Gastroenterology and Hepatology

Gastroenterology deals with the diagnosis, therapy and prevention of diseases of the gastrointestinal tract (oesophagus, stomach, small intestine, large intestine, rectum) as well as the associated organs gallbladder/channels and pancreas.

Hepatology is a special field of gastroenterology that deals with diseases of the liver.

Symptoms
Disease of the oesophagus
Stomach disease
Disease of the small intestine
Diseases of the large intestine
Diseases of the rectum and anus
Diseases of the liver and biliary tract
Diseases of the pancreas
Examinations
Why Swiss Medical Network?
FAQ

What are the symptoms of gastroenterology and hepatology?

If you suffer from persistent

  • heartburn,
  • constipation,
  • diarrhoea,
  • nausea,
  • vomiting,
  • difficulty swallowing,
  • stool irregularities,
  • abdominal pain,
  • weight loss,
  • symptoms such as blood in the stool, pain or itching at the anus,

you should have this assessed by a gastroenterologist - after consulting your family doctor. Yellowing of the skin, increase in abdominal girth or elevated liver values may indicate liver disease and should be clarified by a gastroenterologist/hepatologist.


A colonoscopy for bowel cancer screening is also recommended for symptom-free patients over the age of 50.

Diseases of the oesophagus

Reflux Disease

Reflux means the backflow of stomach contents/acid into the oesophagus. Reflux is a normal process, but when it leads to symptoms such as heartburn, burning in the stomach, belching or, more rarely, hoarseness, coughing and/or inflammation of the oesophagus, it is called reflux disease. The diagnosis is usually made on the basis of the typical complaints or by means of a gastroscopy. In special cases, a 24-hour acid measurement (24h-impedance pH-metry) can also be performed. In addition to general measures (avoidance of sumptuous meals, reduction of excess weight, smoking cessation, raising the head of the bed) and non-prescription antacids (=acid buffers), so-called proton pump blockers (=acid inhibitors) are often used for drug therapy. In selected cases, so-called anti-reflux surgery (fundoplication) can also be discussed.

Dysphagia

There are many reasons for dysphagia with food/fluids getting stuck or chest pain: there may be narrowing (e.g. due to a tumour or chronic reflux disease) or inflammation (e.g. a fungal infection or eosinophilic oesophagitis) of the oesophagus. These can be reliably diagnosed by a gastroscopy. If the gastroscopy does not find an explanation for the dysphagia, there is a functional disorder of the oesophagus, which is characterised either by a reduced slackness of the lower oesophageal sphincter and/or a lack of forward movement of the oesophageal muscles during swallowing. To clarify the function of the oesophagus, a so-called oesophageal manometry is carried out (pressure measurement via a probe which is placed into the stomach through the nose).

Oesophageal cancer

Oesophageal cancer usually develops due to chronic irritation of the oesophageal mucosa. Risk factors are excessive cigarette and alcohol consumption (mainly squamous cell carcinomas in the upper two thirds of the oesophagus) or long-standing reflux disease (mainly adenocarcinomas in the last third of the oesophagus). Oesophageal cancer often manifests itself late with swallowing difficulties, pain behind the breastbone and weight loss. The diagnosis is usually made during a gastroscopy with the removal of tissue samples. This is supplemented by a computer tomography (CT), CT/PET examination and an abdominal endoscopy to determine the extent of the cancer. Therapy depends on the stage of the cancer and in the localised stage consists of surgery or (radiation and) chemotherapy followed by surgery. In patients with distant metastases, surgery can no longer be performed, but chemotherapy can be given with palliative intent. In case of swallowing difficulties due to oesophageal cancer, the insertion of a stent may be useful, depending on the situation.

Disease of the stomach

Gastritis

Gastritis is an inflammation of the stomach lining. Common causes include taking certain medications (especially anti-inflammatories), a bacterial infection with Helicobacter pylori or stress. The most important signs of the disease are a feeling of pressure in the upper abdomen, stomach pain, belching, heartburn, nausea and even vomiting and a feeling of fullness. The diagnosis is made with a gastroscopy, and tissue samples may also be taken in this context. The therapy usually consists of taking so-called proton pump blockers (=acid inhibitors). If an H. pylori infection is detected, antibiotics are also prescribed.

