Acid reflux, gastroesophageal reflux disease (GERD), and chronic heartburn are among the most common digestive conditions affecting adults worldwide. While occasional reflux after a heavy meal is normal, persistent acid reflux can significantly impact quality of life and may lead to serious complications if left untreated. Symptoms such as burning chest discomfort, regurgitation, chronic cough, hoarseness, difficulty swallowing, and disturbed sleep can become increasingly difficult to manage over time.

For many patients, lifestyle changes and medication provide relief. However, some individuals continue to experience symptoms despite treatment, while others develop complications that require more advanced intervention. Fortunately, modern gastroenterology now offers a range of minimally invasive endoscopic treatments that can help manage acid reflux effectively without the need for major surgery.

At GI Doc Cape Town, Dr Eduan Deetlefs offers comprehensive evaluation and advanced endoscopic treatment options for patients suffering from GERD and its complications.

Through diagnostic gastroscopy, therapeutic endoscopy, treatment of Barrett’s oesophagus, dilatation of strictures, and specialised reflux management, patients can receive personalised care designed to improve long-term digestive health.

Understanding Acid Reflux and GERD

Acid reflux occurs when stomach acid flows backward into the oesophagus. Normally, a muscular valve called the lower oesophageal sphincter (LES) prevents stomach contents from moving upward. When this valve weakens or relaxes abnormally, acid can travel back into the oesophagus, causing irritation and inflammation.

Occasional reflux is common and may occur after large meals, spicy foods, alcohol consumption, or lying down shortly after eating.

However, when reflux becomes frequent or severe, it is classified as gastroesophageal reflux disease (GERD).

Common symptoms of GERD include:

• Burning chest pain or heartburn
• Sour taste in the mouth
• Regurgitation of food or acid
• Chronic throat irritation
• Persistent cough
• Hoarseness
• Difficulty swallowing
• Chest discomfort
• Bloating and nausea

Some patients experience “silent reflux,” where throat symptoms occur without obvious heartburn. Others may mistake reflux symptoms for cardiac problems due to chest pain or discomfort.

Without proper treatment, chronic reflux can damage the lining of the oesophagus and increase the risk of complications.

Why Chronic Acid Reflux Should Not Be Ignored

Many people self-manage reflux symptoms with over-the-counter medications for years without investigating the underlying cause. While antacids and acid-suppressing medications can provide relief, persistent reflux may indicate more serious disease.

Untreated GERD can lead to:

• Oesophagitis (inflammation of the oesophagus)
• Oesophageal ulcers
• Bleeding
• Narrowing of the oesophagus (strictures)
• Difficulty swallowing
• Barrett’s oesophagus
• Increased risk of oesophageal cancer

Because symptoms alone do not always reflect the severity of disease, specialist evaluation is important when reflux becomes chronic, severe, or resistant to treatment.

At GI Doc Cape Town, Dr Deetlefs provides advanced diagnostic investigations to assess reflux severity, identify complications, and determine the most effective treatment strategy for each patient.

The Role of Gastroscopy in Acid Reflux Management

Gastroscopy, also known as upper endoscopy, is one of the most important tools in evaluating acid reflux and GERD.

During the procedure, a thin flexible camera is passed through the mouth into the oesophagus, stomach, and upper small intestine. This allows direct visualisation of inflammation, ulcers, narrowing, abnormal tissue changes, and other complications associated with reflux disease.

Gastroscopy may be recommended for patients with:

• Persistent reflux symptoms
• Difficulty swallowing
• Chronic cough or throat irritation
• Unexplained chest pain
• Suspected Barrett’s oesophagus
• Bleeding or anaemia
• Symptoms not responding to medication

The procedure also allows biopsies to be taken if abnormal tissue is detected. These samples can help diagnose Barrett’s oesophagus, infections, inflammation, or precancerous changes.

Dr Deetlefs performs diagnostic and therapeutic gastroscopy using advanced endoscopic technology, helping patients receive accurate diagnoses and early intervention before complications worsen.

Barrett’s Oesophagus: A Serious Reflux Complication

One of the most important complications of chronic acid reflux is Barrett’s oesophagus. This condition develops when repeated exposure to stomach acid causes changes in the cells lining the lower oesophagus.

