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.
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.
A colonoscopy may be performed for various reasons:
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.
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.
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.
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.
A capsule endoscopy is a minimally invasive method of examining the digestive system. It’s a breakthrough in the study of the digestive system due to its capacity to allow specialists to observe and diagnose injuries and conditions of the entire digestive tract, not only a part of it.
Unlike a gastrointestinal endoscopy (in which a flexible tube with a camera is inserted through the mouth), a capsule endoscopy does not cause discomfort or risk of injury. However, a gastrointestinal endoscopy provides the opportunity to take biopsies or perform some treatments during the examination. This is not possible with a capsule endoscopy.
Before taking an endoscopic capsule, patients are required to go through a fasting period. The length of this fasting period will be specified by a doctor.
A capsule endoscopy simply involves swallowing a small capsule with a micro-camera inside it. This camera transmits images of the digestive tract while it passes through it. The capsule will move through the body due to natural contractions in the digestive system and will eventually be expelled naturally through the anus one to two days later.
The endoscopic capsule is used to diagnose or evaluate the following conditions:
Your specialist will likely recommend the following:
The person taking the capsule won’t be able to feel it inside them. Instead, they will feel the same as they normally do.
If the images from the capsule don’t identify any conditions or problems, the digestive system will very likely not have the condition in question. Sometimes, results show that the patient has Crohn's disease, intestinal bleeding, neoplasms, anaemia or other conditions.
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).
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.
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.
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:
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.
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.
Irritable bowel syndrome (IBS) is a functional disorder of the large intestine.
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.
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.
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.
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:
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.
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
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
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.
Dr John Martin graduated from Cambridge University and King’s College Hospital, London in 1990 and completed his gastroenterology training within North West London. He is a highly-experienced gastroenterologist and endoscopist based in London and holds an NHS Consultant post at Imperial College (ICL). He is an expert in colorectal cancer screening, therapeutic and diagnostic colonoscopy and has 25 years experience of managing all aspects of gastroenterology including abdominal pain or discomfort, reflux disease, diarrhoea and constipation, rectal bleeding, Irritable Bowel Syndrome, Crohn’s Disease and Ulcerative Colitis.
Dr Martin teaches colonoscopy both within the NHS Trust and also at national screening centres. He is a bowel cancer screening accredited colonoscopist and an examiner for BCSP colonoscopy accreditation.
Dr Martin is Director of the West London Bowel Cancer Screening Centre, he is the national advisor to Public Health England on endoscopy within the Bowel Cancer screening service and chairs the national advisory committee on quality and safety of endoscopy within screening. He forms an integral part of numerous other professional bodies and has been widely published in peer-reviewed journals.
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:
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:
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.
Different tests can be carried out to determine the cause of abdominal pain:
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:
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.
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:
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.
Gastroesophageal reflux disease (GERD) is a digestive disorder where acid from the stomach leaks back into the oesophagus and causes irritation and discomfort. It usually occurs because of weakness in the lower oesophageal sphincter, the ring of muscle between the oesophagus and stomach. If left untreated it can lead to symptoms such as chest pain and trouble with swallowing.
Many people, including pregnant women, suffer from acid reflux that is caused by GERD. The severity of GERD depends on the dysfunction of the sphincter and the type and amount of fluid brought up from the stomach. GERD can be relieved through diet and lifestyle changes but in more severe, persistent cases may require surgery.
The symptoms of gastroesophageal reflux may include:
Gastroesophageal reflux is caused when there is a repeat occurrence of acid reflux. A circular band of muscle (sphincter) around the bottom of the oesophagus usually relaxes to allow food to pass into the stomach. If it becomes weak, the stomach acid can flow back up into the oesophagus. The backwash of acid irritates the lining of the oesophagus, which causes it to become inflamed.
Risk factors that may increase the risk of GERD include obesity, pregnancy and connective tissue disorders, whereas factors such as smoking, eating late at night, or indulging in foods that are fatty and fried can also aggravate acid reflux.
