Areas of Expertise
Stomach and Esophageal Diseases
Stomach and esophageal diseases cover the conditions behind common complaints such as heartburn, indigestion, difficulty swallowing and upper abdominal pain. Most can be kept under control with an accurate diagnosis, appropriate treatment and lifestyle changes. The information on this page is for general education only; diagnosis and treatment require a physician’s assessment.
01
Gastroesophageal reflux disease (GERD)
A common condition in which stomach contents often flow back into the esophagus, causing burning and discomfort.
Gastroesophageal reflux disease occurs when stomach contents flow back into the esophagus often or for long periods, causing symptoms or tissue injury. A weakened valve at the lower esophagus, hiatal hernia, excess weight, smoking and pregnancy can contribute. It often affects quality of life; less commonly, complications such as inflammation, narrowing or Barrett’s esophagus can develop.
Symptoms
- A burning feeling behind the breastbone
- Sour or bitter fluid coming up into the mouth
- Complaints that worsen after meals or when lying down
- Long-lasting cough, hoarseness or frequent throat clearing
- A feeling of something stuck or a lump in the throat
- Chest pain that may be linked to reflux once heart causes have been ruled out (a heart evaluation comes first)
When to see a doctor
- If swallowing is difficult or painful
- If there is unexplained weight loss, repeated vomiting or anemia
- If you vomit blood or pass black stools
- If complaints persist or return often despite medication
- If a long-standing complaint changes in character
- If chest pain gets worse with effort, spreads to the arm or jaw, or comes with shortness of breath, seek urgent assessment
How is it diagnosed?
Typical symptoms and a response to acid-suppressing treatment are often enough for diagnosis. Upper gastrointestinal endoscopy is done when alarm symptoms are present or treatment does not help. In selected patients, 24-hour pH-impedance monitoring and esophageal manometry may be needed.
Treatment and lifestyle
- Acid-suppressing medicines are used as advised by a physician, for the needed duration.
- Losing excess weight can noticeably reduce symptoms.
- Avoid eating in the two to three hours before lying down.
- Raising the head of the bed can help with nighttime symptoms.
- Stop smoking completely and avoid alcohol, or at least cut down.
- Foods that trigger symptoms can be identified for each person and reduced.
LifestyleLosing excess weight and avoiding late meals before bedtime help reduce reflux symptoms.
02
Gastritis and Helicobacter pylori
Gastritis is inflammation of the stomach lining, and Helicobacter pylori infection is one of its most common causes.
Gastritis is inflammation of the stomach lining. Its most common causes are the Helicobacter pylori bacterium, pain-relief medicines known as NSAIDs, heavy alcohol use and autoimmune processes. H. pylori is very common worldwide and often causes no symptoms, yet it is linked to chronic gastritis, peptic ulcer and, in some people, stomach cancer. Treatment is recommended when it is found.
Symptoms
- Pain or burning in the upper abdomen
- Nausea and a noticeably reduced appetite
- Bloating and fullness after meals
- Feeling full after only a few bites
- Many people have no symptoms at all
When to see a doctor
- If you vomit blood or pass black stools
- If there is unexplained weight loss or constant vomiting
- If swallowing is difficult or there are signs of anemia
- If complaints persist or recur despite treatment
- If there is a family history of stomach cancer
How is it diagnosed?
A breath test or a stool antigen test is used for H. pylori; it can also be shown on biopsies taken during endoscopy. Acid-suppressing medicines and antibiotics can distort test results, so a physician plans the timing of testing. The type and extent of gastritis are assessed by endoscopy and biopsy.
Treatment and lifestyle
- If H. pylori is found, eradication therapy combining an acid suppressor and antibiotics is given.
- The treatment must be taken completely and for the duration the physician advises.
- Clearance of the bacterium is confirmed by a test at least four weeks after treatment.
- Pain-relief medicines should not be used without consulting a physician.
- Stop smoking completely and avoid alcohol, or at least cut down.
- A balanced diet and regular sleep support recovery but do not replace medication.
LifestyleSmoking and alcohol irritate the stomach lining; quitting or cutting down supports healing.
03
Peptic ulcer
A deep sore in the lining of the stomach or duodenum that usually heals with appropriate treatment.
