Specialist Service | gutCARE

Specialized Psychologist


September 22, 2018 0

Our specialized psychologist has a clinical interest in integrating effective psychological care to the treatment of digestive disorders.

Functional Gastrointestinal Disorders

Functional gastrointestinal disorders (FGIDs) are disorders with real gastrointestinal symptoms but no physical abnormalities that your gastroenterologist can detect. The most common FGIDs are Irritable Bowel Syndrome (IBS) and Functional Dyspepsia.

There are several reasons why seeing a psychologist can help you:

  • Stress and psychological/emotional distress (such as depression and anxiety) can worsen your gastrointestinal symptoms.
  • Traumatic life experiences such as sexual or physical abuse are associated with an increased prevalence of IBS and other FGIDs.
  • Comorbid psychiatric disorders such as generalized anxiety disorder and major depression are highly prevalent in patients with FGIDs.
  • The brain-gut axis: our brain exerts a powerful influence over gastrointestinal pain perception, motility and secretion. Conversely, gastrointestinal symptoms also impact patients’ mood and stress levels as well as pain perception.

Role of a Psychologist

As gastrointestinal symptoms are closely linked with psychological factors as outlined above, your psychologist can help you to learn to better manage your emotions, process traumatic life experiences, make lifestyle changes, strengthen coping mechanisms and build resilience.

Depending on the patient’s background history and formulation (gathered during the initial assessment phase of treatment), your psychologist will first work with you to find out your therapy goals and collaboratively work out the most suitable psychological treatment plan that is individualized to you.

Eating Disorders

Eating disorders are mental health conditions that are characterized by extreme variations from safe and healthy eating habits. Eating extremely small amounts of food, severely overeating, or excessive purging may be signs of an eating disorder. The three most common types of eating disorders are:

  • Anorexia Nervosa
  • Bulimia Nervosa
  • Binge-Eating Disorder.

Eating disorders are serious, complex, and potentially life-threatening conditions that affect a person’s physical and emotional health, productivity and relationships.

Some known impacts on the gastrointestinal system:

  • Heartburn or bloating
  • Nausea and Vomiting
  • Significant nutritional deficiency
  • Slowed digestion (also known as gastroparesis)
  • IBS and constipation
  • Binge eating can cause acute gastric dilatation and gastric perforation (rupture), which is potentially life-threatening.
  • Frequent vomiting (purging) can wear down the esophagus and cause it to rupture, creating a life-threatening emergency.

Role of a Psychologist

Psychological factors, such as depression, anxiety, low self-esteem, negative body image, feelings of inadequacy, or lack of control in life, can contribute to the development, maintenance and/or worsening of eating disorders. Your psychologist can help you identify and work through these challenges and develop healthier eating habits.

View our psychologist profile here –>


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June 25, 2018

Fibroscan is a quantum leap in liver health assessment. It measures the stiffness of your liver and helps estimates the amount of scarring in your liver. Fibroscan is non-invasive, quick and painless. The information it provides is different from ultrasound scan and gives you and your doctor a far more complete assessment of your liver health. Simply put, and ultrasound is utilized more for cancer screening, whereas Fibroscan assesses whether you have developed liver fibrosis or scarring and whether you may need to start treatment for your liver disease such as hepatitis B, C or fatty liver disease. A normal liver should have a low median liver stiffness measurement (LSM). The higher your LSM, the more likely you have severe liver fibrosis or cirrhosis.

gutCARE is one of only a few centers in Singapore that utilizes and has experience using both the M probe and the XL probe to more accurately assess patients with different body mass indices.

Are There Any Special Precautions?

It will be can be carried out during an outpatient clinic appointment or during your inpatient hospital admission. Fibroscan is not recommended if have an implantable device, such as a pacemaker or defibrillator or have ascites (Fluid within the abdomen). However, Fibroscan is safe in pregnancy. Please speak to your doctor or our staff if you think this applies to you.

What Do I Need To Do To Prepare For The Scan?

Please do not eat or drink anything for two hours before your fibroscan. Sips of water are permitted. Please continue taking any prescribed medication as you would normally. You will not need to remove your clothing for the scan, but we will need to expose the right side of your abdomen (tummy). Therefore, we encourage women not to wear a dress on the day of the test.

