Frequently asked questions

Occasional bloating is common. But bloating that is constant or steadily increasing can be related to diet, constipation, lactose intolerance, irritable bowel syndrome and other digestive problems.

Not always. Gas forming in the bowel is normal; but a marked increase can be related to eating habits, swallowing air, the digestion of certain carbohydrates, constipation or bowel disease.

One of the important causes of frequent belching is swallowing too much air. Reflux and some stomach complaints can accompany it; but belching alone does not indicate serious stomach disease.

Yes. Routine tests can be normal in disorders of gut–brain interaction such as IBS and functional dyspepsia. Even so, the necessary assessment should be made according to the patient's characteristics before these diagnoses are given.

No. Burning in the stomach or chest area can be related to reflux, but it has other causes too. Complaints that are new, or that come with other alarm symptoms, should be assessed.

Functional dyspepsia, delayed gastric emptying and certain eating habits can cause this complaint. The cause should be investigated where the complaints are persistent or marked.

This is called early satiety. It can be seen with causes such as functional dyspepsia or gastroparesis; early satiety that is new, persistent, or accompanied by weight loss should be assessed.

Recurrent difficulty swallowing should not be accepted as normal. It can have various causes, such as narrowing, inflammation or a motility disorder in the oesophagus, and gastroenterological assessment may be needed.

No. If you cannot even swallow your saliva there may be complete obstruction of the oesophagus, and emergency medical assessment is needed.

It could be, but reflux is not the only cause. Pain during swallowing is called odynophagia and can be related to inflammation or infection in the oesophagus, or to other conditions.

Nausea has a great many causes, from diseases of the stomach and bowel to medicines and metabolic and neurological causes. The cause of persistent or recurrent nausea should be investigated.

Recurrent or long-standing vomiting should be assessed. Where there is vomiting of blood, severe abdominal pain, marked fluid loss, weight loss or a deterioration in general condition, medical help should be sought without delay.

No. Vomiting blood is not normal. It can be a sign of significant bleeding from the stomach or oesophagus and requires emergency medical assessment.

Black, tarry, foul-smelling stool can be a sign of bleeding from the upper digestive system. Iron and certain medicines can also darken the stool; but unexplained black stools should be assessed without delay.

It could be, but not every bleed from the back passage should be put down to haemorrhoids. Other causes such as anal fissure, polyps, inflammatory bowel disease and colorectal conditions can also be present.

A large proportion of short-lived diarrhoea settles on its own. But it should be assessed if the diarrhoea is prolonged, if it is bloody, or if symptoms such as fever, severe pain, fluid loss or weight loss accompany it.

It could be, but IBS is not the only cause of chronic diarrhoea. Causes such as coeliac disease, inflammatory bowel disease, infections, medicines and malabsorption can also be investigated.

Bowel frequency varies from person to person. Opening the bowels fewer than three times a week is one of the criteria for constipation; hard stool, excessive straining and the sense of not emptying fully also matter.

Constipation has many benign causes and cancer is not involved in most people. But assessment is needed particularly where there is a newly developed change in bowel habit, blood in the stool, anaemia or weight loss.

Thin stools alone do not establish a diagnosis of colon cancer. But newly developed and persistent changes in bowel habit should be investigated, particularly if they come with bleeding, iron deficiency or weight loss.

This can be related to steatorrhoea — passing more fat than normal in the stool. Pancreatic enzyme insufficiency, diseases of the small intestine and problems with bile flow can be among the causes.

No. Stool can float because of the gas it contains. In assessing steatorrhoea it is not only floating that is taken into account, but the greasy appearance, the volume and the smell of the stool and any other accompanying symptoms.

Yes. Malabsorption, chronic inflammatory diseases and other gastrointestinal conditions can cause unintentional weight loss. Unexplained weight loss is a finding that needs to be investigated.

Yes. Blood loss from the gastrointestinal system that is very small in quantity and goes on for a long time may not be visible. Gastrointestinal causes should be assessed particularly in iron deficiency anaemia with no explanation.

New or steadily increasing difficulty swallowing, vomiting blood, black stools, blood in the stool, unexplained weight loss, iron deficiency anaemia, persistent vomiting and a marked change in bowel habit are findings that particularly need to be assessed.

Emergency medical assessment may be needed in situations such as severe bleeding, being unable to swallow even saliva, fainting, altered consciousness, or severe abdominal pain of recent onset.

This can appear sometimes immediately after stomach operations and sometimes years later: dumping syndrome. You should consult your doctor about it.

Reflux is stomach contents passing back up into the oesophagus. It happens from time to time in healthy people too; when it is frequent, causes troublesome complaints, or damages the oesophagus, we speak of gastro-oesophageal reflux disease.

Burning behind the breastbone and bitter or sour fluid coming up into the mouth are the most typical. Some people also have chest pain, belching or throat complaints.

Yes. Not every patient with reflux has the typical burning complaint. But it should not be forgotten that throat, cough and voice complaints can have many other causes too.

