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The Institute for Digestive Health & Liver Disease at Mercy: Clinical Conditions and Program Offerings
Renowned medical expertise, unparalleled technology, and Mercy’s mission to provide compassionate and quality care make The Institute for Digestive Health & Liver Disease at Mercy the leading center of its kind in the region.
The Institute for Digestive Health & Liver Disease at Mercy provides world-class expertise in the diagnoses and treatment for:
The Institute for Digestive Health & Liver Disease at Mercy provides comprehensive, state-of-the-art treatment, including:
Biliary Tract Disease
Cholangiocarcinoma (Bile Duct Cancer)
Cholangiocarcinoma is a rare form of cancer that affects the tissue in the bile ducts, which carry bile from the liver to the small intestine. Symptoms, including jaundice and discolored stools, occur when the tumor blocks the bile duct, prohibiting the bile to freely flow. Bile duct cancer is slow growing, so once symptoms appear and a diagnosis is made, the tumor may be too advanced for surgery. When surgery is not an option, other treatments are available, including radiation therapy, chemotherapy, photodynamic therapy, and biliary drainage with palliative endoscopically placed biliary stents to improve quality of life.
Gallstone Disease
Gallstones, the most common form of gallbladder disease, are small, pebble-like substances that form in the gallbladder. If these stones escape the gallbladder, they can lodge in the bile ducts leading from the gallbladder, liver, or pancreas to the small intestine. Discomfort to severe pain after eating may occur because the stones block the flow of bile, an important watery liquid used for food digestion. Additional symptoms include chronic indigestion, upper abdominal pain, nausea and vomiting, and fever. Gallbladder removal and endoscopic removal of retained bile stones are the preferred treatment for those with symptomatic gallstones.
Sphincter of Oddi Dysfunction
The sphincter of oddi, which is located in the upper part of the intestine where the pancreatic and bile ducts enter, is a one way valve that allows the pancreatic and bile secretions to enter the bowel as well as prevents the bowel contents from backing up into the ducts. When the sphincter of oddi malfunctions, the pancreatic and bile ducts do not drain adequately. The result is pressure in the ducts resulting in pancreatitis or biliary pain.
Colon Rectal Disease
Collagenous and Lymphocytic Colitis
Collagenous colitis and lymphocytic colitis are inflammatory conditions of the colon characterized primarily by chronic watery, non-bloody diarrhea as well as abdominal pain or cramps. Diagnosed by microscopic examination of several tissue samples taken from the large intestine lining, collagenous colitis has a larger-than-normal protein band, called collegen, inside the colon lining whereas lymphocytic colitis has an increase in white blood cells, known as lymphocytes, between the cells lining the colon. These conditions may result from an autoimmune response, in which the immune system damages healthy cells for no known reason. Treatment can include dietary changes, followed by medication. If those treatments do not relieve symptoms, surgery may be recommended to remove the inflamed portions of the colon, although this approach is rarely needed.
Crohn’s Disease
Crohn’s disease causes inflammation of the digestive tract. Its symptoms mirror other digestive tract disorders with pain and frequent diarrhea. This ongoing disorder can affect any part of the digestive tract, but most commonly affects the lower part of the small intestine and the colon. Swelling occurs deep in the intestine’s lining, rather than just the inner lining, causing the intestine wall to thicken and block the flow of digestion, which can affect appetite and ability to digest and absorb food. Although it is not known what causes the disease, it is thought that an abnormal response in the immune system and heredity may be factors.
Ulcerative Colitis
Ulcerative colitis, a chronic inflammation of the large intestine, causes ulcers in the lining of the colon and rectum. Symptoms include abdominal pain and bloody diarrhea. The difference between ulcerative colitis and Crohn’s disease is with ulcerative colitis the inflammation occurs in continuous stretches of the colon and is often on the outside layers as opposed to Crohn’s disease in which inflammation occurs in various patches throughout the colon and proceeds deep into the colon wall. It is believed an abnormal activation of the immune system can cause ulcerative colitis. Emotional stress or sensitivity to certain foods are not believed to be causes of the disease, but may trigger symptoms.
