A good number of patients visit with symptoms of dyspepsia, including stomach pain, bloating (a band-like tightness around the stomach), excessive fullness after meals, and early satiety. Fatty liver is also common. In an interview with Rising Kashmir reporter Younus Rashid, Dr. Raese Noor Khan advises against NSAID painkillers and warns patients to avoid herbal remedies for liver ailments, as many such cases lead to acute liver failure,
Could you tell us about yourself and what made you choose gastroenterology as your field?
I am Dr. Raese Noor Khan, a consultant gastroenterologist and liver disease specialist. I work at the GastroPlus Digestive Disease Centre in Anantnag. After completing my MD in Medicine in 2013, I qualified for DM in Gastroenterology in 2014. Upon finishing my degree in 2017, I joined government services. However, after a few months, I quit the job and worked outside the state for a few years. In 2022, I returned and started a full-time gastroenterology centre near GMC Hospital, Anantnag.
I decided to become a gastroenterologist while pursuing my MD residency. I was interested in specialising in an interventional branch of medicine and had to choose between cardiology and gastroenterology. Ultimately, I chose gastroenterology.
For those who may not be familiar, could you briefly explain what gastroenterology is and the types of conditions it deals with?
Gastroenterology is a medical speciality that deals with the digestive system. The term “gastro” pertains to the stomach, and “entero” is related to the intestines; it also encompasses diseases of the liver, pancreas, and biliary system.
What are the most common stomach or digestion-related issues you see in your patients, how do you usually treat them?
I mostly see patients with symptoms of dyspepsia. Dyspepsia is a symptom complex in which patients complain of stomach pain, bloating (a band-like tightness around the stomach), excessive fullness after meals, and early satiety. These symptoms can occur in isolation or in combination.
Many patients also report acid-related symptoms such as burning sensations in the stomach or chest and reflux.
Patients with dyspepsia or acid symptoms are typically managed with a few weeks of acid-suppressive medication. If symptoms persist, last for more than six months, or are accompanied by red flags such as weight loss, iron deficiency anaemia, recurrent vomiting, blood-mixed vomitus, severe abdominal pain, or black, tar-like stools, we usually proceed with investigations. These include abdominal ultrasounds to check for gallbladder stones and endoscopy, particularly to look for H. pylori gastritis.
Patients who present with a history of constipation or increased stool frequency without warning signs like blood in stool, weight loss, or painful defecation are managed with stool-softening medications or anti-motility drugs for those with increased stool frequency. We advise lifestyle modifications, such as adequate fluid intake, proper hydration, and regular physical activity. For persistent or chronic symptoms or the presence of warning signs, we screen the large intestine using sigmoidoscopy or colonoscopy.
Children with acute viral hepatitis often present with vomiting and jaundice and require symptomatic treatment, and most cases are transmitted through contaminated water.
Fatty liver disease is very common in our society. These patients need thorough assessment to rule out secondary causes of fatty liver and evaluate liver stiffness due to fat-related inflammation.
We diagnose one or two cases of gastrointestinal cancers biweekly or monthly.
In Kashmir, many people take painkillers and other medicines without consulting a doctor. How does this affect their stomach and overall health?
There is no harm in taking analgesics for pain relief or other medications for symptomatic improvement occasionally. Being habitual and chronically ignoring the symptoms is a problem. Avoid NSAID painkillers and prefer paracetamol for short-term pain relief.
Acid-suppressing medications provide symptomatic relief.
In many cases, despite symptom relief, gastritis progresses to metaplasia and eventually to the dysplasia-carcinoma cascade.
Lastly, the use of herbal remedies for liver ailments is concerning and can sometimes lead to liver failure.
We have seen more cases of gastroenteritis recently. What do you think is causing this increase?
The surge in cases of gastroenteritis is largely related to the consumption of contaminated food and water; many people consume water from taps, rivers, or springs without boiling it.
There is a need for aggressive public health engineering to ensure the supply of clean drinking water and minimise contamination.
Are there any habits or local factors here in Kashmir that make people more likely to develop stomach issues?
H. pylori infection in the stomach is a risk factor for stomach cancer, and the prevalence is high in developing countries; Kashmir is no exception.
High salt consumption and hot beverages (tea) increase the risk of stomach and oesophagus cancers, respectively.
Excessive intake of sugars, carbohydrates, and red meat contributes to the risk of fatty liver and colon cancer.
When should someone stop ignoring their stomach problems and see a specialist like you?
Anyone with less than six months of acid or dyspeptic symptoms, without warning signs or a family history of stomach cancer, can safely try a few weeks of symptomatic treatment with acid-suppressant medication. However, if symptoms persist or recur after the initial response, it is essential to consult a gastroenterologist. The same approach applies to symptoms of constipation or increased stool frequency—a few weeks of symptomatic treatment in the absence of warning signs is generally acceptable.
Fatty liver, as mentioned earlier, requires proper assessment, and no medication should be taken solely based on an ultrasound showing fatty liver.
Individuals aged 45 to 50 years or older should undergo screening endoscopy and colonoscopy to check for stomach and colon cancers. Those with a first-degree relative diagnosed with stomach or colon cancer should consider screening at the earliest opportunity.
What advice would you give to people to keep their stomach and gut healthy?
Eat less. Limit the consumption of sugar, salt, and carbohydrates; maintain an ideal body weight, as obesity has a strong association with gastrointestinal and liver cancers.
Our food is in our kitchen, not in the market. Processed foods alter our gut bacterial environment and predispose us to diseases involving both gastrointestinal and other organ systems.
We should encourage people to incorporate uncooked food, such as vegetables (salads) and fruits, into their meals.
Hepatitis B and C are risk factors for liver cancer. Test for hepatitis B and C and get vaccinated for hepatitis B.
