CONDITIONS TREATED

Upper Gastrointestinal

Achalasia

Achalasia is the condition where the muscle that controls the opening between the oesophagus and the stomach does not relax properly. This in turn leads to a build up of food in the oesophagus and stops it entering the stomach.

Damaged nerves in the gullet wall causes achalasia. Why the nerve becomes damaged is unknown, but it is thought that a viral infection might be to blame.

The symptoms of Achalasia can start at any time of life and usually come on gradually. Most people have difficulty, and find it painful to swallow their food (this is called dysphagia). Food may be regurgitated or vomited shortly after meals. The "vomit" may sometimes contain recognisable food eaten a long time previously, showing that it was held in the oesophagus for some hours.

Diagnostic Investigations
There are three main diagnostic tests:

Barium Meal and X-Ray
This involves swallowing a white liquid containing barium which allows the oesophagus to be seen clearly on an X-ray. In achalasia, the exit at the lower end of the bullet does not open properly and, together with a lack of the progressive contractions which force food down the gullet, delays the barium passing into the stomach. A chest X-ray will show whether the bullet is widened abnormally.

Endoscopic Diagnosis
A flexible tube with a camera on the end, called an endoscope, is used to look at the lining of the oesophagus and the stomach. Any food that hasn't entered the stomach can be seen. The doctor can also inspect the lining of the stomach to look for abnormalities.

Manometry Test
This test measures pressure waves in the oesophagus. A small plastic tube is passed into the gullet and pressure at different positions in the gullet is measured. In achalasia there are usually weak contractions of the upper gullet and sustained high pressure of the valve at the lower end of the gullet. It is this high pressure and the failure of the valve to relax in response to swallowing that causes food to remain in the lower oesophagus.

Treatment for Achalasia
The aim of treatment is to relax the valve at the base of the oesophagus so that food can pass easily into the stomach. The underlying causes of the condition cannot be cured, but there are various ways in which the symptoms can be improved. These include the following:

Drugs
The valve at the lower end of the gullet may be temporarily relaxed by drugs.

Stretching the Valve
This can be carried out after the patient takes a sedative, or under general anaesthetic. A small balloon (30mm; 1 ½ inches) is used to stretch the muscle fibres of the valve at the lower end of the gullet. This usually improves swallowing, but the process may need to be repeated after one or more years.

Botulinum Toxin ("Botox") Injection
This substance causes muscle fibres to relax. It can be injected painlessly into the valve through an endoscope. This is usually effective for a few months, sometimes for a few years, but this procedure normally has to be repeated. It is not a permanent treatment, but is useful for patients who are unable to have surgery.

Surgery
Under general anaesthetic, the muscle fibres that fail to relax are cut but and this results in a permanent improvement in swallowing. The operation is now often performed by key-hole surgery.

How you can reduce symptoms after treatment
You should always chew your food well. It is best to eat sitting upright and to drink fizzy drinks to ensure that the gullet is kept clear. Using several pillows or raising the head of the bed on wooden supports so that you sleep fairly upright can also be helpful. After dilation or surgery, acid may be able to rise from the stomach into the oesophagus through the weakened valve, causing heartburn. If heartburn develops after treatment it is important to consult your doctor who can give you medication. Any recurrence of swallowing difficulties or weight loss should be reported to your doctor. You may have some chest pain after treatment. This may be difficult to cure, but a drink of cold water often helps to reduce the pain.

Achalasia is not an inherited illness. Women with achalasia can have a normal pregnancy and their children will develop normally.

The risk of cancer for those people suffering from achalasia is slightly increased, so it is important to have treatment although the symptoms may not be severe.

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Achalasia

The condition called Barrett's Oesophagus is damage to the oesophagus caused by acid reflux. The oesophagus carries food to the stomach and is lined by cells similar to those that form the skin. In Barrett's Oesophagus the lining at the lower end of the gullet changes from being skin-like to being like the lining of the stomach. Over a long period of time a small number of people with the condition (about 1 in 100) may develop a cancer of the oesophagus.

