The importance of early diagnosis for gastroenterological diseases

Toilet talk generally isn’t considered polite conversation. However, keeping silent about your bowel health can prove to be deadly. Too often, those suffering from gastroenterological conditions such as bowel cancer or inflammatory bowel diseases (IBD) are diagnosed during more advanced stages, and the prognosis could be devastating. Dr Polychronis Pavlidis, consultant gastroenterologist and expert in all things gastrointestinal, stresses the importance of early diagnosis for these diseases.

IBD is an umbrella term for a variety of chronic diseases that affect the gastrointestinal (GI) tract, the most common kinds being Crohn’s disease and ulcerative colitis. Crohn’s disease can impact any part of the GI tract but is mostly found at the end of the small intestine and the beginning of the colon. Ulcerative colitis mostly affects the colon and the rectum. IBD can onset at a young age, with most diagnoses from around 15 to 30 years old, and can be due to genetic predisposition as well as air quality and lifestyle habits.

Bowel or colorectal cancer starts with unusual growths in the colon or rectum, called polyps. The polyps aren’t initially harmful but as growth continues and spreads, they becomes cancerous tumors. It is recommended to get screened for it from the age of 40 -- but in truth, it can affect anyone and any age. A family history of bowel cancer is something to take into consideration.

Symptoms of gastroeneterological diseases

Signs that something in your GI tract might be wrong are:

• changes to your bathroom habits – either diarrhoea or intense urgency to go to the bathroom; or as a polar opposite, constipation
• abdominal pain
• bloating (distention)
• unexplained weight loss
• fatigue
• increased flatulence
• blood in your stool, which can appear to be a darker or black stool and is therefore sometimes unnoticed

Issues with the GI tend to have delayed diagnoses because these abnormalities are not taken as seriously and may be attributed to diet and external factors, rather than as an indication of your internal condition, and you might try to self-manage the condition. The signs don’t seem to be obvious and might be mistaken as normal, or due to a different health issue, or you might feel embarrassed and choose not to seek assistance. You might blame a really cheesy pizza for an increase in bathroom time, or perhaps the abdominal pain feels similar to menstrual cramps. And though there is a possibility that the reason is as benign as you think, if these symptoms are sustained for several weeks, then a doctor should be consulted as soon as possible.

Screening and diagnosis

The majority of diagnoses for bowel cancer and IBD are via colonoscopy, rectosigmoidoscopy, or CT scans. A biopsy may be further conducted to confirm the results if there are any lingering doubts. These tests help doctors verify if there are any polyps that need to be removed or any damage to the tissue or inflammation in the GI tract.

Screenings help to keep track of your health over time and note any abnormalities. Tests of blood or stool can be done in laboratories and clinics. At-home screening is also possible -- in the UK, people over the age of 60 are invited to be screened for bowel cancer, and every two years are sent test kits to detect blood in the stool.

Benefits of early diagnosis

Treating a disease in an advanced stage is no simple feat. By the time it is diagnosed, it could be at the point where damage is irreversible and the outlook may be fatal. This is why early diagnosis is so important: if the symptoms are noted and reported at an early stage of the disease, the treatment has a higher chance of success in managing it, as well as being less intensive and disruptive.

According to Cancer Research UK, 90 per cent of people with bowel cancer survive for five years or more when diagnosed at the earliest stage, but for those with a later diagnosis, this drops to only 10 per cent. At Stages I and II, the cancer is localised but by Stages III and IV, the cancer will have spread to other tissues and organs, making it much more difficult to treat and eliminate.

Although bowel cancer may be curable, IBD is not, so for these lifelong conditions, it is best to catch them as early as possible so that appropriate medications like anti-inflammatories, corticosteroids, biologics, and immunosuppressants, can be sufficient for the management of the symptoms.

IBDs going untreated can lead to an increase in flare-ups of inflammation and can begin to affect the condition of your skin and bones, and even arthritis

Delayed diagnosis for gastroenterological diseases can mean that medications are ineffective and therefore necessitate surgery. For example, a colectomy, where a part or the whole of the colon is surgically removed, and the patient may need a colostomy bag, possibly for the rest of their life.

If you have concerns regarding your gastrointestinal tract or are exhibiting the above symptoms, Dr Polychronis Pavlidis is available for consultation via his Top Doctors profile.