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We provide personalized, comprehensive and compassionate care for patients with all types of digestive diseases and conditions.
If you or a loved one is experiencing recurrent indigestion, heartburn, ulcers, the discomfort and or pain of irritable bowel syndrome, or other unwelcome gastrointestinal symptoms, Baylor has the expertise and technology to address the problem.
Among the digestive diseases treated at Baylor are inflammatory bowel disease, ulcer disease, acute and chronic liver disease including hepatitis C and cirrhosis, gastroesophageal reflux disease (GERD), chronic diarrhea and irritable bowel syndrome.
Barrett's esophagus is when the normal cells that line your food pipe (esophagus) turn into cells not usually found in your body. The new cells take over because the lining of the esophagus has been damaged. The new, abnormal cells are called specialized columnar cells.
It is very rare that someone with this disease will get cancer of the esophagus. But having Barrett's esophagus may raise your risk of having esophageal cancer.
You may get Barrett's esophagus if you have gastroesophageal reflux disease (GERD) that lasts for a long time. You may also get it if you have swelling of the esophagus (esophagitis). These health problems hurt the lining of your esophagus. This can cause the abnormal cells to take over.
If you have long-term (chronic) heartburn, you are at risk for Barrett's esophagus. You should talk with your health care provider.
You are at greater risk of getting Barrett’s esophagus if you are:
Each person’s symptoms may vary. Some of the most common signs of Barrett’s esophagus are:
In some cases you may not have any symptoms. Or the signs of Barrett's esophagus may look like other health problems. Always see your health care provider to be sure.
Your health care provider will give you a physical exam. He or she will also do a test called an endoscopy. A long, thin tube (endoscope) is put in your mouth and gently pushed down into your esophagus.
The endoscope has a small camera and tools. Your health care provider uses the camera to see the lining of your esophagus. He or she will use the tools to remove a small tissue sample (a biopsy). This tissue sample will be sent to a lab. It will be checked to see if your normal cells have been taken over by abnormal cells.
If you are having trouble swallowing, your health care provider may also do an upper GI (gastrointestinal) barium study. This test may show if you have a narrowing (stricture) of the esophagus. This narrowing happens when the damaged lining of the esophagus gets thick and hard.
Your health care provider will suggest a care plan for you based on:
Right now, there is no cure for Barrett's esophagus. Once the abnormal cells have taken over, the normal cells will not come back.
Your health care provider will make a care plan for you. The plan will try to stop any more damage by keeping acid reflux out of your stomach. Your care plan may include:
You can help lower your risk of getting Barrett’s esophagus by:
Barrett's esophagus occurs when the lining of the esophagus is damaged by stomach acid that leaks backward.
Colon cancer is malignant cells found in the colon or rectum. The colon and the rectum are parts of the large intestine, which is part of the digestive system. Because colon cancer and rectal cancers have many features in common, they are sometimes referred to together as colorn cancer. Cancerous tumors found in the colon or rectum also may spread to other parts of the body.
Excluding skin cancers, colon cancer is the third most common cancer in both men and women. The American Cancer Society estimates that about 140,000 colon cancer cases and about 50,000 deaths from colon cancer occur each year. The number of deaths due to colon cancer has decreased, which is attributed to increased screening and polyp removal and to improvements in cancer treatment.
A type of cancer called adenocarcinoma accounts for more than 95 percent of cancers in the colon and rectum and is usually what is meant by the term colorectal cancer. It is the type we focus on in this section. There are other types of cancer that can be found in the colon and rectum, but they are rare.
Here is an overview of the types of cancer in the colon and rectum:
Adenocarcinoma. Adenocarcinomas are tumors that start in the lining of internal organs. Adeno means gland. These tumors start in cells with glandular properties, or cells that secrete. They can form in many different organs, such as the lung or the breast. In colorectal cancer, early tumors start as small adenomatous polyps that continue to grow and can then turn into malignant tumors. The vast majority of colorectal cancers are adenocarcinomas.
Gastrointestinal stromal tumors (GIST). These are tumors that start in specialized cells in the wall of the digestive tract called the interstitial cells of Cajal. These tumors may be found anywhere in the digestive tract, although they rarely appear in the colon. They can be benign (noncancerous) at first, but many do turn into cancer. When this happens, they are called sarcomas. Surgery is the usual treatment if the tumor has not spread.
Lymphoma. A lymphoma is a cancer that typically starts in a lymph node, which is part of the immune system. However, it can also start in the colon, rectum, or other organs.
Carcinoids. Carcinoids are tumors that start in special hormone-producing cells in the intestine. Often they cause no symptoms at first. Surgery is the usual treatment.
Sarcoma. Tumors that start in blood vessels, muscle, or connective tissue in the the colon and rectum wall.
The following are the most common colon cancer symptoms. However, each individual may experience symptoms differently.
People who have any of the following symptoms should check with their doctors, especially if they are over 50 years old or have a personal or family history of the disease:
A change in bowel habits such as diarrhea, constipation, or narrowing of the stool that lasts for more than a few days
Rectal bleeding, dark stools, or blood in the stool
Cramping or gnawing stomach pain
Unintended weight loss
Weakness and fatigue
A feeling that you need to have a bowel movement that is not relieved by doing so
The symptoms of colon cancer may resemble other conditions, such as infections, hemorrhoids, and inflammatory bowel disease. It is also possible to have colon cancer and not have any symptoms. Always consult your health care provider for a diagnosis.
Risk factors may include:
Age. Most people who have colon cancer are over age 50; however, it can occur at any age.
Race and ethnicity. African-Americans have the highest risk for colon cancer of all racial groups in the U.S. Jews of Eastern European descent (Ashkenazi Jews) have the highest colon cancer risk of any ethnic group in the world.
Diet. Colon cancer is often associated with a diet high in red and processed meats.
Personal history of colorectal polyps. Benign growths on the wall of the colon or rectum are common in people over age 50, and may lead to colon cancer.
