Dr. Manish Joshi

Sometimes, when it comes to problems in the abdominal area, an ultrasound is not clear enough for a diagnosis. In such cases, an Endoscopic Retrograde Cholangiopancreatography (ERCP) may be performed. This procedure gives the doctor a clear view of the duodenum, bile duct, pancreatic ducts, gallbladder and papilla of Vater.

This procedure is usually performed under intravenous sedation without general anesthesia. This procedure involves the use of a duodenoscope, which can be described as a thin, long, flexible tube with a camera at one end. It also has a fiber optic bundle that transmits lights to the camera and a chip to transmit video images to a TV screen.

This is inserted through the patient’s mouth and sent down the throat through the food pipe to the stomach and duodenum while the patient is lying on his or her back. The air pipe is left undisturbed so as to not interfere with the patient’s breathing. Since the patient is not under general anesthesia, he or she can move and turn according to the doctor’s needs. The papilla of Vater is a small nipple like structure with an opening to the bile duct and pancreatic duct. Once this has been identified, a small plastic catheter is passed through the duodenoscope into the bile duct or pancreatic duct through the papilla. Dye is then injected into the area and X-rays are taken of the bile ducts and pancreatic duct. In cases where a biopsy is needed, other instruments can also be passed through the endoscope. Plastic or metal stents can also be passed through this to relieve obstructions in the bile ducts and pancreatic ducts.

ERCP can be used to diagnose and treat a number of conditions in the liver, bile ducts, gall bladder, pancreas and papilla of Vater. These include:

1. Blockage of the bile duct by gallstones, cancer, scars, tumors or compression from adjacent organs.
2. Jaundice due to an obstructed bile duct. This can also cause light stools and dark urine.
3. Persistent upper abdominal pain
4. Unexplained weight loss and loss of appetite
5. Diagnosing a Dysfunctioning Sphincter of Oddi within the Papilla of Vater

ERCP can also be used to confirm pancreatic cancer and cancer of the bile duct. Once the diagnosis is confirmed, the doctors can customize treatment according to the patient’s needs. In case you have a concern or query you can always consult an expert & get answers to your questions!

Anal fissures are the small tears formed in the anal lining. They are also known as anal ulcers. An anal fissure causes a lot of pain and bleeding during your bowel movements. Usually a fissure heals automatically in a few days time. It can be treated with simple home remedies as well.

CAUSES:

1. You can suffer from an anal fissure if you pass hard and large stools. 
2. Also strained childbirth or suffering from violent spells of diarrhea might get you an anal fissure. 
3. Chronic constipation may also be cause of a fissure. 
4. Other rare causes may be anal cancer, HIV, tuberculosis or herpes. 

Individuals of all age groups can suffer from anal fissures. It is not a very serious problem, and heals on its own in a few weeks. Although it can heal itself, there are certain treatments which can help relieve the pain you get from an anal fissure.

SYMPTOMS:

An anal fissure has quite a lot of symptoms for you to understand what you are suffering from:

1. There will be a very visible tear around the anal region. You will be able to spot the tear on the skin very easily.
2. A small lump of skin may form next to the tear.
3. When you will be undergoing your bowel movements, you will feel a very sharp pain in the anal region.
4. You will find spots of blood on the stool passed.
5. You will also feel a burning or an itching sensation in the anal region.

TREATMENT:
Although most fissures do not require treatment, there are a few remedies that will help cure them faster:

1. Stool softeners: You get certain medicines at the chemist, which are known for their stool softening functions. These stool softeners help to soften the hard stools and initiates smooth bowel movements.
2. Eat fibrous foods: Eat foods rich in fiber like fruits, whole grain cereals, raw vegetables, etc.
3. Take warm baths: Take a bath in warm water as it relaxes your anal muscles, helps to relieve irritation in the region, and increases blood flow in the anorectal region.
4. Use ointment: Apply nitroglycerin ointments and topical pain relievers to promote blood flow to the anal region and to relieve discomfort from the region respectively.

In case you have a concern or query you can always consult an expert & get answers to your questions!

