What Your Doctor Doesn't (Have the Time to) Tell You: The Gastrointestinal System

By Jesse P Houghton

Have stomach, intestine, or liver problems? Unsatisfied with your doctor visits? Then this is a must-read!

 

Renowned Gastroenterologist Dr. Jesse Houghton takes the most common gastrointestinal symptoms and diseases, and breaks each of them down into digestible information and pearls of wisdom that all patients

• Language: English
• Publisher: Gastrodoc1
• Release date: May 18, 2023
• ISBN: 9798218179427

Jesse P Houghton

Dr. Jesse Houghton is a renowned gastroenterologist, being board-certified in both gastroenterology and internal medicine.He has worked tirelessly in these fields for over 15 years, taking care of patients with all forms of gastrointestinal and liver diseases.He has a passion for patient education and empowerment.When he isn't in the trenches taking care of his patients, he loves to spend time with his beautiful family, take care of his many plants,and travel the world.

Book preview

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Dr. Houghton is the physician friend you always wish you had. This is a very refreshing book for any patient dealing with symptoms or diagnoses related to the gastrointestinal system. Dr. Houghton, as a board-certified gastroenterologist with many years of experience, delivers what many doctors simply don’t have time for. His words jump off the page, talking to you the way a friend would, explaining both basics and nuances of conditions that can otherwise be terribly frustrating for many patients. And, as I tell my own patients, knowledge is power. This patient-friendly, easy to reference book will serve as a guiding light for many who are facing gastrointestinal conditions. As a physician and colleague of Dr. Houghton’s, I highly recommend this book.

Amit Mehta, MD,

CEO and Founder

Premier Hematology and Tele-Oncology Center, Cary, NC

Does acid reflux, heartburn, or indigestion wake you up in the middle of the night? Or do you suffer from any issues within your gastrointestinal (GI) system? Then this book is for you! Dr. Jesse Houghton, a renowned gastroenterologist, unveils straight-to-the-point facts about symptoms and the host of diseases that negatively impact the GI tract. This book explains complex medical concepts in layman’s terms, allowing readers to make more informed decisions about their health care. Dr. Houghton’s use of natural remedies, when appropriate, to provide patients with more treatment options, is one of my favorite aspects of this book. Get yourself a copy now!!!

Dr. Meshelle A. Lynch, DNP, MSN, APRN, CRNA, BSN, ADN, RN

CEO and founder, Lynch Anesthesia, LLC.

In this age of virtual insanity, rummaging through unreliable resources about one’s health on the internet becomes an inevitable habit that may come with serious risks.

Dr. Houghton’s book is a treasure trove of updated knowledge in Gastroenterology, specifically tailored to empower his readers to confidently take control of their conditions through strongly founded evidence-based information!

Tanya Escalona, MD, FACP, CMQ,

Immediate past Chief of Staff and Former Chief of Medicine,

Southern Ohio Medical Center, Portsmouth, OH

Assistant Program Director Apogee Hospitalist Group

Adjunct Clinical Assistant Professor of Internal Medicine,

The Ohio University Heritage College of Osteopathic Medicine

I am an anesthesiologist who has administered anesthesia to thousands of patients undergoing colonoscopy and EGD. I have also been a patient who has had both procedures multiple times. The topic of colon cancer screening concerns me in a personal way, because my father died of colon cancer in 1982 at the age of 76, before colon cancer screening was common. I believe that Dr. Houghton’s book will inform people about colon cancer screening options and GI diseases in general, while at the same time alleviating their fears, should they need these potentially life-saving procedures. 

Richard A. Richlan, M.D.

Director, Department of Anesthesia

Southern Ocean Medical Center, Manahawkin, NJ

All of the content provided in this book is for informational purposes only. As such, this book is not intended to be a substitute for independent professional medical judgment, advice, diagnosis, or treatment. Always consult with your personal doctor or medical provider and do not delay in seeking actual medical care because of information you have read in this book.

