Category: Blog

A high-fiber diet can provide many health benefits. Firstly, it may help treat chronic constipation and improve the quality of stool. Moreover, a high-fiber diet may also decrease the incidence of colon cancer while also improving markers of fecal inflammation and intestinal symbiosis in parties with Inflammatory Bowel Disease.

A consultation with a gastroenterologist will provide more insight into the benefits of a high-fiber diet, specifically how it can benefit you. A study recently compared Kiwi fruit, prunes, and psyllium for the treatment of chronic constipation. The study found that consuming kiwi results in less bloating. Moreover, kiwi offers the greatest improvement in stool quality in comparison to the other options.

If you have recently started struggling with constipation then a consultation with a gastroenterologist would be best. A consultation allows for further evaluation of possible causes including colon cancer and other obstructive lessons. In the absence of any findings, a high-fiber diet is usually recommended. Most dietary fiber and fiber supplements result in gas and bloating. According to the previously mentioned study, kiwi appears to be more tolerable. If you’d like to schedule a consultation with an experienced and trusted gastroenterologist, contact Katy Stomach Doctor today.

There are multiple treatment options available for managing obesity. This is due to an estimate of 60% of the US population suffering from some degree of obesity. Before exploring options, a baseline assessment of nutritional and medical status should be complete. There is an increased risk of diabetes, hypertension, and cardiovascular disease in patients who suffer from obesity. Other risk factors include an increased risk of liver cancer, colon cancer, and pancreatic cancer.

Before you explore treatment options, you should receive an evaluation by a gastroenterologist. NAFLD (fatty liver) is now the most common cause of end-stage liver disease in the U.S. This disease occurs in the pediatric age group as well as young adults. Since the findings on laboratory evaluations and physical examination are often very subtle. Again, a consultation with a gastroenterologist would be helpful.

Treatment Options & Food Plans

Specific options for the treatment of weight loss include the following: lifestyle modifications, medications, and bariatric surgery. The cornerstone of any treatment regimen is caloric restriction and exercise. Calorie restriction of 1200-15000 calories per day is essential to managing your weight. Most patients who do not lose weight with intake restrictions are underestimating calorie intake.

Food plans are a highly effective method for maintaining and improving weight loss. To ensure your food plan is as effective a possible, you should weigh and measure your food intake. Four ounces of chicken after cooking is about 2 good bites. Although multiple different diets have been promoted, no one diet has been found to be superior. There are no studies that suggest the keto diet is better than the Mediterranean and vice versa.

Whatever diet you chose, it has to be palatable. Since calorie restriction is indefinite, the diet also has to be something reasonably sustainable. In addition to calorie restriction, weekly physical exercise is essential. 150 hours a week of aerobic exercise plus resistance training is just one of many options for physical exercise. It should be noted that exercise alone will not result in significant weight loss. However, it will help maintain weight loss.

Managing Obesity with Medication

Several different medications have been FDA approved for weight loss. This includes phentermine, orlistat, naltrexone/bupropion, and liraglutide. The choice of drug therapy is a balance between efficacy, adverse effects, and patients’ other medical problems. Consulting with a nutritionist and gastroenterologist will help determine the best option for you. If 5% or more weight loss doesn’t occur within three months, you should discontinue your medication.

The last option is bariatric surgery. Gastric balloons have become increasingly popular and offer varying success. Gastric balloons can result in obstruction, gastric ulcerations, and abdominal pain. Endoscopic remodeling results in a type of restrictive surgery with varying degrees of success.

With that in mind, bariatric surgery is an option strictly for patients with a BMI greater than 40 or over 35 with medical problems associated with obesity. Two operations are commonly available; the gastric sleeve and the Roux-en-y. The gastric sleeve removes a portion of the stomach, while the Roux-en-y gastric bypass is more invasive with a 12% complication rate. Although there is a higher complication rate, it results in a significantly higher weight loss.

Obesity is a national epidemic affecting all age groups and genders. Aggressive lifestyle medication associated with calorie restriction is the basis of any program. An aggressive approach with a consultation should be considered. Consult with Dr. James Maher today to learn the best option for you.

