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Abdominal bloating:What can you do to improve?

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“Abdominal bloating every day doctor. I can’t find relief, I’ve done three diets and I don’t know what to eat. I’m afraid of having something wrong “

This surely sounds familiar to you if you suffer from this problem and that’s why I’m going to tell you today about bloating

What is abdominal bloating

Abdominal bloating is the feeling of bloating, fullness, or heaviness in the abdomen. It may or may not be accompanied by an increase in the diameter of the abdomen. Some patients tell me: I feel like a balloon or like I’m pregnant. For all people, the sensation or location may be different, but what is common is that it greatly affects the quality of life. Sometimes bloating comes alone but sometimes it accompanied by problems such as constipation or chronic diarrhea, bowel syndrome irritable or functional dyspepsia.

Abdominal bloating

Pixabay photo

What causes abdominal bloating

There are many causes of bloating such as:

Small Intestinal Bacterial overgrowth SIBO:

It is the increase in the number of bacteria in the small intestine. When this happens, the carbohydrates that pass through this organ are fermented by these bacteria, producing more gas and distension of the intestine wall. See my post about SIBO

Carbohydrate Malabsorption:

It may happen that carbohydrates are not absorbed properly in the small intestine or that, even if this is done well, they are not adequately tolerated. The most common is malabsorption or intolerance to lactose and fructose

Abnormal movement of the digestive tube:

Slower or abnormal movement of the walls of the digestive tract can cause abdominal distention. An example is these diseases: Gastroparesis, Diabetes, chronic constipation or use of medications

Malfunction of the pelvic floor:

When there is weakness or incoordination in these muscles, there may be an inability to expel gas or fecal matter and increase the sensation of distension.

Digestive hypersensitivity:

Nerve endings in the small intestine can cause normal stimuli or activities to be perceived more intensely. May be related to changes in mood

Organic diseases:

Don’t panic but it could be due to abnormal fluid in the abdomen (Ascites) or other problems within your abdomen

Diaphragm incoordination

Under normal conditions, our body accommodates the gas by relaxing the diaphragm (it takes it up) and contracting the muscles of the abdominal wall. In some people, this pattern is reversed and in this case the diaphragm contracts, that is, it goes down and the abdominal muscles relax, which causes obvious distension.

How to diagnose the cause of abdominal bloating

There are many tests that help me identify the source of bloating. Some of these are:

Carbohydrate malabsorption breath tests:

It safely and non-invasively measures whether a carbohydrate such as fructose or lactose is not properly digested. When these are not absorbed by the small intestine, they pass undigested to the colon and are degraded by the bacteria that exist there, increasing the amount of hydrogen gas which can be measured with the breath test.

SIBO Breath test:

The test is performed by administering lactulose and when it is positive it is necessary to study what is producing it. See my article on SIBO

Upper gastrointestinal endoscopy:

Useful to rule out obstruction to the passage of food through the stomach or to take biopsies in the intestine and thus know if there is inflammation that suggests celiac disease or other inflammatory problems of the small intestine.

Total Colonoscopy:

It is necessary to rule out colon cancer or in the evaluation of constipation and chronic diarrhea. In this exam we can also evaluate the functioning of the pelvic floor.

Ultrasound of the abdomen:

It is used to rule out if there is fluid in the abdomen (Ascites), tumors or problems in the ovaries or liver.

Other tests:

According to the symptoms that predominate, I can also request a gastric emptying scintigraphy to rule out gastroparesis or laboratory tests such as calprotectin or tests for celiac disease, among others.

How am I going to help you?

The causes of abdominal distention are multiple and that is why there is no single intervention for all people. The treatment is aimed at improving the discomfort and, if possible, correcting the root of the problem.

I will help you find the solution to this problem in the following way:

I will listen to you and request the tests that I consider most appropriate to find out what is happening to you.

