Constipation is a common complaint and many people just muddle along with the problem, but if it’s persistent you need to be checked by a gastroenterologist to see if there is an intestinal obstruction or other underlying issue.
Constipation can be attributed to any number of conditions, but getting a diagnosis sooner than later could, in some cases, be the difference between life and death.
“Sometimes a patient will come in with intestinal blockage making it difficult to move bowels,” said Dr. Ashley Canipe, MD, a gastroenterology specialist who is part of Indian River Medical Associates.
“They may have abdominal distention, pain or rectal bleeding. Or their symptoms may be just the opposite, with bouts of diarrhea or anemia. Any abnormality of the digestive tract can be diagnosed by a skilled gastroenterologist.”
Gastroenterology focuses on the digestive system and its disorders, including diseases affecting the gastrointestinal tract, which includes the organs from mouth to anus along the alimentary canal.
One of the most common procedures executed by a gastroenterologist is a gastroscopy, where the physician checks your food pipe, stomach and upper part of the small intestine for abnormalities. The minimally invasive procedure involves inserting a thin, flexible camera through your mouth into your stomach and duodenum to diagnose problems and take tissue samples.
Pancreatitis and pancreatic pseudocyst, celiac disease, Crohn disease, diverticulitis, gastroesophageal reflux disease (GERD), peptic ulcers and hiatal hernia are detected in this fashion.
The other most common reason to seek the medical advice of a gastroenterologist is for a colorectal cancer screening. Most of the time colorectal cancer has no warning signs, so it’s advisable to take preventative measures with an endoscopic evaluation – the dreaded colonoscopy – to detect and remove precancerous polyps so you never have to deal with colorectal cancer at all.
“Colorectal cancer is the second-leading cause of cancer-related deaths when men and women are combined, second only to lung cancer,” said Dr. Canipe. “It’s very common, yet very preventable and if it’s caught early enough there is a 90 percent cure rate.
“The best way to prevent colorectal cancer is to have a colonoscopy. Using a lighted, flexible tube to view your rectum and colon, a physician can check and remove precursor lesions before they have the opportunity to grow into cancer.
“These abnormal growths in the tissue are called polyps. Not all polyps are precancerous so at the time of the colonoscopy we remove them all and send them off to the lab. The pathologist will examine them under the microscope and tell us what type, number and size the polyp is, which will determine the interval between your next exam.”
In general, people should start colon screenings around age 50. The length of time between exams is variable. People who are at a high risk of colorectal cancer get surveyed more frequently.
“If we remove large polyps bit by bit, we would want to look at that scar in six months to make sure that there is no residual and also scan the colon again,” explained Dr. Canipe. “And there are general guidelines used to determine the next screening interval based on number, size and type. If a doctor finds only one or two small polyps, he may recommend another screening in five or 10 years. If there’s more than 10 precancerous polyps he may recommend another screening in a year. It is all based on your personal screening and risk factors.
“The lifetime risk of developing colorectal cancer is 1 in 25, yet it is a totally preventable cause of death,” Dr. Canipe said. “People create their own barriers for not getting a colonoscopy. Some think they just don’t need it because they have no symptoms, and they underestimate the 1-in-25 risk of it developing. The fact is if it wasn’t common, we wouldn’t have a screening for it.
“The other barrier that prevents people from getting the screening is the preparation they have to do before the procedure,” continued Dr. Canipe. “Your colon has to be empty and clean for your doctor to get a proper look at it. To make that happen, you’ll have to fast and use strong laxatives beforehand. It’s somewhat unpleasant but it’s temporary and it might save your life. I shamelessly tell my patients that their day of prepping is not as bad as dying.”
The procedure itself is fairly simple and should only take about an hour to complete. The patient receives general anesthesia and will be relaxed and pain free. During the colonoscopy, the doctor uses a colonoscope, a long flexible tubular instrument about a ½ inch in diameter that transmits and image of the colon so the doctor can examine it for abnormalities. The scope bends and moves, allowing the doctor to carefully exam the turns and folds of the colon. If any polyps are found, they are removed with a snare resembling a metal lasso.
“The technology is so advanced that everything is done through the natural orifice of the anus a using snares,” elaborated Dr. Canipe. “There are no incisions, no knives and no scalpels. The procedure is not too onerous and is administered by caring, respectful doctors. The patient actually wakes up feeling refreshed from their slumber.”
It is important that a patient’s gastroenterologist is thorough and diligent in performing the procedure. Ask your doctor about his Adenoma detection rate (ADA), a benchmark on quality for screening colonoscopy.
The ADA measures a doctor’s success at finding benign tumors, and patients should look for a physician with an ADA of at least 25 percent overall – 30 percent in men and 20 percent in women. A high ADR is an indication of a quality colonoscopy. Every 1 percent increase in a physician’s ADR equates to a 3 percent decrease in the patient’s risk for developing colon cancer over the next year.
Dr. Canipe notes that she has a 50 percent ADR and has been part of Indian River Medical Associates since 2015. “All of our procedures are done at the Cleveland Clinic Indian River Scully Endoscopy Center, which is very spa-like. It has its own entrance, so you don’t even have to enter the main part of the hospital. The hospital has taken extreme precautions to keep everyone safe from COVID. All patients are tested for COVID 72 hours prior to their procedure and all caregivers have their temperature checked every shift. Of course, everyone wears full PPE. We strive to make the experience as safe, comfortable and respectful as possible.”
Dr. Ashley Canipe’s office is located in the Cleveland Clinic Indian River Hospital Health and Wellness building located immediately behind the hospital. She can be reached at 772-299-3511.