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Dr. David Purow

Left, Dr. Daniel Jamorabo, gastroenterologist at Stony Brook Medicine and assistant professor of medicine in the Division of Gastroenterology and Hepatology at Stony Brook University’s Renaissance School of Medicine. Right, Dr. David Purow, chairman of Medicine-Gastroenterology at Huntington Hospital. Left by Stony Brook Medicine/Jeanne Neville; right from Northwell Health

No one rushes to make a reservation at a pre-colonoscopy restaurant with a cleansing and well-reviewed special of the day. 

In fact, for most people, the preparation for a potentially lifesaving diagnostic procedure is somewhere between unpleasant and unpalatable.

That, however, may have changed as the U.S. Food and Drug Administration recently approved another incremental improvement in the colonoscopy preparation that could make the preparation and the procedure — which can detect early signs of cancer — less bothersome.

Manufactured by Sebela Pharmaceuticals, Suflave is a low-volume preparation that tastes like a lemon-lime sports drink. It should be available in August.

“Patients really like” Suflave, with about 80 percent finding it palatable, said Dr. Daniel Jamorabo, a gastroenterologist at Stony Brook Medicine and assistant professor of medicine in the Division of Gastroenterology and Hepatology at Stony Brook University’s Renaissance School of Medicine. 

Jamorabo called it a “wonderful addition to the bowel preparations that are out there.”

Jamorabo said the ingredients in most preparations are the same: the difference in the Suflave preparation seems connected to the flavor.

The thinking in the gastrointestinal community is that “we need to find a preparation” that is more pleasant, said Dr. David Purow, chairman of Medicine-Gastroenterology at Huntington Hospital. “That will capture more people who are somewhat reluctant to have a colonoscopy.”

Colonoscopies are a “necessary screening procedure,” Purow added, and health care professionals in the field don’t want the discomfort during preparation to discourage people from getting the procedure.

Indeed, doctors have a much higher success rate with patients when they detect evidence of colon cancer early.

Getting it right

Doctors suggested that the success of preparing for a colonoscopy varies.

Jamorabo estimated that around 10% of patients may not take all the steps necessary to have the screening.

In those circumstances, these patients have to reschedule the procedure and go through drinking fluids that clear out their systems more effectively.

Gastroenterologists urged people to ask questions if they don’t understand any of the steps they need to take to prepare.

For some patients, the COVID-19 pandemic delayed their routine colonoscopy visits, as people stayed away from hospitals and medical care facilities during periods of highest viral infection.

Jamorabo added that colon cancers have started to show up in younger people.

In 2018, the American Cancer Society recommended lowering the age for screenings from 50 to 45.

“It’s showing up more” in people under 50, said Jamorabo. “It may even go lower.”

Doctors discovered stage three colon cancer in late actor Chadwick Boseman before he was 40.

“We don’t know yet” why it’s causing cancer in younger people, Jamorabo added, but “it’s not rare. It’s been going on for a couple of years. We can’t write it off as some statistical anomaly.”

Early symptoms

People can and should be on the lookout for symptoms that might indicate colon cancer.

Unintentional weight loss, such as losing 10 pounds or more in three to four months without changing diet or exercise regimen, could indicate a problem.

Blood in the stool, changes in bowel habits and ongoing constipation could also require medical attention.

More subtle signs, such as fatigue, shortness of breath or decreased appetite, could indicate that people are losing blood in their stool.

As for the overlap between COVID and colon cancer, Jamorabo believes that the ongoing inflammation from the SARS-CoV2 virus could predispose people to cancer.

“I don’t think enough time has elapsed” to know if there’s a link between the virus and colon cancer, he added.

With anxiety building over big-picture issues like global warming and an intensely divided population, people are likely increasingly worried about the state of the world.

“Most gastroenterologists are probably busier than they’ve ever been,” Purow said. “Some of that is probably due to the times in which we are living.”

Stress and anxiety can cause gastrointestinal symptoms that manifest in different ways.

Even with less concern about the pandemic, doctors are still seeing more people with alcoholic liver disease, as some turned to alcohol to relieve their ongoing anxiety.

“We’re trying to expand our network of dietitians and mental health professionals that we’re working with,” said Purow.

Information is power

An important tool in preventing colon cancer involves tracking the colon’s health through colonoscopies.

Having Suflave on the market could “lower the dread” of having a colonoscopy, Jamorabo noted. “We need to make the logistics of the preparation easier.”

Joel Gonzalez, right, with his wife Amanda, daughter Isabella and son Julian. Photo courtesy Gonzalez

Joel Gonzalez was waking up in the middle of the night, gasping for air. During the day, if he ate too quickly, he felt like food was getting stuck in his throat.

In 2018, Gonzalez, who lives in Coram and is a high school counselor, was diagnosed with gastroesophageal reflux disease, or GERD. A small hiatal hernia, in which part of his stomach bulged through an opening in his diaphragm and into his chest, caused the condition.

