As a gastroenterologist, Peter Krims, MD, cares for patients whose symptoms and complaints vary widely. At Middlesex Endoscopy & Gastroenterology in Acton, he performs procedures, including colonoscopies, upper endoscopies and ERCPs, and evaluates patients, some of whom restrict their diets in an effort to gain a sense of control. He is optimistic that the current wave of research on the colon’s microbiological flora will uncover new approaches to treating a range of diseases.
What led you to specialize in gastroenterology?
I was attracted to the detective work. It’s an intellectual challenge to hear a patient’s story and try to put the pieces together, because the same disease can sound totally different in another person. This is due to one’s cultural background, personal background, biases, fears and how the illness presents itself. When I was a resident, endoscopes were coming into use. It was a way to look inside, gain information and fix things less invasively. It seemed like the field was expanding. Today we have breath testing and capsule endoscopy.
Has the capsule endoscope had an impact?
It hasn’t played the role we thought it would, mainly because we want to be able to perform a biopsy when necessary. There’s a capsule for the colon that is about to be approved, so that means colonoscopies might be performed less invasively. But patients will still need the colon preparation and, if a polyp is found, they will need to come back for a colonoscopy, with prep, to have it removed. The colon prep is the Achilles heel; patients tend to say “I want one and done.” They don’t want to come back for a second prep. The important thing is that people have a colonoscopy. The test has contributed to a reduction in colon cancer in terms of incidence and mortality, but there are still a lot of people who will not come in for a colonoscopy.
What do you observe in patients today?
We are seeing more cases of Barrett’s esophagus, which is due to the epidemic of obesity. We see a lot of irritable bowel syndrome, some pancreatitis and hepatitis C. Of course, anyone with hepatitis C should come in for treatment and get cured. Fatty liver is becoming increasingly common, but the challenge is that these patients are often morbidly obese and have diabetes. With their high blood cholesterol and high blood sugar, their main problem tends to be heart disease, not their liver. They are more likely to die of a heart attack. However, there is a subset of patients who will develop liver disease. We need to do a better job in identifying them.
Do you have to counsel patients on what they are eating?
Yes — or not eating. I’m struck by how many people follow highly restrictive diets without any objective evidence that it is helping them. In some cases, they are making themselves unhealthy. We know that a balanced diet including all food groups is best. However, many people struggle with symptoms and use their diet to feel more in control — of their own lives and perhaps the craziness in the world. For example, I spend time with patients who are worried about being sensitive to gluten, but they haven’t had a colonoscopy. They are worrying about things that don’t matter. I also see people who cause GI problems by living on fast food and drinking too much alcohol.
Where is the field headed?
There is tremendous interest in the microbiological flora of the colon. The diversity of bacteria in the colon is huge, and they play a role in a number of diseases. We know there are many commensal organisms in there that are required for health and may be related to a range of conditions, including obesity. We’re just scratching the surface in terms of our understanding. We need more data.