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or an infection. You may have a CT scan (see page 112) or an ultrasound (see page 111). In rare cases, a doctor will recommend a biopsy, in which samples of cells are taken from the intestine and examined under a microscope, or capsule video endoscopy (see page 767), in which you swallow a small pill containing a camera that takes a video of your small intestine. The doctor may perform a procedure called colonoscopy (see page 767) to examine the colon. If just the lower third of the colon is examined, the procedure is called sigmoidoscopy (see page 144). He or she also may recommend a barium X-ray (see page 767) of your intestines.

Treatment

Irritable bowel syndrome can be difficult to treat because the cause is not clear. Several factors can make the condition worse. Try to identify and avoid substances and situations (including psychological or emotional ones) that you think may be causing your symptoms. Taking steps to avoid indigestion (see page 750) and gastrointestinal reflux disease (GERD; see page 750) may help alleviate some of your symptoms. If you are constipated or have alternating bouts of diarrhea and constipation, your doctor may recommend a high-fiber diet with insoluble fiber (fiber that cannot be broken down by the digestive tract) such as wheat bran. People who have diarrhea or excessive gas may benefit by following a bland diet. In rare cases, a doctor may prescribe antispasmodic medications to help decrease intestinal contractions. If stress is triggering your attacks, your doctor may prescribe antidepressants (see page 712) or antianxiety medications (see page 713) to help reduce symptoms of stress. Do not take any over-the-counter medication unless your doctor has recommended it.

Disorders of the Small Intestine

The small intestine is a tube about 1½ inches in diameter and 14 to 20 feet long. It runs from the stomach to the colon (the longest section of the large intestine). The process of breaking down food into small particles that begins in the stomach continues in the small intestine, aided by the secretion of additional enzymes and digestive juices from the pancreas, the gallbladder, and the wall of the small intestine. When food particles dissolve into their smallest units, they pass through the thin lining of the small intestine into the bloodstream. (Fats pass into the lymphatic vessels in the small intestine before they enter the bloodstream.) The inside surface of the wall of the small intestine is covered with tiny fingerlike projections called villi. These projections make the digestive surface area larger, so that more of the tiny particles can be absorbed.

Common Diagnostic Procedures

Doctors can choose from a number of imaging procedures to diagnose disorders of the digestive tract. Some of these procedures are also used for treating gastrointestinal disorders. Following are descriptions of some of the most common diagnostic procedures.

Endoscopic Procedures

Endoscopes are viewing tubes that doctors use to examine a body cavity. Endoscopes are usually flexible, but some (such as the laparoscope) are rigid. Endoscopes

contain small cameras, instruments with which to take tissue samples or perform medical procedures, and lights or light sources. During an endoscopic procedure, a camera or video recorder can take pictures or transmit images to a monitor. Air may be passed into the digestive tract at the time of the procedure to open up the cavity and provide a clearer image.

Here are some of the endoscopic procedures that are used to diagnose or treat disorders of the gastrointestinal tract:

ENDOSCOPIC PROCEDURES

Procedure Part of Body Examined Where Endoscope Is Inserted

Esophagoscopy Esophagus Into the nose or mouth

Gastroscopy Stomach Into the nose or mouth

Laparoscopy Abdominal cavity Through small incision in abdomen

Colonoscopy Colon Into the rectum

Sigmoidoscopy Lower third of the colon Into the rectum

Anoscopy, proctoscopy, rectoscopy Anus and rectum Into the rectum

Capsule video endoscopy Small intestine Swallowed

Upper