I'm Dr.

Ryan Harden, faculty member from the department of family medicine and biobehavioral health at the University of Minnesota Medical School Duth campus and family medicine physician at Gateway Family Health Clinic in Moose Lake.

I am your host for our episode tonight on cup common upper and lower gastrointestinal conditions.

The success of this program is very dependent on you, the viewer.

So, please call in your questions or send them an email to askpbsnorth.org.

Our panelists this evening include Dr.

John Reich, a board certified physician with Essentia Health in Duth where he provides specialized care for gastrointestinal and digestive conditions.

Dr.

Sandy Silver, a physician and faculty member with the University of Minnesota Medical School in Duth, where she combines patient care with medical education and training, and Dr.

Stacy Gutman, a boardcertified general surgeon with Community Memorial Hospital in Cloquet, where she provides a full range of surgical care for the region.

Our phone volunteers tonight are Blake Bartnick from Cambridge, Minnesota, Ava Hill from Aurora, Minnesota, and Ian D. Ralph from Duth, Minnesota.

They are standing by to answer your calls.

And now on to tonight's program on common upper and lower gastrointestinal conditions.

Well, welcome everybody.

I'm I've been excited to have tonight's show because we're fortunate enough to have a surgeon, a primary care physician, and a gastronurologist to field these questions.

I don't think there's a question that we're not going to be able to answer collectively.

So, uh, welcome and thanks for being here.

It's good to be here.

Thank you.

I've been collecting a couple questions from, um, my patients over the past couple weeks in anticipation of the show.

And I think we're going to get some more questions from our callers.

But while we wait for those questions, I wanted to start with a common question that I'm asked in the clinic.

This is from a patient in Sandstone.

Uh, Dr.

Reich, is Cologard better than a colonoscopy?

H uh I I think the short answer is that colonoscopy is what we consider the gold standard for diagnosing and even preventing colon cancer.

And so the the short answer is no.

However, you know, it's a timely question asking about colon cancer screening because it's been well, you know, mediaized that the incidence or the rates of colon cancer particularly in younger people have been going up.

even just in the news in the last couple of days, a a TV and movie star died from from colon cancer at a young age at age 47.

Um, and so there are multiple modalities for screening and you don't have to have a colonoscopy at least initially to be screened if you don't have any other higher risks um such as first-degree relatives with um colon cancer symptoms, things like that.

And so I would say colonoscopy while it is the gold standard because we can find and remove precancerous lesions during it, it's not the only way to screen for colon cancer.

And so it's just very important to to get screened.

And so Colag Guard for that reason, it's not a perfect test and none are, but I I would say it's better than than not doing anything.

Wonderful.

And in addition to colard and colonoscopy, there's even more ways to screen for colon cancer.

So right just important that everybody gets screened.

Yep.

Wonderful.

Thank you.

Uh Dr.

Stove, this is a question I get in my practice a lot.

Patients will end up having a imaging study for another reason and find out they have fatty liver.

So if you could explain what fatty liver is and how we manage that.

So fatty liver it is actually not completely understood but the in in terms of the the different variations it can kind of present as but the the liver itself naturally has some fat in it.

Uh in terms of what happens in the metabolism of the body with relative to things we take in the food we eat the alcohol that maybe may be something that we drink uh that can change the proportion of active functional cells and this fatty cells.

And so the more fatty cells are kind of lazy sitting around doing nothing cells um can impact the ability to for your liver to do its job and its job is to detoxify you from things you eat or side effects of metabolism within your body or medications you may have taken and help process those.

So the the way um to manage it and and I'll also look to you on this one too, but the way to manage it is to is to be as healthy as you can be and what you eat, how much you exercise, what your overall, you know, kind of body mass index is.

Kind of a funny thing we measure looking at height to weight ratios, but it's a way of kind of looking at are we at an optimal place for our height?

Weight itself is kind of funny.

I have had patients who have been upset about by a maybe a a higher weight, but then you look at them and they're 6'2.

So it it you have to think about the whole the whole package really for but fatty liver is something that's quite common, isn't it?

Yeah.

Wonderful.

And but it's across a continuum from something that you notice that's without symptoms and unlikely to cause significant harm to significant changes that can impact the ability to for day-to-day processing of those toxins.

