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Statesville Location
WE’VE MOVED!
340 Signal Hill Drive
Suite A
Statesville, NC 28625

704-978-1144 Phone
704-978-1148 Fax

Mooresville Location
359 Williamson Road
Mooresville, NC 28115

704-235-1829 Phone
704-235-1836 Fax

Hours:
Mon-Thu: 8AM-5PM
Fri: 8:30AM-12:30PM

About Us

Specialty: Gastroenterology

The shared vision and mission of the providers and staff of Piedmont Healthcare Comprehensive Digestive Care is to provide evidence-based, professional and compassionate care with uncompromising excellence. While striving for continuous improvement in our services, we seek to provide exceptional care with a positive attitude in a comfortable environment — focusing on the highest standards of patient satisfaction and care in the field of Gastroenterology and Hepatology. We have a well-deserved reputation for excellence, and are committed to putting the needs of our patients first at all times. Identifying community needs and expanding our services to meet those needs are our ongoing goals.

We are affiliated with Iredell Memorial Hospital, Davis Regional Medical Center and perform our endoscopy procedures at Piedmont HealthCare Endoscopy Center.

Educational Links:

Our Providers

Vivek Trivedi, MD

Medical School
NHL Municipal Medical College
Gujarat University
Ahmedabad, India

Internship
Internal Medicine
Icahn School of Medicine at Mount Sinai
Elmhurst, NY

Residency
Gastroenterology
Icahn School of Medicine at Mount Sinai
Elmhurst, NY

Fellowship
Gastroenterology
Icahn School of Medicine at Mount Sinai
Elmhurst, NY

Hospital Affiliations
Iredell Memorial Hospital
Davis Regional Medical Center

Certifications
Diplomate, American Board of Internal Medicine
Diplomate, Gastroenterology
ASGE STAR Certification for Barrett’s Endotherapy, including Lesion Recognition, Mucosal Imaging, Ablation Modalities, EMR, Radiofrequency Ablation (RFA) and Cryotherapy.

Associations
American College of Gastroenterology (ACG)
American Gastroenterological Association (AGA)
New York Society of Gastrointestinal Endoscopy (NYSGE)

Nikhiel Rau, MD

Certifications

Board Certified in Internal Medicine
ABIM Board Certified in Gastroenterology

Medical School

The American University of Antigua School of Medicine
Osbourn, Antigua and Barbuda

Internship

Icahn School of Medicine Mount Sinai at Elmhurst Hospital Center
New York, NY

Residency

Hepatology Fellowship
Beth Israel Deaconess Medical Center/Harvard School of Medicine
Boston, MA

Fellowship

Bridgeport Hospital Center / Yale New Haven Health
Bridgeport, CT

Tiedre Palmer, FNP-C

Undergraduate Education
University of South Carolina
Columbia, SC
Bachelors of Science in Nursing

Graduate Education
Francis Marion University
Florence, SC
Masters of Science in Nursing- Family Nurse Practitioner

Certifications
Registered Nurse
Advanced Practice Registered Nurse
Certified Family Nurse Practitioner

Associations
American Academy of Nurse Practitioner

Amy Arnold, NP

Undergraduate Education
King University
Bachelors of Science in Nursing

Graduate Education
Chamberlain College of Nursing
Masters of Science in Nursing- Family Nurse Practitioner

Services

Upper GI Tract:

Acid Reflux

Also known as gastroesophageal reflux disease (GERD), acid reflux occurs when stomach acid flows backward into the esophagus. The stomach entrance has a valve called the lower esophageal sphincter (LES) that closes once food passes through it. If the LES doesn’t close completely, acid from the stomach moves into the esophagus, causing heartburn, regurgitation and an acid taste. While most people experience occasional heartburn, anyone who has symptoms two or more times a week may have acid reflux.

Common triggers of acid reflux include eating spicy meals or overeating. Drinking excessive amounts of carbonated drinks, tea, coffee or alcohol also contributes to the condition. In most cases a change in lifestyle combined with over-the-counter antacids effectively treats acid reflux. If symptoms continue, a doctor may recommend prescription medications.

Barrett's Esophagus

YOUR HEARTBURN MAY NOT BE HARMLESS
DON’T IGNORE THE SIGNS.

