Frequently Asked
Questions

Dr. Azaan Ramani, DO is a dual ABIM board-certified gastroenterologist practicing at Texas Digestive Disease Consultants in Southlake and Baylor Scott & White Medical Center in Grapevine. He specializes in colon cancer prevention, colonoscopy, advanced endoscopy, hepatology, fatty liver disease, gut health, and GLP-1 medication management. He has 9 peer-reviewed publications and trained at Baylor University Medical Center (Chief Resident) and UTHealth Houston (Chief Fellow, AOA inductee).

Dr. Ramani practices at Texas Digestive Disease Consultants in Southlake and Baylor Scott & White Medical Center in Grapevine. He serves patients throughout the Dallas–Fort Worth metroplex including Dallas, Fort Worth, Southlake, Colleyville, Grapevine, Frisco, Plano, Irving, Arlington, and Euless.

Yes. Dr. Ramani holds dual ABIM board certifications in Gastroenterology, Hepatology & Nutrition and in Internal Medicine. He is an Alpha Omega Alpha (AOA) honor medical society inductee, served as Chief Fellow at UTHealth Houston, and was Chief Resident at Baylor University Medical Center.

Insurance is managed through Texas Digestive Disease Consultants and Baylor Scott & White Health. Most major commercial insurance plans and Medicare are accepted. Verify your specific plan with the practice before scheduling — visit the contact page to be connected with the right office.

Visit azaanramani.com/contact to send a direct inquiry, or call Texas Digestive Disease Consultants in Southlake or Baylor Scott & White in Grapevine. Most new GI consultations require a referral from a primary care physician — your insurance plan determines whether one is needed.

The American Cancer Society and US Preventive Services Task Force recommend average-risk adults begin colon cancer screening at age 45. Patients with a family history of colorectal cancer, African American heritage, inflammatory bowel disease, hereditary syndromes (Lynch, FAP), or concerning symptoms should be screened earlier. Colon cancer in adults under 50 has been rising for two decades — earlier screening saves lives.

For average-risk adults with a normal colonoscopy and no polyps, the next screening is typically 10 years. If polyps are found, the surveillance interval is set per the 2020 US Multi-Society Task Force (USMSTF) recommendations — typically 3, 5, 7, or 10 years depending on number, size, and pathology (e.g., 1–2 small tubular adenomas: 7–10 years; 3–4 small adenomas: 3–5 years; ≥1 adenoma ≥10 mm, villous, high-grade dysplasia, or ≥5 adenomas: 3 years). IBD, Lynch syndrome, FAP, and strong family history follow more aggressive schedules — often every 1–2 years.

Colonoscopy visualizes the entire colon, removes polyps during the same procedure, and is the most sensitive screening method. Cologuard is a stool-based DNA test that screens every 3 years; if positive, a colonoscopy is still required. Cologuard misses some advanced polyps and has a higher false-positive rate. For most patients, colonoscopy remains the gold standard for both screening and prevention.

No. Colonoscopy is performed under moderate sedation or anesthesia and is not painful. Most patients have no recollection of the procedure. The most common discomfort is mild bloating or cramping for an hour or two afterward as residual air dissipates. The bowel preparation the day before is typically the most challenging part.

Standard preparation includes a low-fiber diet 2–3 days prior, a clear-liquid diet the day before, and a split-dose laxative (typically half the night before, half the morning of). Avoid red, purple, and orange liquids. Stop iron supplements and certain blood thinners as instructed. Confirm GLP-1 medication (Ozempic, Wegovy, Mounjaro) timing with your GI doctor.

Early colon cancer is often silent — which is why screening matters. When symptoms occur, they include: rectal bleeding or blood in stool, change in bowel habits (new constipation or diarrhea), narrowing of stool caliber, abdominal pain or cramping, unexplained weight loss, persistent fatigue (from iron-deficiency anemia), or a feeling of incomplete evacuation. Any of these in someone over 40 warrants prompt evaluation.