Lifestyle and dietary changes should be implemented. The condition is prevalent in those who are overweight or obese as excess weight puts more pressure on the stomach. It is recommended to steadily lose weight.
You should also recognise which foods and drink trigger flare-ups of GERD. It’s recommended to avoid greasy foods, citrus fruit juices, fizzy drinks, caffeine, onions and alcohol. You can try eating smaller meals and avoid lying down after you have eaten.
Smokers should also consider quitting as it damages the lower oesophageal sphincter, and when these muscles weaken it can lead to more frequent heartburn episodes.
It may be recommended to first treat symptoms of GERD with over-the-counter medications such as antacids that neutralise the stomach acid. Medications such as H2 receptor blockers reduce acid production. Proton pump inhibitors can block acid production and give the oesophageal time to heal.
If medications do not work in the long term, your specialist may recommend surgery with either of the procedures, fundoplication or LINX device.
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.
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:
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.
Early diagnosis and effective treatment of acid reflux or GORD can significantly reduce the risk of Barrett's oesophagus developing.
The first line of treatment for Barrett’s oesophagus involves managing the symptoms of acid reflux. This may involve the following measures:
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:
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.
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
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
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.
Blood in your stool can signal that there is an issue somewhere along the gastrointestinal tract. Usually, it’s caused by non-cancerous conditions and isn’t a cause for worry. However, visiting a doctor is necessary to rule out more serious conditions.
Blood in your stool can be the following:
Blood in stool is most commonly a sign of non-cancerous conditions such as
However, it can also be a symptom of bowel or rectal cancer.
In order to rule out any serious cause for concern, you should visit your GP or a gastroenterologist as soon as possible. Based on the cause of rectal bleeding, they will be able to provide you with treatment options.
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%.
The main symptoms of colorectal cancer include:
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.
This condition can be diagnosed with exams such as colonoscopy, sigmoidoscopy, or a colorectal X-ray scan.
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.
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.
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.
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.
Screening aims to determine whether healthy people show any early signs of bowel cancer. Bowel cancer is a common form of cancer for men and women, with approximately 1 in 20 people experiencing it in their lifetime in the UK. Detecting early signs of risk for bowel cancer can ultimately save lives. Bowel cancer in its early stages is more likely to be treated successfully.
In the UK, people over the age of 60 are invited to be screened. Following this, you are invited every two years for screening until the age of 75. Screening involves home tests that detect blood in the stool. If you are registered with a GP in the UK, you will automatically be sent this home test after the age of 60.
Additionally, at age 55 you are invited for a one-off bowel scope screening test (also known as a flexible sigmoidoscopy) where a thin tube with a camera is used to examine the inside of the bowel. This test can detect polyps, which are small growths that could eventually turn into cancer. If polyps are detected, they can be removed.
Bowel cancer screening is offered because it can save lives by detecting early signs of bowel cancer, or your possible risk of developing it. The earlier it is detected, the more successful treatment is likely to be.
For the bowel scope screening, a few weeks before the appointment you will be sent a small plastic pouch containing liquid to perform an enema before the test, as well as instructions on how to do this. On the day of the test you will need to use the enema kit. This will induce a bowel movement before the test. You will also need to wear a hospital gown for the test.
For the home test kit, no preparation is required.
During a bowel scope screening, the camera tube is inserted gently into your bottom to check for polyps. This test is painless, but you might find it slightly uncomfortable. No anaesthesia is required. The test lasts just a few minutes and you return home soon after the test is finished.
The home test kit is for sending a small poo sample to be tested in a laboratory. You will receive instructions on how to take a stool sample with the kit.
Following the bowel scope test, if polyps are found you are told immediately following the test. If polyps are found and removed but are not cancerous you might also be offered a colonoscopy to check for polyps elsewhere in the bowel. If cancerous polyps are found and removed, you will be referred to a bowel cancer specialist to discuss treatment.
