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Preventing Gastrointestinal Cancer

Gastrointestinal (GI) cancer accounts for 1/3rdof cancer deaths in developing countries like india. Stomach, liver and colorectal (large intestine) cancers are the three most common. In addition pancreatic , gallbladder , oesophageal and small bowel cancer are less common but aggressive cancers which have comparatively poorer outcomes even when they are detected at an operable stage. It is imperative to prevent these cancers by lifestyle changes and detect them at an early stage by cancer screening to prevent advanced disease.

The main Strategies to prevent cancer deaths include

  • Diet changes &Life style changes.
  • Identifying cancer families.
  • Preventive screening of at risk induviduals

1.Health and life style

Smoking predisposes to most GI Cancers. Quitting smoking is probably the best decision you can make for your health as it reduces your risk for not just gastric cancer but also many other medical problems like heart disease and stroke. Tobacco chewing can also predispose to throat and esophagus cancer

Alcohol can contribute to gastric, esophageal and colon cancer . Chronic alcoholic intake also leads to chronic liver disease and chronic pancreatitis (scarring of pancreas) predisposing them to liver cancer and pancreatic cancer respectively.

Diet plays an important role. Eating preserved foods such pickled foods and salted meats predisposes to gastric cancer. Food rich in fat intake predisposes to colon and pancreatic cancer. A diet high in fresh fruits and vegtables with plenty of fiber, vitamin A Vitamin C and antioxidants prevents cancer. Likewise people in cold climates used to drinking extremely hot liquids may predispose you to esophageal cancer.A high carbohydrate diet also predisposes to obestity and cancer.

Obesity is a risk factor for gastrointestinal cancer especially for colon and pancreatic cancers. It is also a risk factor for non GI cancers like breast cancer. Obesity can lead to fatty liver disease that predisposes to hepatocellular (liver cancer).An active lifestyle mainitaing BMI less than 25 reduces risk of GI as well as non GI cancers such as breast and ovary.

Acid reflux Long standing acid reflux can predispose you to esophageal cancer and proximal gastric cancer. Patients with persistantrefluxs symptoms for more than 2 years should consult a gastroenterologist for a diagnostic endoscopy to detect barretsesophagus.

Others factors : long term use certain medication , industrial toxins Helicobacter pylori infection, history of radiation therapy can also predispose to GI cancer

2.Identifying at risk families

The following features (if more than 2) if present should make you consider going to doctor for genetic testing and early screening

  • Cancer diagnosed at an unusually young age (less than 50)
  • Cancer in two generations of family
  • Cancer in 2 or more first /second degree relatives
  • Developing more than 1 type of cancer (sametime / separately)in life time
  • Cancer in index patient / first degree relative with proven genetic mutation.

3.Screening

Unlike breast and cervical cancer routine screening is not mandatory for gastrointestinal cancers .Only selected groups of at risk induviduals for some GI cancers need screening for that particular cancer. The screening frequency and modalities vary for individual cancers and are best decided by the gastroenterologist. In the developed world the entire population is screened for colon cancer starting from 50 years of age every 5 years but clear cut recommendations are lacking in India due to lack of data.The at risk patients who need screening include-

Oesophageal cancer : Patients with longstanding reflux disease and new onset dysphagia (difficulty in swallowing), patients with esophageal disease like esophgeal stricture, esophageal motility disoders need screening for esophgeal

Gastric cancer : Patients with family history, Hpylori associated atrophic gastritis, prolonged reflux disease, elderly individuals with low haemoglobin, weightloss , gastrointestinal bleeding and persistant upper abdominal pain Pancreatic cancer :Patients with family history Patients with chronic pancreatitis especially alcoholic and hereditary chronic pancreatitis, Lynch syndrome. Patients with Jaudice and itching .

Intestinal cancer: Family history of intestinal cancer, patients with inflammatory bowel disease like ulcerative colitis/ crohns diseae, Patients with gastrointestinal polyps. Patients with past history of radiation need screening. Patients with history of treated colon cancer are at risk of developing cancer at a new location

Liver cancer : Patients with chronic liver disease secondary to hepatitis B, Hepatitis C, Alcohol , hemochromatosis are highly prone to developing liver cancer. Liver cirrhosis leads to cancer . Likewise Non alcoholic fatty liver disease (NAFLD ) predisposes to cancer . All these patients need ultrasound and blood tests at 6 monthly intervals for early detection.

