⏱ Colonoscopy Prep Timer
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⚠️ This tool is for educational guidance only. It does not diagnose conditions. Please see your physician for evaluation.
Crohn's disease is a chronic inflammatory bowel disease (IBD) that can affect any part of the gastrointestinal tract from mouth to anus. It is characterized by transmural (full-thickness) inflammation, meaning the inflammation extends through all layers of the bowel wall. Crohn's typically follows a relapsing-remitting course — periods of active disease (flares) alternating with periods of remission.
📍 Where it affects
Most commonly the terminal ileum (end of the small intestine) and colon, but can involve any segment. Unlike ulcerative colitis, Crohn's can have "skip lesions" — patches of normal bowel between diseased areas.
📊 Who gets it?
Approximately 780,000 Americans live with Crohn's disease. It most commonly presents between ages 15–35, with a second peak in the 50s–70s. Slightly more common in women. Strong genetic component — first-degree relatives have a 5–20x higher risk.
⚡ What causes it?
Crohn's results from a complex interaction between genetic susceptibility, the gut microbiome, environmental triggers (smoking, diet, antibiotics), and an abnormal immune response. It is not caused by stress or diet, though these can affect symptoms.
🔄 Disease course
Crohn's is a lifelong condition. With modern biologic therapies, many patients achieve deep remission. Goals have shifted from symptom control to mucosal healing — preventing complications like strictures, fistulas, and surgery.
Crohn's symptoms vary widely depending on which part of the GI tract is involved and disease severity. Symptoms may onset gradually or suddenly.
🔴 GI symptoms
Chronic or recurrent diarrhea (often without blood, unlike UC), crampy abdominal pain (often right lower quadrant), urgency, rectal bleeding (when colon involved), nausea, vomiting, reduced appetite, weight loss.
🔥 Systemic symptoms
Fatigue (very common), fever during flares, night sweats, malnutrition and nutritional deficiencies (B12, iron, vitamin D, zinc), anemia, growth delays in children and adolescents.
🔗 Complications
Strictures (narrowing causing obstruction), fistulas (abnormal connections between bowel loops, skin, or bladder), abscesses, perianal disease (fissures, fistulas, skin tags), short bowel syndrome after resection.
🏥 Extra-intestinal manifestations
Occur in 25–40% of patients: joint pain/arthritis, skin conditions (erythema nodosum, pyoderma gangrenosum), eye inflammation (uveitis, episcleritis), primary sclerosing cholangitis, kidney stones, osteoporosis.
🧪 Blood tests
CBC (anemia, white cell count), CRP and ESR (inflammation markers), albumin (nutrition), iron studies, B12, vitamin D, fecal calprotectin (sensitive marker of intestinal inflammation).
🔬 Endoscopy
Colonoscopy with ileoscopy and biopsies is essential. Upper endoscopy if upper GI symptoms. Capsule endoscopy or balloon enteroscopy for small bowel evaluation.
📸 Imaging
CT enterography or MR enterography (MRE) — the gold standard for evaluating small bowel Crohn's extent and complications. MRI avoids radiation and is preferred for follow-up. Pelvic MRI for perianal disease.
🧬 Pathology
Biopsies show transmural inflammation, granulomas (in ~30% of cases — highly specific for Crohn's), cryptitis, and architectural distortion. Normal biopsies do not exclude Crohn's.
Treatment goals have evolved dramatically. Modern IBD care aims for mucosal healing and deep remission — not just symptom control — to prevent long-term complications and surgery.
💊 Induction (flare treatment)
Corticosteroids (prednisone, budesonide) for short-term flare control. Exclusive enteral nutrition (EEN) — especially in pediatric Crohn's. Biologic therapy is now frequently used for induction in moderate-severe disease.
🔬 Maintenance therapy
Immunomodulators (azathioprine, 6-MP, methotrexate). Biologic therapies are the backbone of modern maintenance treatment. Combination therapy (biologic + immunomodulator) may be used for selected patients.
💉 Biologic therapies
Anti-TNF agents (infliximab/Remicade, adalimumab/Humira, certolizumab). Anti-integrin (vedolizumab/Entyvio). Anti-IL-12/23 (ustekinumab/Stelara). Anti-IL-23 (risankizumab/Skyrizi). Selection based on disease location, severity, and patient factors.
🏥 Surgery
Required in approximately 70% of Crohn's patients over their lifetime. Surgery does not cure Crohn's — recurrence at the surgical site is common. Ileocolonic resection for terminal ileal disease. Strictureplasty for multiple strictures.
🚭 Smoking
Smoking significantly worsens Crohn's disease — it increases flare frequency, accelerates disease progression, increases surgical risk, and reduces biologic effectiveness. Smoking cessation is one of the most impactful things a Crohn's patient can do.
🥗 Diet
No single Crohn's diet exists. During flares: low-residue, easily digestible foods. Remission: balanced, nutritious diet. Specific Carbohydrate Diet (SCD) and Crohn's Disease Exclusion Diet (CDED) have evidence. Work with a GI dietitian.
💊 Vaccinations
Immunosuppressed IBD patients are at higher risk from vaccine-preventable illness. Ensure flu (annual), pneumococcal, COVID-19, shingles (Shingrix), and HPV vaccines are up to date before starting biologics. Live vaccines must be avoided on immunosuppression.
