Polyps are abnormal growths on the lining of the bowel. Polyps are common and up to 50% of people will develop colonic polyps during their lifetime. Polyps rarely cause symptoms and are usually only detected by screening or incidentally during examinations for other reasons. If polyps are left in the colon over many years they can slowly enlarge and some may become cancerous. Removing polyps (polypectomy) can prevent them from becoming cancerous and reduces the risk of developing and dying from bowel cancer.

People who develop polyps are at increased risk of developing polyps again in the future. The size of that risk and the speed at which they occur will depend on the number, size, type and location of the polyps. People who are found to have polyps should normally enter a surveillance program with repeat colonoscopies to detect and remove new polyps over time. How frequently colonoscopy needs to be repeated will depending on the findings at your first colonoscopy, your personal and family history.

What is ‘reflux’?

Gastro-oesophageal reflux (GORD) is the passage of stomach contents (food, stomach secretions and gas) into the oesophagus.  Patients may be unaware of reflux (silent reflux) or it may be experienced by patients as a range of symptoms including heartburn, burning pain in the stomach or behind the sternum, discomfort, acid or bitter taste in the mouth and all types of ‘indigestion’.  There are many contributing causes leading to reflux including weakness or abnormal relaxation of the valve at the lower end of the oesophagus (lower oesophageal sphincter) and hiatus hernia that occurs when part of the stomach protrudes through the diaphragm into the chest cavity.

How do I know if I have reflux?

The symptoms of reflux (heartburn, regurgitation and indigestion) may be characteristic and a diagnosis can often be made on this basis alone.  If your symptoms get better with treatment for reflux then this may confirm the diagnosis.  Testing is often not required unless there are concerning features such as vomiting, difficulty or pain with swallowing, food getting stuck or unexplained weight loss.  The most common test used to investigate or diagnose reflux is gastroscopy that allows close, direct examination of the stomach and oesophagus and the taking of biopsies.  Occasionally further specialised testing is required.

Is reflux serious?

Reflux is usually not serious and is simply an inconvenience causing discomfort or other mild symptoms.  Almost everyone experiences symptoms of reflux from time to time, often after overindulging.  Some people have more significant symptoms or complications from reflux and may require medical treatment.

In a minority of people with reflux there may be damage to the oesophagus from exposure to stomach contents causing inflammation, ulceration and scarring.  This is called oesophagitis and may vary in severity from very minor to severe.  In severe cases there can be scarring of the oesophagus resulting in narrowing which can lead to food getting stuck.

In some patients with longstanding reflux there can be an adaptive change to the cells lining the distal oesophagus called “Barrett’s oesophagus”.  People with Barrett’s oesophagus are at an increased risk of developing cancer (although the size of the risk is small) and in this case regular checks of the oesophagus with a gastroscopy are advisable.

How is reflux treated?

Often, simple lifestyle and dietary changes are all that is needed to manage reflux.  Large meals, fatty foods, coffee, alcohol, smoking and lying down with a full stomach after eating can all precipitate or aggravate reflux.  Some people will be able to identify particular foods that cause reflux and can simply avoid that type of food.  Reflux is often worse when people gain weight and losing weight can make a big difference.
Unfortunately, many people continue to have symptoms despite making lifestyle and dietary changes.  For these people and those with oesophagitis or other complications of reflux treatment with medications may be required.  Fortunately most of the medications used for treatment of reflux are both very effective and very safe.  Often these medications can be used just when you get symptoms but some people may find that they require long-term, daily treatment.
For a very small proportion of people the symptoms or complications of reflux can be severe and refractory to medical treatment.  For these people there is a surgical procedure called fundoplication that may help.

What is Barrett’s Oesophagus?

Barrett’s oesophagus is the name given to a change in the normal lining of the lower end of the oesophagus from normal ‘squamous’ lining to an intestinal-type, mucus secreting ‘columnar’ lining.  It is thought that this change occurs due to chronic inflammation and damage caused by exposure to acid and other secretions from the stomach in patients who have gastro-oesophageal reflux (GORD).  Barrett’s does not, in itself, cause any symptoms but most people with Barrett’s will have symptoms of reflux.

Barrett’s oesophagus is considered important because people who have Barrett’s are at increased risk of developing cancer in the oesophagus.  The absolute risk of cancer is relatively small and the majority of people with Barrett’s oesophagus (up to 95%) do not ever develop cancer in the oesophagus.

