Better Health 30 Eng

W e l c o m e
Welcome to
, the magazine
for patients and friends of Bumrungrad
International Hospital.
Gastrointestinal (GI) tract diseases can affect
all of us because daily lifestyle habits often cause
them. Routine symptoms like stomachache may
be familiar, and we often think them harmless.
However, abdominal pain can sometimes be
more serious than you think. In this issue of
, we devote special attention to the
story of the stomachache from various causes.
Though many experience diseases related to
gastric disorders, they do not know much about
these specific maladies. On page 6, we move from
the stomach to the intestines with information
about irritable bowel syndrome (IBS). You’ll
learn that a variety of diseases can cause similar
types of abdominal pain in the IBS landscape
that require diverse treatments.
Biliary obstruction is another GI tract disease
that most people do not know much about.
Our article on page 10 explains the causes and
symptoms of this condition. You might be
surprised to learn that consuming half-cooked
food is a cause of biliary obstruction that can
lead to as high as a 90 percent chance of
developing cancer.
Our feature on page 16 concerns some major
health threats such as pancreatic diseases. This
valuable information will increase your awareness
so you don’t miss the opportunity to get the right
and timely treatment.
We welcome your feedback, ideas and
comments about Better Health. Please e-mail us
at betterhealth@bumrungrad.com.
Here’s wishing you better health.
C o n t e n t s
4 Dyspepsia
Stomach: inside and insights
abdominal pain and dyspepsia
6 Irritable Bowel Syndrome
Get to know and understand IBS
10 Biliary Obstruction Explained
What you need to know about
jaundice and biliary obstruction
14 M.D. Focus
Get to know our doctors
16 Pancreatic Diseases
Pancreatic diseases: another threat
to your GI system
18 Q&A
20 Health Briefs
22 News from Bumrungrad International
Dr. Num Tanthuwanit
Chief Executive Officer
Medical Director and Contributing Editor
4 6 20
Better Health magazine is published by Bumrungrad Hospital Public Company Limited and is produced
for Bumrungrad Hospital Public Company Limited by Oakins and Stone Limited, 10/162 The Trendy
Buiding, 20fl., Room 2001C, Soi Sukhumvit 13 (Saengchan), Khlongtoey - nua, Wattana, Bangkok 10110.
Tel: +66 (0) 2168 7624 Fax: +66 (0) 2168 7625. www.oakinsandstone.com
No part of this magazine may be reproduced without the written permission of Bumrungrad Hospital
Public Company Limited. 2014 by Bumrungrad Hospital Public Company Limited. All rights reserved.
Publication of advertisements or sponsorships shall not constitute an endorsement by Bumrungrad
Hospital Public Company Limited of the products or services promoted, of the company or organization,
nor of the claims made.
Telephone: 66 (0) 2667 1000
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Out-patient
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Website: www.bumrungrad.com

DYSPEPSIA
Stomach: inside and insights
Abdominal pain and dyspepsia
When someone suffers from abdominal pain, the
term “dyspepsia” usually comes to mind. Indeed,
it seems that most people call stomachaches and
other abdominal conditions dyspepsia.
But is it accurate to say that abdominal pain is dyspepsia?
Moreover, what are the causes of abdominal pain and what
types of pain are signs that you should see your doctor
immediately? You’ll find answers to these questions and
more in this issue of .
Abdominal pain as a warning
Everyone has experienced abdominal pain, but in many
different situations and various forms. The characteristics
of abdominal pain cover a range of characteristics: tightening,
contracting, squeezing, or just mild. These various kinds of
pain are warning signs for a variety of diseases. According
to Dr. Siriwat Arnantapunpong, a physician specializing in
gastroenterology and hepatology, abdominal pain falls into
two broad types based on the area in which it occurs.
Upper abdominal pain: above your navel, usually involves
the stomach, liver, gallbladder, spleen, and pancreas.
Lower abdominal pain: below your navel, usually involves
the large intestine, small intestine,
appendix, kidney, and uterus.
“When a patient complains of
abdominal pain, the first thing the
doctor asks is where it hurts so that
he can narrow down which
organs might cause it,” says
Dr. Siriwat.
“
Gastroscopy is a
favored method
because it’s quick and
effective. The procedure
takes no more than
five minutes.”
Dr. Siriwat Arnantapunpong
“Then the doctor focuses the examination and tests on
those areas to promptly diagnose the cause and begin
treatment as soon as possible.”
Two types of disease cause abdominal pain:
1. Surgical conditions and diseases, such as appendicitis,
leaky gut syndrome, intestinal obstruction, acute peritonitis
or intestinal inflammation, intestinal cancer and gallstones.
Open surgery or endoscopic surgeries are the only ways
to treat these diseases.
2. Internal medical conditions and diseases, such as dyspepsia,
flatulence, excessive stomach gas, chronic constipation,
liver diseases, and intestinal infections.
Which kind of abdominal pain is dyspepsia?
Dyspepsia causes tightening, burning, colic pain around
the middle of the stomach, above the navel or epigastric
region (the upper central area of the abdomen). It can be
both acute and chronic pain.
Acute abdominal pain is severe pain that the patient has
never felt until now. Doctors exercise caution when diagnosing
and treating acute abdominal pain because other diseases,
such as gallstones in the gallbladder or pancreatitis, can
also cause this unbearable level of discomfort.
