Dr. Kaiser Raja
Consultant in Liver Diseases, Transplant Hepatology, Gastroenterology and Advanced Endoscopy
Dr. Kaiser is one of the very few dedicated hepatologists in Dubai and United Arab Emirates. He is highly experienced in management of all forms of complex liver diseases such as liver cirrhosis, portal hypertension, chronic hepatitis B and C, autoimmune hepatitis, acute liver failure, alcoholic liver disease, hemochromatosis and fatty liver disease. He has a vast experience in the management of liver cancer and can help you coordinate multidisciplinary treatment of liver cancer with surgeons, interventional radiologists and oncologists. Dr. Kaiser also specialises in the management of children with liver diseases such as autoimmune hepatitis, Wilson disease, metabolic liver diseases and cholestatic liver disorders. He is one of the very few qualified transplant hepatologists in UAE capable of evaluating and counselling patients who need a liver transplant as well as managing patients following a liver transplant . He is associated as a liver transplant physician and chief transplant hepatologist with one of the largest Liver Transplantation programs in South India.
Dr. Kaiser Raja is a consultant physician specializing in diseases of the liver and gastrointestinal tract. Having always been a Gold Medallist in his entire educational career, he has trained in Medicine, Gastroenterology and Hepatology from one the most reputable medical institutions in India, The Postgraduate Institute of Medical Education and Research, Chandigarh. He has followed that with an Advanced Fellowship in Liver Diseases and Transplant Hepatology from the Mount Sinai Medical Centre in New York. He has more than 18 years of experience and medical practice in India, Middle East and North America.
Dr. Kaiser also practices gastroenterology and his expertise includes disorders of digestion, acid reflux disease, inflammatory bowel disease (Crohn’s disease and Ulcerative Colitis), pancreatic and biliary tract disorders and gastrointestinal cancers. Apart from his clinical acumen he has a vast experience in advanced gastrointestinal endoscopy and ERCP. Dr. Kaiser integrates his practice with one the finest surgical teams performing advanced gastrointestinal and hepatobiliary surgery.
More than 18 years of clinical experience as gastroenterologist and hepatologist
Dedicated experience in management on complex liver disease, liver cancer and liver transplantation
Certified Liver Transplant Physician
Expert in Advanced Endoscopy and ERCP with experience of more than 10000 procedures.
American College of Graduate Medical Education (ACGME) accredited Clinical Fellowship in Advanced Liver Diseases and Transplant Hepatology, The Mount Sinai Medical Center, New York, USA.
DM Gastroenterology (Fellowship program in Gastroenterology & Hepatology) Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
MD Internal Medicine (Residency program in Internal Medicine) Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
- Consultant in Gastroenterology, Liver Diseases and Advanced Endoscopy, King’s College Hospital London, Dubai, UAE
- Consultant in Liver Diseases and Transplantation, Integrated Liver Care Program, Aster DM Healthcare Group, Bangalore (India)
- Consultant in Gastroenterology, Liver Diseases and Transplant Hepatology, Integrated Liver Care Program, BGS Global Hospital, Bangalore (India)
- Consultant in Gastroenterology, NMC Speciality Hospital, Abu Dhabi (UAE)
- Clinical Fellow, Division of Liver diseases: Mount Sinai Medical Centre, New York (USA)
- Consultant in Gastroenterology, New Medical Centre, Abu Dhabi (UAE)
American Association for Study of Liver Diseases (AASLD)
International Liver Transplant Society (ILTS)
European Association for Study of the Liver (EASL)
Indian Society of Gastroentrology (ISG)
Indian National Association for Study of the Liver (INASL)
Liver Transplant Society of India (LTSI)
Distinction with gold medals in Anatomy, Physiology, Biochemistry, Pathology, Ophthalmology, ENT, Community Medicine, Internal Medicine, and Obstetrics & Gynecology during MBBS (medical diploma).
Gold medal for overall best academic performance during MBBS in Bhopal University during the session 1990-95.
Medal for best academic performance during M.D. (Internal Medicine) course at PGIMER, Chandigarh.
