Skip to main contentAhmedabad and Gandhinagar · Dr Harsh Shah, Laparoscopic & Endoscopic Stomach Surgeon
Almost every peptic ulcer today is cured with medicine, and the operation that used to be done to reduce acid has been abandoned because tablets do that job better. A surgeon becomes necessary for one of three reasons only: the ulcer bleeds and endoscopy cannot stop it, the ulcer makes a hole, or scarring from years of ulceration blocks the way out of the stomach. Two disciplines run through all of it — every stomach ulcer is biopsied until cancer is disproved, and every blocked stomach is treated as cancer until endoscopy, biopsy and a scan say otherwise. Getting that order right is what separates a cured patient from one who is operated on for the wrong disease.
Shah’s Gastro, Cancer & Robotic Surgery Centre
Dr Harsh Shah
MS, MCh (Surgical Gastroenterology), DrNB (Surgical Gastroenterology)
Registered with Gujarat Medical Council, Reg. No. G-38738
Laparoscopic & Endoscopic Stomach Surgeon
· Apollo Hospital, Bhat, Gandhinagar · Gota OPD, Ahmedabad
Qualified twice over in surgical gastroenterology, and on emergency call for the abdomen that has perforated at two in the morning as well as the clinic on Monday. Ulcer disease is where a surgeon has to be willing to say that the answer is a fourteen-day course of tablets rather than an operation — and equally willing to move within the hour when it is not. Google rating 4.89 from 216 reviews at the Gota listing, and 4.94 from 17 reviews at the Apollo, Bhat listing.
The symptoms of an ulcer and the symptoms of a growth in the stomach are the same symptoms. That is why the diagnosis is never made on the description of the pain — it is made at endoscopy, and in the stomach it is made on the biopsy, not on how the ulcer looks to the eye.
Burning or gnawing pain high in the abdomen, worse or better with food, waking you at night, settling briefly with an antacid — that is the classic story, and it is the reason most people are referred. Black tarry stools, vomiting blood, or an unexplained drop in haemoglobin move the same complaint into a different urgency. So does sudden severe pain that starts in one spot and spreads across the whole abdomen, which is a perforation until proved otherwise and belongs in a hospital the same hour.
| Step | What it settles |
|---|---|
| Upper GI endoscopy | Sees the ulcer, its site and whether it is actively bleeding or carries a vessel at risk of bleeding again. Retained food after a proper overnight fast is itself a finding and points to a blocked outlet. |
| Biopsy of every gastric ulcer | Non-negotiable, and taken from several points around the rim. An ulcer in the stomach can be a cancer that simply looks like an ulcer. Ulcers in the duodenum do not need routine biopsy. |
| Testing for Helicobacter pylori | Done in every ulcer patient — at endoscopy, or by breath or stool test. The stool and breath tests are only reliable if acid-suppressing tablets have been stopped for two weeks beforehand. |
| A full medicine history, taken every visit | Painkillers of the anti-inflammatory type, aspirin, steroids and blood thinners cause and perpetuate ulcers. This is asked at every encounter because the answer changes between visits, and because patients often do not count a painkiller bought without a prescription as a medicine. |
| Where the ulcer keeps coming back | Ulcers that refuse to heal, appear in unusual places, or recur despite proper treatment prompt a blood test for a rare acid-producing tumour, and a fresh hunt for a painkiller still being taken quietly. |
When the problem is a blocked stomach rather than pain, the work-up widens: a contrast-enhanced scan of the abdomen to show where the block is, how long it is and whether anything outside the stomach is causing it, and several deep biopsies of the narrowed segment. In our population tuberculosis is a real cause of a benign-looking narrowing, so tests for it are added wherever the story fits.
An uncomplicated ulcer is treated with acid suppression, removal of the painkiller that caused it, and — in everyone who carries the bacterium — a full eradication course. In this practice the first-line course is the fourteen-day bismuth-based quadruple regimen, and that is a deliberate departure from the prescription most patients arrive holding.
