There are a variety of reasons to visit a gastroenterologist or nutritionist. Some of the most common reasons that patients visit our practice include:
- Colon cancer screening
- Upper endoscopy and colonoscopy
- Diagnosis and treatment of Small Intestinal Bacterial Overgrowth (SIBO)
- Excessive belching or flatulence (gas)
- Difficulty swallowing
- Unexplained nausea and/or vomiting
- Abnormal lab results, including anemia or other nutritional deficiencies
- Unintentional weight changes (gains or losses)
- Suspected or newly diagnosed food intolerances and/or celiac disease
- Management of adult Cystic Fibrosis
Read on to learn about the types of services we offer to diagnose and treat these symptoms.
Gastroenterology and Digestive Disorders
Gastroenterology addresses problems that occur anywhere along the digestive tract - from the mouth, throat and stomach through to the small intestine, colon and rectum - as well as those that affect "accessory organs" such as the pancreas, gallbladder and liver.
Problems can be "functional" in nature, meaning that they are related to abnormal function of the tissues, muscles and organs in the digestive system even though their structures appear normal. Problems may also be "pathological" in nature, meaning that they are related to abnormal structure of the tissues, muscles or organs of the digestive system; these can be caused by a variety of factors, including diseases, abnormal growths, bacterial infections, or dietary patterns.
Our practice specializes in diagnosing the nature of your GI or digestive disorder, and treating it with an appropriate and individualized combination of procedures, medicines, lifestyle changes and/or dietary recommendations to help normalize your digestive function and eliminate the symptoms associated with it. Dr. Goldstein is also registered with the New York State Medical Marijuana program, which allows us to use this therapy for indications such as nausea and inflammatory bowel disease when medically appropriate.
"Endoscopy" (which includes gastroscopy and colonoscopy) refers to procedures in which we look inside your digestive tract through the mouth or anus using a thin, flexible tube equipped with a videocamera. It is often used to evaluate symptoms such as abdominal pain, heartburn and diarrhea and can be used to diagnose conditions such as ulcers, celiac disease, diverticulosis, Crohn’s disease, colitis, and digestive system cancers. For your comfort, these endoscopic procedures are conducted under sedation. We recommend colonoscopy as a screening tool for pre-cancerous colon polyps, or gastroscopy to identify precancerous conditions in the esophagus. Endoscopic evaluation is essential to evaluate the GI tract for sources of bleeding or nutrient malabsorption if you are anemic.
Newer technology called "Capsule Endoscopy" allows you to swallow a pill-sized videocamera that enables us to see the small intestine, which is unreachable by conventional endoscopy, and many be required for certain diagnostic purposes.
Most of our services are performed at Carnegie Hill Endoscopy, the first Center of Excellence in the United States for Fuse™ Full Spectrum Endoscopy™. FUSE technology utilizes instruments with a 330-degree view, rather than the traditional 170-degree endoscopic view. This increases the yield of finding colon polyps by a significant percentage, and has many other applications as well.
Nutrition Therapy and Nutritional Counseling
Whether you are facing a new diagnosis that requires diet or lifestyle change, managing a chronic condition that has nutritional implications, or seeking to maintain good health through positive dietary choices, our nutritionist can provide you with individualized dietary counseling to complement your medical treatment and optimize your health.
Nutrition services are provided by Tamara Duker Freuman, MS, RD, CDN, who specializes in:
- Medical nutrition therapy for acute and chronic conditions such as Irritable Bowel Syndrom (IBS), Small Intestinal Bacterial Overgrowth (SIBO), Crohn’s disease, Ulcerative colitis, celiac disease, reflux, digestive system cancers and a variety of digestive and motility disorders
- Therapeutic lifestyle change to prevent or manage diabetes, hypertension and heart disease
- Optimizing nutrition status for people with food allergies, food intolerances and restricted diets. Expertise in low-FODMAP, low-histamine, elimination diets for EoE, gluten free and plant-based diets.
- Nutrition counseling for weight management (gain or loss)
Motility Disorder Testing
A motility disorder is a condition in which one or more muscular functions in your GI tract is abnormal and may prevent proper processing of food and proper digestion.
Such abnormalities can occur anywhere in the GI tract, from your esophagus to your stomach to your intestines, and may result in vomiting from delayed swallowing; nausea/vomiting from abnormally slow stomach emptying; diarrhea from abnormally fast intestinal contractions; constipation from abnormally slow colon transit; or incontinence from weak anal muscles.
There are a variety of diagnostic tests we use in our office to determine whether you have a motility disorder, including Esophageal Manometry, Anorectal Manometry and Colonic Transit Studies. If appropriate, we work closely with radiologists to conduct other motility tests, such as a Gastric Emptying Study or Transenteric Scintigraphy.
Hydrogen Breath Tests
We offer diagnostic breath testing for a variety of conditions, including:
- Lactose intolerance
- Fructose intolerance
- Sucrose intolerance
- Small Intestinal Bacterial Overgrowth (SIBO)
These tests consist of drinking some sugar water and then periodically breathing into a bag.
They need to be conducted on an empty stomach, so we usually schedule patients for the first thing in the morning, before you’ve had anything to eat or drink for the day. The test generally takes place over three hours, and results are often available immediately. If your breath test reveals a food intolerance, our nutritionist is available to meet with you to answer questions and provide guidance regarding necessary dietary changes to manage your condition.
A Urea Breath Test is also available for diagnosis of H. pylori, a common cause of stomach ulcers.
Nutritional Deficiency Testing
Nutrient deficiencies are a common side effect of numerous digestive disorders, and may result from poor intake, excessive losses from diarrhea, vomiting or a previous GI bleed, poor absorption of nutrients, or increased needs due to active inflammation in the body. Vitamin D deficiency and anemias, due to low stores of iron, Vitamin B12 or folate, are quite common,but other vitamin and mineral deficiencies can also occur. If we suspect a possible nutritional deficiency based on your medical or diet history, we may recommend simple blood tests before you leave our offices to check your nutrition status. If you are diagnosed with a nutrient deficiency, our dietitian will collaborate with you and your other healthcare providers to devise the optimal strategy for repletion.
Preventive Care and Internal Medicine
Dr. Goldstein is also certified as an Internist by the American Board of Internal Medicine and acts as a general physician for many patients. He offers routine general medical services such as checkups, EKGs and vaccinations in addition to specialized GI care. Dr. Goldstein is credentialed as a primary care physician with many insurance companies.