Gastroenterology is a branch of medicine which deals with the diagnosis and treatmeant of the diseases of the digestive system. These diseases usually affect the following organs; esophagus or the tube that delivers food from your mouth to the stomach; stomach, small intestine, large intestine also known as the colon, rectum, liver, gallbladder, or pancreas.Hepatologyencompasses the study of the liver, pancreas, and biliary tree, and is traditionally considered a sub-specialty.The Institute of Liver and Gastro Sciences at Baby Memorial Hospital is best-of-its-kind in the country and offers a wide range of treatments and services for liver and gastrointestinal disorders.
Diseases that affect the above organs are listed below:
Esophagus and Stomach
In this condition the muscles in the lower part of the esophagus fail to relax, which prevents food from passing into the stomach.
This is a condition where the normal lining of the esophagus changes to the type usually found in the intestines. Barrett’s Esophagus is a condition resulted due to chronic reflux of the stomach’s content into the esophagus.
Esophageal cancer occurs in cells that line the inside of your esophagus – the tube that carries food from your mouth to the stomach.
Stomach (Gastric) Cancer
This condition starts at the cells that form the inside lining of your stomach, which can gradually grow into a tumor. This is a gradual disease, growing slowly over a period of time, but if diagnosed early, it has better chance of treatment and cure.
Gastroesophageal Reflux Disease (GERD)
GERD, a chronic digestive tract disease, occurs when the contents of the stomach and/or stomach acid flow back (reflux) into your food pipe (esophagus) which causes irritation in the lining of the esophagus. This mainly occurs due to the improper functioning of lower esophageal sphincter, a valve which opens to allow the food to pass into the stomach and prevent the reflux of the stomach contents in the esophagus.
This is a condition where the natural movement of the stomach’s muscles which propel food trough the digestive tract, either functions poorly or not at all. This can prevent your stomach from emptying fully and also interfere with normal digestion process, causing nausea, vomiting, fluctuations in the blood sugar levels and nutrition.
Peptic Ulcer Disease
Peptic ulcers are open sores that usually develop on the inside lining of your stomach, upper portion of your intestine or the esophagus. There are three types of peptic ulcers, namely; gastric ulcers (develop on the inside of your stomach); duodenal ulcers (develop on the inside of the upper portion of your small intestine also known as the duodenum) and esophageal ulcers (develop on the inside of the esophagus).
Also known as dysphagia, you may take more time and effort to swallow both, solid or liquids. It can be associated with pain, while in some cases, swallowing may become impossible. Occasionally it can occur due to improper chewing or eating too fast, but persistent dysphagia indicates a serious medical condition warranting treatment.
Chronic constipation is a condition where bowel movements are infrequent and there is difficulty in passage of stools. This condition may persist for several weeks or even longer. Even though occasional constipation is common, some people experience chronic constipation that can interfere with their ability to go about their daily tasks. Chronic constipation may also cause excessive straining to have a bowel movement and other signs and symptoms.
Alcoholic Liver Disease
This condition occurs due to excessive intake of alcohol. Any type of alcohol can cause disease. The liver is inflamed due to the alcohol intake and overtime scarring and cirrhosis can also occur, which is the final stage of alcoholic liver disease.
Hepatocellular Carcinoma (Liver Cancer)
Hepatocellular Carcinoma is a form of liver cancer which occurs in the main type of liver cell known as hepatocyte and accounts for the most cases of liver cancer. Causes of this include alcohol abuse, autoimmune diseases of the liver, Hepatitis B or C virus infection, inflammation of the liver that is long-term (chronic) and iron overload in the body also known as hemochromatosis.
Non-alcoholic fatty liver is used to describe the accumulation of fat in the liver of people who drink little or no alcohol. This disease usually, for most people, causes no signs and symptoms and no complications either. Although in some cases, this condition can lead to inflammation and scarring of the liver. At its most severe, nonalcoholic fatty liver disease can progress to liver failure.
This is a condition where pressure in the vein that carries blood from digestive organs to the liver, also known as the portal vein, increase to the point that large veins tend to develop across the esophagus and the stomach so as to get around the blockage in the blood flow through the liver. These large veins are fragile and can bleed easily causing complications due to internal bleeding.
Hepatitis is an inflammatory condition of the liver, commonly caused by a viral infection. There are five types of hepatitis causing viruses namely, A, B, C, D, and E.
