Persistent heartburn, dysphagia and unexplained bleeding should not be ignored. Although these symptoms do not always indicate a serious disease, they may arise from conditions affecting the oesophagus, stomach or first part of the small intestine. A gastroscopy allows a gastroenterologist to examine these areas directly, take biopsies when necessary and, in selected cases, provide treatment during the same procedure.

A gastroscopy is also called an upper gastrointestinal endoscopy or oesophagogastroduodenoscopy. It uses a thin, flexible instrument called an endoscope, which has a light and camera at its tip. The endoscope passes through the mouth, down the oesophagus and into the stomach and duodenum. Images are displayed on a monitor, allowing the specialist to assess the lining of the upper digestive tract in detail.

A gastroscopy examines the oesophagus, stomach and duodenum.

When might a gastroscopy be recommended?

A gastroscopy is not required for every episode of indigestion or stomach discomfort. Short-lived symptoms often improve with simple treatment or lifestyle changes. However, further investigation may be appropriate when symptoms persist, recur, worsen, fail to respond to treatment or occur with warning signs.

The decision is based on the patient’s age, medical history, medicines, family history, examination and test results. A specialist may recommend gastroscopy for one or more of the following concerns.

Persistent heartburn or acid reflux

Occasional reflux is common, but frequent or persistent symptoms may require investigation, particularly when medication does not provide adequate relief. Gastroscopy can identify inflammation caused by reflux, ulceration, narrowing of the oesophagus or changes associated with Barrett’s oesophagus.

Barrett’s oesophagus occurs when long-term acid exposure changes the cells lining the lower oesophagus. It does not mean that cancer is present, but it may require biopsy and follow-up because it is associated with an increased risk of oesophageal cancer. GI Doc explains in more detail when acid reflux may warrant a gastroscopy.

Gastroscopy can assess reflux-related inflammation and Barrett’s oesophagus.

Difficulty or pain when swallowing

The sensation that food sticks in the chest, swallowing that becomes progressively more difficult, or pain when swallowing needs medical assessment. These symptoms may be caused by inflammation, scarring, a stricture, an abnormal ring, eosinophilic oesophagitis, a motility disorder or, less commonly, a tumour.

Gastroscopy helps the specialist see whether a physical narrowing or abnormal area is present. Biopsies may be taken even when the lining looks relatively normal, because conditions such as eosinophilic oesophagitis can require microscopic confirmation. In suitable cases, a narrowed area may be treated with endoscopic dilatation.

A narrowed oesophagus may contribute to difficulty swallowing.

Persistent upper abdominal pain or indigestion

Ongoing discomfort in the upper abdomen, recurrent indigestion, early fullness after eating or unexplained bloating may be linked to gastritis, peptic ulcer disease, infection or other upper digestive conditions. Symptoms alone cannot reliably distinguish one cause from another.

Gastroscopy gives a direct view of the stomach and duodenal lining. It can identify ulcers, erosions, inflammation and structural abnormalities such as a hiatus hernia. It is important to understand that some people with these symptoms have a normal gastroscopy. A normal examination is still useful because it helps exclude visible disease and guides the next stage of evaluation.

Recurrent nausea or vomiting

Persistent or unexplained nausea and vomiting may justify gastroscopy, especially when accompanied by weight loss, dehydration, pain, anaemia or difficulty eating. The procedure may detect inflammation, ulceration, narrowing or an obstruction at the stomach outlet. Other causes, including medication effects, metabolic disorders and delayed stomach emptying, may need different tests.

Signs of upper gastrointestinal bleeding

Vomiting fresh blood, vomiting material that resembles coffee grounds, or passing black, tar-like stool may indicate bleeding from the oesophagus, stomach or duodenum. These symptoms require prompt medical assessment. A gastroscopy can identify causes such as a bleeding ulcer, severe inflammation, a tear, enlarged veins called varices, or an abnormal growth.

Gastroscopy can be both diagnostic and therapeutic. Depending on the finding, a gastroenterologist may inject medication, apply a haemostatic clip or use another endoscopic technique to control bleeding. GI Doc offers both diagnostic and therapeutic gastroscopy and endoscopy procedures.

Gastroscopy can identify ulcers and sources of upper gastrointestinal bleeding.

