Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Functional disorders of the esophagus can be
identified with esophageal motility studies (manometry). For these studies, a
pressure-sensing tube is swallowed and positioned within the esophagus.
Contractions of the esophageal muscle normally cause increases in pressure
within the esophagus that can be monitored by the catheter during and between
swallows of water. Among the abnormalities that can be seen are abnormally high
or abnormally low pressures during swallow-associated contractions and/or during
spontaneous contractions unassociated with swallows.
Gastric emptying study and electrogastrogram
Slow emptying of the
stomach is a common functional abnormality that can lead to bloating, nausea,
and vomiting. Rapid emptying of the stomach is relatively uncommon and can lead
to abdominal pain and diarrhea. Both of these abnormalities--slow and rapid emptying--can
be identified by a gastric emptying study.
The most common type of emptying study is a nuclear medicine study. In this
test, patients drink or eat food labeled with radioactive material. A Geiger counter-like device then is placed over the abdomen and the speed with which the
radioactive drink or food empties from the stomach is monitored.
The electrogastrogram (EGG) is like the electrocardiogram (ECG) for the
heart. Electrodes that are taped to the upper abdomen monitor the electrical
activity generated by the muscle of the stomach. Abnormalities of the electrical
rhythm of the stomach frequently are associated with dyspeptic symptoms,
particularly nausea and vomiting.
Barostatic study
A barostat is an instrument that is used to measure
pressure and determine the compliance (flexibility) of a gastrointestinal organ.
Compliance is a term that describes the effect that internal stretching has on
the organ. The greater the compliance of an organ, the less there is tension
(pressure) generated when the organ is stretched from within.
Compliance is important to the normal function of gastrointestinal organs.
For example, as food fills the stomach during a meal, the muscles of the stomach
must relax (comply) to accommodate the increasing volume of food. If the stomach
does not relax properly, the pressure in the stomach increases abnormally. It is
believed that abnormally high pressures within the stomach (due to reduced
compliance) can lead to symptoms such as early satiety (the feeling of abdominal
fullness or pain after only a small amount of food has been ingested).
The barostat includes a balloon that is placed within a gastrointestinal
organ through the mouth or anus. As the balloon is progressively blown up and
stretches the organ, the pressure within the organ is measured by the barostat.
In this way, abnormal compliance can be identified. Barostats can be placed in
the esophagus, stomach, small intestine or colon. Barostatic studies, however,
probably should be considered experimental. In fact, barostats and expertise in
their use are available in only a limited number of centers.
Small intestinal transit study
Small intestinal transit studies measure the
speed with which food travels through the small intestine. In the most common
type of transit study, a test meal that has been labeled with a radioactive
material is ingested. A Geiger-counter-like device is placed over the abdomen
and is used to follow the radioactive material through the small intestine and
into the colon. Rapid transit is associated with abdominal pain and diarrhea.
Slow transit also may be associated with abdominal pain. Although transit
studies are not difficult to conduct, they are not frequently used because
experience with their use is not wide-spread. They probably should be considered
experimental.
Antro-duodenal motility study
Antro-duodenal motility studies measure the
pressures that are generated by the contractions of the muscles of the antrum
(outlet) of the stomach and the duodenum. For these studies, a pressure-sensing
tube is swallowed or passed through the nose and positioned in the distal
(outlet) part of the stomach (the antrum) and the first part of the small
intestine (the duodenum). Pressures are measured with the stomach empty and
after a test meal. Abnormally high or low pressures as well as uncoordinated
contractions can be identified. These abnormalities are believed to be
associated with symptoms of dyspepsia. Antro-duodenal motility studies and
expertise in their use are not widely available.
Gallbladder emptying studies
Gallbladder emptying studies determine how well
the gallbladder empties. Between meals, the gallbladder stores bile that is
produced by the liver. After meals, the muscles of the gallbladder contract and
squeeze out (empty) most of the bile into the intestine. In the intestine, the
bile assists with the digestion of food.
