We are the combination of four hospitals: the General Hospital, the Children’s Hospital, the Women’s Hospital and the Traumatology, Rehabilitation and Burns Hospital. We are part of the Vall d’Hebron Barcelona Hospital Campus: a world-leading health park where healthcare plays a crucial role.
Patients are the centre and the core of our system. We are professionals committed to quality care and our organizational structure breaks down the traditional boundaries between departments and professional groups, with an exclusive model of knowledge areas.
Would you like to know what your stay at Vall d'Hebron will be like? Here you will find all the information.
The commitment of Vall d'Hebron University Hospital to innovation allows us to be at the forefront of medicine, providing first class care adapted to the changing needs of each patient.
The basis for recovery is pharmacological treatment, which has improved a lot in recent years, and the adoption of healthy lifestyle habits.
In terms of treatment, there are several options, such as corticosteroids, immunosuppressants and biological agents, which are used based on the activity or location of the illness, and depending on the complications that may arise.
Most importantly, once the treatment with the specialist has been agreed upon, it should not be stopped, as this would entail relapses and less control over the illness.
The Digestive System Department caters for patients with digestive diseases with an emphasis on technical and human excellence.
The mission of our Department is to improve the quality of life of patients with digestive diseases, through the development of knowledge (research), and the transmission of knowledge and values (training).
The activity of the Department includes:
The Digestive System Department is a national and international academic centre of reference looking after highly complex digestive disorders in a public, university, community hospital.
Digestive system training itinerary
We offer you a teaching programme designed following the National Council for Digestive System Speciality’s programme. Internationally the department is recognised as a European Training Centre by the European Community's European Gastroenterology Board and as a receiving centre for the UEG Clinical and Research Visiting Fellowship programme and as a collaborator in the Rome Foundation Research Institute’s Investigator Network. Treatment-wise we have membership in national units of reference, such as the Neuroendocrine Tumours Committee and the Adult Primary Immunodeficiency Committee. Furthermore, from the research point of view, our unit has been recognised as a group of excellence by AGAUR (University and Research Grant Management Agency) since 2009 and as a CIBERehd (Centre for Network Biomedical Research on Hepatic and Digestive Disorders) group since 2008.
The teaching unit comes under the Digestive System and Liver Department which combines Digestive System, Endoscopy and Hepatology departments, although we also work in collaboration with Internal medicine, Intensive care medicine, Emergencies and Radiodiagnosis, Nutritional support and Digestive Surgery Departments.
In daily practice, resident doctors visit the patients along with their staff doctors, preparing the clinical record and making the physical examination under their supervision. They also make an assessment of the supplementary tests such as endoscopic, radiology, manometric, and anatomy and pathology examinations needed for proper decision making and to diagnose disorders of the oesophagus, stomach, intestine, colon, pancreas, liver and bile ducts. During residency, doctors get to know about the most frequent conditions in the speciality, and often have the opportunity to come across more complex cases, which are a model for interaction with other units at the hospital. In Hepatology they have the opportunity to learn about the features of severe or chronic hepatitis, or hepatic cirrhosis, as well as carrying out the diagnosis, serological tests, treatment and the possible complications, if there are any, and prevention. During their turn in Endoscopy they have gradual, supervised training that covers all from diagnostic examinations to basic therapeutic endoscopy, as well as assisting those responsible for advanced endoscopy techniques, such as endoscopic ultrasound and endoscopic retrograde colangiopancreatography.
Residents in the Digestive Department are on call for internal medicine during the first year and, subsequently, from the second year of residency onwards, are specialist on-call doctors (approximately 4 shifts per month), alongside a physically present department member.
The Digestive System Programme also carries out significant scientific work at the Vall d’Hebron Research Institute and CIBERehd, with five lines of research:
Why practise this speciality at Vall d'Hebron?
Constipation is a disorder of the bowel habits characterised by emptying the bowels less often or hard stools that are difficult to expel. It affects women more than men, and in most cases there is pain or abdominal discomfort. This condition has very important repercussions on the patient’s personal life, health and social life.
In most cases, the cause of constipation is unknown, with no organic or anatomical injury to explain it, and is defined as functional or primary constipation. In other cases, constipation is the result of certain illnesses or medications, known as secondary constipation.