Yes — and rates are climbing. Colorectal cancer incidence in adults under 50 has been increasing approximately 1–2% per year for two decades. The reasons are not fully understood but likely involve diet, microbiome changes, obesity, and environmental factors. Anyone with rectal bleeding, persistent change in bowel habits, or unexplained weight loss — regardless of age — should be evaluated.

Most polyps are removed during the same procedure (polypectomy) and sent to pathology. Pathology determines whether the polyp was hyperplastic (low risk), adenomatous (precancerous), or had high-grade features. Your follow-up surveillance interval is set based on the number, size, and type of polyps found — typically 3, 5, 7, or 10 years.

It depends. The June 2024 multi-society clinical practice update (ASA, ASGE, AGA, AASLD, IFSO, ASMBS) replaced the earlier blanket "hold for 1 week" recommendation with an individualized approach: patients on a stable dose without GI symptoms can typically continue GLP-1 therapy and follow standard fasting (8 hours solids, 2 hours clear liquids). Patients with active GI symptoms, recent dose escalation, or other aspiration risk factors should consider a 24-hour clear-liquid diet and/or holding the medication. Point-of-care gastric ultrasound can directly assess retained gastric contents. Always coordinate timing with your GI office.

The most common GI side effects of Ozempic, Wegovy, Mounjaro, and Zepbound include nausea, vomiting, constipation, diarrhea, and early satiety. Less commonly: gastroparesis, gallstones, and pancreatitis. Most side effects improve with slower dose titration, smaller meals, lower-fat foods, and adequate hydration.

GLP-1 medications inherently slow gastric emptying — that's part of how they work. In some patients, this can become symptomatic gastroparesis, with persistent nausea, vomiting, bloating, and early fullness. Most cases improve when the medication is paused or the dose is lowered, but persistent symptoms warrant gastroenterology evaluation.

GLP-1 receptor agonists have been used for type 2 diabetes since 2005 and have a generally favorable long-term safety profile. Active areas of monitoring include pancreatitis, gallstone disease, and rare cases of medullary thyroid cancer (contraindicated with personal/family history). Discontinuation often leads to weight regain, suggesting many patients require long-term therapy.

MASLD (Metabolic dysfunction-Associated Steatotic Liver Disease) is the new name for what was previously called NAFLD. The terminology was updated in 2023 to better reflect the metabolic origin of the disease. MASLD affects roughly 1 in 4 American adults and is now the leading cause of chronic liver disease in the U.S.

Yes — early-stage MASLD is often reversible. Evidence-based interventions include 7–10% body weight loss, Mediterranean-style diet, reduced added sugar, regular aerobic and resistance exercise, treatment of type 2 diabetes and dyslipidemia, and minimizing alcohol. GLP-1 medications and resmetirom (the first FDA-approved MASH therapy) are emerging treatments. Advanced fibrosis or cirrhosis may not fully reverse but can be stabilized.

ALT and AST are liver enzymes that rise when liver cells are damaged. The most common causes of mild elevation are fatty liver disease (MASLD), alcohol, medications, and viral hepatitis. Persistent elevation warrants a hepatology workup including viral hepatitis panel, autoimmune labs, iron studies, ultrasound or FibroScan, and sometimes liver biopsy.

FibroScan is a non-invasive ultrasound-based test that measures liver stiffness (a marker of fibrosis) and fat content (controlled attenuation parameter). It takes about 10 minutes, requires no sedation, and helps stratify patients with fatty liver disease into low, intermediate, or high-risk categories — often avoiding the need for liver biopsy.

Hepatitis C is now curable in >95% of patients with 8–12 weeks of direct-acting antiviral therapy. Despite this, many people in the U.S. remain undiagnosed. The CDC recommends universal one-time screening for all adults. If you've never been tested, ask your primary care doctor or gastroenterologist.

The strongest evidence-based interventions are: a diverse plant-rich diet (30+ different plants per week), adequate fiber (25–35 g/day), fermented foods (yogurt, kefir, kimchi, sauerkraut), reduced ultra-processed food intake, regular exercise, 7–9 hours of sleep, stress management, and avoiding unnecessary antibiotics. Probiotic supplements have a small role for specific conditions but are not a substitute for diet.

