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.           

Abdominal ultrasound is a diagnostic test that allows the study of the organs and structures in the abdominal cavity through the use of ultrasound waves. It is possible to carry out simultaneous interventions such as drainage of abscesses or biopsies, and the examination of flow within thee blood vessels through a special ultrasound called Doppler ultrasound.

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.

What is an anal fissure?
An anal fissure (fissures) is a tear or crack in the lining of the anal canal (anus), which causes extreme pain during bowel movements. Anal fissures affect everyone, from men and women to young and old people. It is the most common cause of rectal bleeding in infancy. A fissure tends to occur when passing hard or large stools during a bowel movement. There may also be spasms in the ring of muscle at the end of the anus.

What is the cause of an anal fissure?
Common causes of an anal fissure include passing large stools, constipation and straining during bowel movements, chronic diarrhoea, inflammation of the anorectal area and childbirth. The less common causes of anal fissures include anal cancer, HIV, tuberculosis, syphilis and herpes.

What are the symptoms of an anal fissure?
The symptoms of an anal fissure include:

• Pain, which can sometimes be severe during bowel movements
• Pain after bowel movements
• Blood on the stool or toilet paper
• Itching or irritation around the anus
• A visible crack in the skin around the anus
• A small lump on the skin near the anal fissure

How is an anal fissure treated?
An anal fissure will often heal within a few weeks if the stool is kept soft through increasing the intake of fibre and fluids. Soaking in a warm bath for 10 to 20 minutes daily, especially after toilet use, helps to relax the sphincter and helps it to heal. A doctor may recommend topical anaesthetic creams for pain relief. A Botox (Botulinum toxic type A) injection can paralyse the anal sphincter muscle and aids in relaxing spasms. Blood pressure medications can also help relax the sphincter.

How to prevent an anal fissure?
By preventing constipation it may help in preventing an anal fissure. Constipation can be prevented when eating high-fibre foods, drinking water and regularly exercising to stop from straining during bowel movements.

Risk factors for developing an anal fissure

• Infancy – experts are not sure why but many infants experience an anal fissure during the first year of their life.
• Aging – as an adult ages there is a decrease in circulation and blood flow to the rectal area.
• Constipation – straining when trying to pass hard stool can increase the risk of tearing.
• Childbirth – anal fissures become common in women after they give birth.
• Crohn’s disease – the inflammatory bowel disease causes chronic inflammation of the intestinal tract and this makes the lining of the rectum vulnerable to tearing.
• Anal intercourse. 

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.

Autoimmune hepatitis happens when the body's immune system recognises the liver cells as foreign and starts to attack them, damaging this vital organ.

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 incontinence?

Bowel incontinence describes a loss of control over bowel movements, leading to the patient unintentionally soiling themself. It is thought that as many as one in ten people will experience some degree of bowel incontinence in their lifetime, and is nothing to be ashamed of. It is usually symptomatic of another problem or underlying condition, and is not a normal part of ageing. It usually won’t just go away on its own, but it can be treated effectively, and often cured, so it is always best to consult your GP or a specialist.

What are the symptoms of bowel incontinence?

Bowel incontinence itself is usually a symptom, not a diagnosis. It may occur as a sudden need to go to the toilet, but the patient may not make it in time (urge bowel incontinence). However, other patients have no warning before they soil themselves, feeling no sensation as the stool passes (passive incontinence/passive soiling). Passing wind may also cause slight soiling.

What causes bowel incontinence?

Most cases of bowel incontinence are brought on by bouts of diarrhoea, or conversely, constipation. Another common cause is weakening of the anal sphincter (the ring of muscle that opens and closes the anus).

Long-term causes, such as diabetes, multiple sclerosis, spina bifida, and even dementia can also cause bowel incontinence.

How can it be prevented?

Maintaining a healthy diet and lifestyle can help to reduce the chances of getting diarrhoea or constipation, which are the leading causes of bowel incontinence. This can also stave off type 2 diabetes. However, there is no guarantee of preventing these problems, and there is nothing that can be done to prevent causes such as MS or dementia.  

What is the treatment?