In an observational study, the use of Famotidine (Pepcid) was associated with a lower incidence of mortality, a lower chance of intubation, and lower inflammatory markers. The reason for this association is unclear. Famotidine inhibits histamine release which is found in most tissue. The release of histamine causes a cascade of other inflammatory cytokines and proteases to be release.

Viruses, including COVID, act on cells in the lung to cause histamine release. It is postulated that blocking histamine release, reduces the inflammatory response to this viral infection. It appears that PPIs (Proton pump inhibitors) have the opposite effect. By taking PPIs, you can increase the risk of COVID positivity. However, the increased risk is dose dependant.

You should take the medication once a day as two daily doses could increase the chance of COVID positivity. The PPIs decrease stomach acid secretion. Stomach acid plants an important role in destroying ingested bacteria and viruses. Without gastric acid, patients are at an increased risk for enteric infections including COVID 19. The GI tract is a major conduit for COVID infections invading the small bowel cells which can result in the inflammation of the stomach, small bowel, and colon.

PPIs are immensely popular drugs. It seems that everyone takes these medications. However, the medications usually don’t require chronic use. Most GI conditions require three months of treatment then taper off. Due to the rebound hyperacidity, the longer the drug is taken, the more difficult it is to stop. Consultation with a GI specialist will assist in determining the appropriate use of these medications.

Non-alcoholic liver disease (NALD) refers to a range of liver conditions that affect people who consume little to no alcohol. It is characterized by an increase in fat accumulation in the liver without a significant alcohol presence. NALD is associated with Type 2 diabetes, hypertension, and hyperlipidemia.

This disease is present in at least 80% of patients who have a BMI of more than 35. Additionally, it is more common in women who have a waist circumference over 80 cm and in men whose waist circumference is more than 102 cm. Insulin resistance is the central feature of metabolic syndrome. 

Macrophages in fat produce inflammatory enzymes that break down fat in tissue used predominantly by muscle and other tissue. This inhibits sugar utilization resulting in hyperglycemia, leading to elevated insulin levels. As a result, fatty acid production in the body will further increase.

The over-production of fatty acids leads to elevated triglyceride levels with increased liver fat. This will progressively lead to increased fat in the liver and the development of fibrosis and NASH. 

Fibrosis can lead to worsening liver disease and eventually cirrhosis. Nonalcoholic fatty liver disease (NAFLD) is the most common cause of liver disease in this country. The disease is very common in children 12-18 years old and can also affect young adults and pregnant women.

Studies & Screening Options

In a recent study, the disease was progressive in 23% of children, even those with dietary therapy. Obesity and elevated liver enzymes alone underestimate the presence of NAFLD.  A liver biopsy is accurate but invasive. A Fibro scan, which measures liver stiffness, has limitations but is currently used for screening.

 In the presence of obesity, elevated liver enzymes, or upper abdominal pain, a consultation with a gastroenterologist familiar with this disease is recommended. Multiple drug research trials are currently in progress. If qualified, a referral for a drug trial can easily be done if a patient qualifies. A gastroenterologist can monitor for disease progression and the development of liver cancer.

Colorectal Cancer is the second most common cancer. If diagnosed earlier, the cancer is curable with colonoscopy or surgical resection. However, once the tumor has spread to regional lymph nodes, liver or lung life expectancy is reduced.

Several options are available for colon cancer screening. The stool testing for guaiac has largely been replaced by fecal immunochemical tests. This offers a reasonably accurate and inexpensive screening test for colorectal cancer and advanced cancer. However, it may not be so accurate at detecting large polyps and early cancer.

Another stool testing option includes multitargeted stool DNA (Cologuard). This stool test is relatively new and is more sensitive than the FIT stool test. Additionally, the Cologuard stool exam is more expensive than the FIT exam.

Of course, Colonoscopy remains the most accurate screening test, and the only examination which can remove precancerous polyps and early cancer. With a normal colonoscopy in an average risk patient, repeat colonoscopy is not recommended for 10 years, and the risk of developing colon cancer is greatly diminished for 17 years.

