This is usually manifested as heartburn or regurgitation. A smaller percentage of patients will have symptoms of chest pain, cough or hoarseness.

The diaphragm and the lower esophageal spincter (LES) act as barriers to prevent stomach acid from coming up into the esophagus (reflux). In many patients with gastroesophageal reflux disease (GERD), the LES will relax at inappropriate times; in others, the LES pressure may be too low to prevent the reflux of stomach contents.

The most common symptom of reflux disease is heartburn. Most adults experience heartburn in relationships to specific foods or large meals. If this reflux occurs on occasion, related to such factors, avoidance is the usual treatment. General measures of treatment also include avoidance of foods such as chocolate, peppermint, fatty foods, and alcohol … all which can cause reflux.

Gravity assists drainage of the esophagus, so your doctor may suggest that you elevate the head off the bed six inches. As well, eating small meals instead of large ones, and not eating within three hours of lying down might be helpful.

Occasional use of antacids is acceptable; however, if symptoms persist daily, physicians may recommend medications to suppress acid formation (i.e. pantoprazole, omeprazole). As a first line of treatment, doctors may use medications to increase the tone of the LES or improve the stripping motion of the esophagus (i.e. , Domperidone).

Patients who have frequent reflux or who have atypical manifestations may be asked to have an upper endoscopy to look for complications of reflux.

There are two primary types of cancer of the esophagus: squamous cell carcinoma and adenocarcinoma.

Squamous cell carcinoma - The exact cause of this cancer is not known, but it does appear to be related to ingested substances such as alcohol, tobacco, nitrosamines, and vitamin deficiencies.

One squamous cell carcinoma symptom is difficulty swallowing, which may be progressive from meats to soft foods and then liquids or saliva.

Chest pain, weight loss, painful swallowing, and excessive salivation may also be symptoms. Barium X-rays may suggest the presence of a cancer, but an upper endoscopy is usually used to obtain tissue for proof and to dilate narrowed areas for temporary relief of difficulty swallowing.

Once cancer of the esophagus is suspected, other studies such as CT scans or endoscopic ultrasound (EUS) may be performed to find out how extensive the disease is.

Cancer-Related Terms

One of the bewildering aspects of a cancer diagnosis is the many words that are used to describe the condition. Here are a few that we thought you should know:

Carcinoma — an early form of cancer that has not spread, or a pre-cancer
Dysplasia — the earliest form of a pre-cancerous lesion
Histology — microscopic study of the anatomy of cells
Malignant — a medical condition that becomes progressively worse
Metastasis — term used to indicate that a disease has spread to another organ
Neoplasm — term used for an abnormal mass. (A tumor is a neoplasm.)
Staging — the extent to which a cancer has developed or spread
What is gastritis?
Gastritis is a term commonly used by the public (and sometimes by doctors) to describe episodes of stomach discomfort (usually after eating) sometimes associated with nausea and/or vomiting. We refer also to “upset stomach” or “indigestion”.
What is the Gastric Mucosa?

The stomach has an internal lining, or mucous membrane, called the gastric mucosa. The mucosa must create hydrochloric acid to break down food, but also protect itself from the acidic contents that it creates.

What is Acute Gastritis?

Acute gastritis refers to a sudden onset of inflammation of the stomach lining, called the gastric mucosa. When a gastroenterologist performs an endoscopy, the lining appears reddened, and specimens show lots of acute inflammatory cells (mainly white blood cells, called leucocytes). There may be small, shallow breaks in the surface lining, called acute erosions ("erosive gastritis"), and even tiny areas of bleeding.

What is Chronic Gastritis?

Chronic gastritis refers to a persistent, but low grade, inflammation and damage to the stomach lining. The gastric mucosa becomes thinner as the normal cells are destroyed. The inflammatory cells include lymphocytes, which indicate an immune response. This is very common, especially in less developed countries. When present for many years, the mucosal changes may progress to a stage called metaplasia, with a small increased risk of gastric cancer.

Causes of Acute Gastritis

Acute gastritis is caused by acute irritants that overwhelm the mucus lining that usually protects the stomach mucosa. Irritants include aspirin or other NSAIDs (non-steroidal anti-inflammatory drugs), poisons (including strong alcohol) and certain infections, including the early stages of infection with the bacterium helicobacter pylori. Usually, the inflammation settles quickly when the irritant is removed.