Gallbladder and biliary cancer : some parts of Northern india like the cow belt region are endemic for Gallbladder cancer. Gallstones are assoaciated with gall bladder cancer but a causative relation is not established. Patients with Liver stones ( hepatolithiasis), repeated attacks of bile infection (cholangitis), bile duct anamolies such as bileduct cysts, narrowing (strictures ) and choedochal cyst are at risk for bilary cancer and should get treated with liver specialist.

Dr R Phani Krishna MS (JIPMER), MCh (SGPGIMS), MRCS (Edin) HPB oncologyfellowship (Japan), Transplant fellowship (Leeds UK)Director: Dept. of Surgical Gastroenterology & HPB surgery, Pace Hospitals, Hyderabad. Founder: Hyderabad HPB Oncology Foundation Miyapur: Beside South India Shopping Mall, Mythri Nagar, Madinaguda, Hyderabad, Telangana - 500050. T: 040 48486767



Advances in Liver Cancer Care

In recent years, there have been several advances in treating liver cancer. While removing liver cancer through surgery can be an effective form of liver cancer treatment for some patients, it's not suitable for all patients. As researchers continue to uncover new and innovative treatments, doctors have more options to consider for their patients. Surgical treatment has also become more refined in order.

Chemotherapy Advances?

In the past 2 decades, targeted therapy for liver cancer has seen revolutionary advances. Standard chemotherapy is ineffective in liver cancer patients with severe toxicity. Targeted medications selectively target the cancer cells with minimal systemic side-effects and extend lifespan patients with terminal liver cancer. For some patients, chemotherapy is given along with another therapy. For example, it can shrink a tumor enough to allow doctors to perform surgery safely. As research continues - Better and even more targeted chemotherapies are on the horizon.

Intra-arterial Therapies for Liver Cancer

Liver tumors get their blood supply exclusively from the artery that supplies the liver while the rest of the liver receives dual blood supply. These tumors act as parasites to your body's blood supply. In intra-arterial therapies such as chemoembolization beads deliver cancer-killing medication directly and selectively to the tumor through the artery. These beads also block blood flow to the tumor, which helps prevent it from growing. Likewise Transarterial radioembolization uses Yittrium based microspheres to deliver focussed radiotherapy from within the tumor with minimum side effects to the body. These therapies significantly prolong the life span. They can also be used as a bridge to liver transplant and shrinking tumor prior to surgery.

Liver Tumor Ablation Techniques

Ablation therapies kill a liver tumor instead of removing it. In these techniques, doctors use a probe to kill tumors with hot or cold energy. This minimally invasive approach is most effective for smaller tumors less than 3 cm but may be used for even larger tumors. Microwave ablation and Radiofrequency ablation is usually can be performed safely as day care procedure under imaging guidance. For smaller tumors the results of ablation therapy are equal to surgery and are especially preferred in patients with severe liver disease who can't tolerate surgery.

Liver Transplant Advances

Liver transplantation can be an effective treatment for certain patients with hepatocellular carcinoma, a common type of liver cancer. If a patient has liver disease, such as cirrhosis, liver transplantation can also reduce further the risk of cancer. However, not all patients will be candidates for a transplant; this needs to be determined by a transplant surgeon and his or her team. The decision for liver transplant is made by a multidisciplinary team based on the size, number of tumors and patients health.

Surgery Advances

Surgery for liver cancer which was once a very high risk, bloody affair has undergone major advances in past few decades. Newer instrumentation such as CUSA and waterjet have made bloodless liver resections a possibility. Robotic and laparoscopic liver resections have shortened the post op recovery. Advanced techniques of liver resection such as Parenchyma preserving hepatectomies, portal vein embolization, ALLPS, 3 D configurations liver imaging such as MEVIS have helped us perform major resections safely in diseased livers.

Dr R Phani Krishna MS (JIPMER), MCh (SGPGIMS), MRCS (Edin) HPB oncologyfellowship (Japan), Transplant fellowship (Leeds UK)Director: Dept. of Surgical Gastroenterology & HPB surgery, Pace Hospitals, Hyderabad. Founder: Hyderabad HPB Oncology Foundation Miyapur: Beside South India Shopping Mall, Mythri Nagar, Madinaguda, Hyderabad, Telangana - 500050. T: 040 48486767



Hepatobiliary & Pancreatic (HPB) ONCOLOGY

A Vibrant & Rapidly Evolving Sub-Speciality HPB oncology is specialized multidisciplinary field of medicine dealing with cancers of the Liver, Pancreas, Bile Duct & Gall Bladder.

