Question 1

GERD

Accepted Answer

How is GERD treated?

Diet changes
Reflux symptoms often improve with dietary changes. Avoiding these may improve GERD:
 • coffee
 • citrus drinks
 • tomato-based products (for e.g., cooked tomatoes, stews and red sauces)
 • carbonated beverages
 • chocolate
 • peppermint
 • fatty or spicy foods
 • eating within three hours of bedtime
 • smoking
 • drinking alcohol
 • excess weight gain
 • 
Lifestyle changes
 • Elevate the head of the bed at night may be helpful. A 4-inch foam wedge can be sufficient to decrease reflux. Bricks or blocks can also be placed under the head of your bed
 • Avoid tight fitting clothing over the abdomen as it can worsen reflux symptoms. Should symptoms continue to occur, over-the-counter antacids may decrease discomfort
 • Do not eat within 3 hours of bedtime

Medications
Both H2 blockers and PPIs (also known as “acid blockers”) are available over-the-counter at low doses, or at a higher dose when prescribed by your doctor.

Antacids
These medications work well for treating mild reflux symptoms and are quite safe, with few side effects; however, they only work for a short time or a few hours. Antacids react with acid in the esophagus and stomach to counteract its harmful effects and thus reduce symptoms. Examples of these antacids include TUMS™ and Rolaids.™ More effective acid blockers, like H2 receptor blockers (e.g. famotidine), decrease acid production by the stomach.

Proton pump inhibitors (PPIs)
These medicines, e.g. omeprazole, are safe and highly effective at blocking the final step of acid production in the stomach. They are typically taken once or twice daily, approximately 30 minutes before meals. For reflux symptoms that are severe and/or occur frequently, PPIs are the most effective medical treatment. However, there may be potential side effects of long-term use. You should talk to your healthcare provider about whether to take a PPI and for how long.
Prokinetics, or medications that stimulate muscle activity in the stomach and esophagus, are sometimes provided for the treatment of reflux disease.

Procedures and surgery to treat GERD

When GERD symptoms remain uncontrolled after lifestyle changes and medication use, other endoscopic and surgical treatments are considered. These prevent stomach contents from going up into the esophagus and are considered in patients with proven reflux disease who cannot tolerate medications, do not want to take medications or continue to have symptoms even with medical treatment. As part of the pre-procedure evaluation, you may need testing such as manometry, impedance and pH testing to ensure that you are eligible for the procedure.

There are several procedures and surgeries for treating reflux disease. One type of surgery is known as fundoplication where a part of the stomach is wrapped around the lower end of the esophagus to strengthen the barrier between the esophagus and the stomach. More recently, fundoplication can be accomplished by a specialized upper endoscopy procedure called transoral incisionless fundoplication, or TIF. Other endoscopic treatments are also available which help strengthen the muscle valve in the lower end of the esophagus and help prevent acid reflux. It is important to find a skilled provider who has experience in performing procedures for reflux and can discuss the risks and benefits of these procedures.

Why should GERD be treated?

The purpose of GERD treatment is generally to relieve symptoms. Treatment can also prevent future complications. Untreated GERD can cause inflammation of the esophagus called esophagitis. Long-term GERD can also lead to a change in the lining of the esophagus called Barrett’s esophagus, which puts patients at increased risk for esophageal cancer. Long-term esophagitis from GERD can lead to narrowing of the esophagus, called an esophageal stricture. This can cause food to get stuck in the esophagus, which sometimes needs urgent medical treatment.

When should I see my doctor?

You should see your doctor immediately if you have symptoms such as unexplained weight loss, feeling like food or liquids are getting stuck in your esophagus after you swallow them, having a sense of fullness after a small meal, or signs of internal bleeding such as vomiting blood or noticing blood in the toilet. You should also visit your doctor if symptoms persist after you have made simple lifestyle changes. In addition, if you use over-the-counter medications regularly to treat heartburn or regurgitation, you should consult a physician to determine the best course of treatment for you.

