Gastroinestinal disorders occur when the digestive tract (gastrointestinal) does not function properly. As a result, patients may have difficulty digesting food, absorbing nutrients, or having normal bowel movements.

Several body parts, including the mouth, esophagus, stomach, small intestine, large intestine, and anus, make up the digestive (gastrointestinal) tract. The digestive process begins when food enters the mouth.

When a person begins chewing food, digestive enzymes in the saliva break down the food before it is swallowed.

The esophagus is a muscular tube that carries food and liquids from the mouth to the stomach. The stomach contains harsh enzymes that break down food so it can be absorbed by the body.

Food then enters the small intestine, which contains three parts: the duodenum, jejunum, and ileum. Most of digestion occurs in the small intestine because it is responsible for absorbing nutrients from food.

The remaining food then enters the colon, which also has three parts: the cecum, colon, and rectum. The large intestine absorbs any remaining water from indigestible food matter and eliminates the unusable food matter, or waste, from the body. The anus is the external opening of the rectum. It allows waste (feces) to be excreted from the body.

There are many different types of gastrointestinal disorders. Some gastrointestinal disorders affect multiple parts of the digestive tract, while others only affect the esophagus, abdomen/stomach, intestines, or anus/rectum. The severity of gastrointestinal disorders varies significantly, depending on the specific type of the disease. Some disorders, such as indigestion, are mild while others, such as Crohn's disease, are life-long.

DISORDERS THAT AFFECT MULTIPLE PARTS OF THE GASTROINTESTINAL TRACT

Diarrhea: Diarrhea occurs when an individual has loose stools or watery stools. Diarrhea is a symptom of an underlying health problem, such as an infection, that prevents the intestines from properly absorbing nutrients from food. Acute diarrhea lasts a few days and affects nearly everyone at some point in their lives. Chronic diarrhea generally lasts longer than four weeks and may be a sign of a serious condition such as inflammatory bowel disease (IBD) or gastroenteritis.

Diarrhea is usually caused by a viral, bacterial, or parasitic infection. Diarrhea that is caused by an infection (often called infectious diarrhea) may be passed from person to person. Viruses, such as the Norwalk virus, cytomegalovirus, viral hepatitis herpes simplex virus, and rotavirus are the most likely to cause diarrhea. Infants and young children are most likely to develop diarrhea as a result of a rotavirus infection. If an individual consumes food or water that is contaminated with certain bacteria or parasites, he/she may develop diarrhea. This type of diarrhea is often called traveler's diarrhea because it frequently occurs in people who are traveling to developing countries. Common bacterial causes of diarrhea include campylobacter, salmonella, Escherichia coli (E. coli), Shigella dysenteriae, and Clostridium difficile. Common parasites that are known to cause diarrhea include Giardia lamblia and cryptosporidium.

Diarrhea may be caused by a number of other factors, including lactose intolerance, certain medications (especially antibiotics and anti-HIV medications called antiretrovirals), artificial sweeteners called sorbitol and mannitol (commonly found in sugar-free products and many types of chewing gum), surgery, or other gastrointestinal disorders (such as irritable bowel syndrome or IBS).

Symptoms of diarrhea often include frequent and loose stools, abdominal pain or cramping, bloating, fever, excessive thirst, and dehydration. Diarrhea causes dehydration because the body loses water and salts. Infants and young children are at risk of developing severe dehydration as a result of diarrhea. Patient with severe diarrhea may be unable to control the passage of stool, a condition known as fecal incontinence. When a patient experiences frequent, severe, and bloody diarrhea, the condition is often called dysentery.

Diarrhea usually requires little to no medical treatment. Individuals with diarrhea should drink plenty of water. Patients may also benefit from drinks that contain electrolytes, including Pediatric Electrolyte©, Pedialyte©, or Enfalyte©. Individuals should avoid diuretics, such as caffeine, because they worsen symptoms of dehydration. Certain foods, including rice, dry toast, and bananas may help reduce symptoms of diarrhea. In addition, anti-diarrheal medications, such as bismuth subsalicylate (Pepto-bismol©, Bismatrol©, or Kaopectate©), diphenoxylate atropine (Lomotil©, Lofene©, or Lonox©), or loperamide hydrochloride (Imodium©), may also be taken to reduce diarrhea in patients older than three years of age.

If diarrhea continues for longer than four days or blood is present in the stool, patients should visit their healthcare providers to determine the underlying cause. If an infection is causing symptoms, an antimicrobial medication may be prescribed. The specific type, dose, and duration of treatment depend on the severity and type of infection.

Irritable bowel syndrome (IBS): Irritable bowel syndrome (IBS), also called spastic colon, mucous colitis, spastic colitis, nervous stomach, or irritable colon, is a long-term condition that is characterized by abdominal pain, cramping, diarrhea, and constipation. IBS is a functional bowel disorder because the bowel appears normal but does not function properly.

Although the exact cause of irritable bowel syndrome (IBS) is unknown, researchers believe that poor diet, neurotransmitter imbalances, and infections may contribute to the development of the disorder.

The colon contracts (colon motility) to move the contents inside the colon toward the rectum. During this passage, water and nutrients are absorbed into the body and waste is excreted as stool. A few times each day, contractions push the stool down the colon resulting in a bowel movement.

In IBS patients, the muscles of the colon, sphincters, and pelvis do not contract properly. As a result, patients experience constipation or diarrhea. This causes symptoms of abdominal pain, cramping, bloating, and a sense of incomplete stool movement. Symptoms may improve after the patient has a bowel movement.

Health complications arising from IBS include hemorrhoids (aggravated by diarrhea and/or constipation), depression, weight loss, vitamin and mineral deficiencies, and psychosocial problems.