Luckily, bowel incontinence is highly treatable, enabling most patients to maintain normal bowel function for the rest of their lives. Different treatments include:

• Exercises to strengthen the bowel muscles and anal sphincter.
• Dietary and lifestyle changes – a healthier diet and lifestyle can prevent diarrhoea and constipation.
• Medication can also treat diarrhoea and constipation, depending on the cause.
• There are various surgical options.
• Incontinence products, e.g. anal plugs, incontinence pads, etc. can help to manage the symptoms until you regain some control

In many cases, incontinence can be cured, but even if not it is usually possible to improve bowel control to some degree, and significantly improve the symptoms.

An endoscopic capsule is a device the size of a pill that contains a camera. It is used to perform examinations of the digestive system and to treat diseases of the small intestine and rectum. The endoscopic capsule is swallowed and thus runs through the digestive system providing images of the whole journey. Thanks to the endoscopic camera's build, it is a good method of recording intestinal transit and detecting any pathology of the small intestine and the colon, in a minimally invasive way. Currently, this technique is used in some medical centres as an alternative to traditional endoscopy. 

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.

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

Colon cancer is the proliferation of malignant cells in the colon, which, along with the rectum, is in charge of storing faeces which are then expelled through the anus. Its causes are determined by genetics, sedentary lifestyle and previous illnesses such as polyps, ulcerative colitis and other cancers. The most obvious symptoms of the disease become visible when the disease is advanced: alternating between diarrhoea and constipation, blood in the stool, abdominal pain, loss of appetite, weight loss and fatigue. If detected early there is a good chance of cure, with the most common treatments being radiotherapy, chemotherapy, immunotherapy to strengthen the body's defences, and surgery.

What is colon hydrotherapy?

Colon hydrotherapy, or a colon cleanse, is a bowel cleansing treatment to improve intestinal transit and to activate the circulatory system. The aim is to eliminate accumulated waste and toxins, thus alleviating pressure in the abdominal area and combating intestinal problems.

Why is it performed?

This technique is primarily used as an intestinal cleansing system for people suffering from chronic constipation. In fact, waste can accumulate in the folds of the colon even in those who do not have constipation and whose intestinal transit is regular.

To maximise the results of colon hydrotherapy you are advised to follow a high-fibre diet and to maintain healthy lifestyle habits, including regular physical exercise.

What does it involve?

Colon hydrotherapy consists of introducing a cannula with warm water at low pressure into the large intestine through the anus, to eliminate the accumulated waste. This boosts the reabsorption of water and minerals. While the water is being introduced, a massage is performed to regulate the contractions and rhythm of the colon in order to restore its functioning.

Colon hydrotherapy sessions last around 45 minutes, and complete treatment for the entire colon usually requires three sessions.

Preparing for colon hydrotherapy

Colon hydrotherapy does not require any prior preparation. It is a non-invasive treatment with no side effects. However, certain contraindications should be considered, and people with one or more of the following conditions should avoid colon hydrotherapy:

• Pregnancy
• Haemorrhoids, anal fissures and other anal pathologies that prevent the introduction of the cannula
• Diverticulitis 
• Certain pathologies of the abdomen, such as Crohn's disease or ulcerative colitis
• Severe cardiomyopathies

• Liver diseases such as cirrhosis or kidney failure

• Recent abdominal or rectal surgery or radiotherapy.

Post-treatment care

You can return to normal activities immediately after the colon hydrotherapy session. You don’t need to follow any specific instructions after the treatment, but to optimise the results you should maintain healthy eating and physical activity habits.

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 diabetes?

Diabetes mellitus (DM), or just diabetes refers to a group of metabolic diseases which result in an inability to regulate blood sugar levels. Having too much glucose in your blood can damage the kidneys, eyes, nerves and other parts of the body, including the blood vessels themselves. In extreme cases, diabetes can cause heart disease and strokes, and patients may even require amputation of limbs.

This inability to control blood sugar comes from a problem with the hormone insulin. Insulin is produced by the pancreas, enters the bloodstream, and moves glucose out of the blood and into cells, where it is used to generate energy.

There are two types of diabetes:

Type 1 diabetes – the cells that create insulin are attacked and destroyed by the body’s immune system as part of a defective immune response. It can develop rapidly over weeks or even days.

