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Dawn W. was just 12 years old when she began experiencing unexplained fevers, chronic diarrhea and extreme abdominal pain she described as a heavy rag being twisted and tangled in her stomach.
Through a combination of a medical history evaluation, physical exam, blood tests, stool studies, x-rays and a colonoscopy, she was diagnosed with Crohn’s disease (CD), a common and chronic inflammatory condition of the gastrointestinal tract.
While several other conditions – such as celiac disease, irritable bowel syndrome and ulcerative colitis – have symptoms and findings similar to CD, Dawn’s family history provided some insight. The cause of Crohn’s disease is unknown; however, there is a genetic predisposition in some patients. In Dawn’s case, her father and uncle also were afflicted with Crohn’s, making her part of the 20 percent of the population who have a close relative with the disease.
Since CD is a chronic condition that can be controlled but not cured, our therapy goal was to relieve her symptoms and induce and maintain remission from the disease. We began treatment with anti-inflammatory medications to help reduce inflammations and any infections that might arise.
Early on in her diagnosis, Dawn experienced social difficulties related to the chronic and occasionally unrelenting nature of her disease. Sleepovers with friends were challenging and she recalls spending hours in the bathroom. In middle school, kids called her “Chipmunk Cheeks,” a side effect from the anti-inflammatory medication.
Now a 42-year-old mother of two, Dawn has been living with Crohn’s disease for more than three decades. She has learned how to manage it and integrate it into her life through regular check-ups and colonoscopies, medication, dietary restrictions and an online support community and resources.
Her longtime Crohn’s journey has not been without complications – or unexpected benefits. When she was 27, chronic inflammation and scarring in her intestines resulted in intestinal resection surgery. A decade later, she underwent a second resection. During each of her pregnancies, however, Dawn’s CD took an unexpected pregnant pause and went into remission. She enjoyed the break from her disease, eating a variety of previously avoided foods without any repercussions.
With no cure for CD on the horizon, the medical staff at Northeast Digestive continues to support ongoing research, stay well-informed on the latest medications, therapies and surgeries, and provide digestive patients with compassionate and skilled care.
Like Dawn, most Crohn’s disease patients can live fully productive lives with support from appropriate and timely medical therapy. Her advice to recently diagnosed patients who want to help ensure successful treatment? Maintain a detailed food diary so you know what your particular trigger foods may be and to ensure you are maintaining proper nutrition, always take your medications properly and carefully follow your doctor’s instructions.
by Kelsey Trull, PA-C, MPAS
For many patients struggling with a chronic hepatitis C virus (HCV) infection, treatment has been an unnerving and daunting process; however, that is no longer the case due to several well-tolerated and short duration treatment options that are now available and effective in eradicating the virus.
Previous treatment options, like interferon and ribavirin, had significant side effects that precluded many patients from considering treatment, while other patients were excluded from being a treatment candidate due to associated chronic medical conditions.
Over the last year, however, there have been momentous advancements in the field of hepatitis C treatment and now many of these patients can receive treatment for their HCV infection. Recent developments in the types of hepatitis C medications available now provide more options to both patients and providers when determining a treatment plan.
Prior to beginning treatment, there are a few vita
l aspects of the patient’s history that need to be determined, including: HCV genotype, viral load, degree of liver damage, other co-existing health conditions and any prior response to previous treatments for hepatitis C.
The hepatitis C genotype is the strain or genetic arrangement of the virus. There are six well-studied HCV genotypes and it is important to identify the genotype via a blood test because it determines both the type and length of treatment needed. The most common genotype in the United States is genotype 1, which accounts for approximately 75 percent of cases. The viral load tests the amount of the virus in the blood. While the amount of virus does not predict whether a patient will go on to develop cirrhosis, it can help determine the length of treatment needed. The viral load is also used to determine if a patient is responding well to treatment.
Following determination of the genotype and viral load, the provider may need to order further laboratory studies or diagnostic imaging studies to determine if the liver has any damage. This can be done with either a liver biopsy or noninvasive test that assesses for liver fibrosis, or scarring of the liver.
Once a patient is ready for treatment, he/she can increase the chances of being considered for hepatitis C treatment by avoiding alcohol and illicit drugs, establishing care with a primary care provider and maintaining a healthy lifestyle.
