Algia asks:
My son is being treated at Penn for cancer of the esophagus, which has spread to his stomach. He is on radiation and chemotherapy (pill form).

I am concerned over the lack of appetite he is now experiencing. I keep impressing upon him the need for essential vitamins to fight the cancer. Are patients educated about the importance of good nutrition?

Anil Rustgi, MD responds:
Esophageal cancer is a malignant (cancerous) tumor of the esophagus, the muscular tube that moves food from the mouth to the stomach. If the patient cannot tolerate surgery or the cancer has spread to other organs, chemotherapy or radiation may be used to help reduce symptoms.

If your son is having difficulty swallowing or has a decreased appetite, the following measures may help:

• Avoiding acidic, salty, spicy and rough foods.
• Drinking liquid nutrition supplements such as Ensure®, Boost®, or Carnation Instant Breakfast® to increase protein and calorie intake.
• Mixing food with butter, thin gravies and sauces to make it easier to swallow.
• Trying soft, blended foods such as casseroles, ice cream, yogurt, cheesecake, mashed potatoes, spaghetti with cream sauce, soups and eggs.
• Trying foods with a variety of tastes and textures. Tolerance for foods constantly changes during treatment.
• Using a blender or trying baby foods.

Lou asks:
I get really bad gas, bloating and flatulence almost every afternoon and into the night. I was originally diagnosed with constipation so I changed to a high fiber diet and also started taking the supplements Metamucil® and miraLAX®.

Now, I usually have a bowel movement every morning without a problem, but the high fiber diet gave me more gas and bloating. The laxatives originally worked, but then they gave me diarrhea. Now I have stopped with the high fiber diet and the laxatives. I still get the bloating and gas in the afternoons and I do not know what to do. Can you recommend a prescription or test for me? 

Anil Rustgi, MD responds:
Most people produce one to four pints of gas a day and pass gas about 14 times a day. Passing gas through the mouth is called belching or burping. Passing gas through the rectum is called flatulence. Most of the time, gas does not have an odor. The odor comes from bacteria in the large intestine that release small amounts of gases that contain sulfur.

Gas in the digestive tract comes from two sources: air that you swallow and the breakdown of undigested food by bacteria in the large intestine. Certain foods may cause gas, including many fruits and vegetables. Foods that produce gas in one person may not cause gas in another. For people with lactose intolerance, avoiding milk products will help. For most people, changing their diet and using a prescription or over-the-counter medication helps alleviate excessive gas.

A Penn gastroenterologist can help you with diet and medication decisions related to chronic gas and bloating. To schedule an appointment, call 800.789.PENN (7366) or request an appointment online.

Arthur asks:
I'm constantly bloated. I have irregular bowel movement and there is a lump formed by the left side of my pelvis. What could be the problem?

Anil Rustgi, MD responds:
I recommend starting with your primary doctor. The lump may or not be the result of a gastrointestinal problem. Your doctor knows you best and based on the details of your symptoms, he or she can help diagnose the problem and if necessary, refer you to Penn Gastroenterology.

Laura asks:
I am a 35 year-old woman with an extreme amount of pain in the upper gastric region. I had my gall bladder removed in 1998. I was recently diagnosed with a sliding hiatal hernia. Can a hernia cause stabbing pain all the time in the upper gastric area?

Anil Rustgi, MD responds:
Hiatal hernias are very common. This condition may cause reflux (backflow) of gastric acid from the stomach into the esophagus. A hiatal hernia by itself rarely causes symptoms — pain and discomfort are usually due to the reflux of gastric acid, air or bile. Reflux occurs more easily when there is a hiatal hernia, though a hiatal hernia is not the only cause of reflux.

The goals of any medical treatment are to relieve symptoms and prevent complications. Reducing the backflow of stomach contents into the esophagus (gastroesophageal reflux) relieves pain in most cases. Medications that neutralize stomach acidity, decrease acid production or strengthen the lower esophageal sphincter (the muscle that prevents acid from backing up into the esophagus) may be prescribed. If these measures failure to control the symptoms, or if complications appear, surgical repair of the hernia may be necessary.

To schedule an appointment with a Penn gastroenterologist who can evaluate your condition and recommend the best course of treatment, please call 800.789.PENN (7366) or request an appointment online.