GASTRO HEALTH & FIU
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COLON HEALTH
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ESOPHAGEAL CANCER
ENCOURAGE THE HERO IN YOUR LIFE TO GET SCREENED PEDIATRIC NEWS
FOR YOU AND YOUR FAMILY
A CONVERSATION WITH
KATIE COURIC
SPRING 2013 ISSUE
C onvenient &C ompassionate Galloway Endoscopy Center is an accredited surgical facility offering diagnostic and therapeutic gastrointestinal procedures in a comfortable and convenient outpatient setting. Our compassionate, bilingual staff provides top-quality care while assisting our experienced and highly skilled doctors. Best of all, because of advances in medical technology, endoscopic procedures can be safely performed outside the hospital, so you can return to the comfort of your home the same day as your procedure. You have a choice in healthcare. Isn’t it time you got treated better?
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Gastro Health
Welcomes You
Our physicians, allied professionals and staff are pleased to present our Spring 2013 Issue of Gastro Health Magazine. Following the month of Colon Cancer Awareness, we want to continue the momentum of spreading the word about Colon Cancer, informing men and women 50 and older about the importance of having regular screening tests. As the second leading cause of cancer deaths in the United States, Colon Cancer is up to 90% preventable when detected early. With over 20 locations throughout South Florida, Gastro Health provides outstanding medical care and an exceptional healthcare experience. Talk to your Gastro Health physician today about which screening is best for you. Inside this issue you will find informative and educational articles on various digestive health topics such as inflammatory bowel disease, colon health, and irritable bowel syndrome, among others. We are also delighted to feature Katie Couric, who courageously underwent a live colonoscopy on the “Today” show in March 2000, and according to a study published in 2003 in Archives of Internal Medicine, could have inspired many others to get checked as well. Our team of over 50 board-certified adult and pediatric gastroenterologists, colorectal surgeons, radiologists, pathologists, physician assistants, nurse practitioners, nutritionists and technicians combine their clinical expertise and experience to provide patients with quality medical and preventive care in the field of digestive health. We exceed the expectations of patient experiences by treating everyone as an immediate part of our family. Thanks to patients’ feedback, we have received a 98% satisfaction with our services – confirming the dedication to excellence within our care centers. We are proud to have several of our physicians make the 2011 US News & World Report’s prestigious Top Doctor’s List. Gastro Health’s physicians, allied professionals and staff will continue to achieve excellence in medical care, heal and prevent illness through integrated efforts, while always caring for you and the ones you love.
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Inside this issue
5 Gastro Health
6 How is Your Family Doing? 7 Evidence Points to Colonoscopy 8 A Conversation with Katie Couric 10 Imaging of Colorectal Cancer 12 IBD and Colon Cancer 13 Why Screening Matters 19 Gastro Health Physician Directory 23 Preventing Colon Cancer 24 IBS: The Old and the New 26 Encourage the Hero in Your Life to Get Screened 27 Alienta a Los Héroes en tu Vida Para Que Sean Examinados 28 What Endangers Colon Health? 29 Investigative Overview: Esophageal Cancer 31 Attention Baby Boomers 32 The Gastrointestinal World at the Palm of Your Hand 33 Pediatric Corner 34 Working Hand in Hand
Alejandro Fernandez, MBA, CMPE Chief Executive Officer
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Caring for you and those you love.
Mission To provide outstanding medical care and an exceptional healthcare experience.
GuidinG PrinciPle We will treat each patient as a valued member of our immediate family.
core Values Care and Compassion Provide competent, individualized care in a professional, respectful and caring way. Teamwork Recognize each other as valuable members of our healthcare team by treating one another with loyalty, respect, and dignity. Responsibility Provide excellent and efficient administrative, accounting, personnel, and business management services. Value and Excellence Develop valuable ancillary services that improve our patients’ quality of care and customer experience.
Honesty and Integrity Communicate openly and honestly, build trust and conduct ourselves according to the highest ethical standards. Stewardship Attract and retain great talent and the finest gastroenterologists by actively promoting a professionally satisfying work environment. Accountability Maintain mutually beneficial relationships with top referring physicians, payers, employers, and health systems using performance, outcome, as well as satisfaction measurements to demonstrate accountability and improvement in our care delivery.
Gastro Health
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How Is Your Family Doing Ricardo J. Roman, MD Gastroenterologist
and stomach. In addition to knowing the history of any cancers or polyps that may have occurred in your first degree relatives (parents, siblings, children), it is also important to know whether any such conditions occurred in your second degree relatives (grandparents, aunts/uncles, cousins, nephews/nieces). The age of onset of these conditions is also important.
C
olorectal cancer is the second leading cause of cancer–related deaths in the United States. It may affect as many as 1 in 20 persons over their lifetimes. But did you know that an estimated 1 out of every 4 colorectal cancer patients has a significant genetic or inherited component to his cancer? An accurate and complete family history help determine your individual risk factor for colorectal cancer, and will help your physician determine the most appropriate schedule for screening colonoscopy. The presently recommended guidelines state that starting at the age of 50 (45, if African- American), people should undergo routine colonoscopy screening every 10 years. However, this may not be appropriate if there is a significant family history.
Familial Polyposis
There are two forms of inherited colon cancer, which may be acquired even if only one of your parents had it. Familial Polyposis usually manifests itself at an early age, with hundreds of polyps. Ninety percent of those with Familial Polyposis will develop colon cancer by age 50, and oftentimes much younger.
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GASTRO HEALTH MAGAZINE • SPRING 2013
Those suspected of having this condition need screening beginning in their teens and yearly thereafter. There is genetic testing that can help determine if this condition is existent in any person. Overall, however, Familial Polyposis represents 1% or less of all colorectal cancers.
Lynch Cancer Family Syndrome
The other strongly inherited form, the Lynch Cancer Family Syndrome (also known as HNPCC, or Hereditary Non-polyposis Colon Cancer Syndrome) is much more difficult to distinguish from sporadic, non-inherited colon cancer, and may represent up to 6% of all cases of colorectal cancer. Family history is the key to suspecting it. It is important to know which family members had colon cancer or polyps, and at what age they developed the cancer or polyps. Additionally, with the Lynch Cancer Family Syndrome, there is a significantly higher incidence of other cancers. It is therefore also important to know if any family members have had cancers that occur in this syndrome. Such cancers include endometrial cancer, bladder and other cancers of the urinary tract, ovaries
The majority of patients who have a strong inherited tendency for colorectal cancer do not have either the Lynch Syndrome or Familial Polyposis. In both of these conditions, you inherit a single defective gene that causes the condition, from one parent or the other. In most families with a strong tendency to colorectal cancer, we believe that you inherit multiple genes, each of which slightly predisposes you to colorectal cancer. As such, there is no blood test that can be checked. For these families, the strategy for preventing colon cancer depends on earlier and more frequent colonoscopy screening. When and how often a colonoscopy is recommended depends on the family history. In general, the more first degree relatives you have with colorectal cancer or polyps, and the younger they were when they developed colorectal cancer or polyps, the stronger the inherited tendency.
So, don’t be embarrassed to talk about health issues at the next family reunion. Reach out to some of your other relatives who may be able to fill you in on family health issues that you may not be aware of. What you find out just may save your life.
“Colorectal cancer is the second leading cause of cancer–related deaths in the United States.”
