Call GI North Today!

(404) 446-0600

View the GI North Facebook Page!


View the GI North Twitter Page!


View the GI North YouTube Page!


View the GI North Blog!


GI North Blog

photo of bottles of almond, rice and soy milk on a wooden backgroundWe have written several times here about the condition known as lactose intolerance. Being lactose intolerant means the body has difficulty breaking down and digesting the sugar in milk, also known as lactose. The condition is caused by a deficiency in the enzyme lactase which is produced in the small intestine. Those who are lactose intolerant do not have enough lactase available to digest lactose, resulting in stomach upset when certain dairy products are eaten. Approximately 30 minutes after eating or drinking, diarrhea, gas and bloating occur. The condition, which is also called lactose malabsorption, is usually harmless, but its symptoms can be uncomfortable. The symptoms are similar in adults, toddlers, and infants.

According to the National Digestive Diseases Information Clearinghouse, over 30 million American people over the age of 20 are lactose intolerant.

It’s important to understand certain factors contribute to lactose intolerance. Among them are:

  • Infection. After a bout of infectious diarrhea, some children develop a temporary lactose intolerance that usually improves after a few days or weeks,
  • Increasing age. Lactose intolerance usually appears in adulthood. The condition is uncommon in babies and young children.
  • Ethnicity. Lactose intolerance is most common in people of African, Asian, Hispanic and American Indian descent.
  • Premature birth. Infants born prematurely may have reduced levels of lactase because the small intestine doesn’t develop lactase-producing cells until late in the third trimester.
  • Diseases affecting the small intestine. Small intestine problems that can cause lactose intolerance include bacterial overgrowth, celiac disease and Crohn’s disease.
  • Certain cancer treatments. Radiation therapy for cancer in the abdomen or intestinal complications from chemotherapy, lead to an increased risk of lactose intolerance.


Consider choosing GI North to address your lactose intolerance concerns and digestive health needs. Led by Drs. Cofrancesco and Quijano, GI North is located in Cumming, Georgia. Our offices are open five days a week in order to conveniently treat patients from all over the north Georgia area, including Alpharetta, Roswell, Canton, Suwanee, Sugar Hill, Buford, Duluth, Mountain Park, Norcross, Gainesville, Canton and Lilburn. GI North is also happy to offer treatment in Spanish, if requested, with Dr. Quijano.

While intended to be informational, this article cannot replace professional medical advice. If you suffer from lactose intolerance, require a colonoscopy, or are experiencing gastric distress, contact us at 404.446.0600 to schedule an appointment.

© 2018 GI North Gastroenterology Services. All rights reserved.

When Should You Visit a Gastroenterologist?

photo of a handsome man suffering from stomach ache while lying on sofa at homePeople often attribute stomach problems to stress, aging or a diet filled with rich foods. However, stomach pain or digestive issues should never simply be brushed aside and dismissed as being normal. The reality is that any symptoms you’re experiencing could be signs that something is wrong with your digestive system. This is why it’s so important to book a visit to an office that specializes in digestive disorders if you’re experiencing any symptoms related to your stomach or digestive system. It may not be necessary to live with pain or discomfort any longer once you receive an examination and are given treatment options.

What Are Some of the Common Reasons Why People Visit a Gastroenterologist?

People of all ages can benefit from visiting a gastroenterologist if they have questions regarding their digestive health. You may want to book a visit whether you’ve been managing a digestive disorder for years or you’re experiencing new symptoms that have you feeling concerned. Here’s a look at the common reasons why people often come to see Dr. Cofrancesco and Dr. Quijano here at GI North:

  • Abdominal pain
  • Constipation
  • Diarrhea
  • Heartburn
  • Acid reflux
  • Bleeding

These symptoms can sometimes be the results of diet, lifestyle or genetic factors. They can also point to a more serious condition like polyps, ulcers, ulcerative colitis, Crohn’s disease, irritable bowel syndrome or cancer. This is why early screening is so important if you feel that something just isn’t right with your digestive system.

What Procedures Can a Gastroenterologist Offer?

