What is abdominal pain?

Abdominal pain can be a symptom of many conditions. It is the name given to pain that radiates between the chest and the groin. The most common cause is: constipation, irritable bowel syndrome, food allergies or intolerances, or food poisoning. There are different types of abdominal pain, including: 

• Burning pain: could be caused by gastritis, an ulcer, or reflux.
• Colic pain: could be due to intestinal issues such as diarrhoea or constipation. For females it could be due to menstrual problems and the pain may be located around the uterus.
• Stitches: caused by excess gases or abdominal swelling. 

Condition prognosis         

Condition prognosis depends of the cause of the abdominal pain. The causes may range from simple issues such as excess gas to more complicated conditions such as appendicitis or kidney stones. When a person has abdominal pain, the cause of it must be looked at thoroughly to be able to properly treat it. There are some symptoms which may be a sign of a more serious condition, such as:

• Having a temperature above 38 ºC
• Vomiting
• Blood in the stools
• Sudden weight loss 
• Apathy or pallor.

What are the symptoms?

Different symptoms may indicate what is causing the abdominal pain. It may simply be due to indigestion, however when the pain is strong, it may be due to a more serious issue with the appendix, the gallbladder, the pancreas, or the kidneys among others.  

Medical tests

Different tests can be carried out to determine the cause of abdominal pain:

• Colonoscopy 
• Abdominal ultrasound
• Endoscopy
• Abdominal CT scan
• Blood test.

What causes it?

There could be many causes for abdominal pain, it is important to find the cause and seek medical attention as soon as possible. The most common causes for abdominal pain include:

• Irritable bowel syndrome
• Allergies or intolerances
• Food poisoning
• Gastroenteritis
• Constipation
• Appendicitis
• Bowel block
• Diverticulitis
• Ulcers.  

How can it be prevented?

Abdominal pain can be prevented by following a healthy and balanced diet, and eating small meals often. This will help digestion. It is also important to maintain a healthy weight and to exercise regularly. Stress in known as a cause of cramps and nausea.  

What is the treatment?    

Treatment will depend on the cause and location of the pain. The specialist will recommend what treatment should be used after careful examination. Treatment to treat mild causes include:

• Antacids if the pain is due to indigestion or reflux.
• Antiflatulents to relieve pain caused by gas or diarrhoea.
• Antibiotics used to treat infections. 

What specialist should I see?

Generally, the specialist who treats abdominal pain is a gastroenterologist. Digestive system specialists study the digestive tract including the oesophagus, stomach, small intestine, colon, rectum, anus, as well as the liver, gallbladder, and pancreas. This specialty treats common issues and pathological issues. It treat conditions that may affect other parts of the body and other organs.           

What is achalasia?

Achalasia is a rare disorder that effects the oesophagus (food pipe), making it very difficult to swallow food and drink and for it to pass into the stomach. This happens when the ring of muscle at the end of the oesophagus does not open fully, if at all. As a result, food and drink cannot be squeezed down into the stomach and gets stuck, and is often regurgitated.

What are the symptoms of achalasia?

Not everyone with this disorder has symptoms, but those who do can experience:

• Regurgitating undigested food
• Chest pains
• Coughing fits
• Heartburn
• Excessive saliva and drooling
• Gradual weight loss

The onset of achalasia can happen at any point in your life and if left untreated can increase chances of oesophageal cancer developing. If you experience any of these symptoms, it is important to see the right specialist so that a diagnosis can be made, and a treatment plan put in place.

What causes achalasia?

The cause of achalasia is largely unknown, however, it is thought to occur when nerves in the oesophagus are damaged and cease to work fully, causing the ring of muscle at the end of the oesophagus to stop working. The cause of this nerve damage is not known, but could be linked to infection, or possibly autoimmune conditions. There is also some possibility that achalasia is hereditary and runs in families.

How is achalasia diagnosed?

Diagnosis of achalasia can be difficult as it shares symptoms with other digestive disorders. If your specialist suspects you have achalasia, the following tests are likely to be carried out:

• Manometry – a small tube is inserted into the nose or mouth into the oesophagus to measure for muscle contractions when you swallow and to detect any pressure that builds up.
• Endoscopy – an endoscope passes down the throat so that the oesophageal lining can be examined, and can identify any blockages that may be present.
• X-rays – here the patient swallows a liquid containing barium, and then x-rayed. This procedure highlights how much time it takes for the liquid to pass into your stomach.  

What is the treatment for achalasia?

Although there is no current cure for achalasia, there are certainly measures to alleviate the symptoms. The key to successful treatment is to make it easier for the patient to swallow when eating and drinking. Certain medicines are designed to relax the oesophageal muscles, making it easier to swallow, however, the effects are only temporary.

Other treatment options include:

• Botox injections – injected into the ring of muscle that allows food into the stomach as the botox causes it to relax.
• Surgery – via keyhole surgery (laparoscopy), the ring of muscle is cut and can permanently make it easier to swallow.
• Dilating the muscle – a balloon is passed down the oesophagus to help stretch out the ring of muscle that lets food into the stomach, which makes swallowing easier and less painful. 

Gastroesophageal reflux is a digestive disorder where acid from the stomach leaks back into the oesophagus. It usually occurs because of weakness in the lower oesophageal sphincter, the ring of muscle between the oesophagus and stomach. It also occurs regularly in healthy people, where it manifests as heartburn or acid indigestion but these are usually short, sporadic episodes compared to long-term gastroesophageal reflux disease.

This disease, also known as ARLD, is caused by excess alcohol consumption. The liver usually regenerates, but with excess alcohol consumption over time, it can cease to properly function. There are three stages: alcoholic fatty liver disease, alcoholic hepatitis, and cirrhosis. The sooner any signs of disease are detected, and the sooner the alcohol consumption is reduced or ceased, the better the chance of recovery. 

What is alcoholism?

Addictions to toxic substances are chronic diseases that affect the brain and behavior, characterised by the dependence on one or more drugs which are harmful to the body: in this case, alcohol. Alcoholism may also be known as alcohol abuse, alcohol dependence, or alcohol use disorder.

What are the symptoms of alcoholism?

Indicators of alcohol misuse or alcohol addiction are as follows:

• A need or desire to drink which takes complete priority above other desires
• An inability to control drinking habits or the amount consumed
• Experiencing withdrawal symptoms when not drinking
• Continuing to drink despite harm being caused to the body or in spite of harmful consequences
• Putting alcohol consumption first, rather than taking part in other activities

In others, you may notice changes in behavior or habits which could indicate they have issues with alcohol or a dependence on alcohol. Signs to watch for include:

• Not being able to refuse a drink
• Being regularly intoxicated
• Increasing alcohol consumption to feel the same effects as before (alcohol tolerance)
• Looking tired or unwell
• Being irritable
• Hiding things, or becoming secretive
• Lying about drinking habits
• Becoming more withdrawn or not showing an interest in activities which previously appealed

What are the causes of alcoholism?

Currently, there is no common cause, but there are several important factors which may contribute to how someone develops an alcohol dependence. For example, a person with an alcoholic father or mother is more likely to become an alcoholic themselves. Another cause is related to psychological factors, such as conflict in interpersonal relationships, a need to relieve anxiety, depression, or low self-esteem.

Can alcoholism be prevented?

Providing young people with information on alcohol and its dangers, and supplying them with social tools such as how to refuse alcohol or cope with peer pressure, can play a role in alcohol awareness and prevention. Projects among the wider community try to reinforce the idea that drinking should not be a pastime or habit, and reinforce the idea of drinking only being a norm for those over the age of 18. It is difficult to prevent alcoholism but encouraging a healthy relationship with alcohol and teaching about the warning signs of alcoholism can go a long way to prevent both underage drinking and alcohol abuse.

If you are worried that a loved one or a friend is showing signs of alcoholism, it can be difficult to approach as a subject, but it is important to recognise alcoholism at an early stage to get help as soon as is possible. Being open, supportive and non-judgemental when speaking to your loved one can help them to feel listened to and safe.

If you are concerned about your own drinking habits, seek support from someone you trust, and ask your doctor for advice.

 What is the treatment for alcoholism?

As the reasons for an individual developing an alcohol dependence issue are varied, treatment must be carried out using a multidisciplinary approach. The first step is for the patient to recognise the addiction. To treat withdrawal syndrome, hospital admission may be necessary. This phase is called detoxification, and the last phase involves preparing the patient to stop drinking alcohol altogether. The treatment is multidisciplinary, including psychological therapy, such as group or individual therapy, family or couple psychotherapy, relapse prevention, drug administration, self-help groups, social services, and specialised care, among others.

This condition is an accumulation of fluid in the peritoneal cavity, located in the abdomen area, as the fluid accumulates it distends the abdomen. It can be due to liver disease, cancer, or other conditions. To diagnose the disease a doctor will perform blood tests, ultrasound, and also fluid is extracted and tested.

What is Barrett's oesophagus?

Barrett's oesophagus (spelt “Barrett’s esophagus” in the US) is a condition in which the tissue that lines the bottom of the oesophagus undergoes a change, usually in response to acid reflux from the stomach. It is a relatively common complication of gastro-oesophageal reflux disease (GORD).

Normally, the oesophagus is lined with squamous epithelial cells. However, exposure to stomach acid regurgitating up into the gullet can inflame and damage the cells. This leads to a phenomenon called metaplasia, whereby the cells change into a different kind of cell, in this case columnar cells that are usually found in the lower digestive tract. These cells better resist the stomach acid, protecting the oesophagus.

However, symptoms of reflux can still bother the patient, and in a small number of cases, the cells can become cancerous. For this reason, Barrett’s oesophagus is regarded as a premalignant condition and although the proportion of cases that lead to oesophageal cancer is small, the condition should be monitored once diagnosed.

What are the symptoms of Barrett's oesophagus?

Barrett's oesophagus itself does not produce symptoms. However, it is almost always caused by acid reflux and this can cause a number of other symptoms:

• Heartburn
• Bitter taste in the mouth
• Dysphagia
• Over-production of saliva in the mouth (water brash)
• Chronic dry cough

Causes of Barrett's oesophagus

Barrett’s oesophagus is closely associated with gastric reflux (also known as acid reflux or gastro-oesophageal reflux). This is a phenomenon where stomach acid splashes back up into the oesophagus, usually due to a problem with the ring of muscle that separates the oesophagus from the stomach (the gastro-oesophageal sphincter). If this sphincter loses tone and is unable to close, stomach acid is able to regurgitate back up.

If the patient experiences long-term acid reflux, this is known as gastro-oesophageal reflux disease (GORD). Around 1 in 10 patients with GORD will develop Barrett’s oesophagus.

The exact mechanism that causes Barrett’s oesophagus isn’t fully understood, as not all patients with acid reflux develop the condition.

Can Barrett’s oesophagus be prevented?

Early diagnosis and effective treatment of acid reflux or GORD can significantly reduce the risk of Barrett's oesophagus developing.

What is the treatment for Barrett’s oesophagus?

The first line of treatment for Barrett’s oesophagus involves managing the symptoms of acid reflux. This may involve the following measures:

• Acid-suppressing medication, such as antacids, proton pump inhibitors, etc.
• Avoid tobacco, alcohol and other substances that can affect the oesophagus
• Avoid spicy or acidic food
• Lose weight

Barrett’s oesophagus should be monitored closely via endoscopy to check for signs that the Barrett’s cells are progressing to cancer, in which case they will need immediate treatment.

If the cells become cancerous, the following procedures serve to remove the harmful tissue:

• Radiofrequency ablation – an electrode at the end of an endoscope applies an electrical current to the affected area, destroying the malignant cells, which allows normal cells to grow in their place.
• Endoscopic mucosal resection (EMR) – a thin wire called a snare on the end of an endoscope is used to remove malignant cells.
• Surgical resection – more extensive surgery that may require admission to the ICU. The surgeon removes the affected part of the oesophagus and joins the stomach to the remaining part.
• Photodynamic therapy: It involves the use of a laser device or esophageal balloon together with a medication.
• Cryotherapy
• Other types of procedures using high energy to destroy cancerous cells.

What is a bloated stomach?

A bloated stomach is when the tummy is stretched and puffy, leaving a person feeling uncomfortable. The most common cause of a bloated stomach is gas and air, as gas builds up in the digestive tract when undigested food gets broken down, or from swallowing too much air when eating too fast. For some people, it can be from overindulging but for others, there could be an underlying medical reason such as a food intolerance or irritable bowel syndrome.
 

What are the symptoms of a bloated stomach?

As a bloated stomach is only temporary, it is different from gaining fat mass around the stomach. It is built-up gas in the digestive system that makes the stomach uncomfortable and extends outward. Some people have described it as looking ‘pregnant’. There may be a pain in the abdomen, which should be checked if there are other symptoms occurring in the body.

Other symptoms to check for include:

• Fever
• Hives
• Watery eyes and itchy throat (allergic reaction)
• Constipation
• Diarrhoea
• Vomiting
• Blood in the stool
• Weight loss
• Fatigue
• Irregular periods
• Haemorrhoids

What causes a bloated stomach?

A bloated stomach is mostly caused by air becoming stuck around the abdomen and is normally a problem to do with digestion. There are lots of different underlying reasons that could cause a swollen abdomen, including allergies, hormonal imbalances, thyroid dysfunction and in rare cases, cancer. The possible causes include:

• Lactose intolerance
• Acid reflux
• Constipation
• Stomach flu
• Premenstrual syndrome
• Celiac disease
• A hiatal hernia
• Ovarian cyst
• Gallstones
• Urinary tract infection (UTI)
• Stomach cancer
• Crohn’s disease

How is a bloated stomach treated?

In many cases of a bloated stomach, lifestyle changes can help diminish or prevent it from recurring. As the main cause of a bloated stomach is gas and air, in order to reduce swallowing too much air you can:

• Avoid chewing gum to stop swallowing extra air
• Avoid fizzy drinks
• Avoid foods known to cause gas such as lentils, beans and vegetables like cabbage, broccoli and sprouts.
• Avoid eating quickly, be mindful of chewing more slowly
• Cut back on dairy products

If lifestyle changes, particularly with the diet, don’t help in relieving or improving a bloated stomach, then the doctor may find a medical cause. The doctor may recommend medical treatment, which depends on the condition and the reason behind the abdominal pain.

What is it?

Bowel cancer, also known as colorectal cancer, originates from the development of tumour cells in the mucosa of the bowel. Given that the colon and the rectum are connected, the cancer often develops in one area and spreads to the other: that is why it is also called colorectal cancer.

It has been estimated that this type of cancer is the third largest cause of death in developed countries, and is more common in men than in women. Even though it is a fairly widespread cancer, if detected early survival rate is around 80%.

What are the symptoms?

The main symptoms of colorectal cancer include:

• a sudden and persistent change in your bowel habit
• persistent blood in the stool
• unexpected weight loss
• general fatigue
• anaemia
• lumps in the abdominal area

However, these symptoms can be very mild and can be confused with symptoms for other conditions. That is why you should always pay attention to possible signs such as fatigue (asthenia), loss of appetite and anaemia.

How is it diagnosed?

This condition can be diagnosed with exams such as colonoscopy, sigmoidoscopy, or a colorectal X-ray scan.

What causes it?

One of the main causes of colorectal cancer is genetic predisposition. If there’s a family history of cancer or polyps, your possibility of getting this cancer increases by as much as four times.

An unhealthy diet and a sedentary lifestyle can also lead to developing this type of cancer. The same goes for smoking and excessive alcohol consumption. Finally, chronic inflammatory disease of the bowel can also increase your risk of getting colorectal cancer.

How can it be prevented?

You cannot completely prevent bowel cancer but you can take steps to reduce your risk. According to the latest research, some foods and drink may increase your chances of getting bowel cancer. These include: red meat, processed meat and alcohol. Being overweight or obese can also lead to bowel cancer. On the other hand, an active lifestyle and eating a diet rich in fibre, garlic and milk seems to have a positive effect on bowel health.

How can it be treated?

If detected early (when the cancer is still restricted to one area), the most effective treatment consists in surgically removing the tumour cells. If your doctor thinks there may be further tumour lesions, after surgery you may get started on chemotherapy. If the cancer is already in its more advanced stages, treatment will be more complex, possibly involving radiotherapy and/or further chemotherapy sessions.

Which doctor should I talk to?

For screening exams, you should see a gastroenterologist. Should you be diagnosed with colorectal cancer, you will need to see an oncologist and a general surgeon.

What is bowel cancer screening?

Screening aims to determine whether healthy people show any early signs of bowel cancer. Bowel cancer is a common form of cancer for men and women, with approximately 1 in 20 people experiencing it in their lifetime in the UK. Detecting early signs of risk for bowel cancer can ultimately save lives. Bowel cancer in its early stages is more likely to be treated successfully.

What does bowel cancer screening involve?

In the UK, people over the age of 60 are invited to be screened. Following this, you are invited every two years for screening until the age of 75. Screening involves home tests that detect blood in the stool. If you are registered with a GP in the UK, you will automatically be sent this home test after the age of 60.

Additionally, at age 55 you are invited for a one-off bowel scope screening test (also known as a flexible sigmoidoscopy) where a thin tube with a camera is used to examine the inside of the bowel. This test can detect polyps, which are small growths that could eventually turn into cancer. If polyps are detected, they can be removed.

Why is bowel cancer screening done?

Bowel cancer screening is offered because it can save lives by detecting early signs of bowel cancer, or your possible risk of developing it. The earlier it is detected, the more successful treatment is likely to be.

Preparation for bowel cancer screening:

For the bowel scope screening, a few weeks before the appointment you will be sent a small plastic pouch containing liquid to perform an enema before the test, as well as instructions on how to do this. On the day of the test you will need to use the enema kit. This will induce a bowel movement before the test. You will also need to wear a hospital gown for the test.

For the home test kit, no preparation is required.

What to expect during bowel cancer screening:

During a bowel scope screening, the camera tube is inserted gently into your bottom to check for polyps. This test is painless, but you might find it slightly uncomfortable. No anaesthesia is required. The test lasts just a few minutes and you return home soon after the test is finished.

The home test kit is for sending a small poo sample to be tested in a laboratory. You will receive instructions on how to take a stool sample with the kit.

What do abnormal results mean?

Following the bowel scope test, if polyps are found you are told immediately following the test. If polyps are found and removed but are not cancerous you might also be offered a colonoscopy to check for polyps elsewhere in the bowel. If cancerous polyps are found and removed, you will be referred to a bowel cancer specialist to discuss treatment.

A normal result from a home test kit would indicate no blood in your stool, with no further action required other than another home test kit in two years’ time. If blood is found in your stool sample you will be offered a colonoscopy to do a more thorough investigation.

What is cholelithiasis?

Cholelithiasis refers to the presence of one or more gallstones in the gallbladder. Gallstones are little stones made of cholesterol formed in the gallbladder. The gallbladder is a small organ found underneath the liver and aids digestion by releasing a digestive fluid called bile into the small intestine.

What are the symptoms of cholelithiasis?

Most of time gallstones do not cause any symptoms and do not require treatment, however, if a gallstone happens to get trapped in a duct inside the gallbladder, it can cause the following symptoms:

• Intense and constant abdominal pain (called biliary colic)
• Pain between your shoulders
• Nausea and/or vomiting

Sometimes cholelithiasis can be more serious, especially if the gallstone blocks the flow of bile, and the following symptoms can be triggered:

• Fever
• More intense pain
• Diarrhoea
• Jaundice
• No appetite

What causes cholelithiasis?

Although causes of gallstones are not totally clear, they are thought to occur when there is an imbalance in the make-up of the bile inside the gallbladder. Such imbalances are thought to occur when:

• High levels of cholesterol are found in the gallbladder, meaning there is not enough bile to digest the amount of cholesterol in the gallbladder. The excess cholesterol then forms into gallstones.
• High levels of bilirubin are found in the gallbladder. Bilirubin is a waste product made when red blood cells are broken down. Excess bilirubin contribute to the formation of gallstones.

How can cholelithiasis be prevented?

Research indicates that weight-loss and diet can help to prevent gallstones developing.

A healthy, low-saturated fat diet is recommended. This is helps to reduce the intake of bad cholesterol which can cause gallstones to form. Also recommended, is avoiding the consumption of large amounts of alcohol.

Being overweight is also a risk-factor for developing gallstones. Therefore, maintaining a healthy weight by eating healthily and exercising regularly is highly recommended. Losing weight via low-calorie diets are not recommended however, as they have been linked to disrupting bile production, and can therefore increase chances of gallstones developing.

What is the treatment for cholelithiasis?

If your gallstones do not cause symptoms, then most likely you will not need treatment, but will be recommended to actively monitor your condition, and to return to a specialist if symptoms occur. However, those who do experience symptoms will likely have the following treatment options:

• Gallbladder removal surgery (cholecystectomy) – gallstones can reoccur, so removing the gallbladder entirely is one way to ensure that gallstones do not recur. After it is removed, bile goes straight from the liver in to the small intestine.
• Medications – there are certain medications designed to dissolve gallstones and are taken orally. These need to be taken over a long period of time and are not always effective.

What is chronic diarrhoea?  

