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GASTRO

The Department of Gastroenterology & Endoscopy at B.P.Poddar Hospital delivers best-in-class health care services to patients with diseases of the digestive system. The hospital’s on-board team of gastroenterology & endoscopy specialists diagnose and treat diseases and disorders of the stomach, duodenum and small and large bowel (colon). The Department strives to accelerate the adoption of best practice in the fields of gastroenterology and hepatology. It is multidisciplinary and focuses on the needs of patients and the professionals caring for them.

CONDITIONS

BILE DUCT CANCER

Bile Duct Cancer

Bile duct cancer develops in the cells that line the bile duct, both inside and outside the liver. It mostly affects people over the age of 40 and is more common in men than in women. Bile duct cancer is a major public health problem in regions like the northeast of Thailand where infection with liver flukes is linked to the consumption of raw freshwater fish.

  • Types of Bile Duct Cancer
  • Risk Factors
  • Symptoms
  • Diagnosis
  • Treatment of Bile Duct Cancer

Types of Bile Duct Cancer

There are 2 types of bile duct cancer, depending on its location:

  • Intrahepatic bile duct cancer starts in the cells that line the bile duct in the liver. The cancer then spreads through the liver by growing along the bile duct in a similar manner to liver cancer. Because of this, intrahepatic bile duct cancer is sometimes confused with liver cancer.
  • Extrahepatic bile duct cancer starts in the bile duct outside the liver. The cancer in the bile duct blocks the flow of bile, causing a yellowing of the skin and eyes.

Risk Factors

    The main risk factor for developing bile duct cancer in the northeast of Thailand is eating raw freshwater fish, leading to an infection of liver flukes in the bile duct.
    Other risk factors for developing bile duct cancer include:

  • Chronic inflammation of the bile duct
  • Bile duct disorders
  • Bile duct stones
  • Sclerosing Cholangitis
  • Congenital genetic disorders, such as choledochal cysts (bile-filled sacs that are connected to the bile duct)

Symptoms

In the early stage, bile duct cancer usually does not have any observable symptoms. In the advanced stage, however, symptoms include:

  • Yellowing of the skin and eyes due to a blockage of bile duct flow
  • Abdominal discomfort, swelling, feeling of fullness
  • Pain in the upper right abdomen, possible pain in the back and shoulders
  • Unexplained fever
  • Itchy body
  • Light colored stool and dark urine
  • Tiredness, fatigue
  • Loss of appetite, unexplained weight loss
  • Nausea, vomiting
  • Swollen liver

Diagnosis

The doctor will check the patient’s history and conduct a physical examination supported by the following tests:

  • Blood test to assess liver function and identify possible tumor markers
  • Liver and upper abdominal ultrasound
  • Computerized tomography (CT scan)
  • Magnetic resonance imaging (MRI)

Treatment of Bile Duct Cancer

The most appropriate treatment option will depend on several factors, including the severity of the condition, the size and appearance of the cancerous cells, the stage and spread of the cancer, and the patients’ overall health. Treatment options include the following:

  • Surgery is the main treatment for bile duct cancer.
    • Surgery to remove the tumor is an effective standard treatment that increases the patient’s survival rate.
    • If during the surgery to remove the tumor, the surgeons discover that the cancer has spread to such an extent that it cannot be removed, the surgeons will provide palliative therapy by draining bile to relieve the patient’s itchy skin and jaundice (yellowing of the skin and eyes).
  • ERCP (endoscopic retrograde cholangiopancreatography) is a non-invasive means of diagnosing and treating the cancer which can be used if for any reason the patient cannot undergo surgery to remove the tumor.
  • Chemotherapy/radiotherapy is used if the cancer cannot be completely removed or after the surgery has been performed so as to increase the chance of a complete cure.

Follow-up Care

Follow-up appointments are important. During these sessions, the doctor will ask questions about any symptoms and perform an ultrasound or x-ray examination every 3-6 months for at least 2 years after treatment to observe for any recurrence of the cancer.

CIRRHOSIS

Cirrhosis is a condition which results from permanent damage or scarring of the liver. The scar tissue that forms in the liver prevents the liver from working properly by affecting its ability to produce proteins, store vitamins and minerals and eliminate toxins, as well as blocking the normal flow of blood through the liver.

  • Causes of Cirrhosis
  • Symptoms of Cirrhosis
  • Diagnosis of Cirrhosis
  • Treatment Options

Causes of Cirrhosis

Cirrhosis is caused by several factors, including:

  • Chronic alcohol abuse
  • Hepatitis B, C and D
  • Autoimmune hepatitis
  • Iron build up in the body
  • Wilson’s disease caused by an accumulation of copper in the liver
  • Obstruction of the bile ducts, causing bile to back up in the liver, scarring the liver and developing into cirrhosis
  • Fatty liver, causing chronic inflammation of the liver and cirrhosis
  • Long-term exposure to certain medications
  • Long-term exposure to toxins
  • Repeated bouts of heart failure

Symptoms of Cirrhosis

Most people have few or no symptoms from cirrhosis, but complications do occur based on the stage of evolution of the disease. When symptoms do occur, they may include:

  • Fatigue, loss of appetite with possible nausea and weight loss
  • Irregular menstruation in women; enlarged breast tissue and loss of sexual drive in men
  • Swelling in the legs or abdomen due to low albumin levels and a build-up of fluid in the legs or abdominal cavity
  • Bruising or bleeding easily due to a decrease in the proteins needed for blood clotting
  • Jaundice or yellow discoloration in the skin and eyes caused by an accumulation of the pigment melanin
  • Intense itching of the skin due to bile products being deposited in the skin
  • Mental disturbances as the liver no longer filters out toxins effectively, causing the toxins to build up in the blood, and causing mental impairment, such as poor concentration or forgetfulness
  • Sensitivity to medicines as the liver does not filter medications as effectively as normal, sometimes resulting in the build-up of medications in the body and potentially increasing the effects of the medication
  • Massive bleeding in the stomach or esophagus due to abnormal blood flow, an issue which is life-threatening and requires immediate medical attention

Diagnosis of Cirrhosis

  • History of symptoms
  • Blood tests
  • Other tests
    • Computed Tomography (CT) scan
    • Ultrasound
    • Liver stiffness measurement
    • Tissue sample (biopsy)

Treatment Options

The goals of treatment are to slow down the progression of scar tissue in the liver and to prevent complications by treating the underlying cause. The doctor treats the condition; however, the patients should be careful to limit additional damage that can lead to liver failure.