Chronic abdominal pain is the most common level of pain.
It comes and goes continually for at least a month. This pain
is related to when and what people eat, such as feeling
discomfort from being hungry or too full. This kind of pain
is ordinarily bearable. With proper eating habits or a course
of antacids, the condition should improve.
Dr. Siriwat explains that stomach diseases that cause
chronic abdominal pain include severe gastritis, peptic ulcer
4

or gastric cancer. Among cases of chronic dyspepsia, they
lead to these diseases at a rate of 20 to 25 percent.
The stomach can also suffer from diseases even when
there are no physical anomalies in the organ itself. Rather,
the diseases and pain come from dysfunctions of the
gastrointestinal system. For example, stomach pain can
occur when stomach and intestinal contractions are out of
synchronization, or there is excessive acid in the stomach,
but not enough to be an ulcer. These conditions cause 70 to
75 percent of problems for which patients seek a doctor’s
treatment.
Acid-related stomach conditions, however, do not always
come with abdominal pain. “Many patients come to see
doctors because they vomit blood or have black stools caused
by excessive acid, which causes open wounds and bleeding
in the stomach. Another situation is heartburn caused by
reflux acid in the stomach that inflames esophageal tissue.
In some cases, the inflammation rises up to the throat,
causing coughing fits. All of these symptoms involve the
stomach,” says Dr. Siriwat.
Diagnosis
To find and diagnose chronic abdominal pain, the doctor
reviews the patient’s medical history and performs a regular
physical check-up. The most effective and widely used
method is gastroscopy. With this method, the doctor collects
a tissue sample to find pathological lesions and search for
the helicobacter pylori (H. pylori) bacterium, which causes
many stomach diseases. The doctor can perform these
procedures simultaneously.
“Gastroscopy is a favored method because it’s quick and
effective,” Dr. Siriwat says. “The procedure takes no more
than five minutes. The doctor gives the patient a safe, shortterm
sleeping drug before orally inserting the scope into
the gastrointestinal tract. This method helps the doctor find
the cause swiftly and immediately proceed to treatment.”
Besides gastroscopy, the doctor may include a CT scan
and ultrasound in the diagnosis especially if the patient has
an acute condition. In addition to gastroscopy, other methods
used to find H. pylori are a blood test or breath test, in which
the patient simply has to exhale into a device.
Drugs don’t help?
Suspect H. pylori
H
elicobacter pylori is the main cause of
chronic gastritis, peptic ulcer, gastric ulcer,
stomach cancer and gastric lymphoma. Data show
that there are over 2 billion people currently
infected with these bacteria worldwide.
In Thailand, about 40 percent of dyspepsia
patients are infected with this bacterium. Cases
occur mostly in the northern and northeastern
region where food often hasn’t been cooked well
enough before consumption.
Treatment and prevention
For patients with peptic ulcer and gastritis, which are
not caused by H. pylori, doctors prescribe antacids to
decrease acid in the stomach and help the wound to heal
faster. Doctors may also use medicines that protect stomach
tissue. H. pylori ailments can be completely cured with a
two-week course of antibiotics.
For stomach dysfunction-related dyspepsia doctors
sometimes prescribe a drug called prokinetic. Prokinetic
supports stomach and intestine movement and helps the
stomach and esophagus function better together.
Dyspepsia is not a severe disease. But if the patient neglects
it many complications can follow such as stomach bleeding,
perforation, and stomach obstruction, some of which can
be fatal.
Therefore, Dr. Siriwat advises that people should only eat
food that is well cooked, clean, not too spicy, and consumed
in moderate amounts. Stress control, alcohol and coffee
abstinence, and caution in taking drugs that disturb the
stomach are important factors in preventing dyspepsia.
Follow this routine and your stomach will not suffer from
dyspepsia.
No dawdling for these pains
I
f you suffer come-and-go abdominal pain for four weeks or more,
see your doctor. But if these conditions accompany the pain seek
medical attention immediately:
Abdominal pain with vomiting
Changing abdominal pain such as burning pain turning into squeezing
pain, contracting pain or the pain becomes harsher
Anemia, possibly from losing blood through stomach wounds
Yellow eyes
Chronic fever that stays at around 37.5 – 38 degrees
Weight loss of over 10 percent within 1 to 2 months
Taking antacids for 1 to 2 weeks but showing no sign of
improvement or suffering from other complications
5

IRRITABLE BOWEL SYNDROME
Not that Serious but Chronic
Get to Know and
Understand IBS
The symptoms of chronic abdominal
pain, constipation, and diarrhea that
do not respond sufficiently to medical
treatment affect many people.
What can people do if they have
this condition, known as Irritable Bowel
Syndrome?
Irritable Bowel Syndrome (IBS) is a disease frequently
diagnosed as the culprit of many patients’ digestive
problems. But, not surprisingly, these patients often
misunderstand its symptoms, which are similar to other
diseases, such as various stomach disorders, constipation
and diarrhea.
talks with Dr. Suriya Chakkapak, a surgeon
who specializes in Gastroenterology and Hepatology, to
help you better understand the Irritable Bowel Syndrome
group of ailments.
What is Irritable Bowel Syndrome?