The Causes of Barrett's Oesophagus
The cause is believed to be linked to the 'reflux' of the acidic digestive juices from the stomach up into the gullet. Unlike the stomach, the oesophagus does not have a protective lining, so when it is repeatedly exposed to acid it may become inflamed and painful. Sometimes contents from the duodenum (the first part of the intestine after the stomach), particularly bile, may also reflux into the oesophagus and this mixture can be even more damaging than acid alone. The oesophagus usually heals with time and the lining returns to normal, but sometimes, if bile is present, the lining changes to appear more like the lining of the stomach or small intestine. The condition appears to be more common in men, and people who are overweight. Smoking can accelerate changes to Barrett's Oesophagus.

Symptoms
Most people diagnosed with Barrett's Oesophagus will have been examined because of symptoms associated with gastro-oesophageal reflux, which causes heartburn. Other symptoms may include a salty taste at the back of the mouth (sometimes called water brash), hoarseness due to acid damaging the vocal cords and chest pain. Barrett's Oesophagus can lead to complications such as ulcers in the gullet, bleeding, difficulty in swallowing due to a narrowing of the gullet, and occasionally cancer. The majority of people who have Barrett's Oesophagus have no serious, long term problems.

Diagnosis
An endoscopic examination using a thin flexible telescope passed through the mouth, into the gullet and on into the stomach is the common way of diagnosing the condition. A small biopsy sample is usually taken for examination. This will confirm the diagnosis and also highlight any complications.

Treatment
Three forms of treatment are available for Barrett's Oesophagus:

Medical Treatment Using Drugs
Medical treatment may be used to suppress the production of acid in the stomach and therefore reduce the amount of acid available to reflux into the oesophagus.

Laser or By Heat Energy
The abnormal lining may be destroyed by laser or by heat energy. This is done using an endoscope and it encourages the normal lining of the oesophagus to grow again.

Surgical Operation – Keyhole Surgery
The weakened valve at the lower end of the oesophagus, which allows reflux to occur, can be strengthened by an operation. Keyhole surgery is used. A small incision is made and a small camera is passed into the abdomen to let the surgeon view the affected area. The surgeon will wrap the upper few centimetres of the stomach around the oesophagus to make a new valve. This prevents acid reflux and heartburn recurring. Permanent stitches are used to keep the stomach in place.

How to Help Prevent Acid Reflux
There are a number of ways that patients can prevent acid reflux, including the following:

  • Losing weight, if necessary;
  • Eating smaller meals and at regular intervals;
  • Allowing time for food to be digested before going to bed;
  • Avoiding tight clothes and bending down after meals;
  • Giving up smoking.

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Endoscopy

Endoscopy

Gastro-intestinal endoscopy is the process by which a doctor can look inside the upper part of your digestive system - your oesophagus (gullet), stomach and small intestine (bowel) by passing a tiny camera on the end of a very narrow and flexible tube called an endoscope. The tube is thinner than an index finger.

Endoscopy is used to investigate symptoms such as indigestion, heartburn, upper abdominal pains, difficulties in swallowing or to exclude other abnormalities. This provides a clear diagnosis.

There are other methods of examining the stomach, such as a barium meal, or a CT scan. Although gastro-intestinal endoscopy is less pleasant than a barium meal, it does allow biopsies and photographs to be taken. If you wish, please discuss with your doctor which is the best test for you.

Questions You May Have About Endoscopy

What preparation will I need?
The procedure must be performed on an empty stomach, so you cannot eat or drink for six hours before the test.

What should I bring on the day?
Please bring a list of your medication, and insurance details.

What about taking my medications?
If you are taking anti-inflammatory tablets (such as neurofen, brufen or voltarol) please stop taking them 5 days before your test.

