Gastroenterology

Contact Names/Numbers/Email Addresses


Phone01 414 2091

Department of Gastroenterology
Tallaght Hospital
Tallaght
Dublin 24

Description of Department/Service

The Dept of Gastroenterology is a modern university affiliated unit providing high quality care for the full spectrum of GI diseases to both inpatient and outpatients in our catchment area.  In addition we accept patients outside our catchment area as a tertiary referral centre.  We have daily clinics including dedicated clinics for specific gastrointestinal diseases such as IBD, liver and coeliac disease.  In addition we have dedicated specialist nurses providing support care in conjunction with these clinics.

We have a modern Endoscopy Unit providing both basic and advanced diagnostic and therapeutic procedures for a number of specialist conditions including oesophageal and pancreatic disorders, inflammatory bowel disease and gastrointestinal bleeding.  We are dedicated as a group of doctors, nurses and support staff to providing a high quality service in a friendly and warm environment ensuring the dignity and holistic care of all our patients.

How to find us

The Department of Gastroenterology is located on the second floor Level 2.

Patient Information

Leaflets available:

What is anterograde double balloon enteroscopy (A.D.B.E.) ?

What is retrograde double ballon enteroscopy (R.D.B.E.) ?

What is a gastroscopy?

What is a colonoscopy?

What is an endoscopic ultrasound? 

 What is an E.R.C.P.?

Insertion of colon stent

Insertion of oesophageal stent 

Oesophageal dilation

What is a sigmoidoscopy?

What is a capsule endoscopy?

Oesophageal manometry

What is haemochromatosis?

Bacterial Overgrowth Test

Capsule Endoscopy

G.I. Lab

Gastrointestinal Laboratory

Lactose Intolerance Test

Patency Capsule

Urea Breath Test patient Information sheet

Specialist Services

Inflammatory Bowel Disease (IBD)

The IBD Unit is led by a team of two Consultants with a subspecialist interest in IBD and is located on level 2 of Tallaght Hospital.

Please click here for a detailed explanation of IBD.

GI Physiology

The Gastrointestinal Function Lab (G.I. Lab) is situated within Gastroenterology on level 2 of Tallaght hospital. The highly specialized technology available in the GI Lab helps Doctors to better diagnose and manage a variety of gastrointestinal disease.

Common tests and procedures performed in the GI Lab:

Colorectal Screening

For more information on colorectal screening please click here

H.pylori Infection

Helicobacter pylori (H. pylori) is a bacteria capable of living in the stomach. It is very common but in some cases can have serious consequences.

Tallaght Hospital has been a leader of research into this bacteria dating back to the original Adelaide and Meath hospitals and we regularly present research both nationally and internationally on the consequences and treatment of this disease.

Tallaght Hospital has on site access to non-invasive urea breath tests for detection of H. pylori. Up to 5-10% percent of H.Pylori cases can be resistant to our first line antibiotics and Tallaght Hospital is also a referral centre for culture and sensitivity for resistant cases of H.Pylori .

Liver Clinic

The liver clinic at Tallaght Hospital is run by Dr Niall Breslin and a team of specialist registrars, basic specialist trainees and nursing staff. Patients with a variety of acute and chronic liver conditions are seen. This includes haemochromatosis, non-alcoholic fatty liver disease (NAFLD), alcohol related liver disease, autoimmune liver diseases (including primary biliary cirrhosis, auto-immune hepatitis, primary sclerosing cholangitis), drug induced liver conditions and less common diseases such as alpha-1-antitrypsin deficiency and Wilson's disease. Patients with chronic viral hepatitis are also seen but are usually treated at St James Hospital. The team works closely with the Haemochromatosis venesection clinic as well as with Clinical Nutrition and Liaison Psychiatry. 

Hereditary Haemochromatosis

Hereditary Haemochromatosis is a genetically determined condition leading to an excess absorption of iron from the diet, which in turn leads to accumulation of iron in the body. This accumulation of iron can cause injury to a number of organs if left untreated.

For more information on hereditary haemochromatosis please click here. 

Obscure G.I. Bleeding

Please see Cabsule Endoscopy Service and Double Balloon Enteroscopy Service.

Capsule Endoscopy.pdf 

Education & Research

The Department of Gastroenterology has a substantial academic record and strong links with Trinity College Dublin.  As a teaching hospital the department is involved in providing undergraduate clinical teaching.  As a tertiary referral centre for a multitude of gastrointestinal disorders, Tallaght is a recognised training centre for postgraduate higher specialist training.

The Unit has an international recognition for research excellence - our major research focus includes the following:

  • Clinical Trials Unit
  • Inflammatory Bowel Disease
  • Translational Research supported by the recent TAGG initiative

Clinical Trials Unit

The Clinical Trials Unit situated within the Gastroenterology Department at The Adelaide and Meath Hospital incorporating The National Children’s Hospital provides the infrastructure, physical space, facilities, expertise and culture needed to optimally support patient-focused research studies and clinical trials aimed at understanding  diseases of the GI tract and their treatment.  

