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A growing body of evidence suggests an interesting overlap between the gut, the brain and emotional state. Chronic digestive disorders such as IBS are thought to occur when the enteric nervous system (gut) and the central nervous system (brain) do not ‘communicate’ properly with each other. Serotonin is a neurotransmitter (a chemical messenger) which impacts mood, sleep and appetite. Interestingly, almost all of the body’s serotonin can be found in the gut and the rest is found in the brain. Emotional state is therefore connected in some way to the gut.

A recent study found that a majority of patients with functional Gut conditions also had coexisting psychological conditions (eg anxiety and depression). Another found that patients with chronic digestive disorders (such as IBS) have higher levels of psychological distress and experience a lower quality of life than the general population. 

Individuals with IBS may become particularly anxious about Gut-related events (eg bowel movements, abdominal cramps and mealtimes), also known as Gut symptom-specific anxiety. Because an individual may become hypervigilant to their symptoms, they may experience increased fear and arousal in relation to them. Thinking about symptoms becomes a trigger for anxiety, and the body’s resulting stress response can either make symptoms appear or make them worse. This thought cycle therefore becomes a self-fulfilling prophecy. As a result, gastroenterologists might aim to manage IBS by using psychological therapies in an attempt to reduce symptoms by lowering the body’s stress response.

Psychogastroenterology is the term used to describe the science of applying psychological principles, techniques and therapies to help manage chronic digestive disorders, such as IBS. Its aim is to help patients better manage their symptoms, and may be used in combination with other treatments, such as medication. The main techniques used are cognitive behavioural therapy (CBT), relaxation therapy and hypnosis. 

CBT aims to modify certain thoughts and behaviours so that they are more conducive towards achieving a positive psychological state. Sessions are carried out with a qualified healthcare professional and typically require a regular commitment over a set period of time. New data suggests that remote CBT using video or telephone consultation may be superior to office-based therapy in patients with moderate-severe IBS.

Relaxation therapy involves diaphragmatic breathing exercises and progressive muscle relaxation to help calm the body’s stress response. If the body’s stress response can be reduced then hopefully this can decrease the severity of symptoms an individual experiences and therefore decrease Gut symptom-specific anxiety. 

Hypnosis, despite being a controversial subject in the medical community (due to an historical lack of controlled evidence), has shown to be an effective treatment for IBS for some individuals. Sessions challenge patients to progressively relax their thoughts on IBS symptoms by using calming imagery and sensations. It can bring about improvements in physical and mental wellbeing. 

Although we do not know whether psychological distress is the cause of IBS or indeed a symptom of IBS, it is clear that there is good reason for gastroenterologists to address the psychological aspect of IBS when considering a patient’s treatment plan. 

For more information, please contact Dr Adam Harris. 



Coeliac disease is an autoimmune condition where the small intestine is chronically inflamed, and nutrients from food may not be absorbed properly. This is due to a permanent allergy to gluten in the diet (present in wheat, barley and rye), which activates an abnormal mucosal immune response. Coeliac disease is treated effectively in the majority of patients by sticking to a 100% gluten-free diet indefinitely. Although a gluten-free diet is an effective treatment in most patients, a significant minority develop persistent or recurrent symptoms. Difficulties sticking to such a diet have led to the development of non-dietary therapies, several of which are undergoing trials in human beings.

Coeliac disease is common: in the UK, 1 in 100 people have it, and numbers are rising. It is more common in individuals with a first-degree relative (ie a parent or sibling) with the condition and in people from or with close relatives from Ireland and Finland. Patients with conditions such as type 1 diabetes, microscopic colitis, autoimmune thyroid disease, Down’s syndrome and Turner syndrome are at a higher risk of having coeliac disease.

The diagnosis may be considered in people with iron deficiency anaemia, low folate or vitamin D, chronic fatigue, in pre-menopausal women with osteoporosis, or in those with recurrent abdominal bloating, loose stools, constipation or weight loss. 

In patients with symptoms suggestive of coeliac disease a blood sample may be taken to look for special proteins or antibodies (anti-transglutaminase) that develop in patients with untreated coeliac disease. These are accurate in most cases (about 90%) but the “gold standard” diagnosis requires taking small samples (biopsies) from the small intestine at upper gi endoscopy and looking at these under a microscope to look for the characteristic signs of villous atrophy and an excess of inflammatory cells (lymphocytes). This test may be needed in patients who do respond to a gluten-free diet.