An office that specializes in digestive disorders can provide a wide variety of screenings and procedures. These screenings and procedures provide an inside picture of what might be causing the symptoms you’re experiencing and help to diagnose a digestive disorder or other issue. Here’s a look at the common screenings and procedures we offer to our patients here at GI North:

  • Colonoscopy
  • Cologuard colon cancer screening
  • Therapeutic endoscopic retrograde cholangiopancreatography (ECRP)
  • Upper endoscopy
  • Percutaneous endoscopic gastrostomy (PEG)

While many digestive disorders and diseases do tend to pop up later in life, younger people must also be vigilant when symptoms show up. The reality is that leaving symptoms ignored can lead to damage to various parts of your digestive system and possibly allow for certain types of cancers to form. Not every patient who visits with a gastroenterologist will need to undergo advanced screenings and procedures. Patients can often benefit from the diet and lifestyle changes that can be recommended for specific symptoms.

Are You Concerned About Symptoms of Digestive Disorders?

The team here at GI North understands that experiencing the symptoms of digestive disorders can be frustrating and painful. We want to help you get to the bottom of any pain or discomfort you’re experiencing and provide treatments that can help you to improve your health and receive relief. The GI North office is located in Cumming, GA. We serve patients from Alpharetta, Roswell, Canton, Suwanee and many more surrounding communities. That means that we’re always happy to serve patients from areas like Sugar Hill, Duluth, Gainesville, Lilburn and beyond. Simply give us a call today to book an appointment to meet with Dr. Cofrancesco or Dr. Quijano if you’re looking for a gastroenterologist in Cumming, GA. Dr. Quijano speaks fluent Spanish and is ready to help patients from throughout the Cumming area.

This article is intended only to provide general information regarding digestive disorders and the services provided by GI North in Cumming, Georgia. No portion of this article should be taken as medical advice or used as a substitute for a visit to a qualified healthcare provider. Seek medical help immediately if you are experiencing pain, bleeding or any other serious gastrointestinal issues. You can call GI North to book an appointment with Dr. Cofrancesco or Dr. Quijano if you have any specific questions regarding your digestive health or if you’d like to learn more about the options that are available for specific digestive disorders.

© 2018 GI North. All rights reserved.

photo of healthy vegetarian Quinoa salad with tomatoes and spinachThe FODMAP diet consists of foods that are low in fermentable carbohydrates. In other words, it is a diet that restricts foods that triggers digestive symptoms such as gas, stomach pain and bloating. The acronym for FODMAP is fermentable oligo-saccharide, disaccharides, mono-saccharides and polyols, which are a group of poorly absorbed complex and simple sugars that are found in a multitude of vegetables and fruits as well as wheat and milk.

Rendering to Healthline, the major dietary sources of the four FODMAPs groups are:

  • Oligo-saccharide: Rye, wheat, legumes (beans, lentils, and soybeans) and certain fruits and vegetables like onions and garlic.
  • Disaccharides: Soft cheese, yogurt and milk. Lactose is the main carbohydrate
  • Monosaccharides: a variety of fruit such as mangoes and figs. Also different sweeteners like agave nectar and honey. Fructose is the main carbohydrate.
  • Polyols: various vegetables and fruits including lychee and blackberries. Also, as well as some sugar-free gum that contains low-calorie sweeteners.

Benefits of a FODMAP Diet

Oftentimes a professional gastroenterologist will recommend the FODMAP diet for people with IBS (irritable bowel syndrome) or digestive issues like bloating and gas. The diet limits carbohydrates that are “fermentable oligo-, di-, monosaccharides and polyols. For the most part, the majority of people do not have an issue with FODMAPs unless too many are consumed. However, some people are sensitive to them. This is because FODMAPs attract water into the digestive tract, which can cause bloating and gas. According to WebMD, roughly 3 out of 4 people with IBS had immediate relief after starting a low FODMAP diet. In fact, the biggest relief was felt after 7 or more days on the diet plan.

Since symptoms are generally eased right away, many are tempted to go off the FODMAP diet after a day or two. However, to reap the full benefits it is important to follow through on the diet for the full recommended amount of time. The FODMAP diet can be prescribed by a gastroenterologist for 7 days or more, depending on your condition.

Foods Low in FODMAP

Actually, there are numerous foods that are low in FODMAPs from certain fruits and vegetables to whole grains and proteins. Some of the best sources of low FODMAP foods are:

  • Oils: Olive oil and coconut oil
  • Protein: Tofu, eggs, fish, prawns, chicken, beef, lamb and pork
  • Whole grains: Oats, brown rice, quinoa, millet, maize and buckwheat
  • Seeds: Pumpkin, sunflower, sesame and linseeds
  • Nuts: Walnuts, pecans, macadamia nuts, peanuts, pine nuts and almonds (only 10 per serving)
  • Fruits: Oranges, limes, mandarins, papaya, pineapple, blueberries, strawberries, bananas, kiwi and rhubarb
  • Vegetables: Tomatoes, zucchini, kale, spinach, carrots, bell peppers, bean sprouts and eggplant
  • Dairy: Parmesan cheese, cheddar cheese and lactose-free milk
  • Beverages: Water, peppermint tea, green tea, white tea, black tea and coffee

In addition, there are numerous spices you can use to make your dishes favorable such as basil, chives, chili, pepper, turmeric, mustard seeds, ginger, fenugreek, lemongrass, saffron, salt and white rice vinegar.

