Capsule endoscopy is the video evaluation of the small intestine. The capsule endoscope is a small video camera which is swallowed. After swallowing, you can resume your normal activities. After 8 hours, you bring the data recording equipment back to our office. Later, our physicians will review the images on a computer. We will contact you within a few days with results after our physicians have viewed the images.

For more information see www.givenimaging.com.

Colon cancer is the third most common cause of cancer death in the United States. Men and women are both at risk of developing colon cancer. Most cases of colon cancer begin as a small benign growth in the colon called a colon polyp. With routine colon cancer screening, colon polyps and colon cancer can be found and treated.

Most cases of colon cancer are preventable with routine screening and colon polyp removal.

Colon cancer risk factors include:

• Age greater than 45
• Family history of colon cancer
• Family history of colon polyps

For more information, please visit www.screen4coloncancer.org.

Colonoscopy is the video examination of the colon. If any problems are found, our doctors can take a tissue sample (a biopsy) or remove the problem (ie: colon polyp removal). You will be sedated for your comfort.

More information is available at:

• American Society Gastrointestinal Endoscopy
• American Gastroenterology Association

Endoscopic Retrograde Cholangiopancreatography (ERCP) is a specialized procedure performed at the hospital to evaluate and treat problems of the bile duct. Our doctors will look for problems in the bile ducts (ie a stone or blockage). Frequently stones can be removed. You will be asleep for this procedure.

More information about ERCP is available at:

• American Society Gastrointestinal Endoscopy
• American Gastroenterology Association

Esophageal pH (acid) testing is the measurement of esophageal acid content. You will wear a recording device for 2 days. You can resume your normal diet and activities. After 2 days, you bring the equipment back, and the information will be transferred into a special computer. Later, the study will be reviewed by your doctor.

Esophageal motility evaluates for movement problems with swallowing. This is done at the hospital by GI nurses. Later, the information will be reviewed by your doctor, and you will be contacted with results in a few days.

Approximately 50% of us will develop some hemorrhoid (swollen vein in the rectum or anus) problems in their lifetime. Using a scope, we can evaluate the inside of the rectum to determine the severity of hemorrhoids. A small rubber band can be placed over a hemorrhoid to shrink the tissue. Banding is one of the most effective and affordable treatments for hemorrhoids.

Approximately 90% of the time, banding can be effective at improving your hemorrhoid symptoms. In addition, the banding procedure requires only a minimal preparation and not usually painful. Patients may be able to return to work the same day after banding. Two or three hemorrhoid banding sessions may be needed to fully treat internal hemorrhoids.

Celiac/Gluten Free

Celiac disease is an autoimmune disorder affecting the small intestine. This can result in decreased absorption of nutrients from food. The problem is celiac patients develop a reaction when they eat food with gluten. Gluten is a protein in breads. Wheat, rye, barley, and possibly oats have gluten.

The avoidance of gluten is critical. Even a small amount of gluten can continue the damage to the small intestine.

Please review the following websites for guidance on a gluten free diet:

• Celiac.com
• Celiac.org
• NIDDK gluten free diet examples

Clear Liquid

A clear liquid is food that is clear (you can see through) and liquid at room temperature. Clear liquids are easily digested. Examples include:

Beverages (drinks):

• Clear juices (such as apple, cranberry, or grape)
• Mild tea, without cream or milk
• Mineral or plain water
• Clear soft drinks like ginger ale, lemon-lime soda, or club soda
• Clear sports drinks

Soup:

• Clear broth

Desserts:

• Plain popsicles. Avoid popsicles with pureed fruit or fiber
• Hard candy
• Flavored gelatin, such as Jell-O® without fruit

Any liquid that you can see through can be considered a clear liquid.

Colon Polyp Prevention

What you eat does impact your health. In general, the following guidelines can be recommended to potentially reduce colon polyps or colon cancer:

• Limit food with high content of saturated fats. Red meat and processed foods should be limited. Avoid fried foods. Eat more fish, salmon, and nuts instead.
• Eat more fresh fruits and vegetables. At least 6 to 8 servings of fruits and vegetables should be eaten each day.
• Fiber is important. High fiber foods such as whole grain breads, high fiber cereal, and oatmeal are healthy foods to potentially reduce the formation of colon polyps.
• Getting calcium into you diet is important as well. Milk and other dairy products are good sources of calcium.

Diverticulosis

Dietary modifications for diverticulosis should be focused on improving or avoiding constipation. In general, eating a higher fiber diet will be beneficial.

• Replace your white bread, rice and pasta with whole wheat ones.
• Substitute beans, including soy beans, peas and lentils for meat.
• Consume cereal with more than five grams of fiber per serving.
• Eat several servings of fruit each day.
• Have vegetables with your meals and snacks.
• Increase your fiber intake slowly.
• Drink fluid along with the high fiber foods.

Note: Newer scientific evidence is questioning whether seeds or nuts should really be avoided for patients with diverticulosis. For now, general advice is that seeds and nuts are OK to eat in moderation. It is still advised to avoid popcorn if you have diverticulosis.

Full Liquid

A full liquid diet is a step up from clear liquids on the way to a regular diet. Full liquids can be any food which is liquid at room temperature. The liquid can be creamy. Full liquids are easier to digest than solid food and offer more nutrition than a clear liquid diet.