Probiotics have specific evidence-based uses — preventing antibiotic-associated diarrhea, treating C. difficile recurrence, managing some IBS subtypes, and reducing pouchitis. Evidence is much weaker for general "gut health" supplementation. Strain, dose, and indication matter — not all probiotics are equivalent.

For most healthy patients, direct-to-consumer microbiome testing is not yet clinically actionable. The science is rapidly evolving but no commercial test currently provides validated, personalized treatment recommendations. Reliable use cases remain limited to specific conditions (e.g., C. difficile recurrence, post-FMT monitoring).

Top evidence-supported categories: diverse plants (legumes, whole grains, nuts, seeds, vegetables, fruits), fermented foods (yogurt, kefir, kimchi, sauerkraut, miso), polyphenol-rich foods (berries, olive oil, dark chocolate, green tea), and oily fish (omega-3s). Limit ultra-processed food, added sugar, and excess alcohol.

"Leaky gut" refers to increased intestinal permeability — a real biological phenomenon documented in conditions like celiac disease, IBD, and severe illness. However, "leaky gut syndrome" as marketed by wellness brands is not a recognized medical diagnosis and the proposed treatments are largely unproven. If you have GI symptoms, see a gastroenterologist for evaluation rather than self-diagnosing.

IBS (Irritable Bowel Syndrome) is a functional disorder — abdominal pain and altered bowel habits without structural damage. IBD (Inflammatory Bowel Disease, including Crohn's and ulcerative colitis) is a chronic immune-mediated disease causing visible inflammation, ulceration, and bowel damage. IBD requires very different treatment, often including biologics, and carries colon cancer risk that requires surveillance.

GERD (gastroesophageal reflux disease) results from weakness of the lower esophageal sphincter, hiatal hernia, obesity, or delayed gastric emptying. First-line treatment includes weight loss, smaller meals, avoiding late-night eating, head-of-bed elevation, and acid suppression with H2 blockers or PPIs. Refractory cases may need pH testing, manometry, or anti-reflux procedures.

Most rectal bleeding is from hemorrhoids or anal fissures, but it can also be the first sign of colon cancer, IBD, diverticular disease, or vascular lesions. Never assume bleeding is "just hemorrhoids" — especially if you are over 40, have a family history of colon cancer, have changes in bowel habits, or have bleeding mixed with stool. Get evaluated.

Barrett's esophagus is a change in the lining of the lower esophagus caused by long-standing acid reflux. It carries an increased risk of esophageal adenocarcinoma. Risk factors include chronic GERD, male sex, white ethnicity, age over 50, central obesity, and smoking. Surveillance endoscopy with biopsies is recommended at intervals based on dysplasia status.

Helicobacter pylori is a stomach bacterium linked to peptic ulcers, gastritis, and gastric cancer. Testing (breath test, stool antigen, or biopsy during EGD) is recommended for patients with ulcer history, refractory dyspepsia, family history of gastric cancer, or unexplained iron deficiency. Treatment is typically a 2-week course of antibiotics plus PPI.

Hemorrhoids are swollen vascular cushions in the rectum and anus, common with straining, constipation, prolonged sitting, pregnancy, and aging. Most respond to fiber, fluids, sitz baths, and topical agents. Persistent bleeding, prolapse, or pain may require banding, sclerotherapy, infrared coagulation, or hemorrhoidectomy. Bleeding should never be assumed to be hemorrhoids without evaluation.

See a gastroenterologist for: symptoms more than twice a week, inadequate response to 8 weeks of PPI therapy, alarm symptoms (difficulty swallowing, painful swallowing, unexplained weight loss, vomiting, GI bleeding, or iron-deficiency anemia), or risk factors for Barrett's esophagus (chronic GERD plus male sex, age >50, white ethnicity, central obesity, smoking, or family history of esophageal adenocarcinoma). See the GERD page.

PPIs have a generally favorable long-term safety profile when used at the lowest effective dose for the shortest duration needed. Population studies have raised modest associations with kidney disease, fractures, B12 deficiency, magnesium deficiency, and C. difficile, but causation is not definitively established. The 2022 ACG GERD guideline supports continued PPI use when clinically indicated, with periodic reassessment of need.