Acid reflux. Chest pain. Chronic cough or sore throat. They may seem like harmless symptoms, but they could be a sign of a disease called gastroesophageal reflux disease, or GERD.

Early detection and treatment of GERD is essential, as the disease can lead to serious health problems, including Barrett’s esophagus, a precancerous disease of the esophagus.

If you, or someone you love, have experienced these symptoms, take charge of your health and take the next step towards treatment.

WHAT IS BARRETT’S ESOPHAGUS?

Barrett’s esophagus is a disease affecting the lining of the esophagus, the swallowing tube that carries foods and liquids from the mouth to the stomach. It is caused by injury to the esophagus from the chronic backwash of stomach contents, like acid and enzymes, that occurs with abnormal reflux.

People with Barrett’s esophagus may not have any symptoms. However, chronic heartburn, difficulty swallowing, nausea, chest pain and other symptoms of GERD may indicate a need for further testing. It is estimated that 13% of the people who have chronic acid reflux — those in high risk groups including chronic GERD, Caucasian, male, over age 50 — also have Barrett’s esophagus.

In addition to suffering from chronic heartburn, other factors that may put a person at risk for Barrett’s esophagus include:

  • Obesity
  • Caucasian ethnicity
  • Family history
  • Male gender

Once a person has Barrett’s esophagus, it may continually progress to more serious stages, potentially resulting in esophageal adenocarcinoma, a type of esophageal cancer. There are three stages of Barrett’s esophagus and range from the least serious (intestinal metaplasia without dysplasia) to the most serious (high-grade dysplasia). Dysplasia refers to the abnormalities of tissue or a cell that make it more cancer-like and disorganized. The presence of dysplasia is not considered cancer, but may increase the risk of developing cancer.

Celiac Disease

Celiac disease is a chronic digestive disorder caused by eating foods containing gluten, a protein found in wheat, oats, rye and barley. Genetics are also a factor- those who are diagnosed with celiac disease often have family members who also have the disease. In patients with celiac disease the small intestine becomes inflamed when gluten is consumed because of the immune system’s reaction against the protein. The inflammation doesn’t permit a high rate of nutrient absorption, so patients don’t get the full nutritional benefit of the foods they eat.

Common symptoms include abdominal pain, bloating and gas, diarrhea and weigh loss. Anemia (low blood count) can also occur. Eating a gluten-free diet is an essential treatment for celiac disease. Dieticians can help educate patients on foods that often contain gluten.

Eosinophilic Esophagitis

Eosinophillic esophagitis (EoE) is a disease in which the esophagus becomes inflamed due to large presence of a white blood cell called the eosinophil. The inflammation causes the esophagus to stiffen or narrow which leads to difficulties with swallowing or food getting stuck. Healthy people can have these white blood cells in other parts of the gastrointestinal tract, but their occurrence in the esophagus is an abnormal condition. Initially thought to be rare, EoE is now recognized as one of the most common causes of difficulty swallowing in young adults.

Esophagitis and Stricture

Esophagitis occurs when the lining of the esophagus becomes inflamed. The inflammation can be caused by an infection (bacteria, virus or fungi) or irritation resulting from vomiting, GERD symptoms (stomach acid flowing backward into the esophagus), or other factors such as certain medications or swallowing a large pill with little water.

Symptoms of the condition include heartburn, mouth sores, difficulty swallowing, nausea/vomiting or a feeling of something being stuck in the throat. Treatment methods differ depending on factors contributing to the ailment. They can include antibiotics or antifungal medications to treat bacteria or fungal infections, medications to block acid production or steroid treatment to reduce inflammation. Esophagitis shouldn’t be left untreated because it can cause ulcers, scarring and trouble swallowing.

Gallstones

The gall bladder is a small sac located just under the liver. It stores bile, a digestive fluid produced by the liver that helps digest fats. Gallstones form from cholesterol and other bile components. When high amounts of fat are present, crystals form and combine to form stones. They can range in size from a small grain of sand to a large golf ball.

Most gallstones don’t cause problems or symptoms and thus don’t need treatment. But if a person experiences pain in the right upper abdominal region that lasts longer than one to two hours or is associated with a fever, he or she should see a doctor. Symptomatic gallstones are usually removed during surgery.

