Gastroenterology:
Keeping Digestion Running Smoothly

APPOINTMENTS FOR ENDOSCOPY PROCEDURES are usually arranged through your primary care doctor or gastroenterologist. For general questions, call Holland Hospital Endoscopy at (616) 394-3422.

Unless you study medical science or have had a problem with your digestive system, you might not be aware of the medical specialty gastroenterology. However, chances are you or a loved one has benefited from the expertise of a specialist in this field: Annually, 60 million to 70 million Americans are affected by digestive diseases.

Gastroenterology involves the function and diseases of all the organs and systems of the digestive system, including the esophagus, stomach, small intestine, colon, rectum, pancreas, gallbladder, bile ducts and liver.

"Like almost all bodily functions, we take our digestive tract for granted until something isn't working properly," says Dr. Dozeman, a gastroenterologist at Holland Hospital. "From swallowing problems at the beginning to difficulties with elimination at the other end, digestive tract problems are common. We use a variety of diagnostic tools to help understand the causes of symptoms and guide treatments to prevent the development of more serious complications."

An important tool for diagnosing and treating gastrointestinal conditions is endoscopy, which involves the use of a flexible, lighted tube fitted with a miniature video camera to visually examine the inside of the intestinal tract. The endoscope is connected to a television monitor that the doctor watches while performing the test, and various miniaturized tools can be inserted through the scope to obtain biopsies or conduct other maneuvers.

"Most endoscopy exams take about 30 minutes and are performed on an outpatient basis," says Mary Ratliff, manager of endoscopy at Holland Hospital. An increase in patients – numbering about 500 this year – led to the addition of a new endoscopy procedure room in January 2007, bringing the total to three. A team of 18 RNs and LPNs staff the department.

Two of the most common reasons for performing an endoscopy are for diagnosis of GERD, or acid reflux disease, and screening for colorectal cancer. The latter, called a colonoscopy, is a simple but important procedure that could save your life.

GERD
GERD is short for gastroesophageal reflux disease, also known as acid reflux, indigestion or heartburn. It refers to the backward flow of acid from the stomach up into the esophagus, causing a burning feeling in the chest or throat and, in some people, a sour taste.

In many cases, GERD can be controlled by modifications in lifestyle – for example, losing weight and avoiding caffeine, alcohol and spicy or greasy foods – and over-the-counter antacids. People should see a doctor if those treatments are not effective and acid reflux becomes a daily or weekly problem.

Treatment of GERD begins with an accurate diagnosis. The doctor may recommend an endoscopy to examine the lining of the esophagus for inflammation, cellular changes or ulcers. But the only surefire way to determine if a patient has GERD is to test the pH levels in the esophagus. For this, Holland Hospital uses the Bravo pH monitoring system, in which a recording capsule the size of a pill is attached to the esophagus wall. For two days, the capsule sends information about reflux occurrences to a pager-sized receiver worn by the patient. The patient then brings this information to the hospital, and it is downloaded to a software program for analysis. (The capsule soon falls off the esophagus and passes out of the body through the digestive system.)

If tests confirm that a patient has GERD, treatment options include medication and surgery.

"Over 90 percent of patients do very well with medicine and some lifestyle changes," says Dr. Dozeman. But a lifelong dependency on medication can be costly and inconvenient, so in some cases, surgery may be performed to enhance the function of the sphincter muscle that acts as a gate between the stomach and esophagus.

Doctors warn that if acid reflux is left untreated, the continued acid exposure can damage the lining of the esophagus and lead to serious diseases such as esophageal cancer.

"Acid reflux is not a benign disease, although most people treat it as just that," says Daniel Peshka, DO, gastroenterologist with Michigan Medical PC. "It's important that if you have symptoms, you take them seriously and get professional medical help."

Colorectal cancer
Colorectal cancer – cancer of the colon and rectum – is the second most common cancer killer in the United States. However, it is also one of the most preventable. Most colon cancers arise from polyps – abnormal growths on the wall of the colon that may become cancerous over time. If identified at a very early stage, polyps can be removed before they become cancerous.

A recent study in the New England Journal of Medicine stated that more than 90 percent of deaths from colorectal cancer could be avoided through early detection – accomplished with the simple step of regular screening.

Doctors strongly suggest that all men and women, beginning at age 50, follow screening guidelines recommended by the American Cancer Society. These include:

• An annual fecal occult blood test, which checks for microscopic traces of blood in the stool.
• A flexible sigmoidoscopy once every three to five years to detect colorectal cancer at its earliest and most treatable stage. (The sigmoid colon is the section of colon just above the rectum.)
• A colonoscopy every 10 years, or more often depending on results from other tests. An annual colonoscopy is recommended for patients of any age with a family history of colorectal cancer, or who have a predisposing chronic digestive condition such as inflammatory bowel disease.

For a colonoscopy, the doctor threads a flexible, lighted fiberscope through the rectum and colon to examine the upper portion of the colon. If polyps or small growths are found, they can be removed during the procedure.

A colonoscopy can save a life and is easier than many people think, says Ratliff. "Patients are mildly sedated to keep them comfortable and pain-free, and the actual procedure takes only about a half hour. Most patients are in and out of the hospital within two hours."

Holland Hospital gastroenterologists diagnose and treat a variety of gastrointestinal problems. Some common ones:

Celiac disease – An intolerance to the protein gluten, found in wheat, rye, barley and oats; eating these substances can damage the intestines and result in nutritional deficiencies.

Diverticulitis – Inflammation of a diverticulum, or sac, in the intestinal tract, especially in the colon.

Gallstones – Stones that form in the gallbladder, usually from excess cholesterol.

Hemorrhoids – Veins in the anal canal that become swollen or stretched, resulting in itching and burning.

Inflammatory bowel disease (includes Crohn's disease) – Inflammation of the colon or intestine resulting in bleeding, fever, elevation of white blood cell count, diarrhea and abdominal pain.

Irritable bowel syndrome (IBS) – One of the most common gastrointestinal disorders, characterized by abnormal function of the intestine from unknown causes and resulting in bouts of abdominal pain and constipation or diarrhea.

Ulcers – An area of the stomach or duodenum (upper part of the small intestine) that has been destroyed by digestive juices and stomach acid.

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