There are several variants within primary constipation:
Secondary constipation due to taking certain medication, above all opioids for pain, and due to neurological, metabolic, or infectious diseases (Chagas) or cancer, amongst others.
The most frequent symptom is difficulty evacuating the bowels.
If there is an alteration in rectal evacuation, symptoms may be:
This is a very common condition in adults and children and affects 10-30% of the world population. 69% of patients say that it affects their performance at work or school, and 40% of patients with constipation have consulted a doctor at some time for this reason. In Spain, between 2005 and 2006, twenty-three million units of laxatives where prescribed in a year.
In general, there are no routine tests on patients with chronic constipation as long as there are no causes for concern such as fever, weight loss or rectal bleeding. On the other hand, if constipation has started recently with no apparent cause, or does not respond well to treatment, it must be investigated via different tests such as:
Constipation must be treated in a personalized way and the causes of it starting or worsening must be analysed. Dietary and hygiene habits and any medication being taken must also be looked into.
The lack of response to this treatment should be assessed by specialists.
There are several ways to prevent constipation:
Crohn's disease is a chronic inflammatory intestinal disease that causes recurring lesions anywhere in the gastrointestinal tract. It particularly affects young people who present episodes of stomach symptoms such as diarrhoea, abdominal pain, fever, blood in faeces or fistulas. Crohn's disease can cause various health problems that may result in changes to the patient's personal, social and family life.
Changes in health directly depend on:
All these changes may make the patient feel their quality of life is getting worse and that they should see their doctor often.
Caring for patients with this disease requires a multidisciplinary approach centred around their needs in order to avoid repeat visits. For this reason patients are treated in specialised unit, such as the Crohn’s-Colitis Unit at Vall d’Hebron Hospital.
The disease manifests as flare-ups. In other words, there are periods when symptoms are active and the patient feels unwell (“flare-ups”) and others when the disease calms down (“periods of remission”).
The most common symptoms during a flare-up are:
The incidence rate of Crohn's disease is 1-10 patients/100,000 people a year and its prevalence is 300 per every 100,000 people. It can appear at any age, but is most common in young adults aged 20-40. It affects men and women equally, and factors leading to a predisposition to the disease include smoking, first degree family members with the disease or changes to the faecal microbiota.
Diagnosis is based on the doctor's assessment of the combined symptoms and subsequent complementary tests that identify and locate lesions in the intestine.
The most important test is the colonoscopy, which consists of inserting a flexible tube into the rectum to see inside the intestine, and through which biopsies can be obtained. Radiological tests can also be used such as MRI or CT scans. The results of the biopsies are used to confirm diagnosis.
Recovery begins with pharmacological treatment, which has vastly improved in recent years, and adopting a healthy lifestyle.
There are several treatment options such as corticosteroids, immunosuppressants, and biological agents, which are used depending on the activity and location of the disease, and taking into account any complications that may arise. Once treatment is agreed it is very important not to stop it, as this would result in a relapse and lack of control over the disease.
This syndrome is one of the most frequently treated gastrointestinal disorders in gastroenterology. It is characterized by chronic abdominal pain accompanied by changes in bowel movements in the form of diarrhoea or constipation. It is common in young women and can have a significant impact on the patient’s personal life, health, and economic and social welfare.
Scientific evidence from recent years suggests there are many different factors involved in developing this disease:
It is currently considered to be a disorder caused by an imbalance in the gut-brain-microbe axis This imbalance negatively affects the functioning of the intestinal barrier and activates the digestive system’s immune and nervous system. This creates visceral hypersensitivity and motor disturbances.
The most common symptoms are:
It is classified according to consistency:
It affects 7.8% of the population in Spain and twice the number of women compared to men: 1. IBS is the reason for 10-15 % of primary care appointments and 25-30 % of gastroenterology consultations. Over 50 % of patients are affected by other pain conditions such as fibromyalgia, headache or pelvic pain, and also by other gastrointestinal disorders such as dyspepsia or by anxiety disorders and depression.
IBS is diagnosed by fulfilling a set of clinical criteria based on symptoms and on the exclusion of other organic causes that may act in a similar way.
