Mallory-Weiss syndrome and corrosive injury are caused by vomiting and corrosive ingestion respectively, leading to tears in the gastric mucosa or esophagus. GERD is caused by reflux of gastric acid into the esophagus due to incompetence of the lower esophageal sphincter, resulting in inflammation and ulcers. Hiatal hernia is a protrusion of the stomach through the esophageal hiatus that can cause reflux. Barret's esophagus is a complication of longstanding GERD where the esophageal mucosa is replaced by intestinal metaplasia, increasing the risk of esophageal adenocarcinoma.

1. MALLORY-WEISS SYNDROMEMALLORY-WEISS SYNDROME
 Vigorous vomiting-vert split in the gastricVigorous vomiting-vert split in the gastric
mucosa (below sc jn at the cardia)- 90%mucosa (below sc jn at the cardia)- 90%
 Tear in the oesophagus-10%Tear in the oesophagus-10%
 Presents with hematemesisPresents with hematemesis
 endoscopic injection therapy requird 4 severeendoscopic injection therapy requird 4 severe
casescases

3. CORROSIVE INJURYCORROSIVE INJURY
 Corrosive-sod hydroxide,sulphuric acidCorrosive-sod hydroxide,sulphuric acid
 Accidental ingestion-damageAccidental ingestion-damage
2nouth,pharynx,larynx,oeso,stomach2nouth,pharynx,larynx,oeso,stomach
 Alkalies causeliquifaction,saponification ofAlkalies causeliquifaction,saponification of
fat,dehydration and thrombosis of bv- fibrousfat,dehydration and thrombosis of bv- fibrous
scarringscarring
 Acids-coagulative necrosis with eschar formationAcids-coagulative necrosis with eschar formation
-causes intense pylorospasm with pooling-causes intense pylorospasm with pooling
in the antrum(more gastric damage)in the antrum(more gastric damage)

4. Investigaion- endoscopy
-deep ulcers n black eschars-greatest
risk of perforation
Managemnt-minor injury- pt safely fed
sev injury-feeding jejunostomy
Complication-stricture formation-50%
(oeso resection)

6. GORDGORD
 Loss of competence of LOSLoss of competence of LOS
 Competence affected-obesity,smoking nCompetence affected-obesity,smoking n
excissive eatingexcissive eating
 Gastric acid reflux- extensive inflammmation ofGastric acid reflux- extensive inflammmation of
lower oeso- oesophagitislower oeso- oesophagitis
 Types-a/c – alcohol,burns,stressTypes-a/c – alcohol,burns,stress
c/c – hitus hernia,oesophagojejunostomyc/c – hitus hernia,oesophagojejunostomy

7. PRECIPITATING FACTORS-
 1.structurally defective LOS
 2.short length of oesophagus
 3.ineffective oesophageal
pump(influenced by gravity,oeso motility,salivation)
 4.increased gastric pressure

8. overeating/ingestion of irritants
gasrtic distension
unfolding of sphincter
terminal s epi of oeso exposed to acid
erosion,ulceration,fibrosis,metaplasia
barret”s oeso
AdenoCa

9. AetiopathogenesisAetiopathogenesis
 Acid reflux to LOS – diffuse inflmn withAcid reflux to LOS – diffuse inflmn with
multiple ulcersmultiple ulcers
 Symptoms worse when patient lies downSymptoms worse when patient lies down
 Vicious cycleVicious cycle
 vagal hypersensitivity – oesophagitis –vagal hypersensitivity – oesophagitis –
long muscle spasm – displacement oflong muscle spasm – displacement of
oesophagus – increased regurgitationoesophagus – increased regurgitation

10. CLINICAL FEATURESCLINICAL FEATURES
 Retrosternal painRetrosternal pain
 Epigastric painEpigastric pain
 RegurgitationRegurgitation
 Occult blood in stoolsOccult blood in stools
 Anaemia & weaknessAnaemia & weakness
 Dysphagia(sricture)Dysphagia(sricture)
 Atypical symp – Angina like chest pain , pulm orAtypical symp – Angina like chest pain , pulm or
laryngeal symplaryngeal symp

