Gastroenterology Overview

 

Gastroenterology is a medical specialty concerned with the diagnosis and treatment of conditions that affect the digestive system.

This includes the esophagus, stomach, small intestine, large intestine (colon), liver, gallbladder, and pancreas.

Gastroenterologists use a variety of diagnostic tests and procedures, including endoscopy and imaging studies, to evaluate patients with digestive disorders.

Some common conditions treated by gastroenterologists include acid reflux, ulcerative colitis, Crohn’s disease, hepatitis, and Irritable Bowel Syndrome (IBS).

Treatment options for these conditions can range from lifestyle modifications, medication, to surgery.

The goal of gastroenterologists is to provide comprehensive and effective care to patients with digestive disorders.

This article expands on the tests and procedures that Gastroenterologists offer.

 

Colo-rectal Cancer Screening & Prevention

 

It is recommended that all persons at average risk of Colorectal cancer should first get screened for cancer when they are 50 years of age. 

The American Cancer Society has recently recommended screening from age 45, because of Colorectal cancer occurring in younger individuals.

If you have a family history of colon cancer, you may need to get screened earlier.  This screening should occur 5 years younger than the age of the affected family member.

Besides individuals with a family history of colon cancer, others that are considered at risk of the condition include those with a medical history of polyps and inflammatory bowel disease.

After your first screening, you are also expected to have subsequent screenings in 5–10-year intervals, depending on your risk profile.

You may also be scheduled to have an earlier screening depending on what your doctor found during the first screening.

The screening we have been mentioning here is a colonoscopy. 

This screening is not regarded as the “gold standard” procedure for the prevention of colon cancer but is the only procedure that can both diagnose and remove the pre-malignant polyps.

Through colonoscopy, a gastroenterologist is able to see precancerous polyps in your colon and remove them thus preventing colorectal cancer.

Alternative tests include fecal occult blood test, sigmoidoscopy  and virtual colonoscopy. 

If polyps are discovered on these tests, you will need to undergo a colonoscopy for polyp removal.

These are some conditions of the gastrointestinal system that can also increase your risk of colon cancer such as inflammatory bowel disease – ulcerative colitis and Crohn’s disease.

 

Gastro-Oesophageal Reflux Disease Treatment

 

Gastroesophageal reflux, also known as acid reflux, occurs when the stomach contents reflux or back up into the oesophagus and or mouth. 

Reflux is a normal process that occurs in healthy infants, children, and adults.  Most episodes are brief and do not cause bothersome symptoms or complications.

Symptoms can include:

• Heartburn
• Regurgitation
• Vomiting
• Difficulty or pain with swallowing 

The reflux of stomach acid can adversely affect the vocal cords causing hoarseness or even be inhaled into the lungs (called aspiration).

GORD may be caused by relaxation of the lower oesophageal sphincter or valve, allowing stomach content to enter the oeosphagus.  People with a hiatal hernia tend to suffer more severe reflux.

 

Barrett’s Oesophagus

Well-established risk factors for Barrett’s oesophagus include age older than 50 years, male sex, white race, chronic Gastro-Oesophageal Reflux (GORD), hiatal hernia, elevated body mass index, and intra-abdominal distribution of body fat.

At the time of diagnosis, the pathologist will assess the biopsy specimen for dysplasia.  Dysplasia is the term used when the cells look abnormal or pre-malignant. 

Dysplasia is graded as absent, low-grade or high grade.

 

 

Inflammatory Bowel Disease

 

Inflammatory bowel disease is the collective name of a group of inflammatory conditions of the colon and small intestines. 

IBD comprises ulcerative colitis and Crohn’s disease. The symptoms are fairly diverse, at times delaying accurate diagnosis.

Early diagnosis is important, as the prognosis is improved with prompt and effective treatment. Both conditions are life-long disorders, requiring expert management.

The principal types of the condition include Crohn’s disease that affects the small and large intestine, as well as the mouth, esophagus, stomach, and anus; and ulcerative colitis that is restricted to the colon and the rectum.

IBD is majorly caused by an interaction of environmental and genetic factors. It is also associated with diet, alteration in the microbiota, and breach of intestinal barrier.