IBS is a group of symptoms occurring from bowel
dysfunction, but in which no physical bowel disorder (tumor,
cancer, inflammation, or other conditions, etc.) could be
identified as the cause, Dr. Suriya explains.
IBS patients’ main symptom is chronic stomachache and
abdominal pain, on and off for a period of over six months,
in conjunction with bowel habit disorders.
“ Most IBS patients visit a doctor
presenting stomach pain and
abdominal discomfort—
particularly pain in the lower
abdomen, either on the left
or right side—along with
constipation or diarrhea
symptoms,”
Dr. Suriya Chakkapak
IBS symptoms categories:
Diarrhea Group;
Constipation Group;
Diarrhea Group alternating with Constipation Group;
Mixed type alternating with occasional complication
and diarrhea
“Most IBS patients present with abdominal discomfort –
particularly pain in the lower abdomen, either on the left or
right side – along with constipation or diarrhea symptoms,”
Dr. Suriya says. “In some cases the patient has loose stools
or diarrhea continuously for many days, which adds to his
or her discomfort and anxiety. But a patient with IBS-related
constipation or bound belly experiences symptoms differently
than from general digestive problems. For example, a patient
with a general disorder will have abdominal pain or discomfort
simultaneously. However, after defecation, abdominal
pain or discomfort symptoms diminish.”
Patients with IBS symptoms have no other key indicators
of a dangerous condition, such as fecal
mucus or bloody stools, weight loss,
vomiting, decreasing size of stools or
rectal tenesmus (a feeling of constantly
needing to pass stools).
Causes and Diagnosis
Although IBS is the most frequently
diagnosed bowel disease, the medical
community has still not been able to
identify its cause definitively. Doctors’
best estimate is that some unknown
mechanism causes nerve sensitivity in
gastrointestinal motility (the movement
of food through the digestive system) in
the alimentary canal.
Despite not knowing the root cause,
physicians now understand more about

IBS’s characteristics and effects so can better diagnosis it.
“To diagnose, we start with blood and stool tests, the patient’s
medical history and whether family members have colon
cancer or gastrointestinal cancer,” Dr. Suriya says. “These
procedures enable us to separate and classify symptoms
to be sure that the patient has IBS.”
Regarding using endoscopy (a tubular camera device
that looks inside the digestive tract) to diagnose, Dr. Suriya
says it’s not necessary if the patient has no obvious risk
factors for more serious conditions. Risk factors that do
indicate performing a colonoscopy include the patient being
over 40 years old, which raises the risk for colon cancer,
or a history of constipation for long periods.
After these various examination procedures rule out a
serious physical disorder, a doctor can then diagnose the
patient with IBS.
Symptomatic Treatment
Since IBS has no clear cause, the attending doctor focuses
on treating the patient’s symptoms, such as prescribing
laxatives, medicines that relieve abdominal cramps, antacids
and antidiarrheal regimens. Keep in mind, however, that
these treatments do not eliminate the underlying cause
eating fat-rich foods, then you should avoid them. Also, to
prevent gastrointestinal tract infections and their symptoms,
avoid unclean food and water.”
of IBS. Therefore, the patient may have to endure these
symptoms repeatedly.
Dr. Suriya suggests that since IBS’s cause is unknown,
patients should avoid risky behaviors that may lead to
functional bowel disorder, such as:
Unhealthy eating habits, including irregular eating patterns
(for example, skipping breakfast), taking high-fat and
fast foods, or foods with little or no fiber.
Habits or activities that cause continual stress and anxiety
Allowing abdominal pain to go untreated to the point
where it becomes a chronic symptom
“Patients must be attentive to their condition and avoid
behaviors that cause and aggravate IBS symptoms,” advises
Dr. Suriya. “For example, if you have stomach pain after
Change Your Behaviors; It Helps
Irritable Bowel Syndrome is not a life-threatening disease
nor is it a signal of cancer. Patients with IBS can enjoy
long lives, but enduring these on-and-off aliments results
in poorer quality of life. Because the symptoms cannot
be completely cured, most IBS sufferers are in a state of
ongoing stress worrying that they have a more serious
disease. In practical terms, for example, IBS-related diarrhea
interferes with patient’s daily lives because they have to go
to the restroom so often.
“The best method to cope with IBS is to not think that
it’s a dangerous disease,” Dr. Suriya says. “The more stress
you have, the worse the symptoms get. Along with treatments
doctors prescribe to relieve symptoms patients should adjust
their behaviors in order to lessen symptoms and reduce
the frequency of IBS-related events,” Dr. Suriya concludes.
Irritable Bowel Syndrome requires time to cure. Knowing
and understanding this disease helps people have a better
quality of life.

BILIARY OBSTRUCTION
What you need to know about
jaundice and biliary obstruction
While jaundice may sound familiar to most people,
one of its possible causes — biliary obstruction —
should not be ignored.
Jaundice’s familiar symptoms – yellow-tinted eyes, skin
and urine – can be caused by a myriad of factors.
Besides hepatitis and liver diseases, biliary obstruction
is another possible cause. To better understand the condition
talks to board-certified gastroenterologist
and hepathologist Dr. Yudhtana Sattawatthamrong who
has more than 20 years experience in this field.