What is Helicobacter Pylori?

Helicobacter pylori (or H. pylori) is one of many bacteria that is commonly found inside the stomach. In fact, it is suggested that more than half the world's population has this bacteria, yet never experience any problems. However, an H. pylori infection can increase the risks of developing stomach cancer, gastritis and/or peptic ulcers.

Causes of Chronic Gastritis

Chronic gastritis usually results from infection with helicobacter pylori (or H. pylori). The infection rate of adults in underdeveloped countries may be as high as 90%.

Other causes of chronic gastritis may include:

an auto-immune disease;
specific rare infections (i.e. HIV/AIDS);
Crohn's disease;
gastric surgeries which increase the stomach's exposure to bile.
What are the symptoms of gastritis?

Acute Gastritis Symptoms

Acute gastritis usually does cause an acute upset stomach, with upper abdominal pain or discomfort as the body tries to get rid of the irritant.
nausea and vomiting
bloating and gas
weight loss and/or loss of appetite

Chronic Gastritis Symptoms

In the vast majority of cases, chronic gastritis causes no symptoms. When the damage to the mucosa is severe and long standing, the stomach loses its ability to produce acid. This may cause digestive upsets.

Also lost is the ability to secrete a substance called intrinsic factor, which is necessary for absorption of the important vitamin B12. The patient presents with: tiredness, anemia, symptoms in the limbs such as numbness or tingling.

How is gastritis diagnosed?

By means of endoscopy.

What is a peptic ulcer?

A peptic ulcer —peptic is defined as pertaining to, or associated with, digestion— is a break in the surface lining of the stomach or duodenum which is deep enough to produce a shallow crater (ulcer) in its wall.

Peptic ulcers are found approximately four times as often in the duodenum than in the stomach, and can also be found, albeit rarely, in the lower food pipe or in the small intestine.

It is now known that over 90% of duodenal ulcers are the result of infection with helicobacter pylori (HP).

What is Helicobacter Pylori?

Helicobacter pylori (or H. pylori) is a bacteria commonly found in the stomach. In fact, it is suggested that more than half the world's population has this bacteria, yet never experience any problems. However, an H. pylori infection can increase the risks of developing stomach cancer, gastritis and/or peptic ulcers.

Aspirin and NSAIDs

Aspirin and other NSAIDs (nonsteroidal anti-inflammatory drugs) damage the lining of the stomach and make it more susceptible to damage from acid and enzymes. These drugs, however, only play a small role in causing ulcers but may flare up existing ulcers. People at higher risk of complications include those over the age of sixty, those taking high doses, and those with a past history of peptic ulcer or complications from these drugs.

Smoking also carries an increased risk of ulcers.
What are the symptoms and signs of an ulcer?
The most common symptoms are:

abdominal pain, usually located in the upper central abdomen

pain which may also be felt in the back

pain which may be worse when the stomach is empty; although not always the case, this pain can sometimes be relieved by eating

pain which wakes a patient from sleep

indigestion or heartburn,

vomiting and anemia.

What is a biopsy?

A biopsy is a procedure that captures a small amount of tissue for examination by a pathologist. The pathologist takes the tissue from the biopsy and creates a slide that can be examined under a microscope. Often he will create several slides and stain them with colors that allow better views of the cell structures.

A further advantage of endoscopy is that treatment can be carried out at the same time if the ulcer is bleeding. The majority of ulcers can also be diagnosed by careful barium meal examination and this is an alternative for patients who cannot or do not wish to have endoscopy.

Because of the ability to take biopsies and perform endoscopic treatment, endoscopy is the preferred method of investigation.

Cirrhosis is a disorder of the structure of the liver that occurs when there is continuing liver damage over a prolonged period of time, usually a few years or more. Although alcoholism usually comes to mind when cirrhosis is mentioned, there are many other causes of this disorder. Hepatitis virus infection, autoimmune liver disease (when the body's immune system causes damage to the liver), excess iron in the liver, and adverse reactions to medications, even obesity, in some cases, is a well recognized cause of cirrhosis.

An illustration comparing a normal liver and a cirrhotic liver.
What Are The Consequences of Cirrhosis?
There are three main consequences associated with the presence of cirrhosis.

Varicose veins in the esophagus.

