by Kate Vanskike
You eat Tums like crazy to keep the acid reflux at bay. You eliminate dairy products in an effort to figure out what’s upsetting your stomach. You’ve just turned 50 and your spouse already wants you to schedule your first colonoscopy.
All of these concern the gastrointestinal system—or the “GI tract”—and can be addressed by a physician specialist called a gastroenterologist.
Here, three Providence GI experts talk about the ways they help patients sort through the potential causes of intestinal discomfort and the unique treatment options available. We also bust myths about colonoscopy, an important preventive screening.
The Latest on Heartburn
Gastroenterologists see a lot of people who complain about acid reflux or heartburn. That’s no surprise, says Eashen Liu, MD (pictured left), the newest member of Providence Adult Gastroenterology in Spokane.
“In reality, everyone refluxes,” she says. “It’s a natural phenomenon that our body uses. What makes it a concern is the frequency and duration.”
People often see their family practice physician for reflux symptoms, and many are put on antacid medication. But if symptoms don’t improve after a month or two of treatment, a visit to a GI specialist is in order.
“I see patients who have continued taking acid reducers without seeing results,” Dr. Liu says. “These medications are used by millions of people, but they do come with adverse reactions [like osteoporosis] that should be addressed. And further, we have great technology to evaluate a person’s reflux and determine whether medication should be used on occasion or ongoing.”
In some cases, the gastroenterologist might recommend that the patient wear a device connected to the esophagus for 24 to 48 hours, to record how often and how long reflux lasts.
“It’s important to learn the realities of a person’s persistent reflux,” cautions Dr. Liu. “Too many patients remain on medications when they no longer need them. Or, they are using the wrong drug altogether, one that doesn’t help to heal the esophagus.”
Radio Waves to the Rescue
“Controlling the acid reflux is key,” says Philip Coff, MD, who has more than 30 years’ experience in medicine. Untreated reflux damages the esophagus—the tube that carries food from the mouth to the stomach—and that is bad news.
Called Barrett’s esophagus, the condition can ultimately progress to esophageal cancer. “It’s a bad cancer without a good prognosis,” Dr. Coff warns, “which is why specialists want to heal the tissue in the esophagus ahead of time.”
Treating that damaged tissue can be done with radiofrequency ablation—a big term for an outpatient procedure that only takes 30 minutes. “RFA,” as it’s called, uses a special instrument with an endoscope to ablate (burn off) the damaged area. Destroying that tissue allows new, healthy tissue to regrow normally within just a few weeks. A sedative helps patients relax without having to receive anesthesia, so they can return to other activities quickly.
The best news? “The success rate with RFA is very high,” says Dr. Coff, “and complications are very uncommon.”
The only downside is that treating Barrett’s successfully requires two to four repeats of the procedure. That’s a small price to pay, however, for staving off esophageal cancer, Dr. Coff says. Drs. Coff and Liu agree: Having a little acid reflux right after a meal is normal, but when it becomes a recurrent, daily ordeal, you should see a gastroenterologist.
The Discomfort of Irritable Bowel Syndrome
Irritable bowel syndrome, or IBS, is the most commonly diagnosed GI disorder. It’s a diagnosis of exclusion, Dr. Liu says. In other words, it’s used to describe a collection of symptoms that otherwise do not fit into another disease process. About one in five Americans has symptoms of irritable bowel syndrome, which include abdominal pain and constipation or diarrhea, or both.
Even the causes of IBS can’t be defined because they’re different for everyone, Dr. Liu says.
“What’s really interesting is the connection between what the brain experiences and what happens in the GI tract,” says Dr. Liu. “People who have suffered physical or emotional trauma, and those who have posttraumatic stress disorder, are at a higher risk for IBS. It’s like the GI system has been assaulted and is unable to recover.”
And that, she says, is a really good reminder that physicians need to have a patient’s full history. “We should be able to talk about the ways trauma has left their body imbalanced,” says Dr. Liu. “There’s real comfort for people in knowing there’s a reason for their symptoms.”
New Treatments for a Host of GI Issues
For many patients with various gastrointestinal problems, advanced treatments are the only way to find comfort. Fortunately, Providence Adult Gastroenterology can handle even the most complicated of conditions.
Wichit Srikureja, MD, focuses on advanced endoscopy, which uses a camera on a flexible tube inserted into the esophagus or bowel to diagnose and treat problems. He offers procedures that patients would otherwise have to travel to Seattle to receive, and he’s seeing patients from a broad tri-state area.
|Wichit Srikureja, MD (pictured, center) says having a team of experienced and compassionate caregivers makes high-tech treatments possible for sufferers of serious GI problems.
