Below are the main symptoms and problems that lead to a consultation with a Gastroenterologist/Hepatologist.
Dyspepsia describes a group of symptoms which people often call indigestion. It is an uncomfortable feeling, sometimes painful, high up in the upper abdomen, which usually has some relationship to eating. It is often relieved by simple over-the-counter anti-acid medication. Doctors attach importance to dyspepsia that wakes patients during the night. It has no specific definable cause, but can be linked to Helicobacter infection in the stomach, the presences of ulcers in the stomach or duodenum, or occasionally to gastric cancer.
Heartburn does not originate from the heart but is the sensation produced by acid, which is normally present in the stomach, refluxing to the oesophagus (gullet), which is not designed to cope with acidic contents. It is usually felt behind the breastbone and may feel as if it is radiating up towards the throat. It can often be relieved by simple over-the-counter anti-acid medication. Proton pump inhibitor treatments usually give very effective e relief.
Difficulty in Swallowing
In a normal situation, swallowing is a reflex mechanism about which a person is hardly aware. Any difficulty in swallowing will be felt as an abnormal sensation. Causes in the lower oesophagus (gullet) include inflammation related to reflux and heartburn, stricturing related to long-term reflux and heartburn, and occasionally to oesophageal cancer. Cancer tends to show itself with difficulty in swallowing which gets worse fairly quickly, perhaps just over a few weeks. Sometimes difficulty in swallowing is related to a disordered function of the oesophagus (gullet), and occasionally difficulty in swallowing can be due to a disordered mechanism to do with the back of the throat.
Abdominal pain has a wide range of causes. Pain may originate from any of the abdominal organs, including the bowel and pancreas. In women, it may come from gynaecological problems. Causes can include inflammatory problems, and occasionally cancer, although in the latter case there are usually associated symptoms, particularly weight loss. The majority of liver diseases do not produce abdominal pain. By far the commonest cause of abdominal pain are a series of functional disorders, where no specific cause can be found, but the function of the digestive system is disordered.
Unintentional weight loss has a wide range of medical causes, some of them in the area of Gastroenterology but many of which are not. A Gastroenterologist is well placed to initially assess a patient with unexplained weight loss, and if a problem is found outside the gastrointestinal tract, or if the cause of weight loss cannot be determined, then referral can be made to other appropriate specialties. If no physical cause is found, it is sometimes concluded that weight loss is a symptom of depression.
Change in Bowel Pattern
Even in the normal situation, the pattern of opening bowels can be variable. Nevertheless, a noticeable and significant change in the pattern of going to the toilet for any person can be a significant symptom of important disease, and is occasionally due to cancer. A change in bowel pattern which turns out to be cancer, is often on the looser side rather than on the constipated side. A change in bowel pattern accompanied by rectal bleeding should always be taken more seriously.
In the majority of people, rectal bleeding does not have a serious cause, and is related to the presence of haemorrhoids (piles) or other relatively minor problems around the anal area. Rectal bleeding that could be indicative of cancer is usually persistent, more in the stool than on the paper, and often darker red rather than bright red.
A patient is jaundiced when their skin, and particularly the whites of their eyes, has a yellow tinge. The presence of jaundice usually indicates problems in the liver, although occasionally may indicate a haematological problem, with over-production of the bilirubin pigment that causes jaundice. There may be intrinsic liver problems, including acute infections, such as Hepatitis, or more chronic liver diseases. There may be blockage to the bile duct draining the liver, sometimes due to gallstones and sometimes due to cancers, such as in the pancreas. Jaundice is always an important symptom that needs immediate evaluation.
Abnormal Liver Blood Tests
There is a series of blood tests which together are known as Liver Function Tests. They assess both the working of the liver, but also whether there is anything upsetting or damaging the liver. They will be requested if there is any indication of liver problems, such as if the patient is jaundiced, but they are also requested in a wide range of other clinical situations. A Gastroenterologist or Hepatologist is often asked for an opinion when liver blood tests done in a context of other problems show an abnormality. Three common causes of the chance finding of abnormal liver blood tests include regular excess alcohol consumption, being overweight leading to excess fat in the liver, and a mild reaction to some medication. There is a range of more serious but unusual liver problems that can be discovered when liver blood tests done for other reasons show an abnormality.