What You Should Know About Colorectal Cancer Home Screenings

What You Should Know About Colorectal Cancer Home Screenings

You may have seen the recent reports regarding people receiving a medical bill from a colonoscopy performed as a follow-up measure after having a positive Cologuard® test. If you haven’t, below are links to the story that appeared in various media.

CBS News: Woman hit with nearly $2,000 unexpected bill for colon cancer screening

U.S. News & World Report: Could Home Test for Colon Cancer Mean a Big Medical Bill to Come?

People: Missouri Woman Billed $1,900 for Colonoscopy After Previously Taking an At-Home Cancer Test

One of the points not featured in the report is that a number of these test results might be false-positive, causing people to be fearful of having colon polyps or cancer and likely facing a medical co-payment even though the outcomes of the colonoscopy are negative.

A recent research investigation administered to 450 people introduced at Digestive Disease Week in May 2021 determined that merely two percent of individuals with a positive stool test had colon cancer. And, two-thirds of the patients had a false-positive outcome, which might have caused additional out-of-pocket expenses for a diagnostic colonoscopy to validate the outcomes of the home test, as explained by the news publications. Alternatively, many insurance policies cover a simple colonoscopy screening performed to identify and minimize the chance of colon and rectal cancer as a preventive approach.

Understanding colon cancer

Colon and rectal, or cancer of the large intestine, claims the lives of over 50,000 patients annually. It’s the second most prevalent form of cancer death in the United States. With early and accurate detection, however, colon cancer is preventable, treatable, and beatable. Because this type of cancer frequently starts off as growths in the colon, known as polyps, detecting and excising such areas of tissue is the optimal way to protect against colorectal cancer. There are three types used to perform colorectal cancer (CRC) screenings:

  1. Fecal Immunochemical Test (FIT) – 30% of large polyps can be discovered
  2. Stool DNA (Cologuard tests) – 42% of large polyps can be detected
  3. Colonoscopy – 95% of large polyps can be identified

It’s important to note that colonoscopy remains the gold standard for detecting polyps in the colon. Furthermore, polyps found throughout the course of a colonoscopy are removed during the procedure, minimizing the requirement to undergo additional procedures.

If potential polyps are identified through a positive FIT or a Cologuard test, a colonoscopy is required to excise the growths. Large colorectal polyps might not be detected with FIT and Cologuard testing. When these growths aren’t found and excised, it increases the possibility of colorectal cancer.

Recently, the U.S. Preventive Services Task Force (USPSTF) recommended that screenings for colorectal cancer begin at age 45 as opposed to 50. This means an additional 22 million people age 45 – 49 should be assessed for colorectal cancer within this year alone. Even though home testing kits may appear to be a more convenient, less expensive process, it’s essential to realize that a colonoscopy exam is the only screening method that has the ability to detect and curtail the development of colon cancer.

Colon cancer identification vs. prevention

Cologuard tests are created to discover cancerous indicators (DNA) in the fecal sample collected. However, in 58% of cases, concerning precancerous growths fail to be identified at all with Cologuard. A screening test, like Cologuard, requires repeating every three years if the beginning test results are negative. Cologuard is known to render a substantial amount of false-negative and false-positive conclusions. In a recent study, two-thirds of the people who underwent the Cologuard home test had false-positive findings. Positive test outcomes following the fecal or blood test require a colonoscopy procedure to verify the results. Because the fecal or blood test is regarded as a “screening” assessment, the subsequent colonoscopy is deemed a “diagnostic” colonoscopy.

A colonoscopy procedure serves to identify and minimize the risk of colorectal cancer, as it identifies over 95% of life-threatening, precancerous polyps and removes them at the procedure time. Colonoscopies can also allow doctors to capture a sample of tissue for testing to conclude more accurately if colon cancer is occurring. As a result, colonoscopies are, by and large, more accurate and provide precautionary benefits by removing any precancerous growths detected in the colon.

The predominant types of colonoscopy procedures include:

Preventive/screening colonoscopies are performed commonly for asymptomatic patients (those with no current or past gastrointestinal (GI) symptoms) who are age 45 or older and wish to undergo a baseline screening to ascertain if they are likely to develop colon and rectal cancer. This form of colonoscopy exam lets the doctor look for any concerning areas in the colon and rectum, be it abnormal cells and growths. During a screening colonoscopy, polyps (which can become malignant) can be eliminated and biopsies can be performed to learn if malignant tissue is present in the colon. A screening colonoscopy is recommended once every ten years for patients between the ages of 45 – 75 having no symptoms and who exhibit no personal or family history of gastrointestinal diseases, colon polyps, or colon cancer. Most insurance plans offer coverage for screening colonoscopies for preventive reasons. It’s pertinent to consult with the insurance carrier before having any procedure to gain an idea of coverage amounts and any estimated out-of-pocket expenses associated with this exam under the insurance plan.

