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Javier A. Pou, MD, FACG recognized as Fellow by leading gastrointestinal medical society

We provide these infographics, links and resources to help you prepare for your procedure. We also want you to learn about the importance of preventative and corrective care. If you have any questions, please contact our office.

Patient Education Links

Learn more about colorectal cancer
Colorectal Cancer Health Center
What to expect during a colonoscopy
Obesity and Your Gastrointestinal Health
Celiac Disease (CD)
Have a healthy Thanksgiving dinner strategy, nutritionist says
Podcasts about Colorectal Cancer Awareness
Preventative and Corrective Procedures
Bob Corso of WHSV TV3 interviews Dr. Pou

Colorectal Cancer

The CDC's webpage on colorectal cancer in   English   Spanish

Among cancers that affect both men and women, colorectal cancer (cancer of the colon or rectum) is the second leading cause of cancer deaths in the United States. Every year, about 140,000 Americans are diagnosed with colorectal cancer, and more than 50,000 people die from it.

How Can You Reduce Your Risk?

The risk of getting colorectal cancer increases with age. More than 90% of cases occur in people who are 50 years old or older. Colorectal cancer screening saves lives, but many people are not being screened according to national guidelines. If you are 45 years old or older, getting a screening test for colorectal cancer could save your life. Here's how:

  • Colorectal cancer screening tests can find precancerous polyps so they can be removed before they turn into cancer. In this way, colorectal cancer is prevented.
  • Screening tests also can find colorectal cancer early, when treatment often leads to a cure.

What Are the Symptoms of Colorectal Cancer?

Precancerous polyps and colorectal cancer don't always cause symptoms, especially at first. You could have polyps or colorectal cancer and not know it. That is why having a screening test is so important. Symptoms for colorectal cancer may include:

  • Blood in or on the stool (bowel movement).
  • Stomach pain, aches, or cramps that do not go away.
  • Losing weight and you don't know why.

These symptoms may be caused by something other than cancer. If you're having any of these symptoms, the only way to know what is causing them is to see your doctor.

When Should You Begin to Get Screened?

You should begin screening for colorectal cancer soon after turning 50, then keep getting screened regularly until the age of 75. Ask your doctor if you should be screened if you’re older than 75.

Some people are at a higher risk than others for developing colorectal cancer. Having any of these things may increase your risk

  • Inflammatory bowel disease.
  • A personal or family history of colorectal polyps or colorectal cancer.
  • Genetic syndromes, like familial adenomatous polyposis or hereditary non-polyposis colorectal cancer (also known as Lynch syndrome).

If you think you may be at high risk for colorectal cancer, talk to your doctor about when and how often to get tested.

What Are the Screening Tests for Colorectal Cancer?

Several tests are available to screen for colorectal cancer. Some are used alone; others are used in combination with each other. Talk with your doctor about which test or tests are best for you. The U.S. Preventive Services Task Force recommends these tests to screen for colorectal cancer:

  • Colonoscopy (every 10 years).
  • High-sensitivity fecal occult blood test (FOBT), stool test, or fecal immunochemical test (FIT) (every year)
  • Sigmoidoscopy (every 5 years).

How Can I Pay for Screening Tests?

Many insurance plans and Medicare help pay for colorectal cancer screening. Check with your plan to find out which tests are covered for you. To find out about Medicare coverage, call 1-800-MEDICARE (1-800-633-4227).

CDC's Colorectal Cancer Control Program provides access to colorectal cancer screening to low-income, underinsured, or uninsured men and women aged 50–64 years in 25 states and four tribes.


The preceding information is intended only to provide general information and not as a definitive basis for diagnosis or treatment in any particular case. It is very important that you consult your doctor about your specific condition.

Source — CDC Centers for Disease Control and Prevention

Learn more

Make an Appointment for a Screening

Do you know how to reduce your risk of colorectal cancer? The risk of getting colorectal cancer increases with age. Colorectal cancer screening saves lives, but many people are not being screened. The first step is yours … contact our office to make an appointment.

Make an appointment

What to expect during a colonoscopy

Prep. Sedation. Procedure. Post-Procedure.

This educational video for GI patients, produced by the ACG Institute for Clinical Research and Education, underscores the lifesaving importance of colorectal screening by colonoscopy. The video instills confidence in patients about the effectiveness, safety and importance of colonoscopy. Featuring the experience of a female patient, we follow her through the day of her exam. The video reviews all clinical information regarding colonoscopy and urges viewers to follow all instructions from their health care providers.