Personal history of colon cancer. People who have had colon cancer have an increased risk for another colon cancer.
Family history. People with a strong family history of colon cancer or polyps in a first-degree relative (especially in a parent or sibling before the age of 45 or in two first-degree relatives of any age) have an increased risk for colon cancer.
Ulcerative colitis or Crohn's disease. People who have an inflamed lining of the colon have an increased risk for colorectal cancer.
Inherited syndromes, such as familial adenomatous polyposis or hereditary nonpolyposis colon cancer, also known as Lynch syndrome
Heavy alcohol consumption
Type 2 diabetes
The exact cause of most colon cancer is unknown, but the known risk factors listed above are the most likely causes. A small percentage of colon cancers are caused by inherited gene mutations. People with a family history of colorectal cancer may wish to consider genetic testing. The American Cancer Society suggests that anyone undergoing such tests have access to a doctor or geneticist qualified to explain the significance of these test results.
Although the exact cause of colon cancer is not known, it may be possible to lower your risk of colon cancer with the following:
Diet, weight, and exercise. It is important to manage the risk factors you can control, such as diet, body weight, and exercise. Eating more fruits, vegetables, and whole-grain foods, and limiting red and processed meats, plus exercising appropriately, even small amounts on a regular basis, can be helpful. Avoiding excess alcohol intake may also lower your risk.
Drug therapy. Some studies have shown that low doses of nonsteroidal anti-inflammatory drugs, such as aspirin, and hormone replacement therapy for postmenopausal women, may reduce the risk of colon cancer. But these drugs also have their own potentially serious risks, so it is important to discuss this with your health care provider.
Screenings. Perhaps most important to the prevention of colon cancer is having screening tests at appropriate ages. Screening may find some colorectal polyps that can be removed before they have a chance to become cancerous. Because some colorectal cancers cannot be prevented, finding them early is the best way to improve the chance of successful treatment, and reduce the number of deaths caused by colon cancer.
The following screening guidelines can lower the number of cases of the disease, and can also lower the death rate from colorectal cancer by detecting the disease at an earlier, more treatable stage.
Screening methods for colon cancer, for people who do not have any symptoms or strong risk factors, include the following:
Fecal occult blood test (FOBT). Checks for hidden (occult) blood in the stool. It involves placing a very small amount of stool on a special card, which is then sent to a laboratory.
Fecal immunochemical test (FIT). A test that is similar to a FOBT, but does not require any restrictions on diet or medications prior to the test.
Flexible sigmoidoscopy. A diagnostic procedure that allows the doctor to examine the inside of a portion of the large intestine. A short, flexible, lighted tube with a small video camera on the end, called a sigmoidoscope, is inserted into the intestine through the rectum. The scope blows air into the intestine to inflate it and make viewing the inside easier.
Colonoscopy. A procedure that allows the doctor to view the entire length of the large intestine, and can often help identify abnormal growths, inflamed tissue, ulcers, and bleeding. It involves inserting a colonoscope, a long, flexible, lighted tube, in through the rectum up into the colon. The colonoscope allows the doctor to see the lining of the colon, remove tissue for further examination, and possibly treat some problems that are discovered.
CT colonography (virtual colonoscopy). A procedure that uses computerized tomography (CT) scans to examine the colon for polyps or masses. The images are processed by a computer to make a three-dimensional (3-D) model of the colon. Virtual colonoscopy is noninvasive, although it requires a small tube to be inserted into the rectum to pump air into the colon. If something abnormal is seen with this test, a standard colonoscopy will be needed as follow up.
Barium enema with air contrast (also called a double contrast barium enema). A fluid called barium (a metallic, chemical, chalky liquid used to coat the inside of organs so that they will show up on an X-ray) is administered into the rectum to partially fill up the colon. Air is then pumped in to expand the colon and rectum. An X-ray of the abdomen is then taken and can show strictures (narrowed areas), obstructions (blockages), and other problems.
Screening guidelines for colon cancer
Colon cancer screening guidelines from the American Cancer Society for early detection include:
Beginning at age 50, both men and women should follow one of the examination schedules below:
Fecal occult blood test or fecal immunochemical test every year
Flexible sigmoidoscopy every five years
Double-contrast barium enema every five years
Colonoscopy every 10 years
CT colonography (virtual colonoscopy) every five years
People with any of the following colorectal cancer risk factors should begin screening procedures at an earlier age and/or be screened more often:
Strong family history of colorectal cancer or polyps in a first-degree relative, especially in a parent or sibling before the age of 45 or in two first-degree relatives of any age
Family with hereditary colorectal cancer syndromes, such as familial adenomatous polyposis and hereditary nonpolyposis colon cancer
Personal history of colorectal cancer or adenomatous polyps
Personal history of chronic inflammatory bowel disease (Crohn's disease or ulcerative colitis)
If a person has symptoms that might be caused by colon cancer, the doctor will want to get a complete medical history and do a physical examination. The doctor may also do certain tests to look for cancer. Many of these tests are the same as those done to screen for colon cancer in people without symptoms.
Digital rectal examination. A doctor or other health care provider inserts a gloved and lubricated finger into the rectum to feel for anything unusual or abnormal. This test can detect some cancers of the rectum, but not the colon.
Fecal occult blood test. This test checks for hidden (occult) blood in the stool. It involves placing a very small amount of stool on a special card, which is then sent to a laboratory.
Colonoscopy. A procedure that allows the doctor to view the entire length of the large intestine. It involves inserting a colonoscope, a long, flexible, lighted tube, in through the rectum up into the colon. The colonoscope allows the doctor to see the lining of the colon, remove tissue for further examination, and possibly treat some problems that are discovered.
Barium enema (also called double contrast barium enema). A fluid called barium (a metallic, chemical, chalky liquid used to coat the inside of organs so that they will show up on an X-ray) is administered into the rectum to partially fill up the colon. An X-ray of the abdomen is then taken that can show strictures (narrowed areas), obstructions (blockages), and other problems.
