Conditions & Treatments
Achalasia
Achalasia is a rare disorder of the esophagus. It occurs when there is impaired ability to push food down toward the stomach (peristalsis) that happens when the ring-shaped muscle at the bottom of the esophagus, called the lower esophageal sphincter (LES), fails to relax. The alternating contraction and relaxation of the sphincter is what normally moves food through the tube.
Most people with this disorder experience difficulty swallowing (dysphagia). There may also be mild chest pain that comes and goes. Retention of saliva and ingested food in the esophagus may often cause regurgitation, or they may be propelled into the lungs during breathing (tracheobronchial aspiration). Other symptoms of this disorder are coughing at night and significant weight loss.
Diagnosis
- High-Resolution Esophageal Manometry – These devices measure fluid pressure in the esophagus.
- X-ray Examination (radiology) with Barium – This is frequently useful in the diagnosis of achalasia. It may show enlargement (dilation) of the esophagus and the retention of food and secretions within the esophagus.
Treatment Options
- Botox Injection
- Laparoscopic and/or Robotic Heller Myotomy – Heller myotomy is a laparoscopic surgery that is used to divide the hypertrophic esophagus muscle. The operation opens up the tight muscle fibers of the lower esophagus, allowing food to pass through into the stomach. This is the gold standard treatment.
- Pneumatic Balloon Dilation – In this procedure, an air-filled balloon in the shape of a cylinder is used to disrupt muscle fibers in the lower esophageal sphincter.
Acute and Chronic Pancreatitis
Pancreatitis is inflammation of the pancreas. Pancreatitis can happen once in a while or it can happen all the time (chronic pancreatitis). Abdominal pain, pain after eating, weight loss, nausea, and vomiting are some of the symptoms.
Diagnosis
- Blood Work (amylase and lipase levels)
- CT/MRI scan of the abdomen to evaluate the pancreas
- Endoscopic Retrograde Cholangiopancreatography (ERCP) – In an ERCP procedure, an endoscope (a thin, flexible tube with a tiny video camera on the end) is passed down the throat, through the esophagus and stomach, and into the first part of the small intestine.
- Endoscopic Ultrasound (EUS) – This uses high frequency sound waves to “see” the gastrointestinal tract and lungs. Your Mount Sinai gastroenterologist will insert a tube down your esophagus and stomach, into the small bowel, or into the brachial tubes for the lungs.
Treatment Options
At Mount Sinai, we use a variety of approaches to help patients with pancreatitis. These include simple solutions like fasting to give the pancreas time to rest and repair itself, to more complex treatments including surgery to remove blockages that may be causing the pancreas to become inflamed or swollen with fluid. We also find success with certain medications, including enzymes.
Anal Fissure and Fistula
An anal fistula is an abnormal connection between the anus and the outer skin of the buttocks, usually the result of a previous abscess. Symptoms include pain, swelling, irritation of the skin around the anus, pus, fever, and feeling poorly in general. Surgery is the method of choice to cure an anal fistula and should be performed by a specialist in colon and rectal surgery. The surgery is usually performed on an outpatient basis, though a short hospital stay may be required.
Diagnosis
- Physical examination by one of our expert physicians
- Colonoscopy – After clearing out the large intestine by having the patient drink a liquid that causes diarrhea, and while under light anesthesia, your doctor will insert a flexible tube into the rectum with a camera on its tip so he or she can see inside the colon.
- Rectal Endoscopic Ultrasound – We use sound waves to outline the path of the fistula and look for abscesses.
Treatment Options
- Botox Injections
- Fistulotomy and Fistulectomy – These procedures involve removing the fistula by excising tissue around the outside and then bringing normal tissue back together with sutures.
- Treatment with topical medications
- Sphincterotomies – In this simple surgical procedure, the sphincter is cut or stretched. The surgeon will make a small cut in the internal anal sphincter to release tension.
Autoimmune Cholangitis
Autoimmune cholangitis is a rare inflammatory disease that affects the bile ducts. Primary biliary cholangitis (PBC) is a chronic autoimmune disease of the liver that leads to progressive bile duct damage, dilation (cholestasis), and often end-stage liver disease. The normal flow of bile is disrupted so toxic substances that are usually excreted into the bile get trapped in the liver.
Symptoms include fatigue, upper abdominal pain, itching, weight loss, diarrhea, joint aches, rashes, swelling, chest pain, jaundice, and excess hair growth in unwanted places.
Diagnosis
- Blood Work – We examine blood results for multiple biomarkers and antibodies.
- Endoscopic Retrograde Cholangiopancreatography (ERCP) – This is a procedure to diagnose and treat problems in the liver, gallbladder, bile ducts, and pancreas. It uses X-rays and an endoscope, which is a long, flexible, lighted tube. The scope goes through your mouth and throat, then down the esophagus, stomach, and the first part of the small intestine. Then a tube is passed through the scope and injects a dye.
- Endoscopic Ultrasound (EUS) – This treatment uses high-frequency sound waves to examine the bile ducts.
- Magnetic Resonance Imaging (MRI) – MRI tests use magnets, radio waves, and a computer to take pictures of the inside of your body.
- Percutaneous or Laparoscopic Liver Biopsy – This procedure removes a small piece of liver tissue. It is examined under a microscope to look for disease or damage.
Treatment Options
- Corticosteroid drugs – This may alleviate symptoms and improve blood work and tissue.
- Methotrexate – This medicine may prevent or reverse tissue damage.
- Ursodeoxycholic acid (UDCA) – This is an important medication that slows the progression of the disease.
