The document discusses surgical treatments for gastroesophageal reflux disease (GERD) and achalasia performed by surgeons at Beth Israel Medical Center, including minimally invasive procedures like laparoscopic fundoplication and myotomy which provide relief for patients with these conditions. It also provides an overview of the general surgery division and some of the conditions they treat ranging from hernias and gallbladder disease to obesity and trauma.
This document provides an overview of gastroesophageal reflux disease (GERD). It defines GERD as symptoms or complications resulting from reflux of gastric contents into the esophagus. Approximately 15% of US adults are affected by GERD based on reports of chronic heartburn. The pathophysiology involves transient lower esophageal sphincter relaxations and impaired esophageal clearance allowing gastric acid and other contents to reflux into the esophagus and cause inflammation. Clinical manifestations include heartburn, regurgitation, dysphagia, and chest discomfort. Diagnostics include endoscopy, pH monitoring, and manometry. Differential diagnoses require excluding other causes of esophageal symptoms.
Mr. Sankappa
Definition
Gastro esophageal reflux disease is a chronic and relapsing condition in which prolonged reflux of hydrochloric acid, pepsin and bile salts in the esophagus, oral cavity and respiratory system occurs that leads to esophagitis
Excessive intake of junk foods, coffee, chocolate
Excessive intake of onion, tomato, and beverages
Heavy exercise
Alcoholic and smoking
Medications
Heartburn
Discomfort
Chest pain
Difficulty in respiration
Aspiration pneumonia
After endoscopy the lesions are graded for severity using the Savary Miller grading system;
Grade 1: single or multiple erosions on a single fold.
Grade 2: multiple erosions affecting multiple folds. Erosions may be confluent.
Grade 3: multiple circumferential or rounded erosions.
Grade 4: ulcer, stenosis or esophageal shortening.
Grade 5: Barrett's epithelium. Columnar metaplasia (cellular changes on the microscopic level) in the form of circular or non-circular (islands or tongues) extensions.
Pathophysiology
Management
Antacids: An antacid is a substance which neutralizes stomach acidity, used to relieve heartburn, indigestion or an upset stomach (ex: Rantac, Zantac)
H2receptor antagonist: H2 antagonists block histamine-induced gastric acid secretion from the parietal cells of the gastric mucosa. They include cimetidine, famotidine, nizatidine
Proton Pump Inhibitors: Proton pump inhibitors (PPIs) reduce the production of acid by blocking the enzyme in the wall of the stomach that produces acid (Omeprazole, Rabeprazole, pantoprazole)
Cholinergic drugs:Cholinergic drug, any of various drugs that inhibit, enhance, or mimic the action of the neurotransmitter (acetylcholine, carbachol, methacholine)
Cytoprotective drugs: is a process by which chemical compounds provide protection to cells against harmful agents (carbenoxolone, sucralfate, misoprostol)
Prokinetic drugs: prokinetic, is a type of drug which enhances gastrointestinal motility by increasing the frequency of contractions in the small intestine or making them stronger, but without disrupting their rhythm. (Benzamide, Cisapride, Domperidone).
Endoscopic intraluminal valvuloplasty
Gastric tissue is utilised to increase the integrity of LES By creating a valve like structure.
This document provides information on Gastroesophageal Reflux Disease (GERD). It defines GERD as abnormal reflux of gastric contents into the esophagus causing troublesome symptoms or complications, with more than 2 heartburn episodes per week. Approximately 20% of adults experience frequent GERD symptoms. The document discusses the pathogenesis, risk factors, diagnosis and diagnostic tests, and treatment options for GERD including pharmacologic therapies, surgery, and endoscopic treatments. It provides details on classifications of esophagitis, guidelines for endoscopy and pH monitoring in GERD diagnosis and management.
GERD is caused by pathological reflux of gastric or duodenal contents into the esophagus past the lower esophageal sphincter. It is the most common upper GI condition in western countries. Diagnosis involves endoscopy, pH monitoring, and manometry. Treatment includes lifestyle changes, proton pump inhibitors, fundoplication surgery, and newer endoscopic procedures. Complications may include esophagitis, stricture, Barrett's esophagus, and adenocarcinoma if left untreated.
Gastric volvulus and other types of volvulusPrabha Om
Bhori Singh, a 45-year-old male, presented with abdominal pain, distension and inability to pass flatus or stool for the past few days. Examination and investigations revealed acute intestinal obstruction likely due to gastric volvulus or perforation peritonitis. He underwent an exploratory laparotomy with gastropexy where gastric volvulus was found and repaired by suturing the stomach to the abdominal wall. Post-operatively, he recovered well and was discharged on the 8th day. Gastric volvulus is the twisting of the stomach and can be acute or chronic. Treatment involves endoscopic or surgical reduction and fixation of the stomach to prevent recurrence.
Gastro esophageal Reflux Disease (GERD) and its managementDr. Ankit Gaur
In this presentation I have tried to explain in brief about gastro esophageal Reflux Disease (GERD), its etiology, risk factors, diagnosis, and its management via pharmacotherapy.
This document provides an overview of gastroesophageal reflux disease (GERD). It defines GERD as symptoms or complications resulting from reflux of gastric contents into the esophagus. Approximately 15% of US adults are affected by GERD based on reports of chronic heartburn. The pathophysiology involves transient lower esophageal sphincter relaxations and impaired esophageal clearance allowing gastric acid and other contents to reflux into the esophagus and cause inflammation. Clinical manifestations include heartburn, regurgitation, dysphagia, and chest discomfort. Diagnostics include endoscopy, pH monitoring, and manometry. Differential diagnoses require excluding other causes of esophageal symptoms.
Mr. Sankappa
Definition
Gastro esophageal reflux disease is a chronic and relapsing condition in which prolonged reflux of hydrochloric acid, pepsin and bile salts in the esophagus, oral cavity and respiratory system occurs that leads to esophagitis
Excessive intake of junk foods, coffee, chocolate
Excessive intake of onion, tomato, and beverages
Heavy exercise
Alcoholic and smoking
Medications
Heartburn
Discomfort
Chest pain
Difficulty in respiration
Aspiration pneumonia
After endoscopy the lesions are graded for severity using the Savary Miller grading system;
Grade 1: single or multiple erosions on a single fold.
Grade 2: multiple erosions affecting multiple folds. Erosions may be confluent.
Grade 3: multiple circumferential or rounded erosions.
Grade 4: ulcer, stenosis or esophageal shortening.
Grade 5: Barrett's epithelium. Columnar metaplasia (cellular changes on the microscopic level) in the form of circular or non-circular (islands or tongues) extensions.
Pathophysiology
Management
Antacids: An antacid is a substance which neutralizes stomach acidity, used to relieve heartburn, indigestion or an upset stomach (ex: Rantac, Zantac)
H2receptor antagonist: H2 antagonists block histamine-induced gastric acid secretion from the parietal cells of the gastric mucosa. They include cimetidine, famotidine, nizatidine
Proton Pump Inhibitors: Proton pump inhibitors (PPIs) reduce the production of acid by blocking the enzyme in the wall of the stomach that produces acid (Omeprazole, Rabeprazole, pantoprazole)
Cholinergic drugs:Cholinergic drug, any of various drugs that inhibit, enhance, or mimic the action of the neurotransmitter (acetylcholine, carbachol, methacholine)
Cytoprotective drugs: is a process by which chemical compounds provide protection to cells against harmful agents (carbenoxolone, sucralfate, misoprostol)
Prokinetic drugs: prokinetic, is a type of drug which enhances gastrointestinal motility by increasing the frequency of contractions in the small intestine or making them stronger, but without disrupting their rhythm. (Benzamide, Cisapride, Domperidone).
Endoscopic intraluminal valvuloplasty
Gastric tissue is utilised to increase the integrity of LES By creating a valve like structure.
This document provides information on Gastroesophageal Reflux Disease (GERD). It defines GERD as abnormal reflux of gastric contents into the esophagus causing troublesome symptoms or complications, with more than 2 heartburn episodes per week. Approximately 20% of adults experience frequent GERD symptoms. The document discusses the pathogenesis, risk factors, diagnosis and diagnostic tests, and treatment options for GERD including pharmacologic therapies, surgery, and endoscopic treatments. It provides details on classifications of esophagitis, guidelines for endoscopy and pH monitoring in GERD diagnosis and management.