Currently, there is an oral treatment regimen approved for all genotypes. Treatment duration usually ranges from 8 to 24 weeks depending on genotype, prior treatment experience and degree of fibrosis. In clinical trials, most newer treatment options offer a sustained virologic response (the clinical term used to describe the eradication or clearance of the hepatitis C virus) of approximately 95 percent.
During hepatitis C treatment, it is critical to adhere to recommendations made by your provider, such as scheduling follow-up visits and coming in for necessary laboratory testing. Compliance with both the treatment regimen and recommendations made by your provider will ensure the best chance at receiving a cure.
If you or someone you know needs to be treated for hepatitis C, contact Northeast Digestive Health Center to schedule an appointment with one our gastroenterology providers.
Around the world, 80 percent of people with hepatitis C don’t know they have the disease. The organizers of World Hepatitis Day hope to change that by promoting awareness of this global epidemic.
The hepatitis C virus causes inflammation of the liver and can compromise key functions such as eliminating toxins from the body. Left untreated, the virus can result in fatal liver disease. As many as 2.7 million people in the United States don’t realize they have a chronic infection from hepatitis C.
On July 28, people around the world will learn more about viral hepatitis and the potential methods for quelling the disease on World Hepatitis Day. Sponsored by the World Hepatitis Alliance and endorsed by the World Health Organization>World Health Organization, the day aims to bring together governments, medical professionals, businesses and members of the public to increase understanding of the disease. The Centers for Disease control recommends that anyone born between 1945 and 1965 should get screened.
Viral hepatitis — encompassing both hepatitis B and C — causes some 1.34 million deaths each year along with more than three-quarters of the world’s liver cancer cases. Hepatitis C can be cured, but many people with the disease do not seek treatment because they don’t feel or look ill.
What do you need to know about hepatitis C to protect yourself and your loved ones?
Hepatitis C can be contracted through sharing needles, sexual activity, transfusions, needle stick injuries and other types of blood-to-blood contact. In 10 percent of cases, the cause is not known.
Symptoms of hepatitis C may include:
Many people with hepatitis C do not display any symptoms and don’t realize they have the virus.
Several lab tests can detect the presence of hepatitis C. The Viral Load (PCR) screening determines how much virus is present in the blood and also can confirm how patients respond to treatment and whether the virus is gone. The Hepatitis Genotype test can identify various strains of the virus, indicating how individual patients may respond to treatments.
A Hepatitis C Antibody test can confirm if an individual has been exposed to the virus. Some people are able to overcome the virus on their own and may test positive for antibodies but not for the virus itself.
Lab tests also can provide your doctor with important information about your liver health, and testing may be required to determine if there is any scarring to the liver. Fortunately, there are many noninvasive options available, including Fibroscan.
A number of different treatments are available for hepatitis C and treatment now offer a greater than 90-percent chance of curing the infection. Most of the newer treatments come in the form of pills and last between two and six months, depending on the severity of the disease.
These treatments have minimal or no side effects. Patients who do experience side effects most often report fatigue and headaches, and lab abnormalities may occur as well.
Current treatment options represent a significant improvement over the previous choices, which often had more-serious side effects. In some cases, patients with chronic medical problems could not tolerate the older treatments.
Not everyone with hepatitis C requires treatment; your physician can work with you to determine the best course for managing your condition. If you undergo treatment for hepatitis C, it’s vital that you comply with your physician’s instructions, including getting any needed lab testing and coming in for follow-up visits.
In the comprehensive Hepatitis C treatment clinic at Northeast Digestive Health Center, you can learn about the virus and the best treatment methods for your specific needs. To schedule an appointment, please contact us.
Irritable bowel syndrome is a fairly common — and chronic — disorder, but it’s also frequently misunderstood.
IBS typically causes abdominal pain and cramping, bloating, constipation and diarrhea. In some cases, diet and lifestyle changes can help control symptoms. However, some individuals require medication and other interventions.
If you’re suffering from irritable bowel syndrome, here’s some information you should know about the disorder.
IBS is a disorder of the gastrointestinal system affecting the large intestine, also known as the colon. While the condition causes a number of uncomfortable symptoms, it typically does not result in permanent damage, does not get worse with age, and is not known to shorten lifespan.