Do not stop taking aspirin, clopidogrel or warfarin but please make sure that you have discussed this with your referring doctor before the test. There is a significant risk that a coronary stent will block if these medicines are stopped within one month of stent placement; and a slightly increased risk within the first six months. If the referring doctor thinks it is in your best interests to stop taking them, they should be stopped 10 days before the gastro-intestinal endoscopy.

If you are a diabetic, please let the unit know. We will give you more detailed information about your preparation.

What will happen to me on the day of the test?
Please book in with the endoscopy reception staff when you arrive. They will check a few of your personal details, such as your name and address. We try to ensure that all patients are seen and have their tests within a short period of time of arriving in the unit, but occasionally emergencies take precedence and you may need to wait. The reception staff will keep you informed in the event that this happens.

One of the endoscopy nurses then sees you and asks you some further questions. Before you undergo the test, the doctor (endoscopist) who will be doing the procedure talks you through the consent form and the potential complications. It is important for you to think about these in advance so when you sign the form agreeing to the test you are comfortable that it is a test you really want. Remember, you can change your mind about having the procedure at any time. Please tell the doctor if you have heart valve disease or if you normally are given antibiotics when you visit the dentist.

The endoscopy is usually quick and often takes no more than 5 minutes to complete. It can be performed with a sedative injection administered through a drip in your arm. This will make you drowsy during the procedure and for up to sixty minutes afterwards. This is not a general anaesthetic. Alternatively, a local anaesthetic can be sprayed on to the back of your throat to make it numb. You are awake during the procedure but you will be able to leave the department as soon as the test is completed.

A plastic mouthpiece is placed between your teeth to keep your mouth slightly open. When the endoscopist gently passes the endoscope through your mouth you may gag slightly - this is quite normal and will not interfere with your breathing. The endoscope is thinner than an index finger.

During the procedure, air is put in to your stomach so that the endoscopist can have a clear view. This may make you burp a little. Some people find this uncomfortable. The air is removed at the end of the test. When the procedure is finished the endoscope is removed quickly and easily. Minimal restraint may be appropriate during the procedure. However if you make it clear that you are too uncomfortable the procedure will be stopped. During the test the doctor may take biopsies (tissue samples) and photographs of your bowel, even if it all looks normal. This does not hurt. In addition, it may be necessary to use thermal coagulation to remove small polyps or abnormal blood vessels; this is relatively safe. A nurse is present throughout the procedure to look after you.

What are the complications of gastro-intestinal endoscopy?
Complications are rare, but it is important that you know all the risks before you decide to go ahead with the test.

Minor complications
Despite sedation and pain killers some patients can experience abdominal discomfort or pain.

Major complications
There is a very small risk of bleeding, or of making a hole (perforation) in the intestine, which may require surgery. The risk of this happening is about 1 in 10,000. Other rare complications include aspiration pneumonia, damage to loose teeth or to dental bridgework.

Using sedation can cause breathing complications in up to 1 in 200 procedures, which usually are not serious. To reduce this risk, we monitor your pulse and oxygen levels at all times throughout the test.

If you have severe pain, black tarry stools or persistent bleeding, you should contact your nearest A&E Department for further advice and also inform your consultant through the endoscopy unit staff, or, if after hours, the hospital switchboard – 0207 586 5959.

What happens after the test?
If you choose to have sedation, you will be moved to the recovery area where nursing staff will monitor your condition for 1-2 hours. If you received local anaesthetic to your throat, you can leave the department immediately but will have to wait approximately half an hour before eating or drinking. You may experience a sore throat and may feel bloated due to air in your stomach. Both sensations are normal and will clear up quickly by themselves.

If you are going home the same day you must arrange for someone to escort you home as you may have been given a sedative. Be aware that parking at the hospital is very limited. If no escort is available, please bring enough money to pay for a taxi.

We strongly advise that you do not drink alcohol, operate machinery, drive or make important decisions for 24 hours after your procedure as sedatives can impair your judgment.

You can resume normal activities, work etc the following day.