Long-standing GERD can cause the esophageal lining to change to Barrett's esophagus, which raises esophageal adenocarcinoma risk. ACG recommends one-time screening endoscopy for chronic GERD plus three or more risk factors (male, age >50, white, central obesity, smoking, family history). Once diagnosed, surveillance interval depends on dysplasia status; high-grade dysplasia is treated with endoscopic eradication.

Not always. Empiric PPI is appropriate first-line for classic GERD without alarm features. Endoscopy is recommended for: alarm symptoms (dysphagia, odynophagia, weight loss, bleeding, anemia), inadequate response to 8 weeks of PPI, Barrett's esophagus screening in high-risk patients, or refractory/recurrent symptoms after stopping therapy.

Persistent dysphagia is always worth evaluating. Many causes are benign and very treatable (Schatzki ring, peptic stricture, eosinophilic esophagitis), but progressive dysphagia for solids — especially with weight loss in patients over 50 — can signal esophageal cancer and warrants prompt endoscopy. See the dysphagia page.

EoE is an immune-mediated inflammatory disease of the esophagus, increasingly recognized as a major cause of dysphagia and food impaction in young adults. Diagnosis: endoscopy with biopsies showing ≥15 eosinophils per high-power field. Treatment: PPI, swallowed topical steroids (budesonide or fluticasone), dietary therapy, and dilation when stricture is present.

Dilation is an endoscopic procedure that gently widens a narrowed area of the esophagus — used for peptic strictures, Schatzki rings, EoE-related strictures, and achalasia. Performed under sedation during EGD using a balloon (TTS balloon dilation) or graduated bougie dilators. Most patients eat soft food the same day and return to normal diet within 24 hours. Severe chest pain afterward is not normal and warrants prompt evaluation. See the esophageal dilation page.

Achalasia is a primary esophageal motility disorder with failure of LES relaxation and absent peristalsis. Symptoms: dysphagia for solids and liquids, regurgitation, chest pain, weight loss. Diagnosis: high-resolution manometry. Treatments: pneumatic dilation, peroral endoscopic myotomy (POEM), or laparoscopic Heller myotomy.

Food impaction is a medical urgency. Do not eat or drink anything else. If saliva is being swallowed normally and there is no severe distress, an EGD within 24 hours is needed to remove the food. If there is chest pain, drooling, or inability to manage saliva, go to the emergency department. About half of adult food impactions are from underlying eosinophilic esophagitis or stricture.

Go to the ED for: vomiting blood, persistent black tarry stools (melena), large-volume bright red rectal bleeding, lightheadedness, fainting, or fast heart rate. Chronic mild bleeding (small streaks of blood, occult bleeding, mild melena that has resolved) warrants prompt outpatient evaluation. See the GI bleeding page.

No. Hemorrhoids and anal fissures are common, but colon cancer, advanced polyps, diverticular bleeding, IBD, ischemic colitis, and angiodysplasia present the same way. Bleeding should never be assumed to be hemorrhoids without evaluation — particularly over age 40, with new symptoms, family history of CRC, change in bowel habits, or unexplained weight loss.

In adults — especially men and post-menopausal women — iron-deficiency anemia is most often caused by chronic GI blood loss or impaired absorption. AGA and BSG guidelines recommend bidirectional endoscopy (upper endoscopy + colonoscopy) as the standard initial workup for unexplained IDA. Treating iron without identifying the source can mean missing colorectal cancer, ulcer disease, celiac disease, or vascular lesions. See the iron-deficiency anemia page.

Melena is dark, sticky, tarry stool from digested blood — typically from upper GI bleeding (esophagus, stomach, duodenum) or sometimes the right colon. Distinguish it from dark stool caused by iron supplements or bismuth (Pepto-Bismol). True melena warrants prompt GI evaluation; large volumes or associated symptoms warrant ED visit.

