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Upper Digestive (Oesophagus & Stomach) Disorders

Common Conditions Affecting the Oesophagus and Stomach

The upper gastrointestinal (GI) tract consists of the oral cavity, oesophagus, stomach, and the first part of the small intestine – the duodenum.

Common conditions affecting the upper GI tract include dyspepsia, peptic ulcers, gastritis, cancer, gastroesophageal reflux disease (GERD) or heartburn, and will usually require prompt clinical care by a gastroenterologist or a colorectal surgeon. Find out more about these conditions, the symptoms, diagnosis methods, and treatment options available.
Indigestion (Dyspepsia)
Indigestion, also known as dyspepsia, is often categorised as discomfort or pain in the upper abdomen area, usually due to abnormal functioning of the stomach and part of the small intestine. In general, dyspepsia occurs in approximately 1 out of 4 adults. Common causes include:

Incorrect eating habits such as lack of chewing

Eating spicy or oily foods, citrus fruits, caffeine, alcohol or tobacco

Certain gastrointestinal disorders such as gastritis, peptic ulcers, H.pylori bacterial infection or GERD

Extreme stress or anxiety

Intake of certain drugs such as non-steroidal anti-inflammatory drugs (NSAIDs)
Signs & Symptoms

Symptoms of dyspepsia may arise upon eating, and may come and go. Common signs include:

Frequent burping

Nausea

Abdominal swelling

Pain in the upper abdominal area

Feeling full even after small amounts of food intake

Bloating
Diagnosis

Your doctor may perform a physical examination and prescribe the following tests to determine dyspepsia or indigestion:

Faecal occult stool test

Endoscopy

Blood test

X-ray

Ultrasound

CT scan
Treatment

Your doctor may prescribe medication to help alleviate the discomfort, which may include antacids, antibiotics, proton pump inhibitors (PPIs), or H2-receptor blockers. Often, a change in lifestyle and dietary habits may be recommended.
Gastroesophageal reflux disease (GERD)
GERD, more commonly known as heartburn or acid reflux disease, occurs when the lower oesophageal sphincter (the group of muscles at the bottom of the oesophagus) malfunctions, allowing food content to reverse back into the oesophagus. This then irritates the lining of the oesophagus.

Causes of GERD may include a weakened oesophagus muscle, hiatal hernia, or unusually frequent spontaneous relaxations of the muscle. Lifestyle factors such as stress, smoking, alcohol consumption, intake of spicy food, or other digestive disorders such as peptic ulcers may cause GERD.

GERD affects about 15% of the total population, and is a condition that should not be ignored as severe medical complications may arise if treatment is not promptly sought.
Signs & Symptoms

Common signs include:

Burning feeling in stomach or near chest area

Chest pain

Sour or bitter taste in the mouth (acid regurgitation)

Indigestion

Nausea

Feeling of a lump in throat

Pain and difficulty swallowing

Bloating

Persistent cough or sore throat

Voice hoarseness

If not treated promptly, GERD may lead to more severe gastrointestinal disorders such as

Barrett’s oesophagus, which is characterised by long-lasting gastro oesophageal reflux disease and increases the risk of oesophageal cancer

Inflammation of the vocal cords

Lung damage including pulmonary fibrosis and bronchiectasis

Stricture (blockage) of the oesophagus caused by scar tissues that develop due to recurrent ulcerations

Ulcers in the oesophagus caused by burning from stomach acid
Diagnosis

Your doctor may check your medical history and perform a physical examination. Diagnostic tests such as endoscopy may be recommended.

Treatment

Your doctor may prescribe medication to help alleviate the discomfort, which may include antacids, proton pump inhibitors (PPIs), or H2-receptor blockers. A change in lifestyle and dietary habits may be recommended.
Gastritis
Gastritis is an inflammation of the stomach lining. It can be either acute, with severe attacks that last for a couple of days, or it can be chronic, with long-term nausea and appetite loss. If left untreated, gastritis can result in severe complications.

There are many possible causes for gastritis and these may include:

After surgery, burns or traumatic injury

Excessive alcohol consumption

Infection caused by Helicobacter pylori (H. pylori), a bacteria found in the lining of the stomach, which can weaken the protective coating and therefore result in the digestive juices reaching the stomach lining
Long-term use of non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen

Stress and chronic vomiting (observed in bulimia cases)
Signs & Symptoms

In the majority of cases, gastritis may not result in any symptoms. The most common symptoms of gastritis include:

Black stool due to blood in the bowel actions

Burning feeling in the upper abdomen

Hiccups

Loss of appetite

Nausea and indigestion

Pain in the upper abdomen

Vomiting

Weight loss
Treatment

Your doctor may prescribe medication to help alleviate the discomfort, which may include antacids, proton pump inhibitors (PPIs), or H2-receptor blockers. Often, a change in lifestyle and dietary habits may be recommended.
Stomach Cancer
Stomach cancer (also called gastric cancer) is an abnormal growth of tissue in the stomach. The cancer usually starts in the cells lining the inside of the stomach. The cancer can form a tumour or ulcer within the stomach or it can spread through the wall of the stomach.

People with stomach cancer often have infection with H. pylori (a bacterium), but not everyone who has this infection in their stomach will develop stomach cancer. Stomach cancer is more common in East Asia than in Western countries.
You may be at risk if you:

Are older than 50 years
Consume substantial smoked foods, salted fish and meat, and pickled foods — eating fruits and vegetables high in vitamins A and C lowers the risk of stomach cancer

Have a family member with stomach cancer

Have a type of anaemia that means you cannot absorb enough vitamin B12 (pernicious anaemia)

Have long-term inflammation of the stomach (chronic gastritis)

Smoke tobacco
Signs & Symptoms

Early stomach cancer often does not cause symptoms. As the cancer grows, common symptoms may include:

Chronic abdominal pain

Loss of appetite

Weight loss with no known cause

Other health problems can cause stomach pain (dyspepsia), including acid reflux or gastritis. Less common symptoms of stomach cancer include:

Anaemia

Passing black stools, which is a sign of bleeding

Vomiting
Treatment

Treatment for stomach cancer includes:

Surgery to remove part or all of your stomach, or to reduce complications from the tumour if it is at a late stage

Chemotherapy, sometimes given with radiation therapy after surgery, or to lessen symptoms if you cannot have surgery

Radiation therapy (high-energy x-ray), sometimes given with chemotherapy, to kill any remaining cancer cells after surgery

Targeted therapy to block the growth and spread of cancer cells
References:

http://www.bmj.com/content/334/7583/41

https://aboutgimotility.org/disorders-of-the-stomach/functional-dyspepsia.html

Locke GR. "The epidemiology of functional gastrointestinal disorders in North America." Gastroenterol Clin North Am 1996;25(1):1-19.

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