According to the Food and Drug Administration, IBS affects more than 15 million individuals in the United States alone, and the condition is thought to be underdiagnosed.
IBS is often misunderstood because of the changing nature of the condition and the variety of factors that can play a role. Symptoms can wax and wane, and they can change within the same patient.
Doctors do not fully understand the causes of IBS, and there is no known cure. Of the estimated 20 percent of Americans who suffer from IBS, many don’t realize they have the condition.
IBS is more common among women and people under the age of 45, and symptoms often begin in the late 20s. Doctors know that a family history increases the risk and that psychological issues like anxiety and depression are common in IBS sufferers.
New research also indicates that carbohydrates — and, specifically, a nutrient known as polyols — may play a role. Your diet does not cause IBS, but it may affect the severity of your symptoms. Other research has indicated a possible genetic predisposition in individuals who suffer from IBS. Environmental factors, bacterial and viral infections, and medications also may be involved. However, medical experts have yet to pinpoint an exact cause for the disorder.
In the past few decades, research has revealed that the bodies of individuals with IBS may interpret a normally functioning gut as being abnormal. Daily gut activity — including a growling stomach or the passage of food through the small and large intestines — causes pain and discomfort for people with IBS.
Individuals with the condition also are more likely to suffer from fibromyalgia, which causes pain throughout the body. Fibromyalgia affects only a small number of people, but its symptoms surface in more than half of IBS sufferers.
Experts believe the two disorders are related, although the pain affects different parts of the body. In both cases, patients experience more brain activity in the regions that process pain, potentially enhancing the feelings of pain.
In addition, serotonin — a neurotransmitter that plays a significant role in the gut’s nervous system — may have involvement with IBS. Many patients also experience relief from IBS when symptoms of depression or anxiety are successfully treated.
If you suffer from IBS, it’s important to work with an experienced medical practitioner. Your doctor will advise you about lifestyle changes that may help, including relaxation techniques, modifications to your diet, stress management and exercise.
There is no cure for IBS, but some medications may help with symptoms. For example, antidepressants sometimes can lessen the severity of both fibromyalgia and IBS. In addition, medications may help with possibly related conditions such as headaches and sleep problems.
If you’re suffering from the symptoms of IBS, it’s important to work with a board-certified gastroenterologist to diagnose and treat your condition. To learn more, please contact Northeast Digestive Health Center.
Are you making your gut health a priority this year? Add ‘schedule a routine screening’ to your to-do list. Colon cancer is the third most commonly diagnosed cancer in men and women in the U.S., and it occurs most often in people over the age of 50. However, young or old, colon cancer doesn’t discriminate. Take the right steps to protect yourself and decrease risk factors.
Colorectal cancer, or colon cancer, occurs in the colon or rectum. The good news is that colon cancer, when discovered early, is highly treatable. Even if it spreads into nearby lymph nodes, surgical treatment followed by chemotherapy is highly effective. Most colon cancers first develop as polyps, abnormal growths inside the colon or rectum that may become cancerous if not removed.
Age, family history, race and lifestyle are all risk factors that can raise your chances of developing colon cancer. If you have a parent, sibling or child with cancer, there is a higher risk of developing it, especially if the family member was diagnosed before the age of 60. African-American men and women are at a higher risk, and about 6 percent of American Jews who are of eastern European descent have DNA changes that increase their risk. An inactive lifestyle that includes a diet high in red and processed meat, smoking and heavy alcohol use can increase your risk. Be sure to talk to your doctor about your personal risk and how often you should be screened.
Many colorectal cancers can be prevented through regular screening. Doctors can find precancerous polyps early and remove them before they turn into cancer.
Because there are often no symptoms when colon cancer is first developing, early detection through screening can dramatically reduce your risk. Northeast Digestive Health Center created its Open Access program to make colon cancer screening more accessible and to help save lives.
Colonoscopy is a procedure that uses a long, flexible, narrow tube with a light and tiny camera on one end, called a colonoscope or scope, to look inside the rectum and entire colon. Colonoscopy can show irritated and swollen tissue, ulcers and polyps. If you are unable to have a colonoscopy, your doctor can give you information about other tests that are available.
