Hepatobiliary and Pancreatic Disease Program
The prefix "hepato" refers to the liver, the body's largest internal organ and one of its most indispensable. The pancreas works closely with the liver, and proper functioning of both organs is critical to good health.

A New Specialty
Hepatobiliary and pancreatic (HBP) diseases and their treatments are interrelated on so many levels they have spawned a new specialty in medicine. The HBP surgeon deals primarily with pancreatic cancer and benign and malignant disease of the liver and bile ducts. Newly evolving diagnostic technology has resulted in advanced treatments for these diseases. Medical staff specialists treating these diseases include biliary endoscopy, interventional radiology, pathology, medical oncology and radiation oncology.

This multidisciplinary approach for the treatment of HBP is available through the Hepatobiliary and Pancreatic Disease Program and is essential to the treatment of hepatobiliary and pancreatic cancer. In addition to expertise in all of the required medical specialties, the program offers:

• Multidisciplinary consensus HBP conferences to discuss patients' diagnoses and treatments. Physicians on the medical staff hold these conferences weekly. Surgeons, gastroenterologists, radiologists, pathologists, medical oncologists and radiation oncologists attend this conference to review the diagnosis and treatment for some individual cases. This multidisciplinary approach provides assistance with some patient diagnosis and therapeutic planning as needed.
• Participation in clinical trails for new procedures, medical devices and therapeutic trials. Clinical trails to study new drugs and devices are essential for the advancement of care of HBP diseases because of the relatively low incidence of these diseases. The HBP Program serves as one of several site for clinical trials involving experimental devices and was one of several sites nationwide included in the initial application of radiofrequency ablation of liver tumors. This treatment, performed by physicians on the medical staff, is becoming standard care for many solid organ tumors. Physicians on the medical staff also enroll patients into national protocols for adjuvant chemoradiation for various HBP cancers.
• Access to advanced surgical, radiological and GI lab facilities. The HBP program continues to acquire, test and refine new technology. Facilities include advanced equipment and technology, surgical suites, GI Lab, diagnostic imaging and interventional radiology.
• Access and referrals to support group meetings. The Pancreatic Cancer Support Group meets on the PHD campus the second Monday of each month. For more information, call 214-345-4054. For information about the location of other pancreatic cancer support groups, visit www.pancan.org.

Surgical suites feature the latest equipment including radiofrequency tumor ablation, intraoperative ultrasound and advanced laparoscopic technology. In addition, physicians on the medical staff at PHD performed more Whipple procedures than any other hospital in North Texas. The Whipple is one of the most complex and demanding operations being performed today. The GI lab has endoscopic ultrasound and biopsy capabilities as well as endoscopic retrograde cholangiopancreaticography (ERCP) for the diagnosis and treatment of hepatobiliary and pancreatic diseases. Positron emission tomography (PET) scan, magnetic resonance imaging (MRI) and magnetic resonance cholangiopancreaticography (MRCP) are also available.

• Partially due to their low incidence, hepatobiliary and pancreatic diseases are increasingly recognized as being under treated, and patients should be referred to a hospital where the latest treatment options are available.

For a referral to the HBP Program at Presbyterian Hospital of Dallas, call 1-877-THR-WELL (1-877-847-9355).

Follow this link for more information about HBP and pancreatic cancer.

Inflammatory Bowel Disease Program
Inflammatory bowel diseases (IBD) are common digestive disorders. IBD involves conditions and disease that cause inflammation of the small and/or large intestine, including ulcerative colitis and Crohn's disease. Physicians diagnose Crohn's disease and ulcerative colitis through the following evaluations:

• Medical history and physical exam including stool studies
• Lab blood tests
• Colonoscopy with biopsy
• Flexible sigmoidoscopy  

Ulcerative colitis is a chronic disease that is characterized by ulcers and inflammation of the large intestine. While medication can be successful in the majority of cases, bowel resection surgery is required in a few cases.