How is Barrett’s oesophagus diagnosed?

Barrett’s oesophagus can only be diagnosed by taking biopsies from the part of the affected oesophagus at the time of a gastroscopy.  The diagnosis is often suspected at the time of gastroscopy (endoscopy) based on the appearance of the oesophagus but confirmation with biopsies examined under the microscope is usually performed.

There are no widely accepted recommendations regarding who should have a gastroscopy to check for Barrett’s oesophagus.  Firm recommendations do not exist because of the lack of strong evidence that screening for Barrett’s prevents people from dying from oesophageal cancer.

Many gastroenterologists will recommend gastroscopy to check for Barrett’s in people over the age of 40 who have had reflux symptoms for many years.

How is Barrett’s oesophagus treated?

The treatment options for Barrett’s oesophagus include treatment of gastro-oesophageal reflux, surveillance for development of complications and occasionally eradication of the affected part of the oesophageal lining.

Treatment of gastro-oesophageal reflux with medications that prevent the production of acid by the stomach usually prevents the symptoms of reflux but may be recommended even in the absence of these symptoms as it may prevent the development of cancer.

Regular checks on the oesophagus ‘ surveillance’ with gastroscopy is usually recommended to identify those at highest risk of developing oesophageal cancer or to detect cancers early when treatment is more likely to be successful.  How frequently the oesophagus should be checked will depend on the findings at your previous gastroscopies.

Treatment to eradicate the lining of the affected part of the oesophagus is recommended for some patients at highest risk of developing oesophageal cancer.  This is based largely on how abnormal the biopsies from the oesophagus look when examined under a microscope.  Radio-frequency ablation is currently the most widely accepted treatment but other treatments are under evaluation in clinical trials.

Helicobacter Pylori (H.pylori) is a bacterium that commonly infects the lining of the stomach. H.pylori was first identified as an important cause of stomach problems by two Australians, Barry Marshall and Robin Warren in 1982. They were awarded the Nobel prize for this discovery in 2005.

World-wide H.pylori is extremely common infecting between 1/3 and 1/2 of the global population. The incidence in Australia is much lower and has been declining in recent decades due to improved sanitation, increased detection and more wide-spread use of effective treatments.

Most people who are infected have no symptoms however H.pylori is capable of causing indigestion, ulcers in the stomach and duodenum and is also associated with an increased risk of cancer in the stomach. People who have family members who have had ulcers or stomach cancer are at increased risk of complications.

H.Pylori infection is usually diagnosed with a breath test or at the time of endoscopy. Treatment involves a combination of two or more antibiotics together with anti-secretory treatment for 1-2 weeks and is effective in up to 90% of people. Successful eradication of the infection should be confirmed with repeat testing after treatment. If initial treatment fails then specialist advice may help.

What is IBS?

Irritable bowel syndrome is the term used to describe a group of disorders in which the normal function of the gastrointestinal tract is disturbed without obvious inflammation or damage to the structure of the bowel. The cause of IBS is not fully understood but it is thought to occur due to disturbance of the normal function of the muscles of the gut (dysmotility), the nerves supplying the gut (hypersensitivity) and the microbiological makeup of the gut contents (dysbiosis).
IBS is very common, affecting as many as 1 in 5 people during their lives.  The main symptoms of IBS are abdominal pain, bloating, chronic constipation, chronic diarrhoea or alternating constipation and diarrhoea. The symptoms of IBS often come and go but may be chronic.  IBS is more common in women and often starts in the late teens, twenties or thirties.  Sometimes IBS can occur after an episode of gastroenteritis (post-infectious IBS) and in this case the symptoms often resolve after a period of time.

Is IBS serious?

The symptoms of IBS may be very distressing but, fortunately, IBS never results in damage to the gut, problems with nutrition or more serious conditions.

How do you diagnose IBS?

The diagnosis of IBS can sometimes be made just by talking to your doctor.  If the symptoms are typical then testing may not be required to confirm the diagnosis or exclude other causes.  Certain features are never a part of IBS.  These include bleeding, weight loss and fever.  These symptoms should lead to further testing.
Testing is usually carried out if your symptoms start after 40 years of age, there are any unusual features to the symptoms or there is a history of bowel cancer, inflammatory bowel disease or coeliac disease in your family.  The tests used may include blood tests, stool tests, radiology (ultrasound or CT), or endoscopy (gastroscopy and/or colonoscopy).