Yes. Pain arising from the oesophagus can sometimes resemble cardiac pain. Chest pain that is new or severe should not be assumed to be non-cardiac; emergency assessment should be carried out where needed.

Reflux can contribute to a chronic cough in some patients. But a long-standing cough has many other causes, including the lungs, the ear, nose and throat, and certain medicines.

Reflux can be associated with voice and throat complaints in some people. But it is not right to attribute persistent hoarseness automatically to reflux; other causes should also be assessed.

This complaint may be called globus sensation. It can be related to reflux, to problems in the throat area and to other causes; distinguishing it from genuine difficulty swallowing matters.

In some patients, repeated contact with stomach contents can lead to inflammation and erosions in the oesophagus — reflux oesophagitis. But not every patient with reflux develops damage to the oesophagus.

Reflux itself does not directly "turn into cancer". Some people with long-standing reflux can develop Barrett's oesophagus, and Barrett's oesophagus raises the risk of a particular type of oesophageal cancer; even so, the great majority of people with Barrett's do not develop cancer.

It is the replacement of the normal cells in the lower part of the oesophagus by cells of the intestinal type. It is usually associated with long-standing reflux, and endoscopic follow-up may be needed in suitable patients.

No. Barrett's oesophagus is not cancer. But because it is a condition that can raise the risk of cancer developing, it is followed up according to the patient's characteristics.

Oesophagitis shows that there is inflammation or damage in the lining of the oesophagus. Reflux is one of the common causes, but there can be others such as medicines, eosinophilic oesophagitis and infections.

No. Not every patient with typical reflux complaints necessarily needs an endoscopy. Endoscopy becomes more important where there are alarm findings such as difficulty swallowing, bleeding or unexplained weight loss, or other clinical reasons.

Yes. A proportion of patients with reflux have no visible oesophageal damage at endoscopy. Other tests such as pH monitoring can be used to assess reflux where needed.

It is done to measure the oesophagus's exposure to acid over a set period. It can be used particularly where the diagnosis of reflux is not clear, or where the relationship between the complaints and reflux is being investigated.

It is a test that can assess not only whether what refluxes back into the oesophagus is acid, but also reflux events in liquid and gaseous form. It can also give information about the timing relationship between symptoms and reflux events.

No. A hiatus hernia is displacement of part of the stomach upwards through the opening in the diaphragm. It can make reflux more likely to develop, but not everyone with a hiatus hernia has reflux complaints.

No. The great majority of hiatus hernias do not automatically require surgery. The type and size of the hernia, the complaints it causes and any complications all matter in the treatment decision.

There is no such rule for every patient. The duration of treatment is decided according to the severity of the disease, damage to the oesophagus, complications and whether the complaints recur.

Proton pump inhibitors are effective medicines in widespread use for the right indication. Unnecessary and unsupervised long-term use should be avoided; the need for long-term treatment should be assessed patient by patient.

There is no long list of prohibitions that applies to everyone. Reducing the foods that clearly make the complaint worse for that person, and avoiding large and late meals, is a more individualised approach.

Not eating in the few hours before going to bed, and raising the head of the bed in suitable patients, can help. If there is excess weight, losing weight can also reduce reflux complaints.

In difficulty swallowing arising from the oesophagus, endoscopy is one of the important first investigations in most patients. A barium swallow or manometry may also be needed, depending on the features of the patient's complaint.

Difficulty swallowing that begins particularly with solid food can suggest the possibility of a mechanical narrowing in the oesophagus. Assessment is needed, because the precise cause cannot be established from this symptom alone.

It could be. In achalasia and other disorders of oesophageal movement, difficulty swallowing can be seen with both solid and liquid food. Endoscopy, a barium swallow and, in particular, high-resolution oesophageal manometry can be used in the diagnosis.

Note: it matters that findings such as new or steadily increasing difficulty swallowing, unintentional weight loss, gastrointestinal bleeding or persistent vomiting are assessed rather than being attributed to reflux alone.

A hiatal hernia (stomach hernia) is the sliding of part of the stomach up into the chest cavity, where it should not normally be. It is usually seen in overweight and older people. Belching and reflux complaints are common in these patients. Treatment may be medical or surgical.

It is painful swallowing, arising most often from viruses, from caustic substances swallowed by accident or with intent to self-harm, and from the local effect of medicines on the oesophagus.

You may be asked to have this test if there is a disturbance in the smooth working of your oesophagus and difficulty swallowing because of it, or if surgery for reflux is being considered for you. The test measures the pressures in the oesophagus and gives information about whether it is working properly.

Gastritis is inflammation in the lining of the stomach. Not every stomach ache, burning or indigestion means gastritis; a definite assessment can sometimes require endoscopy and biopsy.

Helicobacter pylori, certain medicines and autoimmune processes are among the important causes. The cause and type of gastritis vary from patient to patient.

The great majority of gastritis is not cancer and does not turn into cancer. But certain situations — particularly long-standing atrophic gastritis and intestinal metaplasia associated with H. pylori — can raise the risk of stomach cancer.