How the bile system works
“The bile duct system, which is part of the digestive
system, can be compared to branches of a tree,” explains
Dr. Yudhana. “Bile is a dark green or yellow-brown liquid
secreted by the liver. It passes through tiny tubes called
bile ducts connected to the gallbladder where it is stored
and becomes concentrated and intensified. When you eat,
food is transported to the stomach and the intestine,
which triggers secretion of a hormone to stimulate the
gallbladder to release bile into the small intestine (the
duodenum) to facilitate fat digestion and absorption.”
Causes of blockages
Bile duct blockage is usually caused by two conditions:
stones and tumors. “Bile duct obstruction caused by
stones can be found anywhere in the bile duct system,”
says Dr. Yudhana. “Gallstones occur when bile, which is
normally fluid, forms stones. Gallstones commonly are
lumps of fatty, cholesterol-like material that has solidified
and hardened. Additionally, bile pigments or calcium
deposits can also form gallstones.”
Gallstones become more common with increasing age
after 40. The risk of forming gallstones also increases
with pregnancy, obesity, diabetes, liver cirrhosis, and
thalassemia. Women with abnormal hormone levels or
who use contraceptive pills have increased risk of forming
gallstones.
“When bile ducts become blocked, bile builds up in the
liver and spreads into the blood stream. Jaundice develops
due to increasing levels of a blood component called
bilirubin, which could lead to life-threatening infections,”
Dr. Yudhana continues.
Patients with obstructed bile ducts caused by stones
and tumors can have differing symptoms. “Patients with
biliary obstruction caused by stones may experience
jaundice accompanied by upper abdominal pain that
radiates to the back, fever, shivering cold, and infection,”
says Dr. Yudhana. “Patients who have blocked bile ducts
caused by tumors will experience jaundice, but not abdominal
Bile duct location diagram
gallbladder
bile duct
small intestine
stomach
pancreas and
pancreatic duct
10

pain since tumors gradually develop and grow.
The bile ducts are increasingly blocked over
time, causing them to swell.”
Ninety percent of biliary obstruction caused
by tumors can further develop into cancer. In
Thailand, bile duct cancer is common in the
northeastern region where people consume
uncooked or undercooked freshwater fish
containing parasites. When the parasites enter
the bile duct, their waste products can cause
bile duct cells to develop uncontrollably which
can develop into cancer.
Diagnosis and treatment
To diagnose biliary obstruction doctors
check the patient’s health history and perform
a blood test to confirm the cause of the
jaundice. An ultrasound test is also prescribed
to examine the bile duct blockages. “Doctors
examine the biliary tree thoroughly, including
intrahepatic bile ducts, the common hepatic
bile duct, and the pancreatic duct. In most
cases ultrasound images are sufficient for
doctors to diagnose and plan treatment. In cases where
an ultrasound is not definitive, we recommend a
CT scan, MRI, MRCP, or an Endoscopic Retrograde
Cholangiopancreatography (ERCP),” says Dr. Yudhana.
Bile duct blockages can be life threatening if left
untreated. “In the past, treating biliary obstruction caused
“ The risk of forming
gallstones increases
with thalassemia,
women with abnormal
hormone levels,
pregnancy, obesity,
diabetes, liver cirrhosis,
and age over 40.”
Dr. Yudhtana Sattawatthamrong
by gallstones required open surgery,” Dr. Yudhana points
out. “A six-inch abdominal incision was made to remove
stones in the bile duct. Nowadays, the surgery is done
using ERCP, which allows doctors to diagnose and treat
biliary blockage by bile duct stones simultaneously. This
procedure doesn’t require any incision in the abdomen
and promotes faster recovery.”
In an ERCP procedure, a flexible tube with a micro-
camera is inserted in the mouth and gently guided down
the throat into the esophagus, stomach, and duodenum
until it reaches the point where ducts from the pancreas
and gallbladder drain into the duodenum. If a bile duct
stone is present, the doctor can sometimes remove it
by dragging it into the small intestine so the body can
eliminate it during bowel movement.
“To treat bile duct blockage caused by tumor the doctor
needs to obtain a tissue sample for further testing to
confirm if the tumor is malignant, which can also be done
during an ERCP session,” Dr. Yudhana says. “If the tumor
is cancerous the doctor will plan additional treatment.
An important point to consider is if the patient also has
jaundice caused by bile duct blockage. Treating this requires
inserting a stent or undergoing surgery to bypass the bile
duct blockage and drain the bile fluid into the intestine
before treating the cancer.”
While diagnoses of biliary blockage can be done quite
easily, spotting the first-stage warning signs or taking
preventive approaches still remain challenging. However,
taking control of your health by eating healthy and doing
regular exercise are very helpful in preventing these
conditions.
12

Get to know our doctors
Meet four Bumrungrad physicians who share their thoughts on a range
of healthcare topics.
Providing the highest standards of patient care requires a hospital-wide commitment and professional expertise.
Bumrungrad’s medical staff includes over 1,300 world-class doctors of the highest caliber, with outstanding
professional credentials and advanced training across the full spectrum of medical sub-specialties.
Dr. Navara Dusitanond Surgeon - General Surgery, Colorectal Surgery
Dr. Nawara graduated (with second-class honors) in the field of general surgery
and as a colorectal specialist from the Surgery Department, Chulalongkorn
University. Before joining the Bumrungrad team, he worked with the Naval
Medical Department, the King Chulalongkorn Memorial Hospital, the Thai Red
Cross Society, and the Chulabhorn Research Institute.