Inflammatory Bowel Disease
Inflammatory bowel disease incorporates disorders that cause inflammation of the intestines. This chronic inflammatory disease of the gastrointestinal tract is thought to be caused by an abnormal function of the immune system, which reacts against the body’s own intestinal tissue. Stress and diet do not cause inflammatory bowel disease, but can affect the symptoms. The major forms of inflammatory bowel disease include ulcerative colitis and Crohn’s disease.
Irritable Bowel Syndrome
Irritable bowel syndrome is a disorder in which the bowel does not function properly. Normally the intestine muscles contract and relax in a coordinated rhythm to move food through the digestive system. With IBS the contractions may be stronger or last longer either forcing food through the system more quickly causing gas, bloating, and diarrhea or slowing the food passage causing constipation. IBS does not cause inflammation or changes in the bowel tissue and does not cause permanent harm to the intestines. People experiencing abdominal pain lasting at least 12 weeks, but not necessarily consecutively, should see a physician to determine if they have IBS. Found more in women than men, people can experience constipation, diarrhea, pain, or a combination of all three. Bloating is also commonly experienced.
Hereditary Colorectal Cancer
Hereditary colorectal cancer is passed between generations through an inherited mutated gene that causes cancer to develop at an early age. Although the majority of colorectal cancer cases are not hereditary, a strong family history of colorectal cancer on one side of the family greatly increases the risk of developing colorectal cancer. There are two types of hereditary colorectal cancers: Familial Adenomatous Polyposis (FAP) and Hereditary Nonpolyposis Colorectal Cancer (HNPCC). With FAP there is a virtually 100 percent chance of cancer developing by the early 40s and it produces hundreds to thousand of polyps in the colon. With HNPCC there is an increased lifetime risk of developing colorectal cancer and an increased risk of uterine and other cancers.
Rectal Bleeding
Rectal bleeding is a common anorectal disorder and can be due to a number of causes, including hemorrhoids, rectal fissure (a tear in the rectum lining caused by the passage of hard stools), diverticulosis (diverticula are outpouchings that project from the bowel wall which occur by decreased fiber in the diet), infection (bacterial dysentery), inflammation, angiodysplasia (a vascular problem that involves enlarged veins and capillaries in the wall of the right colon which can become fragile and bleed), tumors and polyps, trauma, and upper gastrointestinal issues (bleeding from the upper intestine).
Hemorrhoids
Hemorrhoids are a condition in which the veins surrounding the anus or lower rectum are swollen and inflamed. Hemorrhoids, which can be internal or external, can occur due to a number of reasons, including straining to move stool, pregnancy, aging, chronic constipation, or diarrhea. Symptoms of hemorrhoids can include pain and pressure in the anal canal, grapelike lumps on the anus, itching and soreness in or around the anus, and blood on underwear or toilet paper. There are treatment options to relieve pain and symptoms, if they fail to work; there are minimally invasive surgical techniques that can be used.
Colon/Rectal Cancer
Colon and rectal cancers are the second leading cause of cancer death in the United States and claims more lives than either breast or prostate cancer. Approximately 130,000 new cases were diagnosed in 2000, nearly 3,000 in Maryland. Men and women are almost equally affected. African Americans and Hispanics are at higher risk and are more likely to be diagnosed when the disease is at a more advanced stage. Cancer of the rectum is a highly treatable and often curable disease when localized. Surgery is the primary treatment and results in cure in nearly half of all patients.
Colon and rectum cancers typically develop slowly over several years. Most of these cancers begin as a polyp – a growth of tissue into the center of the colon or rectum. A type of polyp known as adenoma can become cancerous. Removing the polyp early may prevent it from becoming cancer. Over 95% of colon and rectal cancers are adenocarcinomas, cancers of the cells lining the inside of the colon and rectum.
Fecal/Stool Incontinence
Fecal/stool incontinence is the inability to control the passage of gas or stool (feces) through the anus. Also known as bowel incontinence, it may occur at any age but is most common among people over the age of 65.
