Gastroenterology & Endoscopy — Town Hospital

Gastroenterology and endoscopy at Town Hospital: an overview

Town Hospital's Gastroenterology & Endoscopy department in the Fifth Settlement, New Cairo, diagnoses and treats conditions of the oesophagus, stomach, bowel, colon and liver, from common complaints such as heartburn, indigestion and bloating to conditions that need long-term follow-up, such as liver disease. The department's doctors specialise in gastroenterology, hepatology and endoscopy; you will find them in the list of doctors above.

The hospital's laboratory and radiology department are in the same building and both run 24 hours a day, with 128-slice CT, a 3 Tesla MRI and ultrasound, so in many cases the consultation, the tests and the scans can be done in a single visit. The outpatient clinics are open every day from 10 am to 10 pm; the department's own clinic days and times vary from doctor to doctor and are shown in the up-to-date clinic schedule.

Conditions the department looks after

Finding the cause of the symptoms and choosing the treatment remains the doctor's decision after the consultation and a review of the tests and scans. These are the conditions patients most often come to the department with.

H. pylori (the stomach germ)

H. pylori is a common bacterial infection that may cause no symptoms, or may cause pain or burning in the upper abdomen, bloating and nausea; it is linked to some cases of gastritis and of stomach and duodenal ulcers. The doctor chooses the right test to diagnose it, such as a stool test for the bacterium, and may ask you to stop some acid-reducing medicines for a while before the test because they can affect the result; never stop a medicine on your own. Treatment usually combines more than one medicine, including antibiotics and a medicine that reduces stomach acid; the doctor sets the plan and its length, and the test is repeated after treatment to confirm that the infection has gone. Antibiotics should never be taken without a prescription, and a previous course should not be repeated without advice. Read more in H. pylori: symptoms, diagnosis and treatment. If you would like an organised check-up, the Stomach Health Package brings together the H. pylori test, an internal medicine and gastroenterology consultation and essential laboratory tests, with a gastroscopy as an optional add-on when it is needed.

Acid reflux and heartburn

Acid reflux happens when stomach acid flows back into the oesophagus, causing burning behind the breastbone and a sour taste in the mouth, and sometimes a cough or a hoarse voice. Treatment usually starts with lifestyle changes, such as losing excess weight, avoiding large meals and eating just before bed, and raising the head of the bed. The classes of medicine the doctor chooses from, depending on the case, include antacids for quick relief, H2-receptor blockers and proton-pump inhibitors. These medicines reduce acid but do not treat every cause of the symptoms; they should not be taken long term without medical follow-up, and children, pregnant women, people with kidney disease or other long-term conditions and people taking other medicines should ask a doctor before using them. Symptoms that continue despite treatment, that start for the first time later in life, or that come with difficulty swallowing or weight loss need a doctor's assessment, and the doctor may decide on a gastroscopy. Read more in How to treat acid reflux.

Gastritis, indigestion and bloating

Many people feel pain, fullness or burning in the upper abdomen after eating, or have bloating and frequent belching. The cause may be inflammation of the stomach lining, for example from H. pylori or from overusing painkillers of the non-steroidal anti-inflammatory class, or it may be functional indigestion, where tests show no clear physical cause. The doctor looks for the cause first, because treatment depends on it, and decides whether tests, scans or a gastroscopy are needed. Read about treating gastritis and about treating indigestion and bloating.

Irritable bowel syndrome and changes in bowel habit

Irritable bowel syndrome (IBS) is a common condition that causes recurring abdominal pain linked to bowel movements, with diarrhoea, constipation or both in turn, and bloating. It is long-lasting but does not cause permanent damage to the bowel, and it is diagnosed after other causes have been ruled out. Treatment relies on changes to diet and lifestyle and on managing stress, with medicines the doctor chooses according to the main symptoms. Blood in the stool, unexplained weight loss, anaemia, symptoms that start after the age of fifty, or a family history of bowel cancer call for further tests chosen by the doctor. Read more in Irritable bowel syndrome: symptoms, causes and treatment.

Fatty liver and liver disease

Fatty liver is one of the most common liver conditions and is linked to excess weight, diabetes and abnormal blood fats; it is often found by chance on an ultrasound scan or in liver function tests. The doctor assesses how advanced it is and the risk factors, and sets a plan based mainly on gradual weight loss, physical activity and control of blood sugar and blood fats, with regular follow-up. The department also looks after abnormal liver function tests and yellowing of the skin and eyes, and the doctor decides which tests are needed to find the cause. Read about fatty liver: symptoms, causes and treatment.

