In an interview with Dr Ana Rita Herculano, a Gastroenterologist working in HPA Health Group, she explained what were the main effects that the pandemic had in this speciality - the branch of medicine focused on the digestive system and its disorders, which can be malignant illnesses (for example, gastric or colorectal cancer) or functional (such as irritable bowel syndrome or functional dyspesia).

Hospitals struggling

Over the past 22 months, hospitals have had to put all their resources into the Covid-19 response and reorganise themselves accordingly. As a consequence, non-Covid-19 patients have been left behind in some hospitals and the number of screenings has dropped dramatically.

“More deaths may result from gastrointestinal cancer in Portugal as a result of the lack of screening and consultations due to the pandemic, namely in the first wave”, said Dr Ana Rita Herculano.

Although some of the consultations were carried out remotely, the services had to comply with Health authorities guidelines, which implied big challenges that postponed and cancelled several screenings, according to a Portuguese study published last year.


Private hospitals were key

In these hard times, private hospitals have played an important role “by allowing screening exams to be carried out when the National Health Service (SNS) was struggling to respond”, said Dr Ana Rita Herculano.

Therefore, “the increase in the number of exams at private hospitals was essential, especially for the diagnosis of gastroenterology cancers in its earlier stages”, she added.


Deadliest cancer

Every year, 370.000 people in the European Union find out they have colorectal cancer. Most of these people have no family history of this type of cancer. Even with the worrying numbers, 90 percent of these patients can survive if they undergo the necessary treatment at an early stage, which is only possible with timely screening, according to the Global Cancer Observatory. That's why screening is the key.

According to health guidelines, after the age of 50 everyone should undergo a colonoscopy- even if they do not have symptoms. However, although 90 percent of colorectal cancers appear after the age of 50, Dr. Ana Rita explained that more and more people become ill at an earlier age, so from 45 years old patients should start thinking about this.


Scheduling your screening

Despite the hard times that all of Europe has been going through since the beginning of 2020, health authorities have been launching campaigns aimed at people aged 50 to 74, focused on screening for occult blood in the stools. “If positive, people were advised to see a doctor for a colonoscopy. This examination is essential for an early detection of lesions like polyps. These lesions, with malignant potential, can be safely removed at an early stage, during the course of a screening exam”, she said.

As for the exam itself, Dr. Ana Rita told The Portugal News that there is nothing to fear. “Screenings nowadays have much improved both in terms of comfort during the exam and in terms of safety. “ A colonoscopy is a safe exam and is currently painless as the patient is put into a deep sedation,” she said.


Functional gastrointestinal (GI) disorders

These disorders are not dangerous or malignant as is the case with cancer, but are the ones that lead more patients to HPA Health Group. In short, functional gastrointestinal disorders and motility disorders are the most GI disorders in the general population. Are characterised by gut-brain interaction and applied to GI disorders where the body’s normal activities in terms of the movement, sensitivity of the nerves of the intestine or the way in which the brain controls some of the functions is impaired. However there are no structural problems such as tumours.

“These are disorders, where the patients have some complaints like a sensation of lump in the throat, persistent burning sensation, difficulty swallowing, pain or discomfort in upper abdomen (functional dyspepsia) or a group of bowel disorders characterized by abdominal discomfort or pain associated with a defecation or change in bowel habit (irritable bowel syndrome with defecation. The diagnostic exams, when needed, like endoscopy, radiology exams and blood test can confirm the patient doesn’t have no organic GI abnormality”, Dr Ana Rita told The Portugal News.


After contracting Covid-19, patients are more vulnerable

Patients, who have recovered from Covid-19, may be more vulnerable to functional diseases than other patients. At the HPA Health Group, there have been more patients with functional gastrointestinal complaints.

“Indeed, now I’m finding more cases of gastrointestinal disorders, especially in patients who were previously infected with Covid-19. Complaints are usually functional dyspepsia and changes in bowel transit habits (mainly irritable bowel syndrome - diarrhoea)”, she said.

Another study, which was published in October 2021, revealed that irritable bowel syndrome and dyspepsia (poor digestion) can occur after infection with Covid-19.

“In this study, 280 patients who recovered from Covid-19 developed symptoms of functional gastrointestinal disorders and mental health disorders. Therefore, risk factors for the prevalence of these gastrointestinal complaints after six months of Covid-19 infection include symptoms such as loss of smell and taste, early onset of these diseases at one and three months after infection, as well as comorbidities and mental health disorders”, concluded Dr Ana Rita Herculano.