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digaram explaining what gastroenterology is | GI NorthAmong the seemingly endless medical specialties, gastroenterology may sound like just another long, confusing name. If referred to a gastroenterologist, there’s no need to be in the dark. Learn what it takes to become a gastroenterologist, what conditions they treat and procedures they perform, and why a patient might be referred to one.


In order to become a specialist in gastroenterology, a lot of study and preparation is required. Requirements include:

  • A bachelor’s degree, often in a scientific field.
  • Attendance at a medical school, which includes study, instruction, and clinical rotations in most specialties
  • Achieving a license to practice medicine
  • Certification from the American Board of Internal Medicine


  • A fellowship in gastroenterology
  • Certification from the American Board of Colon and Rectal Surgery(1)

These qualifications require many years, a lot of money, and a desire to help heal.

The Field of Gastroenterology

Gastroenterology involves treating conditions of the esophagus, stomach, small intestine, colon, rectum, pancreas, gall bladder, bile ducts, and liver.(2) While that may seem like a lot of body parts, they all relate to the digestive system.

Conditions Treated and Procedures Performed

Common conditions like heartburn, irritable bowel syndrome, gall stones, and ulcers fall under the purview of gastroenterology. Less common conditions such as biliary tract disorders or rare nutritional diseases are also treated by gastroenterologists.

Procedures performed include colonoscopies, barium swallows, CT scans, gastric bypass surgeries, and biopsies. Many gastroenterology procedures are simple and allow a patient to return home the same day.

Patient Referral

If a doctor suspects a gastrointestinal issue, or has unsuccessfully attempted treatment of such a condition, a patient may be referred to a gastroenterology practice. A referral does not necessarily mean that a serious condition is present, only that the symptoms or conditions are beyond the scope of the referring doctor.

If a gastroenterology visit is needed, residents of the North Atlanta area are fortunate to have GI North and doctors Confrancesco and Quijano. Spanish speakers are welcome, as Dr. Quijano is a fluent in Spanish. Patients coming from Alpharetta, Roswell, Canton, Suwanee and beyond can be assured that they will receive the top in gastroenterological care at GI North in a comfortable, professional setting.


1) How to Become a Gastroenterologist
2) What is a Gastroenterologist?

© 2015 GI North Gastroenterology Services. All rights reserved.

One of the quotes you probably have been repeating you’re entire life is “An aspirin a day, keeps the doctor away.” Well, now there’s even more proof showing this to be true. Not only does it help prevent strokes and heart disease but it can also help prevent colon and esophageal cancer.

aspirin | prevent colon cancer | Atlanta, GAThere have been new guidelines issued this week (September 15, 2015) from the US Preventative Services Task Force that states a daily low dose of aspirin should be given to people in their 50’s to help provide protection against colon cancer as well as heart attack or stroke. The US Preventative Services Task Force is an independent panel of experts who review the evidence for preventative medicines.

The guidelines suggest that lose dose aspirin has the most benefit for helping prevent colon and esophageal cancer for those in their 50’s. Once people reach their 60’s, they can expect smaller benefits and should be guided by their doctor as to the draw backs or benefits of starting an aspirin regime.

The doctors at GI-North located in Cumming, GA are happy that a low dose aspirin a day could help prevent colon and esophageal cancer but don’t want people to mistake this as a reason not to have a colonoscopy during their 50’s and 60’s. For some more at risk patients, the procedure should be performed at an even earlier age.

The increased awareness of the benefits of having a colonoscopy has been the leading cause of decrease in colorectal cancer of the past 5 to 10 years. While the evidence shown that aspirin can reduce incidence of colorectal neoplasia, it should not be used as a reason to pass on having the procedure.

As in starting a new medication regime, you should discuss with your doctor first. For many patients, aspirin is not tolerated well and can cause bleeding in the stomach, intestinal track and even in the brain. Dr. Simon Cofrancesco and Dr. Sergio Quijano are specialist when it comes to diagnosing and treating any conditions concerning gastrointestinal concerns. They are located in the Northside Forsyth campus in Cumming, GA. They treat patients from all over the north Atlanta metro area.

For more information on the details of the studies conducted refer to this abstract published in the US National Library of Medicine+ or the Daily Mail/Health+

© 2015 GI North Gastroenterology Services. All rights reserved.