A normal result from a home test kit would indicate no blood in your stool, with no further action required other than another home test kit in two years’ time. If blood is found in your stool sample you will be offered a colonoscopy to do a more thorough investigation.
A capsule endoscopy is a minimally invasive method of examining the digestive system. It’s a breakthrough in the study of the digestive system due to its capacity to allow specialists to observe and diagnose injuries and conditions of the entire digestive tract, not only a part of it.
Unlike a gastrointestinal endoscopy (in which a flexible tube with a camera is inserted through the mouth), a capsule endoscopy does not cause discomfort or risk of injury. However, a gastrointestinal endoscopy provides the opportunity to take biopsies or perform some treatments during the examination. This is not possible with a capsule endoscopy.
Before taking an endoscopic capsule, patients are required to go through a fasting period. The length of this fasting period will be specified by a doctor.
A capsule endoscopy simply involves swallowing a small capsule with a micro-camera inside it. This camera transmits images of the digestive tract while it passes through it. The capsule will move through the body due to natural contractions in the digestive system and will eventually be expelled naturally through the anus one to two days later.
The endoscopic capsule is used to diagnose or evaluate the following conditions:
Your specialist will likely recommend the following:
The person taking the capsule won’t be able to feel it inside them. Instead, they will feel the same as they normally do.
If the images from the capsule don’t identify any conditions or problems, the digestive system will very likely not have the condition in question. Sometimes, results show that the patient has Crohn's disease, intestinal bleeding, neoplasms, anaemia or other conditions.
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.
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.
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.
There are many things that could cause diarrhoea, the most common are:
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 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.
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.
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.
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:
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.
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.
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.
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.
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.
The types of colitis are categorised by what causes them. Some of the different types include:
The most common causes of colitis include:
The symptoms of ulcerative colitis may include:
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.
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.
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.
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.
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.
A colonoscopy may be performed for various reasons:
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.
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.
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.
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.
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.
The key symptoms of constipation are:
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.
There are many possible causes of constipation in adults, and sometimes there is no obvious cause.
Common causes include:
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:
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.
In most cases, lifestyle changes will resolve the problem:
If these measures don’t work, the doctor may recommend laxatives to help stimulate bowel movements.
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.
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.
When Crohn’s disease is active, typical symptoms include:
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.
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:
Other risk factors that may contribute include:
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:
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.
Diarrhoea is characterised by a greater fluidity and volume of bowel movements. These stools can sometimes contain blood, mucus, pus and undigested food.
When diarrhoea lasts for many days, it can be a sign of a more serious problem. Chronic diarrhoea that lasts for at least four weeks can be a symptom of a chronic disease.
The main symptoms of diarrhoea, in addition to greater fluidity and volume of the stools, are:
If the cause of the diarrhoea is due to a virus or bacteria, other symptoms such as fever, chills and blood in the stool may appear.
In addition, diarrhoea can cause dehydration.
The most common causes of diarrhoea are:
Sometimes a specific cause is not found. If the diarrhoea disappears after a couple of days it is generally not necessary to investigate further.
Two types of diarrhoea can be prevented: rotavirus diarrhoea and traveller’s diarrhoea. In the first case, there are vaccines available for rotavirus. As for traveller’s diarrhoea, it is important that when travelling, we are careful with the food and beverages we consume in certain countries or in certain regions. Speak to your doctor before going on holiday for advice on avoiding traveller’s diarrhoea. It can help to avoid eating raw fruits and vegetables, and to only drink bottled water.
The main objective of the treatment for diarrhoea is to replenish fluids and electrolytes lost due to dehydration. Depending on the cause, your GP or specialist may prescribe a pharmacological treatment to either stop the diarrhoea or treat the infection.
The digestive system is a tube made up of the mouth, oesophagus, stomach, small intestine and large intestine, which leads to the back passage. It also contains organs such as the liver, gallbladder, and pancreas.