Iron deficiency anaemia

Iron deficiency anaemia can result from gradual blood loss that is not visible. When diet, menstrual loss and other common causes do not fully explain the problem, the digestive tract may need investigation. Gastroscopy may identify ulcers, inflammation, vascular lesions, coeliac disease or an upper digestive tumour. Depending on the patient’s age and circumstances, colonoscopy or small-bowel tests may also be recommended.

Unexplained weight loss or loss of appetite

Unintentional weight loss, reduced appetite, early satiety or progressive symptoms deserve medical attention. These features do not automatically mean cancer, but they are considered warning symptoms because they may occur with significant inflammation, ulcer disease, obstruction or malignancy. Direct examination and biopsy can help establish or exclude important causes.

Abnormal imaging or follow-up of a known condition

Gastroscopy may be advised after an abnormality is seen on a scan or contrast study. It may also be used to monitor a known condition, assess healing after treatment, investigate recurrent symptoms or follow a previously identified abnormality. The timing depends on the condition and the person’s individual risk.

What conditions can a gastroscopy diagnose?

According to the National Institute of Diabetes and Digestive and Kidney Diseases, upper GI endoscopy can help identify conditions affecting the oesophagus, stomach and duodenum. Findings may include:

• Gastro-oesophageal reflux disease and reflux oesophagitis
• Barrett’s oesophagus
• Gastritis and duodenitis
• Gastric or duodenal ulcers
• Hiatus hernia
• Oesophageal strictures, rings or other narrowing
• Eosinophilic oesophagitis
• Coeliac disease, when confirmed by duodenal biopsies
• Helicobacter pylori-associated gastritis
• Oesophageal or gastric varices
• Benign polyps and other abnormal growths
• Oesophageal, stomach or upper duodenal cancer

Not every condition is visible to the naked eye. This is why biopsy can be an important part of the examination.

Why are biopsies taken?

A biopsy is a tiny sample of tissue collected through the endoscope. Patients do not usually feel the tissue being taken. The sample is examined by a pathologist under a microscope.

Biopsies may be used to test for Helicobacter pylori, confirm coeliac disease, diagnose eosinophilic oesophagitis, evaluate inflammation, assess Barrett’s oesophagus or determine whether abnormal cells are benign, precancerous or cancerous. A biopsy does not necessarily mean that cancer is suspected; it is a routine diagnostic tool in many upper digestive conditions.

Small tissue samples can be collected for microscopic analysis.

What happens before and during the procedure?

Patients receive specific preparation instructions from their doctor. Fasting is necessary so the stomach is empty and the lining can be seen clearly. The Mayo Clinic’s upper endoscopy guidance also emphasises discussing medicines beforehand, especially blood thinners, diabetes treatment, iron supplements and anti-inflammatory pain medicines. Patients should not stop prescribed medication unless instructed by their healthcare professional.

Before the procedure, the team reviews the patient’s medical history, allergies and consent. A throat-numbing spray and/or sedation may be used. The patient lies on their side while the endoscope is gently passed through the mouth. It does not block breathing. The procedure itself is usually brief, although extra time may be needed if biopsies or treatment are performed.

Dr Deetlefs’ guide to what happens during a gastroscopy provides additional practical information for patients.

Afterwards, temporary bloating, mild nausea or a sore throat may occur. If sedation was given, the patient needs someone to take them home and must follow the practice’s restrictions on driving, alcohol, work and important decisions. Some findings may be discussed immediately, while biopsy results take longer.

Is gastroscopy safe?

Gastroscopy is generally considered a safe procedure. Complications are uncommon, but can include a reaction to sedation, bleeding, infection or a tear in the digestive tract. The risk may be higher when treatment is performed than when the procedure is purely diagnostic.

The NHS gastroscopy guidance advises urgent medical attention after the procedure for worsening chest or abdominal pain, breathing difficulty, fever, vomiting blood, black stool, or swallowing problems that are severe or getting worse. Patients should use the emergency contact instructions supplied by their treating facility.

Gastroscopy does not diagnose every digestive problem

Gastroscopy examines the lining of the upper digestive tract, but it does not assess the entire small bowel or colon. It also cannot by itself diagnose every functional, motility, pancreatic, gallbladder or liver disorder. Blood tests, ultrasound, CT or MRI, colonoscopy, capsule endoscopy, pH monitoring or other investigations may be more appropriate in some situations.

The aim is not simply to “have a scope,” but to select the investigation most likely to answer the clinical question. A gastroenterology consultation allows symptoms, risk factors and previous results to be considered together before a procedure is planned.

