Swallowing Disorders



Liver Disease & Hepatitis

Gastroesophageal Reflux Disease



Inflammatory Bowel Disease


Irritable Bowel Syndrome

Colon Cancer (Screening and Treatment)



Swallowing Disorders

What is difficulty swallowing (dysphagia)?
Difficulty swallowing is also called dysphagia. It is usually a sign of a problem with your throat or esophagus (the muscular tube that moves food and liquids from the back of your mouth to your stomach.) Although dysphagia can happen to anyone, it is most common in older adults, babies and people who have problems of the brain or nervous system.

There are many different problems that can prevent the throat or esophagus from working properly. Some of these are minor, and others are more serious. If you have a hard time swallowing once or twice, you probably do not have a medical problem. But if you have trouble swallowing on a regular basis, you may have a more serious problem that needs treatment.

What causes dysphagia?
Normally, the muscles in your throat and esophagus squeeze or contract to move food and liquids from your mouth to your stomach without problems. Sometimes food and liquids have trouble getting to your stomach. There are two types of problems that can make it hard for food and liquids to travel down your esophagus:

The muscles and nerves that help move food through the throat and esophagus are not working right. This can happen if you have:
• Had a stroke or a brain or spinal cord injury
• Certain problems with your nervous system, such as post-polio syndrome , multiple sc!erosis , muscular dystrophy, or Parkinson's disease
• An immune system problem that causes swelling (or inflammation) and weakness, such as polymyositis or dermatomyositis
• Esophageal spasm. This means that the muscles of the esophagus suddenly squeeze. Sometimes this can prevent food from reaching the stomach.
• Scleroderma. In this condition, tissues of the esophagus become hard and narrow. Scleroderma can also make the lower esophageal muscle weak, which may cause food and stomach acid to come back up into your throat and mouth.
• Something is blocking your throat or esophagus. This may happen if you have:
• Gastroesophageal reflux disease (GERD). When stomach acid backs up regularly into your esophagus it can cause ulcers in the esophagus which can then cause scars to form. These scars can make your esophagus narrower.
• Esophagitis. This is inflammation of the esophagus. This can be caused by different problems, such as GERD or having an infection or getting a pill stuck in the esophagus. It can also be caused by an allergic reaction to food or things in the air.
• Diverticula. These are small sacs in the walls of the esophagus or the throat.
• Esophageal tumors. These growths in the esophagus may be cancerous or not cancerous.
• Masses outside the esophagus, such as lymph nodes, tumors, or bone spurs on the vertebrae that press on your esophagus.
A dry mouth can make dysphagia worse. This is because you may not have enough saliva to help move food out of your mouth and through your esophagus. A dry mouth can be caused by medicines or another health problem.


What are the symptoms?
Dysphagia can come and go, be mild or severe, or get worse over time.
If you have dysphagia, you may:
• Have problems getting food or liquids to go down on the first try.
• Gag, choke or cough when you swallow.
• Have foods or liquids come back up through your throat, mouth or nose after you swallow.
• Feel like foods or liquids are stuck in some part of your throat or chest.
• Have pain when you swallow.
• Have pain or pressure in your chest or have heartburn.
• Lose weight because you are not getting enough food or liquid.


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Definition of Ulcer
An ulcer is a lesion that is eroding away the skin or mucous membrane. Ulcers can have various causes depending on their location. Ulcers on the skin are usually due to irritation, as in the case of bedsores, and may become inflamed and/or infected as they grow. Ulcers in the gastrointestinal tract were once attributed to stress but most are now believed to be due to infection with the bacterium Helicobacter pylori. GI ulcers, however, are often made worse by stress, smoking and other noninfectious factors.

What is a peptic ulcer?
A peptic ulcer is a break in the inner lining of the esophagus, stomach or duodenum. A peptic ulcer of the stomach is called a gastric ulcer; of the duodenum, a duodenal ulcer; and of the esophagus, an esophageal ulcer. Peptic ulcers occur when the lining of these organs is corroded by the acidic digestive (peptic) juices which are secreted by the cells of the stomach. A peptic ulcer differs from erosion because it extends deeper into the lining of the esophagus, stomach, or duodenum and excites more of an inflammatory reaction from the tissues that are eroded.

Peptic ulcer disease is common, affecting millions of Americans yearly. Moreover, peptic ulcers are a recurrent problem; even healed ulcers can recur unless treatment is directed at preventing their recurrence. The .medical cost of treating peptic ulcer and its complications runs into billions of dollars annually. Recent medical advances have increased our understanding of ulcer formation. Improved and expanded treatment options now are available.


