Brief, factual descriptions of conditions that may be discussed during a gastroenterology consultation.
Hong Kong gastroenterology and hepatology information from Dr Paul Ng. Consultations in Central and Tsim Sha Tsui are by appointment; assessment and care are individual.
GERD occurs when stomach contents flow back into the oesophagus and cause troublesome heartburn or regurgitation, or damage the oesophageal lining. Reflux is more likely after meals or when lying down, but chest or upper-abdominal discomfort can have other causes. Symptoms alone do not always establish the diagnosis.
Reflux can sometimes inflame or narrow the oesophagus, but a normal endoscopy does not rule out GERD because the lining may look normal between episodes. A clear response to acid-suppressing medicine can support a reflux diagnosis, but is not proof that every throat, chest or stomach symptom is caused by acid. Persistent symptoms despite appropriate care may prompt a review of how medicines are used, alternative causes, endoscopy or reflux monitoring. Difficulty swallowing, food sticking, bleeding, repeated vomiting or unexplained weight loss should be raised promptly rather than managed as routine heartburn. Reflux episodes can be influenced by meal timing, body position and individual factors; keeping a brief record of symptoms and possible associations may make consultation more useful. Any proposed lifestyle changes or medicine review should be practical and considered alongside other health needs. A symptom diary can note timing after meals, lying down, sleep and any medicines already tried. This context helps distinguish a recurring reflux pattern from symptoms that need a different assessment, and supports a focused discussion of whether testing would change care.
For discussion in consultation
A clinician considers how often symptoms occur, their effect on daily life, response to previous care and warning signs such as difficulty or pain with swallowing, persistent vomiting, bleeding or unexplained weight loss. Those details help decide whether an initial treatment discussion is reasonable or whether investigation is needed.
Related procedure information
These links are general information, not a recommendation for an examination or treatment.
Bile is made by the liver and normally enters the duodenum through the bile ducts to help digest fat. Bile reflux occurs when duodenal contents flow back into the stomach and sometimes the oesophagus. It differs from acid reflux, although both can coexist. Upper abdominal discomfort, nausea, bitter regurgitation or yellow-green vomit may occur, but symptoms alone cannot diagnose it.
Small amounts of duodenogastric reflux can occur without disease. Troublesome reflux may relate to gastric surgery, pyloric function or altered gut movement; having had a gallbladder removed does not establish the diagnosis. Assessment reviews symptoms, operations and medicines. Gastroscopy may assess the lining and allow biopsies, but seeing bile alone does not prove it causes symptoms. Oesophageal pH monitoring assesses acid exposure, not bile directly. Impedance monitoring can identify non-acid reflux but does not by itself establish that it is bile. Care is individualised according to the likely cause and mucosal findings, and may involve dietary and lifestyle measures, medicines or, rarely, surgical assessment. Evidence for drug treatments is limited. Acid suppression can treat coexisting acid reflux but does not directly stop bile reflux.
For discussion in consultation
Persistent upper abdominal symptoms, vomiting or regurgitation need assessment rather than self-diagnosis. Unexplained weight loss, swallowing difficulty or persistent vomiting warrant prompt review. Vomiting blood, black stools, severe abdominal pain, distension with yellow-green vomiting or inability to keep fluids down require urgent emergency assessment.
H. pylori is a bacterium that lives in the stomach lining and can cause long-lasting inflammation. Many people have no symptoms, while others develop indigestion, gastritis or peptic ulcers; infection is also linked with a higher lifetime risk of stomach cancer. Active infection can be checked with a breath or stool test, or identified from stomach biopsies taken at gastroscopy.
A breath test or stool antigen test can detect active infection without endoscopy; blood antibody tests may remain positive after an old infection and are not generally used to prove eradication. Some acid medicines, antibiotics and bismuth can affect test accuracy, so a clinician may advise how to prepare. Antibiotic resistance and previous treatment influence the regimen, which should be taken exactly as prescribed. A test of cure is commonly performed after treatment at an appropriate interval; do not assume that symptoms or their absence show whether the bacterium remains. Household exposure and regional infection rates may be relevant to a clinician’s assessment, but testing is guided by the individual’s history and reason for consultation. If treatment causes troublesome adverse effects or doses are missed, contact the treating clinician for advice rather than changing the regimen independently. Bring a list of previous eradication courses and antibiotic allergies to the consultation, because these can affect the next testing or medicine choices. Follow the laboratory instructions about temporary medicine holds; the appropriate timing depends on the test and your situation.