GERD is caused by pathological reflux of gastric or duodenal contents into the esophagus past the lower esophageal sphincter. It is the most common upper GI condition in western countries. Diagnosis involves endoscopy, pH monitoring, and manometry. Treatment includes lifestyle changes, proton pump inhibitors, fundoplication surgery, and newer endoscopic procedures. Complications may include esophagitis, stricture, Barrett's esophagus, and adenocarcinoma if left untreated.
Gastric volvulus and other types of volvulusPrabha Om
Bhori Singh, a 45-year-old male, presented with abdominal pain, distension and inability to pass flatus or stool for the past few days. Examination and investigations revealed acute intestinal obstruction likely due to gastric volvulus or perforation peritonitis. He underwent an exploratory laparotomy with gastropexy where gastric volvulus was found and repaired by suturing the stomach to the abdominal wall. Post-operatively, he recovered well and was discharged on the 8th day. Gastric volvulus is the twisting of the stomach and can be acute or chronic. Treatment involves endoscopic or surgical reduction and fixation of the stomach to prevent recurrence.
Gastro esophageal Reflux Disease (GERD) and its managementDr. Ankit Gaur
In this presentation I have tried to explain in brief about gastro esophageal Reflux Disease (GERD), its etiology, risk factors, diagnosis, and its management via pharmacotherapy.
This document discusses gastroesophageal reflux disease (GERD). GERD occurs when stomach contents backflow into the esophagus past the lower esophageal sphincter. Factors that can contribute to reflux include a low pressure LES, spontaneous LES relaxation, hiatal hernia, and gastric distension. Symptoms range from heartburn and regurgitation to respiratory complications. Diagnosis involves endoscopy, pH monitoring, esophageal manometry, and imaging. Treatment includes lifestyle modifications, proton pump inhibitors, and in some cases surgery such as Nissen fundoplication or other anti-reflux procedures. Complications of surgery include gas bloat and dysphagia.
This document provides an overview of gastroesophageal reflux disease (GERD). It begins with phenotypic classifications of GERD and discusses the Montreal definition. It then covers the pathogenesis of GERD including antireflux mechanisms, gastric factors, esophageal clearance mechanisms, and esophageal epithelial resistance. The document discusses the clinical presentation of GERD and diagnostic tests including endoscopic examination, pH monitoring, and testing. It concludes with an overview of treatment approaches including pharmacologic therapy, antireflux surgery, and endoscopic antireflux procedures.
Esophagitis is inflammation of the esophagus caused by injury to the esophageal mucosa. Common causes include prolonged gastric intubation, uremia, ingestion of corrosive substances, radiation, and chemotherapy. Gastroesophageal reflux disease, where stomach acid refluxes into the esophagus, is the most frequent cause in Western countries. Symptoms include dysphagia and heartburn. Treatment involves proton pump inhibitors or H2 blockers to reduce gastric acidity and provide relief. Complications can include esophageal ulceration, bleeding, stricture formation, and Barrett's esophagus.
The esophagus transports food from the mouth to the stomach without secreting enzymes or absorbing nutrients. It has several layers including mucosa, submucosa, and muscularis. The muscularis is divided into thirds with different muscle types. Two sphincters regulate movement of food into and out of the esophagus. Lesions range from mild esophagitis to lethal cancers, producing symptoms like difficulty swallowing. Gastroesophageal reflux disease is the most common cause of esophagitis and can progress to Barrett's esophagus and cancer if untreated.
A young infant presented with persistent vomiting and failure to thrive. Imaging showed malrotation of the gut with the superior mesenteric vein lying superior and lateral to the superior mesenteric artery. Further imaging found gastric volvulus, which was corrected surgically. Gastric volvulus can be primary due to laxity of ligaments, or secondary to anatomical abnormalities, and presents as epigastric pain, vomiting, and inability to pass a tube into the stomach.
This document discusses Herpes Simplex Virus (HSV) esophagitis. It provides information on the management and treatment of HSV esophagitis, which includes hemodynamic stabilization, pain management, and specific antiviral therapy. The treatment of choice is oral or intravenous acyclovir for 7-10 days. It may require longer treatment or alternative medications like foscarnet for acyclovir-resistant cases. Primary and suppressive prophylactic acyclovir treatment is also discussed for high-risk immunocompromised patients.
This document provides an overview of the anatomy, physiology, and common diseases of the esophagus. It begins with the surgical anatomy and physiology of the esophagus and discusses topics like congenital abnormalities, benign and malignant tumors, gastroesophageal reflux disease, and motility disorders. For each topic, it provides details on clinical features, investigations, and treatment options. The document is intended to help understand the esophagus and its relationship to various diseases.
This document discusses Gastroesophageal Reflux Disease (GERD). It defines GERD as refluxed stomach contents entering the esophagus or beyond, causing symptoms or complications. The document discusses the epidemiology, anatomy, mechanisms of reflux, etiology, pathophysiology, clinical manifestations, diagnostic evaluation and treatment approaches for GERD, including lifestyle modifications, medications like PPIs, and surgical procedures. The goals of treatment are to alleviate symptoms, decrease reflux frequency and promote healing of injured mucosa.
This document provides an overview of pathology of the esophagus. It begins with normal anatomy and histology of the esophagus. It then discusses various congenital and acquired malformations, lesions associated with motor dysfunction, different types of esophagitis, Barrett's esophagus, esophageal varices, benign and malignant neoplasms. In particular, it provides detailed descriptions of conditions such as achalasia, hiatal hernia, Barrett's esophagus, highlighting their pathogenesis, clinical features, histopathology, and importance.
This document discusses various esophageal disorders including structural disorders like hiatal hernia and rings, motility disorders like achalasia, and conditions caused by reflux like GERD and Barrett's esophagus. It provides details on the causes, symptoms, diagnoses and treatments of these common esophageal problems.
GERD is a day to day common problem, which is on the increase due to so many obvious reasons. It needs to be addressed to the public and the medical fraternity for proper management and treatment.
Diverticulitis is an inflammation and infection of small pouches called diverticula that form in the lining of the intestines, usually in the colon. It is commonly caused by trapped fecal material and bacteria. Symptoms include crampy lower abdominal pain, fever, and changes in bowel habits. Treatment involves rest, clear liquids, antibiotics, and analgesics. A high fiber diet and fluid intake are recommended for prevention and management of diverticulitis. Nursing care focuses on monitoring for complications, managing pain and nutrition, and health education.
Intestinal obstruction caused by volvulus by dr basilBasil Tumaini
This document discusses intestinal obstruction caused by volvulus, beginning with an introduction that defines intestinal obstruction and its causes. It then covers the historical background, pathophysiology, clinical presentation, and management of volvulus. Volvulus is caused by twisting of the intestine on itself, most commonly occurring in the sigmoid colon. It can lead to bowel obstruction and ischemia. Treatment involves surgical intervention to untwist the intestine and potentially resect nonviable sections.
Esophagitis is inflammation of the esophagus that can have various causes like acid reflux, infections, medications, radiation, and more. Common symptoms include dysphagia, heartburn, and painful swallowing. Diagnosis involves endoscopy and biopsy. Treatment depends on the underlying cause but may include lifestyle changes, antacids, H2 blockers, proton pump inhibitors, and surgery in some cases. Complications can include strictures and Barrett's esophagus.
This document discusses intestinal obstruction, its causes, symptoms, diagnosis and treatment. It notes that an obstruction can occur anywhere along the small or large intestine and can be partial or complete. Common causes include birth defects, scar tissue from prior surgery, hernias and tumors. Symptoms include abdominal cramping, bloating and vomiting. Treatment typically involves passing a tube through the nose to remove material and fluids above the blockage, administering IV fluids and electrolytes, and sometimes surgery.
This document provides information on benign esophageal diseases including achalasia, diffuse esophageal spasm, nutcracker esophagus, esophageal diverticula, Barrett's esophagus, and caustic injury. It describes the pathogenesis, clinical features, diagnosis, and treatment options for each condition. Key points include that achalasia is characterized by failure of the LES to relax, resulting in dysphagia and regurgitation. Diffuse esophageal spasm and nutcracker esophagus are hypermotility disorders causing chest pain. Barrett's esophagus involves metaplastic changes from acid reflux and increases cancer risk. Caustic ingestion causes liquefactive necrosis and stricture formation over time.
