Conditions Treated

There can be many causes of abdominal pain.  The nature of the pain, its severity and location are often helpful in identifying the underlying cause.  Recognizing the typical presentations of specific conditions, keeping a broad differential diagnosis, and utilizing an extensive range of diagnostic tools is necessary to make a timely and accurate diagnosis. 

Gastroesophageal reflux disease (GERD) results when acidic stomach contents reflux into the esophagus and cause either bothersome symptoms or esophageal disease.  It typically results from an incompetent lower esophageal sphincter or hernia.  Classic symptoms of GERD include heartburn, regurgitation or chest pain.  However, other less common symptoms can include trouble swallowing, cough, hoarseness, a persistent sense of a lump in the throat, or wheezing.  Complications of GERD can include narrowing of the esophagus which may cause difficulty with swallowing, precancerous tissue in the esophagus, and rarely esophageal cancer.  Patients with more than infrequent symptoms of GERD should seek medical evaluation.

Most patients can be treated with diet, lifestyle changes and antacid medications.  Some patients whose symptoms fail to respond to these measures may be treated with one a few different surgical procedures which help to create a mechanical barrier to prevent the reflux of acid into the esophagus. 

Barrett’s esophagus (BE) is a condition in which the cells lining the esophagus change to more closely resemble the cells that typically line the stomach.  This condition develops as a consequence of chronic acid reflux into the esophagus.  BE is a precancerous condition and can lead to the development of esophageal cancer over time.  Appropriate treatment and monitoring can help prevent the development of cancer in most patients.  

Patients who have had symptoms of acid reflux for many years may benefit from an upper endoscopy to screen for this condition. 

The gallbladder is a small pouch that sits under the liver and stores bile which is used to help aide in digestion.  The bile ducts are a series of interconnected tubes that help to drain both the gallbladder and the liver.  Common diseases of the gallbladder and bile ducts include gallstones, cholecystitis (inflammatory of the gallbladder), and blockage of the bile ducts.  Symptoms of gallbladder disease can include pain in the right upper quadrant of the abdomen, fevers or jaundice (yellowing of the skin or eyes). 

Patients with these symptoms should seek immediate medical attention.

The pancreas is a digestive organ located in the central abdomen.  It is essential for the digestion of food and regulation of blood sugar.  The most common disease of the pancreas is pancreatitis which is inflammation of the pancreatic tissue.  This can result from excessive alcohol consumption, gallstones, as a side effect to certain medications, from elevated cholesterol/triglycerides or from other diseases. 

Pancreatic cancer is rare but a serious type of cancer.  Typical symptoms include central abdominal pain that radiates to the back and is worse with eating.

Celiac sprue (or celiac disease) is an inflammatory disease of the small bowel which results from exposure to gluten, a wheat protein, in the diet.  Inflammation from gluten exposure leads to damage of the cells that line the small intestine and can result in both symptoms and nutrient deficiencies.  Typical symptoms can include diarrhea, bloating, weight loss, rash, and abdominal pain.  Symptom severity can range from very mild to severe.  Some patients have no symptoms or can develop symptoms late in life.  Iron deficiency anemia and B12 deficiency can occur from this condition as well. 

The diagnosis of celiac sprue can often be made with a simple blood test, but may also require a biopsy of the small intestine. 

Colon polyps are abnormal growths that arise from the lining of the colon. Some polyps are called adenomas and have the potential to grow into colon or rectal cancer if not removed.  Other polyps do not have the potential to become cancer, but can ulcerate, bleed or rarely cause an obstruction of the colon.  Adenomatous polyps are common and can occur in up to 30 percent of average risk 50 year old patients.

All African Americans should begin colorectal cancer screening at the age of 45. Certain factors can increase the risk for development of adenomas such as age, male sex, race, obesity, and smoking.

There are several screening tests for colon polyps and colorectal cancer.  However, screening colonoscopy is the most effective way to identify and remove colon polyps before they develop into cancer.  It is the only colorectal cancer screening strategy that can also prevent cancer. 