What are the causes of peptic ulcers?
For many years, excess acid was believed to be the major cause of ulcer disease. Accordingly, the emphasis of treatment was on neutralizing and inhibiting the secretion of stomach acid. While acid is still considered necessary for the formation of ulcers , the two most important initiating causes of ulcers are infection of the stomach by a bacterium called "Helicobacter pyloricus" (H. pylori) and chronic use of anti-inflammatory medications, commonly referred to as NSAIDs (nonsteroidal anti-inflammatory drugs), including aspirin.Cigarette smoking also is an important cause of ulcer formationas well
as failure of ulcer treatment.


Infection with H. pylori is very common, affecting more than a billion people worldwide. It is estimated that half of the United States population older than age 60 has been infected with H. pylori. Infection usually persists for many years, leading to ulcer disease in 10% to 15% of those infected.

In the past, H. pylori were found in more than 80% of patients with gastric and duodenal ulcers. With increasing appreciation, diagnosis and treatment of this infection, however, the prevalence of infection with H. pylori as well as the proportion of ulcers caused by the bacterium has decreased; it is estimated that currently only 20% of ulcers are associated with the bacterium.


While the mechanism by which H. pylori causes ulcers is complex, elimination of the bacterium by antibiotics has clearly been shown to heal ulcers and prevent the recurrence of ulcers.

NSAIDs are medications used for the treatment of arthritis and other painful inflammatory conditions in the body. Aspirin, ibuprofen (Motrin), naproxen (Naprosyn), and etodolac (Lodine) are a few of the examples of this class of medications. Prostaglandins are substances which are important in helping the linings of the esophagus, stomach and duodenum to resist damage by the acidic digestive juices of the stomach. NSAIDs cause ulcers by interfering with prostaglandins in the stomach.

Cigarette smoking not only causes ulcers, but it also increases the risk of complications from the ulcers such as ulcer bleeding, stomach obstruction and perforation. Cigarette smoking also is a leading cause of failure of treatment for ulcers.

Definition of Duodenal ulcer

Duodenal ulcer:
A crater (ulcer) in the lining of the beginning of the small intestine (duodenum.) Ulcer formation is caused by infection with Helicobacter pylori. Other factors predisposing a person to ulcers include anti-inflammatory medications and cigarette smoking. Ulcer pain may not correlate with the presence or severity of ulceration. Diagnosis is made with barium X- ray or endoscopy. Complications of ulcers include bleeding, perforation and blockage. Treatment involves using antibiotics to eradicate H. pylori, eliminating risk factors and preventing complications.


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Gastroesophageal Reflux Disease

Gastroesophageal reflux disease (GERD) is a condition in which the stomach contents (food or liquid) leak backwards from the stomach into the esophagus (the tube from the mouth to the stomach). This action can irritate the esophagus, causing heartburn and other symptoms.


When you eat, food passes from the throat to the stomach through the esophagus. Once food is in the stomach, a ring of muscle fibers prevents food from moving backward into the esophagus. These muscle fibers are called the lower esophageal sphincter, or LES.


If this sphincter muscle doesn't close well, food, liquid, and stomach acid can leak back into the esophagus. This is called reflux or gastroesophageal reflux. Reflux may cause symptoms, or it can even damage the esophagus.


The risk factors for reflux include:
• Alcohol (possibly)
• Hiatal hernia (a condition in which part of the stomach moves above the diaphragm, which is the muscle that separates the chest and abdominal cavities)
• Obesity
• Pregnancy
• Scleroderma
• Smoking


More common symptoms are:
• Feeling that food is stuck behind the breastbone
• Heartburn or a burning pain in the chest (under the breastbone)
 Increased by bending, stooping, lying down, or eating
 More likely or worse at night
 Relieved by antacids
• Nausea after eating
Less common symptoms are:
• Bringing food back up (regurgitation)
• Cough or wheezing
• Difficulty swallowing
• Hiccups
• Hoarseness or change in voice
• Sore throat

Exams and Tests
You may not need any tests if your symptoms are not severe.
If your symptoms are severe or they come back after you have been treated, one or more tests may help diagnose reflux or any complications:
• Esophagogastroduodenoscopy (EGD) is often used to find the cause and examine the esophagus (swallowing tube) for damage. The doctor inserts a thin tube with a camera on the end through your mouth. The tube is then passed into your esophagus, stomach, and small intestine.
• Barium swallow
• Continuous esophageal pH monitoring
• Esophageal manometry


A positive stool occult blood test may diagnose bleeding that is coming from the irritation in the esophagus, stomach, or intestines.


