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Digestive Diseases

Digestive Disease

March 31, 2011
12:00 p.m. – 1:00 p.m. (EST)

  • Alison Schneider, MD – Gastroenterologist

Ranked number one in Florida by U.S. News and World Report in 2010, our gastroenterologists are second to none in diagnosis and treatments for a multitude of digestive diseases. When you have questions about your health, seek advice from the top ranking experts in their field and get the answers you need.

Cleveland_Clinic_Host: Today's Live Web Chat, "Digestive Disease," with Alison Schneider, MD will begin at 12 noon EST. Please submit your questions by typing them below and then clicking 'Ask'.

Cleveland_Clinic_Host: Thank you for joining us today. We are settling in and will begin answering questions. Thank you for your patience.

Sam: What is food intolerance and what is a food allergy?

Alison_Schneider__MD: It is important to keep in mind that these are two different entities. Food intolerance is a term used commonly used for some type physiological response to a particular food, or compound found in a food. It is not a true food allergy. Food intolerance also does not include food borne illnesses or exposures. A true food allergy requires the presence of IgE antibodies against the food, and food intolerance does not. Common food allergies are eggs, tree nuts, fish, shellfish, milk, wheat, and soy. Common symptoms that we see for food intolerance include: gas, bloating, diarrhea, upset stomach. Symptoms are often chronic, less acute in presentation, and often more difficult to diagnose and pinpoint than a food allergy.

FerrandR: What is a polyp?

Alison_Schneider__MD: A polyp is a growth inside the colon or rectum that is not normal. There are several types and are not always cancerous. Colorectal cancer usually begins as a non cancerous polyp.

Rose2: Is there is a cure for acid reflux?

Alison_Schneider__MD: There are a number of treatments available for acid reflux. These include lifestyle changes, medications, and surgery. There are certain types of foods and physical activities that can make reflux worse. Tips that can help include: Avoid smoking drinking excessive amounts of alcohol. Avoid foods that are known to make reflux worse such as fatty and spicy foods. Chocolate, peppermint, tomato sauce have all been proven to exacerbate symptoms of heartburn. Avoid eating late at night before going to bed and avoid lying down after eating is another helpful change to make. Some of the common medications used include famotidine, omeprazole (to name a few). The most common surgery done is known as a Nissen fundoplication.

VATafel: What is a virtual colonoscopy?

Alison_Schneider__MD: The is a radiological procedure (Cat Scan) used for colorectal cancer screening looking for signs of pre-cancerous growths, called polyps, cancer, and other diseases of the large intestine or colon. The procedure requires a bowel prep and an insertion of a tube into the rectum for expanding the large intestine with gas or liquid to help create the images. Images of the large intestine are taken using computerized tomography (CT) machine. A computer puts the images together to create an animated, three-dimensional view of the inside of the large intestine.

Rose2: Because of acid reflux condition, I cannot eat anything fried (nothing cooked in oil); otherwise, I would spent half the night burping, heartburn, or a lump-like feeling in my throat. By morning, however, all that feeling is gone and I am back to normal. Is this normal? I am 64 yrs old.

Alison_Schneider__MD: Fatty greasy foods very commonly cause symptoms of reflux. It is recommended to avoid eating these types of food commonly. Sometimes, decreasing portion size may help. I would also recommend not eating at least 3 hours before going to sleep and lying down.

MaryAnn: Are gastroenterology procedures painful?

Alison_Schneider__MD: In general, no. For most procedures patients receive intravenous sedation. This helps patients rest and make them feel sleepy for the procedure. Patients are continually monitored during procedures. Medication dosages can be titrated as needed to help relieve any discomfort. It is important to note that after receiving medications for procedures, it is important to understand that one cannot drive after and should not go to work to make important decisions due to the fact that the medicines given for procedures can last longer than the endoscopy itself.

lbrown4438: I know that I have acid reflux and digestive problems, and a Hiatal Hernia, which you found but will it ever just go away. I just can never seem to eat like a normal person any more without feeling bloating and sick?

Alison_Schneider__MD: Once a hiatal hernia is present, it will likely be noted in the future (that will not just "go away"). I would recommend discussing with your physician all medical and surgical options.

KCW: Do you have surgical options for people with GERD?

lbrown4438: What is a Hiatal Hernia?

Alison_Schneider__MD: There are surgical options for the management of reflux disease. The most common surgical treatment is laparoscopic Nissen fundoplication. This surgical technique improves the natural barrier between the stomach and the esophagus and thus prevents acid reflux from occurring. Patients who may consider this option are those who not resolve with medical treatment, those who continually require medications to control their symptoms, or in the setting of a hiatal hernia. Surgery may also be considered in the case that complications occur such as bleeding, recurrent stricture, or metaplasia (abnormal transformation of cells lining the esophagus- also known as Barrett's esophagus), which is progressive. Because medical therapy is often used and works very well, surgery is not necessarily used as initial treatment. Consultation with both a gastroenterologist and a surgeon is recommended prior to making a decision to pursue surgery. A hiatal hernia is when the location of the lower esophagus and diaphragm are not aligned at the same location within the body.

