Gastroenterology and Hepatology
The Department of Gastroenterology and Hepatology at Amrita Institute of Medical Sciences is comprised of the following services and areas of speciality:
- Centre for Liver Diseases
- Centre for Pancreatic Diseases
- Paediatric Gastroenterology
- Diagnostic and Therapeutic Endoscopy and ERCP
- Centre for Swallowing and Oesophageal Disorders
- Gastrointestinal Haemostasis
- Cancer Detection and Palliation Unit
State of the art diagnostic modalities include:
- All forms of upper and lower gastrointestinal video-endoscopy
- Small bowel enteroscopy
- Motility studies
- High speed helical CT scans
- MRI (with facilities for noninvasive cholangio and pancreatography and MR angiography)
- Colour Doppler studies
- Fluoroscopic imaging of the liver, gall bladder, bile ducts, pancreas and intestinal tract
- Intraoperative fluoro-radiology (image intensifier)
Nuclear medicine facilities offer tests such as mebrofenin (HIDA), blood pool and Meckel's scanning and bone scans. All tests provide highly accurate detection of disease. Screening facilities for digestive disorders are also available.
Centre for Liver Diseases
The Centre for Liver Diseases offers comprehensive services to patients with acute, chronic, and end-stage liver diseases. The clinical core of the Centre for Liver Diseases consists of outpatient and inpatient consultations aiming at comprehensive, multidisciplinary approach to a variety of liver diseases. We coordinate and deliver state-of-the-art diagnostic and therapeutic procedures and liver transplantation in an evidence based fashion.
- General Hepatology inpatient and outpatient services
- Liver Transplant Evaluation and Post Liver Transplant follow up
- Diagnostic and Therapeutic (interventional) services
- Patient Education
- Screening and Prevention
Clinical areas provided by inpatient services
- Management of liver cirrhosis and its sequelae like hepatic encephalopathy, ascites, portal hypertensive bleeding, hepatorenal syndrome, spontaneous bacterial peritonitis.
- Management of acute and chronic hepatitis of different etiologies with state-of-the-art medical therapies.
- Treatment of Fulminant hepatic failure in a dedicated ICU area, in close co-operation with the Division of Liver Transplant Surgery.
- Liver Transplantation-pretransplant workup and post transplant followup.
- Multidisciplinary approach to the management of liver malignancies (primary or metastatic).
We coordinate and deliver the following diagnostic and therapeutic modalities in close co-operation with Radiology, the Centre for Laboratory Medicine, Liver Oathology and the Division of Liver Transplant Surgery:
- Endoscopic Facilities
- Lab facilities for clinical pathology, biochemical and virological work up
- Liver biopsy (percutaneous or transjugular) with complete histopathological staining including special stains
- Copper and iron quantification on liver biopsy specimen
- Hepatic vein pressure gradient(HVPG)
- Radiofrequency Ablation (RFA)
- Transarterial Chemoembolization (TACE)
- Percutaneous Aspiration/Drainage of liver abscess/hepatic cyst
- Transjugular Intrahepatic Portosystemic Shunt (TIPS)
- Paracentesis with or without pigtail insertion
- Liver transplantation
State-of-the-art facilities for the complete diagnosis and management of whole spectrum of acute and chronic liver diseases, including:
- Viral hepatitis
- Alcoholic hepatitis
- Lifestyle liver disorders-Fatty Liver, Non-alcoholic Steatohepatitis (NASH)
- Drug-induced hepatitis
- Autoimmune liver disease
- Cirrhosis of various etiologies
- Genetic abnormalities
- Metabolic disorders
- Wilson disease
- Primary sclerosing cholangitis
- Liver tumors, especially Hepatocellular carcinoma and Metastatic liver cancer
- Hepato-Biliary tuberculosis
- Liver abscess
Centre for Pancreatic Diseases
The Amrita Pancreas Clinic
The Pancreas Clinic offers comprehensive services by experienced pancreatologists with long track records for patients with acute and chronic pancreatitis, pancreatobiliary cancers and pancreatic cystic disease. The services comprise comprehensive care including detailed workups, diagnosis, medical or/and surgical treatment, when indicated, on an outpatient as well as inpatient basis. We provide a unique hotline for our registered patients to contact the clinic staff directly in case of an urgent problem. All the newest and world class diagnostic and therapeutic (interventional) services, and screening, including preventive strategies for cancer, are available here. The centre has for many years undertaken research into the causative factors of pancreatitis and published books and research papers. We offer the patient all the current options in treatment with the patient's perceptions in mind. Personal care, counseling, patient education, psychological support and empowerment makes this clinic unique in this category.