Tips for treating and preventing complications of cirrhosis

  • Stop drinking alcohol
  • Avoid medications and substances that increase damage to the liver
  • Avoid raw food, particularly raw seafood, due to possible bacterial infection
  • Eat a proper amount of protein and choose lean protein such as fish, or legume protein such as soy, etc.
  • Avoid adding salt to meals if swelling in the legs and abdomen
  • Get vaccinated for hepatitis A and B, influenza, and pneumonia, because cirrhosis makes it more difficult for patients to fight off infections
  • See a doctor for monitoring the condition
COLON CANCER

Colon cancer is caused by the uncontrolled growth of cells in the colon. It may take years to develop, and at the early stage, there may only be an abnormal growth of tissues known as polyps. However, these polyps can then develop into cancer if left untreated or not removed.

  • Risk Factors for Colon Cancer
  • Symptoms of Colon Cancer
  • Colon Cancer Screening
  • Diagnosis of Colon Cancer
  • Treatment of Colon Cancer

Risk Factors for Colon Cancer

Although the exact cause of colon cancer is unknown, there are some risk factors that may increase the chance of developing the disease.

  • Personal history of polyps: These are usually found on the wall of the large intestine and are not malignant. However, over time some of these polyps can develop into colon cancer.
  • Age: While colon cancer can be found in younger people and teens, it is much more common in older people. 90% of cases involve people over the age of 50.
  • Personal history of IBD (inflammatory bowel disease): Ulcerative colitis and Crohn’s disease are more commonly known as IBD (inflammatory bowel disease) and increase the risk for developing colon cancer.
  • Family history of colon cancer: Having a family member under the age of 60 years with colon cancer increases the risk of colon cancer.
  • Obesity and lack of exercise: There is evidence to suggest that the risk of developing colon cancer may higher in people who are overweight and do not exercise regularly.
  • Smoking: Studies have reported that the risk of colon cancer is higher among smokers than non-smokers.

Symptoms of Colon Cancer

In some cases, people with colon cancer have no abnormal symptoms, so they do not know that they have cancer. Also, there are other diseases with similar symptoms, which can confuse the issue. However, it is important to seek medical attention when the following symptoms appear:

  • Diarrhea, constipation or bloating
  • Blood, bright red or very dark, in the stool
  • Narrowing of stools
  • Abdominal discomfort, burning sensation, bloating and clamping
  • Unexplained weight loss
  • Fatigue or weakness
  • Anemia

Colon Cancer Screening

Colon cancer screening is a method of helping to prevent colon cancer by find the polyps before they turn into cancer. Men and women should begin screening at age 50. The screening can be performed in the following ways:

  • Fecal Occult Blood Test (FOBT) is a test that looks for the presence of polyp or cancer cells. Annual testing with this method significantly reduces colon cancer mortality, while biennial testing reduces mortality rates from colon cancer by 18%.
  • Sigmoidoscope is a procedure where a doctor inserts a tube through the anus to the lower part of the colon so as to examine for polyps, abnormalities and cancer. Using this method, the doctor can cut any abnormal polyps and extract them for further examination.
  • Colonoscopy enables visual inspection of the entire large bowel and specimen collection for biopsy.
  • Double Contrast Barium Enema (DCBE) and CT Scan are alternative methods when patients cannot undergo colonoscopy.

Diagnosis of Colon Cancer

Doctors use a range of tests to diagnose cancer and determine if it has spread to other organs. The method of diagnosis varies depending on several factors, such as age and health of the patient, type of cancer, severity of symptoms and earlier test results. Diagnosis of colon cancer can be performed in the following ways:

  • Biopsy, which involves taking small amounts of tissue samples from the patient, is the most accurate method of detecting colon cancer and providing biomolecular predictors of cancer.
  • Carcinoembryonic Antigen (CEA) is a blood test used to determine the amount of red blood cells or measure the amount of a protein.
  • CT Scan is used to find the location of the cancer and determine how far it has spread to other parts of the body.
  • Ultrasound uses high frequency sound waves to determine how much the cancer has spread to the lungs or other organs.
  • Chest X-ray is used to determine how much the cancer has spread to the lungs.
  • PET Scan is a test that involves the injection of a radioactive substance into an organ or tissue in order to create images that can be examined.

Treatment of Colon Cancer

Treatment of colon cancer requires a multidisciplinary team of physicians such as surgeons, radiologists and cancer specialists who together will make the most suitable treatment plan for each individual patient. The doctors will make their decision based on the following factors:

  • Size, location and characteristics of the cancer cells.
  • Stage of disease and spread of cancer.
  • Patient’s general health

Treatment Options for Colon Cancer

  • Surgery
  • Radiotherapy
  • Chemotherapy
  • Targeted Therapy
  • Angiogenesis
ESOPHAGEAL CANCER

Esophageal cancer occurs when an accumulation of abnormal cells form a tumor in the inner lining of the esophagus. Once the cancer cells have grown into the wall of the esophagus, they can then spread to the lymph nodes, aorta (large blood vessel), and other parts of the body, including the lungs, liver, and stomach.

  • Types of Esophageal Cancer
  • Risk Factors
  • Symptoms
  • Diagnosis
  • Treatments

Types of Esophageal Cancer

  • Squamous cell carcinoma (SCC) is a growth of abnormal cells that form a layer on the lining of the esophagus, predominantly at the beginning and middle of the esophagus.
  • Adenocarcinoma develops from the gland cells of the esophagus.

Risk Factors

Currently, the exact causes of esophageal cancer are not known. However, factors that increase the risk of esophageal cancer developing include:

  • Age: People aged between 45-70 years have the greatest risk.
  • Gender: Esophageal cancer is more than 3 times as common in men than in women.
  • Smoking: The risk increases in accordance with the length of time someone has smoked and the number of cigarettes they smoke.
  • Drinking: Drinking increases the risk of esophageal cancer, especially SCC.
  • Precancerous changes in the cells of the esophagus (Barrett’s esophagus) can lead to adenocarcinoma.
  • Mineral Deficiency: Not eating sufficient fruit vegetables can lead to a mineral deficiency.
  • Obesity

Symptoms

Esophageal cancer does not cause any noticeable symptoms in its early stage. However, the following symptoms will occur in its advanced stage:

  • Difficulty swallowing, especially solid foods, such as meat, bread, or vegetables. In its advanced stage, the cancer is large enough to limit the passage of food through the esophagus and swallowing even water may become painful.
  • Chest discomfort or heartburn
  • Abdominal bloating, indigestion
  • Nausea
  • Choking while swallowing
  • Unexplained weight loss
  • Coughing
  • Pain in the throat or behind the breastbone

Diagnosis

  • The doctor will check the patient’s history and conduct a physical examination
  • The patient will be given a mixture of barium and water to drink. The barium temporarily coats the gullet, stomach and small intestine. X-ray images can then show up any tumors or abnormalities.
  • An upper GI endoscopy is a procedure that allows the doctor to remove a sample of abnormal tissue for further examination.
  • An endoscopic ultrasound can help the doctor to evaluate how much the cancer has grown and whether it has spread to nearby organs.
  • A biopsy is usually performed during the GI endoscopy.
  • A computerized tomography (CT) scan generates three-dimensional images of internal organs and enables the doctor to observe the location and spread of the disease much more definitively than from a standard x-ray.