To improve your symptoms I will give you some special recommendations for you and if you need it you can start a medication. My idea is that you do not restrict yourself in food. You don’t have to stay on bread and water for your distension to improve

If you have abdominal distention I will help you find the solution to this problem. Schedule your appointment for Consultation / Endoscopy / Colonoscopy here: http://wa.me/573207571313

Learn more at http://endoscopyycolonoscopy.com

Cheers,

Mauricio González Hernández

Your Gastroenterologist in Medellín

Video Capsule Colonoscopy: If you are afraid of colonoscopy

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Colonoscopy with capsule endoscopy is an exam that records a video of the interior of the colon, allowing prevention and diagnosis of diseases of this organ without having to perform a normal colonoscopy or administer sedation.

It is an effective, very low-risk exam that also allows you to see the esophagus, stomach and the entire small intestine (the entire digestive tube!). Watch my YouTube video on Capsule Endoscopy Colonoscopy

I recommend it for people who want non-invasive prevention, for those who need a colonoscopy because of their discomfort but are afraid to do it, or for those who have already had a colonoscopy but it was incomplete for anatomical reasons, such as many diverticula or with very difficult anatomy.

How the capsule Colonoscopy is done

Video Capsule Colonoscopy is a high-tech capsule or pill device that has two HD cameras on each side. It is PillCam brand and marketed by the multinational Medtronic.

Colon capsule

I am going to tell you the steps for a capsule colonoscopy procedure:

1️⃣ We program the day and time of your exam. We separate the input which will be exclusive to you and we will explain what is the exam preparation   Schedule your appointment here

2️⃣The night before and the morning of the exam you will take laxatives so that the intestines are very clean and the best images can be taken.

3️⃣You come to our center and sign the consent of the exam

4️⃣My assistant Catalina or Marcela put a wide belt over your clothes, in which a tape recorder data and very thin cables

Belt capsule colonoscopy

5️⃣Open the PillCam COLON 2 capsule case. Doing so will activate and start recording.

6️⃣ You take the capsule with a glass of water.

This is very small, it measures about 3 centimeters and you can easily pass it despite the impression it gives you.

Colon Capsule size

The capsule starts recording a video of the digestive tract and sends the data to the recorder. You will walk about twenty minutes and then return. You will be in my company for a while until we give note that the capsule has passed from the stomach to the small intestine. We do this by looking at the small screen of the data recorder. This may take a few minutes but sometimes it takes a little longer

7️⃣ After it has reached the small intestine you will take a small dose of a laxative (Usually travad) to accelerate the passage of the device through the intestines and to improve the preparation. Once this is done we will tell you what you can eat and when to start.

You will go home or work and return when you feel that the capsule fell to the toilet or at a fixed time that we agreed. Sometimes you will have to take a second dose of oral travad. While the capsule completes the exam you can continue with your normal life taking care that it does not come loose or let go of the belt or tape recorder. It will take care that these are not going to hit or lose. The entire route of the capsule on average takes about 5 hours but there are patients who expel it in 2 or 3 hours

8️⃣ When you return we will remove everything. We download the information to a computer so that I can carefully review and make the report which is usually within 48 hours.

Advantages of Video Capsule Colonoscopy

✅Non Invasive: You are not going to see a needle or have a colonoscope inserted. In the colon by enema they have  you than introduce a contrast through the anus and without sedation. In the case of CT colonoscopy you have to apply contrast and you have to enter the tomograph or the resonator which can cause claustrophobia

✅ No risks: You will avoid the risks of sedation and colonoscopy. It is recommended in people who are delicate health or are many years old

✅ Reliable: Colonoscopy is the most recommended for prevention and diagnosis of colon diseases but when this cannot be done, the most advisable thing is to do a capsule colonoscopy because you can see directly inside this organ. It is more reliable than other tests such as the enema colon, the CT or MRI colonoscopy

✅ More complete: In addition to the colon we will examine the small intestine which is an organ of about 8 meters that very few people have the possibility to be examined and where there can also be diseases that are not they could detect by other diagnostic tests.

✅ You will have a diagnosis despite fear.

Disadvantages

*You have to take laxatives. It is necessary for the intestines to be clean and the chambers to have the better  pictures. If you choose another diagnostic method you also need to prepare with laxatives and even apply enemas for the anus

* It´s impossible to take biopsies or remove a polyp. This is a disadvantage that the enema shares with the colon, the MRI or CT colonoscopy

* There is a small chance that passage through the intestines will take a long time and the colon inspection before the capsule battery runs out which is about 15 hours

What other indications have?

