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2797 Ocean Parkway, 1st Floor

Brooklyn, NY 11235

Tel. 718.615.4000

Fax. 718.615.4004

Alexander Shapsis, M.D., FACG

Board Certified Gastroenterologist

Gastroenterology - Hepatology - Endoscopy

Gastroenterology is a medical specialty within the field of Internal Medicine. Gastroenterologists treat disorders of the gastrointestinal (GI) tract, also known as the digestive system including the esophagus, stomach, small intestine, colon, liver, pancreas and gallbladder.

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About Dr. Alexander Shapsis.Alexander Shapsis, M.D. is a Board-Certified, fellowship-trained Gastroenterologist in the New York area, specializing in all aspects of gastroenterology, hepatology, and hepato-billiary diseases. Born in Moldova, Dr. Shapsis came to the United States with his family in 1991, and completed his undergraduate studies at New York University with a major in Biochemistry and a double Minor in Math and Philosophy. He graduated Cum Laude and finished his medical school training at the SUNY Downstate School of Medicine at the top of his class. He is also the winner of the HIAS scholarship for his academic merits.Dr. Shapsis completed his Internal Medicine Residency at the St. Vincents Medical Center of Manhattan. Following his residency, Dr. Shapsis completed his Fellowship in Gastroenterology at the St. Vincents Medical Center of Manhattan, as well as The Mount Sinai Hospital.Dr. Shapsis is an attending physician at St. Vincents Medical Center of Manhattan, where he teaches residents and Fellows the basics of Gastroenterology. Dr. Shapsis has presented nationally and is a published author of multiple research articles on various topics in gastroenterology and gastrointestinal motility disorders. He is certified by the American Board of Internal Medicine and Gastroenterology and is an active member of the American College of Gastroenterology and American Society of Gastrointestinal Endoscopy. Dr. Shapsis is strongly committed to the care of his patients and the treatment of colon cancer.
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Colonoscopy
Endoscopy
Flexible Sigmoidoscopy
Esophageal Dilation
Variceal Banding
Hemorrhoid Ligation
PILL CAM
Liver Biopsy
Hydrogen Breath Test
Anorectal Manometry

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Colonoscopy Lower Endoscopy (Colonoscopy)What is a Colonoscopy?A colonoscopy is a diagnostic test used to examine the lower portion of your gastrointestinal tract, especially your large intestine. This test is generally performed by a gastroenterologist if you have complained of:•blood in the stool•abdominal pain•persistent diarrhea•a change in bowel habitA colonoscopy may also be ordered if abnormalities in your GI tract were discovered during previous testing. In addition, a colonoscopy is often used as a screening tool for colon cancer in people who are considered to be at risk for developing the disease.How do You Prepare for a Colonoscopy?In order to achieve accurate results, you must take steps to ensure your colon is completely clean before your colonoscopy. Your doctor will give you detailed preparation instructions that should be followed carefully. In most cases, these instructions will include drinking large amounts of a solution meant to cleanse your colon. You may also be asked to drink only clear fluids for several days before your procedure or use laxatives or enemas. Cleaning out your colon will usually involve several bowel movements.In addition to following instructions for cleansing your colon before a colonoscopy, you will also need to give your doctor a detailed medical history that includes any medications youre currently taking, as well as any current medical conditions youre suffering from. This is especially important to prevent unexpected reactions to the sedatives that are generally used to reduce pain and discomfort during the colonoscopy.Click to download Colonoscopy PrepHow is a Colonoscopy Performed?You will be asked to lie on your left side or back on an exam table and sedatives will be administered through an IV. A four foot long, flexible tube known as a colonoscope is then inserted into the anus. The tube is about the thickness of a finger and has a camera and light at the tip. Using the light and camera for guidance, the physician will carefully pass the tube through the rectum and into the colon. Once the colonoscope has reached the cecum, the tip of the colon, or the terminal ileum, the end of the small intestine, the tube will be slowly pulled out. Much of the examination actually takes place as the colonoscope is being removed. The entire procedure can take anywhere from 15 minutes to an hour.In addition to examining the inside of your colon, your gastroenterologist may also perform a biopsy or various treatment procedures during your colonoscopy. A biopsy is simply a removal of tissue for further examination and can be done for a variety of reasons.After the procedure, youll be monitored by healthcare professionals until any sedatives have worn off. You may notice some abdominal cramping or bloating at this time, but this is generally resolved by passing gas. You should be able to resume normal eating when you get home, unless dietary restrictions are given due to polyp removal. You will need to have someone else drive you home and avoid operating heavy machinery for the remainder of the day.In most cases, your gastroenterologist will be able to discuss the preliminary results of your colonoscopy before you leave. The results of any biopsies performed will take a few days to receive.Trained medical staff at the Digestive Diseases Treatment Centers in Brooklyn and Manhattan can answer further questions about having a colonoscopy.

