Diseases

Colon Polyps

What are colon polyps and should I be concerned?

There are two main types of colon polyps and these can only be distinguished by microscopic
examination. Both of these types of polyps occur frequently especially after age 40 to 50 and
may appear in any part of the colon.

Hyperplastic polyps have changes which appear completely benign under microscopic examination, and though there has been some controversy about whether they represent risk of colon cancer, most experts now agree that they do not and that no follow-up is required for these polyps. However, follow-up might be needed if you have had other problems.

Adenomatous polyps (colonic adenomas) are benign growths, but under the microscope these polyps show changes which look like the beginnings of colon cancer. Medical studies have now shown that removing colon adenomas prevents the later development of colon cancer and have proved that polyps should be removed.

Inflammatory: This is most common in patients with ulcerative colitis or Crohn’s disease. These are often called pseudopolyps or false polyps as they are a reaction to chronic inflammation of the colon wall. They are not cancerous.

Keep in mind that different types of colon polyps are common and occur in about 30 to 50 percent of adults. All polyps are initially not cancerous, and can be completely and safely removed. They can usually be detected with colonoscopy. A colonoscopy may also require a follow up examination.

Regardless of what type of polyps you have had in the past, always follow your doctor’s guidelines for follow up.

How often does a polyp turn to cancer and how long does it take for this to happen?

We think that only about 5% of polyps (1 in 20) actually go on to become malignant. In general it appears that it takes at least seven years—longer in most cases—for a small polyp to turn into a cancer.

How accurate is colonoscopy in finding polyps?

Colonoscopy is the most accurate way of looking for polyps, still it finds only about 95% of polyps when the colon is clean. Of course, any study is less accurate when the colon is not clean. In general, larger more dangerous polyps are easier to see than smaller, early polyps.

How often should I be screened if I have had colon adenomas or cancer?

This is a question which continues to be studied carefully in medical trials and recommendations have changed in recent years. Because polyps do grow slowly, once we are fairly certain that the colon is cleared of polyps we can lengthen the interval between studies. For people who had a clean colon and few small polyps on the first colonosocpy, we recommend that the second colonoscopy be done in three years. If no polyps are found then, the third study should be done five years after that. For people who have had many polyps, large polyps, cancer, or a dirty colon at the first study, these recommendations are changed.

Are other colon preparations available?

Other colon preparations are being developed and some people often prefer one prep over another. If you had serious problems with the prep used at your colonoscopy or if your colon was not clean at colonscopy, please mention this to us when you are being scheduled for return. We may be able to find a preparation that suits you better.

Colon Cancer and Screening for Colon Cancer

Each year, nearly 150,000 Americans are disgnosed with colon cancer or colorectal cancer. it is one of the most common forms of cancer, but you have the power to do something about this.

Put simply, colon cancer starts as a growth on the lining of the colon or rectum. The growth is called a polyp. Over time, some polyps may develop into cancer.

Why Should I Get Screened?

Screening can precent as many as 90% of colon cancer cases. Polyps found and remove during a routine colonoscopy never have a chance to develop into cancer. If cancer is present, early detection and treatment are the keys to survival.

When Should I Get Screened?

If you are of average risk, you should get a screening test for colon cancer starting at age 50.

However, if you have a family history of polyps or colon cancer, talk with your doctor about being tested before the age of 50. Recent studies have shown that African Americans have the highest risk of colon cancer and should begin screening at age 45.

Crohn’s Disease

Crohn’s disease is an inflammatory bowel disease (IBD). It causes inflammation of the lining of your digestive tract, which can lead to abdominal pain, severe diarrhea and even malnutrition. Inflammation caused by Crohn’s disease can involve different areas of the digestive tract in different people.

The inflammation caused by Crohn’s disease often spreads deep into the layers of affected bowel tissue. Like ulcerative colitis, another common IBD, Crohn’s disease can be both painful and debilitating, and sometimes may lead to life-threatening complications.

While there’s no known cure for Crohn’s disease, therapies can greatly reduce the signs and symptoms of Crohn’s disease and even bring about long-term remission. With treatment, many people with Crohn’s disease are able to function well.

Inflammation of Crohn’s disease may involve different areas in different people. In some people, just the small intestine is affected. In others, it’s confined to the colon (part of the large intestine). The most common areas affected by Crohn’s disease are the last part of the small intestine (ileum) and the colon. Inflammation may be confined to the bowel wall, which can lead to scarring (stenosis), or inflammation may spread through the bowel wall (fistula).

