Plain Talk About Prevention and Maintenance of GI Diseases-A Pathologist’s Perspective

Normal Stomach HistologyNormal Colon Histology

Histological Examination Remains the GOLD Standard in Diagnosing Gastro-intestinal GI Diseases

Choose an Abdominal CT-Scan to RULE OUT TUMOR after a complete medical evaluation/assessment, then proceed with Endoscope if Necessary CLICK HERE FOR REFERENCE

CLICK HERE FOR CONSIDERATION OF THE PILL-CAMERA OPTION FOR GI DISEASE SURVEILLANCE

CLICK HERE FOR READING REFERENCE

CLICK HERE FOR MORE REFERENCE

At MDC-Atlanta, we give our patient a still-picture copy or video-presentation of the diagnostic pathological image of the patient’s BIOPSY, as this allows patients to understand their disease processes as well as to be able to share images

with other like-minded Experts

CLICK HERE TO VIEW A DEMONSTRATION OF THE PATHOLOGIST’S INTERPRETATION OF A STOMACH BIOPSY

A common reason to seek the attention of a health-care provider is due to “stomach pain” associated with or without weight loss, decrease appetite, fever, chills, night-sweats, nausea, vomiting, diarrhea, and constipation, as these are symptoms that may suggest problems with the Gastrointestinal (GI) System. However, in general, GI symptoms essentially overlap with “constitutional symptoms” which means that other NON-GI diseases must be ruled out. This greatly depends on the patient’s age as well as other known medical or previous surgical conditions. The GI system is a central component for the operation of other human systems as it provides replenishing nourishment, water and electrolytes, as well as other trace elements. It is a system that is directly interactive with our external environment, and is therefore, predisposed to environmentally induced diseases. Because of its location from mouth to anus, neck, chest, abdomen, and pelvis, often times, the esophago-gastrointestinal tract is intimately apart of other systems, and may show overlapping signs of diseases that may NOT be directly linked.

Preventative and Maintenance Health Practices are key to solving many ailments that predispose the GI tract.

Most acute diseases involving the GI tract are typically self-limiting, which means they typically resolve within a few days, and really do not require the attention of a health care provider. We at MDC-Atlanta typically recommend those patients who are otherwise healthy that when experiencing acute GI symptoms, like acute diarrhea, nausea and vomiting without other symptoms, to “rest the intestinal tract” from solid foods, and only drink liquids which contain electrolytes and glucose, for instance, for one to two (1-2) days to allow healing of the lining of the intestinal tract to take place, as from acute viral infections for instance. Symptoms that do not show signs of resolution and/or become worsen WITHIN three (3) days should immediately require evaluation by a licensed health-care provider. Chronic diseases involving the GI tract typically last longer than three (3) months, and should always be evaluated by an appropriately qualified and licensed health-care provider.

Prevention and health maintenance measures regarding the GI tract start with an auspicious patient who monitors self for certain symptoms of GI diseases. Those who are predisposed to developing early GI diseases as related to congenital or inheritance pattern of diseases should always consult with the appropriate professionals regarding scheduled surveillance evaluation. But in general, surveillance of the GI tract by colonoscopy examination should be done by age 50 or sooner when certain symptoms are long lasting (chronic).  Specific symptoms  AT ANY AGE, such as sour taste in mouth after meal, or cramping/burning pain after meal, ongoing vomiting, or other symptoms related to gastro-esophageal reflux disease or gastric ulcers (bleeding), long-lasting diarrhea/rectal bleeding, etc, should ALWAYS be immediately evaluated by a gastrointestinal physician-specialist to rule out patterns of disease via biopsy and/or through microscopic evaluation. I hope someday patients will be able to do their own GI/Bowel prep (fasting for at least 12 hours), followed by swallowing a pill with a camera and small thin-tube with light attached to it to evaluate the upper GI tract (Esophagus, Stomach, and first part of the Duodenum-small intestine) as well as to gather images and even an automated safe biopsy apparatus-collector guided via secure-internet by their primary care physician to rule out diseases earlier before advanced stages.

Common Diseases of the GI TractBasic Functions of the GI TRACT

  There are many more diseases of the GI tract not listed in the above image for the sake of brevity.  These diseases include but are not limited to polyps with or without high-grade (precancerous) changes, ulcers, fungal infection, bacterial infections, etc. Diseases of the GI tract can be divided into TWO (2) main categories: REACTIVE VERSUS NEOPLASTIC (Benign or Cancerous).  Neoplastic diseases are first ruled out by examining a biopsy sample, for instance, under the microscope primarily looking for “PRESERVATION OF THE USUAL OR NORMAL MUCOSAL ARCHITECTURE“, also known as the normal histological pattern.  Neoplastic or tumoral diseases are common place in the GI tract, and generally do not pose significant diagnostic dilemma. However, when evaluating for INFLAMMATORY OR REACTIVE CONDITIONS of the GI tract, appropriate skills must be employed to communicate clinical relevance of the inflammatory lesions, so that appropriate medical therapy can ensue.

GI  inflammatory lesions are further divided into ACUTE versus CHRONIC:

HISTOLOGICAL  PATTERN FOR ACUTE INFLAMMATORY DISEASE OF GI TRACT:

The typical mucosal histological pattern is usually preserved.  However, there may be various forms of regenerative changes or ulceration of the lining surface epithelium.  In addition, acute inflammatory cells, neutrophils, permeate the lining surface epithelial cells, as well as the cells that form the crypt glands, or deeper glands, and may often be seen in clusters within the glandular lumen (neutrophilic abscess, also known as acute cryptitis/crypt abscess for intestinal disease for example).  The lamina propria shows accumulation of mixed inflammatory cells including neutrophils, lymphocytes, plasma cells, histiocytes, including lymphoid aggregates on occasion, and other inflammatory cells, with associated edema or fluid collection within the supporting connective tissue.  Acute GI diseases are caused by ischemia (changes in vascular flow to the mucosa), microorganisms, and/or other toxins.

HISTOLOGICAL PATTERN FOR CHRONIC INFLAMMATORY DISEASE OF THE GI TRACT:

The mucosa is usually distorted by branching glands, “glandular drop out”, irregular spacing of glands, atrophy, etc.  Activity of chronic inflammatory diseases of the intestine may again be highlighted by the presence of neutrophils within epithelium or glandular lumen, as with active inflammatory bowel diseases (Ulcerative Colitis and Crohn’s disease).  The lamina propria is typically expanded by a mixed inflammatory cell infiltrate as described above in the acute process, but also may or may not include various degrees of lymphoid aggregates and/or granuloma formation. There may be various degrees of increased collagen or fibrous tissue formation, as with collagenous colitis or lymphocytic colitis (which also shows the presence of increased numbers of lymphocytes within the epithelium, and nuclear dusting of the lining surface epithelium).   Chronic GI diseases are often caused by an immune mishap, and requires additional serological studies for instance, as well as other specific clinical findings to further define the abnormality.

Treatment of inflammatory diseases of the GI tract includes different types of antimicrobials, corticosteroids, as well as other forms of chemotherapy, and is influenced by the SPECIFIC TYPES OF INFLAMMATORY DISEASES. If you are diagnosed with one of these diseases, you should consider A SECOND OPINION by a different pathologist unaffiliated with the original pathologist, OR request EVIDENCE for the disease, by way of a picture or other clinical diagnostic evidence for disease.

MDC-Atlanta Remains Committed to Keeping Our Patients Informed for Better Quality and Safe Medical Care