How are cancers of the liver pancreas and bileduct (HPB CANCERS) different?

Most of abdominal cancer are readily diagnosed by symptoms such as vomiting, gastrointestinal bleed, intestinal obstruction and basic tests such as endoscopy, colonoscopy and ultrasound. By virtue of their unique anatomical location liver and pancreatic and bile duct tumors are usually missed by these investigations and need specific tests like MRCP (Magnetic resonance cholangiopancreatography), EUS (Endoscopic ultrasound), ERCP (endscopic cholangiopancreatography), Spy scopy and multi-slice CT scan. Their symptoms are also subtle and diagnosis needs a high degree of suspicion and expertise.

What are the usual symptoms of HPB cancers?

Symptoms of early cancer are usually subtle include anorexia, vague abdominal discomfort and by the time overt symptoms develop cancers are usually in an advanced stage. Jaundice can be a presenting symptom in HPB cancers but many patients reach referral centers late after several trials of native medicine without diagnosis. It is not un common to find a patient who has had several ultrasounds and endoscopies for abdominal pain and told that he only 'Acidity' or 'Gas' and by the time he reaches a specialist the imaging shows advanced pancreatic cancers.

How do we arrive at diagnosis?

Mostly diagnosis is arrived at by Triphasic CT scan with liver and pancreatic protocol and MRI with MRCP. In cases with diagnostic dilemma Endoscopic ultrasound (EUS) and EUS guided biopsy is needed. In bile duct and pancreatic cancers spyglass cholangioscopy is needed to confirm diagnosis. Many patients have jaundice that needs relief through ERCP stenting or PTBD stenting. Some patients undergoing a major liver resections need a preoperative portal vein embolization to shrink one half of the liver or a 3D CT volumetry Most of these facilities are available only at specialized HPB centers.

Are there any specific risk factors for liver and pancreatic cancer?

Are there any specific risk factors for liver and pancreatic cancer? Patients with Hepatitis B, hepatitis C, and alcoholic liver disease have a high risk for liver cancer and need 6 monthly imaging and blood tests to detect early cancer. Patients with BMI more than 30, diabetes and fatty liver are at a higher risk for liver disease and liver cancer. Smoking, Obesity, fatty liver and sedentary life style predispose to pancreatic cancer. Chronic pancreatitis secondary to alcoholism and tropical pancreatitis common in India also increases risk for pancreatic cancer.

What is the need for a HPB oncology subspeciality?

Surgical management of HPB cancers carries a higher morbidity and mortality rates than most regular surgeries. Liver and pancreatic surgery is complicated and requires vast experience. In addition to the usual CHOP CUT STITCH approach the HPB surgeon needs an understanding of their complex physiology as well as expertise in vascular surgery as these tumors often involve critical vascular structures. This is especially important in the postoperative period in these high-risk group. It has been scientifically proven that centers with focused and high-volume care in HPB oncology achieve best results. Most cancer centers in India have a jack of all trades approach offering treatment for cancers from head to toe. Specific focused expertise is lacking due to low volumes. In HPB centers surgical expertise in benign and malignant liver conditions and specialized diagnostic expertise leads to higher volumes and expertise with better results.

Are there options other than surgery at an HPB oncology centers?

In patients who are not fit or cancers too advanced for surgery the standard oncological approach is chemotherapy and radiotherapy. These treatments are virtually useless for liver cancer and patients are often misguided that situation is hopeless. In specialized HPB centers treatment options such as radiofrequency ablation, trans arterial chemoembolisation, trans arterial radioembolisation, liver transplantation for liver cancer are added to the armamentarium leading to better results. Like wise in pancreatic cancer laparoscopic pancreatic resections, EUS guided diagnosis and ablations, pancreatic and bileduct stent and endoscopic radiofrequency ablation are available in specialised centers.

