CreativeWriter27 asks:
I've been having a lot of pain on my right side, which a nurse practitioner thinks may be deferred pain from cysts that I have. My ob/gyn doesn't think the cysts are large enough to hurt, so I'm getting another test. Do you think it could be gastrointestinal pain?

Anil Rustgi, MD responds:
There are many different problems that could cause pain on your right side, but if you are experiencing severe abdominal pain you should seek prompt medical attention. Tracking the following information will help your doctor form a diagnosis:

• When you have pain
• Exactly where the pain is located
• Type of pain (such as aching, stabbing, throbbing or cramping)
• How long the pain lasts
• What triggers the pain
• What helps relieve the pain
• How the pain affects you (such as limiting activities or missing work)

Kashyap Panganamamula, MD is a Penn gastroenterologist can evaluate your condition and recommend the best treatment. To make an appointment, please call 800.789.PENN (7366) or you can also request an appointment online.

Ann asks:
Do you perform capsule endoscopies at Penn Medicine at Radnor?

Anil Rustgi, MD responds:
Unfortunately, capsule endoscopies are not done at our Radnor location.

David Jaffe, MD is a Penn gastroenterologist who performs capsule endoscopies at the Hospital of the University of Pennsylvania. Capsule endoscopies are also performed at Penn Presbyterian Medical Center. To schedule an appointment, please call 800-789-PENN (7366) or request an appointment online.

Judy asks:
My 78 year-old mother was prescribed Prevalite® for chronic diarrhea. Since Prevalite® is a cholesterol-lowering drug that can cause constipation, I question its use to treat daily loose bowels.

Anil Rustgi, MD responds:
Prevalite® is a cholesterol-lowering drug, but it also is used to treat patients who have diarrhea related to excess fecal bile acids. It is used because it has the ability to bind the acids in bile, which relieves chronic diarrhea.

Geoffrey Spencer, MD is a Penn gastroenterologist who can give a second opinion and prescribe treatment for your mother, please call 800.789.PENN (7366) or request an appointment online.

Steve asks:
I am 52 years old and was diagnosed with left sided ulcerative colitis in February, 2007. I believe I may have contracted a germ or been exposed to a bacteria in October of 2006—under unusual circumstances too long to explain here—that may have caused my colitis, though I have been told that there is no known cause of ulcerative colitis. I was initially on Asacol® for a number of months and then switched to Lialda™ (4.8g per day; later changed to 2.4g per day). For the most part, my colitis has been in remission.

In April, I had a colonoscopy and was told by my gastroenterologist that he removed two small polyps. I should also note that about one and a half yrs prior to my colitis diagnosis, I was diagnosed with type 2 diabetes, for which I have been on Metformin. Over the last number of weeks, I have had two bouts of constipation and diarrhea. Prior to the second diarrhea bowel movement, while I was having constipation, my gastroenterologist told me to take MiraLax®.

Following the second diarrhea bowel movement, I had a bowel movement of small thin stools. When I told this to my gastroenterologist, he told me to take Citrucel® for five to seven days to add bulk to my stool. I am now in day three and though I do not have constipation or diarrhea, my stool is still very thin. Also, I sometimes have to go back to the bathroom in a short time to complete my bowel movement.

Is it possible that another polyp or obstruction could have developed since my last colonoscopy six months ago? Could I now have colon cancer? I have had faint discomfort in the left lower quadrant of my abdomen the last few days along with these thin bowel movements, in addition to very slight nausea.

Can colitis turn to cancer in less then two years? If in fact, it was bacteria in the environment that may have caused my colitis, could that precipitate my colitis turning into cancer at a faster rate than expected compared to the average case of ulcerative colitis? Should I request that my doctor perform a colonoscopy now – six months since my last one – rather than waiting until one year has elapsed?

Anil Rustgi, MD responds:
Ulcerative colitis is an inflammatory bowel disease that affects the rectum and large intestine. What causes ulcerative colitis is still unknown, but attacks can be brought on by a variety of things, including physical stress or respiratory infections. Colon polyps are growths of tissue that develop. They vary in size and shape and if they are not removed, there is a higher risk of colon cancer.

Since your doctor removed your polyps just six months ago, it is unlikely that additional polyps have developed because they take around five years to reach one half inch, and it takes another five to ten years to develop into cancer. Since you do suffer from ulcerative colitis, you have a higher chance of colon cancer developing – depending on the severity of your case.

