Services provided
At the Melbourne Gut & Liver Specialists we offer the following services.
SPECIALIST CONSULTATION
All our doctors are all qualified physicians in the area of gastroenterology, heptaology, and endoscopy. A consultation is the best way to offer a comprehensive assessment of your symptoms and find the best treatment for you. Initial consultation takes between 30 to 45 minutes, depending on complexity. Follow up appointments are usually 15- 30 minutes in length.
Consultation can be sought for any number of conditions, including but not limited to, iron deficiency, H.pylori infection, reflux disease (GORD), abdominal pain, coeliac disease, liver problems including fatty liver (NAFLD), eosinophilic oesophagitis, irritable bowel syndrome, nutrition, bowel and stomach cancer screening as well as inflammatory bowel disease.
GASTROSCOPY
A gastroscopy is a procedure done to examine your oesophagus, stomach and first part of the small bowel by passing a thing long tube with a small video on the tip through the mouth. This is done under deep sedation so you can be kept very comfortable.
During the gastroscopy small samples can be taken and your doctor can also treat conditions, such as stretching a narrowing (dilatation), stopping bleeding and removing polyps.
For certain patients at high risk of stomach cancer, screening and mapping biopsy can be undertaken.
COLONOSCOPY
A colonoscopy involves a long thin flexible tube being inserted through the large bowel into the end of the small bowel. The aim is to assess the lining of the bowel and to look for any abnormalities such as inflammation, ulcers and polyps (abnormal growths). This is done under deep sedation so that you are kept very comfortable.
During a colonoscopy, samples may be taken and therapeutic procedures can be done such as removal of abnormal growths.
This can be done with methods such as simple cold snaring, hot snaring or endomucosal resection (EMR). Internal haemorrhoids could also be ligated. Other additional techniques such as argon plasma coagulation, clipping, stricture dilatation and chromoendoscopy may be employed for certain conditions.
OPEN ACCESS ENDOSCOPY
In some patients, your GP may determine it is appropriate for you to proceed directly to a gastroscopy or colonoscopy without the need for a consultation first.
This is usually done when the indication is straight forward, such as NBCSP surveillance (positive faecal occult blood test or FOBT), reflux, polyp surveillance, rectal bleeding, iron deficiency and so on.
In this case, you can contact us to arrange a time to have your procedures done. You will meet and discuss your medical problem with the Gastroenterologist on the day of procedure.
Normalising Bowel Habits
& Defaecation Retraining Program
This program is offered by Amelia Chan a continence physiotherapist with postgraduate training and experience in bowel retraining for over 7 years In this program, Amelia will help you to find out the possible contributing factors of your presenting bowel problems and formulate a management plan.
Amelia is trained to find out if your muscles around the rectum and the abdominal muscles are working efficiently for the defaecation process and/or working adequately to help control your bowels.
She is also trained to help you improve your bowel emptying and/or bowel control via dietary changes or efficient use of appropriate laxative at the right time.
Management plan is individualised and could include lifestyle factors modification, choosing the right laxatives or weaning off laxatives, defaecation technique modification, breathing technique modification, stretches, and optimising the abdominal and pelvic floor muscle function for effective defaecation.
She is also experienced in using rectal balloon biofeedback therapy (which involves placing a small balloon in the rectum during the training session at the clinic) to retrain the sphincter and muscles around the rectum to perform correctly during defaecation or respond timely to defer urge. This therapy can also be helpful to train the rectum to register a proper urge to empty.
The first consultation usually takes an hour. Although this could vary between individuals, most patients require an average of 3-4 sessions of training at the clinic to achieve sustainable outcomes as getting the brain to learn new habits takes time. These training sessions are organised over a 3-6 month period and patients need to practice their new routine on a daily basis at home.
Gut directed hypnotherapy and general counselling
Christine offers general counselling and Gut-directed hypnotherapy. Gut-directed hypnotherapy is a clinical hypnosis technique which addresses the brain-gut axis to reduce symptoms of IBS. This technique uses relaxation, imagery and biofeedback to improve the body's ability to digest effectively and manage discomfort.
CDED (Crohns Disease Exclusion Diet)
CDED is a very specific diet that has been shown to be effective in reducing and treating inflammation and damage in the gut caused by crohns disease. Working with your gastroenterologist, you may use the diet in conjunction with crohns medications, or in some cases, as an alternative. The diet consists of 3 phases, and involves both food and enteral nutrition drinks.
Phase 1: (weeks 1-6)
50% of calories come from nutritionally complete drinks, 50% of calories come from a limited range of foods, including mandatory foods each day (chicken breast, potatoes, eggs, apple, banana) and optional extra foods (eg. rice, avocado, certain fruits and vegetables, olive oil, herbs and spices).
Phase 2: (weeks 7-12)
25% of calories come from nutritionally complete drinks, 75% of calories come from a broader (but still limited) range of foods. Mandatory daily foods stay the same, but extra options include more grains (eg. bread, quinoa, oats), fish and greater variety of fruits and vegetables.
Phase 3: (weeks 13 onward)
25% of calories continue to come from nutritionally complete drinks, and there are no longer any mandatory foods. The list of foods is substantially liberalised to include some dairy, more grains and most fruits and vegetables. More flexibility is allowed, with 5 days of the week following the diet and 2 days allowing meals out or disallowed foods (in moderation).
NB. Due to the restrictive nature and very specific requirements of this diet, guidance from an experienced dietitian is recommended. Our dietitian, Marnie Nitschke, is trained and accredited as CDED educator, and is here to help patients through the process.
Low FODMAP diet
The FODMAP diet has been researched and developed specifically for people with Irritable Bowel Syndrome (IBS). Below is a brief explanation of what the acronym stands for, and some of the high FODMAP culprits found in our diet. Our dietitian, Marnie is Monash University FODMAP trained, and has extensive experience using the diet with patients.
These are naturally occurring carbohydrates found in a variety of plant foods, and also some dairy foods. FODMAP sugars can be difficult for us to digest fully, but they are not harmful. The diet involves 3 distinct phases:
Phase 1 - Low FODMAP phase: This phase lasts 2-6 weeks. During this time, you will avoid foods high in all FODMAP groups, and replace these with low FODMAP alternatives.
Phase 2 - Re-challenge phase: During the re-challenge phase, your dietitian will guide you through specific FODMAP challenges, week by week, using carefully chosen foods, to help you determine your level of sensitivity to the different FODMAP sugars.
Phase 3 – Individualized diet: Once you know your trigger FODMAPs and level of sensitivity, your dietitian can help you to reintroduce some high and moderate FODMAP foods. This stage is important, to ensure that your diet is balanced in the long term for optimal health, wellbeing and of course to keep your gut healthy!