Established an Integrated Liver Care (ILC) Program in Bangalore, India comprising of a multidisciplinary team of liver transplant surgeons, hepatologists, interventional radiologists, intensivists and speciality nurses. The ILC team has performed more than 1000 liver transplants and complex hepatobiliary surgeries in India in the last 7 years. ILC also manages patients with advanced liver diseases, liver failure, liver cancer and pediatric liver diseases.
Partnered to establish the Integrated Liver Care (ILC) Foundation. The Foundation’s educational initiative has organised more than 250 continuing medical education (CME) programs for doctors in India. It also organises an Annual International Liver Diseases Conference – Frontiers in Liver Diseases, that is attended by national and international experts in the field of hepatology and liver transplantation.
Contributed to the establishment of an Affordable Pediatric Liver Transplant Program, a collaborative effort between ILC Foundation and The Praveen Agarwal Foundation. This initiative helps facilitate liver transplantation for needy kids with liver failure at a very affordable and subsidised cost. More than 100 children have successfully been transplanted through this initiative.
Patient Care and Health Information
You may consult us for one of the following conditions. We encourage you to educate yourself more about these conditions through the links provided in each section. We have carefully gone through each of these links and these provide authentic patient information and guidance on the related condition and procedures.
Liver Diseases
The most common cause of chronic liver disease. Usually causes no symptoms. Can progress to liver cirrhosis
Fatty liver is an extremely common condition usually detected incidentally on an ultrasound scan. It develops in individuals who are overweight, and in those with diabetics. Even people with mild obesity and especially abdominal obesity are prone to develop fatty liver. Fatty liver is also common in those with metabolic syndrome, which is a combination of obesity, diabetes, high blood pressure, and high cholesterol. Even children who get overweight due to lack of physical activity and improper diet high in carbohydrates and fat are prone to develop fatty liver.
Alcoholic liver disease is a result of overconsuming alcohol that damages the liver, leading to accumulation of fat in the liver, inflammation, and scarring. It can lead to cirrhosis and can be fatal. Most individuals who consume excessive alcohol may not be aware of ongoing liver damage. We recommend a comprehensive evaluation of liver disease, including a Fibroscan of the liver to get an exact idea of the degree of liver damage in chronic alcohol users.
This is a common viral infection of the liver. It is usually detected incidentally. Left untreated it can lead to chronic liver damage, cirrhosis. It is also a risk factor for development of liver cancer. It is recommended that all individuals check for hepatitis B infection at least once in their lifetime. Not all patients with hepatitis B need treatment. Sometimes the virus is in a dormant phase and such patients can be monitored without any treatment. Pregnant ladies should also test for hepatitis B since it can be transmitted to the new-born.
This is a common virus infection of the liver. It is a silent disease and invariably leads to cirrhosis of the liver. It is a major cause of liver cancer. Most patients are detected to have hepatitis C infection only after they have developed advanced liver disease. It is recommended that all individuals check for hepatitis C infection at least once in their lifetime. Hepatitis C can be effectively treated with just 3 months of new anti-viral drugs. Treating the virus before development of advanced liver disease can effectively prevent future complications such as liver failure and avoid a liver transplant.
This is group of diseases (AIH – autoimmune hepatitis, PBC – primary biliary cholangitis and PSC – primary sclerosing cholangitis) in which the immune system of an individual attacks its own liver and leads to chronic liver damage. Patients usually present with abnormal liver function tests, jaundice, itching of skin or abdominal pain. Diagnosis is usually made on a liver biopsy although often the disease is initially suspected by doing special immune markers on the blood. The disease is more common in females. Autoimmune hepatitis is one of the commonest cause of liver disease in children.
These are rare diseases of the liver in which one or more major blood vessels of the liver get blocked by a clot affecting the blood circulation to the liver. The liver is supplied by a large blood vessel called the portal vein and a hepatic artery, while it is drained by three vessels called the hepatic veins. Blockage of the hepatic veins is known as Budd Chiari Syndrome, while blockage of the portal vein is called portal vein thrombosis. These conditions can present suddenly and usually occur in patients who have a blood clotting defect. The blockage can occur insidiously without any symptoms and patients later with portal hypertension, usually in the form of internal bleeding or collection on fluid in the belly. These disorders can be treated by blood thinners or by placing stents to open up the veins. Rarely vascular surgery or liver transplant may be needed.
