WHOLE PERSON HEALTH FROM THE GASTROENTEROLOGY PERSPECTIVE

STEVE SERRAO MD, MPH, PhD

PEJMAN SOLAIMANI MD

RACHEL CARSON PHYSICIAN ASSISTANT

WICHIT SRIKUREJA MD

MANISH SHRESTHA MD, MBBS

BREANNA REYES-GARCIA PHYSICIAN ASSISTANT

Dr.

Steve Serrao:

Many gastroenterology disease conditions can be traced to lifestyle and whole person care. The impact of years and decades of insult to the body by unhealthy food choices, alcohol and smoking are cumulative and can result in terminal disease. Furthermore, we are recognizing the importance and impact of the brain gut axis in patients with inflammatory bowel disease and even among healthy patients. Our Gastroenterology team has put together a collection of conditions that are overlooked and are silently impacting our patients.

Dr.

Wichit Srikureja:

How often do you think about your pancreas? Interestingly, the pancreas is crucial to your health and survival, as it is responsible for two of the most important basic functions of life. First, the pancreas secretes digestive enzymes so our gastrointestinal (GI) track can break down and absorb nutrients (vitamins, minerals, fats, and glucose to name a few) from our diet. Second, once the GI tract absorbs these nutrients. The pancreas is then critical in empowering cells to use the nutrients. For example, the pancreas secretes insulin which enables cells to utilize the glucose they require to work and survive. Without insulin, a person would starve to death no matter how much they ate. With such critical roles to play, it only makes sense to take care of our pancreas.

Pancreatic diseases range from an inflammation called pancreatitis to pancreatic cancer. In the case of some patients with pancreatitis, the inflammation of their pancreas never goes away and is called chronic pancreatitis, a life disrupting and painful condition. Currently, pancreatic cancer is the fourth leading cause of death in our country.

Often, the first time a person learns they have pancreatic cancer is when they visit a doctor because of unexplained stomach pain, jaundice (yellowing of skin and the whites of the eyes), and unintentional weight loss.

For too many, their cancer is already in an advanced stage. Although there are no guarantees, there are certain things known to reduce the risk of pancreatic cancer and pancreatic diseases. First, if you are a smoker, quit. Smoking is an avoidable risk factor for pancreatic cancer. Second, stop drinking alcohol. Heavy alcohol is linked to pancreatic cancer. It is also known that heavy alcohol use can lead to acute and chronic pancreatitis. Chronic inflammation increases pancreatic cancer risks. Third, maintain a healthy weight.

Fourth, eat a healthy diet because it is known to reduce the risk of pancreatic cancer. A diet low in sugar, low in processed and red meats, high in whole grains, fruits and vegetables contributes to the overall health of the pancreas. Let’s keep pancreas happy as it continues to work in the background to make life happen for all of us.

Dr. Pejman Solaimani:

Non-alcohol fatty liver disease (NAFLD) is defined as accumulation of fat in liver cells. NAFLD is the most common liver disorder in western countries and is mainly related to western diet and lifestyle resulting in central obesity, high cholesterol, and diabetes.

Recent advances in healthcare have resulted in significant progress in treatment and eradication of hepatitis C, however, preventing and or reversing NAFLD continues to be challenging in western societies. Most of us believe that if we don’t drink alco- hol, our liver will be fine. Although avoiding excessive alcohol intake can prevent liver damage, other factors such as a healthy diet, regular exercise and other healthy lifestyle modifications are crucial to maintain a healthy liver. Unfortunately, NAFLD can result in inflammation, fibrosis and in most severe cases, cirrhosis. Cirrhosis is an end stage liver disease and is associated with several complications. It increases risk of confusion, ascites, GI bleeding and liver cancer, among many other complications. I can speak for my gastroenterologist colleagues that most of our most challenging cases are when cirrhotic patients present with variceal bleeding requiring emergent upper endoscopy. Although most cases are addressed successfully, there are situations that patients don’t make it because they waited too long.

It is time that we educate our patients on NAFLD risks and the importance of healthy lifestyle modifications. A multidisciplinary approach is critical getting primary care providers, dieticians, and specialists such as endocrinology together would take us in the right direction to minimize the NAFLD risk factors such as obesity, diabetes, and high cholesterol.

Dr. Manish Shrestha:

Inflammatory bowel disease (IBD), comprising ulcerative colitis (UC) and Crohn’s disease (CD), is a chronic inflammatory disorder of the gastrointestinal tract. UC involves the colon, whereas CD can affect any part of the luminal gastrointestinal tract. It is estimated that approximately 3 million US adults have IBD and arises from an uncontrolled immune mediated inflammatory response to intestinal bacteria and their products in genetically predisposed individuals. Its clinical course is highly heterogenous, with symptoms ranging from mild to disabling and severity ranging from mild to severe disease. Although a predominantly intestinal disease, IBD can affect other organ systems, such as joints, eyes, skin, liver, lung, and pancreas. Early diagnosis and prompt treatment are of utmost importance to improve outcomes and maximize the well-being. The management of IBD is rapidly evolving. IBD patients are more likely to suffer from depression, anxiety, fatigue, sleep disturbance and social dissatisfaction than the general population. Despite increased risk for infections, bone disease, and certain malignancies, IBD patients are not receiving preventative care services at the same rate as the general population. In addition to treatment approach directed at healing inflammation, a more comprehensive, holistic approach to IBD care that address the physical, psychological, and social well-being of patients living with IBD realizes the best outcomes for our patients.

Rachel Carson and Breanne Reyes Garcia: It’s no secret that there is a huge brain-gut connection. We notice it throughout our lives; butterflies in our stomach when we see a romantic interest, nausea when we must get in front of a crowd to speak, however, we are reluctant to accept that connection when the symptoms become problematic such as they do with Irritable Bowel Syndrome (IBS), not to be confused with Inflammatory Bowel Disorder (IBD). Mental health is so stigmatized that we are often unwilling to admit the toll it takes on our physical bodies. Patients are often taken aback when they receive a diagnosis of IBS, they feel as though they are being told that their symptoms aren’t real; there must be something else wrong to explain the abdominal pain, the unexpected and unpleasant changes in bowel habits.

The symptoms of IBS for many are triggered by stress/anxiety, and it’s a vicious cycle because those symptoms trigger more stress/anxiety. It truly begins to affect people’s day to day lives, having to schedule their whole day around fear of what symptoms might crop up. It’s important to take time with these patients and provide them with reassurance and resources that can help them overcome these symptoms, such as providing them with a referral to a Nutritionist to help them follow a low FODMAP diet (a diet low in sugars that may cause intestinal distress), telling them about IBS guided apps such as Nerva, and making sure they are setup with Behavioral Health. Most patients end up being appreciative and overall see symptom improvement when the time is taken to provide them with support they need.