Autoimmune Enteropathy
Autoimmune enteropathy is a form of autoimmune disease that causes severe diarrhea and weight loss. It is non-gluten-dependent and is most often diagnosed in male babies, though adults may also be diagnosed with autoimmune enteropathy. Unlike other immune diseases that are affected by gluten, this disease doesn’t improve with a gluten-free diet.
Autoimmune enteropathy is frequently associated with other autoimmune diseases, such as thyroiditis, myasthenia gravis, lupus, and immune deficiencies, such as Common Variable Immunodeficiency. Usually, it is treated with immunosuppressive treatment.
Diagnosis
- Push Enteroscopy – This is a procedure that examines the small intestine, located between the stomach and colon (large intestine), which is made up of the duodenum, jejunum, and ileum. The first few feet of the small intestine can be examined using this longer endoscope (enteroscope). The instrument is introduced through the mouth and slowly advanced through the stomach, duodenum, and into the jejunum.
- Single Balloon Enteroscopy – This is an examination of the lining of the esophagus, stomach, and small intestine with a flexible endoscope, or small camera.
Treatment Options
- Corticosteroids drugs (budesonide and prednisone)
- Immunosuppressive Therapy – These medications reduce immune system activity in the body.
- Combination Therapies paired with IV nutrition
Autoimmune Pancreatitis
Autoimmune pancreatitis affects the pancreas and can also affect the bile ducts, salivary glands, kidneys, and lymph nodes. It occurs when the immune system mistakenly begins to attack healthy organs and glands.
There are two types of autoimmune pancreatitis: Type 1 is present in about 80% of cases and is caused by blocked bile ducts. Type 2 shows itself with recurring episodes of acute pancreatitis. Symptoms include dark urine, pale stool that floats, nausea, vomiting, jaundice, loss of appetite, weight loss, and fatigue.
Diagnosis
- CT or MRI of the pancreas
- Endoscopic Ultrasound (EUS) – EUS uses high-frequency sound waves to evaluate the gastrointestinal tract and lungs.
Treatment Options
- Steroids
Barrett’s Esophagus
Barrett’s Esophagus is a condition in which pre-cancerous cells are present in the esophagus. It is associated with long-term gastroesophageal reflux disease (GERD). This can only be diagnosed with an upper endoscopy and biopsy.
The first line of treatment for Barrett’s Esophagus focuses on controlling acid reflux through lifestyle changes and anti-acid medication. Cases that do not respond well to this treatment or that are more severe may require endoscopic and surgical procedures to remove diseased tissue. In severe cases or when esophageal cancer is found, surgery to remove the esophagus (esophagectomy) offers the best chance for a cure.
Diagnosis
- Upper Endoscopy – This is the use of a tube that has a camera on it to diagnose and take biopsies in the GI tract and lung.
- Endoscopic Ultrasound – This uses high frequency sound waves to evaluate the gastrointestinal tract and lungs.
Treatment Options
- Antacids – These provide quick relief by neutralizing stomach acids.
- Baclofen – This is a prescription drug used to reduce the relaxation of the lower esophageal sphincter, which allows acid backwash.
- Diet Modifications
- H-2 Receptor Blockers (which decrease acid production)
- Lifestyle Modifications
- Proton Pump Inhibitors (stronger acid blockers that also help heal damaged esophagus tissue)
- Minimally invasive laparoscopic or robotic anti-reflux surgery
- Radiofrequency ablation (RFA) – This treatment uses heat produced by radiofrequency waves to destroy the abnormal area.
Bile Duct Strictures
Most bile duct strictures are the result of injuries that happened during surgeries and diseases of the liver, bile ducts, and gallbladder. Strictures mean that the tube that takes bile from the liver to the small bowel is narrowed. This can cause life-threatening complications and distressing symptoms such as right upper abdominal pain, jaundice, itching, weight loss, nausea, and vomiting.
Diagnosis
- CT scan or MRI of the liver
- Endoscopic Retrograde Cholangiopancreatography (ERCP) – This is a procedure to diagnose and treat problems in the liver, gallbladder, bile ducts, and pancreas. It uses X-ray and an endoscope—a long, flexible, lighted tube. The scope goes through your mouth and throat, then down the esophagus, stomach, and the first part of the small intestine. Then a tube is passed through the scope and a dye is injected.
- Endoscopic Ultrasound (EUS) – An EUS uses high-frequency sound waves to evaluate the gastrointestinal tract and lungs.
Treatment Options
- Antibiotics – 70-80% of patients respond to treatment with antibiotics.
- Balloon Dilation or Stenting – These procedures are performed surgically, percutaneously (through the skin), or endoscopically (using a long, tubular instrument).
C. Difficile Infection
Clostridium difficile is a bacterial infection that can cause symptoms ranging from diarrhea to life-threatening inflammation of the colon. Illness from C. difficile most commonly affects people in hospitals or in long-term care facilities and typically occurs after the use of antibiotic medications. In addition to diarrhea, patients can also get fevers, chills, pus in their stool, nausea, severe abdominal pain, weight loss, and kidney failure.
Diagnosis
- Stool Culture – A laboratory will examine a fresh stool sample for disease-causing bacteria. Toxins produced by C. difficile bacteria can usually be detected in a sample of your stool.
- Colonoscopy – After clearing out the large intestine by having the patient drink a liquid that causes diarrhea, and while under light anesthesia, your doctor will insert a flexible tube into the rectum with a camera on its tip so he or she can see inside the colon.
