​Dr. Cristina Poyoga, a primary care gastroenterologist with both medical and psychological training, who is competent in diagnostic and therapeutic endoscopy of the digestive organs and works at the Badea MedLife clinic in Cluj-Napoca, states that patients who come to the office become more and more. more interested in disease prevention, particularly colorectal cancer. According to the gastroenterologist, a close-knit medical team with good communication skills is crucial, especially when a medical diagnosis is difficult to make.

The lack of medical education forces many Romanians to consult a doctor at the last moment, with serious diseases in an advanced state, something that can be observed, especially in statistics that measure morbidity and mortality. However, doctors notice that slowly everything is starting to change in us as well. Young people understand that they need to take care of their health and go to the doctor preventively for scheduled examinations and necessary examinations.

“Later, informed generations will come, generations that read, document themselves. I do not mean those who are looking for medical information in order to engage in self-treatment, for self-diagnosis, but simply to informed people who know that there are certain diseases that can be avoided if they are warned in time,” says Dr. Kristina Pozhoga , a primary care gastroenterologist specializing in endoscopy at Badea MedLife Clinic.

From the experience of working in the office, she claims that: “Most of our patients are diagnosed with pathology of the digestive organs, both organic and functional. A pleasant surprise recently is that patients are beginning to realize the importance of prevention. We no longer accept only patients with advanced diseases. People who care about their health, patients who want to prevent the occurrence of certain diseases and, in particular, colorectal cancer, begin to come,” says the doctor.

This happened to a patient in his 20s who had familial adenomatous polyposis, meaning he had many polyps in the colon, and whose parents had died at a very young age from colorectal cancer. The young man had a colonoscopy in time, which showed that the disease had not yet turned malignant, so he could intervene to prevent the cancer that had stolen his parents.

Unfortunately, the doctor also says, in such a situation, the only way to really prevent colorectal cancer is a total colectomy, or rather, complete removal of the colon. “In this case, colectomy is curative. Of course, this is a rare pathology,” says the doctor.

“You can’t die from a disease you didn’t create”

The role of prevention, especially for colorectal cancer, is extremely important. During a preventive examination, small changes can be detected, which after treatment eliminate the risk of developing a malignant tumor.

“Once I was at a congress abroad, and I really liked the statement of a professor there who said: ‘You can’t die from a disease you don’t make.’ This is the situation of colorectal cancer, which develops from some precancerous lesions, from colorectal polyps. If you have a colonoscopy in time to find these lesions and remove them, you will not get colorectal cancer. It basically becomes a preventable disease. That’s why I say that people are already informed, they know that if they consult a doctor in time, then serious problems can be avoided.”

Psychological factors increase the symptoms of diseases of the digestive organs

An important part of the patients who come to the office have tumor pathology, but there are also many with functional disorders, the doctor also says: “Many patients come with conditions that make us think about the connection between daily stress and body functions. It can be about a violation of intestinal transit, pain in the abdomen, in the upper part of the abdomen. Some come with reflux or gastric or duodenal ulcers. And often psychological factors do not necessarily cause the disease, but intensify the symptoms and somehow lead the patient into a vicious circle, which the doctor must know how to break.”

The main measure that a doctor can take to break the vicious circle that Dr. Pozhoga talks about is timely medical examinations to exclude organic pathology. “After the examination, you must talk to the patient, who must know and understand the mechanism by which the symptoms appear and the mechanism by which he perceives these symptoms. The relationship between the doctor and the patient is especially important. A patient who does not trust his doctor is very difficult to treat. And I say this from a patient’s point of view, because I was a patient myself.”

When she was able to find a good doctor herself, she didn’t necessarily look at what appeared in the media about that doctor or how many degrees he had, Dr. Poyoga also says, “I think the best promotion for a doctor “from person to person”. I was interested in other patients, how satisfied they were and how the respective doctor treated them. I recommend that patients, when looking for a doctor with whom they are going to “go on the road”, go to the first consultation, for example, and not directly to more complex tests, such as an endoscopy. From the first consultation, you know whether you can have a therapeutic relationship with someone or not.”