11. DIAGNOSISDIAGNOSIS
 Assume rather than prevent – Rx isAssume rather than prevent – Rx is
empericalemperical
 Investigations – when patient does notInvestigations – when patient does not
respond to ppirespond to ppi
 24 hr ph recording – gold std24 hr ph recording – gold std
 TLOSR – manometric findingTLOSR – manometric finding
 Ba swallow( in trendelenburg position)Ba swallow( in trendelenburg position)
 OesophagoscopyOesophagoscopy

12. MEDICAL MANAGEMENTMEDICAL MANAGEMENT
 Alcohol minimisedAlcohol minimised
 Loose weightLoose weight
 Coffee & tea minimisedCoffee & tea minimised
 Oeso mucosal protecters(Antacids,H2 blockers)Oeso mucosal protecters(Antacids,H2 blockers)
 Head up tiltHead up tilt
 Oily& spicy food avoidedOily& spicy food avoided
 Large meal avoided at nightLarge meal avoided at night
 PPI most effective drug Rx (8 wks)PPI most effective drug Rx (8 wks)

13. SURGERYSURGERY
 Endoscopic treatmentsEndoscopic treatments
 Surgical treatments –Surgical treatments –
uncomplicated gord –pt”s choiceuncomplicated gord –pt”s choice
Symptomatic on PPI(volume reflux ,Symptomatic on PPI(volume reflux ,
hermit lifestyle , poor compliance)hermit lifestyle , poor compliance)
Laproscopic fundoplicationLaproscopic fundoplication

14. COMPLICATIONSCOMPLICATIONS
 Barret”s oesophagusBarret”s oesophagus
 StrictureStricture
 Oesophageal shorteningOesophageal shortening

15. HIATUS HERNIAHIATUS HERNIA
 Abnormal protrusion of abdominal viscusAbnormal protrusion of abdominal viscus
through oesophageal hiatus into chest.through oesophageal hiatus into chest.
 TYPESTYPES
 1.Sliding hernia(oesophageo gastric1.Sliding hernia(oesophageo gastric
hernia) – 80%hernia) – 80%
 2.Rolling or paraoesophageal hernia2.Rolling or paraoesophageal hernia
 3.Mixed hernia3.Mixed hernia
 4.Massive herniation4.Massive herniation

16. Common symptomsCommon symptoms
 1.Symptoms due to reflux(reflux &heart1.Symptoms due to reflux(reflux &heart
burn)burn)
 2.Symptoms due to2.Symptoms due to
complications(dysphagia,complications(dysphagia,
odynophagia,hematemesis, melaena)odynophagia,hematemesis, melaena)
 3.Nonoesophageal synp(asthma & chest3.Nonoesophageal synp(asthma & chest
pain )pain )

18. SLIDING HERNIASLIDING HERNIA
 Anatomical factors which prevent slidingAnatomical factors which prevent sliding
herniahernia
 1.Presence of 2 cm of intraabd1.Presence of 2 cm of intraabd
oesophagusoesophagus
 2.The angle of His2.The angle of His
 3.Mucosal folds at oesophageocardial jn3.Mucosal folds at oesophageocardial jn
 4.+ intraabd pressure4.+ intraabd pressure
 5.LOS5.LOS

20. CausesCauses
 1.The position of fatty tissue in the hiatus1.The position of fatty tissue in the hiatus
 2.Advancing age – mus degeneration2.Advancing age – mus degeneration
 3.Lower abd trs , preg – raised intraabd3.Lower abd trs , preg – raised intraabd
pressurepressure
 4.Saint”s triad- Gallstone , diverticulosis,4.Saint”s triad- Gallstone , diverticulosis,
hiatus herniahiatus hernia

21. CF
like reflux oesophagitis
commom in women,obese
INVESTIATIONS
Oesophagoscopy- reflux of the gastric acd –
most valuable sign.
Ba meal- gord in trendelemburg