Colonoscopy is important for your health because it prevents colorectal cancer. There was a study done that was published in the New England Journal in 2012, that showed, that removal of polyps can prevent death from colorectal cancer; which is a big finding, because prior to that it wasn’t really known whether it did prevent deaths or not. Now we have the data that shows that doing colonoscopies and finding polyps can prevent you from dying from cancer.

It’s imperative to screen patients for colorectal cancer through a colonoscopy, and now we have better bowel preps that are low volume and now we recommend splitting the dose, meaning that you don’t drink the whole prep at one time, you would drink half the prep the night before, and the other half the early morning of the day of the procedure, so that you can get a better quality study, and find more polyps.

So, during a colonoscopy, what we look for are polyps, angiectasia, diverticulosis, and cancer. Given the fact that there are new techniques, there are new bowel prep agents, and the fact that now we know that colonoscopies prevent death from colorectal cancer, it is more imperative to get screened for colon cancer through a colonoscopy. About 60-70% of the population who are above the age of 50 are getting screened, but we’re still missing about 20-30%. Getting screened late can put you at risk for finding an advanced polyp, or even cancer, which could have been prevented if you were screened earlier.

If you need a colonoscopy and live in the north Atlanta area, Dr. Quijano is at GI North which is located in Cumming, GA. GI North also serves residents in the surrounding areas such as Suwanee, Johns Creek, Alpharetta, Canton, and Duluth. Call (404) 446-0600 for an appointment today.

© 2015 GI North Gastroenterology Services. All rights reserved.

cartoon illustration of a stomach frowningWhether it is during a meeting, at the library, or in a waiting room, your stomach seems to know when to embarrass you. But those growls and grumblings do not only happen when it is quiet or when you are hungry that is just when you notice them.

Growls are a normal part of the digestive system.

Your digestive system moves food and drink through your body absorbing what you need and excreting the remainder. The muscles in your digestive system contract moving the contents downward and churn the contents up. When gas or air mixes with the digestive content, your stomach or small intestine seems to growl during the contractions as the air is compressed.

Your digestive system works continuously.

The contractions occur whether there are contents in your system or not. Therefore, when you are full the growls are less noticeable as they are muffled by the contents, and when your system is empty, it can sound like a bear is in your stomach.

Ways to quiet the grumbles.

It is possible to quiet these natural noises a bit if they become a nuisance or embarrass you often. Try eating smaller more frequent meals, avoiding gaseous foods, eating slower, and refraining from talking and exercising while eating. Occasionally a virus causes growls or eating something disagreeable, so pay attention to your body’s clues and note any food or drink that sounds your alarm.

Excessive growling should be evaluated.

While occasional noises are a normal function of the digestive system, if you have excessive noises, you should visit a gastroenterologist. The grumbles may indicate poor absorption of nutrients in the small intestine, which could mean lactose intolerance or other food sensitivities. The growls could also be symptomatic of a more serious condition such as irritable bowel syndrome.

GI North, located in Cumming, GA, and serves patients in Cumming, Alpharetta, Roswell, Canton, Suwanee, and beyond, is a convenient and informed resource for all your gastroenterology needs. Dr. Quijano, who speaks fluent Spanish, and Dr. Cofrancesco are qualified gastroenterology specialists, who can help you discern the cause of those embarrassing grumbles. The professionals at GI North are here to help you, so contact our office by calling (404) 446-0600 with any questions or concerns.

© 2015 GI North Gastroenterology Services. All rights reserved.

Dr. Sergio Quijano from GI North in Cumming, GA explains the difference between acid reflux and indigestion. Sometimes acid reflux and indigestion can be confused. What we call acid reflux is called G.E.R.D., and indigestion is called Dyspepsia, and they can run hand in hand. Usually it’s caused by a hyper-secretion of acid that can reflux up into your esophagus, that’s called GERD. Or it just sits in your stomach and causes abdominal pain, bloating, feeling like your abdomen is distended, what we call indigestion.

Usually, if you are young with no alarm symptoms, and that means, you’re not losing weight, there’s no family history of gastric cancer, you’re not throwing up blood, you have no problems with swallowing or pain when you swallow, then most of the times what we do is what we call test and treat.

