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Online Chat - My Digestive System: From Beginning to End

Online Chat - My Digestive System: From Beginning to End

Thursday July 28, 2011

Dr. Meisner:
Welcome to today’s online chat on the digestive system. I am Dr. Randy Meisner, a fellowship trained gastroenterologist. I’m here to answer any questions or concerns that you may have about all conditions of the digestive tract and how they are treated.

Comment From Sharon:
Does Irritable Bowel cause burping, fullness, increased peristalsis, and possibly irregular pulse?

Dr. Meisner:
Hi Sharon, unlikely that IBS would cause irregular pulse, but burping, fullness, and increased peristalsis can all be part of spectrum. Anti-bloating diet can help with this, avoidance carbonation, gum chewing, sugar substitutes

Comment From Guest:
Are there issues related to an unusually long large intestine? During a procedure several years ago, it was discovered that part of my large intestine was tucked behind other organs and that it was unusually long. I have never been able to resolve continual constipation issues and wonder if this might be an effect.

Dr. Meisner:
There can be, however, your small intestine plays a role in motility as well. Many of us are constipated and it just may be your system. Fiber twice a day and miralax can be effective as well

Comment From Dianne:
Are you able to tell the condition of the lower esophageal sphincter muscle by doing an endoscopy?

Dr. Meisner:
We can sometimes assess its integrity and whether it is "floppy" or not, but in terms of its pressure, that requires a manometry which is a pressure test of the esophagus where a catheter is inserted into the nose to the esophagus to measure pressure.

Spectrum Health:
FACT: The gastrointestinal tract (the digestive system) is a tube that extends from the mouth to the anus. It is a complex organ system that first carries food from the mouth down the esophagus to the stomach and then through the small and large intestine to be excreted out through the rectum and anus.

Comment From Suzie:
What is a capsule endoscopy, and what can it tell about my insides?

Dr. Meisner:
Capsule endoscopy is a pill that is used to look at the small intestine, the area between the stomach and the colon. It takes several pictures a second and can be used to tell us pathology that we can't see well with scopes

Comment From Sharon:
Can 2-3000 of omega 3's slow the gall bladder or affect the liver?

Dr. Meisner:
Liver test abnormalities are uncommon and I don't know of any known affect on the gallbladder.

Comment From Bart:
I had a Colonoscopy 6 months ago, and everything was fine. Now, I'm seeing bright red blood in my stool, and my bottom itches. What's up with that?

Dr. Meisner:
Could be hemorrhoids, but you should consult your doctor who did the colonoscopy to make sure the exam was complete and there is not a need for further endoscopy at this time

Spectrum Health:
FACT: The digestive system is an intricate system that can be disrupted by disease, diet, and emotional stress. Common digestive problems such as heartburn/gastroesophageal reflux disease (GERD), inflammatory bowel disease (IBD), and irritable bowel syndrome (IBS) cause millions of Americans to suffer daily and limit quality of life. Digestive problems often result in symptoms such as bloating, diarrhea, gas, stomach pain, and stomach cramps.

Comment From Guest:
I've tried several diet and over-the-counter aids for constipation. Apples, cider, fresh fruit, fiber cereal, fiber supplements, you name it. Drinking more water than I already do only increases urination but has no effect on the constipation. Exercise doesn't seem to have an effect and actually causes discomfort sometimes. I had a recent colonoscopy in which everything looked normal. Have you seen any successes with patients with any other remedies I may not have tried? Are there any prescription aids that are effective in cases like this where diet and supplements are not effective?

Dr. Meisner:
I like a combination of high fiber non-bloating supplements like Fibercon, Citrucel twice a day and miralax 1-2 x/day. However, in your case, sometimes the rectal muscles don't work so well and enemas/suppositories may be needed. There are stronger medicines like amitiza to help the bowels move but these require medical consultation. I'd discuss with your physician and consider more testing

Spectrum Health:
FACT: One in 10 Americans experiences heartburn symptoms at least once a week. Heartburn has different triggers, including certain foods, medications, obesity, or even stress. Knowing your triggers will help you design a prevention strategy.

Comment From Sharon:
Does niacin have any impact on the bowel?

Dr. Meisner:
Abdominal pain and diarrhea, flatulence, nausea is reported but not terribly frequent

Comment From Allison:
Is there a lot of pain involved with a colonoscopy, I'm scared!

Dr. Meisner:
Pain is very well controlled Allison, not unusual to be scared of it. We use a narcotic and a sedative to help relax and the vast majority of people do not remember this

Comment From Allison:
At what age should I get a colonoscopy. I only know half of my family's history.

Dr. Meisner:
Good question on only knowing half of family history. No great recommendation to get screened earlier, but if one of your parents had colon cancer sooner or a relative did, it's not unreasonable to get screened between ages 40 and 50, especially if rectal bleeding, change in stool, or unintentional weight loss. Great question!

