Frequently Asked Questions (FAQs)

Emergency Cases

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Monday – Sat 9.00 AM – 8:30 PM
Sunday 10.00 AM – 12.00 PM

We help create a care plan that addresses your specific condition and we are here to answer all of your questions & acknowledge your concerns. Today the hospital is recognised as a world renowned institution, not only providing outstanding care and treatment, but improving the outcomes. Here are some of the general FAQs:

Gastroesophageal reflux disease (GERD)

Gastroesophageal reflux disease (GERD) is a long-term condition where acid from the stomach comes up (reflux backs) into the esophagus.
Esophageal:
Heartburn, Dysphagia (difficulty in swallowing), Odonophagia (painful swallowing), Belching

Extraesophgeal:
Cough, Wheezing, Sore throat, Globus sensation (foreign body sensation), Epigastric pain ,No cardiac chest pain, Headache, Bad breath
Being overweight, Overeating, Eating foods such as citrus, chocolate, and fatty or spicy foods, Having caffeine, Having alcohol, Smoking. Using aspirin and over-the-counter pain and fever medicines. These include nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen
GERD can be a problem if it's not treated because, over time, the reflux of stomach acid damages the tissue lining the esophagus, causing inflammation and pain. In adults, long-lasting, untreated GERD can lead to permanent damage of the esophagus and sometimes even cancer.
Treatment involve life style modification, medical management, endoscopy and endoscopy intervention , surgery?
a) Upper GI endoscopy to look for Hiatus hernia and H pylori.
b) Esophageal manometry
c) 24 hrs. esophageal PH monitoring
1. Radiofrequency ablation of the GE Junction with Stretta catheter
2. Suturing of GE junction using either mucosal sutures with Endocinch device or full thickness suture placement (GERD-X)
3. ARMS (Anti reflux mucosectomy)
Alcohol, Caffeine, Carbonated beverages, Chocolate, Citrus fruits and juices, Tomatoes and tomato-based foods, Garlic and Mint. etc

POEM (PER ORAL ENDOSCOPIC MYOTOMY)

Achalasia is motility disorder of the esophagus (food pipe), where muscles in lower end of food pipe do not relax to allow food to pass into stomach. This causes food to stay in esophagus and leads to sensation of food getting impacted (dysphagia)
Achalasia Cardia manifests as difficulty in swallowing, regurgitation of food and fluid especially at night or sometime chest pain while eating.
Botox injection: With endoscopy guidance Botox is injected directly into the lower oesophageal sphincter muscle thus paralysing the muscle so that food and fluid can flow more easily. Unfortunately results are not long lasting and needs to be repeated frequently

Endoscopic Pneumatic Dilatation (PD): Under fluoroscopic vision a balloon is inflated at the lower oesophageal sphincter to disrupt the muscles. This treatment normally works well but requires repeat procedure within weeks, months and/or years

Heller’s Myotomy (HM): This is a surgical technique done under general anaesthesia in the operation theatre. In this technique lower esophageal sphincter (muscle) is incised from outside. As the sphincter is completely weakened, there is a high possibility of reflux later. So an anti-reflux procedure normally follows

POEM: Per oral endoscopic myotomy
Per oral Endoscopic Myotomy (POEM) is a new endoscopic treatment for achalasia where a small hole followed by narrow tunnel is created within wall of food pipe (Esophagus) till lower end muscle is seen and cut. With the endoscope, the same muscles are cut as in the open surgical procedure but with POEM , precisely muscle is cut and no external scars are left in the abdomen or chest.
Muscle is cut precisely without external scar on body
Hospital stay and procedure cost is less
Procedure is relatively safe without intra and post procedure complication
The patient kept nil per-orally from mid night
Success rate is more compare to other modalities of treatment
No, it is done under anaesthesia. So patient will not be aware of the procedure.
Post procedure patient can have slight pain which can be managed with simple analgesics.
POEM can be performed in endoscopy suite, which is well equipped with modern machines and Anaesthesia support.
Bleeding and perforation- It is a rare risk of the procedure which can be managed mostly endoscopically.

Reflux symptoms- Can be treated easily with acid-reducing medication.
Manometry . Manometry entails insertion of a very thin tube through the nose and into the stomach. Pressure sensors that are present on this catheter define exact motility pattern of oesophagus. It helps to classify the types of achalasia.

Barium swallow. A series of X-rays are performed after barium is swallowed in order is to determine the rate of barium emptying into the stomach.

