Center for Digestive Disorders
Frequently Asked Questions
- What is heartburn?
- How can I control my heartburn?
- Is heartburn serious?
- What causes ulcers?
- What is Irritable Bowel Syndrome?
- What is Hepatitis C?
- What is endoscopy?
- What is an EGD?
- Is endoscopy safe?
- What is a polyp and does it do any harm?
- What is Yellow Jaundice?
- Are hemorrhoids dangerous?
- I saw blood in my stool, what should I do?
- Why do I have trouble swallowing?
- What does the liver do?
- What is Pancreatitis?
- What is a flexible sigmoidoscopy?
- Why is esophageal manometry performed?
- Who should be screened for colorectal cancer?
- What screening tests are available for colorectal cancer?
- Can I reduce my risk of getting colorectal cancer?
1. What is heartburn?
Heartburn is a burning sensation behind the breastbone that results from the reflux (back flow) of acid and other stomach contents from the stomach into the esophagus (swallowing tube). Normally, acid should remain in the stomach when a meal is eaten. Heartburn arises when the "valve" (called the lower esophageal sphincter) between the esophagus and the stomach relaxes abnormally.
2. How can I control my heartburn?
The control of heartburn varies greatly among individuals. If heartburn is mild and occurs only intermittently, it is important to determine what precipitated it. For example, if heartburn occurs only when eating late at night, one should avoid eating within three hours of going to bed. In addition, if heartburn occurs only after eating certain foods or after consuming large quantities of coffee, these foods should be avoided. In general, we recommend the following measures to relieve heartburn:
- Use brick blocks to elevate the head of the bed between 4 and 6 inches. Extra pillows should not be used as they may actually aggravate heartburn. If bricks become uncomfortable for you or your partner, the use of a firm wedge to elevate your trunk and head can be substituted.
- Avoid coffee of any type (including decaffeinated), tomatoes and tomato products, citrus fruits and juices, chocolate, mints, caffeinated beverages, alcoholic drinks and fatty foods.
- Do not lie down for at least 3 hours after eating a meal.
- Stop smoking.
- Lose weight and avoid wearing tight fitting garments.
- Use various medications according to the severity of your heartburn. In general, mild intermittent episodes of heartburn can be treated effectively with antacids. Liquid antacids work more rapidly and more effectively than tablets. Antacids include Mylanta®, Maalox®, Tums® or any products in a local pharmacy that contain a mixture of magnesium hydroxide and aluminum hydroxide or calcium carbonate. If heartburn occurs more frequently, the use of over-the-counter H2-blockers (such as Pepcid-AC,® Tagamet-HB,® or Zantac-75®) can be used. These latter drugs work most effectively before it is anticipated heartburn may occur. If heartburn occurs less than two or three times a week, the episodes can also be treated with a combination of an antacid and an H2-blocker. This combination provides immediate and sustained relief. If heartburn is occurring more frequently than two or three times a week, it is important that you consult a gastroenterologist to determine the severity of your heartburn and whether or not further tests may be indicated.
3. Is heartburn serious?
Although heartburn is merely a nuisance in the vast majority of cases, it can also be a warning sign that more serious problems may be occurring. If you are over age 40 and are having heartburn or "indigestion" for the first time it is imperative that you see a physician as soon as possible. Many persons who are experiencing angina (decreased blood flow to the heart) may experience what they consider heartburn or indigestion. So, it is essential to get a correct diagnosis immediately. If you know you have heartburn, and experience it over a long period of time, an evaluation by a gastroenterologist is important. Acid refluxing into the esophagus can damage the esophagus, leading to inflammation or esophagitis, which can lead to more serious illness, including, in the most extreme cases, cancer of the esophagus. While this is relatively uncommon, certain individuals are at a high risk for the development of severe complications. The most important factors include the duration of heartburn (how many years) and the severity of the symptoms. Acid reflux can also lead to or worsen asthma, chronic cough, hoarseness and even erosion of the teeth.