What Happens During The Scan?

You will be asked to lie on an examination couch and place your right arm above your head. A probe will be placed on your abdominal wall and a vibration wave will be emitted from the probe in pulses. At least 10 readings will be taken to ensure we get an accurate result. The median liver stiffness measurement reading is then calculated by Fibroscan. The scan should take between 5 to 10 minutes to perform and you can return home or to work
immediately.

When Will I Get The Result?

The results are immediate but your referring doctor will need to discuss the results with you at your next outpatient appointment with them. Remember Fibroscan is only one part of your liver assessment and the results need to be considered in the context of your clinical situation.


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June 25, 2018

Most people will experience reflux at various points of their lives. There are cases of severe reflux which may affect the lining of the esophagus and cause symptoms like difficulty swallowing, heartburn, chest pain and regurgitation.

The reflux study involves a reflux and motility (movement) study of your esophagus (swallowing tube that transports food from your mouth to your stomach). it is a diagnostic test to determine if you have Gastro-Esophageal Reflux Disease (GERD) or to identify the cause of various gastrointestinal symptoms present.

The purpose of this study is to check if you have any reflux, and to see if there is a link between your symptoms and reflux. It will also measure the amount of acid that flows from the stomach and into the esophagus during a 24-hour period.

The study involves 2 parts:

Firstly, a small thin tube, that measures pressures, will be placed through your nose into your esophagus. You will then be made to swallow a few sips of water while pressure and distance recordings are taken. The tube will then be removed.

Secondly, a thin wire, that has sensors to measure both reflux and acidity, is passed down the same pathway into the esophagus based on the pressure measurements taken. Afterwards, it is secured with a bit of tape to your nostril and attached to a small handphone-sized device. This wire is left in place for 24hrs to record reflux. You will return the next day to have the device removed.

Many people are worried if this study will affect their daily lives. In fact, once the wire and recorder are inserted, you are advised to carry out your daily routine as per normal, with NO dietary restrictions. The only restrictions are no swimming is allowed, as the data recorder cannot be wetted; and not to go near an MRI machine.

There is minimal risk, and the process is the same as inserting a small thin feeding tube. It will not interfere with eating, drinking or swallowing in any way.

Is there any preparation for the study?

  1. No strong acid suppressants (proton pump inhibitors) 10-14 days before the study, unless otherwise advised by your doctor
  2. No food or drink for 6 hours before the study
  3. No prokinetic medication the day before and on the day of the study (ask your doctor if you’re not sure)

Being properly prepared for the reflex study helps to ensure accurate results and reduce factors that may affect the study. Reflux study is performed at our gutCARE Alvernia clinic by our neurogastromotility specialist. During the study period, you can record down your primary symptoms, the times you are eating and drinking, and when you are lying down (either sleeping or napping).You will need to return the next day to have the recorder removed, and the data downloaded and analysed. The report will be set to your specialist within the next week, where he will discuss with you on your test result and advise on the next course of action suitable for you to help you overcome your esophageal symptoms.


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June 25, 2018

Esophageal manometry is a motility (movement) study of your esophagus (or food pipe), which is a long muscular tube that connects the throat to the stomach. The lower oesophageal sphincter (LOS) lies at the lower end of the esophagus which meets the stomach, and helps to prevent stomach contents like acid from backing up into the food pipe (referred to as acid reflux).

This test can be useful to help diagnose certain health conditions or disorders that is related to the esophagus, such as achalasia, scleroderma or diffuse esophageal spasm. It can also be conducted prior to surgery for reflux disorders and in evaluations of patients with chest pain not associated with heart disease.

The purpose of this test is to check if the muscles and nerves in your esophagus are working well and measures the muscle contractions that occur in the esophagus when you swallow. It also measures the coordination or force of your esophageal muscles food that moves food along into the stomach. Overall, it helps to evaluate how well your esophagus is performing.

During this procedure, a local anaesthetic is sprayed to your nose and throat to numb the nasal area. A small thin tube will be inserted through your nose into your esophagus. This tube contains special tiny pressure sensors and will accurately measure the movement and contraction of the esophagus in real-time. Once it is in place, you may be asked to remain seated or lie your back on an exam table. You will then be made to swallow a few sips of salt water while pressure recordings are taken to check your swallowing function, the strength, pressure and pattern of your esophageal muscle contractions. The tube is slowly withdrawn once the test is done, which lasts about 30 minutes.