🧠 Mental health
Anxiety and depression are significantly more common in IBD. The gut-brain axis is real — stress can worsen GI symptoms. Cognitive behavioral therapy (CBT), gut-directed hypnotherapy, and mindfulness have clinical evidence. Ask your care team for a referral.
Ulcerative colitis (UC) is a chronic inflammatory bowel disease limited to the colon and rectum. Unlike Crohn's disease, UC involves only the innermost lining (mucosa) and always starts in the rectum, extending continuously (no skip lesions) proximally to varying degrees.
📍 Disease extent classification
Proctitis (rectum only — ~30%), left-sided colitis (to the splenic flexure — ~40%), extensive/pancolitis (beyond splenic flexure — ~30%). Extent determines treatment selection and cancer surveillance interval.
📊 Epidemiology
Approximately 1 million Americans live with UC. Bimodal age distribution — peak onset 15–35 and 50–70. Equally common in men and women. Slight family history risk similar to Crohn's.
⚡ Pathophysiology
Mucosal inflammation with crypt abscesses and goblet cell depletion. Unlike Crohn's, inflammation is continuous and superficial (mucosal). This matters for treatment — mesalamine works well for UC but not Crohn's.
🔄 Disease severity
Classified as mild, moderate, or severe based on stool frequency, rectal bleeding, temperature, heart rate, hemoglobin, and ESR (Truelove & Witts criteria). Severe UC may require hospitalization and IV steroids.
🩸 Cardinal symptoms
Rectal bleeding (hallmark of UC), bloody diarrhea, mucus in stool, rectal urgency and tenesmus (feeling of incomplete evacuation), increased stool frequency, crampy lower abdominal pain.
⚡ Severity spectrum
Mild: fewer than 4 bloody stools/day, no systemic symptoms. Moderate: 4–6 stools/day, mild systemic symptoms. Severe: more than 6 bloody stools/day, fever, tachycardia, anemia, elevated ESR/CRP.
🏥 Extraintestinal manifestations
Similar to Crohn's: joint disease (most common), skin (erythema nodosum, pyoderma), eye inflammation. Primary sclerosing cholangitis (PSC) occurs in 2–5% of UC patients and significantly increases cholangiocarcinoma risk.
⚠️ Toxic megacolon
A rare but life-threatening complication — severe colonic dilation (over 6 cm on X-ray) with systemic toxicity. Presents with fever, tachycardia, abdominal distension, and leukocytosis. Requires urgent hospitalization.
Treatment is guided by disease extent and severity. The goal is inducing and maintaining remission — now defined as endoscopic mucosal healing rather than symptom resolution alone.
💊 Mesalamine (5-ASA)
First-line therapy for mild-moderate UC. Available as oral tablets (Lialda, Asacol, Pentasa) and topical formulations (suppositories for proctitis, enemas for left-sided disease). Topical 5-ASA is more effective than oral for distal disease.
💉 Biologic therapies
Anti-TNF (infliximab/Remicade, adalimumab/Humira, golimumab/Simponi), anti-integrin (vedolizumab/Entyvio — preferred for UC), anti-IL-12/23 (ustekinumab), anti-IL-23 (mirikizumab/Omvoh, risankizumab/Skyrizi).
💊 Small molecules
JAK inhibitors (tofacitinib/Xeljanz, upadacitinib/Rinvoq, filgotinib) are oral pills effective for moderate-severe UC. They work quickly but have a different safety profile than biologics — screening required before starting.
🏥 Surgery
Colectomy is curative for UC (unlike Crohn's). Indicated for medically refractory disease, dysplasia, or cancer. J-pouch (IPAA) surgery allows patients to avoid a permanent ostomy. Quality of life after J-pouch is generally very good.
Long-standing extensive UC is associated with an increased risk of colorectal cancer. Regular surveillance colonoscopy is one of the most important aspects of long-term UC management.
🔍 When to start surveillance
Begin surveillance colonoscopy 8 years after diagnosis of extensive colitis (beyond the splenic flexure), or immediately at diagnosis if primary sclerosing cholangitis (PSC) is present.
📅 Surveillance intervals
Every 1–2 years for extensive colitis. Every 2–3 years for left-sided colitis. More frequent if dysplasia was found previously, PSC is present, family history of CRC, or ongoing active inflammation.
🧪 Chromoendoscopy
Dye-spray colonoscopy (chromoendoscopy) improves dysplasia detection and is recommended at surveillance colonoscopy. High-definition white light endoscopy with targeted biopsies is an acceptable alternative.
⚠️ Dysplasia found
Any dysplasia found on surveillance requires multidisciplinary discussion. Endoscopically resectable visible dysplasia: endoscopic resection + close surveillance. Invisible/multifocal high-grade dysplasia: colectomy is recommended.
Biologic therapies are among the most effective treatments for moderate-to-severe IBD. They are targeted medicines that block specific pathways driving inflammation. This guide explains the main classes, what to expect, and important safety information.
🎯 Anti-TNF agents
Drugs: infliximab (Remicade), adalimumab (Humira), certolizumab (Cimzia — Crohn's only), golimumab (Simponi — UC only)
Route: IV infusion (infliximab) or subcutaneous injection
Used for: Both Crohn's and UC. Most studied class. Available as biosimilars.