All right.

Thank you.

Uh Dr.

Gutman, this is a common question I get in the clinic.

What when I had my colonoscopy, I was found to have diverticuli.

What is that?

So I always um explain diverticuli to be these little pockets or holes in your colon wall.

So, um the colon ideally is sort of one long smooth tube where um you know your waste products can move through easily um over time or some people seem to be more prone to it um or more stress on the colon wall and those muscles is that it can actually form these little pockets that it's almost kind of like a um a hole at the golf course um in the side of it.

And so then um one, you know, things aren't going to move through as smoothly.

and then also um stool and other things can get stuck in the side.

Um it's not uncommon to see diverticuli on a patient.

Now there's a difference when you tell someone, hey, you had diverticulosis on your colonoscopy or on an a cat scan versus you are in the hospital or your home with diverticulitis.

And so I think that's a really important distinction to make because a lot of people when you say you have diverticuli immediately go to the oh well I had a friend in the hospital with really bad pain on the left side of his um his abdomen.

And so I think knowing um that you have it just gives you sort of the power to say okay and again it goes back to diet like you're talking about.

One of the most important things to sort of decrease your risk of having issues with it would be to eat more fiber.

um a true like high-fiber diet and staying well hydrated can help um your stool be kind of this happy bulky medium to be able to pass through a little more easily and uh less likely to cause um complications from it.

So diverticulosis or having diverticuli can be something that's asymptomatic definitely and the other side of um having diverticuli also can make you higher risk for getting a bleed um from those.

So those are kind of the two ways that the diverticuli could cause problems.

Inflammation, which would be the itis part of it versus having kind of bleeding from the diverticuli because where those holes are your colon wall is um thinner and um and you can get bleeding from that too.

So but I think having it just gives you the power to sort of know this is something that I have versus it's not something that you need to wake up every day going, "Oh my gosh, I have diverticulosis.

What am I gonna do now?

So, well, excellent.

Thank you for that answer.

Oh, Dr.

Reich, this is a very very common question that I get in clinic probably because it's a common symptom, but what is acid reflux and how do you treat it?

Yeah.

So, acid reflux is one of the most common symptoms in in the entire GI tract.

And there's there's not one sort of specific way that people can feel it.

In fact, many people have what we call silent reflux, meaning it's occurring and and they don't notice it.

But essentially, so the stomach makes acid.

Acid is important to start the digestive process.

And in some people where their esophagus, the swallowing tube, you know, where food goes from your mouth down to your stomach and where your stomach meet one another, there's a sphincter muscle that for various reasons can sometimes um relax too frequently or people can get an alteration in their anatomy a bit where the top of the stomach slides upwards a bit called a hiatal hernia.

And when that occurs, that sphincter muscle just doesn't hang quite as tight as it's supposed to.

And so the acid can a bit more freely kind of move up in the in the improper direction.

And people have various symptoms from that like I said but the most common one is is sort of a burning sort of discomfort in that sort of upper abdomen lower chest area and and that symptom isn't always acid reflux but particularly let's say after meals or when you lay down at night that are those are some of the the times where we say well yeah probably that is acid reflux and in and of itself there are some potential you know consequences of chronic reflux but the way to treat reflux often You know there are certainly ton lots of medicines over the counter to take acid levels down.

Some of them um one's called fotadine or pepsid is is sort of a on the spot acts fairly quickly takes acid levels down or or tums as well as is a quick acting one that um that can help with symptoms relatively quickly.

If this is a daily occurrence and it's very bothersome for you, maybe you want to see one of us.

But also there's uh some stronger, more potent acid reducing medicines like um omerazol and some others are called PPIs.

Um I do like to talk about lifestyle with people too.

And so things like weight loss um if if someone is carrying a few extra pounds particularly around the midsection can help decrease the pressure on the stomach and less reflux.

Um, we'll have people try not eat before they go to bed.

Sometimes even put some 2 by4s or 2 by sixes on the floor under their bed post to raise their bed so that their head's a little elevated so that gravity can keep acid down.

Um, things like caffeine, spicy foods, um, alcohol can increase the acid reflux symptoms.

So, um, it's a it's a bit of a loaded question, but it's a very very common symptoms and there are multiple symptom and it's a multiple ways to approach it.