Signs and Symptoms of Crohn’s Disease

Signs and symptoms of Crohn’s disease can range from mild to severe and may develop gradually or come on suddenly, without warning. You may also have periods of time when you have no signs or symptoms (remission). When the disease is active, signs and symptoms may include:

Diarrhea. The inflammation that occurs in Crohn’s disease causes cells in the affected areas of your intestine to secrete large amounts of water and salt. Because the colon can’t completely absorb this excess fluid, you develop diarrhea. Intensified intestinal cramping also can contribute to loose stools. Diarrhea is a common problem for people with Crohn’s.

Abdominal pain and cramping. Inflammation and ulceration may cause the walls of portions of your bowel to swell and eventually thicken with scar tissue. This affects the normal movement of contents through your digestive tract and may lead to pain and cramping. Mild Crohn’s disease usually causes slight to moderate intestinal discomfort, but in more-serious cases, the pain may be severe and include nausea and vomiting.

Blood in your stool. Food moving through your digestive tract may cause inflamed tissue to bleed, or your bowel may also bleed on its own. You might notice bright red blood in the toilet bowl or darker blood mixed with your stool. You can also have bleeding you don’t see (occult blood).

Ulcers. Crohn’s disease can cause small sores on the surface of the intestine that eventually become large ulcers that penetrate deep into — and sometimes through — the intestinal walls. You may also have ulcers in your mouth similar to canker sores.

Reduced appetite and weight loss. Abdominal pain and cramping and the inflammatory reaction in the wall of your bowel can affect both your appetite and your ability to digest and absorb food.

People with severe Crohn’s disease may also experience

  • Fever
  • Fatigue
  • Arthritis
  • Eye inflammation
  • Mouth sores
  • Skin disorders
  • Inflammation of the liver or bile ducts
  • Delayed growth or sexual development in children

When to see a doctor

See your doctor if you have persistent changes in your bowel habits or if you have any of the signs and symptoms of Crohn’s disease, such as:

  • Abdominal pain
  • Blood in your stool
  • Ongoing bouts of diarrhea that don’t respond to over-the-counter (OTC) medications
  • Unexplained fever lasting more than a day or two

Ulcerative Colitis

Ulcerative colitis is an inflammatory bowel disease (IBD) that causes long-lasting inflammation in part of your digestive tract.

Like Crohn’s disease, another common IBD, ulcerative colitis can be debilitating and sometimes can lead to life-threatening complications. Because ulcerative colitis is a chronic condition, symptoms usually develop over time, rather than suddenly.

Ulcerative colitis usually affects only the innermost lining of your large intestine (colon) and rectum. It occurs only through continuous stretches of your colon, unlike Crohn’s disease, which occurs anywhere in the digestive tract and often spreads deeply into the affected tissues.

There’s no known cure for ulcerative colitis, but therapies are available that may dramatically reduce the signs and symptoms of ulcerative colitis and even bring about a long-term remission.

Diarrhea

Diarrhea describes loose, watery stools that occur more frequently than usual. Diarrhea is something everyone experiences. Diarrhea often means more frequent trips to the toilet and a greater volume of stool.

In most cases, diarrhea signs and symptoms usually last a couple of days. But sometimes diarrhea can last for weeks. In these situations, diarrhea can be a sign of a serious disorder, such as inflammatory bowel disease, or a less serious condition, such as irritable bowel syndrome.

Diarrhea may cause a loss of significant amounts of water and salts. Most cases of diarrhea go away without treatment, but see your doctor if diarrhea persists, if you become dehydrated or if you pass blood in your stool.

Constipation

Constipation is infrequent bowel movements or difficult passage of stools. Constipation is a common gastrointestinal problem.

What’s considered normal frequency for bowel movements varies widely. In general, however, you’re probably experiencing constipation if you pass fewer than three stools a week, and your stools are hard and dry.

Fortunately, most cases of constipation are temporary. Simple lifestyle changes, such as getting more exercise, drinking more fluids and eating a high-fiber diet, can go a long way toward alleviating constipation. Constipation may also be treated with over-the-counter laxatives.

Esophageal & Gastric Ulcers

Peptic ulcers are open sores that develop on the inside lining of your esophagus, stomach and the upper portion of your small intestine. The most common symptom of a peptic ulcer is abdominal pain.

Peptic ulcers that occur on the inside of the stomach are called gastric ulcers. Peptic ulcers that occur inside the hollow tube (esophagus) where food travels from your throat to your stomach are called esophageal ulcers. Peptic ulcers that affect the inside of the upper portion of your small intestine (duodenum) are called duodenal ulcers.