Copyright © 2023 Jesse P. Houghton

All rights reserved. No part of this publication may be reproduced, distributed, transmitted, or used in any form or manner without the express written permission of the publisher, except for brief quotations for a book review, and certain other non-commercial uses as permitted by copyright law.

ISBN: 978-0-578-27783-7 (paperback)

Cover and Interior design by KUHN Design Group | kuhndesigngroup.com

First printed in 2023.

Published by Gastrodoc1 Publishing, LLC

www.gastrodoc1.com

For my patients. For putting your trust in me to care for you and your family members. I hope this book gives just a little back.

Contents

Preface

What is the field of Gastroenterology?

Diseases of the Esophagus

Diseases of the Stomach

Diseases of the Small Intestine

Diseases of the Colon

Diseases of the Liver

Diseases of the Pancreas

Common gastrointestinal symptoms and possible causes

Other Interesting Topics

Medical Terminology

Preface

We all have been there at one time or another. You wait an hour (or longer) in your doctor’s office to see him or her and tell them your symptoms or problem. After watching an hour of TV, scrolling through your social media accounts on your phone, or flipping through magazines you would normally never read in the waiting room, the nurse finally opens the door or window and calls your name. Yes! It’s finally go time! I should be feeling better in no time, you think to yourself. I’m going to ask the doctor this question and tell her this, and she’s going to explain what is wrong with me and I’ll be feeling so much better, and so on. After another 20 minute wait in the exam room, the doctor finally opens the door and comes in to see you. So, what brings you here today? asks the doctor. Well, for the past few weeks … (insert the remainder of the discussion that you actually remembered to tell her/him; inevitably you left important information out). 10 minutes go by, your doctor tells you that this is probably what’s going on, hands you a prescription (or more likely electronically prescribes one), and says he’ll see you in one month. Wait… I forgot to tell her this. And what did she say about that pain I’m having here? I waited two hours for that?!

Well, I’m here to tell you that I understand your frustration. Hence, the writing of this book. We doctors are under more and more pressure to see more and more patients in a smaller and smaller amount of time. This has happened for various reasons, including ever-decreasing insurance payments, a lack of healthcare providers, an aging population, and increased healthcare utilization. I don’t know many doctors who are actually happy about this increased pressure to get patients in and out. I would love nothing more than to spend a half hour speaking with each of my patients, hearing about their day, their kids, and their recent trip. But, alas, that is just not feasible.

Ever since I started training in the field of gastroenterology (and even prior to that, during my internal medicine training), I have always looked up to my mentors and attendings (the name for a practicing doctor who teaches medical students and residents) who could communicate well with their patients. And by that, I don’t mean just rattle off innumerable medical terms in the face of their obviously confused patients and families. Rather, I wanted to be like my mentors who broke things down for their patients and left their patients truly understanding their conditions. They took the time to answer their patients’ and their families’ questions. When the doctor walked out of the room, the patients were more informed from the interaction, not more confused. Surprisingly, leaving a patient more informed as opposed to more confused, seems to be a rare phenomenon in the field of medicine. This seems to be especially true in the specialty fields. This became apparent as I completed training, and then as I began to practice and continue to practice for 15 years now. I made a pledge to myself early on that I would put just as much effort into explaining my patients’ conditions to them as I do in studying, learning, and performing procedures.

By putting my knowledge into a book that patients could easily understand and take in, I felt that I could create the ultimate patient outreach tool. I searched extensively online for books that were geared towards patients, but was surprised to find a lack of patient-centered books written by a physician. I have hence taken the most common questions that I receive from my patients on a daily basis, and have incorporated them into this book. Whether you have an advanced degree, or whether you stopped schooling after high school, my hope is that you gain useful knowledge from this book, and that your life is improved in some way after reading it. If you learn and laugh here and there (after all, we can laugh while we learn; learning doesn’t have to be all serious business), even better.

This book was not meant to be an exhaustive source for all available information on every gastrointestinal disease. Such an endeavor would be nearly impossible to fit into a single book, not to mention not the aim of this author. Rather, my goal is to provide an understandable, relatable, and practical source for patients looking to learn more about their gastrointestinal system and their personal conditions. If you have a condition that is not covered in this book, please realize that it does not mean that your condition is any less important than the ones that are covered here.