Important Reminder: This information is intended only to provide general guidance. It does not provide definitive medical advice. It is very important that you consult your doctor about your specific condition.

ASGE | Gastroesophageal Reflux Disease(https://www.asge.org/home/for-patients/patient-information/understanding-gastroesophageal-reflux-disease)

Question 2

Crohn's Disease

Accepted Answer

Treatment
 • While Crohn’s disease has not cure, the symptoms can be treated. Help manage your symptoms by following your doctor’s advice and watching what you eat.

Medication
 • A type of anti-inflammatory medication (called 5-ASA compounds) to help reduce swelling and discomfort.
 • Corticosteroids to help reduce inflammation
 • Antibiotics to fight bacteria that may lead to infection
 • Medications to control your body’s immune system (the system that fights infection by causing inflammation)

Watch Your Diet
 • Avoid any foods that make your symptoms worse. These foods vary from person to person. But high-fiber foods (such as fresh vegetables) and high-fat foods (such as dairy products and red meat) cause symptoms in many people. Keep track of foods that cause you problems.

Surgery
 • Surgery may help control Crohn’s, relieving digestive tract symptoms. Surgery can remove a severely affected part of the digestive tract. If this is an option for you, your doctor can provide more information.

Consultant: 
Richard A Sundberg, MD, Gastroenterology
With contributions by:
John I. Allen, MD, Gastroenterology
Sherry Kloha, RN, BSN, Patient Education
Myron Lewis, MD, Gastroenterology
Lynda Roberts, MD, FAAFP, Family Practice

Important Reminder: This information is intended only to provide general guidance. It does not provide definitive medical advice. It is very important that you consult your doctor about your specific condition.

Question 3

Irritable Bowel Syndrome (IBS)

Accepted Answer

Medications
 • Certain medications may help regulate the working of your digestive tract. Your doctor may prescribe one or more for you if he or she thinks it might be effective. Medication can’t cure IBS, however, it can only help manage symptoms. Because some medications may make IBS worse, don’t take any medication, especially laxatives, unless your doctor prescribes it for you.

What You Can Do
 • Your doctor may suggest some lifestyle changes to help control your IBS. Two of the most important are changing your diet and managing stress.

Changing Your Diet
 • Your diet may be an important cause of IBS symptoms. You may want to try the following:
 • Pay attention to what foods bother you, and avoid them. For example, dairy products are hard for some people to digest.
 • Drink 6 to 8 glasses of water a day.
 • Avoid caffeine and tobacco. These are muscle stimulants and can affect the working of your digestive tract.
 • Avoid alcohol, which can irritate your digestive tract and make your symptoms worse.
 • Eat more fiber if constipation is a problem. Fiber makes the stool softer and easier to pass through the colon.

Manage Stress
 • If stress or anxiety contributes to your IBS, learning how to manage stress may help you feel better. First, identify the causes of stress in your life and learn new ways to cope with them. Regular exercise is a great way to relieve stress. It can also help ease constipation.

Consultant: 
Richard A Sundberg, MD, Gastroenterology
With contributions by:
Pamela J Cary, MD, Family Practice
Stephen A. Center, MD, Family Practice
Lester F. Goldblum, DO, Gastroenterology
Henry K. Lee Loy, MD, Internal Medicine
*Important Reminder: This information is intended only to provide general guidance. It does not provide definitive medical advice. It is very important that you consult your doctor about your specific condition.

Question 4

Hiatal Hernia

Accepted Answer

You don’t need treatment if your hiatal hernia does not cause any symptoms or problems. If you do have symptoms, some lifestyle changes may help. They include eating small meals, avoiding certain foods, not smoking or drinking alcohol, and losing weight. Your health care provider may recommend antacids or other medicines. If these don’t help, you may need surgery.

Important Reminder: This information is intended only to provide general guidance. It does not provide definitive medical advice. It is very important that you consult your doctor about your specific condition.

Question 5

Hemorrhoids

Accepted Answer

For instant relief of pain and swelling, try sitting in a bathtub of three or so inches of warm water. This is known as “Sitz Bath”. Cotton pads soaked in an astringent such witch hazel, also bring relief for some sufferers.

