Esophagitis

Esophagitis is an inflammation and swelling of the esophagus. It is most often caused by acid-containing stomach contents refluxing back up into the esophagus. The most significant cause of acid reflux is gastroesophageal reflux disease. Other causes of reflux are hernias, vomiting, medications and surgery.
Esophagitis can be caused by other conditions also. These include an infection that can develop in individuals with weakened immune systems, such as caused by HIV or certain medications such as corticosteroids. The infection can be caused by viruses, including herpes and cytomegalovirus, and fungi or yeast, especially Candida infections.
Whether the condition is caused by the irritation from reflux of stomach contents or by infection, in either case the tissues of the esophagus become inflamed.

Hiatal Hernia

Hernias occur when one part of the body protrudes through a gap or opening into another part. And although a hernia can theoretically develop almost anywhere, most are in the abdominal area. This includes hiatal hernias — also known as diaphragmatic hernias — which form at the opening in your diaphragm where your food pipe joins your stomach.
Most small hiatal hernias don't cause any problems, and you may never know you have a hiatal hernia unless your doctor discovers it when checking for another condition. But a large hiatal hernia can allow food and acid to back up into your esophagus, leading to heartburn and chest pain. Self-care measures or medications can usually alleviate these symptoms, although very large hiatal hernias sometimes need surgical repair.
Most small hiatal hernias cause no problems. But larger hernias may cause heartburn, belching or chest pain when stomach acids back up into your food pipe (esophagus). These signs and symptoms tend to become worse when you lean forward, strain, lift heavy objects or lie down, and they can also worsen during pregnancy.
In rare cases, the part of your stomach that protrudes into your chest cavity may become twisted (strangulated) or have its blood supply cut off, leading to:
Severe chest pain
Difficulty swallowing (dysphagia)
Obstruction of your esophagus
Your chest cavity and abdomen are separated by your diaphragm — a large dome-shaped muscle that's responsible for a good part of normal breathing. Your esophagus passes into your stomach through an opening in the diaphragm. Hiatal hernias occur when the muscle tissue surrounding this opening becomes weak and the upper part of your stomach bulges through the diaphragm into your chest cavity. Anything that puts intense pressure on your abdomen — including persistent or severe coughing or vomiting, pregnancy, straining while going to the bathroom, or lifting heavy objects — can contribute to hiatal hernias.
A hiatal hernia in turn can cause or contribute to gastroesophageal reflux. This happens when a hernia slightly displaces the lower esophageal sphincter, a circular band of muscle around the bottom of the esophagus.
Ordinarily, the diaphragm is aligned with the lower esophageal sphincter, which relaxes to allow food and liquid to flow into your stomach when you swallow. The diaphragm supports and puts pressure on the sphincter to keep it closed when you're not swallowing. But a hiatal hernia raises the sphincter above the diaphragm, reducing pressure on the valve. This causes the sphincter muscle to open at the wrong time, allowing stomach acid to flow up into the esophagus.
A hiatal hernia can also cause heartburn if the herniated portion of your stomach becomes a reservoir for gastric acid, which can then easily travel up your esophagus.

Gastroscopy

What is gastroscopy?
Gastroscopy is an examination of the inside of the gullet, stomach and duodenum. It is performed by using a thin, flexible fibre-optic instrument that is passed through the mouth and allows the doctor to see whether there is any damage to the lining of the oesophagus (gullet) or stomach, and whether there are any ulcers in the stomach or duodenum.
The GP will decide when drug treatment alone is sufficient or whether an investigation by gastroscopy at the local hospital is necessary. The procedure is painless and is usually done under a light sedative as a day-case patient in a specialised endoscopy unit. Occasionally, after a discussion with the endoscopist, the procedure will be performed without sedation. When sedation is used, the patient will not be able to drive or operate machinery for the rest of the day. Anyone suffering from stomach problems should consult a doctor who will, in most cases, treat the symptoms without a major examination.

How is a gastroscopy performed?
After explaining the procedure, the endoscopist will spray the back of the throat with a local anaesthetic. This is similar to the anaesthetic used by dentists. It numbs the throat and may make it difficult to swallow. When sedation is used, it is not a full anaesthetic and the patient will still be conscious and aware. A nurse will lie the patient on their left side and the endoscopist will then gently place the end of the instrument into the mouth and ask the patient to swallow it, which feels like swallowing a large piece of food.The endoscopist may need to put some air into the stomach to perform the examination effectively and this can cause discomfort or even a need to belch. This is perfectly normal. The endoscopist will closely examine the lining of the gullet, stomach and duodenum to identify the cause of the symptoms. It will take about 10 to 15 minutes.

Why is gastroscopy useful?
The doctor can study the mucous membrane of the stomach from the top to the bottom, and see irritation, wounds, or tumours. Gastroscopy is effective, and has now replaced the use of X-rays in many cases. It helps the doctor see any abnormalities in the gullet, the stomach and the duodenum. It is precise and safe.
Through the gastroscope, the doctor can take samples or photographs of the mucous membrane. The most modern gastroscopes can also show the areas in the stomach on a TV screen, so that the mucous membrane can be studied thoroughly. This can be recorded on a videotape, and used for later comparison. Patients are often given a gastroscopic examination because of their indigestion symptoms, which can usually be treated with tablets. Occasionally, the cause of indigestion is an ulcer and it is now known that many ulcers are due to bacterial infection in the stomach. A biopsy (a small piece of the lining of the stomach) may be removed during an endoscopy and examined under the microscope in the laboratory to pinpoint an infection. A very small number of patients with indigestion will turn out to have cancer and, again, the diagnosis can be made accurately by biopsy. Further investigation can then be planned to ensure the most effective treatment.

