R. Kyle Barnett, Author at Granite Peaks Gastroenterology of Utah

March is Colorectal Cancer Awareness Month!

Posted on March 10, 2022March 14, 2022 by R. Kyle Barnett

Originally posted on 3/5/2019
Updated on 3/10/2022

Colon cancer is the second leading cause of cancer deaths among men and women combined in the United States, but most cases are preventable with appropriate screening. Efforts to increase colorectal cancer screening are urgently needed.

Who should be screened for colorectal cancer?

The American Cancer Society recommends screening for people at average risk of colorectal cancer at age 45, although some insurance companies have not adapted this recommendation as of yet. Higher risk individuals (for example, those with a family history of colorectal cancer or colorectal polyps, those with a prior history of polyps or those with inflammatory bowel disease) may need to start screening at an earlier age.

How should I be screened?

Various test options are available for colorectal cancer screening.

1. Stool-based tests check the stool for signs of cancer and include fecal immunochemical test (FIT) every year, guaiac-based fecal occult blood test (FOBT) every year or stool DNA test (Cologuard) every 3 years.

2. Visual exams of the colon and rectum look at the structure of the colon and rectum for any abnormal areas and include colonoscopy every 10 years or less, depending on the outcome, CT colonography (virtual colonoscopy) every 5 years or flexible sigmoidoscopy every 5 years.

Note: If a person chooses to be screened with a test other than colonoscopy, any abnormal test result should be followed up with a colonoscopy.

Each test has pros and cons, and one might be a better option for you than another. The most important thing is to GET SCREENED!

My doctor recently recommended a stool DNA test for screening. Is that test as effective as a colonoscopy?

The simple answer is No.

-Cologuard detects the presence of precancerous or cancerous cells by testing DNA from stool samples. It requires no bowel prep, no pre-test diet or medication changes, is done at home and is fairly inexpensive, often covered by insurance.

-However, studies indicate Cologuard detects only 92% of cancers and detects only 42% of precancerous polyps, making it far less effective as a preventative tool.

-It has a 13% false positive rate (meaning the test reads positive in the absence of disease), requiring further testing or confirmation with colonoscopy. This colonoscopy would not be covered by most insurance companies as a screening test; it would be considered a diagnostic test.

-Cologuard must be used for screening every 3 years, as compared to colonoscopy every 10 years – if no polyps were found.

-Colonoscopy detects more than 95% of cancers and more than 80% of all polyps, some of which could be precancerous. In addition, colonoscopy can detect other diseases and allows for the immediate removal of polyps (some of which are precancerous growths).

Does insurance cover my colorectal screening test?

The Affordable Care Act (ACA) requires both private insurers and Medicare to cover the costs of colorectal cancer screening tests. At this time, many, but not all insurers cover the cost of colorectal cancer screening before the age of 50. However, the ACA doesn’t apply to health plans that were in effect before the law was passed in 2010. Check with your insurance provider to be sure.

Make a difference in your life or the life of a loved one. Get screened! Contact Granite Peaks Gastroenterology to schedule your colon cancer screening today.

Liver Disease in Pregnancy

Posted on September 12, 2018April 18, 2019 by R. Kyle Barnett

By R. Kyle Barnett, MD

Abnormal liver tests occur in approximately 3-5% of pregnant women. For some women, test results that would otherwise suggest liver or gallbladder dysfunction in a non-pregnant woman may, in fact, be normal in a pregnant woman. Abnormal test results should be evaluated by a specialist since some diseases, newly diagnosed in pregnancy, may require more immediate intervention for the expectant mother or unborn fetus.

Additional Testing

Managing a pregnant woman with liver disease is a common medical scenario that involves unique challenges, since the mother AND fetus must be considered in any clinical treatment decisions. Pregnant patients who have had abnormal liver tests can expect to undergo some level of additional testing, to address initial testing results.

A standard workup, just as any non-pregnant individual with similar results would have, is the first step. Most liver test results remain the same during pregnancy, except for those produced by the placenta. Abnormalities seen with certain liver tests require further evaluation.

Ultrasound testing is safe and is the preferred imaging type in abnormal liver assessment that suggests gallbladder disease. MRI and CT scans may be used but only under certain conditions in later pregnancy.

