Bowel cancer screening
Bowel cancer is the second most common cancer in Australia, and Australia has one of the highest rates of bowel cancer in the world. Often symptoms are at a later stage and therefore screening is recommended for at risk populations. Screening has been shown to detect cancer and precancerous polyps at an earlier stage with treatment outcomes improved. At risk patients are those over 50 years or with a family history of bowel cancer or polyps. Screening can be undertaken with a home stool sample, a “faecal occult blood test” or by colonoscopy. These two tests have varying accuracy, risks and inconvenience. Consideration or bowel cancer screening should be part of every yearly healthcheck.
Coeliac disease occurs in 0.5-1% of the Australian population. It can onset at any age and often symptoms are present for many years before diagnosis. The symptoms include bloating, diarrhoea, lack of energy and anaemia. There is an allergy to a protein (gluten) found in wheat, barley, rye and oats. The diagnosis is made by obtaining a biopsy at gastroscopy while eating a gluten containing diet. The only treatment is a diet avoiding gluten, which is complicated and usually undertaken with the support of a dietician.
Crohn’s disease is similar to UC but can affect any part of the gastrointestinal tract. Diarrhoea, abdominal pain and feeling generally unwell are frequent symptoms. It tends to occur in young adults and is more likely in smokers. Treatment usually requires medication to modulate the immune system. The pattern of inflammation needs to be determined by colonoscopy and often with magnetic resonance (MRI scans) of the abdomen.
Diverticular disease represents small “pockets” in the lining of the large bowel, usually on the lower left side. These are very common as people age. Most of the time these don’t cause symptoms but uncommonly these can become infected or bleed. It is no longer thought necessary to avoid seeds or nuts. The use of aspirin and anti-inflammatory medications increase the risk of bleeding and infection.
Excess liver fat can lead to inflammation of the liver and over the long term can lead to permanent liver damage. Fatty liver has become the most common cause of liver disease and is associated with the “metabolic syndrome” of obesity, high blood pressure and diabetes. Diet, weight loss and exercise are the cornerstones of treatment.
Functional dyspepsia can be thought of as irritable bowel of the stomach. Patients experience upper abdominal discomfort, nausea, bloating and easy fullness. Gastroscopy is usually needed to identify other possible causes of symptoms such as helicobacter pylori infection or coeliac disease. A trial of acid reducing medication or medication to reduce discomfort, and addressing lifestyle factors such as diet, stress and exercise are the usual course of action.
Gastro oesophageal reflux disease (GORD)
GORD occurs in over 20% of the Australian population, it is related to reduced effectiveness of the valve between the stomach and oesophagus, allowing stomach acid to burn the oesophagus. Symptoms of chest burning or discomfort and regurgitation are frequent. Medication is often effective at controlling symptoms, as well as lifestyle measures such as weight reduction and avoiding trigger foods. Gastroscopy is often needed to identify other possible causes of symptoms and complications of reflux.
Haemochromatosis is a genetic condition leading to excess iron absorption. Excess iron can lead to damage particularly to the liver, pancreas and joints. Early identification with a screening blood test for patients with fatigue or abnormal liver tests and subsequent venesection can prevent complications.
Irritable bowel syndrome (IBS)
IBS occurs in 20% of the Australian population and requires long term management. Symptoms include bloating, abdominal pain, at times constipation or diarrhoea. There is usually a characteristic pattern of symptoms but it is important to identify other conditions such as coeliac disease and Crohn’s disease which might have a very similar presentation. Simple measures such as diet changes can be tried, and simple herbal therapies might also be effective. Increasing the patient’s overall well being and stress management are part of Dr Hall’s holistic plan.
Minimising bowel cancer risk
Lifestyle factors have a significant impact on the risk of developing bowel cancer. To minimise risk consider:
- Daily exercise (including incidental mobility during the office day)
- Reducing weight
- Minimise/stopping cigarette/alcohol consumption
- Reducing red meat intake
- 2 serves of fruit and 3 serves of vegetables (1 serve =1/2cup) every day
Peptic ulcer disease
Peptic ulcers were previously thought to be related to stress but almost all are related to helicobacter pylori infection of the stomach, or aspirin and anti-inflammatory use. Symptoms include upper abdominal discomfort or ache. Bleeding can occur from ulcers often without abdominal pain. Treatment with acid reducing medication, and antibiotics if the bacteria is present, are very effective.
Dr Hall aims to get the most value from a colonoscopy. This includes detailed explanation of the bowel preparation process to maximise the cleanliness allowing the bowel lining to be examined as completely as possible. Dr Hall reviews current journal publications regarding new developments and has incorporated these into daily practice. These include “split” preparation and the use of a “cap” attachment to the colonoscope to ease insertion and improve polyp detection rates. Dr Hall conducts an audit process of colonoscopy performance and this is comparable to published studies.
Ulcerative Colitis (UC)
UC is the long term inflammation of the colon (large bowel) usually presenting with diarrhoea which can be bloody. It frequently occurs in young adults but is often responsive to low risk medication. Determination of the condition is with colonoscopy and other analysis, particularly to exclude infection.