Digestive Health Archive

Heartburn and indigestion are not the hallmarks of a good relationship.

They say that breaking up is hard to do, and that takes on new meaning when you've had a love affair with certain foods. But sometimes our bodies can no longer tolerate our favorites, forcing us to say goodbye to everything from onions, beans, and jalapeos to yogurt and marinara sauce. "Anyone over 30 knows that our body doesn't always work the way it once did, and that gets worse as we get older. The upper and lower digestive tract seem most susceptible to the changes of aging," says Dr. Kyle Staller, a gastroenterologist with Harvard-affiliated Massachusetts General Hospital.

Suspicious sweethearts

The naturally occurring sugars known as FODMAPs (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols) can become harder to digest in older age. These include sugars found in dairy products, wheat, rye, onions, garlic, legumes (chickpeas, lentils, beans), honey, pistachios, cashews, asparagus, and artichokes, among other foods. Some fruits (including mangos, pears, and peaches) contain FODMAPs, as do drinks with fructose or certain artificial sweeteners. Dr. Staller says we don't always know what makes a person develop sensitivity to particular FODMAPs. We do know that eating FODMAPs can result in cramping, diarrhea, bloating, and gas.

What is the test?

A barium swallow, or upper GI series, is an x-ray test used to examine the upper digestive tract (the esophagus, stomach, and small intestine). Because these organs are normally not visible on x-rays, you need to swallow barium, a liquid that does show up on x-rays. The barium temporarily coats the lining of the esophagus, stomach, and intestine, making the outline of these organs visible on the x-ray pictures. This test is useful for diagnosing cancers, ulcers, problems that cause narrowing of the esophagus, some causes of inflammation in the intestine, and some swallowing problems.

How do I prepare for the test?

Tell your doctor and the x-ray technicians if there is any chance you could be pregnant. If you have diabetes and take insulin, discuss this with your doctor before the test.

What Is It?

Cholecystectomy is the surgical removal of the gallbladder, the small saclike organ located near the liver in the upper right side of the abdomen. It is attached to the main duct that carries bile from the liver into the intestine. Bile helps your body to break down and absorb fats. The gallbladder temporarily stores bile from the liver. When you eat, the gallbladder contracts, and squeezes extra bile into the intestine to aid digestion.

There are two ways to remove the gallbladder:

• Traditional surgery - The surgeon cuts open the abdomen and removes the gallbladder through an incision that is about 6 inches long. The abdomen is then stitched closed again.
• Laparoscopic surgery - The surgeon makes four small (less than an inch) incisions for a laparoscope and instruments. A laparoscope is a tube-like instrument with a camera for viewing, and with it the surgeon can to guide the surgical instruments to remove the gallbladder. The gallbladder is cut away from the liver and the bile duct and removed through one of the small incisions.

Over 90% of the time, laparoscopic surgery is used because it requires a shorter hospital stay, is less painful, and has a shorter recovery time compared to traditional surgery. Traditional surgery is usually used because the person has significant abdominal scarring from prior surgery, severe inflammation, unusual anatomy, or other factors that make surgery with a laparoscope very difficult and riskier.

What Is It?

Endoscopy describes many procedures that look inside the body using some type of endoscope, a flexible tube with a small TV camera and a light on one end and an eyepiece on the other. The endoscope allows doctors to examine the inside of certain tube-like structures in the body. Many endoscopes transmit the doctor's view to a video screen. Most endoscopes have attachments that permit doctors to take fluid or tissue samples for laboratory testing.

Upper endoscopy allows a doctor to see inside the esophagus, stomach and top parts of the small intestine. Bronchoscopy examines the large airways inside the lungs (bronchi). Sigmoidoscopy and colonoscopy examine different parts of the lower digestive tract. Each type of endoscopy uses a slightly different endoscope with a different name — an upper endoscope for upper endoscopy, a bronchoscope for bronchoscopy, a sigmoidoscope for sigmoidoscopy and a colonoscope for colonoscopy. Other endoscopes allow doctors to see inside the abdomen and inside joints through small incisions.

What is the test?

This test inspects your esophagus, stomach and the first section of intestine (the duodenum) using an endoscope. An upper endoscopy allows the doctor to explore the cause of such symptoms as difficulty swallowing, abdominal pain, vomiting up blood, or passing blood in the stool. It can also diagnose irritation, ulcers, and cancers of the lining of the esophagus and stomach. During this type of endoscopy, the doctor can also take biopsy samples of tissue.

How do I prepare for the test?

Don't eat or drink anything for eight hours before this test. It's also best to stop taking aspirin and other NSAIDs for several days beforehand, to reduce the chances of bleeding should your doctor need to take a biopsy. Ask your doctor if you should avoid taking any other medicines on the day of the test. If you have diabetes, talk with your doctor about ways to avoid low blood sugar (hypoglycemia) since you will be fasting. If you wear dentures, remove them before the test. Arrange for a ride home because the medicine given for this test will make you drowsy.

A weaker immune system and increased germ exposure make us vulnerable to winter bugs. Here's what you need to know.

Winter is on the way, and along with cold temperatures, the season brings a spectrum of potential health problems for everyone — especially for older adults. That's why it's important to take precautions now, before you get sick.

The cold weather link

Cold weather doesn't cause illness, but it may foster it. "Some studies have found that both cold and flu viruses can multiply and spread more easily in lower temperatures and humidity. Additionally, cold air reduces blood flow to the lining of the nose, throat, and lungs, which may dampen the immune system response," says Dr. Craig Jones, an ear, nose, and throat specialist with Harvard-affiliated Massachusetts Eye and Ear.

Nerve damage might be causing everything from low blood pressure to gastrointestinal distress without your knowing it.

Doctors have long known peripheral neuropathy as a nerve condition that causes reduced sensation, tingling, weakness, or pain in the feet and hands. But those symptoms may be just the tip of the iceberg. Doctors are now learning that neuropathy can cause many more problems.

What is peripheral neuropathy?

Peripheral neuropathy refers to damage to the peripheral nerves throughout the body. These nerves carry messages to and from the brain.

Ask the doctors

Q. I heard that the FDA recently issued a warning related to a specific treatment for Clostridium difficile infections. Can you explain what this warning is about?

A. The FDA issued a warning in June aimed at health care providers who are using fecal transplants to treat Clostridium difficile (C. difficile) infections that have not responded to traditional treatments, such as antibiotics. Doctors perform fecal transplants (which are still considered investigational by the FDA) by introducing stool from a healthy donor into the gastrointestinal tract of the person infected with C. difficile. The introduction of healthful bacteria can sometimes treat the infection, which typically inflames the colon causing symptoms such as severe diarrhea, cramps, and fever. The FDA issued its warning after two immunocompromised adults developed infections from an antibiotic-resistant strain of Escherichia coli (E. coli) following transplants from stool contaminated with the bacteria. Both people got transplants from the same donor. One of the two people died following the infection. To prevent similar problems in the future, the FDA now recommends that doctors performing these transplants follow some new safety measures, including the following:

Given how closely the gut and brain interact, it might seem obvious that the pair often influence each other. Some people feel nauseated before giving a presentation; others feel intestinal pain during times of stress. In any case, emotional and psychosocial factors play a role in functional gastrointestinal disorders.

Treating the whole body

Stress-related symptoms felt in the gastrointestinal tract vary greatly from one person to the next, and treatment can vary as well. For example, one person with gastroesophageal reflux disease might have an occasional, mild burning sensation in the chest, while another experiences excruciating discomfort night after night. As the severity of symptoms varies, so should the therapies, medications, self-help strategies, or even surgeries used to relieve them.