Biopsy. a procedure in which polyps or tissue samples are removed (during a colonoscopy or surgery) from the body for examination under a microscope to determine if cancer or other abnormal cells are present.
Blood count. A test to check for anemia (that can be a result of bleeding from a tumor).
Imaging tests. Tests, such as a CT scan, PET scan, ultrasound, or MRI of the abdomen, may be done to look for tumors or other problems. These tests may also be done if colon cancer has already been diagnosed to help determine the extent (stage) of the cancer.
When colon cancer is diagnosed, tests will be performed to determine how much cancer is present, and if the cancer has spread from the colon or rectum to other parts of the body. This is called staging, and it is an important step toward planning a treatment program. The stages for colon cancer are as follows:
Stage 0 (Cancer in situ)
The cancer is found in the innermost lining of the colon or rectum.
Stage I (also called Dukes' A colon cancer)
The cancer has spread beyond the innermost lining of the colon or rectum to the second and third layers. The cancer has not spread to the outer wall or outside of the colon or rectum.
Stage II (also called Dukes' B colon cancer)
The cancer has spread through into the wall or outside the colon or rectum to nearby tissue. However, the lymph nodes are not involved.
Stage III (also called Dukes' C colon cancer)
The cancer has spread to nearby lymph nodes, but has not spread to other organs in the body.
Stage IV (also called Dukes' D colon cancer)
The cancer has spread to other parts of the body, such as the lungs.
Specific treatment for colon cancer will be determined by your doctor based on:
Your age, overall health, and medical history
Extent and location of the disease
Results of certain lab tests
Your tolerance for specific medications, procedures, or therapies
Expectations for the course of this disease
Your opinion or preference
After the colon cancer is diagnosed and staged, your doctor will recommend a treatment plan. Treatment may include:
Colon surgery. Often, the primary treatment for colon cancer is an operation, in which the cancer and a length of normal tissue on either side of the cancer are removed, as well as the nearby lymph nodes.
Radiation therapy. Radiation therapy is the use of high-energy radiation to kill cancer cells and to shrink tumors. There are two ways to deliver radiation therapy, including the following:
External radiation (external beam therapy). A treatment that precisely sends high levels of radiation directly to the cancer cells. The machine is controlled by the radiation therapist. Since radiation is used to kill cancer cells and to shrink tumors, special shields may be used to protect the tissue surrounding the treatment area. Radiation treatments are painless and usually last a few minutes.
Internal radiation (brachytherapy, implant radiation). Radiation is given inside the body as close to the cancer as possible. Radioactive material is placed next to or directly into the cancer, which limits the effects of surrounding healthy tissues. Some of the radioactive implants are called seeds or capsules.Internal radiation involves giving a higher dose of radiation in a shorter time span than with external radiation. Some internal radiation treatments stay in the body temporarily. Other internal treatments stay in the body permanently, though the radioactive substance loses its radiation within a short period of time. In some cases, both internal and external radiation therapies are used.
Chemotherapy. Chemotherapy is the use of anticancer drugs to treat cancerous cells. In most cases, chemotherapy works by interfering with the cancer cell's ability to grow or reproduce. Different groups of drugs work in different ways to fight cancer cells. The oncologist will recommend a treatment plan for each individual. Studies have shown that chemotherapy after surgery may increase the survival rate for patients with some stages of colon cancer. It can also be helpful before or after surgery for some stages of rectal cancer. Chemotherapy can also help slow the growth or relieve symptoms of advanced cancer.
Colon cancer is cancer that starts in the large intestine (colon) or the rectum (end of the colon). This type is also referred to as "colorectal cancer."
Esophageal cancer is cancer that develops in the esophagus, the muscular tube that connects the throat to the stomach. The esophagus, located just behind the trachea, is about 10 to 13 inches in length and allows food to enter the stomach for digestion. The wall of the esophagus is made up of several layers and cancers generally start from the inner layer and grow out.
The American Cancer Society estimates that about 17,990 Americans will be newly diagnosed with esophageal cancer during 2013, and about 15,210 deaths are expected.
No one knows exactly what causes esophageal cancer. At the top of the esophagus is a muscle, called a sphincter, that releases to let food or liquid go through. The lower part of the esophagus is connected to the stomach. Another sphincter muscle is located at this connection that opens to allow the food to enter the stomach. This muscle also works to keep food and juices in the stomach from backing into the esophagus. When these juices do back up, reflux, commonly known as heartburn, occurs.
Long-term reflux can change the cells in the lower end of the esophagus. This condition is known as Barrett's esophagus. If these cells are not treated, they are at much higher risk of developing into cancer cells.
There are 2 main types of esophageal cancer. The most common type, known as adenocarcinoma, develops in the glandular tissue in the lower part of the esophagus, near the opening of the stomach. It occurs in just over half of the cases.
The other type, called squamous cell carcinoma, grows in the cells that form the top layer of the inner lining of the esophagus, known as squamous cells. This type of cancer can grow anywhere along the esophagus.
Treatment for both types of esophageal cancer is similar.
Often, there are no symptoms in the early stages of esophageal cancer. Symptoms do not appear until the disease is more advanced. The following are the most common symptoms of esophageal cancer. However, each individual may experience symptoms differently. Symptoms may include:
Difficult or painful swallowing. A condition known as dysphagia is the most common symptom of esophageal cancer. This gives a sensation of having food lodged in the chest, and people with dysphagia often switch to softer foods to help with swallowing.
Pain in the throat or back, behind the breastbone or between the shoulder blades
Severe weight loss. Many people with esophageal cancer lose weight unintentionally because they are not getting enough food.
Hoarseness or chronic cough that does not go away within two weeks
Blood in stool or black-looking stools
The symptoms of esophageal cancer may resemble other medical conditions or problems. Always consult your health care provider for a diagnosis.
