Penn Gastroenterology Q&A | Penn Medicine

What is the required prep for a colonoscopy?

noreply@blogger.com (Penn Medicine) — Thu, 09 May 2013 11:28:40 PDT

Question: Prior to a colonoscopy, can I take pills instead of drinking the gallon of liquid?

Answer: A colonoscopy is an examination of the lining of the rectum and colon (the large intestine) through a flexible tube called a colonoscope. This allows a specially trained physician to directly view this area and identify any abnormalities.

The preparation for a colonoscopy involves drinking the liquid, Nulytely®. We suggest drinking the liquid with a combination of Miralax and Gatorade. Pills are not available for this procedure.

For more detailed information, please view Penn’s guidelines for colonoscopy preparation.

To schedule a consultation with a Penn physician, please call 800-789-PENN (7366) or request an appointment online.

What can I eat prior to an Upper GI series procedure?

noreply@blogger.com (Penn Medicine) — Fri, 26 Apr 2013 06:50:12 PDT

Question: I was told that I could have toast with jelly the day before my Upper GI series. Could I have butter instead of jelly?

Answer: An upper GI series is an x-ray procedure designed to examine the esophagus, stomach and duodenum. After these organs have been relaxed by medication and distended with gas, a thin coating of barium suspension is applied to outline their inner surfaces.

It is very important to fast for the requested time before an upper GI series; Penn Gastroenterology gives our patients the following instructions:

Preparation: The presence of food or fluid materials would interfere with the accuracy of the examination. It is therefore necessary to avoid all intake of food or liquid from 9pm of the day preceding your appointment.

After Care: Resume your normal diet. Increase fluid intake and drink plenty of water.
For most patients with normal bowel habits, the passage of barium in the form of "white stools" will present no problem. Patients with a history of constipation may use a mild laxative.

For more detailed information on patient preparation view the full instruction manual.

To schedule a consultation with a Penn physician, please call 800-789-PENN (7366) or request an appointment online.

What could be the cause of persistent diarrhea?

noreply@blogger.com (Penn Medicine) — Thu, 18 Apr 2013 13:05:08 PDT

Question: I am experiencing symptoms that include: sweating, clamy, hot and cold, cramping and fast heart rate. I have also had diarrhea twice in one week and frequently throughout the year. Could I have a serious problem?

Answer: You should seek evaluation with a gastroenterologist related to complete history, physical exam, blood tests, urine tests, imaging studies and endoscopic studies. It would be important to ensure there is no release of “hormones” that can trigger the diarrheal state.

To schedule an evaluation with a Penn gastroenterologist, please call 800-789-PENN (7366) or request an appointment online.

What do you recommend for treating sessile polyps?

noreply@blogger.com (Penn Medicine) — Tue, 09 Apr 2013 14:00:01 PDT

Question: Due to right lower quadrant pain three weeks ago, a CAT scan was done that showed inflamed ileum. One week ago, a colonoscopy revealed normal ileum and diverticular disease. An upper endoscopy showed multiple semi-sessile polyps. I have been on proton pump inhibitors (PPI) for GERD for three years. A biopsy indicated no crohn’s or celiac disease. I have a family history of first degree relatives with esophageal and colon cancer that are deceased. There was no recommendation for a follow up for sessile polyps. I am looking for a GI doctor at Radnor for the above diagnosis.

Answer: It is best to see a gastroenterologist to thoroughly evaluate these concerns and recommend a course of treatment. Dr. David Jaffe and Dr. Octavia Pickett-Blakely are available for appointments at Penn Medicine Radnor. To schedule a consultation, please call 800-789-PENN (7366) or request an appointment online.

What can be done for Sphincter of Oddi Dysfunction?

noreply@blogger.com (Penn Medicine) — Tue, 09 Apr 2013 12:19:18 PDT

Question: I have been diagnosed with Sphincter of Oddi Dysfunction after gallbladder surgery. I am told ERCP (Endoscopic Retrograde Cholangiopancreatogram) is too risky. I am told to live with the pain, which is severe and constant. Does Penn Medicine have a specialist for this disorder?

