In this blog post, consultant gastroenterologist Dr Anurag Agrawal answers the most common questions regarding GI conditions.
Q1. What common gastrointestinal symptoms do gastroenterologists deal with?
The spectrum of GI conditions is vast with an ever changing landscape. We commonly deal with upper and lower GI symptoms such as indigestion, tummy pain and bowel disturbance with rectal bleeding. However, other presentations such as weight loss, appetite loss, anaemia and the silent epidemic of liver disease is also commonly managed by us.
Q2. What is challenging about your field?
Although there are a limited number of symptoms the patients complain of, these could be reflective of a whole variety of underlying problems. So tummy pain could be due to a structural or functional underlying condition. Our job is to diagnose in a timely manner and provide effective treatments for these debilitating conditions in a holistic manner. No two patients are the same and this makes it both interesting and challenging to treat our patients. Endoscopy and radiology are frequently relied upon by us along with blood tests to help aid the diagnostic process.
Q3. What is an endoscopy?
Endoscopy involves placement of a camera attached to the end of a flexible tube usually in the gullet, stomach or bowel. Using this assistive technology, there has been significant progress in the understanding and management especially of structural gastrointestinal conditions such as polyps, cancer and various other inflammatory conditions. Patients can choose to have sedation although increasingly it is being carried out without sedation. The procedure is considered very safe and in most instances it is carried out as a day case with no incision required. The technology and its application has transformed the care that gastroenterologists provide to their patients with various gastrointestinal conditions.
Q4. What medical conditions do you deal with?
In my profession I am blessed to come across so many people and they all have a unique story to tell. The conditions I deal with most commonly however can broadly be divided into upper GI, lower GI, hepato-pancreatico-biliary. Some of these conditions can be labelled as fatty liver, autoimmune liver disease, non-ulcer dyspepsia, peptic ulcer disease, polyps, crohn's and colitis, functional constipation, irritable bowel disease (IBS) and many other conditions.
Q5. What is irritable bowel syndrome (IBS)?
IBS is a common condition affecting up to 10% of the UK population. It can be mild or severely intrusive with severe symptoms which can erode quality of life of sufferers leading to repeated consultations with GP. The common symptoms are:
• Abdominal pain or discomfort,
• Bloating
• Change in bowel habit
This is know as the ABC of IBS.
The bowel habit ranges from constipation to diarrhoea and other patients suffer from a fluctuating bowel habit. Patients can have a whole range of other symptoms such as back pain, fatigue, urinary symptoms and these symptoms are just as important as they have a significant erosive effect on the quality of life. Some patients need investigations to rule out other gastrointestinal conditions such as inflammation, coeliac disease, others need a deeper understanding, and virtually all need effective treatments to improve quality of life.
Q6. How common is IBS and who gets it?
Apart from the common cold, IBS is the commonest medical condition affecting the population. Large scale studies carried out suggest that at least in the west, the prevalence is approximately 10%. Women are more likely to suffer from this condition suggesting a hormonal influence. However, we do see men in the clinic setting with this problem as well. It can affect patients at virtually any age. Various triggers such as infection, stress, diet are common triggers although in many patients a clear precipitating factor is not always forthcoming
Q7. Can you tell us a bit about bloating?
Bloating is a sensation of abdominal swelling experienced by patients. It is highly prevalent in patients with IBS and women often compare this to being pregnant. Characteristically it worsens as the day goes on with resolution overnight. The main triggers are food and sometimes stress. There has recently been a significant advancement in our understanding of bloating with several factors such as abdominal musculature, gastrointestinal muscle contraction, a sensitive gut, bacteria, gas sequestration being under special focus. It may be that some of these aspects are more relevant in producing symptoms in some individuals compared with others. A note of caution however, as some patients with bloating can have underlying pathology such as ovarian or gynaecological conditions and so if bloating is persistent and troublesome, please seek advice from you doctor.
Q8. Can IBS mimic other conditions?
There are several abdominal conditions which have a symptomatic overlap with IBS. These include various inflammatory conditions, coeliac disease and sometimes more sinister causes. It is therefore supremely important that a meticulous history is taken and patients concerns are taken into account. A proportion of patients (not all) need basic or more advanced investigations before diagnosis can be established and treatments can be initiated. One should perhaps emphasise that old myths such as IBS being all in the head or being a diagnosis of exclusion is no longer tenable. It is very much a positive diagnosis and there has been significant progress made in the understanding and management of IBS. Treatment can be very rewarding and for the vast majority of patients we are able to make a difference.
Q9. How do you treat IBS?
As already mentioned, treatment is holistic and tailored to the individual. Frequently there is not one single step which will cure the patient’s problems. A good history and examination with a multi-pronged approach to treatment is frequently necessary. As a medical student, I was taught that medicine is both an art and a science. Nowhere is this truer than managing patients with IBS which to this day remains one of the most thought-provoking and stimulating conditions I manage.
About Dr Anurag Agrawal
Winner of the international Ray Clause memorial award, Dr Agrawal is an experienced gastroenterologist with extensive clinical and research interests. After undertaking his advanced clinical and research training in Liverpool and Manchester where he completed a PhD, Dr Agrawal has been a consultant for over six years.
Clinical interests include endoscopy, irritable bowel syndrome, dyspepsia, hepatology and inflammatory bowel diseases. He has a keen interest in research and has over twenty-five full publications with many more abstracts in several high quality scientific journals.
Read more about Dr Anurag Agrawal’s qualifications, background and clinical interests.
About Ramsay Health Care UK Gastrointestinal Treatments
Ramsay Health Care UK is a leading provider of gastrointestinal treatments in the UK. Our highly qualified and experienced gastroenterologists will discuss with you the best options for your individual needs.