Endoscopy–it is required to exclude any other disorder of the oesophagus which might be contributing towards similar symptoms which might preclude treatment. It is also important to be sure that the oesophagus and stomach are clear of food and fluid just prior to considering POEM in order to reduce the risk of inhaling contents into the lungs.
Tell the doctor if you are taking any blood thinner
Preoperative anaesthesia check up is required
Patient is admitted before the procedure
The patient kept nil per-orally from mid night
Consent is required before the procedure. Risk and benefit is explained
It take approximately 1 ½ hr to 2 hr
Patient will stay in the hospital for observation for one night after POEM
On the following day a chest X-Ray, CT scan or barium swallow will be performed to confirm that no small leaks have occurred
No special precautions are required after this procedure. The patient will be sent home with instruction to remain on a liquid diet for one week followed by a soft diet and antibiotics for one week. Acid reducing medications are prescribed for at least 2 weeks.

Chronic Liver Disease/Cirrhosis

The liver is our body’s largest internal organ. It lies up under ribs on the right side of belly.
Cirrhosis is when scar tissue replaces healthy liver tissue. This stops the liver from working normally. Cirrhosis is a long-term (chronic) liver disease.
The liver does many important things, including:
a. Removing waste from the body, such as toxins and medicines
b. Making bile to help digest food
c. Storing sugar that the body uses for energy
d. Making new proteins
In cirrhosis, scar tissue slows the flow of blood through the liver. Over time, the liver can’t work the way it should. In severe cases, the liver gets so badly damaged that it stops working. This is called liver failure.
The most common causes of cirrhosis are:
a. Hepatitis and other viruses: B and C
b. Long-term alcohol abuse
c. Nonalcoholic fatty liver disease (this happens from metabolic syndrome and is caused by conditions such as obesity, high cholesterol and triglycerides, and high blood pressure)
d. Other less common causes of cirrhosis may include: Autoimmune disorders, where the body’s infection-fighting system (immune system) attacks healthy tissue, Blocked or damaged tubes (bile ducts) that carry bile from the liver to the intestine, Use of certain medicines, Exposure to certain toxic chemicals, Repeated episodes of heart failure with blood buildup in the liver, Parasite infections, Some diseases passed from parent to child (inherited diseases) may also cause cirrhosis. These may include: Alpha1-antitrypsin deficiency, High blood galactose levels, Glycogen storage diseases, etc.
The symptoms may vary depending on how severe cirrhosis is. Mild cirrhosis may not cause any symptoms at all. Symptoms usually appear in moderate to advanced cirrhosis and it may include:
a. Fluid buildup in the belly (ascites)
b. Vomiting blood, often from bleeding in the blood vessels in the food pipe (esophagus)
c. Itching
d. Yellowing of the skin and eyes (jaundice)
e. Muscle loss
f. Loss of appetite & Low energy and weakness (fatigue)
g. Easy bruising
h. Spider-like veins in the skin
i. Weight loss
j. Confusion or encephalopathy as toxins build up in the blood
The symptoms of cirrhosis may look like other health problems.
It is diagnosed with clinical and testing.
The tests are done to diagnose are:
a. Blood tests. These will include liver function tests to see if the liver is working the way it should..
b. Liver biopsy. Small tissue samples are taken from the liver with a needle or during surgery. The samples are checked under a microscope to find out the type of liver disease.
c. CT scan. This is an imaging test that uses X-rays and a computer to make detailed images of the body. A CT scan is done for detection of liver cancer, portal vein block or other complications of cirrhosis.
d. MRI.
e. Ultrasound. This test assesses for ascites, liver veins and any mass.
f. Upper endoscopy (EGD). A lighted flexible camera is placed through your mouth into your upper digestive tract to look for enlarged blood vessels that are at risk of bleeding because of your cirrhosis.
g. If there is fluid in the belly (ascites), the doctor may advise you a low-sodium diet, water pills (diuretics), and removal of the fluid with a needle if required (paracentesis).
Cirrhosis is a progressive liver disease that happens over time. The damage to liver can sometimes reverse or improve if the trigger is gone, such as by treating a viral infection or by not drinking alcohol. The goal of treatment is to slow down the buildup of scar tissue and prevent or treat other health problems. In many cases, we may be able to delay or stop any more liver damage. Your treatment may include:
a. Eating a healthy diet, low in sodium
b. Not using alcohol or illegal drugs
c. Managing any health problems that happen because of cirrhosis
d. If you have metabolic syndrome, it's important to lose weight and also manage any underlying conditions such as diabetes.
Cirrhosis can cause other health problems such as:
a. Portal hypertension. The portal vein carries blood from your intestines and spleen to your liver. Cirrhosis slows the normal flow of blood. That raises the pressure in the portal vein. This is called portal hypertension.
b. Enlarged blood vessels. Portal hypertension may cause abnormal blood vessels in the stomach (called portal gastropathy and vascular ectasia) or enlarged veins in the stomach and the food pipe or esophagus (called varices). These blood vessels are more likely to burst due to thin walls and higher pressure. If they burst, severe bleeding can happen. Seek medical attention right away.
c. Ascites: Fluid collecting inside belly. This can become infected.
d. Kidney disease or failure.
e. Easy bruising and severe bleeding. This happens when the liver stops making proteins that are needed for blood to clot.
f. Liver cancer. You will be screened with an imaging test (ultrasound, for instance) and sometimes blood tests every 6 months if you have cirrhosis.