Most people can control symptoms of IBS with diet, stress management, lifestyle modification, and prescribed medications. A medication called loperamide (Imodium©) is commonly used to treat IBS patients with diarrhea. Laxatives, such as polyethylene glycol (Miralax©), sorbitol, and lactulose (Cephulac©), may be used. Phosphate enemas (Fleet Phospho-soda©) and emollient enemas (Colace Microenema©) have also been used. Suppositories, such as bisacodyl (Dulcolax©), may also be taken. The most widely studied drugs for the treatment of abdominal pain are a group of drugs called antispasmodics, which cause muscle relaxation. Commonly used antispasmodics include hyoscyamine (Levsin© or Levsinex©), dicyclomine (Bentyl©), and methscopolamine (Pamine©).

For some patients, however, IBS may be disabling. They may be unable to work, attend social events, or even travel short distances due to urgency to defecate (pass stool) and/or pain in the colon.

Inflammatory bowel disease (IBD): Inflammatory bowel disease (IBD) refers to two chronic diseases that cause inflammation of the intestines: ulcerative colitis and Crohn's disease.

The cause of IBD remains unknown. However, current research indicates that IBD most likely involves a complex interaction of factors, including heredity, the immune system, and antigens in the environment.

The symptoms of these two illnesses are very similar, which often makes it difficult to distinguish between the two. In fact, about 10% of colitis (inflamed colon) cases cannot be diagnosed as either ulcerative colitis or Crohn's disease. When physicians cannot diagnose the specific IBD, the condition is called indeterminate colitis.

IBD causes chronic inflammation in the gastrointestinal tract and may lead to complications, such as colon cancer. The most common symptoms of both ulcerative colitis and Crohn's disease are diarrhea (ranging from mild to severe), abdominal pain, decreased appetite, and weight loss. If the diarrhea is extreme, it may lead to dehydration, increased heartbeat, and decreased blood pressure. As food moves through inflamed areas of the gastrointestinal tract, it may cause bleeding. Continued loss of blood in the stool may result in low levels of iron in the blood, a condition called anemia.

In addition, Crohn's disease may also cause intestinal ulcers, fever, fatigue, arthritis, eye inflammation, skin disorders, and inflammation of the liver or bile ducts.

Ulcers may extend through the intestinal wall creating a fistula (an abnormal opening). If an internal fistula develops, food may not reach the area of the intestine involved in absorption. External fistulas in the anus may result in continuous bowel drainage onto the skin. Fistulas may also become infected, a condition that can be life threatening if left untreated. Symptoms of a fistula may include pain, fever, tenderness, itching, and general feeling of discomfort.

Toxic megacolon is a rare, but potentially life-threatening complication of severe IBD. Toxic megacolon is characterized by a dilated colon (megacolon), abdominal distension (bloating), and occasionally fever, abdominal pain, or shock. In severe cases, the condition may cause the colon to become paralyzed. Toxic megacolon prevents the individual from having bowel movements. If the condition is not treated, the colon may rupture, resulting in peritonitis, a life-threatening condition that requires emergency surgery.

Other complications may include dehydration, malnutrition, obstruction, ulcers, and anal fissures.

Many medications are used to treat IBD. Anti-inflammatories, such as sulfasalazine (Azulfidine©), mesalamine (e.g. Asacol© or Rowasa©), olsalazine (Dipentum©), and balsalazide (Colazal©), help reduce inflammation. Corticosteroids, such as prednisone (Deltasone©), have been shown to effectively reduce inflammation of the gastrointestinal tract in IBD patients. Medications, called immunosuppressants, have been used to treat IBD. Examples include azathioprine (Imuran©), mercaptopurine (Purinethol©), cyclosporine (e.g. Neoral© or Sandimmune©), and infliximab (Remicade©). A fiber supplement, such as psyllium powder (Metamucil©) or methylcellulose (Citrucel©), may help relieve symptoms of mild to moderate diarrhea. Inflammation may cause the intestines to narrow, resulting in constipation. Laxatives may be taken to relieve symptoms of constipation. Oral laxatives such as Correctol© have been used. A qualified healthcare provider may recommend acetaminophen (Tylenol©) to relieve mild pain. Avoid nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil© or Motrin©) or naproxen (Aleve©), as researchers have found a strong relationship between NSAIDs and IBD flare-ups. Therefore, NSAIDs should not be taken.

If all other treatments fail to relieve symptoms, a qualified healthcare provider may recommend surgery. Surgery is more commonly performed in ulcerative colitis patients because inflammation is limited to the colon. During the procedure, the entire colon and rectum is removed (proctocolectomy).

A new procedure, known as ileoanal anastomosis, eliminates the need for recovered patients to wear a bag to collect stool. This new procedure involves attaching a pouch directly to the anus, allowing the patient to expel waste normally. However, the patient may have as many as five to seven watery bowel movements a day because there is no longer a colon to absorb water. Between 25 and 40% of patients with ulcerative colitis eventually need surgery.

Indigestion (non-ulcer dyspepsia): Indigestion, also called non-ulcer dyspepsia (upset stomach), is a general term that describes discomfort in the upper abdomen. Patients who have indigestion typically suffer from several symptoms, including heartburn, bloating, belching, and nausea.

Indigestion affects nearly everyone from time to time, and it is not considered a serious health condition.

Indigestion may occur if a patient eats too much of a particular food (especially fatty or spicy foods) or eats too quickly. Alcohol, stress, and anxiety may also contribute to indigestion.

Because indigestion is such a common condition, it generally does not require a diagnosis. However, patients who frequently experience indigestion should visit their healthcare providers because it may be a symptom of an underlying medical condition, such as acid reflux disease.

Antacids, such as calcium carbonate (e.g. Tums©, Alka-Mints©, and Rolaids Calcium Rich©), may be taken by mouth to treat symptoms of heartburn and upset stomach. Anti-flatulant medications, such as alpha-galactosidase enzyme (Beano©), simethicone (Gas-X©, Genasyme©, or Mylanta© Gas Relief), may be taken by mouth to prevent and/or treat symptoms of bloating and flatulence (gas).