Coeliac disease is not to be confused with non-coeliac gluten sensitivity, which may present with similar symptoms but in the presence of normal blood tests and small intestine, and may improve on a gluten-free diet. Interestingly, a recent study found a subset of individuals with chronic fatigue syndrome may have sensitivity to wheat and related cereals in the absence of coeliac disease and may respond to dietary restrictions. There is still research to be done.

Advice on gluten free diet and what alternative foods can be eaten to maintain a balanced diet is best obtained from a state-registered dietician with experience in coeliac disease. Your GP (or a consultant gastroenterologist) will be able to make a referral for this advice if required.

For more information, please contact Dr Adam Harris.



Following a month of indulgence, many decide to make lifestyle changes in January. Some try dietary restriction (eg ’Veganuary’) or reduce their total caloric intake, while others abstain from alcohol (eg ‘Dry January’) or jumpstart new exercise regimes. There are even some heroes among us making several changes at once. While it is advised that individuals take proper care of themselves year round, it is appreciated that this does not always happen.

Of topical interest therefore is that intermittent fasting proves beneficial for weight loss in both animal and human studies. As humans, we have not evolved to consume three large evenly-spaced meals throughout the day (plus snacks). This is a symptom of modern life and is due to an abundance of resources. Rather, we went for short stretches of time without food. We still needed to perform, to hunt prey and escape predators, but we did so in a fasted state.

Two methods of intermittent fasting in humans provide evidence-based weight loss, specifically the 5:2 regime (fasting 2 days per week), and daily time-restricted feeding (leaving, for example 18 hours between dinner and breakfast the next day, ie a 6-hour eating period). Comparatively, intermittent fasting seems to provide greater health benefits than a simple reduction in daily caloric intake, and might be considered the method of choice for effective weight control, metabolism of energy, and improved health across the lifespan.

Healthcare professionals may not understand how to prescribe intermittent fasting regimes. Patients may also be unwilling to start one. This may be due to several unpleasant short-term effects, such as increased levels of hunger and irritability, and decreased concentration. Ideally, a patient would ease into the plan over a number of months, in order to minimise any unpleasant effects. This allows time for the body to adjust. The following plans can be considered for 5:2 intermittent fasting and daily time-restricted feeding, respectively:

5:2 Intermittent Fasting

    • For month 1: 1000 calories 1 day per week
    • For month 2: 1000 calories 2 days per week
    • For month 3: 750 calories 2 days per week
    • For month 4: 500 calories 2 days per week

Daily Time-Restricted Feeding

    • For month 1: 10 hour feeding period 5 days per week
    • For month 2: 8 hour feeding period 5 days per week
    • For month 3: 6 hour feeding period 5 days per week
    • For month 4: 6 hour feeding period 7 days per week

A new year provides a convenient opportunity for a fresh start, and widespread participation and media coverage provides a sense of camaraderie between friends, family and colleagues. This may increase the odds of success, and if nothing else, at least everyone is miserable together. If you still find yourself feeling unsatisfied with any lifestyle changes you may have made in January, then what about trying ‘Fasting February’?

For more information, please contact Dr Adam Harris.



This is a very common bacterial infection of the stomach lining. It was first discovered by Drs Warren and Marshall (subsequently awarded Nobel prizes for their amazing finding). It is thought to be caught in childhood and is very common in developing countries. In about 10% of infected individuals the bacterium may lead to a significant increase in the amount of acid produced by the stomach and this may lead to a duodenal ulcer or in older people, a stomach ulcer. Curing the infection (called eradication) will heal the ulcer and prevent it recurring.

Most people with H. pylori infection will be unaware of the infection or may develop intermittent indigestion (dyspepsia); the benefit of eradication therapy in such cases is less clear cut.

There is an association between long standing infection with H. pylori and an increase in the risk of developing cancer of the stomach. The latter condition is however getting less and less common in the UK and this is probably related, at least in part, to the decrease in the number of people infected with H pylori.  Large studies in South East Asia and more recently from Sweden, have shown a decrease in stomach cancer after eradication of the infection.

The infection has evolved with humans and some believe that is may confer a health benefit in some people (ie in those where it doesn’t cause an ulcer or stomach cancer). Thus, recent data found a possible protective role against Barrett’s oesophagus, eosinophilic oesophagitis (a chronic inflammatory disease of the oesophagus) and inflammatory bowel disease (a chronic inflammatory disease of the colon).

Patients who see their GP with indigestion (dyspepsia) may be checked (by a blood, stool or breath test) to see if they are infected with H. pylori and if so, offered treatment to cure the infection to see if the dyspepsia improves. This improvement in symptoms is most likely if the dyspepsia was due to a duodenal or stomach ulcer caused by the bacterial infection. Success or failure may be determined either by improvement in symptoms or by performing a special breath test (can be prescribed by your GP and undertaken either at home or in the GP surgery).

