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Last Updated: Tuesday, 21 March 2006, 12:59 GMT
Inside Medicine: The Gastroenterologist
John de Caestecker
'I enjoy interacting with patients'
In a series focusing on medical specialisms, the BBC News website meets Dr John de Caestecker, who talks about gastroenterology.

Gastroenterology is a branch of medicine concerned with the study of diseases of any part of the digestive tract and also of the liver, biliary tract, and pancreas.

WHAT IS YOUR JOB?

I am a consultant gastroenterologist at Leicester General Hospital. I look after inpatient and outpatient general internal medicine and gastroenterology.

WHAT IS THE MOST COMMON CONDITION?

The most common conditions we deal with are those we term functional conditions - these are conditions for which there are symptoms, but for which we can find no abnormalities - things like Irritable Bowel Syndrome (IBS) and functional dyspepsia (a pain or an uncomfortable feeling in the upper middle part of the stomach).

The most challenging thing though is dealing with people who live with these functional disorders and helping them to accept that they will have to learn to live with them, because although symptoms may be improved, they may not be cured
Dr John de Caestecker

Cancers are not common if one is talking about the volume of cases, but they are the most serious.

The commonest of the gastrointestinal cancers is colon cancer, which is the second or third most common cancer of all cancers.

Other common cancers we get are gullet cancer and pancreatic cancer, which are becoming more common.

We don't know why, but it is probably because of our Western lifestyle and diet - high fat, low roughage, but no-one is certain.

Certainly being more overweight makes these and any other cancers more likely.

Stomach cancer is becoming less common so the number of cases are falling. They are mainly due to a chronic stomach infection with a bug called Helicobacter pylori - and in the Western world, fewer people are getting infected.

WHAT IS THE MOST COMMON PROCEDURE?

This is a series of procedures which we call endoscopy. This a way of examining the lining of the upper or lower gut with a fibre optic endoscope to look for ulcers, cancers and inflammation.

If I am doing two sessions of endoscopy in one day I can end up seeing about 15-20 patients. Some cases though are more complex and involve me doing procedures to remove polyps or gall stones.

WHAT IS THE HARDEST THING ABOUT YOUR JOB?

I am lucky because I do enjoy working with people.

The most challenging thing though is dealing with people who live with these functional disorders and helping them to accept that they will have to learn to live with them, because although symptoms may be improved they may not be cured.

The hardest thing though is dealing with red tape, eg dealing with a lot of management imperatives. Some are worthwhile, but others you feel are just a waste of time.

WHAT IS YOUR MOST SATISFYING CASE?

With the procedures you carry out you can make a big difference to a patient's life, by doing something like removing a gall stone or taking out a difficult polyp (using an endoscope) without needing to do an operation and that is satisfying.

Just being able to sit down and talk to somebody who has cancer and being able to get them to accept what is happening to them, or talking to someone with IBS about their symptoms.

WHY DID YOU CHOOSE THIS SPECIALTY?

I like doing practical things and this speciality offered me the chance to do this - things like endoscopies. But I also like talking to patients and it combines the two.

There is a fairly broad range of conditions, which give me variety.

IF YOU HAD YOUR TIME AGAIN WOULD YOU CHANGE YOUR SPECIALTY?

I am pretty happy in this specialty, so 'no'.

HOW DO YOU SEE THE ROLE DEVELOPING IN THE FUTURE?

I suspect we will be more likely to follow the American and European models for gastroenterology and become much more specialised.

As there are more and more doctors qualifying they will start to sub-specialise and you will start to get doctors specialising in, for instance, dealing with gullet problems and others who deal specifically with gut problems.

CV - Dr John de Caestecker
1977: Graduated from the University of Cambridge
1982: Gained membership of the Royal College of Physicians
1992: MD awarded for thesis, University of Cambridge
1996: Became fellow of Royal College of Physicians





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