For a gallbladder emptying study, a radioactive material is injected
intravenously. The radioactive material is removed from the blood by the liver
and accumulates with the bile in the gallbladder. The gallbladder then is
stimulated to contract with either a meal or an intravenous injection of a
hormone, called cholecystokinin. A Geiger-counter-like device is placed over the
abdomen and the speed with which the radioactivity leaves the gallbladder and
enters the intestine is monitored. Emptying studies of the gallbladder are
widely available since this technology is used for several purposes other than
measurement of gallbladder emptying.
It has been suggested that abnormally slow emptying of
the gallbladder may be associated with abdominal pain. Unfortunately, however,
the studies that support the association between slow gallbladder emptying and
symptoms are weak. Moreover, many people have abnormally slow emptying of the gallbladder but no
symptoms. For these reasons, abnormal emptying studies of the gallbladder
have not been widely accepted for diagnosing functional disorders of
the gallbladder. The lack of a clear association between dyspepsia and abnormalities
of gallbladder emptying is important since it means that patients with
abnormal emptying may not be improved by removal of their gallbladders.
Abdominal pain is pain in the belly and can be acute or chronic. Causes include inflammation, distention of an organ, and loss of the blood supply to an organ. Abdominal pain can reflect a major problem with one of the organs in the abdomen such as the appendix, gallbladder, large and small intestine, pancreas, liver, colon, duodenum, and spleen.
Gallstones are stones that form when substances in the bile harden. Gallstones (formed in the gallbladder) can be as small as a grain of sand or as large as a golf ball. There can be just one large stone, hundreds of tiny stones, or any combination. The majority of gallstones do not cause symptoms.
Anxiety is a feeling of apprehension and fear characterized by physical symptoms. Anxiety disorders are serious medical illnesses that affect approximately 19 million American adults.
Gas or "intestinal gas" means different things to different people. Everyone has gas and eliminates it by belching or farting (passing it through the rectum).
GERD (gastroesophageal reflux disease) is a condition in which the acidified liquid
contents of the stomach backs up into the esophagus. The symptoms of uncomplicated GERD are heartburn,
regurgitation, and nausea. Effective treatment is available for most patients with GERD.
Diabetes mellitus is a chronic condition characterized by high levels of sugar (glucose) in the blood. The two types of diabetes are referred to as type 1 (insulin dependent) and type 2 (non-insulin dependent). Symptoms of diabetes include increased urine output, thirst, hunger, and fatigue. Treatment of diabetes depends on the type.
Nausea is an uneasiness of the stomach that often precedes vomiting. Nausea and vomiting are not diseases, but they are symptoms of many conditions. The causes of vomiting differ according to age, and treatment depends upon the cause of nausea and vomiting.
Stress occurs when forces from the outside world impinge on the individual. Stress is a normal part of life. However, over-stress, can be harmful. There is now speculation, as well as some evidence, that points to the abnormal stress responses as being involved in causing various diseases or conditions.
Depression is an illness that involves the body, mood, and thoughts and affects the way a person eats and sleeps, the way one feels about oneself, and the way one thinks about things. The principal types of depression are major depression, dysthymia, and bipolar disease (also called manic-depressive disease).
Ulcerative colitis is a chronic inflammation of the colon. Symptoms include abdominal pain, diarrhea, and rectal bleeding. Ulcerative colitis is closely related to Crohn's disease, and together they are referred to as inflammatory bowel disease. Treatment depends upon the type of ulcerative colitis diagnosed.
In lactose intolerance, the digestive system cannot digest lactose (the main sugar in milk). Symptoms of lactose intolerance include diarrhea, flatulence, abdominal pain, abdominal bloating, abdominal distention, and nausea. There are several tests to diagnose lactose intolerance. Treatment is generally made with dietary changes, supplements, and adaptation to small amounts of milk.
IBS (irritable bowel syndrome) is a common gastrointestinal disorder involving abnormal gut contractions (motility) characterized by abdominal pain,
bloating, mucous in stools, and irregular bowel habits with alternating diarrhea
and constipation, symptoms that tend to be chronic and to wax and wane over the
years. Treatment options include medication and lifestyle changes such as diet, exercise, and stress management to control symptoms. Also called spastic colitis, mucus colitis, nervous colon syndrome.
