GI DISEASES
Esophagus Diseases
Dysphagia– difficulty in swallowing food or drinking water
Odynophagia– Pain during swallowing Nocturnal regurgitation of liquid in the mouth
Heartburn– Pain in the central part of the chest Acid regurgitation- Return of acid fluid in the mouth
Dysphagia– difficulty in swallowing food or drinking water
Odynophagia– Pain during swallowing Nocturnal regurgitation of liquid in the mouth
Heartburn– Pain in the central part of the chest Acid regurgitation- Return of acid fluid in the mouth
Upper GI endoscopy – During endoscopy, endoscope is passed through the mouth. During endoscopy, esophagus, stomach and duodenum (Upper part of small intestine can be checked).
Esophageal Manometry– A catheter is passed through the nose in esophagus. Sensors on the probe, checks the pressure in the esophagus.
24 hour pH study: A catheter is placed in the esophagus for 24 hours. Sensors on the probe checks the upward movement of acid in the esophagus.
Upper GI endoscopy – During endoscopy, endoscope is passed through the mouth. During endoscopy, esophagus, stomach and duodenum (Upper part of small intestine can be checked).
Esophageal Manometry– A catheter is passed through the nose in esophagus. Sensors on the probe, checks the pressure in the esophagus.
24 hour pH study: A catheter is placed in the esophagus for 24 hours. Sensors on the probe checks the upward movement of acid in the esophagus.
Achalasia Cardia is caused by impaired relaxation of lower oesophageal sphincter (LES). LES is a sphincter or valve between oesophagus and stomach. LES act as a one way valve, once the patient swallows food or drink water, allowing passage of food and water in the stomach. In between the meals, LES closes and prevent the upward movement of food or water.
Achalasia patients complain of difficulty in swallowing, sensation of food or getting stuck in the chest, chest pain (which can be sometimes mistaken for heart attack),regurgitation of food and weight loss. Achalasia symptoms generally appear gradually and worsen over time.
Signs and symptoms may include:
- Dysphagia: Difficulty in swallowing food or drinking water.
- Odynophagia: Pain while swallowing solid or liquids.
- Chest pain: Pain in central part of chest after the meals.
- Weight Loss: Prolonged disease can lead to weight loss and nutritional deficiency.
- Inability to swallow (dysphagia), which may feel like food or drink is stuck in your throat.
- Regurgitating food or saliva.
- Pneumonia (from aspiration of food into the lungs)
- Coughing at night
- Belching
Diagnosis of achalasia begins with a careful medical history focusing on the timing of symptoms and eliminating other medical conditions that may cause similar symptoms
- Upper GI endoscopy to rule out obstructing lesion.Endoscopy which is used to look directly into the esophagus can be normal in achalasia. However, endoscopy can detect tumors of the esophagus which can mimic achalasia.
- Barium swallow.Barium swallow is another useful investigation, during which patient swallows a solution containing barium. An X ray is performed, which confirms of achalasia cardia.
- Esophageal manometry is the test which can confirm the diagnosis of achalasia. In Manometry, a thin probe is passed through the esophagus to assess the peristalsis and lower esophageal sphincter relaxation during swallowing.
- High resolution oesophageal manometry is the best test to diagnose achalasia cardia. During HRM, a small catheter is passed through the nose into the esophagus. This catheter measures the pressure in the esophageal body and at lower esophageal sphincter. Relaxation of lower esophageal pressure is measured by a parameter called integrated relaxation pressure (IRP). High IRP and absent peristalsis are essential for the diagnosis of achalasia cardia.
Medical therapy has limited efficacy in the treatment for achalasia cardia.Endoscopic botulinum injection, balloon dilatation (Penumatic), and Lap Heller Myotomy (Surgery) has been the conventional treatment for Achalasia Cardia. In the recent time, POEM (per oral endoscopic myotomy) has emerged as new and effective treatment for achalasia cardia.
- POEM is an endoscopic treatment, during which very careful cutting of tight muscle fibres at GE junction is performed. For POEM procedure, patient is admitted for 24-48 hours. After POEM procedure, X ray is performed after 24 hours, and liquid diet is started.
- Endoscopic pneumatic balloon dilatation.
- Surgery- Lap Heller’s myotomy.
- Botulinum injection.
- Medical therapy such as calcium channel blockers have limited efficacy.
We at Max Superpeciality hospital are one of the few centers where manometry is being performed and we offer incisionless endoscopic surgery called POEM (Per oral endoscopic myotomy) for achalasia. POEM procedure for achalasia is a safe procedure offering excellent long-term results, also not requiring long hospital stay. After POEM procedure liquid diet is started.
At Max hospital Saket, our gastroenterology team with cumulative experience of more than 150,000 endoscopic procedures, is providing the cutting edge treatment for patients with coplex GI disorders. Our team, under the leadership of Dr Vikas Singla, has one of the highest experience for treatment of achalasia cardia. Team has already performed more than 400 cases of per oral endoscopy myotomy in patients of achalasia cardia with the excellent results.
Achalasia is a disease of oesophagus characterized by difficulty in swallowing food or drinking water.
Achalasia Cardia is caused by impaired relaxation of lower oesophageal sphincter (LES). LES is a sphincter or valve between oesophagus and stomach. LES act as a one way valve, once the patient swallows food or drink water, allowing passage of food and water in the stomach. In between the meals, LES closes and prevent the upward movement of food or water.
Achalasia patients complain of difficulty in swallowing, sensation of food or getting stuck in the chest, chest pain (which can be sometimes mistaken for heart attack),regurgitation of food and weight loss. Achalasia symptoms generally appear gradually and worsen over time.
Signs and symptoms may include:
- Dysphagia: Difficulty in swallowing food or drinking water.
- Odynophagia: Pain while swallowing solid or liquids.
- Chest pain: Pain in central part of chest after the meals.
- Weight Loss: Prolonged disease can lead to weight loss and nutritional deficiency.
- Inability to swallow (dysphagia), which may feel like food or drink is stuck in your throat.
- Regurgitating food or saliva.
- Pneumonia (from aspiration of food into the lungs)
- Coughing at night
- Belching
Diagnosis of achalasia begins with a careful medical history focusing on the timing of symptoms and eliminating other medical conditions that may cause similar symptoms
- Upper GI endoscopy to rule out obstructing lesion.Endoscopy which is used to look directly into the esophagus can be normal in achalasia. However, endoscopy can detect tumors of the esophagus which can mimic achalasia.