Gonzalez started taking medications, which helped relieve the symptoms and enabled him to sleep without experiencing discomfort or waking up suddenly.

In August 2022, after learning that his hiatal hernia had gotten slightly larger and deciding he didn’t want to continue taking reflux medicine for the rest of his life, he met with Dr. Arif Ahmad, director of the St. Charles and St. Catherine of Siena Acid Reflux and Hiatal Hernia Centers of Excellence, to discuss the possibility of surgery.

Gonzalez was so convinced that the surgery would help and confident in Dr. Ahmad’s experience that he scheduled the procedure during that first meeting. Since his November surgery, which took about an hour, he hasn’t had any GERD symptoms and is not taking any medication for the condition.

Gonzalez said he would “absolutely” recommend the surgical procedure, which became a “simple decision” after consulting with Dr. Ahmad.

Caused by a mechanical problem with a valve at the bottom of the esophagus called the lower esophageal sphincter that allows stomach acid to enter the esophagus, GERD affects over 20% of the population.

Symptoms of GERD vary, which means doctors can and do take a range of approaches to treatment.

Hospitals, including St. Charles, St. Catherine of Siena, Stony Brook and Huntington Hospital, have been ramping up their efforts to evaluate and treat GERD.

Port Jefferson-based St. Charles and Smithtown-based St. Catherine of Siena, both part of the Catholic Health system, have been expanding these services at the Acid Reflux and Hiatal Hernia Centers of Excellence.

“There is a big need” for this increasingly focused effort to help patients dealing with the symptoms of GERD, said Dr. Ahmad.

At St. Charles and St. Catherine, Dr. Ahmad, who has been doing hiatal hernia and GERD-correcting surgery for over 25 years, created the center to ensure that the nurses on the floor, the people who do the testing, and the recovery staff are aware of the specific needs of these patients.

Dr. Ahmad has done presentations for the staff to ensure they have “the highest level of expertise,” he added.

Dr. Ahmad, also the director of the Center of Excellence in Metabolic and Bariatric Surgery at Mather Hospital, said he could perform surgery, if a patient needs it, at any of the hospitals, depending on a patient’s request.

Stony Brook’s efforts

At the same time, Stony Brook recently created a multidisciplinary Esophageal Center at Stony Brook Medicine, designed to provide a collaborative care model for diagnosing and treating GERD.

The center provides minimally invasive endoscopic treatments as well as surgical options.

Dr. Lionel D’Souza, chief of endoscopy, said the center provides a cohesiveness that “allows an evaluation by a group of people who are experts and can communicate with each other” to provide a patient-specific plan.

Dr. D’Souza suggested people seek medical attention from their primary care physician or gastroenterologist if they experience any of the following conditions: heartburn every day or severe heartburn several times a week, trouble swallowing, food getting stuck in the throat, anemia, blood in the stool or weight loss without another explanation.

Other partners in the Stony Brook GERD Center include Dr. Olga Aroniadis, chief of the division of gastroenterology, Dr. Alexandra Guillaume, director of the gastrointestinal motility center, and Dr. Konstantinos Spaniolas, chief of the division of bariatric, foregut and advanced GI surgery at Stony Brook Medicine and director of Stony Brook’s bariatric and metabolic weight loss center.

“When someone has a lot of excess weight, the chance of developing GERD is a lot higher,” Dr. Spaniolas said. “Sometimes, getting patients through a program to facilitate with weight loss can help [people] avoid GI symptoms, such as heartburn.”

Stony Brook will see patients in different parts of its network and then, depending on the needs, will determine who is best-suited to start their work up and treatment, Dr. Spaniolas added.

While a potential option, surgery is among a host of choices for people who have ongoing heartburn.

Huntington Hospital, meanwhile, will begin offering esophageal motility testing starting in June. Patients can call Northwell Health’s Heartburn and Reflux Center to schedule an appointment.

A team of gastroenterologists, surgeons and dietitians will work with patients at Huntington to determine the cause of GERD and possible treatments, according to Dr. David Purow, chief of gastroenterology.

Soft foods

Those who have surgery return to solid foods gradually.

Marlene Cross, a resident of St. James who struggled with GERD for about a decade, had the procedure in March.

For the first few weeks, she ate primarily liquids, with some protein drinks and puddings. She added Farina and oatmeal to her diet and then could eat flaky fish.

At 83, Cross, who lost sleep because of GERD-induced heartburn, said the surgery was a success.

“I’m not running a marathon, but I’m definitely feeling a lot better,” said Cross, who is a retired teacher’s assistant for special education students.

Cross urged others who might benefit from surgery to “see a specialist and ask questions and do it” if the doctor recommends it. “The younger you do it, the better.”

Stock photo

As travel-related restrictions from COVID-19 continue to ease, people are considering heading out on the road, to the airport, the pier, or the train station, eager to feed their curiosity and hunger about different regions and cultures.

