What organs do colonoscopy see?

7 Signs It’s Time to See a Gastroenterologist

If you have unexplained or frequent digestive issues, such as abdominal discomfort or changes to your bowel habits, someone’s probably told you to see a gastroenterologist, also sometimes referred to as a GI doctor.

But if you’ve never seen a gastroenterologist before, you may be unsure whether your digestive symptoms really warrant seeing a specialist. You might even be wondering: What is a gastroenterologist?

Dr. Kerri Glassner, a gastroenterologist at Houston Methodist, explains everything you need to know if you’re deciding whether it’s time to see one, including what to expect at your first appointment.

What does a gastroenterologist do?

A gastroenterologist is a specialist with expertise in the disorders and diseases that affect the digestive system — which includes the gastrointestinal tract (esophagus, stomach, small intestine, large intestine, rectum and anus) as well as the pancreas, liver, bile ducts and gallbladder.

The digestive disorders and issues that a gastroenterologist treats include:

• Unexplained changes in bowel habits, including diarrhea, constipation and blood in the stool
• Gastroesophageal reflux disease (GERD)
• Heartburn
• Hemorrhoids
• Inflammatory bowel disease (IBD), which includes Crohn’s disease and ulcerative colitis
• Irritable bowel syndrome (IBS)
• Pancreatitis
• Ulcers

«Gastroenterologists are trained to perform a number of procedures used to help diagnose and treat these conditions, such as upper endoscopy, colonoscopy, biopsy and the various endoscopic techniques needed to visualize the digestive system, including endoscopic ultrasound,» explains Dr. Glassner.

When should you see a gastroenterologist?

Here are seven reasons to consider seeing a gastroenterologist:

1. Ongoing diarrhea

From food to infection to certain medications, many things can bring on a bout of diarrhea. However, if your stool is regularly more liquid than solid, it’s time to check in with a GI doctor.

«Chronic diarrhea can be an indication of a few different digestive disorders, including IBS, IBD or small bacterial overgrowth (SIBO),» says Dr. Glassner. «IBS is the most common cause of chronic diarrhea. Fortunately, there are many treatment avenues your doctor can use to help manage your symptoms.»

2. Constipation

The frequency of bowel movements ultimately varies from person to person, but Dr. Glassner says that less than three a week is typically considered constipation. You might also be constipated if your bowel movements are very small, very hard or difficult to pass.

If you’re constipated more weeks than not, consult a gastroenterologist.

«Constipation can have many causes and it can be hard to manage on your own at home,» says Dr. Glassner. «A GI specialist can help determine the likely cause of your constipation and recommend the lifestyle changes and medications that can help make your bowel movements more regular.»

3. Frequent or severe heartburn

Getting heartburn now and then shouldn’t be a matter of huge concern, and the good news is that occasional heartburn can typically be managed yourself at home.

But if you’re having heartburn symptoms more than a couple of times per week, it could be a sign of GERD — a condition that, over time, can damage and scar the lining of the esophagus.

«Chronic acid reflux doesn’t go away on its own, so it’s important to be evaluated by a specialist,» says Dr. Glassner. «Left untreated, GERD can cause permanent damage to the esophagus. This damage can lead to issues swallowing, cause painful ulcers and even increase a person’s risk of developing esophageal cancer.»

4. Feeling unusually bloated

Bloating, which can feel like your belly is full or tight, is often caused by issues that result in excess gas production, hypersensitivty to gas or gas being trapped in your colon.

«Constipation can cause bloating since the longer waste stays in your colon, the more likely it is to be fermented by resident bacteria, which creates gas,» explains Dr. Glassner. «But bloating can also be a sign of IBS, a food sensitivity such as lactose intolerance, SIBO (small intestinal bacterial overgrowth) or gastroparesis (partial paralysis of the stomach).»

A gastroenterologist can help you identify what exactly is the cause of your bloating and the most effective way to treat it.

5. Sudden or severe abdominal pain

We’ve all dealt with bellyaches, but severe abdominal pain that lasts for hours or abdominal pain that comes on suddenly and intensely isn’t normal.

«A stomach ulcer or peptic ulcer, which is a sore on the lining of your stomach or first part of your small intestine can lead to burning abdominal pain, particularly after eating,» says Dr. Glassner. «An untreated ulcer can cause swelling and scarring that blocks your digestive tract.»

Consistently severe abdominal pain can also be a sign of gallstones, pancreatitis or liver disease. A gastroenterologist can help determine the cause of your pain.

6. Rectal bleeding or blood in your stool

If you see blood on your toilet paper or as you flush the toilet, it could be hemorrhoids — a fairly common issue that can typically be managed with at-home remedies or over-the-counter products.

«However, if hemorrhoids aren’t responding to these treatments or you’re getting them frequently, a gastroenterologist can recommend more advanced treatments that can be help you get relief,» Dr. Glassner adds.