- Barium swallow.Barium swallow is another useful investigation, during which patient swallows a solution containing barium. An X ray is performed, which confirms of achalasia cardia.
- Esophageal manometry is the test which can confirm the diagnosis of achalasia. In Manometry, a thin probe is passed through the esophagus to assess the peristalsis and lower esophageal sphincter relaxation during swallowing.
- High resolution oesophageal manometry is the best test to diagnose achalasia cardia. During HRM, a small catheter is passed through the nose into the esophagus. This catheter measures the pressure in the esophageal body and at lower esophageal sphincter. Relaxation of lower esophageal pressure is measured by a parameter called integrated relaxation pressure (IRP). High IRP and absent peristalsis are essential for the diagnosis of achalasia cardia.
Medical therapy has limited efficacy in the treatment for achalasia cardia.Endoscopic botulinum injection, balloon dilatation (Penumatic), and Lap Heller Myotomy (Surgery) has been the conventional treatment for Achalasia Cardia. In the recent time, POEM (per oral endoscopic myotomy) has emerged as new and effective treatment for achalasia cardia.
- POEM is an endoscopic treatment, during which very careful cutting of tight muscle fibres at GE junction is performed. For POEM procedure, patient is admitted for 24-48 hours. After POEM procedure, X ray is performed after 24 hours, and liquid diet is started.
- Endoscopic pneumatic balloon dilatation.
- Surgery- Lap Heller’s myotomy.
- Botulinum injection.
- Medical therapy such as calcium channel blockers have limited efficacy.
We at Max Superpeciality hospital are one of the few centers where manometry is being performed and we offer incisionless endoscopic surgery called POEM (Per oral endoscopic myotomy) for achalasia. POEM procedure for achalasia is a safe procedure offering excellent long-term results, also not requiring long hospital stay. After POEM procedure liquid diet is started.
At Max hospital Saket, our gastroenterology team with cumulative experience of more than 150,000 endoscopic procedures, is providing the cutting edge treatment for patients with coplex GI disorders. Our team, under the leadership of Dr Vikas Singla, has one of the highest experience for treatment of achalasia cardia. Team has already performed more than 400 cases of per oral endoscopy myotomy in patients of achalasia cardia with the excellent results.
- Smoking
- Alcohol
- Obesity
- Barrett’s esophagus
- Dysphagia- Difficulty in swallowing food or drinking liquids
- Weight loss
- Chest pain
- Upper GI endoscopy- A small tube is passed through the mouth, and biopsy is obtained. During endoscopy, if proper sedation is given, procedure becomes painless.
- CT scan for the spread in surrounding tissue
- Endoscopic Ultrasound to see the depth of the cancer
- PET scan for the distant metastasis
- Very early cancer: Endoscopic technique of ESD
- Locally advanced tumor: Surgery with or without chemoradiotherapy depending upon the stage of the tumor
- Cancer with distant metastasis: Metal stent is placed in the esophagus with the help of endoscopy. Stent helps in eating and drinking. This cane be followed by chemotherapy.
Cancer which is confined to inner layer of esophageal wall such as mucosa or submucosa are known as early esophageal cancer. Such tumors can be diagnosed by a new technique known as image enhanced endoscopy. Such tumor can be cured by a new technique known as endoscopic submucosal dissection (ESD). During ESD, whole tumor can be removed totally with the help of endoscopy avoiding the need of the surgery.
Esophagus cancer is an abnormal growth of cells of inner lining of Esophagus
- Smoking
- Alcohol
- Obesity
- Barrett’s esophagus
- Dysphagia- Difficulty in swallowing food or drinking liquids
- Weight loss
- Chest pain
- Upper GI endoscopy- A small tube is passed through the mouth, and biopsy is obtained. During endoscopy, if proper sedation is given, procedure becomes painless.
- CT scan for the spread in surrounding tissue
- Endoscopic Ultrasound to see the depth of the cancer
- PET scan for the distant metastasis
- Very early cancer: Endoscopic technique of ESD
- Locally advanced tumor: Surgery with or without chemoradiotherapy depending upon the stage of the tumor
- Cancer with distant metastasis: Metal stent is placed in the esophagus with the help of endoscopy. Stent helps in eating and drinking. This cane be followed by chemotherapy.
Cancer which is confined to inner layer of esophageal wall such as mucosa or submucosa are known as early esophageal cancer. Such tumors can be diagnosed by a new technique known as image enhanced endoscopy. Such tumor can be cured by a new technique known as endoscopic submucosal dissection (ESD). During ESD, whole tumor can be removed totally with the help of endoscopy avoiding the need of the surgery.
- Difficulty in swallowing foods
- Food bolus impaction
- Chest pain
- Upper GI endoscopy (Rings and furrows are seen) and biopsy
- Increased eosinophils in esophagus epithelium
- Proton pump inhibitors
- If symptoms persist- Elimination diet and topical steroids
- Difficulty in swallowing foods
- Food bolus impaction
- Chest pain
- Upper GI endoscopy (Rings and furrows are seen) and biopsy
- Increased eosinophils in esophagus epithelium
- Proton pump inhibitors
- If symptoms persist- Elimination diet and topical steroids
- Obesity
- Smoking
- Alcohol
- Pregnancy
- Caffeine
- Carbonated
- beverages (cola pH = 2.75)
- Chocolate
- Spicy food
- Persistent heartburn and acid regurgitation
- Belching
- Sour taste in the mouth
- Sensation of food being struck in throat
- Difficulty or pain when swallowing
- Chest pain
- Hoarseness of voice
- Chronic sore throat
- Dry cough
- Bad breath
- Erosion of tooth enamel
- Typical or atypical symptoms of GERD
- Upper GI endoscopy which can reveal ulcers or inflammation in lower esophagus
- Special endoscopy technique known as image enhanced endoscopy can reveal increase vascularity in lower esophagus
- 24 hour pH study: A thin catheter is placed through the nose in the esophagus. Sensors on the catheter monitor the upward movement of acid.
Complication of GERD
- Peptic stricture – Ring like stricture can form in lower esophagus. This can lead to difficulty in swallowing and food bolus impaction.