The button opens the ACG Institute website. Press play on the video player. The video runs for 6 minutes 40 seconds.

What To Expect

Obesity and Your Gastrointestinal Health

What is obesity and how is it measured?

Obesity Patient Education Pamphlet [PDF] by the American College of Gastroenterology

Obesity is a term used to describe body weight that is significantly greater than what is considered healthy. If you are obese, you have a higher amount of body fat compared to lean muscle mass. Importantly, obesity is a diagnosis, not a judgment of character.

One of the simplest and most accepted ways to measure obesity involves calculation of the body mass index (BMI). BMI is a determination of body fat based on height and weight. Adults with a BMI of 25 to 29.9 are considered overweight while those with a BMI of 30 or more are considered obese. Obesity can be further classified as Class I, II or III depending upon the degree of increase in BMI over 30. Class III obesity is sometimes referred to as extreme obesity. Morbid obesity is when an obesity-associated complication (see below) exists in an individual with any class of obesity. BMI does have some limitations - it may overestimate body fat in those with a muscular build and it may underestimate body fat in those who have lost muscle mass.

What Causes Obesity?

Obesity occurs when you eat more calories than you use doing activities - your body stores the difference. A calorie is a unit of energy in food and drink. Your body needs energy to be healthy and active but if you take in more energy than your body uses, over time you will gain weight. Be aware that eating a diet consisting of low-fat or low-carbohydrate/sugar foods without accounting for the total number of calories consumed can result in weight gain! In addition to eating, activity level and exercise habits, a person's weight is a result of many factors including the environment and culture in which they live, their family history and genetics, and how their body uses the energy consumed ('metabolism').

Can Obesity Be Prevented?

Maintaining a healthy weight requires a balance of the calories consumed from foods and beverages with the calories expended through physical activity and normal metabolism. Healthy foods can provide adequate nutrition and an appropriate number of calories and developing healthy eating habits can lead to healthier favorite dishes and reduced calorie-rich temptations.

To promote healthy eating habits:

  • Eat plenty of vegetables, fruits, and whole-grain products.
  • Include low-fat or non-fat milk or dairy products.
  • Choose lean meats, poultry, fish, lentils, and beans for protein.
  • Serve reasonably-sized portions.
  • Drink lots of water.
  • Limit fruit juice and sodas.
  • Limit consumption of sugar and saturated fat.

Remember that small changes every day can lead to significant benefit over time. In addition to healthy eating, an active lifestyle will help maintain your weight. Choosing to add more physical activity to your day will increase the amount of calories your body burns. This makes it more likely that you'll maintain your weight.

Download pamphlet


The preceding information is intended only to provide general information and not as a definitive basis for diagnosis or treatment in any particular case. It is very important that you consult your doctor about your specific condition.

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What is Celiac Disease (CD)?

Celiac Disease (CD)

What is Celiac Disease (CD)?

Celiac Disease (CD) is a chronic (long-term) digestive disease in which patients have inflammation or irritation of the small intestine, which causes difficulty with absorbing nutrients from the diet. Patients with CD often have other family members with the condition and are therefore susceptible to this disease. Inflammation in the bowel occurs when a patient with CD begins to eat food that contains gluten. Gluten is the name given to certain types of proteins found in wheat, barley, rye and related grains. Oats are currently considered not to be toxic to persons with CD. However, due to the high possibility of contamination with other gluten containing grains, oats are typically not recommended for people with celiac disease.

When food containing the gluten protein arrives in the small bowel, the immune system reacts against the gluten, causing an inflammatory reaction in the wall of the bowel. The small intestine lining is covered by millions of villi, finger-like projections, which act to increase the surface area of the intestine allowing increased absorption of nutrients. The villi are damaged by the inflammation in CD, which results in a decrease in the absorption of food. When gluten is removed from the diet inflammation is reduced and the intestine begins to heal. The time when a patient develops symptoms varies from patient to patient after their first contact with the gluten protein. In many cases is may be decades before symptoms and signs develop, often precipitated by a trigger.

How common is Celiac Disease?

Approximately 1 out of every 100 people may have CD though only 1 out of 10 people with celiac disease may be actually diagnosed and are aware that they have this disease. Some of these patients have mild forms of the disease and may have no symptoms or only mild symptoms. There may be as many as 2-3 million people in the United States and 20 million in the world with CD.

