Gastroenterology treatment in India
Digestive problems cover everything from a gallbladder that needs removing to liver disease that needs managing for life. Most of it is now done through an endoscope or keyhole surgery, which means short stays. This page covers what is worth travelling for and what is better handled at home.
- Commonly treated
- Gallstones, acid reflux, swallowing problems, liver disease, IBD, hernia
- Indicative cost
- Endoscopic pyloric dilatation $4,000; achalasia surgery $4,500–5,000
- Approach
- Mostly endoscopic or keyhole, so short stays and small scars
- Liver disease
- Assessed here; transplant is covered on its own page
- Time in India
- Often 1 to 2 weeks for straightforward surgery
- First step
- A gastroenterologist reviews your scans, scopes and blood results on video, free
Gallstones and the gallbladder
Gallstones are among the commonest reasons for GI surgery anywhere. Many people have them without knowing; the ones that cause trouble produce pain in the upper right abdomen after fatty meals, sometimes with nausea, and occasionally jaundice or fever if a stone escapes into the bile duct.
Removing the gallbladder, a cholecystectomy, is done laparoscopically through several small incisions, and you live perfectly well without it: bile simply drips continuously into the intestine rather than being stored. Most people are eating normally within days, though some notice looser stools after very fatty meals for a few months.
Two things worth knowing. Silent gallstones found incidentally on a scan usually do not need surgery, so an operation offered on the strength of a scan alone deserves a second opinion. And gallbladder cancer is significantly more common in India than in most of the world, which means Indian surgeons are unusually alert to a thickened gallbladder wall or a polyp on imaging. If your scan mentions either, see gallbladder cancer and get it looked at properly rather than assuming it is ordinary stones.
Endoscopy: looking, and treating
An endoscope is a flexible camera passed through the mouth to examine the gullet, stomach and the first part of the small intestine, or through the back passage to examine the colon. It is usually done with sedation and takes minutes.
Increasingly it is not only diagnostic. Bleeding ulcers are treated through it, polyps are removed through it, narrowings are stretched through it, and stents are placed through it to relieve blockages. ERCP, a specialised version, clears stones from the bile duct without surgery. Getting a therapeutic endoscopy rather than an operation is usually the better outcome and worth asking about explicitly.
Difficulty swallowing
Food sticking, or a sensation of it not going down, is a symptom that always deserves investigation rather than reassurance. It has two very different common causes.
- Achalasia, where the muscular valve at the bottom of the gullet fails to relax. It is benign but progressive and it responds well to treatment. A laparoscopic Heller's cardiomyotomy divides the tight muscle and is priced at an indicative $4,500 to $5,000 with a five-day stay. Endoscopic dilatation is the less invasive alternative.
- A narrowing or a tumour of the gullet, which is a different matter entirely and needs urgent endoscopy. See oesophageal cancer.
The distinction is made by endoscopy, not by how the symptom feels, which is why persistent difficulty swallowing should never be treated with acid tablets and left.
Acid reflux and hernia
Persistent heartburn is usually managed with medication and lifestyle change, and most people never need surgery. Where reflux is severe, does not respond to medication, or is driven by a large hiatus hernia, an operation to reinforce the valve can be considered. Long-standing reflux also changes the lining of the lower gullet in some people, which needs monitoring by endoscopy rather than ignoring.
Liver disease
Chronic hepatitis B and C, fatty liver disease and alcohol-related liver disease are the commonest paths to cirrhosis. The important message is that all of them are far more treatable before the liver scars than after.
Hepatitis C is now curable in most people with a course of tablets taken for a few months, and those medicines are made in India and are dramatically less expensive here than in most countries. Hepatitis B is usually controlled rather than cured, with long-term antiviral treatment that protects the liver. Fatty liver responds to weight loss, and where obesity is severe, weight loss surgery can reverse a great deal of it.
Where scarring has already progressed to the point of liver failure, see liver transplant. Where a tumour has developed in a cirrhotic liver, see liver cancer.
Inflammatory bowel disease
Crohn's disease and ulcerative colitis are lifelong conditions managed with medication rather than cured by surgery, though surgery has a role in complications. They are worth mentioning here for one practical reason: the modern biologic drugs that control them well are expensive in most countries, and biosimilar versions manufactured in India cost a fraction of the originator price. If you have been told you need a biologic and cannot afford it at home, that is a specific and reasonable thing to raise at a consultation.
| Procedure | Indicative cost | Hospital stay |
|---|---|---|
| Endoscopic pyloric dilatation | $4,000 | In your estimate |
| Laparoscopic Heller's cardiomyotomy (achalasia) | $4,500–5,000 | 5 days |
| Sleeve gastrectomy / bariatric surgery | $6,000 | 2–3 days |
| Radical cholecystectomy (gallbladder cancer) | $6,500 | 5 days |
| Whipple's pancreaticoduodenectomy | $9,000 | 7–10 days |
| Liver resection | $10,000–11,000 | 7–8 days |
Questions patients ask
How much does gallbladder surgery cost in India?
Laparoscopic gallbladder removal is not listed separately on the partner price list we publish from, so we do not quote a figure for it. Related upper-GI procedures are listed: endoscopic pyloric dilatation at $4,000 and achalasia surgery at $4,500 to $5,000 with a five-day stay. Your written estimate follows a specialist's review of your scans.
Do I need my gallbladder removed if stones were found on a scan?
Not necessarily. Gallstones found incidentally, with no symptoms, usually do not need surgery. Stones causing pain after fatty meals, jaundice or infection generally do. An operation offered on the strength of a scan alone, without symptoms, is worth a second opinion.
Can I live normally without a gallbladder?
Yes. The gallbladder stores bile rather than making it, so afterwards bile drips continuously into the intestine instead. Most people eat normally within days. Some notice looser stools after very fatty meals for a few months, which usually settles.
Food keeps sticking when I swallow. What does that mean?
It always needs investigating with an endoscopy rather than treating with acid tablets. The two common causes are achalasia, a benign failure of the valve at the bottom of the gullet that treats well, and a narrowing or tumour of the gullet, which needs urgent attention. Only endoscopy tells them apart.
Is hepatitis C curable?
In most people, yes, with a course of tablets taken over a few months. The medicines are manufactured in India and cost dramatically less here than in many countries. Hepatitis B is different: it is usually controlled with long-term antiviral treatment rather than cured, which still protects the liver very effectively.
I have been told I need a biologic drug for Crohn's disease but cannot afford it.
Raise it specifically at the consultation. Biosimilar versions of these drugs are manufactured in India at a fraction of the originator price, and for some patients that is the difference between a treatment being possible and not. A gastroenterologist can advise on what applies to your case.
How long would I need to be in India?
For straightforward laparoscopic surgery or a therapeutic endoscopy, often one to two weeks in total including tests beforehand and a check before flying. Liver and pancreatic surgery need considerably longer. Your specialist will give a timeline with the written estimate.