How will I get the results?
The endoscopist will be able to tell you the results after the procedure. If you had sedation, it is a good idea to have someone with you when this occurs because the sedation can make you forget what is discussed. If biopsies were taken, you will be told the final diagnosis by you consultant at a follow-up appointment. Copies of your gastro-intestinal endoscopy report will be sent to your GP.

Any other questions?
Feel free to write down any other questions you may have. No question is ever too minor or too silly to ask, so please feel free to ask any member of the team caring for you if there is anything you wish to know.

If you have any problem understanding or reading any of this information, please contact the Endoscopy Unit staff 0207 483 5164 or 5167.

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Gallstones

The gallbladder is a small sac lying on the underside of the liver. Bile (also called gall) is a greenish-brown liquid produced by the liver. It is stored and concentrated in the gall bladder and passed into the small intestine through the bile ducts to help with digestion, mainly of fats.

Gallstones are hard pieces of stone-like material, round, oval, or faceted, commonly occurring in the gallbladder or the bile duct. Most gallstones are about the size of a pea, but in some cases there can be many very small stones, like fine gravel, or a single stone so large that it completely fills the gallbladder.

Gallstones cause symptoms in fewer than 20% of the people who have them. However, their presence may lead to the gallbladder becoming inflamed (cholecystitis), causing pain below the ribs on the right side. The pain may also be felt in the back and the right shoulder and patients may have fever, nausea and vomiting.

Gallstones may also block the bile duct, leading to obstructive jaundice. This causes yellowing of the skin and the whites of the eyes, darkening of the urine and pale clay coloured stools.

The passage of a gallstone down the bile duct into the duodenum is very painful, and is known as biliary colic. The pain is felt in the upper part of the abdomen, in the centre or a little to the right, and usually occurs about an hour after a meal, especially if the fat content has been high.

The Causes of Gallstones
Bile is a mixture of different chemicals. When the bile can no longer hold these chemicals in a liquid solution, gallstones start to form. Most gallstones are made up of cholesterol, chalk (calcium carbonate), calcium bilirubinate, or a mixture of these. They are more likely to occur if the composition of the bile is abnormal, if the outlet from the gallbladder is blocked or has a local infection, or if there is a family history of gallstones. The liver produces bile that is saturated with dissolved substances and has an excess of cholesterol in it. This may be caused by a relative reduction in bile salts.

Excessive cholesterol may be due to factors such as:

  • A high cholesterol diet
  • Advancing age
  • Excessive refined dietary carbohydrates such as white bread, cakes, and low-fibre cereals
  • The use of oral contraceptives
  • A genetic disorder featuring excessive cholesterol in the blood (hypercholesterolaemia)
  • Liver disease that reduces the levels of bile salts

Diagnosis
Your doctor would probably arrange for you to have some blood tests to look for signs of inflammation or jaundice. The best test for gallstones is an ultrasound scan. This is a very easy scan to have, as a little probe is moved over the upper abdomen in the region of the liver and gall bladder, and usually it is very easy to pick out gallstones on the screen. If the ultrasound scan does not give a clear result then other tests may be needed.

Treatment – Keyhole Surgery
Changes in diet have no effect on gallstones, but it is advisable to eat a well balanced healthy diet, and to control your weight.

Gallstones can be treated by surgical removal of the gallbladder (cholecystectomy) using Laparoscopic (keyhole) surgery also known as Minimally Invasive Surgery (due to the small incision). There is no question that, for most people, surgery is currently the best option for treating gallstones. Gall stones have to be physically removed with the gall bladder in order to get rid of them.

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Gastroesophageal Reflux Disease

Gastro-oesophageal reflux disease (GORD) occurs when there is a reflux of gastroduodenal contents into the oesophagus, causing symptoms that are sufficient to interfere with quality of life. People with GORD often have symptoms of heartburn and acid regurgitation.

This is a common condition with 20–25% of the population experiencing symptoms of GORD, and 7% have heartburn daily.