Monosodium glutamate symptom complex (Chinese restaurant syndrome): Monosodium glutamate symptom complex, also called Chinese restaurant syndrome, is a group of symptoms that some patients develop after eating Chinese foods. Symptoms typically include flushing, headache, sweating, facial pain or swelling, numbness or burning around the mouth, and chest pain.

Although it has been suggested that a food additive in Chinese food, called monosodium glutamate (MSG), may cause the reaction, it has not been proven. Since there is limited scientific data about the condition, it remains unknown if the frequency and amount of MSG exposure increases or decreases an individual's risk of experiencing symptoms.

Patients generally do not require treatment for monosodium glutamate symptom complex because symptoms are mild and resolve on their own. However, if patients experience chest pain or difficulty breathing, they should seek immediate medical treatment because this may be a sign of a serious allergic reaction called anaphylaxis.

Diverticulosis and diverticulitis: Diverticulosis refers to small, bulging pouches (diverticula) in any part of the digestive tract. Diverticula are most often found in the large intestine (colon). However, they may also develop in the esophagus, stomach, or small intestine.

Diverticulosis is a common condition that affects more than half of Americans who are older than 60 years of age. Most patients do not know they have diverticulosis because they do not experience any signs or symptoms of the condition.

However, if the diverticula become infected or inflamed, the condition is called diverticulitis. Patients with diverticulitis typically experience intense abdominal pain, nausea, bloating, bleeding from the rectum, tenderness in the abdomen, difficulty or pain during urination, fever, and changes in bowel movements.

Diverticulitis is usually diagnosed after a computerized tomography (CT) scan is performed. A machine produces images of the internal organs in the abdomen. Inflamed diverticula will be apparent if the patient has diverticulitis.

Mild cases of diverticulitis can be treated with rest, changes in the diet, and antibiotics. Patients should not eat any fiber, including whole grains, fruits and vegetables, for several days. This restricted diet gives the colon time to heal. Antibiotics, such as metronidazole (Flagyl©), moxifloxacin (Avelox©), ciprofloxacin (Cipro©), amoxicillin/clavulanate (Augmentin©), and Imipenem (Primaxin©) are commonly prescribed to kill the bacteria that are infecting the diverticula.

Serious cases of diverticulitis may eventually require surgery to remove the infected part of the colon.

Peptic ulcers: An ulcer is an open sore or break in a body tissue. Peptic ulcers develop on the inside lining of the stomach (gastric peptic ulcer), upper small intestine (duodenal peptic ulcer), or esophagus (esophageal peptic ulcer).

Researchers have found that a bacterial infection with Helicobacter pylori is the most common cause of gastric and duodenal ulcers. Some medications, including aspirin and nonsteroidal anti-inflammatory drugs (NSAIDS), such as ibuprofen (Motrin© or Advil©), may also cause gastric and duodenal ulcers. In addition, smoking tobacco increases a patient's risk of developing ulcers. It remains unclear whether or not excessive alcohol consumption leads to an increased risk of ulcers.

Esophageal peptic ulcers are usually associated with acid reflux disease.

Contrary to popular beliefs, diet and stress do not cause peptic ulcers. However, high levels of stress and acid foods and beverages, such as coffee, may aggravate symptoms of peptic ulcers.

Peptic ulcers generally cause pain that may be felt anywhere from the chest to the stomach. Pain may last a few minutes to several hours. Symptoms are often the worst when the stomach is empty or at night. They may also come and go for a few days to weeks. Less common symptoms include vomiting blood, dark blood in the stools, nausea, vomiting, and unexplained weight loss.

Most ulcers are diagnosed after an X-ray is taken of the upper gastrointestinal tract. An endoscopy may also be performed. During the procedure, a thin tube with a camera (endoscope) is inserted into the mouth and into the digestive tract. This allows the healthcare provider to see if ulcers are present.

Patients take antibiotics, such as amoxicillin (Amoxil©), clarithromycin (Biaxin©), or metronidazole (Flagyl©), if an H. pylori infection is causing peptic ulcers. Patients also take medications called acid-blockers, which reduce the amount of acid in the stomach. As a result, the patient experiences less pain, and the gastrointestinal tract is able to heal. Examples of acid blockers include ranitidine (Zantac©), famotidine (Pepcid©), cimetidine (Tagamet©), and nizatidine (Axid©).

Patients should take their medications exactly as prescribed. If medication is not taken regularly or stopped too early, the ulcer may not heal properly. Also, during treatment, patients should not smoke, consume alcohol, or take nonsteroidal anti-inflammatory drugs (NSAIDs) because they may worsen symptoms.

Pyloric stenosis: Pyloric stenosis is a rare condition that occurs when babies are born with abnormally large muscles at the opening at the bottom of the stomach (pylorus). The pylorus connects the stomach to the small intestine.

Babies with pyloric stenosis are unable to transport food into the small intestine. This may lead to: extremely forceful vomiting (also called projectile vomiting) that may contain blood, weight loss, dehydration, and electrolyte imbalances. Babies are usually hungry after vomiting. They may cry without tears because they are dehydrated.

The exact cause of pyloric stenosis remains unknown. However, researchers believe that genetics plays a role.

Most patients are diagnosed and treated when they are three to 12 weeks old. Babies with pyloric stenosis need to have surgery as soon as possible to correct the pylorus. The surgical procedure, called pyloromyotomy, involves reducing the size of the pylorus muscles. Patients typically experience an improvement in symptoms about 24 hours after surgery.

Colic (infancy): Colic is usually defined as crying for more than three hours a day, three days per week, for longer than three weeks in an otherwise healthy baby.

It remains unknown what causes colic. However, researchers have suggested that it may be caused by gastrointestinal problems, such as lactose intolerance or an immature digestive system. This is because sometimes a colic episode stops after a baby passes gas or has a bowel movement. Other possible causes include maternal anxiety, differences in the way a baby is fed or comforted, and/or allergies.

There is currently no treatment that has been proven to be effective for the treatment of colic in babies. Colic typically goes away once the baby reaches three months of age.