Q: What are your
impressions of working
at Bumrungrad?
A: Bumrungrad is
highly professional in
management, treatment technology and personnel. Each
unit takes responsibility for its duties, which makes taking
care of patients efficient and up to standard. Both the medical
community and patients regard Bumrungrad as one of the
most capable and successful hospitals in the country. For
doctors, working here is quite challenging because we often
take on difficult cases from both domestic and international
patients. In some cases, I’m presented with situations I’ve
never seen.
Q: How do you handle stress?
A: I have many hobbies such as photography and traveling.
But what I like the most is scuba diving because I get to live
with nature to the fullest extent for a full three to four days
on a boat in the middle of the sea. With no phone signal, I am
completely cut off from the outside world. For me, this is the
best way to deal with stress.
Dr. Sudarat Yaisawang Ophthalmologist - Ophthalmology (Eye), Pediatric Ophthalmology
Along with Dr. Sudarat’s practice, which specializes in pediatric ophthalmology
and squinting, she is highly regarded as the president of the Royal College of
Ophthalmologists of Thailand and head of the Ophthalmology Department,
Chulalongkorn University. She held various administrative and academic
positions before coming out of retirement to join the medical staff at
Bumrungrad International.
Q: What are common child vision problems?
A: Because children today spend so much time staring at
computer screens they suffer from nearsightedness at a young
age, which increases more rapidly than in the past. Parents
must warn their children to rest their eyes frequently by
looking into the distance. They should also encourage them
to engage in outdoor activities.
Q: Which cases are most memorable?
A: Although I’m a pediatric ophthalmologist, I treat patients
of all ages. I have several elderly patients who have been
coming to me for so long they seem like close relatives. Some
moved on to other doctors, but they missed me so much
that they have come back to my practice. These longtime,
loyal patients truly
impress me.
Q: What gives you
pride in your work?
A: In 1982, there was turmoil in Cambodia. Thailand gave
support to up to 100,000 refugees at Khao-I-Dang refugee
camp, which lacked sufficient medical personnel. Seeing
this need, I volunteered to be the chief of the Thai Red Cross
Eye Specialist Surgical Team to treat these refugees. I
commuted between the camp and Bangkok every weekend
for more than 10 years. The American Red Cross recognized
my service with a humanitarian award, which made me feel
honored and proud.
14

Dr. Koonlawee Nademanee Cardiology - Arrhythmia Center
For more than 30 years, Dr. Koonlawee has taken care of patients with physiological
cardiac problems and cardiac arrhythmia in Thailand and the US. Along with his
practice, he conducts research continuously to develop and improve treatment.
The medical community holds Dr. Koonlawee in high regard as one of the country’s
finest doctors and dedicated researchers.
Q: What is the most difficult aspect of your work
as a doctor?
A: As a doctor, giving my best to treat patients is all I
want, but to have all patients fully recover is impossible.
Therefore, the more patients I treat, the odds of incurable
cases increase. Even though the number of incurable
patients is small, I think about them, as it’s hard to
restrain my mind. For example, if I treat 100 patients
and can’t cure two percent, this means there are two
incompletely cured people out of 100. But if I treat 1,000
patients the number of incurable cases also rises.
Q: What principles guide your work?
A: Keep learning, always. I strive to remind myself
every day that I have yet to know all that I should.
Accordingly, I constantly
seek additional knowledge
and new technologies and
then adapt them to research
work to acquire the best
benefits in treating patients.
Q: How has treatment
technology changed in recent decades?
A: Medical technology changes dramatically and quickly.
This acceleration occurs not only because doctors are
more competent, but also because many fields of knowledge
have advanced so much, such as software development
and engineering. Additionally innovations, such as
ultrasound, MRI, and CT scans greatly improve and
advance treatment technology.
Dr. Nattawut Wanumkang Ophthalmologist - Ophthalmology, Oculoplastic & Reconstructive Surgery, Cataract
Dr. Nattawut graduated as a specialist from the University of California, San
Diego. He specializes in dacryocystitis, diseases of the eyelids and eye sockets,
and eyelid plastic surgery. He also devotes time to educating colleagues in
new ophthalmological knowledge domestically and internationally.
Q: What sparked your
interest in academics?
A: Giving full involvement
in my specialty is what
underlies my passion for
ongoing study. Intensive
practice and experience prepare us to treat actual medical
problems and train us to always look for better solutions.
I believe we should never stop revisiting and revising our
knowledge. And once we’re confident in our knowledge
and abilities, we must share it through our practice. The
more we give, the more we receive. When we share
knowledge with others, whether they use the knowledge
in their practices or pass it on, this brings me much
happiness.
Academic work is about giving. I think hospitals
prepared with equipment and personnel that can handle
enough cases, can develop into specialized medical centers
for knowledge transfer. We accomplished this goal at
Mettapracharak Watraikhing Hospital. When I joined
Bumrungrad International, I saw great potential to do the
same thing here. Recently, we’ve established seminars
and workshops on Master Techniques in Ophthalmic
Plastic and Reconstructive Surgery, the second International
Training Course with international world-class specialists
who came to Thailand to give lectures. They passed on
their vital knowledge to more than 250 doctors, which I
consider a very successful result.
