Diseases & Conditions

The Section for Endoscopy and Pancreatic – Biliary Disease is devoted to excellence in patient care, research, and education in the fields of gastrointestinal endoscopy and pancreatic disease.

Pancreatic disease includes such disorders as painful masses, sharp, irregular attacks of pain, or an inability to digest food because the pancreas does not produce enough digestive enzymes.

Endoscopes are flexible tubes that can be passed through the mouth or rectum. They allow physicians to see and examine the surfaces of the esophagus (food pipe), stomach, intestine, and colon.

Endoscopic examinations allow physicians to diagnose and treat a variety of intestinal disorders, including abdominal pain, vomiting, and bleeding from the intestinal tract. In addition, benign (non-cancerous) growths of the colon, which can lead to colon cancer, may be detected and removed with the help of an endoscope.

Special versions of the endoscope allow doctors to remove stones from the bile duct (the drainage tube for digestive juices of the liver and gallbladder) and pancreas. A new technique called endoscopic ultrasound allows very clear pictures of the gastrointestinal tract, as well as nearby structures such as the pancreas.

Our section uses a multidisciplinary approach to the care of these patients, meaning that specialists from many different departments work together to plan your care. Specialists in gastroenterology team up with colleagues in surgery, anesthesiology, and radiology.

Additional Resources

• Pancreas Clinic
• Capsule Endoscopy
• Gallstones
• Cancer of the Pancreas
• Pancreatitis
• Esophageal Cancer
• Endosonography
• Stones, Strictures and Cancer of the Bile Ducts
• GI Bleeding Overview
• Acute Pancreatitis
• Chronic Pancreatitis
• Pancreatic Cyst/Pseudocyst (IPMN, MCN)

Cleveland Clinic's Center for Swallowing & Esophageal Disorders offers a coordinated, comprehensive program to treat swallowing and esophageal disorders including Barrett's Esophagus.

The Center's multidisciplinary team includes gastroenterologists, radiologists, thoracic surgeons, neurologists, lung specialists, swallowing therapists, and ear, nose, and throat specialists. Approximately 1,500 patients are seen annually in the Center for Swallowing & Esophageal Disorders, including patients with Barrett’s Esophagus.

Millions of Americans have trouble swallowing or complain of heartburn and acid reflux. These problems may be caused by malfunctioning of the physical structures in the mouth, throat or esophagus, damage to the nerves or muscles coordinating swallowing in these organs, or physical obstruction to these organs.

Acid reflux of stomach contents into the esophagus, throat or mouth can lead to Barrett’s Esophagus and also cause esophagitis and its complications -- chest pain, asthma and breathing problems, or ear, nose and throat complaints including recurrent coughing.

Early diagnosis and intervention are very important. Left untreated, swallowing and esophageal disorders can lead to serious problems.

Additional Resources

• Achalasia
• Barrett's Esophagus
• Eosinophilic Esophagitis
• Esophageal Cancer
• Esophageal Dysmotility
• Esophageal varices
• Esophagitis
• Gastroesophageal Reflux (GERD)
• Heartburn
• Hiatus Hernia
• Hoarseness
• Peptic Ulcer Disease
• Stomach Cancer
• Swallowing Disorders

In conjunction with the Women's Center for Pelvic Disorders, the physicians in this group evaluate and treat patients with pelvic floor disorders, constipation and fecal incontinence.

Patients have access to a number of treatments for fecal incontinence. To achieve a comprehensive diagnosis, the department utilizes specialized equipment, including ultrasound, to visualize the anal muscles, as well as a dedicated laboratory to evaluate stool incontinence.

Additional Resources

• Rectal Prolapse
• Constipation
• Bowel Incontinence

The Center for Gastrointestinal Motility Disorders diagnoses and treats patients with motor abnormalities of the stomach, small intestine and large intestine (colon). Some of these problems are among the most common health concerns. It's estimated that constipation affects up to 10 million Americans, while approximately 20 million Americans suffer from the opposite problem, fecal incontinence.

The center provides the latest and most comprehensive diagnostic and treatment options for bowel incontinence. If necessary, tests are provided by the Radiology and Nuclear Medicine Departments.

Patients seen at the center are offered medical therapy and biofeedback training exercises, or surgical treatment in the departments of general surgery or colorectal surgery.