So, coffee can make heartburn worse, you know, and so I love my coffee.

Uh, and in fact, I don't believe that coffee is harmful.

There's been multiple studies say it's actually good for fatty liver.

Um, and and uh somewhat may be protective of alcohol liver damage.

Not that you should chase your alcohol with coffee, but um but and it may actually be an a strong antioxidant and and and may be good for you, but it can cause increased burning and can cause that sphincter muscle sometimes to release more um relax more frequently.

And so it's just something that it's if it's a trigger for people, we say, well, maybe put a little cream in or maybe maybe you just have to boil the coffee.

Well, I really appreciate that you said you like coffee because I do too.

Dr.

Stove, um, a caller from the iron r range is wondering, are prebiotics and probiotics beneficial for my gut health?

And, you know, that's a that's a good question and it's a big subject.

Uh, there's a lot of things we don't know about the balance of what's normal for any human, let alone an individual human and all the other things that we do.

But I think it's helpful to remember that the biome or the kind of the collection of bacteria that we have in our bowel helps us with our immune system.

Our gut is one of the places where we encounter bacteria and it's figured out how to manage that and that it's the normal bacteria for that area.

It helps uh in in digesting and and also absorbing a lot of the things that we eat.

So prebiotics um is a little bit of a newer kind of a term and it's something to kind of help support the biome.

Probiotics are a little bit more of encapsulated combinations of different bacteria.

I think um I think there are times when particularly after someone's had a stripping of their bacteria from being ill for a while or having a a sequence of maybe several times where they had to get colonoscopies or something that stripped it or on antibiotics for a prolonged time.

And it can be very helpful to nudge your your bowels towards um a more active um flora.

There are some good resources online that can kind of help with with some of the differences out there.

I think my best advice is if people want to have the most active kind of support is refrigerated kinds and mostarmacies and uh food co-ops often carry it too.

You want to actually ask and if it's not obvious where it is by the dried products is ask for the refrigerated ones and what they have.

Um, but the that you know it's in the billions of sometimes of units and it's because the the acidity in the stomach is pretty high.

And I always think about it as sort of it's almost like a torpedo of of of probiotics going through and kind of acids eating away at it.

But by the time it gets into the colon itself, you still got at least a billion left to but something people can get over the counter.

Over the counter.

Um, it is not something that you should have to take every day.

a good diet, a good broad healthy foods, um good balance of balance of food, um and and if there's nothing that's interrupted it, if you haven't gotten significantly and prolonged, uh illness that affected your GI system, you're probably doing fine with just a good diet.

Wonderful.

Dr.

Gutman, a caller from Duth is wondering after a bowel movement, what keeps you from feeling like you got it all out?

So what um like you are they do you think that they're asking what like why they still feel like there's something retained there after they maybe after they have a ball movement they feel like they still need they still need to go right um you know the um anal opening and the muscles down there are potentially smarter than our actual brains right there's there's nothing um else kind of out there that can sense, you know, solid, liquid, or gas um like our anus can.

And um and so potentially it could be that they may have some, you know, kind of something slightly different going on there, whether they might have some internal hemorrhoids um or something that's sort of um triggering that area to say, "Hey, maybe there's still something there."

Um, now patients that have um may have issues with constipation or have to strain a lot are more prone to get things like internal hemorrhoids.

Um, and the kind of pressure difference that having having something there will make them still feel like they have that.

Um, there are other issues that there are plenty of other things, rectal prolapse, other things that are just going to um make the muscles down there not quite feel like it's empty.

And so, um, being aware of that, again, kind of going back, the best way to kind of improve that is going to be again a good high-fiber diet, staying well hydrated, preventing having to strain, you know, and not only straining from the sense of trying to get the bowel movement out, but also prolonged sitting on the toilet is a thing that I think we're seeing more of, especially with more people having their phones with them while they're going to the bathroom.

And so you're not just flipping through a magazine, but now you can continue to scroll.

And so that whatever's increasing the pressure down there could make those issues worse.

But if you're feeling something down there, um, you know, I think it's worthwhile to get it checked out because maybe it is hemorrhoids or something like that.

