Making a Diagnosis
One of the first things a gastroenterologist will ask about is what you’ve been eating and what causes your symptoms to flare up.
"For me, the most important thing is the history--figuring out whether the symptoms are related to diet [or] a particular kind of food. Does food make it better or worse?" says Dr. Dionisio.
“Fleshing out a history can give a good idea of what is most likely going on."
The next most important step is determining if the GI issue is organic, such as an ulcer, or functional, such as irritable bowel syndrome (IBS), says Dr. Dionisio.
"With an organic disorder you will find one or more biochemical and structural abnormalities, such as an elevated blood count or a tumor on the colon," says Dr. Calcagno. "On the other hand, functional disorders can be very complex and rely more on eliminating other problems to find a diagnosis."
Organic disorders include ulcers, ulcerative colitis, Crohn's disease and celiac disease, while functional disorders cover IBS, gastroesophageal reflux disease (GERD) and other conditions where no structural abnormality can be seen.
Unless the symptoms are particularly worrisome—such as unintentional weight loss or bleeding—most physicians will try to start with the least invasive treatments, such as lifestyle modification or medications.
Dr. Polintan recommends eating yogurt with active cultures or taking lactobacillus capsules, consuming smaller, more frequent meals, drinking plenty of fluids and eating a diet heavy in fruits and vegetables. Processed foods, saturated fats and simple sugars should be avoided because they can cause some of the stomach symptoms that send people to a GI specialist, such as gas and bloating. Sometimes, though, lifestyle modifications can be the toughest medicine of all, says Dr. Polintan.
"Many gastrointestinal problems are associated with the issue of obesity and poor eating habits," says Dr. Yang. "But getting people to make [lifestyle] changes over the long term is very difficult. They may even start eating right and try reducing stress for a couple of weeks and feel better, but then they go on vacation and go crazy and are back in the office having the same symptoms again. People want a pill that will make them feel fine no matter what they do, but that's not a long-term solution."
Pinning Down the Problem
When lifestyle changes aren't enough, there are a number of tools at a gastroenterologist's disposal to diagnose GI problems, including endoscopies to view the GI tract and sonograms to look at the liver and gallbladder. Blood tests can also be performed to look for results that may indicate a gastrointestinal issue.
Colonoscopy is probably the most commonly performed GI-related procedure, with a baseline screening recommended for everyone over age 50. Dr. Dionisio says sometimes it can be a struggle to get women to come in for this simple screening.
"I don't know why it is, but women don't seem to think they need a colonoscopy even though they may urge their partner to get one," says Dr. Dionisio.
"Women need to know that colon cancer is distributed evenly between men and women, and it's just as important for them to be proactive in preventing this highly preventable cancer," says Dr. Dionisio.
Ongoing symptoms that may warrant an appointment with a gastroenterologist include:
- changes in stool shape or bowel habits
- abdominal cramps
- frequent heartburn
- weight loss
- upper or lower abdominal pain
Paula Dionisio, MD
Dr. Paula Dionisio, a Pueblo native and graduate of Central High School, graduated magna cum laude from the University of Notre Dame in 3 years before attending Georgetown University School of Medicine. Dr. Dionisio then completed her Internal Medicine Residency and Gastroenterology Fellowship at the esteemed Mayo Clinic.
Lirio S. Polintan, MD
Specialties: Gastroenterology and Internal Medicine
Dr. Lirio S. Polintan has been practicing in Pueblo since 1981. Dr. Polintan is Board Certified in Internal Medicine and Gastroenterology and is a Fellow of the American College of Physicians; American College of Gastroenterology, and American Gastroenterological Association. He is also a member of the American Society of Gastrointestinal Endoscopy.
Charles Ruzkowski, MD
Dr. Chuck Ruzkowski attended Chicago Medical School, Loyola University Medical Center, and the University of Arizona. He has held academic appointments at the University of Arizona and the University of Iowa. He is Board Certified in Internal Medicine and Gastroenterology and has over 15 years of endoscocpic and practice experience.
Barbara Niven, PA-C
Barbara Niven is a certifed Physician Assistant with extensive experience in caring for patients with gastroenterology disorders. She has a special focus on treating patients diagnosed with Hepatitis-C and helping them to understand their treatment options and pathways.