Although Barrett’s oesophagus itself may not cause additional symptoms, it is considered a precancerous condition because it increases the risk of oesophageal adenocarcinoma.

Risk factors for Barrett’s oesophagus include:

• Long-standing GERD
• Chronic heartburn
• Obesity
• Smoking
• Hiatal hernia
• Male gender
• Age over 50

Because Barrett’s oesophagus can develop silently, many patients are unaware they have it until an endoscopy is performed.

Early diagnosis is essential because endoscopic treatments can remove or destroy abnormal tissue before cancer develops.

Endoscopic Treatment for Barrett’s Oesophagus

Modern therapeutic endoscopy has transformed the management of Barrett’s oesophagus. Instead of requiring major surgery, many patients can now undergo minimally invasive endoscopic procedures that target abnormal tissue directly.

Dr Deetlefs offers advanced Barrett’s oesophagus management including:

• Surveillance endoscopy
• Endoscopic mucosal resection (EMR)
• Ablation therapy
• Biopsy monitoring
• Long-term reflux management

Endoscopic Mucosal Resection (EMR)

EMR involves removing abnormal or precancerous tissue from the oesophageal lining using specialised endoscopic instruments. This procedure allows targeted treatment while preserving healthy surrounding tissue.

EMR is commonly used when abnormal cells or early cancerous changes are detected during surveillance endoscopy.

Ablation Therapy

Ablation techniques destroy abnormal Barrett’s tissue using controlled energy delivery. This allows healthy tissue to regrow while reducing cancer risk.

Endoscopic ablation is minimally invasive and can often be performed without hospital admission.

These advanced therapies allow earlier intervention and may prevent progression to oesophageal cancer.

Managing Oesophageal Strictures with Endoscopic Dilatation

Chronic acid exposure can sometimes cause scar tissue formation within the oesophagus. Over time, this may narrow the oesophageal passage, leading to a condition called oesophageal stricture.

Patients with strictures often experience:

• Difficulty swallowing
• Food getting stuck
• Pain when swallowing
• Weight loss
• Regurgitation

Endoscopic dilatation is an effective minimally invasive treatment for oesophageal strictures.

During the procedure, specialised instruments gently stretch the narrowed section of the oesophagus, improving swallowing and relieving obstruction.

Dr Deetlefs performs oesophageal dilatation procedures for patients with reflux-related strictures and other causes of oesophageal narrowing. In severe cases, stent placement may also be considered to maintain oesophageal patency.

The Connection Between Hiatal Hernias and Reflux

A hiatal hernia occurs when part of the stomach pushes upward through the diaphragm into the chest cavity. This can weaken the lower oesophageal sphincter and worsen acid reflux symptoms.

Many patients with chronic GERD also have hiatal hernias.

Gastroscopy can help identify hiatal hernias and assess the degree of reflux-related damage within the oesophagus.

Understanding whether a hiatal hernia contributes to reflux symptoms helps guide long-term treatment decisions.

Lifestyle Changes Still Matter

While advanced endoscopic treatments can be highly effective, lifestyle modification remains an important part of reflux management.

Patients are often advised to:

• Avoid large late-night meals
• Reduce alcohol intake
• Limit spicy or acidic foods
• Stop smoking
• Maintain a healthy weight
• Elevate the head of the bed
• Avoid lying down after meals

These measures may reduce symptom severity and improve the effectiveness of medical or endoscopic treatment.

Dr Deetlefs works closely with patients to develop personalised management plans that combine lifestyle modification, medication when necessary, and advanced procedural intervention when indicated.

When Should You See a Gastroenterologist?

Many people ignore reflux symptoms for years, assuming heartburn is simply a normal inconvenience. However, persistent symptoms should always be evaluated by a specialist, particularly if they interfere with daily life or worsen over time.

You should consider seeing a gastroenterologist if you experience:

• Frequent heartburn
• Symptoms lasting longer than several weeks
• Difficulty swallowing
• Unexplained weight loss
• Chronic cough or hoarseness
• Chest discomfort
• Regurgitation
• Poor response to medication
• Bleeding or black stools

Early investigation can identify complications before they become severe and may significantly improve long-term outcomes.