Gas
Gastritis

Gastritis is a sudden or gradual erosion, inflammation or irritation of the stomach lining. Many factors contribute to gastritis, including excessive alcohol use, chronic vomiting, stress or the use of anti-inflammatory drugs. Infections caused by bacteria or viruses are also causes.

Some people may not experience gastritis symptoms, but common symptoms include: Recurrent upset stomach or nausea, abdominal pain or bloating, indigestion, vomiting or burning feeling in between meals. Loss of appetite and black, tarry stools can also occur.

Gastro Esophageal Reflux Disease

Also known as acid reflux, GERD occurs when stomach acid flows backward into the esophagus. The stomach entrance has a valve called the lower esophageal sphincter (LES). This valve closes once food passes through it. If the LES doesn’t close completely or opens, acid from the stomach moves into the esophagus, causing symptoms such as heartburn, regurgitation, and an acid taste. While most people experience occasional heartburn, anyone who has symptoms two or time a week may have GERD.

Common triggers include eating spicy meals or overeating. Drinking excessive amounts of carbonated drinks, tea, coffee or alcohol also contributes to the condition. In most cases a change in lifestyle combined with over-the-counter antacids effectively treats GERD. If symptoms continue, a doctor may recommend prescription medications or surgery.

Gastroparesis

The literal translation of gastroparesis is “stomach paralysis.” When the stomach functions normally, it contracts to help crush digested food before sending it to the small intestine where further digestion occurs and nutrients are absorbed. People who suffer from gastroparesis can’t crush food or move it to the small intestine because the stomach doesn’t contract normally.

A common symptom of gastroparesis is feeling full shortly after starting a meal. People can also experience bloating, nausea, vomiting and heartburn.

Heartburn and Reflux

Despite its name, heartburn has nothing to do with the heart. It’s the burning sensation that a person experiences in the upper abdomen or below the breast bone that is caused by the esophagus becoming irritated from stomach acid flowing backward, or acid reflux. Acid reflux happens when the muscle valve at the end of the esophagus, called the lower esophageal sphincter (LES) fails to close properly, allowing stomach acid to escape into the esophagus. When the acid irritates the esophagus, heartburn occurs.

Most people experience heartburn at some point, and the irritation can last for several hours. But chronic heartburn may be a symptom of GERD (gastroesophageal reflux disease), which can lead to serious problems if left untreated.

Helicobacter Pylori

Helicobacter pylori, or H. pylori, is a type of bacteria that can enter the body and live in your digestive tract. H. pylori infections are very common and don’t cause symptoms for most people. But after years of infection, people can develop ulcers in the stomach lining or small intestine. The bacteria attacks the lining that usually protects from stomach acid. When enough damage is done, acid gets into the lining and causes ulcers to form.

People with ulcers may experience a burning pain in their abdomen, especially when the stomach is empty. Other symptoms can include bloating, burping, vomiting or not feeling hungry. If a doctor determines that the ulcers are caused by H. pylori, antibiotics will be prescribed.

Hiatus Hernia

A hiatus hernia occurs when the stomach pushes upward through the small opening of the diaphragm called the hiatus. Many people who have this type of hernia might not know about it unless a physician discovers it when examining them for another condition.

Small hiatus hernias don’t cause problems. But a large hiatus hernia can allow food and acid to get into the esophagus, leading to heartburn. Doctors may recommend medications to treat the condition, but a large enough hernia may require surgery.

Lactose Intolerance

Lactose is a sugar found in dairy products like milk, cheese and yogurt. People who are lactose intolerant cannot properly digest the sugar, which leads to abdominal pain, excessive gas and explosive bowel movements. Because the sugar is not broken down in the small intestine as it normally would be, it passes in its whole form to the colon. The colon’s attempt to breakdown the lactose leads to the above mentioned symptoms.

Avoiding or reducing consumption of foods containing lactose is the best treatment for lactose intolerance. If a person knows they may be eating a food that has lactose, he or she can take a non-prescription lactase supplement at meal time to reduce symptoms.

Peptic Ulcer

A peptic ulcer is a sore that occurs in the stomach or small intestine lining, often due to acid. People who have ulcers may have no symptoms. Others will experience pain in the upper abdomen, feeling full or bloated, nausea or vomiting. Ulcers can bleed, either slowly or rapidly. Anemia, or lack of red blood cells, may indicate the presence of an ulcer. People with a rapidly bleeding ulcer may vomit blood or have bloody stool.

