Oesophageal cancer

Oesophageal cancer is a type of cancer that affects the oesophagus (gullet). Patients with this condition may have difficulty in swallowing, throat pain, weight loss or persistent cough. A procedure called ‘oesophago-gastro-duodenoscopy’ (OGD) can confirm the presence of the cancer. During the procedure, a thin tube with an attached camera will introduce through the mouth and down into the gullet to examine its lining. Samples of tissues will be taken for testing under the microscope to confirm the disease.

Oesophageal cancer can be treated with surgery and/or chemotherapy, radiotherapy depending on the severity of the disease.

Gastric cancer

Gastric cancer, also known as stomach cancer, is a type of cancer that affects the stomach. Patients with this condition may have gastric discomfort, sense of gastric fullness after eating a small meal, heartburn, weight loss or anaemia (low red blood cell count). A procedure called ‘oesophago-gastro-duodenoscopy’ (OGD) can confirm the presence of the cancer. During the procedure, a thin tube with an attached camera will introduce through the mouth and down into the stomach to examine the lining. Samples of tissues will be taken for testing under the microscope to confirm the disease.

Gastric cancer can be treated with surgery and/or chemotherapy, radiotherapy depending on the severity of the disease.

Abdominal pain/discomfort

Abdominal or belly pain is a common problem. There are a wide range of causes. But most people have a benign (harmless) cause. The initial assessment is to decide whether it is ‘acute’ (starts suddenly) or ‘chronic’ (longstanding or intermittent).

Patients with acute belly pain should be assessed for a possible underlying serious cause that may require urgent treatment or surgery. People with chronic belly pain also need investigations though most of them have benign causes such as irritable bowel syndrome (IBS) or functional dyspepsia.

Constipation

Constipation is a common problem that people have difficulty in passing motion. The motions may be too hard, infrequent or hard to get out. The common causes of constipation include poor diet, lack of exercise, side effects of some medicines and digestive tract diseases.

Blood tests and a procedure called ‘colonoscopy’ may be needed for further evaluation of constipation depending on the age of the patient and the presence of other symptoms such as weight loss, blood in the stools.

During the colonoscopy, a thin tube with an attached camera is introduced into the anus. The doctor will then advance the tube into the large intestine and examine the lining of the intestine.

Treatment of constipation includes treatment of underlying cause, lifestyle and dietary modifications (regular physical exercise, plenty of water and high fiber diets). Some medicines may help to make bowel motions easier.

Chronic diarrhoea

Chronic diarrhoea is defined as loose stools that last for more than 4 weeks. A wide range of medical problems may cause chronic diarrhoea. Some common causes include irritable bowel syndrome (IBS), chronic infections, inflammatory bowel disease (IBD), malabsorption syndromes, food sensitivity and overactive thyroid disorder.

Stool and blood tests can help to identify the cause of diarrhoea. Special breath tests may be needed to test for lactose intolerance or small intestinal bacterial overgrowth. Not uncommonly, a test called ‘colonoscopy’ may be also required if the above tests do not find the underlying cause. During the colonoscopy, a thin tube with an attached camera is introduced into the anus. The doctor will then advance the tube into the large intestine and examine the lining of the intestine. Samples of tissues can be taken for further testing under the microscope.

Treatment of chronic diarrhoea aims to identify and eliminate the underlying cause. Before the cause is found, it is important to reduce the stool frequency, firm up the bowel movements and deal with any diarrhoea-related complications such as dehydration and electrolyte (chemicals in our blood stream) imbalance.

Haemorrhoids

Haemorrhoids are swollen veins in the rectum (the lower part of the large intestine). They are usually hidden inside, though in some people, it can be seen or felt around the anus. They may cause pain or itchiness, and not uncommonly they can cause bleeding while passing motion.

The most important treatment in haemorrhoids is to keep one from getting constipation which can make it worse. There are also medicines to relieve the swelling, pain and itchiness. In some cases, treatments such as ‘rubber band ligation’ or surgery may be needed.

Small intestinal bacterial overgrowth

Small intestinal bacterial overgrowth (SIBO) is a condition in which abnormal species of bacteria proliferate in large number in the small intestine. Patients may have belly discomfort, excessive gas, loose stools and weight loss. The common causes include intestinal muscle or nerve disorders associated with diabetes, small intestinal diverticulosis (small pouches on the intestinal wall), intestinal obstruction and surgically created blind loop.