In addition to patient care, our staff participates in patient and medical education and clinical research. When appropriate, patients can participate in new treatment trials conducted at Cleveland Clinic.

Additional Resources

• Gastroparesis
• Inflammatory Bowel Disease (IBD)
• Constipation
• Intestinal Pseudo-Obstruction

Descriptions of the conditions commonly seen by specialists in anorectal disease include:

Hemorrhoids

A normal part of the anal anatomy, which helps control bowel motions and gas. When enlarged they may cause discomfort or bleeding and need assessment. Treatment is usually performed in the office with either dietary instructions or application of local hemorrhoid treatments which can be performed at the time of the initial office visit. Larger hemorrhoids may require an operation and, if so, an admission for a day case surgical procedure is arranged.

Anal fissure

Patients have severe pain and sometimes bleeding after passing a bowel motion. Generally, medical treatments can be prescribed in the office. For cases which do not respond to this, a minor surgical procedure can be performed in the office under local anesthetic.

Pilonidal Disease

Patients may develop abscesses between the buttocks, which can be treated in the office and, in rare cases, a general anesthetic required. Definitive later therapy may require a general anesthetic and subsequent wound care.

Anorectal sepsis and fistula

Patients may have severe pain and swelling caused by an abscess in the anal region. The usual initial treatment involves insertion of a small plastic drain under local anesthetic in the office. This gives almost instantaneous relief of symptoms. Some patients with an abscess will later develop a fistula, which requires further treatment. Patients who require further treatment, or patients who have a fistula at their initial visit may require surgery under general anesthetic, which is often arranged at the initial outpatient visit. These fistulas, or abnormal tracts connecting the anal canal or rectum to skin around the anus, sometimes require more than one treatment to heal completely.

Sexually transmitted diseases

Some patients with anal infections may develop pain and/or bleeding. These are treated in the office, sometimes in consultation with the Infectious Disease Department. Some patients may have warts in the anal region, which can usually be treated in the office under local anesthetic.

Malignant tumors

In rare cases, patients develop a swelling or mass in the anal area which is caused by a cancer. Surgeons in this department are experienced at defining the treatment regimes for such tumors which may involve chemotherapy or radiation prior to surgery, or simply proceed with the surgery if needed. The treatment plan is based on individual patient assessment.

Other conditions

Patients may have problems related to the skin around the anus, which can be treated in the office. Patients with discomfort or itch in the anal area can be treated with dietary advice and other suggestions.

• Anal Abscess
• Anal Dysplasia
• Anal Fissures
• Anal Fistula
• Anal Stenosis
• Anorectal Disease
• Anorectal Fistula
• Colorectal Endometriosis
• Condyloma accuminata
• Fecal Incontinence
• Internal Hemorrhoids
• Pelvic Floor Dysfunction
• Perianal Abscess
• Perianal hidradenitis suppurativa
• Pilonidal Sinus and Abscess
• Proctitis
• Pruritus Ani
• Rectal bleeding
• Rectal Prolapse
• Rectovaginal Fistula
• Thrombosed External Hemorrhoid
• Solitary Rectal Ulcer

Links

For more information on anorectal disease, contact:

American Society of Colon and Rectal Surgeons
85 West Algonquin Road, Suite 550
Arlington Heights, IL 60005
Phone: 847.290.9184
Email: ascrs@fascrs.org
Internet: www.fascrs.org

National Institutes of Diabetes & Digestive & Kidney Diseases (NIDDK)
NIH, Building 31, Room 9A04
31 Center Drive, MSC 2560
Bethesda, MD 20892-2560
Internet: www.niddk.nih.gov

American Society for Gastrointestinal Endoscopy
1520 Kensington Rd., Suite 202
Oak Brook, IL 60523
Phone: 630.573.0600
www.asge.org

Patient Information

The liver is the body's most complex organ, performing many essential tasks related to the conversion of food to energy (metabolism).

Carbohydrates, fats and proteins from food are transported to the liver from the digestive organs through the portal vein. Nutrients pass into the smaller branches of the portal vein, and seep through the blood vessel walls and into the liver cells. The cells are tiny manufacturing sites where these materials are used to make essential body-building blocks such as bile, cholesterol, immune factors, plasma proteins and albumin.