How to treat the ulcer depends on its severity and source. Bacteria can cause ulcers, in which case an antibiotic is prescribed. Acid-blocking medicines are also recommended or prescribed.

Lower GI Tract:

Anal Fissure, Abscess and Fistula

Anal fissures, abscesses and fistulas are related conditions occurring near or in the anus that produce similar symptoms. An abscess is an infected cavity filled with pus that’s found near the anus or rectum. Most abscesses result from blocked anal glands. An anal fistula can occur in about half of people who develop an anal abscess. A fistula is a tunnel that forms under the skin connecting the infected glands to the abscess. Painful bowel movements, bleeding, swelling, skin irritation and a fever are common abscess and fistula symptoms.

An anal fissure is a tear in the tissue lining the anus. Fissures can occur from passing large or hard stools and cause pain and bleeding with bowel movements. They are common in infants but can affect people at any age.

Colitis

Colitis is an inflammatory bowel disease (IBD) affecting the large intestine or colon. Normally the body’s immune system fights protects from infection. In people affected with IBD, however, the immune system mistakes food, good bacteria and other intestinal items for foreign material and mounts an attack, sending white blood cells into the intestinal lining. The result is chronic inflammation and ulceration. Patients can experience persistent diarrhea or constipation, looser and more urgent bowel movements, abdominal pain and rectal bleeding. The symptoms come and go, with remission periods lasting anywhere from months to years.

Colon Cancer

Colon cancer, or colorectal cancer, is the third most common cancer diagnosed in men and women in the United States. Most colon cancers begin as small clumps of cells called polyps that grow on the inner lining of the colon or rectum. Not all polyps are cancerous.

Symptoms can include changes in bowel habits (constipation or diarrhea), rectal bleeding and persistent abdominal pain or cramping. Because symptoms are not always present, regular screening for colon cancer is critical. Doctors can remove any detected polyps before becoming cancerous.

Colon Polyps

A colon polyp is a small growth on the inner lining of the large intestine that in some cases can become cancerous. Polyps can be found throughout the colon and vary in size. Because most polyps do not produce symptoms, regular screening for polyp detection and removal is important in preventing colon cancer. Polyps rarely cause changes in bowel habits.

Crohn’s Disease

Like colitis, Crohn’s disease is an inflammatory bowel disease caused by the body’s immune system mistakenly attacking good bacteria located in the gastrointestinal (GI) tract. Inflammation and ulceration results, causing symptoms that include diarrhea, more urgent bowel movements, constipation and abdominal pain. While Crohn’s disease typically affects the end of the small bowel and beginning of the colon, it can affect any area of the GI tract from the mouth to the anus.

Crohn’s disease is a chronic condition. Patients will experience flare-ups of symptoms and periods of remission.

Constipation

Being constipated means having difficult bowel movements that are either less frequent or difficult to pass. While people vary in the amount of time between normal bowel movements, feces become hardened and difficult to pass usually after three days.

In addition to hardened or less frequent bowel movements, you may also experience abdominal pain when constipated. Drinking extra glasses of water each day and adding fruits and vegetables to your diet can relieve the constipation. Regularly drinking fluids and eating a well-balanced diet that contains plenty of fiber will help prevent constipation.

While constipation is a common condition that affects most people at some point, it can be a symptom of more serious gastrointestinal concerns. People should consult a physician when symptoms last longer than two weeks or are accompanied by sever pain, bloody stool or weight loss.

Diarrhea

Diarrhea is a condition that results in loose, runny stools. Nearly everyone is affected by diarrhea at some point and causes can include food, medication, bacteria or viral infections and stress. While most cases of diarrhea resolve on their own, medical treatment should be sought if the condition persists for more than two days without improvement or is accompanied by severe abdominal pain. Sometimes diarrhea can be a symptom of an underlying more serious problem or untreated medical condition.

Hemorrhoids

Hemorrhoids are swollen veins in the anus and lower rectum that can result from straining during bowel movements. These common ailments can be located inside the rectum or under the skin around the anus. Symptoms can include bleeding during bowel movements, itching, irritation or swelling in the anal region.