Spectrum Health:
FACT: Estimated new cases and deaths from colon and rectal cancer in the United States in 2011:

New cases: 101,340 (colon); 39,870 (rectal)

Deaths: 49,380 (colon and rectal combined)

Comment From Louise:
What are some foods that typically cause bloating?

Dr. Meisner:
Bloating foods are carbonated beverages, foods with sugar substitutes, gum chewing, smoking, and even healthy vegetables like radishes, cauliflower, broccoli, eggplant, despite their yumminess.

Spectrum Health:
FACT: Pancreatitis is inflammation of the pancreas. The pancreas is a gland located behind the stomach. It releases the hormones insulin and glucagon, as well as digestive enzymes that help you digest and absorb food. Pancreatitis can be acute or chronic, and the symptoms may include abdominal pain, chills, clammy skin, fatty stools, fever, mild jaundice, nausea, sweating, weakness, weight loss, and vomiting.

Comment From Eliza:
What is FAP?

Dr. Meisner:
FAP is familial adenomatous polyposis, a genetic syndrome that can predispose to colon cancer and several other cancers as well. A family history of colon cancer at a young age should prompt a workup to discuss this with your physician.

Comment From Eliza:
Are all colonoscopies the same? Can there be any variants in the quality of the exam?

Dr. Meisner:
Yes, there can be significant variation in the quality of the exam. The endoscopist (doctor who performs the procedure) MUST take the adequate time to look for polyps as well as clean out the residual stool in the colon. Polyps can be missed by even the best of us, but you sure ensure that you are getting a good quality exam. You go through a lot to have this test done!

Spectrum Health:
FACT: In the past, spicy foods were thought to increase the risk of developing an ulcer. This is no longer considered true. The majority of stomach ulcers are caused by either infection with a bacterium called Helicobacter pylori (H. pylori) or by use of pain medications such as aspirin, ibuprofen, or naproxen (NSAIDs). Spicy food may aggravate existing ulcers in some people, but they do not cause ulcers.

Comment From Jon:
What causes constipation, and how can I treat it naturally?

Dr. Meisner:
Constipation is due to a slowing of the GI tract, and it can be due to anything form the way we're built to something more serious like a narrowing or stricture or cancer. If it is known that your constipation is from a benign cause, over the counter fiber agents and bulk agents like miralax can help. Laxatives like dulcolax and senekot are NOT unsafe; they just can cause more constipation if you stop them

Spectrum Health:
FACT: Among cancers that affect men and women, colorectal is the third leading cause of cancer-related deaths in the U.S. Early detection saves lives, and colon cancer screening is one of the most important things you can do to protect your life and the lives of those you love. It has been stated that ninety-five percent of colon cancer cases are curable if detected and treated early.

Comment From Angela:
For the past few years I have had really sharp intestinal stomach pains that have caused me to have sometimes painful bowel movements. My PCP suggested I visit a gastroenterologist but I haven't had the time to do so yet. Could this be signs of IBS or another digestive problem?

Dr. Meisner:
Good question. If you are young, most likely benign. Visiting a Gastroenterologist (GI) physician is reasonable. Most likely IBS, but signs of a more serious condition would be bleeding, unintentional weight loss, and diarrhea at night, and family history of colon cancer or colitis.

Spectrum Health:
FACT: Despite the thousands of jokes about beans and flatulence, beans are not the number one culprit of gas. Dairy foods actually have that honor, particularly as we age and our bodies are less able to absorb the sugar in milk (lactose).

Comment From Dianne:
Can taking proton pumps cause constipation?

Dr. Meisner:
Not usually, diarrhea more common with them. Aciphex causes the least diarrhea. I would try searching for another cause

Spectrum Health:
FACT: The two major inflammatory bowel diseases, ulcerative colitis and Crohn's disease, share certain characteristics:

Symptoms usually appear in young adults, and may include: abdominal pain, usually in the lower right side, diarrhea, weight loss, rectal bleeding, fever, nausea and vomiting, skin lesions and joint pain.

Symptoms can develop gradually or have a sudden onset.

Both are chronic. In either disease, symptoms may flare up (relapse) after symptom-free periods (remission) or symptoms may be continuous without treatment.

Symptoms can be mild or very severe and disabling.

Comment From Kelly:
What are your thoughts on probiotics?

Dr. Meisner:
They can be helpful Kelly for some irritable bowel symptoms, usually can't hurt. But make sure what you're taking has more than 1 form of bacteria in it to gain the most effect

Comment From Cynthia:
What causes hemorrhoids? What’s the best way to treat them?

Dr. Meisner:
Everyone has hemorrhoids. If you are constipated or frequent diarrhea, these can exacerbate them. Best way to treat is stool softener, over the counter agents and as needed hemorrhoid creams. Our colorectal surgeons also can assist you with refractory treatment

Comment From Denard:
How frequently do you recommend using suppositories to assist with constipation?

Dr. Meisner:
There is no danger Denard to chronic suppository use, but it may be indicative of some problems with rectal dysfunction. I would recommend considering seeing a colorectal specialist in functional bowel disease/constipation if this use is chronic

Comment From Sinharaj:
Are there early signs that I should look for to identify poor circulation if I have type 2 diabetes, and is there anything I can do to reverse this? I'm concerned after hearing about how amputation is common for people with type 2 diabetes...