Through a specialized filtering system, the liver performs the important task of removing toxins and impurities (such as alcohol, drugs and preservatives) from the blood. The liver is also an important site for converting food to energy and storing it as glycogen. Fat-soluable vitamins such as D and E are also stored in the liver.

When liver disease develops, the liver's ability to perform its metabolic, detoxification and storage functions is impaired. When these essential processes are not working as they should, the entire body is affected.

Terms to Help You Understand Liver Disease

Ascites - accumulation of fluid in the abdomen.
Endoscopy - a nonsurgical procedure in which a slim, lighted scope with a camera attached is passed down the throat to aid in diagnosis or treatment.
Jaundice - yellowing of the skin and the whites of the eyes.
Tumor - an abnormal growth of cells which can be benign (non-cancerous) or malignant (cancerous).
Varices - abnormally dilated and lengthened veins.
Shunt - a joining between two veins to reduce pressure and stop bleeding varices.

Common Liver Diseases

More than 100 types of liver disease have been identified. Their common feature is that they all involve damage to the liver that disturbs its ability to function normally. 

Early liver disease may have minimal or no symptoms and often will be passed over as being the flu. As liver disease progresses, characteristic signs develop.

These signs can include a yellow tone to the skin and whites of eyes (jaundice) and brownish urine. In advanced cirrhosis, the abdomen becomes distended with fluid (ascites) and ruptured blood vessels in the stomach and esophagus cause bleeding. The person may vomit blood or pass black stools.

Liver Disease at Cleveland Clinic's Digestive Disease Institute

Cleveland Clinic hepatologists specialize in liver disease. They treat a wide range of common and uncommon diseases of the liver and biliary tract including:

• Chronic viral infections of the liver (hepatitis B link and C link)
• Alcoholic liver disease
• Autoimmune liver diseases
• Acute viral hepatitis
• Fatty liver associated with obesity and diabetes
• Inherited disorders (hemochromatosis link, Wilson’s disease and alpha-1- antitrypsin deficiency)
• Primary biliary cirrhosis (diseases of the bile ducts inside and outside of the liver)
• Primary Sclerosing Cholangitis

Pioneering Treatments

Cleveland Clinic specialists were among the first in the United States to investigate the use of interferon for chronic viral hepatitis. Their research remains at the forefront of antiviral therapy advances today as they investigate many new and experimental treatments.

Some of these therapies are available for patients participating in clinical trials.

Cleveland Clinic hepatologists also are well-versed in new innovative and comprehensive therapies for any stage of liver disease including all complications of cirrhosis. As a result, Cleveland Clinic is a regional center for referral of patients dealing with cirrhosis and its complications.

To help patients, Cleveland Clinic physicians:

• Are prepared to receive and evaluate patients with severe liver failure, readying them for liver transplants if necessary.
• Use sophisticated monitoring equipment to improve patient survival in the interim before transplant, particularly in patients with significant tendencies to bleed.
• Collaborate as surgeons work with hepatologists to offer Ohio’s largest volume of liver transplants, including deceased donor and living donor transplantation.

Fighting Liver Disease

Medical, surgical and radiological specialists cooperate closely to diagnose and treat all types of liver disease and disorders, including liver masses.

Cleveland Clinic surgeons have extensive experience with relatively uncommon hepatobiliary procedures including:

• Resection of biliary tract cancer
• Resection of liver cancer
• Ablation of liver cancers using a radio frequency probe

Cleveland Clinic radiologists offer a sophisticated array of diagnostic and therapeutic options for liver disease. They offer a transjugular intrahepatic portal systemic shunt (TIPS), which is a procedure in which a stent (a tubular device) is placed in the middle of the liver to relieve the pressure in the portal vein. They also employ an approach to treating liver cancers called chemoembolization.