Who does Celiac Disease affect?

CD affects many ethnicities, whites with the highest prevalence in Caucasians. Infants and children may have celiac disease, but CD is more commonly diagnosed in adulthood, and people can be diagnosed even in their seventies or eighties. Females are more likely to be diagnosed with celiac disease than males. Individuals that have type 1 diabetes, thyroid disorders, or relatives with CD are at greater risk for developing CD.

What are the main symptoms of Celiac Disease?

The symptoms or signs of celiac disease are highly variable. Some people have mild inflammation with few symptoms. Even though they may feel quite well there is still damage occurring to the lining of the bowel. Other people have more severe inflammation, which causes symptoms that may be severe enough to lead them to visit their doctor. Occasionally individuals will not have any symptoms at all even though their small intestine is severely inflamed.

The most common symptoms and signs (consequences) are:

  • Abdominal pains
  • Bloating and gas
  • Diarrhea
  • Stools that may float or smell very bad
  • Weight loss
  • Poor growth or weight loss in children
  • Anemia (low blood count)

Other symptoms and signs (consequences) are:

  • Feeling weak
  • Fatigue
  • Low vitamin levels - especially iron, calcium and folate
  • Bone and joint pains
  • Osteoporosis (bone thinning)
  • A skin rash that lasts
  • Infertility
  • Neurological Deficits (neuropathy)
  • Liver enzyme abnormalities

Someone with celiac disease may have a variety of the above symptoms and different people with celiac disease may have completely different symptoms. Celiac disease can mimic the symptoms of more common problems and be misdiagnosed as Irritable Bowel Syndrome (IBS). It is now recommended that patients with symptoms be tested for celiac disease.

How is Celiac Disease diagnosed?

It is important to remember that most patients with abdominal pain, bloating or diarrhea do not have celiac disease. In order to test for celiac disease with blood tests and/or endoscopy the doctor should suspect celiac disease as the cause for the symptoms. When the doctor thinks that celiac disease is possible, but not very likely, then blood tests alone are done. If the blood tests are normal, other tests are rarely necessary. Sometimes the doctor strongly suspects that the symptoms are due to celiac disease, or another similar illness, and will request an endoscopy and biopsy (sampling of the tissue of the small intestine). All tests for celiac disease, except for genetic tests, must be done while the patient is on a normal diet that contains gluten. Patients who are concerned that they may have celiac disease should not restrict their diet prior to seeking medical evaluation because this may cause false negative test results.

Blood tests:

Specific antibody blood tests are used to diagnose patients with CD. These blood tests are also used to test people who may be at risk for having CD but have no symptoms (relatives of patients with CD). The 2 most used tests are the endomysial antibody and tissue transglutaminase antibody tests. Other tests such as tests for gliadin antibodies are not as accurate because they can be abnormal in healthy patients who do not have celiac disease or in people with other digestive problems. Other tests for allergies will not detect celiac disease. Tests on saliva or stool for antibodies are not good substitutes for the blood-based tests. Genetic tests are available to assist doctors when the blood tests are unclear, or when patients continue to have symptoms while on a gluten free diet.


Establishing a firm diagnosis of CD requires taking biopsy samples of the small bowel using endoscopy. Endoscopy involves insertion of a thin flexible tube through the mouth into the stomach and small bowel. Samples are taken from the wall of the small bowel and are examined under a microscope for changes of CD. This test is usually performed with the aid of sedatives.

How is Celiac Disease treated?

Celiac disease is treated by avoiding all foods that contain gluten. Gluten is what causes inflammation in the small bowel. When this is removed from the diet, the bowel will heal and return to normal. Dieticians with expertise in gluten free diets are essential for educating patients and tailoring diets. Medications are not normally required to treat CD except in occasional patients who do not respond to a gluten free diet. There are many CD support groups available for patients and family members.