You can make many lifestyle changes to help treat your symptoms. Avoid foods that cause problems for you. Making changes to your routine before you go to sleep may also help.

Avoid drugs such as aspirin, ibuprofen (Advil, Motrin), or naproxen (Aleve, Naprosyn). Take acetaminophen (Tylenol) to relieve pain. Take your medicines with plenty of water. When your doctor gives you a new medicine, remember to ask whether it will make your heartburn worse.

You may use over-the-counter antacids after meals and at bedtime, although they do not last very long. Common side effects of antacids include diarrhea or constipation.

Other over-the-counter and prescription drugs can treat GERD. They work more slowly than antacids but give you longer relief. Your pharmacist, doctor, or nurse can tell you how to take these drugs.
• Proton pump inhibitors (PPIs) decrease the amount of acid produced in your stomach
• H2 blockers (antagonists) lower the amount of acid released in the stomach


Anti-reflux operations (fundoplication and others) may be an option for patients whose symptoms do not go away with lifestyle changes and drugs. Heartburn and other symptoms should improve after surgery, but you may still need to take drugs for your heartburn.


There are also new therapies for reflux that can be performed through an endoscope (a flexible tube passed through the mouth into the stomach).


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Gallstones are hard particles that develop in the gallbladder. The gallbladder is a small, pear-shaped organ located in the upper right abdomen, the area between the chest and hips, below the liver.


Gallstones can range in size from a grain of sand to a golf ball. The gallbladder can develop a single large gallstone, hundreds of tiny stones, or both small and large stones. Gallstones can cause sudden pain in the upper right abdomen. This pain, called a gallbladder attack or biliary colic, occurs when gallstones block the ducts of the biliary tract


What is a biliary tract?
The biliary tract consists of the gallbladder and the bile ducts. The bile ducts carry bile and other digestive enzymes from the liver and pancreas to the duodenum, the first part of the small intestine.


The bile ducts of the biliary tract include the hepatic ducts, the common bile duct, the pancreatic duct and the cystic duct. The gallbladder stores bile. Eating signals the gallbladder to contract and empty bile through the cystic duct and common bile duct into the duodenum to mix with food.


What causes Gallstones?
Imbalances in the substances that make up bile cause gallstones. Gallstones may form if bile contains too much cholesterol, too much bilirubin or not enough bile salts. Scientists do not fully understand why these imbalances occur. Gallstones also may form if the gallbladder does not empty completely or often enough.


The two types of gallstones are cholesterol and pigment stones:
• Cholesterol stones, usually yellow-green in color, consist primarily of hardened cholesterol. In the United States, more than 80 percent of gallstones are cholesterol stones.
• Pigment stones, dark in color, are made of bilirubin.


Who is at risk for gallstones?
Certain people have a higher risk of developing gallstones than others.
• Women are more likely to develop gallstones than men. Extra estrogen can increase cholesterol levels in bile and decrease gallbladder contractions, which may cause gallstones to form. Women may have extra estrogen due to pregnancy, hormone replacement therapy or birth control pills.
• People over the age of 40 are more likely to develop gallstones than younger people.
• People with a family history have a higher risk.
• American Indians have genetic factors that increase the amount of cholesterol in their bile. In fact, American Indians have the highest rate of gallstones in the United States -- almost 65% of women and 30% of men have gallstones.
• Mexican Americans are at higher risk of developing gallstones.

Other factors that affect a person’s risk of gallstones include:

Obesity. People who are obese, especially women, have increased risk of developing gallstones. Obesity increases the amount of cholesterol in bile, which can cause stone formation.
Rapid weight loss. As the body breaks down fat during prolonged fasting and rapid weight loss, the liver secretes extra cholesterol into bile. Rapid weight loss can also prevent the gallbladder from emptying properly. Low calorie diets and bariatric surgery, (surgery that limits the amount of food a person can eat or digest) can lead to rapid weight loss and increased risk of gallstones.
Diet. Research suggests diets high in calories and refined carbohydrates and low in fiber increase the risk of gallstones. Refined carbohydrates are grains processed to remove bran and germ, which contains nutrients and fiber. Examples of refined carbohydrates include white bread and white rice.
Certain intestinal diseases. Diseases that affect normal absorption of nutrients, such as Crohn’s Disease, are associated with gallstones.
Metabolic syndrome, diabetes and insulin resistance. These conditions increase the risk of gallstones. Metabolic syndrome also increases the risk of gallstone complications. Metabolic syndrome is a group pf traits and medical conditions linked to being overweight or obese that puts people at risk for heart disease and type 2 diabetes.


