20 YEARS IN GAST ROENT E ROLOGY
Gastroenterology: progress and pressures
Graham Johnson discusses how gastroenterology has changed over the past 20 years. He looks at how non-invasive diagnostic testing, prior to endoscopy, could provide a solution to earlier detection and better outcomes for upper gastrointestinal disorders.
The field of gastroenterology has developed immensely over the past few decades, with advances in both diagnostics and therapeutics. Modifications to the endoscope have made imaging and treatment safer than ever, and nationwide campaigns focusing on upper gastrointestinal diseases have increased public awareness. However, the demand for endoscopy has skyrocketed to far beyond the levels the current structure of these services was intended to provide, leaving patients waiting for weeks or even months before receiving a diagnosis. This article discusses how advances in gastroenterology have placed this burden on upper gastrointestinal endoscopy services, and the potential of non-invasive diagnostic testing prior to endoscopy as a solution to earlier detection and better outcomes for upper gastrointestinal disorders. Gastroenterology, defined as the study of diseases of the digestive system, has gained significant traction over the last few decades, expanding at a greater rate than almost any other major acute medical specialty.1
In part,
this is due to substantial progress in our understanding of the fundamental biology surrounding gastrointestinal disease. In the area of upper gastrointestinal medicine, there have been notable advances in, and increased awareness of, a variety of chronic conditions. This ranges from functional disorders of the stomach and oesophagus, including conditions where no obvious organic disease exists, to dyspepsia and reflux diseases – such as Barrett’s oesophagus (BE), atrophic gastritis (AG) and gastric intestinal metaplasia (GIM) – which are significant risk factors for oesophageal and gastric cancer. In addition, the link between Helicobacter pylori infection and gastritis and peptic ulcer disease was also recognised as a significant achievement, when researchers Robin Warren and Barry
NOVEMBER 2022
Marshall were awarded the Noble Prize in Physiology or Medicine in 2005.2
also been a significant increase in public awareness of gastrointestinal complaints – which now account for one in 10 GP appointments1
– leading to a heightened
demand for diagnostic and therapeutic endoscopy. Unfortunately, this ever- increasing rate of referrals for endoscopy is growing to unmanageable levels, and there is a general consensus in the field that more needs to be done to lessen the unsustainable burden on specialist services.
Modernising a trusted technology Conditions of the upper gastrointestinal tract tend to be complex and progressive, making diagnosis both challenging and essential. However, despite significant developments in understanding, gastroenterology still relies heavily on the use of fibre-optic gastroscopes first developed in 1957.3
This method is considered the gold standard for diagnosing
There has
and treating conditions of the gastrointestinal tract, and the technology has seen many advances and iterations over the last few decades, developing into the high definition, high magnification instruments used today. Each of these modifications has been aimed at increasing the diagnostic performance of the endoscope, leading to better imaging performance and reduced user-to-user variability, as well as improving the overall experience of this invasive procedure for the patient.4
Most recently, transnasal endoscopy – which passes an ultra-thin endoscope through the nasal passage under local anaesthetic – and pill-sized cameras that when swallowed capture thousands of detailed images of the gastrointestinal tract, have been adopted widely in the UK, as they are considered more pleasant for the patient and can be delivered in a non-hospital setting.5,6
Guided capsule endoscopy has also proven to be a
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