Colon Polyps
Colon polyps are growths in the large intestine. The cause of most polyps is unknown but occurs commonly in adults. Most are not cancers, although some can turn into cancer. There are generally no symptoms associated with colon polyps and are usually found during routine colon cancer screenings. Most can be easily removed by a physician or in rare cases a surgeon.
Esophageal Disorders
Heartburn
Heartburn is an irritation of the esophagus that is caused by stomach acid. A muscular valve called the lower esophageal sphincter, keeps stomach acid in the stomach. Normally it opens to allow food into the stomach then closes again. But if it opens too often or doesn’t close tightly enough, stomach acid can seep or reflux into the esophagus and cause a burning sensation. Chronic heartburn can indicate serious problems and can develop into gastroesophageal reflux disease (GERD).
Barrett’s Esophagus
Barrett’s esophagus is an uncommon condition in which the consistency of the esophagus’ lining changes. Normally, the esophagus contains flat cells. However, if these cells become damaged, the cells that lie deep in the lining have the potential, during the healing process, to transform themselves into different shapes and take on different functions. These cells often become cube shaped, the same type found in the intestines. The main cause of Barrett’s esophagus is chronic acid reflux, the same factor that causes GERD (gastroesophageal reflux disease). Screening for Barrett’s esophagus in patients with chronic heartburn, and routine surveillance, are recommended because Barrett’s esophagus is a risk factor for the development of esophageal cancer. To properly diagnose Barrett’s esophagus, an upper GI endoscopy must be performed followed by a biopsy of the esophagus. Screening for Barrett’s esophagus in patients with chronic heartburn is recommended due to the increased lifetime risk of esophageal cancer.
Esophageal Cancer
Esophageal cancer can occur anywhere on the esophagus, the tube that connects the throat to the stomach, and affects the inner layers first. The cells of the esophagus begin to grow abnormally, which can eventually form a tumor, due to various factors including heavy alcohol and tobacco use, chronic acid reflux, diet low in fruits and vegetables, obesity, and rare medical conditions. Although symptoms often are not present until late in the disease process, common symptoms include trouble swallowing and a sensation of food being caught in the throat or chest.
Gastroesophageal Reflux Disease
Gastroesophageal reflux disease (GERD) is a chronic, often life-long, condition in which the stomach’s liquid contents back up into the esophagus causing inflammation or damage to the esophagus lining. Some GERD, or acid reflux, occurs in most people. However, in people with GERD, more acid is in the refluxed liquid and the liquid remains in the esophagus for a longer period of time. Heartburn is a common symptom of GERD, but other symptoms include regurgitation, difficulty swallowing and nausea. Other symptoms often also occur from GERD, including chronic cough and reflux induced asthma. GERD can be diagnosed using a trial of treatments such as, an endoscopy, biopsies, x-rays, examination of the throat and larynx, as well as various other tests and studies.
Swallowing Disorders and Motility Disorders
Swallowing disorders, or dysphagia, cause swallowing to be difficult or painful. Nervous system disorders, esophageal problems, or head and spinal cord injuries can cause dysphagia, which is classified into two categories depending on the origin of the swallowing difficulty. Oropharyngeal dysphagia begins prior to food reaching the esophagus and often results from neuromuscular disease or obstructions. In this case, dysphagis is treated by focusing on the underlying condition. Esophageal dysphagia originates in the esophagus and can be caused by GERD, esophageal cancer, esophagits or esophageal-motility disorders. Treatment includes medication for GERD, surgery to remove tumors, and stretching of the narrow passages for mobility disorders. To diagnosis swallowing disorders, an endoscopy, barium swallow study, or video swallow study are used.
Chronic Abdominal Pain
Many times the exact cause of chronic abdominal pain is hard to find. The severity and location of the pain, as well as other symptoms may help determine what is causing the pain. Generalized pain occurs in half of the abdomen or more whereas localized pain is confined to one area of the abdomen. Sudden localized pain that worsens could be serious and should be evaluated by a healthcare professional. Chronic abdominal pain can sometimes be related to an inflammatory bowel disease.