There is no routine screening examination for esophageal cancer; however, people with Barrett's esophagus should be examined often because they are at greater risk for developing the disease.
The following factors can put an individual at greater risk for developing esophageal cancer:
Age. The risk increases with age. In the U.S., most people are diagnosed at 55 years of age or older.
Gender. Men have more than a 3 times greater risk of developing esophageal cancer than women.
Tobacco use. Using any form of tobacco, but especially smoking, raises the risk of esophageal cancer. The longer tobacco is used, the greater the risk, with the greatest risk among persons who have indulged in long-term drinking with tobacco use. Scientists believe that these substances increase each other's harmful effects, making people who do both especially susceptible to developing the disease.
Alcohol use. Chronic or long-term heavy drinking is another major risk factor for esophageal cancer.
Acid reflux. Abnormal backward flow of stomach acid into the esophagus increases esophageal cancer risk.
Barrett's esophagus. Long-term irritation from reflux, commonly known as heartburn, changes the cells at the lower end of the esophagus. This is a precancerous condition, which raises the risk of developing adenocarcinoma of the esophagus.
Obesity. Being very overweight increases the risk of esophageal cancer. This might be because being overweight puts you at higher risk for reflux.
Diet. Diets low in fruits and vegetables and certain vitamins and minerals can increase risk for this disease.
Other irritants. Swallowing caustic irritants such as lye and other substances can burn and destroy cells in the esophagus. The scarring and damage done to the esophagus can put a person at greater risk for developing cancer many years after ingesting the substance.
Medical history. Certain diseases, such as achalasia, a disease in which the bottom of the esophagus does not open to release food into the stomach, and tylosis, a rare, inherited disease, increase the risk of esophageal cancer. In addition, anyone who has had other head and neck cancers has an increased chance of developing a second cancer in this area, which includes esophageal cancer.
In addition to a complete medical history and physical examination, diagnostic procedures for esophageal cancer may include the following:
Chest X-ray. A diagnostic test that uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.
Upper GI (gastrointestinal) series (also called barium swallow). A diagnostic test that examines the organs of the upper part of the digestive system: the esophagus, stomach, and duodenum (the first section of the small intestine). A fluid called barium (a metallic, chemical, chalky, liquid used to coat the inside of organs so that they will show up on an X-ray) is swallowed. X-rays are then taken to evaluate the digestive organs.
Esophagogastroduodenoscopy (also called EGD or upper endoscopy). A procedure that allows the doctor to examine the inside of the esophagus, stomach, and duodenum. A thin, flexible, lighted tube with a tiny video camera on the end, called an endoscope, is guided into the mouth and throat, then into the esophagus, stomach, and duodenum. The endoscope allows the doctor to view the inside of this area of the body, as well as to insert instruments through a scope for the removal of a sample of tissue for biopsy (if necessary).
Computed tomography scan (CT or CAT scan). A diagnostic imaging procedure that uses a combination of X-rays and computer technology to produce horizontal, or axial, images (often called slices) of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general X-rays. If further imaging is needed, your doctor may order a MRI or PET scan.
Endoscopic ultrasound. This imaging technique uses sound waves to create a computer image of the wall of the esophagus, stomach, and nearby lymph nodes. The endoscope is guided into the mouth and throat, then into the esophagus and the stomach. As in standard endoscopy, this allows the doctor to view the inside of this area of the body, as well as insert instruments to remove a sample of tissue (biopsy).
Thoracoscopy and laparoscopy. These methods allow the doctor to examine the lymph nodes and other structures inside the chest or abdomen with a hollow, lighted tube inserted through a small cut in the skin, and remove suspicious areas for further testing.
PET scan. A test that uses a radioactive glucose (sugar) dye to highlight cancer cells and create pictures of the inside of the body. The test is done much like a CT scan. First, the doctor or nurse injects a small amount of radioactive dye into your vein. Then a scanner is moved around your body and takes many pictures of your neck, chest, and abdomen. A computer puts these pictures together to show where the cancer cells are located.
Specific treatment options for esophageal cancer will be determined by your doctor based on:
Treatment may include:
Surgery. Two types of surgery are commonly performed for esophageal cancer. In one type of surgery, part of the esophagus and nearby lymph nodes are removed, and the remaining portion of the esophagus is reconnected to the stomach. In the other surgery, part of the esophagus, nearby lymph nodes, and the top of the stomach are removed. The remaining portion of the esophagus is then reconnected to the stomach.
Chemotherapy. Chemotherapy uses anticancer drugs to kill cancer cells throughout the entire body.
Radiation therapy. Radiation therapy uses high-energy rays to kill or shrink cancer cells.
Photodynamic therapy (PDT) or other laser therapies. In these treatments, an endoscope with a laser on the end is used to destroy cancer cells on or near the inner lining of the esophagus.
Sometimes, several of these treatments may be combined to treat esophageal cancer.
Esophageal cancer is a malignant (cancerous) tumor of the esophagus, the muscular tube that moves food from the mouth to the stomach.
The liver is one of the organs that helps with digestion but is not part of the digestive tract. It is the largest organ in the body and carries out many important functions, such as making bile, changing food into energy, and cleaning alcohol and poisons from the blood.
Hepatitis is inflammation of the liver that sometimes causes permanent damage. It is most commonly caused by viruses, bacteria, certain medications, or alcohol. It may also be caused by certain diseases, such as autoimmune diseases, metabolic diseases, and congenital (present at birth) abnormalities (biliary atresia, Wilson disease). Generally, symptoms of hepatitis include fever, jaundice, and an enlarged liver. There are several types of hepatitis.
Hepatitis C (known as HCV, once called non-A, non-B hepatitis) is a liver disease caused by a bloodborne virus. Discovered in 1989, this strain of acute viral hepatitis causes approximately 20,000 new infections in the U.S. each year.