Ulcer

This is an ulcer of the lining of the stomach or small intestine that occurs because of damage to deep layers of the stomach wall. Ulcers usually develop on the basis of a prolonged inflammation of the mucous membrane of the stomach (gastritis). Possible complaints are stomach pain, nausea and possibly even weight loss. If there is bleeding from the ulcer, black stools (tarry stools or melena) often occur. Bleeding can often be treated well by means of a gastroscopy, after which a therapy with so-called proton pump blockers (=acid inhibitors) is necessary. If there is also an infection with H. pylori, this must be treated with antibiotics.

Stomach cancer

Complaints that indicate stomach cancer are often ambiguous. There may be general digestive complaints such as a feeling of fullness, less appetite or abdominal pain. It is important to see a doctor if you have the following symptoms: difficulty swallowing, frequent vomiting, loss of appetite, unwanted weight loss, bloody or black stools (tarry stools). A gastroscopy with tissue sampling can reliably detect stomach cancer. Further imaging such as computer tomography is used for further assessment. Therapy depends on the stage of the cancer and in the localised stage consists of endoscopic removal or surgery or (radiation and) chemotherapy followed by surgery. In patients with distant metastases, surgery can no longer be performed, but chemotherapy can be administered in a palliative manner.

Diseases of the small intestine

Coeliac disease


Coeliac disease is an intolerance to gluten (gluten protein), which occurs in various types of grain (wheat, rye, barley, oats, spelt) and leads to chronic inflammation/damage of the mucous membrane of the small intestine. This leads to reduced absorption of nutrients such as vitamins, minerals, carbohydrates, fats and typical symptoms such as abdominal pain, diarrhoea, flatulence, etc. The diagnosis is made on the basis of blood tests (antibodies) and tissue samples from the upper small intestine during a gastroscopy. The only effective therapy is a lifelong strict gluten-free diet.

Bacterial overgrowth in the small intestine


Many of our patients suffer from flatulence, abdominal pain and diarrhoea. A possible cause for this can be a change in the intestinal flora, especially in patients who have to take antibiotics repeatedly, have had surgery in the area of the gastrointestinal tract or have a weakened immune system. The diagnosis of a so-called bacterial overgrowth can be made either by means of a breath test or in the course of a gastroscopy by means of aspiration and cultivation of small intestinal juice. Therapy consists of antibiotics followed by a build-up of healthy intestinal flora with probiotics. Commercially offered stool tests with determination of the composition of the intestinal flora are usually not helpful.

Diseases of the large intestine

Colorectal cancer

As already described above (see text on polyps), polyps can degenerate into bowel cancer. Colorectal cancer is common (in men it is the third most common tumour after lung and prostate cancer, and in women it is even the second most common after breast cancer). Early detection and removal of polyps in the course of a colonoscopy is the most effective prevention of bowel cancer. In Switzerland, a screening colonoscopy is recommended (even without symptoms) from the age of 50, and the costs are covered by the health insurance (minus the deductible). Many patients with bowel cancer do not experience any symptoms for a long time. If you experience stool irregularities, blood in the stool or weight loss, you should consult a doctor. The diagnosis is made during a colonoscopy with the removal of tissue samples. Imaging such as computer tomography is used for further assessment. Therapy depends on the stage of the cancer and in the localised stage consists of surgery or surgery followed by chemotherapy. In patients with distant metastases, surgery can no longer be performed, but chemotherapy can be administered in a palliative manner.

Chronic inflammatory bowel diseases (Crohn's disease, ulcerative colitis)

The term chronic inflammatory bowel diseases is used to describe Crohn's disease and ulcerative colitis, which are characterised by chronic or episodic inflammation of the intestinal mucosa. While Crohn's disease can affect the entire digestive tract from mouth to anus, ulcerative colitis is localised only in the colon. The main symptoms are diarrhoea (possibly with blood/mucus) and abdominal pain. In Crohn's disease, symptoms outside the digestive tract such as skin rashes, fistulas or pus accumulations at the anus and joint pain can also be common. The diagnosis is made during a colonoscopy with tissue samples taken. The therapy is adapted individually for each patient and depends on the severity and localisation of the inflammation, the duration of the disease and possibly also concomitant diseases. Immunosuppressants are often used and the drugs often have to be adapted and changed in the course of the disease. In the case of complications such as pus accumulation (abscess), fistulas or narrowing of the bowel (stenosis), surgery is sometimes necessary.

