General surgeons treat stomach ulcers (sometimes called duodenal ulcers), stomach cancer (also called gastric cancer), gastro-esophageal reflux disease also known as GERD), and stomach tumors.

How are these diseases diagnosed?

Patients with diseases of the stomach often first present to their doctor with complaints like nausea, abdominal pains, and heartburn. There are many tests that can be done to diagnose diseases of the stomach. These include:

-Upper GI: a radiological test that is used to visualize the structures of the upper digestive system - the esophagus, stomach and duodenum. If it is desired to see the remaining parts of the small intestine, a small bowel series can be added to the test. These structures are seen during the examination, and the images are also are saved for further review on X-ray film or digital images.

-Barium Swallow/Esophagram: a test that may be used to determine the cause of painful swallowing, difficulty with swallowing, abdominal pain, bloodstained vomit, severe heartburn, or unexplained weight loss.

Barium sulfate is a metallic compound that shows up on x-ray and is used to help see abnormalities in the esophagus and stomach. When taking the test, you drink a preparation containing this solution. The x-rays track its path through your digestive system.

-Endoscopy: a minimally invasive diagnostic medical procedure that is used to assess the interior surfaces of the esophagus and stomach by inserting a tube into the body. The instrument usually has a flexible tube and provides an image for visual inspection and photography. It also enables the physician to take biopsies and retrieve foreign objects.

-Esophageal Manometry: a test that provides information regarding the muscle function of the upper and lower esophageal sphincters as well as peristalsis, or movement of food bolus. The test is also used to measure the pressure inside the lower part of the esophagus. During manometry testing, a thin, pressure-sensitive tube is passed through your mouth or nose and into your stomach. Once in place, the tube is pulled slowly back into the esophagus. When the tube is in the esophagus, you will be asked to swallow. The pressure of the muscle contractions will be measured along several sections of the tube.

-24 Hour PH: measures acid exposure in the esophagus over a 24-hour period. This test can accurately measure whether or not gastroesophageal reflux disease (GERD) is present. The test utilizes an ambulatory recorder, where a 2 mm thin probe is placed through the nose into the esophagus, which is then hooked up to a portable device that is the size of a Walkman tape player. The patient then goes home with the device and wears it continuously for 24 hours. The pH signals are continuously recorded by the box. The next day, the physician downloads the data onto a computer and analyzes it. The doctor then can correlate the symptoms and assess how much acid has refluxed over the 24-hour period

How are these diseases treated?

Perforated duodenal ulcers are surgical emergency and require surgical repair of the perforation. Erosion of the gastro-intestinal wall by the ulcer leads to spillage of stomach or intestinal content into the abdominal cavity. Perforation at the anterior (front) surface of the stomach leads to acute peritonitis (a type of infection), initially chemical and later bacterial peritonitis. The first sign is often sudden intense abdominal pain. Posterior wall perforation leads to pancreatitis (inflammation of the pancreas); pain in this situation often radiates to the back. The Graham Patch procedure is the name of the surgery that is used to close up perforated duodenal ulcers. In this procedure, a piece of the patient's omentum is used to cover the perforation.

Stomach cancer is usually treated by a surgical resection. The extent of this resection is usually determined by the size and extent of the cancer. Gastrectomy is the most common treatment for stomach cancer. In this surgery, the entire stomach (total gastrectomy) or part of the stomach (partial or subtotal gastrectomy) is removed. Following a total gastrectomy, the esophagus is attached directly to the small intestine. Parts of nearby tissues or organs (e.g., the spleen) may also be removed if the cancer has spread. In many cases, surrounding lymph nodes also are removed (lymph node dissection). Surgery for cancer of the upper part of the stomach (the cardia) may require removal of the stomach and part of the esophagus (called esophagogastrectomy).

Gastro-esophageal reflux disease (GERD) is usually treated by a procedure called a Nissen Fundoplication. The surgery is sometimes preferred over the long term use of medications to control GERD symptoms. In a fundoplication, the gastric fundus (upper part) of the stomach is wrapped, or plicated, around the lower part of the esophagus and then stitched in place, reinforcing the closing function of the lower esophageal sphincter: Whenever the stomach contracts, it also closes off the esophagus instead of squeezing stomach acids into it. This prevents the reflux of gastric acid (in GERD). This surgery is usually performed laparoscopically.

Gastric tumors, like gastric cancers, are usually treated by surgical excision. Usually, the extent of the surgery is determined by the size and location of the tumor. Sometimes, very small tumors are able to undergo primary excision, in which only the tumor is removed from the stomach wall. Larger tumors may necessitate partial or total gastrectomy. In some cases, laparoscopic surgery is possible.