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What is constipation?
Constipation means different things to different people. For many people, it simply means infrequent stools. For others, however, constipation means hard stools, difficulty passing stools (straining), or a sense of incomplete emptying after a bowel movement. The cause of each of these "types" of constipation probably is different and the approach to each should be tailored to the specific type of constipation.


Constipation also can alternate with diarrhea. This pattern commonly occurs as part of the irritable bowel syndrome (IBS). At the extreme end of the constipation spectrum is fecal impaction, a condition in which stool hardens in the rectum and prevents the passage of any stool.


The number of bowel movements generally decreases with age. Ninety-five percent of adults have bowel movements between three and twenty-one times per week, and this would be considered normal. The most common pattern is one bowel movement a day, but this pattern is seen in less than 50% of people. Moreover, most people are irregular and do not have bowel movements every day or the same number of bowel movements each day.


Medically speaking, constipation usually is defined as fewer than three bowel movements per week. Severe constipation is defined as less than one bowel movement per week. There is no medical reaso¬n to have a bowel movement every day. Going without a bowel movement for two or three days does not cause physical discomfort, only mental distress for some people. Contrary to popular belief, there is no evidence that "toxins" accumulate when bowel movements are infrequent or that constipation leads to cancer.


It is important to distinguish acute (recent onset) constipation from chronic (long duration) constipation. Acute constipation requires urgent assessment because a serious medical illness may be the underlying cause (for example, tumors of the colon). Constipation also requires an immediate assessment if it is accompanied by worrisome symptoms such as rectal bleeding, abdominal pain and cramps, nausea and vomiting and involuntary loss of weight. In contrast, the evaluation of chronic constipation may not be urgent, particularly if simple measures bring relief.

Constipation facts
• Constipation is defined medically as fewer than three stools per week and severe constipation as less than one stool per week.
• Constipation usually is caused by the slow movement of stool through the colon.
• There are many causes of constipation including medications , poor bowel habits, low fiber diets, abuse of laxatives, hormonal disorders, and diseases primarily of other parts of the body that also affect the colon.
• The two disorders limited to the colon that cause constipation are colonic inertia and pelvic floor dysfunction.
• High levels of estrogen and progesterone during pregnancy also can cause constipation.
• Medical evaluation for the cause of constipation should be done when constipation is of sudden onset, severe, worsening, associated with other worrisome symptoms such as loss of weight, or is not responding to simple, safe treatments.
• Medical evaluation of constipation may include a history, physical examination, blood tests, abdominal X-rays, barium enema, colonic transit studies, defecography, anorectal motility studies, and colonic motility studies.
• The goal of therapy for constipation is one bowel movement every two to three days without straining.
• Treatment of constipation may include dietary fiber, non-stimulant laxatives, stimulant laxatives, enemas, suppositories, biofeedback training and surgery.
• Stimulant laxatives should be used as a last resort because of the possibility that they may permanently damage the colon and worsen constipation.
• Most herbal laxatives contain stimulant-type laxatives and should be used, if at all, as a last resort.


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Colon Cancer


Are you at risk for Colon Cancer?
Colon cancer is the second leading cause of cancer death in the United States, with more than
140,000 new cases and 55,000 deaths expected each year. The lifetime incidence of colon cancer is 5%, with 90% of cases occurring after the age of 50. Men and women are equally affected. We now have an opportunity to use current screening methods not only to detect colon cancer early, but also to prevent this potentially devastating disease.


Colon cancer is often diagnosed in patients who have no symptoms. The ability to cure the disease is directly related to at what stage the disease is diagnosed. If one waits to seek medical attention until after symptoms have developed (rectal bleeding, abdominal pain, or intestinal obstruction), the chance of cure is greatly reduced. Therefore, screening is recommended for all people over the age of 50 regardless of symptoms. However, if one is experiencing rectal bleeding (even small amounts on infrequent occasions), abdominal pain, or symptoms of intestinal obstruction, he or she should seek the evaluation of a physician.


Recommendations for colon cancer screening must take into account several factors. These include the effectiveness, safety and convenience of the test. In addition, consideration must be given to what is best for the individual patient.