Hemorrhoids

Hemorrhoids develop when the veins or blood vessels in and around anus and lower rectum become swollen and irritated. This happens when there is extra pressure on these veins.
Hemorrhoids can be either inside anus (internal) or under the skin around your anus (external).
They are very common in both men and women. About half of all people will have hemorrhoids by age 50.
People get hemorrhoids if when:
• They often strain during bowel movements
• Are pregnant
• Have a family history of hemorrhoids
• Are older
• Have long-term or chronic constipation or diarrhea
Hemorrhoids are very common. Most people will have a hemorrhoid at some time in their life.
Each person’s symptoms may vary. Some of the most common symptoms include:
• Bright red blood in stool, on toilet paper, or in toilet bowl
• Pain and irritation around anus
• Swelling or a hard lump around anus
• Itching
Having blood in your stool can also be a sign of other digestive disorders, such as colorectal cancer. The following examinations may be required for diagnosing hemorrhoids:
• Physical exam. This is done to check anus and rectum and look for swollen blood vessels that are a sign of hemorrhoids.
• Digital rectal exam (DRE).
• Anoscopy. A hollow, lighted tube is put into anus. This is used to see internal hemorrhoids.
• Proctoscopy. A lighted tube is put into your anus. This gives a view of entire rectum.
• Sigmoidoscopy. This test checks the inside of part of large intestine. It helps to tell what is causing diarrhea, belly pain, constipation, abnormal growths, and bleeding. A short, flexible, lighted tube (sigmoidoscope) is put into intestine through the rectum. This tube blows air into your intestine to make it swell. This makes it easier to see inside. A tissue sample (biopsy) can be taken if needed.
• Colonoscopy. This test looks at the full length of large intestine. It can help check for any abnormal growths, tissue that is red or swollen, sores (ulcers), or bleeding. A long, flexible, lighted tube called a colonoscope is put into rectum up into the colon.
Treatment will depend on your symptoms, age, and general health. It will also depend on how severe the condition is.
The main goal of treatment is to reduce your symptoms. This may be done by:
• Sitting in plain, warm water in a bathtub several times a day
• Using ice packs to reduce swelling
• Using hemorrhoid creams or medicines inserted into your rectum (suppositories)
Adding more fiber to your diet means eating more:
• Fruits
• Vegetables
• Whole grains
In some cases, surgery is needed. There are several types of surgeries used to remove or reduce internal and external hemorrhoids. These include:
• Rubber band ligation. A rubber band is placed around the base of the hemorrhoid inside your rectum to cut off circulation to the hemorrhoid. The hemorrhoid shrinks and goes away in a few days.
• Sclerotherapy. A chemical solution is shot (injected) around the blood vessel to shrink the hemorrhoid.
• Electrical coagulation, also called infrared photo coagulation. A special device uses a beam of infrared light to burn hemorrhoid tissue.
• Hemorrhoidectomy and hemorrhoidopexy. These procedures permanently remove your hemorrhoids.
In rare cases, hemorrhoids may cause other problems. These may include:
• Having a low blood count that makes you tired (anemia). This can happen because of bleeding from a long-term or chronic hemorrhoid.
• Blood flow being cut off from a hemorrhoid that is sticking out (prolapsed). This can happen when the blood supply to the hemorrhoid is cut off. This can be very painful and cause bleeding. You may need surgery.
It’s not always possible to stop hemorrhoids from happening. But precautions may reduce your risk of getting hemorrhoids if you:
• Eat a healthy diet, with plenty of fiber and liquids.
• Limit the amount of time while sitting on the toilet.
• Work with your healthcare provider to manage constipation and prevent straining.
• Maintain a healthy weight.

Need Help?!

If we haven’t answered your question already you can contact our doctors, or call us at 18003091944

DR RAJESH KUMAR PRADHAN

Dr. Rajesh Kumar Pradhan

Gastroenterologist
DR KAPIL DEV JAMWAL

Dr. Kapil Dev Jamwal

Gastroenterologist

Dr. Atul Sharma

Gastroenterologist