Diarrhea, abdominal distention, cramps, flatulence and general discomfort may be caused by lactose intolerance in some patients. In the past patients were instructed to delete milk products from their diets and see if it had an effect.

There are a number of problems with this method:
1) Eliminating milk products completely proves to be extremely difficult for most patients;
2) Lactose is present in many unsuspected foods and drugs, making the most diligent patients attempts to comply impossible.

Calcium, vitamins and other nutritional benefits of milk are an important part of diet, especially for women and growing children. A relationship between lactose malabsorption and post-menopausal osteoporosis have been reported making an arbitrary decision to withdraw milk from the diet inadvisable without a demonstrated reason.

Malabsorption tests can provide an indication of the severity of the lactose deficiency and may indicate the patients possibility of including some milk in the diet without generating symptoms of lactose intolerance.

Most gastroenterologists have accepted the hydrogen breath test as the method of choice for diagnosing lactose intolerance. It is not only more accurate, but is non-invasive as well. Our particular testing machine not only looks for hydrogen, but also measures methane gas that can only occur in up to 20 percent of lactose intolerant patients. In other words, a patient who is lactose intolerant may only produce methane. There exist less expensive test units that only measure hydrogen and may, in fact, miss the diagnosis of lactose intolerance.

Our office has acquired a top of the line breath testing analyzer from a company that is the leader in this field, the Quintron Corporation. They have spent hours with our staff instructing them on the proper utilization of the machine and analysis of data. Not only can we test for lactose intolerance, but we also offer breath testing, using the substance called lactulose, for detection of bacterial overgrowth that is being recognized more and more as a significant factor in the mechanisms underlying the Irritable Bowel Syndrome (IBS). IBS patients suffer from abdominal bloating and pain, irregular bowels habits, and often alternating diarrhea and constipation. There is a growing popularity in identifying bacterial overgrowth in patients with IBS symptoms and treating this overgrowth with special antibiotics that target this intestinal overgrowth of bacteria. Clinical studies have shown an improvement in subsets of IBS patients who have bacterial overgrowth. Naturally, those suffering from these symptoms should see their doctor or contact our office for a comprehensive evaluation.

The protocol for the test is simple; nothing by mouth after midnight, no smoking for 1/2 hour prior to and during testing, no napping during the examination and no exercising prior to or during the examination. Detailed instructions are included with the test kits.

Please give the office a call to arrange for a lactose intolerance test. It is usually covered by most insurance companies, is non-invasive in nature, and may prove to be the answer to your needs. We are available to answer any questions you may have as well.

To order your test kit, please call 1-800-542-4448begin_of_the_skype_highlighting              1-800-542-4448      end_of_the_skype_highlighting or go to www.quintron-usa.com.

Everyone occasionally has heartburn. This occurs when stomach acid flows backward into the esophagus, the food pipe that carries food to the stomach. People usually experience heartburn after meals as a burning sensation or pain behind the breast bone. Often, regurgitation of food and bitter-tasting stomach acid accompanies heartburn. Antacids or milk temporarily relieves heartburn for most people.

Why Does Heartburn Occur?
To understand heartburn, let us look at the body's anatomy. The esophagus carries food and liquid to the stomach. A sphincter, or muscular valve, is located at the end of the esophagus at the border between the esophagus and stomach. Known as the lower esophageal sphincter (LES) this muscle contracts much the same as the anus does. The sphincter should maintain a certain pressure to keep the end of the esophagus closed so that stomach juices are not admitted. The LES muscle should only open when food is passed into the stomach.

However, the LES muscle does not always work perfectly. It is felt that the problem is with inappropriate, transient relaxations of this sphincter valve that result in reflux. Sphincter function can be easily overcome by a number of factors, the most common being eating a large meal. Along with swallowed air, a large meal causes an upward pressure in the stomach to rise, thereby overpowering the LES muscle. Other factors that reduce the LES pressure and allow reflux are:

• Nicotine (cigarettes)
• Fried or fatty foods
• Chocolate
• Coffee
• Citrus fruits and juices
• Peppermint
• Pregnancy
• Lying flat
• Hiatus hernia
• Certain prescription medications

Swallowing difficulty, medically termed dysphagia, can arise for a variety of reasons.  Firstly, reflux alone can disturb the muscular contraction or motility of the esophagus and interfere with the passage of liquids and solids.  Often, when reflux is controlled, these symptoms will disappear.

The inflammatory response of the esophagus from chronic reflux can lead to the formation of a ring of scar tissue at the end of the esophagus where it meets the stomach, an area know as the gastroesophageal junction (the location of the LES), that can lead to a mechanical obstruction causing difficultywith swallowing solids.  This entity is known as an esophageal ring or a Schatzki Ring.  In some cases the ring needs to be disrupted in order to resolve the blockage.

Of course with chronic reflux comes the risk of esophageal cancer and although the risk is low, it is very real.  Such tumors can cause significant blockage and bleeding.  The cancers are diagnosed most often by way of video upper endoscopy.  A person presenting with new-onset swallowing trouble, a history of reflux, bleeding, and weight loss should seek a medical evaluation immediately.

There are a variety of primary esophageal motility disorders that cause swallowing trouble.  Achalasia is a disorder that can be quite insidious and involves that loss of motility in the body of the esophagus and the lower esophageal sphincter (LES)fails to relax.  The physical presentation can look like reflux because the patient does not clear contents of the esophagus and those materials can backwash into the upper esophagus and mimic GERD. The diagnosis of Achalasia is made by way of esophageal manometry whereby the wave forms  of the esophagus are measured to make the diagnosis.  Achalasia can be treated surgically (laparoscopically) or by balloon dilation of the lower sphincter.

There are other esophageal motility disorders that can be described by esophageal manometry and they include diffuse esophageal spasm that is often associated wit noncardiac chest pain, the Nutcracker esophagus, and Ineffective Esophageal Motility.  Esophageal motility studies ( manometry) will require the passage of a small caliber tube into the esophagus through a nasal passage.  The test takes about 20-30 minutes to complete and is well-tolerated.  It is performed as an out-patient.