Patients with obscure or hidden bleeding usually have unexplained anemia (red blood cell deficiency), a low blood count, or may have blackened stools.

When traditional imaging studies fail to reveal the source of the bleeding, another high-tech imaging tool, called PillCam, can provide detailed images of the small intestine — an area that’s difficult to reach with traditional endoscopy procedures.

PillCam, or video capsule endoscopy, is a procedure that uses a tiny wireless camera to take pictures of the insides of your digestive tract. The camera is housed in a vitamin-sized capsule that you swallow. As the capsule travels through your digestive system, the camera takes thousands of pictures that are transmitted to a recorder you wear on a belt around your waist.

“In the past, finding the source of bleeding often required surgery,” said Thomas A. Judge, MD, gastroenterologist at the Cooper Digestive Health Institute. “Now the patient comes into the office in the morning, swallows a dime-sized capsule, is attached to external monitoring equipment, and is out and about for the day. The patient returns in approximately eight hours and the equipment is collected. It really couldn’t be simpler.”

The images then are downloaded and carefully reviewed by the gastroenterologist. If a problem is detected and the source of the bleeding is identified, follow-up procedures and treatments can be performed.

In difficult diagnostic cases, video capsule endoscopy may be able to reveal small ulcers or other abnormalities. The procedure has been particularly helpful in diagnosis with patients who suffer from Crohn’s disease, an inflammatory disease of the small intestine.

“Gastrointestinal bleeding is a symptom rather than a disease and can occur anywhere within the digestive system,” Dr. Judge said. “The PillCam is a valuable tool for diagnosing problems, and Cooper is one of the only centers in the region with the experience and expertise to provide the technology, and to use it effectively.”

For more information about video capsule endoscopy or other programs and services available at the state-of-the-art Cooper Digestive Health Institute, located in Mount Laurel, N.J., call 856.642.2133.

Related Links

• Digestive Health Institute
• Division of Gastroenterology
• Thomas A. Judge, MD

When the pouches become inflamed, the condition is called diverticulitis. Ten to 25 percent of people with diverticulosis get diverticulitis. As many as one American in 10 over the age of 40 has diverticulosis, and about half of all people over age 60 have it.

Symptoms of Diverticular Disease

Diverticulosis. Most people with diverticulosis don’t have any symptoms. However, some people may sometimes experience cramping pain or discomfort in the lower abdomen, bloating, and constipation. Other gastrointestinal conditions, such as irritable bowel syndrome, can cause similar symptoms, so experiencing such symptoms doesn’t always mean that a person has diverticulosis.

However, gastroenterologist Steven R. Peikin, MD, who heads the Division of Gastroenterology & Liver Diseases at Cooper, noted that, “Diverticulosis is the number 1 cause of rectal bleeding if hemorrhoids are excluded.”

Diverticulitis. Diverticulitis most commonly causes abdominal pain and tenderness on the lower left side of the abdomen. Usually, the pain is sudden and severe, but it also can be mild and worsen over several days. Its intensity can change. A person may experience cramping, nausea, vomiting, fever, chills, or a change in bowel habits. Diverticulitis can lead to bleeding, infections, small tears (called perforations), or blockages in the colon. These complications always require treatment to prevent them from causing serious illness.

Causes of Diverticular Disease

The leading theory is that a low-fiber diet causes diverticular disease. The disease was first noticed in the United States in the early 1900s, around the time processed foods became part of the American diet, greatly reducing fiber intake.

Fiber is the part of fruits, vegetables, and grains that the body can’t digest. These indigestible foods, sometimes called roughage, help to promote healthy bowel movements. Some fiber, called soluble fiber, dissolves easily in water. It takes on a soft, jelly-like texture in the intestines. You get soluble fiber from oats, barley, and fruits such as oranges and apples. Other fiber, called insoluble fiber, passes almost unchanged through the intestines. Sources of insoluble fiber include whole-wheat flour, nuts, beans, and vegetables such as carrots. Both soluble and insoluble fiber help prevent constipation by making stools soft and easy to pass. Constipation, or hard stool, may cause people to strain during bowel movements. This may increase pressure in the colon, causing the colon lining to bulge out through weak spots in the colon wall. These bulges are the diverticula.

Diagnosing Diverticular Disease

There are many ways to test for diverticular disease. Because most people with diverticulosis don’t experience symptoms, diverticulosis often is found through tests ordered for another problem. For example, diverticulosis frequently is found during a colonoscopy to screen for cancer or to evaluate complaints of pain or rectal bleeding. Diagnostic tests for diverticular disease include:

• Medical history. The gastroenterologist takes an inventory of your general health and symptoms regarding bowel habits, diet and medication use.
• Blood test. This test can help detect infections.
• Stool sample. This test may show bleeding in the digestive tract.
• Digital rectal exam. The gastroenterologist inserts a gloved finger in the rectum to check for pain, bleeding or a blockage.
• Imaging tests, including CT scan, X-ray, abdominal ultrasound or barium enema. These tests use a variety of machines and techniques to create pictures of the structures and activities inside the body.
• Colonoscopy. While a patient is sedated, the gastroenterologist inserts a thin tube through the anus to inspect the colon. A tiny video camera in the tube shows if there are any pouches, inflammation or infection.

Treating Diverticular Disease

Treatment for diverticular disease depends on how serious the problem is and whether the condition is diverticulosis or diverticulitis.