The term chronic diarrhoea is used for cases in which diarrhoea has lasted for several weeks and is quite often linked to other health issues such as weight loss, abdominal pain, vomiting, nausea, high temperature or fever, or being unable to absorb nutrients.       

Diarrhoea is the frequent passage of soft and watery stools. It is thought to be frequent if a person has bowel movements more than three times a day.     

Diarrhoea can be a relatively common issue that normally lasts a few days before going away on its own. When it lasts longer, it may be due to a more serious issue. In cases of chronic diarrhoea, symptoms can come and go.    

Disease prognosis

Diarrhoea continues to be one of the main causes of morbidity and mortality in underdeveloped countries, affecting up to 5% of the world’s population. Risk factors include malnutrition and lack of breast milk, among many others.

It is worth noting that the prevalence of chronic diarrhoea is much lower in the western world, and deaths that arise from it tend to be isolated cases derived from untreatable congenital diarrhoea.

What are the symptoms?

• The main symptom of chronic diarrhoea is an increase in needing the toilet, and a gradual decrease in stool consistency.
• Abdominal pain, commonly known as cramps.
• Nausea or vomiting.
• High temperature or fever.
• In cases of abundant diarrhoea, the person may become dehydrated due to the loss of fluids.  
• Dehydration can be recognised by the following symptoms: extreme tiredness, thirst, dry tongue, muscle cramps, dizziness, and unconcentrated urine among others.

What are the tests for it?

The patient's medical history is important for the initial diagnosis and choice of tests.  

Anamnesis: a medical history of foods that have previously lead to diarrhoea. The faeces are analysed which can quite often indicate a cause.   

Physical examination: signs of malabsorption and malnutrition are looked for: weight, size, body mass index, muscle mass, and many more. It is useful to note the changes from the onset of diarrhoea. During the examination, things such as hydration levels and changes in skin tone will be taken into account.    

Additional tests: these tests vary depending on the patients’ age and diagnosis. The more basic tests will be done first to diagnose more frequent causes.

Causes of diarrhoea   

There are many things that could cause diarrhoea, the most common are:  

• Bacterial contamination of food or water.
• Viral cause: flu, norovirus, or rotavirus. Rotavirus is the most common cause for diarrhoea in children.
• Parasites in food or water.
• Some medications such as; antibiotics, antacids with magnesium, or cancer treatments.
• Some foods or ingredients can cause an intolerance and / or sensitivity such as lactose.
• Some stomach, small intestine, or colon diseases can cause diarrhoea.
• Some colon function issues.

How can it be prevented?

To avoid viral diarrhoea, it is important to maintain good hygiene such as washing your hands with soap and water before and after meals.   

To avoid bacterial or parasitic diarrhoea, it is important to have good food hygiene and to drink clean or bottled water. It is also important to have good hand hygiene as with viral diarrhoea.  

In cases of diarrhoea after eating, it can sometimes be due an intolerance, which is quite difficult to prevent when unknown.

Another type is travellers’ diarrhoea, the recommendation for avoiding this is to avoid undercooked or raw food as well as cold drinks with ice. It is advisable not to drink tap water and to eat foods which have been thoroughly cooked.

Treatment for diarrhoea         

Treatment will depend on the cause and the severity. One of the most important things to do is to compensate for the loss of liquids and minerals. The easiest way to do this is is to increase the amount of liquid ingested with mineral water, herbal teas, or drinks that have sodium, chloride, or potassium.

If the diarrhoea is intense, increasing the water ingested should help alleviate the problem. If it’s not possible to keep liquids down for very long, it’s recommended that you go to the doctor to get electrolytes and water replenished intravenously.  

What specialist should I see?

As it is a relatively common symptom, there are many specialists who could treat and solve chronic diarrhoea problems. Specialists include; gastroenterologists, internal medicine, and family medicine specialists, occasionally surgeons can help treat diarrhoea or chronic diarrhoea.

What is cirrhosis?

Cirrhosis is a disease in which the liver gradually deteriorates due to chronic injury and scarring which results from a variety of factors. The liver has the ability to repair itself, so each time the organ is injured, scar tissue is formed during the healing process. As cirrhosis progresses, more scar tissue is formed, partially blocking blood flow through the liver.

In general, liver damage caused by cirrhosis is irreparable, although early diagnosis of cirrhosis can limit or even reverse the damage.

There are different types of cirrhosis:

• Alcohol-related cirrhosis: this is caused by excessive alcohol consumption and is the most common cause of cirrhosis
• Hepatitis-related cirrhosis: this is caused by the hepatitis virus, making the liver inflamed
• Cryptogenic cirrhosis: it is referred to as this when the cause for the cirrhosis is unknown
• Primary biliary cirrhosis: the immune system causes cirrhosis by mistakenly attacking healthy liver cells, which are subsequently replaced by scar tissue
• Secondary biliary cirrhosis: causes blockage of the bile ducts
• Sclerosing cirrhosis: the bile duct narrows, preventing the bile from flowing out.

Prognosis of cirrhosis:

Cirrhosis is an incurable disease which, if it progresses without a correct diagnosis, can lead to serious complications such as:

• Portal hypertension: high blood pressure in the veins of the liver. Blood flow is reduced, which increases the pressure in the vein that carries blood from the intestine to the liver.
• Swelling in the legs and abdomen: portal hypertension can lead to oedema and ascites, i.e. fluid formation in the legs and abdomen respectively. Both conditions may also be due to the liver's inability to generate the necessary amount of protein in the blood.
• Splenomegaly: an enlarged spleen. A decrease in the number of white blood cells and platelets in the blood may be a sign of cirrhosis.
• Bleeding: portal hypertension can cause the blood to flow into small veins, causing them to increase in size and possibly rupture, leading to severe bleeding. This bleeding is potentially fatal if the veins in the lower oesophagus (oesophageal varices) or stomach (gastric varices) rupture.

Other complications include:

• Jaundice: the skin becomes yellow due to the inability of the liver to remove bilirubin.
• Malnutrition: cirrhosis can hinder the absorption of nutrients, leading to weakness and weight loss
• Infections: cirrhosis reduces the body’s ability to fight infections
• Hepatic encephalopathy: an accumulation of toxins in the brain, which can cause mental confusion
• Osteoporosis: in some cases, people with cirrhosis lose bone strength and are more prone to factures
• Increased risk of liver cancer
• Acute or chronic liver failure

Symptoms of cirrhosis:

One of the main problems with cirrhosis is that there are often no signs or symptoms until the disease is quite advanced and liver damage is significant. Some of the most common symptoms of this disease are:

• Tiredness
• Bleeding easily
• Itchy skin
• Jaundice
• Ascites
• Bruising easily
• Loss or lack of appetite
• Low sex drive
• Nausea
• Swelling in the legs
• Drowsiness
• Weight loss

Can cirrhosis be prevented?

The best way to prevent cirrhosis is to take care of your liver. Therefore, you should:

• Avoid drinking excessive amounts of alcohol
• Eat a healthy, balanced diet
• Maintain a healthy weight
• Reduce your risk of getting hepatitis by having protected sex and not using illicit drugs, particularly those that are injected. There is also a vaccine now available for hepatitis B.

Treatments for cirrhosis:

Treatment for cirrhosis will vary depending on the cause of the disease and whether other complications are present. The aim of treatment is to slow the progression of scar tissue in the liver. In the event of complications, hospitalisation may be necessary. The main treatments are:

• Eating a nutritious diet
• Avoiding alcohol and other substances that can affect liver function
• Diuretics are recommended for oedema and ascites
• Beta-blockers that lower blood pressure may be prescribed for portal hypertension
• Hepatic encephalopathy is treated by cleansing the intestine with lactulose
• People with cirrhosis and hepato-renal insufficiency should have haemodialysis
• Liver transplant. In advanced cases of cirrhosis where the liver stops working, liver transplantation may be the only option. With transplantation, the diseased liver is replaced with a healthy liver from a deceased donor, or with part of the liver of a living donor.

Which specialist treats cirrhosis?

The specialist who diagnoses and treats cirrhosis are hepatologists.

Clinical nutrition refers the branch of medicine which helps patients to combat their medical problem through proper nutrition.

What is coeliac disease?

Coeliac disease is a pathology characterised by permanent intolerance to gluten. This substance is present in wheat, barley, rye and oats. Gluten damages the lining of the small intestine, causing it not to absorb the necessary components of the food, i.e nutrients. It occurs in genetically predisposed individuals who suffer from atrophy of the villi of the small intestine.

The disease can manifest itself at any time of life, from infancy to adulthood. People with family members who suffer from coeliac disease have a greater predisposition to suffer from it. It occurs more often in women than in men.

What are the symptoms?

Depending on the degree of intolerance, there may be only a few symptoms which present, or a great many. It is also possible that no symptoms present.

The most common manifestations of coeliac disease are:

• abdominal pain
• gas
• indigestion
• constipation
• decreased or increased appetite
• diarrhoea
• nausea or vomiting
• unexplained weight loss.

Other problems may also occur such as being more prone to bruising, depression, anxiety, fatigue, delayed growth in children, hair loss, dermatitis, mouth ulcers, nosebleeds, and muscle cramps, and absence of menstrual periods, among others.

Causes of coeliac disease

The exact cause of coeliac disease is unknown. When people with coeliac disease consume foods with gluten, whether or not they are aware of their disease, their immune system causes damage to the villi in the small intestine. This in turn makes the small intestine unable to adequately absorb iron, vitamins and nutrients.

Can it be prevented?

As the cause of coeliac disease is not known, there is no way to prevent its appearance. However, it is important to take into account certain risk factors such as having a family member with this disorder, for early diagnosis and treatment.

What is the treatment?

Coeliac disease cannot be cured. The treatment is to follow a gluten-free diet for life. This helps the symptoms disappear and to heal the villi in the lining of the intestines.

If adequate treatment is not given, certain complications can occur such as autoimmune disorders, bone disease, intestinal cancer, anaemia, or liver disease.

What is colic?

Colic is often associated with infants, but it can occur in adults too.

Infant colic: occurs in some babies during their first months. It refers to when a baby cries with no obvious cause and the crying lasts for more than 3 hours a day, 3 days a week for at least 1 week.

There can be different types of adult colic, such as biliary colic, renal colic and intestinal colic. Colic refers to the pain, usually associated with the intestines and urinary system. The colicky pain can occur once, or recur for weeks, months or years after the initial pain.

• Biliary colic: is produced by the distension of the gallbladder, usually by a gallstone.
• Renal colic: sudden and intense pain caused by kidney or urinary stones.
• Intestinal colic: cramps in the intestines, caused by a blockage in the large or small intestine.

What are the symptoms of colic?

Symptoms in babies with colic include:

• Crying for no apparent reason for long periods of time
• A distended abdomen
• Passing gas

Symptoms of biliary colic: biliary colic is often caused by gallstones, which block the bile ducts between the gallbladder and liver, causing inflammation, pain under the right breastbone and in the abdomen.

Symptoms of renal colic: sudden and intense pain, caused by kidney or urinary stones and is usually located on one side, where the kidney stones are located. Other symptoms might include; nausea, pain when urinating and vomiting.

Symptoms of intestinal colic: intestinal cramps, caused by a blockage in the small or large intestine, causing vomiting, nausea, diarrhoea, loss of appetite and bloating.

What causes colic?

The exact cause of infant colic is not known. However, some possible causes can be that the baby has trapped gas, is in a fussy mood and is experiencing muscle spasms as their digestive system grows or they are oversensitive to environmental stimuli, causing them to become distressed.

The cause of biliary colic in adults is mainly caused by gallstones. These bile stones block the bile ducts leading to pain and inflammation. 

In the case of renal colic, the main cause is the accumulation of salts in the urine (kidney stones). Intestinal colic is caused by blockages in the large or small intestine. The blockages may be the result of an inflammatory intestinal disease like Crohn’s or IBS.

Can colic be prevented?

There are several measures that can be taken to prevent colic. To prevent infant colic, it is advised to hold the baby upright after eating, tapping on the back to eliminate any gas.

Biliary colic is usually related to gallstones, so controlling risk factors for gallstones can help, such as controlling your weight and following a low-fat diet can help towards prevention.

To avoid renal colic, it is recommended to drink plenty of fluids and reduce salt intake. It is recommended to drink 8 t 10 glasses of water a day and to cut back on soft drinks that contain phosphoric acid.

In cases where the patient suffers from intestinal colic, any underlying conditions that contribute to the cramps and painful muscle spasms should be properly treated, for example, IBS.  

What is the treatment for colic? 

A number of things can be done to treat infant colic. Sit the baby upright during feeding, so the baby swallows less air and remember to tap the baby on the back to help them burp any gas that might get trapped after feeding. Calming your baby’s senses may also help them to stop crying. Rocking your baby, holding them in a soft blanket and gently massaging their back can help to soothe them and calm them down.

Pain medication can be prescribed for biliary colic at first and a fat-free diet. If the gallbladder becomes severely painful and inflamed, then surgery to remove the gallbladder will be advised. The surgery can be done with a laparoscope and the patient can go home on the same day. 

To relieve renal colic caused by kidney stones, shock wave lithotripsy (shock waves target and break up the stones, so they can pass in the urine) or a ureteroscopy (a lighted scope is placed into the urethra and bladder to remove the stone) can be used. 

To investigate intestinal colic, the specialist will look into family history, the patient’s own medical history and can perform x-rays, ultrasounds and CT scans to see if there is any blockage in the intestines. If a blockage is found, it will be treated accordingly.

What is colitis?
Colitis refers to the inner lining of the colon becoming inflamed. Colitis can be a symptom of a disease that affects other parts of the body, which causes fevers, chills, fatigue and dehydration. There are many types of colitis that are usually classified by the cause of each one. The two most common types include ulcerative colitis and Crohn’s disease, which are types of inflammatory bowel disease (IBD). Ulcerative colitis causes other manifestations in the body, which include mouth ulcers, swelling of the joints and skin inflammation.

What are the different types of colitis?
The types of colitis are categorised by what causes them. Some of the different types include:
 
• Ulcerative colitis and Crohn’s disease – these two types of colitis are classified as inflammatory bowel disease. Ulcerative colitis occurs when the immune system overreacts to bacteria in the digestive tract. It begins in the rectum and spreads to the colon.
• Pseudomembranous colitis – this type of colitis occurs from the overgrowth of a bacteria known as Clostridium difficile. Normally found living in the intestine, this bacteria does not usually cause problems because of the balance with the good bacteria. Clostridium difficile takes over when medications such as antibiotics destroy the good bacteria. The toxins that are released cause inflammation.
• Ischemic colitis – this occurs when the blood flow to the colon is cut off or restricted.

What causes colitis?
The most common causes of colitis include:
 
• Infections or viruses
• Loss of blood supply
• Chronic diseases
• Allergic reactions

What are the signs of colitis?
 
The symptoms of ulcerative colitis may include:
• Diarrhoea
• Abdominal pain and cramps
• Rectal pain
• Rectal bleeding – experiencing a small amount of blood in the stool
• Desperate to use the toilet
• Inability to defecate even though there is a feeling of urgency
• Weight loss
• Fatigue
• Fever

How is colitis diagnosed?
A physical examination by a specialist helps to determine the cause of a patient’s symptoms. The doctor will take the patient’s blood pressure and check their temperature for fever. There is an examination of the abdomen to check if there is a feeling of tenderness. Bowel sounds are listened to through the use of a stethoscope. A blood test can measure haemoglobin and haematocrit levels to check for anaemia. Stool samples may also be collected to search for bacterial and parasitic infections as the cause of colitis. The stool may be tested for blood too.

How is colitis treated?
The treatment of colitis depends on how bad the disease is within the individual patient. Treatment usually involves a change in diet, nutritional supplements and medication being prescribed. In severe cases, surgery may be required. Mild colitis responds to medicines such as steroids and anti-inflammatories. More severe symptoms will require stronger medication such as immunomodulator medicines, which suppress the immune system to prevent inflammation. Surgery may be required to remove the large intestine, however this can cause other problems in different areas of the body.

Foods to avoid:
• Alcohol and fizzy drinks
• Caffeine
• Dairy products
• Raw fruits and vegetables
• Legumes

Foods to incorporate into the diet:
• Omega-3 fatty acids (found in salmon)
• Probiotics (kefir)
• Iron-rich foods (green vegetables)
• Turmeric
• Folate-rich foods

What is a colonoscopy?

A colonoscopy is a type of endoscopy that is used to examine the colon and small intestine in order to detect any abnormalities (inflammation, ulcers, etc.). The procedure usually lasts around 15-20 minutes.

What does a colonoscopy involve?

It is performed using a thin tube (endoscope) that is inserted through the anus and has a video camera at the end to record the organs and walls it passes through.

Why is it performed?

A colonoscopy may be performed for various reasons:

• to locate any polyps or adenomas
• to screen for colon cancer
• to explore the cause of unexplained changes in bowel habits
• to evaluate symptoms of pain, rectal bleeding or weight loss
• in cases of iron-deficiency anaemia
• for the diagnosis of Crohn's disease or ulcerative colitis.

Preparing for colonoscopy

Before the test you should follow instructions for cleansing the bowel to make it easier for the doctor to observe it. This will involve drinking only liquids in the 24 hours before the procedure, and taking a solution that will help you empty your bowels.

During the procedure, you will be partially or fully sedated. You will be placed on your side and the doctor will insert the endoscope through the anus to pass through your large intestine.

What do you feel during the procedure?

A colonoscopy is usually well tolerated and is rarely painful. At most, you will feel pressure, swelling, or cramping during the procedure. Less than one per cent of patients will experience serious complications.

Meaning of abnormal results

If the specialist feels that a more accurate evaluation is necessary, they will obtain a biopsy of the lining of the bowel for analysis.

If polyps are found during the procedure, these can be removed straight away.

Are there alternatives to this test?

There is now an alternative to traditional colonoscopy that is much less invasive and does not require sedation. This is called a virtual colonoscopy, which is an examination that uses images of the inside of the bowel and colon obtained by means of computerised tomography (CT or CAT scan) instead of images taken by the colonoscopy camera.

Colorectal cancer begins with a polyp that develops in the colon or rectum. When this polyp is covered with adipose tissue it can change into an adenoma, a specific type of polyp, or adenocarcinoma, a type of cancer that contains mucus and other fluids. The tests to detect colon cancer are usually carried out through colonoscopy, a test that introduces a thin and flexible tube with a camera (endoscope) into the anus, and virtual colonoscopy, a radiological examination that obtains images. The purpose of these tests is to determine the presence of adenomas and polyps in the colon and to surgically remove them before they become cancerous.

What is constipation?

The term “constipation” refers to infrequent bowel movements or difficulty passing stool. Constipation is usually defined as when a patient makes less than three bowel movements a week. These bowel movements may be difficult, even painful, and the individual may strain themselves trying to go.

Occasional constipation is common, and can be related to change of routine, going on holiday, or while taking medication. The body usually readjusts quickly and normal defecation rhythm is resumed. However, some people experience chronic (ongoing) constipation, which may require an examination by a doctor to rule out an underlying illness.

What are the symptoms of constipation?

The key symptoms of constipation are:

• Less than three bowel movements a week (apart from young infants – it is quite normal for breastfeeding babies to go a week without pooing)
• Poo is larger than usual and difficult to push out
• Poo is dry, hard, and lumpy

Constipation can also cause general discomfort, with sufferers feeling bloated, sick, or getting stomach aches. Some patients cause further discomfort by straining to push stools out. If the patient successfully defecates, they may feel as though they haven’t completely emptied their rectum.

Causes of constipation

There are many possible causes of constipation in adults, and sometimes there is no obvious cause.

Common causes include:

• Lack of fibre in the diet
• Not drinking enough fluid
• Sedentary lifestyle/not getting enough exercise
• Frequently not going to the toilet when you need to
• Changes to routine or diet
• Psychological factors, e.g. stress, anxiety, depression
• Side-effects of medication

Constipation is relatively common during and up to six weeks following pregnancy. In rarer cases, it may be caused by an underlying medical condition.

Such conditions include:

• Blockages of the colon or rectum – bowel obstructions, anal fissures and even tumours can block the passage of stool.
• Neurological problems – nerve diseases, including Parkinson’s and multiple sclerosis can affect the nerves controlling the muscles in the digestive tract that push faecal matter towards and out of the rectum.
• Problems with the muscles involved in bowel movements – weakened pelvic muscles or disorders that mean they don’t contract and relax in a coordinated way
• Conditions that affect hormones – certain conditions, including diabetes and even pregnancy affect the balance of fluids in the body, and this can lead to constipation.

Can constipation be prevented?

Leading a healthy lifestyle, with a diet rich in fibre can help prevent constipation. It is also advisable to drink plenty of fluids (about two litres of water a day), exercise regularly and go to the bathroom when you feel the urge to defecate, instead of holding it.

What is the treatment for constipation?

In most cases, lifestyle changes will resolve the problem:

• Increase the amount of fibre in your diet, e.g. cereals, fruit, vegetables
• Increase fluid intake
• Exercise more
• Try to establish a regular toilet routine, and, if possible, don’t hold it in; go when you have the urge.

