Joey Wahler (Host): It affects our digestive system and beyond. So we're discussing gastroenterology and good gastro health. Our guest, Dr. Huitt Mattox. He's Director of Gastrointestinal Services for Southeast Georgia Health System. This is Health Matters from Southeast Georgia Health System. Thanks for joining us. I'm Joey Wahler.

Hi there, Dr. Mattox, welcome.

Huitt Mattox, MD: Thank you. Hello.

Host: Great to have you aboard. So first, what exactly is gastroenterology and what are the most common conditions you treat?

Huitt Mattox, MD: Well, gastroenterology is the study and the evaluation of the digestive tract, which starts essentially in the mouth and then through the esophagus, stomach, small intestine, large intestine, liver, pancreas, gallbladder, and bile duct system. So it's a, I always kind of jokingly describe it as when you clean the fish after you cut the head off, all that other stuff is what I take care of.

Host: Very well put, very well put. So what's meant by the term gastro health, good gastro health? How can people improve theirs?

Huitt Mattox, MD: Well, I mean, it starts like in a lot of things with lifestyle. It starts with a good balanced diet. It starts with weight control. It starts with exercise and cardio. But I think now and now they talk more about the biome, the gut biome, as it relates to the small bowel and to the colon. Probiosis is a very popular thing these days. There's not a lot of proof in a real randomized controlled study, but anecdotally a lot of people feel better using probiotics, and I'm certainly not opposed to them. But good health is good living, basically.

Host: And so probiotics, tell us about those.

Huitt Mattox, MD: Well, what they are essentially is the gut is full of gazillions of bacteria. It's normal, so is our mouth, our skin, and these are sort of symbiotic relationships. And it has a lot to do with protecting the rest of the body and processing as well. So if you have an imbalanced gut biome, that can result in certain disease processes, for example, inflammatory bowel disease, has been attributed to dislocation of the gut, particularly the colon and small bowel biome.

Probiotics make an attempt to replace that with a more healthy variety of bacteria, and most of it, quite frankly, is theoretical, but as far as I'm concerned, it's a no harm, no foul thing.

Host: Gotcha. So doc, what specific red flags tell patients they may be having a gastro issue and when should they trust their gut, if you will, by seeking medical attention for it?

Huitt Mattox, MD: Well, I think the number one thing is abdominal pain. I see that quite frequently. Acid related issues, which is reflux or indigestion, may seem mild and benign, but may represent a more serious underlying condition. When it comes to bowel function, certainly if you've had a normal bowel pattern and that changes, that could be a red flag. Certainly bleeding of any kind. And that could be bright red blood either on the tissue or in the water. Or it could be a darker, tarry stool that suggests a more upper digestive source of the problem. But when things change and it persists for a bit, it's good to get it checked out.

Host: So, what's the recommended age to begin wellness screenings in your world? And of course, the granddaddy of them all, if you will, is a colonoscopy, right?

Huitt Mattox, MD: Well, when I started in my career, screening colonoscopy wasn't even a thing. You had to have a symptom to get a colonoscopy. So it wasn't until the early nineties where colonoscopy as a screening tool came on to the floor. And if I could give you a rationale for that for just a minute, it's a little bit of a divergence, but I think it's important.

One of the things we've learned through evaluating the colon is the polyp. And with colon cancer, we may come back to that later; there is a polyp to cancer sequence. And that in those days was just being elucidated and proven to be the case. So that if the theory was, and it's been borne out to be true; that if you identified a precancerous polyp and removed it, then you could decrease that individual's risk of colon cancer. So touching base on colon cancer just a bit; if you look at men and women together, colon cancer is the second leading cause of cancer death. In women, it's breast is number two, and men, prostate is number two, and everybody, lung is number one by a long shot.

But since we both have colons, both men and women, colon cancer then thrusts itself up to being the second leading cause of cancer death and through the understanding of the polyp cancer sequence and using the opportunity to look at a normal colon, someone with no symptoms, because most polyps are quite asymptomatic, you can identify those patients at risk, remove those precancerous polyps, and we've reduced colon cancer deaths in half by doing that. So it's been fairly impressive.

Host: And so, the minimum age recommendation for colonoscopies has changed in recent years, right?