This document summarizes information about esophageal pathology, including the anatomy, histology, physiology, and common diseases of the esophagus. It discusses gastroesophageal reflux disease (GERD) in detail, describing the pathogenesis, clinical manifestations, complications, grading of esophagitis, and treatment options including lifestyle changes, medication, and various surgical procedures to treat GERD such as Nissen fundoplication. It also covers hiatal hernia, its types, symptoms, diagnosis, and treatment.
Medical therapy is very effective for treating symptoms and complications of GERD, with low risks compared to surgical options. While medical and surgical therapies have shown equal efficacy in randomized controlled trials up to 5 years, medical therapy is generally more cost-effective, especially with inexpensive generic proton pump inhibitors now available. True medical failures are rare and should be thoroughly evaluated before considering antireflux surgery, which is best for patients whose main symptom is regurgitation. Surgery should not be recommended solely to prevent esophageal cancer related to GERD.
Highly Advanced Laparoscopic Fundoplication Surgery for Gastroesophageal Refl...SafeMedTrip
Safemedtrip india's number one company of medical treatment, which provide low cost treatment package for international patient. if you have any problem Please scan and email your medical reports to us at hospitalindia@gmail.com or help@safemedtrip.com or call us at +91-9899993637 and we shall get you a Free, No Obligation Opinion from India's leading Specialist Doctors.
This document discusses gastroesophageal reflux disease (GERD). GERD occurs when stomach contents backflow into the esophagus past the lower esophageal sphincter. Factors that can contribute to reflux include a low pressure LES, spontaneous LES relaxation, hiatal hernia, and gastric distension. Symptoms range from heartburn and regurgitation to respiratory complications. Diagnosis involves endoscopy, pH monitoring, esophageal manometry, and imaging. Treatment includes lifestyle modifications, proton pump inhibitors, and in some cases surgery such as Nissen fundoplication or other anti-reflux procedures. Complications of surgery include gas bloat and dysphagia.
This document provides an overview of gastroesophageal reflux disease (GERD). It begins with phenotypic classifications of GERD and discusses the Montreal definition. It then covers the pathogenesis of GERD including antireflux mechanisms, gastric factors, esophageal clearance mechanisms, and esophageal epithelial resistance. The document discusses the clinical presentation of GERD and diagnostic tests including endoscopic examination, pH monitoring, and testing. It concludes with an overview of treatment approaches including pharmacologic therapy, antireflux surgery, and endoscopic antireflux procedures.
Esophagitis is inflammation of the esophagus caused by injury to the esophageal mucosa. Common causes include prolonged gastric intubation, uremia, ingestion of corrosive substances, radiation, and chemotherapy. Gastroesophageal reflux disease, where stomach acid refluxes into the esophagus, is the most frequent cause in Western countries. Symptoms include dysphagia and heartburn. Treatment involves proton pump inhibitors or H2 blockers to reduce gastric acidity and provide relief. Complications can include esophageal ulceration, bleeding, stricture formation, and Barrett's esophagus.
The esophagus transports food from the mouth to the stomach without secreting enzymes or absorbing nutrients. It has several layers including mucosa, submucosa, and muscularis. The muscularis is divided into thirds with different muscle types. Two sphincters regulate movement of food into and out of the esophagus. Lesions range from mild esophagitis to lethal cancers, producing symptoms like difficulty swallowing. Gastroesophageal reflux disease is the most common cause of esophagitis and can progress to Barrett's esophagus and cancer if untreated.
A young infant presented with persistent vomiting and failure to thrive. Imaging showed malrotation of the gut with the superior mesenteric vein lying superior and lateral to the superior mesenteric artery. Further imaging found gastric volvulus, which was corrected surgically. Gastric volvulus can be primary due to laxity of ligaments, or secondary to anatomical abnormalities, and presents as epigastric pain, vomiting, and inability to pass a tube into the stomach.
This document discusses Herpes Simplex Virus (HSV) esophagitis. It provides information on the management and treatment of HSV esophagitis, which includes hemodynamic stabilization, pain management, and specific antiviral therapy. The treatment of choice is oral or intravenous acyclovir for 7-10 days. It may require longer treatment or alternative medications like foscarnet for acyclovir-resistant cases. Primary and suppressive prophylactic acyclovir treatment is also discussed for high-risk immunocompromised patients.
This document provides an overview of the anatomy, physiology, and common diseases of the esophagus. It begins with the surgical anatomy and physiology of the esophagus and discusses topics like congenital abnormalities, benign and malignant tumors, gastroesophageal reflux disease, and motility disorders. For each topic, it provides details on clinical features, investigations, and treatment options. The document is intended to help understand the esophagus and its relationship to various diseases.
This document discusses Gastroesophageal Reflux Disease (GERD). It defines GERD as refluxed stomach contents entering the esophagus or beyond, causing symptoms or complications. The document discusses the epidemiology, anatomy, mechanisms of reflux, etiology, pathophysiology, clinical manifestations, diagnostic evaluation and treatment approaches for GERD, including lifestyle modifications, medications like PPIs, and surgical procedures. The goals of treatment are to alleviate symptoms, decrease reflux frequency and promote healing of injured mucosa.
This document provides an overview of pathology of the esophagus. It begins with normal anatomy and histology of the esophagus. It then discusses various congenital and acquired malformations, lesions associated with motor dysfunction, different types of esophagitis, Barrett's esophagus, esophageal varices, benign and malignant neoplasms. In particular, it provides detailed descriptions of conditions such as achalasia, hiatal hernia, Barrett's esophagus, highlighting their pathogenesis, clinical features, histopathology, and importance.
This document discusses various esophageal disorders including structural disorders like hiatal hernia and rings, motility disorders like achalasia, and conditions caused by reflux like GERD and Barrett's esophagus. It provides details on the causes, symptoms, diagnoses and treatments of these common esophageal problems.
GERD is a day to day common problem, which is on the increase due to so many obvious reasons. It needs to be addressed to the public and the medical fraternity for proper management and treatment.
Diverticulitis is an inflammation and infection of small pouches called diverticula that form in the lining of the intestines, usually in the colon. It is commonly caused by trapped fecal material and bacteria. Symptoms include crampy lower abdominal pain, fever, and changes in bowel habits. Treatment involves rest, clear liquids, antibiotics, and analgesics. A high fiber diet and fluid intake are recommended for prevention and management of diverticulitis. Nursing care focuses on monitoring for complications, managing pain and nutrition, and health education.
Intestinal obstruction caused by volvulus by dr basilBasil Tumaini
This document discusses intestinal obstruction caused by volvulus, beginning with an introduction that defines intestinal obstruction and its causes. It then covers the historical background, pathophysiology, clinical presentation, and management of volvulus. Volvulus is caused by twisting of the intestine on itself, most commonly occurring in the sigmoid colon. It can lead to bowel obstruction and ischemia. Treatment involves surgical intervention to untwist the intestine and potentially resect nonviable sections.
Esophagitis is inflammation of the esophagus that can have various causes like acid reflux, infections, medications, radiation, and more. Common symptoms include dysphagia, heartburn, and painful swallowing. Diagnosis involves endoscopy and biopsy. Treatment depends on the underlying cause but may include lifestyle changes, antacids, H2 blockers, proton pump inhibitors, and surgery in some cases. Complications can include strictures and Barrett's esophagus.
This document discusses intestinal obstruction, its causes, symptoms, diagnosis and treatment. It notes that an obstruction can occur anywhere along the small or large intestine and can be partial or complete. Common causes include birth defects, scar tissue from prior surgery, hernias and tumors. Symptoms include abdominal cramping, bloating and vomiting. Treatment typically involves passing a tube through the nose to remove material and fluids above the blockage, administering IV fluids and electrolytes, and sometimes surgery.
This document provides information on benign esophageal diseases including achalasia, diffuse esophageal spasm, nutcracker esophagus, esophageal diverticula, Barrett's esophagus, and caustic injury. It describes the pathogenesis, clinical features, diagnosis, and treatment options for each condition. Key points include that achalasia is characterized by failure of the LES to relax, resulting in dysphagia and regurgitation. Diffuse esophageal spasm and nutcracker esophagus are hypermotility disorders causing chest pain. Barrett's esophagus involves metaplastic changes from acid reflux and increases cancer risk. Caustic ingestion causes liquefactive necrosis and stricture formation over time.