If these measures don’t work, the doctor may recommend laxatives to help stimulate bowel movements.

What is Crohn’s disease?

Crohn’s disease is a type of chronic inflammatory bowel disease (IBD) that can affect any part of the digestive tract from mouth to anus, but is most commonly found at the end of the small intestine, where this meets the colon (large intestine). It is characterised by inflammation, which is often severe and can be debilitating, and may extend through the whole width of the bowel wall.

Prognosis of Crohn’s disease

Crohn’s is a chronic condition, meaning long-term. There is currently no known cure for Crohn’s disease, although existing therapies make it manageable and can cause the disease to go into remission for years at a time. Flare-ups still occur periodically, however, and can make life difficult.

Symptoms of Crohn’s disease

When Crohn’s disease is active, typical symptoms include:

• Diarrhoea
• Abdominal pain (stomach aches, etc.)
• Blood in the stool
• Fatigue
• Weight loss
• Reduced appetite
• Mouth sores
• Fever

Symptoms can range from mild to severe, and usually develop gradually, but may come on in sudden attacks.

In severe cases, Crohn’s can also affect other parts of the body, including inflammation in the joints, the liver, the skin, and the eyes.

Crohn’s can start at any age, but symptoms usually first manifest in late childhood and early adulthood, with the majority of cases being diagnosed before the age of 30.

It often occurs in flare-ups, which may go into remission with treatment, but will flare up again weeks, months, or even years later.

What are the causes of Crohn’s disease?

The causes of Crohn’s disease are currently poorly understood, but a great deal of research into the illness is being carried across the world and experts are continuing to learn a lot about its mechanisms and possible causes. The leading theories are that it is caused by a combination of some of the following factors:

• Genetics – it is thought that some people are born with genes that predispose them to the development of Crohn’s
• Autoimmune – many experts believe that Crohn’s is an autoimmune disease; that is, the immune system mistakenly attacks cells in the digestive system as if they were invading bacteria or viruses.
• Gut bacteria and antigens – it is possible that certain bacteria or the antigens they produce may trigger the autoimmune response. Another theory is that an imbalance in gut bacteria may have a more direct effect on the development of Crohn’s. Current research indicates that, whatever the mechanism, bacteria seem to be relevant.

Other risk factors that may contribute include:

• Smoking
• Previous stomach bugs
• Living in an urban environment
• Family history, i.e. relatives that also have Crohn’s

Treatments for Crohn’s disease

While Crohn’s disease cannot be cured, there are treatments to reduce and control the symptoms. Sometimes, these treatments can be enough to send the disease into periods of remission. Typical treatment options include:

• Various anti-inflammatory medication, including certain steroids. The type prescribed will depend on the patient and on the severity and location of the inflammation in the digestive system.
• Immune system suppressors may be prescribed to reduce inflammation by targeting the immune system, which makes the substances that cause inflammation.
• Surgery may be the best option – by removing part of the tissue in the digestive tract, and reconnecting the healthy sections, the inflammation can be removed. However, this does not eliminate the chances of recurrence; surgery usually offers a temporary solution in severe cases of the disease.

Which type of specialist treats Crohn’s disease?

Gastroenterologists treat all kinds of inflammatory bowel disease, including Crohn’s disease and ulcerative colitis. Colorectal surgeons are usually responsible for performing operations to treat IBD.

What is diarrhoea?

Diarrhoea is characterised by a greater fluidity and volume of bowel movements. These stools can sometimes contain blood, mucus, pus and undigested food.

When diarrhoea lasts for many days, it can be a sign of a more serious problem. Chronic diarrhoea that lasts for at least four weeks can be a symptom of a chronic disease.

What symptoms does it present?

The main symptoms of diarrhoea, in addition to greater fluidity and volume of the stools, are:

• Cramps or pain in the abdomen
• Urgent need to go to the bathroom
• Loss of bowel control

If the cause of the diarrhoea is due to a virus or bacteria, other symptoms such as fever, chills and blood in the stool may appear.

In addition, diarrhoea can cause dehydration.

Causes of diarrhoea

The most common causes of diarrhoea are:

• Contaminated food or water
• Viruses, such as the flu
• Parasites
• Certain medications such as antibiotics, anti-cancer drugs or antacids that contain magnesium
• Diseases of the stomach, small intestine or colon, such as Crohn's disease
• Irritable bowel syndrome (IBS)
• Intolerance or sensitivity to certain foods, such as lactose intolerance

Sometimes a specific cause is not found. If the diarrhoea disappears after a couple of days it is generally not necessary to investigate further.

Can it be prevented?

Two types of diarrhoea can be prevented: rotavirus diarrhoea and traveller’s diarrhoea. In the first case, there are vaccines available for rotavirus. As for traveller’s diarrhoea, it is important that when travelling, we are careful with the food and beverages we consume in certain countries or in certain regions. Speak to your doctor before going on holiday for advice on avoiding traveller’s diarrhoea. It can help to avoid eating raw fruits and vegetables, and to only drink bottled water.

What is the treatment?

The main objective of the treatment for diarrhoea is to replenish fluids and electrolytes lost due to dehydration. Depending on the cause, your GP or specialist may prescribe a pharmacological treatment to either stop the diarrhoea or treat the infection.

What are digestive diseases?

The digestive system is a tube made up of the mouth, oesophagus, stomach, small intestine and large intestine, which leads to the back passage. It also contains organs such as the liver, gallbladder, and pancreas.

Each part of this system has a different purpose, such as breaking down food, absorbing nutrients, or removing toxins or alcohol.

A digestive disease, or disorder, involves something going wrong with one of the organs in this system.

Digestive diseases can include:

• Problems with the oesophagus – including acid reflux, achalasia,
• Problems with the stomach – including gastro paresis, stomach ulcers, and stomach cancer
• Problems with the gallbladder – including gallstones. and acute cholecystitis
• Problems with the pancreas – including pancreatitis and pancreatic cancer
• Problems with the liver – including liver cysts and liver cancer
• Problems with the intestines – including coeliac disease, dysentery, Hirschsprung's disease, irritable bowel syndrome (IBS), and ulcerative colitis, diverticulitis, colon cancer, and polyps
• Problems with the rectum – including, anal fissure, anal fistula, and haemorrhoids
• Problems with the system as a whole – including Crohn’s disease
• Issues generally related to dietary problems – including constipation, indigestion, flatulence, food intolerances, and lactose intolerance.

What are the symptoms of a digestive disease?

Symptoms of a digestive disease can include:

• bloating
• constipation
• diarrhoea
• stomach pain
• weight gain or loss
• heartburn
• incontinence
• nausea or vomiting

What type of specialist treats digestive diseases?

A gastroenterologist is a type of consultant who specialises in diseases in the digestive system. Depending on your condition, however, they may not be able to make a diagnosis on their own, and may refer you to other specialists, such as radiologists, to conduct further tests.

Diverticular disease is characterized by the presence of diverticula in the colon wall, due to an increase in intraluminal pressure. Diverticula are pockets that usually form on the left side of the colon walls, although it can occupy the entire colon. When an increase in intraluminal pressure produces a pulse of the muscosa occurs through colonic muscle layers in their weak points, which correspond to the points where the neurovascular bundles penetrate. In most cases, diverticular disease have no symptoms, and only when there is bleeding or complications may appear diverticulitis. Diverticulitis (that is infection of the diverticula) in turn can cause abdominal pain, fever and chills. More serious complications can even cause an ruputura or fistulae that require surgery. The treatment of diverticular disease is essential and based on regular consumption of dietary fiber. In the case of diverticulitis, treatment should be done by antibiotics (oral or intravenous), restrictions on food and stool softeners.

What is diverticulitis?

Diverticulitis is a condition affecting the large intestine, or bowel. It is closely related to another condition affecting the bowel, called diverticular disease. Diverticulitis is more likely to occur in those who do not get enough fibre through their diet.  

What causes diverticulitis?

As we get older, small pockets or bulges called diverticula may develop in the lining of the intestine. These do not often cause symptoms and can go entirely unnoticed, but when they do cause symptoms, this is referred to as diverticular disease. Once symptoms become more severe, and the diverticula become infected, or inflamed, this is referred to as diverticulitis.

What are the symptoms of diverticulitis?

Diverticulitis symptoms include:

• Severe, constant tummy pain
• Feeling sick/vomiting
• Fatigue (feeling tired)
• Blood in your stool
• Rectal bleeding
• A high temperature (over 38 degrees Celsius)

If you experience symptoms of diverticulitis, without any previous diagnosis of diverticular disease, you should contact your GP as soon as possible. If you have a previous diagnosis of diverticular disease the symptoms can be managed and treated from home. However, if you notice bleeding, or are experiencing severe pain, it is best to seek medical attention.

How is diverticulitis diagnosed?

Your doctor will take your medical history and make an assessment of your symptoms. This is because they will want to rule out other conditions which can display similar symptoms, such as IBS (irritable bowel syndrome), or bowel cancer.

The doctor may also take blood tests and refer you for a colonoscopy or CT scan.

What is the treatment for diverticulitis?

Diverticulitis is most commonly treated at home using medication to relieve symptoms of pain, and antibiotics. In more severe cases, diverticulitis can be treated at the hospital so the doctor can monitor your progress and symptoms. Treatment in hospital may involve antibiotics administered through injections, and an intravenous drip to provide hydration and nourishment.

If you have already been diagnosed with diverticular disease, a high-fibre diet may help to ease any symptoms you experience with the condition. The ideal amount of fibre for an adult is 30g per day, and your doctor will discuss targets and ways to include fibre in your diet.

In more extreme cases, diverticulitis can be treated with surgery. This type of treatment is rare, and it involves removing the affected section of intestine. However, before any type of surgery, your surgeon will discuss the benefits and risks implied.

This condition is caused by ingestion of medication, supplements or herbal remedies that are toxic and damage liver function. The effects can be jaundice, liver failure or even death, and usually occur after long-term exposure to the toxin.

What is dysmotility?

Dysmotility is a series of related conditions in which the muscles of the digestive tract or the nerves that control them do not work as they should, meaning that the rate at which food passes through the digestive system and the rate at which waste is excreted is abnormally slow or irregular. Bowel dysmotility can lead to some unpleasant digestive symptoms, such as diarrhoea, constipation, bloating, cramping and abdominal pain. The symptoms that appear depend on which part of the digestive tract is affected. Multiple areas of bowel can be affected and the problem can be progressive.

Dysmotility of the stomach is also known as gastroparesis and that of the large intestine is known as slow transit constipation.

Symptoms of dysmotility

Patients with dysmotility in the upper digestive tract (i.e. the oesophagus and stomach) may experience:

• Loss of appetite
• Weight loss
• Heartburn
• Upper abdominal pain, burning sensations or discomfort
• Nausea and vomiting
• Feeling full very quickly when eating

Dysmotility of the small intestine can cause:

• Abdominal pain
• Cramping
• Bloating and distension
• Problems with bowel movements – this may be constipation and or diarrhoea

Some of these problems may be because of altered gut microbes (small intestinal bacteria overgrowth and small intestinal fungal overgrowth (SIBO/SIFO))

Dysmotility in the lower digestive tract (colon and rectum) can cause:

• Constipation not helped by diet or laxatives
• Lower abdominal pain
• Cramping
• Bloating

Medical tests to diagnose dysmotility

• Blood tests can assess the level of malnutrition, anaemia and salt imbalance that may be caused by dysmotility. They may also be able to diagnose the cause of the dysmotility, e.g. diabetes, lupus, etc.
• CT and MRI scans – these can give the doctor a closer look at what is going on inside the patient and rule out mechanical obstruction.
• Motility/transit investigations
• Small intestinal bacterial overgrowth breath test
• Biopsy

What are the causes of dysmotility?

Dysmotility is caused by dysfunction in the nerves and/or muscles in the organs that make up the gastrointestinal (GI) tract. This may be caused by an underlying illness, such as:

• Systemic lupus erythematosus
• Amyloidosis
• Neurofibromatosis
• Parkinson's disease
• Diabetes
• Scleroderma
• Thyroid disorders
• Muscular dystrophies
• Ehlers Danlos and other connective tissue disorders

Dysmotility can also be caused by certain medications and inflammatory conditions such as coeliac disease can also cause a certain degree of dysmotility.

In other cases, there is no known cause, and dysmotility is the primary diagnosis. Examples include:

• Achalasia – a dysmotility disorder of the oesophagus
• Gastroparesis – delayed emptying of the stomach
• Functional constipation
• Functional diarrhoea
• Irritable bowel syndrome (IBS)
• Slow transit constipation
• Panenteric dysmotility
• Chronic intermittent pseudo obstruction

Treatments for dysmotility

The treatment depends on the type and cause of the dysmotility. First, a mechanical blockage must be excluded.

Many causes of dysmotility cannot be cured, meaning that treatment is focussed on the symptoms rather than the cause. This may involve dietary changes, medications to stimulate intestinal movements, or manipulation of the gut microbes. Only very rarely is surgery indicated and even then results are unpredictable.

Which type of specialist treats dysmotility?

Bowel dysmotility is managed by neurogastroenterologists. This is a specific subset of gastroenterologists or gastrointestinal surgeons who have had specialist training in this field.

What is dysphagia?

Dysphagia is the medical term for a person who has swallowing difficulties. Some people cannot swallow certain foods or liquids, whilst others have trouble swallowing at all. The condition is usually caused by nerve or muscle problems, and is more common in the older generation and babies. There are three different types:

• Oral dysphagia – which occurs in the mouth and is sometimes caused by tongue weakness, especially following a stroke.
• Pharyngeal dysphagia – is a problem in the throat that is normally caused by neurological problems, such as Parkinson’s disease.
• Oesophageal dysphagia – is in the oesophagus and is usually because of a blockage or irritation and requires surgery.
   

  

What are the symptoms of dysphagia?

The symptoms of dysphagia may include:

• pain or discomfort when swallowing
• expulsion of food or liquid from the mouth
• involuntary drooling
• residues of food in the mouth or tongue
• frequent clearing of the throat
• swallowing in very small pieces
• the feeling of a blockage in the throat
• frequent bronchitis and pneumonia
   

What are the causes of dysphagia?

Normally, dysphagia occurs secondary to another disease or injury, such as:

• A condition to affect the nervous system – stroke, head injury, multiple sclerosis, dementia
• Cancer
• Gastro-oesophageal reflux disease (GORD)

Risk factors for dysphagia include ageing as this is due to general wear and tear on the body over time. Neurological conditions can make dysphagia more likely.
 

How is dysphagia diagnosed?

A speech-language specialist will try to determine the problem. The patient will take a:

• Swallow study – where the specialist tests different consistencies of food and liquid.
• Barium swallow test – after swallowing a barium-containing liquid, the barium shows up in an X-ray to help the doctor see what is happening in the muscles of the oesophagus.
• Endoscopy – a camera is used to look down the oesophagus.
   

How is dysphagia treated?

The treatment depends on the type of dysphagia that the patient has. Oral dysphagia is a neurological problem and treatment can be a challenge. Swallowing therapy can be done with a speech and language therapist. The patient may also need to be fed through a feeding tube. A nasal tube or PEG (percutaneous endoscopic gastrostomy) is used to feed a patient who is at risk of pneumonia, malnutrition or dehydration.

Oesophageal dysphagia usually requires surgery. If the oesophagus needs to be widened then a small balloon is inserted and then removed. In cases of stiff muscle, Botox® is used to paralyse it in order to reduce constriction. If cancer is the cause of dysphagia, the patient is referred to a specialist for treatment to have a tumour removed surgically.

What is endoscopic mucosal resection (EMR)?

Endoscopic mucosal resection (EMR) is a technique used to remove precancerous growths, early-stage cancer, and other abnormal lesions from the lining of the digestive system.

Patients will be given a sedative to prevent pain, the strength of which depends on the patient and procedure. For EMR of the upper digestive tract, a local anaesthetic will be delivered via a spray to numb the throat and oesophagus.

Why would you have endoscopic mucosal resection?

EMR is a less-invasive option than open surgery, and can be the safest option to remove early-stage cancer or other abnormalities in the digestive tract lining. It can also be used to take tissue samples to help the doctor diagnose the problem, and if the patient has cancer, EMR can help the doctor to know if the cancer has spread to deeper tissues.

Some conditions endoscopic mucosal resection can be used to treat include:

• Barrett’s oesophagus
• Early oesophageal cancer
• Stomach cancer
• Cancer of the small intestine
• Polyps in the colon
• Colorectal cancer
• Noncancerous growths in the uterus (leiomyomas, or fibroids)

What does EMR involve?

Endoscopic mucosal resection may be performed from the upper or lower end of the digestive tract, depending on the location of the cancer or growth. A long, narrow tube fitted with a light and video camera (an endoscope) is inserted into either the mouth (to reach the oesophagus, stomach, or upper part of the small intestine) or the anus (to examine the colon).

To remove tissue, the doctor inserts instruments through the endoscope.

How to prepare for endoscopic mucosal resection

You will have to provide your medical history and details of any medication you use to the doctor before having EMR. You will be instructed not to eat or drink anything from several hours before the procedure, and you may not be able to take certain medication during this time either, as it may interfere with the sedatives you will be given.

Post-operative care

The patient remains in the hospital until the effects of sedation have worn off. The doctor will provide instructions on when they can start eating and drinking again. While most patients go home on the same day, it is advised that someone takes them home, as it is not advisable to drive.

A follow-up appointment will be made to discuss the results of the EMR, and several months after, another endoscopy will be performed to ensure the whole lesion is gone.

What is it?

Endoscopy is the use of cameras to relay images from inside the body.  The device used, known as an endoscope, is a long thin flexible tube with a camera at one end and a light source.

What does it involve?

Endoscopes are inserted in to the body via a natural opening such as the mouth or the anus. There are different types of endoscopy depending on the site and function of the procedure – if the bowel is to be investigated for example, it is referred to as a colonoscopy. If the airways are to be examined, the procedure is referred to as a bronchoscopy.

Endoscopy can also be used for surgery, as in the case of laparoscopic surgery – in this situation the laparoscope (a specific type of endoscope) is inserted through small incisions. Once inserted, the endoscope is able to send images from the inside of the subject’s body back to a TV screen.

What is it for?

Endoscopy is most commonly used to investigate symptoms and help to diagnose conditions relating to the digestive system, although it can be deployed to produce images and aid with many other parts of the body, including the respiratory system, the urinary tract and the female reproductive system. An endoscope can also be used to assist with surgery.

An endoscopy is commonly used to investigate symptoms such as abdominal pain, nausea and vomiting, unexplained weight loss, diarrhoea, blood in the stool or vomiting blood.

How can you prepare for it?

You may be required to avoid food and liquids for a period beforehand, depending on what type of endoscopy you are undergoing. In the case of a colonoscopy, you might be given laxatives to help you evacuate any stool beforehand. You may also be required to stop taking certain medication such as blood thinners to prevent excess bleeding from the procedure.

What does it feel like during the procedure?

The procedure usually only causes mild discomfort although a local anaesthetic is also sometimes used. It is normally performed with the patient conscious, although sedatives can be deployed to help you relax. Antibiotics are sometimes used to reduce risk of infection.

What would a “bad” result mean?

An endoscopy can be used to diagnose a wide range of conditions and the results are interpreted by a specialist.  Whether the results are good or bad clearly depends on what symptoms are being investigated and on which part of the body the endoscopy is being performed.

What is an epigastric hernia?

An epigastric hernia is when fat or body tissue protrudes through the abdominal wall, between the sternum of your rib cage and your belly button. Often there are no symptoms with this type of hernia and they often go unnoticed. This type of hernia is usually small and you can have more than one at a time. Despite showing few symptoms, they can sometimes cause pain in the upper abdominal region. 

What are the symptoms of an epigastric hernia?

Although symptoms with an epigastric hernia are uncommon, a noticeable bulge might present especially when you cough, sneeze, laugh or strain. Sometimes this type of hernia can cause pain and tenderness in the affected area. 

What causes an epigastric hernia?

This type of hernia is usually present from birth due to incomplete abdominal wall development. 

What is the treatment for an epigastric hernia?

These hernias do not heal themselves and surgery is required to repair them.  However, unless the hernia becomes an emergency surgery can be delayed until the patient feels ready, or when a child becomes older. Often when adults are diagnosed with an epigastric hernia, it has become problematic due to obesity, muscle weakness or frequent strain on the abdominal wall due to heavy lifting or straining. 

Surgery can be peformed either openly, or laparoscopically. General anaesthesia is used. If the defected muscle opening is small then sutures usually suffice to close the hole. However, for larger muscular defects, an inserted mesh might be needed to restore strength to the abdominal wall. Such a mesh is permanent and stops the hernia from returning. 

Most patients are able to return to their normal activities within two to four weeks following surgery. 

What is an ERCP?

Endoscopic retrograde cholangiopancreatography (ERCP) is an invasive diagnostic and treatment procedure. ERCP combines the use of endoscopy and fluoroscopy to diagnose and treat problems of the pancreatic or biliary ductal systems.

What does an ERCP involve?