Cleveland_Clinic_Host: For those now joining us, we are currently chatting with Dr. Alison Schneider who is taking your questions about digestive disease. To ask a question, type in the box below and then click 'Ask'.

Alison_Schneider__MD: This leads to a weaker barrier between the esophagus and stomach and thus acid reflux is more likely to occur (regurgitation of stomach contact in an upward direction). This can lead to symptoms of heartburn.

FerrandR: What is IBS?

Alison_Schneider__MD: Irritable bowel syndrome is a group of symptoms associated with chronic abdominal pain, change in bowel habits such as diarrhea and constipation. Mucus may be present with stool. The underlying cause is NOT anatomical or structural- this is why it is often called a functional disorder. Sometimes tests will be performed to rule out a physical disorder. IT is found more commonly in women and usually begins in late adolescence to early the third decade. It is thought that about 10-20 percent of the general population experiences symptoms of IBS.

MaryAnn: What is Acid Reflux and why do we get it?

Alison_Schneider__MD: Acid reflux is a condition when acid from the stomach flows backward into the esophagus. For some people they experience "heartburn symptoms" when the acid is in the esophagus. It is often described as a feeling of burning discomfort located behind the breastbone that moves up toward the neck and throat. Other symptoms may include a bitter taste of sour liquid and excessive clearing of throat. It may happen after certain types of food in particular such as acidic foods, spicy foods, fatty greasy meals and very large portion size of meals.

Suzyq: Please, address GERD and esophagitis remedies?

Alison_Schneider__MD: GERD stand for gastroesophageal reflux disease. Esophagitis refers to inflammation that can occur along the lining of the esophagus as a reflux of acid exposure. Reflux occurs when there is a weakened barrier at the lowest portion of the esophagus (known as the lower esophageal sphincter) such as with a hiatal hernia. This sphincter may also open frequently and thus lead to symptoms of reflux.

Suzyq: What is ischemic colitis?

Alison_Schneider__MD: I think you mean ischemic colitis. That is when the bowel (colon) has a decreased blood flow. This leads to poor oxygen supply and inflammation of the tissue. Treatment is usually supportive care with intravenous fluids and antibiotics.

lbrown4438: Is Acid Reflux and GERD the same?

Alison_Schneider__MD: Yes, very similar.

Peacock: I had my colon removed and in November it was reconnected. I'm learning a new diet; do you have suggestions on food and timing of eating?

Alison_Schneider__MD: I would assume that you may be having some diarrhea? This sometimes occurs when a portion of the colon has been removed. I would perhaps avoid dairy products, fatty and greasy foods. Antidiarrheals are sometimes prescribed. I would discuss this with your physician.

Suzyq: Is it okay to take meds such as omeprazole and Miralax daily for an extended period?

Alison_Schneider__MD: Both medications can be taken over a long-term basis. You should, however, discuss this treatment plan with your physician.

Rose2: I am taking prescription Ranitidine (300mg) to help with digestion. This medication helps somewhat, but side effects are not encouraging. What's your opinion on this medication?

Alison_Schneider__MD: Ranitidine is general a safe medication; however, I would discuss your side effects with your physician.

Glutenfreenow: Please, address gluten intolerance. How it happens and does not show up in testing.

Alison_Schneider__MD: This is difficult question to answer, but a very good one. This is possible, but it may be beyond the scope to answer here. I would discuss this with your doctor.

lbrown4438: What if the Prescription Omeprazole I have been on for the past few years does not work any more, what do you suggest?

Alison_Schneider__MD: One of the first things to make sure of is that you are taking the medication at least 30 minutes before a meal (when it will work best). There are other medications in the proton pump inhibitor class. I would discuss with your physician if there are lifestyle changes that should be addressed or if another one of the medications would be better for you.

lbrown4438: How does someone end up getting ulcerative colitis?

Alison_Schneider__MD: We believe that there are environmental and genetic predispositions to the disease. This is an area of ongoing intensive research.

BillDaws: What is endoscopy?

Alison_Schneider__MD: This test involves passing a small lighted flexible tube through the mouth (called esophago-gastro-duodenoscopy) or colon (called colonoscopy) to examine for abnormalities such as inflammation, bleeding, ulcers or tumors. The test is usually performed with the aid of sedatives and by a specialist physician (such as a gastroenterologist).

KCW: Could some other condition be causing my IBS symptoms?

Alison_Schneider__MD: In order to determine that, sometimes blood tests or other tests will be done to rule out conditions. You would need to discuss with your doctor who will ask particular questions and determine if more testing needs to be done to rule out other conditions.

Suzyq: What causes it?

Alison_Schneider__MD: I assume you are talking about acid reflux. The main mechanism for this is relaxations’ of the lower sphincter known as transient lower esophageal relaxations.

MaryAnn: Is colon cancer preventable?

Alison_Schneider__MD: Factors that increase the risk to develop polyps include: age over 50 years of age or older, a history of polyps before, family history of polyps or family history of colon cancer, a history of inflammatory bowel disease (Crohn's or ulcerative colitis). Lifestyle factors may also play a role including a diet low in fiber, diet high in red meat/processed meat, heavy alcohol consumption and physical inactivity. Diabetes and Obesity have also been shown to increases the risk of colon cancer.