You should seek colon cancer screening if you are in any of the following groups .
• Age 50 years or older.
• Personal history of colon polyps.
• Personal history of inflammatory bowel disease (ulcerative colitis or Crohn's disease).
• Family history of either colon polyps or colon cancer, particularly if that family member is a first degree relative (mother, fat her, brother, sister or child) and if that family member’s colon polyp or colon cancer was diagnose d before age 50.
• Personal history of previous colon cancer.


There are multiple methods of screening for colon cancer. The physicians at Cleveland Gastroenterology Associates ca n recommend an appropriate screening test for you. Screening is generally safe and ca n be provided in a caring, private and cost efficient way that minimizes inconvenience to you and your family.


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Pancreatitis is inflammation of the pancreas. The pancreas is a large gland behind the stomach and close to the duodenum - the first part of the small intestine. The pancreas secretes digestive juices, or enzymes, into the duodenum through a tube called the pancreatic duct. Pancreatic enzymes join
with bile - a liquid produced in the liver and stored in the gallbladder - to digest food. The pancreas also releases the hormones insulin and glucagon into the bloodstream. These hormones help the body regulate the glucose it takes from food for energy.


Normally, digestive enzymes secreted by the pancreas do not become active until they reach the small intestine. But when the pancreas is inflamed, the enzymes inside it attack and damage the tissues that produce them.


Pancreatitis can be acute or chronic. Either form is serious and can lead to complications. In severe cases, bleeding, infection and permanent tissue damage may occur.


Both forms of pancreatitis occur more often in men than women.


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Liver Disease & Hepatitis


The liver is one of the largest solid organs of the body. It is located in the upper right part of the abdomen. Most of the organ lies under cover of the rib cage.


Liver function
It is not just the liver’s size but also its functions that makes it so important.

Its major functions include processing the food that passes through the gut and converting it into energy that can be utilized by the body.

It is also a powerful detoxification center that handles many chemicals, alcohol, poisons and toxins as well as drugs and clears the blood.

The liver also makes bile and stores it in a small pouch like organ called the gall bladder. This bile helps in digestion especially fats.


Causes of liver disease
Liver diseases may vary in causation.

They may be of short duration, acute liver disease, or long term, chronic liver disease. An acute liver disease may also convert into a chronic liver disease over time.

Some liver diseases are caused by infective viruses like Hepatitis virus (A, B and C).

Liver diseases also result from taking in some drugs or alcohol over long term. Sometimes the diseased liver over long term becomes shrunken and scarred.

Such a condition is called cirrhosis. Like other organs liver can also be afflicted with cancers.


Types of liver disease
Alcohol related liver disease is one of the commonest toxin induced liver disease worldwide. In normal cases the liver breaks down alcohol in the body.

If there is too much intake over a long period of time the liver fails to perform its functions leading to a condition called Alcoholic Liver disease.

Alcohol-related liver disease may be of three types – fatty liver disease, alcoholic hepatitis and finally alcoholic cirrhosis.

The alcohol related liver disease begins as fatty deposits on the liver followed by inflammatory changes and finally irreversible tissue scarring or cirrhosis.

The hepatitis phase leads to swelling of the liver and damage. At the initial phases of alcohol liver disease if alcohol is discontinued the changes may be reversed.

Liver disease may also be Non-Alcoholic called Non Alcoholic Fatty Liver Disease. This results in fat deposits on the liver and is seen in obese, diabetic and individuals with high blood cholesterol. It can affect 2-5% of the general population.

Liver disease is thus a wide ranging term that includes all conditions that cause imbalance or disturbance of the functions of the liver.

Liver disease is also called hepatic disease. Since it is a large organ, nearly two thirds of the liver has to be affected for the symptoms of hepatic disease to show in most individuals.

If there is very high blood pressure in the portal vein the condition is termed portal hypertension. This can lead to cirrhosis, enlarged abdomen with fluid (ascitis), bleeding, enlarged spleen, and sometimes jaundice. Bleeding may occur in the esophagus or via rectum.Portal hypertension is often a result of liver cirrhosis that results from chronic liver disease.

Portal hypertension may also sometimes lead to a condition called hepatic encephalopathy where the brain is affected and the person may go into coma. This is usually accompanied by liver failure.

(Dr. Ananya Mandal)


Hepatitis is a disease that includes any type of inflammation of the liver, the result of a complex process that occurs when the liver suffers an injury. Doctors call the inflammation that lasts less than six months acute hepatitis and inflammation that lasts longer than six months chronic hepatitis. While there are many causes of liver inflammation, clinicians divide them into two main categories: viral hepatitis and non-infectious hepatitis.