- Barrett’s esophagus: Lining epithelium of lower esophagus changes to intestinal epithelium. Barrett’s esophagus can predispose to dysplasia and esophageal cancer.
- Life style modification
- Avoiding certain food like citrus fruit, chocolate
- Raising head end of bed
- Small frequent meals
- Medications to reduce acid production and neutralize acid
- Surgical fundoplication
- Endoscopic tightening of GE junction
- GERD-X
- Anti reflux mucosectomy
- Anti reflux mucosal ablation
- Screening of dysplasia by endoscopy/biopsy/image enhanced endoscopy
- RFA/cryoablation of dysplasia in Barrett’s esophagus
- Endoscopic submucosal dissection for early esophageal cancer
- Surgery for advanced esophageal cancer
- Endoscopic dilatation of strictur
Achalasia Cardia is caused by impaired relaxation of lower oesophageal sphincter (LES). LES is a sphincter or valve between oesophagus and stomach. LES act as a one way valve, once the patient swallows food or drink water, allowing passage of food and water in the stomach. In between the meals, LES closes and prevent the upward movement of food or water.
Achalasia patients complain of difficulty in swallowing, sensation of food or getting stuck in the chest, chest pain (which can be sometimes mistaken for heart attack),regurgitation of food and weight loss. Achalasia symptoms generally appear gradually and worsen over time.
Signs and symptoms may include:
- Dysphagia: Difficulty in swallowing food or drinking water.
- Odynophagia: Pain while swallowing solid or liquids.
- Chest pain: Pain in central part of chest after the meals.
- Weight Loss: Prolonged disease can lead to weight loss and nutritional deficiency.
- Inability to swallow (dysphagia), which may feel like food or drink is stuck in your throat.
- Regurgitating food or saliva.
- Pneumonia (from aspiration of food into the lungs)
- Coughing at night
- Belching
Diagnosis of achalasia begins with a careful medical history focusing on the timing of symptoms and eliminating other medical conditions that may cause similar symptoms
- Upper GI endoscopy to rule out obstructing lesion.Endoscopy which is used to look directly into the esophagus can be normal in achalasia. However, endoscopy can detect tumors of the esophagus which can mimic achalasia.
- Barium swallow.Barium swallow is another useful investigation, during which patient swallows a solution containing barium. An X ray is performed, which confirms of achalasia cardia.
- Esophageal manometry is the test which can confirm the diagnosis of achalasia. In Manometry, a thin probe is passed through the esophagus to assess the peristalsis and lower esophageal sphincter relaxation during swallowing.
- High resolution oesophageal manometry is the best test to diagnose achalasia cardia. During HRM, a small catheter is passed through the nose into the esophagus. This catheter measures the pressure in the esophageal body and at lower esophageal sphincter. Relaxation of lower esophageal pressure is measured by a parameter called integrated relaxation pressure (IRP). High IRP and absent peristalsis are essential for the diagnosis of achalasia cardia.
Medical therapy has limited efficacy in the treatment for achalasia cardia.Endoscopic botulinum injection, balloon dilatation (Penumatic), and Lap Heller Myotomy (Surgery) has been the conventional treatment for Achalasia Cardia. In the recent time, POEM (per oral endoscopic myotomy) has emerged as new and effective treatment for achalasia cardia.
- POEM is an endoscopic treatment, during which very careful cutting of tight muscle fibres at GE junction is performed. For POEM procedure, patient is admitted for 24-48 hours. After POEM procedure, X ray is performed after 24 hours, and liquid diet is started.
- Endoscopic pneumatic balloon dilatation.
- Surgery- Lap Heller’s myotomy.
- Botulinum injection.
- Medical therapy such as calcium channel blockers have limited efficacy.
We at Max Superpeciality hospital are one of the few centers where manometry is being performed and we offer incisionless endoscopic surgery called POEM (Per oral endoscopic myotomy) for achalasia. POEM procedure for achalasia is a safe procedure offering excellent long-term results, also not requiring long hospital stay. After POEM procedure liquid diet is started.
At Max hospital Saket, our gastroenterology team with cumulative experience of more than 150,000 endoscopic procedures, is providing the cutting edge treatment for patients with coplex GI disorders. Our team, under the leadership of Dr Vikas Singla, has one of the highest experience for treatment of achalasia cardia. Team has already performed more than 400 cases of per oral endoscopy myotomy in patients of achalasia cardia with the excellent results.
Achalasia is a disease of oesophagus characterized by difficulty in swallowing food or drinking water.
Achalasia Cardia is caused by impaired relaxation of lower oesophageal sphincter (LES). LES is a sphincter or valve between oesophagus and stomach. LES act as a one way valve, once the patient swallows food or drink water, allowing passage of food and water in the stomach. In between the meals, LES closes and prevent the upward movement of food or water.
Achalasia patients complain of difficulty in swallowing, sensation of food or getting stuck in the chest, chest pain (which can be sometimes mistaken for heart attack),regurgitation of food and weight loss. Achalasia symptoms generally appear gradually and worsen over time.
Signs and symptoms may include:
- Dysphagia: Difficulty in swallowing food or drinking water.
- Odynophagia: Pain while swallowing solid or liquids.
- Chest pain: Pain in central part of chest after the meals.
- Weight Loss: Prolonged disease can lead to weight loss and nutritional deficiency.
- Inability to swallow (dysphagia), which may feel like food or drink is stuck in your throat.
- Regurgitating food or saliva.
- Pneumonia (from aspiration of food into the lungs)
- Coughing at night
- Belching
Diagnosis of achalasia begins with a careful medical history focusing on the timing of symptoms and eliminating other medical conditions that may cause similar symptoms
- Upper GI endoscopy to rule out obstructing lesion.Endoscopy which is used to look directly into the esophagus can be normal in achalasia. However, endoscopy can detect tumors of the esophagus which can mimic achalasia.
- Barium swallow.Barium swallow is another useful investigation, during which patient swallows a solution containing barium. An X ray is performed, which confirms of achalasia cardia.
- Esophageal manometry is the test which can confirm the diagnosis of achalasia. In Manometry, a thin probe is passed through the esophagus to assess the peristalsis and lower esophageal sphincter relaxation during swallowing.
- High resolution oesophageal manometry is the best test to diagnose achalasia cardia. During HRM, a small catheter is passed through the nose into the esophagus. This catheter measures the pressure in the esophageal body and at lower esophageal sphincter. Relaxation of lower esophageal pressure is measured by a parameter called integrated relaxation pressure (IRP). High IRP and absent peristalsis are essential for the diagnosis of achalasia cardia.