Cirrhosis is a late stage of scarring (fibrosis) of the liver caused by many forms of liver diseases and conditions, such as hepatitis B, hepatitis C, chronic alcoholism, autoimmune liver disease and non-alcoholic fatty liver disease. Cirrhosis develops slowly over several years. Individuals with early cirrhosis have normal liver function and may not have any symptoms. Their liver scans and blood tests may be almost normal. As cirrhosis progresses, patients may develop fatigue, yellowness of the eyes, swelling of the legs, or distension of the belly due to accumulation of fluid. Patients may also present with internal bleeding, mental confusion or secondary infections. Cirrhosis is the most important cause of liver cancer. A patient suffering from any chronic liver disease should know whether he has progressed to cirrhosis or not. Late forms of cirrhosis ae not reversible and most patients eventually need a liver transplant once signs of liver failure develop. Click on the links below to know more about cirrhosis and its treatment.
Patients with cirrhosis of the liver develop a condition known as portal hypertension. This is a medical term used for increased resistance to blood flow in the liver, which happens in advanced stages of liver disease. Portal hypertension leads to diversion of blood away from the liver to the food pipe and stomach. This essentially leads to development of enlarged veins (called varices) in the food pipe/stomach which can often rupture and cause internal bleeding. Patients with cirrhosis therefore need to assessed for presence of varices in the food pipe/stomach. For this periodic endoscopies are necessary. Portal hypertension can be treated by medications. Portal hypertension can occur in other conditions apart from liver cirrhosis, such as vascular diseases of the liver where the blood vessels carrying blood to the liver get blocked (portal vein thrombosis). To know more about portal hypertension and its complications.
Liver cancer also known as hepatocellular carcinoma (HCC) is a dreaded complication of advanced liver disease and cirrhosis. Anyone with liver cirrhosis is at risk for developing HCC. Presence of diabetes and obesity in patients with liver cirrhosis increase the risk of development of HCC. Liver cancer can be best treated only if it can be detected early. Therefore, all patients with advanced liver disease and cirrhosis should undergo regular screening for HCC. Screening is usually done with USG scans, MRI scans and special blood tests. Depending on the size and stage of the tumor, patients can be treated with surgery, liver transplantation, or radiological interventional techniques such as chemoembolization or microwave ablation. For more information of the diagnosis and treatment on liver cancer, please read further on these links.
A liver transplantation is a lifesaving procedure done on patients who develop liver failure that cannot be treated medically. It may be needed for acute liver failure that may occur as a result of acute severe liver injury due to viruses, drugs or toxins. It is also needed for end stage liver disease arising in advanced decompensated liver cirrhosis. Certain stages of liver cancer can also be cured by a liver transplant. A liver transplant is of two types – deceased donor liver transplant in which the liver from a deceased person is transplanted into a needy patient, and living donor liver transplant in which a healthy person donates a portion of his liver to a patient. The latter is possible because the liver regenerates quite rapidly when it is split. The donated portion of the liver enlarges in the recipient while the remnant portion of the liver regains its original volume in the liver donor. To know more about liver transplantation, you may visit the following sites.
Most important aspects of post-liver transplant care involves regular monitoring of liver functions and management of immunosuppression drugs. After the initial 2-3 years, most transplant patients actually need a very small dose of medications to prevent rejection. In the long term, patients with liver transplant are prone to develop diabetes, hypertension, cardiac disease and most importantly kidney disease. The risk for cancers is also increased and hence age appropriate cancer screening is important. Another major problem is post-transplant weight gain and obesity further increases the risk of diabetes and heart disease. It is important for liver transplant to follow-up regularly with a liver transplant physician. If you stay in UAE and have had a transplant elsewhere, you are welcome to continue you follow-up with Dr. Kaiser Raja who is a certified transplant hepatologist. We can coordinate your care with your transplant centre also.