Expert opinion on the initial age to begin colorectal cancer is evolving. The American Cancer Society recently recommended that all patients start colorectal cancer screening at age 45. Professional gastroenterology societies currently recommend starting at the age of 50 for normal risk patients. Some patients with a family history of colorectal cancer, early colon polyps, or genetic predisposition may need to start screening earlier.

Blood in the stool is never normal.  Often times it can be caused by benign conditions such as internal hemorrhoids or anal fissures (small tears in the lining of the anus).  Sometimes it can be caused by more serious conditions such as ulcers, colon polyps or cancer. 

You should contact your doctor if you have blood in the stool to make sure that it is evaluated and treated.

Abdominal bloating is a very common gastrointestinal symptom.  It can result from excessive swallowing of air, decrease clearance of gas from the intestinal tract, excessive overgrowth of gas forming bacteria in the small intestine, or from malabsorption of nutrients. Diagnostic studies can often help to identify the cause of the bloating to allow for improvement or resolution of symptoms.

Colitis refers to non-specific inflammation of the colon which can cause symptoms of abdominal pain, bleeding or diarrhea.  It can be related to an underlying infection or the result of a chronic inflammatory condition such as Crohn’s disease, ulcerative or microscopic colitis. 

Laboratory studies, stool cultures, radiology studies and colonoscopy are usually helpful in identifying the cause to allow for specific treatment.

Everyone experiences occasional constipation, but chronic constipation should not be ignored. It is recommended to digest 20 to 30 grams of dietary fiber, along with drinking at least 64 fluid ounces of water per day. If these basic regimens do not help, stool softeners, and laxatives are often helpful in treating constipation.  There are several new prescription medications which are safe and effective for this condition. 

Rarely, constipation may be a symptom of a more serious underlying disease.  Persistent or severe constipation should not be ignored.

Crohn’s disease belongs to the family of diseases known as Inflammatory Bowel Disease (IBD). This disease can be found in any of part of either small or large intestine, irritating both the lining and deep tissue layers of the intestines.

The trigger or cause of Crohn’s disease is unknown at this time.  Having other family members with the disease can increase your risk, but it may also occur in patients with no family history.  The immune system becomes active against the individual’s own body which primarily causes damage in the intestine, and occasionally other organs like the skin, eyes, or the liver.

Symptoms may include abdominal pain, diarrhea, blood in the stool, joint pains, skin rashes, loss of appetite, fatigue and weight loss.  This disease can occur at any age, but most commonly is diagnosed in adults under 30 years of age.

Most cases of diarrhea are the result of an infection and resolve on their own without the need for diagnostic studies or medical treatment.  Diarrhea that is associated with bleeding, fevers, and significant abdominal pain requires prompt evaluation by a doctor.  Diarrhea that last for more than a few weeks is more likely to be the result of a chronic inflammatory condition or a functional bowel syndrome.  Stool studies, blood tests, upper endoscopy and colonoscopy can be useful to help identify the source of the diarrhea. 

Diverticula/diverticulosis are small pouches that form in the wall of the intestinal tract, usually in the colon.  They are common and develop as we age.  They are thought to be the results of a diet that is low in fiber but their exact cause is not entirely understood.  Most patients with diverticulosis will have no associated symptoms.  Diverticula can become inflamed and infected causing abdominal pain and fevers.  This condition is called diverticulitis.  If diverticulitis is severe it can be associated with a perforation (tear in the lining of the colon) and with the formation of an abdominal abscess. 

Most cases are treated with antibiotics alone, but more severe cases may require abscess drainage or surgery.  Diverticula can also be associated with significant bleeding.  Rarely diverticulitis can be associated with colon cancer.  

Dysphagia means inability to swallow foods/solids or liquids. It can also refer to the sensation of food being stuck in the neck or chest. This can be caused by acid reflux, scarring of the esophagus from acid reflux, lack of esophageal muscle strength or esophageal spasm.

EoE is caused by an allergic reaction and inflammation which occurs along the lining of the esophagus. This can result in symptoms of difficulty swallowing or getting food items stuck in the esophagus. The diagnosis can be made by endoscopy and biopsy of the lining of the esophagus.