Can gastroscopy be used to examine other parts of the body?
On the way down towards the stomach, gastroscopy can also be used to examine the mucous membrane of the gullet - there are several diseases with symptoms that are easily mistaken for diseases in the stomach. If this examination is performed independently it is called oesophagoscopy, after oesophagus, the medical name for the gullet.

How far can a gastroscope see?
A gastroscope can only examine the lining of the oesophagus (gullet) stomach and duodenum. It will detect conditions in those organs that are causing symptoms but will not, for example, detect gallstones or pancreatic disease.

Are there other uses for gastroscopy?

An increasing use for gastroscopy is to obtain biopsies from the top of the small bowel, mainly to rule out a condition called coeliac disease. This is usually arranged at a hospital clinic but in some areas the test may be available to local doctors.

Why doesn't my doctor just send me for an X-ray?
This is a good point. Barium meals were used for many years for the diagnosis of indigestion symptoms. However, the small disadvantages of gastroscopy - special units, day-case admission and the need for sedation - are far outweighed by the increased accuracy of diagnosis and the ability to take biopsies at gastroscopy. As a result relatively few barium meals are performed nowadays. Is gastroscopy safe? All procedures carry some risk but outpatient diagnostic gastroscopy is very safe. Minor complications are uncommon and major complications are very rare.

Gastritis

Gastritis isn't one disease but a group of conditions, all of which are characterized by inflammation of the lining of your stomach. Commonly, the inflammation results from infection with the same bacterium that causes most stomach ulcers. Yet other factors — including traumatic injury and regular use of certain pain relievers — also can contribute to gastritis.
In spite of the many conditions associated with gastritis, the signs and symptoms of the disease are very similar: A burning pain in your upper abdomen and occasionally, bloating, belching, nausea or vomiting.
In some cases, gastritis can lead to ulcers and an increased risk of stomach cancer. For most people, however, gastritis isn't serious and improves quickly with treatment.


The signs and symptoms of gastritis, which are often relatively mild and short-lived, include:
A gnawing or burning ache or pain (indigestion) in your upper abdomen that may become either worse or better when you eat
Nausea
Vomiting
Loss of appetite
Belching or bloating
A feeling of fullness in your upper abdomen after eating
Weight loss
Gastritis that occurs suddenly (acute gastritis) usually results in the classic combination of nausea and burning pain or discomfort in your upper abdomen, whereas chronic gastritis, which develops gradually, is more likely to cause a dull pain and a feeling of fullness or loss of appetite after a few bites of food. For many people, though, chronic gastritis causes no problems at all.
Occasionally, gastritis may cause stomach bleeding, but it's rarely severe unless there's also ulceration of your stomach lining. Bleeding in your stomach can cause you to vomit blood or pass black, tarry stools and may require immediate medical care.
Because gastritis is one of many common digestive problems with similar signs and symptoms, it's easy to confuse with other conditions, including:


Gastroenteritis. Also called stomach flu, gastroenteritis usually results from a viral infection of your intestines. Signs and symptoms include diarrhea, abdominal cramps, and nausea or vomiting, as well as indigestion. Symptoms of gastroenteritis often resolve within a day or two, whereas the discomfort of gastritis may be ongoing.

Heartburn. This painful, burning sensation behind your breastbone usually occurs after a meal. It develops when stomach acid backs up into your esophagus, the tube that connects your throat to your stomach. Heartburn can also lead to a sour taste and the sensation of partially digested food re-entering your mouth.

Stomach ulcers. If a gnawing or burning pain in your stomach is persistent and severe, you may have an ulcer. Stomach (peptic) ulcers are open sores that develop on the inside lining of the stomach. The most prominent symptom is pain, which is frequently worse at night or when your stomach is empty. Gastritis and stomach ulcers share some of the same causes — especially H. pylori infection — and the one may be a precursor to the other.

Nonulcer dyspepsia. Commonly referred to as indigestion, nonulcer dyspepsia is a functional disorder and not necessarily related to a particular disease. The exact cause isn't known, but stress and overindulging in fried, spicy or fatty foods can aggravate or trigger the upper abdominal pain, bloating, belching and nausea that characterize the condition.

Causes
Your stomach — a hollow, muscular sac — sits in the upper left corner of your abdomen, just under your rib cage. The typical adult stomach is around 10 inches long and can expand to hold about 1 gallon of food and liquid. When your stomach is empty, its tissues fold in on themselves, a bit like a closed accordion. As your stomach fills and expands, the folds gradually disappear.
Your stomach processes and stores food, which it gradually releases into your small intestine. When food arrives from your esophagus, a muscular ring at the joining of your esophagus and stomach (lower esophageal sphincter) relaxes to let it in. Your stomach walls, lined with layers of powerful muscles, then begin churning the food, mixing it into smaller and smaller pieces. At the same time, glands in the wall of your stomach pump out gastric juices — including enzymes and stomach acids — that help break food down further.
One of these, hydrochloric acid, is so caustic that it can dissolve iron nails. Your stomach's tissues are protected from this corrosive acid by the mucous-bicarbonate barrier — a layered buffering system in which bicarbonate regulates the stomach's acid-alkaline balance, and mucous provides a thick, sticky coating for the stomach walls.