But there is always if you aren't up to your screening or haven't been checked out for polyps or other scarier things, then I think that it's worthwhile to be evaluated for.

Yeah.

And that's what I was going to say.

I mean, great answer.

Yeah.

But something that should be checked out by a physician probably.

Yeah.

Okay.

Wonderful.

Thank you.

Uh Dr.

Reich, another common question in the clinic that I get is uh lactose intolerance in children.

What are the symptoms and how do we manage that?

Sure.

And um so so lactose intolerance is an interesting topic as well.

And essentially there's an enzyme in our small intestine.

It's called lactase.

And it basically helps us break um the the lactose down into its simple sugars.

And if we're unable to break it down, then then that gets that lactose gets doesn't get metabolized and it can get to the colon can cause a lot of gas and bloat and diarrhea and just sort of generally sometimes feeling unwell.

Now there's a lot of um questions too that we get about developing lactose intolerance and older age too because actually many adults lose that enzyme as we get older and so people can get lactose intolerance as as we age.

Um there's also a lot of people who aren't necessarily um intolerant to lactose but who are intolerant to some of the other proteins and dairy products particularly milk and ice cream are probably the largest offenders maybe less so cheese and butter but that where you can get more of kind of an irritable digestive system from milk or ice cream dairy products that's not necessarily lactose intolerance um but so it's uh and if Dr.

You know, Stover wanted to comment on sort of what she sees maybe in the pediatric um population with that.

I just don't see as many kids, but it can be a a genetically a lack of a a proper enzyme to break lactose down.

Well, and it's it's complicated in in babies because the I mean, ideally, uh breast milk is the best food because it's sort of built and developed by humanity to be a good absorption form of of nutrition.

Um but kids can run into problems and sometimes it's too much volume.

They get excited.

They get they have using a bottle to get it out obviously and they'll drink a lot and that can cause some some of it to come back up again.

Their esophagus is kind of wimpy when it relative to an adult's esophagus where it comes into the stomach.

So, it can it can come back up again.

I think um you know depends on fat content.

The it's possible that kids have an intolerance, but it's not a true allergy.

Uh that's that's actually relatively rare with milk, but that it's it's the combination of are they take is their body capable of handling the level of the fat, the calcium, the um the you know some of the lac lactose and things like that in the milk.

Um I think it's it's important if a if a baby is continuously throwing up from any kind of food that that definitely is a red flag again to go get checked out.

Uh there's there's some different kinds of things in baby's anatomy that can can impact that.

It's a great calcium source though.

um whether whether it's breast milk or or later as kids graduate from breast milk and go into cow's milk or or other other other kinds of goat milk, those kinds of things, it's a great source of calcium.

And so it's something to talk about with a pediatrician or a family doc if kids are having trouble just for the nutrition and for avoiding some of the the potential that they're irritating their immune system by reintroducing an irritant.

So they're not just little adults, kids.

They are not.

Well, great answer.

Uh, Dr.

Gutman, I took these questions out of order because this is a surgical question.

I think a caller from West Duth is wondering, "Do I need to have surgery for my hemorrhoids?"

Oh, that is a good question.

So, um, I don't see that.

I mean, that's pretty frequent thing that people get referred to me for.

And, uh, I think the short answer is well, it kind of depends on what kind of hemorrhoids you have.

Um there are ways to treat and manage um certain hemorrhoids and um if there so there are kind of two categories.

There are what we call internal hemorrhoids that I was talking about before but they um are going to be inside and then the external hemorrhoids that can kind of come out on the outside.

Um the internal hemorrhoids can actually come out too though.

So it's a little bit of a fine line but it it's based on where they are.

the internal hemorrhoids.

Sometimes those can be managed a little bit less aggressively and you can um do have a procedure that's called banding.

Um or there are other uh modalities out there too to get rid of them.

Um the ones that are more stuck out all of the time um sometimes those do require surgery.

I would say that a lot of it is very patient dependent.

So if you are really bothered by your hemorrhoids, they're getting in the way of hygiene a lot or they're causing you discomfort frequently, you're getting a lot of um pain from them or discomfort, then those are reasons to take care of it.

Some people um we push more of doing kind of banding for internal ones on people who are having bleeding from them.