A peptic ulcer is a deep sore that develops in the lining of the stomach or duodenum. The most common causes are Helicobacter pylori infection and the use of pain-relief medicines known as NSAIDs. Smoking increases the risk. If untreated, it can lead to complications such as bleeding, perforation and narrowing; with proper treatment, most ulcers heal. Symptoms vary from person to person.
Symptoms
- Burning or gnawing pain in the upper abdomen
- Pain that increases on an empty stomach or after meals
- Abdominal pain that wakes you from sleep at night
- Nausea, bloating and early fullness
- Loss of appetite and unintentional weight loss
When to see a doctor
- If you vomit blood or material that looks like coffee grounds
- If you pass black, tar-like stools
- If sudden, very severe abdominal pain occurs
- If there is constant vomiting or food does not pass
- If there is paleness, getting tired easily and palpitations
How is it diagnosed?
Diagnosis is usually made by upper gastrointestinal endoscopy. In stomach ulcers a biopsy is taken to rule out cancer, and a follow-up endoscopy may be needed to confirm healing. H. pylori is also investigated. A blood count can reveal anemia caused by bleeding.
Treatment and lifestyle
- Acid-suppressing medicines help the ulcer to heal; a physician decides the duration.
- If H. pylori is found, eradication therapy markedly lowers the risk of recurrence.
- When possible, pain-relief medicines are stopped or changed with a physician’s guidance.
- Stop smoking completely and avoid alcohol, or at least cut down.
- Regular meals and enough sleep support overall recovery.
- Complications such as bleeding may require endoscopic or surgical intervention.
LifestyleQuitting smoking supports ulcer healing and lowers the risk of recurrence.
04
Functional dyspepsia (indigestion)
A condition in which upper abdominal pain, burning or fullness persists without a clear cause on testing.
Functional dyspepsia is a condition with symptoms such as upper abdominal pain, burning, early fullness or fullness after meals, where endoscopy and other tests find no structural cause to explain them. It is diagnosed after serious causes such as cancer have been ruled out; it is common and not life-threatening, but it can last a long time. Stomach movement, stomach sensitivity and gut-brain interaction are thought to play a role.
Symptoms
- A long-lasting feeling of fullness after eating
- Feeling full very soon after starting a meal
- Pain or burning in the upper abdomen
- Abdominal bloating and a feeling of nausea
- Frequent belching and a feeling of gas in the stomach
When to see a doctor
- If complaints start for the first time after middle age and persist
- If there is unexplained weight loss
- If there is repeated vomiting or difficulty swallowing
- If there are black stools, bleeding or signs of anemia
- If there is a family history of stomach or esophageal cancer
How is it diagnosed?
Diagnosis rests on typical symptoms and the absence of alarm features, using the Rome criteria. Younger patients without alarm features can be tested for H. pylori and treated if it is found. If alarm features or older age are present, endoscopy and necessary blood tests are requested.
Treatment and lifestyle
- If H. pylori is found, treating it reduces symptoms in some patients.
- Acid-suppressing medicines or medicines that regulate stomach movement may be tried.
- Small, slow and regular meals may help.
- Foods that worsen symptoms can be identified for each person and reduced.
- Smoking, alcohol and unnecessary use of pain-relief medicines should be avoided or reduced.
- Regular activity, enough sleep and stress management may ease symptoms.
05
Swallowing difficulty and achalasia
Swallowing difficulty means trouble moving food from the mouth to the stomach; achalasia is a rare cause.
Swallowing difficulty (dysphagia) can arise from the mouth and throat or from the esophagus. Narrowing, inflammation, tumors and movement disorders of the esophagus can cause it. In achalasia, the valve at the lower end of the esophagus fails to relax and esophageal contractions are impaired, so food waits instead of passing into the stomach. Swallowing difficulty, whatever its cause, should be investigated by a physician.
Symptoms
- A feeling of food sticking in the chest with both solids and liquids
- Undigested food coming back up into the mouth
- Choking or coughing while eating
- Chest pain or a feeling of pressure
- Meals taking longer and gradual weight loss
- Nighttime cough or repeated lung infections
When to see a doctor
- If swallowing difficulty is new or steadily worsening
- If food will not pass and even saliva cannot be swallowed, seek care urgently
- If there is unexplained weight loss or inability to eat
- If there is repeated pneumonia or frequent choking
- If swallowing is painful or there is bleeding
How is it diagnosed?