The procedure is performed in three main steps:

1. You will be lying down on your left side, on the fluoroscope flatbed;
2. You will be given intravenous sedation;
3. An endoscope with a camera on one of its ends will be passed through your mouth and oesophagus to your duodenum. The doctor will be able to see the images projected by the camera on a screen. The endoscope will also inject a contrast medium which will allow for a fluoroscopy to be carried out as well.

What is ERCP used for?

You may need an ERCP if:

• You have already done other tests such as an ultrasound or a CT scan and you have a confirmed diagnosis of bile duct stones or pancreatic cancer;
• You have obstructive jaundice: when the flow of bile is obstructed and cannot reach the duodenum, a pigment known as bilirubin remains in the bloodstream, causing obstructive jaundice;
• You have pancreatitis, which can be either acute or chronic. In the first case, the symptoms show up suddenly while in the second case the inflammation shows up progressively; pancreatitis becomes more severe, causing the destruction of the pancreas itself;
• You have kidney stones or gallstones;
• Benign or malignant pancreatic cancer, which could be caused by a proliferation of exocrine or endocrine cells within the pancreas;
• You’re suffering from pancreas divisum, that is, an anomaly of the pancreas where the pancreatic duct is divided into two ducts instead of being a single duct;
• You need to take a pancreatic tissue sample or bile duct cells sample for a biopsy. This is also extremely helpful when it comes to confirming a diagnosis of pancreatic cancer or cancer of the bile ducts.

This procedure can also be used as a treatment for:

• Eliminating bile duct stones;
• Doing a biliary stent, that is, putting a stent inside the bile duct to treat an obstruction or narrowing;
• Treating a bile duct stricture;

How can I prepare for an ERCP?

Here is what you can do to prepare for an ERCP:

• Talk to your GP in order to have your medical, clinical and family history sorted out in advance;
• Do a blood test, an ECG and take your blood pressure;
• If you are on certain medications, you may need to go off of those a few days before the procedure;
• As a precautionary measure, you may need to get started on antibiotics;
• Do not eat anything for at least eight hours before the procedure.

What does it feel like during an ERCP?

Should you be under local anaesthetics, it may feel like you can’t breathe when the endoscope is going down your oral cavity - rest assured though, the air flow won’t be blocked in any way.

What is fatty liver?

Fatty liver disease is the accumulation of fatty acids and triglycerides in liver cells. There are two types:

• Non-alcoholic fatty liver disease: it is the most common cause for obesity due to a build-up of fat in the liver cells. There are other factors that can also trigger the disease, such as oxidative stress, the production and release of toxic inflammatory proteins, or necrosis or death of liver cells.
• Alcohol-related liver disease, also known as alcohol hepatic steatosis: as the name suggests, this disease is caused by excess alcohol intake. The liver breaks down most of the alcohol but during the process, harmful substances to the liver are released that cause inflammation and weaken the body’s natural defences.    

What are the symptoms? 

Symptoms of this disease include upper right abdominal pain, general malaise, and chronic fatigue, among others. However, many patients don’t have symptoms but are diagnosed after having certain imaging tests such as an ultrasound or CT scan for other reasons.  

These imaging tests are not always able to diagnose this disease, for this it’s best to undergo laboratory testing to be able to assess the degree of liver injury by assessing liver enzymes or transaminases.      

Causes of fatty liver?  

Specialists are still unsure as to why some people accumulate fat in the liver and others don’t.  An important factor is that some cases of fatty liver develop swelling which could turn into cirrhosis. There are however some common factors for both types of fatty liver: being overweight or obese, insulin resistance, when cells don’t process sugar in response to the hormone insulin, and high blood sugar levels (hyperglycaemia) which can indicate prediabetes or type 2 diabetes and / or high levels of blood fats, particularly triglycerides.  

How can it be prevented?

In most cases, fatty liver can be prevented if certain lifestyle changes are made, such as following healthy guidelines based on a varied, balanced, and low fat diet. Since alcohol is one of the things that damages the liver, it is very important to stop consuming alcohol.    

Another important factor is to exercise regularly as that helps burn fat; exercises can be aerobic, such as running or walking.        

What is the treatment?           

There is no specific treatment for this disease, however it has been shown that weight loss, regular exercise, and following a balanced diet can help reduce fat in the liver.

Controlling cholesterol levels, diabetes, and / or any other cause for a build-up of fat in the liver is also important.

In cases of morbid obesity, bariatric surgery may be recommended.        

What is food intolerance?

Food intolerance is the adverse reaction of the body to the intake of certain foods. It refers to a difficulty digesting particular foods.

Food intolerance is not the same as a food allergy. The latter triggers a much more rapid reaction in the immune system which is dangerous to the health. Food allergies cause hives, eczema, swelling and difficulty breathing, so it is urgent to seek urgent medical help because in these cases the patient's life is in serious danger. An intolerance, on the other hand, triggers an unpleasant physical reaction, but it is not dangerous.

What are the symptoms?

Symptoms can include:

• Diarrhoea
• Nausea
• Abdominal pain or bloating
• A headache
• Difficulty swallowing
• Fatigue
• Acne or other skin problems.

Why does food intolerance happen?

The number of people who believe that they have an intolerance has risen in the last number of years. Some may assume that they have a food intolerance when their symptoms are actually unrelated – symptoms of food intolerance are very general and typical of many other conditions.

It is not clear why some are intolerant to particular foods. Some reactions may be to additives or chemicals in the food, such as MSG, histamines, artificial preservatives, or artificial flavouring. While intolerance can happen with any food, some of the most common foods that cause food intolerance are eggs, fish, milk, nuts, seafood, soy, gluten and some flours and yeasts.

What is the treatment?

When faced with any type of food intolerance, a doctor should be consulted to detect which food or foods cause those reactions. Testing can be carried out to help detect the problem, or your doctor may encourage you to keep a food diary to help pinpoint what is causing the intolerance. Treatment usually consists of following a diet in which the consumption of the substance or substances that causes the problem is avoided.

What are gallstones?

Gallstones are hard lumps or stones, usually made of cholesterol or sometimes other substances like bilirubin that form in the gallbladder.  

The gallbladder is a small organ situation underneath the liver which releases bile (produced by the liver but stored and concentrated in the gallbladder) into the digestive system to help the body breakdown fats into fatty acids for absorption.

What are the symptoms?

Gallstones don’t always produce symptoms and do not always need treating. In fact, the vast majority of people will not experience symptoms as the gallstones themselves do not cause pain.

In certain circumstances however, a gallstone might become trapped, causing intense pain known as biliary colic. The pain usually starts in the upper right part of the abdomen and radiates to the shoulder.

Further complications can arise whereby the gallbladder becomes inflamed - symptoms can include jaundice (a yellowing of the eyes and skin), fever, persistent pain, nausea and vomiting.

What causes gallstones?

The development of gallstones is thought to be due to too much cholesterol or bilirubin in the bile, leading to the formation of stones. In the majority of cases gallstones are made of cholesterol, however if the liver is producing too much bilirubin (often due to damage) this can result in the formation of stones also.

Improper emptying of the gallbladder is also thought to cause stones, as the bile becomes too concentrated.

How can gallstones be prevented?

Risk factors for the development of gallstones include being overweight, a lack of exercise, a diet containing too much cholesterol and fat that is also low in fibre, and rapid weight loss. It stands to reason therefore that maintaining a balanced diet and a healthy weight can help to prevent the development of gallstones.  Other risk factors for the disease include liver problems and diabetes.

What is the treatment?

Gallstones don’t always need treatment and in many cases the best option is to monitor them and only treat them if symptoms appear. If, however they are causing complications it might be necessary to treat them immediatley. Additionally, patients who have conditions which increase the risk of complications, such as portal hypertension (high blood pressure in the liver), cirrhosis of the liver or diabetes may need more urgent treatment.

In most cases, keyhole surgery is performed to remove the gallbladder, in an operation known as a cholecystectomy. Following the operation, patients can lead a normal life without the gallbladder as the liver will continue to produce bile. 

What is the gastric balloon?

A gastric balloon is a silicone device of a spherical shape that is introduced into the stomach of patients struggling with obesity. By doing so, patients do not feel the need to eat as much and feel full for longer. This can help such patients to lose weight. It is the most effective solution to fight obesity without the need for invasive surgery.

Why have a gastric balloon?

The gastric balloon is indicated for obese patients between 18 and 60 years old with a body mass index (BMI) of 30-40. The gastric balloon makes it easier for patients to maintain a diet aimed at losing weight and reducing food intake. It is important that those who choose to have a gastric band are committed to weight loss and having a healthier lifestyle for the long-term.

What does having a gastric balloon involve?

First there is an initial assessment in which the patient's clinical history is assessed, and a physical examination performed. The gastric balloon is introduced endoscopically and filled with serum to fill the balloon. By doing this, the filled balloon occupies a considerable portion of the stomach, causing a sensation of satiety in the patient and, as a result, the patient feels less hungry and fuller for longer after eating.

Preparation for the gastric balloon:

Before placing the gastric balloon, a post-procedure diet will be discussed with the specialist, as well as advice given on exercise. Before the balloon is inserted, the patient must fast for 6-12 hours.

Aftercare:

You can consume some liquids a few hours after the procedure. During the first few days of adaptation of the gastric balloon, a transition is made from a liquid diet to a solid diet, which is adjusted to each patient and situation. The balloon is usually removed six months after insertion and it is removed using an endoscope. Once withdrawn, the patient continues undergoing a multidisciplinary medical follow-up to consolidate the healthy dietary habits.

What is a gastric band?

Getting a gastric band is a type of bariatric surgery (weight loss surgery). Bariatric surgery aims to reduce the amount of food or calories the patient eats via operations on the upper digestive system (particularly the stomach), which physically and psychologically affect the patient’s approach to food.

A gastric band is a device placed around the upper part of the stomach, creating a small pouch at the top. As there is less space for food in this pouch, the patient gets full quicker when eating, and so eats less.

Why would you have a gastric band?

Gastric bands are principally used to treat obesity, and also can be used to treat type 2 diabetes, sleep apnoea and hypertension. The idea is to force the patient to eat less or reduce calorie intake, so it may be an option in treating any condition that is negatively affected by overeating. Surgical options for weight loss are usually not the first choice of treatment, as losing weight through exercise or dietary change carries minimal risk. However, if this doesn’t work, your doctor may discuss surgical options, such as installing a gastric band.

What does it involve?

The patient is given general anaesthetic to put them to sleep and prevent them from feeling pain during the surgery. Gastric bands are usually implanted using laparoscopy – a minimally invasive surgical technique utilising small incisions, through which a tiny camera is inserted to allow the surgeon to see inside the body. The surgery is then performed by inserting the instruments needed through these small incisions, rather than cutting the patient open.

The surgeon places the band around the stomach, creating a small pouch in the top half, with a narrow “bottle-neck” for food to drain into the larger lower section of the stomach.

The operation may only take half an hour to an hour if your surgeon is experienced with the procedure. Installing a gastric band doesn’t involve any cutting or stapling inside the body.

A small device connected to the band is placed under the skin (usually in the middle of the chest), which allows your doctor to tighten the band after the surgery is complete. This is usually done for the first time about four to six weeks after surgery. It is usually tightened a few times until the ideal tightness is found.

Is it safe to have a gastric band?

There are always certain risks when undergoing surgery, but as it doesn’t involve any cutting inside the body, and (when performed via laparoscopy) only small incisions are made on the outside, gastric band surgery is generally regarded as the safest surgical weight loss procedure, carrying less risk than a gastric bypass or a sleeve gastrectomy.

The other advantage is that gastric bands are removable, so if there are complications, the procedure can be reversed.

What is a gastric bypass?

Gastric bypass surgery is a type of bariatric surgery. Bariatric surgery aims to reduce the patient’s food and/or calorie intake via operations on the upper digestive system (particularly the stomach), which physically and psychologically affect the patient’s approach to food. A gastric bypass involves dividing the stomach into two “pouches”, and connecting the smaller top pouch directly to the small intestine, allowing food to “bypass” most of the stomach. This means that fewer calories are absorbed by the stomach, and due to the smaller space, the patient feels full quicker. As a consequence, they eat less.

Why would you have a gastric bypass?

Gastric bypasses are used to treat a variety of conditions which require the patient to eat less or reduce calorie intake. It is commonly used as a weight loss treatment for morbid obesity, although surgery is rarely the first option – major operations carry risks, and can be expensive, so trying to lose weight via exercise and dietary changes is usually the first port of call. If this doesn’t help you to lose weight, your doctor might discuss surgical options, such as a gastric bypass.

Other conditions that could warrant a gastric bypass include type 2 diabetes, sleep apnoea and hypertension.

Long-term mortality of gastric bypass patients has been shown to be reduced by 40%.

What does it involve?

The amount of food a patient can eat is limited by creating a small pouch in the upper stomach and dividing it from the rest of the stomach. This can either be done by creating a partition (which runs the risk of the stomach healing and returning to its pre-operative function) or by totally separating the two parts. The small intestine is reconstructed so that both parts of the stomach drain into it, rather than just from the bottom of the stomach.

The surgery is often laparoscopic, i.e. using small incisions to insert a small camera and specialised surgical equipment to perform the operation without cutting the patient open.

How long does it take to recover from gastric bypass surgery?

If the surgery is done laparoscopically, the patient may stay in the hospital for 2-3 days, and should be fully recovered in 3-5 weeks. Recovery time will be longer if open surgery is performed.

How much weight will you lose after a gastric bypass?

On average, following gastric bypass surgery patients lose 60% of their extra weight. 

Studies have shown it also significantly reduces the risk of impaired glucose tolerance (IGT) progressing to type 2 diabetes. 

What is gastrointestinal haemorrhage?

Gastrointestinal haemorrhage, otherwise known as GI bleeding, is bleeding that occurs in the digestive system. Bleeding that occurs in the oesophagus, stomach or small intestine is known as an upper gastrointestinal haemorrhage, whereas bleeding in the rest of the small intestine, colon, rectum or anus is known as a lower gastrointestinal haemorrhage. Bleeding can sometimes be life-threatening, and is related to an underlying disorder in the gastrointestinal system.

What are the symptoms of gastrointestinal haemorrhage?

Gastrointestinal haemorrhage can be detected with the presence of blood in the stool, although other symptoms may occur:

• tarry and dark stools
• large amounts of blood coming out of the rectum
• vomiting blood

What are the causes of gastrointestinal haemorrhage?

Gastrointestinal haemorrhage can be caused by a number of conditions, some of which are minor, such as:

• anal fissure
• anal fistula
• haemorrhoids

More serious or long-term conditions which can cause bleeding include:

• diverticulitis
• oesophageal varices
• Crohn’s disease
• oesophagitis
• gastric ulcer
• angiodysplasia

In some cases, bleeding can be a sign of a cancerous condition such as:

• colon cancer
• stomach cancer
• intestinal polyps

How is gastrointestinal haemorrhage diagnosed?

You should seek immediate medical advice if you have blood in your stool or have vomited blood. They will take a full medical history and will usually refer you for tests, including:

• blood tests
• stool samples
• endoscopy or colonoscopy to look inside your gastrointestinal tract
• imaging such as a CT scan

What is the treatment for gastrointestinal haemorrhage?

Gastrointestinal haemorrhage may require immediate primary attention. Emergency treatment may involve:

• blood transfusions
• intravenous fluids and medications.
• gastric lavage (placing a tube to the stomach to empty the contents)

Once the condition is stabilised and your blood levels have returned to normal, treatment will depend on the cause of the bleeding.

Endoscopy is a test used to diagnose or treat (therapeutic endoscopy) possible pathologies of the oesophagus, stomach and duodenum, the upper part of the digestive tract. The endoscope is inserted through the mouth and advanced to see the tract. As the test causes discomfort, it is common practice to slightly sedate the patient. The test lasts 15-30 minutes and is performed on an outpatient basis.

What is gastroscopy?

Gastroscopy is a clinical diagnostic test. Using a thin tube (an endoscope), the inside of the oesophagus, the stomach and the first part of the small intestine (the duodenum) can be visualised. The tube has a light and a camera on the end which sends images to a monitor during the investigation. Hence, a gastroscopy might be used to diagnose conditions related to the oesophagus, stomach and duodenum.

What does gastroscopy consist of?

Gastroscopy is performed with an endoscope, which is a thin flexible tube with a small camera at the end and, in some cases, light. This camera aims to obtain images of the inside of the oesophagus, stomach and duodenum. The procedure lasts around 15 minutes and the tube is inserted through the mouth and it is guided down the throat into the oesophagus and then stomach. The procedure is not painful, but a numbing spray may be used to numb the throat slightly before the tube is inserted.

Why is a gastroscopy done?

A gastroscopy would be done to look for abnormalities in the stomach and duodenum. You can obtain tissue samples for biopsies, remove polyps or determine the presence of some bacteria, such as the bacteria H pylori, which causes many peptic ulcers. During the gastroscopy procedure, bleeding ulcers can also be cauterised.

Preparation for gastroscopy:

In the weeks leading up to a gastroscopy, you may be instructed to stop taking certain medications. The stomach must be empty; you should avoid taking solid food from the previous night and you can only drink water. It is important, too, not to smoke before the test.

How does it feel during a gastroscopy?

The scan does not usually cause pain. However, it does cause a feeling of nausea that occurs when the tube is inserted through the throat, but a numbing spray can be used to make this less uncomfortable.

Gastroscopy risks:

Gastroscopy is very safe, but potential side effects could include mild abdominal pain. Other more serious side effects are, for example, the perforation of some organs, haemorrhages, infections and possible allergic reactions.

What is helicobacter pylori?

Helicobacter pylori is a bug or bacterium that causes stomach infections. The bacterium affects two thirds of the world's population. It grows in the mucous layer of the stomach by secreting urease, an enzyme that converts urea (an important chemical compound for metabolism) into ammonia. As a result, it neutralises the acidity of the stomach and creates an environment ideal for the growth of the pylori bacteria.

What are the symptoms?

H. pylori is characterised by the following symptoms:

• Abdominal pain
• Belching
• Nausea
• Loss of appetite and weight
• Passing gas
• Bloating and a feeling of fullness
• Dyspepsia or indigestion

Helicobacter pylori must be eradicated as soon as symptoms present to avoid further complications such as abdominal infection, peritonitis, haemorrhages or ulcers. The presence of H. pylori can also increase the risk of stomach cancer.

Causes of helicobacter pylori

This bacterium is transmitted through direct contact with an infected person. The infection can be passed on by:

• Stool to mouth (if after defecation the infected person does not wash their hands)
• Contaminated water
• Contact with animals

Can it be prevented?

To prevent H. pylori, good hygiene is important. Wash your hands thoroughly after going to the bathroom and eat in clean places where good hygiene protocol is followed.

What is the treatment?

The treatment for H. pylori includes:

• Antibiotics: to address or prevent infections
• Medications: to reduce the amount of acid produced in the stomach
• Surgery: in the case of the infection causing ulcers.

This disease describes the changes in the brain that happen after liver disease. A healthy liver filters toxins from the blood, but when it is damaged harmful toxins and chemicals can get to the brain causing an array of symptoms like confusion, sleepiness, anxiety, fatigue and in extreme cases seizure.

What is hepatology?

The word ‘hepatology’ comes from the Ancient Greek ‘hepar’ or ‘hepato’, meaning ‘liver’; and ‘ology’, referring to the study of a particular. Hepatology as a medical specialty concerns the study of the liver, gallbladder, pancreas, and biliary ducts, and the management of related disorders. Hepatologists may also be referred to as ‘liver specialists’.

What subspecialties are included under hepatology?

Over the years, hepatology has evolved from being considered as a subspecialty of gastroenterology, to a specialty within its own right. Gastroenterology focuses on the entire digestive system and related disorders, including study of the colon, anus, intestine, stomach, and liver, among other organs and functions, while hepatology focuses primarily on the liver.

Hepatology is a rapidly expanding field, thanks to further understanding of the ‘subspecialty’ itself, and medical advances in the treatment and study of the liver. As it has only recently gained understanding as its own separate specialty, there are few official offshoots from it as a whole, though paediatric hepatology is a notable area of study.

What conditions does a hepatologist treat?

Liver specialists treat conditions affecting the liver, in addition to the diagnosis and treatment of conditions affecting the biliary systems (e.g the pancreas, biliary ducts, and gallbladder). Some conditions a hepatologist would treat include:

• Alcohol damage to the liver
• Cirrhosis
• Liver disease
• Fatty liver disease
• Hepatitis
• Liver cancer
• Gallstones
• Pancreatitis

Hepatologists will also often monitor patients undergoing liver surgery, both pre-operation and post-operation. They may also refer patients for liver surgery if they deem it necessary.

When should I see a hepatologist?

You may be referred to see a hepatologist if you have an ongoing liver problem, such as alcohol damage, cirrhosis, fatty liver disease, or hepatitis. You also may be referred to a hepatologist if your GP decides you need a FibroScan, which is a special test used as an alternative to a liver biopsy. This is a test which can measure the level of hepatic fibrosis and the quantity of liver fat. FibroScan is non-invasive, meaning the amount of damage to the liver is assessed without any samples being removed.