Curing (or eradicating) infection with H. pylori is more difficult than treating other infections. It requires treatment with 2 antibiotics (eg metronidazole, amoxicillin or clarithromycin) and an acid-lowering drug (eg omeprazole or lansoprazole) all taken twice or three times daily for 7-10 days. This treatment will work in about 80-90% of cases. In an era of growing antibiotic resistance, there is no evidence-based treatment for H. pylori patients with penicillin allergy and prior exposure to clarithromycin.

For more information about H. pylori and potential treatment options, please do not hesitate to contact Dr. Adam Harris.



A hiatus hernia is when part of the stomach is pushed (herniated) into the lowest part of the chest through an opening (the hiatus) in the diaphragm. In most cases, the portion of stomach is pushed across the hiatus in a vertical direction and may move up and down producing a sliding hiatus hernia. In less than 10% of cases the stomach may herniate next to the gullet or oesophagus leading to a rolling or para-oesophageal hernia. Hiatus hernias can affect anyone, but they are more common in people who are over 50 years of age, overweight or during pregnancy.

Many people with a hiatus hernia are unaware of it but it may be associated with gastro-oesophageal reflux disease (GORD) due to the movement (reflux) of stomach acid into the gullet. The commonest symptom of GORD is heartburn; other symptoms may include food regurgitation, a bitter or sour taste, bad breath and prolonged coughing. These symptoms occur because the hiatus hernia weakens the barrier between the top of the stomach and the bottom of the gullet (lower oesophageal sphincter complex)

In some patients with GORD and a hiatus hernia, the oesophagus is exposed to long periods of acid induced inflammation that may lead to erosive oesophagitis or even, Barrett’s oesophagus, a condition whereby the lining of the gullet changes its appearance in response to long-standing and regular acid-induced damage.

So how can this all be diagnosed? Most commonly a patient will have an  Upper GI endoscopy whereby a flexible tube is guided carefully and slowly through the mouth and into the stomach and duodenum. This allows the gastroenterologist to examine the lining of the oesophagus, stomach and duodenum (first portion of the small intestine). Alternatively, a barium swallow may be undertaken in the XR department.

How can this condition be treated? Lifestyle changes and medications are the preferred treatments. Lifestyle suggestions include:

  • Adapting eating habits, eating smaller meals more frequently
  • Avoiding lying down for 3 hours after eating or drinking
  • Removing any foods or drinks from your diet that make symptoms worse

There are two classes of medication that supress acid secretion – histamine-2 receptor antagonists (H2RAs) and proton pump inhibitors (PPIs). H2RAs work by blocking the effect of food on acid secretion whereas PPIs block the enzyme making acid. PPIs have emerged as the most effective therapy for relieving symptoms and improving quality of life, as well as healing and preventing damage to the oesophagus.

If patients fail to respond to PPIs or are intolerant of them, surgical repair of the hiatus hernia may be helpful such as laparoscopic fundoplication or lower oesophageal sphincter augmentation (LINX system). Surgery is particularly effective in patients with a hiatus hernia with regurgitation.

For more information about hiatus hernia and potential treatment options, please do not hesitate to contact Dr. Adam Harris.



One of the most common reasons for referral to a gastroenterologist is the feeling of bloating (abdominal distension). It occurs when gas or fluid accumulate in the abdomen, causing expansion of the small or large intestine. In younger people it is usually a benign and harmless, albeit distressing, symptom but rarely it may be due to an underlying disease.

Bloating is most commonly a feature of irritable bowel syndrome (IBS) but the following conditions may cause bloating and need to be considered:

And more rarely:

  • Abnormal fluid accumulation (ascites)
  • Large ovarian cyst or uterine fibroid (noncancerous growths of the uterus)

Investigation of Bloating

The cause of bloating may be clear following a careful history and examination by a doctor. The following tests may be undertaken to help with the diagnosis:

  • Blood test to look for coeliac disease
  • Stool sample to look for Giardia lambliaantigen
  • Hydrogen breath tests for carbohydrate intolerances or small intestinal bacterial overgrowth
  • Faecal calprotectin to exclude inflammation or infection
  • Ultrasound scanning of the abdomen and pelvis (in a female) to exclude abnormal fluid accumulation or enlarged organs

Treatment of Bloating

This will depend upon the underlying cause. Thus, infection with G lambliais cured by tinidazole. Lactose or fructose intolerance may respond to dietary restriction. Small intestinal bacterial overgrowth may be helped by an antibiotic (e.g. rifamixin) or probiotics. IBS with bloating is often relieved by  a low FODMAP diet (avoiding foods rich in short chain carbohydrates that are poorly absorbed in the small intestine and so are rapidly fermented by bacteria in the colon). In patients with a new diagnosis of coeliac disease, a gluten-free diet will need to be followed.

