Ask a General Surgeon: Dr Shanker Pasupathy from Mount Elizabeth (Orchard) Hospital Singapore

Ask a Doctor ForumCategory: General SurgeryAsk a General Surgeon: Dr Shanker Pasupathy from Mount Elizabeth (Orchard) Hospital Singapore
Shanker Pasupathy - General Surgery - Upper Gastrointestinal (EsophagusDr Shanker Pasupathy asked 2 years ago
I am Dr Shanker Pasupathy, General Surgeon based in Mount Elizabeth (Orchard) Hospital Singapore. Ask Me Anything!

I am the director of the Digestive Centre, Mount Elizabeth Hospital. If you are suffering from acid reflux, abdominal pain, cancer, obesity or hernia, you have come to the right place.

We provide comprehensive diagnosis based on detailed symptom history, nutrition and lifestyle evaluation. Treatment options include meal planning and dietary guidance, medications, endoscopy and keyhole surgical interventions.

Our signature programmes include non-invasive weight loss treatments such as Saxenda therapy, Elipse balloon and Endoscopic Sleeve Gastroplasty.

If you have completed your medical workup, you may be eligible for the fast-track bariatric/metabolic surgery pathway. We are also proud to offer state-of-the-art procedures for acid reflux including Linx magnetic sphincter augmentation, Barrx radio-frequency ablation and laparoscopic hiatal hernia repair.

Because we do a thorough work-up, your treatments can often be done as outpatient or day surgery.

Learn more about me here:

I am excited to be here to share/discuss abdominal symptoms, advanced endoscopy, laparoscopy and robotic surgeries with everyone. I will be actively answering questions. Whether you've got questions about cancer, acid reflux, weight loss treatment, gallstones, hernias, ask me anything!

=== Want to ask a question? Submit your question at the bottom of this page. Don’t forget to include your name and email address to get notified when the doctor answers your question.
17 Answers
Rion answered 2 years ago

My grandfather is 70 years old. He was diagnosed with stage 2 esophageal cancer. I want to know what are his chances of recovery if he is treated with targeted therapy or immunotherapy? And are there any risks, especially for an elderly patient like him?

Dr Shanker Pasupathy replied 2 years ago

Your grandfather is fortunate that his cancer was discovered early. Stage 2 esophageal cancer implies that the tumour has not spread beyond the esophagus. His best chance of cure is to remove it completely by surgery.
Normally cancer treatments are discussed at a tumour board meeting when different specialists can recommend the best combination of treatment options based on the biological behaviour (grade) and extent of spread (stage). Targeted therapies are promising new treatments with early trials showing improved results when added to traditional radiotherapy and chemotherapy. Please bear in mind that better outcomes with targeted therapies come with a higher risk of side effects.

Gurpal answered 2 years ago

It has been 3 weeks since my wife was diagnosed with stomach ulcer. Since then, she has not been able to stomach anything solid, and has only taken porridge and soup. Even juices irritates her stomach. What I am concerned about now is that she said her throat sometimes burns after vomiting. Is it a complication we should pay more attention to?

Dr Shanker Pasupathy replied 2 years ago

Sometimes it takes a few weeks before symptoms settle down and she is able to return to her normal food habits. Juices may not always be well tolerated. The best approach is to keep the portions small and slowly increase according to symptoms.
Vomiting is likely to bring up stomach acid and gastric juice into the throat. That is what causes the burning sensation. Try something soothing like a warm (dilute) honey lemon drink.

Patricia Aujla answered 2 years ago
Is an aep of 10.9 concerning?
Dr Shanker Pasupathy replied 2 years ago

Are you referring to the LES pressure? 10mmHg is on the lower limit of normal. Do you have any symptoms?

Jeremiah Lim answered 2 years ago

I often feel my esophagus tightening as I swallow my food. It hurts and it takes a lot of energy for me to eat a meal. Afterwards, i get a neck cramp. Is this a muscle problem or a sign of a condition I should be worried about?

Dr Shanker Pasupathy replied 2 years ago

You may be having a condition where your esophageal muscles are not relaxing when food is going down. Do you have the same symptoms with drinking fluids, or is it only when you take solid food? Yous should probably see a doctor/specialist for a more detailed assessment

Si Han answered 2 years ago

My 58 year old mother has Stage 2 stomach cancer and we are considering a gastrectomy as well as chemotherapy. My question is, as it is, we are planning to put my mother on the Ensure milk diet as she has difficulty swallowing solid food. Would a gastrectomy make her lose even more weight and have her absorb less nutrition?