GI North

If you are having issues with your digestive system or suspect that you have IBS, contact a gastroenterologist as soon as possible. A gastroenterologist can discuss possible solutions or recommend a certain food regime like the FODMAP diet.

At GI North, both Dr. Sergio Quijano and Dr. Simon Cofrancesco are well known for their expertise as a gastroenterologist. In fact, their advanced skills and combined knowledge are sought after in the north Atlanta area. Some of their expertise includes the diagnosis and treatment of various digestive problems like IBS, gastroparesis, gastritis and other stomach issues. In addition, Dr. Sergio Quijano at GI North speaks fluent Spanish.

For easy accessibility, GI North serves Cumming, GA along with the neighboring areas of Canton, Duluth, Roswell, Suwanee, Johns Creek, Milton, Dahlonega, Dawsonville, and Alpharetta.

Caution: This article is not meant to take the place of professional medical advice. If you have any questions or concerns about the FODMAP diet, contact the highly professional staff at GI North and make an appointment with Dr. Simon Cofrancesco, Dr. Sergio Quijano or an M.D. in your area.

© 2017 GI North. All rights reserved.

photo of mixed vegetables in bowl on a wooden table | bland dietThe bland diet consists of simple foods that are bland (not spicy), low in dietary fiber, typically soft and cooked instead of raw. Foods that are avoided include whole grains that are rich in fiber, robust cheese, fried and fatty foods. As well, medications such as ibuprofen and aspirin are discouraged. In addition, caffeine and alcohol are avoided.

The bland diet is named for its natural qualities of soothing the digestive tract. This is because the permitted foods help minimize irritation of the tissues. According to MedicinePlus, the bland diet helps with stomach problems such as diarrhea, gas, nausea, heartburn and ulcers. In addition, the Diet Health Club states that a bland diet may reduce irritation in the gastrointestinal tract plus help with dyspepsia, chronic gastritis, reflux esophagitis and peptic ulcer disease. The diet is also recommended to patients who suffer from hiatal hernia. Moreover, the bland diet is often recommended after intestinal or stomach surgery.

What to Eat

Foods included in a bland diet are:

• Tofu
• Eggs
• Weak tea
• Creamy nut butters
• Custard and pudding
• Soups, especially broths
• Low fat milk and dairy products
• White breads, crackers, and pasta
• Canned, cooked, or frozen vegetables
• Vegetables and fruit juices (avoid citrus)
• Finely ground hot cereals like cream of wheat
• Lean and tender meat like shellfish, whitefish, and poultry (baked or steamed)

Foods to Avoid

Many specialists agree that there are certain foods to avoid when on a bland diet such as:

• Dried fruits
• Fried foods
• Sugary foods
• Nuts and seeds
• Raw vegetables
• Whole grain or bran cereals
• Smoked or cured meats and fish
• Spices like garlic and hot peppers
• Whole grain breads, pasta or crackers
• Robust cheeses such as Roquefort or bleu
• Caffeinated drinks and alcoholic beverages
• High fat dairy like ice cream or whipped cream
• Fruits with a lot of seeds such as figs or berries
• Fermented vegetables like sauerkraut, pickles and kimchi
• Gassy vegetables like cabbage, broccoli, cauliflower, green peppers and cucumber

Diet Tips

There are several tips that can help you stay on track when you are on a bland diet. For instance, always chew your food slowly and never eat in a hurry. In fact, many dieticians feel that making all meals a special event will help you relax and eat slower. In turn, your food has time to digest which reduces stomach issues. Other helpful hints include:

• Stop smoking
• Drink fluids slowly
• Never eat two hours prior to going to bed
• Eat small meals throughout the day instead of one or two large meals

GI North

If you suspect that you may have a stomach problem like gastroparesis or peptic ulcer, you may want to consider a bland diet. In fact, it is highly recommended that you seek professional medical advice as soon as possible if you have health concerns.