Obesity, smoking, and alcohol are all linked to the incidence of GORD. It is also said that some foods, such as coffee, mints, dietary fat, onions, citrus fruits, or tomatoes, may cause GORD. Drugs that relax the lower oesophageal valve, such as calcium channel blockers, may also cause GORD and it is a condition which can 'run in the family'.

Symptoms of GORD
The main symptom of GORD is heartburn. Heartburn often happens after a meal when your stomach is full, or when you lie down, which allows acid to flow upwards more easily. Heartburn is more common if you are a smoker, overweight or pregnant.

Other symptoms of GORD can include:

  • an acidic or sour taste in your mouth,
  • burning pain in your throat,
  • bloating and belching,
  • stomach pains,
  • burning pain in your throat and oesophagus when you swallow hot drinks,
  • regurgitating food (when food comes out of your stomach and back up your oesophagus),
  • nausea and vomiting, and
  • vomiting blood.

The Diagnosis of GORD

  1. Endoscopic Examination – This is the most common test. A thin tube with a microscope on the end is passed down your oesophagus towards your stomach. It enables doctors to see whether the inside of your oesophagus is red and inflamed,
  2. Acidity test on the inside of the oesophagus – the test is performed for a 24-hour period and involves a thin wire being passed through your nose and into your oesophagus. The wire measures how acidic your oesophagus is and displays the results electronically,
  3. Barium swallow – a white liquid containing barium, which shows up white on an X-ray, is swallowed to enable doctors to identify any abnormalities in your oesophagus,
  4. Radiolabelled technetium – in some hospitals radioisotope imaging may be used to demonstrate gastro-oesophageal reflux. The technique uses very small doses of technetium-sulphur colloid to help confirm a diagnosis.

The Treatment of GORD
GORD is a chronic condition, with about 80% of people relapsing once medication is discontinued. Many people therefore require long term medical treatment or surgery.

Medical Treatment

  1. Proton Pump Inhibitors – Proton Pump Inhibitors (PPIs) reduce the amount of acid produced by your stomach, and are usually the first treatment for GORD.
  2. H2 receptor antagonists – H2 receptor antagonists also reduce the amount of acid produced by your stomach. However, PPIs tend to be used more commonly to treat this condition.
  3. Motility stimulants – These medicines speed up the rate at which your stomach empties. They also improve the squeezing of the valve muscle, to help stop stomach contents being brought back up into your oesophagus. Motility stimulants are normally used as an additional treatment to reduce symptoms such as bloating and a feeling of fullness soon after you start a meal.
  4. Alginates and Antacids – Alginates and antacids are usually available without a prescription and are best taken when symptoms occur, such as after meals and at bedtime.

Surgical Treatment
If medicines do not help to control the symptoms of GORD, surgery may have to be considered. The operation is called ‘Fundoplication'. The aim of surgery is to make it harder for stomach contents to re-enter your oesophagus so that there is less reflux.

A number of different surgical procedures are available. You should discuss the alternatives with your specialist so that you are fully aware of what is required and understand the pros and cons of each procedure. The two main types of procedure are:

  • Open anti-reflux surgery – where a large incision is made to allow the surgeon to gain access to your oesophagus,
  • Keyhole surgery – for this procedure, a small incision is made and a small camera (telescope) is passed down your oesophagus to let the surgeon view the affected area.

Where there is a hiatus hernia, the surgeon will bring the stomach back into its original position under the diaphragm, then wrap the upper few centimetres of the stomach around the oesophagus to make a new valve. This prevents acid reflux and heartburn recurring. Permanent stitches are used to keep the stomach in place.

What Patients Can Do to Prevent GORD
There are some lifestyle changes you can make to help prevent GORD developing, or stop simple heartburn turning into GORD. These include:

  • Stop smoking
  • Avoiding foods that you find bring on heartburn,
  • Eating smaller, regular meals,
  • Changing your medication if you think it could be causing symptoms. Make sure you speak to your GP before stopping or starting any medication,
  • If you are overweight try losing weight, to reduce pressure on your stomach
  • Avoid altering your posture – don't wear tight belts and waistbands, and try not to leaning forward a lot during the day, and
  • If you have symptoms at night, try not eating three hours before going to bed, and not drinking two hours before. If you must have a drink, sip water or milky drinks, and avoid caffeine.

