Digesting The Facts About Gastrointestinal Disorders

By Kaaren Valenta

Gastrointestinal disorders run the gamut from minor food intolerances to life-threatening colon cancer. But while food intolerances are little understood and difficult to cure, colon cancer is almost completely preventable with a simple screening test.

“The short answer is we don’t know what causes food intolerances,” Dr Thomas P. Whelan, a gastroenterologist, said at a recent program sponsored by the St Rose Parish Nurse Ministry in the Msgr Conroy Room at St Rose School.

Food intolerances are different than allergies, which cause rashes, hives, wheezing, and sometimes even life-threatening respiratory problems, he said. Food intolerances may cause symptoms such as headache, upset stomach, and nausea.

“Intolerances are very common,” he said. “A highly fatty meal can cause hormones to be released that aren’t released when you eat a salad. Generally you develop more [intolerances] as you get older. There is no specific treatment, no specific test.”

There is a simple screening test to prevent life-threatening colon cancer, however. The test, a colonoscopy, is much more effective than the stool sample, barium enema, and the flexible sigmoidoscopy, Dr Whelan said.

“The standard is the colonoscopy now,” he said. “We know 99.9 percent of the time it prevents colon cancer because 99.9 percent of colon cancers arise from polyps, although they are by nature benign. If we go in and remove all the polyps, we can prevent colon cancer. Only one type of polyp has the risk of developing into colon cancer and even in that, one in 20 would become cancerous. But we can’t tell which, so that’s why we remove them all.”

Anyone who is 50 years old should have a colonoscopy even if there are no symptoms such as change in bowel habits or bleeding, and no family history of colon cancer. There is no reason why the screening cannot be done when someone is in their 40s, he said.

“If there is a family history of colon cancer, get a colonoscopy at age 40 or at an age ten years prior to the onset of the cancer in that family member,” Dr Whelan said.

If polyps are found and removed, another colonoscopy should be done in three to five years, or even sooner, depending on the physician’s recommendation.

“The recommendations is that colonoscopies should be repeated every ten years if there are no signs or symptoms, but I am not telling anyone to wait that long,” he said. “I will say call me in five years and if everything is still good, wait until six years, but I’d definitely do it at seven years.”

Dr Whelan said virtual colonoscopies, which are done by radiologists, usually with a CT scan, requires the same prep — the most objectionable part of the screening. The scan is good at detecting cancer or large polyps, “but we want to remove them before they get that big so a colonoscopy is a better tool,” he said.

Besides, he said, if polyps are found in a CT scan, a follow-up colonoscopy is required to remove them.

“The virtual colonoscopy will have a role when the software is developed that enables them to be used without requiring the patient to prep,” he said. “But the technology is not there yet.”

One of the newest diagnostic tools for gastrointestinal disorders is the “camera pill,” a tiny device that is swallowed by the patient. The camera takes photos as it passes through the digestive tract and transmits them to a computer, Dr Whelan explained.

GERD And Celiac Disease

Many patients that Dr Whelan treats are suffering from acid reflux disease, also known as GERD, gastro esophageal reflux disease. GERD is a condition in which acid, bile, and partially digested food in the stomach back up into the esophagus, the tube that carries food from the mouth to the stomach. Heartburn is one symptom of GERD.

“Thirty to 40 years ago there were very few complains of GERD, but today 30 to 40 percent of my patients have symptoms related to GERD,” Dr Whelan said. “The sphincter muscle [between the esophagus and the stomach] opens up inappropriately at times, causing GERD. Patients get inflammation, heartburn, nausea, the feeling of a lump in your throat, the sensation that food gets stuck.”

Dr Whelan said he gets referrals of patients who complain of sore throat or sinus problems that actually are caused by GERD. Some also have pulmonary disorders, characterized by a cough that will not clear, actually caused by GERD. “You don’t necessary need heartburn to have a diagnosis of GERD,” he said.

Not everyone needs to be treated for GERD, which is a common disorder that usually can be relieved with antacids and other over-the-counter acid reducers and neutralizers. Some patients require prescription drugs to get relief.

Stress can make a lot of symptoms worse, Dr Whelan noted. On the other hand, lifestyle changes can help, such as reducing stress, losing weight, and cutting back or eliminating alcohol, fried fatty food, coffee, chocolate, and other foods that contain caffeine. Giving up smoking also helps, as does reducing the consumption of acidic beverages like grapefruit juice and orange juice.

“Some people can make all these lifestyle changes and still need the pill,” Dr Whelan said. “The pill does have possible side affects, however, such as headaches, belly pain, and diarrhea.”

When GERD is untreated, it can cause chronic inflammation that leads to scarring of the tissue. In some cases, the changes in the lining of the esophagus can lead to ulcers there, a condition known as Barrett’s esophagus, and occasionally cancer.

Some patients that Dr Whelan are diagnosed with celiac disease, an intolerance to anything made from gluten, an allergy to a protein in grains.

“It sets off an inflammatory response in the wall of the small intestine that causes bloating, cramps, abdominal pain, and terrible diarrhea,” Dr Whelan said. “It is a genetic disease and can cause anemia. Lack of vitamin D absorption can lead to osteoporosis in women.”

The treatment is simple avoidance of anything with gluten — anything made with grains such as wheat, rye, and barley. “The more we look for celiac disease, the more we find it,” he said.

Dr Whelan said many gastrointestinal disorders cause diarrhea and one of the most helpful things for patients is acidophilus, live cultures found in some types of yogurt, that restore the bacteria flora of the digestive tract. It is often recommended for patients who are taking antibiotics, he said, because the drugs can also kill the beneficial bacteria in the intestinal tract, causing diarrhea and other problems.

Thomas P. Whelan, MD, is a gastroenterologist with the Village Square Internal Medicine, PC, at 2 Elizabeth Street in Bethel.