5 Things you should know from a Gastroenterologist if you are over 45 years old in 2023

Dr. Paulo Pacheco went to Brown University Medical School, did his internal medicine residency and gastroenterology fellowship at NY Presbyterian Hospital – Weill Medical College, and is currently an attending physician at NYU Langone Medical Center. After completing his medical training, he received a master’s degree at Cornell University in Clinical Epidemiology and Health Services research. He is also the author of the book entitled Living with Chronic Heartburn: The Complete Health Guide to Acid Reflux and Gastroesophageal Reflux Disease.

1. Get screened for colon cancer starting at age 45 for average risk individuals

Colon cancer is one of the highest causes of cancer death in both men and women in the United States and this disease is preventable by screening. There are several ways to screen for colon cancer, however a colonoscopy provides the most comprehensive and thorough approach. A colonoscopy can easily detect precancerous colon polyps as well as colon cancer. It also provides the ability to remove these growths during a short painless and safe procedure. A colonoscopy is typically performed while you are comfortably sleeping and typically takes 20-45 minutes on average. Since colon cancer has been seen more frequently at a younger age, screening guidelines have changed from starting at age 50 to now starting at age 45 for average risk individuals. Those with a strong family history may have to be screened sooner.

 2. If you have frequent heartburn (acid reflux or GERD), speak to your doctor about this and get help

Acid reflux can be a chronic and recurrent condition that can worsen over time and cause irreversible damage to your esophagus.  Since it is very common to experience this in the general population due to the American diet and lifestyle, it often goes underdiagnosed and under or untreated. It can become more problematic with increasing age and can cause irreversible precancerous changes in the esophagus called barrett’s esophagus.  Because there is easy access to over the counter remedies, many patients overlook the importance and potential risks of this condition and don’t seek medical advice. This can cause classic symptoms of heartburn or burning under your sternum, but it can also cause chronic cough, sore throat, hoarseness and even asthma type symptoms and difficulty swallowing in some patients. Treatments include dietary and lifestyle modifications, weight loss, avoidance of certain reflux inducing foods, medications and even surgery for more severe cases. Being seen and discussing this with your gastroenterologist can reduce your long term risk and allow you to live a more comfortable life free of heartburn. 

3. Get screened for fatty liver disease by seeing your doctor at least once a year to check your liver enzymes

Fatty liver disease is a condition that exists when fat builds up in your liver. A lot of people who have fatty liver don’t know it because it does not cause any symptoms. There are two main types of fatty liver: non-alcoholic fatty liver disease (NAFLD) and alcoholic fatty liver disease, also known as alcoholic steatohepatitis. This is often detected from a basic liver panel sent by your primary care provider. It doesn’t cause major problems for most people, but it can turn into a more serious problem if it progresses to cirrhosis of the liver. If you are diagnosed with fatty liver, you should see a gastroenterologist or liver disease expert who can help you reduce your risk. The greatest risk factors are obesity or overweight status, alcohol use or abuse and diabetes, but even those without these major risk factors can have fatty liver. The best ways to reduce this risk is avoidance of alcohol, weight loss, and exercise. Although there is currently no medication proven to cure this condition, there is extensive ongoing research to try to find a pharmacological treatment for patients with this condition.

4. Reduce alcohol and smoking exposures

Several diseases and cancers of the gastrointestinal tract are related to both alcohol exposure and/or smoking exposure. Alcohol and tobacco can individually increase the risk of several cancers, but combined use increases the risk even further.  Excess alcohol or tobacco can increase the risk of gastric cancer, esophageal cancer, colon cancer, liver cancer, pancreatic cancer as well as oral and throat cancers. Since cancers also increase with increasing age, avoidance or reduction is important. Avoidance of alcohol and tobacco can also have other benefits such as improving sleep, dental disease, bad breath, and better skin, while keeping our bones stronger as we age. If patients do not want to stop drinking alcohol for social reasons and enjoyment, I often recommend alternating an alcoholic beverage with a non-alcoholic beverage option when attending a social event to reduce overall exposure and risk.

5. Diet and exercise are important to good gastrointestinal health

Like in other major areas in medicine, exercise and diet play a critical role in good gastrointestinal health. Obesity and overweight status, a diet low in natural fiber and high in saturated fat, and a sedentary lifestyle can all lead to poor health outcomes by the time we are 45 years old and older. Exercise and a good healthy well-balanced diet can also reduce the risk of such diseases such as intestinal and gastrointestinal cancers, fatty liver and cirrhosis, acid reflux and barrett’s esophagus. It also provides ample benefits by helping to provide patients with lower risks of diabetes and obesity related illnesses as well as helping to provide us with stronger bones and reducing the risk of bone loss as we age. It also provides patients overall good health, better sleep and stress reduction. 

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