This document summarizes information about esophageal pathology, including the anatomy, histology, physiology, and common diseases of the esophagus. It discusses gastroesophageal reflux disease (GERD) in detail, describing the pathogenesis, clinical manifestations, complications, grading of esophagitis, and treatment options including lifestyle changes, medication, and various surgical procedures to treat GERD such as Nissen fundoplication. It also covers hiatal hernia, its types, symptoms, diagnosis, and treatment.
Medical therapy is very effective for treating symptoms and complications of GERD, with low risks compared to surgical options. While medical and surgical therapies have shown equal efficacy in randomized controlled trials up to 5 years, medical therapy is generally more cost-effective, especially with inexpensive generic proton pump inhibitors now available. True medical failures are rare and should be thoroughly evaluated before considering antireflux surgery, which is best for patients whose main symptom is regurgitation. Surgery should not be recommended solely to prevent esophageal cancer related to GERD.
Highly Advanced Laparoscopic Fundoplication Surgery for Gastroesophageal Refl...SafeMedTrip
Safemedtrip india's number one company of medical treatment, which provide low cost treatment package for international patient. if you have any problem Please scan and email your medical reports to us at hospitalindia@gmail.com or help@safemedtrip.com or call us at +91-9899993637 and we shall get you a Free, No Obligation Opinion from India's leading Specialist Doctors.
There are four types of hiatal hernias. A paraesophageal hiatal hernia (Type II) occurs when part of the stomach protrudes through the diaphragm into the chest. Complications can include bleeding, incarceration, volvulus, obstruction, and perforation. Surgery is the treatment of choice and involves reducing the hernia, resecting the hernia sac, and closing the diaphragmatic defect.
GERD is caused by reflux of stomach contents into the esophagus. It can be due to transient lower esophageal sphincter relaxations, reduced LES tone, hiatal hernia, or impaired esophageal clearance. Risk factors include obesity, smoking, pregnancy, and connective tissue disorders. Symptoms include heartburn, regurgitation, and chest pain. Diagnosis involves endoscopy or 24-hour pH monitoring. Treatment begins with lifestyle changes and antacids. Proton pump inhibitors are prescribed for moderate to severe cases or those not responding to other treatments. Surgery or endoscopic procedures may be used for cases not controlled by medication.
Gastroesophageal reflux and Hiatal HerniaViswa Kumar
The document discusses GERD/hiatus hernia. It provides information on:
1) The factors involved in GERD pathogenesis including the antireflux barrier, aggressive factors like gastric acid, and mechanisms of reflux.
2) Diagnostic tests for GERD like endoscopy, pH monitoring, and barium swallow which assess esophageal damage, acid exposure, and function.
3) Treatment approaches including lifestyle changes, medications like PPIs, H2 blockers, and prokinetics, and surgical options like Nissen fundoplication.
4) Complications of long-term GERD including Barrett's esophagus, strictures, and adenoc
This document summarizes several studies on surgical repair of hiatal hernias. It discusses the use of mesh reinforcement to reduce recurrence rates for both laparoscopic fundoplications and large paraesophageal hernia repairs. The studies found mesh reinforcement was associated with fewer recurrences compared to primary suture repair, with no reported instances of mesh erosion. Longer follow-up is still needed but current data support the use of mesh for hiatal repairs.
La hernia de hiato es la protrusión del estómago a través del hiato esofágico del diafragma hacia la cavidad torácica. Afecta al 20% de la población y se debe principalmente a debilidad del hiato. Existen tres tipos principales clasificados según la posición del estómago y la presencia de saco herniario. Los síntomas son variados e incluyen acidez y dolor, aunque un gran número de personas no presentan síntomas. El diagnóstico se realiza mediante esofagograma,
Este documento describe tres tipos de hernia hiatal, una condición en la que parte del estómago se introduce en el tórax a través de un debilitamiento en el diafragma. Explica los síntomas, factores de riesgo, diagnóstico y tratamiento de la hernia hiatal, que generalmente incluye cirugía para repararla y aliviar los síntomas en más del 90% de los pacientes.
This document summarizes various medical treatments for chronic anal fissures (CAFs), with a focus on nonsurgical approaches involving smooth muscle relaxation. Lateral internal sphincterotomy (LIS) has traditionally been the gold standard surgical treatment for CAFs, but it can permanently weaken the internal sphincter and cause incontinence in some patients. Recently, nonsurgical treatments using pharmacological agents to relax the internal sphincter and promote healing have been developed, avoiding the risks of surgery. The document reviews several clinical trials examining the use of topical glyceryl trinitrate (GTN) at various concentrations for nonsurgical treatment of CAFs. GTN was found to heal CAFs in 33
The document discusses a new treatment for chronic heartburn called EsophyX that is performed at Nuffield Health Leeds Hospital. It is a minimally invasive procedure that uses plastic fasteners to pull up stomach tissue and prevent acid reflux without surgery. The procedure provides relief for over 80% of symptoms and allows patients to greatly reduce or stop medication. One patient, Patrick Senycia, flew from Australia to have the procedure done in Leeds and says his symptoms were greatly reduced. The EsophyX procedure is positioned as a promising new option for treating chronic acid reflux when medication is not effective.
The document discusses a new treatment for chronic heartburn called EsophyX that is performed at Nuffield Health Leeds Hospital. It is a minimally invasive procedure that uses plastic fasteners to pull up stomach tissue and prevent acid reflux without surgery. The procedure provides relief for over 80% of symptoms and allows patients to greatly reduce or stop medication. One patient, Patrick Senycia, flew from Australia to receive the treatment and has experienced significant reduction in symptoms. The EsophyX procedure is pioneering as one of the most advanced treatments for chronic acid reflux worldwide.
What may have seemed like science fiction, surgery without an incision, is now a reality that is making lives better for patients suffering from chronic acid reflux also known as gastroesophageal reflux disease (GERD). Peter Janu, MD, a general surgeon, provides basic information about GERD as well as common treatment options including the new TIF (transoral incisionless fundoplication) procedure for the treatment of GERD.
Acs0520 Procedures For Benign And Malignant Gastric And Duodenal Disease 2006medbookonline
1) The document discusses surgical procedures for treating benign gastric and duodenal diseases, including perforated duodenal ulcers, bleeding ulcers, and gastric outlet obstruction.
2) A common procedure is an omental patch, where the perforation is closed with sutures and overlaid with omentum. For bleeding ulcers, the ulcer bed may be oversewn and a vagotomy with pyloroplasty performed to reduce acid.
3) Gastric outlet obstruction can be treated with vagotomy and antrectomy or vagotomy with pyloroplasty or gastroenterostomy. The appropriate procedure depends on each patient's situation and medical history.
This summary provides the key details from the document in 3 sentences or less:
Laparoscopic Nissen fundoplication is described as a minimally invasive procedure for gastroesophageal reflux disease. It involves placing 5 trocar ports for instruments and a camera, dissecting the gastrohepatic ligament, wrapping the fundus of the stomach around the lower esophagus, and suturing it in place to create an anti-reflux valve. Proper trocar placement is emphasized to allow adequate exposure and retraction of tissues while avoiding injury to nearby structures like blood vessels.
This document discusses dysphagia, or difficulty swallowing, which can be caused by abnormalities in the oral, pharyngeal, or esophageal phases of swallowing. It describes oropharyngeal dysphagia, which usually results from issues in the mouth or throat, and esophageal dysphagia, which causes chest or abdominal symptoms. The evaluation of a dysphagia patient involves obtaining a history, performing a physical exam, and typically starting with a barium swallow test to identify any lesions. Further tests may include endoscopy, manometry, pH study, and imaging. Management depends on the underlying cause found.
This document summarizes recent advances in the diagnosis and treatment of gastroesophageal reflux disease (GERD).