Biliary colic: Biliary colic, also called a gallbladder attack, describes pain and nausea that accompanies many disorders that affect the gallbladder. The gallbladder is an organ that stores digestive fluids that are needed to break down fats in foods.

Biliary colic may occur when a gallstone moves through the biliary tract towards the small intestine. An attack may also be the result of cholestasis, which occurs when the flow of bile is blocked. Gallbladder attacks may also occur if the gallbladder becomes inflamed.

Gallbladder attacks generally last one to four hours. Common symptoms include pain on the right side of the abdomen, nausea, vomiting, and bloating. The gallbladder, which is located in the lower right side of the abdomen, is usually tender to the touch. The pain may be dull, sharp, or excruciating. It is common for the pain to radiate to the right shoulder blade.

A healthcare provider will be able to tell if a patient is having gallbladder attacks after a detailed medical history and physical examination is performed. The next step is to determine the underlying cause of the symptoms.

Blood tests and liver function tests may be performed to determine if the patient has cholestasis. If the patient's alkaline phosphatase levels are three times higher than normal, cholestasis is indicated.

A computerized tomography (CT) scan, magnetic resonance imaging (MRI) scan, or ultrasound may also be performed. These tests produce images of the internal organs and may help the healthcare provider detect abnormalities, such as gallstones, that may be causing the condition.

An endoscopic retrograde cholangiopancreatography (ERCP) may be performed at the hospital to check for problems in the liver, gallbladder, bile ducts, and pancreas. During the procedure, a thin, flexible tube with a camera is inserted through the mouth into the small intestine. The tube then hooks into the bile duct, allowing the healthcare provider to see the biliary tract.

Treatment of gallbladder attacks depends on the underlying cause. For instance, a gallstone may need to be surgically removed if it is causing symptoms. Antibiotics may be prescribed if an infection is the cause. If a medication is the suspected cause, a healthcare provider may recommend an alternative medication.

Gastroenteritis: Gastroenteritis describes inflammation of the stomach and intestine that causes diarrhea, vomiting, and cramps.

Gastroenteritis is often mistaken for the stomach flu or food poisoning because it causes similar symptoms. Although some doctors may call gastroenteritis the flu, gastroenteritis is not caused by any of the influenza viruses.

An infection in the digestive tract may cause gastroenteritis. This may happen if patients consume foods or beverages that contain disease-causing bacteria, viruses, or parasites. In some cases, the food itself may irritate the patient's digestive tract. For instance, if a lactose intolerant patient consumes a dairy product, the stomach and intestines become irritated, which may lead to gastroenteritis. In addition, some mediations, including aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), some antibiotics, caffeine, laxatives, and steroids, may cause gastroenteritis.

Most patients recover quickly from gastroenteritis. However, babies and the elderly have a greatest risk of developing life-threatening complications, such as dehydration and poor nutrition.

If an infection is causing gastroenteritis, patients take medications called antimicrobials to kill the disease-causing organisms. Commonly prescribed antimicrobials include ciprofloxacin (Cipro©), trimethoprim/sulfamethoxazole (Bactrim©), and rifaximin (Xifaxan©, RedActiv©, or Flonorm©). Adults may also take medications, called antiemetics, which reduce vomiting. Commonly prescribed antiemetics include promethazine (Phenergan© or Anergan©), prochlorperazine (Compazine©), or ondansetron (Zofran©). Anti-diarrheals, such as diphenoxylate atropine (Lomotil©, Lofene©, or Lonox©) or loperamide hydrochloride (Imodium©), may also be taken to reduce diarrhea in patients older than three years old.

Gaucher's disease: Gaucher's disease is a rare, inherited disorder that occurs when a fatty substance called glucocerebroside accumulates in the spleen, liver, lungs, and bone marrow. In some cases, it also affects the functioning of the brain.

Patients with Gaucher's disease are born with low levels of a digestive enzyme called glucocerebrosidase, which breaks down glucocerebroside. This deficiency causes glucocerebroside to build up in the body.

There are three types of Gaucher's disease: Type I, Type II, and Type III. Type I is the most common form. It causes enlargement of the liver (hepatomegaly) and spleen (splenomegaly) and it may also affect the lungs and kidneys. When fat develops in the liver, it is often called hepatic steatosis. Type I may develop at any age. Type II is a fatal condition that develops during infancy and causes severe brain damage. Most children with Type II Gaucher's disease die by the age of two years old. Type III causes the liver and spleen to enlarge and brain damage gradually occurs over time. Type III usually occurs in children and adolescents.

Gaucher's disease is diagnosed after a blood test. Patients with the disorder will have low levels of glucocerebrosidase in their blood.

There is currently no cure for Gaucher's disease. Patients with Type I and Type III Gaucher's disease take enzyme replacement therapy, which has been proven to effectively manage symptoms. However, there is no effective treatment to manage the symptoms of Type II.

ESOPHAGEAL DISORDERS

Gastroesophageal reflux disease (GERD): Gastroesophageal reflux disease (GERD), also called acid reflux disease, occurs when liquid from the stomach backs up (regurgitates) into the esophagus. This liquid may contain stomach acids and bile. In some cases, the regurgitated stomach liquid can cause inflammation (esophagitis), irritation, and damage to the esophagus.

It remains unknown exactly what causes GERD. Several factors, including hiatal hernias (when the stomach pushes up through a hole in the diaphragm muscle), abnormally weak contractions of the lower esophageal sphincter, and abnormal emptying of the stomach after a meal, have been associated with GERD.

Common symptoms of GERD include a burning sensation in the chest that may spread to the throat (heartburn), chest pain (especially when lying down), difficulty swallowing (dysphagia), regurgitating food or sour liquid, coughing, hoarseness, sore throat, and wheezing.