Type 2 diabetes – either the body does not produce enough insulin, or the body’s cells stop responding to it. Patients may not be diagnosed for years, due to generic symptoms. It is by far the most common type of diabetes.

What are the symptoms?

Classic diabetes symptoms include:

• Thirst
• Frequent urination
• Fatigue
• Itching around the genitals, or thrush
• Weight loss/muscle loss
• Blurred vision
• Slow healing

What causes diabetes?

Type 1 diabetes is an autoimmune condition – something causes the immune system to attack healthy pancreatic cells that produce insulin. It appears to run in families, so may be genetic. No one knows exactly what causes the immune system to attack the pancreas, but one theory is that it is triggered by a virus.

Type 2 diabetes is acquired, and usually affects older people. It tends to be associated with obesity and lack of exercise.

How can it be prevented?

Type 1 diabetes appears to be genetic, so there is no way to prevent it.

To reduce the risk of developing type 2 diabetes, it is important to have a healthy and balanced diet, take plenty of exercise, and lose weight if you are overweight or obese. Stopping smoking and drinking alcohol in moderation are also useful tips.

What is the treatment?

Diabetes can’t be cured, but the symptoms can be managed. A healthy diet, regular exercise, and regular blood tests are essential to keep blood glucose levels in check.

Type 1 diabetes patients require regular insulin injections for the rest of their lives to make up for the lack of insulin production by the pancreas.

Type 2 diabetes patients may eventually need to take tablets, as the condition is progressive (it will worsen over time).

You should see your doctor or a specialist as soon as possible if you are experiencing symptoms. If diagnosed with diabetes, a patient is usually referred to a specialist care team for treatment and long-term monitoring of the condition.

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 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 are eating disorders?

An eating disorder is when someone has a very unhealthy attitude to food, body weight or shape. Eating disorders are serious illnesses that can prove fatal if not treated. The most common types of eating disorders are:

• Anorexia nervosa: when an individual tries to keep their body weight as low as possible by not eating enough or exercising excessively, or both.
• Bulimia: characterised by periods of binging and then purging by either use of laxatives or by being deliberately sick.
• Binge eating disorder (BED: loss of control over eating, consuming large portions all at once until you feel ill and consumed by feelings of guilt.

Women are more likely to suffer from these types of disorders. They tend to occur in adolescence and are often accompanied by depression and anxiety disorders.

What symptoms do they present?

The common symptoms of eating disorders are:

• Excessive exercise
• Worrying a lot about your weight and body shape
• Eating very little
• Inducing vomiting after eating
• Taking laxatives
• Depression
• Mood swings
• Having strict routines around food
• Avoiding social settings that could involve food

Additional physical signs include:

• A weight that is very low
• Amenorrhoea (absence of menstruation)
• Digestion problems
• Fatigue
• Feeling cold and dizzy

What causes eating disorders?

The exact causes of eating disorders are not known, however, some risk factors include:

• Having a family history of depression, substance abuse and eating disorders.
• You have been criticised in the past for your weight or body shape.
• You are overly concerned about your weight, for example, because of the nature of your work (e.g. being a model).
• You suffer from anxiety and have low self-esteem.
• You have been sexually abused.

Can eating disorders be prevented?

Prevention of eating disorders refers to any programs or interventions that reduce the risk factors of developing such a disorder. This includes primary and secondary prevention. Primary prevention aims to prevent the onset of an eating disorder, whilst secondary prevention tries to reduce the severity and duration of an eating disorder in someone who has already been diagnosed.

What is the treatment for eating disorders?

Treatment may differ slightly between each case and each type of eating disorder. Recovering from an eating disorder is entirely possible, but recovery can take a while and it will be a different experience for each person.

Physically, treatment will aim to increase your nutritional intake, stop purging and reduce excessive exercise. Together, these will allow the individual to reach a healthier weight. Further to this, treatment will involve individual, group and family psychotherapy sessions (e.g. CBT), nutritional counselling, medical monitoring and medication. Medications that may be given include anti-depressants, but medication must not be the only form of treatment for eating disorders, and may not be given to patients under the age of 18.

