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Digestive Disorders

Digestive disorders include the treatment of diseases of the liver and digestive tract, including the stomach, duodenum, gallbladder, biliary tract, pancreas, small intestine and colon.

Acute Pancreatitis

Acute pancreatitis is an inflammation of the pancreas, a condition that affects about 80,000 Americans annually. The pancreas — a large gland located behind the stomach and close to the upper part of the small intestine — secretes digestive enzymes into the small intestine through a tube called the pancreatic duct. These enzymes help digest the fats, proteins and carbohydrates in food. The pancreas also releases the hormones insulin and glucagon into the bloodstream. These hormones help the body use the glucose it derives from food for energy.

Cholangiocarcinoma

Cholangiocarcinoma is a rare cancer found in the tissue of the bile ducts, occurring in approximately two out of 100,000 people. Men and women are equally affected and most cases occur in people over age 65. The bile duct is a small tube that connects the liver and gallbladder to the small intestine. The ducts carry bile -- the liquid that helps break down fat in food during digestion — out of the liver.

Tumors can develop anywhere on the bile ducts and are typically slow growing. However, by the time a diagnosis usually is made, many of the tumors are too advanced to be surgically removed. Other conditions such as primary sclerosing cholangitis, bile duct cysts and chronic biliary irritation, are associated with an increased risk of cholangiocarcinoma.

Chronic Pancreatitis

Chronic pancreatitis begins as acute pancreatitis and becomes chronic when irreversible scarring of the pancreas occurs. There are a number of things that increase a person's risk of developing this condition, such as alcohol consumption, smoking, genetic factors and other conditions or traumatic events that injure the pancreas. The pancreas may eventually stop producing the enzymes necessary for your body to digest and absorb nutrients. In its advanced stages, the disease can cause the pancreas to lose its ability to produce insulin.

Constipation

Constipation is the infrequent and difficult passage of stools. It is the most common digestive complaint in the United States, resulting in approximately two million doctor visits annually. Women, especially those who are pregnant, and adults aged 65 and older are most commonly affected. Virtually everyone experiences an occasional bout of constipation that resolves itself with dietary changes and time. Although uncomfortable, it is usually not dangerous. However, it can lead to other problems such as hemorrhoids or signal an underlying health condition.

Crohn's Disease

Crohn's disease causes inflammation of the small intestine. Although it may involve any part of the digestive tract from the mouth to the anus, it most commonly affects the last part of the small intestine, called the ileum, and the large intestine, including the colon and rectum. This is considered a chronic condition because it may recur at various times throughout your lifetime, with periods of remission in which you are free of symptoms. There is no consistently accurate way to predict when a remission may occur or when symptoms will return.

The disease may occur in people of all ages, although most are diagnosed before the age of 30. However, it also can affect young children and older people in their seventies or beyond. Crohn's disease occurs most commonly in people living in northern climates and affects men and women equally. The condition can be inherited and is common in some families. About 20 percent to 25 percent of those with Crohn's disease have a close relative who also has the disease or the related condition, ulcerative colitis. The cause of Crohn's disease has not been proven definitely. However, the immune system's response to certain viruses and bacteria that cause inflammation of the intestines is believed to be the primary cause of the disease.

Diarrhea

Diarrhea can be described as an abnormal increase in the frequency, volume or liquidity of your stools. The condition usually lasts a few hours to a couple of days. Diarrhea is typically associated with abdominal cramps. The most common causes of the condition are viruses, bacteria and parasites.

Enterocutaneous Fistula

An enterocutaneous fistula (ECF) is an abnormal connection that develops between the intestinal tract or stomach and the skin. As a result, contents of the stomach or intestines leak through to the skin.

Most ECFs occur after bowel surgery. Other causes include infection, perforated peptic ulcer, inflammatory bowel disease, Crohn's disease or ulcerative colitis. An ECF may also develop from an abdominal injury or trauma, such as a stabbing or gunshot.

Patients with ECFs often experience complex problems requiring a team approach that includes surgeons, nurses, enterostomal therapists, social workers and nutritionists to customize a treatment plan.

Gallstones

Gallstones are solid pieces of material that form in the gallbladder, which is the sac located on the undersurface of the liver in the upper right-hand portion of the stomach cavity. The gallbladder aids in digestion by storing bile, which is produced and secreted continuously by the liver. After a meal, the gallbladder contracts and sends the stored bile into the intestine. When digestion of the meal is over, the gallbladder relaxes and continues to store bile.

About one million new cases of gallstones are diagnosed every year in the United States, and an estimated one in 10 people suffer from the condition, which is particularly common during the mid-life years. Women tend to develop gallstones more commonly than men and at a younger age.

Gastroparesis

Gastroparesis is a disorder affecting the nerves and muscles of the stomach, resulting in a paralyzed stomach that cannot perform its normal function. Normally, your stomach contracts slowly to squeeze solid food into small particles, which are then pushed into the small bowel. With gastroparesis, food is not moved into the small bowel and remains in the stomach for much longer than usual. When food lingers too long in the stomach, problems such as bacterial overgrowth can develop in the small bowel. Also, the food can harden into solid masses called bezoars that may cause nausea, vomiting and an obstruction in the stomach.