Several factors may worsen symptoms of the condition. For instance, spicy foods, fatty foods, chocolate, caffeine, tomato sauce, carbonated beverages, mint, alcoholic beverages, large meals, lying down after eating, some medications (e.g. sedatives, tranquilizers, or blood pressure drugs), and cigarette smoking may worsen symptoms of GERD.

Most cases of GERD can be diagnosed based on the patient's symptoms.

GERD is usually a lifelong condition because there is no cure for the disorder. Patients must take medications for the rest of their lives to manage symptoms. In addition, patients should not smoke because it may increase the amount of stomach acid and worsen symptoms.

Patients with mild cases of GERD may be able to manage their symptoms with over-the-counter medications and changes in the diet. Patients may experience improvements in symptoms if they eat smaller meals and eliminate foods that are known to cause heartburn.

Antacids, such as Gelusil©, Rolaids©, Mylanta©, Maalox©, or Tums©, may neutralize stomach acid and provide quick relief of GERD symptoms. However, they will not help the esophagus heal. Patients who take antacids frequently may experience diarrhea or constipation.

Some over-the-counter H-2 receptor blockers, such as cimetidine (Tagamet HB©), famotidine (Pepcid AC©), nizatidine (Axid AR©), and ranitidine (Zantac 75©), may also help provide quick relief of symptoms. These medications reduce the amount of stomach acid that is produced. Side effects of H-2 receptor blockers, which are uncommon, may include changes in bowel movements, dry mouth, dizziness, or drowsiness. Proton pump inhibitors, such as omeprazole (Prilosec©), may also be taken short-term to help the esophagus heal. Patients should not take these medications long term unless they talk with their healthcare providers first.

Patients with persistent GERD may require prescription-strength medications to manage symptoms and prevent esophageal damage. H-2 blockers, such as Axid©, Pepcid©, Tagamet©, and Zantac©, are commonly prescribed. Examples of prescription-strength proton pump inhibitors include esomeprazole (Nexium©), lansoprazole (Prevacid©), omeprazole (Prilosec©), pantoprazole (Protonix©), and rabeprazole (Aciphex©).

Achalasia: Achalasia is a rare disease that occurs when the muscles of the esophagus are unable to relax. The esophageal sphincter, which is the muscle between the lower esophagus and stomach, is unable to relax enough to allow food to pass into the stomach. Also, the lower half of the esophagus does not contract and relax properly. As a result, the food is not properly pushed down into the stomach, and patients have difficulty swallowing food (dysphagia).

The exact cause of achalasia remains unknown. Researchers believe that several factors, including infections, genetics, and abnormalities in the immune system, may contribute to the development of the condition.

The most common symptom of achalasia is difficulty swallowing solid foods and liquids. Some patients experience heavy sensations in the chests after eating that feels like chest pain. If food collects in the esophagus, it may cause irritation and lead to esophagitis (inflamed esophagus). Some patients may regurgitate their food if it is trapped in the esophagus. If regurgitated food enters the windpipe (trachea), it may cause infections such as pneumonia.

Since patients have difficulty swallowing and consuming foods and beverages, they typically experience weight loss. Other complications may include malnutrition and dehydration.

Achalasia is usually diagnosed after a video-esophagram is performed. During the procedure, the patient drinks a barium solution and video X-rays are taken of the esophagus. The healthcare provider is able to see if the barium enters the stomach properly. If the patient has achalasia, the barium will stay in the esophagus longer than normal. In addition, the lower end of the esophagus will be very narrow.

Some patients may experience an improvement in symptoms if they eat slowly, take small bites, and chew their food thoroughly.

In addition, patients with achalasia usually take nitrates, such as isosorbide dinitrate (Isordil©), and calcium-channel blockers, such as nifedipine (Procardia©) or verapamil (Calan©), to relax the muscles of the esophagus. These medications provide short-term relief of symptoms.

A procedure called forceful dilation, or stretching of the lower esophageal sphincter, is often needed to open the esophagus and allow food to enter the stomach. During the procedure, a tube with a balloon at the end is inserted into the patient's esophagus. The balloon is placed across the sphincter and inflated. As a result, the sphincter stretches out. Forceful dilation successfully treats 65-90% of patients with achalasia. The most serious complication of forceful dilation is rupture of the esophagus, which occurs in about five percent of patients. If a rupture occurs, antibiotics and/or surgery may be required. Forceful dilation is generally quicker and less expensive than surgery.

If forceful dilation is unsuccessful, a surgical procedure, called esophagomyotomy, may be performed. During the procedure, the sphincter is cut, which expands the esophagus and makes it easier for the patient to swallow. The procedure is more effective than forceful dilation. An estimated 80-90% of patients are treated successfully with esophagomyotomy. However, in some cases, dysphagia may return. The most common side effect of esophagomyotomy is GERD. In order to prevent GERD, the esophagomyotomy may be modified so that it does not completely cut the sphincter or the esophagomyotomy may be combined with anti-reflux surgery. Regardless of which surgery is performed, some healthcare providers recommend lifelong treatment with GERD medications, such as Axid©, Pepcid©, Tagamet©, or Zantac©. Other doctors only recommend lifelong treatment if GERD is diagnosed 24 hours after surgery.

Botox injections in the lower sphincter are the newest treatment for achalasia. The botulinum toxin is injected to weaken the sphincter. The effects of treatment usually last for several months. Patients may require additional injections. Patients who are elderly or unable to undergo surgery typically receive this treatment. It may also be performed to help patients gain weight and improve their nutritional status before surgery.

Esophageal spasms: Patients may experience spasms in the esophagus. Esophageal spasms may cause difficulty swallowing, painful swallowing, sensation that something is stuck in the throat, heartburn, and chest pain.

The exact cause of spasms remains unknown. However, eating hot or cold foods may contribute to the condition. Also, gastroesophageal reflux disease (GERD) or heartburn may also play a role in the development of esophageal spasms.

Patients typically take nitrates, such as isosorbide dinitrate (Isordil©), or calcium-channel blockers, such as nifedipine (Procardia©) or verapamil (Calan©), to relax the muscles.

