Diverticulitis

What is diverticulitis?
Diverticulosis happens when pouches form in the wall of the colon. If these pouches get inflamed or infected, it is called diverticulitis. Diverticulitis can be very painful.

What causes diverticulitis?
Doctors aren't sure what causes diverticula in the colon (diverticulosis). But they think that a low-fiber diet may play a role. Without fiber to add bulk to the stool, the colon has to work harder than normal to push the stool forward. The pressure from this may cause pouches to form in weak spots along the colon. Bacteria grow in the pouches, and this can lead to inflammation or infection.

What are the symptoms?
Symptoms of diverticulitis may last from a few hours to a week or more. Symptoms include:

• Belly pain, usually in the lower left side, that is sometimes worse when you move. This is the most common symptom.

• Fever and chills.

• Bloating and gas.

• Diarrhea or constipation.

• Nausea and sometimes vomiting.

• Not feeling like eating.

How is diverticulitis diagnosed?
Your doctor will ask about your symptoms and will examine you. He or she may do tests to see if you have an infection or to make sure that you don't have other problems. Tests may include:

• Blood tests, such as a complete blood count (CBC).

• Other tests, such as an X-ray or a CT scan.

If you believe you suffer from diverticulitis, call your doctor immediately.   In conjunction with the physicians at Integrated Gastroenterology Consultants, you can receive the highest level of care to treat your diverticulitis.

Constipation

Being constipated means your bowel movements are tough or happen less often than normal. Almost everyone goes through it at some point. Although it’s not usually serious, you'll feel much better when your body is back on track. The normal length of time between bowel movements varies widely from person to person. Some people have them three times a day. Others have them just a few times a week. Going longer than 3 or more days without one, though, is usually too long. After 3 days, your poop gets harder and more difficult to pass.

What Are the Symptoms?
You may have:

• Few bowel movements

• Trouble having a bowel movement (straining to go)

• Hard or small stools

• A sense that everything didn’t come out

• Belly bloating

Why Does It Happen?
Some causes of constipation include:

• Changes to what you eat or your activities

• Not enough water or fiber in your diet

• Eating a lot of dairy products

• Not being active

• Resisting the urge to poop

• Stress

• Overuse of laxatives

• Some medications (especially strong pain drugs such as narcotics, antidepressants, and iron pills)

• Antacid medicines that have calcium or aluminum

• Eating disorders

• Irritable bowel syndrome

• Pregnancy

• Problems with the nerves and muscles in your digestive system

• Neurological conditions such as Parkinson's disease or multiple sclerosis

• Underactive thyroid (called hypothyroidism)

Occasionally, constipation can be the result of colon cancer.

Diagnosis
We can help diagnose the cause of your constipation by performing a colonoscopy to rule out colon cancer as well as other motility disorders through a test called anorectal manometry.

If you suffer from constipation, call your doctor or call us at 978-459-6737  to make an appointment.

Colon Cancer

Colon cancer is cancer of the large intestine (colon), which is the final part of your digestive tract. Most cases of colon cancer begin as small, noncancerous (benign) clumps of cells called adenomatous polyps. Over time some of these polyps can become colon cancers.

Polyps may be small and produce few, if any, symptoms. For this reason, doctors recommend regular screening tests to help prevent colon cancer by identifying and removing polyps before they turn into cancer.

Symptoms
Signs and symptoms of colon cancer include:

• A change in your bowel habits, including diarrhea or constipation or a change in the consistency of your stool, that lasts longer than four weeks

• Rectal bleeding or blood in your stool

• Persistent abdominal discomfort, such as cramps, gas or pain

• A feeling that your bowel doesn't empty completely

• Weakness or fatigue

• Unexplained weight loss

Many people with colon cancer experience no symptoms in the early stages of the disease. When symptoms appear, they'll likely vary, depending on the cancer's size and location in your large intestine.

When to see a doctor
If you notice any symptoms of colon cancer, such as blood in your stool or an ongoing change in bowel habits, do not hesitate to make an appointment with your doctor.
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Talk to your doctor about when you should begin screening for colon cancer. Guidelines generally recommend that colon cancer screenings begin at age 50. Your doctor may recommend more frequent or earlier screening if you have other risk factors, such as a family history of the disease.