Exocrine Pancreatic Insufficiency (EPI), also called pancreatic deficiency, is a disorder where the pancreas is unable to produce the sufficient amount of enzymes that are required to digest food. The pancreatic enzymes help to break down and absorb nutrients from the food in the small intestine. So, this disease causes nutritional deficiencies.

Causes of Exocrine Pancreatic Insufficiency
This condition is generally caused as a complication of other diseases because EPI develops only as a result of severe damage to the pancreas. The following reasons can cause EPI:

1. Inflammation of the pancreas: After surgery in the pancreas, stomach or the intestines, there may be inflammation in the pancreas as a post-surgical complication. A high content of triglyceride fat in the blood can also cause pancreatic inflammation and hinder the secretion of the enzymes.
2. Chronic Pancreatitis: In this disease, the pancreatic ducts are swollen and blocked and so the digestive enzymes cannot be passed into the small intestine. This condition is often caused by a heavy consumption of alcohol.
3. Cystic Fibrosis: The digestive fluids and enzymes become thick and sticky and block the passageways of the pancreas and other organs like the lungs and the kidneys. This can obstruct secretion and passage of enzymes afterwards.
4. Shwachman-Bodian-Diamond syndrome: This is an autosomal recessive genetic condition where enzyme-producing pancreatic cells are not formed properly. This rare disorder causes a number of associated disorders like bone marrow diseases, skeletal defects and exocrine pancreatic insufficiency.

Symptoms of Exocrine Pancreatic Insufficiency
The symptoms appear in the middle stages of the disease when the process of absorption of nutrients has already been affected. The common warning signs are:

1. Digestive problems like gas, diarrhea and indigestion because the food remains mostly undigested.
2. Severe and frequent stomach pain in the lower abdominal region
3. Greasy stools due to the excretion of undigested fat
4. Rapid loss of weight and body mass due to mal-absorption of nutrients
5. Constantly feeling bloated and full even if you have not eaten anything
6. A general sense of fatigue and exhaustion
7. Excessive bleeding from small wounds because protein deficiencies hamper blood clotting
8. Pain in the muscles and bones
9. Increased susceptibility to infections of the body systems
10. Anemia
11. Joint pains
12. Abnormal swelling of the limbs or edema

In case you have a concern or query you can always consult an expert & get answers to your questions!

When a hole develops in the wall of the gallbladder, rectum, large bowel, small intestine, stomach or oesophagus, it is called gastrointestinal perforation. It is a medical emergency that needs urgent medical attention.

Symptoms of gastrointestinal perforation (GP) usually include

1. Serious stomach pain
2. Chills
3. Fever
4. Nausea
5. Vomiting

Peritonitis (abdominal cavity lining inflammation) can also accompany the abovementioned condition. So in addition to the above symptoms, you may also experience peritonitis symptoms such as:

1. Fatigue
2. Passing less gas, urine or stools
3. Breathing difficulties
4. Fast heartbeats
5. Dizziness

Certain diseases can cause Gastro-intestinal perforation, such as:

1. Appendicitis
2. Diverticulitis (A type of digestive disorder)
3. Stomach ulcer
4. Gallstones
5. Gallbladder infection
6. Inflammatory bowel diseases (inflammation in the small intestine and the colon)
7. Swollen Meckel’s diverticulum (abnormal bulging of the small intestine at birth)
8. Gastrointestinal tract cancer

Besides diseases, the following conditions can also lead to Gastro-intestinal perforation:

1. Blunt abdominal trauma
2. Gunshot or knife wound to the abdomen
3. Abdominal surgery
4. Stomach ulcers caused by excessive consumption of steroids, anti-inflammatory drugs and aspirin
5. Ingestion of caustic substances or foreign objects

Other than these, drinking alcohol, smoking and bowel injuries (caused by colonoscopy or endoscopy) can lead to GP as well.

Treatment options available
This condition is mostly treated with surgery. The goal of the surgery is to repair the anatomical problem and cause of peritonitis, along with removal of any foreign object in the abdominal socket, such as food, faeces and bile. However, if your doctor deems surgery unnecessary (in instances where the hole closes voluntarily) you will be only given antibiotics.
In some cases, a section of the intestine might need to be removed. An ileostomy or colostomy is performed where a portion of the large or small intestine is removed, which grants intestinal contents to empty or drain into a bag implanted on the wall of your abdomen.