Medical therapy has limited efficacy in the treatment for achalasia cardia.Endoscopic botulinum injection, balloon dilatation (Penumatic), and Lap Heller Myotomy (Surgery) has been the conventional treatment for Achalasia Cardia. In the recent time, POEM (per oral endoscopic myotomy) has emerged as new and effective treatment for achalasia cardia.
- POEM is an endoscopic treatment, during which very careful cutting of tight muscle fibres at GE junction is performed. For POEM procedure, patient is admitted for 24-48 hours. After POEM procedure, X ray is performed after 24 hours, and liquid diet is started.
- Endoscopic pneumatic balloon dilatation.
- Surgery- Lap Heller’s myotomy.
- Botulinum injection.
- Medical therapy such as calcium channel blockers have limited efficacy.
We at Max Superpeciality hospital are one of the few centers where manometry is being performed and we offer incisionless endoscopic surgery called POEM (Per oral endoscopic myotomy) for achalasia. POEM procedure for achalasia is a safe procedure offering excellent long-term results, also not requiring long hospital stay. After POEM procedure liquid diet is started.
At Max hospital Saket, our gastroenterology team with cumulative experience of more than 150,000 endoscopic procedures, is providing the cutting edge treatment for patients with coplex GI disorders. Our team, under the leadership of Dr Vikas Singla, has one of the highest experience for treatment of achalasia cardia. Team has already performed more than 400 cases of per oral endoscopy myotomy in patients of achalasia cardia with the excellent results.
- Smoking
- Alcohol
- Obesity
- Barrett’s esophagus
- Dysphagia- Difficulty in swallowing food or drinking liquids
- Weight loss
- Chest pain
- Upper GI endoscopy- A small tube is passed through the mouth, and biopsy is obtained. During endoscopy, if proper sedation is given, procedure becomes painless.
- CT scan for the spread in surrounding tissue
- Endoscopic Ultrasound to see the depth of the cancer
- PET scan for the distant metastasis
- Very early cancer: Endoscopic technique of ESD
- Locally advanced tumor: Surgery with or without chemoradiotherapy depending upon the stage of the tumor
- Cancer with distant metastasis: Metal stent is placed in the esophagus with the help of endoscopy. Stent helps in eating and drinking. This cane be followed by chemotherapy.
Cancer which is confined to inner layer of esophageal wall such as mucosa or submucosa are known as early esophageal cancer. Such tumors can be diagnosed by a new technique known as image enhanced endoscopy. Such tumor can be cured by a new technique known as endoscopic submucosal dissection (ESD). During ESD, whole tumor can be removed totally with the help of endoscopy avoiding the need of the surgery.
Esophagus cancer is an abnormal growth of cells of inner lining of Esophagus
- Smoking
- Alcohol
- Obesity
- Barrett’s esophagus
- Dysphagia- Difficulty in swallowing food or drinking liquids
- Weight loss
- Chest pain
- Upper GI endoscopy- A small tube is passed through the mouth, and biopsy is obtained. During endoscopy, if proper sedation is given, procedure becomes painless.
- CT scan for the spread in surrounding tissue
- Endoscopic Ultrasound to see the depth of the cancer
- PET scan for the distant metastasis
- Very early cancer: Endoscopic technique of ESD
- Locally advanced tumor: Surgery with or without chemoradiotherapy depending upon the stage of the tumor
- Cancer with distant metastasis: Metal stent is placed in the esophagus with the help of endoscopy. Stent helps in eating and drinking. This cane be followed by chemotherapy.
Cancer which is confined to inner layer of esophageal wall such as mucosa or submucosa are known as early esophageal cancer. Such tumors can be diagnosed by a new technique known as image enhanced endoscopy. Such tumor can be cured by a new technique known as endoscopic submucosal dissection (ESD). During ESD, whole tumor can be removed totally with the help of endoscopy avoiding the need of the surgery.
- Difficulty in swallowing foods
- Food bolus impaction
- Chest pain
- Upper GI endoscopy (Rings and furrows are seen) and biopsy
- Increased eosinophils in esophagus epithelium
- Proton pump inhibitors
- If symptoms persist- Elimination diet and topical steroids
- Difficulty in swallowing foods
- Food bolus impaction
- Chest pain
- Upper GI endoscopy (Rings and furrows are seen) and biopsy
- Increased eosinophils in esophagus epithelium
- Proton pump inhibitors
- If symptoms persist- Elimination diet and topical steroids
- Obesity
- Smoking
- Alcohol
- Pregnancy
- Caffeine
- Carbonated
- beverages (cola pH = 2.75)
- Chocolate
- Spicy food
- Persistent heartburn and acid regurgitation
- Belching
- Sour taste in the mouth
- Sensation of food being struck in throat
- Difficulty or pain when swallowing
- Chest pain
- Hoarseness of voice
- Chronic sore throat
- Dry cough
- Bad breath
- Erosion of tooth enamel
- Typical or atypical symptoms of GERD
- Upper GI endoscopy which can reveal ulcers or inflammation in lower esophagus
- Special endoscopy technique known as image enhanced endoscopy can reveal increase vascularity in lower esophagus
- 24 hour pH study: A thin catheter is placed through the nose in the esophagus. Sensors on the catheter monitor the upward movement of acid.
Complication of GERD
- Peptic stricture – Ring like stricture can form in lower esophagus. This can lead to difficulty in swallowing and food bolus impaction.
- Barrett’s esophagus: Lining epithelium of lower esophagus changes to intestinal epithelium. Barrett’s esophagus can predispose to dysplasia and esophageal cancer.
