Gastroenterology is a medical specialty that has emerged as a specialised practice as recently as 20 years ago. It encompasses diagnosis and management of the ailments of hepatological as well as luminal organs of the gastrointestinal (GI) tract.

What is Gastroenterology?

The luminal organs (oesophagus, stomach, small intestine, colon, rectum) and the hepatological organs (pancreas, gallbladder, bile ducts and liver) are studied (mainly their normal functions and disease states) under the umbrella of gastroenterology: There are five basic functions of the GI tract:

1. Motility

Movement of the consumed food through lumen

2. Digestion

Conversion of food into absorbable material; in stomach and small intestine with the help of liver and pancreas

3. Absorption

Absorption of nutrients and water through large intestine

4. Excretion

Defecation of waste material from rectum through anus

Movement of the consumed food through lumen
Conversion of food into absorbable material; in stomach and small intestine with the help of liver and pancreas
Absorption of nutrients and water through large intestine
Defecation of waste material from rectum through anus
Gut microbiota

The gut microbiome is made up of essential bacteria, protozoa, fungi and viruses which naturally occurs inside the luminal organ of GIT and are termed as ‘Normal microflora’. This microbiome plays an important role in immune modulation, regulation of various hormones and neurotransmitters, along with the production of antioxidants and metabolites. They play important role in regulating obesity, inflammation, diabetes development and even cancers if disturbed.

Gastrointestinal Disorders

The integrity of the GI tract is crucial for the maintenance of these physiological functions. Any hindrance in the structure or function of the GI tract may result in multiple disorders. Some of the common GI diseases are described below along with the means to prevent them.

A) Constipation

It’s a common GI disorder that usually involves difficulty in passing stools or decreased and/or incomplete bowel movements. Constipation can be prevented or treated by increased dietary fibre and fluid intake as well as regular physical activity. An important strategy to avoid constipation is not to resist the urge to defecate. If not alleviated with these strategies, constipation is required to be treated with the use of medication under the instructions of a doctor.

B) Diarrhoea

Three or more bowel movements per day with very loose or watery stool are distinct features of diarrhoea. Abdominal cramps, nausea, bloating, weakness and fever may also be seen in patients with diarrhoea. It could be a consequence of infection, dietary change, specific intestinal disorder or even a side effect of medication/s. Treatment of diarrhoea often includes fluid restoration through consumption of water and juices and anti-diarrhoeal medicines. Since disturbance in GI microbiota is a common phenomenon associated with diarrhoea, probiotics are an important part of the treatment approach to correct GI microbial environment.

C) Peptic Ulcer Disease or Acidity

Overproduction of acids or damage to the epithelial lining in the stomach leads to a condition called gastritis or acidity as commonly known. Ulcers are actually “sores” occurring in the internal lining of the stomach and often affect the duodenum as well in uncontrolled or untreated gastritis. Helicobacter pylori bacteria, analgesic medications (pain killers i.e. NSAIDs like aspirin, ibuprofen etc.) and anti-inflammatory steroids are among the common causes of stomach ulcers. These medications prevent the outermost cells of the stomach to protect against the damage of self-produced acids. Other frequent causative factors are cigarette smoking, psychological stress and excessive alcohol consumption. These factors may accentuate the development of ulcers or even hinder with its healing. The patients with ulcers commonly experience upper abdominal pain. The management of ulcer involves early intervention with antacids, acid suppressant drugs and antibiotics against H.pylori bacteria, which when taken at right time effectively manages ulcers. However, those who don’t take proper medications developed advanced ulcerative disease diminishing significant food digestion, which requires specific diagnostic procedure – through endoscopes – that enables the examination of presence and severity of ulcers and provide rigorous medical treatment and in some surgical interventions are also required.

D) Acid Reflux Disease or Heartburn or GERD (Gastro-Esophageal Reflux Disease)

Regurgitation (or reflux) of acidic contents from stomach back into the oesophagus is referred to as acid reflux disease. It is most commonly experienced as “heartburn.” The patients most often experience a sense of burning in their chest and sour belching. Moreover, the fullness of stomach and abdominal pain are also common symptoms. Acid reflux disease can be helped with lifestyle changes such as smoking cessation, avoidance of fatty food, reducing caffeine uptake, withdrawing from certain medications as well as averting heavy lifting exercises. The condition is treated with the drugs that dampen the production of stomach acid and/or stimulate GI motility.

E) Irritable Bowel Syndrome (IBS)

It is a functional disorder in which the muscles of the colon (large intestine) contract more frequently than in normal condition. It could be due to certain food items or a side effect of medicines. Psychological stress may also trigger this condition.

IBS patients usually experience a change in bowel habit, abdominal pain and abdominal bloating and/or distension. They present with either of major characteristics like

  • Constipation with hard stools or infrequent defecation not responding general laxatives.
  • Diarrhoea with loose stool with preceded cramps in small volumes, or with frequent normal defecation with cramps.

Such patients often experience an urgency to pass stools after food intake. The patients are advised to minimise the stress through coping strategies, reduce the intake of caffeine and enhance fibre intake to reduce the disease severity. Moreover, the mainstay of treatment is the specific diet change and medications as prescribed by gastroenterologists, which may include drugs to regulate GI motility and reduce the pain.

F) Inflammatory Bowel Disease (IBD)

As the name suggests, this condition involves inflammation of the bowel (both small and/or large intestines) due to dysregulated immune response to individuals change in intestinal microbiota. The patients experience loose stool, bleeding through rectum, sharp pain/cramps in the abdominal area; some may also present with weight loss and fever.
IBD is categorized into two types:

  1. Ulcerative colitis – the inflammation generally begins in the rectum and ascends upward up till the large intestine,
  2. Crohn’s disease – herein, the inflammation is of more patchy appearance, it may begin and spread through any part of the GI tract.

IBD is treated with drugs that diminish inflammation. Additional therapy includes a special diet, including probiotics. Serious cases of IBD may also require a surgical approach.

Hepatological/Liver Disorders

Hepatology is the branch of medicine that focuses on diagnosis and treatment of diseases of hepatological organs (the liver, gallbladder, biliary tree and pancreas) that are not the part of luminal GI tract but are crucial for digestive health and homeostasis. Some of the common diseases covered under hepatology are enlisted below:

  • Alcoholic liver disease
  • Fatty liver disease and Non-alcoholic Steatohepatitis
  • Hepatocellular carcinoma (liver cancer)
  • Viral hepatitis A, B, C & E
  • Acute pancreatitis
  • Chronic pancreatitis
  • Pancreatic cancer
Consulting a Gastroenterologist

Following a healthy lifestyle (through diet and physical care) and maintaining proper bowel habits may avert many of the GI conditions. However, once established, these conditions require to be managed by gastroenterologists, who perform endoscopic procedures to make the appropriate diagnosis and treat the condition with a specific approach. However, with advances in the science of nutrition and their role in disease pathology, expert nutritionists are also required in the panel for treatment of these conditions.

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