UPPER GASTROINTESTINAL SURGERY

The upper gastrointestinal system includes THE ESOPHAGUS, STOMACH & the first & second parts of THE DUODENUM.

Esophagus or the food pipe transfers the food that is swallowed to the stomach. In the stomach the food get grinded in the presence of acid and this acidic food is delivered to the duodenum, where the acidic food is neutralized by the bile and pancreatic juices that exit into the second part of the duodenum. 

What are the diseases that commonly affect the upper gastrointestinal system?

  • Gastro Esophageal Reflux Disease

  • Achalasia Cardia

  • Esophageal Cancer

  • Esophageal Diverticula

  • Esophageal Perforations

  • Esophageal Strictures

  • Acid and Alkali Burns of the Esophagus

  • Peptic Ulcer Disease

  • Gastric Cancer

  • Acid & Alkali Injuries of the stomach

  • Rare tumors like Lymphoma, Neuroendocrine tumors, Gastrointestinal stromal tumors

  • Duodenal Perforation (Ulcer related)

  • Gastric Outlet Obstruction (Ulcer Related)

  • Duodenal Gastrointestinal Stromal Tumors

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GASTRO ESOPHAGEAL EFLUX DISEASE 

What is Gastroesophageal Reflux Disease?

Gastro Esophageal Reflux Disease/ GERD is a symptom complex due to regurgitation of food material into the esophagus from the stomach or duodenum and it is characterized by the following symptoms  

  • Heart burn (Pain/Discomfort behind the sternum/centre of the chest)

  • Throat Discomfort/ Feeling of a foreign body sensation (Globus Hystericus)

  • Pain in between the shoulder blades

  • Reflux related cough/throat pain

  • Shortness of Breath (Wheeze/Asthma like symptoms)

  • Sleeplessness (Insomnia)

 

How is it Diagnosed?

GERD is most often a clinical diagnosis. However, an upper gastrointestinal endoscopy can suggest the diagnosis, which is characterized by erosions of the lower esophagus or the gastroesophageal junction. It is graded into various Grades based on the extent of the erosions (Los Angeles Classification).

The gold standard test to confirm  gastroesophageal reflux disease is a 24 hour pH study, which measures the acid/alkali exposure in the esophagus over a period of 24 hours. This test is not done routinely to confirm the diagnosis, but it is done before contemplating any surgical procedure with a diagnosis of GERD

ACHALASIA CARDIA

Achalasia cardia is the failure of the lower esophageal sphincter to relax, there by causing an effect of obstruction to the food pipe, even thought there is no mechanical obstruction

What are the symptoms of Achalasia Cardia?

  • Dysphagia to both solids and liquids (Difficulty in Swallowing)

  • Retrosternal chest discomfort or pain

  • Regurgitation of undigested food material

  • Chronic cough due to silent aspiration of food material into the lungs

  • Sensation of stickiness behind the chest

   

 

How is Achalasia Cardia Diagnosed?

  • Upper GI Endoscopy – Which shows some residual food material in the esophagus and a tough give away sensation when entering the stomach

  • Esophageal Manometry is the Gold Standard Diagnostic test to confirm Achalasia and also to categorize the type of Achalasia. This is a test where the pressure variations across various segments of the esophagus are measured

  • Barium Swallow test is an important inestigation in places where esophageal manometry is not available, which shows a classical “bird beak” appearance of the gastro-esophageal junction.

  • CT scan of the abdomen is a very important investigation especially in the elderly where , presence of an underlying cancer can mimick the same condition where it is termed as “Pseudo-achalasia”.

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