Whether you are battling recurrent heartburn, irritable bowel syndrome (IBS) or inflammatory bowel disease (IBD), or you’ve been diagnosed with a serious gastrointestinal condition such as Crohn’s disease, Novomed’s gastrointestinal (GI) specialist is here to help. As is the case across all of Novomed’s centers, our doctor will take a patient-centered approach and work with you to determine your best course of treatment. Conditions most often treated at Novomed in Dubai include gastroesophageal reflux disease (GERD/GORD) and Barrett’s esophagus. Tests offered in Dubai include the fecal occult blood (FOB) test (or FOBT) and bowel cancer screening by scope.
This is a specialized area of medicine focusing on the gastrointestinal (GI) tract. Common ailments that a gastroentorologist might work with include:
- hepatology diseases (the diagnosis and treatment of diseases of the liver, pancreas, gallbladder and biliary tree )
- pancreatic disease
- gastrointestinal cancer
- endoscopic surveillance
- inflammatory bowel disease, or chronic inflammation of your digestive tract
- reflux oesophagitis, commonly due to gastroesophageal reflux disease
- colon cancer
- irritable bowel syndrome
- polyps, or growths, which typically occur in the large intestine
- jaundice, or a yellowing of the skin
Most of us will experience some sort of gastrointestinal discomfort ̶ constipation or heartburn, for example ̶ at some point in our lives. We can usually learn to predict and manage these symptoms with over-the-counter medication or changes to our lifestyle. There are more serious conditions, though, that need specialized care because of their debilitating symptoms and/or the risk they pose to our long-term health. Our Novomed specialists care for a wide range of common gastrointestinal and liver-related problems, such as as heartburn, diarrhea and rectal bleeding, as well as assisting in weight loss. They also do screening for complex conditions such as Barrett’s esophagus or bowel cancer and testing for abnormal liver functioning (fatty liver).
Symptoms that might lead a doctor to refer you to an gastroenterologist include the following:
- abdominal pain
- unexplained blood in your stool
- unexplained difficulty swallowing
- Loss of appetite or weight
- Heartburn (acid reflux)
- Abdominal pain or bloating
- Esophageal pain
- Excessive gas or belching
- Bowel movement urges that are hard to control
- Change in bowel habits
- Pale-colored stools
- Dark urine
If you’re over 50, you might want to see a gastroenterologist for screening, as the risk for colon cancer increases after this age for both men and women.
In addition to an interview including your medical history, our gastroentorologists have several diagnostic tools at their disposal to make their diagnosis. Examples of the tests they use are:
- abdominal ultrasounds
- Bowel cancer screening
Gastroesophageal reflux describes a situation where the stomach’s contents return back up into the esophagus, causing discomfort. When everything is working as it should, the lower esophageal sphincter opens to allow food to pass into the stomach and closes to prevent food and acidic stomach juices from flowing back into the esophagus. Reflux occurs when the sphincter relaxes inappropriately or is weak, allowing the stomach’s contents to flow up.
Gastro-esophageal reflux disease (GERD, or GORD in the British spelling) is becoming more prevalent in the Middle East and worldwide due to a variety of factors. The most important of these is increased body mass and obesity, particularly among the young.
GERD is usually experienced as retrosternal chest discomfort – in other words, pain or discomfort felt behind the sternum or breastbone. The pain could include a burning sensation (heartburn). This could strike at any time, but most often when you are bending over, or at night. Other common symptoms include nausea, difficulty swallowing, chest pain or the sensation of a lump in your throat.
While antacids will provide short-term relief, more powerful drugs such as omeprazole or lansoprazole would be needed for the long-term elimination of symptoms.
If you have had a recent onset of symptoms, particularly if you are in an older age group, it is important to be examined by a gastroentrologist to rule out other conditions such as esophageal dysplasia or cancer.