Endoscopy Upper Endoscopy (EGD)What is an Upper Endoscopy?Your doctor may have used the term upper endoscopy, EGD or esophagogastroduodenoscopy to describe a diagnostic test that is usually performed by a gastroenterologist. All of these words are interchangeable and refer to a test used to examine the upper portion of your digestive tract, including your:•Esophagus (the tube that moves food from your mouth to stomach)•Stomach•Duodenum (first part of your small intestine)An EGD may be ordered if youve complained of abdominal pain, persistent nausea or vomiting, troubles swallowing, internal bleeding, frequent acid reflux, or other problems that may be caused by a damaged or malfunctioning digestive system.An upper endoscopy may also be used to do a biopsy. A biopsy is simply taking sample tissues from an area for further testing and may be performed for a variety of reasons.Certain treatment procedures can also be performed during an upper endoscopy, including widening the esophagus, removing polyps and repairing gastrointestinal ulcers.How is an Upper Endoscopy Performed?An endoscope is a long, flexible tube about as thick as a small finger that has a light and camera on the end of it. During an upper endoscopy, youll be asked to lie on your left side on an exam table while the tube is placed into your mouth, down your throat, and into your stomach. This allows your doctor to examine the soft tissues inside digestive tract, which are usually unable to see clearly on an X-ray image.After the procedure, youll be monitored by healthcare professionals until any sedatives have worn off. You may notice a mild sore throat at this time, but this can usually be easily resolved with saline gargles. You should be able to resume eating within a few hours after your procedure. If sedatives were used, you will need to have someone else drive you home and avoid operating heavy machinery for the remainder of the day.In most cases, the physician who performed your endoscopy will be able to discuss the results of your exam before you leave. The results of any biopsies performed will take a few days to receive.Does an EDG Hurt?Most people do not experience any pain during an EDG procedure. Many doctors administer some type of sedative and use a numbing throat spray to alleviate any potential pain or discomfort. Depending on the type of sedative youre given and your individual reaction to it, you may even sleep through an upper endoscopy.An EDG is a very safe, minimally invasive procedure. The tube does not interfere with your breathing and complications are extremely rare, usually limited to a reaction to any sedatives given. In order to reduce your risk for these types of complications, be sure to talk to your doctor about any medications you are taking or current medical conditions youre suffering from before having the procedure.How do You Prepare for an EDG?Be sure to follow the specific instructions given to you by your doctor before your endoscopy. In most cases, these instructions will include fasting for at least six hours before the procedure in order to make sure that your stomach is empty.Digestive Diseases Treatment Center performs upper endoscopies for patients in the Brooklyn and Manhattan areas.