A biopsy may not always be necessary every time gastritis is seen. But biopsies can be taken in suitable patients to assess H. pylori, atrophy, intestinal metaplasia or other conditions.

No. A biopsy at endoscopy is not taken only to look for cancer. Biopsies can be done to assess gastritis, H. pylori, coeliac disease, eosinophilic conditions and many other situations.

Helicobacter pylori (H. pylori) is a bacterium that can live in the lining of the stomach. It is one of the important causes of chronic gastritis and peptic ulcer, and it can raise the risk of certain stomach conditions.

Transmission is thought to occur mostly in childhood. Spread by the oral–oral or faecal–oral route is likely; hygiene and living conditions can play a part in transmission.

No. A substantial proportion of people with the infection may have no marked complaint.

When an active H. pylori infection is found, the current approach is to give eradication treatment in suitable patients. The treatment used is chosen according to antibiotic resistance, antibiotics used previously and the person's own characteristics.

More than one antibiotic — and, in some regimens, bismuth — is generally used alongside acid-suppressing treatment so that the bacterium can be eliminated completely. A single antibiotic is not enough and can encourage resistance to develop.

Yes. Having been given treatment does not necessarily mean the bacterium has been eliminated. Eradication needs to be confirmed at the right time with a urea breath test, a stool antigen test, or in some situations biopsy-based methods.

Generally no. Tests done too early can give a falsely negative result. The timing of the check test, and how long certain medicines should be stopped beforehand, should be decided by the doctor.

Generally no. Because antibodies can remain positive for a long time after the bacterium has been eliminated, a blood antibody test is not suitable for confirming eradication.

H. pylori is one of the important risk factors for stomach cancer. But the great majority of people with the infection do not develop stomach cancer.

The need to test adult family members living in the same house can be assessed according to the person's characteristics and current recommendations. Assessment by a doctor matters particularly where there is a risk of stomach cancer or other clinical reasons.

No. Gastritis means inflammation in the lining of the stomach; an ulcer is a loss of tissue extending more deeply into the lining.

Among the most important causes are H. pylori infection and aspirin and certain painkillers (NSAIDs). There are other, rarer causes as well.

It is an ulcer developing in the duodenum, the part of the small intestine after the stomach. H. pylori is one of its important causes.

Yes. Peptic ulcer is one of the important causes of gastrointestinal bleeding. Vomiting blood, vomiting that resembles coffee grounds, or black tarry stools can be seen.

Yes — rarely, an ulcer can lead to complete perforation of the wall of the stomach or duodenum. Very severe abdominal pain of sudden onset can be a sign of this and requires emergency assessment.

Some stomach cancers can look like an ulcer at endoscopy. It therefore matters that biopsies are taken from suitable stomach ulcers and that healing is checked endoscopically where needed.

The likelihood of a typical duodenal ulcer being malignant is very low. They are not assessed in the same way as stomach ulcers in this respect.

Aspirin and certain painkillers in the NSAID group can damage the lining of the stomach and duodenum and raise the risk of ulcer and bleeding. The risk varies with age, dose, duration of use and other medicines taken alongside them.

No. There are different types of stomach polyp and a substantial proportion are benign. The type, size and number of the polyp and the pathology result determine the decision on follow-up or treatment.

No. Intestinal metaplasia is not cancer. But it can be associated with certain situations in which the risk of stomach cancer developing is raised. The need for follow-up is decided according to how extensive it is, H. pylori status, family history and other risk factors.

Note: the severity of stomach complaints and the seriousness of the disease do not always run in parallel. Assessment should not be delayed where there are findings such as gastrointestinal bleeding, unexplained weight loss, recurrent vomiting, difficulty swallowing or iron deficiency anaemia.

This is a mistaken idea that has been around a very long time. Whatever you eat and whatever you do, an ulcer will develop if it is going to. Once one has developed, spicy food can add to your complaints. Ulcers develop most often after the bacterium called H. pylori, or after the drugs called NSAIDs that are used for rheumatic pain, and very rarely after extreme stress, both physical and psychological.

H. pylori (HP) is one of the commonest causes of ulcer and gastritis. The most accurate diagnosis is made on a biopsy taken at endoscopy — the gold standard. A blood test cannot distinguish an ongoing infection from one that has been treated and has passed. A stool test is somewhat more valuable than a blood test for accuracy of diagnosis (HPSA in stool). The urea breath test (INFAI test), which shows HP in the breath, is more valuable in diagnosis than the stool HPSA test. HP converts the substance called urea into ammonia, and the ammonia passes from the stomach into the blood and then, by way of the lungs and respiration, into the breath; the test rests on the principle of showing ammonia in the breath. After treatment for HP, the stool test should be done two months later and the breath test one month later.

Yes. This bacterium can sometimes be resistant to the antibiotics used. New treatment regimens have been developed for that. Today anti-HP treatment should normally run for at least ten days and use two antibiotics. Resistance by this bacterium to the drugs used against HP — failure to respond to them — is becoming more frequent. Consult your doctor about it.