Endoscopy may be necessary during pregnancy, but if possible, not until after the second trimester. Sedation with propofol is acceptable for pregnant patients.

Liver Diseases Unique to Pregnancy

Hyperemesis gravidarum (HG), is a condition which includes severe morning sickness, with symptoms which can include nausea, vomiting, jaundice, weight loss and dehydration which can affect liver function, urine output, blood pressure, cognition and heart rate. Treatment for HG may require hospitalization to ensure the pregnant woman receives fluids and nutrients necessary for her own health as well as that of the fetus, usually followed by bedrest.

Preeclampsia with liver involvement can progress to the level of Severe Preeclampsia, prompting delivery after 36 weeks to limit maternal and fetal complications.

HELLP syndrome, is an unusual set of symptoms that may be related to preeclampsia. It affects liver function, causes the breakdown of red blood cells and produces a low platelet count, which negatively affects blood clotting ability. Immediate delivery is recommended (especially after 34 weeks).

Other Condition That Can Occur

Gallbladder and Biliary System

If symptoms indicate, gall bladder removal is possible during pregnancy using laparoscopic surgical techniques.

Patients with liver masses should be treated prior to pregnancy when possible. Most conditions do not require routine imaging, but those with certain lesions should be monitored by ultrasound to track growth.

Hepatitis

Current recommendations for pregnant women with chronic hepatitis B virus infection include vaccinating infants born to HBV-infected mothers and antiviral medication given during the third trimester to reduce transmission to the newborn. At present, chronically hepatitis B-infected women can still breastfeed, as no strong evidence indicates otherwise.

Women with risk factors for hepatitis C should be screened with blood tests, but screening is not indicated in women without risk factors. Invasive procedures, including an elective C-section, should be avoided if possible in women with chronic hepatitis C, to prevent transmission of hepatitis C to the fetus.

Women with acute hepatitis should be tested for common causes of acute liver injury including viral hepatitis and herpes hepatitis. Those with acute hepatitis suspected to be caused by herpes virus should be treated with antiviral medication.

Women suspected of cirrhosis should have an upper endoscopy to screen for esophageal varices in the second trimester. Those with large esophageal varices should be treated accordingly.

More

There are more liver conditions that could be present during pregnancy for certain at-risk patients. Pregnant women under a doctor’s care will be able to address any health concerns that could affect the mother or fetus.

Patients who know they have hepatitis or feel there is a risk of exposure, have liver conditions that require medical care or have hereditary factors that may indicate liver problems, should consult with their doctor prior to becoming pregnant to ensure the healthiest start for themselves and their baby.

Diagnosing GERD With the Bravo pH Test

Posted on September 5, 2017April 18, 2019 by R. Kyle Barnett

By R. Kyle Barnett, MD

What is GERD?
Frequent heartburn may mean you have Gastroesophageal Reflux Disease (GERD), a condition that lead to serious health problems. It is estimated that 40 percent of Americans are impacted by GERD. Symptoms of GERD may include heartburn, regurgitation, chronic cough, hoarseness, sore throat, chest pain, belching, asthma, and difficulty swallowing.

Up to 26.5 percent of those with chronic GERD may develop Barrett’s Esophagus in their lifetime. Barrett’s Esophagus is the primary risk factor for Esophageal Cancer. Less than 20 percent of people diagnosed with esophageal cancer survive more than five years after their diagnosis.

How is GERD diagnosed?
GERD is often suggested based on your symptoms. However, diagnostic testing may also be needed to assess the severity of your symptoms, and to exclude other contributing factors such as hiatal hernia, inflammation or ulceration in the stomach, or tumor. An upper endoscopy (EGD) is the test performed by your doctor to visualize the lining of the esophagus, stomach and duodenum. Sometimes this test may be normal despite symptoms that suggest GERD. Sometimes medical treatment may not completely control your symptoms.

What is a Bravo pH test?
We have a reflux testing option that may help. It’s a convenient, safe and patient-friendly test that is performed in our outpatient Endoscopy Center. The Bravo pH Test measures the pH level in your stomach acid to help your doctor determine if your symptoms are related to acid reflux or if there is another cause. It will reveal whether your acid is being adequately controlled with medical therapy or if surgical correction may be the solution to your acid reflux. The Bravo test can also determine whether some of your other symptoms (chronic cough, recurrent sore throats, hoarseness, sinus issues, chest pain) are related to GERD.

