If you feel ill with fever, flu-like symptoms or respiratory illness, please call us to reschedule your appointment. Please Do Not Bring Children Under age 16 to Appointments.

Six Ways to Keep Your Gut Moving

Six Ways to Keep Your Gut Moving

By Ginger Bailey, RDN, CD

 

When everything is going well, food moves through our system like a nicely regulated conveyer belt. Fuel goes in, the nutrients we need get extracted and absorbed, and the waste comes out the other end for elimination. But sometimes, this conveyor belt doesn’t work so well – especially if it moves too slowly near the end. When that happens, things get backed up, which can result in some very uncomfortable symptoms. I’m talking, of course, about constipation, and if you’ve ever suffered from it, you know it’s no laughing matter.

Fortunately, there are many things you can do with your diet to keep this system flowing well.

Six Ways to Keep Your Conveyor Belt Moving Smoothly

There are several factors that can make things move slower than they should. Here are a few things you can do with your diet if you frequently find yourself getting “backed up”.

  1. Make sure you get enough fiber. Fiber does two critical things. It helps hold more water in your colon so that your stool doesn’t get dry and hard. It also helps provide bulk that triggers peristalsis – the muscular contractions in our digestive tract that propel food forward. Again, think of it like a grocery store conveyer belt. It helps your colon know there is something there so it can move things along. Fiber is found mainly in fruits, veggies, whole grains, and legumes.
  2. Ease up on the starch and protein. Starches and proteins tend to be more binding. They will usually cause your stool to be harder and hold less water in the colon. It’s okay to have some starch and protein, so long as they are eaten along with fruits and veggies—foods that have a higher fiber content. Many people eat too much starch and protein in proportion to the number of fruits and vegetables they consume, which can cause problems with regularity.
  3. Drink more water. Most people don’t get adequate fluid intake. On top of that, many people consume caffeine which causes more fluid loss! If there isn’t enough fluid going through your system, your colon will try to reabsorb as much fluid as it can to prevent extra losses. In severe cases, this can cause a blockage.
  4. Avoid unnecessary supplements. Many supplements are poorly absorbed by the body. If something isn’t well-absorbed, it will just move through your digestive tract and can stop things up. Look for the USP label on your supplements to make sure they have been tested for absorbability. Try to avoid taking nutritional supplements unless there is no way to get those nutrients through food. (For example, due to food allergies or other medical conditions.) Ask your doctor or dietitian for recommendations about what is necessary for you.
  5. Get up and move! When you get moving, it helps promote peristalsis. If people aren’t getting enough physical movement, they will also tend to have more issues with constipation. Getting up and moving, even in short increments, can really help you get “unstuck”!
  6. Are you taking medications that can cause constipation? Opiate pain medication and muscle relaxers are known to slow the system down and cause constipation. There are other medications that can also have this side effect. If you are concerned about this, talk with your doctor about all the medications and supplements you take. You can discuss options you might have to either change or discontinue medication if other interventions have failed.

 

Hopefully, a few of these simple tips will help get things flowing better – and you feeling better. But, if these suggestions are not enough to fix your slow digestion problems, then it is time to talk with a gastroenterologist or a dietitian who can evaluate your situation and recommend next steps.

 

Constipation can be a symptom of several gastrointestinal conditions. It is best to be sure there is no significant medical reason for your situation, then work on the right solution for your system – everyone is unique.

 

The specialists at Granite Peaks Gastroenterology work with patients with these issues every day. Be sure to talk with them if you are suffering with any sort of digestive health problems to get the expert care you need.

Eating Healthy for Your GI Condition

By Granite Peaks Gastroenterology

Eating a healthy diet is one of the best ways to give your body the right kind of fuel for good health and healthy weight management. In general, maintaining a healthy weight puts less pressure on the gastrointestinal (GI) system, decreasing symptoms for many GI conditions.

However, some healthy foods can cause increased symptoms for individuals suffering with Gastroesophageal Reflux Disease (GERD), Irritable Bowel Syndrome (IBS), Celiac disease and Inflammatory Bowel Disease IBD like ulcerative colitis and Crohn’s disease. Raw vegetables, whole wheat or grains, and high-fructose fruits can aggravate the gut, increasing unpleasant symptoms because the body may have a harder time digesting such foods.

The goal is to eat the healthiest diet that agrees with your system to obtain the best nutrition while avoiding uncomfortable symptoms. Good nutrition supports the entire body and balancing a nutritious diet within the limits of your body’s digestive tolerance levels will achieve good health and a good GI state.