Answer: There is controversy over the authenticity of the condition of Sphincter of Oddi Dysfunction. It would be best to schedule a consultation with Dr. Nuzhat Ahmad who can discuss your symptoms and recommend next steps.

To schedule a consultation with Dr. Ahmad, please call 800-789-PENN (7366) or request an appointment online.

How long after eating should I wait to take my medication?

noreply@blogger.com (Penn Medicine) — Fri, 29 Mar 2013 07:08:04 PDT

Question: I have been diagnosed with Barrett's Esophagus. I take 40 mg of Prilosec® twice a day. Should I take the Prilosec® before meals and at bedtime? If I should take the medication at bedtime, how long after eating should I wait?

Answer: It is best to wait 30 minutes before breakfast and dinner. It is important to see a gastroenterologist about a surveillance upper endoscopy. At Penn, Dr. Gary Falk is a national leader in Barrett’s Esophagus.

Gary Falk, MD, MS is available for appointments at the Perelman Center for Advanced Medicine. He is a Professor of Medicine specializing in Gastroenterology and Co-Director of the Esophageal and Swallowing Disorders Center at Penn Medicine. To schedule a consultation with Dr. Falk or another Penn physician, please call 800-789-PENN (7366) or request an appointment online.

What medications can alleviate gas and diarrhea?

noreply@blogger.com (Penn Medicine) — Thu, 28 Mar 2013 13:00:01 PDT

Question: I have gas and diarrhea. What medications can help with my symptoms?

Answer: It is best to have an evaluation by an internist or gastroenterologist to see if you might have small bowel bacterial overgrowth, malabsorption (e.g. lactose intolerance, or even celiac sprue), or possibly colonic disorders. To schedule a consultation with a Penn physician, please call 800-789-PENN (7366) or request an appointment online.

Could my stomach issues be related to acid reflux?

noreply@blogger.com (Penn Medicine) — Thu, 28 Mar 2013 12:25:43 PDT

Question: I had a Nissen fundoplication done 10 months ago and I am now having stomach issues. Could this be reflux related?

Answer: The stomach issues may be related to the Nissen fundoplication. It depends upon your specific symptoms and what diagnostic tests may be needed. It is best to discuss any questions with your surgeon or gastroenterologist to thoroughly evaluate these concerns and to receive appropriate recommendations.

To schedule a consultation with a Penn physician, please call 800-789-PENN (7366) or request an appointment online.

What type of antibiotics should I take?

noreply@blogger.com (Penn Medicine) — Wed, 27 Mar 2013 13:30:02 PDT

Question: I had C. difficile four months ago for three days with urinary tract symptoms and I was put on Flagyl® for three weeks. Now I have strep throat and my primary physician wants to put me on amoxicillin. Should I go on Flagyl® and what dosage of probiotics is enough to help me if I do take Flagyl®?

Answer: It is best to let your internist know of the C. difficile. There is no need to be on Flagyl® prophylactically if C. difficile was eradicated in the recent past. To schedule a consultation with a Penn physician, please call 800-789-PENN (7366) or request an appointment online.

Why can’t I eat raw fruits and vegetables?

noreply@blogger.com (Penn Medicine) — Wed, 27 Mar 2013 07:50:58 PDT

Question: I can't eat raw fruits or vegetables because they give me heart burn. I've been this way for the last 20 years and no one has been able to tell me why. I've had four scopes done because of ulcers and the physicians thought it was bacteria, but the test came back negative every time. Afterward they prescribed Aciphex® and Dexilant.

I've read posts about other people having this same problem but no one has a real definitive answer. People say that you’re lacking an enzyme, or have an allergy. I'm trying to figure out a solution to be able to have a healthy diet by being able to eat these foods. I know where I can get allergy tested but where can I get enzyme testing done? What is the solution to an enzyme or allergy issue?

Answer: I would see an allergist to see if there is a food allergy. It is best to discuss any questions with your internist or gastroenterologist to thoroughly evaluate these concerns and to receive the appropriate recommendations. You also want to ensure that there is no evidence of Eosinophilic Esophagitis on past endoscopies. You can also get an abdominal ultrasound to ensure that the problem is not gallstones.