Crohn's disease has symptoms that are very similar to ulcerative colitis, but Crohn's can affect the entire GI tract from the mouth to the rectum. Treatment options for this condition include medications, infusion therapy and surgery.

The hospital's team of health care professionals provides IBD information and outreach support on topics including:

• Diagnostic testing, including capsule endoscopy 
• Medication information and options
• Surgical options, including laparoscopic colon surgery 
• Nutritional support · Monthly support group meetings
• Latest research programs
• Genetic testing and counseling

Colorectal Cancer Program
The Colorectal Cancer program at Presbyterian Hospital of Dallas is dedicated to the prevention, diagnosis and treatment of colon cancer. Excluding skin cancers, colorectal cancer remains the third most common cancer in the United States. According to research supported by the National Cancer Institute and the Centers for Disease Control and Prevention, this type of cancer starts as a small growth called a polyp long before symptoms appear. Screening tests can find polyps that can be removed before they turn into cancer.

The American Cancer Society estimated the following statistics regarding colorectal cancer:

• 105,500 new cases of colon cancer each year
• 42,000 new cases of rectal cancer each year
• 57,100 estimated deaths each year from the two cancers combined

Diagnosis and Treatment
It is extremely important to find colorectal cancer early when the chance of being survival is good, according to the National Cancer Institute. Procedures for the diagnosis and treatment of colorectal cancer performed by physicians on the medical staff at Presbyterian Hospital of Dallas include:

• Colonoscopy 
• Anal Nanometry/Pap Smear
• Flexible Sigmoidoscopy
• CT scan
• Barium enema
• Radiation and chemotherapy
• Open and laparoscopic surgery 

Follow this link to read about one patient's journey

Call 1-877-THR-WELL (1-877-847-9355) to schedule an appointment with the Colonoscopy Clinic.

GERD/Peptic Ulcer
Physicians on the medical staff are dedicated to the diagnosis and treatment of gastroesophageal reflux disease (GERD) and peptic ulcers. Physicians on the medical staff use advanced diagnostic tools to create a care plan tailored to meet patient's specific needs.

GERD occurs when stomach acid flow back into the esophagus because the esophageal sphincter does not close properly. Stomach acid irritates the lining of the esophagus and causes heartburn, a burning sensation in the chest or throat. Fluid may even be tasted in the back of the mouth.

Signs of Trouble
Having the occasional bout of heartburn does not necessarily mean a person has GERD. But frequent heartburn should be checked by a doctor as it may lead to more serious health problems. Additional symptoms may include pain in the chest, hoarseness or trouble swallowing. GERD can also cause a dry cough and bad breath.

Getting Help
Physicians on the medical staff, who are experts in treating GERD, utilize the latest diagnostic tools and procedures to help patients with GERD. A diagnosis can be made through endoscopy with or without biopsy, pH studies, and in some cases, barium X-rays.

A patient's care depends on their personal medical condition, but may include:

• Lifestyle changes
• Medication
• Laparoscopic surgery

Peptic Ulcers
Peptic ulcers develop when the stomach's digestive juices irritate and damage tissue, causing sores or holes in the inner lining of the stomach or upper small intestine. While stress and certain foods can worsen an ulcer, most are caused by H. pylori bacteria or the use of common pain medicines such as aspirin that can weaken the stomach's protective lining and allow acid to damage the sensitive lining beneath.

There are two types of peptic ulcers:

• Gastric ulcers (in the lining of the stomach)
• Duodenal ulcers (in the upper small intestine)

Diagnosis and Care
Ulcers are typically diagnosed through upper GI X-rays or endoscopy. Complications that can sometimes develop from peptic ulcers include bleeding, obstruction of the opening between the stomach and the small intestine, and perforation of the stomach and deuodeum. Treatment for peptic ulcer disease involves taking medications that reduce the amount of acid produced by the stomach. Ulcers caused by H. pylori are treated with antibiotics. For those with complications, such as bleeding ulcers, endoscopic treatments performed by physicians on the medical staff may be used.

For a physician referral, call 1-877-THR-WELL (1-877-847-9355).