Conclusion

A gastroscopy may be recommended when upper digestive symptoms are persistent, progressive or associated with warning signs such as difficulty swallowing, gastrointestinal bleeding, iron deficiency anaemia, repeated vomiting or unexplained weight loss. It can diagnose inflammation, ulcers, narrowing, Barrett’s oesophagus, coeliac disease and abnormal growths, while biopsy provides information that cannot always be seen during the examination. In some cases, treatment can also be performed during the procedure.

If you are experiencing these symptoms or have been advised to undergo a gastroscopy, contact Dr Eduan Deetlefs, gastroenterologist in Cape Town, for an assessment.

Dr Eduan Deetlefs Inc

Telephone: 021 202 0626
Email: info@gidoc.co.za
Website:  www.gidoc.co.za

Digestive symptoms are common, but they should not be ignored when they persist, recur, or begin to affect daily life. Persistent abdominal pain, rectal bleeding and unexplained weight loss can be warning signs of conditions that require specialist assessment. Other symptoms, including chronic heartburn, difficulty swallowing, bloating, prolonged diarrhoea, a change in bowel habits, jaundice or unexplained iron-deficiency anaemia, may also need investigation. Modern gastroenterology combines careful clinical assessment with advanced endoscopic procedures to identify the cause, treat selected problems and reduce the risk of complications.

At GI Doc Cape Town, Dr Eduan Deetlefs provides patient-focused care for gastrointestinal and liver-related conditions. He has a particular interest in inflammatory bowel disease (IBD) and iron-deficiency anaemia caused by obscure gastrointestinal bleeding. His services include diagnostic and therapeutic endoscopy, small-bowel investigation, colorectal cancer prevention and advanced interventional procedures.

Why Specialist Gastroenterology Care Matters

The digestive system includes the oesophagus, stomach, small intestine, colon, liver, gallbladder, pancreas and bile ducts. Because disorders in these organs can produce similar symptoms, the cause is not always obvious from symptoms alone. A gastroenterologist evaluates the full clinical picture, including the patient’s history, examination findings, blood tests, imaging and, where appropriate, endoscopy.

Early assessment is especially important when symptoms suggest gastrointestinal bleeding, bowel inflammation, obstruction or cancer. Procedures are selected according to the patient’s symptoms and risk factors; not every patient needs every test. In many cases, an endoscopic procedure can provide a diagnosis, obtain biopsies and deliver treatment during the same session.

Gastroscopy for Upper Digestive Symptoms

A gastroscopy examines the oesophagus, stomach and duodenum using a thin, flexible camera passed through the mouth. It may be recommended for persistent reflux, upper abdominal pain, nausea or vomiting, difficulty swallowing, suspected ulcers, unexplained anaemia or signs of upper gastrointestinal bleeding.

The procedure can identify inflammation, ulcers, narrowing, coeliac disease, Barrett’s oesophagus and certain upper gastrointestinal cancers. Small tissue samples can be taken for laboratory analysis. Depending on the finding, treatment may also be performed, such as controlling a bleeding lesion or dilating a stricture. Patients with reflux-related cell changes may need surveillance or treatment because Barrett’s oesophagus can increase the risk of oesophageal cancer.

Colonoscopy, Cancer Prevention and Polypectomy

A colonoscopy allows the lining of the colon and rectum to be examined directly. It is used to investigate rectal bleeding, persistent diarrhoea, changes in bowel habits, unexplained anaemia and suspected IBD. It also plays an important role in colorectal cancer screening, even when a person has no symptoms.

One of the main advantages of colonoscopy is that polyps can often be removed during the examination. Many polyps are benign, but some types may become cancerous over time. A polypectomy interrupts this progression by removing abnormal tissue before it develops into cancer. Dr Deetlefs also performs endoscopic mucosal resection (EMR) for selected large, flat or complex lesions. These techniques may avoid more extensive surgery, although the safest approach depends on the lesion’s size, position and features.

Capsule Endoscopy and Double-Balloon Enteroscopy

The small intestine is difficult to examine fully with a standard gastroscopy or colonoscopy. Capsule endoscopy uses a swallowable camera to record images as it travels through the digestive tract. It is particularly useful when Crohn’s disease or a small-bowel source of blood loss is suspected after initial investigations have not found the cause. The test can identify ulcers, abnormal blood vessels and growths, but the capsule cannot take a biopsy or provide treatment. Patients with possible narrowing or obstruction need careful assessment because the capsule may become retained.