For discussion in consultation
The reason for testing and choice of an eradication regimen depend on the clinical history, allergies and previous antibiotic exposure, as resistance patterns vary. Treatment commonly uses a combination of medicines rather than one antibiotic alone. A properly timed follow-up test is important to check that infection has cleared; symptom improvement by itself cannot confirm eradication.
Related procedure information
These links are general information, not a recommendation for an examination or treatment.
Gastritis means inflammation of the stomach lining, which may be short-lived or persist over time. It can be associated with Helicobacter pylori, some medicines such as anti-inflammatory pain relievers, alcohol or immune conditions, but the cause is not always clear. Some people have no symptoms; others notice upper-abdominal discomfort, nausea or indigestion. Similar symptoms can occur without gastritis, so symptoms alone cannot confirm it.
Gastroscopy biopsies can identify inflammation that is not obvious from symptoms or the lining’s appearance alone. H. pylori, anti-inflammatory medicines and other factors can contribute, but inflammation patterns have different causes and implications. A biopsy report should be read with the endoscopy findings, medication history and reason for testing; indigestion alone does not show that gastritis is present. Report vomiting blood, black stools, worsening pain or inability to keep fluids down promptly.
For discussion in consultation
Assessment considers the symptom pattern, medicines and relevant health history. Depending on the situation, testing for H. pylori, blood tests or gastroscopy with biopsies may help identify inflammation and its cause. “Gastritis” on a report can describe different microscopic patterns; the biopsy wording and findings should be interpreted with the full endoscopy and clinical history.
Related procedure information
These links are general information, not a recommendation for an examination or treatment.
A gastric ulcer is a break in the stomach lining that extends beyond a superficial irritation. Common contributors include H. pylori infection and anti-inflammatory pain medicines, but an ulcer can have other causes. Some cause upper-abdominal pain or indigestion, while others cause few symptoms until a complication develops. An ulcer is not the same as gastritis, and finding H. pylori is not the only explanation for an ulcer.
An ulcer seen at gastroscopy may be sampled to assess its nature, and clinicians commonly consider H. pylori testing and medicine review. H. pylori is one important cause, but a negative result does not rule out ulcers from anti-inflammatory medicines or other causes. The need and timing of repeat endoscopy depends on the ulcer’s features, biopsy findings and clinical context. Vomiting blood, black tarry stools, fainting or sudden severe abdominal pain are urgent warning signs.
Duodenal ulcers and peptic ulcer disease
Gastric ulcers occur in the stomach; duodenal ulcers occur in the duodenum, the first part of the small bowel. Both are peptic ulcers, but they are not the same anatomical condition. H. pylori infection and NSAID pain medicines are common contributors. Symptoms cannot reliably locate an ulcer. Diagnosis, medicines, H. pylori treatment and follow-up need individual assessment; gastric-ulcer biopsy plans do not automatically apply to every duodenal ulcer.
For discussion in consultation
Gastroscopy can show the ulcer and allow biopsies when needed; clinicians may also test for H. pylori and review pain medicines, other medicines and medical history. Biopsy and follow-up plans depend on the ulcer’s appearance and context. Vomiting blood, passing black tarry stools, fainting or sudden severe abdominal pain needs urgent medical assessment.
Related procedure information
These links are general information, not a recommendation for an examination or treatment.
Gastric intestinal metaplasia is a microscopic change in which some stomach-lining cells take on features more like intestinal cells. A biopsy is needed to identify it. It is not stomach cancer, but it can be part of a pathway associated with increased future risk; most people with the finding will not necessarily develop cancer. Risk varies with its extent and other factors.