• Locations & Directions to Cleveland Clinic

Additional Resources

External Links

For more information about liver disease, please contact:

American Association for the Study of Liver Diseases
1729 King Street, Suite 200
Alexandria, Virginia 22314
Ph.: 703.299.9766
Fax: 703.299.9622
Email: aasld@aasld.org

American Liver Foundation (ALF)
75 Maiden Lane, Suite 603
New York, NY 10038.4810
Ph.: 800.GO.LIVER (465.4837)
888.4HEP.USA (443.7872)
or 212.668.1000
Fax: 212.483.8179
Email: info@liverfoundation.org

Hepatitis Foundation International
504 Blick Drive
Silver Spring, MD 20904.2901
Ph.: 800.891.0707 or 301 622.4200
Fax: 301.622.4702
Email: hfi@comcast.net

United Network for Organ Sharing
P.O. Box 2484
Richmond, VA 23218
Ph.: 888.894.6361 or 804.782.4800

National Institutes of Diabetes & Digestive & Kidney Diseases(NIDDK)
NIH, Building 31, Room 9A04
31 Center Drive, MSC 2560
Bethesda, MD 20892.2560

American Society for Gastrointestinal Endoscopy
1520 Kensington Rd., Suite 202
Oak Brook, IL 60523
Ph.: 630.573.0600

Stomach disorders include indigestion, abdominal pain, and gas, among others. Just about everybody at one point or another will have some kind of stomach or abdominal pain. Most causes are not serious. However, abdominal pain can also be the sign of a serious illness, and it is important to recognize which symptoms are severe and when to call a doctor.

If your abdominal pain is severe, or if you have any of the following symptoms, contact your doctor as soon as possible:

• Nausea, fever, or cannot keep food down for several days
• Bloody stools
• Difficulty breathing
• Vomiting blood
• The pain occurs during pregnancy.
• The abdomen is tender to the touch.
• The pain is the result of an injury to the abdomen.
• The pain lasts for several days.

Treating abdominal pain depends on its cause. Options include medications, antibiotics for infections, or changes in diet to treat abdominal pain caused by certain foods or beverages.

• Acid Peptic Disorders
• Cyclic Vomiting Syndrome
• Dyspepsia
• Gas (Digestive)
• Gastric varices
• Gastritis
• Gastroparesis
• Helicobactor pylori
• Malnutrition
• Upper Abdominal Pain

The small bowel, or small intestine, is part of the digestive system. The small intestine absorbs fluids, proteins, carbohydrates (starches and sugars), iron, fats, vitamins, and minerals (such as calcium, sodium, and potassium) from the foods you eat.

Examples of small bowel disorders include:

• Celiac disease, an autoimmune disorder that affects the body’s ability to digest gluten (a protein found in grains);
• Short bowel syndrome, in which the body cannot absorb enough fluids and nutrients because part of the small intestine is missing or is not working properly, and;
• Lactose intolerance, the inability to digest lactose (a sugar found in milk and dairy products)
• The small intestine has three sections:
  • The duodenum, which is located next to the stomach;
  • The jejunum, which lies between the duodenum and the ileum; and,
  • The ileum, which is the longest section and connects to the large intestine (colon)

If the duodenum and a portion of the jejunum have been removed by surgery, the ileum can take on their role in absorbing nutrients. But if a large part of the jejunum or the ileum is removed, it is more difficult to obtain adequate nutrition. In these cases, nutrients usually have to be provided in a form other than food.

• Abdominal pain
• Celiac disease (Celiac Sprue)
• Constipation
• Diarrhea
• Dysmotility
• Gastroenteritis
• GI Bleeding
• Intestinal Failure
• Intestinal Pseudo-Obstruction (Ogilvie’s Syndrome)
• Ileus
• Irritable bowel syndrome
• Lactose Intolerance
• Malabsorption syndromes
• Mesenteric Ischemia
• Mineral Deficiency
• Radiation Enteritis
• Short Bowel Syndrome
• Small Bowel Bacterial Overgrowth
• Small bowel obstruction
• Small bowel perforation
• Stoma complications (High Stoma Output)
• TPN Failure
• Whipple’s Disease
• Vascular GI Lesions (including Arterio-Venous Malformations)
• Vitamin Deficiency

The gallbladder is an organ that resembles a small pear. The gallbladder stores and dispenses bile, a fluid that is produced by the liver and helps digest fats.

The gallbladder is connected to the liver and the intestine by a group of ducts, including the common bile duct, the hepatic duct, and the cystic duct. When you eat, the gallbladder sends bile through the common bile duct into the intestine to help you digest the food.