However, since you have a very involved case, I recommend you see Mark Osterman, MD, MSCE. Dr. Osterman specializes in inflammatory bowel disease. He can evaluate your condition and recommend the best course of treatment. To schedule an appointment, please call 800.789.PENN (7366) or request an appointment online.

Rachel asks:
My father has pancreatitis with cysts on the pancreas and a blood clot in his lung. He is in severe pain and being treated with Coumadin®, antibiotics and morphine for pain. What is normally the outcome of such severe pancreatitis, and what should we expect along the road to recovery?

Anil Rustgi, MD responds:
Pancreatitis is inflammation of the pancreas – an organ whose function is to release certain hormones and help with digestion. Cysts on the pancreas are a complication of chronic pancreatitis, meaning there is long term inflammation. This inflammation causes irreversible scarring of the pancreas, inhibiting its production of enzymes to digest food.

The treatment for chronic pancreatitis is pain medication and rest. Abstaining from solid food gives the pancreas a break from producing the enzymes needed for absorption, which can help relieve severe episodes of pain. In some cases, surgery is required to remove the pancreatic cysts or to remove dead pancreatic tissue.

Nuzhat Ahmad, MD and Gregory G. Ginsberg, MD are Penn gastroenterologists who specialize in pancreaticobiliary disease. To schedule an appointment with either of them, please call 800.789.PENN (7366) or request an appointment online.

Heather asks:
Do you test and treat for food allergies such as gluten intolerance?

Anil Rustgi, MD responds:
Gluten intolerance is a lifelong disorder also known as celiac disease, an inherited, autoimmune disease. Celiac disease occurs when there is damage to the small bowel from consumption of gluten, wheat, barley, rye and possibly oats. In the small bowel there are threadlike projections called villi, which absorb nutrients from food we ingest. If left untreated, these villi become flattened and can not absorb nutrients properly.

There are several ways to diagnose celiac disease, such as:

• A complete blood count (CBC), which indicates common symptoms like anemia and bone loss.
• Malnutrition.
• Antibody screening tests.
• Small bowel endoscopy, which shows the flattened villi.

The only treatment for Celiac disease involves elimination of gluten, wheat, barley and rye from your diet.

Geoffrey Spencer, MD is a Penn gastroenterologist specializing in the diagnosis and treatment of celiac disease, please call 800.789.PENN (7366) or request an appointment online.

TA asks:
I have had heartburn for over a year and a half now. I have taken every over-the-counter medicine and my clinic provided me with Nexium®, but nothing seems to work long term. My symptoms started over two years ago with lactose intolerance. They now vary from diarrhea to occasional vomiting. Is there another course of action available to me?

Anil Rustgi, MD responds:
If you have heartburn more than twice a week, you may have gastroesophageal reflux disease (GERD). It is best to be examined by a gastroenterologist because the long-term effects of GERD can cause Barrett's esophagus, esophageal ulcers or strictures. Nexium® is a brand name esomeprazole medication used to treat the symptoms of GERD, allowing the esophagus to heal and prevent further damage.

Chronic diarrhea is a condition that could have a variety of causes. It may indicate the need to adjust your diet or that there is a more serious underlying problem.

Geoffrey Spencer, MD is a Penn gastroenterologist who will be able to evaluate all of your symptoms and recommend the best course of treatment. To make an appointment, please call 800.789.PENN (7366) or request an appointment online.

Patty asks:
If someone has had hepatitis B, is it more likely for hepatitis C antibodies to be present without necessarily having the hepatitis C virus?

Anil Rustgi, MD responds:
Hepatitis B and hepatitis C are both diseases of the liver that cause irritation and swelling. When your body identifies this type of virus, it builds a specific antibody to fight off the infection.

Liver damage associated with hepatitis B results mainly from antibody cells that can cause liver inflammation. Hepatitis C often does not cause symptoms until the liver has been permanently scarred – this is known as cirrhosis. It can be detected in routine physical or medical procedure blood tests.

That being said, hepatitis B and hepatitis C are two separate diseases.  Previously having hepatitis B would not make it more likely for hepatitis C antibodies to be produced. If hepatitis C antibodies are present, it would mean that at some point you were infected with hepatitis C.

Thomas Faust, MD is a Penn hepatologist specializing in diseases of the liver. To schedule an appointment with Dr. Faust, please call 800.789.PENN or request an appointment online.