The complications include:

• Bleeding
• Sepsis (Critical and fatal bacterial infection)
• Belly ulcers
• Wound infection
• Bowel infarction (impaired supply of blood to the bowels)
• 6. Permanent colostomy or ileostomy

In case you have a concern or query you can always consult an expert & get answers to your questions!

Feeling bloated or acidic after a heavy meal can take away all the satisfaction the taste of food gave you. Indigestion and gas are some of the most common gastrointestinal problems faced by people around the world. In most cases, indigestion is a result of bad food choices and unhealthy lifestyles. Thus they can simply be relieved at home and do not necessarily need medication. Here are 4 easy steps to lower heartburn, gas and indigestion.

1. Add more fiber to your food: Fiber is crucial to healthy digestion. It is easy to digest and help push waste out of the system by adding bulk. In this way, fiber helps detoxify the system as well. It also prevents diabetes, heart disease, hemorrhoids and other diseases. Add fiber to your diet in the form of whole grains, cereals, fruits, vegetables, nuts and plenty of water. Ideally, a woman should have 25 gms of fiber a day and men should have 38 grams of fiber a day.
2. Healthy food eating habits: How you eat also makes a difference to your digestion. Instead of eating on the move, eat mindfully. Chew your food carefully to begin the digestive system. Eating smaller portions can also help improve stomach functioning. Avoid fast foods that are difficult to digest. Ensure that you do not eat anything for at least an hour before going to bed. Lying down immediately after a meal is one of the leading causes of indigestion.
3. Probiotics: Gut bacteria is essential for healthy digestion. This bacteria helps maintain a healthy inner ecosystem and help fight harmful viruses, yeast and other such microorganisms. This balance of gut bacteria can be affected by an unhealthy lifestyle like excessive alcohol consumption, smoking, stress and certain prescription drugs. Supplementing your natural probiotic enzymes with food rich in probiotics like yogurt or probiotic supplements can help make your digestion better.
4. Exercise Regularly: Exercise is necessary not only for a fit body but also for healthy digestion. Exercising also helps fight stress that is one of the leading causes of indigestion. Taking a walk after meals can help regulate the passage of food and gases in your digestive system. This prevents bloating and heartburn. Physical activity also helps stimulate your bowels to prevent constipation and prevent gaseous build up. Some forms of exercise you could try are yoga, swimming and cycling. A word of caution; always ensure that there is at least an hour's gap between exercising and your last meal.

In case you have a concern or query you can always consult an expert & get answers to your questions!

Bariatric Surgery is a life-saving surgery and not a cosmetic surgery as it generally is regarded. In fact, it is a gastrointestinal surgery to improve, prevent and/or treat obesity which may be life threatening. This surgery is done by laparoscopy, does not involve removal of fat from the body and the weight loss after surgery is gradual i.e. 4-5kg per month and reaches a stable level after 1-2 years of surgery. Bariatric surgery is known to be the most effective and long lasting treatment for morbid obesity and many related conditions, but now mounting evidence suggests it may be among the most effective treatments for metabolic diseases and conditions including type-2 diabetes, hypertension, high cholesterol, non-alcoholic fatty liver disease and obstructive sleep apnea.

Diabetes is a gnawing problem that affects millions throughout the world. It is a disorder that if overlooked can lead to serious diseases; cardiovascular ailments, problems related to vision, kidney problems and many more. While medication tries to regulate your blood sugar levels, it is not always unfailing. Medication along with changes in your diet and lifestyle can still not improve your condition in certain cases. At times it is hard to increase the insulin production in a person's body even after administering medicines solely known for their efficacy. Such kind of diabetic patients can therefore benefit from a Bariatric surgery.

What is a Bariatric surgery?

Bariatric surgery doesn't refer to a single operative method. It involves a host of surgical procedures conducted on a person to rid him or her of obesity. Obesity in combination with diabetes can make a person's life miserable. The treatment of one can come in the way of curing the other. A diabetic patient who also suffers from obesity usually finds it hard to lose weight in spite of exercising or being on diet. Surgery comes to their rescue. This kind of surgery should be fallen back upon as the lender of last resort that is to say when other solutions have not helped. Bariatric surgery is always performed under skilled supervision. It might include reduction of the size of your stomach, removal of a portion of the stomach, or even gastric bypass surgery.