Each part of this system has a different purpose, such as breaking down food, absorbing nutrients, or removing toxins or alcohol.
A digestive disease, or disorder, involves something going wrong with one of the organs in this system.
Digestive diseases can include:
Symptoms of a digestive disease can include:
A gastroenterologist is a type of consultant who specialises in diseases in the digestive system. Depending on your condition, however, they may not be able to make a diagnosis on their own, and may refer you to other specialists, such as radiologists, to conduct further tests.
Diverticular disease is characterized by the presence of diverticula in the colon wall, due to an increase in intraluminal pressure. Diverticula are pockets that usually form on the left side of the colon walls, although it can occupy the entire colon. When an increase in intraluminal pressure produces a pulse of the muscosa occurs through colonic muscle layers in their weak points, which correspond to the points where the neurovascular bundles penetrate. In most cases, diverticular disease have no symptoms, and only when there is bleeding or complications may appear diverticulitis. Diverticulitis (that is infection of the diverticula) in turn can cause abdominal pain, fever and chills. More serious complications can even cause an ruputura or fistulae that require surgery. The treatment of diverticular disease is essential and based on regular consumption of dietary fiber. In the case of diverticulitis, treatment should be done by antibiotics (oral or intravenous), restrictions on food and stool softeners.
Dysmotility is a series of related conditions in which the muscles of the digestive tract or the nerves that control them do not work as they should, meaning that the rate at which food passes through the digestive system and the rate at which waste is excreted is abnormally slow or irregular. Bowel dysmotility can lead to some unpleasant digestive symptoms, such as diarrhoea, constipation, bloating, cramping and abdominal pain. The symptoms that appear depend on which part of the digestive tract is affected. Multiple areas of bowel can be affected and the problem can be progressive.
Dysmotility of the stomach is also known as gastroparesis and that of the large intestine is known as slow transit constipation.
Patients with dysmotility in the upper digestive tract (i.e. the oesophagus and stomach) may experience:
Dysmotility of the small intestine can cause:
Some of these problems may be because of altered gut microbes (small intestinal bacteria overgrowth and small intestinal fungal overgrowth (SIBO/SIFO))
Dysmotility in the lower digestive tract (colon and rectum) can cause:
Dysmotility is caused by dysfunction in the nerves and/or muscles in the organs that make up the gastrointestinal (GI) tract. This may be caused by an underlying illness, such as:
Dysmotility can also be caused by certain medications and inflammatory conditions such as coeliac disease can also cause a certain degree of dysmotility.
In other cases, there is no known cause, and dysmotility is the primary diagnosis. Examples include:
The treatment depends on the type and cause of the dysmotility. First, a mechanical blockage must be excluded.
Many causes of dysmotility cannot be cured, meaning that treatment is focussed on the symptoms rather than the cause. This may involve dietary changes, medications to stimulate intestinal movements, or manipulation of the gut microbes. Only very rarely is surgery indicated and even then results are unpredictable.
Bowel dysmotility is managed by neurogastroenterologists. This is a specific subset of gastroenterologists or gastrointestinal surgeons who have had specialist training in this field.
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:
The symptoms of dysphagia may include:
Normally, dysphagia occurs secondary to another disease or injury, such as:
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.
A speech-language specialist will try to determine the problem. The patient will take a:
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.
Endoscopic mucosal resection (EMR) is a technique used to remove precancerous growths, early-stage cancer, and other abnormal lesions from the lining of the digestive system.
Patients will be given a sedative to prevent pain, the strength of which depends on the patient and procedure. For EMR of the upper digestive tract, a local anaesthetic will be delivered via a spray to numb the throat and oesophagus.
EMR is a less-invasive option than open surgery, and can be the safest option to remove early-stage cancer or other abnormalities in the digestive tract lining. It can also be used to take tissue samples to help the doctor diagnose the problem, and if the patient has cancer, EMR can help the doctor to know if the cancer has spread to deeper tissues.
