It is helpful to come prepared with questions for your doctor. If you are seeking a second opinion for a chronic, reoccurring condition, be sure to bring information detailing when your symptoms started, how your symptoms have changed over time, and other information you feel is important.

You should also bring:

• Your insurance card
• Your driver’s license
• A list of the medications, and dosages, you are currently taking
• A list of any herbs, supplements, vitamins, or homeopathic medicines

Pertinent prior medical records including operative and pathology reports, laboratory tests, and hospital discharge summaries are also recommended.

Dr. Nowain performs most of his procedures at an outpatient facility named La Peer Health Systems. La Peer is located near the Center for GI Health office in Beverly Hills, CA. Certain procedures may need to be done in a hospital setting at Cedar-Sinai Medical Center.

A colonoscopy is a procedure performed under moderate sedation (patients do not feel anything) where a fiber optic camera is passed into the colon (otherwise known as the large intestine) so that your doctor can remove colon polyps, take samples (biopsies), and visually inspect the interior lining.

A colon polyp is a growth on the inside of the colon that could potentially develop into colon cancer over time if not removed.

Most colon polyps do not present with any symptoms, but can be detected and removed during a colonoscopy. Some advanced polyps may present with bleeding.

Colon polyps develop due to changes in ones DNA. As these changes progress, small polyps can become larger polyps. As the polyp grows, it can harbor more advanced precancerous changes and eventually develop into colon cancer. Since a colonoscopy can detect and remove colon polyps, it can prevent colon cancer from developing.

Early colon cancer may present without any symptoms. As the tumor grows, patients may experience sign and symptoms such as blood in the stools, anemia, constipation or diarrhea, changes in the bowel habit, abdominal pain, and weight loss.

The lifetime risk in the United States of developing colon cancer is 1 out of 24 people (~4%). This risk is about the same in men vs. women. Colonoscopy has been proven to significantly reduce this risk.

The American Cancer Society recommends everyone age 45 and older undergo colon cancer screening. This recommendation lowers the screening age to 45 given the alarming trend of colon cancer developing in patients <50 years of age. See next FAQ for exceptions to this recommendation.

If a 1st degree relative has had a colon polyp or colon cancer, colonoscopy should be performed 10 years before the age of their diagnosis. For example, if your mother had colon polyps or colon cancer at age 45, you and your siblings should begin having colonoscopies at age 35.

Symptoms such as blood in the stools, rectal bleeding, diarrhea, constipation, abdominal pain, iron deficiency anemia, IBD (inflammatory bowel disease.

See our pre-colonoscopy instructions for more information.

Most people tolerate the bowel prep very well. Quite honestly, it does not taste very good (like cough medicine), but if you drink it cold and use lemon or lime wedges to change the taste in your mouth, it goes down easier. Despite the taste, it is better than developing colon cancer.

We use moderate sedation given via IV by a highly trained anesthesiologist so that our patients are asleep and comfortable during the procedure. For patients who are nervous before the procedure, the anesthesiologist can give medication to help cut the edge. The medications are short acting and patients wake up fairly quickly from the time they are turned off at the conclusion of the procedure. A responsible adult needs to be available to drive you home from the surgery center.

Dr. Nowain will meet you before the procedure. He is the one performing the procedure and with the assistance of an anesthesiologist, makes sure that you are safe and comfortable the whole time. After the procedure he will meet you in recovery to review the findings.

Dr. Nowain will meet you in recovery after the procedure and let you know what was seen visually and if any biopsies were taken. If biopsies were taken or colon polyps removed, they are sent to a highly trained GI specific pathologist to give us an accurate diagnosis. These results are available approximately one week after the procedure. Depending on the results, Dr. Nowain may call you or request an in office visit to review the results in detail.

When you need to have another colonoscopy depends on what was found during your latest one. Dr. Nowain will tailor this recommendation for you based on your individual results.

An upper endoscopy or EGD is a procedure performed under moderate sedation (patients do not feel anything) where a fiber optic camera is passed from the mouth into the esophagus, stomach, and to the first part of the small intestine (duodenum). The doctor can visually inspect the interior lining of these areas and take biopsies as necessary.

There are a lot of reasons to perform an upper endoscopy. Some of the most common causes include the workup of heartburn (otherwise known as acid reflux or GERD), upper abdominal pain, difficulty swallowing, diarrhea or malabsorption, and iron deficiency anemia.

Some of the most common findings during an upper endoscopy include esophagitis (inflammation of the esophagus), gastritis (inflammation of the stomach), ulcers, H. Pylori infection (a bacteria that likes to live in the stomach), duodenitis (inflammation of the first part of the small intestine) and celiac disease (allergies to gluten).

The only preparation for an upper endoscopy is that you need to avoid food and water for 8 hours prior to the procedure. We often schedule, these procedures in the morning so that a patient’s last meal is dinner the night before.

We use moderate sedation given via IV by a highly trained anesthesiologist so that our patients are asleep and comfortable during the procedure. For patients who are nervous before the procedure, the anesthesiologist can give medication to help cut the edge. The medications are short acting and patients wake up fairly quickly from the time they are turned off at the conclusion of the procedure. A responsible adult needs to be available to drive you home from the surgery center.

Dr. Nowain will meet you before the procedure. He is the one performing the procedure and with the assistance of an anesthesiologist, makes sure that you are safe and comfortable the whole time. After the procedure he will meet you in recovery to review the findings.