How does Bariatric surgery help reduce Diabetes?

Diabetes can be of three basic kinds;

• Type 1 diabetes in which the body produces no amount of insulin.
• Type 2 diabetes in which the body produces an insufficient amount of insulin or Gestational diabetes that pregnant women tend to contract.

Bariatric surgery proves to be very advantageous for patients of Type 2 diabetes:

1. Surgery lowers blood sugar levels considerably. Research shows people with acute diabetes made huge improvements after having undergone a Bariatric surgery. Their blood sugar levels dropped by a noticeable percentage and they felt healthier. Reduced blood sugar is an almost immediate effect in some while for others it does take some time.
2. Bariatric surgery exercises a control over cholesterol, blood pressure and triglyceride levels.
3. The impressive benefits of this operation for a Type 2 diabetes patient are not superficial or temporary. If the patient adheres to the lifestyle prescribed by a doctor, takes medication regularly and follows the basics of post- operative care he or she is likely to remain beyond the ambit of this metabolic disorder.
4. It successfully takes care of ailments resulting from diabetes.
5. Bariatric surgery can eliminate the need for medication or it can reduce the dosage of medicines you take.                 

In case you have a concern or query you can always consult an expert & get answers to your questions!

Rectal cancer is a condition whereby cancerous growth takes place in the rectum. Though not very common, rectal cancer can affect both men and women with the annual incidence rates in India standing at 3.9 per 10000 (in females) and 4.1 per 100000 in males.

Timely treatment and medication have helped many patients to overcome rectal cancer. One of the various treatments used in the case of rectal cancer includes surgical removal of the malignant cells to avoid further aggravation. In fact, there are many surgical options available to treat rectal cancer and the associated complications.

Abdominoperineal Resection Surgery: The Abdominoperineal Resection Surgery or APR is the surgical option used in the case of rectal cancer spreading to areas adjacent to the anus. In this surgery, the surgeon makes a cut in the lower abdomen as well as the perineum (the area between the vulva and the anus). The procedure involves removal of the cancerous outgrowths affecting the rectal part, along with the anus, the part of the rectum that has not been affected by cancer as well as the adjacent lymph nodes. The next step involves the colostomy (attachment of the incised part of the large intestine to an opening located in the abdominal wall). A bag is attached at the end of this abdominal opening. The main idea behind attachment of the bag is to collect the fecal matter (in the absence of the anus). The APR can trigger abdominal pain or erectile dysfunction (in some men). Though the arrangement can be uncomfortable for some, the treatment has helped in the successful treatment of rectal cancer.

Low Anterior Resection Surgery: Low Anterior Resection Surgery or the LAR is identical to the Abdominoperineal Resection Surgery. However, in the case of LAR, the anus is not excised out of the body as the rectal cancer is located well above the anus. Here, there is no attachment of a bag at the abdominal opening as the anus is still intact and healthy, performing its normal functions. In the case, the cancerous growths are in the lower region of the rectum, the surgeon may have to perform a Colo-Anal Anastomosis (a procedure where the cut end of the large intestine is attached to the anus). However, to avoid any complications and to ensure a speedy recovery, a surgeon may perform a temporary colostomy (reversed once a person has recovered fully).

Local Excision: The Local Excision is a surgical procedure used to remove cancer in the rectum as well as a fragment of the bowel, sparing the anus. Depending on the position of rectal cancer, a patient may undergo a Transanal Excision (when cancer lies very close to the anus, the surgery may be initiated at the anus) or a Transcoccygeal Excision (in the case, cancer is located well above the anus, the local excision is carried out through the coccyx). For effectiveness, the surgery may be followed by chemotherapy and radiotherapy.

 Rectal bleeding can be a sign of Rectal Cancer - get yourself checked by a specialist!