Both Dr. Simon Cofrancesco and Dr. Sergio Quijano are renowned gastroenterologists throughout the north metro Atlanta area. They are known for their accumulated knowledge and incomparable patient care. In fact, the two physicians bring many years of expertise to GI North. Their expertise includes the treatment and diagnosis of digestive issues such as gastritis, gastroparesis and other stomach problems. What is more, Dr. Sergio Quijano speaks fluent Spanish and the professional staff at GI North are committed to offering top quality service.

For your convenience, GI North serves Cumming as well as the contiguous areas of Duluth, Milton, Canton, Suwanee, Alpharetta, Dawsonville, Roswell, Johns Creek, and Dahlonega.

Precaution: This article is not meant to be a substitute for professional medical advice. If you have any questions or concerns about the bland diet, make an appointment at GI North with Dr. Simon Cofrancesco or Dr. Sergio Quijano.

© 2017 GI North. All rights reserved.

photo of pregnant woman suffering with nausea in morningMost people are already familiar with the fact that the majority of pregnant women experience some degree of morning sickness. However, some women experience an extreme form of sickness called hyperemesis gravidarum during pregnancy. This is not a condition that can simply be helped with ginger ale and crackers. It is actually a serious and potentially dangerous situation that often requires the attention of a medical professional. It’s important for women to know the difference between typical morning sickness and hyperemesis gravidarum if they are experiencing morning sickness that seems more severe than it should be.

The Basics of Morning Sickness

While the nausea experienced during pregnancy is referred to as morning sickness, it is often an all-day sickness. It occurs due to the spike in hormones that takes place as the placenta develops during the first trimester of pregnancy. Women with morning sickness may experience vomiting or they may simply experience nausea. It typically shows up early in the first trimester and disappears by the 14-week mark. Some women experience morning sickness that lasts much longer. While morning sickness may be an uncomfortable experience, its presence is seen as a sign that a pregnancy is progressing normally. Of course, some women do not experience morning sickness. This is also perfectly normal. Most women can rest assured that what they are experiencing is standard morning sickness if they are still capable of eating and drinking enough to stay nourished and hydrated. Of course, even a woman who experiences a manageable level of morning sickness may still have to deal with heartburn, hemorrhoids, constipation and other gastrointestinal issues while pregnant.

Hyperemesis Gravidarum

What happens when a women is so sick that she becomes dehydrated and loses drastic amounts of weight during the first trimester of pregnancy? This is often a sign that a woman is experiencing hyperemesis gravidarum. Hyperemesis gravidarum became part of the mainstream conversation in 2014 when Kate Middleton was hospitalized while suffering from this condition during her pregnancy. Headlines were made again when she was forced to skip official events due to the condition during another pregnancy in 2017. However, many women suffer from this condition away from the spotlight of the public eye during pregnancy. Hyperemesis gravidarum is a severe form of morning sickness that can be debilitating. Seeking treatment is important because the severe electrolyte imbalances that can occur from frequent vomiting and dehydration can potentially be dangerous for an expectant mother. It is often necessary to be evaluated and possibly seek in-patient therapies to replenish hydration levels to where they need to be. Prescription drugs and hospitalization may be necessary in some instances.

Are You Concerned About Nausea and Vomiting During Pregnancy?

Women should not hesitate to reach out to seek help if they are concerned that their morning sickness may be more severe than what should be expected. Dr. Cofrancesco, Dr. Quijano and the entire staff here at GI North can offer help regarding the gastrointestinal disorders that women experience during pregnancy. Our office is located in Cumming, Georgia. We serve clients from Milton, Canton, Roswell, Alpharetta, Buford, Suwanee, Duluth, Sugar Hill, Lilburn, Norcross, Mountain Park, Gainesville, and other surrounding communities. Don’t hesitate to reach out and make an appointment.

The information contained within the article above should be used for general informational purposes only. No portion of this article should be viewed as medical advice or used in the place of an actual diagnosis. Don’t hesitate to reach out to the staff at GI North if you have any questions regarding gastrointestinal disorders during pregnancy. You can address non-emergency symptoms by booking an appointment at GI North in Cumming, Georgia. Seek medical help immediately if you are experiencing abdominal pain, extreme vomiting, dehydration or any other serious symptoms.

© 2017 GI North. All rights reserved.

Your Liver Will Thank You

illustration of test tube with blood sample positive Hepatitis C virusHepatitis C is a serious disease that can severely damage your liver. Unfortunately, it can even lead to cancer. Baby boomers are especially at risk of having Hepatitis C. To protect yourself, be sure to get tested as soon as possible. Here are some important facts that you should know about Hepatitis C.

