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Conditions We Treat

The condition information provided is not for self-diagnosis or self-treatment. Diagnostic testing and physician expertise are required for diagnosing your symptoms. Check with your physician to determine what may be causing your symptoms and the treatment that is right for you.

Achalasia

Achalasia is a condition in which the esophagus does not contract normally and the lower esophageal sphincter does not relax.

The  symptoms include difficulty swallowing and regurgitation of undigested food.

Diagnostic tests include barium swallow and manometry.

Treatment for achalasia may include injection of botulinum toxin into the lower esophageal sphincter, endoscopic dilation of the lower end of the esophagus, or surgery to cut the lower esophageal sphincter.

Gastroesophageal Reflux Disease (GERD)

Gastroesophageal reflux disease is a condition in which the valve between the lower end of the esophagus and the stomach (lower esophageal sphincter, or LES) does not close properly. This causes stomach acid and juices to flow back to the upper esophagus and throat.

The symptoms of GERD include heartburn on a regular basis, a bitter or sour taste in the mouth, painful swallowing, difficulty swallowing, nausea, throat problems and respiratory problems.

Treatment for GERD usually begins with dietary changes. Foods such as chocolate, coffee, onions and peppermint may cause the LES to relax and not close tightly. Other foods can irritate the esophagus once it is affected by GERD. These include spicy foods, tomato products and citrus fruits. Acid reducers, antacids or prescription medications may be recommended, as well as simple lifestyle changes such as eating smaller meals and raising the head of the bed while sleeping.

More chronic cases of GERD may require more extensive testing and treatment. An endoscopy may be performed to look for possible complications of GERD such as swelling, bleeding or strictures in the esophagus. An endoscopy also may be used to rule out other diseases that cause symptoms similar to GERD symptoms, as well as Barrett's esophagus -- a pre-malignant change in the lining of the esophagus. Other tests that may be performed include esophagus testing and an upper GI series.

Surgery to repair the LES is an option for patients with severe GERD.

Functional Dyspepsia

Functional dyspepsia is a common gastroduodenal disorder that is characterized by bothersome fullness after eating and/or recurrent discomfort, pain or burning in the middle of the abdomen without evidence of structural disease to explain the symptoms. Patients with functional dyspepsia often require an upper endoscopy to exclude other diseases that may cause similar symptoms. Other tests that may be performed include pH testing and a gastric emptying study.

Irritable Bowel Syndrome

Irritable bowel syndrome is a common condition. Its symptoms include abdominal pain or discomfort associated with diarrhea, constipation, or both symptoms alternating.

The cause of irritable bowel syndrome is not known. In some cases, irritable bowel syndrome begins after an intestinal infection or a significant life stressor.

The diagnosis often requires tests such as blood tests, colonoscopy, and imaging studies to exclude other causes of chronic pain and diarrhea.

Treatment for irritable bowel syndrome may include dietary changes, exercise, stress management, medications to control symptoms and reduce pain, and alternative therapies.

Constipation

Constipation is a disorder of defacation in which bowel movements occur infrequently, are difficult to initiate, or result in very hard and small stools.

Causes of constipation include a decrease in the motility of the colon, pelvic floor muscle dysfunction and irritable bowel syndrome. Constipation in a person who previously had regular bowel can be a symptom of an intestinal disorder.

To determine if constipation is related to a gastrointestinal disease, doctors may order tests such as colonoscopy, blood tests, anorectal manometry and defogram.

Treatment for chronic constipation depends on the cause. If no underlying disease is responsible, treatment may include laxatives, enemas and adding fiber to the diet. Beth Israel Deaconess physicians currently are involved in clinical trials of new agents to treat chronic constipation.

Fecal Incontinence

Fecal incontinence is the involuntary passage of stool. An anorectal manometry and ultrasound of the anal sphincter is generally used to determine its cause.

Treatment for fecal incontinence depends on the cause, and may include medications, biofeedback or surgery.

Intestinal Pseudo-obstruction

Intestinal pseudo-obstruction is a disorder of the bowel in which a part of the bowel does not contract properly. The symptoms of intestinal pseudo-obstruction may include difficulty swallowing, distension, pain, fullness, vomiting and constipation. Tests to diagnose intestinal pseudo-obstruction include a swallowing study, manometry and gastric emptying scan.

Contact Information

IBS and Functional Bowel Disorders Program
Digestive Disease Center
Beth Israel Deaconess Medical Center
330 Brookline Avenue
Boston, MA 02215
617-667-2138