Flexible Sigmoidoscopy Flexible SigmoidoscopyYou may be visiting the Digestive Diseases Treatment Centers in Brooklyn or Manhattan because your doctor has ordered a sigmoidoscopy. Find out more about this diagnostic test, including how you should prepare for the procedure to ensure more accurate results.What is a Sigmoidoscopy?A sigmoidoscopy is used to examine the rectum and the sigmoid colon, the last one-third of the colon. This test may be recommended if you have experienced unexplained changes in your bowel habits, persistent abdominal pain, rectal bleeding, or sudden or unexplained weight loss. While a sigmoidoscopy can also be used to screen for certain types of cancer, a colonoscopy that allows your physician to see the entire colon is generally preferred for cancer screening.How is a Sigmoidoscopy Performed?A long, flexible tube about as thick as a finger and known as a sigmoidoscope, is used to examine the rectum and sigmoid colon. A light and camera, which transmits an image onto a video screen in the exam room, are mounted on the tip of the sigmoidoscope. While you lay on an exam table on your left side, the sigmoidoscope is inserted into your anus and carefully guided through the rectum into the sigmoid colon. The colon is then inflated with air to allow the camera to capture a better view. After reaching the transverse colon, the scope is slowly removed, allowing the doctor to further examine the inside of the colon and rectum. The camera will make a recording of this examination so that it can be thoroughly reviewed after the procedure has been completed.A sigmoidoscopy usually takes about 20 minutes. It may take longer if a biopsy, which involves removing tissue samples for further testing, or polyp removal is done. A biopsy may be done for many reasons and does not necessarily mean that cancer is suspected.You may experience cramping or bloating during the first hour after your sigmoidoscopy, but this is can be easily resolved in most cases by passing gas. Alert your doctor immediately if you notice more severe side effects, including severe abdominal pain, fever, bloody bowel movements, dizziness, or weakness.Your gastroenterologist may discuss the preliminary results of your sigmoidoscopy before you are released. However, it will take a few days to get the results of further tissue testing.How do You Prepare for a Sigmoidoscopy?If youre scheduled to have a sigmoidoscopy at the Digestive Diseases Treatment Centers, its important that you follow the preparation instructions that are given to you by your doctor. This may include flushing your colon with an enema 2 hours before your procedure as well as the night before, and following a clear liquid diet for up to 3 days before a sigmoidoscopy. It is usually recommended that you avoid foods that contain red or purple dye beforehand. Failing to follow these instructions may result in inaccurate test results and the need for another sigmoidoscopy or additional testing.Contact the office if you have further questions about an upcoming sigmoidoscopy.

Esophageal Dilation Esophageal DilationThere are a number of health complications, including severe GERD, that can cause blockage or narrowing of the esophagus, the tube that connects your mouth to your stomach. If the esophagus is blocked, swallowing, drinking and even breathing can become difficult. Esophageal dilation is used to widen the esophagus after a blockage or narrowing has occurred.There are multiple techniques that can be used to perform esophageal dilation, depending on what has caused the narrowing or blockage of the esophagus.Simple dilators (Bougies) - A bougie is simply a flexible cylinder that is passed into the esophagus to help open it up. These simple dilators are available in varying thicknesses and more than one may be used during an esophageal dilation.Balloon dilators - Using an endoscope, a physician can insert a balloon into the esophagus and then inflate the balloon. As the balloon inflates, it will stretch and often break the blockage.Achalasia dilators This type of esophageal dilation is typically done with the assistance of X-ray imaging. A large balloon dilator is used to stretch and break blockage in the lower part of the esophagus where food passes into the stomach.Depending on what type of esophageal dilation is performed, the procedure may take anywhere from a few minutes to a half an hour. This is usually an outpatient procedure that can be done in a physicians office or endoscopy suite. The amount of pain relievers or sedation used will vary depending on the technique.

Variceal Banding Variceal BandingBleeding in the digestive tract, specifically the esophagus and stomach, is a very serious complication associated with cirrhosis. This bleeding occurs in people with cirrhosis because of increased blood pressure in the veins that carry blood from the digestive tract to the liver. This bleeding, known as variceal bleeding, can be life-threatening and requires immediate treatment. Esophageal ligation, also known as variceal banding, is one of the most commonly used treatments for bleeding varices.How does variceal banding (esophageal ligation) work?An endoscope is used to put an elastic band around the dilated vein that is causing the problem. This serves to cut off the blood flow to the vein. This procedure often needs to be repeated several times over the course of a few weeks. once the bleeding has been controlled, the varices will need to be checked every 3 to 12 months indefinitely.During variceal banding, a doctor uses an endoscope to place an elastic ring that looks like a rubber band around an enlarged vein. Banding the vein in this manner will cut off blood flow through the vein. It may be difficult to use this procedure while someone is actively bleeding because the device used to place the bands obscures the doctors vision.Esophageal ligation has been shown to be as effective as other treatment options and usually results in fewer complications.