Endoscopy first looks for structural causes such as narrowing, inflammation or a tumor. A barium swallow X-ray may be added. If achalasia is suspected, high-resolution esophageal manometry is the key test; it measures esophageal contractions and valve pressures.
Treatment and lifestyle
- Treatment is chosen according to the cause of the swallowing difficulty.
- In achalasia, medicines have limited effect; interventional methods are used for lasting treatment.
- Options include balloon dilation, surgical myotomy and endoscopic myotomy (POEM).
- Taking small bites, chewing well and eating slowly make swallowing easier.
- For mouth and throat causes, a swallowing therapy specialist can be helpful.
- Nutrition and weight should be monitored; dietitian support may be needed.
06
Barrett’s esophagus
A condition in which the cells of the lower esophagus change after long-term reflux.
In Barrett’s esophagus, the normal lining of the lower esophagus is replaced by intestine-type tissue after long-term acid exposure. It is usually seen in people with reflux for many years, and is more common in men, older adults, smokers and people with excess weight. Because it slightly raises the risk of esophageal cancer, regular follow-up is important. In most people it does not progress to cancer.
Symptoms
- Barrett’s esophagus itself often causes no symptoms
- Heartburn caused by accompanying reflux
- Sour or bitter fluid coming up into the mouth
- Most patients have a history of reflux lasting for years
When to see a doctor
- If swallowing is difficult or painful
- If there is unexplained weight loss
- If there is vomiting of blood, black stools or anemia
- With long-standing reflux, especially with risk factors, ask a physician about screening
- If you have Barrett’s esophagus, do not skip the recommended follow-up endoscopies
How is it diagnosed?
Diagnosis is made when endoscopy shows differently appearing tissue at the lower end of the esophagus and biopsies confirm it. Biopsies also look for dysplasia, a precancerous cell change. The follow-up interval is set by the physician based on these findings.
Treatment and lifestyle
- Reflux is usually controlled with acid-suppressing medicines.
- Endoscopic surveillance and biopsies continue at intervals set by the physician.
- If dysplasia is found, endoscopic treatments such as radiofrequency ablation may be used.
- Stop smoking and lose excess weight.
- Avoiding late meals before bedtime may reduce nighttime symptoms.
- Medication and follow-up plans are individualized; do not stop them on your own.
LifestyleQuitting smoking and losing excess weight support esophageal health by reducing reflux.
07
Eosinophilic esophagitis
A chronic, immune-related inflammation of the esophagus that can cause difficulty swallowing.
Eosinophilic esophagitis is a chronic, immune-mediated disease caused by a buildup of white blood cells called eosinophils in the esophageal wall. It is often linked to food or environmental allergens and is more common in people with asthma, eczema or allergic rhinitis. It is more frequent in young men but can occur at any age. If untreated, it can cause narrowing of the esophagus.
Symptoms
- Food, especially meat, getting stuck in the esophagus
- Difficulty swallowing and pain when swallowing
- Burning or chest pain that persists despite reflux medicines
- Habits such as eating very slowly or washing food down with liquids
- In children, poor appetite, vomiting and poor growth
When to see a doctor
- If a bite gets stuck and will not pass, seek care urgently
- If food sticking keeps recurring
- If swallowing complaints do not respond to reflux medicine
- If a child refuses food, vomits or fails to gain weight
- If swallowing difficulty occurs together with an allergic disease
How is it diagnosed?
Endoscopy is performed; rings, grooves, white spots or narrowing may be seen, although the appearance can also be normal. Diagnosis requires biopsies from different parts of the esophagus showing dense eosinophils, and exclusion of other causes that give similar findings.
Treatment and lifestyle
- Treatment may use proton pump inhibitor medicines or swallowed topical steroids.
- Biologic medicines may be considered in selected patients.
- In diet therapy, suspected foods are removed under physician and dietitian supervision.
- If the esophagus is narrowed, endoscopic dilation can be done.
- Taking small bites and chewing well may reduce food sticking.
- Because the disease is chronic, regular follow-up matters; do not stop medicine or diet on your own.