Treatments

The treatment of esophageal cancer involves the collaboration of a team of medical professionals from various fields, such as surgeons, radiologists, and oncologists, who together will plan the most suitable treatment for each patient. The choice of treatment depends on:

  • Size, location and appearance of cancerous cells
  • Stage and spread of cancer
  • Patient’s overall health

Treatment Options

  • Surgery
  • Chemotherapy
  • Radiotherapy
FATTY LIVER DISEASE

Fatty liver disease is a broad term that describes a wide range of conditions caused by a build-up of fat within the liver cells. It usually shows up as an abnormality during liver function tests. Although fatty liver disease does not generally cause any pain, it may indicate other health problems.

  • Causes of Fatty Liver Disease
  • Risk Factors for Fatty Liver Disease
  • Stages of Fatty Liver Disease
  • Symptoms of Fatty Liver Disease
  • Diagnosis of Fatty Liver Disease
  • Prevention and steps to control Fatty Liver Disease

Causes of Fatty Liver Disease

There are 2 main causes of fatty liver disease:

  • Alcoholic fatty liver disease: Severity varies according to the type, quantity, and length of alcohol consumption.
  • Non-alcoholic fatty liver disease: It is usually associated with metabolic syndromes, such as obesity, diabetes, high blood pressure, high cholesterol, and hepatitis C virus.

Mechanism of Fatty Liver Disease

One of the primary functions of the liver is to store energy. Excessive consumption of certain food types causes fat to build up in the liver. Excess fat then accumulates in the liver cells. Obesity, diabetes, high cholesterol, excessive alcohol consumption, rapid weight loss, and malnutrition are contributing factors to fatty liver disease. However, some patients develop fatty liver disease without any of these conditions.

Risk Factors for Fatty Liver Disease

  • Obesity: Around 20% of obese people have fatty liver disease.
  • Excessive weight: People with a body mass index (BMI) of between 25-30 are at risk
  • Diabetes
  • Excessive alcohol consumption
  • Ultra-sweet foods: Consumption of excessively sweet foods and beverages, such as sweet green tea, is a risk factor

Stages of Fatty Liver Disease

There are 4 different stages of fatty liver disease as follows:

  • Stage 1: The fat builds up in the liver without any inflammation or scarring.
  • Stage 2: The build-up of fat causes inflammation. If the inflammation persists and remains untreated for more than 6 months, chronic liver inflammation will develop.
  • Stage 3: Severe liver inflammation and scarring occur. The liver cells are slowly destroyed.
  • Stage 4: Serious damage to the liver cells causes liver function abnormalities, leading to cirrhosis and ultimately liver cancer.

Symptoms of Fatty Liver Disease

Generally, fatty liver disease causes no noticeable signs and symptoms. Even when symptoms such as fatigue, nausea and pain in the upper right abdomen are observed, they are usually not associated with fatty liver disease. Most patients only discover that they have the fatty liver disease during an annual health check-up or medical examination for other reasons.

Diagnosis of Fatty Liver Disease

  • Blood tests
  • Ultrasound
  • Magnetic resonance imaging (MRI)
  • Biopsy (removing a sample of liver tissue for testing)

Prevention and steps to control Fatty Liver Disease

  • Lose weight if you are overweight or obese. The ideal rate of weight loss is 0.25-0.5 kg per week until you reach a healthy weight.
  • Exercise regularly, at least 5 days a week. If possible, aerobic and anaerobic exercise is recommended, such as fast walking followed by low impact weight lifting.
  • Choose a healthy diet by eating low-fat, high-fibre, and low-energy food.
  • Manage diabetes and high cholesterol. Take medications as directed. Control your diet and exercise regularly.
  • Avoid non-prescription medications and food supplements.
  • Avoid alcohol consumption.
  • Have a regular health check-up.
GALLSTONES

Gallstones are more common in women than in men, especially after the age of 40.

Gallstones are hardened deposits of digestive fluid that form in the gallbladder and are made up of several substances, including cholesterol and bilirubin (main bile pigment), which crystalize in much the same way as sugar collecting in the bottom of a syrup jar. Gallstones can vary in size from as tiny as a grain of sand to as large as a golf ball. People may develop just one single stone or hundreds.

  • Types of Gallstones
  • Risk Factors for Gallstones
  • Symptoms of Gallstones
  • Diagnosis for Gallstones
  • Treatment for Gallstones

Types of Gallstones

There are two types of gallstones:

  • Cholesterol Stones: About 80% of gallstones are made primarily from cholesterol. Usually white, yellow or green in color, they are formed when the gallbladder is unable to process an excess of cholesterol accumulating in the gallbladder bile.
  • Pigment Stones: Pigment stones are smaller and darker than cholesterol stones, and usually occur in patients with cirrhosis or blood disorders such as thalassemia and G6PD deficiency.

Risk Factors for Gallstones

  • Genetics: People with a family history of gallstones are at increased risk.
  • Obesity: Obesity is a high risk factor because it increases the cholesterol in the bile.
  • Estrogen and pregnancy: Estrogen and pregnancy increase cholesterol levels and decrease the motility of the gallbladder. Birth control pills and hormone replacement therapy increase the risk of developing gallstones.
  • Gender and age: Gallstones are more common in women and older people.
  • Diabetes: Higher triglycerides levels and decreased gallbladder movement in people with diabetes are also risk factors.
  • Rapid weight loss: If a person loses weight too quickly, the liver will secrete extra cholesterol and the gallbladder does not contract often enough to empty out the bile, leading to gallstones.
  • Diet: Eating a high-cholesterol and low-fiber diet increases the risk of gallstones.

Symptoms of Gallstones

Gallstones generally do not cause any symptoms. A person usually learns he or she has gallstones while being examined for another illness or during a health check-up. When symptoms do appear, they may include:

  • Severe pain in the upper abdomen or right portion of the abdomen. The pain may last for 15 minutes or several hours and may radiate into the scapula or right shoulder.
  • Vomiting
  • Nausea
  • Other gastrointestinal problems, including abdominal bloating, indigestion, heartburn, gas, and pain after eating fatty foods.
  • Acute inflammation of the gallbladder causes fever, pain in the right hypochondriac region, yellowing of the skin and eyes, and darkened urine.