(I) New diagnostic tests include the PPI test, Bravo capsule, new acid exposure sensors, and multichannel intraluminal impedance to identify acid and non-acid reflux. (II) Therapeutic advances include new drugs targeting transient lower esophageal sphincter relaxations, combination therapy, long-term management strategies, prokinetics, and endoscopic procedures such as Endocinch, Stretta, Enteryx and Gatekeeper. (III) Barrett's esophagus screening and surveillance remains an area requiring further prospective studies to determine who and when to screen.
This document reviews endometriosis, a chronic disease where endometrial tissue grows outside the uterus, most commonly causing pelvic pain and infertility. While endometriosis can only be definitively diagnosed through laparoscopy, many physicians assume pelvic pain in patients with endometriosis is caused by it. The document discusses various medical and surgical treatment options for pain and infertility, but notes they do not restore normal fertility and pain often recurs despite treatment.
This document provides information about open esophageal surgical procedures, including cricopharyngeal myotomy and excision of Zenker's diverticulum. It describes the preoperative evaluation and optimization of patients, including imaging, endoscopy, and nutritional support. The surgical technique is explained in 4 steps: 1) incision and dissection of the pharyngeal pouch, 2) myotomy of the cricopharyngeus muscle and esophagus, 3) freeing or excising the diverticulum using a stapler, and 4) drainage/closure. Postoperative care involves monitoring for complications such as recurrent laryngeal nerve injury, fistula, hematoma, and infection.
This study evaluated the safety and feasibility of a new endoluminal fundoplication (ELF) technique using the EsophyX device to treat gastroesophageal reflux disease (GERD) in 17 patients. The ELF procedure created valves at the gastroesophageal junction that were on average 4 cm long and had a circumference of 210 degrees. At 12 months follow up, 81% of the valves maintained their tightness. GERD symptoms improved in 53% of patients and 82% were no longer taking proton pump inhibitors. The study demonstrated the technical feasibility and safety of the ELF procedure using the EsophyX device to partially reconstruct the antireflux barrier and provide preliminary evidence of its efficacy in reducing GER
improving the out come of diaphragmatic herniaMEDHAT EL-SAYED
This document discusses recurrent diaphragmatic hernias after initial repair in infants born with congenital diaphragmatic hernias. It notes that recurrence rates can be as high as 42% and the need for reoperation is often predictable. The most common indications for reoperation are recurrence of the hernia and feeding problems like gastroesophageal reflux. Recurrence usually presents within the first 2 years of life. Symptoms may include pulmonary or gastrointestinal issues. Diagnosis involves imaging studies like chest x-rays, UGI, or CT scan. Repair can be done via open or minimally invasive approaches depending on factors like hernia size and location. The goal is to ascertain the mode of initial repair failure and
- Anti-reflux surgery (ARS) is an option for treating severe gastroesophageal reflux disease (GERD) when symptoms are not adequately controlled by medications.
- Key factors for successful ARS include confirming the GERD diagnosis, properly selecting patients, comprehensive pre-operative evaluation, and tailoring the surgical technique to each individual.
- Common surgical options are laparoscopic Nissen fundoplication and magnetic sphincter augmentation. Complications can include dysphagia, gas bloat, and recurrence, so patient expectations must be managed. ARS provides long-term symptom control for most appropriately selected patients when performed by an experienced surgeon.
- Anti-reflux surgery (ARS) is an option for treating severe gastroesophageal reflux disease (GERD) when symptoms are not adequately controlled by medications.
- Key factors for successful ARS include confirming the GERD diagnosis, properly selecting patients, comprehensive pre-operative evaluation, and tailoring the surgical technique to each individual.
- Common surgical options are laparoscopic Nissen fundoplication and magnetic sphincter augmentation. Complications can include dysphagia, gas bloat, and recurrence, so patient expectations must be managed. ARS provides long-term symptom control for most appropriately selected patients when performed by an experienced surgeon.
Intestinal obstruction occurs when the lumen of the small or large intestine becomes partially or completely blocked, interrupting the normal flow of intestinal contents. It can be caused by mechanical factors like adhesions, tumors, or hernias obstructing the intestinal walls or lumen, or functional issues where the intestinal musculature cannot propel contents. Symptoms include colicky pain, nausea, vomiting, and constipation. Diagnosis involves abdominal exams, imaging, and lab tests. Treatment focuses on decompressing the bowel, correcting fluid and electrolyte imbalances, and potentially surgically removing the obstruction. Complications can include dehydration, peritonitis, shock, and death if not properly managed.
This document discusses several gastrointestinal diseases including gastroesophageal reflux disease (GERD), gastritis, and peptic ulcer disease. It defines each condition, describes symptoms, risk factors, diagnostic tests, and treatment options. GERD is caused by acid reflux and can cause esophagitis or complications like Barrett's esophagus. Gastritis is inflammation of the stomach lining that is often caused by H. pylori or NSAIDs. Peptic ulcers develop from an imbalance between acid and mucosal protection in the esophagus, stomach, or duodenum and may be associated with H. pylori. Treatment involves eliminating triggers, reducing acid production, and treating any underlying infections.
The document discusses several endoscopic and surgical treatments for GERD, including Stretta RF ablation of the LES, transoral fundoplication using the EsophyX device, and the Medigus U/S surgical endostapler. Stretta involves delivering RF energy to the LES while cooling the mucosa. Transoral fundoplication uses the EsophyX device to endoscopically recreate the valve at the GEJ. The Medigus device combines a gastroscope and stapler to create a 180 degree fundoplication. Indications for these endoscopic procedures generally include chronic GERD symptoms partially responsive to PPI. Surgical fundoplication remains the gold standard
Laparoscopic Ventral Hernia Repair Ppt. DR DILIP S.RAJPALdiliprajpal
This document discusses laparoscopic ventral hernia repair (LVHR). It describes the surgical technique for LVHR, including accessing the abdominal cavity through ports, adhesiolysis, measuring and placing the mesh, and fixing it in place. Proper port placement and handling of meshes like Physiomesh and Proceed are emphasized to minimize infection risk. Wide mesh overlap and transfascial sutures are recommended to prevent mesh migration. Fixation techniques like double crowning help reduce seroma formation. Post-operative port site hernias are also mentioned.
Head and neck cancer refers to cancers that occur in the head and neck region including the oral cavity, oropharynx, larynx, hypopharynx, and nasopharynx. Risk factors include tobacco and alcohol use. Symptoms depend on the location but may include sores, lumps, difficulty swallowing or breathing. Diagnosis involves physical examination, imaging tests, blood tests, and biopsy. Treatment options include surgery, radiation therapy, chemotherapy, and rehabilitation. Research continues on new treatments.
This document discusses the advantages of physician-led hospitals and why physicians must lead in healthcare. It provides examples showing that the top-rated hospitals like Mayo Clinic and Cleveland Clinic have been led by physicians for over 100 years. Physician leadership results in better patient outcomes, satisfaction, economic performance, and physician retention and satisfaction. Studies show physician-led hospitals score higher on quality metrics than non-clinician led hospitals. The document argues physicians possess credibility as leaders since they understand clinical practice from experience. It also discusses the challenges of physician burnout and need for training clinical leaders to succeed in today's team-based healthcare system.
This study evaluated the technical feasibility and safety of using a novel endoscopic suturing device to repair gastrointestinal fistulae in 7 patients. The procedure was technically successful in all patients with no early complications. At follow up of 5.1 months, 6 patients had resolution of symptoms and average weight loss of 22.8 pounds. While the study was limited by its small size and short follow up, the results suggest endoscopic repair of fistulae using this suturing device can be achieved safely and warrants further study.
This document summarizes the market for obesity products and treatments. It discusses how the field is moving "back to basics" to better understand the physiological mechanisms behind obesity and weight loss. This new understanding may help develop more effective minimally invasive solutions. The US market for minimally invasive bariatric devices is expected to grow moderately over the next five years, reaching over $500 million by 2016, driven by factors like the growing obese population. However, current treatment options have only achieved limited success in treating obesity.
This document provides details about an upcoming symposium on endosurgery to be held on September 19th, 2011 at the Apollo Hospital in New Delhi. The symposium will focus on flexible surgery techniques that minimize surgical trauma through natural orifices. Experts will present on robotics, endoscopic stitching and resection devices. The program will include training discussions on weight regain after bariatric surgery and a debate on surgical versus endoscopic solutions. Equipment demonstrations and a panel discussion on the future of endosurgery in India are also included. Attendees should include doctors from Apollo hospitals with expertise in gastroenterology, bariatrics, and endocrinology.