Q: What are your impressions about working
at Bumrungrad?
A: Bumrungrad has many board-specialized doctors
with impressive expertise. I recall a very difficult case
where a patient had cancer on the upper part of the face.
The cancer went through the eye socket into the brain.
We mobilized doctors from all related fields to participate
in the treatment. The surgery took 11 hours to accomplish.
The collegial work environment barely differed from that
of medical school. Such a cooperative scenario is quite
hard to find.
15

PANCREATIC DISEASES
Pancreatic diseases
Another threat to your GI system
P
ancreatitis, pancreatic cancer and pancreatic cysts
may be rare diseases compared to other ailments
in the gastrointestinal system, but these illnesses
can be deadly while showing no noticeable symptoms.
For those who possess risk factors, being informed about
pancreatic diseases and their specific conditions raises
awareness and promotes a patient’s prompt action to engage
specialists for treatment, increasing the odds of survival.
The sooner these diseases get diagnosed, the better the
chances for a cure.
This issue of
has information about pancreatic
diseases from Dr. Rujapong Sukhabote, a physician specializing
in gastroenterology and hepatology.
The pancreas, an introduction
The pancreas is an organ in the gastrointestinal track.
It is a sizable gland, shaped like an elliptical leaf around
10 cm long. The pancreas is not positioned in the abdominal
cavity, but rather is located behind the stomach, close to the
upper part of the small intestine.
The pancreas is composed of two kinds of cells. Endocrine
gland cells produce various hormones including insulin and
glucagon, which control blood sugar levels. Exocrine gland
cells produce juice for digesting food, especially fat. This juice
is delivered to the small intestine through the pancreas.
gallbladder
Pancreas location diagram
bile duct
pancreas
pancreatic duct
Pancreatitis
Pancreatitis is the most common pancreatic disease.
Dr. Rujapong explains that pancreatitis is a condition in
which pancreatic juice cannot flow through the pancreatic
duct, resulting in the self-digesting of pancreatic tissue
and consequently inflammation. Serial incidents of these
inflammations will turn into a chronic condition and cause
calcification in the pancreas. The pancreas will then reduce
in size, limiting its efficiency.
“Pancreatitis comprises two types: acute and chronic,”
says Dr. Rujapong. “The disease starts with acute inflammation.
If the ailment is not properly treated, or is treated, but the
condition reoccurs because the cause is not dealt with, the
inflammation becomes chronic.”
Acute pancreatitis patients suffer from non-stop, intense
pain. “The searing pain feels as if the patient were being
stabbed with a knife,” the doctor notes. “Nausea or vomiting
are also symptoms. In rare cases patients only have minor
abdominal discomfort or no pain at all.”
For chronic pancreatitis, the abdominal pain may be
lessened, but it is accompanied by other complicated
conditions such as chronic stomachache, uncontrollable
sugar levels, diabetes, chronic diarrhea due to undigested
fat, fat-filled feces, weight loss and jaundice.
small intestine
duodenum
Causes of pancreatitis
Heavy alcohol consumption and gallstones in the gallbladder
are the most common causes of pancreatitis. Other causes
are high triglyceride levels, side effects from some drugs,
16

autoimmune diseases, parasites or viruses. “There
is about a 5 to 10 percent chance that the cause
can’t be determined. These patients will time and
again suffer from the disease because we don’t
know what to treat,” says Dr. Rujapong.
Diagnosis and treatment
A patient with acute pancreatitis will probably
see a doctor because of symptoms that include
stomachache, nausea, vomiting, or fever. The doctor
will then perform tests to confirm that the ailment
is pancreatitis. A blood test reveals which of the
pancreas’s enzymes are heightened and ultrasound
and CT scans show if the pancreas is inflamed.
For a patient diagnosed with pancreatitis the
doctor prescribes analgesics and then forbids the
patient from drinking any water or consuming
food for a certain time to stop the pancreas’s
functioning. (The patient will be provided with
enough water for 24 to 48 hours to prevent dehydration.) In
cases of severe pancreatitis where the pancreatic tissue is
in decay, there is a high chance for infection. The doctor will
prescribe antibiotics or perform surgery to directly cleanse
the pancreas.
“Acute pancreatitis can be permanently cured if the cause
is identified,” says Dr. Rujapong. “For example, if there are
gallstones in the gallbladder, removing the gallstones will
resolve the problem. That’s why — unless it is found too
late or with complications — acute pancreatitis has a low
fatality rate. For patients with chronic pancreatitis with an
unknown cause, they need to follow their doctors’ instructions
closely since the disease can lead to other debilitating conditions
such as diabetes or pancreatic cancer.”
Pancreatic cancer
Though rarely found in Thailand, patients with pancreatic
cancer are increasing in number. According to World Health
Organization reports, pancreatic cancer ranks seventh
worldwide and fourth in the USA as the cause of cancer
deaths.
Causes and symptoms
Pancreatic cancer is classed as a severe condition because
diagnosis is difficult and there are no definite symptoms in
the early stage. The patient may complain to his or her doctor
“
Acute pancreatitis has
a low fatality rate because
it can be permanently
cured if the cause is
identified with no
complications.”
Dr. Rujapong Sukhabote
about stomachache, flatulence, loss of appetite or jaundice.