Clostridium Difficile Infection (C. Diff)

Clostridium difficile is a very serious infection, and the incidence is on the rise throughout the world. The CDC reports that approximately 347,000 people in the U.S. alone were diagnosed with this infection in 2012. Of those, at least 14,000 died. Some estimates place that number in the 30,000 to 50,000 range, if the U.S. used the same cause of death reporting methods as most of the rest of the world.

Fecal Microbiota Transplant (FMT) is a procedure in which fecal matter, or stool, is collected from a tested donor, mixed with a saline or other solution, strained, and placed in a patient, by colonoscopy.
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The purpose of fecal transplant is to replace good bacteria that has been killed or suppressed, usually by the use of antibiotics, causing bad bacteria, specifically Clostridium difficile, or C. diff., to over-populate the colon. This infection causes a condition called C. diff. colitis, resulting in often debilitating, sometimes fatal diarrhea.

If you suffer from C. diff, call us at 978-459-6737 for an appointment.

Incontinence

Fecal incontinence is the inability to control bowel movements, causing stool (feces) to leak unexpectedly from the rectum. Also called bowel incontinence, fecal incontinence ranges from an occasional leakage of stool while passing gas to a complete loss of bowel control.  Common causes of fecal incontinence include diarrhea, constipation, and muscle or nerve damage. The muscle or nerve damage may be associated with aging or with giving birth.  Whatever the cause, fecal incontinence can be embarrassing. But don't shy away from talking to your doctor. Treatments are available that can improve fecal incontinence and your quality of life.

Symptoms
Most adults who experience fecal incontinence do so only during an occasional bout of diarrhea. But some people have recurring or chronic fecal incontinence. They may be unable to resist the urge to defecate, which comes on so suddenly that they don't make it to the toilet in time. This is called urge incontinence. Another type of fecal incontinence occurs in people are not aware of the need to pass stool. This is called passive incontinence.

Fecal incontinence may be accompanied by other bowel problems, such as:

• Diarrhea

• Constipation

• Gas and bloating

Diagnosis
At Integrated Gastroenterology Consultants, we use state-of-the-art technology such as anorectal manometry and colonoscopy and work in conjunction with the radiology department at Lowell General Hospital to help diagnose and treat your condition.

If you suffer from incontinence, call your doctor.  You can also call us at 978-459-6737 to request an appointment.

Bloating

Bloating is a common digestive issue that causes a full or swollen sensation in the belly, often accompanied by gas. Understanding the primary causes and effective treatments can help alleviate discomfort and improve your quality of life.

Causes of Bloating

1. Visceral Hypersensitivity: This is the main cause of bloating for many individuals. Visceral hypersensitivity occurs when the body unusually reacts to normal amounts of gas in the gut, leading to a bloated feeling even when gas levels are not high. It's crucial to recognize that this heightened sensitivity is often behind the discomfort experienced from bloating.

2. Excess Gas in the Colon: Less commonly, bloating can result from too much gas in the colon. This condition is typically due to the consumption of hard-to-digest foods or carbonated beverages, which increase gas production and accumulation in the digestive tract.

How to Manage and Treat Bloating

• Avoid Common Dietary Triggers: Try avoiding common trigger foods, such as gluten, dairy, and carbonated beverages (fizzy drinks).

• Follow a Low FODMAP Diet: Implementing a low FODMAP diet can be highly effective in reducing bloating. This diet minimizes the intake of certain carbohydrates that cause gas and discomfort. Foods commonly high in FODMAPs include onions, garlic, beans, and certain grains. Our IGIC nutritionist can provide guidance on adapting to this dietary approach.

• Address Constipation, if Present: Some people who have bloating may have constipation. If so, treating constipation can significantly reduce bloating. Strategies include increasing water intake, incorporating fiber gradually, and maintaining regular physical activity. Sometimes, laxatives or prescription medications might be necessary under medical guidance.

• Treatment Options for Visceral Hypersensitivity:

  • Medications: Neuromodulators such as duloxetine, tricyclic antidepressants, and gabapentin have been effectively used to retrain the gut-brain connection that leads to the sensation of bloating.