Some conditions endoscopic mucosal resection can be used to treat include:
Endoscopic mucosal resection may be performed from the upper or lower end of the digestive tract, depending on the location of the cancer or growth. A long, narrow tube fitted with a light and video camera (an endoscope) is inserted into either the mouth (to reach the oesophagus, stomach, or upper part of the small intestine) or the anus (to examine the colon).
To remove tissue, the doctor inserts instruments through the endoscope.
You will have to provide your medical history and details of any medication you use to the doctor before having EMR. You will be instructed not to eat or drink anything from several hours before the procedure, and you may not be able to take certain medication during this time either, as it may interfere with the sedatives you will be given.
The patient remains in the hospital until the effects of sedation have worn off. The doctor will provide instructions on when they can start eating and drinking again. While most patients go home on the same day, it is advised that someone takes them home, as it is not advisable to drive.
A follow-up appointment will be made to discuss the results of the EMR, and several months after, another endoscopy will be performed to ensure the whole lesion is gone.
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.
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.
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.
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.
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.
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.
When the body’s immune system reacts unusually to specific foods, it is called a food allergy. The body mistakenly produces an antibody when a specific food that triggers the allergy has been consumed. The antibodies start a process that releases histamine for the body to fight what it thinks is invading it. Finding out which foods are causing the symptoms can be more difficult for some people. Food allergies can take a while to diagnose.
An allergic reaction to food can happen within minutes, or it may happen hours later. The most common signs of a food allergy include:
Sometimes the symptoms can be life-threatening and this type of reaction is called anaphylaxis. If someone is severely allergic to certain foods, they need to have an epinephrine (adrenaline shot) as soon as possible.
Any foods can cause allergies but the most common ones to do so are:
It is advised to keep a food diary so that the doctor can look for any trigger foods. A food elimination diet can help in seeing if the reaction goes away. Following an elimination diet, oral food challenges can be held under medical supervision. The patient may have a radioallergosorbent blood test to see how many antibodies that their immune system makes. There is also an allergy skin test, called a scratch test.
It is recommended to stay away from foods that cause the food allergy. Mild allergies will go away without needing to be treated. Antihistamines can help to reduce some skin allergies and other itchy symptoms. In more serious cases, corticosteroids will reduce swelling. In dangerous cases, an epinephrine injection can reverse symptoms.
A specialist can suggest what works as a healthy and nutritious diet. It is important to check the labels and ingredients in processed foods. If prone to allergic reactions then a doctor will prescribe an epinephrine injection kit, which should be carried with the person at all times.
Food allergies and intolerances may have similar symptoms but are different conditions. Intolerances can cause a person to fell ill, whilst a food allergy can make someone feel unwell but can also mean a life-threatening reaction. A food intolerance means that the body cannot digest the food that is eaten or that the digestive system has become irritated. Symptoms include bloating, nausea, gas, abdominal pain and diarrhoea. A food allergy is when the body’s immune system sees food as an invader, which releases the histamine causing reaction symptoms such as breathing problems, swelling, a drop in blood pressure and vomiting.
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.
Gastrointestinal haemorrhage can be detected with the presence of blood in the stool, although other symptoms may occur:
Gastrointestinal haemorrhage can be caused by a number of conditions, some of which are minor, such as:
More serious or long-term conditions which can cause bleeding include:
In some cases, bleeding can be a sign of a cancerous condition such as:
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:
Gastrointestinal haemorrhage may require immediate primary attention. Emergency treatment may involve:
Once the condition is stabilised and your blood levels have returned to normal, treatment will depend on the cause of the bleeding.
A gastrointestinal endoscopy, also known as gastroscopy or digestive endoscopy, is a test that is used to diagnose and treat diseases of the upper digestive system. The upper digestive system comprises of the oesophagus, the stomach and the duodenum (the first part of the small intestine).
