Gastroenterology | Q&A | Motility & Bowel Disorders | Penn Medicine

What could be the cause of persistent vomiting and constipation?

2013-10-30T11:18:00.002-04:00

Question: For the last 30 days, my 7 year-old son has been vomiting intermittently. He has been to the ER twice with the doctors saying it is due to him being constipated and his bowels being full of stool. We have gone to a GI nurse practitioner and she said to do a colon cleanse, which we did and he is still vomiting. He is on MiraLAX® 17g every day and Prevacid® 15mg twice a day. He is still vomiting every two to three days and is still constipated. This has been going on for 30 days. Please help!

Answer: I would urge you to have your son evaluated by an experienced pediatric gastroenterologist to ensure there is no esophagitis, gastroparesis, small bowel dysmotility, apart from presumed constipation. We can facilitate an appointment at Children's Hospital of Philadelphia with Owing Mills, MD, if you wish.

What could be the cause of persistent diarrhea?

2013-04-18T16:05:00.000-04:00

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.

Should my son stop taking acid reflux medication?

2012-12-24T12:03:00.002-05:00

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. 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.

What type of doctor can help with constipation?

2012-10-25T16:17:00.001-04:00

Question: I have lost the urge to have a bowel movement and also cannot force out stool. How do I find a doctor who can help me locate the source of the problem and appropriate treatment?

Answer: The frequency of bowel movements among healthy people varies from three movements a day to three a week. Individuals must determine what is normal for them. As a rule, constipation is suspected if more than three days pass between bowel movements, or if there is difficulty or pain when passing a hardened stool.*

It is best to see an internist or gastroenterologist to evaluate these symptoms. To schedule a consultation with a Penn gastroenterologist, please call 800-789-PENN (7366) or request an appointment online.

* http://www.gastro.org/patientcenter/digestiveconditions/AGAPatientBrochure_Constipation.pdf

What Are The Treatment Options For IBS?

2012-04-30T02:44:00.001-04:00

Question:
I am a 20 year-old female, and heart disease runs in my family. In October 2008, I had very severe sharp pains in my lower abdomen, mostly on my left side, and I was taken to the hospital immediately. I had blood taken and a CT scan and they told me I had an infected and inflamed colon. I was on metronidazole for seven days and saw improvement until the antibiotic ran out and my symptoms came back.
In December 2008, I had a colonoscopy and they diagnosed me with irritable bowel syndrome. I am not satisfied because I continue to have blood and mucus in my stool and recently noticed some new symptoms. I've also been having stomach aches and diarrhea.

Answer:
Irritable bowel syndrome (IBS) is a disorder involving the lower intestinal tract. It involves abdominal pain, as well as alternating constipation and diarrhea. IBS is a common disorder and happens more often in women than men. Although IBS can cause a great deal of discomfort, it does not harm the intestines. No one knows the exact cause and there is no specific test for IBS. However, your doctor may run tests to be sure you don't have other diseases. Most people diagnosed with IBS can control their symptoms with diet, stress management and medicine.

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

What Are The Treatment Options For Diarrhea And Intestinal Cramping?

2011-10-06T15:32:00.001-04:00

Question:
I have had diarrhea preceded by intestinal cramping for the last two weeks. I am 60 and have no history of cancer in my family and no nausea at all. My general physician took a stool sample, which was negative for both parasites and blood. Normally I have two to three episodes during the night, but remain asymptomatic all day. I limit my food to bananas, Gatorade® and toast, and I avoid dairy. During the day, I can perform regular functions.

Answer:
Diarrhea that does not improve after two weeks is considered chronic. The biggest risk of chronic diarrhea is dehydration, so make sure you drink a lot of water and stay as hydrated as possible. I recommend you see a gastroenterologist if your problem does not improve. There are many possible causes of chronic diarrhea and a gastroenterologist can review your symptoms, run further tests, diagnose and treat the cause. If you would like to schedule an appointment with a Penn gastroenterologist, David Ingis, MD can consult with you and recommend next steps.

To make an appointment, please call 800-789-PENN (7366) or request an appointment online.

Are There Physicians At Penn Medicine Who Specialize In Gastroparesis?

2011-10-04T15:35:00.001-04:00

Question:
After a gastric emptying scan, my son was diagnosed with gastroparesis. I am unable to find a gastroenterologist who can treat it. I am from the New Jersey/Pennsylvania area, but I currently live in Florida. We tried another prominent health care organization, but it was quite a disappointment. Do you have any suggestions?

Answer:
Penn gastroenterologists evaluate and treat patients with motility disorders like gastroparesis. David Metz, MD is a Penn gastroenterologist specializing in motility disorders. Dr. Metz sees patients at the Perelman Center for Advanced Medicine.

