Upper gastrointestinal care: oesophagus, stomach, gallbladder, pancreas and liver conditions

The upper gastrointestinal tract runs from the mouth to the duodenum, and in clinical practice the field also includes the gallbladder, bile ducts, pancreas and liver, sometimes grouped as hepatopancreatobiliary disease. Problems range from common, self-limiting complaints such as indigestion to serious cancers and emergencies such as bleeding ulcers.

Several specialists are involved. Gastroenterologists are physicians who diagnose and manage digestive disease and perform endoscopy. Upper GI surgeons are general surgeons with specialist training in oesophageal and stomach surgery, and bariatric work in many centres, while hepatopancreatobiliary surgeons concentrate on liver, pancreas and bile duct surgery. Oncologists, radiologists, pathologists, dietitians and specialist nurses form multidisciplinary teams for cancer. The Association of Upper Gastrointestinal Surgeons (AUGIS) is the professional body, and has subcommittees covering oesophagogastric cancer, hepatopancreatobiliary disease, emergency surgery, bariatrics and endoscopy.

Complex cancer surgery is concentrated in high-volume centres, so a person may be referred beyond their local hospital for an operation while keeping local follow-up.

• Gastro-oesophageal reflux and hiatus hernia. The NHS says a hiatus hernia is when part of the stomach moves up into the chest, is very common over 50 and does not normally need treatment if it is not causing problems.

• Barrett's oesophagus, a change in the lining of the lower oesophagus linked with long-term reflux, which is monitored by endoscopy.

• Peptic ulcer disease, which the NHS describes as sores in the stomach or duodenum causing upper abdominal pain, often worse at night, indigestion and bloating.

• Swallowing disorders such as achalasia and dysphagia, which need assessment for causes including cancer.

• Oesophageal and stomach cancer, which are treated by multidisciplinary teams combining surgery with chemotherapy or radiotherapy.

• Gallstones and their complications, including biliary colic, cholecystitis, bile duct stones and pancreatitis.

• Pancreatic and liver disease, including pancreatic cancer, chronic pancreatitis and liver tumours.

• Obesity-related surgery in some departments, and emergency presentations such as bleeding ulcers and perforation.

Gastroscopy is the central test. The NHS says it is used to find the cause of digestive symptoms, treat problems such as widening the food pipe or stopping bleeding, and check for cancers. You stop eating at least 6 hours beforehand, are offered throat spray or sedation, and a thin flexible tube is passed through the mouth. The test takes 15 to 45 minutes, a biopsy may be taken, and if you have sedation you need someone to take you home and stay with you for 24 hours.

Many conditions are treated with medicines and lifestyle change. For hiatus hernia the NHS suggests smaller meals, raising the head of the bed, weight loss and avoiding smoking, with antacids or stronger acid-suppressing medicines if needed, and tests and sometimes surgery if these fail. Stomach ulcers are treated by removing causes, such as eradicating H pylori with antibiotics and stopping or changing anti-inflammatory painkillers, alongside acid suppression.

Surgery includes keyhole cholecystectomy for symptomatic gallstones, anti-reflux and hiatus hernia repair, oesophagectomy and gastrectomy for cancer, pancreatic and liver resections, and bariatric operations such as sleeve gastrectomy. The NHS says oesophageal cancer surgery removes part, or in a few people most, of the oesophagus and sometimes other nearby tissue, and may be combined with chemotherapy before or after surgery. Recovery from major operations takes weeks to months, with dietary adaptation and specialist nutritional support.

Endoscopic treatments, including dilation, stents, banding, clips for bleeding and removal of early cancers, can avoid open surgery in selected cases.

On the NHS, most upper GI symptoms are first assessed by a GP, who may treat for indigestion, test for H pylori or refer for gastroscopy. Suspected cancer pathways give priority to people with alarm features such as difficulty swallowing, weight loss or persistent vomiting. The NHS advises asking for an urgent GP appointment or contacting NHS 111 for ulcer symptoms with weight loss, difficulty swallowing or persistent vomiting, and calling 999 for vomiting blood or black stools.

Privately, a person can usually see a gastroenterologist or upper GI surgeon directly and have a gastroscopy within days. Ask about the specialist's experience with your condition, whether the quoted price includes biopsies, histology and sedation, and who will manage complications or cancer treatment if something serious is found, because major cancer surgery is often done in specialist NHS centres.

• What do you think is causing my symptoms, and what tests are needed to confirm it?

• What does gastroscopy involve, and do I need sedation and someone to accompany me?

• If treatment is suggested, what are the alternatives, including doing nothing or waiting?

• How will diet and eating change after any operation, and who will support me?

• What follow-up or surveillance is needed afterwards?

• Call 999 or go to A&E for vomiting bright red blood or coffee-ground material, black sticky stools, severe abdominal pain or a rigid tender abdomen, or sudden severe pain spreading to the back with vomiting or yellow skin, as the NHS advises.