Diseases & Conditions

Approximately 70 million people in the U.S. are affected by gastrointestinal (GI) diseases. According to the American College of Gastroenterology, GI diseases are responsible for the hospitalization of more people in the U.S. than any other single group of disorders.

The gastrointestinal tract is divided into four distinct parts that are separated by sphincter muscles; these four regions have distinctly different functions to perform and different patterns of motility (contractions). They are the esophagus (carries food to the stomach), stomach (mixes food with digestive enzymes and grinds it down into a more-or-less liquid form), small intestine (absorbs nutrients), and colon (reabsorbs water and eliminates indigestible food residues).

 

Barrett’s Esophagus (BE)

BE, a complication of GERD, is a pre-cancerous condition in which the lower portion of the esophagus changes to abnormal cells that resemble normal cells found in the stomach. BE develops in about 10-20% of people with chronic GERD or inflammation of the esophagus and evaluating people with a history of GERD is the best way to help detect this condition. 700,000 adults in the U.S. are reported to have Barrett’s esophagus, with the prevalence being twice as common in men. The type of cancer that develops from BE is called esophageal adenocarcinoma. A patient with BE has a 0.5% per year risk of developing esophageal adenocarcinoma.

 

Colon Cancer

Colon cancer is cancer that forms in the large intestine (colon) or the rectum (end of the colon). According to the American Cancer Society, colorectal cancer is one of the leading causes of cancer-related deaths in the United States. However, in almost all cases, early diagnosis can lead to a complete cure.

  

Crohn’s Disease 

Crohn’s disease is a chronic condition that causes inflammation in the lining of the small intestine wall. It usually occurs in the lower part of the small intestine called the ileum, but can affect any part of the digestive tract. Symptoms include diarrhea, abdominal pain, weight loss and rectal bleeding. Roughly 50 percent of all cases of Crohn’s disease are diagnosed in the last part of the small intestine (the terminal ileum) and cecum. This area is also known as the ileocecal region. Other cases of Crohn’s disease may affect one or more of the following: the colon only, the small bowel only (duodenum, jejunum and/or ileum), the anus, stomach or esophagus.

Roughly 500,000 Americans suffer from Crohn’s disease and about 20 percent have a direct relative with some form of IBD. It affects men and women equally. The cause is unknown, but the most popular theory is that the immune system is reacting to a virus or bacterium that causes inflammation.  An upper GI x-ray series and colonoscopy are used to test for inflammation and intestinal abnormalities. Depending on the severity, treatment options include nutritional supplements, drugs and surgery. There is currently no cure for Crohn’s disease.

 

Esophageal Cancer

There are two main types of esophageal cancer. Squamous cell carcinoma can occur anywhere along the esophagus while adenocarcinoma starts at the opening of the stomach and arises only from the cells of Barrett’s esophagus. Over 12,000 people develop esophageal cancer each year in the US and about half of these cases are adenocarcinoma. Barium contrast radiography or endoscopic ultrasonography may be used for non-invasive detection of esophageal cancer. However, esophageal cancer is ultimately diagnosed by endoscopy with biopsy.

 

Esophageal Varices

Varices are varicose veins in the esophagus or stomach that have become enlarged due to increased pressure. The increased blood flow causes these fragile blood vessels to become so stretched that they can break or bleed. Esophageal varices are common in patients with cirrhosis, a condition in which scar tissue forms in the liver and may keep the liver from functioning normally. 360 per 100,000 Americans have cirrhosis and gastroesophageal varices are present in 40-60% of cirrhotic patients. Due to the high mortality rate associated with bleeding from esophageal varices, screening of patients with cirrhosis for the presence of varices is recommended by the American Association for the Study of Liver Diseases. Bleeding from esophageal varices can cause massive hemorrhage or be fatal.

 

Esophagitis

An inflammation, infection, or irritation of the lining of the esophagus, which is the tube connecting the throat to the stomach. If left untreated, this condition can become uncomfortable, particularly while swallowing. Common causes of Esophagitis include bacteria, viruses, GERD and vomiting.