For more information about bloating and potential treatment options, please do not hesitate to contact Dr. Adam Harris.



Irritable Bowel Syndrome (IBS) affects up to 20% of the UK population with women at least twice as likely to be affected as men. Common symptoms include bloating, constipation, diarrhoea and abdominal discomfort.While many help their symptoms by changing diet such as avoiding foods high in FODMAPS, this blog will examine the positive effects that probiotics may have on IBS by modifying the balance, or biodiversity, of the gut bacteria or microbiome. Probiotics are defined as “live microorganisms, which, when administered in adequate amounts, confer a health benefit on the host.”

So, how may a probiotic help to reduce IBS symptoms?

  1. Probiotics may give a boost to the numbers of “friendly bacteria” in the gut. There is some evidence, albeit limited, that the bacterial biodiversity may be altered in individuals with IBS.
  2. An improvement in “friendly bacteria” may help to break down the FODMAPS foods that may exacerbate IBS.
  3. A change in the biodiversity of the gut microbiome may also play a role in modulating the gut’s nervous system, thus reducing the impact of stress on the gut.

Here, I mention 3 probiotics that, to the best of my knowledge, were shown in clinical trials to be significantly better than placebo at relieving symptoms in individuals with IBS.

Symprove is a water-based probiotic that contains four live strains of the ‘friendly bacteria’ lactobacillus available from the internet or directly from the manufacturer. About 70mls of Symprove is drunk at the start of the day, 10 minutes before eating or drinking anything, for 12 weeks. Once a bottle is opened it must be stored in a fridge.

It was shown in a large clinical trial to help IBS. Researchers at London’s King’s College Hospital found that more individuals with moderate-severe IBS achieved remission after a 12 weeks course of Symprove than those taking placebo (an identical looking and tasting supplement but one which didn’t contain any bacteria).

Bio-Kult contains a total of 14 different strains of 5 different bacteria and a minimum of 2 billion live bacteria per capsule. It is taken once or twice daily for at least 28 days and if of benefit, may be used long term. Bio-Kult does not need to be stored in a fridge, is stable at room temperature and has a long shelf-life. The capsules were shown in the laboratory to resist acid or up to 2 hours implying they should survive the acidic environment of the human stomach. A randomized, controlled trial in India found that Bio-Kult was significantly more effective than placebo in individuals with IBS with diarrhoea.

Alflorex, a single strain (Bifidobacterium infantis3564) probiotic is taken once daily in capsule form for a minimum of 28 days.  A single Alflorex capsule contains around 1 billion live bacteria. It was shown to be significantly better than placebo in a large study in women with IBS.

For more information about these treatment options, please do not hesitate to contact Dr. Adam Harris.



A healthy liver should contain little to no fat. Having high levels of fat in the liver is associated with an increased risk of serious health problems, from diabetes and high blood pressure to kidney disease. This month’s blog will discuss non-alcoholic fatty liver disease (NAFLD), the term used for excess fat build-up in the liver. As highlighted in the name, this condition isn’t caused by drinking too much alcohol.

It’s important to detect and manage this condition as early as possible – Stage 1 NAFLD doesn’t usually cause any serious harm but if it the fat build-up continues, it can lead to serious liver damage including cirrhosis.

There are 4 stages of NAFLD:

  • simple fatty liver (hepatic steatosis) – most common stage that may affect 1 in 3 adults in the UK
  • non-alcoholic steatohepatitis (NASH) – a more serious form where the liver has become inflamed, estimated to effect up to 5% of the UK adult population
  • fibrosis –where persistent inflammation causes scarring, but the liver is still able to function normally
  • cirrhosis – the most severe stage which occurs after many years of inflammation. The damage is permanent and can lead to liver failure and liver cancer

Individuals are at an increased risk of developing NAFLD if they:

  • are obese or overweight
  • have type-2 diabetes
  • have high blood pressure & cholesterol
  • are over the age of 50
  • smoke cigarettes

There aren’t usually any symptoms of the condition in the early stages – it is usually diagnosed following an abnormal result from a liver function test (raised GGT and/or ALT; high ferritin) or after an ultrasound scan. Occasionally, a liver Fibroscan or even a biopsy may be required to establish the stage of the disease.

How is NAFLD treated? While there’s currently no specific medication for the condition, the best management is to lose weight, eat a healthy balanced diet & exercise regularly.