Dr. Daniel Jamorabo is the assistant professor of medicine in the Division of Gastroenterology and Hepatology at Stony Brook University’s Renaissance School of Medicine.
Photo by Jeanne Neville/Stony Brook Medicine

While these travelers may be excited about the flavor of the unknown, their stomachs may not be as thrilled with these journeys, demanding attention at inopportune times or threatening to revolt with the biological equivalent of a magma eruption.

Local gastroenterologists — stomach doctors — urged travelers to take precautions as they prepare for journeys to exotic locations, on cruises or even across the country.

“Depending on where people are traveling, they may need shots,” said Dr. David Purow, a gastroenterologist at Huntington Hospital. Some areas might have a higher incidence of cholera or traveler’s diarrhea, which is typically an E. coli infection, he added. People often refer to it as Montezuma’s revenge.

Purow suggested consulting the Centers for Disease Control and Prevention’s website initially, although the government organization which has coordinated much of the response to the COVID-19 pandemic is considered a conservative organization.

Purow urged travelers to search for whether pathogens are endemic to an area, which could include reading message boards. Those boards, however, can be as reliable as so much of the rest of the material on the web, he said, which means residents should use their own judgment about the reliability of what they read.

Upset stomachs can come from a host of sources, including food that’s been out for an extended period or from various forms of contaminated water.

“Always be wary of foods that are room temperature,” said Dr. Daniel Jamorabo, a gastroenterologist and assistant professor of Medicine in the Division of Gastroenterology and Hepatology at Stony Brook University’s Renaissance School of Medicine. “That’s often how people get food poisoning. Listeria is common in dairy, such as goat cheese.”


Often the source of upset stomachs that can put a porcelain damper on traveling, water can cause problems for travelers.

Prior to becoming a gastroenterologist, Jamorabo himself visited Kenya, where he unwittingly picked up the parasite Giardia, which is also a threat to people drinking creek or river water on camping trips.

Jamorabo was sick for three weeks, which encouraged him on future trips to stick to bottled water during his travels for peace of mind.

When bottled water isn’t accessible, he suggested drinking boiled water or using purifier tablets. Some tablets can take up to two hours to purify a gallon of water, although others, which afford less protection, take 35 to
40 minutes.

Jamorabo said salads or fruits, which are peeled or prepared with sources of water that are hard to track, can be
a problem.

He suggested asking residents whether they have filtration systems in their homes or if they use bottled water.

Purow added that “if there is concern, use bottled water as much as you can.”

What to bring

Doctors suggested that people tend to bring stomach remedies with them when they travel, sometimes even taking them prophylactically.

Purow said some people bring probiotics, which are “unlikely to hurt you and may decrease the chance of getting anything or shortening the duration once it’s acquired.”

Pepto Bismol and Imodium could also help prevent or treat an upset stomach, particularly for people who are anxious travelers and who get so-called “traveler’s diarrhea,” doctors said.

Purow warned that people could get black stools from some of these medications, which could also be a warning sign of a gastrointestinal bleed or ulcer.

Taking these medications for symptomatic relief, however, is “fine” and will “not suppress” the need to remove something from the body, Purow added.

One of the dangers of diarrhea is that it can cause dehydration, as the body loses necessary fluids.

Jamorabo suggested traveling with or searching for Pedialyte as a way to restore hydration.

As for the dangers of going on cruise ships, doctors recommended being careful about touching tongs or servers at buffets that many other travelers, who might have brought their own pathogens with them, might also have handled.

“On these cruises, it’s like traveling in a small city,” Jamorabo said. Stomach bugs can “spread like wildfire.”

“Always be wary of foods that are room temperature. That’s often how people get food poisoning. Listeria is common in dairy, such as goat cheese.”

— Dr. Daniel Jamorabo

Mental health

Even for those who stay at home, people may be struggling with their stomach’s response to the mental health strain created by COVID-19, the Russian attack on Ukraine, and concerns about issues like violent storm and global warming.

Stomach doctors have increasingly referred patients to psychologists and psychiatrists.

“Stress can exacerbate” irritable bowel syndrome, said Purow. Concerns about the state of the world have “unmasked GI symptoms for those who didn’t have it before.”

Purow has seen a significant increase in alcoholic liver disease, as people stuck at home raided their own liquor cabinet amid health threats, lockdowns and economic uncertainty.

Jamorabo said more stressful times can lead to an increase in stomach-related discomfort or symptoms.

“We have to pay attention to what triggers people” to have panic attacks, nausea or diarrhea, Jamorabo added.

An under-treated mood disorder could compound GI-related symptoms.

Focusing on the things people can control can help soothe the stomach, such as sleeping well, exercising and eating a healthy diet.

“Look within yourself for your own mental health,” Purow suggested. Outlets such as bottles of vodka don’t tend to help, while speaking to friends and family and eating right can aid overall health, giving digestive systems relief and resilience.