Currently the best way to investigate GERD and simultaneously rule out more serious conditions is through a gastroscopy. This is done after you have been given a sedative and involves passing a narrow tube with a camera at the end through your mouth and into your gullet (esophagus) and stomach. This will allow direct visualization of the lining of the esophagus and biopsies can be taken to aid diagnosis.
The aim of treatment is to reduce damage to the esophagus lining caused by refluxed substances, and also to decrease the amount of reflux (the flow-back of material). As a starting point, your doctor may suggest modifications to your lifestyle and diet, backed by over-the-counter medications when necessary. However, if you don’t experience relief after a few weeks, he could prescribe medication or recommend surgery.
If acid reflux is severe and prolonged, complications such as benign esophageal stricture can occur, which could impair your ability to swallow. Also the lining of the esophagus could change character from squamous to columnar, which means it takes on the characteristics of the intestine rather than the esophagus. This change in cell type is known as “Barrett’s Esophagus ” after the English surgeon who first described it.
As the prevalence of GERD increases, so too do cases of Barrett’s esophagus. Barrett’s esophagus usually follows a long history of GERD, and causes the lining of the esophagus (the tube that takes food from your mouth to your stomach) to take on the character of your intestine’s lining.
There are no specific symptoms of Barrett’s esophagus, but you may experience many of the symptoms of GERD, for example heartburn and nausea.
Barrett’s esophagus can be diagnosed only through an upper endoscopy and biopsy. After you have been sedated, the gastroenterologist will feed a narrow tube with a camera at its tip through your mouth and down into your esophagus and stomach. While Barrett’s esophagus is visible through the camera, the gastroenterologist will also take a small tissue sample to confirm the diagnosis and to check for cancer cells. In the unlikely event that cancer cells are found, treatment options will be discussed. Even if there aren’t any cancerous or precancerous cells, however, you will need regular check-ups as a precaution.
If you are diagnosed with Barrett’s esophagus, the aim of the treatment will be to control acid reflux, which can be done through lifestyle changes and medication. In addition, the gastroenterologist could recommend further intervention, for example treatment with a laser, or surgery.
The change of cell type in the esophagus is known as ‘metaplasia’ and could lead to further cell changes, for example, low-grade and high-grade dysplasia and, in a small number of cases (fewer than 1%), esophageal cancer. Although the risk of esophageal cancer is low, it is important to have regular screenings of the esophagus to rule out further cell changes.
Bowel cancer is also known as ‘colon cancer’ or ’colorectal cancer’, depending on where in the body it begins. It is a leading cause of cancer deaths among men and women, but with regular screening and early detection, this could be avoided.
Bowel cancer is uncommon before the age of 50 unless there is an underlying genetic predisposition.
The most common symptoms are persistent and include blood in stools without an obvious cause, a change in bowel habits such as increased frequency of elimination, and abdominal pain, bloating or discomfort after eating. However, symptoms can be so subtle that only screening can detect it.
Diagnosis and treatment
Screening is possible because there is a well-defined precancerous phase that can be detected. During the screening, the doctor will be looking out for polyps, and will remove them if found. While not all polyps are cancerous, the larger they are and the greater their number, the greater your risk of developing bowel cancer.
Polyps are detectable because they bleed more easily (or are more ‘friable’, in medical terms) than the normal colonic mucosa. This blood can be detected in stool samples in what is called a fecal occult (meaning ‘hidden’) blood test, or FOBT, by chemical, immunological or genetic means.
In the USA, FOBT screening is advised from the age of 50. If the result is positive, we will follow this up with a colonoscopy to investigate. Of those who proceed to colonoscopy, around 10% are usually found to have cancer, approximately 40% have polyps and 50% are normal.
Discovering polyps and removing then completely has been shown to reduce the incidence of bowel cancer developing. Surveillance colonoscopy is instituted in those found to have polyps, and the surveillance interval will depend on the number and size of polyps found. If cancer is detected, the patient will be referred to an oncologist.