In this episode, Dr. Fred Gandolfo delves into the perplexing condition known as a tortuous colon, a common yet challenging issue that often leads to chronic constipation. Dr. Gandolfo explains the anatomy and terminology behind this condition, including its synonyms like redundant colon and dolichocolon, and addresses the frustration faced by both patients and gastroenterologists due to the limited understanding of this ailment.

Dr. Gandolfo answers a listener question from Elizabeth, a 60-year-old woman dealing with a tortuous colon and chronic constipation. He discusses the potential causes, symptoms, and the distinction between a redundant colon as a cause or effect of constipation. The episode explores the average colon length, its variation among individuals, and why women are often more affected by redundant colons than men.

Throughout the discussion, Dr. Gandolfo highlights various treatment options, ranging from dietary changes and laxatives to the potential role of surgery in severe cases. He also touches on the concept of autointoxication and how fecal stasis might stimulate an immune response, leading to non-specific symptoms like brain fog.

Listeners will gain insights into the complexities of managing this condition, the importance of personalized care, and the potential benefits of testing for bacterial overgrowth. Dr. Gandolfo emphasizes the need for patience and collaboration with healthcare professionals to find effective solutions.

Referenced in this episode:

Segmental colon length and mobility study (2015)

Dolichocolon review article (2018)

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In this episode of The Real GI Doc Show, Dr. Fred Gandolfo introduces the concept of direct access colonoscopy, a streamlined approach allowing patients to undergo a colonoscopy without a pre-procedure visit. This initiative is particularly beneficial for healthy individuals aged 45 to 75 who require routine screenings. Dr. Gandolfo discusses the efficiency and convenience of this method, highlighting its potential to reduce unnecessary office visits, save time, and lower healthcare costs.

Dr. Gandolfo reviews the importance of colonoscopy in preventing colon cancer, emphasizing its role as the gold standard in screening. He notes the alarming rise of colon cancer in younger populations, which prompted the reduction of the screening age to 45. By removing polyps during a colonoscopy, the risk of developing colon cancer is significantly decreased.

The episode also outlines who may not be suitable for direct access colonoscopy. Patients with significant medical conditions such as active cardiac disease, severe sleep apnea, or those on blood thinners may require a more thorough pre-procedure evaluation to ensure safety.

Schedule a direct access colonoscopy with Precision Digestive Care 

Referenced in this episode:

- Previous episodes on Cologuard and blood-based tests for colon cancer

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In this episode, Dr. Gandolfo addresses a compelling question from a listener who is curious about the use of GLP-1 drugs, such as Ozempic and Mounjaro, in patients with inflammatory bowel diseases like Crohn's and ulcerative colitis.

Dr. Gandolfo provides a comprehensive overview of GLP-1 drugs, explaining how they function as agonists to stimulate insulin secretion and promote weight loss by altering gut motility and suppressing appetite.

Delving into the potential implications for patients with inflammatory bowel disease, Dr. Gandolfo explores recent studies suggesting that GLP-1 drugs might be well-tolerated and could even offer benefits in reducing bowel frequency for patients who have undergone colectomy. While these findings are promising, he emphasizes the need for further human studies to confirm these effects.

Dr. Gandolfo also addresses common side effects associated with GLP-1 drugs, such as nausea, and reassures listeners about the overall safety of these medications. He highlights the importance of discussing individual risks and benefits with a healthcare provider before starting any new treatment.

Referenced in this episode:

DDW abstract on safety of GLP-1 drugs with IBD

Study of GLP-1 drugs and risk of IBD flare

GLP-1 drugs and possible mechanism of benefit in IBD patients

Pilot study using GLP-1 agonist to reduce diarrhea in colectomy patients

Review of mechanism of action of GLP-1

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Watch this episode on The Real GI Doc Show YouTube channel!

In this episode of The Real GI Doc Show, Dr. Fred Gandolfo delves into a complex patient case submitted by a listener, showcasing the often difficult process of diagnosing and treating chronic gastrointestinal issues.

The episode features a 59-year-old woman who has been experiencing chronic epigastric fullness, bloating, and dependency on laxatives, with no clear diagnosis despite consulting multiple specialists.

Dr. Gandolfo walks listeners through the step-by-step approach a gastroenterologist might take on such a challenging case. He emphasizes the importance of understanding the patient's history, avoiding repetitive tests, and sticking with a trusted physician to ensure a thorough, stepwise evaluation.

The discussion covers potential diagnoses like dyspepsia, gastroparesis, bacterial overgrowth, and the role of psychological factors in GI symptoms.

Listeners will gain insights into the various diagnostic tests available, including blood work, imaging, endoscopy, and breath tests for bacterial overgrowth. Dr. Gandolfo also touches on the therapeutic trials of medications and the potential need for dietary adjustments or specialist referrals.

In addition to the medical discussion, Dr. Gandolfo shares his experience recording the first video episode in his new studio, highlighting the ongoing evolution of the podcast.

