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Gastroenterology

We use advanced diagnostic and treatment techniques to study, diagnose, and treat gastrointestinal (GI) disorders and conditions. Gastrointestinal organs include the esophagus, stomach, small bowel, colon, and gall bladder. If you are experiencing symptoms such as abdominal pain, rectal bleeding, change in bowel habits, or heartburn; please ask your Primary Care Manager for a referral to the Gastroenterology/Hepatology clinic. Once a referral is placed, you may contact the Integrated Referral Management and Appointing Center at 1.855.227.6331 to schedule an appointment.

Hepatology

Our Liver Center is dedicated to identifying, diagnosing, and treating liver diseases. We offer state-of-the-art therapy for conditions including viral hepatitis, metabolic liver diseases and autoimmune liver diseases. Procedures offered include liver biopsy, paracentesis, as well as upper endoscopy and colonoscopy. The Center contributes to medical education, training fellows, residents and medical students while remaining an active research unit. We're a world-wide referral center supporting the Walter Reed National Military Medical Center Transplant Service and providing both pre and post liver transplant management for DOD beneficiaries.

The following summaries aim to provide clear, concise, general information about each condition. Always consult with health care professionals for personalized medical advice and management of these conditions.
 

Alcohol-associated Liver Disease (ALD)

What is it?

Excessive alcohol consumption that leads to fat accumulation in the liver causing inflammation, scarring, and possible end-stage liver disease or cirrhosis 

Symptoms:

Initially symptomless and may progress to abdominal pain, fatigue, swelling, confusion, yellowing of the eyes or skin

Treatment:

Alcohol cessation, dietary changes, supportive care, and in severe cases, liver transplant
 

Autoimmune Hepatitis (AIH)

What is it?

The immune system attacking liver cells, leading to inflammation and liver damage

Symptoms:

Fatigue, abdominal discomfort, yellowing of the eyes or skin, itching, joint pain

Treatment:

Medications that suppress your immune system
 

Barrett’s Esophagus

What is it?

A disorder in which the lining of the esophagus is damaged by stomach acid which can cause precancerous cells to form

Symptoms:

Heartburn, regurgitation, difficulty swallowing

Treatment:

Acid-suppressing medications, endoscopic monitoring or eradication therapies 

Screening:

Screening with an upper endoscopy should be performed in individuals with a history of five or more years of heartburn and three or more of the following risk factors:

  • Male 
  • Age >50 years
  • White
  • Tobacco smoking
  • Obesity 
  • Family history of Barrett’s esophagus or esophageal cancer in an immediate family member
 

Celiac Disease

What is it?

An autoimmune disorder triggered by gluten consumption, damaging the lining of the small intestine

Symptoms:

Diarrhea, abdominal pain, fatigue, rash, weight loss

Treatment:

Gluten-free diet, vitamin supplements
 

Cirrhosis of the Liver

What is it?

Advanced liver scarring due to long-term liver damage, often from conditions like hepatitis or alcohol abuse

Symptoms:

Fatigue, weakness, easy bruising, yellowing of the eyes or skin, jaundice, swelling in abdomen (ascites) and legs (edema), confusion, bright red blood in stool or black and tarry stool

Treatment:

Addressing underlying causes, preventive care, symptom management, and in severe cases, liver transplantation
 

Colon Polyps and Colon Cancer

What are they?

Colon polyps are abnormal growths in the lining of the colon that may develop into cancer over time

Symptoms:

Often symptomless, but may cause rectal bleeding, changes in bowel habits, abdominal pain, iron deficiency anemia, unintentional weight loss

Treatment:

Removal of polyps during colonoscopy; cancer treatment varies and may include surgery, chemotherapy, radiation
 

Constipation

What is it?

Constipation involves infrequent bowel movements leading to discomfort or difficulty passing stools

Symptoms:

Difficulty passing stools, abdominal discomfort, bloating, and a feeling of incomplete evacuation

Treatment:

Dietary changes, fiber supplementation, laxatives, addressing any underlying causes

Crohn's Disease

What is it?