Advanced Reflux Care at GI Doc Cape Town

At GI Doc Cape Town, patients receive comprehensive reflux evaluation and advanced endoscopic care tailored to their individual needs. Dr Eduan Deetlefs combines expertise in diagnostic gastroscopy, therapeutic endoscopy, Barrett’s oesophagus management, oesophageal dilatation, and minimally invasive GI procedures to help patients manage chronic acid reflux effectively.

Modern endoscopic treatments now allow many reflux-related complications to be treated without invasive surgery, offering shorter recovery times and improved patient comfort.

For patients living with chronic heartburn, swallowing difficulties, or reflux complications, early specialist evaluation can make a significant difference in both symptom control and long-term digestive health.

To learn more about reflux management and advanced endoscopic treatments, visit GI Doc Cape Town or contact the practice through GI Doc Contact Page.

Introduction

Gastrointestinal (GI) strictures—narrowings in the digestive tract—can cause pain, difficulty swallowing, bloating, or bowel obstruction. While these symptoms can severely affect daily life, modern medicine offers effective solutions. One of the most common and minimally invasive treatments is endoscopic dilatation.

At Dr. Deetlefs’s practice, patients with strictures due to conditions like Crohn’s disease, ulcerative colitis, or scar tissue from surgery can benefit from this procedure.

In this article, we explain everything you need to know about endoscopic dilatation, including what it is, how it works, preparation, recovery, and potential risks. 

What Are Gastrointestinal Strictures?

A GI stricture is an abnormal narrowing of a section of the digestive tract. Strictures can occur in the:

• Esophagus – leading to difficulty swallowing (dysphagia)
• Stomach or duodenum – causing nausea, vomiting, and bloating
• Small or large intestine – leading to constipation, cramping, or partial obstruction

Common Causes

1. Inflammatory bowel disease (IBD)
• Crohn’s disease is a leading cause of strictures in the small and large intestines
• Chronic inflammation leads to scar tissue formation
2. Surgical scarring
• Post-operative adhesions may narrow sections of the gut
3. Radiation therapy
• Can cause tissue scarring in patients treated for abdominal cancers
4. Esophageal conditions
• GERD, eosinophilic esophagitis, or acid reflux can lead to esophageal strictures
5. Tumors or polyps
• Less commonly, strictures are caused by abnormal growths

What Is Endoscopic Dilatation?

Endoscopic dilatation is a procedure used to widen narrowed sections of the gastrointestinal tract using specialized tools inserted via an endoscope.

The goal is to relieve obstruction, improve swallowing, or restore normal bowel function without the need for major surgery.

Key advantages include:

• Minimally invasive
• Performed on an outpatient basis
• Reduces recovery time compared to surgery
• Can be repeated if strictures recur

How Does the Procedure Work?

Endoscopic dilatation uses either balloon dilators or bougie dilators to gently expand the narrowed area.

Step-by-Step Process

1. Sedation and preparation
• The patient receives sedation or anesthesia
• Positioning depends on the stricture location
2. Insertion of the endoscope
• A flexible tube with a camera allows the gastroenterologist to visualize the stricture
• This ensures precise placement of the dilator
3. Dilatation
• Balloon dilator: Inflated gradually at the site of the narrowing to stretch the tissue
• Bougie dilator: A tapered instrument gently passed through the stricture
4. Assessment
• The stricture is reassessed after dilation
• Multiple passes may be necessary for severe narrowing
5. Completion
• The endoscope is removed
• The patient is monitored briefly before discharge

Endoscopic dilatation is generally safe and effective, with most patients experiencing immediate relief of symptoms.

Who Can Benefit from Endoscopic Dilatation?

