Frequently Asked Questions (FAQs) related to bowel and liver diseases in Sri Lanka
Why does everyone have 'gastritis'?
Symptoms of pain or 'burning sensation' in the upper
abdomen or abdominal fullness after meals or early satiation
are expected in up to 30-50 % of the population worldwide.
However, these are common symptoms and do not
necessarily mean an upper gastrointestinal endoscopy
(UGIE) is needed.
However, patients who also have 'sinister' symptoms of
persistent loss of appetite, unintentional weight loss,
difficulty swallowing food, recurrent vomiting, evidence of
blood loss or anaemia etc., need UGIE to look for an
underlying sinister cause.
Alternatively, stress or even depression may present with
similar 'gastritis' symptoms and should be addressed
accordingly and may not resolve entirely within addressing
these psychological issues.
Screening for large bowel carcinoma?
Colorectal or large bowel carcinoma (CRC) is the third most
common cancer worldwide.
CRC start as a polyp (small fleshy growth in the colon). If
detected early and removed, polyps can be prevented from
Some countries screen asymptomatic (those without
symptoms) adults (45-75 years) by testing the stools for
blood (stool for occult blood on three consecutive days) to
detect patients who are more likely to have colonic polyps
or early CRC. These patients with positive stool occult blood
are invited for screening colonoscopy to detect and treat
The presence of persistent loss of appetite, unintentional
weight loss coupled with a change in bowel habits or
passage of blood in their stools may be suggestive of CRC.
Therefore, if someone has these symptoms, they should be
investigated with a colonoscopy, especially as one grows
What's fatty liver disease, and what does it mean if found in my scan.
Foods rich in calories, unhealthy fats and sugars are
becoming more common in Sri Lanka. More people are
adopting a sedentary lifestyle with reduced day-to-day
physical activity. When we consume more calories than we
use in our daily activities, our bodies save them up and store
them as fat. Not only do we gain weight and become fatter,
but the excess fat also gets deposited in our livers, which is
called 'non-alcoholic fatty liver disease.
Fatty liver disease may be detected incidentally when an
abdominal scan is done for another reason or on routine
blood tests with elevated liver enzymes.
Usually, the fatty liver disease does not cause any
symptoms. However, fatty liver disease is commonly
associated with obesity, diabetes, high blood pressure and
abnormal blood lipids. Therefore, if not detected and left
untreated, fatty liver disease can lead to cardiovascular
complications (heart attacks and stroke), liver cirrhosis, and
Do all patients with fatty liver lead to cirrhosis long
Not everyone who has fatty liver will progress to develop
cirrhosis. The majority will not move to cirrhosis. However, a
minority may progress to cirrhosis slowly, usually over
The risk of progression to cirrhosis in higher among those
with liver fibrosis (scarring of the liver). This risk may be
greater with age, obesity or increased weight, poorly
controlled diabetes, hypertension, high cholesterol and a
family history of cirrhosis and associated alcohol
Controlling these factors, losing weight through regular
physical exercise and maintaining a diet low in calories longterm can reduce or prevent someone with fatty liver from
progressing to cirrhosis.
Can taking diabetic drugs for a long period cause
No, this is a myth. Drugs prescribed for diabetes,
hypertension or high cholesterol never cause cirrhosis. It is
quite the opposite. These drugs, by helping to control
the disease, hypertension or high cholesterol, will help
prevent the development of cardiovascular
complications (heart attacks and stroke) related to
fatty liver disease.
What is cirrhosis of the liver?
Cirrhosis is a common term referring to permanent
liver damage in the presence of long-term liver injury.
However, the extent of the damage and manifestations
is variable. Those with early cirrhosis may not have
symptoms or complications for a long time. Those who
have advanced cirrhosis have a worse outcome and
ideally need a liver transplant.
Is cirrhosis always due to alcohol?
Although long-term, unsafe alcohol intake may lead to
cirrhosis, over half of the patients with cirrhosis in Sri
Lanka have "non-alcoholic" cirrhosis. These patients
have either not consumed any alcohol or consumed
only occasional safe amounts. Many of these patients
have a long history of obesity, diabetes, hypertension
and high cholesterol and likely have cirrhosis related to
non-alcoholic fatty liver disease. In addition, rare
genetic conditions, autoimmune conditions of the liver
and chronic viral hepatitis (hepatitis B & C) may also
cause cirrhosis, so cirrhosis is not always due to
I'm taking alcohol regularly - Can I have cirrhosis?
If you have any concerns, a routine abdominal
ultrasound scan can check if you do or do not have
cirrhosis. Otherwise, you can even do a simple blood
test - complete blood count (CBC) and liver enzymes
(ALT and AST) so the doctor can calculate the risk of
having significant liver fibrosis (early cirrhosis). Those with
abnormal values on this calculation (FIB-4 score) will need a
special liver scan (FibroScan) to detect and estimate liver
stiffness. A FibroScan accurately "rule in" or "rule out"
significant liver fibrosis and see those with advanced liver
fibrosis or early cirrhosis.
If someone has cirrhosis, do they have to abstain from alcohol completely?
If you or a loved one has cirrhosis, it is essential that they
completely stop taking any alcohol. In cirrhosis, any alcohol
consumption quickly causes liver disease progression.
Do all patients with cirrhosis need liver transplants?
Patients with early cirrhosis do not need a transplant.
However, there is a tendency for liver fibrosis to progress
gradually over a while. It is difficult to predict this; in some
patients, the disease may remain very stable for a long time. However, suppose the liver damage has progressed to
advances stages with the development of symptoms (yellow
discoloration of eyes, swelling of the abdominal and ankles)
complications of cirrhosis (vomiting of blood, passage of
dark tarry stools, excessive drowsiness, confusion or
episodes of unconsciousness or early liver cancer). In that
case, a liver transplant is the only treatment that will cure
Liver transplant and Organ Donation
A liver transplant is a complex and demanding surgery that
can be selectively offered to suitable patients. After
successful transplantation, such selected patients can live a
'near normal' life.
There are two sources of organs for transplantation. The
liver can be received from a brain death donor such as those
after a massive brain injury after a road traffic collision,
where there is absolutely no possibility of recovery, but
where in such situations the patient was connected to a
breathing machine or "ventilator" and as a result, their
organs such as their liver, were in good condition. Donation
of such organs by the brain-dead person's family can
potentially save the life of a patient who is waiting for
transplantation and has no hope of otherwise surviving.
Worldwide there is a huge shortage of such organs as there
will usually be more patients who need a transplant, and
only a few organs available for transplant. Hence, good
public awareness to help promote organ donation is vital for
a country to have a successful transplant program.
Alternatively, part of the liver can be donated from a living
donor as around two-thirds of a healthy liver can be
donated, and the remaining liver can "grow back" relatively
soon. This is commonly practised in pediatric patients with
cirrhosis, where their mother or father may donate part of
their liver. Donations of such organs by living donors should
always be made purely with altruistic intentions without any
financial interests etc.
The Sri Lanka Society of Gastroenterology (SLSG) is the country’s foremost organization dedicated to the development and promotion of the fields of Gastroenterology and Hepatology