One of the most common disorders of the gallbladder is gallstones. Gallstones can be tiny (the size of a grain of sand), or may be as large as a golf ball. Depending on the symptoms, people who have gallstones may not need treatment, or they may need to take medication or have surgery to remove their gallbladder. If the stones are in the bile ducts, they usually need to be removed by endoscopy (flexible tubes that can be passed through the mouth or rectum).

Other diseases of the gall bladder and bile duct include cholangitis (infection of the bile duct) and cholecystitis (infection of the gallbladder).

• Acute Biliary (Gallstone) Pancreatitis
• Acute Cholangitis
• Acute Cholecystitis
• Bile Duct Injury and Stricture
• Cholangiocarcinoma
• Cholelithiasis
• Gallbladder Disease
• Gallstones
• Sphincter of Oddi Dysfunction

The colon, also known as the large intestine, is part of the digestive system. The colon’s main job is to process the liquid stool it receives into a manageable amount of solid stool that the body eliminates.

Disorders of the colon include inflammatory bowel disease (Crohn’s disease and ulcerative colitis) and colon cancer.

Crohn’s disease is a long-term illness in which the bowel becomes inflamed and ulcerated (marked with sores). Symptoms include diarrhea, weight loss, and abdominal pain and tenderness.

Ulcerative colitis affects only the large intestine. The main symptom of ulcerative colitis is diarrhea, which usually becomes bloody.

Cancer of the colon and rectum is a major health problem in America today. The good news is that colon cancer is a preventable disease. A colonoscopy can prevent colorectal cancer by finding and removing polyps, small growths in the lining of the large bowel that may indicate cancer.

Many diseases of the colon and rectum can be prevented or minimized by seeking medical care when symptoms develop. People who have symptoms of any of these conditions should consult their doctor right away.

• Clostridium Difficile
• Crohn’s Disease
• Diverticular Disease (including diverticulitis)
• Dysmotility
• Indeterminate Colitis
• Inflammatory Bowel Diseases
• Ischemic Colitis
• Megacolon
• Pouchitis and other pouch complications
• Ulcerative Colitis

The gastrointestinal (GI) tract includes the parts of the body that aid in digestion: the mouth, esophagus (food tube), stomach, and intestines.

A tumor is an uncontrolled growth of cells that forms a mass or lump. Tumors of the GI tract are found in such diseases as esophageal cancer, oral cancer, colon cancer, and stomach cancer.

Oral cancer, which includes cancers of the lips, tongue, cheek, floor of the mouth, hard and soft palate, sinuses, and pharynx (throat), appears as a growth or sore that does not go away.

In many cases, you can take certain measures to help prevent some of these cancers. For instance, tobacco use, whether in the form of smoking, chewing, or exposure to second-hand smoke (smoking by others), can cause cancer of the mouth and larynx, esophagus, throat, and many other parts of the body.

Colon cancer is a preventable disease. A colonoscopy can prevent colorectal cancer by finding and removing polyps.

• Anal Cancer
• Bile Duct Cancer (cholangiocarcinoma)
• Benign Esophageal Tumors
• Benign Liver Tumors (Hemangioma, Adenoma, Focal Nodular Hyperplasia (FNH))
• Bowen’s and Paget’s Disease
• Carcinoid tumor
• Colorectal Cancer
• Colorectal neoplasia
• Desmoid Tumor/ FAP
• Esophageal Cancer
• Gallbladder Cancer
• Gastric Cancer
• Gastrointestinal Stromal Tumors
• Hepatic Granulomas
• Malignant Liver Tumors (Hepatocelluar Carcinoma (HCC), Cholangiocarcinoma)
• Neuroendocrine Tumor
• Pancreatic Cancer
• Pancreatic Endocrine Tumors
• Polyps
• Presacral Tumors
• Primary Liver Cancer
• Small-Bowel Cancer
• Stomach Cancer (Gastric Carcinoma)
• Rectal Cancer
• Tumor of the biliary tract
• Tumor of the liver (benign and malignant)