Dr R Phani Krishna MS (JIPMER), MCh (SGPGIMS), MRCS (Edin) HPB oncologyfellowship (Japan), Transplant fellowship (Leeds UK)Director: Dept. of Surgical Gastroenterology & HPB surgery, Pace Hospitals, Hyderabad. Founder: Hyderabad HPB Oncology Foundation Miyapur: Beside South India Shopping Mall, Mythri Nagar, Madinaguda, Hyderabad, Telangana - 500050. T: 040 48486767



What Causes Gastritis Ulcers?

A stomach ache every now and then is usually nothing to worry about. But, if you’re experiencing a constant gnawing or burning sensation in your stomach, you might have a condition known as gastritis, and you should make an appointment with your gastroenterologist for a thorough exam and possible gastritis ulcer treatment.

What Is Gastritis?

The term gastritis covers several different conditions that share a common factor – inflammation of the stomach lining. The illness is mainly caused by a specific bacterium that is also responsible for causing stomach ulcers. Yet, things like taking too many NSAID pain relievers and excessive alcohol use can also cause the disorder.

Gastritis can be acute (sudden onset) or can slowly get worse with time (chronic). Untreated gastritis can result in the occurrence of stomach ulcers and contributes to a higher chance of developing stomach cancer. Most patients suffer with mild forms of the condition and improve rapidly with gastritis ulcer treatment.

Main Causes of Gastritis Ulcers

  • Helicobacter pylori (H. pylori) – This bacterium enters the body and takes hold in the digestive tract. It can live there for years without causing any problems. However, in some people, the bacterium breaks down the stomach lining, leading to painful ulcers forming anywhere in the upper GI tract.
  • Bile Reflux – This condition occurs when digestive fluid made in the liver backwashes up into the stomach and lower esophagus, which irritates the stomach lining.
  • Infections – Many bacterial, viral, and fungal infections can cause gastritis ulcers.

Other Causes of Gastritis

  • Pernicious anemia (an autoimmune disease)
  • Crohn’s disease
  • Sacroidosis
  • Stress

Symptoms of Gastritis and Ulcers

Gastritis and ulcer symptoms are often quite alike. Ulcers occur when the stomach’s own acid eats away at its protective lining, leaving a raw, irritated sore.

Symptoms can include:

  • Pain in the abdominal area
  • Recurring stomach ache
  • Gnawing or burning in the stomach in the evening and between meals
  • Vomiting
  • Lack of appetite
  • Burping
  • Hiccups
  • Feeling of indigestion
  • Bloating
  • Black stools

Visit your gastroenterologist for gastritis ulcer treatment if you experience any of the above symptoms for more than a week. Although everyone is prone to dealing with some of these symptoms occasionally, persistent abdominal pain is not normal and should be evaluated.

Treatment for Gastritis Ulcers:

After a thorough examination that includes compiling your entire medical history, evaluating all medications you’re taking, and administering necessary blood and stool tests, you doctor will prescribe a gastritis ulcer treatment plan to get you on the road to recovery.

Depending on the severity of your symptoms and if you test positive for H. pylori, your doctor may prescribe the following for your gastritis ulcer treatment:

  • Over-the-counter or prescription-strength antacids
  • Antibiotics to kill H. pylori bacteria
  • Prescription medication to reduce the production of stomach acid
  • B12 shots for pernicious anemia
  • Eliminating food triggers (spicy food, lactose and gluten)
  • Using acetaminophen (Tylenol) instead of NSAIDs for pain relief

If you think you’re experiencing the symptoms of gastritis, make an appointment today with Dr. Phani Krishna Ravula . Dr. Phani Krishna is board certified in gastroenterology and internal medicine and has more than 10 years of experience in the diagnosis and treatment of gastritis and other diseases of the digestive tract. Dr. Phani Krishna effectively and compassionately treats patients in the Hyderabad City area and will tailor a gastritis ulcer treatment plan especially for you.



Gall stones –Frequently asked questions and misconceptions

What causes gallstones?

Gallstone formation occurs secondary to obesity, sedentary lifestyle, fattyfood consumption and constipation. People form some parts of india such as cowbelt (UP Bihr and West Bengal )area have an especially high incidence of stones. Mutiple pregnancies can predispose to gallstones as well.

What problems do gallstone cause?

Gallstones cause sudden onset severe pain in the upper abdomen or right half of abdomen which starts after food intake or in the night /early morning hours. Pain radiates to right shoulder or back, it is moderate to severe and stops within ½ hr to 6 hrs. If pain lasts more than 24 hrs complications of gallstones such as gallbladder infection (acute cholecystitis) pancreatitis/ bile duct-liver infection (cholangitis) / gangrene or perforation are to be suspected.