This condition (also known as HRS) occurs when the liver is damaged by disease, restricting blood flow to the kidneys, which then begin to fail. One of the possible treatments for this is a kidney transplant.

A hiatal hernia occurs when a portion of the stomach ascends to the thorax, through an opening located in the diaphragm, the barrier that separates the thorax from the abdomen. When the stomach moves to the thorax, the aforementioned separation loses its function and a gastroesophageal reflux occurs, that is, the gastric contents return to the oesophagus and irritate it. Symptoms caused by this condition may be burning in the chest or throat, hoarseness, asthma or breathing problems. The symptoms worsen after eating, when sleeping or bending over. The treatment of hiatal hernia depends on its severity, and sometimes it does not require any type of therapy. In mild cases, the aim is to control the symptoms, which improve with changes in the diet and postural changes. In the most severe cases, an operation, usually performed with fundoplication technique (minimally invasive laparoscopy), may be chosen.

What is an incisional hernia?

An incisional hernia is a type of hernia where tissue protrudes through an incision made during previous surgery that hasn’t fully healed. It can occur as a complication from abdominal surgery and is more likely to occur following emergency surgery. The herniated tissue may be part of the intestine, part of another organ in the abdomen, or other abdominal tissue.

What are the symptoms of an incisional hernia?

Although hernias can appear unsightly, often they won’t produce any problems. However, if they become larger, they can become problematic, increasing the risk of complications such as strangulation to the affected tissue.

The main symptom is a lump or bulge in the abdomen close to the site of the surgical incision. Pain is also common, which is often worse while upright and relieved when lying down. Another risk of having an incisional hernia is bowel obstruction in which can result in nausea and pain.

Typical symptoms of incisional hernias include:

• A lump or bulge protruding from the surgical incision
• Abdominal pain
• Constipation
• Nausea
• Fever

What causes an incisional hernia?

Incisional hernias occur following surgery. The surgical incision causes a weakness in the abdominal muscle, through which tissue can herniate if put under pressure. This pressure may be due to the patient engaging in physical activity too soon after the operation, gaining weight rapidly, or becoming pregnant.

What is the treatment for an incisional hernia?

Treatment for an incisional hernia is usually further surgery. This can be performed either as open surgery or laparoscopically. They hernia will be pushed back in and the weakened area of the abdominal wall will be strengthened, sometimes with mesh.

Dyspepsia or indigestion is a term that describes pain or discomfort in the upper abdomen, especially after having a meal. It is a very common problem that can be alleviated by taking antacids and stomach protectors. Sometimes it is related to stress, alcohol consumption, smoking, eating too much fat or eating too fast. Therefore, the discomfort can be reduced with healthy habits, both in diet and in daily routine. It is a benign problem, without major consequences, even if it is chronic, and it can appear and disappear intermittently over the years.

Inflammatory bowel disease (IBD) is used to refer to chronic diseases affecting the intestine. the most common are Crohn’s disease (CD) and ulcerative colitis (UC).

What is intestinal failure?

Intestinal failure occurs when a person’s intestines are unable to digest food properly and absorb fluids, electrolytes and nutrients essential for the body to function.

What are the symptoms of intestinal failure?

When the small intestine fails, the following symptoms can be experienced:

• Bloating
• Diarrhoea
• Fatigue
• Malabsorption of nutrients
• Foul smelling stools
• Poor appetite
• Weakness
• Weight loss
• Vomiting

How is intestinal failure diagnosed?

A range of diagnostic tests can help to diagnose the degree of intestinal failure. Tests may include one or more of the following:

• Abdominal computed tomography (CT) scan; using x-rays and special computer software, 2 and 3D images are created of your intestines to give a clear picture of the bowels, pancreas and other organs.
• Abdominal x-rays; simple x-rays of the abdomen can show any abnormalities
• Barium enema; involves using x-rays and a barium dye to examine the rectum, large intestine and small intestine 
• Blood test; a number of blood tests may be carried out, including a complete blood count, electrolyte and kidney function test to look for liver damage and albumin tests to look for nutritional deficiencies
• Colonoscopy; a small tube and camera are inserted into the rectum and travel to the lower part of the colon 
• Upper endoscopy; a small flexible tube and camera are passed through the mouth and oesophagus to examine the stomach for inflammation, ulcers and infection
• Gastroduodenal manometry; a small tube and camera are passed through the mouth and down the oesophagus to measure stomach and small intestine muscle strength
• Gastric emptying; advanced imaging techniques and tiny amounts of radioactive material are used to examine how food moves from the stomach into the small intestine after a meal
• Scintigraphic gastric accommodation; looks at the volume of content in the stomach after a meal
• Wireless capsule gastrointestinal monitoring system; a tiny pill is swallowed that has a monitoring system attached to look at intestinal activity

What causes intestinal failure?

The most common cause of intestinal failure is short bowel syndrome. This happens when people have had at least half of their intestines removed due to trauma or a condition such as Chron’s. The part of the intestine that is left isn’t capable of digesting all the nutrients that the body needs. Coeliac disease can also cause inflammation that leads to poor absorption of nutrients and can damage the intestines. 

Some people who undergo radiation for gastrointestinal cancer develop scar tissue which can cause intestinal damage that can lead to intestinal failure. Others are born with a malfunctioning small intestine.

Can intestinal failure be prevented?

Intestinal failure can’t be prevented but treatment can prevent further intestinal damage. If conditions like Chron’s and Celiac disease are caught early and managed, this can prevent further intestinal damage from an early stage. Following a healthy diet and lifestyle can also help.

How is intestinal failure treated?

Treatment will depend on the severity of the damage done to the intestines. Patients with very advanced intestinal failure must receive all or most of their nutrients with TPN, which stands for total parenteral nutrition, which provides liquid nutrition through a catheter inserted into a vein in the arm, groin, neck or chest. Patients on TPN can live for many years, but long-term use of TPN can result in complications in the future, such as liver disease and central venous catheter infections.

Other treatments offered include:

• Pain management: using certain pain medications, stress management techniques and alternative medicine to ease pain caused by intestinal damage 
• Motility care: this treats nerve-related pain in the digestive system, using nerve stimulation and medication
• Bowel rehabilitation: to help your body get the nutrients that it needs

What is iron deficiency?

Iron is an important mineral needed by the body, particularly for processes involving oxygen. The principal biological use of iron in humans is as a constituent of haemoglobin – the protein found in red blood cells that binds to oxygen. Haemoglobin enables the red blood cells to transport oxygen around the body and deliver it to the cells that need it. In short, iron is essential to keeping us alive.

Iron deficiency is when the body does not have enough iron, either because the need for iron has increased, or because the intake or absorption of iron has fallen. This shortage of iron means that the body can’t make as many red blood cells (anaemia), and, as a result, less oxygen can be carried by the blood. The ultimate consequence is that the rest of the cells in the body are running on a reduced amount of oxygen.

Iron deficiency anaemia is one of the most common forms of anaemia, and iron deficiency is also one of the most common nutritional deficiencies.

What are the symptoms of iron deficiency?

Most of the symptoms of iron deficiency are related to the associated anaemia. The shortage of iron means a shortage of oxygen reaching respiring cells, and this means the body can’t function at full capacity. Typical symptoms include:

• Fatigue
• Light-headedness/dizziness/headaches
• Weakness
• Pallor
• Irritability
• Shortness of breath
• Heart palpitations
• Brittle nails
• Hair loss
• Cold extremities

Iron deficiency can also affect memory and mental function, particularly in teens, while appetite may be affected in some patients (usually young children with iron deficiency anaemia).

Another strange symptom that has been reported in a number of cases is ‘pica’. This refers to unexplained cravings for strange foods or non-food items.

What causes iron deficiency?

There are several causes of iron deficiency. Most involve blood loss of some description. It is possible to develop iron deficiency simply through a lack of iron in the diet, but this is very unlikely unless the patient is pregnant. However, this will increase the risk of iron deficiency when coupled with one of the following other causes:

• Malabsorption – if your body struggles to absorb iron from food (for example caused by coeliac disease), this will lead to iron deficiency.
• Monthly periods – the most common cause of iron deficiency in women of reproductive age. Usually, only heavy periods will lead to iron deficiency/anaemia.
• Pregnancy – extra iron is needed to supply the growing baby with blood and oxygen, meaning that pregnant women often have to up their iron intake.
• Bleeding in the G-I tract – the most common cause of iron deficiency in men and post-menopausal women, this can be caused by:

• Stomach ulcers
• Stomach cancer
• Taking NSAIDs (Non-steroidal anti-inflammatory drugs) can cause bleeding in the stomach.
• Bowel cancer
• Angiodysplasia

• Chronic kidney disease
• Inflammatory bowel disease

• Crohn’s disease
• Ulcerative colitis

Any other condition or incident that causes blood loss could lead to iron deficiency, even if only temporarily, for example, after giving blood, or losing blood due to trauma.

What is the treatment for iron deficiency?

Treatment usually involves taking iron supplements and/or eating more iron-rich foods, such as red meat, fish, dark green leafy vegetables, beans, pulses, brown rice and eggs. However, in some cases this will not be enough, and the underlying cause will have to also be addressed. It is important for the doctor to monitor the patient, taking more blood tests after a few weeks to see if haemoglobin levels are returning to normal levels.

What is irritable bowel syndrome?

Irritable bowel syndrome (IBS) is a functional disorder of the large intestine.

What are the symptoms?

IBS is characterised by abnormal movements in the muscles of the intestine, which cause discomfort and abnormal function, as well as constipation and diarrhoea alternately. IBS can also provoke abdominal pain, gas, bloating and changes in bowel habits.

Causes of irritable bowel syndrome

Irritable bowel syndrome is usually associated with stress-related problems, although it has been shown that stress does not provoke it, but rather increases its effects. The exact causes of IBS are not clear, although it may occur after an intestinal infection.

This condition is often confused with inflammatory bowel disease (IBD) which, unlike IBS, is caused by the abnormal structure of the colon.

Can it be prevented?

IBS is different in everyone and while the condition itself cannot truly be prevented, it can be avoided after diagnosis through certain lifestyle changes and management of the symptoms. For example, if you have IBS, it is not recommended to skip meals or eat later than you usually do, in addition to not rushing meals or eating too quickly. Avoiding spicy foods or ‘trigger’ foods can also help to keep IBS at bay. Many people with IBS prefer to cook their own meals as it means they can fully control what they are eating, thus avoiding triggers.  

What is the treatment?

For the diagnosis of irritable bowel syndrome, there is no specific test, but it is necessary for the doctor to rule out other conditions in which symptoms are similar. Therefore your doctor may arrange for blood tests or stool samples to be taken to make sure the right diagnosis is given.

Although there is no cure for IBS once diagnosed, as it is a chronic condition, certain measures can help to alleviate the symptoms:

• Try to find ways to help you relax
• Get plenty of exercise
• Keep a food diary to help you monitor triggers
• Eat foods which are easier for you to digest
• Use over-the-counter medication to control symptoms such as cramp and diarrhoea

What is lactose intolerance?

Lactose intolerance is a food intolerance that occurs after the ingestion of lactose. Lactose is a sugar that’s found in milk. To diagnose this intolerance, three medical tests can be performed; a lactose tolerance test, lactose-hydrogen breath test and a faecal pH test.

What are the symptoms of lactose intolerance?

Symptoms usually occur between 30 minutes and two hours after the ingestion of products with lactose. The most frequent symptoms include:

• Abdominal pain
• Nausea
• Bloating and abdominal distension
• Muscle spasms
• Diarrhoea
• Abdominal gas and flatulence
• Floating stools
• Redness of the perianal area
• Vomiting

Other possible symptoms include:

• Tiredness
• Skin problems
• Painful limbs
• Nervousness
• Inability to concentrate
• Sleeping problems

What causes lactose intolerance?

To digest lactose, the body needs an enzyme called lactase. Lactose intolerance occurs when the small intestine does not produce a sufficient amount of lactase to break down lactose, causing symptoms like those mentioned above.

Can lactose intolerance be prevented?

There is no way to prevent lactose intolerance, however, one can avoid consuming products with lactose or consume products that are lactose-free, such as lactose-free milk and cheese. Some people can still tolerate small amounts of lactose, however, if it is recommended to cut out lactose completely, the nutrients found in milk like calcium and vitamin D can be substituted with:

• Almonds
• Tofu
• Beans
• Kale
• Soy milk
• Egg yolks
• Fatty fish like salmon

What is the treatment?

The only treatment for lactose intolerance is to reduce or avoid its intake. You can also take lactase enzyme supplements to help your body to break down lactose.

What is a lactose intolerance test?

A lactose intolerance test measures the ability of the intestines to break down a type of sugar, known as lactose, found in milk and other dairy products, when it is suspected that the substance is not well digested and causes discomfort.

What does it consist of?

There are two types of lactose intolerance tests: a blood test to detect the presence of blood glucose before and after having ingested a substance containing lactose, and the hydrogen breath test, before and after ingesting food containing lactose.

In the breath test, you must blow into a special container and fill it with air. The breath sample is then tested to see how much hydrogen is present. Before the test, you will not be able to eat or drink anything for several hours (you should not eat or drink the night before the test or on the morning of). After the first sample is taken, you will be given a solution containing lactose and asked to drink it. Your breath is then measured every 15 minutes afterwards. Depending on the results obtained in each phase, the test can go on for several hours. Subsequently, the hydrogen of the bags or breath vessels will be analysed to obtain a detailed diagnosis.

Why is it done?

This test is done to find out if you have any signs of lactose intolerance.

Preparation for the lactose intolerance test

You should avoid eating any food or performing any physical exercise for 8 hours before undergoing the test.

How does it feel during the exam?

This test does not cause any pain or discomfort. If a blood sample is taken, then the needle may prick a little, but it should not be painful.

Risks of the lactose intolerance test

This test does not carry any significant risk.

What is the liver?

The liver is one of the vital organs, which sits on the right side of the abdomen. The liver is the largest internal organ in the body. It is also a gland, which means it synthesises substances to then release them in the bloodstream. Glands have different functions in the body, and the liver has many, performing over an estimated 500 different functions.

What does the liver do?

The liver’s main function is to filter the blood which comes through to it from the digestive tract, then pass it around the rest of the body, filtering toxins and making chemicals safe or metabolising them. The liver plays an important part in nutrition, metabolism, hormone production, and functions of the blood. It is an essential organ in the body, and if a significant amount of liver tissue is damaged, it can cause problems such as liver disease.

What happens when the liver is not functioning properly?

If the liver does not function as it should, different symptoms can appear, such as jaundice (when the skin looks yellow in colour), pain in the abdomen where the liver is located, bruising easily, swelling in the abdomen, nausea or vomiting, sleepiness or perhaps slurred speech, and general fatigue or feeling unwell. Depending on the condition, different symptoms present, and a liver function test may be necessary to determine the cause.

Conditions which can affect the liver include:

• Hepatitis, both viral and non-viral.
• Scarring on the liver, otherwise known as cirrhosis.
• Liver failure, where the liver fails to function as it should. There are different stages of liver failure, known as chronic and acute. Chronic liver failure occurs over months or years, whereas acute liver failure comes on suddenly and rapidly.
• Liver cancer
• Fatty liver disease

There are many more conditions which affect the liver, which can be diagnosed by a GP or healthcare provider, and if necessary treated by a specialist, such as a gastroenterologist, or a hepatologist, a doctor specialising in the liver and its related functions. 

What is a liver biopsy?

A liver biopsy is a procedure that is performed to remove a portion of the liver, which will be examined under a microscope to check for signs of damage or disease. There are three main types of biopsy: laparoscopic, percutaneous, and transvenous.

• Percutaneous liver biopsy: this is the most commonly-used technique for obtaining a liver sample. It involves making an incision in the abdomen to insert a needle into the liver to take a sample. Ultrasound, CT scans, and other imaging techniques are often used to locate the liver. Some specialists do not use imaging techniques but locate the liver by palpating the abdomen. Once the biopsy is complete, you will have to lie on your left side for up to two hours to reduce the risk of bleeding. 
   
• Transvenous liver biopsy: this technique is used if your blood coagulates slowly or if there is excess fluid in the abdomen, a condition known as ascites. With a transvenous biopsy, you lie face up on an x-ray table. A small incision is made in your neck and a tube is inserted into the jugular vein. A contrast dye is then injected to be able to view the veins. This fluid illuminates when x-rays are used. A needle is then inserted through the tube and samples of liver tissue are removed. You will be monitored for at least four to five hours to avoid the risk of bleeding. 
   
• Laparoscopic liver biopsy: this type of biopsy is used to obtain a tissue sample from one or more specific areas of the liver, or if there is a risk of infection or cancer spreading. During the test, you will lie on your back and be given a sedative. With laparoscopy, an incision is made in the abdomen, under the rib cage. A tube called a cannula is then inserted and inflated with a gas to give the doctor more space for working in the abdominal cavity. The biopsy needle is inserted through the cannula. Any bleeding can be easily detected with the camera and is stemmed using electric probes. You will be monitored for several hours after the procedure.

The liver is a vital organ that has several basic functions, such as:

• Removing harmful products from the blood
• Fighting infection
• Helping in the digestive process
• Storing energy
• Storing nutrients.

Why is a liver biopsy performed?

A liver biopsy is performed when it is difficult to diagnose a possible liver problem with blood tests or by using ultrasound or x-rays.

A biopsy is often performed to assess the degree of liver damage, a process known as staging. Staging helps guide treatment, and the biopsy helps to diagnose or detect:

• Liver cancer
• Infection
• Cause of abnormal liver enzyme levels detected in the blood
• Cause of unexplained thickening of the liver.

Preparing for liver biopsy

The specialist should be fully informed about any medication you are taking, and you may even be asked to stop taking any medication that affects blood clotting or interacts with sedatives.

Some medications that may not be permitted both before or after a liver biopsy are nonsteroidal anti-inflammatory drugs, anticoagulants, antidepressants, antibiotics, dietary supplements and high blood pressure, diabetes and asthma medications.

You must not eat or drink for at least eight hours before the biopsy, and should plan how you will get home, since you must not drive for at least twelve hours after the procedure. Before the procedure, you will need to have a full blood test to check, among other things, your ability to clot blood.

What do you feel during a liver biopsy?

The moment the needle is inserted to sedate you, you will feel a brief, sharp pain. You might feel a deep pain when the biopsy needle is inserted, which sometimes manifests itself in the shoulder.

Sedation helps you to remain calm during the process. Sedation is different to anaesthesia; you are unconscious under anaesthetic, but with sedation you can communicate with the medical team, though you generally won’t remember the procedure afterwards.

Meaning of abnormal results

There are two outcomes from a liver biopsy: either the results are completely normal, which means that the liver tissue is normal, or the liver biopsy reveals the presence of a liver disease, such as hepatitis or cirrhosis, or the presence of cancer cells or infections such as tuberculosis.

Some of the problems that can be detected through a liver biopsy are:

• Hepatitis
• Haemochromatosis
• Hepatocellular carcinoma
• Hodgkin's lymphoma
• Primary biliary cholangitis
• Cirrhosis
• Fatty liver
• Liver cancer.

Advances in liver biopsy

The use and advancement of technology has led to a series of changes in general medicine and in the liver biopsy procedure. Major progress has been made in imaging techniques, which are sometimes sufficient to determine the state of the liver.

Another advancement is FibroScan, which measures the speed at which elastic waves are propagated through the liver; this helps to assess the health of the liver.

Liver cancer is a form of cancer that starts in the liver, as opposed to secondary liver cancer which starts elsewhere in the body and travels to the liver. Most cancer that is found in the liver is secondary cancer, as many cells travelling around the body end up in the liver, making it more susceptible to liver cancer. If the cancer is a secondary cancer in the liver, it will be treated in the same way that the primary cancer would be treated, such as if it is secondary breast cancer in the liver, the cancer will be treated in the same way as breast cancer, as the cells are the same, only they have travelled to the liver.

Types of liver cancer

There are a number of different types of cancer that start in the liver. These include:

• Primary and secondary liver cancer

  
  As previously highlighted, the liver is vulnerable to primary liver cancer, which means the cancer begins in the liver, or secondary liver cancer, meaning the cancer cells travelled to the liver through the blood stream from another cancerous part of the body. Cancer is treated according the primary type it is, so even if the cancer is present in the liver, in cases of secondary cancer it will be treated in the same way the primary cancer is treated. Most cancers found in the liver are secondary cancer.

• Hepatocellular carcinoma (HCC)

  
  Otherwise known as hepatoma, HCC is the most common form of primary liver cancer. The cancer forms in the liver cells, called hepatocytes, and is more common in older men, especially those who have suffered with cirrhosis.

• Fibrolamellar carcinoma

  
  This form of liver cancer is a rare form of HCC, and affects the fibrous tissue of the liver cells. Fibrolemellar is more common in younger people, and is not linked to cirrhosis or hepatitis.

• Cholangiocarcinoma (bile duct cancer)

  
  Rather than directly affecting the liver, cholangiocarcinoma develops in the bile ducts, which carry bile from the liver to the stomach.

• Angiosarcoma

  
  This is a very rare form of liver cancer, and begins in the blood vessels of the liver. It affects men and women, most often aged in their 70s and 80s, and only affects around 10 people per year in the UK.