Mentioned in this episode:

Episode 4: Bezoars

Episode 24: Sucrose intolerance

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Watch this episode on The Real GI Doc Show YouTube channel!

In this episode of The Real GI Doc Show, Dr. Fred Gandolfo takes on a challenging listener question from David in San Diego, who struggles with anxiety and nausea related to colonoscopy prep.

David's query opens up a broader discussion on the importance of colonoscopy in preventing colon cancer, and the unfortunate lack of an IV alternative for bowel prep. Dr. Gandolfo delves into the various options available, including the limitations of oral prep solutions and some unconventional methods that might be considered in extreme cases.

Dr. Gandolfo emphasizes the significance of addressing anxiety, which not only impacts the ability to undergo medical procedures but also affects overall quality of life. He offers practical advice on managing anxiety and suggests alternative screening methods like Cologuard as a temporary measure.

The episode also sheds light on lifestyle modifications to reduce colon cancer risk, such as adopting a high fiber diet and avoiding smoking and excessive alcohol consumption.

Mentioned in today's episode:

Colonoscopy prep videos on Dr. Gandolfo's YouTube channel

Cologuard podcast episode

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This is a replay of my first guest episode: "The Psychology Behind Healthy Habits: Expert Tips for Real Change With Noreen Vail, PhD."

I spent my podcasting time this week working on my new studio space...excited to start recording there soon! See you next week with new content!

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In this episode, Dr. Fred Gandolfo welcomes a special guest, Dr. Noreen Vail, a licensed psychologist with expertise in behavioral change, to discuss the psychological aspects of making lifestyle changes for managing fatty liver disease. Building on last week's episode about natural treatments for fatty liver, Dr. Gandolfo and Dr. Vail dive into why some patients struggle to make essential changes and how clinicians can better support them.

Topics covered in this episode:

Be sure to subscribe to The Real GI Doc Show for more insights, and reach out with your questions on social media @realgidoc or leave an audio question for Dr. Gandolfo here.

Referenced in today's show- Episode 10: The Natural Way to Treat Fatty Liver Disease at Home

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In this unique episode of The Real GI Doc Show, Dr. Fred Gandolfo takes a moment to reflect on the journey of the podcast and shares exciting future plans. With 25 episodes under his belt, Dr. Gandolfo opens up about the challenges of podcasting, including the importance of listener feedback in shaping the content. He shares his vision for the show, including plans for a dedicated recording space, the addition of video elements, and more engaging interviews. Dr. Gandolfo emphasizes the need for shorter, more dynamic episodes and highlights the popularity of Q&A sessions, encouraging listeners to continue submitting their questions.

Listeners are invited to provide valuable feedback to help steer the direction of the podcast, ensuring it remains relevant and engaging. Dr. Gandolfo also encourages fans to share the show with friends and on social media to expand its reach. This episode is a call to action, inviting the audience to be an integral part of the show's evolution.

Help shape the future of the podcast and join Dr. Gandolfo on this exciting journey!

To contact Dr. Gandolfo by email: [email protected]

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In this episode of The Real GI Doc Show, Dr. Gandolfo dives into the lesser-known topic of sucrose intolerance, just in time for the candy-filled festivities of Halloween.

Many individuals with irritable bowel syndrome (IBS) experience difficulty digesting certain carbohydrates, including sucrose, commonly known as table sugar. Dr. Gandolfo explores the complexities of disaccharidase deficiency, a condition often overlooked in both diagnosis and treatment.

Topics covered in this episode:

• Understanding sucrose intolerance and its impact on gastrointestinal health.

Dr. Gandolfo also discusses the high sugar content in popular Halloween candies and offers insights into how excessive sugar consumption can affect those with and without sucrose intolerance.

References:

Intestinal Disaccharidase Deficiency in Adults: Evaluation and Treatment

Sucrose intolerance in adults with common functional gastrointestinal symptoms

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Royalty Free Music from Tunetank.com Track: A Spooktacular Day by DASAINTZ https://tunetank.com/track/5556-a-spooktacular-day/

In this episode of The Real GI Doc Show, Dr. Fred Gandolfo delves into the common yet often misunderstood issue of rectal bleeding. Rectal bleeding is a frequent cause for visits to healthcare providers and can affect individuals of any age. Dr. Gandolfo uses a real patient case to highlight the importance of understanding and evaluating rectal bleeding, emphasizing the need for proper testing and diagnosis.

• Understanding rectal bleeding and its prevalence across different age groups.

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In this episode, Dr. Gandolfo explores a lesser-known side effect of heavy marijuana use: Cannabinoid Hyperemesis Syndrome (CHS). Although marijuana use is becoming even more prevalent, awareness of this severe vomiting illness still remains low.

Dr. Gandolfo shares a compelling case study of a young patient suffering from CHS, detailing the symptoms, diagnosis, and treatment options available for this condition.

Topics covered in this episode:

• Understanding Cannabinoid Hyperemesis Syndrome and its link to cyclic vomiting syndrome.

Referenced in today's episode:

AGA Clinical Practice Update on CHS (2024)

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