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Upper Digestive (Oesophagus & Stomach) Disorders

  • Common Conditions Affecting the Oesophagus and Stomach

    Conditions of the upper digestive tract

    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)

    Common triggers of indigestion

    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)

    Heartburn, acid reflux and 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 recommende.

  • Gastritis

    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

    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.