March is National Colon Cancer Awareness Month, a time to increase awareness about how important routine screenings are and to honor and remember loved ones affected by the disease. Colon cancer takes the lives of more than 50,000 people every year. Help combat these statistics by getting screened. Northeast Digestive Health Center is also working to combat colon cancer by hosting its first annual 5K Bum Run fundraiser on April 28. All benefits will go to the Colorectal Cancer Alliance.
The bad news is Colon Cancer doesn’t discriminate when it comes to age. The good news is, when discovered early, it’s highly treatable. Young-onset colorectal cancer is on the rise. Approximately ten percent of new colorectal cancer patients are under the age of 50. A number of organizations, particularly the Colorectal Cancer Alliance, are working hard to learn more about this disease and providing support for those currently in their fight. Be informed and get involved, and together, we can change the face of this disease and redefine the odds.
Being able to recognize the risk factors and symptoms of colon cancer is the first step to early detection. Are you at risk? If you notice any warning signs, don’t be afraid to speak up and schedule an appointment with your GI doctor. Some common warning signs to look for are:
If one or more of these apply to you, take charge of your health and contact your doctor right away. Screening saves; because there are often no symptoms when colon cancer is first developing, early detection through screening can dramatically reduce your risk. One of the reasons Northeast Digestive created its Open Access program was to make colon cancer screening more accessible and help save lives.
There are many things you can do to benefit colorectal cancer patients, survivors, and family members. When you donate, fundraise or dress in blue, you will help provide support, raise awareness and fund critical research. The Colorectal Cancer Alliance’s mission is to empower a nation of allies who work with them to provide support for patients and families, caregivers, and survivors; to raise awareness of preventative measures; and inspire efforts to fund critical research.
You can also take action by being an advocate in your community. Create your own fundraiser or participate in one locally. Northeast Digestive Health Center is working to combat colon cancer by hosting its first annual 5K Bum Run fundraiser on April 28. All benefits will go to the Colorectal Cancer Alliance.
Know the facts, get screened and do your part to help end this devastating disease within our lifetime.
Digestive issues – it’s a topic that many find “taboo” and uncomfortable to talk about. The truth is, people shouldn’t have to suffer in silence. Digestive difficulties are more common than one thinks and it’s important to know the facts.
So, how do you know when gas and diarrhea is more than just an inconvenience? We’ve put together this digestive “alphabet soup” to help raise awareness of two common digestive issues: IBS and EPI. Educating yourself on the facts, symptoms and causes will not only help you get a better understanding of these disorders, but it should encourage a visit to the gastroenterologist to get these issues resolved.
Symptoms
Irritable bowel syndrome (IBS) is a fairly common and chronic disorder, but it’s also frequently misunderstood. Symptoms usually include abdominal pain, cramping, bloating, constipation and diarrhea. Feelings of being unable to completely empty bowels, nausea and gas are also common symptoms. IBS is not the same as inflammatory bowel disease (IBD), which is a more serious condition that causes inflammation in the digestive tract.
Facts
According to the National Institute of Health (NIH), an estimated 10-15 percent of Americans are affected by IBS, but only five to seven percent get diagnosed. And surprisingly, it is more common in younger people, rather than those over 45. Women are up to two times more likely than men to develop IBS, perhaps because women’s colons are longer than men’s. The suggested cause of IBS is an imbalance of bacteria in the gut.
Cure
Unfortunately, because doctors do not fully understand the causes of IBS, there is no known cure. In some cases, diet and lifestyle changes can help control symptoms, however some individuals require medication other interventions. Three types of IBS are based on different patterns of changes in your bowel movements or abnormal bowel movements. It can be important for your doctor to know which type you have, as some medicines work on for some types of IBS or make other types worse.
Symptoms
Exocrine Pancreatic Insufficiency (EPI) is a condition that occurs when the pancreas fails to provide the necessary amount of digestive enzymes to aid in the digestion of food. People with EPI can’t properly digest the nutrients in food such as fats, proteins and carbohydrates. Uncomfortable GI symptoms include bloating, gas, weight loss and oily diarrhea that floats. Other symptoms, like tiredness and loss of muscle, may be present due to a lack of nutrients in the body. The symptoms of EPI are very similar to Crohn’s disease, celiac disease, IBD, ulcerative colitis and small intestinal bacterial overgrowth (SIBO), which can make it very hard to diagnose.