The multidisciplinary Pancreas Clinic includes pancreatologists and a paediatric gastroenterologist, with quick back up by other experts such as diabetologists, surgeons, and the services of an ultra-modern Radiology Department and a Metabolic Lab. Dedicated services of a clinic coordinator, diet and nutrition experts and trained medical sociologists are available in the Pancreas Clinic. The clinic has been functioning for the past ten years now and it has one of the largest pancreatic registries in India; nearly 1400 patients.
Diagnostic and Therapeutic Facilities
Facilities include Endoscopic retrograde cholangiopancreatography (ERCP), Multi-Slice CT scan, Magnetic resonance imaging (MRI), Magnetic resonance cholangiopancreatography (MRCP), pancreatic stenting, pseudocyst drainage, Endoscopic ultrasound (EUS), Endoscopic ultrasound-guided FNA (EUS-FNA), celiac plexus block, lithotripsy, etc. Comprehensive management of alcohol related pancreatitis, tropical pancreatitis, autoimmune, metabolic and drug induced pancreatitis etc is also available. Pancreatic function testing and evaluation of idiopathic or unknown causes of pancreatitis is undertaken here.
The highlight of our distinctive Pancreatitis Care Programme is the integration of clinical care of pancreatitis, care of pancreatic diabetes and its complications, advice on diet and life style during each visit, explaining the basis of the disease and the rationale for decision making and making the patient a full partner in the treatment of his/her disease. In this clinic the maximum emphasis is laid on the quality of life of the patient - it is totally patient oriented and not disease oriented.
Management of Pancreatobiliary Cancers
Diagnostic facilities available include non-invasive tumor markers, endoscopic ultrasound (EUS) and EUS —FNA apart from all established imaging modalities. Non-surgical management including biliary drainage and stenting, etc. is available. Evaluation and management of pancreatic cysts and cystic cancers is also undertaken. Excellent support is extended to the Pancreas Clinic by the pancreatobiliary surgeons from GI Surgery. This group of surgeons have a vast experience in hepato- pancreato-biliary surgery and routinely undertake all types of surgeries ranging from the simplest to the most complicated, including liver transplantation.
The Paediatric Gastroenterology wing has been set up to provide efficient diagnosis and management of paediatric gastroenterological and hepatobiliary problems.
Endoscopy including upper and lower GI and ERCP, nuclear scans and endoscopic ultrasonography of paediatric patients are being routinely performed.
Centre for Gastrointestinal Haemostasis
A dedicated team of endoscopists, gastrointestinal surgeons, interventional radiologists, and vascular surgeons are available around the clock for treating patients with upper or lower gastrointestinal bleeding. A fully-monitored emergency ICU service, an outstanding blood bank which provides blood component therapy, and a 24 hour endoscopic and surgical service ensure immediate control of massive bleeding. Complex diagnostic and therapeutic modalities often avoid the need for high-risk surgery.
The availability of all the investigational modalities within the hospital itself makes the AIMS Centre for Digestive Diseases one of the best centres for evaluation of gastrointestinal bleeds. The unit has risen to be a tertiary referral centre in the state of Kerala for this pathology. Patients presenting with GI bleeds are resuscitated in the intensive care setting if needed. A blood bank that is capable of supplying large volumes of whole blood or its components even at short notice helps in the resuscitation of these patients.
The investigation required for each patient is decided after consultation between the surgeon, interventional radiologist and the medical gastroenterologist.
The availability under a single roof of all advanced imaging techniques like Upper GI Endoscopy, Colonoscopy, Enteroscopy, CT Scan, MRI Imaging, On-table Enteroscopy, Angiography and Nuclear Medicine scanning ensures that a patient will not need to be shifted out of the hospital for any evaluation.
Unlike many other centres, all these facilities are available round the clock at AIMS. No time is lost in the evaluation and treatment of these patients.