IBS is a disorder of gut–brain interaction in which recurrent abdominal pain is related to opening the bowels and to changes in bowel habit. Diarrhoea, constipation or both together can be seen.

No. IBS is not a precancerous condition and does not turn into colon cancer. But newly appearing alarm findings should not be attributed automatically to IBS.

IBS is a chronic condition that can flare from time to time. The severity of the symptoms can lessen, increase, or disappear for long periods.

In IBS no structural disease may be seen on routine endoscopy or imaging; but there can be functional changes in bowel movement, in sensitivity and in gut–brain communication. The symptoms the patient experiences are therefore real.

Yes. Because there is two-way communication between the gut and the brain, stress can increase abdominal pain, diarrhoea or other IBS complaints in some people. But IBS is not simply a "disease of stress".

No. Not every patient with IBS needs a colonoscopy. The decision is made according to age, symptoms, family history, bleeding, anaemia, weight loss and other risk factors.

Coeliac disease is an immune system disease triggered by gluten in people with a genetic predisposition. It can damage the lining of the small intestine and impair the absorption of nutrients.

No. Bloating and diarrhoea can occur, but it can also present with iron deficiency anaemia, bone loss or other findings. Some patients have no marked bowel complaint at all.

Generally no. Cutting out gluten before the coeliac tests are done can make the blood tests and the biopsy falsely negative. If coeliac disease is suspected, the proper assessment should be done first.

Yes. In people with a genetic predisposition, coeliac disease can be diagnosed in adulthood and at older ages as well as in childhood.

The mainstay of treatment is a strict gluten-free diet for life. Following the diet correctly, and assessing any nutritional deficiencies, both matter.

Generally no. There is no rule that everyone should eat gluten-free where coeliac disease, or a specific gluten-related problem, has not been demonstrated.

No. Lactose intolerance concerns the digestion of milk sugar; milk allergy is an immune system reaction against milk proteins.

Not exactly. Lactose malabsorption is lactose not being adequately digested and absorbed; lactose intolerance is the appearance of related symptoms after consuming lactose.

Not always. The amount of lactose tolerated varies from person to person, and some dairy products can be tolerated better than others. Unnecessary restrictions can reduce the intake of calcium and other nutrients.

Antibiotics can cause diarrhoea by affecting the gut microbiota. But infections such as C. difficile should be assessed, particularly where the diarrhoea is severe, long-lasting, or accompanied by fever and abdominal pain.

Some probiotics can be of benefit in particular situations, but not all probiotics are the same and they do not help every patient. The product, the bacterial strain and the purpose of use all matter.

The common claim that constipation causes "toxins to build up" in the body is not scientifically correct. But chronic constipation can affect quality of life and should be properly assessed and treated.

No. Normal bowel frequency varies from person to person. In assessing constipation, it is not only frequency that matters but also features such as how hard the stool is, straining, and the sense of not emptying fully.

Not all constipation medicines are the same. Some appropriately chosen treatments can be used long-term; but rather than someone taking laxatives continuously on their own and unsupervised, the cause of the constipation and the right treatment should be established.

Crohn's disease is a chronic inflammatory bowel disease that can affect any part of the digestive system from the mouth to the anus. The last part of the small intestine and the colon are affected most often.

Ulcerative colitis is a chronic inflammatory bowel disease that begins in the rectum and affects a varying length of the large bowel. Bloody diarrhoea is one of its important symptoms.

No. Both are in the inflammatory bowel disease group, but the parts of the bowel they affect, the depth of the inflammation and the complications they can cause are different.

The disease itself does not directly turn into cancer. But the risk of colorectal cancer can rise in inflammatory bowel disease that affects the colon extensively and over a long period; regular colonoscopic follow-up is therefore carried out at the appropriate time.

No. Faecal calprotectin is a test that can show inflammation in the bowel, but it is not specific to any particular disease. It can be raised in inflammatory bowel disease, in some infections and in other situations; on its own it does not establish a diagnosis of cancer.

Note: assessment should not be delayed where long-standing diarrhoea or constipation is accompanied by blood in the stool, unintentional weight loss, iron deficiency anaemia, marked complaints that wake the person at night, or a family history of significant gastrointestinal disease.

The wall of the bowel is nourished by the blood its vessels carry. If the amount of that blood falls or the circulation slows, mesenteric ischaemia develops. It is generally seen in older people, with abdominal pain coming on after meals. If the disease progresses, necrosis of the bowel develops.

It is a disease picture produced by a microscopic parasite, which can cause bloody, cramping and long-lasting diarrhoea. The parasite settles into the wall of the bowel and inside its cells, protecting itself from the effects of antibiotics. It is seen frequently in Türkiye. It often settles as a secondary infection in the inflammatory bowel disease called ulcerative colitis.

Yes. The tuberculosis bacterium can settle, usually in the last part of the small intestine called the ileum and sometimes in the large bowel, and cause findings such as weight loss, abdominal pain and bleeding from the bowel. In a patient with a lung infection the tuberculosis germ can reach and settle there by the swallowing of sputum, by passing into the blood and travelling to the intestines, or directly, with infected food taken by mouth.

