 Hello, and welcome to this edition of Quality of Life. I'm your host, Dave Augustine. Today we are gonna talk about the GI system. Joining us today to help us discuss this topic is Dr. Marla Wolfert from Pravea Health. Welcome to the show, Dr. Wolfert. Thank you. Currently, your offices are located at the Pravea St. Nicholas Health Clinic, I'm Taylor. 1621 North Taylor. Okay, what type of office hours do you handle? Our office is open from 8 to 5. We do procedures Monday through Friday, and then have office hours as well. Okay, could you go in a little bit of your background, your educational background? Where you're from, how long have you been in the area? I actually grew up in Sheboygan County, went away for school. I did undergrad in medical school at UW-Madison, and then I went to Chicago for the rest of my medical training, and I did my GI fellowship at Loyola University. Okay, yep. Wonderful. The GI system, can you give us a description of what does it all consist of? Yeah, so the GI system is pretty broad. It includes the esophagus, the stomach, the small intestine and the large intestine, but it also includes the pancreas, liver, and bile ducts. Wow, I didn't know it was the pancreas and liver. Yeah, yeah, so they contribute to digestion and absorption of food, so they're included in the GI system as well. Okay, how long has the specialty of GI been around? Yeah, GI's been around a long time. It's one of the first recognized specialties within internal medicine, and it's actually been a board-certified specialty since 1941. Okay, what are some of the disorders or issues, diseases that can occur with the GI system? You know, the most common things are things like irritable bowel, inflammatory bowel disease, like Crohn's disease or ulcerative colitis. Also, reflux is a very common thing with that ulcers. And then with the liver being included, we see a lot of hepatitis and cirrhosis as well. Okay, could you go into a little bit more detail about the bowel diseases with the inflammation? Yeah, so the main bowel diseases that we see are Crohn's disease and ulcerative colitis. These are inflammatory conditions of the intestines where the immune system attacks the intestines. The way we differentiate Crohn's disease from ulcerative colitis is Crohn's disease can affect any part of the GI tract from the mouth all the way down to the large intestine where ulcerative colitis is primarily just in the large intestine. Okay. I've always wondered with some of the foods we eat, and how does the GI system affect that or handle it? Because once in a while people can become constipated and then the next time it's like a river, so to speak. Well, I guess what's the difference? How does your body know or react? Yeah, your body reacts through digestion. Some people are more sensitive to foods than others and it all depends on the type of, if you have an underlying condition or a lot of people have irritable bowel disease which definitely affects your sensitivities to food and people can get diarrhea on one occasion and constipation on another. And the mechanism behind that isn't totally understood but we do see it a lot and we do have treatments available. Okay. What causes an ulcer? What causes an ulcer? In general it's acid production. In the early 2000s they did identify a bacteria as well that can cause ulcers. It's something called helicobacter pylori. And that is a more common cause of ulcers but that's less commonly seen in the US than other parts of the world. Certain medications can also contribute to ulcers like nonsteroidal anti-inflammatory medications like ibuprofen and aspirin and those types of medication. Okay. Are there different types of ulcers? Cause I've heard, you have an ulcer in there here. Well it's a bleeding ulcer. There are. There's, the severity is mostly where that differs. Many people have ulcers and don't have symptoms. Some have a lot of symptoms and the most common type of ulcer is an ulcer in the stomach. You can also get ulcers in your esophagus and in your small intestine. Severe ulcers can bleed and those often end up, people end up in the hospital and usually people don't have a lot of symptoms leading up to those. They don't have the pain and the reflux with that. They just come in bleeding. And then finally ulcers can go all the way through the lining of the stomach or intestine and cause a perforation or a hole in the intestines and that's the most serious type of ulcer. One that would probably require surgery or other ones can be handled with medication or diet change or less stress. Exactly, exactly. As far as that goes. You touched them on them before but what is Crohn's disease? So Crohn's disease is an inflammatory condition. It's an autoimmune condition that where the body attacks the lining of the intestines. We're not exactly sure what causes it. There is a genetic predisposition because we do see it more commonly in families but that's not 100%. There is also certain triggers that we think there are in the environment be it diet or certain bacteria that may go through your system and trigger the inflammatory conditioning or activate your immune system to start attacking your own intestines. Wow, interesting. Now you also mentioned colitis. What is that about? So that's just of the colon. The most common type of colitis is an ulcerative colitis. There are other less common types like infectious colitis which can be treated with the antibiotics where ulcerative colitis is more of a lifelong condition. Okay, now