If you, or someone you know, has gastrointestinal issues, consult one of the gastroenterology specialists at Granite Peaks Gastroenterology in Sandy or Lehi. If you have a condition that may require adjustment to your diet, they can help you make the right choices to live a healthy life without the discomfort of GI symptoms.

For the Love of Fiber

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.”

Fiber | Granite Peaks Gastroenterology

ERCP Procedure for Gallbladder and Pancreatic Stones

By Dr. Andrew Heiner, MD

Endoscopic retrograde cholangiopancreatography is an endoscopic technique used by gastroenterologists to view and treat specific issues within the gallbladder and the pancreatic and bile ducts. The ducts drain bile from the liver, gallbladder and pancreas, respectively, and feed that into the duodenum, the beginning of the small intestine.

Reasons an ERCP may be necessary:

• Remove gallstones stuck within the bile duct
• Remove pancreatic stones
• Investigate cause of persistent pain in the upper abdomen
• Find cause of acute pancreatitis
• Alleviate obstruction of bile duct such as those caused by tumors
• Determine reason for weight loss
• Determine reason for jaundice
• If an ultrasound or MRCP shows blockage or stones

What Can Patients Expect When Having an ERCP?
Your gastroenterologist will determine whether this procedure is appropriate for your particular situation. It is similar to having an upper endoscopy in that you will be sedated and a flexible tube with a camera will be gently guided down your throat, through your stomach to the duodenum where the bile duct (known as the papilla) connects. A thin tube is threaded through the scope and into the papilla and ducts. Contrast dye aids x-ray imaging used to shows the location of any stones, blockages (such as tumors) or irregularities of the ducts. From this information, the doctor can make repairs to the area or treat the problem including removing stones, placing a stent, or other surgical techniques to improve function.

This procedure is performed in a hospital setting and the doctors at Granite Peaks are qualified to perform this procedure at various hospitals in the area.

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Abdominal Pain

by James M. Stewart, MD

Abdominal pain is one of the most common complaints a gastroenterologist hears in daily practice. Evaluating abdominal pain is complicated and often involves looking for patterns. The first place to start is with some questions about the pain.

Common questions include:

• When did the pain start? Whether a patient’s pain has been present acutely (starting within the last month) or chronically (starting months to years ago) helps narrow the diagnosis.

• Where does it hurt? Some abdominal pain stays in one part of the abdomen, such as just above the right hipbone (appendicitis) or under the right ribs (gallbladder disease). Other pains may migrate around the abdomen or be very difficult to localize to one spot.

• Does it ever go away? Most pains will come and go but some pains are consistent for long periods of time.

• Is there anything that a patient can do to make the pain better or worse? Is it associated with eating or defecating? Is it worse during the morning or night? Is it exercise or position-related?

• Are there any other symptoms present at the same time as the pain, such as diarrhea or nausea? This can help a physician figure out which part of the gastrointestinal tract is involved.

A physician’s physical exam focuses on palpating places in the abdomen to feel for masses or lumps that may provide clues. The physician is also trying to see if pressure will increase the pain. At the physician’s discretion, further physical exam aids include tapping on the abdomen to listen for trapped air or listening to the bowel sounds within the abdomen.

Bloodwork may be ordered to evaluate for abdominal pain. The physician will often combine physical exam, bloodwork, and the patient’s history with other diagnostic testing to find the cause or to suggest a treatment regimen.

If the physician believes that the pain is coming from the intestinal tract they may use an endoscopy to diagnose abdominal pain. An upper endoscopy is an evaluation through the mouth that looks at the esophagus, stomach, and the first several inches of the small intestine (the duodenum). A lower endoscopy, or colonoscopy, primarily evaluates the large intestine and a little of the very end of the small intestines. Biopsies can be taken during an endoscopy, which can be analyzed under a microscope to provide guidance regarding the pain.

Additional tests include 3D imaging of the abdomen, often done with a CT scan or with an ultrasound or MRI machine. These exams look under the skin and muscles of the abdomen to the organs underneath and see if anything looks unusual about them.

Sometimes, even after all of this testing, there is no obvious source of the abdominal pain. It can be frustrating for patients to not have a definitive cause for the pain.

At this point, a physician and patient discuss the pros and cons of medication, supplement trials or dietary approaches to aid the body. Sometimes, psychotherapy can be helpful if stress or anxiety are manifesting as abdominal pain. It takes patience and sometimes trial and error to find something that helps alleviate the pain. Since opiate-based pain medications can worsen gastrointestinal symptoms and pain, gastroenterologists very rarely use these medications.

