As a naturopathic physician who specializes in the natural treatment of gastrointestinal conditions, I often refer my patients to gastroenterologists for upper endoscopies. An upper endoscopy is an outpatient procedure where patients are lightly sedated and a camera is lowered down into the stomach and the first part of the small intestine. The procedure is extremely safe and well-tolerated, and it is the best way to diagnose many conditions that occur in the upper intestinal tract.
What symptoms might prompt a referral for an upper endoscopy? The most common ones are GERD (gastroesophageal reflux disease) and gastritis (inflammation of the stomach lining). These two conditions can present with very similar symptoms, and often the only way to know which condition a patient is experiencing (or whether they have both conditions), is to physically look around in there with a camera. The camera will show whether there is inflammation in the lower esophagus, which would confirm GERD. When inflammation in the lower esophagus persists for many years, it can also turn into a pre-cancerous condition known as Barrett’s esophagus. This condition requires more aggressive treatment and monitoring to lower the odds of esophageal cancer forming in the area.
When the endoscopy camera looks in the stomach, we can see whether the tissues that line the interior of the stomach are inflamed (indicating gastritis), and to what degree. We also can see if there is an ulcer present. The doctor will do a biopsy in the stomach to test for the presence of H. pylori in the stomach, which is a bacteria that can cause both gastritis and ulcers. If H. pylori is found, treatment would also need to include aggressive antibiotics or herbal treatment to eradicate the bacteria. While H. pylori testing can also be done with a breath or stool test, there is no other way to definitely diagnose gastritis or an ulcer other than an upper endoscopy.
Another significant benefit of an upper endoscopy is that it can identify whether a hiatal hernia is present. A hiatal hernia occurs when either part of the lower esophagus or the upper part of the stomach protrudes upwards into the diaphragm. A hiatal hernia usually impacts the ability of the lower esophageal sphincter (the sphincter between the lower esophagus and the stomach) to function properly, often leading to GERD symptoms. Because there can be so many different underlying causes of GERD, knowledge of whether a hiatal hernia exists is extremely helpful information to have. Severe hernias will require surgery, but smaller hernias are often treated more conservatively.
For the final part of an upper endoscopy, the scope will move further down into the first part of the lower intestine (aka the duodenum) and look for signs of Celiac disease. Celiac disease causes damage to the microvilli in this area. Microvilli are fingerlike projections of mucosa that help with absorption of essential nutrients. The doctor will take biopsies of the microvilli so that a pathologist can look under a microscope and make sure there is no damage. While Celiac disease can also be diagnosed with a blood test, there are occasional false negatives with antibody testing.
As a naturopathic physician, my goal with each patient is to identify and treat the underlying cause of my patient’s symptoms. While more invasive testing is not always necessary in order to do this, with conditions like GERD and gastritis the knowledge gained is often extremely valuable. The better we can target your treatment plan to your exact pathology, the better the outcome typically is.
Dr. Katie Nuckolls is a naturopathic physician and owner of Thrive GI: Natural Digestive Medicine in Vancouver, Washington. She currently sees patients that live in Washington and Oregon for in-office and telemedicine visits. For more information, visit our contact page or schedule a free 15-minute consultation online.