A projection of tissue growing from the inner surface of the colon is called a polyp. There are different types of polyp, and not every polyp is cancer.

No. Most colon polyps are not cancer. But certain adenomatous and serrated polyps in particular can carry the potential to turn into cancer over time.

Some colon cancers can develop from particular polyps over the years. Removing suitable polyps during colonoscopy therefore helps to prevent colorectal cancer from developing.

Most small and suitable polyps can be removed during the same colonoscopy. For polyps that are large, awkwardly placed or have particular features, advanced endoscopic methods or a separate procedure may be planned.

Because the lining of the colon does not perceive pain the way skin does, cutting the polyp generally causes no additional pain. Colonoscopy can also be carried out under sedation or anaesthesia in most centres.

It is examined under the microscope to determine what type of polyp it is, whether it contains precancerous change, and, rarely, whether it contains cancer.

No. An adenoma is not cancer, but some adenomas can carry precancerous features. It therefore matters that they are removed and followed up according to their characteristics.

A tubular adenoma is a common type of adenomatous polyp in the colon. It is not cancer, but it is generally removed completely because of its precancerous potential.

These structural features are taken into account in assessing the risk of the polyp. The timing of the next colonoscopy is decided together with other features such as the size and number of the polyps and the degree of dysplasia.

It is a colonic lesion, most often flat or slightly raised, seen particularly in the right colon. Because it can be a precursor in the development of some colorectal cancers, removing it properly and following it up both matter.

No. Dysplasia is not the same thing as cancer. It means abnormal changes in the cells that may be precancerous; whether it is low or high grade, and the tissue it is found in, determine its clinical significance.

Even where a polyp removed previously was taken away completely, new polyps can develop over time in another part of the colon. Some patients are therefore advised to have a check colonoscopy.

The same interval does not apply to everyone. The timing of follow-up is decided according to features such as the number, size and pathological type of the polyps, how they were removed, and the quality of the colonoscopy.

Not every polyp creates the same risk for family members. The screening plan is decided individually, assessing whether the polyp had advanced features, the degree of relationship and the age at diagnosis.

A substantial proportion of colorectal cancers can be prevented, or detected at an early stage, with appropriate screening. Finding and removing precancerous polyps during colonoscopy matters in this respect.

Yes. The very purpose of screening is to detect precancerous lesions or early cancer before any complaint has appeared. The age at which screening starts, and the method used, are decided according to the person's risk.

Age is an important risk factor, but colorectal cancer can also occur in younger adults. Alarm symptoms should therefore not be disregarded on the basis of age alone.

Colorectal cancer in first-degree relatives in particular can raise the risk. The age at which the relative was diagnosed, and the number of affected family members, can affect when screening should begin.

Blood in the stool, a new and persistent change in bowel habit, iron deficiency anaemia, abdominal pain and unintentional weight loss can all occur. But there may be no symptoms at all at an early stage.

Yes — chronic, invisible gastrointestinal blood loss in particular can lead to iron deficiency anaemia. But iron deficiency has a great many other causes; on its own it does not mean cancer.

No. A positive test shows that blood has been detected in the stool; it can arise from a polyp, from cancer or from other causes. A positive result should be assessed appropriately, most often with colonoscopy.

No. A good-quality, complete colonoscopy that is normal reduces the risk in the following years considerably, but it does not eliminate it for life. Screening may be needed again in future according to the person's risk.

Diverticula are small pouch-like formations developing outwards from the wall of the large bowel in particular. They become more common with age, and in most people they cause no problem at all.

No. Diverticulosis is the presence of diverticula; diverticulitis is inflammation of one or more of those pouches.

Antibiotics are not automatically needed in every patient. In some mild, uncomplicated cases an approach without antibiotics can be considered, according to the patient's general condition and risk factors; treatment should be decided individually.

Note: colorectal cancer may give no symptoms at all in its early stages. Screening and the diagnostic assessment of a patient who has a complaint are therefore two different things. Where there is blood in the stool, unexplained iron deficiency anaemia, unintentional weight loss or a newly developed and persistent change in bowel habit, it is not right simply to wait for the routine screening date.

A haemorrhoid is the knotting and packeting of the veins carrying used blood in the back passage (rectum) — inside it, outside it, or both at once. They are generally not dangerous; sometimes they can cause very heavy bleeding, and sometimes clots form inside these vessels. Warm sitz baths, suppositories or local ointments are usually enough as treatment. Sometimes surgical treatments (an operation, band ligation), laser, infrared or cryotherapy can also be tried.

Yes. Some cancers of the large bowel run in families (Lynch syndrome, the familial adenomatous polyposis syndromes and the like), and in the members of these families colonoscopic examinations are begun from a very young age.

Not always. A rise in enzymes such as ALT and AST tells you more about damage to the liver cells; other markers such as bilirubin, albumin and INR are also taken into account in assessing how the liver is functioning.

