Common Conditions

Bloating is a really common symptom, not a disease in itself. It may be caused by a wide variety of conditions like dietary intolerance, coeliac disease, IBD, irritable bowel syndrome, chronic constipation and slow transit colon ...and many more...

Your investigations will be focussed on excluding serious conditions, but are usually non-invasive (blood, stool and urine tests).

We are learning more about a phenomenon called dysbiosis: an imbalance in the bacteria that normally live in the bowel. These bacteria (including the 'friendly bacteria' that are widely talked about) often help us to break down parts of food that we wouldn't otherwise be able to deal with - particularly things like diary (cow's milk), wheat, and rough or tough vegetables. Maldigestion in the gut can cause fermentation and an acidic environment which, although not dangerous to your health, will result in bloating, discomfort and even severe pain while preventing friendly bacteria from growing back.

After talking to you, we may be able to identify whether this is a problem and recommend a course of probiotic supplementation. You may also benefit from focussed dietary advice and we can arrange for you to see a specialist dietician for this purpose. We do not recommend that you try exclusion diets on your own!

Dyspepsia affects most of us at some point. We are all allowed to have one or two episodes of indigestion or reflux every year without there being an underlying health problem.

However, problems occurring on a daily basis, or even a few times a week, need investigating. This occurs in perhaps 25% of adults in the UK. It is usual for your GP to see and treat you for dyspepsia. Depending on your symptoms, it may be reasonable to first test for an infection in the stomach called Helicobacter, by doing a blood or stool test. If you do have it, getting rid of it should improve things. However, this is not always the case and treatment for Helicobacter is not always successful the first time around.

You may need a gastroscopy to investigate the underlying cause of your indigestion. High-definition endoscopy can detect early changes of acid reflux when outdated technology would have said 'there is nothing wrong here'. The need for gastroscopy will depend on the duration of your symptoms, how old you are, whether or not there are additional symptoms such as vomiting (including vomiting blood), weight loss or other health problems.

Sometimes reflux can be managed with dietary advice and weight loss/exercise. We would definitely encourage you to try this if it is appropriate in your circumstances. However, we can also advise on the safest, most reliable medication and - if you need it - anti-reflux surgery to cope with your symptoms.

Crohn's disease (CD) is an inflammatory bowel disease (IBD) affecting 1 in 1200 people in the UK. We don't yet know exactly what causes CD, but there are a combination of genetic and environmental factors involved.

Symptoms may include: cramping or more constant abdominal pain (often unaffected or getting worse after a bowel motion); diarrhoea; blood in your motions; weight loss or a failure to gain weight through puberty and early adulthood. However, the condition affects people in different ways and in some cases, people can suffer for years before the diagnosis is made.

There are a number of treatments available for CD, ranging from probiotics to potent drugs to control your immune system. We will work with you to ensure a diagnosis is made quickly, and you are given the most appropriate treatment as soon as possible. Dr Hayee has a specialist interest in CD and conducts research into the underlying causes and finding/assessing new treatments.

For more information about Crohn's disease and treatments, you may wish to visit the website of Crohn's and Colitis UK (C&C UK): www.nacc.org.uk, or the European Crohn's and Colitis Organisation: www.ecco-ibd.eu.

Dr Hayee is a member of ECCO and has an active interest in IBD research in the NHS, particularly looking for and testing new treatments and examining the role of gut bacteria in the development of disease.

Ulcerative colitis (UC) is an inflammatory bowel disease (IBD) affecting 1 in 600 people in the UK. The disease is often treated (and classified) according to how much of your colon (large bowel) is involved. The lining of the colon becomes increasingly more irritated, with inflammation, swelling, ulcers and bleeding. Some 'attacks' of UC can be mild, but generally will get worse if left untreated or undiagnosed. Treatments range from natural remedies and probiotics, to potent drugs to control your immune system.

UC typically starts as diarrhoea, urgency (rushing to the loo), with blood mixed in with the motions. Rapid investigation with colonoscopy can establish the diagnosis and treatment can start quickly. Your treatment with depend on how bad your symptoms are, and how much of the colon is involved. It is true that having UC increases your risk of colon cancer, but the risk depends on how long you have had colitis (longer than 8 years), how well-controlled it has been over the years, and how much of your colon is involved. Dr Hayee has a specialist interest in UC and colon cancer surveillance using HD endoscopy.