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Gastro Health
Evidence Points to Colonoscopy
in Preventing Colorectal Cancer
Alfredo J. Hernandez, MD Gastroenterologist
C
olorectal Cancer, also known as Colon Cancer, is the third most common occurring cancer and the second leading cause of cancer-related deaths worldwide. There are two basic ways to screen for colorectal cancer. One way is by collecting stool specimens. The second is by evaluating the lining of the colon, which is done by having a Colonoscopy, Sigmoidoscopy, Barium Enema, or a CT Colonography. A Colonoscopy is considered the most comprehensive method to detect and prevent colorectal cancer. The procedure consists of inserting a thin, flexible tube into the rectum and evaluating the entire colon. This method allows the physician to locate and remove precancerous, or adenomatous, colon polyps.
The guidelines from the American College of Gastroenterology for colorectal cancer screening call for all average risk individuals, male and female, to undergo colonoscopy at the age of 50. Other populations with risk factors or symptoms may have varying age for colonoscopy. For example, African Americans as a subgroup are recommended for screening at age 45. Patients need to be aware that there are other methods of colorectal cancer screening if colonoscopy is not available to them. If the other methods have positive findings, however, colonoscopy will then be advised. The overall evidence continues to point to colonoscopy reducing the risk of colorectal cancer and even mortality.
A recent New England Journal of Medicine article titled Colonoscopic Polypectomy and Long-Term Prevention of Colorectal-Cancer Deaths, shows that removal of precancerous polyps through colonoscopy reduced the death rate from colorectal cancer. This study is one of the first research papers looking at how colonoscopy can not only reduce the incidence of colorectal cancer, but can actually decrease mortality or death from it. The study analyzed prospectively 2,602 patients that had initial colonoscopy and precancerous polyp removal. There were only 12 deaths from colorectal cancer reported in the group studied. When compared to a group from the general public with similar age, sex and race, the number of deaths from the disease was about 25 individuals. Resulting in the conclusion that colonoscopy reduced the incidence of colorectal cancer associated death by 53%.
‘‘A Colonoscopy is considered the most comprehensive method to detect and prevent colorectal cancer.’’
GASTRO HEALTH MAGAZINE • SPRING 2013
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Gastro Health
A CONVERSATION with
KATIE COURIC
I
t’s been 13 years since Katie Couric courageously underwent a live colonoscopy on the “Today” show -- an ef for t to encourage screening after her husband died of colon cancer in 1998. Since then, she has dedicated her life to making sure people stay informed about this very preventable cancer. Here, Katie answers some resonant questions in an interview with NIH MedlinePlus Magazine.
What are the most important messages you have for Americans about how they can protect themselves and their loved ones from colorectal cancer? Katie Couric: Colorectal cancer claims the lives of almost 50,000 Americans each year; it’s still our second-leading cancer killer, and that just shouldn’t be! With appropriate screening and early detection, this is one cancer that is not only highly curable but also highly preventable. If pre-cancerous growths in the colon— polyps—are found during screening, they can be removed before they become malignant. Everyone should begin testing when they turn 50, and those with risk factors—such as a family history of the disease—may need to start earlier. You need to know your family medical history, but also be aware that most people who are diagnosed with colorectal cancer, about 75 percent, have no family history of it. And in its early stage, colorectal cancer usually causes no symptoms at all. Maintaining a healthy diet, exercising regularly, and quitting smoking—or never starting—can lower one’s cancer risk.
What advice do you have for people who have recently been diagnosed with cancer? Katie Couric: In my mind, the most important thing is to never lose hope—never let anyone take it away from you. You and your loved
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ones really need to be there for one another. If you have young children, keep a close eye on how the experience is affecting them. During Jay’s illness, I asked CancerCare, a wonderful non-profit organization, how I could help my then-six-year-old daughter Ellie at school, and they suggested an exercise for her class called the worry cup. Each child puts a penny in a cup and talks about what they’re worried about. It seems a lot of the girls in first grade were worried about something. As a result, I think Ellie felt less alone. Her teacher later told me it was one of the most moving experiences of her career. Patients and caregivers should utilize the skills and resources of their whole healthcare team, including nurses and social workers who can help provide and identify sources of support. Also, be sure to involve your extended family and friends—ask them for help, specifically telling them what they can do. So often, family and friends want to help, but are completely at a loss about how to do that.
You are the co-founder of the Entertainment Industry Foundation’s National Colorectal Cancer Research Alliance. What is the NCCRA? Katie Couric: Once I picked myself up after Jay died, I wanted to help spare other families the terrible heartbreak mine had endured. My friend Lilly Tartikoff introduced me to the Entertainment Industry Foundation, the collective philanthropy for the television and film businesses, and together we launched the NCCRA in March 2000 to raise money for cutting-edge research and promote awareness about the importance of screening. To date, we’ve raised more than $30 million. That money provides critical funding to scientists at leading institutions around the country, who have made some significant breakthroughs in record time. In my book, they and all the other cancer researchers who work 24/7 to try to end this insidious disease are our society’s unsung heroes. A portion of
Gastro Health
You also played a key role in establishing Stand Up To Cancer. Can you tell us a little about that?
the funds served as seed capital for The Jay Monahan Center for Gastrointestinal Health, a GI cancer and wellness center at New YorkPresbyterian Hospital/Weill Cornell Medical Center that provides seamless, compassionate care for individuals who have—or are at risk for developing—gastrointestinal cancers. We also conduct public awareness campaigns, including a very effective one done with the Centers for Disease Control and Prevention (CDC). Morgan Freeman, Diane Keaton, and Jimmy Smits and I have all done PSAs encouraging people to get screened. And our newest ambassador is actor Terrence Howard, who lost his 56-year-old mom to colon cancer last fall.
When you had your colonoscopy taped and shown on morning television, you really helped to educate Americans about the procedure, its importance, and to reduce its stigma. Did you expect such a big reaction?
We’ve seen reductions in colorectal cancer rates recently. Do you credit increased public awareness and screening? Katie Couric: Certainly the awareness efforts of the whole colorectal cancer advocacy community have had an impact. Screening rates are up, and the colorectal cancer death rate fell by almost 10 percent from 2003 through 2005. Another key factor in the declining death rate is that new treatments have been introduced in the last few years. While there has been good progress, something like 40 percent of the U.S. population has still not been appropriately tested. We have to keep up a relentless drumbeat of messages urging people to “talk to your doctor and get screened.”
Katie Couric: Since nothing like that had ever been done before, we didn’t know what to expect. That the number of people having this test rose by 20 percent after The Today Show broadcast of my colonoscopy and our other awareness efforts was a welcomed surprise. I’ve received thousands of letters from people saying I helped motivate them to get screened. It is profoundly gratifying and humbling to have one person tell you that you helped save his or her life, and we have received many, many letters saying just that.
Katie Couric: With advances in technology and other areas, researchers are closer than ever to the kinds of discoveries that can end cancer. But they need more money and easier ways to collaborate on specific research projects with colleagues at other institutions—to work as part of “Dream Teams”—so new treatments get to patients as quickly as possible. That’s what Stand Up To Cancer is all about. We launched in 2 0 0 8, with the three networks collaborating on a simultaneously broadcast fundraising special. We want to make every American aware that they can make a difference in this fight by helping these scientists. Whatever one individual can do in these tough economic times, every contribution—of any size—helps.
The goal of NIH MedlinePlus, is to give people access to trusted, easily understood information about dealing with disease, staying healthy, and the latest research. Do you often hear from people seeking such reliable information? Katie Couric: I do, and I empathize with how bewildering a cancer diagnosis can be. You are already emotionally shell-shocked hearing this terrible news, and you’re thrust into a situation where people are speaking a language you don’t understand. We have to make scientifically based information readily accessible for the general public, and it has to be communicated in a way the average person can understand. So, bravo for NIH MedlinePlus for addressing this need!