Patients with GI strictures caused by:

• Crohn’s disease or ulcerative colitis
• Post-surgical scar tissue
• Esophageal narrowing due to GERD or radiation
• Benign strictures

Symptoms that may indicate the need for dilatation include:

• Difficulty swallowing or sensation of food sticking
• Abdominal pain, bloating, or constipation
• Vomiting or nausea
• Weight loss due to poor intake

Preparation for Endoscopic Dilatation

Preparation varies depending on the stricture location:

Esophageal Strictures

• Fasting: Typically 6–8 hours before the procedure
• Medication review: Blood thinners or other medications may need temporary adjustment
• Sedation plan: Discuss anesthesia options with your gastroenterologist

Intestinal Strictures

• Bowel prep: Cleansing solution may be required for colon or small intestine strictures
• Dietary instructions: Clear liquids prior to the procedure
• Medication review: Especially important for patients with IBD

Preparation is critical for safety, visibility, and optimal results.

Recovery After Endoscopic Dilatation

Most patients can return home the same day. Recovery depends on the stricture location and severity.

Immediate Recovery

• Observation for 1–2 hours post-procedure
• Mild discomfort, cramping, or bloating may occur
• Resume clear fluids initially, then gradually progress to regular diet

Short-Term Recovery Tips

• Eat soft foods for the first few days
• Avoid hard, crunchy, or sticky foods that may irritate the treated area
• Stay hydrated

Follow-Up

• Gastroenterologist may schedule a follow-up endoscopy
• Multiple dilatations may be necessary if strictures recur
• Continuous monitoring for patients with IBD is recommended

Risks and Complications

Endoscopic dilatation is minimally invasive, but potential risks include:

• Perforation of the GI tract (rare)
• Bleeding at the dilation site
• Infection (uncommon)
• Recurrence of the stricture

The procedure is considered safe when performed by an experienced gastroenterologist. Discuss all concerns with your doctor before treatment.

Advantages Over Surgery

Endoscopic dilatation offers multiple benefits compared to surgical intervention:

1. Minimally invasive – no large abdominal incisions
2. Short recovery time – most patients resume normal activities within days
3. Lower risk of complications – less bleeding and infection risk
4. Repeatable – can be performed multiple times if strictures recur

Surgery may be reserved for severe or complicated strictures that do not respond to endoscopic treatment.

Success Rates and Effectiveness

• Success rates vary depending on stricture length, location, and underlying cause
• For short, simple strictures, relief is immediate and long-lasting
• In patients with Crohn’s disease, multiple sessions may be required due to chronic inflammation

Studies indicate that endoscopic dilatation is highly effective in improving quality of life and preventing obstruction without the need for major surgery (ACG Guidelines).

When to Seek Immediate Medical Attention

After the procedure, contact your gastroenterologist if you experience:

• Severe abdominal pain
• Vomiting
• Fever or chills
• Significant bleeding
• Difficulty swallowing or passing stools

Early attention ensures prompt management of any complications.

Long-Term Management After Endoscopic Dilatation

While endoscopic dilatation provides immediate relief from GI strictures, long-term management is crucial to prevent recurrence.

Patients with conditions like Crohn’s disease or ulcerative colitis should work closely with their gastroenterologist to monitor inflammation, maintain remission, and adjust medications as needed.

Nutritional support is also essential—patients may need a diet rich in easily digestible foods, adequate hydration, and supplementation if malabsorption is present.

Additionally, regular follow-up endoscopies or imaging studies may be recommended to detect early signs of stricture recurrence and address them promptly.

Incorporating lifestyle measures such as stress management, avoiding smoking, and following a tailored anti-inflammatory diet can further improve outcomes and support long-term digestive health.

Conclusion

Endoscopic dilatation is a safe, effective, and minimally invasive treatment for gastrointestinal strictures. By widening narrowed areas of the digestive tract, it restores normal function, alleviates symptoms, and can prevent the need for more invasive surgery.

At Dr. Deetlefs’s clinic, we specialize in diagnosing strictures, performing endoscopic dilatation, and managing long-term digestive health.

If you experience difficulty swallowing, persistent bloating, or intestinal obstruction symptoms, don’t wait—early evaluation can improve outcomes and quality of life.

Contact Dr. Deetlefs

If you are experiencing symptoms of a GI stricture, book a consultation with Dr. Deetlefs today.
Take control of your digestive health with expert, minimally invasive care.