Viral Hepatitis
When most people think of hepatitis, they're usually thinking about viral hepatitis. There are five viruses that commonly infect the liver, named using letters of the alphabet -- A through E. What makes viral hepatitis confusing is that each one of these viruses causes a slightly different type of disease and has a different way of spreading. Some of these viral infections can result in acute, chronic or both forms of hepatitis. Since these viruses spread from person to person, doctors also call this type of hepatitis infectious hepatitis.

Non-Infectious Hepatitis
Not all causes of hepatitis are infectious. Chemicals such as alcohol or medications can be harmful to the liver and can cause inflammation. In addition, other health problems like genetic and metabolic disorders, immune-related injury and obesity, can damage the liver and lead to inflammation. Since these types of hepatitis cannot spread from one person to another, clinicians call it non-infectious hepatitis.

Testing for Hepatitis
The many causes of hepatitis create many ways to test for the disease. One basic test is to feel for an enlarged liver, known as hepatomegaly. Your doctor will do this test during clinical examination; if he finds an enlarged liver, they will look for causes and may order a blood test.

Some blood tests look for levels of enzymes and other proteins that may be disturbed when there is liver damage. Other blood tests will look for evidence of specific viruses, levels of toxins such as alcohol or Tylenol or even markers of genetic diseases such as iron or alpha-1 anti-trypsin.

Usually, the diagnosis of hepatitis is made using a combination of tests. More advanced tests might include using imaging technology such as ultrasound, computerized axial tomography (CT) scans or magnetic resonance imaging (MRI).

A liver biopsy, where a doctor removes a small piece of the liver and sends it to a laboratory for further testing, may be necessary if a clear cause of the inflammation cannot be identified or if the doctors need to clarify how much of the liver is involved.

Living with Hepatitis
While some types of hepatitis resolve quickly, other types last for decades and will need to be managed closely by your physician. Living with any type of hepatitis requires having regular medical appointments and following your medical treatment plan.

In addition to medications, your treatment plan may include modifying your lifestyle, such as restricting alcohol and maintaining a healthful body weight, which helps prevent the disease from getting worse. Other lifestyle changes may be necessary to prevent spreading the disease, if infectious, to others.

Finally, seek out others who live with hepatitis. Many support groups exist to help educate and assist people and their families. With a little education and support, people with hepatitis can live full and complete lives

How many types of hepatitis are there?
There are five main types of hepatitis that are caused by a virus, A, B, C, D, and E - plus types X and G.

Hepatitis A- this is caused by eating infected food or water. The food or water is infected with a virus called HAV (Hepatitis A Virus). Anal-oral contact during sex can also be a cause. Nearly everyone who develops Hepatitis A makes a full recovery - it does not lead to chronic disease.

Hepatitis B- this is an STD (sexually transmitted disease). It is caused by the virus HBV (Hepatitis B Virus) and is spread by contact with infected blood, semen, and some other body fluids. You get Hepatitis B by:

 Unprotected sexual intercourse with an infected person (unprotected sex means without using a condom) Using a syringe that was previously used by an infected person (most commonly happens with drug addicts and people who inject steroids).

 Having your skin perforated with unsterilized needles, as might be the case when getting a tattoo, or being accidentally pricked. People who work in health care risk becoming infected by accident in this way.

 Sharing personal items, such as a toothbrush or razor, with an infected person.

 A baby can become infected through his mother's milk if she is infected.

 Being bitten by someone who is infected.

The liver of a person infected with Hepatitis B swells. The patient can suffer serious liver damage due to infection, resulting in cancer. For some patients the hepatitis becomes chronic (very long-term or lifelong). Donated blood is always tested for Hepatitis B.

Hepatitis C- Hepatitis C is usually spread through direct contact with the blood of a person who has the disease. It is caused by the virus HCV (Hepatitis C Virus). The liver can swell and become damaged. In hepatitis C, unlike hepatitis B, liver cancer risk is only increased in people with cirrhosis and only 20% of hep C patients get cirrhosis. Feces is never a route of transmission in hepatitis C. Donated blood is also tested for Hepatitis C.

Misuse of anesthesia can result in the transmission of hepatitis B and hepatitis C viruses, researchers reported in the journal Gastroenterology. The cause of infection tends to be from anesthesia contamination, and not endoscopy contamination. Experts say that more effort is needed to better educate the healthcare community about the importance of strict sterile techniques when using any type of anesthesia.