Diagnosis for Gallstones

  • Evaluation of patient history and a physical examination
  • Blood test to check the functioning of the liver
  • Abdominal ultrasound

Treatment for Gallstones

  • Gallbladder surgery
    • Open cholecystectomy)
    • Laparoscopic cholecystectomy
  • Endoscopic retrograde cholangiopancreatography (ERCP) is performed if the stones are in the bile ducts.

Complications after Gallbladder Surgery

The gallbladder is an organ where bile is stored. Once the gallbladder is removed, bile flows directly from the liver, where it is made, through the small intestine. The bile is less concentrated, but it has no effect on digestion. Approximately 10% of people without a gallbladder may experience diarrhea from the excessive flow of bile.

Laparoscopic cholecystectomy should only be performed by a specialist because of the risk of complications, such as unintended injury to the common bile duct, bile leakage, or bile duct blockage.

GASTROESOPHAGEAL REFLUX DISEASE

Gastroesophageal Reflux Disease (GERD) is caused when stomach acid flows back into the esophagus, causing heartburn and acid reflux to such an extent that they interfere with the patient’s daily activities. GERD can occur in both infants and adults.

  • GERD Causes
  • GERD Symptoms
  • Diagnosis
  • GERD Treatment Options

GERD Causes

  • Abnormality of the lower esophageal sphincter: The lower esophageal sphincter, which acts as a valve between the esophagus and stomach, becomes weak or stays open longer than normal, causing stomach acid to rise up into the esophagus. This abnormality is generally caused by the use of alcohol, tobacco, and some asthma medications.
  • Abnormality of the esophagus: This type of abnormality slows the movement of food into the stomach or causes the stomach contents to flow back and remain in the esophagus longer than normal
  • Abnormality of the stomach: This causes the stomach to empty more slowly and increases reflux symptoms. Fatty foods and chocolate reduce the stomach contractions.
  • Diabetes: While the reasons for this are not known, it was reported in 2008 that GERD is found in approximately 40% of people with diabetes, especially those with complications of diabetes such as neuropathy,

GERD Symptoms

  • A burning sensation in the chest (heartburn) after eating a large meal, or when bending over, lifting a heavy object, or lying down
  • A bitter or sour taste in the mouth – it happens when patients belch and causes complications in the esophagus, such as inflammation, bleeding and difficulty swallowing.
  • Abdominal bloating, feeling of fullness, nausea, and vomiting after eating
  • Chest pain, the sensation of a lump in the throat, and excessive throat clearing
  • Asthma, dry cough, hoarseness and sore throat – these symptoms occur due to the backup of stomach acid into the throat and larynx, causing an inflammation of the voice box.
  • In young children, symptoms include frequent vomiting after drinking milk, anemia, weight loss, growth failure, chronic coughing, asthma at night, and recurrent pneumonia. Some children may temporarily stop breathing during sleep.

Diagnosis

A doctor will diagnose GERD and recommend a course of treatment when the above symptoms are observed. If the symptoms do not improve after following the doctor’s advice or receiving basic treatment, the following tests may be used to provide a more detailed diagnosis:

  • Endoscopy
  • Barium x-ray
  • Nuclear medicine study
  • Esophageal motility test
  • Ambulatory pH test in the esophagus, which produces quick results

Lifestyle Changes

For most patients, the symptoms are not severe and can be reduced through the following simple lifestyle changes:

  • Maintain a healthy weight
  • Avoid tea, coffee, carbonated drinks, fruit juices, sour and spicy food, fatty food, and chocolate
  • Avoid alcohol and tobacco
  • Avoid eating a large meal for dinner, do not lie down immediately after a meal, wait at least 4 hours after eating before sleeping
  • Avoid tight-fitting clothing or belts
  • Eat smaller meals more often
  • Sleep with your head raised at least 6 inches above the bed on a firm pillow
  • Exercise regularly
  • Avoid stress

GERD Treatment Options

  • Medications can heal the esophagus and reduce acid production
  • Surgery may be used in the following cases:
    • In situations where medications are not helpful and the symptoms persist
    • In situations where a patient cannot take medications for extended periods or experiences side-effects
INFLAMMATORY BOWEL DISEASE (IBD)

What is Inflammatory Bowel Disease (IBD)?

Inflammatory Bowel Disease (IBD) refers to the chronic inflammation of the mucosal lining of the intestine or bowel, with the major types being ulcerative colitis and Crohn’s disease.

Inflammatory Bowel Disease Symptoms

Both ulcerative colitis and Crohn's disease are characterized by an inflammation of the mucosal lining of the intestine, and thus both conditions share certain symptoms. However, the extent and location of the inflamed bowel segments are different in each condition. Ulcerative colitis and Crohn’s disease manifest as fatigue, loss of appetite and sometimes a fever, with specific symptoms directly related to the bowel.

These symptoms include irregular bowel movements containing mucous and or/ blood, severe diarrhea, and abdominal pain. The inflammation may result in loss of blood through the bowel. This loss, which may take the form of so-called “occult” or hidden bleeding, can only be detected with a special test and may lead to anemia through the loss of iron.

In both ulcerative colitis and Crohn's disease, symptoms may occur not only in the bowel. More than 25% of patients experience pain or even inflammation (arthritis) in larger and smaller joints of the spine and pelvis. As in other types of arthritis, this joint inflammation results in swelling, pain and restricted movement. The skin in patients with IBD may also react in the form of painful purplish-red areas of thickening, most commonly occurring on arms and legs. Somewhat less frequent symptoms include inflammation of the eyes, particularly the iris and conjunctiva. Both may also be associated uncharacteristically with inflammation of the liver.

Ulcerative Colitis

Ulcerative colitis, which affects only the colon, is typically characterized in its acute phase by diarrhea (mixed with mucous and/or blood). The severity of the diarrhea depends on the inflammatory activity and the extent of the bowel inflammation. Diarrhea may be very severe in cases in which the entire colon is affected. However, if only the final portions of the colon (the sigmoid or rectum) are affected, the stool may be more solid but traces of blood can be detected.

Crohn’s Disease

Crohn’s disease may affect both the small bowel and colon. In its initial phase it may cause few or no symptoms at all and, particularly in cases in which the colon is only partially affected or completely spared, there may be no diarrhea. In many cases, there may be abdominal pain which sometimes can be confused with appendicitis. Crohn’s disease is associated with nutritional deficiencies in its early stages, resulting in significant weight loss.

In some patients the disease manifests with inflammation in the region of the anus, resulting in the formation of fistulae and abscesses. A fistula is a tube-like tract lined with inflammatory cells. It may connect two hollow organs or open into the outer skin or the anal mucosal membrane. Fistulae are found in up to 30% of patients with Crohn’s disease.