Group Objectives:

  • Increase research into the cause and complications of IBD
  • Improve patients' access to new therapies
  • Auditing IBD clinical services
  • IBD Database Management

We are currently investigating many areas to try to identify causes and improve treatment of Crohn's disease and ulcerative colitis, including:

  •  Determining which of our current treatments are most effective in getting these diseases under control
  •  Investigating new medications in treatment of Crohn's disease, Ulcerative Colitis
  •  Assessing Induction and maintenance of clinical response and remission rates of new therapies
  • Evaluating efficacy and safety of new drug therapies 

PUBLICATIONS

  • Click here to view publications

 

For more information please visit any of the following sites:

Irish Society for Colitis & Crohn's Ireland

National Association for Colitis & Crohn's Disease

Irish Society of Gastroenterology (ISGE)

United European Gastroenterolog (UEG)

European Crohn's & Colitis Organisation ECCO

Irish Cancer Society

 

Endoscopy

The Endoscopy Unit is situated on the second floor of the hospital.  The Unit has 3 Endoscopy procedure rooms and two recovery areas.  The Endoscopy Unit is a facility that provides a service for outpatients, inpatients and patients from referring hospitals. Over 9,000 procedures are carried out in the Unit each year.  The Endoscopy Unit is an integral part of the Gastroenterology Unit which comprises adjacent outpatient consultation rooms, a GI function lab and GI Research facility.

The Endoscopy service is supported by 2 Upper GI Cancer Specialist Nurses, a Colorectal Cancer Nurse Specialist, an IBD Nurse Specialist and a Pre-assessment Nurse as well as the trained Endoscopy nurses.

 A variety of procedures are carried out within the Unit including:

  • Diagnostic and therapeutic gastroscopy
  • Diagnostic and therapeutic colonoscopy
  • Flexible sigmoidoscopy
  • Endoscopic ultrasound (EUS)
  • Endoscopic retrograde cholangiopancreatography (ERCP)
  • Double balloon enteroscopy (DBE)
  • Transoesophageal echo cardiography (TOE)
  • Bronchoscopy

Tallaght Hospital is the first centre in Ireland to conduct colorectal cancer screening using Faecal Immunological blood testing.  We are one of only two centres in Ireland that performs Double Balloon Enteroscopy  (both diagnostic and therapeutic) and receive referrals from all over the country for this procedure.

We are also a referral centre for Capsule Endoscopy which is available in only one other centre in the Republic.

Inflammatory Bowel Disease

The IBD Unit is led by a team of two Consultants with a subspecialist interest in IBD and is located on level 2 of Tallaght Hospital.

What is Inflammatory Bowel Disease (IBD)

Inflammatory Bowel Disease is a group of chronic lifelong conditions affecting the digestive tract. It includes both Ulcerative Colitis (UC) and Crohn’s Disease (CD) which are similar but affect different parts of the intestine. UC affects the inner lining of the large intestine while CD can affect any part of the digestive tract from the mouth to the anus.

Clinical features of Inflammatory Bowel Disease

The main features of IBD are bloody diarrhoea associated with frequency, urgency and abdominal cramps.  In severe attacks patients may suffer weight loss and anorexia.

In addition patients may have symptoms from outside the digestive tract including:

•         Arthritis (large joints)

•         ankylosing spondylitis

•         erythema nodosum

•         pyoderma gangrenosum

•         iritis and episcleritis (inflammation of the eyeball)

•         primary sclerosing cholangitis (75% pts have IBD, Geonzon –Gonzales 2006)

How common is IBD

•         15,000 people in Ireland have IBD

•         Incidence in Ireland - 6,000 UC

                                           -  3,000 CD

What causes IBD

The cause of IBD is unknown but is thought to include:

•         Genetic susceptibility

•         A familial tendency 

•         Environmental factors -smoking

      • stress
      • non-steroidal anti-inflammatory drugs  
      • history of appendectomy
      • history of infection with mycobacteria  
      • activation of the immune system
      • possibly diet but not proven

•         Infective agents

•         Seasonal changes

•         Stress – implicated in aetiology of disease  (Mawdsley and Rampton 2005)

Treatment of IBD

Treatment for IBD is often simple and includes both local and oral medications, often the condition can be managed in the community by the patient’s General Practitioner after consultation with a Specialist.  Regular review by a specialist is recommended for complex therapies and disease.  Surgery may be required in difficult cases.

Mary Kennedy is the IBD Clinical Nurse Specialist here at Tallaght Hospital.

The IBD nurse is often your first point of contact if you require any advice regarding your disease.  She provides a rapid point of access for IBD patients, in particular she can provide support, advice and information on your inflammatory bowel condition. Also, she will play an active role in disease and drug education and management. Treatments such as Infliximab (Remicade) and Adalimumab (Humira) are administered by the IBD Nurse.

An advice line is run by the IBD Nurse and the contact number is 01 4142667

Colorectal Screening

There are about 2,000 cases of colorectal cancer in Ireland each year leading to significant disability and mortality.Tallaght Hospital is extremely committed to screening for colon cancer and to the removal of certain polyps which can lead to cancer.