To encourage better bowel movements, your doctor may suggest some initial lifestyle changes, such as improving your diet and increasing exercise. If these changes do not help relieve your constipation, your doctor may suggest one of the following types of laxative.
 • A bulk fiber laxative
 • Hemorrhoidal Suppositories
 • Hemorrhoidal Cream 
 • Metamucil 
 • A stool softener

Laxatives should be used only as directed. Different laxatives work in various ways; let your doctor choose the best one for you.

Prevention
 • Start by practicing good bowel habits.
    • Don’t think you have to have a good bowel movement every day or at the same time; you’ll strain too hard to stay on schedule.
    • If you have the urge to have a bowel movement, respond immediately. Delaying now may mean straining later.
    • Confine your bathroom reading to the tub; sitting and straining too long on the toilet will only encourage swelling.
    • Wipe yourself gently with soft, white, unperfumed tissue, not only to keep the area clean but to avoid any unnecessary irritation.
    • Exercise can aid digestion. Swimming, biking, or just walking is a good idea for your health in general. The biggest change you may have to make in your life is your diet. Most of us don’t get enough fiber, which promotes regular elimination of soft stool.

Important Reminder: This information is intended only to provide general guidance. It does not provide definitive medical advice. It is very important that you consult your doctor about your specific condition.

Question 6

Gastritis

Accepted Answer

Gastritis can be caused by irritation due to excessive alcohol use, chronic vomiting, stress, or the use of certain medications such as aspirin or other anti-inflammatory drugs. It may also be caused by any of the following:
 • Helicobacter Pylori (H.Pylori) - a bacteria that lives in the mucous lining of the stomach. Without treatment the infection can lead to ulcers, and in some people, stomach cancer.
 • Pernicious anemia - a form of anemia that occurs when the stomach lacks a naturally occurring substance needed to properly absorb and digest vitamin B12.
 • Bile Reflux - a backflow of bile into the stomach from the bile tract (that connects to the liver and gallbladder).
 • Infections - caused by bacteria and viruses. If gastritis is left untreated, it can lead to a severe loss in blood, or in some cases increase the risk of developing stomach cancer.

Treatment for Gastritis usually involves:
 • Taking antacids and other drugs to reduce stomach acid, which causes further irritation to inflamed areas.
 • Avoiding hot and spicy foods.
 • For gastritis caused by H.Pylori infection, your doctor will prescribe a regimen of several antibiotics plus an acid blocking drug (used for heartburn).

Once the underlying problem disappears, gastritis usually does, too. You should talk to your doctor before stopping any medicine or starting any gastritis treatment on your own.

Important Reminder: This information is intended only to provide general guidance. It does not provide definitive medical advice. It is very important that you consult your doctor about your specific condition.

Question 7

Esophageal Varices

Accepted Answer

The goals of treatment are to
 • Prevent more liver damage.
 • Prevent varices from bleeding.
 • Control bleeding if it occurs.

Preventing Liver Damage
 • People who have liver disease need to avoid toxins that cause additional stress on the liver and more damage to it. Some suggestions for maintaining a healthier liver include:
    • Avoid alcoholic beverages of ANY kind.
    • Limit use of household cleaners and chemicals.
    • Eat a healthier diet that is low in fat and high in fruits and vegetables, whole grains and lean proteins.
    • Maintain a healthy body weight (excess body fat puts stress on the liver).

Preventing Bleeding
 • Medications to reduce blood pressure in the portal vein can reduce the risk of bleeding. The most commonly used medications are a group called beta blockers. These include Propranolol (InderalⓇ), Nadolol (CorgardⓇ and Carvedilol (CoregⓇ).
 • Patients with a high risk of bleeding may undergo preventative treatment with the same techniques that are used to stop bleeding. The most commonly used technique is variceal ligation.