Huitt Mattox, MD: It started out at age 50 when this process was being understood, and because of earlier cases of younger patients with colon cancer, within the past two or three years, that age has been dropped to 45 years old.

Host: And when you talk about those at risk, who are those at risk?

Huitt Mattox, MD: Well, currently, is anybody over age 45, but there are some other genetic conditions in those with family histories that have a higher percentage of a risk of developed colon polyps and subsequent cancer. So we do treat them somewhat differently, but the vast majority, the vast majority of colon cancer and colon polyp patients are sporadic.

And I'm talking 95%. So they're 5 percent are genetic, or these other things, but the vast majority are just like me and you walking the street. Anybody.

Host: So, for common GI issues, and we'll talk about cancer as you said in a moment, but that aside, what are the treatment options there?

Huitt Mattox, MD: In the upper digestive tract, it's peptic ulcer disease, gastroesophageal reflux disease, gastric cancer. There could be a whole host of other of things that are less common, but those are the big ones. With the lower GI tract, unfortunately colon cancer is one, inflammatory bowel disease, there's some more microscopic issues with inflammation, diverticular disease, a number of these kind of conditions.

Host: And when you mention inflammation there, anti inflammatories are often a recommended way of addressing these conditions, yes?

Huitt Mattox, MD: No, well, not what I deal with, in fact, kind of the opposite. One of the more common causes of peptic ulcer disease is the usage of anti inflammatories or the category of NSAIDs, which stands for non steroidal anti inflammatory drugs, commonly known um, I don't want to name trade names, but ibuprofen, aspirin, and those kinds of things.

And they're very ulcerogenic. The worrisome part about ulcers caused by those products is oftentimes, the first symptom is either profound anemia or bleeding, which is to say the ulcers don't hurt. So, the first time we meet them can be in a moderately extreme situation.

Host: And so how are you usually treating conditions other than cancer? What's usually the remedy there?

Huitt Mattox, MD: Well, in the upper GI tract, we have some very powerful acid suppressing medicines these days. And for reflux or peptic ulcer disease, these medicines can lower acidity to a great degree and allow the body to heal itself. In conjunction with removing the offending agent. It could be a bacteria in the stomach called Helicobacter pylori, or it could be the use of a non steroidal agent.

If you have H. pylori, there's a series of, a regimen of antibiotics and acid blockers we can use to decrease the recurrence. And so we have very effective ways of dealing with peptic related or acid related disorders.

Host: Alright, a few other things here. Since gastroenterology covers so much of the body, how much do you interface with specialists in other areas as well?

Huitt Mattox, MD: Quite a bit, actually. I mean, one of the typical symptoms of, say, reflux is substernal burning, but some people experience chest pain. So they may see their cardiologist first and then see us. And then there's the folks that have ENT problems, sinusitis, those kinds of things; that could be attributed to gastroesophageal reflux.

Certainly with the oncologists, we interface with them quite a bit because we find things that they end up treating both the medical oncologists and the radiation oncologists, and then the primary care doctors as well. Because we're the catch all for things that they can't either figure out or need a, they feel like they need a further in depth look into.

Host: And speaking of which, you led me beautifully into my next question, we touched on it earlier. If a patient of yours is diagnosed with cancer, colon cancer for instance, what are usually the next steps there?

Huitt Mattox, MD: Typically a general surgeon is involved. It could be a radiation oncologist is involved and a medical oncologist is involved. And each one of those would interface with the patient and do the CT scans, all of stuff to extirpate that cancer out of the patient.

But my job is, and this is one of the tougher things that I do is, I take someone who isn't sure that anything's wrong and I gotta tell them. So what I do is, you're about to hit them with a two by four. You know it, but they don't know. So my rule is, I sit down beside them in a chair. I don't stand above them, sit down with them, generally touch them. Could be their foot, could be their leg, their hand, whatever. And just say, look, I got good news and bad news. And just lay it out there because there's no way to hide it. And then say, that's the bad news. The good news is we know you have it and we're going to do everything we can and get everything put in order to make sure that we deal with this.

And when it come, when I get the path back, I don't have staff call them. That's my job. So they know I've got it and they have confidence in that.

Host: And that particular approach of yours, which it sounds like is very well thought out, very methodical in the way that you go about it. Has that evolved for you years, over the years, Doctor? Did you tweak that maybe since you were a younger doctor no? or no?