🛡️ Anti-integrin
Drug: vedolizumab (Entyvio)
Route: IV infusion or subcutaneous injection
Used for: Both Crohn's and UC
Advantage: Gut-selective — acts primarily in the GI tract, resulting in a favorable systemic safety profile. Preferred for older patients and those with infection concerns.
🧬 Anti-IL-12/23 & Anti-IL-23
Drugs: ustekinumab (Stelara), risankizumab (Skyrizi), mirikizumab (Omvoh)
Route: IV loading dose, then subcutaneous maintenance
Used for: Crohn's (ustekinumab, risankizumab) and UC (ustekinumab, mirikizumab, risankizumab)
Excellent safety profile, particularly for patients who have failed anti-TNF therapy.
💊 JAK inhibitors (small molecules)
Drugs: tofacitinib (Xeljanz — UC), upadacitinib (Rinvoq — UC & Crohn's), filgotinib
Route: Oral pills — taken daily
Advantage: Fast onset, oral administration
Note: Require screening for TB, hepatitis, cardiovascular risk. Boxed warning for thrombosis and malignancy in certain populations.
Before starting a biologic — what to expect:
- 1TB screening: Tuberculin skin test (PPD) or QuantiFERON-Gold blood test required. Latent TB must be treated before starting.
- 2Hepatitis B screening: Blood test for hepatitis B surface antigen and antibody. Active hepatitis B is a contraindication; prophylactic antiviral therapy may be needed.
- 3Vaccinations: Update all vaccinations before starting — live vaccines cannot be given once immunosuppressed. Annual flu shot and COVID booster are recommended while on biologics.
- 4Drug level monitoring: Biologic drug levels and anti-drug antibody testing help optimize dosing and diagnose loss of response. Your physician will check these periodically.
Diet does not cause IBD, but it significantly affects symptoms, nutritional status, and potentially disease activity. There is no single "IBD diet" — nutrition management must be individualized based on disease location, activity, and surgical history.
🥗 General principles
Eat a varied, nutritious diet during remission. Avoid restriction unless a specific trigger is identified. Work with a registered dietitian specializing in GI disorders for personalized guidance.
💊 Common nutritional deficiencies
Iron (rectal bleeding, poor absorption), vitamin B12 (terminal ileal disease/resection), vitamin D (very common), folate, zinc, magnesium, fat-soluble vitamins (A, E, K) in small bowel Crohn's.
🧪 Monitoring
Annual nutritional labs including CBC, iron studies, B12, folate, vitamin D, zinc, and magnesium. Ask your physician to include these at your routine IBD monitoring visits.
💧 Hydration
Particularly important during flares with diarrhea. Oral rehydration solutions (Pedialyte, Hydralyte) are better than plain water when stool output is high. Avoid caffeine and alcohol during flares.
🍚 Low-residue diet
During a flare, a low-residue (low-fiber) diet reduces stool frequency and bowel stimulation. Choose: white rice, white bread, eggs, well-cooked skinless poultry/fish, bananas, applesauce, plain pasta.
❌ Foods to limit during flares
Raw vegetables, whole grains, nuts, seeds, legumes, high-fat foods, spicy foods, lactose (if intolerant), alcohol, caffeine, artificial sweeteners (sorbitol, mannitol).
🥤 Liquid nutrition
Elemental or polymeric formulas (Modulen IBD, Ensure, Vital) can provide complete nutrition when food intake is inadequate. Exclusive enteral nutrition (EEN) is a first-line therapy for Crohn's flares in children and adolescents.
🏥 When to seek help
Inability to maintain adequate oral intake, significant weight loss (more than 5–10%), signs of dehydration, or malnutrition warrant contact with your physician and possible dietitian referral or nutritional support.
In remission, the goal is to eat as varied and nutritious a diet as possible. Long-term dietary restriction is associated with nutritional deficiencies and reduced quality of life.
🥦 Reintroduction
Gradually reintroduce higher-fiber foods during remission. Start with cooked vegetables before raw. Track symptoms in a food diary to identify personal triggers without unnecessary restriction.
🫒 Anti-inflammatory eating
A Mediterranean-style diet pattern (fruits, vegetables, fish, olive oil, whole grains) has anti-inflammatory properties and is associated with better IBD outcomes in observational studies.
🚫 Foods to continue avoiding
Ultra-processed foods, emulsifiers (carrageenan, polysorbate 80 — may disrupt gut barrier), excessive red/processed meat, and artificial sweeteners have been associated with increased IBD activity in some studies.
🦠 Probiotics
Evidence for probiotics in IBD is limited. VSL#3 has evidence for pouchitis (inflammation of the J-pouch). Lactobacillus GG for UC. Not recommended as a substitute for medical therapy. Discuss with your physician before starting.
🍞 Specific Carbohydrate Diet (SCD)
Eliminates complex carbohydrates (grains, most dairy, processed sugars) while allowing simple sugars. Some evidence for pediatric and adult Crohn's. Requires significant commitment. Best pursued with dietitian guidance.
🥩 Crohn's Disease Exclusion Diet (CDED)
A structured diet designed to reduce exposure to dietary components that may harm the gut barrier or microbiome (processed foods, gluten, dairy, animal fats) combined with partial enteral nutrition. Strong evidence in pediatric Crohn's, emerging adult data.