Dr. Nowain will meet you in recovery after the procedure and let you know what was seen visually and if any biopsies were taken. The biopsy specimens are sent to a highly trained GI specific pathologist to give us an accurate diagnosis. These results are available approximately one week after the procedure. Depending on the results, Dr. Nowain may call you or request an in office visit to review the results in detail.

Both men and women are equally likely to develop hemorrhoids.

Pressure on the rectum causes hemorrhoids to form. This pressure can come from prolonged sitting, constipation, straining, and even diarrhea. Pregnancy, obesity, and heavy lifting are also associated with hemorrhoids. During the third trimester of pregnancy- and even more so during the delivery process- the uterus lowers down and puts pressure on the anus and forms hemorrhoids.

Most adults will experience hemorrhoids at some point in their life. People with jobs that require sitting all day, truck drivers, weightlifters, and cyclists are examples of demographics that are more likely to develop hemorrhoids.

Symptoms of internal hemorrhoids include pain, itching, burning, and blood in the stool. If large enough, internal hemorrhoids can prolapse or bulge and cause further discomfort.

No. If internal hemorrhoids expand in size, they can prolapse out of the     rectum and look very similar to external hemorrhoids – making it very difficult to distinguish between the two. That’s why it is very important to have a doctor diagnose your hemorrhoids.

No, hemorrhoids are not a risk factor for colon cancer.

Approximately 50% of adults experience internal hemorrhoids. While hemorrhoids do cause anal bleeding, several other conditions can cause it as well, including colon cancer, inflammatory bowel disease, and anal fissures. Your doctor may want to perform a colonoscopy to determine the exact cause of the bleeding. If you are experiencing anal bleeding, you should contact a GI doctor.

To diagnose hemorrhoids, your doctor will perform a thorough and painless examination. Not all bulges on the outside of the anus are external hemorrhoids. It is possible for internal hemorrhoids to prolapse or bulge out, and most prolapsed internal hemorrhoids can be treated by hemorrhoid band ligation.

Yes – the treatment for internal hemorrhoids and external hemorrhoids are different. See our hemorrhoids treatment page for more information.

Hemorrhoid banding is a treatment option for internal hemorrhoids. It is a quick (less than one minute) office based procedure that places a tiny rubber band above the nerve line, onto the internal hemorrhoid. This causes the internal hemorrhoid to reduce in size over time.

The CRH O’Regan system for hemorrhoid banding, used by Dr. Nowain,     was approved by the FDA in 1997.

There are no nerve endings on internal hemorrhoids, so hemorrhoid band ligation typically does not cause pain. Some patients may experience a mild sensation of fullness, dull pressure, or feel the need to use the restroom temporarily. However, most patients leave the examining room without feeling any discomfort.

Yes, hemorrhoid banding is commonly used to treat hemorrhoids. However, not all hemorrhoid banding procedures are the same. Some are more comfortable, and some have lower risks of complications. Hemorrhoid banding simply refers to placing a band around the hemorrhoid to stop the blood flow. The methods used to handle  the hemorrhoids, as well as the size of the tools, can differ.

There are three areas, called columns, where internal hemorrhoids can occur. The safest way to perform hemorrhoid band ligation is by banding one column at a time during different sessions that are separated by two-week intervals. This minimizes the risk of irritation and allows the procedure to be performed safely. Most patients require an average of three sessions (one on each column) before their hemorrhoids are cured, some patients require less than three sessions, and others require more than three (the same column sometimes needs to be banded more than once). To get the best results, your doctor will tailor your treatment according to your individual needs.

Unfortunately, hemorrhoid banding cannot be performed during pregnancy. Instead we typically use medicated ointments to alleviate symptoms. If you have hemorrhoids and plan on getting pregnant, you should have the hemorrhoids treated beforehand. If left untreated, hemorrhoids can increase in size and frequency, and the strain of pregnancy – which itself can cause hemorrhoids – might make your existing hemorrhoids more severe.

It depends. While healing time from this procedure is brief, we recommend that you take it easy following the appointment. If you have a job that requires vigorous work, we recommend that you take the day off. If you have an office job, you could theoretically return to work later in the day.

Hemorrhoid band ligation is 95% effective for curing internal hemorrhoids. To prevent them from recurring, patients should avoid the habits that  caused the hemorrhoids to occur in the first place. DO: Eat a high fiber diet and consume adequate amounts of water daily. DON’T: Strain during bowel movements or sit for prolonged amounts of time (both  on and off the toilet).

A capsule endoscopy is a non invasive procedure used to view the small intestine. Instead of the doctor inserting an endoscope to look inside the GI tract, you swallow a small pill that contains a light and camera. It takes over 50,000 pictures of your intestines over an 8 to 12 hour period. The pill wirelessly transmits images to a small recorder around you wear around your waist. These images are later downloaded to a computer for the doctor to review. The pill camera is disposable and does not require retrieval.

Some of the reasons that small bowel capsule endoscopies are performed are to look for a cause of iron deficiency anemia, bleeding, small bowel lesions or tumors, Crohn’s disease, and for workup of diarrhea and malabsorption.

The small bowel capsule endoscopy is designed to visualize the small intestine. While it gets a few images from the stomach and colon, it is not adequate to fully assess these areas. Furthermore, there is no way of taking a biopsy or sample with the capsule study, which is often necessary in the stomach and colon.