❇️ Your Colonoscopy was incomplete. It happens many times because of the anatomy of the colon that prevents the colonoscope from advancing. In these cases it is preferable to avoid complications

❇️ You had a colonoscopy complication in the past, such as a perforation. I think few have lived this experience they would be willing to repeat the colonoscopy

❇️ There are risks for sedation or examination

❇️Non-invasive prevention of colon and small intestine cancer

Schedule your appointment for capsule colonoscopy in this link. Here we will give you more information and we will tell you how is the preparation for the procedure. Continue to learn more about my services at  https://endoscopiaycolonoscopia.com

Cheers,

Mauricio González Hernández

Your Gastroenterologist in Medellín

Online Consultation with Gastroenterologist

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Do you consult online with your Gastroenterologist? What is that and who benefits from it?

In recent months I have heard many times:

“What I need is for a specialist to examine me”

I’m tired and bored of virtual

Don’t worry, doctor, I travel to have my tests checked.

Although the ideal is a face-to-face appointment, the pandemic taught us that there are times and occasions when a good virtual appointment can be made and that is what I am going to talk about next.

How is the online consultation with the Gastroenterologist

A video consultation is very similar to what I do in my face-to-face consultation. We are going to communicate through Zoom and you are going to tell me what is happening to you, your concerns and worries or what you have done so far. I am going to ask you the questions that I consider pertinent to make a diagnosis.

I will ask you about your personal and family history and if you are taking medications or have had tests done. What changes is that I am not going to examine you nor are we going to have that interaction that the face-to-face consultation gives.

However, what you tell is very valuable to make a diagnosis and propose the best recommendations so that your symptoms improve and know what is happening to you. The online consultation reminds me of my teachers at the National University of Colombia who told me:

“Mauricio, if after talking to your patient you don’t have a diagnosis, it is very unlikely that the physical exam will give it to you”

When we finish I will send you the formulation or the order of the exams that you need. Everything you tell me is stored in the digital medical record that we have enabled for our consultation and your data will be stored with the same responsibility that we do in the face-to-face consultation.

As you can see, it is a serious thing that even generates more work in logistics and development than the normal consultation.

Online consultation is a service that I have had in my portfolio for several years and during that time I have been able to help patients from other parts of Colombia or from other countries.

Online Consultation with Gastroenterologist

How is the procedure for the video consultation

1️⃣ Contact us by WhatsApp at this link http://wa.me/573207571313 or call us at (+57) 3207571313

2️⃣ Schedule the day and time of your appointment.

3️⃣ We will send you the QR code or the account number so that you can transfer the value of your query. Once this is verified you will receive the invitation to the appointment.

4️⃣ At the scheduled time we start the video consultation.

5️⃣ Your orders for exams or the medical formula will be sent to you by WhatsApp. If you need it, we will do a review video consultation or we will do it in person if necessary.

Who does an online consultation help?

After this crisis, online consultation has earned our trust or at least is more familiar. I recommend it in these cases:

You live far from Medellín but you want me to see you in consultation.

You plan to travel and want to make the consultation beforehand to find out if you require exams and be able to schedule them in a timely manner

Review exams or follow up on your discomfort. For example, I have patients who live in municipalities of Antioquia who spend between 2 and 8 hours in a car or bus to get to my office. They perfectly save this trip with a video consultation. We already know each other

You want to avoid traffic congestion or bad weather conditions.

Your work or your obligations prevent you from traveling but you need the consultation because you feel bad

You are abroad and you want me to give you an opinion about a result

I am very happy to have told you this. Schedule your appointment online here so that even in the distance I can help you find the solution to your digestive problems.

Get to know my services at https://endoscopiaycolonoscopia.com

Cheers,

Mauricio González Hernández

Your Gastroenterologist in Medellín

Endoscopy or Colonoscopy and the coronavirus

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The coronavirus and your Endoscopy or Colonoscopy. Today I want to tell you how the presence of this virus in the world affects your procedures or your consultation

Endoscopy and Coronavirus

What we know so far about the Coronavirus COVID 19

The main form of transmission is through drops of saliva and respiratory secretions.