Acid-suppressing tablets are given at full dose for four to eight weeks for a duodenal ulcer and eight to twelve weeks for a gastric one. The anti-inflammatory painkiller is stopped; where it genuinely cannot be stopped, it is covered with acid suppression for as long as it continues. Everyone with an ulcer is tested for Helicobacter pylori and everyone who has it is treated, because eradication is what stops the ulcer returning — a healed ulcer with the bacterium still present is a relapse waiting to happen.
The choice of antibiotics is not a detail. The clarithromycin-based triple therapy still written most often in India performs badly where resistance to that antibiotic is high or simply unknown, which is our situation. The fourteen-day bismuth quadruple regimen is the locked first-line default here, for patients allergic to penicillin as well. Clarithromycin triple therapy remains an option only when the strain has been formally shown to be susceptible to it. Salvage regimens exist for those who fail, and are chosen on testing rather than on guesswork.
Two follow-through steps are treated as part of the treatment rather than optional extras. Cure of the infection is confirmed by a breath or stool test at least four weeks after the antibiotics and at least two weeks off acid suppression — before that, the test lies. And a gastric ulcer is re-scoped at eight to twelve weeks to prove with the eye and the biopsy forceps that it has healed. An ulcer that has not healed by then is re-biopsied, not simply given another month of tablets.
A bleeding ulcer is resuscitated first and treated through the endoscope second. Surgery is the rescue when those fail, not the opening move — and the modern sequence has made emergency ulcer surgery much less common than it was a generation ago.
Resuscitation comes before any procedure: fluids, and transfusion given to a deliberately restrained target rather than to a normal-looking haemoglobin, because transfusing generously makes rebleeding more likely. Intravenous acid suppression is started. Then endoscopy identifies the ulcer and grades what is seen at its base — a spurting vessel, a visible vessel, an adherent clot, a flat spot or a clean base. That grading, not the size of the ulcer, decides who needs treatment through the scope and who can simply be fed and watched.
Where treatment is needed it is always given as two modalities together — an adrenaline injection combined with a clip or a heat probe. Adrenaline alone is not adequate treatment and is not used alone here. If the ulcer bleeds again, the first response is to repeat the endoscopy rather than to head for theatre; if that fails, blocking the feeding artery through a catheter comes next, and an operation is the last rung. Aspirin taken for the heart is usually continued under acid cover, and anticoagulants are restarted on a timetable agreed with your cardiologist, because the risk of stopping them is real too.
A perforated ulcer is a hole through the wall of the stomach or duodenum, and the outcome depends more on how quickly the leak is stopped than on which technique is used to stop it. Delay, shock on arrival and other illnesses are what make it dangerous.
The repair itself is a simple and time-tested operation: the hole is closed with stitches and a tongue of the omentum — the apron of fat inside the abdomen — is tied gently over the repair to seal it, then the whole abdomen is washed out thoroughly. It can be done by keyhole surgery in a patient who is stable, who has come early, and whose perforation is small; an abdomen that is grossly contaminated, or a patient who is unstable or has come late, is better served by an open operation. Converting from keyhole to open is a judgement in the patient’s favour, not a failure.
Two rules apply without exception. A perforation in the stomach has its edges biopsied during the operation, and the patient is re-scoped later to document healing — because a perforated growth and a perforated benign ulcer look identical down a scope at midnight. And a very large or friable hole cannot simply be patched; it needs one of several more involved repairs chosen on the spot according to what the patient can physically withstand. Managing a perforation without an operation is possible in a narrow group — where a contrast study proves the leak has sealed itself, the abdomen is soft, the patient is improving, and a surgeon is standing by to operate the moment that stops being true.
When years of ulceration scar the outlet of the stomach, food stops leaving. Vomiting of stale food eaten hours or days earlier, feeling full immediately, and steady weight loss are the picture. The first treatment is not an operation and not even a scope — it is correcting the body chemistry that the vomiting has wrecked.
