Esophagus and Stomach – Upper GI

Corrosive Injury to Esophagus and Stomach – Acid Injury : Corrosive injury to the esophagus and stomach, particularly from the ingestion of strong acids like sulfuric, hydrochloric, or nitric acid, results in severe damage to the gastrointestinal tract. Acids typically cause coagulative necrosis, leading to the formation of an eschar (a tough, leathery layer of dead tissue), which may limit deeper penetration of the acid but increases the risk of perforation in acute cases. Early symptoms include intense burning pain in the mouth, chest, or abdomen, vomiting (which may contain blood), and difficulty swallowing (dysphagia). If left untreated, acid injury can lead to complications such as strictures (narrowing of the esophagus), fistulas (abnormal connections between organs), and severe infections like mediastinitis or peritonitis from perforation. Endoscopy within the first 24–48 hours is key for evaluating the extent of injury, but should be avoided if perforation is suspected. Long-term management may involve dilation of strictures or even surgical intervention. Furthermore, patients are at a higher risk of developing esophageal cancer, particularly squamous cell carcinoma, years after the initial injury. Early treatment with neutralization (avoiding induced vomiting) and supportive care is essential to reduce mortality and prevent chronic complications.

Cancer Esophagus and Stomach : Cancer of the esophagus and stomach, also known as esophageal and gastric cancer, are serious malignancies that affect the upper gastrointestinal tract. Esophageal cancer is primarily of two types: squamous cell carcinoma, which arises from the cells lining the esophagus, and adenocarcinoma, often linked to Barrett’s esophagus and gastroesophageal reflux disease (GERD). Common symptoms include difficulty swallowing (dysphagia), unintentional weight loss, chest pain, and chronic cough. Gastric cancer, or stomach cancer, typically arises from the lining of the stomach and is often associated with factors such as Helicobacter pylori infection, smoking, chronic gastritis, and certain dietary habits. Early symptoms of gastric cancer may be nonspecific, including indigestion, nausea, and loss of appetite, while advanced stages may present with weight loss, vomiting, and blood in stools. Both cancers are diagnosed through endoscopy, biopsy, and imaging techniques. Treatment options depend on the stage of the disease and may include surgery, chemotherapy, radiation, or targeted therapies. Early detection is crucial for a better prognosis, but many cases are diagnosed at an advanced stage, leading to a lower survival rate.

Motility Disorders / Dysphagia – Achalasia Cardia : Achalasia cardia is a rare motility disorder of the esophagus characterized by the inability of the lower esophageal sphincter (LES) to relax properly and a lack of normal esophageal peristalsis. This results in difficulty swallowing (dysphagia), as food and liquids cannot easily pass from the esophagus into the stomach. Patients often report a sensation of food being "stuck" in the chest, regurgitation of undigested food, chest pain, weight loss, and sometimes aspiration, leading to respiratory complications. The exact cause of achalasia is unclear, but it is believed to be due to degeneration of nerve cells in the esophagus, particularly affecting the myenteric plexus. Diagnosis typically involves esophageal manometry, which shows elevated LES pressure and poor peristalsis, along with barium swallow studies and endoscopy. Treatment options aim to relieve symptoms and improve esophageal emptying. These include pneumatic dilation, laparoscopic Heller myotomy (surgical cutting of the sphincter muscle), and peroral endoscopic myotomy (POEM). Medications like calcium channel blockers or nitrates may also help relax the LES, though their efficacy is limited. While not curable, effective management can significantly improve the quality of life for patients. However, achalasia increases the long-term risk of esophageal cancer, requiring regular monitoring.

Barretts Esophagus : Barrett's esophagus is a condition in which the tissue lining the esophagus undergoes abnormal changes, often due to prolonged exposure to stomach acid from gastroesophageal reflux disease (GERD). This condition is characterized by the replacement of normal squamous cells with columnar cells, a process known as intestinal metaplasia. While Barrett's esophagus itself is not cancerous, it increases the risk of developing esophageal adenocarcinoma, a type of esophageal cancer. Symptoms may include heartburn, difficulty swallowing, and regurgitation of food or sour liquid. Diagnosis typically involves an upper endoscopy, during which tissue samples can be taken for biopsy to assess cellular changes. Management strategies include lifestyle modifications, medications to reduce acid production, and regular surveillance endoscopies to monitor for dysplasia, which indicates precancerous changes. In more severe cases, treatments such as endoscopic ablation or surgical intervention may be necessary. Patients with Barrett's esophagus should work closely with their healthcare providers to manage their symptoms and reduce cancer risk through ongoing monitoring and intervention when needed. Early detection and treatment are key in managing this condition effectively.