Liver Conditions
Alcoholic Liver Disease
Alcoholic liver disease is liver injury attributed to alcohol abuse. Alcohol, which metabolizes in the liver, is the leading cause of liver disease. Excessive consumption of alcohol can lead to acute and chronic liver disease including alcoholic hepatitis, which may respond to medical treatment including steroids, and alcoholic cirrhosis, which is a pre-malignant condition requiring regular screening since it leads to permanent scarring of the liver. Liver damage is generally irreversible and progressively worsens with continued drinking. Symptoms, which vary widely dependent on the stage of the disease, include increased blood pressure, jaundice, nausea, dry retching, diarrhea, and abdominal pain. Early stages of alcoholic liver disease could be managed by abstaining from alcohol. Advanced liver disease may require liver transplantation. Patients with alcoholic liver disease are advised to have preventive vaccination for both hepatitis A & B.
Hepatitis A
Hepatitis A, a liver infection caused by a virus, should not lead to any long-term liver disease. The virus is found in the stool of an infected person and spreads when a person consumes food or drinks that have come in contact with infected stool. After exposure, it can take up to seven weeks to develop symptoms that include loss of appetite, weight loss, fever, stomach pain, sore muscles and feeling tired. Hepatitis A goes away on its own in most cases. Most people are symptom free in a few months. Hepatitis A is prevented by receiving a vaccine in a serious of two shots.
Hepatitis B
Hepatitis B is a virus that infects the liver. Most people get hepatitis B for a short period of time, which is acute hepatitis B. Sometimes the virus causes a long-term infection, called chronic hepatitis B. The virus is spread through contact with the blood and bodily fluids of an infected person. Symptoms may include loss of appetite, weight loss, fever, stomach pain, sore muscles, jaundice, diarrhea or constipation and feeling tired. A simple blood test can detect the virus. Most cases of hepatitis B dissipate without any intervention. Treatment depends on whether the infection is causing liver damage. Currently, there are effective medications for hepatitis B. Most people with chronic hepatitis B live active, normal lives by taking good care of themselves and getting regular checkups including liver cancer surveillance. Sometimes chronic hepatitis B can lead to severe liver damage, which could be prevented with appropriate treatment. In some cases chronic liver disease may require a liver transplant. Hepatitis B is preventable by getting a vaccine in a series of three shots.
Hepatitis C
Hepatitis C, a disease caused by the hepatitis C virus, infects the liver. Over time, it can lead to permanent liver damage as well as cirrhosis, liver cancer, and liver failure. People who have hepatitis C for a short period then get better have acute hepatitis C. Most people already have liver damage by the time they are diagnosed. It is spread by contact with an infected person's blood. Most people have no symptoms when first infected. If symptoms develop they may include joint pain, abdominal pain, itchy skin, sore muscles, dark urine, jaundice, and feeling tired. Hepatitis C can be detected by a simple blood test. If the test is positive for the virus, a liver biopsy may be needed to detect if the virus has caused scarring in the liver. If liver damage is mild medication may not be required. If it is more severe, a treatment plan will be established. There is no vaccine to prevent hepatitis C but there are preventative measures that can be taken. Hepatitis C can lead to cirrhosis especially in those who drink alcohol. Advanced cirrhosis can lead to liver failure and liver cancer. Those who are infected with hepatitis C should consider preventive vaccination for hepatitis A & B. Advanced cirrhosis may require liver transplantation.
Non-alcoholic fatty liver disease (NAFLD)
Non-alcoholic fatty liver disease is one of the most common disorders causing liver enzyme abnormalities. Obesity, hyperlipidemia (high triglycerides and cholesterol) and type II diabetes are important risk factors. It is a spectrum of disease including fatty liver, NASH (non-alcoholic steatohepatitis), fibrosis (scarring) and cirrhosis and can lead to portal hypertension, liver failure, and liver cancer. Appropriate and timely management may reduce the risk. Experimental trails may be available for those with severe disease. People with cirrhosis will require cancer screening while people with NAFLD should consider vaccination for hepatitis A & B.