What is the treatment for IBS?

There is no cure for IBS.  The goal of treatment is to manage the symptoms of the condition.  Treatments should be tailored to the symptoms.  No single treatment works for all patients and successful management will often require trialling several different approaches.

Diet and stress often contribute to IBS or make the symptoms worse and it is important to systematically identify any dietary triggers.  A food diary can sometimes be helpful to identify foods or food additives that are exacerbating the symptoms.

Dietary measures such as increasing (or sometimes decreasing) dietary fibre, avoiding poorly absorbed food components such as fructose, sorbitol, starch and lactose, or reducing alcohol, caffeine and fatty foods may be helpful in some patients.  An experienced and qualified dietician may play an important role in helping people deal with IBS.

Medications that relieve spasm such as Buscopan and Colofac may help pain and bloating.  Anti-diarrhoeal medications may be useful in those with diarrhoea and laxatives can help those with constipation.  Low doses of antidepressant medications have been shown to be helpful in some patients with IBS even in the absence of depression.

Management of stress may be an important part of controlling the symptoms of IBS.

Ulcerative colitis and Crohn’s disease are collectively called inflammatory bowel disease (IBD). Both diseases result from chronic, uncontrolled inflammation in the digestive tract in the absence of an identifiable infection. The cause of IBD is currently unknown but a number of genetic, immunological and environmental risk factors have been identified.
Ulcerative colitis causes inflammation of the mucosal lining of the colon or large bowel. Crohn’s disease can affect any part of the digestive tract. The inflammation in Crohn’s disease can go through the wall of the bowel and extend into adjacent parts of the body causing fistulas and abscesses. The prolonged and uncontrolled inflammation of Crohn’s disease and ulcerative colitis can cause irreversible scarring and damage to the digestive tract over time.
Both Crohn’s disease and Ulcerative colitis vary greatly between individuals. Some people with these conditions will have very mild symptoms that require little or no long-term treatment. Unfortunately, in other people the diseases can be severe, requiring long-term treatment and sometimes surgery. The symptoms of IBD may include abdominal pain, diarrhoea, bleeding from the bowel, weight loss and fatigue. Some people with IBD will also have inflammation in other parts of the body such as the skin, joints and eyes.
In most people the symptoms of IBD fluctuate over time with periods of increased disease activity and periods when there is no identifiable inflammation at all. Unfortunately there is currently no cure for IBD. Ulcerative colitis can be ‘cured’ by the removal of the colon however the disease can usually be controlled without the need for surgery. There is no long-term cure for Crohn’s disease although both medications and surgery may provide long-term control of the disease.
IBD is usually diagnosed after seeing a gastroenterologist and having blood tests, stool tests and a colonoscopy. Other tests including gastroscopy, CT scan and MRI scans and wireless capsule endoscopy may sometimes be required.
The goals of treatment in inflammatory bowel disease are to control inflammation, eliminate symptoms and prevent disease complications and the need for surgery. Once the disease is controlled long-term medical treatment may be required to prevent further ‘flare-ups’.
For further information please see the Crohn’s and Colitis Australia website: www.crohnsandcolitis.com.au

Coeliac is a common condition affecting up to 1% of Australians. People with coeliac disease react to a protein called gluten which is found in wheat. When exposed to gluten people with coeliac disease have an immunological reaction that causes inflammation and damage to the small bowel. This can cause symptoms including bloating, abdominal pain, diarrhoea and weight loss. Untreated coeliac disease can cause a variety of problems including deficiency of important nutrients such as iron and folate, osteoporosis and increase the risk of developing cancer in the bowel. The majority of people with coeliac disease are unaware that they have the disease.
Coeliac disease is usually diagnosed in children and young adults but can be diagnosed at any age. Coeliac disease runs in families and there are genes that increase the risk of developing coeliac disease. Blood tests may be the first clue that someone has coeliac disease and some antibody tests are quite accurate however the diagnosis should always be confirmed by having a gastroscopy to take biopsies from the affected part of the small bowel. It is important that people stay on a diet containing gluten until the diagnosis has been confirmed.
Fortunately coeliac disease can be controlled by avoiding gluten in the diet. Because even small amounts of gluten in the diet are sufficient to keep the disease active a strict gluten-free diet under the guidance of an accredited dietician is advised.
For more information see the Coeliac Australia website: www.coeliac.org.au

Diverticular disease or diverticulosis is a common condition that becomes increasingly common as people age. Over 1/3 of people will have diverticulosis by the age of 50 and more than 1/2 by the age of 70. Diverticula are pockets or pouches that protrude from the wall of the bowel. Diverticulosis can occur in any part of the bowel but is most common in the lower third of the colon (but not the rectum).