- Life style modification
- Avoiding certain food like citrus fruit, chocolate
- Raising head end of bed
- Small frequent meals
- Medications to reduce acid production and neutralize acid
- Surgical fundoplication
- Endoscopic tightening of GE junction
- GERD-X
- Anti reflux mucosectomy
- Anti reflux mucosal ablation
- Screening of dysplasia by endoscopy/biopsy/image enhanced endoscopy
- RFA/cryoablation of dysplasia in Barrett’s esophagus
- Endoscopic submucosal dissection for early esophageal cancer
- Surgery for advanced esophageal cancer
- Endoscopic dilatation of strictur
Dysphagia– difficulty in swallowing food or drinking water
Odynophagia– Pain during swallowing Nocturnal regurgitation of liquid in the mouth
Heartburn– Pain in the central part of the chest Acid regurgitation- Return of acid fluid in the mouth
Dysphagia– difficulty in swallowing food or drinking water
Odynophagia– Pain during swallowing Nocturnal regurgitation of liquid in the mouth
Heartburn– Pain in the central part of the chest Acid regurgitation- Return of acid fluid in the mouth
Upper GI endoscopy – During endoscopy, endoscope is passed through the mouth. During endoscopy, esophagus, stomach and duodenum (Upper part of small intestine can be checked).
Esophageal Manometry– A catheter is passed through the nose in esophagus. Sensors on the probe, checks the pressure in the esophagus.
24 hour pH study: A catheter is placed in the esophagus for 24 hours. Sensors on the probe checks the upward movement of acid in the esophagus.
Upper GI endoscopy – During endoscopy, endoscope is passed through the mouth. During endoscopy, esophagus, stomach and duodenum (Upper part of small intestine can be checked).
Esophageal Manometry– A catheter is passed through the nose in esophagus. Sensors on the probe, checks the pressure in the esophagus.
24 hour pH study: A catheter is placed in the esophagus for 24 hours. Sensors on the probe checks the upward movement of acid in the esophagus.
Achalasia Cardia is caused by impaired relaxation of lower oesophageal sphincter (LES). LES is a sphincter or valve between oesophagus and stomach. LES act as a one way valve, once the patient swallows food or drink water, allowing passage of food and water in the stomach. In between the meals, LES closes and prevent the upward movement of food or water.
Achalasia patients complain of difficulty in swallowing, sensation of food or getting stuck in the chest, chest pain (which can be sometimes mistaken for heart attack),regurgitation of food and weight loss. Achalasia symptoms generally appear gradually and worsen over time.
Signs and symptoms may include:
- Dysphagia: Difficulty in swallowing food or drinking water.
- Odynophagia: Pain while swallowing solid or liquids.
- Chest pain: Pain in central part of chest after the meals.
- Weight Loss: Prolonged disease can lead to weight loss and nutritional deficiency.
- Inability to swallow (dysphagia), which may feel like food or drink is stuck in your throat.
- Regurgitating food or saliva.
- Pneumonia (from aspiration of food into the lungs)
- Coughing at night
- Belching
Diagnosis of achalasia begins with a careful medical history focusing on the timing of symptoms and eliminating other medical conditions that may cause similar symptoms
- Upper GI endoscopy to rule out obstructing lesion.Endoscopy which is used to look directly into the esophagus can be normal in achalasia. However, endoscopy can detect tumors of the esophagus which can mimic achalasia.
- Barium swallow.Barium swallow is another useful investigation, during which patient swallows a solution containing barium. An X ray is performed, which confirms of achalasia cardia.
- Esophageal manometry is the test which can confirm the diagnosis of achalasia. In Manometry, a thin probe is passed through the esophagus to assess the peristalsis and lower esophageal sphincter relaxation during swallowing.
- High resolution oesophageal manometry is the best test to diagnose achalasia cardia. During HRM, a small catheter is passed through the nose into the esophagus. This catheter measures the pressure in the esophageal body and at lower esophageal sphincter. Relaxation of lower esophageal pressure is measured by a parameter called integrated relaxation pressure (IRP). High IRP and absent peristalsis are essential for the diagnosis of achalasia cardia.
Medical therapy has limited efficacy in the treatment for achalasia cardia.Endoscopic botulinum injection, balloon dilatation (Penumatic), and Lap Heller Myotomy (Surgery) has been the conventional treatment for Achalasia Cardia. In the recent time, POEM (per oral endoscopic myotomy) has emerged as new and effective treatment for achalasia cardia.
- POEM is an endoscopic treatment, during which very careful cutting of tight muscle fibres at GE junction is performed. For POEM procedure, patient is admitted for 24-48 hours. After POEM procedure, X ray is performed after 24 hours, and liquid diet is started.
- Endoscopic pneumatic balloon dilatation.
- Surgery- Lap Heller’s myotomy.
- Botulinum injection.
- Medical therapy such as calcium channel blockers have limited efficacy.
We at Max Superpeciality hospital are one of the few centers where manometry is being performed and we offer incisionless endoscopic surgery called POEM (Per oral endoscopic myotomy) for achalasia. POEM procedure for achalasia is a safe procedure offering excellent long-term results, also not requiring long hospital stay. After POEM procedure liquid diet is started.
At Max hospital Saket, our gastroenterology team with cumulative experience of more than 150,000 endoscopic procedures, is providing the cutting edge treatment for patients with coplex GI disorders. Our team, under the leadership of Dr Vikas Singla, has one of the highest experience for treatment of achalasia cardia. Team has already performed more than 400 cases of per oral endoscopy myotomy in patients of achalasia cardia with the excellent results.
Achalasia is a disease of oesophagus characterized by difficulty in swallowing food or drinking water.
Achalasia Cardia is caused by impaired relaxation of lower oesophageal sphincter (LES). LES is a sphincter or valve between oesophagus and stomach. LES act as a one way valve, once the patient swallows food or drink water, allowing passage of food and water in the stomach. In between the meals, LES closes and prevent the upward movement of food or water.
Achalasia patients complain of difficulty in swallowing, sensation of food or getting stuck in the chest, chest pain (which can be sometimes mistaken for heart attack),regurgitation of food and weight loss. Achalasia symptoms generally appear gradually and worsen over time.
Signs and symptoms may include:
- Dysphagia: Difficulty in swallowing food or drinking water.
- Odynophagia: Pain while swallowing solid or liquids.
- Chest pain: Pain in central part of chest after the meals.
- Weight Loss: Prolonged disease can lead to weight loss and nutritional deficiency.
- Inability to swallow (dysphagia), which may feel like food or drink is stuck in your throat.
- Regurgitating food or saliva.
- Pneumonia (from aspiration of food into the lungs)
- Coughing at night
- Belching
Diagnosis of achalasia begins with a careful medical history focusing on the timing of symptoms and eliminating other medical conditions that may cause similar symptoms
- Upper GI endoscopy to rule out obstructing lesion.Endoscopy which is used to look directly into the esophagus can be normal in achalasia. However, endoscopy can detect tumors of the esophagus which can mimic achalasia.