Hemochromatosis
Hemochromatosis is a disorder that most commonly is inherited and causes the body to absorb too much iron. The excess iron builds up in the blood, liver, heart, pancreas, joints, skin and other organs. It may also develop due to having too many blood transfusions, certain blood disorders, or chronic liver disease. Symptoms, which generally develop between the ages of 40 and 60, include fatigue, joint pain, weakness, excess urination and weight loss. Hemochromatosis is treated by removing excess iron from the blood, either by removing blood from the body or by taking a medication that binds to and removes iron from the body. Hereditary hemochromatosis, which requires treatment throughout a person’s life, is a pre-cancerous condition that requires cancer screening.
Primary Sclerosing Cholangitis
Primary sclerosing cholangitis, a chronic, progressive disease of the liver, causes walls of the bile ducts to become inflamed leading to scarring and hardening. The ducts eventually become narrow, prohibiting the free flow of bile from the liver. When too much bile accumulates in the liver, the bile seeps into the bloodstream damaging and shutting down the liver. Often, primary sclerosing cholangitis is suspected after an abnormality appears in a routine blood test during a routine physical. It is diagnosed through cholangiography, an injection of dye into the bile ducts followed by taking an x-ray or MRCP (magnetic resonance cholangiopancreatography). Symptoms can include itching, fatigue, and jaundice as well as chills and fever. Gallbladder and pancreas ducts may also be involved. This increases the risks for the development of biliary cancer or cirrhosis.
Primary Biliary Cirrhosis
Primary biliary cirrhosis (PBS), which occurs mostly in women, may cause itching, skin hyperpigmentation, musculoskeletal symptoms including arthritis and osteoporosis, and eventually can lead to cirrhosis. Much like other forms of liver disease, PBC permanently damages the liver as tissue is replaced with scar tissue. As more scar tissue develops, the structure and function of the liver are affected. It is diagnosed by blood tests and biopsies. Treatment focuses on reducing symptoms, preventing and treating the complications of the disease, and preventing other conditions that may cause additional liver damage.
Portal Hypertension
Portal hypertension is an increase in the blood pressure within a system of veins called the portal venous system. Veins, coming from the stomach, intestine, spleen and pancreas, merge into the portal vein, branch into smaller vessels, travel through the liver. When there is a blockage of the vessels in the liver, it is difficult for blood to flow, thus causing high pressure in the portal system. When the pressure is too high, the blood flow alternates routes to get around the blockage in the liver. The most common cause of portal hypertension is cirrhosis. Cirrhosis results from scar tissue blocking the flow of blood through the liver. Symptoms may include black stools, vomiting blood, fluid in the abdomen (ascites), confusion or forgetfulness, and a low level of white blood cells. It is generally diagnosed by physical exam of the abdomen and can be confirmed by endoscopic evaluations or imaging (ultrasound, CT or MRI). Portal hypertension can be managed by medications, treatment of underlying disease, endoscopic treatment such variceal banding or glue injection or TIPS (transjugular posrtosystemic shunting). Advanced disease may require liver transplantation.
Hepatocellular Carcinoma
Hepatocellular carcinoma is a malignant tumor of the liver. This tends to occur in livers damaged by birth defects, alcohol abuse, or chronic infection with diseases such as hepatitis B and C, alcohol, hemochromatosis, and cirrhosis. This type of liver cancer can possibly be removed with surgery, radiofrequency ablation (RFA), transarterial chemoembolization (TACE), or liver transplantation. A multidisciplinary team approach is important for the best outcomes as it will decide on the best treatment approach. Clinical trials may be available for advanced cancer.
Pancreas
Pancreatitis
Pancreatitis is a disease in which the pancreas becomes inflamed. There are two types of pancreatitis, acute and chronic. Acute pancreatitis is a sudden inflammation that occurs over a short period of time. In the majority of cases, acute pancreatitis is caused by gallstones or heavy alcohol use. Other causes include medications, infections, trauma, metabolic disorders, and surgery. Chronic pancreatitis occurs most commonly after an episode of acute pancreatitis and is the result of ongoing inflammation of the pancreas. The majority of the chronic cases are due to alcohol. Symptoms include abdominal pain, nausea, vomiting, fever, and increased heart rate. Pancreatitis is diagnosed by symptoms, past medical history, and diagnostic testing. It is treated by relieving patient's pain and improving nutritional and metabolic problems that result from loss of pancreatic function.
