Gastroenterology

Washing your hands before eating seems like a simple enough instruction to follow, even though the whys of which are often left out. A search for a delicious plate of kacchi, or the most awakening cup of tea may take you to narrow lanes and dodgy diners, where strict adherence to hygiene is a corner undoubtedly cut. With endless reasons all leading you down the same road, the destination is unavoidable; your stomach being twisted in knots so tight you feel physically incapable of going to work the next day!

Abdominal pain, and its prevalence in the world of gastroenterology, are co-existing symptoms which can have fatal repercussions when ignored and overlooked. Whether it's a stabbing sensation that has you curled up in a ball, or a sharp pain that is either constant or coming and going in waves, about 15-25 percent of any population suffer from abdominal pain, and underlying gastrointestinal disorders at any one time, according to a rough 2013 study.

Speaking of gastrointestinal disorders, organs under this umbrella include, but aren't limited to, the liver, gallbladder, stomach, pancreas, appendix, small and large intestine and anus. And, while we're already on the subject, gastroenterology deals with disorders of the stomach and intestines, almost all of which results in stomach pain.

"When it comes to the GI tract, the most common causes of stomach-ache can be dissected according to the parts of the gut itself," begins Dr Ling Khoon Lin, senior consultant of gastroenterology of Singapore's Mount Elizabeth Hospital. "Fatty livers, nausea, acid reflux, gallstones are all abdominal diseases seeking regular consultations. Even food poisoning is fairly common. But a general practitioner typically treats such cases," he further details.

The good news here is that frequently-seen GI conditions can effectively be treated without extreme intervention. Exercise and diets rich in fruits, vegetables and whole grains will keep fatty livers in check and hygiene in food preparation will prevent foodborne illnesses. Moreover, mild cases of acid reflux, where stomach acid tends to back up the food pipe, causing a burning sensation, can be treated with over-the-counter, or, OTC medications. Antacids and H2 blockers both work by reducing the amount of acid secreted by the stomach, and thus, relieving the patient. You can even ask a pharmaceutical rep to help you with a pepto-bismol for an upset stomach or a laxative for constipation. In any case, a doctor's advice before opting for strong dosages is imperative.

However, after harmless indigestion has been ruled out during diagnosis, abdominal pain lasting more than 24-48 hours, when coupled with blood in vomit or faeces and consistent heartburn and bloating, should be treated by a specialist: a gastroenterologist.

In the world of Gastroenterology, OTC drugs can only do so much. Diseases like inflammation of the appendix and inflammation of the gallbladder, an organ next to the liver, require surgery.

There are other diseases that are treated by a combination of diet modification, prescription drugs, and surgical interventions.

Irritable bowel syndrome (IBS) is a common condition affecting the intestines. While it is not known what causes IBS, it is thought that contributing factors include stress, certain foods like dairy, high fat foods, caffeine and fizzy drinks can make the condition worse. Typically, investigations in IBS patients are normal. No abnormalities are found on endoscopy or colonoscopy.

Your doctor may also recommend you to take up a low-FODMAP diet.

What's FODMAP you ask? The technical explanation simply refers to a group of carbohydrates that are resistant to digestion and which may help to retain liquid in the intestines. Avoiding foods containing FODMAP will mean eliminating some foods e.g. beans, onions, garlic from your diet.

Ulcerative colitis and Crohn's Disease are collectively known as the inflammatory bowel diseases (IBD). These diseases are characterised by ulcers, or open sores in the small and/or the large intestines. If you're experiencing fever, fatigue, abdominal pain, and blood in vomit or stools, getting checked out is definitely in your best interest.

It is not known what causes IBD. Peptic ulcer disease is much more common than IBD. These ulcers are found either in the stomach or the duodenum. The vast majority of these ulcers are associated with Helicobacter pylori, a germ which is found in the stomach. The 2nd most common cause of peptic ulcers are medicines e.g. pain killers.

"Drugs like ibuprofen and aspirin can cause stomach and small intestinal ulcers. These medicines are chemicals that can prove quite toxic for the stomach lining. This can eventually lead to ulcers or open sores and bleeding in the stomach and intestinal walls," informs Dr Ling.

The bad news when it comes to such peptic ulcers and IBD is the possible progression to cancer. This is mainly because both peptic ulcers and gastric cancers have the infecting bacteria in common: Helicobacter Pylori. Patients with longstanding and uncontrolled IBD are also at higher risk of intestinal cancer. And so, untreated and long-standing inflammations of the gut can lead you down the scary abyss of carcinoma.

Regular check-ups and tests like endoscopies and colonoscopies in IBD patients will help to detect intestinal cancers early.