Weeping, purulent fistulae in the region of the anus, particularly if they recur, should always suggest the need for more extensive examination of the bowel. Whenever a patient reports the occurrence of several of the above described symptoms, the physician should consider the possibility of IBD.

Causes of IBD

The actual cause of IBD remains elusive. It is likely, however, that these chronically recurring episodes of inflammation in the bowel are related to a complex interaction between environmental factors and a hereditary predisposition for these diseases. Genetic predispositions require other factors, such as virus or bacteria, change in nutritional behavior or the consumption of certain preservatives or other food additives, or disturbances of the body’s own immune system or intestinal barrier.

To date no definitive evidence has been found to prove a connection between these factors and the development of IBD. It‘s very probable that environmental factors play a role. On the other hand, it is very unlikely that IBD is due to an underlying infectious disease. Hence, infecting other persons with the disease is not possible.

Investigation of IBD

If you suspect that you may have IBD, the following tests should be considered for confirmation:

  • Physical examination of your entire body, especially the abdomen and rectum.
  • Laboratory tests, including blood and stool samples, which may reveal signs of general inflammation.
  • Ultrasound examination of the abdomen to detect any changes, such as widening of the bowel and thickening of its wall.
  • Endoscopy to look at the inner lining of the digestive tract.
  • Radiological examinations, such as x-ray, MRI, and CT scan.

Treatments for IBD

Treatment options for IBD include medication, nutritional management, emotional support and surgery.

The primary goal of treatment is to alleviate the patient’s symptoms (diarrhea, pain, and blood loss) and, once this is successful, to prevent recurrence.

It is important to note that patients with Crohn’s disease who quit smoking have a 60% decreased chance of recurrence over two years.

Nutrition for Those With Inflammatory Bowel Disease

While food does not cause IBD it can cause or worsen symptoms when the disease is active. The goal of nutritional management for people with IBD is to modify their diet to decrease digestive symptoms while maintaining adequate nutrient intake. Your doctor may do a nutritional assessment to determine if you are taking in enough calories, vitamins and minerals. When nutritional needs are not being met, your doctor may suggest a liquid supplement.

Coping with IBD

Although IBD is a chronic disease that has periods of remission and relapse, most people have a normal life span and many have a good quality of life. For those who have chronic and persistent symptoms:

  • 1. Know your body and how IBD affects you.
  • 2. Learn to care for yourself — have control over those things you can control.
  • 3. Develop a support system that works for you: family, friends and support groups.
  • 4. Be sure to follow instructions from your medical team.
LIVER CANCER

Liver cancer is a common form of cancer and a leading cause of death worldwide. Because there are usually no noticeable symptoms in the early stage of liver cancer, most patients are only diagnosed when the disease has reached its advanced stage.

  • Types of Liver Cancer
  • Risk Factors for Liver Cancer
  • Symptoms of Liver Cancer
  • Diagnosis for Liver Cancer
  • Treatments for Liver Cancer

Types of Liver Cancer

  • Hepatocellular carcinoma is the most common type of liver cancer, both worldwide and in Thailand.
  • Cholangiocarcinoma (Bile Duct Cancer).

Risk Factors for Liver Cancer

  • Cirrhosis caused by factors such as alcohol consumption or viral hepatitis
  • Alcohol consumption
  • Hepatitis B Virus (HBV) or Hepatitis C Virus (HCV) infection
  • Exposure to Alfatoxin contamination from peanuts, corn, dried chili peppers, etc.
  • Inherited and metabolic diseases, such as diabetes, which can cause fatty liver and lead to cirrhosis.
  • Exposure to certain chemicals or medications, such as long-term male hormones.

Symptoms of Liver Cancer

Liver cancer does not cause any noticeable symptoms in its early stage. However, the following symptoms will occur in its advanced stage:

  • Pain, especially in the upper right abdomen. In some cases, the pain radiates to the back or shoulder.
  • Swollen abdomen
  • Unexplained weight loss
  • Loss of appetite
  • Fatigue
  • Unexplained fever
  • Lump in the liver
  • Yellowing of the skin and eyes

Diagnosis for Liver Cancer

  • The doctor will check the patient’s history and conduct a physical examination.
  • Blood tests are taken to look for liver function abnormalities, viral hepatitis, and alpha-fetoprotein.
  • Imaging tests such as ultrasound, computerized tomography (CT scan) and magnetic resonance imaging (MRI) are used.
  • The patient will be given a biopsy (non-invasive removal of a sample of liver tissue for testing)

Treatments for Liver Cancer

The most appropriate treatment option will depend on the severity of the condition, the size and appearance of the cancerous cells, the stage and spread of the cancer, and the patients’ overall health. Treatment options include the following:

  • Surgery
  • Chemotherapy
  • Radiotherapy
  • Liver transplant surgery is an option for patients under the age of 70 with a tumor of less than 5 cm.

Prevention is preferable to cure for liver cancer. However, treatment can be effective if the liver cancer is detected early through screening. Up to 90% of liver cancers are caused by HBV and HCV infections that lead to cirrhosis and liver cancer. The liver cancer will then double within 3-6 months. Patients with HBV and HBC should have a liver ultrasound as well as blood tests to check for liver function abnormalities, viral hepatitis and alpha-fetoprotein every 3 months.

PANCREATITIS

Pancreatitis is an inflammation in the pancreas which can be either acute or chronic.

Acute Pancreatitis

Acute pancreatitis is sudden swelling and inflammation of the pancreas, resulting in tissue damage.

  • Symptoms of Acute Pancreatitis
    • Severe and sudden abdominal pain that may radiate to the back and which usually lasts for 2-3 days
    • Nausea and vomiting
    • Fever
  • Diagnosis of Acute Pancreatitis
    • Review of patient history and a physical examination
    • Laboratory testing: amylase and lipase tests
    • X-ray computed tomography

Chronic Pancreatitis

Pancreatitis becomes chronic when the inflammation of the pancreas does not heal or improve and gradually worsens, usually due to factors such as alcohol consumption.