Additionally, don’t assume that blood in the toilet can only mean hemorrhoids.

«Any time you see blood in your stool or have rectal bleeding that is accompanied by changes in your bowel habits or to the color or consistency of your stool, it’s critical that you see a gastroenterologist,» warns Dr. Glassner. «Rectal bleeding isn’t always a huge concern, but it can be a sign of a serious medical condition such as colorectal cancer.»

7. You’re due for a colonoscopy

If you’re over the age of 45 or have a strong family history of colorectal cancer, you’ve probably heard your doctor recommend a colonoscopy.

«Most people begin having screening colonoscopies at age 45,» says Dr. Glassner. «From there, the frequency varies based on your results — but if the findings are normal and you have no other risk factors, you only need to repeat a colonoscopy every 10 years.»

And while a colonoscopy might sound uncomfortable, it can save your life. Early detection of colorectal cancer is important — when caught early, it can lead to less aggressive treatment and better chance of survival.

What happens at a gastroenterology appointment?

If you’ve noticed any of those seven signs, it’s time to consider scheduling an appointment with GI doctor.

At your first appointment, your gastroenterologist will:

• Ask you about your digestive symptoms and medical history
• Recommend any lifestyle changes or medications that can help relieve your symptoms
• Discuss any tests, screenings or procedures that may be needed

You may find it helpful to make a list of your symptoms before your appointment so that you don’t forget to ask about any of the issues you’re having.

«Through this initial evaluation, your doctor will start the process of uncovering the cause of your digestive issues and begin addressing your symptoms,» Dr. Glassner explains. «If your condition is chronic, he or she will also discuss how best to manage your condition over time. Your doctor may also talk to you about additional testing that may be needed if your symptoms don’t improve.»

What to Expect: Colonoscopy vs. Upper Endoscopy

A colonoscopy and upper endoscopy are two procedures performed frequently by gastroenterologists to view and examine various portions of your digestive tract. Colonoscopies inspect the large intestine (colon and rectum) while upper endoscopies observe the esophagus, stomach, and first part of the small intestine.

Colonoscopies and upper endoscopies may be utilized to:

• Screen for Cancers
• Investigate Symptoms
• Diagnose Gastrointestinal Diseases & Disorders
• Control Bleeding
• Extract Polyps, Foreign Objects, Tissue Samples for Biopsy

What to Expect: Colonoscopy

When to Get a Colonoscopy

You should have a serious conversation with your gastroenterologist at age 45. This milestone marks when those at average risk for colorectal cancer should consider screening, and a good way to do so is via a colonoscopy. Symptomatic or not, following this rule of thumb—getting a colonoscopy at age 45—provides the best chances for early (colorectal cancer) detection or, ideally, preventing cancerous developments, altogether.

Those with increased risk of cancer development, however, should be screened sooner than their 45th birthdays. Factors contributing to heightened risk of developing cancerous colorectal polyps include:

Note: African Americans are at heightened risk before age 45.

If you share any of these risks, ask your doctor about appropriate, cautionary next steps. You may also consult the American Cancer Society Guidelines on Screening and Surveillance for the Early Detection of Colorectal Adenomas and Cancer in People at Increased Risk or High Risk.

Bloody stool, chronic abdominal pain, and unintended weight loss are also grounds to contact your gastroenterologist to discuss whether a colonoscopy is warranted.

Before Colonoscopy: Two Steps for a Good Prep

1. 24 Hours Before Your Scheduled Procedure: Do not ingest any food or drink other than clear liquids.

2. Your Doctor will provide a laxative or cleansing solution before your procedure. Use these as directed to help clear your bowels for optimal visibility during the exam.

During Colonoscopy: The Procedure

• A colonoscopy is a relatively quick outpatient procedure; it takes just 15 to 20 minutes to complete, but can vary.
• The procedure entails the use of a colonoscope—a small tube with a light and camera attached—which enters the body via the rectum, and is advanced through to the colon.
• The patient routinely receives sedation/anesthesia to prevent discomfort during the procedure.
• The colonoscope’s camera projects images onto a viewing screen in the surgical area so your doctor can locate and identify any abnormal growths for removal. About 95% of cancerous and larger precancerous polyps can be detected with a colonoscopy.

After Colonoscopy: Now What?

• Once the examination has concluded, your doctor will review the results with you. Note: Biopsy results require more time.
• Due to the sedatives used during the procedure, patients are required to be escorted home from the surgical facility. Even if you feel alert or insist upon taking public transportation (not personally operating a vehicle), your judgement may still be impaired from the anesthesia, and you will not be permitted to leave the premises without an adult escort.
• It’s common to experience some cramping or bloating after a colonoscopy because gas enters the colon during the procedure. Passing gas should relieve the associated discomfort.
• Post-colonoscopy dietary and exercise restrictions will depend on exam results, but you’ll likely be able to eat solid food afterward.