Diseases of the rectum and anus

Haemorrhoids


This is a plexus of veins above the sphincter muscle that seals the anus. If these vein pads swell, the typical complaints occur, such as pain, palpable lumps, itching, oozing and/or loss of bright red blood through the bowel. The diagnosis is made with a rectoscopy (proctoscopy). Therapeutically, attention should be paid above all to good stool regulation; pressing during defecation or too hard defecation should be avoided. Ointments or suppositories can be applied locally according to a doctor's prescription. Depending on the findings, local therapy (e.g. rubber band ligation) or, in the case of more severe haemorrhoids, surgery may be recommended. This has to be decided on an individual basis.

Anal fissure


This is a superficial injury to the anal skin, which can be very painful. In addition, blood is often observed on the toilet paper. As with haemorrhoidal disease, it is important to ensure good bowel regulation and avoid constipation and hard bowel movements. This is the best prophylaxis against the occurrence of such lesions. In addition, sitz baths and special ointments are often recommended to help with healing. The treatment of anal fissures can be lengthy.

Faecal incontinence


Fecal incontinence is defined as the involuntary loss of wind, liquid or solid stool. Faecal incontinence is more common in women and increases sharply with age. It is caused by vaginal births with possible injury to the pelvic floor or sphincter muscle. Surgical operations in the anal region and, more rarely, nerve diseases (e.g. multiple sclerosis) can also lead to incontinence problems. In addition to a detailed questioning and examination of the anal canal/sphincter with a finger, an ultrasound examination of the sphincter is often necessary to exclude a defect and an anal pressure measurement (manometry). Therapeutically, non-surgical solutions are always tried first: stool regulation with dietary fibre or also Imodium or specialised physiotherapy of the pelvic floor and sphincter are often helpful. In selected cases, electrical stimulation of the sphincter or surgery to repair a possible sphincter defect may be necessary.

Diseases of the liver and bile ducts

Elevated liver values


Elevated liver values are often found in the blood by chance, e.g. during a check-up. Various diseases such as infections, alcohol overconsumption, obesity, medication and many more can be the cause of elevated liver values or liver disease. Through a detailed questioning of the patient and extended blood tests, a large part of the reasons can already be found. In addition to an interview and blood tests, an ultrasound of the abdomen is always performed to assess the liver and other structures (such as the spleen, blood circulation, etc.). A measurement of liver elasticity (Fibroscan ®) can also be used to assess liver stiffness, as this increases with increasing scarring (see liver cirrhosis). Sometimes a tissue sample (liver biopsy) is also needed to better assess the cause of the liver disease and its severity.

Hepatitis B


The hepatitis B virus infection can already be transmitted from the infected mother to the newborn during birth and often runs a chronic course. In adulthood, the virus is transmitted in non-vaccinated persons mainly during sexual intercourse and an acute inflammation of the liver often occurs, which can often heal completely. In the case of chronic infection, however, progressive liver damage can occur over the years (see cirrhosis of the liver). In addition, the risk of developing liver cancer (hepatocellular carcinoma, HCC) is increased to varying degrees.
6-monthly ultrasound examinations may be necessary. The virus can be suppressed with medication and thus the progression of liver damage can be prevented.

Hepatitis C


The hepatitis C virus is an infectious pathogen that is transmitted in particular through blood and in most cases leads to chronic inflammation of the liver. The chronic inflammation can go unnoticed for a long time or manifest itself with a variety of symptoms such as chronic fatigue or joint complaints. In about one fifth of those affected, scarring of the liver with its complications occurs after many years (see cirrhosis of the liver), which can be prevented by early treatment of the virus with medication (tablets). After a therapy period of 12 weeks on average, almost all those affected can be cured of the hepatitis C virus with modern medication.

Fatty liver


Fatty liver is the term used to describe increased fatty degeneration of the liver, which usually does not cause any noticeable symptoms. Increased liver values in the blood are often noticeable. Various causes can lead to increased fat storage in the liver, most frequently obesity, diabetes mellitus and dyslipidaemia, but also excessive alcohol consumption. In addition to a detailed questioning of the patient, blood analyses and ultrasound of the liver are important in order to find the cause of the fatty liver and to treat it accordingly. Untreated fatty liver inflammation that has been present for a long time leads to
In about 15% of those affected, cirrhosis of the liver develops after 15 years, with its possible complications.

