Irritable bowel syndrome (IBS) is a very common disorder affecting a significant proportion of the population, particularly young women. IBS can manifest in a number of different ways, most of these involving abdominal pain and a change in bowel function (diarrhea, constipation or a combination of these). Traditional therapies including high fiber diet and anti-spasm medications are of variable benefit. A newer understanding of the biochemical abnormalities in patients with IBS has led to the development of new therapies aimed at correcting these derangements. Some of these are already available and others are in the pipeline. Relief for a troublesome disorder affecting individuals in the prime of their lives is at hand!
Most individuals are considered to be at average risk for colon cancer and the current recommendation is to begin colon cancer screening with colonoscopy at age 50 years. If the first colonoscopy is negative, follow-up at 7 to 10 years is appropriate. The objective is to identify polyps (which usually cause no symptoms) and remove them before they become cancerous. Persons considered at higher than average risk for colon cancer include those with first-degree relatives with colon cancer, individuals and family members with other cancers (such as gynecologic) and especially multiple cancers, and persons with ulcerative and Crohn's colitis. The age at which cancer screening should begin in these patients varies with their personal and family histories. For example those with young first degree relatives with colon cancer should undergo their first screening study at an age at least 10 years younger than that relative. Average risk African-Americans should undergo their initial colonoscopy at age 45 years. Of course anyone with "warning symptoms" such as bleeding, unexplained abdominal pain or weight loss and change in bowels must undergo colonoscopy when these symptoms develop regardless of their age.
Colonoscopy is widely accepted as the "gold standard" for colon cancer screening. No other procedure is as sensitive for the detection of polyps which are known to be precursors of colon cancer. Other tests being used for screening purposes include barium Xrays, stool tests for blood and "virtual" colonoscopy (CT colonography). The latter test is attracting interest as it can be performed without putting patients to sleep with sedation. Unfortunately, just like regular colonoscopy, CT colonography requires a prep or "clean-out" and the procedure can be very painful. In addition the sensitivity of CT colonography for small polyps and flat polyps is significantly less than for regular colonoscopy. For these and other reasons regular colonoscopy remains the procedure of choice for colon cancer screening.
Barrett's esophagus is a change in the lining of the bottom of the esophagus due to long-term exposure to acid. While the condition does not usually cause symptoms, it has the potential to transform into cancer of the esophagus, which is the only cancer increasing steadily in frequency in the U.S. in the last three decades. Research is therefore focused on methods to rid the esophagus of the abnormal Barrett's lining. A new technology allows easy ablation of these cells by burning off the abnormal layer using an endoscopic probe, and encouraging replacement of this layer with normal (non-Barrett's) cells which are not pre-cancerous. Not all patients with Barrett's esophagus are candidates for this exciting new treatment. Ask your physician if the treatment is appropriate for you.
Chronic hepatitis C affects about 4% of the U.S population. Many of these patients are unaware that they are infected as the condition causes no symptoms for many years. Unfortunately a significant proportion of these individuals later develop life-threatening complications such as cirrhosis, liver failure and liver cancer. These serious sequelae can be prevented by early treatment aimed at eradicating the virus. Current treatment includes weekly injections with interferon and daily tablets for 6 months to 1 1/2 years resulting in cure rates of 50 to 90%, depending on the type of hepatitis C. If you feel you may have been at risk for contracting this infection, ask to be tested, as effective treatment is available.