To make an appointment, please call 800-789-PENN (7366) or request an appointment online.

What Are The Treatment Options For Patients With Chronic Constipation Following A Total Abdominal Colectomy?

2011-10-01T15:36:00.001-04:00

Question:
I am a 30 year-old female who had a total abdominal colectomy done for colonic dysmotility. Since the surgery, I have had chronic constipation to the point that I've needed a hemorrhoidectomy and sphincterotomy. I have abdominal pain all of the time. I've tried high fiber, medication, enemas and so on. Do you have any suggestions?

Answer:
With such an involved medical history, it is difficult to say what might reduce your abdominal pain. David C. Metz, MD is a Penn gastroenterologist specializing in motility and bowel disorders. He can review your case and recommend treatment for your condition.

To schedule an appointment, please call 800-789-PENN (7366) or request an appointment online.

Is There A Way To Transfer A Patient With Achalsia To The GI Department At Penn Medicine?

2011-09-28T02:46:00.001-04:00

Question:
My father is in the hospital because he is unable to eat or hold down much of anything. He may be released as they cannot find the cause. His problem seems to be more in the esophagus than stomach or other organs, as he regurgitates within minutes of eating even a few bites. This hospital has sent him for physical rehabilitation twice, only to be sent back each time with infections. My father's symptoms started in spring 2008 and lasted for three month before going into remission until November.

In December, he had catheter ablation and a bladder stone removed. During this time he has been either in the hospital or physical rehab, growing weaker due to not being able to eat. Your article on achalasia seems to match his problem, but his hospital has never mentioned or tested for it. Is there a way to transfer him to Penn where your GI department has more resources?

Answer:
The esophagus is the tube that carries food, liquids and saliva from the mouth to the stomach. There are a number of possible esophagus disorders including:

Esophageal spasm – muscle contractions.
Esophageal stricture – narrowing of the esophagus.
Esophagitis – inflammation, irritation, or swelling of the esophagus.
Achalasia– a rare disorder involving the muscular ring where the esophagus and stomach come together.
Esophageal cancer

Treatment depends on the problem. Some get better with medications or changes in diet. Others may need surgery. David Metz, MD, is a Penn gastroenterologist who specializes in motility and bowel disorders.

To schedule an appointment with Dr. Metz, please call 800-789-PENN (7366) or you can also request an appointment online.

Does Prevalite Help Patients With Chronic Diarrhea?

2011-09-23T02:49:00.001-04:00

Question:
My 78 year-old mother was prescribed Prevalite® for chronic diarrhea. Since Prevalite® is a cholesterol-lowering drug that can cause constipation, I question its use to treat daily loose bowels.

Answer:
Prevalite® is a cholesterol-lowering drug, but it also is used to treat patients who have diarrhea related to excess fecal bile acids. It is used because it has the ability to bind the acids in bile, which relieves chronic diarrhea. A Penn gastroenterologist can give a second opinion and prescribe treatment for your mother.

Please call 800-789-PENN (7366) or request an appointment online.

What Are The Treatment Options For Bowel Incontinence?

2011-09-22T02:50:00.001-04:00

Question:
I have symptoms that started with gas and bloating, and have progressed to feces escaping uncontrollably – sometimes loose, sometimes solid. I have acid reflux and take Nexium®. I am also anemic. I had a colonoscopy and celiac has been ruled out. They found mild inflammation, but nothing they could pinpoint as anything specific. I've tried both Dicetel® and Modulon® with no real improvement. Can you make any suggestions?

Answer:
Short-term diarrhea and loss of bowel control (bowel incontinence) are commonly associated with the flu or food poisoning. Persistent bowel incontinence can be the result of a number of causes including constipation and damage to the muscles that control bowel movements. Chronic diarrhea – loose or frequent stools lasting more than four weeks – can be an indication of a more serious condition.

If celiac disease has been ruled out, your gastroenterologist may choose to administer an endoscopy test for inflammatory bowel disease (IBD) – another common cause of chronic diarrhea. IBD is usually accompanied by abdominal pain. David Metz, MD, is a Penn gastroenterologist who specializes in motility and bowel disorders.

To schedule an appointment with Dr. Metz, please call 800-789-PENN (7366) or you can also request an appointment online.

What Are The Treatment Options for Colonic Intertia?

2011-09-20T02:53:00.001-04:00

Question:
I have been diagnosed with colonic inertia and a sphincter problem. I have seen multiple GI doctors and surgeons — no one seems to have an answer to this other than an ileostomy. I am looking for another route. I have been to sphincter therapy at Penn Medicine Radnor. They tell me my sphincter is working, but the biofeedback checks "holding in" and not "pushing out." My quality of life has been greatly affected for the past two years. Any suggestions would be greatly appreciated.