• Hepatoblastoma

  
  This is another very rare form of liver cancer, which usually affects young children below the age of three. There are usually only around 20 cases of hepatoblastoma per year in the UK.

Symptoms of liver cancer

The usual symptoms of liver cancer include:

• weight loss
• swelling of the abdomen
• jaundice
• pale-coloured or grey poo
• dark urine
• itchy skin
• high temperature
• worsening of health in patients with cirrhosis or chronic hepatitis.

Treatment of liver cancer

There are a number of different treatment options available for liver cancer, depending on the type of liver cancer it is.

The most common type is surgery, with removal of the tumour attempted at first. Liver function may be able to continue as normal if the liver was healthy to begin with.

Liver transplant may also be required if the cancer has developed in a large amount of the liver. The specialist may decide to use localised treatments such as chemotherapy, radiofrequency ablation, cryoablation, radiation therapy or drug therapy.

To make an appointment with a specialist regarding liver cancer, click here.

A hepatic cyst is a cyst on the liver. It may be benign or malignant. Often there are no symptoms, but they can be discovered when a scan is performed on the liver. There are different types of hepatic cysts.

What are liver diseases?          

The liver is one of the biggest and most important organs. It plays a central role in metabolic processes such as keeping the body clean and breaking down nutrients, turning them into energy, while clearing toxins. 

Hepatic diseases are those which affect the liver and don’t allow it to do its job.        

There are different things that can affect the liver, such as viruses, genetic alterations, excess fat, or excessive alcohol consumption, as well as hepatocellular carcinoma, the primary liver cancer.

The most common liver diseases are hepatitis A, B, or C, cirrhosis, hepatocellular carcinoma, jaundice, fatty liver, and haemochromatosis.                

Disease prognosis

The main thing to note about liver diseases is that the liver is quite a resilient organ which can recover from smaller ailments and even function with only part of it being healthy.

It is a serious issue as until there is liver failure it is often not known that there is an issue with the organ, which is why until there is something serious like liver cancer, problems quite often go completely unnoticed.    

Hepatitis or other types of liver inflammation account for up to 80% of primary liver cancers. This is why hepatocellular cancer is a serious problem, and it is the third leading cause of death from cancer worldwide.  

What are the symptoms?  

Symptoms don’t tend to appear until the liver is quite damaged, and the most common ones are:    

• Nausea and dizziness, which can lead to vomiting
• Intense abdominal pain
• Jaundice, which is yellowing of the skin due to high levels of bilirubin in the blood
• Itchy skin
• Fatigue
• Bruising and bleeding easily  

Tests for liver diseases

Liver diseases don’t tend to have symptoms, and the patient quite often only finds out that they have a problem when they are having tests for something else. Some of the tests used to detect and diagnose liver issues include.    

• Liver biopsy: a small needle is used to get a small sample of tissue to check for potential diseases.     
• CT scan: three dimensional imaging of the liver, to check for anomalies.
• Endoscopic retrograde cholangiopancreatography: is a technique that combines the use of endoscopy and fluoroscopy to check for any bile duct obstructions.   
• Ultrasound: to check the liver.
• Blood tests: are used to measure different substances in the blood.

What causes liver diseases?

There are different risk factors that increase the risk of developing liver disease, some include:

• Excessive alcohol consumption
• Injecting drugs
• Blood transfusion prior to 1992
• Tattoos and piercings done in unregulated places
• Diabetes
• Obesity
• Prolonged exposure to chemical products

Liver diseases can have different causes, such as infections, viruses, or parasites, as well as immune system anomalies, genetic problems, or substance abuse, among others.  

How can they be prevented?   

There are many recommendations to prevent liver disease, including:

• Drinking alcohol in moderation     
• Being vaccinated
• Being prudent with medications and avoid mixing them with alcohol   
• Avoiding other people’s bodily fluids
• Protecting skin           
• Avoiding obesity         

What is the treatment? 

Surgical resection: is carried out on patients with single, asymptomatic tumours and who have good liver function.   

Liver transplant: in many cases this is the only option for patients with advanced liver disease.   

Ablation: heat is applied to the tissue.        

Chemoembolisation: is recommended for symptomatic patients who have unresectable carcinoma and who have a tumour that is too big to be treated with radiofrequency. 

Certain liver diseases are treated in particular ways:

Liver cancer: can be treated in different ways, depending on the tumour and the patient’s health.  

Cirrhosis: there is no cure for cirrhosis, however there are certain steps that can be taken to slow and relieve symptoms such as; stop drinking alcohol, limit medication intake, and follow a balanced diet with fruits, vegetables, and cereals.

Hepatitis: There isn’t a specific treatment for hepatitis A, and it will normally pass on its own within a couple of months, patients are recommended to eat less fats, avoid alcohol consumption, and rest. The recommendations for hepatitis B are similar to that of A, but there are also some medications that can keep the virus under control for many years. Treatment for hepatitis C tends to be a course of medication for between 30 to 48 weeks.   

Fatty liver: in cases of non-alcoholic fatty liver the patient is recommended to lose weight and ensure they have a balanced diet. If it is caused by medications, you should stop taking the medication. For alcohol-related liver disease, you are advised to stop drinking alcohol.  

What specialist should I see?

Gastroenterologists and hepatologists (who specialise in the liver and conditions affecting it) can treat liver disease, although internal medicine specialists can also be consulted.

What is a liver function test?

Liver functions tests help diagnose and monitor liver disease by testing the blood. The tests measure the level of certain proteins and enzymes in the blood. Certain enzymes are released by the liver when it is damaged or diseased, and therefore it is helpful to measure these as an indicator. The same can be said for measuring proteins, such as bilirubin, which is a blood waste product that is usually cleared by a functioning liver.

What does a liver function test involve?

If your doctors recommends a liver function test, it is more than likely that a series of tests will be run which measure for different enzymes and proteins. During a liver function test, a sample of blood is taken through a small needle into a tube. The needle usually draws blood from the bend of your arm. Once a blood samples has been obtained, it will be sent to a laboratory for analysis, which can take either a few hours or a few days depending on whether the laboratory is located on-site or not. 

What is a liver function test for?

Typically, a liver function test is used to:

• Determine the severity of a disease, such as cirrhosis (scarring of the liver)
• Screen for liver infections (e.g. hepatitis)
• Measure the progression of liver disease, such as hepatitis, and to see how successful treatment is
• Check for any side effects to medications

If you are experiencing the following symptoms, a liver function test will be carried out to help determine a diagnosis:

• Yellow eyes or skin (jaundice)
• Fatigue 
• Nausea
• Little appetite
• Dark urine and light-coloured stool

How can you prepare for a liver function test?

Before a liver function test food and drink has to be avoided for a certain period as these can affect the results. Certain medications will also have to be avoided before a liver function test. 

What would a “bad” result mean?

Normal results differ for men, women and children. When you receive your results, your numbers will display next to the normal, healthy range. If your results are not normal, further tests will be carried out to aid a diagnosis, or treatment plan. Ultimately, your specialist will explain your results and when the next steps will be. 

What is liver surgery?

The liver is the organ that is responsible for:

• Producing bile which helps the body to absorb fats and cholesterol.
• Removing toxins and bacteria from the blood.
• Processing hormones, nutrients and medication.
• Fighting infection

Liver surgery is the group of surgical procedures used to treat various liver problems, such as:

• Cirrhosis
• Liver cancer
• Hepatitis B and C
• Alcohol-related liver disease (ARLD)

The main type of liver surgery is called a hepatectomy which involves the removal of part or all of the liver. This procedure is also known as a liver resection. If the whole liver is removed, then it is replaced with a healthy one – this is known as a liver transplant.

Why would you have liver surgery?

You would require a liver resection or transplant if your liver was partially damaged, or it can no longer perform its normal functions. Other treatment options would have been tried already, as surgery is needed when the underlying condition for liver problems can no longer be controlled non-surgically.

If just part of your liver is damaged, for example because of cancer, then just part of the liver can be removed surgically, leaving the healthy part of the liver intact.

If the patient suffers from liver failure, then a transplant is required, and without one long-term survival is not possible, as unlike other organs such as the kidneys, there is no machine or device (a dialysis machine) that can replicate the functions of what the liver does.

What does it involve?

A partial liver resection is performed under general anaesthetic and can take between two to five hours. This procedure is mostly carried out to treat either liver cancer or colorectal cancer. It is often performed alongside other treatments such as chemotherapy or radiation therapy. A resection can only be carried out if there are no major blood vessels compromised in the section that needs to be removed. Providing you do not suffer from other liver problems, such as cirrhosis, then the liver can recover and grow back.

A liver transplant involves the removal of the whole liver. The replacement liver must come from a donor that has a liver that is a close match to one’s own and come either from a deceased donor, or from a living donor (in which case the living donor has a section of their liver surgically removed and it is this section that is used to treat the transplant patient).

How to prepare for it

If you require a liver transplant, it involves being placed on a waiting list, as there are more in need of a liver transplant than there are livers available. The waiting list is ordered in terms of priority. Most people on the waiting list are able to stay at home until a viable liver becomes available. When preparing for a liver transplant or resection it is important to be as healthy as possible, adopting a balanced diet, taking regular exercise and not drinking or smoking. It is important to be prepared at short notice for surgery.

Post-operative care

After a live transplant, there will be some time spent in an intensive care unit (ICU), where a ventilator machine will help you breathe. A stomach entering your nose and stomach will provide fluid and nutrients which are removed after a few days. Painkillers will also be administered. You can expect to leave the hospital after two weeks, after which you return home, but have regular check-ups to ensure the body is not rejecting the new liver.

After a liver resection, patients are generally well enough to leave the hospital within two weeks of the procedure, and recovery time depends on how much of your liver was removed, but does take a number of months.

Neuroendocrine tumours (NETs) are a rare form of tumours that appear in the cells of the endocrine cell system. They can be cancerous (malignant) or non-cancerous (benign). There are different types of NET, and the symptoms range from breathing difficulty, digestive disorders or hormone imbalances.

What is it?

Nutrition and dietetics is a medical field studying the characteristics and qualities of food, assessing how nutrients are assimilated by the body and diagnosing their nutritional state. This field also studies how to prevent and treat several conditions associated with your diet and nutrition. Nutrition and dietetics specialists can prescribe the best diet for you based on your individual needs and characteristics.

What conditions does it treat?

Nutrition and dietetics treats all conditions associated with one’s diet and assimilation of nutrients. Some of these involve metabolic disorders and weight management: preventing obesity and being overweight with all associated conditions, as well as eating disorders, by planning a healthy diet. In case you suffer from cardiac or other conditions, your nutritionist will make sure you have the right diet for you and will refer you to the best specialist to treat any condition you may be suffering from.

What are the sub-specialisations of nutrition and dietetics?

Nutrition and dietetics studies foods and their impact on your health, assessing what could be the best diet for your needs. It is associated with other subspecialties, such as endocrinology, but there is no subspecialty for nutrition and dietetics as of yet.

When do I need to see a nutritionist?

You’ll need to see a nutritionist or a dietitian if you need to check up on your diet. If you’re thinking of going on a diet for health or aesthetics reasons, you should talk to a nutritionist to make sure you get the best possible results while not neglecting any major nutrients you need. You should also see a nutritionist if you suspect you may have a metabolic disorder. If you want to radically change your diet, for instance by becoming a vegetarian or a vegan, you should make sure to schedule a follow-up with your nutritionist to monitor your health.

Obesity is defined as having an abnormal or excessive accumulation of fat on the body, enough so that it can be a risk to the health of the person.

There most common way of classifying the amount of weight on the body, and what constitutes as a healthy balance, is the body mass index (BMI), which is calculated by dividing your weight in kilograms, by your height, squared. The NHS classifies obesity as having a body mass index of 30 to 39.9, with those over 40 being classified as severely obese, though it is not necessarily the case as those with a large amount of muscle could be classified as obese due to their weight, when it may not actually be accurate. Another way of measuring excess fat is to measure waist circumference, for men, obesity is generally considered as being larger than 94cm (37in), and 80cm (21.5in) for women.

What causes obesity?

Simply speaking, obesity is caused by consuming more calories than are burned off through physical activity. When food is consumed, especially excessive amounts of fat and sugar in the diet, the body stores it as energy, in the form of fat.

There are some health conditions that can lead to obesity and weight gain, such as problems with the thyroid, especially hypothyroidism.

How is obesity treated?

The best ways of treating obesity is to increase the amount of physical activity you perform on a regular basis, and to reduce the amount of calories eaten, along with eating a healthy, balanced diet.

There are a number of ways that you can do this, such as joining a weight loss group to help you manage your diet and motivate you to continue sticking to it. You can also start activities such as walking, swimming or running. You can begin with exercising for short periods of time, before building up to longer periods. There are a number of surgical procedures available to help deal with weight loss in more severe circumstances, such as gastric band, gastric bypass, and biliopancreatic diversion.

What problems can obesity lead to?

Obesity can be detrimental to the health, leading to problems in different areas of the body. It can cause strain on the heart, leading to coronary artery disease, high blood pressure, high cholesterol, and other conditions. It is one of the leading causes of diabetes type 2, polycystic ovarian syndrome (PCOS), and infertility and can also have detrimental psychiatric effects such as depression along side often having a social stigma.

To see a specialist to help with obesity, click here.

Obesity is one of the most common diseases of modern society, caused by bad eating habits that cause a metabolic disorder in the form of excess fat and consequently overweight. If the caloric intake that provides the body is greater than that required or consumed is stored as fat. Besides, obesity may result in the acquisition of other diseases, such as diabetes mellitus, hypertension, high cholesterol or cardiovascular risk. In any case, obesity treatment tailored to each person according to their age, physique, medical history and daily habits is required. By measuring the body mass index patient's degree of obesity it is known and established a slimming diet should be low calorie, low fat, with the establishment of a rehabilitation plan of eating habits and exercise. The tandem diet-exercise physical is essential for weight loss.

Obesity is one of the most common diseases of modern society, caused by bad eating habits that cause a metabolic disorder in the form of excess fat and consequently overweight. If the caloric intake that provides the body is greater than that required or consumed is stored as fat. Besides, obesity may result in the acquisition of other diseases, such as diabetes mellitus, hypertension, high cholesterol or cardiovascular risk. In any case, obesity treatment tailored to each person according to their age, physique, medical history and daily habits is required. By measuring the body mass index patient's degree of obesity it is known and established a slimming diet should be low calorie, low fat, with the establishment of a rehabilitation plan of eating habits and exercise. The tandem diet-exercise physical is essential for weight loss.

What is oesophageal manometry?

Manometry is a diagnostic procedure used to determine the function of the lower oesophageal sphincter. This is the valve that stops gastric acid from flowing up into the oesophagus. This is performed to diagnose problems with this stage of the digestion process.

What does it involve?

This test involves introducing into the nose a thin probe (2 to 3 mm in diameter) with pressure sensors in it. The probe may have a deflated balloon at the end, which is inflated by means of motion-sensitive receptors once the probe is in the desired position. The device is connected to a computer which records the detected activity. You will normally be seated for the test, but may have to lie down for part of it so that the gastroenterologist can check the pressure in various positions.

The test takes from 15 minutes to an hour. When the tube is removed from the oesophagus through the nose, the gastroenterologist may ask you to swallow so that they can see the muscular contractions of the oesophagus.

The oesophageal sphincter is a determining factor in the cause of gastroesophageal reflux and its activity is analysed during oesophageal manometry

Why is it performed?

Oesophageal manometry is performed to observe the functioning of the oesophagus and the stomach. It records the movements of the oesophagus and oesophageal sphincter in order to check their function if you have problems swallowing or have chest pain, which is the most common reason for this test. It is also currently used to measure and detect complications arising from a lack of pressure or excessive pressure in the colon (anorectal manometry) or urethra (urinary manometry).

An oesophageal manometry can be used to diagnose the following conditions:

• Achalasia – causes difficulty swallowing, with food regurgitation being common.
• Scleroderma – muscles in the oesophagus can stop moving, causing severe reflux.

It will also be used if you suffer from:

• Reflux
• Heartburn
• Difficulty or pain when swallowing
• Chest pain

Preparing for oesophageal manometry

You should not eat or drink anything for up to eight hours before the test, and the last meal you have should be light. You must also inform the specialist about any medication you are taking, as it might interfere with the test results.

What do you feel during the test?

With oesophageal manometry, it is quite common to experience some discomfort or nausea when the tube is passed through the nose and throat. The use of topical anaesthetics is optional for people who are unable to tolerate the discomfort. You can go back to normal activities straight after the test.

Meaning of abnormal results

Abnormal results from the test may indicate a problem with the oesophageal sphincter. The main pathologies detected are:

• Gastroesophageal reflux: the oesophageal sphincter is not functioning properly. It does not act as a valve to prevent food and stomach contents from rising up into the oesophagus, irritating it and causing heartburn
• Achalasia: due to damage to the nerves of the oesophagus, the oesophageal sphincter muscle does not relax enough to allow food to pass properly from the oesophagus to the stomach.
• Oesophageal spasms: these are contractions of the muscles of the oesophageal walls that are uncoordinated, thus preventing food from reaching the stomach.

What are oesophageal varices?

Oesophageal varices are abnormally dilated veins in the lower part of the oesophagus, through which blood flows that would normally pass through the liver. The veins are dilated as a result of blood flow restriction due to a diseased liver.

The main problem with these varices is the risk of rupture , which occurs when the pressure inside the veins is greater than the resistance of their walls, causing major haemorrhages that, in some cases, can be fatal.

Prognosis of oesophageal varices:

Oesophageal varices are a serious problem since bleeding cannot always be prevented, and can potentially be fatal. People who have already suffered a haemorrhage are much more likely to suffer another episode of bleeding. It should also be noted that up to one in three recurrences prove fatal. Oesophageal varices are associated with other types of disorders such as renal, cardiovascular, immune or respiratory disorders.

Symptoms of oesophageal varices:

Oesophageal varices do not cause any symptoms, and in many cases there are no symptoms at all, apart from bleeding. The symptoms of bleeding oesophageal varices are as follows:

• Vomiting
• Vomiting accompanied by a large amount of blood
• The sensation of feeling stunned
• Black stools
• In severe cases, a loss of consciousness may occur.

The specialist may suspect the presence of oesophageal varices if there are symptoms of liver disease, such as a yellowish colouring of the skin and the ‘whites’ of the eyes, which is known as jaundice; a tendency to bleeding, and the formation of haematomas and accumulation of tissue in the abdomen.

Medical tests for oesophageal varices:

The main medical tests for detecting or diagnosing oesophageal varices are:

• Endoscope examination: an endoscope is used to look for signs of bleeding, such as dilated veins, red patches or spots.
• Diagnostic imaging tests: these are scans using computerised tomography (CT) and ultrasound.
• Capsule endoscopy: this involves swallowing a capsule containing a micro camera that takes images of the oesophagus as it passes down the digestive tract.

What causes oesophageal varices?

Oesophageal varices sometimes develop when the flow of blood to the liver is obstructed, often by scar tissue in the liver caused by liver disease. This increases the pressure of blood flow in the vein that carries blood to the liver.

This pressure forces the blood to look for other places to flow, through smaller veins, and swells these veins because of the extra amount of blood, which can sometimes give way and rupture.

Some causes are:

• Acute liver scarring, or cirrhosis: some liver diseases can cause cirrhosis, such as hepatitis infections, alcoholic cirrhosis, fatty liver, etc.
• Blood clots, or thrombosis: a blood clot can cause the formation of oesophageal varices
• Parasites: schistosomiasis is a parasitic infection that can damage the liver, lungs, intestine, and bladder.

Can oesophageal varices be prevented?

To date, there is no specific treatment to prevent the onset of this disease in people with liver disease, although beta-blockers have been proven effective in preventing bleeding associated with oesophageal varices, although they do not prevent the formation of them as such.

Some ways to maintain a healthy liver and liver function include:

• Avoiding excessive alcohol consumption
• Maintaining a healthy, balanced diet
• Maintaining a healthy weight
• Reducing the risk of getting sick from hepatitis
• Using chemicals (domestic or at work) with moderation and caution.

Treatment for oesophageal varices

As already mentioned, the main goal of treatment for oesophageal varices is based primarily on preventing bleeding, which is potentially fatal. If bleeding occurs, there are ways you can try to stop it.

Treatments to prevent bleeding:

• Medication to lower blood pressure
• Use of elastic bands to compress bleeding veins

Treatment for haemorrhage: immediate treatment is essential in the event of haemorrhage. The treatments used to stop the bleeding and to try to reverse the effects of blood loss are as follows:

• Use of elastic bands to ligate bleeding veins
• Drugs that slow blood flow to the portal vein
• Divert blood flow out of the portal vein
• Restore blood volume, possibly by transfusion
• Antibiotics to prevent blood infection
• Liver transplant.

Which specialist treats oesophageal varices?

The specialist responsible for diagnosing and treating oesophageal varices are gastroenterologists.

What is oesophagitis?