How is the Bravo pH test performed?
The Bravo pH Test involves performing an upper endoscopy (EGD) with sedation administered by an Anesthesia Professional. During the EGD, a location for placement of a small pH probe is identified, and the probe is attached to the lower part of the esophagus, where it is monitored for a period of 48 hours. You leave our facility with a recording device that you keep with you for the duration of the test. You are then instructed to register your activities including eating and sleeping, and record when you develop symptoms including heartburn, chest pain or regurgitation. The recorder is then returned to our office, where Granite Peaks Gastroenterology physicians will then analyze the recording, along with your diary of events, and report back to you.

How can this help with my medical care?
The Bravo test can determine if an abnormal amount of acid is present in the esophagus, and whether your ongoing symptoms are related to GERD. It can also be an important part of your evaluation if you are considering surgery for your GERD. Although medical therapy for GERD is effective for most people, there have been some recent concerns about the long-term safety of these medications (called PPIs, or proton pump inhibitors) including possible increased risk of chronic kidney disease, bone loss, heart disease and increased risk of certain gastrointestinal infections. If long-term therapy is considered with these medications, it is important to determine if abnormal acid reflux is present so that the appropriate treatment plan can be made between you and your physician.

If reflux is an issue for you and you would like an evaluation to explore treatment options, call or click today to make an appointment. Together we can decide if you are a candidate for Bravo pH testing. For more information, please visit www.utahheartburnrelief.com.

March is Colorectal Cancer Awareness Month

Posted on March 7, 2017April 18, 2019 by R. Kyle Barnett

By Dr. R. Kyle Barnett

Granite Peaks Gastroenterology has partnered with the American Cancer Society and the National Colorectal Cancer Roundtable to promote “Eighty By 2018.” The initiative joins force with organizations such as ours that are committed to eliminating colorectal cancer as a major public health problem. Together, we are working toward the goal of reaching 80% of adults aged 50 and older to get screened for colorectal cancer by 2018. If we can achieve 80% screening by 2018, 277,000 cases and 203,000 colorectal cancer deaths could be prevented by 2030. This would be truly remarkable!

Consider the following facts:

• Colorectal cancer ranks #2 among killer cancers in the United States. Around 50,000 people die of colorectal cancer each year in the U.S.

• The likelihood of developing colon cancer in your lifetime is 1 in 20

• There are 136,000 new cases of colorectal cancer each year in the U.S

• 1 in 3 American adults (almost 23 million total) aren’t screened for colorectal cancer as recommended

• There is a 90% reduction in cancer risk following colonoscopy and polypectomy

When adults get screened for colorectal cancer, it can be detected at an early stage when treatment is most likely to be successful. In some cases it can be prevented through the detection and removal of precancerous polyps. Colon cancer arises from precancerous growths (polyps) that grow in the colon. When detected early, these polyps can be removed, stopping their progression to colorectal cancer. Prevention is powerful! Unlike other cancer screenings, which only detect a problem, colonoscopy screening can prevent colorectal cancer by removing these precancerous polyps during the exam.

The risk of colorectal cancer is roughly equal in men and women, and is most common after the age of 50, but it can also strike at younger ages. It is also more likely if you have a family history of colorectal cancer or polyps. Symptoms that may be associated with colorectal cancer might include new onset of abdominal pain, blood in the stool, or a change in your typical bowel habits. However, most colorectal cancers produce NO SYMPTOMS and this is why screening is SO IMPORTANT!

Colonoscopy every 10 years is the preferred colorectal cancer prevention test. For normal risk individuals, the American College of Gastroenterology recommends colonoscopy beginning at age 50 (age 45 for African Americans). Other screening tests are also available. Just remember, the best screening test is the one that gets done!

So please join us here at Granite Peaks Gastroenterology and Endoscopy and make the pledge to reach our “80% by 2018” goal. By scheduling your colonoscopy screening, we can take steps to eliminate this terrible disease that can lead to heartbreak for too many. You (and your family) will be glad you did!

Additional resources:
www.nccrt.org
www.cancer.org
www.gi.org
www.utahcolon.com