Flyer for one day seminar for surgeons and gastroenterologists showcasing innovative technologies in endosurgery and robotic surgery
Sept 19, 2011 New Delhi
This study examined whether placing a biologic mesh during abdominal closure would reduce the risk of developing an incisional hernia compared to primary closure without mesh in high-risk patients undergoing gastric bypass surgery. The study found that patients who received a biologic mesh had a significantly lower rate of developing an incisional hernia (2.3%) compared to those without mesh (17.7%). After adjusting for risk factors, placement of a biologic mesh was found to significantly reduce the risk of hernia, while smoking significantly increased the risk. The study suggests prophylactic use of biologic mesh may help reduce incisional hernia rates in high-risk patients.
1. The document discusses endoluminal procedures for weight regain after gastric bypass surgery, including endoluminal gastric pouch reduction (EGPR) and the ROSE procedure.
2. EGPR uses fasteners to narrow the gastric pouch and stoma, resulting in 10-20% excess weight loss typically. The ROSE procedure uses sutures to create folds in the pouch and around the stoma.
3. Studies found these procedures produced 12-25% excess weight loss on average and resolved issues like diarrhea and heartburn in many patients. However, long-term durability is still unknown and behavioral factors impact success.
1) The document describes a prototype endoscopic suturing system that allows full-thickness suturing of the stomach wall for closure of openings (gastrotomies) during natural orifice translumenal endoscopic surgery (NOTES).
2) In vitro tests on isolated pig stomachs showed the system could accurately place running sutures in a pursestring configuration to securely close an 18mm gastrotomy with no leaks.
3) Edge-to-edge closure of gastotomies was also achieved in a leak-proof manner during single intubations using the suturing system.
The OverStitch Endoscopic Suturing System provides physicians the ability to perform running or interrupted stitches within the GI tract. The system is comprised of an Endoscopic Suturing System handle, End Cap, Anchor Exchange, and choice of absorbable or non-absorbable sutures. It is intended for endoscopic placement of sutures to approximate soft tissue and works by delivering anchors and sutures through the endoscope to place stitches. The system is contraindicated for use with malignant tissue or when general endoscopic techniques are contraindicated.
The OverStitch Endoscopic Suturing System allows physicians to perform full-thickness endoscopic suturing through a flexible endoscope in a manner similar to hand suturing. It can deploy both running and interrupted stitches with a single insertion of the endoscope. The system mimics the motion of a curved surgical needle and is designed for controlled suture placement. It is a single-use device available with absorbable or non-absorbable suture materials.
The American Society of General Surgeons (ASGS) supports the use of transoral fundoplication by trained surgeons as a treatment for chronic gastroesophageal reflux disease (GERD) in patients who do not get satisfactory relief from proton pump inhibitors or who wish to avoid lifelong medication dependence. The ASGS believes transoral fundoplication adheres to the same surgical principles as traditional fundoplication techniques by creating a full thickness wrap of the stomach around the esophagus. The ASGS position is supported by peer-reviewed literature demonstrating transoral fundoplication offers comparable results to open and laparoscopic surgery, with high patient satisfaction and relief of GERD symptoms.
Three recent studies published over the past four months involving nearly 200 patients in total provide additional evidence of the positive outcomes of transoral fundoplication (TIF) for the treatment of gastroesophageal reflux disease (GERD). The studies demonstrated a high therapeutic response rate with patients getting off daily proton pump inhibitors, significant response to objective reflux measurements, and a low complication rate of around 2%. The largest study to date involving 124 patients showed 75-80% of patients had normalized symptom scores and 97% were off daily PPI medications post-TIF. The growing body of clinical evidence supports TIF as a safe and effective alternative to traditional anti-reflux surgeries for appropriately selected GERD patients.
Endoluminal procedures like EGPR and ROSE aim to treat weight regain after gastric bypass through minimally invasive techniques. EGPR uses tissue fasteners to reduce the gastric pouch size and narrow the stoma, resulting in 15.5 lb weight loss on average in 6 months. ROSE uses expandable anchors to similarly reduce pouch size and stoma diameter, stopping weight regain in 88% of patients. Both procedures appear safe and can produce near 50% loss of regained weight, though long-term durability is still unknown. Success may depend on factors like a patient's initial weight loss after gastric bypass.
The document describes an intragastric balloon system called Heliosphere BAG for the non-surgical treatment of obesity. It is a temporary balloon that is placed in the stomach for up to 6 months. Clinical studies showed it helped patients lose 9-24 kg on average and had good tolerance, with vomiting lasting less than 3 days for most patients. The balloon uses a patented gold coating process to maintain inflation volume over time and make extraction easier.
This document provides instructions for the implantation and extraction of an intragastric balloon called Heliosphere for the non-surgical treatment of obesity. The implantation procedure involves visually guiding the deflated balloon through the esophagus using an endoscope, then inflating it with saline to a specific volume in the stomach. For extraction, the balloon is first deflated by puncturing it and aspirating the air, then caught and pulled out through the esophagus using grasping forceps under endoscopic guidance. Safety and careful technique are emphasized to gradually pass the balloon through the esophagus and cardia during extraction.
Breast cancer: Post menopausal endocrine therapyDr. Sumit KUMAR
Breast cancer in postmenopausal women with hormone receptor-positive (HR+) status is a common and complex condition that necessitates a multifaceted approach to management. HR+ breast cancer means that the cancer cells grow in response to hormones such as estrogen and progesterone. This subtype is prevalent among postmenopausal women and typically exhibits a more indolent course compared to other forms of breast cancer, which allows for a variety of treatment options.
Diagnosis and Staging
The diagnosis of HR+ breast cancer begins with clinical evaluation, imaging, and biopsy. Imaging modalities such as mammography, ultrasound, and MRI help in assessing the extent of the disease. Histopathological examination and immunohistochemical staining of the biopsy sample confirm the diagnosis and hormone receptor status by identifying the presence of estrogen receptors (ER) and progesterone receptors (PR) on the tumor cells.
Staging involves determining the size of the tumor (T), the involvement of regional lymph nodes (N), and the presence of distant metastasis (M). The American Joint Committee on Cancer (AJCC) staging system is commonly used. Accurate staging is critical as it guides treatment decisions.
Treatment Options
Endocrine Therapy
Endocrine therapy is the cornerstone of treatment for HR+ breast cancer in postmenopausal women. The primary goal is to reduce the levels of estrogen or block its effects on cancer cells. Commonly used agents include:
Selective Estrogen Receptor Modulators (SERMs): Tamoxifen is a SERM that binds to estrogen receptors, blocking estrogen from stimulating breast cancer cells. It is effective but may have side effects such as increased risk of endometrial cancer and thromboembolic events.
Aromatase Inhibitors (AIs): These drugs, including anastrozole, letrozole, and exemestane, lower estrogen levels by inhibiting the aromatase enzyme, which converts androgens to estrogen in peripheral tissues. AIs are generally preferred in postmenopausal women due to their efficacy and safety profile compared to tamoxifen.
Selective Estrogen Receptor Downregulators (SERDs): Fulvestrant is a SERD that degrades estrogen receptors and is used in cases where resistance to other endocrine therapies develops.
Combination Therapies
Combining endocrine therapy with other treatments enhances efficacy. Examples include:
Endocrine Therapy with CDK4/6 Inhibitors: Palbociclib, ribociclib, and abemaciclib are CDK4/6 inhibitors that, when combined with endocrine therapy, significantly improve progression-free survival in advanced HR+ breast cancer.
Endocrine Therapy with mTOR Inhibitors: Everolimus, an mTOR inhibitor, can be added to endocrine therapy for patients who have developed resistance to aromatase inhibitors.
Chemotherapy
Chemotherapy is generally reserved for patients with high-risk features, such as large tumor size, high-grade histology, or extensive lymph node involvement. Regimens often include anthracyclines and taxanes.
Computer in pharmaceutical research and development-Mpharm(Pharmaceutics)MuskanShingari
Statistics- Statistics is the science of collecting, organizing, presenting, analyzing and interpreting numerical data to assist in making more effective decisions.