An inflammatory bowel disease (IBD) causing inflammation anywhere along the gastrointestinal tract

Symptoms:

Abdominal pain, diarrhea (sometimes bloody), weight loss, fatigue, complications like abscesses, fistulas, or strictures

Treatment:

Medications (anti-inflammatories, immunosuppressants), dietary changes, surgery
 

Diarrhea

What is it?

Three or more loose or watery stools per day, often due to infections, medications, or digestive disorders. Diarrhea is considered chronic when it has been present for more than four weeks. Chronic diarrhea may be due to non-infectious causes and require specialty evaluation. Acute diarrhea (present for less than four weeks) typically resolves on its own. 

Symptoms:

Increased frequency of bowel movements, urgency, abdominal cramps, dehydration

Treatment:

Oral hydration, medications to control symptoms, addressing underlying causes
 

Diverticular Disease

What is it?

Diverticulosis is the presence of small pouches (diverticula) in the colon wall. Complications include diverticulitis and diverticular bleeding. Diverticulitis occurs when diverticula become inflamed or infected. 

Symptoms:

Diverticulosis is often symptomless but can cause abdominal pain (often left lower quadrant), fever, nausea, changes in bowel habits. Diverticular bleeding causes maroon-colored bowel movements which may be associated with weakness and lightheadedness.

Treatment:

Diverticulosis itself does not require treatment unless other complications occur, such as diverticulitis. Diverticulitis may require antibiotics, clear liquids, and in severe cases, surgery
 

Esophageal Cancer

What is it?

Cancer in the lining of the esophagus which can spread to other parts of the body 

Symptoms:

Difficulty swallowing (dysphagia), chest pain, weight loss, chronic cough, hoarseness

Treatment:

Depends on stage; options include surgery, chemotherapy, radiation, and palliative care for advanced cases
 

Gallstones and Gallbladder Disease 

What are they?

Gallstones are hardened deposits in the gallbladder. Gallstone related diseases include inflammation (cholecystitis) or obstruction due to stones (choledocholithiasis).

Symptoms:

Abdominal pain (classically right upper quadrant), nausea, vomiting, jaundice (if bile duct is blocked).

Treatment:

Antibiotics, diet changes, medications to dissolve stones, endoscopic (ERCP) removal of stones from the bile duct, surgical removal of the gallbladder (cholecystectomy)
 

Gas

What is it?

Gas in the digestive tract is normal but excessive gas or trapped gas can cause discomfort.

Symptoms:

Bloating, belching, flatulence, abdominal pain or cramps

Treatment:

Dietary adjustments to avoid gas-producing foods, over-the-counter medications (simethicone), lifestyle changes which may include avoiding chewing gum, carbonated beverages, and straws
 

Gastroesophageal Reflux Disease (GERD)

What is it?

GERD occurs when stomach acid flows back up from the stomach into the esophagus

Symptoms:

Heartburn, regurgitation, chest pain, difficulty swallowing, cough, hoarseness

Treatment:

Lifestyle changes (weight management, diet, sleep positioning), medications (antacids, proton pump inhibitors), and in some cases, surgery
 

Helicobacter pylori (H. pylori) Infection

What is it?

A bacterial infection of the stomach lining, predisposing carriers to peptic ulcers and increasing the risk of stomach cancer

Symptoms:

Often symptomless but may cause abdominal pain (typically just under the breastbone), nausea, bloating, and sometimes vomiting

Treatment:

Antibiotics and acid-reducing medications, post treatment testing to ensure eradication of H. pylori
 

Hemochromatosis

What is it?

A genetic disorder causing excessive absorption and storage of iron in the body, leading to organ damage

Symptoms:

Fatigue, joint pain, abdominal pain, and in advanced stages, liver cirrhosis or diabetes

Treatment:

Regular blood removal (phlebotomy) to reduce iron levels, dietary changes, management of complications
 

Hepatitis A, B, and C

What are they?

Viral infections affecting the liver, each transmitted differently; hepatitis A virus (HAV) through contaminated food or water, hepatitis B and C viruses (HBV and HCV) through blood or body fluids

Symptoms:

Yellowing of the skin or eyes, fatigue, abdominal pain, nausea, and in chronic cases (HBV and HCV), liver damage.