Hemorrhoid Ligation Hemorrhoid LigationInternal hemorrhoids are swollen blood vessels that develop inside the anus. These can be treated with a procedure known as hemorrhoid ligation.How is a hemorrhoid ligation performed?Local anesthesia may be used during a hemorrhoid ligation, as well as a sedative to help you relax. You will be asked to lie on your left side while a doctor inserts a scope into your anus in order to locate the internal hemorrhoid. Once the internal hemorrhoid is located, an elastic band is placed around the swollen blood vessel in order to cut off the blood supply to the vessel. When the blood flow has been removed, the hemorrhoid will eventually slough off. This procedure often needs to be repeated 2-4 times, every six to eight weeks, before the hemorrhoid sloughs off completely.After a hemorrhoid ligation, you will be monitored for a few hours before being sent home. You should arrange to have someone drive you home from the hospital after the procedure. You may experience pain and tightness afterward, which can usually be resolved with pain relievers or a sitz bath. You should contact your doctor if you experience bleeding or a fever, as these may be signs of more serious complications, including infection.

PILL CAM Pill CamCapsule endoscopy is a procedure designed to help your physician see what is happening inside parts of your gastrointestinal (GI) tract. The GI tract is the tube which extends from the mouth to the anus in which the movement of muscles digests food. During the procedure, a patient swallows a vitamin-sized pill with a camera inside. Transported smoothly and painlessly through the GI tract by the bodys own natural peristalsis, the PillCam video capsule transmits images of different parts of your body such as the small intestine and the esophagus. Since the first PillCam video capsule was approved by the FDA in 2001, more than 700,000 patients have safely swallowed one of the PillCam video capsules.Capsule endoscopy is the least invasive and most direct way for doctors to see the entire small intestine and esophagus. Hundreds of clinical studies conducted by the worlds leading gastroenterologists have shown the value of the PillCam video capsules in helping doctors diagnose or rule out disorders of the GI tract.The PillCam SB video capsule measures 11 mm x 26 mm and weighs less than 4 grams. It contains an imaging device and light-source on one-side and transmits images at a rate of 2 images per second generating more than 50,000 pictures over an 8-hour period.PillCam SB was initially cleared by the U.S. Food and Drug Administration in 2001 and today is used by physicians to detect and diagnose disorders of the small intestine. This includes Crohns disease, small bowel tumors, malabsorption disorders (such as celiac disease), GI injuries induced by extended NSAID use and suspected GI bleeding of the small bowel.The Companys next generation small bowel video capsule, PillCam SB 2, was cleared for marketing by U.S. Food and Drug Administration in May 2007. It is the same size as the PillCam SB video capsule and offers advanced optics and a wider field of view to image the small intestine. PillCam SB 2 also captures nearly twice the mucosal area per image.How the Procedure WorksA patient fasts starting at midnight the day before the procedure. The following morning they arrive at the physicians office where they are prepped for the procedure. This includes attaching the sensor array to the patients abdomen and the data recorder to a belt around the patients waist. Once these tasks have been completed the patient will be given a glass of water to help swallow the vitamin-sized pill. The patient can resume daily activities once he or she has successfully swallowed the PillCam video capsule. After 8-hours the patient returns to the physicians office to return the device and the pill passes naturally with a bowel movement usually within 24 hours.Images are downloaded by the physician to the Given workstation for review and diagnosis. The proprietary RAPID software installed on the workstation contains an image atlas to help facilitate the analysis.