A statistics is a measure which is used to estimate the population parameter
Parameters-It is used to describe the properties of an entire population.
Examples-Measures of central tendency Dispersion, Variance, Standard Deviation (SD), Absolute Error, Mean Absolute Error (MAE), Eigen Value
Osvaldo Bernardo Muchanga-GASTROINTESTINAL INFECTIONS AND GASTRITIS-2024.pdfOsvaldo Bernardo Muchanga
GASTROINTESTINAL INFECTIONS AND GASTRITIS
Osvaldo Bernardo Muchanga
Gastrointestinal Infections
GASTROINTESTINAL INFECTIONS result from the ingestion of pathogens that cause infections at the level of this tract, generally being transmitted by food, water and hands contaminated by microorganisms such as E. coli, Salmonella, Shigella, Vibrio cholerae, Campylobacter, Staphylococcus, Rotavirus among others that are generally contained in feces, thus configuring a FECAL-ORAL type of transmission.
Among the factors that lead to the occurrence of gastrointestinal infections are the hygienic and sanitary deficiencies that characterize our markets and other places where raw or cooked food is sold, poor environmental sanitation in communities, deficiencies in water treatment (or in the process of its plumbing), risky hygienic-sanitary habits (not washing hands after major and/or minor needs), among others.
These are generally consequences (signs and symptoms) resulting from gastrointestinal infections: diarrhea, vomiting, fever and malaise, among others.
The treatment consists of replacing lost liquids and electrolytes (drinking drinking water and other recommended liquids, including consumption of juicy fruits such as papayas, apples, pears, among others that contain water in their composition).
To prevent this, it is necessary to promote health education, improve the hygienic-sanitary conditions of markets and communities in general as a way of promoting, preserving and prolonging PUBLIC HEALTH.
Gastritis and Gastric Health
Gastric Health is one of the most relevant concerns in human health, with gastrointestinal infections being among the main illnesses that affect humans.
Among gastric problems, we have GASTRITIS AND GASTRIC ULCERS as the main public health problems. Gastritis and gastric ulcers normally result from inflammation and corrosion of the walls of the stomach (gastric mucosa) and are generally associated (caused) by the bacterium Helicobacter pylor, which, according to the literature, this bacterium settles on these walls (of the stomach) and starts to release urease that ends up altering the normal pH of the stomach (acid), which leads to inflammation and corrosion of the mucous membranes and consequent gastritis or ulcers, respectively.
In addition to bacterial infections, gastritis and gastric ulcers are associated with several factors, with emphasis on prolonged fasting, chemical substances including drugs, alcohol, foods with strong seasonings including chilli, which ends up causing inflammation of the stomach walls and/or corrosion. of the same, resulting in the appearance of wounds and consequent gastritis or ulcers, respectively.
Among patients with gastritis and/or ulcers, one of the dilemmas is associated with the foods to consume in order to minimize the sensation of pain and discomfort.
PGx Analysis in VarSeq: A User’s PerspectiveGolden Helix
Since our release of the PGx capabilities in VarSeq, we’ve had a few months to gather some insights from various use cases. Some users approach PGx workflows by means of array genotyping or what seems to be a growing trend of adding the star allele calling to the existing NGS pipeline for whole genome data. Luckily, both approaches are supported with the VarSeq software platform. The genotyping method being used will also dictate what the scope of the tertiary analysis will be. For example, are your PGx reports a standalone pipeline or would your lab’s goal be to handle a dual-purpose workflow and report on PGx + Diagnostic findings.
The purpose of this webcast is to:
Discuss and demonstrate the approaches with array and NGS genotyping methods for star allele calling to prep for downstream analysis.
Following genotyping, explore alternative tertiary workflow concepts in VarSeq to handle PGx reporting.
Moreover, we will include insights users will need to consider when validating their PGx workflow for all possible star alleles and options you have for automating your PGx analysis for large number of samples. Please join us for a session dedicated to the application of star allele genotyping and subsequent PGx workflows in our VarSeq software.
This presentation gives information on the pharmacology of Prostaglandins, Thromboxanes and Leukotrienes i.e. Eicosanoids. Eicosanoids are signaling molecules derived from polyunsaturated fatty acids like arachidonic acid. They are involved in complex control over inflammation, immunity, and the central nervous system. Eicosanoids are synthesized through the enzymatic oxidation of fatty acids by cyclooxygenase and lipoxygenase enzymes. They have short half-lives and act locally through autocrine and paracrine signaling.
The Children are very vulnerable to get affected with respiratory disease.
In our country, the respiratory Disease conditions are consider as major cause for mortality and Morbidity in Child.
Gene therapy can be broadly defined as the transfer of genetic material to cure a disease or at least to improve the clinical status of a patient.
One of the basic concepts of gene therapy is to transform viruses into genetic shuttles, which will deliver the gene of interest into the target cells.
Safe methods have been devised to do this, using several viral and non-viral vectors.
In the future, this technique may allow doctors to treat a disorder by inserting a gene into a patient's cells instead of using drugs or surgery.
The biggest hurdle faced by medical research in gene therapy is the availability of effective gene-carrying vectors that meet all of the following criteria:
Protection of transgene or genetic cargo from degradative action of systemic and endonucleases,
Delivery of genetic material to the target site, i.e., either cell cytoplasm or nucleus,
Low potential of triggering unwanted immune responses or genotoxicity,
Economical and feasible availability for patients .
Viruses are naturally evolved vehicles that efficiently transfer their genes into host cells.
Choice of viral vector is dependent on gene transfer efficiency, capacity to carry foreign genes, toxicity, stability, immune responses towards viral antigens and potential viral recombination.
There are a wide variety of vectors used to deliver DNA or oligo nucleotides into mammalian cells, either in vitro or in vivo.
The most common vector system based on retroviruses, adenoviruses, herpes simplex viruses, adeno associated viruses.
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Microbiology & Parasitology Exercises Parts of the Microscope
Surgery for GERD
1. SurgeryNews
OCTOBER 2009
SPOTLIGHT ON ESOPHAGEAL AND GENERAL SURGERY
Minimally Invasive ANATOMICAL REPAIR
Provides Relief for Patients with PERSISTENT GERD
ELLIOT R. GOODMAN, MD other structural abnor-
Chief of Bariatric Surgery
malities, such as a hiatal
Specialties: General Surgery, Bariatric Surgery
hernia, which often com-
plicates, but does not
Gastroesophageal reflux cause, GERD.
disease, or GERD, affects Fundoplication, for
more than 50 years, was
millions. More than 15 million
first performed as an open
experience daily symptoms, operation by Dr. Rudolph
reports The American College Nissen. The procedure
tightens and repairs the
of Gastroenterology, and LES by dissecting, wrap-
approximately $8 billion is ping and stitching the car-
dia of the stomach around
spent on prescription and Fundoplication involves wrapping and stitching the cardia around the
distal intra-abdominal esophagus.
the distal intra-abdominal
over-the-counter drugs esophagus, providing
annually. Unfortunately, even when coupled with lifestyle additional pressure to recreate a function-
ing sphincter. Laparoscopic intervention
changes, these prescribed medications—including the newest
over the past two decades has produced
proton pump inhibitors (PPI)—do not always relieve symptoms. the same results as open procedures, alle-
viating heartburn in up to 90 percent of
Fortunately, surgery offers a viable alterna- cases, while replacing the six- to ten-inch
tive for many of these patients. The sur- incision with a few small incisions and
geons in the Department of Surgery at
GERD is not typically a reducing LOS from eight days to a single
overnight stay.