Do all gallstones need treatment?What size stones are to be treated?

Unlike in kidney stonesthe treatment of gallstones is not decided by the size and no. of stones. Only the presence of stones and associated symptoms decide treatment. If a patient has symptoms even a singlestone needsremoval irrespective of size .Likewise, if patient has no symptoms and gallstones are detected during general health checkup patient can simply followed up even if he has multiple stones.

Can we just remove the stones and leave the gallbladder alone?

Unlike in kidney stones where the kidneys are healthy. In patients with gallstones the gallbladder is diseased. Treatment was attempted in the early 20th century to dissolve / remove gallstones and leave the gallbladder intact. All such treatments the stones recurred within 3 to 6 months now we understand that gallbladder is the problem more than the stones and standard treatment of gallstones the world over is cholecystectomy (removal of complete gallbladder with stones)

What are digestive / health problems caused by gallbladder removal?

The gallbladder does produce any digestive juices. Its primary fucnction is bile storage in between meals. After cholecystectomy the canal system of the liver (intrahepatic biliary radicles) and common bile duct enlarge in size to accommodate and store bile. So, there is no digestive problems or need to change food habits after gall stone surgery.This is well documented as gallbladder surgery is one of the commonest surgeries done worldwide and there is a huge amount of scientific data to support this.

Can I leave my gallstones untreated? Can I try Native medicine (Unani/Homeo?Ayurveda)

There is no scientific data to support that allopathic or non-allopathic medicines cure gallstones. If one is asymptomatic we may follow up and operate once there is pain. Once you are symptomatic you are at 4-8 % per year at risk of serious complications such as acute cholecystitis/ Pancreatitis/ Jaundice/ cholangitis /gangrene. Patients with gallstones are at risk for these life-threatening complications over the next 10 years. Therefore, cholecystectomy is mandatory in patients with symptoms.

Why are some people unhappy about gallstone surgery?

Gallstones only cause severe abdominal pain and the complications listed above. Symptoms such as abdominal tightness, bloating, indigestion, heartburn, constipation and increased frequency of stools are very common in the general population and are not related to gallstones. Mostly when the patients / treating doctors try to correlate these symptoms with gallstones it leads to unhappiness as these symptoms may not get relieved by a cholecystectomy.



What are the symptoms of Pancreatic Cancer?

Your pancreas gland is responsible for helping you maintain healthy blood sugar levels. When you have a pancreatic disease, it can result in serious health problems.

Types of Pancreatic Diseases

Pancreatic diseases include pancreatic cancer and acute or chronic pancreatitis. Pancreatic cancer develops when abnormal cells in the pancreas multiply and form malignant tumors. Pancreatitis refers to inflammation of the pancreas.

Causes of Pancreatic Diseases

The cause of pancreatic cancer has not yet been found. However there are several risk factors that can increase your risk of having the disease. These include:

  • Obesity
  • Leading a lethargic lifestyle with little to no exercise
  • Smoking
  • Poor diet
  • Diabetes or liver damage
  • Chronic pancreatitis
  • Excessive alcohol intake
  • Family history of pancreatic cancer

Pancreatitis occurs when the digestive enzymes are active in your pancreas. The risk factors for this inflammatory condition include:

  • Family history of pancreatitis
  • Gallstones
  • Certain medications
  • Smoking
  • Elevated calcium levels in your blood
  • High triglyceride levels

Symptoms of Pancreatic Diseases

When you have pancreatic cancer, symptoms usually do not appear until the disease is in an advanced stage. When symptoms do show up, you might have the following:

  • Appetite loss
  • Unexplained weight loss
  • Blood clots
  • Lower back pain or stomach pain
  • Depression
  • Jaundice

When you have chronic pancreatitis, you might have the following symptoms:

  • Pain in your upper abdomen
  • Unexplained weight loss
  • Stools that are oily and have a foul odor

Acute pancreatitis, which requires prompt medical care, can cause any of the following symptoms:

  • Pain in your upper abdomen that might move to your back or become worse after you eat
  • Nausea and vomiting
  • Tenderness in your abdomen
  • Fever
  • Rapid pulse

Treatment for Pancreatic Diseases

The treatment options for pancreatic cancer depends on how advanced it is and whether or not it has spread to other parts of your body. Treatment in general focuses on destroying cancerous cells and stopping cancer from spreading. Pancreatic cancer treatment options include surgery to remove tumors, radiation therapy and chemotherapy. You might be a good candidate for surgery if you have tumors that are in your pancreas and have not spread to other areas. If cancer has spread to other areas, you might need radiation therapy or chemotherapy. Radiation therapy destroys cancerous cells, while chemotherapy lowers the risk of having more cancerous cells grow.