Dr. Meisner:
As a GI physician, you may want to speak to your regular physician about this to do a good vascular exam on your pulses

Comment From Dianne:
Is it true that taking proton pumps cause your bones to weaken? Should I be taking extra calcium supplements?

Dr. Meisner:
 Great question. There is some data that chronic use of proton pump inhibitors (ppi therapy) can cause vitamin d malabsorption and lead to increase risk hip fracture. IF you are on these long term, make sure to discuss Vitamin D and calcium supplementation with your doctor and consider earlier screening for osteoporosis.

Spectrum Health:
FACT: Signs and symptoms of colon cancer include: a change in bowel habits, including diarrhea or constipation, or a change in the consistency of your stool for more than a couple of weeks; rectal bleeding or blood in the stool; persistent abdominal discomfort, such as cramps, gas, or pain; a feeling that your bowel doesn’t empty completely; weakness or fatigue; or unexplained weight loss. Many people with colon cancer experience no symptoms in the early stages of the disease. When symptoms appear, they'll likely vary, depending on the cancer's size and location in your large intestine.

Comment From Angela:
Is there any medication I could take over-the-counter? The intestinal pains often come without warning and I can't really tell if they are related to something I eat. I was hoping there was something I could take that could possibly regulate my intestinal system to avoid the pains and bowel movements

Dr. Meisner:
Angela, it's tough to answer that without a full history. I would try once a day fiber supplement to regular bowels and there is some data on the use of peppermint oil as a natural anti-spasm agent

Comment From Marla:
I heard it's a good thing to examine your stool every now and then to make sure everything is okay. What warning signs should someone look for if they feel they might have a digestive problem?

Dr. Meisner:
Marla, you're talking to the right guy. That's what we do for a living. It's reasonable occasionally to make sure you don't see any gross blood or black stool. Or, if you have dog like me, you might notice chewed up children's toys in his stool

Comment From Desmond:
One of the effects of my constipation is excessive gas. I'm trying to determine whether the gas is attributable to IBS or the presence of stool in my colon. Is it generally true that if the gas is "smellier", the more likely it is that there is actually stool that needs to come out?

Dr. Meisner:
Most likely Desmond the gas is related to dietary measures. Foods that are good for us like vegetables can be gaseous forming. So can healthy foods like beans, hummus, and beer to name a few other culprits. I would suggest dietary modification.

Comment From Guest:
Do you know - could products such as the Muscle Milk drinks have negative effects on the digestive system? It’s something I like to drink as a supplement, but usually have an upset stomach afterwards. Even though there is no actual milk in the product

Dr. Meisner:
I don't know much about muscle milk on the GI tract, more that the excess creatine can affect the kidneys sometimes. There are cheaper ways to get your protein and nutrition though

Comment From Kelly:
Are there other ways to prep for a colonoscopy other than drinking that terrible stuff

Dr. Meisner:
Kelly, for now, that is the best way to do it. We usually split our prep, half at night and half in the morning so it is better tolerated. Remember, hopefully it's only once every ten years so if you do your best you can hopefully avoid it soon again!

Comment From Guest:
What is refractory treatment?

Dr. Meisner:
I'm sorry, that means that all other usual methods have failed

Spectrum Health:
FACT: Signs and symptoms of colon cancer include: a change in bowel habits, including diarrhea or constipation, or a change in the consistency of your stool for more than a couple of weeks; rectal bleeding or blood in the stool; persistent abdominal discomfort, such as cramps, gas, or pain; a feeling that your bowel doesn’t empty completely; weakness or fatigue; or unexplained weight loss. Many people with colon cancer experience no symptoms in the early stages of the disease. When symptoms appear, they'll likely vary, depending on the cancer's size and location in your large intestine.

Comment From Guest:
My toddler daughter often gets hiccups after drinking milk, but not any other liquid. Any cause for concern?

Dr. Meisner:
Not really for now, lactose intolerance usually doesn't present to age 4 or 5 and usually would present more with diarrhea, abdominal pain. By that age, they can usually tell you if it's milk

Comment From Sara:
Is it possible for colonoscopies to cause tearing in the intestinal wall?

Dr. Meisner:
Yes it is. It can cause minor tearing but full thickness tearing is called a perforation. That happens rarely in 1/1000-1500 cases and a bit more frequently if there is a large polyp removed. Remember, this is FAR less than the average person's risk of colon cancer which is 5% in life

Dr. Meisner:
Thank you for taking the time to participate in this online chat. I trust that I have been able to answer your questions. An office evaluation is the best way to determine the appropriate treatment plan for conditions of the digestive system. If you would like more information or to schedule an appointment, please call my office at 616.267.7414. We are located at 4100 Lake Drive S.E. in Grand Rapids, and we also see patients in Greenville and at the West Pavilion in Wyoming. You may also visit shmg.org to learn more.

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