However, in many cases, there are no visible symptoms.
Many times the condition is discovered through a routine
physical check-up. In this instance the doctor notices anomalies
in blood tests and develops a further diagnosis by using
a CT scan.
The cause of this disease is yet to be identified, but those
who smoke, eat meat with high fat content and have a genetic
predisposition are at risk of developing pancreatic cancer.
Additionally, those who suffer from chronic pancreatitis and
pancreatic cysts are also at risk.
Treatment
Surgery to remove the cancer is always the best treatment
as long as the tumor is found quickly and has not yet spread
to other parts of the body. “There are many cases that are
found too late,” Dr. Rujapong warns. “Patients either have
conditions too critical to undergo the operation or have really
low survival rates. That’s why we always advise those who
are at risk to get regular physical check-ups, once every six
months to a year.”
This disease does not always come with obvious symptoms
or a cure. If you are seemingly healthy, but at risk for any
diseases, don’t take it for granted. When it comes to your
health you can’t let your guard down.
Pancreatic cysts
C
ysts are a condition that can occur on any organs or tissue,
including the pancreas. A cyst is a sack containing water or
some other bodily liquid. Sometimes it can contain soft ,
which is a mix of liquid and tissue.
Pancreatic cysts are a rare condition. Many times they are so small
they cause no discernable symptoms. These tiny cysts can be found
using ultrasound or CT scans. If the liquid inside does not show any
abnormality in the test, the doctor will take no action other than to
continue to observe if they get bigger. But if the doctor suspects that
they have a risk of developing into cancer then he or she will immediately
suggest surgery to remove them.
Pancreatic cysts can happen to anyone no matter the patient’s age
or gender. Finding this disease is just one advantage of having regular
physical check-ups.
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D
igestive health problems are found in people
of all ages and in some circumstances are hard
to treat. Accurate advice from experts can help
you deal with the problems properly while also reducing
anxiety.
Q: My daughter has diarrhea. Is it true that I should feed
her yogurt instead of medications?
A: Normally, doctors recommend that you avoid dairy
products when having diarrhea. But fermented milk or
yogurt is the exception, despite that it comes from milk.
This is because yogurt has live or active cultures called
Probiotics such as Lactobacillus and Bifidobacterium. When
eaten in adequate amounts these organisms appear to help
establish a healthier balance of bacteria in the digestive
tract. These live cultures help restore the good bacteria in
your intestine and reduce stomachache or diarrhea caused
by bad bacteria.
However, only eating yogurt is not enough. First and
foremost you should prevent dehydration and a keep a good
balance of liquids and minerals in the body by drinking
water or sport drinks. It is not always necessary to take
medication. Excretion is the body’s natural way to expel
germs and waste. Certain drugs that stop excretion may
result in the body storing germs and cause harmful effects
including slowing down the recovery process.
Q: I tend to get traveler’s diarrhea and am quite
worried about it. Should I preventatively take medicines
before traveling?
A: Anywhere from 20 percent to 50 percent of
international travelers may suffer from the nightmare
of traveler’s diarrhea at some stage during their travels.
The onset of and recovery from traveler’s diarrhea usually
occurs within a week of travel. Therefore, doctors generally
do not recommend taking anti-diarrhea medicine because
it may cause side effects such as flatulence. Normally, the
primary source of infection is ingestion of fecal-contaminated
food or water. Thus, travelers should pay careful attention
to the food and water that they ingest, avoiding
half-cooked, unusual and unclean food items.
Q: I just turned 50 and my doctor has recommended a
colonoscopy for colon cancer screening. Will it hurt? Are
there alternatives to
colonoscopy that are
equally effective?
A: The latest
incidence statistics
from the National
Cancer Institute
claim that among
new cancer patients,
colon and rectal cancer
is second only to breast
cancer. The incidence
rates increase in people aged 50 and over and is more common
among males than females. If you are at risk, you should
consult a doctor or genetic counselor to get screened and
analyze your risk of developing cancer.
Nowadays, there are several methods to screen for colorectal
cancer. Apart from a colonoscopy, the cancer can also be
detected with a fecal occult blood test, sigmoidoscopy and
computerized x-ray. Each method has pros and cons. Specialists
choose the most suitable method for each patient. But
generally, colonoscopy is a safe and highly precise way to
detect colon and rectal cancer. Besides, before starting the
test, patients are given a sedative so that they avoid the
test’s discomfort.
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Have a question? You can submit your question for possible inclusion in future issues of , by e-mail
betterhealth@bumrungrad.com or by mail to Editor, Magazine, Bumrungrad International Hospital,
33 Sukhumvit 3, Wattana, Bangkok 10110, Thailand.

HEALTH BRIEFS
Alcohol with tobacco, a cocktail
for esophageal cancer
It’s a fact that alcohol and tobacco play important
roles in developing esophageal cancer, but a recent
study published in The American Journal of Gastronomy
found that the combination of both doubles the risk
compared to those who either smoke or drink.
Researchers from the University of Michigan,
United States, have assembled data from various
databases including many studies concerning patients
with esophageal cancer and how tobacco and alcohol
affect their conditions.
After systematic review,
they confirmed that
smoking and drinking
are both independent
and dependent risk
factors for esophageal
cancer.