An gastrointestinal endoscopy is carried out with a tool called an endoscope. This is a thin and flexible tube with a camera, and sometimes a light, at the end. The endoscope is inserted through the mouth and the images captured are displayed on the monitor in real-time as the endoscope advances in the body and/or recorded.
Other tools can be placed inside the endoscope. This means that specialists can perform other tests (such as a biopsy) or perform treatments (such as the removal of polyps and cauterization of bleeding blood vessels) at the same time.
The procedure lasts around 15-30 minutes. However, in the event that something unexpected is found, or a quick treatment or biopsy has to be taken, it can last longer.
There are several reasons why a digestive endoscopy may be performed:
Aside from being used as a diagnostic tool, digestive endoscopies can be used for other purposes:
Consumption of food or drink should be avoided in the eight hours prior to the procedure. Also, some patients may be told by their specialist to stop taking their regular medication.
The patient won’t be given any medication before the procedure. However, sometimes a local anaesthetic may be applied to the throat to reduce possible nausea.
Occasionally, intravenous sedation will be administered to relax the patient.
Gastrointestinal endoscopy is a painless procedure and can sometimes only last between three and five minutes. Despite not being painful, it is likely that the patient will notice some discomfort and may feel constant nausea while the endoscope is inserted.
Once the examination is finished, the patient will feel discomfort and numbness in their throat. They may feel like they have excess gas due to ingested air, but this will disappear quickly.
The digestive endoscopy procedure is quite a safe test and complications appear scarcely. The possibility of complications increases the moment the endoscope is used to perform a type of treatment.
Possible complications are:
Thanks to endoscopies, problems that previously required surgical intervention can be diagnosed and treated without it.
In parts of the digestive tract where the gastrointestinal endoscope cannot reach, there is the capsule endoscopy, in which a tiny camera is ingested like a pill. This transmits images of the digestive system to a monitor and leaves the patient without any discomfort.
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.
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.
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.
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.
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 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.
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.
H. pylori is characterised by the following symptoms:
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.
This bacterium is transmitted through direct contact with an infected person. The infection can be passed on by:
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.
The treatment for H. pylori includes:
Indigestion, also medically referred to as dyspepsia, is a pain in the upper abdomen that occurs particularly after eating. It’s a very common condition that can be alleviated by taking medication to reduce heartburn and protect the stomach. Sometimes, indigestion is related to stress, alcohol consumption, smoking, consuming too many high-fat foods or eating too quickly. The discomfort felt from indigestion can be alleviated if healthy habits are acquired.
The prognosis of indigestion is most often positive and without major consequences. However, in many cases, it evolves into a chronic disease and may appear and disappear intermittently over the years. On rare occasions, it originates from serious diseases with a negative prognosis.
The most common symptom is discomfort in the upper abdomen, which usually manifests during or after meals. This pain can be described as a warm or burning sensation in the area between the navel and the lower part of the sternum. In addition, to the sensation of annoying swelling at the beginning of meals or after. These discomforts aren’t related to gastric acidity since it’s symptoms usually begin in the chest and can be transmitted to the neck or throat.
When diagnosing indigestion, specialists resort to two tests:
There is great general uncertainty about the exact causes of dyspepsia. In some cases, the symptoms occur after a large meal or having taken medications that cause some damage to the gastric mucosa, specifically via taking too many aspirin or anti-inflammatory drugs. Some psychological problems such as stress, anxiety or depression can be triggers. There are cases in which patients suffer an ulcer in the stomach in the area of the duodenum, mostly caused by a bacterium called Helicobacter pylori.
The most common causes of dyspepsia are:
There are some habits that can help to prevent the condition such as avoiding stress and exercise immediately after eating and chewing food well. In patients who have previously suffered episodes of indigestion, it’s advisable to avoid taking some medications such as acetylsalicylic acid and some anti-inflammatories on an empty stomach. Speak to your specialist for individual advice.