Dr Shanker Pasupathy replied 2 years ago

There are several issues to address here.
First, has your mother already lost weight? If so, it is imperative to initiate nutrition support/supplementation prior to treatment. Ensure is a good choice as it is generally well tolerated by most patients.
Secondly, both treatments, gastrectomy and chemotherapy, will make her lose weight in different ways. You are correct that some absorptive function will be diminished after gastrectomy, but rest assured that it is routine to provide vitamin and mineral supplementation. Most patients will experience a rebound of weight 2-3 months after surgery. Chemotherapy on the other hand, may be better tolerated by some but not by others. Anorexia, mouth ulcers, vomiting and diarrhoea are potential side effects. In any case, your oncologist will titrate the chemo dose according to response and ensure that your mother is fit before continuing with the cycles.
Thirdly, since your mother has stage 2 stomach cancer, it is potentially completely resectable and therefore curable. You should not hesitate to proceed with surgery.
Finally, please request your treating doctors to refer you to the dietitian early in order to establish a proper nutrition plan and try different types of supplements. That way your mother can pick the ones she prefers and also jazz up her home cooking accordingly. I always find that nutrition preparation before surgery is one of the most important factors to prevent drastic weight loss during therapy.

R Tan answered 2 years ago

I have an ulcer in my stomach. I have had it treated with medications, including antibiotics. Although the pain is slowly relieved, I am now seeing blood in my stools. Is this an expected part of the treatment process? Are there any food or drinks I should avoid?

Dr Shanker Pasupathy replied 2 years ago

It is not normal to see blood in your stools. Please speak with your doctor about this as you may need further investigations to ascertain the cause.

Amarjeet answered 2 years ago

My uncle has stage IIA gastric cancer. He lost his appetite and I am worried this would cause his chemo treatment to not be as effective. Is it ok to give him vitamins to boost his appetite?

Dr Shanker Pasupathy replied 2 years ago

Yes of course. You should speak with a dietitian to boost his nutrition as much as possible in order to tolerate better and recover faster from his treatment.

Kok Siong answered 2 years ago

My son is 12 years old. He has been complaining about pain when swallowing and post-meal stomach aches for the past 3 days. His appetite is affected and he has lost some weight. There doesn’t seem to be a fever, but he said his body feels hot, and he drinks a lot of water to make it go away. There is no vomitting so I don’t think it’s acid reflux. Can I get your opinion on this?

Dr Shanker Pasupathy replied 2 years ago

Your son appears to have painful swallowing and loss of appetite for 3 days. This is usually due to an upper respiratory tract infection. It is a good sign that he is drinking plenty of water as fluids will keep him hydrated. Have you brought him to see a GP? Your son may benefit from a simple checkup (including body temperature, throat check, breath sounds, abdominal examination, etc.) and medications. If necessary, the GP can issue an MC for a few days rest at home.

Rui Ying answered 2 years ago

My husband has ulcerative colitis and also bad acid reflux. The last time he went for an endoscopy and colonoscopy a month ago, he was told his esophageal was quite badly affected. He takes medications everyday to control his acid reflux. My question is, is there any other way besides medications to fix his acid reflux problem for good?

Dr Shanker Pasupathy replied 2 years ago

Yes there is. Let me explain.
Acid is only produced by cells in the stomach. The esophagus is affected when stomach acid refluxes up into the esophagus. Medications can reduce the amount of acid produced but do not prevent reflux taking place, especially after a meal when the stomach is full.
In order to control reflux, it may be necessary to tighten the “lower esophageal sphincter” or the muscle that controls the junction between the esophagus and the stomach. This can be done with a “fundoplication” procedure or by placing a magnetic ring called “Linx”. Both these procedures are carried out by keyhole technique or laparoscopy.

Syazwan answered 2 years ago

Can severe gastro reflux evolve into esophageal cancer?

Dr Shanker Pasupathy replied 2 years ago

Yes. Gastric juice is rich in acid and enzymes for digestion of food. The stomach lining cells produce mucus to protect against this acid. However esophagus lining cells do not. Severe reflux will allow this acid to have prolonged contact with esophageal lining cells and potentially lead to inflammation and ulcer formation. In a small percentage of individuals, repeated episodes of inflammation and ulceration can lead to mutation of the lining cells, potentially turning into cancer.

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