Bacterial Overgrowth

Overview:

Bacterial overgrowth syndrome is a condition associated with an increased number and/or type of bacteria in the upper gastrointestinal tract.

Small bowel bacterial overgrowth may result from structural abnormalities such as diverticula (outpouchings) or strictures (narrowing), abnormal motility, or motor function from diseases such as diabetes, scleroderma, or Crohn’s disease, or from prior gastrointestinal surgery.

Symptoms:

Affected patients may have one or more symptoms including bloating, abdominal discomfort, watery diarrhea, and weight loss.

Damage to the small intestine may occur and interfere with absorption of nutrients and vitamins.

Testing:

The diagnosis is made by breath testing or by culturing bacteria from the small intestine.

Treatment:

Treatment includes eliminating any condition which may predispose the patient to bacterial overgrowth and antibiotics to reduce the number of bacteria.

Celiac Sprue

Overview:

Celiac Sprue, also known as gluten sensitive enteropathy, is a condition that causes damage to the small intestine when foods containing gluten are eaten.

When people with celiac disease eat foods containing gluten, their immune system acts inappropriately and forms antibodies to gluten that attack and damage the lining of the small intestine. This injury prevents proper absorption of nutrients, vitamins, and minerals.

Symptoms:

Symptoms of celiac disease include bloating, abdominal pain, diarrhea, and weight loss. Malabsorption can result in weak bones, anemia and malnutrition.

Testing:

Celiac disease can be diagnosed by testing for abnormal antibodies in the blood or by biopsying the small intestine using an endoscope (a small flexible tube passed through the mouth into the upper digestive tract).

Treatment:

The disease is treated by eliminating all foods containing gluten (wheat, rye, barley, and oats) from the diet.

Crohn’s Disease

Overview

Crohn’s disease is a type of inflammatory bowel disease that can affect any part of the gastrointestinal tract.  Inflammation, ulcers, and narrowing of the digestive tract occur because the body’s immune system is inappropriately attacking the lining of the digestive tract.  Crohn’s disease most commonly occurs in young people, but can also be seen later in life.

Symptoms

Many patients with Crohn’s disease will have symptoms present for many years prior to diagnosis.  The degree and nature of the symptoms is dependent upon the location of the disease in the gastrointestinal tract.  Typical symptoms can include nausea and vomiting, abdominal pain and diarrhea.  Symptoms outside of the digestive tract may occur as well and include eye pain, skin rash, mouth ulcers, and arthritis.  Patients with Crohn’s disease are also at an increased risk for developing gall stones and kidney stones.

Testing

Crohn’s disease is most commonly detected by performing a colonoscopy or x-ray imaging studies of the abdomen, such as an upper GI series, CT scan, or MRI scan.  Blood tests may also be used to detect evidence of inflammation, anemia and malnutrition, which may all be seen in patients with Crohn’s disease.

Treatment

There is no cure for Crohn’s disease, but medications can be used to achieve remission and relieve symptoms.  The specific medications used to treat Crohn’s disease are dependent upon the disease location and severity.  Dietary modification is often helpful in minimizing symptoms.  Patients with narrowing of the digestive tract or active inflammation generally feel better when they consume a diet low in fiber.  A variety of medications such as Mesalamine, corticosteroids, immunomodulator medications (Imuran or 6 Mercaptopurine) and biologic therapy (Remicade, Humira, Cimzia) can be used to achieve remission.  In patients who fail to respond to medical therapy, surgery may be required to remove a diseased portion of the digestive tract; however, surgery is not curative and the disease will frequently recur over time.

Duodenal Ulcer

Overview:

Duodenal Ulcer is an open sore on the lining of the duodenum, the first portion of the small intestine.

Duodenal ulcers most commonly occur in patients taking aspirin or anti-inflammatory drugs (NSAIDS) or in people infected with a bacteria called Helicobacter pylori (H. pylori).

Duodenal ulcers may be complicated by bleeding, perforation (a hole through the wall of the intestine) or stricture formation (a narrowing).

Symptoms:

Patients with an ulcer often complain of a burning or gnawing pain in the upper abdomen, especially after eating. Other symptoms may include nausea, vomiting or bleeding (vomiting blood or passing black or bloody stools).

Testing:

Duodenal ulcers can be diagnosed by x-rays or by passing a flexible tube through the mouth into the esophagus, stomach and duodenum to directly visual the lining of the duodenum (an endoscopy).

Treatment:

Duodenal ulcers are easily treated by medications that reduce acid production. Patients with Helicobacter pylori (H. pylori) infection should also receive antibiotic therapy to eliminate the infection from the stomach, as this will reduce the risk of ulcer recurrence.

Small Bowel Obstruction

Overview:

Small Bowel Obstruction is a blockage of the small intestine. It prevents food, fluid and gas from passing normally through the digestive tract.

Symptoms:

Symptoms of small bowel obstruction include cramping, abdominal pain, nausea, vomiting, abdominal bloating and distension, and an inability to pass gas or have a bowel movement.

Possible causes of bowel obstruction include scar tissue from previous surgery (adhesions), hernias, tumors, radiation therapy and Crohn’s disease.

Testing:

The diagnosis is made by and xray of the abdomen called and obstruction series.   Additional testing such as a CT scan or small bowel follow thru xray may be needed to better define the source of obstruction.

Treatment:

Initial treatment typically includes hospitalization, intravenous fluids, and medications to relieve pain and nausea. A thin plastic tube may be passed through the nose into the stomach (NG tube) to remove fluid and gas trapped above the obstruction. If these measures are not effective surgery may be necessary to relieve the obstruction.