Routine GI Care at AGMG

Learn about Routine GI Care from the doctors of Associated Gastroenterology

At AGMG, our job is to make sure our patients have a healthy gastrointestinal tract. We see all types of GI disorders and our goal is to educate our patients how they can keep themselves in shape. Here are some of the most frequent questions we get in the office.

When should I get a colonoscopy?

Per the American College of Gastroenterology, screening colonoscopy is recommended for patients:

• Age 50 if there is no family history of colorectal cancer or polyps
• Age 45 if African-American (higher rates of colon cancer at earlier ages)
• Age 40 if there is a family history of colorectal cancer or certain polyps
• Less than 40 if there is a family history of colorectal cancer diagnosed before 50 or with certain genetic syndrome

A diagnostic colonoscopy is recommended for any patient regardless of age with concerning symptoms such as bleeding, pain, diarrhea or constipation

How often should I have a colonoscopy?

Per the American College of Gastroenterology, colonoscopy is recommended every 10 years until age 75 if the patient is average risk, has no polyps and there is no family history of colon cancer. If polyps are found or there is a family history of colon cancer then repeat colonoscopy may be recommended in 1, 3 or 5 years. Patients at high risk for colon cancer (IBD or genetic syndromes) may need colonoscopy yearly.

I don’t want a colonoscopy. Are there other options?

This comes up from time to time in the office. A patient might have had a relative with a poor experience during colonoscopy or they have negative opinions about colonoscopy. Typically with a little education and reassurance, the patient will be open to colonoscopy as it is the only test that has been shown to screen for colon cancer and prevent colon cancer. However, there are occasions absolutely refuses to have a colonoscopy. In that care, the best test is the test the patient is willing to have. There are several stool tests that can be used to screen for colon cancer. The important thing to note is that these tests only screen for cancer, they do not prevent cancer. In addition, a positive stool test MUST be followed up with a colonoscopy.

Should I take a probiotic?

The GI tract is host to billions of bacteria (the microbiome). The microbiome is an essential component to digestion, motility and maintenance of health. When the microbiome changes, it can result in symptoms of bloating, diarrhea, pain and perhaps result in disease such as IBD, obesity or even cancer.

There are four ways to alter the microbiome:

• Antibiotics
• Prebiotics (food particles that support the growth/function of bacteria)
• Probiotics (supplemental bacteria)
• Fecal microbial transplant (stool transplant)

Probiotics are an area of active research. There is promise in preventing or treating various conditions. However, most studies have been small and use different bacterial compositions making it tough to draw meaningful conclusions. Be weary of any claims made by probiotic companies. They are not held to the same standard by the FDA and the research to date does not support these claims however slick or expensive they might be.

At this time, there are no formal recommendations on who should take probiotics or what probiotic to take. There is some data to suggest symptom improvement in IBS with probiotics but the effect is unfortunately small. Luckily this is an area of exciting research and will likely improve over the next several years!

How much fiber should I eat?

Fiber is actually a prebiotic. The bacteria in our GI tract use fiber as a food to promote healthy digestion and regular well-formed bowel movements. A high-fiber diet appears to reduce the risk of developing various conditions, including heart disease, diabetes, diverticular disease, constipation and colon cancer. A high-fiber diet will help you have soft, regular bowel movements. Having a bowel movement when your body gives you an urge to go is the best time to have a bowel movement. This will minimize problems with hemorrhoids, fissures, itching and other common colon, rectal and anal problems

The American Heart Association Eating Plan suggests eating a variety of food fiber sources. Total dietary fiber intake should be 25 to 30 grams a day. Currently, dietary fiber intakes among adults in the United States average about 15 grams a day. That's about half the recommended amount.

Great sources of fiber include:

• One serving of whole grain in every meal. This can be done with whole grain bread, pasta or brown rice.
• Legumes and beans
• Fresh fruit or vegetables (juice doesn’t contain fiber, raspberries are especially high in fiber)
• Fiber supplements (Metamucil, Citrucel, Benefiber, Konsyl etc…)

How much alcohol is too much for the liver?

Men and women process alcohol very differently. The American Association for the Study of Liver Disease (AASLD) defines a risk for alcohol liver disease with more than 21 drinks per week in men and 7 drinks per week in woman in patients with no other chronic liver diseases. In this setting a drink is defined as a standard beer, a small glass of wine or 1 ounce of spirits. No more than 4 drinks should be consumed at one sitting for men and 2 drinks for women. It is thought that wine might be safer than beer and spirits.

If a patient has chronic liver disease, no amount of alcohol is safe. If a patient has alcohol abuse or dependence issues, no amount of alcohol is safe.

How much Tylenol is too much for the liver?

Tylenol (acetaminophen) overdose is the leading cause of acute liver injury in the US. This can be either intentional or accidental in the setting of aggressive attempts at pain control. However, small daily doses of Tylenol are safe even with cirrhosis. The maximum daily dose for patients without liver disease is 4000 mg (8 extra strength Tylenol). The maximum daily dose for patients with cirrhosis is 2000 mg (4 extra strength Tylenol). Tylenol is actually safer for patients with cirrhosis than NSAIDs such as ibuprofen, naproxen.

Who should be screened for Hepatitis C?

It is recommended that all persons born between 1945 and 1965 should be screened for hepatitis c infection. It is estimated that 2.6% of this patient group will have chronic hepatitis c with most patients not aware they are infected. In addition to the baby boomer generation, screening is recommended for those with a history of illicit injection drug use or intranasal cocaine use, even if only used once, those who received potentially contaminated blood products or tissue, HIV-infected patients, dialysis patients, men who have sex with men, incarcerated individuals and those who have other potential prior exposure to HCV, or who have the potential for transmission

Please send us all question you might have so we can better serve our patients. Our goal is to educate our patients!