The gallbladder and bile ducts

Gallstones sometimes cause colicky pain in the upper right abdomen after fatty meals, and a stone can move into the main bile duct and cause yellowing of the skin and eyes. These conditions are shared between gastroenterology and the general and laparoscopic surgery department: laparoscopic gallbladder removal is done by the surgeon, and the procedures available in the hospital for bile-duct stones include ERCP (endoscopic retrograde cholangiopancreatography); the team decides on the right procedure and its timing case by case. Yellowing of the skin or eyes with a fever, shivering or severe abdominal pain needs the nearest emergency department straight away.

Gastroscopy in the department

A gastroscopy, or upper GI endoscopy, uses a thin, flexible tube with a camera that passes through the mouth to show the oesophagus, the stomach and the first part of the small intestine (the duodenum). The doctor turns to it when the consultation and tests are not enough to explain the symptoms, or when warning signs appear, such as difficulty swallowing, unexplained weight loss, anaemia or repeated vomiting.

• Before: you will be asked not to eat or drink for a number of hours, following the team's instructions; tell the doctor about your medicines, especially blood thinners and diabetes medicines, and do not stop any medicine on your own.
• During: a throat spray or a sedative may be used depending on your case and the doctor's judgement; the procedure usually takes a short time, and most people feel mild discomfort rather than real pain.
• After: you stay under observation until any sedative has worn off; if you had a sedative, do not drive for the rest of the day and bring someone with you. The doctor explains what the gastroscopy showed and the next step.

Other endoscopic procedures performed in the hospital, as each case requires, include full colonoscopy, sigmoidoscopy (an examination of the lower part of the colon), biopsies taken during endoscopy, removal of colon polyps, banding of oesophageal varices, injection of oesophageal varices, dilatation of the oesophagus, stenting of the oesophagus, and endoscopic placement of a feeding tube (PEG). Before any procedure, the doctor explains why it is needed, its benefits and possible risks, and how to prepare.

A liver biopsy can also be performed in the hospital when the diagnosis needs one, after the doctor has explained why it is needed, its benefits and possible risks.

When to see a gastroenterologist, and when to go to the emergency department

See a gastroenterologist for:

• Heartburn or reflux more than twice a week, or that does not improve with treatment.
• Recurrent abdominal pain, persistent bloating or recurrent indigestion.
• A change in bowel habit, diarrhoea or constipation, that lasts more than a few weeks.
• An abnormal liver function test, or fatty liver found on an ultrasound scan.
• Difficulty swallowing, unexplained weight loss or anaemia with no clear cause, which need an assessment without delay.

Vomiting blood, vomit that looks like coffee grounds, black tarry stools or heavy bleeding from the back passage, especially with dizziness, fainting or pallor, can be signs of bleeding in the digestive tract. Town Hospital's emergency department does not receive patients with digestive (GI) bleeding, so call an ambulance on 123 straight away, without waiting for a clinic appointment and without taking painkillers at home.

The following signs need the nearest emergency department straight away, or an ambulance on 123:

• Sudden severe abdominal pain, or worsening pain with a hard abdomen that is painful to touch.
• Being unable to swallow food or water.
• Yellowing of the skin or eyes with a fever or shivering.
• Confusion or marked drowsiness in someone with liver disease.

Your care, step by step

• Consultation: care starts in the gastroenterology clinic, where the doctor asks about your symptoms and how long you have had them, your medicines and your family history, and reviews any previous tests and scans.
• Tests: blood tests are done in the hospital laboratory and scans in the radiology centre, both open 24 hours a day, and a gastroscopy is requested when the diagnosis needs it.
• Plan: the doctor explains the diagnosis and the treatment options, with and without medicines, and agrees a clear plan and follow-up appointments with you.
• Working with other departments: when needed, the department works with general and laparoscopic surgery, internal medicine and the hospital's other specialties.
• Follow-up: conditions such as H. pylori and fatty liver need follow-up or a repeat test after treatment, at a time the doctor sets.

The hospital is contracted with more than 40 payers, including insurance companies, professional syndicates and government bodies, and cover depends on the payer and the terms of the contract.