk helps the physician determine whether to keep the patient in intensive care unit, general ward or discharge from the hospital.
All patients with bleeding ulcer must be admitted to the intensive care unit (ICU)...
The decision to admit the patient to the intensive care unit or to a general ward room is based on the clinical situation including the health of the patient, amount of blood loss and the speed at which the blood was lost. Certainly, patients with continued rapid blood loss are generally admitted to the ICU. In contrast, patients with slow oozing of small amounts of blood do not require ICU admission and may even be managed as outpatients. Similarly, patients who have stopped bleeding and are not at high risk to rebleed soon also do not need to stay in the hospital.
Gastritis is a well defined and understood condition...
The term gastritis is one of the most confusing terms used in digestive diseases. It means different things to different people (including various physicians) and the meaning may change based on the context of the situation. One of the major source of confusion until recently has been as the lack of agreement on what constitutes gastritis. The consensus these days is the presence of inflammation of the lining of the wall of stomach upon examination under the microscope constitutes gastritis. Another factor causing the disarray has been lack of our understanding regarding causes and mechanisms leading to gastritis. Stomach lining generally responds to most injurious stimuli in the same stereotypic fashion making it difficult to understand the source of inflammation. Another confounding factor is that the �gastritis� as seen directly by endoscopy correlates poorly with the microscopic diagnosis which is the accepted definition. An inflamed stomach wall as seen on endoscopy may be normal on microscopic examination while a seemingly normal stomach lining as seen during endoscopy may turn out to have severe inflammation when examined under microscope.
Gastritis is important in causing digestive symptoms...
Significance of the detection of gastritis on endoscopy continues to be a matter of intense debate. We know that its incidence increases as we grow older but its relationship to stomach symptoms of �indigestion� etc. is controversial. An extremely common form of gastritis is the one caused by infection due to Helicobacter pylori. Eradication of this infection may not resolve the stomach symptoms. The greatest repercussion of the chronic gastritis is that it is a premalignant condition, i.e. it has the potential to lead to cancer. Persons infected with H. pylori have 3 to 6 times greater risk of developing stomach cancer than their non-infected counterparts.
I have no symptoms so I do not have stomach infection...
Infection of the stomach by Helicobacter pylori is a common condition and may involve as many as 40-60% of healthy subjects above the age of 50 in the western societies. The incidence increases with age, with less than 20% involvement in children going up to as high as 60-90% in patients with ulcers and even 100% in patients with certain forms of gastritis.
Surgery is the treatment of choice for definitive prevention of ulcers...
Traditionally, increased acidity was thought to be the cause of ulcer. Therefore operations to reduce acid production were performed to prevent recurrence of ulcers. These days, we understand that most ulcers are related not to increased acidity but to the presence of Helicobacter pylori infection in the stomach. While this is a very resistant organism, effective therapy is available. The eradication of this infection prevents recurrence of ulcer. Thus recommending surgery for a routine stomach ulcer would be like recommending removal of lung for pneumonia, would it not!
Chronic conditions of digestive system start at young age... Almost everyone runs into a problem with digestive system at one point or another. Problems of digestive system affect people of all ages. However, the chronic digestive ailments typically appear in middle age and continue or worsen with ageing. Part of the reason is that the various systemic conditions become more common with age, for example diabetes mellitus which has potential to affect the entire body including digestive tract. Atherosclerosis of the blood vessels may involve the blood supply to the gut and lead to symptoms and sometimes catastrophic consequences. In addition, we tend to take more medications as we grow older and many of these medications have the potential to affect the digestive tract. For example, many of the drugs used for high blood pressure and angina may cause constipation. For every one thousand persons above 45 years, 57 persons suffer from stomach ulcers, 74 have frequent constipation, 95 have hernia problems, 28 have gall bladder condition, and 107 have some other kind of intestinal conditions.Furthermore, for every 100, 000 persons, there are 48 deaths due to cancer of digestive system and 14 due to liver cirrhosis. Digestive ailments do not have significant socioeconomic consequences... Digestive system disorders account for 10% of health care cost in the US. Close to half a billion dollars is spent on laxatives alone in the United States. The cost of ulcer disease alone is over two and a half billion dollars. Over a quarter of million people miss work everyday due to problems with digestive system. In fact, digestive diseases account for more hospital admissions than any other disease in the U.S.
Infectious diarrhea is generally treated with antibiotics... Diarrhea is not a diagnosis but a manifestation of some specific bowel infection. Most acute diarrheal illnesses resolve spontaneously and patients never seek medical attention. The foundation of diarrheal illness is hydration regardless of the cause. Rehydration solutions generally contain glucose and electrolytes like sodium and potassium. Commercial preparations are available. Ingestion of starchy foods like rice, wheat and lentils can help with absorption as well as provide calories. Effective treatment for most infections is available if needed.
I am constipated if I don’t have bowel movement daily... One bowel movement a day may be seen in only 10% of the population. It is not abnormal to have a bowel movement every other day. The range of bowel movements reported in outpatient surveys varies from the extremes of as much as four per day to as little as two per week. Constipation is hard to define. However, since over 90% of the population has three or more bowel movements a week, for practical purposes, anything less than this frequency may be labelled as constipation. Many patients use the term constipation to imply difficulty in defecation or straining during passage of hard stool.
