Why do patients see a gastroenterologist?

We all know that the digestive system comprises the oesophagus, the stomach, the small intestine, the large intestine and the rectum, says Dr Tan. We also know that the digestive system includes the associated organs of digestion, such as the liver, the gall bladder and the pancreas. With so many parts of the body being part of the digestive system it is not surprising that there are many symptoms that patients can experience which can be referred to various parts of the digestive system.

For example, patients may complain of discomfort in the upper part of the abdomen, a symptom that we generally call dyspepsia. The symptoms may be painful or may feel like gas bloat or may feel like a pressure and can be quite intense and uncomfortable.

Yet such symptoms cannot easily be diagnosed on history alone because many parts of the digestive system may give rise to discomfort in the upper abdomen. For example, oesophageal conditions, peptic ulcers in the stomach, ulcers in the duodenum, even the gall bladder or the pancreas and parts of the colon may all give rise to discomfort in the upper abdomen.

It is necessary for a gastroenterologist to take a very good history to analyze the symptoms and the pattern of symptoms, as well as do a physical examination and some tests in order to diagnose the cause of the upper abdominal discomfort.

Also in the oesophagus there is a condition called Gastroesophageal Reflux Disease. This is very common and patients tend to complain of heartburn, which is a burning or hot sensation in the chest. Sometimes they have acid regurgitation, which means sour liquid from the stomach is experienced at the back of the throat. This condition occurs when acid from the stomach rises into the oesophagus, when it shouldn’t because there is a valve between the oesophagus and stomach. When the acid rises up the oesophagus it irritates the oesophageal lining and can cause inflammation or even erosions and sometimes scarring, bleeding and at worst, can change to cancer.

In the large intestine there are many symptoms that patients may complain of. They may complain of constipation or diarrhoea or even an alternation between the two. They may complain of accompanying pain or bloat or cramp or they may complain of blood issuing from the anus with a stool or by itself. Some of these symptoms could represent serious disease. The gastroenterologist will have to analyze these symptoms, perhaps do an examination like a colonoscopy, in order to diagnose what these symptoms are caused by.

In the area of the liver, common symptoms that patients may complain about relate to different kinds of hepatitis diseases. Common symptoms would be tiredness, lethargy, itchiness or jaundice, which is a yellowness of the whites of the eyes as well as the skin. The gall bladder may have problems too and there may be severe pain due to gallstones causing an inflammation of the gall bladder. The pancreas can also cause pain in the upper abdomen due to inflammation and this inflammation can be due to various things including infections or even excessive use of alcohol.

Therefore, gastroenterologists have a role in the community to help patients understand where the symptoms may be coming from and to help them to diagnose whether or not they have a disease entity in the digestive system that needs to be treated.

Dr Tan Chi Chiu is a clinical gastroenterologist, hepatologist and specialist in internal medicine at Gastroenterology and Medicine International. He can be reached at +65 6471 2212.