There are different treatment options that can be used in the management of IBD, including medication, surgery, medical therapies, nutritional and dietetic therapies, and alternative therapy.

 

Ulcerative Colitis & Crohn’s Disease

 

Symptoms of ulcerative colitis are dependent upon extent and severity of disease, and most commonly include:

• Bloody diarrhoea
• Rectal bleeding
• Rectal urgency

Nocturnal defaecation is also often reported. Systemic symptoms of malaise, anorexia, or fever are features of a severe attack.

Distribution of ulcerative colitis may vary from rectal inflammation only to left sided or total colonic involvement (pan colitis).

Remission is defined as complete resolution of symptoms and endoscopic mucosal healing.

Symptoms of ulcerative colitis are dependent upon extent and severity of disease, and most commonly include:

• Bloody diarrhoea
• Rectal bleeding, and/or rectal urgency.

 

 

Functional Gastrointestinal Disorders 

Functional gastrointestinal disorders such as irritable bowel syndrome (IBS), functional diarrhoea or constipation and functional dyspepsia are the most common conditions seen in gastroenterology practice.

The diagnosis can usually be established with a thorough history and careful physical examination. Expensive endoscopic and laboratory tests are infrequently needed. A good dietary history may reveal food triggers.

 

Non-Ulcer Dyspepsia

Symptoms of dyspepsia include upper abdominal pain or discomfort and frequently include symptoms of burning, pressure, or fullness often, but not necessarily, related to meals.

Other common symptoms include early feeling of fullness (satiety), nausea, belching, and bloating.

While dyspeptic symptoms may develop due to diseases such as peptic ulcer or gastritis, the vast majority of people who see doctors for dyspeptic symptoms are ultimately diagnosed as having functional dyspepsia.

 

Small Intestinal Disorders

 

The small intestine is the least accessible portion of the intestinal tract and is fortunately not often the site of major problems.

Several conditions need further elaboration:

1. Small intestinal bacterial overgrowth, where colonic bacteria migrate into the small bowel. Symptoms include abdominal pain or discomfort, bloating and diarrhoea.
   
   2. Celiac disease, a condition where the small intestinal lining is damaged by gluten, found in wheat, oats etc. The diagnosis rests on abnormal blood tests and is confirmed by doing a gastroscopy and small bowel biopsy.3. Crohn’s disease. Crohn’s disease is a type of inflammatory bowel disease (IBD) that causes inflammation in any part of the digestive tract from the mouth to the anus.
   
   4. Lactose intolerance. This condition occurs when the enzyme lactase is deficient, resulting in the inability to absorb lactose or milk sugar. The symptoms occur following lactose ingestion.

   5. Small bowel vascular abnormalities. The small intestine may be the source of intestinal blood loss in patients with abnormal blood vessels. This condition is diagnosed with small bowel video capsule endoscopy.
   
   6. Small bowel polyps and cancer. These abnormalities are much less frequent than polyps and cancer in the colon. Small bowel video capsule endoscopy is the investigation of choice.

 

Liver and Biliary Disorders 

Liver and Biliary disorders are the conditions that affect the liver, gallbladder, and pancreas.

Examples include fatty liver disease and cirrhosis, liver cancer & inherited diseases, such as hemochromatosis & Wilson disease.

Most are amenable to effective treatment. Treatment of chronic hepatitis may prevent subsequent conditions such as cirrhosis and liver cancer.

Non-alcoholic fatty liver disease (NAFLD) is seen worldwide and is the most common liver disorder in Western industrialized countries, where the major risk factors for NAFLD, central obesity, type 2 diabetes mellitus, dyslipidemia, and metabolic syndrome are common.

Non- alcoholic fatty Liver disease is a condition that is characterized by large deposit of fat in the liver (steatosis) caused by factors other than excessive alcohol use.

The causes are generally traceable to genetics, drugs, and diet.

 

 

Contact Dr. Schneider

 

Dr. Schneider is a medical professional with many years of experience in the field.

His services include endoscopy procedures such as, gastroscopy, colonoscopy and video capsule endoscopy.

If you are concerned about any of the above diseases, talk to Dr. Schneider to book your appointment.

For further reading on the procedures we perform, please visit our website or contact Dr. Schneider on 011-482-3010.