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'Swedish Gastroenterology' posts

FDA finally defines gluten free

On August 5th, 2013, the U.S. Food and Drug Administration (FDA) at long last published a formal rule regulating the use of the term "gluten free" on foods and beverages.  Even though this came with a big sigh of relief to the millions of people with celiac disease living in the US, consumers should be aware that the law gives manufacturers one year to be in full compliance (and goes into effect August 5, 2014).

As we head into the final months before the law’s final compliance date, I thought I’d highlight a few other key points about this brand new law:

1. No symbols needed.  The law does not require or recommend manufacturers use any particular symbol or food label, but if a label should include any of the following phrases, compliance must be ensured:
    •    “Gluten-free”
    •    “Free of gluten”
    •    “No gluten”
    •    “Without gluten”

2.  It’s voluntary.  A manufacturer may produce gluten-free foods, but just choose not to label them as such.   

3.  “Gluten-free” does not mean “zero gluten”. The new law defines "gluten-free" to mean that a food contains less than 20 parts per million (20 ppm) of gluten.  (This tiny amount can be visualized as less than a tenth of a grain of salt on a slice of bread, and is acceptable as the standard for people with celiac disease).

4.  As with any rule, there are exceptions.  Although ...

Pivotal time for chronic hepatitis C treatment

An estimated 2.7-3.9 million people in the US are chronically infected with hepatitis C.*  Patients are often diagnosed incidentally, when they donate blood, get life insurance or get a routine physical exam with blood tests showing normal or abnormal liver enzymes.  They may have been diagnosed many years ago with non-A, non-B hepatitis, but forgot about it, never followed up, or did not mention it to their regular health care provider.  In 2012, the Centers for Disease Control (CDC) issued additional recommendations to start screening “Baby Boomers,” those born between 1945-1965.  Though Baby Boomers account for 3.25% of the US population, they account for 3/4 of the hepatitis C infections.*

Patients may have seen a health care provider in the past and told that there is no treatment, that treatments were not effective, or not worthwhile due to side effects.  Patients have been reluctant to seek treatment because they have heard about the terrible side effects associated with treatment, including flu-like symptoms, fatigue, depression, muscle aches, rashes, etc, lasting up to a year. 

However, this is a pivotal time for hepatitis C patients because treatment has improved by leaps and bounds.  In late 2013, two ...

What causes constipation and how is it treated?

People often fear the worst about constipation.  Constipation is very common and only rarely signifies something serious.  Just because the average person has a bowel movement daily doesn’t mean you have to—if normal for you is every 3, 5, or 7 days that is okay so long as it’s not adversely affecting your life. In many cases, people with constipation struggle with it all their lives and are looking to be certain nothing more serious is going on and for a way to treat their symptoms.  Even in people with relatively new onset of constipation, there usually is a simple solution.  It is certainly reasonable to have your constipation assessed but in the absence of other warning signs for more serious disease, additional testing related to constipation is not always essential.

What are the causes of constipation?

Colonic inertia

  • Most cases of constipation are caused by colonic inertia, which is simply a slow moving colon.  Different people are made differently, and the muscles and nerves that are supposed to act in concert to push stool along just work a little slower in people with constipation.  In such cases, if we could look at the colon under the microscope it would look normal but if we took an x-ray of how quickly it pushed stool through, it would on average move things along more slowly.

Pelvic floor dysfunction

  • If ...

Is the FODMAP diet right for you?

FODMAPs is an acronym, coined by two Australian researchers, that refers to Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols.  These are small chain sugars, fibers, and sugar alcohols that are poorly digested by humans, but are easily digested by the bacteria in your intestine and colon.  When the bacteria consume FODMAPs, they produce gas, which leads to symptoms of gas, bloating, abdominal discomfort, and changes in bowel movements.  The FODMAP diet is used to alleviate the impact these types of foods have on your gastrointestinal tract. 

A diet low in FODMAPs food was designed to help minimize symptoms in individuals that suffer from irritable bowel syndrome (IBS) and functional bloating.  You should discuss your symptoms with your physician prior to starting this diet since other gastrointestinal related disorders need to be excluded first (i.e., celiac disease, thyroid disease, inflammatory bowel disease, and others). 

If a diet low in FODMAP is recommended for you ...

Swedish Digestive Health Network – call 1-855-411-MYGI (6944)

In the fall of 2011, Swedish opened the largest, most advanced endoscopy center in the Pacific Northwest. This state-of-the-art unit serves as the procedural space for a broad range of minimally invasive cases performed by gastroenterologists, colorectal specialists, thoracic and bariatric surgeons and pulmonologists on patients with a broad range of digestive and respiratory diseases.  As we celebrated this accomplishment, we were reminded of the complexity of digestive disease and that many times, patients and possibly even referring physicians aren’t sure of what type of specialist is best suited to a particular digestive problem.

There is nothing more distressing as a health care professional than hearing patient horror stories about trying to access care. A chronic illness can cause depression and discouragement; an acute illness or a cancer diagnosis can overwhelm the patient and the patient’s family with plenty of unknowns. 

To address these challenges, a group of 50+ specialists came together and created the Swedish Digestive Health Network.

The Swedish Digestive Health Network focuses on collaboration to ease the way for ...

What is Gastroenteritis?

This past week, Britain’s Queen Elizabeth II was hospitalized with a “stomach bug”. Gastroenteritis (also called the “stomach flu”) is the second most common illness in the United States. So, chances are good that your family has been affected by gastroenteritis already this year!

What are the symptoms of gastroenteritis?
Gastroenteritis is inflammation of the stomach and intestines causing symptoms of diarrhea, vomiting, cramping, and fever. If a person is not able to keep up with fluid losses from diarrhea and vomiting, then they can become dehydrated. Gastroenteritis occurs year-round and affects people of all ages. Those who are young, old, or have a suppressed immune system are more susceptible to severe gastroenteritis and to dehydration.

What causes gastroenteritis?
The majority of cases are caused by a viral infection (occasionally, a bacterial infection) transmitted through contact with another sick person or contaminated food/drink.

I have gastroenteritis, how can I feel better?
Rest and fluids! Staying hydrated is the most important step to controlling gastroenteritis. Some good options for staying hydrated include sports drinks or oral rehydration solutions (such as Pedialyte in drug and grocery stores).

I typically do not recommend any anti-diarrheal medications as this may even prolong the illness. In addition, antibiotic therapy is not helpful unless a specific bacterial cause is identified.

When should I call my doctor?
If you have questions or concerns you should always call your provider. However, things to watch for if you have gastroenteritis include:

Preventing progression of Barrett's esophagus to cancer without surgery

Many people wonder what the treatment for Barrett's Esophagus (BE) is. Treatment for BE without dysplasia consists primarily of controlling esophageal acid exposure, usually with once a day proton pump inhibitor (PPI) medications like omeprazole (Prilosec®). Occasionally, twice a day dosing or even anti-reflux surgery may be necessary to completely control acid reflux. Unfortunately, suppressing acid does not usually cause the Barrett’s tissue to regress or even prevent it from progressing to cancer.

If dysplasia is found on any biopsies, treatment recommendations change:

  • Low-grade dysplasia: Close surveillance with endoscopy every 6-12 months or ablation.
  • High-grade dysplasia: Endoscopic therapy to destroy Barrett’s tissue or surgery.
  • Early cancer: Endoscopic removal of focal cancer followed by tissue destruction or surgery

Experiments performed 20 years ago showed that in most people, once the Barrett’s tissue has been removed or destroyed, normal squamous tissue tends to regrow in the area as long as acid reflux is suppressed.

Endoscopic tissue destruction can be performed many ways:

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