Cirrhosis of the liver


Due to a wide variety of liver-damaging causes, over time the liver undergoes a scarring transformation, which in the advanced stages is called liver cirrhosis. This transformation causes the liver to become hard, making it difficult for blood to flow through the liver. This leads to various complications such as abdominal dropsy (called ascites), bleeding from the oesophagus (oesophageal varices) or an enlarged spleen (splenomegaly). In addition, the altered liver tissue has a greater tendency to develop liver cancer (hepatocellular carcinoma, HCC). To detect such changes early, patients should have 6-monthly ultrasound scans and also a gastroscopy to assess the risk of oesophageal bleeding.

Liver cancer


Liver cancer (hepatocellular carcinoma (HCC)) is a tumour that originates directly from the liver cells. Liver cancer must be clearly distinguished from the more frequent liver metastases in the context of other tumour diseases. The most important risk factor for HCC development is the presence of liver cirrhosis, the most common causes of which are chronic viral hepatitis B or C, chronic alcohol overconsumption and non-alcoholic fatty liver disease. Rarer causes are autoimmune hepatitis and hereditary liver diseases. All patients with liver cirrhosis should therefore receive HCC screening by means of liver ultrasound and determination of the tumour marker AFP in the blood every 6 months. If HCC is detected at an early stage, a cure can be sought by surgery or liver transplantation or local sclerotherapy (radiofrequency ablation). Often, however, patients cannot be treated with the aim of a cure due to an advanced stage or because the liver function is limited. For these patients, methods such as transarterial chemoembolisation (TACE) and treatment with drugs are possible with the aim of slowing down tumour growth.

Gallstones


Gallstones form when bile thickens and clumps together. In most cases, the gallstones settle in the gallbladder, where they never cause any symptoms in 75% of cases. In 25 % of patients, however, they cause symptoms such as pain in the right upper abdomen, sometimes severe colic, nausea and vomiting. If a gallstone obstructs the bile duct, jaundice, fever and possibly pancreatitis may occur. The best and a very simple way to detect gallstones is by ultrasound. Sometimes
magnetic resonance imaging (MRI-MRCP) or endosonography is also necessary. If there are gallstones in the gallbladder without symptoms, no therapy is necessary. Acute gallbladder inflammation is usually treated surgically by removing the gallbladder. If the bile ducts are blocked by gallstones, an endoscopy of the bile ducts (ERCP) must be performed, and the stones can usually be removed. Even if the gallstones have been removed from the bile ducts, the gallbladder should be surgically removed soon afterwards.

Diseases of the pancreas

Pancreatic cancer


Pancreatic cancer (also called pancreatic carcinoma) is a malignant tumour disease of the pancreas. In pancreatic cancer, early symptoms are largely absent, so that the tumour is often only discovered in the late stages. Typical symptoms are pain in the upper abdomen, sometimes radiating to the back, a feeling of fullness, weight loss and sometimes a yellowing of the skin (which is caused by the tumour blocking the outflow of bile). The diagnosis is usually made on the basis of a computer tomography, sometimes further examinations such as endosonography or ERCP are necessary to obtain tissue samples. If the cancer is limited to the pancreas at the time of diagnosis and does not grow too far into the neighbouring vessels, a cure can be achieved by removing the pancreas (usually a so-called Whipple operation is performed). To make sure that all cancer cells are killed, chemotherapy often follows. Chemotherapy is also used in the palliative situation (e.g. if metastases have already spread to other organs). Especially in the case of tumours in the area of the head of the pancreas, there is often a yellowing of the skin due to a blockage of the bile outflow. This can usually be restored by inserting a tube (stent) into the bile ducts as part of a special endoscopy (ERCP).

Pancreatic cysts


The majority of fluid accumulations (cysts) in and around the pancreas are so-called pseudocysts, which can occur as a result of acute or chronic pancreatitis and are benign. However, there can be tumours in the pancreas that are associated with the formation of cysts, so a cyst discovered in the pancreas for the first time should always be well clarified. Usually, a computer tomography and/or magnetic resonance imaging is carried out first, often followed by an endosonography with possibly also puncture of the cyst for analysis for certain tumour markers or under the microscope. Based on all this information, the cyst can usually be well characterised and a therapeutic recommendation (usually either surgery or follow-up by means of images) can be made.