Endoscopic ultrasound is an exploratory procedure that allows visualising the interior walls of various organs and their structures (such as the oesophagus, stomach, intestines), as well as obtaining tissue samples and repairing any lesions found. Before performing this test, the doctor tells the patient how to prepare for it and the preparation depends on the organ to be explored. The procedure is performed by introducing an endoscope (thin, flexible tube with a small attached camera that transmits the images to a monitor) through the mouth or the anus and is guided to the area of interest. This way, a digestive endoscopy or a pancreas endoscopy can be performed in a few minutes, during which the doctor can carry out what is required, such as obtaining samples for analysis or repairing possible injuries. 

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 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 it?

A Fibroscan is a test that allows the assessment of hepatic fibrosis as well as the quantification of liver fat. It is a non-invasive technique that is fast and reliable. It is particularly useful as an alternative to a biopsy.   

Advantages of the Fibroscan     

Regardless of the cause, diseases affecting the liver generally cause inflammation which destroys cells. After this, repair techniques naturally develop with a progressive accumulation of collagen fibre.  

Knowing the degree of fibrosis is useful for diagnosing as well as monitoring and checking any disease progression. In the past this was traditionally done by a liver biopsy. A biopsy involves removing a small sample of the liver to analyse it by puncturing the skin or via the intrahepatic (transjugular) veins.

Despite having been the most widely used technique, a liver biopsy has its drawbacks. The patient must be at the hospital for between 12 and 24 hours, and the assessment is not always easy to read as liver fibrosis distribution is vague and not homogenous.

Complications may arise from a liver biopsy, however, most are mild such as pain at the puncture site, around the liver area, or in the neck or shoulder. More serious complications may include haemorrhage, pneumothorax (collapsed lung), haemothorax, organ perferation, biliary peritonitis, and in very extreme but rare cases, death.     

How can you prepare for it?

The patient should fast for two hours before the test. Once there, they lie down with their right arm raised and placed behind the neck. A transducer or probe is used to measure, and a gel is used on the surface. As it is a non-invasive test, the patient will not feel any discomfort. There are larger scanners available for obese patients. At least 10 measurements are made.  

Why would you do it? 

Fibroscan is quite commonly used in patients who have been diagnosed with or are being monitored for hepatitis C (HCV), chronic hepatitis due to hepatitis B (HBV), a combination of hepatitis C and HIV, alcoholic liver disease, hepatic steatosis (fatty liver) non-alcoholic, chronic cholestatic diseases, liver cirrhosis, and monitoring for pre- and post-liver transplant patients.   

What would a “bad” result mean?

Cases of non-alcoholic fatty liver disease and fatty liver are on the rise in the UK. An increase in the number of new cases is expected due to population diet changes and the increase in metabolic syndromes linked to obesity, high blood pressure, diabetes, and dyslipidaemia (increase in cholesterol and triglycerides).

As well as measuring fibrosis and the CAP (Controlled Attenuation Parameter), the fibroscan is able to quantify liver fat content, which is crucial for early diagnosis.

The test allows the physician to find out the stage of the liver fibrosis (hardness), from a mild stage to a more advanced stage (cirrhosis).

Who performs a Fibroscan?

Fibroscan tests are largely performed by hepatologists and gastroenterologists.

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 is it?

A food intolerance test is a diagnosing tool to identify whether your body is hypersensitive towards a certain food, which could cause an adverse reaction to your system.

Contrarily to food allergies, food intolerances don’t trigger an immediate reaction. The problems arising from food intolerances are caused by the inability of the body to correctly assimilate certain foods and to the irritation some foods may cause, such as headache, unexplained fatigue, indigestion, diarrhoea, swelling and other issues with the digestive process.

What does it involve?

There are several types of food intolerance tests. The most accurate ones are:

• Blood test: for testing for Coeliac disease and for gluten intolerance
• Hydrogen breath test: used to diagnose lactose intolerance. You'll be asked to blow up a balloon-like bag. You'll then be given a drink of lactose solution and your breath will be tested after roughly 30 minutes.

It has been demonstrated that other kinds of tests are not as reliable. Here are some other tests, whose reliability is limited:

• IgG4 tests
• Cytotoxicity test
• ALCAT test
• Vega testing
• MORA Bio-resonance
• Bioscreening
• Muscle testing
• Dria test
• Pulse test
• Biostrength test
• Hair follicle test
• Pulse test
• Sarm test
• Bio-resonance
• Electro-acupuncture
• Iridology
• Bio-resonance
• Auricular-Cardiac reflex
• Skin prick testing - this test was designed to detect food allergies, so it can’t be considered as valid for food intolerances.