There is minimal risk to this procedure, and the process is the same as inserting a feeding tube. Except that in this case it will be removed once the study is done. You may experience some discomfort and slight soreness during the test, in your nose and throat as well as watery eyes.

Is there any preparation for the test?

  1. Avoid eating and drinking for 6 hours before your appointment time
  2. You may be asked not to take certain medications the day before and on the day of the test. Please check if your doctor regarding any medications you are taking so it will not affect and influence the test results

You may resume your normal daily activities after the esophageal manometry is complete.

The test is performed at our gutCARE Alvernia clinic by our neurogastromotility specialist. The results of the esophageal manometry can be received in one to two days, which can be a part of a pre-operative evaluation or to identify the cause of your esophageal symptoms. At the next follow-up appointment, your specialist will discuss the results of your test and provide recommendations or advice on the best way forward depending on your medical needs.


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June 25, 2018

Constipation can be caused by a number of different factors such as dietary intake and lifestyle habits such as lack of fiber and liquid in diet, and lack of regular exercise. When there is excess water absorption in the colon or large intestine, and food moves too slowly through the colon, it results in hard and dry stool or constipation.

Other medical conditions may also be behind constipation including the use of certain medications, too much laxatives, and irritable bowel disease. While most experience the occasional constipation, there are some who suffer from severe or chronic constipation. Besides conducting a physical examination, your doctor may carry out other diagnostic tools and tests to diagnose problems in the colon. Your doctor will also need to be informed of your medical history to learn possible factors that may contribute to your constipation problem. These include changes in stool, duration of symptoms, frequency of bowel movement and any recent unexplained weight loss.

The colon transit study is a motility (movement) study of your colon (large intestines).

The purpose of this study is to check if the movement of faeces (stool) through your colon is normal or slow and assess the function of your bowel. This will guide the specialist in deciding on the type of appropriate treatment for your constipation.

You will have to swallow a small pill/capsule, which contains 24 small plastic rings inside or small ‘markers’ which are visible on X-ray.

After 5 days, you will have to come back for a simple X-ray of your abdomen, which are able to detect how many of the rings are retained and their movement through the colon. Depending on where they are distributed, the markers are also monitored to determine the transit time they take to pass through the colon. Markers concentrated in a single area in the colon may hint to a blockage, while markers scattered throughout the colon may suggested a delay in gut transit.

There are no risks from swallowing the capsule, as the ring markers are made of harmless inert medical grade plastic, and they will all get passed out of the body.

All X-rays involve a very low dose of radiation, therefore if you are pregnant or suspect you might be pregnant, you cannot undergo this study.

Is there any preparation for the study?

  1. NO laxatives, suppositories, enemas or herbal preparations during the 6 days of the study.
  2. NO prokinetic drugs eg. Motilium, Reselor during the 6 days of the study.
  3. Eat and drink normally during the study.

Where do I report for the study?

  1. Head to the gutCARE clinic to see the specialist before you begin the study and consume the capsule
  2. Report for the X-ray (5 days later) KUB at the designated X-ray centre

The X-ray images and report will then be set to your specialist within the next week, and he will review the test results discuss with you on a follow-up appointment regarding the best way forward in helping you overcome your constipation.


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June 25, 2018

Mention tests for gut disorders, and endoscopy, blood and stool assays spring to mind. But what’s bubbling in your gut now offers potentially new insights into common disorders of the gastrointestinal tract – hence the field of Hydrogen-Methane Breath Testing. It can help to diagnose several conditions that cause gastrointestinal symptoms and certain digestive problems.

The wide range of sugars ingested everyday, such as fructose, lactose, sucrose or sorbitol are absorbed within the small bowel. For some people, these sugars are absorbed poorly by the body and the sugars are passed into the colon. Fermentation of incompletely absorbed sugars within the colon may lead to a number of gastrointestinal symptoms like excessive wind, bloating, diarrhoea and abdominal pain.