- Barium swallow.Barium swallow is another useful investigation, during which patient swallows a solution containing barium. An X ray is performed, which confirms of achalasia cardia.
- Esophageal manometry is the test which can confirm the diagnosis of achalasia. In Manometry, a thin probe is passed through the esophagus to assess the peristalsis and lower esophageal sphincter relaxation during swallowing.
- High resolution oesophageal manometry is the best test to diagnose achalasia cardia. During HRM, a small catheter is passed through the nose into the esophagus. This catheter measures the pressure in the esophageal body and at lower esophageal sphincter. Relaxation of lower esophageal pressure is measured by a parameter called integrated relaxation pressure (IRP). High IRP and absent peristalsis are essential for the diagnosis of achalasia cardia.
Medical therapy has limited efficacy in the treatment for achalasia cardia.Endoscopic botulinum injection, balloon dilatation (Penumatic), and Lap Heller Myotomy (Surgery) has been the conventional treatment for Achalasia Cardia. In the recent time, POEM (per oral endoscopic myotomy) has emerged as new and effective treatment for achalasia cardia.
- POEM is an endoscopic treatment, during which very careful cutting of tight muscle fibres at GE junction is performed. For POEM procedure, patient is admitted for 24-48 hours. After POEM procedure, X ray is performed after 24 hours, and liquid diet is started.
- Endoscopic pneumatic balloon dilatation.
- Surgery- Lap Heller’s myotomy.
- Botulinum injection.
- Medical therapy such as calcium channel blockers have limited efficacy.
We at Max Superpeciality hospital are one of the few centers where manometry is being performed and we offer incisionless endoscopic surgery called POEM (Per oral endoscopic myotomy) for achalasia. POEM procedure for achalasia is a safe procedure offering excellent long-term results, also not requiring long hospital stay. After POEM procedure liquid diet is started.
At Max hospital Saket, our gastroenterology team with cumulative experience of more than 150,000 endoscopic procedures, is providing the cutting edge treatment for patients with coplex GI disorders. Our team, under the leadership of Dr Vikas Singla, has one of the highest experience for treatment of achalasia cardia. Team has already performed more than 400 cases of per oral endoscopy myotomy in patients of achalasia cardia with the excellent results.
- Smoking
- Alcohol
- Obesity
- Barrett’s esophagus
- Dysphagia- Difficulty in swallowing food or drinking liquids
- Weight loss
- Chest pain
- Upper GI endoscopy- A small tube is passed through the mouth, and biopsy is obtained. During endoscopy, if proper sedation is given, procedure becomes painless.
- CT scan for the spread in surrounding tissue
- Endoscopic Ultrasound to see the depth of the cancer
- PET scan for the distant metastasis
- Very early cancer: Endoscopic technique of ESD
- Locally advanced tumor: Surgery with or without chemoradiotherapy depending upon the stage of the tumor
- Cancer with distant metastasis: Metal stent is placed in the esophagus with the help of endoscopy. Stent helps in eating and drinking. This cane be followed by chemotherapy.
Cancer which is confined to inner layer of esophageal wall such as mucosa or submucosa are known as early esophageal cancer. Such tumors can be diagnosed by a new technique known as image enhanced endoscopy. Such tumor can be cured by a new technique known as endoscopic submucosal dissection (ESD). During ESD, whole tumor can be removed totally with the help of endoscopy avoiding the need of the surgery.
Esophagus cancer is an abnormal growth of cells of inner lining of Esophagus
- Smoking
- Alcohol
- Obesity
- Barrett’s esophagus
- Dysphagia- Difficulty in swallowing food or drinking liquids
- Weight loss
- Chest pain
- Upper GI endoscopy- A small tube is passed through the mouth, and biopsy is obtained. During endoscopy, if proper sedation is given, procedure becomes painless.
- CT scan for the spread in surrounding tissue
- Endoscopic Ultrasound to see the depth of the cancer
- PET scan for the distant metastasis
- Very early cancer: Endoscopic technique of ESD
- Locally advanced tumor: Surgery with or without chemoradiotherapy depending upon the stage of the tumor
- Cancer with distant metastasis: Metal stent is placed in the esophagus with the help of endoscopy. Stent helps in eating and drinking. This cane be followed by chemotherapy.
Cancer which is confined to inner layer of esophageal wall such as mucosa or submucosa are known as early esophageal cancer. Such tumors can be diagnosed by a new technique known as image enhanced endoscopy. Such tumor can be cured by a new technique known as endoscopic submucosal dissection (ESD). During ESD, whole tumor can be removed totally with the help of endoscopy avoiding the need of the surgery.
- Difficulty in swallowing foods
- Food bolus impaction
- Chest pain
- Upper GI endoscopy (Rings and furrows are seen) and biopsy
- Increased eosinophils in esophagus epithelium
- Proton pump inhibitors
- If symptoms persist- Elimination diet and topical steroids
- Difficulty in swallowing foods
- Food bolus impaction
- Chest pain
- Upper GI endoscopy (Rings and furrows are seen) and biopsy
- Increased eosinophils in esophagus epithelium
- Proton pump inhibitors
- If symptoms persist- Elimination diet and topical steroids
- Obesity
- Smoking
- Alcohol
- Pregnancy
- Caffeine
- Carbonated
- beverages (cola pH = 2.75)
- Chocolate
- Spicy food
- Persistent heartburn and acid regurgitation
- Belching
- Sour taste in the mouth
- Sensation of food being struck in throat
- Difficulty or pain when swallowing
- Chest pain
- Hoarseness of voice
- Chronic sore throat
- Dry cough
- Bad breath
- Erosion of tooth enamel
- Typical or atypical symptoms of GERD
- Upper GI endoscopy which can reveal ulcers or inflammation in lower esophagus
- Special endoscopy technique known as image enhanced endoscopy can reveal increase vascularity in lower esophagus
- 24 hour pH study: A thin catheter is placed through the nose in the esophagus. Sensors on the catheter monitor the upward movement of acid.
Complication of GERD
- Peptic stricture – Ring like stricture can form in lower esophagus. This can lead to difficulty in swallowing and food bolus impaction.
- Barrett’s esophagus: Lining epithelium of lower esophagus changes to intestinal epithelium. Barrett’s esophagus can predispose to dysplasia and esophageal cancer.