What is these tests for?

These tests can identify the underlying cause for some physical problems and find out what therapy works best for you when it comes to treating present intolerances and preventing new ones in the future. You may be able to manage the intolerance by avoiding eating what’s causing the intolerance for a certain period of time and then starting to eat it again in the future in small amounts.

It is essential that you rely on the guidance of a dietician before deciding to eliminate completely a certain food from your diet. Such exclusion could lead to a nutritional deficit if you don’t substitute it correctly. You should be particularly wary of those who advise eliminating certain foods from the diet of children or teenagers who are still growing up.

How can I prepare for it?

The vast majority of the tests doesn’t involve any preparation but an empty stomach. If you need to take the hydrogen breath test, you’ll need to stop taking antibiotics, proton pump inhibitors and gastro-protective agents anywhere from 7 to 21 days before the test.

What does it feel like during the procedure?

None of the test is either dangerous or painful.

What would a “bad” result mean?

As we’ve mentioned before, some of these tests are unreliable and you may need some further testing to confirm or refute a result, since it may depend from several and uncontrollable factors.

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 halitosis?

Halitosis is a common problem characterised by an unpleasant odour on the patient’s breath. Normally, halitosis is caused by poor oral hygiene, with bacteria breaking down pieces of food trapped in the teeth and releasing foul-smelling gases. Halitosis can affect the patient psychologically, due to the stigma of bad breath, and can lead to problems in their social life.

What causes halitosis?

In most cases, the causes of bad breath are oral in nature. In some cases, the smell may originate from the nose, sinuses, throat, lungs, oesophagus, or stomach. Some common causes are:

• Poor oral hygiene – bacteria will build up in the mouth, attracted to pieces of food trapped in the teeth, and will release toxins and gases that cause the unpleasant smell.
• Gum disease
• Eating strong-smelling food, such as garlic and onions.
• Smoking
• Drinking alcohol
• Occasionally, certain illnesses or medications can also cause bad breath.

Can it be prevented?

Halitosis can be prevented with good oral hygiene:

• Thoroughly brush your teeth and gums twice a day
• Floss daily
• Clean your tongue regularly.

You should also book periodic check-ups with a dentist to ensure that your teeth and gums are healthy.

What is the treatment?

In most cases, improving oral hygiene is enough to eliminate bad breath, brushing your teeth and gums, flossing and cleaning your tongue as a daily routine.

Cutting down on or avoiding tobacco, alcohol or certain foods and drinks such as coffee may also be recommended.

If the halitosis is a consequence of a different pathology, such as gastro-oesophageal reflux disease or a H. pylori infection, you may be referred to a relevant specialist to deal with the cause.

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.

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 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 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 malnutrition?

Malnutrition is the result of following an unbalanced diet in which there is a lack of nutrients or the intake of nutrients is not proportionate. Malnutrition increases the risk of infection and disease.

What are the symptoms of malnutrition?

The main symptoms of malnutrition are:

• Major weight loss
• Loss of muscle mass
• Weak and brittle hair and nails
• Prolonged diarrhoea
• Tiredness and irritability
• Low mood and depression
• Longer healing time for wounds

What causes malnutrition?

Malnutrition can be caused by:

• Poor diet: either by not consuming enough food or nutrients or the opposite, by overeating.
• Mental health problems: anorexia or bulimia can lead to malnutrition.
• Mobility problems: some people may have limited mobility, making it difficult to buy or cook for themselves.
• Conditions of the digestive system: even if you follow a healthy diet, your body may not absorb the necessary nutrients correctly due to disorders of the digestive system such as IBS or Chrons. Coeliac disease can also damage the lining of the stomach and prevent the proper absorption of nutrients.
• Alcoholism: can cause gastritis and problems in the pancreas, which hinders the ability to absorb nutrients.
• Economic problems: in underdeveloped countries, food shortages and high prices prevent adequate nutrition.

Can malnutrition be prevented?

