Gastroenterohepatology and gastroenterohepatological procedures.


Gastroenterohepatology is a branch that deals with the illnesses of the digestive system: esophagus, stomach, intestines, liver, pancreas. The digestive system illnesses cover for a major part of the population’s medical problems. The diet, everyday pace of life, stress, work and environment, together with the genetics are important factors in the appearance and development of the gastrointestinal illnesses.

Our check-ups do not aim at discovery and treatment only, but mostly at prevention of the illnesses and their early detection. We pay special attention to gastrointestinal endoscopy. We offer the following check-ups, investigations and services on a regular basis:

  • Gastroenterohepatological subspecialist check-up
  • Ultrasound of the abdomen
  • Upper and lower endoscopy (gastroscopy, colonoscopy, rectoscopy, anoscopy)
  • Consultations, advising, therapy, preventive check-ups, second opinion

Gastroneterohepatological subspecialist check-up

The check-ups in this department are performed by a doctor, specialist, subspecialist gastroenterohepatologist. After an interview about the existing illnesses and the current complaints, the doctor does a physical check-up, and asks for blood analyses if necessary.

If, based on the interview and the physical check-up, the doctor defines the reasons for the disorder, the doctor suggests diet regime and a suitable treatment. However, if that is not the case, and the reason for the disorder still remains vague, then the patient is advised to carry out further investigations like: abdominal endoscopy, colonoscopy, ultrasound of the abdomen etc.

Sometimes it happens that the health problems are not of abdominal origin, so the patient is suggested to consult another specialist doctor.

The patient is recommended to take along any previous medical reports, especially if s/he has already seen other specialists or has had therapy due to the fact  that s/he has had the health problem for a longer period of time.

The ultrasound machine emits sound waves that reflect from the organs in the abdomen and create an image on the screen. The frequency of the sound waves is beyond our hearing and that is why it is called ultrasound.

This procedure is very accurate when examining the liver, gall, pancreas, spleen, kidneys, bladder and prostate for men, large blood vessels and lymph nodes in the abdomen.

The check-up is completely painless and  harmless for the patient or for pregnant women. It lasts several minutes, there are no pains and no special preparation is needed.

Gastroscopy – endocopical examination of the esophagus, the sopmach and the duodenum.

Esophago – gastro – duodenoscopy (gastroscopy, for short) gives a direct insight in the upper part of the digestive tract. It is performed with a thin, flexible optical instrument (gastroscope) which is applied in the mouth to enter the esophagus, the stomach and finally the duodenum. Endoscopy of the upper part of the digestive tract is more detailed and accurate procedure than the X-ray barium.

Trained doctor, subspecialist, gastroenterologist performs the gastroscopy.

The patient is given local anesthetic for the mouth and the throat, and a sedative to feel relaxed during the procedure, whereas the lips are protected with a special tube. The patient is lying on the left side during the procedure. Since air is insufflated for a better view in the channel, the patient might feel a bit tense in the stomach. The patient can breathe freely during the procedure, without a feeling of pain, the only discomfort being a possible light irritation of the throat and a gag reflex. The entire procedure lasts 5 to 15 minutes. Many patients find it lightly uncomfortable, yet some others even fall asleep during the procedure.

Gastroscopy allows your doctor to evaluate the symptoms for permanent pain in the upper abdomen, nausea, vomiting and/or difficulties in swallowing. Gastroscopy is an excellent method for detecting the reasons for bleeding in the upper digestive tract, and is a more precise method than x-rays in discovering ulcers and tumors of the esophagus, stomach and duodenum.

During the procedure the doctor might collect tissue sample (biopsy), that can help differentiate between benign or malign tissue changes.

We must bear in mind that biopsy is taken for many reasons, even without a suspected cancer, for example, testing the presence of  Helicobacter pylori, a bacteria that causes ulcer. This procedure is not only diagnostic, but also therapeutic in the treatment of certain diseases.

