Ph. 410-730-1000

Can the FODMAP diet help me?

Do you often feel bloated and gassy? The FODMAP diet might help! The FODMAP diet was developed by researchers in Australia as treatment for Irritable Bowel Syndrome (IBS) symptoms.

The acronym FODMAP stands for: Fermentable, Oligosaccharides, Disaccharides, Monosaccharides and Polyols

These are complex names for short chain carbohydrates, which can be poorly absorbed by some people. When these molecules are not well absorbed in the small intestine they pass into the large intestine where they may then be digested/fermented by bacteria. This can cause symptoms such as abdominal bloating and distension, flatulence, abdominal pain, nausea, and changes in bowel habits (diarrhea and/or constipation).

A low FODMAP diet involves eliminating high FODMAP foods from the diet for six to eight weeks, and then gradually reintroducing foods one at a time to determine how you tolerate individual foods.

Studies have shown improvement in IBS symptoms when patients follow a low FODMAP diet.

For more information, please contact the office to schedule at appointment at 410-730-1000.

What is a hiatal hernia?

A  hiatal hernia is a relatively common finding.  A hiatal hernia occurs when part of the stomach migrates up into the chest area.  The stomach is usually located below the diaphragm, a muscular layer that separates the chest and abdominal cavities.  There is an opening in the diaphragm through which the esophagus passes.  This is the same opening that the stomach pushes through when you have a hiatal hernia.  Hiatal hernias occur in two forms.  A sliding hernia occurs when the top of the stomach and the lower part of the esophagus migrate upward into the space above the diaphragm.  The orientation of the stomach does not change.  A paraesophageal hernia occurs when the top of the stomach migrates upward into the space above the diaphragm and lies alongside the esophagus.  This is a less common type of hernia, but it can be serious.  The main concern is that the stomach can twist onto itself and lead to a lack of blood flow to the area.

Hiatal hernias usually do not cause symptoms. Symptoms associated with sliding hiatal hernias tend to be similar to gastroesophageal reflux symptoms, such as heartburn and regurgitation, because the hiatal hernia can cause stomach acid to leak into the esophagus.

Paraesophageal hernias may also be asymptomatic. When they are symptomatic they tend to cause pain that comes and goes, nausea, and a feeling of fullness after eating that occurs earlier than expected.

Hiatal hernias can be seen on imaging tests, such as an xray or during an upper endoscopy, which involves a doctor putting a tube down your throat with a camera attached to the end.

The treatment for a hiatal hernia depends on the symptoms. People who experience acid reflux symptoms can […]

By |May 8th, 2017|Gastrointestinal Disease|Comments Off

What is Irritable Bowel Syndrome (IBS)?

Irritable Bowel Syndrome (IBS) is a chronic digestive disorder.  It is the most commonly diagnosed gastrointestinal illness.  The primary symptoms of IBS are abdominal pain and altered bowel habits, including constipation and/or diarrhea.

What is the cause?

The cause of IBS is currently unclear.  One theory suggests that IBS is caused by abnormal contractions of the intestine.  Another theory suggests that IBS may be triggered by a severe gastrointestinal infection, such as salmonella or camphylobacter.   A third theory suggests that the symptoms may be caused by a food sensitivity or allergy.  Other researchers believe that IBS may be caused by increased sensitivity of the intestines, which in turns causes normal amounts of gas or movement to be perceived as painful.

IBS usually begins in young adulthood, and, in the United States, is more common in women than men.

What are the symptoms?

The most common symptoms of IBS are abdominal pain associated with a change in bowel habits.  Other symptoms include bloating, gas, and belching.  The abdominal pain is usually a cramping sensation and may be located around the navel.  It can vary in intensity and may be associated with emotional stress or eating.  Having a bowel movement may relieve the pain. 

Altered bowel movements can include diarrhea, constipation, or both.  The diarrhea may be associated with urgency and a sensation of incomplete evacuation.  About 50% of individuals with IBS notice the passage of mucus.  The diarrhea of IBS usually does not occur during sleep.   The constipation of IBS may occur intermittently, or last for long periods of time.  It may also be associated with a feeling of incomplete evacuation.

How is IBS diagnosed?

IBS shares similar symptoms with other digestive diseases, including inflammatory bowel disease (such as Crohn’s disease […]

By |April 13th, 2017|Gastrointestinal Disease|Comments Off

Do I have too much bacteria in my gut?

