May Marschner, Author at Granite Peaks Gastroenterology of Utah

Belching, Bloating, and Flatulence

Posted on June 9, 2022June 9, 2022 by May Marschner

We know it’s embarrassing when your digestive symptoms become noticeable to others. There can be many causes for the belching, bloating and flatulence that you may experience and your gastroenterologist can help you find the culprit that is interrupting your life. Read on to learn more.

Jump To:

Symptoms and Possible Causes

Conditions That May Cause Symptoms

Diagnosing Your Symptoms

Option to Rule Out Dietary Influences

Originally posted on 4/10/2018
Updated on 6/9/2022

Belching, bloating, and flatulence: Any of these symptoms can be embarrassing, leading to unwanted noises, abdominal discomfort, and general malaise. Occasionally experiencing these symptoms is normal, but if symptoms become excessive or too frequent, they can negatively impact your life.

Symptoms and Possible Causes

Belching occurs when excess air is swallowed, causing the stomach to become too full. Flatulence may be a result of this swallowed air, or it can be caused by gas produced by bacteria in the colon. Bloating is a feeling of fullness in the upper abdomen that may be caused by gas in the stomach or intestines.

Issues that can lead to swallowing excess air:
• Simply eating food
• Chewing gum
• Carbonated beverages
• Experiencing anxiety
• Poorly-fitting dentures
• Postnasal drip

Excess intestinal gas can be caused by:
• Gas-producing foods such as cabbage, cauliflower, broccoli, and beans
• Bran and other high-fiber cereals
• Dairy products including milk, some cheeses, and ice cream – especially those dairy products that lack the enzyme lactase, which is necessary to digest milk sugars
• Bacterial overgrowth – normal bacteria in the gut that produce intestinal gas

Carbohydrates that are not digested well in the small intestine travel to the colon where they are metabolized by bacteria into hydrogen and carbon dioxide gases. This causes cramping, bloating, and flatulence. In some people, these gases can accumulate in the right upper section of the colon, leading to pain similar to gallbladder pain. Gas accumulated in the left upper section of the colon can cause chest pain that feels like a cardiac episode.

Conditions That May Cause These Symptoms

• Those suffering from Irritable Bowel Syndrome (IBS) can be extremely sensitive to increased intestinal gases.
• Patients with altered anatomy from surgical changes or with poor intestinal motility can be at increased risk of bacterial overgrowth, leading to excess gas.
• If postnasal drip is suspected, your doctor may check for sinus problems.

Diagnosing for Belching, Bloating and Flatulence:

Our Granite Peaks Gastroenterology Specialists will meet with you to discuss your symptoms and determine what tests may be needed. They may recommend an upper endoscopy, depending on the frequency, severity, and location of your symptoms. If celiac disease is suspected, this may be detected during an upper endoscopy. If bacterial overgrowth is a possibility, it may be diagnosed with a breath test.

Some Options to Rule Out Dietary Influences:

• Withdraw dairy products from the diet to rule out lactose intolerance
• Eliminate carbonated beverages from the diet
• Eliminate gas-producing foods such as cauliflower, cabbage, broccoli, beans, and bran from the diet—eliminate these ones by one and keep a diary of symptoms
• Avoid sugar-free gum and hard candies—the sweeteners can cause extra gas while chewing gum and sucking on candy cause one to swallow excess air.

Remember that everyone experiences belching, bloating, and flatulence at one time or another. It’s normal! However, if it is interrupting your life, causing you frequent, recurring discomfort; or causing you to feel generally unwell, it is time to seek professional help.

Granite Peaks Gastroenterology Specialists are available to help you find answers and stop these uncomfortable and embarrassing symptoms. Call us today at (801) 619-9000 to make an appointment.

Kristine – Cancer Survivor

Posted on March 19, 2019April 18, 2019 by May Marschner

Developed by May Marschner, PA-C with Kristine, Colon Cancer Survivor

As medical providers, our job is not only to diagnose and treat patients, but also to educate them. I have found over the years, however, that patients with shared experiences are often able to share far more wisdom than any textbook, research study, or lecture by a doctor or physician assistant. Kristine is a friend of mine who was diagnosed with colon cancer 18 months ago. She graciously agreed to share her story with us this month, when the medical community focuses specifically on colon cancer awareness. Life is precious. Come on y’all – get your colonoscopy!

My name is Kristine and I was diagnosed with colon cancer on August 25, 2017. My story is about listening. Listening to your body, listening to your family and listening to the medical community.