Ostomy, Colostomy, Ileostomy

An ostomy is a surgical opening created in the abdomen if an intestinal segment is damaged due to disease or injury and cannot be repaired. Body waste is eliminated through the ostomy. Ostomies that expel feces are called colostomies or ilestomies.

When the ostomy is created waste is expelled through a stoma, or the ending of the large intestine that protrudes out of the abdominal wall. The stoma is oval-shaped and can vary in size depending on the procedure and abdominal shape.

Prevention of Colon Polyps and Cancer

Colon polyps are small growths on the inner large intestinal lining. Not all polyps are cancerous, but colon cancer typically develops from polyps.

Lifestyle changes can greatly reduce the chance of developing polyps. Maintain a well-balanced diet of fruits, vegetables and whole grains, and reduce fat consumption. Limit alcohol and red meat consumption and avoid tobacco products. Exercise regularly and maintain a healthy weight.

Regular screenings can also detect polyps for removal before they potentially become cancerous. Screen first degree family members with polyps at recommended intervals.

Rectal Bleeding

Rectal bleeding is any blood that passes from the anus that can show up in the stool or dripping into the toilet bowl. The blood can range in color from bright red to a dark tar-like color. Bleeding can occur from a variety of acute or chronic conditions. People should seek immediate medical attention if the bleeding is heavy and accompanied by abdominal pain. A physician should be contacted if rectal bleeding lasts for more than a day or two and is not caused by an obvious cause such as constipation.

Liver:

Autoimmune Hepatitis

Autoimmune hepatitis is a chronic disease in which the body’s immune system attacks the liver, causing inflammation and can lead to liver damage. The majority of people diagnosed with the disease are women between the ages of 15 and 40.

Symptoms are minor and include fatigue, aching joints, abdominal discomfort and jaundice (yellowing of skin and whites of the eyes). The condition often occurs suddenly and blood tests and a liver biopsy confirm the diagnosis. Medicines are prescribed to suppress the body’s immune system and stop the attack on the liver.

Cirrhosis

Cirrhosis occurs when hard scar tissue replaces soft healthy tissue in the liver. As the condition becomes worse the liver begins to fail. Other diseases that affect the liver tissue cause cirrhosis, including viral hepatitis, bile duct disease, genetic diseases and chronic alcoholism & non-alcoholic fatty liver disease related scarring.. Symptoms of cirrhosis include loss of appetite, fatigue, nausea, weight loss and abdominal pain, jaundice, easy brusing and abdominal distention.

Fatty Liver

Fat in the liver is normal, but fat levels that comprise more than 5 to 10% of the organ’s weight is a sign of fatty liver disease. There are two main types of fatty liver disease. Alcohol liver disease (ALD) is caused by excessive alcohol consumption over time or even after a short period of heavy drinking. Nonalcoholic fatty liver disease (NAFLD) is more likely found in people who are obese or overweight who are prone to high cholesterol and diabetes, although a specific cause of NAFLD is not known.

Symptoms can include weight loss, nausea, fatigue and in the center or right part of the abdomen.

Hemochromatosis

Hemochromotosis is a condition where the body absorbs too much iron from consumed foods. Excess iron is stored in organs like the liver, heart and pancreas and can lead to serious liver disease, heart problems and diabetes. Hemochromotosis is a genetic condition. Symptoms can include joint and abdominal pain, fatigue and weakness.

Inflammatory Bowel Disease (IBD)

Inflammatory bowel disease describes conditions that cause parts of the gastrointestinal (GI) tract to be come inflamed. The cause of IBD is an abnormal reaction of the body’s immune system wherein it attacks the GI tract, causing inflammation. Common symptoms of IBD conditions include abdominal pain, diarrhea or constipation, bloody stool and the urgency to have a bowel movement. Two common inflammatory bowel diseases are ulcerative colitis and Crohn’s disease.

Irritable Bowel Disease (IBS)

Irritable bowel disease is a chronic condition that affects the large or small intestine (colon), causing cramping, diarrhea, constipation, bloating and gas. Unlike inflammatory bowel disease, IBS does not cause changes in bowel tissue. Symptoms can often be controlled by lifestyle changes or medication.