Hepatitis D - only a person who is already infected with Hepatitis B can become infected with Hepatitis D. It is caused by the virus HDV (Hepatitis D Virus). Infection is through contact with infected blood, unprotected sex, and perforation of the skin with infected needles. The liver of a person with Hepatitis D swells.

Hepatitis E - a person can become infected by drinking water that contains HEV (Hepatitis E Virus). The liver swells but there are no long-term consequence. Infection is also possible through anal-oral sex.

Hepatitis X - if hepatitis cannot be attributed to the viruses of hepatitis A, B, C, D, or E, it is called Hepatitis X. In other words, hepatitis of an unknown virus.

Hepatitis G - this is a type of hepatitis caused by the Hepatitis G virus (HGV). Usually there are no symptoms.  When there are symptoms they are very mild.

What are the signs and symptoms of hepatitis?
Many people with Hepatitis experience either mild symptoms or none at all. Remember that an infected person's feces are always infectious to other people. When symptoms appear, they usually do so about 15 to 180 days after the person has become infected.

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Diverticulosis/Diverticular Disease


What is Diverticulosis/Diverticulitis?
Diverticula are pockets that develop in the colon wall, usually in the sigmoid or left colon, but may involve the entire colon. Diverticulosis describes the presence of these pockets. Diverticulitis describes inflammation or complications of these pockets.


What are the symptoms of diverticular disease?
Uncomplicated diverticular disease is usually not associated with symptoms. Symptoms are related to complications of diverticular disease including diverticulits and bleeding. Diverticular disease is a common cause of significant bleeding from the colon.
Diverticulitis - an infection of the diverticula - may cause one or more of the following symptoms: pain in the abdomen, chills, fever and change in bowel habits. More intense symptoms are associated with serious complications such as perforation (rupture), abscess or fistula formation (an abnormal connection between the colon and another organ or the skin).


What is the cause of diverticular disease?
The cause of diverticulosis and diverticulitis is not precisely known, but it is more common for people with a low fiber diet. It is thought t11at a low-fiber diet over the years creates increased colon pressure and results in pockets or diverticula.


How is diverticular disease treated?
Increasing the amount of dietary fiber (grains, legumes, vegetables, etc.) - and sometimes restricting certain foods reduces the pressure in the colon and may decrease the risk of complications due to diverticular disease.


Diverticulosis of the colon is a common condition that afflicts about 50 percent of Americans by age 60 and nearly all by age 80.
Only a small percentage of those with diverticulosis have symptoms, and even fewer will ever require surgery.


Diverticulitis requires different management. Mild cases may be managed with oral antibiotics, dietary restrictions and possibly stool softeners. More severe cases require hospitalization with intravenous antibiotics and dietary restraints. Most acute attacks can be relieved with such methods.


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Inflammatory Bowel Disease

Inflammatory bowel disease (IBD) involves chronic inflammation of all or part of your digestive tract. IBD primarily includes ulcerative colitis and Crohn's disease. IBD can be painful and debilitating, and sometimes leads to life-threatening complications.

Ulcerative colitis is an inflammatory bowel disease that causes long-lasting inflammation in part of your digestive tract. Symptoms usually develop over time, rather than suddenly. Ulcerative colitis usually affects only the innermost lining of your large intestine (colon) and rectum. It occurs only through continuous stretches of your colon.

Crohn's disease is an inflammatory bowel disease that causes inflammation anywhere along the lining of your digestive tract, and often spreads deep into affected tissues. This can lead to abdominal pain, severe diarrhea and even malnutrition. The inflammation caused by Crohn's disease can involve different areas of the digestive tract in different people.

Collagenous colitis and lymphocytic colitis also are considered inflammatory bowel diseases, but are usually regarded separately from classic inflammatory bowel disease.

Inflammatory bowel disease symptoms vary, depending on the severity of inflammation and where it occurs.

Ulcerative colitis symptoms
Ulcerative colitis is classified according to its signs and symptoms:
Ulcerative proctitis.  In this form of ulcerative colitis, inflammation is confined to the area closest to the anus (rectum), and for some people, rectal bleeding may be the only sign of the disease. Others may have rectal pain, a feeling of urgency or have frequent, small bowel movements. This form of ulcerative colitis tends to be the mildest.
Proctosigmoiditis. This form involves the rectum and the lower end of the colon, known as the sigmoid colon. Bloody diarrhea, abdominal cramps and pain, and an inability to move the bowels in spite of the urge to do so (tenesmus) are common problems associated with this form of the disease.
Left-sided colitis.  As the name suggests, inflammation extends from the rectum up through the sigmoid and descending colon, which are located in the upper left part of the abdomen. Signs and symptoms include bloody diarrhea, abdominal cramping and pain on the left side, and unintended weight loss.
Pancolitis.  Affecting more than the left colon and often the entire colon, pancolitis causes bouts of bloody diarrhea that may be severe, abdominal cramps and pain, fatigue, and significant weight loss.
Fulminant colitis. This rare, life-threatening form of colitis affects the entire colon and causes severe pain, profuse diarrhea and, sometimes, dehydration and shock. People with fulminant colitis are at risk of serious complications, including colon rupture and toxic megacolon, a condition that causes the colon to rapidly expand.