one thing I heard a few people say about and actually a few people I know about they had a condition called diverticulitis. Could you explain a little bit what that's all about? So diverticulitis is an infectious type of condition of the colon or large intestine. What happens is as we get older, certain people get these little out pouches in the colon. We're not entirely sure why some people get that and other people don't. Again, it could be diet, it could be some genetic predisposition but what happens is stool can get impacted in those little out pouches and cause an infection. And that's what we call diverticulitis. So a lot of people have diverticulosis which is just the out pouches and very few people actually get diverticulitis. Okay, I know a few people when my sister was one and then another friend of mine who had it were actually my friend had to go in for surgery and actually took out the piece that was. Yeah, and that again depends on severity and the number of episodes somebody gets. So if you're having frequent episodes of diverticulitis to prevent future episodes and severe episodes in the future, we do often recommend removing that part of the colon. Because I know, excuse me, from the side effects, at least my friend, it could be as simple as eating a strawberry in the seeds or whatever gets stuck in those pouches. Matter of a half an hour, I've seen him go from fine to rolling with the sweats and can hardly stand up, he gets so sick about it, it hits that fast. Yeah, I mean it can definitely come on quickly. The thing is it usually is very treatable which is a good thing. There's actually more and more debate about whether seeds and nuts actually play a role. Some people do notice that, but about five years ago, they did this large over 10,000 person study showing that seeds and nuts may actually not contribute as much as we previously thought. So I don't no longer tell my patients they have to avoid it unless they notice those symptoms when they eat it. Could be more just the smaller content of the food that doesn't go through or digest as much, it could be for a reason or whatever. Exactly, a high fiber diet is what is recommended and that's to give the stool more bulk so that it doesn't go into those little pouches and it stays in the main part of the intestines. Okay, how many cases would you say on average, let's say a month or even a year that you see with issues with the GI system? We see it a lot. I see up to 15 people a day who have some sort of GI issue and I think that's just the tip of the iceberg is oftentimes people delay coming in and don't necessarily want to see the doctor because a lot of people want to avoid that colonoscopy. Right, right, yeah. Would you say the trend is increasing, holding its owner decreasing based on, you know, you always see the obesity rates of the US and the way our foods are. Do you see that trend also climbing or is it holding its own? I think it depends on what type of condition. A lot of GI conditions are related to weight and obesity and so we are seeing certain things more common. Reflux is definitely more common as somebody gains weight because you have that extra pressure on the stomach causing acid to reflux up into your esophagus so that can lead to issues with the esophagus, a lot of heartburn and, you know, those type of symptoms. There's also data to suggest that the incidence of Crohn's and colitis is increasing in the US as well. Okay, with the specialties in the medications that are prescribed nowadays, you know, diabetes to have medications for that, cholesterol, medications for that, you know, it's really fine too. And do you see that also affecting, you know, providing your immune ulcers? Yeah, I think there's more and more medications available but I also think that there's more and more known every day about the way diet and, you know, just our lifestyle plays a role in certain GI disorders. So oftentimes, you know, people who come to see me don't want to take a medication and we're able to fine tune their lifestyle so that they can avoid that. That's not the case in every instance but, you know, those lifestyle changes do help as well. Sure, one thing you also mentioned briefly is hepatitis. Could you go into that a little bit? So hepatitis is just a general term for inflammation in the liver. The two most common types of people have heard about are viral hepatitis, like hepatitis A, B or C. And then also alcohol-related liver disease and those are definitely the most common but there are several other types of hepatitis that we see commonly. It's just not as talked about such as autoimmune types or hereditary forms of hepatitis. Okay, if I'm developing a GI condition what are some of the symptoms? Excuse me, I should be aware of. So the symptoms can vary considerably. A lot of people have pain, some people have diarrhea, some people have constipation, other people just lose weight and we're not sure why. I should also mention colon cancer oftentimes doesn't present with any symptoms until it's very advanced stages. So the symptoms can vary considerably. Okay, and that was my next subject is colon cancer which you had mentioned. Where do polyps come from or where does it start which then turns into colon cancer? So polyps are little growths in the colon. When we look at them at the time of colonoscopy they're little bumps in the colon. They're seen as people get older and then there's certain other things that can contribute to them. It's similar to