To prevent malnutrition in a child, it is recommended that the mother follow an adequate diet during pregnancy, prioritize breastfeeding and introduce foods according to the paediatrician's instructions. As an adult, it is recommended to follow a diet, balanced in all nutrients, vitamins and minerals. There should be a balanced intake of carbohydrates, fats, protein, vitamins and minerals.

How is malnutrition treated?

The treatment depends on the cause and the severity of the malnutrition. In principle, it consists of following a balanced diet, rich in the vitamins and minerals that the person lacks, or if malnutrition is caused by an underlying medical condition, this condition will be addressed and treated first.

Morbid obesity is also known as severe obesity or class III obesity. People are considered morbidly obese when their body mass index is above 40, or even 35 if the patient has a disease or severe disability as a result of being overweight. In many countries it is a public health problem due to the new eating habits of the society.

Morbid obesity can be treated with a low calorie diet and regular exercise. In extreme cases patients can have bariatric surgery.

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 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 are haemorrhoids?

Haemorrhoids, commonly known as piles, are swollen veins in the anus or lower part of the rectum. They are a very common ailment. Haemorrhoids may be either internal or external. External haemorrhoids generate protuberances in the ring of the anus on the outer side, making them easier to diagnose and can cause pain when sitting, in addition to traces of blood when defecating. On the other hand, internal haemorrhoids occur inside the anus causing bleeding in the stool and itching in the anal region.

What are the symptoms of haemorrhoids?

The main symptoms of haemorrhoids are:

• Bleeding from the rectum
• Anal itching
• Anal pain, especially when sitting
• Pain when passing stool
• Feeling one or more hard and tender bumps near the anus

What causes haemorrhoids?

Haemorrhoids occur due to increased pressure in the anus. They can be caused by:

• Effort during bowel movements
• Constipation
• Sitting for extended periods of time
• Pregnancy or childbirth

Can they be prevented?

To prevent haemorrhoids, it is necessary to avoid constipation. For this reason, it is important:

• To drink plenty of hydrating liquids
• Eat a diet rich in fibre
• Use stool softeners to prevent straining if you are constipated

How are haemorrhoids treated?

In the case of external haemorrhoids, the treatment consists of applying creams and warm water in the affected area. In cases of severe pain, you can take painkillers. As for internal haemorrhoids, surgical intervention may be necessary to remove them.

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 radiofrequency treatment?

Radiofrequency is a minimally invasive procedure which can be used to treat varicose veins. It is performed under local anaesthetic, and uses the application of heat to damage tissue, meaning scar tissue forms. This closes the varicose vein and cuts it off, meaning it is destroyed. This type of treatment can be used on large varicose veins.ç

Why undergo radiofrequency treatment?

Varicose veins can be considered unsightly by some, and many wish to have them removed. Varicose veins can also be painful and cause discomfort. Several types of procedure are available for the treatment of varicose veins, and different ones will be indicated depending on the patient and the size of the vein. As radiofrequency is able to destroy larger veins, it may be indicated in patients who have veins of significant size.

What does it involve?

The procedure is performed while the patient is awake, as a local anaesthetic is given to numb the particular area where treatment will be applied. Radiofrequency (an electrical current) is passed through a catheter injected into the vein, which heats up the vein wall and damages it. This causes the vein to close off.

Radiofrequency is generally a successful procedure, and the vein closes off in most patients. One advantage of radiofrequency is that it is less painful than traditional varicose vein surgery, which removes the vein itself.

Some side effects may include burns on the skin, pain after recovery, or clotting in the vein. However, these risks are minimal and usually get better over time.  

How to prepare for radiofrequency treatment

Before the treatment, a medical history will be taken to see if the patient is suitable, and where the procedure should be performed. Medication will also be discussed, and those who take aspirin or blood-thinners (such as ibuprofen) as long-term medication will be told to stop several days before the procedure.

Post-operative care

After the procedure, the surgeon places a dressing on the area which has been treated. This dressing must be worn for at least 24 hours. After these 24 hours are up, the patient then should wear compression stockings for at least two weeks. Some mild pain may be experienced, which can be relieved using over-the-counter painkillers.

A follow-up ultrasound will be taken around a week after the procedure, to check the vein is closed and to see if a deep vein thrombosis has developed. This occurs rarely but it is a possibility and it is important for the surgeon to check.