Gluten Free Diet:

The following grains contain Gluten and are NOT ALLOWED IN ANY FORM:

  • Barley
  • Einkorn
  • Kamut
  • Rye
  • Spelt
  • Triticale
  • Wheat

Frequently overlooked foods that often contain gluten:

  • Basting
  • Pastas
  • Breading
  • Imitation bacon
  • Broth
  • Imitation seafood
  • Coating mixes
  • Marinades
  • Commercial cereals
  • Processed meats
  • Communion wafers
  • Sauces
  • Croutons
  • Stuffings

Getting used to the gluten free diet requires some lifestyle changes. The key to understanding the gluten free diet is to become a good ingredient label reader. If a food has questionable ingredients avoid it and find a similar product that you know is gluten free. Foods containing the following ingredients are questionable and should not be consumed unless it is verified that they do not contain or are not derived from prohibited grains. These products are:


  • Modified food starch
  • Hydrolyzed vegetable protein (HVP)
  • Hydrolyzed plant protein (HPP)
  • Malt vinegar
  • Soy sauce or soy sauce solids
  • Brown rice syrup
  • Dextrin
  • Textured vegetable protein (TVP)
  • Vegetable gum

Be aware that medications may contain gluten ingredients. Gluten containing fillers may be in both prescription and over the counter medications. It is essential to ensure that any medications being taken are gluten free.


  • Beans
  • Quinoa
  • Buckwheat
  • Rice
  • Corn
  • Sorghum
  • Millet
  • Soy
  • Nut Flours
  • Tapioca
  • Potatos
  • Tef

For how long do you remain on the gluten free diet?

Once a diagnosis of CD is established, these individuals need to remain on the gluten free diet for the rest of their lives. While this may be difficult at first, patients usually adapt quite well over time. Dieticians will assist in the dietary transition.

Is there any other way of treating Celiac Disease?

No. There is no other treatment currently available. All patients with CD must remain on a strict gluten free diet. Medications are not normally required. Supplemental vitamins, calcium and magnesium may sometimes be recommended but patients are advised to check with their physician about these supplements. Rarely steroids or other drugs are used to suppress the immune system but only in the most severe of cases.

If you have questions about Celiac Disease, contact our office to set up an appointment. We want to help you to manage this disease.


The preceding information is intended only to provide general information and not as a definitive basis for diagnosis or treatment in any particular case. It is very important that you consult your doctor about your specific condition.


Have a healthy Thanksgiving dinner strategy, nutritionist says

Registered dietitian Tamara Duker Freuman says smart strategies for preparing Thanksgiving dinner for guests who may have food allergies or intolerances begin with vegetarian side dishes, which means not having to have a second vegetarian main dish. She advises using lactose-free dairy products, as little wheat as possible in recipes and offering a gluten-free and nut-free pie for dessert.

By Tamara Duker Freuman
November 13, 2012

Hosting Thanksgiving dinner these days is not for the faint of heart. As the guest list grows, so too does the list of dietary restrictions.

There have always been your vegetarian cousin and your uncle with diabetes. But this year, your sister with Irritable Bowel Syndrome (IBS) is bringing her gluten-intolerant boyfriend, and your nephew with the nut allergy will be joining you. Mom called to remind you that your dad's cholesterol is through the roof, so please go easy on the saturated fat when cooking this year. Oh, and did she mention she's just been diagnosed with lactose-intolerance?

Take a deep breath, and put away the Excel spreadsheet. Hosting a successful and delicious Thanksgiving meal for a digestively diverse crowd doesn't necessarily translate into more work. It just means you need to get smart on strategies that make each dish meet the needs of most people at the table. Here are some tips to get started:

Keep the side dishes vegetarian

By making most—or all—side dishes vegetarian-friendly, you save yourself the work of having to come up with a separate vegetarian entrée for the non-meat eaters. Your veggie guests will leave full and satisfied if they can fill their plates with all the vegetable and grain-based dishes you prepare. So use vegetable stock instead of chicken stock in stuffing (and leave out the sausage); use kosher (gelatin-free) marshmallows in the sweet potato casserole, and use smoked paprika instead of bacon to flavor roasted Brussels sprouts. (Alternatively, you can serve bacon-infused sauces or dressings that can be served on the side if you just can't envision Thanksgiving without bacon!)

Use lactose-free products in all recipes that call for dairy

Lactose-free versions of milk, plain yogurt, and sour cream are available nationwide, and lactose-free plain kefir—a thick, drinkable yogurt—is a great stand-in for heavy cream. This swap won't affect the taste or texture of your dishes at all, but it will make them much more comfortable to digest for guests with IBS and lactose intolerance. Plus, lactose-free kefir is a lower -calorie and lower-cholesterol alternative to heavy cream. As a result, your weight-watching relatives can feel much less guilty about having a nibble of mashed potatoes or a slice of pumpkin pie. Note that aged cheeses (cheddar, Parmesan, etc.) and butter are virtually lactose-free; moderate portions of foods containing these ingredients should be well-tolerated by most guests.