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Obesity / Gastric Balloons

Obesity / Gastric Balloons

Managing your weight is increasingly difficult with the pressures of modern society. Many of us have a weight problem and many of us find it impossible to manage our weight consistently despite the well known health dangers of being overweight.

Most people have heard of the surgical procedures now being used to restrict appetite and to bring bodyweight under control. But for many people the prospect of undergoing major surgery is not acceptable and now The Wellington can offer a new and increasingly popular non surgical alternative - the Intragastric Balloon Programme.

Our specialist endoscopy teams introduce a soft silicon balloon through the mouth and into the stomach and fill it with sterile saline solution. The procedure, carried out by a senior consultant, takes a matter of minutes and is assisted by a local anaesthetic to aid the passage of the balloon.

The balloon reduces the appetite by reducing the space for food and consequently leads to planned and consistent weight loss. During the time the balloon is in the patient's stomach, a course of medication may be needed to reduce the acid content in the stomach to preserve the balloon while its presence helps weight loss.

Our senior consultants work closely with our dieticians to help patients adjust their diet appropriately and to monitor the weight loss over a period of six months. After six months the balloon is removed and our consultants and dieticians review the patient's progress and discuss follow-up dietary and lifestyle regimes or other follow-up treatments.

This new method is internationally recognised as providing a successful non surgical method of bringing body weight under control and we have a full information pack explaining the expected results and all aspects of the treatment for those who would like to consider this option.

For more information about the Intragastric Balloon Programme, please call The Wellington Enquiry line on
+44 (0) 20 7483 5148.

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Pancreatitis

The pancreas is a large and important gland which helps to digest food and produces insulin, the main chemical for balancing the sugar level in the blood.

The pancreas is a solid gland about 10 inches (25cm) long behind the stomach and is shaped like a tadpole. Its head is just to the right of the mid-line and its body and tail point upwards at an angle so that the tail is situated just beneath the extreme edge of the left side of the ribs. The head is closely attached to the first part of the small intestine (duodenum), into which the stomach empties food and liquid, already partially digested. It is to this partially digested food that the pancreas adds its digestive enzymes.

The tube draining the liver of its bile (the bile duct) lies just behind the head of the pancreas and usually joins the bowel at the same place where the fluids from the pancreas enter the bowel.

Food consists of carbohydrates (e.g. starch), proteins (e.g. meat), and fat (e.g. butter), and digestion is not possible without the enzymes produced by the pancreas.

The pancreas makes a number of different enzymes each of which is responsible for breaking down the different types of food into small particles that can be absorbed. The enzymes are made in small glands within the pancreas and travel along increasingly large tubes until finally they reach the main pancreatic tube. This connects the gland to the first part of the bowel where food passes after it has gone through the stomach.

The enzymes are not active when they are first made within the pancreas (otherwise they would digest the pancreas as well) but when they pass into the bowel they are activated by the juices in the bowel. The main enzymes are called amylase (which digests carbohydrates), trypsin (which digests protein) and lipase (which digests fats). The bile which comes from the liver is also very important for the digestion of fat because it acts like a soap and breaks up the fat into minute droplets so that the pancreatic lipase can digest it.

Insulin and Glucose
All the body's cells use glucose (sugar) as an energy source. The level of sugar in the blood is kept constant by insulin, which is made by special cells in the pancreas. If the cells are not working properly and insulin is lacking then diabetes develops.

What is Pancreatitis?
Pancreatitis is inflammation of the pancreas and can be a very unpleasant and serious illness. There are two forms of it - the acute form which may be severe and life threatening with complications; and much less commonly, the chronic form which can cause continuing and severe pain and poor function of the pancreas, affecting digestion and causing weight loss.

