When you first meet with you Consultant Gastroenterologist in the hospital, they will take a medical history and ask you to describe your symptoms. They will want to know things like:
- What symptoms you have
- When these symptoms first appeared
- Whether your symptoms have been getting more noticeable/severe
- Whether any particular foods, drinks or activities make your symptoms worse
- If you have any particular concerns about any of your symptoms (for example, are you worried about bowel cancer?)
A physical examination may also be carried out.
At this stage, it may be found that your symptoms are not a cause for concern and that no further investigation or treatment will be needed.
In other cases, additional investigation will be needed, and this is often by endoscopy. An endoscope is a thin, flexible tube, about the diameter of a pencil, with a camera and light at one end. The camera provides a real time image to a screen.
Depending on your specific symptoms, you may need a Gastroscopy, a Colonoscopy, a Flexible Sigmoidoscopy or an Endoscopic Retrograde Cholangiopancreatography (ERCP). If required, these can easily be arranged for you by your Consultant Gastroenterologist.
- A gastroscopy looks at the upper part of the GI tract. Introduced into the body through the mouth, the endoscope is moved down the oesophagus, into the stomach and then along to the first part of the small intestine (the duodenum).
- A colonoscopy looks at the lower part of the GI tract. The endoscope is inserted through the rectum and then moved up and around the large intestine and into the lower part of the small intestine.
- A flexible sigmoidoscopy is a simpler procedure, only looking at the left side of the bowel. It is commonly used when somebody has been experiencing rectal bleeding. Similar to a colonoscopy, the endoscope is introduced through the anus to allow your consultant to examine the lower part of your large bowel.
- An ERCP looks at the bile ducts system in and out of liver. The endoscope enters the mouth and is moved down the oesophagus and into the stomach and duodenum. A special dye that shows up on X-ray is then injected to show the outline of the bile ducts and pancreatic duct. If anything is discovered, such as a blockage within the bile ducts, it may be possible to treat it during the endoscopy (this is known as therapeutic endoscopy).
With any of these endoscopic investigations, if anything unusual of concerning is seen, a biopsy may be taken for further analysis. This involves carefully removing a tiny sample of tissue from the area in question and sending it for examination under a microscope.
Additional tests, including blood tests, Stool test, MRI scan, CT scan and ultrasound, can all be arranged by your Consultant if required. (Please note that some investigations may need to be arranged off-site.)
Once any results are back, your Consultant will discuss suitable treatment options with you in order to create a suitable treatment plan. If the results have found something that needs referral to another specialist (for example, a diagnosis of cancer would necessitate referral to the Multidisciplinary team including Oncology), this is easily arranged.