What that means is we usually check for a bacteria called Helicobacter Pylori. This bacteria is commonly found in a lot of people, and most of the time causes no symptoms. But there is a certain population where it can cause the feelings of indigestion. And so we try to look for the bacteria either through a breath test, a stool test, and sometimes through blood. And if you have this bacteria, we treat it with antibiotics.

Sometimes, if you don’t have it, then the treatment would be usually what we call a proton pump inhibitor, which is an acid reducing medicine, like Nexium, Prylosec, which you can find over the counter.

Reflux disease can sometimes present as having some damage in your esophagus, but actually most of the time when we do an endoscopy in patients with acid reflux, the esophagus looks normal. But that doesn’t mean that you don’t have reflux disease. It just means that you don’t have damage. And the population where we find damage is actually not that often.

GI North is located in Cumming, GA and also serves residents in the surrounding areas such as Alpharetta, Johns Creek, Suwannee, and Duluth Dr. Cofrancesco and Dr. Quijano are ready to help you with your digestive issues. Call (404) 446-0600 for an appointment today.

© 2015 GI North Gastroenterology Services. All rights reserved.

photo of stressed woman with hands on stomach having bad achesThe causes of the irritable bowel syndrome also referred to as spastic colon, are unclear. Thus, the aim of treatment is to relieve the symptoms of the disease so that you can live as normally as possible.

Most often, you can successfully control the mild signs and symptoms of this disease by changing your diet and lifestyle and learning to manage stress. Also, drink lots of fluids, get enough exercise and get enough sleep.

If your problems range from moderate to severe, you may require more than lifestyle changes. Your doctor may also suggest medications.

Dietary Changes

Some of the dietary changes recommended by the staff at GI North include:

Eliminating high-gas foods. If you are passing high amounts of gas or are experiencing bothersome bloating, your doctor may suggest eliminating items such as vegetables— especially cabbage, cauliflower, and broccoli— carbonated beverages, and raw fruits.

Eliminating gluten. Studies show that some people with a spastic colon report a reduction in the diarrhea symptoms if they cut out on gluten (rye, wheat, and barley). This recommendation is, however, controversial and there is not much evidence to support it.

Eliminating FODMAPs. Some people show a higher sensitivity to certain types of carbohydrates such as lactose, fructose, fructans, and others, often referred to as FODMAPs (fermentable, oligo-, di-, monosaccharides, and polyols). FODMAPs are usually found in certain vegetables, grains, dairy products, and fruits. You may get relief from spastic colon symptoms by adhering to a strict low-FODMAP diet, and then reintroducing other foods as time goes.

Medications for Irritable Bowel Syndrome

Currently, two drugs have been approved for treating spastic colon.

Alosetron (Lotronex). Alosetron has been specially designed to relax the colon and slow down the movement of waste products of digestion through the lower bowel. However, this drug may only be prescribed by doctors who are enrolled in a special program, and it is supposed to be used for severe diarrhea-predominant IBS in women who have not responded to other forms of treatment. However, it has not approved for use by men. This drug should only be considered when other forms of treatment have failed because it is linked with rare but significant side effects.

Lubiprostone (Amitiza). Lubiprostone functions by increasing the secretion of fluids in your small intestines to help in the passage of fluids. It is approved for use by women aged 18 and above who have spastic colon with constipation. So far, it has not been proved to be effective in men. Besides, its long-term safety has not been determined. This drug may cause side effects that include diarrhea, nausea, and abdominal pain. Lubiprostone is prescribed for women suffering from IBS with severe constipation in cases where other forms of treatment haven’t been successful.

If you are in pain due to irritable bowel syndrome or other liver problems, visit or contact GI North to speak with a professional. Dr. Cofrancesco and Dr. Quijano of GI North are more than ready to attend to your needs and they serve the residents of Cumming, GA, as well as the surrounding areas of Alpharetta, Roswell, Canton, and Suwanee. Dr. Quijano also speaks fluent Spanish, which is an added advantage for all Spanish-speaking people.

© 2015 GI North Gastroenterology Services. All rights reserved.

Tips for Dealing with Heartburn

cartoon illustration of a red pepper breathing fireWe have all seen the latest trend of catchy television commercials advertising various heartburn medications featuring larger than life pizza slices and BBQ ribs that attack people. These scenes are humorous but for anyone that suffers from heartburn it is anything but funny. Statistics show that heartburn is the most common gastrointestinal malady today with 10% of Americans experiencing symptoms every day and night. If you suspect that you are suffering from heartburn put out the fire by calling (404) 446-0600 to schedule an appointment with the experts at GI North.