ALT is an enzyme found particularly in liver cells. It can rise in fatty liver, viral hepatitis, with medicines and in many other situations; on its own it does not establish the diagnosis of any particular disease.

No. AST is also found in muscle and other tissues outside the liver. A raised AST should therefore be assessed together with the other laboratory results and the clinical picture.

No. Alcohol can raise the GGT but it is not the only cause. A raised GGT can also be seen in bile duct disease, with certain medicines and in various liver diseases.

ALP is an enzyme related particularly to the bile ducts and to bone. Whether the rise is coming from the liver and bile ducts or from another source is assessed together with the other tests.

No. As well as diseases of the liver and bile ducts, bilirubin can also rise in situations such as excessive breakdown of red blood cells and Gilbert's syndrome.

Generally no. Gilbert's syndrome is an inherited condition causing a mild and intermittent rise in bilirubin, and it mostly requires no treatment.

It is the accumulation of more fat than normal in the liver cells. The term MASLD is now used for fatty liver related to metabolic risk factors.

Yes. Excess weight is an important risk factor, but fatty liver can also develop in people of normal weight. Metabolic status and other causes should be assessed together.

Not every fatty liver progresses to cirrhosis. But in some people inflammation and fibrosis develop and can progress over the years to advanced liver disease.

In people with excess weight, appropriate weight loss, regular physical activity and control of metabolic risk factors are the main approaches. Treatment is planned according to the person's accompanying conditions and the degree of damage in the liver.

Taking herbal products or supplements without a doctor's advice is not appropriate. Some products sold as "natural" can even cause liver damage.

No. ALT and AST can be normal or only slightly raised in some chronic liver diseases. Other methods such as fibrosis assessment and imaging are used where needed.

It is an increase in scar tissue in the liver as a result of long-standing liver damage. The advanced stage of fibrosis is called cirrhosis.

It measures the stiffness of the liver non-invasively and gives information about the likelihood of fibrosis. The result is assessed together with the other clinical and laboratory findings, not on its own.

Cirrhosis is the state in which advanced fibrosis and permanent disruption of the liver's structure have developed as a result of long-standing liver damage. It can be the final stage of many different liver diseases.

No. Cirrhosis can run for a long time without symptoms or complications. Fluid collecting in the abdomen (ascites) is one of the complications that can appear in the later stages of the disease.

Cirrhosis itself is not contagious. But some infections that can lead to cirrhosis, such as hepatitis B or hepatitis C, can be transmitted by particular routes.

Which hepatitis B test is positive matters. HBsAg, anti-HBs, anti-HBc, HBeAg and HBV DNA each give different information; the state of the disease cannot be established from a single "hepatitis test positive".

No. The decision to treat is made by assessing the HBV DNA level, the ALT, fibrosis in the liver, age and other clinical features.

Acute hepatitis B can be cleared by the immune system in the great majority of adults. In chronic hepatitis B, the treatments used today can suppress the virus powerfully; complete and lasting virological cure is rarer.

Yes. The virus can now be eliminated completely in the great majority of patients with hepatitis C, using direct-acting antiviral medicines.

Not in every patient. Particularly in people who had already developed advanced fibrosis or cirrhosis before treatment, the risk of liver cancer can persist even after the virus has been cleared, and regular follow-up may be needed.

No. The great majority of simple liver cysts found on imaging are benign and need no treatment. But the imaging features of the cyst matter.

No. The word "lesion" does not mean cancer. Cysts, haemangiomas and many other benign formations can be seen in the liver. Contrast MRI, CT or other investigations may be needed depending on the features of the lesion.

Note: liver diseases can progress for a long time without symptoms. It is therefore not right to abandon the follow-up of liver findings already detected simply on the grounds that "I feel well" or "my ALT is normal".

The liver is a factory. It is where the proteins the body needs are made, along with the clotting and defence substances in the blood, and it is also where harmful substances are disposed of.

It is the liver growing beyond its normal size. It can be recognised on examination by your doctor, and also by imaging methods such as ultrasound and tomography. It has a great many different causes, and the treatments are directed at the cause.

It is a picture ranging from hepatitis to cirrhosis, running with damage and repair in the liver, brought on by long-term and heavy use of alcohol. The time and the quantity needed for cirrhosis to appear differ between men and women. Generally a minimum of eight to ten years at 40 grams of alcohol a day causes damage to the liver, but in women both the time and the quantity are far less.

It is the collection of fluid in the abdomen, from causes either in the liver or outside it.

Oesophageal varices are the blood vessels of the oesophagus widening considerably and forming knots or packets. Blood absorbed through digestion should go first to the liver and from there to the heart and the tissues; because of advanced liver disease it turns back instead and is channelled into the veins of the oesophagus, which is how they arise, and they can cause bleeding that puts life at risk. The bleeding can start by itself, with no cause at all.

It is a coma arising from advanced liver disease. In liver patients a coma can be brought on by bleeding, by loss of water and electrolytes through diarrhoea and the use of certain drugs, by a diet excessively high in protein, or by other infections in the body. The patient can usually be brought out of the coma with medical treatment.