For more information about UC and treatments, you may wish to visit the website of Crohn's and Colitis UK (C&C UK): www.nacc.org.uk, or the European Crohn's and Colitis Organisation: www.ecco-ibd.eu.

Dr Hayee is a member of ECCO and has an active interest in IBD research in the NHS, particularly looking for and testing new treatments and examining the role of gut bacteria in the development of disease.

Barrett's oesophagus affects up to 2% of adults in the UK and occurs as a response to acid reflux over time.

The cells lining the bottom of the oesophagus form layers of flat 'sheets', designed to cope with the passage of food. As food passes, the top layer of cells can be scraped off, but rapidly replaced from the lower layers. This arrangement is great for protecting against surface contact, but is not great at protecting against acid reflux. Over time, prolonged acid expsoure will cause these cells to change shape, becoming more 'blocky' (like the cells lining the stomach). Think of it as a way of them 'protecting' themselves against damage. The problem is that in making this change, the risk of developing oesophageal cancer (adenocarcinoma) in these cells increases.

Although the absolute risk of developing cancer in Barrett's to any single person is small, there is no doubt that the risk is considerably higher compared to someone who doesn't have the condition. For this reason it is advisable to have a gastroscopy at least every two years to check on this. The risk increases: depending on the length of the 'segment' of Barrett's oesophagus; whether reflux is controlled; in men; in smokers; the types of cells in the segment of Barrett's oesophagus. In our opinion, a high-quality, high-definition endoscopy is essential at all stages of your investigation and follow-up. Dr Hayee has a specialist interest in HD endoscopy and detecting the very earliest stages of cancer and, more importantly, pre-cancerous changes that can be treated before they progress.

An hiatus hernia occurs when the top part of your stomach is pushed up into your chest. At the top of the stomach there is a ring of muscle (the lower oesophageal sphincter or LOS) which opens, to allow food through, and closes to prevent acid and stomach contents from coming back up (reflux).

This muscle is reinforced by two anatomical features. First is the diaphragm, a strong sheet of muscle separating your chest from your abdomen. Second is the bend at the join between the oesophagus and stomach (the angle of His). Both these reinforcements are lost with an hiatus hernia, and the LOS is not strong enough by itself to prevent reflux. Because the hernia will also stretch the diaphragm, it can cause a dull, constant aching (sometimes sharper) just because of its presence - independent of the problems with reflux.

We can investigate whether your symptoms of abdominal pain, indigestion or reflux are due to an hiatus hernia and offer treatment options ranging from medication to minimally-invasive surgery.

Would it surprise you to learn that there might not be any such thing as IBS?

Now that we've got your attention, that's not strictly true. IBS is a syndrome - which means a collection of symptoms that fit together. However, specialists have come to realise that there are people with specific conditions that might have previously been labelled as having IBS, so there is actually a defined cause (and treatment) in these cases. Sometimes we never pin-point the original cause, but from talking to you, it may be possible to determine if - for instance - your 'IBS' was triggered by infection, a dietary intolerance or antibiotics.

The diagnostic criteria for IBS centres around having pain or abdominal discomfort associated with a change in your bowel habit (the number of times you go to the loo or the consistency of your stool). We can usually make a positive diagnosis of IBS without resorting to endoscopy, but sometimes this is necessary if there is some doubt about what is going on.

Dr Hayee uses non-invasive tests first (particularly blood, stool and urine tests) to work out if there is irritation or inflammation in your bowel - rather than 'IBS'. Further investigations are based on the results of these tests.

Chronic constipation is a surprisingly common condition (up to 10% of the UK population have it, with up to 40% having episodes of constipation in any given one-year period). It is not a disease - just a symptom (ie. a sign of an underlying problem) - so can have a number of different causes.

It makes sense to ensure you are keeping well-hydrated and have a regular, balanced diet, but if you are seeking specialist medical help for constipation, the chances are you will have tried these 'lifestyle' approaches already!

