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We talk to prof. Grażyna Rydzewska – Vice-president of the Polish Society of Gastroenterology.
Professor, abdominal pain, constipation, diarrhea, heartburn are ailments faced by almost all Poles. How do we know when to see a doctor?
Each of us has heartburn, but if it happens at least once a week and repeats itself constantly, we are talking about reflux disease. Therefore, if a patient is constantly taking over-the-counter medications, it is a sure sign that he should see a doctor. It is similar with diarrhea, which each of us had and we can treat it with home remedies, however, if it lasts more than four weeks, it requires medical consultation. Constipation is rarely incidental, usually aggravating slowly and becoming a chronic matter, here patients often make the mistake of reporting to a doctor only when there is no reaction to classic herbal irritants, which we do not recommend as a first-choice treatment.
What diseases do gastroenterologists encounter most often?
In common gastroenterological practice, 10-20 percent. of patients have acid reflux disease, which in milder cases can be treated by GPs. Among other common pathologies associated with excessive secretion of hydrochloric acid is peptic ulcer disease and the well-known need for eradication of Helicobacter pylori. The second numerous group are functional disorders of the digestive tract, the most common of which is irritable bowel syndrome. As many as 1/4 of the Polish society has, has or will have this type of symptoms because it is a set of symptoms that does not have to be constantly present and appears in weaker periods resulting from a change in diet or infection. Irritable bowel syndrome is all that we have already said a bit about, i.e. abdominal pain with disturbed bowel movements. The third important group are people suffering from habitual constipation or other pathologies that occur individually, such as, for example, persistent gas, which more and more people complain about. Of course, gastroenterology is not only that, because you should also remember about gastrointestinal neoplasms, so when diagnosing functional diseases, seemingly harmless to life, we should carefully eliminate patients with the so-called alarm symptoms, i.e. those with a higher risk of serious pathology. Another important group of diseases is malabsorption or inflammatory bowel diseases such as Crohn’s disease and ulcerative colitis, which affect a smaller number of patients.
Why is cancer diagnosed at a rather advanced stage in Poland?
This is rather due to the lack of education, because in Poland there is a screening program in Poland, thanks to which every patient over 50 can be tested for free and virtually without a queue. However, we do much less of these tests than we could, because patients do not come to the tests, and even if the patient signs up and then finds out that it is not a finger blood sample, but a colonoscopy, it often postpones the examination. Public awareness is insufficient in this regard. I know examples from abroad where this system works very well. Patients come to the screening tests themselves, even more often than they should, or it is sent by their employer who wants a healthy employee. We need to see the need for preventive examinations ourselves. It should be remembered that the availability of tests such as gastroscopy, colonoscopy is quite good, we only need to convince patients of the advisability of such a test and encourage them to think about their health.
Are innovative therapies emerging in gastroenterology?
I am the Vice-President of the Prix Galien Competition Jury in which two drugs competed for the main prize this year – gastrological and oncological. “Our” drug, vedolizumab, used in the treatment of patients with ulcerative colitis and Crohn’s disease, is an innovative preparation, as are many oncological drugs. This is an area that he has been dealing with for years and I would like to point out that vedolizumab ensures that our patients will be treated safely, without the side effects of current biological therapy. Therefore, we can talk about the progress in gastroenterology, which in the field of pharmacotherapy mainly concerns non-specific inflammatory bowel diseases and hepatitis. Progress is also in many other areas, less spectacular, such as acid reflux disease where new proton pump inhibitors appear all the time that allow us to treat our patients more effectively.
In Poland, probiotics are advertised quite a lot. How do we know which to choose?
I am very positive about probiotics. I believe that these are very good and very safe preparations that have almost no or very low side effects and can undoubtedly have a beneficial effect in many different disease entities. However, we must remember that the effect of probiotics is strain-dependent, i.e. they only work on selected indications. For this reason, we should rather follow the doctor’s suggestions, because the regulations on over-the-counter preparations are quite liberal and if the preparation is safe, it is often registered without sufficient research. It is definitely better to use preparations with a documented effect and tested, and they are. We have some that work well in flatulence and irritable bowel syndrome, others work well, for example, in constipation and diarrhea. Therefore, of course, I recommend the use of probiotics, but judiciously and carefully considering the strain that is in it.
What are the main problems in gastroenterology?
There are many problems in gastroenterology. Unfortunately, we diagnose late inflammatory bowel diseases, especially Crohn’s disease. It is probably related to the fact that most abdominal symptoms are common symptoms that we all have. Therefore, they are often ignored by patients, but also by doctors for quite a long time, and only when the alarm symptoms begin to appear, we take appropriate action. We must also remember that the progress of science is very big all the time. When I was studying gastroenterology, there was a widespread belief that duodenal ulcer is a disease of directors, stressed people, and then it turned out that it was Helicobacter pylori and we had a tangible cause of the disease. I believe that we still know very little about the proper composition of the microbiome and its impact on various processes in the body and on our well-being, obesity and depression. We have started to look closely at it now, and I think there is great potential and power in modifying this microbiome. There is still a lot ahead of us.
Prof. dr hab. n. med. Grażyna Rydzewska – Head of the Gastroenterology Clinic of CSK MSW in Warsaw, Vice-President of the Polish Society of Gastroenterology
The text comes from the supplement “Zdrowy Brzuch” developed by the Medical Media Solutions publishing house. The project was published on April 7, World Health Day, together with the “Our City” newspaper. We are a partner of the campaign and the publication is available online especially for our readers.