To schedule a consultation with a Penn physician, please call 800-789-PENN (7366) or request an appointment online.

What treatments are available for unwanted odor?

noreply@blogger.com (Penn Medicine) — Tue, 26 Mar 2013 08:57:02 PDT

Question: I am a 25 year-old sedentary male college student. I am 6’1’’ and 200 pounds. I have noticed a consistent foul odor in my anal area and I am experiencing bloody discharge upon defecation. I had a colonoscopy within the last two years due to bloody discharge and a hemorrhoid. The constant foul odor began within the last year and still remains present. Do you know the cause of the odor and what treatments are available?

Answer: I would suggest the following tests:
1. Send the stool for culture/sensitivity, ova/parasites, C. difficile testing.
2. Test the stool for qualitative fat.
3. Discuss getting another colonoscopy with your gastroenterologist if your previous colonoscopy was complete two years ago.
4. Look into getting a hydrogen breath test for lactulose (new).

It is best to discuss any questions with your internist or gastroenterologist to thoroughly evaluate these concerns and to receive the appropriate recommendations. To schedule a consultation with a Penn physician, please call 800-789-PENN (7366) or request an appointment online.

Can certain intestinal elements cause weight gain or weight loss?

noreply@blogger.com (Penn Medicine) — Fri, 22 Mar 2013 11:03:35 PDT

Question: If a person has an extra amount of intestinal villi, would that cause them to lose weight or gain weight and why?

Answer: There is no relationship to weight gain or loss if the intestine has extra villi. If villi in the intestine are blunted, that can be associated with certain malabsorptive disorders, which could cause diarrhea and weight loss. It is best to discuss any questions with your internist or gastroenterologist to thoroughly evaluate these concerns and to receive the appropriate recommendations. To schedule a consultation with a Penn physician, please call 800-789-PENN (7366) or request an appointment online.

Am I going to the bathroom too much?

noreply@blogger.com (Penn Medicine) — Fri, 22 Mar 2013 11:03:31 PDT

Question: I have four to six bowel movements per day. None are usually runny and there is no cramping or abdominal pain involved but it is very annoying having to go to the bathroom this many times. Is this normal?

Answer: It depends if there are other symptoms, such as abdominal pain or cramping, blood in the stool or weight loss. Other possible issues include lactose intolerance, gluten sensitivity and bacterial overgrowth in the small intestine. An evaluation should be done by your gastroenterologist. To schedule a consultation with a Penn physician, please call 800-789-PENN (7366) or request an appointment online.

How can I receive my past colonoscopy results?

noreply@blogger.com (Penn Medicine) — Sat, 16 Mar 2013 20:39:43 PDT

Question: I had a Colonoscopy at Penn in either 2006 or 2007 and my new doctor has requested that I get the results of that procedure. How do I get that result for him?

Answer: Is your doctor at Penn Medicine? If your physician is not at Penn, it will be best to follow up with your physician. To request testing results from a Penn physician, please call 800-789-PENN (7366).

Is frequent belching as sign of GI issues?

noreply@blogger.com (Penn Medicine) — Wed, 16 Jan 2013 12:05:40 PST

Question: My 13 year-old son has been burping up recently eaten food in liquid form. He says it happens ten to twenty times a day and it's not particularly acidic. He said it just tastes like the food he just ate. Should I be worried?

Answer: Belching is usually a minor symptom, but if it doesn’t go away or if you also have other symptoms, it is best to call a health care provider. I recommend that your son see a pediatric gastroenterologist to make sure he doesn't have gastroparesis. To schedule a consultation with a Penn physician, please call 800-789-PENN (7366) or request an appointment online.

Who can treat achalasia?

noreply@blogger.com (Penn Medicine) — Mon, 07 Jan 2013 14:17:00 PST

Question: I was just diagnosed with achalasia. Is there a gastroenterologist at Penn Medicine who specializes in achalasia? I would like a doctor to review my manometry.

