Gastroenterology And Hepatology

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. 

Services

• General Hepatology inpatient and outpatient services
• Liver Transplant Evaluation and Post Liver Transplant follow up
• Diagnostic and Therapeutic (interventional) services
  Research
• 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 follow up.
• 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 Pathology and the Division of Liver Transplant Surgery:

• Endoscopic Facilities
• Ultrasonogram
• 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

Outpatient activities

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
• Hematochromatosis
• Wilson disease
• Primary sclerosing cholangitis
• Liver tumors, especially Hepatocellular carcinoma and Metastatic liver cancer
• Hepato-Biliary tuberculosis
• Liver abscess

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. We provide:

• Diagnosis, medical or/and surgical treatment on an outpatient as well as inpatient basis. 
• Unique hotline for our registered patients in case of an emergency.
• Latest diagnostic and therapeutic (interventional) services, and screening, including preventive strategies for cancer. 
• Personal care, counseling, patient education, psychological support and empowerment.

Supporting Services

• Multidisciplinary Pancreas Clinic includes pancreatologists and a pediatric gastroenterologist
• Quick access to other experts such as diabetologists, surgeons, and the services of a modern Radiology Department and a Metabolic Lab
• Dedicated services of a clinic coordinator, diet and nutrition experts, and trained medical sociologists available
• The clinic has been operating for 10 years with one of the largest pancreatic registries in India (1400 patients)

Diagnostic and Therapeutic Facilities

• 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, and lithotripsy.
• Comprehensive management of alcohol-related pancreatitis, tropical pancreatitis, autoimmune, metabolic and drug-induced pancreatitis available.
• Pancreatic function testing and evaluation of idiopathic or unknown causes of pancreatitis offered.
• Distinctive Pancreatitis Care Program includes integration of clinical care, care for pancreatic diabetes and its complications, advice on diet and lifestyle, patient education and involvement in treatment decisions.
• Emphasis on patient quality of life, with a patient-oriented approach rather than a disease-oriented approach.

Management of Pancreatobiliary Cancers

• Diagnostic facilities available: Non-invasive tumour markers, endoscopic ultrasound (EUS) and EUS-FNA, established imaging modalities.
• Non-surgical management options available, including biliary drainage and stenting.
• Evaluation and management of pancreatic cysts and cystic cancers offered.
• Support from experienced pancreatobiliary surgeons from GI Surgery with vast experience in hepato-pancreato-biliary surgery, 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.

Under a single roof at the Gastrointestinal Haemostasis Centre the availability 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. We provide:

• Dedicated team of endoscopists, gastrointestinal surgeons, interventional radiologists, and vascular surgeons available 24/7 for treatment of upper or lower gastrointestinal bleeding
• Fully-monitored emergency ICU service and 24 hour endoscopic and surgical service for immediate control of massive bleeding
• Outstanding blood bank with capability to supply large volumes of blood components for patient resuscitation
• Availability of all investigational modalities in-house makes AIMS Centre for Digestive Diseases one of the best for evaluation of gastrointestinal bleeds
• Tertiary referral center for this pathology in the state of Kerala
• Patients with GI bleeding are resuscitated in the ICU if needed

Investigation for each patient decided through consultation between surgeon, interventional radiologist, and medical gastroenterologist.

• A dedicated liver clinic has been a part of GI department for almost a decade now with experience in Pre and post liver transplant management, Hepatobiliary malignancies and metabolic liver diseases.
• Transplant team composed of experienced transplant and vascular surgeons, supported by a large GI surgical and anesthetic team
• Pre-transplant workup and follow-up done at a monthly liver transplant clinic conducted by experienced hepatologist and the transplant team
• Treatment plans for individual patients with end-stage liver disease streamlined at the clinic
• Intensive Liver Care Unit intended for successful management of patients with various liver related condition.

• Founded by Prof V Balakrishnan, one of the first gastroenterologists of the country, the clinic has made giant strides into the world of pancreatic diseases.
• Pancreas clinic conducted in coordination with Medical Gastroenterology and Endocrinology departments for integrated care in diagnosing and treating those with diseases of the pancreas.
• coordinated with a group of Therapeutic endoscopists, pathologists, oncologists, diagnostic and interventional radiologists and surgeons

Comprehensive mental health services by multidisciplinary team comprising of Gastroenterologist, Psychiatrist, Psychologist and Clinical Nutritionist. The clinic deals with improving the physical, psychological, and emotional wellbeing of patients with disorders of the gastrointestinal tract such as irritable bowel syndrome (IBS), Inflammatory bowel disease (IBD) and Chronic liver disease (CLD).

The Amrita IBD clinic allows experienced specialists in the field to deliver focused care and facilitate interdepartmental cooperation during follow up and rehabilitation. At Amrita Hospital, Kochi, we have also started IBD registry to compile the records of all IBD patients and have initiated research studies including community outreach and screening programs, multigene mutation analysis and immunologic studies.

This clinic aims to identify patients early, maintain a detailed disease registry and provide top of the line treatment to all patients of IBD.

Amrita Hospital, Kochi is one of the few centres in South India to have a fully equipped motility lab replete with High resolution manometry for oesophagus, antroduodenal motility, biofeedback techniques and pH metry and Anorectal manometry. With a constantly changing definition for motility disorders of the GI tract, Amrita Hospital, Kochi has maintained global standards and kept up with recent updates to allow uniformity in disease interpretation and management. Experienced motility experts are in charge of the lab along with able GI technicians who are adept at performing the procedure with great ease.

Dysphagia is difficult to swallowing and a specialized clinic has been initiated in the hospital for patients with dysphagia. HRM studies are invaluable for these patients and can dictate management in a significant proportion. The GI department aims to team up with Neurology and the Head and neck department in order to adopt a global approach and provide optimal treatment.

Paediatric gastrointestinal diseases constitute a major portion of gastroenterology practice. GI diseases in the young are a unique set of diseases that require a separate skill set and experience. Endoscopic procedures in this population require the acquisition of separate, specifically tailored endoscopes to accommodate for differences in anatomy and indication.  There are only a few centres in India that offer training and services in paediatric gastroenterology. The GI department of Amrita Hospital, Kochi has a fully equipped division dealing with paediatric GI diseases with qualified paediatric gastroenterologists and basic paediatric endoscopes and accessories.