Diagnostic criteria known as the Rome IV criteria have been established by medical consensus by committees of experts. The following are required for diagnosis:
When determining treatment, it is important patients understand the chronic and fluctuating nature of the disease. To draw up an appropriate treatment plan, the doctor must identify the dietary and psychic-social causes of the illness.
Specific treatments are beginning to be introduced for IBS, such as linaclotide, eluxadoline and lubiprostone, but not all are available in Spain. There are also many treatments designed to control symptoms, such as anti-spasmodic drugs, laxatives and anti-diarrhoeals.
Chagas disease is an infection caused by the “Trypanosoma cruzi” parasite which is transmitted through the bites of an insect (the “kissing bug”). The disease can also be spread from mother to child (vertical transmission), through blood transfusion, organ donation from people infected with the disease or from eating food contaminated with the parasite. For the moment, the number of new cases has been reduced thanks to policies to eliminate the insect in countries where it is endemic, as well as thanks to screening programmes aimed at blood and organ donors and pregnant women. The future challenges to cure this disease are maintaining and increasing these measures in addition to developing new treatment evolution and response markers for patients in the chronic phase, and new drugs to treat the disease.
Chagas disease is endemic to Latin America and is a global health challenge due to migration from countries in the region. Transmission via insect is mainly found in Bolivia, which has the highest number of cases. There are also infections in north-west Argentina, Peru, Paraguay, Ecuador, Nicaragua and southern Mexico. Outside these areas it is more commonly transmitted from mother to child.
Most patients with Chagas disease do not show any symptoms, which makes it difficult to detect. The disease develops in two phases:
This disease affects six to seven million people, but 60 million are estimated to be at risk of infection. There are 11,000 cases in Catalonia.
There are currently two drugs that are used to treat Chagas disease: Benznidazole and Nifurtimox. Specific treatment is needed to address any cardiac and/or gastrointestinal complications that may arise.
Since 2011, Catalonia has implemented the “Protocol for screening and diagnosing Chagas disease in pregnant Latin American women and their babies”. This programme allows possible congenital cases to be detected, and at the same time actively screens blood and organ donations from donors.
An autoimmune disorder, coeliac disease is the genetically predisposed reaction to ingesting gluten; a protein found in wheat, rye, barley, oats, spelt, kamut, and triticale. For coeliacs, ingesting gluten damages the villi in the small intestine, affecting their capacity to absorb nutrients from food (proteins, carbohydrates, fats, vitamins and minerals). People of any age may have the condition, and although people from any part of the world may be affected, it appears to be most common among white people whose ancestors were from Northern Europe. The most recent studies show the disease affects around 1 person in 100, and it is currently considered the most common chronic intestinal disorder in the western world.
Although some coeliacs may not show any symptoms, the most common are:
It is not fully understood why someone may develop coeliac disease, but several genetic factors are known to make people predisposed to the condition. However, it appears that having a genetic predisposition does not necessarily lead to the disease and that certain environmental factors are required. Despite its genetic origin, we cannot say that it is an inherited disease, although if we look at the general population, the likelihood of someone having the condition is increased if a family member also has it. If there is a family history then the likelihood of having it is 10 %.
First-degree relatives of coeliacs and people with related illnesses such as type 1 diabetes or autoimmune diseases are at greater risk.
Coeliac disease may occur at any age and is more prevalent in women than in men. In Catalonia 1 in every 204 citizens has the condition and it is more common in children than in adults.
The diagnostic process is based on clinical suspicion or recognising some of the risk factors. Serological markers such as anti-transglutaminase antibodies or deamidated gliadin peptide antibodies are used. If they are positive, an endoscopic intestinal biopsy should be performed to confirm diagnosis.
Genetic testing for HLA-DQ2 and HLA-DQ8 can also be carried out to identify people at risk of developing the disease.
Treatment for coeliac disease currently consists of completely and permanently eliminating gluten from the patient’s diet.
Coeliacs cannot eat any foods that contain wheat, oats, barley, or rye. In most cases, complete and lasting recovery from the intestinal damage is achieved, provided the patient does not go back to eating foods containing gluten. Avoiding gluten is only recommended for people with coeliac disease or non-coeliac gluten intolerance and is not necessary, nor recommended, for the general population.
Digestive System, General Hospital
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