Hepatitis A: Derives from infection caused by hepatitis A virus and is transmitted by consuming food or water contaminated by the feces from a person who is infected with the disease.
Hepatitis B: Derives from infection caused by hepatitis B virus and is transmitted through punctured wounds or contact with infectious body fluids, such as blood, saliva, or semen. Injection drug use, having sex with an infected partner, or sharing razors with an infected person increase your risk of getting hepatitis B.
Hepatitis C: Derives from the hepatitis C virus and is transmitted through direct contact with infected body fluids, typically through injection drug use and sexual contact.
Hepatitis D: Also known as the delta hepatitis, it is a serious liver disease derived from the hepatitis D virus. It is transmitted through puncture wounds or contact with infected blood. Hepatitis D is a rare form of hepatitis that occurs in conjunction with hepatitis B infection.
Hepatitis E: Hepatitis E is a waterborne disease caused by the hepatitis E virus (HEV). Hepatitis E is mainly found in areas with poor sanitation and is typically caused by ingesting fecal matter.
Pancreas and Biliary Tract
This condition refers to the inflammation of the pancreas, which causes sudden and severe abdominal pain. The pancreas is located at the back of the mid-abdomen and is responsible for producing digestive juices and certain hormones like insulin. This condition can develop as a side effect of gallstones or moderate to heavy alcohol consumption over a period of years.
In this condition, the ability of your pancreas to digest food and regulate blood sugar is totally impaired due to inflammation. Unlike acute pancreatitis, this condition does not get better with time and is usually a permanent one, though pain and symptoms can be managed with proper treatment and medications.
Bile Duct Cancer (Cholangiocarcinoma)
This type of cancer starts in the bile ducts, which are thin tubes that reach from the liver to the intestine. Bile ducts move fluid called bile from the liver to the small intestine, where it helps in digesting fat in the food. It can happen in the parts of the bile ducts that are outside or inside the liver.
Gallstones are hardened deposits of digestive fluid that can form in your gallbladder, which holds bile (a fluid helpful in digestion). Gallstones range in size from as small as a grain of sand to as large as a golf ball. Some people develop just one gallstone, while others develop many gallstones at the same time.
Sphincter of Oddi Dysfunction (SOD)
Sphincter of Oddi is a muscle which controls the flow of digestive juices and other chemicals within the digestive tract, liver and pancreas. When this muscle is working properly, it opens to allow bile and pancreatic juice to flow through and then closes again. However, in a condition called SOD, the sphincter muscle does not open when it should, thus preventing bile and pancreatic juice from flowing through and causing a backup of digestive juices, leading to bouts of severe pain in the abdomen.
This condition occurs in the tissues in your pancreas, which secretes fluids that aid in digestion and hormones like insulin that help regulate the metabolism of sugars. If cancer develops in pancreas, it will require surgical removal, which is the only chance of cure.
Jaundice is a medical term used to describe the yellowing of the skin and eyes. This condition forms when there is too much bilirubin (a yellow pigment that is formed by the breakdown of dead red blood cells in the liver) in your system. Jaundice may indicate a serious problem with the function of your liver, gallbladder, or pancreas.
Small and Large Intestine
This type of cancer starts in the colon or rectum, which are located in the lower part of the digestive system. Most colorectal cancers are adenocarcinomas (cancers that begin in cells that make and release mucus and other fluids). Colorectal cancer often begins as a growth called a polyp, which may form on the inner wall of the colon or rectum. Some polyps become cancer over time. Colorectal cancer can be prevented if polyps are identified and removed in the early stages.
This condition is part of inflammatory bowel disease (IBD), which causes inflammation in the lining of your digestive tract, leading to abdominal pain, diarrhea, fatigue, weight loss and malnutrition. The inflammation caused by Crohn's disease often spreads deep into the layers of affected bowel tissue and it Crohn's disease can be both painful and debilitating, and sometimes may lead to life-threatening complications.
Familial Adenomatous Polyposis (FAP)
FAP is a rare, inherited condition that causes extra tissue called polyps to form in your colon and rectum. Polyps can also occur in the upper gastrointestinal tract, especially the upper part of your small intestine also known as the duodenum.
Irritable Bowel Syndrome (IBS)
IBS is a common condition affecting the colon or the large intestine. This usually causes cramping, abdominal pain, bloating, gas, diarrhea and constipation and needs long term management as it is a long term disease. Even though signs and symptoms are uncomfortable, IBS — unlike ulcerative colitis and Crohn's disease, which are forms of inflammatory bowel disease — doesn't cause changes in bowel tissue or increase your risk of colorectal cancer.