If the patient is at risk risk for developing colon cancer, then colonoscopy is the preferred examination. Otherwise any option, including stool tests or colonoscopy, is acceptable. If the stool test is positive, then proceeding with a colonoscopy is necessary.

The Stool test requires repeating at frequent intervals whereas the colonoscopy is more sensitive and usually requires less frequent examinations. Most importantly, any of the above examinations are better than doing nothing. Consultation with a GI specialist who performs colonoscopies will help determine the best choice.

Daily Aspirin intake reduces the risk of colorectal cancer in high-risk Lynch Syndrome carriers. Lynch Syndrome is the most common hereditary cause of colon cancer; accounting for 5% of colorectal cancer.

In observational trials, daily Aspirin intake has been show to decrease Colorectal Cancer in average risk patients by 20-40%. These potential benefits of long-term therapy must be weighed against potential adverse effects including gastrointestinal bleeding and renal toxicity.

Consulting with a GI specialist will help determine whether this preventive therapy is advisable.

With effective treatment of Hepatitis C and Hepatitis B, fatty liver is now the most common cause of liver disease in the US. Although it has no clear cause, fatty liver is linked to obesity, insulin resistance, hypertension, heart disease, and elevated cholesterol. Certain ethnic groups, especially Hispanics, have a higher prevalence of fatty liver. 

Most commonly, fatty liver does not cause any specific symptoms. However, it may cause mild fatigue and dull right upper abdominal pain. This is due to the stretching of Gleason’s capsule. It can also cause a mild elevation of liver enzymes. 

Since no specific blood tests are available to diagnose fatty liver, other types of liver disease will need to be ruled out. This includes testing for alcohol intake, as well as blood tests to rule out Hep B, Hep C, and Wilson’s Disease. Medication history in the patient will help rule out drug reaction. 

Usually, fatty liver is diagnosed by an imaging study. On abdominal ultrasound, the liver has increased echo patterns suggestive of increased hepatic density. More specific tests include a FibroScan, which measures liver density. Although not always necessary, liver biopsy can confirm the diagnosis and severity of the liver disease. 

Fatty liver itself does not cause any significant liver dysfunction. It does, however, indicate significant metabolic problems, including an increased risk of developing diabetes, hypertension, and heart disease. However, fatty liver can progress into nonalcoholic steatohepatitis (NASH). 

On liver biopsy, NASH looks just like an alcoholic liver disease with increased fat and fibrosis. If this occurs, consultation with a GI specialist is recommended. NASH can progress to cirrhosis, which is end-stage liver disease. Even without progression to cirrhosis, the development of liver cancer (HCC) is increased. Even with the high prevalence of fatty liver, the development of HHC will substantially increase in this country. 

Although the treatment of fatty liver is an intense research area, no drug therapy is currently available. Obeticholic acid (OCA) is in phase three trials and shows promise. It has significant side effects such as pruritis and elevation of cholesterol, which may limit its use. If the patient is obese, a limited weight loss of 10% body weight can reverse fibrosis. Although no clinical trial has been published, low-dose aspirin may be of benefit as it can decrease the development of liver cancer. 

Fatty liver is now the most common cause of liver disease in this country. Consultation with a GI specialist or liver specialist is recommended for further evaluation and treatment options.

Colorectal Cancer (CRC) is a common and lethal disease. It is estimated that 100,000 cases of CRC are diagnosed in the US annually. Approximately 53,000 Americans are expected to die of CRC every year. Although the mortality rate of CRC is decreasing, it remains the third most common cause of cancer-related death in women and the second most common in men.

Although the incidence of CRC in patients over 50 has been decreasing, CRC incidence in patients aged 40-50 has been increasing.  The US Preventative Services Task Force recommends screening for average-risk African Americans at age 45. 

The type of screening should be a shared decision between the patient and the GI specialist. Colonoscopy, which is recommended by most GI MD’s is the only screening test proven to decrease CRC mortality. Optimally, this procedure should be performed at 50 in average-risk patients, and if negative, repeated every ten years. 

