DRS. SCHMIDT, MICALE, PALANCE, LIN & WELINSKY are specialists in Gastroenterology, a branch of medicine that focuses on conditions affecting your gastrointestinal (GI) or digestive tract and liver. Your digestive tract includes your esophagus (food pipe), stomach, liver, gallbladder, intestines (small and large), and pancreas. Our Practice offers a full array of GI-specific diagnostic services to help you resolve or control any digestive issues you may experience.
The following are some of the conditions that are commonly diagnosed and treated in the specialty of gastroenterology:
COLONOSCOPY (LOWER ENDOSCOPY)
An endoscopic examination of the large intestine from the rectum to the ileo-cecal valve using a colonoscope. This procedure is used for cancer screening as well as for identifying bleeding sites, polyps, and inflammation.
ESOPHAGOGASTRODUDODENOSCOPY (EGD OR UPPER ENDOSCOPY)
The direct visualization of the esophagus (food pipe), stomach and part of the small intestine using an endoscope. This procedure is useful in identifying bleeding sites, polyps, varices (enlarged veins) and foreign bodies.
BARRETT’S ESOPHAGUS
A condition in which the cells of the lower esophagus (food pipe) become damaged due to repeated exposure to stomach acid and can increase the chance for esophageal cancer.
CANCERS OF THE DIGESTIVE TRACT
Cancer occurs when abnormal cells reproduce at a rapid rate and do not die within an expected lifetime for a cell. These abnormal cells clump together and cause malignant tumors. Cancer cells can invade and destroy nearby healthy tissue, causing changes in how a particular system functions. Cancers of the digestive system include:
- stomach cancer
- liver cancer
- colon cancer
- pancreatic / gall bladder cancer
- esophageal cancer
CELIAC DISEASE
A disease in which a person cannot tolerate gluten, a protein found in wheat, barley and rye. As a result, the small intestine becomes damaged, interfering with the absorption of nutrients from food.
COLITIS / ULCERATIVE COLITIS
Colitis is an inflammation of the bowel which can occur due to a variety of reasons, such as infection, poor blood supply or autoimmune issues. In ulcerative colitis, ulcers are present in addition to the inflammation. These ulcers can also produce bleeding and abdominal pain.
COMMON BILE DUCT STONES
These are gallstones that block the common bile duct, a small tube that carries bile from the gallbladder to the intestine. Blockage can cause abdominal pain, fever and jaundice (yellowing of the skin).
DIVERTICULOSIS / DIVERTICULITIS
Aging and continued pressure can cause the lining of the intestine to develop small pouches that bulge outward through weak spots in the wall of the intestine. Diverticulosis is the condition of having many of these small pouches. If these pouches become inflamed or infected, the condition is known as diverticulitis.
DYSPEPSIA (INDIGESTION)
A term used to describe the discomfort that occurs in the upper abdomen. Symptoms may include, heartburn, nausea, burning sensation and bloating. Some of the causes of dyspepsia include gastroesophageal reflux disease (GERD), ulcers, or gallbladder disease.
DYSPHAGIA (DIFFICULTY SWALLOWING)
Swallowing is a complex process involving many muscles and nerves. Swallowing consists of three phases; the first is voluntary (chewing your food). Once the chewed food is pushed to the pharynx (back of the throat), the remaining two phases occur automatically. Weak muscles or damaged nerves play a role in causing dysphagia.
ESOPHAGEAL STRICTURE
An esophageal stricture is the narrowing of the esophagus (food tube). This narrowing is usually caused by the build-up of scar tissue. Scar tissue can occur as a result of acid reflux, ingestion of corrosive liquids, or other types of damage to the esophagus. Esophageal strictures can lead to swallowing difficulties that can be corrected with esophageal dilatation.
GALLSTONES
The role of the gallbladder is store bile, a substance produced by the liver and used to help the body digest fat. Gallstones can develop if the bile contains too much cholesterol or if the gallbladder does not fully empty. Gallstones can block the normal flow of bile and cause pain, yellowing of the skin and eyes, and possible infection of the liver, gallbladder or pancreas.
GERD (ACID REFLUX)
A digestive disorder that affects the ring of muscle between the esophagus (food pipe) and the stomach. As a result, stomach content backs up or regurgitates into the esophagus. This regurgitation can inflame and damage the lining of the esophagus.