Answer: Gary Falk, MD, MS, is available for appointments at the Perelman Center for Advanced Medicine. He is a Professor of Medicine specializing in Gastroenterology and Co-Director of the Esophageal and Swallowing Disorders Center at Penn Medicine. To schedule a consultation with Dr. Falk or another Penn physician, please call 800-789-PENN (7366) or request an appointment online.

Who can treat intestinal metaplasia?

noreply@blogger.com (Penn Medicine) — Mon, 07 Jan 2013 11:14:47 PST

Question: Where can I find a specialist in intestinal metaplasia? I am 33 years-old and I was diagnosed after an endoscopy.

Answer: It would be best to see a physician at Penn Gastroenterology. Gary Falk, MD, MS, is available for appointments at the Perelman Center for Advanced Medicine. He is a national expert on intestinal metaplasia in the esophagus. To schedule a consultation with Dr. Falk or another Penn physician, please call 800-789-PENN (7366) or request an appointment online.

Why does a multivitamin produce nausea?

noreply@blogger.com (Penn Medicine) — Wed, 26 Dec 2012 08:11:36 PST

Question: I have recently started taking a multivitamin. It seems to be giving me energy, but I have also developed a feeling of starvation after taking the vitamin. If I try to eat, I feel too full and nauseous. I have a cold as well. I’m not sure what’s causing the fullness and nausea. How can I be hungry and full at the same time?

Answer: Sometimes colds (viral infections) can cause gastrointestinal upset and difficulty with emptying from the stomach. I would suggest seeing a gastroenterologist through your internist to consider obtaining the following:

•    Upper GI series
•    Possible, blood tests
•    Possible gastric emptying scan if indicated by upper GI series

To schedule a consultation with a Penn physician, please call 800-789-PENN (7366) or request an appointment online.

Can chest pain be related to problems with the GI tract?

noreply@blogger.com (Penn Medicine) — Wed, 26 Dec 2012 08:11:29 PST

Question: I've recently been experiencing a quick two second pain on the left side of my chest that pulsates up through the left side of my neck. This is immediately followed by almost non-stop belching. I was so scared this was heart related that I went to the ER. After an EKG, chest x ray, and blood work, they said my heart was fine and that it could be something with my GI tract. I have notice lately that after eating, I get bloated fast and burp up acid.

Answer: It would be best to get a barium swallow of the esophagus, and then seek further consultation with upper endoscopy and perhaps, other measures, as needed. It is best to see an internist or gastroenterologist to thoroughly evaluate these concerns and recommend a course of treatment. To schedule a consultation with a Penn physician, please call 800-789-PENN (7366) or request an appointment online.

Should my son stop taking acid reflux medication?

noreply@blogger.com (Penn Medicine) — Wed, 26 Dec 2012 08:11:19 PST

Question: My 19 year-old son has been taking Prilosec OTC® for about 1.5 years for acid reflux. It controls his reflux but he has recently been complaining of frequent, acute GI distress— every one to two days— and very frequent bowel movements— on average, six to seven times per day. He says his rectum feels distended as often as once a day. Should we consider taking him off the daily OTC medication?

Answer: Try taking your son off of Prilosec OTC®. It is best to see a gastroenterologist to thoroughly evaluate these concerns and recommend a course of treatment. Dr. John Draganescu is available for appointments at Radnor and Dr. David Ingis is available for appointments at Penn Presbyterian Medical Center. To schedule a consultation with a Penn physician, please call 800-789-PENN (7366) or request an appointment online.

Can marijuana treat Cyclic Vomiting Syndrome?

noreply@blogger.com (Penn Medicine) — Fri, 14 Dec 2012 13:38:25 PST

Question: My significant other has Cyclic Vomiting Syndrome and it has gone without a cure for a very long time due to lack of research. Can marijuana use treat CVS?

Answer: There is no FDA approval for use of the drug for cyclic vomiting syndrome. This syndrome requires coordinated care between psychiatry, nutrition, and gastroenterology.

It is best to see an internist or gastroenterologist to thoroughly evaluate these concerns and recommend a course of treatment. To schedule a consultation with a Penn physician, please call 800-789-PENN (7366) or request an appointment online.