Controlling Bleeding
 • Bleeding from esophageal varices is an emergency that requires immediate treatment. In the hospital, patients receive large amounts of fluid and blood to replace what has been lost.
 • Two different, non-surgical treatments are available to stop variceal bleeding - variceal ligation performed through an endoscope, and transjugular intrahepatic portosystemic shunt (TIPS) done by a radiologist using x-ray.
 • Bleeding esophageal varices is a life-threatening condition and can be fatal in up to 50% of patients. People who have had an episode of esophageal varices are at risk for bleeding again.
 • Treatment with variceal ligation is effective in controlling first-time bleeding episodes in about 90% of patients. However, about half of patients treated with variceal ligation will have another episode of bleeding within 1 to 2 years. Medication and lifestyle changes can help reduce the risk of recurrence.

Cleveland Clinic
Important Reminder: This information is intended only to provide general guidance. It does not provide definitive medical advice. It is very important that you consult your doctor about your specific condition.

Question 8

Peptic Ulcers

Accepted Answer

How are ulcers treated?
 • Some ulcers will require treatment during the upper endoscopy procedure. Ulcers that are bleeding or look like they bleed recently should be treated to stop or prevent bleeding.
 • Nearly all peptic ulcers will be treated with a PPI. PPIs are powerful acid blocking drugs. There are six PPIs available in the United States. These are omeprazole (Prilosec®, Zegerid®), lansoprazole (Prevacid®), pantoprazole (Protonix®), rabeprazole (Aciphex®), esomeprazole (Nexium®), and dexlansoprazole (Dexilant®). PPIs require food in the stomach to activate the medicine. Patients should eat a meal within 30 minutes to 1 hour after taking this medication for the acid blocking therapy to work most effectively.
 • An important part in treating ulcers is by identifying what caused them. Patients with ulcers caused by NSAIDs should try to avoid these medicines. They can talk to their doctor about other medications that can be used to treat pain.
 • Patients found to have H. pylori should be treated for this infection. The recommended treatments can require taking up to four medicines at one time. The stomach that has a high acid level and multiple medications are required to help the antibiotics work in this harsh environment. This makes H. pylori infection very hard to cure. Therefore, it is very important that people being treated for this infection take the entire course of prescribed medicines.
 • After treating H. pylori infection, your doctor should perform a test to make sure the infection is cured (fully treated). This can be done with a breath test, a stool test or another upper endoscopy with biopsy. Taking a PPI can make these tests less reliable, so these medicines should be stopped for two weeks before checking for cure.

Important Reminder: This information is intended only to provide general guidance. It does not provide definitive medical advice. It is very important that you consult your doctor about your specific condition.
Peptic Ulcer Disease - American College of Gastroenterology(https://gi.org/topics/peptic-ulcer-disease/)

Question 9

Barrett's Esophagus

Accepted Answer

Medication and daily habits
If you also have GERD along with Barrett’s esophagus, your doctor will have you start or stay on drugs to hold back the acid in your stomach. You can get these medications through your doctor, though you can also buy some without a prescription. Talk with your doctor about which choices are best for you before you take any medicines.

You can also help reduce reflux by staying away from certain foods like:
 • Chocolate.
 • Coffee.
 • Peppermint.
 • Greasy or fatty foods.
 • Spicy foods.
 • Alcohol.

Try eating small, well-balanced meals throughout the day.

Periodic surveillance endoscopy
In order to find any changes in the tissue in your esophagus (the tube that links your mouth and stomach) that could suggest pre-cancer cells or cancer, your gastroenterologist may choose endoscopic surveillance, or routinely taking a look at and removing some tissue. With this, your doctor is able to watch for signs of pre-cancer or cancer in the hopes of finding it early. Talk to your gastroenterologist about how often you need testing based on your disease.

Endoscopic eradication therapies
If you have cells that are highly abnormal in your tissue sample, or high-grade dysplasia, your doctor may suggest an endoscopic eradication therapy. These therapies not only kill the cells that are not normal, but they can also cause your body to start making normal esophageal cells.

These therapies are a bit more intense and are done at a hospital or an outpatient endoscopy center by a gastroenterologist.
 • You will get medicine to numb your throat.
 • You will get medicine to help you relax, so you should not feel pain during the procedure.