It is a picture, seen more often in women, in which certain antibodies the body produces against a number of substances go on causing damage in the liver.

It is a clinical picture running with yellowing of the skin and mucous membranes, which arises when the substance called bilirubin, produced by the liver, cannot drain away into the bile or is made in more than the normal amount. It can arise most often from the germs that cause hepatitis and from blockage of the gallbladder and bile ducts by a stone or a tumour, and it can also arise from other causes such as blood disorders. The treatments too vary with the cause.

It is inflammation of the liver lasting longer than six months. If it runs for years it can sometimes turn into cirrhosis of the liver, and it is a matter for gastroenterology.

It is a clinical state that arises after taking certain drugs that damage the liver cells (anaesthetic agents such as halothane and the like), chemical substances (heavy metals and the like), or food poisons (mushrooms and the like). It runs with a picture varying from disturbance in the biochemical tests, through jaundice, nausea and vomiting, as far as hepatic coma. Those due to drugs generally settle on their own within three weeks once the drug is stopped; sometimes hospital treatment is needed.

Every known kind of drug can damage the liver. This is in fact bound up with our genetic make-up and is a matter of chance. How long the drug is taken, and in what quantity, are important factors too.

Yes. At every stage of pregnancy, liver disorders can develop — both those due to the pregnancy itself and those due to all the other known causes. Some of them carry a risk to life, and the pregnancy may even have to be ended.

No. Surgery is not automatically needed in every patient with gallstones that cause no complaint at all. The decision is made according to the complaints, any complications and the person's own characteristics.

Typical gallstone pain is generally felt in the right upper or upper middle abdomen and can sometimes spread to the back or the right shoulder. The characteristics of the pain matter in reaching the diagnosis.

Gallstones that cause no complaint may cause no problem for years in many people. But because a different approach may be needed in certain particular situations, the finding should be assessed together with the person's clinical picture.

Yes. Small stones leaving the gallbladder can obstruct the area where the bile and pancreatic ducts open, and this can cause acute pancreatitis.

Yes. If a stone drops into the main bile duct and blocks the flow of bile, the bilirubin can rise and jaundice can develop.

It is inflammation developing in the gallbladder, generally as a result of the gallbladder duct being blocked by a stone. Constant right upper abdominal pain, tenderness and fever can occur.

Most gallbladder polyps are not cancer. But their size, growth, appearance and the patient's risk characteristics all matter in the decision on follow-up or surgery.

The same approach is not applied to every polyp. Whether follow-up is needed is decided according to the size of the polyp, its imaging features and the patient's own risk factors.

It is the presence of small crystals and thickened bile material in the gallbladder. It can sometimes disappear completely; in some people it can be related to gallstones, cholecystitis or pancreatitis.

The presence of a stone in the main bile duct that carries bile to the intestine is called choledocholithiasis. It can lead to complications such as jaundice, cholangitis or pancreatitis.

ERCP is an endoscopic procedure used to treat stones, strictures and obstructions in the bile and pancreatic ducts in particular. Today it is mostly carried out for treatment rather than simply to reach a diagnosis.

Yes. In suitable patients, stones in the main bile duct can be removed during ERCP. Methods such as sphincterotomy, a balloon or a basket are used where needed.

Where the flow of bile is disturbed by a stone, a stricture, a tumour or some other cause, a stent can be placed to keep the bile duct open and allow the bile to flow.

It is inflammation in the bile ducts, and in particular an infection accompanying an obstruction. Fever, abdominal pain and jaundice can occur, and acute cholangitis can require emergency treatment.

No. Bile duct strictures can also have benign causes such as stones, previous procedures and inflammatory conditions. But because malignant causes have to be excluded, detailed assessment matters.

The pancreas produces the enzymes that help digest proteins, fats and carbohydrates. It also secretes hormones such as insulin, which take part in regulating blood sugar.

It is inflammation of the pancreas of sudden onset. Gallstones and alcohol are among its commonest causes; but medicines, a high triglyceride level and other causes can also lead to pancreatitis.

The severity of the disease varies from person to person. While most cases run a mild course, organ failure and serious complications can develop in some patients.

A raised lipase on its own does not establish a diagnosis of acute pancreatitis. The patient's pain, how far the lipase level has risen and, where needed, the imaging findings are all assessed together.

It is a chronic disease that leads to permanent structural damage in the pancreas over time. In its later stages, digestive enzyme insufficiency, fatty stools, weight loss and diabetes can develop.

Greasy stools that are hard to clean away, weight loss and malnutrition can occur. Measuring faecal elastase in the stool, and other investigations, can help with the diagnosis in suitable patients.

No. There are different types of pancreatic cyst; some are entirely benign, while certain cystic lesions can carry the potential to become cancerous over time. The type and features of the cyst have to be established.

An IPMN is a type of cystic lesion developing from the pancreatic ducts and containing fluid and mucin. Not every IPMN is cancer, but because certain types and certain imaging features carry a higher risk, follow-up or treatment may be needed.

