Gastroenterology Information Center Feature Archive

Case Study: Abdominal pain, distention, and constipation

Case Study: Abdominal pain, distention, and constipation

A 64-year-old man presents to the emergency department with abdominal pain and distention, as well as constipation of 8 days' duration.

An unusual pelvic mass in a 43-year-old woman

An unusual pelvic mass in a 43-year-old woman

A woman who is in generally good health presents with a visibly enlarged abdomen with left-sided dominance and increased pelvic pressure that had worsened.

An unusual cause 
of respiratory distress in an infant

An unusual cause 
of respiratory distress in an infant

A congenital condition is found in an infant with respiratory and gastrointestinal symptoms.

Odorous stools, laboratory abnormalities after gastric bypass surgery

Odorous stools, laboratory abnormalities after gastric bypass surgery

A patient comes to her yearly nutrition check-up 11 years after undergoing gastric bypass surgery with reports of loose stools with significant odor several times per day.

Crohn disease: diagnosis and treatment

Crohn disease: diagnosis and treatment

A condition prone to recurrence, Crohn disease has a complicated presentation and pathophysiology, but multiple treatment options are available.

Probiotics in clinical practice

Probiotics in clinical practice

Probiotics may be beneficial for antibiotic-associated diarrhea, digestive symptoms, necrotizing enterocolitis, respiratory tract infections, and other health conditions.

OTC and herbal 
treatment of upper
 and lower GI problems

OTC and herbal 
treatment of upper
 and lower GI problems

A wide array of OTC and herbal products can help treat patients with GI issues.

Soothing coughs and sore throats with marshmallow

Soothing coughs and sore throats with marshmallow

The leaves and roots of the marshmallow plant can be used as an antitussive and for sore throat relief.

Managing anal fissures

Managing anal fissures

Anal fissures can be confused with hemorrhoids in everyday primary practice but require their own treatment protocol.

Abdominal cramping, foreign body in 
the stool of a child

Abdominal cramping, foreign body in 
the stool of a child

A child presents to the emergency department with a seven-inch live 
worm in his stool.

When abdominal pain is not appendicitis

When abdominal pain is not appendicitis

Clinicians might need to consider an uncommon array of causes when faced with a pediatric patient suffering from abdominal ailments.

Think broadly to diagnose the cause of chronic abdominal pain

Think broadly to diagnose the cause of chronic abdominal pain

When diagnosing the cause of chronic abdominal pain, a more specific history and a broad consideration of causes can help with diagnosis.

Untreated ischemia in limb leads to negligence lawsuit

Untreated ischemia in limb leads to negligence lawsuit

Clinicians missed several opportunities to advocate for their patient, leading to the loss of a leg.

Progressive difficulties swallowing indicated more than 'just heartburn'

Progressive difficulties swallowing indicated more than 'just heartburn'

Extensive food allergy testing revealed that a patient's difficulty swallowing was caused by foods common in her diet.

Antibiotics may suffice in appendicitis

Antibiotics may suffice in appendicitis

More than 80,000 children undergo appendectomies each year.

Steroid dose increase after CRS unnecessary to prevent hypotension

Steroid dose increase after CRS unnecessary to prevent hypotension

No difference in hypotension between low-, high-dose steroids for IBD patients undergoing major colorectal surgery.

The challenges of identifying 
Prader-Willi syndrome

The challenges of identifying 
Prader-Willi syndrome

Children with this condition develop an insatiable appetite that leads to obesity, diabetes, hypertension, and behavioral problems when not treated.

Dietary adjustments to control Hashimoto disease

Dietary adjustments to control Hashimoto disease

Are there any studies that support eliminating foods like sugar, milk and wheat to improve Hashimoto disease symptoms?

Identifying the cause of bilateral ear pain

Identifying the cause of bilateral ear pain

Consider unusual causes of chronic or recurrent ear pain.

Recurring GI symptoms following winter fever and cough

Recurring GI symptoms following winter fever and cough

A young man presents with constant periumbilical pain, extreme weakness, anorexia, nausea, constipation, and orthostasis.

Marigold: Calendula may help mitigate dermatitis, other ailments

Marigold: Calendula may help mitigate dermatitis, other ailments

Medicinal properties of marigold-derived compounds include antiviral, anti-inflammatory and antitumor effects.

Evaluating and managing 
pediatric food allergy

Evaluating and managing 
pediatric food allergy

An approach involving primary-care clinicians, and specialists — including 
allergists, gastroenterologists, nutritionists and counselors — is crucial.

Preventing diarrhea after esophageal reconstruction

Advising patients to take OTC antidiarrheal medications at specific times in relation to when they eat their meals can help reduce the number of bowel movements.

Diagnosing nonalcoholic fatty liver disease

Nonalcoholic fatty liver disease (NAFLD) is rapidly emerging as one of the most common "incidental findings" identified with radiographic testing. One in four adults is found to have the condition when undergoing abdominal ultrasound.