Liver Biopsy Liver BiopsyIn a liver biopsy, the physician examines a small piece of tissue from your liver for signs of damage or disease. A special needle is used to remove the tissue from the liver. The physician decides to do a liver biopsy after tests suggest that the liver does not work properly. For example, a blood test might show that your blood contains higher than normal levels of liver enzymes or too much iron or copper. An x ray could suggest that the liver is swollen. Looking at liver tissue itself is the best way to determine whether the liver is healthy or what is causing it to be damaged.PreparationBefore scheduling your biopsy, the physician will take blood samples to make sure your blood clots properly. Be sure to mention any medications you take, especially those that affect blood clotting, like blood thinners. One week before the procedure, you will have to stop taking aspirin, ibuprofen, and anticoagulants.You must not eat or drink anything for 8 hours before the biopsy, and you should plan to arrive at the hospital about an hour before the scheduled time of the procedure. Your physician will tell you whether to take your regular medications during the fasting period and may give you other special instructions.ProcedureLiver biopsy is considered minor surgery, so it is done at the hospital. For the biopsy, you will lie on a hospital bed on your back with your right hand above your head. After marking the outline of your liver and injecting a local anesthetic to numb the area, the physician will make a small incision in your right side near your rib cage, then insert the biopsy needle and retrieve a sample of liver tissue. In some cases, the physician may use an ultrasound image of the liver to help guide the needle to a specific spot.You will need to hold very still so that the physician does not nick the lung or gallbladder, which are close to the liver. The physician will ask you to hold your breath for 5 to 10 seconds while he or she puts the needle in your liver. You may feel pressure and a dull pain. The entire procedure takes about 20 minutes.Two other methods of liver biopsy are also available. For a laparoscopic biopsy, the physician inserts a special tube called a laparoscope through an incision in the abdomen. The laparoscope sends images of the liver to a monitor. The physician watches the monitor and uses instruments in the laparoscope to remove tissue samples from one or more parts of the liver. Physicians use this type of biopsy when they need tissue samples from specific parts of the liver.Transvenous biopsy involves inserting a tube called a catheter into a vein in the neck and guiding it to the liver. The physician puts a biopsy needle into the catheter and then into the liver. Physicians use this procedure when patients have blood-clotting problems or fluid in the abdomen.RecoveryAfter the biopsy, the physician will put a bandage over the incision and have you lie on your right side, pressed against a towel, for 1 to 2 hours. The nurse will monitor your vital signs and level of pain.You will need to arrange for someone to take you home from the hospital since you will not be allowed to drive after having the sedative. You must go directly home and remain in bed (except to use the bathroom) for 8 to 12 hours, depending on your physician's instructions. Also, avoid exertion for the next week so that the incision and liver can heal. You can expect a little soreness at the incision site and possibly some pain in your right shoulder. This pain is caused by irritation of the diaphragm muscle (the pain usually radiates to the shoulder) and should disappear within a few hours or days. Your physician may recommend that you take Tylenol for pain, but you must not take aspirin or ibuprofen for the first week after surgery. These medicines decrease blood clotting, which is crucial for healing.

Hydrogen Breath Test Hydrogen Breath TestA hydrogen breath test (or HBT) is used as a clinical medical diagnosis for people with irritable bowel syndrome, and common food intolerances. The test is simple, non-invasive, and is performed after a short period of fasting (typically 8-12 hours). Even though the test is normally known as a "Hydrogen Breath Test" some physicians may also test for methane in addition to hydrogen. Many studies have shown that some patients (approximately 35% or more) do not produce hydrogen but actually produce methane. Some patients produce a combination of the two gases. Other patients don't produce any gas, which are known as "Non-Responders", some physicians believe that these individuals actually produce another gas which has not been determined yet. In addition to Hydrogen and Methane, some facilities also utilize Carbon Dioxide (CO2) in the patients breath to determine if the breath samples that are being analyzed are not contaminated (either with room air or bronchial dead space air).Tests vary from country to country, so the following information is provided as a rough guide to typical uses of the hydrogen breath test:Fructose malabsorption - the patient takes a base reading of hydrogen levels in his/her breath. The patient is then given a small amount of fructose, and then required to take readings every 15, 30 or 60 minutes for two to three hours. If the level of hydrogen rises above 20 ppm (parts per million) over the lowest preceding value within the test period, the patient is typically diagnosed as a fructose malabsorber. If the patient produces methane then the parts per million for the methane typically rises 12 ppm over the lowest preceding value to be considered positive. If the patient produces both hydrogen and methane then the values are typically added together and the mean of the numbers is used to determine positive results, usually 15 ppm over the lowest preceding value.Lactose intolerance - the patient takes a base reading of hydrogen levels in his/her breath. The patient is then given a small amount of pure lactose (typically 20 to 25 g), and then required to take readings every 15, 30 or 60 minutes for two to three hours. If the level of hydrogen rises above 20 ppm (parts per million) over the lowest preceding value within the test period, the patient is typically diagnosed as a lactose malabsorber. If the patient produces methane then the parts per million for the methane typically rises 12 ppm over the lowest preceding value to be considered positive. If the patient produces both hydrogen and methane then the values are typically added together and the mean of the numbers is used to determine positive results, usually 15 ppm over the lowest preceding value.Small Bowel Bacterial Overgrowth Syndrome (SBBOS) or Small Intestinal Bacterial Overgrowth (SIBO) - the patient is either given a challenge dose of glucose, also known as dextrose (75-100 grams) or lactulose (10 grams). Breath samples are then collected at 15 minute or 20 minute intervals after the baseline is collected for 3-5 hours. Positive diagnosis for a lactulose SIBO breath test - typically positive if the patient produces approximately 20 ppm of Hydrogen and/or Methane within the first two hours (indicates bacterial in the small intestine), followed by a much larger peak (colonic response). This is also known as a biphasic pattern. Lactulose is not absorbed by the digestive system and can help determine distal end bacterial overgrowth, which means the bacteria is lower in the small intestine. Positive diagnosis for a glucose SIBO breath test - Glucose is absorbed by the digestive system so studies have shown it to be harder to diagnose distal end bacterial overgrowth since the glucose typically doesn't reach the colon before being absorbed. An increase of approximately 12 ppm or more in hydrogen and/or methane during the breath test could conclude bacterial overgrowth.The excess hydrogen or methane is typically caused by an overgrowth of otherwise normal intestinal bacteria.