- Life style modification
- Avoiding certain food like citrus fruit, chocolate
- Raising head end of bed
- Small frequent meals
- Medications to reduce acid production and neutralize acid
- Surgical fundoplication
- Endoscopic tightening of GE junction
- GERD-X
- Anti reflux mucosectomy
- Anti reflux mucosal ablation
- Screening of dysplasia by endoscopy/biopsy/image enhanced endoscopy
- RFA/cryoablation of dysplasia in Barrett’s esophagus
- Endoscopic submucosal dissection for early esophageal cancer
- Surgery for advanced esophageal cancer
- Endoscopic dilatation of strictur
Achalasia Cardia is caused by impaired relaxation of lower oesophageal sphincter (LES). LES is a sphincter or valve between oesophagus and stomach. LES act as a one way valve, once the patient swallows food or drink water, allowing passage of food and water in the stomach. In between the meals, LES closes and prevent the upward movement of food or water.
Achalasia patients complain of difficulty in swallowing, sensation of food or getting stuck in the chest, chest pain (which can be sometimes mistaken for heart attack),regurgitation of food and weight loss. Achalasia symptoms generally appear gradually and worsen over time.
Signs and symptoms may include:
- Dysphagia: Difficulty in swallowing food or drinking water.
- Odynophagia: Pain while swallowing solid or liquids.
- Chest pain: Pain in central part of chest after the meals.
- Weight Loss: Prolonged disease can lead to weight loss and nutritional deficiency.
- Inability to swallow (dysphagia), which may feel like food or drink is stuck in your throat.
- Regurgitating food or saliva.
- Pneumonia (from aspiration of food into the lungs)
- Coughing at night
- Belching
Diagnosis of achalasia begins with a careful medical history focusing on the timing of symptoms and eliminating other medical conditions that may cause similar symptoms
- Upper GI endoscopy to rule out obstructing lesion.Endoscopy which is used to look directly into the esophagus can be normal in achalasia. However, endoscopy can detect tumors of the esophagus which can mimic achalasia.
- Barium swallow.Barium swallow is another useful investigation, during which patient swallows a solution containing barium. An X ray is performed, which confirms of achalasia cardia.
- Esophageal manometry is the test which can confirm the diagnosis of achalasia. In Manometry, a thin probe is passed through the esophagus to assess the peristalsis and lower esophageal sphincter relaxation during swallowing.
- High resolution oesophageal manometry is the best test to diagnose achalasia cardia. During HRM, a small catheter is passed through the nose into the esophagus. This catheter measures the pressure in the esophageal body and at lower esophageal sphincter. Relaxation of lower esophageal pressure is measured by a parameter called integrated relaxation pressure (IRP). High IRP and absent peristalsis are essential for the diagnosis of achalasia cardia.
Medical therapy has limited efficacy in the treatment for achalasia cardia.Endoscopic botulinum injection, balloon dilatation (Penumatic), and Lap Heller Myotomy (Surgery) has been the conventional treatment for Achalasia Cardia. In the recent time, POEM (per oral endoscopic myotomy) has emerged as new and effective treatment for achalasia cardia.
- POEM is an endoscopic treatment, during which very careful cutting of tight muscle fibres at GE junction is performed. For POEM procedure, patient is admitted for 24-48 hours. After POEM procedure, X ray is performed after 24 hours, and liquid diet is started.
- Endoscopic pneumatic balloon dilatation.
- Surgery- Lap Heller’s myotomy.
- Botulinum injection.
- Medical therapy such as calcium channel blockers have limited efficacy.
We at Max Superpeciality hospital are one of the few centers where manometry is being performed and we offer incisionless endoscopic surgery called POEM (Per oral endoscopic myotomy) for achalasia. POEM procedure for achalasia is a safe procedure offering excellent long-term results, also not requiring long hospital stay. After POEM procedure liquid diet is started.
At Max hospital Saket, our gastroenterology team with cumulative experience of more than 150,000 endoscopic procedures, is providing the cutting edge treatment for patients with coplex GI disorders. Our team, under the leadership of Dr Vikas Singla, has one of the highest experience for treatment of achalasia cardia. Team has already performed more than 400 cases of per oral endoscopy myotomy in patients of achalasia cardia with the excellent results.
Achalasia is a disease of oesophagus characterized by difficulty in swallowing food or drinking water.
Achalasia Cardia is caused by impaired relaxation of lower oesophageal sphincter (LES). LES is a sphincter or valve between oesophagus and stomach. LES act as a one way valve, once the patient swallows food or drink water, allowing passage of food and water in the stomach. In between the meals, LES closes and prevent the upward movement of food or water.
Achalasia patients complain of difficulty in swallowing, sensation of food or getting stuck in the chest, chest pain (which can be sometimes mistaken for heart attack),regurgitation of food and weight loss. Achalasia symptoms generally appear gradually and worsen over time.
Signs and symptoms may include:
- Dysphagia: Difficulty in swallowing food or drinking water.
- Odynophagia: Pain while swallowing solid or liquids.
- Chest pain: Pain in central part of chest after the meals.
- Weight Loss: Prolonged disease can lead to weight loss and nutritional deficiency.
- Inability to swallow (dysphagia), which may feel like food or drink is stuck in your throat.
- Regurgitating food or saliva.
- Pneumonia (from aspiration of food into the lungs)
- Coughing at night
- Belching
Diagnosis of achalasia begins with a careful medical history focusing on the timing of symptoms and eliminating other medical conditions that may cause similar symptoms
- Upper GI endoscopy to rule out obstructing lesion.Endoscopy which is used to look directly into the esophagus can be normal in achalasia. However, endoscopy can detect tumors of the esophagus which can mimic achalasia.
- Barium swallow.Barium swallow is another useful investigation, during which patient swallows a solution containing barium. An X ray is performed, which confirms of achalasia cardia.
- Esophageal manometry is the test which can confirm the diagnosis of achalasia. In Manometry, a thin probe is passed through the esophagus to assess the peristalsis and lower esophageal sphincter relaxation during swallowing.
- High resolution oesophageal manometry is the best test to diagnose achalasia cardia. During HRM, a small catheter is passed through the nose into the esophagus. This catheter measures the pressure in the esophageal body and at lower esophageal sphincter. Relaxation of lower esophageal pressure is measured by a parameter called integrated relaxation pressure (IRP). High IRP and absent peristalsis are essential for the diagnosis of achalasia cardia.