What does the future hold for Katie Couric? Katie Couric: We’ll have to wait and see! I’m focused on three things above all else: my job, my cancer work, and most importantly, my family: being the best mother I can to my two wonderful daughters, and the best daughter I can to my wonderful parents.
Reprinted, with permission, from NIH MedlinePlus Magazine | Spring 2009
GASTRO HEALTH MAGAZINE • SPRING 2013
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Gastro Health
Imaging of
Colorectal Cancer
Daniel Seckinger, MD Radiologist
C
olorectal cancer is a common malignancy associated with substantial morbidity and often leads to death. It would be nice to have a single preferred imaging study for diagnosis and workup of colorectal cancer, yet even with advances of modern imaging such a single imaging modality is not universally accepted.Currently, imaging of colorectal cancer can be divided into either the investigation of a possible colon cancer or the workup of a known colon cancer which has already been diagnosed, usually by colonoscopy. Let’s first look into imaging of a possible colon cancer. This usually will involve a CT examination of the abdomen and pelvis for symptoms such as abdominal pain, bloating, change in bowel habits or blood in the stool. Symptoms may be nonspecific in that myriad other disorders of the internal abdomen and pelvis can be associated with similar problems. In these cases, the detection of a colon cancer depends in large part on the size of the lesion. Considering that cancer may present at the earliest stage as a polyp, at times less than 1 cm in size, the detection of an early-stage tumor may only approach 50% at best with standard barium oral contrast CT. As disease progresses, there will be a stage of focal colon wall thickening often followed by narrowing of the colon lumen. Finally, as disease progresses further, there may be a well-defined mass. CT detection rates increase as disease becomes more severe but still may only approach 80%. A dedicated CT screen exam called CT Colonography, or virtual colonoscopy, has a much higher colon cancer detection rate as a screening exam than does a barium enema. CT Colonography can approach optical colonoscopy for lesion detection. A feature of CT Colonography is that it is considered less invasive than colonoscopy; a limitation is that if it does detect a lesion, the patient will still then need to undergo the colonoscopy for tissue biopsy for diagnosis/lesion removal. CT imaging plays an important role as a staging tool in the workup of already diagnosed colon cancer, comparable to MRI. CT can detect the spread of disease beyond the colon wall, can evaluate for the spread of disease to regional or distant lymph nodes, and can be used to assess the spread to other body organs as metastatic disease. Many surgeons prefer CT imaging for staging prior to colon cancer surgery. Both CT and MRI have limitations in evaluation of lymph nodes in that only the size of a node is assessed. While enlarged nodes are more likely to harbor spread of disease, there can be enlarged lymph nodes that are not involved with tumor, just as there can be small lymph nodes thought
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to be ‘normal’ size which do contain microscopic disease. This is a major reason for increased use of a functional imaging exam known as PET/ CT in the workup of colorectal cancer to evaluate increased cellular metabolism of a labeled sugar compound to evaluate extent of disease spread either regional or to distant organs such as liver.
“Imaging of colorectal cancer can be divided into either the investigation of a possible colon cancer or the workup of a known colon cancer which has already been diagnosed.” To summarize, CT continues to detect many unsuspected carcinomas. The high-resolution multidetector CT at Gastro Health Imaging provides excellent detail for colon imaging. Your Gastro Health physician has access to the full armamentarium of imaging studies available to best workup your presenting signs and symptoms, some of which can be associated with colon and rectal cancer. Even with significant imaging advancements in recent years, there is still not a single imaging study to accomplish both colon screening and workup of a potentially detected mass. Therefore, most would agree colonoscopy remains the gold standard in diagnosis of colorectal cancer.
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Gastro Health
IBD
and
Cancer
Colon
Somal S. Shah, MD Gastroenterologist
I
Inflammatory Bowel Disease (IBD) is a condition characterized by chronic inflammation of the intestines. The two most common types of IBD are Crohn’s Disease (CD) and Ulcerative Colitis (UC). Although the overall risk of colon cancer in IBD is only 95 cases per 100,000 – this is much higher than for the general population. In IBD, the main risk factors for colon cancer are the amount of intestine involved as well as the duration of the disease. It’s been estimated that patients with extensive UC have about a 2.5% increased risk of colon cancer. This increased risk is seen after eight to ten years of disease. This can increase up to 20% after thirty years of disease. Ulcerative Colitis, limited to the left side of the colon, also carries a high risk of colon cancer even though this higher risk is not seen until after 15 years of disease. Crohn’s Disease also carries a higher risk CRC after seven years of disease. Both Crohn’s Disease and UC patients should be screened for colon cancer with colonoscopy every one to two years starting seven years after disease duration. Cancer in IBD is typically seen in areas of chronic inflammation, which can lead to an abnormal cell growth of colon cells called dysplasia. Dysplasia is known to be a precursor to colon cancer. Detecting dysplasia by colonoscopy has been shown to be an effective manner for preventing deaths in IBD. Dysplasia can be found in both colonic growths as well as a normal appearing colon. This means that frequent biopsies need to be taken throughout the colon in order to try to detect dysplasia. Furthermore, a confirmed finding of dysplasia should lead to a total removal of the colon as there is no way to determine if there is cancer away from an area of dysplasia. The goal of colonoscopy in IBD is to detect dysplasia. An endoscopist must take multiple biopsies during the procedure in order to get an adequate sampling of the colonic mucosa. It takes up to 33 biopsies to detect dysplasia with a 90% confidence. Besides multiple random biopsies, there are other techniques that can help detect dysplasia including the use of jumbo forceps in order to obtain large biopsies for pathology analysis. Another aid that can be used to better detect dysplasia is chromoendoscopy. This refers to the topical application of temporary stains to better characterize inflammatory changes within the colon. The most commonly used stain, indigo carmine, has been shown to be more effective that a random biopsy protocol in detecting dysplasia.
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“Cancer in IBD is typically seen in areas of chronic inflammation, which can lead to an abnormal cell growth of colon cells called dysplasia.” In conclusion, the presence of IBD carries a high risk for the development of colon cancer. Frequent screening colonoscopy with multiple biopsies is an effective way to prevent the development of colon cancer, and should be standard of care for any patient with IBD.
Gastro Health
FROM ADENOMA TO CARCINOMA,
WHY SCREENING MATTERS Antonio E. Martinez, MD Pathologist Pathology Medical Director
G
The purpose of this article is to educate patients regarding colon cancer screening for the detection of adenomatous polyps or adenomas. These polyps can generally be considered precursors to colon cancer, the third most common type of cancer diagnosed in both men and women in the United States. As a pathologist who analyzes tissue under a microscope, I directly appreciate the benefits of screening colonoscopy in the prevention and early detection of colon cancer.
So what is an adenomatous polyp? An adenomatous polyp, or adenoma, is a benign tumor that makes glands (the same glands that line the colon). Adenomatous polyps are thought to give rise to cancer through what is known as the adenoma-carcinoma sequence.
What is a carcinoma? In the context of colon cancer, the appropriate term is adenocarcinoma, which is a malignant tumor that makes glands. Malignant tumors, by definition, invade tissues (in this case the wall of the colon) and have the capacity to spread to other organs (metastasize) by way of blood vessels.
What is the adenoma-carcinoma sequence? This is a sequence of genetic alterations that leads to the development of cancer- beginning with the development of an adenoma, which progresses to an adenocarcinoma.