  • Symptoms of Chronic Pancreatitis
    • Abdominal pain, which may come and go or be continuous
    • Pale or clay-colored stool, fatty or oily stool
    • Unexplained weight loss
  • Diagnosis of Chronic Pancreatitis
    • Review of patient history and a physical examination
    • Laboratory testing: amylase and lipase tests
    • Ultrasound to check for other possible causes of the symptoms, such as gallstones
    • X-ray computed tomography

Pancreatitis Risk Factors

  • Gallstones, which can block the pancreatic duct, causing inflammation of the pancreas and eventually leading to pancreatitis
  • Alcoholism

Treatment Options

  • Avoid consuming excessive amounts of food or drink in order to reduce the work pressure of the pancreas
  • Take fluids intravenously to prevent dehydration and maintain an appropriate balance of fluids in the body
  • Take pain-killing medication
  • Avoid the consumption of alcohol
  • Undergo gallbladder surgery. If the pancreatitis was caused by gallstones, the doctor may recommend surgery to remove the gallbladder.
STOMACH CANCER

Stomach cancer begins when a mutation causes a cancerous cell to grow and divide at a rapid rate. The cancer can develop in any part of the stomach and spread to other organs, such as the liver, pancreas, intestines, lungs, ovaries, and lymph nodes.

  • Risk Factors
  • Symptoms
  • Diagnosis
  • Treatments

Risk Factors

The exact causes of stomach cancer are currently not known. However, factors which increase the risk of stomach cancer include:

  • Age: Older people have a greater risk of developing stomach cancer.
  • Gender: Stomach cancer is more than twice as common in men.
  • Family History: People with a family history of stomach cancer have a greater risk.
  • Race: It is more common in Asia than in Europe and the United States.
  • Foods: Pickled, salted and smoked foods may increase the risk of stomach cancer. Fruits and vegetables help reduce the risk.
  • Infection with Helicobacter pylori: This bacterium causes inflammation and peptic ulcers, which may increase the risk of stomach cancer.
  • Underlying Conditions: Previous stomach operations or underlying conditions, such as anemia and chronic stomach inflammation, produce a higher risk of stomach cancer.
  • Occupation: Exposure to certain chemicals and dust is positively associated with stomach cancer.
  • Lifestyle: Alcohol, tobacco, and a diet low in fruits and vegetables increase the risk of stomach cancer.
  • Obesity: There is evidence suggesting men who are overweight may have an increased risk of stomach cancer. However there is no correlation between obesity and stomach cancer in women.

Symptoms

There are usually no noticeable symptoms during the early stage of stomach cancer. However, the symptoms in the advanced stage are similar to those caused by other conditions, such as peptic ulcer and viral gastroenteritis.
In the advanced stage, symptoms may include:

  • Abdominal discomfort, especially in the upper and middle part of the abdomen
  • Blood in the stool
  • Vomiting that may contain blood
  • Unexplained weight loss
  • Abdominal pain or bloating after eating
  • Fatigue

In general, if you experience any of the following symptoms, you should consult a doctor immediately:

  • Indigestion or abdominal discomfort
  • Abdominal bloating after eating
  • Slight nausea
  • Loss of appetite
  • Heartburn

Diagnosis

  • The doctor will check the patient’s history and conduct a physical examination
  • The patient will be given a mixture of barium and water to drink. The barium
  • Temporarily coats the gullet, stomach and small intestine. X-ray images can then show up any tumors or abnormalities.
  • An upper GI endoscopy is a procedure that allows the doctor to examine the lining of the stomach and remove a sample of abnormal tissue for further examination.
  • An endoscopic ultrasound can help the doctor to evaluate how much the stomach cancer has grown and whether it has spread to nearby organs.
  • A lung x-ray is used to detect any abnormality in the lungs and check whether the cancer has spread to this area.
  • A computerized tomography (CT) scan generates three-dimensional images of internal organs and enables the doctor to observe the location and spread of the disease much more definitively than from a standard x-ray.

Treatments

The treatment of stomach cancer involves the collaboration of a team of medical professionals from various fields, such as surgeons, radiologists, and oncologists, who together will plan the most suitable treatment for each patient. The choice of treatment depends on:

  • Size, location and appearance of the cancerous cells
  • Stage and spread of the cancer
  • Patient’s overall health

Treatment Options

  • Surgery
  • Chemotherapy
  • Radiotherapy

PROCEDURES

BARIUM ENEMA

What is a Barium Enema?

A Barium Enema is a type of radiology examination to check the abnormalities of the large intestine. In this procedure, the examination involves inserting the Barium mixture and air into the rectum. An x-ray is taken afterwards.

  • What is a Barium Enema?
  • How is it done?
  • Why is it done?
  • Risks & complications
  • Alternatives
  • Candidate eligibility

How is it done?

Patients will be asked to change into a hospital gown. The nurse will insert the enema tube into the rectum. A barium mixture will then flow into the rectum, filling up the entire large bowel. In most cases, air will be used to push the barium along and to distend the bowel. X-ray will be taken and a radiologist will report the results.

Why is it done?

This is an investigation to find out the abnormalities of the large intestine i.e. tumors, cancer or obstruction in the large intestines, etc.

Risks & complications

The risks of Barium Enema are as follows:

  • After the examination, the patient may be constipated. Therefore, after the examination, it is strongly recommended that large amounts of water and vegetables should be consumed. In the case where a patient has a history of constipation, laxatives may be used in order to prevent constipation. The radiologist will decide accordingly.
  • In rare cases, some patient may develop allergic reactions to certain brand of Barium sulfate. Therefore, if there is a history of allergic reactions, the radiologist must be consulted before hand.
  • As this examination involves using x-ray, it is not recommended for patients who are pregnant.
  • In rare cases, there is a risk of bowel perforation. The barium sulfate may leak from large intestine into the abdominal cavity which may cause infection. In high risk cases, the doctor will consider using another kind of contrast media (water soluble) or another procedures altogether.

Alternatives

The radiologist may discuss alternative approaches to the Barium Enema procedure. Alternatives include Colonoscopy and Virtual colonoscopy.

Candidate eligibility

The best Barium Enema candidates are in the following cases:

  • Any patient who has no signs or symptoms, as part of a check up procedure; or
  • For patients who are found to have abnormal signs and symptoms such as melena stool, chronic diarrhea and constipation, weight loss and abdominal mass.
CAPSULE ENDOSCOPY

Capsule Endoscopy is used to examine the small intestine section of the digestive system. The patient swallows a small capsule which contains a miniature camera. The capsule then travels to parts of the digestive system similar to a miniature shuttlecraft with a camera and flashlight, photographing and transmitting radio signals to a receiver attached to the patient’s abdomen.

The procedure takes about eight hours during which the patient can carry on with normal activities. Capsule endoscopy can detect disorders in the small intestine which is very long and cannot be reached by a gastroscope. Capsule endoscopy gives an accurate diagnosis and the patient suffers no pain. The capsule is then disposed in normal excretion. It is recommended for cases where there are unknown causes of anemia, chronic diarrhea, unexplained stomach ache and suspected tumors in the small intestine.

COLON CAPSULE

Capsule colonoscopy is a procedure similar to the capsule endoscopy for the small intestine. The major difference is that the colon capsule is equipped with two cameras on either side.