other types of cancer. As we age we get more genetic variation in our cells and those mutations can lead to dysregulation of cell growth and overproduction. And over time those polyps can change more and more and turn into cancer. Okay, I had my first polyp when I was 30 years old so I got on a three year plan as far as that goes so as far as colonoscopies. Which brings us to our next subject is what are some of the diagnostic technologies they use nowadays? Yeah, so there's your standard EGD and colonoscopy which are a visual examination of the GI tract. With the EGD we're able to look at the esophagus, stomach and the first part of the small intestine. And with the colonoscopy we're able to look at the colon and then just the very end of the small intestine. So with both of those tests we don't get a great look at the entire small intestines and there's about 20 feet left that we don't see. Luckily small intestine disorders are much less common than the other kinds. But there is a pill camera available to look at the rest of the small intestine if we need to. And that's changed care a lot because now we can actually see what's going on in that area without just guessing or trying to rely on CT scans or other imaging that don't give us as much information. Wow, so you can swallow a camera and that too shall pass, how about that? The only thing about that is we aren't able to biopsy with that like we are with other two procedures. But it could give you at least an indication what's going on so that way you can take the next step if you have to as far as that goes. Okay, that's excellent. What about with medicines or what do you usually use for treatments? Some of the medicines you may prescribe? You know, I think the most common prescription we see in our office is things for reflux. There are several different types of medications available for reflux, mainly being your proton pump inhibitors are the most common things like omeprazole and zoprazole, pantoprazole. There's a whole host of them and they vary in their strength and that determines which one we're gonna give a patient. There's also less strong medications that are available over the counter that block histamine, block acid in the stomach that way. And I would say that is definitely our most common medication as reflux is so common these days. What about medications you can purchase like Melox or Milk and Magnesia, things like those. So Melox is, Melox, Toms, Gavaskan, all those medications work good for immediate relief of acid reflux. The pills tend to work better to prevent symptoms in the future. Then there's a whole host of other medications available for diarrhea, constipation, I prescribe fiber a lot because I think it helps with a vast majority of people's symptoms. So that's always a good thing to try when you're either having constipation or diarrhea. And then there's specific antidiarrheals or over the counter laxatives that we can use as well. How often should I be checked for my GI system? So in general, colon cancer is what we check for in everybody. It's recommended that as soon as you turn 50, you start having your colonoscopy and that's to check for polyps and remove the polyps so that they don't turn into cancer. 90% of colon cancers do occur after the age of 50 and that's why it's recommended to start at age 50. If you do have other risk factors that put you at higher risk for colon cancer, it's recommended to start earlier. And then in general, everybody else, it really depends on symptoms. There's no need to get a colonoscopy at the age of 20 unless you're having symptoms. And then as for colon cancer screening, it's recommended at the very least to do it every 10 years but if you have polyps, you do have to come back sooner as you mentioned before. Now I graduated to the five-year plan before I was on the three-year plan. It's usually three or five so it's not too often. I think the worst thing about it, people don't like about colonoscopies is the prep. Yeah, the prep is definitely the worst part of the entire test. Unfortunately, there's no way around it because without cleaning out the colon, we're not able to see anything and most of the screening tests for colon cancer do require a prep. Fortunately, the prep has changed a lot in the last 15 years. Now we use a lot lower volume prep. We're able to split it up so you're not drinking all that liquid at once. It's a little better tasting. I don't wanna say it tastes great because it's still a medication so it's not gonna taste wonderful but what's nicer, it's usually a lot less and you get to just follow it with a liquid of your choice. Like light beer. Tastes great less filling, there you go. I don't know about that, but. I know that was one of the things, the first ones I had, you almost had to drink like a gallon of that wonderful cherry flavored chalky mix. And he says, you have to drink it all while you get halfway down and you can't hold it down anymore, exactly. No, you gotta keep drinking. It's nice now that it's a much lower volume and I oftentimes split it up between half at night and half in the morning so it gives your system a break in between and actually it helps clean you out much better when you do that. Exactly. It's a lot better when you used to have to use enemas and everything from the early days. It's like wow, so. It's changed a lot and I think they'll continue to improve it but no matter what I think you'll always have to do some sort of prep and have to spend most of the night on the