It’s a myth that spicy foods or a stressful job can cause peptic ulcers. Doctors now know that a bacterial infection or some medications — not stress or diet — cause most peptic ulcers.

Esophageal Strictures & Dysphagia

An esophageal stricture is a gradual narrowing of the esophagus, which can lead to swallowing difficulties. The strictures are caused by scar tissue that builds up in the esophagus.
When the lining of the esophagus is damaged, scarring develops. When scarring occurs, the lining of the esophagus becomes stiff. In time, as this scar tissue continues to build up, the esophagus begins to narrow in that area. The result then is swallowing difficulties.

One of the conditions that can lead to esophageal strictures is gastroesophageal reflux disease. Excessive acid is refluxed from the stomach up into the esophagus. This causes an inflammation in the lower part of the esophagus. Scarring will result after repeated inflammatory injury and healing, re-injury and rehealing. This scarring will produce damaged tissue in the form of a ring that narrows the opening of the esophagus.

Causes, incidence, and risk factors of esophageal strictures

  • Gastroesophageal reflux (GERD)
  • Prolonged use of a nasogastric tube
  • Ingestion of corrosive substances
  • Viral or bacterial infections
  • Injuries caused by endoscopes

Symptoms of Esophageal Strictures

  • Difficulty swallowing
  • Discomfort with swallowing
  • A felling that food gets stuck in the esophagus
  • Regurgitation of food
  • Weight loss

GERD (Gastro Esophageal Reflux Disease), commonly called Reflux

Gastroesophageal reflux disease (GERD) is a chronic digestive disease that occurs when stomach acid or, occasionally, bile flows back (refluxes) into your food pipe (esophagus). The backwash of acid irritates the lining of your esophagus and causes GERD signs and symptoms.

Signs and symptoms of GERD include acid reflux and heartburn. Both are common digestive conditions that many people experience from time to time. When these signs and symptoms occur at least twice each week or interfere with your daily life, doctors call this GERD.

Most people can manage the discomfort of heartburn with lifestyle changes and over-the-counter medications. But for people with GERD, these remedies may offer only temporary relief. People with GERD may need stronger medications, even surgery, to reduce symptoms.

Liver Disease

Nonalcoholic fatty liver disease is a term used to describe the accumulation of fat in the liver of people who drink little or no alcohol.

Nonalcoholic fatty liver disease is common and, for most people, causes no signs and symptoms and no complications. But in some people with nonalcoholic fatty liver disease, the fat that accumulates can cause inflammation and scarring in the liver. This more serious form of nonalcoholic fatty liver disease is sometimes called nonalcoholic steatohepatitis. At its most severe, nonalcoholic fatty liver disease can progress to liver failure.

Signs and Symptoms of NFLD

Nonalcoholic fatty liver disease usually causes no signs and symptoms. When it does, they may include:

  • Fatigue
  • Pain in the upper right abdomen
  • Weight loss

Nonalcoholic fatty liver disease occurs when your liver has trouble breaking down fats, causing fat to build up in your liver tissue. Doctors aren’t sure what causes this. The wide range of diseases and conditions linked to nonalcoholic fatty liver disease is so diverse that it’s difficult to pinpoint any one cause.

Types of nonalcoholic fatty liver disease

Nonalcoholic fatty liver disease can take several forms — from harmless to life-threatening. Forms include:

  • Nonalcoholic fatty liver. It’s not normal for fat to build up in your liver, but it won’t necessarily hurt you. In its simplest form, nonalcoholic fatty liver disease can cause excess liver fat, but no complications. This condition is thought to be very common.
  • Nonalcoholic steatohepatitis. In a small number of people with fatty liver, the fat causes inflammation in the liver. This can impair the liver’s ability to function and lead to complications.
  • Nonalcoholic fatty liver disease-associated cirrhosis. Liver inflammation leads to scarring of the liver tissue. With time, scarring can become so severe that the liver no longer functions adequately (liver failure).

Risk Factors

A wide range of diseases and conditions can increase your risk of nonalcoholic fatty liver disease, including:

  • Certain medications
  • Gastric bypass surgery
  • High cholesterol
  • High levels of triglycerides in the blood
  • Malnutrition
  • Metabolic syndrome
  • Obesity
  • Rapid weight loss
  • Toxins and chemicals, such as pesticides
  • Type 2 diabetes
  • Wilson’s disease

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