The stomach is the first portion of the digestive tract in the abdomen, excluding the small portion of the abdominal esophagus. It was believed that the stomach’s highly acidic environment would keep it immune from infection. However, many studies indicate that most cases of stomach ulcers, gastritis, lymphoma and even gastric cancer are caused by Helicobacter pylori infection. One of the reasons this bacterium can survive is the production of an enzyme called urease that metabolizes ammonia and carbon dioxide to neutralize the hydrochloric acid produced by the stomach.

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The esophagus is a part of the digestive tract of human beings formed by a muscular tube of about 30 cm. The organ communicates the pharynx with the stomach. It extends from the sixth or seventh cervical vertebra to the eleventh thoracic vertebra. Food passes through it from the pharynx to the stomach. The esophagus runs through the neck and the posterior mediastinum (posterior to the thorax) until it enters the upper abdomen, crossing the diaphragm. The esophageal function is the food bolus transportation from the mouth to the stomach. Peristaltic waves are carried out between the upper and lower esophageal sphincters.

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Gastritis is the inflammation of the gastric mucosa. The gastroscopy appears reddened, presenting in various forms of reddish images in flames or as subepithelial hemorrhages. However, an accurate diagnosis is obtained by endoscopic examination. It is possible that only a part of the stomach is damaged or the whole gastric sphere is affected. Several causes include poor eating habits, stress, abuse of analgesics (aspirin, piroxicam, indomethacin, among others), autoimmune disorders or Helicobacter pylori infection.

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Anorectal pathology is very common in medical practice. However, it has been neglected due to certain psychosocial and cultural factors.

Our duty as medical practitioners is to change this behaviour, giving our patients the confidence and security they need. It is necessary to understand that their problem should not be, for any reason, a shameful or even an isolated case. Patients with benign (non-neoplastic) anorectal problems have an excellent prognosis once they have received medical care; when they have, they carry a host of questions and fears that few dare to express.

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Colitis is a gastrointestinal disorder consisting of the inflammation of the colon and the entire large intestine.

There are different types of colitis depending on the cause:

• Amebic.
• Ischemic.
• Irritable colon.
• Viral.
• Idiopathic.
• Polyposis.
• Ulcerative.

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Hiatus hernia or hiatal hernia is a pathological situation that occurs when part of the stomach is pushed into the thorax. The esophagus enters the abdomen from the thorax through a hole in the diaphragm. The stomach protrudes through this weakened hiatus and causes heartburn and chest pain. Persistence of this hernia can lead to metaplasia of the esophageal mucosa and result in Barrett’s esophagus. There are two types of Hiatal hernias:

• Sliding hernia
• Paraesophageal hernia

The word reflux means to go against a flow, in this case, the normal flow of food. Food passes from the mouth to the throat (pharynx) when swallowed. Then into the esophagus and then into the stomach. In the stomach, the food mixes with gastric juices composed of acid. This acid does not harm the stomach because the organ produces a mucous substance that protects it from the action of hydrochloric acid; however, this protective mucus is not produced in the esophagus, pharynx or mouth. Therefore, food and stomach acid returning to the esophagus cause irritation and burns.

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Esophageal manometry is a test to measure the pressure inside the lower esophagus. When swallowing, muscles in the esophagus contract to help push food into the stomach. Valves or sphincters inside the esophagus open to allow food and liquid to pass through and then close to prevent food, liquid, and stomach acid from flowing back up. The sphincter at the bottom of the esophagus is called the lower esophageal sphincter (LES).

During esophageal manometry, a thin, pressure-sensitive tube is passed through the mouth and nose into the stomach.

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Anorectal manometry is a technique for assessing the movements of the anus-rectum by recording intrarectal and anal canal pressures. A probe is inserted through the anus after lubricating it with a gel. The probe is connected to pressure recording equipment communicating to a computer monitor.

During the study, the patient can visualize the movements recorded on the monitor and is invited to perform various manoeuvres to know the functional state of the sphincters and the ability of these in conditions of retention and defecation. No preparation is required before the test.

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Esophageal impedance is one of the most recent diagnostic tools to evaluate gastroesophageal reflux disease. This technique is based on the continual monitoring of the electrical conductivity in the esophagus. A very fine probe is passed through the nose and placed in the esophagus 5 cm from the lower esophageal sphincter. This probe is connected to a monitor that records the esophagus pH for 24 hours. During this period, the patient leaves the clinic and carries out his normal activities in order to be able to evaluate as accurately as possible what is happening in his usual daily activities.

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Esophageal pH testing is defined as a broadly diagnostic test used in the field of gastroenterology and consists of recording the acidity levels of the esophagus by using a probe with acid-sensitive receptors and a computer to record the results obtained.

Both studies require the placement of a probe from the nose into the lower portion of the esophagus (in pH measurement) and into the stomach (in manometry). Sedatives and anesthetics are not usually used in the study since they can modify the result of the study.

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Biofeedback techniques generate auditory or visual signals using electronic instruments that allow a person to become aware of abnormal physiological and biological changes. Using these techniques, the patient modifies his or her organic states and provokes normal functioning. The objective of BF is to achieve in the person voluntary control, without the use of instruments, of his biological states. These techniques have given good results in treating impotence and gastrointestinal disorders (diarrhea, incontinence).

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Upper gastrointestinal endoscopy, or also (esophagogastroduodenoscopy)ranks high in the diagnostic evaluation and therapeutic management of some pathologies. Safety, anatomical refinement, and ability to obtain tissue samples justify its use as one of the foremost medical diagnostic instruments.