4. What causes ulcers?
Ulcers are most commonly caused by infection with a bacterium called Helicobacter pylori (H. pylori). It resides in the stomach and causes an inflammation of the stomach (gastritis). Although a very large number of individuals, particularly those over the age of fifty, are infected with this germ, in most individuals it causes no harm and has no symptoms. In only a small proportion, less than five percent, will ulcers develop. Currently, it is recommended that antibiotics be used to treat this infection if it is associated with a proven peptic ulcer. In addition to H. pylori, one of the most common causes of ulcers is the use of aspirin and a class of drugs called nonsteroidal anti-inflammatory drugs (NSAIDs). These drugs include prescription medications such as such as Motrin and Naprosyn, as well as over-the-counter medications such as Advil and Aleve. Tylenol and other forms of acetaminophen do not cause ulcers, but their use in very large doses, or in combination with alcohol, can lead to liver damage. It is also important to realize that certain medications that one can purchase without prescription, such as Alka-Seltzer, Goody Powder and Standback, also contain aspirin and can lead to serious damage to the stomach. Finally, a significant proportion of individuals develop ulcers without infection with H. pylori or without consuming NSAIDs. If you are experiencing pain in the center of the abdomen below the rib cage, see a gastroenterologist to determine whether or not you do have an ulcer.
5. What is Irritable Bowel Syndrome?
Irritable Bowel Syndrome (IBS) is a common disorder of the intestine that leads to crampy pain, gas, bloating, and changes in bowel habits. Some people with IBS have constipation, others have diarrhea, and some people experience both. Sometimes a person with IBS has the urge to move the bowels but cannot do so. The cause of IBS is unknown and while there is no cure, effective treatment is available.
6. What is Hepatitis C?
Hepatitis C is a virus that infects the liver. It is the most common form of viral hepatitis and the most significant cause of chronic liver disease in the U.S. Hepatitis C is commonly transmitted by contact with contaminated blood. Twenty to thirty percent of people with chronic hepatitis C get cirrhosis of the liver. The progression of hepatitis C is slow and usually is not diagnosed until liver problems develop. Cirrhosis caused by hepatitis C can lead to hepatocellular carcinoma (liver cancer). If you have any of the following risk factors you should have a simple blood test to diagnose if you have been exposed to Hepatitis C.
A simple blood test can tell whether you have Hepatitis C. Patients with chronic Hepatitis C must be closely monitored by a gastroenterologist, and in some cases treatment can be offered.
8. What is an EGD?
EGD is an acronym for esophagogastroduodenoscopy. It is an endoscopic procedure that visualizes the esophagus, stomach and the first portion of the intestine. Upper endoscopy (also known as an upper GI endoscopy, or EGD) is a procedure that enables your physician to examine the lining of the upper part of your gastrointestinal tract, i.e. the esophagus, stomach and duodenum (first portion of the small intestine) using a thin flexible tube with its own lens and light source. Upper endoscopy is usually performed to evaluate symptoms of persistent upper abdominal pain, nausea, vomiting or difficulty swallowing. It is also the best test for finding the cause of bleeding from the upper gastrointestinal tract and way to find the bacteria which cause ulcers.
9. Is endoscopy safe?
Absolutely. The majority of endoscopic procedures are performed in an outpatient setting. Patients can go home after the procedure is completed. As with any medical procedure, there are some small risks associated with endoscopy.
10. What is a polyp and does it do any harm?
A polyp is a growth often occurring in the large intestine (colon). Polyps rarely cause symptoms. Some polyps are precancerous (adenomas) meaning that if not removed they could develop slowly into a cancer. Gastroenterologists can perform a procedure called colonoscopy to detect polyps of the large intestine and remove them preventing cancer of the colon.
11. What is Yellow Jaundice?
This is a yellow discoloration of the skin. It can be best recognized in the eyes and under the tongue. Sometimes it is accompanied by dark urine. In almost all instances is it caused by a liver condition that must be evaluated by a physician. If you do have jaundice, see your doctor immediately.
