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Gastrointestinal Symptoms You Can’t Ignore

Heather Gerst, DO

The Uncomfortable Truth

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• If you suffer from gastrointestinal (GI) symptoms, such as gas, constipation, or diarrhea, you are definitely not alone

Your Doctor Has Seen it All

• Your doctor can determine if your symptoms are warning signs of serious GI problems that require treatment

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When Should I See a Doctor

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• Everyone experiences the occasional bout of GI issues

• See a doctor if your symptoms persist or disrupt your daily activities

Your Digestive System

• Transforms food into nourishment for body

• Waste products excreted through bowel movements

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Common GI Disorders

• GERD

• Irritable Bowel Syndrome (IBS)

• Celiac Disease and Gluten Insensitivity

• Colorectal cancer (CRC)

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GER and GERD

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• Gastroesophageal Reflux (GER) occurs when the contents of your stomach reflux up into your esophagus, causing symptoms.

• Heartburn, sourbrash, indigestion, throat clearing, frequent cough, tooth decay, earache, jaw pain, chest pain, difficulty swallowing.

• 20% of the population suffers from GERD and it’s the most common gastrointestinal diagnosis.

• People who are overweight or smoke are more likely to develop GERD.

GERD

• Foods to avoid that cause GER or make it worse:

▪ Coffee/Caffeine

▪ Nicotine

▪ Alcohol

▪ Peppermint

▪ Chocolate

▪ Carbonated beverages

▪ Tomato products

▪ Greasy foods.

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GERD

Lifestyle changes

Medications: antacids, H2blockers, PPI’s

Seek Prompt Medical Attention

For These Symptoms •Blood in your stool

•Black tarry stools

• Persistent heartburn (acid reflux)

•Difficulty swallowing

• Abdominal pain

•Chest pain

•Nausea or vomiting (especially if you have blood in your vomit)

•Unexpected weight loss

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What’s with the Gluten-Free

craze? Gluten= a protein found in wheat, barley, rye, malt

Celiac disease = autoimmune- mediated allergy to gluten, damages

small bowel mucosa from exposure to gluten in people carrying gene

mutations HLA-DQ2 and HLA-DQ8

Damaged mucosa causes: malabsorption, abdominal pain and

bloating, diarrhea, nausea/vomiting, IDA, rash, constipation, pale/fatty

stools, elevated liver enzymes, fatigue, weight loss

Diagnosed with blood tests and small bowel biopsies

Requires a completely gluten-free diet to treat it

Can lead to lymphoma and micronutrient deficiencies

Non-Celiac Gluten Sensitivity

-absence of mucosal damage, antibody markers or genetic

mutations

-no weight loss, anemia, rash, abnormal lft’s

-BUT experiences diarrhea, bloating, flatulence, abdominal

discomfort, nausea with gluten intake– gets better when

stops gluten

-is improvement from low carb diet?

-changes in GMO/hybrid grain crops to blame for NCGS?

**Going gluten free can lead to deficiencies in: Vit A, D,

B12, folate, iron, Mag, Ca, Zinc.

What Does Your Poop Say?

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Irritable Bowel Syndrome (IBS)

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• You may have diarrhea or constipation (or both), bloating and the feeling you haven’t finished a bowel movement.

• IBS is treatable. If you suspect you have IBS, keep a diary of what you eat and when you have symptoms and then see your doctor.

• IBS describes a group of symptoms that includes abdominal pain or discomfort and changes in bowel patterns.

• Hypersensitive gut

• 10-15 of U.S. adults have IBS, especially women.

Symptoms of IBS

• Recurrent abdominal pain

or discomfort (3 days per

month in the last 3 mos)

• Pain is associated with

improvement after

BM, change in stool

frequency, change in

stool

form/appearance

• “Rule-out” diagnosis

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Updates on Probiotics

“live microorganisms when administered in adequate amounts confer

health benefits on the host”—WHO

-Trillions of good bacteria live in our gut

-Imbalance of good and bad can lead to symptoms, infections, illness

-Probiotics MAY alleviate or prevent

None FDA regulated

Many trials performed….. Conflicting results

-May provide benefit in IBS and AAD

Who Should NOT Take Probiotics

*Chronic infections

*Pancreatitis

*Immunocompromised:

steroids, chemo,

indwelling catheters, GI

tract infections, ICU

*Pregnant

*Structural heart disease

*Abnormal CBC/WBC

*Long-term PPI’s or

opioids

SEPSIS

Could Probiotics Cause

Symptoms?

Lactic Acidosis Brain Fog?

Colorectal Cancer (CRC)

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• More than half of all GI cancers are cancers of the colon and rectum

• CRC is the 2nd deadliest cancer

• Overall lifetime risk is about 1 in 20

• PREVENTABLE with screening colonoscopy

• TREATABLE if caught early with colonoscopy

• Screening reduces death from CRC ▪ Average risk adults begin

screening at age 50

▪ African Americans begin screening at age 45

▪ First degree relatives begin screening at age 40 / 10 yrs younger than relative’s diagnosis

▪ Ask your doctor when you should begin screening

Never too young!

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• Colon cancer in ages 18-

49 is on the rise!

• Cancers found in 18-29 yr olds

have distinct cellular features

(signet ring) from those in >50

yrs old- more advanced at

diagnosis

• Gene mutations associated

with early onset colon cancers-

tumors can develop in kids

• Younger cases associated with obesity epidemic? Processed foods?

• Regardless of age- promptly discuss ALL symptoms with your doctor

Symptoms

#1 symptom of colon

cancer is no symptom at

all

**May experience

abdominal pain, change

in stools or bowel habits,

blood in stools, nausea,

gas, bloating, low blood

counts, unintentional

weight loss

Prevention

• Lower your risk by: ▪ Not smoking

▪ Alcohol in moderation

▪ Eating a healthy diet

▪ Less red/processed meats

▪ Getting regular exercise

▪ Get your screening colonoscopy!

Colonoscopy Prep

Shorter process

Less volume

Better tasting

Absolutely necessary

Facts

Risk of colon cancer is

1/20

Risk of colonoscopy

complication is 1/10,000

Other tests are NOT:

- 100% accurate

- Complete

- preventative

Colonoscopies ARE:

- Effective

- Complete

- Covered by

insurance

- Preventative and

therapeutic

Action Items

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• See your doctor promptly if you experience symptoms.

• To help you doctor make an accurate diagnosis, keep a record of your symptoms, including what you ate and when your symptoms occurred.

• Ask your doctor how you can reduce your risk for colorectal cancer and when you should begin screening.

For More Information

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• Appointments at the Digestive Disease Center

• 570-321-3454

• Now seeing patients at:

• UPMC-Susquehanna Williamsport, UPMC-Muncy Valley Hospital and UPMC McElhattan Outpatient Center

• QUESTIONS?

UPMC Colonoscopy Services

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UPMC Susquehanna Williamsport Regional Medical Center 700 High Street 2nd Floor Williamsport, PA 17701 570-321-3454 UPMC Susquehanna Lock Haven 24 Cree Drive Lock Haven, PA 17745 570-286-3584 UPMC Susquehanna Soldiers + Sailors One Main Street Wellsboro, PA 16901 570-723-0716

UPMC Susquehanna Muncy 10 Shady Lane, Suite 101 Muncy, PA 17756 570-321-3454 UPMC Susquehanna Sunbury 350 N 11th St 3rd Floor, Suite A Sunbury, PA 17801 570-286-3584