This produces images from more angles according to the difference in the size of the colon and the small intestine. After the procedure, the images and data are analyzed by computer to determine a quick and accurate treatment plan and an accurate cause of the disease.

COLONOSCOPY

What is a Colonoscopy?

The term “colonoscopy” means looking inside the colon. It is a procedure performed commonly by a gastroenterologist, a well-trained subspecialist. The colon, or large bowel, is the last portion of your digestive or GI tract. It starts at the cecum, which attaches to the end of the small intestine, and it ends at the rectum and anus. The colon is a hollow tube about five feet long, and its main function is to store unabsorbed food products prior to their elimination.

The main instrument that is used to look inside the colon is the colonoscope, which is a long, thin, flexible tube with a tiny video camera and a light on the end. By adjusting the various controls on the colonoscope, the gastroenterologist can carefully guide the instrument in any direction to look at the inside of the colon. The quality picture from the colonoscope is shown on a TV monitor and gives a clear detailed view. Colonoscopy is more precise than an x-ray.

This procedure also allows other instruments to be passed through the colonoscope. These may be used, for example, to painlessly remove a suspicious-looking growth or to take a biopsy – a small piece for further analysis. In this way, colonoscopy may help to avoid surgery or better define what type of surgery may need to be done.

A shorter version of the colonoscope is called a sigmoidoscope, an instrument used to screen the lower part of the large bowel only. The colonoscope, however, is long enough to inspect all of the large bowel and even part of the small intestine.

More information about the procedure, as well as preparation instructions, can be found in this video:

How is it done?

During the procedure, everything will be done to ensure your comfort. An intravenous, or IV, line will be inserted to give you medication to make you relaxed and drowsy. The drug will enable you to remain awake and cooperative, but it may prevent you from remembering much of the experience.

Once you are fully relaxed, your doctor will do a rectal exam with a gloved, lubricated finger; then the lubricated colonoscope will be gently inserted.

As the scope is slowly and carefully passed, you may feel as if you need to move your bowels, and because air is introduced to help advance the scope, you may feel some cramping or fullness. Generally, however, there is a little or no discomfort.

The time needed for colonoscopy will vary, but on the average, the procedure takes about 30 minutes. Afterwards, you will be cared for in a recovery area until the effects of the medication have worn off. At this time, your doctor will inform you about the results of your colonoscopy and provide any additional information that you need to know. You will also be given instructions about how soon you can eat and drink, plus other guidelines for resuming your normal routine.

By the time you are ready to go home, you will feel stronger and more alert. Nevertheless, you should rest for the remainder of the day. It is advised that you have a family member or friend take you home.

Why is it done?

Colonoscopy is a safe and effective way to evaluate problems such as blood loss, pain, and changes in bowel habits, such as chronic diarrhea or abnormalities that may have first been detected by other tests. Colonoscopy can also identify and treat active bleeding from the bowel.

Colonoscopy is also an important way to check for colon cancer and to treat colon polyps – abnormal growths on the inside lining of the intestine. Polyps vary in size and shape and, while most are not cancerous, some may turn into cancer. However, it is not possible to tell just by looking at a polyp if it is malignant or potentially malignant. This is why colonoscopy is often used to remove polyps, a technique called a polypectomy.

Colonoscopy is also used as a screening and surveillance test for patients with a family history of colonic cancer.

Risks & complications of a colonoscopy

Although colonoscopy is a safe procedure, complications can sometimes occur. These include perforation – a puncture of colon walls, which could require surgical repair. When polyp removal or biopsy is performed, hemorrhage (heavy bleeding) may result and sometimes require blood transfusion or reinsertion of the colonoscope to control the bleeding.

As sedation medications need to be used for the procedure, there are risks associated with the medications used, for example allergic reaction and/or side effects. As with any invasive procedures, there are risks of infections. Again, these complications are unlikely. Be sure to discuss any specific concerns you may have with your doctor.

Alternatives to colonscopy

The doctor may discuss alternative approaches to Colonoscopy with you.

Candidate eligibility

Patients who are deemed fit after assessment(s) with the specialist(s).

Endoscopic Ultrasound

What is Endoscopic Ultrasound (EUS)?

Endoscopic ultrasound (EUS) allows your doctor to examine the lining and the walls of your upper and lower gastrointestinal tract. The upper tract is the esophagus, stomach and duodenum; the lower tract includes your colon and rectum. EUS is also used to study internal organs that lie next to the gastrointestinal tract, such as the gallbladder, pancreas, kidney, and adrenal glands.

  • What is Endoscopic Ultrasound (EUS)?
  • How is it done?
  • Why is it done?
  • Risks & complications
  • Alternatives
  • Candidate eligibility

How is it done?

Tell your doctor in advance of the procedure about all medications that you’re taking and about any allergies (especially Latex) you have to medication. He / she will tell you whether or not you can continue to take your medication as usual before the EUS examination.

For EUS of the upper gastrointestinal tract, you should have nothing to eat or drink, not even water, usually six hours before the examination. Your doctor will tell you when to start this fasting.

For EUS of the rectum or colon, your doctor will instruct you to either consume a large volume of a special cleansing solution or to follow a clear liquid diet combined with laxatives or enemas prior to the examination. The procedure might have to rescheduled if you don’t follow your doctor’s instructions carefully.

Your endoscopist will use a thin, flexible tube called an endoscope. Your doctor will pass the endoscope through your mouth or anus to the area to be examined. Your doctor then will turn on the ultrasound component to produce sound waves that create visual images of the digestive tract.

Why is it done?

EUS provides you doctor more detailed pictures of your digestive tract anatomy. Your doctor can use EUS to diagnose the cause of conditions such as abdominal pain or abnormal weight loss. Or, if your doctor has ruled out certain conditions, EUS can confirm your diagnosis and give you a clean bill of health.

EUS is also used to evaluate an abnormality, such as a growth, that was detected at a prior endoscopy or by x-ray. EUS provides a detailed picture of the growth, moreover tissue or cells can be studied by needle aspiration aswell which can help your doctor determine its nature and decide upon the best treatment.

In addition, EUS can be used to diagnose diseases of the pancreas, bile duct and gallbladder when other tests are inconclusive.

Risks & complications

Like other endoscopy procedures, EUS is safe and well tolerated. But no procedure is without risk, which with EUS are quite rare. Complication rate for EUS without the fine needle aspiration is about one in two thousand. This is similar to the complication rate of other endoscopy procedures. Sometimes, patients can develop reactions such as hives, skin rash or nausea to the medications used during EUS. The main complication of serious note is perforation (making a hole in the intestinal wall) that may require surgical repair. This is quite rare and all precautions are taken to avoid it.