Treatment Options
- Medical Treatment – This includes Vancomycin (Vancocin HCL, Firvanq) or Fidaxomicin (Dificid). Metronidazole (Flagyl) may be rarely used if Vancomycin or Fidaxomicin aren’t available.
- Fecal Material Transplant (FMT) – This restores healthy intestinal bacteria by placing another person’s (a donor’s) stool in your colon through a colonoscope or nasogastric tube.
Celiac Disease
Celiac disease is also called celiac sprue or gluten-sensitive enteropathy. It is a chronic disorder of the digestive tract that results in an inability to tolerate a protein commonly found in wheat, rye, and barley. When patients with celiac disease ingest gluten, their immune system kicks in and creates an inflammatory response that damages the lining of their intestines, resulting in maldigestion and malabsorption of food nutrients. Gastrointestinal symptoms may include diarrhea, flatulence, increased bowel sounds, weight loss, weakness, fatigue, and abdominal pain. Other symptoms include anemia, numbness, weakness in muscles, and skin rashes.
Diagnosis
- Blood Tests for Immunoglobulin – This anti-tissue transglutaminase antibody (IgA TTG) is the best first test for suspected celiac disease, although biopsies are needed for confirmation.
- Upper Endoscopy, or EGD (Esophagogastroduodenoscopy) – This test looks at the lining of your food pipe (esophagus), stomach, and duodenum. It uses a thin, lighted tube or endoscope that has a camera at one end. Biopsies and cultures for bacteria can be taken.
- Wireless Capsule Endoscopy – This is a procedure where you swallow a capsule that contains a camera that takes thousands of digital pictures. It is then retrieved in the stool so the images can be uploaded into pictures.
Treatment Options
- Gluten-free Diet
Chronic Anemia
Anemia means you don’t have enough red blood cells, which can be a sign you’re bleeding somewhere along your GI tract. Anemia can cause headache, fatigue, cravings for ice, shortness of breath, a fast pulse, and pale skin. Causes include multiple types of cancer, autoimmune disorders, Crohn’s disease, inflammatory bowel disease, lupus, and long-term infections, such as HIV and kidney disease.
Diagnosis
- Colonoscopy – After clearing out the large intestine by having the patient drink a liquid that causes diarrhea, and while under light anesthesia, your doctor will insert a flexible tube into the rectum with a camera on its tip so he or she can see inside the colon.
- Upper Endoscopy, also called EGD (esophagogastroduodenoscopy) – This test looks at the lining of your food pipe (esophagus), stomach, and duodenum. It uses a thin, lighted tube or endoscope that has a camera at one end. Biopsies and cultures for bacteria can be taken.
- Wireless Capsule Endoscopy – This is a procedure where you swallow a capsule that contains a camera that takes thousands of digital pictures. It then is retrieved in the stool so the images can be uploaded into pictures.
Treatment Options
- Blood Transfusion
- Iron Infusion
- Medical Management – This depends on the underlying cause and may include B2 or iron supplements.
Chronic Gastrointestinal Bleeding
Gastrointestinal bleeding is a symptom of a disease, and may indicate hemorrhoids, peptic ulcers, colonic polyps, diverticulitis and diverticulosis, ulcerative colitis and Crohn’s Disease, tears in the esophagus, or cancer in the stomach, colon, or esophagus.
Diagnosis
- Colonoscopy – After clearing out the large intestine by having the patient drink a liquid that causes diarrhea, and while under light anesthesia, your doctor will insert a flexible tube into the rectum with a camera on its tip so he or she can see inside the colon.
- Upper Endoscopy, also called EGD (esophagogastroduodenoscopy) – This test looks at the lining of your food pipe (esophagus), stomach, and duodenum. It uses a thin, lighted tube or endoscope that has a camera at one end. During an upper endoscopy, your Mount Sinai doctor may take tissue samples to examine under a microscopy. This is called a biopsy. Your doctor may also take samples to look for bacteria.
- Wireless Capsule Endoscopy – This is a procedure where you swallow a capsule that contains a tiny camera that takes thousands of digital pictures. It is then retrieved in the stool so the images can be uploaded into pictures.
Treatment Options
- Blood Transfusion
- Proton Pump Inhibitor – This will suppress stomach acid production.
- Surgery, such as a polyp removal procedure
Colon Polyps
Colonic polyps are slow-growing overgrowths of the inside lining of the large intestine. Polyps carry a low risk (< 1%) of becoming malignant, and they usually don’t cause any symptoms. However, they are common as we age and require removal when detected to make sure they don’t turn into colon cancer.
Diagnosis
- Colonoscopy – After clearing out the large intestine by having the patient drink a liquid that causes diarrhea, and while under light anesthesia, your doctor will insert a flexible tube into the rectum with a camera on its tip so he or she can see inside the colon.
- Endoscopic Mucosal Resection – An endoscopic mucosal resection is performed with a long, narrow tube with a light and a camera. The procedure is used to remove pre-cancerous, early-stage cancer, or otherwise affected tissue.
- Minimally Invasive Techniques – These techniques include laparoscopy and/or robotic surgery to remove the affected colon.
Treatment Options
- Removal and surveillance of colon polyps
Colonic Dysmotility
Dysmotility means food, nutrients, and stool don’t move through the digestive tract properly. Today, we believe chronic dysmotility is caused by the nerves that control the GI tract. These nerves are attacked by immune cells, resulting in poor function. Symptoms include an early feeling full, nausea, vomiting, bloating, diarrhea, constipation, and involuntary weight loss.
Diagnosis
- Colonoscopy – After clearing out the large intestine by having the patient drink a liquid that causes diarrhea, and while under light anesthesia, your doctor will insert a flexible tube into the rectum with a camera on its tip so he or she can see inside the colon.