Anorectal Manometry

KHROM DERM SPECIALS.pdf

Anorectal Manometry
Patient Information on Anorectal Manometry What is anorectal manometry? Anorectal manometry is a test performed to evaluate patients with constipation or fecal incontinence. This test measures the pressures of the anal sphincter muscles, the sensation in the rectum, and the neural reflexes that are needed for normal bowel movements. PREPARATION FOR THE PROCEDURE Give yourself one or two Fleet® enemas 2 hours prior to your study. You can purchase the Fleet enema from a pharmacy or supermarket. You should not eat anything during the two hours prior to the procedure. If you are diabetic, this may involve adjusting your diabetic medications. You may take regular medications with small sips of water at least 2 hours prior to the study. THE PROCEDURE The test takes approximately 30 minutes. You will be asked to change into a hospital gown. A technician or nurse will explain the procedure to you, take a brief health history, and answer any questions you may have. The patient then lies on his or her left side. A small, flexible tube, about the size of a thermometer, with a balloon at the end is inserted into the rectum. The catheter is connected to a machine that measures the pressure. During the test, the small balloon attached to the catheter may be inflated in the rectum to assess the normal reflex pathways. The nurse or technician may also ask the person to squeeze, relax, and push at various times. The anal sphincter muscle pressures are measured during each of these maneuvers. To squeeze, the patient tightens the sphincter muscles as if trying to prevent anything from coming out. To push or bear down, the patient strains down as if trying to have a bowel movement. Two other tests may be done: first, an anal sphincter electromyography (EMG), a test to evaluate the nerve supply to the anal muscle; second, measurement of the time it takes to expel a balloon from the rectum. After the examination, you may drive yourself home and go about your normal activities. Anal Sphincter EMG Anal sphincter electromyography (EMG) is recorded with a small plug electrode placed in the anal canal. The patient then is asked to relax, squeeze and push at different times. The anal sphincter muscle electrical activity is recorded and displayed on a computer screen. Anal sphincter EMG confirms the proper muscle contractions during squeezing and muscle relaxation during pushing. In people who paradoxically contract the sphincter and pelvic floor muscles, the tracing of electrical activity increases, instead of decreasing, during bearing down to simulate a bowel movement (defecation). Normal anal EMG activity with low anal squeeze pressures on manometry may indicate a torn sphincter muscle that could be repaired. Balloon Expulsion Test For this procedure, a small balloon is inserted into the rectum and then inflated with water. The patient goes to the bathroom and tries to defecate (expel) the small balloon from the rectum. The amount of time it takes to expel the balloon is recorded. Prolonged balloon expulsion suggests a dysfunction in the anorectum area. What can be learned from anorectal manometry? The anal and rectal area contains specialized muscles that are helpful to regulate proper passage of bowel movements. Normally, when stool enters the rectum, the anal sphincter muscle tightens to prevent passage of stool at an inconvenient time. If this muscle is weak or does not contract in a timely way, incontinence (leakage of stool) may occur. Normally, when a person pushes or bears down to have a bowel movement, the anal sphincter muscles relax. This will cause the pressures to decrease allowing evacuation of stool. If the sphincter muscles tighten when pushing, this could contribute to constipation. Anal manometry measures how strong the sphincter muscles are and whether they relax as they should during passing a stool. It provides helpful information to the doctor in treating patients with fecal incontinence or severe constipation. There are many causes of fecal incontinence. Weak anal sphincter muscles or poor sensation in the rectum can contribute to fecal incontinence. If these abnormalities are present, they can be treated. Biofeedback techniques using anal manometry and special exercises of the pelvic floor muscles can strengthen the muscles and improve sensation. This can help treat fecal incontinence. There are many causes of constipation. Some involve sluggish movement through the whole colon, whereas others involve the anal sphincter muscles. In some patients with constipation, the anal sphincter muscles do not relax appropriately when bearing down or pushing to have a bowel movement. This abnormal muscle function may cause a functional type of obstruction. Muscles that do not relax with bearing down can be retrained with biofeedback techniques using anal manometry. Risks of Anorectal Manometry Anorectal manometry is a safe, low risk procedure and is unlikely to cause any pain. Complications are rare: it is possible that a perforation (tearing) or bleeding of the rectum could occur. Equipment failure is a remote possibility. If you are allergic to latex, you should inform the nurse/technician before the test so that a latex free balloon can be used.

