Gi system disease

1. AGENDA
1-Gastroesophageal
reflux disease
2-inflammatory
esophageal disorder
3-esophageal motility
disorder
4-other types of
esophageal disorders

2. GASTROESOPHAGEAL REFLUX DISEASE
Defenition:
Prevalence:
 Affects 20-50% of population in
European countries(20million people
daily experience heartburn)
 10% of population everyday 20%
experience it weekly
 Prevalence in Iran 21.2% Higher in
Asian countries

3. PATHOGENESIS
‫های‬ ‫فکتور‬ ‫و‬ ‫مری‬ ‫محافظوی‬ ‫های‬ ‫فکتور‬ ‫میان‬ ‫موازنه‬ ‫خوردن‬ ‫برهم‬
‫معده‬ ‫حملوی‬
Antireflux barrier
 LES: 3-4cm lower of esophagys, pressure during rest is
10-35mmhg.damaged by cck
antahonist,anticholinergic,somatostation,morphine,Gaba
agonist, Cigarettes
Hiatal hernia decrease LES pressure
 Esophageal acid clearance
 Volume clearance:15ml
 Acid clearance:Salive PH 6.4-7.8
 Tissue resistance

4. PREDISPOSING FACTORS
I. Gastric Acid secretion
 Acid
 Pepsin
I. Duodenogastric reflux
 Bile Acids
I. Delayed gastric emptying
 Gastroparesis
 Partial gastric outlet obstruction

5. CLINICAL
MANIFESTATIONS
Heart burn
Regurgitation
Dysphagia
Less common:
• Water brash
• Odynophagia
• Hiccup
• Nause and vomiting
• Burping

6. EXTRAESOPHAGEAL
MANIFESTATIONS
 Chest pain
o Similar to Angina pectoris
o Located substernal
 Asthma and pulmonary
disease
• In 30% of cases GERD is
associated by Asthma
• Cause chronic cough in 20%
• Aspiration
pneumonia,Interstitial
pulmonary fibrosis, Chronic
Bronchitis,Bronchiectasis,Cystic
fibrosis

7. DIAGNOSIS
 Esophagoscopy:Savary miller grading
 Bernstein test
 Therapeutic trial
 Esophageal PH monitoring

8. COMPLICATIONS
Barrett’s
esophagus
 Long segment
 Short segment
• Low Grade dysplasia’
• High grade dysplasia
 Treatment:PPI,Esopha
gectomy,Ablation,res
ection

9. ADENOCARCINOMA
OF ESOPHAGUS

10. Peptic
Stricture
 Heartburn is relieved
 Endoscopy and
biopsy
Treatment
I. Balloon dilatation
II. Polyvinyl catheter
III. Triamcinolone

11. DIFFERENTIAL DIAGNOSIS OF GERD
cardiovascular
Angina
pectoris
Esophagitis
Pill induced
espophagitis
Infectious
esophagitis
Radiation
esophagitis
Gastric
Peptic
ulcer
Achalasia,DES
Esophagea
l motility
disorder
functional
Non ulcer
dyspepsia

12. TREATMENT
Mild intermittent symptoms
 Lifestyle modification
o Sleeping 3h after dinner
o Head elevation 6 inches
o Avoid foods high in
fat,tomato,spicy foods,alcohol
,cigarettes coffee
 Antiacids
 H2 receptor blockers
Troublesome symptoms
 PPI +Sodium bicarbonate OD for
4-8 weeks-8-12 weeks
 In barrett’s esophagitis,severe
esophagitis,peptic stricture PPI BID
 Unresponsive patients:High dose
PPI
o Omeprazole 40mg BID
o Seek for ZES,pill induced
esophagitis in refractory cases

13. SURGERY
Surgical fundoplication
Indication for surgery?

14. INFLAMMATORY ESOPHAGEAL DISORDERS
Viral esophagitis
• HSV,VZV,CMV,HIV
Bacterial esophagitis
• Lactobacillus,B-
hemolytic
streptococcus,TB
mycobacterium
Fungal esophagitis
• Candida esophagitis
Other types
• Radiation,Corrosive,pill
induced,Diverticula,We
bs and
rings,eosonophillic