Your main symptom: going less often than 'normal' (at least once a day for most people) will typically have been on-going for several years. A change in bowel habit to constipation, when you do not normally have trouble with your bowel habit (particularly occurring in the last 12-18 months) will usually need colonoscopy. Constipation that has been there for longer than this (more than 18 months or for most of your life) will usually not.

After a focussed consultation, we can provide rapid investigations depending on the additional symptoms you have, and come to a conclusion without putting you through unnecessary tests or investigations of dubious value. We will be realistic about what can be achieved and use natural remedies where possible. If you require onward referral to other Specialists, we can arrange that too.

Polyps are growths on the lining of your bowel or stomach. Although some polyps have a genetic cause (they run in families), most are sporadic (appearing with age, time or wear-and-tear).

Some polyps are merely overgrowths of normal lining - called inflammatory or hyperplastic. There is no risk of these polyps turning into cancer (although if you have very many hyperplastic polyps we would normally monitor you more closely). The main type of polyps that we are concerned about are called 'adenomatous'. These are benign polyps which - if left - do have the potential to turn into cancer. Although this risk is low, and it often takes several years for this transformation to happen, it is usually advisable to have adenomatous polyps removed if they are found.

Polyp removal can be completed safely at endoscopy and you should not require an additional procedure, unless the polyp is very large. In this case it is advisable to book another test specifically to remove the polyp.

Once you have had one or more polyps, the chances are that you will 'make' more, so it is advisable to have repeat testing. The timing of this test depends on how many polyps were found and how large they were.

With HD endoscopy and new digital image enhancement technology it is possible to detect more polyps (where they otherwise might have been missed), to characterise polyps and tell what treatment is best. Dr Hayee has a specialist interest in HD endoscopy and polyp detection and removal and uses the British Society of Gastroenterology guidelines on polyp surveillance to guide his practice.

Sometimes, coeliac disease is referred to as wheat allergy, but this is not really accurate. It is an autoimmune condition triggered by eating wheat. Specifically, your immune system reacts to a part of wheat called gluten and this results in a wider reaction: attacking the lining of your gut (small bowel). A 'gluten-free diet' will usually be all that is required to keep you healthy.

This is definitely not the same thing as wheat intolerance. Many more people will have wheat intolerance than have true coeliac disease, but will feel much better for not eating wheat. Wheat intolerance is often an acquired condition (ie. not one you were born with) and may be a sign of underlying dysbiosis (see 'Bloating' above). Coeliac disease is relatively easy to diagnose (and exclude) with a blood test. If you have a positive blood test we will also need to perform a gastroscopy to take biopsies from your small bowel. A gastroscopy might be needed if there is some doubt (even after blood testing) as to the diagnosis.

Coeliac disease is common, affecting up to 2% of the UK population, but can affect people in different ways with varying severity. Sometimes the symptoms can be vague and mild so that - it is estimated - only 10% of people with the condition know that they have it (ie. have been diagnosed). It is often difficult to exclude gluten from the diet, but sometimes, persistent symptoms may mean you have an associated condition. We can help explain and investigate this as well as giving you access to specialist dieticians to support you in maintaining a healthy gluten-free diet.

The EndoBarrierTM, is not a surgical procedure. It is a revolutionary new flexible intestinal lining placed using an endoscopy (gastroscopy). The device enables better control of type 2 diabetes and associated loss of weight, by mimicking the changes brought about by weight loss surgery (gastrojejunostomy). The difference is that there is no surgery, no scars, no removal of organs and all completely reversible. EndoBarrier insertion is a day-case procedure, but it does involve a general anaesthetic, so careful planning is required. You will spend most of the day in hospital after the procedure, under observation (at least 6-8 hours afterward). In very exceptional circumstances you might be admitted overnight for observation if required.

It is definitely not appropriate for everyone, and there are always risks to every procedure. You must have been assessed by a medical specialist in type 2 diabetes and obesity (Metabolic Medicine). The criteria for who will benefit are well-defined and we can discuss these with you before coming for evaluation. Although we do accept self-referrals, we would need to ensure that you had made contact with a Metabolic Medicine specialist that would manage your condition after insertion.

For more information about EndoBarrier, please contact us or visit the product website.