Providing Comprehensive Gastrointestinal Care
Dr Nanda provides a comprehensive evaluation of all
gastrointestinal symptoms and disorders, specialising in:
Dr Nanda has undergone advanced fellowship training at world renowned centres in order to provide diagnostic and advanced/therapeutic endoscopic procedures including:
Endoscopic Ultrasound:
Endoscopic Mucosal Resection
ERCP:
Colonoscopy
Upper Endoscopy:
Nutrition:
What we eat and drink, normally travels the length of our gastro-intestinal tract. It provides us with all the key elements to sustain us, from carbohydrates, fats, & proteins, to vitamins and minerals, and other elements.
What we eat also has a key interaction with the millions of normal ‘healthy’ bacteria that reside in our digestive tract, and it also plays a role in almost all disorders that affect our gastro-intestinal tract. It is what sustains us, and at times, what ails us.
Science has an ever increasing understanding of these interactions, and thus, in managing both good gastro-intestinal health and disease, a close analysis and understanding of your nutrition is vital.
Working closely with dietitians and other specialists, Dr Nanda has particular expertise and fellowship training in nutrition management, and how it can improve your general and GI health. Call today to arrange an appointment.
Coeliac Disease:
Coeliac disease is a condition in which the immune system responds abnormally to a protein called gluten, which the leads to damage to the lining of the small intestine. Gluten is found in wheat, rye, barley, and numerous prepared foods. The small intestine is responsible for absorbing food and nutrients. Therefore, damage to the lining of the small intestines can lead to difficulty absorbing important nutrients; this problem is referred to as malabsorption. The cause of coeliac disease is not clear, but a combination of genetic and environmental factors is important. Symptoms vary from very mild, to more troubling symptoms including diarrhoea, weight loss, abdominal discomfort, excessive gas, and other symptoms caused by vitamin and nutrient deficiencies. Coeliac disease is difficult to diagnose on history and physical examination. Fortunately testing is available that can easily diagnose coeliac disease. This includes blood tests for antibodies and nutritional deficiencies, and taking a small intestine biopsy during upper endoscopy. Although coeliac disease cannot be cured, a gluten-free diet usually stops the damage to the intestinal lining and the malabsorption and symptoms that result. Families also need to be aware of their increased risk of coeliac disease, and first-degree relatives (parents, brothers, sisters, children) should consider being tested, especially if anyone has signs or symptoms of the condition. Testing is typically done with a blood antibody test.
Irritable bowel syndrome / functional bowel disorder
What is Irritable bowel syndrome?
Irritable bowel syndrome (IBS) is the commonest of the functional gastrointestinal disorders with an estimated prevalence of 10%. It accounts for up to 20 % of all GP visits and up to 50% of outpatient visits to a Gastroenterologist. It is a chronic, relapsing and often life-long disorder, characterized by the presence of abdominal pain/discomfort associated with defaecation, a change in bowel habit, the sensation of abdominal distension, and may include associated noncolonic symptoms. People with persistent symptoms of IBS have poor physical function, impaired quality of life and high healthcare costs.1
Incidence rates of IBS are seldom calculated, and prevalence estimates fluctuate both between and within countries. The pooled prevalence rate that one study cited for North America, Europe, Australia, and New Zealand was 8.1%.2 There appears to be a female predominance. IBS is common both in developed and developing countries.
The following physiologic and psychological variables have been proposed as potential factors in the aetiology and pathophysiology of IBS:
Disturbances in the brain–gut axis, including disruption of central and autonomic functions, peripheral hormones, amines, and peptides, have been documented in patients with IBS.3
Diagnosing IBS: Based on the Rome IV criteria
Characteristic | Rome IV criteria |
Diagnostic time frame |
|
Symptom description |
|
Symptom association (2 or more) |
|
The differential diagnosis of IBS should include coeliac disease, microscopic colitis, inflammatory bowel disease, bile acid malabsorption, colorectal cancer, and dyssynergic defecation. For the most part, patient diagnosis remains one of exclusion, with treatment being symptom driven.
Pharmacologic management of IBS focuses on the predominant bowel symptom (diarrhoea or constipation) and abdominal pain. Patient education, suggestions for lifestyle modifications, and reassurance should be provided with all IBS treatments.
Potential pharmacological interventions for IBS:
Abdominal pain/bloating | Constipation predominant IBS | Diarrhoea predominant IBS |
Antispasmodics | Psyllium | Opioid agonist |
Peppermint oil | Polyethylene Glycol | Antibiotics (Rifaximin) |
Mibeverine | Chloride channel activators | Probiotics |
SSRI or Tricyclic antidepressants |
| Bile acid sequestrants |
While these pharmacological agents may transiently help symptoms, NONE alter the natural history of the condition apart from rifaximin (a nonabsorpable antibiotic). Rifaximin has been shown to improve symptoms and provide sustained relief.
References:
The biliary tree is the medical term for the gallbladder and the ducts (tubes) that lead from the gallbladder & liver down to the small intestine. These tubes carry Bile, which is produced in the liver, and concentrated in the gallbladder. The gallbladder is tucked up underneath the liver, and is located in the right upper quarter of the abdomen. Bile is a complex mixture that aids the body in digesting foods, especially fat.
