Digestive Clinic

These symptoms are often known as “gastritis” or “stomach cramps” and they are by far the commonest gastrointestinal complaint in the outpatient settings. Besides pain or discomfort, “bloating” and “indigestion” may be the other  presenting symptoms. There are many conditions which present in this manner and it may be challenging to differentiate the benign conditions from the sinister ones from time to time. Depending on the nature, the severity of the conditions and the patient profile including age and family history, the management strategy may vary. Although the majority of the cases are non-structural in origin, any pain or discomfort which does not resolve over time warrants further investigation. This is especially when the pain is associated with weight loss or significant appetite change. The common investigations to evaluate persistent upper abdominal pain includes Gastroscopy (OGD) and ultrasound or CT scan of the abdomen.

Another distinct type of abdominal pain, seen mainly among the younger generations living in a stressful environment, is known as Functional Abdominal Pain (FAP). This pain has known triggers which can make the symptoms worse from time to time. The hallmark of this group of conditions is the absence of significant findings on scans, blood tests and endoscopy which can result in repeated consults, elaborate tests and frustrated patients. The major impact are the disturbing symptoms which may be incapacitating although rarely leads to serious outcomes. Common complaints include bloating, cramps, loose stools and constipation. A classical disorder, known as irritable bowel syndrome, may present with frequent bowel habit change ranging from severe constipation to diarrhoea. Effective treatment requires patience, good supportive care as well as adjustments to life style, eating habits and medications. Most patents improved with treatment and can manage their symptoms with few medications.

This complaint is mostly seen in elderly patients with neurological or muscular problem especially after a stroke or severe illness. However, it is not unusual to find younger patients suffering from swallowing disorders. The most important condition that needs to be excluded is a structural cause of blockage such as food bolus or growth in the oesophagus. Rarer causes include local inflammation or poor relaxation of the lower oesophageal muscular ring (sphincter) may require specific treatment such as anti-inflammatory drugs or dilation procedure. In the more extreme situation, surgery may be the treatment of choice.

Each and everyone of us will experience constipation or loose stools from time to time. This has a direct relationship with what we eat or drink and does not necessarily qualify as bowel habits change. These acute problems are usually short-lived with or without specific treatment. However, when constipation or diarrhoea persist or worsen beyond a few weeks or when the bowel habits become significantly different from usual, it will be prudent for one to exclude more sinister problems within the digestive tract. Chronic infections or inflammation of the digestive tract can result in excessive water loss in stools and malabsorption while lack of dietary fiber and exercise may result in constipation. Occasionally, such bowel habits change is the only early sign of colonic cancer especially when blood is also found in stool samples. The greatest mistake in most cases is to attribute such rectal bleeding to “heatiness” or piles without any confirmation.

The gallbladder and the bile ducts constitute a very important part of our digestive system. Bile juice secreted by the liver is normally concentrated in the gallbladder before being released into the small intestine for digestion. Stones can develop in the gallbladder under certain circumstances such as pregnancy and the stones may migrate down the bile duct causing obstruction and infection. The presenting symptoms may be pain, fever, yellow discolouration of the eyes (jaundice) and dark coloured urine. Depending on the actual location of the stones, special endoscopic procedures (eg. ERCP) may be required. Surgery is also frequently required to remove the gallbladder and gallstones to prevent recurrent problems.

Besides stone disease, problems in the bile duct systems such as polyps or narrowing may be discovered. This again may cause jaundice and weight loss and sometimes required special treatment to drain the obstruction. Occasionally, cancer can develop in the gallbladder and the bile duct and surgery or ERCP procedure may be required.

These tests range from the usual blood, urine and stools sampling to tissue acquisition in the form of biopsies through endoscopy. These specimens and tissue samples obtained are analysed in specialised laboratories to aid in diagnosis and treatment of many digestive related conditions.

Urea breath test (UBT) is a test to identify active Helicobacter pylori (H. pylori) infection. H. pylori are bacteria (germs) that reside in the stomach and duodenum (the first part of the small intestine) resulting in chronic infection. This infection may be acquired at any age and remained in our body for a very long period of time. Although infected individuals may not experience any problem or symptom, H. pylori is known to cause gastric or duodenal ulcers, risking significant bleeding. H. pylori have also been linked to the development of stomach cancer and lymphoma.

This test involved an assessment of the subject’s breath following the ingestion of a substrate. It takes only a short while to complete with practically no discomfort expected throughout. Depending on the findings, a combination of antibiotics may be given to you for eradication purpose. Click here to read more on the test.