🌿 Low-FODMAP diet
Not specifically an IBD diet — it treats functional symptoms (bloating, gas, diarrhea) that often coexist with IBD in remission. Does not reduce intestinal inflammation. Useful when IBS-like symptoms persist despite IBD being in remission.
🥛 Lactose restriction
Lactose intolerance is more common in IBD. Symptoms often improve by reducing lactose intake. Lactase enzyme supplements can help. Calcium and vitamin D supplementation is important if dairy is restricted.
Living with IBD is not just a physical challenge. Anxiety and depression affect up to 30–40% of people with Crohn's or ulcerative colitis — significantly higher rates than the general population. The gut-brain axis is a real bidirectional communication system: GI inflammation affects brain function, and psychological stress can trigger IBD flares.
🧠 Anxiety & depression in IBD
The unpredictability of IBD (fear of flares, accidents, social situations) contributes significantly to anxiety. Depression is closely linked to disease activity — treating the IBD often improves mood. But psychological support is separately important and should not wait.
💬 Cognitive Behavioral Therapy (CBT)
CBT has strong evidence for improving quality of life in IBD patients, reducing anxiety and depression, and improving coping with chronic illness. Gut-directed CBT and hypnotherapy also have data for improving GI symptoms.
🤝 Peer support
Connecting with others who have IBD can be profoundly helpful. The Crohn's & Colitis Foundation offers support groups, online communities, and peer connections. MyCrohns&ColitisTeam is a social network for IBD patients.
🧘 Mind-body approaches
Mindfulness-based stress reduction (MBSR), yoga, and gut-directed hypnotherapy have evidence for improving quality of life in IBD. These are complementary to — not replacements for — medical therapy.
These are the most trusted and comprehensive IBD patient resources available. We recommend these organizations and channels as supplements to your care with our practice.
🏥 Crohn's & Colitis Foundation (CCF)
The leading IBD patient advocacy organization. Free brochures, support groups, nutrition guides, and the IBD Help Center with live specialists available 24/7.
crohnscolitisfoundation.org →
🔬 American College of Gastroenterology (ACG)
Professional GI society with outstanding patient education library covering all GI conditions, treatment guides, and video resources.
gi.org/patients →
🏛️ American Gastroenterological Association (AGA)
GI Patient Center with comprehensive IBD, GERD, liver, and GI cancer resources written by specialists and reviewed for patient accessibility.
gastro.org →
🧬 NIH / NIDDK
National Institute of Diabetes and Digestive and Kidney Diseases — evidence-based patient information on all digestive conditions, research updates, and clinical trial finder.
niddk.nih.gov →
Please follow these instructions prior to your colonoscopy, and also follow the instructions for your specific prescribed bowel preparation below.
- 12 Days Before: Do not eat foods high in fiber — whole grain breads and cereals, fruits, nuts, seeds, quinoa, popcorn, and vegetables (cooked or raw).
- 21 Day Before — Clear Liquid Diet Only: Do not eat solid foods. Drink only clear liquids: water, clear fat-free broth, gelatin, apple or white grape juice, ice pops, carbonated beverages, sports drinks, tea, coffee (sugar okay). No dairy products.
- 3Day of Procedure: Do not eat solid foods.
- 4Medications: If you take daily medications, you may take them with sips of water before your scheduled arrival time. Follow your managing provider's instructions for diabetes and blood thinner medications.
- 5Transportation: Make arrangements for a responsible adult to drive you home. You may NOT leave in a taxi, rideshare, or other transportation service without a responsible adult with you.
FOLLOW THESE INSTRUCTIONS ONLY. DO NOT FOLLOW INSTRUCTIONS ON/IN THE BOX.
Obtain Suflave prep from pharmacy + 2 Dulcolax Laxative tablets.
- 12 Days Before Procedure: Regular diet. Take 2 Dulcolax Laxative tablets at bedtime.
- 2Day Before — Clear Liquid Diet Only: Nothing solid. Avoid all alcoholic beverages.
- 3Day Before at 5:00 PM — First Dose: Open 1 flavor packet into 1 bottle. Fill with lukewarm water to fill line, cap and gently shake. Drink 8 oz every 15 minutes until bottle is empty. Then drink 16 oz of water within the next 1–2 hours. (This must be water — cannot be replaced with another liquid.)
- 4Day Before at 10:00 PM — Second Dose: Repeat same process with second bottle. After finishing, drink 16 oz of water within the next hour.
- 5Nothing by mouth after MIDNIGHT. This includes gum, mints, and chewing tobacco. You may brush your teeth.
Purchase: (4) Dulcolax Laxative tablets · (1) bottle Magnesium Citrate (any flavor) · (1) 8.3 oz bottle MiraLAX or (2) 4.1 oz bottles
- 1Day Before — Clear Liquid Diet Only: Nothing solid. Avoid all alcoholic beverages.
- 2Day Before at 3:00 PM: Take all four Dulcolax Laxative tablets.
- 3Day Before at 5:00 PM: Mix 7 capfuls of MiraLAX with 32 oz of clear liquid (Gatorade or other clear liquid). Drink over 1–2 hours.
- 4Day Before at 7:00 PM: Drink 1 bottle of Magnesium Citrate followed by 8–16 oz of clear liquid over 1–2 hours.