- Gastroduodenal Manometry or a Colon Motility Study – Both tests measure intestinal contractions and measure a pattern of contractions. The results help confirm slow GI movement.
Treatment Options
- Dietary Changes
- IV Nutrition
- Medication
- Surgery – Sometimes, a surgical procedure will be required to relieve pressure, or to remove a section of the intestines.
Colorectal Cancer
Colorectal cancer is the second most common cancer in the United States. It affects about 140,000 people each year and results in approximately 60,000 deaths. However, the disease is potentially curable if diagnosed and treated in its early stages.
Although colorectal cancer may occur at any age, more than 90 percent of patients are over age 40. At this age, the risk doubles every 10 years. In addition to age, other high-risk factors include a family history of colorectal cancer and polyps, and a personal history of ulcerative colitis, colon polyps, or cancer of other organs.
Colorectal cancer is a silent disease. However, as it becomes more advanced, rectal bleeding and changes in bowel habits, i.e., constipation or diarrhea, abdominal pain, and weight loss, may develop.
Diagnosis
- Cologuard Stool DNA Test – This test examines a stool sample for genetic signs of colon cancer.
- Colonoscopy – After clearing out the large intestine by having the patient drink a liquid that causes diarrhea, and while under light anesthesia, your doctor will insert a flexible tube into the rectum with a camera on its tip so he or she can see inside the colon.
- FIT Annual Fecal Immunochemical Test (FIT) – This test can detect blood in the stool that cannot be seen by the naked eye.
Treatment
Colorectal cancer requires surgery in almost all cases for a complete cure. Radiation and chemotherapy are sometimes used in addition to surgery, along with a wide range of new medicines, including immunotherapy and drugs that prevent blood vessels from forming that are required to feed tumors. Between 80 and 90 percent of patients return to normal health when the cancer is detected early.
Crohn’s Disease
Crohn’s disease is a type of inflammatory bowel disease and is a chronic inflammatory condition primarily involving the end of the small intestine and/or the large intestine, or colon. Symptoms include cramping, abdominal pain, diarrhea, fever, weight loss, and bloating. Because it is a chronic condition, Crohn’s may recur over the course of a patient’s entire life.
The majority of patients are between 16 and 40 years of age. It occurs equally in men and women, and appears to run in families. Initial treatment for Crohn’s is medication. Surgery may be required for more advanced or complicated cases. The most common procedure for these cases involves the removal of the diseased portion of the bowel.
Diagnosis
- Colonoscopy – After clearing out the large intestine by having the patient drink a liquid that causes diarrhea, and while under light anesthesia, your doctor will insert a flexible tube into the rectum with a camera on its tip so he or she can see inside the colon.
- Wireless Capsule Endoscopy – This is a procedure where you swallow a capsule that contains a tiny camera that takes thousands of digital pictures. It is then retrieved in the stool so the images can be uploaded into pictures.
Treatment Options
- Medications – These medicines contain 5-aminosalicylic acid (5-ASA), which helps control inflammation. Doctors use aminosalicylates to treat people newly diagnosed with Crohn’s disease who have mild symptoms. Aminosalicylates include: Balsalazide, Mesalamine, Olsalazine, and Sulfasalazine
- Patients with more advanced disease may require surgery to remove their colon or a portion of their colon.
Diverticular Disease
Diverticulosis of the colon is a common condition that affects about 50 percent of Americans by age 60 and nearly all by age 80. Only a small percentage of those affected have symptoms, and even fewer will ever need surgery.
Diverticula are pockets that develop in the colon wall. Diverticulitis describes the presence of these pockets, along with inflammation and complications from these pockets.
The major symptoms of diverticular disease are cramps, abdominal pain, diarrhea, change in bowel habits, including diarrhea, and, occasionally, severe rectal bleeding. Left lower quadrant pain is most common. Diverticulitis may cause chills and fever. It may lead to more serious complications, such as perforation, abscesses, or fistula formation that may require hospitalization and surgery.
Diagnosis
- CT scan of the abdomen and pelvis to evaluate the affected colon
- Colonoscopy – After clearing out the large intestine by having the patient drink a liquid that causes diarrhea, and while under light anesthesia, your doctor will insert a flexible tube into the rectum with a camera on its tip so he or she can see inside the colon.
Treatment Options
Diverticulosis and diverticular disease is usually treated by changes in diet and occasionally with medications to help control pain, cramps, and changes in bowel habits. More serious cases may be managed with hospitalization, oral or intravenous antibiotics, dietary restrictions, and stool softeners. Surgery may be required for patients with frequent episodes, complications, or severe attacks when there is little or no response to medication.
Dysphagia
Dysphagia means having difficulty swallowing. Some people may be completely unable to swallow or may have trouble safely swallowing liquids, foods, or saliva. There may also be pain while swallowing (odynophagia).
Diagnosis
- Videofluoroscopic Swallow Study (VFSS) – This is a test where your doctor takes a videotaped X-ray of the entire swallowing process by having you consume several foods or liquids along with liquid barium. It creates a “movie” of your swallowing all the way through the digestive tract.
- Flexible Endoscopic Evaluation of Swallowing with Sensory Testing (FEESST) – This procedure uses a lighted fiberoptic tube, or endoscope, to view the inside of the mouth and throat while examining how the patient’s swallowing mechanism responds to a puff of air, food, or liquid.
- High-Resolution Esophageal Manometry – This measures fluid pressure in the esophagus.