The oesophagus is part of the digestive system and it connects the mouth to the stomach. The mouth and the oesophagus are separated by cardia, which is a type of valve that aims to prevent gastric juices go up to the mouth once they have passed through the stomach.

The term oesophagitis is used when the oesophageal mucus is inflamed, with an additional layer covering it. The mucus quite often becomes irritated or inflamed.

Oesophagitis prognosis:

Oesophagitis may be caused by several factors, most of which respond well to treatment. When oesophagitis is not treated, it can cause structural changes to the oesophagus which interrupt its normal function. Some complications may include:

• Tearing of the oesophageal tissue
• Difficulty swallowing
• Oesophageal scarring
• Stenosis (narrowing) of the oesophagus
• Barrett’s oesophagus: if gastroesophageal reflux goes untreated for many years then it may cause Barrett’s oesophagus, which could in turn lead to oesophageal cancer.

What are the symptoms of oesophagitis?

Oesophagitis symptoms include:

• Difficulty swallowing
• Pain when swallowing
• Sharp pain when eating
• Food getting trapped in the oesophagus
• Heartburn, acid reflux
• Hoarseness
• Sore throat
• Cough
• Acid regurgitation.

Many oesophagitis symptoms are caused by a variety of symptoms that affect the digestive tract. However, the patient should see a specialist in the following cases:

• Symptoms last several days
• Symptoms don’t improve even with antacids
• Symptoms are making eating difficult
• Symptoms come with a headache, muscle pain, or a fever
• Chest pain for several minutes
• There is a history of heart problems and the patient has pain or discomfort in the chest
• There is pain or discomfort when trying to eat
• Shortness of breath
• Intense vomiting which may be yellowish or greenish in colour and contain blood.

Tests for oesophagitis:

When the patient sees the specialist, they will ask a series of questions and carry out a physical exam. There are certain tests to detect oesophagitis:

• Barium X-ray: the patient ingests some barium or takes a pill that contains it. The barium coats the mucus in the oesophagus and stomach, making the organs visible. It enables certain changes or conditions to be seen.
• Endoscopy: a large, thin tube with a camera on the end is inserted. This is useful for detecting any unusual activity in the oesophagus.
• Laboratory tests: during an endoscopy, samples are taken and sent to a lab for analysis. They can be used to diagnose a bacterial, viral, or yeast infection, white blood cells, or identify potential abnormal cells that could indicate that the issue is due to oesophageal cancer.

What causes oesophagitis?

There are risk factors that increase the chances of having gastroesophageal reflux. They include:

• Eating just before going to sleep
• Excessive consumption of alcohol, chocolate, caffeine, or mint flavours
• Eating big portions of greasy food
• Spicy food
• Smoking
• Obesity or being overweight
• Hiatus hernia.

There are many causes for oesophagitis:

• Reflux oesophagitis: this happens when there is an issue in the lower oesophageal sphincter, which is what ensures that the acid in the stomach is far away from the oesophagus. If this doesn’t work properly and it opens when it shouldn’t or doesn´t close, the stomach content returns to the oesophagus. This is known as gastroesophageal reflux. This is a common and continuous disease. The main issue is that it could become chronic, damaging oesophageal tissues.
• Eosinophilic oesophagitis. Eosinophils are white blood cells that play a crucial role in allergic reactions. Eosinophilic oesophagitis happens when there is a concentration of white blood cells in the oesophagus in response to an allergen. Some foods that can cause it include; milk, eggs, wheat, beef, and rye.
• Lymphocytic oesophagitis. Uncommon oesophagus disorder in which there is a high number of lymphocytes in the oesophageal lining.
• Drug-induced esophagitis. Some medications can cause tissue damage, an example of this is taking a pill without water. The medications may be anti-inflammatory painkillers, antibiotics, potassium chloride, bisphosphonates, or quinidine.
• Infectious oesophagitis. A bacterial or viral infection in the oesophagus can cause this, although it is very rare.

How can oesophagitis be prevented?

The simplest way to prevent oesophagitis is to stop or reduce consumption of certain foods and consume others which are healthier.

• Avoid eating big meals and those high in fat, particularly two or three hours before going to sleep. This is because fat is slow to digest and can cause reflux.
• Reduce or stop consuming caffeine and alcohol.
• Have a food schedule and try not to leave too much time between meals.
• Avoid lying down just after eating.
• Eat food high in fibre.
• Lose weight if needed.

What is the treatment for oesophagitis?

The treatment for oesophagitis mainly focuses on reducing symptoms and managing complications.

Reflux oesophagitis:

• Over the counter medications such as antacids, which are medicines that reduce or stop acid production
• Prescription medicines
• Surgery: fundoplication can be used to improve oesophageal conditions. Part of the stomach is wrapped around the valve that separates the oesophagus and the stomach, strengthening the sphincter and preventing the acid from re-entering the oesophagus.

Eosinophilic oesophagitis:

• Proton pump inhibitors
• Steroids
• Stop eating the allergen (food) and elemental diets.

Drug-induced oesophagitis: treatment focuses on avoiding the medication that has caused the issue:

• An alternative medication will be recommended
• Take a liquid version of the medication
• Sit down for at least half an hour after taking the medication.
• The stomach can be expanded in cases where the narrowing is very bad. In order to do this, an endoscopic device is used. There are different kinds of endoscope, some are cone shaped and widen little by little and there others where there is a balloon on the end that expands upon insertion.

What specialist should I see?

The specialists who study and treat oesophageal issues and digestive diseases are generally gastroenterologists.

What is it?

The pancreas is a large gland in the abdomen, which produces enzymes that aid in digestion. Pancreatic cancer is when abnormal cells develop in the pancreas and multiply out of control. As these cells do not function normally, as they multiply they hinder bodily functions, eventually leading to death if not treated.

Cancer can develop in different parts of the pancreas:

• Ductal adenocarcinoma develops in the lining of the pancreatic ducts (which carry the enzymes produced to the digestive system). Around 95% of pancreatic cancer cases are ductal adenocarcinomas.
• Ampullary cancer develops at the ampulla of Vater. This is where the pancreatic duct meets the bile duct before entering the intestines.
• Cystic tumours – although the pancreas can develop benign cysts (fluid-filled sacs), occasionally it grows cancerous ones.
• Neuroendocrine tumours start in the endocrine cells, which produce hormones like insulin.
• Acinar cell carcinomas develop in the cells that synthesise the pancreatic juice (the mixture of digestive enzymes).
• Lymphoma – cancer of the lymphatic tissue, which threads through the entire body, including the pancreas.

What are the symptoms?

In the early stages, pancreatic cancer may not show any symptoms, making it hard to diagnose. Symptoms such as abdominal pain, indigestion and weight loss can manifest as the cancer develops and grows. Unfortunately, these symptoms are common and can indicate a number of other conditions. Other possible symptoms include:

• Jaundice (yellow skin and eyes, itching)
• Change in bowel habits, e.g. constipation, diarrhoea
• Nausea/vomiting
• Difficulty swallowing
• Diabetes (especially if only recently developed or diagnosed)

What causes pancreatic cancer?

The causes are not fully understood, but certain risk factors have been identified, such as age (patients are generally 50-80 years old), smoking, and a history of certain conditions (e.g. diabetes, chronic pancreatitis, stomach ulcer and H. pylori infection). There is thought to be a genetic factor in some cases, as in about 1 in 10 cases the patient’s parent or parents also had pancreatic cancer. 

What is the treatment?

Pancreatic cancer is difficult to treat, as it is rarely detected until the tumour has become quite large. Treatment depends on the type, location and size of the tumour, as well as the age and general health of the patient. If it is possible to remove the tumour completely, this is the preferred option, but in cases where this is not possible, different treatment will be recommended to contain the cancer, prevent further growth and minimise the damage it does to the body.

The three main treatments, which may be used individually or in combination are:

• Surgery
• Chemotherapy
• Radiotherapy

Recovering from surgery on the pancreas can be long and painful, and the bowel will stop working for a while, meaning that the patient cannot eat or drink immediately afterwards, and may be referred to a dietician for the duration of the recovery process.

What is pancreatitis?

Pancreatitis is the inflammation of the pancreas, which is a gland found behind the stomach. The pancreas is key to the digestion of food, through the production of certain enzymes as well as the production of hormones that aid in the processing of blood glucose levels. There are two types of pancreatitis; acute and chronic. Acute pancreatitis is when the pancreas becomes inflamed suddenly. Chronic pancreatitis is when the pancreas becomes permanently damaged due to inflammation of the pancreas over many years.

What are the symptoms of pancreatitis?

The symptoms of acute pancreatitis include:

• Sudden abdominal pain
• Fever
• Diarrhoea
• Nausea & vomiting

The symptoms of chronic pancreatitis include:

• Repeated, and often severe abdominal pain (sometimes accompanied by nausea)
• Oily, bad-smelling stools

If you experience frequent abdominal pain, it is important to see a specialist.

What causes pancreatitis?

Acute pancreatitis is thought to occur when digestive enzymes activate whilst still in the pancreas, causing irritation of the pancreatic cells and hence inflammation. Acute pancreatitis has also been linked to both gallstones, alcohol consumption, infections, and some medications.

Chronic pancreatitis has largely been attributed to long-term alcohol abuse, smoking, hereditary genetic mutations and immune system problems.

In some cases, the cause for a pancreatitis diagnosis is never confirmed.

How is pancreatitis diagnosed?

There are a number of tests used to make a diagnosis, such as:

• Blood tests to check for enzyme levels in the pancreas.
• Stool tests to measure fat levels. Oily stools can indicate that there are problems with the digestive system.
• MRI or CT scans to check for gallstones.

What is the treatment for pancreatitis?

Treatment for acute pancreatitis looks to support bodily functions until inflammation has subsided. The first step in treating acute pancreatitis is to let the pancreas heal, and for the inflammation to subside. To do so, you must be treated in hospital where you will receive intravenous fluids to replace lost fluids, and medicines to manage pain. Fasting for a few days also helps the pancreas to recover.

Once the pancreas has recovered, doctors can get to work on treating the underlying cause of pancreatitis. Frequently, such additional treatments can include:

• Pancreas surgery – sometimes it is necessary to either remove damaged pancreatic tissue, or to drain excess fluid from the pancreas.
• Gallbladder surgery – removing the gallbladder may be necessary if gallstones are the cause of your pancreatitis.
• Treating alcohol dependency – if alcohol abuse is the cause of your pancreatitis, then you may be entered into an alcohol addiction program.

For those suffering from chronic pancreatitis, then further treatments might be needed, including:

• Lifestyle changes – adopting a low-fat, nutritious diet, avoiding alcohol and stopping smoking tends to show the best results for people suffering from chronic pancreatitis.
• Enzyme supplements – these assist in the digestion of food and can be taken with each meal.
• Pain medication – chronic pancreatitis causes continual abdominal pain, so managing this pain is often needed.

What is pH monitoring?

pH monitoring is a diagnostic test of the digestive system and is used to measure acid in the oesophagus. It is performed using a probe with acid-sensitive receptors.

What does it involve?

pH monitoring involves passing a probe through one of your nostrils and positioning it in the lower portion of the oesophagus. The probe is a flexible tube of approximately 2 mm in diameter, with sensors at the tip. You will have to breathe in through the nose to allow the probe to be positioned correctly. Anaesthetic or sedation is not usually used in pH monitoring as it may interfere with the results.

Why is it performed?

pH monitoring is usually performed for people who suffer from heartburn (pyrosis) or regurgitation in order to determine the acid levels in the oesophagus coming from the stomach.

People affected by gastroesophageal reflux often require this test for the diagnosis and evaluation of the treatments they are having. In fact, this test is more effective than endoscopy in detecting this condition, and identifies more than 90% of people with reflux.

Preparing for pH monitoring

You should avoid smoking and using excitant substances such as caffeine for 48-72 hours prior to the test and must not eat or drink anything for 6-8 hours prior the test.

Before the procedure, you should inform the specialist about any treatment you are having or any medication you are taking, in case they might affect the results of the test. For example, you should stop taking antacids at least 8 hours before the test, as this would have a significant effect on the results.

What do you feel during pH monitoring?

Since no sedation or anaesthetic is used during the test you may experience discomfort in the nose and throat and there may be some slight bleeding.

This occurs mainly when the probe is inserted and removed, but it is usually well tolerated during the test. 24-hour pH monitoring may be recommended in some cases, during which time you must leave the probe in place for a full day, eating and sleeping as normal.

Meaning of abnormal results

Abnormal results may mean that you have high levels of acid in your oesophagus. The gastroenterologist will determine the degree of reflux and will be able to identify the cause, such as problems with the oesophageal sphincter.

In this case, you may need to take medication for the reflux and heartburn problems, or even undergo surgery if you do not respond adequately to the medication.

What is a polypectomy?

A polypectomy is a minimally-invasive procedure carried out with a colonoscope or hysteroscope to remove polyps in certain parts of the body such as the colon or uterus. Therefore, the most common types of polypectomy are colon polypectomy and uterine polypectomy.

Why is a polypectomy done?

A polypectomy is done to remove polyps, which are abnormal growths that can grow in size, causing problems, bleed or be cancerous. Usually, once a polyp is removed, they will be examined in a laboratory to determine whether it is cancerous or not. However, most polyps are benign (non-cancerous). Polyps in the colon are often found during a colonoscopy, which is offered to people in the UK over the age of 50 to check for early signs of colon (bowel) cancer. If signs of cancer are found, then usually further tissue will need to be removed and other cancer treatments discussed.

How is a polypectomy performed?

Polypectomy by hysteroscopy for uterine polyps are carried out by introducing a hysteroscope through the vagina and the cervix to remove or cut polyps with special surgical instruments.

Colon polyps are usually removed at the same time as a colonoscopy. A colonoscope is a special, thin, flexible tube inserted into the rectum and into the colon. It has a light and camera to show the insides of your colon, allowing the surgeon to introduce special instruments to remove any polyps found. There are two main methods of polyp removal via colonoscopy:

• Snare polypectomy – a thin wire is looped around the base of the polyp and is cauterised with heat, which stops any bleeding and cuts off the polyp.
• Piece-meal polypectomy – this can remove larger polyps by removing the polyp piece by piece.

Preparation for polypectomy:

For a colon polypectomy, the bowel must first be cleared. This is done by performing an enema before the test using a special at-home kit. Local anaesthesia is used for uterine and colon polypectomies, and there should be little to no discomfort.

Aftercare:

Following a uterine polypectomy, you can return home the same day and it is normal to have some bleeding for 4-5 days, as well as some brown-coloured discharge. You should take 1-2 days off work to rest. Following a colon polypectomy you can return home the same day, and you can expect to experience some bloating and cramps for the first 24 hours. You will need to avoid certain foods, such as spicy food, coffee, tea, alcohol and fizzy drinks. For both types of polypectomy, you should not drive for 24 hours. Once the polyps have been analysed, if cancer is detected your doctor will schedule a follow-up to discuss next steps.

Polyps are abnormal tissue growths. They can form in different parts of the body:

• Colon polyps
• Uterine polyps
• Nasal polyps, etc.

Polyps are a common problem and most of them are benign, although some types have been linked to cancer. 

What is primary biliary cholangitis (PBC)?

Primary biliary cholangitis, otherwise known as primary biliary cirrhosis, or more commonly PBC is a liver disease, where the bile ducts become damaged. The bile ducts are important for carrying bile fluid from the liver to the stomach, used for breaking down and digesting food. PBC causes damage to the bile ducts, meaning bile fluid cannot travel through them, leading to a build-up of bile fluid in the liver, which in turn leads to cirrhosis of the liver.

What are the symptoms?

The symptoms are minimal or non-existent in the early stages, but can eventually lead to the following:

• Extreme tiredness (fatigue) no matter how much you rest
• Unexplained itchiness anywhere on the body (otherwise known as Pruritus). The itchiness doesn’t go away, even when you scratch it
• Dry mouth and dry eyes
• Pain in the upper abdomen

PBC is often diagnosed following the diagnosis of a problem with the liver, which may be picked up following a routine blood test.

What are the causes of PBC?

The causes of this disease are not fully understood, however it is believed to be an autoimmune disease (a disease caused by the body’s natural reaction to an infection or disease), which occurs when the body mistakenly attacks the bile ducts.

When the bile ducts are attacked, they become damaged, swollen, and scarring occurs meaning the bile ducts don’t function properly. Bile fluid is not able to flow, and becomes backed up in the liver, causing damage to the liver.

Who is affected by PBC?

PBC affects approximately 20,000 people in the UK, with around 90% of those affected being women aged between 40 and 60, though it can be diagnosed at any age. PBC affects more people on average in the UK, than in other parts of the world, though the reason for this is unknown.

How is PBC treated?

There is currently no known cure for PBC. The condition gradually gets worse over time, as the damage to the bile ducts becomes more extensive. There are certain medications available that slow the progress of the disease down. Medications are also prescribed to help with the itchiness associated with the disease. 

What is primary sclerosing cholangitis (PSC)?

Primary sclerosing cholangitis (PSC) is a chronic liver disease that affects the bile ducts. The disease causes inflammation and scarring in the bile ducts which causes the ducts to harden and narrow, affecting the transfer of bile liquid, which is used for digestion, from the liver to the small intestine. The disease eventually leads to cirrhosis of the liver, liver failure and can lead to bile duct cancer and liver cancer.

What are the symptoms of PSC?

PSC often doesn’t show symptoms, but some patients may experience debilitating symptoms of the disease. Symptoms to expect include:

• Itching (otherwise known as Pruritus). This is defined as severe, unexplained itching anywhere on the body that persists no matter how much you scratch
• Fatigue. Feeling tired all the time, even if you get lots of rest can be a symptom of liver damage or PSC
• Jaundice (yellow colour to the eyes and skin)
• Urine that is dark in colour
• Pain in the upper abdomen
• Fever and chills
• Weight loss
   

Causes of PSC

There is currently no known cause of primary sclerosing cholangitis. It is thought that it could be an autoimmune disease, triggered by a reaction to an infection, though it does not respond to immunosuppressants. It is more common in people who have had inflammatory bowel disease, such as ulcerative colitis or Crohn’s disease.

Who is at risk from PSC?

Primary sclerosing cholangitis can affect people of any age but is more common in those aged between 30 and 50 years of age. It is more common in men, and especially those with inflammatory bowel disease.

How is PSC treated?

No treatment has yet been developed, but there are a number of ways that the disease can be managed.

The only long-term way of treating the disease is by liver transplant, although this is only done in a very small number of patients with PSC, and it is possible for the disease to return after transplantation.

Some treatments are prescribed to relieve the symptom of itching, and antibiotics may be prescribed to treat acute episodes. Vitamin supplements may also be required, as the disease causes a lack of vitamins A, D, E and K.

Surgery may be required in the form of balloon dilation or stenting to open up severe blockages in the bile duct.

Patients with PSC will survive for an average of 21.3 years before either liver transplant is required, or they suffer a PSC-related death.

What is a second medical opinion?

A second medical opinion is when you consult with a doctor that is not your regular doctor about a potential diagnosis and/or treatment plan. There is no legal right to a second opinion, however, it is rare for a doctor to refuse.

Why would you get a second medical opinion?

Patients may consider a second medical opinion if they are facing a new diagnosis or recommended treatment because sometimes this can feel confusing and a second opinion can put their mind at ease.

In addition, there are certain situations where a second medical opinion is sought after:

• Potential treatment is risky and could be life-changing or the diagnosis is possibly life-threatening
• The diagnosis is not clear-cut
• If you are considering a new treatment approach that is experimental

The aims of obtaining a second medical opinion are:

• To confirm whether a diagnosis is correct and/or appropriate.
• To confirm whether a suggested treatment is correct and/or appropriate.
• To compare information received from each doctor so that you can make an informed decision – sometimes a second medical opinion can rule out the need for a potentially unnecessary invasive procedure.

Possible disadvantages of seeking a second medical opinion include:

• The process can delay the start of treatment.
• Logistically, seeing another specialist might be difficult and possibly time-consuming.
• It might be stressful to hear the same diagnosis again.

How would you seek a second medical opinion?

You can request a second medical opinion from your GP or consultant, but before doing so it is recommended that you ask for as much clarification and explanation about the initial diagnosis and treatment, before seeking a second opinion.

Obtaining a second medical opinion does not mean that the second doctor will then take over – if that is what the patient decides, then this needs to be agreed formally between doctors and hospitals. 

What is it?

Short-bowel syndrome (SBS) or short gut syndrome is a disorder caused by a functional loss of a portion of the small intestine - a fundamental organ for the absorption of nutrient substances during the digestive process. This in turn causes poor absorption of nutrients from food. SBS may derive from the surgical removal of the intestine, or it may be due to severe intestinal conditions.

What are the symptoms of short-bowel syndrome?

The main symptoms of SBS are:

• diarrhoea
• abdominal pain
• fatigue
• weight loss
• foul smelling stools
• bloating

How is it diagnosed?

SBS is usually diagnosed after a surgery to the intestine or alongside a diagnosis of an intestinal disorder.

What causes short-bowel syndrome?

SBS can be caused by conditions such as Crohn’s disease, actinic enteritis or by neoplasms. In some cases, SBS can also be congenital: some babies are born with a shorter intestine, compared to the normal size of an infant’s intestine.