- 5Day Before at 10:00 PM: Mix 7 capfuls of MiraLAX with 32 oz of clear liquid. Drink over 1–2 hours.
- 6Nothing by mouth after MIDNIGHT. This includes gum, mints, and chewing tobacco. You may brush your teeth.
FOLLOW THESE INSTRUCTIONS ONLY. DO NOT FOLLOW INSTRUCTIONS ON/IN THE BOX.
Pick up Sutab prep + 2 Dulcolax Laxative tablets from pharmacy.
- 12 Days Before Procedure: Regular diet. Take 2 Dulcolax Laxative tablets at bedtime.
- 2Day Before — Clear Liquid Diet Only: Nothing solid.
- 3Day Before at 5:00 PM — First Dose (12 tablets): Open 1 bottle. Fill container with 16 oz of water. Swallow each tablet with a sip of water — you may take up to 1 hour. Then drink 2 additional 16 oz containers of water (32 oz total) over 1–2 hours. (Must be water — cannot be replaced with another liquid.)
- 4Day Before at 10:00 PM — Second Dose (12 tablets): Open 2nd bottle. Fill container with 16 oz water. Swallow each tablet with a sip of water over up to 1 hour.
- 5Nothing by mouth after MIDNIGHT. This includes gum, mints, and chewing tobacco. You may brush your teeth.
✅ Clear liquids you CAN have
Water & flavored water · Strained pulp-free juices (apple, white grape) · Coffee or tea (no milk/cream, sugar okay) · Clear broth or bouillon · Kool-Aid · Gatorade & sports drinks · Soft drinks / carbonated beverages · Ensure Clear · Plain Jell-O (no fruit or topping) · Popsicles, Italian ice, snowballs
❌ Items to AVOID
All solid foods · Dairy products (milk, cream, yogurt, ice cream) · Pulpy juices · Alcohol · Red or purple colored drinks or Jell-O (can resemble blood during procedure)
Cancellation Policy
Please call at least 48 hours prior to your scheduled procedure. Failure to do so will result in a $200 cancellation fee.
Covington: 985-871-1721 ext. 443 · Slidell: 985-641-8982 ext. 151
- 148 hours before: Avoid high-fiber foods, fermented foods (yogurt, kefir, sauerkraut, kombucha), and probiotics.
- 224 hours before: Avoid complex carbohydrates — no beans, lentils, whole grains, or starchy vegetables.
- 312 hours before: Fast completely — water only. No smoking. Avoid vigorous exercise.
- 4Morning of test: Do not brush teeth with toothpaste or use mouthwash. No probiotics. Water is fine.
- 5Baseline reading: Take a resting breath sample before consuming anything.
- 6Consume substrate: Drink the lactulose or glucose solution provided, mixed in 8 oz water within 5 minutes.
- 7Readings every 20 minutes for 3 hours. Remain seated between readings — no eating, drinking, or smoking.
- 8Upload results via FoodMarble app and share your report access code with our office.
- 124 hours before: Avoid all dairy and fermented foods.
- 212 hours before: Fast completely — water only.
- 3Substrate: Consume 25g lactose dissolved in 8 oz water within 5 minutes.
- 4Readings every 30 minutes for 3 hours. Record all symptoms (bloating, cramping, diarrhea).
- 124 hours before: Avoid high-fructose fruits (apples, pears, mangoes, watermelon), honey, agave, HFCS.
- 212 hours before: Fast completely — water only.
- 3Substrate: Consume 25g fructose dissolved in 8 oz water within 5 minutes.
- 4Readings every 30 minutes for 3 hours. Record all symptoms.
H₂ — normal
Baseline under 20 ppm. Rise less than 20 ppm throughout. Bacteria are not fermenting the substrate in the small intestine.
H₂ — positive SIBO
Rise of ≥20 ppm above baseline within the first 90 minutes of the lactulose or glucose test.
CH₄ — positive IMO
Any reading ≥10 ppm above baseline suggests intestinal methanogen overgrowth, associated with constipation-predominant symptoms.
Flat-line result
If neither rises meaningfully, SIBO is unlikely. A small number of patients produce hydrogen sulfide (not measurable by standard devices) and may need further evaluation.
Pathology reports use specific medical terminology that can be confusing. Here are the most common findings — explained in plain language.
- 1You will receive a written summary before leaving — including findings, polyps removed, and recommended follow-up interval.
- 2Biopsy results return in 3–7 business days. Our office will contact you.
- 3Diet: Resume regular diet as tolerated. Bloating and gas are expected for 12–24 hours.
- 4Sedation: No driving, alcohol, or major decisions for the rest of the day. Have a responsible adult with you.
- 5If a polyp was removed: Avoid NSAIDs (ibuprofen, Advil, Aleve, naproxen) and aspirin for 7 days. Tylenol is safe for pain.
- 1Mild sore throat is common for 1–2 days. Ice chips, throat lozenges, and soft foods help.
- 2Resume regular diet as tolerated (unless dilation was performed — follow specific instructions given).
- 3Biopsy results return in 3–7 business days. H. pylori results may take up to 2 weeks.
- 4Same sedation restrictions — no driving for the rest of the day.
- 1Labs, imaging, or records ordered today will be reviewed upon receipt. You do not need to call to confirm they arrived.
- 2If a procedure was scheduled, prep instructions will be sent within 2 business days.