HEMORRHOIDS
The anus is the opening at the end of the rectum. It is the last part of the GI tract. Swollen veins around the anal canal are known as hemorrhoids. Hemorrhoids can either be internal (inside the anal canal) or external (at or outside the anal canal).
HEPATITIS
Hepatitis is the inflammation of the cells of the liver. This inflammation can be caused by a virus, alcohol, infections, medications, toxic agents, obesity, and autoimmune diseases and congenital disease. Some forms of hepatitis resolve with no damage to the liver; while other forms may be chronic and lead to serious liver problems. Depending on the cause of hepatitis, some forms are contagious and can easily spread from person-to-person. Fortunately, therapy is available to treat hepatitis.
H. PYLORI
Helicobacter pylori (H.pylori) is a bacterium that causes chronic inflammation of the inner lining of the stomach. H.pylori can be acquired by ingesting contaminated food and water or from person –to-person contact. It is also the most common cause of ulcers in the stomach and/or the small intestine. Medications are available to eradicate this bacterium. H.pylori is also associated with stomach cancer and MALT lymphomas.
INFLAMMATORY BOWEL DISEASE
Crohn’s Disease and Ulcerative Colitis are the two chronic disorders that comprise inflammatory bowel disease. Both cause the intestines to become irritated and inflamed. In Ulcerative Colitis, ulcers are commonly found in the lower section of the large intestine and rectum. Crohn’s disease usually affects the small intestine and parts of the large intestine. Crohn’s causes inflammation that extends much deeper into the intestinal wall, as opposed to Ulcerative Colitis which only affects the lining of the intestine. Bothproblems can cause abdominal cramping, diarrhea, bleeding and weight loss. Left untreated, inflammatory bowel disease can lead to more serious problems.
IRRITABLE BOWEL DISEASE
Irritable Bowel Disease (IBS) is a common disorder that affects the large intestine. Unlike inflammatory bowel disease, it does not cause inflammation, ulcers or permanent damage to the intestine. IBS symptoms include abdominal cramping, bloating, diarrhea and constipation. These symptoms can be controlled by managing lifestyle, diet, stress and when indicated, with medications.
LACTOSE INTOLERANCE
This is the inability to digest and absorb lactose, a sugar found in milk and milk products. Lactose intolerance occurs when there is either a deficiency or reduced activity of lactase, an enzyme produced by the small intestine that breaks down lactose for absorption. When lactose intolerance is present, cramping, gas, bloating and diarrhea usually occur following the ingestion of dairy products
PANCREATITIS
The pancreas is a large gland located behind the stomach that is responsible for secreting digestive enzymes (needed to help digest food) and for producing insulin and glucagon (needed to help regulate glucose or sugar in our system). When the pancreas becomes inflamed, the condition is known as pancreatitis. Pancreatitis can either be acute or chronic. Either form can be serious and lead to more severe complications. Common causes of pancreatitis include gallstones, excessive alcohol use, infections, certain medications, autoimmune and hereditary disorders and ulcers. Symptoms include fever, abdominal pain, nausea, vomiting and changes in stool.
POLYPS
These are abnormal growths of tissue that project from the lining of some organs such as the stomach or the colon (intestines). Polyps can be benign (non-cancerous), pre-cancerous (high likelihood of turning into cancer) or cancerous. The medical procedure for removing polyps is called a polypectomy.
SMALL BOWEL BACTERIAL OVERGROWTH
While a small amount of bacteria in the small intestine is normal, an increased amount can cause a problem with the absorption of food and nutrients. Some medications or slow movement of food through the intestine can cause the amount of bacteria to increase. Common symptoms of bacterial overgrowth include abdominal pain, bloating, gas and diarrhea.
STRICTURES
A stricture is a narrowing of a hollow organ such as your esophagus or colon. Strictures can be temporary or permanent. Some causes of strictures are inflammation, pressure, or scarring. In some instances, doctors can stretch the narrowing through a procedure called dilation.
ULCERS
An ulcer is an erosion in the protective lining of the wall of the esophagus, stomach or small intestine. Depending on its location, an ulcer can be caused by excessive stomach acid, H.pylori bacteria, excessive alcohol, daily or very frequent use of aspirin, ibuprofen or other blood-thinning medications, and smoking. Depending on the location of the ulcer, symptoms may include burning or gnawing feeling in the upper abdomen, heartburn, blood in the stool or when vomiting, and anemia.