I pledge to you that the information in this book is current and accurate as of the writing of this book. Keep in mind that medical knowledge and best practices change over time, and so newer recommendations will certainly come about after this book is written. In addition, there are exceptions to every rule, condition, and treatment, and so I aim to cover the generally accepted best practices. Lastly, my personal practice is limited to those ages 17 and older, and so I do not cover pediatric GI conditions.

Enjoy the book and be well!

Chapter 1

What is the field of Gastroenterology?

Gastroenterology is a long and somewhat confusing word. It’s even difficult to pronounce for most people. My patients have referred to it as anything from gastrology to gastroentology and everything in between. Most simply refer to it as gastro and subsequently to me as their gastro doc or their GI doc. That is perfectly fine with me. I don’t care how they pronounce it, as long as they keep calling me their gastro doc.

The field of gastroenterology encompasses the study of the gastrointestinal system. The gastrointestinal system starts in the mouth and goes all the way down to the rectum and anus (Yes, anus is an uncomfortable word to say and think about, but trust me, by the end of this book you will be a natural). So, let’s look at the GI system from the viewpoint of a piece of food you eat. Starting from the mouth, we then enter the esophagus, then the stomach, then the small intestine, then the large intestine (also referred to as the colon), to the rectum, and out through the anus. This is the simplified version, as each of the above sections of the GI tract can be broken down into different subsections.

The easiest of these sections to remember is the esophagus, which is simply broken down into thirds; the upper third, the middle third, and lower third.

The stomach has several sections. The curved part at the top is the gastric fundus. The part just below where the esophagus connects to the stomach is the cardia (not to be confused with the heart). The large section in the middle is the gastric body. The part just below the body is the antrum. And the part right before the stomach connects to the small intestine is the pylorus (don’t worry if it is a little confusing, I have included pictures of each organ in their individual sections later on in the book).

The small intestine is over 20 feet long, and so it may not make much sense that it is called the small intestine, seeing as the large intestine is only five to six feet long. However, we are essentially referring to the diameter of the lumen (space within the intestine), when we call it small and large (the small intestine is narrower than the wider large intestine). Despite its length, the small intestine has just three parts. The duodenum is the first part, the jejunum comes next, and the last part is the ileum. There’s a small caveat here: the duodenum is broken down into four sections itself. The first part (commonly referred to as the duodenal bulb), the second part, the third part, and fourth parts.

Lastly, we arrive at the colon or large intestine. Again, these terms are used interchangeably, although most doctors and medical personnel use the term colon (but feel free to say large intestine if you prefer). The colon has several parts. Where the ileum (last part of the small intestine) connects to the colon is called the cecum. There is a valve where the two connect, called the ileo-cecal valve. Next, we enter the ascending colon, followed by the transverse colon, descending colon, sigmoid colon, and then the rectum. The very short part where the rectum leads to the outside (or leads to the toilet I suppose), is the anus. So yes, there is essentially one long tube from the mouth to the anus. If we measure this entire tube, it would be roughly 30 feet from mouth to anus. Quite a journey!

Patients sometimes ask me how long it takes for food to go from being swallowed to defecated (pooped) out. The short answer is … it depends on the patient. Some patients’ GI tracts move more slowly or more quickly than others. It also depends on whether you are a man or woman. In general (very general terms), it takes around 33 hours for a man, and 47 hours for a woman to eat, digest, and then eliminate a meal.¹ ² We refer to the time it takes food to move through the GI tract as the transit time of the food. That being said, I have seen some unusual transit times in my years. I have also heard some shocking patient stories around this topic as well. I have had patients tell me that as soon as they eat something, they poop it out within a couple of hours. On the flip side, I have had patients tell me they go two months in between bowel movements (I swear—more than one patient has told me this). More on these topics later in the book.