GERD – Gastroesophageal Reflus Disease / Gastritis : Gastroesophageal reflux disease (GERD) is a chronic condition characterized by the backflow of stomach acid into the esophagus, leading to symptoms such as heartburn, regurgitation, and difficulty swallowing. This occurs when the lower esophageal sphincter (LES) weakens or relaxes inappropriately, allowing stomach contents to escape. Risk factors for GERD include obesity, smoking, pregnancy, and certain dietary choices. On the other hand, gastritis refers to the inflammation of the stomach lining, which can be acute or chronic. Common causes of gastritis include infection with Helicobacter pylori, excessive alcohol consumption, and long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs). Symptoms of gastritis can include stomach pain, nausea, vomiting, and a feeling of fullness after eating. Both conditions may share some overlapping symptoms, making accurate diagnosis essential. GERD can lead to complications such as Barrett's esophagus and esophageal strictures, while untreated gastritis can lead to ulcers or increase the risk of stomach cancer. Treatment for GERD often involves lifestyle changes, antacids, and medications like proton pump inhibitors, while gastritis may require antibiotics for infections or dietary modifications. Regular follow-up with healthcare providers is important to manage symptoms and prevent complications in both conditions.

Gastrointestinal Stromal Tumor- GIST : Gastrointestinal stromal tumors (GISTs) are rare tumors that arise from the interstitial cells of Cajal or precursor cells in the gastrointestinal tract, most commonly found in the stomach and small intestine. These tumors are characterized by mutations in the KIT or PDGFRA genes, which play a crucial role in cell growth and division. GISTs can be benign or malignant, with malignant forms having the potential to metastasize to other parts of the body. Symptoms of GISTs often include abdominal pain, gastrointestinal bleeding, and palpable masses. However, many GISTs are asymptomatic and may be discovered incidentally during imaging for other conditions. Diagnosis typically involves imaging studies, such as CT scans or MRIs, and a biopsy to confirm the presence of tumor cells and assess genetic mutations. Treatment primarily involves surgical resection of the tumor, especially in localized cases. For metastatic or unresectable GISTs, targeted therapies such as imatinib (Gleevec) are commonly used, as they inhibit the growth of tumor cells by targeting the mutant proteins. Regular follow-up and monitoring are essential, as GISTs can recur after treatment. Due to their unique biology, GISTs are distinct from other gastrointestinal tumors, making specialized care crucial for effective management.

Hiatus Hernia : A hiatus hernia occurs when a portion of the stomach protrudes through the diaphragm into the chest cavity, specifically through the hiatus, an opening in the diaphragm for the esophagus. This condition can be classified into two main types: sliding hiatal hernias, where the stomach and part of the esophagus slide up and down, and paraesophageal hernias, where the stomach pushes through the diaphragm beside the esophagus, which can be more serious. Common symptoms of a hiatus hernia include heartburn, regurgitation, difficulty swallowing, and chest pain. Some individuals may be asymptomatic, making diagnosis through imaging studies, such as X-rays or endoscopy, essential for identifying the condition. Risk factors for developing a hiatus hernia include obesity, age, smoking, and a family history of the condition. Lifestyle modifications, such as weight loss, dietary changes, and avoiding large meals, can help manage symptoms. Medications like antacids, proton pump inhibitors, and H2 receptor antagonists may be prescribed to alleviate acid reflux symptoms associated with hiatus hernias. In severe cases, surgical intervention may be necessary to repair the hernia and prevent complications such as strangulation or esophageal reflux. Regular monitoring and a collaborative approach with healthcare providers can ensure effective management of hiatus hernia symptoms and prevent long-term complications.

Peptic Ulcer Disease : Peptic ulcer disease (PUD) refers to the formation of open sores or lesions in the lining of the stomach, small intestine, or esophagus, primarily caused by the corrosive effects of stomach acid. The two most common types of peptic ulcers are gastric ulcers, located in the stomach, and duodenal ulcers, found in the upper part of the small intestine. The primary causes of PUD include infection with Helicobacter pylori, prolonged use of nonsteroidal anti-inflammatory drugs (NSAIDs), and excessive alcohol consumption. Symptoms often include abdominal pain, bloating, heartburn, and nausea, with pain typically occurring on an empty stomach or several hours after eating. Complications can arise, such as bleeding, perforation, and gastric obstruction, which require immediate medical attention. Diagnosis is commonly achieved through endoscopy, where tissue samples can be taken for biopsy, as well as imaging studies like X-rays. Treatment for PUD typically involves a combination of medications, including proton pump inhibitors (PPIs) to reduce stomach acid, antibiotics to eradicate H. pylori infection, and antacids for symptom relief. Lifestyle changes, such as avoiding irritants like tobacco and spicy foods, can also help manage symptoms. In some cases, surgical intervention may be necessary for severe or recurrent ulcers. Early diagnosis and treatment are crucial to prevent complications and promote healing in individuals with peptic ulcer disease.