Pancreatic Cancer
Pancreatic cancer is a disease in which cancerous cells form in the tissue of the pancreas. Symptoms include pain in the abdomen and back, jaundice, unexplained weight loss, loss of appetite, fatigue, and depression. Facts that increase the risk of pancreatic cancer can include smoking, chronic pancreatitis, a long history of diabetes, and heredity. Pancreatic cancer can be diagnosed by a variety of diagnostic tests. There are various treatments for pancreatic cancer including surgery, chemotherapy, and radiation therapy.
Stomach and Duodenum
Gastric (Stomach) Cancer
Gastric or stomach cancer symptoms do not often occur early in the disease process, making it hard to diagnose early. By the time symptoms appear, the cancer may have spread to other areas. An upper endoscopy and stomach x-rays are preformed to diagnose stomach cancer. Early symptoms may include heartburn, abdominal pain, and microscopic internal bleeding. Additional symptoms include discomfort in the upper and middle abdomen, vomiting blood, weakness, and fatigue, although having these symptoms do not necessarily indicate stomach cancer.
Gastroparesis
Gastroparesis is a condition in which the stomach muscles do not function normally. The stomach muscles regularly contract and propel food through the digestive tract. With gastroparesis, the muscles work poorly preventing the stomach’s ability to empty properly causing nausea or vomiting. Blood sugar levels and nutritional intake can be affected as well. There is not cure to gastroparesis, but an adjustment of eating habits and some medications can help control symptoms. Various tests, including gastric emptying studies, gastroduodenal manometry, upper endoscopy, electrogastrogram, and MRI are used to detect gastroparesis.
Peptic Ulcer Disease
Peptic ulcers are open sores in the lining of the stomach, upper small intestine, or esophagus. Burning pain is the most common symptom. Bacterial infection, including Helicobacter pylori (H. pylori), and some medications can cause ulcers to develop. Regular use of pain relievers, smoking, and excessive alcohol consumption are contributing factors. An upper GI x-ray and endoscopy are used to diagnose ulcers.
Capsule Endoscopy
Capsule endoscopy is a minimally invasive procedure designed to help physicians see what is happening inside the gastrointestinal (GI) tract, which is the tube that extends from the mouth to the anus. It is the movement of muscles along the tract that digests food. A capsule endoscopy can substitute or supplement traditional endoscopy procedures and requires a patient to swallow a vitamin-sized pill that is a small camera. The pill passes smoothly and painlessly through the GI tract as the camera transmits continuous images. This technology is used to diagnose digestive disorders, such as Crohn's disease, celiac disease, ulcerative colitis, and tumors. People experiencing symptoms of chronic abdominal pain, an upset stomach, unexplained weight loss or anemia, may benefit from capsule endoscopy.
Chromoendoscopy
Chromoendoscopy uses nontoxic dyes to identify areas of dysplasia. It provides the ability to visualize mucosa at the cellular level, thus facilitating the diagnosis of abnormal cellular changes and early-stage cancers in the GI tract and biliary tree, the path through which bile is secreted by the liver to its endpoint in the duodenum. Chromoendoscopy reveals otherwise invisible changes of the GI lining, enabling the endoscopist to obtain what would otherwise be an unobtainable directed biopsy. Chromoendoscopy helps diagnose gastroesophageal reflux disease (GERD), esophageal cancer, gastric cancer, inflammatory bowel disease, Crohn’s disease, and ulcerative colitis. It also helps in the diagnosis and evaluation of adenomatous colon polyps and colon cancer.
Colonoscopy
Colonoscopy is an outpatient procedure during which the large bowel (colon and rectum) is examined from the inside with a thin scope that has a light and camera at its tip. Colonoscopies are usually used to evaluate symptoms like abdominal pain, rectal bleeding, or changes in bowel habits. They are also used to screen for colorectal cancer. The procedure takes approximately 30–60 minutes and is performed as an outpatient. A colonoscopy is generally tolerated with minimal discomfort.