Enlarged spleen

Fluid in stomach (ascites)

fluid retention in the legs

risk of bleeding with injury, surgery, dental extractions

jaundice (yellowing of the eyes and skin)

drowsiness, confusion and even unconsciousness.

cancer after cirrhosis has been present for many years.

What Are Other Considerations In Cirrhosis?

If confusion or drowsiness is a problem, a syrup called lactulose is used in mild laxative doses that lead to a slight increase in bowel movements (no more than 3-4 daily). This often improves thinking and consciousness.

Patients with cirrhosis who have a bleeding tendency, may need to be given a transfusion of clotting factors, prior to or during such procedures as dental extraction and surgery. Frequently, doses of a variety of medications (such as sedatives, pain killers, or even antibiotics) must be reduced for use in patients with cirrhosis.

When cirrhosis is advanced and liver function is poor, and when there is difficulty controlling bleeding from varices, liver transplantation may be the appropriate treatment.

What Is The Outlook For Someone With Cirrhosis?

It should be emphasized, that in many cases, neither the patient nor the physician are aware of the fact that cirrhosis is present. Patients may have cirrhosis for many years without any reduction in health. However once complications of cirrhosis occur, this is usually accompanied by some reduction in life expectancy, depending on the cause and severity of the decrease in liver function. It is important to remember that treating the cause of cirrhosis is almost always worthwhile, as it is likely to lead to an improvement in liver function, health and improvement in patient's life expectancy.

Acute pancreatitis is usually a sudden and severe illness caused when the pancreas rapidly becomes inflamed. Pancreas enzymes and various poisons (toxins) may enter the blood stream in an acute attack, and injure other organs such as the heart, lungs and kidneys. However, the pancreas can return to virtual normality if the cause of the attack is found and treated.

What is pancreatitis?

Pancreatitis is a disease in which the pancreas becomes swollen and inflamed causing it to not work properly. The enzymes which the pancreas normally produces to help digestion in the small intestine can attack the pancreas itself. The two most common types of pancreatitis are acute and chronic.

Mild forms of pancreatitis (so called edematous pancreatitis) may resolve quite quickly, within a few days, without residual damage to the pancreas or other organs.

What are the causes of acute pancreatitis?
The two most common causes of acute pancreatitis are:


    excessive consumption of alcohol

Gallstones and acute pancreatitis

Gallstones commonly form in the gallbladder. However, if a stone moves into the bile duct (through the cystic duct), it can become impacted (stuck) at the exit into the duodenum (papilla of Vater). This exit hole is normally shared with the pancreatic duct, so that an impacted stone can block the pancreas … and cause pancreatitis.

Alcohol and acute pancreatitis

Alcohol causes acute pancreatitis by direct poisoning of the gland. There is no completely safe level of consumption, and yet many people drink heavily for years without ever developing pancreatitis (or other alcohol-related diseases such as liver and heart disease).

Other causes of acute pancreatitis

    Poor drainage of the pancreatic duct resulting from partial obstruction — causes of obstruction include small tumors, as well as scarring and spasm of the muscular sphincter (sphincter of Oddi). Some patients are born with unusual drainage systems (i.e. pancreas divisum), which can interefere with drainage.

    A severe blow or direct injury to the upper abdomen, often incurred during a vehicular accident, but occasionally the result of a complication from a medical test or treatment (such as ERCP or surgery)

    A complication of some medicines and/or when the blood contains too much calcium or fat (especially triglycerides).

    Pancreatitis can also be caused by tiny stones (sludge or crystals) which cannot be seen on standard X-ray tests and scans. They can be found by special techniques such as during an ERCP examination. When stones, sludge or crystals are found, the gallbladder should be (almost always) removed via cholecystectomy.

What are the symptoms of acute pancreatitis?

    sudden severe upper abdominal pain (often referred to as epigastric pain)

    severe pain that might also be felt in the back

    nausea and vomiting


    fever and chills

    racing of the heart (also known as tachycardia)

    Symptoms are often severe enough as to require immediate medical attention and usually admission to hospital for pain medicines (analgesics) and intravenous (IV) fluids

Treatment for acute pancreatitis

Inflammation in acute pancreatitis involves the whole pancreas, so diabetes can result (either temporary or permanent) due to damage to the parts which normally produce insulin, known as islets of Langerhans. Patients may need multidisciplinary care in an intensive care unit, including artificial ventilation and other forms of life support.