Liver Disease

The liver is the organ that is necessary for food digestion and getting rid of toxic substances in the body. Liver diseases, which can be genetic or caused by a variety of factors, prevent the organ from working effectively. Symptoms of various liver diseases include jaundice (yellowing of the skin and whites of the eyes), abdominal pain, nausea and vomiting, fatigue and changes in urine and stool colors.

The Liver & Hepatitis

Hepatitis is inflammation of the liver. Viruses are the most common cause of the condition, but toxic substances and autoimmune diseases can also be the reason. The most common forms are hepatitis A, B and C. Symptoms are not present in the first weeks after infection. But when they do occur they can include jaundice (yellowing of the skin and whites of the eyes), fatigue, abdominal pain, poor appetite and a mild fever.

Primary Biliary Cholangitis

Primary biliary cirrhosis is an autoimmune disease in which the body begins fighting its own cells. Sometimes called PBC, this is a condition in which bile ducts in the liver are destroyed, allowing harmful substances to build up in the liver. People with PBC can remain symptom-free for years. Early symptoms can include fatigue, itchy skin and dry mouth. Advanced symptoms can include jaundice (yellowing of the skin and whites of the eyes), pain in the abdomen, muscles or joints, darkening of the skin and elevated cholesterol levels. People in the later stages may also experience swollen feet and ankles, steatorrhea (greasy diarrhea) and fluid buildup in the abdomen due to liver failure.

Primary Biliary Cholangitis

Primary biliary cholangitis is an autoimmune disease in which the body begins fighting its own cells. Sometimes called PBC, this is a condition in which bile ducts in the liver are destroyed, allowing harmful substances to build up in the liver. People with PBC can remain symptom-free for years. Early symptoms can include fatigue, itchy skin and dry mouth. Advanced symptoms can include jaundice (yellowing of the skin and whites of the eyes), pain in the abdomen, muscles or joints, darkening of the skin and elevated cholesterol levels. People in the later stages may also experience swollen feet and ankles, steatorrhea (greasy diarrhea) and fluid buildup in the abdomen due to liver failure.

Some disorders can easily be treated with medications. When extensive testing or surgery is required, rest easy knowing that our team is highly-skilled in the latest technology and techniques, including:

Endoscopic Gastroduodenoscopy (EGD)
Colonoscopy
Pancreatography (ERCP)
Endoscopic Radiofrequency Ablation (RFA)

Endoscopic Radiofrequency Ablation (RFA) is a procedure performed to ablate the precancerous cells in the esophagus that arise as a result of long term acid reflux (also called Barrett’s esophagus and ablation, to prevent esophageal adenocarcinoma).

Hepatitis B Treatment
Hepatitis C Treatment

Videos

Colonoscopy Overview

Preperation for a Colonoscopy

Thrive Capsule Endoscopy

3-2-1 Get Screened! Colorectal Cancer Awareness

Alternative Diagnostics at Comprehensive Digestive Care

Video Capsule Endoscopy Medical Animation

Questions to Ask About a High-Quality Colonoscopy

Barrx™ 360 RFA Balloon Catheter Animation

Barrx™ 90 Focal Ablation Catheter Animation

Barrx™ Channel RFA Endoscopic Catheter Procedure Animation

Reviews

Thank You Note

“Thank you very much for the thoughtful gift of a rose and a card. I felt very special! I always look forward to the office visits (believe it or not)! Thank you again for starting my birthday out right.”

– Terrie A.

“My husband had a colonoscopy with Dr. Trivedi, and he and the whole staff were absolutely wonderful. They were the best and I couldn’t ask for better. Thanks to the whole staff, my husband said they were great! Thank you!”

– Donna C.

“Tiedre Palmer, NP – very personable, friendly, she listened to our concerns and was very informative.”

“Your staff was very friendly! I appreciate taking care of insurance without questioning why I did not have my card. Smiling and assuring!”

– Laura S.

“Thank you so much for being kind to my dad and our whole family. You spent the extra time explaining his illness and the ERCP you performed. It was a scary procedure for him but he is doing amazingly well. We thank God for using you to help him get better!”

– Sharon W.

“Your staff are great people! Thank you for understanding my pain and being so caring.”

– Rita P.

“Thank you for showing kindness and understanding on my 1st visit to the office!”

– Shannon Z.

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