  • Psychological Therapies: Gut-directed hypnotherapy and cognitive behavioral therapy (CBT) are commonly used for chronic gut pain disorders. These also retrain the gut-brain connection that leads to the sensation of bloating.

Bloating and Abdominophrenic Dyssynergia: Why Do I Look Pregnant if There Isn’t Excess Gas?

You might have noticed that when you feel very bloated, your abdomen is distended, making you look pregnant even though you’re not. You might be experiencing a lesser-known condition called abdominophrenic dyssynergia. This condition is characterized by a coordination issue between the diaphragm and abdominal muscles.

Abdominophrenic dyssynergia can cause significant bloating without the presence of too much gas. This condition leads to the distension of the abdomen due to improper synchronization between your diaphragm, which is crucial for breathing, and the muscles in your abdomen. The resulting effect can make your belly extend outward, resembling a pregnant belly, which can be confusing and uncomfortable for those affected.

It's important to note that abdominophrenic dyssynergia is a benign condition and does not pose serious health risks. Treatment often focuses on managing symptoms and may include physical therapy to improve muscular coordination and breathing techniques. In some cases, targeted exercises or interventions to strengthen core muscles and enhance diaphragmatic function may be recommended by healthcare providers.

If you suffer from bloating, call us at (978) 459-6737 to schedule an appointment.

Bloody or Dark Stool

Gastrointestinal Bleeding/Anemia

Anemia from gastrointestinal (GI) bleeding can have multiple causes. Upper GI bleeding is caused by ulcers, inflammation of the stomach lining or stomach cancer. Bleeding in the lower GI tract can be attributed to intestinal polyps, abnormal blood vessels, colorectal cancer, hemorrhoids, infectious diarrhea and inflammatory bowel disease.

The symptoms of GI bleeding.
Gastrointestinal bleeding has a number of symptoms, including blood in the stool or on toilet paper as well as stools that are black or very dark. Sometimes, slow GI bleeding can be "silent," without any noticeable change in bowel movement or stool. These people are often anemic and display pale skin color, shortness of breath and weakness.

Anemia can have serious consequences.
Losing blood means losing red blood cells, which contain the substance hemoglobin that carries life-giving oxygen. A deficiency of hemoglobin leads to a lack of sufficient oxygen to the organs and other tissues, which can have a wide range of consequences to your health. So gastrointestinal bleeding must be identified and diagnosed so it can be treated and stopped.

At Integrated Gastroenterology Consultants, our board-certified GI specialists provide comprehensive diagnosis of suspected gastrointestinal bleeding and anemia backed by years of advanced training and hands-on experience. We offer these and other diagnostic procedures:

• Upper endoscopy to evaluate the esophagus, stomach & duodenum

• Capsule endoscopy to diagnose problems in the small intestine

• Colonoscopy to evaluate for bleeding in the lower digestive tract

We perform most scope procedures in our state-of-the-art endoscopy center, where we can get you in quickly, cater to your comfort and protect your privacy and give you the specialized, compassionate care you deserve. Call us today.

For more information or to schedule an appointment, call your doctor or call us today at 978-459-6737.

Barrett’s Esophagus

In Barrett's esophagus, tissue in the tube connecting your mouth and stomach (esophagus) is replaced by tissue similar to the intestinal lining.

Barrett's esophagus is often diagnosed in people who have long-term gastroesophageal reflux disease (GERD) — a chronic regurgitation of acid from the stomach into the lower esophagus. Only a small percentage of people with GERD will develop Barrett's esophagus.

Barrett's esophagus is associated with an increased risk of developing esophageal cancer. Although the risk is small, it's important to have regular checkups for precancerous cells (dysplasia). If precancerous cells are discovered, they can be treated to prevent esophageal cancer.

Risk factors
Factors that increase your risk of Barrett's esophagus include:

• Chronic heartburn and acid reflux. Having GERD that doesn't get better when taking medications known as proton pump inhibitors or having GERD that requires regular medication can increase the risk of Barrett's esophagus.

• Age. Barrett's esophagus can occur at any age but is more common in older adults.

• Being a man. Men are far more likely to develop Barrett's esophagus.

• Being white. White people have a greater risk of the disease than do people of other races.

• Being overweight. Body fat around your abdomen further increases your risk.

• Current or past smoking.