Patients are advised not to partake in strenuous activity for a few weeks afterwards, but light activity is encouraged and the patient will be able to return to work soon after the procedure. 

Rectal cancer is the formation of malignant cancer cells in the rectal tissues. Symptoms of rectal cancer include changes in bowel movements (diarrhoea or constipation) and blood in the stool.

What is it?

Sigmoidoscopy is a test to examine the rectum and the lining of your sigmoid colon - the lower part of your large intestine. It is carried out to see if there’s any potential abnormal growths of tissue, also known as polyps, or to see if there is a tumour in its early stage.

Using this test, the doctor can verify and (if need be) remove polyps which could grow to become tumours at the same. It has been estimated that sigmoidoscopy can lower your chances of developing large intestine cancer by 45%.

What is it for?

You may need to have a sigmoidoscopy if you are having persistent diarrhoea (with traces of blood or mucus in your stool), changes to or irregular bowel habits, persistent abdominal pain or possible chronic anaemia.

What does it involve?

Sigmoidoscopy involves passing a very small, flexible endoscope (about 1 cm thick) through the anus. The endoscope has a camera and a light at its end. The probe allows the gastro-enterologist to accurately examine the internal lining of the intestine. Your doctor will be able to see if there are any polyps and take a small tissue sample for further analysis. The test takes around 10 minutes in total.

How can I prepare for it?

Preparing for this procedure is quite simple. To make sure the doctor has a clear view of your colon, it must be completely empty, so that any polyps or lesions will be clearly visible. You may have to take an oral laxative the night before or up to six hours before the exam. You can usually eat light soups and drink water before the operation as these will not interfere with the test.

What does it feel like during the procedure?

Sigmoidoscopy doesn’t usually require any anaesthetic, as it will only cause a mild discomfort. You may be prone to pain due to some potential anatomical peculiarities, such as a very long intestine, scarring due to previous surgery or inguinal hernia. In this case, your doctor will give you something to relive the pain.

Once the test is over, you can go back home without any problems. There may be some side effects, such as some bloating or abdominal cramps. However, these symptoms should not last more than a couple of hours.

Serious complications from sigmoidoscopy are extremely rare (less than 1%) and may involve bleeding or perforation caused by the probe.

What would a “bad” result mean?

At the end of the test, your doctor will be able to give you a result. If nothing suspicious is found, you won’t have to repeat the exam.

However, if the doctor found polyps, they will either be removed during the procedure, or a histological examination will be carried out on a tissue sample collected during the exam. After a couple of weeks, your results will be ready. If the doctor needs to know more, you may be asked to undergo a colonoscopy.

Finally, if a tumour is found, you will be immediately referred to a surgeon.

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 stereoscopy?

Stereoscopy or stereoscopic imaging is a technique used to collect three-dimensional (3D) images and create the illusion of depth through the stereographic image or stereogram. Two slightly offset images are shown separately to each eye of the viewer. Both images are the same but from a slightly different angle or perspective. The brain is then tricked into thinking that the two flat images shown together are one image in 3D. Special eyewear (polarized glasses) or liquid crystal shutter glasses are needed for the brain to make sense of the picture.

What does it consist of?

There are three ways that stereoscopy can be done.

• Two images can be shown separately and shutter glasses used to filter the image so that the correct eye sees it.
• Both images are superimposed on each other and polarized glasses are used to combine the images.
• Each image is shown directly into each eye, without the need for glasses, done using a parallax barrier on a screen, allowing both eyes to see different images.

Why is it done?

Stereoscopy can be applied to several fields. In the case of medicine, it helps to visualize the width, length and depth of images of the interior of the body from images obtained by CT or Nuclear Magnetic Resonance, both for teaching or research and for diagnosis and intervention.

Stereoscopy helps to reliably detect foreign bodies and abnormalities, expanding the information that a traditional radiograph would provide. Stereoscopes are used by optometrists, ophthalmologists and visual therapists to diagnose and treat binocular vision and visual disorders.

Meaning of abnormal results

If abnormalities are found after stereoscopy, your doctor will go over the results with you and advise you on the course of treatment needed for your particular case.

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 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.