Recovery from this infection is rare--about 75 to 85 percent of infected people become chronic carriers of the virus. Approximately 20 percent of people infected with hepatitis C virus will become sick with jaundice or other symptoms of hepatitis. Sixty to 70 percent of these people may go on to develop chronic liver disease.
Chronic liver disease due to hepatitis C causes between 8,000 and 10,000 deaths and is the leading indication for liver transplantation each year in the United States.
Transmission of hepatitis C occurs primarily from contact with infected blood, but can also occur from sexual contact or from an infected mother to her baby. Blood transfusions prior to 1992 and the use of shared needles are other significant causes of the spread of hepatitis C.
The following describes people who may be at risk for contracting hepatitis C:
Children born to mothers who are infected with the virus
People who have a blood-clotting disorder, such as hemophilia and received clotting factors before 1987
People who require dialysis for kidney failure
People who received a blood transfusion before 1992
People who may participate in high-risk activities, such as intravenous (IV) drug use and/or unprotected heterosexual or homosexual sexual contact
There is no vaccine for hepatitis C. People who are at risk should be checked regularly for hepatitis C. People who have hepatitis C should be monitored closely for signs of chronic hepatitis and liver failure.
The following are the most common symptoms for hepatitis C. However, each individual may experience symptoms differently. Symptoms may include:
Loss of appetite
Nausea and vomiting
Vague stomach pain
Jaundice. A yellowing of the skin and eyes.
Dark yellow urine
Muscle and joint pain
Symptoms may occur from two weeks to many months after exposure. The symptoms of hepatitis C may resemble other medical conditions or problems. Always consult your doctor for a diagnosis.
In addition to a complete medical history and physical examination, diagnostic procedures for hepatitis C may include the following:
Liver biopsy. A procedure performed to remove tissue or cells from the body for examination under a microscope.
Specific treatment for hepatitis C will be determined by your doctor based on:
Extent of the disease
Expectations for the course of the disease
At the present time, a vaccine is not available for the prevention of hepatitis C. Treatment may include biological therapy with interferon.
An injury to the liver characterized by the presence of inflammatory cells in the tissue of the organ.
Irritable bowel syndrome (IBS) is a disorder that affects your large intestine or colon. It causes:
When you have IBS your colon looks normal. But it does not work the way it should.
Health experts have not been able to find an exact physical cause for IBS. It is often thought that stress is one cause. Stress may make IBS symptoms worse.
IBS is a long-term, chronic condition. It can be painful. But it doesn’t cause lasting harm to your intestines. And it doesn’t lead to serious disease such as cancer.
There is no link between IBS and Crohn's disease, ulcerative colitis, or other inflammatory bowel diseases.
The exact cause of IBS isn’t known. Some experts think that if you have IBS your colon may be more sensitive than normal. That means it has a strong reaction to things that should not normally affect it.
When you have IBS, your colon muscles begin to move and tighten uncontrollably (spasm) after only mild stimulation or after normal events such as:
Women with IBS seem to have more symptoms during their periods. This could mean that the chemicals (reproductive hormones) released during a woman’s menstrual cycle may increase IBS symptoms.
Some things can make IBS symptoms worse. The 2 things most likely to make your IBS symptoms worse are the foods you eat and having emotional stress.
You are more likely to be at risk for IBS if you:
Each person’s symptoms may vary. Some of the most common symptoms include:
The symptoms of IBS may look like other health problems. Always see your doctor to be sure.
Your health care provider will look at your past health and give you a physical exam. He or she will also do lab tests to check for infection and for redness and swelling (inflammation).
There are usually no physical signs to tell for sure that you have IBS. There is also no exact test for IBS.
Your health care provider will do lab tests and imaging tests to make sure that you don’t have other diseases. These tests may include the following:
Your health care provider will create a care plan for you based on:
Treatment for IBS may include:
Good fiber sources may include:
Whole wheat bread, granola bread, wheat bran muffins, Nutri-Grain waffles, popcorn
Bran Flakes, Raisin Bran, Shredded Wheat, Frosted Mini Wheats, oatmeal, Mueslix, granola, oat bran
All-Bran, Bran Buds, Corn Bran, Fiber One, 100% Bran
Beets, broccoli, Brussels sprouts, cabbage, carrots, corn, green beans, green peas, acorn and butternut squash, spinach, potato with skin, avocado
Apples with peel, dates, papayas, mangos, nectarines, oranges, pears, kiwis, strawberries, applesauce, raspberries, blackberries, raisins
Cooked prunes, dried figs
Peanut butter, nuts
Baked beans, black-eyed peas, garbanzo beans, lima beans, pinto beans, kidney beans, chili with beans, trail mix
The diarrhea and constipation that occur with IBS can cause hemorrhoids. If you already have hemorrhoids, they may get worse.
Your quality of life may be affected by IBS, because the symptoms may limit your daily activities.
Irritable bowel syndrome (IBS) refers to a disorder that involves abdominal pain and cramping, as well as changes in bowel movements.
Pancreatic cancer is the fourth most common cause of cancer death in the U.S. Pancreatic cancer occurs when a cell in the pancreas is damaged and this malignant (cancer) cell starts to grow out of control.
There are several types of pancreatic cancers, including the following:
Adenocarcinoma of the pancreas. The most common pancreatic cancer, which occurs in the lining of the pancreatic duct.
Adenosquamous carcinoma. A rare pancreatic cancer.
Squamous cell carcinoma. A rare pancreatic cancer.
Risk factors for pancreatic cancer include:
Age. Most pancreatic cancer occurs in people over the age of 55.
Smoking. Heavy cigarette smokers are 2 or 3 times more likely than nonsmokers to develop pancreatic cancer.
Obesity and physical inactivity. Pancreatic cancer is more common in people who are very overweight and in people who don't get much physical activity.
Diabetes. Pancreatic cancer occurs more often in people who have type 2 diabetes than in those who do not.
