Stomach & Esophageal Disorder Treatment in Gandhinagar & Ahmedabad | Niraaya Hospital

As described in the Hernia section, a hiatal hernia occurs when abdominal contents - primarily the stomach - herniate through the oesophageal hiatus in the diaphragm into the chest. Sliding hiatal hernias (Type I) are strongly associated with GERD and managed with laparoscopic fundoplication. Large para-oesophageal hernias (Types II-IV) require laparoscopic repair of the hiatal defect with mesh reinforcement plus fundoplication, due to the risk of gastric volvulus.

Symptoms of a large hiatal hernia include: epigastric pain after eating, early satiety (fullness after small amounts), difficulty swallowing, respiratory symptoms from compression of the lungs by the intrathoracic stomach, and iron deficiency anaemia (from chronic mucosal erosion at the level of the diaphragm - "Cameron's lesions").

Peptic ulcers are mucosal defects in the stomach (gastric ulcer) or duodenum (duodenal ulcer) caused by an imbalance between acid/pepsin-mediated tissue injury and the stomach's mucosal defence mechanisms. The two overwhelmingly dominant causes are:

• Helicobacter pylori (H. pylori) infection - a spiral-shaped bacterium colonising the gastric mucosa, disrupting mucosal defences and promoting acid hypersecretion
• NSAIDs (non-steroidal anti-inflammatory drugs) - aspirin, ibuprofen, diclofenac - which inhibit prostaglandin synthesis and directly damage the gastric and duodenal mucosa

The medical management of peptic ulcer disease - H. pylori eradication therapy (triple therapy: two antibiotics + PPI for 14 days), PPI-based acid suppression, and NSAID cessation - is highly effective. The vast majority of uncomplicated ulcers heal with medical treatment.

Surgical management is required for complications:

Perforated peptic ulcer: The ulcer erodes through the full thickness of the stomach or duodenal wall, releasing gastric contents into the peritoneal cavity. This is a surgical emergency - the patient develops sudden-onset, severe generalised abdominal pain (often described as the worst pain of their life), a rigid, board-like abdomen, and rapidly deteriorating vital signs. Erect chest X-ray or CT shows free air under the diaphragm. Emergency laparoscopic peritoneal lavage and repair of the perforation (Graham patch closure) is the procedure of choice - Dr. Patel performs this as an emergency at Niraaya Hospital, Gandhinagar.

Bleeding peptic ulcer: Active bleeding from a peptic ulcer causing haematemesis (blood vomiting) or melaena (black, tarry stools) is initially managed endoscopically - injection therapy, thermal coagulation, or mechanical haemoclip placement. Surgical intervention (laparoscopic or open) is required when endoscopic haemostasis fails or when re-bleeding occurs after two endoscopic attempts.

Gastric outlet obstruction: Pyloric stenosis from chronic duodenal ulcer scarring causes gastric outlet obstruction - presenting with projectile non-bilious vomiting, weight loss, and abdominal distension. Managed with endoscopic balloon dilation or surgical gastrojejunostomy (bypass of the obstructed pylorus).

Achalasia is a rare but important primary oesophageal motility disorder - characterised by failure of relaxation of the lower oesophageal sphincter (LOS) in response to swallowing and the loss of normal peristaltic contractions in the oesophageal body. As a result, food and liquid progressively fail to pass from the oesophagus into the stomach - accumulating in a dilated, aperistaltic oesophagus.

Achalasia typically presents in the third to fifth decades with progressive dysphagia - initially for solids (particularly bread, rice, and meat), then for liquids as the disease advances. Regurgitation of undigested food (often at night, causing aspiration pneumonia), chest pain, and significant weight loss are common. The diagnosis is confirmed with barium swallow (showing the classic "bird's beak" appearance at the gastro-oesophageal junction) and oesophageal manometry (the gold standard - demonstrating absent peristalsis and incomplete LOS relaxation).

Benign gastric tumours - including GISTs (gastrointestinal stromal tumours), lipomas, and leiomyomas - are often discovered incidentally on endoscopy. Small GISTs below 2 cm with low-risk features can be monitored; larger GISTs and symptomatic benign tumours require laparoscopic or open wedge resection (removal of the tumour with a margin of normal stomach). Gastric lipomas and leiomyomas are typically enucleated endoscopically or laparoscopically.

Gastric adenocarcinoma (stomach cancer) is the surgical malignancy requiring gastrectomy - partial or total - depending on location and stage. Detailed management is covered on the dedicated GI Cancer Surgery page.