In conditions that result in malabsorption (food not being absorbed into the body like normal), food products will move more quickly through the GI tract. In conditions that result in decreased contractions of the GI tract, food will obviously move more slowly from the mouth to anus. We can actually measure how long a small camera takes to move through our GI tract. So, the transit time of someone’s GI tract can be objectively measured. The above GI transit numbers would be in a healthy adult patient. In disease states, these numbers can vary dramatically. The function of the various parts of the GI tract will be discussed later. Besides the esophagus, stomach, and intestines, there are other major organs that are included in the field of gastroenterology. Both the liver and pancreas are included as well.

The liver is the largest solid organ in the body. It is located in the right upper abdomen, mostly behind the rib cage. When enlarged, it can be felt below the rib cage. This occurs mostly in cases of chronic liver disease. It weighs about three pounds and is about the size of a football. It is dark red to brown in color. As mentioned, it can become enlarged and heavier in chronic liver conditions (this is called hepatomegaly). It can also shrink and become small and nodular in advanced cirrhosis. The liver can be divided roughly into a larger right lobe and the smaller left lobe.

For surgical purposes (for example, when transplanting a liver or taking a section out due to a tumor), the liver can be divided even further into 10 segments, which is based upon the vascular supply to the liver.

The pancreas is a soft gland that lies behind the stomach in the center of the abdomen. It is about six inches in length. It can be divided into a head, neck, body, and tail. Within the center of the pancreas and traveling through it, is the pancreatic duct.

We also deal with the gallbladder and bile ducts. The gallbladder is a pear-shaped sack that sits tucked underneath the liver, in the right upper abdomen, under the protection of the ribs. Gallbladder problems usually fall under the domain of the general surgeon, as most gallbladder problems are dealt with by removing it surgically.

The bile ducts start in the liver as multiple small branches and, like the branches of a tree, they come together to form the common bile duct, which would be the trunk of the tree. A small branch of this bile duct attaches to the gallbladder, and is called the cystic duct. The common bile duct ends in the small intestine (duodenum) at a small nub with a tiny opening, referred to as the papilla.

As you can imagine, with all of the above organs, each with their own functions and potential problems, the field of Gastroenterology is quite broad and wide ranging. Indeed, GI problems affect almost everyone at one point or another. This keeps us gastroenterologists quite busy, as you might guess.

It should be mentioned that most specialties of the field of internal medicine (more appropriately named general medicine) have their own sub-specialties, with a more and more specific focus for physicians within those individual fields. The specialties of the broad foundation field of internal medicine include: gastroenterology, cardiology, nephrology, pulmonology, infectious disease, rheumatology, hematology, and endocrinology. So, any doctor specializing in these fields would have to have gone through a three-year internal medicine residency training (with the first year of residency commonly referred to as the "intern year’’).

Getting back to the field of gastroenterology, there are physicians within the field of gastroenterology that specialize in hepatology (study of liver disease), pancreatology (study of pancreas disease), esophageal disorders, and so on. You may be wondering … is it necessary for all patients with gastrointestinal symptoms to see one of these sub-specialists? In general, the answer is no. Without taking anything away from these specialists, they come in to play more for patients with less common (and potentially serious) conditions that require this type of specialization. In fact, most of the time it is the general gastroenterologist who refers patients to these sub-specialists. Most patients with more common conditions can usually be effectively managed by a general gastroenterologist (this is of course, provided that the gastroenterologist is worth his/her salt, as they say).

Chapter 2

Diseases of the Esophagus

The esophagus is a muscular tube that runs from the back of the throat down to the stomach. It is completely separate from the windpipe (trachea) and lies directly behind it. It is normally around 25 cm (10 inches) in length.

The esophagus has a sphincter muscle both at the very top, as well as the bottom (the upper esophageal sphincter or UES, and the lower esophageal sphincter or LES). These sphincters are made up of a thickened band of muscles and are closed most of the time; opening up during swallowing and belching. The job of the esophagus is fairly simple: to propel the food that we swallow from the mouth down into the stomach, so it can start to be digested. The other functions of the esophagus are to keep the food