ACUTE ABDOMEN AND STOMACH DISORDERS

Appendicitis: Appendicitis occurs when an organ in the lower right-side of the abdomen, called the appendix, becomes inflamed and filled with pus.

The cause of appendicitis is not always clear. In some cases, appendicitis may occur if food waste or a solid piece of stool becomes trapped in an opening near the appendix. It may also occur after an infection.

The most common symptom of appendicitis is severe pain in the lower right-hand side of the abdomen. Additional symptoms may include nausea, vomiting, loss of appetite, low-grade fever, constipation, bloating or inability to pass gas, diarrhea, and abdominal swelling.

Patients with appendicitis will have high levels of white blood cells in their blood. Imaging studies are also performed to determine if the appendix is enlarged.

Patients with appendicitis must have their appendix surgically removed as quickly as possible. Since the appendix has no known purpose, the patient's life is unaffected after the appendix is removed.

If the appendix is not removed quickly, it may break open or rupture. If the appendix ruptures, it may lead to an infection in the lining of the abdominal cavity. Infections may cause a condition called peritonitis, which occurs when the abdominal lining becomes inflamed. If the appendix ruptures, the patient may start to feel better. However, soon after, the abdomen may swell because it becomes full of gas and fluid. At this point, the abdomen usually feels hard, tight, and tender to the touch. Severe pain also develops throughout the entire abdomen. Patients may be unable to pass gas or have a bowel movement. Additional symptoms of peritonitis include fever, thirst, and decreased urination.

Patients who have symptoms of peritonitis should seek immediate medical treatment. Even if the condition is treated quickly, it may be fatal. Patients will receive aggressive treatment with intravenous antibiotics. Surgery is necessary to remove the burst appendix. Patients will also receive all fluids and nutrition through injections until their condition is improved.

Stomach inflammation (gastritis): Stomach inflammation, also called gastritis, may develop suddenly (acute) or gradually over a longer period of time (chronic).

Most cases of gastritis are caused by an infection with the same bacterium (Helicobacter pylori) that causes stomach ulcers. Gastritis may also be caused by traumatic injury or surgery, excessive alcohol consumption, and regular use of nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Motrin© or Advil©) or naproxen (Aleve©).

A condition called bile reflux disease may also cause, or occur simultaneously with, gastritis. Bile reflux occurs when bile, a fluid that helps digest fats, flows upward from the small intestine into the stomach and esophagus. Bile reflux has also been found to be common after gallbladder removal, or as a result of complications from gastric surgery which may damage the pyloric valve (a ring of muscle that separates the stomach from the duodenum) such as gastrectomy, or gastric bypass. Further inflammation and damage to the lining of the stomach and esophagus may occur as a result.

In rare cases, gastritis may occur when the body's own immune cells attack the stomach. It remains unknown what triggers this autoimmune reaction. The acid in the stomach may worsen symptoms of gastritis.

Symptoms of gastritis generally include a burning pain or aching in the upper abdomen that may worsen when food is eaten, nausea, vomiting, loss of appetite, bloating, feeling of fullness in the upper abdomen after eating, and weight loss. In some cases, gastritis may cause stomach bleeding. Symptoms of stomach bleeding include blood in the vomit and black or dark-colored stools.

In some cases, gastritis may lead to ulcers and an increased risk of stomach cancer.

In most cases, patients fully recover quickly once treatment is started. Patients typically take antacids, such as Tums©, Mylanta©, or Rolaids©, to help neutralize the stomach acid. This helps reduce symptoms of gastritis quickly. Acid blockers, such as cimetidine (Tagamet©), ranitidine (Zantac©), nizatidine (Axid©), or famotidine (Pepcid©), may be taken to reduce the amount of stomach acid that is produced. Proton pump inhibitors, such as omeprazole (Prilosec©), lansoprazole (Prevacid©), rabeprazole (Aciphex©), and esomeprazole (Nexium©), may also be taken to reduce the amount of stomach acid produced.

If an infection with H. pylori is causing gastritis, patients generally receive a combination of antibiotics and proton pump inhibitors. Commonly prescribed antibiotics include amoxicillin (Amoxil©), clarithromycin (Biaxin©), and metronidazole (Flagyl©).

Hypochlorhydria (low stomach acid): Hypochlorhydria occurs when patients have low levels of stomach acid, also called hydrochloric acid. The body needs stomach acid in order to break down foods so that they can be absorbed in the intestines.

Natural aging, a poor diet, chronic use of certain medications, and past infection with the Helicobacter pylori bacteria may limit a patient's ability to produce hydrochloric acid.

Hypochlorhydria may also be a symptom of an underlying medical condition such as Addison's disease, depression, asthma, eczema, gallstones, hepatitis, osteoporosis, psoriasis, thyroid disease, and autoimmune disorders.

If there is low acidity in the stomach, patients may only be able to partially digest food. This may lead to malnutrition. Symptoms of hypochlorhydria may include bloating, gas, belching, burning or dryness of the mouth, heartburn, multiple food allergies, rectal itching, redness or dilated blood vessels in the cheeks and nose, adult acne, hair loss (in women), iron deficiency, undigested foods in the stool, yeast infection, as well as diarrhea or constipation. Patients with hypochlorhydria also have an increased risk of developing infections in the gastrointestinal tract because it provides an ideal environment for disease-causing organisms, such as bacteria.

Patients with hypochlorhydria take betaine hydrochloride or glutamic acid hydrochloride with meals and snacks. These medications increase the amount of stomach acid, which helps the body properly break down and digest foods.

Ileus: Ileus occurs when the small and/or large intestine is partially or completely blocked. Ileus is a non-mechanical blockage. Unlike mechanical blockages, which occur when the bowel is physically blocked, a non-mechanical blockage occurs when the rhythmic contractions that move material through the bowel, called peristalsis, stops.