Persistent vomiting strips the body of acid, chloride and potassium, producing a disturbance that causes cramps, drowsiness and in severe cases fits, and that makes anaesthesia dangerous. It is corrected with salt-containing fluid first and potassium added once the kidneys are proved to be working. Alongside that, a wide tube passed into the stomach empties and washes it out over two or three days, so a stomach stretched by months of retention regains some tone. Nutrition is assessed at the same visit — significant weight loss, a low body mass index or a low albumin each trigger dietitian involvement and a period of feeding before any planned surgery.
Only then does treatment of the narrowing itself begin, and the nature of the scar decides everything that follows.
| Situation | What is done |
|---|---|
| Short, soft, recent narrowing from ulcer disease | Graded balloon dilatation through the endoscope over several sessions, with acid suppression and eradication. Most avoid surgery. |
| Narrowing that keeps closing after an adequate series of dilatations | Surgery. Persistent failure is a reason to refer, not a reason for one more attempt. |
| Long, fibrotic, angulated or corrosive narrowing | Surgery from the outset — stretching will not hold, and repeated attempts risk tearing the wall. |
| The usual operation | A keyhole bypass: a loop of small bowel is joined to the lowest part of the stomach so food leaves through a new, wide opening. The scarred outlet is left alone. |
| Dense scarring of the lower stomach, or corrosive injury | The scarred lower portion of the stomach is removed and the remainder reconnected. |
| A short, supple narrowing found at operation | The outlet is simply widened rather than bypassed. |
One operation that used to be standard is no longer offered: cutting the nerve that drives acid production. Tablets control acid better than that operation ever did, and it carried its own long-term penalties. For the same reason, planned surgery for an uncomplicated ulcer that has simply not been treated properly is obsolete — the correct response there is a proper eradication course and removal of the painkiller, not an incision.
After a patch repair, and after a bypass for a blocked stomach, you are got out of bed the same day and feeding is reintroduced as the bowel wakes. The one expected nuisance after a bypass is a stomach that empties slowly for some days — anticipated, managed with a tube and patience, and not a sign that anything has gone wrong.
Pain is controlled with combinations that minimise strong opioids, fluids are given to measured targets rather than by routine, and you are kept warm through the operation. You go home once you are free of fever for a day, tolerating soft food, walking independently and comfortable on tablets — and not before the eradication course has been prescribed and explained, the painkiller question settled in writing, the confirmatory test booked, and, for any gastric ulcer or gastric perforation, the date of the repeat endoscopy written on the discharge paper.
What is discussed in full before consent, in plain words rather than a list of numbers: bleeding that needs a transfusion, infection of the wound, a clot in the leg or lung, a strain on the heart, the possibility of converting from keyhole to open surgery. For a patch repair — the repair leaking, a collection of pus inside the abdomen, the need to re-operate, the stitches giving way in an abdomen that was already infected, and the risk to life, which in perforation is driven above all by how long the leak has been open, by shock on arrival and by other illnesses. For a bypass or a partial removal of the stomach — a leak at the join, the slow emptying described above, an ulcer forming at the new join later, bile washing back, and weakness after meals. The individualised figures for your age, your nutrition, your other illnesses and how long you waited are given at the consent discussion itself, in writing, because pooled averages do not describe any particular person.
★★★★★
“My husband is suffering from last 5 to 6 years regarding stomach problem. We consulted Dr Harsh Shah. We are satisfied with his way of treatment and best diagnosis. Thank you so much again.”
Prexa H Parikh · Google review
★★★★★
“It is one of the best hospitals for gastric problems, the staff is humble, service is good. My dad is getting treated by Harsh Sir, whenever we came here on regular check-ups or emergencies he has treated him according to the situation. Once we entered the premises of the hospital they just took over all your stress by doing what they do best. I will recommend to everyone with any gastric problem that this is your go-to place in an emergency.”