• Abdominal pain
• Achalasia
• Acid Peptic Disorders
• Acute Biliary (Gallstone) Pancreatitis
• Acute Cholangitis
• Acute Cholecystitis
• Acute Pancreatitis
• Alcoholic Liver Disease
• Amyloidosis
• Anal Abscess
• Anal Cancer
• Anal Dysplasia
• Anal Fissures
• Anal Fistula
• Anal Stenosis
• Anorectal Disease
• Anorectal Fistula
• Autoimmune Liver Disease
• Barrett's Esophagus
• Benign Esophageal Tumors
• Benign Hepatic Lesions
• Benign Liver Tumors (Hemangioma, Adenoma, Focal Nodular Hyperplasia (FNH))
• Bile Duct Cancer (cholangiocarcinoma)
• Bile Duct Injury and Stricture
• Biliary Atresia
• Bowen’s and Paget’s Disease
• Byler’s Disease
• Carcinoid tumor
• Celiac disease (Celiac Sprue)
• Cholangiocarcinoma
• Cholelithiasis
• Cholestatic Liver Disease
• Crohn’s Disease
• Chronic Pancreatitis
• Clostridium Difficile
• Colorectal Cancer
• Colorectal Endometriosis
• Colorectal neoplasia
• Condyloma accuminata
• Constipation
• Cyclic Vomiting Syndrome
• Desmoid Tumor/ FAP
• Diarrhea
• Diverticular Disease (including diverticulitis)
• Drug Hepatotoxicity
• Dysmotility
• Dyspepsia
• Dysphagia

• Eosinophilic Esophagitis
• Esophageal Cancer
• Esophageal Dysmotility
• Esophageal varices
• Esophagitis
• Fatty liver (NAFLD and NASH)
• Fecal Incontinence
• Fulminant Hepatic Failure
• Gallbladder Cancer
• Gallbladder Disease
• Gallstones
• Gastroesophageal Reflux (GERD)
• Gas (Digestive)
• Gastric Cancer
• Gastric varices
• Gastritis
• Gastroenteritis
• Gastrointestinal Stromal Tumors
• Gastroparesis
• GI Bleeding
• Heartburn
• Hepatic Cysts (Simple Cysts and Polycystic Liver Disease)
• Hepatic Granulomas
• Hiatus Hernia
• Ileus
• Indeterminate Colitis
• Inflammatory Bowel Diseases
• Internal Hemorrhoids
• Intestinal Failure
• Intestinal Pseudo-Obstruction (Ogilvie’s Syndrome)
• Irritable bowel syndrome
• Ischemic Colitis
• Ischemic Liver Injury
• Lactose Intolerance
• Malabsorption syndromes
• Malignant Hepatic Lesions
• Malignant Liver Tumors (Hepatocelluar Carcinoma (HCC), Cholangiocarcinoma)
• Malnutrition
• Megacolon
• Mesenteric Ischemia
• Mineral Deficiency

• Neuroendocrine Tumor
• Non Alcoholic Steatotic Hepatitis
• Pancreatic Cancer
• Pancreatic Cyst/Pseudocyst (IPMN, MCN)
• Pancreatic Endocrine Tumors
• Portal Hypertension
• Pelvic Floor Dysfunction
• Perianal Abscess
• Perianal hidradenitis suppurativa
• Pilonidal Sinus and Abscess
• Polyps
• Pouchitis and other pouch complications
• Presacral Tumors
• Primary Biliary Cirrhosis
• Primary Liver Cancer
• Primary Sclerosing Cholangitis
• Proctitis
• Pruritus Ani
• Radiation Enteritis
• Rectal bleeding
• Rectal Cancer
• Rectal Prolapse
• Rectovaginal Fistula
• Short Bowel Syndrome
• Small Bowel Bacterial Overgrowth
• Small-Bowel Cancer
• Small bowel obstruction
• Small bowel perforation
• Solitary Rectal Ulcer
• Sphincter of Oddi Dysfunction
• Spontaneous Bacterial Peritonitis
• Stoma complications (High Stoma Output)
• Stomach Cancer (Gastric Carcinoma)
• Swallowing Disorders
• Thrombosed External Hemorrhoid
• TPN Failure
• Tumor of the biliary tract
• Tumor of the liver (benign and malignant)
• Ulcerative Colitis
• Upper Abdominal Pain
• Vascular GI Lesions (including Arterio-Venous Malformations)
• Viral Hepatitis A
• Viral Hepatitis B
• Viral Hepatitis C
• Viral Hepatitis D
• Viral Hepatitis E
• Vitamin Deficiency
• Whipple’s Disease