What is Heartburn and How is it Caused?

There are several ways to treat and/or cope with heartburn but before we learn to cope we need to understand exactly what heartburn is. Heartburn, also referred to as indigestion, is a medical condition that causes a burning sensation in the chest due to stomach acids that escape up into the esophagus. The sensation may be mild or extremely painful, depending on the severity of the condition. When functioning properly, stomach acids are kept out of the esophagus by the lower esophageal sphincter (LES) muscle. When this muscle is weakened, it doesn’t close as it is supposed to, resulting in the reflux of acid into the esophagus. It can be quite painful and scary if you don’t know what it is – many people mistake heartburn for a heart attack! It’s normal for some people to suffer from heartburn occasionally therefore there is no need to be overly concerned; however, if you suffer from heartburn on a regular basis and the pain is causing a negative impact on your life you should see a doctor and start a treatment plan for long term relief.

Long Term Effects of Heartburn

The acids in our stomach used to digest food are so strong that when the delicate tissues in our esophagus and mouth are exposed they become irritated and ulcerated causing erosion that burns no matter what you eat or drink. If left untreated heartburn sufferers run the risk of developing a variety of more serious conditions. To determine severity, an upper endoscopy procedure is performed to visually examine the upper digestive system (esophagus, stomach and beginning of the small intestine), with a tiny camera on the end of a long, flexible tube. The endoscopy procedure will help to determine if any of the following conditions are present:

  • Esophagitis, Barrett’s Esophagus, and Esophageal Cancer
  • Narrowing of the Esophagus
  • Respiratory Problems
  • Voice and Throat Problems
  • Dental Problems Due to Reflux

Foods and Lifestyle Habits to Avoid

  • Coffee, tea, cocoa, cola drinks, and other caffeine-containing products
  • Peppermint and chocolate
  • Fried and fatty foods
  • Citrus fruits or tomato products
  • Smoking
  • Alcohol
  • Obesity
  • Aspirin, contraceptives or postmenopausal hormone preparations
  • Over eating
  • Lying down or bending over too soon after eating and late-night snacks

Heartburn Treatment

There are a variety of treatments available to relieve the symptoms of heartburn depending on diagnosis. Minor, occasional heartburn can be treated using over-the-counter medications such as Prilasec, Prevacid, and Zantac. Individuals with more severe symptoms may be prescribed Nexium, Protonix, or others. Once diet and medication is balanced and under control, symptoms will begin to lessen or subside. Make an appointment with one of the Gastroenterologists at GI North to end your pain today! Visit or call (404) 446-0600 for more information.

© 2015 GI North Gastroenterology Services. All rights reserved.

What’s the Buzz?

photo of Cologuard® Cancer Screening Kit

Cologuard® is a noninvasive colon cancer screening test that can be done at home. It is available by prescription only.

You may have recently heard about a new colon cancer test called Cologuard® that is being used at many Gastroenterology practices throughout the US. Cologuard is a noninvasive colon cancer screening test for adults 50 years or older who are at average risk for colon cancer. It’s important to understand that Cologuard detects cancerous cells but does not provide any preventive measures such as polyp detection that could progress into cancer over time. Cologuard is not for everyone and many physicians are of the opinion that Cologuard can never take the place of a colonoscopy procedure. The Gastroenterologists at GI North prefer to use the colonoscopy procedure due to its proven accuracy in detecting cancerous cells, polyps, and ulcers in the large intestine. If you live in the Atlanta area and are experiencing abdominal pain, changes in bowel habits, or notice blood in your stool, don’t ignore it! Contact GI North in Cumming, GA at 404-446-0600 today and schedule a consultation to discuss your bowel problems – it could save your life.

Colon Cancer Screening

It is a well known fact that colon cancer screenings are an important part of adult preventive care as we age and enter into our 50’s. Screenings can detect a variety of abnormal growths, typically polyps that develop on the lining of the large intestine or rectum. Polyps are fairly common; however, some are dangerous and can become cancerous over time. If polyps are found during a colonoscopy they will be removed and examined carefully to see if any cancerous cells are present. Colon cancer often has no obvious signs or symptoms in its early stages. By the time symptoms show themselves, in many cases the cancer has advanced to a later stage.