Now that much of the population is vaccinated, the symptoms are milder and can be similar to a common flu. Other symptoms may be cough, fever, or fatigue.

Between 5 % and 50 % of infected people may present nausea, vomiting or diarrhea prior to the onset of fever and cough.

The genetic material of the virus has been found in the fecal matter of infected people, so it is suspected that there is also Fecal-Oral transmission.

This virus can spread even without symptoms, in what we call the prodromal phase, which lasts an average of 5 days (0 to 14 days).

People most likely to have severe disease are those over 60 years old, those with debilitating diseases or those who are not vaccinated.

Despite the fact that we have been freed from almost all restrictions, it is still important to wash your hands and wear a mask if you have flu symptoms or are in a health area

How Coronavirus affects my Upper endoscopy or Colonoscopy

1️⃣ There is a risk of infection:

An endoscopy or a colonoscopy are procedures in which there is a risk of transmitting the virus to patients and health personnel.

The risk is higher in upper gastrointestinal endoscopy because, even if it is done with sedation, there is a greater probability that aerosols of saliva or respiratory secretions will be expelled into the environment.

In addition, there is close contact between the patient and the health personnel (during the examination the distance between the patient and the doctor and the nurse is about 20 to 30 centimeters).

During colonoscopy, virus particles also come out with flatus and fecal matter.

In the informed consent, it will appear that there is a probability that you will become infected during the procedure or during the stay in the Endoscopy or Colonoscopy center. We are all vaccinated but we do not trust this invisible enemy

2️⃣Do not take the test if you are sick:

If you currently have a cough or an active respiratory infection (even if you think it’s just a cold), if you have been in contact with people infected with Coronavirus or if you suspect that you have the infection, schedule your Endoscopy or Colonoscopy for another date.

3️⃣Some habits of the pandemic continue

If possible, come with only one companion so that there are no crowds in the waiting room. When you go to the procedure room we will ask you to wash your hands and forearm

The person you came with will not go to the recovery room or the endoscopy room. Your gastroenterologist and their assistants will continue to wear masks during procedures

Online consultation with your Gastroenterologist

When you come to the consultation with your Gastroenterologist, you will see that some habits still continue:

You are going to see me with a mask, in a work uniform and when I examine you I am going to put on gloves.

When you leave my office, you will see that one of my assistants comes in to clean and disinfect surfaces and remove the cover from the stretcher.

We continue with the online consultation service (Video Consultation). In this we talk about everything as if you were with me in the office and there if you are going to see my face.

Learn more about the online consultation Here: https://endoscopiaycolonoscopia.com/online consultation with gastroenterologist/

Schedule your appointment for Endoscopy / Colonoscopy / Consultation in person or online at this link http://wa.me/573207571313 or on the phones ☎️ 60 4 3223087 or 3207571313.

Learn more about my services at https://endoscopiaycolonoscopia.com

Cheers,

Mauricio González Hernández 

Your Gastroenterologist in Medellín

IBS has a cure ?

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IBS has a cure doctor? My life is no longer the same, please help me! This is something I hear almost every day and it breaks my heart to see so much helplessness and anguish in people. In this article I will give you my perspective on some of the most common concerns regarding this topic

What are the symptoms of irritable bowel syndrome IBS?

As a Gastroenterologist, I make the diagnosis of irritable bowel syndrome or irritable colon when a person tells me that they have pain in their abdomen and that their stool has also changed in consistency (diarrhea, constipation or both) or that the number of times they are going to defecate is different than it was before

You don’t need to go to the bathroom 30 times to say it’s diarrhea. It is enough that the stool becomes soft or liquid even once or twice a day. Nor is it necessary for you to have a bowel movement every 8 days, only if it is difficult or unpleasant. These symptoms may be accompanied by distention in the abdomen, flatulence, sounds in the abdomen, weakness, headache, among others.