The course of ulcerative colitis varies, with periods of acute illness often alternating with periods of remission. Most people with a milder condition, such as ulcerative proctitis, won't go on to develop more-severe signs and symptoms.

Crohn's disease symptoms
Inflammation of Crohn's disease may involve different parts of the digestive tract in different people. The most common areas affected by Crohn's disease are the last part of the small intestine called the ileum and the colon. Inflammation may be confined to the bowel wall, which can lead to scarring (stenosis), or inflammation may spread through the bowel wall (fistula).

Signs and symptoms of Crohn's disease can range from mild to severe and may develop gradually or come on suddenly, without warning. Signs and symptoms may include:

Diarrhea.The inflammation that occurs in Crohn's disease causes cells in the affected areas of your intestine to secrete large amounts of water and salt. Because the colon can't completely absorb this excess fluid, you develop diarrhea. Intensified intestinal cramping also can contribute to loose stools. Diarrhea is a common problem for people with Crohn's.
Abdominal pain and cramping.  Inflammation and ulceration may cause the walls of portions of your bowel to swell and eventually thicken with scar tissue. This affects the normal movement of contents through your digestive tract and may lead to pain and cramping. Mild Crohn's disease usually causes slight to moderate intestinal discomfort, but in more-serious cases, the pain may be severe and include nausea and vomiting.


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Irritable Bowel Syndrome


What is Irritable Bowel Syndrome?
Irritable bowel syndrome (IBS) is a common disorder of the intestines that leads to crampy pain, gassiness, bloating, and changes in bowel habits. Some people with IBS experience constipation; others have diarrhea; and some people experience both. Sometimes the person with IBS has a crampy urge to move the bowels but cannot do so.

The cause of IBS is unknown, and as yet there is no cure. Doctors call it a functional disorder because there is no sign of disease when the colon is examined. IBS causes a great deal of discomfort and distress, but it does not cause permanent harm to the intestines and does not lead to intestinal bleeding of the bowel or to a serious disease such as cancer. Often IBS is just a mild annoyance, but for some people it can be disabling. Most people with IBS, however, are able to control their symptoms through medications prescribed by their physicians, diet, and stress management.


How does a good diet help IBS?
For many people, eating a proper diet lessens IBS symptoms. Before changing your diet, it is a good idea to keep a journal noting which foods seem to cause distress. Discuss your findings with your doctor. For instance, if dairy products cause your symptoms to flare up, you can try eating less of those foods. Yogurt might be tolerated better because it contains organisms that supply lactase, the enzyme needed to digest lactose, the sugar found in milk products. Because dairy products are an important source of calcium and other nutrients that your body needs, be sure to get adequate nutrients in the foods that you substitute.

Dietary fiber may lessen IBS symptoms in many cases. Whole grain breads and cereals, beans, fruits and vegetables are good sources of fiber. Consult your doctor before using an over-the-counter fiber supplementation. High-fiber diets keep the colon mildly distended, which may help to prevent spasms from developing. Some forms of fiber also keep water in the stools, thereby preventing hard stools that are difficult to pass. Doctors usually recommend that you eat just enough fiber so that you have soft, easily passed, and painless bowel movements. High-fiber diets may cause gas and bloating, but within a few weeks, these symptoms often go away as your body adjusts to the diet.

Large meals can cause cramping and diarrhea in people with IBS. Symptoms may be eased if you eat smaller meals more often or just eat smaller portions. This should help, especially if your meals are low in fat and high in carbohydrates such as pasta, rice, whole grain breads and cereals, fruits, and vegetables.


What are gas-forming foods?
The following foods have been found to cause excessive gaseousness in some people:

• Legumes
• Beams
• Peas
• Nuts
• Sweet Potatoes
• Cabbage

• Broccoli
• Cauliflower
• Dairy products (milk, ice cream, etc.)
• Carbonated beverages
• Slurping hot liquids.
• Beer


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