Heartburn

Heartburn, also known as acid indigestion, is a common symptom of gastroesophageal reflux (GERD) or acid reflux. You may experience GERD when acid contents in your stomach back up into your esophagus. This occurs when a muscle at the end of the esophagus, called the lower esophageal sphincter (LES), fails to operate properly. The LES opens when swallowing to allow the passage of food to the stomach and then closes to prevent food juices from returning, or refluxing, back into the esophagus.

The cause of heartburn is unknown, but certain factors may contribute to the condition. They include:

  • Specific foods such as garlic, spicy foods and fried foods
  • Smoking
  • Caffeine
  • Pregnancy
  • Being overweight
  • Alcohol
  • Certain medications, such as nitrates and some muscle relaxants

Intestinal Failure

Intestinal failure occurs when your intestines can't digest food and absorb the fluids, electrolytes and nutrients essential to live. Intestinal failure is most often caused by short bowel syndrome, a problem that affects people who have had half or more of their small intestine removed due to injury or surgery to treat conditions such as trauma or mesenteric artery thrombosis. Intestinal failure also may be caused by digestive disorders, such as Crohn's disease or chronic idiopathic intestinal pseudoobstruction syndrome, which causes the bowel to malfunction.

Irritable Bowel Syndrome

Irritable bowel syndrome (IBS) is a common gastrointestinal disorder that affects the normal functions of the intestines, causing recurrent abdominal pain and discomfort, changes in bowel function, diarrhea and constipation. People with IBS have colons that are more sensitive and react to things that might not bother other people, such as stress, large meals, gas, medicines, certain foods, caffeine and alcohol.

IBS occurs in an estimated one in five Americans, and is more prevalent among women. It usually develops in late adolescence or early adulthood around age 20 and rarely appears for the first time after the age of 50.

Obesity

An estimated 60 percent of Americans aged 20 years and older are considered overweight and one-quarter are considered obese. Being overweight means that you have an excess amount of body weight, including muscle, bone, fat and water. Being obese means that you have an excess amount of body fat.

Obesity significantly increases your risk of developing life-threatening conditions, such as heart disease, stroke, high blood pressure, type 2 diabetes and some forms of cancer. Each year, approximately 280,000 adults die from an obesity-related condition in the United States. Additionally, studies have shown that people who are overweight often suffer from societal discrimination, which may lead to depression, self-esteem and body issue problems.

Primary Sclerosing Cholangitis

Primary sclerosing cholangitis (PSC) causes inflammation and scarring of the bile ducts located inside and outside the liver. The ducts carry bile — the liquid that helps break down fat in food — out of the liver. As scarring accumulates, the ducts become blocked causing bile to build up in the liver, which damages liver cells. Eventually, if left untreated, PSC can cause liver failure or hardening of the liver, called cirrhosis.

PSC typically begins between the ages of 30 and 50, occurring most often in men. Although the cause of the condition is unknown, research has shown that it may be an autoimmune disorder, meaning that the immune system mistakes certain body parts and organs as foreign invaders and thus wrongly attacks them. PSC also may be genetically linked to another condition, called ulcerative colitis, which causes inflammation of the colon. It is estimated that 70 percent of PSC patients also suffer from ulcerative colitis. In addition, people with PSC have an increased risk of developing cholangiocarcinoma and cancer of the bile ducts.

Ulcerative Colitis

Ulcerative colitis, also called colitis or proctitis, is an inflammatory bowel disease of the large intestines. Although inflammation usually occurs in the rectum and lower part of the colon, it may affect the entire colon. Unlike Crohn's disease, ulcerative colitis is limited to the colon.

It is estimated that as many as one million Americans are affected with colitis or Crohn's disease. Most cases of colitis are diagnosed before the age of 30, although it can affect anyone, including children and older people between the ages of 50 and 70. There is a greater incidence of the disease among Caucasians and Jews than in other populations.

Ulcers

A peptic ulcer is a sore that forms in the lining of the stomach or the beginning of the small intestines, called the duodenum. Ulcers are common, affecting an estimated 25 million Americans.

Contrary to popular belief, ulcers are not due to stress and diet. A bacterial infection brought on by the bacteria Helicobacter pylori (H. pylori) is the cause of the majority of all stomach ulcers. Prolonged use of nonsteroidal anti-inflammatory drugs (NSAIDs) or pain relievers such as aspirin, ibuprofen and naproxen sodium, which affect the stomach's ability to protect itself from acidic stomach juices, also may lead to ulcers.

Ventral Hernia

Hernias most commonly develop in the abdominal wall, where an area weakens and develops a tear or hole. Abdominal tissue or part of the intestines may push through this weakened area, causing pain and potentially serious complications.

Ventral hernias are a type of abdominal hernia. They may develop as a defect at birth, resulting from incomplete closure of part of the abdominal wall, or develop where an incision was made during an abdominal surgery, occurring when the incision doesn't heal properly.

Incisional hernias can develop soon after surgery or many years later. They affect as many as 30 percent of the patients who have abdominal surgery, such as an appendectomy.


Reviewed by health care specialists at UCSF Medical Center.

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