Facts
Anything that damages the pancreas and stops or blocks the release of its enzymes can result in EPI. There are many causes of EPI – the two most common are cystic fibrosis and chronic pancreatitis. Other medical conditions that can cause EPI are celiac disease, Crohn’s disease, diabetes, pancreatic cancer and more. Different stool studies can help determine the diagnosis of EPI.
Cure
The good news is EPI is a manageable condition. The goal of treatment is to replace the digestive function of the pancreas. EPI symptoms can be treated with diet, vitamin and mineral supplements and pancreatic enzyme replacement therapy (PERT). PERTs are the main treatment for EPI – they help break down the nutrients in food. Eating plenty of fruits and vegetables, having smaller meals more frequently, and abstaining from alcohol and smoking is advised. If you have been diagnosed with EPI, you should work with your doctor to make sure all your dietary needs are being met.
If you’re spending too much time in the bathroom, you’re not alone. If you’re suffering from the symptoms of IBS or EPI, it’s important to work with a board-certified gastroenterologist to diagnose and treat your condition. To learn more, contact the professionals at Northeast Digestive Health Center.
Do you get stomach pains, gas and bloat, nausea or diarrhea every time you eat ice cream, cheese or another delicious dairy product?
It’s important to understand you are not alone. Approximately 65 percent of the human population has a reduced ability to digest lactose after infancy. Between 30 and 50 million people in the United States alone are lactose intolerant. Studies suggest that about one to two percent of children have experienced a milk allergy, which most ultimately outgrow. A milk allergy is found more commonly in boys than girls.
Although there’s a lot of confusion surrounding the two, milk or dairy allergies and lactose intolerance are not related. The terms may sound similar, but they are two entirely different digestive problems. People with an allergy experience symptoms because their immune system reacts as though dairy products are dangerous invaders and could result in a life-threatening allergic response. Those who are lactose intolerant cannot digest the sugar in milk (lactose) because they have a deficiency of lactase, an enzyme produced by cells in the lining of the small intestine.
There are two types of milk protein – casein and whey. Casein, the “solid” part of milk, makes up about 80 percent of milk protein. Whey, found in the liquid part of milk, makes up the other 20 percent. These proteins are found in many foods – including places that you might not expect. For example, some canned tuna, granola bars, meats, energy drinks and other nondairy products may contain casein or whey.
Milk allergies usually show up early in life but can develop at any age. It’s the most common food allergy in children, but many can outgrow milk allergies by age five. A food allergy to milk is more severe than a lactose intolerance, as allergic reactions can begin within minutes or can be delayed for several hours. Milk allergy usually only refers to cow’s milk, but it is possible that you may also be allergic to other types of milk, like soy.
Symptoms:
Unlike an allergy, dairy intolerance involves problems in the digestive system that stem from the missing enzyme, lactase. Babies and young children usually have sufficient amounts of the lactase enzyme to digest milk sugars. However, the amount of lactase produced by the body decreases over time, which is why many teens and adults will develop a dairy intolerance suddenly.
Symptoms:
Unlike lactose intolerance, a milk allergy can be life threatening so it’s crucial to get an accurate diagnosis of symptoms, especially for children. Some people can tolerate foods containing milk that have been extensively heated, such as baked goods. But anyone experiencing symptoms should consult with a doctor to get properly tested.
Usually a professional, like the physicians at Northeast Digestive, can determine whether someone is experiencing an allergy or intolerance just based on their symptoms and other factors. If more information is needed there are a few diagnostic tests available.
Hydrogen breath test – The breath test takes about two hours. The patient is asked to drink a lactose-containing beverage. Fifteen minutes after drinking, the patient is instructed to blow up balloon-like bags every 15 minutes for two hours. The air is tested for the presence of hydrogen. Hydrogen and other gases are produced when undigested lactose in the colon is fermented by bacteria.
Blood test – The most common allergy test is a blood test. It is required to measure the amount of lgE antibodies in the blood that respond to milk proteins.
Skin prick – A skin prick test involves a small drop of milk extract being placed on the skin to see if it causes a local reaction.
Cutting out dairy – A doctor may simply recommend cutting dairy out of a diet to see if symptoms improve.