What is the proper diagnosis for severe abdominal, back and leg pain?

noreply@blogger.com (Penn Medicine) — Fri, 14 Dec 2012 13:30:51 PST

Question: I have abdominal pain on my right side and into the crest of my hip as well as back pain. Pain comes and goes throughout the day and is severe. Motrin® does not help ease the pain. Pain now radiates into the right side of my front upper thigh. The pain lessens when I lay down and worsens with sitting up and when I lean forward. I have some pain before and after bowel movements. I had a rash and mouth sores which eventually went away.

I had a CT scan at the ER in November which revealed swollen lymph nodes and mesenteric panniculitis. My doctor never treated this and gave me pain medication to help alleviate the symptoms. I never took the medications and the symptoms didn’t go away. I now have dizzy spells where I feel like my body is dropping. My erythrocyte sedimentation rate rate is 27. I also went to the ER in August but nothing was found on the CT scan. Should I go see a GI doctor or a surgeon? Who would know how to diagnose these symptoms? Should I have the CT scan re-read?

Answer: Due to the diverse nature of the symptoms, it is best to see an internist or gastroenterologist to thoroughly evaluate these symptoms and recommend a course of treatment. To schedule a consultation with a Penn physician, please call 800-789-PENN (7366) or request an appointment online.

Can cisapride treat idiopathic gastroparesis?

noreply@blogger.com (Penn Medicine) — Fri, 14 Dec 2012 13:27:09 PST

Question: If a patient is diagnosed with idiopathic gastroparesis, which had been resistant to numerous trials of medical treatment, could cisapride be another option for treatment?

Answer: If a health care provider cannot identify the cause, even with medical tests, delayed gastric emptying is diagnosed as idiopathic gastroparesis. Diabetes is the most common known cause of gastroparesis. Other identifiable causes of gastroparesis include intestinal surgery and nervous system diseases such as Parkinson’s disease or multiple sclerosis. Although the reasons are unclear, gastroparesis is more prevelant in women than in men.

Gastroparesis is treated based on the severity of the person’s symptoms. It is a relapsing condition—the symptoms can come and go for periods of time. Treatments usually can’t cure the chronic condition. People can, however, manage the condition through treatment so they can be as comfortable and active as possible.

Cisapride is no longer an FDA approved drug and is off the market. It is best to see an internist or gastroenterologist to thoroughly evaluate these concerns and recommend the right course of treatment. To schedule a consultation with a Penn physician, please call 800-789-PENN (7366) or request an appointment online.

How can I alleviate the side affects caused by my medications and coffee?

noreply@blogger.com (Penn Medicine) — Thu, 15 Nov 2012 14:06:57 PST

Question: I have developed an intolerance to coffee on an empty stomach in the past few years. It makes me nauseous. More recently, I started having heartburn so I began taking Prevacid®, 15 mg/day. Then I took Bactrim® DS for a urinary tract infection, and was nauseous for two days. Since then I have been experiencing mild nausea sometimes at the end of a meal. It only lasts a few minutes or so. This is accompanied by excessive salivation. How can I alleviate these symptoms?

Answer: You may want to increase the Prevacid® 15 mg to twice a day, once in the morning and once in the evening. Avoid coffee, tea and alcohol (if applicable). Sometimes, the Bactrim® can cause nausea and that should subside soon.

It is best to see an internist or gastroenterologist to thoroughly evaluate these concerns and recommend a course of treatment. To schedule a consultation with a Penn physician, please call 800-789-PENN (7366) or request an appointment online.

Is bleeding following a small intestine dissection normal?

noreply@blogger.com (Penn Medicine) — Thu, 15 Nov 2012 13:00:01 PST

Question: I had a small intestine dissection (in two areas) due to a complication with a laparotic partial hysterectomy for fibroids. As a result of this dissection, I am bleeding in a very light flow that is pink and not red. How long can I expect to bleed?

Answer: It is best to see a general surgeon to evaluate these concerns. Dr. Daniel Dempsey is available for appointments at the Perelman Center for Advanced Medicine. To schedule a consultation with Dr. Dempsey or another Penn gastrointestinal surgeon, please call 800-789-PENN (7366) or request an appointment online.