Gender. More men than women are diagnosed with pancreatic cancer.
Race. African-Americans are more likely than Asians, Hispanics, or whites to be diagnosed with pancreatic cancer.
Family history. The risk for developing pancreatic cancer is higher if a person's mother, father, or a sibling had the disease.
Cirrhosis of the liver. People with cirrhosis have a higher risk of pancreatic cancer.
Workplace exposures. Exposure to certain occupational pesticides, dyes, and chemicals used in the metal industry may increase the risk of pancreatic cancer.
Some genetic syndromes. Certain inherited gene mutations, such as in the BRCA2 gene, increase the risk of pancreatic cancer.
Chronic pancreatitis. Long-term inflammation of the pancreas has been linked with increased risk for pancreatic cancer.
The following are the other most common symptoms of pancreatic cancer. However, each person may experience symptoms differently. Symptoms may include:
Pain in the upper abdomen (belly) or upper back
Jaundice (yellow skin and eyes, and dark urine)
Extreme tiredness (fatigue)
An enlarged abdomen from a swollen gallbladder
Pale, greasy stools that float in the toilet
The symptoms of pancreatic cancer may be a lot like those of other conditions or medical problems. Always consult your doctor for a diagnosis.
In addition to a complete medical history and physical examination, diagnostic procedures for pancreatic cancer may include the following:
Ultrasound. A diagnostic imaging technique that uses high-frequency sound waves to create an image of the internal organs. Ultrasounds are used to view internal organs of the abdomen such as the liver, pancreas, spleen, and kidneys and to assess blood flow through various vessels. The ultrasound may be done using an external or internal device:
Transabdominal ultrasound. The technician places an ultrasound device on the abdomen to create the image of the pancreas.
Endoscopic ultrasound (EUS). The doctor inserts an endoscope, a small, flexible tube with an ultrasound device at the tip, through the mouth and stomach, and into the small intestine. As the doctor slowly withdraws the endoscope, images of the pancreas and other organs are made.
Computed tomography scan (CT or CAT scan). A diagnostic imaging procedure that uses a combination of X-rays and computer technology to produce horizontal, or axial, images (often called slices) of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general X-rays.
Magnetic resonance imaging (MRI). A diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body.
Endoscopic retrograde cholangiopancreatography (ERCP). A procedure that allows the doctor to diagnose and treat problems in the liver, gallbladder, bile ducts, and pancreas. The procedure combines X-ray and the use of an endoscope, a long, flexible, lighted tube. The scope is guided through the patient's mouth and throat, then through the esophagus, stomach, and duodenum (first part of the small intestine). The doctor can examine the inside of these organs and detect any abnormalities. A tube is then passed through the scope, and a dye is injected that will allow the bile and pancreatic ducts to be seen on an X-ray.
Percutaneous transhepatic cholangiography (PTC). A needle is put through the skin and into the liver where the dye (contrast) is injected so that the bile duct structures can be seen by X-ray. This test is generally only done if an ERCP cannot be done.
Pancreas biopsy. A procedure in which a sample of pancreatic tissue is removed (with a needle or during surgery) for examination under a microscope.
Special blood tests
Positron emission tomography (PET). A type of nuclear medicine procedure. For this test, a radioactive substance, usually bound to a type of sugar, is injected through a vein before the body is scanned. The radioactive sugar collects in cancer cells, which will show up on images. This test is not as specific as CT scanning, and is not used alone to diagnose pancreatic cancer. A PET scan is often done in combination with a CT scan.
Specific treatment for pancreatic cancer will be determined by your doctor based on:
Location and extent of the disease
Type of cancer
Your tolerance of specific medicines, procedures, or therapies
Depending on the type and stage, pancreatic cancer may be treated with the following:
Surgery. This treatment may be necessary to remove the tumor, a section, or the entire pancreas and often parts of other organs. The type of surgery depends on the stage of the cancer, the location and size of the tumor, and the person's health. Types of surgery for pancreatic cancer include the following:
Whipple procedure. This procedure involves removal of the head of the pancreas, part of the small intestine, the gallbladder and part of the common bile duct, part of the stomach, and lymph nodes near the head of the pancreas. Most pancreatic tumors occur in the head of the pancreas, so the Whipple procedure is the most commonly performed surgical procedure for pancreatic cancer.
Distal pancreatectomy. If the tumor is located in the body and tail of the pancreas, both of these sections of the pancreas will be removed, along with the spleen.
Total pancreatectomy. The entire pancreas, part of the small intestine and stomach, the common bile duct, the spleen, the gallbladder, and some lymph nodes will be removed. This type of operation is not done often.
Palliative surgery. For more advanced cancers, surgery may be done not to try to cure the cancer, but to relieve problems such as a blocked bile duct.
External radiation (external beam therapy). A treatment that precisely sends high levels of radiation directly to the cancer cells. The machine is controlled by the radiation therapist. Since radiation is used to kill cancer cells and to shrink tumors, special shields may be used to protect the tissue surrounding the treatment area. Radiation treatments are painless and usually last a few minutes. Radiation therapy may be given alone, or in combination with surgery and/or chemotherapy.
Chemotherapy. The use of anticancer drugs to kill cancer cells. In most cases, chemotherapy works by interfering with the cancer cell’s ability to grow or reproduce. Different groups of drugs work in different ways to fight cancer cells. The oncologist will recommend a treatment plan for each individual. Chemotherapy may be given alone, or in combination with surgery and radiation therapy.
Medication (to relieve or reduce pain)
Long-term prognosis for individuals with pancreatic cancer depends on the size and type of the tumor, lymph node involvement, and degree of metastases (spreading) at the time of diagnosis.
Pancreatic cancer begins in the pancreas. The cause is unknown, but it is more common in smokers and in obese people.
Diarrhea is when your stools are loose and watery. You may also need to go to the bathroom more often.
Diarrhea is a common problem. It may last 1 or 2 days and goes away on its own.