22. TREATMENT
 1.Conservative treatment
Principles:
1.Lifestyle changes
-decrease in wt
-Diet cntrol
-decreasd alcohol n tobecco consumption
2.Oesophageal mucosa protection
-Antacids
-H2 blockers
-PPI

23. SurgerySurgery
 IndicationsIndications
-Intractable pain-Intractable pain
-Complication –hge or stricture-Complication –hge or stricture
Types of surgeryTypes of surgery
1.Nissen”s total fundoplication1.Nissen”s total fundoplication
2.Partial fundplication(Tupet)2.Partial fundplication(Tupet)
3.Belsey mark IV operation3.Belsey mark IV operation
4.Hill”s repair4.Hill”s repair

25. ROLLING HERNIAROLLING HERNIA
 Cardio –oeso jn is normal.Cardio –oeso jn is normal.
 Greater curvature of stomach ascends intoGreater curvature of stomach ascends into
a preformed sac in mediastinum.a preformed sac in mediastinum.
 Compression of heart & lung.Compression of heart & lung.

26. Clinical FeaturesClinical Features
 No retrosternal burning painNo retrosternal burning pain
 Discomfort after a small mealDiscomfort after a small meal
 Feeling of fullness after meal or dysphagiaFeeling of fullness after meal or dysphagia
 PalpitationsPalpitations
 RTI or hiccough (phrenic nerve irritation)RTI or hiccough (phrenic nerve irritation)

27. InvestigationInvestigation
Ba mealBa meal
RxRx
 Reduction of sac &repair of hiatusReduction of sac &repair of hiatus
MIXED HERNIAMIXED HERNIA
Both rolling & sliding hernia +Both rolling & sliding hernia +
Symptoms & Rx - mixedSymptoms & Rx - mixed

29. BARRET”S OESOPHAGUSBARRET”S OESOPHAGUS
 When columnar mucosa extends at least 3When columnar mucosa extends at least 3
cm into oesophaguscm into oesophagus
 Intestinal metaplasiaIntestinal metaplasia
PathogenesisPathogenesis
 Rptd reflux –Shifting of oesogastric jnRptd reflux –Shifting of oesogastric jn
upwards – Further increase in reflux –upwards – Further increase in reflux –
Intestinal metaplasia of middle & lowerIntestinal metaplasia of middle & lower
oesooeso

31. PATHOLOGICAL TYPESPATHOLOGICAL TYPES
 1.Gastric type – Chief & parietal cells1.Gastric type – Chief & parietal cells
 2.Intestinal type – Goblet cells2.Intestinal type – Goblet cells
 3. junctional type – Mucous glands3. junctional type – Mucous glands
CLINICAL TYPESCLINICAL TYPES
-Long segment : Metaplastic changes more-Long segment : Metaplastic changes more
than 3cmthan 3cm
-Short segment:Changes less than 3 cm-Short segment:Changes less than 3 cm

32. Incidence of malignancyIncidence of malignancy
 Lower &Midle oeso more prone to developLower &Midle oeso more prone to develop
CACA
 CA will be invasive & more proximalCA will be invasive & more proximal
TYPES OF DYSPLASIATYPES OF DYSPLASIA
-Low grade : negligible risk for ca-Low grade : negligible risk for ca
-High grade :very high risk for ca-High grade :very high risk for ca

33. RxRx
 Laser photodynamic therapyLaser photodynamic therapy
 Argon beam plasma coaulationArgon beam plasma coaulation
 Lap antireflux surgeryLap antireflux surgery
 High dose PPIHigh dose PPI
 Oesophagectomy(High grade dysplasia)Oesophagectomy(High grade dysplasia)
ComplicationsComplications
 1. Oesophageal ulcers1. Oesophageal ulcers
 2.Oesophageal strictures2.Oesophageal strictures
 3.Dysplasia & adenoca3.Dysplasia & adenoca