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You are here: MEDICA Portal. Magazine & More. MEDICA Magazine. Topic of the Month. Volume archives. Our Topics in 2010. August 2010: Of the Stomach and Gut. Blood.

“You should eat healthy”

“You should eat healthy”

Photo: Raw Meat asked Professor Tobias Goeser, Director of the Department of Gastroenterology and Hepatology at the University Hospital of Cologne. Professor Goeser, in the media we keep hearing the term bowel care. An Internet search at Google using the keyword delivers 34,900 hits. But can you really care for your bowels?

Tobias Goeser: Of course you can care for your bowels, but the question should be: ’What kind of good things can you do for your bowels and thus for your entire body?’ How can I fight bad things off? The goal needs to be in maintaining an undisturbed intestinal function and prevent malignant diseases in this organ. So what is harmful to bowels?

Goeser: Several substances we take in orally can be harmful to the bowels. Take medicine for example: the group of headache pain killers for instance, among them Aspirin or rheumatism drugs like Ibuprofen. Even though the damages generally heal once the drug’s use is discontinued, you should not be all too reckless with these types of drugs. Real emergencies – as in patients who need to go to a hospital, because they bleed from their stomach and bowels after use of these drugs – are rare. Or take antibiotics, which can damage the intestinal flora and cause diarrhea. All that said the gut has a great self-healing ability, which is why these disruptions usually spontaneously subside. So avoiding harmful substances is great and also feasible. Yet can I actively do something through bowel care to prevent cancer?

Goeser: The most important thing, when you take the example of colorectal cancer, is to prevent it if possible. There are different criteria, which are connected to a higher risk of colon cancer: This includes for instance eating a low-fiber diet or too much red meat like beef or pork. Also consuming lots of alcohol, not enough exercise and excess weight increase the risk for polyps in the colon and thus the risk of colon cancer. In regards to your diet, the simple recommendation is: You should eat healthy without eating meat every day, but make sure to have plenty of fiber and calcium in your diet. But this does not mean that everybody who eats red meat makes a big mistake, since the risk for colon cancer through this particular food is only slightly increased. On the other hand you can balance this disadvantage through preventive examinations. In this case you should make sure that there are no polyps in the bowels. The development of these polyps, which are known as the precursor to a cancerous colon disease, happens more often than you think. At the moment it is assumed that about every fifth person at the age of 50 and every second person at age 80 has polyps in their colon, and every twentieth person will have colon cancer in the course of their life. This is why it is crucial that you identify the preliminary stage, meaning the polyps that develop in the colon, and remove them before colon cancer can develop. This is why it’s recommended to have a colonoscopy starting at around 50 years of age and repeat them at regular intervals. The cycle depends on the findings. If you didn’t have any polyps and there is no increased risk for colon cancer, an examination every eight to ten years is sufficient. So with this type of bowel care you can do your best in the sense of preventing the development of tumors as best as possible. Is a colonoscopy or coloscopy an accredited preventive medical examination?

Goeser: Yes and it is covered every ten years by the statutory health insurance companies. If polyps were discovered during the colonoscopy, the health insurance company also covers further examinations as well as subsequent colonoscopies.

Photo: Professor Goeser 
Professor Goeser; ©private Some patients are very afraid of a colonoscopy. How reliable are alternative procedures like testing for blood in your stool, the so-called occult blood test?

Goeser: It depends. It matters how much assurance the patient would like to have. The simplest, most uncomplicated procedure is definitely testing for blood in the stool. Patients need to provide a stool sample three times per year, which is then examined for possible bleeding. However, if blood is found even once, you must have a colonoscopy at any rate. The second possibility in case you are very scared of a colonoscopy, would be to look only at a partial section of the colon – the last forty to fifty centimeters. This is often done in the US. I think this is essentially useless, because the scared patient does not gain much from this.
But getting back to the assurance for the patient: if you regularly perform the test for occult blood, you can prevent about thirty percent of all colon cancers. If on the other hand you regularly get a complete colonoscopy done, you can prevent about 70-90 percent of all colon carcinoma. This is why each patient needs to ask themselves, how much assurance they want in terms of early detection for colon cancer. Of course it is an unpleasant procedure to irrigate the bowels before the endoscopy. The endoscopy itself however today is in most cases done under anesthesia, so patients will have no recollection of the examination. Are there serious side effects to a colonoscopy? Many patients argue with their fear of perforation of the bowels to avoid the examination.

Goeser: The bottom line is that the patient visits the right physician. This means, the physician has already performed a certain minimum number of colonoscopies to ensure the necessary safety and specialization and thus is able to perform the examination safely and reliably. This is the case for medical specialists in gastroenterology for example. Under these conditions, the risk of accidently piercing the bowels during a simple colonoscopy is about 1 in 3000. If polyps need to be removed, the risk increases slightly, depending on size and site of the polyps. Keyword virtual coloscopy. Does this procedure have a future?

Goeser: There are two types of virtual coloscopies: One is performed in the CT (computer tomography) with x-ray radiation, the other is done in a magnetic resonance tomography (MRT). The advantage of both procedures is that no endoscope needs to be inserted into the bowels. The disadvantage of x-ray: The radiation exposure is very strong, which is why the Federal Office for Radiation Protection recommends performing this type of examination sparingly. The limitation of this procedure is also that about a third of important findings are being overlooked, including tumors. What’s more, after the detection of a polyp or even a tumor, a regular coloscopy needs to be performed anyway. Should this subsequently not be immediately possible, the irrigation procedure would have to be done again. In summary, this examination is to be rejected due to its high radiation exposure and lack of certainty in discovering polyps.
Performing the examination using magnetic resonance tomography is another conceivable way, because the radiation exposure could be avoided. Unfortunately, technology is not far enough advanced yet, where even smaller changes can be safely identified. Thus far you can only diagnose larger changes with reasonable certainty. In addition, the exam currently lasts a long time, sometimes up to two hours. The big hope of virtual coloscopy is that you can spare the patient the trouble of having to do a colonic irrigation – but this also has not been accomplished yet. For all these reasons, a “normal“ colonoscopy is preferred. Diseases like ulcerative colitis and also Crohn’s disease have been increasingly diagnosed in the past decades. Asia is slowly following, a continent where these diseases have been barely known for the longest time. Do you think there is a connection between our by now almost global diet?

Goeser: These diseases indeed have also something to do with diet. With Crohn’s disease we know this a little better than in the case of ulcerative colitis. In both diseases there is definitely a genetic predisposition. This is the prerequisite so these diseases can develop. In addition, many other factors flow into this disease pattern, which we still have not exactly identified. Is diet playing a role? That’s possible. We have known for some time for instance, that the Japanese who have a relatively high risk for stomach cancer, reduce this risk once they move from their native country to the US. This means, a relationship between diet and health or tumor disease is given. Medical science however is not yet in a position to say: If you have a certain genetic predisposition, then you only have to omit a certain food item and you will stay healthy. Until this is possible, we can still do something good for our bowels through a healthy and well-balanced diet, and prevent bad things by having preventive coloscopies.

This interview was conducted by Simone Ernst and translated by Elena O'Meara


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