If you have any questions about non-alcoholic fatty liver disease, please do not hesitate to contact Dr. Harris.



The low FODMAP diet is a relatively new concept in the UK.  It is recognised by NICE as an effective diet for managing the symptoms of IBS such as abdominal pain, wind and bloating. About 70% of people with IBS who try the diet will achieve an improvement in their gut symptoms.FODMAPS are found in a wide range of foods including: onion, garlic, wheat, lactose, honey, nuts and many fruits and vegetables (apples, pears, broccoli and avocado to name but a few).

Once ingested, some FODMAPs are not absorbed in the small intestine and cause osmotic diarrhoea.  As they pass into the large intestine they are fermented by colonic bacteria which may result in gas production and symptoms such as wind, pain and bloating.

Reducing dietary intake of FODMAPS has been shown to improve gut symptoms in most people with functional bowel disorders such as irritable bowel syndrome (IBS).

The low FODMAP diet is a complex approach however and involves a 4-8 week period of restricting FODMAP rich foods. This is followed by the systematic reintroduction of these foods back into the diet. The purpose of this stage is to identify foods that trigger symptoms and ensure a nutritionally balanced diet at the end of the process.

It is important that people who undertake the diet receive good quality advice from a Registered Dietitian on how to follow the different stages of the low FODMAP diet. It isn’t as simple as following a list of ‘foods to eat’ and ‘foods not to eat’. High FODMAP ingredients are often hidden in processed foods. Because the diet is relatively new, the information available on the internet and elsewhere can be misleading and create confusion.

An important point of note is that if the diet isn’t followed properly, it’s unlikely to be effective.

For more information please contact Ali Todd, Registered Dietitian, on 07810 367549 or for an appointment 07757 757571. In addition, further information is available on her website.



What is it?

  • Colonic diverticulosis is the condition whereby diverticula, or pockets, form from the lining of the colon. These protrusions of the colon lining occur at sites of weakness in the muscle wall possibly due to increased pressure from muscle contractions.
  • Diverticulitis is an inflammatory process that causes acute symptoms and may be associated with serious complications.

What may cause it?

  • Potential risk factors include increasing age; diets low in fibre, high in red meat and refined carbohydrates; obesity.
  • There is no evidence that seeds or nuts cause diverticulitis.
  • Changes in the biodiversity of the colonic bacteria

What are the symptoms?

  • Diverticulosis is often asymptomatic and found on investigation by colonoscopy or CT scanning. It may be associated with low abdominal cramping, bloating or constipation.
  • Diverticulitis, due to infection or inflammation of the diverticula, may cause localized lower left sided abdominal pain with either diarrhoea or constipation and fever. Bleeding may occur.

How common is it?

  • Classically, this is a disease process that predominantly affects people over the age of 70 years and is more common in developed countries. It is however getting more common in younger people possibly related to obesity.

What tests are needed to diagnose it?

  • A colonoscopy enables the gastroenterologist to examine the lining of the colon to confirm diverticulosis and to exclude colon cancer or inflammatory bowel disease.
  • An abdominal CT scan is a radiological test used to diagnose diverticulitis and to look for complications.
  • A blood test may be performed to look for any signs of infection or inflammation within the colon.

How do you treat it?

  • Individuals with diverticulosis are advised to eat a healthy and balanced diet, avoid too much red meat and to lose weight if obese. Use of a prebiotic and/or a probiotic may be of benefit but at present this is an evidence-free zone.
  • Mild diverticulitis is usually treated with oral antibiotics. A recent placebo-controlled trial however did not show, in the outpatient setting, that antibiotics were any better than placebo.
  • Patients with complications of acute severe diverticulitis such as an abscess (collection of pus) or perforation (a hole in the colon) require emergency admission to hospital for intravenous antibiotics and sometimes urgent surgery.
  • Long-standing severe diverticulosis or following recurrent attacks of diverticulitis the colon may get narrowed (stricture formation) and surgery may be required to avoid obstruction.

If you have any questions, please do not hesitate to contact Dr. Harris.



At West Kent Gastroenterology, we work hard to provide our patients with top-class care. You will enjoy friendly, fast and modern treatment by a highly experienced gastroenterologist. We carefully review patient satisfaction and feedback, and at West Kent Gastroenterology we are continuously making improvements to our services, ensuring the highest level of care possible.

Clinic Locations

Nuffield Hospital
Kingswood Road, Tunbridge Wells, TN2 4UL

Spire Hospital
Fordcombe Road, Tunbridge Wells, Kent, TN3 0RD

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London Road, Sevenoaks, Kent, TN13 2JD

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