Kandarp Yogi · Google review
Reviews below are real Google reviews from Dr Harsh Shah’s listings, quoted as written.
From the first consultation to recovery there are five stages, and at each one you are told what happens next and when.
Emergency admission for a bleeding or perforated ulcer, and planned surgery for a blocked stomach, are covered by most health insurance policies and by cashless arrangements at Apollo Hospital, Bhat. Emergencies are admitted first and the paperwork follows.
What moves the estimate: whether the admission is an emergency or planned; whether treatment is endoscopic, keyhole or open; how many dilatation sessions are needed; whether a period of tube feeding is required before surgery; the room category; and the length of stay, which after a perforation depends on how unwell you were on arrival. For planned admissions the office prepares the pre-authorisation with the clinical justification and the record of completed medical treatment attached, and seeks cashless approval before you come in. Bring the policy document, your identification, previous records, imaging on disc as well as film, the endoscopy and biopsy reports, and your current prescriptions.
Almost certainly not. The great majority of ulcers heal with acid-suppressing tablets, removal of the painkiller that caused them, and a full course to eradicate the bacterium. Surgery is reserved for three complications — bleeding that endoscopy cannot stop, a hole through the wall, and a scarred outlet that blocks food from leaving. The old operation to reduce acid production is no longer done, because tablets do it better.
Because the commonly prescribed clarithromycin-based combination fails often where resistance to that antibiotic is high or unmeasured, which describes our population. The fourteen-day bismuth-based quadruple course is used first-line here instead. Clarithromycin is kept for the situation where testing has shown your particular strain is still susceptible to it.
Because a cancer in the stomach can look exactly like an ordinary ulcer, and neither the symptoms nor the appearance can separate them reliably. Several biopsies are taken from around the rim at the first endoscopy, and the scope is repeated at eight to twelve weeks to confirm the ulcer has actually healed. An ulcer that has not healed by then is biopsied again rather than given more tablets. Duodenal ulcers do not need this.
That pattern — vomiting stale food, feeling full after a few mouthfuls, losing weight — suggests the outlet of the stomach is blocked, usually by scarring from long-standing ulceration. It needs assessment promptly, partly because the vomiting itself disturbs your body chemistry dangerously, and partly because a blockage must be investigated properly before it is assumed to be from an ulcer at all.
Often, yes. A short, soft narrowing is stretched with a balloon passed through the endoscope, widened gradually across several sessions and combined with acid suppression and eradication; most patients treated this way avoid an operation. A long, dense or acid-burn narrowing will not stay open, and there the honest advice is surgery rather than a further series of attempts.
Usually yes, and stopping them permanently carries its own serious risk. Aspirin taken to protect the heart is generally continued or restarted early under cover of acid suppression. Anticoagulants are restarted on a timetable worked out with your cardiologist or physician. Anti-inflammatory painkillers taken for joint or muscle pain are a different matter — those are the ones stopped, and alternatives are suggested.
Shah’s Gastro, Cancer & Robotic Surgery Centre
Gota, Ahmedabad, Gujarat
Google rating 4.89 from 216 reviews
Dr Harsh Shah consults at two addresses in the Ahmedabad–Gandhinagar area: the clinic at Gota, Ahmedabad, and Apollo Hospital at Bhat, Gandhinagar.
Patients reach Dr Harsh Shah with long-standing ulcer symptoms, and as emergencies with a perforation, from across Gujarat — Gandhinagar, Rajkot, Surat, Vadodara, Bhavnagar, Jamnagar, Junagadh and Kutch — and from Rajasthan and Madhya Pradesh. If the problem is not an emergency, send the endoscopy report and your prescription list on WhatsApp first, so the consultation is spent on the decision rather than on collecting paper.
Bring the endoscopy report with the biopsy result , and a complete list of every painkiller and blood thinner you take. Those two things decide most of the plan. Call +91-63555-64601 · WhatsApp Dr Harsh Shah's office
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