The small bowel, also known as the small intestine, is part of the digestive system that connects the stomach with the large bowel or colon. The main purpose of the small intestine is to digest and absorb food into the body. The small bowel is divided into three parts: the duodenum (which food from the stomach empties into), the jejunum and the ileum (which empties undigested food into the large intestine or colon).

The entire gastrointestinal tract, including the small intestine, normally contains bacteria. The number of bacteria is greatest in the colon and much lower in the small intestine. The types of bacteria within the small intestine are different than the types of bacteria within the colon. Small intestinal bacterial overgrowth (SIBO) refers to a condition in which abnormally large numbers of bacteria are present in the small intestine, and the types of bacteria found in the small intestine is more like the bacteria found in the colon.

What causes small intestinal bacterial overgrowth?

Disorders that affect one or more of the protective mechanisms can lead to SIBO. In general, SIBO can be divided into categorical causes as follows:

Functional and motility disorders — The small bowel has a mechanism for cleansing the small bowel of debris called the migrating motor complex.  This system can be disrupted at times in patients with irritable bowel syndrome, narcotic use, intestinal pseudo-obstruction, diabetes, patients with a history of radiation therapy to the abdomen, and scleroderma.

Anatomic disorders — Anatomic abnormalities can lead to SIBO by causing stasis. Anatomic disorders associated with SIBO include adhesions from previous surgery; strictures due to radiation, inflammatory bowel disease, or tumors of the small bowel; small intestinal diverticulosis; blind intestinal loops; reversed segments; and gastric bypass for the treatment of obesity.

What are […]

The dreaded colonoscopy prep. Why does it matter so much? (And how it has improved!)

Many people dread the preparation required for a colonoscopy. There are many factors involved in the performance of a high quality colonoscopy, and one of the most critical factors is the adequacy of the bowel preparation. The quality of the prep can impact the difficulty, speed, and completeness of the examination.

Dr. Schub has worked hard to improve the prep process as much as possible, with an aim towards reducing the burden on patients and helping more patients obtain a successful colonoscopy. The prep currently consists primarily of Miralax, a tasteless laxative which you will mix into a clear beverage of your choice, and four laxative pills. Since we began using this prep, we have witnessed a reduction in prep-related complaints without a reduction in the quality of the preps. It is important to read through the entire colonoscopy prep instructions well before your procedure date. That way you will know what to expect and can get any questions you may have answered in advance.

A colonoscopy can detect colon cancer before it has spread to other parts of the body. It can also find and remove polyps, growths that can develop into colon cancer. Colon and rectal cancers are the second leading cause of cancer-related deaths in the United States, making colonoscopy one of the most important screening tools we have in our fight against cancer. If you have questions about whether you are due for a colonoscopy please call the office today to discuss further with a  provider.

By |February 7th, 2017|Colon Cancer, Patient Education|Comments Off

New Hepatitis C Treatment

Hepatitis C is a contagious liver disease that ranges in severity from a mild illness lasting a few weeks to a serious, lifelong illness that attacks the liver. It results from infection with the Hepatitis C virus (HCV), which is spread primarily through contact with the blood of an infected person. Hepatitis C can be either “acute” or “chronic.” The Center for Disease Control (CDC) states that an estimated 3.2 million persons in the United States have chronic Hepatitis C virus infection. Most people do not know they are infected because they don’t look or feel sick. The CDC and United States Preventive Services Task Force (USPSTF) recommend screening for HCV infection to adults born between 1945 and 1965 in addition to those at high risk for infection.

Treatment for Hepatitis C has evolved dramatically over the past few years. In recent years several pill based medications have been approved by the Food and Drug Administration (FDA) for treatment of Hepatitis C. These medications have very high cure rates, and minimal side effects.  The new medications eliminate the need to take multiple pills a day or give yourself weekly injections of interferon.

If you are interested in screening for Hepatitis C or treatment options available please call and schedule an office visit.


By |December 27th, 2016|Gastrointestinal Disease|Comments Off


Constipation is a very common complaint. It can be caused by a variety of issues, and can also be idiopathic, which means the cause is unknown.  An evaluation of constipation will include a search for possible causes, as well as the implementation of strategies to correct the problem.  Constipation can be associated with abdominal bloating and distension, and can be a source of great anxiety and frustration.