Is there something you can do to prevent the adenomacarcinoma sequence from occurring? In other words, what things can be done to reduce the risk of developing colon cancer? It is thought that the progression from an adenoma to a carcinoma takes 10-15 years and that this process occurs most commonly after the age of 50. For this reason, colon cancer screening guidelines recommend colonoscopy, and other screening methods, beginning at that age. The purpose of colon cancer screening is to detect and remove polyps or to detect colonic adenocarcinoma at an early stage – before it spreads. For individuals who have a family history, genetic predisposition or other conditions which may lead to the development of colon cancer at a younger age, screening may be recommended earlier.
While the adenoma-carcinoma sequence describes a series of genetic abnormalities leading to cancer, environmental factors such as diet and other lifestyle characteristics are thought to play an important contributing role in the development colon cancer. The so-called “Western” diet, characterized by high intakes of red and processed meats, refined grains and sweets is thought to contribute to the relatively increased incidence of colon cancer in the United States. On the other hand, a diet high in fruits, vegetables, poultry, and fish may lower the risk for the development of the same disease. In conclusion, colon cancer is thought to develop from precursor lesions (adenomatous polyps) that can be detected early and removed through screening colonoscopy. Other factors to consider include your individual risk, particularly family history, and maintaining a healthy lifestyle, which includes diet and exercise. Each individual should discuss the most appropriate screening strategy with their physician.
GASTRO HEALTH MAGAZINE • SPRING 2013
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Caring for You and Those You Love
PHYSICIAN DIRECTORY Gastro Health is a medical group made up of the finest physicians and allied health professionals in South Florida specializing in the treatment of gastrointestinal disorders, nutrition, and digestive health. Our team of board-certified physicians, physician assistants, nurse practitioners, nutritionists and technicians combine their clinical expertise and experience to provide patients with quality medical and preventive care in the field of Gastroenterology. With numerous office locations, endoscopy centers, diagnostic imaging, pathology laboratory, in-office infusion therapy, and affiliations with South Florida’s premier hospitals – Gastro Health continues to achieve excellence in medical care.
PHYSICIAN DIRECTORY
Gastro Health
Francisco J. Baigorri, MD * Gastroenterologist Care Center 1
Simon Behar, MD * Gastroenterologist Care Center 3
Barry E. Brand, MD Gastroenterologist Care Center 2
Gustavo Calleja, MD * Gastroenterologist Care Center 1
Marc S. Carp, MD Gastroenterologist Care Center 6
John P. Christie, MD Colorectal Surgeon Care Center 1
Lewis R. Felder, MD Gastroenterologist Care Center 7
Edward Feller, MD Gastroenterologist Care Center 15
Jose P. Ferrer, Jr., MD * Gastroenterologist Care Center 3
Jose P. Ferrer, Sr., MD * Gastroenterologist Care Center 3
Mark S. Friedman, MD Gastroenterologist Care Center 8
Nelson Garcia Jr. MD * Gastroenterologist Care Center 8
Daniel Gelrud, MD * Gastroenterologist Care Center 1
Harris I. Goldberg, MD Gastroenterologist Care Center 1
Ruben Gonzalez-Vallina, MD * Pediatric Gastroenterologist Care Center 12
Pedro J. Greer Jr., MD * Gastroenterologist Care Center 11
Guillermo Gubbins, MD * Gastroenterologist Care Center 10
Alfredo J. Hernandez, MD * Gastroenterologist Care Center 11
Enrique Hernandez-Sanchez, MD* Pediatric Gastroenterologist Care Center 14
Eugenio J. Hernandez, MD * Gastroenterologist Care Center 3
Moises E. Hernandez, MD * Gastroenterologist Care Center 3
Richard E. Hernandez, MD * Gastroenterologist Care Center 5
Raghad Koutouby, MD Pediatric Gastroenterologist Care Center 13
Eduardo Krajewski, MD * Colorectal Surgeon Care Center 9
Robert C. Lanoff, MD * Gastroenterologist Care Center 2
* Habla EspaĂąol
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GASTRO HEALTH MAGAZINE • SPRING 2013
Gastro Health
Jose A. Lavergne, MD * Gastroenterologist Care Center 7
James S. Leavitt, MD Gastroenterologist Care Center 1
Marc Lederhandler, MD Gastroenterologist Care Center 1
Jerry Martel, MD, MPH * Gastroenterologist Care Center 8
Antonio Martinez, MD * Pathologist Pathology Medical Director
Flavia Mendes, MD * Gastroenterologist Care Center 1
Pedro Morales, MD * Gastroenterologist Care Center 8
Brett R. Neustater, MD Gastroenterologist Care Center 7
Javier L. Parra, MD * `Care Center 1
Alfredo Rabassa, MD * Gastroenterologist Care Center 1
Andres I. Roig, MD * Gastroenterologist Care Center 3
Ricardo J. Roman, MD * Gastroenterologist Care Center 7
Seth D. Rosen, MD Gastroenterologist Care Center 2
Neil E. Rosenkranz, MD Gastroenterologist Care Center 2
S. Lawrence Rothman, MD Gastroenterologist Care Center 1
Eduardo Ruan, MD * Gastroenterologist Care Center 1
Andrew I. Sable, MD Gastroenterologist Care Center 2
George A. Sanchez, MD * Gastroenterologist Care Center 1
Howard I. Schwartz, MD Gastroenterologist Care Center 1
Daniel Seckinger, MD Radiologist
Somal S. Shah, MD * Gastroenterologist Care Center 11
Arie Slomianski, MD * Gastroenterologist Care Center 1
David A. Sommer, MD Gastroenterologist Care Center 2
Marcos Szomstein, MD * Colorectal Surgeon Care Center 9
Stefania L. Vernace, MD Gastroenterologist Care Center 1
* Habla Espaùol GASTRO HEALTH MAGAZINE • SPRING 2013
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Gastro Health
Allied Healthcare Staff
Amber M. Abraham, PA-C
Darlene Boytell-Perez, ARNP *
Sabrina Kaplan, PA-C*
Rebecca Karousatos, MS, RD, LDN
Hernando Mispireta, ARNP *
Ronal R. Ricano, PA
Hengameh Shahidpoor, ARNP
Kayce Tugg, MSN, RN
Care Centers Care Center 1 Main Office 7500 SW 87 Avenue, Suite 200 Miami, FL 33173 305-913-0666
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Care Center 7 Main Office 16855 NE 2nd Avenue, Suite 202 North Miami Beach, FL 33162 305-770-0062
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* Habla Español
GASTRO HEALTH MAGAZINE • SPRING 2013
Care Center 12 9260 SW 72nd Street, Suite 217 Miami, FL 33173 305-271-7330
Ellen Matas-Sosa, PA-C
Insurances AARP Medicare Complete American Heritage Life Insurance American Medical Security AvMed Care Center 14 Baptist Executive Health 9980 Central Park N. Boulevard, Suite 316 Beechstreet Boca Raton, FL 33428 561-206-6064 Blue Cross Blue Shield Cigna Care Center 15 Coventry Health Care 8353 SW 124 Street, Suite 203 Miami, FL 33156 Dimensions Health 305-259-8720 First Health Network HealthSun Health Plans Imaging Center 7500 SW 87 Avenue, Suite 200-A Humana Miami, FL 33173 Humana Champus Tricare 305-468-4190 JMH Health Plan Pathology Laboratory Mail Handlers Benefit Plans 9000 SW 87 Court, Suite 110 Medica Health Plan Miami, FL 33176 305-468-4194 Medicare Part B MultiPlan Neighborhood Health Plan OneSource Preferred Care Partners Simply Healthcare United Healthcare VISTA Health Plans Care Center 13 8940 N. Kendall Drive, Suite 603-E Miami, FL 33176 305-512-3345
Gastro Health
PREVENTING COLON CANCER
Flavia Mendes, MD Gastroenterologist
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olorectal cancer (cancer of the large intestine or rectum) is the second most common cause of cancer deaths in the United States. Around the world, it is the second most common cancer diagnosed in women and the third most common cancer in men. Approximately 5 in 100 people without risk factors will develop colorectal cancer in their lifetime.