If diarrhea lasts more than 2 days it may mean you have a more serious problem.
Diarrhea may be either:
Diarrhea may be caused by many things, including:
Many people get traveler's diarrhea. This happens when you have food or water that is not safe because of bacteria, parasites, and even food poisoning.
Severe diarrhea may mean you have a serious disease. See your health care provider if your symptoms don’t go away or if they keep you from doing your daily activities. It may be hard to find out what is causing your diarrhea.
Each person’s symptoms may vary. Symptoms of diarrhea may include:
Dehydration is a serious side effect of diarrhea. Symptoms include:
Diarrhea symptoms may look like other health problems. Always see your doctor to be sure.
To see if you have diarrhea, your health care provider will give you a physical exam and ask about your past health. You may also have lab tests to check your blood and urine.
Other tests may include:
Your health care provider will make a care plan for you based on:
In most cases you will need to replace the fluids you have lost.
You may also need a medicine that fights infection (antibiotic) if a bacterial infection is causing your diarrhea.
Having good personal habits can keep you from getting diarrhea caused by bacteria or a virus. It is important to:
When you are traveling, make sure anything you eat and drink is safe. This is even more important if you travel to developing countries.
Travel safety tips for water and other liquids include:
Travel safety tips for food include:
In most cases diarrhea is a short-term problem. Often it only lasts for a few days. Be sure to take plenty of liquids when you’re having a bout of diarrhea.
Some health problems can make diarrhea last longer or keep coming back. These include inflammatory bowel disease and irritable bowel syndrome. If another health problem is causing your diarrhea, follow your health care provider’s advice for treating that problem.
Call your health care provider if:
Diarrhea that lasts for more than two weeks is considered chronic. In an otherwise healthy person, chronic diarrhea can be a nuisance.
Crohn's disease occurs when there is redness and swelling (inflammation) and sores along your digestive tract. It is part of a group of diseases known as inflammatory bowel disease or IBD.
Crohn’s disease is a long-term, chronic illness that may come and go at different times in your life. In most cases it affects the small intestine, most often the lower part called the ileum. In some cases it affects both the small and large intestines.
Sometimes the inflammation may be along your whole digestive tract. This includes your mouth, your food pipe or esophagus, your stomach, the first part of your small intestine or duodenum, your appendix, and your anus.
Experts don’t know what causes Crohn's disease. It may be that a virus or a bacteria affects the body's infection-fighting system (immune system). The immune system may create an abnormal inflammation reaction in the intestinal wall that does not stop.
Many people with Crohn’s disease have abnormal immune systems. But experts don’t know if immune problems cause the disease. They also don’t know if Crohn’s disease may cause immune problems. Stress does not seem to cause Crohn's disease.
Crohn's disease may happen at any age. It most often affects people ages 15 to 35 years old. It affects men and women equally.
You may be more at risk for Crohn’s disease if you:
Each person’s symptoms may vary. Symptoms may include:
You may have no symptoms for a long time, even years. That is called being in remission. There is no way to know when remission may occur or when your symptoms will return.
The symptoms of Crohn's disease may look like other health problems. Always see your healthcare provider to be sure.
You may be checked for signs of Crohn's disease if you have had long-term or chronic:
Your healthcare provider will look at your past health and give you a physical exam.
Other tests for Crohn's disease may include the following:
Your healthcare provider will create a care plan for you based on:
There is no cure for Crohn's disease. But there are some things that can help to control it. Treatment has 3 goals:
Treatment may include:
Surgery may help to reduce long-term or chronic symptoms that don’t get better with therapy. Surgery may also fix some problems such as a blocked intestine, a hole or perforation, an abscess, or bleeding.
Types of surgery may include:Draining abscesses in or near fistulas. An abscess is a collection of pus or infection. Treatment includes antibiotics, but sometimes surgery is needed.
Crohn’s disease may cause other health problems. These may include:
Common symptoms of malabsorption include the following:
An inflammatory disease which may affect any part of the gastrointestinal tract, causing a wide variety of symptoms.
Gastroesophageal reflux disease (GERD) is a digestive disorder that is caused by gastric acid flowing from the stomach into the esophagus.
Gastroesophageal refers to the stomach and esophagus, and reflux means to flow back or return. Gastroesophageal reflux (GER) is the return of acidic stomach juices, or food and fluids, back up into the esophagus.
The following is the most common symptom of GERD. However, each individual may experience symptoms differently.
Heartburn, also called acid indigestion, is the most common symptom of GERD. Heartburn is described as a burning chest pain that begins behind the breastbone and moves upward to the neck and throat. It can last as long as two hours and is often worse after eating. Lying down or bending over can also result in heartburn.
Most children younger than 12 years of age, and some adults, diagnosed with GERD will experience a dry cough, asthma symptoms, or trouble swallowing, instead of heartburn. Heartburn pain is less likely to be associated with physical activity.
The symptoms of GERD may resemble other medical conditions or problems. Always consult your doctor for a diagnosis.
GERD typically occurs when acid from the stomach backs up into the esophagus. The lower esophageal sphincter (LES), a muscle located at the bottom of the esophagus, opens to let food in and closes to keep it in the stomach. When this muscle relaxes too often or for too long, acid refluxes back into the esophagus, causing heartburn.
Other lifestyle contributors to GERD may include the following:
Consuming certain foods, such as citrus,chocolate, fatty, and spicy foods
Use of nonsteroidal anti-inflammatory (NSAIDs) drugs, such as aspirin and ibuprofen
Other conditions associated with heartburn may include the following:
Gastritis. This is inflammation of the stomach lining
In addition to a complete medical history and physical examination, diagnostic procedures for GERD may include the following:
Esophagogastroduodenoscopy (also called EGD or upper endoscopy). An EGD (upper endoscopy) is a procedure that allows the doctor to examine the inside of the esophagus, stomach, and duodenum. A thin, flexible, lighted tube, called an endoscope, is guided into the mouth and throat, then into the esophagus, stomach, and duodenum. The endoscope allows the doctor to view the inside of this area of the body, as well as to insert instruments through a scope for the removal of a sample of tissue for biopsy (if necessary).
