Upper Gastrointestinal Diseases

Esophageal cancer

Achalasia cardia

Gastritis

Gastroesophageal Reflux Disease (GERD)

Gastric (Stomach) cancer

Esophageal Cancer

Brief : Cancer occurring in the food pipe (esophagus). Esophagus is a tube-like structure connecting the throat to the stomach assisting the transit of food after swallowing. Cancer occurs in the inner lining cells of the esophagus.
Common Causes 1. Chronic GERD - Unaddressed GERD can irritate the lower end of esophagus and leads to cancer
2. Barrett’s esophagus - its a pre-cancerous condition leading to adenocarcinoma. This is a condition associated with acid reflux. Regular follow up is essential in a patients diagnosed with Barrett's esophagus.
3. Smoking
4. Tobacco chewing
5. Alcohol consumption
6. Obesity
7. Elderly population (Age > 60 years)
8. Genetic causes
9. Low fiber diet and consumption of processed food
10. Rare causes - Plummer-Vinson syndrome
Symptoms: 1. Difficulty in swallowing (Dysphagia) (Most important symptom)
2. Feeling of food stuck in the chest
3. Weight loss
4. Loss of appetite (Anorexia)
5. Coffee colored vomiting
6. Black colored tarry stools (Melena)
7. Hoarseness of voice
8. Cough
9. Easy fatiguability
Diagnosis: 1. Upper GI Endoscopy - small thin tube with camera is passed through the mouth in to the esophagus and detect the area of cancer and helps in taking small piece of tissues (Biopsy) for microscopic examination to detect cancer.
2. Barium esophagogram
3. CT scan and PET Scan - to stage the disease
4. Endoscopic Ultrasound - useful especially in early stages of cancer
Treatment:
Involves Multidisciplinary approach and treatment modalities include
1. Endoscopic mucosal resection (EMR) or Endoscopic submucosal dissection (ESD) - For early stage cancers and smaller size can be excised using endoscopy procedures.
2. Surgery - Esophagectomy ( removal of esophagus involved with cancer ) followed by restoration of continuity of food tract. Surgery can be performed by minimally invasive procedures like VATS (Video Assisted Thoracoscopic Surgery).
3. Chemotherapy - depending on the stage of the disease chemotherapy is administered sometimes before or after surgery. These are the medications to kill cancer cells and can have side effects.
4. Radiation therapy
5. Chemoradiation ( combination of chemo and radiotherapy)
6. Best supportive care - in case of stage 4 when the disease is spread to distant organs palliative care is the best line of management

Achalasia Cardia

Struggling to Swallow! Under stand Achalasia: It is a type of esophagus motility disorder. Esophagus is like a food pipe carrying the ingested food into the stomach through a gate called as lower esophageal sphincter (LES). LES relaxes to pass the contents into the stomach and then closes to prevent reflux. In Achalasia Cardia this gate fails to open (relax) leading to food accumulation in the food pipe.
Causes: It occurs when the lower esophageal sphincter fails to relax, often due to nerve damage, autoimmune factors, or unknown causes.
Symptoms: A. Dysphagia - Difficulty in swallowing
B. Feeling of food getting stuck in the chest
C. Regurgitation - undigested food coming back into the throat
D. Chest pain or discomfort or heaviness in chest (Note - always rule out cardiac causes first in case of these symptoms)
E. Weight loss due to poor nutrition (unexplained weight loss)
F. Rare symptoms like choking or coughing and bad breath
Diagnosis :
Common set of investigations include:
1. Barium Swallow - Patient swallows a paste like substance and undergoes a sequence of X Ray examinations. (Beware if you are pregnant, as X ray is contraindicated). This test highlights the areas of narrowing or irregularities along the food pipe.
2. Upper GI endoscopy - A thin flexible tube with camera is passed into the patient's food pipe to assess the gate (LES) between lower end of food pipe and beginning of stomach. This procedure also detects other conditions like gastritis, hiatus hernia etc..
3. Esophageal Manometry - A small flexible tube is passed into the esophagus and studies the synchronisation of the muscles and measures the respective pressure during the events of swallowing. This is the gold standard investigation for the diagnosis of Achalasia Cardia.

Treatment :
A. Non Surgical: 1. Botox injections - temporarily relaxes the LES muscles and provides relief
2. Pneumatic dilation - endoscopic procedure where in a balloon is passed through the LES muscle to expand the opening.
3. POEM - Per-Oral Endoscopic Myotomy. LES Muscle fibres are cut using endoscopic procedure.
B. Surgical management: Laparoscopic Heller Myotomy - Minimally invasive surgical procedure where procedure is performed through small incisions. In this procedure LES muscle fibres are cut and reinforced with the wrap of the stomach covering the cut muscle fibres. This procedure is known as fundoplication.

Gastroesophageal Reflux Disease (GERD)

Brief : GERD occurs when stomach acid repeatedly flows back into the esophagus, causing irritation, discomfort, and long-term digestive disturbances.
How It Is Caused: It develops from weakened lower esophageal sphincter function, obesity, overeating, hiatal hernia, or lifestyle habits that trigger frequent acid reflux.
Symptoms: Symptoms include frequent heartburn, chest burning, acidic taste, nighttime reflux, chronic cough, throat irritation, and difficulty sleeping due to persistent discomfort.
Effects of This Disease : It leads to persistent heartburn, chest burning, sour regurgitation, throat irritation, and long-term esophageal inflammation that affects daily comfort.

How Dr. Divya Kiran Treats GERD
Dr. Divya Kiran ensures accurate diagnosis with endoscopy and imaging, offering customized treatment using medicines, lifestyle correction, minimally invasive procedures, and long-term monitoring for effective reflux control.

Gastric (Stomach) Cancer

Brief : Gastric cancer forms when abnormal cells grow in the stomach lining, gradually affecting digestion, appetite, and overall health condition significantly.
How It Is Caused: It results from chronic gastritis, H. pylori infection, smoking, poor diet, genetic factors, and long-term inflammation of the stomach lining.
Symptoms: Symptoms include persistent indigestion, stomach pain, early fullness, nausea, unexplained weight loss, fatigue, and reduced appetite that worsens over time.
Effects of This Disease : It causes indigestion, stomach discomfort, weight loss, fatigue, and may spread to nearby organs when untreated, severely impacting health.

How Dr. Divya Kiran Treats Gastric Cancer
Dr. Divya Kiran offers detailed diagnosis through endoscopy and biopsy, providing tailored treatment with minimally invasive surgery, oncology coordination, nutritional support, and continuous monitoring for safe recovery.

Gastritis

Brief : Gastritis occurs when the stomach lining becomes inflamed, causing discomfort, indigestion, and digestive disturbances that affect daily activities.
How It Is Caused: It develops from H. pylori infection, excessive painkiller use, alcohol, stress, or irritation weakening the stomach’s protective lining over time.
Symptoms: Symptoms include upper stomach pain, burning sensation, nausea, bloating, indigestion, early fullness, and decreased appetite during flare-ups or ongoing irritation.
Effects of This Disease : It causes stomach burning, nausea, bloating, indigestion, and reduced appetite, affecting daily comfort and long-term digestive health if unmanaged.

How Dr. Divya Kiran Treats Gastritis
Dr. Divya Kiran identifies the cause using endoscopy and tests, providing targeted treatment with medications, diet planning, lifestyle correction, and follow-up to restore healthy stomach function.