Diverticulosis symptoms can be relieved by eating high-fiber foods and, sometimes, mild pain medications can help.

Diverticulitis treatment focuses on clearing up the inflammation and infection, resting the colon, and preventing or minimizing complications. Depending on the severity of symptoms, treatment may include bed rest, oral antibiotics, a pain reliever and a liquid diet. If symptoms ease after a few days, the gastroenterologist will recommend gradually increasing the amount of high-fiber foods in the diet.

Severe cases of diverticulitis, with acute pain and complications, likely will require a hospital stay. Most cases of severe diverticulitis are treated with intravenous antibiotics and a few days without food or drink to help the colon rest. In some cases, surgery may be necessary.

Summary

• Diverticular disease is more common in people as they grow older.
• A low-fiber diet is the most likely cause of the disease.
• Most people are treated with a high-fiber diet and pain medication.
• Add whole-grain foods, and high-fiber fruits and vegetables to your diet.
• Contact a doctor if you notice symptoms such as fever, chills, nausea, vomiting, abdominal pain, rectal bleeding, or change in bowel habits.

Related Links

• Cooper Digestive Health Institute
• Steven R. Peikin, MD

Gastrointestinal problems affect more than a million people in the U.S. every year. Selecting the physicians and practice that provide the best care for your unique needs is extremely important.

The Cooper Digestive Health Institute, the largest outpatient gastroenterology center in South Jersey, provides patients with the most advanced testing and treatment in a state-of-the-art outpatient facility. Cooper gastroenterologists diagnose and treat many complex disorders and diseases of the digestive tract, but one of the more prevalent health problems being seen in patients is gastroesophageal reflux disease (GERD).

GERD is a digestive disorder that is caused by gastric acid flowing from the stomach into the esophagus. Heartburn is the most common symptom of GERD and is described as a burning chest pain that begins behind the breastbone and moves upward to the neck and throat. For most people, over-the-counter antacids can help, but the cause of the problem remains.

“People that tend to be overweight, smoke, overeat and consume a lot of caffeine or alcohol are more susceptible to this disorder,” said Steven R. Peikin, M.D., Director of the Cooper Digestive Health Institute and author of GERD: It’s More Than Just Heartburn. “I think what some people don’t realize is in many cases, gastroesophageal reflux disease can be prevented through simple diet and lifestyle changes.”

Some ways to manage heartburn include the following:

• Monitor the medications you are taking – some may irritate the lining of the stomach or esophagus.
• Quit smoking.
• Eat smaller portions.
• Do not lie down or go to bed right after a meal.
• Limit alcohol consumption.
• Elevate the head of the bed six inches.
• Lose weight, if necessary.

If you’d like to learn more about GERD, including available treatment options, we invite you to download and read GERD: It’s More Than Just Heartburn, a free eBook by Dr. Steven Peikin, online at cooperhealth.org/gerd.

Related Links

• Cooper Digestive Health Institute
  Located at 501 Fellowship Road in Mount Laurel, New Jersey, the Cooper Digestive Health Institute staff is committed to implementing innovative medical techniques and maintaining excellence in patient care, while offering a full range of gastrointestinal services.
• Download Your Free Digestive Health eBook
  This short book is available free as an Adobe PDF; an EPUB file, which can be viewed on a number of devices including the iPhone and Sony eReader; or a MobiPocket file, which can be viewed using a Kindle, Blackberry and other mobile devices.

“This new device is going to increase early diagnosis of pancreatic diseases and cancer,” said Adam B. Elfant, M.D., Director of Therapeutic Endoscopy at the Cooper Digestive Health Institute. “The ability to finally biopsy difficult-to-reach areas within the ductal system and pancreas will allow patients to be treated sooner if cancer is found, leading to better outcomes for patients. This is a remarkable step in diagnosis for this devastating cancer,” Dr. Elfant said.

Cooper is the only center in South Jersey that offers the SpyGlass™ system.

SpyGlass™ uses a tiny fiber-optic camera – not much bigger than a pencil point – inserted through a catheter (or tube) via the mouth into the upper digestive tract. Threaded through the stomach and into the bile ducts, the camera can be “steered” in four directions, allowing physicians to pinpoint the spot they want to examine. With SpyGlass™, physicians are able to see clear, three-dimensional, color images in real time. SpyGlass™ also uses a light probe and miniature forceps for physicians to take tissue samples for biopsy. Most procedures are done on an out-patient basis.

Until now, direct visualization of the pancreatico-biliary system was not widely performed due to the limitations of traditional visualization systems and diagnostic testing.  For many patients, exploratory surgery has been the only way to secure a diagnosis.

Being able to diagnose pancreatic disease without the need for an invasive surgical procedure represents significant progress.  With a more timely diagnosis, patients can begin treatment much earlier, resulting in the potential to dramatically improve outcomes.

According to the American Cancer Society, in 2008 nearly 38,000 Americans were diagnosed with cancer of the pancreas–the fourth-leading cause of cancer death in the United States.  Pancreatic cancer is a “silent” disease, with patients often not exhibiting symptoms until late in the disease process.  As a result, the majority of patients with late-stage disease have a poor prognosis for survival.

Symptoms like unexplained weight loss, persistent loss of appetite, or light-colored stools should always prompt concern. Consistent or worsening discomfort (abdominal pain and/or bloating), nausea, vomiting or diarrhea also is worrisome. If you feel something’s not right, see your doctor.