Determining the cause of your abdominal pain can be a process, but one well worth discussing with your gastroenterologist to alleviate pain, discomfort and its interruptions to living your life well.

Diagnosing GERD With the Bravo pH Test

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.

Anal Fissures Symptoms and Treatment

By Kelsey Tolbert and Andrew Heiner, MD

Your rectal pain and bleeding may actually be from a fissure
Anal fissures are one of the most common rectal disorders. They are caused by a tear or cut in the anal canal. The symptoms often mimic those of hemorrhoids, and therefore fissures are often mistreated or misdiagnosed. An anal fissure can be acute (lasting < 6 weeks) or chronic (lasting >6 weeks).

Symptoms
The main symptom associated with an anal fissure is pain with defecation. The severity of pain ranges from a mild discomfort to a debilitating, stabbing sensation. Pain can last anywhere from a few minutes to several hours and sufferers often describe the sensation as the feeling that they are “pooping glass.” Anal fissures may also cause bright red bleeding with bowel movements, itching, and/or anal spasm.

Causes
Anal fissures occur when there is high pressure in the anal canal, resulting in the anal sphincter muscle being stretched beyond its capacity. This most frequently occurs with constipation, diarrhea, childbirth, anal intercourse or other trauma.

While fissures are most often benign, they can also be manifestations of more serious conditions such as inflammatory bowel disease malignancy or sexually transmitted infections. If you have symptoms of a fissure, especially if symptoms persist for more than 4-8 weeks, you should see your healthcare provider.

Acute Anal Fissures
The vast majority of anal fissures fall into this category. Acute fissures heal on their own within a few weeks and only require mild conservation therapy. Common ways to treat fissures include:

  • – Taking warm baths. Fill a tub with a few inches of warm water and sit for 20 minutes 2-3 times a day, particularly after bowel movements. The warm water will help to relax the sphincter muscle to promote healing and pain relief. Toilet seat sitz baths are an inexpensive alternative and can be purchased online or at most grocery stores.
  • – Softening or bulking up stool. Avoiding constipation and diarrhea is very important to the healing and prevention of an anal fissure. Taking Metamucil or Citrucel fiber powder twice daily will help to give stool form and promote complete evacuation. Stool softeners or MiraLAX can also be used.

Chronic Anal Fissures
The presence of an anal fissure often causes the anal sphincter muscle to spasm. This spasm can cause the edges of the cut to widen (worsening the tear) and reduce blood flow to the area (prolonging healing). For these reasons, anal fissures can become a cyclical and chronic problem. Chronic anal fissures are treated by a health care provider, often in conjunction with fiber supplementation and warm baths. Common treatments for chronic fissures include ointments, creams, Botox injections, medications, and/or surgery. In some cases, treatment of hemorrhoids can improve anal fissures and prevent reoccurrence.

When to see a Doctor
– If symptoms persist for more than 4-8 weeks
– If you develop rectal bleeding
– If pain is impacting daily activities
– If you develop a change in bowel habits

Each of these can be signs of a more serious condition or may reflect the need for more aggressive treatment. At your appointment, your physician will most likely perform an anal exam and may refer you to have a colonoscopy.

Prevention
Anal fissures can usually be prevented by regulation bowel movements to avoid straining or irritation. This is best achieved by eating well, exercising, and staying well hydrated. Taking a daily fiber supplement such as Metamucil or Citrucel powder is also a good idea, as this promotes overall bowel health.

If you are experiencing symptoms of anal fissures, schedule an appointment with a Granite Peaks Gastroenterology physician today.

Living with Celiac Disease

Denise is the Pathology Lab Manager at Granite Peaks Gastroenterology. She shares her story about how she first learned that she had the condition, and tips for living with Celiac Disease.

In 2008, I came to work for Granite Peaks Gastroenterology. I learned about the importance of digestive health, including being screened at the age of 40 if you have a family history of colon cancer. I was a few years overdue and quickly scheduled a colonoscopy. I had been experiencing diarrhea, gas, bloating and fatigue (all symptoms of celiac disease) for at least 20 years. My daughter used to tease me by telling me napping was my talent. It’s true – I was good at it! Although I had reported my symptoms to at least four previous doctors, it had never resulted in a diagnosis. Eventually, I gave up and stopped telling my doctors of my symptoms, convinced it was “all in my head.”