Endoscopic ultrasound (EUS) uses ultrasound from inside the body to look at the bile duct, pancreatic cysts and diseases related to the bile duct, and to determine the stage of esophageal, gastric and rectal cancers. Endoscopic retrograde cholangiopancreatography (ERCP) goes inside the bile duct to treat those conditions. Another complicated procedure is the single balloon endoscopy, which uses a much longer scope to go deep into the small bowel.
Ask Dr. Srikureja for a success story and he’ll give you dozens. Take, for example, the woman from Hermiston, Ore., who had excruciating pain from gallstones. She went to two other hospitals for treatment, but her problem remained. Then she came to Spokane where Dr. Srikureja successfully removed the stones with a combination of EUS and ERCP techniques.
Another woman, from southeast Washington, traveled all the way to Seattle when radiation for head and neck cancer left her with such a tight esophagus that she couldn’t swallow. Doctors there wouldn’t offer another treatment after the first stent in her esophagus closed again. She came to Spokane looking for hope and found it with the Providence GI team.
“She still has some difficulty swallowing, but we were able to open up her esophagus enough to improve her quality of life,” says Dr. Srikureja.
Advanced endoscopy may not be glamorous, but it’s life changing—and often lifesaving as well. An 87-year-old woman suffered a severe case of Clostridium difficile (often called C. difficile), a bacterial infection in the colon that causes chronic diarrhea. Over the course of six months, “Anna” would end up in the hospital repeatedly for extreme dehydration because none of the antibiotics was effective in treating her infection.
But Dr. Srikureja had a solution—a rare treatment that proved to be 100 percent effective. Called fecal transplantation, the procedure involved having a healthy family member donate stool, which was then diluted and injected into Anna’s colon. The good bacteria in the healthy feces totally cleaned the bad bacteria out, and within two days, Anna’s chronic diarrhea was gone.
When Dr. Srikureja called to check on her, she said, “Doctor, I’m like a new person.”
The Providence GI team handles a multitude of situations that other physicians have not been able to treat. From treating pancreatic and colon cancers to healing lesions in the stomach, the group is creating a center of excellence that’s drawing patients from a vast region.
“None of these amazing treatments would be possible without a very dedicated and highly trained team of nurses, anesthetists, X-ray technicians and support staff,” says Dr. Srikureja. And, he adds, they wouldn’t be possible without his reliance on a higher power either. “I really believe that God helps when I ask, and that’s why I like to offer to pray with my patients.”
|Tom came to Providence in Spokane, WA, for a colonoscopy that allowed for the early detection and treatment of colon cancer. Years later, he came back for relief from IBS.
Newscaster Katie Couric so badly wanted people to know the importance of colon cancer screening that she had her colonoscopy performed on live television. Still, most of us aren’t crazy about having the exam, even knowing that ours will occur in a much more private environment than hers.
According to the American Cancer Society, more than 50,000 people die from this form of cancer every year. More than 90 percent of people with the disease are age 50 or older. That’s why individuals should start getting checked at that half-century milestone. The good news is, when found early, it’s highly treatable. The bad news: Many people aren’t getting the screening until they have symptoms, when the cancer has already begun its damage.
What’s the hang-up? Many factors keep people from planning that 50th birthday colonoscopy, says Dr. Liu. “Let’s face it—this is an intimate procedure, examining a private area,” she says. “We can’t change that. But we can address some of the other barriers that keep people from doing what they need to do.”
Choose a physician you’re comfortable with. “Find one you can relate to,” Dr. Liu says.
Know your options to prepare for the exam. “Most people think the bowel prep [drinking a jug of awful-tasting stuff] is worse than the exam itself,” she says. “Fortunately, we have alternatives. We can offer the drink in smaller volumes, or allow a patient to do ‘split preparation’ [consuming half a gallon the night before and the other half the morning of the procedure].” Better yet, new products can mix with Gatorade to make them more palatable.
Relax—it’s pain-free. You can choose to be asleep for the procedure if that is more comfortable, so long as you have someone else drive you home afterward. Or, if you prefer to stay awake for the procedure, you can return to work or activities that very same day.
Rest assured that if polyps are found during the screening colonoscopy, the physician can go ahead and remove them immediately, reducing the chance for them to turn into cancer.
“You should not avoid having a colonoscopy because of anxiety about the procedure,” advises Dr. Coff. “We can alleviate your concerns.”