toilet the night before. Sure, I know my wife and she has hers, she's actually allergic and can't keep any of the crepes down so she has to go the natural way and just drink water and let her system clean itself out. So by the time it's over she's really hungry. As far as that goes. Then it's several days without eating. So who can perform a colonoscopy? I mean people like yourselves and your specialty and those surgeons have done it so who can really perform a colonoscopy? You need to have training in colonoscopies. In general, all gastroenterologists are trained to do colonoscopies. Some general surgeons are trained. I think 10, 15 years ago more general surgeons were trained but as people are coming out of their training now they are getting less of that just because the field of gastroenterology has picked up considerably over the last few years. So those are the general two. There are a few family doctors in the country who still do colonoscopies and again they tend to be older physicians who were trained years ago but that's definitely not something that's still happening today. Right, I know you always hear the cases of people had a colonoscopy, it should be a routine thing then they wind up piercing the intestine or the bowel. How likely is that to happen? That's actually very rare. Less than one in a thousand. So it's very uncommon, especially in somebody who is trained well in colonoscopy technique and that's I think why some of the you'll hear less and less of these other specialties doing it. So the colonoscopy they put you out pretty much nowadays. Yes, yes. Compared to the early days where you were still awake and everything. The early days people were unsedated and watched the whole thing. These days most people are completely asleep the entire test. It's not a general anesthesia. So occasionally somebody will wake up during the test but we always give more medication to make sure you're comfortable. And I think over the years the focus on comfort has really become a forefront and it's less of an issue than it was even 15 years ago. I know the one colonoscopy I had and the doctor's retired so I can use his name. I had Dr. Lisburg and I kept waking up and I'd point at the camera, well look at that, what's that, look at that, what's that? So then he says give him some more, I don't like him moving around like that so he had to keep knocking me out. As far as that goes, the first one I had to give me the camera, here do you want to look? So I got to look and it was interesting as far as that goes. And you know, some people don't mind and are interested by it and want to watch. That's not the majority. And we realize that we want to make that the procedure the best experience we can for patients because we realize it's not necessarily a fun thing to have done. I think again it comes to the prep because the colonoscopy itself, you're pretty much out so you really don't feel much of anything. When they give you the medication to knock you out, the last one I had, I had to swallow the camera as well because they found out I do have a bleeding ulcer in my esophagus so I'm taking meds for that. But other than that, it wasn't bad. The last ones aren't bad so they've come a long way as far as that goes. Is there anything I can do for my lifestyle to help prevent colon disease or GI patients? With most gastrointestinal disorders, following a healthy lifestyle, things that are gonna be healthy for your other organs helps with your colon as well. A high fiber diet does reduce your risk of colon cancer. It also helps treat constipation and diarrhea and can be very helpful for irritable bowel syndrome. Maintaining a healthy weight through diet and exercise can help with reflux, colon cancer, basically every disease I've talked about today. So like most other physicians we recommend regular exercise, eating a high fiber diet with fruits and vegetables and trying to watch your intake of saturated fats and those types of things. And then of course quitting smoking and limiting your alcohol is helpful as well. So you can't do anything fun and you'll be fine. Just kidding. We have to wrap pretty quick. So do you have any final thoughts as far as? Yeah, I think the most important thing people can do is to get their screening colonoscopy when they turn 50. That's the one thing you can do to prevent colon cancer that's the most effective at preventing colon cancer. So while it's not the most pleasant thing and you don't wanna do it every day, it is very important and can help prevent any future problems. So. Okay. Just briefly, where can I go to read about or find out more? I mean, is there websites or do you have a website available? The Prevea website has a lot of information and that's www.prevea.com and that's P-R-E-V-E-A. I also think the Mayo Clinic website has a lot of general information about a lot of the G.I. disorders. If you wanna know something specific about Crohn's or Colitis, there's the Crohn's and Colitis Foundation of America. That's good. And then the American Cancer Society is always good for colon cancer. Okay, wonderful. Well, Dr. Wolfert, I'd like to thank you for coming on our show. I'm talking about the G.I. system. It's been a pleasure having you. My pleasure to be here. Okay. Thank you. Thank you as well. This concludes our episode of Quality of Life, the G.I. system. I'm your host, Dave Augustine and if you have any questions or suggestions, please contact us on our website at www.wscscheboykin.com. Thanks for watching.