Heartburn & Gastroesophageal Reflux Disease (GERD) Explained:

Heartburn & Gastroesophageal Reflux Disease (GERD) Explained:

Heartburn is a common symptom but doesn’t necessarily mean you have a disease. Heartburn is a typical symptom of reflux, or flow of gastric contents into the esophagus. Most patients feel a burning pain or pressure like pain around the sternum that can radiate up to the throat and mouth. Some experience only regurgitation or reflux with bitter or metallic taste in the mouth along with small particles of food. Reflux is a normal part of physiology, however, it is considered a disease (Gastroesophageal Reflux Disease or GERD) when symptoms become frequent such as two or more times per week. This article explains some of the common treatments for GERD, as well as indications for endoscopy and surgical referral.

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AETNA is Now Covering Colon Cancer Screening at Age 45

AETNA is Now Covering Colon Cancer Screening at Age 45

The American Cancer Society recently updated its recommendations on the age at which to start colon cancer screening. This article briefly discusses how one insurance company is ahead of the pack by providing this preventative service at age 45, as opposed to age 50.

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Practical Information for Someone with Acute Diarrhea

Practical Information for Someone with Acute Diarrhea

This is an update to a previous article on acute diarrhea. Diarrhea can be a scary experience as it can be painful, disrupting to work and social life , and sometimes feels like it’s never going to end. This article arms you with some practical information on acute diarrhea to help you get through a tough experience.

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What's causing my abdominal pain? When size does matter!

Abdominal pain is a common reason to visit a gastroenterologist's office.  The most common scenario I encounter is a patient presenting with right sided abdominal pain after eating.  The intensity and temporal relationship to their meals often allows me to more easily determine the cause. Patients often report pain within 30 minutes to 1 hr of eating.  They find the discomfort peaks after meals and then decreases towards the start of the next meal. They often wake up feeling well. The pain is also often described as a discomfort rather than pain.  Patients often do not have associated symptoms of reflux such as heartburn or regurgitation.  Warning signs such as vomiting, weight loss, diarrhea, prompt a different conversation and work up.

In the absence of warnings signs or signs suggestive of a peptic process or reflux I typically find these patients are over-eating and/or are eating too quickly. Many have a history of anxiety, depression, or other mood disorder.  I will typically have patients try a proton-pump inhibitor for 2-4 weeks and if there is no improvement I have them focus on portion size, time spent eating, and have them reduce the fat and carbohydrate contents of their meals. 

I hypothesize that many of these patients have visceral hypersensitivity. They further have anxiety and busy jobs that require long hours and little time for relaxation.  These factors lead to overeating and rushing. Latenight overeating is also a factor so I encourage each of these patients to take a good look at the quality of their life and encourage them to take more time for themselves.  I remind them to eat protein and complex carbohydrate rich breakfast (fruits , granola, and yogurt) and to have a good sized lunch. They should be cautious to eat slowly and to chew well. I recommend smaller portions at night so they avoid eating large heavy meals prior to laying down. Avoidance of seltzer and sodas is also helpful.

If medication, life-style changes, or dietary modifications do not help I will obtain an abdominal ultrasound and upper endoscopy to assess for organic causes.  There are a select group of patients who have already had these tests so I do not repeat them.  If these tests are unrevealing I will recommend a 4-8 week trial of a tricyclic antidepressant, which will treat the underlying visceral hypersensitivity by modulating the output of the enteric nervous system to the central nervous system. Signals representing stretching of the walls of the digestive tract will dampen and patients will have less discomfort with meals. 


Cyclospora on the rise as cause of watery diarrhea

The CDC just announced that gastrointestinal infections with Cyclospora are on the rise.  

Patients with acute diarrhea, or diarrhea that persists beyond 2 weeks should be tested for this pathogen. 

Doctors need to keep in mind that Cyclospora must be requested specifically as typical stool examinations for ova and parasites do not test for it.