Surveillance colonoscopies are advised if a patient has a history of colon cancer, colon polyps, or GI disease but may be showing no gastrointestinal symptoms either in the past or present. The requirement of a surveillance colonoscopy may range depending on the individual’s personal history. People with a history of colon polyps would have a surveillance colonoscopy and most likely undergo further surveillance assessments at shortened intervals (such as every 2 – 5 years). It’s important to contact the insurance provider prior to receiving any exam to determine what is covered and any estimated out-of-pocket expenses surrounding this exam under the individual’s benefits.

Diagnostic/follow-up colonoscopies are carried out when a patient shows or has a history of gastrointestinal symptoms, polyps, anemias, or gastrointestinal disease or diagnosis. An individual’s medical history and results from any previous colonoscopy procedure(s) establish the need for a diagnostic colonoscopy. For example, if a patient takes a non-intrusive colon cancer screening test, such as FIT or Cologuard, and receives any kind of positive result, a diagnostic colonoscopy would generally be required to validate the outcomes of the screening assessment. Diagnostic colonoscopies commonly result in personal costs. As such, it’s critical to talk with the insurance provider ahead of having any colonoscopy to determine coverage limits and any potential personal financial responsibility.

Patients who are 45 or older should undergo screening for colon cancer as a preventive and baseline measure for future colon health. It’s imperative to realize the variations between available colorectal cancer screenings and what they can reveal. Colonoscopy continues to be the most reliable method of cancer detection and the only form of colon cancer prevention available.

Find out more about colon cancer screenings in Phoenix, AZ

Colon cancer screenings are effective examinations that can save lives. If you have further inquiries surrounding home colon and rectal cancer screenings or want to book a colonoscopy, contact Arizona Digestive Health today. Our Phoenix, AZ gastroenterologists routinely provide colonoscopy exams for colon cancer screening and are here to help you experience long-term digestive health.

Sources:

 

U.S. Preventive Services Task Force. Final Recommendation Statement, Colorectal Cancer: Screening. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/colorectal-cancer-screening

American Society for Gastrointestinal Endoscopy. https://ww-w.asge.org/home/about-asge/newsroom/media-backgrounders-detail/colorectal-cancer-screening

Society Task Force on Colorectal Cancer. The American Journal of Gastroenterology 2017;112:1016-1030. http://doi.org/10.1038/ajg.2017.174

U.S. Food and Drug Administration. Summary of Safety and Effectiveness Data (SSED). https://www.accessdata.fda.gov/cdrh_docs/pdf13/P130017b.pdf

Gastrointestinal Endoscopy Journal, Volume 93, No. 6S: 2021 AB95

How Is Gastroparesis Treated?

How Is Gastroparesis Treated?

August is gastroparesis month. What is gastroparesis?

The term gastroparesis refers to nonmotile stomach. It’s one of the most severe and concerning gastrointestinal (GI) motility problems as it prevents the natural mechanical movement of the stomach muscles. When functioning normally, forceful muscular contractions help food migrate through the gastrointestinal tract. When gastroparesis is present, however, the stomach’s ability to digest food slows considerably or comes to a halt. This can block the proper emptying of the stomach and may lead to other medical issues. The seasoned gastrointestinal (GI) physicians at Arizona Digestive Health in Phoenix, AZ commonly provide treatment for gastroparesis.

What are the signs and symptoms of gastroparesis?

Nearly one out of every 25 people in the United States, including children, develops gastroparesis. The GI condition is more common among females. It’s also more widespread in patients who have been living with diabetes for a long time. Common signs of gastroparesis include:

  • Chronic pain in the abdomen
  • Inconsistent blood sugar levels
  • Frequent nausea
  • Feeling full even with eating very little
  • Vomiting of undigested food
  • Abdominal bloating
  • Poor appetite and unintended loss of weight
  • Heartburn or gastroesophageal reflux (the backup of stomach contents into the esophagus)

Numerous individuals living with gastroparesis may not experience any recognizable symptoms. At times, it occurs briefly and subsides naturally or improves with medical attention. Certain cases may be unresponsive to care.

What factors cause gastroparesis?

Unfortunately, the main source of this GI concern is not always obvious. However, physicians have pinpointed a number of causes that can contribute to gastroparesis, including the following:

  • Damage to the vagus nerve. Diabetic conditions, viral infection, and surgery to the small intestine or stomach can harm the vagus nerve. Essential for managing the intestinal system, the vagus nerve causes the muscles in the gut to contract to move food into the small intestine. An impaired vagus nerve is unable to send proper signals to the muscles in the stomach. In these cases, food can remain in the stomach for a longer period of time as opposed to migrating into the small intestine for proper digestion.
  • Amyloidosis: Amyloidosis is a condition that develops when deposits of protein fibers accumulate in organs or tissues throughout the body.
  • Scleroderma: This condition affecting the muscles, skin, organs, and blood vessels.
  • Medications: Narcotics, high blood pressure medications, certain antidepressants, and allergy medications can result in sluggish gastric emptying and induce gastroparesis-like symptoms. These forms of medications tend to worsen the effects of gastroparesis.