DIAGNOSTIC AND THERAPEUTIC PROCEDURES
Our physicians are highly proficient in the performance of the specialized procedures associated with diagnosing and treating problems with your digestive system. Depending on the type of procedure, your insurance plan benefits and your personal preference, the following procedures can be performed in our office, our endoscopy center (Teaneck Gastroenterology and Endoscopy Center) or in one of the hospitals that our physicians retain privileges; e.g.. Holy Name Medical Center, and Englewood Hospital and Medical Center.
The following are some of the procedures commonly performed in the specialty of gastroenterology to help diagnose or treat a GI-related condition:
ABDOMINAL ULTRASOUND
This test examines the organs and other structures of the upper abdomen by using reflected sound waves to create a picture. It can be used to provide a detailed evaluation of the abdominal aorta, liver, gallbladder, spleen, pancreas and kidneys.
BACTERIAL OVERGROWTH TESTING
An easy test to determine if there is an overgrowth of bacteria in the small intestine. A baseline breath sample is taken at the beginning of the test. After a period of fasting (12 hours) a lactulose drink is administered and a follow-up breath sample is taken 30 minutes later and then every 15 minutes for the next 90 minutes.
BIOPSY
A biopsy is diagnostic tool for determining the presence of disease or to identify possible causes for symptoms. It involves the removal of a piece of tissue from the patient which is then sent to a laboratory for analysis. In the laboratory, a pathologist examines the tissue under a microscope and determines if the tissue is healthy (benign) or if it shows a disease or abnormality.
ENDOSCOPIC ULTRASOUND (EUS)
This test combines endoscopy (the use of a lighted tube) and ultrasound (the use of sound waves) to obtain images and information about the digestive tract and specific organs such as the liver, gallbladder, pancreas and aorta. An EUS can also allow the physician to perform a fine needle aspiration (FNA) and obtain samples of enlarged lymph nodes and / or tumors.
ESOPHAGEAL DILATION
This is a procedure to help stretch (dilate) a narrowed area of the esophagus (food pipe) The narrowed area is called a stricture . Common causes of narrowing are scarring acid reflux disease, radiation therapy and cancer.
FLEXIBLE SIGMOIDOSCOPY
An examination of the lower part of the large intestine only (rectum, sigmoid and descending colon) using a flexible sigmoidoscope or colonoscope. This procedure is useful in identifying bleeding sites, tumors and inflammation.
H. PYLORI (HELICOBACTER PYLORI) BREATH TEST
A noninvasive and nonradioactive breath test that can be used to diagnose, monitor and ensure that an H. Pylori infection has been cured.
HEMORRHDIAL BANDING
This procedure is a non-surgical method of removing hemorrhoids. It entails the application of a band at the base of the hemorrhoid which stops the blood supply to that area, causing the hemorrhoid to shrivel and die.
LACTOSE BREATH TESTING
An easy test to determine the presence of lactose intolerance. A baseline breath sample is taken on day one of testing. The next day (or at the patient’s convenience) an additional breath sample is obtained after a period of fasting (12 hours) and the ingestion of a glass of milk.
POLYPECTOMY
A polypectomy is a medical procedure for the removal of polyps. Polyps are abnormal growths of tissue that can be found in the stomach or colon. Once they are removed, they are sent to the laboratory for analysis. Polyps can be benign (no cancer), pre-cancerous (can turn into cancer if not removed) or cancerous.
SMALL BOWEL CAPSULE ENDOSCOPY
Capsule endoscopy is a technology that uses a swallowed video capsule to take pictures of the esophagus (food pipe), stomach and small intestine. This test is useful in diagnosing bleeding caused by abnormal collections of blood vessels, lymphomas and Crohn’s Disease (a chronic inflammatory bowel disease involving the intestine).
THERAPEUTIC ENDOSCOPIC RETROGRADE CHOLANGIO PANCREATOGRAPHY( ERCP)
A test that examines the tubes that drain the liver, gallbladder and pancreas by using a lighted tube and x-ray. The doctor can take biopsies, remove gallstones and / or place stents into narrowed ducts to enlarge them and promote drainage.