Digestive Health

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Gluten intolerance or low FODMAPs?

June 18, 2014

Despite test results that show no evidence of their children having neither any detectable allergies to wheat nor any signs of celiac disease, many parents choose to have their children follow a gluten-free diet.  This is because of convincing stories of how gluten (a protein found in wheat and other grains) seems to cause their kids to have belly aches, nausea, bloating and a variety of other symptoms.  

For years, this was hard to explain without a scientific explanation.   Gastroenterologists like me had a hard time supporting families who wanted to follow gluten free diets, without a good “medical reason”.  Then, in 2011, researchers from Australia conducted a double-blind, randomized, placebo-controlled, rechallenge trial in nearly 3 dozen patients (none of whom had celiac disease or wheat allergy), all of whom described worsening symptoms when unkno...

Does your child have a food allergy or food sensitivity?

June 09, 2014

“Every time my child eats, his belly hurts. I think he must have a food allergy. Can you help us?”

Countless times have I heard this from parents of children worried about foods being the cause of their child’s gastrointestinal (GI) complaints. Some families wonder whether their child should start a “gluten-free” or other type of dietary change. More often than not, families have already tried a few diets before meeting with me.

Parents considering these types of elimination diets need to be aware of a few key points:
The difference between “food allergy” and “food sensitivity”:

Sports drinks and energy drinks

June 03, 2014

I recently wrote a short post for the Issaquah Soccer Club on the topic of sports & energy drinks.

What is inflammatory bowel disease (IBD)?

May 21, 2014

Inflammatory bowel disease (IBD) is a chronic (i.e. long-lasting) inflammatory condition of the gastrointestinal system. IBD is often confused with irritable bowel syndrome (IBS) because of their similar acronyms, but the two conditions are not related. IBD affects approximately 1.4 million Americans and is most commonly diagnosed between 15-40 years of age.

IBD can be categorized into ulcerative colitis and Crohn’s disease. Though there are clear differences between the two, they are closely related and sometimes difficult to distinguish.

Ulcerative colitis is a condition where inflammation affects the most superficial layer of the large intestine (colon). It typically starts at the rectum and can involve a varying amount of the colon. In contrast, the inflammation of Crohn’s disease can affect all layers of the intestine and can involve any area of the gastrointestinal tract – from the mouth to the anus. The type of inflammation seen in Crohn’s disease may lead to long-term complications such as strictures or fistulas (abnormal connections to other organs) that are typically not seen in ulcerative colitis.

Why aren't my bowel habits normal?

April 21, 2014

Do you have irregular, uncomfortable, or distressing bowel habits? Irritable Bowel Syndrome (IBS) is the most common gastrointestinal condition affecting an estimated 15% of the general population. It is most common among women aged 30 to 49 years old.

IBS is a chronic condition of the digestive system that is not generally associated with more concerning findings of anemia, weight loss, family history of colorectal cancer, inflammatory bowel disease, or celiac disease. Symptoms of IBS include abdominal discomfort, constipation and diarrhea. Despite extensive research, no common cause of IBS has been identified. Some theories include:

FDA finally defines gluten free

February 26, 2014
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"

Living with achalasia like Seahawk Malcolm Smith

February 06, 2014

On February 3, 2014, Yahoo Sports published an article regarding this years’ Super Bowl MVP, Malcolm Smith, as not only achieving recognition for his Super Bowl performance, but also dealing with a rare swallowing disorder known as achalasia.
 
Achalasia is a rare disorder with a prevalence of 10 cases per 100,000 individuals.  Men and women are equally affected and it is usually diagnosed between the ages of 25 to 60 years.  The disease often comes on slowly and is gradually progressive with problems swallowing solids and liquids, and movement of undigested food particles back up into the mouth unintentionally (bland regurgitation).  Patients also often complain of a burning chest sensation. Other symptoms include hiccups, difficulties belching, and sometimes weight loss.

The condition can be seen with radiology studies including a barium esophagram that shows a dilated, or larger than normal, cali...

Updates on LINX - GERD reflux management system

January 27, 2014

Since my initial LINX blog post 20 months ago, we have been engaged in a dialogue with patients from around the world who suffer from gastroesophageal reflux disease or GERD.  Despite my initial trepidation to “blogging”, this has been a rewarding experience to hear about patient’s problems, their concerns about the current treatments (PPI’s and Nissen fundoplication) and simply interacting with them.  I thank the patients who have taken time to share their thoughts on the blog.

 

When our social media manager asked me to provide an update on LINX, I realized that I have been simply responding to patient’s questions and I haven’t posted any of my thoughts or updates on what is happening with the LINX device.

There are some exc...

Troubles swallowing food or liquids - what does it mean?

January 13, 2014

Dysphagia refers to the sensation of food or liquid being delayed or hindered from the mouth to the stomach. This abnormality is increasingly recognized as an important concern that requires attention and study. There are many causes of impaired swallowing, which are categorized into two types, mechanical, a structural barrier to food bolus movement, and motility disorders, involving abnormal muscle movement. There are also two major anatomical sites, oropharyngeal and esophageal.

Oropharyngeal dysphagia is related to problems with the initiation of the swallows and clearing the food bolus from the mouth to the esophagus. This usually occurs within a second of swallowing and you may feel that you cannot initiate a swallow or food hangs up in the neck region. A test that is commonly used to evaluate this is a modified barium swallow or videofluoroscopic swallowing study. This study provides critical information on inability or excessive delay in initiation of swallowing, unintentional inhalation of food, unintentional expulsion of food from the nose or mouth, and/or abnormal retention of food in the back of the throat after swallowing. Most oropharyngeal dysphagia patients benefit from swallow rehabilitation programs.

Infants with Milk Allergy

January 10, 2014

A 4 week-old infant and his mother came to my office last week.  The mother had started seeing small flecks of blood and stringy mucous in the infant’s diapers a week prior.  The baby was fine in every other way, breast feeding normally, and looked quite healthy when I examined him.

I diagnosed the infant as having cow’s milk protein-induced proctocolitis, the term referring to allergic inflammation of the lower gastrointestinal tract from exposure to cow’s milk.

This is a diagnosis I make often. Here's what you should know about infants with milk allergies:

  1. It’s more common than you think. 2-3% of infants in the U.S. are allergic to cow’s milk protein. It is even more common in infants with eczema or who have parents or siblings with allergies.
  2. It’s seen in breast fed babies. Over 50% of infants with this condition are breast milk-fed infants.