Like most organ systems in the body, the biliary tree can also be affected by inflammation & infection, and by benign & cancerous growths. Biliary diseases can cause pain in the right upper corner of the abdomen, and cause jaundice, (yellow tinged skin & eyes, and pigment changes in the stool and urine), by a disruption to the normal drainage of bile. Gallstones are another common biliary disease which can range from being completely asymptomatic to causing severe pain, jaundice, pancreatitis and infection.
Biliary diseases are diagnosed through a comprehensive history, physical examination, imaging tests (e.g. CT scans), and advanced endoscopic procedures (e.g. ERCP).
Treatments of biliary disease can include, diet & lifestyle changes, specific medications, advanced endoscopic procedures and surgery
Dr Nanda has particular expertise and fellowship training in the assessment and management of pancreatic disease. Call today to arrange an appointment.
Diseases of the Pancreas and Biliary Tree
The pancreas is a solid organ in the abdomen that makes hormones (e.g. insulin) and enzymes (e.g. ) that help breakdown food. These substances are either secreted directly into the blood-stream, or join the secretions of the gallbladder, via a tube or duct, which eventually enters into the small intestine.
There are many conditions that can affect the pancreas. Some of these happen quickly (i.e. Acute), whilst others occur slowly (i.e. Chronic). An example of an acute condition is acute pancreatitis, in which the pancreas becomes inflamed, loses much of its function
Pancreatic disease can cause intense symptoms such as upper abdominal pain, sweats, jaundice (yellow tinged skin and eyes) & diarrhoea or it can be virtually silent, until it is fairly advanced.
Like most organs in the body, the pancreas can also be affected by benign and cancerous growths.
Pancreatic diseases are diagnosed through a comprehensive history, physical examination, laboratory testing, imaging tests and advanced endoscopic procedures (e.g. ERCP).
Treatments of pancreatic disease can include, diet & lifestyle changes, specific medications, advanced endoscopic procedures and surgery
Dr Nanda has particular expertise and fellowship training in the assessment and management of pancreatic disease. Call today to arrange an appointment.
Colorectal Cancer Screening
Bowel Cancer – The Facts
Bowel cancer is the second leading cause of cancer related death in Australia, with 80 Australians dying from the disease every week. If you are over the age of 50, or have a family history of bowel cancer this places you at increased risk. It develops in the large intestine, where it can grow to form an abnormal lump of tissue, often called a ‘polyp’. Many of these polyps are not cancerous, but over many years, some may turn into bowel cancer. If left untreated, it can spread to other parts of the body. The good news is that bowel cancers that are caught early are treated successfully in 90% of patients.
Why Screening Works
Early testing for bowel cancer saves lives, and is being actively promoted by the Australian Government. Because bowel cancer often develops without symptoms, screening tests are the best way of detecting the disease when it is still early, and treatable. The test looks for any blood in the stool (often in microscopic quantities you can’t see) which can be an early sign of bowel cancer, and other bowel related conditions. The earlier you are diagnosed, the more effective the treatment. Extensive research studies have shown that bowel cancer screening reduces deaths from bowel cancer. The screening test for bowel cancer is a simple, non invasive test called Faecal Occult Blood Testing (FOBT). It is a test done in the privacy of your own home without the need to get your hands dirty, and is then sent via post to get a result.
If you want peace of mind, then contact the rooms for a free screening kit
Inflammatory Bowel Disease
Ulcerative colitis (UC) and Crohn’s disease (CD), collectively called inflammatory bowel disease (IBD) is a chronic inflammatory condition of the intestinal tract resulting from a dysregulated immune response. IBD affects around 85,000 people in Australia. Its incidence is rising in developing countries and is as common as type 1 diabetes or schizophrenia. The pathogenesis appears to suggest an underlying genetic susceptibility coupled with dietary, environmental and gut microbial changes leading to an ‘overdrive’ in immune response. IBD is characterised by a relapsing remitting course, which is variable amongst affected individuals.
Histologically, the inflammation in UC is does not extend beyond the submucosal layer of the bowel wall and in CD it affects all layers (transmural). Transmural inflammation causes complications such as strictures, fistulisation, perforation and abscess formation in CD. Smoking history is associated with adverse outcomes in CD but appears to be protective in UC.
Ileocolonoscopy and biopsy remain the gold standard for diagnosis of colonic and terminal ileal disease, and will usually confirm the diagnosis. Medical therapy is focussed on attaining clinical remission and achieving mucosal healing. A simplified step-up treatment pyramid is shown below:
Biologic agents are drugs directed against specific molecules in the inflammatory pathways involved in IBD. These agents have been a major game changer in the management of IBD patients.
What’s new?
IBD medications considered safe to use in pregnancy are the corticosteroids, sulfasalazines, 5-ASA preparations, thiopurines and biologic agents. The best pregnancy outcomes occur in women whose IBD is in remission at conception and throughout the pregnancy.
Opportunistic infection is always a risk in patients treated with immunosuppressant medication. Appropriate vaccination is helpful in reducing this risk, but does not prevent it completely.
References:
