Dr Nikhil Bhangale : Gastroenterologist, Hepatologist & Endoscopist

Causes of acid peptic disease (hyper-acidity)

Diet irregularities (irregular meal times, excessive oily or spicy foods, excessive caffeine intake from tea / coffee)

Bad habits (smoking , alcohol)

Helicobacter pylori infection
Drugs like pain killers (NSAIDS), steroids

Stress

Systemic diseases affecting stomach like CKD, CLD, COPD, ZES (Zollinger-Ellison Syndrome) and endocrine disorders.

Symptoms of acid peptic disease (commonly referred by people as Hyper-acidity)

Epigastric / upper abdominal pain
Nausea
Vomiting
Indigestion, abdominal fullness / heaviness
Heartburn
Chest burning with Chest discomfort
Loss of appetite / weight
Hematemesis or melena (blood in vomit / stool)
Anemia (low hemoglobin)

Alcoholic liver disease (ALD)

It has spectrum of asymptomatic fatty liver, alcoholic steato-hepatitis, liver cirrhosis and severe alcoholic hepatitis (SAH).

As such treatment options are very few and limited, so strict alcohol abstinence remains mainstay treatment.

Common myths

Biopsy means cancer !! 😫

Truth: Biopsy only means taking sample from inside for examination, and it can be done endoscopically or sonography / CT scan guided. Biopsy is important because certain illness can be diagnosed from tissue structure like tuberculosis, IBD (inflammatory bowel diaease), H.Pylori infection, CMV infection, allergic conditions like eosinophilic enteritis, celiac disease, benign tumours and also of course cancers.

So, cancer is one of the reason to take, but not the only cause.
So next time, someone says biopsy, don't panic, just ask "why ??"

What is colorectal cancer screening ?

It is checking of large intestine by various modalities like colonoscopy, CT colonography, stool test like FOBT (F***l occult blood test) or FIT (f***l immunochemical test), stool DNA test.
These can help with early detection of cancer or precancerous lesions like polyps, which can be removed to prevent cancer.

Colonic polyps - precursors of colon cancer

Polyps are small growths which can involve any part of colon and are usually asymptomatic & benign (harmless), however they can be pre-cancerous. Evolution to cancer depends on various risk factors (modifiable & non- modifiable).
Removal of such polyps (colonoscopy with polypectomy) can reduce of future cancer development.

Risk factors for colorectal cancer (CRC)

Non-modifiable risk factors

Age > 50 years
Males > females
Genetic mutations / syndromes
Family history of colon cancer
Other cancers like uterine / ovarian cancer

Modifiable risk factors

Less exercise / physically inactive
Low fiber diet (low in fruits / vegetables)
High fat diet
High processed meat consumption
Obesity / overweight
Alcohol
Smoking
IBD (inflammatory bowel disease)

Colorectal cancer is a cancer involving colon (large intestine and re**um).
Such patients can present with abdominal pain, weight loss, new onset constipation / diarrhoea or recent onset change in bowel habits, blood in stools, loss of appetite like symptoms.

However , many times it can be completely asymptomatic , silently growing inside. Very commonly it presents with only anemia (low hemoglobin) in patients.

Beware !! Long standing illicit use of PPI can be harmful, it DOUBLED the chances of NAFLD (Non-alcoholic fatty liver disease) and liver injury.
As per recent study

Long-Term PPI Use Associated With Increased Risk for NAFLD Researchers examined the relationship between long-term use of proton pump inhibitors and the development of nonalcoholic fatty liver disease.

IBS and IBD are many times wrongly interpreted by people / patients leading to confusion. this image shows important common and differentiating features of each.

IBS is relatively milder disease and required multimodal management like pharmacological (drugs) , psychological support, diet adjustment, meditations etc.

While IBD is relatively more severe than IBS , and specific disease which involves inflammation and damage of intestinal walls leading to multiple complications if not properly controlled. Management is diet adjustment and pharmacological (drugs) , which involves anti-inflammatory, immunosuppressive drugs.

Learn the difference which sets these 2 illness apart.

Inflammatory bowel disease (IBD) is chronic inflammatory disease state which involves intestines.
This is medical disease and usually doesn't require any surgical management.
Surgery may be required only selected cases as recurrence of disease can occur even after surgery, if not adequately controlled with medications of IBD.

Colon Cancer Risk Quadruples Within Year of Appendicitis.

Surprising findings, need more studies to see how much it applies to indian population as well.

Colon Cancer Risk Quadruples Within Year of Appendicitis The investigators say acute appendicitis is likely an early warning sign for colon cancer, not a cause of it. The study covered was published as a preprint and has not yet been peer reviewed.

Hepatitis (Hepat - liver, itis- inflammation)
Hepatitis is liver inflammation due to infective or non-infective causes.

It can present as
• Flu like symptoms (fever)
• Fatigue
• Nausea vomiting
• Jaundice (yellowing of skin /urine / eyes)
• Abdominal pain
• Loss of appetite or weight loss
• Pale coloured stools sometimes
• Rarely body rash and other extra-hepatic symptoms

What is gastroporesis
(Gastro- stomach, paresis - paralysis) It means weakening of stomach muscles, causing defective delayed stomach emptying.
It can be because of damage to Vegus nerve (which provides nerve supply to stomach) or damage to stomach muscles (due to myopathy).

Such patients can present with sign and symptoms like:
• Feeling full soon after having meal
• Post prandial (post meals) bloating, fullness or heaviness
• Abdominal pain
• Weight loss
• Malnutrition
• Heartburn

H. pylori is carcinogenic infection (cancer causing) which is completely curable with appropriate antibiotic therapy. It can be diagnosed while doing gastroscopy (upper GI endoscopy) with help of RUT(Rapid urease test).