Complications
Esophageal cancer
People with Barrett's esophagus have an increased risk of esophageal cancer. The risk is small, even in people who have precancerous changes in their esophagus cells. Most people with Barrett's esophagus will never develop esophageal cancer.

Diagnosis
Endoscopy is generally used to determine if you have Barrett's esophagus.  A lighted tube with a camera at the end (endoscope) is passed down your throat to check for signs of changing esophagus tissue. Normal esophagus tissue appears pale and glossy. In Barrett's esophagus, the tissue appears red and velvety.  Your doctor will remove tissue (biopsy) from your esophagus. The biopsied tissue can be examined to determine the degree of change.

Screening for Barrett's esophagus
Barrett's esophagus diagnosis
The American College of Gastroenterology says screening may be recommended for men who have had GERD symptoms at least weekly that don't respond to treatment with proton pump inhibitor medication, and who have at least two more risk factors, including:

• Being over 50

• Being white

• Having a lot of abdominal fat

• Being a current or past smoker

• Having a family history of Barrett's esophagus or esophageal cancer

While women are significantly less likely to have Barrett's esophagus, women should be screened if they have uncontrolled reflux or have other risk factors for Barrett's esophagus.

Treatment
If you have evidence of precancerous changes in the esophagus, we are the only center in the Merrimack Valley that offers  radiofrequency ablation, which uses heat to remove abnormal esophagus tissue. Radiofrequency ablation may be recommended after endoscopic resection.

If you are at risk of having Barrett’s esophagus or have been told you have Barrett’s esophagus, contact your doctor.  You can also call us at 978-459-6737 to request an appointment.

Celiac Disease

Celiac disease (gluten-sensitive enteropathy), sometimes called sprue, is an immune reaction to eating gluten, a protein found in wheat, barley and rye.

If you have celiac disease, eating gluten triggers an immune response in your small intestine. Over time, this reaction damages your small intestine's lining and prevents absorption of some nutrients (malabsorption). The intestinal damage often causes diarrhea, fatigue, weight loss, bloating and anemia, and can lead to serious complications.

There's no cure for celiac disease — but for most people, following a strict gluten-free diet can help manage symptoms and promote intestinal healing.

Symptoms
The signs and symptoms of celiac disease can vary greatly.  The most common signs are diarrhea, fatigue and weight loss. Adults may also experience bloating and gas, abdominal pain, nausea, constipation, and vomiting.

However, more than half of adults with celiac disease have signs and symptoms that are not related to the digestive system, including:

• Anemia, usually resulting from iron deficiency

• Loss of bone density (osteoporosis) or softening of bone (osteomalacia)

• Itchy, blistery skin rash (dermatitis herpetiformis)

• Damage to dental enamel

• Mouth ulcers

• Headaches and fatigue

• Nervous system injury, including numbness and tingling in the feet and hands, possible problems with balance, and cognitive impairment

• Joint pain

• Reduced functioning of the spleen (hyposplenism)

• Acid reflux and heartburn

Diagnosis
We can diagnose celiac disease though performing an endoscopy.  In this procedure, your doctor uses a slender, flexible, lighted tube to examine the esophagus, stomach and first part of the small intestine (duodenum).   A small piece of tissue can be taken from the small intestines to make the diagnosis.

If you have celiac disease or are concerned you may have celiac disease, call your doctor.  You can also call us at 978-459-6737  to make an appointment.

Abdominal Pain

What Are the Most Common Causes of Abdominal Pain?

Whether you've got a mild stomachache, sharp pain, or cramps, abdominal pain can have many causes. For instance, you might have indigestion, constipation, a stomach virus, or, if you're a woman, menstrual cramps.

Other possible causes include:

• Irritable bowel syndrome (IBS)

• Crohn's disease

• Food poisoning

• Food allergies

• Gas

• Lactose intolerance

• Peptic ulcers

Pelvic inflammatory disease.Some other causes include:

• Hernia

• Gallstones

• Kidney stones

• Endometriosis

• Gastroesophageal reflux disease (GERD)

• Appendicitis

When Should You Contact Your Doctor?
If your abdominal pain is severe, doesn't go away, or keeps coming back, talk to your doctor. Or, if you wish, call us at 978-459-6737 to request an appointment. At Integrated Gastroenterology Consultants, we have board-certified specialists capable of running diagnostic tests to help diagnose the cause of your pain.