Other complications that may occur from gastroparesis are:

  1. Extreme dehydration. Frequent vomiting could result in a state of dehydration.
  2. Poor nutrition. Appetite loss and repeated vomiting can induce insufficient caloric intake and thwart the ability to digest adequate nutrients.
  3. Undigested food. Food that remains in the stomach can form a hard mass referred to as a bezoar. A bezoar may cause nausea and vomiting and can be fatal if it blocks food from passing into the small intestine.
  4. Unpredictable blood sugar changes. While gastroparesis isn’t a cause of diabetes, frequent variations in the rate and the volume of food migrating into the small bowel could lead to inconsistent blood sugar levels. Such variations in blood sugar have a negative effect on diabetic conditions which, in turn, might cause further issues with gastroparesis.
  5. Reduced quality of life. The health effects of gastroparesis can make it complicated to perform daily tasks and activities.

Diagnosing gastroparesis

Gastrointestinal physicians specialize in treating gastric disorders, such as gastroparesis. In addition to learning about a patient’s symptoms and medical history, a gastroenterologist will complete a physical evaluation and most likely order certain blood screenings, including those performed to assess blood sugar levels. Additional processes utilized to identify gastroparesis could include:

  • Four-hour solid gastric emptying study: This test determines the time it takes food to makes its way through the stomach. Individuals receive a meal that includes a special radioactive isotope. An image of the stomach is performed one minute after the meal is consumed. Additional scans are then captured at the one, two, and four-hour marks post-consumption to examine how the food passes through the stomach and bowels.
  • SmartPill™ motility testing system: With this test, patients swallow a miniature, digestible capsule that houses an electronic device. Once the capsule is ingested and migrates down the digestive system, it delivers gastric information to a receiver kept on the patient. SmartPill mobility testing records and monitors how fast food passes through the GI system.

Treating gastroparesis

Gastroparesis is a long-standing health illness. Treatment usually doesn’t resolve gastroparesis, but it can help to control and manage its symptoms. People living with diabetes need to continually assess and control their blood glucose values to minimize issues with gastroparesis. In some cases, patients with gastroparesis might benefit from medications, like:

  • Erythromycin: This is an antibiotic that causes gastric contractions and assists in propelling food through the gastric tract. Side effects include loose bowels and the risk of developing antibiotic-resistant bacteria if taking the medication for a long time.
  • Reglan: This type of medication also stimulates stomach muscle contractions to help propel food into the small intestine. It can help relieve stomach upset and vomiting. Secondary effects might include loose bowels and, on rare occasions, a serious nerve disorder.
  • Antiemetics: These medications help minimize queasiness.

Some people may be candidates for surgical procedures to treat gastroparesis, including:

  • Gastric bypass: With a gastric bypass, a little pouch is developed from the upper area of the stomach. Half of the small intestine is connected directly to the newly created small pouch. This surgery substantially limits the quantity of food the patient can consume. A gastric bypass might be more effective than either gastric electrical stimulation or medication therapy for patients who are both obese and diabetic.
  • Gastric electrical stimulation: A small device referred to as a gastric stimulator is placed into the abdominal region. This stimulator contains two leads connected to the stomach muscles that administer tiny electric shocks in an effort to help manage the need to regurgitate.

Alternative approaches to treat gastroparesis include:

  • IV Nutrition: During this parenteral, or intravenous, feeding process, nutrients directly enter the bloodstream through a catheter routed into a vein in the chest area. Like a jejunostomy tube, parenteral nutrition is a temporary option for treating advanced cases of gastroparesis.
  • POP: Peroral pyloromyotomy (POP) is a newer treatment during which a doctor inserts a flexible, thin scope in the throat and advances it to the stomach. The doctor then severs the pylorus, or the structure that empties the stomach, allowing stomach contents to migrate into the small intestine more normally.
  • Feeding/jejunostomy tube: In a severe case of gastroparesis, a jejunostomy tube or feeding tube might be appropriate. A special tube is surgically inserted through the abdomen into the small bowel. Liquid nutrients are administered through the tube, which then go straight into the small bowel and enter the bloodstream more quickly. The jejunostomy tube is typically a temporary treatment.

Can a special diet help with gastroparesis?

As per the American College of Gastroenterology, a healthy diet is a pillar of gastroparesis treatment and also serves as a natural approach to managing the condition. In addition, physicians can recommend medication and perform other medical services to improve symptoms of the GI condition. However, these medical therapies work most effectively when following a certain diet. This type of diet includes limiting the consumption of foods that are hard to digest, like high fiber and fatty foods. Doing so can help enhance digestion and reduce the risk of complications associated with gastroparesis.

Should you or a loved one experience gastroparesis signs or symptoms, or complications related to a diagnosis of gastroparesis, we encourage you to visit a Phoenix, AZ gastrointestinal physician near you as soon as possible. Please reach out to Arizona Digestive Health today to schedule a consultation with one of our board-certified gastroenterologists.

Patient Resources:

Article Sources:

https://www.mayoclinic.org/diseases-conditions/gastroparesis/symptoms-causes/syc-20355787

https://my.clevelandclinic.org/health/diseases/15522-gastroparesis