What examinations and clarifications can be carried out?

Gastroscopy and colonoscopy

During gastroscopy, the oesophagus, stomach and the first part of the small intestine (duodenum) are examined with a fine and flexible endoscope. If necessary, tissue samples are taken. During colonoscopy, the whole large intestine and the last part of the small intestine are examined. The most common reason for having a colonoscopy is to screen for bowel cancer. If polyps are found in the colon, which could grow and degenerate over the years, they are removed straight away.

Proctoscopy

This is an examination of the rectum and the anal canal with an approx.
15 cm long device. The examination only takes a few minutes, is usually not painful and is carried out
painful and is performed while the patient is awake. No special preparations are
preparations are necessary.

Ultrasound

Abdominal ultrasound is a simple, non-painful examination with no
X-rays, which provides a very good overview of all the abdominal organs
abdominal organs (liver, gall bladder, bile ducts, pancreas, kidneys, spleen, large abdominal
abdominal vessels, intestines).

Elastography of the liver

During this examination, the elasticity or stiffness of the liver is measured using a special ultrasound method.
stiffness of the liver is measured. An increased stiffness of the liver indicates scars that are
can develop in the course of chronic liver diseases/inflammations.

Functional diagnostics (manometry and ph-metry)

In selected situations, the function of the oesophagus must be measured.
(oesophageal manometry) or the pelvic floor/sphincter muscle (anal manometry).
must be clarified. For oesophageal manometry, a fine probe is inserted through the nose into the
probe is inserted through the nose into the stomach and then various swallow
swallowing tests must be carried out. This examination is often supplemented by a
24-hour acid measurement (pH-metry), for which another very fine probe is placed in the
and you can go home and go about your daily activities as normal.
and go about your daily activities normally. Before an oesophageal manometry or pH-metry you must not
not eat for 6 hours. For anal manometry, the patient is awake and no special preparation is required.
preparation (no bowel evacuation necessary), a short probe is inserted into the rectum.
and then various squeezing and pinching manoeuvres are carried out.

Procedure of a gastroscopy or colonoscopy

The gastroscopy or colonoscopy can easily be done on an outpatient basis. You are not allowed to eat anything for 6 hours before the gastroscopy.
completely empty your bowels with strong laxatives at home. The examinations take place take place under sedation: You will be injected with a drug. This means that you will not feel the examination, but you will be awake again immediately after the examination. During the examination and the time you are awake, you will be monitored and receive receive oxygen through your nose. For legal reasons and for your safety, you must refrain from driving for at least 12 hours after the treatment.

Why you should choose Swiss Medical Network

Our gastroenterologists are experienced specialists who use the latest diagnostic technologies and take the time to treat the entire spectrum of gastrointestinal and liver diseases. Our specialists have excellent networks with doctors from other disciplines and can therefore provide you with comprehensive care.

FAQ

Do I have to prepare for the examinations?

The preparation varies depending on the examination. You will receive precise instructions from us on a preparation sheet. For the colonoscopy in particular, it is very important that you follow the instructions very carefully. If you have any questions regarding the preparation, please contact our practice team.

Do I really have to drink all the laxative solution for the colonoscopy?

Yes, this is very important in order to achieve optimal bowel cleansing. Only when the bowel is well prepared can we assess the mucosa/polyps well. If there is still too much stool/food residue in the bowel, we will have to stop the examination and you will have to come back and prepare again. Please also follow the recommendations for changing your diet before the colonoscopy. By cooling the mixed laxative solution or by adding syrup or clear liquids.

I am taking blood thinners, what do I have to consider before a gastrointestinal endoscopy?

If possible, please discuss with your family doctor whether you can continue to take your blood thinners before and during the gastroscopy or colonoscopy, whether you need to stop taking them and whether blood-thinning injections may be necessary to bridge the gap. If your family doctor is not available, please call our practice at least 1 week in advance (www.gastrobethanien.ch) so that we can help you.

Doctors with this specialisation

Dr. med. Serge Zeeh

Specialisation
Gastroenterology and Hepatology, Internal medicine
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Dr. med. Guillaume Bonnaud

Specialisation
Gastroenterology and Hepatology
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