- 3New prescriptions may take 24–48 hours at your pharmacy. Contact the pharmacy before calling our office.
Select a condition to learn about symptoms, diagnosis, and treatment. Conditions are organized by category.
The low-FODMAP diet reduces fermentable carbohydrates that trigger IBS symptoms. It is a temporary elimination protocol — not a permanent diet — followed by structured reintroduction.
Phase 1: Elimination (2–6 weeks)
Remove all high-FODMAP foods: garlic, onion, wheat, rye, lactose, apples, pears, legumes, cashews, honey, HFCS.
Phase 2: Reintroduction
Reintroduce one FODMAP group at a time over 6–8 weeks to identify personal triggers. Do not skip this phase.
Phase 3: Personalization
Maintain a diet based on individual tolerances — not a blanket low-FODMAP diet indefinitely.
Best resource
The Monash University FODMAP app is the gold-standard for current FODMAP ratings of specific foods.
✅ Foods to eat
White bread, white rice, pasta, eggs, tender chicken or fish, well-cooked vegetables without skins, canned fruit without seeds, dairy in small amounts.
❌ Foods to avoid
Whole grains, nuts, seeds, raw vegetables, corn, popcorn, dried fruit, berries, beans, lentils, tough meats, foods with skins or hulls.
Days 1–3: Soft diet
Eggs, yogurt, bananas, applesauce, white toast, rice, soft pasta, soup.
Avoid for 7 days
Seeds, nuts, popcorn, raw vegetables, spicy foods, NSAIDs, aspirin. Tylenol is safe for pain.
Grains to avoid
Wheat (all forms: spelt, kamut, farro, durum, semolina), barley, rye, triticale. Oats only if certified gluten-free.
Hidden gluten
Soy sauce, malt vinegar, beer, many condiments, modified food starch, some medications and supplements.
Safe grains
Rice, corn, potatoes, quinoa, buckwheat, millet, certified GF oats, teff, amaranth, sorghum.
Cross-contamination
Use separate cutting boards and toasters. Specify celiac disease when dining out — dedicated fryers and prep surfaces matter.
Rubber band ligation is the most effective office-based treatment for internal hemorrhoids (grades I–III). A small elastic band is placed around the base of the hemorrhoid, cutting off its blood supply. The hemorrhoid shrinks and falls off within 7–10 days.
Who is it for?
Internal hemorrhoids causing bleeding, prolapse, or discomfort that has not responded to dietary and lifestyle changes.
Success rate
Approximately 70–80% effective per session. Most patients require 2–3 sessions spaced 4–6 weeks apart.
What it does NOT treat
External hemorrhoids (outside the anal opening) cannot be banded. Surgical hemorrhoidectomy may be needed for large external or mixed hemorrhoids.
Duration
The banding itself takes only a few minutes — typically performed in the office during a colonoscopy or flexible sigmoidoscopy visit.
- 1If banding is performed at the time of a colonoscopy, follow your standard bowel prep instructions.
- 2If performed as a standalone office procedure, a Fleet enema the morning of the visit is typically sufficient. Follow specific instructions given at scheduling.
- 3Blood thinners: Please discuss blood thinner use with your physician prior to discontinuation.
- 4Eat a light meal beforehand unless instructed otherwise. No sedation is typically required for in-office banding.
- 1Diet: Increase fiber intake (25–35g per day) and fluid intake. A stool softener (docusate) may be recommended.
- 2Activity: Avoid heavy lifting, straining, and strenuous exercise for 48–72 hours.
- 3Pain management: Mild discomfort and pressure for 1–3 days is normal. Tylenol is appropriate. Avoid NSAIDs for at least 7 days.
- 4Band passage: The band and hemorrhoid tissue fall off within 7–10 days. A small amount of blood or tissue in the toilet at that time is normal.
- 5Sitz baths: Sitting in warm water for 10–15 minutes 2–3 times per day can relieve discomfort.
During the procedure
You will be positioned on your side. A small anoscope is inserted to visualize the hemorrhoid. The band placement takes seconds — you may feel pressure but typically not sharp pain.
Immediately after
A sensation of fullness, pressure, or mild aching is normal for 24–48 hours. Most patients return to normal activity the same day.
Days 2–10
The banded tissue gradually shrinks and falls off. Some spotting of blood is expected. Avoid constipation — straining increases bleeding risk.
Follow-up
A follow-up visit is scheduled 4–6 weeks later for additional banding sessions if needed.
Capsule endoscopy allows your doctor to examine the entire small intestine — a region standard endoscopy and colonoscopy cannot reach. You swallow a vitamin-sized capsule containing a tiny camera that takes thousands of photos as it passes naturally through your digestive tract.
Why it's ordered
Obscure GI bleeding, unexplained iron-deficiency anemia, Crohn's disease evaluation, small bowel tumors, celiac disease assessment.
How long?
You wear a recording device for approximately 8–10 hours. The capsule passes naturally in a bowel movement within 24–72 hours.
Is it safe?
Yes for most patients. If you have known bowel narrowing (stricture), swallowing difficulties, or a pacemaker, notify our office before the test.
Sedation needed?
No — you simply swallow the capsule with water. Most patients go about their normal day during the recording period.
- 13–5 days before: Stop iron supplements — iron can coat the bowel lining and interfere with image quality.