A wide diversity of endoscopic instruments is available that allows its diagnostic and therapeutic application to be extended to a wide range of pathologies, both benign and neoplastic.

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Colonoscopy is a visual examination of the colon mucosa (large intestine). In order to perform it, a flexible probe (colonoscope) will be introduced through the rectum. The doctor will use the optical probe to see any abnormalities such as ulcers, polyps or tumors.

If necessary, in the course of the examination, small tissue samples (biopsies) or intestinal fluid will be collected for microscopic examination without causing pain.

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The endoscopic bowel system capsule or PillCam allows the doctor to visualize the patient’s colon non-invasively. In the form of a disposable, easy-to-swallow capsule, a miniaturized camera is used to find disorders in the digestive system, such as polyps. Because it does not require any sedative, PillCam offers a more comfortable and less risky alternative to other methods.

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SmartPill is an ingestible capsule used by doctors to measure; pressure, pH and temperature. The pill travels through the gastrointestinal tract assessing gastrointestinal motility. The SmartPill motility monitoring test can be performed in a clinic or doctor’s office to evaluate motility disorders such as gastroparesis (a condition in which stomach contents empty too slowly) and chronic constipation.

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Gastrolyzer is a portable, non-invasive breath analysis device that monitors the breath’s hydrogen, methane and oxygen levels. It can aid in detecting and investigating gastrointestinal disorders such as lactose intolerance, small intestinal bacterial overgrowth and irritable bowel syndrome.

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Helicobacter pylori is a bacteria that infects the mucosa of the human gastric epithelium. Many ulcers and some types of gastritis are related to H. pylori infections. In many cases, infected subjects never develop any symptoms.

This bacteria lives exclusively in the human stomach, the only known organism that can subsist in such an extremely acidic environment. It is a spiral bacterium (from this morphological characteristic derives the name Helicobacter) and can literally “screw itself” to colonize the stomach epithelium.

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Stretta therapy is a minimally invasive procedure. It helps to reduce the symptoms of gastroesophageal reflux disease, allowing patients to eliminate and significantly reduce the use of a Proton-pump inhibitor. Stretta is an ambulatory procedure performed in less than 60 minutes, allowing patients to return to normal activities the next day. Stretta requires no incisions, stitches or implants.

The Stretta system delivers radiofrequency energy to the muscle between the stomach and esophagus, remodeling and enhancing muscle tissue, resulting in a better barrier and less reflux.

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Because the organism functions with bacteria, these coexist harmoniously with their primary host. However, the use of antibiotics and other diseases affect the balance of intestinal bacteria. Fecal microbiota transplantation is the transfer of healthy intestinal bacteria to a sick organism with digestive system disorders. This helps to correct dysbiosis and restore balance in the body.

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Liver biopsy is the medical process of obtaining a small sample of liver tissue for direct examination under a microscope. Although blood tests and clinical assessment provide much information, liver biopsy provides much higher accuracy for clinical decisions in diagnosing liver disease. The biopsy provides vital information to confirm any diagnostic suspicion. Nowadays, blood tests help to determine the cause of liver disease before the biopsy. However, liver biopsy is still the method of confirmation.

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Hepatitis is an inflammatory condition or disease affecting the liver. The causes may be infectious (viral, bacterial, among others), immune (autoantibodies, autoimmune hepatitis) or toxic (e.g. alcohol, poisons or drugs). Depending on its etiology, it is also considered a sexually transmitted disease. There are specific hepatitis viruses (hepatotropic viruses), i.e. those that only cause hepatitis. The most important are; A, B, C, followed by D and E viruses, and finally, F and G, the last ones and the least studied.

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It is the direct visualization of the lower digestive tract, rectum and sigmoid. It is a method of exploration performed with a sigmoidoscope. The probe uses cold light to view the mucosa of the lower digestive tract in the distal 25 cm in order to look for possible alterations.

The sigmoidoscope introduced is flexible and equipped with a photographic and video system.

It has a working channel to introduce forceps to take biopsies, probes with a balloon to dilate and electrosurgical equipment.

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In the digestive system, the duodenum is the part of the small intestine that connects the stomach to the jejunum. The duodenum is located in the upper and posterior part of the abdomen, in the retroperitoneum. Also, the only portion of the small intestine is fixed and formed entirely by smooth muscle. Its inflammation leads to duodenitis and is usually associated with gastritis and/or ulcers. After the food is combined with gastric acid, it descends into the duodenum. Here, it mixes with bile from the gallbladder and digestive juices from the pancreas. Absorption of vitamins, minerals and other nutrients begins in the duodenum.

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The Heliprobe is a device that diagnoses Helicobacter Pylori (HP) infection based on detecting 14CO2 in exhaled air. The Heliprobe determines three results:

• Grade 0 corresponds to a non-infected patient.
• Grade 1 (borderline): digestive endoscopy and biopsy are recommended.
• Grade 2: patient infected by HP.

Positive cases may require treatment with triple antibiotic therapy.

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Secca Therapy is a treatment option for patients suffering from bowel control disorder. Secca does not use implants, incisions or stitches and takes approximately 60 minutes. The treatment is for patients who have not responded to first-line therapies and search to avoid invasive surgery or foreign body implantation.

The Secca Therapy delivers Radio Frequency energy to the internal anal sphincter muscle, remodeling and improving the structure of the muscle and resulting in improved sphincter function. The system treats problems that can cause bowel incontinence and weak sphincter without surgery. As Secca Therapy does not involve surgery or the introduction of foreign substances, it can be used in patients without excluding other treatment options.

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