H Pylori Eradication Therapy Curbs Risk for Stomach Cancer Results of a large retrospective study support the potential for substantial stomach cancer prevention in the United States through H pylori screening and treatment.

जय जय महाराष्ट्र माझा,गर्जा महाराष्ट्र माझा
महाराष्टादिनाच्या सर्वांना हार्दिक शुभेच्छा !

IF YOU CAN WORK HARD THEN YOU CAN
ACHIEVE ANYTHING YOU DESIRE.
Happy labour day wishes to all !!

What is Helicobacter pylori infection ?

H.Pylori is a long standing infection of stomach

Affects stomach specifically, causing severe repeated acidity related episodes.

Can be present in upto 80% of general population

Stomach cancer causing infection (carcinogenic infection)

It can be checked during endoscopy, and treated with medicines if positive.

Liver is one of largest and most important, multifunctional organ of our body, which performs many crucial functions to keep our body healthy and fit.
So, care for your liver.. and
Live(r) Long !!
Wishing everyone happy "world Liver day" !!

Dr Nikhil bhangale.
Consultant gastroenterologist, hepatologist and interventional endoscopist.

What is Endoscopic Retrograde Cholangiopancreatography (ERCP) ?

This procedure involves treatment of biliary tract or pancreatic duct diseases like stones, narrowing (stricture) or cancers with stone removal / stricture dilatation / stent placement.

What is gastroscopy & colonoscopy ?

Both scopies are type of endoscopy, but require different type of special endoscope.

Gastroscopy (UGI endoscopy or EGD scopy) is endoscopic examination of upper intestinal tract which includes pharynx, esophagus , stomach and duodenum.

While colonoscopy is retrograde endoscopic examination (starts from a**l opening, in reverse direction towards small intestine) of large intestine and very last part of small intestine (terminal ileum).

Good health is the foundation on which the success of your life is built. You can never move ahead in life if you stay sick.
Wish you all a Healthy life and happy world health day !
Let's be healthy and build a better tomorrow for us !!

What is endoscopy ?

It is a procedure to examine inside of gastrointestinal tract with help of endoscope (a thin flexible tube with camera at end to visualize) .
It is direct under-vision, non invasive modality and it can be used for both diagnostic and therapeutic purposes.
With endoscopy, doctor can diagnose various illness and also can treat endoscopically, like endoscopic mucosal resection (EMR) / endoscopic submucosal dissection (ESD) for early cancers, variceal banding / band ligation for esophageal varices, ERCP stenting for bile duct obstruction due to cancers / stones, peroral endoscopic myotomy (POEM) for achalasia cardiac, endoscopic ultrasound guided gastro-jejunostomy (GJ), etc.
Unnecessary surgery and related morbidity can be avoided with endoscopy with minimally invasive / non-invasive way.

Common causes of pancreatitis:

Gall stones
Alcohol use
Smoking
Abnormal lipid profile
Autoimmune / genetic
Pancreatic divisum
Trauma
Post ERCP

Visit best gastroenterologist near you for proper evaluation and management.

Happy Gudi Padwa everyone!!

Dr Nikhil Bhangale : Gastroenterologist, Hepatologist & Endoscopist in dombivli kalyan.

New ACag recommendations are to start colorectal cancer screening from age of 45 years.
Such recommendations are for general public.
But in indian scenario where there are no such recommendations due to lack of adequate research,
colorectal cancer screening is must, at least for high risk groups like patients with inflammatory bowel disease (IBD), family history of colorectal (large intestinal) cancer or intestinal polyposis syndromes, etc.

Dr Nikhil Bhangale : Gastroenterologist, Hepatologist & Endoscopist

March is ! experts at The American College of Gastroenterology urge you to talk to your doctor about lifesaving . Age 45 is now recommended to start screening for all average-risk adults. Learn more: gi.org/coloncancer

What is acute pancreatitis ?

It is inflammation / swelling of pancreas due to various reasons like alcohol use or gall stones, etc. (स्वादुपिंडाची सूज)

Such patients can present with abdominal pain, backache, nausea, vomiting or sometimes fever.

Colon cancer can be prevented through regular screening.

colorectal cancer (CRC) screen is useful tool for this purpose, which can detect early precursors of cancer like polyps and their removal can prevent cancers.

Dr Nikhil Bhangale : Gastroenterologist, Hepatologist & Endoscopist

A message on the Power of Prevention for . With doctors can: Find a polyp; remove a polyp; and interrupt the natural progression from polyp to . "Colorectal Cancer: You Can Prevent It." Learn more: gi.org/coloncancer

Wish you all Happy holi !!

Dr Nikhil Bhangale Gastroenterologist, Hepatologist and Interventional Endoscopist Dombivli

What is inflammatory bowel disease (IBD) ?

It is long standing disease causing inflammation of intestines as intestinal ulcers, erythema (redness) and bleeding.

IBD has mainly 2 types:
1) Ulcerative colitis (involves only large intestine)
2) Crohn disease (can involves anywhere from mouth to a**l ca**l)

Consult best gastroenterologist near you for appropriate treatment.

Almost all hepatitis C patients should be treated with currently available anti-virals which are very effective in achieving cure of hepatitis C and also help with preventing progession of liver disease.

Dr Nikhil Bhangale : Gastroenterologist, Hepatologist & Endoscopist

New Issue of Evidence-Based GI: An ACG Publication!

ACG members: explore this month’s commentaries and audio summaries including endoscopy, eosinophilic esophagitis, HCV and cirrhosis, and lower GI bleeding.

🟣 gi.org/ebgi