- 2Day before: Low-fiber, low-residue diet. Avoid red or orange colored foods and drinks.
- 3Day before after 9:00 PM: Nothing to eat. Clear liquids only (water, white grape juice, plain broth).
- 4Medications: Take essential morning medications with a small sip of water at least 1 hour before swallowing the capsule. Hold GLP-1 medications (Ozempic, Wegovy) — contact our office for guidance.
- 1Arrive and have the sensor belt or vest fitted to your abdomen.
- 2Swallow the capsule with a small amount of water.
- 3First 2 hours: Nothing to eat or drink. Remain upright.
- 4After 2 hours: You may drink clear liquids.
- 5After 4 hours: You may eat a light snack (crackers, toast).
- 6Avoid MRI scans and strong magnetic fields. Avoid strenuous exercise and repeated bending during the recording period.
- 1Resume normal diet and activities once the recording device is returned.
- 2The capsule passes naturally within 24–72 hours. You do not need to retrieve it.
- 3Your physician will review the images (takes several days) and contact you with results.
- 4If you do not pass the capsule within 2 weeks, contact our office. Capsule retention is rare but can occur with strictures.
FibroScan® is a non-invasive, painless ultrasound-based test that measures liver stiffness (fibrosis) and fat content (steatosis). Used as an alternative to liver biopsy for assessing liver damage in NAFLD/MASLD, hepatitis B and C, alcoholic liver disease, and other chronic liver conditions.
Why it's ordered
To assess liver fibrosis stage, monitor disease progression, evaluate fatty liver disease (NAFLD/MASLD), or follow up after hepatitis treatment.
How it works
A probe placed on the skin over the liver sends a mild vibration and ultrasound wave. The speed of the wave indicates liver stiffness. Takes 5–10 minutes.
Is it painful?
No — completely painless. Only a mild vibration on the right side of your abdomen. No needles, no sedation, no radiation.
Limitations
Results may be less reliable with very high BMI, active hepatitis inflammation, or significant ascites. Your physician will factor this into interpretation.
- 1Fast for at least 2–3 hours before the test. Water is fine.
- 2Avoid alcohol for at least 24 hours before your appointment.
- 3Wear comfortable, loose-fitting clothing that allows easy access to the right side of your abdomen.
- 4Continue all regular medications unless instructed otherwise.
Liver stiffness (kPa)
Lower values (under 7 kPa) generally suggest minimal fibrosis. Higher values suggest advancing fibrosis or cirrhosis. Your physician will discuss your specific result in context.
CAP score — fat content
Measures hepatic steatosis (liver fat). Higher scores indicate greater fat accumulation. Used to grade and monitor fatty liver disease.
What happens next?
Depending on results, your physician may recommend lifestyle changes, medication, additional imaging (MRI), or in rare cases, liver biopsy for definitive staging.
Can it replace biopsy?
In many cases, yes. FibroScan reduces the need for invasive biopsy. Biopsy may still be needed when results are inconclusive.
- 1Nothing to eat or drink for at least 6–8 hours before the procedure.
- 2Medications: Take essential medications (blood pressure, heart, seizure) with a small sip of water up to 4 hours before. Hold diabetes medications the morning of the procedure.
- 3Blood thinners: Please discuss blood thinner use with your physician prior to discontinuation.
- 4Sedation: You will receive IV sedation. Arrange for a responsible adult to drive you home.
- 5The procedure takes approximately 10–20 minutes. You will receive a summary of findings before leaving.
EUS combines an endoscope with a high-frequency ultrasound probe to produce detailed images of the GI tract walls and nearby organs (pancreas, liver, bile ducts, lymph nodes). It can also obtain tissue samples (FNA/FNB) from deep structures.
Why it's ordered
Pancreatic cysts or masses, pancreatitis, bile duct stones, submucosal GI tumors, staging of GI cancers, unexplained abdominal pain.
Prep (upper EUS)
Nothing to eat or drink for 6–8 hours. IV sedation is used. Arrange a driver.
Prep (lower EUS)
If examining the rectum or lower GI tract, a bowel prep or enema may be required. Follow specific instructions provided.
If a biopsy is taken
Results return in 5–7 business days. Please discuss blood thinner use with your physician prior to discontinuation.
ERCP combines endoscopy and X-ray imaging to diagnose and treat problems in the bile ducts and pancreatic duct — removing stones, treating blockages, or placing stents.
Why it's ordered
Bile duct stones, strictures, pancreatic duct problems, jaundice, recurrent pancreatitis, or biliary leaks after surgery.
Prep
Nothing to eat or drink for 6–8 hours. IV sedation or general anesthesia is used. You will need a driver — do not drive for 24 hours.
Blood thinners
Please discuss blood thinner use with your physician prior to discontinuation.
After the procedure
Mild sore throat and bloating are common. Eat light foods several hours after. Watch for fever, severe abdominal pain, or jaundice — these require immediate attention.
Early detection is the single most important factor in GI cancer outcomes. Please discuss your personal and family history with your physician to determine the right screening strategy for you.
Colorectal Cancer (CRC)
Colorectal cancer is the 3rd most common cancer in the US. The vast majority arise from adenomatous polyps over 10–15 years — making colonoscopy one of the most powerful cancer prevention tools available.