Minimize the presence of wheat flour at the table, and consider whole-grain, gluten-free alternatives

Traditional bread-based stuffing isn't doing anyone any favors—it's a no-go for diabetics as well as weight-conscious and gluten-intolerant guests. Why not use wild rice or quinoa as the base for a healthier and more nutritious stuffing loaded with traditional flavors like chestnut, mushroom, sage, and thyme? A dish like this also adds substance to a vegetarian meal. Separately, note that wheat flour is found in many store-bought convenience foods used in holiday fare—French's French Fried Onions, for example, to top green bean casserole or Campbell's Cream of Mushroom soup for the gravy. If you use these ingredients in your recipes, try seeking out gluten-free substitutes, or serve them on the side whenever possible to avoid contaminating the whole dish for those who must avoid gluten. If you're making gravy from scratch, swap all-purpose flour for sweet rice flour to make it gluten-free. Easy as pie!

Speaking of pie, make sure to offer at least one dessert that can be enjoyed by the gluten-free and nut-free crowd

If apple and pecan pies are already on the menu, why not offer pumpkin in an alternative form, like individual custards or gluten-free quick bread? How about a flourless chocolate cake or chocolate-dipped poached pears? Living Without magazine publishes a terrific holiday edition full of allergy-friendly recipes, and a simple Google search will yield recipes for hundreds of allergy-friendly desserts that can be enjoyed by everyone at the table. Alternatively, gluten-free baking mixes for cookies, cakes, and brownies—most of which are also nut-free—are widely available in supermarkets nationwide and help you whip up another dessert in no time flat. As if it needed to be said, fresh fruit is always an appropriate and safe option for ending an indulgent holiday meal. Simply offering a bowl of clementines or platter of fresh grapes is a gesture that will be appreciated by guests with dietary restrictions, and those watching their weight or blood sugar levels.

The downside of hosting a wildly successful holiday meal in which everyone feels included, of course, is that they're likely to come back next year. Consider yourself warned!

Tamara Duker Freuman, MS, RD, CDN, is a NYC-based registered dietitian whose clinical practice specializes in digestive disorders, Celiac Disease, and food intolerances. Her book, The Bloated Belly Whisperer, focuses on healthy eating and gluten-free living.

If you have questions about gastro distress, contact our office to set up an appointment. We want to help you feel better!


The preceding information is intended only to provide general information and not as a definitive basis for diagnosis or treatment in any particular case. It is very important that you consult your doctor about your specific condition.

Source: The Bloated Belly Whisperer

Preventative and Corrective Procedures

Javier A. Pou, MD, FACG recognized as Fellow by leading gastrointestinal medical society

Through our investment in training and technology, we are dedicated to providing our patients with the best environment for preventative and corrective procedures.


Colonoscopy — lets your doctor examine the lining of your large intestine (the colon) for abnormalities.

Hemorrhoid Banding

CRH O'Regan Hemorrhoid Banding System — utilizes a non-surgical, patented device that is: fast (as little as 60 seconds), painless (return to work the same day), proven, easy (no anesthesia, fasting or other prep), and covered by most insurance plans.


Upper Endoscopy — lets your doctor examine the lining of the upper part of your gastrointestinal tract, which includes the esophagus, stomach and duodenum (first portion of the small intestine).

We are here to answer your questions.

Dr. Pou is approachable and patient. Our procedure metrics surpass national benchmarks.

Bob Corso of WHSV TV3 Interviews Dr. Pou about colonscopy advice

A change to address the unknown — 6 GIs react to U.S. Preventive Services Task Force's recommendation to lower CRC screening age to 45

The U.S. Preventive Services Task Force proposed lowering the colorectal cancer screening age to 45 in response to growing early-onset CRC rates. In the news article linked below, six gastroenterologists discuss how the change will affect their practice.

Shenandoah Valley Gastroenterology was the first GI practice to validate the changes in screening colonoscopy to age 45 as seen in an interview of Dr. Pou on WHSV.

Watch Dr. Pou Interview on WHSV Reaction from 6 Gastroenterology Practices

Make an Appointment for a Screening

Do you know how to reduce your risk of colorectal cancer? The risk of getting colorectal cancer increases with age. Colorectal cancer screening saves lives, but many people are not being screened. The first step is yours … contact our office to make an appointment.

Make an appointment