Treatment:

Hepatitis A often resolves on its own; HBV and HCV may require antiviral medications, monitoring, and lifestyle changes
 

Irritable Bowel Syndrome (IBS)

What is it?

A functional gastrointestinal disorder characterized by abdominal pain and changes in bowel habits (diarrhea, constipation, or both)

Symptoms:

Abdominal pain or discomfort, bloating, altered bowel habits

Treatment:

Dietary changes, stress management, medications (antispasmodics, laxatives)
 

Lactose Intolerance

What is it?

The inability to digest lactose, a sugar found in milk and dairy products

Symptoms:

Bloating, diarrhea, abdominal pain, and gas after consuming dairy products

Treatment:

Avoiding foods containing lactose, lactase enzyme supplements
 

Liver Cancer

What is it?

Cancer in the liver

Symptoms:

Abdominal pain, swelling (ascites), jaundice, weight loss, symptoms related to liver failure

Treatment:

Surgery, liver transplant, ablation therapy, chemotherapy, targeted therapy, palliative care
 

Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) formerly known as Nonalcoholic Fatty Liver Disease (NAFLD) 

What is it?

Excessive fat buildup in the liver associated with metabolic disorders (diabetes, high cholesterol, etc.) causing liver inflammation and damage

Risk Factors:

Obesity, type 2 diabetes, high cholesterol, metabolic syndrome

Symptoms:

Often initially symptomless, may progress to fatigue, abdominal discomfort, liver-related complications

Diagnosis:

Liver function tests, fibrosis scan, imaging (ultrasound, MRI), liver biopsy

Treatment:

Weight loss, dietary changes (low fat, low sugar), exercise, management of underlying conditions such as diabetes, regular monitoring
 

Pancreatic Cancer

What is it?

Cancer of the pancreas

Risk Factors:

Smoking, family history, chronic pancreatitis, obesity, diabetes

Symptoms:

Often presents late with abdominal or back pain, weight loss, jaundice, digestive issues

Diagnosis:

Imaging tests (CT scan, MRI), biopsy, blood tests (CA 19-9)

Treatment:

Varies and may include surgery, chemotherapy, radiation therapy, targeted therapy, palliative care
 

Pancreatitis

What is it?

Inflammation of the pancreas, which can be acute (sudden and short-term) or chronic (long-term).

Causes:

Gallstones, alcohol abuse, certain medications, infections, genetic factors

Symptoms:

Upper abdominal pain, nausea, vomiting, fever, and in severe cases, organ failure

Diagnosis:

Blood tests (amylase, lipase), imaging tests (CT scan, MRI), and sometimes endoscopic ultrasound

Treatment:

Varies and may include fasting, pain management, intravenous fluids, and addressing underlying triggers like gallstones or alcohol
 

Peptic Ulcer Disease

What is it?

Open sores that develop on the inner lining of the stomach or the upper part of the small intestine    

Causes:

H. pylori infection, prolonged use of NSAIDs (nonsteroidal anti-inflammatory drugs such as aspirin, ibuprofen, and naproxen), excessive alcohol consumption, smoking

Symptoms:

Abdominal pain (burning or gnawing), bloating, nausea, black bowel movements, and occasionally vomiting blood (sign of severe ulcer)

Diagnosis:

Endoscopy, breath or stool tests for H. pylori, imaging tests if complications are suspected

Treatment:

Antibiotics to eradicate H. pylori, medications to reduce stomach acid (proton pump inhibitors), and dietary changes, stress management
 

Primary Biliary Cholangitis (PBC)

What is it?

A chronic autoimmune condition in which the bile ducts in the liver become inflamed, leading to bile buildup and liver damage

Symptoms:

Fatigue, itching (pruritus), dry eyes and mouth, abdominal pain, and in advanced stages, jaundice and cirrhosis

Diagnosis:

Blood tests (liver function, antibodies) and sometimes liver biopsy

Treatment:

Medications (ursodeoxycholic acid) to improve bile flow, medications to manage symptoms, monitoring liver function and disease progression
 

Primary Sclerosing Cholangitis (PSC)

What is it?