Can too much fish oil lead to GERD?

Is there any indication that taking too much fish oil — particularly green-lipped mussel oil — can cause stomach problems in a person with a history of gastroesophageal reflux disease?

Mysterious stomach pain when coughing

Could a liver infarct be the cause of a patient's dull, intermittent pain in the right-upper-quadrant? Or is something else to blame?

Treating chronic esophageal reflux

What treatment options are available for chronic esophageal reflux? Is surgery ever preferable to long-term treatment with a proton-pump inhibitor?

Puzzling GI upset in a teenager

Esophagogastroduodenoscopy, colonoscopy, complement fixation, celiac, sonogram, gynecologic workup and routine labs have all been negative in a teen with a three-year history of recurrent chronic abdominal pain and diarrhea. What steps should be taken next?

Recurrent bouts of biliary colic

A gastroenterologist and surgeon have recommended cholecystectomy for a patient with recurrent biliary colic and a 3% biliary ejection fraction on CCK-HIDA scan. Is this advisable?

Reflux rebound after stopping PPI therapy

What is the likelihood of acid-reflux rebound in a patient stopping a proton-pump inhibitor (PPI) (pantoprazole [Protonix]) after taking the medication for one month or more?

Which radiologic test to use for abdominal pain

How do I know which radiologic tests to choose when evaluating abdominal pain?

Can a gluten-free diet tame inflammation?

Is there a connection between celiac disease (CD) and inflammation?

Avoiding reflux when stopping PPIs

Can patients be weaned from proton pump inhibitors without causing a reflux flare?

What to do after a positive FOBT

Should a man with a positive fecal occult blood test and a normal colonscopy without GI symptoms be referred to a gastroenterologist?

GI referral in a woman with iron-deficiency anemia

When should a menstruating woman with iron-deficiency anemia be referred for GI workup?

Diagnosis and management of celiac disease in adults

Diagnosis and management of celiac disease in adults

As this condition becomes more prevalent in primary care, clinicians need to emphasize the importance of lifelong adherence to a gluten-free diet.

What is causing this patient's syncope and abdominal symptoms?

A white woman aged 53 years has had several episodes of syncope that start with nausea, abdominal cramping, and, often, an urge to defecate.

Aspirin use in a patient at high risk for GI bleed

What treatment would you recommend for this patient at high risk for a recurrent cardiac event?

Immigrant refuses appendicitis care

Language barriers and financial concerns could have had fatal results, but an insistent nurse prevailed.

A common symptom turns deadly

A common symptom turns deadly

Was the clinician negligent for allowing a patient with recurrent diarrhea to delay his follow-up appointment?

Imaging options for patients with acute abdominal pain

Imaging options for patients with acute abdominal pain

Each of the three primary modalities—plain films, diagnostic ultrasound, and CT scan—must be weighed against their strengths and weaknesses.

Who should be screened for celiac disease?

How reliable are antigliadin serology tests?

How long can a patient with GERD take a PPI?

Is there a limit to how long a patient with GERD symptoms can be treated with a proton pump inhibitor?

Noncapsule forms of bifidobacteria

Where can I find find a liquid bifidobacteria supplement?

Another look at GERD treatment

Tolerability is often confused with long-term safety.

Mixing NSAIDs with antiplatelet therapy

Mixing NSAIDs with antiplatelet therapy

Combining these agents may compound GI complications. New guidelines help primary-care clinicians identify and protect patients most at risk.

Irritable bowel syndrome made simple

Irritable bowel syndrome made simple

The authors place particular emphasis on the IBS's status as a true disease as opposed to a figment of the patient's imagination.

Practical guidelines for managing GERD

Practical guidelines for managing GERD

Start with antisecretory drugs, i.e., proton-pump inhibitors, then make medication, dosage, and lifestyle changes to suit the individual patient.

Early recognition of atypical celiac disease

Early recognition of atypical celiac disease

Celiac disease doesn't look the way you might expect. A new position statement and technical review from the American Gastroenterological Association provide updated guidelines.

Methylnaltrexone may relieve opioid-induced constipation

Compared with placebo, methylnaltrexone yielded a higher rate of bowel movement without laxative within four hours of first dose, within four hours after two or more of the first four doses, within four hours after four or more of the first seven doses, and after one or more of seven doses.

Biliary dyskinesia

Speeding through history

Mr. B, a 34-year-old physician assistant, was having another frenetic day in the gastroenterology clinic, and he was not happy. When he had taken the job a year ago, he had hoped it would...

Anemia in a patient previously treated for renal insufficiency

Anemia in a patient previously treated for renal insufficiency

Two months after moving to the United States from Egypt, 67-year-old Mr. A presented to the emergency department with moderate shortness of breath that worsened on...

Choosing the best test for colon cancer

There are five to select from, and each has its advantages and drawbacks. Two physician specialist help you sort through the options

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