If you are 50 years of age or older, or if you have any of the risk factors listed above and have never had a colonoscopy or other screening tests for colorectal cancer, you should discuss this with your physician. Colorectal cancer can be prevented!
There are several factors associated with increased risk of developing colorectal cancer, including age, family history of colon cancer, inflammatory bowel disease and African American race. This cancer is uncommon in people younger than 40 years old, and the majority of the cases occur after 50 years of age. An individual with a single first-degree relative with colon cancer has a twofold risk increase of developing colon cancer when compared to the general population. Several studies have shown that physical activity, consumption of fruits and vegetables and high fiber content in the diet may decrease the risk of colorectal cancer. Additional steps you can take include avoiding smoking, excessive alcohol, and the consumption of red meat. Most cases of colorectal cancer begin as small “growths” called polyps (or adenomas). Over time, these polyps may grow and become malignant (cancerous). Screening tests have been developed to detect polyps and prevent them from transforming into cancer and/or to detect colon cancer at an early stage, allowing for successful treatment and decreasing the chance of death from the disease. Current guidelines recommend that all adults be screened for colorectal cancer starting at the age of 50, even if there are no signs or symptoms of the disease. Patients with risk factors such as family history and inflammatory bowel disease should also be screened. African Americans may need to start screening at an earlier age and/or more frequently than the general population. Once adenomatous polyps are detected, the person is also considered at increased risk and will require surveillance with examination at shorter intervals. Regular screening has been shown to reduce the risk of developing colorectal cancer by up to 90 percent. A Colonoscopy is the most complete screening test available, as it can detect most small polyps and almost all large polyps or cancers. It has the advantage of allowing for removal of the detected polyps, preventing the development of cancer. If a lesion suspicious for cancer is found, biopsies can be done at the same time for diagnosis.
‘‘Several studies have shown that physical activity, consumption of fruits and vegetables and high fiber content in the diet may decrease the risk of colorectal cancer.”
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Gastro Health
Andrew I. Sable, M.D. Gastroenterologist
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IBS:The Old and The New
BS (irritable bowel syndrome) is functional disorder of the gastrointestinal tract, meaning it is caused by a problem with the way the gastrointestinal tract works. People who suffer from IBS do not have intestinal tract damage, but rather suffer from a constellation of symptoms that occur together. For those people recently diagnosed with IBS or those who have suffered for many years, it remains important to understand that IBS is a chronic but manageable condition. There is no single treatment or medication for IBS. Successful treatment depends on a close and on-going relationship with your physician as well as lifestyle and dietary changes and the use of medications.
Only a gastroenterologist should prescribe this medication. Amitiza (Lubiprostone) is prescribed for adult women and men who have IBS with constipation. It is taken twice a day and works by increasing the fluid secretion into your intestine thereby softening your stool and increasing bowel movements. This medication has a long track record and has been shown to be safe and effective in patients with IBS-C and also those with chronic constipation as well. The “new kid on the block” is Linzess (Linaclotide). It is a novel medication that gained FDA approval in late 2012 to treat patients with chronic constipation and those with IBS and constipation. Linzess is taken once daily and has been shown to relieve discomfort associated with IBS-C and help with more complete evacuation of stools.
Lifestyle and Dietary Changes
IBS Symptoms Can Be Treated
Keeping a dietary log will help you recognize foods that may trigger symptoms. Limiting caffeine and alcohol intake, minimizing dairy products, and avoiding sugar substitutes and artificial sweeteners can significantly decrease the frequency and urgency of diarrhea. Avoiding beans, uncooked vegetables and lowering the fat content of your foods may alleviate gassiness and bloating. Daily fiber supplements and increased water intake help with constipation-predominant IBD (IBS-C).
Estimates suggest that IBS affects up to 15% of Americans. Because of its chronic and episodic nature, IBS has considerable impact on its sufferers’ lives. The most important thing to keep in mind is that IBS symptoms can be treated. Establish a good relationship with your physician and make sure you are fully evaluated for other potential underlying diseases. Treatment of IBS involves long-term strategies using a combination of lifestyle changes, dietary modifications and medication to minimize symptoms.
In addition to dietary changes, lifestyle modifications help reduce symptoms in IBS as well. Smoking cessation is critical for overall health as well as the health of your intestinal tract. Regular physical exercise has been shown to reduce the frequency of symptoms and protect against symptom deterioration. Several studies have also demonstrated the benefits of stress management through behavioral modification on the symptoms of IBS.
Medications for IBS Keeping in mind that the treatment of IBS is multi-faceted, medications play an important role. Traditionally anticholinergic medications such as Bentyl and Nulev have been used to help temporarily alleviate bloating and discomfort. Imodium can be helpful for those with frequent diarrhea and urgency. Fiber supplements seem to benefit those with constipation and alternating IBS-D and IBS-C. Antidepressants and anti-anxiety medication may also provide some benefit for more chronic symptoms. Within the last several years, probiotics and even antibiotics have been used with some success in IBS. This benefit may be due, in part, to bacterial imbalances in the intestine that may exist in patients who suffer from IBS. Some of the recently approved medications for IBS have a more specific focus. Several years ago, Lotronex (Alosetron) was approved for women with IBS and diarrhea; this medication is designed to relax the intestine and slow the transit of stool thereby helping with diarrhea and bloating.
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GASTRO HEALTH MAGAZINE • SPRING 2013
“Successful treatment depends on a close and on-going relationship with your physician as well as lifestyle and dietary changes and the use of medications.”
Gastro Health
GASTRO HEALTH MAGAZINE • SPRING 2013
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Gastro Health
Encourage the Hero in Your Life to Get Screened
By: Andrew Spiegel, CEO of the Colon Cancer Alliance
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onder Woman, Superman and Batman are heroes throughout the world, but not all heroes wear capes and masks. As we leave behind the month of March, National Colorectal Cancer Awareness Month, I encourage you to ask the heroes in your life to get screened for colon cancer. Unfortunately, I didn’t get that chance. My mother was my hero and a simple test could have saved her life. In 1998, she was diagnosed with metastatic colon cancer. She exhibited numerous symptoms, which were ignored by her physicians, and died nine months later. At that time, the disease received little attention, despite it being the second leading cause of cancer deaths in the United States. Few had heard of colon cancer back then and even less were screened for the disease. It was then that I vowed to help bring greater public awareness to the disease and to provide support for those already affected. The Colon Cancer Alliance’s “Get the Hero in Your Life Screened” program was created to help people openly discuss colon cancer and encourage screenings. Colon cancer is up to 90 percent preventable through screening. Encouraging the heroes in your life to get screened could save their lives, whether they are at high risk, age 50 or older, or have a family history of the disease. Today, colon cancer affects 1 in 20 people. More than 143,000 Americans will be diagnosed with the disease this year and 51,690 people will lose their battle to this cancer. But the good news is that this cancer is often beatable when detected and treated in its early stages. In fact, it can be prevented altogether when polyps are removed before they develop into cancer. We have a long way to go, but by educating individuals, we can take a giant step toward a world free of colon cancer. Talking about this disease can make a world of difference. The Colon Cancer Alliance hears of heroes who are battling and beating this
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GASTRO HEALTH MAGAZINE • SPRING 2013
disease. Heroes like Teri Griege. This mother of two was diagnosed with stage IV at just 48 years old, the odds were stacked against her but she didn’t give up - she continued to fight, going through radiation and 12 rounds of chemotherapy, all while training for an Ironman Triathlon. In 2011, she went on to complete the Ironman World Championship and was featured as an inspirational athlete on the NBC Ironman broadcast seen around the world.
