Dr. Gerasim Temelkov is a specialist in gastroenterology and internal medicine with over 14 years of international experience, including in some of the leading university clinics in Germany — Düsseldorf and Münster. There, he led a department for gastroenterology, oncology, and metabolic diseases and was actively involved in the national colorectal cancer early-diagnosis program.
After returning to Bulgaria, he founded the first Center for Prevention and Treatment of Colorectal Cancer in the country, headed the gastroenterology department at Lozenetz Hospital, and today leads the gastroenterology department at the Second City Hospital in Sofia while also developing his own clinical practice.
Dr. Temelkov, what motivated you to specialize in gastroenterology and dedicate yourself to colorectal cancer prevention?
Gastroenterology combines the best of internal medicine, covering multiple organs and systems and providing a comprehensive view of the body through modern technologies and knowledge. Colorectal cancer prevention is one of the great victories of medicine in recent decades. Modern methods allow us to completely prevent this serious disease — to me, that is a remarkable achievement that literally saves lives.
What are the most common conditions you encounter in your daily practice in Bulgaria?
Definitely fatty liver disease. One-third of the global population is overweight — and Bulgaria is no exception. But it’s important to emphasize: the disease can develop even in people with normal body weight.
I also see many patients with irritable bowel syndrome and various abdominal complaints.
You mentioned that you are among the first doctors in Bulgaria to use artificial intelligence (AI) in diagnostics. How exactly does AI help during endoscopic examinations?
Imagine AI as an additional pair of eyes that observe alongside the doctor during a colonoscopy. Unlike human vision, they never get tired, never get distracted, and are not limited by biological capabilities. AI does not replace the knowledge and experience of the gastroenterologist, but it significantly improves the quality of the examination. In the end, every doctor wants the best for their patients — right?
What advantages does AI-assisted endoscopic diagnostics offer patients?
The quality of the examination increases significantly. Imagine a tiny polyp — only half a millimeter. It may sometimes be missed by the human eye, but this is exactly where AI alerts the doctor to a suspicious finding. It is an invaluable tool when dealing with a high workload and many patients, where the risk of statistical error increases.
In Germany you led a clinical department and were part of a national colorectal cancer screening program. What good practices from Germany do you apply in Bulgaria today?
This professional experience is invaluable, especially when monitoring patients with an increased risk due to family history. I apply the established German algorithm — when a patient asks when they should have their next preventive colonoscopy, they receive an individual plan based specifically on their case, not a template answer. This way both doctor and patient can feel confident.
What does the “Prevention” package you offer include and why is it so important to do screenings preventively, not only when symptoms appear?
Prevention means the patient seeks medical care when they have no complaints. When symptoms are already present, we are talking about treatment, not prevention. The preventive package includes a comprehensive internal-medicine evaluation that gives the patient peace of mind regarding their health and future.
What symptoms should not be ignored and require a consultation with a gastroenterologist?
Blood in the stool in any form, unexplained weight loss, and anemia of unknown cause. These are warning signs that require immediate consultation.
How important is preparation for gastroscopy and colonoscopy?
It is crucial for the quality of the examination. Proper preparation leads to accurate diagnostics. Every specialist has the responsibility to provide clear and understandable instructions. I have prepared a short and practical preparation guide for my patients, which is provided before the procedure.
What are the risks if someone postpones these examinations, especially with family history?
Simply put — the risk is developing colorectal or stomach cancer. Today we can effectively prevent these diseases through timely endoscopic examinations, so awareness and responsibility are essential.
Your message to those who postpone preventive care?
When performed correctly, endoscopic examinations are painless and entirely tolerable for the patient. And they can save a life.
If I had to sum it up in one sentence: “Your health is not a gamble — put yourself first!”