Dr Sean Preston, Consultant Gastroenterologist at London Digestive Centre, The Princess Grace Hospital and The Harley Street Clinic – speaks to us about what he expects will be the biggest changes in gastroenterology in the next five years, his involvement in the Nightingale Hospital during the COVID-19 peak, and why people should visit London Digestive Centre for their care.

When did you first realise that you wanted to be a gastroenterologist?

I first realised that I wanted to help people – specifically patients with gastroenterological concerns –when I was a medical student under the tutelage of leading gastroenterologist Dr Hugh Barron. He exposed me to the breadth of conditions that can be treated across a range of patient groups and age ranges.

After working as a consultant for many years, myself and a few colleagues decided to form the London Digestive Health group. It is comprised of good friends of mine (many of whom I first met at medical school over 30 years ago), who have spent their lives understanding luminal gastroenterology at leading London NHS teaching hospitals. Eleven years after the group was formed - our shared desire to help patients has only continued to grow. Nothing makes me happier in my role than being able to offer patients the best possible level of care. Our work with some patients spans decades, meaning we’re able to see them through so many different stages of their life and in many cases become more than patients, which is something special. 

What do you expect will be the biggest change in the diagnosis and treatment of gastroenterology in the next five years?

I think one of the biggest changes will be an increasing focus on the importance of screening within the gastrointestinal tract. There has already been a rise in colonoscopy screening in particular - a trend which has come from the USA and Australia, where the incidence of this cancer occurring has fallen by over 60% in certain populations

That's why we would encourage anyone over the age of 50 to book a consultation and colonoscopy in the absence of symptoms, to look for polyps (benign growths) and have them removed where necessary – preventing them from becoming cancerous.

In recent years we’ve also seen more patients coming to us with irritable bowel syndrome (IBS) symptoms such as bloating, abdominal discomfort, diarrhoea and constipation - and we expect this to increase further in the next few years. We have expert dietitians within the London Digestive Health group who specialise in the low FODMAP diet, which is often very helpful to patients with IBS.

The low FODMAP diet cuts out and then reintroduces certain carbohydrates found in a wide range of food (such as onions, garlic, mushrooms, apples and milk) in a structured manner for a period of time to reduce or eliminate symptoms. London Digestive Health also has a doctor which specialises in gastroenterological hypnotherapy, which can also be invaluable to this patient group. 

Due to COVID-19, how has the care you have provided differed?

During the peak of the pandemic, I was seeing the majority of my patients virtually – the only patients I saw face-to-face were those who required emergency endoscopic procedures, such as those with obstructing oesophageal or colonic cancers.

Also, when it was first announced that the Excel Centre in Docklands would be transformed into the Nightingale Hospital, I was asked if I could lead in bringing together a team of 20 endoscopists to provide an emergency 24-hour gastrointestinal rota for any patient at the hospital who may have a significant gastrointestinal bleed. I managed to bring together these doctors who all kindly agreed to give up their free time to support the hospital. Thankfully, during the first peak of COVID-19 none of the patients needed our services, but it was paramount that we had that level of support readily available and continue to stand ready to support where required.

I am now seeing a lot more patients in clinic – it's so wonderful to see patients’ faces in-person once again.

Why should a patient choose London Digestive Centre for their care?

Many patients will visit London Digestive Centre after spending months or even years seeing other doctors without a diagnosis being established. When patients come to me, I am able to spend a lot of time with them during their consultation to understand their full medical history, their current symptoms and the impact these symptoms are having on their day-to-day life. Time allows me to gain a better understanding of their symptoms and allows me to choose the most clinically appropriate tests and examinations. From there, I can quickly start them on the most effective treatment plan, involving other members of our multidisciplinary team where necessary.

Many patients over the years have benefited from this thorough approach. For example, one young female patient who was in the process of writing up her PhD was experiencing recurrent vomiting and was unable to keep any food down – which caused her to lose 15kgs in weight. She had visited multiple gastroenterologists, but no one could get to the bottom of her symptoms.

Using the expertise within London Digestive Health, and following a range of very specialised gastrointestinal physiology tests, a diagnosis was reached – rumination syndrome. This condition is so rare, that many consultants haven’t even heard of it. Every time she ate, food was coming back up again rather than progressing down the gastrointestinal tract and being absorbed. We devised a treatment plan involving medication and a programme of biofeedback, which meant that she was able to complete her PhD, regain weight and live a normal, healthy life. 

The treatment of patients such as the example I just described is only possible because of the outstanding multidisciplinary team we have. We have seven consultant gastroenterologists, two specialist gastroenterology dietitians and a clinical hypnotherapist. As a group, we also have great relationships with other gastrointestinal surgeons, clinical oncologists and radiologists, most of whom work in the same building as us, enabling us to work together and devise the best possible treatment plan for patients. Between us, consultants within London Digestive Health are often able to offer patients a consultation on the same day as their initial phone enquiry. Consultations are available Monday-Friday 8.00am-8.00pm.
To learn more or to request an appointment with Dr Sean Preston, visit www.londondigestivehealth.co.uk
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