Diverticulosis runs in families and is more common in people who have less fibre in their diet. Diverticulosis is thought to arise from excessive pressure on the wall of the bowel over long periods of time causing the lining of the bowel to bulge out through gaps in the muscle layer. Diverticulosis usually causes no symptoms at all although people with diverticulosis may have symptoms of irritable bowel syndrome due to spasm in the muscles of the wall of the bowel and increased gas production.

A small proportion of people with diverticulosis will develop complications including bleeding from the diverticula, infection (diverticulitis) and rarely even perforation causing peritonitis. Diverticulitis usually causes acute abdominal pain often with fever and should not be confused with diverticulosis or diverticular disease itself.

Increasing dietary fibre or using fibre supplements may reduce symptoms of irritable bowel syndrome and cramping and bloating associated with diverticulosis. Over time increased dietary fibre may prevent diverticulosis from becoming more severe although we do not know if it prevents people from developing complications of diverticulosis. Acute episodes of diverticulitis should be treated with antibiotics. If attacks of diverticulitis are frequent or there are other severe complications of diverticular disease surgery may be an option to remove the affected segment of the bowel.

Fatty liver disease is an increasingly common problem affecting more than 1 in 5 Australians. It is now the most common cause of liver disease in the developed world. It occurs due to the deposition of fat within the liver and the inflammation that this causes. The major risk factors for fatty liver disease are obesity, type 2 diabetes and high blood cholesterol levels. Most people with fatty liver disease have no symptoms. Over time, some patients with fatty liver disease will develop permanent scarring of the liver (cirrhosis) and complications associated with cirrhosis such as jaundice, retention of fluid, bleeding and liver cancer. Fortunately this is only a small minority of people with fatty liver disease. People with fatty liver disease are at increased risk of heart disease, stroke and vascular disease and this is the most important implication of a diagnosis of fatty liver disease for most.
Most people with fatty liver disease are diagnosed in their 40s and 50s. The diagnosis is usually made with a combination of blood tests and an abdominal ultrasound. A liver biopsy is only required if there is doubt about the cause of the problem or to assess how much scarring has occurred in the liver.

The main treatment for fatty liver disease is reduction of dietary fats, weight loss and regular exercise. A small minority of people may need medications to reduce inflammation in the liver. People with fatty liver disease are at increased risk of vascular disease and should be assessed and treated for risk factors for vascular disease including high blood pressure, high cholesterol and diabetes. Hereditary haemochromatosis is a condition in which excess iron accumulates in the body. It can usually occurs due to an inherited gene abnormality (HFE gene) which damages the function of proteins that normally operate to control how much iron is absorbed into the body. This leads to the accumulation of iron in the liver, heart, pancreas, and joints leading to dysfunction of those organs. Hereditary haemochromatosis is one of the most common inherited conditions in Australia. As many as one in 300 Australians is affected. There are a number of commonly occurring mutations in the HFE gene. You need to inherit two mutated genes to develop significant iron overload and the symptoms of haemochromatosis.

Most people diagnosed with hereditary haemochromatosis have affected family members and the condition is diagnosed by screening of relatives. In other cases the condition may be suspected on the basis of abnormal blood tests for iron or liver function done for other reasons. Rarely patients develop symptoms of an enlarging liver or liver failure, heart failure or diabetes. A gene test is available that detects the mutations in the HFE gene responsible for more than 95% of cases of hereditary haemochromatosis.

Treatment of haemochromatosis is not always needed straight away. When iron levels are too high then excess iron can be removed by regularly removing blood. Your body will replace the lost blood quickly but use up the extra iron stores to do so. When there are signs of damage to the liver or other organs then a lot of iron may need to be removed quickly and so frequent treatments every few weeks may be required. When iron levels are at a safe level then most people manage to keep them at a safe level with 3 or 4 treatments per year. Ongoing monitoring with blood tests is required to ensure that iron levels stay in the safe range.