Frequently Asked Questions About Digestive Health & IDH

What are colon polyps and what does it mean if I have them?

Colon polyps are small growths that come from the lining of the colon.  Usually they are very small (few millimeters in size), and generally cause no symptoms to those who have them.  It is important to identify and remove certain polyps, because they may be a precursor to the development of colon cancer.

Most polyps are not "cancerous" per se, but those which are precursors called adenomas (pronounced "AD-ah-NO-ma") can develop into cancers if they are not removed.  The process of cancer development can still take years to develop, but usually cause no symptoms until a cancer develops.  By then it may be too late.

There are some known inherited conditions which can predispose certain individuals to having more polyps or early polyp development.  If you have siblings or parents who developed polyps before age 60, you may be at higher risk of developing polyps.

Screening for polyps using colonoscopy is usually done every ten years.  However if polyps are found, then the next colonoscopy is generally done sooner.  The timeframe depends on the number, size and quality of the polyps themselves.

Is there something I can do with my diet to prevent having colon polyps?

Numerous studies evaluating different diets or supplements have been done.  However, none have convincingly shown that polyps can be reduced because of a particular diet.  The general recommendation is that a diet that is rich in fiber has benefits for the good bacteria that reside in the colon and also the lining of the colon itself.  A diet rich in fresh fruits and vegetables has high levels of antioxidants which reduce the risk of developing many types of cancer. 

What is diverticulosis and diverticulitis?

Diverticulosis is a common condition of the colon where small pouches or sacs form in the colonic wall.  This occurs because of defects in the muscle layer of the colonic wall.  Think of squeezing a small balloon with your hands.  The areas between your fingers allow bulging of the balloon when you squeeze.  With the normal squeezing action of the colon, there can be bulges that form at the areas where there are muscle defects.  As we get older, more defects like this can develop and more pouches may form.

Diverticulitis occurs when the small pouches develop infection and swelling.  This is a painful complication of diverticulosis which occurs when debris or stool lodge into the pouch and cannot be spontaneously released.  Symptoms can include abdominal pain, fever and constipation.  Oftentimes, patients need antibiotics to resolve the infection.  Occasionally, hospitalization is required and even sometimes surgery needed in severe cases.

What diet do I need to be on for diverticulosis?

There are myths perpetuated about avoiding foods which contain seeds and nuts.  Nature has a way of keeping swallowed seeds and nuts intact; it is suggested that particles may lodge themselves into diverticular pouches and cause diverticulitis.  However, there are no clinical studies that actually prove that this is the case.  After years of doing colonoscopy, I still have not seen any seeds or nuts stuck in a diverticula.

Some studies suggest that a diet rich in fiber can prevent diverticulosis from forming in the first place.  It can also reduce the chance of diverticulitis as well.  The way this works is that fiber increases the water content of stool, making it bulkier and softer.  This makes stool easier to evacuate, and it prevents stool from drying out and becoming pellet-like.  These pellets do get stuck in diverticula and principally cause diverticulitis.

I’m having rectal bleeding.  What does that mean?

Rectal bleeding is always concerning to patients when they first see it.  It can range from seeing red streaks on the toilet paper when wiping to copious amounts of red blood in the commode.  The causes for bleeding range from benign things such as hemorrhoids to chronic inflammatory conditions to neoplastic causes, such as polyps or cancer.  Bleeding in nearly all cases is intermittent, so the fact that the bleeding comes and goes really does not necessarily mean you can forget about it.  You should have any rectal bleeding evaluated by a gastroenterologist as soon as you can.

When would I need to have colonoscopy done?

A colonoscopy is a simple outpatient procedure where a flexible camera is inserted through the rectum and advanced to view the entire large bowel (about 3 feet long in most people).  It is used for screening for colon cancer in men and women, starting at age 50.  If there is a history of colon cancer in your family, the recommended screening starts earlier (age 40 in most people).

Other reasons for having colonoscopy include evaluation of rectal bleeding, chronic diarrhea, chronic constipation, a history of colon polyps, abdominal pain suggesting a colonic source or anemia from an undetermined cause.

I’m concerned that I might have an ulcer.  What should I do?

Ulcers of the stomach and small bowel can occur from using medications like aspirin, ibuprofen, Motrin, naproxen, Aleve or many others of the same type of medications called NSAIDs (Non Steroidal Anti-Inflammatory Drugs).  They can also occur from having a chronic infestation in the stomach of a bacteria caused Helicobacter pylori, which is present in about 30% of all Americans.  Other less common causes for ulcer disease include gastric cancers or inflammatory bowel conditions. 

The best initial test to see if you have an ulcer would be to have an upper endoscopy or EGD.  This test is performed by a gastroenterologist and uses a small, flexible camera.  After a patient is sedated, the camera is passed through the mouth and into the stomach and small intestine to look for ulcers.  If ulcers are present, biopsies are generally taken to help determine the actual cause for the ulcer.  Medications are also usually prescribed at the time to promote ulcer healing.

What is lactose intolerance?

Lactose intolerance is a common condition which is acquired during adulthood, resulting from the inability to absorb lactose, the naturally occurring sugar found in milk and dairy products.  The lactase enzyme is present in newborn children so that mother’s milk or formula can be absorbed properly for nutrition.  As we get older, the reliance on milk and dairy is less, and many of us lose the enzyme in later life.

The effect of this is the inability to absorb lactose.  Lactose stays in the intestinal tract, and is later eaten up by the normal bacteria which live in the tract.  Oftentimes, byproducts from lactose consumption lead to gas pain, bloating, cramps and diarrhea.  There are tests available to see if you have lactose intolerance, but the easiest way to find out is to go without milk or dairy products (cheese, ice cream, etc.) for 2 weeks and see if your gas or diarrhea symptoms improve.

What is celiac disease?

Celiac disease is an increasingly recognized problem where the small intestine becomes inflamed because of a response to gluten, a protein found in wheat, barley, rye and oats.  The inflamed bowel can cause decreased absorption of minerals and nutrients.  Symptoms include diarrhea, weight loss, gas and bloating.  There are other symptoms outside of the GI tract which can also occur, such as a specific type of skin rash, low blood counts (anemia), weakness and even thinning bones (osteoporosis).

The diagnosis can be made with simple blood tests and an upper endoscopy procedure.  The main treatment is going on a gluten-free diet.  Correction of certain mineral deficiencies might also be needed if they are found.

What are the symptoms of gallstones?

A gallstone is a common condition where bile in the gall bladder crystallizes and forms stones.  Usually these stones are small, and cause no symptoms at all.  However, sometimes they may become stuck in the passage leading out of the gall bladder and cause pain.  The usual symptoms from gallstone pain include pain in the right upper side of the abdomen, which is usually brought on after eating greasy or fatty foods.  Sometimes the feeling of nausea and vomiting may accompany the pain.  Usually the treatment for this is surgical removal of the gall bladder.

If fever or jaundice (a yellowing of the eyes or skin) occurs, this could be a serious problem where the gall bladder itself has become inflamed.  Consequences could include rupture of the gall bladder which could lead to widespread infection or even death.  You should seek immediate medical help, and possible hospitalization.  Treatments include measures to reduce fever and inflammation of the gall bladder, and eventual surgical removal of the gall bladder.