- pH Impedance Test – This is a diagnostic tool that monitors reflux in your esophagus over 24 hours. It uses a device with a small acid-sensitive tip that can determine the acidity of liquid that pushes out of the stomach and how often the liquid comes up.
Treatment Options
- Botox Injection
- Esophageal Dilation – This procedure allows a doctor to stretch (or dilate) the esophagus. A special scope stretches the esophagus to ease discomfort. It is minimally invasive and does not require incisions or stitches.
- Medical management with drugs
Eosinophilic Esophagitis
Eosinophilic esophagitis, or EoE, is an allergy or immune disorder that occurs when large numbers of white blood cells called eosinophils are found in the inner lining of the esophagus. These white blood cells can release substances into surrounding tissues that causes inflammation. The inflammation causes symptoms like pain, loss of appetite, vomiting, or food getting stuck in the esophagus.
Diagnosis
- Upper Endoscopy (also called EGD (esophagogastroduodenoscopy) – This test lets your doctor look at the inside of your food pipe (esophagus), stomach, and duodenum. It uses a thin, lighted tube, or endoscope, that has a camera at one end. As part of the procedure, the doctor may take a sample of tissue to examine under a microscope. This is called a biopsy. Samples are also checked for certain types of bacteria.
Treatment Options
- Esophageal Dilation – During this procedure your doctor uses a special scope to stretch (or dilate) the esophagus. It is minimally invasive and does not require incisions or stitches.
- Medical management with drugs
- Changes in diet
Esophageal Spasms
Esophageal spasms are contractions within your food pipe. These spasms may last from a few minutes to a few hours, and often occur suddenly. They are sometimes mistaken for chest pain.
Diagnosis
- Testing for food allergies
- High-Resolution Esophageal Manometry – This test measures fluid pressure in the esophagus.
- pH Impedance Test – This is a diagnostic tool that monitors reflux in your esophagus over 24 hours. It uses a device with a small acid-sensitive tip that can determine the acidity of liquid that pushes out of the stomach and how often the liquid comes up.
Treatment Options
- Dietary Changes
- Medical management using steroids and proton pump inhibitors.
Familial Adenomatous Polyposis
Familial polyposis is an inherited condition that affects the large intestine (colon and rectum). People with familial adenomatous polyposis can develop hundreds of polyps on the inner lining their colon and rectum, and eventually, these polyps can become cancerous if they’re not removed. As the name implies, familial adenomatous polyposis is an inherited disease that runs in families.
The polyps associated with this condition commonly develop just after puberty, and 90% of people with the condition will have detectable polyps by age 25. By age 35 to 40, some of the polyps will likely already become cancerous.
Many individuals have no symptoms. Others experience diarrhea, constipation, abdominal cramps, bloody stool, or weight loss.
Diagnosis
- Colonoscopy – After clearing out the large intestine by having the patient drink a liquid that causes diarrhea, and while under light anesthesia, your doctor will insert a flexible tube into the rectum with a camera on its tip so he or she can see inside the colon.
Treatment Options
The only definitive treatment for familial polyposis is the surgical removal of the large intestine. Since the goal is to prevent cancer, the operation is done as soon as polyps are discovered. There are several types of surgery to treat this condition.
Fecal Incontinence
Gas or stool incontinence means someone cannot control their bowel contents, so stool and gas can leak out suddenly without warning. Causes include diminished muscle strength with age, nerve or tissue injury that occurs to a woman during childbirth, trauma, or infections around the anal area.
Diagnosis
- Ano-rectal Manometry – This test measures how well the rectum and anal sphincters work together to eliminate stool (feces).
- MR Defecography Magnetic Resonance (MR) – This noninvasive test uses magnetic resonance imaging to obtain images at various stages of defecation to evaluate how well the pelvic muscles are working and provide insight into rectal function. It is used to help determine the cause of fecal incontinence and constipation.
Treatment Options
- Bulking Medications
- Dietary Changes
- Electrical Biofeedback – This may be used to help patients to sense when stool is ready to be expelled.
- Exercises (to strengthen the anal muscles)
- Surgery – This may include sphincter repair or reconstruction.
Gastroesophageal Reflux Disease (GERD)
Gastroesophageal reflux disease (GERD) is considered a functional bowel disorder, or FBD. It happens when acid from the stomach flows backwards into the esophagus, irritating the esophageal lining. Symptoms include heartburn or burning in the chest, regurgitation (bringing food back up), chest pain, nausea after eating, a sour taste in your mouth, and difficulty swallowing. Most symptoms of GERD can be managed with lifestyle changes and medication. However, surgery to wrap the upper portion of the stomach around the esophagus (fundoplication) can strengthen the valve between the esophagus and stomach, preventing reflux of gastric acid.
Diagnosis
- Esophagram – This is a test where your doctor takes a videotaped X-ray of the entire swallowing process by having you consume liquid barium. It creates a “movie” of your swallowing all the way through the esophagus and stomach to determine the cause and amount of gastroesophageal reflux
- Upper Endoscopy – A camera is placed on the tip of a tube that is inserted into the esophagus, into the stomach, and into the small bowel to take pictures and to allow your doctor to take out tissue samples or biopsies.
Treatment Options
- Lifestyle and Diet Modifications
- Antacids – These provide quick relief by neutralizing stomach acids.
- Proton Pump Inhibitors, which are stronger acid blockers that also help heal damaged esophagus tissue.
- H-2 Receptor Blockers – These decrease acid production.
