Digestive Health Archive

What Is It?

In a bowel obstruction (intestinal obstruction), a blockage prevents the contents of the intestines from passing normally through the digestive tract. The problem causing the blockage can be inside or outside the intestine. Inside the intestine, a tumor or swelling can fill and block the inside passageway of the intestine. Outside the intestine, it is possible for an adjacent organ or area of tissue to pinch, compress or twist a segment of bowel.

A bowel obstruction can occur in the small bowel (small intestine) or large bowel (large intestine or colon). Also, a bowel obstruction can be total or partial, depending on whether any intestinal contents can pass through the obstructed area.

What Is It?

Gastroenteritis is an inflammation of the intestines that causes diarrhea, abdominal cramps, nausea, loss of appetite, and other symptoms of digestive upset. In adults, the two most common causes of gastroenteritis are viral and bacterial infections:

• Viral gastroenteritis — In otherwise healthy adults, viral infections of the digestive tract are often responsible for mild episodes of gastroenteritis. These viral infections include the Norwalk virus, rotaviruses, adenoviruses and other agents.
  
  The viruses are very contagious, and usually spread from one person to another on unwashed hands, or by close contact with an infected person, such as sharing food or eating utensils. Viral gastroenteritis often spreads very easily in institutions and other situations where people live in close quarters, such as prisons, nursing homes, cruise ships, schools, college dorms and public campgrounds.
  
  The viruses also can be spread when someone either touches an infected person's stool or touches surfaces contaminated with infected stool. For this reason, health care professionals and child care workers have an especially high risk of viral gastroenteritis, particularly if they do not wash their hands thoroughly after dealing with soiled diapers, bedpans or bathroom fixtures.
  
  In some circumstances, the agents that cause viral gastroenteritis also can be carried in water or food, especially in drinking water or commercial shellfish that have been contaminated by sewage runoff. Infected food handlers who don't follow proper sanitary procedures also can spread viral gastroenteritis in meals served in restaurants and cafeterias.
• Bacteria — Salmonella, shigella, Campylobacter jejuni, E. coli and many other types of bacteria can cause gastroenteritis. They can be spread by close contact with an infected person, or by drinking or eating infected food or water. In some cases, the disease is caused by a toxin that is produced by bacteria growing on food that has been prepared or stored improperly. If a person eats this germ-filled food, symptoms of gastroenteritis are triggered either by the bacteria themselves or by their irritating byproducts. Symptoms from a toxin usually begin within a few hours. Symptoms from the bacteria can occur within a few days.

Each year in the United States, millions of people develop gastroenteritis by eating contaminated food, while millions more suffer from mild bouts of viral gastroenteritis. In otherwise healthy adults, both forms of gastroenteritis tend to be mild and brief, and many episodes are never reported to a doctor. However, in the elderly and people with weakened immune defenses, gastroenteritis sometimes can produce dehydration and other dangerous complications. Even in robust adults, certain types of aggressive bacteria occasionally cause more serious forms of food poisoning that can cause high fever and severe gastrointestinal symptoms, such as bloody diarrhea.

What Is It?

A hernia occurs when part of an internal organ or body part protrudes through an opening into an area where it shouldn't. A hiatal hernia is named for the hiatus, an opening in the diaphragm between your chest and your stomach. Normally, the esophagus (the tube that carries food to the stomach) goes through this opening. In a hiatal hernia, part of the stomach and/or the section where the stomach joins the esophagus (called the gastroesophageal junction) slips through the hiatus into the chest.

There are two types of hiatal hernias:

• Sliding — A part of the stomach and the gastroesophageal junction slip into the chest. Sliding hiatal hernias are common, especially in smokers, overweight people and women older than 50. These hernias are related to naturally occurring weaknesses in the tissues that normally anchor the gastroesophageal junction to the diaphragm and to activities or conditions that increase pressure within the abdomen. These activities or conditions include persistent or heavy coughing, vomiting, straining while defecating, sudden physical exertion and pregnancy.
• Paraesophageal — The gastroesophageal junction remains in its proper place, and a fold of the stomach slips into the chest, pinched between the gastroesophageal junction and the diaphragm. Of the two types of hiatal hernias, paraesophageal hernias are more likely to cause severe symptoms.

Symptoms

Sliding hiatal hernias may not cause any symptoms, or they may cause heartburn that is worse when you lean forward, strain or lie down. There may be chronic belching and, sometimes, regurgitation (backflow of stomach contents into the throat).

Your digestive system can become more irregular with age, but there are ways to make everything run smoothly.

Your body goes through many changes during your life, and one of the most drastic involves how your digestive system functions.

"Digestion is a constant evolution," says Dr. Kyle Staller, director of the gastrointestinal motility laboratory at Harvard-affiliated Massachusetts General Hospital. "Expect to have new issues arise as you age."

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.