If you have any questions about these therapies, be sure to bring them up with your doctor.

Common forms of endoscopic eradication therapies
This therapy uses radio waves to kill pre-cancer and cancerous cells in the Barrett’s tissue. An electrode mounted on a balloon or an endoscope makes heat to kill the Barrett’s tissue and pre-cancer and cancerous cells.

Complications may include:
 • Chest pain.
 • Cuts in the lining of your esophagus.
 • Strictures (narrowing of the esophagus).

Endoscopic mucosal resection (EMR)
Your doctor will lift the Barrett’s tissue, inject a solution underneath or apply suction to the tissue, and then cut the tissue off. The doctor then removes the tissue with an endoscope. Gastroenterologists do this procedure at certain hospitals and outpatient centers.
Doctors sometimes combine endoscopic mucosal resection with radiofrequency ablation or photodynamic therapy.

Complications may include:
 • Bleeding.
 • Tearing of your esophagus.

Photodynamic therapy (PDT)
This therapy uses a light-activated chemical, an endoscope, and a laser to kill pre-cancer cells in your esophagus. A doctor injects the chemical into a vein in your arm, and you return 24 to 72 hours later to finish the procedure.

Complications may include:
 • Sensitivity of your skin and eyes to light for about six weeks after the procedure.
 • Burns, swelling, pain and scarring in nearby healthy tissue.
 • Coughing, trouble swallowing, stomach pain, painful breathing and trouble breathing.

Important Reminder: This information is intended only to provide general guidance. It does not provide definitive medical advice. It is very important that you consult your doctor about your specific condition.

Question 10

Schatzki Ring

Accepted Answer

Treatment
 • Asymptomatic Schatzki rings seldom worsen over time, and need no treatment.
 • Symptomatic Schatzki rings may be treated with esophageal dilatation, using bougie or balloon dilators. These have been found to be equally effective. Bougie dilatation involves passage of long dilating tubes of increasing size down the esophagus to stretch the area of narrowing, either over a guidewire passed into the stomach by endoscopy (The Savary-Gillard system) or using mercury-weighted dilators (the Maloney system). This is usually done with intravenous sedation to reduce discomfort. Dilatation can produce some temporary irritation. A short course or Proton Pump Inhibitor therapy may decrease aggravation by stomach acid reflux into the esophagus. The duration of the benefit of dilation varies, but may be from months to years. Dilation may be repeated if narrowing recurs.

Important Reminder: This information is intended only to provide general guidance. It does not provide definitive medical advice. It is very important that you consult your doctor about your specific condition.

Question 11

Ulcerative Colitis

Accepted Answer

Treatment
Ulcerative Colitis can be treated. Help manage your symptoms by following your doctor’s instructions and watching what you eat.
 • Medication: Your doctor will try to find the medications that work best for you. These may include: 
    • A type of anti-inflammatory medication (called 5-ASA compounds) to help reduce swelling and discomfort.
    • Corticosteroids to help reduce inflammation.
    • Medications to control your body’s immune system (the system that fights infection and causes inflammation).
    • Antibiotics to fight bacteria that may lead to infection.
 • Watch your diet:
    • Avoid any foods that make your symptoms worse. These foods vary from person to person. But high-fiber foods (such as fresh vegetables) and high-fat foods (such as dairy products and red meat) cause symptoms in many people. Keep track of foods that cause you problems.
 • If Surgery is Needed:
    • Surgery can cure ulcerative colitis. But it involves removing the colon. If this is an option for you, your doctor can give you more information.

Consultant: 
Richard A Sundberg, MD, Gastroenterology
With contributions by:
John I. Allen, MD, Gastroenterology
Sherry Kloha, RN, BSN, Patient Education
Myron Lewis, MD, Gastroenterology
Lynda Roberts, MD, FAAFP, Family Practice

Important Reminder: This information is intended only to provide general guidance. It does not provide definitive medical advice. It is very important that you consult your doctor about your specific condition.

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