- Laparoscopic Antireflux Surgery – This is a minimally invasive procedure that fixes your acid reflux by creating a new valve at the bottom of your esophagus. The surgeon wraps the upper part of the stomach (the fundus) around the lower portion of the esophagus. This strengthens the esophogeal sphincter to prevent acid and food from flowing back into the esophagus.
- Magnetic sphincter augmentation or LINX Device Implantation – This is a ring of tiny magnets that are strong enough to keep the junction between the stomach and esophagus closed to refluxing acid but weak enough to allow food to pass through.
- Medical Treatment
Gastroparesis
This occurs when food stays in the stomach too long before emptying into the small intestine. The symptoms of gastroparesis may include feeling full shortly after starting a meal, feeling full long after eating a meal, nausea, and vomiting. Diabetes is the most commonly known cause of gastroparesis.
Diagnosis
- Gastric Emptying Study – This is done by ingesting a special sandwich and being imaged immediately, every 10 min for one hour, and then at two, three, and four hours. The amount of food that stays in the stomach is calculated for each interval.
Treatment Options
- Medical Management
Heliobacter Pylori (H. Pylori) Infection
H. Pylori is a type of bacteria that infects your stomach. It can damage the tissue in your stomach and the first part of your small intestine (the duodenum). This can cause redness and pain from inflammation. It can also cause painful sores called peptic ulcers in your upper digestive tract. People can feel pain, bloating, and nausea. People with H. pylori may also burp a lot.
Diagnosis
- Urea Breath Test – This test checks if there is any carbon after you swallow a urea pill that contains carbon molecules. If H.pylori is present in the stomach, it will break down the test solution, and radiolabeled carbon dioxide (13C) will be released into your breath.
- Upper Endoscopy – A camera is placed on the tip of a tube that is inserted into the esophagus, into the stomach, and into the small bowel to take pictures and to allow your doctor to take out tissue samples or biopsies.
Treatment Options
- Medical Treatment, such as antibiotics and acid reducers
Hemorrhoids
Hemorrhoids are enlarged, bulging blood vessels in and around the anus and lower rectum. External hemorrhoids develop near the anus and are covered by very sensitive skin. Painful swelling may occur if a blood clot forms in one. An external hemorrhoid feels like a hard, sensitive lump and bleeds only if it ruptures. Internal hemorrhoids develop within the anus beneath the lining. The most common symptom is painless bleeding and protrusion during bowel movements. However, pain may occur if the hemorrhoid protrudes from the anal opening and cannot be pushed back inside.
Diagnosis
- Evaluation by one of our expert physicians
- Colonoscopy – After clearing out the large intestine by having the patient drink a liquid that causes diarrhea, and while under light anesthesia, your doctor will insert a flexible tube into the rectum with a camera on its tip so her or she can see inside the colon.
Treatment Options
- Treatment of mild hemorrhoids may include increasing the amount of fiber and fluids in a patient’s diet. Eliminating excessive straining may help, and sitting in plain, warm water for about 10 minutes may bring some relief.
- Banding of Hemorrhoids – Banding of hemorrhoids is accomplished by tying off the base of the hemorrhoid with a suture so the hemorrhoid dies and falls off.
Hiatal Hernia
A hiatal hernia occurs when a portion of the stomach pushes upward through the hole in the diaphragm that’s supposed to only allow for the esophagus to pass through. Instead, the stomach pushes through this opening.
Diagnosis
- Esophagram – This is a series of X-ray pictures of the esophagus, which are taken after the patient drinks a liquid with barium sulfate.
- Upper Endoscopy – A camera is placed on the tip of a tube that is inserted into the esophagus, into the stomach, and into the small bowel to take pictures and to allow your doctor to take out tissue samples or biopsies.
Treatment Options
- Lifestyle and Diet Modifications
- Medical Treatment with antacids, Prilosec, Zegerid, Nexium, Protonix, AcipHex, Dexilant.
- Laparoscopic and Robotic Hiatal Hernia Repairs – All hernias classified as types II through IV should be repaired. A minimally invasive laparoscopic approach can repair them.
Irritable Bowel Syndrome (IBS)
Irritable bowel syndrome (IBS) is a condition where patients have frequent or infrequent bowel movements and abdominal pain. They can have diarrhea, constipation, or a combination of both. The symptoms are erratic and include abdominal pain, bloating, and gas. IBS is different from IBD or inflammatory bowel disease (Crohn’s and Ulcerative Colitis) in that there is no underlying inflammation, ulcers, rectal bleeding, or scarring.
It tends to begin in adolescence and is often related to stress, your gut microbiome, food choices, hormones, and exposure to antibiotics, all of which can disturb the gut microbiome. Other symptoms include clear or white mucus with bowel movements, indigestion or heartburn, nausea, vomiting, and stress-related symptoms.
Diagnosis
- Colonoscopy to rule out inflammatory bowel disease, colon or rectal cancer, or some other more serious condition. After clearing out the large intestine by having the patient drink a liquid that causes diarrhea, and while under light anesthesia, your doctor will insert a flexible tube into the rectum with a camera on its tip so her or she can see inside the colon.
- Upper Endoscopy – A camera is placed on the tip of a tube that is inserted into the esophagus, into the stomach, and into the small bowel to take pictures and to allow your doctor to take out tissue samples or biopsies.
Treatment Options
- Lifestyle and Diet Modifications
- Supplements – These include probiotics, anti-diarrheal medications, anti-constipation medicine, and fiber supplements.