Normal vaginal bleeding (menorrhea) occurs through the process of menstruation. Abnormal vaginal bleeding in women who are ovulating regularly most commonly involves excessive, frequent, irregular, or decreased bleeding. Causes of abnormal may arise from a variety of conditions.
Helicobacter pylori (H. pylori) is a bacterium that causes chronic inflammation (gastritis) of the inner lining of the stomach in humans. This bacteria also is the most common cause of ulcers worldwide.
Chest pain is a common complaint by a patient in the ER. Causes of chest pain include broken or bruised ribs, pleurisy, pneumothorax, shingles, pneumonia, pulmonary embolism, angina, heart attack, costochondritis, pericarditis, aorta or aortic dissection, and reflux esophagitis. Diagnosis and treatment of chest pain depends upon the cause and clinical presentation of the patient's chest pain.
Small intestinal bacterial overgrowth (SIBO) refers to a condition in which abnormally large numbers of bacteria (at least 100,000 bacteria per ml of fluid) are present in the small intestine and the types of bacteria in the small intestine resemble more the bacteria of the colon than the small intestine. There are many conditions associated with small intestinal bacterial overgrowth, to include: diabetes, scleroderma, Crohn's disease, and others. There is a striking similarity between the symptoms of irritable bowel syndrome and SIBO. It has been theorized that SIBO may be responsible for the symptoms of at least some patients with irritable bowel syndrome. Symptoms of SIBO include: excess gas, abdominal bloating, diarrhea, and abdominal pain.
Learn about osteoporosis, a condition characterized by the loss of bone density, which leads to an increased risk of bone fracture. Unless one experiences a fracture, a person may have osteoporosis for decades without knowing it. Treatment for osteoporosis may involve medications that stop bone loss and increase bone strength and bone formation, as well as quitting smoking, regular exercise, cutting back on alcohol intake, and eating a calcium- and vitamin D-rich balanced diet.
A peptic ulcer is an ulcer in the lining of the stomach, duodenum, or esophagus. Ulcer formation is related to Helicobacter pylori bacteria in the stomach, use of anti-inflammatory medications, and cigarette smoking.
Gastritis is an inflammation of the stomach lining. Causes of gastritis include drinking too much alcohol, medications such as NSAIDs, ibuprofen, aspirin, H. pylori infection, severe infections, burns, anemia, and autoimmune disorders. Gastritis is diagnosed with endoscopy, blood tests, or stool tests. Treatment depends upon the cause of gastritis.
The major goal in treating diabetes is controlling elevated blood sugar without causing abnormally low levels of blood sugar. Treatment for type 1 diabetes is with insulin, exercise, and a diabetic diet. Treatment for type 2 diabetes is first treated with weight reduction, a diabetic diet, and exercise. When these measures fail to control the elevated blood sugar, oral medications are used. If oral medications are still insufficient, insulin medications are considered.
Menstruation (menstrual cycle) is also referred to as a "period." When a woman menstruates, the lining of the uterus is shed. This shedding of the uterine linking is the menstrual blood flow. The average menstrual cycle is 28 days. There can be problems with a woman's period, including heavy bleeding, pain, or skipped periods. Causes of these problems may be amenorrhea (lack fo a period), menstrual cramps (dysmenorrhea), or abnormal vaginal or uterine bleeding. There are a variety of situations in which a girl or woman should see a doctor about her menstrual cycle.
Managing your diabetes is important. The goal of diabetic therapy is to control blood glucose levels and prevent the complications of diabetes. Information about exercise, diet diet, and medication will help you manage your diabetes better. Blood glucose reagent strips, blood glucose meters, urine glucose tests, tests for urinary ketones, continuous glucose sensors, and Hemoglobin A1C testing information is also provided in this article.
In hypoparathyroidism, the parathyroid gland does not produce enough parathyroid hormone. Causes of hypoparathyroidism include injury to the parathyroid glands, autoimmune disorder association, or may be present ab birth. Symptoms of hypoparathyroidism include: tingling fingers, toes, and lips, brittle nails, dry, coarse skin, dry hair; memory loss, headaches, severe muscle cramps, cataracts, malformed teeth, and convulsions. Treatment of hypoparathyroidism is to restore the calcium and phosphorus to normal levels in the body.
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