It Tends to Affect Baby Boomers the Most

According to the Centers for Disease Control and Prevention, people born between 1945 and 1965 are five times more likely to have Hepatitis C. Although experts have yet to pinpoint exactly why it is so prevalent in this age group, some believe that it may stem from infected medical equipment. In the past, hospitals weren’t forced to abide by certain safety regulations.

Serious Liver Damage Could Occur

When left untreated, Hepatitis C can cause serious liver damage. The importance of getting tested in a timely manner cannot be stressed enough. Thousands of people are unknowingly living with this silent killer. Without the proper treatment, it is only a matter of time before Hepatitis C begins to take a toll on their health. Major weight loss, extreme weakness, and a buildup of abdominal fluid are just a few of the symptoms that stem from a severely damaged liver.

Hepatitis C Can Be Treated

Over the years, treatment for Hepatitis C has come a long way. Under the guidance of a well-trained doctor, there is a good chance for most individuals to make a full recovery. Experienced medical facilities, such as GI North, have successfully treated numerous people suffering from Hepatitis C.

Getting Tested Remains the Most Critical Step to Take

The first step to overcoming Hepatitis C is to get tested. You certainly deserve the extra peace of mind. If antibody testing detects that you were exposed to Hepatitis C, the next step is to obtain viral load testing. It can determine whether or not the virus is actually in your bloodstream. Even after you have been treated for Hepatitis C, you should still get periodically tested to make sure the virus is not active.

GI North encourages you to get tested at your earliest convenience. Dr. Cofrancesco and Dr. Quijano proudly serve Cumming, GA, and the entire surrounding area. You can always look forward to experiencing a high level of professionalism. Dr. Quijano also speaks fluent Spanish, which makes our advanced medical facility even more accommodating.

*This article is not meant to take the place of professional medical advice. Please make an appointment at GI North or with an MD in your area.

© 2017 GI North. All rights reserved.

photo showing 4 lactose free foodsReceiving a new diagnosis for a long-term condition can be something of an emotional roller coaster ride. On the upside, you finally understand what has been causing your health troubles. On the flip side, you many need to adopt some or even many lifestyle changes. Fortunately, learning that your digestive troubles are the result of lactose intolerance can mean a pleasant ride through the delicious world of milk alternatives.

Understanding lactose intolerance

Lactose is a form of sugar that naturally occurs in milk. During infancy, when milk is the primary source of nutrition, humans produce an enzyme called lactase that enables the breakdown and utilization of lactose in the body. In later life, as additional food sources become necessary, about 65 percent of people begin to produce less lactase than in infancy. If lactase production is sufficiently low, a symptomatic state of lactose intolerance can develop.

Without lactase, lactose becomes indigestible. Rather than being broken down and absorbed, the lactose remains in the gut and can hinder the absorption of fluids from the digestive tract. This can lead to a form of watery diarrhea often experienced by people with lactose intolerance. Undigested lactose also acts to feed the microbes that naturally reside in the intestines. The microbes then produce an excess of gas and the associated sensation of bloating that is also a common symptom of lactose intolerance.

Treating lactose intolerance

Given that the symptoms of lactose intolerance are due to a naturally occurring component of milk, avoidance of dairy products leads to resolution of symptoms. In consideration of all the delicious dairy-containing foods, however, it is no surprise that total elimination of dairy from the diet is not the way in which most sufferers of lactose intolerance prefer to treat the condition. Rather, many people who suffer from lactose intolerance prefer to use non-lactose containing dairy alternatives for their favorite snacks and recipes.

Popular lactose-free products and dairy alternatives

Fortunately, a variety of lactose-free and non-dairy “milk” products are now widely available. When searching for milk alternatives, be sure to start with a look in the grocer’s dairy and frozen food sections for any lactose-free milk and dairy products. These are made by the adding lactase directly to the milk, resulting in a similar although slightly sweeter-tasting product.

Another option for enjoying favorite foods while avoiding lactose is the use of milk alternatives. Almond milk, coconut milk, soy milk, rice milk and hazelnut milk are just a few of the popular and readily available options. Not only can these be found on store shelves, they are often also offered in places where dairy products are commonly used such as coffee shops and ice cream parlors. For those who enjoy a bit of creativity in the kitchen, many recipes for homemade milk alternatives are also being developed and shared.