Answer:
Colonic inertia is a type of functional constipation caused by a decrease in muscle activity in the colon. Functional constipation means that the bowel is healthy but not working properly. It stems from problems in the structure of the anus. These abnormalities result in an inability to relax the anal sphincters – the rectal and anal muscles that allow stool to exit. An ileostomy procedure is a type of ostomy surgery in which a surgeon removes the colon and rectum, and attaches the bottom of the small intestine to the stoma (an opening in the abdomen), bypassing the bowel. David Metz, MD, is a Penn gastroenterologist who specializes in motility and bowel disorders.

To schedule an appointment with Dr. Metz, please call 800-789-PENN (7366) or you can also request an appointment online.

What Are The Treatment Options For Severe Bloating And Flatulence?

2011-09-16T02:55:00.001-04:00

Question:
I get really bad gas, bloating and flatulence almost every afternoon and into the night. I was originally diagnosed with constipation so I changed to a high fiber diet and also started taking the supplements Metamucil® and miraLAX®.

Now, I usually have a bowel movement every morning without a problem, but the high fiber diet gave me more gas and bloating. The laxatives originally worked, but then they gave me diarrhea. Now I have stopped with the high fiber diet and the laxatives. I still get the bloating and gas in the afternoons and I do not know what to do. Can you recommend a prescription or test for me?

Answer:
Most people produce one to four pints of gas a day and pass gas about 14 times a day. Passing gas through the mouth is called belching or burping. Passing gas through the rectum is called flatulence. Most of the time, gas does not have an odor. The odor comes from bacteria in the large intestine that release small amounts of gases that contain sulfur.

Gas in the digestive tract comes from two sources: air that you swallow and the breakdown of undigested food by bacteria in the large intestine. Certain foods may cause gas, including many fruits and vegetables. Foods that produce gas in one person may not cause gas in another. For people with lactose intolerance, avoiding milk products will help. For most people, changing their diet and using a prescription or over-the-counter medication helps alleviate excessive gas. A Penn gastroenterologist can help you with diet and medication decisions related to chronic gas and bloating.

To schedule an appointment, call 800-789-PENN (7366) or request an appointment online.

What Are The Treatment Options For Abdominal Pain In Patients With Type 1 Diabetes?

2011-09-15T02:58:00.001-04:00

Question:
I am a type 1 diabetic and have been since 1972. For years I have had minor pain in my lower left abdomen, but not enough to mention. Now, ever since I had the intestinal bug that was going around, I have been having pretty bad pains. I want to get checked out but don't know what doctor to request. Can you help?

Answer:
Pain in the abdomen doesn't always mean a serious problem but if it lasts more than a week, you should see a health care provider. Seek medical help immediately if you experience any of the following:

abdominal pain that is sudden and sharp
additional pain in your chest, neck or shoulder
a stiff, hard abdomen that is tender to the touch
blood in your stool or vomit
inability to move your bowels (especially if you are also vomiting)

I recommend starting with your primary doctor as that person knows you best. If you have abdominal pain, your primary doctor may well consider referring you to a Penn gastroenterologist after evaluating your history, physical tests and an appropriate examination. If you are over 50 or have a family history of colorectal cancer, you should also think about having a colorectal cancer screening performed. David Metz, MD, is a Penn gastroenterologist who specializes in motility and bowel disorders.

To schedule an appointment with Dr. Metz, please call 800-789-PENN (7366) or you can also request an appointment online.

Are There Physicians At Penn Medicine Who Specialize In Small Intestine Bacterial Overgrowth?

2011-03-02T02:56:00.001-05:00

Question:
Is there a doctor or group of doctors that deal with small intestine bacterial overgrowth (SIBO)? I am from Lancaster, PA and cannot find anyone who is knowledgeable about treating it and its effects.

Answer:
The main purpose of the small intestine is to digest and absorb food into the body. The entire gastrointestinal tract, including the small intestine, normally contains bacteria. Small intestinal bacterial overgrowth (SIBO) refers to a condition in which abnormally large numbers of bacteria are present in the small intestine. The coordinated activity of the muscles of the stomach and small intestine moves the food from the stomach, through the small intestine, and into the colon.

Even when there is no food in the small intestine, muscular activity sweeps through the small intestine from the stomach to the colon. This activity is important for the digestion of food, but it also is important because it sweeps bacteria out of the small intestine and thereby limits the numbers of bacteria in the small intestine. Anything that interferes with the progression of normal muscular activity through the small intestine can result in SIBO. David Metz, MD, is a Penn gastroenterologist who specializes in motility and bowel disorders.

To schedule an appointment with Dr. Metz, please call 800-789-PENN (7366) or you can also request an appointment online.