Intragastric Weight Loss Balloon: Orbera

The intragastric weight loss balloon is the only non-surgical weight loss strategy proven to help people lose weight. Your weight loss journey begins with a personalized evaluation. You’ll start receiving the education you need to prepare you for success. After that, the Orbera balloon is inserted into your stomach during an upper endoscopy. This is a non-surgical procedure where you will be completely asleep and comfortable. The balloon will remain in place for six months, helping to control portion size and curb appetite. With the help of the weight loss balloon and personalized coaching, you’ll focus on healthy eating, exercise, and lifestyle habits to maximize your success. The weight loss balloon is removed from your stomach at six months. After the weight loss balloon is removed, you’ll continue receiving support to help you achieve and maintain your optimal weight and healthy lifestyle.

Integrated Gastroenterology Consultants uses the Orbera Weight Loss System. Orbera is a year-long program for helping you lose weight by changing your habits. See more about the Orbera balloon, including FAQ videos, below.

Our advanced endoscopist, Dr. Allen Hwang, is the only doctor in the US north of New York who places intragastric weight loss balloons. Call (978) 459-6737 for a consultation on weight management and the weight loss balloon.

How the Orbera Weight Loss System Works

It’s a Tool, Not a Shortcut

How Much Weight Did You Lose?

What’s Life Like After It’s Out?

Does It Really Work?

Does It Require Surgery?

Is It Worth It?

What Does It Feel Like?

The First Thing That Works

More Than a Balloon

Fecal Transplant (FMT or Stool Transplant)

Fecal Microbiota Transplantation (FMT) is a medical procedure used to restore the balance of bacteria in your digestive system. This treatment is particularly effective for individuals suffering from recurrent Clostridioides difficile (C. diff) infections, a condition that can cause severe diarrhea and is often resistant to standard antibiotic treatments. FMT is being studied for its potential benefits in treating other gastrointestinal disorders as well.

The procedure involves transferring stool from a healthy donor into the intestinal tract of the patient. This is typically done via a prescription FMT pills (such as from Vowst) or enemas, or less commonly through a procedure. The idea is to introduce beneficial bacteria to outcompete the harmful C. diff bacteria. Most patients who undergo FMT for C. diff infections experience a significant improvement in their symptoms. The procedure is generally considered safe and has a high success rate for treating recurrent C. diff infections. It's important to consult with your healthcare provider to understand if FMT is an appropriate treatment for your condition, the process involved, and any potential risks or side effects.

ERCP

ERCP, which stands for Endoscopic Retrograde Cholangiopancreatography, is a procedure used by doctors to diagnose and treat problems in the liver, gallbladder, bile ducts, and pancreas. During an ERCP, a flexible tube with a tiny camera at the end, called an endoscope, is gently inserted through the mouth, down the throat, and into the stomach and small intestine. This allows the doctor to see images of these organs on a screen and identify any issues such as gallstones, blockages, or inflammation. Additionally, if any problems are found, the doctor can perform treatments like removing gallstones or widening narrowed ducts using special instruments passed through the endoscope.

If you have any questions, please call our office at 978-459-6737.

Esophageal Manometry

Esophageal manometry is a specialized test used to evaluate the function of the esophagus, the tube that connects your throat to your stomach. This test is particularly helpful if you're experiencing symptoms like difficulty swallowing, pain when swallowing, or persistent heartburn. It's also commonly used to diagnose conditions such as achalasia, a disorder affecting the ability of the esophagus to move food toward the stomach, or to assess esophageal function before anti-reflux surgery.

During esophageal manometry, a thin, flexible tube is gently passed through your nose, down your throat, and into your esophagus. This tube measures the muscle contractions of your esophagus when you swallow, assessing the coordination and strength of these contractions. The procedure typically takes about 30 to 45 minutes and is done on an outpatient basis. While the test may be a bit uncomfortable, it's not usually painful. Before undergoing esophageal manometry, your healthcare provider will explain how to prepare for the test, what you can expect during the procedure, and how to interpret the results.