What to Expect: Endoscopy

When to Get an Upper Endoscopy

While the main purpose of a colonoscopy is to determine colon health, an upper endoscopy provides visibility into the upper portion of your digestive system.

The range of coverage provided by an upper endoscopy includes:

• Esophagus
• Stomach
• Beginning of the Small Intestine (Duodenum)

Your doctor may suggest an upper endoscopy to investigate symptoms such as nausea, vomiting, abdominal tenderness, difficulty swallowing, or gastrointestinal bleeding. The findings of an upper endoscopy often include the keys to diagnosing and treating whatever it is causing a patient’s digestive discomfort.

Before Upper Endoscopy: EGD Prep Guide

• Preparation for an upper endoscopy (also known as an EGD, short for esophagogastroduodenoscopy ) requires you to abstain from food and drink for eight hours.
• There is no bowel prep solution involved in upper endoscopy preparation, however.
• The fasting period for an upper endoscopy may be shorter (four to eight hours) than for a colonoscopy (24 hours).
• Diabetics, smokers, and those on certain medications may be given additional instructions for upper endoscopy preparation.

During Upper Endoscopy: The Procedure

• Upper endoscopy patients are deeply sedated throughout, so there is no physical discomfort during the procedure.
• A gastroscope is an optical instrument similar to the aforementioned colonoscope, comprised of a small tube with a light and camera attached for image projection on a screen in the operating room. The tube enters the body via the mouth, and then is guided down through the esophagus, into the stomach and to the duodenum.
• Gastroscopes may be fixed with additional attachments to remedy certain afflictions, on the spot. For instance, your doctor may be able to stretch narrowed areas or even stop GI bleeding, as soon as the issue is identified.
• During an upper endoscopy, tissue samples may be collected for a biopsy to test for diseases and conditions, such as anemia or cancers affecting the digestive system.

After Upper Endoscopy: Getting Home

• Regarding anesthesia, the guidelines for post-procedure travel arrangements are the same for a colonoscopy. You’ll need an escort to accompany you on your way home.
• It is normal to feel gassy and/or to have a sore throat/pain swallowing in the days immediately following this procedure.

Colonoscopy for bowel cancer

A colonoscopy looks at the whole of the inside of your large bowel.

An endoscopist (a specially trained healthcare professional) uses a flexible tube called a colonoscope. The tube has a small light and camera at one end. The endoscopist puts the tube into your back passage and passes it along the bowel. They can see pictures of the inside of your bowel on a TV monitor.

Why you might have a colonoscopy

You might have a colonoscopy to:

• help find the cause of your bowel symptoms
• look for early signs of bowel cancer as part of the national screening programme, or if you are at high risk of bowel cancer
• monitor you after treatment for bowel cancer

Before your test

Your bowels need to be empty for a colonoscopy.

To do this you take medications (laxatives) to empty your bowel the day before your test. A laxative is a liquid bowel preparation.

After taking the laxatives you might need the toilet often and very suddenly. You might have some cramps. It is sensible to stay at home for a few hours after taking laxatives so that you are near a toilet.

The hospital might ask you to eat a low fibre diet for 1 or 2 days before the test. It is very important to drink plenty of clear fluids. This includes:

• water
• black tea or coffee
• squash (without red or purple colouring)
• clear soup

You should get written instructions before your test about what you need to do.

Contact the hospital for advice if you are diabetic or taking regular medication. You might need to stop some medicines before your test.

What happens

You usually have a colonoscopy as an outpatient in the endoscopy department at the hospital.

Before the procedure you’ll see your endoscopist. They’ll explain the procedure to you and ask you to sign a consent form. This is a good time to ask any questions you may have.

You wear a hospital gown and might also wear paper shorts with an opening at the back.

You’re offered painkillers and a medicine to relax you, these make you drowsy (sedation). You have these as injections into a small tube (cannula) in your vein. Some hospitals use gas and air (Entonox). This is a fast acting pain relief that you breathe in through a mouth piece.

You lie on your left side with your knees drawn up towards your chest. The colonoscope goes into your back passage (rectum) and passes into your bowel. The tube bends easily so it can pass around the curves in your bowel.

The endoscopist puts a small amount of gas is put into your bowel to help see all the bowel lining.

The endoscopist may press on your stomach or change your position to help the tube pass through your bowel.

During the test they take photographs of your bowel lining. And the endoscopist can remove tissue samples (biopsies). If they see any growths (polyps) they remove them with a wire loop put down the colonoscope. You might also have a dye sprayed onto the lining of the bowel to show up any abnormal areas. This is called chromoscopy.

Colonoscopies can be uncomfortable but shouldn’t be painful.