And the therapeutic relationship should be two-way: “Even I, as a doctor, do not believe that I can give everything to any patient. We have to work very well together for him to benefit from my therapeutic advice or readings.”

The most common diseases of the gastrointestinal tract

In the list of diseases of the gastrointestinal tract, the first two places are occupied by irritable bowel syndrome – a functional disorder of the digestive tract, which is manifested by discomfort, especially in the lower abdomen, and ulcerative dyspepsia syndrome – which does not necessarily mean an ulcer, but which can mimic an ulcer and which also is a functional disorder with symptoms particularly in the upper abdomen.

Tumor pathology has also become quite common, says doctor Kristina Pozhoga: “However, I would not put tumor pathology in third place, but steatosis of the liver in all its aspects, which is a disease of the modern lifestyle. That is, we eat incorrectly, lead a sedentary lifestyle. This is what leads to fatty liver disease. This pathology takes the first place among liver pathologies, since there are not so many cases of chronic viral hepatitis,” the gastroenterologist notes.

Steatotic liver disease and even liver fibrosis are diseases that can regress to some extent, primarily through lifestyle changes. In addition, the pharmaceutical market is currently investing significant resources in researching drugs aimed at reducing the degree of steatosis or fibrosis of the liver, says Dr. Poyoga.

The role of psychoemotional balance in the treatment of digestive disorders

In a context where many digestive diseases are also related to stress and psychological problems, it would be ideal to learn to manage what we can manage. “It’s very difficult, but I think a psychologist or a psychiatrist can help. In my medical work, there were cases of patients, especially those with irritable bowel syndrome, that I could not manage in any way except with the help of a psychiatrist. I work very well with psychiatrists and when I see that the symptoms do not subside, even after several meetings with patients, after several therapeutic attempts, after several conversations, I also refer them to a psychiatrist. This does not mean that these people have a psychiatric pathology. This is not the problem. But due to the influence of the central nervous system on the autonomic nervous system, which in turn affects the functions of the digestive tube, the psychiatrist has a slightly different “weapon” than we do to influence this symptomatology. Usually, patients do not take psychiatric drugs for a long time. But after a month or two of treatment prescribed by a psychiatrist, the symptoms subside.”

A good doctor has a team he can rely on

A team of good doctors, of which she is a part, is extremely important to Dr. Christina Poyoga. “I don’t think there’s any part of medicine that you can say you can do yourself. When I talk about the team, I don’t mean only doctors of another specialty. If we want to have a holistic approach to the patient, we also need a nurse, a psychologist, a nutritionist. We need many people and many specialties in the team, and not only medical. And as a gastroenterologist, I have nothing to do without an anatomopathologist, surgeon, tomographer, and we can add other specialties as well.”

All these specialists understand how to cooperate for the benefit of the patient, and sometimes this communication leads to better results than in well-known foreign hospitals. “We even had a case of a patient who could not be diagnosed at the AKH hospital in Vienna. We diagnosed this due to several factors. First of all, because the patient complied with all medical indications and agreed to all the studies we proposed. He saw that I tried very hard, but could not reach a diagnosis. And neither he from me, nor I from him. In the end, we came to the diagnosis – Langerhans histiocytosis – an extremely rare pathology. Until we made a diagnosis, the pathologist and I spoke every day for two weeks. Since he was suspicious, I gave arguments against it that I had from the patient’s history. And we proceeded with other diagnostic suspicions and so on, until it was not possible to determine what the patient’s pathology was. That’s why communication and teamwork are vital,” adds Dr. Kristina Pozhoga.

Despite the fact that it is a difficult specialty, the doctor says that he would not change it: “I really liked this specialty. I was a student of Prof. Dr. Olivia Pasco in the course of gastroenterology and during my internship at the Institute of Gastroenterology. I was not only his student, but also a resident, as he had the gift of showing the beautiful side of gastroenterology. I believe it helped me develop a more pragmatic and patient-centered way of thinking, and if I hadn’t done this specialty residency, I would have taken the exam again. This is what I wanted to do since I first entered the Institute of Gastroenterology as a student,” concludes Dr. Pozhoga.

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