Now capsule endoscopy can do a therapeutic procedure internally : Dr. Lorance Peter

April 28, 2019

The interaction between food and the bacterial flora influences the genetic expression in our intestinal epithelial cells. Generally, there are tremendous improvement in the expression of multiple types of inflammatory diseases like fatty liver, inflammatory bowel disease and celiac disease.

Shahid Akhter, editor, ETHealthworld spoke to Dr. Lorance Peter, HOD and Senior consultant (Department of Gastroenterology and Hepatologist) at Columbia Asia Hospital, Bangalore to know more about interaction between food and the bacterial flora and also about the advancements in endoscopic procedures.

Gastroenterology trends

Globally and in India, there has been a lot of progress in diagnosing diseases and understanding the exact patho-physiology or what leads to the disease. There have been tremendous leaps and bounds in progress.

For example, diseases like fatty liver, inflammatory bowel disease, food allergies and gluten allergies - people are recognizing the key factors involved including the nutrition, and how it causes expression of the disease by producing some changes in our genetic expression. People have done extensive research and there are hundreds of papers coming out every month.

Basically, the concept is that our gut microbiome which we carry around 2-3 kgs in each individual, has a diverse nature. There are good and bad bacteria and how our food and nutrition affects the type of bacterial flora. The interaction between food and the bacterial flora influences the genetic expression in our intestinal epithelial cells. Generally, there are tremendous improvement in the expression of multiple types of inflammatory diseases like fatty liver, inflammatory bowel disease and celiac disease.

Even this has been put into therapeutic strategies, by trying out changing of bacterial flora in these conditions. For example, there has been recent trends on changing of bacterial flora, even globally and in India.

The other trend which is trending in gastroenterology is newer technologies. We have newer equipments, technologies, accessories and instruments that we use and even miniaturizing into a capsules.The progress is moving towards capsule endoscopy that can do a therapeutic procedure internally.

We have developed the recent trend in endoscopy which is called third-space endoscopy. First space is our external space and second space is our internal space. What is inside our mouth or intestines and digestive system is the second space.

Third space is in between these two spaces. Now, we have realized that we can go through the second space into our intestines and tunnel it through the third space and can do lot of therapeutic procedures like early detection and removal of cancers, even tumors through mouth or the rectal area or colonoscopy area.

There are tremendous progress made in these kind of endoscopic procedures because of the progress made in refining and making better tools which work through these instruments. This is catching up globally and in India we have leaders in these kind of procedures and doing very advanced therapy.

The third progress is in the medications. From giving anti-inflammatory or anti-tumor cells and we are going into targeted therapies in every field. Like inflammatory diseases, we are able to look at what is causing the inflammation, what are the pathways involved and target the therapy through certain blockers or even monochonol biologics which go and blocks the specific activated pathway.

Gastroenterology: Impact of technology

Initially a few years back, we had capsule endoscopies which has come in. Few years back, it was just a visualization after mucosa and now we have capsules which not only visualizes the mucosa, forward and backward in better angles, better resolution, more frames per second and also which can measure the pH, transit, temperature and can detect abnormal blood and cells in the mucosa.

The miniaturization technology is becoming quite advanced. Even therapeutic procedures, people are looking at capsules which can biopsy, from deeper inside and even basic simple procedures like bleeding points, coagulation are things which are also catching up in the newer technologies.

The transplantation and the process of organ preservation, all these technologies have made leaps and bounds and changes have been made in this field.

Gastroenterology: Challenges

The major challenges are infectious diseases. We still have a challenge in controlling them, giving safe water, safe and complete vaccination and preventing infectious diseases is a big challenge in India itself because of our poor sanitation, poor health issues and general care.

The other challenges are complex diseases. Understanding what causes the real disease and what prevents a person from getting/not getting a disease or what is the trigger factor for many diseases like inflammatory bowel disease, celiac disease and fatty liver. We are all scratching on the top and we are trying to reach that what exactly is the reason.

There may be a future where we are able to identify what exactly is going wrong in a particular person and what is his genetic makeup. What is the process which is happening in such a person, and we can prescribe personalized medicine.

Identifying these factors requires sophisticated testings, which may be testing your genomics, metabolomics or even transcriptonomics or proteinomics. What kind of proteins are you producing in your blood? What kind of RNA are you transcribing? That will tell us as to what exactly is going wrong in a person and getting into a particular personalized care for them.

Columbia Asia Hospital: As differentiator

In Columbia Asia we have a more holistic kind of an approach to every disease and we have complete set of the latest equipments, for diagnosis and therapeutics. We have a skilled group of people handling each department and in majority of the cases, we have a combined discussion between the surgeon, physicians, pathologists, nutritionists and we arrive at a common ground and also we respect the patient’s rights. We also include the patient’s conscious decision and inform decisions in managing these patients.

We are able to give informed, consensual treatment to each patient taking in the inputs of the surgeons, medical specialists and everyone involved. Hence we are able to give a comprehensive therapy.