Why even the lactose-tolerant are going dairy-free

Even those who can drink regular milk, often enjoy and choose dairy-free milk alternatives. In addition to the great flavors, the lighter texture and consistency of non-dairy milk products also adds variety to cooking and baking. Another common reason cited for choosing non-dairy milk alternatives is the added health benefits. Milk alternatives are generally lower in calories that animal milk, making them a welcome addition to a weight loss plan. Milk alternatives also make for a simple way in which the benefits of specific nutrients can be added to the diet. For example, oats are rich in B vitamins and coconut is one of the few sources of medium-chain fatty acids, making these popular choices as non-dairy milk alternatives.

Creating your lactose-intolerance treatment plan

While intended to be informational, this article cannot replace professional medical advice. Seek out a qualified medical professional near your if you have any questions or concerns regarding lactose intolerance.

Consider choosing GI North to address your lactose intolerance concerns and digestive health needs. Led by Drs. Cofrancesco and Quijano, GI North is located in Cumming, Georgia and also serves the surrounding areas of Alpharetta, Roswell, Canton, Suwanee, Sugar Hill, Buford, Duluth, Mountain Park, Norcross, Gainesville, Canton and Lilburn. GI North is also happy to offer treatment in Spanish, if requested, with Dr. Quijano.

© 2017 GI North. All rights reserved.

photo of paper with colon cancer and dark blue ribbon | GI NorthWhen abnormal cells in the colon and/or rectum begin to destructively divide, a malignant tumor can form, resulting in a diagnosis of colorectal cancer. These cancers often begin as a polyp that grows in the tissues lining the colon and rectum. Most polyps are not cancerous, but an adenoma type of polyp can be precancerous and does have an increased risk of turning into a cancerous tumor.

Colorectal cancer is the second leading cause of death from cancer disease in the United States, which is why having regular colonoscopy screenings is very important, especially for people over the age of 50 or those with a family history of the disease. Undergoing a colonoscopy for colorectal cancer at intervals advised by your physician is critical, because 90% of cancers detected during these screenings are curable when they are found at an early stage.

Colonoscopy Screenings

colonoscopy is an outpatient procedure conducted by a gastroenterologist to view the inner lining of your entire colon and part of your small intestine. A colonoscope, which is a thin, flexible tube, has a tiny video camera and light attached, allowing your doctor at GI North to discover any polyps, tumors, ulcers, or other areas of inflamed tissue or bleeding throughout your rectum and colon. A video and still photos are taken as the colonoscope is guided through your colon. If anything suspicious is found during the colonoscopy, a sample of tissue or abnormal growth will be taken at that time.

The colonoscopy procedure is performed at GI North by Dr. Cofrancesco or Dr. Quijano. Before the screening begins, you will be given a sedative and pain medication to ensure your comfort, and the medical staff will monitor your vitals throughout the procedure. There is a period of preparation that patients must undergo a day or two prior to a colonoscopy. Both of the gastroenterologists at GI North have specific bowel prep instructions for their patients that will usually involve a clear liquid diet and specific laxatives to take by mouth or enema, as the colon must be completely cleansed before the procedure takes place.

Cologuard Screenings

Though a colonoscopy is the gold standard for detecting colorectal cancer and other related health issues of the digestive tract, some patients desire a less invasive screening method. The physicians at GI North offer patients the Cologuard test an an alternative to a colonoscopy when certain criteria can be met, such as having no family history of colon cancer and no known bowel diseases or syndromes in addition to other standards. Cologuard is used to look for abnormal cells in the colon by examining a single stool sample that is mailed to a lab for testing. Your physician will consult with you when the results are received.

GI North is located in Cumming, Georgia. Our gastroenterologists and their staff are prepared to serve patients from the surrounding areas such as Roswell, Alpharetta, Milton, Duluth, Canton, Suwanee, Sandy Springs, Marietta and beyond. Dr. Simon Cofrancesco opened GI North in 2011 after serving as Chief of Staff at Southwest Mississippi Regional Medical Center. Dr. Sergio Quijano hails from Lima, Peru, and is fluent in Spanish. He is double board-certified in internal medicine and gastroenterology.

This article is not meant to take the place of professional medical advice. If you suffer from peptic ulcer disease, need a colonoscopy, or are experiencing gastric distress, contact GI North at 404.446.0600 to schedule an appointment.

© 2017 GI North. All rights reserved.

medical illustration showing gastroparesis | GI NorthDelayed gastric emptying or gastroparesis is a condition that happens when the stomach takes too long to empty food into your small intestines. The disorder can be caused by an illness such as diabetes, lupus or other conditions. Symptoms can range from mild to severe, which typically includes bloating, nausea, vomiting and heartburn.