Gastroenterology
This is a form of inflammatory disease affecting the colon. It leads to loose stools often mixed with blood. A colonoscopy is needed for diagnosis. There are good long term treatment options and the disease can be controlled very well. Newer biological drugs have completely changed the treatment landscape. You can contact us in case you have uncontrolled disease and wish to consider biological drugs. Patients with long standing disease also need a colonoscopy once every two years since there is a risk of colon cancer in these patients. We use advanced colonoscopy techniques including narrow band imaging and magnification high resolution endoscopy that makes detection of early cancer easier.
This is an inflammatory bowel disorder (IBD) that usually affects the small bowel and colon, but can affect other areas as well. It usually presents with abdominal pain, diarrhea, blood in the stools, weight loss and anemia. The disease has a variable course and some patients can have severe disease requiring surgical removal of affected segments of the bowel. Newer biological drugs are invariably required to control severe disease. Patients with Crohn’s disease are also at risk of developing bone and joint disorders and skin problems. I work with a team of excellent radiologists, pathologists, rheumatologists and surgeons and can provide you with an opinion regarding troublesome Crohn’s disease.
Most patients with chronic acid reflux are able to control their symptoms only by taking a daily acidity reducing pill such as Omeprazole or Nexium. There ae some who are not completely relieved even after use of these pills. If you have troublesome acid reflux, you merit a proper evaluation with an endoscopy to assess your food-pipe and the valve at the lower end of the food-pipe that keeps the acid from coming up. Certain allergic diseases of the food-pipe actually mimic acid reflux and these need to be excluded especially if you do not have adequate relief with acid suppressants. It is also important to measure the degree of acid exposure especially if you have an atypical symptom of acid reflux such as cough, soreness of throat or difficulty in swallowing. Now we have excellent endoscopic techniques that can help control acid reflux. Endoscopic fundoplication, done by the GERDx device actually tightens the lower esophageal sphincter reduces symptoms of acid reflux.
IBS is a very common digestive disorder that has a significant impact on the affected patient’s quality of life. Although it is a very benign disease and never leads to anything serious but patients continue to suffer from abdominal pain, bloating, and altered and bowel habits. Symptoms fluctuate over time and may be related to eating habits and lifestyle stress. Some patients spend a lot of time getting unnecessary investigations and endoscopies over and over again. While it is important to exclude conditions such as inflammatory bowel disease, gluten allergy, lactose intolerance and small intestinal bacterial overgrowth, a positive diagnosis of IBS is important so that patients can be counselled properly, explained diet and lifestyle modifications and given drugs for symptomatic relief as needed. Many patients of IBS have a fear of developing cancer which is not true.
Food allergies occur when your body has an immune response to certain foods. Eight types of food account for about 90% of all food allergies. These include eggs, fish, milk, peanut, shellfish, soy, tree nuts and wheat. Allergies usually occur in children when they get exposed to these foods for the first time. It is rare for a food allergy to present for the first time in an adult. Most patients confuse food allergy with food intolerance. A food allergy can be life threatening and occurs with even a small amount of ingested food. Food allergies presents hives, vomiting, belly pain, throat tightness, hoarseness, coughing, breathing problems, or a drop in blood pressure. Food intolerance on the other hand is not life threatening and presents as nausea, gas, cramps, belly pain, diarrhea, irritability, or headaches. The affected individual can sometimes tolerate smaller amounts of that food item well without any reaction. There is a comprehensive food intolerance test available that tests you more than 300 food substances and helps you in designing a food exclusion diet. This may be helpful in some patients with irritable bowel syndrome where certain specific foods seem to trigger symptoms.