Teri vowed to do everything possible to beat the disease and inform others about the importance of being screened. After her diagnosis, she convinced both of her sisters, now with a family history of colon cancer, to get screened. They followed her advice and by doing so, discovered precancerous polyps and early-stage colon cancer, potentially saving both their lives. It’s heroes like Teri who are making a difference in the lives of others. We all have heroes in our lives, whether it’s our mother, father, grandparent, spouse or friend. Unfortunately it’s too late to save my mom, but you still have time. Tell the heroes in your life to get screened. Visit www.ccalliance.org for more information about the “Get the Hero in Your Life Screened” program and the importance of screening. It could save a life!
Gastro Health
Alienta a Los Héroes En Tú Vida Para Que Sean Examinados
Por Andrew Spiegel, Director Ejecutivo de La Alianza Contra el Cáncer del Colon Traducido en Español: Dr. Jose Mendoza
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a Mujer Maravilla, Superman y Batman son héroes en todo el mundo, pero no todos los héroes usan capas y máscaras. Al dejar atrás el mes de marzo, Mes Nacional de Concientización Sobre el Cáncer Colorrectal, los animo a pedirles a los héroes en sus vidas que realicen un examen de detección de cáncer del colon. Por desgracia, yo no tuve esa oportunidad. Mi madre era mi héroe y una prueba sencilla podría haber salvado su vida. En 1998, ella fue diagnosticada con cáncer del colon metastásico. Ella presentó numerosos síntomas, los cuales fueron ignorados por sus médicos, y murió nueve meses después. En ese momento, la enfermedad no había recibido mucha atención pública, a pesar de ser la segunda causa principal de muerte por cáncer en los Estados Unidos. Pocos habían oído hablar del cáncer del colon en aquel entonces y aún menos fueron examinados para detectar esta enfermedad. Fue entonces cuando yo me comprometí a contribuir para crear conciencia pública de la enfermedad y para proporcionar apoyo a los pacientes ya afectados.
El programa de La Alianza Contra el Cáncer del Colon “Consigue Que El Héroe En Tú Vida Sea Examinado” fue creado para ayudar a las personas a discutir abiertamente el tema del cáncer del colon y fomentar los exámenes preventivos necesarios. El cáncer del colon es 90 por ciento prevenible mediante la detección temprana. Anima a los héroes en tú vida que están en alto riesgo, como tener 50 años o más, o que tienen antecedentes familiares de la enfermedad, para que se realicen una prueba que podría salvar sus vidas. Hoy en día, el cáncer del colon afecta 1 de cada 20 personas. Más de 143.000 Estadounidenses serán diagnosticados con la enfermedad este año y 51.690 personas perderán la batalla contra este cáncer. Pero la buena noticia es que este tipo de cáncer a menudo se puede vencer cuando se detecta y trata en las primeras etapas. De hecho, se puede prevenir por completo cuando se eliminan los pólipos antes de que se conviertan en cáncer. Tenemos un largo camino por recorrer, pero educando a cada individuo, podemos dar un gran paso hacia un mundo libre de cáncer del colon.
Hablando de esta enfermedad puede hacer un mundo de diferencia. La Alianza Contra el Cáncer del Colon se entera de los héroes que luchan contra y vencen a esta enfermedad. Héroes como Teri Griege. Esta madre de dos hijos fue diagnosticada con estadio IV con tan sólo 48 años de edad. Las probabilidades estaban en contra de ella, pero ella no se dio por vencida. Ella continuó luchando, pasando por radiaciones y 12 rondas de quimioterapia, mientras que entrenaba para el triatlón Ironman. En 2011, ella llegó a completar el Campeonato del Mundo de Ironman y fue presentada como una atleta inspiracional en la transmisión mundial en un programa de NBC . Teri se comprometió a hacer todo lo posible para vencer a la enfermedad e informar a otros sobre la importancia de ser dectectada a tiempo. Después de su diagnóstico, convenció a sus dos hermanas, ahora teniendo historia familiar de cáncer del colon, de realizarse exámenes de detección. Ellas siguieron su consejo y al hacerlo, descubrieron pólipos precancerosos y cáncer del colon en etapa temprana. Potencialmente ella salvó la vida de ambas. Son héroes como Teri que están haciendo una diferencia en las vidas de los demás. Todos tenemos héroes en nuestras vidas, ya sea nuestra madre, padre, abuelo, esposo, esposa o amigos. Por desgracia, es demasiado tarde para salvar a mi mamá, pero tú todavía tienes tiempo. Inspire a los héroes en tú vida para que se realicen las pruebas de detección. Visite nuestra página www.ccalliance.org para obtener más información sobre el programa “Consigue Que El Héroe En Tú Vida Sea Examinado” y la importancia de la detección. Esto podría salvar una vida!
GASTRO HEALTH MAGAZINE • SPRING 2013
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Gastro Health
What Endangers Colon Health? Rebecca Karousatos, MS, RD, LDN Medical Nutrition Therapist
Sedentary Lifestyle
Red and Processed Meats
Learn ways to be less sedentary: • Try to be more active during your leisure time. Find new activities that include at least some exercise – directly or indirectly. • Do active housework. • When it’s safe, park farther away from your destination and walk. • Take the stairs instead of an elevator or escalator. • Go for a walk or jog during your lunch break. No time during lunch? Go after work instead!
Grill smart! Cancer-causing compounds are produced when meats are cooked at very high temperatures. Grill vegetables, tofu and fruit instead. If you choose to grill meat: • Use marinades • Flip frequently • Remove fat • Use foil and avoid direct flame • Do not eat charred meat
A sedentary lifestyle promotes colon cancer. Sedentary activities include things like: • Watching television • Sitting at a desk • Surfing the web
Alcohol
Red and processed meats contain elements that can increase your risk of colon cancer. • Eat no more than 3 ounces of beef, pork or lamb per day. Choose chicken, legumes and fish more often. • Limit your consumption of processed meats like hot dogs, bacon, sausage and deli meats.
Alcohol destroys folic acid, which is a key to good health. Consider supplementing your diet with 400 mcg of folic acid per day if you do not plan to give up alcohol. Limit alcohol consumption to no more than: • 1 drink per day (women) • 2 drinks per day (men)
Excess Calories
Excess calories usually come from energy-dense foods. These foods are usually: • Low in fiber • High in fat • High in sugar
Too Many Refined Carbohydrates
Chronic elevations of insulin and insulin growth factors (IGF) increase your colon cancer risk. • Eating high-sugar, refined-carbohydrate foods triggers excessive insulin and IGF production, which can increase the growth of cancer cells in the colon. • High-sugar, refined-carbohydrate foods include foods made with sugars and white flour. Replace these with fruits, vegetables or whole grain foods.
Prevent Colon Cancer!
• Stay active. • Maintain a healthy weight. It is better to be pair shaped than • • • • •
apple-shaped. Eat a low-fat, high-fiber, plant-based diet. Follow MyPlate’s advice and fill half your plate with fruits and vegetables every day. Get enough folate and vitamin D in your diet. Avoid eating too much meat and meat cooked at high temperatures. Try plant protein foods instead. Avoid excess alcohol consumption.
