7975 Lake Underhill Rd., Suite 360
Orlando, FL 32822
3000 N. Orange Ave., Suite C
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PATIENT CORNER
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What is Gas?
Gas mainly comes from two main sources:
Swallowed air and normal breakdown of certain foods by harmless bacteria naturally present in the large intestine.
Gas is made primarily of odorless vapors-carbon dioxide, oxygen, nitrogen, hydrogen, and sometimes methane.
The unpleasant odor of flatulence, the gas that passes through the rectum, comes from bacteria in the large intestine that release small amounts of gases containing sulfur.
Although having gas is common, it can be uncomfortable and embarrassing.
Understanding causes, ways to reduce symptoms, and treatment will help most people find relief.
Everyone has gas and eliminates it by burping or passing it through the rectum.
However, many people think they have too much gas when they really have normal amounts.
Most people produce about 1 to 4 pints a day and pass gas about 14 times a day.
Some of the following will reduce the gas problems:
Avoid eating chewing gum and drinking soda.
Eat slowly
Avoid or decrease the amount of the following foods: beans,
vegetables (such as broccoli, cabbage, Brussels sprouts, onions, artichokes, and asparagus),
fruits (such as pears, apples, and peaches),
whole grains (such as whole wheat and bran),
milk and milk products
Taking digestive enzymes may also reduce the gas.
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Our next Patient Appreciation Day is:
Tuesday, 02/09/10
Time: 8:00am-10:00am
Breakfast will be served!
Please also note your calendars for the following Patient Appreciation Day scheduled for:
Wednesday, 4/14/10
Time: 5:30pm-7:30pm
Join our Physicians and Staff for refreshments and appetizers!
Please R.S.V.P. for both events to 407-384-7388.
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Celiac Disease
Case Studies of Capsule Endoscopy
Patient's Corner:
Dietary Recommendations for Maintaining Good Gastrointestinal Health
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In the previous issue of the newsletter we discussed about colon cancer including epidemiology, signs and symptoms, risk factors and pathophysiology. In this issue diagnosis and treatment of colon cancer will be presented.
Any comments and suggestions can be e-mailed to sseela@dlcfl.com. |
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Differential Diagnosis of Colon Mass
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Malignant Lesions: 
- Primary Adenocarcinoma of Colon
- Lymphoma
- Carcinoid Tumor
- Kaposi's Sarcoma
- Prostate Cancer
- Crohn's Colitis
- Lipoma
- Diverticulitis
- Endometriosis
- Solitary Rectal Ulcer
- Tuberculosis
- Amebiasis
- Infections with Fungi and Protozoa
- Extrinsic Lesion
Diagnostic Tests for Colon Cancer:
- Colonoscopy is the single best test as it also can localize synchronous neoplasms.
- Air contrast barium enema supplemented with Flexible Sigmoidoscopy, but it is less effective.
- Double contrast barium enema or CT colonography is useful in patients with tortuous colons and obstructive lesions.
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Colorectal Cancer Management
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Management of Colon Cancer is based on the stage that can be summarized as follows:
Stage 0: Since cancer has not grown beyond the mucosa, surgery to take out the cancer is all that is needed. This may be accomplished in many cases by polypectomy or local excision through the colonoscope. Colon resection may be necessary if tumor is too big to be removed by local excision.
Stage I:Surgical resection to remove the cancer is the standard treatment.
Stage II: In this stage no nodal involvement is present. Surgical resection is usually the only treatment needed. Radiation or chemotherapy may be recommended. Radiation can be given to the local area of the abdomen where the cancer was growing. Chemotherapy is not standard treatment for this stage of colon cancer and should only be given as part of a clinical trial.
Stage III:This is a more advanced stage. Cancer has spread to nearby lymph nodes, but it has not yet spread to other parts of the body. Surgical resection is the first treatment and then receive chemotherapy with 5-FU and leucovorin. Radiation therapy may be needed if cancer was also large enough to grow into adjacent tissues.
Stage IV: In this stage the cancer has spread to distant organs and tissues such as the liver, lung, peritoneum, or ovary. The goal of surgery (segmental resection or diverting colostomy) in this stage is usually to relieve or prevent blockage of the colon and to prevent other local complications. In some patients with extensive metastases, blockage can be prevented or managed by inserting a stent through the tumor during colonoscopy so that surgery can be avoided. Surgery may not be recommended if overall health status is poor.
Surgery in stage IV is usually not done with the expectation of curing the colon cancer. However, if only a few metastases (usually 5 or fewer) are present in the liver and can be completely removed along with the colon cancer, surgery can help prolong life. Intra arterial chemotherapy may also be recommended. |
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Emerging Technologies: Capsule Endoscopy |
Introduction
Modern endoscopic techniques have revolutionized the diagnosis and treatment of diseases of the upper gastrointestinal tract (esophagus, stomach, and duodenum) and the colon. The last remaining frontier has been the small intestine:
- The small intestine has been difficult to evaluate.
- Upper GI series with small bowel follow-through is time consuming and less effective.
- Capsule Endoscopy is a revolutionary diagnostic test, especially for small bowel.
- It allows direct visualization of small bowel mucosa.
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Capsule Endoscopy Procedure |
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Capsule endoscopy is a technology that uses a swallowed video capsule to take photographs of the inside of the esophagus, stomach, and small intestine:
- It needs bowel prep similar to colonoscopy
- Patients are asked to swallow a capsule, which is slightly larger than a vitamin pill.
- The capsule contains a battery, camera and a transmitter.
- The capsule takes the pictures of the esophagus, stomach and the entire small bowel as it passes through.
- The photographs are transmitted by the radio transmitter to a small receiver (slightly bigger than a pager) that is worn on the waist of the patient.
- Approximately eight hours later the photographs are downloaded from the receiver to the computer.
- The capsule will be passed out in the stools.
What are the limitations of capsule endoscopy?
While the capsule provides the best means of viewing the inside of the small intestine, there are many inherent limitations and problems with its use, the most important of which is that the capsule does not allow for therapy. Other problems include:
- Abnormalities in some areas of the intestine are missed because of rapid transit of the capsule and blurred, uninterpretable photographs.
- At times, transit is so slow that the capsule examines only part of the small intestine before the battery fails.
- If abnormalities are discovered that require surgical resection or further investigation, it may be difficult to determine exact location in the small intestine the abnormality is and thereby help direct therapy. However this can be estimated.
- If there are strictures in the small bowel the capsule can get stuck that would need surgery. On other hand this will provide a diagnosis that would need surgery anyway.
- May be time consuming, but physicians are getting more experienced.
- Benefits far outweight limitations above described.
What type of diseases can be diagnosed with capsule endoscopy?
Capsule endoscopy continues to improve technically. It has revolutionized diagnosis by providing a sensitive (able to identify subtle abnormalities) and simple (non-invasive) means of examining the inside of the small intestine.
Some common examples of small intestine diseases diagnosed by capsule endoscopy include:
- Angiodysplasis (collections of small blood vessels located just beneath the inner intestinal lining that can bleed intermittently and cause anemia).
- Small intestinal tumors such as lymphoma, carcinoid tumor, small intestinal cancer.
- Crohn's disease of the small intestine.
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Wishing you and your family Happy Valentine's Day on February 14th!
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