Bernstein test. A test that helps to confirm that the symptoms are a result of acid in the esophagus. The test is performed by dripping a mild acid through a tube placed in the esophagus.
Esophageal manometry. This test helps determine the strength of the muscles in the esophagus. It is useful in evaluating gastroesophageal reflux and swallowing abnormalities. A small tube is guided into the nostril, then passed into the throat, and finally into the esophagus. The pressure the esophageal muscles produce at rest is then measured.
pH monitoring. This measures the acidity inside of the esophagus. It is helpful in evaluating gastroesophageal reflux disease (GERD). A thin, plastic tube is placed into a nostril, guided down the throat, and then into the esophagus. The tube stops just above the lower esophageal sphincter, which is at the connection between the esophagus and the stomach. At the end of the tube inside the esophagus is a sensor that measures pH, or acidity. The other end of the tube outside the body is connected to a monitor that records the pH levels for a 24 to 48 hour period. Normal activity is encouraged during the study, and a diary is kept of symptoms experienced, or activity that might be suspicious for reflux, such as gagging or coughing. It is also recommended to keep a record of the time, type, and amount of food eaten. The pH readings are evaluated and compared to the patient's activity for that time period.
Specific treatment for GERD will be determined by your doctor based on:
Extent of the condition
Expectations for the course of the condition
In many cases, GERD can be relieved through diet and lifestyle changes, as directed by your doctor. Some ways to manage heartburn include the following:
Monitor the medications you are taking--some may irritate the lining of the stomach or esophagus.
Watch food intake and limit fried and fatty foods, peppermint, chocolate, alcohol,citrus fruit and juices, tomato products, and caffeinated drinks, such as coffee, soda pop, and energy drinks. .
Eat smaller portions.
Watch consumption of alcohol.
Do not lie down or go to bed right after a meal. Instead, wait a couple of hours.
Lose weight, if necessary.
Elevate the head of the bed 6 inches by placing bricks or cinderblocks under the legs of the bed.
Take an antacid, as directed by your doctor.
Ask your doctor about use of over-the-counter medicines called "H2-blockers" and "protein pump inhibitors". Formerly available only by prescription, these drugs can be taken before eating to prevent heartburn from occurring. Also, promotility medications, which help to empty food from the stomach, may be prescribed by your doctor.
Occasionally, a surgical procedure called fundoplication may be performed to help keep the esophagus in proper position and prevent reflux.
A condition in which the liquid content of the stomach backs up into the esophagus.
Ulcerative colitis is part of a group of diseases called inflammatory bowel disease (IBD).
It is when the lining of your large intestine (the colon or large bowel) and your rectum become red and swollen or inflamed. In most cases the inflammation begins in your rectum and lower intestine and moves up to the whole colon.
Ulcerative colitis does not normally affect the small intestine. But it can affect the lower section of your small intestine (the ileum).
The inflammation causes diarrhea, making your colon empty itself often. As the cells on the lining of the colon die and come off, open sores or ulcers form. These ulcers may cause pus, mucus, and bleeding.
In most cases ulcerative colitis starts when you are between the ages of 15 and 30 years old. Sometimes children and older people get it. It affects both men and women and seems to run in some families (is hereditary).
Ulcerative colitis is a long-term, chronic disease. There may be times when your symptoms go away and you are in remission for months or even years. But the symptoms will come back.
If only your rectum and lower colon are affected, your risk of colon cancer is not higher than normal. Your risk is higher than normal if the disease affects your whole colon.
In rare cases, when severe problems occur, ulcerative colitis can lead to death.
Experts don’t know what causes ulcerative colitis.
It may be that a virus or a bacteria affects the body's infection-fighting system (immune system). The immune system may create abnormal redness and swelling (inflammation) in the intestinal wall that does not go away.
Many people with ulcerative colitis have abnormal immune systems. But experts don’t know if immune problems cause the disease. They also don’t know if ulcerative colitis may cause immune problems.
Having stress or being sensitive to some foods does not seem to cause ulcerative colitis.
Right now there is no cure, except for surgery to remove the colon.
Some things may make you at higher risk for ulcerative colitis. These include your:
Each person’s symptoms may vary. The most common symptoms include:
In some cases symptoms may also include:
The symptoms of ulcerative colitis may look like other health problems. Always see your health care provider to be sure.
Your health care provider will give you a physical exam and do some blood tests. The blood tests will check if you don’t have enough healthy red blood cells (anemia). They will also check if your white blood cell count is high. This is a sign of redness and swelling (inflammation).
Other tests for ulcerative colitis include:
There is no special diet for ulcerative colitis. But you may be able to manage mild symptoms by not eating foods that seem to upset your intestines.
Medical treatment may include:
There are several types of surgery, including the following:
Ulcerative colitis is a long-term, chronic condition. It can lead to problems over time, including:
Call your health care provider right away if:
Is a group of inflammatory conditions of the large intestine and small intestine.
The following are the latest statistics available from the Centers for Disease Control and Prevention and the American Liver Foundation:
Cirrhosis and other chronic liver diseases are common disease-related causes of death in the U.S. Approximately 31,000 people in the U.S. die each year from cirrhosis.
The vast majority of cases of cirrhosis could be prevented by eliminating chronic alcohol abuse.
Approximately 2.7 to 3.9 million people in the U.S. are chronically infected with the hepatitis C virus. About 16,000 people die of hepatitis C annually in the U.S.
Hepatitis B kills approximately 3,000 people in the U.S. annually, and 1.2 million people in the U.S. are infected with the virus.
The term "liver disease" applies to many diseases and disorders that cause the liver to function improperly or cease functioning.
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