🗓️ Screening — when to start
Average risk: age 45. High risk (family history of CRC or advanced polyps in first-degree relative before age 60): age 40 or 10 years before youngest affected relative's diagnosis.
🔍 Screening options
Colonoscopy every 10 years (gold standard). Cologuard (stool DNA) every 3 years. FIT (fecal immunochemical test) annually. Positive non-colonoscopy tests require follow-up colonoscopy.
⚠️ Symptoms
Change in bowel habits lasting more than 4 weeks, rectal bleeding, blood in stool, persistent abdominal pain, unexplained weight loss, iron-deficiency anemia.
🧬 Risk factors
Age, personal/family history of polyps or CRC, IBD, Lynch syndrome or FAP, obesity, physical inactivity, heavy alcohol, smoking, red/processed meat consumption.
Pancreatic Cancer
Pancreatic ductal adenocarcinoma (PDAC) is often asymptomatic until advanced stages. Early detection — when surgical resection is still possible — dramatically improves outcomes.
⚠️ Symptoms
Painless jaundice, new-onset diabetes over age 50, unexplained weight loss, mid-back or upper abdominal pain, loss of appetite, light-colored stools and dark urine, acute pancreatitis without clear cause.
🧬 Risk factors
Smoking, obesity, chronic pancreatitis, new-onset diabetes, family history, BRCA1/2, PALB2, ATM, Lynch syndrome mutations, IPMN cysts.
🔬 Diagnosis
CT scan with pancreatic protocol, MRI/MRCP, EUS with FNA/FNB biopsy. CA 19-9 tumor marker useful for monitoring.
🛡️ High-risk surveillance
Patients with strong family history or specific genetic mutations may qualify for surveillance with EUS or MRI — discuss with your physician.
Esophageal Cancer
Two main types: adenocarcinoma (from Barrett's esophagus, related to GERD) and squamous cell carcinoma (related to smoking and alcohol).
⚠️ Symptoms
Progressive dysphagia (solids first, then liquids), unexplained weight loss, chest pain or pressure, hoarseness, chronic cough, vomiting, regurgitation.
🧬 Risk — adenocarcinoma
Chronic GERD, Barrett's esophagus, obesity, male sex, age over 50, smoking, white race.
🧬 Risk — squamous cell
Heavy alcohol use, tobacco smoking, achalasia, caustic ingestion, poor nutrition, HPV.
🛡️ Prevention
Aggressive GERD treatment and Barrett's surveillance are the primary prevention strategies for adenocarcinoma. Smoking and alcohol cessation for squamous cell carcinoma risk.
Gastric (Stomach) Cancer
Incidence has declined in Western countries but remains important to recognize early. H. pylori is the most important modifiable risk factor.
⚠️ Symptoms
Indigestion, persistent nausea, loss of appetite, unintentional weight loss, early satiety, vomiting, black tarry stools, abdominal pain.
🧬 Risk factors
H. pylori infection, smoking, family history, diet high in salted/smoked/preserved foods, atrophic gastritis, intestinal metaplasia, prior gastric surgery, East Asian ancestry.
🔬 Diagnosis
Upper endoscopy with biopsies is the primary diagnostic tool. CT for staging. EUS for local tumor staging.
🛡️ H. pylori & prevention
H. pylori eradication reduces gastric cancer risk. Patients with intestinal metaplasia or dysplasia on gastric biopsies require endoscopic surveillance per guidelines.
Biliary Tract Cancer (Cholangiocarcinoma)
Includes cholangiocarcinoma (bile duct cancer) and gallbladder cancer. Often diagnosed at an advanced stage due to vague early symptoms.
⚠️ Symptoms
Painless jaundice, dark urine, pale stools, right upper quadrant pain, unexplained weight loss, itching (pruritus), fever from biliary obstruction.
🧬 Risk factors
Primary sclerosing cholangitis (PSC), hepatitis B or C, cirrhosis, biliary cysts, IBD (especially UC with PSC), obesity, diabetes.
🔬 Diagnosis
MRCP, CT scan, ERCP with brush cytology, EUS-guided FNA/FNB. CA 19-9 and CEA tumor markers.
🛡️ PSC surveillance
Patients with primary sclerosing cholangitis have significantly elevated cholangiocarcinoma risk. Annual MRCP and CA 19-9 testing is recommended.
Hepatocellular Carcinoma (HCC)
HCC is the most common primary liver cancer. It typically arises in the setting of chronic liver disease or cirrhosis. Regular surveillance in high-risk patients is critical — early detection allows curative treatment.
🧬 Risk factors
Cirrhosis from any cause, chronic hepatitis B (even without cirrhosis), chronic hepatitis C, MASLD/NASH, hemochromatosis, alpha-1 antitrypsin deficiency.
⚠️ Symptoms
Often silent in early stages. When symptomatic: right upper quadrant pain, unexplained weight loss, jaundice, abdominal swelling (ascites), sudden deterioration in a cirrhotic patient.
🛡️ Surveillance — who qualifies
All patients with cirrhosis, chronic hepatitis B meeting criteria, and certain patients with advanced fibrosis. Surveillance: liver ultrasound with AFP every 6 months.
💊 Treatment
Surgical resection, liver transplantation (curative for selected patients), ablation (RFA, microwave), TACE, TARE (Y-90 radioembolization), or systemic therapy (atezolizumab + bevacizumab) for advanced HCC.