Gallstones are bits of solid material that may be formed in the gall bladder. The gallbladder is a little organ located under the liver. You won't not know you have them until they've block your bile duct, causing pain that will need immediate medical intervention, and even hospitalisation in some cases.They may comprise of cholesterol, salt, or bilirubin, which consists of red platelets. Gallstones vary in size. They can be as little as a grain of sand or as even the size of an apricot in many cases.

Women are more likely to develop gallstones than men. Read on to know more:

Causes: There are a number of causes for this condition, especially in women. These causes are as follows:

1. Intake of anti-conception medication pills, hormone trade treatment for menopause side effects, or pregnancy
2. Fasting
3. Malfunctioning of the gall bladder
4. High cholesterol levels
5. Gallstones may be created when there is excessive amount of cholesterol in the bile discharged by the liver. This bile normally separates the cholesterol and helps in the normal functioning of the liver and other digestive organs of the body.
6. Bilirubin: Bilirubin is a substance created when your liver wrecks old red platelets. A few conditions, like cirrhosis of the liver and certain blood issues causes the liver to create more bilirubin than it ought to. This can lead to complicated conditions like gallstones.
7. Bile: Your gallbladder needs to exhaust bile to be sound. In the event that it discharges its bile content, the bile turns out to be excessively thick which causes stones to shape.
8. Weight: Being overweight or underweight can also cause a malfunction which can lead to the appearance of such stones. The diet also has a bearing in such cases.

Symptoms:

1. Fever
2. A yellowish tint in your skin or eyes, which can demonstrate jaundice
3. Sickness or retching
4. Clay coloured stools
5. Pain in the right upper quadrant of your stomach area
6. Nausea
7. Vomiting
8. Other digestive issues

Treatment:

Numerous individuals with gallstones may be asked to go through surgery to remove the gallbladder. These include the following:

1. Laparoscopic cholecystectomy: The specialist passes instruments, a light, and a camera through a few little cuts in the midsection.
2. Open cholecystectomy: The specialist makes bigger cuts in the belly to expel the gallbladder. You may have to spend a couple days in the hospital after the operation.
3. Without getting operated: If you have a mild condition and your specialist feels you shouldn't have an operation, he may recommend medicines like chenodiol, ursodiol, or both. These medications work by dissolving cholesterol stones. One may experience mild loose motions as a side effect. If you wish to discuss about any specific problem, you can consult a Gastroenterologist.

Undigested food that lurks around in the digestive tract produces a host of disorders due to intestinal distress. These disorders range from acidity to gastro-oesophageal reflux and even colon diseases like cancer, irritable bowel syndrome, constipation, gallstones, ulcers and Crohn's disease. Cramps, nausea, vomiting, loose motions, gas, and acidity are some of the most common symptoms that visit the patient as a result of such ailments. There are many ways of dealing with such intestinal distress, as follows :-

1. Diet: Introduce plenty of fibre into your diet to aid the digestion process. This can cut the risk of many such ailments and also aid in the treatment of the same. Intestinal distress is largely caused by food that is still lurking around in the digestive tract, so it is important to clean out the digestive system with plenty of fibre and water.
2. Nutrition for better Digestive System Health: Food that is rich in minerals, vitamins, antioxidants and iron will help in creating a stronger system that cleanses the digestive tract and helps in reducing the production of excess acid in the stomach. A balanced diet with plenty of nutrition aids digestion and makes the immunity stronger.
3. Study your Triggers: Watch out for foods that can trigger reflux action and other acidity related issues on the intake. These can include fatty food, fried and oily food as well as extremely spicy food. Stress is also a major trigger of intestinal distress, so it would be a good idea to avoid stressful situations or take medical help to deal with them in a better manner.
4. Medication: Antacids and other medication to prevent the onset and growth of such distress can be sought out after due consultation with a medical practitioner. Medication will help in dealing with and altering the acid level production in the stomach.
5. Surgery: In very extreme cases like ulcers and large size gallstones, surgery may be helpful so that you avoid rupturing the stomach's lining which can lead to a serious infection or even internal bleeding.

Knowing your triggers and getting into a better routine as far as your diet goes is as important as seeing a doctor about the severity of your case when it comes to intestinal distress.

If you wish to discuss about any specific problem, you can consult a Gastroenterologist.