How is it treated?

Treatment can include:

• Dietary management: eating small meals through the day and taking extra nutrients
• Drugs to slow down food as travels through the intestines;
• In severe cases, total parenteral nutrition (TPN): delivery of nutrients intravenously if you are unable to digest enough nutrients through your intestines

What is a stent?

A stent or endoprosthesis is a small, flexible tube, and is usually made of biocompatible plastic material. It is used to repair or support arteries, veins, and ducts in the body. There are several models and brands of stent to suit the person’s needs and the type of surgery.

Stent placement is aimed at strengthening the venous wall and facilitating proper blood supply to the body. This is a minimally invasive surgery and is usually carried out under general anaesthetic, though it may also be carried out under local anaesthetic, depending on the duct and pathology to be treated.

Why are stents used?

Stent placement is aimed at treating ducts that have become narrow or blocked due to disease. It is most commonly used in blood vessels, but can also be used in the oesophagus, bile duct, trachea and bronchi.

In the case of aortic aneurysms, a vascular stent is inserted through a small incision in the groin and is advanced through the femoral artery until it reaches the aorta and the location of the aneurysm, in order to strengthen the vessel wall.

When used in the oesophagus, the stent allows food to pass through. In the bile duct, it is used to open the duct to allow bile to pass into the intestine.

In the trachea and bronchi, the stent opens the vessels to allow normal breathing.

What does it involve?

The surgery involves making a small incision, usually in the groin, through which the stent is guided by a catheter through the iliac vessel to the site where it is to be implanted. This procedure may be complemented by follow-up X-rays (fluoroscopy or a CT scan) or ultrasound which will allow the vascular surgeon to monitor and verify the correct implantation of the stent.

The catheter will be removed once the endoprosthesis has been guided to the ideal location and is properly positioned in the vessel. The entire procedure usually takes around two hours.

Preparing for stent placement

Before the surgery, the specialist may request a diagnostic imaging test in order to observe the characteristics of the vessel to be treated. A medical history will also be taken to see if you are a candidate for surgery. You may not be a good candidate for a stent if the blood vessels are irregularly shaped, if the aneurysm is too large, if you are pregnant or if you have any condition that would contraindicate a 2-hour operation.

Just before surgery, the area of the groin where the incision is to be made will be cleaned and shaved, and you will be given a local or general anaesthetic. You may need to fast if you are having an anaesthetic.

Post-operative care

Normally, after the operation you will have to remain in a horizontal position for four to six hours. Your hospital stay will be from two to four days and, depending on the case, you may need to be monitored overnight in an intensive care unit (ICU).

During the postoperative days you may experience some groin discomfort, thigh swelling, a pinching sensation in the legs, fever and constipation.

Most stents require periodic checks to make sure that the treated vessel is functioning properly and that the endoprosthesis is in good condition.

Alternatives to stent placement

Stent placement is currently the most advanced and innovative procedure for repairing, opening and strengthening vascular ducts. The alternative to this procedure is conventional open surgery, which entails a larger incision and a higher risk of complications as well as a longer post-operative period.

What is stomach cancer?

Stomach cancer, also known as gastric cancer, is cancer that develops in the stomach or the stomach lining. There are different types of stomach cancer, including:

• Adenocarcinomas – stomach cancer that develops in the lining of the stomach.
• Lymphoma of the stomach – cancer develops in the lymphatic tissue (the tissue that drains infection-fighting fluids).
• Gastrointestinal stromal tumours (GISTs) – these form in the muscle of connective tissue of the stomach wall.

Prognosis of stomach cancer:

Depending on your age, overall health and the stage of your cancer, your outlook will differ.

In the UK, approximately 5000 people die from stomach cancer each year. Approximately 40% with stomach cancer will survive 1 year after diagnosis; 20% will survive at least five years after diagnosis and 15% will survive for at least 10 years after diagnosis.

Symptoms of stomach cancer:

Initial symptoms of stomach cancer can include:

• Persistent indigestion
• Trapped wind
• Feeling bloated after meals
• Stomach pain

Advanced cancers may have the following symptoms:

• Blood in the stool or very dark, black coloured stools
• Weight loss
• Loss of appetite

Medical tests to diagnose stomach cancer:

If any of the above symptoms are experienced persistently, see a doctor as soon as possible. If your GP suspects stomach cancer, you will be referred to a specialist for further tests.

The following diagnostic measures may be used to diagnose stomach cancer:

• Blood test
• Stool test
• Endoscopy to check for stomach ulcers or signs of cancer. A biopsy will be taken for further testing.
• Endoscopic ultrasound can help confirm the stage of cancer.
• CT scans
• Laparoscopy surgery to provide a more detailed analysis of the abdomen.
• Barium swallow X-ray

What are the causes of stomach cancer?

We are not sure exactly why the cells of the stomach change and become cancerous, but there are certain risk factors that can increase your risk for developing stomach cancer. These include:

• Being aged 55 years of older
• Being male – men are twice as likely to develop stomach cancer
• Smoking
• Having H. pylori infection
• Eating a diet low in fibre, fruit and vegetables.
• Eating a diet with lots of pickles and salted or smoked meats.
• Family history – you are more likely to develop stomach cancer if a close relative has had the condition.
• Having stomach ulcers
• Having another type of cancer
• Being overweight
• Drinking large quantities of alcohol

Can stomach cancer be prevented?

Stomach cancer cannot be prevented, however, by controlling some of the above risk factors, where possible, you will be less likely to develop this condition.

Treatments for stomach cancer:

Treatment options will depend on your overall health and the stage of the stomach cancer. The primary treatments for stomach cancer are chemotherapy and/or radiotherapy. Surgery may also be recommended to remove tumours. The aim of treatment is to remove the cancer, either surgically or through conservative treatments. If a tumour cannot be removed then treatment will aim to slow down its growth. Certain medications are also used, including trastuzumab, which is a drug used to treat breast cancer as well.

Which type of specialist treats stomach cancer?

A multi-disciplinary team will treat stomach cancer, made up of gastroenterologists, surgeons, medical oncologists and clinical oncologists.

What is it?           

A gastric ulcer, which is also known as peptic or stomach ulcer, is a sore in the mucous membrane that lines the stomach or duodenum, the first segment of the small intestine.  

The most common symptom is heartburn, which may happen after eating or during the night, this can last several hours.  

Prognosis

Withh treatment and dietary changes (having a balanced diet, not smoking, reducing alcohol consumption) symptoms normally improve over time.  

What are the symptoms?

The symptoms of a gastric ulcer vary from person to person, and in some people they are asymptomatic, this is especially true of small ulcers. Heartburn is considered to be the most common symptom of peptic ulcers, and it can last between a few minutes to several hours, and can affect the person intermittently for several days or weeks.  

Other common symptoms include:

• Feeling full
• Difficulties drinking a normal amount of liquid
• Hunger and feeling empty after eating
• Nausea
• Stomach ache. 

A gastric ulcer can also cause other less common symptoms:

• Swelling
• Being gassy and burping
• Lack of appetite
• Felling fatigued
• Vomiting
• Chest pain
• Weight loss
• Dark stools.

Medical tests

The specialist will ask the patient about the symptoms being experienced, their medical history, and they will carry out a physical examination to check if there is swelling and pain the stomach. They will also use a stethoscope to check for any unusual sounds around the abdomen area.  

An ulcer is often treated with medications, and a test is carried out two weeks later to check that they have been effective.  

If the medication has not worked, the doctor may opt to carry out an upper endoscopy, where a thin tube with a camera on the end is inserted in the throat to examine the state of the stomach. A biopsy may also be carried out.      

What causes it?

The gastric ulcer sore is formed when the stomach is exposed and vulnerable to its own acidity. This can be caused by different things:

• Genetics
• Medications that affect the lining of the stomach
• Infection caused by Helicobacter pylori
• Excessive consumption of alcoholic drinks, which irritate the gastric mucosa
• Stress

The patient’s lifestyle can also be the cause of an ulcer. Having an unbalanced diet rich in fat and sugar can worsen symptoms. Irritants such as caffeine, spices, and peppers can aggravate symptoms and cause the ulcer to worsen. This can cause other gastric issues to appear or progress, and example being gastroesophageal reflux disease (GERD).  

How can it be prevented?

A gastric ulcer is known to get worse with alcohol and tobacco use. In the past it was thought that it was caused by eating too much spicy food. Now we know that stress can be a contributing factor.   

A person can live with an ulcer, they normally heal between eight and ten weeks. By following a balanced diet, and dropping habits such as smoking, coffee, alcohol, and chocolate consumption, can prevent an ulcer forming. Not eating too late at night can also help.        

What is the treatment?

There are several medications that can be used to treat a gastric ulcer.

If H. Pylori is the cause of the ulcer, the treatment will be what is known as triple therapy. This is a combination of antibiotics with bismuth subsalicylate.    

Other medications that can neutralise heartburn and the stomach lining include:

• Proton pump inhibitors
• Histamine receptor blocker
• Stomach protectors.

If anti-inflammatory medications have caused the ulcer and there is no sign of H. Pylori, then reducing the amount of medications taken is crucial, another option is to look into a different type of painkiller.       

What specialist should I see?

The specialist who treats gastric ulcers is a gastroenterologist.     

What is ulcerative colitis?

Ulcerative colitis is a condition where the large intestine and rectum become inflamed and eventually produce ulcers. It is a type of inflammatory bowel disease, along with Crohn’s disease. Inflammatory bowel disease affects more than 620,000 people in the UK .

Can it be cured?

Ulcerative colitis is a long-term condition, which means it can’t be cured. Instead, treatment focusses on managing the symptoms, and achieving “remission”, where no symptoms occur.

This doesn’t mean that symptoms can’t come back – ulcerative colitis is a fluctuating condition involving “flare-ups” (see below).

Symptoms of ulcerative colitis

The main symptoms of ulcerative colitis include:

• diarrhoea, often containing blood
• stomach pain and rectal pain
• fequently needing to go to the toilet
• weight loss
• fatigue

Ulcerative colitis is characterised by “flare-ups”, where symptoms worsen for a period of time, and you can experience symptoms in other parts of the body. These can include:

• mouth ulcers
• a high temperature
• painful and swollen joints
• irritated eyes

Everyone experiences ulcerative colitis differently. With the right treatment and self-management, some people can experience long periods of “remission” where you only experience mild symptoms, or even none at all.

Diagnosis

Diagnosis will usually involve a combination of:

• taking a stools sample to rule out other conditions such as an infection or colon
• blood tests to rule out anaemia or inflammation
• sigmoidoscopy or colonoscopy to see inside your large intestine

Sometimes the doctor might need to do an X-ray to check if there are serious complications, but this is much less common.

What causes ulcerative colitis?

It’s not clear exactly what causes ulcerative colitis. Many health professionals now think that it could be an autoimmune condition, involving the immune system mistakenly attacking healthy cells. This may be triggered by an infection in the large intestine.

However, other factors appear to play a role:

• you’re more likely to have the condition if a family member has had it
• having certain genes makes you more likely to have the condition
• the condition is more common in places with better sanitation

Ulcerative colitis therefore seems to be caused by a combination of genetic and environmental factors.

Treatment

Treatment for ulcerative colitis includes lifestyle and diet changes, medication, and in very rare cases, surgery.

Lifestyle changes

For some people, making changes to their diet can help control the symptoms and reduce the frequency of “flare-ups”. Some helpful changes can include:

• Making sure you stay hydrated by drinking plenty of liquids through the day
• Making sure you have a well-balanced diet with all the vitamins and minerals you need, possibly with the aid of supplements
• Avoiding foods you have any intolerance to (e.g. avoiding dairy products if you’re lactose intolerant)
• Eating smaller, more frequent meals, rather than a few large meals

Medication

Your doctor may prescribe a combination of drugs to achieve different goals, including:

• Anti-inflammatory drugs such as aminosalicylates and corticosteroids
• Immunosuppressants usually used to treat flare-ups, or to treat patients who haven’t responded to anti-inflammatory drugs

Surgery

Surgery is generally only recommended when a patient hasn’t responded to medication, or are experiencing severe flare-ups that significantly affect their day to day life.

Surgery will involve removing the colon, and replacing its function with an ileostomoy or ileo-anal pouch. This results in a complete cure of the condition.

What is ultrasound?

Ultrasound is a diagnostic imaging procedure that allows you to see organs and soft structures inside the body. At present, they can be 2D, 3D or four-dimensional images. Ultrasound is a non-invasive technique, in which radiation is not used and thanks to this, it is used to visualise developing foetuses.

What does an ultrasound scan consist of?

It is carried out using high frequency sound waves emitted through a transducer that captures the echo of different amplitudes which occurs when they ‘bounce’ off the organs. These signals, once processed by a computer, give a series of images.

Why are ultrasounds carried out?

With this procedure you can clearly differentiate the shape and size of each structure inside the body. In medicine it is used to see the heart, kidneys, liver and blood vessels, among other organs. In addition, ultrasounds are also carried out on patients who are pregnant. Another function is the study of different tissues of the body such as the blood flow of arteries and veins to detect arteriosclerosis and blood clots. Ultrasounds also allow the analysis of the thyroid gland and other soft structures of the neck as well as tendons, ligaments, muscles and joint structures, and mammary glands.

Preparation for Ultrasound

Usually, you do not need any type of preparation for having an ultrasound. In cases where the area to be examined is the abdomen, the specialist may tell you to drink three glasses of water approximately one hour before the test.

How does it feel during the ultrasound?

During the ultrasound, the patient will lie on a table or stretcher with the area to be analysed exposed. The specialist will apply a transparent gel that will allow the movement of the roller built into the transducer. During the scan the expert will interpret the images and determine which shots are correct according to each case. The only slight discomfort that can be felt is the gentle pressure that the specialist applies when passing the transducer over the body area. The gel applied can also feel quite cold when applied.

Meaning of abnormal results

The types of images that are considered abnormal are:

• Congenital anomalies
• An alteration to tissue due to trauma or injury
• Cysts

Upper gastrointestinal (GI) surgery is surgery performed to treat pathologies of either the upper gastrointestinal tract (small bowel), gall bladder, liver, pancreas or oesophagus. 

What is hepatitis?

Hepatitis is the general term for inflammation affecting the liver, consequently causing it to function improperly. There are several kinds of viral hepatitis, including A, B, C, D, and E.

Hepatitis can also be caused by drinking too much alcohol. There is also another form of hepatitis called autoimmune hepatitis, in which the immune system attacks the liver and damages it.

What are the symptoms?

Symptoms of hepatitis include:

• Cloudy urine
• Fatigue
• Febricula
• Itching
• Jaundice
• Loss of appetite
• Nausea or vomiting
• Weight loss
• Headaches
• Pharyngitis and cough

Causes of hepatitis

Hepatitis can occur for different reasons:

• Immune cells of the body that attack the liver
• Viral infections
• Liver damage caused by excess alcohol or toxins
• Overdose of medications such as for analgesics.

Viral hepatitis can be passed on in different ways, depending on the type. For example, hepatitis B is common worldwide, but is not common in the UK, and it is spread through the blood of an infected person. Hepatitis D is another form of hepatitis which only affects those already infected with hepatitis B.

Hepatitis C is the most common type of hepatitis in the UK. It is also transmitted through the blood of an infected person, and is most commonly transmitted through needle sharing when injecting drugs.

Hepatitis E is on the increase in Europe and is passed on through raw or undercooked pork and offal. It can also be passed on through uncooked venison, shellfish, and wild boar.

Can it be prevented?

Hepatitis A and B can be prevented through a vaccine. To avoid getting hepatitis B and C, it is important not to share personal items such as razor blades, and make sure that proper hygiene protocol is followed if you are getting a body piercing or tattoo.

Hepatitis A and E can be avoided by not consuming or using food or water that is not clean, washing hands thoroughly after going to the bathroom, and washing hands after being in contact with the blood, faeces or bodily fluids of an infected person.

What is the treatment?

The treatment varies according to the cause of the condition. The treatment for hepatitis A, for example, may simply be bed rest. In the case of hepatitis B, medication may be administered but only if chronic. Hepatitis C is treated through antiviral medications. Your hepatologist or specialist will advise on the best form of treatment, if necessary.

In cases of liver damage, a transplant may be necessary.

What is a virtual colonoscopy?

A virtual colonoscopy, also known as a CT colonography, is a type of scan which produces detailed images of the large intestine using low bursts of radiation. The scan is generally used to look for small growths called polyps in the colon and screen for bowel cancer.

What does it involve?

A virtual colonoscopy is similar to other types of CT scan. It involves lying on a bed inside a CT scanner which rotates around you taking hundreds of detailed pictures of your abdominal organs. These are combined to produce a three-dimensional model of your large intestine and any growths within it. The doctor can then “look around” the model, as though they were actually travelling through the colon.

Unlike a traditional colonoscopy, a virtual colonoscopy can be carried out while awake, and is much faster, taking only 15 minutes to complete.

Why is it done?

A colonoscopy is most commonly performed to detect small growth called polyps in the large intestine. These do not cause symptoms but can turn into bowel cancer if not removed, so it’s important to detect them early.

Bowel cancer is one of the most common forms of cancer in the UK, which is why bowel scope screening is automatically offered to people over the age of 55. A colonoscopy is only recommended as a follow-up to polyps being found during bowel scope screening. In most cases, a traditional colonoscopy is offered, but some people have health problems that would make this unsafe. In this situation, a virtual colonoscopy is an effective alternative.

How to prepare

Your doctor will advise you on any dietary restrictions before the exam. It is likely you will be required to clear out your bowels, in which case you may only be able to drink liquid in the day before the exam, and you might be given medication or a laxative. It is also usually necessary to drink a contrast liquid to help polyps show up better in the scan. You should let the doctor know if you have problems with your heart, liver, or kidney, because this process is not safe for everyone.

Finally, you should tell the doctor if you might be pregnant, as a CT scan could carry risks for your child.

What to expect

The procedure is very fast and painless. You will be asked to lie down on the exam table, and a small tube will be inserted into your rectum, to help inflate the intestine and reveal any polyps that are “hiding”.

The exam table will then slide into the scanner, which will rotate around you capturing images at a high speed. You might be asked to hold different positions, turn onto your back or side, or hold your breath for a few seconds. Once the scan is finished, the tube will removed and you will be free to leave.

What do abnormal results mean?

In the vast majority of cases, an abnormal result means that polyps have been found but they are not cancerous. If polyps are found, they cannot be removed during a virtual colonoscopy, so you will need to return for another appointment.

Bowel cancer is a much rarer result. If it is found, you will likely be given an appointment to see a specialist as soon as possible.

Recent advances in virtual colonoscopies

Virtual colonoscopies have benefited from recent advances in CT scanning technology. Now, CT scanning machines can produce much more detailed pictures, resulting in an accurate three-dimensional model that is effective for recognising larger polyps. The speed of picture taking has also increased, meaning less time on the exam table and a better patient experience.

Vomiting involves the “throwing up” of the contents of your stomach. Rather than a condition in itself, vomiting is a symptom of a wide variety of illnesses.

What can cause vomiting?

There are many conditions which can cause vomiting, so it can be difficult to know for certain. In children, vomiting is commonly a reaction to motion sickness, over-eating, a milk allergy, food poisoning, or viral infection. If you find yourself vomiting after a meal, it could be a result of food poisoning, gastritis, or a stomach ulcer. Vomiting as part of morning sickness occurs in 25-55% of women who are pregnant .

Other things which can cause vomiting include:

• gallbladder disease
• intense pain
• medication
• concussion
• having too much alcohol
• brain tumour
• norovirus
• migraine
• urinary tract infection

How long does vomiting last?

Vomiting shouldn’t last more than 1-2 days and is generally harmless. It’s important to see a GP if you are still experiencing symptoms after 2 days.

It’s important to see a GP if you or your child are still experiencing symptoms after 2 days.

You should also see you’re a doctor if you or your child:

• are unable to keep fluid down
• have green or yellow vomit
• are still dehydrated after using oral hydration sachets (see below)

Finally, take your child to the GP if they have a high temperature (over 38C) or are unable to keep fluid down.

How can vomiting be prevented?

You can reduce your chances of feeling nauseous by eating smaller meals through the day rather than a few large meals, eating slowly, and keeping your head elevated after eating.

If you feel nauseous already you can help by resting in a sitting position and drinking small amounts of liquids, avoiding citric juices like orange juice.

How is vomiting treated?

You can do a lot to treat vomiting yourself and make sure you stay hydrated. It’s important to:

• get lots of rest
• drink water or squash in small sips if necessary
• eat when you feel you can
• avoid fruit juice or fizzy drinks

If your baby is vomiting, carry on giving them breast or bottle feeds, in smaller but more frequent measures. It can also help to give them small sips of water between feeds.

You might also find it helpful to take a painkiller such as paracetamol or ibuprofen. Don’t give aspirin to children under 16.

If you are still vomiting after 24 hours, a pharmacist might recommend oral rehydration sachets, which you mix with water. The GP may also prescribe medication if vomiting is associated with pregnancy or motion sickness.