Klekter: My son took accutane a few years ago for acne. He has begun having abdominal issues and has been diagnosed with IBS after a colonoscopy. Is there a connection?

Alison_Schneider__MD: I do not know of a clear association with irritable bowel syndrome and this.

lbrown4438: When I was a child my Mother would always say that I had a nervous stomach, which now is GERD and the hiatal hernia. Do you think that from being a nervous person, this could cause all this issues as you grow older? My Mom had a bad bleeding Ulcer and always said it was from nerves.

Alison_Schneider__MD: From my experience- the term "nervous stomach" mostly refers to a functional bowel disorder such as functional dyspepsia or perhaps irritable bowel syndrome. Of course these could occur in the setting of a hiatal hernia (there may be 2 diagnosis occurring). Some of the most common reasons for stomach ulcers to occur include: age, use of NSAID medications such as aspirin, infection of the stomach with H. pylori bacteria.

Suzyq: How does ischemic colitis differ from ulcerative colitis; do they have different causes?

Alison_Schneider__MD: Ischemic colitis is related to poor blood flow. Ulcerative colitis is when the inflammation mechanism of the colon lining is abnormally "active" as if there is an infection in the colon (but no true infection is there). The second condition is more related to genetic factors and environmental triggers, but not necessarily poor blood flow to tissue. These are different entities.

BillDaws: What are the symptoms of Acid Reflux / GERD?

Alison_Schneider__MD: Gastro-esophageal reflux is a condition in which acid from the stomach flows backward up into the esophagus. Sometimes, people will experience heartburn symptoms when excessive amounts of acid reflux go into the esophagus. Many describe heartburn as a feeling of burning discomfort, localized behind the breastbone, which moves up toward the neck and throat. Other less common symptoms include throat clearing, hoarseness.

MaryAnn: How do you diagnose a food allergy or intolerance?

Alison_Schneider__MD: Diagnosis of food intolerance can include hydrogen breath testing for lactose intolerance and fructose malabsorption, professionally supervised elimination diets. An elimination diet is when a certain food or compound is completely removed from the diet (usually for a few weeks) and we look to see if symptoms improve. If a particular food is found that causes symptoms, long-term avoidance can be done or one can try to establish a level of tolerance at which symptoms do not occur. Your physician can discuss these tests in more detail. Testing for food allergies is very different and can be done with what is called ELISA testing for IgG-antibody mediated immune responses to specific foods. These tests need to be done in a lab.

KCW: What are recommendations for colon cancer screening if I have a family history?

Alison_Schneider__MD: It is recommended to start screening at age 40 or 10 yrs less than the age of affected individual. Overall, the lifetime risk is 10-16% vs. 5.5% of the general population. Colonoscopy is considered by many to the screening test of choice. A colonoscopy can be both diagnostic and therapeutic (as polyps can be removed at the time of the procedure).

Nystrom: When should you see a gastroenterologist vs. your primary care doctor?

Alison_Schneider__MD: In general, if a primary care provider begins to evaluate/treat a symptom or complaint and finds no improvement of more advance testing/procedures is needed you will likely be referred to a specialist. I often recommend starting at a lower dose as symptoms of gas and bloating may occur. It may take time for the body to adjust to increased amounts of fiber.

Cleveland_Clinic_Host: We have approximately 8 minutes left in the chat. We received a large amount of questions and we will continue to answer as many as possible. We apologize if we did not get to your question. If you have additional questions after the chat, please use our contact link clevelandclinic.org/webcontact to submit your questions.

Nystrom: At which Cleveland Clinic Florida location(s) are there gastro specialist?

Alison_Schneider__MD: We are located in Weston, Florida. We have a West Palm Beach office as well that we will have some from our department seeing patients at soon.

VATafel: Are there long-term complications or symptoms that can be related to heartburn?

Alison_Schneider__MD: There are some chronic symptoms associated with heartburn that are important to mention that may signify if some serious damage has occurred. These include the symptoms of difficulty swallowing or a feeling that food is trapped behind the breast bone. Having bleeding such as vomiting blood, or having tarry, black bowel movements. Also, the sensation of acid refluxed into the windpipe causing shortness of breath, coughing, or hoarseness of the voice, unexplained weight loss. For any of these symptoms you should discuss with your physician.

VATafel:

Alison_Schneider__MD: It is recommended to have 25- 30 g of fiber daily. In general, the average American takes in 5-10 g daily. Thus we often will recommend a fiber supplement such as psyllium husk. One should introduce fiber gradually into their diet to avoid symptoms of gas/bloating which can occur. It sometimes may take the body time to adjust to increased fiber.

Cleveland_Clinic_Host: I am sorry to say that our time with Dr. Alison Schneider is now over. Thank you again Dr. Schneider for taking the time to answer our questions today about Digestive Disease. If you are interested in scheduling an appointment with Dr. Schneider, or any one else from our Digestive Disease Institute in Florida, please call toll free 877.463.2010.

Alison_Schneider__MD: Thank you very much for participating in this chat today..

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