Colon Cancer Screening

Colon cancer screening is an important step in preventing or catching colon cancer early. The usual recommendation is to start screening at age 45, but if you have a family history of colon cancer, your doctor might suggest starting sooner. Early detection is key to effective treatment and can stop cancer before it develops.

A colonoscopy is the most comprehensive method for colon cancer screening. In this procedure, a doctor checks your colon and rectum using a camera on a flexible tube. If they find small growths, called polyps, they can remove them right away. This not only helps detect cancer but can prevent it from forming. While some people may be nervous about getting a colonoscopy, it's a very effective tool against colon cancer and is generally needed only once every 10 years if your test results are normal.

Home stool tests are another option. These tests, including names like the fecal immunochemical test (FIT) and the FIT-DNA test, look for signs of cancer in your stool. They are simpler and can be done at home, but they aren’t as thorough as a colonoscopy. If anything unusual shows up in these tests, you’ll still need a colonoscopy for a full check and to remove any polyps.

Talking to your healthcare provider about the best screening option for you is important. While stool tests may seem easier, a colonoscopy is the only method that can both detect and prevent cancer by removing polyps. Regular screening, in whatever form, is crucial for maintaining good health and protecting against colon cancer.

Colonoscopy

A colonoscopy is a medical test that doctors use to look inside your colon and rectum. It’s one of the best ways to check for colon cancer and to prevent it. Most people should start getting a colonoscopy at age 45, but some might need it earlier if there’s a history of colon cancer in their family. Catching any issues early can lead to better treatment outcomes and can help stop cancer from developing.

During a colonoscopy, your doctor uses a long, flexible tube with a tiny camera on the end. This camera lets them see the entire inside of your colon and find things like polyps, which are small growths. Polyps can sometimes turn into cancer, so the doctor can remove them during the colonoscopy, which helps prevent cancer from starting. The idea of a colonoscopy might make you nervous, but it’s a safe and effective way to protect yourself against colon cancer. Most people need to have a colonoscopy only once every 10 years if everything looks normal.

Before a colonoscopy, you’ll need to prepare by following your doctor's instructions, which usually include a special diet and taking a laxative to clean out your colon. On the day of the test, you’ll be given medication to help you relax or sleep, so you shouldn’t feel anything during the procedure. Recovery is usually quick, and most people can get back to their normal activities the next day.

If you’re due for a colonoscopy or have concerns about colon cancer, talk to your healthcare provider. They can guide you on when to start screening and what to expect. Regular colonoscopies are a major part of staying healthy and can be life-saving by catching and preventing colon cancer.

Find our prep instructions here.

Intragastric Weight Loss Balloon: Spatz

The Spatz3 Adjustable Balloon System is the world’s first and only adjustable gastric balloon. This non-surgical weight loss solution offers patients a higher weight loss success rate than ever before. With the highest weight loss results and highest success rates of all 8-month gastric balloons, the Spatz3 has proven to have an 84% success rate and 15% weight loss, far exceeding every non-adjustable balloon in non-comparative studies. In addition, FDA Clinical Trials show that Spatz balloon patients lost five times as much weight as those on diet alone.Spatz Medical is committed to the patient’s journey, helping them achieve their weight loss goals, while learning to listen to body cues that ultimately contribute to long-term weight management success.

Integrated Gastroenterology Consultants now offers the Spatz3 Adjustable Balloon System as one option for intragastric balloons. See more about the Spatz3 balloon below.

Our advanced endoscopist, Dr. Allen Hwang, is one of the only doctors in the US north of New York who places intragastric weight loss balloons. Call (978) 459-6737 for a consultation on weight management and the weight loss balloon.

Anorectal Manometry

Anorectal manometry is a test that doctors use to check how well the muscles and nerves in your rectum and anus are working. It's especially helpful if you have issues like constipation or trouble controlling bowel movements (fecal incontinence). This test can help your doctor figure out why you're having these problems and how to treat them.

During the test, a small, flexible tube with sensors is inserted into your rectum. It measures muscle pressure when you relax and squeeze. The procedure is quick, typically taking about 30 minutes, and you can usually go back to your normal activities right after. It might feel a bit uncomfortable, but it shouldn’t be painful. If your doctor suggests an anorectal manometry, they’ll explain how to prepare and what to expect during the test.