Clinical gastroenterology

摘要

Gastroenterology has emerged from the backwoods of medical specialties only over the past 20 years. The influences behind this rapid transformation have been twofold. Firstly, the massive improvement in the technology of diagnosis, through radiology but especially in the use of fibreoptic endoscopy. Secondly, there has been substantial progress in medical treatment—not only in using new drugs but also in recognising that the endoscope is an important instrument in treatment as well as in diagnosis. The impact of these changes on clinical practice has been profound for physicians as well as surgeons. In some major centres gastroenterology has undergone binary fission into hepatology and "hollow organ" gastroenterology. Advances in liver disease will be the subject of a later report, but before concentrating on the key aspects of progress in gastrointestinal disease I cannot resist citing the paper that has given me the most pleasure over the past year. It pronounces the death sentence on the use of bran in the irritable bowel syndrome. For years I have been listening to advocates of bran in functional bowel problems in the certain knowledge that it just doesn't work in the patients I treat. It now seems that 55% of patients with the irritable bowel syndrome are made worse with bran while only 10% improve. Progress in functional aspects of gastrointestinal disease has been slow but there are many other areas in which important progress has been made. Our starting point is self selected as being unquestionably the greatest leap forward for years.