Tallaght hospital performs over three thousand colonoscopies per year in our three endoscopy suites. Our endoscopists are experienced in removing all forms of polyps including very difficult polyps.Tallaght hospital was the first hospital in Ireland to begin a programme of screening for colon cancer similar to the nationwide program in the UK.

In anticipation of a nationwide colon cancer screening program using immunochemical tests to detect microscopic traces of blood in the stool, Tallaght has been conducting a pilot screening program. This began in December of 2008 and has almost completed it’s second round of screening. The results of the first round have been published already in peer reviewed scientific journals.

As part of this pilot we have also tested new stool markers and we are the first centre using capsule colonoscopy to screen for polyps and cancers.

Tallaght hospital has been shortlisted as one of the potential screening centres for the awaited national colorectal cancer screening programme. Our lab is also the first in Ireland to begin using the Faecal Immunochemical Test (FIT) and has experience and research based on that.

GI Physiology

The Gastrointestinal function lab (G. I. Lab) is situated within Gastroenterology on level 2 of Tallaght hospital. The highly specialised technology available in the GI Lab helps Doctors to better diagnose and manage a variety of gastrointestinal disease.

 Common tests and procedures performed in the GI Lab:

 Oesophageal Manometry

A real time pressure analysis of oesophageal function performed by expert GI Physiologists.  Commonly employed for the investigation of:

            Gastro-oesophageal Reflux

            Achalasia

            Nutcracker Oesophagus

            PreOperative assessments

 

  • 24 Hour pH Monitoring

An ambulatory overnight diagnostic procedure to measure total oesophageal acid exposure through small nasal canulas placed and analysed by our highly trained GI Physiologists.  This procedure is useful in assessing:

1.      Severity of Gastro-oesophageal Reflux

2.      Suitability for surgery

 

  • Capsule Endoscopy

A revolutionary procedure which allows images of the gut to be transmitted from a small ingestable capsule as it travels through the alimentary canal.  This non-invasive, day procedure is performed by expert physiologists and doctors.

Tallaght Hospital is the national referral centre for all Capsule Endoscopy procedures and is an international leader in Capsule related research. Available capsule procedures include:           

  1. Small Bowel Endoscopy
  2. Patency Capsules
  3. PillCam Colonoscopy

 

  • 13C Urea Breath Test

This non-invasive test checks for the presence of Helicobacter pylori infection in the stomach. It is a quick test (approx 30 minutes) and involves drinking a glass of orange juice and giving a sample of breath, then swallowing a tablet labelled with carbon 13. After a 30 minutes wait another breath sample is taken.

If the carbon 13 is present in the second sample it indicates the presence of Helicobacter Pylori. This can then be treated with a course of antibiotics from your referring GP.

Urea Breath Test Patient Information Leaflet.pdf (size 85.9 KB)

Hereditary Haemochromatosis

Incidence

Hereditary Haemochromatosis is Ireland’s most common inherited disease and affects thousands of Irish adults. For someone to develop Haemochromatosis both their mother and father will have a defective gene.

In Europe as a whole between 1 in 300 and 1 in 400 people have the potential to develop iron overload. In Ireland by contrast recent studies show that the proportion of the population with susceptibility to iron overload is the highest in the world. 1 in 5 Irish people are carriers of the gene, and 1 in 83 people have two genes.

Signs and Symptoms

 The most common symptoms are:

  • Chronic fatigue, tiredness or lack of energy.
  • Joint pain, especially the first 2 finger joints but can be in any joint in the body.
  • Abdominal pain.
  • Sexual dysfunction - impotence is common in males and decreased libido in both males and females.
  • Skin pigmentation - many patients present with bronzing of the skin.
  • Palpitations.

Many patients find that these symptoms improve following the lowering of their iron but unfortunately this isn’t the case for everyone.

Diagnosis

A simple blood test, taken when you are fasting, is the best way to test if you have too much iron in your blood.

If these tests are above the normal level, a genetic test (a blood test) can be carried out to confirm Hereditary Haemochromatosis.

Your doctor may wish to send you for other tests to check for any damage caused by the raised iron levels in your body, such as:

 •          Further blood tests

•          Liver biopsy

•          CT/MRI scan

•          Ultrasound

•          ECG

Treatment in the Haemochromatosis Clinic in Tallaght Hospital

The Haemochromatosis Clinic was set up in 2010 and is a nurse led clinic, under the care of Consultant Hepatologist and Gastroenterologist Dr. Niall Breslin.

Treatment of haemochromatosis is relatively simple and very effective. It involves the regular removal of blood, known as Venesection or Phlebotomy therapy, and is much the same method as is used for blood donation.

When referred for treatment you will be contacted by a nurse to arrange an appointment for Venesection and to give you instructions on what to do prior to coming in for your appointment. You may need to attend once a week for venesection, until your iron levels return to a normal level. Blood samples will be taken regularly to monitor your progress. After your iron levels have returned to normal, you will need to have regular blood tests, usually every 3-4 months. The need for further venesection will be based on the results of your iron levels in these regular blood tests.