A rare autoimmune condition which causes inflammation, scarring, and narrowing of the bile ducts inside and outside the liver

Associated Conditions:

Often linked with inflammatory bowel disease (IBD), particularly ulcerative colitis

Symptoms:

Fatigue, itching, abdominal pain, jaundice, fever and in advanced stages, cirrhosis and liver failure

Diagnosis:

Liver function tests, imaging (MRCP, ERCP), and sometimes liver biopsy

Treatment:

Management of symptoms, medications to improve bile flow, monitoring for complications like bile duct cancer
 

Stomach Cancer

What is it?

Cancer in the cells lining the stomach. Adenocarcinoma is the most common type of stomach cancer.

Risk Factors:

H. pylori infection, smoking, family history, obesity, certain dietary factors (e.g. smoked foods)

Symptoms:

Early stages may be symptomless, but may include abdominal pain, bloating, nausea, loss of appetite, weight loss

Diagnosis:

Endoscopy with biopsy, imaging tests (CT scan, PET scan), and sometimes laparoscopy

Treatment:

Varies and may include surgery, chemotherapy, radiation therapy, targeted therapy, palliative care
 

Ulcerative Colitis

What is it?

A type of inflammatory bowel disease (IBD) causing inflammation and ulcers in the lining of the colon and rectum

Symptoms:

Diarrhea (often bloody), abdominal pain, urgency, fatigue, weight loss, fever, dehydration

Diagnosis:

Colonoscopy with biopsy, blood tests (CRP, ESR), stool tests, imaging (CT scan)

Treatment:

Medications that are anti-inflammatory and may suppress your immune system, dietary changes, managing flare-ups, and in some cases, surgery (colectomy)

Colonoscopy

An internal examination of the colon (large intestine), using an instrument called a colonoscope.

ERCP

Endoscopic retrograde cholangiopancreatography (ERCP) is a procedure used to identify stones, tumors, or narrowing in the bile ducts. The procedure is done through an endoscope.

Esophageal Manometry (Motility) Studies

Diagnostic services include esophageal motility studies, 24-hour pH monitoring of the esophagus, hydrogen breath testing, and 13 C urea breath testing for the detection of heliobacter pylori infection.

Sigmoidoscopy

An internal examination of the lower large bowel (colon), using an instrument called a sigmoidoscope.

Upper Endoscopy

An upper GI and small bowel series is a set of x-rays taken to examine the esophagus, stomach, and small intestine.

Wireless Pillcam Endoscopy

Capsule endoscopy allows the physician to examine the lining of the small intestine.
The patient swallows a capsule the size of a large vitamin that contains a mini-camera and a light source.
The capsule passes naturally through the digestive system while the camera takes pictures of the intestine.
These images are transmitted to small sensors, which are placed on the abdomen. the physician for processing.
A receiver the size of a Walkman, which is worn around the waist, will store the images.
Eight hours after ingesting the capsule, the test is finished and the receiver can be returned to the physician for processing.
 

Are you age 45 or above?

Beginning at age 45, you should follow one of the screening options below. 

Option 1: Yearly
  • Fecal occult blood test; all positive tests should be followed by a colonoscopy every 5 years
Option 2: Every 5 Years
  • Flexible sigmoidoscopy
  • Sigmoidoscopy
  • Double-contrast barium enema
Option 3: Every 5-10 Years
  • Colonoscopy
IMPORTANT: You should begin screening earlier than age 45 or screen more often if you have any of the following colon cancer risk factors:
  • Strong family history of colorectal cancer or polyps, meaning a parent, sibling or child who developed cancer or polyps younger than age 60
  • Families with hereditary colorectal cancer syndromes
  • Personal history of colorectal cancer or polyps
  • Personal history of chronic inflammatory bowel disease
Additional information about alternative methods for colon cancer screening and who may benefit from earlier screening can be found on the CDC website.

For more information about Colon Cancer, visit MedlinePlus.

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301-295-4600 
Fax: 301-295-4599

Hours

Monday - Friday, 8 a.m. to 4 p.m.

Location

Arrowhead Zone
Building: 9 Floor: 1
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