Moreover, gastroparesis can be a temporary reaction to something your body is dealing with. It can also be a long-standing and chronic condition.

Possible causes

Although there has been numerous research done, specialist do not know the exact cause of delayed gastric emptying. However, it is believed to be linked to nerve signals in the stomach that may be disrupted. It is thought that the vagus nerve may be damaged. The vagus nerve regulates the movement of food through the digestive tract. If the nerve becomes damaged it may causes slow digestion or no digestion at all.

Other possible cause s of gastroparesis includes muscle diseases, infections, medications and other conditions. On the other hand, the causes is often labeled as idiopathic which means the cause is unknown.

Are you at risk for gastroparesis?

When it comes to gastroparesis, there are certain health conditions that can make it difficult for your stomach to empty. In turn, the slowed digestion may increase your risk of developing gastroparesis. These risk factors include:

  • Infection
  • Parkinson’s
  • Autoimmune disease
  • Diabetes mellitus (DM)
  • Certain cancer treatments
  • An overactive thyroid (hypothyroidism)
  • Eating disorders such as bulimia and anorexia
  • Some medications that slows stomach digestion

Signs and symptoms

There are many signs and symptoms that indicate the possibilities of having gastroparesis. According to the Mayo Clinic, the signs and symptoms include:

  • Nausea
  • Vomiting
  • Acid reflux
  • Loss of appetite
  • Abdominal bloating
  • Pain in the Abdomen
  • Blood sugar level changes
  • Malnutrition and weight loss
  • Feeling full after eating just a few bites
  • Vomiting undigested food that has been eaten a few hours earlier

In addition, there are numerous people with gastroparesis that do not have any noticeable signs and symptoms whatsoever.

Seeing a doctor at GI North

If you suspect that you may have gastroparesis, it is highly recommended that you seek professional medical advice as soon as possible. Generally a gastroenterologist is an optimal choice for the best professional advice and diagnosis.

At GI North, gastroenterologists Dr. Simon Cofrancesco and Dr. Sergio Quijano are renowned for their expertise and outstanding patient care. The two physicians bring many years of knowledge to the clinic. Their specialties in diagnoses and treatment of digestive issues include gastroparesis, gastritis and other stomach issues. In addition, Dr. Sergio Quijano speaks fluent Spanish. Plus our exceedingly trained and professional staff is dedicated to offering the best quality in personal care and service.

For optimum convenience, GI North serves Cumming as well as the surrounding areas of Alpharetta, Dawsonville, Milton, Canton, Johns Creek, Roswell, Dahlonega, Duluth and Suwanee.

Note: This article is not intended to replace professional medical advice. If you have any questions or concerns about gastroparesis, make an appointment at GI North with Dr. Sergio Quijano, Dr. Simon Cofrancesco or an M.D. in your area.

© 2017 GI North. All rights reserved.

photo of a cute girl hugging a golden retriever with love, her eyes closed, smiling. | Celiac DiseaseWhen a doctor identifies celiac disease in a child, the process of health recovery begins. Diagnosis is a “light bulb moment.” Now, there’s an explanation for a child’s chronic abdominal pain, gas, diarrhea, or constipation. Diagnosis also reveals the reason for the vomiting, weight loss, and delayed growth that some children exhibit.

Gluten Allergy

All these symptoms reflect an abnormal immune response to gluten. This is a mixture of elastic proteins, found in wheat, rye, and barley. Gluten is the agent that gives bread dough its stretchy texture. When gluten is mixed with water and kneaded, its proteins stick together. In fact, the English word “gluten” derives from the Latin term for glue. Celiac disease is a serious allergic reaction to gluten.


Celiac disease tends to be hereditary, passed through family generations via genes. However, a parent can unknowingly carry the trait without becoming ill.

In children, celiac disease can be activated by viral infection, bacterial gastroenteritis, physical injury, or severe emotional stress. These triggers account for the age variations in affected children. Some kids develop the disease as tykes while others don’t get sick until their teens.


For infants and toddlers, evidence of celiac disease can be irritability, bloat, and vomiting. Older kids and teens may display signs that seem unrelated to the digestive system. These include achy joints, chronic fatigue, rash, mouth sores, recurring headaches, and delayed puberty.