Mesenteric Panniculitis
Mesenteric panniculitis is also known as sclerosing mesenteritis. It is a rare disease of the fatty (adipose) tissue of the mesentery, which is the connective tissue that attaches the small and large intestines to the abdominal walls. During mesenteric panniculitis, there is fat degeneration and necrosis (death), chronic inflammation, and at times, scarring of fatty tissue within the mesentery. This inflammation can progress and is thought to be an autoimmune disorder, which is when the body attacks its own tissues/organs.
Symptoms include abdominal pain, nausea, vomiting, bloating, feeling full early at meals, loss of appetite, and diarrhea or constipation. Systemic symptoms such as fatigue are common.
Diagnosis
- A computerized tomogram (CT) or other imaging of the abdomen shows thickening of the mesentery, sometimes with lymph node enlargement. CT scans are a series of X-ray images taken from different angles around your body that uses computer processing to create cross-sectional images (slices) of the bones, blood vessels, and soft tissues inside your body.
- Tissue Biopsy – A biopsy is a sample of tissue taken from the body which is then examined under a microscope.
Treatment Options
- Medicine – This is used to bring down inflammation in the body. The most commonly prescribed medication is a corticosteroid.
Microscopic Colitis
Microscopic colitis is a type of chronic inflammatory bowel disease (IBD) in which there are increased reactions of the immune system that cause inflammation of the inner lining of your colon. Causes include genetics and an overactive immune response, as well as smoking and certain medications. The primary symptom is chronic diarrhea.
Diagnosis
- Colonoscopy – After clearing out the large intestine by having the patient drink a liquid that causes diarrhea, and while under light anesthesia, your doctor will insert a flexible tube into the rectum with a camera on its tip so her or she can see inside the colon.
Treatment Options
- Lifestyle Modifications – Modifications may include dietary changes and the addition of fiber to your diet.
- Medical Management – This will help control diarrhea and can assist in smoking cessation.
- Minimally Invasive Laparoscopic and/or Robotic Colon Resections – During a colon resection, your doctor removes the diseased portion of colon. A surgeon will then sew the healthy ends of the colon back together.
Pancreatic Cancer
There is a 1 in 67 chance of developing pancreatic cancer. It is more common in obese people with a history of diabetes mellitus and among smokers. Alcohol use is implicated if there are other risk factors, along with genetics. Because patients with pancreatic cancer rarely have symptoms until the disease has advanced, it oftentimes has a poor prognosis. Once pancreatic cancer has advanced, symptoms include anorexia, weight loss, nausea, vomiting, and pain under the ribs that radiates to the back.
Diagnosis
- Computed Tomography (CT) – CT is a series of X-ray images taken from different angles around your body that uses computer processing to create cross-sectional images (slices) of the bones, blood vessels, and soft tissues inside your body.
- Magnetic Resonance Imaging (MRI) – An MRI is an imaging technique that uses a magnetic field and computer-generated radio waves to create detailed images of the organs and tissues in your body. It is made of magnets that cause the magnetic field to realign with the water molecules in our body and produce radio waves to produce faint signals that create 3D cross-sectional images like slices of bread.
- Positron Emission Tomography (PET) – A PET uses a radioactive drug (tracer) to show rapidly metabolizing cells in your body, like cancer cells that grow and divide more rapidly than normal cells. On a PET scan, these areas show up as bright spots. This scan can sometimes detect disease before it shows up on other tests.
- Transcutaneous Ultrasonography (TUS) – This imaging is similar to endoscopic imaging, except that the probe is placed on the outside of the body.
- Endoscopic Retrograde Cholangiopancreatography (ERCP) – This is a procedure to diagnose and treat problems in the liver, gallbladder, bile ducts, and pancreas. It uses X-ray and an endoscope, a long, flexible, lighted tube. The scope goes through your mouth and throat, down the esophagus, stomach, and the first part of the small intestine. Then a tube is passed through the scope and your doctor injects a dye that shows up on the X-ray.
- Endoscopic Ultrasound (EUS) – This uses high frequency sound waves to evaluate the gastrointestinal tract and lungs by inserting a tube down the esophagus and the stomach, into the small bowel, or into the brachial tubes for the lungs.
- Biopsy – We collect tissue samples that can be checked for abnormal cells in a pancreatic mass.
Treatment Options
- Surgical and Oncology Referral – Our surgical approach can be tailored to the tumor’s location, size, and locally invasive characteristics. Curative resection options include pancreaticoduodenectomy, with or without sparing the pancreas; total pancreatectomy; and distal pancreatectomy. We perform many of these procedures, both robotically and laparoscopically, allowing the patient to recover more quickly.
Pancreatic Cysts
Pancreatic cysts are fluid-filled, saclike pockets on or in your pancreas. Pancreatic cysts are typically found during imaging testing for another problem. They are divided into two groups: benign and cancerous. Symptoms include weight loss, midabdominal pain, feeling full, and nausea. Pancreatitis and gallstones are common causes.
Diagnosis
- Computed Tomography (CT) – CT is a series of X-ray images taken from different angles around your body that uses computer processing to create cross-sectional images (slices) of the bones, blood vessels, and soft tissues inside your body.
- Magnetic Resonance Cholangiopancreatography (MRCP) -MRCP is considered the imaging test of choice for monitoring a pancreatic cyst. It is especially helpful for evaluating cysts in the pancreatic duct.
- Magnetic Resonance Imaging (MRI) – These scans are good for soft tissue masses and organ masses. This imaging technique uses a magnetic field and computer-generated radio waves to create detailed images of the organs and tissues in your body. It is made of magnets that cause the magnetic field to realign with the water molecules in our body and produces radio waves to produce faint signals that create 3D cross-sectional images like slices of bread.