What is being measured in Breath Testing?

Breath testing involves measuring the amount of gases produced inside the small intestines of the gut, following the administration of a test substrate. Hence, the idea of alveolar gas sampling. The concept being that gases produced in the gut diffuses into the blood stream, and then out again through the alveoli in the lungs into the exhaled air, where it can be easily collected and measured.

The gases of interest are Hydrogen and Methane. These are produced by the microbes in our gut, as a metabolic product of carbohydrate fermentation in the intestine. By manipulating the “food” (otherwise known as a substrate) they receive, we can measure different functions of the gut – currently the two with clinical applicability are Small Intestinal Bacterial Over Growth (SIBO) and FODMAP Intolerances. When these gases are detected in the breath, it provides information to learn more on your digestive health. Such examples are, if you are intolerant to or are unable to digest certain sugars, or there is abnormal growth of bacteria within the small bowel.

How does Breath Testing works?

When ingested sugars are not completely absorbed, bacteria within the large bowel produce hydrogen and/or methane gas that will be detected in the breath test. The poor absorption of an orally ingested sugar is indicated by amounts larger than normal and above baseline levels of exhaled hydrogen or methane in your breath.

It is a simple, non-invasive test which involves patients to drink a sugar drink before taking a baseline breath sample at regular intervals for 2-3 hours depending on the type of test. For example, samples are taken at 20min intervals for SIBO and 60mins for Lactose. The levels of hydrogen and methane are sequentially tracked and plotted by our Neurogastromotility specialist to measure the levels of hydrogen and methane present in the breath.

The results are available within 2-3 days. Your doctor will be able to evaluate conditions such as lactose intolerance or other digestive disorders and present effective treatment options as well as personalised recommendations for your digestive health. Breath testing is available at gutCARE clinic, which can be taken as part of a useful investigation and management of your gut condition. Book your appointment with us and talk to one of our highly trained gastroenterology specialists regarding your health.

 


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June 25, 2018

Specialized Dietitian

Specialized dietitian has an interest in the role of food in improving your gut health.  They are very helpful for a number of digestive conditions:

Irritable Bowel Syndrome

Your dietitian can help you identify possible food triggers for your gut symptoms.

For those with persistent and troublesome symptoms, Modifying FODMAP intake is a highly effective approach for irritable bowel syndrome and other functional bowel disorders (bloating, wind, pain). This approach can help give people control over their symptoms rather than the symptoms controlling them.

FODMAP is an acronym for the group of sugars that are poorly absorbed by our digestive tracts:
Fermentable
Oligo-saccharides (fructans and galacto oligosaccharides/ GOS)
Di-saccharides (lactose – milk sugar)
Mono-saccharides (excess fructose)
And
Polyols (eg sorbitol, mannitol)

FODMAPs can be poorly absorbed in the gut and are then fermented by our gut bacteria to produce gas, and cause more water to pass through the bowel. In people with IBS this can trigger symptoms such as bloating, pain, and diarrhoea.


The low FODMAP diet can seem quite complex and confusing, therefore advice is best provided by a dietitian who has received training in this area and can easily explain the diet.  They can also ensure that your diet is nutritionally balanced.

The first phase is the low FODMAP diet which restricts these sugars for 2-6 weeks. The second phase is to re-challenge with some of the high FODMAP foods. Once you have identified the major triggers the third phase is to move to a long term modified FODMAP diet which allows symptom control.

Two or three appointments are usually required to complete this process.

Coeliac Disease

Coeliac disease is an auto-immune condition caused by a reaction to gluten found in wheat, rye and barley. Damage to the bowel lining occurs and the body can’t absorb nutrients from food properly. The only treatment is a careful gluten free diet. Your dietitian can help you to make the necessary changes to your diet and lifestyle whilst making sure your diet is nutritionally adequate.

Inflammatory Bowel Disease

You may have questions about what diet is best for IBD. Your dietitian can help to identify potential triggers and at the same time ensure your diet is balanced and will help your gut heal.

Fatty liver

Your dietitian can help you to optimise the balance of your diet to improve fatty liver.

Being overweight can result in excess fat being stored in the liver, achieving a healthy weight and being active regularly can help.

View our Dietician profile here –> 


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