The Rising Burden of Gastrointestinal Cancers and Hepatobiliary Diseases in Lebanon

I am a Lebanese gastroenterologist, a graduate of Saint Joseph University (Beirut). Over the past few years, my concern has grown steadily as I witness not only statistics but also the faces and stories behind them: patients arriving later, tumors larger, livers more cirrhotic, and opportunities for cure diminished. These are no longer abstract headlines in newspapers; they unfold daily in my clinic and endoscopy suite.

The Numbers Speak – and They Trouble Us

In the past five years at my clinic, the number of colonoscopies detecting high-risk polyps has increased by nearly 30%. The proportion of patients under 50 presenting with alarming symptoms (rectal bleeding, anemia, weight loss) has almost doubled compared to previous years. In hepatology, nearly one-third of new patients now present with metabolic fatty liver disease (NAFLD), many of them already showing significant fibrosis on elastography. These figures may not represent the entire nation, but they mirror a concerning trend shared by many colleagues across Lebanon.

Why Are Cases Increasing?

Lebanon is blessed with a rich culinary culture and vibrant social life. Yet this also brings challenges: salty diets, high intake of processed meats, charcoal-grilled foods, along with elevated rates of smoking and alcohol consumption. Helicobacter pylori remains a silent burden, fueling ulcers and gastric cancer risk.

On the liver side, sedentary lifestyles, obesity, and prediabetes/diabetes are fueling NAFLD, compounded by the lingering prevalence of hepatitis B and C. Economic hardship delays screening, meaning diseases are often discovered late. I recall a 52-year-old businessman, outwardly healthy, who postponed colonoscopy for two years. When he finally returned, what could have been a removable precancerous polyp had already invaded deeply, requiring major surgery and chemotherapy.

The Wider Impact Beyond the Digestive Tract

Fatty liver is not just a liver disease; it is a metabolic alarm bell. Patients with NAFLD face a higher risk of coronary artery disease and stroke. In practice, I often see patients referred for elevated liver enzymes. Ultrasound confirms fatty liver, elastography shows moderate fibrosis, and further evaluation reveals uncontrolled hypertension and dyslipidemia. Early diagnosis in such cases is not only about saving the liver or colon but also about reducing future cardiovascular events.

Why Specialized Centers Matter

• Early and accurate detection: High-definition gastroscopy and colonoscopy with enhanced imaging (NBI, BLI, chromoendoscopy) reveal subtle flat lesions that older methods may miss. Advanced techniques like EMR and ESD allow complete removal of precancerous lesions, reducing the need for surgery. For biliary and pancreatic disease, ERCP and EUS provide minimally invasive diagnostic and therapeutic solutions.
• Comprehensive liver assessment: Elastography (FibroScan/Shear wave) quantifies fibrosis and steatosis non-invasively, guiding whether biopsy or medical follow-up is needed. Combined with viral, metabolic, and inflammatory testing, this provides a full picture of risk.
• Safety as a priority: Procedures follow strict sterilization protocols, with anesthesiology-trained teams ensuring safe sedation. This is especially critical for complex interventions like ERCP or ESD, where physician expertise directly impacts outcomes.
• Evidence-based decisions: Accredited centers adhere to international guidelines (ESGE, AGA, ASGE), engage in multidisciplinary case discussions, and tailor treatments rather than applying one-size-fits-all protocols.

What Every Patient Should Know

• Colorectal cancer often develops from polyps over years. Timely colonoscopy removes them before malignancy. A family history of colorectal cancer means earlier and more frequent screening.
• H. pylori infection is a key risk factor for gastric cancer. Testing and eradication with proper regimens significantly reduce long-term risk.
• Metabolic fatty liver disease can be reversed with a 7–10% weight loss, control of blood sugar, cholesterol, and blood pressure, along with 150 minutes of exercise weekly. Don’t wait until liver enzymes rise or fibrosis develops.
• Cardiovascular risk and fatty liver go hand in hand: controlling blood pressure, glucose, and lipids slows NAFLD progression, reducing cirrhosis and liver cancer risk.

A Real-World Case

One of my patients, a 56-year-old schoolteacher, finally agreed to a screening colonoscopy after years of postponement. We found a flat 2.5 cm polyp in the cecum. With ESD, it was completely removed, and pathology revealed high-grade dysplasia – meaning that with just a little more delay, invasive cancer would have been likely. Two months later, he returned with relief on his face: “Doctor, you convinced me that screening is not about finding disease, but about preventing it.”

A Call to Action

• If you are over 45 – or younger with a family history – talk to your doctor about colorectal cancer screening.
• If you experience persistent heartburn, swallowing difficulty, or upper abdominal pain, don’t ignore it – an endoscopy can reveal early, treatable disease.
• If ultrasound shows fatty liver, ask for elastography and cardiovascular risk assessment. These are interconnected gears in the machine of your health.
• Choose accredited centers with certified gastroenterologists, modern equipment, strict safety protocols, and structured follow-up care.

As a gastroenterologist trained at Saint Joseph University, I believe the future of healthcare in Lebanon depends not only on technology but also on community trust and discipline: seeking care early, screening on schedule, changing lifestyles, and respecting evidence-based recommendations. Gastrointestinal cancers and hepatobiliary diseases are not destiny. With timely diagnosis, appropriate tools, and strong medical expertise, we can shift the curve – from late to early, from helplessness to empowerment.

If you or a loved one are concerned about digestive symptoms or test results, do not hesitate to seek comprehensive evaluation. Every day of delay can be a missed opportunity; every proactive step, however small, may change the course of life.