This is a chronic condition of the large intestine (colon), where in the lining of the colon is inflamed and develops tiny open sores, or ulcers, that produce pus and mucous. The combination of inflammation and ulceration can cause abdominal pain and frequent emptying of the colon. This condition is a result of an abnormal response by your body's immune system.
Most of the diseases that we treat at BMH are manageable, but it definitely has an adverse effect on the quality of life of the patient. We at BMH are committed to not only treat the disease, but also try to improve the quality of life of our patients with help of advanced technologies and clinical care. Facilities available at BMH are listed below.
Upper GI Endoscopy
Upper gastrointestinal (GI) endoscopy is a procedure where a gastroenterologist uses an endoscope (a long, flexible tube with a camera) to view the upper part of the gastrointestinal tract including the esophagus, the stomach and the first part of the small intestine. You will have to fast for at least four to eight hours to ensure your stomach is empty for the procedure. Anesthetic will be sprayed into your mouth so that your throat is numb, as the endoscope is inserted into your esophagus and down to the upper GI tract.
Colonoscopy is the exam of the large intestine or the colon. This procedure uses a colonoscope, fitted with a tiny camera on the end, which is inserted into your colon from your rectum to view it from the inside. You will be given sedatives to relax during the procedure.
In this procedure, a sigmoidoscopeis used to see inside the sigmoid colon and rectum, which is the area of the large intestine nearest to the rectum. You will be given sedatives to relax during the procedure.
In this procedure,a chemical called a sclerosantis injected directly into an enlarged vein or into the wall of the esophagus next to the enlarged veins. The substance causes inflammation of the inside lining of the vein, causing the vein to scar and collapse. This then forces blood to reroute through healthier veins.
Endoscopic variceal ligation
In this procedure an enlarged vein or a varix in the esophagus is tied off or ligated by a rubber band and delivered via an endoscope.Varices develop due to portal hypertension and a major risk with them is bleeding. You will have to fast for at least four to eight hours to ensure your stomach is empty for the procedure. You will be given sedatives via IV to relax during the procedure.
In this procedure, a narrowed area of the esophagus is stretched or dilated using various techniques. It is usually performed as a part of a sedated endoscopy.
A stent is placed in the esophagus to keep a blocked area open. This makes it easy for the patient to swallow solids and liquids. Esophageal stents may be self-expandable metallic stents, or made of plastic, or silicone, and may be used in the treatment of esophageal cancer.
Percutaneous endoscopic gastrostomy(PEG)
In this procedure a tube called the PEG tube is passed into a patient's stomach through the abdominal wall. This helps in feeding the patient in cases where oral intake is not adequate (for instance, because of dysphagia or sedation).
ERCP (Endoscopic retrograde cholangiopancreatography) is a diagnostic and therapeutic procedure which detects the diseases of the liver, bile ducts and pancreas. Through an endoscope (fitted with a camera at its tip), the doctor can view the inside of the stomach and duodenum, and inject radiographic contrast into the bile ducts or pancreas duct to see them on radiographs. The procedure needs to be done on an empty stomach. Sedatives will be given to you to induce relaxation and sleepiness. A light local anesthesia will be administered to decrease the gag reflex.
This procedure makes use of nasobiliary catheters, which are simply long polyethylene tubes (twice the length of the endoscope), with multiple distal side holes. They are inserted into the bile ducts for effective drainage, with proximal end of the drain being shifted from mouth to the nose. A short plastic tube is passed through a nostril into the pharynx, and brought out through the mouth. The top of the biliary drain is then fed back through it; both are withdrawn at the nose until the drain lies straight in the pharynx.
Pancreatic stone removal and stenting
Interventional endoscopy is used to treat patients with chronic pancreatitis to remove stones and provide relief. Also, stents are placed into the pancreatic ducts in order to clear blockage and provide drainage of pancreatic juice.
Other facilities available at BMH’s Institute of Liver and Gastro Sciences include: Biliary cytology; Fundal glue injection/ Heamoclip application/ Heater probe application; Polypectomy; CBD stone removal/ stenting;CBD stricture dilatation; Foreign body removal; Endoscopic Ryle’s tube placement, etc. Other services that we offerare expert management of GI disorders, hepatobiliary and pancreatic diseases; OGD Scopy; sigmoidoscopy and colonoscopy.