Unfortunately, avoidance of milk or items containing milk products is the only way to manage an allergy. Reading ingredient labels very carefully, checking with dining staff at restaurants when eating out, and taking other precautions to avoid allergens is the best way to know what you are putting in your body. A doctor may also recommend carrying an auto-injector containing epinephrine, which is the only treatment for anaphylactic shock. For lactose intolerance, talk to your doctor about taking a dietary supplement that contains lactase. Be wary of many medicines that contain lactose, which is used as a filler, especially in white tablets.
Fortunately, it’s fairly easy to substitute milk in 2018. Soy, nut, rice and veggie-based milks are popular alternatives. Dairy-free brands like So Delicious, Enjoy Life, Almond Breeze and Ripple have perfected recipes that taste just as great as the real thing, if not better.
Want to learn more, get tested or speak to a digestive health professional about your symptoms? Contact us and request a same-day appointment!
The liver is one of the hardest-working organs in your body. It performs hundreds of functions and plays a vital role in sustaining life by processing nutrients, fighting off infection, creating bile, controlling blood sugar and removing toxins. Protecting your liver health is not only crucial to your digestive system but also key to living a healthy life.
There are more than 100 diseases that can affect the liver and they differ in intensity and severity. Some problems can resolve themselves and leave no lasting damage, but others can cause irreversible damage and the consequences are severe. We’ve put together a “Liver Disease 101” primer to help you better understand the importance of protecting your liver health.
Deaths by liver disease have increased dramatically and millennials are among the hardest hit. A new study from the British Medical Journal said cirrhosis-related deaths increased by 65 percent from 1999 to 2016, and deaths from liver cancer doubled. Liver cancer has moved to the sixth-leading cause of cancer deaths in 2016.
The liver normally weighs three pounds. When more than five to 10 percent of your liver’s weight is fat, you have a “fatty liver.” Inflammation that causes scarring is a common symptom of liver injury, which can lead to cirrhosis.
Alcoholic fatty liver – When alcohol floods the system, the liver starts to form abnormal deposits of fat. This causes inflammation and scarring, and eventually, your healthy liver tissue is replaced with scar tissue. Heavy drinking impairs the liver from breaking down fats.
Non-Alcoholic Fatty Liver Disease (NAFLD) – About 80 million U.S. residents, including 6 million children, are thought to have NAFLD thanks to a rise in obesity rates over the last three decades. It’s the No. 1 liver condition in children. This condition can be caused by obesity, high cholesterol and diabetes because of a sedentary lifestyle and consumption of too much sugar and processed carbohydrates.
Both forms of fatty liver can result in cirrhosis, liver failure, liver cancer and even death.
Cirrhosis is a disease in which the liver becomes severely scarred as a result of many years of continuous injury. Common causes are alcohol abuse and Hepatitis C. When your liver is damaged, your body lays down collagen to repair it. Fibrosis, or thickening of the liver tissue, then occurs.
The liver cleans blood as it exits the gut. When toxins, sugars and fats are consumed, the liver has to work hard and may get overloaded. If it’s “plumbing” gets blocked up, that can cause scarring that reduces liver function.
The silent killer
Scar tissue develops silently and patients can live years with no symptoms only finding out they have significant liver damage years later through a routine medical exam.
Initial symptoms include:
Severe symptoms include:
The liver has an amazing ability to regenerate itself even after severe damage, but it is important to start a liver-friendly lifestyle in order to help your liver repair itself.
Increase physical activity – Aerobic exercise helps burn carbohydrates, fats and proteins, which leads to the liver processing more efficiently.
Maintain a healthy diet – Eat a healthy diet that includes vegetables, whole grains, fruits and healthy fats.
Limit alcohol consumption – Alcohol is not good for the liver, as it is destructive to the body’s main detoxifying organ. Consider limiting your alcohol consumption to one drink daily for women and no more than two daily for men.
An accurate diagnosis of liver disease is the first step toward treatment. It’s good to know the methods of diagnosis are no longer confined to an invasive and painful liver biopsy. FibroScan, a revolutionary new tool, can instantaneously diagnose liver disease through transient elastography. Through a quick, non-invasive and painless procedure, the technology provides immediate results to the operator. Northeast Digestive is one of the only GI practices in North Carolina that offers this tool.