Endoscopic Retrograde Cholangiopancreatogram (ERCP)
An endoscopic retrograde cholangiopancreatogram (ERCP) is a procedure that combines the use of a flexible, lighted scope with X-ray pictures to examine the tubes that drain the liver, gallbladder, and pancreas. The scope is passed through the mouth and moved gently down the throat into the esophagus, stomach, and duodenum until it reaches the point where the ducts from the pancreas (pancreatic ducts) and gallbladder (bile ducts) drain into the duodenum. This procedure is useful in the identification of strictures or areas of narrowing, identification and biopsy of suspicious lesions, and gallstones. It also is used for patients with abdominal pain and jaundice. An ERCP takes approximately 30-60 minutes and may involve an admission to the hospital.
Endoscopic Ultrasound (EUS)
An EUS is a procedure that is able to obtain detailed images of the digestive tract and the surrounding tissue and organs beyond the digestive tract walls. It utilizes high frequency ultrasound during endoscopy to evaluate and diagnose both upper and lower digestive tract disorders. For the procedure a small ultrasound transducer is installed on the tip of a scope with a camera at the end. This obtains high-quality ultrasound images of organs. EUS images are often more accurate and detailed than images provided by traditional ultrasound. This procedure is used to detect tumors in the pancreas, stage gastrointestinal cancers, and detect stones in biliary ducts. Fine needle aspiration (FNA) allows for biopsies during the EUS. This procedure takes approximately 1–2 hours.
Esophagogastroduodenoscopy (EGD or endoscopy)
An EGD is an endoscopic procedure that allows direct examination of the esophagus, stomach, and duodenum. Endoscopies use a thin scope with a light and camera at its tip to look inside the upper digestive system. Taking approximately 30–60 minutes, an endoscopy is an outpatient procedure. An upper endoscopy is generally tolerated with minimal discomfort and is used to evaluate abdominal pain, heartburn, persistent nausea or vomiting, swallowing difficulties, upper gastrointestinal bleeding, chest pain in the absence of heart disease, or bloody stools. It may also be used for periodic screening or surveillance. Lower endoscopies are used to diagnose bleeding, polyps, hemorrhoids, diverticulosis, and angiodysplasia.
Hydrogen Breath Testing
A hydrogen breath test, a simple, non-invasive test performed after a short period of fasting, measures the amount of hydrogen in the breath to diagnose conditions that cause gastrointestinal symptoms. The body produces too much hydrogen when lactose is not broken down properly in the small intestine. The test requires a patient to drink a solution of lactose, fructose, sucrose, or glucose mixed in water. After drinking the solution, the patient breaths into a plastic bag every 15 minutes. Fructose breath testing determines if fructose is being malabsorbed in the body. Lactose breath testing indicates lactose intolerance. Lactulose breath testing can reveal a bacterial overgrowth. These tests are commonly used to diagnose patients with irritable bowel syndrome and common food intolerances.
pH Monitoring
A pH monitor is used to record the acidity level in the esophagus over a 24-hour period. A small tube with a pH sensor on the end is passed through the nose into the lower esophagus. The tube is left in place for 24 hours with the portion of the sensor affixed to the face. The sensor is connected to a small recording device that is worn. Another version is wireless and a small pH sensor is affixed to the lower esophagus using suction. The small probe is able to communicate wirelessly with a recording device outside the body for 48 hours. The probe ultimately falls off and passes through the remainder of the digestive tract. This is used to diagnosis acid reflux and esophageal function.
Remicade Infusion
Infliximab (brand name Remicade) is used to treat various autoimmune disorders. Remicade is an advanced treatment that has shown to have substantial benefits in patients with inflammatory bowel diseases such as Crohn’s Disease and ulcerative colitis. Blocking a substance in the body called tumor necrosis factor (TNF) may reduce the inflammation in your body. Remicade is a protein that recognizes, attaches to, and blocks the actions of the TNF. Although Remicade will not cure inflammatory bowel disease, it may help patients feel better and relieve symptoms. Remicade is an IV infused medication given over two hours by a healthcare professional.
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