For more information, check out www.preventcancer.org Copyright 2012. Food and Health Communications. Reprinted with permission from www.foodandhealth.com 24 ::
GASTRO HEALTH MAGAZINE • SPRING 2013
Gastro Health
INVESTIGATIVE OVERVIEW: George Sanchez, MD Gastroenterologist
ESOPHAGEAL CANCER
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Esophageal cancer can occur when normal cells seen in the esophagus become abnormal and begin to replicate out of control. The esophagus is the muscular tube which helps move food from the mouth to the stomach. Esophageal cancer is not very common in the United States, but can occur often in men over the age of 50. There are two main types of cancer: Squamous Cell Carcinoma and Adenocarcinoma. Certain risk factors have been shown to increase the risk of esophageal cancer, which include smoking, alcohol consumption, obesity and gastric reflux.
What are the symptoms? Early stages of esophageal cancer may not produce any symptoms. However, once symptoms develop people can frequently experience difficulty swallowing (especially solid food), weight loss, pain or burning in the chest and hoarseness. Although these symptoms can be seen with esophageal cancer, there are other conditions which can also cause these symptoms. Therefore, you should be seen by your doctor for further evaluation.
How is esophageal cancer diagnosed? Barium Swallow The patient is given Barium to swallow and X-rays are taken as it goes down the esophagus. This can help detect abnormal lining in the esophagus or even abnormal growth.
Upper Endoscopy This is when a thin tube with a light at the end of it is introduced through the mouth and into the esophagus while you are asleep. This can directly look at the lining of the esophagus and can take samples of tissue from the esophagus, called a biopsy. The tissue is then looked at under the microscope by a pathologist and can diagnose the tissue as cancerous. If indeed cancer is diagnosed, further evaluation must be performed to determine if the cancer has spread to other areas from where it originally started. This process is called cancer staging and is important to determine the appropriate treatment required.
How can it be treated? Esophageal cancer usually requires more than one modality of treatment. Surgery can be used to remove the part of the esophagus where cancer
cells are located. The remainder of the esophagus is then connected to the stomach so that food can be digested appropriately. Another way to treat it is using Radiation Therapy, which consists of high-energy radiation used to shrink and eliminate cancer cells. The last way to treat esophageal cancer is using Chemotherapy, which uses medicines to eliminate cancer cells. Often by using a combination of these different treatment regimens, esophageal cancer can be cured. If the cancer cannot be cured, there are other treatment options used to help improve symptoms. These consist of using a laser beam or electric current to help eliminate cancer cells or performing a procedure to help widen the part of esophagus which is blocked. After treatment, it is important to have regular follow-up visits with your doctor to make sure you remain cancer free.
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T:7.675 in
Gastro Health
TO LOWER THE VOLUME
PREPOPIKTM is a trademark of Ferring B.V. © 2013 Ferring B.V. All rights reserved. PK/247/2013/US
JF 3/7/13
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GASTRO HEALTH MAGAZINE • SPRING 2013
13PREP0045 Revised Cover Tip TRIM: 7.675” x 4.9” BLEED: NONE
To learn more, scan this code with your smartphone, or go to www.prepopik.com.
T:4.9 in
BE PREPARED…
Gastro Health
Attention
Baby Boomers
I
n August 2012, the Centers for Disease Control issued new guidelines for screening of the Chronic Hepatitis C infection. The previous guidelines had targeted only persons thought to be at high risk, such as those who received a blood transfusion prior to 1992, used intravenous illicit drugs, were on hemodialysis, had HIV disease, known exposure to the virus, or born to a mother with known hepatitis C. However, now the new recommendations state that any person born between 1945 and 1965 should be screened once, regardless of risk factors.
S. Lawrence Rothman , MD Gastroenterologist
CDC issues new guidelines for Hepatitis C screening for the ”Boomer” Generation (1945-1965)
The new guidelines were adopted for several reasons. Firstly, 75% of those with hepatitis C were born in those years. Also, more than half of people with hepatitis C are unaware that they have it. Complications and deaths from chronic hepatitis C are on the rise. It has been shown that screening is cost-effective and saves lives. Finally, new treatments can cure up to 75% of chronic hepatitis C cases. Screening involves a simple blood test performed only once. Normal results of so-called liver function blood tests do not rule out hepatitis C. Up to 50% of persons infected can actually have normal results of these tests. Hepatitis C is a virus that attacks the liver. It is mainly transmitted through contaminated blood. Hepatitis C can be present and actually cause no symptoms for many years, even decades, and has therefore been called the “silent epidemic.” Up to 20% of those infected will develop severe scarring and liver impairment known as cirrhosis of the liver and a significant percentage of these will develop primary liver cancer. Chronic hepatitis C is the most common indication for liver transplantation in the United States. It is the cause of up to 15,000 yearly deaths, with the number expected to rise. So, if you were born between 1945 and 1965 and wish to be screened, please call a screening hotline or be sure to set up an appointment with Gastro Health by calling (305)468-4180. GASTRO HEALTH MAGAZINE • SPRING 2013
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Gastro Health AnswersIn Dyspepsia AnswersIn Medicine Ltd
AnswersIn Heartburn AnswersIn Medicine Ltd
AnswersIn Hepatitis C AnswersIn Medicine Ltd
Bowel Mover Track and Shape Apps
Crohn’s Diary Janssen Biotech, Inc.
Diet Buzz Joe Sriver
Alejandro Fernandez, MBA, CMPE Chief Executive Officer
GI Buddy Crohn’s & Colitis Foundation of America
GI Monitor WellApps
martphone and tablet apps have come a long way in recent years, particularly in the field of public health. If you have a chronic gastrointestinal disorder like Crohn’s & Colitis, Heartburn, or Hepatitis; are sensitive to Gluten; or just want to lose weight, there are hundreds of apps you can download. These apps may be able to help you track your symptoms and assist in finding patterns in your diet and lifestyle that may be aggravating your symptoms, and will assist you in trying to avoid these in the future. Many of these apps have been designed for both iPhones and Android platforms. Here is a small list of top-rated apps:
Is That Gluten Free? Midlife Crisis Apps, LLC
Healthy Diet & Grocery Food Scanner ShopWell
myIBD The Hospital for Sick Children
Tummy Trends By Takeda Pharmaceuticals
Weight Watchers Weight Watchers International, Inc.
Where to Wee wheretowee.com
THE GASTROINTESTINAL
WORLD AT THE PALM OF YOUR HAND
S
If you suffer from ulcerative colitis (UC)
You may be able to control symptoms by addressing an underlying cause Did you know the inflammation caused by UC may be damaging your intestinal lining, without you even knowing? © Janssen Biotech, Inc. 2013
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GASTRO HEALTH MAGAZINE • SPRING 2013
3/13
Talk to your doctor to learn about the importance of treating more than just UC symptoms. K25RGU13004R1
Gastro Health
PEDIATRIC GASTROESOPHAGEAL REFLUX DISEASE:
HELPING YOU DECODE ITS SYMPTOMS Enrique Hernandez-Sanchez, M.D. Pediatric Gastroenterologist
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Gastroesophageal reflux disease (GERD) occurs when gastric contents flow back into the esophagus, leading to complications such as inflammation of the esophagus, failure to gain weight, respiratory symptoms or choking. GERD is extremely prevalent among babies, with up to 20% incidence among full term babies and up to 40% incidence on premature babies. With nearly four million births in 2011 in the United States, and a 12% prematurity rate, that translates into 900,000 new cases per year. This number does not account for what we call “happy spitters” or babies that thrive well and have no fussiness, but still have mild to moderate volume spit-ups that worry their caretakers enough to seek medical help. “A baby that spits is a healthy baby,” your grandmother will tell you. However, recently we have made several associations between GERD and chronic respiratory illnesses such as asthma, hoarseness and chronic ear infections. These children may have absolutely no symptoms of acid reflux. Since babies do not come with an instruction manual, I want to give you some clues on the most common GERD symptoms.
