gastro associates of tidewater patient portal

What are the office hours of Gastroenterology Associates of Tidewater?

Thank you for interest in Gastroenterology Associates of Tidewater. Office hours for all our locations are Monday through Friday, 8:00 am to 5:00 pm. If this is a medical emergency, call 911 or contact your physician immediately. For existing patients, please contact us through our secure Patient Portal!

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Why choose our gastroenterology services?

All of our physicians are board certified gastroenterologists and use the most comprehensive state of the art medical equipment available. We believe in providing state of the art medical expertise with an integrated team approach to healthcare delivery. the finest quality and compassionate care to our patients.

Where can I find a gastroenterologist in Norfolk VA?

search site here: Colonial Gastroenterology 11803 Jefferson Avenue Suite 230. Ph: (757) 534-7701 Digestive & Liver Disease Specialists 885 Kempsville Rd Suite 114 Norfolk, VA 23502. Ph:(757) 466-0165 Gastroenterology Associates 113 Gainsborough Sq., Ste. 100, Chesapeake, VA 23320. Ph: (757) 436-3285

What is portal hypertensive gastropathy?from pubmed.ncbi.nlm.nih.gov

Portal hypertenisive gastropathy (PHG) and GAVE syndrome are recently discovered entities who can be associated with bloodloss from gastrointestinal tract at patients with or without liver cirrhosis. PHG will be developed at 65% of patients with portal hypertension caused by liver cirrhosis but it could be developed at portal hypertension which is not caused by the liver cirrhosis. PHG is often assosiated with portal hypertension patients and presence of esofageal and /or gastric varices. Mechanism of pathogenesis PHG is still not completely cleared up, but regulation of gastric nitric oxide level, postaglandins, tumor necrosis factor (TNF) and epidermal growth factor production could be important factors in development of portal hypertensive gastropathy. Mechanisms who participate in originating of Gastric Antral Vascular Ectasia (GAVE) are also not completly clear. Classic characteristics of this syndrome are red, often haemorrhagic lesions most often located in stomach antrum, and who could result in blood loss. More than 70% of patients with GAVE syndrome have no cirrhosis or portal hypertension. But when liver cirrhosis is present, it is very difficult to make difference between GAVE and PHG. This review will be focused on incidence, clinical importance, etiology, pathofisiology and treatment of PHG, and how to differentiate between GAVE syndrom and PHG in a case that there exists.

What is the pathophysiology of GAVE?from ncbi.nlm.nih.gov

The pathophysiology of GAVE is not fully understood. In patients with cirrhosis, portal hypertension appears not to be essential in its development as patients do not respond to portal pressure-reducing therapies, such as TIPS or surgical shunt 40, 62. Liver insufficiency seems to play a significant role in the development of GAVE because it develops in patients with more severe liver dysfunction 59and it has been shown to resolve after liver transplantation 61, 63. Speculation regarding an accumulation of substances not metabolized by the liver which may induce vasodilatation and/or angiogenesis has been suggested as a posible mechanism 62. The association between GAVE and hormones with vasodilating properties such as gastrin 18, 54, 59and prostaglandin E264has also been suggested. Finally abnormal antral motility 65and mechanical stress 18have also been associated to the pathogenesis of GAVE which is further supported by the antral distribution of the lesions.

What is the best way to diagnose PHG?from ncbi.nlm.nih.gov

Some studies have evaluated alternative non-endoscopic methods for the diagnosis of PHG 31, 32such as MRI or CT although until further evaluation in larger populations is available, endoscopy still remains the chief diagnostic method. In a study evaluating the efficacy of capsule endoscopy in the evaluation of the presence and size of varices, capsule endoscopy was shown to have only moderate sensitivity and specificity for the detection of PHG 33. Future studies should specifically evaluate its efficacy in evaluating not only the presence but also the severity of PHG as capsule endoscopy will be particularly important in the evaluation of lesions in the small bowel.

What are the characteristics of GAVE syndrome?from pubmed.ncbi.nlm.nih.gov

Classic characteristics of this syndrome are red, often haemorrhagic lesions most often located in stomach antrum, and who could result in blood loss. More than 70% of patients with GAVE syndrome have no cirrhosis or portal hypertension.

Where is portal hypertension located?from ncbi.nlm.nih.gov

Its typical location is in the gastric fundus and upper body of the stomach although it can affect the whole stomach and even other areas of the gastrointestinal tract, such as the small bowel or the colon 1-8.

How to treat GAVE?from ncbi.nlm.nih.gov

The most numerous studies evaluating the use of thermoablative methods in the treatment of GAVE are with argon-plasma coagulation which produces thermal coagulation by applying high frequency electric current that is passed through with argon gas without direct contact with the mucosa. Several studies have demonstrated the beneficial effect of this method in patients with GAVE 46, 58, 60, 72-78. The main advantage of argon-plasma coagulation is that it is easy to use and the risk of perforation is lower than with Nd:YAG laser. Large areas of mucosa may be treated in a single session although this is very time consuming. Complications associated to this method are the development of hyperplasic polyps 78-80and gastric outlet obstruction 77, 81. The settings for the electrical power (20 to 80W) and gas flow (0.5-2 L/min) vary throughout the studies. The technique combines both focal pulse and “paint brush”. The sessions should be repeated every 2-6 weeks as needed.

How effective is neodymium yttrium aluminium coagulation?from ncbi.nlm.nih.gov

The use of neodymium:yttrium-aluminium-garnet (Nd:YAG) laser coagulation has shown to be effective in reducing rebleeding and transfusion requirements 54, 56, 68-71. Its main advantage is that it can be applied to a fairly large suface area of the mucosa in a single session and that its hemostatic response may be observed earlier. On the other hand the risk of perforation is greater than with other thermablative approaches such as argon plasma coagulation as the thermal effect penetrates deeper. The Nd:YAG laser is placed 1 cm from mucosa surface and is used with a power setting between 40-90 W with short pulse durations (0.5-1 sec). Sessions should be repeated every 2-4 weeks until the therapeutic goal is achieved.