The surgical procedures performed in this department can be broadly divided into:-
Hepatobiliary Surgery: Liver resections for Liver and Biliary Tract Cancers and Biliary Stone-related Surgeries.
Pancreatic Surgery: Surgery for Pancreatic Cancer, Acute and Chronic Pancreatitis.
Colorectal Surgery: Surgery for Colorectal Cancer, Colonic Diverticulitis, Complex Fistulae, Piles and Inflammatory Bowel Disease like Ulcerative Colitis and Crohn’s Disease.
Esophago Gastric Surgery: For Esophageal and Gastric Cancers, GERD- Reflux disease and Hiatus Hernia.For Esophageal and Gastric Cancers, GERD- Reflux disease and Hiatus Hernia.
Bariatric Surgery: for Morbid Obesity and Metabolic Syndrome.
Hepatic/liver resections are done commonly for liver tumors. It requires good preoperative planning, meticulous surgery and intensive postoperative care for good results. The following procedures are done regularly in the department.
Major Hepatectomy for Hepatocellular and Cholangiocarcinoma.
Gall Bladder Cancer Surgery.
Choledochal Cyst Surgery.
Gall Bladder Stone Surgery (Laparoscopic Cholecystectomy).
A good number of the pancreatic surgeries are done laparoscopically.
WhipplesPancreaticoduodenectomy for Carcinoma Pancreas and Periampullary Carcinoma
Frey’s Lateral Pancreatojejunostomy for Chronic Pancreatitis
Distal and Median pancreatectomy
Pancreatic Necrosectomy and surgery for Pseudocyst
Luminal GI Surgery
These procedures are done for lesions of Esophagus, Stomach, Small Intestine and Colon. Most of these procedures are done laparoscopically. They include
Thoraco-Laparoscopic Esophagectomy for Esophageal Cancer
Laparoscopic Surgery for Achalasia Cardia
Laparoscopic Fundoplication for Hiatus Hernia/ GERD
Radical Gastrectomy for Gastric Cancer
Small Bowel Resections/Strictureplasty
All types of laparoscopic Colonic and Rectal Resections
Lap. Restorative Proctocolectomy with Ileal Pouch Anal Anastomosis (IPAA) for Ulcerative Colitis / FAP
Bariatric and Metabolic Surgery
Today, with sedentary lifestyle and bad food habits, obesity is a problem faced by many across age groups. Obesity leads to various health problems like Diabetes, Hypertension, Sleep Apnea, etc. Bariatric Surgery is an absolutely safe and secure method that gives quick results. This type of surgery actually minimizes the size of the stomach so that intake is lessened as one gets the filled feeling with just a little food.
Advanced GI Laparoscopy
This unit is a specialisedcentre for all GI laparoscopic procedures. Surgeries commonly performed in the department are:
Laparoscopic Anterior Resection for Carcinoma Rectum
Laparoscopic APR for Anal Canal Tumours
Laparoscopic Colonic Resections (Hemicolectomy, Segmental Colectomy)
Laparoscopic Restorative Proctocolectomy with IPAA for Polyposis Coli and Ulcerative colitis
Thoraco-Laparoscopic Surgery for Esophageal Cancer
Laparoscopic Surgery for Achalasia Cardia (Cardiomyotomy)
Laparoscopic Fundoplication for Gastroesophageal Reflux Disease (GERD)
Laparoscopic Surgery for Inguinal Hernia (Lap TEP & TAPP repair)
Laparoscopic Mesh Repair for Incisional & Umbilical Hernia
Laparoscopic CBD exploration for CBD Stone
Laparoscopic Surgery for Choledochal Cyst
Laparoscopic Resection for Liver Lesions
Laparoscopic Bariatric/Obesity Surgery
Laparoscopic Pancreatic Necrosectomy
Equipment / Facility
The operations suites are well equipped with all most modern facilities. This state of art theatre complex is well equipped to perform all major GI surgeries like Liver Resections, Liver Transplantation, Pancreatic Resections and all advanced GI Laparoscopic Surgeries.
High Definition 3-Chip Camera system from Karl-Storz
Ultrasonic Dissector for Liver Resection from Stryker (CUSA)
Gen X system of Harmonic Scalpel and Enseal of Ethicon
Force Triad-Ligasure Vessel Sealing System of Covidien
Intraoperative Ultrasound from Aloka
Argon Plasma Coagulator from ERBE