SIBO can be confirmed by culturing small intestinal fluid or more commonly, the non invasive glucose breath test. Treatment of SIBO consists of treatment of the underlying disease and antibiotic therapy.

Alcoholic fatty liver disease

Alcoholic fatty liver disease is a condition when fat tissue builds up in the liver of people who have excessive alcohol drinking. Most people with alcoholic fatty liver disease have simple fatty liver that may go away if they stop drinking. But in some cases, it can progress to liver inflammation and lead to liver scarring and liver cancer.

Blood tests and imaging test of the liver such as ultrasound scan can be performed if alcoholic fatty liver disease is suspected. Treatment of alcoholic fatty liver disease is simply to quit drinking.

Liver cirrhosis and its complications

Autoimmune liver disorders

Primary biliary cirrhosis (PBC) and autoimmune hepatitis (AIH) are the two most common autoimmune liver disorders. They happen when the body’s immune system (‘infection-fighting system’) attacks the normal liver and causes injury and inflammation. If the disease is left untreated, it may progress to liver cirrhosis (scarring of the liver).

Patients with autoimmune liver disorder may have no symptom. In some, they may feel weak or have jaundice (yellowish eyes or skin) or belly pain.

Some blood tests should be done if autoimmune liver diseases are suspected. For most patients, a test called ‘liver biopsy’ is usually needed. In this test, a needle will be inserted into the liver and a small sample of tissue will be taken for examination under the microscope.

Treatment of autoimmune liver diseases includes medicines to control the liver inflammation or slow down the liver damage. In patients with severe liver cirrhosis, liver transplantation (a type of surgery in which a diseased liver is replaced with a healthy liver from another person) is an option and should be considered.

Wilson’s disease

Wilson’s disease is a genetic disorder in which too much copper builds up in the body, mainly in the liver and brain. This can result in liver injury and brain damage.

Patients with Wilson’s disease may have symptoms due to liver injury such as jaundice (yellowish eyes or skin), belly pain and vomiting, and/or symptoms associated with brain damage such as arm tremor, slowness of movement and unsteady walk.

Some blood tests should be done if Wilson’s disease is suspected. For most patients, a test called ‘liver biopsy’ is usually needed. In this test, a needle will be inserted into the liver and a small sample of tissue will be taken for examination under the microscope.

Treatment of Wilson’s disease includes medicines to remove the excess copper and to prevent buildup of copper. In patients with progressive liver disease and severe liver cirrhosis (scarring of the liver), liver transplantation (a type of surgery in which a diseased liver is replaced with a healthy liver from another person) is an option and should be considered.

Pancreatitis

Pancreatitis is a condition when pancreas gets irritated and swollen. There are a wide range of causes of pancreatitis, but the most common causes are gallstones and alcohol abuse. Patient with pancreatitis usually have severe belly pain. Further blood tests and sometimes imaging tests may be needed to confirm the diagnosis.

Treatment of pancreatitis involves treatment of underlying cause. The patient usually needs to stay in the hospital. Most patients get over pancreatitis without any long lasting effects.

Pancreatic cancer

Pancreatic cancer is a type of cancer that affects the pancreas. Patients with this condition usually have no symptom in the early stage. As the disease progresses, some may have belly discomfort, weight loss, jaundice (yellowing of the eyes and skin) or diarrhoea. The diagnosis usually requires the combination of blood test, X-ray imaging and biopsy (remove a small sample of tumor and examine it under the microscope). Pancreatic cancer can be treated with surgery and/or chemotherapy, radiotherapy depending on the severity of the disease.

Gallbladder cancer

Gallbladder cancer is a type of cancer that affects the gallbladder. Patients with this condition usually have no symptom in the early stage. As the disease progresses, some may have belly discomfort, weight loss, dark urine or jaundice (yellowing of the eyes and skin). The diagnosis usually requires the combination of blood test, X-ray imaging and biopsy (remove a small sample of tumor and examine it under the microscope). Gallbladder cancer can be treated with surgery and/or chemotherapy, radiotherapy depending on the severity of the disease.