Beth Israel Medical Center have been life-threatening illness, but
While time-proven benefits of mini-
performing laparoscopic fundoplication,
the standard GERD surgery, since 1995.
left untreated, it can have mally invasive techniques include less pain,
medication and scarring, pursuit of further
Patients considered have persistent serious complications.
improvements continues. One recent
symptoms ranging from a burning
advance currently being explored at
sensation mid-abdomen, commonly the reflux—a weakened lower esophageal
Beth Israel is transoral incisionless fun-
referred to as heartburn, to more atypical sphincter (LES) or poorly functioning gas- doplication (TIF), an incisionless, natural
complaints including sore throat, swallow- troesophageal valve (GEV)—both of orifice approach done in the OR under
ing difficulties and dry cough. Unlike which have been found to contribute to general anesthesia. Through the mouth,
medications that relieve heartburn the reflux of gastric contents back into the endoscope carries a sterile, single-use
by reducing acid production, surgery the esophagus causing inflammation and EsophyX™ device, which deploys multiple
corrects anatomical problems causing burning. Surgery will also correct (CONTINUED ON PAGE 2)
2. BI Surgeons TREAT GERD
RARE ESOPHAGEAL DISORDER
(CONTINUED FROM PAGE 1)
polypropylene fasteners, transfixing and
BURTON G. SURICK, MD
Attending, Department of Surgery
achieving serosa-to-serosa fusion, creating
Specialties: General Surgery, Minimally Invasive Laparoscopic Surgery, Bariatric Surgery a functional gastroesophageal valve. Most
patients who opt for GERD surgery are
In direct contrast to GERD, achalasia is a rare esophageal disorder suitable candidates for traditional laparo-
scopic fundoplication. The EsophyX™
resulting from an overly tight lower esophageal sphincter (LES), procedure is appropriate for those
which keeps food from passing through. Only 2,000 people without large hiatal hernias (over 2 cm),
esophageal strictures, or significant scar-
develop this condition annually in the US, according to The
ring from prior abdominal surgery.
Society of Thoracic Surgeons, but untreated it has unpleasant All patients undergo careful
consequences. Fortunately, surgeons like Beth Israel Medical evaluation and screening. Good
motility in the esophagus, determined
Center’s Burton Surick, MD, and Richard Friedman, MD, are by manometry testing, is required, as is
performing a minimally invasive surgery with great success. eliminating a cardiac diagnosis, which
can sometimes mimic GERD symptoms.
Endoscopic evaluation and an upper GI
series is standard to view the esophagus
surface and check for abnormalities.
Additional tests performed include 24-hour
pH monitoring, done on an outpatient
basis to record acid levels while a patient
goes about normal activities.
GERD is not typically a life-threatening
illness but, left untreated, it can have
A: Failure of the valve at the lower esophageal sphincter (LES) results in food entrapment and distension of the
esophagus. B: Myotomy requires splitting the LES muscle to release the valve and allow food passage into the
serious complications, including bleeding,
stomach. C: A portion of the cardia is repositioned and reattached over the site of the incision. ulcers, strictures, and Barrett’s esophagus,
a pre-cancerous condition that can even-
tually lead to a fatal outcome. Palliative
Called a myotomy, the procedure involves Symptoms of achalasia may include medical management does not correct
splitting the LES to disrupt the muscle progressive difficulty in swallowing, eating
the problem, and lifelong treatment and
fibers, allowing food to pass more easily and drinking, the need to wash food
monitoring is necessary to prevent deteri-
into the stomach. As an open surgery, down with liquids, regurgitation of food,
oration. Anatomical repair offers cure,
myotomy has been performed for decades. heartburn, chronic cough, weight loss, and
and incisionless advances reduce OR
The laparoscopic approach, initially used in chest pain or pressure that may increase
risks, potentially prompting physicians
the 1990s, has proved highly successful— after eating, or radiate to the back, neck
and their patients to opt for surgical inter-
nearly 95 percent of patients experience and arms. Patients with these complaints,
vention earlier.
years of symptom relief afterwards. Other which can appear similar to GERD, under-
treatments include application of an endo- go complete evaluations that include
scopic balloon within the LES that expands esophageal endoscopy and manometry.
For further information or to refer a
and tears the valve muscles, and a Botox
patient for surgical GERD intervention,
injection administered under endoscopic
please contact Elliot Goodman, MD, at
guidance that paralyzes the valve. But For further information about achalasia
neither provides relief for as long, or for as or to refer a patient to Burton Surick, MD, (212) 844-8838.
many patients as does myotomy. Currently, or Richard Friedman, MD, please call
no oral medications are available either. (212) 420-4520.
2
3. Beth Israel’s GENERAL SURGERY SPECIALISTS
Provide ADVANCED CARE FROM A TO Z
MICHAEL LEITMAN, MD
Chief of General Surgery
Specialties: Oncologic Surgery, Bariatric Surgery
General surgery specialists at Beth Israel Medical Center treat thousands of patients each year.
Providing interventions for a wide range of conditions from appendicitis to obesity, these
physicians treat diseases affecting the abdomen and its organs. Individualized treatment plans,
increasingly with minimally invasive surgery (MIS), a multidisciplinary team approach, and
collaboration with referring physicians, are all hallmarks of the division.
What is general surgery? Recent laparoscopic advances
Key Administration
In spite of its name, general surgery is a Further refinements to MIS include single
surgical specialty that focuses on the incision laparoscopic surgery (SILS),
diagnosis and treatment of diseases and MARTIN KARPEH, MD involving the application of a special
disorders affecting the abdomen, digestive Chairman, Department of Surgery device at the navel that accommodates
(212) 420-4041
tract and endocrine system. The most the three necessary instruments for chole-
common conditions treated by Beth Israel MERYL GOLD cystectomy, a technique in use at Beth
surgeons include gallstones and other Administrator, Department of Surgery Israel for the past six months. Another
gall bladder disease, a variety of hernias (212) 420-4457 advance, natural orifice endoscopic
(inguinal, recurrent, bilateral, ventral, surgery, performed with an endoscope
KATHERINE ZAYAS
and incisional), obesity, pancreatitis, Administrator, Ambulatory Surgery through one of the body’s natural orifices,
appendicitis, bowel obstructions, colon (212) 844-8203 includes the EsophyX™ and StomaphX™
inflammation and cancer, and trauma. procedures, which treat gastroesophageal
The broad perspective of these spe- reflux and revise gastric bypasses, respec-
cialists enhances comprehensive and A Vast Array of Treatments tively. Over the past year, Beth Israel has
thorough diagnosis, and allows for the established itself as a leader in the metro-
most skillful surgical solutions possible. The General Surgery Division provides politan area, performing more than 70
laparoscopic as well as open treatments for StomaphX™ procedures with good results.
patients with:
Minimally invasive • Hernia
In addition to improving care through
treatment is preferred • Gallbladder disease and gallstones technical advances, the collegial environ-
Over the last 15 years, these solutions • Gastro-esophageal reflux disorder (GERD) ment of Beth Israel Medical Center, and
• Pancreatitis the Division of General Surgery in particu-
have increasingly involved minimally
• Appendicitis
invasive surgery (MIS). Well-established lar, provides superior patient care via
• Diverticulitis disease
benefits for both physician and patient • Inflammatory bowel disease collaboration between different specialties.
hone in on one central principle— • Biliary (liver) diseases Treating obesity, for example, necessitates
• Trauma partnerships among endocrinologists,
reducing surgical risk. Smaller incisions
and reduced trauma translate to fewer behavioral specialists and general surgeons.
Additionally, within the Division of
wound complications, less post-op pain, General Surgery, is the following specialized
less pain medication, shorter LOS, faster program:
• Bariatric Surgery Program
recovery and fewer scars. MIS techniques For further information on general
are now standard care for many proce- surgery services or to schedule a consulta-
dures including cholecystectomy, Nissen www.BISurgery.org tion with a general surgeon, please call
fundoplication and hernia repair. (212) 844-8203.
3
4. NONPROFIT
ORGANIZATION
US POSTAGE
PAID
PERMIT NO. 8048
NEW YORK, NY
Beth Israel Medical Center
First Avenue at 16th Street
New York, NY 10003
In this
issue... Laparoscopic Treatments for GERD;
Treating the Rare Disorder of Achalasia;
Advanced General Surgery Care from A to Z
SurgeryNews
OCTOBER 2009
SPOTLIGHT ON ESOPHAGEAL AND GENERAL SURGERY
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The Department of Surgery is planning to go digital with future issues of Surgery News. If you
would like to receive future copies electronically, please drop us an e-mail with “Electronic SN”
in the subject line. Simply provide your full name, address, medical specialty and e-mail address
to: paphilippe@chpnet.org.
Beth Israel surgeons provide first-rate, state-of-the-art quality care to all patients and collaborate with
referring physicians to create an individualized treatment plan. For more information about surgical services
at Beth Israel Medical Center, call (212) 420 - 4044 or visit our Website at www.BISurgery.org.
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