Ileus is usually associated with an infection of the peritoneum, which is the membrane that lines the abdomen. This is most common in infants and children. Intestinal surgery may lead to temporary ileus that lasts two to three days. Ileus may also be a complication of surgery on other body parts, such as the chest or joints. Other medical conditions, including kidney disease and heart disease, may cause ileus. Some chemotherapy drugs, such as vincristine (Oncovin©, Vincasar PES©, or Vincrex©) or vinblastine (velban© or Velsar©), may cause ileus.

Symptoms of ileus may include abdominal distention, abdominal cramping, nausea, vomiting, bloating or failure to pass gas, and difficulty having bowel movements.

Patients with ileus must receive nutrition and fluids intravenously to give the intestines time to heal. If an infection is causing the condition, antibiotics are prescribed. Other medications, including cisapride and vasopressin (Pitressin©), may be prescribed to stimulate the intestines to contract and relax.

INTESTINAL DISORDERS

Celiac disease (non-tropical sprue): Celiac disease, also called non-tropical sprue, is a digestive disorder that occurs when an individual's immune system overreacts to gluten, a protein found in wheat, rye, barley, and oats.

When a patient with the disease eats food that contains gluten, the immune cells flood to the stomach and intestine to destroy the gluten. However, among these immune cells are autoantibodies that attack the lining of the intestine by mistake. As a result, the intestinal lining becomes damaged.

It has not been determined what triggers this reaction in celiac patients. However, celiac disease is associated with autoimmune disorders, such as lupus. Autoimmune disorders occur when the patient's immune system mistakenly identifies body cells as harmful invaders, such as bacteria. As a result, the immune cells in celiac patients attack the patient's intestinal cells when gluten is consumed.

Celiac disease causes symptoms of abdominal pain and bloating after consuming gluten.

Additionally, complications, including poor absorption, may occur if the patient continues to eat gluten-containing foods. When the intestinal lining is damaged, patients have difficulty absorbing nutrients. Symptoms of poor nutrition include weight loss, diarrhea, abdominal cramps, gas, bloating, fatigue, foul-smelling or grayish stools that may be oily (steatorrhea), stunted growth in children, and osteoporosis (hollow, brittle bones).

If celiac disease is suspected, blood tests will be performed to determine whether or not the patient has autoantibodies associated with the disease. If autoantibodies are present, a positive diagnosis is made.

Although there is currently no cure for celiac disease, the condition can be managed with a gluten-free diet. Patients should avoid all foods that contain gluten. This includes any type of wheat (including farina, graham flour, semolina, and durum), barley, rye, bulgur, Kamut, kasha, matzo meal, spelt, and triticale. Therefore, foods such as bread, cereal, crackers, pasta, cookies, cake, pie, gravy, and sauce should be avoided unless they are labeled as gluten-free. In general, patients who strictly follow a gluten-free diet can expect to live normal, healthy lives. Symptoms will subside several weeks after the diet is started, and patients will be able to absorb food normally once they avoid eating gluten. A dietician or certified nutritionist may help a patient with celiac disease develop a healthy diet. Patients with celiac disease may also find gluten-free cookbooks to be a helpful resource. Many products, including rice flour and potato flour, can be used as substitutes for gluten-containing flour.

Menke's kinky hair disease: Menke's kinky hair disease, also called Menke's disease, is an inherited disorder that decreases the body's ability to absorb copper. Cells in the body need copper to function properly. The disease is characterized by sparse and coarse hair, short stature, and progressive deterioration of the nervous system.

Symptoms develop during infancy. Babies with Menke's kinky hair disease show slightly slowed development for two to three months after birth. The baby's condition will worsen after this time and he/she will lose previously developed skills. Other symptoms include silver or colorless hair, seizures, and osteoporosis (hollow and brittle bones).

There is currently no cure for Menke's kinky hair disease. Patients may receive injections of copper. However, patients typically die by the age of ten.

Acrodermatitis enteropathica: Acrodermatitis enteropathica is an inherited condition that occurs when the body is unable to absorb zinc. This trace element is necessary for the functioning of over 300 different enzymes and plays a vital role in an enormous number of biological processes.

The exact cause of acrodermatitis enteropathica remains unknown. However, researchers believe that genetics may play a role.

Symptoms of acrodermatitis enteropathica may include red and swollen patches of dry and scaly skin, crusted or pus-filled blisters on the skin, swollen skin around the nails, mouth ulcers, red and glossy tongue, impaired wound healing, as well as hair loss on the scalp, eyelashes, and eyebrows. Additional symptoms may include pinkeye, sensitivity to light, decreased appetite, diarrhea, irritability, failure to grow, and depressed mood.

A zinc deficiency can be diagnosed after a blood test.

Although there is no cure for the disorder, zinc supplements taken by mouth daily have been shown to effectively manage symptoms. Without treatment, acrodermatitis enteropathica will lead to death. Skin lesions usually heal one to two weeks after treatment is started. Other symptoms begin to improve within 24 hours.

ANORECTAL DISORDERS

Hemorrhoids: Hemorrhoids are inflamed veins in the anus and rectum. Hemorrhoids may develop inside or outside of the rectum, depending on the specific veins that are affected.

Hemorrhoids are common, affecting nearly half of individuals who are older than 50 years of age.

Hemorrhoids develop when there is increased pressure in the veins of the anus and rectum. This is often due to straining during constipation, sitting or standing for extended periods of time, pregnancy, childbirth, and diarrhea. Obese patients have an increased risk of developing hemorrhoids.

Internal hemorrhoids are not painful because pain nerves are not present inside the membranes of the rectum. However, internal hemorrhoids may cause bleeding when stools are passed. External hemorrhoids are usually painful. The veins outside of the rectum are swollen and may itch. Bleeding may occur, especially when straining to move the bowels.

External hemorrhoids can be diagnosed after observing the inflamed veins. If internal hemorrhoids are suspected, a healthcare provider may examine the rectum with an anoscope, proctoscope, or sigmoidoscope.

