Gastrointestinal (GI) health is central to our overall health, immunity and well-being. Huntington Hospital’s Medical Director of Gastroenterology, Richard Nickowitz, MD, offers the five most common questions his patients ask him about GI health.
What are the most common gastrointestinal diseases?
Gastroenterologists care for a wide variety of problems related to the intestinal tract, liver, gallbladder, bile duct system and pancreas. Many of the conditions we see are chronic, requiring ongoing management. Some cause more acute illness, requiring intervention leading to successful treatment. Heartburn, often described as regurgitation, acid reflux or gastroesophageal reflux, affects a fair number of our population and often is treated by lifestyle modification and over-the-counter or prescription medication. Helicobacter pylori is an increasingly recognized infection that may lead to gastritis, ulcers and, rarely, gastric cancer. Irritable bowel syndrome with varying manifestations of gastrointestinal symptoms should be distinguished from inflammatory bowel disease, which consists of ulcerative colitis and Crohn’s disease. Gastroenterologists regularly see patients for anemia and internal bleeding to identify a source and provide treatment. We care for a wide variety of liver diseases as well, including hepatitis B and C, alcoholic liver disease and non-alcoholic fatty liver disease — a problem that is increasing throughout the country. I should also mention the importance of screening for colon cancer as it is a disease that can be prevented or quite often found early with proper assessment.
How do you identify or diagnose these types of diseases?
Many of the diseases listed above have symptoms that point toward a diagnosis merely by talking to your gastroenterologist and undergoing a physical examination. Often blood tests or imaging studies, such as an abdominal ultrasound or a CT scan of the abdomen and pelvis, may be requested. Gastroenterologists also perform several types of endoscopic procedures, including upper endoscopy, enteroscopy (visualization of the proximal small bowel), flexible sigmoidoscopy and colonoscopy. One other procedure we perform is endoscopic retrograde cholangiopancreatography (ERCP) in which we are able to visualize the common bile duct and the pancreatic duct as well as treat stones and tumors presenting in this part of the body. One significant advancement in safety has been the novel development of disposable (one-time use) ERCP scopes. Huntington Hospital is the first healthcare facility in the San Gabriel Valley and the second in Los Angeles County to have these disposable ERCP scopes put into use. This is new technology that will enhance safety while performing this intricate procedure.
My family member has put off his endoscopy due to COVID-19; is it safe for him to have the procedure?
While all medical procedures do have risks, when talking about the performance of an ERCP, the single-use scope will certainly reduce the risk of infection secondary to this procedure. Infections are a rare, but known, complication of reusable ERCP scopes due to their intricate technical design. Because each disposable ERCP scope is used once (and then recycled to provide material for non-medical use), the risk of infection is reduced markedly.
I would like to be clear and point out that this risk of infection does not at all translate to endoscopes used for upper endoscopy and colonoscopy.
Being in the middle of the COVID-19 pandemic, Huntington Hospital is following established guidelines to assure safety for our patients and staff. We are testing all patients who undergo endoscopic procedures at the hospital. Additionally, the staff and physicians are well versed in the proper use of personal protective equipment (PPE) of which the hospital has adequate supply. Therefore, at this time, we do feel that the performance of necessary endoscopic procedures is safe for all involved.
What are the screening guidelines for colon cancer? Who should get colonoscopies and how often?
Currently, the U.S. Preventive Services Task Force (USPSTF) recommends that all patients undergo a screening colonoscopy at age 50 in the absence of symptoms and in the absence of a family history of colon cancer. For African American patients, the recommendation is to undergo a screening colonoscopy at age 45. The American Cancer Society (ACS) recommends that all patients begin colon cancer screening at age 45. For those patients with a family history of colon cancer, we recommend that they undergo their initial colonoscopy 10 years earlier than the index case. For patients with no family history in the absence of symptoms, a screening colonoscopy may be done every 10 years. For those patients with a first- degree relative with colon cancer, we recommend a surveillance colonoscopy at least every five years. Those patients who were found to have polyps on a colonoscopy will have their surveillance schedule determined by their gastroenterologist.
Any advice on how to maintain good digestive health?
To maintain good digestive health, I often tell my patients to be smart and sensible. Eating a healthy, well-balanced diet with an ongoing regimen of exercise and weight control is of utmost importance. There are many dietary recommendations and supplements out there. One needs to be judicious in following recommendations from dubious sources. It is important to discuss dietary matters with your general medical doctor and your gastroenterologist or a nutritionist/dietitian. In general, we recommend a relatively low-fat diet with good dietary fiber as well as moderate consumption of red meat and alcohol. Regular exercise and weight control should be goals for most people. If you have any questions, do not hesitate to ask your friendly GI doc!