H. pylori is a spiral shaped bacterium found in the majority of peptic ulcers. If you have H. pylori infection, you may experience symptoms such as pain or burning in the chest or upper abdomen, indigestion, nausea, excess gas, vomiting or fatigue.

Hemorrhoids are the veins in your anus and lower rectum. They can become inflamed and swollen, especially from pregnancy, constipation and excessive straining during bowel movements. Symptoms can include bleeding during bowel movement, itching, pain or discomfort in the anal area and lumps near the anus. Bleeding during bowel movements is also a symptom of other digestive diseases like colon cancer, making it very important to speak with your doctor to rule out any more serious conditions.

Treatment can be as simple as increasing fiber and fluids in the diet, soaking the hemorrhoid and plain warm water for 10 minutes at a time, as well as topical medications. More invasive techniques of treatment include ligation, injection, coagulation and hemorrhoidectomy.

Gastritis is an inflammation of the stomach lining. There are a variety of causes, including infection, drinking too much alcohol, and the overuse of NSAIDs. Gastritis can cause pain in the upper abdomen, nausea and vomiting.

Hepatitis means “inflammation of the liver.” This can be caused by alcohol, fatty liver, viral hepatitis or autoimmune disorders.

Hepatitis C is an infection of the liver caused by the hepatitis C virus (HCV). It is usually spread through intravenous/illicit drug use, blood transfusion, or other rare causes of blood to blood contact with an infected person. Many infected patients remain healthy indefinitely; but 75% will develop a chronic infection. This can lead to cirrhosis in some patients, and also increase her risk of liver cancer. Effective, well-tolerated treatment options are now available.

Hiatal hernias occur when your stomach pushes through a weakness in your diaphragm into your chest cavity. Small hernias will generally go unnoticed, but the larger hernias have the ability to cause acid reflux. These hernias are one of the leading causes of GERD. Over-the-counter medications are usually sufficient for treating a hernia, but large hernias may require surgery.

IBD is a chronic inflammatory disease of the digestive system. There are 2 types: Crohn’s disease and ulcerative colitis. Crohn's disease generally can affect any part of the digestive tract while ulcerative colitis only affects the colon. IBD presents with varied symptoms including abdominal pain, diarrhea, bloody stool, fever, weight loss, arthritis and rashes. Some test that might be ordered including blood work, stool test, upper endoscopy, colonoscopy and CT scans. Medications to treat IBD include aminosalicylates, corticosteroids, immunosuppressants, antibiotics, biologic therapies, and surgery.

IBS is a very common problem in America. Women are three times more likely to suffer from IBS. Symptoms included crampy abdominal pain, feeling bloated, gas, constipation, diarrhea, and excessive mucus in the stool. Some people complain of either constipation or diarrhea, later experienced another symptom, then alternate again. The causes of IBS are not well understood; there are likely multiple factors involved.

Many symptoms of IBS can be controlled with lifestyle modifications, including avoiding your personal food triggers, smoking and caffeine. Getting regular sleep, as well as relaxing and avoiding stress, may help some individuals.

Nash or nonalcoholic steatohepatitis is characterized by the buildup of fat in the liver that is accompanied by inflammation. This is often found in patients who are overweight, have diabetes or high blood sugar, and/or have high cholesterol. The excess buildup of fat in the liver can lead to inflammation, which can lead to scarring of the liver, or cirrhosis. Treatment focuses on low-fat diet, exercise, weight loss and addressing the underlying conditions of obesity and diabetes.

Peptic ulcer disease (PUD) is a very common problem. Symptoms include a gnawing, burning pain in the upper abdomen. Some patients have no pain but simply present because of nausea, anemia (low blood count) or the presence of blood in the stool. Causes of peptic ulcer disease including H. pylori infection, NSAIDs and stress.

The diagnosis of PUD is usually made by endoscopy. Treatment options include antacid medication, treatment of bacterial infection, diet and rarely, surgery.