If you have uncomfortable bloating, abdominal pain, diarrhea or gas that just won’t go away, your primary physician may refer you to a gastroenterologist. But these highly-trained doctors treat the entire digestive system, not just gastrointestinal-related issues. Lawrence S. Rosenthal, MD, director of advanced endoscopy/endoscopic oncology at Saint Barnabas Medical Center and a gastroenterologist with RWJBarnabas Health medical group, answers questions on three timely, gastroenterological public health issues that are more common than you think.
Q: What should people know in general about gastroenterological health?
A: One of the most important things to discuss is colon cancer screening. It is still the most significant public health benefit gastroenterologists provide. Many people, for understandable reasons, have previously been intimidated by the process of undergoing a colonoscopy. The reality is that it has become much dure itself is brief, painless and afterwards the patients usually
don’t even realize they’ve even undergone a colonoscopy! It is certainly the gold standard test to prevent colon cancer and is arguably the most effective cancer prevention test in any field of medicine. It does not need to be performed frequently; on average every five to 10 years, depending on your family medical history as well as the results of the procedure.
Q: Why is a colonoscopy so effective?
A: Because we are not looking for cancer, we are preventing cancer from occurring. We are looking for polyps, which are benign. We completely remove them during the colonoscopy, and this prevents polyps from developing into cancer. I almost never see colon cancer in a patient undergoing routine screening and surveillance in a timely interval. The vast majority of colon cancers are preventable with routine screening and surveillance.
Q: How is the procedure easier now than it was in previous years?
A: In almost all patients, it can be done as an outpatient procedure. The entire procedure takes around 20 minutes. The sedation we use is very effective; you wake up within three minutes of the procedure being over, you recover quickly and you can eat almost immediately after the procedure. The entire process, including arriving an hour before the procedure as well as the recovery, is usually less than 2 hours total. The laxative bowel preparations are better than they were even five to seven years ago as well. They require a much smaller volume of a flavored liquid laxative—as little as two 5-ounce glasses of fluid—and patients mostly drink a clear beverage of their choice to activate the laxative. Once people undergo a colonoscopy for the first time, they inevitably see it is much easier and more comfortable than they previously imagined.
Q: What screening guidelines do you follow?
A: If there is no family history of colon cancer or polyps and no symptoms, the initial screening colonoscopy should occur at age 50. For an individual with a family history of cancer or polyps but who is still asymptomatic, we recommend undergoing a colonoscopy at age 40. Under very unusual circumstances, it may be earlier. Screening is repeated every 10 years, unless polyps are found, which is common, and would typically necessitate follow up in 3-year or 5-year intervals, depending upon the specifics. Still, that’s only a few times in one’s adult life.
These guidelines may be evolving, however. The American Cancer Society recently updated its recommendations to begin screening in average-risk patients at age 45. This recent American Cancer Society recommendation has not been universally adopted and may not be covered by insurance yet, but that may be changing in the next year or two.
Q: What other GI-related topics are patients interested in?
A: The safety of antacid medications to treat GERD—gastroesophageal reflux disease. One-third of the adult population will develop acid reflux and it is a very common ailment we
discuss in our office. We have made tremendous progress over the years in terms of medical therapy for GERD. Medications called proton pump inhibitors, like Prilosec and Nexium, are incredibly effective in treating this problem and have been widely used for decades. In recent years, a few studies raised questions regarding the long-term safety of these medications. When these studies were compared to the over 900 independent clinical studies conducted over the last 25 years involving the medications, the safety data was reassuring. The recent studies prompted many physicians to adjust the way they use the medications in practice to help their patients. I try to have an exit strategy when prescribing these daily medications at the outset so as to encourage short-term rather than long-term use in an attempt to prevent people from taking them indefinitely. I typically recommend patients who are having frequent acid reflux use the medication for a few months. Then I try to take them off and suggest diet and lifestyle changes, along with other less frequent medication use strategies, to reduce long-term dependence
on the proton pump inhibitors. There are also some promising nonsurgical procedures that may help reduce the need for medications in GERD. One is called transoral incisionless fundoplication, or the TIF procedure. Though not widely used yet, it is an endoscopic procedure where gastroesophageal junction can be tightened, so there is less reflux.
Q: What do you want people to know about the treatment of IBS (irritable bowel syndrome)?
A: One thing I have been impressed by over the last several years is the expanding role of nutrition in effectively managing irritable bowel syndrome. IBS is a very common condition. It’s a clinical diagnosis based on a constellation of symptoms, including abdominal pain, bloating, diarrhea and/or constipation. We don’t have a comprehensive grasp on the mechanism of the
condition. Traditionally, we have treated IBS with a wide variety of medications, like laxatives, antidiarrheal and antispasmodic medications, antibiotics and even antidepressants in some cases.
More recently, we are seeing a greater impact of the role of nutrition in treating IBS. There are impressive results from Australian studies showing how diet modification has a significant impact on IBS symptoms like bloating. Some studies show over 60 percent of patients have significant improvement in quality of life with specific dietary changes. This has been very effective in our practice. We have been utilizing a GI nutritionist to help us with the treatment of patients with IBS with great success.
To schedule an appointment with a Saint Barnabas Medical Center-affiliated gastroenterologist, call 1.888.724.7123 or go to rwjbh.org/sbmc.