I did not listen to my body. I had been having abdominal pain for several months. It was very intermittent. Soon after, I began having very unusual bowel movements. I thought I had developed an egg allergy or had become lactose intolerant. I was also up several times a night having bowel movements or feeling the need to urinate.

I didn’t listen to family. My grandmother had lost a long and painful battle with colon cancer when I was 18. I had been reminded by my mom to get tested, but I didn’t listen.

I didn’t listen to the medical community. I had not had a colonoscopy at age 50. (The recommended age now has been reduced to 45 by the American Cancer Society).

I finally listened to my sub-conscious. I needed to get tested. I called and made the appointment. The procedure itself is simple, you are prepped, you are asleep, you are awake. That’s it.

Then I had to listen. I had to listen to the doctor who performed the procedure tell me that there was a large tumor in my sigmoid colon. It was so large he could not see past it.

I listened to one surgeon tell me that I would need radiation and chemotherapy before surgery to shrink the tumor and a second surgeon’s plan of surgery and then chemotherapy. I went with the second opinion.

November 16, 2017, I had surgery to remove the tumor. All went well. I was home in four days. 48 hours later I was in the ER with a reconnect site leak. I spent 5 days hoping it would resolve itself and then listened as my surgeon told me I would need surgery to wash out my abdomen, place a drain and have an ileostomy. I also listened as he told me that all the tested nodes came back negative. Good news, finally.

I spent 2 weeks in the hospital with complications, an ileostomy that would not stop leaking, edema in my legs and a bladder that would not wake up. Finally, things began to resolve, and I spent a week in rehab before coming home.

The New Year brought more listening. Listening to my body on New Year’s Eve that landed me in the ER with an infection and 48 hours in the hospital with IV antibiotics and then listening to my oncologist. There was something on my liver. Scans confirmed it, it had metastasized to my liver. I was now stage 4.

I had a liver ablation and my port placed, then chemotherapy treatment started a few days later.

While chemotherapy is not enjoyable in any way, it isn’t what it was when my grandmother had it. There are medications that prevented me from having nausea and vomiting. I did 12 rounds of FOLFOX, every two weeks, which required an IV treatment and then 48 hours of wearing a pump of chemo drugs. The two days after being disconnected are the worst and I spent my treatment weekends in bed. Food tasted funny, cold sensitivity is real and the neuropathy started to set in by round 11 of 12.

On November 5, 2018 I listened as my oncologist told me I was NED (no evidence of disease)!

After treatments are over and you are waiting for scans every 6 months, the mind plays games and is probably the most difficult part of the journey. It’s hard not to listen. You are no longer actively treating and killing off the cancer cells. You are waiting for scans and hoping you get to listen to another good report. (“scanxiety” is real in the cancer community).

I have found support in online colon cancer groups and there is one thing that has been very worrisome to me, there is a growing number of colon cancer patients that are young, in their 30’s and 40’s. Often, they are misdiagnosed because it is not “recommended” to have a colonoscopy before age 45. Sadly, many of these young people are stage 4 before they are properly diagnosed. That is why it is so important to listen to your body and fight until someone listens to you.

Everyone faces their journey differently. I am very vocal about it, I want others to listen to my story. I sought out online support groups that have been a wealth of information and support. They get it. Others choose to not be as vocal, preferring to keep it to themselves. I understand that at times it is hard for family and friends to understand everything we are experiencing. I don’t look sick and sometimes that is difficult for others to understand. They may say we look great, but inside we are still fighting. I suggest finding someone who will listen to you, who understands all the fears, the scanxiety, the rollercoaster ride of emotions. And, if you can, become an advocate. This month my Facebook page will be filled with information and funny memes to remind people to be screened. Last year I had 3 friends who listened and scheduled appointments to be screened!

So, remember:

– Listen to your body.

– Listen to your family history

– Listen to the medical community

– Listen to that voice in the back of your head

And, listen to me. Early detection through screening is crucial! The symptoms that led me to my colonoscopy didn’t present themselves until the tumor had grown quite large. If I had been screened at age 50, I may not have had to endure all the complications, the ileostomy, and chemotherapy. The idea of the embarrassment of a colonoscopy (and I know for many that is a factor) would have prevented so many other uncomfortable and much more embarrassing procedures.

I will not let colon cancer define me, but I will not let it stop me from educating as many people as I can, and I hope they listen because the only way we can prevent others from late stage diagnosis is to talk until they listen and get screened.