If capsule images reveal an abnormality, or if a deeper examination is needed, double-balloon enteroscopy can reach sections of the small bowel that conventional endoscopy cannot. It may be used to take biopsies, treat bleeding, remove selected polyps, or dilate a stricture. The United States National Institute of Diabetes and Digestive and Kidney Diseases provides further patient information about diagnosing gastrointestinal bleeding, including the role of capsule endoscopy.

ERCP for Bile Duct and Pancreatic Duct Disorders
 

Endoscopic retrograde cholangiopancreatography (ERCP) combines endoscopy with X-ray imaging to access the bile and pancreatic ducts. It is most often used when treatment is likely to be needed, for example to remove bile duct stones, relieve an obstruction, widen a narrowing or insert a stent.

Symptoms that may prompt investigation include jaundice, dark urine, pale stools, fever with upper abdominal pain or abnormal liver tests. ERCP can provide rapid relief when a duct is blocked, but it is a specialised procedure with recognised risks, including pancreatitis, bleeding, infection and perforation. Dr Deetlefs will assess whether ERCP is appropriate and explain the expected benefits, alternatives and risks.

Stricture Dilatation, Stents and Barrett’s Treatment

Inflammation, scarring, long-standing reflux or cancer can narrow part of the gastrointestinal tract. A stricture may cause food to stick, difficulty swallowing, vomiting, pain or signs of bowel obstruction. Endoscopic dilatation gently widens selected narrowed areas. In some situations, an oesophageal, gastric or duodenal stent may be placed to keep the passage open and improve swallowing or the movement of digestive contents.

For selected patients with Barrett’s oesophagus and abnormal cell changes, endoscopic mucosal resection or ablation may remove or destroy affected tissue. Ongoing reflux management and surveillance remain important because treatment and follow-up are tailored to the biopsy results and the degree of dysplasia.

Specialist Care for Inflammatory Bowel Disease

Crohn’s disease and ulcerative colitis are chronic inflammatory conditions that may cause diarrhoea, bleeding, abdominal pain, fatigue, weight loss and nutritional deficiencies. Management may include endoscopy, imaging, laboratory monitoring, medicines, biological therapy and nutritional or iron support.

Dr Deetlefs provides ongoing IBD assessment and treatment planning, including an in-room infusion service for biological therapies and intravenous iron. He is also associated with Spoke Research Inc, a clinical trial centre focused on biological studies in IBD. The goal is not only to control symptoms, but also to monitor inflammation, prevent complications and support long-term quality of life.

When to Seek Prompt Medical Help

Arrange a medical assessment for persistent digestive symptoms, recurring bleeding, unexplained anaemia, difficulty swallowing or an ongoing change in bowel habits. Seek urgent medical care for vomiting blood, passing a large amount of blood, black tar-like stools, severe or worsening abdominal pain, a rigid or swollen abdomen, fainting, or jaundice accompanied by fever. Online information cannot replace an examination and an individual diagnosis.

Conclusion

Advanced gastroenterology allows many digestive conditions to be investigated accurately and, in selected cases, treated without major surgery. The right procedure depends on the symptoms, medical history and findings from the initial consultation. Early specialist assessment can clarify the cause of ongoing symptoms, support timely treatment and reduce avoidable complications.

Patients in Cape Town who are experiencing persistent abdominal pain, reflux, rectal bleeding, difficulty swallowing, unexplained anaemia, weight loss or changes in bowel habits can contact Dr Eduan Deetlefs Inc to arrange an assessment.

Practice: Dr Eduan Deetlefs Inc | Telephone: 021 202 0626
Address: The Park Building (opposite Life Vincent Pallotti Hospital), Suite 304, 3rd Floor, Park Road, Pinelands, Cape Town, 7405
Email: info@gidoc.co.za
Website: www.gidoc.co.za

DISCLAIMER: PLEASE READ CAREFULLY

The information on this website is to provide general guidance. In no way does any of the information provided reflect definitive medical advice and self-diagnoses should not be made based on information obtained online. It is important to consult a Gastroenterologist or medical doctor regarding ANY and ALL symptoms or signs including, but not limited to: abdominal pain, haemorrhoids or anal / rectal bleeding as it may a sign of a serious illness or condition. A thorough consultation and examination should ALWAYS be performed for an accurate diagnosis and treatment plan. Be sure to call a physician or call our office today and schedule a consultation.