13. I saw blood in my stool, what should I do?
You need to consult your doctor. Blood in the stool warrants an endoscopic examination of the large intestine (colon) to identify a possible source of the bleeding even if you suspect hemorrhoids. If you bleed a lot you must go to the nearest ER for immediate evaluation.
14. Why do I have trouble swallowing?
There are many reasons why swallowing is impaired usually related to the esophagus (swallowing tube) such as acid reflux or, in some cases, cancer. You must see a gastroenterologist to identify the reason of your problem.
15. What does the liver do?
The liver is the central organ for synthesis of important proteins in your body without which you cannot live. It also stores from food, sustains strength for fighting infections and make the blood clot when necessary.
16. What is Pancreatitis?
Pancreatitis is a rare disease in which the pancreas becomes inflamed. Damage to the gland occurs when digestive enzymes are activated and begin attacking the pancreas. In severe cases, there may be bleeding into the gland, serious tissue damage, infection and cysts. Enzymes and toxins may enter the bloodstream and seriously injure organs, such as the heart, lungs and kidney. There are two forms of pancreatitis. The acute form occurs suddenly and may be a severe, life-threatening illness with many complications. Usually, however, the patient recovers completely. If injury to the pancreas continues, such as when a patient persists in drinking alcohol, a chronic form of the disease may develop, bringing severe pain and reduced functioning of the pancreas that affects digestion and causes weight loss.
17. What is a flexible sigmoidoscopy?
Flexible sigmoidoscopy is a procedure that enables your physician to examine the lining of the rectum and colon (large bowel) by inserting a flexible tube that is about the thickness of your finger into the anus and advancing it slowly into the rectum and lower part of the colon. If the doctor sees an area that needs evaluation in greater detail, a biopsy (sample of the colon lining) may be obtained and submitted to a laboratory for analysis. If polyps are found, they can be biopsied, but are not removed at the time of the sigmoidoscopy. The doctor performing the exam will likely request that you have a colonoscopy (a complete examination of the colon) to remove any large polyp that is found. Colonoscopy can also check the remainder of your colon for the presence of other polyps.
Your doctor may want you to have an esophageal manometry because you have difficulty swallowing, pain in swallowing, non-cardiac chest pain (a cardiac work up has ruled out heart problems), or if you have had chronic heartburn in the past and may now be considering surgery as an alternative to continued medication.
19. Who should be screened for colorectal cancer?
Anyone over the age of 50, regardless of gender or race/ethnicity, is at increased risk of colorectal cancer warrants screening. Individuals with a family history of colorectal cancer or polyps are at an even higher risk and warrant screening at an even younger age. Screening should begin around age 40 if only one first-degree relative (parent, sibling or child) had either cancer or polyps, and as early as 25 if multiple first-degree relatives were affected. Patients with a personal history of colorectal polyps, cancer or inflammatory bowel disease (ulcerative colitis or Crohn's disease) are also at high risk and warrant periodic colonoscopy.
20. What screening tests are available for colorectal cancer?
There are four main screening tests for colorectal cancer, including stool blood testing, flexible sigmoidoscopy, barium enema, and colonoscopy. The tests vary with respect to accuracy in detecting polyps or cancer, risks, convenience, discomfort, preparation, frequency of repeat testing, and costs. While any of the tests may be appropriate for individuals at increased risk because they are 50 years of age or older, colonoscopy may be a better choice for those at higher risk because of personal or family history of colorectal cancer or polyps, or because of a history of chronic inflammatory bowel disease. At-risk individuals need to discuss the various options with their provider.
21. Can I reduce my risk of getting colorectal cancer?
Yes. A healthy diet can help reduce the risk. In general, eat five or more servings of fruits and vegetables a day, replace red meat with chicken, fish, nuts, and legumes, take a multivitamin containing 0.4 mg of folic acid, and limit alcohol to two drinks per day for men and one drink per day for women.
Moderate physical activity, at least 30 minutes per day, is also important. This may include brisk walking, dancing and gardening. Start slowly and build up to 30 minutes per day. Of course, exercise has myriad health benefits and even moderate exercise can help reduce the risks of many diseases. Maintain a healthy weight and avoid smoking, as well.