Approximately 10,000 cases of acute pancreatitis occur in the United Kingdom every year. It occurs when the pancreas suddenly becomes inflamed and the two most common causes for it are drinking too much alcohol (alcohol induced pancreatitis) or gallstones within the bile tubes (gallstone pancreatitis). The symptoms of acute pancreatitis are severe upper abdominal pain and vomiting. The pain may be felt in the back and the patient feels very unwell. Fortunately, three out of four cases of pancreatitis cure themselves without any specific treatment.

It is best to rest the pancreas by not allowing the patient to eat anything until it has settled. However, one person in four will have a very bad attack (severe acute pancreatitis) which may require a prolonged stay in the intensive care unit and operations to remove parts of the gland that have been destroyed by the attack. Although excessive drinking of alcohol or gallstones are commonly identified causes of acute pancreatitis (two thirds of all cases), your doctor will want to do various tests when you have recovered from the attack to make sure that the diagnosis is definite and that you are unlikely to get another one.

The pancreas can return to normal after pancreatitis. Even if the pancreas has been inflamed and becomes scarred it will continue to work normally because there is so much more pancreatic tissue than we need. However, in some people the inflammation may continue and produce a condition called chronic pancreatitis.

Chronic Pancreatitis is a condition in which the pancreas is severely diseased and its function is impaired. It usually follows many years of alcohol abuse. Patients with chronic pancreatitis have pain, mal-absorption of food, leading to weight loss or diabetes. The condition is often painful and special treatment for the pain may be required. Eventually it may ‘burn out' leaving the sufferer pain free but requiring treatment for loss of pancreatic function.

Diagnosis
After your doctor has talked to you and made a physical examination he or she may wish to do some blood tests and special X-rays. A check on the level of amylase in the blood is a very helpful test for inflammation of the pancreas. Sometimes it may be necessary to check the motions to see whether there is an excess quantity of fat present, indicating that the pancreas is not producing its normal enzymes. A very useful test is an ultrasound scan which is a relatively simple and painless way of obtaining a ‘picture' of the pancreas gland. The pictures are made by using sound waves, which bounce off solid organs and can be recorded on a scanner (a sort of radar). In addition there are two further diagnostic procedures:

CT Scan
This is a type of X-ray in which the patient lies on a couch and moves through a large ‘doughnut' which carries out the X-ray as the patient moves through. This shows excellent pictures of the pancreas, which may be helped by drinking some liquid to outline the intestines around it.

ERCP (Endoscopic retrograde cholangiopancreatography)
This is a special investigation using a flexible telescope (endoscope) passed through the mouth and stomach so that it lies opposite the opening of the pancreas in the bowel. You are usually given heavy sedation for this test.

Once the endoscope is in the correct position, a tiny plastic tube is passed into the pancreas opening and some x-ray liquid is injected to outline the pancreatic tubes, after which X-ray pictures are taken. This procedure is very useful, since pictures of the inside of the pancreas can be obtained and also treatments can be given via the endoscope. For example, narrowing of the bile or pancreatic tubes can be widened and, most importantly, stones in the bile tubes can be removed. Although inflammation can occur after this examination, this is generally a safe procedure.

Treatments for a Failing Pancreas
There are many pancreatic enzyme preparations available and some are more effective than others. How much of the enzyme replacement you require will be determined by your doctor but sometimes up to 20-30 capsules every day are required. You may also need to take a tablet to reduce the level of acid in the stomach so that the pancreatic enzyme supplements can work better. The capsules are often taken with meals or snacks.

If you are diabetic because your pancreas does not work you will need insulin and this has to be given by injection. All diabetics who require insulin quickly learn how to inject themselves once or more daily. You will be under the care of a specialist team for this problem.

The pancreas is a very important gland and fortunately diseases that affect it are relatively rare compared with other digestive diseases.

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