Symptoms of Cyclosporiasis include watery diarrhea that can be profuse, along with bloating, nausea, fatigue, weight loss and flatulence. Other symptoms can include fever, muscle aches (myalgia), and vomiting. The parasite is transmitted from contaminated food or water. Symptoms occur about 7 days after ingestion and can last for a few days to months if left untreated. Treatment is with Bactrim(trimetoprim/sulfamethoxazole), a sulfa drug. Unfortunately, according to the CDC, if you are allergic to sulfa drugs you will need to be monitored for recovery and provided supportive treatments.

FODMAPs in The Press!

I am pleased to see news coverage of the low fodmap "diet."

Many of my patients that I have diagnosed with either Irritable bowel syndrome (#IBS), bloating, or chronic diarrhea have found it helpful.

The term "diet" in association with fodmaps is a misnomer. I feel more like this is a road map to reducing symptoms and improving quality of life. It's important to follow this road map closely with the help of both your gastroenterologist and a dietician experienced in it. 

Keep in mind that anyone with symptoms of bloating, diarrhea, abdominal pain should seek a diagnosis first before assuming they have IBS, as its diagnosis remains at this time one of exclusion. There is no diagnostic test. A physician must first rule out other causes through careful exam and history taking. In some, blood work, imaging, and colonoscopy or endoscopy may be required. 

A Diet Low in FODMAPS Can Improve Symptoms of Bloating in Irritable Bowel Syndrome: Go Low FODMAP!

Irritable bowel syndrome (IBS) affects 1 in 6 people and is characterized by chronic abdominal pain associated with a change in bowel form or frequency. Typically pain or discomfort related to IBS is relieved with bowel movements. Bloating is often a common symptom and one of the many reasons patients come to Gotham Medical Associates. About one third of patients with IBS have a form of IBS in which they are constipated most of the time (IBS-C), while another third of patients have frequent loose stools (IBS-D), the remaining group has mixed symptoms (IBS-M).

The exact causes of IBS are unclear but likely include genetics, environment, stress levels, and diet. If you or someone you know suffers from IBS you may deal regularly with the discomfort of bloating, increased flatus, and irregular bowel movements. All of this can occur despite eating what is considered to be a “healthy diet”. The purpose of this inaugural newsletter is to introduce our patients at Gotham Medical Associates to the FODMAPS, particularly those patients with symptoms of bloating and or those who have been diagnosed with IBS.

What are FODMAPS? FOMDAPS are a group of sugars collectively called Fermentable Oligosacharides Disacharrides, Monoscharrides, and Polyols. These sugars and sugars alcohols vary in size, length and shape. They are ubiquitous in our diet and include the common Disaccharide, lactose, the Monosaccharide fructose, and well as sugar alcohols including sorbitol, xylitol and mannitol. Other less knowns FODMAPS include the fructans, which are longer molecules. 

How do FODMAPS cause symptoms? When FODMAPS are undigested, unabsorbed, or over-abundant they reach the colon and are fermented by the colonic bacteria. In the process of fermentation hydrogen gas and lactic acid are produced. This ultimately leads to bloating, loose stools, and abdominal pain.  For some, and for unclear reasons, this results in constipation and bloating.

Is Gluten a FODMAP? No, in fact, Gluten is a group of proteins found in wheat. It is hypothesized that ingestion of wheat (containing gluten) results in bloating as a result of coincidental FODMAPS found naturally within wheat. 

What is a Low FODMAP diet? The Low FODMAP diet is based on research conducted by the Monash University in Australia. A strict interpretation of the diet would be to exclude all high FODMAP-containing items from the diet for 4-6 weeks and then a “re-challenge” phase whereby foods are reintroduced one-by-one to systematically determine which foods are culprits. This strategy can be restrictive on the diet due to possible excessive dietary exclusions, and the long term risk of FODMAP exclusion is not known, thus it should only be attempted under the guidance of a nutritionist with expertise in this area. Gotham Medical Associates can link its patients up with qualified nutritionist if needed.

Visit Gothammedicine.com for more details on the Low FODMAP Diet. 

If you are interested in obtaining a consultation with one of our Gastroenterologists please call 212-227-3688. Our staff will be happy to assist you, your friend or family member!