‘Often by the time the patient reaches us, the alcohol damage is irreversible’

Gastroenterologist Aoibhlinn O’Toole’s work ranges from cancer to inflammatory bowel disease

Dr Aoibhlinn O’Toole is a consultant gastroenterologist at Beaumont Hospital, Dublin. Photograph: Dara Mac Dónaill

Dr Aoibhlinn O’Toole is a consultant gastroenterologist at Beaumont Hospital, Dublin. Photograph: Dara Mac Dónaill

 

What attracted me to gastroenterology as a specialty was the wide range of diseases that present to us, from acute emergencies to the management of chronic gastrointestinal disorders, meaning that each week in the hospital is different.

I treat patients for diseases of the entire gastrointestinal tract from the mouth to the anus.

On a typical day, I’ll be in the endoscopy department scoping patients, and I will also see patients in the outpatient clinic and check up on any inpatients.

Endoscopy is the use of flexible fiber-optic endoscopes to examine the oesophagus, stomach and duodenum (OGD) , the colon and distal small bowel (colonoscopy) and the bile ducts (ERCP). These tests can help diagnose swallowing problems, abdominal pain, weight loss, diarrhoea and constipation.

We can remove polyps, inject bleeding lesions, stent obstructions and remove gallstones using these techniques. Colonoscopy can diagnose colon cancer and precancerous lesions. We hope to capture colon cancer at an early stage so that we can operate and prevent the disease spreading to other organs.

There have been advances in the treatment of colon cancer, particularly in immunotherapy and tailored therapy, and also importantly, in earlier detection of the disease.

Colon cancer is one of the cancers that has a precancerous form – colon polyps – which we can remove to prevent cancer from developing.

I see patients in the clinic twice a week, roughly a third of whom are new and the rest are returning for ongoing management and results of tests. We have a gastroenterology ward where we do rounds of all our sick inpatients with liver failure, acute Crohn’s and colitis and malnutrition.

Unfortunately, we see a lot of alcohol-related complications in Beaumont hospital and Prof Frank Murray, our consultant gastroenterologist and specialist in liver disease, has campaigned to change alcohol pricing to try and reduce the burden of alcohol-related diseases on the health service.

We see a lot of cases of liver failure in Beaumont. The majority of the cases of liver failure that we treat are alcohol-related and other causes include viruses like hepatitis and paracetamol overdose.

There is a real need to increase drink awareness in this country, to reduce access to alcohol and increase price. Often by the time the patient reaches us, the damage is irreversible.

Every day starts with checking my emails, which include updates from our medical director on how best to manage the service, grant applications for research, managing data on clinical trials we participate in, and alerts from the journals on literature to guide treatment plans.

Breakfast and lunch are usually eaten over a meeting such as the GI X-ray and pathology conferences and our multidisciplinary GI cancer meetings.

The highlight of my week is the inflammatory bowel disease (IBD) case conference, where all members of the team meet to present the inpatient and challenging outpatient cases to make individualised treatment plans, as well as teaching the junior staff and medical students about the management of complex cases.

Having completed my specialist training in Ireland, I moved to Boston where I subspecialised in the field of inflammatory bowel disease at the Brigham and Women’s Hospital and at the Beth Israel Deaconess Medical Center.

Crohn’s disease and ulcerative colitis are chronic inflammatory conditions of the gastrointestinal tract. Common symptoms include fatigue, diarrhoea, weight loss and abdominal pain but joint pain, red sore eyes, rashes and mouth ulcers often accompany the GI symptoms.

We still don’t have a good understanding of what causes IBD, but it is thought to be an environmental trigger in a genetically susceptible patient.

Research now is focusing on the microbiome, the bacteria within our gut and the role they play in disease.

It is an exciting field to be in. As we gain a better understanding of what drives the disease, we can improve our treatment options to target the culprit inflammatory pathways.

Our patients have the opportunity to be enrolled in clinical trials into new medications and contribute to research into the causes of IBD.

IBD can be diagnosed at any age, but most patients present in their 20s or 30s, a critical period for an individuals’ academic and vocational career as well as personal relationships and reproduction. Our job is to get our patients well and to keep them well so that living with IBD does not impinge on their quality of life.

We offer a chronic disease self-management programme in Beaumont that we initially recruited IBD patients for.

As a result of great improvements in quality-of-life scores after completion of the programme, this incentive has now been rolled out to other patient groups in the hospital.

There can be some confusion between IBD and Irritable Bowel Syndrome or IBS, but they are two totally different conditions. IBS can generally be treated by dietary and lifestyle changes and medication if required, but unlike IBD, it does not damage the structure of the intestines.

People do not really understand the impact IBD can have on patients and the symptoms are so intimate that they can be reluctant to discuss their condition with family, friends, employers and work colleagues.

One to 2 per cent of Irish people are affected by IBD and the incidence is rising, particularly paediatric cases. It is a disease of the Western world and the hygiene hypothesis would suggest that immunisation and lack of exposure to bugs during early childhood may be compromising our immune systems.

We work closely with the Irish Society of Colitis and Crohn’s (ISCC) and I travel nationally for education meetings, fund-raising and to raise awareness.

I was delighted to be given the opportunity to help with the results from their recent Gut Responses report and their employer handbook for IBD.

Inevitably, consultants need to sit on many committees to ensure that the hospital services run to the best of their ability given our financial and staffing constraints.

I sit on the medical cogwheel committee, the endoscopy users group and the infusion suite group so that we can advocate for our patients and their needs.

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