When I relayed my symptoms to Dr. J. David Schmidt at Granite Peaks GI, however, he convinced me to do an upper and lower colonoscopy. My procedure revealed no colon cancer, but my celiac disease diagnosis was obvious. I was relieved to have an answer and to know my symptoms were real and I wasn’t losing my mind. I am truly grateful to Dr. Schmidt, who encouraged me to get tested.

The only treatment for celiac disease is a gluten-free diet. Gluten is in many foods. My first trip to the grocery store was overwhelming. I quickly learned that the best thing I could do is have a positive attitude about living with celiac disease. Don’t think about what you cannot eat. Concentrate on what you can eat. It is important to have foods in their most natural state, such as fresh meats, fruits and vegetables.

Celiac disease is an autoimmune disease. Having an autoimmune disease makes a person susceptible to other autoimmune diseases. I have diabetes and Hashimoto’s (hypothyroid), both of which fall in the autoimmune category. Why I went undiagnosed for so long will always be a mystery to me. Listen to your body – you know it better than anyone else!

If you are having symptoms of Celiac Disease, contact Granite Peaks Gastroenterology today for an appointment with one of our specialists: (801) 619-9000.

Management of Acute Diarrhea

Management of Acute Diarrhea

Source: Adapted from the American College of Gastroenterology

Risk Factors for Stomach Cancer

By Christopher Cutler, M.D.

November is Stomach Cancer Awareness Month. Approximately 22,000 people are diagnosed with stomach cancer every year in the United States, and 11,000 die from it. The physicians at Granite Peaks Gastroenterology would like to make you aware of the risk factors for stomach cancer:

Age, gender, race – Stomach cancer most commonly affects people in their 60s and 70s. Men are two times more likely to develop stomach cancer than women. Stomach cancer is more common in African Americans, Hispanics, and Asians than in Caucasians.

Salt – The risk of stomach cancer increases with a high intake of salt and salt-preserved foods (salted fish).

Nitrates – Nitrates are a natural component of some foods and are also used as a food additive. Diets that are high in processed meats have been associated with a higher rate of stomach cancer. In fact, processed meats (ham, bacon, sausage, jerky) are classified as a group 1 carcinogen.

Diets low in fruits and vegetables – Eating fruits (especially citrus) and vegetables is protective against stomach cancer, possible decreasing the risk by 30-40%. The protection against stomach cancer provided by fruits and vegetables is probably related to their Vitamin C content, which is thought to decrease the formation of carcinogens in the stomach. Cooked vegetables do not offer as much protection as raw vegetables.

Obesity – Excess body weight (BMI greater than 25) is associated with an increased risk of stomach cancer. This risk increases with increasing BMI.

Smoking – The risk of stomach cancer is increased 1.53 fold in smokers, and this risk is even higher in men. The risk decreases after 10 years of smoking cessation.

Alcohol – Heavy alcohol consumption may be a risk for stomach cancer.

Helicobacter pylori – This bacteria, which is present in the stomach of half the world’s population, is a common cause of ulcers and stomach cancer. H pylori is a group 1 carcinogen and may increase the risk of stomach cancer six fold. There is a reduced incidence of stomach cancer after successfully treating H pylori with antibiotics.

Epstein Barr Virus – It is estimated that 5-10% of stomach cancers in the world are associated with this virus.

Occupational exposure – Occupations such as mining, metal processing and rubber manufacturing may increase the risk of stomach cancer.

Gastric surgery – The increased risk of stomach cancer after stomach surgery may be due to the regurgitation of bile and pancreas juice into the remaining stomach.

Blood group – Individuals with blood group A have a 20% increased risk of stomach cancer compared to those with blood groups O, B, and AB.

Family history – This accounts for up to 10% of cases of stomach cancer. There are also many inherited cancer syndromes (Lynch Syndrome) which increase the risk of stomach cancer.

Pernicious anemia – Also known as Vitamin B12 anemia, this may increase the risk of stomach cancer 2-6 fold. Some societies recommend a one-time screening endoscopy in these people to identify pre-cancerous lesions.

Screening everyone for gastric cancer in this country is not recommended. Screening with an endoscopy should be considered for high-risk groups, such as those with a history of: pernicious anemia, adenomas in the stomach, intestinal metaplasia of the stomach, familial adenomatous polyposis, or Lynch Syndrome.

If you have any questions about stomach cancer or its risks, please be sure to contact your medical provider at Granite Peaks Gastroenterology.

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