Examples:

• Water
• Fruit juices, including nectars and juices
• Cream, custard, and pudding
• Ice cream, frozen yogurt, and sherbet
• Fruit ices and popsicles
• Sugar, honey, and syrups
• Soups (creamy soup is ok if no solids)
• Sodas, such as ginger ale and Sprite
• Gelatin (Jell-O)
• Boost, Ensure, Resource, Sustacal. and other liquid supplements
• Tea or coffee with cream or milk and sugar or honey

For more information, see this full liquid diet.

Gas Reduction

Gas in the digestive tract—the esophagus, stomach, small intestine, and large intestine—comes from two sources:

• swallowed air
• normal breakdown of certain undigested foods by normal bacteria

To minimize the amount of intestinal gas, you can reduce the intake of gas forming foods like beans, broccoli, cabbage, brussels sprouts, onions, milk and milk products.

Gastroparesis

Gastroparesis is a medical condition where the stomach is slow to empty. A number of conditions, such as diabetes, can cause gastroparesis. Symptoms include nausea, abdominal pain, and a sensation of being full. Typical diet recommendations include eating more frequent but smaller meals, avoiding high fat foods, minimizing fiber, and drinking more liquids.

See this gastroparesis diet from the University of Virginia for excellent dietary advice.

High Fiber

A high-fiber diet can be useful for a number of digestive issues including constipation. Fiber is normally found in beans, grains, vegetables, and fruits. The typical American diet is low in fiber content.

Most dietary fiber is not digested. It stays within the intestine where it affects the consistency of stool. There are two types of fiber, each of which is thought to have its own benefits:

• Soluble fiber is made of carbohydrates and dissolves in water. Examples include fruits, oats, barley, peas, and beans).
• Insoluble fiber do not dissolve in water. Examples include wheat, rye, and grains. The traditional fiber – wheat bran – is a type of insoluble fiber.

It is recommended to have 6 to 8 servings of fruits and vegetables, and choosing 5 to 10 servings of whole grain breads, cereals, rice and pasta each day. When you increase fiber, do it slowly and drink more water to avoid any constipation.

Eating high fiber foods or adding a fiber supplement to your diet can improve your digestive function. Conditions like constipation, irregular bowel movements, and hemorrhoids may be improved with fiber.

Irritable Bowel Syndrome

Eating certain types of processed sugars can lead to digestive problems for some people. These FODMAP sugars (fermentable – oligo – di -mono saccharides) can be irritating to irritable bowel syndrome patients.

Lactose Free

Lactose intolerance is the inability to digest lactose, a sugar found in mild and dairy products. Lactase in the enzyme that breaks down lactose. Without enough lactase, patients can get abdominal bloating and cramps, gas, or diarrhea after eating.

Avoiding foods with lactose or taking a lactase supplement with food is helpful to reduce the symptoms of lactose intolerance.

Foods with high lactose content include milk, cheese, yogurt, and ice cream. Some milk or ice creams are “Lactose Free.” Please read the labels carefully on food.

An alternative to avoidance is eating small amounts or taking a Lactase supplement with food. Over the counter enzyme supplements containing lactase are helpful. They usually are labeled a dairy easing supplement.

Low Fat

The amount of fat in the diet can be important to your digestion. Even modest reduction in dietary fat can have a significant improvement in your digestive and overall health.

Watch all fats, not just cholesterol.

Cholesterol is not the only important thing to consider. The total fat content is important, particularly saturated fats, in addition to cholesterol.

• Saturated fats are found in high quantities in foods of animal origin. These are converted to cholesterol by the liver. Limiting saturated fat is wise.
• “Polyunsaturated” fats are generally from non-meat sources, and are better for you. However, these fats can lower the level of your “good cholesterol.”
• “Monounsaturated” fats can lower the bad cholesterol and increase the good cholesterol.

Foods with saturated fats are often high in cholesterol. Foods that are low in cholesterol can be high in saturated fats, and therefore the label of “No Cholesterol” does not mean the food is healthy. Try to avoid food high in cholesterol and high in saturated fats.

The small intestine is the middle portion of the digestive system. In the past, the small intestine was not able to be examined with a scope. New technology involving a much longer scope “an enteroscope” now allows for examination of some of the small intestine. In addition, the use of a balloon assisted procedure known as “single balloon enteroscopy” allows for even more of the small intestine to be evaluated. Balloon enteroscopy is frequently used to follow up results of preliminary testing such as x-rays and capsule endoscopy.

During ERCP, visualization of the inside of the bile duct is now possible. Spyglass cholangioscopy refers to a revolutionary new system which allows a small fiber optic probe to be inserted into the bile duct. Improved visualization of the bile duct allows for more accurate evaluation. In addition, stones within the bile duct can be fragmented with a miniature shock wave system, Electrohydraullic lithotripsy.

Upper endoscopy “EGD” is the video examination of the esophagus, stomach, and duodenum. During the exam if any problems (i.e. a stomach ulcer) are found, our doctors can take a tissue sample (a biopsy). You will be sedated for your comfort.

More information is available at:

• American Society for Gastrointestinal Endoscopy
• American Gastroenterological Association