Difficulty is swallowing or dysphagia should be evaluated properly. It can be due to inflammation of the food-pipe, ulcers or acid reflux. Eosinophilic esophagitis is an allergic condition of the food-pipe that causes dysphagia in young people. In older adults, cancer of the food-pipe can cause difficulty in swallowing. Disorders of the muscle of the food-pipe called esophageal motility disorders also cause dysphagia. Investigations for dysphagia include upper endoscopy, barium swallow and esophageal manometry. To know more about causes and evaluation of dysphagia,
Pancreatic diseases are often difficult to diagnose and treat. Acute inflammation (pancreatitis) occurs due to excess alcohol intake or due to stones in the gallbladder that migrate to the bile duct and block the pancreatic duct. Several drugs and toxins also cause acute pancreatitis. Chronic pancreatitis on the other hand causes repeated episodes of pain and can lead to formation of stones within the pancreas. Patients with chronic pancreatitis may go on to develop diabetes and fat malabsorption. Cancers and neuroendocrine tumors can also develop in the pancreas and these require detailed investigations and a multidisciplinary approach to management. I work with a team of experienced gastroenterologists, advanced endoscopists, radiologists and pancreatic surgeons and can offer a comprehensive opinion of pancreatic disorders and pancreatic tumors.
Celiac disease is intolerance to gluten in diet. While classical celiac disease presents in children with diarrhea and growth retardation, it is becoming quite common for celiac disease to present in adults with bloating, gas, fatigue, anemia and osteoporosis. All patients with undiagnosed digestive disorders should check for celiac disease. Blood tests such as deamidated gliadin peptide antibodies and tissue transglutaminase antibodies are quite accurate for the diagnosis.
Polyps in the colon are common after the age of 45 years. Most colon polyps are small and harmless. Some polyps are large and can present with bleeding in the stool. Over time, some types of colon polyps can progress to colon cancer. It has been conclusively shown that looking for polyps with a colonoscopy and removing them significantly reduces the risk of colon cancer. A Colonoscopy is recommended once every 10 years starting at the age of 45. Individuals with a family history of colon cancer are at a higher risk and may require more frequent colonoscopies and may also benefit from genetic testing to ascertain the risk of colon cancer.
Bariatric surgery has become a popular technique to help lose weight. However, about 20 percent of patients develop one or more troublesome symptoms after bariatric surgery. These include acid reflux, abdominal pain, vomiting, diarrhea, anemia, failure to lose gain, internal hernias, vitamin deficiencies, osteoporosis and dumping syndrome. These symptoms significantly impair quality of life and therefore it is important to identify the correct reason for the symptoms and treat appropriately. Dr. Kaiser Raja has a vast experience in the management of post-bariatric surgery complications and you can benefit from his opinion in case you are suffering from a troublesome complication.
Common cancers in the digestive tract occur in the colon, stomach, pancreas, and liver. Treatment of gastrointestinal cancers requires multidisciplinary care from gastroenterologists, oncologists, and surgeons.
Procedures
Most chronic liver diseases such as alcohol related liver disease, non-alcoholic fatty liver, chronic hepatitis B and C lead to progressive liver damage. With increasing liver damage, the liver develops scarring or fibrosis that makes the liver firm. A Fibroscan is a type of scan that can measure the stiffness of your liver, which in turn reflects the degree of /fibrosis in your liver. It is a simple, non-invasive and painless test which gives immediate results. It is the single most accurate bedside measurement of severity of chronic liver disease.
A liver biopsy is used to diagnose diseases of the liver such as hepatitis, cirrhosis, infections and cancer. It can also be used to examine a transplanted liver for signs of transplant rejection. Liver biopsies are typically performed percutaneously by inserting a needle through the skin under ultrasound or CT guidance. The liver can also be biopsied via a catheter inserted through the jugular vein (a large neck vein). This is known as a trans jugular liver biopsy (TJLB). It is essential to have an expert liver pathologist interpret liver biopsies.
All patients with liver cirrhosis are at risk for developing liver cancer (HCC). It is essential to detect liver cancer at an early stage when it is small (<2-3 cm). Small cancers can be treated easily. Various ablative techniques can be used to treat small liver cancers. These include radiofrequency ablation (RFA), microwave ablation (MWA) and stereotactic body radiotherapy (SBRT). Dr. Kaiser Raja is an expert in the management of liver cancer and can guide you on the most appropriate treatment modality for liver cancer and as well as other options for liver cancer such as surgery and liver transplantation.
