1 / 21

Benign Peptic Stricture or Gastro-Esophageal Reflux Disease (GERD )

Group D Florendo-Gaspar. Benign Peptic Stricture or Gastro-Esophageal Reflux Disease (GERD ). GERD. Symptoms manifests when gastric acid and other gastric contents backflow into the esophagus →burning sensation “heartburn” Almost everyone has occasional heartburn usually after meals.

sade-brewer
Télécharger la présentation

Benign Peptic Stricture or Gastro-Esophageal Reflux Disease (GERD )

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Group D Florendo-Gaspar Benign Peptic Stricture orGastro-Esophageal Reflux Disease (GERD)

  2. GERD • Symptoms manifests when gastric acid and other gastric contents backflow into the esophagus →burning sensation “heartburn” • Almost everyone has occasional heartburn usually after meals. • If symptoms occur ≥2 a week for at least 3months, it may be a GERD.  http://www.gerd.com Harrison’s Principles of Internal Medicine, 17th edition

  3. Incidence and Epidemiology • One of the most prevalent GI disorders. • 15% of individuals have heartburn and/or regurgitation at least once a week • 7% - 10% of the population experience symptoms of heartburn daily. • Most cases of heartburn occur because of excess acid reflux • 10% of patients with functional heartburn • Many individuals control symptoms with OTC medications without consulting a medical professional, thus, is likely underreported. http://www.gerd.com Harrison’s Principles of Internal Medicine, 17th edition

  4. Incidence and Epidemiology • Occurs in all age groups • Prevalence increases in people older than 40 y/o • No sexual predilection exists (M=F) • White males are at a greater risk for Barrett esophagus and adenocarcinoma than other populations. 8-15% of patients with GERD → adenocarcinoma • 50% of patients develop esophagitis • GERD is a chronic, but treatable condition, and it is extremely common.  http://www.gerd.com Harrison’s Principles of Internal Medicine, 17th edition

  5. Pathophysiology • The LES plays an important role in digestion. • It may open more often than it should or it may open at the wrong times, allowing stomach acid to back up into the esophagus. • This can be extremely painful. • If this continues for a long time, a portion of the esophagus can become “raw.” This is called erosive esophagitis and it can lead to serious medical problems (scarring, bleeding and ulcers) http://www.gerd.com

  6. Etiologies • Reflux happens when gradient b/w LES and stomach is lost and is usually due to transient or sustained decrease in LES tone. • Transient hypotension of LES is due to: • Vagovagal reflex Harrison’s Principles of Internal Medicine, 17th edition

  7. Etiologies • Sustained hypotension of LES may be due to: • Muscle weakness • Scleroderma-like diseases • Myopathy associated with chronic intestinal pseudoobstruction • Pregnancy • Smoking • Anticholinergic drugs • Smooth-muscle relaxants • Surgical damage to the LES, and esophagitis Harrison’s Principles of Internal Medicine, 17th edition

  8. Other causes of Reflux • Increase in gastric volume • After meals with pyloric obstruction, gastric stasis, acid hypersecretion state • Close proximity of gastric contents to the GEJ • Recumbency, bending down, hiatal hernia • Increase in gastric pressure • Obesity, pregnancy, ascites, tight clothes Harrison’s Principles of Internal Medicine, 17th edition

  9. Complications • Reflux esophagitis • Mild esophagitis • Erosive esophagitis • Peptic stricture Harrison’s Principles of Internal Medicine, 17th edition

  10. Reflux esophagitis • Develops when the damage caused by acid, pepsin, and bile cannot be counteracted by the mucosal defenses Harrison’s Principles of Internal Medicine, 17th edition

  11. Mild esophagitis • Micsoscopic changes • Mucosal infiltration with granulocytes, or small numbers of eosinophils • Hyperplasia of basal cells • Elongation of dermal pegs Harrison’s Principles of Internal Medicine, 17th edition

  12. Erosive esophagitis • Mucosal damage with redness, friability, superficial linear ulcers, exudates • Histology • Polymorphonuclear infiltrates • Mild eosinophilic infiltrates • Granulation tissue . • May heal by intestinal metaplasia →Barrett’s esophagus Harrison’s Principles of Internal Medicine, 17th edition

  13. Peptic stricture • Luminal constriction resulting from fibrosis • 2 types: • Short strictures • 1-3 cm • seen in the distal esophagus, near the GEJ caused by spontaneous reflux • Long/Tubular strictures • Caused by persistent vomiting or by prolonged NGT intubation Harrison’s Principles of Internal Medicine, 17th edition

  14. Clinical Features • Heartburn • Regurgitation of sour material into the mouth

  15. Heartburn • Induced by the contact of refluxed material with the sensitized or ulcerated esophageal mucosa • Angina like/ atypical chest pain

  16. Diagnosis

  17. Barium Swallow • Esophagoscopy • Mucosal biopsies Mucosal injury • Berstein test

  18. Long-term (24–48 h) • esophageal pH recording Reflux

  19. Management decisions Patho- physiologic factors

  20. Treatment Goals of Treatment : • provide symptom relief • heal erosive esophagitis • prevent complications.

More Related