There are various types of treatments that the specialist may indicate:
Doctors who specialize in digestive diseases, such as gastroenterologists, treat indigestion.
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).
Iron is an important mineral needed by the body, particularly for processes involving oxygen. The principal biological use of iron in humans is as a constituent of haemoglobin – the protein found in red blood cells that binds to oxygen. Haemoglobin enables the red blood cells to transport oxygen around the body and deliver it to the cells that need it. In short, iron is essential to keeping us alive.
Iron deficiency is when the body does not have enough iron, either because the need for iron has increased, or because the intake or absorption of iron has fallen. This shortage of iron means that the body can’t make as many red blood cells (anaemia), and, as a result, less oxygen can be carried by the blood. The ultimate consequence is that the rest of the cells in the body are running on a reduced amount of oxygen.
Iron deficiency anaemia is one of the most common forms of anaemia, and iron deficiency is also one of the most common nutritional deficiencies.
Most of the symptoms of iron deficiency are related to the associated anaemia. The shortage of iron means a shortage
of oxygen reaching respiring cells, and this means the body can’t function at full capacity. Typical symptoms include:
Iron deficiency can also affect memory and mental function, particularly in teens, while appetite may be affected in some patients (usually young children with iron deficiency anaemia).
Another strange symptom that has been reported in a number of cases is ‘pica’. This refers to unexplained cravings for strange foods or non-food items.
There are several causes of iron deficiency. Most involve blood loss of some description. It is possible to develop iron deficiency simply through a lack of iron in the diet, but this is very unlikely unless the patient is pregnant. However, this will increase the risk of iron deficiency when coupled with one of the following other causes:
Any other condition or incident that causes blood loss could lead to iron deficiency, even if only temporarily, for example, after giving blood, or losing blood due to trauma.
Treatment usually involves taking iron supplements and/or eating more iron-rich foods, such as red meat, fish, dark green leafy vegetables, beans, pulses, brown rice and eggs. However, in some cases this will not be enough, and the underlying cause will have to also be addressed. It is important for the doctor to monitor the patient, taking more blood tests after a few weeks to see if haemoglobin levels are returning to normal levels.
Irritable bowel syndrome (IBS) is a functional disorder of the large intestine.
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.
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.
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.
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:
The oesophagus is part of the digestive system and it connects the mouth to the stomach. The mouth and the oesophagus are separated by cardia, which is a type of valve that aims to prevent gastric juices go up to the mouth once they have passed through the stomach.
The term oesophagitis is used when the oesophageal mucus is inflamed, with an additional layer covering it. The mucus quite often becomes irritated or inflamed.
Oesophagitis may be caused by several factors, most of which respond well to treatment. When oesophagitis is not treated, it can cause structural changes to the oesophagus which interrupt its normal function. Some complications may include:
Oesophagitis symptoms include:
Many oesophagitis symptoms are caused by a variety of symptoms that affect the digestive tract. However, the patient should see a specialist in the following cases:
When the patient sees the specialist, they will ask a series of questions and carry out a physical exam. There are certain tests to detect oesophagitis:
There are risk factors that increase the chances of having gastroesophageal reflux. They include:
There are many causes for oesophagitis:
The simplest way to prevent oesophagitis is to stop or reduce consumption of certain foods and consume others which are healthier.
The treatment for oesophagitis mainly focuses on reducing symptoms and managing complications.
Reflux oesophagitis:
Eosinophilic oesophagitis:
Drug-induced oesophagitis: treatment focuses on avoiding the medication that has caused the issue:
The specialists who study and treat oesophageal issues and digestive diseases are generally gastroenterologists.
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.
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.
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:
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.
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 (clumps of cells) that appear as small bumps mostly on the inner lining of the large intestine (colon) or on the rectum (anus). It is also possible to develop polyps in the ear canal, cervix, stomach, nose and uterus.