Mild cases of hemorrhoids are usually treated with over-the-counter creams or ointments, such as Preparation H©. Warm baths may also help improve symptoms.

If a blood clot forms in a hemorrhoid, a healthcare provider can make a surgical incision to remove the clot.

Rubber band litigation may be used to treat severe or persistent cases of hemorrhoids. During the procedure, small rubber bands are inserted around the base of the hemorrhoids. This cuts off the blood supply in the vein until the hemorrhoid falls off.

During a procedure called sclerotherapy, a chemical is injected near the hemorrhoid to shrink the inflamed vein.

If these therapies are ineffective, the hemorrhoids may be surgically removed in a process called hemorrhoidectomy.

Rectal prolapse: Rectal prolapse occurs when the inner lining of the rectum, called the rectal mucosa, protrudes from the anus. Rectal prolapse occurs when the tissues that normally support that rectal mucosa become loose and allow the tissue to slip down through the anus.

Without treatment, the condition may worsen and a large part of the rectum may protrude from the body through the anus. When this happens, the condition is called a complete prolapse. Most patients do not realize that they have rectal prolapse until it reaches this stage. Initially, the rectum may protrude during certain activities, such as coughing or laughing. Eventually, the prolapsed rectum may protrude more frequently or permanently.

Patients may be able to feel the tissue protruding out of the anus. Common symptoms of rectal prolapsed include pain during bowel movements, mucus or bleeding from the protruding tissue, and inability to control bowel movements.

Most patients with rectal prolapsed require surgery. The surgeon reattaches the rectum to the backside of the inner pelvis. Surgery may be performed through the abdomen or the perineum.

Stool softeners, such as calcium docusate (Surfak©) or sodium docusate (Colace©), may help reduce pain and straining during bowel movements.

Rectal inflammation (proctitis): Rectal inflammation, also called proctitis, occurs when the lining of the rectum (rectal mucosa) becomes swollen. Patients with proctitis often experience rectal bleeding, anal and rectal pain, frequent urge to have a bowel movement, passing mucus through the rectum, feeling of rectal fullness, and diarrhea.

There are many potential causes of proctitis. The most common cause is sexually transmitted diseases, which are acquired through anal or oral-anal intercourse. Other causes may include inflammatory bowel disease (IBD) and bacterial infections, such as streptococcus. Less common causes include chemicals (such as hydrogen peroxide enemas), injury to the rectum, radiation therapy that is applied near the rectum (for conditions such as prostate or cervical cancer), and medications or objects that are inserted into the rectum.

Several tests may be performed to diagnose the underlying cause of proctitis. Blood tests may be performed to detect possible infections. A colonoscopy may be performed to examine the inside of the colon for abnormalities. Healthcare providers may also use a swab to collect a sample of fluid from the rectum or urethra. The sample is then tested for STDs.

Most cases of proctitis are effectively treated and patients experience a full recovery. Treatment depends on the underlying cause of proctitis. If a bacterial infection is present, antibiotics, such as ciprofloxacin (Cipro©), levofloxacin (Levaquin©), penicillin, amoxicillin (Amoxil© or Trimox©), azithromycin (Zithromax©), clarithromycin (Biaxin©), or clindamycin (Cleocin©), may be taken. If a viral infection (e.g. herpes) causes proctitis, antivirals, such as such as acyclovir (Zovirax©), may be taken. Corticosteroids may be taken if radiation therapy is causing proctitis. If IBD is causing symptoms, anti-inflammatories, such as sulfasalazine (Azulfidine©) or anti-diarrheals, such as psyllium powder (Metamucil©), may be taken.

Laxative-induced colon damage: Laxatives are medications that are used to stimulate bowel movements. They are primarily used to treat constipation. Patients who overuse laxatives may develop colon damage. Long-term use of laxatives may cause the muscles in the colon to become weak from lack of use. The nerves in the lining of the colon may also become damaged. As a result, this may slow intestinal mobility and cause constipation.

Symptoms of laxative abuse include weight loss, hair loss, vomiting, abdominal pain, low energy, dehydration, dry eyes, headaches, mood swings, and bone pain.

Therefore, patients should not take laxatives more frequently than the packaging label suggests. If symptoms persist, patients should consult their healthcare providers to diagnose and properly treat the underlying cause.

PREVENTION

Patients should not take laxatives more frequently than the packaging label suggests. If symptoms persist, patients should consult their healthcare providers to diagnose and properly treat the underlying cause.

Patients who have a history of indigestion should eat smaller, more frequent meals to help prevent symptoms. Limiting spicy, fried, or fatty foods may also reduce the risk of indigestion.

Patients should not consume excessive amounts of alcohol because it irritates the stomach. Abusing alcohol may cause inflammation or bleeding in the stomach.

Patients are encouraged not to smoke because smoking damages the protective lining of the stomach. Smoking increases an individual's risk of developing gastritis and ulcers. In addition, smoking increases the amount of stomach acid and delays healing, which increases a patient's risk of developing stomach cancer.

Patients should limit their use of nonsteroidal anti-inflammatory drugs (NSAIDS), such as ibuprofen (Motrin© or Advil©) because they may cause stomach inflammation and bleeding, as well as ulcers.

Patients should properly wash all produce thoroughly before eating to reduce the risk of developing gastrointestinal infections.

Individuals who are in areas of the world that have poor sanitation should only drink bottled water to avoid the risk of gastrointestinal infections. If this is not possible, individuals should boil their water before drinking it. This kills any disease-causing bacteria or parasites that may be living in the water.

Patients should only consume dairy products that have been pasteurized. This reduces the risk of developing a gastrointestinal infection that may cause diarrhea.

Individuals should avoid or limit their intake of the artificial sweeteners sorbitol and mannitol because they may cause diarrhea. These artificial sweeteners are commonly found in sugar-free products and chewing gum.

Patients with gastrointestinal disorders should take their medications exactly as prescribed in order to prevent complications from occurring.

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