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2797 Ocean Parkway, 1st Floor

Brooklyn, NY 11235

Tel. 718.615.4000

Fax. 718.615.4004

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Alexander Shapsis, M.D., FACG

Board Certified Gastroenterologist

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Alexander Shapsis, M.D., FACG

Board Certified Gastroenterologist

General InformationWe are committed to serve your needs and make your visit as pleasant and smooth as possible. In order to help us in that process, please review the following information. (scroll down for more info)Office Hours:Mon, Tue, FriWed, ThuWhat to Bring to Your Appointment (New or Established patients):Please bring your insurance card(s), photo ID, list of current medications, and any recent laboratory or imaging testing done previously that may help at this visit. If your insurance plan requires that you obtain a written referral from your primary care physician, please make sure that you do so, and bring with you to your visit. Payment Information:Co-payments and balances are collected at the time of service. We accept Cash, Personal Checks, VISA, MC, Discover, and AMEX.Atlantic Gastroenterology participates with most major insurance plans. Give the office a call to inquire about your specific insurance plan.

2797 Ocean Parkway, 1st Floor

Brooklyn, NY 11235

Tel. 718.615.4000

Fax. 718.615.4004

OTHER OFFICE LOCATION

EGD ENG.pdf

EGD Instructions SPANISH.pdf

EGD RUS.pdf

Colonoscopy Preparation Eng.pdf

Colonoscopy Preparation (Gol-Nul-Half) RUSSIAN.pdf

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Office address:2797 Ocean Parkway, 1st Floor, Brooklyn, NY 11235Telephone: 718 615 4000 FAX:718 615 4004E-mail: info_atgastro.comLocal Trains/Buses: Trains F Q and Busses B36 B1 B4
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Alexander Shapsis, M.D., FACG

Board Certified Gastroenterologist

Please, take the time to review instructions before a procedure

2797 Ocean Parkway, 1st Floor

Brooklyn, NY 11235

Tel. 718.615.4000

Fax. 718.615.4004

EGD ENG.pdf

EGD RUS.pdf

EGD Instructions SPANISH.pdf

Pill

Colonoscopy Preparation Eng.pdf

Colonoscopy Preparation (Gol-Nul-Half) RUSSIAN.pdf