Huitt Mattox, MD: Yeah. And that's a great question, Joey. Yeah, actually I have. I've been doing this 35 years and you get a little more into being patient with those kinds of things. I have a saying, and the people that know me know this. It's like when you have to be on call or work on the weekend or work on the holiday.

I said, doesn't it, isn't it awful to have to get called? I said, yeah, but you know, what's worse being the person that needs me. So if you take that approach, and focus on making sure that they're comfortable, then they know you have their back, that you have their case and your attention, it helps a lot.

And yeah, I have in my younger, brasher days, I was maybe not as attentive to that. But I am now.

Host: I'm sure that people watching and listening appreciate your candor and the perspective you've gained over the years. How about technology, Doctor? What's the biggest way in which technology has advanced over the years for resolving GI issues?

Huitt Mattox, MD: Well, the endoscope itself, the tool we use, when I learned you had to look down a small eye hole, like looking in a microscope; now it's projected up on a 40, 50, 60 inch screen with high resolution computer chips. So the acuity of what we can see and what we can remove is dramatically better than what I learned on.

In fact, in those days, the assistant who works the polypectomy snare or the biopsy forceps couldn't even see what you were doing. You had to tell them, and that's one issue. The second issue is the patient protections that we now afford, which include typically using anesthesia services for safety purposes.

The anesthesia is much better than it used to be, far less side effects than it used to have. They use blood pressure monitoring, oximetry. A lot of monitoring so that the procedure itself is far safer than I learned how to do it in the 80s. And that's a really good thing. Some of the therapeutics are amazing.

I wish I had them back in the day where you can treat some of these more insidious inflammatory bowel disease with these amazing drugs that can make it go away. And we didn't have near those options in the 80s and 90s when I was coming along.

Host: Well, I'm sure you have many great patient success stories, Doctor. What's the one area in which you would say most of those are falling into these days?

Huitt Mattox, MD: Well, the one thing that when I came here in 1990, it was just about synchronous with the advent of laparoscopic cholecystectomy. So, the holy grail these days of surgery and intervention is get inside, but make as small as hole as possible to get there. And so laparoscopic cholecystectomy was just coming on board.

Well, and cholecystectomy is the most common operation performed in the United States. About a half a million gallbladders removed every year. And about 20 percent of those, one of those stones will get out of the gallbladder and get trapped into the common bile duct. In the old days, there was a big operation they had to undergo to remove that stone.

Now we have endoscopic equipment that we can go down through the mouth, stomach, and into the small bowel, identify the opening of the pancreas and bile duct, which they share the same opening, insert a little wire catheter in there, make an internal incision that you don't ever see, and through devices, balloons, baskets, can remove those stones.

And so, a complication or a, a medical situation that would require a large operation and a long postoperative recovery, they get to go home sometimes the next day.

Host: Wow.

Huitt Mattox, MD: Yeah. It's impressive. And the technology that allows that and the devices that allow for that, make us look pretty smart.

Host: I'm sure they do. And so finally, Doc, in summary here, what's your advice for someone with a GI concern? What's job one for them if they think they may have one? And what can they expect from you if they happen to see you for it?

Huitt Mattox, MD: Well, you know, know your body, listen to your body. I mean, you have a little pain and it goes away and that kind of thing, or you see a minor self limited problem, then we all push that aside. That's human nature, I think. But a persistent problem when you're going to the restroom and you're seeing blood on the tissue consistently, or you're having chest pain, or you're having difficulty swallowing and it's recurring; then you should get checked out.

When they come to see me, I'll sit down with them. They'll tell me in their words what they're experiencing. I may want to take them down a certain path because there's certain things that I want to know that they might not know to tell me that I can elucidate from them. And then we would then start on a plan of either diagnostic testing, but typically would segue most commonly to endoscopy of some sort.

Host: Well, folks, we trust you're now more familiar with good gastro health. Dr. Huitt Mattox, a pleasure. Keep up the great work. And thanks so much again.

Huitt Mattox, MD: Thanks, Joey. Nice to meet you.

Host: Same here. And for more information, please visit sghs.org/gastro. Now, if you found this podcast helpful, please share it on your social media.

I'm Joey Wahler, and thanks again for being part of Health Matters from Southeast Georgia Health System.