This is a specialised interventional radiology procedure that involves placement of a stent in the liver to reroute the blood flow and thereby reduce the portal pressure which is the pressure of the blood flowing through the liver. It is usually done in patients with liver cirrhosis who have recurrent bleeding from esophageal/gastric varices or in those patients who have uncontrollable ascites due to end stage liver disease. You are welcome to contact to Dr. Kaiser Raja who is an expert in the management of advanced liver diseases and can suggest whether TIPS may be a useful option.
You can contact us for all the regular basic and advanced endoscopic procedures, including gastroscopy, colonoscopy, removal of polyps, dilations of strictures, placement of luminal stents and intragastric balloons. We also do advanced endoscopic procedures like GERDx (endoscopic fundoplication) for acid reflux disease, removal of large and complex colon polyps by EMR (endoscopic mucosal resection) and ESD (endoscopic submucosal dissection).
This is specialised endoscopy for assessment of the small bowel. The small bowel is about 3 to 5 metres long and a regular endoscope cannot be used to evaluate it. Diseases of the small bowel usually cause abdominal pain, diarrhea and bleeding. Common diseases of the small bowel are Crohn’s disease, small bowel ulcers, polyps and tumors. Small Bowel Enteroscopy uses a specialised long endoscope aided by a spiral motor or a balloon based overtube to examine the entire length of the small bowel. Biopsies can be taken and polyps can be removed during the procedure.
Capsule endoscopy or Endocam is a novel way of examining the small intestine. Our small bowel is about 3 to 5 metres long and a regular endoscope cannot be used to evaluate it. Although we have a long endoscope known as a small bowel enteroscope that can be used to visualise the small bowel, this is an invasive procedure and requires deep sedation. Capsule endoscopy, on the other hand, involves swallowing of a large pill like device that has a camera to take pictures as it passes through the gut. The images are transmitted to an external device and later read by the physician. This is a simple screening procedure for diseases of the small bowel. It is done as an out-patient, and requires no special preparation. It is commonly used for evaluation of Crohn’s disease, occult blood loss, iron deficiency and malabsorption syndromes.
These are highly advanced endoscopic procedures used for the purpose of diagnosing and treating abnormalities of the bile ducts and pancreas. These are commonly used in the treatment of bile duct stones, bile duct strictures (narrowing), pancreatitis, and cancers of the bile duct or pancreas. Dr. Kaiser is an expert in ERCP and performs these complex procedures even in patients who had a liver transplant and suffer from narrowing of the bile duct.
While bariatric surgery in the form of sleeve gastrectomy or gastric bypass are popular surgical techniques for weight loss, certain simple endoscopic techniques can also help you lose weight. Placement of gastric balloon is a simple way to lose weight. However, patients may regain weight after the balloon is removed. We now have a endoscopic suturing device that can be used to reduce the size of the stomach permanently and works similar to a laparoscopic sleeve gastrectomy. This technique is known as ESG (endoscopic sleeve gastroplasty). You can contact us to learn more about this technique.
Most patients with chronic acid reflux are able to control their symptoms only by taking a daily acidity reducing pill such as Omeprazole or Nexium. There ae some who are not completely relieved even after use of these pills. Traditionally some patients have needed anti-reflux surgery known as laparoscopic heller’s myotomy. However, a lot of patients are put off by the idea of having a surgery for acid reflux. Now we have excellent endoscopic techniques that can help control acid reflux. Endoscopic fundoplication, done by the GERDx device actually tightens the lower esophageal sphincter by placing actually sutures and reduces symptoms of acid reflux. Another technique known as endoscopic Stretta procedure using radiofrequency waves to stimulate the lower esophageal sphincter and works very well for those with mild acid reflux requiring daily medications.
Polypectomy is a common endoscopic procedures to remove polyps from the colon. While removal of small polyps is quite a straightforward procedure, larger polyps require advanced endoscopic techniques such as endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD). You may contact us in case you have been detected to have a large colon polyp and wish to get it removed by one of these techniques.
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