Upper GI & Esophageal Care
Stomach & Esophagus Conditions
Gold-standard diagnostic protocols (HD Narrow Band Endoscopy, 24-Hour pH Impedance, High-Res Manometry) and incisionless POEM surgery for acid reflux, ulcers, swallowing disorders, and tumors by Dr. Ankita Gupta in Greater Kailash, Delhi.
POEM ProtocolIncisionless Achalasia Relief
24-Hr pH StudyExact Reflux Quantification
HD NBI SuiteJapanese Micro-Vascular View
15 MinsPainless Sedation Endoscopy
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GERD & Chronic Acid Reflux
Gastroesophageal Reflux Disease (GERD) occurs when stomach acid, bile, and gastric juices chronically flow backward into the esophagus due to a transiently relaxed lower esophageal sphincter (LES) or hiatal hernia.
Symptoms & Warning Signs
- Persistent burning pain in chest (heartburn), often worsening after lying down
- Sour, bitter fluid regurgitation into the back of throat or mouth
- Chronic unexplained dry cough, sore throat, or hoarseness in the morning
- Pain or sensation of a lump in the throat (globus sensation)
Diagnostic Evaluations
- Upper GI Endoscopy with Japanese Narrow Band Imaging (NBI) to evaluate esophagitis
- 24-Hour Impedance-pH Monitoring (Gold Standard for acid exposure quantification)
- High-Resolution Esophageal Manometry to test LES valve pressure
- Barium swallow study if anatomical hiatal hernia is suspected
Treatment & Management
- Optimized PPI & Potassium-Competitive Acid Blocker (P-CAB) therapy
- Circadian diet timing (stopping meals 3 hours before sleep, elevating head)
- Weight management protocols to reduce intra-abdominal gastric pressure
- Endoscopic or laparoscopic anti-reflux surgical evaluation for refractory cases
Protocol curated by Dr. Ankita Gupta (DM Gastroenterology, Gold Medalist)
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H. Pylori Infection & Peptic Ulcer Disease
Helicobacter pylori is a spiral-shaped bacterium that colonizes the stomach lining, neutralizing stomach acid and producing toxins that break down protective mucus, leading to gastric and duodenal ulcers.
Symptoms & Warning Signs
- Gnawing, burning stomach pain between meals or in the middle of the night
- Pain that temporarily improves after eating or taking antacids, but returns
- Early fullness, bloating, frequent burping, and mild nausea
- Alarm signs: Black tarry stools, vomiting coffee-ground material, severe anemia
Diagnostic Evaluations
- Rapid Urease Test (RUT) on endoscopic mucosal biopsy sample
- 13C Urea Breath Test (non-invasive, high diagnostic sensitivity)
- Endoscopic inspection to assess ulcer depth, bleeding risk, and rule out malignancy
- Stool antigen testing for post-treatment eradication confirmation
Treatment & Management
- Targeted 14-day 1st-line Quadruple or Triple Eradication antibiotic regimen
- High-dose acid suppression to allow mucosal healing of ulcer crater
- Endoscopic hemoclip application or APC if ulcer has active visible vessels
- Follow-up breath testing 4 weeks post-treatment to verify complete eradication
Protocol curated by Dr. Ankita Gupta (DM Gastroenterology, Gold Medalist)
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Achalasia Cardia & Motility Spasms
Achalasia is a rare neurodegenerative esophageal motility disorder where the nerves controlling esophageal peristalsis are lost, preventing the lower esophageal sphincter from relaxing during swallowing.
Symptoms & Warning Signs
- Progressive difficulty swallowing both solids and liquids (dysphagia)
- Regurgitation of undigested, non-acidic food eaten hours earlier
- Substernal chest pain mimicking cardiac angina
- Nocturnal coughing, choking episodes, and unexplained weight loss
Diagnostic Evaluations
- High-Resolution Esophageal Manometry (Chicago Classification v4.0)
- Barium Swallow showing classical 'bird-beak' tapering at gastroesophageal junction
- UGI Endoscopy to rule out pseudoachalasia caused by gastric tumors
Treatment & Management
- Peroral Endoscopic Myotomy (POEM) - scarless, incision-free endoscopic division of tight muscle
- Pneumatic balloon dilatation of lower esophageal sphincter
- Botulinum toxin (Botox) endoscopic injection for elderly or high-risk patients
- Permanent restoration of comfortable eating and swallowing
Protocol curated by Dr. Ankita Gupta (DM Gastroenterology, Gold Medalist)
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Gastric Cancer & Pre-Malignant Polyps
Stomach cancer often develops silently from chronic atrophic gastritis, intestinal metaplasia, or gastric adenomas. Early screening with magnification endoscopy catches precancerous lesions when they are 100% curable.