 

Gastrointestinal Bleeding, Ulcerations, Lesions and Small Bowel Tumors

GI bleeding is a symptom rather than a disease and can occur anywhere within the digestive system. Common causes of bleeding in the small intestine include ulcers in the duodenum (sores in the lining of the upper small intestine) and ulcerations due to inflammation from ulcerative colitis or Crohn’s disease. GI bleeding may be traced to other areas not associated with the small intestine such as hemorrhoids (enlarged veins) in the anal area or benign (non cancerous) growths or polyps in the colon.

Symptoms depend on the location of the bleeding and its severity. Changes in bowel habits and the presence of pain may tell the doctor which part of the GI tract is affected. A thorough physical examination, blood tests and GI imaging are used to make a diagnosis.

 

Gastrointestinal Reflux Disease (GERD)

Occurs when the lower esophageal sphincter (LES) muscle malfunctions or does not close properly and stomach acid leaks back into the esophagus causing a burning sensation in the chest or throat. This acid can irritate and sometimes damage the delicate lining on the inside of the esophagus. The most common symptom is heartburn, an uncomfortable burning sensation behind the breastbone, most commonly occurring after a meal. Complications of severe or chronic GERD include inflammation, ulcers and bleeding of the esophagus. Overtime scarring or narrowing of the esophagus may occur. A pre-cancerous condition, Barrett’s esophagus, may also develop as a complication of GERD. An estimated 61 million Americans, or 44% of the US adult population, have heartburn at least once a month, and more than 19 million people suffer from GERD and experience symptoms at least twice a week. GERD is the third most prevalent disease in the US but most GERD sufferers are not screened for more serious disease.

 

Inflammatory Bowel Disease (IBD)

Inflammatory Bowel Disease is the general name for diseases that cause inflammation of the intestines.  Approximately one million Americans are estimated to suffer from IBD with males and females affected equally. Crohn’s disease and ulcerative colitis are classified as IBD and may share similar symptoms.

 

Irritable Bowel Syndrome(IBS)

Irritable Bowel Syndrome is one of the most common functional GI disorders, affecting about 20 percent of the Western population and accounting for 3.5 million physician visits in the U.S. annually. The term "functional" is generally applied to disorders where the body's normal activities in terms of the movement of the intestines, the sensitivity of the nerves of the intestines, or the way in which the brain controls some of these functions is impaired. However, there are no structural abnormalities that can be seen by endoscopy, x-ray, or blood tests. Thus it is identified by the characteristics of the symptoms and infrequently, when needed, limited tests. The Rome diagnostic criteria categorize the functional gastrointestinal disorders and define symptom based diagnostic criteria for each category.

Although the symptoms of IBS may appear similar to ulcerative colitis and Crohn’s disease, it does not cause inflammation, intestinal bleeding or lead to cancer. IBS is characterized by chronic abdominal pain, bloating and altered bowel function such as diarrhea and constipation, or an alternating pattern between the two. It most often affects people in their late-teens to early 40s and may run in families. X-rays and endoscopy may be performed to check for intestinal abnormalities and rule out IBD. There is no cure, but symptoms may be controlled with diet modification, medicine and stress management. 

 

Polyp

Polyps are abnormal tissues that grow inside your body. Most polyps are not dangerous but over time, some types can turn into cancer. Most small polyps don't cause symptoms. Often, people don't know they have one until their doctor finds it during a regular checkup or while testing them for something else. Polyps are one of the most common conditions affecting the colon and rectum, occurring in 15-20 percent of the adult population.

 

Ulcerative Colitis

Ulcerative colitis (UC) causes inflammation and ulcers in the top layers of the lining of the large intestine, though it can also occur in the small intestine. Symptoms such as diarrhea, weight loss and rectal bleeding, are similar to Crohn’s disease. Inflammation usually occurs in the rectum and lower part of the colon, but can affect the entire colon. An estimated 500,000 people in the U.S. have ulcerative colitis.

UC typically affects people between the ages of 15 to 40 and appears to be hereditary.  Similar to Crohn’s disease, the cause is unknown, but the immune system is suspected of reacting to a virus or bacterium that causes inflammation in the intestinal wall. About five percent of people with UC develop colon cancer. Diagnostic methods include barium enema, colonoscopy, MRI and CAT scan. Depending on the severity, treatments include diet modification, medication and surgery. Currently remove the diseased colon through surgery is the only cure.

 

References:
   
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Crohn’s and Colitis Foundation of America (ccfa.org)
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