Medical therapy has limited efficacy in the treatment for achalasia cardia.Endoscopic botulinum injection, balloon dilatation (Penumatic), and Lap Heller Myotomy (Surgery) has been the conventional treatment for Achalasia Cardia. In the recent time, POEM (per oral endoscopic myotomy) has emerged as new and effective treatment for achalasia cardia.
- POEM is an endoscopic treatment, during which very careful cutting of tight muscle fibres at GE junction is performed. For POEM procedure, patient is admitted for 24-48 hours. After POEM procedure, X ray is performed after 24 hours, and liquid diet is started.
- Endoscopic pneumatic balloon dilatation.
- Surgery- Lap Heller’s myotomy.
- Botulinum injection.
- Medical therapy such as calcium channel blockers have limited efficacy.
We at Max Superpeciality hospital are one of the few centers where manometry is being performed and we offer incisionless endoscopic surgery called POEM (Per oral endoscopic myotomy) for achalasia. POEM procedure for achalasia is a safe procedure offering excellent long-term results, also not requiring long hospital stay. After POEM procedure liquid diet is started.
At Max hospital Saket, our gastroenterology team with cumulative experience of more than 150,000 endoscopic procedures, is providing the cutting edge treatment for patients with coplex GI disorders. Our team, under the leadership of Dr Vikas Singla, has one of the highest experience for treatment of achalasia cardia. Team has already performed more than 400 cases of per oral endoscopy myotomy in patients of achalasia cardia with the excellent results.
- Smoking
- Alcohol
- Obesity
- Barrett’s esophagus
- Dysphagia- Difficulty in swallowing food or drinking liquids
- Weight loss
- Chest pain
- Upper GI endoscopy- A small tube is passed through the mouth, and biopsy is obtained. During endoscopy, if proper sedation is given, procedure becomes painless.
- CT scan for the spread in surrounding tissue
- Endoscopic Ultrasound to see the depth of the cancer
- PET scan for the distant metastasis
- Very early cancer: Endoscopic technique of ESD
- Locally advanced tumor: Surgery with or without chemoradiotherapy depending upon the stage of the tumor
- Cancer with distant metastasis: Metal stent is placed in the esophagus with the help of endoscopy. Stent helps in eating and drinking. This cane be followed by chemotherapy.
Cancer which is confined to inner layer of esophageal wall such as mucosa or submucosa are known as early esophageal cancer. Such tumors can be diagnosed by a new technique known as image enhanced endoscopy. Such tumor can be cured by a new technique known as endoscopic submucosal dissection (ESD). During ESD, whole tumor can be removed totally with the help of endoscopy avoiding the need of the surgery.
Esophagus cancer is an abnormal growth of cells of inner lining of Esophagus
- Smoking
- Alcohol
- Obesity
- Barrett’s esophagus
- Dysphagia- Difficulty in swallowing food or drinking liquids
- Weight loss
- Chest pain
- Upper GI endoscopy- A small tube is passed through the mouth, and biopsy is obtained. During endoscopy, if proper sedation is given, procedure becomes painless.
- CT scan for the spread in surrounding tissue
- Endoscopic Ultrasound to see the depth of the cancer
- PET scan for the distant metastasis
- Very early cancer: Endoscopic technique of ESD
- Locally advanced tumor: Surgery with or without chemoradiotherapy depending upon the stage of the tumor
- Cancer with distant metastasis: Metal stent is placed in the esophagus with the help of endoscopy. Stent helps in eating and drinking. This cane be followed by chemotherapy.
Cancer which is confined to inner layer of esophageal wall such as mucosa or submucosa are known as early esophageal cancer. Such tumors can be diagnosed by a new technique known as image enhanced endoscopy. Such tumor can be cured by a new technique known as endoscopic submucosal dissection (ESD). During ESD, whole tumor can be removed totally with the help of endoscopy avoiding the need of the surgery.
- Difficulty in swallowing foods
- Food bolus impaction
- Chest pain
- Upper GI endoscopy (Rings and furrows are seen) and biopsy
- Increased eosinophils in esophagus epithelium
- Proton pump inhibitors
- If symptoms persist- Elimination diet and topical steroids
- Difficulty in swallowing foods
- Food bolus impaction
- Chest pain
- Upper GI endoscopy (Rings and furrows are seen) and biopsy
- Increased eosinophils in esophagus epithelium
- Proton pump inhibitors
- If symptoms persist- Elimination diet and topical steroids
- Obesity
- Smoking
- Alcohol
- Pregnancy
- Caffeine
- Carbonated
- beverages (cola pH = 2.75)
- Chocolate
- Spicy food
- Persistent heartburn and acid regurgitation
- Belching
- Sour taste in the mouth
- Sensation of food being struck in throat
- Difficulty or pain when swallowing
- Chest pain
- Hoarseness of voice
- Chronic sore throat
- Dry cough
- Bad breath
- Erosion of tooth enamel
- Typical or atypical symptoms of GERD
- Upper GI endoscopy which can reveal ulcers or inflammation in lower esophagus
- Special endoscopy technique known as image enhanced endoscopy can reveal increase vascularity in lower esophagus
- 24 hour pH study: A thin catheter is placed through the nose in the esophagus. Sensors on the catheter monitor the upward movement of acid.
Complication of GERD
- Peptic stricture – Ring like stricture can form in lower esophagus. This can lead to difficulty in swallowing and food bolus impaction.
- Barrett’s esophagus: Lining epithelium of lower esophagus changes to intestinal epithelium. Barrett’s esophagus can predispose to dysplasia and esophageal cancer.
- Life style modification
- Avoiding certain food like citrus fruit, chocolate
- Raising head end of bed
- Small frequent meals
- Medications to reduce acid production and neutralize acid
- Surgical fundoplication
- Endoscopic tightening of GE junction
- GERD-X
- Anti reflux mucosectomy
- Anti reflux mucosal ablation
- Screening of dysplasia by endoscopy/biopsy/image enhanced endoscopy
- RFA/cryoablation of dysplasia in Barrett’s esophagus
- Endoscopic submucosal dissection for early esophageal cancer
- Surgery for advanced esophageal cancer
- Endoscopic dilatation of strictur