But be careful with what I just said: The discomfort must have been going on for more than three months, even if it is intermittent. If these symptoms appeared on you the weekend after a party, even if you feel like what I just wrote, it is not irritable colon. It is also not irritable colon that you only feel bloated or flatulence.

Why do I have this problem?

A lot of research has been done on this topic, but we still don’t have a concrete answer. We know that in people with irritable bowel there are several of these alterations:

There is greater sensitivity in the walls of the intestines and they move and work differently.

The intestinal flora (the bacteria that normally live in the intestines) is altered by the growth of unhealthy bacteria.

Our brain is connected to the digestive system through nerves, hormones and chemicals. When events such as stress, emotional trauma, states of anxiety or depression that affect our brain, it transmits signals to the intestines that increase their sensitivity.

Changes in digestive hormones change

A state of microscopic inflammation may exist.

Increased intestinal permeability (leaky gut)

Although medicine has tried to group the symptoms or possible causes under a single diagnosis, I believe that each person can have a different origin of the problem and that is why you can see that in the world there is no single or specific treatment.

IBS has a cure?

During all the years that I have seen patients with irritable bowel syndrome, I almost always hear the same story. They have visited clinics, hospitals, various famous doctors and there they are told:

You have an irritable bowel and that doesn’t heal, so get used to living sick.

You are too young to need an exam.

Your colonoscopy came back normal, so what you have is stress

If you have pain take antispasmodics, if you have diarrhea anti diarrhea, if you have constipation laxatives.

You have to remove meat, milk and dairy products, eggs, gluten, fruits and vegetables. The Nothing Diet

For me, irritable bowel syndrome is just an intermediate diagnosis. It’s just the reflection that something is wrong.

Even if you meet the criteria for irritable colon, keep this in mind so that you can find the solution to this problem:

You need tests to rule out other diseases that cause the same symptoms, but it is not always the colonoscopy

Normal exams don’t mean you don’t have anything. What you tell is always the most important

There are things that make us sick but are not diagnosed by an endoscopy, a colonoscopy, a CT or an MRI

Sometimes we ourselves get sick.

The cure may involve patience, faith, perseverance, and work for you. We always want things now, now, but it’s not always like that

So, IBS has a cure ? The answer is YES, as long as we discover and address the roots of the problem. There’s the Intringulis

What can cause my irritable bowel symptoms?

I’m just going to give you a few day-to-day examples. If what accompanies your pain is diarrhea, there are things we should always think about such as Crohn’s disease, ulcerative colitis, microscopic colitis, allergies in the intestines, celiac disease, overgrowth of bacteria in the small intestine, among other diseases.

If what predominates is that there is constipation, we must rule out, for example, problems with your pelvic floor, endometriosis, strictures or tumors in the intestines, altered intestinal flora, medications and other things.

The idea is not that you have to cross out all the possible diseases or take all the exams. Thinking about doing that can frustrate you. Simply let yourself be guided by your gastroenterologist

How can I help you?  Your IBS has a cure

I am going to listen to you so that I can use all my experience, intuition and knowledge to find out what is happening to you.

I will advise you the most appropriate exams or review the ones you already have. If we discover a cause of your problems, we will initiate the appropriate treatment.

I will guide your diet so that your nutritional status and quality of life are not altered. You don’t always need to restrict yourself and sometimes that’s something that only makes things worse.

Depending on your discomfort, I will recommend some medications or therapies so that your symptoms improve.

I will monitor your progress and we will evaluate together if you need adjustments. If you have lived with irritable bowel for a long time, we will seek in every way to improve and achieve our goal.

If you want to know if your IBS has a cure schedule your appointment with me so that we can start this journey.

You can do it by WhatsApp by clicking this link: http://wa.me/573207571313 or on the phones

☎️ 60 4 3223087 / 3207571313

Learn more about my Endoscopy and Colonoscopy Center at https://endoscopiaycolonoscopia.com/en/

I’ll wait for you!

Mauricio González Hernández 

Your Gastroenterologist in Medellin

 

Member of these societies

Asociación Colombiana de Gastroenterología
American society for gastrointestinal endoscopy
american gastroenterological association

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