The finding describes a tissue pattern, not a visible mass, and the amount of stomach sampled affects how confidently its extent can be mapped. More extensive or incomplete-type changes, persistent H. pylori and a close family history may alter risk, but no single factor gives an exact prediction for an individual. Treating H. pylori, when present, is an important risk-reduction step. The potential value of repeat endoscopy depends on the biopsy details, overall risk, health and preferences; surveillance intervals should be based on a clinician’s review rather than a generic schedule. Ask for the pathology wording and the areas sampled to be explained, since “metaplasia” alone does not describe how much of the stomach is involved. If surveillance is discussed, the expected benefit, procedural burden and any change in health or preferences can be revisited. A pathology report should be interpreted with the endoscopy findings and biopsy locations, since limited sampling may not represent the entire stomach. A clinician can explain whether the finding is focal or more widespread and what that means for your individual risk.
For discussion in consultation
The pathology report is reviewed for which stomach areas were sampled and involved, and whether H. pylori is present or has been treated. Family history, background risk and the quality of the original examination can also matter. A repeat gastroscopy or surveillance is not automatically beneficial for everyone; the possible benefit and burden should be considered individually.
Related procedure information
These links are general information, not a recommendation for an examination or treatment.
Autoimmune gastritis occurs when the immune system damages acid-producing glands in the stomach, mainly in its body and upper part. Reduced acid and intrinsic factor can affect iron and vitamin B12 absorption. Some people have few digestive symptoms and are investigated because of a deficiency or anaemia.
It differs from H. pylori-related gastritis, although both can coexist. Diagnosis brings together stomach biopsies, blood counts, iron and vitamin B12 levels, and selected antibody tests; a positive antibody test alone does not establish the diagnosis. Pernicious anaemia is a later manifestation in some people, not another name for every case of autoimmune gastritis. Assessment also considers associated autoimmune conditions, particularly thyroid disease, and H. pylori. Care includes correcting deficiencies and individual follow-up. The condition can increase the risk of certain stomach tumours, but does not mean cancer is present. Decisions about repeat endoscopy depend on biopsy findings, disease extent, other risks and shared discussion, rather than one fixed interval for everyone.
For discussion in consultation
Unexplained iron or vitamin B12 deficiency deserves assessment rather than supplements alone. Report numbness, tingling or balance problems promptly. Vomiting blood, black tarry stools, fainting or severe breathlessness requires urgent care.
Related procedure information
These links are general information, not a recommendation for an examination or treatment.
Gastroparesis is delayed emptying of food from the stomach when there is no physical blockage. It may cause feeling full after a few bites, prolonged fullness after meals, nausea, vomiting, bloating or upper-abdominal discomfort. Poor intake and repeated vomiting can affect hydration and nutrition, although these symptoms also occur in other conditions.
A gastric-emptying test is usually considered only after a physical blockage has been excluded and medicines that alter motility have been reviewed. The test measures how quickly a standard meal leaves the stomach over time; results can be affected by preparation, blood glucose and medicines. Diabetes, previous surgery and some neurological or connective-tissue disorders may be associated, but sometimes no cause is identified. Symptoms alone cannot diagnose gastroparesis, and symptom intensity does not reliably measure the delay. Persistent vomiting, dehydration or difficulty maintaining nutrition deserves timely clinical attention. The clinician may also assess whether symptoms could arise from another stomach or bowel condition. Test results should be interpreted using the prescribed protocol, because an incomplete or altered test meal can make comparison unreliable. The clinician may ask about meal size, vomiting frequency and weight or hydration changes, since these help assess the effect on nutrition. Report medicines and supplements accurately, as some can alter motility or test results; do not stop prescribed medicines without advice.
For discussion in consultation
Review may include diabetes control, prior surgery, other illnesses and medicines that slow stomach movement. If symptoms and history support it, a standardized gastric-emptying test may be considered after obstruction is excluded. Test preparation and timing matter, and the measured delay does not always match how severe symptoms feel.
Related procedure information
Pyloric injection is not recommended routinely for gastroparesis. This link is not a treatment recommendation.
These summaries are for general information only. They cannot establish a diagnosis or determine whether you need tests, surveillance or treatment. Your own results, risks and options must be reviewed in an actual consultation with a qualified clinician. Do not start, stop or change treatment based on this page.
References are provided for background reading; they do not replace a consultation.
Questions about a finding on your scan, blood test or endoscopy report? Discuss the full report and your history in a consultation.
About this information
This is general educational information, not a diagnosis, a personalised recommendation or consent for a procedure. Whether to investigate or treat, the alternatives (including no procedure), benefits and risks require individual clinical assessment and discussion.