For the Love of Fiber

Posted on December 20, 2018April 18, 2019 by May Marschner

By May Marschner, PA and Dr. Andrew Heiner

Fiber, fiber and more fiber…yes, it is important, but did you know it actually helps prevent hemorrhoids and may lower cholesterol?

Most of us know a high-fiber diet has many health benefits, from improving digestion to lowering cholesterol and preventing some diseases. However, most Americans still struggle to get even close to the recommended daily dose of 25-35 grams per day.

Fast Facts

-People who eat enough fiber daily appear to be at a lower risk for developing coronary heart disease, diabetes and high blood pressure.

-There is evidence fiber supplementation in obese individuals enhances weight loss; however, fiber alone should not be used as a weight-loss method.

-Fiber can help improve hemorrhoid irritation, constipation, diarrhea and can improve irregular bowel habits. Consult a doctor before using if you have these symptoms as they may indicate other health issues.

-With the holidays fast approaching and most people eating more and differently than they normally would, now is a perfect time to increase your fiber intake.

Tips from the Experts for Increasing Fiber Intake

-Slowly start to add more fiber to your diet. If you do this slowly, you are less likely to have GI discomfort. Make sure you drink more fluid, mainly in the form of water, when increasing fiber intake.

-Eat more soluble fiber. Soluble fiber absorbs water. It is found in oat bran, barley, nuts, seeds, beans, lentils and some fruits and vegetables. It is also found in psyllium husk, like that found in Metamucil and similar products.

-Eat more insoluble fiber. Also known as “roughage,” insoluble fiber does not dissolve in water and our digestive systems do not break it down. It is found in foods such as wheat bran, nuts, some vegetables and whole grains.

-Avoid processed snacks with lots of added fiber. These types of snacks, such as bars, can cause gas and bloating and can also have a lot of extra sugar.

Fiber Supplementation

If you find it difficult to get enough fiber in your daily diet, you may choose to add a supplement to increase your fiber intake. Fiber powder is a supplementation used to bulk up the stool. There are several types including cellulose, pectin, gum and psyllium husk. You may have heard of or seen Metamucil on the counter at your grandmother’s house. This contains psyllium husk.

Always consult your healthcare provider prior to adding fiber if you are experiencing any gastrointestinal issues. Determining that symptoms are not caused by a significant health problem is important before making any dietary changes. Dr. Heiner is a strong proponent of the fiber supplement, Metamucil (and no, he does not own stock in the company!).

“Metamucil is magic!” Dr. Heiner says, “It can prevent both constipation and diarrhea. Taken in adequate doses, it produces the perfect BM. Everyone is different, but many do best when they double the recommended dose. When you no longer need toilet paper, you’re probably on the right dose for you. There is virtually no downside to taking Metamucil. Those who take it every day for the rest of their lives will not regret it.”

Osteoporosis – The GI Connection

Posted on December 18, 2018April 18, 2019 by May Marschner

Edited by May Marschner, PA-C

Osteoporosis is a common disease in which bones become thin and weak, leading to an increased risk of fractures. In fact, people with osteoporosis can break a bone simply by falling at home. More than 1.3 million osteoporosis-related fractures occur every year in the United States. A common misconception is this is a disease that only affects women, but 20 percent of hip fractures in the elderly occur in men.

There are many GI conditions and therapies that may increase your risk of developing osteoporosis. If you have any of these risk factors, your gastroenterologist may recommend screening for osteoporosis. The goal of screening is to identify people who are at increased risk of sustaining a low-trauma fracture who would benefit from intervention to minimize that risk.

Who Should be Screened for Osteoporosis

-all women aged 65 and older and all men aged 70 and older

-post-menopausal women younger than 65 who have certain risk factors for fractures (previous fracture, family history of hip fracture, low body weight, smoking, excess alcohol use, rheumatoid arthritis)

-people taking chronic steroids, such as prednisone at a dose of more than 5 mg daily for more than 3 months

-people with malabsorption and maldigestion conditions such as celiac disease, chronic pancreatitis and short gut syndrome—these conditions may lead to decreased vitamin D and calcium absorption

-people with inflammatory bowel disease such as ulcerative colitis and Crohn’s disease

-people with chronic liver disease such as primary biliary cirrhosis

-people who have undergone certain weight loss procedures such as gastric bypass

Screening for Osteoporosis

The best tool to diagnose osteoporosis and to monitor changes in bone mass over time is a simple XRay called a DEXA scan. If you have any of the above-mentioned gastrointestinal conditions, or if you take steroids regularly (or have in the past), your gastroenterologist may recommend a DEXA scan.