Fecal Immunochemical Testing (FIT) is a stool test done annually and is recommended in patients unable or unwilling to have a colonoscopy. If the FIT result is positive, a colonoscopy must be performed by a GI specialist. FIT is comparable to colonoscopy in the detection of CRC but has a lower detection rate for advanced adenomas, which may harbor localized cancer. 

Computed Tomography Colonography (CTC) is an option for patients at risk of complications from sedation or the procedure itself. CTC requires a colonoscopy laxative preparation and is done without sedation. It is relatively sensitive in identifying large polyps, which, if seen, would require a colonoscopy. 

Stool for guaiac fecal occult blood is insensitive and requires multiple stool samples. This test has been largely replaced by more specific stool tests (FIT). Most importantly, any option is better than nothing. Many patients believe that without abdominal pain, change in bowel habits, or rectal bleeding, the risk of developing colon cancer is very low. Most patients found to have colon cancer are asymptomatic and average risk. Discussion with a GI specialist will help determine the best option.

Chronic Ulcerative Colitis (CUC) is an inflammatory disease involving the distal colon, although it may extend to involve the entire colon. CUC is characterized by diarrhea commonly associated with rectal bleeding and colicky abdominal pain. Urgency is severe and involves the entire colon; colonic dilation may occur, resulting in perforation. Any type of bloody diarrhea requires consultation with a GI specialist.

Extraintestinal manifestations (infections that occur outside of the intestine) of CUC are common. These include arthritis involving the large joints and ocular problems resulting in blurred vision. 

Evaluation of possible ulcerative colitis includes laboratory and radiologic imaging. However, the diagnosis will eventually require colonoscopy done by a GI MD who performs colonoscopies. An endoscopy will evaluate the severity and extent of the inflammation. Colon biopsies will be obtained to establish the diagnosis and exclude other causes of colon inflammation.  

In the past, treatments of ulcerative colitis were limited to oral mesalamine and corticosteroids. Although treatment of mild CUC often begins with mesalamine, treatment failures are common. Corticosteroids are often used to treat moderate to severe CUC, but again, treatment failures are common, as are side effects. 

 Even if clinical response occurs, this regimen cannot be used to maintain remission. Fortunately, multiple biologic therapies are now available with new innovative drugs on the horizon. The current goal of treatment is mucosal healing. 

If this can be achieved, then complications of this disease, such as an increased risk of colon cancer, can be avoided. A total colectomy due to perforation or toxic megacolon can also be avoided. This therapy requires monitoring by GI specialists. 

With the national obesity epidemic, bariatric surgery is commonly performed. Patients who have undergone bariatric surgery require lifelong vitamin and mineral supplementation. Consultation with a GI specialist regarding malabsorption of vitamins and minerals will prevent the development of these complications.

After Roux-en-Y gastric bypass (RYGB), a long portion of the proximal small bowel is bypassed. This portion of the small bowel is critical in absorbing iron, multiple vitamins, and essential minerals. Calcium, magnesium, iron, zinc, folic acid, and copper are absorbed in this portion of the small bowel. Without supplementation, vitamin and mineral deficiencies will occur. Many patients are told to take one or two multivitamins a day.

Most of these supplements do not contain enough iron nor calcium, such as selenium, zinc chromium, and copper. Nutritional supplements need to be tailored to the individual patient’s nutritional requirements. A GI MD can monitor this.

After sleeve gastrectomy, the recommendations for multivitamin and mineral supplementations are generally the same. After either type of gastric surgery, a nutritional assessment is recommended every six months for the first year. Laboratory testing will be needed annually after that. A GI specialist can manage this assessment.

Below is a summary of the recommended vitamin and mineral supplements following surgery. Also listed are the disease complications associated with the specific deficiency.

  Vitamins and Minerals

 It is crucial that, after weight loss surgery, you ensure you’re getting the necessary vitamins and minerals. Nutritional deficiencies will most likely occur as you are eating less. This means you may not be getting the necessary vitamins and minerals from your food intake. You should have your labs checked regularly.