Again though, if you're having any kind of bleeding, that's definitely something that you need to go and see see your doctor for um to make sure because if it's hemorrhoids, that's one thing, but if there's other causes that could be causing bleeding, too.

Um and again, I would put more money on more fiber, more water.

Yeah, I really appreciate that answer, but the punchline is every anytime you have rectal bleeding, it needs to be checked out by a physician.

Okay, great.

Thank you.

Um Dr.

Reich, this is a GI question definitely.

Are esophageal spasms common and what how do we treat them?

So esophageal spasms are I I was I would say the answer that I have is I'm a bit biased because I see it relatively frequently.

However, just in the general community they're probably not particularly common.

And essentially esophageal spasms present as usually sort of a a chest pain that sometimes can double people over and and sometimes many times mistaken for a heart attack.

Now I will say if you're having chest pain symptoms, you need to be evaluated for your heart.

But there are multiple reasons why it may happen.

Acid reflux can irritate the esophagus and it and it the esophagus is essentially just a long muscular tube and it pushes food down when you swallow.

But sometimes it just can it can all tighten up like you're flexing your bicep muscles or something but it's on the inside it be quite painful.

And so often if we think that that's what someone's having their heart seems fine everything else um we'll try to reduce acid levels see if that helps and and sometimes we will use um some versions of muscle relaxers that actually sometimes are used as heart medicines.

One's called delta another one also isorbide some other things to try to just settle settle those down.

So, it's it's relatively common and it's benign, but it can be disabling for people.

And so, it's something that, you know, if you're having those symptoms, come and see us in the clinic and and we can talk through some of the options.

Wonderful.

Thank you, Dr.

Stove.

Common question that I get, can stress cause ulcers?

That is a good question.

Um, stress is one of those things that our body has a reaction to and one of those that reaction is to produce more acid in the stomach in response to stress.

uh and the the if if you think of the acid in this against that stomach lining, it's like it's hydrochloric acid which is will etch glass.

I mean it's strong acid and our body is built with cells in that lining that turn over very quickly so that they stay healthy and can help in absorption and in motion to kind of help the food move around.

And so if the acid is is higher than the body is built to protect itself, you'll get burns.

And if you if that's compounded by taking anti-inflammatory medications like like ibuprofen or aspirin that those are acidic enough to create little their own little burn marks kind of or sizzle marks in the in the lining of the stomach.

And so stress often gives you a headache which makes you take ibuprofen and then you know if you're having a cup of coffee which is acidic or a glass of alcohol which is a solvent that can reduce some of the mucus in the lining.

Um those can all compound the problem of a bad stomach.

Wonderful.

Thank you, Dr.

Gutman.

I apologize for this.

We have less than a minute, but a surgical question.

I have gallstones.

Do I need surgery?

Oh, so probably about 30% of people have gallstones.

If we imaged everyone, um, if you are having symptoms, so the most common textbook answer would be if you have pain on the right side of your upper abdomen, um, that seems to happen 20 or 30 minutes after you eat a piece of pizza or something fatty or greasy, then you could be having problems from gallstones.

If you just found them randomly on a image test and weren't having any symptoms from them, you don't need them today to get it out would be the short answer.

All right.

Wonderful.

Uh, one quick question.

We just have a couple seconds left.

Is omerazil I'll put this out to everybody.

Is omerazole bad for us?

It depends.

There's there's there's pros and cons.

It can reduce the ability to absorb things like calcium, which we need for bones.

Um, but it also helps as you were talking about earlier in reducing acid and protecting the lining just made.

So many fewer people need to have surgery for bleeding ulcers or perforated ulcers.

So think always talk to your doctor, but overall talk to your doctor.

Take a multivitamin if you were going to be on it for extended periods of time.

There you go.

Well, I want to thank our panelists, Dr.

Stacy Gutman, Dr.

Sandy Stove, and Dr.

John Reich.

Please join doctors on call next week where Dr.

Mary Owen will be joined by regional experts for a panel discussion about caring for patients with serious illness and end of life concerns with a panel of experts from around the region.

And if you're looking for more tips, tricks, and conversation around health and wellness in the Northland, make sure to check out Northern Balance on PBS North YouTube channel.

Thank you for watching and for joining us for season 44 of Doctors on Call.

Good night.