Recent evidence supports alternate-day dosing of oral iron (60–120 mg elemental iron every other day) — better absorption with fewer GI side effects than daily dosing. Take with vitamin C; avoid taking with calcium, antacids, coffee, or tea. Recheck labs in 2–4 weeks. IV iron is preferred for malabsorption, intolerance, severe anemia, or ongoing significant blood loss.

Two main causes: H. pylori infection and NSAID/aspirin use. Less common: Zollinger-Ellison syndrome, Crohn's disease, and stress-related mucosal injury in critical illness. Smoking, alcohol, and stress can worsen ulcers but don't typically cause them on their own. See the peptic ulcer disease page.

Test for H. pylori if you have: peptic ulcer disease (active or history), unexplained iron-deficiency anemia, ITP, MALT lymphoma, family history of gastric cancer, or before starting long-term NSAIDs. Routine screening of asymptomatic adults is not recommended in the U.S. PPIs must be held for 1–2 weeks and antibiotics for 4 weeks before non-invasive testing to avoid false negatives.

Per the 2024 ACG H. pylori guideline, first-line therapy in most U.S. settings is bismuth quadruple therapy × 14 days (PPI + bismuth + metronidazole + tetracycline) given rising clarithromycin resistance. Rifabutin triple therapy (PPI + amoxicillin + rifabutin) is also an acceptable first-line option. Always confirm eradication at least 4 weeks after completing antibiotics with urea breath test or stool antigen.

Gastric ulcers — unlike duodenal ulcers — can occasionally represent malignancy that looks benign on initial appearance. Standard practice: biopsy all gastric ulcers and repeat endoscopy in 8–12 weeks to confirm healing. Persistent gastric ulcers warrant additional biopsies and consideration of surgery. Duodenal ulcers do not typically require routine repeat endoscopy.

Generally no — or only with a co-prescribed PPI. NSAIDs significantly raise the risk of recurrent ulcer and bleeding. If an NSAID is essential, use the lowest dose, shortest duration, consider COX-2 selective, and always with a PPI. Eradicate H. pylori first before resuming long-term NSAIDs.

Diagnosis requires (1) typical symptoms — nausea, vomiting, early satiety, postprandial fullness; (2) upper endoscopy to exclude mechanical obstruction; and (3) confirmation of delayed gastric emptying — most commonly by 4-hour gastric emptying scintigraphy. Wireless motility capsule and 13C breath testing are alternatives. Hold opioids, anticholinergics, and GLP-1 agonists for 48–72 hours before testing — these all slow gastric emptying and can falsely diagnose gastroparesis.

Foundation: small frequent meals (5–6 per day), low-fat, low-residue/low-insoluble-fiber, soft textures during flares, adequate hydration, walking after meals, staying upright during and after meals. Avoid raw vegetables, skins, seeds, popcorn, and dried fruit. Liquid nutrition (smoothies, broths, electrolyte beverages) is sometimes used during severe flares.

It depends on the cause. Post-viral idiopathic gastroparesis can resolve over time. Diabetic gastroparesis often improves with strict glycemic control but tends to be chronic. GLP-1–related usually improves with dose reduction or discontinuation. Refractory cases benefit from pyloric-directed therapies (botulinum toxin, balloon dilation, G-POEM) and gastric electrical stimulation. See the gastroparesis page.

An upper endoscopy (EGD) uses a thin flexible camera to examine the esophagus, stomach, and first part of the small intestine. It is performed under sedation, takes 15–20 minutes, and allows biopsies, polyp removal, and treatment of bleeding. Common indications include reflux, dysphagia, anemia, ulcers, and Barrett's surveillance.

Capsule endoscopy is a swallowed pill-sized camera that records images of the small bowel as it passes through. It is most useful for unexplained GI bleeding, suspected Crohn's disease, and small bowel tumors. The capsule is excreted naturally; no sedation is needed.

Most patients return to normal activities the same evening or next day. You should not drive for the rest of the day after sedation. Mild bloating and gas are common. Resume your normal diet gradually. Heavy work, exercise, and travel are typically fine within 24 hours unless polyps were removed (in which case your doctor may advise restrictions).