What is Helicobacter pylori Helicobacter pylori (H. pylori) infection is the major cause of peptic ulcer. It is associated with as many as 90% of duodenal ulcers and 75% of gastric ulcers. Peptic ulcer can lead to obstruction, bleeding or even perforation resulting in peritonitis. Symptoms of peptic ulcer: Abdominal discomfort (between navel and breastbone) A dull pain or burning sensation Discomfort occurs when the stomach is empty (between meals or during the night) Situation can be briefly relieved by eating food Pain can last for minutes to hours Discomfort comes and goes for several days or weeks How is H. pylori infection diagnosed? Blood test +Blood test - A blood sample is taken to test for H. pylori antibodies. If positive, it means you are now infected with, or have been infected with H.pylori in the past Urea breath test +Urea breath test - This test is more accurate to detect H. pylori than blood test and can be used to test the effectiveness of treatment Stool antigen test +Stool antigen test - A stool sample is collected to test for H. pylori antigens Endoscopy +Endoscopy - The procedure can be done under local anaesthesia to the throat, or intravenous sedation to minimize patient discomfort The endoscope (a thin flexible tube with a tiny camera on the end) is passed through the throat to the stomach and duodenum for closely examining the lining We are able to take photos, videos and remove a tiny piece of tissue (biopsy) for examination If bleeding is detected, haemostasis can be secured by injecting medicine, heat probe or clips Treatments of H. pylori infection The standard treatment for H. pylori infection is triple therapy including: Clarithromycin (antibiotics) Proton pump inhibitors (acid production suppressors) Amoxicillin or metronidazole (antibiotics) The treatment lasts for 10-14 days.

Instrument and procedure

An upper gastrointestinal endoscopy is a safe, effective means of visually examining the full lining of the oesophagus, stomach and duodenum, using a soft, long, flexible, tubular instrument. It is used to diagnose problems of the upper digestive tract and perform biopsies. Usually, the patient is also given intravenous sedation and is monitored closely during the procedure.

The examination process will be recorded in a DVD, a report with relevant photos will be explained and given to patient for safe-keeping

Indications

Diagnostic oesophago-gastro-duodenoscopy is especially valuable for evaluating upper gastrointestinal lesions and mucosal changes such as oesophagitis and gastritis. The major indications are:

• Upper abdominal pain or distress
• Anorexia
• Weight loss
• Acid regurgitation
• Unexplained chest discomfort
• Swallowing difficulties
• Repeated vomiting
• Suspected upper gastrointestinal malignancies
• Evaluation of unexplained iron deficiency anaemia
• Upper gastrointestinal bleeding (tarry stool or coffee ground vomiting)

What is colorectal cancer? Cancer of colon, rectum and anus (colorectal cancer) is a malignant neoplasm affecting the lower gastrointestinal tract. Colorectal cancer is a common cause of cancer deaths in Hong Kong. In 2010, 1,864 deaths were caused by colorectal cancer, accounting for 14.3% of all cancer deaths. Common symptoms of colorectal cancer include change in bowel habit (diarrhoea, constipation, etc.), blood or copious mucus in stool, vomiting, anemia and weight loss. Colorectal cancer screening Fecal occult blood test +Fecal occult blood test - A chemical test to check stool (solid waste) for even a small amount of blood Barium enema +Barium enema - Barium and air are instilled through the anus into the colon X-rays are taken to look for abnormal areas Virtual colonoscopy +Virtual colonoscopy - CT scan & software technology to create detailed images of colon Colonoscopy +Colonoscopy - A colonoscope (thin flexible tube with a tiny camera on the end) is passed through the anus to closely examine the lining of the colon The procedure is usually done under intravenous sedation to minimize patient discomfort Diagnostic and therapeutic procedures such as biopsies, removal of polyps and haemostasis can be carried out at the same time Treatments of colorectal cancer The main types of treatment that can be used for colon and rectal cancer are: Surgery Radiation therapy Chemotherapy Targeted therapy Depending on the stage of the cancer, 2 or more of these types of treatment may be combined at the same time or used sequentially.

Instrument and procedure Colonoscopy is a safe, effective means of visually examining the full lining of the colon and rectum, using a soft, long, flexible, tubular instrument. It is used to diagnose colon and rectum problems and at the same time, perform biopsies as well as remove polyps. Most colonoscopies are done with minimal discomfort. Usually, the patient is also given intravenous sedation and is monitored closely during the procedure. The examination process will be recorded in a DVD, a report with relevant photos will be explained and given to patient for safe-keeping Indications Change in bowel habit Persistent abdominal pain Persistent unexplained blood in stool Unexplained anaemia Unexplained weight loss or tiredness

Bowel Preparation Guideline

Colorectal cancer screening

Screening tests are used to find cancers before they are large enough to cause any warning signs. Because finding cancer early means that you are more likely to be cured, it is important for you to have appropriate screening test. Colonoscopy is a universally accepted method for this purpose. Colorectal cancer is more common in older people, so doctors usually screen people 45-50 years of age or older. Some people have risk factors that make them more likely to get colorectal cancer at a young age. Screening should begin earlier in these people.

You should begin screening at a younger age if any of the following are true about you:

• Have had colorectal cancer or large polyps in the past
• Have a close relative (brother, sister, parent or child) who has had colorectal cancer before age 60
• Have ulcerative colitis or Crohn’s disease
• Have a family history of cancer of various organs