15. Viralesophagitis
 Symtpoms:dysphagia,odynophagia,Chest
pain,hematemesis
 Diagnosis:Endoscopy,Culture,Biospy
 Treatment: Acyclovir 400mg 5times in a day,
for 14-21days Foscarnet 90mg/kg Bid 2-3w
Ganciclovir 5mg/kg Bid
 Glucocorticoids or thalidomide
Fungalesophagitis
 Candida
 Syptoms:dysphagia,odynophagia
 Diagnosis:filling defect ,grape
clusters,yellow and white patchy plaques
in endoscopy yeast or hyphaloform
 Treatment:fluconazole 200 state then
100mg OD for 7d Amphotericin B 10-
15mg qid for 7 Nystatin 10-20ml
suspension Qid

16. OTHER TYPE OF ESOPHAGEAL DISORDER
Radiation
esphagitis
 Doxorubicin,Bleomycin
,Cisplantin
 Stymptoms are
dysphagia and
odynophagia
 Treatment :viscous
lidocaine,indomethacin
Corrosive
esophagitis
 Caustic agent
 Dilator is for opening
strictures
Pill induced
esophagitis
 NSAIDs:Aspirin, Naproxen ,Ibuprofen
 Biphosphonates:Aldendronate,Etidronat
e ,pamidronate
 Antiviral
drugs:Nelfanavir,Zidovudine,Zalcitibine
 Antibiotics:Tetracycline,doxyxyline,Clinda
mycin,pencillins
 Chemotherapeutic agent;Doxurubicin
,bleomycin,Cisplantin
 Others:
Theophylline,multivitamin,vitamin
C,KCL,ferrous sulfate

17. ESOPHAGEAL
DIVERTICULA
‫است‬ ‫مری‬ ‫جدار‬ ‫زدگی‬ ‫بیرون‬ ‫از‬ ‫عبارت‬
I. Zenkers diverticulum
Location: posterior hypopharyngeal wall
Symptoms: Halitosis, Dysphagea ,
esophageal obstruction, regurgitation of saliva
I. Epiphrenic diverticula
Rarely casue symptoms
I. Diffuse intramural diverticulosis
cause strictures and chronic candidiasis
Treatment
Diverticulectomy

18. ESOPHAGEAL WEBS
AND RINGS
 Either Inflammatory or
congenital
 Affects 10% of people
 The only symptoms is
Episodic dysphagia to solids
 Contractile ring ‫عضلی‬ ‫حلقه‬
 Schatzki ring‫مخاطی‬ ‫حلقه‬

19. SHATZKI’S RING

20. EOSINOPHILLIC
ESOPHAGITIS
Allergens & Antigens
Clinical findings:
 Heartburn,Dysphagia
 Children:Abdominal pain,Chest Pain,🤮vomiting
Laboratory findings:
o Eosinophilia
o IGE level is high
o Barium radiography shows multiple concentric rings
o Endoscopy,Biopsy,Histology
o Tests for allergen
Treatment
 PPI BID
 Avoid Eggs,Walnut,Soya,Wheat
 Corticosteroids:Budesonide,futicasone

21. ESOPHAGEAL
MOTILITY DISORDER
1-Achalasia
2-Diffuse
esophageal
spasm
3-Scleroderma
esophagus

22. ACHALASIA
Defenition:
Clinical findings:Chest pain, Dysphagia,Regurgitation
Diagnosis:
 Radiography with barium
 Manometry
 Cholecystokinin test
 Endoscopy
Treatment:Nitrates, Nifedipine,Botulinum injection, Ballon
dilation,Hellers myotomy

23. DIFFUSE ESOPHAGEAL SPASM
Defenition and pathophysiology:
Clinical findings:Chest pain, Dysphagia
Diagnosis:
 Radiography with barium
 Manometry
Treatment:Nitrates,
Nifedipine,Tranquilizers,Anticholinergics(dicylomine)
SAMPLE FOOTER TEXT 20XX 23

24. SCLERODERMA
ESOPHAGUS
DYSMOTILITY
Defenition:Affects 80% of
systemic sclerosis patients
Clinical findings:Heratburn,
Dysphagia,Regurgitation
Diagnosis:
 Radiography with barium
 Manometry
Treatment:Fluids ,PPI