When FNA is performed complications occur more often but are still uncommon (0.5-1.0%). Passing a needle through the gut wall may cause minor bleeding. If unusual bleeding occurs, the patient may be hospitalized briefly for observation, but blood transfusions are rarely needed. Infection is another rare complication of FNA.

Alternatives

As mentioned, EUS provides good image of internal organ, however the other investigation such as CT scan, MRI, PET/CT, can provide additional information as well, especially the organ that located outside the field of EUS. (Normally EUS gives picture within 7-8 cms. from the tip of endoscope.)

Candidate eligibility

  • Tumor staging ( Lung cancer, cancer of gastrointestinal tract, Pancreatic tumor )
  • Large or thickening fold or growth at the wall of gastrointestinal tract
  • Various disease of gall bladder, bile duct and pancreas
TERCP (ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY)

The procedure is used to assist the examination, diagnosis and treatment of bile and pancreatic duct abnormalities such as the obstruction at bile duct, pancreatic duct from gallstone and polyp.

Endoscopic Retrograde CholangioPanereatography (ERCP) is a technique that combines the usage of X-ray together with the endoscope. The endoscope is inserted into the mouth and guided through the stomach into the small intestine and into the opening of the bile duct. A contrast media is injected into the duct for X-ray to examine abnormalities in the bile and pancreatic ducts. If gallstones are found in the bile duct, the opening may be enlarged to remove the stone by an elective wire. The cut at the opening will heal within a week.

FIBROSCAN

Fibroscan’s ultrasound elastrography uses low frequency elastic waves to deliver highly accurate assessments of liver fibrosis.

Formerly, patients who had to undergo biopsies every two or three years felt threatened by the name of the procedure, but they are now able to return home immediately after the scanning. The instrument is positioned in order to emit elastic ultrasound waves to the liver. The fibroscan software then converts the velocity of the echoes into values that the doctor can use to further predict the disease.

The whole procedure takes only about 10 minutes and the results can help doctors to instantly determine a treatment plan.

GASTROINTESTINAL MOTILITY PLANNING

Two types of GI tract function evaluation:

  • AnorectalManometry is used to assess chronic constipation which suggests malfunction of colon, diaphragm, or sphincter, which can cause difficulty in passing stool. It may be administered to babies suffering from constipation from birth, if there is suspicion of rectal nerve defect.
  • Esophageal Manometry is a test to assess the function of esophagus and upper and lower esophagus sphincter. It is usually given to those who have difficulty swallowing, have chest pain, or other diseases related to malfunction of the esophagus. It can also test the function of the stomach and in patients suspected of stomach malfunction.
UPPER GI ENDOSCOPY (GASTROSCOPY)

What is Upper GI Endoscopy (Gastroscopy)?

The term “endoscopy” refers to a special technique for looking inside a part of the body. “Upper GI” is the portion of gastrointestinal tract (the digestive system) that includes the esophagus, the swallowing tube leading to the stomach, which is connected to the duodenum, the beginning of the small intestine. The esophagus carries food from the mouth for digestion in the stomach and duodenum. This procedure is often referred to as a "gastroscopy".

A gastrocopy is a procedure performed by a gastroenterologist, a well-trained subspecialist who uses the endoscopy to diagnose and, in some cases, treat problems of the upper digestive system.

The endoscope is a long thin, flexible tube with a tiny video camera and light on the end. By adjusting the various controls on the endoscope, the gastroenterologist can safely guide the instrument to carefully examine the inside lining of the upper digestive system.

The high quality picture from the endoscope is shown on a TV monitor; it gives a clear, detailed view. In many cases, upper a GI endoscopy is a more precise examination than X-ray studies.

How is it done?

During the gastroscopy, everything will be done to help you be as comfortable as possible. Your blood pressure, pulse, and the oxygen level in your blood will be carefully monitored. Your doctor may give you a sedative medication; the drug will make you relaxed and drowsy, but you will remain awake enough to cooperate.

You may also have your throat sprayed or be asked to gargle with a local anesthetic to help keep you comfortable as the endoscope is passed. A supportive mouthpiece will be placed to help you keep your mouth open during the endoscopy. Once you are fully prepared, your doctor will gently maneuver the endoscope into position.

As the endoscope is slowly and carefully inserted, air is introduced through it to help your doctor see better. During the procedure, you should feel no pain and it will not interfere with your breathing.

Your doctor will use the endoscope to look closely for any problems that may require evaluation, diagnosis, or treatment.

In some cases, it may be necessary to take a sample of tissue, called a biopsy, for later examination under the microscope. This too is a painless procedure. In other cases, the endoscope can be used to treat a problem such as active bleeding from an ulcer.

When your gastroscopy is completed, you will be cared for in a recovery area until most effects of the medication have worn off.

Your doctor will inform you about the results of the upper GI endoscopy and provide any additional information you need to know.

After your gastroscopy, you will be given instructions regarding how soon you can eat and drink, plus other guidelines for resuming your normal activity.

By the time you are ready to go home, you’ll feel stronger and more alert. Nevertheless, you should plan on resting for the remainder of the day. This means not driving, so you’ll need to have a family member or friend take you home.

Why is it done?

A gastroscopy can be helpful in the evaluation or diagnosis of various problems, including difficult or painful swallowing, pain in the stomach or abdomen, and bleeding, ulcers, and tumors.

Risks & complications

Years of experience have proved that the upper GI endoscopy is a safe procedure. Typically, it takes only 15-20 minutes. Complications rarely occur. These include perforation – a puncture of the intestinal wall, which could require transfusion.

Occasionally, minor problems may persist, such as a mild sore throat, bloating, or cramping; these should disappear in 24 hours or less.

As sedation medications need to be used for the procedure, there are risks associated with the medications used, for example, allergic reaction and/or side effects. As with any invasive procedures, there are also risks of infections.

Again, these complications are unlikely. Be sure to discuss any specific concerns you may have with your doctor.

Alternatives

The doctor may discuss alternative approaches to the upper GI endoscopy with you.

Candidate eligibility

Patients who are deemed fit after assessment(s) with the specialist(s).

VIRTUAL COLONOSCOPY (CT SCAN)

Virtual Colonoscopy is the examination of the body and internal organs by high speed computer X-ray through the abdomen. The software creates a 3D virtual image of the colon with minute details without the need for insertion of the colonoscope through the anus. The accuracy of virtual colonoscopy highly depends on colon preparation. Limited consumption of food and use of a laxative to clear up the colon are necessary for clear images for computer analysis. Besides producing virtual images, the procedure can help the doctor screen for polyps within the colon. Virtual colonoscopy and provide an instant and accurate diagnosis similar to that produced by traditional colonoscopy.