The results of a DEXA scan are quantified with a T-score.

-a T-score from +1 to -1 signifies normal bone density

-a T-score between -1 and -2.5 signifies osteopenia (pre-osteoporosis)

-a T-score of -2.5 or less signifies osteoporosis

Prevention and Treatment for Osteoporosis

-stop smoking and excess alcohol consumption

-participate in regular weight-bearing and muscle-strengthening exercises

-get enough calcium—the recommended daily allowance of calcium is 1000 mg per day for men and pre-menopausal women, and 1000-1500 mg per day for post-menopausal women; the average dietary intake of calcium in this country is only 500 mg daily, meaning that most people need to take 500-1000 mg of a calcium supplement daily; foods and drinks high in calcium include milk, cheese, yogurt, leafy green vegetables, and foods fortified with calcium such as cereals and juices

-get enough vitamin D—you should get at least 600-1000 units daily; your body naturally makes vitamin D through sunlight exposure—foods and drinks high in vitamin D include salmon and tuna and foods fortified with vitamin D like milk and cereals

-medications may be prescribed by your doctor to help reduce bone loss—the most common medications are biphosphonates and include Actonel, Fosamax, Boniva and Reclast

-treat the underlying disease appropriately and/or reduce use of medications that increase your risk for osteoporosis

How Proton Pump Inhibitors (PPIs) Might Affect Your Bones

Proton pump inhibitors (Prilosec, Prevacid, Nexium) block the production of acid in your stomach. Studies are controversial, but PPIs may decrease the absorption of calcium and increase the risk of fractures in people over the age of 50. The risk may increase with increasing dose and duration of PPI therapy. Short term PPI use has not been associated with bone density changes. Discuss with your doctor the benefits of taking a proton pump inhibitor if you have an increased risk of bone fractures. If a PPI is necessary long-term, the doctor will likely recommend a calcium supplement that doesn’t need stomach acid for absorption, such as calcium citrate (Cal-Citrate).

In summary, if you have a condition such as celiac disease, chronic liver disease, ulcerative colitis or Crohn’s disease; if you take chronic prednisone; or if you have undergone a prior gastric bypass procedure, you should talk to your Granite Peaks gastroenterologist about osteoporosis screening, prevention and treatment.

C. Difficile Infection

Posted on February 28, 2018April 18, 2019 by May Marschner

Antibiotics are effective medications commonly used to treat infection. Although safe, they can cause side effects, including diarrhea, in up to 20% of patients, usually improving when the antibiotics are stopped. In some patients Clostridium difficile infection (CDI) can develop due to a toxin-producing bacteria that causes a severe form of diarrhea associated with antibiotic use. Symptoms can range from mild diarrhea to severe colon inflammation that can be fatal.

With increased antibiotic use in the U.S., Canada and other countries, the number of CDI cases has dramatically increased. C. difficile spores are very common in the environment and difficult to get rid of. They produce two main toxins that cause inflammation in the colon.

Although most cases of CDI are antibiotic-related, there are additional risk factors that do not include antibiotic use such as older age, weakened immune system, being in a hospital or long-term care facility. Those with inflammatory bowel disease are more likely to get CDI and may face a more intense illness than patients with IBD or CDI alone. Acid-suppressing medicines may also increase the risk of contracting CDI.

Patients experience diarrhea, the most common symptom, and may experience abdominal cramping associated with the watery stool. Vomiting, fever, nausea and generally feeling unwell can accompany the diarrhea. Severe cases include fever and abdominal distension.

A stool test is necessary to verify the presence of toxin in the stools and determine appropriate treatment. In mild cases, an antibiotic such as metronidazole may be used. If that isn’t effective, vancomycin is the next step and is usually effective.

While antibiotic treatment is effective in most cases of CDI, up to 20% of patients could experience recurrent symptoms and recurrence statistics rise from there (up to 60%) if the patient is not responding to a second round of antibiotic therapy.

For these patients, the most effective method for treating CDI is known as a fecal microbiota transplant, which has been effective in more than 90% of patients receiving the treatment in randomized controlled trials. The doctors at Granite Peaks Gastroenterology have experience and have had success with this treatment in multiple patients suffering from CDI who were unresponsive to traditional antibiotic treatment.

Don’t let symptoms go unattended. Check in with your doctor if you have symptoms of CDI, especially if you’ve recently used antibiotics. The sooner it is treated, the more likely it is that you’ll have a quick and complete recovery.