Over time, malnutrition can lead to hair loss, nosebleeds, easy bruising, and changes in tooth enamel and color. Understandably, teens are often subject to depression and panic attacks.


When a GI North doctor suspects celiac disease, he first conducts a screening blood test, before gluten is omitted from the diet. The disorder is implicated by high levels of certain antibodies in a blood sample. Antibodies are blood proteins that attack alien substances in the body, typically viruses and bacteria. In the case of celiac, the immune system views gluten as an enemy.

Then, antibodies destroy villi, finger-like projections lining the small intestine. Injured villi can’t absorb nutrients from food, leading to malnutrition.

If blood testing implies celiac disease, our doctor performs endoscopic biopsy. This procedure involves removing a tissue sample from a child’s small intestine, to examine the villi. Seeing flattened villi confirms celiac disease.


Fortunately, regardless of a child’s age, symptoms typically resolve with strict adherence to a gluten-free diet. Making dietary changes is crucial for kids to maintain a healthy weight, height, and bone strength.

However, avoiding gluten sources isn’t easy, and reading labels is vital. You can identify wheat, barley, and rye on packaging. However, traces of gluten can lurk in processed foods, without being stated on labels. Likewise, gluten is an unclaimed ingredient in some soaps, toothpastes, nutritional supplements, and medicines.

Symptoms can flare in a child with minimal exposure to gluten. Tiny toaster crumbs can cause intestinal damage. Cross-contamination can also occur from ingesting something that has touched food containing gluten.

Parents can buy home testing kits, but they can only identify gluten in a quantity of 10 parts per million (ppm) or more. Some children are sensitive to gluten in amounts less than 10 ppm.

Celiac Service Dogs

However, dogs have an advantage over humans by being able to smell gluten. Training a dog in gluten detection involves teaching it to recognize and flag the scent with a gesture, such as a raised paw. Trainers reward a dog for correct responses with treats. A dog can become so adept at identifying gluten that it can smell it through packaging.

On average, training takes up to three months. Like a service dog for the blind, a gluten-detecting dog can travel with a child in public places, such as school, stores, and restaurants. Here’s a video clip describing the training process.

Training Standards

One way to locate a qualified scent trainer is by contacting O.D.O.R. Service Dogs Inc. This organization consists of professional service dog trainers and researchers, dedicated to the highest standards of allergen detection.

To ensure canine reliability, O.D.O.R. has devised standardized tests for trainer use. O.D.O.R. also provides ongoing trainer education. For additional information, contact the agency at its website or e-mail O.D.O.R. here.

Qualified Dogs

Nosey Service Dogs is a non-profit organization that trains gluten-detecting dogs and makes them available. For information, visit the Nosey DDP website.

Owner Training

Alternatively, you can hire a professional trainer to teach a dog you’ve selected for gluten detection. To ensure that a trainer is qualified, they should meet the following criteria:

  • fully assess whether a dog is teachable
  • involve the owner in the training process
  • offer at least three months of training
  • provide follow-up for ongoing detection success

Willow Service Dogs is an organization that works with dog owners, training their pets in gluten detection. The agency’s founder is keenly aware of the challenges of maintaining a gluten-free diet, having celiac disease herself. Dawn Scheu and her staff teach dogs to meet the gluten detection standards established by O.D.O.R.

One test canines must pass is consistently flagging gluten in food, medicines, and hygiene items. Other mandated tests are room searches, public product checks, supermarket searches, assessing restaurant meals, and checking items in a gluten-free environment. Here’s further information on Willow Service Dogs.

About GI North

Two board-certified gastroenterologists lead our practice, Dr. Cofrancesco and Dr. Quijano. With 20+ years of experience, the doctors diagnose and treat a wide range of digestive conditions. We provide accurate testing with advanced technology, including upper endoscopy and colonoscopy. Our doctors are affiliated with Northside Hospital-Forsyth. Additionally, Dr. Quijano is fluent in Spanish, for the care of Hispanic patients.

At GI North, we’re committed to providing the highest quality of gastrointestinal care. This includes timely appointments and thorough visits, where you’ll have ample time to ask questions and voice your concerns. We strive to ensure your comfort and confidence in our doctors’ expertise.

Located in Cumming, Georgia, we welcome our neighbors from surrounding towns, including Alpharetta, Buford, Canton, Dawsonville, Duluth, Gainesville, Roswell, and Suwanee. Here you can read further about our gastroenterology practice. Here’s information on how our doctors evaluate and treat celiac disease.

©2017 GI North. All rights reserved.

Fill out my online form.