Symptoms & Warning Signs
- Persistent upper abdominal discomfort, bloating, or indigestion after small meals
- Unintentional significant weight loss and progressive loss of appetite
- Chronic iron deficiency anemia from silent microscopic mucosal oozing
- Vomiting after meals or feeling early satiety (inability to finish normal portion)
Diagnostic Evaluations
- High-Definition Narrow Band Imaging (NBI) with dual-focus zoom
- Targeted multipoint biopsies of abnormal mucosa or polyps
- Endoscopic Ultrasound (EUS) to determine tumor depth (T-staging)
- Contrast CECT Abdomen and PET-CT for systemic staging
Treatment & Management
- Endoscopic Mucosal Resection (EMR) or Submucosal Dissection (ESD) for early superficial tumors
- Complete avoidance of open stomach surgery when caught at stage 0/1
- Multidisciplinary oncological surgery and adjuvant chemotherapy for advanced stages
- Strict surveillance protocols for high-risk family members
Protocol curated by Dr. Ankita Gupta (DM Gastroenterology, Gold Medalist)
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Esophageal Strictures & Webs
Narrowing of the esophagus can result from long-standing acid reflux scarring (peptic stricture), corrosive ingestion, radiation therapy, or congenital rings (Schatzki ring) and webs.
Symptoms & Warning Signs
- Sensation of solid foods getting stuck midway behind breastbone (dysphagia)
- Having to drink excess water to force food downward
- Painful swallowing (odynophagia)
- Avoidance of solid foods leading to progressive nutritional decline
Diagnostic Evaluations
- Diagnostic UGI Endoscopy to visualize lumen diameter and exclude malignancy
- Barium swallow fluoroscopy mapping the length and caliber of stricture
- Mucosal biopsy to rule out eosinophilic esophagitis or carcinoma
Treatment & Management
- Controlled Radial Expansion (CRE) balloon dilatation under light sedation
- Savary-Gilliard wire-guided dilators for tight or tortuous strictures
- Temporary self-expanding metallic stent (SEMS) placement for refractory narrowing
- Intralesional steroid injection to prevent recurrent scar formation
Protocol curated by Dr. Ankita Gupta (DM Gastroenterology, Gold Medalist)
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GIST & Gastric Lymphoma
Gastrointestinal Stromal Tumors (GIST) and gastric MALT lymphomas originate in the deeper muscular and lymphoid layers of the stomach wall, requiring specialized endoscopic ultrasound to differentiate from ordinary polyps.
Symptoms & Warning Signs
- Often discovered incidentally during routine endoscopy for acidity
- Vague upper abdominal fullness or palpable mass
- Occasional gastrointestinal bleeding presenting as anemia or melena
- Early satiety and post-prandial heaviness
Diagnostic Evaluations
- Endoscopic Ultrasound (EUS) identifying exact muscular layer origin
- EUS-guided Fine Needle Biopsy (EUS-FNB) for immunohistochemistry (CD117 / DOG-1 / Ki-67)
- H. pylori testing (critical, as early gastric MALT lymphoma often resolves with H. pylori cure)
- Multiphasic CT abdomen to assess vascularity and tumor margin
Treatment & Management
- Targeted oral tyrosine kinase inhibitors (Imatinib) for GIST
- Endoscopic full-thickness resection (EFTR) or laparoscopic wedge resection
- H. pylori eradication therapy for low-grade gastric MALT lymphoma
- Long-term surveillance protocols with serial endoscopic ultrasound
Protocol curated by Dr. Ankita Gupta (DM Gastroenterology, Gold Medalist)