How Cologuard Works

Cologuard uses advanced stool DNA technology to find altered DNA from abnormal cells in the colon, which could be associated with cancer or precancer. The test does not require any special preparation and can be performed in the privacy of your own home without any down time. How is this possible? The Cologuard collection kit is shipped directly to your home where you collect a single stool sample using the kit. Once completed, you send the kit back to Exact Sciences Labs via prepaid UPS shipping or pick-up. Exact Sciences Labs provides the results back to your doctor who will contact you to discuss the results.

Cologuard verses Colonoscopy

Colon cancer is the second-leading cause of cancer mortalities in men and women combined in the United States. Each year an estimated 150,000 people in the US will be diagnosed with colon cancer and an estimated 49,000 people will die from the disease. While both screening methods detect abnormalities in the colon, Cologuard is not considered to be preventive care or a replacement for diagnostic/surveillance colonoscopy for high-risk individuals. Cologuard comes with a long list of caveats concerning patient eligibility including family cancer history, known bowel diseases, and several cancer related syndromes.

A colonoscopy has an extremely high success rate for detecting cancerous cells in the colon without eliminating patients due to family history or illness AND goes one step further by detecting polyps or bowel disease. Some people are afraid of the procedure or have difficulty tolerating the preparation for a colonoscopy and may prefer Cologuard if they are eligible.

Resources and Next Steps

Colon cancer is one of the most preventable, yet least prevented, cancers in the US today. It is the third most diagnosed cancer, and second leading cause of cancer deaths in both men and women 50 years of age and older. Despite these facts, colon cancer is one of the most treatable cancers if it is found early through screening. Even if you don’t have any symptoms, regular screening is worthwhile, because it can save your life. If you are age 50 it is time to have a colonoscopy. GI North Gastroenterology Services is conveniently located in Cumming, GA treating patients from all over north Georgia including Dahlonega, Dawsonville, Johns Creek, Alpharetta, Milton, Suwanee, Duluth and Canton. Learn more about GI North, here or call 404-446-0600 today to schedule an appointment.

© 2015 GI North Gastroenterology Services. All rights reserved.

Celiac Disease

photo of gluten free pizza | GI North | Cumming, GAThe word “celiac” is taken from the Greek word for “hollow,” in regards to the bowels. Celiac disease is an immune reaction to ingesting gluten. Gluten is a protein found in wheat, barley, and rye. With celiac disease, if you eat gluten, then your immune system triggers a response in your small intestine. This causes abdominal pain, nausea, and other bowel problems. If this disease persists untreated then you can have inflammation in the small intestine that leads to malabsorption, meaning that your stomach is not absorbing the proper nutrients. If this disease occurs in children, it can lead to developmental problems if it is not treated.

Celiac disease effects around 0.6 to 1 percent of the world’s population, according to the New York Times. It is a growing epidemic and complications can range from diarrhea and anemia to osteoporosis, a disease in which bones become fragile and more likely to fracture. There is no cure for celiac disease; however, eating a gluten-free diet helps with the symptoms and lets you lead a healthy normal life. GI North can provide you with relief from these symptoms and celiac disease by providing excellent care with the latest techniques and technology.

Celiac Disease Awareness Month

Because we know how serious celiac disease can be, GI North happily supports Celiac Disease Awareness Month. Celiac Disease Awareness Month occurs each year in the United States to raise money for the National Foundation of Celiac Awareness. The events that occur during this month raise awareness for celiac disease and provides information about important things that the National Foundation of Celiac Awareness has done over the past year. Also, this supports the research into finding a cure for the disease because one is not known as of today.

There are many events that occur during the month of May that go towards the awareness of celiac disease. This include:

  • A Gluten-Free Labeling Summit: a number of researchers, legislators, and food businesses meet and fight to have the Food and Drug Administration (FDA) create proper gluten-free labeling on food.
  • Ask the Dietician: people use Twitter and other forms of social media, created by the National Foundation of Celiac Awareness, to chat with experts on dietary advice.
  • Webinars: include topics that about gluten-free dieting and celiac disease, and also address those who are 60+ years old with celiac disease or are gluten intolerant.
  • Catwalk for Celiac: final fundraiser which is a fashion show, dinner and dance for families who want to participate. Learn more about this New York event, here, or check your area for a celiac fundraiser near you.