- Endoscopic Retrograde Cholangiopancreatography (ERCP) – This is a procedure to diagnose and treat problems in the liver, gallbladder, bile ducts, and pancreas. It uses X-ray and an endoscope, a long, flexible, lighted tube. The scope goes through your mouth and throat, down the esophagus, stomach, and the first part of the small intestine. Then a tube is passed through the scope and your doctor injects a dye that shows up on the X-ray.
Treatment Options
- Drainage – Sometimes, a cyst can be drained. A flexible tube, or endoscope, will be passed through the mouth to the stomach and small intestine. The endoscope has a special needle that can drain the cyst. Other times, the cyst needs to be drained through the skin.
- Surgery – Some pancreatic cysts need to be surgically removed. This is done robotically or laparoscopically.
Pancreatic Neuroendocrine Tumors
Pancreatic neuroendocrine tumors start in neuroendocrine cells, a special kind of cell found in the pancreas. Neuroendocrine cells are also found in other areas of the body. Neuroendocrine cells (sometimes just called endocrine cells) in the pancreas are found in small clusters known as islets. These islets make essential hormones like insulin and glucagon (which help control blood sugar levels) and release them directly into the blood.
Diagnosis
- Computed Tomography (CT) – This is a series of X-ray images taken from different angles around your body. Computer processing is used to create cross-sectional images (slices) of the bones, blood vessels, and soft tissues inside your body.
- Endoscopic Retrograde Cholangiopancreatography (ERCP) – This is performed with an endoscope, a thin, flexible tube with a tiny video camera on the end. It is passed down the throat, through the esophagus and stomach, and into the first part of the small intestine.
- Endoscopic Ultrasound (EUS) – This uses high frequency sound waves to evaluate the gastrointestinal tract and lungs by inserting a tube down the esophagus and the stomach, into the small bowel or into the brachial tubes for lungs.
- Magnetic Resonance Imaging (MRI) – This is good for soft tissue masses and organ masses; it is an imaging technique that uses a magnetic field and computer-generated radio waves to create detailed images of the organs and tissues in your body. It is made of magnets that causes the magnetic field to realign with the water molecules in our body and produces radio waves to produce faint signals that create 3D cross-sectional images like slices of bread.
Treatment Options
- Surgery – Some surgery can remove the tail of the pancreas, which leaves the head portion of the pancreas. When the tumors are located in the head of the pancreas, more of the pancreas may need to be removed.
- Chemotherapy – This uses chemicals to kill cancer cells.
- Targeted Therapy – Targeted therapy employs medications, which can treat recurrent or advanced pancreatic neuroendocrine tumors.
Peptic Ulcer Disease
Peptic ulcer disease can involve the stomach or duodenum and causes sores inside the GI tract. Ulcers can cause a gnawing or burning sensation that happens after meals. They can also cause bleeding, anemia, feeling full quickly, unexplained weight loss, progressive difficulty eating or pain in the mouth or esophagus when trying to swallow, and vomiting.
Diagnosis
- Upper Endoscopy – A camera is placed on the tip of a tube that is inserted into the esophagus, into the stomach, and into the small bowel to take pictures and to allow your doctor to take out tissue samples or biopsies.
Treatment Options
- Lifestyle and diet modifications
- Medical Treatment – Sometimes, our physicians recommend proton pump inhibitors, as well as antibiotics if there is an H. Pylori infection.
- Minimally Invasive Surgical Procedures – These can help with peptic ulcer disease, especially if there is acute bleeding.
Pouchitis
Pouchitis occurs only in patients who have had surgery to remove the entire large intestine and rectum. These patients sometimes have an ileal pouch-anal anastomosis (connection), which is a pouch created to store stool since they no longer have a rectum. Pouchitis happens when this pouch becomes inflamed or irritated.
Diagnosis
- Endoscopy or Pouchoscopy (endoscopy of the pouch) – This is used to determine how widespread the patient’s inflammation is, and whether or not the ileum is irritated. It will also show if there is inflammation of the anal connection zone to the ileum.
Treatment Options
- Antibiotics
- Bismuth Enemas – This is used to stimulate stool evacuation.
- Medication, including an anti-parasitic drug, tinidazole.
Ulcerative Colitis
Ulcerative colitis is a type of inflammatory bowel disease that affects the large bowel lining or colon. Symptoms include rectal bleeding, diarrhea, abdominal cramps, weight loss, and fever. Patients who have had severe ulcerative colitis for many years are at an increased risk of developing colon cancer.
Diagnosis
- Colonoscopy – After clearing out the large intestine by having the patient drink a liquid that causes diarrhea, and while under light anesthesia, your doctor will insert a flexible tube into the rectum with a camera on its tip so he or she can see inside the colon.
- Wireless Capsule Endoscopy – This is a procedure where you swallow a capsule that contains a tiny camera that takes thousands of digital pictures. It is then retrieved in the stool so the images can be uploaded into pictures.
Treatment Options
- Medications
- Immunosuppressive Medications – These are drugs that slow down your immune system to stop the inflammation that is causing the colon and rectum to swell.
- Biologics – Like immunosuppressive medications, biologics target the immune system by acting on specific immune system proteins that encourage inflammation.
- Surgery, which may require the removal of your entire colon and rectum.
Our Physicians
Kfir Ben-David, MD
Roni Jacobson Endowed Chairman of Surgery
Program Director, General Surgery Residency
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- Mount Sinai Medical Center (Main Campus)
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- Gastroenterology
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Jonathan Nachman Mazurek, MD
- Gastroenterology
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