4 min. for reading
Andrei Kharitonov is a famous gastroenterologist, candidate of medical sciences, popularizer of non-anxious and non-punitive medicine, designed to teach us to stop harming ourselves with ignorance and outdated myths. This kind of fearless enlightenment is what his new book is aimed at. “Myths and Legends of Gastroenterology”.
How and why did you decide to be not just a doctor, but a myth-fighter? What was that moment?
A doctor, in principle, by the nature of his activity, is engaged in education. We, gastroenterologists, educate on the subject of nutrition and diets – there is always a lot of information around this, including unscientific and contradictory. And it is very difficult to evaluate this information on your own.
Every day at appointments, my patients refer to a couple of mythical attitudes taken from sources of varying degrees of authority: from relatives, acquaintances, doctors. In the end, I decided: I would write a book about real gastroenterology. But only in such a way as not to frighten or harm.
How many people are ready for new information, even simple ones? The degree of reader conservatism – is it high and does it interfere with your work?
Yes. High. Information that is completely at odds with conventional wisdom is often rejected out of hand. Even literally in the doctor’s office. How is it that gastritis doesn’t hurt? My grandmother also said that if your stomach hurts, it’s definitely gastritis. How is it that food doesn’t scratch your stomach? Where then does the erosion come from?
Objections are a constant story that my colleagues and I regularly encounter. I’m also lucky: it happens that patients come already a little prepared after my articles, publications on social networks, and videos. In general, today an information blog for a doctor is a good help. The new patient no longer looks with disbelief: doctor, what do you mean, how useless is it to test feces for dysbacteriosis?
And how do you interact with fearful patients who are not inclined to believe your prescriptions and refutations?
I don’t rush or argue. In these situations, I start by saying that new, unfamiliar information is normal. Science does not stand still, but constantly supplies us with new data. It is no secret that the old ideas of doctors about diseases of the gastrointestinal tract were often based only on their own experience. In the absence of scientific research results, gastroenterology often relied on the opinions of medical authorities.
And today there is a lot of new data. At the reception, I like to give examples, sometimes telling what people usually feel with a particular illness. The patient listens, recognizes himself and his symptoms in these cases – and then trust is born.
A little statistics: what questions do people come to you with most often? So to speak, rating or top city queries?
It seems to me that today the situation is like this: the doctor most often sees at an appointment the diseases with which he is most involved. Patients who are already aware of the areas of interest and competence of this specialist specifically turn to him. Most often in my office there are people with functional pathology of the digestive organs. For example, with irritable bowel syndrome (including severe forms of this disease), with persistent “exacerbations of gastritis”… which in fact turn out to be completely different diseases. After all, now we know that gastritis does not have exacerbations, should not bother a person with symptoms at all, and this is what sometimes makes it dangerous. “Gastritis doesn’t hurt” – this fact haunts me and, in fact, prompted me to start writing the book.
A considerable percentage of my patients come with ulcerative colitis and Crohn’s disease – I began treating these diseases back in 2005. There are other various pathologies, but the three listed above are the ones I encounter most often at appointments.
What’s next for us? What diseases or conditions are successfully cured and leave our everyday life, and what is still worth fearing and why?
Most of the diseases detected in the gastroenterologist’s office are chronic and not yet completely curable. Forecasting is difficult, but it is possible to transfer global data to our realities. We see an increase in the prevalence of functional (when there are symptoms, but doctors find nothing) pathology of the digestive system: functional heartburn, functional constipation, irritable bowel syndrome, functional dyspepsia, and so on. This category is not dangerous, but greatly reduces the quality of life. Not least of all, this trend is associated with the dietary habits of the population and the increasing incidence of anxiety disorders and depression. Sometimes our surroundings become the unwitting culprit. Relatives know how to exert psychological pressure regarding food: until you finish the soup, you won’t leave the table! How many times have I said, don’t eat dry food! – and this is considered a risk factor for some gastroenterological diseases. Well, we, doctors, with one careless “authoritative” word, not to mention outright intimidation, can dump a patient into a pit of depression.
The incidence of fatty liver disease is increasing worldwide due to excess caloric intake and low physical activity. It would seem that fatty liver is so dangerous? But sometimes fatty liver can even lead to cirrhosis.
You also need to be wary of an unbalanced diet: several years ago, scientists identified a real epidemic of ulcerative colitis and Crohn’s disease – serious problems to the development of which unbalanced nutrition makes a significant contribution.
But this seems to be good news: peptic ulcers of the stomach and duodenum are on the decline. We have learned to completely cure it.
How would you describe the average urban resident today from the point of view of gastroenterology: condition, risks, prospects?
Most often, this is an anxious person, sometimes even depressed, who works a lot and does not always get enough sleep. He may have several diseases of the digestive system at once. At the same time, he tends to monitor his health, but does not always know what to do to prevent diseases of the gastrointestinal tract. Therefore, it is precisely such a patient who runs the risk of being captured by myths and becoming a victim of dubious and unreasonably expensive approaches to treatment. It is good that in Moscow there is accessible, high-quality and modern medical care with a developed education system – this allows us to hope not only for the successful treatment of diseases, but also for preventing their development.
Photo: personal archive of Andrey Kharitonov