It is best if the procedure is performed on an empty stomach, so the patient should not eat or drink (except for water) 6 hours prior to the procedure. Your doctor will tell you when to restrain from food. You should inform the doctor about the possible therapies you take, (so that the doctor can modify the doses if necessary), possible drug allergies, heart or lung problems. You should also inform the doctor if you are bound to take antibiotics when performing dental procedures, because in that case you will have to take antibiotic treatment for the gastroscopy as well.

After the procedure the patient remains under control until the drugs’ effects fade away. The patient might feel a slight discomfort in the throat or bloating, because of the air in the stomach. The patient is allowed to eat immediately after the procedure, provided the doctor does not recommend differently. Generally speaking, the results are available immediately after the procedure, except for some cases when it might take several days due to further examinations.

If the patient has taken sedative prior to the procedure, s/he is not recommended to drive even if s/he does not feel fatigue at all. For this reason, it is good to be accompanied home after the procedure, since the sedative can influence reasoning and reflexes for the rest of the day.

Complications are possible, yet very rare, especially when the procedure is performed by an experienced doctor, especially trained for this kind of examination. Light bleeding at the place of biopsy or when removing a polyp is possible, but it is usually really minor and there is seldom need for further steps. Other potential complications are: reaction to the medicaments that were used, heart and lung complications, and perforation of the area being examined. It is very important to recognize the signs of possible complications as soon as possible, so if the patient feels fever, high temperature, difficulties in swallowing or swallowed throat, chest or stomach pain, s/he should immediately inform the doctor.

Colonoscopy – endoscopic examination of the large bowel and a distal part of the small bowel.

Examination of the large bowel is necessary in cases of occult bleeding and/or presence of blood in the stool, unexplained anemia, irregular stool, sudden constipation, periodic constipation and diarrhea, unexplained stomach pain, bloating, weight loss, family history of colorectal cancer.

The doctor will give you detailed instructions regarding diet restrictions and cleaning the colon, which is essential before the procedure.  Generally speaking, the preparations are based on consuming laxatives a day or two before preforming the procedure. The colon must be completely clean so that the procedure can be accurate and thorough, therefore you must follow the doctor’s instructions carefully and precisely.

Colonoscopy is not complicated and it rarely causes heavy pains. The patient might feel pressure, bloating, or cramps in the stomach. Therefore the patient is given pain killers and sedatives before the procedure, to feel more relaxed and cope possible discomfort. The patient lies on the back, or on the side, while the doctor slowly examines the colon. The procedure usually lasts 15 to 60 minutes.

The patient is given and explained the examination results. However, in case of possible biopsy, it will take several days for a final interpretation of the results.

If the patient has taken sedative prior to the procedure, s/he is not recommended to drive even if s/he does not feel fatigue at all. For this reason it is good to be accompanied home after the procedure, since the sedative can influence reasoning and reflexes for the rest of the day. The patient might feel cramps in the stomach due to the air insufflated during the procedure. The discomfort disappears after letting the gases out. Generally, the patient can eat after the procedure, however possible reductions might be suggested, especially after a polypectomy.

Ви бидат објаснети резулатите и наодот од прегледот, иако понекогаш можно е да има потреба да се почекаат резулатите од евентуалната биопсија за целосно да биде интерпретиран наодот.

Complications are possible, yet very rare when performed by an experienced doctor, especially trained to perform the procedure. Light bleeding after biopsy or polyps removal may appear, but it is usually minor, and there is no need for further monitoring.

Colon perforation is possible, but very seldom complication, which takes surgery to be resolved. Other possible complications might be: intolerance of the therapy (the drugs prescribed), heart and lungs complications.

Although the complications are rare cases, it is extremely important to recognize the signs of possible complications as early as possible. The patients should contact the doctor if they feel sharp stomachache, fever and high temperature, notice rectal bleeding, which can sometimes appear several days after the procedure.