When gallstones cause a severe attack of acute pancreatitis, the treatment plan may include attempts to remove the stone(s). This is usually first attempted by ERCP, but can also be done with a standard surgical operation.

Unfortunately, there is no specific treatment for pancreatitis. Treatment for acute pancreatitis is largely supportive, such as:

    adequate pain control

    replacement of fluids and nutrition (which has to be given through a vein)

    bowel rest to reduce the production of enzymes by the pancreas, thereby reducing swelling

    Antibiotics are needed when an infection is detected in the pancreas or other organs. There are experimental medicines aimed at reducing the secretion of pancreatic poisons, and neutralizing their effects.

Patients may require treatment for local complications of pancreatitis, such as pseudocysts and abscesses. When pseudocysts cause continuing symptoms (such as pain or pressure on other organs), the fluid must be drained. This can be done by:

    passing a tube through the abdominal wall (percutaneous cyst drainage)

    surgery (pseudocyst-gastrostomy)

    ERCP (endoscopic cyst drainage)

When these are performed, it is usually necessary to leave a tube behind for continuing drainage.

Celiac disease (sometimes referred to as celiac sprue, non-tropical sprue, or gluten-induced enteropathy) is essentially a sensitivity to gluten which is a component of wheat. Patients with celiac disease who ingest any wheat products develop abnormalities in the lining of the small intestine, particularly the upper part

Wheat, rye, barley and oats contain the proteins that make up gluten and will all affect patients with celiac disease. It is believed that there is an immunological response to components of gluten which result in inflammation of the lining of the small intestine. The mucosa can become so damaged that it can become "leaky"; water and salts can leak out of the cells into the small intestine and be lost with diarrhea.

Patients may experience Anemia, Diarrhea, weight loss, gastric distension, features of other associated disorders such as diabetes, dermatitis herpetiformis (a particular type of skin disorder), and bone pain from osteoporosis/osteomalacia. However, some patients may not have any symptoms.


Anemia is probably one of the most common findings. Blood tests are available (antigliadin and antiendomysial antibodies). The antiendomysial antibody test is the most specific. The ideal way to confirm celiac disease is to perform an upper endoscopy and to inspect and take samples from (biopsy) the small intestine.


The treatment of celiac disease is to remove all gluten from the diet. Even small amounts of gluten can prevent a clinical response. It is important for the patient to become very familiar with gluten free products.

Patients on gluten free diets should have supplements of vitamins, particularly vitamin D, folic acid, and iron. These may need to be given by injection if they cannot be absorbed in the oral form.

Foods to be taken















What is IBD?

Inflammatory Bowel Disease is a set of conditions that affects the colon and small intestine. There are two primary forms of inflammatory bowel disease (IBD), Crohn's disease and ulcerative colitis. Both are classified as autoimmune disorders. An autoimmune disorder is a condition that takes place when the body's immune system errantly attacks its own healthy tissue.

What are the symptoms of IBD?

    persistent abdominal pain

    bowel sores


    intestinal bleeding

    weight loss

    In some cases, the inflammatory processes associated with Crohn's disease and ulcerative colitis trigger skin lesions, joint pain, inflammation of the eyes, and liver disorders.

Diagnosing IBD
Inflammatory bowel diseases are diagnosed through:
flexible sigmoidoscopy, whereby the intestinal lining is viewed directly through a flexible tube inserted through the anus Samples of inflamed intestinal tissue may also be taken for microscopic examination.
What are the treatments for IBD?
Treatment for both disorders includes:

    dietary adjustments



    No specific dietary regimens have proved fully effective, although avoidance of foods which exacerbate inflammation is recommended.

Both Crohn's disease and ulcerative colitis are initially treated with sulfasalazine and mesalamine. More serious cases of Crohn's disease are treated with prednisolone, metronidazole or azathioprine. With ulcerative colitis, surgery becomes necessary in one in four patients, for whom the prognosis is usually good.

While medication, diet, and surgery may lead to temporary remission, both disorders persist throughout the patient's lifetime.

OPD Timing

Private Clinic, Residence

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Bharat Vikas Parishad Hospital

10:00 AM to 2:00 PM
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