Lactose intolerance is an uncommon condition... Lactose intolerance is actually very common and the prevalence is based on ethnicity. It is more common among jews and blacks and less so among caucasian whites. In certain populations of asian, mediterranean and oriental origin, the prevalence may be as high as 90%. Lactase products in the drug and health food stores is a billion dollar industry.
Healthy subjects digest and absorb all the ingested food... Healthy subjects excrete as much as 7% of ingested fat in stool. Up to 2.5 g of nitrogen (surrogate for protein) is excreted per day. Although 10-15% of the ingested carbohydrate reaches the large intestine (colon) unabsorbed, it is broken down (fermented) by the bacteria in the colon and thus does not form part of the stool. And you wondered where the flatus comes from!!!
Patients with inability to swallow have to be fed intravenously...
Intravenous feeding has a high complication rate and is unnatural. Gut should be used whenever possible and such is the case in most instances. A feeding tube can be passed through the nose down to the stomach or the small bowel for feeding. Another option is to create an opening in the abdominal wall and pass a feeding tube through that into the stomach or intestine. This can be accomplished by endoscopy and without open surgery in most instances. IBS and IBD are the same... IBS denotes irritable bowel syndrome whereas IBD means inflammatory bowel disease. IBS is characterized by a constellation of symptoms of abdominal pain and abnormal bowel habits and normal imaging tests as well as endoscopy. IBD, on the other hand, shows evidence of structural damage to the bowel wall on the various tests.Symptoms are not arising from the stomach because it is normal by scope (endoscopy)... Endoscopy only assesses the structure of the lining of the wall of stomach. Thus we can easily see inflammation, ulcers, obstruction etc. However, we cannot assess the functioning of the stomach by just seeing the lining of the wall of the stomach. Symptoms in a structurally normal stomach may arise due to malfunctioning stomach, e.g. delayed stomach emptying of food into the small intestine.
Benign stomach ulcers can go on to become cancer...
Stomach ulcers must be carefully examined and biopsies performed to exclude cancer. Follow up endoscopy and biopsies are generally recommended in such cases to confirm healing and lack of cancer. Even a cancerous ulcer may heal with treatment. However, the notion that benign ulcers can undergo change to cancer has not been confirmed by the literature.A diagnosis of stomach cancer can be easily made by the physician based on typical signs and symptoms... Stomach cancer is difficult to diagnose merely on clinical grounds since the patient complaints are generally vague and nonspecific. Classic description includes a triad of weight loss, early feeling of fullness of stomach on eating and the presence of a mass on examination of the abdomen. However classic this triad may be, it is uncommon to see patients who present with this classic combination of clinical features.
Whiskey drinking does not increase risk of Traveler’s diarrhea... Contrary to popular wisdom, even undiluted hard liquor/whiskey may not be strong enough to overcome the bacteria present in the contaminated ice used with the whiskey. Carbonated beverages, beer and wines are generally innocuous and do not lead to Travelers diarrhea. Cooked Food is always safe against Traveler’s diarrhea... The old adage applies here and is simple to follow,� If you cannot boil it, cook it, or peel it, forget it�. Cooked foods, if allowed to stand and then partially reheated for human consumption represent a hazardous situation which may not be easily recognized by the traveller. Food from the street vendors should be consumed at your own peril. Home cooked food on the other hand is much safer.
The damage to the bowel occurs during the period of reduced blood flow and improves when the blood flow is restored...
You would think that the damage to bowel wall should occur primarily during period of reduced blood supply and would improve with restoration of blood flow. Actually, the damage to the bowel wall due to reduced blood flow is worsened when the blood flow resumes after the period of reduced blood flow. This is known as reperfusion injury and the damage to the bowel wall is actually worse than that during the period of reduced blood flow.Injury due to vasospasm (spasm of blood vessels) occurs in heart and not the gut... Vasospasm is often an important factor responsible for accentuating the bowel wall injury occurring due to reduced blood flow. Sometimes this localized spasm may persist long after the blood flow to the bowel has been restored resulting in a prolonged period of damage to the bowel wall. All fat deposited in the body is same metabolically...
Fat deposited in the abdomen (increasing your waist line) poses more medical problems than that deposited in the hips. However, this abdominal fat is also the one that is metabolically more active and thus it is the first one to disappear when we lose weight. In the evolutionary context, the hip fat was meant as a food storage warehouse to be used in times of need and thus important for survival of life.
Pain and Itching in my anal area is due to hemorrhoids Severe pain is an unusual symptom of hemorrhoids unless the blood in the hemorrhoid has clotted off to give rise to what is known as a thrombosed hemorrhoid. Not infrequently, the pain ascribed to the hemorrhoid is actually a fissure or a tear in the lining of the anal wall. Similarly itching in the anal region is much more likely to be due to skin conditions of the area including poor personal hygiene and less likely to be due to hemorrhoids.
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