Endoscopic ultrasound (EUS) can assess the wall of the cyst, its internal structure, whether there is a nodule and its relationship to the pancreatic duct in detail. In selected patients a sample can be taken from the cyst fluid or the tissue during EUS.

Pancreatic cancer may give no symptoms in its early stages. Findings such as jaundice, unexplained weight loss, loss of appetite and new or steadily increasing upper abdominal and back pain can occur; but none of these on its own means pancreatic cancer.

Note: findings such as jaundice and fever due to bile duct obstruction, severe and persistent abdominal pain, recurrent vomiting or a marked deterioration in general condition should be assessed without delay.

It is a state that arises when bile cannot flow in the direction it should and passes into the blood instead. It comes about through a stone, a tumour, pressure from a lymph node, or pressure from mass lesions inside the liver on the bile ducts or the gallbladder, all of which block that flow. In some cases the treatment is surgical.

Endoscopy is looking at the digestive system from the inside with a thin, flexible instrument that has a camera at its tip. Gastroscopy examines the oesophagus, the stomach and the duodenum.

It can be done for many reasons, such as investigating difficulty swallowing, gastrointestinal bleeding, unexplained iron deficiency anaemia and certain stomach and oesophageal complaints. It also allows biopsies to be taken and some treatments to be carried out where needed.

Endoscopy can be done under sedation or anaesthesia. The method used is decided according to the patient's state of health, the procedure being carried out and the practice of the centre.

In procedures carried out under sedation or anaesthesia, the discomfort the patient feels can be reduced considerably. Depending on the anaesthetic method used, memory of the procedure may also be very slight or absent altogether.

A standard diagnostic gastroscopy is generally a short procedure. The time can be longer where biopsies are taken or a therapeutic intervention is carried out.

An empty stomach both makes the examination easier and reduces the risk of stomach contents passing into the airway. The fasting time should follow the anaesthetic and procedure instructions given.

Generally no. Taking a biopsy of the lining is not felt by the patient as a cut or a needle prick.

No. A biopsy is not taken only to look for cancer. Biopsies may also be needed to assess H. pylori, coeliac disease, gastritis, eosinophilic oesophagitis and many other conditions.

Some diseases can be present at the microscopic level without producing any visible change to the naked eye. Biopsies can therefore be taken from normal-looking lining where necessary.

Colonoscopy is examining the large bowel from the inside with a flexible instrument that has a camera at its tip. Where needed, the last part of the small intestine — the terminal ileum — can also be assessed.

It can be done for many reasons, such as colorectal cancer screening, blood in the stool, iron deficiency anaemia, certain changes in bowel habit, chronic diarrhoea and polyp follow-up.

Residual stool can hide the lining of the colon and small polyps. Good bowel preparation increases the quality of the colonoscopy and the likelihood of detecting lesions.

The bowel may not be adequately cleaned and some lesions may be missed. Where the preparation is inadequate, the colonoscopy may have to be repeated at an earlier date.

Not always. In patients with long-standing and severe constipation, the preparation may need to be started earlier or a different preparation plan may be needed; the doctor should therefore be told beforehand.

Fasting and a change in diet can affect blood sugar, and a temporary adjustment to insulin and other diabetes medicines may be needed. Rather than the patient changing their own medication, an individual plan should be drawn up before the procedure.

Do not stop them on your own decision. The decision should be made by assessing together why the medicine is being taken, the bleeding risk of the procedure being carried out and the risk of clotting.

Most suitable polyps can be removed during the same procedure. For polyps that are very large, awkwardly placed or have particular features, an advanced endoscopic procedure or a different treatment may be planned.

Yes. The most important complications are bleeding and, rarely, perforation of the bowel wall. The risk varies with factors such as the size and site of the polyp, the method of removal and the medicines the patient is taking.

Temporary bloating and a sense of wind can occur because of the gas given during the procedure so that the bowel can be seen. But severe or steadily increasing abdominal pain, fever or obvious bleeding should not be regarded as normal.

A small amount of blood can be seen after a biopsy or polypectomy. But if heavy, repeated or clotted bleeding develops, medical assessment is needed.

Endoscopic ultrasound (EUS) is a method that combines endoscopy with ultrasound. It allows detailed assessment of the pancreas, the bile ducts, the wall of the digestive tract and the surrounding structures.

Yes. Where needed, a cell or tissue sample can be taken with a needle under EUS guidance from the pancreas or from certain lesions around the digestive tract.

No. EUS is used mainly for imaging and, where needed, sampling. ERCP is an endoscopic procedure used today particularly to treat obstruction, stones and strictures in the bile and pancreatic ducts.

Yes. Complications such as pancreatitis, bleeding, infection and, rarely, perforation can develop after ERCP. The procedure is therefore carried out for an appropriate indication, weighing the expected benefit against the risk.

If severe or steadily increasing abdominal or chest pain, obvious bleeding, vomiting of blood, fever, persistent vomiting, breathlessness, fainting or a marked deterioration in general condition develops, medical help should be sought without delay.