Below you will find the recommended supplements for patients of weight loss surgery. However, make sure you always consult your doctor as your individual needs may differ.

  Multivitamin

Take a high-potency, chewable multivitamin and mineral supplement containing a minimum of 18 mg of iron, 400 mcg of folic acid. Selenium, copper, and zinc daily. Brands that contain this formula include Centrum adult chewable multivitamins. Take two tablets daily until at least three months after your surgery, and then one tablet daily for life.

  Calcium

Take 1,200 to 2,000 mg daily to prevent calcium deficiency and bone disease. To enhance absorption, take the calcium supplement as two to three divided doses throughout the day. For example, take 500 to 600 mg tablets three times a day. Calcium citrate is the preferred form of calcium.

  Vitamin D

Take 800 to 3,000 international units (IUs) of vitamin D daily. This total amount should be taken as 400 to 500 international units (IUs) twice a day with your calcium supplement. If you prefer, you can take a combination of calcium-vitamin D supplement as long as it contains the proper dosages to avoid taking multiple pills.

  Vitamin B12

Take 500 mcg of vitamin B daily. This can be taken as a tablet or a liquid under the tongue. Remember, whole pills must be crushed. You may need additional folic acid or iron supplements, particularly if you are a female and still menstruating.

You should never take non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen, Advil, Motrin, Aleve, Vioxx, Naprosyn, or Celebrex. This is because these medications increase the risk of developing ulcers. 

Ulcers become increasingly difficult to diagnose and treat following bariatric surgery. Always consult with your doctor or pharmacist before starting a new medication.

Trouble with constipation is common among patients of bariatric surgery. Should this present a problem, there are a few things that might help; Benefiber being one of those things. Two teaspoons of Benefiber powder can be mixed into hot or cold drinks. You can also take Benefiber in the form of a caplet or chewable pill. Metamucil could also help. 

Helicobacter Pylori Infection (H Pylori) is the most prevalent chronic bacterial infection. This infection is associated with chronic stomach inflammation, stomach and duodenal ulceration, and stomach atrophy. Having this infection increases your risk of developing gastric cancer and gastric lymphoma (M A L T).

H pylori is often diagnosed by upper endoscopy by a GI specialist for evaluation of upper abdominal pain. H pylori can cause gastric and duodenal ulcers. The eradication of the infection will decrease the possibility of recurrent ulcers. In patients taking nonsteroidal anti-inflammatory medications, H pylori’s presence increases the chance of ulceration and intestinal bleeding. 

H pylori can also cause chronic gastritis, which is a surface inflammation of the stomach. Chronic gastritis can result in atrophic gastritis, which can lead to iron malabsorption and anemia. Atrophic gastritis can lead to the development of gastric cancer. If a patient has a family history of gastric cancer, screening for H Pylori infection is recommended. A low grade gastric mucosal lymphoma ( M A L T) can result from such an infection. Often the only treatment needed is the eradication of the infection. Limited evidence suggests that eradication of H pylori improves platelet count in some patients with idiopathic thrombocytopenic purpura (IT). 

If you are experiencing upper abdominal pain, see a GI MD. Depending on the circumstance, an H pylori breath test can be ordered. Treatment will be administered if the test result is positive. If the pain is accompanied by GI bleeding, anemia, or weight loss, an upper endoscopy (EGD) by a GI specialist will be necessary. It may also be needed if you have a family history of stomach cancer.

Antibiotics with a proton pump inhibitor are used to treat H pylori. Since the bacteria are now resistant to multiple antibiotics, this can be exceedingly difficult and require multiple regimens prescribed by a gastroenterologist. A new drug regimen, Talicia, which I helped research, is 90% effective in eradication. 

Confirmation of cure is essential. The conventional treatment is only 60%-70% effective. This testing is usually done by H pylori breath test at least two months after completing treatment. Once the cure is confirmed, H pylori can not reoccur. If treatment is not successful, then a continued infection can lead to an increased risk of gastric cancer. A GI specialist can monitor this process.