If you have acute pancreatitis, you will need to prompt care at the hospital to reduce inflammation and allow your pancreas to recover. Treatment usually includes fasting, pain medications and intravenous fluids. You might also need treatment for the underlying cause of pancreatitis. If you have chronic pancreatitis, treatment options depend on the underlying cause. Some options that are available include surgery to remove bile duct obstructions, gallbladder surgery and pancreas surgery. You might also benefit from endoscopic ultrasound to ease chronic abdominal pain, dietary changes, and enzyme supplements.

Pancreatic Disease Prevention

You can’t completely prevent pancreatic diseases, but you can lower your risk of them. A few ways to lower your risk include:

  • Stop smoking
  • A well balanced diet
  • Maintaining a healthy weight

If you have symptoms of pancreatic disease, please contact Dr. Phani Krishna to schedule an appointment. Dr. Phani Krishna will conduct an evaluation to determine what is causing your symptoms.



When Should I See a Stomach Doctor ?

A stomach doctor – also called a gastroenterologist – handles ailments of the digestive system, including everything from esophageal problems to liver disease.

In this blog, Dr. Phani Krishna Ravula explains the symptoms as well as the need for screenings that should prompt you to make an appointment with a stomach doctor.

What is a stomach doctor?

A gastroenterologist specializes in diagnosing and treating diseases of the gastrointestinal tract. This includes the stomach, intestines, esophagus, liver, pancreas, colon, and rectum.

This type of specialist has advanced training and education beyond medical school that encompasses internal medicine as well as gastroenterology.

When should you see a stomach doctor?

A gastroenterologist’s advanced training and education makes this type of doctor very well qualified to diagnose and treat stomach disorders and to conduct and interpret screenings.

Any of the following can be a good reason to see a gastroenterologist:

  • Rectal bleeding
  • Bowel leakage
  • Change in bowel movements
  • Diarrhea
  • Black, tarry stools
  • Dark urine
  • Abdominal pain
  • Heartburn
  • Indigestion in mid- to late life that previously didn’t exist
  • Difficulty swallowing
  • Esophageal pain
  • Belching or flatulence
  • Vomiting
  • Loss of appetite
  • Unexplained weight loss
  • Lack of energy

What are some common conditions treated by stomach doctors?

Conditions frequently treated by stomach doctors include the following:

  • Heartburn/GERD (gastroesophageal reflux disease)
  • Inflammatory bowel disease – such as Crohn’s disease
  • Irritable bowel syndrome (IBS)
  • Celiac disease – makes your body unable to process gluten

What types of screenings do stomach doctors conduct?

  • Colonoscopy – This test allows your doctor to use a long, flexible lighted tube with a tiny video camera on the end to see inside your colon. Your doctor can spot polyps and if needed, remove them or take a small tissue sample to use for a biopsy.
  • Upper gastrointestinal endoscopy (EGD) – This procedure allows your doctor to use a fiberoptic scope to view your esophagus, stomach, and the upper part of your small intestine. It can be used to help relieve certain swallowing problems, remove polyps, and check for signs of ulcers, celiac disease, inflammation, and more.
  • Endoscopic ultrasound – High-frequency sound waves are used to produce images of your digestive tract and nearby organs. This allows your doctor to check for disorders of the esophagus, pancreas, stomach, and more.

If you’re experiencing any symptoms related to your gastrointestinal tract, make an appointment today with Dr. Phani Krishna Ravula. He is trained gastroenterologist with more than a decade of experience. Dr. Phani Krishna Ravula will diagnose the cause of your symptoms and provide the most effective treatments possible to help you get relief.



What Causes Gastritis Ulcers?

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Gall stones –Frequently asked questions and misconceptions

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When Should I See a Stomach Doctor?

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What are the symptoms of Pancreatic Cancer?

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