Some people may develop only one whilst others can develop two or more at a time. They can either be on a stalk and therefore have the appearance of a mushroom or appear much flatter and have a broad base.
Polyps are usually non-cancerous (benign) but in some cases, and if left undetected, they can eventually become cancerous (malignant). They are very common and it is unusual for them to occur in anyone below the age of 40. They most often occur in people over the age of 60.
The symptoms of the polyp depend on the location. Some of these may include:
The causes of polyps depend on the location. Some known causes include a mutation in the genes of the cells, a cyst, a tumour, inflammation, chronic stomach inflammation and a foreign object.
Risk factors for polyps include smoking and drinking excessive alcohol, having a family history of polyps and cancer, obesity and conditions that are not managed well such as type 2 diabetes or Crohn’s disease.
The specialist will perform a physical examination and ask questions about your medical history. They will use imaging tests like X-rays, ultrasound or a CT scan to have a better look at the infected area.
If the doctor suspects that the polyp is cancerous, they may perform a biopsy. If the polyp is in the colon, a colonoscopy may be required to give the doctor a better image and they will be able to remove them.
Not all polyps require treatment as they are benign and, for example, in cases of throat polyps, they typically go away on their own. Polyps may be surgically removed with a procedure called polypectomy to further prevent them from developing into cancer.
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.
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%.
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.
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.
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.
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.
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.
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:
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.
Initial symptoms of stomach cancer can include:
Advanced cancers may have the following symptoms:
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:
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:
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.
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.
A multi-disciplinary team will treat stomach cancer, made up of gastroenterologists, surgeons, medical oncologists and clinical oncologists.
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.
Withh treatment and dietary changes (having a balanced diet, not smoking, reducing alcohol consumption) symptoms normally improve over time.
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:
A gastric ulcer can also cause other less common symptoms:
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.
The gastric ulcer sore is formed when the stomach is exposed and vulnerable to its own acidity. This can be caused by different things:
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).
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.
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:
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.
The specialist who treats gastric ulcers is a gastroenterologist.
Ulcerative colitis is a condition where the large intestine and rectum become inflamed and eventually produce ulcers. It is a type of inflammatory bowel disease, along with Crohn’s disease. Inflammatory bowel disease affects more than 620,000 people in the UK .
Ulcerative colitis is a long-term condition, which means it can’t be cured. Instead, treatment focusses on managing the symptoms, and achieving “remission”, where no symptoms occur.
This doesn’t mean that symptoms can’t come back – ulcerative colitis is a fluctuating condition involving “flare-ups” (see below).
The main symptoms of ulcerative colitis include:
Ulcerative colitis is characterised by “flare-ups”, where symptoms worsen for a period of time, and you can experience symptoms in other parts of the body. These can include:
Everyone experiences ulcerative colitis differently. With the right treatment and self-management, some people can experience long periods of “remission” where you only experience mild symptoms, or even none at all.
Diagnosis will usually involve a combination of:
Sometimes the doctor might need to do an X-ray to check if there are serious complications, but this is much less common.
It’s not clear exactly what causes ulcerative colitis. Many health professionals now think that it could be an autoimmune condition, involving the immune system mistakenly attacking healthy cells. This may be triggered by an infection in the large intestine.
However, other factors appear to play a role:
Ulcerative colitis therefore seems to be caused by a combination of genetic and environmental factors.
Treatment for ulcerative colitis includes lifestyle and diet changes, medication, and in very rare cases, surgery.
For some people, making changes to their diet can help control the symptoms and reduce the frequency of “flare-ups”. Some helpful changes can include:
Your doctor may prescribe a combination of drugs to achieve different goals, including:
Surgery is generally only recommended when a patient hasn’t responded to medication, or are experiencing severe flare-ups that significantly affect their day to day life.
Surgery will involve removing the colon, and replacing its function with an ileostomoy or ileo-anal pouch. This results in a complete cure of the condition.
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