Vomiting An occasional teaspoon or two is normal, but if your baby is bringing up more than one tablespoon several times per day, they are losing plenty of calories that could impact their weight in the long run. Additionally, fluid dribbling is not the same as projectile vomiting. Your baby will likely get a contrast X-ray if he or she is having forceful emesis to rule out a blockage.
Overfeeding Use this simple formula to calculate your baby’s maximum feeding volume: WT in Kilograms = maximum gastric volume. Then subtract 0.5-1 ounce, and you will have the maximum feeding volume. This formula works for up to 8 oz.
Arching Not very specific, but when it occurs after meals it does suggest GERD. Its extreme form is called Sandifer’s Syndrome.
Feeding Refusal It usually is a late symptom present in babies who have suffered from acid reflux for a while, and have made an association between pain and feedings. These children are called “sleeper-feeders” as they will eat better when they are half-asleep. A combination of medications is needed to reverse this symptom.
Straining Associated with MSPI more than GERD, it may be caused by small nodules in the rectosigmoid due to allergies. These babies strain constantly, despite passing soft stools, which could have mucous or traces of blood.
Heartburn Not every child with heartburn will suffer from GERD, since allergic esophagitis and Candida can mimic its symptoms. Heartburn evaluation will usually include an upper endoscopy.
Cough As the esophagus grows it gets longer, and while gastric contents may not reach the mouth, they may reach the airway and cause micro-aspiration and damage to the larynx. Consider GERD if your child has chronic cough, has no allergies and is not getting better with antibiotics or asthma medications. I hope this summary of symptoms will help you decode your child’s reflux blues, and remember to always consult your pediatrician before treating your baby for any condition.
Fussiness If your baby is fussier in the evening, your pediatrician will likely consider infantile colic. Fussiness as a main symptom may be an indication of GERD, but we should consider first Milk-Soy Protein Intolerance (MSPI), which usually creates fussiness 24-hours a day, and can be accompanied by eczema, cradle cap and a microscopic amount of blood in stools.
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WORKING
Hand in Hand
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FIU College of Medicine and Gastro Health Partner up in Education
n 20 0 9 Florida International Universit y opened the new Herber t Wertheim College of Medicine, the first public medical school in South Florida, with an initial class of 4 3 students. Two years before the first class started, the dean of the new medical school approached Gastro Health to form a partnership to develop the Gastroenterology curriculum. Dr. Daniel Gelrud of Gastro Health was named director of the Gastrointestinal System and Nutrition course. With the leadership of Dr. Gelrud, doctors from Gastro Health have developed the curriculum of what the new young doctors will learn about gastrointestinal diseases. The doctors from Gastro Health give lectures and participate in innovative case conferences that help students learn basic Gastroenterology as well as the latest advances in the field. Medical Students from FIU participate through hospital rotations with Gastro Health doctors at South Miami and Baptist Hospitals, as well as their Galloway Medical Park office located at 7500 SW 87th Avenue. The students are exposed to the latest advances and new technologies mastered by these doctors. Several Gastro Health physicians come from academic backgrounds. Dr. Javier Parra taught medical s tudent s and Gas troenterology fellows advanced endoscopic procedures including ERCP (Endoscopic Retrograde Cholangiopancreatography) and En teroscopy at t he University of Miami. Dr. Flavia Mendes was also a professor from the University of Miami with expertise in Hepatology before joining the practice. Dr. Daniel Gelrud was an assistant professor at the Albert Einstein College of Medicine in New York. Gastro Health is a comprehensive gastroenterology group whose physicians have expertise in many areas. FIU medical students benefit from that experience. Dr. Rothman and Dr. Mendes have special interest in liver disease. Students learn about Ulcerative colitis and Crohn’s disease from Dr. Schwartz and Dr. Leavit t. Biliary disease and complications of liver disease is taught by Dr. E . Hernandez and Dr. Leavit t . Dr. Rabassa introduces the students to important common conditions such as ulcer and reflux disease. Dr. Ruan explores the causes of diarrhea and constipation. Dr. Calleja tackles the common and important irritable bowel syndrome (IBS), while Dr. Baigorri digs into the complex issue of the obesity epidemic in the United States. The association between the FIU School of Medicine and Gastro Health proves the commitment of providing academic level state-of-the-art care to patients. This academic environment is conducive to the practice of excellent medicine that not only benefits patients, but also the future medical doctors who rotate through Gastro Health’s facilities.
Course Director Daniel Gelrud, MD Teaching Faculty Alfredo Rabassa, MD Andres I. Roig, MD Andrew I. Sable, MD Eduardo Ruan, MD Eugenio Hernandez, MD Flavia Mendes, MD Francisco J. Baigorri, MD Gustavo Calleja, MD George A. Sanchez, MD Howard Schwartz, MD James Leavitt, MD Javier Parra, MD Lawrence Rothman, MD Marc Leaderhandler, MD Stefania Vernace, MD
Care Center 11 Satellite Office Florida International University 885 SW 109 Avenue, Suite 131 Miami, FL 33199 305-856-7333
Gastroenterologists Alfredo J. Hernandez, MD Pedro Greer, Jr., MD Somal S. Shah, MD
Colon cancer is the second-deadliest form of cancer in the U.S., yet it doesn’t have to be. Did you know that it’s 90 percent preventable? Screening is the key. Colon cancer stops with you This simple procedure – called a colonoscopy – can actively prevent colon cancer. Do it for you and your loved ones. If you are at-risk, get screened, and get on with your life! Who should get screened? Anyone 50 and older People who have a family history of polyps or colon or rectal cancer African-Americans who are 45 and older Other minority groups where the disease is more prevalent
Simon Behar, M.D. Jose P. Ferrer, Sr., M.D. Jose P. Ferrer, Jr., M.D. Nelson Garcia, Jr., M.D. Alfredo Hernandez, M.D. Eugenio J. Hernandez, M.D. Moises E. Hernandez, M.D. Jerry Martel, M.D., M.P.H. Seth D. Rosen, M.D. Andrew Sable, M.D. Galloway Surgery Center 7600 SW 87th Ave., Suite 100 Miami, FL 33173 Phone: 786-245-6100 www.gallowaysurgerycenter.com
To schedule your colon cancer screening, please call 786-245-6100
New
Leave questions in the past. Get answers to why response to infliximab may be lost. PROMETHEUS® Anser™ IFX measures both serum infliximab levels and antibodies to infliximab in the same sample, providing valuable information to help guide your treatment decisions for patients who lose response to infliximab. Order PROMETHEUS Anser IFX if you suspect your IBD patient has lost response to infliximab. Call Client Services at 888-423-5227. www.anserifx.com PROMETHEUS, the Link Design, For the person in every patient, ANSER, and the ANSER design mark are trademarks or registered trademarks of Société des Produits Nestlé S.A. Vevey, Switzerland. ©2013 Société des Produits Nestlé S.A. Vevey, Switzerland. All rights reserved. IFX13010 02/13 Prometheus diagnostic services provide important information to aid in the diagnosis and management of certain diseases and conditions. How this information is used to guide patient care is the responsibility of the physician.
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Assays and methods within this test may be covered by one or more US pending or issued patents. For details, please go to www.prometheuslabs.com.
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