Survival rate of bowel cancer
increases with vitamin D
Arecent study from the University
Edinburgh, United
finds that patients with bowel
cancer supplied with enough
vitamin D have distinctly
higher chances of
surviving the disease,
especially those in stage
2, at which point the
tumor may be quite
large but the cancer has
not yet spread.
Researchers tested
blood samples from almost
1,600 patients after surgery
for bowel cancer and found that
three quarters of patients with high
vitamin D levels are still alive after five years while those
with low vitamin D survive at a rate of less than two thirds.
This has evidently proved that vitamin D helps increase
the survival rate, though the nature of the relation still
remains unclear.
However, the study also says that the research only
observes natural vitamin D intakes such as from sunlight
or food. Further study is still needed to know whether
vitamin D supplements yield the same effect.
Training toddlers to eat
veggies should begin
before the age of two
“M
y child does not eat vegetables.” This is a cause for
concern for parents in many households worldwide.
No matter how many tricks parents have up their sleeves,
they find it difficult to get their children to say yes to those
green leaves. Many have given up on trying, but a recent
study by a cooperative effort at universities in England,
France and Denmark has found the latest trick for parents
to try: have your children eat vegetables as early and as
continually as possible.
The study had 403 preschool children, aged 4 months to
3 years, eat 100 to 200 grams of artichoke puree 5 to 10
times by serving it as meals or afternoon snacks and
observed how much each child ate. The result is 40 percent
of all children were likely to eat more vegetables each time,
21 percent consumed most of what was offered every time,
16 percent still refused the food even after five attempts
and the rest are those whose patterns were too variable
to specify.
“Younger children are less picky about their food,”
a researcher involved in the study says. “We found
that training children to eat vegetables should begin
before the age of two. You also need to be consistent
and the result should show after 5 to 10 times.”
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Bumrungrad International hosts the
Asian Full-Endoscopic Workshop
B
umrungrad Spine Institute, led by Dr. Verapan Kuansongtham
(fourth from left) and Dr. Sompoch Paiboonsirijit (fourth
from right), together with St. Anna Hospital Germany, recently
hosted the Live Surgery and Lecture of Full-Endoscopic
Operations of the Lumbar, Thoracic and Cervical Spine. An
international roster of surgeons attended, including several
from Thailand. The workshop will be conducted once in Thailand
and twice in Germany each year. This was the fifth of such
workshops held in Thailand.
Bumrungrad announces
‘Simulation Training Center’
M
r. Dennis Brown (first from left), Bumrungrad’s Corporate
CEO, Dr. Jitra Anuras (second from left), acting Medical
Director, together with hospital executives recently announced
the launch of a unique Simulation Training Center.
Bumrungrad is Thailand’s first private hospital to use such an
innovative training facility to improve patient care. The Simulation
Training Center is currently equipped with the latest full-body
manikin and infant manikin, which can simulate more than 60 key
situations including pulse, heart rate, pulmonary sound, sweating,
tearing, and purple nails. The simulation center can accommodate
registered nurses for up to eight sessions per day.
Picture shows (From Left): 1. Dr. Thanet Wattanawong 2. Dr. Visith
Dusitnanond 3. Mr. Mack Banner 4. Dr. Verapan Kuansongtham
5. Dr. Sompoch Paiboonsirijit 6. Mr. Dirk Goehel 7. Dr. Semih Oezdemir
8. Ass. Prof. Dr. Chi Heon Kim
Bumrungrad selects IBM Watson to
transform care for cancer patients
D
r. Num Tanthuwanit, Chief Executive Officer and Medical
Director of Bumrungrad (2nd from right), and Parnsiree
Amatayakul, Managing Director, IBM Thailand (3rd from right),
recently announced a new collaboration to use IBM Watson
cognitive computing technology to improve patient care.
Bumrungrad is the first medical institution outside North
America to use IBM Watson for Oncology, a system developed
with Memorial Sloan Kettering Cancer Center, the world’s oldest
and largest private cancer center. IBM Watson will help oncologists
develop treatment plans based on the latest clinical evidence
relevant to each patient’s case.
Pictured (from left to right): 1. Mr. Ryan Musch 2. Dr. Narongsak
Kiatikajornthada 3. Dr. James S. Miser 4. Ms. Parnsiree Amatayakul
5. Dr. Num Tanthuwanit 6. Mr. Nattee Kosolpisit
Tangmo returns home with her father after recovering
from heart surgery funded by Rak Jai Thai charity program
T
angmo, an almost 2-year-old girl from Surat thani, is one of the 28 children suffering
from congenital heart defects that got a Rak Jai Thai-funded operation in 2014.
Rak Jai Thai is a project established by Bumrungrad International and Bumrungrad
Hospital Foundation, in conjunction with the Cardiac Children Foundation of Thailand.
The project supported Tangmo with no-cost heart surgical treatment until her full recovery.
She’s now at home living a normal life with family and friends. Since 2003, Rak Jai Thai
charity program has provided no-cost heart surgeries to 710 needy patients.
Those wanting to support the program can make donations by check or bank transfer
to the Bumrungrad Hospital Foundation (Bangkok Bank savings account # 197-0-111157,
North Nana branch). Please fax a copy of your bank transfer confirmation receipt to
Bumrungrad’s accounting department at 0 2667 2031. For more information, please
contact 0 2667 1398.
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