Blame for much of the causes of celiac disease falls on our society being gluten-rich and how a lot of our food contains wheat. However, the epidemiology of celiac disease counteracts this idea because other countries, such as Finland and Russia who do not eat as much wheat, still have a high population of those who have celiac disease. Also, genetics cannot describe the disease either because there is no gene that has been found that is similar in all celiac patients. This vagueness that follows celiac disease makes Celiac Awareness Month so important.

To learn more about how to donate to the National Foundation of Celiac Awareness and ways you can participate in Celiac Disease Awareness Month, visit For help with digestive disorders or if you need a diagnostic procedure, such as an upper endoscopy, done please contact GI North today by calling 404-446-0600. Dr. Cofrancesco or Dr. Quijano would love to meet with you. Dr. Quijano is new to the practice and speaks fluent Spanish.

© 2015 GI North Gastroenterology Services. All rights reserved.

medical illustration of a body highlighting the liver | GI NorthLiver cirrhosis, also known as hepatic fibrosis, is an abnormal condition in which an irreversible scarring of the liver occurs. The main causes of this disease include excessive consumption of alcohol, fatty liver disease, and viral hepatitis B and C. Alcohol consumption contributes to between 20 and 50 percent of all hepatic fibrosis cases, and every year, 36,500 Americans die from this disease.

During the early stages of hepatic fibrosis, the symptoms are not very pronounced. But as the scar tissues accumulate, the ability of the liver to function properly is hampered. The following signs and symptoms may manifest when this happens:

  • Blood capillaries in the body become visible on the skin and the upper part of the abdomen
  • Insomnia
  • Fatigue
  • Itchy skin
  • Loss of appetite
  • Loss of body weight
  • Nausea
  • Tenderness and pain in the liver area
  • Blotchy or red palms

The staff at GI North would like you to know that hepatic fibrosis can affect the absorption of food in the body. On the other hand, your diet may influence your appetite, weight, and amounts of vitamins in your body. For this reason, a dietetic change is often recommended for anybody suffering from this disease. In addition, your doctor may recommend a lifestyle change depending on how well your liver is working.

Tips for Managing Liver Cirrhosis

The following tips will guide you in improving the quality of your life, and also to prevent further damage to your liver.

1. Don’t drink alcohol

Whether your hepatic fibrosis was caused by chronic consumption of alcohol or another disease, avoid drinking alcohol. Drinking alcohol will damage your liver further, making your condition more hopeless.

2. Eat less sodium in your diet

Excess salt is likely to make your body retain fluids. This in turn worsens the swelling of your legs and abdomen. Instead, use herbs to season your food. And if you eat already prepared foods, choose the ones with low sodium.

3. Eat a balanced diet

Individuals suffering from hepatic fibrosis can get malnourished. You can fight this situation with a healthy plant-based diet that contains a variety of vegetables and fruits. You also need to eat lean proteins such as poultry, fish or legumes, and to incorporate whole grains into your diet. In addition, avoid raw seafood.

4. Avoid getting infected

Hepatic fibrosis makes it difficult for your body to fight off infections. Thus, protect yourself by avoiding sick people, and wash your hands with soap frequently. Furthermore, you need to be vaccinated against hepatitis A and B, pneumonia, and influenza.

5. Be careful when using over-the-counter medications

When you are suffering from hepatic fibrosis, it becomes more difficult for your liver to process drugs. Thus, ask for your doctor’s advice before taking any medications including non-prescription drugs. Avoid drugs such as aspirin, Advil and Motrin. Your doctor may also recommend that you avoid acetaminophen, or that you take it in small doses to relieve pain.

Liver cirrhosis is a chronic, incurable health condition that should not be neglected. If you notice any symptoms of the disease, seek professional help from the GI North. Dr. Cofrancesco and Dr. Quijano serve the residents of Cumming, Ga area as well as the surrounding areas such as Alpharetta, Canton, Roswell, and Suwanee. In addition, Dr. Quijano speaks fluent Spanish, which is an added advantage for the Spanish speaking people in these areas.

© 2015 GI North Gastroenterology Services. All rights reserved.

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