Dr. Schub has a special interest in helping his patients overcome this issue, and has developed specific and proven treatment strategies.

If you are struggling with this issue, please contact our office for an appointment today so we can begin working with you to resolve this problem.

By |November 3rd, 2015|Gastrointestinal Disease|Comments Off

What is anorectal manometry?

If you suffer from chronic constipation or fecal incontinence, anorectal manometry can help! These problems are often stressful and embarrassing and can greatly impact a patient’s quality of life. Anorectal manometry testing, which is offered in our office, can help diagnose the root cause of the problem and guide potential therapies, including biofeedback. Biofeedback is a treatment technique which allows patient to “see” activity inside their body. This allows a patient to recognize and then improve certain behavior. For example, sometimes individuals with constipation have developed a “paradoxical” response when they attempt to have a bowel movement, during which they contract rather than relax the sphincter muscles when attempting a bowel movement. During a biofeedback session this behavior can be “shown” to the patient on a computer monitor and then corrected. The patient will “see” how their body responds to the normal behavior and re-learn the behavior. Biofeedback can also help patients who suffer from fecal incontinence by improving their ability to hold in stool. Anorectal manometry is painless and takes approximately 20 minutes to complete. There is minimal preparation and you can drive yourself to and from the appointment.

If you suffer from defecation problems, you are not alone. Please call our office today to schedule an evaluation by Dr. Schub so we can help.

Does it matter who does your colonoscopy?


A recent article in the Journal of the American Medical Association (JAMA) evaluated colonoscopy screening programs. A key quality indicator for colonoscopies is the “adenoma detection rate” (ADR). Colon cancer most commonly develops from a type of polyp called an adenoma. Adenomas are found and removed during colonoscopy. In 2014 The New England Journal of Medicine (NEJM) published a study showing a significant reduction in the likelihood of developing colon cancer among patients whose doctors removed a greater number of adenomas. Gastroenterologists who perform colonoscopies have different adenoma “pick-up” rates. In fact, in the NEJM study, the doctors’ adenoma detection rates ranged between 7.4 and 52.5%.

The most recent study by JAMA looked at the lifetime benefits, complications, and costs of colonoscopy screening programs at various levels of ADR. The study looked at data from 57,588 patients who were seen by 136 physicians between 1998 and 2010. The study found that the lifetime incidence of colon cancer, and the likelihood of death from colon cancer decreased as the ADR rates increased. Higher ADR rates were also found to be linked to lower screening costs. The authors attributed this to the avoidance of expensive cancer treatment costs. The study concluded that higher ADR in screening colonoscopy is associated with a lower risk of colon cancer, a lower death rate from colon cancer, and significant cost savings.

Dr. Schub takes great pride in his high adenoma pick-up rate. Make sure you ask your gastroenterologist for his or her adenoma detection rate before scheduling this important procedure!

For more information:

Douglas Corley, Christopher Jensen, Amy Marks, et al., “Adenoma Detection Rate and Risk of Colorectal Cancer and Death,” New England Journal of Medicine. 370:1298-1306, April 3, 2014. DOI: 10.1056/NEJMoa1309086

Reinier G. S. Meester, […]

By |June 25th, 2015|Colon Cancer, News|Comments Off

Fructan Intolerance

Our office currently offers breath tests to check for intolerances to lactose and fructose as well as evaluate for bacterial overgrowth. Now our office is pleased to start offering a breath test for fructan intolerance as well.


Fructans escape digestion in the upper gastrointestinal tract and reach the large intestine virtually intact. In the large intestine fructans are fermented and act as prebiotics. PREbiotics are different from PRObiotics. Probiotics are good bacteria that help keep your digestive system healthy by controlling the growth of harmful bacteria. Prebiotics are carbohydrates that cannot be digested by the human body.  They act like food for probiotics.


For some individuals fructans may contribute to gastrointestinal symptoms such as bloating, gas, or abnormal bowel habits. It is good to know if you are fructan intolerant as simple dietary modifications may improve your symptoms.  A few example of high fructan containing foods are wheat, onions, garlic, broccoli, and artichoke. If you test positive for fructan intolerance we will provide dietary recommendations.


By |April 3rd, 2015|Gastrointestinal Disease|Comments Off